This is an excellent book, destined to be a classic. Edited by 3 highly respected clinicians from Yale University’s Child Study Center, this timely book summarizes the controversies in the fields of psychiatry, psychology and neurology with regard to Asperger syndrome.
Although this syndrome was described more than 50 years ago by Austrian Hans Asperger, it is only in the last 20 years, since Lorna Wing translated the original paper into English and published it, that this disorder has become known (and widely debated) in the English-speaking world. This has coincided with the increased recognition of an autism spectrum of disorders with a relatively high frequency compared with the rarity of core autism (Kanner’s autism).
The book is divided into 5 sections: behavioural aspects; family genetics and neurobiological aspects; diagnostic constructs; practical issues related to assessment, treatment and other supports; and perspectives on research and clinical practice.
The first 4 chapters relate to behavioural aspects and include a description of the syndrome and similarities and differences from high functioning autism. Chapter 1, by Volkmar and Klin, summarizes the diagnostic issues from a historical perspective and reviews the evidence for the validity of Asperger syndrome as a separate diagnostic concept. There is some repetition with the third section, which focuses on related diagnostic concepts. This is one of the down sides of any book with 27 contributors.
After reading chapter 1, I went straight to section 3, “Related diagnostic constructs,” because the authors are renowned in the field of child psychiatry and autism-related diagnostic constructs. Rourke and Tsatsanis write on nonverbal learning disabilities, Bishop on language disorders (particularly semantic, pragmatic language disorders) and Wolff on schizoid personality in childhood. For psychiatrists interested in phenomenology, this section is the highlight of the book. These chapters allow us to review our diagnostic constructs from the perspective of clinicians working outside the field of autism.
The second section reviews genetics, imaging and psychopharmacology. Although Asperger syndrome and atypical autism (pervasive developmental disorder not otherwise specified) are the most common autism syndromes seen in general practice, individuals with these disorders have not routinely been included in psychopharmacologic studies on autism. Hence, the evidence for the effectiveness of psychopharmacologic treatment of individuals with Asperger syndrome is largely anecdotal. Educational and behavioural interventions are generally seen as the mainstay of management, but I agree with the authors (Martin, Patzer and Volkmar) that psychotropic medications can be an important component of an individually tailored treatment plan.
Section 4, on assessment and treatment issues, has an excellent chapter on behavioural interventions including social communication skills training.
The last section has thoughtful chapters by Canadian psychiatrist Peter Szatmari on classification; a review of past and future research by Lorna Wing; and essays by parents describing, first-hand and movingly, the experience of parenting a child with Asperger syndrome.
In all this is a great book. It is not cuddly enough to take to bed with you, but rather like an old friend one visits warmly and often. It is an authoritative, clinical and rewarding read about real-life patients.