The Psychobiology of Underachievement
by Donald C. Ross - 1970
Mental and emotional development is highly relevant to school achievement. The author has worked on a classification which conceptualizes emotional development—and maldevelopment—as a product of a child's biologic nature interacting with his environment. The categories of the classification are briefly defined, the etiologies discussed, and the manifestations of each described in terms of observable school performance and behavior.
Mental and emotional development is highly relevant to school achievement. For several years I have worked on a classification which conceptualizes emotional development—and maldevelopment—as a product of a child's biologic nature interacting with his environment. The categories of the classification will be briefly defined, the etiologies discussed, and the manifestations of each described in terms of observable school performance and behavior. These behavioral descriptions should assist the teacher in identifying the appropriate category and utilizing the suggestions under it for facilitating school achievement and satisfactory classroom behavior. Naturally, some categories are more closely associated than others with poor school achievement and undesirable classroom behavior.
Classification of Psychiatric Disorders in Children*
A. Maladaptive reactions derived from gross environmental stress
B. Maladaptive reactions derived from cerebral maldevelopment or injury
C. Maladaptive reactions derived from unconstructive interaction between
the child and his emotional environment ,
(Subcategory: The striving, decompensated child with primary defective self-image)
D. Psychotic reactions
E. Absence of emotional maldevelopment
Maladaptive Reactions Derived from Gross Environmental Stress
Brief Reactions A child in this category decompensates* emotionally under unusual stress of short duration and compensates again when the stress is alleviated. The primary stress may not impinge directly upon the child but on the family, causing a temporary breakdown or decompensation at home. The child reacts to the family breakdown and withdrawal of his usual emotional supports by decompensating. Manifestations of decompensation may include irritability, fears, somatic symptoms, and regressive symptoms. In the classroom, a sudden lowering of the levels of academic and behavioral performance should alert the teacher to the possibility of the child's decompensating under stress.
Such a change in the child's behavior or performance should be brought to the attention of the parents, since it may be that the decompensating stress is in an area of the child's life other than school. Occasionally, an overly strict or irritable teacher will decompensate a mild, conforming child, especially in the early grades. Sometimes it is the aggressive behavior of another child that causes the decompensation.
While the cause of the disturbance is being determined, the teacher should make every effort to bolster the child's coping capacity with encouragement and support. To scold, punish, or criticize would only lead to further decompensation. Pressures must be suitably lowered or eliminated during the period of decompensation. If, as occasionally happens, a teacher has taken a dislike to this particular child, she will need to examine her own feelings and attitudes in an effort to deal constructively with the situation. A conference between the teacher and parents to examine and pinpoint the stressful factors, to plan ways of reducing those factors with which the child could not be expected to cope, and to map ways of assisting him to cope better with the others can be helpful.
Prolonged Reactions A child in this category has been exposed to gross environmental stress over a prolonged period, perhaps at a critical time in his emotional development. Sometimes the damage to his personality organization is permanent. The intellectual and emotional damage these children have suffered as a result of early emotional deprivation may show itself in lowered intellectual functioning and superficiality in their patterns of relating. How common these children are, even among the disadvantaged population, is unknown. Certainly, large numbers of negatively-organized and unorganized children (categories defined and described below) come from a chaotic and punitive home atmosphere, and it may be that in this population negatively-organized and unorganized reactions are often superimposed upon a basic blunting of mental and emotional life resulting from early emotional deprivation. This is an area about which much needs to be learned, as it is full of implications for rehabilitation programs. For example, what is the upper age limit for successful intervention and rehabilitation? Much effort is now going into the understanding of these problems, and the solutions will undoubtedly be complex, both sociologically and politically.
Middle- and upper-class children sometimes suffer from prolonged reactions to gross environmental stress. Sometimes the stress is a chronic illness with frequent life-threatening crises, such as severe asthma or hard to control diabetes, which restricts the child to the point where normal life experiences are missed, development of autonomy is retarded, achievement is reduced, and a high level of anxiety is ever present. There is little the school can do but cooperate with the parents and provide the child with as much education as possible in terms of extra help, homebound teaching, etc.
