The field of child mental health in general and developmental psychopathology in particular is a relatively recent one. Work in the area increased dramatically in the 20th century with an explosion of knowledge over the last several decades in particular. This body of work draws on various, sometimes distinctive and sometimes overlapping, historical and professional traditions and disciplines. It includes expanding knowledge about both normative/typical child development and developmental processes as well as about the origins, expression, and treatment of psychopathology. Parts of the field have their origins in the social welfare movement and the concern for better approaches to juvenile justice. Another contribution stems from the long-standing concerns for children with significant intellectual deficiency (mental retardation). Another line of work relates to mental illness originating in childhood or having precursors in childhood. All these efforts had their origins in an interest in children and their development that had begun to increase in the 1700s and also was fueled by concerns for the education of future citizens. This area of work and the overlap of educational and child developmental and mental health concerns remain an important issue for schools and mental health professionals to this day.
Interest in understanding children’s development can be traced to ancient times. Several different models of development were proposed. The preformationists included individuals like Hippocrates who assumed that body structures in the embryo were formed simultaneously, whereas others like Aristotle suggested that development was more dynamic with the embryo formed by a series of transformations and differentiations (Hunt, 1961
). Preformationist thought continued well into the 1600s when, with the development of the microscope, small humans were initially seen in views of human sperm (see Figure 1.1
Consistent with this view was the notion that children could survive on their own without considerable parental support. The story of Romulus and Remus (see Figure 1.2
) reflects this view. In reality, of course, for birds and mammals, a considerable dependence on an adult caregiver(s) is required. This fantasy does, however, persist into the present with periodic reports in the popular press of children being cared for by animals (see Candland, 1993
Children were typically viewed as “chattels” (moveable property) with limited rights, and high rates of child mortality (particularly infant mortality) were observed.
FIGURE 1.1. Hartsoeker’s drawing of a human sperm (1694) reflected “preformationist” ideas about embryologic development. The increased awareness of the complexity of development during the embryonic period paralleled an increased interest in the ways in which children’s psychological development changed and reorganized over time. From Hartsoeker, N. (1694). Essay de dioptrique. Chez Jean Anisson. Courtesy of Harvey Cushing, John J. Whitney Medical Library, Yale University School of Medicine.
FIGURE 1.2. Romulus and Remus and their she-wolf mother. Sculpture in Vatican Museum. Photo by F. R. Volkmar.
Views of children, their development, and education began to change during the 18th century in a time that has come to be called the “Enlightenment.” The nature of child development and needs for education became much discussed. In countries like the newly independent United States, there were particularly important issues for having an educated electorate. And, in the expansion of the United States, provision was made for country schools to serve this need.
The Enlightenment was not a single movement and indeed many of the philosophers central in it had divergent and sometimes contradictory views. For example, John Locke, the Scotch physician and philosopher, was interested in education and psychological development. He suggested that babies are born with a mind that is a blank slate (tabula rasa), on which experience and growing conscious awareness shape the developing child. For him, education was therefore essential. Although agreeing with Locke on the importance of education, in contrast to him, the philosopher Jean-Jacques Rousseau believed that children were innately good and that a corrupt society contributed to their difficulties.
In the 19th century, the growing emphasis on education, attempts to reform child labor laws (not to mention concerns about slavery), and an expanding interest in women’s rights (including the right to an education) had a major impact. Darwin’s work on evolution revolutionized psychology as well as biology (see Figures 1.3
Darwin was interested in psychological development in men and animals (and published a book on facial expressions in man and animals—1871) to clarify potential biologic relationships and similarities in emotional expression. His interest in children also reflected an awareness that, to some extent, children’s development has important similarities, particularly at the embryologic level, to evolutionary development (Darwin, 1859
). Darwin (1877)
also kept a detailed diary of one of his children’s development. His work inspired subsequent psychologists, including Freud as well as individuals like G. Stanley Hall, who tried to
understand child development in an evolutionary context. Darwin’s book on the Expression of Emotion in Man and Animals
marks the beginning of comparative psychology, and along with his baby diary of his developing child, the beginning of the field of child psychology.
FIGURE 1.3. Charles Darwin c. 1860 by Julia Margaret Cameron.
FIGURE 1.4. From Charles Darwin: Plate I. Expression of emotion in man and animals. Reproduced with permission from Darwin Online.
