|
Items in cart [0] |
Questions? Call 888-624-8373 |
| ||||||||||||
| Copyright © 2009. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 370
CHAPTER 9
The Status of Research
Related to Psychopathology
Thomas M. Achenbach
Several factors make the study of psychopathology of schoolmate children
especially important. First, referrals for mental health services rise rap-
idly after the age of 5 (Baldwin et al., 1971; Rosen, 1979~. Second, mental
health problems become closely intertwined with children's functioning in
school and their general educational development. Third, mental health
problems appear to crystallize into more tenacious patterns during middle
childhood than in the preschool years. And mental health problems in-
crea~ingly extend into the world outside the family, often hindering chil-
dren's integration into age-appropriate social networks.
Aside from the broad impact of mental health problems and the sharp
rise in referrals from the preschool to the elementary school period, what is
distinctive about the psychopathology of middle childhood? Unlike major
adult disorders, such as schizophrenia and manic-depressive conditions, most
disorders of middle childhood involve exaggerations of behavior that nearly
all children show in some degree. Many disorders of middle childhood also
involve a failure to develop age-appropriate behavior, rather than the decline
or deviation from attained levels of functioning often seen in disorders of
adolescence and adulthood. And most disorders of middle childhood appear
at first glance to be less ominous and more tractable than disorders of
adolescence, in which physical size, sexual maturity, suicidal behavior, de-
linquency, bizarre ideation, and the waning of parental control play larger
roles. Whether disorders of middle childhood actually are less ominous or
370
OCR for page 371
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 371
more tractable is an empirical question that can be answered only through
longitudinal research.
On one hand, existing longitudinal evidence suggests that many disorders
of adolescence are direct outgrowths of childhood disorders rather than
emerging de novo (Rutter, 1980; Rutter et al., 19761. On the other hand,
some childhood behavior problems that have attracted abundant clinical
attention, such as phobias and bed-wetting, may in fact be relatively benign,
transitory, and easily treated (see Achenbach, 1982~. A major task for
research is to distinguish between those childhood problems that are typically
self~correcting without intervention, those that are best handled by parents
or teachers, and those that require professional help to prevent interference
with further development.
As this chapter emphasizes, research on the psychopathology of middle
childhood requires a blending of traditional developmental research with
its focus on developmental processes and sequences and clinically oriented
research with its focus on individual differences. The traditional separation
of these contrasting but equally necessary approaches has limited our un
derstanding of the relationships between normal developmental mechanisms
and pathological deviations of development.
To elucidate the current status of research related to psychopathology, ~
first consider two key aspects of recent research: the role of recent research
in dispelling myths of earlier eras and some new directions taken by recent
research efforts. ~ then consider the conceptual implications of paradigms
that shape the study of child psychopathology. Thereafter, ~ consider research
needs in terms of the prospects for blending clinical and developmental
approaches; the methodological and theoretical challenges and contributions
of the developmental study of psychopathology; the effects of buffers, pre-
vention, and intervention on the development of disorders; and the training
needed to advance developmental research on psychopathology.
IMPLICATIONS OF RECENT RESEARCH: DISPELLING MYTHS
Although there has long been a vast literature on behavior disorders of
childhood, little of it was firmly grounded in programmatic research. Instead,
it was a potpourri of practitioners' personal experiences, theoretical dogma,
and isolated empirical findings, often extrapolated far beyond their original
context. The fragility of the research base was reflected in cycles of changing
advice about childrearing and behavior problems. Successive editions of
the Infant Care Bullean of the U.S. Children's Bureau (1981), for example,
show drastic changes in advice to parents and in the consequences imputed
OCR for page 372
372
DEVELOPMENT DURING MIDDLE CHILDHOOD
to various practices, despite the lack of data to support either the initial
views or the later reversals (see Achenbach, 1982, Ch. 2, for examples).
The research base is still too weak to provide definitive guidelines for
understanding, preventing, ant] treating most behavior disorders, yet the
research of the 1970s and 1980s has helped combat certain influential myths.
This is an essential step in creating a sounder basis for unclerstanding and
treating childhood disorders. As the simple and sovereign assumptions of
earlier years give way to a more empirical orientation, there is an increasing
need for research methods and paradigms geared specifically to child psy-
chopathology. This section illustrates the role of research in dispelling myths
and considers the emergence of new approaches to research.
MBD/Hyperactivity/Attention Deficit Disorder
Throughout the 1960s and 1970s the most publicized behavior disorder
of childhood was at first known as MBD, then as hyperactivity or hyper-
kinesis, and most recently as attention deficit disorder with hyperactivity.
This disorcler exemplifies the following key aspects of behavior problems of
middle childhood:
1. The onset of schooling brings a sharp rise in referrals for the disorder,
with a peak at about age 9.
2. The problem behaviors are not blatantly pathognomonic in themselves
but rather are exaggerations of behavior that most children show in milder
degrees.
3. The problem behaviors do not represent a decline from previously
attained levels but rather an impediment to the development of important
new behaviors.
4. Clinical referrals are prompted by adults' discomfort with the child's
behavior rather than by the child's own requests for help.
Historical Context
During the 1930s and 1940s, Alfred E. Strauss, Heinz Werner, and Laura
Lehtinen developed methods for diagnosing and educating brain-damaged
children (Strauss end Lehtinen, 1947~. Normalchildren, retarded children
with brain damage, and retarded children without known brain damage were
compared on various perceptual and cognitive tasks. The behavioral differ-
ences that were found between the brain-damaged and other children were
interpreted as signs of brain damage.
Strauss's work helped to foster a stereotype of the brain-damaged child.
The stereotype featured hyperactivity, impuIsivity, distractibility, short at
OCR for page 373
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 373
tension span, emotional lability, poor performance on perceptual-motor
tasks, and clumsiness. Children who showed these behaviors but for whom
there was no direct evidence of brain damage were assumed to have subtle
brain damage and were labeled with such terms as the following: Strauss
syndrome, diffuse brain damage, minimal brain damage, minimal brain dys-
function, and minimal cerebral dysfunction. MBD (minimal brain damage
or dysfunction) was soon invoked as an explanation for many forms of
problem behavior.
