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Book Forum: CHILD PSYCHIATRY   |    
Severe Stress and Mental Disturbance in Children
Am J Psychiatry 2000;157:295-296. doi:10.1176/appi.ajp.157.2.295
View Author and Article Information
Minneapolis, Minn.

edited by Cynthia R. Pfeffer, M.D. Washington, D.C., American Psychiatric Press, 1996, 673 pp., $69.95.

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This well-organized volume begins with basic reviews of animal and human research on vulnerability and resilience, neurophysiology, and endocrine concomitants of loss and trauma. Chapters on sudden unexpected trauma cover the effects on children of natural disasters (e.g., hurricanes), man-made disasters (e.g., a plane crash), and deliberate assaults on children (e.g., killings in school settings). Several contributors review the literature on stress and medical illness, including asthma, the immune system, childhood cancer, and juvenile diabetes. Ensuing chapters expound on suicide among youth, including its effect on peers, siblings, and other family members. Next, in a section on psychiatric disorders associated with parental neglect and abuse, the controversial issues of memory and dissociation receive a balanced treatment, with findings grounded in clinical observation, animal studies, and innovative human studies of early memory. A final section examines the interaction between normal child development and trauma, adoption, divorce and remarriage, and death of a parent.

Themes encountered repeatedly throughout these 22 chapters include the following: 1) models for understanding the effects of diverse stressors on children, 2) research paradigms for studying trauma-related phenomena, including the use of disasters as "laboratories" for studying children and their families, 3) factors favoring illness, maladjustment, and coping by traumatized children, 4) normal and abnormal courses following loss, abuse, and life-threatening trauma, 5) prognosis of stress-related behaviors, syndromes, and disorders, 6) epidemiology of psychiatric sequelae, along with potential preventive interventions, 7) excellent reviews regarding memory and dissociation in traumatized children, and 8) effects of loss and trauma on family relationships and child development.

Readers seeking psychotherapeutic and psychopharmacological guidance in the care of traumatized children will be disappointed. However, this book should serve to stimulate our foundations, institutes, pharmaceutical companies, and health systems to undertake rigorous treatment research, including both short- and long-term outcomes, in traumatized children. Entirely missing or touched on briefly are topics that involve refugee and immigrant children, i.e., acquired mental retardation, the tortured child, refugee children in camps and resettlement countries, intergenerational conflict, child combatants, children raised during war and in concentration camps, and brain-injured children.

Although reading this entire book can be a daunting task, parts of it are highly relevant to several audiences. Anyone new to the stress/trauma research field will discover nuggets from a widely but thinly distributed research literature.

Pediatricians, family physicians, child psychologists, and child and adolescent psychiatrists will be glued to the chapters on memory, dissociation, child abuse, and the effects of divorce, remarriage, and death on children and families. Clinicians and researchers focused on adult psychiatric casualties of trauma will find much of the book extremely valuable for those difficult cases in which patients’ original traumata occurred in childhood, or in which adult trauma follows a history of childhood trauma. One leaves this book with an appreciation for the investigators drawn to this difficult field. The editor has achieved the enviable goal of shaping a book that is not only a complete entrée to the topic but also a resource for clinicians and investigators. Many will want it on their personal bookshelves near at hand.




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