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and those is the “middle/working middle class”categories have some education at or belowthe level of a bachelor’s degree. This distinctiondoes not take socioeconomic status directlyinto account and is author defined. However,the author’s definitions are applied in a mannerthat appears consistent throughout the bookand aligns with the familiar caricatures of“white collar” versus “blue collar” professions.The tone of her book skews her portrayal of the 2groups and at times evokes empathy from thereader toward well-intentioned yet ineffectualparenting.

Parenting Out of Control shows the perils whenparents engage technology to remain tethered toadolescent and young adult children. Given thatseparation from the nuclear family and personalindividuation are core goals in the teen’s transi-tion to adulthood, this presents a new hurdle forteens to clear. The vivid image of a collegecampus teeming with students speaking to theirparents on cellular telephones while strollingthrough the grounds is set forth as an inspirationfor this study. The openness and ambivalence ofparental roles define Nelson’s critique of uppermiddle class parenting practices. Dr. Nelsonquotes an upper middle class parent as engagingin “one, two, three, maybe” parenting versus thepopular “1 . 2 ... 3 ... magic” discipline. Bycontrast, the middle/working middle classparents are portrayed as using technology in autilitarian manner to ensure the safety of theirchildren.

The anecdotes of Parenting Out of Controlsuggest that academically successful and high-achieving parents may lack commonsense andreal-life skills in their roles as parents. Incontrast, the need for firm limits by middle andworking class parents to ensure safety whenliving in areas with higher crime rates does notoffer up a glamorous alternative. The firm limitsand clear expectations offered by the workingmiddle class parents align with commonsenseparenting practice and reflect the sort of parentalguidance many professionals offer to families.This book is a cautionary tale for parents re-garding surveillance technologies, includingcellular telephones, and the ongoing need for trueemotional connections and trust in parent–childrelationships.

Dr. Nelson’s book offers tremendous valida-tion to all the working class parents out therewho struggle to provide for their children andexercise judicious limit setting and supreme

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parental authority. The material in the book isalso validating for professionals who work withchildren and families and persevere in config-uring family structures that nurture and supportchildren. To all the psychiatrists in the readership,do not be swayed by the criticisms of educatedparents! Dr. Nelson’s anecdotes and thesis caninspire parents and professionals to re-examinehow to best approach surveillance and commu-nication with teens and young adults.

The canon of parenting books and mediaaddressing vulnerabilities of socioeconomicallyprivileged youth is mounting. Dr. Nelson’s bookadds a scholarly narrative rich with anecdotesto illustrate her thesis. She provides descriptiveanecdotes from multiple families, and, althoughclearly favoring the working class families, pointsout strengths and vulnerabilities in all the familiessurveyed. Dr. Nelson’s work offers evidence forparents and professionals alike that parenting inany era remains an exercise in humility.

Gwendolyn Lopez-Cohen, M.D.Yale Child Study Center

New Haven, CTgwendolyn.lopez-cohen@yale.edu

http://dx.doi.org/10.1016/j.jaac.2013.07.003

Keeping Your Child inMind: OvercomingDefiance, Tantrums, andOther Everyday BehaviorProblems by Seeing theWorld Through YourChild’s Eyes. ByClaudia M. Gold, M.D.Philadelphia: Da CapoPress; 2011.

n Keeping Your Child in Mind, Dr. Golddescribes “how to be” with children who have

I behavioral problems. This insightful book

directs parents’ attention to the meaning of theirchild’s behavior, rather than “what to do” withthe unwanted actions of a child. Gold wantsnothing less from the readers than to have themgrasp the importance of seeing the world throughtheir child’s eyes.

Gold, who writes for the Boston Globe opinionpage, is a pediatrician who subspecialized indevelopmental and behavioral pediatrics followedby studies in psychoanalysis at the Berkshire

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Psychoanalytic Institute. She also pursuedpsychoanalytic research at the Yale Child StudyCenter/Anna Freud Center and graduated froman infant–parent postgraduate program. In thisbook, she provides a comprehensive review ofclassic and contemporary theories of attachmentand scientific studies of brain development andbehavior in an easy-to-read style, making it aninvaluable educational book for parents andpractitioners.

