Statistical Results of an Eight-Year Testing Program of a Psychological Clinic in a Charity Hospital
- Author:
Persis White Simmons, Ph.D. 1
The Psychological Clinic of the Indiana University Medical Center was opened February, 1923,2 under the direction of the late Herman H. Young, professor of Clinical Psychology at Indiana University.
It was the desire of President W. L. Bryan, Dr Charles P. Emerson, Dean of the Medical School, Dr Frank Hutchins, Head of the Department of Nervous and Mental Diseases, Robert E. Neff, Administrator of the Medical Center, Miss Ethel P. Clark, Director of the Nurses Training School, and Dr W. P. Moenning, Chief Resident Physician of Robert Long Hospital, to cooperate with Dr Young to ascertain what types of cases from a psychological viewpoint came to the Center as free cases. It was necessary for the court to declare a case “indigent” before it was eligible for free services, and the cases therefore came from the inferior economic groups. The purpose of this paper is to present the data from the routine psychometric examinations of “indigent” cases, hereafter referred to as an experimental group, and to indicate what test performances may be expected of individuals who are dependent on charity. The work covers an eight-year period. During this time the work was first under the direction of Herman H. Young and later under the direction of Mary H. Young.
Although the work was done in a hospital clinic, no individual was given a psychological examination when he was acutely ill. Each examination was made when the individual was able to leave the ward and come to the clinic rooms. Because of the fine spirit of cooperation in the hospital, the children looked forward eagerly to the examination and even begged to be “next.” It was possible to establish exceptionally fine rapport with practically every child. i Assistant Director of Research, Psychological Clinic, Indiana University Hospitals, 1928-1931.
2 Young, H. H. The Psychological Clime, Indiana University, Indiana University News Letter, 1928, 11, 1-8. 128
The routine examinations which are tabulated here do not include the entire program of the clinic. Coincident with the testing program, recommendations were made in regard to the disposition of the cases and psychological research was directed in the field of speech, the training of spastics, behavior and personality problems. We are concerned here, however, only with the trend of the test scores secured over a period of eight and one-half years, on over two thousand individuals that came from homes of inferior economic status.
The Stanford Revision of the Binet-Simon Intelligence Scale The Stanford Revision of the Binet-Simon Intelligence Scale could be given to only 2315 of the total number of 2558 cases. Age, vision, hearing, speech, et cetera, made it impossible in some instances to give this test. Chronological Number of Age Cases 3 66 4 95 5 139 6 200 7 206 8 203 9 184 10 233 11 198 12 188 13 170 14 168 15 175 16 22 Older than 16 68 Total 2315
The frequency at the different ages does not vary significantly. From ages five through fifteen it is practically the same at each age. Below five and above fifteen years of age there are fewer cases than at other ages. The small number of cases above fifteen years of age may be due to the fact that individuals sixteen years ?f age or older are not compelled to attend school in Indiana and are, therefore, not brought to the attention of socio-educational agencies. The few cases below five years of age may be due to the fact that most children below six are not yet in school and to the fact that unusual physical or psychological development is not so noticeable to the layman when a child is very young.
Table I shows the I.Q.3 distribution of the experimental cases from age five through age fourteen. The I.Q.’s have been grouped in intervals of ten. The percentage of cases which occurs at each interval is given. In addition, the cumulative percentage, reading from the lower scores to the higher scores, is indicated. In order to compare the test performances of the experimental group with those of an unselected group, the percentages and the cumulative percentages obtained by Terman with the Stanford Revision of the Binet-Simon Intelligence Scale,4 are also presented. The unselected cases used by Terman will be referred to as the control group. Any arbitrary unit of I.Q.’s may be compared and it will be noted that the I.Q.’s of the experimental group are definitely inferior to those of the control group. For example, consider the units in which approximately one third of the I.Q. ‘s of the control group occurred:
31.3 per cent of the I.Q.’s of the control group, were lower than 96. 69.3 per cent of the I.Q.’s of the experimental group were lower than 96. 33.9 per cent of the I.Q.’s of the control group were between 96 and 105. 16.5 per cent of the I.Q.’s of the experimental group were between 96 and 105. 34.9 per cent of the I.Q.’s of the control group were above 105. 14.2 per cent of the I.Q.’s of the experimental group were above 105. Consider the range between I.Q. 86 and I.Q. 115. 77.1 per cent of the control group were in this range. 47.5 per cent of the experimental group were in this range.
