Ebooks File Textbook of Men S Mental Health 1st Edition Jon E. Grant All Chapters

Full download ebook at ebookgate.
com
Textbook of Men s Mental Health 1st Edition

Jon E. Grant
https://ebookgate.com/product/textbook-of-men-s-
mental-health-1st-edition-jon-e-grant/
Download more ebook from https://ebookgate.com

More products digital (pdf, epub, mobi) instant
download maybe you interests ...
Textbook of men s health and aging 2ed Edition

Lunenfeld B.
https://ebookgate.com/product/textbook-of-men-s-health-and-
aging-2ed-edition-lunenfeld-b/
Menopause A Mental Health Practitioner s Guide 1st

Edition Donna E. Stewart
https://ebookgate.com/product/menopause-a-mental-health-
practitioner-s-guide-1st-edition-donna-e-stewart/
Men s health 3ed Edition Kirby R.
https://ebookgate.com/product/men-s-health-3ed-edition-kirby-r/
The Stressed Sex uncovering the truth about men women

and mental health 1st Edition Daniel Freeman
https://ebookgate.com/product/the-stressed-sex-uncovering-the-
truth-about-men-women-and-mental-health-1st-edition-daniel-
freeman/
Appalachia s Children The Challenge of Mental Health
1st Edition David H. Looff
https://ebookgate.com/product/appalachia-s-children-the-
challenge-of-mental-health-1st-edition-david-h-looff/
Mental Health Information for Teens Health Tips about

Mental Wellness and Mental Illness Teen Health Series
3rd Edition Karen Bellenir
https://ebookgate.com/product/mental-health-information-for-
teens-health-tips-about-mental-wellness-and-mental-illness-teen-
health-series-3rd-edition-karen-bellenir/
The Future of Mental Health Deconstructing the Mental

Disorder Paradigm 1st Edition Eric Maisel
https://ebookgate.com/product/the-future-of-mental-health-
deconstructing-the-mental-disorder-paradigm-1st-edition-eric-
maisel/
Older People s Mental Health Today A Handbook 1st

Edition Toby Williamson
https://ebookgate.com/product/older-people-s-mental-health-today-
a-handbook-1st-edition-toby-williamson/
Teaching Mental Health 1st Edition Theo Stickley
https://ebookgate.com/product/teaching-mental-health-1st-edition-
theo-stickley/
TEXTBOOK OF MEN’S
MENTAL HEALTH
This page intentionally left blank
TEXTBOOK OF MEN’S
MENTAL HEALTH
Edited by
JON E. GRANT, M.D., M.P.H., J.D.

MARC N. POTENZA, M.D., PH.D.
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is
accurate at the time of publication and consistent with general psychiatric and
medical standards, and that information concerning drug dosages, schedules,
and routes of administration is accurate at the time of publication and consis-
tent with standards set by the U.S. Food and Drug Administration and the gen-
eral medical community. As medical research and practice continue to advance,
however, therapeutic standards may change. Moreover, specific situations may
require a specific therapeutic response not included in this book. For these rea-
sons and because human and mechanical errors sometimes occur, we recom-
mend that readers follow the advice of physicians directly involved in their care
or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views

and opinions of the individual authors and do not necessarily represent the pol-
icies and opinions of APPI or the American Psychiatric Association.
All patient names in this book are fictional. To protect confidentiality, these
cases are composites of several people’s stories, and case details have been
changed to protect patients.
Copyright © 2007 American Psychiatric Publishing, Inc.

ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper

10 09 08 07 06 5 4 3 2 1
First Edition
Typeset in Palatino and Futura Condensed.
American Psychiatric Publishing, Inc.

1000 Wilson Boulevard
Arlington, VA 22209–3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
Textbook of men’s mental health / edited by Jon E. Grant, Marc N. Potenza.—
1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58562-215-X (hardcover : alk. paper)
1. Men—Mental health. 2. Men—Psychology. I. Grant, Jon E.
II. Potenza, Marc N., 1965– . III. Title: Men's mental health.
[DNLM: 1. Men—psychology. 2. Mental Health. 3. Mental Disorders.
4. Sex Factors. WA 305 T3558 2006]
RC451.4.M45T49 2006
616.89'0081—dc22
2006014699
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
CONTENTS
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
I
Boys and Men at Different Life Stages
1 Childhood: Normal Development and Psychopathology . . . . . . . . . . . . . . . .3
Eric L. Scott, Ph.D.
Ann M. Lagges, Ph.D.
2 Adolescence: Neurodevelopment and Behavioral Impulsivity . . . . . . . . . . .23
Craig A. Erickson, M.D.
R. Andrew Chambers, M.D.
3 Older Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Rani Desai, Ph.D.
II
Psychiatric Disorders in Men: Assessment and Treatment
4 Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
Carlos Blanco, M.D., Ph.D.
Oriana Vesga López, M.D.
5 Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Yael Levin, B.A.
Gerard Sanacora, M.D., Ph.D.
6 Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
N. Will Shead, M.Sc.
David C. Hodgins, Ph.D.
7 Antisocial Personality Disorder, Conduct Disorder, and Psychopathy. . . . . . 143
Donald W. Black, M.D.
8 Sexual Health and Problems: Erectile Dysfunction,
Premature Ejaculation, and Male Orgasmic Disorder. . . . . . . . . . . . . . . . . 171
David L. Rowland, Ph.D.
9 Impulse Control Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Jon E. Grant, M.D., M.P.H., J.D.
Marc N. Potenza, M.D., Ph.D.
10 Posttraumatic Stress Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Dolores Vojvoda, M.D.
Steven Southwick, M.D.
III
Sociocultural Issues for Men
11 Fathering and the Mental Health of Men . . . . . . . . . . . . . . . . . . . . . . . . . 259
Thomas J. McMahon, Ph.D.
Aaron Z. Spector, M.S.N., A.P.N.
12 Men, Marriage, and Divorce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Scott Haltzman, M.D.
Ned Holstein, M.D., M.S.
Sherry B. Moss, M.A.
13 Body Image and Muscularity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Roberto Olivardia, Ph.D.
14 Aggression, Violence, and Domestic Abuse . . . . . . . . . . . . . . . . . . . . . . . . 325
Caroline J. Easton, Ph.D.
Tara M. Neavins, Ph.D.
Dolores L. Mandel, L.C.S.W.
15 Culture, Ethnicity, Race, and Men’s Mental Health. . . . . . . . . . . . . . . . . . . 343
Declan T. Barry, Ph.D.
16 Mental Health of Gay Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .363
Michael King, M.D., Ph.D., F.R.C.P., F.R.C.G.P.,
F.R.C.Psych.
17 Overcoming Stigma and Barriers to Mental Health Treatment . . . . . . . . . .389
Deborah A. Perlick, Ph.D.
Lauren N. Manning, B.A.
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .419
CONTRIBUTORS
DECLAN T. BARRY, PH.D.
Associate Research Scientist, Yale University School of Medicine, New
Haven, Connecticut
DONALD W. BLACK, M.D.

Professor of Psychiatry, Department of Psychiatry, The University of Iowa
Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
CARLOS BLANCO, M.D., PH.D.

Assistant Clinical Professor of Psychiatry, New York State Psychiatric In-
stitute at Columbia University Medical Center, New York, New York
R. ANDREW CHAMBERS, M.D.

Director, Laboratory for Translational Neuroscience of Dual Diagnosis
Disorders, Institute of Psychiatric Research, Department of Psychiatry,
Indiana University School of Medicine, Indianapolis, Indiana
RANI DESAI, PH.D.

Associate Professor of Psychiatry and Epidemiology and Public Health,
Yale University School of Medicine, West Haven, Connecticut
CAROLINE J. EASTON, PH.D.

Assistant Professor of Psychiatry, Director of Forensic Drug Diversion,
and Director of Substance Abuse and Domestic Violence Services, Divi-
sion of Substance Abuse, Department of Psychiatry, Yale University
School of Medicine, New Haven, Connecticut
CRAIG A. ERICKSON, M.D.

Chief Resident in Psychiatry and Fellow in Child Psychiatry, Depart-
ment of Psychiatry, Indiana University School of Medicine, Indianapo-
lis, Indiana
JON E. GRANT, M.D., M.P.H., J.D.

Associate Professor of Psychiatry, University of Minnesota Medical
Center, Minneapolis, Minnesota
ix
x TEXTBOOK OF MEN’S MENTAL HEALTH
SCOTT HALTZMAN, M.D.

Clinical Assistant Professor of Psychiatry and Human Behavior, Brown
Medical School, Providence, Rhode Island
DAVID C. HODGINS, PH.D.

Professor of Psychology, Department of Psychology, University of Cal-
gary, Alberta, Canada
NED HOLSTEIN, M.D., M.S.

Clinical Assistant Professor, Department of Community and Environ-
mental Medicine, Mount Sinai School of Medicine, New York, New
York
MICHAEL KING, M.D., PH.D., F.R.C.P., F.R.C.G.P., F.R.C.PSYCH.

Professor of Primary Care Psychiatry, Department of Mental Health Sci-
ences, Royal Free and University College Medical School, London, En-
gland
ANN M. LAGGES, PH.D.

Assistant Professor of Clinical Psychology in Clinical Psychiatry, Co-
chief, Mood Disorders Clinic, Riley Child and Adolescent Psychiatry
Clinic, Riley Hospital for Children, Indiana University School of Medi-
cine, Indianapolis, Indiana
YAEL LEVIN, B.A.

Research Assistant, Yale Depression Research Program and Depart-
ment of Psychiatry, Yale University School of Medicine, New Haven,
Connecticut
ORIANA VESGA LÓPEZ, M.D.

Assistant Clinical Professor of Psychiatry, New York State Psychiatric
Institute at Columbia University Medical Center, New York, New York
DOLORES L. MANDEL, L.C.S.W.

Program Coordinator of Drug Diversion, Forensic Drug Diversion, and
Director of Substance Abuse and Domestic Violence Services, Division
of Substance Abuse, Department of Psychiatry, Yale University School
of Medicine, New Haven, Connecticut
Contributors xi
LAUREN N. MANNING, B.A.

Research Assistant, Northeast Program Evaluation Center, West Haven
Veterans Affairs Medical Center and Department of Psychiatry, Yale
University School of Medicine, New Haven, Connecticut
THOMAS J. MCMAHON, PH.D.

Associate Professor, Yale University School of Medicine, Department of
Psychiatry and Child Study Center, West Haven Mental Health Clinic,
West Haven, Connecticut
SHERRY B. MOSS, M.A.

Lecturer in Psychiatry, Harvard Medical School, Boston, Massachusetts
TARA M. NEAVINS, PH.D.

National Institute on Drug Abuse Postdoctoral Fellow, Forensic Drug Di-
version, and Substance Abuse and Domestic Violence Services, Division
of Substance Abuse, Department of Psychiatry, Yale University School of
Medicine, New Haven, Connecticut
ROBERTO OLIVARDIA, PH.D.

Clinical Instructor of Psychology, Department of Psychiatry, Harvard
Medical School, Belmont, Massachusetts
DEBORAH A. PERLICK, PH.D.

Associate Professor of Psychiatry, Mount Sinai School of Medicine, New
York, New York
MARC N. POTENZA, M.D., PH.D.

Associate Professor of Psychiatry, Yale University School of Medicine,
New Haven, Connecticut
DAVID L. ROWLAND, PH.D.

Professor, Department of Psychology, Valparaiso University, Valparaiso,
Indiana
GERARD SANACORA, M.D., PH.D.

Director, Yale Depression Research Program and Associate Professor of
Psychiatry, Yale University School of Medicine, New Haven, Connecticut
xii TEXTBOOK OF MEN’S MENTAL HEALTH
ERIC L. SCOTT, PH.D.

Assistant Professor of Clinical Psychology in Clinical Psychiatry, Co-
chief, OCD/Tic/Anxiety Disorders Clinic, Riley Child and Adolescent
Psychiatry Clinic, Riley Hospital for Children, Indiana University School
of Medicine, Indianapolis, Indiana
N. WILL SHEAD, M.SC.

Doctoral Student, Department of Psychology, University of Calgary, Al-
berta, Canada
STEVEN SOUTHWICK, M.D.

Professor of Psychiatry, Department of Psychiatry, Yale University School
of Medicine, New Haven, Connecticut
AARON Z. SPECTOR, M.S.N., A.P.N.

Graduate Student, Yale University School of Nursing, Psychiatric and
Mental Health Nursing Specialty Program, New Haven, Connecticut
DOLORES VOJVODA, M.D.

