Some Behavior Changes in A Juvenile Paretic
- Author:
Mary V. Louden
University of Pittsburgh Patty was a colored girl of eleven years when she was first referred to the psychological clinic from the out-patient department of a local hospital.1 The hospital reported the following clinical findings: Spinal Fluid “Wassermann, four plus; Blood “Wassermann, anti complimentary; Kahn, negative; Colloidal Gold, 5555552200-0 and 5555554210-0.
Her abnormality was first noted in school. She had seemed to make average school progress until she reached 2-A, which grade she repeated. She also repeated the third grade where she became slow and seemed sleepy. Her writing became unintelligible; her speech, incoherent ; and her behavior, unpredictable. She lost her way when sent to school, lost her sense of propriety in school and cried to be taken home, and did not seem to be able to adjust well with the group.
It was at about that stage that Patty was first seen by a psychologist. There were then noted in her test performance great irregularities, the nature of which seemed to indicate that she once had been able to master material which was now beyond her ability and only part of which she now retained. The case has now been studied twenty-six months, during which time five examinations have been made. Despite some irregularities in the successes and failures from time to time on the Stanford Revision of the Binet, there has been a fairly constant downward trend in I.Q. with a total loss of twenty points. Her successive ratings have been 58, 47, 47, 50, 38. It is also to be noted that on the first examination Patty passed all test items at the four-year level; on each of the next three examinations she failed one item, and on the last retest, two items in the four-year battery. Thus far she has never failed any test in the three-year battery and never did she score any success beyond the eight-year level.
i The author is indebted to the Pediatric Clinic of the Allegheny General Hospital and to Dr Theodore Elterich in particular for cooperation, for certain information included here, and for permission to publish this report. Some test items?comparison of weights (V-l), right and left hand (YI-1), morning or afternoon (VI-alt.), and differences (VII-5)?show an irregular alternation of success and failure from time to time. These fluctuations seem to be due largely to chance, perhaps depending upon whether the particular test was presented on the upward or the downward swing of her rapidly fluctuating attention. These variations actually did cancel each other so far as score was concerned.
The tests below eight years which were failed most consistently, indeed almost invariably, are repeating 12-13 syllables (IV-alt.), patience (V-5), three commissions (V-6), counting thirteen pennies (VI-3), repeating 16-18 syllables (YI-6), description of pictures (VII-1), repeating five digits (VII-2), diamond (VII-6), and reversing three digits (VII-alt.). The nature of these failures suggests that Patty’s characteristic fluctuating attention is too fleeting to permit the carrying out of instructions or perhaps even to allow their comprehension. A complete summary of successes and failures is appended. Her poor penmanship, as well as her failure on the diamond, is predominantly a matter of eye-hand coordination. That performance has become progressively poorer. In the diamonds reproduced below, note the fringes which Mateer found characteristic in the performance of luetics.
The Porteus mazes also reflected tremors; however, failure on them was due to something more than faulty coordination. Although Patty never scored a success on the five-year maze, her performance became decidedly poorer from test to test, being marked March 15, 1932 March 15, 1932 November 24, 1933 ? November 24, 1933 by more fringes and irregularities. Her last performance was a succession of random stabs at the paper. Earlier failures had seemed to be due to incoordinated efforts to trace between the lines of the maze, but this random marking anywhere on the sheet seemed to indicate complete failure to grasp the problem. Not in test performance alone has this progressive loss of motor coordination been evident. On her last visit to the psychologist, Patty’s gait was exceedingly faulty. She felt her way down steps as would a child just learning that feat. She was unable to adjust her clothing or tend to her physical needs. Her speech had become more and more indistinct until it was impossible to understand much that she said.
A tendency toward constant and incoordinated motion, hypersensitivity to stimuli and rapid fluctuation of attention have increased over this period until it is now almost impossible to administer any test. The tendency toward irrelevant conversation, present throughout the period of this study, has become extreme. At the last interview, Patty was in constant activity. No less constant was the flood of speech which was disconnected, irrelevant, and garbled. Perseveration of a few ideas seemed to have reached the point of obsession.
