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Down Syndrome Across The Life Span

2003, Child and Adolescent Mental Health

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This book introduces foundational elements of clinical and professional practice for frontline staff in child and adolescent mental health services. It provides clear guidance on navigating the complexities of CAMHS while addressing child development and mental health factors. Despite its ambitious scope, the book presents challenges such as uneven coverage and a need for better representation of psychological evidence related to practices for children with Autism Spectrum Disorders (ASDs), all while emphasizing the importance of play in educational approaches.

Child and Adolescent Mental Health Volume 8, No. 4, 2003, pp. 197–199 Book News A Multi-Disciplinary Handbook of Child and Adolescent Mental Health for Front-Line Professionals N. Dogra, A. Parkin, F. Gale & C. Frake (Foreword by P. Vostanis) London: Jessica Kingsley, 2001. pp. 176. £14.95 (pb). ISBN: 1-85302-929-7. This book sets out to introduce ‘frontline’ staff new to child and adolescent mental health services to some basics elements of clinical and professional practice. It marks the first attempt to publish a core child mental health training package that is not written from the view point of one professional group or orientation and that aims to be accessible to staff joining CAMHS from a wide variety of backgrounds. The book is clear, concise and well laid out. It avoids specialist language and offers clear definitions. It provides good guidance on the basic clinical and legal parameters of the work and a helpful summary of the way CAMHS meshes with other services – an issue that can often seem very confusing to those new to CAMHS. The suggestions on how to approach initial meetings with families, though sometimes rather dogmatic, are likely to be a source of reassurance and help to those facing such situations for the first time. Similarly, the sections on child development and factors influencing mental health in young people offer some useful summaries. The weaknesses of the book largely reflect the difficulties inherent in the endeavour. Some chapters are uneven as the authors struggle to cover wide areas in simple terms. For example, the discussion of individual presenting problems are necessarily rather truncated at times – and are likely to need to be supplemented with additional reading on particular issues. Complex issues are sometimes oversimplified or presented rather one-sidedly. To take a small example: in discussing the debate about the use of the term ‘mental health’, the authors characterise those who prefer use of the term ‘emotional literacy’ as ‘misguided and colluding with the assumptions that mental is a negative or pejorative term’ (p. 21). Whilst a lengthy discussion of this topic in a book of this sort would be impracticable, a more neutral tone and fuller referencing might have been helpful at times. Likewise, the descriptions offered in relation to some aspects of CAMHS structure and function, such as the likely core composition of teams, the particular roles of different professionals, and the theoretical underpinnings of some of the clinical techniques outlined, may be rather more open to debate than implied in the text. These quibbles aside, I think this is an important and timely book. Not only does it offer much sensible advice and information for new ‘front line staff’, it may also be of relevance to more experienced clinicians. It offers the latter group the opportunity to test their own basic assumptions against those of the authors. It may help such readers to clarify and refine their own thinking about what constitutes the fundamental building blocks of clinical work in CAMHS across disciplines and what constitutes the minimum knowledge base necessary for all staff to ensure both safe and best practice. Miranda Wolpert Bedfordshire and Luton Community NHS Trust Down Syndrome Across The Life Span M. Cuskelly, A. Jobling & S. Buckley (Eds.) London: Whurr, 2002. pp. 219. £35 (pb). ISBN: 1-86156-230-6. This book is, as many now are, the product of a conference, this one held in Sydney, Australia, in 2000, and including ‘parents, professionals and researchers as both presenters and audience’. Just over half the authors listed are Australians, with other contributors coming from the UK, Italy, Canada, and the US. The first half is about learning and education, the second about life styles and family life, with a chapter on verbal-motor behaviour placed rather oddly amongst these last. In the first half Jennifer Wishart provides a useful summary of her work with very young children with Down syndrome, rehearsing her now well-known findings on their instability in learning. In addition, she reports on a study of trainee teachers, showing that their awareness of the basic facts about