Psychological and Developmental Assessment: Children WithDisabilities and Chronic Conditions. Edited by Rune J.Simeonsson and Susan L. Rosenthal. New York: GuilfordPublications, 2001, 386 pp., $60.00 (hardcover).

The untold benefits generated by advances in medical sci-ence during the past several decades have also been accompa-nied by serious, if unintended, consequences. The prolongedpublic political and social debate about the future of our healthcare system is being pushed largely by the enormous monetarycosts associated with new and expensive medications and sur-gical procedures, as well as the costs of end-of-life care for alarge and longer-lived post–World War II generation. Muchless attention has been paid to a parallel phenomenon, viz., therapidly increasing number of children with disabilities who arealive largely because of the progress in multiple medical spe-cialties, which permits the survival of many children who oth-erwise would have succumbed to premature birth, brain injury,cancer, and other life-threatening conditions. Indeed, we arefortunate to live in a society that has created a “new wave” ofdisabled individuals who might have perished in earlier times.At the same time, however, we are challenged to adequatelycare and provide for many of these individuals who have sur-vived but at the cost of suffering functional disabilities, par-ticularly cognitive and mental impairment.

Any plan or program to help disabled children with psy-chological or developmental problems must be based on anadequate and comprehensive clinical assessment, as opposedto simply “testing.” As the authors of this book point out, how-ever, there is only a limited body of literature on how to dothis. Hence, the purpose of this volume is to provide both gen-eral guidelines for assessment and specific techniques. Accordingly,the book is divided into sections on “Dimensions and Issues,”“General Strategies and Measures,” “Specialized Strategies andMeasures,” and “Ethical and Legal Issues.”

A preliminary, “overview” chapter offers both a clear ratio-nale for the need of specialized assessment approaches for dis-abled children, as well as a cogent discussion of some of the keyconcepts involved. These include the nature of “disability,” thelimitations of most current standardized instruments, and adescription of three general assessment strategies, viz., psy-chometric, “ecobehavioral,” and “qualitative-developmental”(Piagetian). How these three perspectives were selected to definethe universe of organizing assessments is not clear. More impor-tant, however, the authors are quite clear about the importanceof distinguishing inter- versus intraindividual differences andthe need for a comprehensive assessment to be both multi-variate and flexible in approach.

The first section, on “Dimensions and Issues,” consists oftwo chapters that address a number of areas uniquely impor-tant to the assessment of disabled children, including the mis-

leading use of labels such as “multiply handicapped” and theneed for environmental accommodations when administeringstandardized tests. These chapters also highlight the impor-tance of dimensional diagnoses with functional information,as well as the need for accountability in measuring progressand the challenge of attribution and relevance of change.

The second section, “General Strategies and Measures,” haschapters describing in depth the three general assessment strate-gies. The chapter on “Quantitative Assessment” contains adetailed discussion of specific instruments by age group andhas useful tables with examples of applications of various testsand practice recommendations for children with disabilities.The next two chapters present detailed information about theapplication of Piagetian theory to cognitive assessment and theuse of an “ecobehavioral” approach which focuses primarilyon modifying the environment either to enhance a child’s devel-opment or to decrease symptoms. In contrast to the specificityof these chapters, the final chapter in this section, “Assessmentof Family Context,” is disappointingly brief and superficial.

The third section, “Specialized Strategies and Measures,”will probably be of most use to clinicians dealing with indi-vidual patients. The chapter on “Assessment of Trauma andMaltreatment in Children With Special Needs” does not addsignificantly to the large body of literature available concern-ing this topic. The chapter is nonetheless important, however,for discussing the multiple causal pathways connecting dis-abilities and risk for maltreatment, as well as for warning thatbehaviors that signal abuse may be misattributed to the dis-ability. The next chapter, “Infant Assessment,” also overlapswith much that has already been written about assessment ofthis age group. What is most useful here is a thorough descrip-tion of the domains of assessment, e.g., cognitive functioning,although the section on assessment of attachment offers littlein the way of practical approaches.

Of the remaining six chapters in this section, five cover theassessment of children with motor, visual, hearing, and neu-rological impairments, respectively, and one discusses childrenwith chronic illnesses. Each chapter does a good job of ori-enting the reader to the most important medical conditionsinvolved and/or their causes, and describes special considera-tions for assessing children with these impairments and assess-ment priorities, as well as how to select or interpret appropriatetest instruments. The chapter on neurological impairment hasa particularly useful discussion of executive functions and “thedysexecutive child.” The remaining chapter in this section, con-cerning children with autism, seems singularly out of place inthis text. The definition of “autistic spectrum” versus perva-sive developmental disorders has itself been the subject of anextensive literature. The attempt to bring this large and com-plex topic under the umbrella of “disabilities and chronic con-ditions” falls short of a thorough brief review.