Assistant Professor of Psychiatry, Department of Psychiatry, Yale Uni-
versity School of Medicine, New Haven, Connecticut
INTRODUCTION
Since the late 1990s, the volume of research on gender issues in mental
health has grown significantly. One important point that the gender lit-
erature has demonstrated, in addition to clarifying how women’s health
differs from that of men’s, is how little we actually know about men’s
mental health concerns. Although the great body of research in mental
health has historically been based on men, until recently the research has
largely failed to address how male gender integrally influences the clin-
ical presentation and treatment of various disorders. Thus this volume
reflects an exciting moment in the history of men’s mental health. Re-
search on women’s health has highlighted the important premise that
diagnosis, etiology, prevention, and treatment efforts should carefully
consider how men and women differ as well as how they are similar.
This volume builds on this premise by presenting the latest research on
what mental health care professionals should know about men’s psychi-
atric issues.
Although many clinicians encounter men with mental health issues,
many have never considered the unique issues faced by men at various
stages in life or how men present differently with certain disorders. In ad-
dition, clinicians may be relatively unaware of how treatment responses
in men differ from those in women. Thus, a primary aim of this book is to
document salient aspects of men’s mental health throughout the life
span, the clinical presentation and treatment of various psychiatric disor-
ders frequently observed in men, and sociocultural topics of particular
relevance to men.
The first part of this text highlights three important stages in men’s
lives. Scott and Lagges (Chapter 1, “Childhood: Normal Development
and Psychopathology”) and Erickson and Chambers (Chapter 2, “Adoles-
cence: Neurodevelopment and Behavioral Impulsivity”) provide compre-
hensive descriptions of normal childhood and adolescent development,
respectively, and highlight the major developmental issues encountered
by boys and how boys differ from girls in their developmental trajectories.
At the other end of the age spectrum, Desai (Chapter 3, “Older Men”) de-
scribes the biopsychosocial changes that occur as men age.
xiii
xiv TEXTBOOK OF MEN’S MENTAL HEALTH
A primary aim of this book is to provide clinicians with information

on how men differ from and are similar to women with respect to clin-
ical presentation and treatment of psychiatric disorders. As such, the
second part of this text addresses areas of clinical care in which men
present unique clinical issues. Disorders that are more prevalent in men
are examined by Shead and Hodgins in Chapter 6, “Substance Use Dis-
orders,” and by Black in Chapter 7, “Antisocial Personality Disorder,
Conduct Disorder, and Psychopathy.” These chapters provide a com-
prehensive understanding of these various disorders as well as treat-
ment approaches. Although the treatment of men’s sexual functioning
has made tremendous advances since 2000, few mental health clinicians
address this important topic. To enhance the overall care of male pa-
tients, Rowland has provided an invaluable chapter on male sexual
functioning (Chapter 8, “Sexual Health and Problems: Erectile Dysfunc-
tion, Premature Ejaculation, and Male Orgasmic Disorder”).
Certain psychiatric disorders are seen less frequently in men. There-
fore, when men present with these disorders, clinicians often assume
that the presentation and treatment will be similar to what is seen and
used in women. Disorders less commonly seen in men but with impor-
tant clinical and treatment differences are explored by Blanco and López
in Chapter 4, “Anxiety Disorders,” by Levin and Sanacora in Chapter 5,
“Depression,” and by Vojvoda and Southwick in Chapter 10, “Posttrau-
matic Stress Disorder.” Finally, in Chapter 9, “Impulse Control Disor-
ders,” we address certain disorders that are seen more frequently in men
(pathological gambling, compulsive sexual behavior) and other disor-
ders that are less commonly encountered (trichotillomania, kleptoma-
nia, compulsive buying).
The last section of the book, Part III, focuses on several sociocultural
issues of particular salience to men. McMahon and Spector discuss the in-
fluence of fathers on the family and the impact of fathering on children’s
mental health in Chapter 11, “Fathering and the Mental Health of Men.”
Haltzman and colleagues examine how men think about and behave in
intimate relationships in Chapter 12, “Men, Marriage, and Divorce.”
Body image, a problem long associated with women, has become a seri-
ous and underrecognized health issue for many men. Olivardia discusses
the clinical presentation of and treatment options for male eating disor-
ders, muscle dysmorphia, and steroid abuse in Chapter 13, “Body Image
and Muscularity.” Easton and colleagues address the complex issues un-
derlying male aggression and violence and how various interventions of-
fer hope for this public health problem in Chapter 14, “Aggression,
Violence, and Domestic Abuse.” Mental health issues appear to be intrin-
sically linked to issues of culture and ethnicity in men. In Chapter 15,
Introduction xv
“Culture, Ethnicity, Race, and Men’s Mental Health,” Barry provides in-
sight into how these factors may influence men’s willingness to seek
treatment and the effectiveness of the services offered. Because of the
high rates of psychiatric disorders among gay men and gay men’s reluc-
tance to access mental health care, King has provided a thorough look at
issues particular to gay men and how clinicians may better understand
and address these concerns in Chapter 16, “Mental Health of Gay Men.”
Finally, an important clinical issue involves the reluctance of many men
to access mental health treatment. In Chapter 17, “Overcoming Stigma
and Barriers to Mental Health Treatment,” Perlick and Manning examine
the issues men face as they consider seeking help for their mental health
problems and what clinicians may do to address these concerns.
In summary, men’s mental health represents an important yet largely
neglected area of clinical care. As the chapters of this volume eloquently
attest, extraordinary progress has been made regarding how men with
various psychiatric disorders present differently from women and how
treatment interventions may need to be modified based on gender issues.
This volume presents a multidisciplinary perspective on men’s mental
health issues by addressing developmental issues, incorporating psycho-
social issues unique to men, and presenting treatment options for a wide
array of psychiatric disorders. We hope that clinicians who wish to better
understand how they can make wise decisions regarding the care and
well-being of men with mental health issues will find this text valuable.
Jon E. Grant, M.D., M.P.H., J.D.

Marc N. Potenza, M.D., Ph.D.
PART I
BOYS AND MEN AT

DIFFERENT LIFE STAGES
1
CHILDHOOD
Normal Development and Psychopathology
ERIC L. SCOTT, PH.D.

ANN M. LAGGES, PH.D.
Boys and girls differ during childhood in patterns of normal develop-

ment and in the psychiatric disorders most frequently encountered. In
this chapter, we focus on major developmental issues encountered by
boys and girls and highlight how boys and girls differ in their develop-
mental trajectories. For example, boys tend to acquire language more
slowly and experience childhood psychiatric disorders like attention-
deficit/hyperactivity disorder (ADHD) and autistic disorder more fre-
quently than do girls. Additionally, we highlight areas in which male
gender may be a protective factor that enhances the way children can
cope with challenges along their developmental paths.
Case Vignette
Mrs. Smith brought her 12-year-old son, Tony, in for an evaluation at the
local mental health clinic, believing he had significant mental health
problems manifesting as behavioral outbursts, irritability, and a poor at-
tention span. She saw some increased irritability at home, and his teach-
3
4 TEXTBOOK OF MEN’S MENTAL HEALTH
ers complained that he was performing poorly in school, had been

uncooperative and refused to do his work, had been fighting more with
his peers, and appeared to be having staring spells. His appetite had
waned lately, and he had always been a poor sleeper.
Upon his interview with the mental health professional, Tony was
irritable and resentful of his mother for making the appointment, choos-
ing to look at the floor of the office rather than make good eye contact.
His minimal answers to questions usually ended with “I don’t know.”
He vehemently denied feeling depressed but endorsed sleep and appe-
tite problems, poor concentration, and irritability. He was somewhat
hopeful about the future but expressed many comments such as “what
difference does it make?” and “who cares?” He had dropped many con-
tacts with his friends and was staying in his room more often than usual.
His mother chalked up his behavior as a combination of the cold winter
weather and changes in his interests in friends, particularly the drinking
that she knew some of his friends were doing. The most bothersome
portion for her was the decline in his school performance. She feared the
educational implications that would accrue if this downward slide con-
tinued into high school.
Considerations in the diagnostic process for Tony would include any

history of early attachment problems between Tony and his mother as
well as recent stressors such as divorce or fights at school that could indi-
cate a significant adjustment problem. Although the school personnel
may consider Tony a prime candidate for ADHD, many of his problems
are highly consistent with a major depressive disorder or a learning dis-
ability. In a thorough workup for each of these disorders, it may be help-
ful to observe Tony for several sessions alone, without his parents, and
also to speak with the school personnel directly to rule out any learning
difficulties. Finding out more about his family’s history of depression or
other affective problems may also offer a clue about both his genetic and
his environmental loading for depression.
TYPICAL EMOTIONAL DEVELOPMENT AND MOOD DISORDERS

Infants are capable of expressing a range of emotions soon after birth.
Being able to display feelings such as contentment, distress, and fear al-
lows the infant to communicate on a basic level and therefore have basic
needs met long before language develops. Smiling encourages adults to
continue interaction, and cries of distress motivate caregivers to try to
ascertain and remedy the source of the distress. Interestingly, a sponta-
neous neonatal smile, a startle response, distress, and disgust are all
present at birth. A social smile appears at 4–6 weeks. Anger, surprise,
and sadness can be expressed by 3–4 months. Fear and shame or shy-
Childhood 5
ness are observable at approximately ages 5–8 months, and contempt

and guilt appear in the second year of life (Santrock 1990).
Early studies of gender differences suggested that girls and boys
show few, if any, differences in emotional development before age 1 year
(Maccoby and Jacklin 1974). However, findings emerged in the decades
that followed and suggested that some gender differences in emotional
functioning are apparent as early as birth. For example, during the neo-
natal period, male infants tend to smile less, be more irritable and diffi-
cult to soothe, and show greater emotional lability than female infants
(Feldman et al. 1980).
Many of these gender differences appear to persist into the first year
of life. Weinberg et al. (1999) explored these differences, using Tronick’s
face-to-face still-face paradigm. This interaction involves 2 minutes of
the mother and infant playing, then 2 minutes of the mother looking at
the infant, but not smiling, talking, or touching the infant, and finally,
2 minutes of the mother and infant playing (Tronick et al. 1978). The
second segment of this procedure, the still-face portion, is theoretically
the most difficult for the infants because they must regulate their own
emotional state without any cues from their mother. Male infants dis-
played more difficulty than female infants in regulating their emotional
states when faced with these abrupt shifts in interaction with their
mothers (Weinberg et al. 1999). As a group, the boys displayed more
negative emotion than did the girls during all three portions of the pro-
cedure, not just the still-face portion. One possible explanation for this
finding is that male infants may rely more on emotional cues from and
interaction with others to help regulate emotional states; girls may be
more able to self-regulate at an earlier age. It is important to note, how-
ever, that individual differences were present; some girls in the study
displayed high levels of negative emotion and some boys displayed rel-
atively low levels of negative emotion during the exercise (Weinberg et
al. 1999).
Studies have also shown that during the early childhood years, boys
tend to show greater emotional effects from parental conflict and stress
in caregivers (Kerig 1999; Laumakis et al. 1998). One possible explana-
tion for this finding, given the previously discussed research involving
younger children, is that during these early years boys may still be look-
ing to their primary caregivers for assistance in emotional regulation.
Highly stressed parents are unlikely to be able to provide calming cues
for their young boys.
For many years, it was believed that boys were more vulnerable to pa-
rental conflict and environmental stressors throughout development.
More recent research has suggested, however, that as girls and boys grow
older, girls tend to be more vulnerable than boys to parental conflict; spe-
cifically, parental conflict during the adolescent years has been found to
be more associated with depressive symptoms in girls than in boys
(Davies and Lindsay 2004). One partial explanation for this difference
may involve the social expectations for boys to become more indepen-
dent and self-sufficient as they grow older, whereas girls are expected to
become more connected with others on an emotional level as they enter
adolescence.
These findings may in part explain why, during the prepubertal
years, boys display a slightly higher rate of depressive disorders than
do girls; after puberty, rates of depressive disorders in adolescents mir-
ror the gender split of adults, with depressive disorders occurring about
twice as frequently in girls than in boys (Hankin et al. 1998). A review
of the literature exploring possible reasons for this gender by age inter-
action in rates of depression suggests that a number of factors are in-
volved, including social (Davies and Lindsay 2004) and biological
(Cyranowski et al. 2000) factors. Regarding biological factors, hormonal
differences that appear in adolescence (Angold et al. 1998) as well as ge-
netic factors (Merikangas et al. 1985) have been implicated in this gen-
der by age interaction. Differences in gender-based socialization, such
as the previously described expectation for girls to be more emotionally
connected to others, are also likely to play a role (Wichstrom 1999).
Kessler et al. (2001) suggested that cross-cultural studies are likely to be
helpful in further separating biological and social influences on adoles-
cent depression.
In considering a diagnosis of a depressive disorder in a boy, either
major depression or dysthymic disorder, it is important to remember
that in children, mood may be irritable rather than depressed or sad.
Depressed boys often express their irritability by throwing tantrums or
showing an increase in aggressive or destructive behavior. It is also im-
portant to remember that concentration problems can be a symptom of
a depressive disorder rather than always indicating ADHD. Grades of-
ten drop due to these concentration problems, feelings of worthless-
ness, and the lack of motivation to do well in school associated with a
broader experience of anhedonia; getting good grades is no longer plea-
surable. When a boy presents with general “behavior problems,” drop-
ping grades, and concerns from parents and teachers regarding poor
attention, the child should be screened for depressive disorders as well
as the more commonly diagnosed ADHD.
Studies consistently indicate that the majority of both boys and girls
diagnosed with depression also carry at least one comorbid diagnosis.
Patterns of comorbidity differ with gender; girls are more likely to present
Childhood 7
with comorbid anxiety disorders, whereas boys are more likely to present
with comorbid substance use disorders. Both girls and boys frequently
present with comorbid conduct disorder (Kessler et al. 2001; Ruchkin and
Schwab-Stone 2003).
Although gender by age differences in rates of depression have been
well documented, no comparable differences have been found in rates of
new-onset manic symptoms (Kessler 2000). In addition, no gender differ-
ences have been found regarding the frequency of cycling between manic
and depressive episodes; suicidality; rates of specific manic symptoms
such as elated mood, grandiosity, or racing thoughts; psychotic symp-
toms; or rates of comorbid oppositional defiant disorder (ODD; Geller et
al. 2000). Boys diagnosed with bipolar disorder are, however, more likely
than girls to carry a comorbid diagnosis of ADHD (Geller et al. 2000).
Suicide is the most serious possible outcome of depression or any
other psychiatric disorder. Although it has been well documented that
adolescent girls attempt suicide more often than adolescent boys, ado-
lescent boys complete suicide at a higher rate (Salkind 2002). The most
frequently cited explanation for the greater completion rate of suicide at-
tempts by adolescent boys is that they tend to choose more violent, lethal
methods such as firearms or hanging, whereas adolescent girls are more
likely to use methods such as drug overdose that are more frequently
less lethal (Salkind 2002). These findings suggest that the intersection be-
tween depression and impaired impulse control (see Chapter 9, “Im-
pulse Control Disorders”) may be particularly lethal for boys and men.
SOCIAL DEVELOPMENT
The first social task infants face involves forming an attachment to the
caregiver. Attachment refers to the bond between a caregiver and the
child that leads the child to feel safe, secure, and trusting that his or her
needs will be met by the caregiver. Insecurely attached infants may be
indifferent toward the caregiver or may simultaneously cling to and
push away from the caregiver and appear inconsolable.
Although it is commonly believed that females are “more social”
than males, research suggests that this supposition may not be the case
for infants. Male infants were found to be more likely than female infants
to look at, smile at, fuss for, reach to be picked up by, and vocalize to their
mothers during a structured interaction (Weinberg et al. 1999). These au-
thors suggest that this higher level of both positive and negative social
behavior may serve to assist the infant boys in obtaining more assistance
from their mothers in regulating their emotional states, such as when
their mother smiles in response to their smile to confirm a happy mood

or their mother soothing them in response to their distress. These types
of interaction help assure the infant that his mother will help keep him
comfortable emotionally and can further facilitate attachment.
Social demands and types of social interaction change as children
grow older. The child’s social world expands beyond the family, and
peer relationships become increasingly important beginning in the pre-
school years. By middle childhood, friendships and group activities
tend to play major roles in a child’s life. Although individual differences
are always present, boys as a group tend to form friendships based on
common activities rather than the emotional intimacy more often cited
by girls. Boys are also more likely than girls to select competitive over
cooperative forms of play. Both boys and girls display aggression in
their social relationships, but boys tend to display more overt forms of
aggression, such as physical or verbal aggression, whereas girls tend to
rely on more covert forms of aggression, such as social isolation (Sal-
kind 2002).
LANGUAGE DEVELOPMENT AND DISORDERS

