Psychomotor Activity and Feeblemindedness
- Author:
Lowell S. Selling, a.m., sc.m., m.d.
Institute for Juvenile Research, Chicago**
PART ONE
In dealing with the relationship of psychomotor activity to feeble-mindedness we must first define psychomotor activity. Under the heading of disorders of (volition) action, White26 says:*** “Decreased psychomotor activity corresponds in the motor sphere to difficulty in thinking in the psychic sphere. Whereas, in difficulty in thinking, we might say that there was a slowness in the liberation of voluntary motor responses. The patient’s movements are slow and deliberate and we find here the same distinction of initial and executive retardation… .
“Increased psychomotor activity: This is just the opposite of the above condition and is due to an abnormally facile release of voluntary motor responses. It manifests itself in great restlessness, constant activity, even to the point of violence and destructiveness, and like the flight of ideas, the various acts are not consistently directed to a definite goal but to this and that end under the influence of chance associations.”
Diefendorf7 gives as the increase of impulse the term motor excitement, which I assume from the following definition to be the same as increased psychomotor activity: “The universal indication of increase of volitional impulse is motor excitement. But we are really justified in speaking of an increase of volitional impulse only when there is a marked disproportion in the intensity of the excitation and the importance of the motives… . Patients will not remain in bed, show a pronounced restlessness, and constantly busy themselves….
“Impeded Release of the Volitional Impulse.?The strength and rapidity with which a volitional impulse is converted into action is dependent, not only on its own intensity, but also on the resistance which it has to overcome. Psychomotor retardation is probably *Thanks are due to the psychologists of the New York City Children’s Hospital and of the Bellevue Mental Clinic for their assistance.
** Studies from the Institute for Juvenile Research, Chicago. Series C, No. 162. For these references see Bibliography at conclusion of article. due to an increase of resistance. Such patients require special efforts of the will for every movement. All the actions are characteristically slow and weak except when a powerful emotional shock breaks through the resistance.”
We may summarize the above definitions as follows: Psychomotor activity is expressed in movement, pathological variations of which manifest themselves in hyper- and hypo-activity of the organism (patient). Hyper-psychomotor activity shows itself in restlessness and continual movement, while decreased, the activity is manifest by a quiescent state of the organism. The movements included by definition are those of the striped or voluntary muscles with the exception of those of vocalization, which though voluntarily innervated do not seem to be governed by the rules applying to the striped musculature in general. This is sometimes considered to be due to the fact that this group is cranially innervated as is the tongue, and that the brain stem segments may be aroused independently of the cord segments. It is a moot question as to exactly what causes voluntary movement. James11 says that every feeling produces a movement and every movement is a movement of the entire organism. In another place, he expresses his “Law of Diffusion” stating that “A process set up anywhere in the centers reverberates everywhere, and in some way or other affects the organism throughout making its activities either greater or less.” This results in a concept of movements which is independent; a discussion of the forces or constitution of will and the drive behind voluntary movement.
It has been found by Wada24 that hunger contractions “not only arouse the sensation of hunger but prepare the whole body for activity even during unconscious states. The experiments on bodily movements of men, infants, and rats, showed that bodily movements occur simultaneously with hunger contractions, while in quiescent periods very few bodily movements occur.’’
Stoddard20 in a footnote says that while he uses the term voluntary for psychomotor activities he only means to imply by this those due to movements arising from impulses from the Rolandic area and not from the pre-frontal areas.
Fere9 expressed the dynamogenic fact that anything affecting the receptors will affect the musculature, especially the voluntary musculature, and particularly if there is some feeling aroused with it. This again agrees with Wada although we must include the inPSYCHOMOTOR ACTIVITY 277 teroceptors as well as the exteroceptors, to which Fere probably gave sole credit. The proprioceptors must be included as shown by the work of Barany, reported by Jones12. In this case, changing the position of the body in any plane brought about more or less marked bodily reactions (forced movements).