Gold first discusses academic research thatled to the concept of holding a child in mind,with a close eye on Bowlby’s theories of attach-ment, the writings of Winnicott, and the researchthat followed the work of these psychoanalysts,including that of Fonagy et al. regarding theconnection between secure attachment and re-flective functioning. She takes us further throughcontemporary research, including Tronick’swork supporting Winnicott’s theory of the good-enough mother, finding that “moments ofdisruption [between mother and infant] enhancedevelopment of emotional regulation” (p. 20),and the work of Michael Meany on behavioralepigenetics and how the expression of genes isinfluenced by life experiences and the potentialeffects this has on development and behavior.

In the second chapter, Gold transports us frominfant and child psychological research to currentscientific understandings of brain developmentand thoroughly prepares readers for the discus-sion of the most common behavioral challengeschildren tend to develop at various ages. Shewrites about research done by Seigel, Schore,and Kandel on the inter-relations between braindevelopment and parental attunement to chil-dren’s feelings and then examines the biologicalregulation of emotions by analyzing the develop-ment and function of the medial prefrontal cortexand its relation with the amygdala, hypothalamus,and insula and their connections to the right brain.

With this review of historical and contempo-rary research as a backdrop, Gold then helpsreaders rethink behaviors with insightful descrip-tions of the underlying meaning of behavioralissues at different stages of development. In thefollowing chapters, she outlines how to “holdyour child in mind” as a newborn (living withcolic), an infant (managing sleep), a toddler(discipline and limit setting), a preschooler (sepa-ration anxiety and “explosive” behavior), a school-age child (learning and social challenges), anda teenager (in supporting the search for identity).This developmental division is a great advantage

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of the book, because it can be easily used asa reference source for clinicians and parents toconsult for some of the most frequent behavioralproblems at any point of a child’s development.

Gold explains that the key to success is theability to tolerate the strong emotions of a child,to create what Winnicott called a holding envi-ronment, and to refrain from focusing solely onfixing the problems to make them go away. Shestates that this capacity to tolerate and hold thechild’s emotions helps the child feel secure andsafe and eventually the child will be able to“safely separate and explore the world” (p. 95).Dr. Gold acknowledges that this is a difficultprocess and adds that “it takes a lot of hard workand support for parents to sustain this kind ofthoughtfulness and emotional presence of mind”(p. 120). She encourages readers and affirmsfor clinicians how keeping the parents in mindand making them feel supported in their par-enting efforts also can create a change in them.The conclusion is that this time-consuming anddifficult process is worth the effort when it resultsin a better understanding of the child and familyand a substantial change in the child’s emotionaland behavioral well-being. Gold quotes Bowlbywho stated that “successful parenting is a prin-cipal key to the mental health of the next gener-ation” (p. 206).

Throughout the book, Gold brings the parents’conflicts into the equation when looking into themeaning of children’s problematic behaviors.The author highlights the importance of recog-nizing how problems that a parent has are mostlikely absorbed by and reflected in the child’sbehavior. She invites parents to consider whetherthe behavior of their child is reminiscent ofexperiences the parent had in the past. Althoughit may be ideal for parents to come to understandthe role their conflicts play in a child’s currentbehavior, practitioners will recognize the chal-lenges of pursuing this with parents who are lessinsightful into their own conflicts or who areotherwise insisting the child’s problems solelybelong to the child. Dr. Gold concedes that “par-ents may find it easier to focus on their child’sbehavior than to face seemingly overwhelmingconflict in their marriage” (p. 13). Nevertheless,Gold is right about not avoiding this topicaltogether: parents may become more insightfuland more open to how their own conflicts per-petuate or exacerbate their child’s behavioraldisturbances if this is a topic for discussion,however sensitive.

