BOOK REVIEWS
natural extension of describing development. However, most descriptions appeared superficial, particularly in the area of the major psychiatric syndromes. Although this edition could have been updated much more significantly, this book has the merit of being thematically broad. A few chapters, such as the one by Hauser and Greene, represent a meaningful contemporary contribution. Unfortunately, the large amount of overlap between chapters frequently leaves the reader with an overwhelming sense of repetition. Various editorial strategies could have helped the reader to make a synthesis, such as including a more elaborated introduction, promoting multiple authorship, cross-referencing chapter, and including summaries. Martin St-Andre, M.D., F.R.C.P.(e) Research Fellow Brown University School of Medicine Providence, Rhode Island
Refugee Children: Theory, Research, and Services. Edited by Frederick L. Ahearn, [r., D.S.W., and Jean L. Athey, Ph.D., Baltimore: The Johns Hopkins Press, 1991, 230 pp., $40 (hardcover). The reader of this volume is presented with its relevance in the opening sentence, which notes that the world's refugee population increased 52.5% between 1984 and 1989 to an estimated 15.1 million persons, and that nearly half (about 7.5 million) of those were children. The remainder of the volume is aimed at describing how children react to a variety ofrefugee experiences;what developmental, health, and mental health problems potentially derive from refugee status; how children attempt to adapt and cope in the face of such circumstances; and what intervention strategies might effectively mitigate against potentially adverse consequences and/ or facilitate adaptation to the refugee experience. The volume is arranged with three major sections: Theoretical Overviews, Research Studies, and Service and Treatment Issues. There are three or four chapters to each section, each chapter being contributed by a different author(s). The volume flows logically, is generally quite readable, and a common thread of purpose is discernible throughout. At times, the introductory sections and literature reviews of related chapters are a bit redundant, although this would be difficult to avoid given the relatively sparse empirical literature regarding children and the refugee experience. In general, however, the chapters augment and facilitate one another, and the reader finishes the volume having vicariously visited the experience of refugee children and families, and having done so in a developmentally sensitive framework. The volume avoids a pitfall potential to such efforts, namely, that the scholarly focus on catastrophic international events be overwhelmed by social and political foci. The reader does experience the horror of the Pol Pot Khmer Rouge rule of Cambodia, the years of related oppression in much of the rest ofSoutheast Asia, and the trauma ofthe political instability
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and civil war that has plagued Central America, particularly El Salvador in recent years. One is reminded, however, that these "push" factors (those which prompt a person to flee danger or oppression) are counterbalanced within the larger refugee population by those factors which "pull" (the opportunity for educational, vocational, economic, and lifestyle advancement). Those motivated by the former may be viewed as "refugees," whereas those motivated by the latter are more likely to be termed "immigrants" within the larger resettlement community. Nonetheless, these "predeparture" motives are but one phase in the overall refugee experience. In addition, the process of resettlement includes phases of flight, firstasylum, and settlement, each of which poses characteristic stresses and challenges to the refugee child and family. Although the findings of the authors are largely predictable, they serve to suggest the biopsychosocial model be expanded to a biopsychosociocultural model and to remind the clinician of the constant need for cultural sensitivity in working with refugee children and families. The child's response fO the refugee experience is founded on a biologically based endowment or temperament, which bestows both individual vulnerabilities and coping skills.Whereas trauma, loss, and deprivation predictably complicate outcome for the child, family integration, cultural continuity, and social and community support may serve to buffer the adverse effects of the child's resettlement experiences. The reader is reminded repeatedly that separation from parents is even more stressful to refugee children than is the experience of trauma itself. The impact on the child of refugee status is not limited to direct stresses but includes indirect stresses as well. The disorganizing effectsofresettlement on parents may undermine their parental strengths and exacerbate their parental deficiencies. Insofar as the process of acculturation tends to progress more rapidly among children than among their parents, traditional roles and boundaries may become dissolved, disrupted, or reversed. Likewise, this more rapid acculturation among children may be viewed by parents as a repudiation of traditional family and cultural values, thus creating another source of conflict between parent and child. Neither do the stresses of refugee status on the child occur in a developmental vacuum. Physical injury, malnutrition, and illness may all underpin developmental pathology in refugee youth. Abuse, neglect, and other forms of traumatic experience also may contribute to developmental deviation. Identity formation and consolidation may be particularly complicated among refugee youth insofar as they are called on both to acculturate within the dominant culture and to enculturate within their traditional, native culture. Racism, prejudice, discrimination, and harassment are both common to the refugee experience and detrimental to the process of development. The authors close with reminders that refugee children represent a special population with unique treatment needs and service-delivery requirements. Bilingual and bicultural staff are as essential as clinically trained staff. Traditional methods of healing must be integrated with conventional
