The purpose of the first segment of the Entrepreneurial Arch is to identify an opportunity to build an organization that can make an impact. Building a business is like building a ladder to climb to a new place. Both the construction and the placement of the ladder are important. How you build it determines the effectiveness of the firm’s execution. Where you place the ladder determines where your company can go. Sadly, too many young firms focus entirely on building the ladder and pay little attention to the placement of that ladder. They focus all their energy on developing a product and very little time thinking about the business.

Entrepreneurs are notorious for trying to build successful firms in very unattractive industries. There is a high correlation between the problem an entrepreneur chooses for the business to solve and the attractiveness of the industry in which the business will be launched. That correlation is ˗0.77 (Shane, 2008). That’s a significant correlation, unfortunately in the negative direction! This means that most entrepreneurs are consistently picking unattractive industries in which to start their businesses, thereby creating businesses that are destined to fail. This correlation suggests that our instincts are not very good at choosing high-value opportunities. In fact, the number suggests that we would generally be better off following the opposite of our “gut feel!”

Growth is the number one concern of corporate executives, economic developers, and government officials desperately trying to reduce unemployment (Shleifer and Vishny, 1997; Ernst & Young, 2012). And why not, since growth is at the heart of economic prosperity – personal, corporate, or regional? Entrepreneurship is at the heart of growth. Growth is driven by entrepreneurs discovering new business opportunities from which they create new businesses and new lines of business within existing companies. Innovatively solving complex problems through organizations is what professional entrepreneurs do. As Archimedes said, “Give me a lever long enough and a fulcrum on which to place it and I shall move the world.” Organizations are that lever, entrepreneurs are that fulcrum.

All companies rely on innovations to grow over time. In a presentation at Stanford University in 2005 Geoffrey Moore, author of Crossing the Chasm and Escape Velocity, said this about the connection between innovation and growth:

The only way to maintain differentiated margins is to continue to drive innovative growth. Innovation is the tool of the entrepreneur (Drucker, 1985). Throughout this chapter we will draw upon aspects that were developed in other segments of the Entrepreneurial Arch. Growth is not simply about “marketing.” It is not something that a single group in the firm can accomplish on their own. As this chapter will illustrate, growth is an aggregation of all the activities of the Arch that precede this one.

As mentioned in Chapter 1, no “mental” health problem is exclusively mental. Every human action, thought and feeling is rooted in our physiology. This is not to suggest that the role of environmental influences in shaping children’s behavior and development is minimal or can be ignored. The biological and environmental factors contributing to development are intricately intertwined and mutually influential. No biological event can lead to a behavior without the presence of an environmental context in which to enact that behavior, and no environmental event can elicit a behavioral response without also affecting biological functions. In this chapter, we review the neurophysiological, neuroendocrine and autonomic underpinnings of children’s emotional and behavioral problems.

Some foundations

Currently observable patterns of feeling, thinking and acting can be attributed to the processes of natural selection that have shaped the evolutionary course of mammalian and human development. These processes have established interconnections between the limbic system, the prefrontal cortex and other neural areas (MacLean, 1990). Emotions and behaviors evolved and have been preserved because, throughout the evolutionary history of our species, they promoted adaptive responses to salient events (Johnson-Laird and Oatley, 1992; Lazarus, 1991). Many aspects of children’s mental health problems stem from breakdowns in that normal, adaptive process (Frijda, 1994). The elicited emotion is not appropriate for the evoking stimulus, or it is felt too strongly or not strongly enough, or the bodily arousal it produces fails to support the behaviors that would constitute an appropriate response.

You have a plan for executing your business, but that plan is dependent upon resources. This segment is about marshaling the resources you need to launch your business. The resources that you will need will, in turn, depend on human and financial capital, the emphasis of this chapter. The final segment of the Entrepreneurial Arch, managing growth, will cover the challenges involved in the continued addition of people and resources to the firm as you grow beyond the first five years. This chapter will focus on acquiring the resources you need to survive those critical first five years.

Entrepreneurs tend to focus on obtaining the financing for their business, but financiers tend to focus on the management team. Clearly you need both in order to launch a successful firm. It is a chicken-and-egg problem for those launching new firms. Jim Collins, author of Good to Great, said that great leaders start with people (Collins, 2001b). They “get the right people on the bus, the wrong people off the bus, and the right people in the right seats.” He summarizes why in this way:

This chapter will begin with a discussion of people. It will be followed by a discussion of capital. Due diligence will be a part of the discussion on acquiring capital as no institution will provide your team capital without some level of due diligence. Start with people, then money.

