Clinic Reports
Case 8305
This case, a boy eleven years and two months old, was referred to the Neurological Clinic of the University Hospital by his teacher because of what she called “nerves.” The examining physician in the hospital suspected mental deficiency and referred the case to the Psychological Clinic.
Earl, as we shall call this boy, is decidedly microcephalic. His head goes up in a peak from the forehead. His eyes are dull and the whole picture is one of heaviness, thickness, dullness. He sat in a chair without sign or sound, showed no interest?scarcely any sign of life. He looked as though he would have stayed put all day if he had not been forced into some activity. During the examination he was compliant rather than cooperative. The history showed that Earl had been going to school for five years, but he was still in the second grade. His Intelligence Quotient of G5 was no surprise, but his performance on the Witmer Cylinders and the Dearborn Formboard was. From a quantitative point of view his performance was consistently superior to that of 80% of boys at the ten year level. Qualitatively it showed excellent comprehension and discrimination. He has given signs of mechanical ability at home. On one occasion he took apart an old clock and with the “works” rigged up a windmill which he had running. This he did without help or suggestion from any one. The question raised here is whether this mechanical ability is really sufficient to amount to a talent when compared with the mechanical ability of other boys or whether it stands out as a talent as compared with the low proficiency level of Earl in other, i.e., intellectual fields. This is the kind of case which Dr Witmer differentiates as mentally normal but intellectually an imbecile. In intellectual pursuits Earl is a Low Grade Imbecile on the Barr Classification?trainable but only slightly educable. He is not likely to get beyond second grade proficiency in school. Nevertheless he has good enough judgment to take care of himself and he has excellent mechanical ability. Case 8348
This case, on the other hand, is an imbecile on every scale. Amos, a little colored boy, nine years and nine months old, came ambling into the Clinic accompanied by his mother. His gross motor move222 THE PSYCHOLOGICAL CLINIC ments were somewhat uncertain. His face wore a perpetual grin. His head was large. The girth was equal to the median for twelveyear-old boys. His weight was average for his height and age according to the norms used by the Philadelphia Board of Education. The Pediatric Clinic at the University Hospital had referred Amos to the Psychological Clinic for a determination of his mental status. The medical history showed that the child had convulsions from the time he was ten months old until he was four years old. He was three years old before he talked, and four years old before he walked or was clean. The medical diagnosis was rickets and tetany with convulsions. The examining physician suggested that it was probably a case of hemorrhage during convulsions with low grade cerebritis.
An investigation of school proficiency demonstrated that after more than three years’ training, Amos had not learned to recognize printed letters or write any part of his name. Although he has been placed in the second grade of a special orthogenic school for backward children, he has neither first grade proficiency nor first grade competency.
On the Stanford revision of the Binet-Simon scale, Amos received an Intelligence Quotient of 49. His mental age was four years, nine months, his basal age three, and the highest level at which he passed tests, seven. The I.Q. and mental age obtained from these tests are too generous an estimate of the boy’s intellectual level. Work on the performance tests was quantitatively and qualitatively very inferior. Amos’s discrimination or discernment is excessively low. He has sufficient efficiency to pick up the blocks of the Three Block and Witmer Formboards and to place them over a hole, but he has not sufficient form discrimination to place them correctly even after careful training. Amos has a very restricted span of attention. The forward auditory span for digits is three, and four once out of about five presentations. The visual span is four and he did not comprehend the reverse span. In short, all psychological test results in this case were inferior to 99 per cent of boys at the ten year level of competency. Amos has no intellect and a very low degree of intelligence. His intelligence was not accurately measured in the Clinic since he did not successfully complete any of the new problems presented to him. However, it is probable that his intelligence is not greater than that required by such a response as putting on more clothing when he feels cold or, in the common vernacular, coming in out of the rain. Amos is neither educable nor trainable. His general performance level was estimated by Dr Witmer at about two years. The diagnosis is feebleminded, not higher than a Low Grade Imbecile, Barr classification.