The distribution of the control group above and below this range is comparatively equal, but the distribution of the experimental group is definitely weighted at the lower extremity. 11.2 per cent of the I.Q.’s of the control group were below 86. 11.8 per cent of the I.Q.’s of the control group were above 115. 47.4 per cent of the I.Q.’s of the experimental group were below 86. 5.2 per cent of the I.Q.’s of the experimental group were above 115. Or consider the wider range between I.Q. 76 and I.Q. 125. s In the hospital records, Young used the term “Binet Test Age Quotient” rather than “Intelligence Quotient.” See Young, H. H., Basic points of reference in mental and educational measurements, The Educational Outloolc, 1931, 6, 13-14. The numerical computation was the same as that for the I.Q., and for the sake of clarity ‘1 I.Q.’’ is used in this article. 4 Terman, L. M. The measurement of intelligence, New York, Houghton Mifflin Co., 1916, p. 66.
94.7 per cent of the control group were in this range. 69.0 per cent of the experimental group were in this range. Again, the distribution of the control group above and below this range is comparatively equal, but the distribution of the experimental group is definitely weighted at the lower extremity. 2.6 per cent of the I.Q.’s of the control group were below 76. 2.8 per cent of the I.Q.’s of the control group were above 125. 29.2 per cent of the I.Q.’s of the experimental group were below 76. 1.7 per cent of the I.Q.’s of the experimental group were above 125. These results are consistent with previous studies, which have concluded that, as a whole, indigent cases rank lower than unselected cases. In addition to this general trend in correlations between test performance and socio-economic status, two factors should be mentioned which may have been contributive to the large percentage of inferior scores in the experimental group. They are: first, the early elimination of these lowest groups from the public schools, where the control cases were obtained; second, the fact that the noticeably deficient people more easily attract the attention of such social agencies as cooperate with a charity hospital. Table II presents the I.Q. range and the quartiles for each age. The ages have been grouped in twelve-month units; for example, 3 includes all children 3 years 0 months of age to 3 years 11 months of age, inclusive.
The median I.Q. at any given age is lower than the approximate median I.Q. of the control group, 100.
In the control group, the distribution of I.Q.’s at each age from 5 to 14 was symmetrical. The middle fifty per cent of the I.Q. ‘s of the cases fell approximately between 93 and 108; that is, Qx was approximately 93 and Q, was approximately 108. The middle fifty per cent of the I.Q. ‘s of the experimental group did not conform to this distribution. Qx was lower than 93 at each age and Q, was consistently lower than 108 at each of these ages. Likewise, the range from Qx to Q3 was approximately 15 for the control group, but was greater than 15 for the experimental group. This is not surprising as it scarcely would be anticipated that measures of spread in regard to scores of an unselected group would conform with those of a selected group, such as this experimental group of cases. The distribution of scores of the experimental group deviates to a marked extent from a normal distribution. At year 15 there was less difference between the median I.Q.’s of the two groups. The median I.Q. of the control group was 90. 132 THE PSYCHOLOGICAL CLINIC of the experimental group 85. And at year 16, the median I.Q. of the experimental group, 91, was superior to the median I.Q. of the control group, 80. The similarity of scores of these two groups, no doubt, is due to the fact that the 15 and 16 year old children of the control group were “left-over retardates” and “below average in intelligence.’’ They would, therefore, be expected to have lower test scores than the younger children of the control group who were more truly an “unselected” group.
Both Table I and Table II show that one conclusion is clearly Table I Intelligence Quotient Distribution Stanford Revision, Binet-Simon Intelligence Scale Ages 5 to 14 Inclusive
I.Q. Range Experimental Group Number of Cases Percentage of Cases Cumulative Percentage Control Group (1) Percentage of Cases Cumulative Percentage 55 and below 56- 65 66- 75 76- 85 86- 95 96-105 106-115 116-125 126-135 136-145 Above 145 Total 164 145 248 348 417 314 171 66 24 4 4 1906 8.6 7.6 13.0 18.3 21.9 16.5 9.0 3.5 1.2 .2 .2 8.6 16.2 29.2 47.5 69.4 85.9 94.9 98.4 99.6 99.8 100.0 .3 2.3 8.6 20.1 33.9 23.1 9.0 2.3 .5 .3 2.6 11.2 31.3 65.2 88.3 97.3 99.6 100.1 Table II I. Q. Range and Quartiles of Experimental Group Ages Three to Sixteen, Inclusive Chronological Age Least I.Q. Greatest I.Q. Qi Qa Qa 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. Older than 16 .. 61 54 37 36 38 34 26 35 29 27 25 24 31 19 27 167 141 133 132 136 194 135 137 158 154 121 129 122 104 105 89 88 83 77 84 74 76 72 71 72 70 63 63 73 60 96 94 91 90 90 87 86 84 82 82 85 91 72 107 100 103 100 101 100 99 98 97 99 100 93 91 93 83
evident: the test scores of the experimental cases are definitely and consistently inferior, from ages 4 to 15, to the test scores of the control group. In fact, the average I.Q. for the entire experimental group is 84.2, which is 15.8 points lower than the approximate average I.Q. of 100 obtained by Terman. Stated another way, 76 per cent of the experimental cases had I.Q.’s of 100 or less. The average I.Q. of 84.2 for the experimental group is also 8.8 points lower than the average I.Q. of 93 obtained by Terman for the group of children selected from among his unselected group and designated as “inferior social class.”5 A possible explanation of the lower ranking of the Indiana University Medical Center Group is that the criteria for social classification used by the teachers who selected Terman’s ‘ inferior social class included a social group above the level that would be declared “indigent” by a court.
