Clinical Child Psychology Library – serie

There are few things that stir up our culture more than sex, particularly sex and children. Sexual behavior in children represents, to far too many people, further proof of the moral decay of our society. Any issue that provokes as strong an emotional reaction as childhood sexuality is obviously in need of a rational discussion. The best features of thought and reason include their moderating influence on overheated and reaction emotions. Consequently, this book by Betty Gordon and Carolyn Schroeder represents a very important, and even brave, counter to irrationality. When the Surgeon General of the United States is forced to resign because the words "children" and "masturbation" appear in the same sentence, you know that there is a great deal of misunderstanding about sexuality. My own evolution as a researcher in the area of child sexual abuse is a model of how naivete can be corrected by knowledge. Some of my early research in sexual abuse of children led me to realize that sexual behavior was a reliable marker of victimization in a relatively large percentage of children (Friedrich, Urquiza, & Beilke, 1986). My blinders to sexuality were evident in that I had not even hypothesized that to be the case in this early, exploratory research. When I realized how important sexual behavior was, several colleagues and I set out to interview parents and foster parents of sexually abused children more specifically. These adults were routinely quite reactive to our queries.

There are few things that stir up our culture more than sex, particularly sex and children. Sexual behavior in children represents, to far too many people, further proof of the moral decay of our society. Any issue that provokes as strong an emotional reaction as childhood sexuality is obviously in need of a rational discussion. The best features of thought and reason include their moderating influence on overheated and reaction emotions. Consequently, this book by Betty Gordon and Carolyn Schroeder represents a very important, and even brave, counter to irrationality. When the Surgeon General of the United States is forced to resign because the words "children" and "masturbation" appear in the same sentence, you know that there is a great deal of misunderstanding about sexuality. My own evolution as a researcher in the area of child sexual abuse is a model of how naivete can be corrected by knowledge. Some of my early research in sexual abuse of children led me to realize that sexual behavior was a reliable marker of victimization in a relatively large percentage of children (Friedrich, Urquiza, & Beilke, 1986). My blinders to sexuality were evident in that I had not even hypothesized that to be the case in this early, exploratory research. When I realized how important sexual behavior was, several colleagues and I set out to interview parents and foster parents of sexually abused children more specifically. These adults were routinely quite reactive to our queries.

For many years, anxiety and phobie disorders ofchildhoodand adolescence were ignored by clinicians and researchers alike. They were viewed as largely benign, as problems that were relatively mild, age-specific, and transitory. With time, it was thought, they would simply disappear or "go away"-that the child or adolescent would magically "outgrow" them with development and that they would not adversely affect the growing child or adolescent. As a result ofsuch thinking, it was concluded that these "internalizing" problems were not worthy or deserving of our concerted and careful attention-that other problems of childhood and adolescence and, in particular, "externalizing" problems such as conduct disturbance, oppositional defiance, and attention-deficit problems de­ manded our professional energies and resources. These assumptions and asser­ tions have been challenged vigorously in recent years. Scholarly books (King, Hamilton, & Ollendick, 1988; Morris & Kratochwill, 1983) have documented the considerable distress and misery associated with these disorders, while reviews ofthe literature have demonstrated that these disorders are anything but transitory; for a significant number of youth these problems persist into late adolescence and adulthood (Ollendick & King, 1994). Clearly, such findings signal the need for treatment programs that "work"--programs that are effective in the short term and efficacious over the long haul, producing effects that are durable and generalizable, as weil as effects that enhance the life functioning of children and adolescents and the families that evince such problems.

For many years, anxiety and phobie disorders ofchildhoodand adolescence were ignored by clinicians and researchers alike. They were viewed as largely benign, as problems that were relatively mild, age-specific, and transitory. With time, it was thought, they would simply disappear or "go away"-that the child or adolescent would magically "outgrow" them with development and that they would not adversely affect the growing child or adolescent. As a result ofsuch thinking, it was concluded that these "internalizing" problems were not worthy or deserving of our concerted and careful attention-that other problems of childhood and adolescence and, in particular, "externalizing" problems such as conduct disturbance, oppositional defiance, and attention-deficit problems de­ manded our professional energies and resources. These assumptions and asser­ tions have been challenged vigorously in recent years. Scholarly books (King, Hamilton, & Ollendick, 1988; Morris & Kratochwill, 1983) have documented the considerable distress and misery associated with these disorders, while reviews ofthe literature have demonstrated that these disorders are anything but transitory; for a significant number of youth these problems persist into late adolescence and adulthood (Ollendick & King, 1994). Clearly, such findings signal the need for treatment programs that "work"--programs that are effective in the short term and efficacious over the long haul, producing effects that are durable and generalizable, as weil as effects that enhance the life functioning of children and adolescents and the families that evince such problems.