Problems of Diagnostic Criteria
The early attempts to identify children with subtle brain damage soon
gave way to an indiscriminate use of MBD as a label for a heterogeneous
group who had little in common with the brain-damaged children originally
studied by Strauss and his colleagues. Hyperactive behavior, in particular,
became virtually synonymous with MBD. The concept of MBD was further
broadened to encompass school learning problems. Some people used MBD
interchangeably with the terms LD (learning disability) and SED (specific
learning disability; e.g., Ochroch, 1981~. Under the assumption that an
attention deficit is a core problem in hyperactivity, the official psychiatric
nosology eventually adopted the diagnostic category of attention deficit
disorder with hyperactivity (American Psychiatric Association, 19801.
During the 1970s a flood of publications on hyperactivity suggested that
there was a national epidemic, and American children were diagnosed as
hyperactive at 60 times the rate of British children (Weiss and Hechtman,
1979~. Yet behavioral ratings by teachers, who often instigate referrals for
hyperactivity, showed that American schoolchildren were not perceived as
more hyperactive than schoolchildren in Canada, West Germany, or New
Zealand (Trites, 19791. The popularity of the diagnosis of hyperactivity in
this country, thus, did not appear to reflect significant behavioral differences
between American children and those in other Westem countries. Fur-
thermore, research on children diagnosed as hyperactive showed that many
were not exceptionally or consistently deviant in activity level, although
they might be deviant in other ways, such as aggressiveness (e.g., Loney
and Milich, 19821.
It seems that the concepts of MBD and hyperactivity had expanded far
beyond the phenomena the terms were originally coined to designate. A
lack of standardized diagnostic data was partly to blame for the overuse of
the diagnosis. Yet even when clinicians were given identical data about
putative cases, agreement on the diagnosis of hyperactivity was poor. Anal-
yses of diagnoses made from standardized case materials, for example, showed
that individual clinicians differed in the cues they relied on, the way in
OCR for page 374
374
DEVELOPMENT DURING MIDDLE CHILDHOOD
which they weighted the cues, and their awareness of the diagnostic "pol-
icies" guiding their judgments of hyperactivity (UlIman et al., 1981~.
Despite individual variations in their use of data, however, the clinicians
in the UlIman study generally weighted teachers' and parents' reports of
hyperactivity more heavily than data obtained from clinical assessments.
Other research also has shown that reports by "significant others" in a child's
everyday environment are typically weighted more heavily in clinical di-
agnoses than are clinical observations of behavior (McCoy, 19761. This
suggests that one antidote to the misuse of popular diagnostic concepts is
to make better use of data on behavior occurring outside the clinical setting.
Etiological Assumptions
As hyperactivity became a catchall term for a wide variety of problem
behaviors, the assumption of an organic etiology remained dominant, but
different versions of it were propagated with great conviction. One version
was based on the apparent efficacy of stimulant drugs in reducing hyper-
activity. In a book written for parents, Wender and Wender (1978:21) state
that:
In virtually all instances hyperactivity is the result of an inborn temperamental difference
in the child. How the child is treated and raised can affect the severity of his problem
but it cannot cause the problem. Certain types of raising may make the problem worse,
certain types of raising may make the problem better. No forms of raising can produce
[such problems] in a child who is not temperamentally predisposed to them.
Wender and Wender have argued that hyperactive children have a specific
deficiency in the functioning of the neurotransmitter dopamine and that
the efficacy of stimulant drugs indicates that they compensate for this de
~.
tlclency.
Another organic explanation for hyperactivity concerns abnormal sensi-
tivities to foods. The leading proponent of this explanation is the allergist
Ben Feingold. According to Feingold, heightened sensitivity to naturally
occurring salicylates and artificial colors, flavors, and other food additives
causes hyperactivity in many children. Diets free of these substances are said
to produce dramatic results (Feingold, 1976:24, 26~:
The child who was abusive, disobedient, incorrigible, and disdainful of attention moves
coward becoming affectionate, lovable, and responsive to guidance.... In [mentalI"'
retardation the clinical response may be dramatic, as evidenced by improved behavior,
better coordination of both fine and gross muscles, and improved reaming ability. All
of these gains induce a marked transformation in the patient, whose expression becomes
more alert and bright, his social adjustment improves, permitting him to function as a
self-sufficient person who does not require one~to~one attention or instruction.
OCR for page 375
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 375
The Wender and FeingoIc} positions reflect widespread assumptions that
specific organic abnormalities cause diverse behavior problems labeled as
hyperactivity, despite a lack of well-validated diagnostic criteria. The impact
of these assumptions on treatment is illustrated by survey findings that
stimulant medication was used to treat 85 percent of children whose phy-
sicians considered them hyperactive (Sandoval et al., 1980~. Parents of other
children have joined Feingold associations around the country and attempted
to abide by the Feingold dietary strictures.
Research Findings
Although specific causes have not been identified for hyperactivity, re-
search conducted in the 1970s and 1980s has cast doubt on popular etio'
logical assumptions. Diverse studies have shown, for example, that brain
damage does not necessarily cause hyperactivity and that most children
diagnosed as hyperactive are probably not brain damaged (see Achenbach,
1982, for a review of the evidence). Although stimulant medication has
been shown to reduce activity levels and to improve attention, it has the
same effects on well~functioning nonhyperactive children (Rapoport et al.,
1980~. This casts doubt on the assumption that behavioral responses to
stimulant medication substantiate neurotransmitter deficits unique to hy-
peractive children. Furthermore, follow-up studies show that medication
alone does little to improve the long-term social or academic functioning
of hyperactive children (e.g., Gittelman, 1982~.
With respect to Feingold's claims, carefully controlled studies show neg-
ligible differences in hyperactivity when children are on I;eingold versus
normal diets (e.g., Harley et al., 1978; Weiss et al., 1980~. If food sensi-
tivities actually play any role at all, it is restricted to a very small proportion
of hyperactive children.
Inattentive and overactive behaviors are undoubtedly of concern in their
own right since organic abnormalities may well be involved. Yet the as-
sumption of a disease-like entity with a single organic cause seems less fruitful
at this point than systematic study of the broader contexts in which the
maladaptive behavior occurs. Findings that children treated for hyperactivity
vary greatly in activity level and other behaviors and that the different
behaviors predict different aspects of outcome call for a stronger focus on
overall adaptive patterns.