We see by these statements that stimulation of any receptor may bring about movement. Szymansky, however, found that in addition to these movements there is a rhythmic movement inherent in the organism, which claim is apparently confirmed by the work of Richter16. These movements are probably of the kind known as voluntary and the question arises as to how much of the dynamogenie sensations of Fere (including all receptors, of course), must be included in the category with these movements. Warden10 gives the following rule: If the forces causing the movements, i.e., exciting the receptors, lie primarily without the body the movement is involuntary, while if they lie within the body they may be considered as voluntary. We see then that restlessness need be neither voluntary nor involuntary. From this we may say that if (1) A number of external stimuli are coming in and the individual is active, rapidly adjusting himself to them, the movement would be largely involuntary; but he might (2) not be acted upon by many external stimuli, so his restlessness, i.e., increased psychomotor activity would be voluntary. (3) In the case of decreased psychomotor activity, if there were many external stimuli and no response, the disorder would be involuntary and have a different neurological “Anlage” than (4) where there are no stimuli, hence no response would occur. The literature contains many references to observations of the activity of the different grades of feebleminded. Binet and Simon3 are among the oldest observers to give us concise and graded descriptions of the activity of the feebleminded. Ballard1 says that epileptic feeble-minded individuals show slow, awkward movements.
Moreau15 in his interesting little historical book (1888) states that individuals who were fools (probably meaning feeble-minded) were less vivacious than others.
Clark5 cites a girl with an I.Q. of 76 who needed more activity in school, her conduct disorders being due to restlessness. She, however, is not an illustrative case of the problem before us as apparently suppression of the restlessness was the cause of disorder.
SUMMARY OF LITERATURE (IN CHRONOLOGICAL ORDER) Authors Morons Imbeciles Idiots 1. Moreau (‘88) Slowed activity (?) Slowed activity (?) 2. Krafft-Ebing (‘05) Insufficiencies (?) Quiet (?) 3. Binet and Simon (‘06) Normal activity (-}-) Slowed activity (?) Apathy ? 4. Mendel (‘06) Active (-{-) or Not ? apathetic (?) moving 5. Starr (‘13) Constant motion 6. Barr (‘13) Active (-}-) Active & -apathetic ? 7. Sherlock (‘17) Hyperactivity (-f) Quiet (?) Convulsed (-{-) 8. Church Peterson (‘22) Active (-{-) Several or ? types 9. Sollier et Courbon (‘24) Normal (-f) Incessant -|?|- Constant -?movement movement 10. Bowers (‘24) Senseless movements
Sherlock17 describes idiots as being quiet except when “from time to time the ungainly frame is racked by convulsions.” He gives the impression of hyperactivity on the part of imbeciles directed in a mischievous manner. Von Krafft-Ebing13 gives the following: “The idiot remains lazily quiet because motives for movement are wanting. In the most profound degree of this condition, that of apathetic idiocy, the motor side of life is limited to purely reflex movements and automatic acts with, perhaps, at most, certain instinctive movements and desire for food.” And again, “In imbeciles there are also insufficiencies of activity.’’ Mendel14 says that “Highest idiots … in many cases do not have the capability of moving about.” He says that there are active and apathetic imbeciles.
Sollier and Courbon18 say about the idiot: ‘’ Instable, ils se balancent, ont des movements stereotypes de la tete ou des membres, poussent sans caus des cris …; ils se roulent a teirre, de chirent, cassent, mangent malproprement et gloutonnement …” As to the imbecile, they say, “Ils sont sanz cesse en movement.” With reference to the moron they claim that action is normal.
Starr29 says a feeble-minded child may be “exceedingly active, in constant motion?the activity being, however, aimless.’’ Bowers4 writes, “Idiots lead a purely vegetative existence” except at times when they cry or make inarticulate sounds and senseless movements. Barr2 gives two types, the apathetic and the excited, who make a rhythmic movement. In both forms is found a certain amount of reflex action. He says that imbeciles are active. The literature on the subject is summarized above. From the foregoing summary it is easy to determine that there is no consistency on the part of clinicians in either a description of the types of movement or in describing movements in relation to the degree of feeble-mindedness. Of course, the borderline between each of the classes is fine, but most of the authorities above cited agree that the line between normality and moronity (if this neologism may be allowed) is determined by 1. Necessity of assistance in performing social duties; and 2. Inability to develop over a mental age of twelve. The line of demarcation between moronity and imbecility is: 1. Inability to take one’s place in society; and 2. No development farther than that of a seven-year-old child in mental growth. The line between imbecility and idiocy may be drawn where: 1. The individual is inarticulate; and 2. Mental development reaches its maximum at the level of an average two-year-old child.
