Advances in. Clinical Chila Psychology

Advances in Clinical Chila Psychology

ADVANCES IN CLINICAL CHILD PSYCHOLOGY Advisory Editors DENNIS P. CANTWELL, University oj California at Los Angeles RACHEL GITTELMAN, New York State Psychiatric Institute and College of Physicians and Su~~eons, Columhia University JOHN C. MASTERS, Vanderbilt University HERBERT C. QUAY, University oj Miami JUDITH RAPOPORT, National Institute oj Mental Health MICHAEL RUTTER, Institute oj Psychiatry, University oj London A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.

Advances in Clinical Child Psychology UJlume 8 Edited by Benjamin B. Lahey University of Georgia Athens, Georgia and Alan E. Kazdin Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Plenum Press New York and London

The Library of Congress cataloged the first volume of this title as follows: Advances in clinical child psychology. v. 1- New York, Plenum Press, c1977- v. ill. 24 em. Key title: Advances in clinical child psychology. ISSN 0149-4732 1. Clinical psychology-collected works. 2. Child psychology-collected works. 3. Child psychotherapy - Collected works. RJ503.3.A37 618.9'28'9 77-643411 ISBN 978-1-4613-9822-6 DOl 10.1007/978-1-4613-9820-2 ISBN 978-1-4613-9820-2 (ebook) 1985 Plenum Press, New York Softcover reprint of the hardcover 1 st edition 1985 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

This series is dedicated to the children of the world, especially MEGAN, EDWARD, ERIN, NICOLE, and MICHELLE

Contributors Steven R. Asher Kate B. Carey Robert E. Emery Norman Garmezy Rachel Gittelman Arthur C. Houts Nancy C. Hubert Michael E. Lamb Gloria R. Leon James A. Levine Stephen A. Maisto Bureau of Educational Research, University of Illinois, Champaign, Illinois Department of Psychology, Vanderbilt University, Nashville, Tennessee Virginia, Charlottesville, Virginia Minnesota, Minneapolis, Minnesota Department of Psychology, New York State Psychiatric Institute; Columbia University, College of Physicians and Surgeons, 722 West 168th Street, New York, New York Department of Psychology, Memphis State University, Memphis, Tennessee UCLA School of Medicine, Harbor-UCLA Medical Center, Torrence, California Department of Psychology, Psychiatry, and Pediatrics, University of Utah, Salt Lake City, Utah Minnesota, Minneapolis, Minnesota Vice-President, Bank Street College of Education, New York, New York Department of Psychology, Vanderbilt University, Nashville, Tennessee vii

viii Ann S. Masten Jennifer T. Parkhurst Phyllis White Phelan Joseph H. Pleck Donald K. Routh Michael S. Shutty, Jr. Jan L. Wallander CONTRIBUTORS Minnesota, Minneapolis, Minnesota Illinois, Champaign, Illinois Minnesota, Minneapolis, Minnesota Center for Research on Women, Wellesley College, Wellesley, Massachusetts Iowa, Iowa City, Iowa Virginia, Charlottesville, Virginia Southern California, Los Angeles, California

Preface A decade ago, Advances in Clinical Child Psychology was conceived to provide approximately annual updates on the forward edge of research and practice in this rapidly growing field. A look back at the 56 chapters published in previous volumes provides a broad overview of the direction of advancement in clinical child psychology, at least as viewed by one collection of editors, consulting editors, and authors. The trends are clear: There have been decreasing numbers of advances in modes and methods of therapy, an increasing emphasis on the family, a renewed interest in experimental psychopathology (studies of classification, etiology, and prognosis), a growing rapprochement between biological and psychological perspectives, and continued strong interest in cognition and social relationships. The current volume clearly shows these directions in the growth of the field. One chapter discusses etiology, four are concerned with the psychopathology of specific diagnostic categories, one takes an expanded cognitive approach to social competence, and two look at the family system by examining the effects of male parents and children on other members of the family. A final chapter opens discussion on the important topic of the nature of excellence in the training of clinical child psychologists. It is hoped that this chapter will initiate a national dialogue on this multifaceted and often neglected topic. As always, we happily express our gratitude to the authors who prepared these chapters and to the consulting editors who suggested many of the chapter topics and who frequently provided invaluable editorial assistance. Thank you also to our editor at Plenum Press, Eliot Werner, for his consistently effective and cheerful assistance with all phases of the series. BENJAMIN B. LAHEY ALAN E. KAZDIN ix

