Handbook of Developtnental Handbook of Developmental Psychopathology

Edited by Michael Lewis Robert Wood Johnson Medical School New Brunswick, New Jersey and Suzanne M. Miller Temple University Philadelphia,

Plenum Press • New York and London Library of Congress Cataloging-In-Publication Data

Handbook of developmental csychopathology I edited by Michael le~ts and Suzanne M. Miller. p. em. Includes bibliographical references. ISBN-13: 978-1-4615-7144-5 e-ISBN-13: 978-1-4615-7142-1 DOl: 10.1007/978-1-4615-7142-1 1. Child psychopathology. 2. Child development. I. lewis, Michael, 1937 Jan. 10- II. Miller Suzanne M. [DNlM, 1. Child Development Disorders. 2. Mental Disorders--in infancy & childhood. WS 350 H2359J RJ499.H332 1990 616.92'69--dc20 DNLM/DlC for library of Congress 69-23243 CIP

© 1990 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1990 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N,Y. 10013 All rights reserved

No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Contributors

Thomas M. Achenbach Janet P. Boldizar Center for Children, Youth, and Families Department of Sociology and Social Psychology Department of Florida Atlantic University University of Vermont College of Medicine Boca Raton, Florida 33431-0991 Burlington, Vermont 05401 Bret A. Boyer Department of Psychology Ilana Attie Temple University New York Hospital-Cornell Medical Center Philadelphia, Pennsylvania 19122 Westchester Division White Plains, New York 10605 Jeanne Brooks-Gunn Educational Testing Service Gabor Barabas Princeton, New Jersey 08525 Department of Pediatric Neurology Robert Wood Johnson Medical School Patrick Burke New Brunswick, New Jersey 08903-0019 Behavioral Science Division Children's Hospital , Pennsylvania 15213-2583 Russell A. Barkley Department of Psychiatry Susan B. Campbell University of Massachusetts Medical Center Department of Psychology Worcester, Massachusetts 01605 Pittsburgh, Pennsylvania 15260 Andrew Baum Department of Medical Psychology Dennis P. Cantwell Uniformed Services University of the Health Department of Psychiatry Sciences University of California at Los Angeles Bethesda, Maryland 20814 Neuropsychiatric Institute Los Angeles, California 90024

Adina Birnbaum Alice S. Carter Department of Psychology Child Study Center Temple University Yale University Philadelphia, Pennsylvania 19122 New Haven, Connecticut 06510-8009 v vi CONTRIBUTORS

Dante Cicchetti Leonard D. Eron Departments of Psychology and Psychiatry Department of Psychology , and University of Illinois Mt. Hope Family Center Chicago, Illinois 60680 Rochester, New York 14608 Janet E. Fischel Judith A. Crowell Department of Pediatrics Department of Psychiatry State University of New York at Stony Brook State University of New York at Stony Brook Stony Brook, New York 11794 Stony Brook, New York 11794

Robert Cohen Department of Psychology Department of Psychology Center for Applied Psychological Research University of Memphis State University , Minnesota 55455 Memphis, Tennessee 38152 Sara Harkness Laura M. Davidson Department of Human Development and Department of Medical Psychology Family Studies Uniformed Services University of the Health College of Health and Human Development Sciences Pennsylvania State University Bethesda, Maryland 20814 University Park, Pennsylvania 16802

Curtis K. Deutsch Shriver Center Margaret E. Hertzig Waltham, Massachusetts 02254; and Department of Psychiatry Harvard Medical School Cornell University Medical College Boston, Massachusetts 02115 Payne Whitney Clinic New York, New York 10021 Susanne E. Dunn Department of Psychology Jeffrey A. Hoffman Duke University 703 Northwest Terrace Durham, North Carolina 27706 Silver Springs, Maryland 20902

Denise Durbin Patricia Howlin Department of Psychology Department of Psychology Temple University University of London Philadelphia, Pennsylvania 19122 Institute of Psychiatry de Crespigny Park Jacquelynne S. Eccles London SE5 8AF, England Department of Psychology University of Michigan Ann Arbor, Michigan 48109 L. Rowell H uesmann Present address: Department of Psychology, Department of Psychology University of Colorado University of Illinois Boulder, Colorado 80309 Chicago, Illinois 60680

Nancy Eisenberg Jerome Kagan Department of Psychology Department of Psychology Arizona State University Tempe, Arizona 85281 Cambridge, Massachusetts 02138 CONTRIBUTORS vii

Marcel Kinsbourne Suzanne M. Miller Shriver Center Department of Psychology Waltham, Massachusetts 02254, and Temple University Harvard Medical School Philadelphia, Pennsylvania 19122 Boston, Massachusetts 02115 Katherine Nitz Sharon Landesman Department of Human Development and Family Departments of Psychiatry and Psychology Studies Frank Porter Graham Child Development Center Pennsylvania State University University of North Carolina at Chapel Hill University Park, Pennsylvania 16802 Chapel Hill, North Carolina 27599-8180 Kurt Olsen Mary D. Laney Department of Psychology Department of Pediatrics University of Rochester UMDNJ-Robert Wood Johnson Medical School Rochester, New York 14608 New Brunswick, New Jersey 08903 David G. Perry Michael Lewis Department of Psychology Institute for the Study of Child Development Florida Atlantic University Robert Wood Johnson Medical School Boca Raton, Florida 33431-0991 University of Medicine and Dentistry of New Jersey Louise C. Perry New Brunswick, New Jersey 08903-0019 Department of Psychology Florida Atlantic University Robert M. Liebert Boca Raton, Florida 33431-0991 Department of Psychology State University of New York at Stony Brook Anne C. Petersen Stony Brook, New York 11794 Department of Human Development Pennsylvania State University Barclay Martin University Park, Pennsylvania 16802 Department of Psychology University of North Carolina Robert Plomin Chapel Hill, North Carolina 27514 Department of Human Development and Family Studies Frank J. Menolascino Pennsylvania State University Department of Psychiatry University Park, Pennsylvania 16802 University of Nebraska, and Creighton University Joaquim Puig-Antich Omaha, Nebraska 68105 Western Psychiatric Institute and Clinic Pittsburgh, Pennsylvania 15213 Andrew W. Meyers Department of Psychology Martha Putallaz Center for Applied Psychological Research Department of Psychology Memphis State University Duke University Memphis, Tennessee 38152 Durham, North Carolina 27706

