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Annual progress in child psychiatry and child development
Volume 79 Number 1
The book shel[
levels of gonadotropins with the various stages of puberty. Similarly the measurement of androgen levels in blood has provided the clinician with important diagnostic tools in the study of pituitary-gonadal function; much of this work is discussed in the chapters on testicular function, and a scheme is suggested for the evaluation of hypogonadal states. It should be stated, however, that the usefulness of clomiphene in such an evaluation remains to be more fully explored. A brief review of the relationship between phenotype and chromosomal aberrations in gonadal dysgenesis is presented, attempting to show their bearing on the pathogenesis of the somatic anomalies seen in these patients. The last two chapters deal with adrenal function. Interesting data on cortisol production rates as measured by the isotope dilution principle, are presented both in normal and pathological states. Although these methods have recently come under criticism because of certain theoretical arguments, the results retain grosso modo their validity if not their utmost precision. Iatrogenic adrenocortical suppression is the final topic. It is extremely well discussed and documented, leading to some recommendations useful to the clinician concerned with the effects of glucocorticoid therapy. This problem is, of course, not peculiar to the adolescent.
Raphael David, M.D. New York, N. Y.
Sudden infant death syndrome. Proceedings of the second international conference on causes of sudden death in infants E d i t e d b y A b r a h a m B. B e r g m a n , M.D., J. Bruce Beckwith, M.D., a n d C. G e o r g e R a y , M.D., Seattle a n d L o n d o n , 1970, U n i v e r s i t y of W a s h i n g t o n Press, 248 pages. $10.00. Sudden unexpected death in infancy, or "crib death," is probably not a new syndrome, but it is one that has been clearly delineated and brought into sharp focus during the past 10 years. The first international conference on this subject, held in 1963, did much to formulate the salient features and to suggest the major areas open to research. At the second international conference in Seattle, in 1969, advances and accomplishments since 1963 were broadly sum-
1 65
marized and are now published in this excellent comprehensive monograph. Epidemiologic studies discIose the striking similarities of the main features of this condition, whether it occurs in such diverse areas as Canada or Czechoslovakia. The main problems that hamper progress still persist. These involve difficulty in recoNgtion, definition, and reporting of the syndrome, and the fact that potential victims can not be detected with any reliability prior to death. Thus studies must of necessity be largely retrospective. Of the various explanations offered, those that suggest viral infection or obstruction of the upper respiratory passage appear to have crystallized into well-formulated hypotheses that still require definitive proof. Of special interest in this review was the inclusion of a study of physiological adjustments of normal young infants with special reference to interrelations between the cardiopulmonary and autonomic nervous systems. This approach might well shed new light on this difficult problem.
Renata Dische New York, N. Y.
Annual progress in child psychiatry and child development E d i t e d by S. Chess a n d A. T h o m a s , N e w York, 1970, B r u n n e r / M a z e l , 385 pages. $15.00. As the volume of literature on child behavior reaches overwhelming proportions, the need for selectivity becomes urgent and, indeed, imperative if one is to keep abreast of what is new and significant. To meet this need, Chess and Thomas are performing a real service in selecting each year the 30 odd contributions that they consider worth bringing to the attention of workers in the closely related fields of child psychiatry and child development. In the wide range of subjects covered, the pediatrician will find much that will be of practical as well as theoretical interest. This reviewer might single out Jerome Kagan's paper on the greater volume of babbling noted in the female infant during visual fixation. Of more directly practical interest is a clinical study by Anthony on children of psychotic parents living at home, a situation that has become increasingly common as psychotic
1 66
T h e book shelf
patients are discharged from institutions and treated in after-care clinics. Paradoxically, it appears that the child is less severely disturbed when the parent is more alienated from reality, while lesser degrees of parental deviation are more likely to be mirrored by the child. In a long-term, longitudinal study of patients who manifested schizophrenia with autism during childhood, L. Bender challenges some widely held beliefs, notably, the supposed vulnerability of Jewish children. Her study reaffirms the influence of a genetic factor and also Kanner's statement that failure to use communicative language at age 5 foreshadows an unfavorable course. This study is of special significance, though it is a preliminary report based on 30 of the 50 subjects under investigation. Rheingold and Samuels show how the fussing of I0-month-old infants ceases when sameness is relieved by the introduction of fresh stimulation in the form of new toys. Both experimental and control subjects were from intact, well-functioning homes. (Substitute rocking for fussing, a n d similar results will be observed in infants in congregate shelters.)
The Journal o/ Pediatrics Jul), 1971
In "Changing Times," Gondor and Gondor advocate greater use of children's drawings as diagnostic aids in behavior disorders. They present a series of drawings by children ranging in age from 8 to 13 years. Comparisons are made between productions by deprived and middle class children. More eloquent and more lasting than words, the child's graphic activity expresses the impact of today's exciting world and the child's reaction to what he sees and hears and feels. This reviewer is impressed by what drawings can tell not only during latency and adolescence but also during the preschool years when remedial measures are more likely to bear fruit. These are but a few of the many readings covering the field from infancy to adolescence. The authors are to be complimented for their discrimination in selecting some of the most significant articles of the year.
