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1. The immature and inexperienced child finds it very difficult to verbalise his complaints and to express
them in an adequate way, while the anxious or depressed adult will make it obvious, by what he says
or does, that he has problems, is unhappy or frightened, a child only rarely reveals spontaneously
what is troubling him. Even worse for him, he may express his unsettled state by quite inappropriate
means, such as mischievous behaviour or telling lies, thus not only misleading the adults who want
to help him but even alienating those from whom he would require in his predicament most support.
A vicious circle is created which has to be broken by the intervention of the Chila Guidance Clinic
by recognising the true nature of the problem and improving the fundamental disturbance.
2. Children have a vivid imagination but lack experience. Even with high intelligence they may be only
very vaguely aware of social obligations and lack commonsense to deal with difficult situations. They
pay unaue attention to imagined feelings and grievances, are often subject to unreasonable fears and
they tend to falsify experience by preoccupations in phantasy. This will create emotional tensions
which are difficult to understand for the parents and may cause behaviour problems which cannot be
judged by adult standards.
3. As the child is aeveloping his personality he is in a constant state of flux. Even severely disturbed
behaviour can improve without residual damage to his future mental stability, if handled expertly,
while abnormal mental states in adults are more persistent because their behaviour patterns are strongly
fixed. On the other hand, intervention in a child's disturbance is more vital, as it may also grow with
advancing age.
4. There is no equivalent in adult life to the relationship of a child with his parents and his experiences
in school. Being less independent he has limited opportunity for expressing his own personality and
his life is very much influenced by his parents and the codes set by the school. It is for these reasons
that no investigation and treatment of a child's problems can be successful if we do not study his home
circumstances and take his position at school into consideration. The aid of the educational psychologist
and psychiatric social worker is, therefore, indispensable to a children's psychiatrist. This is quite
a different approach from the treatment of adults, where mental and emotional problems can and should
be only dealt with by the medical psychologist in the seclusion of the psychiatric consulting room with
the security of complete professional secrecy.
The time at the disposal of the child psychiatrist at the Tetherdown clinic is limitea, but he managed
tosee 114 individual cases (including 43 reviews) during the year, compared with 108 (34) in 1965. Seven
children were given more regular psychotherapeutic help by him. while the other children from our long
treatment waiting list were seen by the psychotherapist.
The majority of the 64 referrals dealt with came from the School Health Department and Headteachers,
smaller numbers reached us directly from the Children's Officer, General Practitioners and parents.
While we had less difficulty in finding places for maladjusted pupils in residential schools we were
hampered by the persisting lack of in-patient provisions for autistic children and disturbed adolescents.
A readily available unit for short-term observation of disturbed children of all ages would greatly improve
our present diagnostic facilities.
Enuretic children can, in selected cases, be helped by psychotherapy, but some are more suitable
for treatment by medication or deconditioning by the electrical alarm pads which does not require referral
to this clinic. Many cases referred to us reveal themselves as being due to social problems which do
not really require our more specialised services which are treatment of emotional disturbance and not
management of behaviour problems due to vicissitudes in the material environment or unalterable family
circumstances. This needs to be stressed as a large number of unpromising referrals prevents the
necessary more intensive attention to the urgent psychiatric problems in which we specialise.
Fewer parents failed to take advantage of the referral (seven compared with twenty last year) and.
on the whole, we found the co-operation of parents, family doctors, hospital specialists, heads of social
agencies and other interested departments very encouraging".
Rheumatism Supervisory Centre
The Rheumatism Supervisory Centre operates at the Prince of Wales's Hospital under the overall
direction of Dr. I.M. Anderson, consultant paediatrician, with the close co-operation of the Health
Department. Weekly sessions are held.
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