greatly from those of very young children, some potential memories may not be accessed.

Developmental Changes in Information Processing Capacity

Does the absolute capacity of the memory stores change with development? The answer to this
question is unknown and, according to some experts, may be unknowable. It is clear, however,
that memory span, a measure of working memory, improves reliably with age. Memory span is
defined as the number of single words or digits individuals can report in order immediately
after hearing them. It increases from about two items at age two to five items at age seven to
seven items in adulthood. The amount of in- formation that individuals can hold in memory at
any one time determines at least in part what they can learn.
It appears that age-related improvements in the memory span are attributable to two factors:
changes in the resources that are available in the information processing system and
differences in the efficiency with which older children and adults apply these re- sources. One
of the most important developmental changes in the information processing system is in the
speed of processing. Robert Kail asked individuals from ages six to twenty-one to perform a
variety of cognitive tasks ranging from mental addition to memory search. He found a
remarkably similar pat- tern of age-related increases in reaction time in the performance of all
of the tasks. It should be noted that speed of processing is important in executing many
cognitive functions, from moving information from the sensory register to working memory to
applying strategies. Hence, developmental differences in speed of processing can influence
children’s capabilities to perform a variety of academic and everyday tasks.
Processing capacity increases if more resources are available; it can also be enhanced if the
resources necessary to perform the task can be decreased. Sim- ply providing extra time for
study or problem so lying improves children’s performance in some but not all tasks. Perhaps
the most important determinant of task demands is the learner’s relevant knowledge.
Familiarity with the to-be-remembered material affects the memory process at every step of
information processing. Imagine how difficult it would be, for example, for someone who
speaks only English to remember a string of digits presented in another language.
Michelene Chi provided a classic demonstration of the importance of prior knowledge. In this
investigation, children who were chess experts had better memories for chess positions than
did nonexpert adults, even though the adults demonstrated the expected advantage in
remembering digits. Here, prior knowledge of chess eliminated age differences in memory.
Because children’s knowledge bases in- crease as they get older simply through their
experiences in the world, age differences in memory may be explained to a great extent by
differences in task- relevant knowledge.
Changes in the knowledge base also affect the organization of information in long-term
memory and hence partially determine whether or not material can be reported. As depicted in
the semantic network model of memory, items are represented as nodes and the nodes for
associated items are linked. Knowledge about a particular content domain (such as dinosaurs or
soccer) creates semantic associations between previously unconnected items, resulting in the
formation of connections between nodes. When one item is recalled, the activation spreads to
associated items as well, increasing the likelihood that they will also be re- ported. Items that
are represented as part of an extensive network of information within a content area are also
less likely to be lost over time. Moreover, age differences in children’s long-term event recall
are minimized when younger and older children have high levels of prior knowledge about the
to-be- remembered components of the experience.
Knowledge also enhances memory by making it easy to apply strategies for encoding and
retrieving information. As discussed in the next section, the development of memory strategies
is another important reason for age-related increases in children’s ability to remember,
especially in academic settings.
The Acquisition of Memory Strategies
A child’s intentional memory shows dramatic improvement when he can effectively use
memory strategies. These deliberate tactics for remembering develop over a lengthy period
that spans the elementary and middle school years. Preschool children use very simple tactics
for remembering in some special task settings; for example, a four-year-old can be expected to
use a marker to denote an object’s hiding place in preparation for subsequently finding it. Pre-
scholars do not, however, use mental strategies and indeed do not typically differentiate
memory and perception. By age seven, most children spontaneously use rehearsal to enhance