It is a justifiable prediction, on the basis of the results obtained at the Medical Center, that individuals who are dependent on charity will as a group rank inferior to an unselected group on the Stanford Revision of the Binet-Simon Intelligence Scale. This prediction does not imply, however, that no individuals will make superior scores. The facts are to the contrary. The I.Q. s of the experimental group ranged from 24 to 194, but fewer superior scores were made by this group than by the control group. Only 24 per cent of the experimental cases had I.Q.’s above 100, whereas approximately 50 per cent of the control group had I.Q.’s above 100.
Results of the Witmer Formboard
The Witmer Formboard was given to one thousand nine hundred sixteen of the experimental group. Those who were crippled in any manner were eliminated from this study. One thousand eight hundred seventy-three were under sixteen years of age. The decile rankings of the first trial records of these cases were computed according to the standardization of H. H. Young and M. H. Young.6
The number of cases in each decile and for each age group is given in Table III. There was a negligible sigma difference between the scores of the boys and those of the girls and the results were, therefore, combined in one table. The chronological ages 5 Terman, L. M. Op. tit., p. 72. 6 Young, H. H., & Young, M. H. The Witmer formboard?first trial records, Psycliol. Clin., 1923, 15, 85-92.
Table III Age-Decile Distribution of Experimental Group on Witmer Formboard Age Decile 10 Total 4 5 6 7 8 9 10 11 12 13 14 15 Adult 56 59 35 39 62 49 68 48 38 28 39 23 12 30 21 20 16 24 18 5 20 5 22 5 13 20 14 19 19 19 27 23 5 11 14 5 11 19 17 6 13 21 9 14 11 6 12 3 10 13 16 12 30 11 12 8 7 6 8 9 5 2 12 18 16 8 10 3 11 13 12 3 3 2 13 15 12 17 11 21 23 6 5 9 2 3 2 11 13 17 17 13 13 4 9 21 7 12 2 7 10 21 18 11 9 9 15 6 5 10 11 1 24 20 11 13 9 8 14 15 14 106 154 213 193 192 174 194 159 147 119 113 109 43 Total 556 186 189 142 147 113 139 146 134 151 13 1916
Note: Young’s standardization of Witmer Formboard used. are indicated in the first column. The deciles are indicated across the top of the table. The figures appearing in the table are the number of cases found in each age-decile unit.
In order to compare the test performances of the experimental group with those of an unselected group, the unselected cases examined by the Youngs will be referred to as the control group. In the standardization of the control group, the zero column represented the longest time record for each age. In this table it represents the cases whose time record was the same as, or longer than, the longest time for each age as found in the control group. The 10 column7 represented the shortest time record for each age. In Table III it shows the number of time records that were the same as the shortest time record for each age of the control group. None was shorter than the control group. In determining the -percentiles of the control group, each age group was divided into 10 units. Each decile, therefore, represents ten per cent of the cases at any given age. The time records of the experimental group do not conform to the distribution for the control group? there is a preponderance of cases in the 0 column as will be noted from either Table III or Table IV.
