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Skills Training for Children With Behavior Disorders: A Parent and Therapist Guidebook
BOOK REVIEWS
in the field of childhood antisocial behavior and aggression. Decades of research in criminology, sociology, ethology, psychology. and psychiatry have produced voluminous research; however, authors in the respective fields rarely refer to another's work or use another's findings. This tension has increased with the recent addition of several psychiatric diagnoses (oppositional defiant disorder, conduct disorder, and antisocial behavior) that imply the presence of psychopathology as the internal force of aggression and related antisocial behaviors, diverting attention from ecologically driven antisocial behavior and criminological concepts. This recent development has not gone uncriticized, but scientist-clinicians feel increasingly justified in pursuing this conceptualization of antisocial behavior, as evidence accumulates that internal factors-whether genetic, constitutional. or environmentally induced-trigger and perpetuate such behaviors. At a time like this, this volume is a welcome addition co our body of knowledge.The volume contains the proceedings of a unique conference sponsored by the Academy in the fall of 1995 . taking an integrated approach to aggression . The authors are a biologist with special interest in the hormonal and neurotransmitter aspects of aggression and a clinician with special interests in the forensic aspects of juvenile antisocial behavior. Both are well known in the field and have a distinguished research record. Russo provides an excellent opening chapter in which the problem of integrating wide ranging findings is attacked with considerable erudition, bypassing the outdated "nature versus nurture" debate. Ferris provides an integrative chapter that seeks valiantly to handle the exciting range of findings reported. The book is divided into seven sections: biological correlates of aggression; serotonin, stress, and impulsivity; psychosocial interactions , neuronal plasticity and behavior; personality and aggression: high risk children; psychosocial interventions and aggression; afterwords; and a special section that is a reprint of the poster presentation. As can be expected from a multiauthor volume, the contributions are not of even quality, but most of the major research groups in the field in the United States and Canada are represented and most of their contributions fulfill expectations. There are some notable absences, however: Rutter, Farrington, Dodge, Borduin, just to mention a few; therefore, the book is not a complete volume, but no doubt organizational detail prevented such. The tone of all of the contributions is balanced and cautious, reflecting the general tone of the conference. Much effort is dedicated to cross-referencing findings from different fields. This is not alwayssuccessful, but this is more reflective of the absence of suitable theoretical models to integrate the diversity of findings. One would hope that conferences such as this one and this volume will provide the impetus and stimulation for the generation of such models.
1476
The format of the contributions variesgreatly. A discussion chapter is provided only after sections 1 and 4, and I thought it highly desirable to have similar chapters after all of the other sections. A list of authors and their affiliations also would have been useful. Who will benefit from this compendium? Clearly, it belongs in the library of any researcher in the field, clinical or basic, because it provides a summary of our knowledge at this time. The volume also will be helpful co those who work clinically with aggressive and antisocial children and adolescents. because it summarizes the state of the art and identifies several promising area of research that should be followed into the near future, such as the serotoninimpulsivity connection, aggression and attachment status, and abuse and its adverse long-term outcome mediators. Clinical intervention reports constitute a small part of the volume, reflecting our relative lesseractivity in this area, so it is to be expected that the general clinician will most likely turn elsewhere to update his or her knowledge. Also absent are forensic contributions. so the forensic expert will not be satisfied. The volume is quite advanced in its reporting, so most trainees will find the reports too detailed for the acquisition of general knowledge. For those, however,with special interest in this subject, the book provides a rapid way to catch up co the seminal issues in the field. Overall, though, it is a welcome and needed addition to the library of those with a special interest in the subject. Hans Steiner, M.D. Professorof Psychiatry and Director of Training Division of Child Psychiatry and Child Development Stanford University School of Medicine. Palo Alto, CA
