Clinic Reports. XXVII.
Rachael, fourteen years nine months old, was brought to the Psychological Clinic by a social worker because of suspected mental and moral deficiency. She left the parochial school March, 1917, having reached only the third grade, and was unable to do the work of that grade.
Her father and mother separated about two years ago. There are two younger children, eleven and eight years old, whom the mother took with her. She has not been seen since. The father, who has been a “Jack of all trades,” left at the same time, but returned to his mother this month and is now working and assisting in the support of Rachael. He is 42 years old and earns from $12 to $15 a week. The mother is 35 years old. Previous to her marriage she was employed in a mill, and had little education.
Rachael lives with her grandmother and an uncle who has, until recently, entirely supported the family. The grandmother is an energetic and intelligent woman, now handicapped by illness. She is conscientious in her advice to the girl, but does not understand her. In speaking of her she calls her a “backward kind of girl to learn.” Three years ago the grandmother placed her in a protectory, where she remained two years. On her return she went to a parochial school. She constantly played truant both before her protectory experience and afterwards.
Rachael ‘keeps the house clean under supervision. She can wash, iron, make over clothes that are sent to her from more prosperous cousins, and can mend her clothing. Last summer she worked for two weeks in a factory but was discharged because she resented the supervision of the forewoman. She does not get along very well with people. She is careless about her clothing, often not combing her hair until evening, but when she is going out or expects company, she spends much time before the mirror. She likes the theatre and moving-pictures. She has always been untruthful and she admitted it when the worker talked with her. She said that she disliked school, that it was difficult for her to recite her lessons in the class room even when she knew them. She is inhibited by the presence of the other children. She does not dislike arithmetic and has studied long division.
At the school the Mother Superior said that she would not permit Rachael to return, for the sake of the other children, because from her they might learn dishonesty and untruthfulness. She also said that the girl is unable to learn and would not be benefited by the school training.
Because of the mother’s desertion, it was impossible to get the history of Rachael’s birth and childhood. According to the grandmother both parents were temperate when this child was born. About three years ago the family physician advised the removal of her adenoids and tonsils to see if it would make any difference in her school work, but it had no effect. She does not look well now, and complains of back-ache when she washes. The doctor has recommended a careful examination by a neurologist and a psychologist. He believes that the girl has depraved tendencies.
Rachael did uneven work in the mental examination. Her best time in the Witmer formboard was 17 see., the time of a child of 11? years. She showed a lack of memory in copying the design blocks. In the Dearborn Formboard and Healy Construction test she profited by instruction. Her performance of the Cylinder test was better than that of the other tests, but, in both the Formboard and the Cylinder tests her shortest time was in the second trial, which shows a tendency to tire and become confused. Her memory span was 5 digits, and sometimes 6. Her mental age score by the Stanford Revision of the Binet Scale was 9 years and 2 months.
The diagnosis was not higher than a high-grade imbecile, Barr’s Classification; and the recommendation, that she be sent to a private school for mentally deficient children, if the family could afford it; if not, that she be given custodial care. Anna B. Pratt, A.M., Graduate Student. XXVIII. The question of the differentiation of social from mental sufficiency was presented for consideration in an interesting case referred to the Psychological Clinic in January, 1918. No recent case illustrates so well as this one, that a distinction must be made between social and intellectual standards of feeblemindedness. Early in January, Axel’s father brought him to the clinic because of the boy’s retardation in school. The following account is based upon the initial examination, supplemented by the results of a second examination made three weeks later.
Although fifteen years of age, Axel is only in the third grade of a public school and has been there for ten terms. He entered the first grade when six years old, and was passed regularly through the first and second grades into the third, where his academic insufficiencies began to manifest themselves. His performance at the clinic substantiated the report of six years of pedagogical retardation. So far as demonstrated by reading, writing and number work, his school proficiency is below that of the average second grade pupil. Since nothing is known in regard to the regularity of his school attendance, this apparent lack of proficiency must not be ascribed arbitrarily to mental defect. It may be due, at least in part, to lack of training. The fact that clinic instruction, both oral and kinesthetic, failed to teach him the words desk, bread, etc., militates against the validity of the hypothesis that his failure in school work is to be accounted for by inadequate instruction. That there is some fundamental defect of mental functioning seems to be indicated in a general way by the tests mentioned above and more specifically by the memory span test. Repeated efforts showed that Axel’s immediate recall is limited to four digits. According to Dr Humpsione’s “Study of Associability,” the mean memory span for third grade children, distributed in age from six to thirteen years, is 5.2. The same monograph gives 6.8 as the mean for the fifteenth year. While 4 was found to be the minimum for each year from nine to eighteen, nevertheless, from a comparison of the difference between the mean memory span of third grade pupils and Axel’s own memory span, and also from the mean for fifteen years as compared with Axel’s, it may be inferred that this boy is below the performance level for memory span for his chronological age as well as below that of children doing third grade school work.
