Abstract
Writing a handbook of child and adolescent psychiatry that is practical, approachable and not too long is a major achievement. This feat is achieved by dealing only with clinical disorders – developmental influences do not get a look in, although inevitably some discussion of developmental issues creeps into various chapters, notably, disorders of attachment, gender identity disorders and specific developmental disorders of speech and language. Brevity has also been achieved by the multiple contributors giving authoritative accounts of practice, which is condensed from research but which deliberately excludes extensive referencing. Indeed, many chapters are very lightly referenced. As such this book most successfully fills a space between recent editions of introductory texts to child psychiatry and major reference texts. It is unequivocally pitched at child and adolescent psychiatrists or other specialists whose practice includes child mental health.
There is a definite Eurocentric tone to the book, with seven of the contributors coming from Europe, just five from North America and the balance of the 28 from England. I found that nearly every chapter had something to offer. Indeed, freed from the shackles of detailed referencing, each felt like a discussion with an experienced but evidence-driven clinician. I might disagree on some individual points but the clarity of the writing made it easy to understand where each author was coming from and why. It might be anticipated that the lack of referencing would be an invitation to unwarranted speculation and theorizing – this does not happen and indicates very good editorial control. Instead, there are interesting and balanced discussions of the predictable problems associated with the diagnosis and management of certain disorders, for example, adjustment disorders (Peter Hill), personality disorders (Jonathan Hill, Michaela Swales and Marie Byatt), conduct disorders (Stephen Scott) and gender identity disorders (Peggy Coen-Kettenis).
The range of disorders covered is definitely guided by the ICD-10 rather than the DSM-IV. Most chapters, though, include an excellent comparison between the two diagnostic systems and how the differences might affect actual day-to-day practice. Despite the diversity of contributors coherence is maintained by having each author follow a set common structure: introduction, definition and classification, epidemiology, clinical picture, aetiology, treatment and outcome; and it works well. Where evidence can support treatment algorithms and flow charts these are also included. The attraction of such flow charts is that they are explicit, whether or not you agree with them, but in most instances I did.
The strong focus on clinical practice makes this a very practical book. A bonus is that many chapters include in their appendices copies of commonly used instruments and questionnaires, particularly those in the public domain. Other frequently used instruments are well referenced or else there is a tabulated evaluation of their psychometric properties. The goal is clearly to assist clinicians in choosing and using these measures in everyday practice.
My quibbles are few and I suspect they stem from the complexities of pulling together a multi-author book complicated by Richard Harrington's untimely death. Most references pre-date 2000, which is perfectly reasonable for classic publications. However, I suspect the omission of recent references has contributed to the lack of any discussion (in the section on bipolar disorders) of the trans-Atlantic controversy regarding the boundaries of bipolar disorders and attention-deficit–hyperactivity disorder. The implications for practice flowing from these differences are significant. Eric Taylor gives a wonderfully balanced account of the hyperkinetic disorders, but the place of atomoxetine in their management hardly rates a mention. In the management of treatment-resistant psychoses the target dose range of clozapine (300–450 mg/day up to 900 mg/day) is higher than I have usually found necessary or tolerable. Those quibbles aside, this is an immensely readable and accessible book and I would strongly recommend that every service obtain its own copy, because it is excellent value for money. I believe trainees and psychiatrists, whatever their level of experience, will value and readily use it.
Bill Watkins
Christchurch, New Zealand