- Email: [email protected]
Diagnostic Assessment in Child and Adolescent Psychopathology
BOOK REVIEWS
ing tasks and assignments, and application and practice of newly acquired skills in increasingly anxiety-provoking situations” (pp. 253–254). All these techniques, along with working with the family, are discussed in detail with many illustrative therapy transcripts. In “Part IV. Special Populations and Topics,” James Varni, Anntette La Greca, and Anthony Spirito present CBT interventions for children with chronic health conditions. Sophisticated health-related quality-of-life instruments such as the Pediatric Quality of Life Inventory are presented which help guide clinicians in interventions. Cognitive-behavioral interventions for pain management, adherence to medical treatment plans, and problem-solving skills training are presented in detail. Grayson Holmbeck, Craig Colder, Wendy Shapera, Venette Westhoven, Laura Kenealy, and Anne Updegrove discuss CBT with adolescents. An overview of recent research on CBT with adolescents is presented. Biological, cognitive, and interpersonal factors are reviewed to provide a framework for understanding adolescent development and adjustment. Developmental psychology concepts relevant to adolescent CBT are developed and then integrated in the presentation of a case example of CBT. Thomas Ollendick and Neville King present the final chapter, “Empirically Supported Treatments for Children and Adolescents.” The authors review in detail the efficacy of psychosocial treatments for autism, depression, anxiety, phobias, ADHD, and oppositional/conduct problems. Criteria for determining whether the treatment is well established, probably efficacious, or experimental are clearly discussed. Interesting research assessing the effect of flexibility in the implementation of instructions and suggestions in manual-based CBT is discussed. Clinicians are encouraged to build on their established clinical skills, learn new skills, and know when to refer a patient to another treatment that may be more effective. I highly recommend the second edition of Child and Adolescent Therapy to any psychiatrist and anyone interested in the mental health of children and adolescents. It is fully revised and updated since the original publication in 1991 and would be useful to any reader who has the first edition. This volume nicely summarizes the major advances in the practice and research of CBT with youth, particularly over the past 9 years. Major advances in CBT with youth with anxiety and depression and excellent “how to” sections are well described in this second edition. CBT with youth with obsessivecompulsive disorder is not covered in great detail. The book by John March and Karen Mulle on this topic nicely complements Child and Adolescent Therapy.
Diagnostic Assessment in Child and Adolescent Psychopathology. Edited by David Shaffer, M.B., Christopher P. Lucas, M.B., and John E. Richters, Ph.D. New York: Guilford Press, 1999, 398 pp., $45.00 (hardcover).
Gilbert J. Custer, Jr., M.D. Austin, TX Member, Workgroup for Consumer Issues, AACAP
One of the most important advances in psychiatric research and clinical practice in the second half of the 20th century has been the emergence of a dynamic and uniform nosology based on research diagnostic criteria. Despite their shortcomings and lack of developmental sensitivity, by standardizing the definition of categorical diagnoses, the DSM and ICD systems have permitted the use of advanced scientific methods to study the epidemiology, pathophysiology, genetics, natural course, and response to treatment of psychiatric disorders. Universal acceptance of diagnostic criteria alone, however, is insufficient to ensure that all cases identified in either research or clinical settings do, in fact, have the same disorder. Equally important in the determination of “caseness” is the accuracy of assessment. As the authors of this well-edited book point out, the science of assessment is catching up with that of nosology as the result of technological advances in the use of standardized assessment instruments. With the notable exception of the assessment of preschool children, these advances include the use of computers and sophisticated scoring algorithms, the incorporation of measures of functional impairment, improvements in psychometric quality, the emergence of instruments tailored to more precise research questions, and more control over sources of bias. Organized into four sections, the book’s 13 chapters offer an exceptionally comprehensive and useful overview of the “state of the art” in child and adolescent assessment at the turn of the new century. The first section, concerning the assessment of general psychopathology, consists of separate chapters on respondentbased interviews (RBIs), interviewer-based interviews (IBIs), and behavior rating scales. Each approach has its benefits and disadvantages. For example, RBIs, such as the Diagnostic Interview Schedule for Children, are more easily standardized and computerized, cheaper to administer, and more suitable for large-scale screening than IBIs such as the Diagnostic Interview for Children and Adolescents (DICA) or the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) family of interviews. The DICA and KSADS, however, are much more flexible in dealing with responses of questionable validity and with atypical phenomena. Behavior rating scales have the advantage of ease of administration, the ability to use multiple informants, and the ability to compare subjects to normative samples, but are limited by low interinformant concordance, lack of information concerning onset and duration of symptoms, and vulnerability to a variety of biases. The first two chapters of this section,