Infants typically begin to babble at about ages 3–6 months and usually
speak their first words between 10 and 13 months. By ages 18–24
months, children are typically using two-word phrases. Between 27 and
34 months, children normally begin using three-word phrases and are
able to use some basic grammatical principles such as plurals and past
tense. At this age, they are also able to ask the ever-popular toddler
“who, what, where, and why?” questions (Santrock 1990).
There has been some suggestion that expressive language delays are
more common in boys (19.2%) than in girls (7.9%) up to approximately
age 18 months (Horwitz et al. 2003). Because this difference seems to be-
come nonsignificant in the age groups above 18 months, and because
behavior problems first become significantly associated with language
delay around age 30 months (Horwitz et al. 2003), it is unclear whether
there are any clinically meaningful implications of this difference in the
very young age group. It may simply be that boys are more likely than
girls to show some initial delay in expressive language but that this de-
lay may not be indicative of later pathology. Therefore, parents who
note that their baby boy is not speaking quite as early as his sister did
may not have cause for alarm.
Childhood 9
COMMUNICATION DISORDERS AND

PERVASIVE DEVELOPMENTAL DISORDERS
If an apparent delay persists beyond approximately 18 months, a thor-
ough evaluation is warranted. Communication disorders listed in DSM-
IV-TR (American Psychiatric Association 2000) include phonological dis-
order, expressive language disorder, mixed receptive-expressive lan-
guage disorder, and stuttering, and all of these disorders are more
common in males than in females.
If a language disturbance is accompanied by marked deficits in so-
cial functioning and the presence of difficulties such as stereotyped be-
havior or restricted interests, parents may wish to pursue an evaluation
for autistic disorder or other pervasive developmental disorders. Autis-
tic disorder is about four times more common in boys than in girls. Boys
as a group, however, tend to have milder symptoms with less severe
cognitive impairment (Fombonne 1998). Asperger’s disorder, which is
characterized by impairment in social interaction and restricted or ste-
reotyped interests or behaviors, is also believed to be more common in
boys than in girls (American Psychiatric Association 2000).
NORMAL FEAR AND ANXIETY DISORDERS

Most children experience mild to moderate fears during normal develop-
ment (Ollendick 1983). Researchers have identified common themes of
worry throughout the developmental trajectory, starting with fear of loud
noises and strangers from ages 0 to 9 months. At age 1 year, children often
begin having some fear of separation from caregivers and heightened
alert around strangers. Continuing throughout the early years of devel-
opment, children’s fears are often of concrete objects, people, or stimuli.
However, for children around ages 8–9 years, these fears become more
abstract, corresponding to the more complex cognitive abilities of chil-
dren of this age. This feature was illustrated by Kashani and Orvaschel
(1990), who demonstrated that most adolescents feared social interac-
tions and ridicule secondary to embarrassing social blunders. Younger
children in this study showed much more fear of separation from caretak-
ers and of strangers.
In the early years, attachment is an important element to consider
when determining whether fears are developmentally appropriate or
problematic. Attachment, as found by Ainsworth et al. (1978) in the
Strange Situation Task, can categorize children into three types: se-
curely attached (approximately 65% of children are in this category),

avoidant (approximately 25%), and anxious/avoidant (10%). As men-
tioned earlier, attachment style can significantly influence the experi-
ence of normal childhood fears. Children with secure attachments show
less fear of strangers and are more easily comforted by caretakers upon
reunion during the Strange Situation Task. Attachment styles can have
both immediate and more far-reaching implications for children. For
example, Fagot and Kavanagh (1993) showed that boys with anxious
and avoidant attachment styles were treated differently by their parents
(i.e., these boys received less direction and guidance) than girls with the
same attachment styles. As compared with insecurely attached girls, in-
securely attached boys tended to show more aggression, attention-seek-
ing behavior, and manipulation of peers (Turner 1991). Additionally,
anxious and avoidant attachment styles in childhood have been highly
predictive of later psychopathology (West et al. 1993). Unfortunately,
little has been documented in terms of gender differences in childhood
attachment styles. However, Williams and Blunk (2003) in their study
of 52 mother–infant dyads found that the majority of boys (76%) but not
girls (39%) were securely attached. In their study examining attachment
as a protective factor against attention and behavior problems, Fearon
and Belsky (2004) categorized more boys than girls into the avoidant at-
tachment style (60% vs. 40%). No gender differences were found among
the other attachment styles. Despite good attachment style in both
males and females, attachment style did not protect against high levels
of social risk for attention problems as reported by mothers—namely,
poverty, poor educational opportunities, and poor maternal IQ. How-
ever, the study found that boys with avoidant attachment showed less
inattention than did girls with avoidant attachment styles.
Gender Differences
In general, in both clinical and nonclinical samples boys show less anx-
iety and fear than girls (Albano et al. 1996; Ollendick 1983). Unlike the
presentation of affective disorders, anxiety manifestation does not ap-
pear to have a significant gender by developmental age interaction. Fol-
lowing is a review of some of these gender differences.
Developmentally, one of the first anxiety disorders to present is sep-
aration anxiety disorder, with a typical onset between ages 7 and 9 years
(Last et al. 1992). It is characterized by intense fear, sadness, emotional
distress, and worry upon separation from a parent, caretaker, or guard-
ian. Children fear permanent separation and harm befalling the parent
Childhood 11
in the child’s absence (American Psychiatric Association 2000). Commu-

nity samples of children show prevalence rates of separation anxiety dis-
order between 2% and 12% (Bowen et al. 1990; Kashani and Orvaschel
1990). However, children referred for psychiatric treatment have much
higher rates, ranging from 29% to 45% (Last et al. 1992, 1996). Separation
anxiety disorder follows a developmental course, with a peak between
ages 6 and 12 years and declining prevalence thereafter (Weiss and Last
2001).
Two separate findings regarding separation anxiety disorder should
be noted. First, the preponderance of children diagnosed with the dis-
order are female. Kashani and Orvaschel (1990) found that 21% of fe-
males compared with 4.8% of males in a community sample of children
ages 8–17 years met the diagnosis of separation anxiety disorder. Other
studies have found odds ratios between males and females to be be-
tween 0.4 (Anderson et al. 1987) and 0.56 (McGee et al. 1990). Second,
most children (92% in one sample of children 5–18 years old) recovered
from the disorder, but one-quarter subsequently developed other forms
of pathology, most often a depressive disorder (Last et al. 1996). Male
gender seems protective against anxiety disorder and may prevent an
individual from later development of an affective disorder.
Male gender also appears protective against overanxious disorder,
now called generalized anxiety disorder (GAD; American Psychiatric As-
sociation 2000). GAD is characterized by multiple fears causing clinically
significant distress, including headaches, fatigue, stomachaches, and
muscle tension. Age at onset within child and adolescent samples indi-
cates GAD begins between ages 9 and 12 years but can be seen in younger
children (Last et al. 1992). Children under age 12 generally show fewer
symptoms of GAD than do their adolescent counterparts (Cohen et al.
1993; Kashani and Orvaschel 1990). Some studies show equivalent rates
of the diagnosis between the genders during early childhood, when the
diagnosis is less common, but later in life the prevalence estimates for
GAD decrease for males and increase slightly for females over the course
of adolescence into adulthood (Strauss et al. 1988; Werry 1991). The most
common comorbidity among individuals with GAD during early child-
hood is ADHD or separation anxiety disorder, whereas in adolescence
major depression and simple phobia are more frequently comorbid.
Although social phobia is a relatively rare anxiety disorder in the
general population (<1%; Anderson et al. 1987), social phobia is more
common among clinically referred samples of individuals, with esti-
mates ranging from 27% to 30% (Last et al. 1992, 1996). Like panic disor-
der, typical age at onset for social phobia is later than that of separation
anxiety disorder, occurring between ages 11 and 15 years (Last et al.
1992) and lasting well into adulthood, with a waxing and waning course
(American Psychiatric Association 2000). More females than males are
affected (Anderson et al. 1987; Francis et al. 1992; Last et al. 1992), with
an odds ratio of 5 between females and males. Specific phobias show
largely the same pattern as other anxiety disorders regarding gender dis-
tribution, but with a stronger preponderance of females.
Obsessive-compulsive disorder (OCD) does not follow the gender-
based pattern for anxiety disorder with respect to prevalence estimates
(Last and Strauss 1989; Last et al. 1992). Most studies show that slightly
more boys than girls are affected by OCD, with some studies showing
that 60% of referred males have the disorder.
Anxiety Summary
The developmental pathway of anxiety in children often follows their
cognitive development. For example, younger children are more prone
to fear the dark, separations, monsters, and strangers. As children’s
cognitive and abstract abilities develop, they become more sophisti-
cated and complex in their fears. They start to fear social situations and
evaluations by others along with developing a burgeoning sense of so-
cial importance. Others’ perceptions of them mean more in adolescence
than in elementary school. Male gender protects against fears, worries,
and anxiety disorders. Whereas female rates of anxiety disorders begin
to rise steadily throughout adolescence, male rates tend to remain fixed.
One recent theory for the explanation of the differences between
males and females comes from Ginsburg and Silverman (2000). In a
sample of 66 boys and girls between 6 and 11 years old, the investiga-
tors found that boys and girls scoring higher on self-reported masculine
role orientation on the Children’s Sex Role Inventory endorsed more
statements of assertiveness, leadership, and confidence and had a lower
number, frequency, and intensity of fears. Therapists often work to in-
still this kind of attitude and behavioral style in children of both gen-
ders during cognitive-behavioral therapy (e.g., Kendall’s Coping Cat
manual [Kendall 2000]). However, this assertiveness and confidence is
often coupled with oppositional behavior and aggression, behaviors
that often lead to more problems for boys, as is described in the follow-
ing section.
ATTENTION AND BEHAVIOR

Ruff and Rothbart (1996) highlighted two attention systems that are im-
portant for the maintenance of attention in youngsters. The first system
Childhood 13
is behavioral inhibition, commonly thought of as “a specific class of behav-

iors of withdrawal, seeking comfort from a familiar person, and sup-
pression of ongoing behavior, when confronted with unfamiliar people
or novelty, as opposed to vocalizing, smiling, and interacting with the
unfamiliar object or setting” (Craske 1997, p. A11). With increasing age,
an infant or young child will continually develop increasing ability to at-
tend to important stimuli while ignoring other distractions. Although
this system has stability over time and across situations, a second sys-
tem, labeled attention, is thought to be more important for sustaining
vigilance during structured activities like the school setting. Attention to
tasks is evident during infancy but, according to Ruff and Rothbart
(1996), becomes increasingly important during the second year of life,
continuing into adulthood. It is during this period that most gender dif-
ferences in attention arise. ADHD, involving impairments in sustained
attention and behavioral inhibition (Barkley 1998), is arguably most
problematic for boys in school and other structured settings. Attention
problems in males are often coupled with oppositional behavior and are
more likely to initiate a referral to a mental health clinic. “The consider-
ably higher rate of males among clinic samples of children compared to
the community surveys seems to be due to referral bias in that males are
more likely than females to be aggressive and antisocial and such behav-
ior is more likely to get a child referred to a psychiatric clinic. Hence,
more males than females with ADHD will get referred to such centers”
(Barkley 1998, p. 85). Supporting this conclusion is the evidence that
males are often more aggressive than females within community sam-
ples of children with ADHD but not among clinic samples (Gaub and
Carlson 1997).
DSM-IV-TR states that between 3% and 5% of children manifest
ADHD in one of its three forms. Symptoms include inattention, poor or-
ganizational skills, impulsivity, losing things, excessive fidgeting, fre-
quently leaving one’s seat in the classroom, and being easily distracted.
The symptoms reach their peak during early childhood, after age 5,
with hyperactivity declining throughout adolescence and into adult-
hood. Symptoms of inattention and poor organizational skills are likely
to linger into adulthood. Importantly, males have the disorder more of-
ten than females, with reported male-to-female gender differences in
ADHD ranging from 2:1 to 9:1.
In a meta-analysis examining the gender differences in boys and
girls with and without ADHD, Gaub and Carlson (1997) found that im-
pairments in several domains were not significantly different for boys
and girls. These domains included impulsivity; math, reading, and
spelling grades; social/peer functioning; and fine motor skills. Boys
with ADHD, however, showed higher levels of inattention, more inter-

nalizing disorders, and more peer aggression. Boys with ADHD re-
ferred for treatment showed no greater risk for internalizing disorders
than those not referred for treatment; this finding is in contrast to re-
ferred girls with ADHD, who showed substantially higher rates of anx-
iety than nonreferred girls with ADHD. Boys and girls with ADHD
both show higher rates of aggression compared with non-ADHD peers,
but among those with ADHD, boys show the highest rate of comorbid
aggression. Finally, ADHD children of both genders who are being
treated psychiatrically show high rates of impairment compared with
their nontreated peers with ADHD.
In a study of aggression and violence in youth, males tended to view
“walking away” and nonviolent resolution of problems as less mascu-
line. Boys also tended to select active coping strategies as a way to pre-
vent violence, such as learning to get along with others, compared with
girls, who tended to want to avoid problematic situations (Reese et al.
2001). Boys tended not to focus as much on schoolwork or education
compared with girls (Reese et al. 2001). Indeed, ODD as defined by
DSM-IV-TR includes behaviors that are negativistic, hostile, and defiant
toward authority figures and is more prevalent in males than females.
Additionally, conduct disorder, a more severe form of ODD, is more
prevalent in males, is usually seen in older children, and often leads to
adult antisocial and criminal activity (Romano et al. 2001).
PLAY PROCESSES: ROUGH-AND-TUMBLE PLAY AND AGGRESSION

