The Canadian Journal of Psychiatry

A brief outline² of child psychiatric facilities in each of the 10 provinces was gathered with the help of the corresponding members of the Nucleus Committee on Child Psychiatry. Some of the outstanding facts are underlined and the suggestion of a systematic survey of the needs for Child Psychiatry is made.

In a long term research project we are investigating the effects of Trifluoroperazine on Ego functions and Ego structuration in children with character disorders. Enough data has been collected on a specific aspect: motor activity, to be reported here. Thirty-three children, all boarding in a residential school were chosen. All of them were investigated by a psychiatrist, a neurologist and a psychologist at the start of the experiment. The psychological tests used were the Bender-Gestalt, Goodenough and Draw-A-Tree Test. These examinations were repeated after two months.

The children were then divided in three comparable groups, as regard the psychiatric, neurological and psychological pathology. Only some aspects of behaviour were not equally divided among the three groups. For instance, hypermotility was equally distributed in two groups, but nearly absent in the third group, which is then used as a control for the level of collective motor activity in the institution.

One group was put on Trifluoroperazine, the second group on a placebo, (identical to the active tablet) and the third group was without medication. These groups did not correspond to natural groups inside the institution, and only one of us knew the code. Trifluoroperazine and placebo were prescribed at a dose of 0.50 mg./per 10 lbs of body weight/per day. The doses were increased when needed after two weeks, at a ration of 0.25 mg./per 10 lbs. The children were seen regularly for 5–10 minutes once a week, and a complete observation form filled every two weeks by the nursing and teaching staff. We have devised a method to obtain a score from these observations and plot them in a graph. Figure 1 shows our results with Trifluoroperazine. The poor results on the collective activity of group I is explained by its opposite effects on two types of hyperkinetic children. The qualitative and quantitative study of the individual motricity curves allows us to distinguish two main types of hyperactivity.

Type 1 (Figure 2): A curve with wide oscillations, the incursions of which travel at any point of the ordinate. These curves are obviously given by children whose motor activity is capable of variations. These children so grouped according to their curves, show a normal neurological examination and no sign of anaclitic depression. They respond well to Trifluoroperazine, with a mild akinesia, handwriting changes and a decrease in their motor activity. Small doses are sufficient. This type of hyperactivity is a good indication for the drug.

Type 2 (Figure 3): The characteristic of this curve is relative flatness. Clinically these patients exhibit flatness of affect, depression, and all have an Extra-Pyramidal Syndrome (not associated with medication). This association, flatness of motor activity and flatness of affect with depression seem interesting. We discuss at length the possibilities for research in this group. Trifluoroperazine would seem to be contra-indicated in these children, since it has a tendency to exacerbate their hyperactivity.

Since its earliest descriptions, the concept of childhood schizophrenia has changed considerably. Some contemporary clinicians and researchers have made it so broad as to include a wide range of clinical entities which confuse the picture.

The author has attempted, in the light of the most prevalent psychopathological theories, to untangle this confusion, and stress the importance of the psychotic nucleus in childhood schizophrenia. Pseudo-neurotic and borderline cases should be carefully assessed and eliminated, as well as hallucinatory conditions found in many organic syndromes.

A strict differential diagnosis respecting the essential psychotic components of schizophrenia should help delineate childhood schizophrenia as a separate clinical entity and afford means of re-evaluating the literature on this subject in a more critical light.

This paper is addressed to the problem of consultative assistance by a child guidance clinic in cases from long distances who come for brief investigation. A method of intensive family diagnosis is described, in which the child and both parents participate in joint and individual interviews throughout a two or three day period. Two case illustrations are outlined and some relevant points are discussed.