The Underwood Report :Chaired by J.E.A. Underwood

 

Committee on Maladjusted Children (1955) Report of the Committee on Maladjusted Children (Chairman: J. E. A. Underwood) London: Her Majesty’s Stationery Office

 

The idea that there might be ‘maladjusted’ children arose out the development of intelligence tests by Alfred Binet (1903); previously such children had been dismissed as ‘mental defectives.’ But the discovery of a group of children who were significantly under-performing in relation to their measured intelligence caused a reappraisal and a search for suitable treatment methods. We now know that most disturbance arises from insecure attachments which often result in poor peer group relationships (Ladd, 2005) or from family discord (Rutter, 1971) and that the most effective remedies are to change the child’s circumstances (Clarke and Clarke, 1976; Fogelman, 1983). But that was all a long time in the future when the Committee on Maladjusted Children met to try and assemble all the existing evidence on the subject.

Key points

•  The term ‘maladjusted’ is new but the issues can be traced back over half a century to the development of school health services and the recognition that some children presented as ‘mental defectives’ because of poor home circumstances.
• After the end of the First World War recognition of the needs of children by psychiatric clinics in the US and UK led to the development of child guidance clinics in the US and their introduction, along with psychiatric social work training, to the UK during the 1920s.
• Voluntary and local authority initiatives between the wars led to the establishment of independent boarding and day schools and child guidance clinics.
• The 1944 Education Act introduced the term ‘maladjusted’, while many of the evacuee hostels set up during the Second World War continued as hostels for maladjusted children after the end of the war.
• Post-War legislation placed new responsibilities on health and local education authorities to provide child guidance clinics and support children in special schools but demand outran supply.
• The peak ages for referral to a child guidance clinic are eight and nine.
• Maladjustment has many symptoms but its underlying cause is a failure of personal relationships.
•  Child guidance clinics should work with children and their families, schools and school health services to prevent maladjustment.
• Day special schools and classes should be expanded.
•   Residential care should provide a temporary home during treatment and local authority reception centres should be used for observation and assessment.
• Former evacuee hostels should receive greater support from local authorities, should be involved in work with parents and should be open all year round.
•  Boarding schools should focus on educational treatment, should not have completely separate teaching and care staff and should have links with other services and families; there should be an expansion in their provision, especially for children with low or high IQs
•  Local education authorities should be responsible for after-care, which might include a hostel or support from a child guidance clinic.
• Reports to magistrates should be factual and intelligible.
• Too many maladjusted children are being sent to approved schools because of a shortage of special school places.
• Greater use of child guidance services could be made in dealing with children before the court
• Their own study suggested that the number of maladjusted children was three to six times the estimate of the Ministry of Education and staffing levels nowhere met estimates of the number needed.
• Child guidance clinics should be approved as centres where psychiatrists could obtain the Diploma in Psychological Medicine.
•  Educational psychologists should have a degree, a teaching certificate, three years’ teaching experience and a certificate; structural factors currently limited the supply of educational psychologists.
•  There needed to be more psychiatric social workers; structural factors likewise limited the supply.
• Teachers and house staff should be trained; wardens and senior teachers should have joint training and there should be refresher courses for all staff.
•   Prevention requires a positive approach and greater co-operation among existing services rather than the creation of new services.

Content

 

In the Introduction, the Committee say that they were appointed in October 1950 by Mr George Tomlinson, Minister of Education, that they met in full committee for 57 days and in sub-committees for 43 days, that they visited establishments for maladjusted children and that three local authorities collaborated in a pilot survey on the incidence of maladjustment. There is nothing novel or revolutionary in their report; just the term ‘maladjusted’ is new.

 

In Chapter I Scope of the Enquiry, they note that the 1944 Education Act had expanded school health services to cover the diagnosis and treatment of maladjustment but that adjustment is a matter of degree.

 

In Chapter II History of the treatment of maladjusted children in this country, they recall that in 1884 Francis Galton had set up an ‘anthropometric laboratory’ at the International Health Exhibition and that this had evolved into a case history sheet to be updated by schools every 29 February.

