Diagnostic Education?
An Education for The Fortunate Few.1 The Psychological Clinic Copyright, 1917, by Lightner Witmer, Editor. Vol. XI, No. 3 May 15, 1917 :Author: Lightner Witmer, Ph.D., University of Pennsylvania.
In 1744 Pereira presented to the Academy of Science at Rochelle, France, a boy born deaf whom he had taught to talk. By the results of an educational experiment, Pereira demonstrated the analytic separateness of two of the important elements involved in language. The child comes into the world endowed at birth with a reflexly functioning cerebral center,?the speech center, an instinct for language. The human being begins to talk as he begins to breathe. The words which he hears initiate the cerebral excitations which produce the coordinations of muscular contractions necessary to bring about the child’s first approximations to correct articulation. The coordinated movements of the speech mechanism excite in their turn motor or kinesthetic sensations which leave in the brain, and ultimately at the disposal of the child’s volition, kinesthetic and verbal memory images. If the speech mechanism of a deaf child can be stimulated in some other way than through the reflex cerebration initiated in the hearing child by verbal perceptions, the deaf child, like his hearing brother, will acquire the memory images of spoken words and when these are controlled by his attention and imagination he will show a similar voluntary control over language. There is, in my opinion, no more significant single event in the history of education than Pereira s demonstration before the Academy of Science at Rochelle of the Power of articulate language acquired by a deaf boy through scientific training. It stimulated directly the education of the deaf, the blind and the feebleminded, and has culminated in the training o Helen Keller. Adapted by Montessori to normal children, it enabled her to make children under five years of age almost teach themselves to read and write. Seguin emphasized the physiological lAn address delivered before the American Philosophical Society, Philadelphia, Pa., on April 13, 1017. feature of this educational method. Montessori has preferred to emphasize the appeal to the free activities of the child. In my work, which I consider a modern phase of Pereira’s and Seguin’s work, I lay special stress upon the necessity of the analytical diagnosis? a continuing diagnosis, to be made not only at the time of the first examination of a child, but through a more or less prolonged period of educational treatment, so that every step is determined or prescribed as the result of known factors measured, so far as may be, and assigned relative values in the course of the educational treatment to be prescribed. For this method I can for the present find no better term than “diagnostic education.”
Diagnostic education is to be found in the home, intimately combined with instinctive and traditional elements. Sometimes the parent punishes his child because he is annoyed, irritated, or angered at the child’s behavior. This is orthogenic treatment; that is to say, it tends to produce normal and favorable reactions in the child. Even the lower animals understand and react favorably to a powerful display of emotion. A parent will also act upon traditional principles and theories. For example, he may believe in corporal punishment or he may disbelieve in corporal punishment. He may ascribe unique value to discipline and minimize freedom, or he may exalt freedom to the level of a fetish, and taboo discipline. Even the thoughtful parent does little more than select from the common stock of human knowledge those rules of guidance which happen to be most congenial to him. Few parents are absolutely devoid of observation and reflection however. They do not apply the same principle to all children, nor to the same child under all circumstances. Whenever a parent determines, as a result of observation and reflection, to punish one child for a particular offense and not to punish another, or to mete out different kinds of punishment adapted to the individual needs of different children, he has recognized a difference in the constituent elements of the children. He has made a differential diagnosis and has prescribed what appeals to his judgment as the orthogenic treatment.
In school, all children are taught according to their age and level of development what society in the main holds to be good for them. There is a maximum of general principles and uniform methods based upon our understanding of an average, but often very hypothetical, child. The subjects of the curriculum are selected with reference to their universal value and are applied to all children alike. At the best, there is some recognition of the existence of groups of children having diverse characteristics and requiring a diverse educational treatment. In the elementary schools, in high school, and in college, there is a minimum of differential diagnosis and of orthogenic treatment prescribed to meet the needs of the individual pupil. Such treatment is often held up to us as an ideal. It is proclaimed by some schools as a real existent, but as a matter of fact, for reasons which will appear in the couise of this paper, it can never become a dominant element in a school system.