short-term memory performance. Retrieval strategies (such as going sequentially through the
alphabet) begin to be spontaneously used around third grade. Children’s self- directed use of
organization, the ability to impose a semantic structure on the to-be-remembered items to
guide memory performance, emerges later in the elementary school years. For example, a fifth
grader could be expected to remember what to take on a school field trip by reviewing the
activities involved and packing accordingly (e.g., “things to do on the bus,” “what I need for the
nature walk,” “things PH need at lunch”) by herself. It is unlikely, however, that a third grader
would use organization as a guide with- out the direction of an adult. Elaboration, a highly
effective strategy that involves actively creating a representation integrating new information
with existing information, may not be used spontaneously by children until early adolescence.
An eighth grader may remember the definition of the word “fruition” by creating an image of a
ripe pear on a bough, but it is unlikely that most sixth graders would do so.
Most students do not acquire optimally effective study skills, which can be considered forms of
memory strategies, until adolescence. By the later elementary school years, children allocate
more study time to test items that they have previously missed on practice tests; in contrast,
younger elementary school children devote comparable amounts of attention to items that
they have previously gotten correct and incorrect. By high school good students can be
expected to take spontaneous and effective notes and to emphasize key information in
studying.
Regardless of the strategy under consideration, its use emerges initially in highly supportive
task set- tings. At early points in the acquisition of memory strategies, children use a strategy
when adults instruct them to use the strategy but they do not generate the strategies
spontaneously, a limitation described as a production deficiency. Additional preparation time,
the use of familiar materials, and cues that may reduce memory demands are other factors that
increase the likelihood that strategies will be used. When they are fully acquired, strategies are
applied spontaneously in a wide array of task settings. Metamemory, or knowledge about the
operation of the memory sys- tem, contributes to the development of strategies. Metamemory
involves understanding the demands of the task and the relevant characteristics of the re-
membered, as well as identifying and using effective task approaches and monitoring their
effectiveness. In general, the development of metamemory in- creases with age, corresponding
to changes in actual memory performance.
Fostering Children’s Memory Development
Memory develops largely through social interaction, and consequently parents and teachers
play a critical role in assisting children in developing good memories. During early childhood,
everyday adult- child interactions provide the basis for memory development by fostering
language development and helping children acquire scripts for common events. Conversations
that include reminiscing about the re- cent past are significant in helping children under- stand
what memory is and what should be remembered. Developing family traditions and
participating in rituals encourage reminiscing.
When a child begins formal schooling, adults can contribute to the child’s acquisition of
metamemory and memory strategies by modeling their own approaches to tasks involving
memory and discussing their memory failures. It is important that teachers and parents
recognize that strategies develop over an extended period. Children’s use of effective memory
strategies in studying should be monitored, and adults should help children simplify tasks by
providing external memory aids and other supports as needed. Informal instruction in the use
of memory strategies should be incorporated into class presentations and assignments.
It is also important to keep in mind that memory is facilitated by advances in other domains of
development. As examples, narrative skills increase children’s abilities to provide reports of
their personal experience; problem-solving techniques increase functional working memory
capacity. The development of the knowledge base plays a vital role in memory performance.
Hence, providing children with opportunities to learn about the world contributes significantly
to their capacity to remember effectively.
See also: COGNITIVE DEVELOPMENT; LEARNING
MANARCHE
Menarche refers to the first menstrual flow experienced by a girl during puberty. Menstruation means
that the physiological and hormonal changes underlying re[productive processes matured sufficiently to
produce the endometrium lining of the uterus, which is sloughed off at the end of the menstrual cycle if
implantation of fertilized ovum has not occurred.

