Clinic Reports. XVI
Elizabeth was nine years and nine months old when she was brought to the Clinic on April 23, 1917, by her sister, aged twenty-one. They desired a mental diagnosis prior to her admission to a girls’ school. Two other sisters had been brought previously for the same reason and diagnosed as normal. Elizabeth was a bright-eyed, nervous, thin little thing, under-weight and microcephalic. She was neat and clean, but did not look well nourished. Her height waB 124.5 cm., between the minimum and mean for 9 yrs. Her weight was 22.1 kg., mean for 8 yrs.; below minimum for 9 yrs. The head girth was 49.2 cm.; the minimum for 5 yrs. is 49.31, for 9 yrs. 51.03.
The formboard revealed weakness in coordination, and more especially ln distribution of attention, but this weakness was not of such a degree as to prevent her from giving a performance entirely normal in time and quality. With the Witmer cylinders she gave a very good performance; in quality distinctly normal. Persistence of attention was good.
At first she thought the Healy puzzle A hard and pouted over it, but stuck to it and inside of one minute had worked it out intelligently. The two following trials it presented no problem to her at all. She constructed it instantly. In copying patterns with the design blocks she was very slow because she tried to copy the edges as well as top. When she was told not to do this she put them together block by block, consulting copy each time. Analytic attention was good. Elizabeth showed some constructive imagination in that she composed for herself a rather pretty design with the blocks.
Her performance with the Healy completion test clearly showed good imagination and very poor distribution of attention. She put the blocks in quickly, about half of them wrong, then looked the board over and corrected all ?f them. She gave adequate reasons for placing all ten blocks, such as “It’s & block of wood. It’s just dropped off from where he is sawing.” Her memory span for digits was 5 forward and 3 backward.
Binet-Simon Tests, Stanford Revision, showed her mental age to be 8 yrs. 9 mos., I. A., 897.
Her imagery was particularly good. She reproduced Binet designs with ease, and not only described but interpreted pictures. In looking at pictures her observation based on analytic attention was excellent. On the Binet Scale, her mental retardation is measured by one year.
She reads in Second Reader fairly rapidly but inaccurately. Frequently miscalls words, substituting another that looks something like it. Her efficiency in arithmetical reasoning is adequate, but she is distinctly below par in handling numbers. In the same way, her ability to learn to read 18 distinctly above her specific efficiency in spelling and recognizing words. Elizabeth appears, according to report, to have been absent from school as much or more than she has attended. She says she does not like it, that the teacher gives her spelling words and numbers that are “too hard for her.” She plays normally. She mentioned and gave a clear description of five or six of the games children of her age play such as “In and out the Valley,” “Tap on the Back,” etc.
Elizabeth presents a very clear picture of a child of normal mentality, retarded two or three years in school work, and approximately one year on the mental age scale, whose retardation can be remedied without individual instruction. She should be put somewhere where she will be properly nourished and compelled to go to school, assigned to a grade where the work is not “too hard” for her, probably 1 B. Under such circumstances she ought to progress rapidly toward normal efficiency. Eye and ear examinations were recommended, as possible factors in her poor distribution of attention may be imperfect sight and hearing.
Sarah W. Parker, A.M. Graduate Student. XVII. During the spring of 1912, Gabriel and his two brothers were brought to the clinic by a representative of the S. O. C. because of backwardness. The diagnoses were deferred on the cases of Gabriel, then ten years of age, and the youngest boy, then four; while the second brother was found to be a low grade imbecile (Barr classification) and was recommended for Spring City, to which he gained admission, and there he still remains. The youngest brother has since died.
Gabriel was returned to the clinic today at the request of the Social Service Department in order that his progress might be noted and a definite diagnosis made.
When examined in 1912, the mental age by the Binet scale was found to be nine years. Today the Terman Revision gives a grading of ten years and five months, all the ninth year tests being passed, three of the tenth year and two of the twelfth year. This gives an intelligence quotient of .66. He gave a satisfactory performance on the cylinder test and did the Healy puzzle boards and all the designs that were given him with the design blocks. But in the work with these last tests, he was slow in making corrections and adjustments, proceeded largely by trial and error and repeated his errors. After having tried for a long time to make an evidently impossible placement with one of the Healy puzzles, on the second trial he made two distinct attempts to make this same placement. He has a memory span for five digits. A lack of language ability may have been responsible for a number of failures in the Binet series but only the intellectual deficiency could account for the type of performance in these other tests. Gabriel is an Italian boy who will soon be sixteen years of age, a little under size for his age yet probably normal for his nationality. He is a very quiet boy, lacking in energy and initiative, who gets along well with the other children. He makes a very favorable impression because of his neat appearance and his deferential and frank attitude in conversation. He does not find it easy to understand questions despite his long school training but this may be attributed to the use of Italian in the home.
He lives with the sister of his mother, whose husband is earning a good wage; and as he is the only child in the home he has very good care and treatment. It is not usual in the foreign quarters to find relatives trying to put a boy back in school when he is almost at the age where he could obtain his working papers.