Paul Miller LynnP. Rehm Department of Psychology Department of Psychology Arizona State University University of Houston Tempe, Arizona 85281 Houston, Texas 7720~5341 viii CONTRIBUTORS

J. Steven Reznick Nancy Snidman Department of Psychology Department of Psychology Yale University Harvard University New Haven, Connecticut 06520 Cambridge, Massachusetts 02138

Michelle Rodoletz Charles M. Super Department of Psychology Department of Human Development and Family Temple University Studies Philadelphia, Pennsylvania 19122 College of Health and Human Development Pennsylvania State University University Park, Pennsylvania 16802 Donald K. Routh Department of Psychology University of Miami Everett Waters Coral Gables, Florida 33124 Department of Psychology State University of New York at Stony Brook Stony Brook, New York 11794 David C. Rowe Department of Family Studies University of Arizona Charles Wenar Tucson, Arizona 85721 Department of Psychology Ohio State University Columbus, Ohio 43210-1222 David E. Scharff Washington School of Psychiatry Allan Wigfield Washington, DC 20009 Institute for Social Research University of Michigan Theodore Shapiro Ann Arbor, Michigan 48106 Department of Psychiatry Present address: Department of Human Cornell University Medical College Development Payne Whitney Clinic University of Maryland New York, New York 10021 College Park, Maryland 20742

Judith G. Smetana William Yule Graduate School of Education and Human Department of Psychology Development University of London University of Rochester Institute of Psychiatry Rochester, New York 14627 de Crespigny Park London SE5 8AF, England Foreword

Developmental psychopathology is the new child on the block. As yet not an overly sturdy child, but one clearly out of the cradle, an active toddler and an enterprising explorer of the boundaries of its province. It wasn't always so. Only 15 years ago Thomas Achenbach in publishing the first edition of his book used a recently coined title, Developmental Psychopathology, and began the volume with a provoking first sentence: "This is a book about a field that hardly exists yet. " Seven years later when the second edition appeared, that sentence had been deleted. In place of the original 13-page chapter, on the "Developmental Approach to Psychopathology in Chil• dren," there was a 40-page chapter focused on the biological, cognitive, social-emotional, and educational perspectives in development, together with a lengthy account of develop• mental periods and an integrative statement on the constituents of a developmental framework. Other signs and symptoms began to appear. Child Development, a doyen for develop• mentalists, devoted a special issue, under the guest editorship of Dante Cicchetti, to an emergent developmental psychopathology. This year saw the publication of a new journal, Development and Psychopathology (1989), edited by Cicchetti and Nurcombe. And attend• ees at recent meetings of the Society for Research in Child Development can attest to the growing interest of the membership in the linkage of development and psychopathology as seen and heard via posters, symposia, and guest speakers. Now there comes another milestone, this Handbook of Developmental Psycho• pathology, which readers will quickly identify as a gateway volume to a new interdisciplin• ary basic and clinical science. The discipline is sufficiently youthful that definitions as to its contents and course may vary even as promulgated by several of the contributing authors to this volume. Some examples:

. . . a general approach to understanding relations between development and its maladaptive devia• tions (Achenbach). Developmental psychopathology is the study of the prediction of the development of maladaptive behaviors and processes (Lewis). . . . normal development gone awry . . . the search for understanding is conducted at the interface between normal and abnormal development (Wenar). A developmental perspective on the study of psychopathology takes into account the continuities and discontinuities between normal growth and psychological disorder, age-related changes in modes of adaptation and symptom expression, behavioral reorganizations that occur around salient developmental challenges, internal and external sources of competence and vulnerability, and the effects of development on pathology and of pathology on development (Attie, Brooks-Gunn, and Petersen).

