The Certification of Children of School Age
By F. C. Shrubsall, Esq., M.A., M.D., F.R.C.P. ^ (Principal Assistant Medical Officer, London County Council.) Although the existence of mental defect from birth or an early age has been recognised in this country, educational provision for children thus affected only dates from the closing years of the last century. The Elementary Education (Defective and Epilephc^Children) Act, 1899, permitted Local Education Authorities to establish schools for m tive children who were above the level of imbeciles but were not merely backward. The certification of children under this act is earned out by medical practitioners specially recognised by the Board of Education for t e: puipose. The Mental Deficiency Act, 1913, made it a duty for all Local Education Authorities to ascertain which children in their area were mentally defective and to notify to the Local Control Authority the names of children between the ages of seven and sixteen who were incapable of receiving ben t in a specia school or whose presence was detrimental to others. For the purpose of t is ascertainment the provisions of the foregoing act were to apply. The Board of Education require that before the name of any child who is 36 STUDIES IN MENTAL INEFFICIENCY. not an idiot or imbecile or a moral imbecile, is sent from the Local Education Authority to the Local Control Authority they shall be seized of the facts and have given their formal permission; they make the same proviso with regard to any child of whatever mental categoiy who is blind or deaf within the meaning of the Education Act of 1893. The Elementary Education (Defective and Epileptic Children) Act, 1914, made obligatory on Local Education Authorities suitable provision for the education of defectives between the ages of seven and sixteen and, within certain financial limitations, allowed the provision of residential school accommodation. The parents’ interests are safeguarded by provisions that they shall be consulted and that a child shall not be sent to a school not within reach ot the child’s residence, or to a boarding school without the consent of the parents in writing, unless it be shown to the satisfaction of a court that such consent is unreasonably withheld, such consent not to be deemed to be unreasonably withheld if this is with a bona fide intent to benefit the child. It is also provided that the certifying medical practitioner shall, if directed by the Local Education Authority or if requested by the parent, consult with the head teacher of any school the child may have attended before he gives his certificate. A copy of any report made by the teacher is to be sent to the Local Education Authority. If a court refuse to make an order sending a child brought before them to a school, they shall award costs to the parent unless for good cause it shall otherwise order. Should a child be discharged from a special school as no longer defective the certificate shall be returned to the parent and not received in evidence in any legal proceedings without the consent of the child or its parent. The chief work of a Certifying Officer acting for an Education Authority is therefore to determine whether a child is defective at all and not merely backward, and if defective, whether not being imbecile or idiot he is educable in a special school. The composite nature of the diagnosis involved has been more completely recognised abroad, where the examination is conducted by a commission which includes an inspector and the rector of the school in addition to the medical officer. It was the usual practice in this country under the Act of 1899 for the teacher of the special school and the class teacher, or less often the head teacher of the school the supposed defective had attended, to be present at the statutory examination so that the decision could be made by the medical officer in consultation. Clearly some such procedure, though possibly only in the form of written reports, is contemplated by the Act of 1914. Wherever possible, personal consultation is a great advantage. In any case a statement as to the abilities of any child under observation should be received from the head by the medical officer as, though he alone is responsible for the final decision, it is only right that the fact of failure to profit by the education provided should be certified by the teacher as the member of the profession primarily concerned. The preliminary question of the existence of scholastic retardation having STUDIES IN MENTAL INEFFICIENCY. ^7 been established the next step is an investigation into the cause and the probability of permanence of the condition. Mental deficiency is only a small factor relatively to the total. Though hereditary limitation of educational ability is common, physical defects and absence due to illness are responsible for about a quarter of the cases, and truancy, constant change of school, and bad home conditions for rather more than a quarter. Information on these points is essential for the certifying medical officer who must make large allowances, especially in cases of illness and malnutrition. The form of nomination for special examination in general use is one approved by the Board of Education which gives information as to : ? 1. The duration and regularity of school attendance. 2. The habits of the child; whether cleanly, obedient, mischievous, spiteful, etc. 3. The capacity of the child as to reading, writing, calculation, drawing, memory and rhythm. 