 

In 1880 education had become compulsory and in 1890 the London School Board had appointed a medical officer; by 1905 85 local authorities had medical officers and in 1907 local education authorities were given a duty to provide for the medical inspection, and where necessary treatment, of children.

In 1899 special schools for children of sub-normal intelligence had been established and in 1905 the Binet-Simon scale had been published. However in 1909 the Chief Medical Officer’s Report had stated, “A spurious form of mental deficiency is not infrequently associated with bad home conditions …”.

By 1913 there were psychiatric clinics in a few local authorities and the Central Association for Mental Welfare had been founded under Dame Evelyn Fox; this found that maladjusted children as well as mentally deficient children were being brought to it. (The National Association for the Care of the Feeble Minded had dissolved itself to make way for this organisation.)

In 1913 the London County Council had appointed Cyril Burt as its psychologist and in 1919 Hector Cameron had described in The nervous child the link between the physical and emotional well-being of a child. In 1920 Dr Crichton Miller had instituted the founding of the Institute for Medical Psychology which, as the Tavistock Clinic, opened a children’s department in 1926.

In 1909 William Healy had founded the Juvenile Psychopathic Institute in the US, the same year as the US National Committee for Mental Hygiene had been founded. In 1920 this turned its attention to child guidance and in 1922 set up the first demonstration clinic. In 1925 Mrs St Loe Strachey had visited the US and in 1926 called a meeting to set up child guidance clinics, following an invitation to UK social workers to train in the US.

In 1927 the Jewish Health Organisation opened the London Child Guidance Clinic under Dr Emanuel Miller and in 1929 the London Child Guidance Training Centre opened in Islington. A 1929 Report of the Board of Education stressed that a lot of maladjusted children were among those regarded as mentally retarded and agreed to the placement of maladjusted children under section 80 of the Education Act 1921 in the independent boarding schools that had been established in the 1920s. In 1932 a day school was started in Leicester, a voluntary organisation in Northampton opened a home for 25 maladjusted girls and Birmingham set up the first local authority child guidance clinic. By 1937 there were seventeen wholly and five partly local authority child guidance clinics alongside clinics run by voluntary organisations.

During the Second World War the Education Act 1944 had been passed and at the end of the War many hostels for difficult evacuees continued as hostels for maladjusted children under the terms of the 1945 Handicapped Pupils and Special Schools Regulations. The National Health Service Act 1946 placed obligations on regional hospital boards to provide child guidance clinics.

However, local authorities could not find enough schools to meet demand and by December 1954, when there were

• 33 boarding special schools
• 3 day special schools
• 45 boarding hostels  300 child guidance clinics, mostly part-time (204 provided by local authorities, a few by voluntary organisations and the rest by regional hospital boards),

there were 1,077 maladjusted pupils in independent schools and 1,157 in special boarding schools.

In Chapter III Normal development, the Committee define ‘maturity’ as when conduct becomes expressive and characteristic of a person but acknowledge the difficulties in defining ‘normal’ because:

•  what is normal for one child is not for another;
• what is normal at one stage is not at another;
•  all aspects do not develop at the same rates as each other; and
• normal is not the same as ‘good.’

 

They argue that children make progress via constant discovery and note that the peak ages for referral to a child guidance clinic are eight and nine. They add that after infancy children need peer-group relationships within a restructured world and harmonious relationships with their parents. During adolescence children become unsettled and undergo far-reaching changes; they need emancipation, develop an interest in the opposite sex and need work, achievement and self-respect. Normally children keep reasonably in touch with reality.

In Chapter IV The nature, symptoms and causes of maladjustment, they argue that the Handicapped Pupils and Special Schools Regulations 1945 definition of maladjusted children as “pupils who show evidence of emotional instability or psychological disturbance and require special educational treatment in order to effect their personal, social, or educational re-adjustment” is insufficient because it:

• is too general,
• does not address provision, and
•  ignores children outside the education system.