Another form of prolonged reaction to gross environmental stress is mal-adaptive behavior initially caused by a life crisis but sustained long after the crisis has ended. For example, a nine-year-old boy was blinded in one eye by a missile thrown by another child. The treatment of the eye required severe restriction of a normally active child. The child further restricted himself by avoiding social contacts because he regarded himself as disfigured. He reacted to the frustration and stress by irritability and explosiveness which were handled by severe punishment, thereby prolonging the reaction over a four-year period. Serious behavioral difficulties and underachievement in school resulted. The difficulties of such a child cannot be resolved in the classroom, and the possibility of psychiatric referral should be discussed with the parents.
Unstable parents, marital conflicts, broken homes, and the prolonged custody battles which often ensue also act as the gross environmental stress that decompensates a child and reduces his ability to achieve in school. Here again the school can best serve the child by recognizing the problem and encouraging the parents to seek professional assistance.
Maladaptive Reactions Derived from Cerebral Mal-development or Injury
Uniform Defective Mentation (The Mentally Subnormal Child) Uniform defective mentation is usually diagnosed long before the early school years, and the child is institutionalized or placed in retarded trainable or retarded educable classes. Occasionally, however, intellectually subnormal children go unrecognized; usually these are defective children who are highly motivated and have high persistence, long attention spans, good organization, and excellent memories. They get through the first four to six grades, particularly in elementary schools that emphasize rote learning, by long hours of conscientious application to memorization. Eventually they reach the place where memory can no longer compensate for understanding; grades drop in spite of maximal effort with the result that these striving children begin to decompensate with irritability, tearfulness, somatic symptoms, etc. This pattern is probably even more common among children in the dull-normal range of intelligence (IQ 70 to 90) than it is among children in the retarded range (IQ below 70) because the disability of the dull children is more subtle and, therefore, more apt to be overlooked. The most important steps in management are early recognition and appropriate placement. Schools are notoriously reluctant to discuss children's intellectual capacities with parents, but unless parents have the facts about the learning capacities of their children, they cannot form realistic expectations and plans for them. In many communities the school is the only available professional organization to provide parents with the facts about their children's intellectual potentials and assist in the assimilation and constructive use of such facts. Conclusions about intellectual functioning should be reached only on the basis of individual intelligence testing administered by a qualified and experienced psychologist.
Selective Defective Mentation (The "Brain Injured" Child) A child with this defect is often referred to as "brain injured" on no greater evidence than the fact that he turns in a better-than-retarded performance (sometimes above average) on standard intelligence tests, but fails poorly on certain parts of the tests and on other psychological tests because of difficulties in perceiving abstract relationships, in verbalizing, in associating concepts with symbols (specific reading disability), or in other selective areas of intellectual functioning. A term such as "selective defective mentation" better describes these conditions, since they cannot always be related' to discernible brain injury.
Although the "brain injured" child has been described as hyperactive and distractible, it is important to remember that many hyperactive and distrac-tible children are not "brain injured" and that many who are in this category are neither hyperactive nor distractible. In fact, some of the most pathetic situations involve highly persistent children who struggle to learn in spite of their disabilities and receive much undeserved criticism for their failures because their disabilities have not been recognized. The stress resulting from unrecognized disabilities may cause these children to develop symptoms of emotional distress, e.g. irritability, somatic symptoms, etc. It is not uncommon for their poor school achievement to be regarded as secondary to their emotional difficulties when the exact reverse is the case. Parents of these children are therefore often unjustly blamed for creating problems in their children that are affecting their school work.
A selective intellectual difficulty in discerning relationships should be suspected when a well-motivated child who performed well during the early school years with rote material begins to have increasing difficulty with material that involves the understanding and ordering of relationships, such as word problems in arithmetic. The diagnosis can be established by the administration of individual psychological tests by an experienced psychologist. Perceptual motor problems are revealed particularly well by some of the subtests of the Wechsler Intelligence Scale for Children and by Bender's Visual Motor Gestalt Test.
