Childhood Neurosis: The Past 75 Years

Neurosis in childhood, as in adulthood, generally refers to a state marked by anxiety and associated with secondary symptoms such as obsessive thoughts and/or compulsive behavior, hysterical conversion symptoms, phobic avoidances, and sometimes depression. These symptoms not only cause difficulties for the parents, like other childhood disorders, but are felt by the child to be ego alien—unwanted intrusions on his general routine and sense of well-being. Fish and Shapiro (1965) characterize children with obvious neuroses as moderate to high in severity of maladaptation, and further describe them as follows:

[These children show] generally well-patterned organized behavior that is marked to varying degrees by manifestations of anxiety, and expressions of helpless dependency and inadequacy. These children can usually articulate some awareness of their subjective distress or “nervousness” although they may be unaware of its relation to their other difficulties. They are usually acutely aware of social demands although they interpret these according to their own needs and fears. They generally make some attempt to conform to the demands of the

An earlier draft of this paper was supported by and presented to the National Institute of Health Committee on Program Development as a working paper. I would like to thank Dr. R. Ostman for his valuable aid in searching the literature for this presentation.

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situation and to gain acceptance or approval from authoritative figures, but may become immobilized by anxiety [p. 48].

In contrast to some other psychopathologies of childhood, reality testing is preserved, I.Q. is within normal range, delinquent behavior is absent, and autism is not in evidence.

It should be noted at the outset that recent classificatory systems give small prominence to neuroses in childhood because of their relative insignificance for larger mental-health movements which have occupied our recent interest. For example, in “A Tri-Axial Classificatio