Play is an essential activity for a child’s development (Erikson 1950; Frost
et al. 2001; Piaget 1962). Play forms the backbone of children’s daily lives;
it encompasses children’s social interactions, learning, and recreation.
Providing an opportunity for children to engage in learning through
play is a hallmark of childhood. Plato declared in The Republic, “Our chil-
dren from their earliest years must take part in all the more lawful forms
of play, for if they are not surrounded with such an atmosphere they can
never grow up to be well conducted and virtuous citizens.”
In the context of the earlier discussion of aggression, one particular
type of play, termed rough and tumble (R&T), warrants specific discussion
(Pellegrini and Smith 1998). R&T play is distinct from aggression and a
normal part of children’s everyday play. Aggression includes hitting
with fists, pushing, and frowning, whereas R&T includes wrestling,
jumping, hitting at, and laughing (Blurton-Jones 1976). During physi-
cally aggressive interactions, the use of demeaning language, insulting,
Childhood 15
harassing, crying, and grimacing are common, whereas laughter and

smiling characterize R&T play bouts (Blurton-Jones 1976). Children’s re-
ports are positive after participating or watching R&T play on video
clips (Boulton 1993). However, when viewing an aggressive interaction
they correctly characterize it as negative and aversive (Smith and Boul-
ton 1990).
The consequences of aggressive interactions and friendly play also
differ such that directly after R&T play the children continue playing to-
gether either in more roughhousing or in other social games, such as tag,
hopscotch, marbles, or jumping rope, but they move away from one an-
other after aggression, with little likelihood of a friendship developing
(Blurton-Jones 1976; Humphreys and Smith 1987; Pellegrini 1989). Play
bouts rarely draw crowds of observers on a playground, whereas ag-
gressive interactions draw other children’s attention (Smith and Boulton
1990). Although the perceived aggression seen in R&T play is a healthy
developmental stage for male children, aggression in male adolescence
may be associated with a range of behavioral difficulties (see Chapter 2,
“Adolescence: Neurodevelopment and Behavioral Impulsivity”).
There is considerable debate within the developmental literature re-
garding gender differences in play (Maccoby 1997). Many researchers
have concluded that boys’ preferences of play partners, objects, and ac-
tivities are different from those of girls, especially in mixed-gender social
settings (Maccoby 1997; Maccoby and Jacklin 1987). Most researchers
used playgrounds and other naturalistic settings where groups of boys
and girls were together. Based on such studies, certain investigators
have concluded that robust gender differences exist in the R&T play of
boys and girls, with boys playing more roughly than girls (Humphreys
and Smith 1987; Pellegrini 1989; Pellegrini and Smith 1998). However,
others have found only modest gender differences (Blurton-Jones 1972;
Boulton 1996; DiPietro 1981; Fry 1987; Maccoby and Jacklin 1987). Ani-
mal studies using mixed-gender groups in complex social situations
yield large gender effects (Meaney and Stewart 1981), whereas “paired
encounters” procedures generally do not (Panksepp and Beatty 1980).
Similar observations have been made in studies of children (Scott and
Panksepp 2003).
In a study of young (ages 3–6 years) same-gender, same-age play
pairs, Scott and Panksepp (2003) found only a few modest differences be-
tween boys’ and girls’ R&T play behaviors. These findings contrast with
those of previous studies of older children, in which gender differences
were commonly identified (DePietro 1981; Humphreys and Smith 1984,
1987; Pellegrini 1989). Scott found that boys showed only modest in-
creases in physical play solicitations like taps on the chest but no differ-
ence in wrestling-type behavior. Female pairs demonstrated more gross

motor activities like rolling, walking, and gymnastics. In another review,
Pellegrini and Smith (1998) noted a slightly higher rate of play solicita-
tions among boys as compared with girls. Elsewhere, Pellegrini (1989)
noted that boys were more likely to engage in physical contact play bouts
than were girls and concluded that boys are generally rougher than girls.
Age influences the amount of R&T play. Humphreys and Smith
(1984, 1987) reported a developmental curve in which 13% of 7-year-
olds’ time is spent in R&T play, but this percentage declines to 9% and
5%, respectively, in 9- and 11-year-olds. However, Boulton (1996) found
no differences in the relative percentage of time spent in R&T play when
he tested children ages 8–11 years. Scott and Panksepp (2003) studied
the free play of children ages 3–6 years and performed separate analy-
ses for two age groups (children ages 36–52 months and 52–72 months)
and found no reliable and systematic differences in frequency of R&T
play in these two age groups. These observations, combined with those
of Humphreys and Smith (1987), suggest that R&T play remains con-
stant until age 7, when it starts to decline in frequency.
In summary, when boys and girls play together, there may be a pre-
ponderance of male-generated R&T play, but in same-gender play
pairs, those differences in frequency tend to diminish. Therefore, the
common conception of males being rougher and displaying more ag-
gression may in part reflect play within mixed-gender groups.
CONCLUSION
We have highlighted some of the normal trajectories of childhood de-
velopment, including the cognitive and social development of children,
and some of the important gender differences seen in the most common
childhood psychiatric disorders. Much of the anecdotal evidence and
many of the clinical impressions we have as clinicians are borne out in
the literature. For example, males tend toward more aggressive expres-
sion of ADHD and depression, whereas females are less physical. Fe-
males have the preponderance of cases of anxiety, with the exception of
OCD. We hope that this information will guide a thorough and compre-
hensive examination of the child, especially in those cases in which it
may be easy to overlook some anxiety that overshadows aggressive be-
havioral outbursts.
Less intuitive differences or lack of differences between the genders
is also highlighted in this chapter, including the section on R&T play.
Much talk and some controversy exist over the frequency of R&T play
Childhood 17
among girls. Study results depend on how the act of R&T play is exam-
ined. Girls prefer a same-gender play partner without many onlookers,
whereas boys will engage in R&T play in mixed-gender settings without
regard to spectators’ presence. This pattern could also have implications
regarding aggression as well. Males consistently show little inhibition in
their displays of aggression compared with females.
By highlighting gender differences, especially the unexpected ones,
we hope that mental health professionals will be inspired to take a closer
look at children of both genders to “expect the unexpected”—for exam-
ple, aggression or pervasive developmental disorders in girls or anxiety
in boys. Parents long for well-informed and compassionate care for their
children when bringing them for mental health appointments. Our de-
sire is for clinicians to be well informed in order to make good decisions
about differential diagnoses in both boys and girls.
KEY POINTS
• Male gender seems protective against depression and anxiety
when compared with rates in females.
• Male gender is a risk factor for attention problems, particularly for
co-occurring aggression if ADHD is diagnosed.
• Despite a great deal of cultural perceptions that boys and girls
engage in very different styles of play, these differences may
largely be an artifact of the setting of the play. When children are
in mixed-gender play groups, males tend toward more R&T play,
but this difference largely dissolves in paired same-gender play
situations.
PRACTICE GUIDELINES
1. The majority of both boys and girls diagnosed with depression
also carry at least one comorbid diagnosis. Girls are more likely
to present with anxiety disorders, whereas boys present with
substance use disorders. However, both girls and boys frequently
present with conduct disorder when depressed.
2. Be sure to assess males for anxiety disorders even though rates of
anxiety disorders are higher among females. Anxiety can easily
be overlooked as male children get closer to adulthood, as the
gender gap widens, and rates of male anxiety disorders stay
relatively stable as compared with a growing incidence of
anxiety in females. The one exception is OCD, which is more
commonly diagnosed in males than females across all age
groups.
3. In assessments of children with ADHD-like symptoms, boys are
more likely to be referred for treatment because of a co-occurring
behavioral difficulty related to the behavioral inhibition inherent
in the ADHD. Be sure to assess boys for their level of anxiety,
aggression, and inattention, because these may be elevated
compared with females.
REFERENCES
Ainsworth MS, Blehar MC, Waters E, et al: Patterns of Attachment: A Psycho-
logical Study of the Strange Situation. Oxford, England, Erlbaum, 1978
Albano AM, Chorpita BF, Barlow DH: Childhood anxiety disorders, in Child
Psychopathology. Edited by Mash EJ, Barkley RA. New York, Guilford,
1996, pp 196–241
American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiat-
ric Association, 2000
Anderson JC, Williams S, McGee R, et al: DSM-III disorders in preadolescent
children: prevalence in a large sample from a general population. Arch Gen
Psychiatry 44:69–76, 1987
Angold A, Costello EJ, Worthman CM: Puberty and depression: the roles of age,
pubertal status and pubertal timing. Psychol Med 28:51–61, 1998
Barkley R: Attention-Deficit Hyperactivity Disorder. New York, Guilford, 1998
Blurton-Jones N: Categories of child-child interaction, in Ethological Studies of
Child Behavior. Edited by Blurton-Jones N. New York, Cambridge Univer-
sity Press, 1972, pp 97–127
Childhood 19
Blurton-Jones N: Rough-and-tumble play among nursery school children, in

Play: Its Role in Development and Evolution. Edited by Bruner JS, Jolly A,
Sylva K. New York, Basic Books, 1976, pp 352–363
Boulton MJ: Children’s abilities to distinguish between playful and aggressive
fighting: a developmental perspective. British Journal of Developmental
Psychology 11:249–263, 1993
Boulton MJ: A comparison of 8- and 11-year-old girls’ and boys’ participation in
specific types of rough-and-tumble play and aggressive fighting: implica-
tions for functional hypotheses. Aggress Behav 22:271–287, 1996
Bowen RC, Offord DR, Boyle MH: The prevalence of overanxious disorder and
separation anxiety disorder: results from the Ontario Child Health Study.
J Am Acad Child Adolesc Psychiatry 29:753–758, 1990
Cohen P, Cohen J, Brook J: An epidemiological study of disorders in late child-
hood and adolescence, II: persistence of disorders. J Child Psychol Psychi-
atry 34:869–877, 1993
Craske MG: Fear and anxiety in children and adolescents. Bull Menninger Clin
61(suppl):A4–A36, 1997
Cyranowski JM, Frank E, Young E, et al: Adolescent onset of the gender differ-
ence in lifetime rates of major depression: a theoretical model. Arch Gen
Davies PT, Lindsay LL: Interpersonal conflict and adolescent adjustment: why
does gender moderate early adolescent vulnerability? J Fam Psychol 18:
160–170, 2004
DiPietro JA: Rough and tumble play: a function of gender. Dev Psychol 17:50–
58, 1981
Erikson EH: Childhood and Society. New York, WW Norton,1950
Fagot BI, Kavanagh K: Parenting during the second year: effects of children’s
age, sex, and attachment classification. Child Dev 64:258–271, 1993
Fearon RMP, Belsky J: Attachment and attention: protection in relation to gen-
der and cumulative social-contextual adversity. Child Dev 75:1677–1693,
2004
Feldman JF, Brody N, Miller SA: Sex differences in nonelicited neonatal behav-
iors. Merrill Palmer Q 26: 63–73, 1980
Fombonne E: Epidemiology of autism and related conditions, in Autism and
Pervasive Developmental Disorders. Edited by Volkmar FR. Cambridge,
England, Cambridge University Press, 1998, pp 32–63
Francis G, Last CG, Strauss CC: Avoidant disorder and social phobia in children
and adolescents. J Am Acad Child Adolesc Psychiatry 31:1086–1089, 1992
Frost JL, Worthan S, Reifel S: Play and Child Development. Upper Saddle River,
NJ, Merrill Prentice Hall, 2001
Fry DP: Difference between play fighting and serious fighting among Zapotec
children. Ethol Sociobiol 8:285–306, 1987
Gaub M, Carlson CL: Gender differences in ADHD: a meta-analysis and critical
review. J Am Acad Child Adolesc Psychiatry 36:1036–1045, 1997
Geller B, Zimerman B, Williams M, et al: Diagnostic characteristics of 93 cases

of a prepubertal and early adolescent bipolar disorder phenotype by gen-
der, puberty and comorbid attention deficit hyperactivity disorder. J Child
Adolesc Psychopharmacol 10:157–164, 2000
Ginsburg GS, Silverman WK: Gender role orientation and fearfulness in chil-
dren with anxiety disorders. J Anxiety Disord 14:57–67, 2000
Hankin BL, Abramson LY, Moffitt TE, et al: Development of depression from
preadolescence to young adulthood: emerging gender differences in a 10-
year longitudinal study. J Abnorm Psychol 107:128–140, 1998
Horwitz SM, Irwin JR, Briggs-Gowan MJ, et al: Language delay in a community
cohort of young children. J Am Acad Child Adolesc Psychiatry 42:932–940,
2003
Humphreys A, Smith P: Rough-and-tumble in preschool and playground, in
Play in Animals and Humans. Edited by Smith PK. London, England,
Blackwell, 1984, pp 241–270
Humphreys A, Smith P: Rough-and-tumble, friendship, and dominance in
schoolchildren: evidence for continuity and change with age. Child Dev
58:201–212, 1987
Kashani JH, Orvaschel H: A community study of anxiety in children and ado-
lescents. Am J Psychiatry 147:313–318, 1990
Kendall P: Cognitive Behavioral Therapy for Anxious Children: Treatment
Manual, 2nd Edition. Ardmore, PA, Workbook Publishing, 2000
Kerig PK: Gender issues in the effects of exposure to violence on children. Jour-
nal of Emotional Abuse 2:87–105, 1999
Kessler RC: Gender differences in major depression: epidemiologic findings, in
Gender and Its Effect on Psychopathology. Edited by Frank E. Washington,
DC, American Psychiatric Press, 2000, pp 61–84
Kessler RC, Avenevoli S, Merikangas KR: Mood disorders in children and ado-
lescents: an epidemiologic perspective. Biol Psychiatry 49:1002–1014, 2001
Last CG, Strauss CC: Obsessive-compulsive disorder in childhood. J Anxiety
Disord 3:294–302, 1989
Last CG, Perrin S, Hersen M, et al: DSM-III-R anxiety disorders in children: so-
ciodemographic and clinical characteristics. J Am Acad Child Adolesc Psy-
chiatry 31:1070–1076, 1992
Last CG, Perrin S, Hersen M, et al: A prospective study of childhood anxiety dis-
orders. J Am Acad Child Adolesc Psychiatry 35:1502–1510, 1996
Laumakis MA, Margolin G, John RS: The emotional, cognitive, and coping re-
sponses of preadolescent children to different dimensions of conflict, in
Children Exposed to Marital Violence: Theory, Research, and Applied Is-
sues. Edited by Holden GW, Geffner R, Jouriles EN. Washington, DC,
American Psychological Association, 1998, pp 257–288
Maccoby EE: Gender and relationships: a developmental account. Am Psychol
45:513–520, 1997
Maccoby EE, Jacklin C: The Psychology of Sex Differences. Stanford, CA, Stan-
ford University Press, 1974
Childhood 21
Maccoby EE, Jacklin CN: Gender segregation in childhood, in Advances in