ix x FOREWORD

Actually, these and other authors in their chapters provide case and research examples that reflect a commonality of definition not unlike the editorial commentary written by editor Cicchetti on the first page of the first issue of the first volume of Development and Psychopathology. The emphasis is thus placed on the developmental course of disorder, but always in relation to non-disordered behavior as well. There is interest too in the origins of disordered behavior that may not appear clinically until adulthood. Differential diagnoses, treatment, and prognosis, while important, are to be viewed contextually against the background of development. "The developmental psychopathologist," these authors note, "is concerned with the origins and time course of a given disorder, its varying manifestations with development, its precursors and sequelae, and its relation to non-disordered patterns of behavior. " This last phrase is particularly important, for as Sroufe and Rutter (1984) earlier noted, developmental psychopathologists are equally interested in children who may evi• dence precursors of a disordered behavior pattern, yet fail to develop the disorder proper, as well as those who in time manifest the complete pattern of pathology. This orientation to two groups, those who actualize their risk potential and others who, despite equivalent risk status, escape disorder, accords centrality to the concepts of risk and protective factors, elements which reflect the province and contributions of epidemiology. For Sroufe and Rutter, risk research is in many ways "the paradigmatic developmental psychopathology" with its emphasis on longitudinal study and differentials in the develop• mental course of at-risk subjects, control, and comparison groups. The significant contrasts are with those who go on to develop the disorder as opposed to those who do not. Those who escape disorder spur the search for so-called "protective" factors that operate to contain risk. Such exemplars can provide a deepened understanding of development, and in time, an empirical basis for primary preventi9n efforts. Thus the significance of contrasts of clinically disordered children and adults with their more adaptive counterparts lies in providing new insights into variants that reflect individualized biogenetic, familial, en• vironmental, and personality elements. Thus, one can anticipate research programs of the future that will reflect the multiplicity of sciences that contribute to the role of development in psychopathology. This handbook, in part, demonstrates this hoped-for catholicity of viewpoints. In terms of coverage, the 37 chapters of this volume attend to the major disorders set forth in DSM-ill-R under the heading of "Disorders Usually First Evident in Infancy, Childhood, or Adolescence." In many instances the effort has been made (with varying degrees of success) to provide a developmental emphasis in relation to these diverse disorders. But the constraints when these are evident are less author~imposed than they are field-imposed, reflecting the status of a classification system often devoid of a developmental focus. To bolster the effort the editors' have wisely organized multiple chapters around a given disorder to provide a needed diversity that typically is absent in psychiatric texts. For example, attention deficit disorder is discussed in chapters by Barkley (" Attention Deficit Disorders: History, Definition, and Diagnosis' '), Campbell (' 'The Socialization and Social Development of Hyperactive Children"), and Deutsch and Kinsbourne ("Genetics and Biochemistry in Attention Deficit Disorder"). Conduct Disorder provides even more diversity, via six chapters that brook across the disorder and provide research reviews on "Behavioral Genetics and Aggressive Behavior in Childhood" (Plomin, Nitz, & Rowe), "The Learning of Aggression" (Perry, Perry, & Boldizar), "The Stability of Aggressive Behavior" (Eron & Huesmann), "Morality and Conduct Disorders" (Smetana), and "The Development of Prosocial Behavior versus Nonprosocial Behavior in Children" (Eisenberg & Miller). Anxiety disorders are given a similar outreach in chapters on their "Nature and Development" (Miller), "Separation Anxiety" (Crowell & Waters), "Test Anxiety in the School Setting" (Wigfield & Eccles), "Posttraumatic Stress in Children following Natural and Human-Made Trauma" (Davidson & Baum). To this array I would add the FOREWORD xi significant chapter by Kagan on the "Temperamental Qualities of Inhibition and Lack of Inhibition, " particularly in light of recent accounts of behavioral inhibition in children of parents manifesting panic disorder and agoraphobia (see Rosenbaum et al. in the May, 1988 issue of the Archives of General Psychiatry). Depression too is given a broad canvas with superb chapters by Cantwell ("Depres• sion across the Early Life Span"), Miller and Birnbaum ("Etiological Perspectives on Depression in Childhood"), Burke and Puig-Antich ("Psychobiology of Childhood De• pression") and Rehm and Carter ("Cognitive Components of Depression"). I hesitate to single out any individual chapters, given the breadth and depth of this excellent volume, but to the reader interested in the efforts to link contexts of development to institutional settings and to treatment potential for behavior disorder in children, I strongly recommend Landesman's chapter "Institutionalization Revisited: Expanding Views on Early and Cumulative Life Experiences," as well as Meyers and Cohen's "Cognitive Behavioral Approaches to Child Psychopathology: Present Status and Future Directions. " In several ways Landesman exemplifies the power of a developmental focus in relation to individual adaptation to institutional experiences and environments. I find a tie to the critical attributes of a developmental psychopathology contained in her commentary on the predictive features of institutions. Landesman emphasizes the functional characteristics of the child's care-providing environment, such as the quality and amount of social interac• tion, the presence of developmentally appropriate activities, and the variety of choices available to the children. These she asserts are more important in terms of consequences for the child than are the usual structural characteristics such as the size of the facility, the ratio of adult staff to children, etc. In this regard I commend to the reader similar observations by Trudy Festinger in her volume on the consequences of foster care for disadvantaged minority youth (Festinger, 1983). This emphasis on institutional climate has its parallel in renewed efforts to study the impact of school climate on the development of competence in children from disadvantaged environments (see Comer, 1980; Mortimer, Sammons, Stoll, Lewis, & Ecob, 1988; Rutter, Maughan, Mortimer, & Ouston, 1979). Here the joint power of environmental and individual variation serve as co-influencing factors in the patterns of children's adaptation. Although not an uncommon event it is an understudied one now being redeemed by the efforts of developmental researchers to look both at the "haves" and the "have-nots" under conditions of equivalent disadvantage. Another chapter in this superb volume that is required reading is Cicchetti and Olsen's "Developmental Psychopathology of Child Maltreatment." If one wishes to see how the developmental sciences can contribute to needed knowledge about the origins of psycho• pathology, it is contained in this chapter on . Example after example of develop• mental research on maltreated children is provided that produces insights into the conse• quences of such stressful family pathology on the behavioral functioning of victimized children. An added bonus is the authors' listing of 12 recommendations for future research directions. To these 12 I would add several others:

• Pursuit of the underlying mechanisms for factors identified as "risk" or "protec• tive" in their action • The search for the substrates of defined competencies in different behavioral domains • An increased emphasis on the biology and psychology of temperament and their phenotypic transformations over time • Short-term longitudinal studies of children's adaptation particularly at critical transition points in development • Rigorous efforts to define more adequately a typology of coping responses, the xii FOREWORD

systematization of their measurement with particular attention to rigorous psycho• metric development, and the testing of such instruments for their predictive rather than their postdictive power I have kept you too long from this substantial volume. To editors and authors go my congratulations for a task well done, one that should move forward the scientific bases of an emergent developmental psychopathology. To the editors go my appreciation for their invitation to write the Foreword to this contributory volume. Norman Garmezy Professor of Psychology, Emeritus Minneapolis, Minnesota

