Three Behavior Problems
- Author:
Arthur Phillips, Clinic Teacher
The Psychological Clinic, University of Pennsylvania Within the year three children who present a similar behavior problem at three stages of development have been examined in the Psychological Clinic by Dr Miles Murphy. One is a boy; the other two are girls. The boy, Richard, was three years old at the time he was examined in July, 1929. The second, Marjorie, was nine years and one month old on October 1, 1929. The third, Ellen, was fifteen years old in April, 1929. The diagnosis in all three cases was deferred until after a period of clinic teaching. Richard was brought to the Clinic because of highly negativistic behavior and lack of speech; Marjorie, because of fears, retardation and speech, and Helen, for the same reasons as Marjorie. The symptom complex of the three has these common features: fear, retardation, speech. The cases are interesting (1) because they represent various stages of development of a single type of behavior due to insufficient or misguided home training; (2) because of retardation in mental growth as a resultant of such behavior and (3) because they are all speech cases although differing in the manifestations of their speech behavior. Richard is a case of negativism in speech. He refused to talk. Marjorie is a case of infantile mutilation plus a number of peculiar speech mannerisms, while Ellen stammers and stutters. In all three cases fear plays a part as the outcome of hysterical organisms. They might be studied from the standpoint of fear and the consequent retardation mentally and educationally. A more or less detailed study of each of them separately will bring out their likenesses and differences.
Richard
Richard is the first of two children of an average American family. The second child is a daughter of eighteen months. Neither of the parents may be described as intellectual. When the parents brought the child to the Clinic the father’s attitude was described by the examiner as something akin to admiration. He narrated with some gusto the temper tantrums of his son, his defiance of teaching, his refusal to talk, his marked non-conformity of behavior. He was not without concern for the welfare of his child, else he would not have brought him to the Clinic nor did he fail to realize that Richard was a real problem both in himself and because he was teaching the same type of behavior to his sister. But his concern was colored by admiration for his unusual child. He appeared to enjoy the fact that the boy’s behavior gave some prominence to the family in the community. The mother shared the father’s admiration for the child, but her point of view was slightly different. The child was her problem from morning to night. She was exhausted by her efforts to control the recalcitrant boy, albeit they were misdirected. She was at her wits’ end. She wanted expert advice as to how to manage him.
Richard’s life history of three years is briefly summed up: he walked at thirteen months, was clean at two years and a half. He does not talk yet; he has never been to school. His food habits are good. What bulks largest in the history is the behavior aspect. His parents describe him as wild; he does not obey. He wanders away from home?has done so ever since he was able to walk. Now that he is three his temper tantrums have grown worse. “When Richard is cross,” says his father, “he throws himself down, kicks, bangs his head 011 the floor, spits and throws any handy objects at me or his mother.”
On the day of his appearance at the clinic he manifested all of his repertoire of behavior tricks. lie wandered about the Clinic rooms aimlessly and when his will was interfered with, this youngster of three, strong and active in body, dropped to the floor and became a mass of wriggling, kicking, squirming flesh, a beautiful illustration of the results of the “laissez faire” method of child training. Was he deaf? No, he understood the meaning of the commands that he received. lie was defiant and only after firm treatment was he reduced to anything that resembled docility. It was too much for Richard to remain long in the guise of an obedient child. Suddenly he brushed from the table before him the pile of blocks with which a color test was being given. “Good,” said the examiner, “that’s fine. Now push the rest 011 the floor.” At this the youngster took a block in each hand and with good aim levelled a block at the examiner’s head. Down on the floor he went, screaming, kicking the blocks in every direction. Under the persuasion of a still firmer hand, Richard picked up the blocks, although he yelled lustily all the while he was doing it. In every respect his parents’ reports were confirmed. He was now dirty and sticky and was taken to the wash room to be cleaned lip. He retreated to a corner and cried, ‘’ Mama, mama.’’ This call with a decided ‘’ no ” some time previous were the only two evidences of spoken language that Richard gave. By this time he was exhausted, too much so even for play. He climbed up in a large chair, put his head in his arm and was very nearly asleep when it was time for him to appear before a class in Psychology.