Even in well-ordered homes where thoughtful parents are employing diagnostic education, the diagnosis is not expert diagnosis. In consequence, thoughtful parents are able to achieve satisfactory results only with children who approximate the average or hypothetically standard child in mental and physical constitution. Both the parent and the school fail in the orthogenic treatment of an exceptional child. For these children an expert diagnosis is required before a satisfactory educational treatment may be prescribed. Among such exceptional children, I include not only those we call feebleminded, but also those who are exceptionally gifted. With both classes of children our aim should be the maximum development possible for each child, which in the case of the gifted child necessarily means something higher than an average level of attainment and proficiency. For some years I have devoted myself to the analytic diagnosis and educational treatment of children who resist educational treatdent by ordinary methods. The task which I set myself and my assistants is to obtain the maximum amount of development in a minimum amount of time with a given expenditure of effort. The measured progress of the child is therefore the object, and at the same time, the test, of the correctness of my diagnosis and of the resultant efficiency of the prescribed treatment. Some of these children are not feebleminded. They possess one or more mental defects which, however, do not distinguish them from normal children, for I define as a mental defect any mental attribute which interferes with a child’s proficiency or progress.
Nevertheless, many children, even some concerning whom I have been doubtful at the first examination, must be diagnosed as feebleminded. In these children the retardation is of such degree or character that we cannot conceive of the possibility of the child s attaining to the normal standard of social proficiency. By this, I mean that he cannot be expected to support himself, be permitted justly to have children,, or even to maintain an existence at large without constant disciplinary guardianship. The diagnosis of feeblemindedness would appear, therefore, to involve the piognosis of permanent deficiency. Moreover, in my experience, the feebleminded child usually manifests peculiarities of body, general behavior, and of mind which often enable us to distinguish him easily from the child who is retarded but not feebleminded. The general diagnosis of feeblemindedness is a social classification based upon the observation of a child’s behavior. We do not observe that the child has a feeble mind, and therefore is and must remain socially incompetent. We observe the incompetence and deficiency of the child’s present behavior. If the child’s performances do not conform in character and amount to what we know to be standard for his age of development, we assert the existence of a mental status which we cannot observe. A child of three years who cannot be trained to habits of personal cleanliness may be safely diagnosed as feebleminded, provided his life history is not one of continuous and serious illness. A child of six who has normal hearing and who does not talk, especially if his history shows that he has been slow in learning to walk, will invariably justify on further examination a diagnosis of feeblemindedness, provided there is no specific defect of the organs of speech. A child of eight who has not been able to learn, although taught, the colors red, yellow, green and blue, or who cannot under standardized conditions pass the formboard test, which involves the discrimination and matching of eleven different forms, will invariably prove incapable of learning to read and write. A child of twelve whose memory span is shown to be not more than three will not be able to attain to the intellectual level of a normal adult. The general diagnosis of feeblemindedness, then, is a Sociological classification based upon actual and latent proficiency of behavior, interpreted in psychological terms. In doubtful eases a careful analytic interpretation of a child’s performances must be made. Our so-called mental tests are simply agencies by which we stimulate the child to perform under our observation. The analytic interpretation, that is to say, the analytic diagnosis will be expressed in such terms as fear, shyness, anger, pride, jealousy, rage, sensation, imagination, memory, attention, understanding, intellect and intelligence. It is well to remind those who are not psychologists, and even some who are, that these terms are abstract terms derived from the observation of human and other animal behavior. The phrenologist attempts to read mental character from bumps on the head. The psychologist discovers all of the character with which he credits an individual in that individual’s behavior. Psychological tests simply provide material which is meaningless until adequately interpreted. For this reason, the Binet tests, expressed in terms of so-called mental age, furnish very unreliable data in doubtful cases, especially in the hands of amateurs who lack experience and psychological insight. This experience can be gained only from actual work with children. The general diagnosis or an analytical diagnosis must be tested by subsequent observations. In many cases they can only be adequately tested if the child is subjected to a thorough-going course of training. If I had not personally supervised the gruelling training of a boy of twelve years whom I diagnosed as having congenital aphasia but who was otherwise normal, I should speak with great hesitation of the existence of this condition in a child. Congenital aphasia, congenital illiteracy, congenital amusia or tonedeafness, and what I would call congenital anarithmia, are defects of memory which appear in the course of the education of the child and present unusual difficulties in training the memory in these respective directions.