With selective defective mentation the most important steps in management are early recognition and placement of the child in a class for neuro-logically handicapped children. Most school systems have classes for retarded educable children, but classes for children with selective defective mentation are not generally available, although many school systems are developing plans for them. Many children with selective defective mentation do not do well in classes for the retarded because they are in many areas far advanced over the other children in the class. These children are often placed in slow classes which likewise do not readily meet their needs. Such a class may, however, be the best alternative if no specialized class is available. If the slow class is small, the teacher may be able to provide individual assistance more specifically geared to the child's deficiency.
Maladaptive Reactions Derived from Unconstructive Interaction Between the Child and his Emotional Environment
The Unorganized Child This child is characterized by a personality organization that is less well developed than is age appropriate, and an anxiety-free attitude. As he becomes older, however, and in an advanced stage of the syndrome, the child becomes anxious about chronic failure. The syndrome of the unorganized youngster seems to develop in a child who has shown low persistence, short attention span, and high distractibility since infancy, in interaction with an emotional environment that has been either permissive or disorganized and has consistently not expected much of the child in the way of achievement.
In the classroom, unorganized children are usually pleasant and friendly but distractible and inattentive. The more active ones are restless and interested in playing, while the less active daydream. Unorganized children are often not well regarded by other children, who consider them babies. Their work is careless, impulsive, and incomplete; and their poor performances cause them little concern.
Unorganized children are trying to teachers because they are disruptive. To function effectively they require an environment that is as distraction-free as possible. It is important for the teacher to realize that the unorganized child is not simply an unmotivated child who could be a model student if he wished. These children develop organization with great difficulty; therefore, since there is little native organization, the child is dependent upon the environment to provide it. Internalized organization and self-discipline can be developed, but only after the child has had considerable exposure to a consistently organized, structured, and disciplined environment. Punishment, ridicule, and criticism are not substitutes for environmental organization and structure and are therefore not effective. Instead, they may cause the child to lose confidence and develop a fear of failure, which actually reduces his ability to attend. The teacher should, however, place a firm expectation on the child for greater organization and self-discipline. All unorganized children will benefit from such a change of atmosphere, but those whose lack of organization was more the result of a disorganized environment or low parental expectations will respond dramatically. Children whose unorganized pattern of behavior is more the result of an inherently low capacity for persistence and attention will respond more slowly to training, but they will respond.
If the teacher does not allow for the fact that the child's less-than-average capacity to attend is at least in part temperamentally determined and beyond the child's control, she is likely to expect too much change too quickly. Lack of change will cause frustration in the teacher and may be expressed by overt or covert anger at the child, which, if sufficiently intense and chronic, may so damage the child's self-confidence that he begins to resemble more and more the striving, decompensated child with primary defective self-image. The physiologic component in the unorganized syndrome can sometimes be strikingly illustrated by the dramatic improvement that is observed in some of these children following amphetamine medication, which reduces restlessness and improves the child's capacity to attend. Consultation with the child's family physician or school physician regarding the advisability of medication should be considered in those children who benefit least from external organization and structure. Any rehabilitation program will be more effective if the teacher first gains parental understanding and cooperation.
