The Use of Anna Freud's Developmental Profile in the Differential Diagnosis of a Young Severely Handicapped Child

We have recently become interested in the use of Anna Freud's Developmental Profile in the assessment of severely retarded children, especially those who so frequently puzzle child psychiatry and paediatric departments because different aspects of their symptomatology, behaviour and history suggest a bewildering range of possible organic and psychological diagnoses, from which different people will choose according to their own training, experience and theoretical predilections. Therapeutic results with these children often seem unpredictable partly because incorrect diagnosis may result in inappropriate treatment; but also because our still considerable ignorance of very early psychopathology allows for over-optimism as well as undue pessimism concerning prognosis and treatability.

Originally intended for the diagnostic assessment of emotionally disturbed children, the Profile has subsequently been used to assess the results of treatment, as well as in research and teaching. It has been adapted for use with adults, adolescents and babies, with physically handicapped children, etc.

We had had relatively little experience of using the Profile with mentally defective and organically damaged children. At Charing Cross Hospital the Department of Child Psychiatry is often consulted by staff of the Child Development Centre which receives for assessment and treatment a steady flow of children with varying degrees and types of developmental delay and distortion, of whom Jane B is a good example. Her social worker was in doubt as to the appropriateness of Jane's treatment programme, and together we made a Profile as a learning experience for us both in clarifying our thinking about a difficult case.

Jane had been referred at the age of 20 months by her local paediatrician for a second opinion about her developmental delay. In the Child Development Centre the extremely experienced senior consultant had judged her to be a potentially normal child whose development was being inhib