Seguin set himself the task of making feebleminded children normal. Wherever the line, i. e. the social criterion, may be drawn, separating the feebleminded from the normal, there must be some children just below this line, who might, by appropriate training, be lifted into the class of normal. In practice, however, experts are very slow to diagnose a child as feebleminded. Consequently, I am often compelled to give a diagnosis of feeblemindedness where others have diagnosed the child, in many cases to save the parents’ feelings, as merely backward. On the other hand, in only one case do I know the diagnosis of feeblemindedness to have been positively given by competent authority where the results of training indicated either that the diagnosis was mistaken or the feeblemindedness had been cured. This is a boy who, fourteen months ago at the age of two years and seven months was diagnosed as feebleminded by an expert authority on children’s diseases as well as by myself.
This boy was born of apparently normal and healthy parents, who have three older children said to be normal. It is asserted that his birth was normal and there was nothing to attract attention about his development until he was six months old. Then he tad whooping cough; not a very bad case, but after this attack he showed anomalies of development. If placed on the floor he stayed just where he was put. If he fell forward he lay face down on the floor until picked up. If attractive objects were not within his reach he made no effort to get them. He spent most of his time lying in bed, unresponsive and indifferent. He did not begin to creep until he was two years and two months old, and then only after his knees were worked forward one at a time. He did not stand alone until he was two years and two months old and began for the first time to step out at two years and three months. A month later he was abie to walk about the room, but when I saw him first at the age of two years and seven months his walking was timid and wabbly. He could not even creep up or down stairs. He sat or lay in bed. If a card or a block were given him, he would hold it by the hour looking intently at it while scratching the side away from him with his nails. When lying in bed, he rolled his head so constantly to and fro that the hair on the back of his head was rubbed off. He dug his fingers into his ears and into his mouth, especially when irritated, so that for three months after I undertook his training it was impossible to get the constant sores cleared up. If the effort was made to take him from the bed he went into a paroxysm of apparently violent passion; at all events there was the most vociferous howling and tearing at his ears and mouth. At the same time his face became a purplish red, the whites of his eyes were violently inflamed, the gums bled and for a time I felt that in trying to subdue these spells I ran the risk of causing a cerebral hemorrhage. He said only a few words ” kitty, daddy.” When asked what the crow says, he could say “caw, caw.” His comprehension of language seemed to be confined to pointing when asked to his mouth, eyes, nose and ears. In playing with blocks he would pile one feebly on top of the other. He made no effort to imitate any copy that was set him. If asked to put a block on the floor, he gave no indication of understanding the word block or floor. He did not seem to look at things. Objects like a lighted match seemed to appear suddenly in his field of vision, giving him a distinct shock. He was fond of holding a book in his hand and turning the pages. He could hold a watch to his ear and say “tick-tock.” He could not feed himself and did not seem to know enough to close his mouth on a spoon. When the food was put in his mouth he would shut his lips and chew it quietly, but would take another spoonful without swallowing the first. He did not bring up again food which he swallowed?a good sign. Digestion was good; bowels fairly regular and normal. He was still in diapers. There were no physical anomalies excepting an apparently large head which suggested hydrocephalus. This had been the diagnosis of at least two physicians, but others, including the children’s specialist, affirmed that he was not hydrocephalic. One physician suggested polio-encephalitis but for the most part no etiology was ventured. The boy’s appearance and behavior would, in my opinion, have brought a diagnosis of feeblemindedness from any medical or psychological expert. My examination confirmed this diagnosis so completely that I at first declined to undertake the boy’s educational treatment, and only accepted him on trial at the very earnest solicitation of the parents. I can give you only a glimpse of this boy’s training, what and how I have taught him and more important perhaps, what he has taught me. I consider all training to fall under two heads, disciplinary and intellectual. By disciplinary training, I mean the training of a child’s general behavior to conform to what we approve. It involves self-disciplined freedom of conduct, as well as obedience, the discipline of analytic and persistent concentration of attention, as well as the formation of regular habits of eating and sleeping. This boy has been under training fourteen months. During all that time the training has had disciplinary value and for about ten months only was it devoted to specifically intellectual training. This began March the 19th, in the second month, when I put before him the formboard consisting of eleven blocks of different shape, each of which had its corresponding receptacle. He would not make the slightest effort even to pick up a block to put it back in place. I then tried him with the peg board, a board of 36 holes, into which a corresponding number of pegs of the same size and shape can be placed. He could not imitate my action of putting a peg in its hole. He would not put a peg in the hole even when I placed the peg in his hand. I had to