Childhood is a syndrome which has only recently begun to receive serious
\nattention from clinicians. The syndrome itself, however, is not at all
\nrecent. As early as the 8th century, the Persian historian Kidnom made
\nreferences to “short, noisy creatures,” who may well have been what we
\nnow call “children.” The treatment of children, however, was unknown until
\nthis century, when so-called “child psychologists” and “child
\npsychiatrists” became common. Despite this history of clinical neglect,
\nit has been estimated that well over half of all Americans alive today have
\nexperienced childhood directly (Suess, 1983). In fact, the actual numbers
\nare probably much higher, since these data are based on self-reports which
\nmay be subject to social desirability biases and retrospective distortion.<\/p>\n
The growing acceptance of childhood as a distinct phenomenon is reflected
\nin the proposed inclusion of the syndrome in the upcoming Diagnostic and
\nStatistical Manual of Mental Disorders, 4th edition, or DSM-IV, of the
\nAmerican Psychiatric Association (1990). Clinicians are still in
\ndisagreement about the significant clinical features of childhood, but the
\nproposed DSM-IV will almost certainly include the following core features:<\/p>\n
o Congenital onset
\no Dwarfism
\no Emotional lability and immaturity
\no Knowledge deficits
\no Legume anorexia<\/p>\n
Clinical Features of Childhood:<\/p>\n
Although the focus of this paper is on the efficacy of conventional
\ntreatment of childhood, the five clinical markers mentioned above merit
\nfurther discussion for those unfamiliar with this patient population.<\/p>\n
CONGENITAL ONSET<\/p>\n
In one of the few existing literature reviews on childhood, Temple-Black
\n(1982) has noted that childhood is almost always present at birth,
\nalthough it may go undetected for years or even remain subclinical
\nindefinitely. This observation has led some investigators to speculate
\non a biological contribution to childhood. As one psychologist has put it,
\n“we may soon be in a position to distinguish organic childhood from
\nfunctional childhood” (Rogers, 1979).<\/p>\n
DWARFISM<\/p>\n
This is certainly the most familiar marker of childhood. It is widely
\nknown that children are physically short relative to the population at
\nlarge. Indeed, common clinical wisdom suggests that the treatment of the
\nso-called “small child” (or “tot”) is particularly difficult. These
\nchildren are known to exhibit infantile behavior and display a startling
\nlack of insight (Tom and Jerry, 1967).<\/p>\n
EMOTIONAL LABILITY AND IMMATURITY<\/p>\n
This aspect of childhood is often the only basis for a clinician’s
\ndiagnosis. As a result, many otherwise normal adults are misdiagnosed as
\nchildren and must suffer the unnecessary social stigma of being labelled a
\n“child” by professionals and friends alike.<\/p>\n
KNOWLEDGE DEFICITS<\/p>\n
While many children have IQ’s with or even above the norm, almost all will
\nmanifest knowledge deficits. Anyone who has known a real child has
\nexperienced the frustration of trying to discuss any topic that requires
\nsome general knowledge. Children seem to have little knowledge about the
\nworld they live in. Politics, art, and science — children are largely
\nignorant of these. Perhaps it is because of this ignorance, but the sad
\nfact is that most children have few friends who are not, themselves,
\nchildren.<\/p>\n
LEGUME ANOREXIA<\/p>\n
This last identifying feature is perhaps the most unexpected. Folk wisdom
\nis supported by empirical observation — children will rarely eat their
\nvegetables (see Popeye, 1957, for review).<\/p>\n
Causes of Childhood:<\/p>\n
Now that we know what it is, what can we say about the causes of childhood?
