Developmental Help: Intensive Treatment of a Nursery Child

This is a report on Susanna, an only child of Spanish parents who has just turned 6. She has been in treatment since she was 4 years 3 months. The case provides an opportunity to examine developmental delay in a pre-latency child, who came to treatment in time to be fully restored to the normal path of development, and to consider technical issues relating to the term ‘developmental help’. It also illustrates ways in which work with the parents can help them to change and thereby assist the child's ongoing treatment and improvement.

Susanna began to attend the Centre's Nursery School when she was 3 years 6 months. The Nursery staff referred her for treatment at the age of 4 because they were concerned about her lack of progress in language development. Many children from families whose first language is not English and who have a poor command of English learn it rapidly following their entry to our Nursery School. This was not the case with Susanna. After attending the Nursery for six months her language remained garbled and difficult to understand. The Nursery staff's concern about her lack of progress in this area was heightened by their discovery that her facility in Spanish was equally poor.

In the Nursery teacher's attempt to assess the nature of Susanna's language difficulties, discussions with her mother revealed a tense and deteriorating relationship between mother and child. The mother described persistent battling, especially around mealtimes. If someone tasted anything from her plate she would refuse to eat, or if there was one thing that she did not like on her plate, she would not eat the rest of the food. Her mother would enter into the struggle by coaxing, warning and threatening. In this way Susanna was often successful in her bids to control her mother. Frequently, after refusing food during the day she would insist that her mother bring her special food when she went to bed. If Susanna's particular requirements were not met, she exploded into tantrum