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cal errors were noted. The cover is attractive and colorful, presenting a title that
is appropriate and accurately reflects the content of the book.
Jeannie Golden
East Carolina University
REFERENCES
Haynes, S. N., & O'Brien, W. H. (1990). Functional analysis in behavior therapy. Clinical Psychology Review. 10. 649-668.
Mace, F. C , Lalli, J. S., & Lalli, E. P. (1991). Functional analysis and treatment of aberrant
behavior. Research in Developmental Disabilities, 12, 155-180.
Northrup, J., Wacker, D., Sasso, G., Steege, M., Cigrand, K., Cook, J., & DeRaad, A. (1991). A
brief functional analysis of aggressive and alternative behavior in an outclinic setting. Journal of
Applied Behavior Analysis, 24, 509-522.
Samson, D. M., & McDonnell, A. A. (1990). Functional analysis and challenging behaviours.
Behavioural Psychotherapy, 18. 259-271.
Sovner, R., & Hurley, A. D. (1983). Preparing for a mental health consultation. Psychiatric Aspects
of Mental Retardation Newsletter, 2(10).
Szymanski, L. S., & Tanguay, P. E. (1980). Emotional disorders of the mentally retarded persons:
Assessment, treatment, and consultation. Baltimore, MD: University Park Press.
Mental Health Aspects of Mental Retardation: Progress in Assessment and
Treatment. Edited by Robert J. Fletcher and Anton Dosen. New York:
Lexington Books, 1993, 438 pp., $45.50.
In the last 10 years, there has been exploding interest and research in the area of
mental health issues as they affect people with mental retardation. The edited
book Mental Health Aspects of Mental Retardation by Robert Fletcher and Anton
Dosen captures a wealth of information with respect to people who have a dual
diagnosis of mental illness and mental retardation. Individual chapters are written by international authorities in the area; thus, the book reflects both an international and an interdisciplinary approach.
The editors describe the purpose of the book as reviewing current assessment and treatment methods applicable to the most commonly diagnosed mental
health disorders in people with mental retardation. The aim of the book is to
provide information to a variety of professionals working in the field of mental
health and mental retardation. Fletcher and Dosen have succeeded in their purpose and aim. The book presents both the latest theory and research and also
provides information from the clinical experience of some of the most internationally renowned experts who work with this population.
In terms of organization, the book is divided into four parts. Part 1 is an
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overview of mental health and mental illness in persons with mental retardation.
The first chapter by Dosen entitled, "Mental Health and Mental Illness in Persons
with Mental Retardation: What Are We Talking About?" attempts to clarify
relevant terms. A very important issue is what constitutes mental health in people
with mental retardation. The second chapter, written by Frank Menolascino and
Mark Fleisher, reviews the history of treating people with a dual diagnosis
(mental illness/mental retardation) with the intent of projecting what will be
needed in the future. As more and more people with mental retardation are
integrated into their home communities, the authors raise the important issue of
whether generic services can be utilized to serve people with a dual diagnosis or
do parallel services need to be developed.
Part 2 of the book covers the issue of assessment and diagnosis. This section
is organized around psychiatric syndromes and challenging behaviors that are
seen in people wim mental retardation. The chapter by William Gardner and
Janis Graeber is devoted to assessing severe behavior disorders. Gardner and
Graeber present an excellent case for a multidimensional diagnostic approach in
which both external and internal variables must be taken into account in assessing severe behavior disorders. The authors point out the necessity of a good
collaborative interdisciplinary approach rather than working from a single discipline perspective.
Chapter 4, by Dosen and Jan Gielen, examines depression in people with
mental retardation. This chapter describes the major difficulties in diagnosing
depression in this population, particularly in people with severe and profound
mental retardation. This chapter is excellent in that the newer assessment procedures are reviewed as well as some of the behavioral equivalents in people who
have severe and profound mental retardation. The chapter by Andrew Reid on the
assessment and diagnosis of schizophrenic and paranoid syndromes (chapter 5) is
also superb in identifying the problem of diagnosis when a person is nonverbal.
This problem is again pointed out in the chapter by Steven Reudrich in his
description of bipolar mood disorders.
The assessment and diagnosis of personality disorders in people with mental
retardation is covered in chapter 7 by Lawrence Dana. Dana makes a very good
point in describing how the traditional living environments of people with mental
retardation are likely to have a negative impact on personality development.
Dana justifiably indicates that the diagnosis of a personality disorder must be
reviewed periodically because many behaviors can change dramatically if a
person is exposed to a functional, integrated setting.
Chapter 8 examines self-injurious behavior (SIB). In a similar fashion to the
chapter by Gardner and Graeber, on severe behavior disorders, Dosen attempts to
explain the importance of assessing biological variables and social/emotional
factors that may combine in a unique fashion to produce SIB. The last chapter in
Part 2 of the book reviews dementia. This chapter, by Dennis Harper, covers
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some of the most recent research findings and points out the extreme difficulties
in looking at dementia in people with mental retardation. Harper suggests a
number of confounding variables, including changes in expectancy, preexisting
cognitive and psychosocial deficits, lack of environmental stimulation, and
chronic drug treatments, that may affect mental processes. Harper also provides a
very thorough review of the literature on dementia in aging adults with mental
retardation.
Part 3 of the book covers treatment approaches, and is organized so that the
chapters correspond with various syndromes described in Part 1. In fact, the
same authors who address diagnoses and assessment were asked to discuss
the treatment of those disorders. Although different methodologies are described
in Part 3, all of the chapters have commonalities. First, a major theme in most of
the chapters is that treatment must be multifaceted and interdisciplinary. Second,
many of the chapters are based not only on research but also on the extensive
experience of the authors. In fact, authors such as Dosen, Perry, and Ruedrich
rely very much on their experience in treating mood disorders. They point out
that there is not a large body of literature, and most research is poorly controlled,
particularly in the area of psychopharmacology with people who have mental
retardation.
Part 4, the final section of the book, addresses specific treatment methodologies. In chapter 16, Fletcher reviews the literature and his experience with
psychotherapy for persons with mental retardation. His discussion of the prevailing attitude that people with mental retardation cannot benefit from psychotherapy provides an excellent criticism of this commonly held belief. Fletcher
points out a number of psychotherapeutic and counseling options that may be
useful in treating a variety of mental health problems. Chapter 17, by John
McGee, provides a discussion of Gentle Teaching. He indicates that the major
emphasis of this technique is developing a reciprocal rather than a controlling
relationship, and valuing the person you are working with.
A chapter by Fletcher and Thomas Duffy on group therapy with people who
have mental retardation is a very thorough review of the literature, but, more
important, the authors propose a process that could be used by clinicians in
setting up a group. The final chapter in Part 4, by Klaus Hennicke, provides an
interesting discussion of how systems theory could be applied in the area of
mental illness and mental retardation. This approach appears to have a great deal
of promise when looking at issues in families and communities.
In conclusion, the edited book by Fletcher and Dosen is a "must read" for
those involved with individuals who have a dual diagnosis of mental illness and
mental retardation. The book brings together a wide range of research findings
and clinical practice directions that will guide the field for years to come. Mental
Health Aspects of Mental Retardation is written in a fashion to describe what is
currently known about assessing and treating people with dual diagnosis. The
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book points to a number of issues that need further exploration, such as the
diagnosis of various forms of mental illness and treatment with different social,
psychological, and biological packages. If there are drawbacks with the book, it
would be that they center on the sophistication of- some of the chapters, which
may not be clear to all readers. As the editors point out, however, readers are at
least exposed to the approaches that are being developed.
R. Matthew Reese
Child Development Unit
Kansas University Affiliated Program