The father died eight years ago, as the result of an assault one night while returning from work. He was a strong, healthy man, a laborer, of good habits so far as we can ascertain. The evidence we have from the first visit by the mother five years ago, indicates that she may be of low mentality. She did not know how long she had been in the country, nor how old she was, and could not speak English. Two years ago she left her son and is now living with a man not her husband. Two children died shortly after birth, the death of one being attributed to a fall of the mother during pregnancy.
Gabriel started to school at the age of six, and has attended quite regularly up to his dismissal three weeks ago. This was because a tubercular condition was suspected and his presence was considered dangerous to the other children in the class. He will be admitted to an open air class that is soon to be started in his neighborhood. He was recently promoted to the fifth A grade, not because of capability, but in order that he might not be discouraged, for he was making an effort to progress. He is said at the school to do fourth grade work, but our examination does not indicate that he can do satisfactory work of a grade higher than the third. We are unable to determine the lengths of time he has spent in the intervening grades.
The diagnosis is high grade imbecility, according to the Barr classification. The lack of development during the past five years may have been largely due to the physical condition but the retardation is now too great to expect that he can ever attain a normal mental level.
Owing to the possession of favorable characteristics, perseverance and sincerity, he should make a good workman at tasks not requiring much mental activity. Franklyn C. Paschal, A.M., Harrison Fellow in Psychology.
XVIII. A pale-faced boy, with eyes that gave evidence of double vision, was brought to the Clinic by his mother upon the recommendation of the Social Service Department of the University Hospital because of failure to progress in school. He was below the normal for boys of his age in both height and weight, and was decidedly microcephalous.
Job’s mother said that he had not been like the other children since his birth, when she thought that he was injured. She was twenty-five years old when he was born and was suffering from hay fever and asthma. She was also worried and not well nourished because his father was drinking more than at any other time before or since. About three weeks before the full term of gestation she fell and brought on premature birth. She had no physician and the birth was a dry one with long, hard labor. The child had to be turned and was partially asphyxiated. His eyes were suppurated and there was also slight rupture of the navel. The woman who was caring for her did not know what to do for the little five pound baby, who moaned all night although they tried to make him comfortable with hot water bottles.
The mother partially nursed him but was unable to care for him herself, and the fourteen year old girl, whom she employed, did not properly feed him and dropped him two or three times. Job was not troublesome but held his head down and did not seem to notice things. He walked at fourteen months and talked at thirty months. He can now dress himself, and generally uses a spoon, although he can use a fork but not a knife. He has an enormous appetite. He began school between six and seven years of age and at nine years of age he was still in the 1 A Grade when he was excluded because he could not learn. His conduct was fair and he was seldom absent. He allows other children to impose upon him but gets along well with them.
His nose and throat seem to be in good condition and he has had no operations. His only diseases have been whooping cough, measles and scarlet fever. About a year ago he began to have attacks at irregular intervals of two or three days in which he fell, grasping at any object near by and twitching all over. The attack lasts for only two or three minutes when he jumps up as though nothing had happened and appears brighter than before.
While waiting for his mental examination, Job was playing with the peg board and he was allowed to finish it. He did not know the colors by name, and at times he made a mistake in matching blue and green. He showed some planfulness in putting away the pegs but he missed two or three without noticing it. The quality of the performance might have been due to defective vision. The formboard, however, revealed the true situation, which was later corroborated by the intelligence quotient. He showed no understanding of the test, placing each block above a recess and only one happened to be over its own recess. At the end of eighty-six seconds he was apparently satisfied with the performance. The blocks were replaced but no instruction was given. In the second trial he placed the square by chance in the right recess and he succeeded in getting seven into the right places but was as satisfied as ever with the others when they were on top of the holes. The third time he took longer than in the other trials and had only three right. He was then given the simpler formboards containing three figures each. He succeeded with the circles and the simpler figures but with the circle-star-cross he interchanged the star and cross. He was then given the lower row of the formboard which he did correctly after some trouble with the star. After placing successfully two rows he tried the whole board. He would take one space at a time and look for the block, showing no distribution of attention. His visual sensitivity and analytical attention were also very poor. The performance suggested that double vision might be responsible for some of his failures. Each eye in turn was covered and he was given the test, but the performance was qualitatively the same except that it showed the effect of practice, indicating that the boy was, to a small extent, trainable.
Tested by the Stanford Revision of the Binet-Simon Scale, Job passed only four of the three year old, two of the four and five year old, and but one of the six year old tests, giving a score of 3 years 6 months. He could not count beyond two, and after four or five trials he still repeated each digit as it was given when an attempt was made to find his memory span.
Thus the performance of the formboard, which was that of a three year old child, exactly corresponded to the mental age and would have been sufficient for the diagnosis,?feebleminded not higher than low grade imbecile, Barr’s classification; an uneducable and only partially trainable case. When custodial care in an institution for feebleminded children was recommended, the mother said for the first time that an application made to Elwyn at the suggestion of the school physician, had been refused, and through the Board of Education an application was now on file at Spring City. Anna B. Pratt, A.M., Graduate Student.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.