hold his hand, guide it to the hole and place it in position, but after having done this once, he put five or six pegs in successively. In all he put in 15 before I stopped, although after the first six he put in each successive peg only when I said emphatically, “Put in another peg. I never knew him to fill the board with 36 pegs as the result of a general command. His attention appeared to wander and he always desisted. In this, his behavior was exactly like that of a chimpanzee whom I taught, though not with the same ease, to put pegs into a board. Subsequent events proved that the reason he objected to putting 36 pegs into the board was because this action bored him and not because he lacked persistent powers of attention. I tried him again with the formboard, giving him a circle which he could not place in position. I then took his hand and put the circle into its proper place. I gave him the circle again. He put it back in place. I then gave him another inset and moved his hand to the proper place. He put this in position. I then gave him a third inset o different form, directed him to the right place and he put this m position. I then gave him two at a time and later three at a time. He was able in the first lesson to pick up one of the three blocks and put it back in its proper position. I was not able to accomplish this much with the chimpanzee after many months of instruction. His coordination was good. Two days later he could replace four insets without a single error, and on the seventh day, six insets. In two weeks’ time, without any urging, he was putting away the entire eleven insets in 85 seconds. Good distribution of attention was shown by the fact that while trying to force one block into the wrong place he reached out and picked up another block and placed it in its correct position. From this two weeks’ experience I judged him to have a trainable and retentive memory, to have good images, good powers of sensation, good distribution of attention, excellent analytic attention and an interest in a relatively difficult problem, but no interest in such a simple problem as the peg board. The chief factor requiring training appeared to be his persistent concentration of attention. The formboard mastered, interest began to wane and so I gave him my cylinder test, which offers eighteen cylinders varying in height and diameter. Adults attempting to work this test for the first time will take about one minute and will make many false moves. In seventeen days he was able to put back all the cylinders in three minutes with no final errors, and in three weeks he could do it in two minutes. He then lost all interest in the cylinders and so on April the 17th I found it necessary to provide something new for his further intellectual development. Meantime, following his work with the formboard, he had been practiced on the Montessori geometric insets, the series of six trays of very complicated forms. This work I considered in the nature of drill, training his powers of attention both analytic and persistent.
On April 17th I taught him the letter B, using for the purpose the large wooden block letter, saying, “This is B. Put B on the chair.” In the afternoon he had forgotten it. After three separate periods of instruction he could pick out A, B, and C. He was asked to name them at the same time but would name only B. Some things you can force a child to do, but some things you cannot. I could compel him to pick out these letters, but I could not compel him to name them, so I had to tempt him with new letters and new words. I got him to say “V” on one trial by dragging out the V sound. He loved the sound of the letter and the feel of making it, but it took nearly two weeks to get him to say F. Someone worked an hour before he could be made to say the word shoe. The shoe was thrown up in the air and caught and while being thrown the word shoe was said. Apparently he said the word shoe because he thought it was part of the process of throwing it into the air. On May 9th, or in about three weeks time, he had learned to pick out all twenty-six letters. He now needed some drill on these letters because he was still apt to confuse M, N and W. As part of this drill work he was taught to name the letters as they appeared printed in a child’s alphabet book. During the month of June, his so-called lessons were discontinued. They commenced again the first week in July. This time I began testing his ability to learn combinations of letters. He was given the three letters of the word cat and told to arrange them in the proper order, that is to say, to spell the word cat. The interruption of a month made it somewhat difficult to bring him down to this work. He was very much interested now in observing and naming objects. Asked to spell a word, he would hear a motor going by and say, “It’s a motor car,” or look at his shoes and say, “It’s a shoes.” On July 20th I found it necessary to prescribe a new exercise for further training his persistent and analytic attention. Holding up one or more fingers I said One finger, two fingers, three fingers, four fingers.” It took the mont of July to teach him to arrange the letters of the words cat, boy an Vi-Q, when these were presented to him. During August he learne to spell cat and boy when the six letters of these two words were given him. He spelled cat or bat, whichever was asked, when the four letters B, C, A, and T were given. When a child is being taught, I always insist that he shall be taught at attention, on his toes as it were. Work is work and play is play. I even find that the same Person cannot both teach and play with a child. Regularity of work is also an essential. The interruption of a few days usually means a great waste of time before the child’s attention can be regained and held. In the early part of September he showed a great gain, when after an interruption of four or five days he buckled down to work again without waste of effort.