Reduced rates of infant and child mortality also meant that more children survived to need educational and other services. Beginning in the 19th century, several factors contributed to reducing mortality rates (see Box 1.1
). These included better nutrition, housing, sanitation, various public health efforts (e.g., as the mechanisms of disease pathogenesis became clear), the development of immunizations to prevent the frequent, serious childhood infections, and, finally, the development of antibiotics. Before the 1800s, child mortality in general and infant mortality in particular was high with considerable fluctuation reflecting epidemics, famine, conflict, and other factors. Probably, at least one-third of infants succumbed to illness on average.
Pediatrics began to develop as a specialty with the growing awareness of differences in medical care in younger patients reflecting differences in physiology and drug metabolism. Hospitals for the care of sick children began to be established in Europe and the United States. These medical specialists also were increasingly concerned with fostering children’s healthy development and providing practical guidance to parents.
Interest in intellectual deficiency/mental retardation also contributed to the development of the various child specialists. Although recognized since antiquity, scientific interest increased as attempts were made to understand the underlying brain basis of severe cognitive impairment, for example, the English anatomist Thomas Willis related intellectual deficiency to small brain size, and by 1866 John Down suggested that the syndrome that now carries his name (Trisomy 21) reflected an evolutionary throwback in development. Inspired by Darwin, individuals in the eugenics movement suggested the idea of improving society through selective breeding. (See Gould, 1996
for an excellent discussion.)
A different, and more optimistic, approach to the care of the mentally retarded arose in France where work by Itard on the so-called feral child, Victor (see Figure 1.5
), stimulated his interest in the remediation of significant developmental difficulty. His inspiration of the French physician Édouard Séguin led to a new approach in classifications and attempts to improve functional outcome. Séguin immigrated to the United States and had a profound influence on the development of intervention programs. In the United States, a series of special institutions, originally focused on rehabilitation of developmentally disabled children, were created. Other such institutions were established to care for children with blindness or deafness. A professional organization was established in 1876 that became what would be the American Association on Mental Retardation. The development of the first reliable tests of intelligence by Binet and Simon (see Chapter 6
) also contributed to earlier identification of less severely impaired children with developmental delays. Clinics for the care of children with developmental difficulties began to be established in the late 19th century.
Although the development of institutions and better approaches to assessment were positively intended, both led to abuses. Intelligence tests were used, sometimes highly inappropriately, to bolster the efforts of the eugenics movement, and, over time, the many negative effects of institutionalization also became apparent. In the United States, G. Stanley Hall, a pioneer psychologist and educator, began to use new approaches to study normative development. He used questionnaires to assess what children had learned and to document their interests and activities. He used this information in helping teachers understand development. The growing child study movement led to the establishment, in the early 20th century of a number of research centers around the country. Around this time, the length of children’s years of education began to increase as increase in technology required a more educated workforce. Hall’s work influenced many in the next generation of researchers including Arnold Gesell, and Gesell’s student, Benjamin Spock.
FIGURE 1.5. Victor the “wild boy” of Aveyron was reported to be a feral child who had lived alone in the woods prior to his eventual capture. Although reports of wild or “feral” children abound in mythology, we usually see reports relate either to children raised in profound isolation (but NOT by animals) or with serious developmental problems like autism. From Itard, E. M. (1802). An historical account of the discovery and education of a savage man, or of the first developments, physical and moral, of the young savage caught in the woods near Aveyron, in the year 1798. London: Richard Phillips.
