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Luke was referred at 3 years 6 months. His family were well known to the Centre and he himself had been observed since infancy. These circumstances ought to have provided the opportunity to trace the development of his disturbance, but despite the wealth of observational material, many questions remained unanswered.
Centre staff were puzzled and dismayed when Luke's early promising development came to an abrupt halt early in his third year and continued to deteriorate into his fourth year.
At the time of referral, his nursery school teachers were becoming increasingly concerned about his high level of anxiety and his disruptive influence on the group of children. Often his behaviour was provocative and contrary; he seemed to feel he was naughty and was drawn to imitate other children who behaved badly. At other times he was exceedingly sensitive to any criticism or limit-setting and would cover his face or run away and hide.
Most noticeable of all was the pressure of his anxiety. He would wander restlessly about on tiptoe, unable to settle down. On occasion he would become panic-stricken and begin to run round in circles. His teachers noticed Luke spinning in circles or spinning objects in a withdrawn manner. Sometimes he ran about as if driven. He was attracted by the record player and asked constantly to listen to records, although he appeared to derive little pleasure from them. He complained that he was ‘tired’ in the middle of many activities and the staff felt his attention-span was shortening. Sadness about separation from mother also threatened to overwhelm him sometimes during nursery hours.
Luke was a precociously verbal child, but his speech tended to be anxiety-driven and was felt as a bombardment by adult and child alike. At times his verbosity deteriorated into gabble. He clamoured for the adult's undivided attention and could not tolerate the rival needs of his peers.
In many ways he seemed a vulnerable child, driven by unmanageable anxiety and ill-equippe