Mahin Hassibi

Disorders of Biological Functions

The need for food is such a basic survival requirement that one would hardly expect to encounter numerous problems associated with feeding in childhood. From early infancy, children’s appetites can be adversely affected by physical illnesses, overexcitement, fatigue, and emotional factors, but the majority of eating disturbances in early childhood are caused by the child’s reaction to the regulatory demands of his caretakers. The process of regulating the child’s intake begins with birth. The interval between feedings, the amount of food, and later on the nature of the nutritious material allowed or forbidden are all matters of parental choice and cultural norms. Thus the battle between rigid parents and difficult infants may begin with the feeding preferences of the child and the regulatory demands of the mother. Child care manuals have reversed their earlier advocacy of rigid timing and duration for infant feedings and ideal ages for weaning. Parents are now advised to observe their infants for cues and to allow them to regulate their own intake. However, there are general expectations as to when a child should begin to imitate the eating habits of his family and community.

Physically Handicapped Children

The psychiatric problems that arise in physically handicapped children can be divided into two major categories: those in which the physical defect is complicated by primary psychiatric disorders, and those in which the behavioral pathology is of a reactive nature. Examples of the first group are retardation, chronic brain syndrome, psychosis, and developmental delays. The same causative agent may produce different constellations of symptoms in a particular child, such as a combination of spastic diplegia, mental retardation, and brain damage, each with its own set of symptoms. In the reactive category, behavior problems may reflect stress on the child who cannot cope with the normative environmental demands because of his physical limitations, or they may appear as the consequence of inappropriate handling. An example of the latter is the failure of some parents to expect as much self-care activity as the child is capable of, thus creating unnecessary helplessness. Both primary and reactive psychiatric disorders may coexist in a particular child.

Organic Brain Syndromes

Epilepsy is a periodic, recurrent state of impaired consciousness associated with abnormal brain activities that may be clinically manifested by localized or generalized seizures, disturbances of the vegetative system, and alteration in sensation, perception, thinking, and emotional state.

Introduction: Disease, Disability, and Psychodiagnostic Concepts in Childhood

Webster’s Dictionary defines disease as “an aberration of a living body that impairs its function.” By this definition, the concept of disease is easily applicable to physical illnesses where the optimal functioning of an organ or a system is known, and direct links can be traced between a damaged or pathological organ and various symptomatic manifestations of its deviant functioning. Thus, one can speak with relatively high levels of assurance about physical disease-entities, their distinguishing characteristics and, in most instances, their defined etiologies. When one enters the realm of aberrant psychological states and behaviors, however, the disease-concept is applied problematically at best. Behavioral abnormalities and psychiatric conditions do not have simple linear relationships with the brain and its malfunctioning. Furthermore, even though the state of physical well-being is almost universally recognizable, behavioral or psychological normalcy is a value-laden concept, varying broadly in its application from community to community and subject to changes in interpretation in different times. Psychological disorders are more aptly defined and better understood when they are conceptualized as disabilities rather than diseases. By disability, we mean failure to perform as expected in a psychological task or function that is considered essential at a given point in life by a particular cultural community.

Specific Language Dysfunctioning in Children: A Historical Overview

The origins and growth of awareness of specific impairments in the linguistic functioning of children may be looked at in terms of three roughly chronological but overlapping and ongoing aspects: clinical recognition, conceptualization, and classification. The first aspect is characterized by the discovery, mainly during the first third of this century, that a population of children existed in facilities for the mentally deficient or the deaf who were neither imbecilic nor hard of hearing. Rather, these children displayed what appeared as circumscribed aberrations in the development and use of their native language, but they were relatively normal in other respects. On the basis of the paucity of published studies, the occurrence of such cases was thought to be something of a rarity. Gradually, an increasing number of writers reported such cases, and detailed accounts of directly observable symptoms grew. As more probing questions were posed, more thorough examinations appeared in the literature, and inferences were made regarding the specific nature of the linguistic defects and their etiology. Thus emerged the second aspect—theoretical conceptualization.

Childhood Psychosis: A Historical Review

The official glossary of the American Psychiatric Association defines psychosis as “a major mental disorder of organic or emotional origin in which the individual’s ability to think, respond emotionally, remember, communicate, interpret reality and behave appropriately is sufficiently impaired so as to interfere grossly with his capacity to meet the ordinary demands of life.” According to this definition, the severity and pervasiveness of the impairment are the two key features of the clinical diagnosis. However, it must be noted that in order to designate any function as deviant or impaired the range and fluctuation of its normal operation must be clearly defined. Also, “the ordinary demands of life,” against which the individual’s shortcomings are to be judged, need to have identifiable criteria. The official classificatory scheme is silent on both of these accounts. Diagnosticians differ in their assessment of the degree of impairment due to their sociocultural expectations of the normative behavior, professional training, philosophical bent or their personal life history.

The Psychological Testing of Dysphasic and Psychotic Children

The distinctions and similarities between dysphasic and psychotic behavior that we have discussed thus far extend to the children’s reactions and responses to psychological testing. The use of standard tests in making differential judgments about these children is, however, fraught with misconception and open to serious misinterpretation when test results and responses are accepted at face value and when preconceived categorical notions of test interpretation are applied.

Deviant and Normal Social Development

The child’s adaptation and development of various aspects of his personality are dependent upon the availability of a group of well-tested coping mechanisms and viable strategies provided in the social network. Their need for social survival makes it necessary for parents to help induct the child into the social milieu through encouragement, direct teaching, and even coercion. The innate impetus for socialization compels the child to accept what is offered, learn what is exhibited, and actively select from what is present. Gradually the child’s unique personality is shaped, and a complex psychological being is created. On the other hand, incorporating each new individual into the social network confronts the system with a new challenge. As the social system shapes the child’s personality, it is in turn modified by him. This reciprocal interaction prevents the fossilization of the social network, and assures the guided development of each individual’s psychology.

Psycholinguistic Development: Functioning and Dysfunctioning

Language, viewed as it must be for the practical evaluation of problems in human communication, consists of holistic acts that involve complex, interconnected operations and determinants— physical, perceptual, cognitive, emotional and social, as well as linguistic. They are subjective acts to the extent that their meanings derive from the individual’s interpretations of inner and outer experience and from their communal validity which is a matter of degree from person to person and situation to situation. They are objective acts in that they utilize a code with conventional referents and rules of grammar. Thus, in making judgments about aberrations of human communication, their primary and secondary components and systemic effects, one must consider all of their aspects interactively, from both the standpoint of the patient’s phenomenological world and the standpoint of the congruence or incongruence of his acts with the shared rules and practice of communication in his particular community. When the patient is a child, one must consider one other, highly complicating factor—the patient is somewhere along the road of developing the mechanisms of communication and of learning its conventions from his immediate and extended community.

Normal Social Development

Every human infant is born in a social milieu and his survival, both biological and psychological, is dependent on such an environment. It may therefore be assumed that the capacity to respond to interpersonal cues and to develop social ties is among the important biological endowments of human beings. Although we do not have the necessary genetic information as yet to support such a hypothesis, we may observe seemingly innate tendencies on the part of the infant, which, if not directly causative, can be said to encourage and set the stage for socialization. We do not and cannot know how a human infant might have developed under a radically different set of circumstances, but we do know that even in vastly different forms of societies and with various philosophies of child rearing, the task of socialization of a child begins with the earliest interactions between him and his human environment. These interactions require social receptivity and reciprocity and are dependent on the presence of certain factors in the individual as well as in his surroundings.