Clinic Reports. XXIX
The average teacher who looks at Jonas will anticipate trouble in trying to have him progress at the usual rate in school. Any person who merely glances at him is likely to note his head, which is very much enlarged above the eyebrows and seems to be entirely too large for the rest of his body. It is not surprising that, when he was taken by his mother to a hospital, they gave a diagnosis of hydrocephalus and advised that he be taken to the Psychological Clinic at the University of Pennsylvania for a mental examination. The teacher who has learned in the past that such a head is most frequently accompanied by feeblemindedness, will probably suspect in this child some serious mental deficiencies. Is the suspicion of the experienced teacher supported by findings of the examiners at the Clinic?
Jonas first came to the Clinic three years ago in October, when he waB only two years and eight months old. Nothing is given in family history of any feeblemindedness, insanity, epilepsy, or tubercular tendency; and the child has had no diseases other than occasional spasms. His first tooth appeared at ten months; he began walking at eighteen months; was bottle fed; seemed to be growing normally in infancy, and was not troublesome. His mother reported that she began to think of him as unlike other children when he was about one year old, because he was not as active as most children. She did not notice then that his head was too large. By the time he reached the age of two and a half she had become especially anxious, for he did not seem to be able to learn to talk. Then it was that she determined to take him to a hospital to learn the cause of his backwardness. There, on account of the shape of his head, his occasional spasms and his inability to talk, the diagnosis of hydrocephalus was given and a question raised as to his mental status.
At the first examination at the Psychological Clinic he passed readily the Kuhlmann tests for two year old children, but the use of the Binet tests was difficult because of his language defect. Matching colors with color cubes was apparently difficult and the formboard was beyond his level of development. He had no physical stigmata of feeblemindedness except his very large head, which at that time was 53.3 cm.?the mean girth for a boy of twelve years according to Hastings’s Manual. A diagnosis of “mentality probably normal” was given, with the recommendation of home training with Montessori materials and encouragement to talk. Since there are other children in the home older than Jonas, it ought to have been easy to carry out the latter part of the recommendation made by the examiner. As a result of that first examination one would expect the child to have a normal mental development if his language deficiency disappeared.
A second examination was arranged for about a year later when the child was three years and nine months old, to see if there was very marked improvement in language ability and mentality. The mother reported that his head seemed smaller to her than it had a year previous. “Actual measurement showed that the head girth was only one-tenth centimeter greater than it had been at the time of the first examination. Again certain kinds of tests were inappropriate because he did not articulate clearly or attempt sentence formation. His memory span for digits was two, though he had a mental age score of three years plus on the Binet Scale. Reactions to tests not involving language were not a very great deal better quantitatively than they had been at the time of the first examination; but again his behavior was not qualitatively that of a feebleminded child. His first trial with the formboard was again a failure, not because of lack of persistence, but apparently because of inadequate form perception and failure to comprehend what constituted a satisfactory solution. No real teaching of the formboard was done at that time, since interest was then in the reaction of the child to the test, rather than in a study of any learning process. The diagnosis was that he was probably a normal child slow in development.
How big a factor that slowness in development was going to be, was the especially interesting question. After an absence of two years and four months, Jonas was again brought to the Clinic by his mother for a final answer to her question whether the boy with this big head was going to get along satisfactorily in life. He is now six years old, attended kindergarten last year, and was put into first grade in February. His teacher is not at all sure that he is going to get along in school. He is not yet enunciating clearly?pronouncing “a” as a “d”; “ch” as “s”; and such a word as house he says as though spelled oud. During the time spent at the Clinic he did not use of his own initiative a single complete sentence. As soon as he saw the formboard he seemed interested in it and started taking out the blocks without being told to do so. On the first two trials he replaced the blocks, confusing on both trials the diamond and hexagon, showing very good co5rdination and an understanding of the test without instruction. On the third trial he put all the blocks away without difficulty in 31 sec., but gave no evidence of planfulness in the arrangement of the blocks when taking them out prior to this trial. His behavior with the Witmer cylinders was especially interesting. He used both hands, and after working for ten minutes and thirtyseven seconds had all the cylinders placed, but only seven of them right. All the wrong ones were removed by the examiner and a minimum of instruction was given by correctly placing two cylinders for him. His total time for completing the test on this first trial was eleven minutes and four seconds. It was a slow but very intelligent performance for a six year old boy. On a second trial his time was less than one-half of his first time and the errors made were very few and rather minor ones. He completed his third trial in 2 min. 17 sec. Qualitatively his behavior was that of a bright child whom one shou d never suspect of being feebleminded. He had no difficulty in the matching of colors. Whatever difficulty there was in saying color names was removed after very little teaching and effort on the part of the child. Design blocks offered no difficulty, and he seemed to be interested in them. With the Terman revision of the Binet-Scale Tests, he has a mental age score of five years and six months,? a retardation of only six months. Associability is not likely to be inadequate when he begins learning to read, for he very readily learned and remembered three words from a primer. This child is now normal mentally. To overcome his language defect he needs training in the forming of correct speech habits. If this is done, he will progress through school at normal rate and be the sort of child who will always have the approval of the teacher, for he likes to work at school subjects, is persistent, and has better than average control of attention. It is interesting to note that his head girth in these last two years and four months has not appreciably increased. Perhaps as his language defect disappears and as his body grows so that his head will be less conspicuously large, teachers will not mark him from the beginning of his term in their classes as a child who must be suspected of stupidity, if not feeblemindedness.
