by Kevin T. Kalikow
W W Norton, 2012
Review by Leo Uzych, J.D., M.P.H. on Nov 13th 2012
Your Child in the Balance (Revised Edition) is a book about children, adolescents, and psychiatric medicines. The author, Dr. Kevin T. Kalikow, is a Clinical Assistant Professor of Psychiatry and Behavioral Sciences, at New York Medical College; Kalikow also has a private practice, specializing in child and adolescent psychiatry. With a didactically sharp writing needle, Kalikow injects sharply a potent dose of informative discourse and thoughtfully opinionated views, into the veins of the corpus of child psychiatry. Staring intently at this thorny field, Kalikow spots many gaps in clinical and research knowledge; and indeed, an important thematic message resonating through the book's body is that much remains unresolved, clinically and researchwise, regarding the use of psychiatric medicines to treat children and adolescents. Kalikow, by means of a deftly handled brush, has painted skillfully a canvas detailing some of the possible benefits as well as risks associated with using psychiatric medicines. The finished canvas contributes significantly to the ongoing debate enveloping the issue ridden realm of children, adolescents, and psychiatric medicines.
The writing of Kalikow is styled in a relatively informal manner, to the possible displeasure of academically inclined readers.
The book's didactic strength is strengthened by some referenced research materials embedded in its substantive body, although readers coveting academic type discipline may lament that swaths of the book's substantive territory are not specifically research referenced. Citations for these referenced research materials, alphabetized by author last name, are given in a "References" section, placed structurally after the text's end.
Additionally, following the text, is a "Recommended Reading" structural section, providing citations for an array of books germane substantively to child psychiatry.
Strands of anecdotal material ("vignettes") are very considerably interwoven, in substantively relevant manner, into the textual tapestry; these anecdotal data have a substantively enlivening effect, and contribute materially to the book's substantive composition.
But critically, the widespread insinuation of anecdotal matter into cracks of the textual edifice may, from an academic perspective, diminish its academic strength.
The substantive concoction prepared in intellectually delectable fashion in the cauldron of Kalikow delectably blends ingredients of: information, musings, questions, criticisms, and opinions (all tethered, in content, to child psychiatry).
Nineteen chapters are the mainstay structural pillars upholding the book's foundation.
Structurally, there are also two appendices: in one appendix (titled: "Are You Wise If You Try an SSRI?"), Kalikow expounds thoughtfully about children, adolescents, and SSRIs, encompassing comment about possible attendant dangers; in a second appendix (titled: "Brand Names and Generic Names of Medicines Used in this Book"), various medicines are listed, by brand name and by generic name.
Over the course of nineteen chapters, Kalikow traverses considerable substantive ground. In a manner which continues notably across the length and breadth of this ground, Kalikow's discourse is continually informative, thoughtful, and critically questioning.
In Chapter 2, Kalikow particularly traverses the ground of pondering criteria for "changing" a person's body (with medicines, for example).
And then, in Chapter 3, Kalikow grapples, intellectually, with the issue: If the brain of a child, or older person, is changed (for instance, with medicines), then there is the risk of changing the person's identity.
Following some relatively generalized comment about psychiatry, in Chapter 4, Kalikow, in Chapter 5, draws readers' gaze raptly to the nettlesome field of a doctor's duty to treat, focusing especially on weighing possible benefits versus risks in the context of prescribing medicines.
Kalikow tackles the challenge of psychiatric evaluation of children and the possible need to medicate, in Chapter 6; he next addresses, in Chapter 7, evolving diagnostic criteria pertinent to child psychiatry.
In Chapter 8, Kalikow keenly views the area of the burden of proof, in the context of prescribing psychiatric medicines to children and adolescents.
Within the frame of Chapter 9, Kalikow fits in child psychiatry centric discussion encompassing: ADHD, obsessive compulsive disorder, depression, bipolar disorder, and autism.
Centerstage is reserved, in Chapter 10, for so called "off label" use of selected psychiatric medicines for children, with tentacles of discourse reaching to: panic disorder, anxiety, bulimia, bipolar disorder, schizophrenia, and ADHD.
Critical examination of risks of selected medicines is the intellectual crux, of Chapter 11.
And, in Chapter 12, relatively subtle psychological and social side effects associated potentially with taking medicines fall within the ken of Kalikow's critically discerning and wide ranging view.
Insightful musings concerning some perceived "concealed" consequences of medicines is the substantive matter forming the composition of Chapter 13.
In Chapter 14, Kalikow considers carefully some alternatives to medicines, with respect to treatment. Psychotherapy falls within the range of perspicacious comment; cost issues are pertinently studied, also.
The attention of Kalikow, in Chapter 16, is glued to some factors associated possibly with the decision of a prescriber to write a prescription; the marketing of medicines, as well as insurance connected issues, are inside the ambit of discussion.
The crux of Chapter 17 is whether psychiatric medicines for children may be "overprescribed"?
Finally, in concluding Chapter 19, Kalikow proffers some practical advice intended to assist parents struggling with the issue of whether their children should take medicine.
Cautious readers may caution that Kalikow has trekked gingerly in an expansive realm (of children, adolescents, and psychiatric medicines) that has many remaining uncharted patches; other experts may support views not advanced by Kalikow; and certainly, the issue filled field of psychiatric medicines, children, and adolescents is of ongoing clinical and research interest.
All parents, however, certainly should benefit by reading this helpful book.
Moreover, at a professional level, child psychiatrists particularly, and mental health professionals in general, should be held in thrall by the writing efforts of Kalikow; the book's contents, likewise, should be of enthralling interest professionally to pediatricians.
© 2012 Leo Uzych
Leo Uzych (based in Wallingford, PA) earned a law degree, from Temple University; and a master of public health degree, from Columbia University. His area of special professional interest is healthcare. Twitter @LeoUzych