Clinic Reports. XXII
Abraham, a Russian Jewish boy, was brought by his teacher to the Psychological Clinic January 6, 1916, at seven years and six months of age. He was one of fifteen children who had failed on the Witmer formboard test when Dr. H- H. Young, then a research student in Psychology at the University of Pennsylvania, gave this test to all supposedly normal children?approximately 1400? over six years of age of an entire school to procure data for the purpose of standardizing the test. Abraham was completing his second term in the 1 A grade, and Was not to be promoted; nevertheless, his teacher did not consider him backward until Dr Young suggested it. The result of the examinations at the Clinic revealed the fact that Abraham was not only backward but unquestionably feebleminded, and in my opinion his grade is that of a low grade imbecile. My diagnosis is based on Dr Young’s report of Abraham’s failure on the formboard, the results of the examination of January 6, 1916, the results of a re-examination made nine months later, and on his pedagogical history. This diagnosis is further confirmed by his backwardness in teething and in learning to walk and talk, by a lack of motor control and poor co-ordination, and by the fact that he is still unable to dress himself completely.
Abraham’s reactions to the tests given him at the Clinic show that he is deficient in distributive and analytic attention. He lacks alertness and initiative; he has poor motor control and poor co-ordination; his imageability and associability are not sufficient to perform successfully such a test, for instance, as the design blocks. His pedagogical history indicates that his memory is resistant to training, due to deficient retentiveness. In my opinion, Abraham’s greatest Cental defects are his lack of understanding or lack of comprehension, lack of planfulness and deficient intelligence.
Abraham spent two terms in a regular 1 A grade class, and a little more than one term in a special class. The special class teacher states that he is doing 1 A grade work. The results of the re-examination at the Clinic do not confirm this report. If the work he is doing may be called 1 A work, it is of a very inferior quality. In my opinion Abraham’s mental deficiency is so marked that he will never be able to read and write sufficiently well to use these acquirements successfully as tools, i. e. he is not educable. It is possible to teach him to perform simple tasks only under supervision. Therefore, future institutional care is recommended for this boy because it is impossible for him ever to become selfsupporting. There is no reason to suspect that Abraham’s mental deficiency is hereditary, nor are there any facts indicating an arrest of development in utero. The boy’s mother does not appear to be very intelligent; nevertheless, from casual observation, there is no reason to suspect feeblemindedness. This boy’s mental deficiency can therefore not be ascribed to any specific cause. It is congenital and due to general physiological retardation. The same causes which brought about the physiological retardation in teething and in the instinctive reactions of walking and talking, are undoubtedly responsible for a permanent cerebral arrest, resulting m mental deficiency.
Abraham’s case is of interest because it serves to demonstrate the value of the Witmer formboard as a testing device in detecting mental deficiency and in determining a prognosis of social incompetency. The formboard is a test which normal children four years of age are able to perform successfully on the first trial. Abraham’s performance of this test was so poor that Dr Young immediately suspected mental deficiency, although it had escaped the notice of the boy’s teacher and the authorities of the school. Dr Young reports that Abraham failed to comprehend the task set for him, and that he placed the blocks over the recesses in a haphazard manner without any attempt whatever to insert them in their proper places. It required nearly twelve minutes to teach him to perform this test, which the average seven and a half year old boy will perform in twenty-five seconds. According to Dr Young’s norms based on the best record of three trials, the poorest 20 per cent of boys seven years and three months of age perform this test within the limits of thirty-two to forty-five seconds, without any assistance whatever. At the time of the re-examination in October, Abraham was eight years and three months of age. His best time was forty-two seconds after having performed the test eight times previously. The poorest 20 per cent of boys of this age in one of three trials perform the test within the limits of twenty-eight to thirty-seven seconds. This quantitative comparison gains in significance when we keep in mind that this boy had to be taught how to perform the test; and that even then, after a number of trials, he was unable to measure up to the age group to which he belongs. Abraham’s inability to measure up to the norms cited is partly due to a lack of motor control and poor co-ordination, but mainly to deficient form recognition, deficient distribution of attention, and deficient analytic attention. The fact of greatest significance with reference to Abraham’s reaction to the formboard when he was first given the test by Dr Young was his inability to comprehend the task set for him. That his lack of comprehension is a permanent defect, and has always been present, is, in my opinion, confirmed by the fact that when the cylinder test was placed before Abraham he was as much at a loss to know what was required as when he was instructed for the first time to replace the forms of the formboard.
