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Anxiety in children
BOOK REVIEWS Book Review Editor:
Kenneth S. Robson, M.D.
Children and Behavior Therapy. By Anthony Graziano and Kevin C. Mooney. New York: Aldine Publishing, 1984, $29.95. The New Short- Term Therapies for Children: A Guide for the Helping Professions and Parents. By Lawrence E. Shapiro. Englewood Cliffs, N.J.: PrenticeHall, 1984. $7.95 paperback, $16.95 cloth. Counseling and Therapy for Children. By Jim Gumaer. New York: Free Press, 1984, $20.00.
of the field of child behavior modification. There are extensive reviews of the literature which are broken down into discrete categories. Individual chapters pertain to autistic children, mentally retarded children, juvenile delinquency, control of fear, somatic systems, and intervention in the school. In each area, relevant experimental work and evaluative techniques are discussed. One does not have to buy any of the theoretical assumptions underlying behavior modification to appreciate the careful and thoughtful work which informs this volume. The child psychiatrist who wishes to understand or employ behavioral techniques will be well satisfied with the choice of this text. Each of these books will serve a different readership. The Shapiro book is aimed at a lay audience and succeeds in introducing many of the therapies available to children in distress. Likewise, the Gumaer volume broadly and comprehensively spans the therapeutic spectrum. Its readership will optimally be drawn from a population with some extant interest and expertise in the realm of behavioral disorder and treatment. The Graziano and Mooney book is a real textbook. As such it will have differential utility for students and practitioners at a variety of levels and from a variety of disciplines. The volume certainly should prove useful to child psychiatrists.
Reviewed by James M. Herzog, M.D. * Children with problems abound; so do methods aimed at their remediation. These three volumes are all concerned with the constituents of the child therapist's armamentarium. Interestingly, and perhaps provocatively, none is authored by a child psychiatrist. One wonders how much this may reflect currently evolving role definitions in our field? Importantly, none of these volumes is exclusively directed at the child psychiatric practitioner; the intended audience is transdisciplinary and at multiple levels of experience. Counseling and Therapy for Children and The New Short- Term Therapies for Children both introduce or reacquaint the reader with a wide variety of therapeutic models and techniques. Among those which are defined, described, and demonstrated are: individual counseling, play therapy, art therapy, music therapy, bibliotherapy, relaxation and guided fantasy, family therapy, hypnotherapy, behavioral counseling, and group modalities. Not surprisingly, the organotherapies are psychopharmacology. Both the Gumaer and Shapiro volumes provide sufficient conceptual scaffolding for each therapy presented so that it is quite possible to read each volume with little or no formal background. Lawrence Shapiro's book is, in fact, billed as a guide for helping professionals and parents. The lay parent would have no difficulty in mastering the text. I found the Gumaer work to be somewhat more complex. Perhaps this volume could be thought of as ideally aimed at the mental health field student rather than at a lay audience. Child and Behavior Therapy is neither a survey nor introductory text. It is a comprehensive exploration
Anxiety in Children. Edited by Ved P. Parma. London: Methuen, Inc., 1984, 222 pp., $25.00. Reviewed by Joseph Biederman. M.D. t Anxiety disorders occur frequently in adults and have been the subject of considerable research. There has been an increasing interest in anxiety disorders of children but little has been done to further our understanding in the field. This book dealing with anxiety disorders in children contains 12 chapters. Chapter 1 provides an overview of the psychoanalytic approach to anxiety in childhood. Chapters 2-4 deal with the recognition of childhood anxiety by means of psychometric tests, psychiatric interviews, and projective techniques. Chapters 5-10 deal with cross-cultural perspectives, family dysfunction, anxieties about death, spiritual anxiety, anxiety about school, and anxiety relating to illness. The final two chapters deal with treatment issues.
• James M. Herzog, M.D., is the Director of Training in Child Psychiatry at the Children's Hospital Medical Center-Judge Baker Guidance Center. Boston, Mass.
t -loseph Biederman, M.D., is Director, Pediatric Psychopharmacology Clinic, Massachusetts General Hospital, Boston, Mass.
