Pediatric Annals

Book Review 

CLINICAL STUDIES IN BEHAVIOR THERAPY WITH CHILDREN, ADOLESCENTS AND THEIR FAMILIES

Gerald M Spielman, MD

Abstract

James M. Stedman, Ph.D., William F. Patton, Ph.D., and Kay F. Walton, M.S. CLINICALSTUDIESIN behavior therapywith children, adolescentsandtheirfamilies Springfield: Charles C Thomas, 1973, 399 pp., $18.50 cloth, $14.95 paper.

In this fascinating collection of clinical studies the authors illustrate how the principles of learning are applicable to a wide range of human situations. If the reader can shake off the image of the trained seal honking horns in harmony for the reward of a fish, he or she can appreciate how useful the techniques of behavior modification are.

The basic philosophy of the "behaviorist" psychologist is summed up by Drs. Kanfer and Saslow in their article on behavioral analysis as an alternative to diagnostic classification when they state, "... the job of psychological treatment involves the utilization of a variety of methods to devise a program which controls the patient's environment, his behavior, and the consequences of his behavior in such a way that the presenting problem is resolved."

Such methods are described in great detail, and the inference made throughout this collection of articles that standard psychotherapy falls short of resolving problems is not subtle. If the clinician desires rapid removal of an unwanted symptom he or she should consider behavior therapy. After all, what pediatrician would not like to cure enuresis in seven days without the use of drugs or alarm systems?

The techniques used to resolve such problems, simplistically put, involve the use of positive reinforcement (tokens, candy, praise, money, stars on a chart) and aversive conditioning (mild electroshock, punishment, withdrawal of privileges, etc.) after a period of observation of the patient's behavior. Such conditioning is directed toward a specific symptom or symptom complex.

The range of the book is extremely broad, covering most phases of clinical work. The language of the text is highly technical, and the first chapter is devoted to a helpful glossary that must be referred to frequently in order to avoid confusion. Seven sections are presented. The first includes the chapter on definitions, an article on behavioral analysis, and another on interview and evaluation procedures.

Section II deals with behavioral approaches to some common and not so common problems, such as school phobia, enuresis, encopresis, anorexia nervosa, and obsessive compulsive neurosis. Section III presents four articles on behavioral classroom management, which can be of special interest to the pediatrician who has more than a passing relationship* with school systems.

Sections IV, V, and VI deal with behavior therapy in groups. Section VI is especially informative in describing how parents can be used as therapists in the home for such problems as dyslexia, sibling rivalry, and asthmatic attacks.

Section VII is devoted to therapy in psychotic children ; it presents striking evidence of how behavioral techniques can help improve behavior and learning in these patients. For the interested student additional readings are offered in the form of an annotated bibliography. The articles themselves are well selected. Each is a carefully constructed experiment designed to solve a particular problem and illustrate a particular behavioral technique.

This is a superb work for the student of clinical psychology. Pediatricians probably use more of these techniques, without realizing it, than any other practitioner. It is difficult to argue with a system that promotes learning through reward and praise and demon^ strates how effective properly managed punishment can be.

This reviewer would not like to get involved with the controversy surrounding behavioral versus standard psychotherapy. We can only object to the feeling we get of the child as laboratory animal. Behavior therapy involves much attention and work on the part of therapist as well as parent -attention and…

James M. Stedman, Ph.D., William F. Patton, Ph.D., and Kay F. Walton, M.S. CLINICALSTUDIESIN behavior therapywith children, adolescentsandtheirfamilies Springfield: Charles C Thomas, 1973, 399 pp., $18.50 cloth, $14.95 paper.

In this fascinating collection of clinical studies the authors illustrate how the principles of learning are applicable to a wide range of human situations. If the reader can shake off the image of the trained seal honking horns in harmony for the reward of a fish, he or she can appreciate how useful the techniques of behavior modification are.

The basic philosophy of the "behaviorist" psychologist is summed up by Drs. Kanfer and Saslow in their article on behavioral analysis as an alternative to diagnostic classification when they state, "... the job of psychological treatment involves the utilization of a variety of methods to devise a program which controls the patient's environment, his behavior, and the consequences of his behavior in such a way that the presenting problem is resolved."

Such methods are described in great detail, and the inference made throughout this collection of articles that standard psychotherapy falls short of resolving problems is not subtle. If the clinician desires rapid removal of an unwanted symptom he or she should consider behavior therapy. After all, what pediatrician would not like to cure enuresis in seven days without the use of drugs or alarm systems?

The techniques used to resolve such problems, simplistically put, involve the use of positive reinforcement (tokens, candy, praise, money, stars on a chart) and aversive conditioning (mild electroshock, punishment, withdrawal of privileges, etc.) after a period of observation of the patient's behavior. Such conditioning is directed toward a specific symptom or symptom complex.

The range of the book is extremely broad, covering most phases of clinical work. The language of the text is highly technical, and the first chapter is devoted to a helpful glossary that must be referred to frequently in order to avoid confusion. Seven sections are presented. The first includes the chapter on definitions, an article on behavioral analysis, and another on interview and evaluation procedures.

Section II deals with behavioral approaches to some common and not so common problems, such as school phobia, enuresis, encopresis, anorexia nervosa, and obsessive compulsive neurosis. Section III presents four articles on behavioral classroom management, which can be of special interest to the pediatrician who has more than a passing relationship* with school systems.

Sections IV, V, and VI deal with behavior therapy in groups. Section VI is especially informative in describing how parents can be used as therapists in the home for such problems as dyslexia, sibling rivalry, and asthmatic attacks.

Section VII is devoted to therapy in psychotic children ; it presents striking evidence of how behavioral techniques can help improve behavior and learning in these patients. For the interested student additional readings are offered in the form of an annotated bibliography. The articles themselves are well selected. Each is a carefully constructed experiment designed to solve a particular problem and illustrate a particular behavioral technique.

This is a superb work for the student of clinical psychology. Pediatricians probably use more of these techniques, without realizing it, than any other practitioner. It is difficult to argue with a system that promotes learning through reward and praise and demon^ strates how effective properly managed punishment can be.

This reviewer would not like to get involved with the controversy surrounding behavioral versus standard psychotherapy. We can only object to the feeling we get of the child as laboratory animal. Behavior therapy involves much attention and work on the part of therapist as well as parent -attention and work that perhaps were missing in the first place. That the methods work, and that problems are quickly resolved, no one can question. But can behavior therapy give an unwanted child love, the neglected child care? There must be more.

10.3928/0090-4481-19740701-09

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