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ADHD: Attention Deficit Hyperactivity Disorder
Childhood Mental Disorders and Illnesses

by Joel Paris
Brunner/Mazel, 2000
Review by David J. Mullen, M.D. on Dec 5th 2001

Myths of Childhood

 This work by Joel Paris, MD, Professor of Psychiatry at McGill University, appears in some respects to echo some of the positions taken in Judith Rich Harris’s controversial 1998 book The Nurture Assumption. Unlike Harris, however, his perspective is that his of a highly regarded and experienced clinician and as such his arguments addressing clinical issues are delivered with greater authority.  Both books present considerable challenges to the long-standing assumption, taken by both mental health professionals as well as the lay public, that childhood experiences generally and those of early childhood in particular, play an especially critical role in the development of the adult personality.  Like Harris, he presents data undermining the notion that subtle nuances of parenting can result in significant psychological damage to the majority of children. His evidence-supported argument contends rather that the majority of children are quite resilient even in the face of major stresses with only a minority developing significant psychopathology.  Even then the stresses that seem to be most closely associated with pathology are not single events in most cases but events that recur frequently over a long span of time.

However, despite the emphasis on resilience, he does acknowledge the concept of vulnerability both to trauma as well as parenting technique. The data from Jerome Kagan’s study of inhibited children and the impact of differential parenting is given as exemplifying such vulnerability.  It is this last point, the existence of relative vulnerability, that is subsequently elaborated into an argument that genetically based temperamental factors are key elements to understanding the relative risks for developing psychopathology.  In addition, I feel that it is here, in his appreciation of individual vulnerability that Paris’ clinical experience and knowledge are most clearly advantageous. He states most clearly that the impact of parenting should not be under-estimated and certainly cannot be dismissed. Rather he seeks to define his efforts in the present volume as seeking to counter-balance strong historical trends toward discounting the significance of temperamental and biological factors in personality and psychopathology. Again, environmental factors are not discounted but are seen as less critical than is commonly perceived, especially with regard to the role stressful events in pathology.

The author focuses a good deal of criticism on two schools of clinical work: 1) psychodynamic/psychoanalytic and 2) “recovered memory” based therapy.  Both are censured for an excessive reliance on the “primacy of childhood” assumption as well as for depending too much upon clinical inference rather than empirical data derived from controlled studies.  In addition, recovered memory approaches are strongly criticized for ignoring an increasing body of such empirical information regarding the formation of memories and the reliability of recall under the influence of suggestion.  Finally, Paris echoes the concerns of many regarding harm that numerous individuals and families have suffered as a result of abuse accusations stemming from eager therapists seeking for evidence of abuse/neglect in all of their patients.

I think one could make a case that Paris is overstating his case somewhat regarding the relative insensitivity of the personality to environmental events in childhood and the relationship of such events to psychopathology.  First, the variables described tend to be of the rather broad variety (Five Factor Model, Cloninger’s dimensions of personality, etc.), rather than the more specific personal idiosyncrasies of interest to the psychoanalytically oriented clinician.  Secondly, the threshold  Paris is utilizing for diagnosing disorder is not completely clear.  Presumably he means DSM criteria are met but the clarity and consistency of use of the DSM are not without problems and controversy, particularly from a depth psychological perspective.  Paris does acknowledge that childhood maltreatment may result in “distress”, but the line between distress and disorder is not always so well defined.  Most persons enter treatment because they are in distress not because they have learned that they meet specific formal diagnostic criteria. I suspect the author’s zealotry may be explained in part by the author’s former commitment to psychoanalytic models of pathology and treatment

However, despite this limitation and on the whole, this book is well written and well balanced.   Empirically supported, data is effectively marshaled in favor of his position that childhood primacy in the development of personality may be less significant than has been thought and the centrality of traumatic events may be substantially less critical than most persons, lay and professional alike, may believe..  Despite I therefore recommend this thoughtful work to anyone interested in the relationship between child development and psychopathology.

 © 2001 David Mullen

Dr. Mullen is an Associate Professor of Child and Adolescent Psychiatry in the University of New Mexico School of Medicine. He is the Deputy Medical Director of the UNM Children's Psychiatric Hospital and attending physician in that facility's adolescent inpatient unit. His interests include the application of evolutionary psychological principles to the understanding of child and adolescent psychopathology, especially the disruptive behavior disorders.