The Role of Research in Dispelling Myths
Dispelling myths may seem like a prosaic task for research, yet false
assumptions about the causes and cures of psychopathology are pernicious
OCR for page 376
376
DEVELOPMENT DURING MIDDLE CHILDHOOD
and must be unmasked through programmatic research. Only in the last
decade has child psychopathology attracted enough serious research to test
influential assumptions. Such research is needed to produce the measures,
constructs, and basic data for a positive science able to generate valid theories
as well as to dispel myths.
Although research on hyperactivity is a key example, some instructive
parallels are evident in recent research on a strikingly different disorder:
infantile autism, which begins much earlier but typically remains a per-
manent handicap. The role of research in dispelling myths about autism is
especially pertinent because the popular assumptions about autism were the
reverse of the assumptions about hyperactivity.
When Kanner ~ 1943) initially described the syndrome of autism, he care-
fully distinguished it from other disorders, such as schizophrenia. Yet others
soon used the term interchangeably with schizophrenia, childhood psychosis,
and atypical personality, which they blamed largely on environmental fac-
tors, especially parental behavior and attitudes. Despert (1947) and Rank
(1949), for example, implicated mothers who were immature, narcissistic,
overintellectual, and incapable of mature emotional relationships. Bettel-
heim ~ 1967) indicted mothers who "wish that [their] child should not exist"
(p. 125), and Wolman (1970) cited "parents [who] inadvertently hated one
another and use the child emotionally" (p. vii). These claims were buttressed
mainly by the authors' psychodynamic interpretations of cases they had seen.
An absence of research support did not prevent such claims from dominating
the field until the 1970s, with the result that many parents were personally
blamed for their child's condition (e.g., Kysar, 1968~.
As~with hyperactivity, a growing body of research has shown that widely
held assumptions about the etiology of autism were not justified. However,
in this case, doubt was cast on unsupported assumptions of an environmental
rather than an organic etiology. Research on parents of autistic children,
for example, shows no evidence that parental personalities or child-rearing
practices cause autism but, instead, that certain parental characteristics may
be responses to the stress of having an autistic child (see Achenbach, 1982,
for a review of evidence). Although research on organic factors has not
firmly supported alternative explanations for autism (see Cohen and Shay-
witz, 1982), it now seems abundantly clear that it was wrong to blame
parents for autism.
L~PL~ICATIONS OF RECENT RESEARCH:
SOME NEW DIRECTIONS
Recent research has not only helped to dispel myths but has also opened
new perspectives on the developmental aspects of psychopathology. Al
OCR for page 377
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 377
though oriented largely toward the study of psychopathology per se, the new
approaches invite a closer alliance with the study of normal development,
and they may shed more light on developmental processes than traditional
clinical research has. To highlight the new directions, ~ consider research
on children assumed to be at high risk for psychopathology, behavioral
assessment, and taxonomic research.
Research on High-Risk Children
Major adult disorders, such as schizophrenia, have been intensively studied
for decades, but research on people who already manifest such disorders
cannot tell us which of their abnormalities are intrinsic to the disorder and
which ones might reflect consequences of the disorder, such as rejection of
other people, institutionalization, and drug therapies. Experimental manip-
ulation of hypothesized causes would be the method of choice for pinpointing
etiologies, but the hypothesized causes cannot ethically be inflicted on peo
ple.
As an alternative to studying people who already manifest a major disorder,
Mecinick proposed longitudinal research on children who are statistically at
high risk for developing certain disorders (Mednick et al., 1981~. By com-
paring the developmental course of children at risk who eventually manifest
a disorder, at-risk children who do not manifest it, and control children
who are not at risk, Mednick hoped to identify specific etiological factors.
Mednick applied this strategy to longitudinal research on children who have
schizophrenic mothers. Such children are considerably more likely to man-
ifest schizophrenia in adulthood than are the children of nor~achizophrenics,
although most children of schizophrenics do not become schizophrenic.
Mednick's research began with a cohort of Danish children who had
schizophrenic mothers and a demographically matched comparison group
whose families were free of mental disorders. Denmark was chosen because
it has public health services that can aid in the identification and longitudinal
study of groups at risk, plus centralized case registers of mental disorders.
As Mednick's subjects were followed into young adulthood, some mani-
fested severe psychopathology. The findings implicate different precursors
of major disorders in males and females. Among males psychophysiological
lability was a significant precursor, whereas among females early onset of
schizophrenia in their mothers was a precursor (Mednick et al., 1978~.
Teacher ratings also showed different relationships to later schizophrenia in
males and females. Boys who later became schizophrenic were reported by
their teachers to behave inappropriately and to present disciplinary problems.
By contrast, girls who later became schizophrenic were reported to be poorly
controlled, anhedonic, withdrawn, and isolated (John et al., 19821. A
OCR for page 378
378
DEVELOPMENT DURING MIDDLE CHILDHOOD
further finding was that, among high-risk males who showed psychophys-
iological lability, those who became schizophrenic had experienced more
paternal absences ant! more institutional care, especially in the first and
sixth through tenth years of life (Walker et al., 1981~.
In addition to identifying possible precursors of major disorders and sex
differences in the precursors, studies of high-risk children have demonstrated
the importance of comparing the developmental courses of children who are
at risk for different disorders. It has been found, for example, that certain
attentional deficits shown by children of schizophrenics are also shown by
children of parents having unipolar affective disorders (Harvey et al., 19811.
This indicates that abnormalities found in high-risk children are not nec-
essarily unique to the condition for which the children are thought to be
at risk. Instead, some abnormalities may reflect a general psychopathology
or vulnerability factor. Or they may reveal links among disorders that appear
separate in adults.
Behavioral Assessment
Behavioral research has stimulated another type of approach. Several
reports of behavioral therapies for children were published in the 1920s and
1930s. There was then a general eclipse of behavioral interventions until
the late 1950s. By the 1970s, however, behavioral methods had spawned a
large body of literature on case studies and clinical series illustrating particular
techniques. Controlled comparisons with other approaches were rarer, but
the behavioral emphasis on explicit documentation of problems and out-
comes nevertheless yielded a far more objective data base than decades of
literature on psychotherapy had.
One of the main rallying points for behavior modifiers was their rejection
of traditional assessment in favor of behavioral assessment. By traditional
assessment they meant mainly psychodynamic, medically oriented, and per
venality-trait approaches. A fundamental contrast was drawn between the
traditional emphasis on inferences about underlying variables such as psy-
chodynamic constructs, disease entities, and personality and the behav-
ioral emphasis on observable behaviors and the environmental contingencies
supporting them (Mash and Terdal, 19811.
