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12 and HoldingA Guide to Asperger SyndromeA Lethal InheritanceA Mother's Courage: Talking Back to AutismA Parent's Guide to Asperger Syndrome and High-Functioning AutismA Special EducationA Toss Of The DiceA Tribe ApartA User Guide to the GF/CF Diet for Autism, Asperger Syndrome and AD/HDA Walk in the Rain With a BrainABC of Eating DisordersADD-Friendly Ways to Organize Your LifeADHD Grown UpADHD in the Schools: Assessment and Intervention StrategiesADHD NationAdolescence and Body ImageAdolescent DepressionAggression and Antisocial Behavior in Children and AdolescentsAll Alone in the UniverseAlpha GirlsAmericaAnother PlanetAntisocial Behavior in Children and AdolescentsAsperger Syndrome and Your ChildAsperger Syndrome, Adolescence, and IdentityAsperger's and GirlsAssessment of Childhood DisordersAttention Deficit DisorderAttention-Deficit Hyperactivity DisorderAttention-Deficit/Hyperactivity DisorderAutism - The Eighth Colour of the RainbowAutism and MeAutism's False ProphetsAutistic Spectrum DisordersBad GirlBeen There, Done That? DO THIS!Before I DieBetween Two WorldsBeyond AppearanceBig Mouth & Ugly GirlBipolar ChildrenBipolar Disorder in Childhood and Early AdolescenceBipolar DisordersBipolar KidsBlackwell Handbook of Childhood Cognitive DevelopmentBody Image, Eating Disorders, and ObesityBody Image, Eating Disorders, and Obesity in YouthBoy AloneBrain-Based Therapy with Children and AdolescentsBreaking PointBreathing UnderwaterBringing Up ParentsBullying and TeasingBullying PreventionBut I Love HimCan't Eat, Won't EatCaring for a Child with AutismCatalystChild and Adolescent PsychiatryChild and Adolescent Psychological DisordersChild and Adolescent PsychopathologyChild NeuropsychologyChild Well-BeingChildren and SexualityChildren Changed by TraumaChildren with Emerald EyesChildren with Sexual Behavior ProblemsChildren, Sexuality and SexualizationChildren’s Dreaming and the Development of Consciousness City of OneCommunication Issues In Autism And Asperger SyndromeConcepts of NormalityConcise Guide to Child and Adolescent PsychiatryConquering the Beast WithinConsuming KidsContesting ChildhoodCount Us InCrackedCrossesCutCyber-Safe Kids, Cyber-Savvy TeensDamageDemystifying the Autistic ExperienceDescartes' BabyDilemmas of DesireDirtyDisconnected KidsDoing SchoolDon't Bother Me Mom--I'm Learning!Don't Pick On MeDying to Be ThinEarly Intervention Programs and PoliciesEating an ArtichokeEducating Children With AutismEight Stories UpElijah's CupEmerald City BluesEmotional and Behavioral Problems of Young ChildrenEpilepticEthical Dilemmas in PediatricsEvery Girl Tells a StoryExiting NirvanaExploiting ChildhoodEye ContactFacing BipolarFamily HistoryFast GirlsForever YoungFreaks, Geeks and Asperger SyndromeFreewillFrictionGirl CultureGirl in the MirrorGirlfightingGirlhoodGirlWiseHandbook of Evidence-Based Therapies for Children and AdolescentsHandbook of Preschool Mental HealthHealing ADDHelping Children Cope With Disasters and TerrorismHelping Hyperactive KidsHelping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional ProblemsHelping Students Overcome Depression and AnxietyHelping Teens Who CutHollow KidsHope's BoyHow Infants Know MindsHow to Keep Your Teenager Out of Trouble and What to Do If You Can'tHurry Down SunshineI Am Not Joey PigzaIdentifying Hyperactive ChildrenIf Your Adolescent Has an Eating DisorderIn the Company of CraziesIncorporating Social Goals in the ClassroomIntegrated YogaIntrusive ParentingIssues for Families, Schools and CommunitiesJake RileyJoey Pigza Loses ControlJoey Pigza Swallowed the KeyJuvenile-Onset SchizophreniaKim: Empty InsideLearning and Behavior Problems in Asperger SyndromeLearning Disorders and Disorders of the