A Case of Mental Deficiency and Doubtful Social Competency
DIAGNOSTIC TEACHING.
- Author:
Doris Wilcox,
Senior, School of Education, U. of P. Two years ago John was brought to the Psychological Clinic for examination because of suspected feeblemindedness. He was at that time seven years old and in the first grade of school where he had been doing very poor work for nearly two years. His absences were few, and his conduct was reported by his mother and teacher to be good. He played with other children of his own age, and “got along” very well with them.
There was nothing significant about the birth or family history. His health was fair. He was nervous and could not sit still, and trembled easily. He had never suffered from convulsions or any serious accidents. He had had his tonsils and adenoids removed, but had undergone no other operations. Before he was five years old he had had measles, diphtheria, scarlet fever and whooping cough. The child appeared fairly well grown and normally developed. He had no marked somatic stigmata.
The psychological examination proved inconclusive. His performance tests were poor, yet not poor enough to warrant a diagnosis of feeblemindedness. His minimum time from three trials on the Witmer Formboard was 33 seconds. (Experiments have shown that most normal children of his age do it in about 25 seconds.) He failed on the Cylinder Test, but the failure was not a bad one. He was able to copy correctly one of three simple designs made with four colored blocks, and he compared five weights accurately.
The informational tests were not conclusive because the child was only seven years old and only in the first grade, and the examiner could only guess at the previous training and environment. The fact that John had been nearly two years in the first grade was not particularly significant. That may have been the fault of the school, or may have been due to the boy’s inability to adjust himself to the ways of the schoolroom.
By spelling out the words, he read with difficulty from the Aldine Primer, “Sing, girls, this is my.” “Come again some other day,” he read. “See the boy and girl.” When asked, “What’s the thing to do if it is raining when you start to school?” he answered, “Take an umbrella.” “What’s the thing to do if you find that your house is on fire?” “Tell the fireman.” “What’s the thing to do if you are going some place and miss your car?” “Wait.”
According to the Binet-Simon Tests he scored 5 years 6 months with an I. Q. of 76.7. If the alternate of “morning or afternoon” in the 6-year tests had been given in place of the mutilated pictures, he would have scored 6 years and 4 months, and an I. Q. of 88.4. The examiner realizing that the results were insufficient upon which to base a scientific diagnosis, deferred a statement of John’s mental status, and suggested that he return to the clinic in the course of a year for further examination.
John returned to the clinic this spring. He is now nine years old and in the second grade. His aunt, who brought him, says he is a good boy, does errands well and helps his mother around the house. He plays with children younger than he is. He is fairly healthy. The only trouble with him?according to his aunt?is that he’s “dull in school.”
Accordingly, I combined with the re-examination an attempt to teach. John has now been to the clinic four times, remaining about an hour each time.
I began with the Formboard, first as a test, then as didactic material. John did not remember having seen it before. His first performance took thirty-nine seconds. His movements were jerky and ill-coordinated. He made four errors but corrected them. His second performance was somewhat improved. He made only two errors and finished successfully in thirty seconds. Then I replaced the blocks, using both hands, and calling attention to the position of the ones he found difficult?the star and the cross. John tried a third time, and reduced his record to twenty seconds. With practice and instruction on following days, he has learned to complete the performance correctly in nineteen seconds with no errors. He failed on the Cylinder Test the first time I gave it to him. He placed the cylinders in any holes where they would go and made no attempt at correction. After five minutes he gave up, saying, “There’s one over.” I then removed the cylinders and showed him how to perform the test, calling his attention to the way the blocks fit. Then I removed them and told him to replace them. The child took up one cylinder and tried it in many holes until he found where it belonged. Using this method throughout he completed the performance in ninety seconds. Then I called his attention to the plan of the apparatus, showed him where the long holes were and where the short holes were. He tried again and reduced his time to eighty-six seconds. He made fewer errors than before. He has practiced six times on the cylinder since, and can do it now correctly in eighty seconds with perhaps only six false moves.
