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The 36-hour day: Caring at home for confused elderly people
BOOK REVIEWS
609
One shortcoming of the book is the lack of an overview chapter, scanning the entire field. Such an overview would have added considerably to its value, particularly in view of the fact that it is the inaugural volume launching a new series. It would also have helped the non-specialist reader to place in perspective the data and ideasin the different chapters. On the whole, this is a very welcome series, and its first volume a suiliciently stimulating one to make the interested reader look forward to the succeeding publications. P.
R. J. MCMAHON and R. DE V. PETERS(Eds): Childhood Disorders: Behavioral-Developmental New York (1985). Pages xii + 277. S30.00.
DE SILVA
Approaches. Brunner/Mazel,
This fascinating volume is one in a continuing series of publications which have grown out of the annual Banff International Conferences on Behavior Mod&ation. The main contributors to the conference are required to write a chapter, separate from their conference contributions, but around the same theme for inclusion in a volume in this series. This volume presents a group of such papers from the 15th conference, held in 1983, which focused on a behavioural-developmental approach to childhood disorders. The book is divided into two sections. The first section gives an overview of the conceptual foundations for a behavioural-developmental approach to childhood behaviour problems from both an applied behaviour analysis and a cognitive-behavioural persepective. The three chapters in this section, by leading exponents in the field, provide a useful backdrop against which to read the rest of the book. The 6rst chapter is a general argument for the use of a broad behavioural-developmental approach together with a brief overview of the volume. The other chapters, on applied behaviour analysis by Baer, and on cognitive-behavioural approaches by Meichenbaum and colleagues, provide a useful and up-to-date introduction to their respective approaches. The second section provides a number of examples of such an approach as it has been applied in interventions with a range of conditions and age groups. A wide range of applications is covered in this section. The section begins with a useful discussion of assessment, taxonomy and taxometry by Achenbach, areas which are often neglected in behavioural analysis. The following chapter, by Bricker and Littman, describes an evaluative study of a parent monitoring questionnaire for the detection of infants at risk or developmental problems. This study provides useful evidence for the reliability, validity and cost-effectiveness of such a screening procedure in the detection of infants who may benefit from a developmental intervention programme. This is succeeded by a chapter by Kysela and colleagues who present a decision-making mode1 for the integration of handicapped/‘exceptional’ children into a normal preschool environment. Following on from preschool integration is a paper by Walker and colleagues on the uses of social skills training in the integration of handicapped children into least restrictive environment school settings. A relatively comprehensive set of evaluation measures and an intervention package designed to improve both peer and stali acceptance of integrated children is presented in some detail. A useful chapter by Jenson and Young provides an overview of work with autistic children, their families, peers and outside professionals. The discussion of peer group influences in the modification of behaviour in such children parallels nicely the examples given by Meichenbaum and colleagues in their discussion of social withdrawal in Section 1. The next chapter, by Wolfe, on the use of intervention strategies in the primary prevention of child abuse is, in my opinion, one of the most important contributions in this volume. Wolfe pulls together a wide range of clinical and research evidence which is of fundamental importance in the further development of preventative services in this area. Barkley provides a review of research on the area of attention deficit disorder with hyperactivity. The review is based around a series of studies carried out at the Medical College of the University of Wisconsin, principally concerned with effects on parentxhild interaction, of stimulant medication on behaviour and on the situational specificity of hyperactive behaviour patterns. The final chapter concerns parent-adolescent conilict, and is by Robin of Michigan. This chapter takes a systems approach to the area, and reviews the evidence for problem solving, cognitive restructuring and communication training as therapeutic tools to be used within a behavioural family-systems approach to such problems. Overall, this is a useful volume in the area of child behavioural work and should, by virtue of its clarity of presentation and quality of material coveted, be made widely available. It cannot be seen as a comprehensive handbook, confining itself as it does to a limited selection of topics, and should rather be viewed as the statement of a general philosophy, illustrated with examples of areas of current application. As with any book of this type, there is some variability in the quality of presentation from chapter to chapter. However, it is to be highly recommended as a pot-pourri of recent North American work in the area of behavioural-developmental analysis and intervention with children. KENAIllU3
N. L. MACE and P. V. for Confied
RAEINS,
with B. A. CASTLET~N,C. CLOKEand E. MCEWEN: The 36-Hour Day: Caring at Home London Age Concern (1985). Pages xix + 232. f5.95.
