What Do Children Come to the Psychological Clinic For?
The Psychological Clinic Copyright, 1930, by Lightner Witmer, Editor Vol. XIX, No. 1 March, 1930 :Author: Miles Murphy
Assistant Professor of Psychology, University of Pennsylvania The nature of the work done in the actual practice of clinical psychology is a matter of concern to anyone who is interested in the problems and the development of this branch of psychology. An answer to the question why children come to the Psychological Clinic would seem to be of some significance in this connection. The present paper attempts to answer this question by an examination of clinical records of one year (1929) in the Psychological Clinic of the University of Pennsylvania. A study of these cases will be of value as an indication of the status of clinical psychology in a large urban community well equipped with different agencies for handling various problems of individual and social welfare. We are, moreover, dealing here with a long established clinic having a well developed technique for the examination and general treatment of cases. The Psychological Clinic is fairly well known to the public from whom the cases to be examined must naturally come. It receives frequent notice in the press, and a knowledge of the nature of its work is widely disseminated through the student body of a large university.
The work of the Psychological Clinic is divided into three general divisions each represented by what might be called a clinic within the Clinic. The first of these is the clinic for general mental examinations, the second is the clinic for the examination of defects of speech and the third is the clinic for vocational guidance. The cases examined in the speech clinic and the vocational guidance clinic are not included in this study because of the more highly specific nature of the problems which they present. We confine ourselves to the clinic for general mental examination in which, in the year 1929, 3G0 children were examined. This number does not include children who, having had their first examination prior to 1929, were re-examined during the year. In three cases the clinic records were not available so that the study comprises only 357 cases. These children were examined by Dr Lightner Witmer, Dr Morris S. Vitcles and the author.
In order to give some preliminary notion of these cases as a group, their chronological ages are shown in Table I. Under age 1G are included all children who are sixteen and not seventeen, so throughout the table.
Table I. Chronological Ages Age Male Female Total 17 and over 2 4 6 16 0 1 7 15 3 3 6 14 11 2 13 13 17 2 19 12 21 9 30 11 20 10 30 10 26 9 35 9 25 10 35 8 22 15 37 7 27 12 39 6 19 15 34 5 16 7 23 4 12 12 24 3 14 3 17 2 2 0 2 Total 243 114 357
The question, “What Do Children Come to the Psychological Clinic for?” can be approached in two ways. In the first place we can consult the minds of those who bring or send children to the Clinic, for obviously very few, if any, children come of their own accord. Then, too, we can study objectively the actual cases which are examined. Every person or agency that refers a case to the Clinic receives a preliminary information blank which is to be filled out and presented at the time of the examination. Frequently the questions on the blank are not answered and the Clinic Social Worker fills out the blank in conference with the person bringing the child. In any case the information on the blank is checked by the social worker in such a conference and, where possible, additional information is secured. The people who bring children to the Psychological Clinic are, as we would expect, a very heterogeneous group. Some have studied psychology in school, others have read about it in newspapers, magazines and popular books and have an interesting orientation toward the science. Some of these persons are physicians, attorneys and other professional people, others have never been beyond the third grade and some can scarcely speak the English language or write in any language. Naturally in such a group one cannot expect much uniformity of terminology in expressing reasons for bringing children to the Clinic. In classifying the reasons given consequently some interpretation was found necessary. Nevertheless the attitude and interest of these people has an important influence in the development of clinical psychology and merits some attention. It is further necessary to bear in mind that any child for whom an application is made is examined, and there is no selection of cases whatever. The causes for which these children were brought to the Psychological Clinic are given in Table II. In securing the material for this table I examined all the preliminary information blanks. Because of the variability in the method of expression used in different cases it was necessary to group the causes in general classes. These judgments I made on the basis of the reason given by the person bringing the child and also any remarks which may have been added by the social worker. For example, “unable to learn to read,’ if found on the preliminary information blank, would be classed under “school retardation.”
Table TI Causes Male Female Total No. Percent No. Percent No. Percent School retardation 58 24 10 14 74 21 Behavior -17 10 0 8 56 10 Interest 32 13 24 21 56 16 Mental status 31 13 32 28 63 IS General retardation 25 10 14 12 39 11 Educational guidance …. 10 7 11 10 *-7 Nervousness 10 4 2 2 12 Miscellaneous 24 10 6 5 30
A brief explanation seems necessary with reference to some of the terms used in the foregoing table. Under “interest” are included those cases who were brought primarily because parents were interested or curious to know what psychology had to say about their children. Psychology is very much ‘’ in the air” nowadays and people hear about it. Very often, for example, the parents believed their children to be superior and wanted to have their opinion confirmed. “Mental status” is a very general term. It includes those children who were brought for the ascertainment of their competency as compared with all children. Many of these were brought by social agencies who were giving the children assistance or contemplated doing so. Sometimes it was a question of determining whether the child was normal or feebleminded. “Nervousness” is a term sometimes used by parents in giving a reason why an examination is desired. It covers, of course, a “multitude of sins.” The different categories given in the table are not mutually exclusive. Cases of “school retardation” might in some instances be cases for “educational guidance.” In all such cases the expression used in the preliminary information blank was followed as far as possible. The reader will probably have observed in Table I that these cases show a very decided sex difference. There are more than twice as many boys as girls. In the general population the sexes are about equally divided in the ages included in this group so that some factor or factors must be at work to produce this sex difference. Most of the children who come to the Psychological Clinic arc in one way or another problem cases. It may be of course that boys are more likely to develop problems than girls. We have no evidence on this point one way or another so it remains a matter of conjecture. A plausible explanation is that a certain degree of deviation or delinquency is considered by parents to constitute a greater problem in a boy than in a girl since upon maturity greater social responsibility is anticipated for the boy than the girl. In the Psychological Clinic at least it still seems to be a “man’s world.”