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 0 : 5 , M AY 2 0 0 1
611
BOOK REVIEWS
“Respondent-Based Interviews” and “Interviewer-Based Interviews,” provide an excellent discussion of the evolution and dimensional nature of these types of measurement, pointing out how they can be understood to exist on a spectrum depending on degree of specification of questions, degree of definition of symptoms, and flexibility of questioning permitted. Of particular value to both researchers and clinicians, all three chapters also contain concise but thorough descriptions of the structure, administration, clinical features, and psychometric properties of most of the broad-band RBIs, IBIs, and behavior rating scales currently in use. The book’s second section consists of three chapters focusing on rating scales for specific areas of psychopathology: disruptive behavior problems, anxiety and mood disorders, and pervasive developmental and communication disorders. With respect to disruptive behavior disorders, the authors warn of the risk of using narrowly focused scales for diagnostic purposes because of the high rate of comorbidity. Also, as the chapter points out, there are advantages, disadvantages, and different problems of bias and distortion depending upon the scale being used, and upon whether it is a behavior rating or behavior observation scale. The authors review eight such scales in common use, pointing out their similarities and that their primary utility is measuring treatment effects. The chapter on scales for mood and anxiety disorders emphasizes the underlying concepts which should govern their use, viz., “what is useful and what works” (p. 131). Two anxiety and one depression measure are reviewed in detail, with briefer mention of several others. Unfortunately, two of the newer and quite promising anxiety measures (the Multidimensional Anxiety Scale for Children [MASC] and the Screen for Child Anxiety Related Emotional Disorders [SCARED]) are not included because of a paucity of research literature involving their use. The chapter on pervasive developmental and communication disorders begins with a good overview of autism and other pervasive developmental disorders, and then separately summarizes, with useful commentary, both dimensional and categorical interview and checklist instruments for autism and language disorders. All of the chapters in this section underscore the importance of the adjunctive use of standardized measures in the context of careful clinical assessment and, where appropriate, a multidisciplinary team approach. The third section of the book incorporates five chapters covering a range of special aspects of assessment: assessment of functional impairment, family history of psychiatric disorder, retrospective adult assessment of childhood psychopathology, translation and adaptation of diagnostic instruments for cross-cultural use, and the cultural, racial, and economic context of assessment. The chapter on impairment reemphasizes that measuring impairment, whether in terms of functional performance or level of subjective distress, is essential in deter-
mining “caseness” for both epidemiological and specific clinical purposes. The chapter goes on to review most of the instruments currently available and concludes that two, the Children’s Global Assessment Scale and the Columbia Impairment Scale, appear to be the most useful. The chapters on family history and retrospective assessment contain elegant discussions of the methodologies available and the challenges inherent in accessing these data. Similarly, the chapters on cross-cultural use of assessment instruments and cultural sensitivity in assessment present clear and thoughtful descriptions of the difficulties encountered when trying to attain “cultural equivalence” (p. 288) and to eliminate bias when standardized assessment moves beyond the original reference group or mainstream American culture. The final section, describing biological measures, is divided into chapters on sleep and neuroendocrine measures, and neurochemical measures. Both are excellent introductions to the complexities and methodological problems that confront researchers, as the brain basis of mental illness is uncovered for at least certain disorders. While little from either chapter is applicable for general clinical use, they convey the sense of excitement and anticipation of what is to come. Most of the chapters are well written, comprehensive, and packed with useful information. As can often occur with an edited, multiauthored compilation, some chapters contain repetitive descriptions and definitions. The chapter on anxiety and mood disorders contains much less practical information than most other chapters and focuses too much on the philosophy of assessment, and it is too extensive in describing just two scales which are of limited use. These are minor flaws, however, in an otherwise wonderful collection which, although it will certainly become at least partially obsolete in the face of the acceleration of discoveries in neurobiology, will remain of considerable value for many years.
