Clinical Child Psychology

Advances in Clinical Child Psychology VolUlne 11

ADV ANCES IN CLINICAL CHILD PSYCHOLOGY Advisory Editors DENNIS P. CANTWELL, University of California at Los Angeles RACHEL GITTELMAN, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University HERBERT C. QUAY, University 0/ Miami JUDITH RAPOPORT, National Institute of Mental Health MICHAEL RUTTER, Institute of Psychiatry, University 0/ 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 Volume 11 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, cl977- v. ill. 24 cm. 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-13: 978-1-4613-9831-8 e-isbn-13: 978-1-4613-9829-5 DOl: 10.1007/978-1-4613-9829-5 1988 Plenum Press, New York Softcover reprint of the hardcover I st edition 1988 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 Mark Belding F. M. C. Besag Donald M. Burke Marcy Bush Jerome A. Cerny Dante Cicchetti Donald J. Cohen John D. Coie J. A. Corbett Greta Francis Department of Psychology, Duke University, Durham, North Carolina St. Piers Lane, Lingfield Surrey, England Department of Psychology, State University of North Dakota-Minot, Minot, North Dakota Department of Psychology, University of Rochester, and Mt. Hope Family Center, Rochester, New York Department of Psychology, Indiana State University, Terre Haute, Indiana Departments of Psychology and Psychiatry, University of Rochester, and Mt. Hope Family Center, Rochester, New York Child Study Center, Yale University, New Haven, Connecticut Department of Psychology, Duke University, Durham, North Carolina Department of Psychiatry, University of Birmingham, Kidderminster, England Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania vii

viii Cynthia G. Last Rolf Loeber o. Ivar Lovaas CONTRIBUTORS Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Psychology, University of California, Los Angeles, California Wendy B. Nelles Gordon L. Patzer Wendy K. Silverman Tristram Smith Department of Psychology, State University of New York, Albany, New York College of Business Administration, Loyola Marymount University, Los Angeles, California Department of Psychology, State University of New York, Albany, New York Department of Psychology, University of California, Los Angeles, California Cyd C. Strauss Sheree Toth Marion Underwood Fred R. Volkmar Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Psychology, University of Rochester, and Mt. Hope Family Center, Rochester, New York Department of Psychology, Duke University, Durham, North Carolina Child Study Center, Yale University, New Haven, Connecticut

Preface With this volume, Advances in Clinical Child Psychology enters its second decade. The goal of the series is to provide clinicians and researchers in the fields of clinical child psychology, child psychiatry, school psychology, and related disciplines with an annual compilation of statements that summarize the new data, concepts, and techniques that advance our ability to help troubled children. Looking forward, the series intends to highlight the emerging developments that will guide our field of inquiry and practice; looking back, the eleven volumes in the series provide an interesting chronicle of changes in our understanding. Each year, scholars are chosen whose recent work is on the leading edge of clinical child psychology and its sibling disciplines, who offer potentially important new theoretical viewpoints, or who are well qualified to discuss topics of emerging importance that are not identified with one particular laboratory. Perhaps more than in any previous volume, the authors of the present volume have achieved fully the goals of the series. Volume 11 is a rich source of exciting ideas, important new information, and cogent analysis. The topics of these chapters, moreover, can be seen to represent the important broad themes in clinical child psychology today. The volume begins with two chapters that describe emerging theoretical perspectives. Cicchetti, Toth, and Bush describe a general theoretical framework for childhood psychopathology that encompasses a wide variety of disorders. Loeber provides a more tightly delimited model of the development of several varieties of antisocial behavior in children and adolescents. Both models, however, share a similar developmental-ontogenetic view of deviant behavior that has long been paid little more than lip service in clinical child psychology. Coie, Belding, and Underwood summarize and interpret evidence on the role of aggression in the development of social competence. Although the level of analysis is somewhat different, their piece is clearly related to Loeber's chapter in both content and developmental perspective. Strauss also provides a cogent look at the development of social competence, but examines the role of maladaptive levels of anxiety rather than aggressive behavior. Related chapters that provide important additional information on the long-neglected topic of childhood ix