Down syndrome, such as life expectancy, was sketchy and inaccurate and, dismayingly, that few (13%) would welcome the chance of teaching in integrated settings. Literacy and numeracy, both important skills for people with Down syndrome, are discussed in later chapters and some innovative teaching strategies described. Within this section is a chapter by Giorcelli on inclusion in mainstream education. In most current thinking it is accepted almost as indisputable that this is the ideal provision for children with Down syndrome, but Giorcelli acknowledges that, despite the advantages for many, it is not invariably the best option. In the second half of the book Jobling and Cuskelly look at life styles of adults living in the family home. Two-thirds of people living in Queensland were working, compared with only 10% in my own study of people in the South–East of England (Carr, 1995). However, most of the people in Queensland were in sheltered employment, which seems to have been generously provided in this part of Australia. As has been found elsewhere, leisure and social activities were relatively limited, and relied mainly on facilitation provided by the families. Here I feel I must enter a disclaimer. The authors state, more than once, that, in contrast to theirs, my (1995) data showed that ‘urban and rural factors influenced adults’ life styles’. In fact, I did not claim to have shown this, simply suggesting it as a possibility, without reference to data. It would be unfortunate if this were now to be construed as established fact. Further, on the theme of employment, Contardi describes a pre-work training course completed by 200 people with Down syndrome, and the subsequent working life of eight people. This work was in MacDonald’s fast food outlets and, remarkably, shows MacDonald’s to have been admirable employers for this group in providing standardised training and work routines that appear to have been well suited to this group. Cuskelly and colleagues look at three aspects of what is expected. The book is unusual both in some of the topics presented – photography as a means of self-expression for people with Down syndrome (Gothard), self-regulation (Glenn and Cunningham), working with parents in developing countries Ó 2003 Association for Child Psychology and Psychiatry. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA 198 Book News (McConkey); and in the way the material is presented: overall and, with some exceptions, in generalised terms, rather than as evidence experimentally arrived at. This may well be found a refreshing change by some readers though I confess I found it frustrating. So there is much of interest and value in this book. Prospective buyers should be warned, however: the book by no means covers the life span of people with Down syndrome. Most of it concerns people under the age of 30, the oldest person referred to being aged 42; there is nothing on older people, let alone on people in the latter stages of life. The editors say that ‘Not all areas of importance... have been included’, which is fair enough. Nevertheless, they would have been well advised to choose a different, and less misleading, title. As things stand, given the fairly high price, the reader could be forgiven for expecting a more comprehensive book than this one is. Janet Carr Bookham, Surrey Reference Carr, J. (1995). Down’s syndrome: Children growing up. Cambridge: Cambridge University Press. Children’s Rights in Education S. N. Hart, C. P. Cohen, M. F. Erikson & M. Flekkoy (Eds.) London: Jessica Kingsley, 2001. pp. 240. £15.95 (pb). ISBN: 1-85302-977-7. This book is based on an international conference to promote educational aspects of the UN Convention on the Rights of the Child (UNCRC). The Convention was adopted without dissent in 1989 and ratified by 191 countries, a record claimed as unparalleled by any other human rights treaty. Chapters 1–4 provide a context for the relationship between children’s rights in education, UNCRC and related treaties, and problems in meeting the stipulated international standards. Chapters 5–7 focus on the major human rights themes of democracy, inclusion and participation in education settings. Chapters 8–9 cover the role of adults in formal and informal positions of power, and the two concluding chapters discuss features of learning environments that respect human rights. There is a useful index. UNCRC is described as ‘a common standard of achievement for all peoples and all nations’ requiring a ‘change of attitude and perception of who a child really is’ (pp. 15–16). The authors review progress since 1989 and identify issues that have preoccupied the Committee on the Rights of the Child, which evaluates reports from national governments. Problems are acknowledged, not least that more than 100 million children worldwide still have no schooling. Support for the Convention is combined with frustration at the obstacles