Intellectual Disability: Understanding Its Development, Causes, Classification, Evaluation, and Treatment
http://www.100md.com
《新英格兰医药杂志》
The scope of this book is well described by its subtitle. It is intended to be a comprehensive summation of the author's experience over the past 30 years as an academic clinician and a child psychiatrist caring for persons with intellectual disability. It is a valuable guide and resource for anyone working in this field, whether a physician or not, and at all levels of training.
The book has several themes. It establishes the designation "intellectual disability" as a replacement for the more familiar term "mental retardation." It puts forward the concept of behavioral phenotypes, which has been pioneered by the author — that is, that specific genetic or chromosomal disorders are associated with specific behavior patterns. The book invokes a developmental perspective in that changes in behavior and intellectual function occur during the trajectory of development, with important consequences for care.
Persons with intellectual disability often have dual diagnoses — that is, behavioral and psychiatric disorders in addition to intellectual disability — and these should be treated appropriately by psychoeducational and pharmacologic means. The most difficult part of caring for a child with intellectual disability is often not the intellectual limitation, but the associated lack of behavioral and emotional control. Psychopharmacologic interventions that permit the child to control his or her behavior and affect have revolutionized the care of the intellectually disabled for many families and constitute an under-recognized advance in this field of medicine. (Indeed, a criticism of the term "intellectual disability" is that it does not encompass these other dimensions.)
The book contains a rich mine of material. It describes the historical understanding, social concepts, epidemiology, and classification of intellectual disability. Advances occurring in the genetics, neuroscience, diagnosis, and management of syndromes causing intellectual disability are discussed. A schema, reflecting the author's common sense and experience, is outlined for evaluating the infant or child suspected of having intellectual disability — a task made increasingly complex and expensive as genetic, metabolic, and neuroimaging tests proliferate and as a specific diagnosis permits the monitoring of future pregnancies and other family members, for example. The psychiatric and behavioral symptoms that accompany intellectual disability are thoroughly described, and their psychopharmacologic management is authoritatively discussed. In addition, there is extensive material on legal, social, ethical, and spiritual aspects of intellectual disability, and appendixes containing lists of resources and agencies and reports of governmental and research conferences.
The book is solely text, with some tables but no illustrations or diagrams. The references are up to date. The familiar syndromes associated with intellectual disability (Down's syndrome, fragile X syndrome, Rett's syndrome, Prader–Willi syndrome, and so on) are excellently described with a genetic, neuropathophysiological, and neuroimaging background. The coverage is not extensive enough, however, for the book to be recommended as a textbook on genetic or neurologic diagnosis of intellectual disability. For example, autism is discussed in only one and a half pages, and epileptic encephalopathies also receive little attention. Still, developmental pediatricians, child psychiatrists, administrators, educators, and others caring for children or adults with intellectual disabilities — and especially trainees in these fields — will benefit from reading this book and taking to heart the major themes. For the reader, the time spent is rather like that on clinical rounds with a broadly experienced senior professor.
G. Robert DeLong, M.D.
Duke University Medical Center
Durham, NC 27710
delon006@mc.duke.edu((Developmental Perspectiv)
The book has several themes. It establishes the designation "intellectual disability" as a replacement for the more familiar term "mental retardation." It puts forward the concept of behavioral phenotypes, which has been pioneered by the author — that is, that specific genetic or chromosomal disorders are associated with specific behavior patterns. The book invokes a developmental perspective in that changes in behavior and intellectual function occur during the trajectory of development, with important consequences for care.
Persons with intellectual disability often have dual diagnoses — that is, behavioral and psychiatric disorders in addition to intellectual disability — and these should be treated appropriately by psychoeducational and pharmacologic means. The most difficult part of caring for a child with intellectual disability is often not the intellectual limitation, but the associated lack of behavioral and emotional control. Psychopharmacologic interventions that permit the child to control his or her behavior and affect have revolutionized the care of the intellectually disabled for many families and constitute an under-recognized advance in this field of medicine. (Indeed, a criticism of the term "intellectual disability" is that it does not encompass these other dimensions.)
The book contains a rich mine of material. It describes the historical understanding, social concepts, epidemiology, and classification of intellectual disability. Advances occurring in the genetics, neuroscience, diagnosis, and management of syndromes causing intellectual disability are discussed. A schema, reflecting the author's common sense and experience, is outlined for evaluating the infant or child suspected of having intellectual disability — a task made increasingly complex and expensive as genetic, metabolic, and neuroimaging tests proliferate and as a specific diagnosis permits the monitoring of future pregnancies and other family members, for example. The psychiatric and behavioral symptoms that accompany intellectual disability are thoroughly described, and their psychopharmacologic management is authoritatively discussed. In addition, there is extensive material on legal, social, ethical, and spiritual aspects of intellectual disability, and appendixes containing lists of resources and agencies and reports of governmental and research conferences.
The book is solely text, with some tables but no illustrations or diagrams. The references are up to date. The familiar syndromes associated with intellectual disability (Down's syndrome, fragile X syndrome, Rett's syndrome, Prader–Willi syndrome, and so on) are excellently described with a genetic, neuropathophysiological, and neuroimaging background. The coverage is not extensive enough, however, for the book to be recommended as a textbook on genetic or neurologic diagnosis of intellectual disability. For example, autism is discussed in only one and a half pages, and epileptic encephalopathies also receive little attention. Still, developmental pediatricians, child psychiatrists, administrators, educators, and others caring for children or adults with intellectual disabilities — and especially trainees in these fields — will benefit from reading this book and taking to heart the major themes. For the reader, the time spent is rather like that on clinical rounds with a broadly experienced senior professor.
G. Robert DeLong, M.D.
Duke University Medical Center
Durham, NC 27710
delon006@mc.duke.edu((Developmental Perspectiv)