Elderly People. Hodder & Stoughton,
Recently, at a carers’ support group, the following conversation between a carer and her GP was reported: Carer: My husband’s memory seems to be getting far worse, doctor. Doctor: Well, he’s getting on a bit, isn’t he? It’s only age, you know. Carer: Actually, I think that he has Alzheimer’s disease. Doctor: What’s that? Never heard of it!
610
BOOKREvrEws
Some GPs and many members of the public may not have heard of Aixheimer’s disease, or may not know of any of the other dementing disorders other than as ‘going senile’, but for those carers and professionals who are interested in really understanding the dementing disorders, there are now several informative books available. The 36-Hour Day is one of them. ‘Translated’ from the American version, it is basically aimed at the families of those caring for those suffering from a dementing disorder (and, thank goodness, the offensive label ‘dements’ is not to be found in its pages). As a professional, I found that it taught me a lot, and it gives me a standard of service to which I can aspire. It gives me a picture of the many adjustments which have to be made by the carers, and some insight into what it might feel like to be in the position of a sufferer. The book has been well-received by the members of the carers’ group I am involved with, although some carers have told me that they find parts of the book harrowing, as its truths are so close to the bone. I am not sure that it is the kind of book I would thrust into the hands of carers whose relative has been diagnosed as having an early dementia, as to paint the canvas in too fully at an early stage may be to demolish all hope for the future and merely instil dread and anxiety. At the moment there is a gap on the bookshelf for a beginner’s guide’, so to speak. I recommend this book highly to all those who work with the elderly, and for reading by carers of moderate or severely dementing people who are interested in reading about the condition. If you are considering buying the book, then do so direct from Age Concern, as they get some financial benefit from their direct sales.
J. D. KEEHN:Animal Models in Psychiatry. Routledge & Kegan Paul, London (1986). 251 Pages. E20.00 As Keehn points out in the Preface, it is important to understand that certain atIIictions of humans are also afflictions of lower animals, and that in so far as we share a common biological origin with these animals, then whatever is learned about the one necessarily adds to our knowledge about the other. Accordingly, this book summarizes much evidence to show how knowledge of natural behaviour of animals, and also experimental laboratory study, can be useful to furnish us with models of abnormal behaviour in humans. Particularly important is the inclusion of behavioural disorders in animals, of a non-experimental origin, that resembles human disorders under similar circumstances. Various behavioural anomalies found in laboratory animals are discussed in more detail, as is their relation to comparable human disablements. The last four chapters of the book examine animal contributions to the analysis of human neuroses and psychophysiological disorders, addictions, psychoses and disorders of childhood. There is no doubt that the book will be useful to behaviour therapists who are interested in the wider context of their discipline, and who will find much of use as well as of interest in this book, written by a psychologist with practical experience in both the animal and the clinical psychology fields. There are odd omissions. Thus Keehn discusses the Solomon, Kamin and Wynne study of traumatic avoidance learning, but leaves out its major point of interest for clinical psychologists, which had already been pointed out by the authors in their paper, namely the fact that this behaviour resembles obsessive-compulsive behaviour in humans. Furthermore, the methods of flooding with response prevention they used to ‘cure’ the animals could be used for treatment of this human disorder (as indeed it has been so treated, with great success, by Rachman and Hodgson). Again, Keehn refers to conditioning theories of neurosis, but makes no mention of the large animal literature supporting the concept of incubation of anxiety. These are odd omissions which lessen the value of the book, but even as it is it will well repay study. H. J. EYSENCK
S. A. HUSNN and T. VANDIVER: Suicide in Childrenand Adolescents.MTP Press, Lancaster, Lancs./Spectmm York (1984). Pages xviii + 284. f22.50.
Rooks, New
The authors of this book have made a useful guide to a rather scattered literature. about self-injury in young people. The vast majority of the book (as of the literature) is not in fact about suicide but about children who have taken overdoses or otherwise harmed themselves. They include separate considerations of the associated factors in different age bands and this is a welcome ordering of the information. They include a review of single case studies and a descriptive bibliography which make a difficult literature readily accessible to clinicians. All this is a real service both to clinicians and researchers. The book would be a good text for a discussion group. Its fault is probably inseparable from the present status of research in this area. A large number of studies and reports are of markedly inferior methodology to the extent that it is hard to know whether any true conclusions can be drawn. This book does not achieve a rigorous critical account; but the state of the art probably does not yet allow for that. Them are some critical questions unanswered. What is the relationship of attempted to completed suicide? Can one separate risk from precipitating factors? What factors mediate the known associations such as family breakdown? What should the targets of intervention be? Gne hopes that this book will help to arouse interest in these questions.
