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Some behaviour problems and their treatment Hood, Jean Archibald 1937

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LE 2 6 7 / 9:«? 7 <r:? SOME BEHAVIOUR PROBLEMS AND THEIR TREATMENT, by Jean Archibald Hood. A Thesis submitted for the Degree of M A S T E R O F A R T S i n the Department of PHILOSOPHY. THE DIVERSITY OF BRITISH COLUMBIA OCTOBER, 1937. Some Behaviour Problems and their Treatments Chapter I, The development of personality. Chapter II. The Child Guidance Clinic and Its Methods. Chapter III. Problem cases. a. Problem cases which appear among children with undesirable personal habits. b. Problaa cases which appear among children with undesirable personality traits. c. Problem cases which appear among children with delinquent tendencies. Chapter IV. Summary. Appendix. Additional case studies. The Development of Personality. Chapter I* Psychologically, the term, personality, connotes a person's entire mental make-up - his intellect, his temperament, his s k i l l , his morality, together with his many other attitudes (i.e. his habitual mode of response.) Each individual has developed a personality of his own; and the differences i n personality are due both to heredity and to environment. The marked differences shorn by infants at birth - differences in size and in general bodily appearance, in anatomical traits, in the sensitivity of his organs, In the conductivity and modiflability of the nervous system (on which the level of intelligence depends), in the strength of the natural urges or so-called "instincts" - are differences due to heredity; but other differences that depend on the individual's experiences, on the way he learns by experience and the way he learns to adjust to his d i f f i c u l t i e s and to his successes, are differences due to environment» Let us look briefly at the way in which an infant develops from birth. He begins, as one psychologist has said, as a bundle of instincts and reflexes. A l l his behaviour (i.e. his responses to stimulation) i s at the automatic, .instinctive level. A sudden loud noise w i l l bring a fear response. Restraint w i l l bring the anger response. He has to learn to see, to hear, to taste; and then, through constant responding to stimuli, he gradually learns to perceive what he sees. His experiences gradually develop their feeling tone. His emotional responses are, at f i r s t , primitive ones. There are differences in the intensity and duration of these responses, owing to the innate differences already mentioned. From the time of birth, the child i s constantly responding to stimulation from the environment; but soon he i s making new responses, not the universal i n s t i n c t i v e ones. He i s learning. He i s growing mentally - i n t e l l e c t u a l l y , s o c i a l l y and emotionally. Whether he w i l l develop into a mentally healthy Individual depends both on the stimulation he i s receiving from the environment and on the responses he i s learning to make to that stimulation. From b i r t h onward, he i s meeting obstacles i n his environment, thwartings of h i s fundament a l urges, p a r t i c u l a r l y of the urge for mastery or f o r s o c i a l approval. Whether he w i l l develop into a well-adjusted, mentally healthy i n d i v i d u a l depends on the response he learns to make to these inevitable thwartings. He may learn to make mentally unhealthy adjustments. Take, f o r example, the r e t i r i n g , non-communicative, daydreaming c h i l d who l a t e r develops into the schyophienic type of patient, with whom our mental hospitals are crowded. He i s not learning to meet h i s thwartings. He i s evading them; and instead of experiencing the f e e l i n g that comes from having successfully surmounted obstacles, h i s urge f o r mastery has been s a t i s f i e d , unhealthily, by daydreaming and building castles i n the a i r . We a l l indulge i n day-dreaming to some extent; but when th i s daydreaming, t h i s shrinking from r e a l i t y becomes our habitual response to any d i f f i c u l t i e s we are encounter-ing, we s h a l l soon be l i v i n g e n t i r e l y a l i f e apart. Our mental hospitals are f i l l e d with such individuals - individuals who have learned i n t h e i r youth to make these unhealthy mental responses to the thwartings of t h e i r urges. If we look around us, we s h a l l f i n d everywhere people who are i l l -adjusted, people of the worrying, overanxious type, people who cannot get on with t h e i r fellows, people who are a n t i - s o c i a l - a l l types of maladjusted personalities of varying degrees of maladjustment. The extremely maladjusted individuals are incarcerated i n our mental hospitals and penal i n s t i t u t i o n s . From s t a t i s t i c s recently available, i t i s conservatively estimated that the mental health of twenty per cent of the pupils in any average class in any average school w i l l be such as to interfere with t h e i r success i n adjustment to adult l i f e , and that four per cent of the pupils in the class w i l l f i n a l l y be committed to mental hospitals. The tragic side of t h i s s i t u a t i o n is that from at least two-thirds to three-fourths of these maladjusted individuals could have learned to adjust to t h e i r d i f f i c u l t i e s In healthy ways had t h e i r trend been recognized during t h e i r early, formative years. Mental i l l - h e a l t h does not develop suddenly. There is generally a long, history of gradual development. I f the signs of maladjustment were recognized i n the early years of development before the unhealthy responses to the thwartings and d i f f i c u l t i e s had become habitual ones, the outlook for a mentally healthy adult population would be bright. With t h i s outlook i n view, c h i l d guidance c l i n i c s have been established during the la s t two or three decades i n nearly every country fo r the purpose of singling out the children who are already beginning to learn to adjust to their d i f f i c u l t i e s i n mentally unhealthy ways, and for the purpose of tra i n i n g them i n learning to make s o c i a l l y acceptable adjustments so that they w i l l develop into mentally healthy adults. This thesis does not purport to give a f u l l psychological treatment of a l l the causes or of a l l the kinds of maladjustment. Some types of maladjustments have been b r i e f l y discussed. It i s rather an account, p a r t i c u l a r l y from the soc i o l o g i c a l point of view, of the work that i s being done at the Pr o v i n c i a l Child Guidance O l i n i c i n Vancouver with children who are already showing signs of faulty adjustment - "problem cases", as they have been cal l e d . I l l u s t r a t i v e cases have been taken from the everyday work of the c l i n i c ; and the general methods of the c l i n i c have been described, The diagnosis and prognosis f o r each case, the suggested treatment and, where possible, the results of the treatment, have been given, A b r i e f summary of some of the outstanding factors i n the cases has also been appended. The C h i l d Guidance C l i n i c and I t s Methods. Chapter I I . The aim of the C h i l d Guidance C l i n i c has been pointed out i n the previous chapter. To help i n achieving t h i s aim, the ideal c l i n i c would have a complete h i s t o r i c a l account of the individual and of his family and connections, and complete medical, psychological and p s y c h i a t r i c a l account of the i n d i v i d u a l . There would be, i n any case study, the diagnosis of the trouble ( the assigning of causes f o r the maladjustment), the prog-nosis or the predicted future development of the individual, the treatment, and a record of follow-up work over a period of years. F i n a n c i a l outlay f o r such a c l i n i c i s heavy. The P r o v i n c i a l Child Guidance C l i n i c i n Vancouver had to s t a r t i n a small way, without much f i n a n c i a l support. I t was established by a group of enthusiastic but already heavily-worked government o f f i c i a l s , looking to "prevention of mental i l l - h e a l t h rather than cure". It has gradually developed, as a government service, to help private individuals or various welfare agencies. The routine procedure f o r the study of any patient entering the c l i n i c i s thorough and exhaustive. Roughly, i t may be said to f a l l into three di v i s i o n s : a study of the person's environment, his mentality and his physical condition. The study of the person's environment must include a review of home l i f e , conditions of school or place of work-with i t s accompanying s o c i a l contacts. This information i s obtained through the various c h i l d welfare agencies or through the s o c i a l workers. The child's mentality i s studied through mental tests, conversation, and observation of the c h i l d at play. The standard mental test at the Vancouver c l i n i c i s the Stanford-Binet. This i s often supplemented with the Porteus Maze test, various association and achievement tests, and, i n the cases of children who are of normal intelligence and yet who are backward i n school, with an examination f o r reading d i s a b i l i t i e s . Obser-vation through conversation i s accomplished through talks with the psychiatrist himself. Observation of the child at play i s generally made by the social worker as the child i s waiting i n the play-room for his turn to be examined. The physical examination i s made by the psychiatrist and nurse. In special cases, specific tests may be procured through the Vancouver General Hospital* F i n a l l y , the writing of the case history i s of great importance. This document must show, i n concise form, the complete history of the patient, and must be available before the examination i s started. The case history f a l l s naturally into sections. The f i r s t of these i s a short, but most important one. It i s a concise statement of the main problems presented by the case. The next section covers a l l the i n -formation with regard to the immediate family and to the family history generally. The personal history of the patient, which follows t h i s , i s necessarily detailed. I t may be divided into four parts. 