THE PSYCHOLOGY OF UNDERACHIEVEMENT: DIFFERED DIAGNOSIS AND DIFFERENTIAL TREATMENT H. P. Mandel and S.I. Marcus New York. NY. lohn Wiley & Sons, 1988. 597 pages.
The general thesis of this broad review is that nonachicvement syndrome (NAS), rather than being an entity in and of itself, is actually a disorder stemming from multiple causes. Through the investigation of these causes and the determination oï a diagnosis and a treatment program the authors subscribe to the medical model of illness.
Alter the initial interview the first step in the assessment process is to establish what level of personality development the individual has attained. In identifying such levels the authors draw on a variety of developmental theories rather than relying wholly upon one school, such as that of Freud, Rogers, Erikson. etc.
The second step is the classification of the subject into one of four major personality types: overanxious disorder, conduct disorder, academic problem disorder, and identity disorder. Each of these personality types will have its unique shaping effect upon the diagnosis and upon the optimal treatment plan.
The third step is to reach a differential diagnosis and a differential treatment design. The assessment progresses through several stages: the "observation." the "'dynamic," and the "treatment" diagnoses. Alter consideration of the limitations imposed by environmental, social, motivational, and idiopathic personality factors one arrives finally at a "practical" diagnosis - a formulation that is tantamount to a treatment prescription.
This is a well-written book that will probably have more appeal for the advanced clinician or the research-minded reader than for the average therapist who deals with educational problems of youth and adolescence. The latter will undoubtedly be enlightened, however, by the exposition of a truly comprehensive approach to a diagnostic methodology. Each chapter in each of five sections has ample documentation (a bibliography of over 1000 references occupies the last 62 pages of the book).
One disappointment is the paucity of outcome data relating to improved achievement levels, especially when the most comprehensive differential diagnostic approaches were reviewed. As to changes in underlying personality attributable to treatment the authors themselves state. "There has also been an absence of more rigorous follow-up research." In commenting about the overall approach to the nonachicvement syndrome which the authors find to be the most thorough and expethent, they point out that "this procedure is time-consuming and requires not only a high degree of general clinical experience, but also expert professional training in this type of differential diagnosis."