609
One shortcoming of the book is the lack of an overview chapter, scanning the entire field. Such an overview would have added considerably to its value, particularly in view of the fact that it is the inaugural volume launching a new series. It would also have helped the non-specialist reader to place in perspective the data and ideasin the different chapters. On the whole, this is a very welcome series, and its first volume a suiliciently stimulating one to make the interested reader look forward to the succeeding publications. P.
R. J. MCMAHON and R. DE V. PETERS(Eds): Childhood Disorders: Behavioral-Developmental New York (1985). Pages xii + 277. S30.00.
DE SILVA
Approaches. Brunner/Mazel,
This fascinating volume is one in a continuing series of publications which have grown out of the annual Banff International Conferences on Behavior Mod&ation. The main contributors to the conference are required to write a chapter, separate from their conference contributions, but around the same theme for inclusion in a volume in this series. This volume presents a group of such papers from the 15th conference, held in 1983, which focused on a behavioural-developmental approach to childhood disorders. The book is divided into two sections. The first section gives an overview of the conceptual foundations for a behavioural-developmental approach to childhood behaviour problems from both an applied behaviour analysis and a cognitive-behavioural persepective. The three chapters in this section, by leading exponents in the field, provide a useful backdrop against which to read the rest of the book. The 6rst chapter is a general argument for the use of a broad behavioural-developmental approach together with a brief overview of the volume. The other chapters, on applied behaviour analysis by Baer, and on cognitive-behavioural approaches by Meichenbaum and colleagues, provide a useful and up-to-date introduction to their respective approaches. The second section provides a number of examples of such an approach as it has been applied in interventions with a range of conditions and age groups. A wide range of applications is covered in this section. The section begins with a useful discussion of assessment, taxonomy and taxometry by Achenbach, areas which are often neglected in behavioural analysis. The following chapter, by Bricker and Littman, describes an evaluative study of a parent monitoring questionnaire for the detection of infants at risk or developmental problems. This study provides useful evidence for the reliability, validity and cost-effectiveness of such a screening procedure in the detection of infants who may benefit from a developmental intervention programme. This is succeeded by a chapter by Kysela and colleagues who present a decision-making mode1 for the integration of handicapped/‘exceptional’ children into a normal preschool environment. Following on from preschool integration is a paper by Walker and colleagues on the uses of social skills training in the integration of handicapped children into least restrictive environment school settings. A relatively comprehensive set of evaluation measures and an intervention package designed to improve both peer and stali acceptance of integrated children is presented in some detail. A useful chapter by Jenson and Young provides an overview of work with autistic children, their families, peers and outside professionals. The discussion of peer group influences in the modification of behaviour in such children parallels nicely the examples given by Meichenbaum and colleagues in their discussion of social withdrawal in Section 1. The next chapter, by Wolfe, on the use of intervention strategies in the primary prevention of child abuse is, in my opinion, one of the most important contributions in this volume. Wolfe pulls together a wide range of clinical and research evidence which is of fundamental importance in the further development of preventative services in this area. Barkley provides a review of research on the area of attention deficit disorder with hyperactivity. The review is based around a series of studies carried out at the Medical College of the University of Wisconsin, principally concerned with effects on parentxhild interaction, of stimulant medication on behaviour and on the situational specificity of hyperactive behaviour patterns. The final chapter concerns parent-adolescent conilict, and is by Robin of Michigan. This chapter takes a systems approach to the area, and reviews the evidence for problem solving, cognitive restructuring and communication training as therapeutic tools to be used within a behavioural family-systems approach to such problems. Overall, this is a useful volume in the area of child behavioural work and should, by virtue of its clarity of presentation and quality of material coveted, be made widely available. It cannot be seen as a comprehensive handbook, confining itself as it does to a limited selection of topics, and should rather be viewed as the statement of a general philosophy, illustrated with examples of areas of current application. As with any book of this type, there is some variability in the quality of presentation from chapter to chapter. However, it is to be highly recommended as a pot-pourri of recent North American work in the area of behavioural-developmental analysis and intervention with children. KENAIllU3
N. L. MACE and P. V. for Confied
RAEINS,
with B. A. CASTLET~N,C. CLOKEand E. MCEWEN: The 36-Hour Day: Caring at Home London Age Concern (1985). Pages xix + 232. f5.95.
