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J Can Acad Child Adolesc Psychiatry. 2009 August; 18(3): 261.
PMCID: PMC2732734

Assessment of Childhood Disorders, Fourth Edition Eric J. Mash, Russell Barkley Editors. The Guilford Press: New York, NY, 2007. 866 pp, US $85.00.

Reviewed by Hilary Le Page, MB, ChB, FRCPC

In this edition, 33 North American authors in 17 chapters aimed to give a best practice approach to the evaluation of childhood disorders using the best and most cost effective measures. There are seven sections: the first being on assessment of child and family disturbance and described as a state of the art conceptual framework, emphasizing strengths as well as deficits. Other sections are on behavioural disorders including substance use and abuse, mood disorders and suicide risk, anxiety disorders, developmental disorders including early onset schizophrenia, children at risk, and lastly problems of adolescence. There are 6 entirely new chapters from the previous edition including those on post traumatic stress disorder, bipolar disorder, suicidal and self harming behaviour, early onset schizophrenia and personality disorders. This book is marketed as an invaluable reference for any mental health clinician or researcher who works with children, adolescents and families.

My aim in reviewing this book, as a psychiatrist in a community clinic, was to update my knowledge, in order to have a more informed discussion with my psychology colleagues and to select better assessment instruments given the budgetary limitations and paper overload from which we and our patients suffer. Would it also allow me to better solve the diagnostic dilemmas I so often face around complex cases and comorbidity challenges? Was it practical? Did the authors validate the methods, measures and questionnaires that I had found useful during the course of my career?

Most chapters followed the same format with an overview of recent research on the disorder, DSM IV diagnostic criteria, discussion of aetiology and developmental features. The author then discussed assessment considerations including identification of the purpose of the assessment, whether for research, clinical setting or screening, diagnosis and case formulation, treatment design and planning, and treatment monitoring and treatment evaluation (Mash and Hunsley, 2005). Assessment methods including diagnostic interviews (unstructured, semi-structured and structured), self-report and clinician rating scales, parent and teacher and sometimes peer ratings were discussed with a description of strengths and difficulties of each measure. Observational measures were described where appropriate. Chapters were extensively referenced and two chapters had appendices which I associated with added value. One chapter had sample clinic forms and one had a more detailed description of measures including from where they could be obtained. In each chapter there was something to add to one’s assessment repertoire providing one was able to access it. I found the inclusion of a chapter on personality disorder refreshing. Shiner, who wrote on assessing personality disorder, started by making a case for assessment of personality disorder in adolescents, arguing that there were potentially large costs involved in misdiagnosing adolescents with other disorders leading to improper prescription of medication and absence of treatment to target key symptoms. She also mentioned that the criteria involved in the evaluation of personality attributes deviated from what would typically be expected in a cultural context as well as being inflexible and enduring. She made a case for a dimensional model of personality pathology such as that for the Big Five personality traits (Costa and Widiger, 2002) of neuroticism, extraversion, and openness to experience, agreeableness and conscientiousness. She also mentioned the possibility of personality dimensions underlying both Axis I and Axis II disorders. There was no mention of the work of Jeffrey Young on early maladaptive schemas, a concept I have found useful and tangible. She included a useful table of measures for assessing personality traits in adolescents and from where they could be obtained.

This is not a book I would buy for a personal or clinical library, but would be useful as a departmental reference, especially if setting up a sub-specialty clinic. It was well written, but because the material to be covered relied heavily on references which could not immediately be accessed, I sometimes found it frustrating. I thought there was variability in chapter quality. It did leave me better informed in discussions with my psychology colleagues for whom I felt it was primarily written. In Australia there seems to be a profound sensitivity about who can actually administer and score various instruments and the training required to do this. Therefore, this might be worth more mention in future editions. I could find no mention of the Strengths and Difficulties Questionnaire by R. Goodman which we are forced to administer every three months nationwide in Australia to youths and parents as an outcome measurement in the CAMHS (Child and Adolescent Mental Health Service) system. I did not feel I got much help around the diagnostic complexities of ADHD whilst the chapter was really helpful around client engagement. It intrigued me that there was so little discussion around attachment and its assessment throughout the book. I was delighted when one author mentioned chart review in the context of the assessment of child sexual abuse and the need for a multi-gated, multi-informant, multi-variate and multi-method assessment, which really summed up the main theme of the book.

Regarding price in these times its value for money may depend on the exchange rate at time of purchase but it may be a bargain in Canada!

Articles from Journal of the Canadian Academy of Child and Adolescent Psychiatry are provided here courtesy of Canadian Academy of Child and Adolescent Psychiatry