612
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 0 : 5 , M AY 2 0 0 1
Robert Racusin, M.D. Department of Psychiatry Dartmouth Medical School Lebanon, NH
Treating Huckleberry Finn: A New Narrative Approach to Working With Kids Diagnosed With ADD/ADHD. By David Nylund. San Francisco: Jossey-Bass, 2000, 234 pp., $39.95 (hardcover). Do you remember Mark Twain’s Huckleberry Finn? Had you read it for the first time as a child and adolescent psychiatrist would you have enjoyed it as much? Every few years a book appears, usually authored by a psychiatrist, that dissects some larger-than-life figure and presents new insights into his or her behavior. The psychobiography genre has achieved
ing tasks and assignments, and application and practice of newly acquired skills in increasingly anxiety-provoking situations” (pp. 253–254). All these techniques, along with working with the family, are discussed in detail with many illustrative therapy transcripts. In “Part IV. Special Populations and Topics,” James Varni, Anntette La Greca, and Anthony Spirito present CBT interventions for children with chronic health conditions. Sophisticated health-related quality-of-life instruments such as the Pediatric Quality of Life Inventory are presented which help guide clinicians in interventions. Cognitive-behavioral interventions for pain management, adherence to medical treatment plans, and problem-solving skills training are presented in detail. Grayson Holmbeck, Craig Colder, Wendy Shapera, Venette Westhoven, Laura Kenealy, and Anne Updegrove discuss CBT with adolescents. An overview of recent research on CBT with adolescents is presented. Biological, cognitive, and interpersonal factors are reviewed to provide a framework for understanding adolescent development and adjustment. Developmental psychology concepts relevant to adolescent CBT are developed and then integrated in the presentation of a case example of CBT. Thomas Ollendick and Neville King present the final chapter, “Empirically Supported Treatments for Children and Adolescents.” The authors review in detail the efficacy of psychosocial treatments for autism, depression, anxiety, phobias, ADHD, and oppositional/conduct problems. Criteria for determining whether the treatment is well established, probably efficacious, or experimental are clearly discussed. Interesting research assessing the effect of flexibility in the implementation of instructions and suggestions in manual-based CBT is discussed. Clinicians are encouraged to build on their established clinical skills, learn new skills, and know when to refer a patient to another treatment that may be more effective. I highly recommend the second edition of Child and Adolescent Therapy to any psychiatrist and anyone interested in the mental health of children and adolescents. It is fully revised and updated since the original publication in 1991 and would be useful to any reader who has the first edition. This volume nicely summarizes the major advances in the practice and research of CBT with youth, particularly over the past 9 years. Major advances in CBT with youth with anxiety and depression and excellent “how to” sections are well described in this second edition. CBT with youth with obsessivecompulsive disorder is not covered in great detail. The book by John March and Karen Mulle on this topic nicely complements Child and Adolescent Therapy.
Diagnostic Assessment in Child and Adolescent Psychopathology. Edited by David Shaffer, M.B., Christopher P. Lucas, M.B., and John E. Richters, Ph.D. New York: Guilford Press, 1999, 398 pp., $45.00 (hardcover).
Gilbert J. Custer, Jr., M.D. Austin, TX Member, Workgroup for Consumer Issues, AACAP
One of the most important advances in psychiatric research and clinical practice in the second half of the 20th century has been the emergence of a dynamic and uniform nosology based on research diagnostic criteria. Despite their shortcomings and lack of developmental sensitivity, by standardizing the definition of categorical diagnoses, the DSM and ICD systems have permitted the use of advanced scientific methods to study the epidemiology, pathophysiology, genetics, natural course, and response to treatment of psychiatric disorders. Universal acceptance of diagnostic criteria alone, however, is insufficient to ensure that all cases identified in either research or clinical settings do, in fact, have the same disorder. Equally important in the determination of “caseness” is the accuracy of assessment. As the authors of this well-edited book point out, the science of assessment is catching up with that of nosology as the result of technological advances in the use of standardized assessment instruments. With the notable exception of the assessment of preschool children, these advances include the use of computers and sophisticated scoring algorithms, the incorporation of measures of functional impairment, improvements in psychometric quality, the emergence of instruments tailored to more precise research questions, and more control over sources of bias. Organized into four sections, the book’s 13 chapters offer an exceptionally comprehensive and useful overview of the “state of the art” in child and adolescent assessment at the turn of the new century. The first section, concerning the assessment of general psychopathology, consists of separate chapters on respondentbased interviews (RBIs), interviewer-based interviews (IBIs), and behavior rating scales. Each approach has its benefits and disadvantages. For example, RBIs, such as the Diagnostic Interview Schedule for Children, are more easily standardized and computerized, cheaper to administer, and more suitable for large-scale screening than IBIs such as the Diagnostic Interview for Children and Adolescents (DICA) or the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) family of interviews. The DICA and KSADS, however, are much more flexible in dealing with responses of questionable validity and with atypical phenomena. Behavior rating scales have the advantage of ease of administration, the ability to use multiple informants, and the ability to compare subjects to normative samples, but are limited by low interinformant concordance, lack of information concerning onset and duration of symptoms, and vulnerability to a variety of biases. The first two chapters of this section,