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One of the shortcomings of this book is thatalthough she does take into account the geneticand neurobiological influences for healthy devel-opment, some readers might judge that otherfactors influencing child development are givenlittle attention, including relationships with non-parental family figures, relationships with peers,medical health and illness, and community vari-ables, including school, economy, and availableresources. Also, some fathers might believe theirrole is neglected or even undermined in this bookbecause most of the narrative is about the rela-tionship of the mother with the child.

In the thought-provoking final chapter,“Beyond Medication,” Dr. Gold touches on the“exponential growth in the number of childrenon psychiatric medications” and argues that thisis caused by “marketing by the pharmaceuticalindustry and our society’s expectations of a quickfix” (p. 183). She adds that the insurance industryhas contributed indirectly to this trend, withproviders having to see more patients in lesstime to remain financially viable. Gold observesthat parents can sometimes see developmentallyappropriate behaviors as if they were symptomsof a disorder, and that if these behaviors arethen explored only within the limitations of a30-minute appointment with a provider, theeffect is not only improper treatment but, poten-tially, has deleterious effects on the child’s senseof self. She writes that “prescribing psychiatricmedications is a common endpoint of all thesesocial trends” (p. 184). Gold argues that thereare consequences for children:

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when families rely primarily on medica-tion, children do not have the opportu-nity to develop coping skills to adapt tonew situations and frustrations. Equallyimportant, in medicating the symptomsaway, the underlying issues in relation-ships are not addressed. Medication canhave the effect of silencing everyone.(p. 184)

She does point out that, at times, children do, infact, require medication. Her primary point in thischapter is toexpress concern regarding“overrelianceon medication to treat complex problems” (p. 186).

Beyond medication, the question of how labelsaffect a parent’s ability to hold his or her child inmind comes up. Dr. Gold provides an interestinganalysis of the studies of Wosniak and Biedermanand the use of juvenile bipolar disorder to

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describe irritable children with aggressive andprolonged temper tantrums. Gold reports that theuse of antipsychotic medications in children hasdoubled since their studies and she bemoans thefact that using antipsychotics in these childrenmight have “prevented us from understandingthese children in a way that leads to meaningfulinterventions” (p. 195). She talks frankly aboutthe implications of labeling children with a psy-chiatric disorder and reports how these changesin practice might be reflected in the forthcomingnew diagnostic criteria. She confirms “there aresignificant forces in our health care system thatmay make it difficult to support a parent’s effortsto reflect upon the meaning of her child’s be-havior” (p. 199–200) but adds that many clini-cians who prescribe psychoactive medications inchildren do, in fact, insist that children andfamilies be in therapy. Unfortunately, all toooften, owing to lack of availability and access togood quality care, such good intentions may notbe enough. She expresses hope that in primarycare settings, family concerns and children’sbehavioral issues can be discussed and primaryprevention can be provided.

At the end, on a resoundingly optimisticnote, she quotes Nobel Prize–winning JamesHeckman: “each dollar devoted to the nurturingof young children can eliminate the need forfar greater government spending on remedialeducation, teenage pregnancy, and prison” (p.206). Whether or not Heckman’s statement isempirically true, the underlying principles Golddescribes in this book are likely to have a similareffect: a parent’s ability to nurture a child withdifficult behaviors through mindful containmentis a sound investment for the future.

Jimena Tuis Elizalde, M.D.Baystate Medical Center

Tufts University School of MedicineSpringfield, MA

jimena.tuis@baystatehealth.orghttp://dx.doi.org/10.1016/j.jaac.2013.07.004

Disclosure: Dr. Henderson reports no biomedical financial interests orpotential conflicts of interest.

Dr. Lopez-Cohen reports no biomedical financial interests or potentialconflicts of interest.

Dr. Tuis Elizalde reports no biomedical financial interests or potentialconflicts of interest.

Note to Publishers: Books for review should be sent to Schuyler W.Henderson, M.D., M.P.H., NYU Child Study Center, One ParkAvenue, 7th Floor, New York, NY 10016 (email: Schuyler.Henderson@bellevue.nychhc.org).

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