CHILDRfl
BIRMINGHAM CONFERS ON PSYCHOTIC
by Robina S. Ado October the Birmingham Association for Mental Health held a one-d; on "The Psychotic Child" which met with such an enthusiaf response that it had to move its meeting place to the larger hall at the Univers1' which was packed with over 600 people. The current keen interest in the subF itself and the imposing names on the programme combined to attract staff ff? child guidance clinics, and from children's departments, teachers and others concert 1 with the care of children, as well as parents themselves. Mrs. Tolley, Secretary the local association and the indefatigable organiser of the conference, must been overwhelmed by her own success. Professor Trethowan (Chair of Psychiatry, Birmingham), made a friendly man who held the conference together and drew out the points for discussion, the Brains' Trust at the end, when he selected from a spate of written questions poi" ^ for the panel of Speakers to answer, he showed his sympathy for the needs of of the of audience and his awareness the complexities subject. Dr. Charles Burns (Senior Psychiatrist, Child Guidance Clinic, Birmingham began by stating that hitherto psychotic children had been grouped with the menta*' defective and we were only beginning to learn to distinguish the condition of the1 "cut off" children, who could make merely selective contact but were capable development. He urged the need for early diagnosis in order to help the pare" accept the nature of the problem, and because therapy can be effective. These chf' ren need to achieve simple human contacts in order to open the doors to percept^, In spite of our lack of knowledge at present, he thought the conference was time in that it would serve to join parents, the public, the authorities and technical stf in pressing for more investigation and further provision. Dr. Mildred Creak (Physician in Psychological Medicine, Hospital for S'? Children, Great Ormond Street), stressed the need to learn from the parents, $ spoke from her many years of experience. In 1958 the Mental Health Reseat Fund gave Great Ormond Street Children's Hospital a grant to make a ten-y?i study of psychotic children. It was necessary to attempt a definition to estimate incidence of psychoses among children, and her working-party of experts had set ol nine points which established in their view the diagnosis of a schizophrenic child.
LAST Conference
ch^J
1.
Gross and sustained impairment of emotional relationships with
people. 2.
Apparent
unawareness
inappropriate
of his
to his age.
own
personal identity
to a
degree
3.
Pathological preoccupation with particular objects or certain characteristics of them, without regard to their accepted functions.
4.
Sustained resistance to change in the environment and a to maintain or restore sameness.
5.
Abnormal perceptual experience (in
striving
the absence of discernible
organic abnormality).
6.
Acute, excessive,
and
seemingly illogical anxiety is
a
frequent
phenomenon. 7.
Speech may have been lost, or never acquired, or may have failed develop beyond a level appropriate to an earlier stage.
to
8.
Distortion in motility patterns.
9. A background of serious retardation in which islets of normal, near normal or exceptional intellectual function or skill may appear. 26
These points can be summed up in escriptive phrase "children who do
re.ceive
the not
or transmit the earliest signals" w'lh all the peculiarities of behaviour which follow. The "refrigerated parent" 111 ay then not receive these signals, or them not understand them. Anus "coldness" may be the only way of lv'ng with a disintegrated child, and the Parent had become "refrigerated" in
Reiving
Self-defence.
^r-
Creak urged
a "remorseless follow of these children, and ln the histories, found evidence 0 studying Very severe neglect or inadvertent neglect. It seemed that children with an lr,telligence quotient in the lower 80s particularly liable to succumb to "ese conditions. They may form a sPecial group of psychotic children. She ^eried whether there was brain damage ?r injury to the central nervous system. n any case she thought cases should be plcked up earlier and more provision made for them.
UP to learn
more
J!ere
an infant in order to live through a more satisfactory experience. E.C.T. and drugs might alleviate symptoms and make communication easier, but what is needed is a therapeutic environment based on warmer relationships throughout the twenty-four hours. Factors contributing to the condition are multiple, but the
way of entry to communication with the
patient is through the environment. Parents'
Viewpoint
parents' point of view was eloquently expressed by Mrs. Judy Fryd, The
Editor of "Parents' Voice". She described the plight of her own daughter and the years of difficulty she had experienced in
finding adequate help
and
treatment.
Now parents of
'J^udsley
psychotic children were banding together to press for more and better investigation provision. Groups had been formed within the National Society for Mentally Handicapped Children and were helping each other by arranging discussions, publishing a Bulletin and planning nursery centres for psychotic children. The Society for Autistic Children had also
^ychotic
starting
Dr.
Kenneth
Cameron (Consultant Bethlem Royal Hospital and Hospital) said that minimal ra'n damage may play a part, but children are to be found r?ughout the whole range of intelli\ typical history was that of the ild who had developed normally until e age of two years, was responsive and Passed the usual milestones, perhaps ered some stress and was un-
hysician,
been formed in an ambitious scheme for a centre for such children.