The Negatively-Organized Child This child is continuously engaged in a battle of wills with one or more of the adults in his life. Opposition may be overt, where the child refuses to do what he is told, or it may be covert, where he goes through the motions of carrying out his parents' wishes but accomplishes little. The conflict may begin at any point in the child's development where the parents' expectations are unrealistic in relation to the child's needs and serve to antagonize him. Negative organization commonly begins at the onset of a developmental stage. For example, at the time of learning to walk, if a parent overrestricts an active, intense, and determined child to protect him from injury, the child will react with oppositional behavior. Regardless of the area in which the conflict begins, it will eventually, if allowed to persist, spread into all areas of the parent-child interaction and into the child's relationships with other adults, including teachers. In school this can lead to poor achievement and disciplinary problems. Adults generally react to the negatively-organized child with hostility which is often expressed by their advocating harsher discipline. The purpose of the discipline is to attempt to change the child's basic nature from one of high activity and determination to one of moderate activity and malleability, and to vent parental rage. The child reacts with intense fear and rage, which feeds the struggle, and this continuing experience so sensitizes him to control that fear of restriction becomes the overriding consideration in his interpersonal relationships and largely determines their pattern. His maldevelopment therefore takes the form of a lifelong avoidance of relationships that place control in the hands of others, even though this means the frustration of his dependency needs and the sacrifice of those advantages that reward submission and compliance. Emotional deprivation develops as a direct result of the conflict with parents and others and the consequent loss of the dependency-need satisfaction. The deprivation may manifest itself in symptoms such as stealing, overeating, etc., which in turn produce intensified efforts to discipline and control the child, setting up a vicious cycle.
School behavior is likely to be affected before school performance, as the child reacts oppositionally to classroom restrictions, expecially if they are rigidly enforced. These children are angry and resistant; while they may submit temporarily in direct confrontation with authority, their overall behavior is likely to be worsened by episodes of surrender. When the syndrome is well developed, they are contentious and love to provoke the teacher into making false accusations or into unbecoming, unprofessional behavior which can then be used against him. Negatively-organized children are at war with authority and love to best it. The older, more intelligent children can be very sophisticated troublemakers who are expert at covering their tracks. The older, less intelligent, and severe cases are less ingenious and are consumed by their chronic rage, the inhibition of which is beyond their control. This rage may be expressed by acting-out behavior that is destructive, predatory, and dangerous to others.
By the time the negatively-organized child's maldevelopment has become manifest in school, the syndrome is well advanced, and the maldevelopment is a structured part of the child's personality organization. A true negatively-organized child (to be differentiated from an irritable, striving, decompensated child with primary defective self-image) will be locked in battle with his parents, and outbursts will not be uncommon. Underachievement and social dysfunction on this basis cannot hope to be cured in the classroom. The teacher can, however, avoid reinforcing the child's maldevelopment by refusing to be drawn into struggles with him characteristic of his relationship with his parents. With older, severely-afflicted children, it may be literally impossible for the teacher to stand aside. With the less severely afflicted, it may be possible if the teacher keeps in mind how fearful these children are of control and how quickly enraged they become at a modicum of control that would go unnoticed by the average child. However satisfying a program of strict discipline might be to frustrated parents, a loose rein and a light touch are the sine qua fion of management. Parents of such children should be strongly advised to seek immediate psychiatric care for the child.
The Striving, Decompensated Child The striving, decompensated child is characterized by high standards of performance in all areas of life, coupled with inadequate development of self-reliance. He is conscientious, conforming, anxious, and very sensitive to adverse criticism. Such children have usually from an early age been mild and adaptable, with a positive outlook, good persistence, and low distractibility. Their tendency to dependence is often fostered by parents who have high expectations for achievement and conformity but who do not expect much in the way of autonomy and self-reliance. Without adequate self-reliance the stress engendered by striving to meet parental (and later self-) expectations becomes overwhelming and leads to decompensation in one form or another.
When striving children decompensate, they do so with a variety of symptoms. Those with a predisposition to develop somatic symptoms under stress may have complaints such as abdominal pain, pain in the legs or arms, headaches, dizzy spells, vomiting, etc. Some children may exhibit compulsions, obsessions, phobias (including school phobia), or regressive symptoms such as fearfulness, overeating leading to obesity, sexual deviation, or hysterical episodes.
In class these children's behavior is usually exemplary. They are quiet, conforming, usually well-organized, sometimes anxious and shy. They are self-critical and sensitive to the criticism of others. A reprimand from the teacher can cause much anguish, and even a reprimand directed at another child can be disturbing. The lack of independence may or may not be obvious and can range from the very dependent child who keeps the teacher involved by constantly asking permission and direction and who informs on classmates' misdemeanors, to the child who performs just a little less well on independent work. With some of these striving children, one has the impression that their energy resources are insufficient to allow them to comfortably meet their own standards and that their efforts to meet these standards create self-induced stress.
