The title of this single-author work draws attention immediately to a gap in the completeness of our knowledge due to the dearth of information about adults on the autism spectrum. The author counts among the generation to first draw our attention to the wealth of understanding of autism to be found in studying the more able adult. Tantam's published work on this topic came to wide notice with two papers in the British Journal of Psychiatry in 1988 based on his PhD work under the title of ‘Lifelong eccentricity and social isolation’. Tantam's devotion to the topic, often under the title Asperger Syndrome, has been as a physician, psychotherapist and clinical scientist and the depth and span of this unique single-author work testifies to that. As he explains, the book begins with the sciences that are basic to our understanding of autism spectrum disorders (ASD), drawing on an exhaustive review of the current literature, tempered by his own ‘clinical experience of which research findings are likely to be of particular clinical relevance’ (most of the cited studies having been published since 2005). The second part is a detailed clinical overview of ASD drawing on case descriptions ‘illustrating not only the direct consequences of having a disorder of psychological development but also the different, often creative and original, ways that a person can accommodate to it’. Tantam writes about the clinical assessment of the ADSs, their aetiology, presentation in infancy, childhood, adolescence, and adulthood taking account of different contexts including school and college. Many who read Autism Spectrum Disorders Throughout the Life Span will know the author or will have heard him speak in public and will find his voice clearly echoed in the written narrative. Tantam has his own views and wastes no time in sharing them with the reader. His style is admirably succinct. The span of this volume ranges from genetics, to brain sciences and neurology, neuropsychology and for, those with ASD, the bewildering environment of social interaction. Autism researchers should be prepared for a constant line of scepticism. In a chapter on the neurology of the superficial structures of the brain – concerning one of my own pet candidates for a brain basis (or metaphor) for autism, Tantam summarizes as equivocal the evidence for research on mirror neurons (parietal cortex neurons responsible in primates for general senses and muscular control that respond to the observed actions, and some claim ‘intentions’, of others). In more general terms he is often sceptical at the over-interpretation of the relevance to autism of animal model findings. For those keen to advocate the particular importance of specific brain areas in autism he offers the reminder that there are very few areas of the brain that have not in some way been implicated. Turning to the world of clinical assessment and management Tantam has unearthed an encouraging number of recent studies of intervention effectiveness, a much neglected topic especially for the adult with ASD. His advice on drug treatment is rightly cautious devoting most time and energy to other aspects of management. There can be few writers in the field with the author's range of clinical experience with adults to draw on. His approach is very much that of the traditional physician in a one-to-one clinical relationship with the patient, which can be contrasted with the team-based approaches increasingly favoured in contemporary practice (where resources permit). I am in agreement with his view that much good comes from helping the person with ASD with an explanatory framework (my term) for their condition, where possible, with one or two key others committed to supporting that individual in their life. (Readers in professional practice should note first an annex on ethical issues.) I did quibble with one or two detailed aspects of the work. Tantam takes a strong line on the interconnectedness of autism and another developmental disorder that is also characterized by executive functioning deficits, attention deficit disorder. I am reminded that, in contrast to clinical evidence and numerous case studies, there is hardly anything in the book that takes an epidemiological and public health perspective; in relation to the example of ADHD and ASD, it is quite possible that the frequent co-occurrence of these two conditions in clinical practice reflects referral patterns (typically alongside more general intellectual impairment) which future evidence from whole population samples may require us to reconsider. In fairness to the author's thorough and balanced approach he does cite neuropsychological research showing that patterns of executive functioning differ in the two conditions. Regarding presentation, the academic in me, who wants to quickly chase up sources of evidence, was frustrated by the tiresome use of numbered footnotes within chapters that must be cross-checked first in order to identify source articles. Hopefully if there is to be an online or electronic version we can expect direct links to scholarly sources. Although, as in many areas of brain research, advances are coming at breathtaking speed, I can still recommend this volume as containing much understanding and clinical wisdom that is unlikely to change radically with future revisions of the research evidence that I hope the author will be able to share with us. The reader will find no unnecessary time-wasting repetition in Autism Spectrum Disorders Throughout the Life Span in contrast to the multi-chapter, multi-author, and sometimes prolix alternative academic works on autism that compete with this volume.
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