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even psychotherapy may be needed; for another, an indication of the need for a
special line of instruction; for yet another, adjustment of home circumstances and
explanations to perplexed parents of the special needs of the child; while in a few
but often the more involved cases it may prove that one or both parents require
psychiatric care. For this reason it will probably prove advisable for child guidance
clinics or departments to be attached or closely affiliated to centres in which the
minor mental disturbances or disabilities of adults are investigated or treated.
This branch of remedial or preventive medicine is in its infancy but is likely to
expand with the development, under the Mental Treatment Act, of out-patient
departments and observational wards, as distinct from the old idea of the asylum.
It seems probable too that ultimately arrangements will be required for the temporary
care of a certain number of children away from their homes so as to afford both
children and parents the benefits of a much needed change and rest from continuous
family associations, such a change as has been for years available to those of adequate
means in the public boarding schools for boys and girls. Another branch of the work
which is likely to develop is the question of special provision for coaching children
who have failed to receive adequate grounding in the fundamentals of one or more
of the three elements (reading, writing and arithmetic), and who, by reason of age
or special attainments in other subjects, have been promoted beyond their level but
would suffer by being returned to a much lower class. It may require considerable
research and an expenditure of time which could not be given by the school teacher,
even if possessed of adequate psychological qualifications and experience, before an
appropriate line of approach is discovered and proved to be effective. Work of this
kind is being carried out increasingly by the psychologists attached to the various
hospitals with child guidance departments and by the child guidance clinics.
Departments dealing with maladjusted children with full provision for
psychological and social investigation are now in action at Guy's Hospital, University
College Hospital, Great Ormond Street Hospital, and the Maudsley Hospital, Denmark
Hill. To a lesser extent, work is commencing elsewhere. The school medical
service is in liaison with these departments by the agency of the care committee
organisation and the almoner's departments of the hospitals, reports are
exchanged and action taken as regards any feature of the school work which
can advantageously be modified. The relationship has become closer during
the last year and is likely further to be extended as experience is gained. A voluntary
clinic has been established at "The Quest," Clarendon-road, in the Kensington area,
under the direction of Dr. Lowenfeld, in which a small number of maladjusted children
are studied, chiefly whilst they are occupied in a kind of playroom-occupation centre
during two afternoons in each week. Though the methods of expression or emotional
trends form the central feature of the work of this centre any child who requires it
is given a full physical or psychological examination and a social worker loaned
from the Child Guidance Council, ascertains the home situation and arranges any
necessary explanations or adjustments. The children's room contains material for
tests of intelligence, the expression of phantasy, constructional work and social or
individual games. The types with which work is done comprise:
(a) Children who need emotional release, who need to be encouraged in selfexpression
since their repressions have often resulted in educational backwardness.
(b) Children whose interest has become diffused and who need a framework
within which such interests can be concentrated. This condition is, it is pointed out
in a report of the centre, sometimes found in association with epilepsy and allied
disorders. Though this centre is less closely linked with the medical work in the
schools than those of the other centres, reports are received from time to time and
the social worker keeps in contact with the children's care organisation in all that
concerns those patients who attend London elementary schools. During the year
ended September, 1930, some 98 cases had applied for treatment and 54 had been
accepted of which 20 are stated to have been referred directly or indirectly through
the school care committees. The clinic is close to the county boundary and many of