child

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 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

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