Clinical and abnormal psychology: A textbook for educators, psychologists and mental hygiene workers

Citation preview

RIVERSIDE TEXTBOOKS IN EDUCATION EDITED BY ELLWOOD P. CUBBERLEY DEAN OF THE SCHOOL OF EDUCATION LELAND STANFORD JUNIOR UNIVERSITY

CLINICAL AND ABNORMAL PSYCHOLOGY A Textbook for Educators, Psychologists and Mental Hygiene Workers BY

J. E. WALLACE WALLIN, P H . D . Director Bureau of Special Education and Psycho-Educational Clinic and Professor of Clinical Psychology, Miami University Consulting Psychologist to the Department of Instruction of Dayton, Ohio Author of " The Education of Handicapped Children," eta.

HOUGHTON MIFFLIN COMPANY BOSTON • NEW TOBK • CHICAGO • DALLAS • SAN FBANCISCO

tRjeftibtnffte$1x00 Cambtfone

COPYRIGHT,

1927

BY J. E. WALLACE WAIXIN ALL RIGHTS RESERVED

CAMBRIDGE . MASSACHUSETTS PRINTED IN TUB U.S.A.

TO MY FATHER AND MOTHER

EDITOR'S INTRODUCTION the time is fast approaching, with the new interest everywhere manifest in health education and child-welfare work, when our cities at least will provide for careful individual study, at public expense, of all peculiar, retarded, divergent, and problem types of children, with a view to promoting the efficiency of the instruction given in our schools and the better adaptation of teaching to the peculiar needs of these pupils, may be taken for granted. The more we study the child, the more diverse his needs appear to be, and each new study of individual differences only brings out, more fully than was known before, variations in children's educational possibilities that call for differential treatment, and often for remedial care. Intelligent parents look after such matters in the case of their own children, and an intelligent public will in time look after the noeds of its wards in the public schools. That there are thousands of children in our public schools to-day for whom the regular classroom instruction is but poorly adapted, and who are gaining but little from attendance at the school, every intelligent educator knows. Because we do not spend more money on the education of these children, we are wasting much of that which we now spend. The compulsory-education law has placed them in the school and holds them there, but their attendance is not productive of satisfactory results. What they need is first a careful scientific examination and diagnosis, that will locate defects interfering with proper school progress, the prescription of remedial treatment, and then specialized instruction in classes in which they can make what is, for them, satisfacTHAT

via

EDITOR'S INTRODUCTION

tory educational progress. Many children in our schools today do not profit by mass instruction, adapted as it is to average capacity and to pupils free from serious developmental defects. It has been especially difficult for the educator to handle these problem children, in part because he has lacked specialized classes into which to put them, but largely because his training has not been such as to enable him to recognize their defects or to indicate what it is best to do for them once the defects are revealed. He has tried differentiated class sections and smaller classes, but these have not solved the problems presented by their presence. There is no hope, either, that with time we shall be able to include such training in his professional preparation. The knowledge called for is far too extensive and far too technical, asd the service needed can best be provided by the organization of a special staff. Just as we have in turn added the special subject-matter teacher, the school nurse, the visiting home teacher, the school health officer, and the school dentist to our educational staff, and all for the purpose of enabling the classroom teacher to make her instruction more effective, so shall we in time add specialists in the diagnosing of mental and developmental defects, and in the prescribing of remedial treatment and instruction for the problem chiki forced into the schools by the operation of the compulsoryeducation law. This new specialist we call a clinical psychologist, and it is the work of this new educational and psychological expert that the present volume describes. This newfieldof usefulness and service has only recently been opened up, aad the technique of the work is new and as yet but imperfectly understood. Based as the service is on fundamental studies and clinical experiences in psychology and medicine, with the emphasis on diagnosis and remedial procedures, it is not

EDITOR'S INTRODUCTION

ix

surprising that we have as yet but few trained workers in this branch of public-school service. The present volume represents a painstaking organization of this new field of clinical and abnormal psychology, in terms that the school officer can understand, and is the first such organization for the lay worker in the English language. We are all under debt to the author for the work he has done in making available, in organized textbook form, the results of the work of hundreds of clinical investigators who have studied the mental and the developmental defects of children and youth. The present number is a companion volume to the author's Education of Handicapped Children, published some three years ago in this series of educational texts. AVhereas the earlier volume dealt with the teaching of such children, the present volume deals with mental and developmental defects and their diagnosis, and the prescription of remedial and educational treatment for them. The primary concern of the earlier volume was instructional procedures with handicapped children; the primary concern of the present volume is psychological methods and diagnostic technique, with a consideration of the causes for and the educational implications of each type of mental defect. The two volumes constitute a scientific guide to the proper handling of defectives and subnormal children, and should prove of large usefulness to that rapidly growing body of men and women interested in remedial welfare work with youth, as found in our schools, orphanages, juvenile courts, and psychological clinics. As a textbook in clinical and abnormal psychology the present volume should find an important place for itself in educational institutions, while to the clinical worker in public-school systems it will prove invaluable. ELLWOOD P. CDBBERLEY

PREFACE book, like the companion volume on The Education of Handicapped Children, is based on a course of lectures delivered, since 1912, in over a half-dozen universities and schools of education. It is the outgrowth of more than seventeen years of labor, in several States, devoted to mentally, educationally, and socially abnormal children. This work has included the individual examination of seven thousand cases, the organization and administration of systems of developmental and reconstructive training, and the perusal of the avalanche of books and articles which have appeared during this period in the highly productive field of psychological and educational tests and mental hygiene, and in cognate fields. The book, naturally, is not an exact duplicate of the lectures. The treatment of some topics has been expanded, and of others considerably abridged. The condensations affect particularly topics which are more or less incidental to the main movement of thought, or which have been amply treated by the writer elsewhere. In many cases administrative and scoring techniques for the tests referred to, and summaries of test results, have not been presented in detail because they can easily be found by consulting the available literature on the subject. Moreover, the book covers only that part of the course — which, however, constitutes much the larger part — which dealt with psychological examination methods. The discussion of pedagogical, physical, and anthropometric examination methods, anatomical and psychical stigmata of degeneration, and the investigation of the environmental, developmental, and he-