\nRecent years have seen a flurry of theory and speculation from a number of
\nperspectives. Some of the most prominent are reviewed below.<\/p>\n
Sociological Model<\/p>\n
Emile Durkind was perhaps the first to speculate about sociological causes
\nof childhood. He points out two key observations about children:<\/p>\n
1) the vast majority of children are unemployed, and
\n2) children represent one of the least educated segments of our society.<\/p>\n
In fact, it has been estimated that less than 20% of children have had more
\nthan fourth grade education.<\/p>\n
Clearly, children are an “out-group.” Because of their intellectual
\nhandicap, children are even denied the right to vote. From the
\nsociologist’s perspective, treatment should be aimed at helping assimilate
\nchildren into mainstream society. Unfortunately, some victims are so
\nincapacitated by their childhood that they are simply not competent to
\nwork. One promising rehabilitation program (Spanky and Alfalfa, 1978) has
\ntrained victims of severe childhood to sell lemonade.<\/p>\n
Biological Model<\/p>\n
The observation that childhood is usually present from birth has led some
\nto speculate on a biological contribution. An early investigation by
\nFlintstone and Jetson (1939) indicated that childhood runs in families.
\nTheir survey of over 8,000 American families revealed that over half
\ncontained more than one child. Further investigation revealed that even
\nmost non-child family members had experienced childhood at some point.
\nCross-cultural studies (e.g., Mowgli & Din, 1950) indicate that family
\nchildhood is even more prevalent in the Far East. For example, in Indian
\nand Chinese families, as many as three out of four family members may have
\nchildhood.<\/p>\n
Impressive evidence of a genetic component of childhood comes from a
\nlarge-scale twin study by Brady and Partridge (1972). These authors studied
\nover 106 pairs of twins, looking at concordance rates for childhood. Among
\nidentical or monozygotic twins, concordance was unusually high (0.92),
\ni.e., when one twin was diagnosed with childhood, the other twin was almost
\nalways a child as well.<\/p>\n
Psychological Models<\/p>\n
A considerable number of psychologically-based theories of the development
\nof childhood exist. They are too numerous to review here. Among the more
\nfamiliar models are Seligman’s “learned childishness” model. According to
\nthis model, individuals who are treated like children eventually give up
\nand become children. As a counterpoint to such theories, some experts have
\nclaimed that childhood does not really exist. Szasz (1980) has called
\n“childhood” an expedient label. In seeking conformity, we handicap those
\nwhom we find unruly or too short to deal with by labelling them “children.”<\/p>\n
Treatment of Childhood:<\/p>\n
Efforts to treat childhood are as old as the syndrome itself. Only in
\nmodern times, however, have humane and systematic treatment protocols been
\napplied. In part, this increased attention to the problem may be due to the
\nsheer number of individuals suffering from childhood. Government statistics
\n(DHHS) reveal that there are more children alive today than at any time in
\nour history. To paraphrase P.T. Barnum: “There’s a child born every
\nminute.”<\/p>\n
The overwhelming number of children has made government intervention
\ninevitable. The nineteenth century saw the institution of what remains the
\nlargest single program for the treatment of childhood — so-called “public
\nschools.” Under this colossal program, individuals are placed into
\ntreatment groups based on the severity of their condition. For example,
\nthose most severely afflicted may be placed in a “kindergarten” program.
\nPatients at this level are typically short, unruly, emotionally
\nimmature,and intellectually deficient. Given this type of individual,
\ntherapy is essentially one of patient management and of helping the child
\nmaster basic skills (e.g. finger-painting).<\/p>\n
Unfortunately, the “school” system has been largely ineffective. Not only
\nis the program a massive tax burden, but it has failed even to slow down
\nthe rising incidence of childhood.<\/p>\n
Faced with this failure and the growing epidemic of childhood, mental
\nhealth professionals are devoting increasing attention to the treatment of
\nchildhood. Given a theoretical framework by Freud’s landmark treatises on
\nchildhood, child psychiatrists and psychologists claimed great successes in
\ntheir clinical interventions.<\/p>\n
By the 1950’s, however, the clinicians’ optimism had waned. Even after
\nyears of costly analysis, many victims remained children. The following
\ncase (taken from Gumbie & Poke, 1957) is typical.<\/p>\n
Billy J., age 8, was brought to treatment by his parents. Billy’s
\n affliction was painfully obvious. He stood only 4’3″ high and
\n weighed a scant 70 lbs., despite the fact that he ate
\n voraciously. Billy presented a variety of troubling symptoms. His
\n voice was noticeably high for a man. He displayed legume
\n anorexia, and, according to his parents, often refused to bathe.