There are various differences of opinion among the authors cited above but there is no more than a year’s difference between any two. Tredgold22 classifies idiots as apathetic and excitable?”the former are mild, placid, inoffensive creatures … the excitable type who are chair ridden still manage to find an outlet for their excitability in the almost ceaseless performance of automatic actions. Some will spend the day turning the head from side to side, or nodding up and down, others rock the body to and fro or beat upon the chest with the hand, often keeping time to the movement with a monotonous inarticulate chant, others unceasingly suck their fingers. These movements cease during sleep and are terminated by the advent of the feeding time or at the entrance of a stranger, although at times a visitor seems to stimulate them into more violent activity.’’
PART TWO
The purpose of this study was at first merely to see if feebleminded children were more or less restless as they stood lower in the scale of intelligence. The plan was to obtain a correlation. Cases of secondary amentia, i.e., of known etiology, were not considered. The estimate of activity was, of necessity, put in numerical form and classified into five categories. 1. Extremely restless; when the individual was never still, this being taken in the literal sense.
2. This class was that of hyperactivity in which the individual was found to be decidedly restless?noticeably restless. (The writer used as an illustration the remark that the observer should feel as though he wanted to exclaim, “What a restless person!”) 3. The third category was normal activity, which obviously would form the largest class as all those individuals would be included, who, by elimination, could not be called either hyper- or hypo-active.
4. The fourth when the individual was quiet. The descriptive terms used were: ‘’What a quiet person!” “He hasn’t any pep!’’ 5. Here the classification ends with the final group: the inert. The observations were made by clinical psychologists who expected to make a valid report as to whether a child was abnormally restless or not, or abnormally quiet, during a test made by them.
Table I
Results?Distribution Activity 1 2 3 4 5 T I.Q. 100-90 3 2 5 90-81 5 5 1 11 80-71 1 5 8 4 1 19 70-61 2 3 9 2 1 17 60-51 1 1 8 2 3 15 50-41 5 7 2 2 16 40-31 1 7 1 2 3 14 30-21 3 3 2 3 11 20-11 2 2 2 1 7 10-0 2 2 T. 12 34 44 15 12 117 The correlation between the two factors was worked out by the Contingency Coefficient of Correlation?Yule’s Modification, as the number of categories was too small for effective use of the Pearson Coefficients. The Coefficient of Correlation (e) = /j/??? (N )2 ? = Sigma ? = .57 Nr Nc Vn 1 - C2 P. E. = .6745 X ?^7^? = .045 (for 5 categories) when it approaches the Pearson r formula, the regular formula being so complicated that it is not even given in ordinary texts. The following question was raised: Are the results obtained by four different observers on a question of this kind comparable 1 It was attempted to make them so by the definition of each class. The extremes are unmistakable?complete lethargy and continued activity. On the other hand, classes 2 and 4 were not to receive any individual who did not have marked activity or some decided slowness.
