Child Guidance Clinic Research Articles

Childhood antecedents of schizophrenia: developmental sequencing and specificity of problem behavior.

Childhood antecedents of schizophrenia were explored for 148 boys seen in child guidance clinics prior to the onset of adolescent or adult disorders. Those most disturbed in childhood were more likely to be preschizophrenic, and their disturbed behavior was relatively specific to that grouping. Childhood problems with motor coordination and attention were associated with impulsive, inappropriate behavior which led to peer rejection followed by increasing seclusiveness. Clinical grouping of the most disturbed boys produced composite descriptions for four groups.

Evaluation of a Mental Health Service for Young Children: Development, Outcome and Satisfaction.

Over a 10-year period (1984-1996) a child guidance clinic developed a service in the community for parents with young children with mental health problems. This included support for primary care staff and training courses. The clinical input to the young children developed from a clinic within the child guidance clinic (1984-87), to a specialist clinic for under fives (1990-91) to a service run by a nurse in the community (1994-95), with nurses referring to colleagues only the more complicated cases. The work in 1990-91 was compared with the work in 1994-95. The family and clinic scored the outcome of the work, by recording the severity of the problem, separately, on unanchored 5-point Likert scales before and after treatment. For the evaluation in 1994-95 a satisfaction questionnaire was also developed. The cost of running the two different clinics was calculated. The results indicated that there was a slight fall in the effect size for the clinical work in 1994-95, but this method of working was two-thirds of the cost of the previous clinic. The parents were satisfied with both services. The post-contact parental satisfaction questionnaire had face validity, construct validity and internal consistency. Nurses working on their own in the community can be a cost effective method for working with families with young children. Some families will need to be referred on to specialist teams and more work needs to be done to establish which families and when referral is appropriate. The questionnaire was shown to be a valid and reliable way of assessing family satisfaction.

‘At All Costs Let Us Avoid Any Risk of Allowing Our Hearts to be Broken Again’: A Review of John Bowlby’s Forty-Four Juvenile Thieves

In this classic study, Bowlby reports on 88 children seen in the London Child Guidance Clinic during the 1930s. Half of them were referred for stealing, and half for other problems. Bowlby distinguishes several factors which may lead to mal- adjustment, but was particularly concerned with the hypothesis that prolonged separation of the child from the mother in the early years was a causative factor in delinquent character formation. Such separation, thought Bowlby, was especially instrumental in the development of an ‘Affectionless Character’ often seen in the persistent offender. Development of this indifferent, or dismissive pattern of attachment protected these children from forming close, personal relationships, hence eliminating ‘any risk of allowing our hearts to be broken again.’ His first empirical study, Bowlby’s comprehensive and detailed analysis of the 44 thieves ushered in his revolutionary human attachment theory and foretells the enormous contribution of his subsequent career.

Five-Year Review of Adolescent Mental Health Usage in Singapore

Introduction: To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. Materials and Methods: Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. Results: Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. Conclusions: There is a growing demand for adolescent mental health services. As the demands and stresses on today’s youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.

CHILDHOOD ANTECEDENTS OF SCHIZOPHRENIA: DEVELOPMENTAL SEQUENCING AND SPECIFICITY OF PROBLEM BEHAVIOR

Childhood antecedents of schizophrenia were explored for 148 boys seen in child guidance clinics prior to the onset of adolescent or adult disorders. Those most disturbed in childhood were more likely to be preschizophrenic, and their disturbed behavior was relatively specific to that grouping. Childhood problems with motor coordination and attention were associated with impulsive, inappropriate behavior which led to peer rejection followed by increasing seclusiveness. Clinical groupings of the most disturbed boys produced composite descriptions for four groups.

Adult ADHD: a controversial diagnosis?

