Child and Adolescent Neurology

Whether one approaches the mental ills of childhood from the background of pediatrics or the background of psychiatry or neurology, the essential knowledge base remains the same. It is somewhat paradoxical that childhood as a developmental stage of life was largely ignored until the beginning of the sixteenth century. It was Juan Luis Vives (1492–1540), working in the court of King Henry VIII, who first emphasized child development and the proper upbringing of children (2). At about the same time, Paracelsus (1493–1541) also discussed the diseases of children and emphasized that the mind and body were a unit and mental illnesses were physical diseases to be treated with medicine. Child neurology is therefore part of the knowledge base for all psychiatrists.

Child and Adolescent Neurology is another addition to Mosby’s Neurology Psychiatry Access Series, which includes Folstein’s Geriatric Psychiatry, Knoefel’s Geriatric Neurology, Bloom’s Adult Neurology, Parmelee’s Child and Adolescent Psychiatry, and Guze’s Washington University Adult Psychiatry. These books are designed to facilitate understanding by introducing order based on a discriminator model rather than simply listing diseases. To quote from Dr. David’s preface,

The structure of this textbook, therefore, unifies the approaches of the 41 different authors into three sections: Pediatric Neurologic Evaluation, General Pediatric Neurologic Diseases and Disorders, and Common Pediatric Neurologic Problems. The first section, Pediatric Neurologic Evaluation, is a remarkably clear and useful manual for the neurologic history, neurologic examination, and laboratory procedures including neuroimaging. It provides a very useful outline form for the neurologic history and examination that is specifically exempted from copyright concerns and may be reproduced for clinical use without further permission from the author or the publisher.

The neurologic history and examination forms are particularly to be recommended to students and residents learning how to evaluate children, both neurologically and psychiatrically, because they lead to a differential diagnosis that is both complete and standardized for effective communication. In addition to the narrative text, diagnostic tables are placed in easy-to-reference boxes, and helpful “Pearls and Perils” boxes for conditions that are particularly common or dangerous appear frequently throughout the book. Also very helpful are the “Consider Consultation When” boxes, which alert the reader to situations that may require specialty expertise beyond that of the average pediatrician.

This is a true “how-to-do-it” book; it is not meant to be a substitute for the more in-depth coverage of books such as the encyclopedic Pediatric Neurology Principles and Practice(3), which is a more conventional reference book for the specialist but lacks the lucid pedagogic style of David’s more accessible text. Neurology of Hereditary Metabolic Diseases of Children(4) is particularly helpful for a discussion of the differential diagnosis of the hereditary metabolic disorders, compared with the static encephalopathies and developmental abnormalities so commonly seen in pediatric practice. One might wish to begin with Child and Adolescent Neurology for initial access and then supplement it with An Atlas of Clinical Syndromes(5), another Mosby book, a German text that in translation is an enormous catalog of syndromes both common and rare along with their discriminating characteristics. That text will allow the practicing physician to make the kind of diagnosis generally associated with specialty genetic clinics. For the doctor in training, the Atlas of Pediatric Physical Diagnosis(6) has 2,248 illustrations to complete the basic library of a practicing pediatric psychiatrist or neurologist.

The recently published practice parameters of the American Academy of Child and Adolescent Psychiatry (7) and, of course, DSM-IV include physical and laboratory examination as required in making a diagnosis. However, how many child psychiatrists actually incorporate a physical examination in a meaningful way? There has been a trickle-down effect of adult biological psychiatric practice on child psychiatry as the biological revolution has made it more obvious than ever that the major mental illnesses of childhood are based in neurotransmitter dysfunction, genetics, and anatomy. As psychopharmacology has been extended to childhood, it has become mandatory to consider the entire biological basis of behavior in pediatric psychiatric diagnosis, which, in the past, had been more or less limited to psychodynamic formulations, often based on Freudian developmental theory or what might have been referred to as behavioral or developmental pediatrics.

Early intervention research into schizophrenia, the entire attention deficit hyperactivity disorder industry, and the burgeoning field of learning disabilities have radically transformed the practice of child psychiatry. Child and Adolescent Neurology does not pretend to be a psychiatric textbook (schizophrenia does not even appear in the index, and psychotic behaviors are referenced only in regard to complex partial seizures), but it has an excellent chapter on attention deficit hyperactivity disorder by Mary B. McMurray and Russell A. Barkley, as well as useful discussions of the different learning disabilities.

In addition to the annotated bibliography that appears at the end of each chapter, there is a section at the end of the book with more extensive bibliographic data, which is a valuable resource by itself. The treatment sections of each chapter are clear, concise, and logical as well. The inborn errors of metabolism have never been presented so clearly as in the chapters by Paul Maertens and William L. Nyhan with their tables and diagnostic features in easy-to-reference boxes.

In summary, this is a book to buy, not only for those specializing in child and adolescent neurology but also for child and adolescent psychiatrists or those general psychiatrists who realize that adult diseases play out against a background of development or may even have their origins in infancy and childhood. This would be an excellent text for those preparing for the board examination in psychiatry, containing as it does clear and concise tables, charts, and “pearls.” I look forward to the future works in this Access Series by Mosby with the hope that they will be as authoritative and useful as David’s Child and Adolescent Neurology.