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 0 : 5 , M AY 2 0 0 1
611
BOOK REVIEWS
“Respondent-Based Interviews” and “Interviewer-Based Interviews,” provide an excellent discussion of the evolution and dimensional nature of these types of measurement, pointing out how they can be understood to exist on a spectrum depending on degree of specification of questions, degree of definition of symptoms, and flexibility of questioning permitted. Of particular value to both researchers and clinicians, all three chapters also contain concise but thorough descriptions of the structure, administration, clinical features, and psychometric properties of most of the broad-band RBIs, IBIs, and behavior rating scales currently in use. The book’s second section consists of three chapters focusing on rating scales for specific areas of psychopathology: disruptive behavior problems, anxiety and mood disorders, and pervasive developmental and communication disorders. With respect to disruptive behavior disorders, the authors warn of the risk of using narrowly focused scales for diagnostic purposes because of the high rate of comorbidity. Also, as the chapter points out, there are advantages, disadvantages, and different problems of bias and distortion depending upon the scale being used, and upon whether it is a behavior rating or behavior observation scale. The authors review eight such scales in common use, pointing out their similarities and that their primary utility is measuring treatment effects. The chapter on scales for mood and anxiety disorders emphasizes the underlying concepts which should govern their use, viz., “what is useful and what works” (p. 131). Two anxiety and one depression measure are reviewed in detail, with briefer mention of several others. Unfortunately, two of the newer and quite promising anxiety measures (the Multidimensional Anxiety Scale for Children [MASC] and the Screen for Child Anxiety Related Emotional Disorders [SCARED]) are not included because of a paucity of research literature involving their use. The chapter on pervasive developmental and communication disorders begins with a good overview of autism and other pervasive developmental disorders, and then separately summarizes, with useful commentary, both dimensional and categorical interview and checklist instruments for autism and language disorders. All of the chapters in this section underscore the importance of the adjunctive use of standardized measures in the context of careful clinical assessment and, where appropriate, a multidisciplinary team approach. The third section of the book incorporates five chapters covering a range of special aspects of assessment: assessment of functional impairment, family history of psychiatric disorder, retrospective adult assessment of childhood psychopathology, translation and adaptation of diagnostic instruments for cross-cultural use, and the cultural, racial, and economic context of assessment. The chapter on impairment reemphasizes that measuring impairment, whether in terms of functional performance or level of subjective distress, is essential in deter-
mining “caseness” for both epidemiological and specific clinical purposes. The chapter goes on to review most of the instruments currently available and concludes that two, the Children’s Global Assessment Scale and the Columbia Impairment Scale, appear to be the most useful. The chapters on family history and retrospective assessment contain elegant discussions of the methodologies available and the challenges inherent in accessing these data. Similarly, the chapters on cross-cultural use of assessment instruments and cultural sensitivity in assessment present clear and thoughtful descriptions of the difficulties encountered when trying to attain “cultural equivalence” (p. 288) and to eliminate bias when standardized assessment moves beyond the original reference group or mainstream American culture. The final section, describing biological measures, is divided into chapters on sleep and neuroendocrine measures, and neurochemical measures. Both are excellent introductions to the complexities and methodological problems that confront researchers, as the brain basis of mental illness is uncovered for at least certain disorders. While little from either chapter is applicable for general clinical use, they convey the sense of excitement and anticipation of what is to come. Most of the chapters are well written, comprehensive, and packed with useful information. As can often occur with an edited, multiauthored compilation, some chapters contain repetitive descriptions and definitions. The chapter on anxiety and mood disorders contains much less practical information than most other chapters and focuses too much on the philosophy of assessment, and it is too extensive in describing just two scales which are of limited use. These are minor flaws, however, in an otherwise wonderful collection which, although it will certainly become at least partially obsolete in the face of the acceleration of discoveries in neurobiology, will remain of considerable value for many years.
612
J . A M . A C A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 0 : 5 , M AY 2 0 0 1
Robert Racusin, M.D. Department of Psychiatry Dartmouth Medical School Lebanon, NH
Treating Huckleberry Finn: A New Narrative Approach to Working With Kids Diagnosed With ADD/ADHD. By David Nylund. San Francisco: Jossey-Bass, 2000, 234 pp., $39.95 (hardcover). Do you remember Mark Twain’s Huckleberry Finn? Had you read it for the first time as a child and adolescent psychiatrist would you have enjoyed it as much? Every few years a book appears, usually authored by a psychiatrist, that dissects some larger-than-life figure and presents new insights into his or her behavior. The psychobiography genre has achieved