The behavioral assessment method par excellence is the structured re-
cording of behaviors as they occur in natural settings. From published reports
of behavior therapy, we might conclude that direct observations are not
only easy and routine for behavior modiDers but also that they somehow
avoid all the reliability and validity problems raised by traditional assessment.
Such is not the case, however. Because it is seldom practical to have trained
OCR for page 379
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 379
observers record problem behaviors for routine clinical assessment, there is
often a gap between the idealized mode! of behavioral assessment and what
behavioral clinicians really do (Wade et al., 1979~. Furthermore, many
problem behaviors, such as stealing, setting fires, and fighting, are unlikely
to occur under the watchful eyes of trained observers. And even where
exceptionally thorough observations have been done in the homes of very
cooperative families, the observed contingencies seem to account for little
of the variance in problem behaviors (Patterson, 19801.
The limitations of direct observations under natural conditions and the
lack of perfect agreement among various assessment methods have led be'
havior modifiers to advocate multimethod behavioral assessment (Nay, 19791.
For assessments of children the multiple methods include interviews, stan-
dardized tests, checklists and log books completed by parents and teachers,
observations in natural and clinical settings, and simulation of problem
.
situations.
The advent and broadening of behavioral assessment has greatly enriched
the study and treatment of psychopathology by workers of many persuasions.
Nevertheless, in dispensing with psychodynamic, disease, and personality
constructs, behavioral assessment faces a major problem in "how to reduce
the plethora of fine objective behavioral categories into fewer, more mean'
ingfu! and interpretable categories" (Hetherington and Martin, 1979:1541.
This raises questions of taxonomy, to which ~ now rum.
Taxonomic Research
Research on children at risk, behavioral assessment, and most other as-
pects of psychopathology concerns individual differences. In studies of chill
dren at risk, for example, the goal is to identify variables differentiating
children having poor outcomes from those having good outcomes. In be-
havioral assessment the goal is to pinpoint specific behaviors and the en-
vironmental contingencies that must be modified to improve a child's
functioning. But the study of individual differences must ultimately find a
basis for conceptually grouping children according to higher order patterns
of similarities and differences.
A common strategy is to form groups of children whose behavior patterns
are similar in the hope that they will be found similar in other important
ways, such as the etiology, prognosis, and optimal treatments for their dis-
orders. Grouping children according to behavioral similarities is also nec'
essary for clinical communication, program planning, and the training of
clinicians. In short, taxonomies of behavior are fundamental to the study
and treatment of psychopathology.
OCR for page 380
380
DEVELOPMENT DURING MIDDLE CHILDHOOD
Nosolog~cal Approaches
One approach to taxonomy is an outgrowth of traditional medical no-
sology. This approach assumes that each disorder consists of an underlying
disease entity that manifests a distinctive symptom pattern. According to
this view, the goal of taxonomic research is to obtain precise descriptions
of symptom patterns in order to form groups of individuals who all have the
same disorder and to discriminate them from individuals who have different
disorders. Once this is done, individuals who have the same disorder can
be studied to determine the underlying nature, cause, and optimal treatment
of the disorder. Because it is assumed that a specific disease underlies each
symptom pattern, the nosological approach puts great emphasis on identi-
fying each disorder in a present versus absent fashion.
The dominant version of the nosological approach to behavior disorders
is the Amerian Psychiatric Association's Diagnostic and Statistics Manual of
Mental Disorders (the "DSM"~. The first two editions of the DSM (DSM-
I, 1952; DSM-~l, 1968) were composed mainly of narrative descriptions and
inferred psychodynamics of purported disorders, as negotiated by committees
of psychiatrists. The newest edition (DSM-~l, 1980) bases the taxonomy
of adult disorders on research diagnostic criteria (RDC) that have been
evolved for discriminating between long-established taxa, such as schizo-
phrenia and manic-depressive conditions.
In a major departure from the narrative descriptions and inferred dynamics
of disorders in DSM-l and DSM-~l, DIM- specifies decision rules for the
diagnosis of each disorder. However, the lack of well-established taxa of
childhood disorders left the job of specifying criteria for childhood disorders
largely to the process of committee negotiations.
Although successive drafts of DIM- showed improvements in the in-
terjudge reliability of adult diagnoses, there was a decline in the reliability
of child diagnoses from early drafts to later drafts (see DSM-~l, Appendix
F). Furthermore, two studies have shown poorer reliability for DIM-
diagnoses of children than for DSM-~l diagnoses, which were themselves
not very reliable (Mattison et al., 1979; Mezzich and Mezzich, 1979~. The
innovations that improved the reliability of adult diagnoses thus seem to
have made the nosological diagnoses of childhood disorders even less reliable
than before. Better reliability has been obtained for some specific disorders
(Edelbrock et al., 1983), and standardized clinical interviews may help
improve the reliability of DSM diagnoses in general (Costello and Edelbrock,
1982~. However, it remains to be seen whether the DSM categories validly
discriminate between children whose disorders actually differ in important
ways.
OCR for page 387
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 387
to see whether there are possible developmental or cohort effects. If there
are no significant age differences, any developmental or cohort effects across
this particular age span may be negligible. If there are significant age dif-
ferences, however, it may be worth conducting a longitudinal~sequential
study in which children of several cohorts are assessed as they age from 6
to 11 in order to see whether there are uniform changes with age in all
cohorts or whether changes occur in all cohorts at the same points in time,
regardless of age.
Although feasible for one or two distinctive disorders, such as hyperac-
tivity, this strategy would~ be impractical for many of the behavior problems
that afflict school-age children. Furthermore, because the necessary studies
of a specific disorder are not likely to be launched until there is already
widespread alarm about the disorder, it would be too late for the most
informative comparisons between periods of apparent low prevalence and
apparent high prevalence. As an altemative, it would~ be preferable to have
periodic normative-epidemiological assessments of a broad range of behavior
problems in large representative samples, as discussed in the next section.
Normative Epidemiological Research
Developmental research seeks to identify the mechanisms and sequences
of development that characterize children in general. Yet developmental
studies seldom obtain normative data on representative samples using pro'
cedures that are widely replicable. Instead, most developmental studies em-
ploy procedures devised to suit a particular conception of theoretical variables,
as assessed in samples chosen for convenience rather than representativeness.
The practical utility of the procedures and their generalizability to other
situations are seldom considered, even though the aim is to derive generalized
conclusions.