Child Development and Behavior, Vol 20. Edited by Reese HW. New York,
Academic Press, 1987, pp 239–288
McGee R, Feehan M, Williams S, et al: DSM-III disorders in a large sample of ad-
olescents. J Am Acad Child Adolesc Psychiatry 29:611–619, 1990
Meaney MJ, Stewart J: Neonatal androgens influence the social play of prepu-
bescent rats. Horm Behav 15:197–213, 1981
Merikangas KR, Weissman MM, Pauls DL: Genetic factors in the sex ratio of ma-
jor depression. Psychol Med 15:63– 69, 1985
Ollendick TH: Reliability and validity of the revised Fear Survey Schedule for
Children (FSSC-R). Behav Res Ther 21:395–399, 1983
Panksepp J, Beatty WW: Social deprivation and play in rats. Behav Neural Biol
30:197–206, 1980
Pellegrini AD: Elementary school children’s rough-and-tumble play. Early
Child Res Q 4:245–260, 1989
Pellegrini AD, Smith PK: Physical activity play: the nature and function of a ne-
glected aspect of play. Child Dev 69:577–598, 1998
Piaget J: Play, Dreams and Imitation in Childhood. New York, WW Norton,
1962
Reese LE, Vera EM, Thompson K, et al: A qualitative investigation of percep-
tions of violence risk factors in low-income African American children.
J Clin Child Psychol 30:161–171, 2001
Romano E, Tremblay RE, Vitaro F, et al: Prevalence of psychiatric diagnoses and
the role of perceived impairment: findings from an adolescent community
sample. J Child Psychol Psychiatry 42:451–461, 2001
Ruchkin V, Schwab-Stone M: What can we learn from developmental studies of
psychiatric disorders? Lancet 362:1951–1952, 2003
Ruff HA, Rothbart MK: Attention in Early Development. New York, Oxford
University Press, 1996
Salkind NJ (ed): Child Development (Macmillan Psychology Reference Series).
New York, Macmillan Reference USA, 2002
Santrock JW: Children, 2nd Edition. Dubuque, IA, William C Brown Publishers,
1990
Scott E, Panksepp J: Rough-and-tumble play in human children. Aggress Behav
29:539–551, 2003
Smith P, Boulton M: Rough-and-tumble play, aggression and dominance: per-
ception and behavior in children’s encounters. Hum Dev 33:271–282, 1990
Strauss CC, Lease CA, Last CG, et al: Overanxious disorder: an examination of
developmental differences. J Abnorm Child Psychol 16:433–443, 1988
Tronick EZ, Als H, Adamson L, et al: The infant’s response to entrapment be-
tween contradictory messages in face-to-face interaction. J Am Acad Child
Turner PJ: Relations between attachment, gender, and behavior with peers in
preschool. Child Dev 62:1475–1488, 1991
Weinberg MK, Tronick EZ, Cohn JF, et al: Gender differences in emotional ex-
pressivity and self-regulation during early infancy. Dev Psychol 35:175–
188, 1999
Weiss DD, Last CG: Developmental variations in the prevalence and manifesta-
tions of anxiety disorders, in The Developmental Psychopathology of Anx-
iety. Edited by Vasey MW, Dadds MR. New York, Oxford University Press,
2001
Werry JS: Overanxious disorder: a review of its taxonomic properties. J Am
Acad Child Adolesc Psychiatry 30:533–544, 1991
West M, Rose MS, Sheldon A: Anxious attachment as a determinant of adult
psychopathology. J Nerv Ment Dis 181:422–427, 1993
Wichstrom L: The emergence of gender difference in depressed mood during
adolescence: the role of intensified gender socialization. Dev Psychol 35:
232–245, 1999
Williams SW, Blunk EM: Sex differences in infant–mother attachment. Psychol
Rep 92:84–88, 2003
2
ADOLESCENCE
Neurodevelopment and Behavioral Impulsivity
CRAIG A. ERICKSON, M.D.

R. ANDREW CHAMBERS, M.D.
Case Vignette
After 17 years of a troubled marriage marked by frequent absences of
the husband due to job requirements, episodes of infidelity, and fighting
when both spouses were drinking, Mr. and Ms. Morris decided to di-
vorce. Their two children, Sarah, 13, and Brian, 15, had previously pre-
sented as normally adjusted children, active in school and performing
better than average academically.
In the 2-year period after Mr. Morris moved out of the house to an-
other city with his girlfriend, both children experienced increasing dif-
ficulties. Sarah began to isolate herself more frequently in her bedroom,
had frequent crying spells and trouble sleeping, and told her mother
that she was becoming scared of her older brother and his friends. Brian
began experimenting with marijuana, alcohol, and prescription drugs,
including painkillers and sedatives acquired from his peers. On several
occasions, he brazenly smoked marijuana in the house and was at other
times suspected of being intoxicated on unknown substances. A threat-
ening verbal conflict with his family members resulted in the police be-
ing called, and on a separate occasion he was arrested for underage
23
drinking. In one “practical joke” on his mother, Brian filled his mother’s
clothes drawers and wardrobe with dried cat food. Brian also began
staying out at night with a group of his peers who engaged in vandal-
ism, including one incident in which the group rigged a neighbor’s
mailbox with fireworks and filmed them going off with the home video
camera. At school, his grades dropped, and he was recommended for
assessment for attention-deficit/hyperactivity disorder (ADHD). A di-
agnosis of ADHD was made, and Brian was placed on a psychostimu-
lant medication. Soon after this treatment was initiated, Brian was noted
to have scored the highest in the school district on yearly academic
achievement tests taken just before the ADHD diagnosis. However, new
concerns emerged that he was sharing the medication with his friends.
The medication treatment for Brian was stopped. Family and indi-
vidual psychotherapy for both Sarah and Brian was begun, and Sarah
demonstrated remission of her depressive symptoms. Over the next
2 years, Brian stopped experimenting with drugs, acquired a stable dat-
ing relationship, and went on to college, which he reported liking much
more than high school.
Adolescence is a period of significant change in the brain and body,

encompassing alterations in cognitive, emotional, motor, and motiva-
tional spheres of functioning. Adolescent neurodevelopment trans-
forms the brain from a childhood design optimized for learning, play,
and receiving adult care and resources to a configuration optimized for
being a care or resource provider in adult social and occupational roles.
In this chapter we describe emerging evidence suggesting that gender
differences in brain structure and function interact with adolescent neu-
rodevelopmental events in producing differential vulnerabilities to
psychiatric disorders in adulthood. Adolescent neurodevelopment is
associated with greater risk-taking, sensation seeking, and impulsive
behavior in the exploration of adult roles, especially in boys. Superim-
posed on a background of a greater tendency toward externalizing dis-
orders, or disorders involving aspects of motor control in young boys,
brain changes of adolescence may render males more likely to have a
variety of impulse control or motivational disorders in adulthood.
NEUROPSYCHOLOGICAL AND PSYCHIATRIC PROFILES OF

MALES IN CHILDHOOD AND ADULTHOOD
Although the existence of and causes behind gender differences in
higher-order brain function have long been a topic of debate (Craig et
al. 2004), mounting evidence suggests that neuropsychological profiles
of males and females do trend differently across ages (Constantino and
Todd 2003; Grant et al. 2004). Moreover, differential rates of psychiatric
Adolescence 25
disorders between boys and girls and men and women lend credence to
the notion that normative gender differences in brain function instill
differential vulnerabilities to psychopathology (Grant et al. 2004; Mash
and Dozois 1996).
Neurobehavioral differences between healthy boys and girls have
been noted even before and shortly after birth, when male fetuses and
babies exhibit increased limb movements (Almli et al. 2001). These dif-
ferences in psychomotor behavior appear to continue into toddlerhood,
as boys tend to show increased rough and tumble play (Pellegrini and
Smith 1998) and less symbolic play (Lyytinen et al. 1999) compared
with girls (see Chapter 1, “Childhood: Normal Development and Psy-
chopathology”). Still other gender differences encompassing cognitive,
sensory processing, emotional, and social behaviors are apparent in
early childhood (Braungart-Ricker et al. 1998; Eisenberg et al. 1989;
Lundqvist and Sabel 2000; Lundqvist-Person 2001; Malcolm et al. 2002;
Weinberg et al. 1999). Toward grade-school ages, these trends continue
as the developmental course of boys is marked by increased interest in
and displays of externalizing behavior involving physical, nonverbal
interactions with the environment or social peers (Mash and Dozois
1996). Boys appear to excel particularly well in visual-spatial skills and
mathematics, possibly reflecting some cognitive specialization toward
psychomotor interactions with the physical (nonsocial) environment
(de Coutern-Myers 1999; Hyde et al. 1990; Silverman and Eals 1992).
This propensity in boys contrasts with the internalizing behaviors pre-
dominant in girls, which involve emotion-laden perceptions of self and
others, increased social aptitude, and verbal communication skills—
behaviors that possibly reflect increased specialization toward interac-
tions with the psychosocial milieu (Eisenberg et al. 1995; Thayer and
Johnsen 2000). For instance, girls ages 7–15 years show higher social
responsiveness and understanding compared with similar-age boys
(Constantino and Todd 2003). It remains unclear to what extent these
gender trends result from 1) neurogenetic programming responding to
evolutionary pressures that favor gender-role dichotomization or 2) the
tendency for parenting and culture to instill such gender-biased pheno-
types through learning (Hinshaw 2003; Silverman and Eals 1992). Nev-
ertheless, because genes and environmental learning both influence
brain form and function, some neurobiological foundation likely sup-
ports a tendency toward greater specialization of what might be called
cognitive-motivational-motor functioning in boys and cognitive-social-
emotional functioning in girls.
Compared with trends in healthy functioning, differentiated forms of
psychopathology occurring in boys and girls follow a similar but perhaps
more pronounced dichotomization. Preadolescent boys suffer signifi-

cantly more than girls from the following disorders: pervasive develop-
mental disorders (Klinger et al. 2003), attention-deficit/hyperactivity
disorder (ADHD; Barkley 1996), oppositional defiant disorder (Hinshaw
and Lee 2003), conduct disorder (Hinshaw and Lee 2003), obsessive-
compulsive disorder (Mash and Dozois 1996), and Tourette’s syndrome
or tic disorders (Giedd 1996). Notably, not only are all of these disorders
frequently comorbid in preadolescent boys in various combinations but
these disorders also collectively involve core symptoms associated with
dysregulated behavior within the cognitive-motivational-motor domain,
often in association with deficits of functionality in the cognitive-social-
emotional domain. In contrast, preadolescent girls tend to show greater
likelihood for disorders involving the expression of anxiety symptoms
(Crick and Zahn-Waxler 2003; Lewinsohn et al. 1998), but without robust
behavioral dysregulation. Thus girls may tend to show dysregulated
functionality rather than deficits in the cognitive-social-emotional do-
main while being relatively resistant to dysregulation of behavior within
the cognitive-motivational-motor domain.
From an engineering standpoint, evidence for gender trends in
healthy mental functioning and psychiatric disorders in childhood sug-
gest that some degree of functional specialization toward cognitive-
motivational-motor faculties in boys versus cognitive-social-emotional
faculties in girls corresponds to a greater complexity of neurobiological
systems that serve each of these gender-biased functional sets. Al-
though such neurobehavioral specialization may protect against defi-
cits within a functional set, increased neurobiological complexity
required for such specialization may entail greater vulnerability to dys-
regulated performance within the functional set, particularly during
the complex changes of the brain occurring in adolescence. Thus the
prevalence distributions of adult forms of psychopathology show gen-
der trends that appear in many ways to elaborate on or accentuate
childhood dichotomizations. For instance, men appear to be particu-
larly vulnerable to disorders of motivation and psychomotor impulse
control, showing a 2:1 margin over women in prevalence of alcohol and
other substance use disorders, antisocial personality, and completed
acts of suicide and homicide (Grant et al. 2004; Kaplan and Sadock
2000). In contrast, women have greater vulnerability, with a greater
than 2:1 ratio compared with men, for major depressive and anxiety dis-
orders, borderline personality disorder, and expressions of suicidal ide-
ation rather than completed acts (Grant et al. 2004; Kaplan and Sadock
2000). Even for major psychotic disorders such as schizophrenia and bi-
polar disorder, in which the prevalence distributions are evenly divided
Adolescence 27
between the genders, there appear to be similar gender-specific subsyn-

dromal trends. For instance, males with schizophrenia are particularly
vulnerable to developing substance use disorders, have earlier-onset
schizophrenia, and appear to have greater deficits within the cognitive-
social-emotional sphere of functioning (Lindamer et al. 2003; Opler et
al. 2001). In bipolar disorder, some evidence suggests that men may
have a higher proportion of manic-impulsive episodes, whereas fe-
males may be more prone to the depressive phases of the disorder (Ar-
nold 2003; Roy-Byrne et al. 1985).
In sum, both healthy traits and patterns of psychopathology show
gender-biased trends through early childhood, adolescence, and adult
ages. Characteristics of normative traits and psychopathology commonly
emerging during adolescence may relate to the increased complexity and
refinement of particular neural systems occurring in adolescent neuro-
development (Figure 2–1).
ADOLESCENT BEHAVIOR, IMPULSIVITY, AND PSYCHOPATHOLOGY