1. Prenatal conditions. 2® From birth to six years—development including feeding habits, age of walking and talking, age of bowel and bladder control, and a re-cord of any diseases or il l n e s s e s . 3 . From six years to adolescence—a record of school progress, not-ing any retardation or acceleration. Social reactions and personality t r a i t s may be Indicated by such words as " w i l l i n g , stubborn, secretive, friendly", and i l l u s t r a t e d wherever by concrete examples. 4. The period of post-adolescence—an account of further education-a l progress or of economic and industrial a c t i v i t i e s . In t h i s case history, then, the c l i n i c provides the information 7 e necessary before the psychiatrist can make a diagnosis of the trouble and suggest a treatment. Problem Cases. Chapter I I I . "What i s a problem case? The term has a wide application. I t applies at one extreme, to the c h i l d who i s the despair of h i s parents because he refuses to eat the food provided f o r him; and i t applies at the other extreme, to the youth who has taken his share i n a bank hold-up. I t i s used of the boy who i s too quiet and shy to take his share i n the play of his fellows, as well as of the man who believes that the whole world i s against him. In the following presentation of problem cases, only those eases were chosen where f a u l t y adjustments or habits were due to environmental conditions alone. This excludes a l l cases where the mental capacity was subnormal. The cases were then, for purposes of discussion, c l a s s i f i e d under the three types of maladjustment:-(a) cases manifesting undesirable personal habits. (b) cases manifesting undesirable personality t r a i t s . (c) cases manifesting a n t i - s o c i a l ( i . e . delinquent) habits. a. D i f f i c u l t i e s of the f i r s t group seem to occur more often among young children, and seem to spring more often from a single cause than the others. The most usual are: thumbsucking, n a i l - b i t i n g , enuresis, mastur-bation, mannerismsj peculiar food fads, disturbances in sleep. A number of these may be due to physical causes which can frequently be removed. Others are due to mental causes which cannot be changed by physical treatment. Case 1. A t y p i c a l problem i n enuresis i s to be found i n the case of a six-year old boy. He was referred to the c l i n i c by the Children's Aid Society because of enuresis, stubborness and disobedience. The o r i g i n a l trouble was at f i r s t probably a physical problem. Through unwise treat-ment, however, both at home and at school, and through focussing the boy's attention upon h i s d i f f i c u l t y , the trouble had been prolonged several years beyond the point where i t should have ceased. The boy, by p e r s i s t i n g in his c h i l d i s h habit, was able to hold the attention of the family on himself,- to the exclusion of h i s younger s i s t e r . His mental age was 6; chronological age 6 years 3 months; and I. Q,. 9jj. He was a healthy boy, eating well and sleeping soundly. He b i t h i s n a i l s , however, and suffered from persistent enuresis. His teacher re-ported that at f i r s t he spent h i s entire school time i n day-dreaming, a l -though his attitude was improving. Even at school he lacked sphincter control. The teacher, after consulting with the mother who approved of the method of treatment, threatened him with whipping. He enjoyed farm l i f e , and helped hi s f o s t e r father around the grounds. He played with his young s i s t e r , although he thought that she was too young. He was K See footnote at bottom of Page 10. s t u b b o r n and d i s o b e d i e n t , not a f f e c t i o n a t e h i m s e l f , but jeo.lous of a f f e c t i o n shown t o o t h e r s , s u s p i c i o u s , s t o l i d , u n t r u t h f u l and g i v e n t o day-dreaming• H i s f a t h e r , who was f a i r l y i n t e l l i g e n t but l a c k i n g i n i n -i t i a t i v e , worked i n a lumber m i l l * The mother had died, two y e a r s b e f o r e t h e boy was brought t o t h e c l i n i c The f i r s t f o s t e r p a r e n t s , who were i n t e r e s t e d o n l y i n t h e money t h e y would r e c e i v e f o r t h e i r c a r e o f t h e c h i l d r e n , d e a l t v e r y c a s u a l l y w i t h t h e i r c h a r g e s . They were removed t o a f o s t e r home o f t h e Children»s A i d S o c i e t y , There was a s i s t e r a y e a r and a h a l f younger. She was b r i g h t , a c t i v e , n o rmal, and was i n d u l g e d and p r a i s e d . She was fond o f t h e p a t i e n t . I t was suspected t h a t she was h e l d up as an example f o r t h e p a t i e n t t o f o l l o w . The f o s t e r s i b -l i n g s , a g i r l and a boy i n t h e e a r l y t w e n t i e s , f o l l o w e d t h e f o s t e r mother's l e a d i n t h i s d i s c r i m i n a t i o n . The c l i n i c d e c i d e d t h a t t h e e n u r e s i s was t h e p r i n c i p a l problem. The f o s t e r p a r e n t s were t o l d t h a t t h e y had emphasized t h i s f a i l i n g t o t h e boy t o o much. He was t o be g i v e n no d r i n k a f t e r supper, and not t o be admonished f o r f a i l u r e , but r a t h e r t o be rewarded f o r s u c c e s s , Gn no account were t h e y t o speak o f t h e m a t t e r b e f o r e t h e p a t i e n t , nor t o use c o r p o r a l punishement. They were t o show no d i f f e r e n c e o f a t t i t u d e be-tween t h e two c h i l d r e n . S i n c e t h e c h i l d was not r e t u r n e d t o t h e c l i n i c , the treatment was p r o b a b l y s u c c e s s f u l . Case 2. i t second cs.se o f e n u r e s i s was c o m p l i c a t e d w i t h d e s t r u c t -i v e n e s s . T h i s case seems t o be worth q u o t i n g i n f u l l , even a l t h o u g h one * M e n t a l age i s t h e term used t o i n d i c a t e i n y e a r s the mental d e v e l o p -ment o f an i n d i v i d u a l . When t h i s mental age i s p l a c e d over t h e chrono-l o g i c a l age and expressed i n t h e form o f a f r a c t i o n and m u l t i p l i e d by 1 0 0 , t h e r e s u l t i n g f i g u r e i s known as t h e i n t e l l i g e n c e q u o t i e n t ( I . Q.) The I . Q. of a person o f average i n t e l l i g e n c e would t h e r e f o r e be 1 0 0 . other has been given. Here, though there was a physical weakness to be-gin with, that weakness v/as made use of deliberately by an uncomfortable and unhappy boy. Both the father and mother were l i v i n g . The mother however, who was suffering from tuberculosis, had not had the strength to cope with the patient and his younger s i s t e r . In order that they might receive the attention that they required, they were placed i n an i n s t i t u t i o n by the parents. The report from the i n s t i t u t i o n stated that the boy was under weight, and that his sleep was restless. His bed had to be changed every night even when he was taken up every three hours. On one occasion at least, t h i s state of the bed seemed to have been planned, because the boy had pulled up the robber sheet, had tucked i t carefully i n again, and de-clared that the bed was dry. He v/as an untidy, quarrelsome c h i l d , and somewhat of a bully, deliberately destroying the other children's toys. Since he resented c r i t i c i s m , deliberately l i e d and took things from the lockers, he did not get on well with his companions. He had been i n the i n s t i t u t i o n six months when brought to the c l i n i c . When the boy's l i v i n g conditions at the Institution were investig-ated, i t v/as found that he was cold at nights, since he was forced to sleep on an uncovered rubber sheet. He was given quantities of milk at a l l times of the day i n an effort to bring his weight up to normal. The other children, who were told not to play with him because he was a " d i r t y " boy, obeyed instructions. The boy was apparently old enough to realize that his troublesome behaviour was the quickest means of his be-ing returned home. The c l i n i c recommended that he be sent baek to his mother, who v/as better and could cope with him. The mother was told not to mention the enuresis, but to v/atch his time for drinking. She reported that there was an improvement. Case 3. Eating problems, as w e l l as t h i s ,of enuresis, are very often used as a means of a t t r a c t i n g a t t e n t i o n , and even of b u l l y i n g the family i n t o submission to the c h i l d ' s d e s i r e . In the case which follows the c h i l d ' s misbehaviour at t a b l e seemed to be the only method of s e l f expression f o r him, since the normal channels were a l l blocked by over-p r o t e c t i v e parents. The boy was 6 years 5 months c h r o n o l o g i c a l l y , and 6 years 2 months mentally. The I . Q> was 96, The parents reported that he was hard to , manage at any time., but e s p e c i a l l y so at meal time. He had had no i l l -nesses, and has a good a p p e t i t e , but plays with h i s food, t a l k i n g con-t i n u a l l y , throwing h i s hands around and making himself a general n u i s -ances He sleeps w e l l , but i s slow over washing and dressing. He b i t e s h i s n a i l s and becomes tense at times. His moods s h i f t r a p i d l y from those of a l i k e a b l e boy to those of a mean one. Many forms of punish-ment have been t r i e d without any success. Since he has no companions of h i s own age, he contents himself with h i s t o o l s and plays alone. He i s given no allowance, The people he l i v e s w i t h adopted him because they both wanted c h i l d r e n , but had none. The boy does not know that he i s adopted, but they plan to t e l l him i n the f u t u r e . The father i s Interested i n the c h i l d , and reads with him. The mother i s e x c i t a b l e and nervous. A l -though the family was formerly w e l l o f f f i n a n c i a l l y , i t i s not so at the present time. The boy, however, lacks for nothing. I t was f e l t that the boy, with such over-protection, had a protest feeding d i s a b i l i t y . The family conversation which takes place before him shows that a scene i s expected. He enjoys the a t t e n t i o n which he receives and the correction which is