To the extent that childhood is analogous to slavery, the comparison of the disorder is valid. Fortunately, childhood is not so validly likened to slavery, and as such, the comparison is not very useful. Is it necessary for us to compare and contrast slavery and childhood? Is there some other way that your observation should be applied to childhood disruptive behavior?
No, he doesn’t argue that. SSRI’s do work.
The implied science behind psychiatry doesn’t exist. The justifications for the working of SSRI’s offered by doctors to patients are simply wrong, and known to be wrong.
(There’s also outright misinformation – for example, SSRI’s are not addictive in any clinical sense, but they are habit-forming and they do have withdrawal symptoms. These basic facts were denied for quite a long time, and even now some doctors are either unaware of them or don’t bother themselves to inform their patients of this.)
** The instruments were designed to reflect the DSM criteria. Duh. The whole point of this study was to compare how the physician’s diagnoses (which would be based on clinical interviews) and the results of the survey instruments (which are based on empirical association of symptoms) matched.
As the article points out, there are significant differences between clinical practice and psychometric definitions of mental disorders. That’s why the study was being done – to see how application matched theory.
They found that the associations of symptoms in the DSM model of the conditions matched fairly well with how the kids were actually diagnosed. But not THAT well, which means the operational definitions used weren’t the same as the DSM criteria.
The authors identified several reasons why this is so, including inconsistent operationalization between the measures.
I have to go – I’ll continue this when I get back.
How embarrassing! The study examined parent and teacher ratings using three different questionnaires in 11 samples. There were no physician diagnoses involved! The examination was the degree to which the latent factors agreed with or differed from the model described in the DSM. As in: “Here the DSM-IV model is tested against the data by means of factor analysis. The basic assumptom is that DSM-IV syndrome dimensions are latent variables (factors) whose manifestations are behavioural symtoms. […] In other words, the items in a syndrome scale should measure a common factor in order to be valid.” This is the methodology of the article, and you clearly do not comprehend it.
Silly, silly. Just for grins, I did a search in adobe of the article for the words “clinical practice.” They weren’t found. Please cite which page you find anything like what you just said. The point of the article was to test whether the latent stucture suggested by the DSM-IV for these disorders would be supported by an empirical test of parent and teacher ratings. Do the referents (behaviors/symptoms) fall together empirically as we propose that they would theoretically. The answer is that the model is supported, but can be improved.
Silly, silly. There were no actual diagnoses studied. Please cite or quote from the page you feel suggests that.
The purpose of the discussion of inconsistent operationalization between the CBCL, the Ontario Child Health Studies Scales - Revised, and the Child Symptom Inventory - 4, was to illustrate that the different ways these questionnaires assess the symptoms of interest has a great deal to do with why the overall model fit didn’t reach a statistically satisfactory level. It also suggests that this is a relatively conservative and more real-world based challenge of the theoretical underpinnings of the DSM-IV. Despite differences in the manner of assessing the items, the underlying structure proposed by the DSM-IV (rather than an unstructured model or a one, two or three factored model) best explained the data.
Your analysis of a relatively straightforward application of a widely used statistical technique, factor analysis, is sad and reflective of a real deficit in comprehension of actual science. Unless of course you can cite or quote anything from the paper that actually supports your assertions above.
Dang it! Why did the boards just lose my post?!
All right, while I try to re-establish what I just typed:
Um, hello, Hentor… didn’t you notice that the two groups they studied were children from the general population and those clincally referred (thus satisfying at least one of the DSM diagnoses)?
More to the point, the questionnaires were based on the actual DSM diagnostic criteria – we can easily see that from the short list they provide. They’re extremely vague (what’s “too fearful”?) and thus one of the reasons the DSM model statistically failed to account for the variance noted.
Yes, I said failed. The six-factor DSM model was the best at describing the patterns they saw. But it failed to meet the mathematical standards set.
The whole point of comparing clinical and non-clinical populations is to allow the researchers to screen out the “baseline” correlations between the factors. They’re thus left with the correlations among children who already have a psychiatric diagnosis.
Note: the point of the study wasn’t to take a whole bunch of different factors, see how they were correlated to each other, and then seeing if those associated factors were similar to those used in the DSM. That would have been a true examination of whether psychometric studies suggested the same categories as clinical experience and tradition.
