This book considers, from a number of different professional perspectives, children's problems presenting in school.
Teachers refer to ‘emotional and behavioural difficulties’ (EBDs) when describing a group of children who pose a challenge in the classroom. Child and adolescent psychiatrists, meanwhile, refer to ‘ behavioural and emotional disorders with onset usually occurring in childhood and adolescence'.’. These latter are psychiatric diagnoses classified by the World Health Organization in ICD—10. It is readily apparent that these concepts do not describe the same children. The terms are not synonymous, and although there is likely to be overlap between the two categories, the implications of the two expressions are rather different. The majority of children identified as having EBDs will be unknown to child and adolescent mental health services (CAMHS), while a number of those who are being treated by CAMHS with internalising disorders would not be identified by the education system. The average perfectionist with anorexia nervosa, for example, might be the last pupil identified as having an EBD, at least in the early stages. In the educational concept, the emphasis is on management, particularly the need to avoid reinforcement of maladaptive behaviour. It is not surprising that teachers are as concerned about the impact of disruptive behaviour on the class as on the individual's learning. Child mental health services emphasise the importance of information-gathering and reaching a diagnosis before embarking on management, which tends to have more of an individual or family focus.
The book is arranged in three sections, covering the understanding, assessment and support of children with such difficulties. The first, substantially written by the editor, reviews the major biological and psychosocial theories and the changing epidemiology of emotional and behavioural difficulties. The second covers psychological and psychiatric assessment. The third discusses a range of therapeutic approaches, from cognitive—behavioural therapy through psychoanalytic psychotherapy to parenting therapies. The contributions by Diane Montgomery on classroom management are particularly strong and include a chapter on the special needs of ‘able misfits’, who are often neglected in this area.
Although the individual chapters are interesting and offer good advice, there is a lack of a unifying editorial attempt to address the important issues in the relationship between the disciplines in the management of these children. The chapters written by child psychiatrists, covering assessment and cultural issues, for example, could have been prepared for a book on an entirely different topic. It would have been interesting to see more discussion of the differences in the concepts of children's problems and of the deficiencies at the interface between education and CAMHS. These include:
the almost total neglect of child mental health issues in teacher training, which leaves teachers confused in distinguishing bad behaviour from illness or disability;
the shortage of time devoted to teaching about schools in the training of child psychiatrists, given that the average child spends 16 000 hours in school between the ages of 5 and 16 years;
the tiny amount of educational psychology provision available to most schools;
the financial implications of identifying children as having special educational needs, which deter schools from initiating full neuropsychological assessments; and
a lack of clarity in many districts about pathways of referral between school, community paediatrics, educational psychology and CAMHS.
Nevertheless, this is a useful book for those working both in child mental health services and in education. It is as interesting for what it does not address as for what it does.
- © 2000 Royal College of Psychiatrists