Listen to thisLet me begin by showing you a few slides. We shall not need a screen, projector or any other such equipment. Mental slides will be quite sufficient for us today. All of us child care workers have seen this type of slide often enough. But these slides make up the stuff of which child care is made. I simply wish to look with you at a few of these slides to see a few familiar situations and also to explore the sorts of new problems we are having to face in our work with children.
Case 1. The Case of the Indignant Sucker
We see in this slide a dining area with a small group of kids, maybe a
dozen. At one end of the group is David, at the other is John. All of
these children have been thoroughly diagnosed so you need have no fear.
There is a good thick file on each child. I can’t take time to give you
John's diagnosis but David is pre-psychotic.
I’m not entirely sure what psychotic means, but I do understand that it’s smart to say “pre”. If you say “pre” you simply cannot be wrong. You do not have to commit yourself about when the psychosis is going to take place. Will you please forget about diagnosis?
Returning to our slide we see that David has got bored. Eating politely is not what he has been used to. He wants some action. One thing he has learned is that it is best to get someone else to start the action. He decides on John. After blinking at him very slowly he takes his own glass of milk and tips it just a very small amount. Only a few drops of milk spill onto the table. John's attention has been engaged by David and without hesitation he rises and throws his own glass of milk over the chief child care worker. John yells at the worker: “That guy is bugging me, why can’t you get him off my back?”. The worker, while drying himself off, begins the investigation. Quizzing John he is told finally: “David made me do it”. Quizzing David he is told “It’s nothing to do with me”. David is indignant and yells: “You sons of bitches, why do you always have to get me mixed up in it?”.
Now both children in our slide need treatment but treatment for what? I would hazard a guess that David's misbehaviour is not pathological and go on to assert that his behaviour is over-skilled for the market value of his age. If he were a little older and if he were in a different social context he would likely by doing very well indeed. Somewhere along the line David has got to learn to use this talent for instigation to positive effect. Somehow John has got to learn not to be drawn into this type of difficulty. The one child needs the other but both need the services of an acute child care worker who can deal with the situation as it arises.
Those of us who work daily with children have to be sorting out continually the situations described in Slide 1 and know that this is not usually an easy task. The child care worker is the one who is there. Behaviours such as these described in Slide 1 do not occur during the clinical hour. It means that people who are with these children have to be careful. David and John have to be watched. If they get too bored some distraction may be necessary.
Case 2. Will you take him back?
The matter of distraction can be illustrated through the use of a second
slide. Imagine a classroom situation in which one child is very, very
active. He has been diagnosed as hyperkinetic. Someone has sold me, the
teacher, on this kid and on the significance of his diagnostic
classification. After he comes to the classroom I find him to be
constantly on the move. This is alright up to a point but the other kids
have to know that I’m no fool. So I arrange for a distraction. I arrange
for him to be able to go to the pencil sharpener more-or-less when he
feels like it. This is a good arrangement since sharpening pencils is a
reasonably legitimate activity for the student. This works out very well
for a time. But after a few days he
begins to play the xylophone using the other kids' heads as an
instrument. I can’t tolerate this, nor can the other children. So now I
go back to the diagnostic centre and say that he has now got some new
symptoms and suggest that maybe he should be placed elsewhere. This is a
slide that we have all seen and one which we should be trying to
eliminate from the series. One intervention worked well (use of the
pencil sharpener as a distraction), now is the time to create a new
intervention, not arrange another clinical interview. Thinking up ways
of intervening is, of course, not easy. This is particularly true when
there is a lot of action taking place. Let me illustrate this in a third
slide.
Case 3: Paranoia Under the Chestnut Tree
In this slide we see the waterfront guy. He likes kids and has been
taken on for this reason. It is a difficult job since with swimming
there has to be order. He has made the arrangements very clear at the
beginning of camp; the children can have a lot of freedom but the one
thing which is not permitted is dunking one another. But still the fact
is that spirits do run high and children do do it and that is what has
happened in the slide. That our worker has seen it happen is something
of a fluke given that he labours under a tremendous physical handicap,
no eyes in the back of his head. Swivel his head though he may, he
cannot see it all.
And so we have our slide of the worker’s frantically swivelling head picking up Bobby in the action of dunking John. So he gets Bobby to sit under the chestnut tree. There’s no point in faulting the worker. He did warn the kids and, anyway, he is, as I said, a good fellow. So now we have Bobby under the tree. Now what you have to realize is that the tree is like a throne. From his throne Bobby sees if not everything, then a very great deal. Certainly his eyes see what our guard does not see due to lack of eyes in back of head. His greater elevation is a distinct advantage. Now he is able to start digging up his paranoid fantasies. Now he has the evidence that no one likes him anymore.
The problem which I have been discussing in this slide is a familiar one to us and it is largely a problem of timing. Any limit may be O.K. but how long does the limit last? The snag is that longer does not mean that effects are achieved faster. What about sexual insults? When we as workers receive a sexual insult from a child we are perhaps inclined to treat them about twice as hard as for oral insults. Say thirty minutes for sexual insults and 15 minutes for oral ones. Returning to Bobby’s crime we find ourselves faced with the huge problem of timing. How long can we leave him under the tree? The waterfront man has got to let him back but when? Unless the child is considered very closely we shall leave him in a situation where his own crazy fantasies will become stronger and stronger. (“Say, Ray, didn’t you see Bill shoving Peter under? Why don’t you pick on him like you pick on me ... “). So timing must be considered rather carefully.
Child care workers do not get enough training in the art of timing. When is it best to talk to the child, now or tomorrow? As a general rule we need to be flexible in terms of what the individual child needs. To be sure the child has to be bounced but how do I ensure that the kid will benefit from the inference not be further damaged by it? Trying to ensure that one particular child benefits when you are working with a group is sometimes very hard to arrange as the next slide clearly shows.
Case 4: Ghouls for Breakfast
Imagine now that you are with a group of youngsters aged about 8 to 13.
In this scene we find a staff who has finally decided on the use of a
behavior modification programme. This staff is a little more
sophisticated than some because they have at least given some thought to
the whole matter of finding appropriate reinforcers for the particular
children in their care. The members do at least realize that the whole
of North American society cannot be revolutionized by the use of M and M
candy and they know that such candies can be infantilizing to an eight
year old. In our slide the staff persons have been very thoughtful about
finding reinforcers that are appropriate for each child. Charlie,
though, has presented a bit of a problem. So far as can be determined,
there is nothing much that Charlie wants except for the opportunity to
stay up until 10:00 p.m. on Friday night so that he can watch the Ghoul
Show. The staff are dead-set against the proposal thinking that ghouls
are the last thing that Charlie needs. But they finally give in figuring
he will not make it anyway (i.e. that he will fail to collect the right
number of points during the week for doing the various assigned tasks.)
Charlie does make it. In view of the contract the staff have to go through with their side of the bargain. He watches the T.V. show. At breakfast Charlie has his moment. Half of the children become so agitated they wet themselves. But after a few days all the children want to watch the Ghoul Show. This they have decided is what they need, not candies. You can, I think, imagine the child care worker’s predicament at this point and there is no need to elaborate the situation further. In pointing to a behavior modification programme as being instrumental in creating this difficulty, it should be realized that I am by no means being critical of this approach. What I am critical of is over-simplification. All I am trying to do is warn against taking too surface a view of these children's difficulties and also to point out that great care is needed in the design of any group-treatment programme.
This feature: Redl, Fritz. (1982). Child Care Work. Journal of Child Care. 1 (2) pp.3-6
