IPT Book Reviews

Title: Handbook of Child Psychiatric Diagnosis   Positive Review Positive Review
Editors: Cynthia G. Last and Michel Hersen
Publisher: John Wiley and Sons 1989

John Wiley and Sons
1 Wiley Dr.
Somerset, NJ 08875-1272
$65.00
  

Description:

The goal of the editors is to bring together the large volume of research on classification of childhood psychiatric disorders generated by the development of DSM-III (Diagnostic and Statistical Manual of Mental Disorders, Third Edition) and DSM-III-R (Out of Print)(Out of Print).  To accomplish this the editors have organized the book into four parts.  First, they cover general issues and the history of diagnosis of childhood maladaptive behavior.  In the second part there are 18 chapters on the DSM diagnostic categories for children.  Each of these chapters follows the same format as DSM-III and adds the recent research data for each classification.  A final section of each chapter presents in detail any modification found in DSM-III-R.  The third part of the book has four chapters on significant issues in the field of diagnosis of childhood disorders. The last section is a chapter suggesting the needs and directions of future research on the classification of children's aberrant behaviors.
  

Discussion:

The meat of this book is the second part with the detailed treatment of the diagnostic categories of childhood disorders.  The editors have done a good job of marshaling well written chapters by authors who obviously are well acquainted with the specific diagnosis they are describing.  The book is better balanced and more even in quality than most edited books.  Following the format of DSM-III undoubtedly contributes to this greater uniformity of quality.  The two most valuable features are the discussion of the research and the careful and explicit attention to the differences between DSM-III and DSM-III-R.  Any clinician who either makes diagnostic judgments for children or must understand them will benefit from this material.  Mastering the approach to diagnosis suggested here would go a long way toward increasing the reliability and validity of psychiatric diagnosis.

Prior to the choice to move psychiatric diagnosis into a more behavioral and atheoretical approach, there was little research evidence available.  Now there is a lot of work being done.  There are problems to be sure, but the direction seems to be improvement in specificity and accuracy of the classification decisions.

The treatment of reliability and validity is sound and thoughtful.  While the research evidence suggests reliability may be gradually improving, the book clearly shows the long way yet to go and the pressing need for continuing the effort embodied in DSM-III and DSM-III-R.  The final chapter on future directions for research is stimulating and provocative.  The program outlined, of course, is idealistic but it would surely advance the knowledge base and greatly improve the efficacy and utility of diagnosis for childhood disorders.

The goal of the editors to provide information about the research evidence now available has been met.  The research is carefully analyzed and the meaning and impact of the evidence is well described.  Having the mass of research data assembled into a manageable and rather neat package is much more effective than trying to find, read, and summarize the articles.  This strength of the volume alone is worth the price.

The book can also be read with benefit by non-mental health professionals who must relate in one way or another to the classification of childhood disorders.  An attorney who needed to know what a specific diagnosis meant, for example, could find everything necessary to deal responsibly and effectively with a diagnosis of a child.  Unfortunately, there are also many mental health professionals who are sloppy and imprecise in their diagnostic judgments.  In some instances it may well be the case that a given diagnosis is made for considerations other than the actual behavior of the child.  Insurance and third party payments may have an impact on a given diagnosis as may other circumstantial considerations.  This book would assist in both perceiving and responding to a diagnostic assignment that may be based on considerations other than the actual behavior of the child.

In handling allegations of child abuse, diagnosis by a mental health professional is often a major factor in determining the response of the system to a child and the disposition made.  Diagnosis is frequently determinative for such decisions by the judicial and child welfare system.  Even a cursory scanning of this book could benefit those professionals who are involved in using diagnostic classifications to meet their responsibilities.  Having it available as a resource and reference volume could be beneficial to all parties concerned.  The issues of reliability and validity for diagnosis of childhood disorders should be understood by other professionals.  This volume can materially assist in a careful assessment and understanding of diagnostic judgments.

Reviewed by Ralph Underwager, Institute for Psychological Therapies, Northfield, Minnesota

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