K. S. Holt DEVELOPMENTAL PAEDIATRICS Reading, Mass.: Butterworths, 1977, 304 pp., $11.95.
In the preface to Developmental Paediatrics, the University of London - based author makes the startling statement that "the relatively slow expansion of paediatrics and the preoccupation of many paediatricians with investigative medicine has led to a neglect of child health and rearing just at a time when knowledge of child development is increasing rapidly. . . ." He goes on to say that "this situation is being remedied by the establishment of developmental paediatrics" - a forewarning that the perspective of the title may not be applicable to American pediatrie practice. Upon completing the book, I found my forebodings valid; for the most part, this "treatise" proved to be a disappointment.
It would be an injustice not to give due credit to the lucid description of the observable pattern of child development as described by Holt, and it would be inequitable not to cite as quite good his delineation of changes in the neurologic responses and developmental milestones with maturation. But the developmental evaluation should also address the pathogenesis of the deficit for proper management, and this area is almost completely ignored. Examples of this lack include no mention of lead poisoning, clinical or subclinical; no mention of viral infections, including the congenital rubella syndrome, cytomegalovirus encephalopathy, and slow virus infections; no mention of hypothyroidism; and no mention of many other conditions associated with mental retardation, such as Down's syndrome or tuberous sclerosis.
It is hard to understand the lack of importance accorded the medical history; the subject is "covered" in four brief paragraphs. These contain statements that lack substantiation: "It is common knowledge that the history may be misleading and erroneous," and "developmental paediatricians are aware of the limitations of a history." Most specialists in child development would take issue here, for usually a careful history defines the problem or, at least, offers leads in determining the nature and extent of possible insults to the central nervous system.
The failure to deal with minimal brain dysfunction is equally inexplicable - even to one who disagrees with the concept that children who are impulsive, highly distractible, and hyperkinetic have brain disease as the basis for their abnormal behavior or learning disabilities. Furthermore, soft neurologic signs are not recognized as such even though there is again controversy as to whether such factors as clumsiness, mixed dominance, and tandem gait aberrations can indeed be regarded as unequivocal or diagnostic of neurologic abnormalities. It is probably significant that the author, when referring to hyperactivity, places the term in quotes. When the author says without evidence that "amongst children with uncertain and mixed [hand] preference there is a greater than average number with neurological disturbances" and then goes on to say that "it is most dangerous to attribute a child's difficulties to handedness problems without very careful evaluation," the statements are confusing.
Further omissions include the failure to even mention dyslexia, autism, anxiety neuroses, and the use of specific medications and elimination diets in the treatment of "hyperactivity."
The orientation towards the British reader detracts from the usefulness of the book on this side of the Atlantic: the costs of psychologic tests are given in pounds, and some of the terminology is baffling. "Nappies," "skittles," "fridge," and "floor brushes" I was able to decipher, but "Smarties" left me thwarted until research revealed that Smarties are like MScM's.
The jacket blurb describes the illustrations as "excellent"; "satisfactory" would be more precise. It states that this book is "a must for all child health specialists"; "an available reference work for pediatrie interns and residents" would be more apt.