Menarche typically occurs after other pubertal changes are well established, and marks the
completion of puberty. The mean age of the menarche for girls in the United States is twelve, but it may
occur normally from ages ten to sixteen. Early menstrual cycles are often irregular and may include no
ovulation or multiple ovulations.
 Menarche often is acknowledged by family or community rituals, recognizing the adolescent’s
entrance into womanhood and sexual potential. Challenges of adolescences for a girl include the
incorporating the new status and potential into her self-concept and coping with reactions of family and
peers.

See also: ADOLESCENCE; MENSTRUAL CYCLE; PUBERTY

MENSTRUAL CYCLE
The menstrual cycle is periodic flow of blood and cells from the lining of the uterus in human
females and the females of most other primates, occurring about every twenty-eight days. The
beginning of menstruation, or menarche (the first menstrual period), typically starts between
the age of ten and seventeen is a sign of readiness for childbearing.
During each cycle, the lining, or endometrium, of the uterus experiences a rapid generation of
cells and vein-filled channels in preparation for pregnancy. Halfway through the cycle, an ovum
(egg) is released from an ovary. The womb passes through the fallopian tube, and if fertilized by
a sperm, the womb is implanted into uterus, and the thickened lining helps support the
pregnancy. If the womb is not fertilized, the tissues and blood are shed.
The many myth and taboos related to menstruation have caused some cultures of
chastise it as “uncleaned” or a “curse”. For a young girl, menarche is simply related to growth
and body weight. Signs of the puberty can begin after the age of eight, but early physical
menstruation may result in social pressure because of increased attention.
See also: ADOLESCENCE; CONTRACEOTION; MENARCHE; PUBERTY
MENTAL AGE
Mental age refers to an age-normed level of performance on an intelligence test, and it became
a popular way of referring to “mental level” as measured by the Binet-Simon Scale of 1908. The
Binet-Simon Scale identified the academic skills typical of specific age groups. In 1912 Wilinam
Stern used chronological age as a denominator to be divided into mental age, resulting in an
intelligent quotient. In1916 Lewis Terman multiplies this intelligence quotient by 100 (to
eliminate the decimal places) and called the result an IQ score. Terman’s formula of mental age
divided by chronological age multiplied by 100 became popularized as the formula for
calculating a person’s IQ. Adult intelligence does not change from year to year so the concept of
mental age is less meaningful when discussing adults. Contemporary IQ tests use calculative
indexes to determine scores rather than the calculation of IQ scores based upon Terman’s
formula. A contemporary equivalent of mental age is the Standard Age Score of the Stanford-
Binet IQ test, which was formulated in 1987.
See also: MILESTONES OF DEVELOPMENT

MENTAL DISORDERS
Children’s mental health problems have emerged from a long history of misunderstanding and neglect
to become the central concern of an active group of researchers and practitioners. The last few decades
of the twentieth century witnessed an explosion of knowledge about the nature of disorders that affect
children, their frequency of occurrence, their developmental course, and the effectiveness of
treatments.

In both children and adults, mental disorders typically are defined in one of two ways: as a category or
along a dimension. Categorical approaches are typified by the American Psychiatric Association’s di-
agnostic criteria, as published in the Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. ‘The
definitions of mental disorders in the DSM-IV are characterized predominantly by symptom criteria for
diagnoses, as well as by taking into account impairment and, for some disorders, age of onset. For this
approach, clinical interviews are the typical measurement.

In contrast to categorical approaches, dimension- al approaches emphasize symptoms along a

continuum from none or few symptoms to clinically significant levels of symptoms. The dimensional
approach is typically measured by reliable and valid questionnaires administered to parents, teachers, or
the children under study, with lists of behaviors that the respondent indicates as being characteristic of
the child, sometimes or somewhat characteristic, or not characteristic of the child. Children are assigned
a score along the continuum or are indicated as exceeding, or not, an empirically established cutoff for
clinically significant levels of behavior problems or, at the next lower level, of borderline significance.

The mental disorders that children can develop are commonly divided into two groups: disruptive or
externalizing behavior disorders (e.g., attention- deficit hyperactivity disorder, conduct problems) and
emotional or internalizing behavior disorders (e.g., anxiety, depression). In addition, children also can
develop other disorders that do not fit into this classification system, such as autism, schizophrenia, and
eating disorders.

An important perspective within which to under- stand children’s mental disorders is development. By
its nature, children’s behavior fluctuates over time. One of the biggest challenges for parents and
practitioners is to distinguish between normal developmental changes and the emergence of a disorder
(atypical changes). Development is also an important consideration in determining whether early signs
of a disorder will emerge as a full-blown disorder, develop into a different disorder, or resolve into
healthy functioning.

