The central premise of “Contemporary Neurobehavioral Syndromes” is that the clinical neuropsychologist of the early 21st century is faced with new syndromes that depart from the “traditional” disorders (stroke, brain trauma, dementing disorders, learning disabilities, etc.) their training prepared them for. The editors attribute the growth of knowledge to advances in neuroimaging, neuropsychological assessment, and the biological revolution in psychiatry. Three specific inclusion criteria were offered for a contemporary syndrome: (a) syndromes that did not exist before the 20th century (e.g., exposure to depleted uranium), (b) syndromes for which a paradigm shift occurred (e.g., autism re-conceptualized from a disorder of faulty child-rearing practices to a developmental neurobiological disorder), and (c) syndromes that were incompletely understood (e.g., neuro-developmental disorders stemming from prenatal exposure to methylmercury). Thus, a primary goal of the text is to provide an update on various syndromes that have been re-conceptualized or did not exist decades ago. Contemporary Neurobehavioral Syndromes also aims to provide chapters of relevance to neuropsychologists, and although it is generally clearly written, it is uneven in the degree to which it succeeds.
Comprised of an introductory chapter and 10 content chapters written by scientist-practitioners with appropriate expertise in the respective disorder, each captures a different syndrome or group of related syndromes. These include pre-term birth, autism, adult attention-deficit/hyperactivity disorder (ADHD), dementia with Lewy bodies, deployment syndromes, neurobehavioral aspects of post-traumatic stress disorder (PTSD), comorbid disorders, behavioral toxicology, respiratory disorders, and fibromyalgia, chronic fatigue and related “neurasthenic disorders.” Chapters that were particularly successful in reviewing the clinical science and research methods and integrating that review with ramifications for neuropsychological assessment, diagnosis, and intervention dealt with long-term outcome following pre-term birth, autism, adult ADHD, PTSD, and respiratory disorders. In Chapter 2, on pre-term birth, the neuropsychological phenomena are presented in detail and contextualized nicely within a general neuro-medical framework. The reader of chapter three (autism) will come away with a good appreciation of the relationship of white matter pruning, reduced functional connectivity, and complex cognition deficits in autism, among other topics. Functional imaging, behavioral genetics, and neuropsychological deficits are effectively reviewed in the chapter on adult ADHD. In a book with a neuropsychological contextualization, this chapter could have touched on the current debate as to the usefulness of clinical neuropsychological assessment in adult ADHD diagnosis and treatment. The reader will find “pre-disposing vulnerability” and excitotoxic perspectives on PTSD capably reviewed in a very well organized and written chapter. While the quality and potential etiology of the deficits in PTSD patients comes through quite clearly in this chapter, provision of effect sizes between PTSD and control groups could help the reader appreciate the extent and implication of neuropsychological involvement in this complex anxiety disorder. The chapter on respiratory disorders and neuropsychological dysfunction (Chapter 10) provides exceptional detail on test selection as well as neuropsychological signs and symptoms and a perspective on treatment. Neuropsychologists with particular interest in these topics would find this thin book a welcome and valuable addition to their libraries.
The remaining chapters are uneven in quality for a number of reasons, and some are notable for a lack of focus. For some of these relatively new disorders, basic science may be available but the translation to applied science has yet to occur or is limited in scope. In these chapters, application and relevance to selection of instruments, approach to the interview and/or evaluation, diagnostic decision-making, and especially, to follow-up psycho-education and intervention efforts, are limited. As such, these chapters may be of more interest to researchers in those areas as opposed to clinicians. In two or three of the chapters (behavioral toxicology, fibromyalgia and chronic fatigue, and deployment syndromes), the primary neurogenic risk factor is stress-mediated, and the clinical presentation is essentially of a somatoform disorder. Consequently, hypothalamic-pituitary axis mediation is reviewed in several chapters. As a matter of organization, consolidation of these chapters into a single chapter dealing with stress disorders and somatization may have been preferable. Chapter 5, Dementia with Lewy Bodies, offers content relevant to pharmacotherapy and medical management but less regarding cognitive function. The chapter addressing Persian Gulf and other “deployment” syndromes (Chapter 6) focuses on a model of the disorder, but the content raises questions as to the rationale for its inclusion in a neurobehavioral syndromes volume. The chapter on comorbid disorders (Chapter 8) is short and broad-ranging, offering definitions of dual diagnosis, comorbidity, and co-occurrence, and then providing short reviews of five frequently co-occurring conditions: substance abuse and cognitive disorder, TBI/PTSD, schizophrenia and substance abuse, affective disorder and substance abuse, and depression and dementia. Behavioral toxicological disorders chapter (Chapter 9) also covers broad ground, dealing with known neurotoxins (methylmercury), toxins of unclear status (depleted uranium), and psychiatric disorders involving a stress reaction to harmless odors (sick building syndrome). Fibromyalgia, chronic fatigue, and related “neurasthenic” disorders (Chapter 11) continues the focus on stress-related and somaticizing disorders without much cognitive dysfunction. Significant attention is devoted to the medical criteria for the disorders, and to the question of whether fibromyalgia and chronic fatigue, are, or are not, differing manifestations of the same latent construct.
Contemporary Neurobehavioral Syndromes is designed to bring the reader into synch with emerging or re-conceptualized disorders. It works to bridge the gap between the established field of neuropsychological assessment and this emerging literature to varying degrees of success. In some of the chapters, there was a tendency to review the new science without sufficient synthesis or the formulation of a model of newer disorders. Perhaps this tendency was related to a limited breadth of clinical science for some disorders, raising the question as to the decision to devote a complete book chapter to them. Critical issues such as ecological validity of assessment procedures, actuarial tools, use of performance-based as opposed to self-report based assessments, or computer applications are not emphasized, nor does the interface of neuropsychological data with emergent paradigms in neuroimaging or behavioral genetics receive emphasis.
In short, although Contemporary Neurobehavioral Syndromes has a promising premise, perhaps half the material does not fulfill that promise. Clinical neuropsychologists in search of the basic science of emerging disorders may find this volume useful, but may not find as much clinical utility here nor be able to draw a connection between the content and their clinical practice. Clinical research scientists may find the material here more useful.