Table IV indicates the percentage of experimental cases which occurred in each age-decile unit. It indicates the respective percentages for the figures which appear in Table III. 7 Indicated as 100 by Young. Table IV Experimental Group Percentage of Cases in Each Decile for Each Age on Witmer Formboard Age Decile 0 10 Total 4 5 6 7 8 9 10 11 12 13 14 15 Adult 52.8 38.3 16.4 20.2 32.3 28.2 35.1 30.2 25.9 23.5 34.5 21.1 27.9 14.1 10.9 10.4 9.2 12.4 11.3 3.4 16.8 4.4 20.2 11.6 8.4 9.4 7.3 9.9 10.9 9.8 17.0 15.6 4.2 9.7 12.8 11.6 7.2 3.1 7.5 10.8 5.7 9.5 9.2 5.3 11.0 7.0 9.4 8.4 7.5 6.2 15.6 6.3 6.2 5.0 4.8 5.0 7.1 8.3 11.6 1.9 7.8 8.5 8.3 4.2 5.7 1.5 6.9 8.8 10.1 2.7 2.8 4.7 12.3 9.7 5.6 8.8 5.7 12.1 11.9 3.8 3.4 7.6 1.8 2.8 4.7 10.4 8.4 8.0 8.8 6.8 7.5 2.1 5.7 14.3 5.9 10.6 1.8 16.3 7.5 6.5 9.8 9.3 5.7 5.2 4.6 9.4 4.1 4.2 8.8 10.1 2.3 5.7 5.2 11.3 10.4 5.7 7.5 4.6 5.0 9.5 12.6 12.4 7.3 2.3 .5 1.0 .5 1.0 2.7 1.8 100.0 99.9 100.0 100.0 99.9 100.1 100.0 100.0 100.0 99.9 100.0 100.0 100.0
Note: Young’s standardization of Witmer Formboard used. The inferiority of the time records of the experimental group is evidenced by the zero column: e.g., at four years of age the time records of 52.8 per cent of the experimental group were the same as, or inferior to, the poorest time record of the four-year-olds of the control group. Or at year five the time records of 38 per cent of the experimental group were the same as, or inferior to, the poorest time record of the control group. Although there were instances in which individuals of the experimental group did as well as those of the control group, more of the time records of the experimental group fall in the lower deciles.
Psychological Conclusions
The psychological diagnosis or conclusion for each case was made according to the Herman H. Young modification of the Goddard classification. The Young classification is not based on the I.Q. alone, but is an index of the ability of the child, inferred by the examiner and based upon all possible types of observations and all the information available in regard to the particular individual. It is an index of the ulopoda of the individual,8 that is, the ultimate limit of possibility of development of abilities. It is a prediction of the complexity and proficiency of performances which could be expected of the individual in the most favorable environment.
8 See 3, p. 16.
Table V gives the classification which was used and the number of cases for each clinical conclusion. Here again, we find a large percentage of the experimental cases to be of inferior ulopoda. Seventeen and four tenths per cent were classified as Table V Distribution of Experimental Cases According to Clinical Conclusions Number of Conclusion Cases Feebleminded: Idiot 14 Imbecile 125 Moron 307 Borderline Mental Ability 148 Normal Mental Ability: Very Low Normal Mental Ability 208 Low Normal Mental Ability 509 Slightly Below Average Normal Mental Ability 321 Average Normal Mental Ability 549 Slightly Above Average Normal Mental Ability 192 Above Average Normal Mental Ability 27 Superior Normal Mental Ability 140 Very Superior Normal Mental Ability 18 Total 2558 “feebleminded”; 6 per cent were classified as “borderline”; and 41 per cent fell in the classifications between “borderline” and “average normal mental ability.” A total of 63.8 per cent of the individuals examined were considered to be inferior to the individual of “average normal mental ability.” Of the experimental group 63.8 per cent could not be expected to compete satisfactorily with the average of their respective age groups. Only 21.5 per cent were of “average normal mental ability”; and 14.7 per cent were above “average.”
Summary
1. Age did not affect the frequency of cases between the ages of five and fifteen. 2. The Binet Test performances of the group as a whole were inferior to those of an unselected group. The distribution of the test scores was not normal but was skewed in favor of the inferior scores. a. Slightly more than 75 per cent of the cases fell below I.Q. 100. STATISTICAL RESULTS OF TESTING PROGRAM 137 b. The average I.Q. was 84. 3. The time ratings of the group as a whole on the Witmer Formboard were inferior to those of an unselected group. 4. On the basis of clinical conclusions, 63.8 per cent of the cases were below “average normal mental ability”; 21.5 per cent were of “average normal mental ability” and 14.7 per cent were above ‘’ average normal mental ability.’’ 5. As a whole the test performances of the group of cases referred to a charity hospital by the Indiana courts were inferior to those of an unselected group.
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