x PREFACE anxiety disorders are provided by Last and Francis on phobias for school situations and by Silverman, Cerny, and Nelles on the familial nature of anxiety disorders. Together, these three chapters provide a helpful update on several important aspects of research on the internalizing disorders. A pair of chapters similarly presents an update on highly important new developments in the assessment (Volkmar and Cohen) and treatment (Lovaas and Smith) of children with pervasive developmental disorders. The final two chapters in the volume deal with the importance of constitutional factors in childhood psychopathology. Patzer and Burke have written a superb integrative review of studies showing the association of childhood psychopathology with physical unattractiveness. In a related chapter with a more clinical emphasis, Corbett and Besag have provided an excellent overview of both medical and psychological aspects of epilepsy. We appreciate the roles played by the advisory editors in suggesting excellent topics and in thoughtfully editing some of the chapters. As always, our strongest thanks go to the chapter authors for their outstanding contributions. BENJAMIN B. LAHEY ALAN E. KAzDIN

Contents Developmental Psychopathology and Incompetence in Childhood: Suggestions 1 for Intervention Dante Cicchetti, Sheree Toth, and Marcy Bush 1. The Organizational Perspective on Developmental Psychopathology..................................... 1 2. The Transactional Model.............................. 2 3. Illustrative Conditions Involving Disorders of Development... 3 3.1. Down Syndrome... 4 3.2. Nonorganic Failure-to-Thrive... 4 3.3. Childhood Depression... 5 3.4. Offspring of Depressed Parents... 6 3.5. Child Maltreatment... 7 4. Stage-Salient Issues of Early Development........ 7 4.1. Homeostatic Regulation of the Development of a Reliable Signalling System (0 to 3 Months)... 8 4.2. Management of "Tension" (Cognitively Produced Arousal) and the Differentiation of Affect (4 to 6 Months)... 10 4.3. The Development of a Secure Attachment (6 to 12 Months)... 12 4.4. The Development of an Autonomous Self (18 to 24 Months)... 15 4.5. Symbolic Representation and Further Self-Other Differentiation (24 to 36 Months)... 17 4.6. Establishing Peer Relations... 27 4.7. Adaptation to School............................ 33 5. Implications for Intervention... 39 5.1. Developmental Considerations in Intervention... 43 5.2. Interventions for Infancy through Toddlerhood.... 47 5.3. Interventions for Toddlerhood through Early Childhood... 52 xi

xii CONTENTS 5.4. Parent-Specific Intervention...................... 57 6. Conclusion.......................................... 58 7. References........................................... 59 Natural Histories of Conduct Problems, Delinquency, and Associated Substance Abuse: Evidence for Developmental 2 Progressions Rolf Loeber 1. Introduction......................................... 73 1.1. Tools That Help to Identify Progression........... 75 2. Progression from Conduct Problems to Delinquent Acts... 77 3. Progression from Less- to More-Serious Forms of Delinquency and Substance Use: Different Developmental Paths... 80 3.1. Versatile Offenders....................... 80 3.2. Exclusive Violent Offenders... 80 3.3. Exclusive Property Offenders... 80 3.4. Exclusive Substance Abusers..................... 81 4. Hypotheses Concerning Joint Properties of AggressivelVersatile and Nonaggressive Paths.......... 82 4.1. Hypothesis 1... 82 4.2. Hypothesis 2................................... 82 4.3. Hypothesis 3... 85 5. Hypotheses That Apply Only to AggressivelVersatile Path... 86 5.1. Hypothesis 4................................... 86 5.2. Hypothesis 5................................... 87 5.3. Hypothesis 6................................... 87 6. Hypotheses Pertaining to Exclusive Nonaggressive Path... 89 6.1. Hypothesis 7........................... 89 6.2. Hypothesis 8................................... 89 7. Hypotheses Concerning Exclusive Substance Abuse Path... 90 7.1. Hypothesis 9........ 90 7.2. Hypothesis 10................ 91 8. Findings on Developing Progressions Based on Official Records of Delinquency............................... 91