References Cicchetti, D. (1989). Development and Psychopathology, 1,1-4. Comer, J. P. (1980). School Power. New York: The Free Press. Festinger, T. (1983). No one ever asked us: A postscript to foster care. New York: Columbia University Press. Mortimer, P., Sammons, P., Stoll, L., Lewis, D., & Ecob, P. (1988). School matters: The junior years. Somerset, England: Open Books Publishing, LTD. Rosenbaum, J. F., Biederman, J., Gersten, M., Hirshfeld, D. R., Meminger, S. R., Herman, J. B., Kagan, J., Reznick, 1. S., & Snidman, N. (1988). Behavioral inhibition in children of parents with panic disorder and agoraphobia. Archives of General Psychiatry, 45, 463-470. Rutter, M., Maughan, B., Mortimer, P., & Duston, 1. (1979). Fifteen thousand hours: Secondary schools and their effects on children. Cambridge: Harvard University Press. Sroufe, L. A., & Rutter, M. (1984). The Domain of Developmental Psychopathology. Child Development, 83, 173-189. Preface

The study of developmental psychopathology must combine questions about development on the one hand, and maladaptive behaviors on the other. Therefore, we offer, as have others, the definition of developmental psychopathology as the study of the prediction of development of maladaptive behaviors and processes. The thrust of the definition of developmental psychopathology forces something more than a simple combination of two sets of interests. First and foremost, it is the study of change and development in maladaptive behaviors and processes. This goal stands as the basic definition of this domain. Second, however, is a much more important and interactive level of mutual informing. Combining the study of development with the study of psycho• pathology broadens the scope of each domain in unique and exciting ways. From a developmental perspective, it introduces the problems of change and transformation, and from a psychopathological perspective, it introduces the concept of individual difference, and with it the variety of possible processes and outcomes. The study of developmental psychopathology begins with the realization that mal• adaptive behaviors often have an historical cause. Although most broad theories of mal• adaptive behavior adhere to such a view, it is the psychoanalytic position which most clearly expresses the developmental perspective that disorders in adulthood have their roots in historical events, some of which occur in infancy and some in early childhood. Erikson's model of stages of development offers a viable framework for the factors which might be related to subsequently different forms of psychopathology. The view that maladaptive developmental factors are the cause of subsequent psycho• pathology is so widely held that to argue its necessity seems redundant. Nevertheless, there is relatively little study, either in development or in clinical psychology, which touches upon this point. Thus, for example, in the study of development, most researchers tend to emphasize developmental processes and the normal course of growth. While there are studies on the development of pathological conditions, these remain few relative to the large number of normative studies. The literature in clinical psychology, on the other hand, is full of studies of pathological conditions, yet has concerned itself relatively less with explora• tions of their initial causes or the stability and consistency of these conditions over time. In part, the study of developmental psychopathology is hampered by at least two major factors. The first is that it is inherently difficult to conduct longitudinal investigations which could serve as a source for the understanding, not only of normal development, but of the development of psychopathology. There are few longitudinal studies currently available. Not surprisingly, therefore, this lack contributes to the dearth of information on the early causes of maladaptive behavior. This is due to the cost of such studies, both in terms of

