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\title{The Etiology and Treatment of Childhood\thanks{The author would
like to thank all the little people}\ \thanks{This research was funded in
part by a grant from Bazooka Gum}}
\author{Jordan W. Smoller\\{\it University of Pennsylvania}}
\maketitle
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 reference 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
{\it Diagnostic and Statistical Manual of Mental Disorders, 4th
Edition}, or {\it DSM-IV}, of the American Psychiatric Association
(1985).  Clinicians are still in disagreement about the significant
clinical features of childhood, but the proposed {\it DSM-IV} will
almost certainly include the following core features:
\begin{enumerate}
\item Congenital onset
\item Dwarfism
\item Emotional lability and immaturity
\item Knowledge deficits
\item Legume anorexia
\end{enumerate}
\begin{center}
{\bf Clinical Features of Childhood}
\end{center}
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.

{\bf 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).

{\bf Dwarfism}

This is certainly the most familiar clinical 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).

{\bf 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
labeled a ``child'' by professionals and friends alike.

{\bf Knowledge Deficits}

While many children have IQ's within 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 ignorent 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.

{\bf 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).

\begin{center}
{\bf Causes of Childhood}
\end{center}

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.

{\bf 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 a 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 the 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.

{\bf 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 and Din, 1950) indicate that familial 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 (.92), i.e., when one twin was diagnosed with
childhood, the other twin was almost always a child as well.

{\bf 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 labeling them ``children.''

\begin{center}
{\bf  Treatment of Childhood}
\end{center}

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 of necessity
very basic.  The strategy is essentially one of patient management and
of helping the child master gsic 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 and Pokey, 1957) is typical.

\begin{quotation}
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 pounds, 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
behavior.''  His sexual esperience was non-existant.  Indeed, Billy
considered women ``icky.''

His parents reported that his condition had been present from birth,
improving gradually after he was placed in 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 hald down a ``paper route.''
\end{quotation}

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 comprised 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, and 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 suggest 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 professionals today.  And,
beyond the psychological pain it brings, childhood has recently been
linked to a number of physical disorders.  Twenty years ago, Howdi,
Doody, 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.


\begin{center}
{\bf References}
\end{center}

\begin{itemize}
\item American Psychiatric Association (1985).  {\it The diagnostic
and statictical manual of mental disorders, 4th edition:A preliminary
report}. Washington, D.C.:APA.
\item Barby,B.,\& Kenn,K.(1971).  The plasticity of behavior. In B.
Barby \& K. Kenn (Eds.), {\it Psychotherapies R Us}. Detroit: Ronco
Press.
\item Brady,C.,\& Partridge,S.(1972). My dad's bigger than your dad.
{\it Acta Eur. Age, 9}, 123-126.
\item Flintstone,F.,\& Jetson,G.(1939). Cognitive mediation of labor
disputes. {\it Industrial Psychology Today, 2}, 23-35.
\item Fudd,E.J.(1972). Locus of control and shoe-size. {\it Journal of
Footwear Psychology, 78}, 345-356.
\item Gumbie,G.,\& Pokey,P. A cognitive theory of iron smelting. {\it
Journal of Abnormal Metallurgy, 45}, 235-239.
\item Howdi,C., Doody,C.,\& Beauzeau,C.(1965). Western civilizaion:A
review of the literature. {\it Reader's Digest, 60}, 23-25
\item Moe,R., Larrie,T.,\& Kirly,Q.(1974). State childhood vs. trait
childhood. {\it TV Guide}, May 12-19, 1-3.
\item Moe,R., Larrie,T., Kirly,Q.,\& Shemp,C.(1984). Spontaneous
remission of childhood.  In W.C.Fields (Ed.),{\it New Hope for
Children and Animals}. Hollywood: Acme Press.
\item Popeye,T.S.M.(1957). The use of spinach in extreme
circumstances. {\it Journal of Vegetable Science, 58}, 530-538.
\item Popeye,T.S.M.(1968). Spinach: A phenomenological perspective.
{\it Existential Botany, 35}, 908-913.
\item Rogers,F.(1979). {\it Becoming My Neighbor}. New York: Soft
Press.
\item Ruler,Y.(1923). Assessing measurement protocols by the
multi-method multiple regression index for the psychometric analysis
of factorial interaction. {\it Annals of Boredom, 67}, 1190-1260.
\item Spanky,D.,\& Alfalfa,Q.(1978). Coping with puberty. {\it Sears
Catalogue}, 45-46.
\item Suess,D.R.(1983). A psychomentric analysis of green eggs with
and without ham. {\it Journal of Clinical Cuisine, 245}, 567-578.
\item Temple-Black,S.(1982). Childhood:An ever-so sad disorder. {\it
Journal of Precocity, 3}, 129-134.
\item Tom,C.,\& Jerry,M.(1967). Human behavior as a model for
understanding the rat. In M. de Sade (Ed.), {\it The Rewards of
Punishment}. Paris: Bench Press, 1967.
\end{itemize}

\begin{center}
{\bf Further Readings}
\end{center}

\begin{itemize}
\item Christ,J.H.(1980). Grandiosity in children. {\it Journal of
Applied Theology,1}, 1-1000.
\item Joe,G.I.(1965). Aggressive fantasy as wish fulfillment. {\it
Archives of General MacArthur, 5}, 23-45.
\item Leary,T.(1969). Pharmacotherapy for childhood. {\it Annals of
Astrological Science, 67}, 456-459.
\item Kissoff,K.G.B.(1975). Extinction of learned behavior. Paper
presented to the Siberian Psychological Association, 38th Annual
Meeting, Kamchatka.
\item Smythe,C.,\& Barnes,T.(1979). Behavior therapy prevents tooth
decay. {\it Journal of Behavioral Orthodontics, 5}, 79-89.
\item Potash,S.,\& Hoser,B.(1980). A failure to replicate the results
of Smythe and Barnes. {\it Journal of Dental Psychiatry, 34}, 678-680.
\item Smythe,C.,\& Barnes,T.(1980). Your study was poorly done: A reply
to Potash and Hoser. {\it Annual Review of Aquatic Psychiatry, 10},
123-156.
\item Potash,S.,\& Hoser,B.(1981). Your mother wears army boots: A
further reply to Smythe and Barnes. {\it Archives of Invective
Research,56}, 570-578.
\item Smythe,c.,\& Barnes,T.(1982). Embarrassing moments in the sex
lives of Potash and Hoser: A further reply. {\it National Enquirer},
May 16.
\end{itemize}
\end{document}
