A Student’s Report of A Clinical Examination.
- Author:
Helen R. Squier,
Graduate Student, University of Pennsylvania.
[In the course in Clinical Psychology at the University of Pennsylvania, a class composed of graduate and undergraduate students in the School of Education, the students are required to observe and make note of the examination of children brought before the class for that purpose. In the final examination of this class at the end of the first term of the present year the class was required to observe and record their observations on the performance of a child, who was examined by an advanced graduate student in Clinical Methods under the direction of the instructor. Each member of the class was required, as a part of the examination, to hand in a paper which should include notes on the clinical examination, an analytical diagnosis, a final diagnosis and recommendation. The case was interesting and difficult of diagnosis because of the conflicting results of the different tests. The diagnosis recorded as given by the clinical psychologist was: “Retardation on the anatomical scale, four years; on the pedagogical scale, five years; on mental age score, six years. Quantitatively feeble-minded. Considering the family history and mechanical tests will probably be above the line of social competency.” It was recpriimended that the boy be taken from school and put to work. The diagnosis and recommendation were not known to the class until after their papers had been handed in.
The following paper was submitted by Miss Helen R. Squier, B.S. in Ed., a graduate student in Psychology, and is reproduced here as it was handed in without emendation.
Physical Characteristics.
C. is decidedly small for his age, which was fifteen years, but, aside from this, he has no noticeably abnormal bodily characteristics. His head, however, was quite suggestive. Though it was not measured, I believe its circumference must have been a little smaller than the average normal head circumference of 22 inches, and there 1 Dr H. J. Humpatonc was the instructor of the class and the clinical psychologist responsible for the examination and diagnosis.?L. W., Editor.
seemed to be a slight depression of the occipital lobe. He has a very high arch in the roof of his mouth, his lower jaw is short, his upper jaw extended. The high arch and the bad mouth formation in general arc not necessarily signs of mental deficiency, but they are found more frequently in feeble-minded children than in normal children.
Analytical Discussion.
1. The Mechanical Tests. It was evident from the first effort lie made with the form board that he was capable of passing this particular test. He worked with good plan, and showed a contracted particularization and a distribution of attention that were quite sufficient for the test. He was successful in his first trial in 18 seconds. In the second trial, he picked up several blocks at once, and worked from the bottom of the pile in his hand to the top, showing that he had a clear conception of the problem before him, and that the form board space perception is quite within the range of his abilities. When, in the third trial, he was asked to take the blocks out for himself, he made such good use of his opportunity that he was successful in 13 seconds, in spite of the fact that his movements were still rather slow. In fact, the slowness of his movements suggested to me a lack of interest?a feeling that he need not put forth his whole effort to satisfy the demands of the examiner, and this suggestion was supported by the evidence of the other mechanical tests.
In his first attempt at the cylinder test, he still worked rather slowly, using the right hand only. His first block was wrong, but he corrected this when he found the block that really belonged in the hole in which he had placed this first cylinder block. At last, at the end of 72 seconds, the cylinders were all right except two, and he quickly corrected those two at suggestion. It was evident that he felt that this test demanded more of him than the form board had done, for, in the second trial, he worked a little more quickly, though he continued to use only one hand. His space perception seemed quite adequate for his task, and he was quite accurate in gaging the comparative size of the holes and the cylinders. His plan was to stick to one cylinder till he found the right hole for it. He was successful with no errors this time in 4G seconds, proving that he had profited decidedly by his first attempt. In the third trial, he used both hands, and moved more quickly than he had formerly, but he “worked” only one side of the board at a time. He showed, however, that he comprehended the plan on which the board was built, and was succcssful in 36 seconds. This record is quite as good as some college records.
He built his chevrons by individual blocks, rather than by an observation of the whole effect, and showed a better contracted particularization than a distribution of attention. When he was working with the double chevron, he worked along long rows, instead of completing one chevron and then trying to go on with the next, as most children do. The result was that he ended with all his blocks in one long row, though their relation to each other was correct except for this. He corrected his mistake a block at a time, with less single block analysis, and a greater eye for the general effect. The whole test, however, showed that he worked by consideration of details as such rather than by trying to get the general effect. He was successful in the first transfer on blocks after he had made the double chevron, but in the second attempt at transfer he forgot the method and movements of the examiner, hesitated, and failed. He easily remade the design he copied from the blocks of the examiner, however, and was successful at his third attempt at change. It took him 2 minutes and 1G seconds to do Healy A for the first time, but he worked steadily and was evidently putting all the energy at his command into the task before him. On the second trial he shortened the time to 29 seconds, and on the third, to 4 seconds, thus showing a large degree of trainability in connection with mechanical performances and concrete objects. I think that the second trial indicated a comprehension of method, and the third, the fact that lie had remembered either the movements involved or the final appearance of the completed test?probably a combination of both.
It would almost seem as if lie had made use of his experience with Healy A in his performance with Healy B, though his surprising success with Healy B in 2G seconds may have been due more to good luck than good management. The fact, however, that he fitted the oblong-circle combination together and placed them in their proper positions in the test at the same time showed that he had an immediate comprehension of the nature of the test. He was successful on the second trial in 22 seconds and made ver}7- few mistakes. His performance of Healy B, together with the Healy Completion Test, showed at least some degree of visual imagination, though the fact that he failed to imagine hands on a watch interchanged suggests that his visual imagination is limited. However, his ability to tell time would have to be tested before his failure with this watch test could be properly analysed and explained.
The Binet Series.