xiii xiv PREFACE monetary expenditure and in terms of time an investigator must spend before there is sufficient payoff to facilitate a career. The second major difficulty confronting the study of developmental psychopathology has to do with the problem of meaning. While we understand, at least in part, what we mean when we talk about a specific pathological condition in adults, we are often at a loss to understand what the same condition might mean for a young child. That is, it is not clear that the meaning of maladaptive behavior is consistent over age. This problem of consistency of meaning over age is one that has plagued developmen• tal science and psychopathology for some time. A basic tenet of is that the behaviors that underlie a given construct can change as a function of age. This is but one example of the way in which developmental principles can help elucidate critical issues in psychopathology. At the same time, psychopathology, the study of individual differences, or deviant behavior, can inform developmental theory. Consider, for example, the problems that occur in the study of development when a normative approach is taken. A normative approach tends to force us into thinking that the developmental process has a single path leading to a specific outcome. A clinical perspective allows for a reconsideration of such a view. It draws us into understanding that multiple models of development are possible, where process as well as outcome can be variable. It should be clear that the importance of the problem of developmental psycho• pathology necessitates continued investigation and we see this handbook serving as an important reference for those trying to study this domain. This volume should help to educate and inform those scholars interested in development and in problems related to psychopathology. Therefore, the scope of the handbook is extensive, especially since it captures the intellectual excitement and growth of two areas of study and application. The handbook not only addresses the academic community, but those who, during the course of their day, devote their time and energy to the treatment of maladaptive behavior. As articulated in individual chapters as well as in the volume as a whole, the multiple issues of theory and practice are considered. The book is also intended to provide a framework around which undergraduate and graduate courses can be structured. Only a handbook broad in scope, bringing together experts across a wide area of problems and domains could hope to capture the challenge of the study of developmental psychopathology. We have undertaken this volume, in part, to meet this challenge. We have done so because there exists at the moment no comprehensive and single volume source in which these issues have been addressed. This is surprising, given the large and rapidly growing literature in developmental psychology and psychopathology. We there• fore have attempted to fill this gap by including experts in developmental psychology who focus on maladaptive behaviors and processes. Likewise, we have found those scholars and practitioners of the study of psychopathology who are interested in a developmental per• spective and have joined them together in this volume. It is, therefore, a unique effort aimed at addressing an 'important problem in the study and understanding of maladaptive development. The integration of developmental and clinical psychology is an important step toward greater understanding, prediction, and management of normal and abnormal behavior. Accordingly, the present volume aims to provide a broad and comprehensive perspective on psychopathology in childhood, within a developmental context. It targets conceptual, diagnostic, and treatment issues as they relate to the field at large, and with respect to specific disorders and conditions. While we follow the broad outlines of current taxonomy, as reflected in the Diagnostic and Statistical Manual of Mental Disorders (DSM) , we also go beyond the limitations of this classification system. In the current version (DSM-III-R), and in the ongoing revision, only certain problems are specifically identified as being relevant to childhood and early development. These include various disruptive behaviors (e.g., attention deficit disorder, conduct disorder), various forms of anxiety disorder (e. g., separation anxiety, avoidant disorder), eating PREFACE xv disorders (e.g., anorexia nervosa, bulimia nervosa), gender identity disorders, tic and elimination disorders, mental retardation and autism. All of these problems playa central role in the growing field of developmental psychopathology and receive broad attention here. While these disorders can occur in adulthood, they usually have their origins in infancy, childhood, or adolescence. The remainder of the diagnostic system includes disorders that have typically been associated with the psychopathology of adulthood. However, many of these problems• such as depression and schizophrenia-are relevant to the nature and course of early development. The current volume provides a focus on these phenomena, and explores the extent to which separate childhood diagnostic categories may be warranted. In future work, it will be exciting to examine if, and how, distinct adult classification diagnoses should be applied to the evolution or late appearance of disorders that usually have their first onset in the beginnings of life. The book is divided into six major sections. The first section deals with key conceptual and theoretical issues in the study of developmental psychopathology, and provides an overview of the constructs, models, challenges, and cultural factors that are central to the field. Developmental psychopathology is conceptualized as a "macroparadigm," which can coordinate diverse theoretical models (e.g., biological, behavioral, psychoanalytic) and thereby serve to integrate the study of psychopathology from birth to maturity. A model is proposed that argues for the adoption of a "transformational" perspective, which not only emphasizes the way in which the child and environment interact, but also how each is transformed and changed by the other. Methodological strategies for predicting the cause and nature of pathology over time are highlighted. The application of cultural approaches to psychopathology is also considered, which helps alert us to how the culture defines notions of sickness and deviance and, in part, shapes the course and outcome of outlying behaviors. Important diagnostic and classification considerations are also highlighted. In particular, attention is given to the validity and usefulness of the diagnostic categories and to the need to specify the source from which diagnostic information is obtained. Sections II through V explore the major specific clinical disorders that are relevant to childhood and development. The first section focuses on "undercontrolled" or disruptive disorders, specifically attention deficit disorder and conduct disorder. It begins with a focus on attention deficit disorder, which is one of the most common reasons children are referred for treatment. Conceptually, a model is proposed in which the deficits in sustained atten• tion, impulse control, and poor regulation of activity level are seen as a result of more basic deficits in rule-governed behavior or in the way in which consequences regulate sustained responding. The importance of socialization influences to the etiology of the disorder, as well as of genetic and biomedical contributions, is also reviewed. Several chapters are devoted to conduct disorder and related problems of aggression. A range of issues is considered, including evidence for two main types of aggressive disorder: group (so• cialized) and solitary (unsocialized). While the role of genetics in the development of aggression is not well established, there is considerable evidence for the role of social cognitive deficits and for the influence of the family, the peer group, and the mass media. Furthermore, there is an impressive stability of aggressive behavior across time and genera• tions. Finally , conduct-disturbed children appear to reason at lower levels of moral maturity than do nondisturbed children, which seems to be an important barrier to the development of prosocial behavior. Section III deals with' 'overcontrolled" or anxiety-related conditions. Little research is currently available on the major clinical anxiety disorders that are specifically applied to children, such as separation anxiety, avoidant disorder, and overanxious disorder. The agenda for future research includes the development of multi-method assessment batteries and the broadening of psychological theories. In addition, temperamental characteristics appear to be important in some cases of anxiety disorder. For example, children who have a low threshold for fear and threat tend to react by displaying protective inhibitory behaviors. Peer relations are also central to and predictive of adaptive function in children. Among xvi PREFACE various anxiety conditions that are not specifically identified with but are relevant to childhood (e.g., test anxiety, posttraumatic stress, child maltreatment, and fears and phobias) important advances in conceptualization, treatment, and prevention are reviewed. In Section IV, we present a perspective on depression as it relates to early develop• ment, and review its etiology, psychobiology, and cognitive components. It is suggested that the manifestation of depression in childhood must be evaluated in terms of age• appropriate signs and symptoms. Future research is needed to establish criteria and assess• ment instruments for the diagnosis and subtyping of depressive episodes. Evidence which suggests that exposure to early loss and other adverse familial and personal experiences are risk factors for the development of depression in young children. The biological parameters of childhood depression appear to be more complex, with age and puberty exerting an important influence. Finally, as with adults, a variety of cognitive deficits have been identified in youngsters. However, these need to be considered and explored with respect to the child's stage of cognitive development. Specific and pervasive disorders are presented in Section V. These range from more generalized conditions (e.g., borderline disorders, schizophrenia, autism, and mental retar• dation) to more delimited conditions (e. g. , eating disorders, elimination disorders, physical disorders, and sexual disorders). Early childhood autism is the most common of the severe and pervasive childhood disorders and appears to be related to underlying biological and physiological disturbances. With respect to borderline disorders, the current literature needs to be supplemented by prospective longitudinal research, studies of high risk sub• jects, and more sophisticated etiological models. The study and management of mental retardation is particularly challenging, given the serious nature of the disorder and the fact that it is so frequently linked with other severe behavioral and psychological problems. Among the more specific disorders, eating problems are prevalent and appear to be most likely to emerge in adolescence. This seems to be due, in part, to the convergence of particular physical changes and psychosocial stresses during this period, particularly in the lives of females. With regard to elimination problems, enuresis (bedwetting) is the most common form. Since these problems can be persistent, it is important to develop useful theoretical models and applied treatment modes. A number of other physical disorders are also considered in this section, including tics (which appear to have a genetic component) as well as sleep disorders and stuttering. Lastly, the development of a range of normal and pathological sexual patterns is explored, including masturbation, effeminate behavior, sexual identity, homosexuality, and paraphilias. Finally, Section VI concludes with a focus on the management of psychopathology, and provides an evaluation of the effects of institutionalization as well as of the efficacy of a variety of psychotherapeutic intervention approaches. The effects of institutionalization on young children are considered first and it is concluded that the negative consequences can be at least partly offset by providing some stability in at least one close human contact. While treatment considerations are tackled throughout the volume with respect to specific disorders, the fmal chapters provide an overarching appraisal of critical aspects of the therapies themselves, as they are applied to children. Treatment approaches explored include dynamic, family, community and cognitive-behavioral modalities. These tech• niques need to consider the child in a developmental context in which social, emotional, and environmental influences are highlighted. In conclusion, the volume provides a broad and in-depth coverage of the impact of developmental influences on clinical disorders in childhood and explores their linkages with subclinical and normal behaviors. For each disorder, its nature, origins, and evolution over the life cycle are explored, paying close attention to the confluence of behavioral, psychological, genetic, and social factors that are involved. As such, the volume presents a state-of-the-field compendium of our current level of understanding of who is most vulnera• ble to disorder, the factors that predispose toward disorder, and the conditions that activate, exacerbate, or reverse disorder during the beginnings of life. Michael Lewis Suzanne M. Miller Contents

