Clinic Reports. XXV
By the series of tests now in use, it is possible not only to determine the approximate degree of general mental deficiency, but frequently to detect also the specific major incapacities which must be taken into account in making a prognosis of further development, either with or without orthogenic treatment, The examination of Lida in May, 1917, is a.case in point.
A general diagnosis of mental deficiency could have been made merely from her physical appearance. She was eleven and a half years old, a slight girl, a little under height, with a head no larger than that of a small five year old child (49.9 cm.), covered by a dirty scalp, and straight fair hair that was ill-kept and lifeless. Pale blue eyes popped out of her yellow face. An open mouth, which the first finger of her left hand constantly pulled down at the corner, showed a small tongue, and an underdeveloped mouth cavity. Even the hands, with dry, flaky skin and fingers short and stubby, particularly above the knuckles, distinctly betrayed her imbecility.
The brief history, too, given by the mother, was suggestive of feeblemindedness: severe marasmus for the first eighteen months, slowness in walking and talking, followed by inability to get on in school, and finally, Lida’s recent demotion from grade 2B to “some sort of a testing class,” which was the immediate occasion for the mother’s anxiety and complaint.
A specific and analytic diagnosis, however, could be made only on the basis of the mental tests. These measured the degree of the deficiency, determined the presence of at least a minimum of most of the mental capacities essential to development, and detected a few grave specific incapacities.
An initial performance of the peg board in 2 minutes, revealed a very slow rate of movement, a fair co-ordination of eye and hand, persistent concentration of attention apparent in the steadiness and system of her performance; and the work with the colored pegs showed good visual discrimination.
The formboard, completed in the time it would take a six year old girl to do the work, brought out the same factor of low rate of movement, together with feebleness in distribution of attention, as well as evidence of a fair amount of space perception, analytic attention, and the ability to imitate roughly the movements of the examiner in placing the blocks, but not the purpose which was the motive behind the movement, i. e. ability to imitate within the narrow range of her understanding.
The Witmer cylinders, while emphasizing the deficiency in distribution of attention, indicated the presence of genuine persistence in that Lida worked steadily for nine minutes before giving up the task as a failure; and the ability to profit by instruction, in that, after a few minutes of instruction and practice, she completed the test in 93 seconds.
The Healy construction puzzle A, which she worked on for five minutes before giving up, and after a single showing of the completed arrangement, solved three successive times, revealed the same assets of persistence and trainability, as well as the capacity to attend analytically to a visual image, and the lack of normal ingenuity and constructiveness.
Her final success, in spite of slowness and difficulty, in reproducing from a copy patterns with the design blocks, gave further evidence that she possessed (288) CLINIC REPORTS. 289 a certain low degree of analytic attention, perception of physical relations in simple form, and the ability to imitate.
A memory span of 5 digits forward, and 3 digits backward, indicated sufficient trainability of memory for some progress in learning. The Healy completion test, while it emphasized again the poor distribution of her attention, and showed, by her repeated failure to remember how to take out a block, an unretentive memory, brought out a certain meager associability of images and constructive imagination in that she was able to give acceptable reasons for her seven correct placements, and reasons that satisfied her for the three incorrect ones; “That rooster’s tumbling out of that cage.” “That rooster’s jumping to peck that ball.” “That bird is flying away from the boy.” The Terman-Binet tests fixed her mental age at 7 years, 10 months, with a retardation of 3 years, 8 months, and an I.Q. of 68. Her successes and failures in this series showed clearly the ability to understand, discriminate, compare, and define at an 8 year level, but conspicuous failure to do so at the next higher level. On all tests dependent on retentive memory, such as naming the days of the week, or the months, she either succeeded with obvious effort, or failed after straining her mind as though she had known them and was trying vainly to recall them. Evidence that Lida was, indeed, educable was furnished by the fact that, in spite of an unfavorable environment, and the unspecialized treatment of the public schools, she seemed to have reached the level of a first grade pupil. She read satisfactorily from the Aldine first reader, reproducing what she had read by repeating the sentences, with her good immediate, but unretentive, memory, almost word for word. She spelled at about the same level, and learned to spell back from a single repetition, but a few minutes later could not recall it. In number work, she knew most of the addition, and a few of the lower multiplication, combinations; could add two numbers of three figures with carrying, subtract two numbers of three figures if no borrowing was involved, multiply one number by another occasionally, but could do no long multiplication, or long or short division.