Disruptive or Externalizing Behavior Disorders

The disruptive or externalizing disorders consist of attention deficit hyperactivity disorder (ADHD),
conduct disorder, and oppositional defiant disorder. Because the latter two are both considered
disruptive behavior disorders, they are typically considered together.

Attention Deficit Hyperactivity Disorder

ADHD has as its primary symptoms inattention, impulsivity, and hyperactivity. Research has shown that
inattention symptoms tend to cluster apart from symptoms of impulsivity and hyperactivity, while the
latter two tend to cluster together. The DSM-IV maintains this distinction by including two sets of
symptoms. In order to meet diagnostic criteria for ADHD, the child’s parents or teachers must report the
presence of at least six symptoms of inattention (e.g., is often easily distracted by extraneous stimuli) or
six symptoms of hyperactivity-impulsivity (e.g., often fid- gets with hands or feet or squirms in seat). In
both cases, the symptoms must: (1) have been present and been causing impairment before age seven
years; (2) have been present for six months or more; and (3) cause clinically significant impairment in
terms of interpersonal or academic functioning in two or more settings and must differ from normal
developmental expectations. Alternatively, behavior rating scales, on which respondents rate individual
symptoms of ADHD, provide a dimensional, age-sensitive, quantitative assessment of ADHD-related
problems, along with an indication of the level at which the scores are considered to be indicative of
clinically significant problems.

Although reports vary depending on the criteria used, with DSM-IV based criteria the estimates of the
incidence of ADHD are about 3 percent to 5 percent of the general population of children. As with the
other externalizing disorders, it occurs much more frequently in boys than in girls, with a typical ratio of
six to one in samples attained from treatment settings and three to one in community samples.

Although some children show signs of ADHD as early as infancy, for most children the first signs of
behavior that differs from developmental expectations emerge between the ages of three and four
years. An- other common time for children to be first identified is at school entry.

No one knows exactly what causes ADHD. Biological factors are likely to include genetic transmission
and pregnancy and birth complications, and may also include brain injury or lead exposure. Researchers
percent of the variance in ADHD symptoms) and neurobiological factors (with more support found for
irregularities in brain structures than for neuro- chemical imbalances). The notion that sugar and other
dietary factors cause ADHD has received little support. Family factors have not been found to play a
clear role in causing ADHD, although family influences are known to be important in the developmental
course and emergence of associated symptoms.

The frequent co-occurrence of other conditions and the extent to which ADHD symptoms cause
problems in multiple settings (e.g. home, school) complicate treatment of ADHD. These characteristics
contribute to the lack of consensus on the best treatment for ADHD as well as the understanding that no
one approach works for all children and that many children with ADHD will benefit from a multifaceted
treatment program. In addition, there is consensus that treatments must be ongoing and must be
sensitive to children’s developmental level and other strengths and needs of the child and the family.
Stimulant medications, the most frequently used treatment, lead to dramatic improvements in
symptoms in about 80 percent of children with ADHD. To treat the problems often associated with
ADHD (e.g., conduct problems, depression), which have not been found to benefit from stimulant
medications, parent management training (PMT) is an effective approach. Al- though there are many
variations on PMT, standard features typically include providing parents with an understanding of the
disorder and techniques for managing their child’s behavior problems. ‘Treatment approaches that
combine stimulant medication with PMT have shown the greatest effectiveness. Al- though many other
interventions are available, the evidence for their effectiveness is limited. At the be- ginning of the
twenty-first century, a large study funded by the National Institute of Mental Health was underway and
was evaluating the effectiveness of an intensive intervention combining medication, PMT, and
classroom interventions. This study offered great promise for providing information on the best
treatments for children with ADHD.

Conduct Problems (Disruptive Behavior)

The primary behaviors that fall into this category are aggression, noncompliance, defiance, and aversive
interpersonal behavior. The DSM-IV categorizes children with the less severe form of disruptive behavior
disorders as having oppositional defiant disorder (ODD). Symptoms of ODD include a pattern of
negativistic, defiant, noncompliant, and argumentative behavior, lasting for at least six months and
causing significant impairment in social or academic functioning. In contrast, aggression and violation of
rules characterize conduct disorder (CD). The fifteen symptom-based criteria are clustered into four
groups: (1) aggression to people and animals, (2) destruction of property, (3) deceitfulness or theft, and
(4) serious violation of rules. From the dimensional perspective, ODD and CD are considered
externalizing behavior problems, further distinguished as two subtypes: delinquent and aggressive.