Clinical research, by contrast, is often spurred by the need for quick,
practical procedures that can be readily applied in a variety of settings. This
is exemplified by the abundance of procedures for assessing hyperactivity.
Few of these procedures, however, are based on normative data that show
how individual children compare with representative samples of their peers.
Lacking either native data or a litmus test for the positive diagnosis of
disorders such as hvDeractivirv. we cannot place much faith in the meaning
~ --I r ---~- - -' ' ~ ~
of particular scores.
Both developmental research and clinical research seek conclusions that
are generalizable beyond the samples that are actually studied. Yet their
research samples and procedures seldom justify generalization of their find'
ings. There is thus a basic need for standardized assessment procedures to
OCR for page 388
388
DEVELOPMENT DURING MIDDLE CHILDHOOD
provide common denominators across diverse research and practical con-
texts. It is essential that these procedures be normed on large representative
samples of children to provide baselines for comparisons with subsequent
research samples and for judgments of how individual children deviate from
their peers.
Most previous efforts to obtain normative and/or epidemiological data on
children's behavior disorders have used a small number of behavior problem
items chosen on the basis of convenience or assumed significance. In some
cases the assessment procedures have been severely constrained by the over-
riding requirements of large-scale surveys, such as the federal government's
health examination survey (Roberts and Baird, 19711. In other cases they
have been geared to a particular sample of convenience that was selected
for ready availability rather than representativeness (e.g., Tuddenham et
al., 1974~.
Very few studies have obtained data on behavior disorders in representative
samples using procedures that could be readily transferred to subsequent
research and clinical applications (see Achenbach and Edelbrock, 1981, for
a review of studies). However, when this is done, it provides a normative
data base with which to compare findings obtained by the same procedures
in new contexts. Without such a data base, developmental research on
psychopathology tends to be random and noncumulative, unable to relate
the findings of one study to those of other studies or to individual children.
Periodic repetitions of normative-epidemiological studies at intervals of ap-
proximately 10 years would make it possible to reshape the normative data
base according to advances in assessment methodology. If certain marker
variables were kept standard from one decade to the next, it should be
possible to detect major secular changes in behavior disorclers.
It is also important to compare data obtained with similar procedures for
children of either sex, for children from different ethnic and socioeconomic
groups, and for children viewed from different perspectives. For example,
despite higher mental health referral rates for school-age boys than girls
(Eme, 1979), parents report similar numbers of problems for boys and girls
in normative samples. Boys' problems, however, tend more often to involve
undercontrolled externalizing behavior, whereas girls' problems tend to in-
volve overcontrolled intemalizing behavior (Achenbach and Edelbrock, 1981~.
Furthermore, teachers report higher rates of school problems for boys than
girls in normative samples (Eclelbrock and Achenbach, 1984~. Where ethnic
and socioeconomic differences have been assessed separately, socioeconomic
status accounts for much more variance than ethnicity. Parents of lower
socioeconomic status, for example, report more problems and fewer compe-
tencies than parents of upper socioeconomic status, whereas black and white
OCR for page 389
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 389
parents matched for socioeconomic status do not differ much in their reports
of either problems or competencies (Achenbach ant! Edelbrock, 1981~.
Psychopathology and Educational Development
During middle childhood, school becomes a central arena for both success
ant! failure (see Epps and Smith, in this volume). Children must master not
only academic skills but also diverse social skills. Failure to master either
type of skill on an age-graded schedule can lead to a pervasive sense of
failure that hampers further development. What may at first be merely a
delay or weakness in a specific skill, such as reading, listening attentively,
or making friends, can become a source of alienation from the entire ecu'
cation process.
When children do not progress as expected, they are often assigned to
bureaucratically defined categories of special services, such as classes for the
reaming disabled or social/emotionally disturbed. However, by the time
special services creak into action, the problems are often multiple, since
what begins as a learning problem usually engenders behavioral and emo'
tional problems. Similarly, what begins as a behavioral or emotional problem
often impedes reaming.
Its central role as a developmental arena during middle childhood and its
responsibility for providing appropriate help make the school a key focus for
developmental research on psychopathology. Yet not much research has
focused on the interactions between children, their families, and their schools
that lead to adaptive versus maladaptive development during middle child-
hood. Recent government funding cuts and legislation that mandates least
restrictive environments have combined to curtail the use of special ecu'
cation placements. This further increases our need for understanding the
role of school-related variables in healthy development.
One requirement for improving research on relationships between psy-
chopathology and educational development is the type of normative-epi-
demiological data base discussed in the previous section. Because teachers
are well situated to observe behavior problems related to educational de-
velopment, standardized teachers' assessments of the behavior of represen-
tative samples of their pupils can provide a data base on which to build
subsequent studies of specific relationships between psychopathology and
educational development, as illustrated by the research cited earlier on
precursors of schizophrenia (John et al., 1982~.
Efforts to form such a data base suggest that teachers apply such terms as
hyperactivity too broadly to provide much discriminative validity (Edelbrock
and Achenbach, 1984~. A data base for school behavior must therefore seek
OCR for page 390
390
DEVELOPMENT DURING MIDDLE CHILDHOOD
more precise discrimination among behavior patterns than is afforded by
popular quasi-diagnostic labels. Once a normative data base is available,
research can be more finely tuned to the study of such issues as the way
particular patterns of children's problems and competencies interact with
particular classroom and teaching styles to facilitate or impede development.
The role of molar differences between schools can also be studied, as has
been done for the impact of secondary schools on juvenile delinquency in
Britain (Rutter et al., 1979~.
The Role of Specific Risk and Protective Factors
Earlier in this chapter ~ discussed the study of children at high risk for
particular disorders as one of the new directions taken by developmental
research on psychopathology. Such studies have mainly sought to pinpoint
predictors of major adult disorders such as schizophrenia. However, most
childhood risk factors do not lead to such gross deviances. The loss of parents
through death, divorce, or abandonment, for example, triggers a variety of
reactions falling well short of schizophrenia. Aside from the immediate
emotional reactions, the loss of parents can affect adaptive development by
altering children's economic circumstances and everyday contacts with adults,
including opportunities for modeling of adult behavior. Other environmental
changes, such as a move to a new home or school and integration with
unfamiliar ethnic or socioeconomic groups, likewise constitute risk factors
that trigger diverse reactions. Personal characteristics that conflict with the
demands of a particular environment and major illnesses are additional risk
factors that can impede development. The long-term outcomes may include
school failure, identity diffusion, withdrawal, aggression, and delinquency,
which are not necessarily recognized as psychopathology.