There is a peculiar lack of correlation between C.’s memory span for digits, which is 7, his inability to repeat more than 3 digits backward, and his inability to repeat correctly simple sentences of 18 syllables, which Stanford revision of the Binet Tests places at the 0-year level. The seven digit memory span suggests an adequate range of distribution of attention and a good power of association. The inability to repeat numbers in reverse order, however, combined with the fact that C. always had the correct numbers in his repetitions suggests a serious flaw in this associability, and may indicate one of the causes of C.’s lack of success in school work. The mere possession of facts which we arc unable to manipulate at will docs not get us very far.
I believe that children are able to reproduce sentences as much through a comprehension of their meaning and a rcvocalization of that meaning as by the auditory memory of certain words and syllables. If the child comprehends a word or a series of words easily, it makes no difference whether that series of words contains ten syllables or sixteen?he will be able to reproduce it with equal facility. Two such sentences as: “It is nearly half-past one, the house is very quiet, and the cat has gone to sleep,” and “The apple tree makes a cool, pleasant shade on the ground where the children are playing,” are by no means equal in difficulty to the same child, though they have about an equal number of syllables. The first of these sentences contains three ideas or elements, while the second contains but one. The elements in the first sentence are very simple, however, and clothed in exactly the language that would come most naturally to the child who had comprehended and imaged the ideas involved. The one element in the second sentence, however, is more detailed and complex than is any one of the elements in the first sentence, and is therefore more difficult than are the three elements combined in the first sentence. The first sentence tests the ability of the child to comprehend and associate intelligently and usefully. The second tends more to test the ability of the child to hold in his mind several details at once, without the necessity of reproducing them in anything but the form in which he heard them. That, perhaps, may be the explanation of why C. failed to repeat the first sentence correctly, and succeeded in repeating the second sentence. He could not visualize or image in any other way three ideas at the same time, though he was capable of reproducing a more complicated series of words involving only one picture or idea. This theory would explain the seven digit memory span and the three digit reverse. Had the retentiveness of his memory been tested in some way, the whole series of tests might have enabled us to make a very accurate analysis of his mental abilities.
The idea that his trouble lies in defective control of an adequate associability, combined with an inability to form images readily and accurately hooks up with the rest of his performance of the Binet Tests. His reading was, of course, below par for a boy of his age, since he read at the approximate rate of 2 words per second, and made 5 errors. It was the reproduction of what he read, however, that was especially interesting. Technically, it was a failure. He could not reproduce the passage with the required precision without suggestion. But the questions of the examiner revealed the fact that the knowledge of the meaning of the passage was there in decidedly larger quantity than the performance of the boy would have indicated. Here again we have the impression of an adequate memory span, with a bad control of association.
When he was asked to make a sentence containing three stated words, he was able to make a sentence that made sense, but there were only two of the three required words in it. This was true of each of the first two trials of sentence construction, though he corrected the second of the sentences at the suggestion of the examiner. His failure to make rhymes suggests very clearly his lack of what we might almost call voluntary associability, as distinguished from that uncontrolled associability that is suggested by the memory span of the subject.
His success with the discrimination of likeness between objects suggests, perhaps, his mechanical tendency. He notices, for example, that apples and peaches grow on trees, rather than that they are fruits or good to eat. He observes that iron and silver are both found in dirt, rather than that the}’’ are both simply metals; and that a ship and an automobile both have machinery, rather than that they both can go without being pulled, or that they are both to ride in. He can see no way in which a book, a teacher, and a newspaper arc alike, but he observes that a rose, a potato, and a tree all grow. There was nothing in the mechanism or structure of the book and teacher and newspaper that suggested any resemblance to him.
His whole Binet examination indicates a failure in observation and interpretation of the abstract that is so characteristic of people with so-called “low intellectual ability.” He does not know what to do before undertaking something very important, or why you should judge people by their actions rather than by their words, because these questions are too abstract for his comprehension. He knows what to do when he has accidentally broken something that belongs to someone else, because that situation is more concrete than the other two I have mentioned. His comprehension of pily and charity are most concrete. His definition involves no generalization, but an account of a concrete tli ing in his experience.
Diagnosis and Prognosis.
Quantitatively, the boy is of course feeble-minded. If the Binet tests can really give an intellectual level, or an age level, he is 6 years retarded, so that he is not higher than a middle grade imbecile. His I. Q. is about Gl, when it should be at least 80 or 85 if he is to be considered as belonging possibly to the normal class of children. Qualitatively, however, so many questions arise that a diagnosis of this boy becomes peculiarly difficult. If we were to take the mechanical point of view, we might almost be justified in saying that the boy is normal, with a tendency toward congenital illiteracy. If we were to take the intellectual, abstract side, we would most certainly say that he is feeble-minded, with a possible mechanical bent or ability. The thing that must be of the greatest assistance in deciding the question is his social proficiency, and neither the clinical examination nor his history, so far as it could be given to us, gave very much clue to this. If he has no more ability to conform socially than his “comprehension” tests would indicate, he is most certainly mentally deficient; but his failure in connection with these may be a failure in expression, rather than knowledge. The prognosis in connection with the case depends a great deal upon his environment. I have not had enough experience as yet to know whether or not training could even in part eradicate the serious defects in his “voluntary association;” but even if this could have been done several years ago, it is probably too late for it now, and it is probable that his environment will always be such that he will be injured rather than benefited by it. If he had a relative or a publicspirited friend with a garage or other machinery repair shop, he could be apprenticed to him and be self-supporting, even outside of an institution. He seems to have enough mechanical intelligence to copy a machine, or to learn to adjust and repair machinery along lines that he could easily be taught. He could never produce a machine from printed directions, and he could never invent a new machine or suggest an improvement on an old one. But he could be made useful around an automobile shop, with adequate supervision. At all events, it is quite clear that he is not getting very much out of his school life. It would probably be better for him and the school both if he could be given a domestic or working certificate, and found some such job as the one outlined above.
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