Mrs. Fryd gave voice to the sense of and helplessness felt by many mothers who are painfully aware of their child's divergence from normal development and who struggle to achieve recognition of their need only to be told there is no provision for such cases. The psychotic child required education in so far as she was able to respond, as well as treatment, and both had to be adapted to his failure to communicate. In most parts of the country provision was nonexistent. Failure to provide for an early diagnosis, inadequate care in investigation, unfair condemnation of the mother; all such criticisms were evidence of the frustration parents felt in seeking help with their acute problem. Mrs. Fryd spoke for those who are usually not heard when the problem of the psychotic child is discussed. The possibilities of treatment and its particular difficulties were vividly illustrated in the films which Dr. Gerard
gence.
inadequacy
^
c?rnforted,
went
withdrawal ^ct've nd
through
a
period of
and then made a slow
Perhaps partial
This is in recovery. the storv of the continuous development of the mentally Warded. In spite of the difficulties and angers of an early diagnosis, he would that a diagnosis should be
to ^?ntrast ?Wness of
^v?cate made.
Treatment
.
depended on an understandpsychological developent> his gradual differentiation between ? Self and the non-self (here tribute was
8 of the child's
|r!d n's
?
to the late Mrs. Norman's work in
field), deling.
and the internal components The patient must be met at 'evel of experience and he needed an aggeration of maternal care. Perhaps e s'ck child may need to be treated as
's
27
Special
in Child Psychiatry, These had been used in the television programme "Lifeline" but additions were given at the conference. Pictures of boys of three, six and sixteen years old illustrated the lack of contact and communication, the odd behaviour, and the selective perception. It was encouraging to find progress, and the oldest boy, though still worried, eccentric and occasionally anti-social was able to take his place at a grammar The fact that three times as school. many boys as girls fall into this category, and the physical resemblance of some of the psychotic children, made Dr. Vaughan think there is a genetic basis.
Vaughan (Physician
Basic
requirements
new
(c possibili1
urgently required
lead Gradually from the different contrib1) tions emerged a picture of the psycho^ child, differing from the subnormal wj? which it had long become confused, wi( criteria for diagnosis now being esta^ lished and experience of education3,1
Inspiring
environmental
and
Claims for
experience, recogni-
more
psychotherapeut'
encouraging result special provision
treatment which gave
psychotic children, for research and cof
tion of achievement, and responsibility. The child can dare to progress only if he has the support and encouragement of a warm
were
where suitable of transfer to schoolsThe Parents of Autistic Childf1 ^ Society asked which authority should responsible for the education of psycho*1 children?Health or Education? Shou'1 children ^ all non-communicating grouped as a special class of handicap The advantages of keeping education treatment in the foreground were obvio^ but it was realised that psychotherap was also needed. Dr. Creak paid a tribute to the Rudo' Steiner Schools which could provide therapeutic environment for these cbiW ren because they were based on fafl$ units.
Dr. Kellmer Pringle (Senior Lecturer in Education and Deputy Head of the Department of Child Study, University of Birmingham Institute of Education) brought in the new possibilities of education for the handicapped. As with normal children, learning is possible only if emotional and psychological needs are satisfied. She gave four basic require-
ments?security,
units
psychotic children, with the
Guys Hospital) displayed.
centrated effort were convincingly ma^ The enthusiasm of the speakers worki"' with these children was matched by $ enthusiasm of the audience. The Bin" ingham Local Association is to be cof gratulated on the inspiring lead it bf * given to serious study and co-operation a growing field of urgent importance.
relationship.
After describing the fascinating case of a psychotic boy, which she had followed over twelve years, Dr. Pringle made a specific plea for ?80,000 to finance a three years' study based on small day units where a team led by an educational psychologist would have scope for full investigation and educational treatment of a few selected cases of psychotic childShe believes that such children may ren. need prolonged educational training, perhaps to the age of 22 if they have missed much schooling. The question of whether psychotic children should be segregated or attend ordinary schools was raised at the Brains Trust. It was agreed that where possible they should join the ordinary stream, but as they required individual attention large classes were contra-indicated. They were not likely to do well at the slow pace of E.S.N, schools because they need stimulus for the moments when they can work.