His behavior before the class was somewhat more submissive though it was still negativistic but light was beginning to dawn 011 Richard’s mind. He knew that he was not at home. At home he was perfectly adjusted because all the elements in his environment changed according to his desire but at the Clinic the environment was constant in one direction, at least?110 amount of yelling, screaming, kicking sufficed to alter insistence on obedience. There was only one thing to do and that was for him to change. The change was not marked nor prolonged but it was sufficient to indicate that with a different method of procedure than that used at home Richard’s behavior might be made to conform to what was normally expected of a boy of three.
On account of his lack of speech and negativistic behavior it was impossible to proceed far in a psychological examination. He matched colors but the sounds that he made in trying to name them could not be interpreted sufficiently well to credit him with naming colors. On the peg board he showed good coordination and after having completed the task he methodically put the pegs away in the box. With the Witmer Formboard he failed on first trial but after instruction completed the task. His performance quantitatively was that of the inferior one per cent of six-year-old children. Diagnosis was deferred and Richard was referred to the Clinic Teaching Department to complete the diagnosis.
Richard received seven hours of clinic teaching. His arrival on the first day was heralded by screaming and yelling, ‘’ Da, da, “bye, bye.” He clutched his father’s hand and refused to be separated from him. This child who apparently showed no fear when he wandered away from home to a considerable distance showed every symptom of fear toward people who were strangers to him. It was not the fear of being left alone; it was the fear of the little tyrant that he would lose his crown.
For the first hour it was impossible to do anything with him because of his constant yelling. At the end of the hour he was sitting calmly in a little chair in the corner of the room with his hands folded in his lap. Richard had capitulated for the time being. On each successive visit the same type of behavior was displayed but with diminishing intensity and decreasing duration. His negativism evaporated through constant friction or contact with an environment that knew no change. By the end of his period of clinic teaching his behavior was normal.
The only problem that remained as far as this aspect of Richard’s personality was concerned was a transfer of the type of teaching he received in clinic to his own home. It was now a question of training the parents?converting them from a state of hopeless despair and impossibility to one of a willingness to attempt sane, sensible methods of teaching this boy that his happiness consisted in adjusting himself to the desires and convenience of those with whom he is to live. Learning this lesson there is every reason to predict that Richard can go to school and profit by instruction. The psychological tests given to him after his behavior had been reduced to something like normality showed that he was both trainable and educable. The Witmer Formboard upon which he failed at the first examination in the Clinic he performed in the first trial in 154 seconds, which by Dr Hallowell’s standard makes him superior to eighty per cent of boys his own age, and his time on the second trial of 95 seconds gives him the same rating. His auditory memory span was three, which is entirely adequate as only forty per cent of boys his age have a memory span higher than this. He was also taught to do the Witmer Cylinders, a test standardized at the six-year level. There is every indication, therefore, that this child is of normal mentality and that intellectually he is above the median of three-year-old children and should make normal progress through the grades provided that the parents adhere rigidly to the common sense program of training laid down by Dr Murphy which involved two very simple principles: (1) Speak to the child as if you expect him to obey. (2) Allow no single act of disobedience to pass unnoticed or undisciplined until the old bad habits are stamped out and new and better habits stamped in. The parents were advised to bring Richard back to the Clinic for examination for his speech defect by Dr E. B. Twitmyer after the lapse of a year or eighteen months.
