J . Child Psychol. Psychiat., 1961, Vol. 2, pp. 216 to 223. Pergamon Press Ltd. Printed in Great Britain.

"MATURATION"—A REPORT ON THE FIRST EUROPEANCONGRESS OF PAEDO-PSYCHIATRY*

C. KOUPERNIK

37 Rue Er lander, Paris 16

THE first European Congress of Paedo-Psychiatry was devoted to different aspects ofmaturation. This report will concentrate on the most essential and most coherenttopics of the Congress (which have already been reported in printf), giving only apassing glance at various communications which will be published in extenso in 1961.

A certain number of papers were devoted to the most obvious aspect of matura-tion—the biological. It is traditional to oppose maturation—as a kind of endogenousevolving schema—to the action of the environment. We shall see, however, that thevery term maturation has been regarded from a completely different point of viewby other schools of thought.

Within the framework of a biological concept, the first report by J. L. Camusand C. Koupernik was devoted to the endocrine glands. The authors limit themselvesto their actions after birth on the brain. They point out that during the phase ofrapid cerebral growth, during the first three years, the endocrines are relativelysilent. Proceeding with their analysis of the various forms of endocrine activity, theyattach little importance, in this context, to somatotropic endocrine action on thebrain. The thyroid hormones seem to them to act mainly as energizers. With regardto the gonadotropic hormones—the cortico-suprarenal and the sexual—it wouldseem unlikely that they play any important role in the normal subject before puberty.

In this phase it is well to be suspicious of facile schemata; particularly the attribu-tion of the final orientation of the libido entirely to the infiuence of sex hormones; awhole series of experiments, e.g. by Goldstein, Beach, and Zuckerman bear thisout.

Next, the lessons from pathology were considered, and it is clear that the dis-orders of the thyroid yield the richest information.

When a rapporteur is faced with the painful task of analysing his own report, whichno longer satisfies him, he has a choice of two attitudes: omission or self-criticism. Wehave adopted the latter, not from masochism, but from a concern for truth. It seemsto us, on re-reading—and after friendly discussion with Jean Tusques, one of thewriters who has given most thought to the problem—that we have misinterpreted histhought. This will emerge clearly in the second volume of reports; suffice it to saythat we have failed to distinguish clearly enough between the effects of the thyroidon morphogenesis and on metabolism respectively.

Finally, the various aspects of the psychopathology of precocious puberty came

*Held under the auspices of the European Association of Pedo-Psychiatrists. Paris, 16th-20thSeptember, 1960.

fReport of proceedings of the First European Congress of Pedo-Psychiatry. Paris S.P.E.I., 14rue Drouvot, Paris, 1960, 207 pp.

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under review. Here again. Dr. H. Stutte (Federal Germany), who has made aspecial study of intellectual and emotional disturbances of abnormal pubertal states,made a valuable contribution.

The second paper, by J. E. Gruner, was concerned with the histological studyof the maturation of the nervous system. Gruner considered in turn the maturationof neurones, that of other nerve tissue, that of functional systems, and finally theagents of maturation. The first section deals with the history of neuroblasts. Theconsiderable dimensions of neuronic prolongations in relation to the small volumeof the perikaryon require an intense degree of protein synthesis, while its functioningrequires an enzyme activity which is polarized on the one hand at the level of theperikaryon, and, on the other, at the synaptic end.

There are three disciplines through which we can approach the study of thisdevelopment: cytology in the traditional sense, cell-chemistry, and electronicmicroscopy. The first of these allows us to group the phenomena in the followingmanner:

(1) A phase of nuclear maturation and appearance of functional units. (2) Aphase of maturation of the perikaryon (development of the Nissl corpuscles andoutgrowths). This phase is sudden, and of the greatest interest, insofar as it signalizesthe appearance of the first thalamic fibres in the cortex, and probably correspondsto the establishment of cortical electrogenesis. (3) A third phase is characterized bya considerable increase in the amout of cytoplasm in certain cells and formation ofnumerous collaterals with synaptic endings, a neuronal specialization, and, finally,a specialization of the enzymes (adrenergic, cholinergic and histaminergic).

Cellular chemistry shows that a cytologic crisis is accompanied by a chemicaland, especially, an enzymic one. Thus, in the chick embryo, acetylcholine-esteraseappears before the formation of the vessels.