This volume is designed to provide a comprehensive overview of autism for the many educated and thoughtful parents, professionals, and other concerned citizens with an interest in these important issues. It has grown out of our assumption that there are many people interested in our field who want the most up-to-date information available without having to locate and read through the growing literature in this area. From our university bases, we are fortunate in having access to state-of-the-art information about autism and related develop­ mental disorders. Our goal in this volume is to synthesize this information and present it comprehensively and objectively. This volume is the culmination of 2 years of hard work identifying, organizing, writing, rewriting, and editing the most up-to-date information available about people with autism, their families, and the state-of-the-art about the nature, causes, underlying mechanisms, diagnosis, and treatment of autism. We hope it will help the many friends, colleagues, families, and interested citizens who have expressed their interest in a publication of this kind. v Acknowledgments A project ofthis scope could not have been completed without the help of many fine friends and colleagues, too numerous to name. As with all of our professional activities we are indebted to our TEACCH colleagues and the many families and professionals we know in North Carolina, around the United States, and throughout the world for their interest, support, insights, and generosity in sharing their ideas and observations. We hope that our final product reflects their many superb contributions.

This volume is designed to provide a comprehensive overview of autism for the many educated and thoughtful parents, professionals, and other concerned citizens with an interest in these important issues. It has grown out of our assumption that there are many people interested in our field who want the most up-to-date information available without having to locate and read through the growing literature in this area. From our university bases, we are fortunate in having access to state-of-the-art information about autism and related develop­ mental disorders. Our goal in this volume is to synthesize this information and present it comprehensively and objectively. This volume is the culmination of 2 years of hard work identifying, organizing, writing, rewriting, and editing the most up-to-date information available about people with autism, their families, and the state-of-the-art about the nature, causes, underlying mechanisms, diagnosis, and treatment of autism. We hope it will help the many friends, colleagues, families, and interested citizens who have expressed their interest in a publication of this kind. v Acknowledgments A project ofthis scope could not have been completed without the help of many fine friends and colleagues, too numerous to name. As with all of our professional activities we are indebted to our TEACCH colleagues and the many families and professionals we know in North Carolina, around the United States, and throughout the world for their interest, support, insights, and generosity in sharing their ideas and observations. We hope that our final product reflects their many superb contributions.

This timely volume explains the pitfalls and problems of managed care for those practitioners, especially child clinicians, who wish to take part in it, while mapping out independent financing strategies for those who wish to remain outside the system. Managing Managed Care provides an overview of the managed care marketplace as it currently affects children and families, reviews relevant legal and financial issues, and illustrates with case examples some problems of the system.

The introduction of the concept of managed care into mental and physical health care appears to be a juggernaut of unparalleled impact. The two extremes of thought about this impact are (I) that managed care is a villainous foe to be resisted in order to bring back the earlier halcyon years of independence in practice decisions with greater reimbursement for psychologists' services or (2) that managed care is a laudatory attempt to restrain health care costs that are out of control and spiraling upward by rooting out mismanagement and reversing financial incentives to provide unnecessary care. The former view calls managed health care such names as "mangled care" and distributes bumper stickers stating "Just Say No to HMOs. " The latter view points to the slowdown of increases in health care expenditures and the enhancement of health care affordability and appropriateness for greater numbers of persons resulting from managed care cost-containment strategies and service review procedures. Mental or behavioral health care has been as strongly impacted as medical care under managed care. Where managed care has forced practitioners' attention to validated procedures and to examining previous wasteful practices, we ap­ plaud the movement. Where managed care has had adverse impact, we think there needs to be greater public, legal, and regulatory attention to its excesses and abuses.

Clinical neuropsychology for infants and young children is an emerging field that contains as much promise as it does perplexing practical and theoretical questions. Infant and Early Childhood Neuropsychology is a groundbreaking study that provides an assessment framework and diagnostic clues for clinicians and researchers, as well as the first documentation and description of this new field for students. The clearly written text translates neuroanatomic issues into clinical applications for professionals charged with making neuropsychological assessments of infants and young children.