PART I ISSUES AND THEORIES OF DEVELOPMENTAL PSYCHOPATHOLOGY

Chapter 1 Conceptualization of Developmental Psychopathology 3 Thomas M. Achenbach

Why Do We Need Developmental Psychopathology? ...... 3 Developmental Psychopathology as a Conceptual Framework ...... 4 Relations between Developmental Psychopathology and Other Approaches ...... 6 The Relevance of Developmental Periods ...... 8 Applications of Developmental Psychopathology ...... 10 An Assessment Model for Developmental Psychopathology ...... 10 Summary and Conclusions ...... 13 References ...... 13

Chapter 2 Models of Developmental Psychopathology ...... ' ...... 15 Michael Lewis

Trait or Status Model ...... 16 The Environmental Model...... 18 The Interactional Model ...... 22 Summary...... 25 References ...... 25

Chapter 3 Challenges to the Study of Developmental Psychopathology ...... 29 Michael Lewis

Prospective and Retrospective Prediction ...... 29 Nature of Maladaptive Behavior...... 31 Diagnostics, Screening, and Evaluation ...... 33 xvii xviii CONTENTS

Catastrophe and the Notion of Predictability ...... 37 Summary...... 38 References...... 38

Chapter 4 Culture and Psychopathology ...... 41 Sara Harkness and Charles M. Super

Early Formulations of Culture and Psychopathology: Benedict and Mead ...... 41 Freudian Theory in the "Culture and Personality" School...... 42 Cross-Cultural Perspectives on Mental Illness: Epidemiology and the "Culture-Bound Syndromes" ...... 43 Individual Differences and the "Goodness of Fit" ...... 45 Cultural Structuring of Responses to Individual Differences ...... 46 Cultural Structuring of Responses to Behavioral Distress in the United States: The "New Morbidity" ...... 48 Culture and Developmental Psychopathology ...... 49 References ...... 50

Chapter 5 Taxonomy in Developmental Psychopathology: Consider the Source 53 Donald K. Routh

The Importance of Sources of Information ...... 55 Review of Research Concerned with Different Sources of Information in Assessment ...... 57 Use of Multisource Information in the Diagnosis of Child Psychopathology ...... 58 Use of Specific Sources of Information ...... 59 Conclusions ...... 61 References ...... 61

PART II UNDERCONTROLLED DISORDERS

Chapter 6 Attention Deficit Disorders: History, Definition, and Diagnosis 65 Russell A. Barkley

History ...... '" ...... , ...... 65 Description...... 67 Developmental Course ...... 69 Current Diagnostic Criteria ...... 70 Summary...... 72 References ...... 72

Chapter 7 The Socialization and Social Development of Hyperactive Children ...... 77 Susan B. Campbell

Introduction ...... 77 Developmental Tasks and Hyperactivity ...... 78 CONTENTS xix

Socialization Influences ...... 80 Peer Relationships ...... 86 Summary and Conclusions ...... 88 References ...... 89

Chapter 8 Genetics and Biochemistry in Attention Deficit Disorder...... 93 Curtis K. Deutsch and Marcel Kinsbourne

Diagnostic Heterogeneity ...... 93 Etiological Heterogeneity ...... 94 Family Studies ...... 94 Twin Studies ...... 96 Adoption Studies ...... 97 Dysmorphology ...... 98 Genetic Latent Structure Analysis ...... 99 Biochemical Hypotheses...... 99 References ...... : ...... 103

Chapter 9 Conduct Disorders ...... lO9 Barclay Martin and Jeffrey A. Hoffman

Categorical Approaches: Formal Diagnostic Systems ...... 109 Dimensional Approaches ...... llO Relationship between Conduct Disorders and Other Disorders ...... III Prevalence ...... : ...... 112 Stability and Course ...... 112 Psychological Correlates ...... 114 Conclusions...... 116 References ...... 116

Chapter 10 Behavioral Genetics and Aggressive Behavior in Childhood ...... 119 Robert Plomin, Katherine Nitz, and David C. Rowe