Discussion point M. Morton Hunt's paperbd'c' book, "Mental Hospitals", quotes P Henry Brill, director of Pilgrim Stfl1' Hospital in New York on the crim1 rate of former mental patients: "Though it may surprise you, tfe ex-mental patient is more law-abidif1 than the average citizen by sever2 hundred per cent". Dr. Brill cited study of 5,000 ex-patients whic^ showed that the arrest rate of thos1
?
with no previous arrest twelfth that of the
general population". 28
was
only
ofl1
correspond^-
BIRMINGHAM CONFERS ON PSYCHOTIC
by Robina S. Ado October the Birmingham Association for Mental Health held a one-d; on "The Psychotic Child" which met with such an enthusiaf response that it had to move its meeting place to the larger hall at the Univers1' which was packed with over 600 people. The current keen interest in the subF itself and the imposing names on the programme combined to attract staff ff? child guidance clinics, and from children's departments, teachers and others concert 1 with the care of children, as well as parents themselves. Mrs. Tolley, Secretary the local association and the indefatigable organiser of the conference, must been overwhelmed by her own success. Professor Trethowan (Chair of Psychiatry, Birmingham), made a friendly man who held the conference together and drew out the points for discussion, the Brains' Trust at the end, when he selected from a spate of written questions poi" ^ for the panel of Speakers to answer, he showed his sympathy for the needs of of the of audience and his awareness the complexities subject. Dr. Charles Burns (Senior Psychiatrist, Child Guidance Clinic, Birmingham began by stating that hitherto psychotic children had been grouped with the menta*' defective and we were only beginning to learn to distinguish the condition of the1 "cut off" children, who could make merely selective contact but were capable development. He urged the need for early diagnosis in order to help the pare" accept the nature of the problem, and because therapy can be effective. These chf' ren need to achieve simple human contacts in order to open the doors to percept^, In spite of our lack of knowledge at present, he thought the conference was time in that it would serve to join parents, the public, the authorities and technical stf in pressing for more investigation and further provision. Dr. Mildred Creak (Physician in Psychological Medicine, Hospital for S'? Children, Great Ormond Street), stressed the need to learn from the parents, $ spoke from her many years of experience. In 1958 the Mental Health Reseat Fund gave Great Ormond Street Children's Hospital a grant to make a ten-y?i study of psychotic children. It was necessary to attempt a definition to estimate incidence of psychoses among children, and her working-party of experts had set ol nine points which established in their view the diagnosis of a schizophrenic child.
LAST Conference
ch^J
1.
Gross and sustained impairment of emotional relationships with
people. 2.
Apparent
unawareness
inappropriate
of his
to his age.
own
personal identity
to a
degree
3.
Pathological preoccupation with particular objects or certain characteristics of them, without regard to their accepted functions.
4.
Sustained resistance to change in the environment and a to maintain or restore sameness.
5.
Abnormal perceptual experience (in
striving
the absence of discernible
organic abnormality).
6.
Acute, excessive,
and
seemingly illogical anxiety is
a
frequent
phenomenon. 7.
Speech may have been lost, or never acquired, or may have failed develop beyond a level appropriate to an earlier stage.
to
8.
Distortion in motility patterns.
9. A background of serious retardation in which islets of normal, near normal or exceptional intellectual function or skill may appear. 26
These points can be summed up in escriptive phrase "children who do
re.ceive
the not
or transmit the earliest signals" w'lh all the peculiarities of behaviour which follow. The "refrigerated parent" 111 ay then not receive these signals, or them not understand them. Anus "coldness" may be the only way of lv'ng with a disintegrated child, and the Parent had become "refrigerated" in
Reiving
Self-defence.
^r-
Creak urged
a "remorseless follow of these children, and ln the histories, found evidence 0 studying Very severe neglect or inadvertent neglect. It seemed that children with an lr,telligence quotient in the lower 80s particularly liable to succumb to "ese conditions. They may form a sPecial group of psychotic children. She ^eried whether there was brain damage ?r injury to the central nervous system. n any case she thought cases should be plcked up earlier and more provision made for them.
UP to learn
more
J!ere
an infant in order to live through a more satisfactory experience. E.C.T. and drugs might alleviate symptoms and make communication easier, but what is needed is a therapeutic environment based on warmer relationships throughout the twenty-four hours. Factors contributing to the condition are multiple, but the
way of entry to communication with the
patient is through the environment. Parents'
Viewpoint
parents' point of view was eloquently expressed by Mrs. Judy Fryd, The
Editor of "Parents' Voice". She described the plight of her own daughter and the years of difficulty she had experienced in
finding adequate help
and
treatment.
Now parents of
'J^udsley
psychotic children were banding together to press for more and better investigation provision. Groups had been formed within the National Society for Mentally Handicapped Children and were helping each other by arranging discussions, publishing a Bulletin and planning nursery centres for psychotic children. The Society for Autistic Children had also
^ychotic
starting
Dr.
Kenneth
Cameron (Consultant Bethlem Royal Hospital and Hospital) said that minimal ra'n damage may play a part, but children are to be found r?ughout the whole range of intelli\ typical history was that of the ild who had developed normally until e age of two years, was responsive and Passed the usual milestones, perhaps ered some stress and was un-
hysician,
been formed in an ambitious scheme for a centre for such children.
