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
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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