It is unlikely that the services of child care workers will cease to be needed during the next decade. The figures tend to show a steadily increasing demand for help with children who cannot live with their biological families for a number of different reasons. This seems to be a reflection of:—

Firstly, an increased awareness of the meaning of unusual behaviour in children, i.e., that the child who does something unacceptable like running away, stealing or failing to perform well in school is really showing signs of emotional stress, and secondly, in part due to an increase in social disruption of the family and a change in the values of a significant proportion of middle class parents. There is no way we can expect that all children can spend all their young lives living with a family, either their biological family or an alternative one.

Traditionally, when children were seen by their parents or teachers as exhibiting “problem” behaviors (e.g. tantrums, disobedience, stealing, reading difficulties, social withdrawal, incontinence) they were brought to the notice of a professional (often a psychologist) who proceeded to carry out “therapy” in a clinic or hospital. The child was seen as primarily the person with whom one should work, and the clinic as the setting where therapy should take place. Even in those cases where some form of “family therapy” was undertaken the emphasis remained on seeing the child in a clinical setting and rarely it seems was the parent or teacher taught specific behavior change skills.

Contemporary behaviour modification (or therapy) seems to offer what is both a useful theoretical and practical approach to the treatment of a very wide range of childhood and adolescent disorders (Gelfand and Hartmann, 1975; Herbert, 1975). We intend in this paper to describe this relatively new method of assessment and treatment of problem behaviour as it applies in family settings, and examine its relevance to social work practice. In doing this we shall consider briefly the nature of the social work task. After a discussion of the theoretical basis of behaviour therapy we shall attempt to demonstrate how the methods themselves can be applied in the social work setting giving examples from our casework in the Child Treatment Research Unit (C.T.R.U.) at the School of Social Work, Leicester University.

The medical examination of the newborn infant for adoption should reduce the risk of the prospective parents adopting a child with a potentially serious disease or abnormality, and ensure that the infant being adopted is healthy (Betheras, 1976). Genetic and clinically obvious conditions apart, an early detection of brain damage was said to be of highest importance in such an examination, because adopting parents “… find it insupportable if a child cannot respond adequately to their love and affection” (Tizard, 1969, p. 44). However, because even gross brain damage may be undetectable in the early weeks of life, and the prediction of future development of the neonate is seldom possible from a paediatric examination (Tizard, 1969; Karelitz, 1956), there appear to be only very limited prospects to reduce “… the magnitude of the risk that adoptive parents must taken when they adopt newborn infants” (Karelitz, 1956, p. 94).