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Treatment of Childhood DisordersReview - Treatment of Childhood Disorders
Third Edition
by Eric J. Mash and Russell A. Barkley (Editors)
Guilford Press, 2006
Review by Ben Lovett
Jan 23rd 2007 (Volume 11, Issue 4)

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.


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