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.
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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.
From the Internet. © Jordan W. Smoller, University of Pennsylvania