Contents Risk, Vulnerability, and Protective Factors in Developmental Psychopa thology Ann S. Masten and Norman Garmezy 1 1. Introduction... 1 2. The Concepts of Risk, Vulnerability, and Protective Factors... 2 2.1. Risk and Risk Factors............................ 2 2.2. Vulnerability... 8 2.3. Protective Factors... 14 3. Infants at Risk... 15 3.1. Risk Factors in Prematurity... 19 3.2. Comments... 22 4. Children at Risk for Psychopathology... 22 4.1. Children at Risk for Delinquency... 22 4.2. Children at Risk for Schizophrenia................ 28 4.3. Children at Risk for Affective Disorder............ 31 4.4. The Pros and Cons of Risk Research... 33 5. Summary of General Trends and Future Directions... 34 5.1. Retrospective to Prospective Designs.............. 36 5.2. Main Effects to Interactional Models... 36 5.3. Developmental Trends... 37 5.4. Protective Factors and Stress Resistance... 39 6. Implications for Preventive Interventions... 40 7. References... 43 Anxiety Disorders in Children Rachel Gittelman 1. Introduction... 53 2. Classification of Anxiety Disorders-Children........... 54 2.1. Separation Anxiety Disorder of Childhood... 55 2.2. Avoidant Disorder of Childhood... 56 2 xi

xii CONTENTS 2.3. Overanxious Disorder........................... 57 2.4. Simple Phobia... 57 3. Assessment... 58 4. Epidemiology of Anxiety Disorder... 59 5. Correlates of Anxiety Disorders in Children............. 61 5.1. Social Class... 61 5.2. Gender... 61 5.3. Birth Order... 61 5.4. Traumatic Experiences... 62 5.5. Personality Correlates... 62 5.6. Family Characteristics... 64 5.7. Medical Factors................................. 65 5.8. Genetic Factors... 65 5.9. Age... 67 6. Treatment Approaches................................ 68 6.1. Intense Psychotherapy... 68 6.2. Brief Psychotherapy............................. 68 6.3. Psychopharmacology... 70 7. Prognosis: Ultimate Significance of Childhood Anxiety Disorders............................................ 71 7.1. Follow-up Studies... 72 7.2. Retrospective Studies... 73 8. Conclusions... 74 9. References... 75 Anorexia Nervosa 3 Gloria R. Leon and Phyllis White Phelan 1. Classification... 81 2. Demographic Characteristics... 81 2.1. Incidence... 81 2.2. Prevalence... 82 2.3. Other Demographic Features..................... 82 3. Anorexia Nervosa Subtypes.......................... 83 3.1. Family Characteristics... 84 3.2. Other Classification Strategies.................... 84 3.3. Physiological Influences... 85 4. Personality Processes... 85 4.1. Contributing Variables... 85 4.2. Personality Test Findings... 86 4.3. Self-Control and the Body... 87

CONTENTS xiii 5. Sexual Concerns... 88 6. Body Image... 88 6.1. Nature of the Disturbance... 88 6.2. Prognostic Indicators............................ 89 6.3. Other Prognostic Indices... 90 7. Anorexia Nervosa in Males............................ 90 8. Sociocultural Factors.................................. 91 9. Family Processes..................................... 92 9.1. Theoretical Formulations... 92 9.2. Family Research... 93 9.3. Issues in the Study of the Family................. 93 10. Anorexia Nervosa and Affective Disorder............... 94 10.1. Personal and Family History Data... 94 10.2. Physiological Evidence... 95 11. Interfaces with Other Disorders... 96 12. Endocrine and Physiological Findings... 97 12.1. Gonadotropin Dysfunction....................... 97 12.2. Amenorrhea... 97 12.3. Other Endocrine Findings... 98 12.4. Physiological Dysfunction... 99 12.5. Hypothalamic Dysfunction Hypotheses... 99 13. Treatment of Anorexia Nervosa........................ 100 13.1. Psychodynamic Approaches... 100 13.2. Family Approaches... 100 13.3. Behavioral Approaches... 101 13.4. Cognitive-Behavioral Approaches................. 102 14. Treatment Outcome... 103 15. Issues in the Treatment of Anorexia Nervosa... 103 15.1. Inpatient versus Outpatient Treatment............ 104 15.2. Rate of Weight Gain... 104 15.3. Follow-up Issues................................ 104 16. Conclusions... 105 17. References... 106 Long-Term Prognosis for Children with Attention Deficit Disorder with Hyperactivity (ADD/H) Jan L. Wallander and Nancy C. Hubert 4 1. Definitional Issues... 114 2. Research Review... 115

