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provides treatment for the family could be extended to the community.
The number of cases of school phobia, a complaint more fully
explained in the previous report, remained at a high level, and many
children presented themselves with severe psychosomatic symptoms,
particularly vomiting, diarrhoea and abdominal pain, which at first
conceded the underlying problem of separation anxiety which required
psychiatric attention. In a few cases there has been a tendency to
mental and physical collapse and in one case even a suicidal attempt
was made. The circumstances and symptoms allow a sharp distinction
from truancy, and intensive psychotherapy is called for in all
cases, even if this means more absence from school, since research
has shown that such children without the expert treatment are liable
to remain misfits in society with severe personal and social disturbances
in later life. The cases at this clinic were roughly
divided equally between boys and girls, and the age range spread
from six years to sixteen years, with at least half being of secondary
school age. This corresponds with the general observation that
school phobia can occur independently of sex at any age during the
child's scholastic career. Intelligence levels ranged from very low
average to one very superior.
On the whole, school phobia tends to occur in more intelligent
children and seems fairly independent from failure or success in
school, while truancy is more frequent in backward children who find
the requirements of the school difficult. In almost every case of
school phobia we found parental problems of an emotional nature
involving the child. More than half the children were thought to be
over-indulged or lacking firm control at home. Many were overweight.
In fact, most cases of school phobia seem to develop from
a family problem rather than a difficulty in the school situation.
Many children come from culturally superior homes and had ambitious
but anxious parents who were most disturbed and helpless in coping
with the failure to attend school.
In contrast we found that the ordinary truant more often comes
from a family which does not appreciate the advantages of education.
While the truant spends his time roaming about the streets frequently
making a nuisance of himself in the company of similarly minded
boys and enjoying his absence from school, we found that the victim
of school phobia either remains at home or wanders aimlessly and
alone in a most unhappy mood, frequently amounting to severe
depression. These cases are time consuming for the child guidance
staff and often immediate attention is essential. Treatment consists
of intensive individual therapy on analytic lines by a trained psychotherapist,
and more recently the educational psychologist has experimented,
under psychiatric guidance, with a new approach based on
Behaviour Therapy and Learning Theory which showed promise.
"Crisis of Adolescence" has become a common reason for
referral and appears to occur now at a younger age, as many of the
children were this year only about twelve years old. This somewhat
earlier incidence may reflect the earlier onset of adolescence in the
population. I introduced the term Adolescent Crisis some years ago
to describe adolescents who were referred with a variety of most
disturbing symptoms, which at any other age would have indicated
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