School-Refusal, Enuresis and Encopresis: Some Aspects of Aetiology and Management
In this text we have concentrated upon the management of behaviour problems which fall primarily into an oppositional category. Clinically we have not so often been involved in the treatment of children who present with problems in which anxiety or fear seems to play a major part. Our method of history-taking may tend to minimise the importance of anxiety or high arousal. In the assessment section (part I) we suggested that complaints like ‘My child is very anxious’, can be broken down into overt behaviours such as, decreased appetite, refusal to go to school, poor sleep, etc. In examining the behaviour at this level it is often possible to offer firm and consistent proposals for management, which will remedy the presenting problem. However when anxiety or arousal is very high, either in the parent or the child, it may inhibit their capacity to follow instructions. For instance, it is well known that intense anxiety reduces the performance of a student in an examination.
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