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As is always the case, the referrals were made for a multiplicity of symptoms rather than because of an isolated
problem and the maladjustment of the individual children had usually a multi-factorial etiology. Naturally
parents, teachers and others were worried about various degrees and intensities of behaviour problems, at home
or in school, but not every child exasperating its teachers in school, suffers from a psychological disturbance.
Very frequently the fault must be sought elsewhere, perhaps in a sphere of social disturbance into which the
Clinic cannot intervene and fails to supply the suitable remedy. The Clinic's team are equally concerned about
the violent or aggressive child, as they are about the very withdrawn pupil who is no trouble to his teachers but
opts out in school and keeps unduly to himself at home, and because he is not really a nuisance tends to be
overlooked. The diagnosis and the treatment of school refusal because of either school phobia or truancy remains
a tricky problem while severe depression and suicidal threats which are not entirely uncommon among children,
even if they are fortunately rare, must always be taken very seriously. Such contrasting and diverse symptoms as
bed-wetting, stealing, nightmares or unreasonable compulsion, to name but a few, may be the expression in a
child of the same personal problem, often the result of emotional disturbance which reflects a social difficulty
within the home or an educational handicap at school. Fortunately, symptoms which would have been regarded
as signs of a more ominous disturbance with very unfortunate prognosis, if they occurred in an adult, may
express in children only a temporary emotional crisis which can even resolve itself spontaneously, even if it
usually benefits from supportive treatment or therapeutic crisis intervention. In contrast, however, the very
plasticity and impressionability of a young individual who is constantly growing in body and mind will make
him deeply vulnerable to many dramatic impressions which would hardly touch an adult. As is almost universally
the case in Child Guidance Clinics in this country and abroad boys (123) predominated this year again over
girls (52). There was a fairly even distribution of referrals of children in the age range of 5 to 14 years.
The now time-honoured team-approach of the Child Guidance Clinic, its methods and aims, its relationship with
the schools psychological service, the role of the Child Psychiatrist in a non-medical educational setting, his
relationship to the children's branch of the Social Services Department and the psychiatric aspects of the Child
Health Service as it will follow the reorganisation of the National Health Service, are all at present under
consideration and in a state of flux, so that it is difficult to make any pronouncement or to give explanations
on these points which will be, of course of great interest to anybody concerned with the Child Guidance Service.
Let us hope that the near future will bring a solution to all the outstanding issues in the interest of our young
clients whose happiness, whatever the future brings us, must remain our principal concern."