Skills Training for Children With Behavior Disorders: A Parent and Therapist Guidebook. ByMichtUl L. Bloomquist. Ntw York: Guilflrd Press, 1996, 272 pp., $29.95 (softCOVtr). Michael Bloomquist's new work provides a useful contribution for clinicians working with children who exhibit a wide range of externalizing problems. such as oppositionaliry, aggression , and attention deficit. He has written a "cookbook" in the best sense of the term. It is a volume with a coherent theoretical theme, i.e., cognitive-behavioral treatment , and offers a set of procedures, "recipes," that can be used separately or together in combination at the discretion of the "cook." The tone is optimistic and upbeat. A key assumption of the author is that "it is the parent who is in the best position to help the child and change the nature of the parent-child relationship" (p, x), By focusing on enhancing parental competencies as a part of the solution. Bloomquist
j. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 36 :10, OCTOBER 1997
BOOK REVIEWS
avoids the tendency to denigrate parents as the source of the problem. This text could be used easily in several ways. It could serve as an adjunct to pharmacological treatment, the session content of a behavioral family therapy approach , or tips for struggling parents from a therapist seeing a child in individual therapy. It would be useful for parents who find parenting classes unavailable and impractical or who just need help with a specific parenting task such as time out. Bloomquist states that the book could be used by parents without a therapist's help. but I am more skeptical. From a clinical training perspective, this work will address the neophyte clinician's concerns about what to actually do in a parent training session. Section 1 presents parents with brief definitions of the common behavior disorders. Common treatment modalities are explained as well. The second chapter of this section helps parents to conduct a self assessment, which explores 10 parent and child focus areas: parents' stress, parents' thoughts, parental involvement and positive reinforcement, family interactions. discipline related to compliance and rulefollowing in children. children's social behavior skills. children's social and general problem-solving skills, children's ability to cope with anger, children's ability to engage in selfdirected academic behavior, and children's emotional wellbeing and level of self-esteem. Parents assess themselves by rating several items for each topic. These topics comprise the array of skills most commonly addressed in the cognitivebehavioral treatment of children. Parents are encouraged to evaluate their scores and their own gut reaction to determine their initial focus. This exercise starts the process of encouraging parents to be active in choosing their own treatment. The chapters in the next two sections provide the treatment directions corresponding to these 10 focus areas.The chapters are written in a concise manner with brief definitions relatively free of theoretical jargon, short clinical vignettes, and direct suggestions written in outline form. Numerous handouts appear at the end of the chapters to aid in implementing various procedures. These handouts include information summaries, goal sheets, and data recording sheets. Guilford Press has graciously consented to give permission to copy these materials for clinical use. Section 5 provides information and suggestions for the therapists. Bloomquist places his theoretical and empirical review of the techniques in one of the last chapters. Although the chapter is a well-written summary of cognitive-behavioral treatment, its placement underscores Bloomquist's emphasis on practical interventions over conceptual framework. He also addresses relevant procedural issues such as dealing with resistance, training methods, and group versus family treatment. This work reflects the savvy of one who has been in the clinical trenches and maintains a broad, inclusive view of what works with children . He describes medication in
positive terms. He also acknowledges that some parents may not be ready for his form of intervention. A more subtle example of his savvy is found in his use of forms. I have found that parents often need coaching regarding how to start some of these activities. By giving examples of forms filled out by other parents. Bloomquist helps get things started for parents, reducing their resistance to participation. Bloomquist's guidebook represents a well thought out presentation of a set of cognitive-behavioral techniques that he makes eminently useable for the clinician, even one without an extensive behavioral background. In this era of managed health care, when the pressure is increasing for both efficiency and effectiveness, Bloomquist aids practitioners in providing a variety of directly useable techniques in one handy source. Robert J. Thompson, Ph.D. Assistant Clinical Professor, Child and Adolescent Psychiatry Oregon Health Sciences University, Portland
Children in Families: Research and Policy. Edited by Julia Brannen and Margaret O'Brien. London: Falmer Press, 1996, 224 pp., $24.95 (soficooer).
