Every year, dozens of books come
out on the treatment of children with emotional and behavioral problems. The
quality of the information is variable, to put things euphemistically. As
difficult as it is for practicing clinicians to navigate the confusing and
often contradictory treatment programs, it’s even harder on parents, who
desperately want to understand their children’s conditions, but are unsure
about how best to help them. The individuals whom parents often turn to—social
workers, special education teachers, school psychologists, pediatricians and
family physicians—often know little more than interested parents do about these
conditions. It’s a tough situation for millions of children, who increasingly
have multiple diagnoses but inconsistent case management.

The newest edition of Treatment
of Childhood Disorders steps boldly into this context. Mash and Barkley’s
third edition stands at 884 pages, a veritable encyclopedia covering 11
different problems ranging from neuropsychological conditions (ADHD, learning
disabilities) to psychosocial trauma (sexual abuse), as well as childhood
versions of common adult mental disorders (depression, anxiety). An
introductory chapter by Mash is followed by others authored by authorities in
the field of child clinical psychology. The text is not meant to be read
straight through (except perhaps by graduate students), but instead will serve
as a reference for anyone interested in an up-to-date review of therapies for
these problems. And "therapies" does not just refer to psychotherapy;
indeed, especially notable is the book’s integration of psychopharmacology into
relevant chapters. Too often, the split between psychology and psychiatry keeps
texts in clinical psychology from detailed and serious discussion of
pharmacological treatment options, which are thoughtfully covered here.

Mash’s introduction is not merely
a preview of the chapters that follow; it stands on its own as a 60-page primer
on the "cognitive-behavioral systems approach" to child therapy. This
approach generally views childhood disorders as excesses or deficiencies in
behaviors, affected by the child’s cognitive processes (attention, memory,
judgment, etc.), and occurring within larger systems such as families and
schools. Mash describes the history and evolution of this approach before
reviewing the supporting evidence for it; this evidence includes research
demonstrating the effects of behavioral contingencies and cognitive processes
on disorder symptoms as well as the efficacy of cognitive-behavioral
interventions. Also covered are the ways that demographic factors, cultural
issues, medical/physiological dysfunction, and assessment techniques influence
treatment. Unfortunately, at some points, Mash tries to be so inclusive of all
possible issues that the cognitive-behavioral systems approach loses some its
potential distinctiveness. For instance, his emphasis on "the important
role of genetic and neurobiological processes" is no doubt warranted in
clinical practice, but this emphasis fails to differentiate his
cognitive-behavioral conceptualization from, say, a medical conceptualization
of childhood disorders.

Detailed discussion of each
chapter would itself require a chapter-length essay, but a summary of two
representative chapters will give potential readers a sense of the content. The
book’s coverage of conduct problems comprises what is by far the longest
chapter (131 pages), but its organization is typical of the others. The authors
begin with a thorough but concise review of research on the definition of
conduct problems, the official diagnoses (oppositional defiant disorder and
conduct disorder), and information on the epidemiology and suspected causes of
these problems. A similarly comprehensive section on assessment follows, in
which various methods (rating scales, behavior observation, interviews) are
discussed. The remaining pages cover the various treatment options and
prevention programs, classified by population (child vs. adolescent), problem
type (overt vs. covert aggression), and program implementation style
(home-based, school-based, community-based, skills training, and
psychopharmacology). The writing is clear and readable, if somewhat dense and
textbookish. Studies are summarized ably, and readers are referred to further
sources when necessary. Several features are nice surprises not found in
comparable books: a section on predictors of treatment outcome (e.g., problem
severity, family characteristics), a fairly detailed review of drug therapy for
conduct problems, and a discussion of future directions for research and
practice.

The chapter on learning
disabilities is more intellectual, reflecting the disagreements that scholars
in this field have over basic issues in defining and conceptualizing these
disabilities. The chapter opens with a lengthy historical overview that covers
various conceptual models and argues that a learning disability should be assessed
by monitoring a student’s responsiveness to increasingly intensive instruction
and academic interventions, and that it should be defined as a failure to
respond to instruction or intervention. This is actually a hotly debated
definition, but one justified by the literature review that follows. The
authors summarize the intervention efficacy literature, classifying
interventions by the academic subject area that they target (reading,
mathematics, and written language). Enough methodological details of each study
are given to allow readers to make judgments about which research is most
relevant to an individual child’s problems. The very existence of this chapter
will be a surprise to some readers, who think of the "treatment" for
learning disabilities as being a special education classroom. The interventions
for academic skills discussed so thoroughly in this chapter let readers know
what special education for students with learning disabilities should consist
of.

Despite its breadth and depth,
there are a few disappointing features of Treatment of Childhood Disorders.
First, bipolar disorders are not discussed in any detail, despite the huge
growth in research on children and adolescents with bipolar disorder conducted
since the last edition of the text. The diagnosis is becoming increasingly
common, and a generally authoritative handbook like this one might be expected
to discuss treatment options for the disorder. Second, little systematic
attention is given to the special needs of preschool children. Although a few
of the chapters discuss the effects of age on treatment outcome more generally,
most of these discussions compare adolescents with children, neglecting the
preschoolers who represent a growing segment of the mental health consumer
population. Finally, the chapters are extremely uneven in their use of specific
examples of clinical techniques, which would be more helpful if they were used
more often in all of the chapters.

Still, these disappointments are
small things, when compared to the magnitude of the achievement that this book
represents. To have compiled so much information and analysis into a single
volume is almost incredible. Treatment of Childhood Disorders should not
only be required reading for graduate students in clinically oriented areas of
psychology; it should also be on the shelves of the social workers, school
psychologists, and pediatricians whom parents go to for help. Finally, copies
should be in the public libraries, where citizens can go for a trustworthy
source of information on the disorders that they increasingly find their
children diagnosed with. Parents may have to look up a few technical terms, or
bring photocopies of relevant sections to a mental health professional for
assistance, but these efforts will be amply repaid by the wise guidance found
in every chapter.

© 2007 Ben Lovett

Ben
Lovett is currently a doctoral candidate in the psychology department at Syracuse University, where his research interests include learning disabilities and ADHD.

Categories: ChildhoodDisorders