When striving children decompensate, disorganization may manifest itself by what appears to be careless errors at a simple level: for example, mistakes in multiplication, division, spelling, etc. If the teacher misinterprets this disorganization for genuine carelessness and scolds the child, the disorganization will increase. Other in-school symptoms of decompensation are fingernail biting, hair pulling, nose picking, tics, headaches, abdominal pain, etc.
Often working at a level beyond that expected for their measured ability, these children frequently produce superior grades. Group intelligence test results are apt to be inflated because the test content is limited to written work, a task at which these children excel as a result of years of conscientious practice on written assignments. Teachers are frequently unaware of this fact with the result that parents are told that the child is not working up to his potential as determined by these tests, when in fact he would be found to be working beyond it if he were tested by more comprehensive individual intelligence tests. Teachers can do much to promote the mental health of these children by encouraging them to lower their standards and increase their independence and self-reliance. Likewise, sharing their understanding of the child with the parents can help to create a more favorable home environment for the youngster.
Subcategory: The Striving, Decompensated Child with Primary Defective Self-Image This child is a variant of the striving, decompensated child described above. In addition to the striving pattern and inadequate self-reliance, this child has a strong conviction that he cannot succeed and, unlike the group as a whole, usually does not achieve to capacity in school.
The child's defective image of himself seems to have been developed by his uncritical acceptance of his parents' concept that he is somehow inadequate or unlikely to meet the standards they have set for him. Less-than-average sensory-motor coordination* or primary reaction patterns1 of low persistence, short attention span, and high distractibility may produce in the parents great impatience and dissatisfaction if the child has difficulty meeting their high expectations. Their criticism serves only to make the child anxious and reinforces his inability to persist with a task. Sometimes the parents' view of him as inadequate is the result of an irrational projection of inadequacy on the child by one or both parents.
A defective self-image may develop as a result of a child's being expected to take an important developmental step, such as starting school, with inadequate emotional support from the parents. Sometimes a crisis in the family at this time robs the child of the support he needs for achievement. Failure to achieve under these circumstances may bring parental criticism rather than needed support; consequently, he decompensates in the area of school achievement and comes to regard it as impossible. This belief, combined with the knowledge that if he does not succeed in school he cannot obtain the parental approval he so much desires, creates anxiety in the child sufficient to set up a cycle of continual poor achievement and reinforces his conviction that the situation is hopeless and the work far beyond his ability. A harsh, critical, earlv grade teacher, or even a basically kind teacher who is herself over-stressed and impatient, can create in a child such a fear of failure, disorganization, and a loss of confidence that he does fail constantly.
Striving, decompensated children with primary defective self-image may be so anxious for results that they cannot take the time to go through the steps necessary for achievement. Instead, they jump to conclusions, guess, and fail to develop effective learning techniques. In this way they may resemble unorganized children who also hurry through a task, but they can be differentiated by the paralyzing anxiety they manifest.
They may react to their sense of worthlessness by withdrawal or by developing an irritating facade of bravado, inappropriate enthusiasm, and jocularity which may be interpreted by the teacher as evidence of lack of serious purpose. To gain status with their peers, they may sometimes assume the role of the class clown. They may needle and criticize more successful children whom they envy. The distress of failure may lead to self-deprecation and frustration, irritability, tears, and even explosiveness. Failure leads to increasing anxiety and incompetence, and the resulting criticism, both self and environmental, leads to more failure.