Joseph Di Leo, M.D. New York, N. Y.
The book shel[
levels of gonadotropins with the various stages of puberty. Similarly the measurement of androgen levels in blood has provided the clinician with important diagnostic tools in the study of pituitary-gonadal function; much of this work is discussed in the chapters on testicular function, and a scheme is suggested for the evaluation of hypogonadal states. It should be stated, however, that the usefulness of clomiphene in such an evaluation remains to be more fully explored. A brief review of the relationship between phenotype and chromosomal aberrations in gonadal dysgenesis is presented, attempting to show their bearing on the pathogenesis of the somatic anomalies seen in these patients. The last two chapters deal with adrenal function. Interesting data on cortisol production rates as measured by the isotope dilution principle, are presented both in normal and pathological states. Although these methods have recently come under criticism because of certain theoretical arguments, the results retain grosso modo their validity if not their utmost precision. Iatrogenic adrenocortical suppression is the final topic. It is extremely well discussed and documented, leading to some recommendations useful to the clinician concerned with the effects of glucocorticoid therapy. This problem is, of course, not peculiar to the adolescent.
Raphael David, M.D. New York, N. Y.
Sudden infant death syndrome. Proceedings of the second international conference on causes of sudden death in infants E d i t e d b y A b r a h a m B. B e r g m a n , M.D., J. Bruce Beckwith, M.D., a n d C. G e o r g e R a y , M.D., Seattle a n d L o n d o n , 1970, U n i v e r s i t y of W a s h i n g t o n Press, 248 pages. $10.00. Sudden unexpected death in infancy, or "crib death," is probably not a new syndrome, but it is one that has been clearly delineated and brought into sharp focus during the past 10 years. The first international conference on this subject, held in 1963, did much to formulate the salient features and to suggest the major areas open to research. At the second international conference in Seattle, in 1969, advances and accomplishments since 1963 were broadly sum-
1 65
marized and are now published in this excellent comprehensive monograph. Epidemiologic studies discIose the striking similarities of the main features of this condition, whether it occurs in such diverse areas as Canada or Czechoslovakia. The main problems that hamper progress still persist. These involve difficulty in recoNgtion, definition, and reporting of the syndrome, and the fact that potential victims can not be detected with any reliability prior to death. Thus studies must of necessity be largely retrospective. Of the various explanations offered, those that suggest viral infection or obstruction of the upper respiratory passage appear to have crystallized into well-formulated hypotheses that still require definitive proof. Of special interest in this review was the inclusion of a study of physiological adjustments of normal young infants with special reference to interrelations between the cardiopulmonary and autonomic nervous systems. This approach might well shed new light on this difficult problem.
Renata Dische New York, N. Y.
Annual progress in child psychiatry and child development E d i t e d by S. Chess a n d A. T h o m a s , N e w York, 1970, B r u n n e r / M a z e l , 385 pages. $15.00. As the volume of literature on child behavior reaches overwhelming proportions, the need for selectivity becomes urgent and, indeed, imperative if one is to keep abreast of what is new and significant. To meet this need, Chess and Thomas are performing a real service in selecting each year the 30 odd contributions that they consider worth bringing to the attention of workers in the closely related fields of child psychiatry and child development. In the wide range of subjects covered, the pediatrician will find much that will be of practical as well as theoretical interest. This reviewer might single out Jerome Kagan's paper on the greater volume of babbling noted in the female infant during visual fixation. Of more directly practical interest is a clinical study by Anthony on children of psychotic parents living at home, a situation that has become increasingly common as psychotic
1 66
T h e book shelf
patients are discharged from institutions and treated in after-care clinics. Paradoxically, it appears that the child is less severely disturbed when the parent is more alienated from reality, while lesser degrees of parental deviation are more likely to be mirrored by the child. In a long-term, longitudinal study of patients who manifested schizophrenia with autism during childhood, L. Bender challenges some widely held beliefs, notably, the supposed vulnerability of Jewish children. Her study reaffirms the influence of a genetic factor and also Kanner's statement that failure to use communicative language at age 5 foreshadows an unfavorable course. This study is of special significance, though it is a preliminary report based on 30 of the 50 subjects under investigation. Rheingold and Samuels show how the fussing of I0-month-old infants ceases when sameness is relieved by the introduction of fresh stimulation in the form of new toys. Both experimental and control subjects were from intact, well-functioning homes. (Substitute rocking for fussing, a n d similar results will be observed in infants in congregate shelters.)
The Journal o/ Pediatrics Jul), 1971
In "Changing Times," Gondor and Gondor advocate greater use of children's drawings as diagnostic aids in behavior disorders. They present a series of drawings by children ranging in age from 8 to 13 years. Comparisons are made between productions by deprived and middle class children. More eloquent and more lasting than words, the child's graphic activity expresses the impact of today's exciting world and the child's reaction to what he sees and hears and feels. This reviewer is impressed by what drawings can tell not only during latency and adolescence but also during the preschool years when remedial measures are more likely to bear fruit. These are but a few of the many readings covering the field from infancy to adolescence. The authors are to be complimented for their discrimination in selecting some of the most significant articles of the year.
Joseph Di Leo, M.D. New York, N. Y.