Marjorie
Marjorie was referred to the Psychological Clinic by the Neurological Clinic of the Hospital of the University of Pennsylvania as a case of mental retardation and with the request that her mental status be determined. She was nine years of age when she was brought to the Clinic on October 1, 1929. She is the youngest of five children. Between her and the fourth child in the family there is seven years difference in age. Between luer and her oldest sister there is nineteen years difference. Marjorie is thus a babe in a family of adults. The father is a clerk in a railroad office. He is an intelligent, industrious and stable character, the kind that make up the warp and woof of our middle class American people. The family has a keen interest in education. One of the girls is a library assistant, a second is a high school graduate and the third is a sophomore in the high school. The mother is of a nervous type, has a goiter and exhibits the signs of emotional instability found in hyperthyroidism. The history records that when the family moved from western Pennsylvania three years ago, the mother became homesick and has remained so ever since. There is no discounting the effect of homesickness upon the physical and especially nervous condition of the one suffering from it. Three years of nostalgia have resulted in a condition approaching melancholia. Her attitude to her youngest child has been undoubtedly conditioned by her temperamental weakness. As for Marjorie, her very appearance, her entire bearing suggests fear and apprehension. She has never played with children. She is afraid to be out of the presence of some member of her family. In the presence of strangers, she hangs her head, mouths her fingers and withdraws at a slight approach toward her of one whom she does not know. She is an infant of nine years, definitely retarded in all her social contacts. At home she refuses to go to bed until some member of the family goes with her. In a family of adults, this has meant that Marjorie is often up until nearly midnight, losing that restful sleep so needful for the physical well being of a child. When the family finally reaches the conclusion that Marjorie should go to bed earlier, they all go to bed at the same time. This single fact is indicative of the way in which the child is being trained. The mother is afraid to say a single cross word to her child. Marjorie is also infantile in her speech. She has a peculiar habit of tacking a short e sound on the end of every letter and word. Besides, she has some infantile mutilations. Ecliolalia is added. A question asked her is most certain to be repeated.
Marjorie has never been to school. She has a fear of school. She will remain only so long as some member of the family stays with her; becomes hysterical when they withdraw and has to be restrained by force. All that this nine year old girl had of formal educational achievement was the ability to print a few simple words. Three years have come and gone and the family have not been able to leave her in school. She is pedagogically retarded, infantile in speech and a bundle of nervous fears. It may seem hard to lay these things at the door of the home or of the mother, but undoubtedly there is where the blame belongs. Marjorie represents at a subsequent state of development, the type of behavior that we saw in Richard. She undoubtedly rules the household of which she is a member. All its arrangements even to retiring at night are adapted to the whim and fancy of this child. She has learned how to keep the control of the family situation in her own hands. She has learned fear; she has been taught it and knows how to use it most effectively for her own purposes.
In her first examination in the Clinic, the Intelligence Quotient obtained was 75. To the examiner it seemed a conservative estimate of the subject’s intellectual level. She had had no school training and failed on such tests as she probably would have passed if she had been exposed to school life. Her demonstrated language ability was limited. Her forward memory span for digits was five, her reverse was two. She gave the reverse only after instruction as to the meaning of reverse and of the process involved. No visual span colild be obtained because she could not read numbers. Her work on the Witmer Formboard while qualitatively good was quantitatively only fair. With the Witmer Cylinders, a test standardized at the six-year level, her approach was entirely trial and error. The first trial was technically a failure?the performance of a sixyear-old child below the median. The only good feature that she showed was her trainability. On second trial, she showed marked improvement though her performance was scarcely that of a median nine-year-old child.