The other side of the coin concerns positive adaptive characteristics of
both child and environment that facilitate coping with developmental chal-
lenges. Under the banners of social competence and the invulnerable child,
positive adaptive characteristics have won considerable fanfare in recent
years. Despite the popularity of competence as a theoretical construct, how'
ever, much remains to be teamed about the specific strengths that enable
some children to deal constructively with major risk factors that would
debilitate other children. Social cognition and peer relations may be espe-
cially fruitful areas of study in this regard (see the chapters by Fischer and
Bullock and Hartup, in this volume).
To understand both the preexisting competencies that enable children to
cope with threats to their development and the competencies that can be
fostered by stress or by therapeutic interventions, we need more than a priori
notions of competence, such as children's popularity with peers or favorable
OCR for page 391
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 391
impressions they make on adults. Instead, we need to study situations likely
to be debilitating and to pinpoint the variables that predict good and poor
outcomes when children's coping abilities are severely tested. Both the best
and the worst outcomes must be analyzed if we are to understand what
distinguishes between competence and incompetence and how we might
enhance the coping abilities of children who would otherwise suffer poor
outcomes.
Evaluation of Prevention and Intervention Efforts
Like the current emphasis on competence, current enthusiasm for pre'
vention rather than treatment of psychopathology reflects a reaction against
illness models. Although it is easy to advocate prevention, it i often much
harder to carry it out. Even though thousands of tragic deaths are known
to be caused by voluntary behaviors (smoking, drunken driving, overeating,
the use of guns), for example, massive efforts at changing behaviors have
met with little success. Where the specific causes of behavior disorders are
unknown, the call for prevention hardly seems more likely to be answered
with success. In fact, some of the most ambitious efforts to prevent problem
behaviors in children, such as delinquency, seem to have inadvertently
increased the behaviors (McCord, 1982; O'Donnell et al., 19791.
Yet prevention is on a continuum with intervention efforts designed to
ameliorate problems after they emerge. Secondary prevention, for example,
refers to preventing conditions that are evident from causing further harm.
Considering the massive outlays for unproven interventions, more priority
needs to be given to evaluating the outcomes of efforts to overcome male'
captive development, whether they are called primary or secondary preven-
tion or therapeutic intervention.
Behavioral and drug therapies for psychopathology in middle childhood
have been accompanied by more scientific evaluation of outcomes than the
previously dominant psychodynamic therapies were. Nevertheless, most out'
come evaluations compare the effect of a particular treatment with no treat'
ment or one other treatment on samples of subjects regarded as homogeneous
because they manifest particular target symptoms. Unfortunately, such stud'
ies cannot detect potentially important interactions between characteristics
of the subjects and particular treatments. Thus, if a treatment shows a
statistically significant superiority for a group of subjects, it may be wrongly
viewed as the treatment of choice for all children manifesting the problem
used to define the group.
Yet in the very few studies that have analyzed interactions between subject
and treatment variables, interactions with such gross variables as age and
socioeconomic status have been found to account for more variance than
OCR for page 392
392
DEVELOPMENT DURING MIDDLE CHILDHOOD
the main effects of treatment. Love and Kaswan (1974), for example, found
that a treatment that was beneficial for upper-cIass children actually seemed
harmful for lower-cIass children. Exactly the reverse pattern was found for
a second treatment. Although controlled evaluations of the outcome of
interventions for child psychopathology are difficult, expensive, and lengthy,
such evaluations should be mandatory for all efforts at prevention and ther-
apeutic intervention.
Training for Developmental Research on Psychopathology
Developmental research on psychopathology requires skills and interests
spanning two areas that have differed in training programs, occupational
roles, reward systems, and consumer audiences. Developmental psychologists
are mainly trained to carry out research on developmental processes and
sequences defined in terms of theoretical and laboratory-based concepts.
They are oriented toward academic careers built on scholarly publications
intended for an academic audience. Clinicians, by contrast, are trained
mainly in the use of clinical assessment and intervention procedures. They
are oriented toward the delivery of clinical services in which interpersonal
relationships with patients and other practitioners are paramount. Day-to-
day coping with practical problems usually takes precedence over abstract
research issues.
How can developmentally sophisticated research be used to help troubled
children? Because so many different problems remain to be solved, a wide
range of personal orientations can contribute. For example, the more the-
oretically or methodologically oriented researcher can find abundant chal-
lenges in devising rigorous assessment procedures for complex clinical
phenomena and evolving research designs to untangle interwoven devel-
opmental and clinical problems. At the other extreme, the more clinically
oriented researcher can find challenges in trying to translate detailed knowI-
edge ~ ~ individual cases into researchable general questions.
Because not every researcher can be expected to master all the skills
relevant to developmental research on psychopathology, it is unrealistic to
expect the same people to be expert clinicians and statisticians and meth-
odologists and theoreticians. Furthermore, work with children takes second
place to work with adults in most clinical training programs, while clinical
research is relatively peripheral to most research training programs. People
who want to do developmental research on psychopathology must therefore
piece together the necessary training experiences for themselves. As a con-
sequence, potential workers in this field have diverse and checkered back-
grounds. The fact that they span two areas having different professional
OCR for page 393
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 393
trajectories also necessitates piecing together employment that will enable
them to work at the interface of developmental research and clinical services.
This can be difficult at all times but especially during a period of scarce
funds for both research and clinical services.
The number of people doing developmental research on the psychopath-
ology of middle childhood is small; their employment prospects and research
support are tenuous; and they are not sufficiently concentrated in any one
place to provide comprehensive training programs. It is, therefore, important
to find ways to facilitate research in this area and to train new researchers.
Even a small cadre of serious researchers who are able to pursue long-term
programmatic research could greatly improve our knowledge and treatment
of the psychopathology of childhood.
SUMMARY
During middle childhood, mental health referrals rise rapidly as mental
health problems become intertwined with school functioning, crystallize into
more tenacious patterns, and hinder integration into social networks outside
the family.
Psychopathology in middle childhood typically involves exaggerations of
bed - ors that most children show to some degree and failures to develop
age-appropriate behaviors. A major task for research is to distinguish between
childhood problems likely to be self-correcting, those that can be handled
by parents or teachers, and those that require professional help to prevent
interference with further development.