attempted. He has no proper play-mates, not sufficient play and no group a c t i v i t i e s . He has no idea of the value of money. He i s inclined to be too dependent, and exhibits negativism. The parents were cautioned not to give him so many orders, and not to be too anxious about, but to let the child express himself' more. They were advised to see that he had playmates his own age, and group a c t i v i t i e s . The follow-up one month later reported that there had been no pro-gress. Meal-time i s s t i l l a signal to the boy to act his worst. The mother claims that they t r i e d the suggestion of l e t t i n g the boy alone, but that he got out of hand completely. He s t i l l has no allowance and no companions. One month l a t e r , the mother states that an allowance has been given him. The boy bought a cheap t r a i n which broke after two or three days. Although the boy says that he w i l l not buy anything so easily broken again, theVmother can see no value i n the experience and claims that the money was wasted. Following this incident, the boy was deprived of one cent from his weekly allowance every time he was bad. There was no allowance l e f t for him by the end of the week. The boy's reaction i s , nI don't care. I was t i r e d of that game anyway." Lessons i n tap-danc-ing were planned to give him group a c t i v i t y , with the promise of gym-nasium classes for the following year. A month later there was further conversation with the mother about the emotional connection between parents and children, for i t was be-lieved that the child was s t i l l being over-directed. It was shown how some parents t r y to l i v e t h e i r lives through the c h i l d , and expect him to go t h e i r pace. Once again the d e s i r a b i l i t y of freedom for the child i n non-ossen t ia l s was s t r e s sed . I t i s thought that there w i l l be no fur ther progress t i l l the parents grasp and act upon these f a c t s . Case 4, S t i l l another case which seems to f i t i n t o t h i s c l a s s i f i -c a t i o n i s that of a seven and a h a l f year o ld boy wi th an I . Q. of 93, Here the undesirable personal habi t which manifested i t s e l f was described as " f i t s of some s o r t " . The doctors thought that they were from p h y s i c a l causes which he would outgrow. The root of the matter , however, seemed to be deeper, and the " f i t s " to be a d i f f e ren t sort of r eac t ion against • o v e r - p r o t e c t i o n . The boy had had convulsions w i th t e e t h i n g , and l a t e r wi th an at tack o f measles. The doctor sa id that the c h i l d would soon out grow such con-v u l s i o n s . The father was dead. The mother, who supported the f a m i l y , was an ardent churchwoman. The boy was a good s leeper , and the doctors thought that h i s " f i t s " were due t o d i e t . Although he was a leader i n p l a y , l i k e d a c t i v e games and had many f r i e n d s , he was miserable at s c h o o l . I l l s f i t s l a s t ed about f i v e minutes, dur ing which time he s t i f f e n -ed out , w i t h h i s eyes r o l l e d backs During the examination at the c l i n i c , i t was noted that the boy had very l i t t l e confidence i n h imse l f , that he looked for someone e lse to get him out of d i f f i c u l t i e s . The mother was warned'not to ,do so much for him, but t o a l l ow him to act on h i s own re -s p o n s i b i l i t y . A year l a t e r the mother reported that she r e a l i z e d how much of t h i s t roub le had been due t o nerves, and that she had t r i e d to a s s i s t him to help h imse l f . He l i k e d h i s school b e t t e r , although h i s progress was s t i l l not outs tanding. The pat ient had announced h imse l f cured a f t e r prayer., and had had no s p e l l s s i n c e . Case 5 , Mannerisms, i f they have no d e f i n i t e p h y s i c a l cause, are nea r ly always the r e s u l t of some inner c o n f l i c t or t e n s i o n . This t ens ion may spring from a desire to hide something, or from a sense of g u i l t , or as a reaction from some outside strain which a child may sense without understanding. Such a case follows. In common with the two previous cases, this problem was created by an over-anxious rriother who tr i e d to protect her son from a l l hard exertion. A boy of 13-|- years of age was brought to the c l i n i c because of the mannerism of eye-blinking. He had had the usual, diseases of childhood. His health habits were good, although he had stuttered and had bitten his nails when he was younger. His school v/ork was "Good, i f he makes up his mind to i t . " His mother reported that " i t takes a lot out of him physically i f he t r i e s too much"* She says of herself, " I f I t r y , I nearly always get a l l I want, but at times the goal has not been worth the effort for what i t has taken out of me." Although she was exceedingly nervous, she had t r i e d to get over the handicap and believed that she had succeeded. It was thought that the boy's nervous mannerism was caused by the tension'which radiated from the. over-anxious mother. She said that she f e l t better after the matter had been explained to her, and that she would have a more steadying influence on the boy. As the tension becomes less , the boy's trouble should disappear. The case i s too recent to show results yet. Problem Oases which Appear Among Children of Undesirable Personality..: 1 -:. b. The second group of behaviour problems i s a large one, i n spite of the fact that such cases are very often not recognized as problems by parents and teachers. The symptoms.are: sensitiveness; seclusiveness, secretiveness, overanxiety, i n a t t e n t i o n , apathy, day-dreaming, f a n c i f u l l y i n g , "nervousness" and a tendency to cry e a s i l y , moodiness, obstinacy, quarrelsomeness, s e l f i s h n e s s , l a z i n e s s . The conditions which cause these symptoms to appear very often l i e In the home. They may spring from a sense of tension and unhappiness be-tween the adults of the household, or from a f e e l i n g of unjust treatment, or from a fear of f i n a n c i a l i n s e c u r i t y , or even from i m i t a t i o n of the grown ups. Sometimes they may have t h e i r o r i g i n i n the c h i l d ' s school l i f e , i n a sense of i n f e r i o r i t y to other c h i l d r e n , or i n e f f o r t which i s unrecognized because i t s r e s u l t s are not so spectacular as those of b r i g h t e r p u p i l s , or they may spring from lack of proper play o u t l e t s . Cases which very often go unrecognized, or, at l e a s t , untreated, are the negative o n e s — s e n s i t i v e n e s s , seclusiveness, excessive day-dreaming. I n a t t e n t i o n . Since these t r a i t s are not a c t i v e l y d i s t u r b i n g to the peace of family or c l a s s , they often escape n o t i c e . However, some cases have : been brought to the c l i n i c f o r treatment. Case 6. A t y p i c a l case, dealing with l i s t l e s s n e s s and i n a t t e n t i o n , was re f e r r e d by parents who were anxious about the boy's school progress, The parents were correct i n t h e i r estimate of the c h i l d ' s a b i l i t y . H i s I. Q. was 115. Although he had made excellent progress up t o grade IV, he had then l o s t i n t e r e s t . He was obedient, but would put f o r t h no e f f o r t . His i n t e r e s t s were i n Meccano toys and a i r p l a n e s . The father was a submissive type who made no attempt at d i s c i p l i n e . The mother was working, and ge t t i n g a good s a l a r y . There was f r i c t i o n between the boy and his brother, aged three, because the baby lost bolts and parts from the p a t i e n t ' s toys. Upon examination, i t was found that the boy's atten-t i o n was ea s i l y gained and well retained. There was a considerable gap i n his school work due to a change of school. Apparently, the c h i l d was not able to overcome t h i s handicap by himself. His mother, who over-directed him. i n everything that he did, hindered him from developing any i n i t i a t i v e . She v/as cautioned that she should give fewer orders, and was advised that the boy be sent to private school where he would be under the guidance of men teachers. Case 7. Occasionally a basic t r a i t which might pass unnoticed has a reaction, which cannot be overlooked. A good example of t h i s follows. A ten year old boy of average intelligence was referred to the c l i n i c for his hard manner. The orig i n of th i s assumed characteristic was to be found i n the attitude of the step father. The c h i l d v/as i l -legitimate. The f i n a n c i a l conditions of the home v/ere good, with the father contributing to the support of the patient. However, the step-father was jealous of the c h i l d , and showed his feelings. The boy had stolen money twice, apparently more from bravado than for the sake of the money* It was from his habit of frequently crying i n secret that his extreme s e n s i t i v i t y v/as discovered. The plan of treatment was for him to j o i n a Scout Troop, and to have a small regular allowance. No further information i s available for t h i s case. Case 8. Sometimes the individual's response to home conditions un-f i t s him for functioning as one of a group. Such a case i s to be found i n the instance of a g i r l whose chronological age v/as 14 years 10 months, whose mental age v/as 13 years 3 months, and whose I. Q. was 96. She had run away from a g i r l s ' camp, and had never been active i n a group. Since the fathei-'s death, the mother, who was a fortune t e l l e r and c l a i r -voyant, had supported the family. There were two sisters and one brother none of whom was unusual. The patient, who had been i l l , expected to keep the centre of the family attention on herself. As she grew stronger and her i l l n e s s no longer gained t h i s for her, she t r i e d other means of making herself noticed, even though they were not approved by the family. Although she was affectionate, she was very reticent about herself. An example of this characteristic was the fact that she did not t e l l the camp director why she refused to swim. As she had had trouble with her ears, she could not go into the water. But although