}. AM . ACAD. CHILD ADOLESC. PSYCHIATRY, 36:10, OCTOBER 1997
Books on sociology are not common reading fare for child and adolescent psychiatrists, but it is useful to read through a book such as this one from time to time to renew one's perspective on the social context of one's patients and their families. This book, assembled largely from contributions in Great Britain and focusing mainly on children in European countries, offers some interesting ways to view children in their families and to review the possible effects of certain social realities as they must inevitably be reflected in practice. This review will be more of a report of some of the significant provoking ideas. First, the contributors describe contemporary children and families, contrasting the "postmodern" child with the "modern" child; the child and "fractal identities"; children at work with and for their families; continuity and discontinuity in the transition from childhood to adulthood; demographic changes and effects on children in families; children's views of "family"; the economic situations of children in different countries; the recursive relationship between "family policy" and social structure; and the effects of social interventions and teenage pregnancies. Essayist Chris Jenks describes the postmodern child as a nostalgic object: the repository of adult experience that was protected and cared for, the adult's sentimental memory bank , and companion to the stressed adult. In contrast , the modern child, introduced by Rousseau, merited the devotion
1477
in the field of childhood antisocial behavior and aggression. Decades of research in criminology, sociology, ethology, psychology. and psychiatry have produced voluminous research; however, authors in the respective fields rarely refer to another's work or use another's findings. This tension has increased with the recent addition of several psychiatric diagnoses (oppositional defiant disorder, conduct disorder, and antisocial behavior) that imply the presence of psychopathology as the internal force of aggression and related antisocial behaviors, diverting attention from ecologically driven antisocial behavior and criminological concepts. This recent development has not gone uncriticized, but scientist-clinicians feel increasingly justified in pursuing this conceptualization of antisocial behavior, as evidence accumulates that internal factors-whether genetic, constitutional. or environmentally induced-trigger and perpetuate such behaviors. At a time like this, this volume is a welcome addition co our body of knowledge.The volume contains the proceedings of a unique conference sponsored by the Academy in the fall of 1995 . taking an integrated approach to aggression . The authors are a biologist with special interest in the hormonal and neurotransmitter aspects of aggression and a clinician with special interests in the forensic aspects of juvenile antisocial behavior. Both are well known in the field and have a distinguished research record. Russo provides an excellent opening chapter in which the problem of integrating wide ranging findings is attacked with considerable erudition, bypassing the outdated "nature versus nurture" debate. Ferris provides an integrative chapter that seeks valiantly to handle the exciting range of findings reported. The book is divided into seven sections: biological correlates of aggression; serotonin, stress, and impulsivity; psychosocial interactions , neuronal plasticity and behavior; personality and aggression: high risk children; psychosocial interventions and aggression; afterwords; and a special section that is a reprint of the poster presentation. As can be expected from a multiauthor volume, the contributions are not of even quality, but most of the major research groups in the field in the United States and Canada are represented and most of their contributions fulfill expectations. There are some notable absences, however: Rutter, Farrington, Dodge, Borduin, just to mention a few; therefore, the book is not a complete volume, but no doubt organizational detail prevented such. The tone of all of the contributions is balanced and cautious, reflecting the general tone of the conference. Much effort is dedicated to cross-referencing findings from different fields. This is not alwayssuccessful, but this is more reflective of the absence of suitable theoretical models to integrate the diversity of findings. One would hope that conferences such as this one and this volume will provide the impetus and stimulation for the generation of such models.
1476
The format of the contributions variesgreatly. A discussion chapter is provided only after sections 1 and 4, and I thought it highly desirable to have similar chapters after all of the other sections. A list of authors and their affiliations also would have been useful. Who will benefit from this compendium? Clearly, it belongs in the library of any researcher in the field, clinical or basic, because it provides a summary of our knowledge at this time. The volume also will be helpful co those who work clinically with aggressive and antisocial children and adolescents. because it summarizes the state of the art and identifies several promising area of research that should be followed into the near future, such as the serotoninimpulsivity connection, aggression and attachment status, and abuse and its adverse long-term outcome mediators. Clinical intervention reports constitute a small part of the volume, reflecting our relative lesseractivity in this area, so it is to be expected that the general clinician will most likely turn elsewhere to update his or her knowledge. Also absent are forensic contributions. so the forensic expert will not be satisfied. The volume is quite advanced in its reporting, so most trainees will find the reports too detailed for the acquisition of general knowledge. For those, however,with special interest in this subject, the book provides a rapid way to catch up co the seminal issues in the field. Overall, though, it is a welcome and needed addition to the library of those with a special interest in the subject. Hans Steiner, M.D. Professorof Psychiatry and Director of Training Division of Child Psychiatry and Child Development Stanford University School of Medicine. Palo Alto, CA
