Psychiatr Serv 49:252-253, February 1998
© 1998 American Psychiatric Association
Do They Grow Out of It? Long-Term Outcomes of Childhood Disorders
edited by Lily Hechtman, M.D., F.R.C.P.C.; Washington, D.C., American Psychiatric Press, 1996, 287 pages, $40
Maryann Davis, Ph.D.
This book has an intriguing title and preface that suggest a holistic look at what happens to children with psychiatric disorders as they grow up. The long-term consequences of childhood psychiatric disorders is a burning issue among clinicians, parents, teachers, and others who live and work with these youngsters. This book is not for the lay reader, but is a good source for clinicians and mental health professionals as a quick, readable overview of the existing relevant literature, and its limitations.
The book emphasizes the relationship between child and adult psychiatric disorders: do childhood disorders continue over time, do children simply "grow out of it," what impact does treatment have, and do children develop some other disorder as they age? Generally, each chapter addresses a major child diagnostic grouping, such as anxiety disorders, defines the disorders, discusses the weaknesses of the research base for that diagnostic grouping, and primarily examines whether the disorder subsides over time and what the impact of treatment is. Some chapters also review causal mechanisms, general epidemiology, and mediating factors and include a brief description of common problems, such as teen pregnancy, that are associated with the disorder.
Do They Grow Out of It? has two major shortcomings. The book's purpose to review what is known about long-term outcomes for this child population, based on the research literature—a valuable approach. However, the book falls short of describing the immense complexity and difficulty of conducting the required research, which would clarify why there is such a small research base from which to examine the question. This shortcoming leaves the reader wondering why more isn't known.
Second, while the preface talks about a holistic approach, the book is strongly disorder based. Human experience does not fit neatly into psychiatric syndromes. Many children with serious emotional or behavioral disorders have more than one disorder, or they have significant "symptoms" that do not reach diagnostic criteria but are important factors in their, and their families', lives. Although diagnostic classification for grouping purposes has some value, it is clearly insufficient for understanding the developmental pathways of children with psychiatric disorders into adulthood; the whole child develops, not just things related to what we identify as a diagnosis. The book itself alludes to the shortcomings of this approach by including two chapters that are not on a single diagnostic group, a chapter on suicidal behavior and a chapter on comorbidity. Some chapters also discuss broader symptomatology rather than just children who fit into diagnostic groups.
The focus on diagnostic categories also diminishes the importance of examining other types of functioning—such as the eventual ability to hold a job, maintain adequate relationships, or stay out of trouble with the law—that are more broadly of interest to families and others involved with these children over the long haul. Lastly, focusing on disorders does not reveal protective factors, or strengths. They are equally important in understanding the lives of these children and their families and communities.
Footnotes
Dr. Davis is affiliated with the Center for Psychosocial and Forensic Services Research in the department of psychiatry of the University of Massachusetts Medical Center in Worcester.
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