What they instead did was take the descriptions of six different conditions from the DSM, mixed them together into a checklist, and examined how teachers and parents associated them when describing children with psychiatric diagnoses.
They found that the DSM’s six-category model was the best match to the data of the models they considered – but it still failed to meet statistical standards of validity. It failed – a point you seem to have utterly ignored.
Sorry, it is evident that you don’t understand the basic method of analysis they used. You don’t understand that despite it including a clinically derived sample, the data were not diagnoses but parent and teacher ratings. Your failure to appreciate the nuances of the discussion of improvement of model fit versus ultimate goodness of fit is therefore not surprising.
As I said from the beginning, you are on an agenda-driven crusade, and cannot even rationally discuss empirical evidence. So sad.
They were trying to learn whether “objective” parent and teacher ratings organized themselves into groups similar to the DSM diagnoses.
Since the instruments they used in that process relied on the DSM criteria themselves (which were intentionally made to limit diagnosis overlap), it’s not surprising that the results fit the DSM model best.
As I’ve said from the beginning, you’re trying to avoid a conclusion you don’t like by wallpapering it over with quotes from research studies.
Their conclusions were as follows: the results fit the DSM model best, and were generally consistent with that model, but they failed to meet the standards of validity. They suggested that the problems were: symptoms that were aspects of more than one disorder, insufficiently precise operationalizations in the checklist options (which were taken straight from the DSM), and limited ability to represent the complex and multidimensional nature of the problems.
Thus, they couldn’t show that the diagnostic criteria in the DSM were internally consistent, although they suspected that better measurements might have been enough to demonstrate it.
Of course, since they were examining a population of children who had already managed to match at least one DSM diagnostic category (problems-in-living generally isn’t enough), it’s not so surprising that the results matched the DSM: it defined the population in the first place.
You just cannot get it right. The data came from both clinical and population samples, meaning that not all had a history of meeting criteria for diagnosis. Yeesh.
And these are simply the basics.
About one study.
Ooof.
** You’re lying. You’re lying twice, actually: first by claiming that cultural and social opinions do not affect the DSM diagnostic criteria (which is obviously the case, as most of them refer to cultural and social norms), then again by claiming that you didn’t say that social factors were not an issue.
I’m aware that not everyone had been given a diagnosis. Obviously.
If they looked only at clinical populations, they wouldn’t be able to tell if the items on the checklist were “normally” associated with each other. Duh. Without knowing the relationship between the items for presumably healthy children, it would be impossible to determine whether any correlations found with the diagnosed children were significant or not.
Clearly, if certain items were highly associated even in normal children, then that wouldn’t support the internal validity of the DSM criteria very much. That wouldn’t suggest the existence of a latent variable (an “underlying condition”) at all.
I can’t tell if you simply don’t understand these issues, you’re trying to confuse everyone else into thinking you know what you’re talking about, you’re utterly ignorant of even basic logic and experimental design, or you’re simply lying. I don’t like any of those possibilities.
While I admit to a curiousity as to the critical mass necessary for you to make a (self) correction, I have to say that this discussion has now run out of any value that it might have had for me. I have grown tired of your citeless assertions, misstatements, evasions, and side-steps. I am not sure what is wrong with you. I do know that I don’t want to be involved with whatever it is any further.
If anyone else does wish to have any reasonable discussion or debate on the topic, I am very willing to participate.
All right, now I know you’re lying.
In order to study the children who had been clinically referred with a DSM diagnosis, it would first be necessary to develop a baseline. That’s what the normal population is for: it allows them to determine what the correlations between the items are for presumably healthy kids.
Psychometric instruments are only useful if they’re normed first, yet you’re trying to imply that the norming process was the focus of the research instead of a means to the end of studying the clinical population. No one is this stupid and ignorant; ergo, you’re being deliberately deceptive.
Hentor the Barbarian:
John Holt might disagree with you. Not that that makes him automatically right, and you wrong, but the peoples of the antebellum south (and probably much of the more refined north for that matter) in the time frame referenced took the institution of slavery and race for granted.