Estimates of the frequency of occurrence among school-age children of ODD range from 5 percent to 25
percent and of CD from 5 percent to 20 percent. As with ADHD, both ODD and CD are more frequently
diagnosed in boys than in girls. ODD is twice as common in males than females, although only before
puberty; rates are about even in post pubertal males and females. The male to female ratio for CD is be-
tween two to one and three to one.

Children may be first diagnosed with ODD or CD at any point in childhood. ODD may be present as early
as three years of age and is usually diagnosed by the early school years. Some researchers consider ODD
to be a milder, earlier version of CD, although the matter is controversial. Only about 25 percent of
children with ODD progress to the more severe CD. On the other hand, most children who meet the
criteria for CD were previously diagnosed with ODD and had persisting ODD symptoms. Children with
childhood-onset (i.e., before age ten years) of CD, who are more likely to be boys, have been found to
be more likely to persist in antisocial behaviors over time. In a 1996 research report, Terri Moffitt and
her colleagues delineated two alternative developmental pathways for children with conduct problems.
The re- searchers described one group of these children, those with early onset and problems that
persist, as following the life-course-persistent path, whereas those whose conduct problems first
emerged later in adolescence and were typically limited to the teen years were described as following
the adolescent- limited path.

The development of ODD or CD is likely to have origins in multiple factors associated with diverse
pathways. Researchers have found evidence that several factors are related to the development of ODD,
CD, or both: genetically based, early temperament difficulties (e.g., having lower frustration tolerance),
neurobiological factors (e.g., low psychophysiological arousal), social-cognitive factors (e.g., cognitive
distortions), family patterns of interaction (e.g., inadequate monitoring of the child’s behavior), and
family environmental stress and adversity (e.g., marital dis- cord).

Evidence for the effectiveness of treatment of children with serious conduct problems is not promising.
Although families are likely to be offered a range of treatment options, none of them has been shown to
be strongly effective. As with ADHD, the treatments that are most likely to be effective include a
combination of treatments targeting not only the child but also the family, school, and neighborhood.
The most effective treatments also take into consideration the developmental status of the child and
the developmental trajectory of conduct problems for the child, with the children most difficult to treat
being those who are farther along in the trajectory. Three approaches to treatment that have at least
some empirical support are parent management training (focused on teaching parents new skills for
managing their child’s behavior); cognitive problem-solving skills training (focused on changing
children’s perceptions and appraisals of interpersonal events); and multisystem treatment (focused on
the context with- in which the child functions, including family, school, neighborhood, and the legal
system).

Emotional or Internalizing Disorders

Some children develop depression and anxiety, disorders that involve not only maladaptive thoughts
and emotions but also maladaptive behaviors. It is important to distinguish these disorders from
common depressed mood or childhood worries and fears. Knowledge of normal development of
emotions and cognitions is helpful in making these distinctions.
Anxiety

Anxiety disorders in children are most likely to fall into the DSM-IV diagnostic categories of generalized
anxiety disorder, simple phobia, separation anxiety disorder, obsessive-compulsive disorder, or
posttraumatic stress disorder. Children diagnosed with generalized anxiety disorder have a consistent
pattern, lasting six months or more, of uncontrollable and excessive anxiety or worry, with the concerns
covering a broad range of events or activities. In addition to worry, symptoms include irritability,
restlessness, fatigue, difficulty in concentrating, muscle tension, and sleep disturbances. Deborah Beidel
found that this disorder commonly begins at around age ten, is persistent, frequently co-occurs with
depression, and is often accompanied by a number of physical symptoms such as sweating, suffering
from chills, feeling faint, and having a racing pulse.