The study of psychopathology in middle childhood requires a blending of
research on developmental processes and sequences with clinically oriented
research on individual differences.
Recent research has helped dispell influential myths about the origins and
nature of certain disorders, such as hyperactivity and autism. It has also
stimulated new approaches to the developmental understanding of psycho-
pathology, as exemplified by studies of children at high risk for psycho-
pathology, by behavioral assessment, and by taxonomic research. The
nosological and multivariate-descriptive taxonomic paradigms can lead to
very different ways of conceptualizing the psychopathology of middle child-
hood.
REFERENCES
Achenbach, T.M.
1982 Developmental Psychopathology. Second ed. New York: John Wiley & Sons.
In Developmental psychopathology. In M.E. Lamb and M.H. Bernstein, eds., Developmental
press Psychology: An Advanced Textbook. Hillsdale, N.J.: Lawrence Erlbaum.
OCR for page 394
394
DEVELOPMENT DURING MIDDLE CHILDHOOD
Achenbach, T.M., and Edelbrock, C.S.
1978 The classification of child psychopathology: A review and analysis of empirical efforts.
Psychological Bulletin 85:1275-1301.
1979 The child behavior profile: I. Boys aged 12-16 and girls aged 6-11 and 12-16. Journal
of Consulting and Clmical Psychology 47:223-233.
1981 Behavioral problems and competencies reported by parents of normal and disturbed
children aged four to sixteen. Monographs of the Society for Research in Child Development
46:Serial No. 188.
1983 Manual for the Child Behavior Checklist and Revised Child Behavior Profile. Burlington:
University of Vermont.
Adam, J.
1978 Sequential strategies and the separation of age, cohort, and time-of-measurement con
tributions to developmental data. Psychological Bulletin 85:1309-1316.
American Psychiatric Association
1980 Diagnostic and Statistical Manual of Mental Disorders. Third edition. Washington, D.C.:
American Psychiatric Association.
Baldwin, J.A., Robertson, N.C., and Satin, D.G.
1971 The incidence of reported deviant behavior in children. Intemational Psychiatry Clinics
8:161-175.
Baltes, P.B., Reese, H.W., and Nesselroade, J.R.
1977 Life-Span Developrnenta1 Psychology: Introduction to Research Methods. Monterey, Calif.
BrookstCole.
Bettelheim, B.
1967 The Empty Fortress. New York: Free Press.
Bradley, C.
1937 The behavior of children receiving benzedrine. American Journal of Psychiatry 94:577-
585.
Carlson, G.A., and Canewell, D.P.
1982 Diagnosis of childhood depression: A comparison of the Weinberg and DSM-III criteria.
Journal of the American Academy of Child Psychiatry 21:247-250.
Cohen, D.J., and Shaywitz, B.A.
1982! Preface to the special issue on neurobiological research in autism. Journal of Autism and
Developmental Disorders 12: 103- 107.
Costello, A., and Edelbrock, C.
1982 Structured interviewing: A progress report on the NIMH Diagnostic Interview Schedule
for Children (DISC). Paper presented at the American Academy of Child Psychiatry,
Washington, D.C., October.
Despert, L.
1947 Psychotherapy in childhood schizophrenia. American Journal of Psychiatry 104:36-43.
Eaton, W.O.
1983 Measuring activity level with actometers: Reliability, validity, and arm length. Child
Development 54:720-726.
Edelbrock, C., and Achenbach, T.M.
1980 A typology of child behavior profile patterns: Distribution and correlates for disturbed
children aged 6-16. Journal of Abnormal Child Psychology 8:441-470.
1984 The teacher version of the child behavior profile. Journal of Consulting and Clinical
Psychology.
Edelbrock, C., Costello, Ad., and Kessler, M.D.
1983 Empirical corroboration of the attention deficit disorder. Journal of the American Academy
of Child Psychiatry.
OCR for page 395
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 395
Eme, R.F.
1979 Sex differences in childhood psychopathology: A review. Psychological Bulletin 86:574-
595.
Feingold, B.F.
1976 Hyperkinesis and learning disabilities linked to the ingestion of artificial food colors and
flavors. Journal of Leaming Disabilities 9:551-559.
Gittelman, R.
1982 Prospective Follow-up Study of Hyperactive Children. Paper presented at the American
Academy of Child Psychiatry, Washington, D.C., October.
Goldberg, H.K., Schiffman, G.B., and Bender, M.
1983 Dyslexia. Interdisciplinary Approaches to Reading Disabilities. New York: Grune & Stratton.
Harley, J.P., Matthews, C.G., and Eichman, P.
1978 Synthetic food colors and hyperactivity in children: A double~blind challenge experi-
ment. Pediacncs 61 :818-828.
Harvey, P., Winters, K., Weintraub, S., and Neale, ].M.
1981 Distractibility in children vulnerable to psychopathology. Journal of Abnormal Psychology
90:298-304.
Hetherington, E.M., and Martin, B.
1979 Family interaction. In H.C. Quay and J.S. Werry, eds., Psychopathological Disorders of
Childhood. Second ed. New York: John Wiley & Sons.
Horn, J.L., and Donaldson, G.
1977 Faith is not enough: A response to the Baltes Schaie claim that intelligence does not
wane. American Psychologist 32:369-373.
John, R.S., Mednick, S.A., and Schulsinger, F.
1982 Teacher reports as a predictor of schizophrenia and borderline schizophrenia: A Bayesian
decision analysis. Journal of Abnormal Psychology 91:399-413.
Kanner, L.
1943 Autistic disturbances of affective contact. Nervous Child 2:217-250.
Kysar, ].E.
1968 The two camps in child psychiatry: A report from a psychiatrist father of an autistic and
retarded child. American Journal of Psychiatry 125:103-109.
Loney, J., and Milich, R.
1982 Hyperactivity, inattention, and aggression in clinical practice. In M. Wolraich and D.K.
Routh, eds., Advances in Behavioral Pediatrics. Vol. 2. Greenwich, Conn.: JAI Press.
Love, L.R., and Kaswan, J.W.
1974 Troubled Children: Their Families, Schools, and Treatments. New York: John Wiley & Sons.
Mash, E.J., and Terdal, L.G.
1981 Behavioral Assessment of Childhood Disorders. New York: Guilford Press.
Mattison, R., Cantwell, D.P., Russell, A.T., and Will, L.