Finally, electronic microscopy is still too recent a development to give us a clearand complete picture of maturation. Gruner reports the result of his own researcheson sections of cortex from the posterior third of the hemisphere in the embryo chickof 8-17 days, and of a 2-day-old chicken. This enabled him to demonstrate that thenucleus grew up to the 17th day, and that the relation of the perikaryon to its out-growth decreased rapidly after the 14th day. Biological equilibrium in the neuronedepends on the establishment of synapses, as shown by experiments in which thefocus of wing growth is ablated in the chick embryo. In the same manner, inWerdnig-Hofmann disease, the malformation of the neuro-muscular junction is thecause of a secondary degeneration of neurones Finally, it may prove difficult todistinguish between maturation and ageing of the cell structure. Even the cell is notimmune to philosophy.

An equally remarkable contribution dealt with the study of non-neuronal tissue,such as the sheath of Schwann, glia, ependyma, meninges and blood-vessels; themeninges remain undifferentiated almost up to the time of birth, and blood-vesselsare developed late and slowly. Finally an essential feature of perinatal pathologyshould be noted: the haemato-encephalic barrier is insufficient in the immaturebrain. On the other hand, immature neurones are more sensitive to carbon dioxideintoxication, and less so to anoxia, than the adult brain. But this maturation of thehigher centres and of supporting elements does not occur in a featureless manner; the

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general tendency is for the development of functional units or mechanisms. Thereforethe posterior longitudinal bundles and the motor proto-neurones are the first to form,shortly followed by the sensory proto-neurones, and the auditory and vestibularsensorial systems. The vegetative system goes through a critical phase at the 11 thday, and develops over a long period. Different parts of the neo-cortex develop atdifferent rates; most slowly in the central opercular region. This is important, sincethose regions which are the latest to form are the most fragile. The formation ofcortical sulci is brought about by the convergence of multiple factors, some neuronal,'others reticular Finally this report distinguishes, in respect of factors of maturation,between intrinsic, environmental, humoral, and endocrine factors.

A. Schwenk (Federal Germany) presented a valuable report on the biochemicalaspects of endocrine maturation. In particular he demonstrated that differences inoestrogen levels, between boy and girl, appear from the eighth year; equally theamount of 17-ketosteroids is about a third higher in boys than in girls from this age.Finally the endocrine determinant of the various sexual structures is analysed.

C. Dreyfus-Brisac and N. Monod reported on their unique study of the develop-ment of cerebral electrogenesis in infancy. They first recall that electroencephalo-graphic activity as registered by present methods finds its origin in the slow dendriticpotentials. On the other hand, maturation varies from one species of animal toanother, even of the same class. The potentials aroused in an immature animal havea longer duration and more diffuse localization than in the adult subject. Finally,the progressive acceleration of alpha rhythm is not a sufficient criterion of develop-ment, which can only be adequately described by the use of various criteria, someconcerned with duration (continuity or discontinuity) others topographic, othersdynamic (reactivity). The authors studied the premature infant successively from5 to 8 months of foetal age, which is characterized by discontinuous and paroxysmalrate of activity, lack of synergism between the hemispheres, low reactivity, andand absence of differentiation between waking and sleeping. At this stage (between5 and 8 months) there is rapid progress, so that at the age of 8 (foetal) months thewaking rhythm differs from that in sleep. It is noteworthy that this age of 8 months ismore important than the normal age, at term, of 9 months.

A second important stage occurs at 3 months (after birth) when an occipitaltheta rhythm of 3 and 4 cycles/sec appears for the first time. It is not till 5 monthsthat a theta rhythm of 5 cycles/sec appears, which is the precursor of the adultalpha rhythm.

From 3 months to 3 years, during the waking period, there is an acceleration inoccipital activity, while the changes occurring in sleep become much more complex.We must not forget that the sleep rhythm of a small child changes considerably withage. The authors distinguish a first stage in the sleep rhythm characterized byamplification and slowing in the occipital region on going to sleep, followed byspindles, then by a few slow Rolandic spikes. From 8 months to 2 years a first phaseof hypersynchrony on sleeping (4 cycles/sec; 50-60|J.V) is followed by a diminu-tion of amplitude, then by supervening of spikes and spindles. On the other hand,from 2 to 3 years, hypersynchrony can be replaced by a fiattening, while spikesbecome sharper. It is not till after 3 years that sleep produces a rhythm like the adult's(disappearance of occipital rhythm, and Rolandic spikes, sometimes a series). In

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general, in the course of development, spindles will appear as sleep becomes deeper,while the Rolandic spikes become even sharper, so that each stage has a charac-teristic 'pattern' of sleep.

The second part of the report is devoted to pathological conditions. The authorsdraw attention to the frequency of a slow anterior dysrhythmia of a polymorphic ormonomorphic delta type, of slow spikes in pathological cases in the first two months oflife. This type of pathological picture is not found before the stage of 8 months offoetal age. Another important factor in the electrical pathology of the neo-nate isabnormal lability during sleep characterized by hyperhythmia. Finally, as regardsparoxysmal crises, this report reminds us that a crisis of the grand-mal type does notexist in the new-born and that one never finds a generalized discharge of spikes atthis stage.