CONTENTS xiii 9. The Development of Substance Abuse and Antisocial Behavior... 93 9.1. Progression in Substance Abuse.................. 93 9.2. Conduct Problems/Delinquency and Substance Abuse... 94 10. The Relationship between Progression and Desistance... 96 11. The Rate of Progression or Innovation Rate......... 99 12. The Transition Probabilities between Behaviors within Progressions......................................... 103 13. Conclusion... 106 13.1. Summary of the Three Developmental Paths... 107 13.2. Summary of the Probabilistic Nature of Progressions... 110 13.3. Clinical and Therapeutic Implications............. 111 13.4. Judicial Implications... 113 13.5. Some Factors That Influence Progressions......... 113 14. References... 115 Aggression and Peer Rejection in Childhood John D. Co ie, Mark Belding, and Marion Underwood 3 1. Introduction......................................... 125 2. Methodological Considerations... 126 3. Studies of Aggression and Peer Rejection in Preschoolers....................................... 128 3.1. Peer Reports of Aggression...................... 128 3.2. Teacher Ratings of Aggression... 128 3.3. Direct Observations of Aggression... 129 4. Aggression and Rejection in School-Aged Children...... 130 4.1. Peer Reports of Aggression.................. 130 4.2. Teacher Ratings of Aggression... 132 4.3. Direct Observations of Aggression... 133 5. Aggression and Rejection in New Peer Group Contexts.. 134 5.1. Summary.................................. 135 6. Defining Aggression.................................. 136 7. Types of Aggression and Peer Rejection............................................ 142 8. Qualitative Dimensions of Aggression and Peer Rejection........................................ 144 9. Consequences of Aggression for Rejected Children...... 150

xiv CONTENTS 10. Conclusions... 152 11. References... 154 Social Deficits of Children with Internalizing Disorders Cyd C. Strauss 4 1. Introduction......................................... 159 2. Background................................... 160 2.1. Internalizing Disorders in Childhood and Adolescence.................................... 160 2.2. Methods Used to Measure Social Deficits in Children....................................... 164 3. Relationship between Social Adjustment and Internalizing Disorders: Research Review... 168 3.1. Studies of Anxiety and Social Deficits in Nonclinic Samples... 169 3.2. Studies of Anxiety and Social Deficits in Clinic Samples... 172 3.3. Studies of Depression and Social Deficits in Nonclinic Samples... 176 3.4. Studies of Depression and Social Deficits in Clinic Samples... 179 4. Contrast with Social Deficits of Children with Externalizing Disorders... 181 5. Integration of Findings and Conclusions................ 182 6. References........................................... 185 School Phobia 5 Cynthia G. Last and Greta Francis 1. Introduction......................................... 193 2. Oassification and Diagnosis........................... 194 3. Associated Features... 197 3.1. Anxiety... 197 3.2. Depression..................................... 197 3.3. Externalizing Behavior Problems... 198 3.4. Social Adjustment... 199 3.5. Dependency.................. 199 3.6. Medical Problems............................ 200

CONTENTS XV 4. Epidemiology........................................ 200 4.1. Prevalence and Incidence........................ 200 4.2. Sex... 201 4.3. Age... 201 4.4. Intelligence... 202 4.5. Social Class... 202 4.6. Birth Order... 203 5. Course and Prognosis... 203 6. Familial Factors... 205 7. Assessment.............. 206 7.1. Diagnostic Interviews... 206 7.2. Fear/ Anxiety Questionnaires..................... 208 7.3. Behavioral Approach Test... 210 7.4. Teacher/School Attendance Report... 211 7.5. Social Skills... 211 8. Behavioral Treatment................................. 211 9. Pharmacological Treatment............................ 215 10. References... 218 The Familial Influence in Anxiety Disorders: Studies on the Offspring of 6 Patients with Anxiety Disorders Wendy K. Silverman, Jerome A. Cerny, and Wendy B. Nelles 1. Introduction......................................... 223 2. The Family Data... 224 3. The Rationale for Directly Evaluating the Offspring of Patients with Anxiety Disorders... 228 4. Studies of the Offspring of Patients with Anxiety Disorders............................................ 229 4.1. Parental Diagnostic Information.................. 232 4.2. Validity of Reported Child Behavior Problems..... 233 4.3. Child Problems................................. 234 4.4. Differential Risk... 238 4.5. Summary of the Research... 240 5. Mechanisms of Familial Transmission... 241 6. Conclusion.......................................... 244 7. References........................................... 244

