Mary C. MacKay
THE SIX SYMPTOMS covered in this chapter—enuresis, encopresis, tics, stuttering, thumb-sucking, and nail‐ biting—are special in the sense that each may occur as an isolated symptom, not necessarily part of any syndrome. When first diagnosed as a symptom, the response occurs at a specific stage of development and is the result of stress related to that particular stage. Beginning as a bodily response to some inner and/or outer conflict, it may eventually become a habit with its own functional autonomy.
There are other special symptoms of children, including fire setting, hair pulling, and various eating and sleeping disorders. These particular six were chosen, however, not because they are any more troublesome than others, but because they are more likely to occur as isolated symptoms and to be treatable as such.
Since these symptoms are all developmentally determined, they may cluster together in various combinations to produce age‐ related syndromes which are then more difficult to treat. Since they may occur as part of normal development, it is important to make an early differential diagnosis, to treat only if necessary, and then in the least obtrusive manner.
There is controversy as to the exact etiology of these symptoms, with the spectrum ranging from simple maturational factors through elaborate psychoanalytic constructs. Most psychiatrists today, including this author, are of the opinion that, for the most part, they are multifaceted in origin.
In the United States, if a child continues to suffer urinary incontinence diurnally past