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Child Psychopathology, 2nd Edition
BOOK REVIEWS
Child Psychopathology, 2nd Edition. Edited by Eric J. Mash, Ph.D., and Russell A. Barkley, Ph.D. New York: Guilford Press, 2003, 802 pp., $70.00 (hardcover). When published in 1996, the first edition of Child Psychopathology completed a trilogy of work edited by Dr. Mash and his coeditors, Dr. Barkley and Dr. Terdal. At the time it was described as “concise yet comprehensive, historical yet timely” (Sexson, 1998) and potentially “a classic in its field” (Edwards, 1998). While the last to be published, it stood conceptually as the first of the three, establishing the history and knowledge base of numerous psychopathological disorders of childhood and adolescence, and it was followed each year with new, up-to-date revisions of the previous two works, Assessment of Childhood Disorders (Mash and Terdal 1997) and Treatment of Childhood Disorders (Mash and Barkley, 1998). But as noted in the preface, “research in child, adolescent, and developmental psychopathology continues to flourish, even more so than when the first edition of this text was published” (p. xi), and only 7 years later, Dr. Mash and colleagues are undertaking the herculean labor of new editions of these three works, starting with the second edition of Child Psychopathology. Is this necessary? Yes. But is this a trivial revision? I think not: roughly 40% of the references in this second edition date from these past 7 years, and the book has expanded from 650 pages to 802. Despite the title, the volume addresses psychopathology from birth through adolescence. The structure of the book is identical to that of the first edition (17 chapters in five sections). The introductory section and its single chapter on the developmental systems perspective—the longest in the book—is required reading despite the fact that a volume like this is more likely to be read as a reference than cover to cover. Drs. Mash and Dozois take on issues of the continuity, stability, and validity of diagnostic categories; this is a perspective necessary to appreciate the subsequent chapters fully. The remaining sections are behavior disorders (ADHD, conduct and oppositional defiant disorders, and adolescent substance abuse disorders), emotional and social disorders (mood disorders, anxiety disorders, PTSD, social withdrawal), developmental and learning disorders (autistic spectrum disorders, childhood-onset schizophrenia, mental retardation, learning disabilities), infants and children at risk (disorders of infancy and toddlerhood, child maltreatment), and eating disorders and health-related disorders. The chapter on tic disorders from the previous edition has been replaced by the chapter on substance abuse. The structure of
500
Assistant Editor: Andrés Martin, M.D., M.P.H.
these chapters typically proceeds from a description of core behaviors, symptoms, and deficits through a brief historical perspective, a discussion of existing criteria, epidemiology (including ethnic and cultural factors), developmental course, comorbidity, and etiology. Only one of the 40 contributing authors (Dr. Zeanah) has a medical degree, but the authors have nevertheless incorporated much of current understanding from neuropsychiatry (neurophysiology, neuroanatomy, and neurochemistry, in addition to neuropsychology) and genetics. This is a synthesis of multidisciplinary research. Assessment and treatment of these disorders are addressed in separate volumes, but it is unusual (and artificial) for authors of a review chapter to exclude these issues, especially so in the case of assessment and measurement; what we know about a disorder depends first and foremost on the definition of our terms. One of the prevalent themes throughout the book is the fuzzy and changing boundaries of our categorical definitions, our pragmatic desire to use discrete pigeonholes to describe extraordinarily complex and dynamic phenomena, and the difficulty in applying criteria based primarily on adult disorders to adolescents, children, and even infants. The ambivalent stance toward DSM is evident and appropriate. The problem of clear definition of terms and thresholds seems most apparent in the chapter on child maltreatment, when discussing findings on the psychosocial consequences of “maltreatment” without specifying the type or severity of abuse and neglect. As in most compilations, the text is uneven. In some chapters, the references are so profuse that the act of reading the material presented becomes difficult due to the constant parenthetical interruptions; at other times, I found myself engrossed and even deeply affected by the authors, as in the chapter on PTSD. However, it did not seem that this variability reflected differences in the styles or expertise of the authors, but differences in the material itself, its subject matter and the volume of research to be presented. At all times, the material is accessible to trainees as well as to experienced clinicians. The chapters concerning autistic spectrum disorders and mental retardation are particularly noteworthy. The former details the expansion of this category, while the latter describes the political aspects of redefinitions. Including a chapter on social withdrawal is well justified in the text. There are some weaknesses: the chapter on childhood mood disorders is not short but devotes a scant four-plus pages to bipolar disorder, failing to do justice to the current controversy surrounding this diagnosis. The section on develop-