The crises of the new-born are mono-hemispheric, but are capable of being propa-gated from one hemisphere to another afterwards. There is no necessary correlationbetween the clinical aspect and the encephalogram in regard to these paroxysmalmanifestations. The crises of the premature infant appear to be different from thoseof the new-born, being essentially clonic, brief, and shown by 'salvoes' of spikes. Inthe infant it is also possible to observe paroxysms of grand-mal, while petit-mal isvery exceptional; in any case, bilateral synchronous spike-wave curves are not found.The electrical record typical of petit-mal only appears at the age of 3. We shouldalso note that, according to Gibbs, the electric foci are displaced backwards. Theimportance of the 2 main stages, i.e. 8 months foetal life and 3 years of age, is obviousin respect of both physiology and pathology. The authors' longitudinal studies haveshown them that some infants can have a sleep rhythm of adult type from 1 yearonwards, although others still showed a hypersynchrony beyond the age of 4. Otheraspects of this electrical ontogenesis can show actual phasic differences. Theselongitudinal studies have also been concerned with cases of abnormal children, andthus the authors raise the question of how to tackle the problem of an abnormalE.E.G. when there is no indication of a clinical disturbance.

The late Professor T. P. Simson (who died suddenly in February 1960) had thecourage, despite the rapid progress of her illness, to prepare a report on the onto-genesis of the higher centres in relation to child development. The new-born infantshows only unconditioned reflexes, some ahmentary, others of defence (eye blink,general motor reactions, etc.). Other unconditioned reflexes will appear in the courseof growth, while others existing at birth will change.

As regards the establishment of conditioned reflexes, Simson recalls that thesedepend strictly on the development of receptor mechanisms. From birth there aresigns of vestibular, cutaneous, thermal and pain sensations, while visual sensationis very elementary at birth, and lags behind the auditory. The earliest conditionedreflex properly so-called was discovered by Koltsova about the 11th day: at thisstage 66 per cent of infants become calm when in the feeding position, as against5 per cent on the 9th day; this type of conditioned reflex will then increase in com-plexity in relation to the elaboration of the sensory and perceptual mechanism. Thefbrmation of most conditioned reflexes, at first vestibular and auditory, then visual,is already quite advanced at 2^ months. But this may be even earlier in prematurebabies, thus showing the effect of environment. As the child gets older, conditioned

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refiexes are formed more rapidly, while passive inhibition diminishes. At first thechild acquires the ma,jority of its conditioned refiexes by imitation (the first systemof sensori-motor signals), then speech acquires great importance. Conditionedrefiexes formed at the level of the second signaUing-system were then referred to, andsuggest an interesting approach to general pedagogic problems.

The report by J. Scherrer, F. Contamin and R. Verley, dealt with evoked electro-cortical reactions, and with the study of motor behaviour and neuro-vegetativephenomena, in mammals inferior to primates. Firstly, the nerves or receptors arestimulated, causing a certain amount of cortical activity, which is amphfied;secondly, certain cerebral zones are stimulated, and motor or neuro-vegetativeresponses recorded. The study of the motor response of the rat foetus shows that the15th day is a crucial date, insofar as it is marked by the joining of motor neuroneswith the muscle fibres. It is then that spontaneous activity starts, which proceedsin the cephalo-caudal direction. The 15th day also sees the beginning of refiexactivities in the rat. According to Coghill, it is not a question of the successive appear-ance of fragmentary activities, but a differentiation starting from a global kind ofactivity. On the other hand, Windle tends to think that there is a progressive in-tegration. Modern studies, notably those of Scherrer and his colleagues, tend ratherto support Coghill. Another important observation: in the mammiferae, therespiratory musculature is capable of reacting to stimuli quite early, while thecardio-vascular system has only rudimentary reactivity at birth. Post-natal electro-physiological studies of animals demonstrate that synaptic connections already existbefore the corresponding receptive organ is functioning. Studies of electrocorticalresponses also show that myelinization is not essential to the conduction of incomingimpulses. Scherrer and Oeconomos showed in 1953 that induced electrical activityprecedes spontaneous electro-cortical activity in the course of functional maturation.

Last but not least, there is no absolute parallelism between different species ofmammals. For example, the cat and the rabbit are born in a low state of maturationbut develop rapidly. The rabbit reaches maturity after 1/25 of its life-span, and thecat after 1/15. Even if man had a life-span of 100 years he would reach maturity, atthis rate, by the age of 4 or 6. Thus all extrapolations from animal to man areextremely hazardous.