Maladjustment involves a failure of personal relationships; maladjusted children find receiving and giving difficult; they do not respond to love, comfort or reassurance and are not readily capable of improvement by ordinary discipline. Maladjusted children may not necessarily be troublesome; they may be passive but insecurity and anxiety may lead to aggression as a means of relief. This however does not mean that all delinquents are maladjusted. Pupils receiving special education for other reasons may also be maladjusted.

They list as symptoms:

• nervous disorders
• habit disorders,
•   behaviour disorders,
•   organic disorders,
• psychotic behaviour,
•  educational and vocational difficulties,

but stress that these are symptoms. The causes may be:

• personal relationships,
•   family environment,
•   community influences,
•   physical factors,
•  educational factors.

 

In Chapter V Statutory authority for treatment of maladjusted children, they summarise the provisions for the discovery (that is, ascertainment) of maladjusted children, special educational treatment, school health services and child guidance clinics.

 

The first is the responsibility of the NHS and the second of local health authorities. The Education Act 1944 lays duties on local authorities to provide sufficient schools and to ‘ascertain’ children. The committee note that ‘ascertain’ is often used as if it has some technical significance, but it does not, which is why they have used ‘discover.’ They also note that a certificate only needs to be issued if parental opposition is expected.

 

They go on to summarise the provisions of the Education Act 1944 as amended by the 1948 Act and the Education (Miscellaneous Provisions) Act 1953 that relate to maladjusted children and the NHS Act 1946. In particular they note section 28 of the Act requiring the health service to “make arrangements for the purpose of the prevention of illness, the care of persons suffering from illness or mental defectiveness, or the after-care of such persons”.

 

In Chapter VI Child Guidance, they are argue that child guidance should

• deal with children in and with their families,
• prevent maladjustment,
• be linked to schools,
• be closely associated with the school health service, and
• inspire the confidence of those who come into contact with it.

 

They stress the need for school psychological services and the role of school health services but regret that there is currently no obligation to provide child guidance clinics; they need to be made available to all children including those at independent schools. The team should consist of:

•  a psychiatrist to link with the hospital,
• an educational psychologist to link with schools and teachers,
•   psychiatric social workers to link with school health and welfare authorities

in a ratio of, generally, ½:1:2 or possibly 1:1:2 or 1:2:3 in particular situations along with a consultant paediatrician, a child psychotherapist and a speech therapist.

 

Any diagnosis should lead to either treatment or support for the parents. Involving the child and their parents in the diagnosis can be a form of treatment that leads to the cessation of symptoms.

 

They envisage each clinic having up to 300 cases a year and needing accessible premises and equipment. However, they do not recommend the use of case conferences, originally set up by the London County Council to control expenditure.

 

In Chapter VII Day special school and classes, they note that only three local authorities provide them at present but they see possibilities in:

•   part-time classes,
• full-time classes,
•   day special schools,
•   home tutors,
•   special classes,
•  open air day schools, and
• independent day schools,

along with other possibilities that could be developed.

In Chapter VIII Residential treatment: (1) preliminary considerations, they consider residential care as a temporary substitute home providing special teaching and therapeutic treatment for children and parents in cooperation with the child guidance clinic.

As there are no facilities under the Education Act 1944 for observation and assessment, they recommend using Children’s Department reception centres for this purpose and stress that decisions need to be made, especially over progress, holidays and return to home/ordinary school. Children may need to be taken into care if they do not have a suitable home to which to return.

In Chapter IX Residential treatment: (2) hostels and foster homes, they consider the 45, mostly former evacuee, hostels (37 local authority) providing 830 places. Their staffing ratio is around 1:3, with a married couple as warden and matron in 24 but no trained staff. Eight have over 24 children and thirty 12-20 children; eighteen are boys only and nine girls only, while six hold girls and junior boys mostly on the recommendation of a child guidance clinic.

Local authority hostels are visited by child guidance clinics but not voluntary hostels; the children are not worse behaved in school than other children.

They recommend that the local authority provide pocket money if the parents do not and that the children should be able to do out of school jobs. They note that little work was being done with parents even though contact with families was generally good and recommend that the warden should initiate contact with parents in preparation for the child to return home.

