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Book Forum: Child/Adolescent Psychiatry   |    
What Works With Children and Adolescents? A Critical Review of Psychological Interventions With Children, Adolescents and Their Families
IVAN FRAS, M.D.
Am J Psychiatry 2002;159:1071-1071. doi:10.1176/appi.ajp.159.6.1071
View Author and Article Information
Binghamton, N.Y.

Edited by Alan Carr. New York, Routledge, 2001, 364 pp., $34.95 (paper).

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This attractively printed and bound volume is a compilation of 11 reviews of child psychiatric disorders by mental health professionals with bachelor’s and master’s degrees, supervised by the editor. The reviewers took all English-language publications in the psychological literature from 1977 to 1997, reportedly "the most methodologically robust investigations that could be located through computer and visual literature search methods." They subjected the material to tabulations of data and statistical analysis; this presentation of data takes up roughly half of the book.

The narrative text presents the methods and substantive findings of the psychological literature reviewed and offers the authors’ conclusions as to what are effective treatment approaches at the end of the chapters on each disorder as well as at the end of the book, where all of the conclusions are presented once more. Most chapters present the findings under headings of Method and Methodologic Features, Substantive Findings, and main treatment approaches, such as Parent Training (of several types), Child-Focused Training (again, of several types), and Self-Instructional Training. Finally, each chapter ends with a Conclusions section. Although the emphasis is on behavioral approaches, some psychodynamic treatments are evaluated as well. The Conclusions sections address each disorder under the headings of "What Works?" and "What Does Not Work?"—the latter being invariably shorter. The authors also offer discussions of the implications of their conclusions for treatment and for the development of treatment delivery systems.

The editor has approached the entire project with the expanded question, "What works for that specific problem under which circumstances?" This question is pragmatic and, as the editor points out, counteracts the simplistic therapeutic nihilism of some of the older studies of psychotherapies.

In keeping with the editor’s way of addressing this entire topic, we may ask ourselves, "What does this book offer to which reader?" It depends on what the reader’s work in mental health consists of. The large amount of statistical minutiae will be welcomed by those doing research on purely psychological treatments. The practicing clinician will likely skip the tabulations and find plenty of interest in the narrative. It is my impression that the book is of greatest use to the experienced clinician, who will either find confirmation of his or her clinical wisdom or learn new treatment approaches. Examples of these are resilient peer therapy in child abuse, the "chronic care" model with "increased service contact at transitional points" in attention deficit hyperactivity disorder, and the use of family therapy in drug abuse. There are many more examples of treatments that are novel and helpful.

A very small weak spot is the coverage of psychopharmacology, which, fortunately, is extremely limited, occurring only in the context of attention deficit disorder and obsessive-compulsive disorder. The authors’ coverage of pharmacotherapy shows their total lack of expertise in that field and, in the case of attention deficit disorder, had best been left out completely because it is quite misleading. One area that I wish were covered is that of pervasive developmental disorder and autism, where this team’s critical review would be welcome.

Overall, this book can be recommended to a wide spectrum of readers because most readers can find either something new or a reaffirmation of their current treatment approaches. Moreover, administration and organizational impetus is often given by the authors under the heading of "Service Development," providing agency administration with data to implement treatment programs or changes in those programs.

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