A Clinical Examination Blank for Backward Children in the Public Schools
The Psychological Clinic Vol. I. No. 7. December 15, 1907. :Author: J. D. Heixman, University of Pennsylvania.
Children begin their public-school life at different ages, some as early as five, others not until eight or older. Even where education is compulsory, the age of entrance will frequently be above that prescribed by law. This is due in part to an evasion of the law and in part to ill-health and the influx of a foreign population. Nevertheless, the majority of children are under seven years of age when first entered upon the enrollment records of the public schools.
It is the aim of the schools to have each child do the work of one grade in a single year, so that if a child enters the first grade at the age of six years he should, if the school succeeds in its purpose, begin the work of the second grade at the age of seven years; of the third grade at the age of eight and so on through the grades. The schools, however, do not succeed in realizing this ideal scheme of progress. A very cursory examination of school reports or enrollment records will reveal the fact that there is a large number of children in the public schools who must often have failed to make the necessary promotions.
From the analysis of the enrollment figures of the Camden schools for 1905-06 it appeared that about 2,000 public school children, or 26% per cent of the entire number, were retarded, meaning by retarded those children of the first grade who were nine years old or more, of the second grade those who were ten or more and so on. A realization of the extent of this retardation led Mr. Bryan, the city superintendent, to study by means of a statistical inquiry the conditions producing it, and also to consent to a clinical examination of the 2,000 children whom his statistics showed to be retarded. This examination was carried (189) No. Name Grade Class 190 Address Grade Class 190 Address School 190 Teacher School 190 Teacher Progress E G F D vD Date of birth Age Conduct E G F D vD Age on entering school No. years in school Attendance vR R I vl A School history (Rel) Most deficient in Best in Habits 54321 54321
Father living dead Normal vG G M SI D Deficient Bkw IHIM II Id Mother living dead Health vG G F P vP Home Care vG G F P vP Step-father, Step-mother Nutrition F G M P St ” Culture vG G F P vP Nationality F. Support R W M P vP ” Discipline vG G F P vP ” M. Occupation of provider Birthplace Child works at Lives with Anormality Asymmetry Home Lang. Trunk Older brothers living dead Arms ” sisters ” ” Legs Younger brothers ” ” Hands ” sisters ” ” Feet Eye, R. ) Cranium Eye, L. ) Forehead Defects Face Disease Ears Ear, R. | Eyes Ear, L. j Nose Defects Lips Disease Palate Co-ordination 5 4 3 2 1 Tonsils vB Bold Norm Shy vS Naso-ph’nx Am Resp Pass Sull Sur Mth Breathg Sto In A1 Nerv vN Teeth vR Refl Norm Imp vl Tongue Stu Wilf Firm Flex Vac Voice Stammer (inf) 5 4 3 2 1 Speech Stutter 5 4 3 2 1 Diseases Filled In by Date Laboratory of Psychology, University of Pennsylvania. The J. Lewis Crozer Fund. oil by me during the second half of the school year 1906-07. Its object was to discover the social, educational and other factors which delayed the normal progress of the child.
In order to facilitate this investigation and to secure data that were relatively uniform and of scientific importance, the first task was the preparation of a suitable blank. I propose to describe and analyze this blank in the hope that it may prove of service to others who may contemplate the preparation of a blank for a similar investigation. The blank is of such a character that it may also serve as a model to teachers who are persuaded of the utility of keeping a permanent record of each child. Such a record, revised each year and sent with the child as it is promoted or transferred from one school to another, would more than repay the teacher for the time devoted to making the records. To do this work properly, presupposes on the part of the teacher, a knowledge of the individual child which is really indispensable to its proper discipline and instruction?a knowledge, however, which many teachers lack. The required use of this blank will go far towards compelling the teacher to gain this necessary knowledge. A case presents itself to my mind which forcibly illustrates how children may be made to suffer on account of the ignorance of the teacher. This was a girl, nine years old and in the first grade. She did very poor work and had little promise of being promoted. The mother was very urgent in demanding that her child should be promoted at the close of the term. Partly owing to the parent’s insistence and partly in consequence of a school regulation, this poor child, who was a microcephalic imbecile, was detained an hour or more almost every day after the regular school session in order that she might study her lessons. On further inquiry, I discovered that no matter liow much time the child devoted to her lessons, she learned nothing. The keeping of such a record would do more than benefit the teacher and the pupil. Properly made and preserved, these records would constitute a repository of data, upon which to build generalizations of the utmost significance to the school system and all connected with it, whether in the capacity of patron or pupil, teacher or supervisor.