Self in Children and AdolescentsLearning Outside the Lines Let Kids Be KidsLiberation's ChildrenLife As We Know ItLisa, Bright and DarkLook Me in the EyeLoserLove and SexLove That DogMad at SchoolMaking ADD WorkMaking American BoysManicMastering Anger and AggressionMaverick MindMedicating ChildrenMind FieldsMind to MindMommy I'm Still in HereMore Than a LabelMy Flesh and BloodMyths of ChildhoodNew Hope for Children and Teens with Bipolar DisorderNew Look at ADHD: Inhibition, Time, and Self-ControlNo Child Left DifferentNo Two AlikeNon-Drug Treatments for ADHDNot Much Just Chillin'NurtureShockOdd Girl OutOdd Girl Speaks OutOne Hot SecondOne in ThirteenOphelia SpeaksOphelia's MomOur Journey Through High Functioning Autism and Asperger SyndromeOut of the WoodsOvercoming ADHDOvercoming School AnxietyParenting a Child Who Has Intense EmotionsParenting Children With ADHDParenting Your Out-Of-Control TeenagerPediatric PsychopharmacologyPediatric PsychopharmacologyPediatric PsychopharmacologyPeople with HyperactivityPhobic and Anxiety Disorders in Children and AdolescentsPINSPlease Don't Label My ChildPraising Boys WellPraising Girls WellProblem Child or Quirky Kid?Problem GirlsPsychotherapy for Children and AdolescentsPsychotherapy with Children and AdolescentsPurgeRaising a Moody ChildRaising BlazeRaising Generation RxRaising Resilient ChildrenReady or Not, Here Life ComesReclaiming Our ChildrenRedressing the EmperorReducing Adolescent RiskRemembering Our ChildhoodResilience in ChildrenRethinking ADHDReweaving the Autistic TapestryRitalin is Not the Answer Action GuideRitalin NationRunning on RitalinRunning with ScissorsRutter's Child and Adolescent PsychiatrySeeing EzraSex and the American TeenagerSex, Therapy, and KidsSexting and Young PeopleSexual Teens, Sexual MediaShort Term 12Should I Medicate My Child?SmashedSnapshots of AutismSongs Without WordsSophie Spikey Has a Very Big ProblemSpeakStaying Connected to Your TeenagerStick FigureStraight Talk about Psychiatric Medications for KidsStraight Talk about Psychological Testing for KidsStraight Talk about Your Child's Mental HealthStrange SonStudent DepressionSuicidal Behavior in Children and AdolescentsSurvival Strategies for Parenting Children with Bipolar DisorderSurviving OpheliaTaking Charge of ADHD, Revised EditionTaming the Troublesome ChildTemple GrandinThe American Psychiatric Publishing Textbook Of Child And Adolescent PsychiatryThe Anti-Romantic ChildThe Bipolar ChildThe Boy Who Loved WindowsThe Boy Who Was Raised as a DogThe Buffalo TreeThe Bully Action GuideThe Bully, the Bullied, and the BystanderThe Burn JournalsThe Color of AbsenceThe Curious Incident of the Dog in the Night-TimeThe Depressed ChildThe Developing MindThe Dragons of AutismThe Einstein SyndromeThe EpidemicThe Evolution of ChildhoodThe Explosive ChildThe Eyes of van GoghThe Fasting GirlThe Field of the DogsThe Flight of a DoveThe Hidden Gifts of the Introverted ChildThe Horse BoyThe Identity TrapThe Inner World of a Suicidal YouthThe Inside Story on Teen GirlsThe Kindness of StrangersThe Last Normal ChildThe Little MonsterThe Medicated ChildThe Myth of LazinessThe New Gay TeenagerThe Nurture AssumptionThe OASIS Guide to Asperger SyndromeThe Other ParentThe Perversion of YouthThe Philosophy of AutismThe Psychoanalytic Study of the ChildThe Real Truth About Teens and SexThe Ride TogetherThe Rise and Fall of the American TeenagerThe Science of ADHDThe Sex Lives of TeenagersThe Survival Guide for Kids With LD*The Unhappy ChildThen Again, Maybe I Won'tTherapy with ChildrenThings I Have to Tell YouThings Tom LikesThrough the Glass WallThumbsuckerTotally WiredTouching Spirit BearTrauma in the Lives of ChildrenTreating ADHD and Comorbid DisordersTreatment of Childhood DisordersTwistedUnder