she suffered from teasing among.the g i r l s , and actual punishment from the instructor, she would give no reason for her refusal. The mother believed that the daughter, l i k e the father, had been born under an "unlucky star". The plan advanced was that the mother keep the child active, and that she was not to stress any sickness. Case 9. Sometimes the symptoms are so slight: that they can be classed under the general heading of "nervousness". This f a i l i n g may be intensified by temperamental trends which, as we have discussed, are d i f f i c u l t to a l t e r . Nevertheless, i n the cases studied, the nervousness has been Intensified by strain of some sort i n the home. The case quoted i n f u l l Is a long one, but i t i s interesting as an example of what may be done with a deep-seated and long-standing nervous condition. The g i r l was 16 years 9 months old. Her intelligence was normal. Her d i f f i c u l t y was that she was continually crying and worrying over her homework, her future and social position, her mental condition. Her health was only f a i r . She was wakeful and unrefreshed i n the morning. She ate neither breakfast nor lunch. Since she had weak arches, she wore special shoes. Her father, a professional man i n Europe, contracted sleeping sickness and was refused admittance to th i s country. The mothe i s capable, i n t e l l i g e n t and upright. There are two brothers, one of whom, l i k e the g i r l , i s over-ambitious,, The other i s estranged from the family. When the patient was young, she was.accustomed to a luxurious home. The patient was very musical, Although she was fond of swimming, she f e l t that she had no time for recreation. In her school work, she was anxious to learn. Since she had plodded along over language d i f f i -c u l t i e s , her attainment was below the average. She was so t e r r i f i e d of f a i l i n g , that she would not help in the house i f i t meant that she would have to spare time from her studies. U n t i l two years previously, she was normal and happy. Then she lost the companionship of a friend who had to take care of a sick mother At the same time, family and fina.ncial troubles grew acute, While the young g i r l had these worries on her mind, she was forced to change her school because the trouble with her arches prevented her from walking. There were few v i s i t o r s to the home. Although financial con-ditions were becoming worse, the family sent the patient to a camp for a summer, hoping that her mental attitude would benefit by the change. However, there was an emotional outbreak following a sleep-walking epi-sode—an outburst of rage at the nurse. Obviously camp was not suitable for a g i r l of so unstable a temperament. Even there her mind was f i l l e d with worries about the health of her mother and brothers, and with fears that she would have to earn her l i v i n g i n a menial position. The recommendations and follow-up information are as follows. F i r s t , i t was advised that she be removed from her home and board at the school she was already attending as a day pupil. During this year she passed her matriculation in two subjects. It was in this-summer that the camp episode occurred. After her next v i s i t to the c l i n i c , i t was advised that she board at another school, where she would have outdoor recreation among companions of her own age. There was considerable im-provement here, although the patient s t i l l .worried over her mother's health. After the thi r d v i s i t to the c l i n i c , i t was found, that she did not jo i n i n the various exercises and games of the school because she lacked money and equipment. It was then decided that she should l i v e at home and take as many subjects as she could handle comfortably t i l l she finished her education. Her trouble, the c l i n i c ree.lize'd, was due to her mother's condition. But i t was realized that, i f the patient were removed from home, she would be further upset, and would gradually shut herself off. With improvement, her fears l e f t her, her health built up, and her eating and sleeping became more normal. She i s now happily married to a: man of assured income and good social background. She has moved away from the scene of her former unhappiness and fear. Case 10. A very interesting case was brought to the c l i n i c by anxious parents who did not realize what the real d i f f i c u l t y was. They requested an examination because their son had no idea of play. It was during discussion of the boy that they mentioned casually that the child was incurably s e l f i s h . His mental age was 10 years 4 months, and his chronological age ?;as 9 years 4 months» The mother was a graduate nurse. The father was interested i n his home and children. The s i s t e r , aged seven, was a l i v e l y child who found no d i f f i c u l t y i n keeping herself amused. Although the boy had had two convulsions when he was a baby, his health was good. His class work at school was satisfactory, but he would not play; he refused to jo i n i n any group or team work. I f he had to go.outside, he would stand at the edge of the playground with his hands i n his pockets and with his hat on.. He started swimming lessons, but was afraid of the water. He would not go to Sunday School t i l l his mother took a class i n the same department. The family had catered to him because he was "different". He had a typewriter whieh.he l e f t outside when he f e l t so inclined. He had several printing sets, with which he maile^ a sports paper. He was not much interested, however, even i n t h i s . He liked music, and would read everything he could find. The chief characteristic of the boy was, the parents thought, that he wanted always to be i n command of things. Although he was p o l i t e , he was usually whining about something, or arguing when his temper was aroused. Then they volunteered the information that he was incurably s e l f i s h , and hoarded his money. The treatment suggested was that the boy be encouraged to sifim so that he might get the benefit of the sun, A bat and glove, It was thought, might encourage his playing among the boys. He was to go to League games with his father. It was advised that he join a mymnasium class, so that the competition of games might improve his s e l f i s h ten-dencies. Above a l l , he was not to be given the centre of the stage at home. In the follow up, i t was found that the patient was taking music and dancing lessons for rhythm, had joined a gymnasium class, and was taking advantage of the back yard which had been f i t t e d up for play. (This work had been done for him, without any assistance from him.) He was playing better, though s t i l l not enthusiastically. His parents were now really concerned about his selfishness. He would share nothing, even with his l i t t l e s i s t e r . He accepted i t i n the natural course of events that he should be waited on, hand and foot. The social worker observed that the father had the attitude that his wife was there for the sole purpose of attending to him. It seems l i k e l y that the boy, who i s imitative of the father even to the way he wears his clothes, classes himself as a male creature who i s to be served by the woman members of his household. The original problem, then, has i n great part been removed; but the other problem of selfishness i s not l i k e l y to improve i n the atmosphere of his home. Case 11. Lying may spring from a number of causes, It might occur from an effort to obtain an u n f u l f i l l e d wish. It might be the result of a fear-.of punishment, deserved or otherwise. It might be occasioned by hatred, or a desire to do some person harm i n the eyes of others. But occassionally there Is a case of lying where the causes are so deeply hidden that they are hard to find. Such a case i s to be found i n a l i t t l e g i r l , 6-|- years of age, with an I» Q. of 97. She was reported by her step-mother. Nothing was known of the child's parents. The step-father was dead. There were two step-brothers, aged 18 and 21. The home was a happy one. The child sought the approval of a l l her teachers. Because the other children do not l i k e her managing ways, she has no companions of her own age. She always had some imaginative story to t e l l as truth to anyone who would l i s t e d . One day she reported that the teacher's car had burnt up. Another day she said that the children at school had stolen her apples. It was later discovered that she had thrown the apples av/ay, and the children had returned them to her. She returned home one day from the school, which was about half a mile away, saying that some boys had molested her. She had even torn her clothes to give colour to her story. Later, she told the teacher that her mother starved her. Since the child seemed to have no childish outlets, and, apart from school, was always i n the company of adults, the suggestion was made that the mother take a foster child or two into the home. A year l a t e r , the child was reported as l i v i n g happily with two other children, a g i r l and a boy, who had been taken into the home. The trouble about imaginative lying had disappeared. Case 12. The cause of stubbornness, too, sometimes l i e s i n the home. Selfishness, i n a previous case, was copied from a s e l f i s h father. Subbornness i n a child i s often the result of obstinacy on the part of the parents. By unwise treatment, a child's w i l l may be broken t i l l he becomes apathetic or lacking i n i n i t i a t i v e , or, i t may be hardened into an unreasonable and unreasoning stubbornness. The child who has not had the opportunity for mixing with other children and for having the easy give-and-take of comradship i s more l i k e l y to prove obstinate than the child who has played much with others. An unsympathetic attitude on the part of parents or brothers and sisters may result i n a withdrawal into s e l f and accompanying stubbornness. In at least one case studied here, there seems to be some ground for believing that there might have been some hereditary t r a i t . This case, complicated by violent f i t s of temper, was found i n the study of an 8 year old g i r l with a mental age of 7 years 8 