Handbook of treatment of mental disorders in childhood and adolescence

248 in later years but “is an etiologic factor in some of the most common and least understood psychiatric disorders.” According to one study, half of a series of hyperactive children had later emotional problems that interfered with their social adaptation in general. Of practical importance is that many of these patients respond to drugs of amphetamine-like action. Favorable response to other drugs is also described (i.e., imipramine, amitriptyline, diphenylhydantoin, carbamazepine, lithium, and phenothiazine). Given the controversial nature of MBD even in children, the concept is even more open to controversy when applied to adults. The syndrome or group of syndromes overlaps with schizophrenia, the borderline states, epileptic disorders, personality disorders, and even mental retardation; the therapeutic responses are far from specific or reliable and supporting data are open to other interpretations. One gets the impression, to paraphrase Pirandello that we have a group of facts in search of a theory; and it may well be that in the long run another explanation will be found for the clustering of the reported findings and the puzzling pattern of therapeutic responses (and nonresponses) that are described. Yet one must remember that this was essentially a brainstorming session, and while the concepts are not well defined, the cases do correspond to what is seen in ordinary clinical practice. Indeed, the case reports were so clear that I for one wished that there had been more. In general, the authors at the symposium based their work on a syndrome (or syndromes) characterized by (I) a family history of a spectrum of disorders of the MBD class, (2) a history of childhood MBD in the proband, (3) the presence of such clinical findings as impulsiveness, emotional overreaction, (4) short attention span, (5) easy distractibility, (6) poor selfimage, (7) learning problems and their derivatives, (8) difficulty in spatial orientation (getting lost when driving), (9) positive reaction to stimulant drugs, and (10) the presence of soft neurological signs and psychological findings of similar significance. This book is not for those who demand a fully organized logical theory ready for didactic presentation. It will be of interest to those who wish to consider another approach to understanding and treating puzzling and atypical cases. It may even be of practical use provided that the reader is willing to give the text the careful study that such an application requires.-Henry Brill, M.D.

BOOK REVIEWS Handbook of Treatment of Mental Disorders in Childhood and Adolescence. Edited by Benjamin B. Wolman. Englewood Cliffs, Prentice Hall, 1978. The appearance of this book is important for the field of child psychiatry, as presently there is no text that attempts to address the issues involved in the treatment of childhood and adolescent mental disorders so extensively. The book is divided into two sections: the first is a description of the main approaches in dealing with disturbed adolescents and children; the second describes specific disorders and syndromes and the appropriate therapeutic techniques. In Section 1 a serious omission occurs in that the treatment modality of group psychotherapy is not addressed at all. The reason for such an omission is mystifying. However, because of it a large gap in any overall attempt to discuss main approaches exists. Especially today, group psychotherapy with children and adolescents has assumed a great importance and needs thorough discussion. Another important general issue is not included in this section. In Dr. Schemer’s chapter, he gives an excellent discussion for indications and contraindications for family therapy; unfortunately, this is not adequately dealt with anywhere else. A discussion of the reasons why individual psychotherapy may be chosen in preference to group, or psychoanalysis as opposed to psychotherapy, etc., are not really indicated. Such a chapter explaining what the general indications and contraindications for each of the general modes of treatment are would be invaluable to the readers. This absence, coupled with that of a chapter on group seriously compromises the psychotherapy, editor’s stated goal of a comprehensive, objective, up-to-date presentation of all major treatment methods currently applied in childhood and adolescent mental disorders. As with any book that has many authors, the quality of the chapters varies. In Dr. Solomon’s chapter. great stress is placed on medication and dosages. However, for a book on treatment, a detailed discussion of the special techniques needed in psychotherapy with the minimal brain dysfunction (MBD) child and strategies useful in engaging and working with the parents of these children is essential. Without such a discussion the approach to the child with MBD and his family is piecemeal and often ineffective. Dr. LaVietes’s chapter on “Mental Retardation: Psychological Treatment” is ex-

BOOK REVIEWS cellent and could serve as a paradigm for anyone writing on a particular treatment with a specific population. She gives detailed technical comments that are often the essence of treatment; hers meets the editor’s criteria of being current and comprehensive. Dr. Maloney’s chapter is also very good. Not only does it deal with behavior modification and its use in antisocial behavior, but also the legal and ethical is-

249 sues that trouble many today. Other excellent chapters include those written by Drs. Campbell, Scharfman, Schemer, Schroeder, Green, and Kestenbaum. Even though the book has certain flaws, it has many excellent qualities and the editors should be complimented for their attempt.--John D. O’Brien,

M.D.