The Entrepreneurial Arch is a graphic representation of a methodology to discover and develop a new financially sustainable organization. The methodology also guides you to a business that aligns with your capabilities; a new venture that both creates and captures value. The systematic reshaping and de-risking attributes of the methodology are aimed at increasing the odds of your post-launch success. There are a lot of moving parts to contend with in discovering and building a new business. Teams often get overwhelmed by the process. Some try to use the structure of the business plan or other dashboard appliances to help them establish some semblance of order during the process. Unfortunately these can cause more harm than good as they typically represent a hodgepodge of activities that range from discovery to operations. By contrast, the Entrepreneurial Arch lays out a rational order for the activities necessary to create and simultaneously de-risk your potential new venture. The method outlined in this book has six segments. These segments represent the dissection of the process of business discovery and launch into manageable parts. This assists in keeping teams on track, so they are not worrying about the kind of financing they may need, for example, when they are still in the business design stage. The tools necessary to perform the activities of each segment appropriately are introduced and described as part of the overall methodology.

The first half of the Arch is focused on discovering a viable, high-value business that your team or organization can act upon. This is a learning process that involves identifying, describing, reshaping, quantifying, and ultimately assessing potential new ventures. The second half of the Arch focuses on implementing the discovered business. The actions described here are segmented into planning, launching, and growing the firm.

Anxiety is characterized by distress or uneasiness regarding danger, real or perceived, or concern about an upcoming stressful event. According to a classic theory proposed by Alpert and Haber (1960), anxiety is often facilitative and helpful. It can lead to trying harder at a pursuit in which one wants to do well. Anxiety can also serve a protective function by steering children and adults away from situations in which they will experience danger or so much failure and disappointment that they will lose enthusiasm for whatever endeavor is involved. Anxiety becomes debilitative when it begins to interfere with successful functioning in family, school and work settings. Indeed, fears are a very integral and usually constructive part of the normal development of children. It is useful to conceptualize fear or panic as pertaining primarily to an imminent threat or danger, whereas anxiety refers to worrying about a real, imagined or exaggerated threat that will occur in the future (Craske, 1999). Throughout childhood, children worry about getting sick, failing in school and looking foolish (e.g., Ollendick, Matson and Helsel, 1985). This makes it difficult to notice that some children experience anxiety on a chronic basis at levels well above the norm for their ages. In fact, problematic anxiety is very common among children and adolescents. However, anxious children and adolescents, who rarely disrupt the routines of families and schools, often remain unnoticed. Even the mental health community has only developed awareness of the extent of the anxiety problems of young people in the past 30 years or so. Although some anxiety problems begin in early childhood, anxiety disorders at that stage are only beginning to receive the attention of researchers and practitioners. Conditions that interfere substantially with the daily lives of school-age children and adolescents remain relatively understudied compared to other psychological problems that are very prevalent in the population at large.

Classification, compassion and science: a historical perspective

Throughout most of history, psychological problems were not differentiated in any way. All individuals suffering from “idiocy” and “lunacy,” as the combined condition was known in seventeenth-century Britain, were lumped together to be scorned and ridiculed. Some of the madhouses of the time had separate sections for the “mad” and the “foolish.” Showing more insight and sympathy than most of their contemporaries, some writers from ancient Greeks through Shakespeare portrayed “fools” as displaying keen insight that was expressed in a confusing but highly perceptive manner (Andrews, 1998). Such undifferentiated concepts of mental illness did not die as recently as is sometimes thought: The US census of 1840, in one of the earliest attempts to determine the prevalence of mental illness, included only a single category “idiocy/insanity,” which was only replaced 40 years later with seven types of mental disorder (Mash and Barkley, 2002).

Whatever the limitations of the medical model that is at the core of much contemporary practice in the mental health professions, this way of looking at psychological disorder, with the image of being sick that comes with it, is undoubtedly more benevolent than the previous image of being simultaneously deranged and dimwitted. The term “medical model” has surely been defined more frequently and probably more clearly by its critics than by its proponents. However, it is fair to say that its assumptions include, first of all, that mental disorders and distress function in much the same way as physical diseases. Hence, once the exact disease has been identified from among those that are known, the condition needs to be treated in a more or less standard way that is prescribed by qualified professional experts (these features are delineated in somewhat disparaging language by McCready, 1986).

