PubMed · 4522616
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K De Hirsch. 1974. Learning disabilities: an overview.. https://pubmed.ncbi.nlm.nih.gov/4522616/
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Although externalizing behavior typically peaks in toddlerhood and decreases by school entry, some children do not show this normative decline. A sample of 383 boys and girls was assessed at ages 2, 4, and 5 for externalizing behavior and at age 2 on measures of emotion regulation and inattention. A longitudinal latent profile analysis was performed and resulted in 4 longitudinal profiles of externalizing behavior for each gender. Poor emotion regulation and inattention were important predictors of membership in the chronic-clinical profile for girls, whereas socioeconomic status and inattention were important predictors of membership in the chronic-clinical profile for boys. Results are discussed with respect to the development of adaptive skills that lead to normative declines in externalizing behavior across childhood.
The systematic analysis of acting-out episodes can be used in assessing analytic progress. Variables to be considered are the nature of the wish, the type of defense, and the degree of concreteness (versus symbolization) of the mental processes used in attempting actualization (as distinct from the resort to action). Two acting-out episodes of a borderline patient who acted out as a character trait, both occurring outside the analytic setting, are presented as illustrations. In the first one, occurring relatively early in the analysis, when split-off negative and positive self-images had to be rigidly maintained, ejection of the negative self-image was actualized via the regressive use of a symbolic equation and the mechanism of displacement, obliterating the distinction between an internal feeling and an external thing that here was literally thrown out. The later episode, occurring after the split was healed and within the context of a frustrating heterosexual involvement, contained an acted-out allusion to identification and competition with the mother. As in a dream, via associations, an unconscious wish for oedipal victory was revealed. Whereas in the first episode the goal of ejection was central, with splitting and denial the underlying defenses, it was absent from the second, in which an attempt was made to actualize a repressed infantile wish and made greater use of symbolization. It is concluded that acting-out episodes at different periods of the analysis, when systematically analyzed, can serve in assessing a patient's progress.
The author presents the analysis of an 8 year-old boy prematurely born after a high-risk pregnancy, then hospitalized for two weeks. He was never breastfed and presented vomiting, intense activity and inadequate behaviour as symptoms. His highly dysfunctional family is composed of a non-productive father and a homely, though aggressive, mother. The patient displayed a rigid defensive structure with perverse aspects and a cruel superego. His constant interest in magical characters frequently disguises an avoidance of reality. By means of transference interpretations, a trustworthy link with the analyst now allows him his own mental space, where hidden psychotic states come to light. In the clinical material, this boy's skills for insight mingle with oscillations from severely defensive states to integration and vice versa. The analytic relationship in this often hostile scenario has become strong. The analysis is hampered by constant demands from family and school--both expect the analyst to prevent his frequent acting out. Whereas some perverse polymorphism is part of childhood and may persist throughout life, it is likely that the patient's pathological organization may yield to reality and facilitate reparation, relinquishing the world of make-believe as well as the intense projective mental functioning.