Normal adolescence is typified by increased interest in and motivation
toward novelty and sensation seeking, associated with a developmen-
tally unprecedented desire to explore adult behavior and roles through
active participation (Moore and Rosenthal 1992; Yates 1996). Changing
cognitive, emotional, motor, and motivational faculties compel or result
from adolescent fascination with, and participation in, popular music,
fashion, social gatherings, group memberships, sexuality, competition
in sports and academia, use of adult tools (e.g., automobile driving),
and adult occupational roles (Moore and Rosenthal 1992; Siegel and
Shaughnessy 1995).
Yet the interest in and capacity for adult things in adolescence car-
ries the risk of inexperience. Despite adolescence being characterized as
a time of physical vitality and resilience, overall morbidity and mortal-
ity rates increase twofold during this period in association with behav-
ior characterized as impulsive, high risk, or the result of poor decision-
making (Clayton 1992; Dahl 2004). Disorders that result from or are
characterized by impulsive behavior, such as problem gambling, sub-
stance use disorders, intermittent explosive disorder, sociopathy, com-
pleted suicide, and early-onset schizophrenia, are typified both by
periadolescent onset and male predominance (Asarnow and Asarnow
1996; Chambers and Potenza 2003b; Chambers et al. 2003; De Gaston et
al. 1996; Kandel et al. 1992; Kohler 1996; Mash and Dozois 1996; Wagner
and Anthony 2002). Adolescent male vulnerability to disorders involv-
Cognitive-social-emotional disorders Cognitive-motor-motivational disorders

Anxiety disorders Impulse control disorders
Major depression Substance use disorders
Borderline personality disorder Antisocial personality disorder
Later-onset schizophrenia, more Earlier-onset schizophrenia, more
socially intact socially impoverished
Suicidal gestures Suicide completion
Prefrontal-limbic Adulthood Prefrontal-striatal
specialization liability? specialization liability?
Adolescence
Prefrontal cortical restructuring
Dopamine system maturation
Increased subcortical-limbic sex hormone activity
Childhood
Internalizing disorders Externalizing disorders

Anxiety disorders Tic disorders
Oppositional defiant
disorder
Attention-deficit
hyperactivity disorder
FIGURE 2–1. Conceptual diagram of the developmental trajectories of gender-associ-

ated traits and psychopathologies emerging through adolescence.
In males (right cone), adolescent neurodevelopmental events may elaborate on
and complicate tendencies for specialization in cognitive-motor-motivational
domains of mental functioning and produce greater liability for impulse con-
trol–related disorders in adulthood. In contrast, a female (left cone) tendency
for specialization in cognitive-social-emotional domains may interact with ad-
olescent neurodevelopmental events to cause greater liability for anxiety disor-
ders, major depression, and borderline social-emotional defenses in adulthood.
Significant areas of overlap between the developmental cones reflect the fact
that gender differentiation in vulnerability to psychopathology along a social-
emotional versus motor-motivational continuum is only partial, and significant
numbers of males and females have disorders on both sides of the continuum.
Adolescence 29
ing impulsivity as a parameter of dysregulated cognitive-motivational-

motor control contrasts with disorders of female preponderance emerg-
ing at this developmental stage. Disorders more prevalent in adolescent
females include mood and anxiety disorders, borderline defensive
structures, and eating disorders (Kaplan and Sadock 2000; Kessler et al.
2001; Mash and Dozois 1996), which involve significant components of
dysregulated emotional perceptions of self or others as a dimension of
cognitive-social-emotional control.
For both males and females, psychiatric disorders of adult form and
gender prevalence distributions begin to emerge in adolescence. Know-
ing the brain systems involved in impulse control is particularly infor-
mative in understanding the neurobiological underpinnings of males’
enhanced vulnerability to impulse control disorders.
GENERAL NEUROCIRCUITRY OF IMPULSE CONTROL

A wealth of animal research and human pathophysiological and neu-
roimaging data indicates that the brain is organized into semisegregated
modular systems that 1) collect multimodal sensory data about the inter-
nal status of the individual or external environment, 2) process these data
according to decision-making computations that optimize the selection
and sequencing of behavioral output consistent with survival fitness, and
3) execute specific behavioral programs (see Chambers and Potenza
2003a and 2003b for reviews of corresponding literature). The middle, de-
cision-making stage of this input-output processing is associated with
neural substrates localized to the anterior half of the brain (Figure 2–2).
Key components of this primary motivational circuitry include the
following: 1) the prefrontal cortex region (encompassing orbitofrontal,
anterior cingulate, and dorsolateral sections); 2) the ventral striatum re-
gion (nucleus accumbens, shell, and core); and 3) the midbrain source
of dopamine to these regions, the ventral tegmental area (VTA). Provid-
ing sensory input to primary motivational circuits, the posterior half of
the cortex collects and processes primary and multimodal sensory in-
formation (e.g., of the five senses) while temporal and midline limbic
structures (including the hypothalamus, amygdala, and hippocampus)
provide internally generated homeostatic, emotional, and contextual
memory information.
Executing behavioral output as directed by primary motivational
circuits are the midcoronal motor cortices, the dorsal striatum, and the
midbrain source of dopamine to the dorsal striatum, the substantia ni-
Prefrontal cortical
restructuring
Motor-sensory cortex
Prefrontal cortex
To cortical (via thalamus)
and brain stem motor centers
Dorsal striatum
Hypothalamus/
septum Hippocampus
Ventral striatum
VTA
Amygdala
SN
Raphe nuclei
Dopamine system Increased subcortical-limbic
maturation sex hormone activity
FIGURE 2–2. Major brain systems implicated in adolescent neurodevelopment.

Primary motivational circuits implicated in impulse control (bold outlined struc-
tures) undergo significant adolescent-age revisions encompassing prefrontal cor-
tical restructuring and functionally robust dopaminergic systems maturation.
Subcortical-limbic structures that are important sites of responsivity to sex hor-
mone efflux during adolescence (e.g., hypothalamus/septum, hippocampus, and
amygdala) interconnect with primary motivational circuits, possibly mediating
neurohormonal influence over impulse control.
Note. Open arrows=major excitatory (glutamatergic) connection pathways;
solid arrows=dopamine projections; dotted arrows=serotonin projections;
SN =substantia nigra; VTA =ventral tegmental area.
gra. Broadly interconnected with primary motivational circuits at corti-

cal and subcortical levels, this motor output system instantiates the
extrapyramidal system, which directly controls the sequencing of con-
crete motor movements as generated by the classic pyramidal motor
system.
Primary motivational circuitry is itself composed of interconnected
subsystems that can be viewed as functioning according to how they
participate in the promotion or inhibition of motivational programming,
Adolescence 31
so that specific motor routines may be acted on as a result of the deci-

sion-making process (Chambers and Potenza 2003b; Chambers et al.
2003). In association with the promotion of motivational programming
for behavioral output, dopamine released from neurons in the VTA into
the nucleus accumbens (and to a lesser degree into the prefrontal cortex)
is associated with responsivity to natural rewards, novelty, stressful or
aversive stimuli that require evasive action, and the intake of addictive
drugs. In association with the inhibition of motivational programming,
the prefrontal cortex sends glutamatergic afferents to the nucleus accum-
bens. Functional and anatomical abnormalities of the prefrontal cortex
have long been associated with disturbances in executive cognitive func-
tion, impulsivity, and perseverative behavior—whether occurring in the
context of gross neurological disorders or in the broad spectrum of psy-
chiatric disorders associated with poor impulse control. Disruptions of
the serotonin system, which projects from midbrain centers (raphe nu-
clei) into prefrontal cortical, ventral striatal, and VTA stations of primary
motivational circuitry, are also implicated in disorders of impulse con-
trol in various psychiatric conditions.
Although greatly oversimplified in terms of the countless subsys-
tems, neuronal types, varieties of neurotransmitters, and intracellular
and neurocomputational events involved in motivational impulsivity,
this depiction of primary motivational circuitry provides a general con-
ceptual platform for understanding disorders of impulse control in
which the prefrontal cortex, ventral striatum, and VTA-dopaminergic
systems play a central role (Chambers et al. 2003). Generally, patholog-
ical or developmental states that in some way represent a compromise
of prefrontal cortical function or serotonin functions concomitant with
enhanced potency of subcortical dopamine function predispose to traits
or clinical phenotypes of psychiatric disorders involving impaired im-
pulse control. Also, because neurocomputational events that subserve
healthy versus impaired decision-making are linked with the ventral
striatum as a convergence zone of frontal cortical glutamatergic and
subcortical dopamine afferents, pathological disturbances or develop-
mental changes in other brain regions (e.g., hippocampus, amygdala)
that also project directly into the ventral striatum may also modulate
impulse control.
In summary, specific neural substrates located in the anterior por-
tion of the brain, including but not limited to the frontal cortex, ventral
striatum, and VTA-dopaminergic system, are key systems involved in
motivational programming. Dysregulation in these systems may alter
motivational programming to encompass behavioral impulsivity.
ADOLESCENT NEURODEVELOPMENT IN BRAIN AREAS

MODULATING IMPULSE CONTROL
Major neurodevelopmental events during adolescence have been char-
acterized as encompassing changes in primary motivational circuitry,
predominantly in the prefrontal cortex (Figure 2–2). Additional but
more subtle changes may also occur in subcortical components of this
circuitry, including the striatum, and with regard to the functionality of
monoaminergic transmitter systems (dopamine and serotonin) that in-
nervate primary motivational circuits. Also, subcortical limbic systems
such as the hippocampus, amygdala, and hypothalamic nuclei, which
are connected with primary motivational circuitry at various points,
may change in response to adolescent-age alterations in sex hormone
levels.
Because of the relative ease with which the prefrontal cortex can be
studied using neuropsychological, histopathological, and neuroimag-
ing approaches, together with the fact that its compromise is arguably
the most closely linked with impulsive behavior, most of the available
evidence for adolescent brain changes focuses on the prefrontal cortex.
Neuropsychological dimensions of prefrontal cortical function such as
working memory, complex problem solving, and abstract thinking
markedly approach adult levels of performance during adolescence
(Feinberg 1983; Woo et al. 1997; Yates 1996). Corresponding to these
functional changes are adolescent-age microstructural alterations of the
prefrontal cortex that entail the loss of neuronal interconnections,
termed synaptic pruning (Huttenlocher 1979; Rakic et al. 1994). Aspects
of this synaptic pruning may correspond to metabolic and anatomical
neuroimaging changes of the prefrontal cortex in adolescence. For in-
stance, metabolic energy usage in the brain globally declines to adult
levels during adolescence, with the prefrontal cortex reaching adult lev-
els last (Chugani et al. 1987; Kety 1956). These declines may in part rep-
resent decreasing energy requirements associated with decreasing
prefrontal cortical synaptic connections pruned in adolescence. Addi-
tionally, investigations on the specific patterns of adolescent synaptic
pruning indicate that connections between neurons of the prefrontal
cortex that are relatively proximal to one another tend to be prefer-
entially pruned (Lewis 1997; Woo et al. 1997). Meanwhile, connections
between prefrontal cortical neurons that are relatively distal to one an-
other may be preferentially preserved and strengthened via increases in
axonal myelination (Paus et al. 1999; Woo et al. 1997). In sum, these mi-
crostructural changes may result in gross changes of frontal cortical
Adolescence 33
gray and white matter observed in adolescence. Possibly as a result of a

net reduction of frontal cortical synapses (but not neurons themselves),
there is a relative reduction in the volume of cortical gray matter that
proceeds in a wavelike fashion from late childhood through early adult-
hood in a caudal to rostral gradient, where the prefrontal gray shows
reductions last (Gogtay et al. 2004; Lewis 1997; Sowell et al. 1999). Con-
versely, a rostral to caudal pattern of thickening of the corpus callosum
up through adolescent ages may correspond to the preservation and
myelination-related fortification of prefrontal cortical long-tract con-
nections (Paus et al. 1999; Thompson et al. 2004). Together, these micro-
and macrostructural changes may represent adolescent transitioning of
the prefrontal cortex to a configuration that increasingly emphasizes
broadly distributed, long-range connections over local connectivity;
these connections may correlate with enhanced abstract reasoning skills
and other adultlike cognitive styles (Gonzalez-Burgos et al. 2000; Woo
et al. 1997).
Changes in monoaminergic neurotransmitter systems that project
into the primary motivational circuitry are also implicated in adolescent
neurodevelopment. In terms of the dopaminergic system, the age-
related incidence of several neuropsychiatric illnesses thought to be in-
trinsically related to dopamine activity appears to reflect a relative func-
tional robustness of dopamine function in late childhood and early
adolescence that diminishes later into adulthood. Thus the incidence of
tic disorders in late childhood and early adolescence (treated with dopa-
mine receptor antagonists) contrasts with the increasing incidence of
Parkinson’s syndrome (treated with dopamine agonist drugs) with ad-
vanced adult age (Leckman and Cohen 1996; Sano et al. 1996). Moreover,
aspects of increased dopaminergic system functionality are associated
with both drug addictions and schizophrenia, which in turn most com-
monly have postadolescent or early adulthood onset (Audrain-McGov-
ern et al. 2004; Chambers et al. 2001, 2003). These clinical observations
are paralleled by preclinical studies showing that adolescent rodents are
in several measures more sensitive to dopaminergic system stimulation
provoked either pharmacologically or by environmental stimuli such as
novel contexts (Adriani et al. 1998; Laviola et al. 1995; Spear and Brake
1983).
Cellular protein and neurochemical markers of monoaminergic neu-
rotransmitter function suggest that although dopaminergic system pro-
jections to the prefrontal cortex mature up through adolescence, the
serotonin system reaches functional maturity much earlier in childhood
(Lambe and Krimer 2000; Rosenberg and Lewis 1995; Takeuchi et al.
2000). Notably, although increased functionality of the dopaminergic
Another random document with
no related content on Scribd:
C1 Five toes, nose Proboscid’eans
prolonged into a
snout
C2 Toes odd number, E’quines
less than five
C3 Toes even number, Ru’minants
upper front teeth
lacking, chew the
B3 Digits with nails or Ungulates
cud
hoofs
C4 Toes even number, Swine
upper front teeth
present, not cud-
chewers
C5 All limbs having Quad’rumans
hands
C6 Two limbs having Bi’mans
hands
Exercise in Classification.—Copy the following list, and by reference to
figures write the name of its order after each mammal:—
Ape (Figs. 405, 406)
Rabbit (Fig. 345)
Dog (Figs. 356, 408)
Hog (Figs. 357, 393)
Bat (Figs. 347, 370)
Cat (Figs. 337, 348)
Armadillo (Figs. 349, 365)
Cow (Figs. 344, 386)
Walrus (Fig. 340)
Monkey (Figs. 352, 401)
Horse (Figs. 355, 395)
Ant-eater (Figs. 354, 364)
Antelope (Fig. 391)
Mole (Figs. 367, 368)
Beaver (Figs. 372, 373)
Duckbill (Fig. 359)
Tapir (Fig. 384)
Dolphin (Figs. 379, 397)
Use chart of skulls and Figs. 381, 382, 395–400 in working out this exercise.
Man’s dental formula is (M ⁵⁄₅, C ¹⁄₁, I ²⁄₂)2 = 32.
In like manner fill out formulas below:—
Cow (M—C—I—)2 = 32
Rabbit (M—C—I—)2 = 28
Walrus (M—C—I—)2 = 34
Bat (M—C—I—)2 = 34
Cat (M—C—I—)2 = 30
Armadillo (M—C—I—)2 = 28
Horse (M—C—I—)2 = 40
Whale (M—C—I—)2 = 0
Am. Monkey (M—C—I—)2 = 36
Sloth (M—C—I—)2 = 18
Ant-eater (M—C—I—)2 = 0
Dog (M—C—I—)2 = 42
Hog (M—C—I—)2 = 44
Sheep (M—C—I—)2 = 32
The lowest order of