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 33:1, JANUARY 1994
BOOK REVIEWS
health care techniques. Linkages to the refugee community, as well as among the component parts of the human services system are essential. The full spectrum of services is necessary, and such features as accessibility, flexibility, and affordability must be provided. Although such a system is, by definition, cost intensive, the cost may still be less than that of failing to provide such a system, at least in terms of human adaptation and development. Therein may lie the greater applicability of this volume. Although operationalized around the experiences of refugee children and families, it is in a broader context a study of the adaptation of survivors. Many, perhaps most, of our patients are survivors of one form or another. Often, that which we respect most about them is their remarkable resilience. In fact, was it not the indefatigable and indomitable spirit of children that drew many of us to our respective professions? The reader who responds affirmatively will find this volume of interest. Donald W. Bechtold, M.D. Assistant Professor of Psychiatry University of Colorado School of Medicine Denver, Colorado
Guidebooks for Parents, Briefly Noted The Journal recently received several volumes that provide specific resources and guides for parents. No attempt is made here to critically review these works. Rather, we hope Journal readers may be more interested in knowing of their existence so they may undertake their own critical review if and when necessary. Charles H. Hart has compiled a source book for parents who have an autistic child: A Parent's Guide to Autism, New York: Simon and Schuster Inc., 1993, 125 pp., $9.00 softcover. Some of the questions this book discusses are: Are all people with autism alike? If my child scores low on an IQ test, is he/she autistic? Is autism caused by the parents, and could we have done anything to prevent it? If autism is a birth defect, why does it take years for the effects to show up? Chapters on education and treatment also are provided. A Guide to Mental Retardation by Mark McGarrity (New York: Crossroad Publishing Company, 1993,264 pp., $29.95, hardcover) desires to be a comprehensive resource for parents, teachers, and helpers of the mentally retarded. The book is organized along developmental lines. After a historical introduction, chapters on infancy, childhood, adulthood, etc. follow. There is an appendix discussing the medicaid waiver and excepts from public law as they affect the retarded. Caring for Kids with Special Needs: Residential Programs for Children andAdolescents(Princeton, NJ: Peterson's News,
J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 33:1, JANUARY 1994
481 pp., $89.95, hardcover) is a resource volume intended to help parents and professionals find residential facilities of all types that offer treatment to young people (aged 18 years and under) with emotional, cognitive, and substance-abuse disorders. Facilities include drug and alcohol recovety centers, boarding schools, psychiatric hospitals, wilderness programs, camps, and general hospitals with psychiatric units. Some 800 facilities are described. The Children's National Medical Center under the direction of David Mrazek, M.D., William Garrison, Ph.D. and Laura Elliott has published The A to Z Guide to Your Child's Behavior (New York: G. P. Putnam's Sons, 352 pp., $14.95, softcover). This volume provides a reference to more than 200 of the most common behavioral and developmental stages children experience from birth to 12 years old. Each entry (such as biting, moodiness, bed wetting, etc.) gives a brief description of the behavior, current expert opinions, and an overview to the solutions of problems. The book attempts to fill a gap among parenting books that teach principles of parenting but neglect to give specificsuggestions and strategies for addressing particular problems. Testing and Your Child by Virginia E. McCullough (New York: Plume Books, 334 pp., $12.00, softcover) lists about 150 of the most common medical, educational, and psychological tests given to children and adolescents. The author attempts to explain what each test seeks to establish and gives a description of the procedures involved, including how the test is administered and by whom, what the test measures (and what it does not), what (if any) preparation is required, how the test is scored, how to evaluate the results, and what follow-up testing might be recommended. Mixed Feelings: Love, Hate, Rivalry and Reconciliation Among Brothers and Sisters, by Francine Klagsbrun (New York: Bantam Books, 428 pp., $22.50, hardcover) explores for both parents and professionals alike the sibling bond and the imprint that sibling experience leaves on adult lives. Issues of parental favoritism, birth order, competitiveness, scapegoats, family secrets, and sibling illness/death are some of the issues covered in this volume. The author conducted in-depth interviews on 122 subjects and used a survey of 272 additional subjects in compiling the data for the work. Finally, What to do Until the Grown Up Arrives: The Art and Science ofRaising Teenagers, by Joseph Novello, M.D. (Seattle: Hogrefe and Huber Publishers, 349 pp., $24.50, hardcover) strives to help parents find answers to some current parenting dilemmas. The book is arranged in an annotated question-and-answer format. The material is organized by age groups and by type of concern, such as school, sexual development, siblings, drugs, so that information can be easily accessed. The intention is to provide parents with usable and accurate advice. William H. Sack, M.D.
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