Disturbance in Object Relationships in a Three Year Old Boy

In this paper I wish to present and discuss some material from the first nine months in the treatment of a three year old boy who shows severe disturbance in early object relationships. It had not been found possible to reach any firm diagnostic opinion in one interview and I was asked, in the first place, to see him for a period of observation. Although no detailed neurological investigations had been carried out, it was considered that he might be a borderline psychotic, a brain damaged or an autistic child. There has, in fact, been no break in the continuity of my twice weekly interviews for observation and treatment.

Malcolm was brought to us by his adoptive parents who realised that he was not like other children of his age. He was making no attempt to speak except for the use of three words. These were Da, Ball and Bobo (which meant animal): there was a significant lack of any word for Mother. He would take his adoptive mother's hand to feed him but would not try to feed himself, and as he did not bite or chew his food he was still on an entirely soft diet No progress towards control of urine and faeces had been established although regular potting had been carried out since his first birthday. He was described as uncontrollable and very destructive, tearing the wallpaper and throwing things around the house and out of the windows since he first began to toddle. When he was left alone at night he threw the blankets out of his cot which he moved from side to side of the bedroom although it was not on castors. During the day he liked to have other children or adults in the room though he paid them little attention and never played with them. The only indication of positive contact was his enjoyment of sitting on the floor between the legs of his adoptive father and being given a ride on his shoulders.

Malcolm was born in hospital: he weighed under five pounds, was jaundiced at birth and was born with a hernia. He was never seen by his own mother and, during his fi