We will pass quickly over the report made by M. Verdun on anthropologicalbiometry and maturation, because we consider that the author's conclusions, if nothis method, fail to correspond to scientific criteria as generally accepted. WithFriedeman's paper we are on a fresh tack, because this author, while starting from abiological basis (notably his description of secondary sexual characteristics) studiesthe emotional, moral, intellectual and social aspects of maturation. Notably in hissection on emotional maturation, we find a sort of longitudinal study of the formationof the concept of the object. With regard to social maturity, the work of R. F.Nielson seems to demonstrate that from the age of 6^ the child becomes a socialbeing capable of collaborating in a common task. It would seem that there is a phasecommon to both sexes up to the age of 6, followed by a second phase of differentiationup to adolescence. Friedeman adumbrates an interesting parallel between social andbiological maturation, especially between 6 and 10. He considers that there is a realphysiological crisis corresponding, according to German authors, to a primary

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change in gestalt. (In our opinion, this hypothesis of a physiological crisis at 6 yearsis not proven. We are also critical with regard to the contention that there is acentripetal tendency in the girl, directed to the family, and a centrifugal one in theboy.) In this very complete report there is another interesting observation: in 1956the cases of early menses appearing between 9 and 11 were 60 times more numerousthan in 1906, thus showing the influence of environmental factors in maturation.

Van Stockert's report also deals with the effect of experience on adolescents.Thus the upheavals produced by two world wars and the collapse of traditionalvalues, seem to the author to be determining factors.

With the report by Fontes, dealing with maturation after puberty, we reach morepsychodynamic concepts. He stresses the dialectic balance between progression andregression. Preceding authors dealt with maturation as a potential force inherent inliving matter, strongly determining the direction in which development took place;here the same notion is used in the psychological sense of a state of equilibrium. Thisstate of equilibrium cannot be attained or remain stable unless the subject haspassed through the crises of the years preceding puberty, i.e. the oedipal situation,jealousy, frustration, being an only child, etc. On the other hand, this developmentcan only be understood on the human level. In effect, the adult animal finds anenvironment which accepts him just as he is, while on the contrary, man, the"eternally maladjusted", seeks to perfect it, whence a continual state of insecurityand anxiety. This anxiety reaches its height at the time of adolescence, that is tosay at the moment when the human being takes flight and leaves the protection ofits parents.

Having left behind endocrines and neurones, we find ourselves in the fleld ofpsycho-analysis with the report by Mme. J. Favez-Boutonier on psycho-analysisand maturation. She firstly recalls Freud's insistence on the concept of instinct. Thesuccession of stages which he describes is essentially attributes to the action of suchinstinct. This has led Daniel Lagache, one of the leading French psycho-analysts,to speak of maturation of the instincts. Yet there is a second tendency, alreadyimplicit in the writings of Freud, which allows considerable influence to the effectof experience, of the environment, and thus certain disciples of psycho-analysishave gradually slipped into 'culturalist' positions. The author concluded by sayingthat it is an essential element of psycho-analysis to envisage human instinct asinvolving conflict. This is why the term maturation is somewhat misplaced inpsycho-analysis, since it implies an idea of stability, whose static character is opposedto all the implications of this doctrine. On the psychic plane, man is never completed;one can speak of his 'becoming', but not of his maturation.

Cl. Launay, A. Doumic, and J. Trelat undertook the study of maturation in thefamily setting. Such a study has the advantage of being synthetic, and placing theproblem in the actual human framework. The authors distinguish a "preconscious"stage lasting till 3 years of age, marked especially by the predominance of themother; the oedipal stage from 3 to 6, then a latent period from 6 to 12, and flnallyadolescence. Contrary to the other reports, this one is studded with clinical exampleswhich render it very vivid and instructive. These examples illustrate various specialcases: that of a weak father, of grand-parents living in the home, of children broughtup by a mother alone, of adopted children, etc.

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E. Miller studies maturation in the setting of the child's school life, stressing thefact that school denotes the entry of a child into an abstract system. Thus we canobserve the opposite types of reaction, one being an attachment to concrete objects—a genuine defence against anxiety—and the other a flight into abstractions devoid ofany affective significance. He referred to an important distinction between intellectand intelligence made by Barzun, which causes us to judge of a child's potentialitiesin three dimensions: his intelligence quotient, the family culture, and ecology. Inother words, the school allows us to envisage the development of a child from a pointof view which is both dynamic and reahstic, and which is influenced by the field-theory of Lewin. The school thus appears as a kind of incubator of social values,while at the same time it produces certain anti-social tendencies, in the form of"school-phobia". This condition, which is quite frequent, can result from variousfactors, such as disturbance in relationships between parents and child; a difficultyin social relationships closely resembhng jealousy between sibhngs; a difficulty inadopting the teacher as a parent-figure; anxiety caused by some forms of learning,such as mathematics. Finally two essential processes must be distinguished in orderto understand the meaning of maturation in the school life of the child: substitution,and sublimation.