.',06
BOOK REVIEWS
The stated purpose of Anxiety in Children was to give a "broad" discussion of the issues of anxiety in children, focusing particularly on what those involved in mental health and educational and clinical psychology can do to help. These goals are certainly not met in this book. In fact, the book provides only an overview of analytic theory and treatment of childhood anxiety disorders, reviewing an already known and well-established literature. Although there are some useful clinical descriptions of patients and some useful guidelines in terms of treatment, the narrow analytic perspective omits information from other fields which have shed some light in our understanding of anxiety disorders in adults. Throughout the book the chapters are loosely organized. There is a basic confusion about what anxiety means: anxiety as a pathological state, anxiety as a symptom, anxiety as a disorder, and normal anxiety are intermingled. It seems that each author offers his or her own definition and understanding of the term. Documentation is limited, and most of the references are dated. Despite its overall major limitations, some chapters may be of some interest to the reader. Chapter 2 examines psychometric tests and provides a reasonable review of some of the available scales to measure anxiety in children. Chapter 3, which focuses on the psychiatric assessment of the anxious child, is the only such chapter dealing with childhood anxiety in the context of psychiatric diagnoses. Chapter 10anxiety related to illness and its treatment-is a useful overview of children's coping strategies with disease. Nothing particularly useful in the understanding and treatment of childhood anxiety can be found in the middle chapters. One chapter offers a cross-cultural perspective and stresses the importance of age, sex and socioeconomic status in the development of chiidhood anxiety. Chapter 6 offers the well-known family systems perspective for understanding all disorders, including childhood anxiety. The two chapters on anxieties about death and the one on spiritual anxiety are particularly poor and confusing. Issues of fear, separation, abnormal, and normal behaviors are not adequately addressed. The two treatment chapters are very poor and their relationship to childhood anxiety is obscure. One attempts to deal with the psychological treatment of childhood neuroses and the other with the treatment of psychotic anxiety. These chapters offer general treatment guidelines not necessarily specific to anxiety disorders. The term neurosis is used in a general way and, accordingly, its proposed treatment is nonspecific. There is nothing new to be learned from this chapter about the treatment of childhood anxiety even
507
from the psychotherapeutic perspective. An even more confusing chapter is the one dealing with psychotic anxiety and its treatment. The author's meaning of this term is unclear and his dealing with the topic of psychotic disorders of childhood is dated and at odds with modern psychiatry. In summary I did not find this book to be informative or of much interest to the informed clinician. It may be of some value to individuals with interest in an overview of broad psychoanalytic perspective in childhood anxiety.
Anorexia Nervosa: A Clinician's Guide to Treatment. By Walter Vandereycken and Rolf Meermann. Berlin: Walter de Gruyter, 1984, 264 pp., $44.60. Reviewed by Stephen P. Herman, M.D.* "Why should I listen to your telling me I have to gain weight, when I feel so good this way?" Thus spoke the bright, articulate, pretty and emaciated young woman seated in my office. Coincidentally, I had just finished Vandereycken and Meermann's highly readable guide, Anorexia Nervosa and felt some comfort in the knowledge that I was by no means alone in my frustration and confusion about this mysterious ailment. With so many books available today on eating disorders, this one serves a definite purpose by providing cogent literature reviews on every aspect of anorexia nervosa and by offering very practical assistance in its diagnosis and treatment. The authors' stated purpose-to write a helpful, practical guide rather than a therapeutic cookbook-has been fulfilled. Researchers, clinicians, and newcomers to the field from a variety of disciplines will find much valuable information within its pages. The 11 chapters cover every aspect of this ailment, beginning with the first chapter on making a reliable diagnosis. Following the DSM-III criteria, the authors nevertheless point out that this is a spectrum disorder, existing on a continuum. Various rating scales are reviewed and clinicians are urged above all to assess the patient's behavior. Chapter 2 provides excellent reviews of the different etiological theories, including psychodynamic, systems, sociocultural, biological, and cognitive-behavioristic. Chapter 3 covers the oft-neglected subject of prevention and early detection, reviewing at-risk groups and the reasons why there may be a significant delay from symptom onset to appropriate recognition arid treatment. The acute stage of severe malnutrition and the problems of nutritional rehabilitation are covered in the fourth chapter as is the dilemma of when to use tube feeding or total parenteral nutrition. Chapter 5 discusses outpatient • Dr. Herman is Assistant Clinical Professor of Psychiatry, Cornell University Medical College, New York, N.Y.