The secret of rehabilitation of this type of child is to convince him that achievement is possible, and the only way he will become convinced is by achieving. Therefore, the teacher should try to organize teaching for the child in such a way that he will achieve; and it is essential for the teacher to have a firm but noncritical approach which conveys to the child the teacher's belief that he can do the work, indeed, that she insists that he do it and do it well, and gives approval for a job well done. To facilitate accomplishment, the work may have to be divided into relatively small tasks, each of which the child would view as encompassable. Kindly persuasion, reassurance, and praise should be given generously. For this purpose some individual or small group supervision is obviously necessary. In some cases, in addition to what individual instruction can be given in class and after class, it may be possible to enlist one of the parents as tutor, but this must be done cautiously and only after learning something of the relationship between the parents and child. If the parent is intolerant and contemptuous of the child's poor performance, he should not serve as a tutor. In the presence of such a parent, the child will make careless mistakes, arousing the parent to a state of suppressed rage which will further disorganize the child. If class schedules do not provide for sufficient individual assistance, a private tutor working in close collaboration with the teacher should be considered. The tutor must clearly understand that his task is both to impart knowledge and to develop a sense of self-confidence in the child, each part dependent on the other. This task requires more than routine tutoring, and the tutor should be not only an experienced teacher but a patient, tolerant individual who considers the educational rehabilitation of this kind of child a challenge. Teachers sometimes regard the necessity for a tutor as an unfavorable reflection on their teaching ability. With seriously underachieving children of this type, individual instruction beyond what a busy teacher in an average-size classroom can provide may be absolutely necessary, and a tutor therefore indispensable.
The teacher should also help such a child to gain success in areas other than school work: extracurricular activities, peer relationships, etc. These children are apt to give up quickly when they encounter difficulty in an activity, and consequently, fail to develop skills, competency, and self-respect. They need firm encouragement to practice throwing a ball until they do it well just as much as they need firm encouragement to practice long division until they do that well. To this end, collaboration with gym, art, and music teachers should be part of the total rehabilitative effort.
The teacher should make it his business to become acquainted with the parents, who almost never have an understanding of the basis of the child's under-achievement. Usually they have only been told by teachers, school psychologists, etc., that the child is not living up to his academic potential and assume, naturally, that his lack of effort results from a lack of motivation rather than from disorganization, a sense of hopelessness, and fear of failure. If parents understand the situation, many can adopt the appropriate tactics. In those cases when rational explanations of the child's underachievement do not alter those parental attitudes that are reinforcing the problem, psychiatric referral should be considered, because it is unlikely that an educational approach alone can succeed.
Psychotic Reactions Under this heading fall the psychotic reactions which occur early in childhood, such as autism and symbiotic psychosis, as well as the psychotic reactions which occur during and after puberty, the etiologies of which are still unknown.
These reactions often preclude school attendance. If the child is in school, his unrelatedness and grossly inappropriate behavior usually lead to ready detection. Much of the inappropriate behavior is the result of the child's inability to judge social situations and monitor his behavior by reacting appropriately to the continual cues that normal people react to automatically in the course of daily interpersonal contact. The child may try to handle social situations by rote, which gives his behavior a ludicrous quality. Repeated social failures produce discouragement and low self-esteem, made worse by the hostile teasing these children are often exposed to by their peers. Those of this group capable of learning—and some are quite bright—need as socially protective a situation as the school and parents can devise.
Absence of Emotional Maldevelopment This category is necessary in a classification of child psychiatric disorders. There are always a certain number of children referred for psychiatric evaluation, usually as part of a total comprehensive medical investigation, and emotional maldevelopment is not found. Children in this category could still be underachieving as a result of educational gaps from poor teaching, moves from one school to another, illness, etc.
Differentiation of the Most Important Underachievement Categories It is very important to differentiate among the several categories of children with school achievement problems because their handling is different in the classroom. The distinguishing features among the three categories most commonly associated with school achievement problems—the Unorganized Child, the Negatively-Organized Child, and the Striving, Decom-pensated Child with Primary Defective Self-image—will be reviewed.
The Unorganized versus the Negatively-Organized Child While the unorganized child's daydreaming, inattentive behavior, and preoccupation with trivia (sometimes described by the parents as playfulness) are irritating, they are not deliberately provocative or calculated to enrage the teacher. With the negatively-organized child, the teacher will sense his involvement in a struggle and find himself regularly and disproportionately angry with the child.