Individual Differences and the Normal Distribution ...... 119 Quantitative Genetics ...... 120 Behavioral Genetic Research on Disorders Related to Aggressive Behavior ...... 121 Behavioral Genetic Research on Aggressive Behavior ...... 125 Other Behavioral Genetic Issues concerning Aggressive Behavior...... 128 References ...... 131

Chapter 11 Learning of Aggression ...... 135 David G. Perry, Louise C. Perry, and Janet P. Boldizar

Social Learning Theory ...... 135 Social Cognition and Aggression ...... 136 Family Influences on Aggression ...... 138 xx CONTENTS

Peer Influences on Aggression ...... 141 Media Influences on Aggression...... 142 Conclusions ...... , ...... 144 References .. , ...... , 144

Chapter 12 The Stability of Aggressive Behavior-Even unto the Third Generation...... 147 Leonard D. Eron and L. Rowell Huesmann

Stability of Aggression over 22 Years ...... 148 Intergenerational Transmission of Aggression ...... 151 A Cross-National Study...... 152 Implications of Stability of Aggression ...... 152 References ...... ISS

Chapter 13 Morality and Conduct Disorders ...... 157 Judith G. Smetana

Theories of Moral Development ...... 157 Relations between Moral Judgment and Delinquency ...... 160 Modification of Juvenile Delinquents' Moral Reasoning ...... 171 Conclusions ...... 176 References ...... 177

Chapter 14 The Development of Prosocial Behavior versus Nonprosocial Behavior in Children ...... 181 Nancy Eisenberg and Paul Miller

Personal Characteristics Associated with Nonprosocial versus Prosocial Responding ...... 182 Socialization of Prosocial Behavior ...... 183 Summary ...... 186 References ...... 187

PART III OVERCONTROLLED DISORDERS

Chapter 15 Anxiety in Children: Nature and Development ...... 191 Suzanne M. Miller, Bret A. Boyer, and Michelle Rodoletz

Diagnosis ...... 191 Summary ...... 193 Assessment of Childhood Anxiety Disorder ...... 193 Epidemiology of Childhood Anxiety Disorders ...... 197 Evolution and Outcome of Fear and Anxiety ...... 199 Theories of Etiology ...... 202 Conclusions ...... 203 References ...... 203 CONTENTS xxi

Chapter 16 Separation Anxiety ...... ••...... •. 209 Judith A. Crowell and Everett Waters

Development of Separation Responses ...... 209 Mechanisms and Functions of Separation Protest ...... 210 Normal Individual Differences ...... 212 Traumatic Separation...... 212 Psychopathology ...... '...... 215 Treatment of Separation-Related Problems ...... 216 References ...... 217

Chapter 17 The Temperamental Qualities of Inhibition and Lack of Inhibition ..... 219 Jerome Kagan, J. Steven Reznick, and Nancy Snidman

Introduction ...... 219 Biological Contributions ...... 221 Summary ...... 224 References ...... 224

Chapter 18 The Importance of Peer Relations ...... 227 Martha Putallaz and Susanne E. Dunn

Sociometric Measures ...... 228 Predictive Evidence of Peer Acceptance ...... 228 Explanations for the Risk Relation ...... 233 References ...... 234

Chapter 19 Test Anxiety in the School Setting ...•...... •.•.... 237 Alan Wigfield and Jacquelynne S. Eccles

Conceptualizing Test Anxiety ...... 237 School Evaluation and Anxiety ...... 242 Conclusion and Directions for Future Research ...... 246 References ...... 247

Chapter 20 Posttraumatic Stress in Children following Natural and Human-Made Trauma ...... 251 Laura M. Davidson and Andrew Baum

Precipitating Events ...... 252 Symptoms of PTSD ...... 253 Natural versus Technological Disasters ...... 253 Human-Made Events...... 254 Natural Disaster...... 257 Conclusions ...... ,257 References ...... 257 xxii CONTENTS

Chapter 21 The Developmental Psyc~opathology of Child Maltreatment ...... 261 Dante Cicchetti and Kurt Olsen

Introduction ...... 261 Goals of This Chapter ...... 261 Historical Perspective ...... 262 The Developmental Psychopathology Perspective ...... 263 Definitional Issues ...... 264 Sequelae of Child Maltreatment: Initial Studies ...... , ...... 265 The Influence of Current Etiological Models upon the New Wave of Studies on the Developmental Sequelae of Child Maltreatment ...... 266 Recent Research Studies on the Developmental Sequelae of Child Maltreatment ...... 267 Prevention ...... 275 Conclusion ...... , 276 References ...... 277

Chapter 22 Childhood Fears and Phobias ...... 281 Charles Wenar

Definition...... 281 Summary of Evidence ...... 282 Nature of the Fear Response ...... 284 Overcoming Fears ...... 288 From Fears to Phobias ...... 289 References ...... 290

PART IV DEPRESSION

Chapter 23 Depression across the Early Life Span ...... 293 Dennis P. Cantwell

Introduction ...... 293 Depression: Symptoms, Syndrome, Disorder ...... '" 293 Clinical Picture and Subtypes ...... 295 Assessment ...... 298 Etiologic Theories ...... 300 Links between Depression in Infancy, Preschool, Grade School, and Adolescence ',' ...... 302 Directions for Future Research ...... 306 References ...... 308

Chapter ,24 Etiologic Perspectives on Depression in Childhood ...... 311 Suzanne M. Miller, Adina Birnbaum, and Denise Durbin

Depression and Loss ...... 311 Parental Influences ...... 312 Children'sFactors ...... 320 Conclusions ...... 322 References ...... 323 CONTENTS xxiii

Chapter 25 Psychobiology of Childhood Depression ...... 327 Patrick Burke and Joaquim Puig-Antich