Kenneth S. Robson, M.D.
Children and Behavior Therapy. By Anthony Graziano and Kevin C. Mooney. New York: Aldine Publishing, 1984, $29.95. The New Short- Term Therapies for Children: A Guide for the Helping Professions and Parents. By Lawrence E. Shapiro. Englewood Cliffs, N.J.: PrenticeHall, 1984. $7.95 paperback, $16.95 cloth. Counseling and Therapy for Children. By Jim Gumaer. New York: Free Press, 1984, $20.00.
of the field of child behavior modification. There are extensive reviews of the literature which are broken down into discrete categories. Individual chapters pertain to autistic children, mentally retarded children, juvenile delinquency, control of fear, somatic systems, and intervention in the school. In each area, relevant experimental work and evaluative techniques are discussed. One does not have to buy any of the theoretical assumptions underlying behavior modification to appreciate the careful and thoughtful work which informs this volume. The child psychiatrist who wishes to understand or employ behavioral techniques will be well satisfied with the choice of this text. Each of these books will serve a different readership. The Shapiro book is aimed at a lay audience and succeeds in introducing many of the therapies available to children in distress. Likewise, the Gumaer volume broadly and comprehensively spans the therapeutic spectrum. Its readership will optimally be drawn from a population with some extant interest and expertise in the realm of behavioral disorder and treatment. The Graziano and Mooney book is a real textbook. As such it will have differential utility for students and practitioners at a variety of levels and from a variety of disciplines. The volume certainly should prove useful to child psychiatrists.
Reviewed by James M. Herzog, M.D. * Children with problems abound; so do methods aimed at their remediation. These three volumes are all concerned with the constituents of the child therapist's armamentarium. Interestingly, and perhaps provocatively, none is authored by a child psychiatrist. One wonders how much this may reflect currently evolving role definitions in our field? Importantly, none of these volumes is exclusively directed at the child psychiatric practitioner; the intended audience is transdisciplinary and at multiple levels of experience. Counseling and Therapy for Children and The New Short- Term Therapies for Children both introduce or reacquaint the reader with a wide variety of therapeutic models and techniques. Among those which are defined, described, and demonstrated are: individual counseling, play therapy, art therapy, music therapy, bibliotherapy, relaxation and guided fantasy, family therapy, hypnotherapy, behavioral counseling, and group modalities. Not surprisingly, the organotherapies are psychopharmacology. Both the Gumaer and Shapiro volumes provide sufficient conceptual scaffolding for each therapy presented so that it is quite possible to read each volume with little or no formal background. Lawrence Shapiro's book is, in fact, billed as a guide for helping professionals and parents. The lay parent would have no difficulty in mastering the text. I found the Gumaer work to be somewhat more complex. Perhaps this volume could be thought of as ideally aimed at the mental health field student rather than at a lay audience. Child and Behavior Therapy is neither a survey nor introductory text. It is a comprehensive exploration
Anxiety in Children. Edited by Ved P. Parma. London: Methuen, Inc., 1984, 222 pp., $25.00. Reviewed by Joseph Biederman. M.D. t Anxiety disorders occur frequently in adults and have been the subject of considerable research. There has been an increasing interest in anxiety disorders of children but little has been done to further our understanding in the field. This book dealing with anxiety disorders in children contains 12 chapters. Chapter 1 provides an overview of the psychoanalytic approach to anxiety in childhood. Chapters 2-4 deal with the recognition of childhood anxiety by means of psychometric tests, psychiatric interviews, and projective techniques. Chapters 5-10 deal with cross-cultural perspectives, family dysfunction, anxieties about death, spiritual anxiety, anxiety about school, and anxiety relating to illness. The final two chapters deal with treatment issues.
• James M. Herzog, M.D., is the Director of Training in Child Psychiatry at the Children's Hospital Medical Center-Judge Baker Guidance Center. Boston, Mass.
t -loseph Biederman, M.D., is Director, Pediatric Psychopharmacology Clinic, Massachusetts General Hospital, Boston, Mass.