Marjorie was referred to the Clinic Teaching Department for further study. On her first visit, October 11, 1929, her mother accompanied her to the class room where she was to receive individual instruction. While working at the board with one hand, the child clung tenaciously with the other hand to her mother who was seated close by her and who was not permitted to move one inch. The hour became one of study not only of the child but of the mother. Which exceeded the other in fear it would be hard to estimate. Which was the more difficult to handle can readily be stated. The Clinic Teacher was persuaded after the first hour that if firmness were used this child would not throw herself into a paroxysm but would yield slowly, reluctantly, and yet each time with some positive gain. The experiment could not be tried on this first occasion, not because the child could not be separated from the mother, but because the mother could not be separated from the child. She positively refused to withdraw from the room upon request for fear that her child might be thrown into nervous prostration. We arranged for an older sister to bring her the next time. She was an intelligent young woman who was ready to cooperate. She withdrew from the Clinic room upon request. Marjorie did throw herself into a fit. She stamped and clutched like an animal at bay. She screamed and yelled. It took a half hour to quiet her but Marjorie never repeated the performance to the same extent. Weeks passed and each time Marjorie’s behavior showed improvement until finally she came smilingly, willingly into the Clinic room. It looked on the surface as if her fear had been conquered but what had really happened was that she had adopted the teacher into the family and now she must hold on to the teacher as she held on to her parent. Out of this too Marjorie emerged. It is not asserted that in the brief period of three months Marjorie’s behavior has become normal but this much has been demonstrated, that Marjorie can become adapted to a new situation and a new environment provided that the proper methods are used, and that no serious injury to the child could possibly result from exacting strict obedience.
During the twenty-four hours of clinic teaching, attention was directed to the correction of her speech defect and to instruction in the elements of arithmetic, reading and writing as well as to the behavior problem which the child possessed. In all three directions she has shown improvement. Her trainability has been demonstrated both in the correction of infantile mutilation of speech and in the progress which she has made in learning to spell and write. The academic instruction proved to be good mental hygiene. When her fears were dislodged she became obedient, cooperative and eager to learn. She learned to recognize and to write the letters of the alphabet and passed on to the formation of simple sentences with comparative ease. Her greatest difficulty in spelling was caused by her defective auditory imagery. She had difficulty in associating the sounds of certain letters with their written form. This defect was probably due to her poor articulation. As articulation improves, it is to be expected that her auditory imagery may be more accurate. Another evidence of her trainability that makes the prognosis of her scholastic improvement favorable is the increase in her Intelligence Quotient. On January the sixth, three months after her first examination she received an I.Q. of 84. Her Basal Age had advanced from six to seven. Her Mental Age showed an advance of one year and three months. Equally significant if not more so is the fact that her reverse memory span increased one point. At her first examination she was not able to reverse two numbers until after detailed instruction. She can now give three readily, a score which rates her approximately above the lowest quintile of children her age. Any diagnosis of her mental status must be tentative but there is every indication that her retardation is of the type that is rapidly curable provided that the attitude which has been developed in Marjorie in the Clinic will carry over to her work in the school room. Changes in her behavior have been so marked that the Clinic Teaching Department recommended that she be sent to public school. For this step, Marjorie also appears eager.
For her speech defect, Dr E. B. Twitmyer, after an examination conducted March 14,1930, directed that she receive correctional work by a student in Orthogenics B, a course in which clinical instruction and laboratory experience in speech work is offered to students in psychology. Marjorie was assigned a teacher and is making rapid progress toward a permanent cure.
Ellen
Ellen is an only child. A physician who had been treating her for anemia referred her to Dr Murphy because she refused to go to school. This however was not a new complaint as we shall presently see. When Ellen appeared at the Clinic in April 1929, she was fifteen years of age, prepossessing in appearance, well developed physically, an attractive child. Her home background is good. Her mother is a sensible woman, her father is a local politician? what is ordinarily called a ward manager, easy going, more concerned with the smooth running of the local political machine than with the welfare of his daughter of whom in an unintelligent way he is exceedingly fond.
