Review of "Phobic and Anxiety Disorders in Children and Adolescents"
By Thomas H. Ollendick and John S. March (Editors) Oxford University Press, 2004 Review by Roy Sugarman, Ph.D. on Oct 23rd 2005
As with so many recent works, these editors set out to "bridge the
gap" between evidence based, scientific approaches, the academic royal
road to expertise, and the pragmatic, most useful way of doing things from a
clinician's perspective. Perhaps
uniquely, these authors contrived to have at least a psychologist and
psychiatrist write each chapter as a way of appearing multidisciplinary, to
gain the perspective of each in each chapter, often with multiple authors.
In this way, the 19 chapters address the increasingly fragile population
of modern children, but inevitably, still following the model that these
children are possessed of some illness entity, some sickness, without really
engaging in a meaningful discourse around the morbidity in social settings, and
no mention of social capital and other epidemiological work is effectively
entertained. Social phobia, yes, social
capital no. If one becomes ill, this is
internally systemic, and treated in this way.
Miller and others (see the review
of Facing Human Suffering) have a different slant on things in
balancing, or at least confronting, the "bridge", as does Weisz, with
a specific approach to children and adolescents (see the review
of Psychotherapy for Children and Adolescents: Evidence-Based Treatments and Case Examples).
In this book, even Ferdinand et al's chapter 16, dealing with prevention
and intervention, makes only passing reference to society, and its demands, by
demonstrating primary intervention to be a form of preparation of schools and
other settings to deal with vulnerable individuals. Vulnerable here then
implies that there are those who will get ill, all things being equal, and
those that will not.
A more modern approach perhaps, is that there are certainly vulnerable
brains which will become ill in even normal settings, but that there are also
normal brains which will become unsettled in extreme settings, and there is no
shortage of this in today's world. And of course there are vulnerable brains in
extreme settings too. There is also the
question of the pressure of modern society representing a less than normal,
more than extreme setting in everyday experience, and then of course there is
the breakdown of family, decline in values that rely on religious opiates, and
drugs, environmental toxins and so on, hence the rising rate of psychiatric
conditions in each successive generation of children.
These Ch 16 authors do mention "interventions may aim to strengthen
coping and problem solving strategies" but again, little mention of what
may happen beyond the individual, and certainly another issue: for many Western
countries in the world, smaller numbers of local medical and nursing graduates
entering the postgraduate training programs.
The nature of the work has changed, and shortages of mental health
workers in the medical fields, if not psychology, are now common. Countries like Australia cannot meet their
mental health nurses and psychiatry registrar quotas and must recruit far and
wide. And then there is the recovery
movement and its input on behalf of the philosophy of consumers of these
services. Finally, many Western countries have a backward view of the value of
psychological input and its burgeoning evidence base, and the most uncertain
value medication in remission, versus improvement.
Controversies also abound with regard to ADHD and other contentious
diagnostic and treatment entities, and other authors such as Scott Lilienfeld
and colleagues have pointed out the thinness of the science which is
overrepresented in this book as more competent than clinicians believe it to be
(see the following books by Scott and others Rethinking ADHDand also Science and Pseudoscience in Clinical Psychology
However, the book stays true to itself and its market
in most competent ways, with three sections dedicated to Foundational issues,
Assessment and treatment of specific disorders, and predictably, future
directions for research and practice, without really doing much real
"bridging" as the other books above may have done in a somewhat more
direct and philosophical way.
Part one describes diagnostic issues, etiology of fear
and panic, development and epidemiology of anxiety disorders, developmental
issues, and comorbidity of childhood and adolescent anxiety disorders, from a
prevalence point of view, finishing with a combined psychosocial and
pharmacological approach, written by March and Ollendick themselves. This is the best chapter in the book, as the
In a perfectly evidence-based world, selecting an
appropriate treatment from among the many possible options would be reasonably
straightforward. However, in the
complex world of clinical practice, choices are rarely so clear-cut ...
expected outcomes vary by disorder, by treatment modality, and certainly by
factors specific to the child, the clinician, and the setting(s) in which they
live and work (p. 141).
A lessons from the clinic section follows in this
chapter, emphasizing the importance of differential therapeutics, rating
scales, the limits of tailoring treatments, dose-response and time-response
issues, the monitoring of desirable and undesirable outcomes, emphasis on psychoeducation,
all well done but far too brief. A huge
decision tree is provided in the practice guidelines section for OCD as an
example, very comprehensive, and this book would've been stronger with more of
this discussion and integration.
Section II consists of chapters dedicated to phobia,
social anxiety, school refusal, separation anxiety, child onset panic disorder,
generalized anxiety disorder, OCD, PTSD and selective mutism. Again, unlike Weisz and others, the discussions
are heavy on research, assessment, diagnosis, and light on how-to-do this and
how to actually sit down and confront the issues, e.g. school refusal. Novice psychologists confronting the
conditions for the first time would be hard-pressed to find the manual in the
chapter, of lets say what to do on day one.
These are academic chapter's hell bent on informing, and there really
are lots of those around. Few are as
integrated as they need to be, and all assume that the reader will receive
training from somewhere else, a workshop, which will provide. They will tell us Kendall 1990 did something
with this or that condition, and of course we might have to then seek out
Kendall. What Kendall and colleagues
produced is not discussed; there are no windows that set out in stepwise
cookbook fashion what the approach was, or how it works.
Edited books like these, with around 140 references
per chapter are great reference sources, but after reading, they go on the
shelves with not much further need.
Books such as Weisz's are likely to hardly rest there for many moments
before being whipped out, heuristically useful as they are, with much more
pragmatics, much less aesthetics, although they balance the divide better then
This is then for me the divide between the edited
textbook-like March and Ollendick offering from Oxford, and the paperback I-
wrote- it- all- myself work such as John Weisz's offering from Cambridge
University Press: I know who wins the race in dealing with the same subject
matter. In the editing, March and
Ollendick's authors have trotted out the litany of things they must, but as
Miller pointed out, the student will be left disappointed and not really
informed or equipped. On the other
hand, John Weisz wrote it all himself, structured and organized each chapter himself,
and the result is an immediate reference guide for the serious clinician who
wants to know the evidence base, and also, really accurately, what to then do
with the results of those offerings, and not to have to go to Kendall and find
out what the application really was.
Read both offerings, of similar lengths, and the Weisz
offering is the most valuable in terms of bridging the gap between the evidence
base and clinical practice, where children and adolescents are concerned.
This does not imply that the March/Ollendick offering
is not a superior, competent work in itself: it just does not compare in what
it says it sets out to do, comparing it to books of similar length, published
in the same year, and setting out the same parameters and ambitions. Weisz's organization is also superior, given
his control over all the chapters as writer, and his reference sections at the
end are superior, breaking down authors and subjects into separate sections,
and then by page numbers. Weisz also
went wider, bringing in communications theory, from the sixties, existentialism
from Buber and others, wide ranging far beyond the March/Ollendick parameters,
and paying more than lip service to clinical applications, in detail.
Both books serve their purpose admirably: I know which
one I would buy however, and which one will get used most often, with telling