A Group of Children as Clinical Problems
- Author:
Gertha Williams,
Graduate Student, University of Pennsylvania. Most of the cases received at the Psychological Clinic of the University of Pennsylvania come as individuals, not in groups, but nine of the cases examined during the summer of 1914 came as one group with certain characteristics in common. They were all Jewish and were sent to the Clinic by a Jewish charitable institution in Philadelphia. With the exception of one child they lived at the Home during the day, returning to their own homes at night. The nine children are:
Albert 7 years backward Sam 9 years backward Bella 8 years delinquent Jacob 7 years backward David 12 years delinquent Morris 11 years backward Bessie 10 years delinquent Celia 7 years backward Rose 8 years backward
Albert is seven years old and an only child. He was brought to the Clinic because of pedagogical retardation. His father is dead and his mother is employed in a factory. She is in poor health and is soon to undergo an operation. They live on the fourth floor of a tenement, occupying but one room, which is fairly clean. Albert’s health is good and there are no marked physical defects. The mental examination showed him to be of normal mentality although his mental processes are sluggish. He has a slight speech defect. He may require special instruction to bring him up to grade. It was recommended that he begin again in the first grade in the fall and if, in the teacher’s judgment, he does not make satisfactory progress that he be transferred to a special class at the end of one month.
Jacob is seven years old. He was brought to the Clinic because of backwardness in school. His mother died of tuberculosis; otherwise the family history is good. The father is a laborer and is reported to possess only low-grade intelligence. But as he is able to support his family and himself, he is probably not feebleminded. Jacob has one sister who is backward.
While pedagogically retarded, Jacob seems to be of normal mentality, but he is in a poor physical condition. He is anemic, restless, and easily fatigued. His poor physical condition is the probable explanation of his retardation, and the first consideration should be given to proper physical care. Special instruction, preferably in a special class, may be necessary to held him overcome the retardation his physical condition has caused and bring him up to his grade.
Sam is nine years old. He was brought to the Clinic because of backwardness. He has been in school three years and is now in the upper second grade doing poor work. He does not like school but is fond of ” cleaning up,” and does work of that nature well. He does not obey readily, but this is rather because he forgets or fails to understand. He is quarrelsome and does not get along well with other children. His health is good but he is always in a very unhygienic condition. His mother is employed during the day, and as she is of low-grade intelligence, is unable to give him proper care. The father is dead.
Sam reads with good pronunciation and articulation and with fair expression. His arithmetic is only fair with concrete material. In general conversation his answers are unintelligent. According to the Binet scale his mental age is just seven; his responses are very slow. He could not reproduce the lozenge correctly but realized that his reproduction was poor. His auditory memory is only fair; visual memory poor. Questions associated with his life he answered well, but those requiring thought were more difficult for him. He described a picture of common objects accurately and was able to execute three commissions, but he could not compare a butterfly and a fly, or wood and glass.
Sam is a more discouraging case than the other two boys. His health is good but the home conditions are poor. His mentality is doubtful, but one does not like to call him feebleminded without further observation. He is a good example of a case in which the special class teacher can render valuable assistance to the examiner in making a final diagnosis. He should be placed under a teacher capable of making intelligent observations of his reactions, and returned to the Clinic for re-examination. Then a diagnosis can be made, based partly upon the teacher’s report of his progress and partly upon the two examinations.
Bessie is ten years old. She was brought to the Clinic because she is reported to be nervous, disobedient, and morally irresponsible. Her behavior with boys is undesirable, indicating that she might become immoral when older. She writes silly notes to the boys and is, as the social worker who brought her expressed it, “fresh” with them. While not vicious she is disobedient, noisy and quarrelsome. She is unusually well developed physically and is in good health. Her birth was natural and she was a healthy baby and seemed like other children. She has had no serious illnesses except diphtheria. Her tonsils have been removed.
