In working with disturbed children, one inevitably asks oneself, how did these children become that way? This question takes on especially large proportions when the young patients do not readily fall into expectable and recognizable nosologic categories. I am certain that every one of the children presented here was born a healthy and normally, or even superiorly, endowed infant. I have in each chapter formulated some psychodynamic assumptions based on developmental precepts that in part explain what happened in each of the cases. There are, however, some further reaching theoretical formulations that allow for more generalized hypotheses about these children. These formulations are useful in identifying the child who does not fit the standard nosologic categories.