\n His intellectual functioning was also below normal — he had
\n little general knowledge and could barely write a structured
\n sentence. Social skills were also deficient. He often spoke
\n inappropriately and exhibited “whining behaviour.” His sexual
\n experience was non-existent. Indeed, Billy considered women
\n “icky.” His parents reported that his condition had been present
\n from birth, improving gradually after he was placed in a school
\n at age 5. The diagnosis was “primary childhood.” After years of
\n painstaking treatment, Billy improved gradually. At age 11, his
\n height and weight have increased, his social skills are broader,
\n and he is now functional enough to hold down a “paper route.”<\/p>\n
After years of this kind of frustration, startling new evidence has come
\nto light which suggests that the prognosis in cases of childhood may not
\nbe all gloom. A critical review by Fudd (1972) noted that studies of the
\nchildhood syndrome tend to lack careful follow-up. Acting on this
\nobservation, Moe, Larrie, and Kirly (1974) began a large-scale longitudinal
\nstudy. These investigators studied two groups. The first group consisted of
\n34 children currently engaged in a long-term conventional treatment
\nprogram. The second was a group of 42 children receiving no treatment. All
\nsubjects had been diagnosed as children at least 4 years previously, with
\na mean duration of childhood of 6.4 years.<\/p>\n
At the end of one year, the results confirmed the clinical wisdom that
\nchildhood is a refractory disorder — virtually all symptoms persisted and
\nthe treatment group was only slightly better off than the controls.<\/p>\n
The results, however, of a careful 10-year follow-up were startling. The
\ninvestigators (Moe, Larrie, Kirly , & Shemp, 1984) assessed the original
\ncohort on a variety of measures. General knowledge and emotional maturity
\nwere assessed with standard measures. Height was assessed by the “metric
\nsystem” (see Ruler, 1923), and legume appetite by the Vegetable Appetite
\nTest (VAT) designed by Popeye (1968). Moe et al. found that subjects
\nimproved uniformly on all measures. Indeed, in most cases, the subjects
\nappeared to be symptom-free. Moe et al. report a spontaneous remission
\nrate of 95%, a finding which is certain to revolutionize the clinical
\napproach to childhood.<\/p>\n
These recent results suggests that the prognosis for victims of childhood
\nmay not be so bad as we have feared. We must not, however, become too
\ncomplacent. Despite its apparently high spontaneous remission rate,
\nchildhood remains one of the most serious and rapidly growing disorders
\nfacing mental health professional today. And, beyond the psychological pain
\nit brings, childhood has recently been linked to a number of physical
\ndisorders. Twenty years ago, Howdi, Doodi, and Beauzeau (1965) demonstrated
\na six-fold increased risk of chicken pox, measles, and mumps among children
\nas compared with normal controls. Later, Barby and Kenn (1971) linked
\nchildhood to an elevated risk of accidents — compared with normal adults,
\nvictims of childhood were much more likely to scrape their knees, lose
\ntheir teeth, and fall off their bikes. Clearly, much more research is
\nneeded before we can give any real hope to the millions of victims wracked
\nby this insidious disorder.<\/p>\n
REFERENCES<\/p>\n
o American Psychiatric Association (1990). The diagnostic and
\n statistical manual of mental disorders, 4th edition: A preliminary
\n report. Washington, D.C.; APA.
\no Barby, B., & Kenn, K. (1971). The plasticity of behaviour. In B.
