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Child & Adolescent Development: Overview

Review of "The American Psychiatric Publishing Textbook Of Child And Adolescent Psychiatry"

By Jerry Wiener and Mina Dulcan (Editors)
American Psychiatric Publishing, 2004
Review by Christian Perring, Ph.D. on Jun 18th 2004
The American Psychiatric Publishing Textbook Of Child And Adolescent Psychiatry

This third edition of The American Psychiatric Publishing Textbook of Child and Adolescent Psychiatry is a large book with 1114 pages.  The index alone is 40 pages long.  It contains 56 chapters divided into ten different sections.  These cover an overview of the field, assessment and diagnosis, developmental disorders, psychotic and mood disorders, attention-deficit and disruptive behavior disorders, anxiety disorders, eating disorders, disorders affecting somatic function, other disorders and special issues, and treatment.  It's an impressive tome representing the current mainstream thinking on the nature and treatment of mental illnesses of young people, and given the increasing concern over child mental health and the increasing rates of prescriptions of psychotropic drugs to the young, it is an essential reference. 

As usual with such reviews, I need to be clear that I lack the expertise to assess the accuracy of the scientific claims made by the many authors.  Indeed, I will confess that I have not read all of the entries, and have only skimmed large portions of the book.  It is hard to imagine any single expert with the breadth to assess the whole book, and would probably be very difficult to find anyone with the time to read it all with careful scrutiny.  Most readers will probably dip into some chapters much more than others.  Obviously it is aimed primarily at psychiatrists, but it should be accessible to clinical and academic psychologists, and even to non-professionals who are ready to familiarize themselves with the scientific and technical language.  The chapters are organized so that it is normally possible to browse to get an overview of the topic at hand and then to read carefully about the particular aspect one is interested in. 

For the purposes of this review, I will focus on those chapters that raise more social and philosophical questions.  One of the most interesting chapters from this point of view is Irving Berlin's history of the development of the subspecialty of child and adolescent psychiatry  (CAP) in the US.  If psychiatry as we know it is young compared to the rest of medicine, CAP is barely out of its infancy.  The Academy of Child Psychiatry was formed in 1924 and in 1943, the American Psychiatric Association established the Committee on Psychopathology of Childhood, which soon changed its name to the Committee on Child Psychiatry.  In 1952, the committee requested the American Psychiatric Association to endorse subspecialty certification in child psychiatry but was turned down.  In a slightly different form, this request was eventually approved in 1957.  It was only in 1930 that the first child psychiatry clinic was created, at Johns Hopkins, and in 1935, Leo Kanner published the first textbook on child psychiatry.  By 1963, there were about 200 board-certified child psychiatrists and another 200 or so in training.

Berlin briefly outlines the different treatment movements that have been popular in CAP, including Freudian psychotherapy, psychotherapy influence by the work of Carl Rogers and Erik Erikson, family and group therapy, behavior therapy, and mental health consultation and crisis intervention.  He notes that delinquency has been poorly understood and poorly treated since the 1800s, and was considered a particular problem for much of the first half of the twentieth century and especially in the 1950s.  His brief account provides just enough information to make it clear that much more historical and conceptual work could be done on the relation between delinquency and child and adolescent mental illness.  Similarly, he briefly mentions the development of the wide category of autism and the later splitting into the concept of childhood schizophrenia and what we now consider the developmental disorder of autism, but leaves most of the details for the reader to explore elsewhere.  Berlin finishes by noting that historically, CAP has been given low status and while programs such as Head Start were proven to be effective, they were underfunded.  In the current age, managed care priorities are determined by poorly designed and conducted outcome studies and cost containment is the primary goal of those administrating health care. 

Hector Bird discusses the role of culture, race and ethnicity in CAP.  He sets out some of the controversies about race and culture, although he simply assumes that race is a biological concept without addressing the debates that have surrounded this assumption.  He addresses concerns about the medicalization of cultural difference, the historical neglect by psychiatry of minorities, and simple racism.  Then there are straightforward cultural and ethnic differences in the rates of different mental illnesses: for example, African Americans tend to experience higher levels of emotional distress than whites, but this can be accounted for in terms of socioeconomic status.  In Asian cultures, there is disapproval of strong displays of emotion in public, and this may well affect how people with mental illness behave.  The chapter is interesting, even though it does not say much about how these cultural differences play out in the symptoms of mental illness in children and adolescents. 

Robert Schreter discusses economic issues in CAP, covering managed care, health insurance, social security disability, social services, and the forms of help provided by the school system.  He sets out some of the profound problems faced by these different aspects of health and education, and some possible solutions.  This short chapter does not provide a great deal of detail, but it at least gives references for those who want to pursue the topic.

The second section on assessment and diagnosis starts out with two chapters on classification.  The book's editors contribute their own short chapter on the history of the DSM's approach to classifying mental disorders of young people, while David Shaffer provides a more conceptual investigation to psychiatric nosology.  Both chapters have sound information and excellent references, without saying anything new or surprising.  The other chapters in this section address issues of clinical assessment, interviewing, and testing.  They do an excellent job of summarizing the standard information in the field, paying attention not just to the scientific questions of accurately determining what problems a young person has, but also how to communicate effectively with parents and children. 

The remainder of the book sets out the state-of-the-art information about developmental disorders, psychotic and mood disorders, attention-deficit and disruptive behavior disorders, anxiety disorders, eating disorders, disorders affecting somatic function, and treatment.  There is a consistently high standard of writing, and the book is easy to use as a source of the most current theories.  Maybe most importantly, authors are very open about the limits of knowledge, especially concerning the efficacy of different dorms of treatment.  While some of the information in the chapters is quite technical, it is possible for those without a medical training to understand most of the material, and this makes the Textbook an invaluable resource for anyone doing research in a wide variety of aspects of CAP. 

There are places where some authors seem a little overconfident about their claims.  To give one topical example, in their chapter on psychopharmacology, Joseph Biederman et al recommend SSRI antidepressants as the first line of treatment for major depression in children and adolescents, with no mention of the increased risk of suicidal behavior in adolescents that some SSRI medications may cause.  An omission such as this is of great concern, since it calls into question the objectivity of the whole book.  Given the increasing importance of CAP in medicine and in our culture generally, it is essential that books published by the American Psychiatric Association retain the greatest credibility possible.  There is considerable potential in our society for a backlash against the increasing use of psychiatric medication for children, and so editors of books such as The American Psychiatric Publishing Textbook of Child and Adolescent Psychiatry have a profound obligation to maintain their scientific neutrality and to eschew any hint that they might be apologists for or even representatives of the pharmaceutical industry. 

 

© 2004 Christian Perring. All rights reserved.

 

Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.

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