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Rutter's Child and Adolescent PsychiatryReview - Rutter's Child and Adolescent Psychiatry
Fifth Edition
by Michael Rutter (Author), Dorothy Bishop, Daniel Pine, Steven Scott, Jim S. Stevenson, Eric A. Taylor and Anita Thapar
Wiley-Blackwell, 2008
Review by Stephanie Moulton Sarkis
May 26th 2009 (Volume 13, Issue 22)

Rutter's Child and Adolescent Psychiatry (5th ed.) is a 1230 page guide and manual of the field of pediatric mental health.  There are 118 contributors to the book, with the majority of the contributors having a Ph.D. or M.D. degree.  The authors represent the Australia, Canada, the Netherlands, the United Kingdom, and the United States.

This is the 5th edition of the book, with the first edition published in 1976.  The 5th edition includes a preface to the current edition, plus also provides the preface to first edition.  The chapters in the 5th edition were subject to the same peer review process as those employed by scientific journals.   The 5th edition also includes new chapters such as "What Clinicians Need to Know about Statistical Issues and Methods" and "Health Economics". A CD included with the book contains the entire text of the manual in a searchable format. 

There are five parts to the manual:  Conceptual Approaches, Clinical Assessment, Influences on Psychopathology, Clinical Syndromes, and Approaches to Treatment.

Part I, Conceptual Approaches, contains 18 chapters, including "Clinical Assessment and Diagnostic Formulation", "Using Epidemiology and Longitudinal Approaches to Study Causal Hypotheses", "Children's Testimony", "What Can We Learn from Structural and Functional Brain Imaging?"

Part II, Clinical Assessment, contains 4 chapters: "Use of Structured Interviews and Observational Methods in Clinical Settings", "Using Rating Scales in a Clinical Context", "Psychological Assessment in the Clinical Context", and "Physical Examination and Medical Investigation".

Part III, Influences on Psychopathology, contains 11 chapters, including "Psychosocial Adversity and Resilience", "Impact of Parental Psychiatric Disorder and Physical Illness", "Child Maltreatment", and "Residential and Foster Care".

Part IV, Clinical Syndromes, contains 26 chapters, including "Disorders of Attention and Activity", "Substance Use and Substance Use Disorder", "Autism Spectrum Disorders", and "Attachment Disorders in Relation to Deprivation". 

Part V, Approaches to Treatment, contains 15 chapters, including "Cognitive-Behavioral Therapies", "Provision of Intensive Treatment: In-patient Units, Day Units, and Intensive Outreach", "Genetic Counseling", and "Special Education". 

On the first page of each chapter, the citation information is given, including the names of the editors, the copyright date, and the ISBN number of the book.

In Chapter 11, "What can we learn from structural and functional brain imaging?" (Frith & Frith, 2008), the authors describe various brain imaging techniques, including magnetic resonance imaging (MRI), positron emission tomography (PET), and electroencephalograph (EEG).  The chapter includes a section on difficulties in using brain scans in with children.  The authors state that "practice" in a mock scanner can be very helpful to children.  The authors also address the issue of children having difficulty remaining completely still for an MRI.  The use of sedation is addressed, with the caveat that tasks involving a fully alert child cannot be completed.  The chapter refers to other chapters that provide information on various imaging techniques and disorders, including dyslexia and autism.  The chapter's section on autism references up-to-date studies. 

Chapter 19, "Use of Structured Interviews and Observational Methods in Clinical Settings", provides synopses of five general child and adolescent psychiatric interviews (Couteur & Gardner, 2008).  The chapter also gives synopses of four other structured interviews for specific disorders, including autism.  The chapter contains a section titled "Considerations in Selecting an Instrument or Method", which includes considerations such as the complexity of coding, and unit of analysis (event-sampling methods and timing duration). 

Chapter 22, "Physical Examination and Medical Investigation" (Baird & Gringras, 2008), provide a well-designed Table (22.2a, p. 320-321) with details of a developmental exam.  The table goes form newborn to 11 months, and covers areas such as appropriate gross and fine motor skills, language, and drawing.  The table provides examples of appropriate figure drawings for children 3 to 5 years of age.  The chapter also gives the steps of a neurological motor exam.  The authors provide the steps of the exam, and also provide possible observations and the coordinating diagnosis.  

In Chapter 31, "Psychopathology in Refugee and Asylum Seeking Children" (Hodes, 2008), Table 31.1 (p. 477) provides a chart of the stages of refugee experience ("Pre-flight", "In-flight", and "In resettlement communities"), along with applicable studies and findings for each stage.  The chart provides research regarding Cambodian, Kurdish, Iranian, Palestinian, and Bosnian child refugees.  The author discusses the prevalence of Post-Traumatic Stress Disorder (PTSD) in the pediatric refugee population, and also discusses the resilience of refugee children.  Families with stronger social networks, proficiency in the language of the country of resettlement, and work opportunities produce children who tend to have less psychopathology as a result of their experiences. 

Chapter 34, "Disorders of Attention and Activity" (Taylor & Sonuga-Barke, 2008), is divided into ten sections: Clinical Presentations; Diagnostic Definitions; Subtypes of Disorder; Coexistent Disorders; Etiology and Pathophysiology; An Integrative Framework for ADHD Etiology and Pathophysiology; Epidemiology; Longitudinal Course; Clinical Assessment; and Treatment.  In the "Etiology and Pathophysiology" section, the authors discuss the genetic, environmental, and biological nature of Attention Deficit Hyperactivity Disorder (ADHD), including a discussion regarding catecholamine dysregulation.  In the section "An Integrative Framework for ADHD Etiology and Pathophysiology", Figure 34.1 (p. 531) is a diagram of the relationship between genes, environment, and neurocognition.

Chapter 68, "Juvenile Delinquency" (Bailey & Scott, 2008), has an interesting section on the role of Autistic Spectrum Disorders on delinquent behavior.  The author writes that more studies need to be conducted on the comorbidity of autism and delinquency, and especially how ADHD impulsivity overlaps with the impulsivity seen in autism and delinquency.  The chapter also discusses "Interventions for Particular Crimes and Groups" including firesetting/arson, and female delinquents. The author points out that although far fewer girls have delinquent behavior than boys, they have similar risk factors.  The author makes an important statement that "Intervention is not solely the removal of risk, but also the enhancement of protective factors" (p. 1113). 

The writing in the book is fairly technical, as the book's intended audience is the medical professional that works in pediatrics; particularly, child and adolescent counselors, psychologists, and psychiatrists.  The Rutter's guide is the definitive guide on pediatric mental health.   It is an extremely helpful and thorough resource for any clinician working in the field of mental health and/or pediatrics.  It is a "must-have" for a clinician's library.

© 2009 Stephanie Moulton Sarkis

Stephanie Moulton Sarkis PhD NCC LMHC is the author of three books:  10 Simple Solutions to Adult ADD, Making the Grade with ADD, and ADD and Your Money.  She is an adjunct assistant professor in Counselor Education at Florida Atlantic University, and has a private practice in Boca Raton, Florida.  She can be reached at www.stephaniesarkis.com or Stephanie@stephaniesarkis.com.


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