4. Any other information. Where necessary, further information may be obtained from the attendance officer or from the Care Committee, who are probably well acquainted with the family. The capacity is usually estimated in grades and standards and the child is expected to advance, on an average, a standard a year from Standard I. at 6^ to Standard VII. between 13 and 14. The ordinary educational curriculum provides that a child in the lowest grade of the Infant School shall commence to learn the letters of the alphabet, in Grade II., these are combined in two and three letter words. In Grade III., the infant reader contains such sentences as ” The dog is my pet,” ” It is a bad pig to put its foot in the mud.” In Standard I. Readers, such phrases as ” Nell put on her cloak and tonnet and went for a walk ” occur. A rather easy Standard II. reading would be such as ” In a cottage outside a wood, a little girl lived with her parents.” In arithmetic the children in the lower grades learn the meaning of number proceeding to the decomposition of numbers, i.e., six is two threes or three twos. In the standards they proceed to written numerical work, first of addition and subtraction of units then of tens and gradually passing to higher rules. Writing begins in the Infants’ School by copying and then transcription, by the time the child passes to the Standards in the senior school, the writing of simple two or three letter words from dictation is usual. A child is usually promoted from the infants’ department at 6, retention till seven being possible if there is a standard in the infants’ school, or till eight it there is a standard II. It is at the time of transfer that children most usually attract attention to their backwardness. In some areas the question of promotions is dealt with by the head teachers of the infants and senior departments in consulation with the inspector. This consultation might well form the basis for a conference to include the 28 STUDIES IN MENTAL INEFFICIENCY. medical officer which might serve for the purpose of a preliminary or even for the statutory examination. The term tackward is not defined in the Education Acts, but as the Board of Education require returns to be made of children who are two and three years respectively behind the normal, it may be presumed these are the backard children and prospective candidates for admission. It would be very desirable that all backward children should receive a special medical inspection to ascertain the presence of any defect of vision or hearing which may be keeping them partially out of touch with their environment, any cause of ill health which may be lowering mental as well as physical tone, and that any such should be treated prior to the statutory examination. Unless he has already made such an examination this must be one of the first tasks of the certifying officer, who, if he finds such defects would te well advised to link the child in the appropriate manner for treatment and refer him back meanwhile for a further period in the ordinary school, unless he finds evidence of deep defect. The distinction between the merely backward and the mentally defective child is presumably that the former would make steady progress, albeit not at the normal rate, 111 large classes being likely ultimately to attain to say Standard IV., while the latter would always need more individual attention and special methods. Educability depends not only on certain general attributes called general intelligence, but also on certain special aptitudes. Normal individuals show a wide range of variation, in accordance with the laws of probability, both in general and special aptitudes but it has long been noted that great irregularity of mental development is a characteristic of defectives of all grades. Failure in certain special aptitudes is to be found in all classes of the community, including those of the highest mental grade. When the failure is in something of little social importance such as music or drawing it may pass unnoticed, or at the most the individual is said to have no talent in some direction, when the missing aptitude is of social importance it may attract even undue attention at an early stage. Similarly the possession of some special aptitude of social value may enable a genuine defective to maintain a position in the world. Under present conditions the presence of some aptitude in handling linguistic and numerical symbols is postulated before a child can be educated in ordinary schools, though latterly a somewhat greater use of manual dexterities has been introduced. The child who cannot read, write or calculate is certain to be brought for examination. Some evidence on these points will be submitted ty the teacher and this will be checked to a considerable extent in the course of the examination. Such a child is unquestionably defective in the sense of the definition of feebleness of mind applicable to children, i.e., that they are incapable of education in ordinary schools. But it by no means follows that the child who fails because of mal-development of some special educational aptitude, though undoubtedly deviating from the bulk of his fellows in certain mental traits, may STUDIES IN MENTAL INEFFICIENCY. *9 not prove acceptable in the world however much he may need special education. Far more important is the degree of development of the powers of reasoning out problems of daily and social life, and in this connection it is interesting to note that the definition in the German code of Common Law of imbecility (under which our feeble-minded would be included), is inability to consider the consequences of acts. Assessment of this ability by tests appropriate to the age of the child is really the whole matter for examination. In adult life the feeble-minded are those who, apart from physical defects, show normal possibilities of activity, a moderate development of the cognitive and affective mechanisms, but fall short in the higher powers of generalization and