In contrast to generalized anxiety disorder, children with the other anxiety disorders have a much
narrower focus of their concerns. Simple phobia is typically focused on a specific situation or object.
With separation anxiety, children display excessive fear and worry about becoming separated from their
primary attachment figures. This disorder is often ex- pressed as school refusal or school phobia.
Obsessive- compulsive disorder consists of specific obsessions (abnormal thoughts, images, or impulses)
or compulsions (repetitive acts). Posttraumatic stress disorder symptoms develop in reaction to having
experienced or witnessed a particularly harrowing event. Symptoms include sleep disturbances,
irritability, attention problems, exaggerated startle responses, and hyper- vigilance.

For phobias and separation anxiety disorder, it is particularly necessary to determine if a child’s fears
reflect typical concerns of the age group or are clinically significant. Onset of a fear at a time that is
different from children’s age-typical fears is often an important indication of clinical significance. Other
important indications of clinical significance include fear reactions that are strong, persistent, and
intense and that interfere with school, family, or peer relationships. Similarly, it is essential to distinguish
symptoms of obsessive-compulsive disorder from typical childhood rituals and routines.

Although generalized anxiety disorder and specific phobias are among the most common disorders in
children, the other anxiety disorders are rare. Diagnosis of anxiety disorders is particularly difficult
because it is so dependent on self-reports from the children. Children may not recognize that their fears
are excessive and typically do not complain about them, although they will go out of their way to avoid
situations that evoke the anxiety.

The anxiety disorders are typically viewed as haying their origins in learning experiences. Children may
learn fears through imitation, instruction, or direct reinforcement. Similarly, compulsive behavior can
develop from a chance occurrence when a child felt positive reinforcement for engaging in a particular
behavior because it was associated with reduced anxiety.

Anxiety disorders that begin in childhood often persist into adulthood. Thus it is particularly important
to treat them early. Behavioral or cognitive therapies have been most successful. ‘Treatment typically
involves a combination of graduated exposure to the feared situation and teaching the child adaptive
and coping self-statements. The effectiveness and safety of using medications was the subject of several
studies at the beginning of the twenty-first century; some early findings showed promising results from
the use of antidepressants.

Depression (Mood Disorders)

Depression is another relatively common disorder that often first appears in childhood or adolescence.
The DSM-IV includes the depression diagnoses of major depression and dysthymia. To be diagnosed
with major depression, children must experience either depressed mood (or irritability) or loss of
interest in their usual activities plus other symptoms such as sleep or appetite disturbance, loss of
energy, or trouble concentrating. These symptoms must be present nearly every day for two weeks or
more. For dysthymia, the symptoms are typically of a lower level of severity but persist for one year or
more. For both disorders, the symptoms must cause impairment and must reflect a change from the
child’s usual level of functioning. Standardized questionnaires are also used to measure depression and
determine whether a child’s level of symptoms are in the no depressed range or indicate mild,
moderate, or severe levels of depression.

Studies of community samples have found that from 2 percent to 5 percent of children have mood
disorders. Rates increase with age. Although rates are about equal for boys and girls in childhood,
beginning at puberty girls are twice as likely as boys to receive a depression diagnosis. Depression is a
recurrent disorder, with each additional episode in- creasing the likelihood of a recurrence.

Early stages in the emergence of depression are often missed because children are not likely to
recognize or report their distress. Once a depression disorder emerges, it is typically persistent and
progresses from relatively mild symptoms to more severe symptoms.

Genetics contribute to the likelihood of a child- hood depression occurring, as do neurobiological factors
and stress. Children with particular patterns of thinking, such as blaming themselves for negative
outcomes while not giving themselves credit for positive outcomes, may be more vulnerable to
depression than others.

