A Case of Intermittent Imbecility
The Psychological Clinic Copyright, 1929, by Lightner Witmer, Editor Vol. XVIII, Nos. 6-7 November-December, 1929 :Author: Lightner Wither, Ph.D.
Director of the Psychological Clinic, University of Pennsylvania Assisted by
Arthur Phillips, Clinic Teacher
Carl is a good illustration of the necessity for caution in making a diagnosis 011 the result of a brief observation or a few tests, or even as a result of an extensive observation for a whole day. This boy, nine years and ten months of age, was brought to the Clinic October 1, 1929, by his mother because of school retardation and non-conformity of behavior, which she stated to be a lack of interest and taking money. He had been referred to the Phychological Clinic by two physicians in her neighborhood. The school attended had been a country school about twenty-five miles from Philadelphia.
On the occasion of this first examination, Carl presented the typical appearance of an imbecile?mentally deficient and physically degenerate. His performance level seemed to be that of a low grade imbecile (Barr classification), which means that he would not be able to get beyond the first grade in school proficiency. Moreover the prognosis seemed very unfavorable. It did not look as if he would be able to earn his living even at some time in the future. During the entire period of this examination, he presented the picture of one who is deficient in energy and vitality. His articulation was very slovenly, increasingly so as the examination progressed. He grew very tired. His responses became slower and slower. The physical examination revealed protruding scapulae and abdomen. His chest expansion was but one inch. His testicles were small and the left one undescended.
In the Binet-Simon examination he obtained an I.Q. of 86, his mental age being eight years and six months. His I.Q. placed him just superior to the lowest quintile at the ten year level. His audito166 THE PSYCHOLOGICAL CLINIC vocal memory span was five. His reverse span was three but he did not give three consistently. The rating for the reverse span correlates closely with his I.Q. In the performance tests his movements were inefficient. He displayed only fair discrimination and distribution of attention. He failed the cylinders, a test passed by fifty per cent of six year olds on first trial. He also failed the Dearborn on first trial, a test at his own age level. In both these tests he scored a success on second trial after instruction, showing average retention and trainability.
The non-conformity in behavior of which the boy’s mother complained consisted in stealing money from home for the purpose of buying ice cream, and in restlessness in school. His teacher complains that she cannot keep him still and asserts she never had a child so nervous. His mother notes restlessness and moaning in his sleep. The total picture suggests a deficit of physical and mental capacity.
What first caused me to hesitate in my diagnosis of this boy’s condition was the statement of the mother that the boy was suffering from an open heart. He was referred to Dr Max Trumper, in charge of the Psycho-biochemistry Laboratory of the Psychological Clinic. Dr Trumper’s examination of the heart was negative. The pulse rate was a little above normal. It was suspected that this was a compensation for a poor blood count. The laboratory examination revealed that the ‘’ Complete blood count was normal with the single exception of a slight increase in the white cell count which indicates either a chronic low grade infection or a closed focal infection. The differential white count shows poor resistance.”
The Social Service Department was directed to make a school visit. The visitor’s report contains this statement: “Carl is responsive on occasions, so that his teacher becomes encouraged. On other occasions, it is impossible to control his attention or make any impression upon him.”
Carl was given a second mental examination on October 4, 1929. His general appearance on this day was much improved. He looked more healthy. He was mentally more alert. He showed no evidence of fatigue even at the end of a battery of tests. His Binet I.Q. advanced ten points. He occasionally gave six as his audito-vocal span ?an increase of one. His performance tests showed a marked -improvement quantitatively and qualitatively over the preceding examination. As a result of this changed picture, Carl was referred to the Clinic Teaching Department to complete the diagnosis. Two problems presented themselves: first, to determine his general competency for school progress; second, to study the apparent variability in his behavior, both physical and mental. His mother brought Carl twice a week a distance of twenty-five miles so that he might report for a nine o’clock teaching hour. So anxious was she to do all within her power to improve her son’s condition.