Post-traumatic stress disorder (PTSD) is a severe and long-lasting reaction to a traumatic event that involves intense fear, horror and feelings of hopelessness (American Psychiatric Association, 2000). Common traumata vary considerably, including war, sexual abuse, physical abuse and natural disasters such as earthquakes, floods and tidal waves. Such traumatic experiences are, unfortunately, very common: It is estimated that one child in four experiences a significant traumatic event before reaching the adult years (Costello et al., 2002). Many children who live through a traumatic event will show some symptoms of PTSD immediately after the event (Aaron, Zaglul and Emery, 1999). Indeed, it would probably be abnormal for them not to react. Moderate psychological distress shortly after the trauma can thus be considered normal (Cohen, D. et al., 2010). However, on the average, about 30 percent of sufferers continue to have symptoms of PTSD one month after the traumatic event (Kessler et al., 1995; Cohen, D. et al., 2010).

Mental health professionals were as slow to recognize the clinical significance of PTSD in childhood and adolescence as they were to acknowledge the extent and severity of anxiety disorders. Awareness increased largely as the result of widespread knowledge of several important historical events that affected children that were brought to public attention by authors, journalists and photojournalists. This chapter begins with a section on the slow process leading to the recognition of PTSD as a real and serious problem for children and adolescents. Information on diagnostic criteria follows. The section on prevalence includes information about the factors that have been found to differentiate children and youth who are most and least likely to develop PTSD after a potentially traumatic incident. The section on causes and correlates is devoted primarily to biological processes that are thought to influence individual reactions to traumatic events. The chapter closes with a section on treatment.

Do as many children and adolescents of the Yoruba tribe in Nigeria get depressed as do children and adolescents in Norwegian fishing villages or members of street gangs in São Paulo, Brazil? If they do, are the features of their depressive episodes the same? Even if they are, can their depression be treated effectively by psychologists in essentially the same ways? Culture is so present in the thinking, feeling and behavior of individuals everywhere that its influence must be understood thoroughly when the causes, manifestations and treatment of psychopathology are contemplated (e.g., Hallowell, 1934).

In addition to the contact among cultures brought about by immigration, the influence of Western culture on non-Western parts of the world is also increasing because of the globalization of knowledge transmission in the sciences. Lambasting the ubiquitous Americanization of thinking about mental health around the world, Watters (2010) maintains that the wanton exportation of American thinking about mental disorder has resulted in the erosion of indigenous wisdom about psychological distress in other societies. Consequently, Western classification systems are applied to populations to which they may be inapplicable. Watters insists that non-Western people in some cases are actually beginning to suffer in ways that are being imported along with Western teachings about psychopathology.

This chapter provides a historical introduction to most of the major theories that have influenced and still influence both theory and practice. Like most historical accounts, this chapter is organized in roughly chronological order as far as possible. However, so much of the intellectual history in this area began in the late nineteenth and early twentieth centuries that many important developments occurred almost simultaneously at that time. One important insight to be gained from this historical journey is that ideas about children and their psychological difficulties do not develop in a vacuum. As will become apparent, theories of psychopathology are influenced by the intellectual, social and political climates of the eras in which they emerge.

Children’s symptoms as an economic burden to their families

Most scholars who attempt to trace the historical roots of the study of child psychopathology are struck by what they see as the indifference of adults during most of the years of recorded history to children’s psychological difficulties (e.g., Kanner, 1962). Indeed, there is relatively little reference in literature or folklore, medical or theological writings about the subject before the nineteenth century. This indifference is not really surprising given the fundamental differences between the implications of mental illness in childhood and adulthood. Regardless of the historical period, adult psychopathology is more likely to cause economic hardship than child psychopathology (Ries, 1971, cited by Gelfand and Peterson, 1985). That the economic burden of psychopathology would be a prominent concern may be shocking to the contemporary reader, who is probably privileged to live in the relatively recent historical period in which children and their special needs are known and when child labor is no longer common in the Western countries though it unfortunately persists in some parts of the world.

