New Psychiatric Disease

http://www.pshrink.com/humor/Childhood.html

Edward S. Hume, M.D., J.D.
General Adult Psychiatry
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:

1. Congenital onset
2. Dwarfism
3. Emotional lability and immaturity
4. Knowledge deficits
5. 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)0. Embarrassing moments in the sex
lives of Potash and Hoser: A further reply. National Enquirer, May 16.


--
Dorothy

There is no sound, no cry in all the world
that can be heard unless someone listens ..

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