Your Child: What Every Parent Needs to Know: What’s Normal, What’s Not, and When to Seek Help

Your Child, created by the American Academy of Child and Adolescent Psychiatry (AACAP) under the editorship of recent AACAP President David Pruitt, with input from dozens of leading child and adolescent psychiatrists, is a fine and useful book. It is aimed at parents, and it will help a great many parents, but it should also be useful to those who give parental advice to parents, including grandparents, teachers, and countless media people as well as medical and nonmedical professionals who work with parents on issues of growth and development and health and mental health.

The book will also be useful in placing and demystifying child psychiatry and in demonstrating that child psychiatry knows a great deal, is capable of integrating research and clinical and nonclinical data, and is sensibly and supportively interested in parents, families, and the whole child—not just pathology—and in the essence of good psychiatry: biopsychosocial integration.

It is clearly difficult to review fairly a book of such vast scope. It is also tempting, when facing such a verbal monument, to pick on flaws and problems and imperfections. I will mention a few of these, but my qualms only slightly dent my judgment that this is probably a good book for every reader of this review to look at and to give to someone. Relative to most psychiatric books, it is something of a bargain at $27.50.

Half or more of the book is reasonably devoted to normal growth and development; even when problems in children are addressed, normal development is usually a necessary part of defining and understanding.

There is a section on The Life of a Child, broken into chapters on the first year, ages 1 and 2, ages 3–5, and ages 6–11. There is a section on Day-to-Day Problem Behaviors, including chapters on “Challenges at Home,” “The Family Redefined,” “School-Related Concerns,” “The Child and the Community,” and “The Child With Chronic Illness.” A section on Serious Problems includes “Emotional Disorders,” “Disruptive Behavior Disorders,” “Developmental Disorders,” “Psychotic Disorders,” and “Sleep Disorders.” Part 4 deals with Seeking Help and discusses how, when, and what the options are. There are useful appendixes on psychiatric medications and on medical, psychological, educational, and developmental tests.

The headings are clear. The index is generally handy. The formats are straightforward. I would have liked a few tables, graphs, and charts, e.g., some in the familiar pediatric textbook style on clusters such as developmental tasks and milestones at age 1, 2, 3, etc.

The feel of the book is a bit too much like a cookbook: heavy, hard to read except on a table or counter, and with double-columned pages. The tone and style are a bit bland at times, even perhaps a bit too safe and conventional. It often feels written by a committee—an excellent committee, but still a committee—as in its lists of safe possible treatments for a problem, with rather little help in choosing among them. Organizational blandness creeps in. I wish the AACAP had played a bit less safe. (In one of the book’s few, and welcome, excursions into bluntness, it says at one point, firmly and clearly, Never spank. That is a position currently taken by the academies of both pediatrics and child psychiatry but still considered provocative by some large segments of the American public.)

The general tone is cheerful, appreciative, and supportive, much as Dr. Spock is, though without quite his pithy personality. In fact, except for a few other books by organizations (e.g., the AACAP’s companion volume, Your Adolescent [1] and two good books by the American Academy of Pediatrics [2, 3]), the chief rivals of this volume are likely to be dozens of books by Spock, Brazelton, Leach, Fraiberg, Greenspan, and many others, who tend to speak with more personal voices—which, when matched with good sense, can have great appeal.

I found myself wondering if a few spinoffs based on this book might be viable, e.g., 1) a spinoff based on this book but written by one major child psychiatrist, quirks and all, presumably with royalties split with the AACAP, and 2) a shorter edition, with slightly simplified vocabulary, to reach beyond the usual upper-middle-class book buyer.

The book does not drown the reader in psychopharmacology. That is a mercy, and a welcome contrast to recent APA meetings. The book focuses on behavior far more than on feeling or mental events and sometimes seems to me to slight feelings and conflicts, psychodynamics, and the whole of psychology in favor of what is easiest to observe. The word “psychoanalyst” is conspicuous by its absence, even on a list of the spectrum of practitioners. Cognitive behavior therapy gets about twice as much space as psychodynamic psychotherapy (pp. 406–408), and here and elsewhere the authors seem to me to miss a good chance to comment on the overlapping and integrative potential of various therapies, rather than the either/or of research protocol therapies.

There is not a lot that specifically acknowledges prevention, an area of wide and deep importance in child psychiatry. For instance, there is not even a short chapter on prenatal care. As to social psychiatry, although poverty is the subject of a good note and there are good comments on sex, alcohol and other drugs, and television (ration it; watch some with your kids), there is only brief mention of social and cross-cultural factors and differences, and such differences are more or less narrowly assumed to mean those of recent immigrants. Also, there is remarkably little on social, economic, judicial, and governmental decisions and policies as they affect children—areas in which the AACAP is knowledgeable and active.

Despite my or any reader’s inevitable quibbles, Your Child is accessible, reasonable, educated, and helpful on hundreds of important child issues. It is a good book for parents, psychiatrists, and others to dip into and will strike many readers, or dippers, as an excellent place to consult the current wisdom of the tribe.