Attention deficit hyperactivity disorder (ADHD) is characterised by inattention, hyperactivity and impulsivity with onset in children before the age of seven years. ADHD is the most common disorder presenting to child guidance clinics and has been shown to be a well-validated diagnosis. Current estimates of prevalence range from 1%5%. The concept of adult ADHD as a clinical entity is an emerging but controversial area in psychiatry. While childhood ADHD is accepted as a reliable and valid diagnosis, the validity of adult ADHD as a disorder is unclear. This paper reviews the likely presenting features of adult ADHD and common comorbid disorders. Guidelines for assessment and management are discussed and the evidence for validity of the diagnosis is critically examined.

Comparison of childhood problem behaviors in boys with subsequent schizophrenic, antisocial, and good adult outcomes.

Childhood problem behaviors for 145 boys seen in child guidance clinics were used to compare four adult outcome groups: antisocial men, schizophrenic subjects with good outcomes, schizophrenic subjects with poor outcomes, and subjects with good outcomes. Delinquent and aggressive factor scale scores distinguished the antisocial outcomes from the other groups. A preschizophrenic factor along with lower IQ separated schizophrenics with poor outcome from the others. Subjects with good outcomes had lower scores on factor scales, higher IQ, and less disturbed families. Schizophrenics with good outcomes were the most difficult to identify correctly.

Taming the Troublesome Child: American Families, Child Guidance, and the Limits of Psychiatric Authority

When our children act up - whether they're just moody and rebellious or taking drugs and committing crimes - our solution, so often now, is to send them to a psychiatrist or developmental psychologist for help. What makes us think this will work? how did we come to rely on psychological explanations - and corrections - for juvenile misconduct? In this book, these questions lead to the complex history of guidance, a specialized psychological service developed early in the 20th century. Kathleen Jones puts this professional history into context of the larger culture of age, class, and gender conflict. using the records of Boston's Judge Baker Guidance Centre from 1920 to 1945, she looks at the relationships among the social activists, doctors, psychologists, social workers, parents and young people who met in the child guidance clinic, then follows the clinicians as they adapt delinquency work to the problem of nondelinquent children - an adaptation that often entailed a harsh critique of American mothers, Her book reveals the uses to which professionals and patients have put this interpretation of juvenile misbehaviour, and the conditions that mother-blaming has imposed on social policy and private child rearing to this day.

Child Guidance and the Democratization of Mother-Blaming

adults do wrong? These questions dominated the news after the 1999 Columbine massacre, when two teenage boys opened fire in their suburban high school and killed fifteen people, including themselves.1 As mounting concerns about playground bullies, computer game junkies, and schoolyard shooters lead to frenzied discussions about why children go bad and how society can save them, Kathleen Jones's elegant study of child guidance is a cautionary tale. Taming the Troublesome Child weaves together a cultural analysis of ideas about children, an intellectual history of child psychiatry, and a penetrating discussion of the day-to-day workings of one of the nation's premier child guidance clinics, Boston's Judge Baker Guidance Center, from 1920 to 1945. It is a compelling analysis of the rise and eventual triumph of an exclusively psychological paradigm for explaining children's misbehaviorand a convincing argument for the limits of that paradigm as a solution to juvenile crime and family troubles, both today and in the past. The history of child guidance, as the psycho-dynamic framework for assessing children's problems and preventing delinquency was called, is conventionally studied as part of the professionalization of the child sciences and helping professions, and the philanthropic efforts of the Commonwealth and Rockefeller Funds. While scholars have illuminated many of the class and status issues that guided the founders of child guidance, they have been relatively uninterested in the dynamics of gender and age. By contrast, Taming the Troublesome Child, reflecting the influence of recent scholarship on welfare and women's history, emphasizes the gendered dimensions of expert authority and the client's role in its construction. Focusing on the Judge Baker clinic, Jones describes the creation of child guidance as a collaborative process involving multiple interactions between psychiatrists and social workers, therapists and patients, and parents and children. She also revises the