control, having perhaps reason enough for their individual guidance but not enough for their social relations. In proportion the same holds good for children bearing in mind their normal social environment is the school; those who cannot care for themselves individually in due proportion for their age would be classed as imbecile or. idiot, those who can fend for themselves but are incapable of competing with their normal fellows in the lower classes of a school need special instruction. The general lines of the necessary medical examination are laid down in the report, 306. M. or Schedule F., required to be submitted to the Board of Education in connection with any case referred to that body, and which sets the form of record required to be kept at a special school. This asks for information 011 the family and personal history of the child, the physical condition including any stigmata or defects of the special senses. Under mental conditions it requires date as to: ? {a) The reactions of the Motor Mechanism : Including the power of executing movements from imitation or command, and signs of incompetence or instability, or any disturbance as tremors, fits or paralysis. (b) Reactions from sensory stimuli: Including the attention to and perception of colour, shape, size, smell. The formation of memory images as shown by the recognition or recollection of objects, sounds, etc. The association of ideas, judgment of ideas, judgment of length, etc., recognition or recollection of similarity, contrast, etc., between objects, general concepts. (c) Emotional conditions. (d) Tests of intelligence : Including the description of pictures, objects, etc,, reading, counting, manipulation of numbers and simple money values, writing and manual tests. (e) Mental age as estimated on the Binet Simon Scale. (/) Will Power as tested during the foregoing. (#) Other Moral Characteristics. The Board of Education recommend that the Binet Simon Tests should be 3<D STUDIES IN MENTAL INEFFICIENCY. used for the purpose of assessment of intelligence, and in the course of working through these the answers to most of the questions in the schedule will be obtained with the possible exception of those relating to interest or emotional conditions, though even as to these much evidence will have arisen incidentally. A description of these tests would take up too much space, so the reader may be referred to one of the many books in which they are set out in detail. The Certifying Officer must recollect that tests are simply performances to order on the basis of which he may make a quantitative estimate as to how far the individual falls short of the normal standard for his age, the diagnosis of the nature of the defect must rest on the psychological acumen of the observer. It is essential that good relations be established at an early period between observer and child so that it as often profitable to begin by letting the child have a book or picture to look at while some of the history is obtained from the parent. A deficiency of two years on the Binet Scale up to the age of eight, or three years up to twelve, and four years above that age, is usually accepted as the limit between the intelligence suitable to an ordinary school and that qualifying for special instruction, tut this must always be checked by evidence of attainments and general behaviour or street knowledge. While this represents the general relation between the results of the application of the Binet Tests and the probable determination with regard to education, it must be borne in mind that the important point is not the actual result, pass or failure, so much as the behaviour of the child with regard to each test. The total result may give an expression of mental age, the behaviour may show lack of attention, of co-ordination, memory, etc. Emotional conditions are important and may lead to a postponement of the examination or a temporary reference back to school and subsequent re-examination. A child who could pass tests for age eight, and do work up to Standard IT., would not be likely to be deemed fit for a special school even at the age of ten unless there were other evidences of failure. A child of ten who failed at eight and could only just do Standard I. work would probably be sent to a special school if the evidence showed he had had a favourable trial in an ordinary school. One who could pass at eight but not do more than Standard I. work would probably be referred for special teaching in a backward class if such existed. At eight, ia child who could not pass the tests for seven and only know up to a few two letter words and also showed deficiency in number would probably be sent if there was evidence of weakness in attention or association. If better in either number or reading, he would probably be referred back for a time. If he failed the six tests he would probably be sent to a special school if he had had a reasonable chance beforehand. A seven year old who failed some five tests and most six tests and was unable to tell the letters or to count would probably be sent to a special school, particularly if there was other suggestive evidence of deficiency. A child at seven who cannot pass the three year old tests, whose attention STUDIES IN MENTAL INEFFICIENCY. 