\no Barby & K. Kenn (Eds.), Psychotherapies R Us. Detroit: Ronco press.
\no Brady, C., & Partridge, S. (1972). My dads bigger than your dad. Acta
\n Eur. Age, 9, 123-126.
\no Flintstone, F., & Jetson, G. (1939). Cognitive mediation of labour
\n disputes. Industrial Psychology Today, 2, 23-35.
\no Fudd, E.J. (1972). Locus of control and shoe-size. Journal of Footwear
\n Psychology, 78, 345-356.
\no Gumbie, G., & Pokey, P. (1957). A cognitive theory of iron-smelting.
\n Journal of Abnormal Metallurgy, 45, 235-239.
\no Howdi, C., Doodi, C., & Beauzeau, C. (1965). Western civilization: A
\n review of the literature. Reader’s digest, 60, 23-25.
\no Moe, R., Larrie, T., & Kirly, Q. (1974). State childhood vs. trait
\n childhood. TV guide, May 12-19, 1-3.
\no Moe, R., Larrie, T., Kirly, Q., & Shemp, C. (1984). Spontaneous
\n remission of childhood In W.C. Fields (Ed.), New hope for children and
\n animals. Hollywood: Acme Press.
\no Popeye, T.S.M. (1957). The use of spinach in extreme circumstances.
\n Journal of Vegetable Science, 58, 530-538.
\no Popeye, T.S.M. (1968). Spinach: A phenomenological perspective.
\n Existential botany, 35, 908-813.
\no Rogers, F. (1979). Becoming my neighbour. New York:Soft press.
\no Ruler, Y. (1923). Assessing measurements protocols by the multi-method
\n multiple regression index for the psychometric analysis of factorial
\n interaction. Annals of Boredom, 67, 1190-1260.
\no Spanky, D., & Alfalfa, Q. (1978). Coping with puberty. Sears
\n catalogue, 45-46.
\no Suess, D.R. (1983). A psychometric analysis of green eggs with and
\n without ham. Journal of clinical cuisine, 245, 567-578.
\no Temple-Black, S. (1982). Childhood: an ever-so sad disorder. Journal
\n of precocity, 3, 129-134.
\no Tom, C., & Jerry, M. (1967). Human behaviour as a model for
\n understanding the rat. In M. de Sade (Ed.). The rewards of Punishment.
\n Paris:Bench press.<\/p>\n
FURTHER READINGS<\/p>\n
o Christ, J.H. (1980). Grandiosity in children. Journal of applied
\n theology, 1, 1-1000.
\no Joe, G.I. (1965). Aggressive fantasy as wish fulfilment. Archives of
\n General MacArthur, 5, 23-45.
\no Leary, T. (1969). Pharmacotherapy for childhood. Annals of
\n astrological Science, 67, 456-459.
\no Kissoff, K.G.B. (1975). Extinction of learnt behaviour. Paper
\n presented to the Siberian Psychological Association, 38th annual
\n Annual meeting, Kamchatka.
\no Smythe, C., & Barnes, T. (1979). Behaviour therapy prevents tooth
\n decay. Journal of behavioral Orthodontics, 5, 79-89.
\no Potash, S., & Hoser, B. (1980). A failure to replicate the results of
\n Smythe and Barnes. Journal of dental psychiatry, 34, 678-680.
\no Smythe, C., & Barnes, T. (1980). Your study was poorly done: A reply
\n to Potash and Hoser. Annual review of Aquatic psychiatry, 10, 123-156.
\no Potash, S., & Hoser, B. (1981). Your mother wears army boots: A
\n further reply to Smythe and Barnes. Archives of invective research,
\n 56, 5-9.
\no Smythe, C., & Barnes, T. (1982). Embarrassing moments in the sex lives
\n of Potash and Hoser: A further reply. National Enquirer, May 16.<\/p>\n","protected":false},"excerpt":{"rendered":"
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