months. The mother v/as married, at the age of fourteen, to a man who v/as so cruel and stubborn that she was forced to leave him. There are three sisters besides the patient. The mother's mother and sist e r both have bad tempers. The child's moods show in her face. During one of her stubborn moods, she w i l l do no school work, although at other times she works extremely neatly. She w i l l p u l l her hair, become furious at her pencil, bite her eraser. She w i l l scream i f she i s corrected. She i s so lack-ing i n team s p i r i t that she deliberately t r i e s to keep her team from gaining points. The mother i s not stubborn, but loses patience v/ith the children and gives i n to them. The older si s t e r has a disposition similar to the patient's, although i t i s not-so pronounced. The younger children are,good natured and easy to handle. .A few months after the original report about the home conditions had been written, information v/as brought i n that.the mother i l l - t r e a t e d the patient, whipping her and marking her back. S t i l l l a t e r , the c i t y nurse believed that the child should be removed from the home, as the mother did not know how to handle her. The suggested treatment was that, since the home situation was not good, (the other children called her "goofy") she would be benefitted by being i n another home where she would be quieter, and where she . would remain for a considerable period. Problem Cases which Appear Among Children with Delinquent Tendencies. C« The th i r d group of problems Is to be found among children who are either definitely delinquent, or, at least, acquiring habits which might eventually lead them into conflict with the lav/. These tendencies are so i n conflict with the lives of the people around them that th e i r faults cannot be overlooked so easily as the less spectacular person-a l i t y trends of the previous group. In this section are the disobedient children—so seriously dis-obedient as to be called•incorrigible. They are the teasing children -who w i l l stop at nothing i n order to have thei r l i t t l e jokes. They are the children who have temper tantrums. They are the braggarts and de-f i e r s of authority. They are the young people who keep late hours and who seek bad companions. They are the children who play truant, l i e or st e a l , who are destructive or cruel to animals or persons, or who i n -dulge i n unusual sex a c t i v i t i e s . The term disobedience covers a number of these misdemeanours such as keeping late hours, seeking bad companions, and defying.authority. Some cases are hard to c l a s s i f y , so numerous are the forms that the d i s -obedience takes. Case 13. A g i r l of sixteen, of average intelligence, was referred to the c l i n i c for refusing to stay at home at nights. She would come i n at any time after midnight and refuse to t e l l where she had been. The family were on r e l i e f , with the mother earning a l i t t l e by washing dishes. The three people l i v e i n two shabby, i l l - k e p t rooms which they have not attempted to make attractive. The g i r l i s healthy and ath-l e t i c , being a good swimmer, baseball and basketball player. She has one special friend who, the parents claim, i s a bad influence because she does not have to be home early. The patient w i l l not read. A l -though she failed her grade six work, she was promoted because of her age. Of a l l her subjects, she enjoyed only Art. Her teachers reported that she would not apply herself. The c l i n i c suggested that the g i r l refused to stay home because i t was so unattractive. Since she had a r t i s t i c a b i l i t y , i t was possible that she might feel more interest i n the home i f she could be persuaded to help make i t more i n v i t i n g . Her ambition was to become a hair-dresser. It v/as recommended that she t r a i n in her chosen work as. soon as possible. Case 14-o Temper tantrums seem to occur most frequently 'among children who are overprotected and "spoiled". In some cases, the c h i l d -ren may outgrow t h i s method of gaining the i r own way. In most instances;, however, they need help In gaining self-reliance. There i s one case of special interest because the tantrums seemed to be the result, not of pampering and indulgence, but of a mental conflict caused by an Irregularity i n the personal l i f e of the mother. The problem v/as found i n a. teen-aged g i r l of normal intelligence. The mother had divorced her husband and v/as l i v i n g with a common-lav/ husband who would not marry her because of the children. He v/as a middle aged man with old-fashioned Ideas about instant and unquestioning obedience. The g i r l s were resentful—"T/hy should we mind him?" He suspected them i f they were out after dark. That t f t e l g i r l s must have known of the relationship i s shown i n their persistent resentment and fai l u r e to obey the man. There were continual quarrels In the house, with the mother undecided, but generally siding with the rnana For one week "neither spoke to us kids," The patient was miserable at home and hated school. She v/as not 27. i notable at school f o r e i t h e r good or bad behaviour. The c l i n i c r e -commended observation i n a foster-home f o r at l e a s t a year. Her r e -actions were normal-to' the family s i t u a t i o n i n the home. Case' 15. The truancy cases studied have a l l had t h e i r causes i n the home5- or i n factors over which the home had c o n t r o l . In one i n -stance i t was a d i s l i k e of the step-mother intense enough t o cause the c h i l d to run away. In two other instances, the c h i l d r e n did not have enough to occupy t h e i r time and energy. The fourth case was one i n which the g i r l had no proper play o u t l e t s . The background of t h i s i n -stance was very s i m i l a r to the ones i n cases 3. and 10, In the f i r s t , a feeding d i s a b i l i t y ¥/as the outcome, i n the second, imaginative l y i n g ; and i n the one quoted, truancy. The g i r l was nine years and four months of age, with an I , Q. of 95. She was i l l e g i t i m a t e , and had been cared f o r by people she r e -membered as her own parents. They moved away, leaving her with other foster-parents, although they took with them a c h i l d of t h e i r own whom she believed was her s i s t e r . She had Impetigo, but apart from that was always w e l l . She was an average p u p i l i n her studies, but her conduct was below average. She was w i l l i n g to do chores, f o r which work she was always p a i d . She was somewhat of a tomboy and l i k e d rough play. . She had no companions of her own age, but enjoyed the society of the foster-mother. She l i k e d to t a l k and t o be the centre of the stage. She would f i t her conversation to the l i s t e n e r . To her, there were no ! I c l a s s d i s t i n c t i o n s . She had a good imagination and a wonderful memory. 1 Her f i r s t truancy .from school occurred when her parents urged her to work harder a f t e r she had brought home a note from her teacher. The ! second truancy took place when she was coming home from her grand- /! I mother's. She was p i c k e d up by t h e New Westminster p o l i c e . The t h i r d t i m e she f a i l e d t o r e t u r n home, she s a i d t h a t she had l e f t h e r bag on t h e s t r e e t - c a r and f e l t t h a t she s h o u l d not go home w i t h o u t i t . She had been t a k e n out of s c h o o l a f t e r t h e f i r s t i n c i d e n t and g i v e n t u t o r -i n g , under which system she m0.de r a p i d p r o g r e s s . A f t e r examining h e r , t h e c l i n i c suggested t h a t she might be s u f f e r i n g from mythomania. She was found t o have d e f e c t i v e v i s i o n . I t was d e c i d e d t h a t she a t t e n d G i r l .Guide camp f o r t h e summer, s i n c e she was l a c k i n g i n p r o p e r p l a y o u t l e t s w i t h c h i l d r e n of her own age. Case 16. One t h i n g e s s e n t i a l f o r t h e normal development o f a c h i l d i s a f e e l i n g of s e c u r i t y . I n the case which follows-, t h e .problem o f l y i n g seems t o have been caused, p a r t l y by f e a r of punishment, but c h i e f l y by t h e l a c k of a sense of s e c u r i t y . So deeply has the f e e l i n g r o o t e d i t s e l f i n the c h i l d ' s l i f e t h a t t h e r e seems t o be l i t t l e hope t h a t t h e problem w i l l be c o r r e c t e d . The boy was n i n e and a h a l f years-'old, w i t h an I . Q. o f 106. H i s d i f f i c u l t y was a f a i l u r e t o a d j u s t i n h i s f o s t e r home, and an i n c u r a b l e h a b i t o f l y i n g . The f a t h e r , a l t h o u g h he v/as a drunkard and gambler who d i d not p r o v i d e f o r the c h i l d , v/as i n t e l l i g e n t and g r a t e f u l f o r t h e c a r e t h e C h i l d r e n ' s . A i d S o c i e t y g i v i n g h i s son. The mother v/as dead. There v/as an o l d e r b r o t h e r adopted by an u n c l e who c o u l d not a f f o r d t o t a k e t h e two c h i l d r e n . A. p a r t i a l l i s t of #his f o s t e r homes f o l l o w s . When th e f a t h e r had pla.cedhim i n someone's c a r e , and de-s e r t e d , t h e c h i l d f e l l t o t h e care of t h e C h i l d r e n ' s A i d S o c i e t y . The s o c i e t y p l a c e d him i n a home v/here he remained o n l y f i v e months be-cause t h e f o s t e r - m o t h e r o b j e c t e d t o m e d i c a l s u p e r v i s i o n . H i s s t a y i n t h e next home l a s t e d f o r s i x months, when he was g i v e n up because o f food-fussiness and enuresis. He had been i n his next home.for two years when he was moved to the home of people who wished to adopt him.