Elsie Bartlett, A.M., Oraduate Student. XXX. Hilda, 15 years 9 months old, was sent to the Clinic by the Vocational Guidance Committee, because she had seemed to be unable to adjust herself to any environment. She is an attractive girl, tall for her age, with a sweet responsive face.
Her mother died of tuberculosis when she was a baby and her father died three months later. An intimate friend of her mother took Hilda and has always treated her like one of her own children. There were two other older children. The sister is employed in a bank. The brother was brought up at Girard College and is now living with Hilda in her foster home. He has been taking evening courses, and is a reliable fellow, earning $20.00 a week as a clerk, although he is not strong.
The foster parents are of Swedish descent and have had limited education and opportunity. The father is a pattern maker and the home is a very good one. His wife was a dressmaker, and her two married daughters are expert needle-women who are greatly interested in Hilda. She has three sons at home, all working and doing well.
Hilda seems to have a good mind, but lacks ambition and is extremely careless both in school and home. She spent two and one-half years in 6-A grade and her average was as low as 5J^. When her foster mother studied with her, her average would come up to 8. The principal of the school had Hilda come to her office each day to recite. This also brought up her average, but the mother objected because she thought it too much like prison for the child to be confined with the principal, away from the other children. As soon as she was put back into the regular grade her average fell. It has been impossible to get an accurate school report because the principal of the last school which she attended destroyed the records. He thought that she must have been a good pupil as she was in the 7-A grade when she left at 14 years of age. Her teachers did not remember her, so thought that she must have been an average child in school. At home she was given twenty music lessons, but showed no interest in the music and refused to practice.
Hilda held six positions in factories from August 1916 to January 1918. She was discharged from her last position where she was earning $7.00 a week. During her factory experiences, Hilda had been sent to the home of one of her foster sisters, because she became such a problem at home. As the change seemed to benefit her and she was fond of children, the mother secured a position for her as nurse maid. Her employer reported that she played well with the children but showed no intelligence in caring for them, and was discharged because she teased one of them until he had hysterics.
At home she is extremely careless about her clothing. She will use hairpins to pin on her buttons, although an attempt has been made to teach her sewing. The mother is kind-hearted but not always wise in dealing with her. She had a hard childhood herself and has wanted Hilda “to have it easy.” She has given her nice clothing and the girl has become extravagant. It was impossible to find out anything about Hilda’s babyhood. She has had no serious diseases or accidents. Pubescence was established last Summer. She has always bitten her finger nails, and when she is upset over anything, bites her nails until they bleed. She is subject to bilious attacks which are apt to follow over-eating, especially too many sweets. She has severe headaches over the middle lobe?parietal headaches?and at these times is subject to dizzy spells.
The mental examination showed good intelligence. Her best time with the Witmer formboard was 12 sec., which is a little less than the medium time for an adult. Her performance showed good analytical and distributive attention. Her best time for the Witmer cylinders was 48 sec. Both the formboard and cylinder performances were very intelligent. She showed quick observation and good memory in copying the design blocks and in following the changes made in the blocks by her instructor. Her memory span was at times 8 digits, although she failed in 6 and 7 at other times. Her mental age score on the Binet scale was 12.87 years.
The diagnosis was normal mentality, and it was recommended that she be taken to a nerve specialist for examination. Anna B. Pratt, A.M., Graduate Student.
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