.',06
BOOK REVIEWS
The stated purpose of Anxiety in Children was to give a "broad" discussion of the issues of anxiety in children, focusing particularly on what those involved in mental health and educational and clinical psychology can do to help. These goals are certainly not met in this book. In fact, the book provides only an overview of analytic theory and treatment of childhood anxiety disorders, reviewing an already known and well-established literature. Although there are some useful clinical descriptions of patients and some useful guidelines in terms of treatment, the narrow analytic perspective omits information from other fields which have shed some light in our understanding of anxiety disorders in adults. Throughout the book the chapters are loosely organized. There is a basic confusion about what anxiety means: anxiety as a pathological state, anxiety as a symptom, anxiety as a disorder, and normal anxiety are intermingled. It seems that each author offers his or her own definition and understanding of the term. Documentation is limited, and most of the references are dated. Despite its overall major limitations, some chapters may be of some interest to the reader. Chapter 2 examines psychometric tests and provides a reasonable review of some of the available scales to measure anxiety in children. Chapter 3, which focuses on the psychiatric assessment of the anxious child, is the only such chapter dealing with childhood anxiety in the context of psychiatric diagnoses. Chapter 10anxiety related to illness and its treatment-is a useful overview of children's coping strategies with disease. Nothing particularly useful in the understanding and treatment of childhood anxiety can be found in the middle chapters. One chapter offers a cross-cultural perspective and stresses the importance of age, sex and socioeconomic status in the development of chiidhood anxiety. Chapter 6 offers the well-known family systems perspective for understanding all disorders, including childhood anxiety. The two chapters on anxieties about death and the one on spiritual anxiety are particularly poor and confusing. Issues of fear, separation, abnormal, and normal behaviors are not adequately addressed. The two treatment chapters are very poor and their relationship to childhood anxiety is obscure. One attempts to deal with the psychological treatment of childhood neuroses and the other with the treatment of psychotic anxiety. These chapters offer general treatment guidelines not necessarily specific to anxiety disorders. The term neurosis is used in a general way and, accordingly, its proposed treatment is nonspecific. There is nothing new to be learned from this chapter about the treatment of childhood anxiety even
507
from the psychotherapeutic perspective. An even more confusing chapter is the one dealing with psychotic anxiety and its treatment. The author's meaning of this term is unclear and his dealing with the topic of psychotic disorders of childhood is dated and at odds with modern psychiatry. In summary I did not find this book to be informative or of much interest to the informed clinician. It may be of some value to individuals with interest in an overview of broad psychoanalytic perspective in childhood anxiety.
Anorexia Nervosa: A Clinician's Guide to Treatment. By Walter Vandereycken and Rolf Meermann. Berlin: Walter de Gruyter, 1984, 264 pp., $44.60. Reviewed by Stephen P. Herman, M.D.* "Why should I listen to your telling me I have to gain weight, when I feel so good this way?" Thus spoke the bright, articulate, pretty and emaciated young woman seated in my office. Coincidentally, I had just finished Vandereycken and Meermann's highly readable guide, Anorexia Nervosa and felt some comfort in the knowledge that I was by no means alone in my frustration and confusion about this mysterious ailment. With so many books available today on eating disorders, this one serves a definite purpose by providing cogent literature reviews on every aspect of anorexia nervosa and by offering very practical assistance in its diagnosis and treatment. The authors' stated purpose-to write a helpful, practical guide rather than a therapeutic cookbook-has been fulfilled. Researchers, clinicians, and newcomers to the field from a variety of disciplines will find much valuable information within its pages. The 11 chapters cover every aspect of this ailment, beginning with the first chapter on making a reliable diagnosis. Following the DSM-III criteria, the authors nevertheless point out that this is a spectrum disorder, existing on a continuum. Various rating scales are reviewed and clinicians are urged above all to assess the patient's behavior. Chapter 2 provides excellent reviews of the different etiological theories, including psychodynamic, systems, sociocultural, biological, and cognitive-behavioristic. Chapter 3 covers the oft-neglected subject of prevention and early detection, reviewing at-risk groups and the reasons why there may be a significant delay from symptom onset to appropriate recognition arid treatment. The acute stage of severe malnutrition and the problems of nutritional rehabilitation are covered in the fourth chapter as is the dilemma of when to use tube feeding or total parenteral nutrition. Chapter 5 discusses outpatient • Dr. Herman is Assistant Clinical Professor of Psychiatry, Cornell University Medical College, New York, N.Y.