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.

Categories: ChildhoodDisorders, MentalHealth