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 43:4, APRIL 2004
BOOK REVIEWS
mental disorders offers nothing on the subject of language/communication disorders, which seems a serious oversight. The final chapter on health-related disorders is overly ambitious and inclusive, offering a bird’s-eye view of the scope of these disorders yet unable to provide the detail of other chapters. Fortunately, Dr. Mash and his colleagues are planning new editions of the other two volumes over the next 2 years. This is a very good thing: as other major trilogies (Matrix, Terminator, and Lord of the Rings) were completed last year, we desperately need another one to foster a sense of hope, excitement, and anticipation. And at the current rate of research in child psychopathology, this series by Drs. Mash, Barkley, and Terdal is destined to become the Star Wars of child psychopathology. Jeffrey Wahl, M.D. Medical College of Ohio Toledo DOI: 10.1097/01.CHI.0000111369.94169.8f Edwards JH (1998), Child psychopathology (review). Psychiatr Serv 49:256 Mash EF, Barkley RA (1998), Treatment of Childhood Disorders, 2nd ed. New York: Guilford Mash EJ, Terdal LG (1997), Assessment of Childhood Disorders, 3rd ed. New York: Guilford Sexson S (1998), Child psychopathology (review). J Am Acad Child Adolesc Psychiatry 37:199–220
Bipolar Disorder in Childhood and Early Adolescence. Edited by Barbara Geller and Melissa DelBello. New York: Guilford Press, 2003, 342 pp., $40.00 (hardcover). Bipolar Disorder in Childhood and Early Adolescence is advertised as a “state-of-the-science review of knowledge in this area, covering all aspects of theory, research, and practice” [inside back cover]. One third of the 34 contributors are from Washington University in St. Louis, although 15 institutions are represented in the work. The assertion that “leading clinical and basic science researchers share findings from established research programs, weigh in on methodological issues and controversies, and highlight essential questions that are still unaddressed” (ibid) supports the further contention that this is the first comprehensive text on the topic. The intended audience includes child and adolescent psychiatrists, pediatricians, family practitioners, psychologists, and other ancillary practitioners who see this population of youngsters. The book is divided into three sections. Chapters 1 through 4 focus on the diagnosis, natural history, and longitudinal course of the disorder. Chapters 4 through 11
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 43:4, APRIL 2004
cover neurobiology and genetics. The remainder of the book is concerned with treatment issues. In spite of some very valuable material, this book does not measure up to its billing. A multitude of factors prevent it from fulfilling its goals, not the least of which is the current state of the science regarding this disorder. There is not very much science available to review. Attempts to fill in gaps of knowledge lead to a book that is often jumbled and patchy, rather than comprehensive and cohesive. Chapters are often reports of a specific research study—for instance, the first chapter, on epidemiology and suicidal behavior, is in fact a summary of part of the Oregon Adolescent Depression Project. The chapter on psychotherapy with children with bipolar disorder is a description of a specific child group therapy program that was developed as part of a larger multifamily psychoeducational program for families of preadolescent children with mood disorders. Since preliminary studies of the efficacy of this program were reported elsewhere, this chapter contains just a description of the program. Some of the chapters do not contain information of direct relevance to the topic of the book. For example, chapter 10, on sleep and other biological rhythms, looks at the adult literature because of the lack of available literature in children and adolescents. The applicability of adult work to the younger population is highly speculative, especially given the very different presentations of bipolar disorder in these different age groups. In addition, since there is so little literature on sleep disorders in adults with bipolar disorder, the literature on sleep disorders in adult depression is presented instead. Similarly, the chapter on neuroimaging focuses on a hypothetical connection between the ability to recognize facial affect and bipolar disorder, and on a review of findings in adults with bipolar disorder. The chapter on affective neuroscience and pathophysiology of bipolar disorder seems premature, as very little work in this field has been done with humans or clinical populations. Some hypotheses have been generated with regard to children with bipolar disorder, but it seems too early to develop studies in this population. The hypotheses about the role of NMDA receptor hypofunction in idiopathic psychotic disorders in chapter 6 are fascinating but so conjectural that the placement of this chapter in this book with its stated subject matter, goals, and audience seems hard to justify. Chapters on pervasive developmental disorders and bipolar disorder in children and on the immune system and bipolar disorder are not convincing in their basic assertions. For example, there is a lack of substantiation of the claim that there is a significant comorbidity between disorders in the autistic spectrum and bipolar disorder. The works cited, as presented in this chapter, do not explore the possible 501