Back of Ellen’s refusal to go to school lie her fears. She is afraid of crowds; she is afraid to ride in trolley cars. When pressed for a reason for these fears, she gives another fear?she fears that she will faint. She has the whole thing visualized. She faints, the crowd gathers, the ambulance comes to take her to the hospital, her picture is in the paper. The odd thing is she has never fainted in her life. Nevertheless because of this fear Ellen will not go into crowds alone or with anyone else. When she needs a new dress, her mother must go to the shops and send home a number from which Ellen makes her selection. The extent to which this child is able to carry out her imperious will was strikingly illustrated when the time came for her to enter the communicants’ class of her church and prepare for Holy Communion. Ellen refused to attend the class and her spiritual advisor had to come to the house to give her instruction and when the day came for her first Communion, arrangements had to be made for the church edifice to be opened in the afternoon so that Ellen might receive the sacred rite in private attended only by her mother. For the same reason her education has suffered. She has attended school approximately six months in nine years. The family was not able to provide her with a regular tutor. A tutor was however secured eacli time when the Board of Education became insistent upon the child’s receiving some form of instruction. This tutor came one hour a week and not regularly. At her first appearance in the Clinic, Ellen was judged to be of approximately average intellectual competency. No detailed psychological study of her was undertaken because of her excitability and her great apprehension. She did not allow her mother to go out of the room. She was afraid of the examiner, suspicious of the entire procedure. When she was asked to read, she showed adequate reading proficiency for her age but as soon as she became excited she stammered and stuttered and flopped her hands at her side like a hen flopping her wings. She had approximately 4 B competency in arithmetic.
Ellen came to the Clinic for clinic teaching four times. Then she refused to come any longer. The family did not possess an automobile. Her aunt’s automobile had to be called into service but as this aunt lived at a great distance and was unable to be at Ellen’s service as continuously as her mother, and as Ellen refused to ride on a trolley, her teaching as far as the Clinic was concerned was at an end. Arrangements however were made for her clinic teacher, a senior student in Dr Witmer’s class in Orthogenic Methods, to carry on the study and instruction of Ellen at her own home. At this time it appeared wise that Dr Murphy should have a straight-forward talk with the young lady and went to her home for this purpose. Ellen had been examined by a neurologist and no signs of neurological involvement had been discovered. She was too old now for the application of the “hot stove treatment” which had been applied in the case of Richard and Marjorie so an attempt was made to reason her out of her fears by pointing out how they were depriving her of the normal life of a young girl and would shut her out from many of the enjoyments of life as well as from filling a useful place in the world. Such appeals to Ellen however failed to register. It was then pointed out to her rather severely that her condition was that of an overgrown baby and that the chief handicap in her case was that she was too old to be treated any longer like a baby and given that type of discipline that proved effective with younger children. She was also informed that the chief reason why she could not be cured was that she did not want to be cured?that she liked baby treatment. At this, the young miss jumped up, stamped her foot and ran upstairs calling out on the way, “I would rather stay as I am than be cured by you.” She entered an upstairs room and she could be heard stamping and scolding like a termagant for ten minutes. She had good use of her faculties?there was no stammering. It was an outburst of temper rather than a nervous fit. To whom was she storming but to her father, the haven of refuge to which she always fled when tilings did not go precisely her way. Ellen is infantile because her father wants to keep his baby girl. Indeed he was so much disinterested in the entire effort to change his baby into a normal girl of fifteen that he never came downstairs to interview the psychologist. Through May and June under the direction of the Psychological Clinic orthogenic treatment was continued. Her teacher made weekly visits, giving her instruction in the elementary subjects of common school education, in an effort to overcome the pedagogical retardation which was the result of Ellen’s unique behavior. She made excellent progress and by the end of the college year had obtained a sixth grade proficiency in grammar, geography, history, arithmetic, and spelling.
