Most psychiatrists who assess and treat child patients see anxious children daily. This comprehensive book serves to stimulate the clinician to view the phenomena we encounter in office practice from several perspectives.
The editors, Dr. Silverman of Florida International University and Dr. Treffers of the Leiden University Medical Center, have worked with the presenters at a May 1997 international research conference to produce a well-integrated volume. In addition to the 12 chapters based on presentations at the conference, they have included four others. One of the added chapters is a historical overview of how anxiety and its disorders in children and adolescents were viewed before the 20th century. In this chapter the editors remind us of the importance of societal factors in the appraisal of many clinical presentations.
The other three added chapters consider the neuropsychiatry underlying pediatric anxiety disorders, child-parent relationships (with emphasis on attachment theory), and the pharmacological treatment of pediatric anxiety. Most of the authors of the additional chapters are North American, but the conference-based chapters were prepared by a diverse international group representing five European countries and Israel.
Of particular interest is the chapter by Drs. Fonsecca and Perrin, who discuss the classification and assessment of childhood and adolescent anxiety disorders. They contrast the DSM/ICD categorical approach with the dimensional view of anxiety as occurring on a continuum of severity. Taking developmental and cultural factors into consideration, they conclude that “a comprehensive assessment should include several self-report measures for the child and a structured interview.” Epidemiology is reviewed by Dr. Verhulst, who emphasizes the prevalence findings in the general population (6%–10%) and contrasts that with the 2% who were evaluated as functionally “handicapped.”
Clinicians will naturally gravitate toward the two chapters that discuss the treatment of anxiety disorders. Drs. Silverman and Berman review the research literature on psychosocial interventions. The excellent review of pharmacological treatment of pediatric anxiety disorders is written by Drs. Stock, Werry, and McClellan. With a table on benzodiazepines and a table on a variety of other medications, this chapter could well serve as a concise reference for clinicians of all disciplines.
The last chapter, written by Dr. Klingman of Israel, considers prevention of anxiety disorders and has posttraumatic stress disorder as its main focus. Dr. Klingman relates his experiences in helping families and children go through traumatic events successfully (i.e., with minimal resultant anxiety). His five-level model of prevention serves to provoke our thoughts of how we can help today’s children as they develop in these troubled times.
Research possibilities, the importance of complete, developmentally relevant assessment, and the need for improving and using preventive strategies for anxiety disorders are all brought to our attention in this book.