Case 83C2
November 23rd there was seen in the Psychological Clinic a little boy of three years and three months who presented an interesting manifestation of the motivation of superiority. He was brought because of evidences of precocity. His parents complain of his embarrassing behavior at home. He will get up before a gathering of grown people and endeavor to entertain them by reciting poetry which he has taught himself to have on hand for such occasions. This practice is very annoying to his mother who finds children’s recitations painful. One day before company, he asked his father to tell him the meaning of antediluvian. The father whose education and intellectual interests are very restricted was much embarrassed to have to admit that he did not know the meaning of the word. To this, young Leo replied in high scorn, “Why father, I am ashamed of you!’’ Fancy this from a three-year-old, and you have something of the joys attendant upon rearing a child with superior intellectual motivation, in an average middle class family. If any adults pay much attention to another little child in his presence, Leo will drag his playmate, be it boy or girl, by main force from the group of admiring elders, and will establish himself in place. When the boy was a mere baby of one and a half years (he had had but six months’ experience in the art of walking upright), he fell all the way down a flight of stairs. At the bottom he picked himself up, with teeth and fists clenched to brace himself against tears. In a rage he turned upon his mother and demanded why she had not taught him to walk downstairs properly so that he would not fall.
Again, on the street, Leo can beat all the other children in races. This has become such tame sport that now he will give them handicaps and if, as he overtakes them, they do not hear him coming and get out of his way, he runs deliberately into them and precipitates a wreck. The mother asks if this is wickedness in her son. We can only say that this behavior is typical of the manifestations of superiority. It is successful non-conformity to the accepted pattern of behavior in a child. We say it is successful because he is getting away with it among his peers. They accept him as their leader, and the bigger boys cannot bring themselves to whip such a little fellow. Here is a picture of boundless energy coupled with enough discretion to know how much tyranny he can carry off. He has the motivation that will not be denied, to excel in all competitions. He has the desire to surpass even the superiority of his own performances. His behavior is typical of the egocentric genius who will not be deprived of the center of the stage.
Three Mongolians and Two Cretins
Throughout the academic year, 1928-29, and perhaps during the last two or three years no cretinous child has been brought to the Psychological Clinic for diagnosis and there have been very few mongolians. “With a curious tendency of cases to appear in groups, which physicians have noticed in connection with their clinic practice, three mongolians were brought to the Psychological Clinic for examination within a period of two weeks.
The first of these was 6 years, 4 months, of age and was referred by a School Principal who refused to take the child as one of his pupils and advised the mother to bring her to the Clinic for an examination. She presented a very typical mongolian appearance with many of the accompanying symptoms. Her muscular tonicity was greatly diminished. She sat tailor fashion and could put her heels over her head and was very active. It was interesting to observe that the child had a Caesarian birth and that her mother was 40 years old at the time of her birth.
The second of these children was 9 years, 5 months old, a child of Russian parents. In her case the mongolian facial appearance was not nearly so striking and indeed was no greater than might be expected from the admixture of mongolian blood in the Russian race. Nevertheless, she was definitely feebleminded and would have to be classed as a mongolian imbecile.
The last of these mongolians was 4 years, 8 months, of age, referred by a physician because of ‘’ absence of the thyroid gland.’’ He could not talk plainly and was not yet clean. He is the youngest of 5 children, his mother being 44 years of age at the time of his birth. His mother had whooping cough from the fifth month of pregnancy until he was born. This boy is not higher than an Idio-Imbecile on the Barr Classification.
CLINIC REPORTS 225
Of even more interest is a cretinoid girl, age 6 years 4 months, brought to the Clinic for examination November 12th. This child was referred by the Hospital of the Graduate School of Medicine of the Universtiy of Pennsylvania and was brought to the Clinic by a Social Worker from that institution. The girl did not walk or talk until she was 4 years old and was not clean until she was 5. She has been under treatment supervised by the Hospital ever since she was 6 months old.
She was suffering from rickets and intestinal infantilism and was so mal-nourished that at the age of 3 she weighed only 11 pounds. At the Hospital she is called the “banana baby” because according to the Social Worker she lives on bananas and butter milk. Her daily diet consists of 16 to 20 bananas and 2 to 4 quarts of butter milk. At the present time the girl is up to the average for her age in weight and height. She has, however, a very large and pendulous abdomen. The interesting thing about this case is that the child has just the faintest suggestion of the physical appearance and physiognomy of a cretin. The slope of the shoulders and her walk, which has just a slight approximation of what the Germans described as the bear walk of the cretin, suggested cretinism to the examiner. Her skin, however, was neither cretin nor mongolian, but in perfect condition and one has to feel her flesh in order to feel the myxedematous texture. Her hair also was in good condition and she had very lustrous eyes. The child has that slow responding rather vacant expression characteristic of the cretin and she is emotionally normal and good natured. She is not lively enough to be called witty as is sometimes the case in cretins. With this girl it was just like stirring up in a pond to get a little reaction but you have to stir her up every time. Curiously enough the following week a child Avas brought to the Clinic who presented all the sjmiptoms of true cretinism. At the age of eight her height was below the median for five-year-olds, she had the physiognomy and chalk-white, pudgy skin characteristic of the cretin. In short she represented the classical picture of cretinism so completely that further description is unnecessary.
