The final section is concerned with

moving towards a proactive rather than

reactive school response. This is tackled

in two chapters �Predicting the difficul-

ties� and �Monitoring and evaluation�.Readers will find a wealth of practical

advice and encouragement that is bal-

anced by an acknowledgement of the

limitations of individual interventions

and the potential costs, overt and hid-

den, of each one. A whole-school ap-

proach is advocated and exemplified,

including schools that have considered

the needs of the staff. The central opti-

mistic messages are that it is possible to

intervene, that effective, creative prac-

tice does exist and that attention to this

area can bring benefits, short-term and

long-term, for all those involved.

Susan Pearson

University of Leeds

Rebuilding Attachments withTraumatized Children: Healingfrom Losses, Violence, Abuse andNeglectRichard KaganNew York: Haworth, 2004. pp. 278.

$39.95 (pb). ISBN: 0-7890-1544-7.

Real Life Heroes: A Life Storybookfor ChildrenRichard KaganNew York: Haworth, 2004. pp. 97.

$12.95 (pb). ISBN: 0-7890-2164-1.

Rebuilding Attachments with Trauma-

tised Children and the accompanying

workbook Real Life Heroes are a distil-

lation of the clinical work undertaken

by Richard Kagan with high-risk chil-

dren. The referrals to his service were of

children on the brink of harm to them-

selves or others, and with a history of

severe neglect, physical and sexual

abuse, and often disrupted family his-

tories with multiple placements and

loss of attachment figures.

Kagan uses creative arts, drawing,

story-telling and music to help children

and their carers build a web of security,

in which the children can develop trust

and self esteem. The author is clearly a

dedicated and passionate advocate for

the very unhappy children he sees, and

works not only with the children them-

selves but also with their wider net-

work, to make coherent narratives of

their past and construct a safe environ-

ment in whatever permanent place-

ments they are to live in. The books

are full of suggestions for activities,

daily routines and celebrations to ce-

ment together a framework to foster

secure relationships.

As a resource for those working with

abused children, foster carers and

adoptive families the book is full of ideas.

Unfortunately, Real Life Heroes is un-

likely to work as a book for children.

Permission is not given to photocopy

pages, so that each child would need his

or her own copy. However, the introduc-

tory section is not designed for children,

and not all pages would apply to every

child. The option to photocopy, or down-

load, particular pages would have al-

lowed a therapist to be selective and

tailor a programme for aparticular child.

While of limited relevance to mental

health professionals, Rebuilding Attach-

ments with Traumatised Children would

be a valuable resource for social work-

ers, and those supporting carers of

looked after children on a long-term

basis and moving towards permanent

placement. The prompts and checklists

provide a structure for assessment and

intervention and the activities are

accessible and user friendly.

Christine Puckering

Royal Hospital for Sick Children,

Glasgow

Young Children and Trauma:Intervention and TreatmentJoy D. Osofsky (Ed.)London: Guilford Press, 2004. pp. 319.

£30.00 (hb). ISBN: 1-59385-041-7.

Our understanding of the effects of

psychological trauma on infants and

toddlers has increased significantly

over recent years. This compilation re-

views the impact of severe stress on

young children, including the effects on

the brain, behaviour, relationships and

functioning. There are useful chapters

on assessment, diagnosis and treat-

ment. There are also descriptions of

the innovative and collaborative work

taking place in the States between the

courts, child welfare agents, psycholo-

gists and psychiatrists. These service

delivery models are set in a range of

clinical, legal and community settings.

Although the contributions vary in

quality and interest, overall the book

provides a helpful, up-to-date, more

refined and differentiated picture of

the effects of trauma on infants and

young children coupled with the new

interventions that have been developed

to meet the needs of this particular

group of vulnerable children.

David Howe

University of East Anglia, Norwich

Young People and SubstanceMisuseI. Crome, H. Ghodse, E. Gilvarry,P. McArdleLondon: Gaskell Publishers, 2004. pp.

222. £15.00 (pb). ISBN: 1-904671-01-2.

Despite a decade of exploration, servi-

ces for children and adolescents with

substance use problems remain rudi-

mentary. Possibly the next decade will

see some major change and develop-

ment. The views of experienced practi-

tioners are essential in guiding such

service development and expansion.

This book fills a major gap in the

current English literature on addic-

tions. The authors are some of the key

clinicians and academics striving to

develop research and clinical services

for young people. It has chapters cov-

ering basic background issues inclu-

ding epidemiology, developmental

issues, and approaches to treatment

and prevention, and although multi-

authored, it reads well as an integrated

and well-edited text.

Problems of tobacco, alcohol and

other drugs are now some of the most

common problems in young men and

increasingly also in young women, and

there is substantial overlap in the like-

lihood of involvement with illegal drugs

for those who are heavy smokers and

drinkers. More recently the issue of

cannabis and psychosis has become

prominent. There is now some robust

evidence that early involvement in hea-

vy cannabis use is associated with

increased risk of onset of psychosis.

The chapter of psychiatric comorbid-

ity explores this issue well and provides

a good framework for considering these

issues and the chapters on treatment

cover the best available evidence for

current treatment.

Overall this is a very useful book that

should be in the possession of all adult

and child and adolescent psychiatrists,

all paediatricians and general adult

psychiatrists if they are to keep abreast

of this rapidly changing field.

Michael Farrell

The Maudsley Hospital, London

Book News 61