PART THREE
1. It might appear that the age of the subjects caused a predominance of hyperactivity, since constant movements are the prerogatives of the infant and Healy10 says that restlessness is the prerogative of youth; but upon analyzing the ages it was found that the range of ages was from 45 years to 4 years and 10 months, with the majority of the ages about puberty and with the lower limit higher than the rest of the classes’ lower limits. It is interesting to note that we found the majority of hyperactive cases at about the age of puberty. So we see that while adolescence has a bearing on this factor, it is not sufficient to explain the excessive number of hyperactives in this group. The reason for the mode being found in group two, then, I believe to be merely due to selection. The correlation of the intelligence against the activity in a descending scale of activity was found to be .57 with an .04 probable error. Of course when discussing coefficients of correlation, there are many factors to be taken into consideration, and on the face of this coefficient alone one cannot make any statement. In the first place it is necessary to see if any extraneous factors are here involved. The first one of these is whether the examination situation would tend to make children less restless as intelligence decreases or more restless as intelligence increases. It is obvious that as the child’s intelligence decreases he becomes less interested in his surroundings and situations would then have less effect upon him. On the other hand, the conditions of the examination might cause brighter children or adults to become restless. For two reasons this appears to be doubtful, first, because clinical psychologists are trained to give the tests in such a way that unusual mental tension is avoided, and, second, the scatter diagram shows a very even distribution of the high and low types of activity, both of the extremes being found throughout the mid-range. The other explanation may be a neurological one: that there is some sense deprivation in the lower grades, or that the neural connections are in some way amiss. 2. An analysis of the low grades shows only that there is a tendency toward retardation and that, in all probability, the excited individuals are retarded individuals who have some neural excitation from some undetermined internal source. The predominance of nervous lesions in this type indicates that some motor or sensory tract has often been injured, but the literature fails to give any inPSYCHOMOTOR ACTIVITY 283 dication as to whether a particular group of tracts has been found destroyed in these individuals. Those in whom the greatest predominance of lesions has been found, however, the micro- and hydrocephalics, manifest the least disability on the motor side. 3. There is apparently no basis for Tredgold’s explanation that excitation is due to the explosiveness of the nerve cell itself, that there was something inherent in the cell which enabled it to go off. This of course, never occurs in the normal individual but only in the abnormal. From this explanation alone, the theory meets its doom, as there is no physiological fact known which says that a nerve can act without stimulus. Psychomotor activity would apparently be more apt to agree with the findings of Wada than the above.
SUMMARY
1. Psychomotor activity increases somewhat as the intelligence increases within the limits of average and inferior intelligence. 2. There is reason to believe that this increase is due to exteroceptor stimulation superimposed on interoceptor stimulation, which appears to be the only kind of sensation found in the lowest intelligences. 3. There is no reason to believe that the nerve cells of these individuals possess a spontaneity not possessed by other nerve cells. (If any such exists.) 4. Activity is higher at adolescence. This may be a secondary endocrinological factor. BIBLIOGRAPHY I Ballard, E. Fryer, An Epitome of Mental Disorders, 1917. 3 Barr, Martin “VV., Mental Defectives, 1913. 3 Binet and Simon, The Intelligence of Feeble-minded Children, 1906. * Bowers, Paul E., Manual of Psychiatry, 1924. B Clark, Conduct Disorders of the Feeble-Minded. Mental Hygiene, January, 1918. 6 Church-Peterson, Nervous and Mental Diseases, 1922. 7 Diefendorf, A. Ross, Clinical Psychiatry, 1908. 8 Doll, Clinical Studies in Feeble-Mindedness. “Fere, Revue Philosophique XXIV p. 572. i0Healy, William, The Individual Delinquent, 1917. II James, William, Principles of Psychology, II, p. 372. “Jones, I. L., Vertigo and Nystagmus, 1917. 13 Krafft-Ebing, R. von, Textbook of Psychiatry, 1905. ” Mendel, E., Textboolc of Psychiatry, 1907. 15 Moreau, Paul, Fons et Bouffons, 1888. ” Richter, Comparative Psychology Monographs, Vol. I, No. 2, p. 36. 11 Sherlock, E. B., The Feeble-Minded, 1917. 18 SOLLIER ET Courbon, Pratique Semiologique des Maladies Mentales, 1924. 18 Starr, M. Allen, Nervous Diseases, Functional and Organic, 1913. 20 Stoddard, W. H. B., Mind and its Disorders, 1921. 71 Terman, Lewis M., The Measurement of Intelligence, 1916. 33 Treadway, Some Observations on Feeble-Mindedncss, Dept. Public Health Publications. 13 Tredgold, A. F., Mental Deficiency, Fourth Ed., 1922. * Wada, Toni, Effect of Hunger, Archives of Psychology, No. 57. 33 Warden, Carl J., Personal Communication. 28 White, William A., Outlines of Psychiatry, Ninth Ed., 1924.
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