- His prospective parents, however, did not wish a boy who talked baby talk and suffered from enuresis. They also resented supervision, and com-pared the child unfavorably with the i r own son. In his next home, where he stayed only two months, he was so unhappy that he was removed. He was seven months in his new home. He had good care and training there along with five other children, three of whom were Children's Aid Society wards. I t was f e l t , however, that the foster-mother was too s t r i c t . He was therefore moved to another home where he so disgraced himself by his untruths that he was removed to the Orphanage after three months. There he was found to be normal, likeable-and mis-chievous 0 F i n a l l y , he was wanted for adoption by a childless couple who were kindly and i n t e l l i g e n t . The boy was underweight, although he slept soundly. His enuresis, which had stopped for the last four months, was due to laziness. A l -though he had shown himself to be a fussy eater i n his foster homes, he ate'well while.in the Orphanage. His progress i n school was normal-, but he was not 'ambitious. He did not l i k e strenuous games-, but was fond of badminton, reading, music, mechanical toys. His companions were usually younger than himself. He had l i e d continually from the age of seven. There was a ques-t i o n as,to whether his-habit might have original ed•from a fear of pun-ishment. His foster home at that time was unsatisfactory. He register-ed no emotion, and seemed unimpressed when scolded. It was possible that his indifference might be due to the number of adjustments that he had had to make. Since he regarded the f i r s t adoption home as his own, he might have been h u r t at h i s abrupt l o s i n g o f i t . He enjoyed a t t e n t i o and a f f e c t i o n 5 was generous and u n s e l f i s h , but would misbehave behind, t h e g u a r d i a n ' s back. I n s p i t e of h i s happy-go-lucky n a t u r e , h i s f i r s t r e p l y t o a p r o p o s i t i o n was "no". The t r e a tment recommended x>ia& t h a t he be moved t o h i s new a d o p t i o n home where he would be the o n l y one i n t h e home, and where he would have u n d e r s t a n d i n g f o s t e r - p a r e n t s . Perhaps here he c o u l d b u i l d up a " c e n t r e " f o r h i m s e l f . A d o p t i o n was not recommended. The f o s t e r - m o t h e r took him. Because she was a f r a i d t h a t he would be h u r t , she kept him from p l a y i n g w i t h o t h e r boys. A l a t e r report, s t a t e d . t h a t he was e s t a b l i s h e d i n h i s foster-home. There i s no.marked improvement, except t h a t he i s p l a y i n g w i t h t he boys more. Case 17. S t e a l i n g , whether s e r i o u s or p e t t y t h e f t , i s one of the most common d e l i n q u e n c i e s . A g a i n , w i t h v e r y few e x c e p t i o n s , t h e causes o f t h l s j . d e l i n q u e n c y l i e i n t h e home. Unhappy or a n t a g o n i s t i c homes, l a c k of adequate s u p e r v i s i o n and t r a i n i n g make f e r t i l e ground i n which t h i s f a u l t may f l o u r i s h . The unhappiness may s p r i n g from an unrewarded attempt t o p l e a s e an unsympathetic and e x a c t i n g p a r e n t . I t may be g r i e f f o r t he l o s s o f a mother. I t may come from a sense o f u n f a i r n e s s . I n some c a s e s , so g r e a t i s . the t e n s i o n t h a t t h e c h i l d commits a t h e f t s e r i o u s enough t o p l a c e him i n t h e I n d u s t r i a l S c h o o l . The f o l l o w i n g , however, i s a t y p i c a l case i n which a f o s t e r home was thought t o be adequate t o remedy t h e s t e a l i n g . A t w e l v e y e a r o l d g i r l , of I . Q. 106, was r e p o r t e d f o r s t e a l i n g . H e r - f a t h e r was a. good workman* Her mother was u n t i d y and apt t h e s h r i e k and nag. She b e l i e v e d t h a t t h e p a t i e n t was a " r o t t e n a p p l e " , and would never improve. She always expected the w o r s t . There were two s i s t e r s and three brothers, a l l normal. The patient's behaviour at school mid Brownies was good. At home, however, money was always missing. The patient was remarkably generous. She was the cause of contention i n an otherwise peaceful home. The c l i n i c believed that she would be be t t e r o f f i n another home, as the unsympathetic a t t i t u d e i n her own would probably hold her back. However, since she had been improving a l i t t l e , i f the parents so de-s i r e d , she might be given a fur t h e r t r i a l where she was. When the d i f f i c u l t y f i r s t arose, the family finances were low; now they were more adequates Case 18. One case of s t e a l i n g which was brought forward was due, not to f a u l t y home c o n d i t i o n , but to a reading d i s a b i l i t y , . Because i t exemplifies the occasional p h y s i c a l background of delinquency, i t i s worth quoting i n f u l l . A boy 7 years 8 months of age, and I.Q, 91, was brought to the c l i n i c f o r s t e a l i n g . His health was only f a i r . His schooling had suffered because he had l o s t several months on account of h i s poor p h y s i c a l c o n d i t i o n . His teacher reported that he had t o be encouraged, or that he would f a l l behind. Some days he seemed a l e r t ; others, he could not concentrate. He was fond of animals and books. He was popular, and played with w e l l -mannered boys of his own age. He had taken pennies, which he said were given t o him. Later, he took a k n i f e , and then various amounts of money with which to buy things that he wanted. The store-keeper was warned not to s e l l anything t o him. He was s e n s i t i v e , dependable and fond of company; he neither held a grudge, nor showed o f f , although he was i n c l i n e d to day-dream. The mother was at that time unable to have the boy with her, His home was a Children's Aid Society foster-home where he was comfortable and well cared for, along with three other wards of that Society. The c l i n i c a l diagnosis of the case was that the boy v/as suffering from a serious reading d i s a b i l i t y , and that he needed special i n -struction. The stealing was a substitute for his complex concerning his schooling. Case 19. The cases of stealing which pass through the Juvenile Court and Industrial Schools are very numerous. As typical instances, the following are appended. A boy was sent to the c l i n i c by the Children's Aid Society because he stole, l i e d and was generally unreliable In foster homes. He was transferred to the School. He was given every'help, and stayed longer than necessary i n order to f i n i s h his grade eight work. He then went to his father who was working some distance away from any c i t y . The boy did well there, u n t i l the father became so exacting that he drove his son away. The l a t t e r went to the towns looking for work. He met some men who gave him some stolen clothes. A l l innocently, he wore them down the main street, and was taken i n charge by the police. He was sent for ten days to Okalla, and then sent back to the School. When he l e f t there, he found work i n the lumber camps. He s t i l l writes to the School, and seems to be doing.well. Case 20. Another boy, whose mother had died, at the age of seven stated his intention of becoming a bold, bad bandit. Since he did not have the courage to f u l f i l , his ambition himself, he contented himself with encouraging others to do what he wanted to do. He was not popular with the other boys. Since the School found-, plenty of work for him to do, he f i n a l l y pretended that he was crazy. So successful was his pre-tense that he was sent to a mental hospital for observation. When the fraud was discovered, he was then sent back to the school, where he made a general nuisance, of himself. He was out for two years, and then was returned for questioning. Although he i s s t i l l blustering, the author-i t i e s have not been able to connect anything definite with him. - He has now come to the point where his great need i s to build up his s e l f -confidence, so that he can transform his high-sounding phrases into concrete and acceptable action. Case 2 1 • A t h i r d boy who was sent to the school for stealing found i t very hard to settle down and become a reasonable c i t i z e n . When he l e f t the School, he joined his father i n the i n t e r i o r . It i s unknown whether his father was too s t r i c t with him or not, but, at any rate, the boy ran back to the School. He was then sent to his mother, who kept him a public school for six weeks t i l l the police sent him back to the School. The supervisor reports that, although they cannot build him up physic-a l l y , he i s more, stable than when he came. Case 22. S t i l l another boy was a Juvenile Court case. He had been charged with petty p i l f e r i n g twelve different times, and also with the theft of a. car. He was physically perfect, and would do nothing to abuse his body. He ran away from the School i n a "borrowed" speed boat. He was then kept under close supervision t i l l he settled down, worked with the others and became reasonably contented. When he could not find work on his dismissal, he helped himself to a car so that he could try his luck Inland. He was returned to the School, where he again proved himself a natural leader, both i n the gymnasium and i n the class and shop. The second time he was released he went home, where, his family report, he has completely changed. He i s now i n a Forestry camp, where he i s constructing, i n his spare time, a wrestling ring for the amusement of the men, Case 23, The last case i s of a boy, 9 years and 3 months old, who had a penchant for taking other boys' bicycles. After he had "borrowed" six i n one week, and had failed to return two of them, leaving them where he had finished with them, he was sent to the School. His father, who had worked steadily t i l l his wife's death, was drinking heavily, correcting his two boys spasmodically and indifferently. The older brother who was better behaved at this time, was ashamed of the nine year old. The two boys prepared t h e i r own meals whenever they f e l t hungry, went to bed when they were rea.dy, and allowed t h e i r two roomed shack, •it. that had been clean while the i r mother l i v e d , become f i l t h y . The young boy became the favorite with the boys at the School, during his eighteen months there. On his release he was placed i n a foster home i n a farm-ing d i s t r i c t . Twice he ran away back to the School so that he could be \yith the" boys. Following t h i s , he bought a. bicycle, did well for a time, and then went wild again. The foster home was too quiet for him after the. companionship