mammals contains only two
species, the duckbill and the
porcupine ant-eater, both living in
the Australian region. Do you
judge that the duckbill of
Tasmania (Fig. 359) lives chiefly
in water or on land? Why? Is it
probably active or slow in
movement? It dabbles in mud and
slime for worms and mussels, etc.
How is it fitted for doing this?
Which feet are markedly webbed?
How far does the web extend? The
Fig. 344.—Skull and front of lower jaw web can be folded back when not
of Cow. in use. It lays two eggs in a nest of
grass at the end of a burrow. Trace
resemblances and differences
between this animal and birds.
The porcupine ant-eater has numerous quill-like spines (Fig. 360)
interspersed with its hairs. (Use?) Describe its claws. It has a long
prehensile tongue. It rolls into a ball when attacked. Compare its
Fig. 346.—Walrus (see Fig.
341).
jaws with a bird’s bill. It lays

one egg, which is carried in a
fold of the skin until hatched. Fig. 345.—Rabbit. A, B, incisors; C, molars
Since it is pouched it could be
cl
assed with
the
pouched
mammals
(next
order), but
it is egg- Fig. 347.—Bat.
Fig. 348.—Cat.
laying.
Suppose the two
animals in this
order did not
nourish their
young with milk
Fig. 349.—Armadillo. after hatching,
would they most
resemble
mammals, birds, or reptiles?
Write the name of this order. —— (See
Table, p. 193.) Why do you place them in this Fig. 350.—Horse (front
order (——)? (See p. 193.) The name of the of jaw).
order comes from two Greek words meaning
“one opening,” because the ducts from the
bladder and
egg glands
unite with
the large
intestine
and form a
cloaca. What Fig. 351.—Greenland Whale.
other classes
of
vertebrates are
similar in this?
Fig. 352.—American Monkey.
Fig. 353.—Sloth (Fig.

363).
Fig. 354.—Ant-eater (Fig. 364).
Fig. 355.—Horse.
Fig. 356.—Dog. Upper (A) and lower (B) jaw.
Fig. 357.—Hog.
Fig. 358.—Sheep.
Fig. 359.—Duckbill (Ornithorhynchus
paradoxus).
Fig. 360.—Spiny Ant-eater (Echidna

aculeata). View of under surface to show
pouch. (After Haacke.)
Fig. 361.—Opossum (Didelphys Virginianus).
Pouched Mammals.—These animals, like the last, are

numerous in the Australian region, but are also found in South
America, thus indicating that a bridge of land once connected the
two regions. The opossum is the only species which has penetrated to
North America (Fig. 361). Are its jaws slender or short? What kinship
is thus suggested? As shown by its grinning, its lips are not well
developed. Does this mean a low or a well-developed mammal?
Where does it have a thumb? (Fig. 361.) Does the thumb have a nail?
Is the tail hairy or bare? Why? Do you think it prefers the ground or
the trees? State two reasons for your answer. It hides in a cave or
bank or hollow tree all day, and seeks food at night. Can it run fast on
the ground? It feigns death when captured, and watches for a chance
for stealthy escape.
The kangaroo (Fig. 362), like the opossum, gives birth to
imperfectly developed young. (Kinship with what classes is thus
indicated?) After birth, the young (about three fourths of an inch
long) are carried in a ventral pouch and suckled for seven or eight
months. They begin to reach down and nibble grass before leaving
the pouch. Compare fore legs with hind legs, front half of body with
hind half. Describe tail.
What is it used for when
kangaroo is at rest? In
jumping, would it be
useful for propelling and
also for balancing the
body? Describe hind and
fore feet. Order ——.
Why? ________. See
key, page 193.
Imperfectly Toothed
Mammals.—These
animals live chiefly in
South America (sloth,
armadillo, giant ant-eater)
and Africa (pangolin). The
Fig. 362.—Giant Kangaroo. sloth (Fig. 363) eats
leaves. Its movements are
remarkably slow, and a
vegetable growth resembling moss often gives its hair a green colour.
(What advantage?) How many toes has it? How are its nails suited to
its manner of living? Does it save exertion by hanging from the
branches of trees instead of walking upon them?
Judging from the
figures (363, 364, 365),
are the members of this
order better suited for
attack, active resistance,
passive resistance, or
concealment when
contending with other
animals? The ant-eater’s
claws (Fig. 364) on the
fore feet seem to be a
hindrance in walking; for
what are they useful?
Why are its jaws so
Fig. 363.—Sloth of South America.
slender? What is
probably the use of the
enormous bushy tail?
The nine-banded
armadillo (Fig. 365)
lives in Mexico and
Texas. It is
omnivorous. To escape
its enemies, it burrows
into the ground with
surprising rapidity. If
unable to escape when
pursued, its hard,
stout tail and head are
turned under to
protect the lower side
of the body where
there are no scales.
The three-banded Fig. 364.—Giant Ant-eater of South America. (See
species (Fig. 366) lives Fig. 354.) Find evidences that the edentates are a
in Argentina. Compare degenerate order. Describe another ant-eater (Fig.
the ears and tail of the 360).
two species; give
reasons for differences.
Why are the eyes so
small? The claws so
large? Order______.
Why? ______.
Fig. 365.—Nine-banded Armadillo of Texas and

Mexico. (Dasypus novemcinctus.) It is increasing
in numbers; it is very useful, as it digs up and
destroys insects. (See Fig. 347.)
Fig. 366.—Three-banded Armadillo (Tolypeutes tricinctus).
Insect Eaters.—The soft interior and crusty covering of insects

makes it unnecessary for animals that prey upon them to have flat-
topped teeth for grinding them to powder, or long cusps for tearing
them to pieces. The teeth of insect eaters, even the molars (Fig. 368),
have many sharp tubercles, or points, for holding insects and
piercing the crusty outer skeleton and reducing it to bits. As most
insects dig in the ground or fly in the air, we are not surprised to
learn that some insect-eating mammals (the bats) fly and others (the
moles) burrow. Are the members of this order friends or competitors
of man?
Fig. 367.—The Mole.
Fig. 368.—Skeleton of Mole. (Shoulder blade is turned upward.)
Why does the mole have very small eyes? Small ears? Compare the
shape of the body of a mole and a rat. What difference? Why?
Compare the front and the hind legs of a mole. Why are the hind legs
so small and weak? Bearing in mind that the body must be arranged
for digging and using narrow tunnels, study the skeleton (Fig. 368)
in respect to the following: Bones of arm (length and shape), fingers,
claws, shoulder bones, breastbone (why with ridge like a bird?),
vertebræ (why are the first two so large?), skull (shape). There are no
eye sockets, but there is a snout gristle; for the long, sensitive snout
must serve in place of the small and almost useless eyes hidden deep
in the fur. Is the fur sleek or rough? Why? Close or thin? It serves to
keep the mole clean. The muscles of neck, breast, and shoulders are
very strong. Why? The mole eats earthworms as well as insects. It
injures plants by breaking and drying out their roots. Experiments
show that the Western mole will eat moist grain, though it prefers
insects. If a mole is caught, repeat the experiment, making a careful
record of the food placed within its reach.
Fig. 369.—Skeleton of Bat.
As with the mole, the skeletal adaptations of the bat are most
remarkable in the hand. How many fingers? (Fig. 369.) How many
nails on the hand? Use of nail when at rest? When creeping? (Fig.
369.) Instead of feathers, the flying organs are made of a pair of
extended folds of the skin supported by elongated bones, which form
a framework like the ribs of an umbrella or a fan. How many digits
are prolonged? Does the fold of the skin extend to the hind legs? The
tail? Are the finger bones or the palm bones more prolonged to form
the wing skeleton?
Fig. 370.—Vampire (Phyllostoma spectrum) of South America. × ⅙.
The skin of the wing is rich in blood vessels and nerves, and serves,
by its sensitiveness to the slightest current of air, to guide the bat in
the thickest darkness. Would you judge that the bat has sharp sight?
Acute hearing?
The moles do not hibernate; the bats do. Give the reason for the
difference. If bats are aroused out of a trance-like condition in
winter, they may die of starvation. Why? The mother bat carries the
young about with her, since, unlike birds, she has no nest. How are
the young nourished? Order ________. Why? ________. (Key, p.
193.)
Fig. 371.—Pouched Gopher (Geomys bursarius) × ¼, a large,
burrowing field rat, with cheek pouches for carrying grain.
The
Gnawing
Mammals.
—These
animals
form the
most
numerous
Fig. 373.—Beaver.
Fig. 372.—Hind foot a, fore foot
order of
b, tail c, of Beaver. mammals.
They lack canine teeth. Inference? The
incisors are four in number in all
species except the rabbits, which have six (see Fig. 345). They are
readily recognized by their large incisors. These teeth grow
throughout life, and if they are not constantly worn away by gnawing
upon hard food, they become inconveniently long, and may prevent
closing of the mouth and cause starvation. The hard enamel is all on
the front surface, the dentine in the rear being softer; hence the
incisors sharpen themselves by use to a chisel-like edge. The molars
are set close together and have their upper surfaces level with each
other. The ridges on them run crosswise so as to form a continuous
filelike surface for reducing the food still finer after it has been
gnawed off (Fig. 345). The lower jaw fits into grooves in place of
sockets. This allows the jaw to work back and forth instead of
sidewise. The rabbits and some squirrels have a hare lip; i.e. the
upper lip is split. What advantage is this in eating? In England the
species that burrow are called rabbits; those that do not are called
hares.
Name six enemies of rabbits. Why does
a rabbit usually sit motionless unless
approached very close? Do you usually
see one before it dashes off? A rabbit has
from three to five litters of from three to
six young each year. Squirrels have fewer
and smaller litters. Why must the rabbit
multiply more rapidly than the squirrel in
Fig. 374.—Position of Limbs
in Rabbit.
order to survive? English rabbits have
increased in Australia until they are a
plague. Sheep raising is interfered with
by the loss of grass. The Australians now ship them to England in
cold storage for food. Rabbits and most rodents lead a watchful,
timid, and alert life. An exception is the porcupine, which, because of
the defence of its barbed quills, is dull and sluggish.
The common rodents are:—
squirrels
rabbits
rats
mice
beavers
muskrats
porcupines
guinea pig
pouched gopher
prairie dog
prairie squirrel
chipmunk
ground hog
field mouse
Which of the above rodents are commercially important? Which are
injurious to an important degree? Which have long tails? Why? Short
tails? Why? Long ears? Why? Short ears? Why? Which are aquatic?
Which dig or burrow? Which are largely nocturnal in habits? Which
are arboreal? Which are protected by coloration? Which escape by
running? By seeking holes?
Fig. 375.—Flying Squirrel (Pteromys volucella). × ¼.
Economic Importance.—Rabbits and squirrels destroy the eggs

and young of birds. Are rabbits useful? Do they destroy useful food?
The use of beaver and muskrat skins as furs will probably soon lead
to their extinction. Millions of rabbits’ skins are used annually, the
hair being made into felt hats. There are also millions of squirrel
skins used in the fur trade. The hairs of the tail are made into fine
paint brushes. The skins of common rats are used for the thumbs of
kid gloves. Order ________. Why? ________.
Elephants.—Elephants, strange to say, have several noteworthy
resemblances to rodents. Like them, elephants have no canine teeth;
their molar teeth are few, and marked by transverse ridges and the
incisors present are prominently developed (Figs. 376, 377). Instead
of four incisors, however, they have only two, the enormous tusks,
for there are no incisors in the lower jaw. Elephants and rodents both
subsist upon plant food. Both have peaceful dispositions, but one
order has found safety and ability to survive by attaining enormous
size and strength; the other (e.g. rats, squirrels) has found safety in
small size. Explain.
Suppose you were to observe
an elephant for the first time,
without knowing any of its
habits. How would you know
that it does not eat meat? That
it does eat plant food? That it
can defend itself? Why would
you make the mistake of
thinking that it is very clumsy
and stupid? Why is its skin Fig. 376.—Head of African Elephant.
naked? Thick? Why must its
legs be so straight? Why must it
have either a very long neck or a substitute for one? (Fig. 376.) Are
the eyes large or small? The ears? The brain cavity? What anatomical
feature correlates with the long proboscis? Is the proboscis a new
organ not found in other animals, or is it a specialization of one or
more old ones? Reasons? What senses are especially active in the
proboscis? How is it used in drinking? In grasping? What evidence
that it is a development of the nose? The upper lip?
The tusks are of use in uprooting
trees for their foliage and in digging soft
roots for food. Can the elephant graze?
Why, or why not? There is a finger-like
projection on the end of the snout
Fig. 377.—Molar Tooth of which is useful in delicate
African Elephant. manipulations. The feet have pads to
prevent jarring; the nails are short and
hardly touch the ground. Order ________. Why? ________. Key,
page 193.
Whales, Porpoises, Dolphins.—As the absurd mistake is
sometimes made of confusing whales with fish, the pupil may
compare them in the following respects: eggs, nourishment of young,
fins, skin, eyes, size, breathing, temperature, skeleton (Figs. 209,
379, and 397).
Fig. 378.—Harpooning Greenland Whale (see Fig. 351).
Porpoises and dolphins, which are smaller species of whales, live

