Dulcan's Textbook of Child and Adolescent Psychiatry

The field of child psychiatry has historically been fraught with controversy and stigmatization, yet this text offers hope in its presentation of a comprehensive and contemporary evidence base, supporting best-practice approaches for the assessment and treatment of youths with mental illness. One is struck by the scope and depth of the text, which leave the reader feeling empowered and inspired by how far the field has come in establishing a solid, scientifically rigorous reservoir of knowledge to guide one's practice. This text bears little resemblance to its previous edition, in that 56 of 65 chapters feature new lead authors. It is enormously expanded in its scope, with the addition of over a dozen new sections and an increase in chapters devoted to treatment, from seven to 18 chapters. Emphasis was clearly given to ensuring the authors' reliance on the most current evidence base, along with developmentally informed approaches with practical applications.

Some examples of domains in which substantial progress has been made in recent decades include pediatric psychopharmacology, functional and structural brain imaging, and genetics and epigenetics. The involvement of industry in pediatric psychopharmacology research was limited until the enactment of legislation providing pharmaceutical companies with an additional 6 months of drug patent exclusivity protection in return for conducting specific studies in children. The legislation, which was initially enacted in 1997 and then confirmed and expanded in 2002 and 2007, provided a powerful incentive for industry-funded pediatric research. The impact was substantial, as demonstrated by industry sponsorship of more than 300 pediatric studies from 1998 through May 2008. The exponential increase of controlled trials of medication in pediatric populations has vastly improved clinical outcomes, with an expanded evidence base regarding pharmacokinetics, efficacy, and safety.

The literature available on functional and structural brain imaging has likewise burgeoned, particularly during the past two decades. Until recent years, functional imaging studies could not be ethically performed in children because of the risk of exposure to radioisotopes. However, recent advances in imaging technology, which circumvent the use of radiation, have increasingly paved the way for the inclusion of adolescents, and even younger children, in such trials, helping to inform the field regarding the neurophysiology and structural implications of childhood psychiatric disorders. Finally, with the successful completion of the Human Genome Project and advancing technologies related to identifying and understanding genetic processes, the field has seen tremendous progress in the domains of genetics and epigenetics. Sophisticated technologies and designs applied to long-term prospective studies have increasingly informed the field regarding mechanisms of mental illness development, with overall findings pointing to a gene-environment interaction as etiologic in most cases.

The authors managed to distill and consolidate the vast literature presently available to the field, with a focus on more current findings. The chapters were designed to be comprehensive and balanced, with practical applications and key points highlighted. For example, the chapter on attention deficit hyperactivity disorder (ADHD), by Steven R. Pliszka, M.D., was organized in a clear and easy-to-follow manner, with handy tables and bulleted summary outlines to reiterate key points and present core principles in a readily digestible fashion. The writing style is very concise and crisp, facilitating efficient consumption of the materials. The information compiled is balanced, offering multiple points of view within each category as appropriate, including contradicting perspectives along with evidence in their support. For example, the conflicting data from various research groups related to the rates of comorbidity in ADHD and childhood bipolar disorder are presented objectively, with Dr. Pliszka theorizing a rational explanation for the discrepancy. The available data regarding stimulant efficacy are known to be vast, but the author managed to capture essential “take-home” points, concisely summarizing what the totality of data has revealed. Relatively newer research findings related to more recently developed long-acting medications and neuroimaging technologies are presented and summarized in a straightforward manner. In summary, the author was adept in culling a massive and complex body of literature and presenting key findings in a concise and readily comprehensible fashion.

The chapter on substance abuse, by Oscar G. Bukstein, M.D., M.P.H., and Deborah Deas, M.D., M.P.H., is well organized, current, and comprehensive. Sections mentioning newer phenomena, such as Internet addiction, were added to reflect contemporary culture and trends. I appreciated the section devoted to prevention programs, which was primarily organized around guiding principles. The assessment section was developed with an eye toward practical applications, with easy-to-read tables summarizing major screening and diagnostic tools as well as reference ranges. Key summary points are highlighted in a bulleted and readily retained fashion.

I was curious as to how the text would tackle the thorny, murky, controversial topic of pediatric-onset bipolar disorder. I was amazed and relieved to discover that the vast and varied literature on this broad topic was organized and distilled into a relatively concise, neutral, and intelligible chapter, by authors Gabrielle A. Carlson, M.D., and Stephanie E. Meyer, Ph.D. The inclusion of case vignettes was critical to demonstrating the nuances and complexities of assessing youths for bipolar spectrum disorders. All controlled medication trials are summarized amply and depict detailed, as well as bulleted, summary tables, which have practical utility in a busy clinical or teaching site. Furthermore, what is known about behavioral, psychosocial, and family treatments is reviewed and presented in a consolidated fashion. I appreciated the ability of Drs. Carlson and Meyer to fairly represent the varied and sometimes contradictory perspectives held by subject matter experts and researchers across the world. In addition, the authors were adept at highlighting the potential pitfalls and confounders in assessing and treating youths suspected of having mood disorders, which will prove useful to all practitioners who might encounter such cases.

I found Dr. Mina Dulcan's chapter on psychiatric classification, including past, current, and future systems, to be fascinating and relevant. With so much of child psychiatry research organized around diagnoses, the background, rationale, and methodology for defining and validating diagnostic criteria are essential for any provider to understand. Additionally, the various classification systems used internationally, spanning all ages, are reviewed, ensuring readers a broadened scope of available diagnostic tools.

In summary, I found Dulcan's textbook of child and adolescent psychiatry to be the best of its kind. It provides an authoritative, concise review of the most current literature in a manner that is balanced and intelligible. The material was organized in a readily digestible manner, with well-written narratives, bulleted summaries, and easy-to-read tables. This text would serve well as a definitive and comprehensive reference and guide to any provider assessing and treating youths with mental illness in any setting.