Almost Feebleminded
- Author:
Rosenstein, M.A.
Assistant Director, The Herman H. Young Foundation for Research in Clinical Psychology, Indianapolis
Too often the apparent exactness of quantitative scores in psychological examinations causes the examiner to interpret these scores uncritically. In our work at this Foundation we insist that Intelligence Quotients and percentile scores on various tests are relatively of minor importance even if they are exact. They represent a quantitative measure of what the individual has done but give no index as to how he went about earning his Intelligence Quotient or his scores on other tests. These quantitative measures give no indication of the cause for low scores nor do they indicate the possibility of developing the individual’s capacities. Certainly an Intelligence Quotient of 89 will not tell us that the child is unstable and performed in such a way that he could be diagnosed as a psychopath. Nor does the 20th percentile on a test, or the time of 153 seconds required to complete a test, give any idea whether the child moved slowly and carefully with great planfulness, or whether his was a trial and error type performance. We are interested in whether the child has adaptability, poise, trainability, and conformity, whether he is observant, shy, easily disturbed emotionally, persistent, or easily defeated by a difficult problem, and a host of other qualitative items. In other words, we are interested in items which can not be measured but which must be inferred and for which we can obtain no score for statistical treatment. The method is psychological, rather than psychometric. Here are presented three cases in which superficial examination would have resulted in a diagnosis of feeblemindedness but in which such diagnosis was later found to be incorrect after a period of training and diagnostic teaching.
Henry
“Henry, four years and three months of age, was brought to the psychological clinic, while an in-patient of the hospital, because he could not speak. I found him shy and withdrawn and had to coerce him into doing anything at all. He usually sat looking on with a faint pinched smile, his hands in his lap. After being shown how to put a block away in the Witmer Formboard, instead of his reaching for it, I had to lift his hand, put the block into it and show him the proper recess for it. After several trials he could put away one or two blocks, but no more. His method was trial and error. He could not or would not build a Pink Tower after instruction, but seemed to show comprehension of what was expected of him. “At no time did he make a sound, not even a grunt, showing approval or disapproval. He did not, after a long period of instruction, give me a duplicate of the color block in my hand, although he did give me a block. The child urinated, and sat through the rest of the examination without giving the slightest indication that he knew what his condition was. The whole picture seemed to be one of mental retardation and a conclusion that he was close to the borderline of feeblemindedness was made, the lack of speech being felt to be only of minor importance. The prognosis seemed unfavorable. It was felt that he would always need supervision, and speech training was not recommended.”
The above are excerpts from the report of the first examination given Henry by the writer. He had been sent not only as a speech case but to verify the conclusion of the physician in charge of the ward where Henry was a patient, that he was feebleminded. Later investigation showed that two physicians in Henry’s home town had concluded that the child was feebleminded and that nothing could be done for him, and the mother had accepted this diagnosis about a year before, and had gone on her way taking this as another one of her burdens, which must be borne, along with widowhood and privation. There was something, however, in the quality of Henry’s performances, or lack of performance, which interested the examiner and which forced him to insist on a re-examination the afternoon of the same day. It was deemed advisable to see what the child could do with material when left alone to his own devices. He was placed in a closed room with Pink Tower material and the Witmer Formboard with the blocks laid out for the first trial. There was also a box of color cubes. All this material was placed in different parts of the room, on the floor. About an hour later, the observer returned to find that Henry had replaced all the blocks of the Witmer Formboard into the proper recesses; that he had made a long train of the color cubes and that he had begun playing with the Pink Tower material. These results made the examiner feel that the case merited further research. The conclusion was changed from borderline to deferred and it was felt that it might be best to bring the mother and child back at another time. The whole picture was one of a shut-in personality and the problem in the observer’s mind was to find out whether there was something inside the child worth looking for, or whether he was simply feebleminded. Due to economic conditions and the distance required to travel the mother did not bring Henry back for about five weeks. At this time she told us that he did make other sounds besides “no,” but that these sounds were not intelligible. On reviewing the case, the examiner felt that the urination was possibly part of a temper tantrum situation in response to being forced to do certain things.
When his mother was asked concerning discipline at home it was found that no disciplinary measures were ever employed and that because she had several other children to take care of, the child did not get the attention which should have been given him by his mother. The mother felt that discipline might do some good but that she could not provide it. At the psychological clinic, corporal punishment is very rarely, if ever, employed, but in this case it seemed worth a trial. With his mother’s permission it was decided to try the experiment. The child was asked to make the sound “ah.” He did not. He just stood looking on. I asked him to give me his hand; he did not comply. I then told him to do as I asked and unless he would obey me, it might be necessary to spank him, and that I would spank him if he did not follow my instructions. I then again asked him for the sound “ah.” There was no response. I gave him a light slap across one cheek; urination and temper tantrum involving kicking and screaming followed. I waited until this display was ended and asked him for the sound “ah.” Again the temper tantrum and urination followed but without my having to slap him. It was then decided to alternate the slap and the ” ah ” until a sound was gotten, approximating the one desired. After about six such combinations of “ah” and a slap he gave me the sound clearly and distinctly. I then tried “ee” and he gave it. Then I asked for the “oo” and he gave it. I then tried these three sounds with an initial letter of b, s, t and m and he gave all the sounds correctly the first time asked for. This made the examiner feel that the previous conclusion might be wrong and that it was influenced by this extreme negativism which could not be broken through without forceful measures. Henry was given these sounds as speech exercises together with several others and was to return a few weeks later.
