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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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  389. [page] UNIXJOKE
  390. [page] UNIXUSER
  391. [page] UNIXWORL
  392. [page] UNIXXMAS
  393. [page] UNPROD
  394. [page] UPBEAT
  395. [page] USERTYPE
  396. [page] VERSIONS
  397. [page] VI
  398. [page] VIRUSES
  399. [page] VIRUSMAN
  400. [page] VSECRET
  401. [page] WALKMAN
  402. [page] WC
  403. [page] WCLEAN
  404. [page] WDOGS
  405. [page] WEBADD
  406. [page] WEBOD
  407. [page] WEIRD
  408. [page] WEREWOLF
  409. [page] WHISKEY
  410. [page] WINCHRIS
  411. [page] WISDOM
  412. [page] WM10
  413. [page] WOMENSAY
  414. [page] WORLDEND
  415. [page] WRITEC
  416. [page] WRITING
  417. [page] WSD
  418. [page] WVIRUS
  419. [page] WVRES
  420. [page] XMASFAQ
  421. [page] XMASFILE
  422. [page] XMASSCI
  423. [page] XSONGS
  424. [page] XSONG AN
  425. [page] XTIAN
  426. [page] YEAR
  427. [page] YODA
  428. [page] YODASONG
  429. [page] Abooks
  430. [page] Acme
  431. [page] Actmovie
  432. [page] Adamcat
  433. [page] Adameve2
  434. [page] Adameve3
  435. [page] Addvi
  436. [page] Alares
  437. [page] Alcoholwarning
  438. [page] Amish
  439. [page] Anagrams
  440. [page] Astrolog
  441. [page] Aussiewild
  442. [page] Autopun
  443. [page] Awol
  444. [page] Bambigun
  445. [page] Baywatch
  446. [page] Bcube
  447. [page] Beforecomp
  448. [page] Bgbruss
  449. [page] Billbeast
  450. [page] Bingo
  451. [page] Bisbrain
  452. [page] Breadkills
  453. [page] Breastmilk
  454. [page] Budfrog
  455. [page] Buypaint
  456. [page] Califdiary
  457. [page] Catail
  458. [page] Catclaw
  459. [page] Catconverter
  460. [page] Catdiet
  461. [page] Cathaiku
  462. [page] Cathat
  463. [page] Catmeals
  464. [page] Catrule2
  465. [page] Cbooks
  466. [page] Celdeath
  467. [page] Chachi
  468. [page] Child80s
  469. [page] Childcom
  470. [page] Cigar
  471. [page] Circusduck
  472. [page] Comphaiku
  473. [page] Compjarg
  474. [page] Compmf
  475. [page] Compxmas
  476. [page] Corpapes
  477. [page] Corpmemo
  478. [page] Countries
  479. [page] Cperil
  480. [page] Cutekids
  481. [page] Dam
  482. [page] Darwin97
  483. [page] Deadmail
  484. [page] Decoy
  485. [page] Directoryinq
  486. [page] Disappoint
  487. [page] Divinecomp
  488. [page] Dnapers
  489. [page] Doctorchild
  490. [page] Dogbreeds
  491. [page] Dogjob
  492. [page] Driveinsane
  493. [page] Drnotes
  494. [page] Dummies
  495. [page] Earache
  496. [page] Engmanagers
  497. [page] Enlarge
  498. [page] Excuses
  499. [page] Femkinds
  500. [page] Firm
  501. [page] Fromnj
  502. [page] Fromnj2
  503. [page] Gaycartoon
  504. [page] Gaydisc
  505. [page] Geekcar
  506. [page] Geektheo
  507. [page] Gendercomm
  508. [page] Genderwork
  509. [page] Gengreet
  510. [page] Girlfrnd
  511. [page] Glitter
  512. [page] Godscandl
  513. [page] Godskids
  514. [page] Godtqm
  515. [page] Greekgifts
  516. [page] Grill
  517. [page] Gullible
  518. [page] Gutfart
  519. [page] Hamletcat
