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Several of the very few lengthy follow-up studies on the problems of behavior disorders in childhood are cited, as are various theories advanced to explain the type of behavior disorder under discussion.
Ninety children were studied twenty years after their discharge from The Pennsylvania Hospital. The children had been from four to fifteen years old when originally admitted for observation for from one to thirty-nine months. None showed signs of organic brain damage or was diagnosed psychotic while at the hospital. They did show symptoms labeled 'aggressive behavior disorders of childhood', with truancy, stealing, teasing, disobedience, restlessness, or destructiveness.
Of the sixty-six followed to age eighteen or over, twelve had become psychotic by age eighteen. Fourteen of the children eventually made adequate social adjustments; thirty-nine never made adequate adjustments. Of these, twelve committed at least one crime (including only one crime of violence). In the original group the ratio of males to females was two and a half to one; in the psychotic group, six males to seven females; in the group adjusting well, six males to one female. The backgrounds of these children were significantly different from those of sixty postencephalitic children. Prognosis for girls showing aggressive behavior is worse than for boys. Sexual acting out by the age of twelve and inability to get along well with peers while in the hospital proved indicative of poor prognosis.
In almost every case the adjustment achieved by age eighteen showed little further change. There is often considerable fluctuation before eighteen and it is difficult to predict the final outcome. Twenty-one per cent of these children made a normal adjustment by age eighteen and there was no significant change in this percentage in the longer follow-up. Immediately after their hospital experience sixty-six per cent of the children showed considerable improvement. This figure, contrasted with the late