W. W. Norton & Company Description: This 227 page book is based upon the premise that "'normal' developmental patterns can often be deceptive and misleading. Behaviors that are suggestive of psychopathology may actually be entirely adaptive responses of a young child confronting such traumatic events as divorce, the birth of a new sibling, caregiver separation, and the move to a new neighborhood." It is intended for health care professionals who work with preschool children. Case histories of children form the skeleton upon which the author carefully places the flesh of developmental theory, research in child development, psychoanalytic theorizing, and the experience of a concerned and compassionate child psychiatrist. Each case history presents the circumstances which brought the given child to the attention of the mental health professionals and the evaluation of the child by the author. After a careful review of the child's behavior, background, developmental history, and family characteristics, the question of the meaning and interpretation of the behavior of the child is explored. Each child is seen as a normal, adaptive child responding to the stresses of his or her life. However, in each case, the symptoms which may be interpreted to demonstrate pathology are carefully reviewed against appropriate concepts and research to show why it is more accurate and a more reliable diagnosis to conclude there is no pathology but rather a child adapting and coping effectively with life stresses. The book has seven chapters. Chapter 1 is introductory and lays the groundwork for the best understanding of the next six. It reviews the concepts and assumptions of developmental psychiatry. The goal is to be able to identify normal developmental phenomena and distinguish them from symptoms often mistaken as evidence of pathology. Chapter 2 uses a case history to teach the reader how to use the process of observation and interaction with a child to make that distinction between normal and abnormal behavior. Four "lenses" are proposed and illustrated as the theoretical framework for processing observations to tell what is normal and what is pathological. They are (1) locus of control, (2) aggression, (3) cognitive development, and (4) play. Chapters 3 through 7 use a specific case history to illustrate the use of each of these four "lenses" in drawing a conclusion about the child. Chapter 6 adds the fifth concept of the development of prosocial behavior through using research and by theorizing about aggression and altruism to conclude that a child's failure to develop prosocial actions may reflect an adaptive response by the child. There is no summary. The book ends without any attempt to tie
it together. You suddenly confront the first page of the bibliography.
I found
myself actually turning the next page to see if there wasn't some binding error
and that there was something more to end the book that had gotten put out of
place. Discussion: This book should be carefully read by every professional who is involved in reaching judgments or conclusions about children. This is especially true for every professional who may be involved in any responsible fashion in handling accusations of child abuse. Judges, attorneys, physicians, nurses, psychologists, teachers, preachers, parents, and social workers would benefit from knowing what this book teaches. The aim and purpose to increase the accuracy of discriminating normal and pathological behavior should certainly be shared by every professional who makes any decision whatsoever that affects the lives of preschool children. The evidence with respect to mental health professionals suggests that there is a bias in the direction of overinterpreting behavior as pathology. We do not want to let "kids will be kids" blind us to real problems but there may also be behaviors that are normal and adaptive but which present opportunity for adults to further the learning and proper growth of the child. This is the position the book takes in several of the specific cases. If adults can avoid labeling a child "sick" or "crazy" and instead see how a behavior causing concern may be adaptive but also needs to be attended to, the child will be markedly helped. Especially in sorting through the meaning of behaviors that may be included in the lists of "behavioral indicators" but may not be caused by experiences of abuse, the skill taught by this book is crucial for a child. One of the most difficult areas for professionals attempting to deal with child abuse is "failure to thrive" or emotional neglect. Every child in the case studies in this book could have been seen as an emotionally abused or neglected child. A professional who would make that judgment would most likely intervene in the family in a well-intentioned but intrusive manner. If the child is, instead, a normal child responding adaptively to stresses, that could exacerbate the situation and result in the development of true pathology. The child could be permanently damaged by well-intentioned but mistaken judgment. Each chapter in this book weaves together a helpful summary of appropriate research evidence, clinical experience, and wisdom that will increase the accuracy of judgments about children. The four "lenses" are explained well. The supporting research is adequately reviewed and described. Psychoanalytic theory, for those with a dynamic bent, is related to the concept and the research in a helpful though sometimes strained fashion. In each case, there are illustrative examples of the dialogue between the evaluating mental health professional and the child. These sections give the actual questions asked of the child to gain information about the four lenses and the child's answers. This is a very helpful aspect of the book. A practicing professional could benefit simply from seeing how questions can be asked to get good and useful information from a child. An example is the questions asked to get information on the interaction between control and depression.
The concept and research on learned helplessness is then used as a way to understand and interpret the child's depression and the issue of internal or external control. The chapter on play and the meaning and interpretation of children's play behavior is very helpful. Possibly there is no other behavior subject to more misinterpretation and overinterpretation by adults than a child's play. Very often a child's play behavior, observed by a day school or day care worker, is seen as suggesting abuse. It may then cause an investigation and intervention that goes too far and treats the child as pathological or abused when that may not be the case. Following the process outlined in this chapter and mastering the knowledge of research and theory on child's play contained within it could only result in better and more reliable understanding by adults and, in turn, improved judgments and decisions. This book is highly recommended for all professionals. It is a valuable contribution to the effort to deal responsibly, compassionately, but, above all, effectively with young children. They deserve the best adults can give them. This book will help us do that. Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota 55057.
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