Dulness in Rural Children
18 MENTAL WELFARE. By G. A. Gordon Johnstone, M.A., M.D. Cantab., D.P.H., Assistant County Medical Officer, Lanes, (late of Wilts.) The early diagnosis and certification of Mentally Defective cases is becoming increasingly important, but we are still a considerable distance from the posi- tion where we can make full use of the Mental Deficiency Act.
Generally speaking, it would be true to say that practically all mental defectives should be diagnosed whilst they are of school age. The great majority of them are in attendance, at some time, at our public elementary schools. There is no difficulty in recognising the Idiot, Imbecile and the low-grade Feeble- minded groups, but it is not easy always to distinguish the high-grade Feeble- minded children. In the first place, the possibility of mental deficiency has not occurred to the teacher and, in the second, it is not always possible for a case of this type to be recognised by its behaviour during the ordinary routine medical inspection held at our public elementary schools.
When we remember that the present definition of Feeble-minded Persons is ” persons in whose case there exists from birth or from an early age, mental defec- tiveness so pronounced that they require care, supervision, and control for their own protection or for the protection of others,” etc., it will be appreciated in dealing with a feeble-minded adult brought to notice for anti-social( behaviour, that it is important to be able to refer to some earlier part of the person’s life for information which, if satisfactorily obtained, may enable the case to be dealt with by the more humane machinery of the 1913 Act than by the ordinary penal code.
During recent years, School Medical Inspectors have been using, to an increasing extent, some form of standardised scale of test questions, which makes the work of diagnosis more easy and more accurate, but these scales must, of course, be reg’arded only as one of several methods of diagnosis, much in the same way as a stethoscope is of value in the diagnosis of a case of pneumonia.
Nobody would diagnose a borderland case of mental deficiency by a standard scale alone, but the more we know about the use of a scale the fewer the mis- takes we shall be likely to make, and the more clearly we shall realise the limi- tations of its use.
Work with the aid of a scale has hitherto been chiefly done1 in urban areas. The following figures are, however, derived from observations on elementary school children in one of the most sparsely populated counties in England, and apply only to Dull and Backward children?cases which are just above the level of certification, unless they have exhibited any marked features such as mental instability or anti-social behaviour, etc.
In this series of cases, by means of the Stanford Revision of the Binet Simon Scale, the mental breakage points have been ascertained, that is to say, in each individual case those years have been taken in which the child has begun to fail in his answers. For instance, let us suppose that we are dealing with a dull child of twelve years of age, whose mental age is found to be nine-and-a-half years? with an intelligent quotient of approximately 80. In the scale tests, the child will probably be found to miss one or two questions of the eight-year-old group, .Mental welfare.
? Lonc ia nnCftWpr onlv one or two in the ten yesr
more in the nine year sToup. perhaps o ? The record of these tilree group, and to fail completely f ? asinJfailure, has been noted, and the years in which there was a gr, y ? convenience, the group has been results have been combined and analysed For ^en.en^^ g? ^ ^ limited to children whose intelligence qu ncrPc virv from six to four- the figures 69 and 80, and ?
struct^^bhTwhich’demonstrat^ “he gradual breakdown as the dull children further and further behind in their failures with the question.
STAMFORD REVISION.
Age Group No. of questions put … No. answered correctly Percentage answered correctly 20 17 85 62 42 157 110 67 70 288 188 62 390 249 63 480 255 53 470 277 59 10 403 202 50 12 155 51 33 17 17 J
It will, however, be more instructive to consider the various age groups in more detail, and to notice the individual breakage points and their nature. During the first year age group, owing to the small number of observations and the relatively slight deviation from normal of the children^ no very definite features are shown. It is, perhaps, just worth noticing that in the four year group only three out of ten children could repeat four digits (one out o tiiree trials). The successful performance of this test depends large y upon aiten ion <*nd concentration. Again, in Group 5, the two earliest breaking points are tests in which sustained attention and memory are involved . (a) Arrangement o two triangles to make a quadrilateral like one shown; and (b) the performance ?f three simple errands.
In Group 6, we meet with another feature. Less than half the children could name three out of four common English coins. This test is of doubtful value, especially in essentially rural children. Less than half the children could repeat a sentence (one of three trials) of 16-17 syllables. This test again depends on memory and sustained concentration.
In Group 7, we again find that the two weakest groups of answers are in those subjects where sustained concentration is required : ^a) Ability to repeat five numbers forward, and (b) three numbers backwards. 1 he failures were not due to the inability of the children to understand the nature of the tesL, but to lack of power to fix their minds on it. Next to these answers is the comparative^ poor response when asked to name the days of the week-only twenty out of thirty-five children being able to do this.
In Group 8, it is rather surprising to find that the worst answered questions (fifteen out of sixty-eie-ht) of the whole group in the Ball and Field test, which, ^ a certain extent, depends upon practical planning. We might expect better results in rural children, but in practice they have great difficulty in grasping the nature of the problem and even then their efforts are poor. Next in order of Poorness is the vocabulary test. Only one out of three could give satisfactory definitions to twenty simple words. ‘I his failure is also noticeable in later age groups. Only thirty-nine out of seventy-five were able to give similarities between coal and wood, etc. The answers to these questions were often interesting. It was often remarkable how a child, after once grasping- the idea of similarity in the first part of the question, and giving a satisfactory answer, returned almost persistently to give replies of contrast. This is, again, in some degree a con- centration test.
The nine year group of questions, generally speaking, is of a rather more practical nature than the other age groups, and it has been noticed that the percentage of correct replies shows a slight increase. The poorest response is found in the inability of naming the months of the year (eleven out of twenty-six children), and only half the children could do a simple addition sum, using postage stamps. The other two poor responses in this group are again found in prob- lems which require attention and sustained mental effort: (a) repetition of four numbers backwards, and (b) finding three rhymes to a given word. Failure in the latter appears to be due more to lack of attention and ability to concentrate than to poverty of vocabulary.
By the time we come to the ten year group, there is a marked increase in the breakage points of dull children. Once again the problem demanding con- centration heads the list of failures. Only eleven out of thirty-six repeated six digits correctly in order. The next worst failure is in the vocabulary test, where only one child in three was successful. Following this is a comparative failure (eleven out of twenty-nine) in a test which depends upon several factors, but chiefly upon concentration. The child is asked, with appropriate demonstration, to say as many words as possible in three minutes. The problem is easily under- stood, and failure seems to be chiefly due to the child being unable to keep the problem continually in his mind.
The figures in the twelve year group are small. Most of the dull children brought forward by teachers had broken down completely before reaching this mental age. We may just note that only one child in five passed the vocabulary test. It seems as if this fest is perhaps hardly fair for rural children. The next most evident failure is in the Dissected Sentences test, which requires ability in the use of words, as well as initiative and concentration.
For practical purposes, the 14 year group is beyond the dull children of elementary school age.
From the above, we see that the two weakest factors are : (1) Sustained Mental Effort; (2) Vocabulary and Word Usage. It may also be noted that the breakdown occurs last in : (1) Association tests, relating to common objects and their functions, and (2) Tests of spontaneous interest in environment. Comprehension in these children is slow, but not unduly poor.
In using the Stanford Revision Scale, these factors should be borne in mind, in so far as rural children are concerned.
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