Clinical neuropsychology for infants and young children is an emerging field that contains as much promise as it does perplexing practical and theoretical questions. Infant and Early Childhood Neuropsychology is a groundbreaking study that provides an assessment framework and diagnostic clues for clinicians and researchers, as well as the first documentation and description of this new field for students. The clearly written text translates neuroanatomic issues into clinical applications for professionals charged with making neuropsychological assessments of infants and young children.

This book outlines a scientific approach to understanding and treating children and adolescents who display a severe pattern of aggressive antisocial behaviour. Unlike other works which tend to focus exclusively on research data or practical guidelines for treatment approaches, this reference integrates both of these aspects, providing clear guidelines for intervention based on the most current research. Outstanding features include 23 tables and figures, and two chapters detailing a comprehensive approach to treatment tailored to the needs of the individual child or adolescent.

As reflected in the title, the purpose of this book is to guide clinicians in understanding and treating youth with severe antisocial behavior. Children and adolescents with conduct disorders operate at quite a high cost to society. In many opinion polls, juvenile crime and violence is rated as one of the most pressing concerns for many in our society. This widespread concern has prompted professionals from many disciplines to search for more effective interventions to prevent and treat youth with such disorders. This book is my attempt to summarize the current status of this very important endeavor. In providing this guide to clinicians, I have attempted to emphasize the critical link between understanding the clinical presentation, course, and causes of conduct disorders and designing effective interventions for children and adolescents with these disorders. Many past books, book chapters, and review articles have emphasized one or the other of these objectives. Some have provided excellent summaries of the vast amount of research on youth with conduct disorders without explicitly and clearly describing the clinical applica­ tions of this research. Others have focused on the implementation of specific interventions for youth with conduct disorders that is divorced from a basic understanding of the many diverse and clinically important characteristics of this population. The overriding theme of this book is that successful clinical inter­ vention requires an integration of both bodies of knowledge.

Here is an efficient guide to measuring and graphing behavioral outcomes, and letting the results influence clinical decisions. The authors, all clinical psychologists, describe how the `continuous' measurement of outcomes can document clinical results and provide practical methods for clinicians to routinely get and use credible, precise data. They provide numerous clinical examples that illustrate how behavioral health outcomes can be measured directly and simply.

Here is an efficient guide to measuring and graphing behavioral outcomes, and letting the results influence clinical decisions. The authors, all clinical psychologists, describe how the `continuous' measurement of outcomes can document clinical results and provide practical methods for clinicians to routinely get and use credible, precise data. They provide numerous clinical examples that illustrate how behavioral health outcomes can be measured directly and simply.

1. It is incumbent on medical providers that they are asking patients to - here to regimens with demonstrated eficacy, Providers need to remind themselves of the Hippocratic oath: "I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit ofmy patients, and abstain from whatever is deleterious and mischievous" (as cited in Cassell, 199 1, p. 145). 2. Providers need to abandon the "blame and shame" approach to dealing with medical adherence problems. It is tempting to blame patients for adherence failures and shame them into changing their behavior. Providers need to share the blame (or better yet omit blame) and look at their own attitudes and behaviors that impact adherence. For example, failing to simplify regimens or minimize negative side effects can adversely impact patient adherence. 3. Patients and their families are no longer (or maybe were never) satisfied with apassive role in their health care. In fact, the tern compliance lost favor in the literature because it implied for some an authoritarian approach to health care that required unquestioned obedience by patients to provider recommendations (DiMatteo & DiNicola, 1982). Comprehensive and effective health care requires a cooperative relationship between providers and patients and their families. It also acknowledges the following realities, particularly for treating persons with chronic illness: "Doctors do not treat chronic illnesses. The chronically ill treat themselves with the help of their physicians; the physician is part of the treatment.

Pain is a complex, multidimensional phenomenon, with physiological, behav­ ioral, emotional, cognitive, and developmental aspects (Zeltzer, Barr, McGrath, & Schechter, 1992). To effectively evaluate and manage pain in children, the clini­ cian must be able to assess the unique ways these complex dimensions interact for the individual child and integrate these dimensions into a treatment plan. This can be a daunting task. The purpose of this book is to provide a framework for conceptualizing pain problems in children that can guide the practitioner in developing an evaluation and treatment plan that is optimal for the individual child. This book is not in­ tended to be a comprehensive, exhaustive review of the literature on pain manage­ ment in children. There are several excellent books of this nature (e.g., Bush & Harkins, 1991: McGrath, 1990; Ross & Ross, 1988). Instead, this book is an at­ tempt to outline an hypothesis testing process of case conceptualizing and treat­ ment planning that can help structure the task of sorting through the complex interrelationships that determine children's pain.