Rebels with a cause

This important book could be considered as a sequel to the earlier Stress, Coping, and Development in Children which Norman Garmezy and Michael Rutter edited in 1983. Then it was unclear whether the relationship found in adults between stress and psychopathology held for children and what the stressors for children might be. This book records how the field has progressed.

In his preface, Robert Haggerty states that the goal of the book is to illustrate the importance of four complex themes: the interrelatedness of risk factors and problem outcomes; the variability in individuals in resilience and susceptibility to stress; the processes and mechanisms linking stressors to outcomes; and the interventions which might ameliorate some of the problem outcomes of particular stressors. How does the book match up to Robert Haggerty's themes? There appears to be clear evidence that specific risk factors are related to specific problem outcomes. For example, Saundra Nettles and Joseph Pleck note that being a black youth is associated with an increased use of hard drugs relative to a white youth but a reduced use of soft drugs (chapter five). Alternatively, there is clear evidence of a link, though of modest magnitude, between family stressors and the health of the child (chapter six).

There is also clear evidence of individual differences in resilience and susceptibility to stressors. One of the clearest demonstrations of this is provided in a study cited by Ronald Barr and his colleagues in chapter six. This study involved some luck. While Thomas Boyce, one of the co-authors of the chapter, was collecting data looking at the relationship between immune competence in five-year-olds and respiratory tract infections, the 1989 San Francisco Bay Area Loma Prieta earthquake struck. This allowed a natural experiment relating predisaster measures of immunological competence to respiratory illness following the disaster. The child's prior immunological competence was found strongly to predict the child's probability of illness after the earthquake. But even more interesting than this was the interaction with parental stress behaviour. If the child's parents were unreactive to the earthquake, the child did not show the increase in illness even if their immunological performance would have suggested susceptibility. The effect of immunological performance was only found for the children of parents who were reactive to the earthquake, ie, the parents reactivity at least partially determined the child's resilience to the earthquake stressor.

The processes and mechanisms linking stressors to outcomes is the weakest theme in the book despite the admirable chapter by Susan Gore and John Eckenrode (chapter two) and some of the detailed analyses of Ronald Barr and his colleagues (chapter seven). Indeed, the reader sometimes has the impression that while there is considerable data on some of the risk and protective factors associated with particular stressors, notably parental divorce, there is little theory which links the elements. Many of the studies seem data rather than theory-driven. This lack of good theory is noted by the authors concentrating on intervention effects (chapters eight and nine). But, as they note, given the potential benefits it is better to design interventions even in the absence of good theory. And, despite this lack of knowledge, they report that, for example, "the teaching of affective, cognitive and behavioural skills can have at least some short-term effects on health and behaviour problems".

I recommend this book to any psychologist, psychiatrist, social worker or educator who is involved in the research into or amelioration of childhood problems.

R. J. R. Blair is a lecturer in psychology, University College London.