They note that only nineteen are open all year round and recommend that they all should be; where that is not possible, the local authority needs to liaise with the Children’s Department over children who cannot go home for holidays.

They also note that the hostels are often not full and recommend better regional co-ordination over places.

They recommend the use of foster placements only if the child is able to tolerate family type relationships and that foster parents should get adequate remuneration.

In Chapter X Residential treatment: (3) boarding schools and conclusions, they focus on educational treatment, stressing that the children should not be cared for by completely separate education and caring staff. They consider staffing ratios and the options for mixed sex schools for older pupils but note that there is higher demand for boys’ places than for girls’. They note that having girls and junior boys means boys have to change schools; it would be better to have all-age single-sex schools.

They outline four main points of view in managing behaviour:

•  Anti-social behaviour must be tolerated to allow children to work through problems.
•   Maladjusted children should be given a share in the running of the home to learn that rules are needed.
•  Maladjusted children need a regular pattern of life under a benevolent dictator.
• Maladjusted children should be treated, after an initial period of tolerance, as normal children.

 

They consider links with child guidance clinics, school health services and psychiatric services, relationships with parents, holidays and the use of boarding schools as hostels. They recommend that future planning should include the provision of schools to meet the needs of boys with low and high IQs and note that, even if other facilities are improved, there will still be a need for more boarding places. So there needs to be regional consultation on provision.

They end by considering boarding special schools for delicate children, independent schools whose use can be reduced in due course by greater provision, and hospital units.

In Chapter XI After-care, they note that most children will be still at school, but for those who have left school they recommend that the local education authority be responsible for helping with employment rather than the youth employment service.

There also need to be hostels provided under section 28 of the NHS Act 1946, section 29 of the National Assistance Act 1948 or section 19 of the Children Act 1948 and continuing access to child guidance.

In Chapter XII The maladjusted child in relation to the juvenile courts, they note that courts tend to ask for psychiatric reports where there is evidence of:

•   irrational behaviour,
•   recidivism,
•  bed-wetting, etc.
•  a sexual offence,

or the child is likely to be removed from home.

They note that the Children Act 1948 does not cover admission where a parent can no longer tolerate a child’s behaviour and so the courts are reliant on the Children and Young Persons Act 1933 for probation reports and reports from the local education authority. It is important that these reports are factual and intelligible to lay magistrates.

There is a problem that, notwithstanding Home Office and Ministry of Education advice that handicapped children should be sent to special schools rather than to approved schools, the shortage of places in special schools leads to maladjusted delinquents being sent to approved schools, especially because so few maladjusted schools will admit older boys.

They note that a Fit Person Order may be used when parents refuse to consent and stress the importance of using child guidance facilities in remand homes, reception centres, etc.

In Chapter XIII The size of the problem, they outline the difficulties in estimating the size of the problem which are partly compounded by the low number of facilities. So they undertook surveys in Berkshire, Birmingham and Somerset which had 5.4%, 7.7% and 11.8% child guidance cases respectively. The Ministry of Education had estimated 1-2% in 1946 while the Advisory Council on Education in Scotland had suggested 5% in 1952 though it was not clear what it was 5% of.

They note that local authority estimates of staffing needs are well above current provision and there needs to be an increase in teaching and house staff.

In Chapter XIV The turnover and supply of child guidance staff, they note that no child guidance clinic is recognised for the Diploma in Psychological Medicine available to psychiatrists and that medical students are taught little about child psychiatry. Paediatricians and psychiatrists need to have the option to qualify in each others’ disciplines.

They recommend that educational psychologists should have a degree plus a teaching certificate, three years’ teaching experience and then complete a one-year certificate but raise the possibility of in-service training rather than full-time training for the certificate.

In 1954 the Whitley Council for the Health Services had introduced a psychologist grade but they are no substitute for an educational psychologist. The supply of educational psychologists is not limited by pay but by financial support while training, the concentration of courses in London and Birmingham, misunderstanding about the nature of work and narrowness in the field of recruitment; all these need to be addressed.

