The Cassar Family: Regression, Dementia and a Return to Work
The Cassar family live in a two-bedroom flat in Msida. Daniel (38) works night shifts twice a week at the airport; Sara (36) is a full-time pharmacy assistant. Their children are Luca (7) and Mia (2). Sara's mother, Rose (74), has early-stage Alzheimer's and moved in three weeks ago after a fall; she sleeps in the living room and needs reminders to take her blood-pressure tablets. Before the move, Mia had been dry in the day for three months; now she refuses the potty, wakes at 02:00 and clings to Sara. Luca, who had been dry at night for two years, has started bedwetting again, says he hates school and has missed four days. Sara sleeps about five hours a night and is considering giving up work. Daniel says he cannot change his shifts. There is no family nearby, and they have not asked social services for respite.
1. Interpret Mia's potty refusal and night waking and Luca's bedwetting and school reluctance. Use at least two developmental concepts and explain why punishment or intensive potty training would be counterproductive.
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Mia is two, in Erikson's autonomy-versus-shame/doubt stage, and toilet training is one of the first areas where she can exercise control. Rose's arrival, the loss of the spare room and Sara's divided attention have disrupted her secure base, so potty refusal and 02:00 waking are best read as regression and attachment behaviour, not defiance. Luca is seven and had been dry at night for two years; secondary bedwetting and school reluctance suggest anxiety and regression under family stress. In family-systems terms, the children are expressing tension that the adults are carrying.
Punishment or intensive potty training would increase shame and turn the potty into a battle, which can prolong regression. Shaming Luca for bedwetting risks lowering self-esteem at the industry-versus-inferiority stage. The response should be calm, predictable routines, reassurance, brief special time with each child and no blame. Physical causes should also be ruled out: constipation and urinary infection for Mia, and GP advice for Luca if secondary enuresis persists. The judgement is that behaviour is communication; change the environment and adult responses rather than punish the child.
2. Propose a realistic four-week plan covering mornings, after-school time, bedtime and Rose's safety, taking account of Daniel's two night shifts. Identify who does what and one measurable indicator.
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In the morning, clothes and bags should be laid out the night before. Daniel does the school run on the three nights he is not on shift; on shift days Sara does a shorter version, with breakfast set out and no screen time until dressed. After school, Luca has 20 minutes of uninterrupted time with one adult before homework, and Mia has a potty sit of no more than two minutes after snack, with no pressure and no reward chart beyond praise. Daniel takes Luca to football on Saturday to protect a predictable routine.
At bedtime, 19:00 bath, 19:30 story and lights out by 20:00; a night light stays on, and Mia is returned calmly to bed at 02:00 with minimal talk. Luca has a mattress protector and is not shamed. Rose needs labels on doors, a night light, a locked medication box and a dosette box for her tablets; a day centre place should be requested for two days a week, and Sara should ask social services for a carer's assessment. Daniel takes Rose's morning medication on his late-shift days. The measurable indicator is the number of wet nights for Luca and the number of calm potty sits for Mia per week, reviewed after four weeks. If Luca remains wet after six weeks, the GP should assess him.
3. Sara is considering leaving her job. Evaluate this decision against alternatives, using financial, developmental and caregiver-burden arguments. Recommend a course of action.
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Leaving work would reduce immediate income and long-term pension contributions, and could increase Sara's isolation. It might relieve acute stress, but it would not by itself meet Rose's need for supervision or give the children more quality attention, because Sara would be more exhausted. The developmental argument is not that mothers must stay at home; it is that children need stable, responsive care and that caregiver stress harms the whole family. A tired, resentful parent at home is not automatically better than a supported working parent.
The alternatives should be tested before resignation: request flexible hours or a temporary reduction, ask about carer's leave, secure a day-centre place for Rose, ask social services for respite, and hold a family meeting to redistribute tasks. Daniel could take one night shift off per fortnight or do school drop-off on his days off. Financially, the family should compare Sara's net pay with the cost of respite and childcare, and consider whether a career break would be hard to reverse. The recommendation is an eight-week trial of negotiated flexible work plus external respite, with a review. Sara should not resign until the trial shows that work is unmanageable even with support.