to its full implementation. What has UNCRC achieved? Many papers are stronger on rhetoric than substance. Thus Gerison Lansdown regards the near universal ratification of the Convention as ‘a huge leap forward for children’ while arguing that ‘paper commitments are not enough’ (p. 56). Fredriksson goes further, suggesting that ‘in some cases it is doubtful if the intention ever was to implement the policy’ (p. 70). That said, Flekkoy’s chapter is full of refreshingly down to earth examples of how the Children’s Ombudsman in Norway acts as an advocate for children both in disputes over their schooling and in matters of educational policy. Tensions between the values on which UNCRC is based are acknowledged. In Northern Ireland, for example, the right of parents to choose the education they want for their children may conflict with reduction of prejudice and stereotypes. However, no paper deals with these tensions in depth. More important, no author questions the assumed universality of the values in the Convention. Western rhetoric on rights and responsibilities is evident throughout the book, but contrasts starkly with the Confucian emphasis in Chinese cultures on perfectability (of an individual as well as of a skill) through repeated practice and respect for elders. Where the Norwegian Ombudsman sees part of her job as investigating children’s complaints, the dominant emphasis in many Eastern cultures would be on love and respect for parents and, by extension, for teachers and political rulers. There is a huge chasm between such ideologies and those of UNCRC. As Fredriksson observes, ratification may sometimes have less to do with commitment to the prescribed standards than with convincing international donors that intentions are good. Overall, this is a useful review of progress since adoption of UNCRC. The authors do not question the philosoph- ical underpinning of the Convention, nor the assumed universal acceptance of its aims, but they do identify its achievements and the challenges it presents to national governments. As a reminder of international expectations this volume should have a place in LEA and CAMHS libraries. David Galloway University of Durham The Father’s Book: Being a Good Dad in the 21st Century David Cohen Chichester: John Wiley, 2001. pp. 283. £8.99 (pb). ISBN: 0-470-84133-8. This book is written for fathers by a psychologist. It claims to be ‘A mine of information. . . you’ll wonder how you ever coped without it’ (backcover). After a brief introduction and a chapter on the history of fatherhood, the chapters follow the child’s developmental course from the start of the pregnancy through to adolescence, with additional chapters on step/part-time fathers, various disorders, drink and drugs until the final chapter ‘Will they ever leave home?’. At every stage the author uses a lighthearted approach mixed with serious research findings. Much of the information is useful and informative but some of the references are quite dated, with about half going back to the 1980s or earlier. Given the time that a book takes to come together this is not necessarily the author’s fault. The problem is that in the last 20 years there has been an explosion of papers and research findings about different aspects of child development and in particular about fathering. Does it work as a book? Although I have much enjoyed other popular books, for example Steve Biddulph’s Raising boys, I found this book deeply frustrating. I wondered if this was because I was a woman, a mother and an academic. The book is obviously not for me, so I gave it to a colleague to read who is at least a man and a teenager’s dad. What was his verdict? ‘Well, it is neither one thing nor another’. He did not rate it as an academic book but neither did he rate it as a book for Dads. I felt sad because we desperately need more books to engage fathers and to remind them of the major impact they can have on their children’s lives. Ann Buchanan University of Oxford Book News Child and Adolescent Therapy: Cognitive-Behavioural Procedures (2nd ed.) Phillip C. Kendall (Ed.) Developing Play and Drama in Children with Autistic Spectrum Disorders D. Sherratt & M. Peter New York: Guilford Press, 2000. pp. 432. £35.00 (hb). ISBN: 1-57230-556-8. London: David Fulton Publishers, 2002. pp. 166. £15.00 (pb). ISBN: 1-85346-697-2. In the first edition published in 1991, this book provided excellent reviews of the applications of cognitive behavioural therapy in the field of child and adolescent mental health. The second edition adopts the same basic format, with chapters describing the evidence base for CBT and providing details of assessment and treatment procedures, with helpful case examples. Chapters address specific applications of CBT according to the nature of problems or disorders to be addressed. These include aggression, attention deficit hyperactivity disorder, anger, depression, anxiety