An Introduction to Developmental Disabilities: A Neurodevelopmental Perspective.

Brown FR, Elksnin N, eds. San Diego, CA 92105-1197, Singular Publishing Group Inc, 1994, illus, paperback, 218 pp, $34.95.

Fourteen authors are credited with contributing to this information-packed text, including a physical therapist, an occupational therapist, and a speech and language pathologist. The preface summarizes basic neurodevelopmental principles that the authors believe transcend discipline-specific approaches and facilitate adoption of a generalist's perspective. A central principle is that "the most common presentation of developmental disabilities is that in which a child evidences subtle and diffuse neurological dysfunction ... accompanied by behavioral and emotional handicapping conditions." The authors express their hope that "a combination of an interdisciplinary and generalist's approach will help the reader develop a broad-based and integrated perspective on the variety of dysfunctions that can arise in persons with developmental disabilities," and that the book will "serve as an introduction and provide a background for understanding more detailed treatises."

In the first chapter, the author develops the concept of the generalist's perspective and proposes that the physician is ideally positioned to function as a generalist in the early identification and management of children with developmental disabilities. Also, other professionals are encouraged to incorporate a generalist's perspective. He proposes that physicians expand their traditional examination to include a neurodevelopmental history and neurodevelopmental examination in four major developmental domains: motor (gross, fine, and oral), visualperceptual and problem solving, language (expressive and receptive), and social-adaptive. Specific guidelines are given for both the process and content of conducting this history and examination, including a listing (based primarily on work by Gesell) of developmental milestones in each of the domains. The chapter also includes a brief but detailed description of the most common primary, neurologically based, disabling conditions (cerebral palsy, mental retardation, communication disorders, learning disabilities, attention-deficit hyperactivity disorder, and minimal brain dysfunction) and the most common secondary disabling conditions (poor self-concept and inappropriate attention-seeking behaviors).

Subsequent chapters address children with motor impairment; cognitive impairment; and speech, language, and hearing impairment. There is a chapter on the analysis and modification of behavior problems, one on family issues, and a final chapter entitled the "Spectrum of Developmental Disabilities" that presents two case examples illustrating the basic underlying neurodevelopmental principles.

The chapter entitled "Children With Motor Impairment" was coauthored by a physical therapist and an occupational therapist, and is the most appropriate for physical therapy personnel. The chapter is basically organized by patterns of normal motor function (gross, fine, and oral) and motor dysfunction (tonal difficulties, dyscoordination, and extraneous movements). Supplementing the basic narrative is a table of developmental motor milestones in each of the motor areas (compiled from five different references), a questionnaire for parents in each of the motor areas, and a list of more than 30 selected pediatric assessment tools. Assessment and intervention are touched on very briefly.

The chapters on children with cognitive impairment and speech, language, and hearing impairment begin with a discussion of the components of normal function in each area and then describe several neurodevelopmental disorders (eg mental retardation, autism, learning disabilities) from a discipline-specific perspective.

The difficulty for the reader is clearly identifying the focus of the book and following the loose organization. This uncertain focus is common to many references on neurodevelopmental disorders. Most professionals would agree that the majority of neurological problems are subtle and diffuse and that there is a need to assume somewhat of a generalist's perspective. Yet, it is difficult to discuss either normal or abnormal neurodevelopmental function without breaking it down into narrow, discipline-specific compartments, as the authors of this text did.

The book would have been easier to read if the overall organization was improved. The "underlying neurodevelopmental principles" that are referred to over and over again are never clearly stated in concise terms. If they are labeled as "principles," they could and should be clearly delineated, even numbered, in the very beginning of the text. Also, each chapter is organized differently and written from a very different perspective. Gross motor milestones are given in chapter 1 and repeated in chapter 2; there is information about some of the more common neurological conditions (eg, mental retardation) in several different chapters. The only way topics within chapters are categorized is by the use of subheads. Conclusions that close each chapter are sometimes summaries of the preceding information, sometimes guides to information in coming chapters, and sometimes just brief restatement of the principles.

With rare exception, the information presented is comprehensive, up to date, and well referenced. There is information that would be worthwhile, even to the seasoned pediatric therapist who works within an interdisciplinary or multidisciplinary team model. There is too much information to be of interest to physical therapy personnel who are not specialized in the area of pediatrics. Karen Yundt Lunnen, PT Western Carolina University Cullowhee, NC

Ms Lunnen is an assistant professor in the developing physical therapy program at Western Carolina University, and bas over 20 years of clinical experience with children who have neurodevelopmental dysfunction.