Children who had difficulties with the law became a focus of increased concern. In the early 1900s, Healy established a clinic that advised the juvenile court regarding children. Healy’s psychologically informed approach proved influential. He collaborated with a number of individuals including Jane Adams, whose work at Hull House in Chicago served as a base for the development of social work as a discipline. Healy eventually moved to Boston where he and a colleague founded the clinic supported by the Judge Baker Foundation. Around the same time, Arnold Gesell, one of the first PhDs in developmental psychology, moved to Yale where he completed medical and pediatric training and founded what would become the Yale Child Study Center. In contrast to Healey’s work, Gesell strongly emphasized the recognition of innate factors in development. Gesell conducted innovative work in charting normal development in infants and younger children using techniques like still-frame movie cameras to examine more precisely the aspects of infant motor development (Gesell et al., 1938
). Gesell’s work had a profound influence on pediatrics, education, and child rearing practices. The contrasting views of various individuals, each emphasizing either biologic or environmental factors, paralleled earlier debates on the relative contributions of nature versus nurture (see Chapter 2
). These tensions continued theoretically, for example, in the tensions between theories of development grounded in behaviorism and psychoanalysis. The increased interest in children with developmental, mental health, and legal issues led to the establishment of the American Orthopsychiatric Association in the 1920s. This organization strongly supported the importance of interdisciplinary collaboration in child mental health work. The interface of mental health issues with pediatrics led to the formal establishment of child psychiatry as a discipline. Although psychiatrists like Maudsley in the 1800s had recognized the childhood onset of major psychiatric difficulties, it was only
in 1930 that Leo Kanner was recruited to Johns Hopkins to serve as a liaison between pediatrics and psychiatry there and wrote the first textbook of psychiatry devoted to children (1935). Among his many accomplishments was his pioneering work in pediatric consultation-liaison psychiatry (see Chapter 27
) and the recognition of autism as a distinctive condition (see Chapter 7
). Before World War II, pediatricians were beginning to spend time training in child psychiatry as fellows in various sites around the country. At this time, psychoanalytic influences also became strong, and were further strengthened by an influx of European psychoanalysts before and subsequent to the war. The federal government established the first training grants shortly after the war. As the Child Guidance clinics increased, so did the need for psychiatrists with specialized child training. The American Academy of Child Psychiatry was established in 1953, and by 1957 the field was recognized as a subspecialty of psychiatry with standards for training and board examinations and its own journal.
THEORIES OF DEVELOPMENT
Over the past century, a number of attempts have been made to provide broad, overarching theories of development. Typically, these approaches draw on one or more perspectives in their attempt to account for the complex interplay of biologic and experiential/psychological factors that play a role as children grow and develop. These approaches vary in a number of respects. Some focus more on one aspect of development (emotional or cognitive), whereas others are more concerned with mechanisms (e.g., of learning). Although many early theories, like Freud’s, were concerned with early development, subsequent work has often extended these theories to other aspects of the life cycle, for example, Erik Ericson was inspired by psychoanalytic theory and provided an overarching model for development from infancy to old age (see Table 1.1
TABLE 1.1 Eric Erickson’s Stages of Development
Stage of Development
Approximate Age Range
Trust vs. Mistrust
Depending on task: with consistent caretaking environment, infant develops a sense of trust in the social world.
Autonomy vs. Shame and Doubt
18 months to 3 years
Young child develops a sense of their control and independence.
Initiative vs. Guilt
The child becomes more assertive and interactive in play and interaction.
Industry vs. Inferiority
Peers and the ability to work and learn become important.
Identity vs. Role Confusion
Major focus on development of sense of self and personal values
Intimacy vs. Isolation
Development of capacities for intimacy, family connectedness
Generativity vs. Stagnation
Nurturing of others and sense of contribution to others and society
Ego Integrity vs. Despair
65 years to death
Appreciation of personal accomplishments and sense of having led a successful life
An increased awareness of the complexity of both genetic and experiential mechanisms and their interaction has also clarified important issues in development. For example, genes may change in their function over time. Specific environmental factors may have more effects at some points than at others. For example, early exposure may predispose some children to develop allergic responses. Another complexity arises because some traits, behaviors, and features may reflect a stronger genetic or psychological component. Environmental factors, including both endogenous and exogenous, may contribute, in varying degrees, to development. The idea of experience-dependent plasticity has been used when there are strong effects of experience at certain points in development. A child deprived of vision early in life may later have trouble if sight is restored in coordinated use of the eyes and perception of depth and three dimensions. Finally, of course, development occurs in a family-societal context. The environment that children experience is itself partly shaped by the parents’ experience and endowment.
All theories of development face several important challenges. How is the interplay between endowment (nature) and experience (nurture) to be understood? How and why does change happen? Is development continuous or discontinuous? For example, for a theorist like Piaget who proposes rather major changes in cognitive functioning over childhood, what accounts for these changes? Relating theories to age and normative expectations presents another challenge. Early studies of child development were initially concerned with documenting normative processes. It became possible to describe typical behavior of a 1-year-old simply by evoking age as an explanation. Given major changes and developmental accomplishments, it is typical for presentations on children’s development to be constructed around intervals that are roughly age defined, for example, infancy, toddler, preschool, school age, and adolescence. Although understandable, this type of exposition tends to perpetuate the notion that somehow developmental change is caused by age alone. Over time, the field has moved from an initial focus on simple measures and age-related correlation to more sophisticated approaches. Although many broad theories of development have been postulated, a recent trend has been the focus on very specific aspects of development. In this chapter, we briefly summarize three major theories of development that have had a major impact on the field: psychoanalysis, Piaget’s cognitive theory, and learning theory.
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