Breaker

*4*

Physical/psychological assessment of unidentified toddler: "Baby Smith"

Physical: The child's general health is excellent. She is well nourished and well cared for, and is not suffering from any disease or ailment. Blood test indicates minute traces of benzodiazepine (possibly Mogadon) and stronger traces of paracetamol in her system. There is no evidence of past or recent abuse, sexual or physical, although there is some evidence (see below) that she has suffered past, continuing, or recent psychological trauma. The physical evidence suggests that she was separated from her parent/guardian within 3-4 hours of being found-most notably in terms of her overall cleanliness and the fact that she hadn't soiled herself. In addition she showed no signs of dehydration, hypothermia, hunger, or exhaustion, which would have been expected in a child who had been abandoned for any length of time.

Psychological: The child's behavior and social skills are typical of a two-year-old; however, her size and weight suggest she is older. She presents evidence of mild autism, although knowledge of her history is needed to confirm a diagnosis. She is uninterested in other people/children and reacts aggressively when approached by them. She is overly passive, preferring to sit and observe rather than explore her environment. She is unnaturally withdrawn and makes no attempt to communicate verbally, although will use sign language to achieve what she wants. Her hearing is unimpaired, and she listens to everything that's said to her; however, she is selective about which instructions she chooses to obey. As a simple example, she is happy to point to a blue cube when asked, but refuses to pick it up.

While she is unable or unwilling to use words to communicate, she resorts very quickly to screams and tantrums when her wishes are thwarted or when she feels herself stressed. This is particularly evident when strangers enter the room or when voices rise above a monotone. She invariably refuses any sort of physical contact on a first meeting but holds out her arms to be picked up on a second.This would indicate good recognition skills, yet she evinces a strong fear of men and screams in terror whenever they intrude into her space. In the absence of any indication of physical or sexual abuse, this fear may stem from: unfamiliarity with men as a result of being raised in a sheltered, all-female environment; witnessing male aggression against another-e.g. mother or sibling.

Conclusions: In view of the child's backward development and apparent stress-related disorders, she should not be returned to her family/guardians without exhaustive inquiries being made about the nature of the household. It is also imperative that she be placed on the "at risk" register to allow continuous monitoring of her future welfare. I am seriously concerned about the traces of benzodiazepine and paracetamol in her bloodstream. Benzodiazepine (a strong hypnotic) is not recommended for children, and certainly not in conjunction with paracetamol. I suspect the child was sedated but can think of no legitimate reason why this should have been necessary.

N.B. Without knowing more of the child's history, it is difficult to say whether her behavior is due to: (1) autism; (2) psychiatric trauma; (3) taught dependence, which, while leaving her ignorant of her own capabilities, has encouraged her to be consciously manipulative.

Dr. Janet Murray