Of more interest from the point of view of this article was the attack made on her abnormal behavior. Her teacher wisely concluded that before progress could be made she had to win Ellen’s confidence. She took her for a great many walks. At first Ellen was reluctant to go, refusing because she was afraid, then, taking a short walk or rather a short run, for during the whole way her one idea seemed to be to get back home. Before leaving the house, she insisted that the vestibule door be left open, that the front door be left closed but unlocked and that mother sit at the front window and wait for her return. Immediately upon her return, she looked to see that all these arrangements had been carried out in detail, and needless to say, they had been. Slowly this was modified, the walks became longer and partook more of the nature of an agreeable outing. The doors were allowed to be locked and Ellen took with her her own key to admit herself upon her return. Visits were made to the library where in selecting and returning books she forgot her nervousness and became absorbed in things about her. A short while after when visiting the optician, Ellen actually spoke to the gentleman who was a stranger to her, a thing which up to this time she had consistently refused to do. The child became more normal in her reaction. She renewed acquaintance with her girl friends, they visited her at her home and she even went to the home of one of them.
The summer months, July and August, and September, brought a great change to this young lady and the development which had started under the patient guidance of her orthogenic teacher bore fruit. The family spent the summer at a small seashore resort where the colony was small and the places of amusement and entertainment are all more or less concentrated. Life was simple, less complex than in the great city, all of which made for Ellen’s adjustment. She made new friends among the girls and, mirabile dictu, among the boys. She went bathing, rowing, riding, walking, and even attended a dance. She attended movies with or without a companion without any hestitation. She served at a women’s lunch at the Yacht Club. The old fears of fainting had gone.
Upon her return to the city in the fall, however, she refused to go to school. She has not yet been on a trolley car. In every other respect her conduct approaches that of a normal child. She mingles in social activities with those of her own age. She never stammers when speaking with someone whom she does not know or who does not know that she stammers. She speaks on the telephone, answers the door bell without reluctance, and there is every reason to make a favorable prognosis in her case. Owing to Ellen’s refusal to return to the Psychological Clinic, it was impossible to arrange for her examination by Dr E. B. Twitmyer. Nor was she in condition to undertake speech training, success in which, as Dr. Twitmyer frequently points out, is so largely dependent on “the will to be cured.’’
It is not too much to say that the picture which the psychologist drew of the activities and enjoyments normal to her own age which she was missing bore fruit. The patient, tactful and intelligent treatment of her teacher whom she came to regard as a close friend and confidant can not be emphasized too strongly as a factor in the progress made toward normal behavior.
To sum up, these three problem cases bring to our attention a cause of retardation that is receiving in this clinic and elsewhere increasing emphasis. Retardation may be due to physical causes? poor health, mal-nutrition, glandular dystrophies, defects of vision and audition. It may also be due to an inferior intellectual endowment, deficiencies in discriminability, associability, in memory and attention. Of such cases our clinics furnish abundant examples.
The third cause of retardation is that of defective social control. It is not implied of course that these three types of causes of retardation are mutually exclusive and independent factors. All three may be part of the picture in any clinic case, but there are cases in which one or the other appears to be more dominantly etiological. It is indubitable that the social factor lies behind the intellectual retardation of Richard, Marjorie and Ellen. The prognosis in each case is favorable or unfavorable just in the measure in which these three children may be brought under social control.
A study of these three cases clinically throws forward the importance of training in the early years of life. It is a psychological commonplace that youth is impressionable. That quality is attributed to the plasticity of the nervous tissue. As the child lives not only under instruction but primarily by his own efforts at adjustment and adaptation, he forms a more or less ordered system of habits. In the pre-scliool child, apparently it takes very little to set this process of habit formation going in a definite direction. The earlier such a tendency is set up in the child’s organism, the longer it has to run, the more strength it accumulates, the more difficult it is to stamp it out. The genetic roots of habits reach back into early infancy. The child of three or four has already undergone considerable development. He has been taught and has taught himself many things. The persistence of such an early acquired habit was illustrated in the case of Richard as well as by the increasing difficulty of handling approximately the same problem in the case of the older children.
The supposition upon which the treatment of these three cases was based is that the present status was the result not of inborn tendencies, innate characteristics, but the result of habits established and therefore, like all habits, amenable to control. In these three cases this supposition was empirically verified. The familiar truth was also forcibly illustrated?the longer the life history of a habit, the greater the difficulty in modifying it.
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