Clinic Reports. XIX
An overgrown girl of 14 years 10 months was brought to the Clinic by a volunteer worker from the social service department of a hospital. Physicians who had questioned her, thought her “either innocent or slick.” She does not seem to care for the boys in school although she plays with girls of her own age and gets along well with them.
Adelaide lives in three rooms with her father, who is a watchman, and her brother 19 years old, who works every day in a paper factory. The mother is dead. Adelaide keeps house for the family. In summer she does the cooking and baking, but in winter a married sister, who has a little store near by, cooks their dinners and suppers and brings them to their home. A younger brother, ten years old, lives with the sister. Adelaide said they use one of their rooms for a kitchen, her father and brother sleep in the front room and she sleeps in the middle room by the window.
The sister complains that Adelaide is dull and lazy. She refuses to work or to keep clean and it is difficult to push her. Adelaide says that she is not well. She had an operation for adenoids and tonsils last winter and has felt dull since. Three weeks ago she fell on a slippery floor and hit her head against the sink. She cherishes a feeling of resentment, and thinks that people are down on her. The only studies that she likes in school are arithmetic and spelling. She began school when she was six years old and is now in the sixth A grade of the public school. She has had many absences but her conduct is good.
Adelaide’s teacher did not know of the apparent total deafness in the left ear which was quickly discovered by testing at the Psychological Clinic. This followed scarlet fever which she had when she was three years old. She has had two operations for deafness in a different hospital, but the social worker who brought her, thought that her hospital did not know this history. Scarlet fever has been her only disease. After she was three years old she was troublesome but she was not ill. She walked at 12 months but did not talk until she was 24 months old. Nothing is known of the circumstances of her birth, except that her mother was then 36 years old.
The mental examination revealed slow understanding and movement, with poor analytical attention but good persistence of attention and responsiveness. She worked the problems in decimals, which she is now studying, accurately but slowly. Simple mental problems she did more quickly than anything else.
She did not know the meaning of simple abstract words, although she said that she had had them in spelling lessons. She read and reproduced fairly well Terman’s story of the New York fire. Her voice is husky and she lisps slightly, more noticeably when she is reading. She writes well. She can repeat five digits backward, but she transposed the last three digits when trying to repeat six forward.
Her Binet age was only 9 years, 7 months, but the performance was not qualitatively feebleminded, rather that of a backward child. She also responded like a child of nine when asked what she wanted to do when she left school. She did not know and did not seem to have thought about it. This backwardness might be explained by her deafness and the fact that her father speaks Yiddish in the home. Her household duties have kept her much indoors, and she has probably had little companionship with girls of her age.
The diagnosis was “No evidence of feeblemindedness.” A social investigation and an aural examination were recommended. Anna B. Pratt, A.M., Graduate Student. XX. Solomon is a colored boy of ten and a half years, brought by the woman who is taking care of him, because his non-conformity has caused her to desire to have him taken out of her charge unless something can be done to remedy his present condition.
Nothing is known about the history of the boy, previous to coming into his present home at the age of two years and three months. The mother is a servant, but nothing whatever is known of the father.
An attempt was made to enter him in school at the age of seven, but he was refused as being of too low mentality. He attended kindergarten over a term, and is now in the first A grade, but is making no progress.
He runs away from home and from school, malting his escape from the latter even after being taken inside. He has stayed away from home for several days at a time and will not tell where he has been, though from statements he makes, it is evident that he knows where he has been. He steals money in small amounts and other articles, and will deny taking things when he has them in his hands. It is said that he does not seem to recognize the difference between right and wrong.
He is greatly retarded in physical development, his height being that of a seven year old boy, his weight and head girth being those of a boy of eight. His enlarged tonsils, very small nostrils, and catarrh, all together make breathing difficult. His teeth are very defective, badly aligned, saw-edged, and anterior to the molars there is no occlusion, the space between the incisors being as much as half an inch.