3? can scarcely be held, and who shows a constant restlessness, cannot be educated in a special school, though he may be again re-examined at a later date. Most children seen ,at the age of 7?8, who have not previously been tried in an infants’ department, prove to have a mentality of three years or less. They sometimes know their name and a few common objects, but it is a very usual experience to get no response. In such cases it is not unusual to see them on two occasions, at an interval of some months, before terming them imbecile. When they have been in an infant school and there is a history of complete failure to take interest in any school work, of vegetative placidity or restless wandering, the task is easier and a diagnosis can be given at one examination. In general it may be said any child up to eight who could do some four year old tests and up to ten who could do some five year old tests would be given i’ trial in school. Children excluded from a special school as imbecile after trial are those who have made no progress or inappreciable progress after a considerable trial. In few oases have they learnt more than two-letter words, most are uncertain of letters. They have usually failed to learn to do more than count units, if indeed they have attained to this. Their mental age usually shows some five or more years retardation and their basal Binet age, i.e., the age for which they can pass all the tests, appears in the majority of instances to be unchanged or perhaps to have risen one year in several years’ school attendance. The responses to higher years may vary. No child should be excluded as long as either the Medical Officer or the teacher is satisfied that definite, even though slow, educational progress is being made. When such progress is limited to acquiring slight habits of order and obedience it is doubtful if it would be held to justify the cost of special school education, particularly if retention meant the exclusion of some child who could derive greater benefit. In broad outline, the conditions under which children are returned from a special to an ordinary school may be stated to be that they have made such advances in the special school that they seem likely to have a chance to make good in the ordinaiy school. This would usually mean that their attainments were such that they could undertake work in the second or higher standard, that their retardation, as measured by a graduated scale, was not more than two years up to the age of twelve, and above that they shewed a mental age at least equal to ten; that definite progress was being made in all the mental faculties required for such school life, and that they shewed a reasonable amount of school knowledge and power to fend for themselves. While it is clear a child cannot be retained in a special school, should such improvement have occurred as to render attendance thereat no longer enforceable, it is well in weighing the evidence to consider that the child would return to a low Standard, among much younger children, and might possibly lose in large measure the manual training which has probably helped his recovery, since such is usually provided only for those in the higher standards of the ordinary school. 33 STUDIES IN MENTAL INEFFICIENCY. Much must depend on the possibilities of the locality. Wherever possible, a consultation of the matter with the head teachers of the special and ordinary school is most desirable. Unless the latter is willing, voluntarily, to take the child, he is scarcely likely to afford the sympathetic oversight needed at the recommencement of normal school life. In case of doubt or dispute as to whether a child is still certifiable, the final court of appeal on the question of fact of deficiency is the Board of Education. Towards the end of the school period the question of suitability for employment and life in the world has to be considered. It is the duty of every Local Education Authority to notify the name of any child leaving a special school to the Local Control Authority, should there be any circumstances which would justify guardianship or institutional care. Every case, then, must be reviewed on approaching the age of sixteen, from the standpoint of social efficiency. Reading can largely be ignored and the decision based on the general adaptability as in the case of adults. The diagnosis of feebleness of mind should be made on failure to carry out such tasks or to follow such instructions as might be received in daily life. Ability to tell the time; to understand simple money values; to remember instructions; to perform simple manual tasks without constant repetition of the instructions; some reason, foresight and power of profiting from mistakes in dealing with a problem such as opening a box, completing a more complex form-board or a picture, are of importance. The question as to notification to the Local Control Authority must largely depend on the evidence as to school and out of school behaviour, the home circumstances, prospects of employment and the like. The information is rarely available at first hand to the certifying officer but comes from Teachers, Care Committees, After Care Workers, Attendance Officers and the like. It would not appear that the evidence available need be sufficiently strong to enable the Local Control Authority to prove that any withholding of consent was unreasonable, though any evidence in support of the view that the case might come under this category should be recorded.
Bibliography
- Reference type:
Journal Article
- Record-number:
17213
- Author:
Shrubsall, F. C. Esq
- Year:
1920
- Title:
The Certification of Children of School Age
- Journal:
Stud Ment Ineffic
- Volume:
1
- Issue:
2
- Pages:
25-32
- Epub-date:
1920/04/15
- Date:
Apr 15
- Short-title:
The Certification of Children of School Age
- Alternate-journal-name:
Stud Ment Ineffic
- PMCID:
PMC5109080
- Accession-number:
28909960
Note
Shrubsall, F C Esq
eng England Stud Ment Ineffic. 1920 Apr 15;1(2):25-32.
- Author-address:
Principal Assistant Medical Officer, London County Council.
- Name-of-database:
PubMed
- Language:
eng
- Copyright:
internal-pdf://2742356834/The Certification of Children of School Age.pdf
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