The Handbook of Preschool Mental Health fills an important gap. While there has been an increasing demand from clinicians to identify and treat disorders in the preschool period, young children’s mental health is understudied. The structure of the handbook is in three parts: I - Normative Development in the Preschool Period; II - Mental Disorders Arising in the Preschool Period; and III – Assessment and Intervention in the Preschool Period. Half the book comprises psychopathological disorders (Part II) which weighs as a dominant section of the book. The range of authors has good depth and chapters are well written.
Part I on normal development is restricted to three developmental areas with importance to psychopathology: social development, cognitive development and emotional competence (for social functioning). These three chapters gave a developmental psychological approach to preschoolers with breadth in the approach, particularly the chapter on social development.
In the section on disorders, all nine chapters are common disorders in the preschool population. For example, the Attention-Deficit/Hyperactivity Disorder chapter was a very rich contribution to preschool diagnosis and treatment. Naturally with the vast research on ADHD, this particular chapter had elegant analysis and a thorough source of material upon which to draw.
Oppositional Defiant Disorder is very important in this population. It is probably under-diagnosed, particularly in comorbid children. The chapter tackled validity, clinical meaning of the symptoms and the utility of making the diagnosis in preschoolers. This chapter alone makes the excellent book well worth buying for its breadth and depth.
The Anxiety Disorders chapter presented a very good review of the prevalence, risk factors and diagnostic issues. Assessment was presented in a way that many of us will immediately use. The treatment section of the chapter presented for clinicians, residents, and graduate students an immediate method of coping with lack of evidence on how to treat and what to do about it.
Similarly, the PTSD chapter dealt with the literature on traumatized preschoolers, and spelled out diagnostic alternative criteria for preschoolers. Considering the lack of time this condition has been researched, information on clinical course, assessment methods and treatment are progressing quite systematically. The developmental differences table was very helpful as it reviews evidence based approach.
Attachment Disorders chapter provided up-to-date examination of the field of diagnosis of Reactive Attachment Disorder: its course, assessment, comorbidity and treatment. It also dealt carefully with the caution necessary in defining a serious condition with such broad criteria. Equally, they were careful on descriptions of possible clinical treatments. The chapter contained a subsection in comorbidity examining RAD and PTSD in children which was the best description that I have seen of how they may interact.
The Autism Spectrum Disorders chapter would update professionals very well on all the psychopathological sections needed for diagnosis and treatment. Particularly helpful were sections on early manifestations, comorbid diagnoses and associated conditions and the range of assessment instruments available. The treatment section was much less thoroughly dealt with because a whole chapter was devoted to Early Intervention for Autism in the third section of the book. This second chapter supplied a useful table on interventions and their evidence.
Part III, Assessment and Intervention in the Preschool Period had some gems. Neuropsychological Assessment by Mrakotsky and Hellelfinger was easy to read and full of good information in understanding cognitive and skill development in preschoolers. The chapter on Psychopharmacology had breadth — addressing developmental neuropsychopharmacological issues, ethics, “off label” issues and a very good table on psychotropics reported in the literature with preschool children.
What was missing? Perhaps the most important was a chapter on relationship disorders which zero-to-three’s have been tackling. Not including it firmly puts this book into the DSM system, whereas there may be a need for transition between the two diagnostic methods in this age group. Also, while the book examined issues of diagnoses and their efficacy in preschoolers from an individual disorder perspective, it lacks an overall section on these concerns. Despite these two areas, I highly recommend this book to our colleagues in the Academy.