Clinical Studies of Retarded Children
The Psychological Clinic Vol. I. No. 4. June 15, 1907. :Author: Geokge W. Twitmyeb, Superintendent of Schools, Wilmington, Del.
Public education, in its broadest sense, may be regarded as a people’s deliberate effort to secure for their children in physical, intellectual and moral development the best that the race has achieved. The specific achievements of the race, upon which education as a process draws for direction and guidance, are found in the history of civilization, in sanitary engineering, psychology, pedagogy and hygiene. Pedagogy, in its modern aspect, is the theory and art of education and is the scientific and humane application of the world’s best thought and practice to the development of all children, whatever their condition by nature or environment may be. Every child has a right to an education,? that is, to the development of its powers to their fullest possibilities. This does not mean that all children should have the same education, but it does mean that each child should be educated in accordance with its capacities and possibilities, in short in acccordance with its individuality.
The school is maintained and supported for the children; its only excuse for being is that it shall give the individual child a start in the right direction, toward right living, right thinking and right doing. Whatever conduces to the accomplishment of this purpose is educational, and is worthy of careful consideration and profound study. The child in all its relation to the school is the center of educational concern; school houses, courses of study, text books, all the instrumentalities at the command of the teacher and the management, are of secondary importance. The school training of children means the care of individuals, not of the community; it means a careful study of each child in all its moods and tenses, of its individuality and expressive acts, of its temperament, environment and physical condition, so as to adapt the educative process and surroundings to its personal needs. There are in all schools children who, through accident, sickness, disease, environment or heredity, have certain peculiarities of mind or body, and must therefore be given individual care and attention if they are not to fall behind or fail altogether in their school work. Tor several years the failure of many pupils to be promoted regularly from grade to grade?retardation?has been a subject for the serious consideration of all connected with the management of the Wilmington schools. With the hope of ascertaining definitely the causes of retardation, two lines of inquiry were instituted; one bearing on the course of study and the quality of teaching in the several grades, the other bearing directly upon the individual child.
In comparing the course of study in our schools with the courses followed in a number of other progressive cities, the amount of work to be accomplished by our children was found to be about the same as that required elsewhere and in no sense excessive. It was also discovered that a normal child of average ability, by ordinary work and with not too many distracting engagements out of school hours, could easily master in the allotted time the required course in the several grades. The teaching, too, from year to year is becoming very sympathetic, more rational, more painstaking, more individual, and therefore enables a larger number to complete the grades regularly.
Every school has some unfortunate children who cannot keep pace with their more fortunate neighbors; they are known as “backward children, dullards or defectives.” These children are often burdened with some physical defect, or mortgaged by some inherited abnormality which, if properly diagnosed and treated, may be relieved. Children are dullards by the law of cause and effect. The dulness or retardation of every child is the effect of some cause, sometimes trivial, sometimes serious, but generally discoverable and remediable. It is the duty, nay, the high privilege of the teacher to discover the retardation, diagnose its causes, where possible, and suggest to parents the proper treatment. During the last five years, with the assistance of principals and grade teachers, I have made a careful study of non-promoted pupils in all grades. The causes of mental retardation as discovered by our teachers, may be roughly stated as follows, viz: irregularity in attendance and truancy; bad or indifferent domestic conditions and low ideals of life and conduct; want of parental care and discipline; vicious associates; malnutrition and fatigue; defective eye-sight, defective hearing, and such physical defects as catarrli, enlarged tonsils and adenoids; tobacco and alcoholic poisoning; the sequellse of scarlet fever, diphtheria, measles, whooping cough and typhoid fever; chorea and nervousness manifested in mental irritability, depression, emotional excitement, morbid fears, lack of self-control, persistent ideas, weakness of memory and concentration, exaggerated mobility, tremors and twitching movements of groups of muscles; stammering, stuttering, and other developmental defects.
An accurate determination was made of the number and age of all the children in each year of the twelve-years’ course of study. The results for a single year have been selected for presentation in the following table:
Table I.