That you do not see, in the pathologizing of rebellious and (from an adult perspective) undesirable behavior of children, a parallel to the pathologizing of rebellious and (from a plantation culture perspective) undesirable behavior of slaves does not make Dogface wrong even if we do all agree that the institution of childhood and the institution of slavery are not line-item compatible or equally disposable and unnecessary elements of our social structure.
And although the debate hasn’t taken place yet, I suspect I’m closer to Holt’s perspective than yours with regards to childhood and the right of adults to control children and demand/expect compliant behavior without rebelliousness.
Unfortunately, your link did not lead me to any content of John Holt’s book to evaluate his position. Perhaps you could elaborate if it is worthwhile. (I did find a web page I found clever in what I assumed to be a reference to Ayn Rand entitled “Who was John Holt?”).
I am not at all familiar with the data regarding Northern and Southern attitudes regarding slavery, but I can generally agree with this statement.
I did not say that I did not see a parallel. However, the parallel quickly breaks down when the question of whether slavery and childhood are analogous is given any scrutiny. For instance, was American slavery intended in any meaningful way to benefit the slaves? How is this different or similar to a parent/child relationship? If removed from the condition of slavery, will the person likely be better off or worse off? How does this compare with children and parents? Was it typical, if not universal, for a slave to regard the condition of slavery as enforced and coercive and against their will? Is it typical for children to regard childhood as such? If we can make any inferences from parental report of non-compliance alone, it appears normative for children to be somewhat non-compliant, whereas only 1% to 9% of parents report severe or frequent non-compliance (Kalb & Loeber (2003) Pediatrics, 641-652).
I have no idea what Holt’s nor your position is regarding rebelliousness. I suppose that it is romantic to regard children as at worst showing civil disobedience or defying unjust authoritative commands, although I think the comparison you make rather belittles the severity of hardships suffered by slaves.
Is there a difference between “demanding compliant behavior without rebelliousness” and pervasive and severe non-compliance with rules and commands? This is a crucial question to resolve for the purposes of this discussion.
Three points to clarify – Oppositional Defiant Disorder is more than being rebellious (i.e. non-compliant and defiant or arguing with adults), it is also being hostile, intentionally annoying others, being irritable, angry and vindictive. If one wished to construct a scenario matching these aspects to slavery, one could do so. Certainly, someone stolen from their home and compelled to live and work for another under threat of death would show these qualities, and perhaps would even be so changed by the experience to show the behaviors regarding their peers as well (i.e. acting spitefully, intentionally troubling, and blaming co-slaves for their problems) although the latter is a notable stretch, in my opinion.
Secondly, as I’ve said before, we are not talking about Thoreau or Martin Luther King, Jr., or Gandhi here. We are talking about chronic and pervasive high levels of problems with sitting down on the bus, doing homework, going to bed, engaging in hygiene activities, not repeatedly poking your neighbor with a pencil or scissors or cutting their clothing, not bothering other students in class or disrupting the classroom, not being hostile to peers and adults, not “getting people back” for perceived slights, accepting responsibility for one’s behaviors, wearing seatbelts when told to do so. At what point should a five year old be able to decide if they want to pull their mother’s hair from the back seat of the car so that she is unable to move her head from the headrest? When do you think it a good idea for a six year old to say “Fuck you!” to parents and peers, or yell racial epithets at strangers of different ethnicities? If you really wish to establish a context in which children are morally justified in engaging in such behaviors, or in which it would be appropriate for parents and teachers to suggest that it is a child’s right to choose whether or not they should engage in these behaviors, I will be interested to hear it.
Finally, in addition to the fact that ODD as a whole involves much greater than mere rebelliousness (and is a risk factor for bad outcomes) even severe non-compliance alone is a risk factor for later aggressive behavior towards others, peer rejection, and the development of delinquent and criminal behavior (McMahon and Forehand, 2003). Thus, it is hard for me to adopt a romantic view of severe non-compliance being in any way a morally acceptable choice for a child to make, and that they are likely to experience good results.
As an afterthought, do you have children? If so, was it wrong for you to establish boundaries for acceptable behavior, or did you choose not to enforce any expectations? Did you honestly at any point liken your parenting to slavery? If not, do you honestly think it a good idea to allow a child to make any choice that they would prefer?