S. Ahusjo has studied scholastic problems from another angle, based on someremarkable statistical studies which he has initiated in Sweden. We should note, tostart with, how elastic is the Swedish system, which allows about 3 per cent of children(the legal age for starting school being 7) to start their schooling a year later. Thereare also various types of special classes, some of which are designed for the immaturechild who is not yet ready to face ordinary schooling, others for children with aslight intellectual handicap (that is with an I.Q. 70-85), others for the word-blind,and a fourth variety termed 'observation classes' for children whose behaviour isunsatisfactory. There are also special classes for different types of sensory handicaps;open-air classes for delicate children; for cases of cerebral palsy; and finally specialschool for children who are so handicapped that they cannot lead a normal ornear-normal school life. It is to be noted that there are significant differences in thesexes. The proportion of boys suffering from dyslexia is greater than would be expectedon statistical grounds. Also 50 per cent of boys in normal classes who have beeninvestigated show symptoms such as instability, aggressiveness and destructivetendencies. These are only found in 20 per cent of girls, whose most frequentsymptoms are reluctance to speak, a tendency to withdrawal, asthenia, depressionand psychosomatic symptoms.

G. Bollea and A. Novelletto were concerned, in their interesting report, with themedico-legal implications of the concept of maturation. They insist on the need toexamine every case thoroughly in order to decide on imputability or legal responsi-bility, according to biopsychological immaturity and not merely to age. The factorswhich maintain this immaturity are numerous, and the Italian authors insistespecially on the importance of harmony or disharmony between these factors. Thussome subjects who might appear to be 'hypermature' in some respects, turn out to be'dysmature', insofar as this accelerated growth occurs at the expense of a lack ofbalance in other respects.

The report by R. Dellaert deals with a similar question. The author tends to

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renounce the idea of 'responsibility' while retaining that of 'fault', thus preservinga quality of 'sanction', for his decisions instead of merely depending on psycho-pedagogic treatments, which are obviously ineffective. It goes without saying thatthis 'sanction' aims at eventual re-adjustment.

I. Van Lennep's report (circulated in roneotype) deals with vocational aspectsof maturation, and stresses the fact that vocational success cannot be predictedsimply in terms of I.Q., since another important factor, namely the social quotient,intervenes. His own studies have shown that children of relatively precociouspuberty make better relations and show more spontaneous adaptability. Boys andgirls who develop rapidly show a leaning to the arts, while those who develop moreslowly are more attracted by technical pursuits. On the other hand the 'precocious'group when questioned before puberty as to the occupation which attracted them,expressed the ambition to be chauffeurs, aviators, naval officers, or engineers; whilethe 'slow' group were inclined to be missionaries, theologians or priests, watch-makers, mechanicians, etc. On the contrary the 'precocious' group showed profoundaversion to legal or theological careers. In general the precocious group were easierto orientate than the slow. Besides this. Van Lennep singles out two other individualgroups. The first, after a brilliant start, settles down at about the age of 20, at alower level of achievement than would be expected, while the other on the contrarycontinues with a slow and regular progress, and blossoms out at about 30.

We will return later on to the many other communications which enriched thisCongress; but would mention at this point the new direction taken by those psycho-analysts, especially Male, who have emphasized the importance of adolescence as aturning point in development. This stand-point seems to us more realistic than theconstant reference back to confiicts in infancy. Male stresses particularly the dangerthat somatic and genital maturation may get out of step especially the suppressionof instinctive life—which determines so many forms of pathological behaviour inadolescence.

We should also mention the excellent contribution of M. Soule who described thematurational deviations produced by abnormal upbringing (children in public care).In most of these cases of these cases an active, intensive form of psychotherapy isrequired, rather than the "classic" method.

Another very definite point of view was expressed by Myassichtchev, whostressed the incompatibility between Pavlovian doctrine and psycho-analysis.

In conclusion, one may say that this first Congress has been marked by con-vergence, even between the representatives of disciplines as different as histologyand psycho-analysis; it has also furnished a meeting point for specialists from allparts of our old continent to discuss their work and ideas. Moreover, the very themeof the Congress was such as to induce in all of us a dynamic attitude—the only onewhich allows us to apprehend fully that constantly changing creature, the child.