All the items of the blank, which is reproduced in actual size on the page opposite, may be classified somewhat roughly into three groups: one group pertains to the child in the home, ?This investigation was conducted on the J. Lewis Crozer Fund, provided by Mrs. Crozer as a memorial to her husband and to further the scientific study and remedial treatment of backward children. another to the child in the school, and the third to the child as a mental and physical entity. Jnst as there are three main groups of facts, so there are three main sources from which to gain our information: the home, the teacher and the child himself.
When large numbers of children are to be examined within a limited period, it is impossible to undertake to see the parents of every child and the necessary information must be obtained from other sources. Frequently the child’s teacher will have some knowledge of the home conditions. In my experience, however, the principal is more likely to know the home, especially if she has held her position long enough to become acquainted with the district. It is also a practical expedient to use the child’s appearance as an index of the home conditions. In my work, I attempted to obtain facts about the home from the teacher, principal and child.
The blank makes no provision for obtaining certain data of value, such, for example, as the circumstances of the child’s birth. A number of considerations entered into the determination of the number and kind of data, for the collection of which provision was made. To prepare a blank four times the size of this one would have been a comparatively easy task. Our blank limits the data to those considered most essential for an understanding of the child’s status in the school, i. e., his backwardness in grade for his years. The blank must bo as convenient as possible to handle and must be filled with the least possible expenditure of time. ISTot an item appears on this blank without having had its purpose and relative value subjected to critical scrutiny. In certain cases, however, important facts may come to light which ought not to be passed by; these should be carefully entered on the back of the blank. The blank was only put into its present form after several days’ trial. This resulted in a few alterations, but for the most part it was left as originally conceived by Professor Witmer.
There are a number of preliminary data at the head of the blank which may usually be obtained from the ordinary school records. These are name, address, grade, class, school, teacher, date of birth, and age; sometimes even age on entering school and number of years in school can be obtained from the records. In the Camden schools it was possible to obtain all but the two last named items from the regular registration books. It will be noticed that grade, class, school, address, and teacher are duplicated. This is explained in the following way. When I began my work I examined the blanks Mr. Bryan had used in his inquiry during the year 1905-06. From these records I obtained the name, grade, class, address and teacher for each one of the 2,000 cases of retarded children. These facts are required to identify and locate the child, therefore I entered them upon my blank before beginning the actual examination. But when I began the examinations, I found that the location of the child had changed in a large percentage of cases, due to promotion, transfer or change of residence; hence the duplication. If the facts which serve to identify and locate the child are obtained from the school records for the year in which the investigation is carried on, some of the items on the blank need not be duplicated, but this does not apply to grade and class. The grade and class of the year previous to that of the examination should be entered for every child upon the blank, so that when a child’s progress is reported by the teacher as good, the investigator can at once compare this judgment with the number of classes or grades the child made during the previous year. Frequently teachers will report progress “good” simply because the -child in question is then doing well. They do not take into consideration the length of time involved. When their attention is called to the fact that the child made no promotion during the previous year, they frequently reverse their judgment. After we have obtained the name, grade, class, school, address, and teacher of the child, he may be said to be located. We now know where to go to find liim, whether at school or at home, in order to obtain the other data called for by the blank. Moreover, age, grade and class give the child’s intellectual status, enabling us to measure the extent of his retardation. Date of birth and age are both called for, in order that one may serve as a check upon the other. If there is any inconsistency, the information must be regarded as unreliable. The same may be said about age on entering school and number of years in school.
