Autism Spectrum Disorder (Primer on) Edited by Christopher J. McDougle. Oxford University Press. 2016. £49.32 (pb), 518 pp. ISBN 9780199349722

This book is a substantial overview of autism spectrum disorder (ASD), its 26 chapters covering diagnosis, aetiology, comorbidity, management and service delivery. It is authoritative, drawing on a wide range of expertise, a variety of disciplines and specialists of repute as well as family members and a person with ASD. It is largely readable, with few lapses into medical or sociological recitation and, given the delays inherent in an edited book, it is relatively up to date.

The individual chapters are well planned: most set out the background to a topic before narrowing down to ASD and end with a summary and a selection of key points. Thus it is only after broad introduction to the methodology and limitations of epidemiology that there is a discussion of ASD's prevalence. Given the misuse of statistics to promote such ideas as an autism epidemic, increased mortality, the effect of a variety of factors and the efficacy of unusual treatments, this is essential to any understanding of evidence.

The management of ASD is well covered, with contributions from therapists and services. Although the focus is American, notably in its account of education and employment, it illustrates principles which are equally applicable to our ever-changing UK scene. However, nearly all the authors are from the USA and there is little about the effect of country and culture on ASD's presentation and management.

Some chapters, particularly those on genetics, bring out the heterogeneity of ASD and note the failure to identify a consistent endophenotype for the final common pathway of a disparate variety of mechanisms. However, the overall impression is of an enduring perception of ASD as an entity. Yet, it is a disorder defined by a cluster of symptoms, which, being shared with other neurodevelopmental disorders, has blurred boundaries; fault lines which shift as concepts evolve. This is compounded when the diagnosis determines the interpretation of a symptom (e.g. inattentiveness in attention-deficit hyperactivity disorder becomes sensation-seeking in ASD) or affects the threshold at which, say, motor anomalies in ASD are seen as indicative of developmental coordination disorder. This diagnostic fuzziness is not discussed and I wondered whether this might be because the book is intended to be a primer for trainees.

This made me think back to my own days as a trainee. It was a time when there were many competing pressures and I thought that – in spite of my interest in autism at that time – although I might consult the book about specific points, I would be unlikely to read the bulk of it.

Here I found a real flaw in that, although the book is attractively produced, all the entries in the index, whether topic heading or specific item, are left-justified and in the same font, hampering the ready discovery of a point.

However, this is carping in the light of a book that is a considerable achievement in pulling together an up-to-date, well-referenced review of the field in depth. I have enjoyed it, use it for reference and recommended it to others. I think there is still a niche for a primer – a ruthlessly slimmed down book that restricts itself to what should be known by, say, most paediatricians or psychiatrists.