Elderly People. Hodder & Stoughton,
Recently, at a carers’ support group, the following conversation between a carer and her GP was reported: Carer: My husband’s memory seems to be getting far worse, doctor. Doctor: Well, he’s getting on a bit, isn’t he? It’s only age, you know. Carer: Actually, I think that he has Alzheimer’s disease. Doctor: What’s that? Never heard of it!
610
BOOKREvrEws
Some GPs and many members of the public may not have heard of Aixheimer’s disease, or may not know of any of the other dementing disorders other than as ‘going senile’, but for those carers and professionals who are interested in really understanding the dementing disorders, there are now several informative books available. The 36-Hour Day is one of them. ‘Translated’ from the American version, it is basically aimed at the families of those caring for those suffering from a dementing disorder (and, thank goodness, the offensive label ‘dements’ is not to be found in its pages). As a professional, I found that it taught me a lot, and it gives me a standard of service to which I can aspire. It gives me a picture of the many adjustments which have to be made by the carers, and some insight into what it might feel like to be in the position of a sufferer. The book has been well-received by the members of the carers’ group I am involved with, although some carers have told me that they find parts of the book harrowing, as its truths are so close to the bone. I am not sure that it is the kind of book I would thrust into the hands of carers whose relative has been diagnosed as having an early dementia, as to paint the canvas in too fully at an early stage may be to demolish all hope for the future and merely instil dread and anxiety. At the moment there is a gap on the bookshelf for a beginner’s guide’, so to speak. I recommend this book highly to all those who work with the elderly, and for reading by carers of moderate or severely dementing people who are interested in reading about the condition. If you are considering buying the book, then do so direct from Age Concern, as they get some financial benefit from their direct sales.
J. D. KEEHN:Animal Models in Psychiatry. Routledge & Kegan Paul, London (1986). 251 Pages. E20.00 As Keehn points out in the Preface, it is important to understand that certain atIIictions of humans are also afflictions of lower animals, and that in so far as we share a common biological origin with these animals, then whatever is learned about the one necessarily adds to our knowledge about the other. Accordingly, this book summarizes much evidence to show how knowledge of natural behaviour of animals, and also experimental laboratory study, can be useful to furnish us with models of abnormal behaviour in humans. Particularly important is the inclusion of behavioural disorders in animals, of a non-experimental origin, that resembles human disorders under similar circumstances. Various behavioural anomalies found in laboratory animals are discussed in more detail, as is their relation to comparable human disablements. The last four chapters of the book examine animal contributions to the analysis of human neuroses and psychophysiological disorders, addictions, psychoses and disorders of childhood. There is no doubt that the book will be useful to behaviour therapists who are interested in the wider context of their discipline, and who will find much of use as well as of interest in this book, written by a psychologist with practical experience in both the animal and the clinical psychology fields. There are odd omissions. Thus Keehn discusses the Solomon, Kamin and Wynne study of traumatic avoidance learning, but leaves out its major point of interest for clinical psychologists, which had already been pointed out by the authors in their paper, namely the fact that this behaviour resembles obsessive-compulsive behaviour in humans. Furthermore, the methods of flooding with response prevention they used to ‘cure’ the animals could be used for treatment of this human disorder (as indeed it has been so treated, with great success, by Rachman and Hodgson). Again, Keehn refers to conditioning theories of neurosis, but makes no mention of the large animal literature supporting the concept of incubation of anxiety. These are odd omissions which lessen the value of the book, but even as it is it will well repay study. H. J. EYSENCK
S. A. HUSNN and T. VANDIVER: Suicide in Childrenand Adolescents.MTP Press, Lancaster, Lancs./Spectmm York (1984). Pages xviii + 284. f22.50.
Rooks, New
The authors of this book have made a useful guide to a rather scattered literature. about self-injury in young people. The vast majority of the book (as of the literature) is not in fact about suicide but about children who have taken overdoses or otherwise harmed themselves. They include separate considerations of the associated factors in different age bands and this is a welcome ordering of the information. They include a review of single case studies and a descriptive bibliography which make a difficult literature readily accessible to clinicians. All this is a real service both to clinicians and researchers. The book would be a good text for a discussion group. Its fault is probably inseparable from the present status of research in this area. A large number of studies and reports are of markedly inferior methodology to the extent that it is hard to know whether any true conclusions can be drawn. This book does not achieve a rigorous critical account; but the state of the art probably does not yet allow for that. Them are some critical questions unanswered. What is the relationship of attempted to completed suicide? Can one separate risk from precipitating factors? What factors mediate the known associations such as family breakdown? What should the targets of intervention be? Gne hopes that this book will help to arouse interest in these questions.