Closely associated with all the data mentioned above are ‘progress, conduct, and attendance. After progress appear the letters E, G, F, D and vD; these are abbreviations for the words excellent, good, fair, deficient and very deficient. The letters used in connection with conduct are the same as those used with proqress, and stand for the same words. The letters following attendance are vE, R, I, vl, and A; they are symbols for the words very regular, regular, irregular, very irregular, and absent. These letters, standing for words, are used because they are likely to mean more to the person doing the grading, than mere figures standing for so many grades. However, figures may be employed. In connection with normal, which for the sake of compactness is used for normal mentality, both figures and letters appear. The same arrangement is employed in connection with deficient, standing for deficient mentality. To indicate the grades of co-ordination, stammer, and stutter, only figures are employed, because no significant words suggest themselves. Below the item coordination are five groups of letters and words which are used to grade five different mental or moral qualities, whose purpose will be considered later. The other qualities which it was thought profitable to grade are health, nutrition, support, home care, home culture, and home discipline.
I have now made mention of all the data involving the gradation of qualities, conditions and functions; I shall next consider the system of grading. It will be noticed that a fivepoint system is adhered to throughout, and there are some reasons why a five point, rather than a four or six point, or some other system, should have been chosen. It appears to be the most natural system. In our every-day judgments we are apt to classify with respect to a system of five grades. When asked to grade the mentality of a child, it does not seem difficult to say that he is either good or poor, or neither. But we constantly meet with exceptional cases which we feel should be classed as very good or very poor, and therefore one more grade appears necessary at each end of the three already given. In asking teachers to grade the mentality of their pupils, I frequently asked them whether the mentality was good or poor, without telling them how many grades of mentality I used. In very many cases they responded, “neither,” meaning medium, or, “lie is very good,” or, “He is very poor.”
Another reason for preferring the five-point system is its easy adaptation to other systems. In translating this system into the percentile system, or the reverse, the lowest grade would include all the points from 1-20 per cent; the second from 21-40; the third from 41-GO; the fourth from Gl-80; and the fifth from 81-100. Although somewhat imperfectly, it may be articulated with a three-point system by combining the two points at each extremity of the five-point system. Again, some four-point systems are simply five-point systems in disguise. Such, for example, is the one used in the college of the University of Pennsylvania. Hero the symbols D, G, P, and N”, stand for the words distinguished, good, passed, and not passed, respectively. The group marked IT has really not been analyzed and graded because tlio college has no interest in grading students who fall below the passing mark; but if the E” group were graded according to relative ability, it would be found that the students in it would distribute themselves into two groups which would be related to each other like the D and G groups.
In connection with normal mentality, for which normal appears 011 the blank, I wish to explain in what way the figures are used to indicate gradation. Directly after normal are placed the symbols vG, G, M, SI and D, standing for the words very good, good, medium, slow, and dull. Where such words or their symbols are used there can be no doubt as to the grade for which they stand, but this is different where figures are employed. Here it will be observed that D is placed below the figure 1; therefore the figure 1 indicates the lowest grade of normal mentality. The highest grade of mentality is indicated by the figure 5, placed above vG; and medium mentality by the figure 3 above M. Consequently, the higher the figure, the higher is the grade of mentality which it denotes. This use of the highest figure for the highest, and the lowest figure for the lowest degree of the quality after which it appears, is followed wherever figures are used for grading. In general, this is contrary to custom, but it is adhered to in this blank for the sake of being consistent with the percentile system of marking grades. Just as in the percentile system, so in this system the lower numbers 3tand for the lower grades.