of f i f t y other boys. However, he has settled down f a i r l y well now, and should do wett. Some of these cases could have been handled successfully outside of the Industrial School altogether. In the case just quoted, the older brother, who became a problem after the younger brother had l e f t , was dealt with s a t i s f a c t o r i l y i n a foster home. Although that home is s t i l l not far enough away from the father's influence, the boy had greatly Im-proved. The brother, on the other hand, whose desire for a bicycle was so strong that he would go any lengths to f u l f i l i t , became i n i n s t i t u -tionalized ca.se who found i t d i f f i c u l t to settle back into normal l i f e . I t would seem, then, that the removal of strain end tension i n the -lives of these potential delinquents may be the remedy. For the simpler cases, a foster home under wise supervision i s sufficient to resolve the problem. For other cases of long standing which need con stant training and supervision, the Industrial School offers the best training* Summary from Case Studies. The cases f u l l y outlined and discussed i n the foregoing chapter were chosen as i l l u s t r a t i v e cases from three hundred that had been ca r e f u l l y studied. A l l the children were so-called "problem cases" -children who were not adjusting h e a l t h i l y and acceptably either to t h e i r own limitations or short comings or to the thwartings and obstacles i n the i r environment - children who would, i n l a t e r l i f e , be expected to be more seriously maladjusted. Their habits i n responding i n s o c i a l l y unacceptable ways were already being formed. What were the l i m i t a t i o n s or thwart ings with which they were faced? In the f i r s t group of cases, we f i n d that some of the children had physical d i f f i c u l t i e s ; and because the urge f o r s o c i a l approval was being thwarted by these d i f f i c u l t i e s , the children were compensating for t h e i r feelings of i n f e r i o r i t y by responding (behaving) i n unacceptable ways. In a l l the other cases i n this group, we f i n d that the d i f f i c u l t i e s or obstacles l a y i n the home relations - tension on the part of the parents, over di r e c t i o n and over-anxiety by adult members of the family. In one case, a c h i l d had formerly been the centre of attention i n the family because of i l l - h e a l t h , was now well and,consequently, no longer the centre of attention. Since h i s urge f o r s o c i a l approval was no longer being s a t i s f i e d , he was gaining attention by responding i n undesirable ways -undesirable as f a r as his future development was concerned. In the second group of cases we f i n d that, although the d i f f i c u l t i e s and obstacles that the children are facing are p r a c t i c a l l y the same, these children are responding i n ways different, but equally undesirable. They are developing such habits as selfishness and l y i n g rather than personal habits such as n a i l b i t i n g , mannerisms, feeding d i s a b i l i t i e s . In the t h i r d group of cases, we s t i l l f i n d d i f f i c u l t i e s i n the home, as i n the other two groups, hut we also f i n d other d i f f i c u l t i e s , though here again i t i s the urge f o r self-approval or mastery that i s being thwarted. Take, f o r example, the boy with the reading d i s a b i l i t y . Since the urge for mastery was thwarted, he s a t i s f i e d i t by stealing and other a n t i - s o c i a l a c t i v i t i e s . From this b r i e f summary of cases, i t may be seen how i t i s that children learn to respond to the d i f f i c u l t i e s which they are constantly encountering. The c h i l d who is not a problem case i s one who i s learning to adjust i n a mentally healthy way. Our problem case children are learning to respond i n so-called "unhealthy" ways'. The discussion of our cases shows that this l a t t e r group.can be trained to develop habits of adjustment that w i l l help them to be successful i n adult l i f e . Only by detecting signs of maladjustment i n the early formative years can we hope to develop a well adjusted race of adults capable of functioning up to the f u l l extent of t h e i r inherited capacities. Our Child Guidance C l i n i c s are helping towards t h i s goal. 39. Appendix, Additional Case Histories. >^  Case 24. Problem—lack of i n i t i a t i v e . Case 25. I.Q. 96. Chronological age 6 years 7 months. Health-- Spinal meningitis makes her feet droop as she walks. She had a poor appetite. Habits. W i l l not sleep by herself—Cannot dress herself, a l -though she helps a l i t t l e . Has no interest i n school, and cannot be taught punctuality. Is taken to school by parent. The teacher has to see that she eats lunch. Does not make friends on own i n i t i a t i v e , but only i f they go to her. Ho tantrums, and no deliberate disobedience, but simply lack of obedience. Is de-pendent rather than affectionate. Family— One brother, aged three, referred at the same time for temper tantrumso Treatment—Both children badly over-protected. The g i r l demands too much of parents* attention and help. They were cautioned to let her do more on her own—gradually to shorten the distance they took her to school, and the time spent with her at night. Problem—Completely negative personality, and the physical trouble of enuresis. Cronological age—7 years 6 months. Mental age 6 years 6 months. (The boy's mental age would ordinarily leave hirn outside the restricted group used for this study. However, the person giving the test made a note that the rating was not valid because the patient was frightened.) History—The father had deserted. The mother drinks and smokes heavily. Two brothers and two s i s t e r s , one subnormal. Home conditions—Vei-y l i t t l e known, except that there i s poverty. Habits—Enuresis apparently hopeless. There i s no attempt made at school work. Patient i s s t i l l i n grade 1 . Has never been heard to form a complete sentence. P l a n — Fo st er-h ome. Case 26 a Problem— Fear and nervousness; fear of the dark, fear of being alone, fear of anything new, Y H i s t o r y — Father no longer able to work. .'' f The mother fights a l l the boy's battles, threatening the playmates with the police " i f they don't treat my boy right.' 1 H a b i t s — Eats what he l i k e s , and vomits what he d i s l i k e s . Can not be trusted to stay in bed, but weeps and whines. Is up ten or twelve times i n the night. He needs con-stant prodding to accomplish anything. Can play only as a much younger child would. Cries when anything . happens to him, and complains that he i s picked on. He i s at a sanatorium, and i s notices.bly worse after a v i s i t from his mother. Treatment-The boy i s badly over-protected, and uses his fears to hold the centre of the stage. I f he should be kept where he i s , the mother should not v i s i t him. Case 27. Problem— A g i r l with nervous fears. j S J i i s t o r y — Father of.uncertain temper—had deserted. Mother bright and attractive. Two older brothers, both normal, and one brother re-ferred at the same time for being nervous and i r r i t a b l e and hard to manage. H a b i t s — She was nervous about school, and wakened early for fear that she would be late. She would not eat with strangers. Mother thought that she would help the situation by sending the child to the Fresh A i r Camp, but patient had to be sent home because she refused t o eat. Treatment-The boy's school should be changed, since he was back-ward , and.regarded as a nuisance where he was. The g i r l should be given normal outlets, and play with children of her own age. Case 28: ) Problem— Boy referred for crying and nervousness. Age 12 years; I. Q. 109. H i s t o r y — Father was worried about the boy because several of the maternal family had committed suicide. Father often makes fun of son for being a cry-baby. School— Private school. On one occasion, was to tales part i n a play, but came home before i t started, '{[hen asked for explanation, he rationalized his actions. Was told that, as eldest of the family, he had responsi-b i l i t y . He went and enjoyed the play. Treatment-The boy should be encouraged i n sports and other accomplishments so that he w i l l compensate w i l l and feel at home in the presence of others. Follow-up—A report that the father has stopped jeering, and that the boy should do well with the co-operation of his parents. Case 29. Problem— Two brothers referred for nervousness. Chronological age; 12 years, I. Q. 123. He was over-anxious to co-operate i n the psychometric test, and became flustered when he could not understand what was wait-ed of him. H a b i t s — Sleeps w e l l — i s mechanically minded—is depend-able. His brother, although younger, i s t a l l e r , and the older brother feels i n f e r i o r . Chronological age of brother, 9 years 3 months; I. 0. 