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When we treat or discuss child patients who have been referred to as for help with a wide variety of mainly neurotic disturbances we usually take it for granted that a host of factors, both internal and external, have combined and contributed to produce the clinical picture presented by any child at the time of referral. But although it is the endeavour of every diagnostician and of every therapist to tease out, either at the diagnostic stage or in the course of the ongoing treatment, the multiple pathogenic factors which were responsible in bringing about a particular disturbance, every diagnostician and clinician knows only too well from his experiences what an intricate and difficult task this is. This is due both to the complexity in the functioning of the mental apparatus and to our lack of sufficient knowledge of the internal effects of a developing child's earliest experiences.
Many attempts have been made to tease out more systematically the various factors which have contributed to a child's neurotic disturbance and to assess them in their metapsychological implications. Perhaps the outstanding example of such a systematizing attempt, serving the purpose of a more accurate diagnostic evaluation of child patients referred for treatment, is the Diagnostic Profile developed by Anna Freud (1962) and tested and modified over many years at the Hampstead Clinic. It attempts to give a detailed account of all the factors, both internal and external, which may have been crucial in determining the genesis and nature of a child's disturbance. Thus it takes into account such factors as the family background and personal history, the possibly significant environmental influences, the development of the drives, the ego and the superego, the development of the total personality, the assessment of regression and fixation points as well as of conflicts etc., the synthesis of all these features ideally enabling the diagnostician to arrive at a diagnosis of sufficient accuracy.