Childhood Syndrome
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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 that
over 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. Not
only 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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| Michelle Steiner | First say to yourself what you would |
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