Book Review
Child Psychiatry 
The Neurobiology of Autism Margaret Bauman, Thomas Kemper, editors. Baltimore (MD): Johns Hopkins University Press; 2005. 404 p. US$95.00.
Reviewer
rating*: Good
Review by: Stuart Fine
Vancouver, British Columbia
This book makes the enigma of autism spectrum disorders (ASDs) a little more understandable. The editors are Margaret Bauman from Harvard University and Thomas Kemper from Boston University. They have written the chapter “Structural Brain Anatomy in Autism—What is the Evidence?” Their chapter sets high standards for clarity and comprehensiveness. Unlike the first edition, this edition has no overview of the clinical signs and symptoms of ASD but, rather, begins with a chapter on the epidemiology of pervasive developmental disorder, where we are reminded that ASDs are associated with cerebral palsy, fragile X syndrome, Tourette syndrome, phenylketonuria, neurofibromatosis, congenital rubella, and Down syndrome. There are excellent clinical descriptions of fragile X syndrome and tuberous sclerosis in separate chapters.
Most of the chapters are recently referenced and succinct, which reflects the good editing. The book is divided into 4 sections: Clinical Observations, Neuroanatomic Investigations, Genetic Initiatives, and Neurobiological Research. It may be useful to read the editors’ epilogue first, because it is an excellent introduction to the newer findings over the last decade and what we may expect in the future. There is little overlap with the first edition, published in 1994, which emphasizes that there have been many new ideas about etiology, genetics, comorbidity, and neuropathology.
For clinicians, the first section is particularly interesting, as several general areas, such as language and communication, memory and executive functions, and approaches to psychopharmacology, are presented. More specific topics, such as head size, the role of the vagus nerve, and gastrointestinal issues, are covered in detail in other chapters. This is an interesting pattern—a large topic in one chapter is followed by a chapter that examines one aspect in more detail. For example “reelin” is mentioned in the chapter on gene expression; later, there is a chapter devoted to reelin. One chapter about the role of the vagus nerve covers the somatic symptoms found in ASD, including gastrointestinal symptoms. Later, there is a chapter on gastrointestinal symptoms that offers greater detail, but without repetition.
The Neuroanatomic Investigations section covers possible anomalies in brain development; for example, some brains from autistic subjects had increased brain weight and white matter volume in children, reduced numbers of Purkinje cells in the cerebellum, and reduced neuronal size and increased cell density in the forebrain limbic system. A chapter on myelin suggests that myelin in autistic adults “may not mature or be fully functional.” One chapter has a review of the anomalies of the orbital frontalBamygdala system. Another describes an animal model in rats infected with the borna virus, with resulting brain morphology and behaviour similar to that found in human ASD. The rats’ social interactions, emotionality, and cognitive abilities in spatial discrimination, learning, and memory were abnormal.
The section titled Genetic Initiative favours the multiple gene disorder hypotheses and suggests “fifteen different interacting genes of moderate effect.” It also cites several candidate susceptible genes. There are chapters on chromosome 7, chromosome 15, fragile X syndrome, and tuberous sclerosis complex.
Reelin is one of the genes on chromosome 7q. The level of reelin protein is decreased in the cerebellum of individuals with autism. The level is also changed in the blood of patients with schizophrenia, major depression, and bipolar disorder. Reelin is involved in brain development, and biochemical, neuroanatomic, and genetic data point to the involvement of lack of reelin in both neuroanatomical and behavioural changes in autism.
In the section on neurobiologic research, there are chapters on serotonin, the GABAergic system, the cholinergic system, the brain-derived neurotrophic factor and dopamine, and the immune system.
The book is attractively presented, with several sections that the first edition did not have. For the average clinician, the genetic and neurobiologic research is interesting, with relevance to practice. For the researcher, good summaries on various research topics are offered.
This is a good reference book for clinicians and researchers working in this field. For a hardcover technical book with sections requiring such specialized expertise, the price is reasonable.
*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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