near the shore and eat fish. Explain the expression “blow like a
porpoise.” They do not exceed five or eight feet in length, while the
deep-sea whales are from thirty to seventy-five feet in length, being
by far the largest animals in the world. The size of the elephant is
limited by the weight that the bones and muscles support and move.
The whale’s size is not so limited.
The whale bears one young (rarely twins) at a time. The mother
carefully attends the young for a long time. The blubber, or thick
layer of fat beneath the skin, serves to retain heat and to keep the
body up to the usual temperature of mammals in spite of the cold
water. It also serves, along with the immense lungs, to give lightness
to the body. Why does a whale need large lungs? The tail of a whale
is horizontal instead of vertical, that it may steer upward rapidly
from the depths when needing to breathe. The teeth of some whales
do not cut the gum, but are reabsorbed and are replaced by horny
plates of “whalebone,” which act as strainers. Give evidence from the
flippers, lungs, and other organs, that the whale is descended from a
land mammal (Fig. 397). Compare the whale with a typical land
mammal, as the dog, and enumerate the specializations of the whale
for living in water. What change took place in the general form of the
body? It is believed that on account of scarcity of food the land
ancestors of the whale, hundreds of thousands of years ago, took to
living upon fish, etc., and, gradually becoming swimmers and divers,
lost the power of locomotion on land. Order____. Why?____.
Elephants are rapidly
becoming extinct because of
the value of their ivory tusks.
Whales also furnish valuable
products, but they will
probably exist much longer.
Why?
Fig. 379.—Dolphin. The manatees and
dugongs (sea cows) are a
closely related
order living upon
water plants, and
hence living close
to shore and in the
mouths of rivers.
Order____. Why?
____.
Hoofed
Fig. 380.—Manatee, or sea cow; it lives near the shore
Mammals.—All and eats seaweed. (Florida to Brazil.)
the animals in this
order walk on the
tips of their toes, which have been adapted to this use by the claws
having developed into hoofs. The order is subdivided into the odd-
toed (such as the horse with one toe and the rhinoceros with three)
and the even-toed (as the ox with two toes and the pig with four). All
the even-toed forms except the pig and hippopotamus chew the cud
and are given the name of ruminants.
Horse and Man Compared.—To which finger and toe on man’s
hand and foot does a horse’s foot correspond? (Figs. 381, 383, 399.)
Has the horse kneecaps? Is its heel bone large or small? Is the fetlock
on toe, instep, or ankle? Does the part of a horse’s hind leg that is
most elongated correspond to the thigh, calf, or foot in man? On the
fore leg, is the elongated part the upper arm, forearm, or hand?
(Figs. 395, 399.) Does the most elongated part of the fore foot
correspond to the finger, the
palm, or the wrist? (Fig. 382.)
On the hind foot is it toe, instep,
or ankle? Is the fore fetlock on
the finger, the palm, or the wrist?
(Figs. 382, 385, 399.) Is the hock
at the toe, the instep, the heel, or
the knee?
Specializations of the
Mammals.—The early
mammals, of which the present
marsupials are believed to be
typical, had five toes provided
with claws. They were not very
Fig. 381.—Left leg of man, left hind leg rapid in motion nor dangerous in
of dog and horse; homologous parts fight, and probably ate both
lettered alike. animal and vegetable food.
According to the usual rule,
they tended to increase faster
than the food supply, and there were continual contests for food.
Those whose claws and teeth were sharper drove the others from the
food, or preyed upon them. Thus the specialization into the bold
flesh eating beasts of prey and the timid vegetable feeders began.
Which of the flesh eaters has already been studied at length? The
insectivora escaped their enemies and found food by learning to
burrow or fly. The rodents accomplished the same result either by
acquiring great agility in climbing, or by living in holes, or by
running. The proboscidians acquired enormous size and strength.
The hoofed animals found safety in flight.
Fig. 382.—Skeletons of Feet of Mammals.
P, horse; D, dolphin; E, elephant; A, monkey; T, tiger; O,

aurochs;
F, sloth; M, mole.
Question: Explain how each is adapted to its specialized

function.
Fig. 383.—
Feet of the
ancestors of
the horse.
Fig. 384.—Tapir of South America (Tapirus americanus).
× ¹⁄₂₅.
Questions: How does it resemble an elephant? (Fig. 376.) A

horse? (p. 210.)
Ungulates, as the horse,

need no other protection than
their great speed, which is
due to lengthening the bones
of the legs and rising upon
the very tip of the largest toe,
which, to support the weight,
developed an enormous toe-
nail called a hoof. The cattle,
not having developed such
speed as the horse, usually
have horns for defence. If a
calf or cow bellows with Fig. 385.—Horse, descended from a small
distress, all the cattle in the wild species still found in Western Asia.
neighbourhood rush to the
rescue. This unselfish instinct to help others was an aid to the
survival of wild cattle living in regions infested with beasts of prey.
Which of Æsop’s fables is based upon this instinct? The habit of
rapid grazing and the correlated habit of chewing the cud were also
of great value, as it enabled cattle to obtain grass hurriedly and to
retire to a safe place to chew it. Rudiments of the upper incisors are
present in the jaw of the calf, showing the descent from animals
which had a complete set of teeth. The rudiments are absorbed and
the upper jaw of the cow lacks incisors entirely, as they would be
useless because of the cow’s habit of seizing the grass with her rough
tongue and cutting it with the lower incisors as the head is jerked
forward. This is a more rapid way of eating than by biting. Which
leaves the grass shorter after grazing, a cow or a horse? Why? Grass
is very slow of digestion, and the ungulates have an alimentary canal
twenty to thirty times the length of the body. Thorough chewing is
necessary for such coarse food, and the ungulates which chew the
cud (ruminants) are able, by leisurely and thorough chewing, to
make the best use of the woody fibre (cellulose) which is the chief
substance in their food.
Ruminants have
four divisions to the
stomach. Their food is
first swallowed into
the roomy paunch in
which, as in the crop
of a bird, the bulky
food is temporarily
stored. It is not
digested at all in the
paunch, but after
Fig. 386.—Skeleton of Cow. Compare with horse being moistened,
(Fig. 395) as to legs, toes, tail, mane, dewlap, ears, portions of it pass
body. successively into the
honeycomb, which
forms it into balls to be belched up and ground by the large molars as
the animal lies with eyes half closed under the shade of a tree. It is
then swallowed a second time and is acted upon in the third division
(or manyplies) and the fourth division (or reed). Next it passes into
the intestine. Why is the paunch the largest compartment? In the
figure do you recognize the paunch by its size? The honeycomb by its
lining? Why is it round? The last two of the four divisions may be
known by their direct connection with the intestine.
Fig. 388.—Section of cow’s stomachs.
Identify each. (See text.)
Fig. 387.—Food traced through
stomachs of cow. (Follow The true gastric juice is secreted only
arrows.) in the fourth stomach. Since the cud or
unchewed food is belched up in balls
from the round “honeycomb,”
and since a ball of hair is
sometimes found in the stomach
of ruminants, some ignorant
people make the absurd mistake
of calling the ball of hair the
cud. This ball accumulates in the
paunch because of the friendly
custom cows have of combing
each other’s hair with their
rough tongues, the hair
sometimes being swallowed.
Explain the saying that if a cow
Fig. 389.—Okapi. This will probably
prove to be the last large mammal to be stops chewing the cud she will
discovered by civilized man. It was found die.
in the forests of the Kongo in 1900.
Questions: It shows affinities (find

them) with giraffe, deer, and zebra. It is a
ruminant ungulate (explain meaning—
see text).
Fig. 390.—African Camel (Camelus dromedarius).
Does a cow’s lower jaw

move sidewise or back and
forth? Do the ridges on the
molars run sidewise or
lengthwise? Is a cow’s horn
hollow? Does it have a bony
core? (Fig. 344.)
The permanent hollow
horns of the cow and the
solid deciduous horns of the
deer are typical of the two
kinds of horns possessed by
ruminants. The prong-
horned antelope (Fig. 391) of
the United States, however,
is an intermediate form, as
its horns are hollow, but are
shed each year. The hollow Fig. 391.—Prong-horned Antelope
horns are a modification of (Antelocarpa Americana).
hair. Do solid or hollow horns branch? Which are possessed by both
sexes? Which are pointed? Which are better suited for fighting? Why
would the deer have less need to fight than the cattle? Deer are
polygamous, and the males use their horns mostly for fighting one
another. The sharp hoofs of deer are also dangerous weapons. The
white-tail deer (probably the same species as the Virginian red deer)
is the most widely distributed of the American deer. It keeps to the
lowlands, while the black-tailed deer prefers a hilly country. The
moose, like the deer, browses on twigs and leaves. The elk, like cattle,
eats grass.
Fig. 392.—Rocky Mountain Sheep (Ovis montana). × ¹⁄₂₄.
The native sheep of America is the big horn, or Rocky Mountain

sheep (Fig. 392). The belief is false that they alight upon their horns
when jumping down precipices. They post sentinels and are very
wary. There is also a native goat, a white species, living high on the
Rocky Mountains near the snow. They are rather stupid animals. The
bison once roamed in herds of countless thousands, but, with the
exception of a few protected in parks, it is now extinct. Its shaggy
hide was useful to man in winter, so it has been well-nigh destroyed.
For gain man is led to exterminate elephants, seals, rodents,
armadillos, whales, birds, deer, mussels, lobsters, forests, etc.
Fig. 393.—Peccary (Dicotyles torquatus) of Texas and Mexico. × ¹⁄₁₂.
Our only native hog is the peccary, found in Texas (Fig. 393). In
contrast with the heavy domestic hog, it is slender and active. It is
fearless, and its great tusks are dangerous weapons. The swine are
the only ungulates that are not strictly vegetable feeders. The habit of
fattening in summer was useful to wild hogs, since snow hid most of
their food in winter. The habit has been preserved under
domestication. Are the small toes of the hog useless? Are the “dew
claws” of cattle useless? Will they probably become larger or smaller?
Order?
Illustrated Study of Vertebrate Skeletons: Taking man’s skeleton as
complete, which of these seven skeletons is most incomplete?
Regarding the fish skeleton as the original vertebrate skeleton, how has it been
modified for (1) walking, (2) walking on two legs, (3) flying?
Which skeleton is probably a degenerate reversion to original type? (p. 209.)
How is the horse specialized for speed?
Do all have tail
vertebræ, or vertebræ
beyond the hip bones?
Does each have shoulder
blades?
Compare (1) fore
limbs, (2) hind limbs, (3)
jaws of the seven
skeletons. Which has
relatively the shortest
jaws? Why? What seems
to be the typical number
of ribs? limbs? digits?
Does flipper of a
dolphin have same
bones as arm of a man?
How many thumbs
Fig. 394.—Bird.
has a chimpanzee?
Which is more specialized, the

foot of a man or that of a
chimpanzee? Is the foot of a
man or that of a chimpanzee
better suited for supporting
weight? How does its
construction fit it for this?
Which has a better hand, a
man or a chimpanzee? What is
the difference in their arms?
Does difference in structure
correspond to difference in
use?
Which of the seven
skeletons bears the most
complex breastbone?
Which skeleton bears no
neck (or cervical) vertebræ? Fig. 395.—Horse.
Which bears only one?
Are all the classes of
vertebrates represented in this chart? (p. 125.)
Fig. 396.—Ox.

Ebooks File Textbook of Men S Mental Health 1st Edition Jon E. Grant All Chapters

Uploaded by

Copyright:

Available Formats

Ebooks File Textbook of Men S Mental Health 1st Edition Jon E. Grant All Chapters

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ebooks File Textbook of Men S Mental Health 1st Edition Jon E. Grant All Chapters

Uploaded by

Copyright:

Available Formats

Full download ebook at ebookgate.

Textbook of Men s Mental Health 1st Edition

Download more ebook from https://ebookgate.com

Textbook of men s health and aging 2ed Edition

Menopause A Mental Health Practitioner s Guide 1st

Men s health 3ed Edition Kirby R.

The Stressed Sex uncovering the truth about men women

Mental Health Information for Teens Health Tips about

The Future of Mental Health Deconstructing the Mental

Older People s Mental Health Today A Handbook 1st

Teaching Mental Health 1st Edition Theo Stickley

JON E. GRANT, M.D., M.P.H., J.D.

Books published by American Psychiatric Publishing, Inc., represent the views

Copyright © 2007 American Psychiatric Publishing, Inc.

Manufactured in the United States of America on acid-free paper

Typeset in Palatino and Futura Condensed.

American Psychiatric Publishing, Inc.

DONALD W. BLACK, M.D.

CARLOS BLANCO, M.D., PH.D.

R. ANDREW CHAMBERS, M.D.

RANI DESAI, PH.D.

CAROLINE J. EASTON, PH.D.

CRAIG A. ERICKSON, M.D.

JON E. GRANT, M.D., M.P.H., J.D.

SCOTT HALTZMAN, M.D.

DAVID C. HODGINS, PH.D.

NED HOLSTEIN, M.D., M.S.

MICHAEL KING, M.D., PH.D., F.R.C.P., F.R.C.G.P., F.R.C.PSYCH.

ANN M. LAGGES, PH.D.

YAEL LEVIN, B.A.

ORIANA VESGA LÓPEZ, M.D.

DOLORES L. MANDEL, L.C.S.W.

LAUREN N. MANNING, B.A.

THOMAS J. MCMAHON, PH.D.

SHERRY B. MOSS, M.A.

TARA M. NEAVINS, PH.D.

ROBERTO OLIVARDIA, PH.D.

DEBORAH A. PERLICK, PH.D.

MARC N. POTENZA, M.D., PH.D.

DAVID L. ROWLAND, PH.D.

GERARD SANACORA, M.D., PH.D.

ERIC L. SCOTT, PH.D.

N. WILL SHEAD, M.SC.

STEVEN SOUTHWICK, M.D.

AARON Z. SPECTOR, M.S.N., A.P.N.

DOLORES VOJVODA, M.D.

A primary aim of this book is to provide clinicians with information

Jon E. Grant, M.D., M.P.H., J.D.

BOYS AND MEN AT

ERIC L. SCOTT, PH.D.

Boys and girls differ during childhood in patterns of normal develop-

ers complained that he was performing poorly in school, had been

Considerations in the diagnostic process for Tony would include any

TYPICAL EMOTIONAL DEVELOPMENT AND MOOD DISORDERS

ness are observable at approximately ages 5–8 months, and contempt

their mother smiles in response to their smile to confirm a happy mood

LANGUAGE DEVELOPMENT AND DISORDERS

COMMUNICATION DISORDERS AND

NORMAL FEAR AND ANXIETY DISORDERS