Tiie Numbeb of Children of Each Age in Each Year of School Life from the First to the Twelfth Year. G 7 8 9 10 11 12 13 14 15 1G 17 18 19 20 21 99 PRIMARY 558 559 243 72 24 17 9 4 24 305 471 255 97 44 20 11 5 7 259 418 257 121 67 27 6 2 36 2 GO 409 286 137 98 30 6 5 1 23 196 323 267 141 55 16 12 2 GRAMMAR 15 159 346 269 144 72 14 4 1 Tt’ls 1,4S7 1,232 1,162 1,269 1,036 1,024 781 635 298 224 125 35 9,311 1 9 114 266 234 123 28 26 141 224 179 54 10 high school 1 3 62 118 88 19 5 2 9 55 92 56 9 2 1 6 26 46 30 15 1 1 582 873 1,010 1,028 999 959 987 960 769 575 321 155 60 29 2 1 1
The results do not vary much from year to year. In the several years, they have revealed many interesting and some quite amazing facts. Table I shows that in the particular year, the statistics of which I have selected for the purpose of illustration, there were 1,487 pupils in the first-year course. The larger number of these pupils are from 6 to 8 years of age, inclusive, but a not inconsiderable number range from 9 to 13 years of age, and one member of this grade is as old as 16. In the second school year, there are 1,232 pupils, the largest number are ranging from 7 to 9 years of age, but a considerable number range from 10 to 14, and a small group is precocious, being but 6 years of age. In the third year there are 1,162 pupils, the majority of whom range from 8 to 11 years; quite a number are from 12 to 14, and a small group of seven children are but 7 years of age. In the fourth school year the largest number of children fall between the ages of 9 and 12, but more than a hundred range from 13 to 16 and two are but 7 years of age and thirty-six are but 8 years of age. The inspection of tho figures for each of the twelve years of the school reveals similar conditions for each year. In each school year there are many children seriously retarded. In the primary and grammar grades, these retarded children are from one to six years behind the normal grade; a few are shown to be from one to two years in advance of the normal grade.
In a large number of cases the retardation was due to various causes entirely beyond the reach or control of the school; such, for example, as entering school at an age above the required school age, irregular attendance caused by prolonged sickness, or the necessity of helping to support the family, incorrigibility, truancy, etc. Children who are retarded because of irregular attendance and truancy cannot be studied with sufficient thoroughness to determine their mental and physical status. In the absence of a compulsory attendance law these children cannot be kept continuously under observation. We have, however, great hope of improving tho mental, moral and physical condition of many of the children belonging to this group of backward pupils, when tho new compulsory attendance law goes into operation at the opening of the next term.
Of the retarded children who have been subjected to examination and treatment during the past five years, 1,487 have been carefully examined and studied by teachers, principals and superintendents, and were treated in school by corrective training or in the home by the family physician. The observation and investigation undertaken by principals and teachers included tests of eye-sight and hearing, the detection of nasal obstruction, enlarged tonsils and suspected adenoid growths, the ascertainment of tho presence of decayed teeth, defective speech, nervous troubles and fatigue, malnutrition and mental defects. The result of tho examination and subsequent treatment accorded these children is shown in Table II. Of the 1,487 cases of retardation examined for mental and physical defects, 1,231, or 82.8 per cent, were found to have defects of some kind; 1,001, or 67.2 per cent, were given pedagogical or medical treatment adapted to ameliorate the condition discovered. Of this number 841 children, or 84.1 per cent, were improved by the treatment given them. As to the remaining 15.9 per cent, many of the cases treated passed from under our observation before the results of the treatment could be satisfactorily determined.
Table II.
