A Survey of Referral Problems to a Psychiatric Preschool Program: Patient Characteristics and Therapeutic Considerations

Abstract

This study provides a detailed account of the nature of referral problems found in a consecutive series of 90 cases admitted to a psychiatric preschool treatment program. The characteristics of the sample, including age, sex, and ordinal position of the children are described. The type of presenting problems and such features of the child as speech and language function and intelligence are included as well. The characteristics of the parents are also included, such as their social class and their marital and psychiatric status. These results are understood in the context of a developmental-interactional frame of reference, such that four categories of problems can be identified: 1) those children with organic/constitutional difficulties; 2) those children with mild developmental difficulties that put them in conflict with their parents’ or teachers’ expectations; 3) those children whose problems are reactive to family conflict and marriage breakdown; and 4) those marginally coping parents who decompensate when their preschooler reactivates unresolved internal conflicts of their own, which are then projected onto the child who becomes the identified patient. The nature and details of the treatment program are described with particular reference to the four categories of problems identified. The unique advantage of a program such as this, and the difficulties providing service and continuity of care for these children and families are highlighted. The importance of an integrated and comprehensive approach which coordinates the educational, social and psychiatric services is emphasized if preventive psychiatry is to retain its meaning and fulfill its mandate.