Memory, too, has shown a change. Whereas Patty once remembered the examiner’s name from one interview to another, on the last occasion she asked the name every time she wished to address any remarks to that same person. No picture of Patty’s behavior during this period of deterioration would be adequate without the mention of at least two other tendencies. On each visit to the clinic Patty was in a state of great euphoria. Any performance was interrupted repeatedly to shake hands with the examiner and to tell her again and again that it was good to see her. An equal manifestation of joy was brought forth by the presence of a nurse, a doctor, or anyone whom she recognized even in the most general way. Another striking characteristic of her performance has been the pronounced deficiency of auto-criticism which now seems to amount to total absence of that trait. Every request, if executed at all, is followed by ‘4 Is that all right? Is that all right? … etc.” This interrogation seems to be a request for praise, rather than the expression of any doubt as to the satisfactory nature of her performance. It is asked with the same eagerness and in the same tone of voice whether the task has been perfectly executed or most obviously and absurdly failed. It is unfortunate that we have no objective record of Patty’s behavior prior to the havoc of disease. We have only the mother’s word that she seemed to be “normal” and the teachers’ report that she made average progress in school for a time. But despite the fact that we do not know from what level she has fallen, we do know that instead of the increase of twenty-six months in mental age which should have been expected in the duration of this study, Patty has actually lost eighteen months as reflected in test scores. “We also have evidence that this loss may be greater than test scores indicate, for despite the fact that she now scores a Binet mental age of five years, she does not perform as an average child of five. There are present here certain physical and personality traits which detract from the significance of the test score and which must Binet Results from Five Successive Examinations Date of Examination
Oct. 23, 1931 Mar. 15, 1932 July 2, 1932 Dec. 24, 1932 Nov. 24, 1933 Year III 1. Parts of body 2. Names familiar objects. 3. Pictures, enumeration. . 4. Gives sex 5. Gives last name 6. Repeats 6-7 syllables… Alt. Repeats 3 digits Year IV 1. Compares lines 2. Discrimination of forms 3. Counts 4 pennies 4. Copies square 5. Comprehension, 1st degree… 6. Repeats 4 digits Alt. Repeats 12-13 syllables… Year V 1. Comparison of weights 2. Colors 3. Aesthetic comparison 4. Definitions, use or better 5. Patience, divided rectangle… 6. Three commissions Alt. Gives age Year VI 1. Right and left 2. Mutilated pictures 3. Counts 13 pennies 4. Comprehension, 2nd degree.. 5. Coins 6. Repeats 16-18 syllables Alt. Morning or afternoon Binet Results from Five Successive Examinations?Continued Year VII 1. Fingers 2. Pictures, description 3. Repeats 5 digits 4. Ties bow-knot 5. Gives differences 6. Copies diamond Alt. I Names days of week. .. Alt. II Repeats 3 digits reversed Year VIII 1. Ball and field 2. Counts 20-0 3. Comprehension, 3rd degree.. 4. Similarities, two things 5. Definitions, superior to use.. 6. Vocabulary, 20 words Alt. I Six coins Year IX 1. Date 2. Weights (3, 6, 9, 12, 15). 3. Makes change 4. Repeats 4 digits reversed. 5. Three words 6. Rhymes Date of Examination Oct. 23, 1931 + + + + + Mar. 15, 1932 + + + + * + 0 July 2, 1932 + + + 0 + Dec. 24, 1932 + + + + + + 0 Nov. 24, 1933 + + * Success, doubtful. t Year X given, no tests passed. Key: +, test was passed. ?, test was failed.
0, test omitted because all test items on previous level were failed or for some other reason provided for by Terman.
be considered in all plans for her care. Here we have a thirteenyear-old girl who can scarcely climb stairs alone, who falls frequently, who cannot be intrusted with the simplest errand, who no longer can dress herself nor tend to her simplest physical needs, and on whom the most patient and persistent instruction is wasted, for her attention is ever diverted by a multitude of stimuli. All this makes her a physical burden in need of constant care, yet we have not mentioned the most serious problem of such a child in the home or in the neighborhood. The real gravity of the situation lies in the fact that Patty cannot be relied upon to sense cause and effect relationships, nor to use proportion in her behavior, nor to comprehend the gravity of her acts. We are told that the window and the baby and all other objects have” equal chances of being the recipient of blows with a knife or hammer or any object she may have in her hand. So it has come about that the younger children in the family are never safe in her presence. The mother has been anxious for the child’s recovery from the first. She has been cooperative with the hospital and diligent in her care of this unfortunate girl, yet even she has become convinced that it would be better if Patty could be adequately cared for outside the home. Immediate institutionalization seems to be imperative.
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