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firm control at home. Many were overweight. In fact, more 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 witha variety of most disturbing symptoms,
which at any other age would have indicated serious mental disorder, but seemed to
respond to a minimum of treatment with a complete remission or cure.
Our evening clinic continues to prove its usefulness by facilitating the attendance
of adolescents and working parents, especially fathers. While this weekly session
had been always fully booked, we are less happy that in spite of repeated efforts by
the Child Guidance Team, some twenty cases that had been referred by head teachers or
school medical officers during the year, either failed to attend after having accepted
appointments, or did not respond at all. In many cases the parents had agreed initially
to the referral but had apparently no intension of following this up. As we have a
timetable of appointments which must allow up to one hour for every interview, such
failure to attend without fair notice is most uneconomical and unfair to others on our
long waiting list. Even more time consuming were a number of parents who having
accepted appointments failed to keep them and then required appointments at another
time.
The building of the new Neurophysiology Department at the Whittington Hospital
has enabled us to obtain Electro-Encephalograms locally when required, but we remain
appreciative to Dr. Sakula who until recently provided this service at the Central
Middlesex Hospital. We are particularly pleased with the excellent co-operation we
enjoy from Dr. Yudkin and the Paediatric Department at the Whittington Hospital. It
is very important that the Child Guidance Clinic co-operates with the local children's
hospital to ensure consultation and investigation of doubtful cases, and bladder and
bowel disturbance can be observed in hospital to exclude organic factors before
psychotherapy is commenced. ATurkish Cypriot boy, referred for most aggressive
behaviour in school, turned out to be a most complex case of brain damage, and he
required five different specialist examinations to enable an adequate diagnosis. The
most interesting and unusual referral of two autistic brothers aroused widespread
interest and they had the benefit of the advice from specialists in three different
hospitals before appropriate treatment was arranged by this clinic.