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Review of "Child and Adolescent Psychiatry"

By Jeremy Turk, Philip Graham and Frank Verhulst
Oxford University Press, 2007
Review by Stephanie Moulton Sarkis, PhD, NCC, LMHC on Oct 20th 2008
Child and Adolescent Psychiatry

The book consists of ten chapters: Introduction, Familial influences, Neurodevelopment and neuropsychiatric disorders, Developmental psychopathology, Adolescence and psychiatric disorders often beginning in adolescence, Child-adult continuities in psychiatric disorders, Psychosocial aspects of physical disorders, Psychological aspects o specific physical conditions, Prevention and treatment, and Services. 

Two of the book's authors are from the United Kingdom, while the third author is from the Netherlands.  Therefore, spelling and grammar usage are in British English, as opposed to American English.  For example, "pediatrician" is "paedatrician", "etiology" is "aetiology", and "percent" is "per cent".  This is a very small adjustment to make, considering the vast wealth of information in the book. 

The book is well organized and uses a decimal system to differentiate paragraphs and sub-paragraphs.  For example, the third section of Chapter 3, "Neurodevelopment and neuropsychiatric disorders" is named "Intelligence and Learning Disorders", and is labeled 3.3.  A subsection under that, "Intellectual (learning) disability" is labeled 3.3.2.  This organizational system makes it easy to find information. 

In Chapter 1, "Introduction", in section 1.5 "Assessment and diagnosis of psychiatric disorders", the authors make an important point about the aim of assessment and diagnosis.  While the first aim of assessment and diagnosis is to determine the nature and severity of the problem, identify causes, and form a plan with the child and parents, the authors state that "A secondary but important set of aims relates to the need to communicate sympathy and support for the child and family members, to convey understanding of their problems, and to provide meaning and significance for their predicament" (p.25).  This is an important point, because all clinicians run the risk of focusing solely on being "problem solvers" rather than providing empathy and support.  The authors also present an excellent list of questions that should be addressed with the parents along with questions that should be addressed with the child.  The authors make a point of addressing the importance of seeing older children and teenagers separately at some point in the initial session. 

In Chapter 2, "Familial influences", the authors provide a table on page 45 which lists the responsibilities of parents, such as "give physical care", and then lists the tasks that must be undergone to meet that parental responsibility.  For example, for the responsibility "give physical care", the tasks in the next column are "Feeding, shelter, rest, health, and protection."  These may seem like basic responsibilities, but are important enough to be recommended reading for clinicians.  In sections such as "Physical abuse – prevalence" (and throughout the book), statistics are given for the UK, Hong Kong, and the US (p.47). 

In Chapter 3, "Neurodevelopment and neuropsychiatric disorders", the authors provide a table not only with the average age of developmental milestones, but also provide the age at which there needs to be concern if those milestones have not yet been mastered.  This is an important part of assessing appropriate development, due to the fact that children can have some variability in the acquisition of skills.  This information will also be of benefit to parents who may be concerned about their child's developmental progress.

In Chapter 4, "Developmental psychopathology", the authors list "external influences" which can affect fetal development.  One of these influences is "the vulnerability of the parents, especially the mother, to psychiatric disorders, especially depressive and anxiety states" (p. 192). The authors state that "women who have such disorders before pregnancy are more likely to have similar problems during pregnancy and after the birth" (p. 192).  It would have been helpful for authors to cite a study showing the specific vulnerabilities of women who have anxiety or depression versus other psychiatric disorders.  In this chapter, the authors not only describe factors within the child that affect attachment, but also factors within family members, specifically parents.  These factors include sibling behavior, whether the pregnancy was planned, and living conditions.  This is very helpful information for clinicians, particularly those who prefer a systemic approach to treatment. 

In Chapter 5, "Adolescents and psychiatric disorders often beginning in adolescence", the authors provide information about teenage pregnancy.  They write that teenage mothers usually have had a relationship with the father for "several months or even years" and that "many of these pregnancies are not seen as unwelcome by the girls themselves" (p. 270).  This chapter also contains a complete section on eating disorders, including information on assessment, treatment and outcome. 

Chapter 6, "Child-adult continuities in psychiatric disorders", although brief, is particularly helpful in discussing the transition of disorders from childhood into adulthood.  The authors provide information on the different types of continuity of psychiatric disorders.  This is how the disorder changes or does not change throughout the lifespan.  In the chapter, the authors make an important point that even if all children with psychiatric disorders were to get better without treatment, childhood treatment would still be worthwhile if it "reduced the length or severity of the problem…or improved the quality of life for child and family" (p. 313). 

Chapter 7, "Psychosocial aspects of physical disorders", includes a wealth of information on how parents are impacted by a child's disorder.  The chapter even discusses the differences in psychological impact when a child is born with a disorder and when a disorder is diagnosed later in childhood.  The chapter also gives information on caring for a child with a terminal illness, including the psychological reactions of both the child and the parents. 

In Chapter 8, "Psychological aspects of specific physical conditions", the authors discuss the psychological sequelae of pediatric physical injuries, including head injury, accidental poisoning, and burns.  The chapter also details the prevalence and psychosocial aspects of human immunodeficiency virus (HIV).  The book also provides information on the psychological impact of medical conditions for virtually every system in the body, including the endocrine, gastrointestinal, and respiratory systems.

Chapter 9, "Prevention and treatment", details psychotherapy treatments, including behavioral therapy, group therapy, and family therapy.  For each treatment modality, the authors provide indications and contraindications.  The authors also provide a section on "mechanisms of change in individual psychotherapy", including catharsis, insight, learning alternative coping strategies, and "development of internal structure" (p. 426). 

In Chapter 10, "Services", the authors detail the education and training of particular mental health clinicians.  The authors describe the education and training of clinicians specifically in the United Kingdom (the authors acknowledge this), and the information may not necessarily apply in other countries.  Likewise, the information on legislation affecting children applies to policies in England and Wales.  However, most of the information in the chapter is applicable worldwide. 

This book is an excellent resource not only for mental health clinicians, but also for pediatricians and physicians in general practice.  It is applicable to all levels of knowledge – graduate students in their first year of training to physicians who have been practicing for a considerable amount of time.  It is very interesting and helpful to read a text that provides a perspective on pediatric mental health from another country.  Clinicians can be of even greater help to children when they acquire knowledge from sources outside their own region.   

© 2008 Stephanie Moulton Sarkis

Stephanie Moulton Sarkis PhD NCC LMHC is the author of 10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction & Accomplish Your Goals and Making the Grade with ADD: A Student's Guide to Succeeding in College with ADD.  Dr. Sarkis is a National Certified Counselor and Licensed Mental Health Counselor.  She has a private practice in Boca Raton, Florida and is an adjunct assistant professor at Saint Leo University.