the Wolf, Under the DogUnhappy TeenagersUnstrange MindsWastedWe've Got IssuesWeather Reports from the Autism FrontWhat about the KidsWhat in the World Are Your Kids Doing Online?What Works for Whom?What Would Joey Do?What's Happening to My Body? Book for BoysWhat's Happening to My Body? Book for GirlsWhat's Happening to Tom?When Nothing Matters AnymoreWhen Your Child Has an Eating DisorderWhose America?Why Don't Students Like SchoolWill's ChoiceWinnicott On the ChildWorried All the TimeYou Hear MeYoung Minds in Social WorldsYoung People and Mental HealthYour Child, Bully or Victim?
Models of mental illness in children are a specific case of the general point Karl Popper made by defining the status of scientific theories as "nets cast to catch what we call 'the world.'" Seventy four years ago, the finest mesh explanatory net cast across the world of pediatric psychopathology was Leo Kanner's landmark text Child Psychiatry (1935), which defined for a generation of clinicians a pluralistic and avowedly anti-theoretical conception of its subject, illustrated by his 1973 observation that:
There are those who look on infantile sexuality alone, others on early mother-child relationship, others on faulty conditioning, still others on neuropathology or biochemistry alone as the open sesame to the gates of understanding and the passkey to therapeutic planning. What happens to a psychotic child and his family often has been 'programmed' not so much in accord with the specific circumstances of each patient's illness as by the predictable uniform ritualism of the approacher's orientation.
Kanner's sensitivity to his work's complexity -- his unwillingness to reduce his patients' intricate, multi-dimensional problems to one dimensional solutions -- is echoed in Beauchaine and Hinshaw's collection of 21 papers which endeavors to synthesize the genetic, environmental, neurological, cognitive and cultural variables of child and adolescent mental disorder in an integrated developmental psychopathological (DP) framework which eschews reductive notions of a singular "open sesame to the gates of understanding" for a multi-factorial, non-linear, dynamic systems approach. Adopting this sophisticated approach is no small task, Hinshaw concedes: "Smooth, packaged, easily digestible accounts are not found within these pages, as the kinds of reciprocal, interactive, cascading, and integrative models needed to facilitate further understanding are far from simple or linear." Digestibility aside, this 669 page text succeeds in providing an extremely cogent guide to leading-edge research in all the major child and adolescent mental disorders; the three innovative key principles that unite DP's interdisciplinary paradigm; and the potential shape of future research.
The first key feature of DP's non-linear approach is the concept of "multifinality": the idea (familiar from chaos theory) that a single set of conditions can lead to a wide array of possible outcomes, a principle vividly exemplified by Bruce D. Perry's paper on the catastrophic impact of abuse and maltreatment on "all of the major molecular processes involved in brain development." The negative neurological affects of abuse are so global in nature that almost any pathological outcome can flow from it, Perry shows. Maltreatment may thus be "the Great Imposter," the overlooked primary causal factor in a range of ostensibly diverse clinical profiles typically interpreted through the lens of differentiated DSM-IV diagnoses. Understanding the neurophysiological processes that drive abuse-related disease pathways could illuminate a diagnostic framework that more accurately depicts the underlying causal mechanisms of maltreatment's painful progression into pathology, Perry suggests.