In school she is in the upper fourth grade. She entered school at five and has had two long absences. Her conduct in school is only fair. She reads with good expression, articulation, and pronunciation. In memory type she is visual. Her spelling is good in that words recognized with difficulty or misread are spelled with some degree of accuracy. Her written spelling is superior to the oral. In arithmetic she is inaccurate but reasons fairly well. There is nothing in her mental condition to account for her delinquent tendencies, as her mentality is certainly normal. The home is crowded but fairly clean. The father and mother are of ordinary mentality. At the time the home was investigated the father was just recovering from the effects of an operation and the mother was ill and expecting to have an operation in the near future. It seems to me that right here we have the probable explanation of her delinquent tendencies. With the father and mother both ill, there is no one to take proper care of a girl of her age. She needs judicious discipline and a favorable environment. She is to be returned to her grade in the fall, and if delinquent tendencies continue, is to be removed from her home for a time. These few cases are fairly representative of the group and will serve to illustrate the following points:
In all examinations of children at the Clinic the practical side of the question is never lost sight of. There is always an attempt to answer the question, “What is best to be done for this child?” The whole examination revolves about this point. In order to answer this question several other questions must first be answered. The clinicist asks himself in what way the child deviates from the normal. There are two possibilities. The child may be backward or delinquent, as in the cases cited above. This problem does not detain the examiner long, as the reason for bringing the child to the Clinic usually clears up this point. Then the cause of the delinquency or backwardness of the child must be determined. This is not so easily discovered. The cause may be found in the child’s mentality, in his physical condition, or in his environment. In the cases of Albert and Sam, for example, the cause was found in the mentality of the children, in Jacob’s case it was his physical condition, and in Bessie’s an unfavorable environment. After the child’s condition is diagnosed, definite and specific advice is given to the parent or guardian as to what is to be done for him. This advice is of a practical nature, based upon real conditions, and is not merely an ideal prescription of what would be best for the child under conditions which do not exist. The advice varies with each child. It may be the suggestion of an institution, public or private, a special class or other form of individual instruction. Or the examiner may merely suggest a different method of dealing with the child in the home.
In the giving of advice much tact is necessary. The best of advice must be sugar-coated. Parents are loath to believe their children feebleminded. Also there is much ignorance and prejudice against institutions to be overcome. If the trouble is in the home itself, the situation is a delicate one. It is very difficult to persuade a parent that his method of dealing with his child is wrong or that his home is not the proper place in which to bring up his child. The work of the social service department is of great importance to the Clinic, for follow-up work is absolutely necessary to secure the best results. The parents need help and encouragement in carrying out the recommendations of the examiner. The formality of entering a child in an institution would discourage most parents if there were not some one to help them. It is often necessary for the social worker to go into the home and help the parents to readjust themselves and their home to the needs of the child. It is also her duty to see that the child is brought to the Clinic for re-examination on the advice of the examiner. This careful follow-up work makes it possible to keep in touch with the cases tested at the Clinic and to learn the effect upon the child of the treatment recommended. Thus there is a check upon one’s own work which is of great value when a similar case comes up. It is not always possible to give a final judgment of the child’s mentality at the time of the first examination. The diagnosis is essentially a prognosis and for this reason it is often necessary to keep the child under observation for a time or to try the effect of a given course of treatment or special instruction upon him. Then when the child is brought for re-examination a truer judgment of his mentality can be made, based upon the progress he has been able to make under proper conditions.
It will be seen that the clinicist cannot rely on any set of mental tests alone to give him a complete picture of any given case. No source of information is to be disregarded. The answer may be given by the mental tests or the solution may lie in the environment of the child or in his physical condition. Each child is treated as an individual and no general rule can be framed to apply to all cases. The examiner must be ready to follow any “lead” given him, whether it be found in the mental examination or in some apparently insignificant bit of information brought to light in the preliminary examination. Every action of the child is significant from the time he enters the room until he leaves it.
It is here that the experience of the examiner is important. He must have the tact to get the needed information about the child from a sometimes reluctant parent and the ability properly to interpret the child’s behavior during the examination. Dr Knox of Ellis Island has very aptly named this ability of the clinicist to “size up” a given case from his experience with other similar cases the “human test”.
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