Chess, S., and Thomas, A., eds. ANNUAL PROGRESS IN CHILD PSYCHIATRY AND CHILD DEVELOPMENT New York: Brunner/Mazel, 1975.
In this edition, the seventh in their excellent series, Drs. Chess and Thomas have again demonstrated their ability to identify current issues of significance to pediatrics and to child psychiatry and to gather together material of importance to practitioner, medical educator, and investigator alike. Their criticai judgment is evident both in what they have included and in what they have omitted from the enormous volume of papers that yearly flood the literature.
The articles are arranged under topical headings that embrace the entire spectrum of development from infancy through adolescence. The range is broad and inclusive. Subjects of special pertinence to current social concerns are well represented: cross-cultural studies of sex-role differentiation, testing for competence rather than "intelligence," an evaluation of Head Start, the effects of maternal employment on the child, therapeutic abortion in adolescent girls, identification problems of the Plains Indian adolescent, child abuse, and the civil rights of mentally ill and mentally retarded children. Organic brain dysfunction and learning disabilities are subjects that recur under a variety of topical headings - including "Learning Issues," "Brain Dysfunction," "Clinical Issues," and 'Tsychopharmacology" - attesting to the continuing importance of this subject and the multiplicity of unresolved problems attendant upon it.
Certain contributions are outstanding in this collection. The article by Rubin, Rosenblatt, and Balow on the psychologic and educational sequelae of prematurity has important implications for perinatologists, pediatricians, psychiatrists, and educators. The same groups would find Sécher, Faro, and Windle's study on asphyxiated monkeys a classic in research design as well as in clinical implications for human infants. Gottfried's critical review of the literature dealing with intellectual consequences of perinatal anoxia should be studied by every clinical investigator in this field before clinical study is undertaken.
Three articles are especially important for the insights they provide into special psychologic problems of childhood and adolescence. Poznanski deals with fears in childhood with exceptional clarity, in a presentation that manages to be lucid without sacrificing depth. Schowalter, Ferholt, and Mann describe with great sensitivity a terminally ill adolescent's decision to die, conveying their own ambiguities and difficulties as well as those of the patient. Allen's contribution on the Plains Indian adolescent transcends the specific ethnic problems and serves as a paradigm for all adolescents searching for autonomy, self-identification, and union with society.
To balance the picture, one would have to note that review articles on fields in which the author has not himself done original work come off less well. Thompson, on learning disabilities, does not convey a sense of personal experience or observation - in contrast, for example, to the work of Wolff and Hurwitz, who report actual studies.
Another example of derivative work that lacks the ring of authenticity is the article by Grinspoon and Singer on the therapeutic use of amphetamines in hyperkinetic children. Although the authors have done a thorough review of the literature, their bias (against) conveys a polemical rather than a scholarly flavor. They find it "impossible to believe that the 200,000 or more school children who are now being routinely administered stimulants are all [sic] suffering from organic brain damage of deficiencies in crucial CNS chemicals." Pediatricians and child psychiatrists who care for the urban poor in such districts as central Brooklyn would have to dissent from that view. This is not "impossible to believe" when one takes into account the high prevalence of perinatal hazards (teenage pregnancies, inadequate prenatal care, prematurity, small-for-dates babies, excessive multiparity) and environmental hazards (infection, malnutrition, exposure to lead, accidental injury). No doubt Needleman, who discusses subclinical lead poisoning - with its implications for neurologic deficits and learning problems among the urban poor - would also have no difficulty "believing" the high prevalence of organic brain syndromes.
Taken as a whole, this volume has everything to recommend it: breadth, depth, selectivity, and pertinence. It is a book to own and use. Although some of the problems raised will eventually be resolved, the articles chosen and the topics selected will have lasting importance in developmental and behavioral pediatrics.