James Mentally Deficient and Socially Retarded
- Author:
Arthur Phillips
- Role:
Clinic Teacher
- Affiliation:
The Psychological Clinic, University of Pennsylvania
Attention
Prepared by the possession of two notebooks and a reader for real work, James presented himself (on the opening day of summer school at the University of Pennsylvania, July, 1929) to the department of diagnostic education of the Psychological Clinic.
Upon an uncritical observer, James would make a favorable impression. Although not of athletic proportions, he is fairly well developed. His smile is animated; his interest in his surroundings, keen; his contact with individuals, agreeable; his conversation, ready. Even to a graduate student, he might appear as a hopeful clinic teaching case.
This was not his first appearance at the Psychological Clinic, nor did he come for his first period of clinic teaching. On November 20, 1926, when he was one month short of ten years of age, his mother brought him to the clinic for mental examination. He had been referred by the Superior of a parochial school. Her brief note stated,
“James has been a pupil in our first grade. His conduct has been good, and while he attends regularly, he does not grasp the matter taught. I hope that you may be able to improve the boy’s condition.”
At the time, however, James, was enrolled in an Orthogenic Backward Class of the Public Schools, to which he had gone from the parochial school which he entered at the age of seven. He was presumed to be doing second grade work. His conduct at the public school is again described as good; his work, poor.
James is the fourth son in an average Irish-American family. Of the seven siblings, three died in infancy?one of gastroenteritis, another of meningitis, and a third of influenza. The oldest brother, then 26 years old, had finished high school. He was a road constructor. The second son, age 24 years, had finished the eighth grade. He was a printer. The third son had completed the third year in high school. He was doing engineering work. Then comes James. His medical history states that his delivery at birth was difficult. He was breast-fed for about six weeks. At eight months, he had gastroenteritis.
A nurse came from a nearby hospital every week from that time on for four years with professional services. James walked at two years and talked at four years. Up to his fourth year, he used sign language exclusively. The physician who attended him in his first illness warned the parents to expect about two years retardation. Measles is the only disease recorded thereafter. The attack was mild. Tonsils and adenoids have been removed.
Besides the retardation in talking, the boy was slow in learning to take care of himself. He was six years old before he could dress himself. His conduct as a child was in every way conformed to his mother’s wishes. Pie was not hard to discipline, was always obedient, never had temper tantrums, and ate with good appetite all that was set before him.
At his first appearance at the Psychological Clinic, he was examined by Dr Edwin B. Twitmyer. On the Binet-Simon, he obtained an I.Q. of 70, which placed him in the lowest decile of ten-year-old children. His memory span, audito-vocal?five, is the score made by 40 per cent of boys at the ten year level who are below the median, and superior to 10 per cent. His visual span was five, which is the score of the lowest decile.
An inspection of the Binet-Simon record booklet, shows that his basal year was four. Of the starred tests at five years, he missed only the third?aesthetic comparison; at the six year level, he failed only the mutilated pictures test; at the seven year level, only in copying the diamond, at the eight year level, only in counting 20-0. On the Witmer Formboard, a test passed by 50 per cent of four-year-old children, his performance on first and second trial judged quantitatively was not as good as the median six-year-old performance. The cylinders, a six-year-old test, he failed to solve on first trial. In the second trial, his performance was wholly trial and error. He showed little ability to profit by his mistakes, and unintelligently removed blocks correctly placed. His time was 280 seconds on this trial, not as good as the average six-year-old time. Poor discriminating ability and low power of analysis were shown. During the examination, his conversation revealed an infantile intellectual organization. No high degree of motivation was displayed. His social conformity, ready smile, and pleasing manners were remarked. Although in the second grade, he showed no proficiency in reading, writing and arithmetic.
Dr Twitmyer recommended an eye examination and a period of clinic teaching to determine the limit of his educability. At the close of the six weeks period of teaching, the results were summarized as follows: “James has a very low degree of trainability. He learns the simplest things only after constant repetition. His educability also is low. He is unable to grasp new ideas and associate them with material already familiar. He will probably not be able to get beyond the second or third grade in school. With careful individual teaching, he may be brought to read enough to get along in the world.”
James reentered the parochial school in January, 1929, in the second grade, and there he remained, and there he was at the end of the school year, 1929. His mother brought him to the summer school with the urgent request that he be given help in reading and arithmetic. He was assigned as teacher, a graduate student, and was taught for an hour a day for five weeks. His teacher was enrolled for the course in Clinical Field Work, Educational Guidance, conducted by Dr Lightner Witmer, under whose supervision the clinic teaching is carried on at the University of Pennsylvania. For purposes of comparison, James, was given another mental examination. His I.Q. was found to be 59, a loss of 11 points. His mental age was 7 years and six months, a gain of only six months in two years and nine months time. His basal year changed from the fourth to the sixth inasmuch as he had learned to distinguish a pretty face from an ugly face, and to note what was missing in a mutilated face or body. At the seven year level, he drew a passable diamond but contented himself with mere enumeration in the pictures?a test for which he received credit in the former examination. He had not learned to count from 20-0 at the eight year level. At the nine year level he had two credits?date and months. At the ten year level, he scored through an increase in his vocabulary, rating 30 as compared with 20 in 1926.