Table II also shows a number of sex differences. There are many more behavior problems among the boys, and likewise more cases of school retardation. The striking thing is that in spite of the much smaller number of girls there were nevertheless more girls than boys brought out of interest in the examination. A second method which can be used to answer the question why children come to the Psychological Clinic consists in a study of diagWHY CHILDREN COME TO CLINIC 5
Table III Diagnosis Male Female Total No. Percent No. Percent No. Percent Normal mentality 188 77 82 72 270 7G Borderline 3 2 5 4 8 2 Feebleminded 30 12 20 18 50 14 Deferred 22 9 7 fi 29 8
noses and performances within the Clinic. Table III shows the diagnoses of these children as made by the examining psychologists. Of the 50 cases of feeblemindedness 5 were diagnosed as High Grade Imbeciles, 12 as Middle Grade Imbeciles, 21 as Low Grade Imbeciles and 9 as Idio-Imbeciles, all on the Ban* classification. In three cases the degree of feeblemindedness was not determined. In all but seven cases institutional placement was recommended. In 41 of the cases in which a diagnosis of normal mentality was given the diagnosis was qualified by the statement “intellectually deficient.” Fifty-one were diagnosed as being superior to 80 per cent, 14 superior to 90 per cent, 8 superior to 99 per cent. Thus a total of 73 eases were diagnosed as superior to at least 80 per cent as against 99 which were diagnosed as either feebleminded, borderline or intellectually deficient.
It would be useful to compare these children in some way with a group of normal children. Because of the great range in age it is very difficult to compare test results. The Intelligence Quotient, however, takes into account differences in age, and although equal Intelligence Quotients at different ages are not exactly equal the measure will serve as an approximate basis of comparison. At the
Table IV
INTELLIGENCE QUOTIENTS FOR MALES Percentile First Grade Fifth Grade Fifteen Tear Average Clinic Cases 19 2D 100 148 15G 154 153 172 90 124 122 123 123 130 80 118 114 117 116 122 70 ii4 109 in m 113 GO 110 104 106 107 105 50 10G 100 102 103 98 40 .102 95 97 98 91 30 1], 98 90 91 93 8G 20 90 SG S5 87 7G 10 83 80 75 79 G5 0 49 55 50 51 28 G THE PSYCHOLOGICAL CLINIC INTELLIGENCE QUOTIENTS FOR FEMALES Percentile First Grade Fifth Grade Fifteen Year Average Clinic Cases 1929 100 160 151 144 152 163 90 124 118 118 120 134 80 118 110 110 113 123 70 114 106 105 10S 115 GO 110 102 101 104 107 50 105 99 97 100 93 40 101 95 93 96 85 30 96 89 88 91 79 20 90 83 81 85 71 10 82 76 74 77 54 0 55 54 54 54 33
Psychological Clinic percentile tables derived from the test results of large groups of normal children in the public schools arc used as an aid to diagnosis. These decile tables have so far been prepared for children in the first grade, the fifth grade and at the fifteen year level. The foregoing table of percentiles provides a comparison of the Intelligence Quotient in each of these groups. The figures in the column “average” constitute an arbitrary measure. This average is the average of the percentile figures at the three levels. It docs not mean that if these three groups were actually combined and the results treated together the final percentiles would be those given, but merely represents an effort to combine all chronological ages among the normal children as they are combined among the Clinic cases. In fifteen of the Clinic cases the Intelligence quotient was not obtained, and the results therefore included only 342 cases. It will be seen from the percentile tables that the Clinic group shows a much greater amount of variability than the normal group. There is an overloading at both ends of the distribution. This is of course to be expected in as much as the Clinic deals primarily with the exceptional child. Twenty per cent of the Clinic cases are superior in Intelligence Quotient to approximately ninety per cent of the normal group and likewise twenty per cent of the Clinic cases are inferior to ninety per cent of the normal group. The former group has theoretically a slight advantage in that there is a preponderance of cases at the earlier age levels as Table I shows.
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