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Am J Psychiatry 1921;77:365-384.
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What recommendations are to be made to meet these delinquency and behavior disorders in children?We have seen that with one group of cases truancy and delinquency occur in the nervous child, due for the most part to inability of the child, because of his nervous condition, to adjust to the rather rigid requirements of school life. Again we have seen that certain personalities while often possessing exceptionally good qualities, still are so constituted as to be unable, unaided, to make suitable adjustment in the environment in which most children must get along. Then there are the cases which are the product of the environment itself—these cases gradually developing because of the combination of circumstances—these probably being the most unfortunate of all because of the continued unfavorable development in adult life.The first step would appear to be an examination of the child both as to his physical health, and as to the social and environmentalboth as to his physical health, and as to the social and environmental conditions bearing upon the problem. At times the difficulty may be dependent upon some physical disorder such as defective vision, or adenoids, or malnutrition, and in such cases the remedy is comparatively simple. But in the majority of instances the social and environmental problem is the important one. The medical examination should be supplemented by a social investigation, and to carry out this work social service workers with a knowledge of psychiatric problems are of great value; and for carrying out certain recommendations, an association with Child Welfare Societies is necessary.A necessary feature of the management of these children is their separation from the general classes of the school. Whether this should be done by arranging for a special class in the general school, or whether a separate school should be made use of, is a question which would have to be considered from all angles. But in any case, separate classes are quite necessary. These children do not get along well in the large classes and they are a disturbing element for the others. They need special observation and study, and arrangements have to be made for recreation or teaching which cannot be carried out in a general class. Whenever possible it is desirable that they receive the same kind of general education as the other children, as they are handicapped without it, and their individual tendencies are accentuated if their education does not conform, in a general way, to that which others receive.In many instances it is probable that transferring the child to a separate class and making such arrangements for him as may be indicated, would solve the problem. But in many of the cases also, a change in respect to home and neighborhood environmentstated above social service workers with psychiatric training are valuable to do the necessary investigating and the follow-up work. A feature of this service which would seem particularly advisable is a follow-up system after the child leaves school. Such children need guidance, of course, quite as much at that time as at any other, and it is quite evident how much could be gained by this feature.What results may be expected from therapeutic agencies as outlined above? We are scarcely in a position to know the extent of the benefits which may be had, but we do know that comparatively little can be done in the management of such problems unless they are understood. In approaching questions of this kind, a knowledge of the medical and social background of the cases is needed, in the schools, by the public and by the medical profession as well. In this direction, of course, has been one of the greatest needs of medical education in the past. In matters pertaining to the health of the body much attention has been given; but in matters pertaining to the social and environmental influences which may make for mental health or illness, much less has been accomplished. With a broader dissension of the understanding of these problems there is reason to believe that important advances may be made. If we are right in thinking that these conditions are, after all, much more susceptible to treatment and management than perhaps was thought at one time, the gains for both the individual and for society would be very great.Of course it is almost needless to say that the proper time to effect these changes is during childhood. It would be unfortunate for any one to gct the impression that such conditions as delinquency and conduct disorders of school children are not susceptible to change. In adults we meet with them after they have been developing for years, and then, indeed, they may be very firmly fixed. But during school age is the proper time, not only to inculcate proper ideals and ambitions, but also to correct tendencies which may be detrimental to character in later life. In observing these cases of delinquency one gets the impression that the very terms used, such as incorrigibility, chronic truancy, and so on, make the situation appear much more formidable than it really is. These children are apt to be regarded as being inherently abnormal or different from others, but if they can be given the proper assistance before their tendencies become rigid and fixed, it is believed that the remedy is not difficult.Delinquencies in most instances are not serious affairs in the beginning. They often start as the result of mismanagement and an intelligent handling of the situation is all that is necessary to correct early cases. We surely cannot associate these minor cases with the conditions we encounter in adult delinquents; but one is nevertheless inclined to believe that these same minor cases, if allowed to go on year after year in school life, gradually become more marked, and may, indeed, turn out unfavorably later. It is felt that we must free ourselves of the idea that these conditions are inherent or inherited, and so there is nothing to be done about them. They are to a great extent the result of failure on our part to do the best possible thing for a very important element in the community. This failure has been due to lack of understanding rather than to conscious indifference or neglect, and it is felt that the support of the people in any community may be depended upon, when recommendations are made to them as to how best their children may be assisted and guided.

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