THE ETIOLOGY & TREATMENT OF CHILDHOOD
Jordan W. Smoller, University of Pennsylvania
Childhood is a syndrome which has only recently begun to receive serious
attention from clinicians. The syndrome itself, however, is not at all recent.
As early as the 8th century, the Persian historian Kidnom made references to
"short, noisy creatures," who may well have been what we now call "children."
The treatment of children, however, was unknown until this century, when
so-called "child psychologists" and "child psychiatrists" became common. Despite
this history of clinical neglect, it has been estimated that well over half of
all Americans alive today have experienced childhood directly (Suess, 1983). In
fact, the actual numbers are probably much higher, since these data are based on
self-reports which may be subject to social desirability biases and
retrospective distortion.
The growing acceptance of childhood as a distinct phenomenon is reflected in the
proposed inclusion of the syndrome in the upcoming Diagnostic and Statistical
Manual of Mental Disorders, 4th edition, or DSM-IV, of the American Psychiatric
Association (1990). Clinicians are still in disagreement about the significant
clinical features of childhood, but the proposed DSM-IV will almost certainly
include the following core features:
* Congenital onset
* Dwarfism
* Emotional lability and immaturity
* Knowledge deficits
* Legume anorexia
Clinical Features of Childhood:
Although the focus of this paper is on the efficacy of conventional treatment of
childhood, the five clinical markers mentioned above merit further discussion
for those unfamiliar with this patient population.
CONGENITAL ONSET
In one of the few existing literature reviews on childhood, Temple- Black
(1982) has noted that childhood is almost always present at birth, although it
may go undetected for years or even remain subclinical indefinitely. This
observation has led some investigators to speculate on a biological contribution
to childhood. As one psychologist has put it, "we may soon be in a position to
distinguish organic childhood from functional childhood" (Rogers, 1979).
DWARFISM
This is certainly the most familiar marker of childhood. It is widely known that
children are physically short relative to the population at large. Indeed,
common clinical wisdom suggests that the treatment of the so-called "small
child" (or "tot") is particularly difficult. These children are known to
exhibit infantile behavior and display a startling lack of insight (Tom and
Jerry, 1967).
EMOTIONAL LABILITY AND IMMATURITY
This aspect of childhood is often the only basis for a clinician's diagnosis. As
a result, many otherwise normal adults are misdiagnosed as children and must
suffer the unnecessary social stigma of being labelled a "child" by
professionals and friends alike.
KNOWLEDGE DEFICITS
While many children have IQ's with or even above the norm, almost all will
manifest knowledge deficits. Anyone who has known a real child has experienced
the frustration of trying to discuss any topic that requires some general
knowledge. Children seem to have little knowledge about the world they live in.
Politics, art, and science -- children are largely ignorant of these. Perhaps it
is because of this ignorance, but the sad fact is that most children have few
friends who are not, themselves, children.
LEGUME ANOREXIA
This last identifying feature is perhaps the most unexpected. Folk wisdom is
supported by empirical observation -- children will rarely eat their vegetables
(see Popeye, 1957, for review).
Causes of Childhood:
Now that we know what it is, what can we say about the causes of childhood?
Recent years have seen a flurry of theory and speculation from a number of
perspectives. Some of the most prominent are reviewed below.
Sociological Model
Emile Durkind was perhaps the first to speculate about sociological causes of
childhood. He points out two key observations about children: 1) the vast
majority of children are unemployed, and 2) children represent one of the least
educated segments of our society.
In fact, it has been estimated that less than 20% of children have had more than
fourth grade education.
Clearly, children are an "out-group." Because of their intellectual handicap,
children are even denied the right to vote. From the sociologist's perspective,
treatment should be aimed at helping assimilate children into mainstream
society. Unfortunately, some victims are so incapacitated by their childhood
that they are simply not competent to work. One promising rehabilitation program
(Spanky and Alfalfa, 1978) has trained victims of severe childhood to sell
lemonade.
Biological Model
The observation that childhood is usually present from birth has led some to
speculate on a biological contribution. An early investigation by Flintstone and
Jetson (1939) indicated that childhood runs in families. Their survey of over
8,000 American families revealed thatover half contained more than one child.
Further investigation revealed that even most non-child family members had
experienced childhood at some point. Cross-cultural studies (e.g., Mowgli & Din,
1950) indicate that family childhood is even more prevalent in the Far East. For
example, in Indian and Chinese families, as many as three out of four family
members may have childhood.