Child Psychopathology, 2nd Edition. Edited by Eric J. Mash, Ph.D., and Russell A. Barkley, Ph.D. New York: Guilford Press, 2003, 802 pp., $70.00 (hardcover). When published in 1996, the first edition of Child Psychopathology completed a trilogy of work edited by Dr. Mash and his coeditors, Dr. Barkley and Dr. Terdal. At the time it was described as “concise yet comprehensive, historical yet timely” (Sexson, 1998) and potentially “a classic in its field” (Edwards, 1998). While the last to be published, it stood conceptually as the first of the three, establishing the history and knowledge base of numerous psychopathological disorders of childhood and adolescence, and it was followed each year with new, up-to-date revisions of the previous two works, Assessment of Childhood Disorders (Mash and Terdal 1997) and Treatment of Childhood Disorders (Mash and Barkley, 1998). But as noted in the preface, “research in child, adolescent, and developmental psychopathology continues to flourish, even more so than when the first edition of this text was published” (p. xi), and only 7 years later, Dr. Mash and colleagues are undertaking the herculean labor of new editions of these three works, starting with the second edition of Child Psychopathology. Is this necessary? Yes. But is this a trivial revision? I think not: roughly 40% of the references in this second edition date from these past 7 years, and the book has expanded from 650 pages to 802. Despite the title, the volume addresses psychopathology from birth through adolescence. The structure of the book is identical to that of the first edition (17 chapters in five sections). The introductory section and its single chapter on the developmental systems perspective—the longest in the book—is required reading despite the fact that a volume like this is more likely to be read as a reference than cover to cover. Drs. Mash and Dozois take on issues of the continuity, stability, and validity of diagnostic categories; this is a perspective necessary to appreciate the subsequent chapters fully. The remaining sections are behavior disorders (ADHD, conduct and oppositional defiant disorders, and adolescent substance abuse disorders), emotional and social disorders (mood disorders, anxiety disorders, PTSD, social withdrawal), developmental and learning disorders (autistic spectrum disorders, childhood-onset schizophrenia, mental retardation, learning disabilities), infants and children at risk (disorders of infancy and toddlerhood, child maltreatment), and eating disorders and health-related disorders. The chapter on tic disorders from the previous edition has been replaced by the chapter on substance abuse. The structure of
500
Assistant Editor: Andrés Martin, M.D., M.P.H.
these chapters typically proceeds from a description of core behaviors, symptoms, and deficits through a brief historical perspective, a discussion of existing criteria, epidemiology (including ethnic and cultural factors), developmental course, comorbidity, and etiology. Only one of the 40 contributing authors (Dr. Zeanah) has a medical degree, but the authors have nevertheless incorporated much of current understanding from neuropsychiatry (neurophysiology, neuroanatomy, and neurochemistry, in addition to neuropsychology) and genetics. This is a synthesis of multidisciplinary research. Assessment and treatment of these disorders are addressed in separate volumes, but it is unusual (and artificial) for authors of a review chapter to exclude these issues, especially so in the case of assessment and measurement; what we know about a disorder depends first and foremost on the definition of our terms. One of the prevalent themes throughout the book is the fuzzy and changing boundaries of our categorical definitions, our pragmatic desire to use discrete pigeonholes to describe extraordinarily complex and dynamic phenomena, and the difficulty in applying criteria based primarily on adult disorders to adolescents, children, and even infants. The ambivalent stance toward DSM is evident and appropriate. The problem of clear definition of terms and thresholds seems most apparent in the chapter on child maltreatment, when discussing findings on the psychosocial consequences of “maltreatment” without specifying the type or severity of abuse and neglect. As in most compilations, the text is uneven. In some chapters, the references are so profuse that the act of reading the material presented becomes difficult due to the constant parenthetical interruptions; at other times, I found myself engrossed and even deeply affected by the authors, as in the chapter on PTSD. However, it did not seem that this variability reflected differences in the styles or expertise of the authors, but differences in the material itself, its subject matter and the volume of research to be presented. At all times, the material is accessible to trainees as well as to experienced clinicians. The chapters concerning autistic spectrum disorders and mental retardation are particularly noteworthy. The former details the expansion of this category, while the latter describes the political aspects of redefinitions. Including a chapter on social withdrawal is well justified in the text. There are some weaknesses: the chapter on childhood mood disorders is not short but devotes a scant four-plus pages to bipolar disorder, failing to do justice to the current controversy surrounding this diagnosis. The section on develop-
