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The theoretical basis upon which understanding of these problems
restsis essentially psycho-analytic, and it has been found possible
to apply much of the knowledge of the origins of human behaviour
revealed thereby to this work with small children where the
difficulties are in statu nascendi.All the cases seen had
already resisted the therapeutic armoury of the health visitor and,
quite often, of the family doctor.
The feeding problems were found to be the ones which responded
best and it was rare for a child of 10-24 months to continue to be
a feeding problem after three or four weekly half hour interviews.
My impression is that this is because there is quite often a
specific, localised, and fairly easily determined set of factors
at work, with perhaps a single instinctual drive as a basis.
The sleep disorders are more difficult, and my way of looking
at it has developed to the point where I regard a sleep disorder
as commonly of a non-specific nature in the same way as a temperature,
or albuminaria, or jaundice in physical medicine. The treatment,
therefore, has involved a survey covering a fairly wide range of
domestic activities and routines in infant and child handling, in
an examination of events in the household preceding the sleep
disorder in question, a study of the emotional attitudes of the
mother and their effect on the child, and quite often and more
difficult, an understanding of the frightening meaning to the
child of what grown ups consider to be ordinary events, As each
facet of the problem is dealt with there tends to be a general
improvement, but any one of these factors which has not been dealt
with in the clinical survey which takes place during the interview
is 1iable to re-stimulate a further sleep disturbance. Therefore
we have had cases which have taken ten or more interviews.
The most serious disturbance which has come to light in the
children seen, of those which it is possible to discuss briefly
here, is that of restless over activity. I have got to the point
of considering that it is an indication of a gross emotional
disturbance in the mother and that it may be a disorder in the
child itself as well, or simply a reaction by the child and, of
course, the second of these two has the best prognosis (though
there is no simple way of telling at the original consultation).
It is most disturbing to see this state of affairs in a one year old
child and to realise that in this particularly plastic time when
a tremendous amount of growth and development has yet to take place
the child is already developing mechanisms of behaviour which are
of a grossly pathological type in order to deal with his inner
emotional forces,