Diagnostic Teaching. A Case of Infantile Stammer Resulting in Apparent Imbecility
- Author:
Frances Q. Holsopple, M.A.,
Graduate Student, University of Pennsylvania.
The “attempt to teach” perfects the diagnosis and begins the remedial educational treatment. Its value was demonstrated in the case of George, an eight-year-old boy originally brought to the clinic for speech training. A social agency interested in the family wanted to know whether anything could be done for him. The report stated that he had always been slightly deaf, and that he had become entirely deaf in one ear following a mastoid operation. The degree of deafness has not been satisfactorily determined, as a long series of experiments with words and other sounds seems to indicate that the deafness is largely central. Apparently his ability to hear the tick of a watch is more nearly normal than his ability to hear words. At first it was sometimes necessary to speak to him in a raised voice in order to secure his attention, but now he responds to a normal or even a lowered tone.
When George first came to the clinic, he had an extremely bad infantile stammer. He was unable to articulate a single word that anyone but his mother could understand. There were no traces of anything learned during the two years he had been in school. His reactions were infantile and showed how much he depended upon his mother as his interpreter. The failure to use the muscles of his mouth had produced a vacant expression. Nothing else in his appearance or manner suggested qualitative feeblemindedness. He is a sturdy, red-haired boy with plenty of energy.
George was accepted for training after an examination in which he tried with some success to imitate the examiner’s lip movements in sounding long e and final t. He learned to pronounce eat and meat intelligibly at once. The trainability discovered by this attempt to teach was apparently his only normal ability. He did the formboard and cylinders poorly and was of course unable to do any parts of the Binet tests for which language was required. An attempt to test his memory span showed that his articulation was so bad that he responded to a series of three or of four digits with three indistinguishable sounds. From any evidence except the attempt to teach, he would have been diagnosed as feebleminded.
From the last of January to the first of April, George was taught in the clinic for half an hour each week. It took several periods to teach him the articulation of the final consonant in such a sentence as “I eat meat.” He improved rapidly, however, learning to pronounce all final consonants, and to differentiate t and k even when both occurred in the same monosyllable. His sounding of the sibilant was a real triumph, as all the front teeth had just been extracted, and he was obliged to invent a tongue position as a substitute. So much progress would have been impossible without the intelligent co operation of his mother, who drilled him at home on the words he learned in each lesson.
As soon as the initial c was learned, words like cocoa, coffee and cake were easy. Eyes, ears and nose were the first in which he learned to sound final s. George was very careful to enunciate yes distinctly, but he had a great deal of trouble for a few weeks in remembering when to say no and nose. Tea, time, and such difficult combinations as some time and thank you were practiced next. After two months training, he still made mistakes with the complex consonants in candy and drink.
At the end of the first eight weeks, it was decided to reinforce the auditory and kinaesthetic images with the visual. George came to the teaching clinic one afternoon each week, in addition to the speech clinic. The first attempts to determine his proficiency in reading and spelling showed that he had received very little benefit from his work in school. When he was given a box of anagrams, he spelled his name correctly in capital letters, running the first and last names together. He also picked out the words “Frank” and “doy,” reading the latter ” boy.” He knew the names of the following letters, A, C, M, T, E, F, R, L. He had no idea of sounding them. The teacher started at once with phonics to teach simple words containing sounds which he pronounced most clearly. George learned individual sounds fairly well, but was very slow to pronounce new words as wholes. In four weeks he could spell and sound the following words: Dog, Ran, Boy, Cat, Hat, Fat, Rat, Bat, Ball, See, Stop, run, now, get, can, and he was able to begin the Haliburton Primer and proceed normally.
Since beginning the primer George’s interest has increased, if any increase was possible. He is inordinately proud of his ability to read. Between May 1st and May 15th he has learned to read, spell, and sound all words in the first eight pages of the Haliburton Primer. The teacher is making an especial effort to overcome the tendency to monotone in reading connected sentences. He imitates various inflections well and is gradually overcoming this. The improvement in articulation is evident from his ability to pronounce distinctly such a word as “pitch.”
It has been interesting to notice the improvement in the boy’s ability to discriminate auditory sensations, as the kinaesthetic images have been built up. The more he can talk, the more he can hear. As he has begun to differentiate auditory stimuli, his ability to particularize and to distribute attention has become apparent. By the time he could articulate the numerals intelligibly, he was able to reproduce a series of five digits.
Although George is certainly no lower than border-line mentality, no one performance gave an indication of his capabilities. In his case the threshold of sensibility was so high and motibility so ineffective, that an ordinary stimulus failed to produce reaction. The slight deafness, probably in combination with lowered vitality, had cut him off from the outside world. His condition resembled that of the “idiot by deprivation” in the narrowing of range of interests. His ability to give definite particularization was so poor that even the manual performance tests were affected. On the other hand, as soon as he began to react to the clinic teaching, interest, attention, and alertness were stimulated to the modification of his whole behavior.
The work with this boy shows how successfully the attempt to teach may supplement the results of the tests. It is not necessary to hear George read in order to appreciate the progress he has made. He is different in manner and appearance. The use of the correct lip positions has removed the vacant expression. He makes fairly successful efforts with words which he has never had in his lessons, and the consciousness that he can make himself understood has made him more self-reliant. Since he is not so dependent upon his mother he has begun to play with other children. If he attends the clinic lessons during the six weeks, summer term, he may even enter the second grade in the fall. This could never have been predicted without the attempt to teach, for in his case the teaching furnished the basis for the prognosis.
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