Skills Training for Children With Behavior Disorders: A Parent and Therapist Guidebook. ByMichtUl L. Bloomquist. Ntw York: Guilflrd Press, 1996, 272 pp., $29.95 (softCOVtr). Michael Bloomquist's new work provides a useful contribution for clinicians working with children who exhibit a wide range of externalizing problems. such as oppositionaliry, aggression , and attention deficit. He has written a "cookbook" in the best sense of the term. It is a volume with a coherent theoretical theme, i.e., cognitive-behavioral treatment , and offers a set of procedures, "recipes," that can be used separately or together in combination at the discretion of the "cook." The tone is optimistic and upbeat. A key assumption of the author is that "it is the parent who is in the best position to help the child and change the nature of the parent-child relationship" (p, x), By focusing on enhancing parental competencies as a part of the solution. Bloomquist
j. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 36 :10, OCTOBER 1997
BOOK REVIEWS
avoids the tendency to denigrate parents as the source of the problem. This text could be used easily in several ways. It could serve as an adjunct to pharmacological treatment, the session content of a behavioral family therapy approach , or tips for struggling parents from a therapist seeing a child in individual therapy. It would be useful for parents who find parenting classes unavailable and impractical or who just need help with a specific parenting task such as time out. Bloomquist states that the book could be used by parents without a therapist's help. but I am more skeptical. From a clinical training perspective, this work will address the neophyte clinician's concerns about what to actually do in a parent training session. Section 1 presents parents with brief definitions of the common behavior disorders. Common treatment modalities are explained as well. The second chapter of this section helps parents to conduct a self assessment, which explores 10 parent and child focus areas: parents' stress, parents' thoughts, parental involvement and positive reinforcement, family interactions. discipline related to compliance and rulefollowing in children. children's social behavior skills. children's social and general problem-solving skills, children's ability to cope with anger, children's ability to engage in selfdirected academic behavior, and children's emotional wellbeing and level of self-esteem. Parents assess themselves by rating several items for each topic. These topics comprise the array of skills most commonly addressed in the cognitivebehavioral treatment of children. Parents are encouraged to evaluate their scores and their own gut reaction to determine their initial focus. This exercise starts the process of encouraging parents to be active in choosing their own treatment. The chapters in the next two sections provide the treatment directions corresponding to these 10 focus areas.The chapters are written in a concise manner with brief definitions relatively free of theoretical jargon, short clinical vignettes, and direct suggestions written in outline form. Numerous handouts appear at the end of the chapters to aid in implementing various procedures. These handouts include information summaries, goal sheets, and data recording sheets. Guilford Press has graciously consented to give permission to copy these materials for clinical use. Section 5 provides information and suggestions for the therapists. Bloomquist places his theoretical and empirical review of the techniques in one of the last chapters. Although the chapter is a well-written summary of cognitive-behavioral treatment, its placement underscores Bloomquist's emphasis on practical interventions over conceptual framework. He also addresses relevant procedural issues such as dealing with resistance, training methods, and group versus family treatment. This work reflects the savvy of one who has been in the clinical trenches and maintains a broad, inclusive view of what works with children . He describes medication in
positive terms. He also acknowledges that some parents may not be ready for his form of intervention. A more subtle example of his savvy is found in his use of forms. I have found that parents often need coaching regarding how to start some of these activities. By giving examples of forms filled out by other parents. Bloomquist helps get things started for parents, reducing their resistance to participation. Bloomquist's guidebook represents a well thought out presentation of a set of cognitive-behavioral techniques that he makes eminently useable for the clinician, even one without an extensive behavioral background. In this era of managed health care, when the pressure is increasing for both efficiency and effectiveness, Bloomquist aids practitioners in providing a variety of directly useable techniques in one handy source. Robert J. Thompson, Ph.D. Assistant Clinical Professor, Child and Adolescent Psychiatry Oregon Health Sciences University, Portland
Children in Families: Research and Policy. Edited by Julia Brannen and Margaret O'Brien. London: Falmer Press, 1996, 224 pp., $24.95 (soficooer).
}. AM . ACAD. CHILD ADOLESC. PSYCHIATRY, 36:10, OCTOBER 1997
Books on sociology are not common reading fare for child and adolescent psychiatrists, but it is useful to read through a book such as this one from time to time to renew one's perspective on the social context of one's patients and their families. This book, assembled largely from contributions in Great Britain and focusing mainly on children in European countries, offers some interesting ways to view children in their families and to review the possible effects of certain social realities as they must inevitably be reflected in practice. This review will be more of a report of some of the significant provoking ideas. First, the contributors describe contemporary children and families, contrasting the "postmodern" child with the "modern" child; the child and "fractal identities"; children at work with and for their families; continuity and discontinuity in the transition from childhood to adulthood; demographic changes and effects on children in families; children's views of "family"; the economic situations of children in different countries; the recursive relationship between "family policy" and social structure; and the effects of social interventions and teenage pregnancies. Essayist Chris Jenks describes the postmodern child as a nostalgic object: the repository of adult experience that was protected and cared for, the adult's sentimental memory bank , and companion to the stressed adult. In contrast , the modern child, introduced by Rousseau, merited the devotion
1477