  520. [page] Harleywomen
  521. [page] Heshe
  522. [page] Hist2
  523. [page] Homeontheweb
  524. [page] Horsechick
  525. [page] Hotelphone
  526. [page] Howinst
  527. [page] Idiotcontra
  528. [page] Idiotlabel
  529. [page] Ielinux
  530. [page] Ievirus
  531. [page] Induhvid
  532. [page] Installsoftware
  533. [page] Interlight
  534. [page] Irishtoast
  535. [page] Jellydiver
  536. [page] Jesussaves
  537. [page] Jmoore
  538. [page] Ken
  539. [page] Kenbarb
  540. [page] Kidslearn
  541. [page] Kingleer
  542. [page] Klingonprog
  543. [page] Latin
  544. [page] Laundryday
  545. [page] Lblawyer
  546. [page] Leprosy
  547. [page] Letterd
  548. [page] Lovecake
  549. [page] Macdevil
  550. [page] Maketenure
  551. [page] Makingcakes
  552. [page] Manfriend
  553. [page] Marypopp
  554. [page] Mathschool
  555. [page] Mcdonnell
  556. [page] Medmemo
  557. [page] Mentrans
  558. [page] Menway
  559. [page] Mflwebst
  560. [page] Miass
  561. [page] Microcoke
  562. [page] Microwait
  563. [page] Monicacomm
  564. [page] Moretechsupp
  565. [page] Movesouth
  566. [page] Movielessons
  567. [page] Mstvdin
  568. [page] Nerdseas
  569. [page] Nightstand
  570. [page] Ntmoney
  571. [page] Numbeast
  572. [page] Nymag
  573. [page] Octopus
  574. [page] Oschicken
  575. [page] Palmer
  576. [page] Pants
  577. [page] Pardef
  578. [page] Parrots
  579. [page] Pattiwhack
  580. [page] Pc12days
  581. [page] Pcunix
  582. [page] Perfcpl
  583. [page] Phead
  584. [page] Philly
  585. [page] Popfresh
  586. [page] Prayer
  587. [page] Prayers
  588. [page] Prisonwork
  589. [page] Progevol
  590. [page] Projman
  591. [page] Punsigns
  592. [page] Pupil
  593. [page] Qmodo
  594. [page] Queenflight
  595. [page] Rabhunt
  596. [page] Rapsong
  597. [page] Reaganair
  598. [page] Reclett
  599. [page] Redjedi
  600. [page] Relgolf
  601. [page] Remember
  602. [page] Resume
  603. [page] Richbill
  604. [page] Rphrases
  605. [page] Samstarwars
  606. [page] Santatoday
  607. [page] Santawoman
  608. [page] Scot
  609. [page] Secure
  610. [page] Shakeins
  611. [page] Slkbooks
  612. [page] Slogans
  613. [page] Smartdog
  614. [page] Southernsay
  615. [page] Spellchk
  616. [page] Starchain
  617. [page] Startfinish
  618. [page] Starwarstitanic
  619. [page] Statemottoes
  620. [page] Stateslogans
  621. [page] Strayrules
  622. [page] Stressrel
  623. [page] Tamagot
  624. [page] Techcalls
  625. [page] Telemkt
  626. [page] Tennec
  627. [page] Texas
  628. [page] Thebet
  629. [page] Travagt
  630. [page] Treklife
  631. [page] Truestupidity
  632. [page] Twister
  633. [page] Unigrade
  634. [page] Userology
  635. [page] Vagday
  636. [page] Vbride
  637. [page] Vday
  638. [page] Wbread
  639. [page] Webarchitect
  640. [page] Whotrek
  641. [page] Win2bit
  642. [page] Win98liner
  643. [page] Winsuit
  644. [page] Wiscapp
  645. [page] Womdict
  646. [page] Womworld
  647. [page] Xenacard
  648. [page] Xmas9liv
  649. [page] Xmaslegal
  650. [page] Xturkey
  651. [page] Y2kcomp
  652. [page] Y2kgilligan