The influences of family environment on personality traits

In order to clarify the influences of family environment on the development of personality traits, 150 children (104 males and 46 females, mean age 13.2 +/- 2.4 years) who had been interviewed at the Child Guidance Clinic in Osaka were investigated. From 13 behavioral characteristics (activity, talkativeness, sociability, social skills, rule-keeping, will, aggression, emotional control, imagination, anxiety, maturity, intelligence, and neuroticism), factor analysis identified three personality traits: extraversion, maturity, and intellect. The effects of family environment (maternal and paternal participation in child rearing before and after 4years of age, child-rearing style, parental relationship, sibling relationship, number of siblings, birth order, and socioeconomic status) on these personality traits were examined based on a structural equation model. The results found, first, that extraversion was negatively associated with overprotection/interference and with maternal participation in child rearing. Maturity correlated with high socioeconomic status, appropriate child-rearing style, and paternal participation in child rearing. Intellect was related to high socioeconomic status and maternal participation in child rearing. Second, path analysis with selected variables revealed that 8% of variance in extraversion, 14% in maturity, and 10% in intellect was due to family environment. Third, children with high introversion or high intellect had stronger influences from family environment than did those with high extraversion or low intellect.

Against all odds—a personal account of epilepsy

Whilst most 9 year olds were enjoying the fruits of childhood with their own families in their own homes I was thrown into an unwelcome situation which should not be wished upon any child. For the previous three years, since 1970, I had developed severe behavioural disturbances, caused by my epilepsy and its medication. I began with the condition at the age of two, following a bout of measles. My temperature was higher than normal and I was sweating profusely. My breathing stopped and a district nurse gave me the kiss of life. I had further black outs and it wasn’t until I was three and a half that epilepsy was diagnosed and I had to attend ‘H’ Infirmary for treatment. I started at my village primary school and everything was fine but for the fact that I couldn’t sit still or concentrate. I was hyperactive and disruptive as an infant and the medical officers recommended a remedial school that I attended for a year. I returned to my primary school after this before moving up to the middle school. The larger environment proved difficult and my behaviour deteriorated. Other pupils, unable to understand, taunted me about my condition and dared me to do various things, which stupidly I did. For example I spat down a staircase and at one time drank the paint water. The teachers were briefed on my situation, but a female member of staff refused to return to school unless I was expelled. At home I created an intense atmosphere and wouldn’t accept discipline from my parents. When asked to do something I would go into a tantrum and turn my bedroom upside down. I attended child-guidance clinics and they suggested a special school. I had become a leper in my community. Nobody wished to be associated with me. Waiting lists were long for special schools so I was admitted to a children’s unit in a psychiatric hospital. This was the lowest period of my childhood. I was amongst the most difficult children and witnessed some horrific incidents. I myself was no angel but certain medication wasn’t helping. My parents were constantly pressing the consultants at ‘H’ Infirmary to change my drugs but they refused. At Easter time I left the children’s unit with no progression although I had been labelled as ‘a most difficult child’. It was back to square one. I was confined to home and again causing friction amongst my parents, brother and sister. It was difficult for them to take me anywhere, as one of my obsessions was that people were always starting at me, and I often confronted them. My future looked bleak and my parents feared what would become of me. The turning point came through a strange source— a television programme. My parents viewed the documentary featuring a new children’s hospital for epilepsy and other disorders in the Oxford area. My mother wrote to the doctor who had been featured. My GP was annoyed that she had ‘gone over his head’, but granted a referral. I first met the doctor in March 1973 and he was a huge influence. Highly regarded in his field, he went on to become a professor at a top university. He had a no-nonsense attitude and we were happy to be guided by him. His first reaction was to recommend a school for the maladjusted in preference to an establishment like the David Lewis Centre. His second was to gradually reduce all medication (which his northern counterparts had refused to do). My mother visited the education department headquarters and refused to leave without seeing the director of education. Within 12 days I was accepted as a pupil thanks mainly to the intervention of my Oxford specialist. My rehabilitation had begun. I was soon 30 miles from home, in a strange place and I found it very difficult to settle. We broke up for Spring bank holiday and I came home. But when I was due to return I ran away through the fields at the back of the house, my brother leading the chase to catch me. When he did I was returned to school. There were 31 boys when I first arrived but this rose to about 60 shortly afterwards. The purpose of the school was to adapt the pupils to some kind of stability. Only one other pupil had epilepsy. The majority had behaviour and emotional disturbances connected