Solomon’s mental age according to the Terman revision of the Binet tests, is six years and six months. All the tests of the fourth year were passed, one was missed in the fifth and the sixth years, while two tests were passed in the higher ages. The only thing in which he showed a performance approaching normal for his age was the memory span for digits, where he was able to give six; but with considerable training he could not be taught to give two backward. The formboard was done in a manner satisfactory for the first half of the seventh year, but the cylinder test and design block performances would have been considered poor for the sixth year. The Healy Construction Puzzle A was a complete failure. He works steadily and with fair speed, for ten minutes at a time, but in only two instances did he show evidence of planning or methodical procedure. The coordination was very poor for his age. Imagination is deficient. Some of his language difficulty is due to malformation of the mouth, which makes speaking so difficult as to distract his attention from what he is trying to say. The diagnosis is low grade imbecility. Recommendations were made for a Wassermann test, nose and throat examination, and attention to the teeth. Solomon should be placed in an institution before he becomes dangerous to society. Already he is showing a wild delight in fire, which with his stealing, makes him Undesirable even in a home where he can receive good care.
Franklyn C. Paschal, A.M., Assistant in Psychology. 154 THE PSYCHOLOGICAL CLINIC. XXI. Cyrus, 8 years and 2 months of age, was brought to the Psychological Clinic by his mother and grandmother. He was referred to the Clinic by his teacher in a private school because of backwardness, which she attributed to “lack of concentration and perseverence to a marked degree.” He started kindergarten at 5 years and 9 months of age and one year later entered the first grade of a public school, in which grade he spent three terms. Subsequently he was tutored at home for four months and since the third of January, 1917, has been attending a private school. He had spent approximately six weeks in this school when his teacher referred him to the Clinic to determine his mental status presens and to obtain advice. In my opinion, Cyrus is mentally deficient, i. e. feebleminded, his grade being probably middle grade imbecile (Barr Classification). The differential diagnosis is a tentative one because some of his deficiency may be due to a lack of discipline. The diagnosis of mental deficiency is based on the result of the examination at the Clinic, on his pedagogical history, and the presence of symptoms of Mongolism.
The boy’s primary mental defect is a lack of attention. Even his teacher recognizes this fact and attributes to it his lack of progress. His attention is easily distracted and he is deficient in analytic and distributive attention. He is alert and willing, but due to insufficient planfulness, deficient associablilty and deficient powers of observation, his efforts are poorly directed and ofttimes futile. He is very energetic and vivacious, but his movements, especially those of his hands and arms, are excessive and poorly controlled.
Cyrus is a very good actor. It is his chief delight to entertain those around him. He talks incessantly in an incoherent manner, passing from one subject to another with the greatest facility. These monologues are accompanied by the most appropriate gestures. In the presence of his mother these spontaneous, loquacious outbursts are inhibited, but a slight suggestion with the mother’s sanction is sufficient to start him off. This facile use of spoken language, if properly controlled, is a very conspicuous asset for this boy. In my opinion discipline and expert training can accomplish an improvement in his behavior so marked that an uninured observer would not suspect mental deficiency.
This boy’s mental deficiency, in my opinion, is due to an arrest of development’in utero. His lack of persistent attention, the texture of the skin of his hands and arms, the palms of his hands, excess of movement and the tendency to flit from one thing to another are symptomatic of Mongolism. The face does not show any of the typical Mongoloid stigmata nor is the form of the hand typical, nevertheless his behavior suggests it and the fact that the mother was in poor health during the period of gestation also is significant. Cyrus was backward in walking and talking and was threatened with rachitis for the first two years of h’R I’ffi. The latter fact is indicative of malnutrition, resulting in functional retardation and, in my opinion, was nothing more than the continuation of an inter-uterine condition. At present he is precocious at least a year in height and weight.
Cyrus is attempting first grade work. His teacher reports that he “is now reading a first reader with a great deal of assistance.” In my opinion his acquisition of written or printed language is largely mechanical, i. e. he acquires it in the same manner as he would the performance of a trick. The number of words which he is able to recognize and graphically reproduce is very limited, certainly more limited than it ought to be for a normal boy who has received the attention that Cyrus has received. In number work he is able to count to twenty. This is not an enviable record for a boy of eight who has been under instruction for six terms. In spite of his facility in the use of spoken language it is not likely that he will be ever able to acquire the fundamentals of an education so that it will be of much assistance to him in the practical affairs of life.
Cyrus’ mental deficiency is due to a lack of ability so marked that he will probably never be able to maintain himself independently in society. Nevertheless, inasmuch as the family is able to care for this boy and the differential diagnosis is only a tentative one, immediate institutional care is not recommended. A complete pedagogical report should be obtained; he should receive careful individual instruction in school work at the hands of a good disciplinarian; the discipline in the home should be more rigid, and another mental examination should be made to determine the grade of feeblemindedness. Frank H. Reiter, Ph.D., Instructor in Psychology.
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