He was able to copy quickly and easily a square made with four design blocks. But once, when it was necessary for me to leave him alone for a few minutes, 1 told him to copy with his blocks a printed pattern (which required sixteen blocks.) When I returned, fifteen minutes later, he was working futilely, trying to do it with four blocks. When I suggested using all his blocks, he set to work and completed the design in two minutes and forty seconds.
One day he made two rows each containing five blocks. He told me there were ten altogether. But when I asked, “How many are five times two?” he answered “twelve.” According to him at that time, 4X3 = 6, 5X3 = 15, 4X3 = 9, 3X3 = 6,2X3 = 8,2X4 = 12. Realizing that I had aimed too high, I began with simple addition. I found that he could count up to twelve. He knew 1 + 1 = 2, 2+1=3, 3+1=4, 4+1=5, 5+1=6. With blocks he found that 6 ? 1 = 5, 6-2=4, 6-3 = 3, 6-4 = 2, 6-5 = 1, 6-6 = 0. When I took away the blocks, he answered that 6 ? 3 = 2, 6 ? 4 = 9 and 6?1=0. So I gave him the blocks again, and he solved the problem 6 ? 3 = ?. He drew three strokes and added three more. He drew six tents and erased three. Drew a road with three trees on each side. Then I made him say 3+3 = 6, 6 ? 3 = 3, 2X3 = 6, each one at least five times, and he finally learned these combinations. After four lessons, using similar drill each time, he has competency with numbers up to six, but he is not efficient enough with them to give an immediate correct answer.
He knew his alphabet and could recognize and make his letters. But he could not sound them. I sounded b, f, r, and I, and showed him the position of my mouth. After almost countless repetitions he learned to sound those four letters. But when I placed them separately before ed (a word he already knew) he was unable to synthesize, and finally I had to tell him the words fed, led, bed, and red. It was only by writing these words, spelling them aloud and with anagrams and drilling upon them many times that he finally learned them. By using the same method with all the unfamiliar words I have brought him to the point where he now can read the first four pages of “The Mother Goose Primer.”
Among other things, John possessed a speech defect. He is a lazy, baby talker. I am working now with breathing and speech exercises. He is able to hold his breath now, can sound e for six seconds, a for eight and o for fourteen. At first he said the familiar rhyme: “Barber, barber ” like this, “Babor, sha a pi How many wi make a wi Four and twenty wi gi the babor a piece o’ snuff.” The only speech gain he has made has been in learning to say this one rhyme correctly.
Having made the attempt to teach we are now in possession of enough material to give a fair basis for diagnosis. John is, as his aunt says, dull. But what does dull mean? In this case, it means lacking in intelligence; that is, he is nearly always unable to solve what for him is a new problem. With him, it seems to be a general defect. Knowing the sounds of the letters, he can not synthesize and make a word. Seeing the cylinders and cylindrical spaces, it does not occur to him to make the former fit into the latter. He counts two rows of five and finds that there are ten. Yet immediately afterward he says that two times five are twelve. He can’t copy the block design because he doesn’t see that he needs sixteen blocks instead of four.
He doesn’t solve the new problem. Why? If we analyze his performances we find that he is lacking in imageability, associability, and contracted particularization.
Furthermore, once the problem is solved, it is very difficult for him to learn the solution. There must be drill, drill, drill, and presentation in many forms. It takes many stimuli to bring about imagery adequate to survive.
Without a doubt, John is feebleminded according to Barr’s classification. He is “backward or mentally feeble.” His “mental processes are slow and require special training and environment to prevent deterioration.”
But he can be taught?that has been proved?if one is willing to take the trouble. His conduct is conformed, and he has no marked somatic stigmata. He is patient and persistent and willing to try. I am Avilling to prognose that, with these assets, he can be trained for a place in the world. He will probably be able to learn to do simple, manual work and become self-dependent.
He can be taught simple reading, writing and arithmetic. Where? Certainly not in the schoolroom with a class of children! John is a type of child for whom clinical teaching holds out the only hope. Individual instruction, attention to his special defects, special drill?this alone can give him what he needs.
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