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J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 41 :8 , AUGUST 2002 1021

The final section, “Ethical and Legal Issues,” consists of onlyone chapter, but one that is well worth reading and a welcomeaddition to any text on clinical practice. The chapter succinctlytouches on a number of critical matters, e.g., informed con-sent, confidentiality, the competence of the examiner, federaland case law, the use of computer-assisted assessments andassistive technology, managed care, and respecting patients’dignity and privacy. These are topics of relevance to almost allchild patients, but they present specific challenges when oneis working with disabled children and their families.

This volume will be of particular interest to psychologists,and it may have been written with that professional audiencein mind (there are no physician contributors). Nevertheless,developmental pediatricians and child and adolescent psychi-atrists who have regular contact with disabled children in theirpractice will also find useful information, particularly withrespect to “assessing the assessment” done by nonphysicians aspart of a comprehensive evaluation.

Robert Racusin, M.D.Department of Psychiatry

Dartmouth Medical SchoolLebanon, NH

Children Who Remember Previous Lives: A Question ofReincarnation, Revised Edition. By Ian Stevenson. Jefferson,NC: McFarland & Co., 2001, 345 pp., $45.00 (softcover).

This book would probably go unnoticed by the Journal,except that it summarizes extensive psychological research involv-ing thousands of children over many years and was written bya distinguished psychiatrist and scholar. The author, Ian Stevenson,M.D., is the Carlson Professor of Psychiatry at the Universityof Virginia. Stevenson’s unsettling thesis is that there are manychildren who claim to remember previous lives and that theirstatements are evidence that human personality survives deathand returns in another body, i.e., reincarnation happens.

Although most Western psychiatrists would not give a sec-ond thought to the investigation of reincarnation, Stevensonhas been a serious and prolific student of this alleged phe-nomenon for 40 years. His seminal book, Twenty Cases Suggestiveof Reincarnation, was first published in 1966. Stevenson’s reg-istry of cases, in which young children have made statementsindicating they are the reincarnated personas of the recentlydeceased, holds about 3,000 files. Stevenson and his assistantshave studied children and families from most parts of the world,but especially Southeast Asia, the Middle East, northern India,western Africa, and the Tlingit tribe of Alaska and Canada.They have found that the typical, fully developed case has fivecomponents: an elderly person predicts that he will be rebornafter his death; after his death, a person dreams that the per-

son will return to a particular family; a baby is born and isfound to have birthmarks or perhaps birth defects that corre-spond to wounds or other marks on the body of the deceasedperson; when the child starts talking, he makes statementsabout the deceased person’s life; and the child’s behavior matchesthe behavior that would have been expected from the deceased.

Stevenson distances himself from more questionable meth-ods of investigating past lives, including past-life readings andhypnotic regression. He is generally skeptical about these meth-ods of studying reincarnation, but he does not dismiss them alto-gether. He downplays the reliability of déjà vu experiences,dreams, nightmares, and meditation for learning about a per-son’s previous lives. In making his case for the plausibility of rein-carnation, Stevenson particularly values “the spontaneous utterancesabout previous lives made by young children. With rare excep-tions, these children speak of their own volition; no one has sug-gested to them that they should try to remember a previous life”(p. 55). For collateral evidence, Stevenson cites many cases withphysical findings, that is, the child has a birthmark or a defor-mity in the same place as an injury or wound of the individualwhose personality the child has supposedly assumed.

So what does this have to do with mainstream child and ado-lescent psychiatry? First of all, this book provides a fascinating,comprehensive account of an interesting transcultural topic—reincarnation—and the role of young children in perpetuatingthis belief in many parts of the world. In some cultures—suchas the Hindu, Buddhist, and native Alaskan—reincarnation ispart of the belief system and the childish statements of sup-posedly reincarnated persons keep the beliefs alive. Second,Stevenson emphasizes that reincarnation, if it were true, wouldprovide an explanation for a number of clinical and behavioraloddities in children (for example, phobias in young children:perhaps a little girl is intensely afraid of knives because in a pre-vious life she was stabbed to death). Stevenson cites examplesin which a child’s unusual interests, a child’s unusual aptitude,certain addictions and cravings, precocious sexuality, and gen-der-identity confusion might be explained by reincarnation.

Stevenson’s research also relates to an important clinical andforensic issue in child and adolescent psychiatry—the credi-bility of young children. In his investigations Stevenson asks,Is this child telling the truth when he insists that he remem-bers a previous life in a nearby village? Stevenson is aware thatfrauds and hoaxes are possible, such as a family who claimedfor the purpose of notoriety that their child was the reincar-nation of John Kennedy. He knows that false memories maycome about through the mechanisms of misattribution, sug-gestion, and bias. For instance, he notes that parents who arebelievers may ask their young children leading questions.However, Stevenson appears to have an overly simplistic viewof how suggestion and indoctrination take place. He knowsthat adults may question children in a suggestive manner, buthe does not address how easily parents can do this without any

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1022 J . AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 41 :8 , AUGUST 2002