The Mental Hygiene Problems of School Attendants
- Author:
Frances V. Markey
Mental Hygiene Clinic, Judson Health Centre and Columbia University This paper presents an analysis of the problems of 295 sc oo children referred to the Judson Health Centre Mental Hygiene Clinic during three years of operation. More than thiee-fourths of the total cases during this period were treated here. The remaining fourth consisted largely of children attending school and, to some extent, of school attendants without Stanford-Binet I.Q. s. Chronological age, sex, school status, referral agency and leason for referral were obtained from the record forms of the 295 children.1 The tables below show the distribution of the eases according to referral agency and reason for referral in relation to the other factors mentioned.
The referral agency is indicated on the clinic folders and may be classified readily under the headings indicated. In some instances, however, parents are the ultimate source of certain cases classified under Centre; that is, parents coming to the Centre for service in other health fields often discuss the mental hygiene problems of their children with the clinic personnel who in turn recommend the case to the Mental Hygiene division. Less frequently, as may be seen in Table I, the parents themselves, knowing of the services rendered by the clinic, proceed directly to the mental hygiene personnel. For some cases the Bureau of Attendance (truancy division of the public schools) made recommendations ; these were counted as school referrals. The heading ‘ Other Agencies” subsumes miscellaneous social agencies, such as clinics, child placement agencies, hospitals, etc.
The clinic folders- indicate also the reason for referral. The basic difficulties of the child may not correspond to the reason given; however, the problem stated is the source of difficulty so far as the referral agency is concerned. The truancy cases were usually described as discipline-truancy, but in our classification truancy only is used since the word discipline is used, on the whole, to conform with the terminology of the public school’s truancy agents. Enuresis, stammering, and masturbation were classified as neurotic. The headings “Backward” and “Vocational Guidance” are self explanatory. The miscellaneous cases include: suspected superiority (8 cases), mother epileptic (6), member of family of patient (5), referred to sight conservation class (4), scholarship aid (3), interested in art (2), referred for placement (2), glandular defects and epilepsy (3). A request for scholarship aid is in a sense a request for vocational guidance, but these cases are not classified as such since scholarship aid does not constitute a problem in job placement.
The cases were drawn largely from the neighborhood immediately surrounding the Centre, a Latin-American area. Some of the schools were informed of the work done by the clinic and were invited to refer cases; educational work had been carried on with the parents also to secure cooperation with the clinic. These factors were probably of significance in determining the kinds of cases referred.
Table I shows that the most frequent single problem for which Table I Type of Problem on Referral and Source of Case (with Chronological Age and Sex) Source of Case Backward Boys Girls Neurotic Boys Girls Problem Vocational Discipline Boys Girls Boys Girls Truancy Boys Girls Miscellaneous Boys Girls Centre N = 161 Mdn. C.A. 10. 20 9 17 10 21 9 27 10 14 13 14 18 13 12 11 12 9 School N = 97 Mdn. C.A. 13. 10 9 10 11 2 10 4 11 1 15 3 15 10 5 12 37 14 13 12 Parent N = 27 Mdn. C.A. 10. 3 12 4 10 1 12 1 13 G 10 2 10 Other agencies N = 10 Mdn. C.A. 11. 3 11 1 17 4 10 Total Boys 161 Total Girls 134 Mdn. C.A. 12.. Total 295 33 10 63 30 11 30 9 64 34 10 10 14 28 18 15 36 9 21 10 37 14 13 12 57 50 18 9 33
cases are referred is neurotic behavior; however, if truancies are added to the school discipline cases, non-conformity in school totals most. The Centre refers almost equal numbers of neurotics and backward children, the school refers more truants than other kinds of cases, but also refers many backward and discipline cases. Parents refer discipline cases more than any other, with neurotic and backward children next in order. This distribution implies that the emphases of parents, schools and health agencies aie harmony of parent-child relationships, conformity to rules and mental health, respectively. Boys are brought to the clinic more often than girls, especially for discipline and truancy, the ratios for all cases being 1.5 to 1 and for truancy 3 to 1 (approximately). Girls on the other hand are referred more often for neurotic behavior, indicating perhaps that adults show greater concern over neurotic symptoms in girls. Table I shows also that girls are referred to the clinic at a slightly later age than boys, except when truants; this suggests that boys receive attention earlier for exceptionalness of any kind. Truant girls, on the other hand, may be apprehended sooner because of inexperience. Children are recommended to the clinic at an earlier age by the Centre personnel and by parents than by the school authorities, pointing perhaps to lack of sensitivity on the part of the school to problems in mental health. Table II shows that the median Intelligence Quotient of the girls is lower in all but the discipline and truancy cases; however, the age-grade retardation is less for the girls in almost all types ?f problems (in computing age-grade status, no retardation less than one-half year was counted; our figures place the children in a more favorable light than would be the case if the one-half year cases had been included). There seems a tendency for girls to present problems when slightly retarded in age-grade status as compared with more retarded boys. Girls, although less intelligent, are less retarded; this tendency has been observed in other studies. The group as a whole, it may be noted, tends to be subnormal in intelligence; the children referred by the school are somewhat more retarded than those referred by the Centre and by parents. The age-grade status of the school cases is considerably lower on the average than Centre and parent cases.
Summary
In general, the analysis shows that mental hygiene cases from this particular area are slightly retarded in intelligence. Health
Table II
Median I.Q. and Average Age Gbade Retardation of 295 Cases According to Problem, Sex and Source of Case Source of Case Backward Boys Girls Neurotic Boys Girls Vocational Boys Girls Discipline Boys Girls Truancy Boys Girls Miscellaneous Boys Girls Centre Mdn. I.Q. 86… Av. Age Grade 0.9 72 2.0s 71 1.2 95 0.9 89 0.9 94 1.2 83 0.8 89 1.3 96 0.9 103 0.1 99 0.1 School Median I.Q. 83 Av. Age Grade 1.8 77 2.0 69 2.2 82 1.5 97 0.0 82 2.0 75 2.3 94 1.9 90 1.2 87 2.0 87 1.5 97 2.0 Parent Mdn. I.Q. 96… Av. Age Grade 0.8 82 2.7 82 0.7 101 0.5 112 0.7 127 |3.0 97 0.0 0.8 97 0.7 127 2.0 112 0.5 Other Agencies Mdn. I.Q. 84… Av. Age Grade 1.4 89 1.0 67 3.0 82 1.0 86 1.5 Mdn. I.Q. 86… Av. Age Grade 1.3 74 2.1 72 1.4 94 0.9 91 0.8 94 0.9 81 1.4 1.4 94 0.9 87 2.0 87 1.5 104 1.0 97 0.8
Boldface indicates acceleration. workers at the Centre are relatively more sensitive to neurotic traits, school personnel to disciplinary difficulties, and parents to discipline as mental hygiene problems. Girls are referred to the clinic at later ages than are boys for most problems. Girls when referred are more retarded intellectually than boys but less retarded in age-grade status for most problems. Children referred by health workers are somewhat brighter and younger than children referred by school officers, on the whole. School cases are predominantly cases of non-conformity to school regulations; nonconformity is emphasized more than intellectual retardation or even school retardation by school authorities in recommending children to a mental hygiene clinic.
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