xvi CONTENTS Diagnosis of Pervasive Developmental Disorders 7 Fred R. Volkmar and Donald J. Cohen 1. Issues in Oassification................................ 249 2. Historical Background... 251 2.1. Childhood Psychosis-Childhood Schizophrenia.................................. 251 2.2. Kanner's Syndrome............................ 252 2.3. Subsequent Diagnostic Concepts... 253 2.4. False Leads for Research... 253 3. Infantile Autism/Autistic Disorder... 255 4. Categorical Approaches to the Diagnosis of Autism... 260 4.1. Rutter's (1978) Criteria... 261 4.2. National Society for Autistic Children's Definition...................................... 261 4.3. DSM-III....................................... 262 4.4. DSM III-R...................................... 264 5. Alternative Approaches to the Diagnosis of Autism... 266 6. Subtypes of Autism... 269 7. Nonautistic PDD-Other Diagnostic Concepts... 271 7.1. Atypical PDD, PDD Not Otherwise Specified...... 271 7.2. Autistic Psychopathy (Asperger's Syndrome) and Schizoid Disorder............................... 272 7.3. Disintegrative Psychosis/Childhood Onset PDD... 273 7.4. Childhood Schizophrenia........................ 274 8. Epidemiology and Natural History... :... 275 9. Summary: Areas for Future Research................ 277 10. References... 278 Intensive Behavioral Treatment for Young 8 Autistic Children O. Ivar Lovaas and Tristram Smith 1. Introduction......................................... 285 2. The Autistic Children................................. 287 2.1. Behavioral Description... 288 2.2. Assessment.................................... 288 2.3. Differential Diagnosis... 289 3. The Behavioral Model as an Alternative to Diagnosis 290 4. Summary of Behavioral Studies on Autistic Children... 293

CONTENTS xvii 5. Overview of the UCLA Young Autism Project... 295 5.1. Method... 295 5.2. Treatment... 297 6. Main Findings.............................. 303 6.1. Pretreatment Comparisons... 303 6.2. Posttreatment Data... 305 6.3. Additional Analyses of the Experimental Group... 306 7. Discussion... 309 8. Implications for Treatment... 312 9. Theoretical Implications............................... 314 10. Implications for Research Methodology................. 317 10.1 Pretreatment Measures.......................... 317 10.2 Treatment Controls... 318 10.3 Dependent Variables............................ 319 10.4 Independent Variables (Treatment Procedures)... 320 10.5 Follow-up Studies... 321 11. Brief Summary and Future Directions... 321 12. References... 322 Physical Attractiveness and Childhood Adjustment Gordon L. Patzer and Donald M. Burke 9 1. Introduction......................................... 325 2. The Physical Attractiveness Phenomena... 325 2.1. Intrapersonal Differences... 326 2.2. Age-Group Generalizability...................... 328 2.3. Integral Components............................ 329 3. Childhood and Physical Attractiveness... 330 3.1. Ubiquity... 330 3.2. Social Development............................. 333 3.3. Self-Concept... 338 3.4. School Environment... 340 3.5. Mental Health.................................. 344 4. Theoretical Perspective... 349 4.1. Nature... 350 4.2. Nurture... 351 4.3. Summary................................ 351 5. Conclusion......................................... 352 5.1. Recapitulation... 352

xviii CONTENTS 5.2. Anecdotal Data................................. 353 5.3. Epilogue................................... 358 6. References........................................... 359 Epilepsy and Its Treatment in Children 10 J. A. Corbett and F. M. C. Besag 1. Introduction......................................... 369 2. Diagnosis and Classification........................... 369 2.1. Classification................................... 370 2.2. Etiology....................................... 371 3. Seizure Patterns in Childhood......................... 373 3.1. Neonatal Seizures... 373 3.2. Infantile Spasms................................ 374 3.3. The Lennox-Gastaut Syndrome... 375 3.4. Febrile Convulsions............................. 375 3.5. Absence Seizures (Petit Mal).............. 376 3.6. Generalized Tonic-Clonic Seizures (Grand Mal Epilepsy)... 377 3.7. Partial Seizures................................. 378 3.8. Complex Partial Seizures... 379 3.9. Reflex Epilepsy................................. 380 4. Prevalence of Epilepsy in Childhood... 380 5. Investigation of Epilepsy.............................. 381 6. Treatment of Children with Epilepsy.... 381 7. Epilepsy and Behavior................................ 382 8. Cognitive Deterioration in Epilepsy... 384 9. Conclusions......................................... 390 Index... 395