Impressive evidence of a genetic component of childhood comes from a large-scale
twin study by Brady and Partridge (1972). These authors studied over 106 pairs
of twins, looking at concordance rates for childhood. Among identical or
monozygotic twins, concordance was unusually high (0.92), i.e., when one twin
was diagnosed with childhood, the other twin was almost always a child as well.
Psychological Models
A considerable number of psychologically-based theories of the development of
childhood exist. They are too numerous to review here. Among the more familiar
models are Seligman's "learned childishness" model. According to this model,
individuals who are treated like children eventually give up and become
children. As a counterpoint to such theories, some experts have claimed that
childhood does not really exist. Szasz (1980) has called "childhood" an
expedient label. In seeking conformity, we handicap those whom we find unruly
or too short to deal with by labelling them "children."
Treatment of Childhood:
Efforts to treat childhood are as old as the syndrome itself. Only in modern
times, however, have humane and systematic treatment protocols been applied. In
part, this increased attention to the problem may be due to the sheer number of
individuals suffering from childhood. Government statistics (DHHS) reveal that
there are more children alive today than at any time in our history. To
paraphrase P.T. Barnum: "There's a child born every minute."
The overwhelming number of children has made government intervention inevitable.
The nineteenth century saw the institution of what remains the largest single
program for the treatment of childhood -- so-called "public schools." Under this
colossal program, individuals are placed into treatment groups based on the
severity of their condition. For example, those most severely afflicted may be
placed in a "kindergarten" program. Patients at this level are typically short,
unruly, emotionally immature,and intellectually deficient. Given this type of
individual, therapy is essentially one of patient management and of helping the
child master basic skills (e.g. finger-painting). Unfortunately, the "school"
system has been largely ineffective. Notonly is the program a massive tax
burden, but it has failed even to slow down the rising incidence of childhood.
Faced with this failure and the growing epidemic of childhood, mental health
professionals are devoting increasing attention to the treatment of childhood.
Given a theoretical framework by Freud's landmark treatises on childhood, child
psychiatrists and psychologists claimed great successes in their clinical
interventions.
By the 1950's, however, the clinicians' optimism had waned. Even after years of
costly analysis, many victims remained children. The following case (taken from
Gumbie & Poke, 1957) is typical. Billy J., age 8, was brought to treatment by
his parents. Billy's affliction was painfully obvious. He stood only 4'3" high
and weighed a scant 70 lbs., despite the fact that he ate voraciously. Billy
presented a variety of troubling symptoms. His voice was noticeably high for a
man. He displayed legume anorexia, and, according to his parents, often refused
to bathe. His intellectual functioning was also below normal -- he had little
general knowledge and could barely write a structured sentence. Social skills
were also deficient. He often spoke inappropriately and exhibited "whining
behaviour." His sexual experience was non-existent. Indeed, Billy considered
women "icky." His parents reported that his condition had been present from
birth, improving gradually after he was placed in a school at age 5. The
diagnosis was "primary childhood." After years of painstaking treatment, Billy
improved gradually. At age 11, his height and weight have increased, his social
skills are broader, and he is now functional enough to hold down a "paper
route."
After years of this kind of frustration, startling new evidence has come to
light which suggests that the prognosis in cases of childhood may not be all
gloom. A critical review by Fudd (1972) noted that studies of the childhood
syndrome tend to lack careful follow-up. Acting on this observation, Moe,
Larrie, and Kirly (1974) began a large-scale longitudinal study. These
investigators studied two groups. The first group consisted of 34 children
currently engaged in a long-term conventional treatment program. The second was
a group of 42 children receiving no treatment. All subjects had been diagnosed
as children at least 4 years previously, with a mean duration of childhood of
6.4 years.
At the end of one year, the results confirmed the clinical wisdom that childhood
is a refractory disorder -- virtually all symptoms persisted and the treatment
group was only slightly better off than the controls.
The results, however, of a careful 10-year follow-up were startling. The
investigators (Moe, Larrie, Kirly , & Shemp, 1984) assessed the original cohort
on a variety of measures. General knowledge and emotional maturity were assessed
with standard measures. Height was assessed by the "metric system" (see Ruler,
1923), and legume appetite by the Vegetable Appetite Test (VAT) designed by
Popeye (1968). Moe et al. found that subjects improved uniformly on all
measures. Indeed, in most cases, the subjects appeared to be symptom-free. Moe
et al. report a spontaneous remission rate of 95%, a finding which is certain to
revolutionize the clinical approach to childhood.
These recent results suggests that the prognosis for victims of childhood may
not be so bad as we have feared. We must not, however, become too complacent.
