Book Review
Child Psychiatry 
Basic Child Psychiatry Philip Barker. Oxford (UK): Blackwell Science Limited; 2004 248 p. CAN$52.95.
Reviewer
rating*: Good
Review by: Nasreen Roberts, MD
Kingston, Ontario
At a time when there is an acute shortage of child and adolescent psychiatrists in Canada and the rest of the world, those who practise or are training to practise family medicine or general adult psychiatry increasingly find themselves having to assess and manage children and adolescents with psychiatric problems. Considering that the cumulative prevalence rate of psychiatric disorders among children and adolescents is about 5% to 22%, there is indeed an urgent need to educate primary care physicians, pediatricians, general psychiatrists, and health workers to enable them to recognize and manage some of these disorders.
As the title suggests, this is an introduction to the basics of child psychiatry. The book is divided into 23 short chapters that encompass all diagnostic groups in child psychiatry, starting with a brief review of developmental factors and ending with one on prevention. All chapters are well organized and written clearly and concisely with most salient and current references at the end of the book for those wishing to further pursue any of the topics. Chapter 4, on epidemiology, gives a brief description of major research into incidence and prevalence of child and adolescent psychiatric disorders. It provides a context in which to view each of the diagnostic groups. Chapter 5 “Assessing Children and Their Families” is a tour de force. At 19 pages, it is the longest chapter. It virtually walks the reader step by step through the interview and assessment process with sample questions to elicit information, strategies for maximizing attainment of rapport, and comprehensive history taking. The chapter ends with a useful grid for formulating the information of predisposers, precipitators, perpetuators, and protectors in the 4 domains of constitutional, temperamental, physical, and environmental factors. This chapter is a testimony to the author=s clinical experience and expertise in direct care of children and their families. There are 12 chapters dedicated to major disorders, including a chapter on reaction to stress. These chapters are organized systematically with definitions and prevalence, causes, descriptions, assessment and treatment, and outcome for each disorder.
Chapter 17, “Mind Body Relationship,” takes dichotomous concepts and thoughtfully demonstrates their interdependence and circularity, helping to divert attempts from linear causality and solutions to more appropriate multidimensional thinking.
The chapters on infant psychiatry, special problems of adolescence, and psychiatric disorders in mentally retarded children provide basic information but highlight the complexity and expertise required for assessment and management.
Chapter 22, “Treatment Approaches,” gives an overview of treatment paradigms with criteria for use, treatment goals, and expected outcomes. The pharmacotherapy section presents various medications in tables with dosage and main side effects. However, as psychopharmacology is advancing at a rapid pace, no book can remain current. This book is no exception. Since its publication, there have been several governmental alerts and advisories on the use of selective serotonin reuptake inhibitors in children and adolescents, and this book’s first-line evidence on atypical antipsychotic use in children is limited.
The last chapter of the book, “Prevention,” aptly describes this subject as the “Cinderella of child psychiatry.” It describes primary prevention and discusses protective factors, resilience, and methods for primary prevention. This chapter highlights the urgent need for attention to preventing and ameliorating psychiatric morbidity and improving outcome.
Philip Barker is a seasoned clinician, an established scholar, and a teacher. I experienced his lucid and comprehensive second edition of this book as a medical student, and his book on family therapy was a recommended text when I was a resident. Further, I had the privilege of being a colleague of Dr Barker’s and benefited from his clinical consultations and expertise in child psychiatry. This present edition is succinct and clearly written; it contains recent references to developments in the field since the sixth edition, published in 2000.
This book is packaged with an attractive cover and is paper-bound, which explains its reasonable price. I recommend this text as a reference for medical students and residents in family medicine, pediatrics, and general psychiatry. It would also be a useful text on the shelf of a family doctor. Further, it would be appropriate for workers in the child mental health field.
*Reviewer
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Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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