This lack of comprehension I believe to be due to deficient intelligence. The formboard furnished a new problem for this boy, which he was unable to solve, but which four year old normal children can solve. Furthermore, this inability to comprehend a new situation is so marked in Abraham’s case that it will be impossible for him ever to occupy a position in the affairs of life. His inability to pass the formboard test revealed this deficiency at once and to such a marked degree that it seems to me that the Witmer formboard is not only of value as a testing device in detecting mental deficiency but serves as a means for a prognosis of social incompetency.
Frank H. Reiter, Ph.D., Instructor in Psychology. XXIII Enoch, an eight year old boy, was brought to the Clinic by his guardian and the school nurse. Although he had attended a kindergarten for a year and entered the first grade at six years of age, he was still in the first grade at the time of his transfer to an orthogenic class. His backwardness in school and the fact that he had failed to pass the mental tests necessary for entrance to Girard College caused his guardian to bring him to the Psychological Clinic. The preliminary examination was rather inconclusive, since his guardian had no definite knowledge of the child’s family history. He had been a healthy baby, but did not begin to walk or talk until two years old. His guardian thought that this backwardness was due to neglect, the child’s mother having died during his infancy. Her death closely followed the death of the father from tuberculosis. Enoch plays with children of his own age, but allows them to impose upon him. Such a history shows a doubtful heredity and infantile backwardness, but no specific indications of feeblemindedness. During this first examination Enoch was given the formboard and cylinder tests, work with color cubes, and the Binet test. He was successful with the formboard test, but it was done very slowly and similar blocks were confused, showing deficient analytic attention. His failure to solve the cylinder test was due to poor analytic attention and poor distribution. He had twelve final errors at the end of seven minutes and fifteen seconds. He succeeded on the second trial, using the trial and error method. The result of the Binet test showed that his basal age was five years and mental age score seven years four months. However, his general behavior, lack of energy, poor analytic attention, poor distribution of attention, and his general appearance, caused Dr Witmer to &ive a tentative diagnosis of not normal?a high grade imbecile, probably of tubercular origin, although no qualitative feeblemindedness was shown; and to recommend a school visit, medical examination, and psychological re-examination. The school visit was made during the following week. Enoch is in a special orthogenic class, consisting of backward boys taken from the first and second grades. Reading and drawing lessons were observed. Reading was taught by the Aldine method. Drawing involved measuring, tracing, and coloring. Enoch’s work showed his backwardness quite definitely. In reading he failed to recognize some, glad, and sway, although he read correctly come, way, and away. About five minutes were spent trying to teach him sway by prefixing s to way, hut without success. He misunderstood the directions for drawing. He was slow in comprehending what was to be done and his attention wandered frequently. The teacher said that Enoch’s slowness was partly offset by perseverance. She thought he could be helped in her class, but a large amount of individual attention would be necessary.
The medical examinations?eye and Wasserman?were negative. The boy showed no stigmata of tuberculosis.
Enoch returned to the Clinic for re-examination during the following month. At this time he still confused similar formboard blocks, and used the trial and error method in the cylinder test; but he showed good reasoning and imageability iu the Healy completion test and work with design blocks. His slowness was evident in all of these tests, but especially in reproducing designs. With the Goddard adaptation board Enoch’s slowness was again apparent. His eye c?uld not follow the proper space quickly enough, so that his failures almost equalled his successes. On the whole Enoch made a very much better impression during this examination than during the previous one. He seemed more wide awake and active. His work with the various tests given was of average quality, although the time required to complete them was above the average. On the basis of these examinations Dr Witmer diagnosed Enoch as at present normal but extremely slow and somewhat dull. He noted that the amount of retardation would probably increase and ultimately result in feeblemindedness. This case illustrates the futility of trying to make a final diagnosis ?n incomplete data. Dr Witmer’s tentative diagnosis of feeblemindedness was discarded when further examination proved more encouraging, and retardation was shown to be less than it had at first seemed. Dr Witmer recommended that Enoch remain in the special class, and also receive orthogenic treatment from the Clinic, thus lessening the probability of ultimate feeblemindedness. Lillian Moore, Senior in Education.
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