>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 Durkheim 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.
>