Beginning September 8th, words were printed on pieces of paper and passed to him to read. He began to read words by first spelling them. On September the 11th the words “I see a cat, were put before him and he was asked to read the sentence. Dog, yig, etc., Were on September 14th substituted for the word cat. By September 19th he could read the sentences, “A man can see me. A boy can see a dog.” On September 21st I tested his newly acquired ability by putting Monroe’s primer in his hand for the first time. He read, “I can see a man. A man ran. A cat can see a rat.” It was done haltingly, but it showed that from this time on the acquisition of reading was to be only a matter of drill. He can now both spell and sound words and will probably be graduated into the first reader by the first of next June.
I do not care whether this boy can read or not. ave a him taught reading because it was the best way to engage his interest, and train his attention, imagination, and memory. He liked it, so far as anyone can be said to like work. Intellectual work I call this, and intellectual work I say without hesitation, is an advantageous mental and hygienic stimulus to any boy of three years of age. The intellectual capabilities of many children ranging from three to six years of age are allowed to lose their edge through not being adequately developed and trained. Whether this boy was feebleminded or merely backward, the fact remains that he began to read at the age of three years after less than three months teaching with not more than twenty minutes instruction a day?a worthy accomplishment for even a normal boy. I contend that this was done by no unusual device or educational method. It was accomplished because it was based upon expert analytic diagnosis followed by a prescribed course of treatment, which involved the preparation of a fitting environment and the choice of painstaking and intelligent nurses and teachers without whose aid my psychological analysis would have been made in vain.
This boy has had a nurse and a teacher assigned to him individually and he has benefited from time to time by the intelligent cooperation of a corps of four or five teachers. I call this an education for the fortunate few because its effective employment requires individual training as well as individual diagnosis. Individual training means individual training, one teacher devoting herself to one child. Its expense would seem to preclude its general adoption in schools. Diagnostic education applied to any child, normal or feebleminded, will aim to develop proficiency and intellectual ability. The cerebral mechanisms of each child must be coordinated and controlled through the acquisition of intelligence and the development of the will. This is an important part of every child’s education. Nevertheless, the higher aim of diagnostic education should be the training of intelligence, by which I understand the child’s creative imagination, his power to think and act for himself, his ability to solve what for him are new problems. As higher intellectual levels, are reached, creative imagination should be kept alive and stimulated to more difficult tasks. While intelligence is the most distinctive and valuable attribute of civilized man, it is the congenital gift of only a few, or else mass education permits it to fall into disuse in all but a few. The boy whom I am using today for purposes of illustration is not, in my opinion, a genius. At the best he is a normal boy who was seriously handicapped at the age of two years and seven months. Discipline and selective intellectual training were essential to accomplish the results which I have recited; but before all else my diagnosis indicated, and the prescribed treatment encouraged, the exercise of his intelligence in the directions in which he naturally found delight. What might not a similar educational treatment based upon an analytic diagnosis accomplish for one who is unusually gifted? What I plead for, I presume, is “the education of a prince of intelligence”
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