Book Review
Child Psychiatry
Language Impairment and Psychopathology in Infants, Children and Adolescents. Nancy J Cohen. Thousand Oaks (CA): Sage; 2001. 231 p. US$29.95
Reviewer
rating*: Very Good
Review by: JH Beitchman, MD
Toronto, Ontario
This book is part of the Sage Publications series on developmental clinical psychology and psychiatry. According to the series editor, the author is to present the latest theory and research on specific types of dysfunction, diagnostic and treatment approaches, and special problem areas that affect adjustment. Authors are asked to bridge potential theory, research, and clinical practice and to outline their current status and future directions. This book’s theme is the relation of language and communicative impairments to development and psychopathology. Its author, Dr Nancy Cohen, has more than fulfilled the editor’s expectations.
Cohen summarizes a vast array of material, bringing to bear both her knowledge of the literature and her experience as a clinician, educator, and researcher. Organized into 7 chapters and using a developmental framework, this book encompasses the definitions and terminology of language and communicative disorders; the associated conditions; the relation to development, attachment patterns, emotional regulation, and other key social and emotional processes; and assessment and intervention. Each chapter ends with a brief summary of key points—a handy reminder and reference for readers. The book is liberally spaced with clinical vignettes that enrich and enliven the text.
The section dealing with social and emotional development nicely illustrates the relevance of language and communication to affect regulation, attachment, social cognition, and play. It provides a framework for understanding social relationships in atypical behaviour of children and adolescents that will be especially useful to practising child psychiatrists and other child clinicians.
This book should be required reading for those less familiar with the relevance of language impairments to psychopathology. One of its key messages is the high frequency of unsuspected language disorders among children referred to mental health clinics. As an example of the overlap, Cohen provides a table of the psychiatric disorders in which the psychiatric symptoms could indicate or be a reaction to language and communication impairments. She lists 7 disorders that range from attention- deficit hyperactivity disorder to selective mutism and childhood schizophrenia. Clinicians need to consider these possibilities when formulating their diagnoses and treatments.
This volume has a great many strengths. It provides an up-to-date single source for most of the literature on language impairment that is relevant for mental health clinicians. It superbly describes and summarizes much child development literature. The sections on infancy and preschoolers are particularly good and should be required reading for residents in psychiatry and trainees in other mental health disciplines.
The chapter on assessment will interest clinicians and researchers: it offers excellent source material and ideas for language and developmental assessments. This chapter employs a comprehensive, multidimensional framework for assessing children and adolescents. It moves from the initial interviews with parents, teachers, and the children themselves to the assessment of cognition, achievement, social cognition, play, and socioemotional functioning. It lists appropriate assessment tools, and tables illustrate some of the key concepts discussed, such as symbolic play development or the levels of interpersonal negotiation strategies. Psychiatrists may be unfamiliar, or only vaguely familiar, with many of the tools and concepts described in this chapter. However, if clinicians are to fully appreciate, understand, and be of maximum assistance to children and adolescents with psychiatric disorders, knowledge of the key issues in this chapter is a must. In many instances, psychiatrists will need to collaborate with other mental health professionals, such speech-language pathologists or psychologists, to ensure that children receive comprehensive assessments. Psychiatrists should at the very least be aware of these issues and know when to refer for a more comprehensive assessment.
The chapter on treatment summarizes various approaches that may help children with language and communicative problems. These include interventions to improve social emotional competence in infants, children, and adolescents. Strategies to enhance social competence or conversational skills or to identify and label emotions are some of the techniques illustrated as part of a broad treatment approach to children with language and communicative problems.
This book concludes by emphasizing 3 major theses: 1) the value of a lifespan approach to understanding the interface between language, communication, and socioemotional behaviour disorders; 2) the importance of knowing the child’s language and communicative competence, so that diagnostic understanding and treatment is appropriate to the needs and competencies of the child; and 3) the importance of building collaborative relationships across professional disciplines.
All clinicians who are serious in their desire to help children and adolescents should be familiar with the contents and ideas discussed in this book. As a paperback, it is a little on the expensive side. Nevertheless, it is well worth owning. It is excellent.
*Reviewer
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