DP's second key feature is the concept of "equifinality": the idea that the same pathological outcome can derive from multiple developmental pathways, a principle illustrated by Joel Nigg and Molly Nikolas' paper on Attention-Deficit/Hyperactivity Disorder (ADHD). The authors describe the disorder as a heterogeneous phenotype that stands on the extreme end of a continuously varying trait (rather than a uniform, discrete syndrome). Heritable features of the dopaminergic and noradrenergic systems, prenatal exposure to toxins, and family, social and cultural factors interact in recursive loops to produce disordered top-down (frontal-striatal) and bottom-up (frontal-limbic) neural circuits manifesting behaviorally in an array of comparable yet sub-phenotypically heterogeneous combinations of inattention and hyperactivity, often comorbid with anxiety disorders, Oppositional Defiant Disorder or Conduct Disorder, and learning disorders, Nigg and Nikolas report. Future research should adopt an integrated "person-centered" (rather than "variable-centered") approach to investigate the etiologies of specific sub-phenotypes to aid the prevention and long-term treatment of ADHD, the authors recommend.
The third key feature of DP is its implicit refutation of the nature/nurture fallacy, a principle powerfully demonstrated, for instance, in Geraldine Dawson and Susan Faja's paper on Autism Spectrum Disorders (ASD). Much of the first 50 years of ASD-related debate after Kanner first used the term "autism" in 1943 fixated upon an either/or debate about Kanner's partial attribution of autism to uncaring primary caregivers ("refrigerator mothers"), even though Kanner himself explicitly framed parental influence as only one factor of a disorder that was also "innate" (Kanner 1963). From a DP perspective, by contrast, the task of locating the disorder's core impairments and neurological substrates in the face of autism's complex symptomology involves an integrated understanding of the interactions played between anomalies in 100 candidate genes and environmental factors in the developmental course of a child's capacity for socialization and attunement. The good news is that intensive parental and educational intervention can now boost the limited "social motivation" which is hypothesized to be associated with the autistic child's impaired cortical dopaminergic reward circuitry. Continued interdisciplinary dialog could yield increasingly sophisticated models of the complex gene-environment interactions that result in ASD risk processes, with profound implications for further improvements in treatment if supported by robust social policy, Dawson and Faja conclude.
While the retrospective act of sketching the evolution of the mind sciences in the seven decades from Kanner's Child Psychiatry to Beauchaine and Hinshaw's Child and Adolescent Psychopathology is easier than the speculative act of imagining the field's growth in the decades ahead, it is still tempting to imagine an historical path that will one day edge the field towards the type of granular predictive modeling of complex, non-linear systems currently achievable in the physical sciences -- such as climatology, for instance, a field in which supercomputers operating at 200 petaflops (200 quadrillion calculations per second) are now theoretically capable of supporting the creation of models that grid the planet's colossally complex weather patterns at a scale of a single kilometer: the size of a single cloud system. By analogy, perhaps an integrated synthesis of genetics, neuroscience, and cognitive and developmental psychology will some day yield a diagnostic "net" which could "catch the world" of human minds with an ultra-fine mesh wrought at the scale of a single person. Individually person-centered, predictive psychopathology backed by warp-speed computation remains science fiction for now. Yet such a refined future model, whose first blueprint is arguably outlined in this book, might really be the "open sesame to the gates of understanding."
© 2009 Jason Thompson
Jason Thompson teaches children with special needs in an Oakland public elementary school. He is studying for a MA in Special Education at San Francisco State University and a MA in Buddhist Studies at Sunderland University in the UK. He has a MA in English Literature from Oxford University. His research interests include developmental psychopathology, and the intersection of Buddhist thought with the western mind sciences. He has published journalism in the British and American media, and recently had a paper accepted for publication in "Philosophy, Psychiatry and Psychology."