Record of 1,487 Cases of Retardation (Boys and Girls) Examined for Mental and Physical Defects. defects Of some kind. Sight Hearing Speech Enlarged tonsils Nasal stenosis Adenoids Badly decayed teeth. Finger twitches Malnutrition Nervousness Fatigue Mental defects presenting defects No. 1,231 1,202 232 102 315 245 40 99 149 332 672 321 285 82.8 80.8 15.6 6.9 21.2 16.5 2.7 6.7 10.0 22.3 45.2 21.6 19.2 No. 1,001 956 120 10 203 150 28 90 78 300 600 300 IMPROVED 67.2 No. e-S841 56.6 64.3 723 48.6 8.1 0.7 13.7 10.1 1.8 6.4 5.2 20.2 40.3 20.2 84.1 75.6 24.2 29 1.9 5 0.3 50.0 198 13.3 97.5 120 8.1 80.0 28 1.8 100.0 238 421 296 16.0 79.3 28.3 | 70.1 19.9 98.7
Table II analyzes the causes of retardation and the results of treatment with respect to the discovered conditions. Thus 1,202, or 80.8 per cent, of the children had defective eyesight. Very nearly all the children who had defects of any kind had defective eye-siglit. The next largest defect to be noted in the table is nervousness, with 45.2 per cent. Enlarged tonsils with 21.2 per cent, malnutrition with 22.3 per cent, and fatigue with 21.G per cent come next in order, and are of about equal frequency. Mental defects are present in 19.2 per cent of the cases. Nasal stenosis is observed in 16.5 per cent, finger twitches are observed in 10 per cent, defective speech in 6.9 per cent, badly decayed teeth in 6.7 per cent of the cases, adenoids in 2.7 per cent. It is quite possible that many of these classes of defect occurred more often than this table shows them to have appeared. The work was done without the assistance of the expert psychologist and physician. Similar defects may have existed in other cases not discovered by us. The first work of this kind must naturally be liable to some errors of omission.
The column showing the percentages of cases improved by treatment is of interest. The 28 cases of adenoids treated all showed improvement. Over 90 per cent of improvement is shown in those cases manifesting fatigue or presenting enlarged tonsils. The record of improvement in cases suffering from malnutrition, defective eye-sight, nasal stenosis, and nervousness is also worthy of mention. Three-fourths of the cases treated were improved. Of the 120 children who were treated for defective hearing about one-fourth were improved by the methods of treatment. Of the 10 cases of defective speech, one-half are reported as improved. These results were secured through the hearty co-operation of teachers and principals, in the absence of specialists trained in mental and physical diagnosis. The results obtained in the limited time which could be given to this work, were of necessity crude and tentative; they were, however, sufficiently exact to show that many of the grosser causes of backwardness and mental retardation can be correctly diagnosed by class teachers untrained in the use of anthropometric and psycho-physical measurements. They show, also, that much can be done without expert interven tion for the amelioration of many whose school life is a constant struggle against handicaps that can be removed by the exercise of a little good judgment, tactful procedure, and genuine human sympathy.
The careful diagnosis and correct interpretation of physical characteristics is of inestimable value to the teacher in understanding her pnpils, when such study is supplemented by more or less detailed observation of the different manifestations of intellectual activity. It is certainly true that in a general way mental condition and activity are portrayed in physical characteristics, but in accounting for a child’s readiness or dullness in profiting by the discipline of the school room it is necessary for the teacher to observe carefully both mental and physical attributes.
The aim of these studies was not to determine how many more children could be promoted by discovering certain physical, temperamental and environmental peculiarities as the causes of retardation. Rather was it through a correct interpretation of individual characteristics and conditions to solve the problem of placing each child in the best relation to the educational forces and instrumentalities at our command, to the end that he may not be hindered by any convention, tradition, prescription group, or class standard; in other words, to utilize all his available energy without waste. We have made only a beginning in this important, work and there is much yet to be done. The problem involves more than the determination of a child’s capabilities in terms of the grade fiction.
The presentation of typical cases, the method of diagnosis and corrective training and treatment, the co-operation of the home in medical treatment, and the results secured must be left for another article.
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