There are courses for psychiatric social workers in London, Manchester and Edinburgh with a new one in Liverpool but there needs to be an increase in the numbers; the shortages are down to:

•   poor salaries,
• lack of financial support during training,
•   concentration of training in four areas,
•   ignorance/prejudice about the work,
•   lack of mobility between branches of social work, and
•   depletion through marriage.
  

In addition to proposals to deal with these, the Committee recommended appointing secretaries, using trainees in child guidance clinics and increasing preventive work.

 

In Chapter XV The training and supply of teachers and house staff, they argue for training for special school teachers and house staff but not for domestic staff and set out the qualities needed in teachers and house staff; they note the current arrangements for the training of teachers and that there are arrangements for house staff to train on the CRCC but only one had done so so far. They recommend that the CCRC be extended to cover education and that there should also be an extended period for those working with maladjusted children.

The recommend advanced training for those likely to become wardens and raise the possibility of joint training for senior teachers in maladjusted schools and potential wardens.

They recommend refresher courses for existing staff and stress the need to make caring more attractive as a profession.

In Chapter XVI Prevention, they argue for a positive approach to mental health through prevention, better health and school health services, GPs, the consultant paediatric service, health visitors and school nurses and for doctors, nursery schools and classes, primary and secondary schools, teachers, child guidance clinics and other agencies be better utilised to this end.

Chapter XVIII contains a Summary of recommendations, after which there are number of appendices.

Discussion

Unlike the Curtis Report (Care of Children Committee, 1946) which had addressed a crisis in long-standing services, this report traces the evolution and progress of a new type of service for children identified as ‘maladjusted,’ a term introduced by the Education Act 1944 as a catch-all for children who were not doing well at school but did not have learning disabilities.

Its strength in 1955 lay in its awareness raising; today its strength is as a comprehensive historical snapshot of the development of services for children in need of emotional care and support. Perhaps most significant is its description of maladjustment as a failure of personal relationships which makes receiving and giving difficult so that the child does not respond to love, comfort or reassurance. This more broadly based understanding was soon to be overwhelmed by Bowlby’s theory of maternal deprivation. Today we know that children who lack secure attachments and who fail to make satisfactory peer-group relationships are more likely to have low attainments and to suffer from behavioural and other difficulties (Ladd, 2005).

Its advocacy of greater collaboration with families and among existing services reflects this approach; rather than seeking to blame mothers, as Bowlby (1952) had done, it saw the way forward as greater collaboration between existing services and with families and expanding services where they were in short supply.

In the end, while the report validated what many people were already doing and encouraged greater cooperation among providers and with families, it did not provide a rallying cry or a point of departure for a particular group as other reports did, such as the Curtis Report (Care of Children Committee, 1946) or Crime – a challenge to us all (Labour Party Group, 1964).

References

Binet, A (1903) L’étude expérimentale de l’intelligence Paris: Schleicher Frères et Cie

Bowlby, E J M (1952) Maternal care and mental health: a report prepared on behalf of the World Health Organization as a contribution to the United Nations programme for the welfare of homeless children (Second ed.) Monograph Series No 2 Geneva: World Health Organization Previously published in the Bulletin of the World Health Organization 1950

Cameron, H C (1919) The nervous child London: Oxford University Press

Care of Children Committee (1946) Report of the Care of Children Committee [Chairman: Myra Curtis] Cmd 6922 London: His Majesty’s Stationery Office.

Clarke, A M and Clarke, A D B (Eds) (1976) Early experience: myth and evidence London: Open Books See also Children Webmag May 2010.

Fogelman, K (Ed.) (1983) Growing up in Great Britain: papers from the National Child Development Study London: Macmillan See also Children Webmag January 2011.

Labour Party Study Group (1964) Crime – a challenge to us all: report of the Labour Party Study Group (Chairman: Lord Longford) London: Labour Party

Ladd, G W (2005) Children’s peer relations and social competence: a century of progress London: Yale University Press

Rutter, M (1971) Parent-child separation: psychological effects on the children Journal of Child Psychology and Psychiatry 12 (4), 233–260