126. H a b i t s — Cries too easily; Day enuresis for a while, but trouble has cleared up now. He has many friends. Fie i s mechanical and neat, where the brother i s not. He i s the youngest, and trades on that fact. Treatments—The two should be encouraged i n group play and i n the learning of different games. They should j o i n Cub or Scout movements. Academically, their future w i l l present no problems, but they should be en-couraged i n physical exercise to even up their personalities. Case 30. Problem— Boy referred for nervousness and i r r i t a b i l i t y . Chronological age 12 years 3 months; I. Q. 109. H e a l t h — Never good. The only time his mother spanked him he fainted. He i s easily upset. One day when a boy in his class had fought with the teacher about tak-ing the strap, the patient had come home so excited he could not eat. He walks i n his sleep. Companions— Boys and g i r l s of his own age. Character- For the last year, i r r i t a b l e and unstable emotionally. Has been spanked for tantrums, with result noted above; has not been touched since. Is fond of children, but i s suspicious. He w i l l hold a grudge, and brood. Case 31 H i s t o r y — Father had died. The mother had threatened suicide at that time. She i s nervous and easily upset. The home conditions are good. Treatment— Since the mother i s of a fearful and anticipatory . type, and has radiated this tendency to the boy, she i s advised not to overprotect hirn, but to encourage him to do things for himself and to lead him into group sports. Problem— Boy of sixteen who was inco r r i g i b l e . Intelligence Quotient— 93. H i s t o r y — The case seems to be complicated with poor family heredity, although there i s no specific weakness In the boy. Father had dementia praecox with paranoidal tendencies. The mother had died when the patient was a ch i l d . There are two brothers and one si s t e r , none of high mental grading. Home— The standards of the Step-mother's home are high but exacting, and the atmosphere was antagonistic. H a b i t s — The boy sleeps we l l , although he masturbates, smokes heavily, and has been intoxicated. He i s dirty i n appearance. He i s laxy, Insolent, quarrelsome, con-ceited and s e l f i s h . Treatment— It i s recommended that he be deported to his father's country where i n f l u e n t i a l relatives might procure him what he wants—a position as a s a i l o r . Case 32. Problem— G i r l , i n c o r r i g i b l e , who has committed one theft. H i s t o r y — The father a man of college education who deserted the mother. The mother an unstable woman who t r i e s to shift her responsibilities onto others. Hab i t s — The patient i s out every evening, sometimes t i l l twelve. (She has not been encouraged to bring her friends home, because her mother was ashamed of the basement rooms i n which they li v e . ) According to the mother's report, the g i r l w i l l not bathe frequently enough. (The suggestion was raised that this re-fusal may be due to insufficient privacy. There i s no bathroom.) On one occasion she had taken twenty dollars of her mother's money which she spent on shows and gave to friends. (Since the stealing was only a specific instance, i t may be considered an outcrop of her general attitude.) She constantly uses profane language. She i s untruthful, quarrel-some, stubborn, and suspicious of her s i s t e r . Treatment— I t i s recommended that she be placed i n a foster home for at least six months, because of her need for training and management. Since she needs the closest supervision, i f she cannot get t h i s adequately i n a foster home, she should be placed i n the G i r l ' s i n -dust r i a l School* The stealing w i l l disappear as the i r r i t a t i o n caused by the home grows less. It i s suggested that there be v/ork done i n the home to prepare for the patient's re-establishment should she improve. Case 33. Problem— Boy with temper tantrums. Age 3"years. Psychometric test not taken because of his age. He comes from a normal family and seems to be bright. History-- Has a sis t e r who i s a. problem because she lacks i n -i t i a t i v e . The parents are i n ordinary circumstances. Health-- Good. H a b i t s — Temper tantrums at least once a day when he cannot have what he wants. He stamps and kicks, and then shakes a l l over. It i s hard to divert his attention from one object of Interest to another. He i s said not to understand very well what i s said to him. Treatment— Both children are overprotected. The boy can manage his mother as he wishes. The parents are advised to let the children do more on their own i n i t i a t i v e . Case 3^  Problem— Boy with temper tantrums. Chronological age 3 years 4 months; mental age 3 years 2 months. H i s t o r y — Mother v/as i l l during most of the pregnancy. The child had had nurse-maid care, but had t i r e d out two nurses. There had been a long succession of physical Hi. Case. 35, illnesses. He comes from a family outstanding i n l i t e r a r y endeavor. Health—* Wakens easily and stays av/ake. W i l l not eat when crossed i n anything—is never hungry. Cannot hold pencil, nor use his hands. Cannot repeat any nursery rhymes. Has no playmates. Treatment— His illnesses have l e f t him the centre of attention. He should he taught to do things for himself, should have definite times for play and should not be i n -terfered with at that time. He should attend kinder-garten for the play with other children. He i s over-directed and supervised, and not taught a sufficient amount of accurate and completed fact. (Stories should be read repeatedly), With more outlet for his energies, he w i l l eat and sleep better. Follow-up— He greatly enjoys Nursery School. He sleeps better, i s less i r r i t a b l e , and i s improving in every way. Problem— G i r l so unhappy because of d i s l i k e for step-mother that she runs away. Hea l t h — Thin and wiry build. She i s highly strung. H a b i t s — U n t i l her father's remarriage, she was very dirty. Now she i s clean, with enuresis checked. Companions— No special friends, but plays with class mates at school and with step-sisters at home. She i s not en-couraged to bring friends home. Per s o n a l i t y — She i s agreeable, and untruthful only in matters concerning the step-mother, whom she has disliked since her father's marriage. Her d i s l i k e may be caused by objections advanced by some old friends of the father. On one occassion, she ran away to her grandmother. She was sent home, scolded, but not punished. Later, she ran away, but returned to school so as not to miss any new work. There are marks on her body which she says were i n f l i c t e d by the step-mother. They are believed, however, to be s e l f - i n f l i c t e d . Family— The father i s a t h i n , harrassed man, much disturbed by the situation. The mother neglected the child and husband. The step-mother has a child from a previous marriage. The union i s satisfactory, with no bickering. The parents are afraid of what step the patient may take next. She has threatened the father. Treatment— I t i s advisable to remove the patient from the home to see, i f her attitude toward the step-mother may improve. The patient i s not truly revealing her-self in the home. She should be encouraged to speak of her feelings freely to the mother, while the woman remains as silent as possible. Problem— Boy who has had contact with the Juvenile Court for stealing. Referred for running away. Chronological age 15 years, mental age 14 years 6 months. Health— Normal. There are marks of old wounds. H a b i t s — Sleep Irregular, bed-time at 11 or 1 A.M. He had no night terrors. Fortnightly sleeps away from home i n a barn. He smokes heavily.. He has failed twice i n school because of lack of effor t . He l e f t school several months ago, and has since- been "just hang-ing around". He f e l t that most of the teachers "had i t i n for me»" I n t e r e s t s — Boxing. He has a gang who sneak into shows, pick up scrap-iron for the the junk dealer. He belongs to no public club or organization, but appears to be the leader of his - own gang. Personality—He i s easy to approach, but resentful of cr i t i c i s m that he feels i s unjust. He i s quicktempered, self confident, loyal to his friends. He i s not spite-f u l , nor does he hold a grudge. H i s t o r y — His parents are immigrants, now on r e l i e f . There are ten children. The home conditions are clean and ti d y . The family Is musical. Treatment— He wishes to attend Barber College, The d i f f i c u l t y l i e s i n the boy's not having enough to do. He should be kept busy. His interest in boxing might be diverted to gymnasium work under supervision. The boy admits his d i f f i c u l t i e s , and realiz.es where they w i l l lead i f they are continued. He should remain at home under the friendly supervision of the court. C a s e 37, J Problem— A g i r l who runs away. H i s t o r y — Father had f a i r health. He was nervous and restless, and disappeared some ten years ago. The mother i s doing domestic work. There Is one brother, who is normal and bright. H6. Home-- The house i s neat. The mother has roomers, although the patient does not help her much. The patient would rather do anything than housework. Companions-- She has many who undermine the mother's control and keep the g i r l out at nights. Work— She has had three housework positions which she l e f t after a short time because, she said, they were too hard. I n t e r e s t s — Swimming, bicycling and reading "trash". Treatment— She should take any opportunity for factory work, and join the Y.W.C.A. for group instruction, so that she w i l l have her time more f u l l y occupied. Case 38. Problem— A g i r l reported for stealing, lying, hurting com-panions and destroying property. Chronological age 11 years 4 months, I. Q. 99. H i s t o r y — The father i s a steady worker, although at the present time he i s working at whatever he can get. '-"<.> The mother, who i s dead, was not a clean housekeeper, and was only an indifferent mother. H a b i t s — The g i r l i s always hungry. At night she i s always wide awake rather than drowsy. He had bad sex habits. School— She Is i n grade six, and not doing her best work. Treatment— She must be moved from her present situation. The father and grandmother, with whom she i s staying, are w i l l i n g for this to be done. Since she was un-trained and neglected when taken by the grandmother, she needed more supervision than the old woman could give her. Case 39. Problem. A g i r l with kleptomaniac tendencies. Age 13 years 3 months; I . Q.. 94. H i s t o r y — The father i s on pension because of d i s a b i l i t y . The mother i s always i n an extremely nervous condition. There are three brothers and two sisters who are a l l excitable and Irresponsible. Character and habits. She i s Inclined to be quarrelsome. A l -Hi though she i s obedient and friendly, she i s ego-t i s t i c a l , quick-tempered and impulsive. Her f i r s t known theft was the sum of eleven do l l a r s o She has been caught silvering copper coins. She has stolen a dinghy and a bicycle. She was accused of breaking, entering and stealing two r i f l e s , money and keys. Treatment— It i s no use to try leaving her at home, as there i s no support there, only constant checking and nagging by the mother. There w i l l be only d i f f i c u l t i e s i f there i s an attempt to place her i n a foster home. The best solution i s the Industrial School. 


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