Preface

Autism spectrum disorder (ASD) is one of the most heterogeneous conditions in psychiatry and clinical psychology. To begin to understand autism, one must embrace complexity and ever-increasing complexity. This makes it difficult for professionals to keep up to date with all aspects of autism, thus the need to bring together various aspects of this condition in new books. Controversial problems include the lack of biomarkers and the lack of sub-types, as discussed in Chapter 1 by Michael Fitzgerald. This chapter also focuses on the problem with truly scientific screening and diagnostic instruments and indeed the 'gold standard diagnosis' in autism is a clinical diagnosis by an expert in autism.

Co-morbidity is common and central to the presentation of autism in clinical practice. In relation to co-morbidity, epilepsy is an important comorbidity in the presentation of autism as demonstrated in Chapter 2 by Akhter Shaheen. Autism without some co-morbidity is uncommon. Factors associated with this co-morbidity are many and include multiple genetic and environmental factors. Shaheen also explores genomic copy number variants and metabolic disorders and concludes on the importance of metabolic factors in the pathogenesis of the ASD–epilepsy connection.

Chapter 3 by Yulia Furlong covers the 'hot topic' of autism and gender, which has been much discussed by psychiatrists and psychologists, particularly those in the justice system. This chapter provides the most current thinking on this particularly important topic with a focus on diagnosis, occurrence rates, aetiology, informed consent, legal issues, and treatment.

Section 2 examines the neurobiological aspects of autism.

Chapter 4 by Michael Beenstock examines parenting and reproductive stoppage in ASD. The author distinguishes between absolute non-stoppage when parents have no further children and relative non-stoppage when they have fewer children. Both types of non-stoppage vary with the age of diagnosis.

Chapter 5 by Harumi Jyonouchi and Lee Geng focuses on the association between monocyte cytokine profiles and co-morbid conditions in ASD. The authors point out that the presence of co-morbid medical conditions may hold a key to assessing pathogenesis in markedly heterogeneous ASD conditions. Unfortunately, these are not properly sought for in routine ASD evaluation of children. The authors describe their research in this area with a focus on GI symptoms, allergic rhinitis, sleep disorders, and paediatric acute-onset neuropsychiatric syndrome, among other conditions. They concluded that there is an association between monocyte cytokine parameters and specific co-morbid medical conditions existing in ASD subjects studied.

Chapter 6 by John Rothman examines the role of catecholamines in the aetiology of autism and a proposed therapy. The author notes a growing body of evidence supporting the role of catecholaminergic dysfunction in the core symptoms of ASD. He suggests that exerting a presynaptic effect to inhibit tyrosine hydroxylase and thus the synthesis, storage, and release of all catecholamines Li-79 (a tyrosine hydroxylase inhibitor) may diminish neurotransmitter release and its associated growth factors, exerting a therapeutic effect on ASD.

Chapter 7 by João Xavier Santos, Célia Rasga, and Astrid Moura Vicente examines exposure to xenobiotics and gene-environment interactions in ASD. The xenobiotics include air pollutants, persistent organic pollutants, pesticides, and so on. This systematic review suggests neuropathological mechanisms including oxidative stress and dysregulation of signalling pathways. This line of research opens novel and important perspectives to future prevention and personalised interventions for ASD.

Section 3 covers interventions in ASD.

Chapter 8 by Maria Rhode and Kate Grayson describes an observationally and psychoanalytically informed parent/toddler intervention for young children at risk of ASD. The chapter discusses a recent randomized controlled trial on a parent-mediated intervention that demonstrates that supporting parental confidence is essential to improvement. Study samples were between eighteen and twenty-four months old and were in the high-risk category of the Checklist for Autism in Toddlers (CHAT). This study showed that a significantly lesser proportion of treated children were later diagnosed than the CHAT would predict and that the treatment merits further study, with higher numbers.

I would like to thank the Author Service Manager, Maja Bozicevic, who was always most helpful.

> **Michael Fitzgerald** Professor, Department of Psychiatry, Trinity College, Dublin, Ireland

> > **1**

Section 1

Profile, Controversial Issues,

Gender and Co-Morbidity

in Autism
