98 BOOK REVIEWS

V. P. VARMA (Ed.): Anxief,v in Children. Croom Heim, London (1984). 222 Pages. f 14.95.

This book contains 12 chapters concerned mostly with the analysis. from wide& differing perspectives and in different situations, of anxiety and fears in children. Only ane chapter, written by Martin Herbert from a behavioural standpoint. tackles treatment of these problems in any extensive and systematic way. The topics include: anxiety about spiritual issues. written by a priest; anxiety about death and illness and its treatment; anxiety about school and learning; family influences on anxiety; and three chapters on investigation by psychometric tests, interview and projective techniques.

Many of the contributions appear to be informed principally by clinica! wisdom and in many cases this appears to have been derived second hand, several of the chapters drawing extensively on other authors’ reviews. especially of a

psychodynamic nature. Those chapters which could have drawn an extensive empirical research on the treatment of childen’s anxieties are

particularly disappointing because they almost entirely ignore such work. The chapters on anxiety about illness and its treatment and about school and learning are particularly disappointing in this respect.

This book could be regarded as a source of interesting hypotheses and speculation about childhood anxiety but for more reliable material, especially about the treatment of these problems, there are more helpful books currently in print.

D. J. MULLER (Ed.): Remediaring Children’s Lmguage. Croom Helm, London (1984). 256 Pages. E16.95.

Language is a behaviour which finds expression through the workings of voluntary muscles. As such it was exposed to functional an&is by Skinner about 30 years ago. Chomsky’s subsequent attempt to discount this approach, in bvour of a mentaXistic and rationalistic model, met with considerable support, and his views have been widely accepted.

This book advocates a revival of the use of Skinner’s operant techniques to rehabilitate early language disorders, and proposes that the child’s familiar daily environment provides the optimal setting for treatment. It is edited by Dave Muller, a psychologist specializing in remediating language, and is divided into three main sections.

In the first, language is discussed as a voluntary behaviour which obeys conditioning laws, The second and most readable chapter is written by D. F. Mowrer, and he succeeds in lucidiy condensing complex issues relating to the behavioural model. He then reviews recent work on the application of these methods to the treatment of Ianguage disorders, with an emphasis on educationaf context. The role of social and cultural facsors in speech development is addressed in Chapter 3, and current research in pragmatics, exploring speech as an interactive tool, is presented.

While Section 1 orobes the theoretical foundations, Section 2 is devoted to their therapeutic applica6ons. Of particular interest to therapisis and clinicians is the step-by-step guidance through the “Lincoln interact&e Profile”, a means for individual assessment of children either exhibiting, or at risk for. developing a communication disorder. This technique has the advantage of reducing the traditional narrative nature of assessments in favour of objective quantification by one or more clinicians, and lends itself to computerized storage. The importance of the mother or primary caregiver is emphasized, and the screening procedure is centred around the interactive dyad.

The relationship between caregiver and child is further explored in a therapeutic context by the next two chapters. Parents are considered as important collaborators in therapy, in the light of their current interaction with the child, and as helpers in treatment.

Although improvement of speech is the appropriate goal for much therapy, in some cases dysarthric, dyspraxic or autistic children may benefit more from the introduction of non-speech systems as communication enhancers. Such supplementary systems as picture-boards, cued-speech and various sign languages are briefly defined, and guides for their implementation are set out.

In the t’inaf section, four remedial fanguage programmes applicable to the severely mentalfy handicapped are critically evafuated. The Makaton programme, based on British sign language, receives special attention due to its widespread use in the U.K.

In the concluding chapter, John Harris supports the case for parental involvement in therapy directed towards facilitating development. He sums up the whole orientation of the book by stating: “The problem for the language clinician is thus not simply one of playing a better game within the established rutes. Instead, it is the more difficult problem of persuading the other players of the need to change the rules.‘”

GENA H. CO~JNALLY

Transient psychosis is a concept embodying widely disparate elements, including ‘micropsychotic episodes’ lasting, perhaps, a few hours and ‘acute exacerbations of schizophrenia and mania’. In attempting to produce a concise account of the subject, the editors must therefore be credited with great courage. To the proMem of definition must be added the difficulty that as an episode of psychosis can only be described as transient once it is over, the diagnosis of transient psychosis can never be made in a patient actually suffering from it. Lastly, the book addresses itself lo the group of patients known as ‘borderline’ and admits that about this group there is ‘conceptual, diagnostic, etiofogical, therapeutic and prognostic confusion’. The authors do littfe to improve this sorry state of affairs. it may reasonably be supposed, therefore, that the

BOOK REVIEWS 99

editors have taken on an impossible task. The result is a work replete with long lists of differential diagnoses, flow-charts and detailed tables, a great deal of advice based on the extensive clinical experience of the authors, a pronounced dearth of hard evidence from controlled trials, and a few outstanding chapters which could serve as valuable sources of reference.