Developmental and Psychiatric Evaluation in the Preschool Context

This article documents the ways in which a school-based developmental evaluation can be an effective and powerful alternative to the traditional clinic-based evaluation. The child is not taken to a strange new place but observed and evaluated in his or her naturalistic environment. The families have increased access to care, and the foundation is laid for cohesive, trusting working relationships with families and teachers. Children are evaluated in one of two models or a combination of both naturalistic observation and individual direct assessment. Tensions between the clinical and educational system exist, but the early childhood evaluator who educates himself or herself about the cultures and forces at work can build from the strengths of each system to effect positive growth for young children at risk for developmental delays or psychiatric disorders.

The Arm of the School that Extends into the Homes: The Visiting Teacher Movement, 1906 to 1940

This article traces the development of the visiting teacher movement, from 1906 to 1940, with particular attention paid to the disjuncture between professional discourse and actual practices. Three main points are argued. First, early visiting teacher work drew from multiple sources, including social settlements, juvenile courts, private philanthropies, and women's clubs. The discussion of the origins of visiting teachers in multiple urban settings attested to the diversity of their work in communities and in schools. Second, most visiting teachers’ work remained essentially unchanged, despite their later participation in child guidance clinics. Even though visiting teachers worked in conjunction with psychiatrists and psychologists, their practices still relied upon traditional approaches used in the first part of the century. Third, the medical and psychiatric discourses surrounding visiting teacher work in the 1920s and 1930s assumed a powerful life of its own. In a most curious manner, these languages formed a critique of teachers’ social relations with students and of their classroom practices generally. Subsequently, many teacher education programs initiated mental hygiene and psychology courses for their student teachers. The article concludes with lessons educators and policy makers might take from the visiting teacher movement, especially those related to the current school-linked social services model.

Crianças com dificuldade de aprendizagem: um estudo de seguimento

Considerando que dificuldades de aprendizagem são fator de vulnerabilidade no desenvolvimento, intensificadas quando presentes outras condições adversas, buscou-se verificar a associação entre condições antecedentes e ajustamento atual, em adolescentes que quando crianças foram atendidos em um ambulatório de psicologia por dificuldades de aprendizagem. Os adolescentes e suas mães foram entrevistados. Dados referentes às condições de vida na época do atendimento foram obtidos em prontuários. Avaliados 41 adolescentes de ambos os sexos, com idade média de 13 anos e nove meses, foram constituídos dois grupos: G1, com nove adolescentes encaminhados a serviços de Saúde Mental por apresentarem atualmente dificuldades severas de ajustamento; G2, com dez adolescentes apresentando dificuldades mínimas de ajustamento. Comparando os grupos, observou-se maior acúmulo de fatores negativos antecedentes, familiares e pessoais, no grupo de adolescentes com pior ajustamento atual. Torna-se clara a necessidade de acompanhamento psicológico das crianças com dificuldade de aprendizagem associada a outras condições de vulnerabilidade.