Three Superior Children
Last January, a girl, seven and a half years of age, was referred to the Psychological Clinic by a student of Psychology at the University of Pennsylvania because of difficulty which the child’s mother experienced in the way of discipline. This girl was examined and her competency proved to be superior to ninety per cent of girls her age. She had an audito-vocal memory span of seven forward and five reverse and her Intelligence Quotient was 132. She showed signs of very early development. She walked at eleven months, talked at nine months and was clean at eight months. She had a brother, fifteen years of age, who was a sophomore in high school. He was doing excellent work in the academic course. Out of interest, the mother was asked to bring him to the Psychological Clinic for an examination. His competency proved to be practically equal to that of his sister. He had an audito-vocal memory span of seven forward and six reverse and an Intelligence Quotient of 122. He also showed early development. He walked at ten months, talked at ten months and was clean at eight months. The parents of these children were of Polish Jewish extraction. This year a cousin of these children, a little boy, three years old, was brought to the Psychological Clinic having been referred by the mother of the other two children. The fathers of these children were brothers. This younger boy, it was interesting to note, likewise, proved to be superior. At the age of three, he had an auditovocal span of five forward and an Intelligence Quotient of 148. Like the other children he showed a specific talent in language ability. He has no brothers and sisters.
Report of the Psychological Clinic Summer School July 1 to August 9, 1929 Number of New Cases 93 Number of Old Cases 5 98 Diagnoses Normal mentality 58 Deferred 10 Borderline 1 Retardation 4 High Grade Imbecile (Barr) 1 Middle Grade Imbecile (Barr) 1 Low Grade Imbecile (Barr) 4 CLINIC REPORTS 227 Types: Mongolian 2 Hydrocephalic 1 Constitutional Psychopathic Inferior 1 Mild Cretinism 1 Idio-Imbecile (Barr) 2 Dyslalia 2 Profound Stammer 8 Deaf 4 Negativism 1 Cleft Palate … 1 98 Recommendations Clinic or Diagnostic Teaching 16 Speech Training 8 Pre-School Class at Psych. Clinic 2 Specific Vocational Guidance given 6 Specific Educational Guidance given 33 Appropriate Medical Exam, and Treatment 23 Examination in psycho-biochemistry laboratory 2 Specific advice concerning home treatment 10 Treatment accorded a normal child 9 Re-examination in Psych. Clinic 6 Swimming 3 Institutional Placement 7 Educational Social School or Teacher 22 San Christopher’s Day Nursery 1 School Nurse 1 Family Society 1 Parent-Teachers’ Assoc 3 Media Community Center 1 Mt. Airy School for Deaf 1 Religious Social Worker for Board of Ed. 1 Main Line Federation of…. Medical Churches 1 Physician 12 House of Holy Child 1 University Hospital 3 Mt. Sinai Hospital 1 Out of Town Cases Abington, Pa 1 Camden, N.J 1 Ardmore, Pa 2 Churville, Pa 1 Audubon, N.J 1 Collingdale, Pa 2 Barnesville, Pa 1 Collingswood, N.J 1 Bethlehem, Pa 1 Darby, Pa 1 Brooklawn, N.J 1 Fox Chase, Pa 1 Bryn Mawr, Pa 1 Haddon Heights, N.J 2 228 THE PSYCHOLOGICAL CLINIC Hazelton, Pa 1 SoudertoAvn, Ta Lansdowne, Pa 1 Tamauqua, Pa Newton Square, Pa 1 Upland, Pa North Wales, Pa 1 Westville Grove, N..J Norwood, Pa 1 Wilmington, Del Oxford, Pa 1 Woodbury, N.J 2 Sharon Hill, Pa 1 Wyncote, Pa 1 Springhouse, Pa 1 Report of Clinic Teaching Social Service Report Number of Old Cases Taught… 1 Home and school visits 4 Number of New Cases Taught. . 13 Demonstration Cases 19 14 23 Total number of hours taught… 211
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