His auditory span had not changed. It was 5. His visual, 6, had increased one. He gave a reverse of 2, with 3 on second trial with the same series, which ranks him in the lowest decile of ten-yearolds. His time on the Witmer Formboard showed some improvement, but did not change his decile rating. He used but one hand in this test and showed only fair discrimination. His intelligence was not adequate for a successful solution of the Witmer Cylinders on first trial. With minimum instruction, he solved the problem in typical trial and error fashion. Qualitatively, his performance was somewhat better as no unintelligent behavior was noted. His performance on the second trial was at least 25 per cent better than JAMES 189
in 1926, but not much better than the median six-year-old performance. A comparison of the tests made in 1926 and 1929, thus shows the meagerness of the gains that James had made. His retardation had become accentuated as he had grown older. His mental age and chronological age had increased in the ratio of 1:5. Analytically considered, the Binet-Simon shows some little advance. Aesthetic judgment has appeared, as well as “perceptual familiarity” with the human face and form. His vocabulary has increased ten points. His temporal orientation has improved. Beyond this, the Binet tells us only that he can copy a diamond?and that not too well. In the Formboards, there has been quantitatively and qualitatively some improvement. By the Binet, his performance level is that indicated by an I.Q. of about 60, and a mental age of seven years and six months. On the performance tests, his rating is hardly superior to that of the median six-year-old child. His reverse memory span which is especially diagnostic of intellectual capacity and ability to make progress in school correlates closely with his performance on the Formboards.
For further analysis of James’ competency, an attempt was made to teach him reading and arithmetic. In reading, a second reader was chosen as presenting a problem difficult for this boy of nearly thirteen years. His rate of reading proved slow as there were many words which he did not know. In learning a new word, phonic analysis was used to help him work out the parts of the word. He knew the sounds of the letters, although he frequently made many mistakes and could not discriminate between the long and short vowels. “When the sounds of the letters were known and correctly given, he could not synthetize the integral parts to form a syllable or word. This pointed to a defect of associability, already indicated by his specific memory span deficit. At this point the difficulty was in the field of audition. He had correct auditory images of letter or syllable sounds but failed to combine them to form a more complex unit.
Visual imagery was next exploited. Words were presented to James either on paper or on the blackboard divided into syllables or parts; e.g., in vit ed. Each part would be recognized, and pronounced correctly, but James was never able to bring the parts together to form a single word. When the syllables were sounded for him closely enough together to approximate the sound of the whole word, he achieved his only success. Repeated attempts to get James to bring the sounds closer together by degrees resulted in failure. After several attempts James would come out with some such expression as this, “Honest, I don’t know. You tell me.” The learning process was further impeded by defects in the fields of attention and retention. In distractability, James is at the top of the scale and, by the same token, in attention very near the bottom. If interest in one’s surroundings is a good thing, James has such an excess of this quality, that it amounts to a positive defect. If anyone entered the classroom during his lesson, James’ immediate concern was to find out who he was, why he came, what he was doing. Often in the middle of reading a sentence, he would blurt out a question such as these?”I’m a good boy, huh?” “Will you give me your pencil?” “Where did you get your beads’?” “What time is it?” In retention, his rating is equally low. When a new word is drilled in, it does not stay long. Half a page away, it has an entirely strange appearance to James. He learned proud in one line. He could not read proudly in the next line.
His reading comprehension is of the same grade as his rate of reading. Two pages an hour was about James’ limit. What he derives from his reading approaches the zero point. An illustration or two will suffice. He read the sentence, “A bottle is empty when it has in it.”, the blank space to be filled in by either “something” or “nothing.” James chose “something.” Again he read, “A tree grows on the .”, the space to be filled in by “land” or “ocean.” James selected “ocean.” Any word at all would have done as his usual method of reading indicates. He would read along until he came to an unfamiliar word, guess at it, making the substitution whether it was meaningful or not, and then go on reading.
With arithmetic, the defects, so far enumerated, were combined with the total absence of the concept of numbers. A unit means nothing to James. In the Binet-Simon, at the eight-year level, he failed in counting backwards from 20-0 after receiving help from the examiner, who started him off with “20, 19, 18?now go ahead.” With such a handicap, it was especially difficult to make any progress in either addition or subtraction. His arithmetic achievement consists in adding one to another digit, and in combining two like numbers. Combinations such as 5 and 6, 3 and 4, 5 and 2, he had not mastered at the end of the clinic teaching period of five weeks. Ocassionally it appeared as if a particular number combination had been drilled in, but his retention was so poor that there was no assurance of his giving the correct answer a half an hour later. James has been attending school five years. During that period he has acquired a low second grade proficiency in spelling and writing, a first grade proficiency in reading, and not even first grade proficiency in arithmetic. He is not educable enough to learn any method of analyzing new words, although he can be trained to recognize a few more words that he now knows. In arithmetic, he has not sufficient trainability to learn the fundamental processes, nor intelligence sufficient to apply them to the simplest mathematical problems. He will never be able to make change readily, nor to conduct his own affairs. He will always need supervision and direction and will never be mentally independent. Socially, he has the orientation of a boy of ten. His conversation and actions are slightly infantile, but he is amenable, obedient, co-operative. He presents no problem of discipline either at home or at school.
The diagnosis of Dr Twitmyer as expressed in the summary of 1926 has been completely justified. With orthogenic individual instruction, during the past three years instead of the classroom instruction, he probably would have obtained a grade higher in proficiency in the three R’s. However, what this boy needed was training in the manual arts. There are a number of useful arts in which a boy with the competency rating of an eight-year-old might be trained. He would probably never be able to learn anything well, but he could learn to do several things with a degree of efficiency that would enable him to make some contribution to society and be worth his “board and keep.”
The very qualities that appear like assets now, his amiability, amenability, may prove his undoing once the discipline and guiding hand of a devoted mother are removed. He has sufficient mentality to know what other people consider to be right and wrong, but not sufficient to make any independent moral decisions. His malleability will make him responsive to the influence of his surroundings. The prognosis in this case depends 011 the kind of training James receives in the next few years. A long apprenticeship in simple manual occupations would be required to fit him for a place in the world. He will always need guidance and protection to keep him from becoming the dupe of the designing and the prey of the unscrupulous.
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