If the teacher observes the parents or inquires into the history of their handling of the child, he will learn that the unorganized child was handled per-missively, accounting for the absence of anxiety, and that the negatively-organized child was handled restrictively, often punitively, by strict parents. An important feature differentiating these two categories is the absence of anxiety in the unorganized child and the presence of it in the negatively-organized child.
The Unorganized versus the Striving, Decompensated Child with Primary Defective Self-Image While both these categories include low persistence, short attention spans, and high distractibility, the differentiating feature is again the lack of anxiety in the unorganized child and the prominence of it, often to a crippling degree, in the striving, decompensated child with primary defective self-image. His anxiety is usually accompanied by self-deprecation and fear of failure manifested by avoidance of tasks sufficiently difficult to make him anticipate failure.
The Negatively-Organized versus the Striving, Decompensated Child with Primary Defective Self-Image These children are often the most difficult to differentiate, as both are angry. The striving, decompensated child with primary defective self-image may decompensate with rages that are the product of intense frustration and stress caused by parents and teachers who mistakenly believe his poor performance stems from lack of motivation. The rages of the negatively-organized child, however, do not represent episodes of disorganization but safe opportunities for the expression of chronic anger, e.g., a vicious assault on another child after having provoked the other child to attack him first. Both types of children may lie. The child with defective self-image lies defensively to protect himself from having his inadequacies revealed. The negatively-organized child lies to gain an advantage.
Psychiatric Referral At several points in this paper psychiatric referral has been suggested. Such a step requires more than a teacher stating to parents his opinion about the desirability of professional help. The suggestion should be made only after there has been considerable consultation on the child's scholastic and/or behavioral difficulties in school and a broadening of the discussion to include his overall adjustment to peers, siblings, and parents, and his ability to successfully carry through an age-appropriate task at home. Where psychiatric referral is truly indicated, there is likely to be malfunctioning in several areas of the child's life.
Psychiatric referral is not a step that most parents take lightly. It often conjures up fears of mental illness and creates a profound sense of parental failure because of the current popular bias in favor of environmental explanations for all the emotional ills of childhood as embodied in the cliche, "There are no problem children, only problem parents." Discussion of temperamental differences in children and pointing to the other well-adjusted siblings, if possible, can be supporting. The teacher should not be discouraged if his suggestion is not acted upon immediately. Such a process takes time and involves a great deal of thought. The parent who seeks psychiatric assistance for his child out of personal conviction rather than just dutifully accepting the teacher's recommendation will likely make better use of the service, which, of course, will work to the child's advantage.
* Psychosomatic illness: In the system of classification proposed here, no special category is set aside for psychosomatic illness. Children with psychosomatic symptoms can be categorized as either striving, decompensated or as suffering from maladaptive reactions derived from gross environmental stress. Where the psychosomatic condition is a maladaptive reaction derived from gross environmental stress, the stress may be organic illness such as asthma. This, however, is more a medical than an educational concern.
* Decompensation is the loss of adequate functional power resulting in breakdown and symptomatology. The symptoms are myriad: explosiveness, anxiety attacks, phobias, compulsions, depression, etc. Somatic symptoms are also common, and the type manifested seems to depend upon the individual's area of greatest physiologic vulnerability (muscular, gastrointestinal, circulatory, etc.). Symptoms occur after a person's coping resources have been exceeded by gross environmental stress, or following the usual stresses of life, when a person's coping capacity is reduced by emotional maldevelopment.
* Less-than-average sensory-motor coordination can, in addition to parental dissatisfaction, bring down peer group censure upon the unfortunate child who is a liability in competitive physical team games. The teasing and ridicule of the peer group intensifies his defective self-image.
1 A. Thomas, S. Chase, H. Birch, and M. E. Hertzig, "A Longitudinal Study of Primary Reaction Patterns in Children," Comprehensive Psychiatry, Vol. 1, 1960. Thomas, et al., have developed a profile consisting of nine behavioral characteristics which can be observed in infants between three months and two years of age. These characteristics seems to develop as primary reaction patterns independent of environmental influences.