Treating Mental Illness and Behavior Disorders in Children and Adults with Mental Retardation
Doŝen and Day endeavor to provide a sourcebook for "all disciplines working in the field of mental health care for mentally retarded people." Their text contains 29 chapters by some three dozen contributors covering a wide range of treatment methods.
Chapters on individual therapy describe psychoanalytic, rational-emotive, and supportive psychotherapies. Chapters on behavior modification go well beyond the usual token reinforcement systems to describe numerous ways to think about and discover the antecedents that can initiate and maintain aggressive and self-injurious behaviors.
Group therapy is addressed in several chapters. Two authors review some of the available treatment packages for social skills training, anger management, dating skills, and dealing with sexuality. Another chapter reviews group therapy techniques for use with mentally retarded sex offenders. Two chapters briefly address issues that emerge in working with the patients' families.
Information on psychopharmacology is scattered throughout the text. A carefully researched and richly documented chapter by Willem M.A. Verhoeven and Sigfried Tuinier reviews the evidence on the efficacy of opiate antagonists, lithium, beta blockers, neuroleptics, selective serotonin reuptake inhibitors, anticonvulsants, and buspirone for self-injurious behaviors. Other authors describe general approaches to the mentally retarded patient who has schizophrenia, mood and anxiety disorders, attention-deficit hyperactivity disorder, or autism. Brief mention is made of a small number of syndromes such as Lesch-Nyhan, fragile X, Prader-Willi, and Cornelia de Lange.
This book may be useful for clinicians and administrators who wish to explore a variety of interventions that have been attempted with mentally ill, developmentally delayed children and adults. It is not a how-to manual. One could not read the chapter on self-injurious behavior and design an effective behavior modification program, or the chapter on social skills training and run a group. However, the book provides a good survey of biological, behavioral, and psychotherapeutic approaches and an extensive list of references for each topic. Having reviewed the available approaches, the reader can use the references to look into the practicalities of implementing a particular strategy.
The next edition of this book would benefit greatly from the inclusion of information for clinicians about how to work effectively with schools, group homes, sheltered workshops, and Special Olympics coaches. Additionally, families and professionals often want names, phone numbers, and Web site addresses for support groups, professional associations, listserves, and sources of up-to-date and accurate information about various syndromes and treatments. An annotated list would be helpful.
Dr. Newell is affiliated with the department of medical education at Oakwood Hospital in Dearborn, Michigan, and with the department of psychiatry at the University of Michigan in Ann Arbor.