1979 A comparison of childhood psychiatric disorders. Archives of General Psychiatry 36:1 2 1 7-
1222.
McCord, J.
1982 The Cambridge-Somerville Youth Study: A sobering lesson on treatment, prevention,
and evaluation. In A.J. McSweeney, S.J. Fremouw, and R.P. Hawkins, eds., Practical
Program Evaluation for Youth Treatment. Springfield, Ill.: Charles C. Thomas.
.,
McCoy, S.A.
1976 Clinical judgments of normal childhood behavior. Journal of Consulting and Clinical
Psychology 44:710-714.
Mednick, S.A., Griffith, ].J., and Mednick, B.R.
1981 Problems with traditional strategies in mental health research. In F. Schulsinger, S.A.
Mednick, and J. Knop, eds., Longitudinal Research. Methods and Uses in Behavioral Science.
Boston: Nijhoff.
OCR for page 396
396
DEVELOPMENT DURING MIDDLE CHILDHOOD
Mednick, S.A., Schulsinger, F., Teasdale, T.W., Schulsinger, H., Venables, P.H., and Rock,
D.R.
1978 Schizophrenia in high risk children: Sex differences in predisposing factors. In G. Serban,
ea., Cognitive Defects in the Development of Mental Illness. New York: Brunner/Mazel.
Mezzich, A.C., and Mezzich, ].E.
1979 Diagnostic Reliability of Childhood and Adolescent Behavior Disorders. Paper presented
at the American Psychological Association, New York, September.
Nay, R.W.
1979 Multimethod Clinical Assessments. New York: Gardner Press.
Ochroch, R., ed.
1981 The Diagnosis and Treatment of Minimal Brain Dysfunction in Children. A Clinical Approach.
New York: Human Sciences Press.
O'Donnell, C.R., Lydgate, T., and Fo, W.S.O.
1979 The buddy system: Review and follow-up. Child Behavior Therapy 1:161-169.
Patterson, G.R.
1980 Mothers: The unacknowledged victims. Monographs of the Society for Research in Child
Development 45:Serial No. 186.
Quay, H.C.
1979 Classification. InH.C. Quay and]. Werry, eds., Psychopatholog~calDisordersofChildhood.
Second ed. New York: John Wiley & Sons.
Rank, B.
1949 Adaptation of the psychoanalytic technique for the treatment of young children with
atypical development. American ]oun~al of Orthopsychiatry 19: 130- 1 39.
Rapoport, J.L., Buchsbaum, M.S., Weingartner, H., Zahn, T.P., Ludlow, C., and Mikkelsen, E.~.
1980 Dextroamphetamine. Its cognitive and behavioral effects in normal and hyperactive boys
and normal men. Archives of General PsychiatTy 37:933-943.
Roberts, J., and Baird, J.T.
1971 Parent ratings of behavioral patterns of children. U. S. Department of Health, Education,
and Welfare Publication no. (HSM) 72-1010. Washington, D.C. U.S. Government
Printing Office.
Rosen, B.M.
1979, An overview of the mental health delivery system in the United States and services to
children. In I.N. Berlin and L.A. Stone, eds., Basic Handbook of Child Psychiatry. Vol.
4. New York: Basic Books.
Rutter, M.
1980 Changing Youth in a Changing Society. Cambridge, Mass.: Harvard University Press.
Rutter, M., Graham, P., Chadwick, O.F.D., and Yule, W.
1976 Adolescent turmoil: Fact or fiction? Journal of Child Psychology and Psychiatry 17:35-56.
Rutter, M., Maughn, B., Mortimore, P., and Ouston, J.
1979 Fifteen Thousand Hours: Secondary Schools and Their Effects on Children. Cambridge, Mass.:
Harvard University Press.
Sandoval, J., Lambert, N.M., and Sassone, D.
1980 The identification and labeling of hyperactivity in children: An interactive model. In
C.K. Whalen and B. Henker, eds., Hyperactive Children: The Social Ecology of Identification
and Treatment. New York: Academic Press.
Spitzer, R.L., and Cantwell, D.P.
1980 The DSM-III classification of the psychiatric disorders of infancy, childhood, and ado-
lescence. Jounull of the American Academy of Child Psychiatry 19:356-370.
Strauss, A.A., and Lehtinen, L.E.
1947 Psychopathology and Education of the Brain-lnjured Child. New York: Grune & Stratton.
OCR for page 397
THE STATUS OF RESEARCH RELATED TO PSYCHOPATHOLOGY 397
Trites, R.L., ed.
1979 Hyperactivity in Children. Etiology, Measurement, and Treatment. Baltimore, Md.: Unit
versity Park Press.
Tuddenham, R.D., Brooks, J., and Milkovich, L.
1974 Mothers' reports of behavior of ten~year-olds: Relationships with sex, ethnicity, and
mother's education. Developmental Psychology 10:959-995.
Ullman, D., Egan, D., Fiedler, N., Jurenec, G., Pliske, R., Thompson, P., and Doherty, M.E.
1981 The many faces of hyperactivity: Similarities and differences in diagnostic policies. JouTru~
of Consulting and Clincial Psychology 49:694-704.
U.S. Children's Bureau
1981 Infant Care. U.S. Department of Health and Human Services. Washington, D.C.: U.S.
Government Printing Office. Serial.
Wade, T.C., Baker, R.B., and Hartmann, D.T.
1979 Behavior therapists' self~reported views and practices. The Behavior Therapist 2:3-6.
Walker, E., Hoppes, E., Emory, E., Mednick, S., and Schulsinger, F.
1981 Environmental factors related to schizophrenia in psychophysiologically labile high-risk
males. Journal of Abnormal Psychology 90:313-320.
Weiss, G., and Hechtman, L.
1979 The hyperactive child syndrome. Science 205:1348-1354.
Weiss, B., Williams, J.H., Margen, S., Abrams, B., Caan, B., Citron, L.]., Cox, C., McKibben,
]., Ogar, D., and Schultz, S.
1980 Behavioral responses to artificial food colors. Science 207:1487-1489.
Wender, P., and Wender, E.
1978 The Hyperactive Child and the Learning Disabled Child. A Handbook for Parents. New York:
Cramm.
Wolman, B.B.
1970 Children Without Childhood. New York: Grune & Stratton.
.,
Representative terms from entire chapter:
developmental research
