Book Review
Child and Adolescent Psychiatry 
A Guide to Asperger Syndrome. Christopher Gillberg. Cambridge (UK): Cambridge University Press; 2002. 178 p. US$30.00.
Reviewer
rating*: Excellent
Review by: Jovan Simeon, MD
Ottawa, Ontario
This handbook is intended for those affected by Asperger syndrome (AS) and their families, but especially, it is intended for clinicians working with children, adolescents, and adults with developmental or psychiatric problems. The author, a world-renowned authority in the field, gives an up-to-date, clear, and comprehensive description of AS, one of the most common variants of the so-called autism spectrum disorders. Definitions of the syndrome are reviewed, as are various diagnostic criteria; prevalence; symptoms during childhood and adolescence; associated psychiatric, school, and social problems; background factors; diagnostic assessment; outcome; and management. To provide individuals with AS with an optimal education and training, it is also important to identify their strengths; a special chapter is devoted to famous people who possibly suffered from AS, with a specific discussion of Ludwig Wittgenstein, the philosopher and mathematician. Seven case vignettes of patients ranging from age 6 years to 52 years vividly illustrate some typical features of the syndrome throughout the lifespan. An AS Diagnostic Interview and a screening questionnaires for children and adults are appended.
AS acquired the status of a diagnostic entity only about 20 years ago, and thus, many clinicians do not seem sufficiently familiar with it. To complicate matters, the author reviews 4 somewhat different diagnostic criteria for the syndrome—his own, Szatmari’s, the ICD-10 criteria, and the DSM-IV criteria. Pointing to the drawbacks of the latter 2, the author clearly implies that the diagnostic criteria of the ICD-10 and the DSM-IV may have to be revised; otherwise, appropriate services and research may be compromised. Of special theoretical and practical interest is the apparently frequent association of AS and tic disorders. The combination of attention-deficit hyperactivity disorder and motor-perceptual dysfunctions (deficits in attention, motor control, and perception [DAMP]) is described as a diagnostic concept new to North American readers.
Usually, conspicuous symptoms of the syndrome do not appear before age 4 years; in most cases, the classic picture of the syndrome emerges during the early school years. In addition to the typical symptoms (that is, communication and language problems, impaired social reciprocity, narrowness of interests, and obsessions and compulsions), many other psychiatric problems are often associated (or comorbid) with AS. This can make recognizing it very difficult, especially during adolescence and adulthood. Because affected people often seek help for the associated problems, they may easily be misdiagnosed. The long-term outcome of the syndrome can vary greatly, but the basic characteristics persist. The etiology of the condition is not known, but genetic and organic factors appear implicated. AS and autism often occur within the same larger family tree.
For optimal management of individual patients, the author stresses the importance of good knowledge of the syndrome by all involved and the collaboration of medical, psychological, and educational services; in particular, however, he stresses a good understanding of the individual being helped. The syndrome has no cure and no specific therapy. Nevertheless, psychosocial and behavioural approaches outlined in this book, combined with the symptomatic use of various medications, offer clear and useful guidelines. I highly recommend this book to all those involved in evaluating and managing developmental and personality disorders.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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