On returning for his speech lesson two weeks later Henry cooperated beautifully and gave all the sounds, “ah,” “ee,” and “oo” with the initial sound of b, k, d, g (hard), j, 1, m, n, p, r, s, t and w. He had also learned to say his name “Henry.” He also said “yes.” He was no longer the shut-in individual; he smiled, and was willing to play and took a walk with the examiner and there was no sign of temper tantrum or urination. The speech work was continued for several months and the mother commented each time on the great personality change in the boy; that he plays with other children; that he uses and acquires words by himself and seems to be an entirely different boy to such an extent that neighbors comment on the change. Henry has not been seen for several months, and within the last few days a letter was received from the mother saying, “concerning Henry’s progress in speech, it is great. I am sure you would not think him the same little boy. There is not very much he doesn’t say,” etc.
Ruth
Ruth, three and a half years old, was referred to the clinic by the physician in charge of the Out-Patient medical service with the statement that there was nothing wrong with her physically, and that she was probably a psychological case rather than a medical case. She was brought in because she had never walked or talked. According to the parents the family physicians had given the diagnosis that she could not, because of physical conditions, support her own weight. I attempted to establish rapport with the child. During the first hour and a half she displayed crying and temper tantrums involving kicking and attempts at slapping the examiner and spitting. Then after about a half hour of attempting games with colored cubes and a tray of toys I decided it might be more efficient to experiment with walking. I raised her from behind by her arms so that all her weight was on her arms with her feet just about to touch the floor. The child resisted the attempt to force her to stand on her legs in such a way that I felt certain she could carry her weight if insistence were made on it, and so for about an hour and twenty minutes there was a battle between the examiner and the child, who was constantly in a temper tantrum. Finally she tired of resting on her arms and placed her whole weight on her feet and after several unsuccessful attempts to catch me napping she finally gave up and supported herself on her legs. Her mother was then called into the room and the child was so anxious to get away from me and reach her mother that she had no difficulty in walking twelve or fifteen feet to reach her. The experiment was tried over again and the child again walked toward her mother. This was done several times to prove definitely that it was not merely a chance performance.
An attempt was then made to get Ruth to speak. Believing that she might want a drink after crying for so long a time the examiner brought a glass of water into the room and drank some of it. It was then placed just out of her reach. She made signs asking for it. The word “drink” was then introduced and after several unsuccessful attempts to get the glass accompanied by my repetitions of the word “drink” and “say drink,” she finally came through with the word “drink” and got the water. After she had taken a mouthful, the glass was again removed from her and insistence was made that she say “drink” before she got it again. She did so. Because of her temper tantrums and the amount of time that would be necessary to make her go through a psychological examination, no attempt was made to estimate the child’s mental abilities. However, from the general performance it seemed reasonable to infer that she was not feebleminded. Recent report from the county nurse in charge of the case states that because of the parents’ lack of cooperation and because they themselves feel that it would be a waste of time to come to the clinic regularly the child has not gone beyond the results obtained in the clinical experiment described above.
Donald
Donald, just past five years of age, was brought to the clinic to verify the opinion of the medical examiner that he was a ‘’ spastic idiot.” The case was seen by the late Herman H. Young, Director of the Psychological Clinics, and he decided to defer his conclusion with the tentative diagnosis that the boy was not lower than low normal mental ability, based upon the qualitative performances on mechanical tests and some of the Binet-Simon questions in which he could give responses by moving his hands. He was almost a classical picture of the proverbial “vegetative organism.” He could not sit up, nor balance himself; apparently all he could do was lie on his back and await attention. He could not swallow, except when his head was held back until the reflex took place and he could not talk because of the extreme spasticity which affected his entire body; he drooled continuously and copiously.
It was decided to begin working with him on speech and after twenty-three lessons, extending over a period of two years, he was given a Binet examination and attained a Binet Test Age of six six years which with a chronological age of seven years, four months, gave him an Intelligence Quotient of 81. He was started with simple sounds like “ah,” “ee” and “oo,” which were combined with consonants and he improved rapidly so that at the end of two years he could speak well enough to be understood. In the meantime work had been begun on his walking and with graduated physical exercises and physiotherapy he could walk with assistance and did not need to be carried. The problem of his education was taken up and with the cooperation of the mother the child was taught reading and arithmetic and is now able to handle fifth grade reading material and fractions satisfactorily.
In 1930 he learned to swallow, and after another year and a half of concentrated attention on his walking he is able to make his way alone for a distance of about fifty yards. The problem of permitting him to walk alone involved not only the mechanics of walking but also the problem of raising himself up from the ground when he fell. This took a month of intense practice and now he can lift himself to his feet, balance himself and start from where he left off.
His condition at present is still one of extreme spasticity; however, because of the results obtained over these several years of work with him, it is felt that with continued and patient effort and training he can be helped much further along the road toward normality in his physical condition. From a previous diagnosis of spastic idiocy and a tentative diagnosis of low normal mental ability, it is now felt that the tentative diagnosis should be not lower than average normal mental ability, with the definite conclusion as to the ultimate possibility of developing his abilities being deferred. At the Herman H. Young Foundation clinics we are now working with five spastic individuals, one of them a college student, the others under ten years of age and we have seen enough improvement in these individuals since the inception of our work with them to warrant the belief that there is a need in this country for an institution especially equipped for, and designed to specialize in work on such persons.
The above three cases taken from our files containing several thousand records of case examinations are not the only ones which should indicate to the patient worker in psychological research that extreme care and deliberation be exercised before a decision is made that nothing worth while can be accomplished without spending many hours of intense and trying etfort in improving and developing the individual’s mental, physical and educational status. Our position in the clinics has been, that regardless of how low the upper limit may be, it is our duty to do our best, to develop all the abilities of the individual to their maximum if his problem may be approached by the techniques of the psychological clinic. s
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