Gross, M. B-, and Wilson, W. C. MINIMAL BRAIN DYSFUNCTION New York: Brunner/Mazel, 1974, 206 pp., $10.95.
This book is a report on neuropsychiatrie, psychologic, and electroencephalographic data collected from more than a thousand children who were consecutive patients at the Fox Valley Mental Health Center in Elgin, Illinois, over a period of years.
The purpose was to analyze and delineate more precisely the nature of the minimal brain dysfunction syndrome (MBD), and to determine what laboratory and clinical correlations exist, as well as what treatments are effective.
The setting and uniformity of the patient population are ideal (almost entirely lower-middle and middle class). Controls with normal schoolchildren were established, derived from schoolchildren in the same geographic area.
Based on the statistical treatment of their data, the authors concluded that MBD represents a real and very common disorder, whereby restlessness and distractibility are major differentiating factors. EEG data are found to be useful in reinforcing one's clinical impression, but too crude to be relied on in toto. The treatment of this syndrome is documented by careful and detailed descriptions of various agents used, such as stimulants, nonstimulants, anticonvulsants, and major tranquilizers.
In a chapter on the efficacy of therapy, they discuss in detail the type and dosage of the various agents used, and stress the need and outline the criteria for increase, change, or combination of various agents. They are reassuring in reporting on their findings about adverse effects - such as those on blood pressure, personality, and addiction - which they consider to be minimal to zero.
It goes without saying that in a study of this kind, which tries to pull together so many data, one is left open to criticism. The authors, to their credit, tend to be open-minded. One, for example, takes issue with their artificial groupings of EEG data. Group 4 appears to be quite a mixed bag of abnormalities, which raises questions as to the validity of its statistical elaboration. Equally subject to question is their rather biased comment, on the Lombroso study, about "residential" schools, which they consider to be centers of behavioral and learning problems. The school in this instance does not appear to be of that type.
Psychotherapy is written off as useless, except for adolescents "in a number of cases." Indications for such treatment are not discussed. One is somewhat skeptical about this rather dogmatic statement, because it is difficult to imagine that children, as described in this monograph, would not have to cope with significant difficulties in their psychosexual development.
Unfortunately, control data derived from agencies dealing with either a merely psychotherapeutic or mixed psychotherapeutic and chemical approach are not available.
In summary: The authors have done a laudable job of focusing in on this most complex problem, communicating a great deal of practical data based on their long and varied experience in this field. The book will be of particular interest to those involved with children, either as physicians or as teachers.