The mother’s statement that she had taught Lida the multiplication tables over and over again till she seemed to know them perfectly, but that always in a few days she would have forgotten them, corroborated the suspicion of a grave defect in retentive memory.
The series of tests taken together, presented a picture of a mind in which all capacities were seriously below normal, but present in sufficient quantum to insure the ability to profit by instruction within strict limits set by her major defects in distribution of attention and memory retentiveness.
It was possible, therefore, to diagnose Lida as a middle grade imbecile. Her school efficiency is about that of a first grade pupil. She would profit by work in the special class of the University Summer School, a public school special class, training at the Elwyn Training School for the Feebleminded, or, in default of the above, return to the first grade.
Sarah W. Parker, A.M., Graduate Student, University of Penna. XXVI Myra, a rather large child of three years, with her head on one side, and a peculiar expression of the mouth, was a deaf-mute. She has been sent to the Clinic because a social worker at a hospital wished her to learn to speak. At her first visit to the Clinic it was recommended that she be sent to a private school for the deaf before she was four years old, in order that she might be taught speech. The diagnosis was given that her mentality was apparently normal for a deaf child. She was returned from the school as unteachable. They had wanted to dismiss her within a week of her admission, but had not done so, because the Clinic had requested further experimentation. It was desirable to make a re-examination to determine what should be further recommended. There was no significant history, either in regard to disease, birth, or family. Her performance with the pegboard was qualitatively poor. The pegs were placed slowly, with poor coordination and without any perceptible method or planfulness. On the second trial she improved to some extent, and her pegs were placed with some system. She filled a row before proceeding to the next row, but even here she did not fill the whole row in order.
In the formboard test it was evident that she used the trial and error method in the first trial. There was almost no form perception shown. She completed this trial in 146 sec., but when she came to the second trial she stopped at 270 sec., without placing the blocks. In further trials she showed no great improvement. Her manner of handling the blocks was very poor, and her recognition of the relationship between the block and the recess was feeble. Although this was the predominant feature of the test, yet there were times when she would take the wrong block away, and using the other hand, would fill in the right block with precision. This happened so frequently that there was some question as to her distribution of attention, and it seemed possible that the poor quality of her performance could be explained as a lack of correct distribution of attention. It is possible that her deafness can be accounted for in the same way,?that is to say, she may receive the sound stimuli through the proper organs in the normal way, and yet her attention may not be drawn to these stimuli.
At this point there was a return to the pegboard test, to determine her ability to distinguish colors. The idea of completing a single row with a given color was not too complicated for her, but she did not get the idea of doing it with blue or green. Moreover, when several rows were started for her, she could not grasp the idea of completing each with its own color. Experimentation with the colored cubes showed that she could distinguish blue and green with these blocks, and it is a question whether she was unable to distinguish the blue and green of the pegs, or whether it was merely another example of poor distribution of attention. Myra took some time to get by imitation the idea of piling two blocks of a given color, but at last she was able to do this.
Her performance with the Montessori cylinders showed a low degree of intelligence. When she had placed all but two of the cylinders correctly, that is, when she had two of them transposed, she could not solve the problem. After much experimentation, it seemed possible that she had really learned this; but it was a new problem, and though very simple, it seemed decidedly too complex for her.
The most pronounced features of the case were the slowness with which Myra learned, her lack of imagination, and of intelligence,?that quality which would enable her to solve a new problem. On the whole it would seem that she had the mental development of an eighteen months old child. This estimate of her mental level does not make any allowance for the possibility that she has been deaf all her life, and yet it seems that if she had been merely deaf, and of otherwise normal mentality, her improvement at the school would have been more rapid.
One of the most interesting elements of the case was the irregularity of Myra’s performance. At one moment she would seem very dull, and at others she would do things that indicated a superior mental development.
Before she left, Dr Witmer recommended that a Wassermann test be made, to be sure that her underdevelopment was not due to syphilis, and he suggested that the mother bring her back again in a year to see what could be done toward putting her in an institution. He graded the child as a low grade imbecile (Barr classification), or lower.
Donald M. Marvin, A.M., Harrison Fellow in Sociology.
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