After this general treatment of the graded items, I wish to consider these items individually, and first mentality. The immediate purpose of the preparation and employment of this blank was the collection of data for an investigation of the causes of retardation. Much of the retardation may be accounted for by a low degree of mentality; and to determine the number whose mental capacity is low, gradation was not avoidable. The grades of normal mentality appear on the blank after the word normal. The symbols employed are vG, G, M, SI, and D, and they stand for the words very good, good, medium, slow, and dull. These words were not used to grade the class standing of the children, but their mental capacity or ability. The use of the words very good, good, and medium for grades 5, 4, and 3, will be accepted without comment. It may seem that perhaps we should have chosen the words poor, and very poor for grades 2 and 1 respectively. These words indeed are often applied, but the endeavor was made to use on the blank, words which would appeal most to the natural judgments of the teacher. It’was thought that many teachers speak of their children as being “slow” and that this means more as a grading of mental capacity than the term poor. A “dull” child the teacher also understands readily,’ and this seemed to be a more striking term for children who are in the lowest grade of normal mentality than the rather indefinite term very poor. Whatever catchwords may be employed, they serve only to assist the investigator to assign the child his proper position in one of the five grades represented by 5, 4, 3, 2 and 1. It is commonly assumed that all children in the public schools are of normal mentality. If this were true, it would be possible to distribute all our cases over the five grades of normal mentality which have just been discussed. However, it does not take a very extensive investigation of the mental capacity of children who are retarded in school progress to discover that many of them are subnormal in mental capacity. Indeed, for every thousand children examined we find one or more children who are properly cases for an institution for feebleminded children. We must provide for a large number of children to be distributed over classes or grades that are recognizably deficient in mentality. To preserve the five-point system, children who are discovered to be mentally deficient are distributed over five grades. The highest grade of these deficient children is called backward; the lowest grade would be the idiot. The middle grade is occupied by what is generally characterized as an imbecile of medium grade. Between him and the backward child we place the imbecile of high grade. Between him and the idiot we place the idio-imbecile. In this scheme of classification we omit the imbecile of low grade, whom we should classify either as an imbecile of medium grade or as an idio-imbecile; and we fail to recognize more than one grade, of idiot. The mentally deficient are therefore represented on the blank by grades 5, 4, 3, 2, and 1, for which the following symbols are employed, Bkw, III, IM, II, and Id.
A different point of view might have given rise to a different system of classification. Thus, Ireland and Shuttleworth both make use of a pathological classification. This must necessarily be as incomplete as is our knowledge of the pathological conditions of the feebleminded. It is undoubtedly of value, however, to the physician, for he looks to the pathology of the idiot to throw light upon its etiology, diagnosis, and prognosis. But these pathological conditions are usually not the causes of idiocy, but mere concomitants. The essential fact of idiocy is mental deficiency. In the British Medical Journal for 1002 Dr Eichholz says: “Feeblemindedness or mental deficiency is not so much a symptomatic condition to which a medical man can apply his art with hope of success, as a social and educational grouping which has gradually arisen in connection with the development of elementary education in this and other countries.” Moreover, it is recognized that the hope for the greatest improvement of the feebleminded lies in their instruction and training,?that the problem is an educational problem, and not a medical one. Even the physician becomes a trainer when he undertakes the daily care of the feebleminded child. This has been recognized from the time of Itard through Seguin to Sollier and Barr. In Die Kinderfeliler, Vol. VII, p. 97 J. Triiper quotes the following passage by Dr Pelman, the’ psychiatrist at Bonn, from the introduction to the German edition of Sollier’s, “Psychologie de l’idiot et de l’imbecile”: “What we meet as the pathological foundation of idiocy are the sequelae of diseased processes that have long since run their course. These one can no longer obviate through any known medical art. The feeblemindedness which has its basis in a congenital brain disease, or in one acquired in the first years of life, is no longer susceptible of cure. The task of the physician can therefore receive but a small reward.”
It appears to be generally admitted that the most satisfactory classification of the feebleminded is psychological or educational. A psychological classification, however, does not appear to me as practical as an educational one. Even so fundamental a psychical process as the attention, upon which Sollier bases his psychological classification, is not such a measure of general capacity as to bo of much service in determining the place of these children in schools and institutions. Of all the schemes of classification which have been offered, the most practical, in my judgment, is that of Dr Martin W. Barr. It is based upon educability. Omitting the moral imbecile, it is as follows: I. Asylum Care : 1. Idiot, (a) Profound, unimprovable; (b) Superficial, improvable in self help only. 2. Idio-imbecile, improvable in self help and helpfulness. II. Long apprenticeship and colony life under protection: Imbecile, (a)Low grade, trainable in industrial and simplest manual occupations; (b) Middle grade, trainable in manual arts and simplest mental requirements; (c) High oradc, trainable in manual and intellectual arts. III. Trained to for a place in tiie world: Backward or mentally feeble, mental processes normal but slow and requiring special training and environment to prevent deterioration.
The five grades of mental deficiency that are used on the blank are practically the same as those which have been presented by Dr Barr. The three highest grades of the mentally deficient are in complete agreement. The low grade imbecile, however, is not given a separate classification on the blank, nor is the class of idiots subdivided into the profound and the superficial. (To be continued.)
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