This same limited associability was demonstrated also by the inability of Axel to spell correctly words of more than three letters, although he was trained through several sense channels. This immediately raises the unanswered question: does school ability as measured in ordinary academic terms, depend upon associability as that factor is reflected in the memory span test? It seems reasonable to conclude that his school retardation is dependent to a certain degree upon his evident failure in associability.
A differential diagnosis of this case is complicated by the contradictory evidence presented by Axel’s low scores in intellectual tests already considered, as compared with his excellent performance of the mechanical tests. Although in these mechanical tests his rate and energy were low, his performance both qualitatively and quantitatively was superior to his other records. His best time with the formboard at his first examination was 22 sec. So far as time is concerned this places his performance on the level of the highest quintile for 9.75 years, according to Dr Young’s standardization. While this is below the performance level for his chronological age from the standpoint of time, his handling of the blocks gave an impression that the slowness was due to somewhat feeble musculature rather than to any deficiency of imageability in associability. Whether the reduction in performance time of the formboard test to 17 sec. on his second examination, can be accounted for as due to retention of impressions received at the first performance, seems somewhat doubtful. If the improvement in performance be due to that factor, then the theory that his school retardation is the outcome of specific defect in associability and retentiveness is open to question, unless he is an example of what Dr Witmer calls a “congenital illiterate.” The cylinders, Healy A, Healy B and Healy Completion tests, all showed results directly comparable with the formboard test. Control and co ordination were normal; attention, both analytic and distributive, was good; imageability and understanding fair; and intelligence at least high enough for the solution of simple mechanical problems. More in accord with his memory span, however, was his performance with the design blocks, and this may furnish a clue to the apparently contradictory character of Axel’s other performances. He was able to copy easily the simple designs, but he was unable to reproduce from memory the double chevron or to imitate two or three moves with the blocks. He showed very plainly that his observation is defective.
The examination as a whole showed not merely retardation or backwardness but an inequality in development. Since this inequality exists, is the causation to be found in structural defect or in abnormal functioning? If it be a structural defect of central origin, it is obvious that future development is impossible, but if the structural defect be peripheral, or if it be purely functional, there is a possibility of improvement, provided proper treatment can be given. The clinical examination proved that Axel’s sensitivity is normal, consequently his low performance level is not traceable to imperfect sensations. Although his sense organs, structurally and functionally, seem to be normal, in other respects Axel’s physical development has not kept pace with his years. He is not yet pubescent; his height is that of a boy of eleven; his weight is that of a boy of ten, and his head girth is less than the minimum for nine years. His feeble muscular development, apparently less than that of the normal boy of ten, is shown in his poor standing posture. In addition to these more or less significant physical abnormalities, Axel exhibits certain other stigmata which may indicate an inherited taint or an imperfect development in utero. His face is slightly asymmetrical, his ears rather low in position and outstanding; his lower jaw is poorly developed, with the chin decidedly receding, although there is no history of adenoids or thumb-sucking. Of special importance as a diagnostic clue, is the fact that he has a fairly well marked ptosis of the eyelids, since this is sometimes the result of inherited syphilis. Lack of growth and delayed pubescence are sometimes accompaniments if not results of syphilitic taint. The suspicion of the existence of inherited syphilis is, however, not confirmed by anything reported in connection with the family history; in fact, investigation of the family history reveals nothing of diagnostic value. Whether or not these physical defects, therefore, are of such a character that they may be improved or corrected, can only be determined after a thorough medical examination is made; consequently the first recommendation in Axel’s case is that the boy be placed where such a medical examination can be carried out. Until this result is known any diagnosis must be purely tentative. Judged by his school history and his clinical performance, Axel’s status presens on the intellectual scale is that of a feebleminded child, probably not higher than a high grade imbecile (Barr’s classification) but it must be repeated that final judgment is to be held in reserve until after the medical report is made. This apparently feebleminded condition may seem to point to the desirability of institutional care for Axel, but his competency measured in terms of mechanical achievement indicates a degree of proficiency high enough to warrant placing him above the socially feebleminded group. His attitude toward others is friendly, he plays not only with younger children but also with boys of his own age and no complaint is recorded in regard to his conduct in school, consequently unless some change occurs at the onset of puberty, Axel probably will continue to conform to social usage. Does this social conformity, taken in connection with his performance of the mechanical tests, sanction placing him in the normal wage-earning group of the community, or should his mental inferiority be the criterion by means of which his future is to be determined? Elmira Lodor, 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.