disorders and chronic health conditions. Introductory and concluding chapters set the theoretical context and address evidence-based practice. A chapter, new to this edition, on developmental perspectives in working with adolescents provides a detailed and helpful overview. Chapters have been contributed by leading researchers in the field. There has been substantial development in the research and practice base for CBT over the past 10 years and this is fully reflected in the content. For example, the chapter on ADHD describes the complex nature of problems that can be presented and details a range of approaches that can be helpful in targeting functional impairments, those where there is no evidence base and applications of a combination of psychosocial and pharmacological treatments. The importance of combined and comprehensive treatments and need for the better development of treatment approaches to be theory driven, is highlighted. This book remains a primary reference source on applications of CBT with children and adolescents. It will prove useful to trainees and those new to the field, as well as experienced clinicians. Chrissie Verduyn Royal Manchester Children’s Hospital I know the practice of the authors of this book, so when they assert (p.vii) that their approach to teaching play and drama ‘works’ I believe them. However, does this book alone substantiate that and help other practitioners make it work for them? The book is inspirational and has sufficient detail for others to replicate the work, but lacks evidence for the assertion. There are good observational vignettes, but the evidence presented is about how children with autistic spectrum disorders (ASDs) can and do play, if we have the sensitivity to see, and about how to intervene to support their natural abilities, rather than about the basis for this particular programme. I very much welcome the positive approach, challenging ‘deficit’ views of autism. For teachers in England and Wales, also, it provides a useful cross referencing to National Curriculum objectives, which will provide a rationale for any sceptical inspectors. There are clear examples of practice, at different levels of play and drama ability, and a framework for assessing the level of play, and developing and extending it beyond the activity. It would be hard for practitioners, after reading this book, to dismiss play as irrelevant or too difficult for any child with an ASD. The problem with the book is paradoxical: at one level it is too ambitious, attempting to locate the benefits of play to children with ASDs at a biological and psychological level, without mustering the weight of scientific support for these analyses; at the pedagogical level, however, it does not present the evidence to justify the programme. The reductionist (biological) ‘evidence’ for teaching the programme does not add much to the argument whereas the educational argument could be compelling. It is the passionate conviction of the authors that children with ASDs 199 need a holistic approach and that ‘playdrama intervention brings... social competence rather than impairment within the grasp of many children’ (p. 37). Practitioners may want to (and should) locate their practice in deeper understanding of how individuals with ASDs think and learn, and the emphasis on the role of emotion is welcome. However, the psychological evidence needs to be better represented, to show its relevance and actual practical ‘evidence’ that the programme ‘works’ (which might persuade practitioners to try) is missing. A chapter on possible brain mechanisms (if the authors wanted to explore this) should have been presented separately and its speculative status clearly signalled. As it is, in spite of signposting and clearly demarcated sections, there is ‘hopping about’ between practical suggestions, presumed biological and psychological underpinning and justifications from educational theory. Inevitably, this leads to some repetition. I would have liked to see an account of what the approach was, its rationale (in mostly educational, but perhaps also some psychological terms), the evidence of outcome (who has it been tried with? for how long? what is the evidence that improvements were related to this approach? for whom did it not work? why? what can be done? and so on) and then ways in which it can be developed and used within the curriculum (which is done very well). All in all, however, this book is a welcome addition to the growing literature on ASDs and play. It is particularly relevant, since play has often been marginalised in the education of children with ASDs – the very children who need it most. It is uplifting to hear of good educational practice with children with ASDs and the lively and committed style should encourage other practitioners to be bold and extend and enrich the lives of children with ASDs in the process. Rita Jordan University of Birmingham