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 43:4, APRIL 2004
BOOK REVIEWS
mental disorders offers nothing on the subject of language/communication disorders, which seems a serious oversight. The final chapter on health-related disorders is overly ambitious and inclusive, offering a bird’s-eye view of the scope of these disorders yet unable to provide the detail of other chapters. Fortunately, Dr. Mash and his colleagues are planning new editions of the other two volumes over the next 2 years. This is a very good thing: as other major trilogies (Matrix, Terminator, and Lord of the Rings) were completed last year, we desperately need another one to foster a sense of hope, excitement, and anticipation. And at the current rate of research in child psychopathology, this series by Drs. Mash, Barkley, and Terdal is destined to become the Star Wars of child psychopathology. Jeffrey Wahl, M.D. Medical College of Ohio Toledo DOI: 10.1097/01.CHI.0000111369.94169.8f Edwards JH (1998), Child psychopathology (review). Psychiatr Serv 49:256 Mash EF, Barkley RA (1998), Treatment of Childhood Disorders, 2nd ed. New York: Guilford Mash EJ, Terdal LG (1997), Assessment of Childhood Disorders, 3rd ed. New York: Guilford Sexson S (1998), Child psychopathology (review). J Am Acad Child Adolesc Psychiatry 37:199–220
Bipolar Disorder in Childhood and Early Adolescence. Edited by Barbara Geller and Melissa DelBello. New York: Guilford Press, 2003, 342 pp., $40.00 (hardcover). Bipolar Disorder in Childhood and Early Adolescence is advertised as a “state-of-the-science review of knowledge in this area, covering all aspects of theory, research, and practice” [inside back cover]. One third of the 34 contributors are from Washington University in St. Louis, although 15 institutions are represented in the work. The assertion that “leading clinical and basic science researchers share findings from established research programs, weigh in on methodological issues and controversies, and highlight essential questions that are still unaddressed” (ibid) supports the further contention that this is the first comprehensive text on the topic. The intended audience includes child and adolescent psychiatrists, pediatricians, family practitioners, psychologists, and other ancillary practitioners who see this population of youngsters. The book is divided into three sections. Chapters 1 through 4 focus on the diagnosis, natural history, and longitudinal course of the disorder. Chapters 4 through 11
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 43:4, APRIL 2004
cover neurobiology and genetics. The remainder of the book is concerned with treatment issues. In spite of some very valuable material, this book does not measure up to its billing. A multitude of factors prevent it from fulfilling its goals, not the least of which is the current state of the science regarding this disorder. There is not very much science available to review. Attempts to fill in gaps of knowledge lead to a book that is often jumbled and patchy, rather than comprehensive and cohesive. Chapters are often reports of a specific research study—for instance, the first chapter, on epidemiology and suicidal behavior, is in fact a summary of part of the Oregon Adolescent Depression Project. The chapter on psychotherapy with children with bipolar disorder is a description of a specific child group therapy program that was developed as part of a larger multifamily psychoeducational program for families of preadolescent children with mood disorders. Since preliminary studies of the efficacy of this program were reported elsewhere, this chapter contains just a description of the program. Some of the chapters do not contain information of direct relevance to the topic of the book. For example, chapter 10, on sleep and other biological rhythms, looks at the adult literature because of the lack of available literature in children and adolescents. The applicability of adult work to the younger population is highly speculative, especially given the very different presentations of bipolar disorder in these different age groups. In addition, since there is so little literature on sleep disorders in adults with bipolar disorder, the literature on sleep disorders in adult depression is presented instead. Similarly, the chapter on neuroimaging focuses on a hypothetical connection between the ability to recognize facial affect and bipolar disorder, and on a review of findings in adults with bipolar disorder. The chapter on affective neuroscience and pathophysiology of bipolar disorder seems premature, as very little work in this field has been done with humans or clinical populations. Some hypotheses have been generated with regard to children with bipolar disorder, but it seems too early to develop studies in this population. The hypotheses about the role of NMDA receptor hypofunction in idiopathic psychotic disorders in chapter 6 are fascinating but so conjectural that the placement of this chapter in this book with its stated subject matter, goals, and audience seems hard to justify. Chapters on pervasive developmental disorders and bipolar disorder in children and on the immune system and bipolar disorder are not convincing in their basic assertions. For example, there is a lack of substantiation of the claim that there is a significant comorbidity between disorders in the autistic spectrum and bipolar disorder. The works cited, as presented in this chapter, do not explore the possible 501