Family History Studies of Childhood Depression ...... 327 Neuroendocrine Studies...... 329 Polysomnography ...... 332 Biological Treatment of Childhood Depression ...... 334 References ...... 335

Chapter 26 Cognitive Components of Depression ...... •...... 341 Lynn P. Rehm and Alice S. Carter

Self-Evaluation ...... 342 Personal Causation ...... 345 Time Concepts ...... 347 Distortion of Present and Past Events ...... 347 Concluding Comments ...... 348 References ...... 349

PART V SPECIFIC AND PERVASIVE DISORDERS

Chapter 27 Borderline Disorders in Childhood ...... 355 Dante Cicchetti and Kurt Olsen

Introduction ...... 355 History ...... 355 Diagnostic Issues ...... 360 Etiology ...... 362 Follow-Up Studies ...... _ ...... 364 Treatment...... 364 Future Directions ...... 367 References ...... 368

Chapter 28 Taxonomy of Major Disorders in Childhood...... 371 Patricia Howlin and William Yule

Early Childhood Autism ...... 371 Characteristics of Autism ...... 372 The Causes of Autism ...... 374 LaterOutcome ...... 375 The Classification of Autism...... 376 The Differential Diagnosis between Autism and Other Childhood Disorders ...... 377 Autism or Childhood Schizophrenia? ...... 377 Autism as a Form of Mental Retardation ...... 378 Autism and Severe Developmental Language Disorders ...... 379 Autism and Asperger's Syndrome ...... 379 Distintegrative Disorders ...... 380 xxiv CONTENTS

Concluding Comments ...... 381 References ...... 382

Chapter 29 Autism and Pervasive Developmental Disorders ...... 385 Margaret E. Hertzig and Theodore Shapiro

Origins and Classification ...... 385 Epidemiology...... 387 Clinical Characteristics from Infancy to Adulthood ...... 388 Theories of Autism ...... 389 . Treatment and Education...... 391 References ...... 392

Chapter 30 The Nature and Types of Mental Illness in the Mentally Retarded 397 Frank J. Menolascino

Introduction ...... 397 Diagnostic and Treatment Challenges ...... : ...... 398 Nature of Mental Illness in the Retarded ...... 400 Influences of the Level of Retardation ...... 400 Frequency and Types of Mental Illness in the Retarded ...... 402 Conclusion ...... 406 References ...... 407

Chapter 31 A Developmental Perspective on Eating Disorders and Eating Problems ...... •...... 409 !lana Attie, Jeanne Brooks-Gunn, and Anne C. Petersen

Eating Disorders ...... 410 Theories of Etiology ...... 411 The Developmental Emergence of Eating Problems ...... 414 Cultural Influences ...... 414 Proximatelnfluences .... " . '" ...... , " ...... 415 Eating Disorders and Developmental Psychopathology ...... 416 References ...... 418

Chapter 32 The Elimination Disorders: Enuresis and Encopresis ...... 421 Robert M. Liebert and Janet E. Fischel

Basic Physiological Mechanisms ...... 421 Nomenclature and Prevalence ...... 422 Clinical Diagnosis ...... 423 Etiology ...... 424 Treatment...... 425 A Final Word about Treatment ...... 428 References ...... 428 CONTENTS xxv

Chapter 33 Physical Disorders ...... ;...... 431 Gabor Barabas

Tourette Syndrome and Tics in Childhood ...... 431 Sleep Disturbances and Disorders of Arousal ...... 434 Enuresis ...... 437 Encopresis ...... 438 Stuttering ...... 439 References ...... 440

Chapter 34 Sexual Development and Sexual Psychopathology: An Object Relations Point of View ...... 441 David E. Scharff

Object Relations Theory ...... 441 Sexual Development ...... 442 The Causes of Sexual Symptomatology ...... 444 Sexual Symptomatology in Childhood ...... 445 Sexual Symptomatology in Adolescence ...... 446 Sexual Difficulties in Adulthood ...... 446 Sexual Dysfunctions and Adult Sexual Symptomatology ...... 446 Concerning the Lack of Specificity in Cause and Effect ...... 447 Sexual Identity...... 447 Homosexuality and the Paraphilias ...... 448 The Paraphilias ...... 449 Sexual Maturity ...... 450 References ...... 450

PART VI INTERVENTION

Chapter 35 Institutionalization Revisited: Expanding Views on Early and Cumulative Life Experiences ...... 455 Sharon Landesman

Early Themes in the Study of Institutionalization ...... 455 Controlled Environments and the Search for Causal Relationships ...... 456 Individual Differences in Response to Environments ...... 458 Modem Forms of Institutionalization: Distinguishing Features ...... 459 Toward a Developmental Taxonomy of Care-Providing Environments ...... 460 Conclusion ...... 461 References ...... 461

Chapter 36 Perspectives and Interventions: Psychoanalysis and Psychoanalytic Psychotherapy, Family Therapy, and Community Psychology ...... 463 Mary D. Laney

Introduction ...... 463 Psychoanalysis and Psychoanalytic Psychotherapy ...... 464 xxvi CONTENTS

Family Therapy ...... 466 Community Psychology ...... , ...... ,...... 469 Summary ...... 472 References ...... , 472

Chapter 37 Cognitive-Behavioral Approaches to Child Psychopathology: Present Status and Future Directions ...... 475 Andrew W. Meyers and Robert Cohen

A Cognitive-Behavioral Perspective ...... 475 The Transition to a Cognitive-Behavioral Model ...... 476 Critical Issues in the Cognitive-Behavioral Model...... 478 A Developmental Perspective for Cognitive Behavior Therapy ...... 479 Elaborating the Developmental Perspective ...... 482 References ...... 483

Author Index ...... 487

Subject Index ...... 511