The Arm of the School that Extends into the Homes: The Visiting Teacher Movement, 1906 to 1940

This article traces the development of the visiting teacher movement, from 1906 to 1940, with particular attention paid to the disjuncture between professional discourse and actual practices. Three main points are argued. First, early visiting teacher work drew from multiple sources, including social settlements, juvenile courts, private philanthropies, and women's clubs. The discussion of the origins of visiting teachers in multiple urban settings attested to the diversity of their work in communities and in schools. Second, most visiting teachers’ work remained essentially unchanged, despite their later participation in child guidance clinics. Even though visiting teachers worked in conjunction with psychiatrists and psychologists, their practices still relied upon traditional approaches used in the first part of the century. Third, the medical and psychiatric discourses surrounding visiting teacher work in the 1920s and 1930s assumed a powerful life of its own. In a most curious manner, these languages formed a critique of teachers’ social relations with students and of their classroom practices generally. Subsequently, many teacher education programs initiated mental hygiene and psychology courses for their student teachers. The article concludes with lessons educators and policy makers might take from the visiting teacher movement, especially those related to the current school-linked social services model.

The Arm of the School that Extends into the Homes: The Visiting Teacher Movement, 1906 to 1940

This article traces the development of the visiting teacher movement, from 1906 to 1940, with particular attention paid to the disjuncture between professional discourse and actual practices. Three main points are argued. First, early visiting teacher work drew from multiple sources, including social settlements, juvenile courts, private philanthropies, and women's clubs. The discussion of the origins of visiting teachers in multiple urban settings attested to the diversity of their work in communities and in schools. Second, most visiting teachers’ work remained essentially unchanged, despite their later participation in child guidance clinics. Even though visiting teachers worked in conjunction with psychiatrists and psychologists, their practices still relied upon traditional approaches used in the first part of the century. Third, the medical and psychiatric discourses surrounding visiting teacher work in the 1920s and 1930s assumed a powerful life of its own. In a most curious manner, these languages formed a critique of teachers’ social relations with students and of their classroom practices generally. Subsequently, many teacher education programs initiated mental hygiene and psychology courses for their student teachers. The article concludes with lessons educators and policy makers might take from the visiting teacher movement, especially those related to the current school-linked social services model.

Maudsley Community Item Sheet

The Bethlem Royal and Maudsley Hospitals Item Sheet system for registering clinical data generated by psychiatric assessments is long established, with a proven track record as an instrument of scientific research. However, its use has not spread beyond the originating institution, despite being available in the public domain for many years. To address this problem we have designed a modified version of the Item Sheet. The new system has been simplified and improved to facilitate the use of this research aid in child guidance clinics and similar settings.

Bowlby before Bowlby: the sources of an intellectual departure in psychoanalysis and psychology.

John Bowlby's first scientific papers express a viewpoint of the etiology of childhood disorders that gradually developed during his university years and the first years of his professional life. As becomes clear from, among other things, Bowlby's private correspondence, it was the period spent as a student at Cambridge, his work as a teacher at two progressive schools, and his work at a child guidance clinic that allowed him to articulate a view on childhood deviancy that was at variance with the Kleinian variant of psychoanalysis. Bowlby's position as an 'independent' thinker in the British Psycho-Analytical Society can be understood against the background of these intellectual influences.

Bowlby before Bowlby: The sources of an intellectual departure in psychoanalysis and psychology

John Bowlby's first scientific papers express a viewpoint of the etiology of childhood disorders that gradually developed during his university years and the first years of his professional life. As becomes clear from, among other things, Bowlby's private correspondence, it was the period spent as a student at Cambridge, his work as a teacher at two progressive schools, and his work at a child guidance clinic that allowed him to articulate a view on childhood deviancy that was at variance with the Kleinian variant of psychoanalysis. Bowlby's position as an ‘independent’ thinker in the British Psycho-Analytical Society can be understood against the background of these intellectual influences. © 1998 John Wiley & Sons, Inc.

The Value of a Social Work Practicum in Activity Group Therapy

BSW students placed in a child guidance clinic were paired gender-wise and assigned co-facilitation responsibilities of two latency age activity groups composed of children the same gender as the co-facilitators. Preparation included an introduction to Activity Group Therapy through film, readings, and discussion. The students composed their own six-member groups from a pool of candidates referred by the staff. Weekly supervision was held throughout the 32-week duration of the groups. The growth noted in the students by their supervisor through this group practicum is discussed.