Mrs. Fryd gave voice to the sense of and helplessness felt by many mothers who are painfully aware of their child's divergence from normal development and who struggle to achieve recognition of their need only to be told there is no provision for such cases. The psychotic child required education in so far as she was able to respond, as well as treatment, and both had to be adapted to his failure to communicate. In most parts of the country provision was nonexistent. Failure to provide for an early diagnosis, inadequate care in investigation, unfair condemnation of the mother; all such criticisms were evidence of the frustration parents felt in seeking help with their acute problem. Mrs. Fryd spoke for those who are usually not heard when the problem of the psychotic child is discussed. The possibilities of treatment and its particular difficulties were vividly illustrated in the films which Dr. Gerard
gence.
inadequacy
^
c?rnforted,
went
withdrawal ^ct've nd
through
a
period of
and then made a slow
Perhaps partial
This is in recovery. the storv of the continuous development of the mentally Warded. In spite of the difficulties and angers of an early diagnosis, he would that a diagnosis should be
to ^?ntrast ?Wness of
^v?cate made.
Treatment
.
depended on an understandpsychological developent> his gradual differentiation between ? Self and the non-self (here tribute was
8 of the child's
|r!d n's
?
to the late Mrs. Norman's work in
field), deling.
and the internal components The patient must be met at 'evel of experience and he needed an aggeration of maternal care. Perhaps e s'ck child may need to be treated as
's
27
Special
in Child Psychiatry, These had been used in the television programme "Lifeline" but additions were given at the conference. Pictures of boys of three, six and sixteen years old illustrated the lack of contact and communication, the odd behaviour, and the selective perception. It was encouraging to find progress, and the oldest boy, though still worried, eccentric and occasionally anti-social was able to take his place at a grammar The fact that three times as school. many boys as girls fall into this category, and the physical resemblance of some of the psychotic children, made Dr. Vaughan think there is a genetic basis.
Vaughan (Physician
Basic
requirements
new
(c possibili1
urgently required
lead Gradually from the different contrib1) tions emerged a picture of the psycho^ child, differing from the subnormal wj? which it had long become confused, wi( criteria for diagnosis now being esta^ lished and experience of education3,1
Inspiring
environmental
and
Claims for
experience, recogni-
more
psychotherapeut'
encouraging result special provision
treatment which gave
psychotic children, for research and cof
tion of achievement, and responsibility. The child can dare to progress only if he has the support and encouragement of a warm
were
where suitable of transfer to schoolsThe Parents of Autistic Childf1 ^ Society asked which authority should responsible for the education of psycho*1 children?Health or Education? Shou'1 children ^ all non-communicating grouped as a special class of handicap The advantages of keeping education treatment in the foreground were obvio^ but it was realised that psychotherap was also needed. Dr. Creak paid a tribute to the Rudo' Steiner Schools which could provide therapeutic environment for these cbiW ren because they were based on fafl$ units.
Dr. Kellmer Pringle (Senior Lecturer in Education and Deputy Head of the Department of Child Study, University of Birmingham Institute of Education) brought in the new possibilities of education for the handicapped. As with normal children, learning is possible only if emotional and psychological needs are satisfied. She gave four basic require-
ments?security,
units
psychotic children, with the
Guys Hospital) displayed.
centrated effort were convincingly ma^ The enthusiasm of the speakers worki"' with these children was matched by $ enthusiasm of the audience. The Bin" ingham Local Association is to be cof gratulated on the inspiring lead it bf * given to serious study and co-operation a growing field of urgent importance.
relationship.
After describing the fascinating case of a psychotic boy, which she had followed over twelve years, Dr. Pringle made a specific plea for ?80,000 to finance a three years' study based on small day units where a team led by an educational psychologist would have scope for full investigation and educational treatment of a few selected cases of psychotic childShe believes that such children may ren. need prolonged educational training, perhaps to the age of 22 if they have missed much schooling. The question of whether psychotic children should be segregated or attend ordinary schools was raised at the Brains Trust. It was agreed that where possible they should join the ordinary stream, but as they required individual attention large classes were contra-indicated. They were not likely to do well at the slow pace of E.S.N, schools because they need stimulus for the moments when they can work.
Discussion point M. Morton Hunt's paperbd'c' book, "Mental Hospitals", quotes P Henry Brill, director of Pilgrim Stfl1' Hospital in New York on the crim1 rate of former mental patients: "Though it may surprise you, tfe ex-mental patient is more law-abidif1 than the average citizen by sever2 hundred per cent". Dr. Brill cited study of 5,000 ex-patients whic^ showed that the arrest rate of thos1
?
with no previous arrest twelfth that of the
general population". 28
was
only
ofl1
correspond^-