The book is organized into four sections, addressing concepts and definitions. aetiological factors, vulnerable populations and evaluation and management. In the first section, the difficulties of defining the concepts are well-reviewed, and perhaps best illustrated by a ‘Map of the Universe’ of borderline states in Chapter 2 which is divided into nine regions and two realms in order to accommodate the differing usage of the terms by different authors. The second section provides an excellent review of drug-induced psychotic reactions and of medical causes of acute psychosis. A chapter on cultural factors unfortunately misses an opportunity to provide a well-documented description of the various culture-bound syndromes presenting an acute psychoses. The third section, on transient psychoses in personality disorders, children and the elderly, is in general disappointing. Some interesting and graphic case histories are presented but data on epidemiology, genetics and prognosis are lacking. The section on management includes a section on forensic aspects which demonstrates the art of defensive psychiatry, well-developed in the U.S. but becoming increasingly relevant in the U.K. and makes the useful statement that ‘patients who like their doctors seldom sue’. A paper on catatonia demonstrates that the syndrome is not as rare as is widely supposed and in another chapter, making a plea for more referrals, an author charges the general practitioner with being an ‘over-restraining filter’. Most psychiatrists, in contrast, greatly appreciate this filtration system and would certainly not encourage an increase in the pore size.

In spite of its shortcomings, the book provides a wealth of clinical descriptions and wisdom, which will be of value to therapists working with the groups of patients described.

PAUL ROBINSON

J. DUBBING (Ed.): Scienrr@c Studies in Mental Rerardution. Macmillan, London (1984). xvi + 592 Pages. E59.00

This book is a collection of papers presented at the First European Symposium on Scientific Studies in Mental Retardation, held at Lincoln College, Oxford, in 1983. The papers had been circulated to selected experts prior to presentation and their critical comments are included at the end of each paper.

The diversity of the subject matter illustrates clearly how no one discipline could or should dominate this field. The papers cover epidemiology and prevention, biomedical research, cognitive and linguistic research and psychosocial and service aspects. In general all papers appeared to me to be of a particularly high standard. With some effort they are comprehensible to those outside that particular field yet comprehensive enough for the expert, giving a valuable review and list of references. The chapters on epidemiology in the first section are a clear and valuable overview for individuals of any discipline working with the intellectually impaired. The more specific chapters are useful if you are trying to understand some specific aspect of handicap such as autism. Taken together they encourage a view of mental handicap that encompasses the areas of developmental pathology (delay vs difference), illnesses causing handicap, genetics and the effects (positive and negative) of the family, education and prejudice.

For those involved in behavioural treatments there are useful chapters on motor skills, development of communication and cognition and family processes, to mention a few.

This book is not for light reading, but for reference and as a useful start for those developing a particular interest in some aspect of mental retardation. It is informative and challenging. The editor and his team are to be complimented on this. If there is any criticism it is of the layout and typeface which do not encourage one to persevere in the face of difficulties in understanding the complexities of linguistic research or neurochemistry! It is expensive at E59.

A. HOLLAND

C. R. HOPPER and R. E. DUNKLE: The Older Aphasic Person: Strategies in Treatment and Diagnosis. Aspen Systems Corp., Rockville, Md (1984). viii + 229 Pages. f34.95.

The book represents the combined effort of a social worker and a speech-language pathologist both with academic and clinical background in gerontology.

The book is divided into six chapters. The first two provide basic information on linguistic, neurological and psychological aspects of language with special reference to the problems of elderly Ss. Chapter 3 discusses the disorders that mimic aphasia. It deals with differential diagnosis attempting to provide clinical pointers to distinguish between dementia and depression. The last three chapters deal with the problem of rehabilitation. Chapter 4 is of interest in that it provides a brief account of the different methods of treatment available whilst Chapters 5 and 6 are concerned with the services provided by different departments and therefore it is only applicable to the social structure of the U.S.A. The book provides illustrative case histories in Chapters 2, 3 and 6. It is helpful to find in one book concise information of the language problems encountered in elderly Ss and for this reason it will be of help to psychologists and psychiatrists working in the field of old age.

MARIA A. WYKE