School proficiency tests revealed that this boy who is in the third grade in public school was graded too low in arithmetic and much too high in reading. He had a good 3A efficiency in arithmetic and was competent to take up 3B. In reading and spelling he displayed a questionable IB proficiency. Clinic teaching discovered that Carl has his ups and downs. He has days when relatively he produces the goods called reading and days when he is utterly listless and inefficient. He gazes off into space with mouth wide open and an imbecilic expression. Indeed the changes are more kaleidoscopic still. He attacks his reading with considerable zeal. Large words like “wheelbarrow” and “grindstone” which are new in the lesson, are no obstacles to his progress. Then suddenly the slump comes and he cannot discriminate between “was” and “is.” Words that he has been taught he is able to recognize in other settings immediately whether placed on the board or printed in the text. His retention, however, is not good for words. A word learned thoroughly on Tuesday may be forgotten by Thursday. His comprehension as tested by the immediate recall of story content is good. When he has worked out a word in the reader he usually knows what the word means. He has some logical imagination which works under pressure in the analysis and synthesis employed in word building. In the ten hours of teaching he has read fifty-eight pages in Elson’s second reader?about one-fourth of the book. The words that he missed in reading were used for spelling. They were drilled in by constant repetition and repeated review. He knows them as well as he knows anything, that is to say, some days he knows them and some days he does not know them.
His reading difficulty is due in part to the system of instruction used. With a specific memory span deficit, the “word and sentence” method of reading fails to accomplish results. This is the case with Carl. More can be accomplished by using phonic analysis and syl168 THE PSYCHOLOGICAL CLINIC labification, building up words from letter sounds to syllables and larger units. This procedure has been followed with Carl and has yielded reasonable results. By the continuance of this method, Carl probably would attain enough reading ability to use in mastering elementary history and geography. Considering his mathematical ability and his good comprehension for what he does read or is read to him, there is no reason why he should not reach at least the fifth grade in school.
However, he will not be able to earn his living in any position requiring more than fifth grade competency and from now on he should have training, definite and systematic, in simple manual occupations. In the tests and clinic teaching the best quality he has shown is his trainability in handling concrete material. While there is no promise of definite superiority in any occupaton, he could learn to do many things passably well and fill at least a small niche of productiveness in the world.
There is no indication from the clinical study of Carl that any behavior problem will complicate his social adjustment. He has not shown in our observation of him the restlessness of which his teacher complains. There has been no hyper-activity. Each morning Carl waits patiently and quietly, sometimes for a half hour, for the arrival of his clinic teaching hour. He disturbs no one. Even when other children are present in the lobby and moving about he remains seated in his chair. Pie has presented the appearance rather of one who is inert and hard to arouse.
The only excitement and enthusiasm that he has shown in his visits to the Clinic appeared when he was describing some social or recreational activity?a Halloween Party or football game. Then he bubbles over with excitement. His speech tumbles out in a torrent so as to be hardly intelligible. Carl is exceedingly proud of his athletic ability. When he tackles a runner, the runner comes down. They can’t get away from him. He admits, however, that he is only a substitute on the school team. To capitalize some of the motivation displayed in these types of activities and harness it to a school task is one of the problems in Carl’s case. Carl has shown no interest or emotionalized attention in reading, quite naturally, for the printed page means nothing to him. It is a fair presumption that a great deal of his misbehavior and nervous restlessness in school is due to the fact that the limited amount of energy that Carl possesses has no outlet during the school hours except during the arithmetic Period, and that when he is employed in a task adequate to exploit his meager powers of mind and body he will cease to give trouble. As for stealing, our investigation has not shown anything more than the appropriation of petty sums at home to be spent, as his Mother avers, 011 ice cream. Such conduct might be viewed as quite normal in a boy of Carl’s age. What is normal to one age, if not controlled and directed in the right direction may become abnormal ^ter. With a boy of his general conformity, it should not be difficult to handle this problem. The clinical findings indicate that Carl has normal mentality. On the intellectual scale he is somewhat above a middle grade imbecile, Barr classification. His specific defect is a lack of educability in reading and a lack of trainability in spelling. With concrete Material his trainability is above average. His motivation is adequate for any task or activity in which he is able to achieve some degree of success. His volitional endurance is low and is complicated by his readiness to fatigue. What abilities he has function inefficiently. Any prognosis of this boy’s future is dependent upon his Physical condition. He is at this point in his life history essentially a medical problem. The recommendation of the Clinic Teaching Department was that the case be closed.
Disclaimer
The historical material in this project falls into one of three categories for clearances and permissions:
Material currently under copyright, made available with a Creative Commons license chosen by the publisher.
Material that is in the public domain
Material identified by the Welcome Trust as an Orphan Work, made available with a Creative Commons Attribution-NonCommercial 4.0 International License.
While we are in the process of adding metadata to the articles, please check the article at its original source for specific copyrights.