Now that a high-value business opportunity has been identified by working through the opportunity identification segment of the Entrepreneurial Arch, it is time to enter the design phase. The business design segment of the Entrepreneurial Arch, Figure 3.1 below, is the segment in which your business will be framed (designed). The axiom for product development is “design–build–test.” This approach creates a natural feedback loop in which designs are built, tested, and then redesigned based on testing results. Products that are complex and expensive to build are generally tested, via computer simulations, before construction begins. The designs are updated after the testing portion. This is not to say that, after the product is eventually built, there are not re-adjustments to the design; there are. The approach does succeed in accelerating learning and translates to faster product development.

The purpose of the Entrepreneurial Arch is to accelerate learning and thereby accelerate the development of viable new firms or new lines of business within large firms. To do this, companies should follow a mantra slightly modified from that of product development: Design–test–build. The goal is to “get to plan B” before ever launching a flawed “Plan A.” That certainly does not mean that there will not be adjustments to the plan once the company is launched; of course there will be. As German military strategist Helmuth von Moltke (1800–1891) is paraphrased as saying, “No battle plan survives contact with the enemy.” It is not a question, therefore, of whether your business will change as you progress across the Arch – it will – the only question relates to the degree of that change. The goal is to make substantial changes during the design stage and smaller refinements once you have launched.

In the psychology department where I have taught for the past 32 years, I am regarded as one of the more research-oriented of the clinical-psychology professors and one of the most clinically oriented of the researchers. Although the commitment to bridge research and practice is strong in North America, tension between the two pillars of clinical psychology emerges all too often. Such tension is often much greater in the countries where I have collaborated and worked around the world. My need to resolve as much of this tension as possible for the students I teach and for my overseas colleagues was the primary impetus for this book. My course on child psychopathology has always been among my favorites. However, I have never found a textbook that bridges research and practice very well or one that my students enjoy reading. I have endeavored to provide such a resource by writing this volume. Let me mention some of its distinctive features.

Consistency of writing style. I want to tell the story from the beginning to the end in a coherent way. Therefore, I have been actively involved in writing all the chapters. Except for a few for which I needed the expertise of co-authors in areas that are outside my main fields of competence, I have written them all.

This chapter is devoted to conditions characterized by the violation of social norms and the disruption of orderly routines. The clinical diagnosis of disruptive behavior disorder evokes what has sometimes been seen as confusion between being bad and being sick. For instance, Heydon (2008) argues strongly for the “de-pathologizing” of behavior problems because considering them a disorder inevitably leads to blaming the child and his or her parents, absolving the community, school and society.

Beginning with this chapter, the chapters devoted to specific disorders are organized in similar sequence. This chapter begins with the important distinction between disruptive behavior disorders that are evident during childhood and those that first appear during adolescence; many experts consider these two separate disorders. The diagnostic criteria specified in the new DSM-5 and in the ICD are presented next. Considerable space is devoted to the possible causes of disruptive behavior disorders (including physiological, family, peer, media and neighborhood influences) and to the ways in which disruptive behavior disorders affect the functioning and well-being of children and adolescents. Information about the stability of disruptive behavior disorders and the prospects of recovery appear next. The chapter concludes with a descriptive summary of the major known treatments for disruptive behavior disorders and the evidence for their effectiveness.

Psychotherapy with children may or may not be conducted in a manner that resembles the widespread stereotype in which a person seeing a psychotherapist “opens up,” reveals their feelings and inner conflicts and receives support from the therapist and insight about the causes of their difficulties. Many but certainly not all children have the capacity to undergo such a process, which of course depends on having the vocabulary needed to describe one’s inner emotional life and to understand and make use of the therapist’s input.

This chapter provides a global overview of psychological interventions in common use with children and adolescents. More information about the interventions used in the treatment of specific disorders appears in subsequent chapters. The chapter begins with an introduction to the major theories of psychotherapy. It continues with deliberation about the applicability of these approaches to the childhood and adolescent stages. Axline’s non-directive play therapy is then introduced as a case example of a technique with an important place in the history of child psychopathology, followed by a section on contemporary evidence-based practice. The chapter continues with a section on the research basis of child and adolescent psychotherapy. The tool of meta-analysis is introduced at that point. The chapter concludes with some remarks about the emerging field of cybertherapy.