Despite its apparently high spontaneous remission rate, childhood remains one of
the most serious and rapidly growing disorders facing mental health professional
today. And, beyond the psychological pain it brings, childhood has recently been
linked to a number of physical disorders. Twenty years ago, Howdi, Doodi, and
Beauzeau (1965) demonstrated a six-fold increased risk of chicken pox, measles,
and mumps among children as compared with normal controls. Later, Barby and
Kenn (1971) linked childhood to an elevated risk of accidents -- compared with
normal adults, victims of childhood were much more likely to scrape their knees,
lose their teeth, and fall off their bikes. Clearly, much more research is
needed before we can give any real hope to the millions of victims wracked by
this insidious disorder.
REFERENCES
* American Psychiatric Association (1990). The diagnostic and
statistical manual of mental disorders, 4th edition: A preliminary
report. Washington, D.C.; APA.
* Barby, B., & Kenn, K. (1971). The plasticity of behaviour. In B.
* Barby & K. Kenn (Eds.), Psychotherapies R Us. Detroit: Ronco
press.
* Brady, C., & Partridge, S. (1972). My dads bigger than your dad.
Acta Eur. Age, 9, 123-126.
* Flintstone, F., & Jetson, G. (1939). Cognitive mediation of labour
disputes. Industrial Psychology Today, 2, 23-35.
* Fudd, E.J. (1972). Locus of control and shoe-size. Journal of
Footwear Psychology, 78, 345-356.
* Gumbie, G., & Pokey, P. (1957). A cognitive theory of
iron-smelting. Journal of Abnormal Metallurgy, 45, 235-239.
* Howdi, C., Doodi, C., & Beauzeau, C. (1965). Western civilization:
A review of the literature. Reader's digest, 60, 23-25.
* Moe, R., Larrie, T., & Kirly, Q. (1974). State childhood vs. trait
childhood. TV guide, May 12-19, 1-3.
* Moe, R., Larrie, T., Kirly, Q., & Shemp, C. (1984). Spontaneous
remission of childhood In W.C. Fields (Ed.), New hope for children
and animals. Hollywood: Acme Press.
* Popeye, T.S.M. (1957). The use of spinach in extreme
circumstances. Journal of Vegetable Science, 58, 530-538.
* Popeye, T.S.M. (1968). Spinach: A phenomenological perspective.
Existential botany, 35, 908-813.
* Rogers, F. (1979). Becoming my neighbour. New York:Soft press.
* Ruler, Y. (1923). Assessing measurements protocols by the
multi-method multiple regression index for the psychometric
analysis of factorial interaction. Annals of Boredom, 67,
1190-1260.
* Spanky, D., & Alfalfa, Q. (1978). Coping with puberty. Sears
catalogue, 45-46.
* Suess, D.R. (1983). A psychometric analysis of green eggs with and
without ham. Journal of clinical cuisine, 245, 567-578.
* Temple-Black, S. (1982). Childhood: an ever-so sad disorder.
Journal of precocity, 3, 129-134.
* Tom, C., & Jerry, M. (1967). Human behaviour as a model for
understanding the rat. In M. de Sade (Ed.). The rewards of
Punishment. Paris:Bench press.
FURTHER READINGS
* Christ, J.H. (1980). Grandiosity in children. Journal of applied
theology, 1, 1-1000.
* Joe, G.I. (1965). Aggressive fantasy as wish fulfilment. Archives
of General MacArthur, 5, 23-45.
* Leary, T. (1969). Pharmacotherapy for childhood. Annals of
astrological Science, 67, 456-459.
* Kissoff, K.G.B. (1975). Extinction of learnt behaviour. Paper
presented to the Siberian Psychological Association, 38th annual
Annual meeting, Kamchatka.
* Smythe, C., & Barnes, T. (1979). Behaviour therapy prevents tooth
decay. Journal of behavioral Orthodontics, 5, 79-89.
* Potash, S., & Hoser, B. (1980). A failure to replicate the results
of Smythe and Barnes. Journal of dental psychiatry, 34, 678-680.
* Smythe, C., & Barnes, T. (1980). Your study was poorly done: A
reply to Potash and Hoser. Annual review of Aquatic psychiatry,
10, 123-156.
* Potash, S., & Hoser, B. (1981). Your mother wears army boots: A
further reply to Smythe and Barnes. Archives of invective
research, 56, 5-9.
* Smythe, C., & Barnes, T. (1982). Embarrassing moments in the sex
lives of Potash and Hoser: A further reply. National Enquirer, May
16.
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