‘Treatments that have been found to be successful often involve intervention into the psychosocial
components of the disorder. For example, treatment may involve helping the children identify and
modify mal- adaptive beliefs and perceptions, develop social skills and problem-solving abilities, and
broaden their re- sources for coping with stress. A particularly effective focus in treatment of
adolescents with depression has been on interpersonal relationships, addressing the stage-salient
concerns of adolescents. Although they are often prescribed, evidence for the effectiveness of
antidepressant medication in children and adolescents has been mixed, possibly because of the
methodological challenges of studying medications during periods of still rapid development.

Other Disorders

The disorders included in this last category involve more extreme deviations from normal development
than the externalizing and_ internalizing behavior disorders. Parents typically become extremely
concerned when symptoms of these disorders emerge. ‘Two of these disorders, autism and child- hood
schizophrenia, are considered pervasive developmental disorders in the DSM-IV, a term suggesting not
only that the disorders emerge early but also that they affect all of the developing systems, including
social, language, and cognitive-intellectual.

Autism

Autism is an extremely rare condition, occurring in fewer than 5 out of 10,000 individuals, possibly more
common in males. Symptoms, which must emerge before the age of three years to meet DSM-IV
diagnostic criteria, include impairment in social interaction (e.g., avoidance of eye contact) and
communication (e.g., delayed or inadequate speech), as well as repetitive and stereotyped patterns of
behavior, interests, or activities. Thus autism develops early and disrupts development in all key areas.
The causes of autism are not known, but research findings center on genetic factors, including
chromosome abnormalities, and brain injuries or anomalies in brain development. Research on
treatment for autism has been controversial because parents understandably pursue a wide range of
activities to help their children. Behavioral treatments of specific problematic behaviors have been
shown to be successful and often involve teaching the parents the skills to manage their children’s
behavior. Evidence for the effectiveness of medications have been mixed but offer some promise.

Schizophrenia

Schizophrenia also is rarely diagnosed in children, probably occurring in fewer than | in 1,000 children,
and the DSM-IV does not even include criteria for a specific category of childhood schizophrenia. In
childhood, although not in adolescence, schizophrenia occurs more frequently in males than females.
Symptoms include hallucinations and delusions, disorganized or incoherent speech, and disorganized
behavior. Onset is typically in late childhood or adolescence following predominantly normal
development. Once it emerges, the course of schizophrenia is characterized by episodes alternating with
periods of improvement and relapse. The causes of schizophrenia are most likely genetic and other bio-
logical considerations. Treatment may involve the same antipsychotic medications that are used with
adults. Research indicates that medications may be most effective when combined with a program of
helping the family to manage the child’s behavior and minimize stress levels.

Eating Disorders

The DSM-IV includes two eating disorders. Anorexia nervosa is characterized mainly by refusal to
maintain even minimally normal body weight, symptoms of intense fear of gaining weight even though
underweight, and disturbance in the perception or experience of one’s body weight or shape. The
second disorder, bulimia nervosa, is diagnosed when individuals engage repeatedly in binge eating
alternating with inappropriate methods to prevent weight gain. Eating disorder symptoms and
associated behaviors can also be measured with questionnaires. Eating dis- orders tend to be more
prevalent in industrialized countries and are relatively rare, with prevalence estimates typically fewer
than 2 percent, nearly all girls. Onset is typically around adolescence and may be associated with a
stressful event. Causes are likely to include a combination of biological, family, and sociocultural factors
as well as individual psychological characteristics of the child. Treatment, often resisted, requires
coordination between medical attention and therapy, including behavioral intervention, training in self-
monitoring, and the development of coping skills.

See also: ANTISOCIAL BEHAVIOR; ATTENTION DEFICIT HYPERACTIVITY DISORDER; AUTISM

MENTAL RETARDATION

Mental retardation (MR) is a developmental disability, defined by looking at three aspects of a child. IQ
score, adaptive functioning, and the age of onset determine where a child lies in the continuum of
mental retardation.

A numerical component of MR is defined by an 1Q intelligence test. An IQ test measures and predicts

how well individuals learn in their environment. The average IQ score of a typical developing child falls
be- tween 80 and 119. An IQ score below 70 to 75 characterizes a child for further evaluations to
determine if