xiv CONTENTS 2.l. Prospective Studies... 115 2.2. Follow-up Studies... 124 2.3. Retrospective Studies... 126 2.4. Family Studies.................................. 129 3. Research Critique... 131 3.1. Diagnosis... 132 3.2. Sample Constitution... 132 3.3. Research Design................................ 133 3.4. Measurement... 133 4. Implications... 134 4.1. Prognosis... 134 4.2. Theory... 135 4.3. Treatment... 137 5. Conclusions... 141 6. References... 141 Origins of Alcohol Abuse in Children and Adolescents Stephen A. Maisto and Kate B. Carey 1. Introduction... 149 1.1. Definitions of Alcohol Consumption Patterns in Youth... 150 l.2. Survey Data on Drinking Patterns of Children and Adolescents... 154 1.3. A Note on Continuity... 158 2. Theoretical Models of Etiology......................... 158 2.1. Self-Derogation Theory... 159 2.2. Problem Behavior Theory... 160 2.3. Social Learning Theory... 161 2.4. Socialization Theory............................. 162 2.5. Zucker's Developmental Model.................. 164 2.6. Other Longitudinal Studies... 165 2.7. Speculations on the Development of Drinking Practices............................... 167 3. A More Detailed Look from Selected Studies............ 169 3.1. Cognitive Factors... 169 3.2. Peers and Parents............................... 178 3.3. Summary... 183 4. Treatment of Alcohol Abuse in Youth.................. 185 4.1. General Conclusions about Etiology... 185 4.2. Description of Treatment Programs... 187 5

CONTENTS XV 4.3. A Note on Drinking Outcome Goals.............. 190 4.4. Directions for Future Clinical Research............ 191 5. Summary... 193 6. References... 193 Goals and Concerns: Implications for the Study of Children's Social Competence Jennifer T. Parkhurst and Steven R. Asher 6 1. Terms... 201 1.1. Goals... 201 1.2. Value... 202 1.3. Importance and Commitment... 202 1.4. Concerns... 203 2. Goals, Concerns, and Social Relationship Problems...... 204 2.1. Problems Caused by Children's Goals... 204 2.2. Problems Caused by Children's Concerns... 207 3. Assessment of Goals and Concerns... 211 3.1. Methods for Assessing Children's Concerns... 212 3.2. Assessing Children's Goals... 220 4. Conclusions... 225 5. References... 226 The Role of the Father in Child Development: The Effects of Increased Paternal Involvement Michael E. Lamb, Joseph H. Pleck, and James A. Levine 7 1. What's in It for the Children? Paternal Influences in Two-Parent Families.................................. 232 1.1. Infancy... 232 1.2. Older Children... 235 1.3. Summary... 241 2. Single Fathers........................................ 242 2.1. Are Children with Single Parents Really "at Risk"? 243 2.2. Are Single Fathers More Likely to Fail than Single Mothers?................................. 244

xvi CONTENTS 2.3. Are Single Parents More Successful with Children of Their Own Sex?... 245 2.4. Summary... 246 3. What's in It for the Mothers?... 247 3.1. Do Mothers, Especially Employed Mothers, Want More Help from Their Spouses?... 248 3.2. Does Role Overload Affect the Mental Health of Women?... 249 3.3. Does Paternal Participation Enhance Wives' Satisfaction?... 250 3.4. Summary... 251 4. What's in It for the Fathers?... 252 4.1. Why Might Some Men Want to Become More Involved?... 254 4.2. Do Closer Relationships Follow When Fathers Are More Involved?........................ 255 4.3. What Are Other Possible Rewards of Increased Paternal Involvement?................... 255 4.4. How Does Increased Paternal Involvement Affect the Father's Personality and Feelings about Himself?... 256 4.5. Summary... 258 5. Conclusion... 259 6. References... 260 The Impact of Children on Adults Arthur C. Houts, Michael S. Shutty, Jr., and Robert E. Emery 8 1. Introduction... 267 2. Historical and Theoretical Perspectives... 268 2.1. The Child as Passive Recipient... 268 2.2. The Child as Active Agent... 271 3. Evidence for the Impact of Children on Adults... 272 3.1. Evidence from Normal Child Development... 273 3.2. Child Behavior and Positive Reciprocal Interactions..................................... 275 3.3. Child Behavior and Negative Reciprocal Interactions..................................... 278 4. Clinic-Referred Children... 280 4.1. Child Abuse.................................... 281 4.2. Hyperactivity... 283

CONTENTS XVll 4.3. Childhood Autism... 284 4.4. Temporal Sequencing and the Etiology of Childhood Disorders... 285 5. Implications for Assessment........................ 287 5.1. Traditional Assessment.......................... 288 5.2. Behavioral Assessment... 289 5.3. Family Systems Assessment...................... 292 6. Implications for Treatment... 293 6.1. Reciprocal Influence and Family Systems Therapy.. 294 6.2. Individual Therapy for Children Reconsidered..... 294 7. Summary and Conclusions... 297 8. References... 298 Training Clinical Child Psychologists Donald K. Routh 9 1. Introduction... 309 2. General Background... 309 3. Recent Literature on Training in Clinical Child Psychology... 312 4. A Look at Present Members of the Section on Clinical Child Psychology..................................... 314 4.1. Method... 314 4.2. Results... 315 4.3. Discussion... 320 5. General Discussion... 322 6. References... 324 Index......................................... 325