THIS

«ii

PREFACE

reditary factors of mental abnormalities is omitted. Because of the wide range of psychological topics included, it has been necessary to make extensive deletions, and to confine the discussion of many problems to the main essentials. Exhaustive consideration of all the topics treated would require two or three volumes instead of a single book. Consequently, the author was confronted with the alternative of treating exhaustively a few major topics in clinieal and abnormal psychology, or of covering the subject matter so broadly as to supply a purview of the entire field. The latter plan was adopted, because the book is intended to serve as a systematic introduction to the science and art of clinical psychology — the first systematic book in this subject, so far as the author is aware. It aims to give a fairly adequate picture of the inner mechanism of the psychological and psychoeducational clinic, and to touch incidentally upon various topics in abnormal psychology with which the clinical psychologist, mental and educational tester, specialclass teacher, visiting teacher, social worker, medical student preparing for work in mental hygiene, and others interested in abnormal-behavior problems should be familiar. A comprehensive survey, in spite of necessary brevity, will furnish orientation and perspective, show the relationship between topics, and supply the essential groundwork for further study. This book will serve its purpose if it succeeds in opening up the field for the general reader, and in supplying a broad foundation of facts, procedures, and principles on which the technical worker may build. Students who desire to qualify as experts in mental and educational tests, in psychoclinical and psychiatric investigations, in special-class teaching, or in any other phase of mental hygiene should study the companion volume also* and follow the leads supplied in both volumes for further preparation. When used as companion texts, the two books

PBEFACE

*&

will supply a fairly comprehensive introduction to the whole field. This book will not be without value as a review course in normal psychology for students who need to review their psychology. Many sections have been introduced by brief expositions of fundamental concepts in normal psychology for the purpose of orientation and review. The experience of the author has shown that many students, even those who have had prior courses in psychology—it is assumed that all have had such courses — will not derive maximum benefit from the discussions without such introductory explanations. In order that the maximum results may be secured from the use of the book as a text, the author suggests that class demonstrations of many of the tests discussed will increase the interest and concreteness of the presentation. The writer has always supplemented the lectures with such demonstrations. In brief courses, especially when presented to students of limited preparation, it is suggested that the assignments be confined to the sections of most importance from the standpoint of the purposes of the course, and that a few minutes be spent in preparation for the advance assignment — clarifying the more difficult conceptions, showing the relationships between various topics, and calling attention to sections which should be thoroughly mastered and others which may be read more superficially or omitted. Most of the technical terms used are introduced in parentheses* and in such a way that the context indicates their meanings. The composition of the book has been beset with numerous difficulties and delays. Never having had a sabbatical year, and having taught continuously in summer sessions since 1910, the writer has been constantly interrupted by the daily routine of examinations, interviews, correspond-

xiv

PREFACE

ence, lectures, inspections, trips into various sections of the State, and other responsibilities attaching to a position whose chief duties are of an administrative, clinical, and teaching nature. It is a pleasure to express my appreciation of the services rendered by my assistants, Miss Margery Gilbert and Miss Charlesanna Coles, who have read the manuscript and offered various suggestions for its improvement. Miss Gilbert has also rendered valuable assistance in the correction of the proofs and the preparation of the index. Mr. C. A. Barker has assisted with the indexing. J. E. W. W.

CONTENTS PART I INTRODUCTION CLINICAL EXAMINATIONS, DEVIATIONS FROM NORMS, AND GENERAL AIMS AND PRINCIPLES I. CLINICAL EXAMINATIONS AND PSYCHOLOGY

•

8

I I . DEVIATIONS IN CHRONOLOGICAL, PHYSIOLOGICAL, ANATOMICAL, PSYCHOLOGICAL, EDUCATIONAL, AND SOCIO-INDUSTRIAL AGE . . .

20

H I . CORRESPONDENCE BETWEEN INDICES OF DEVELOPMENT

THE DIFFERENT 53

IV. AIMS AND METHODS OF A PSYCHOCLINICAL E X AMINATION

71

V. GENERAL DIRECTIONS, FACTS, AND PRINCIPLES

TO OBSERVE IN MAKING PsYCHOCLiNiCAii O B SERVATIONS AND TESTS

101

PART H INTELLIGENCE THE GENERAL LEVEL OF INTELLIGENCE AND SPECIFIC INTELLECTUAL ABILITIES AND DISABILITIES VI. T H E LEVEL OF GENERAL INTELLIGENCE

.

. 133

VET. INDIVIDUAL MEASURING SCALES OF INTELLIGENCE

148

xvi

CONTENTS

VlII. IX.

GROXTP TESTS OF INTELLIGENCE

.

•

.

.183

PSYCHOLOGICAL THEORIES AND STANDARDS OF MENTAL DEFECTIVENESS

197

X.

SPECIFIC INTELLECTUAL ABILITIES AND DISABILITIES; SENSATIONS, PERCEPTIONS, AND A P PERCEPTIONS • 212

XI.

KEENNESS OF SENSIBILITY; DEFECTIVE VISUAL ACUITY; COLOR BLINDNESS; DEFECTIVE AUDITORY ACUITY 221

XII.

KEENNESS OF DISCRIMINATIVE SENSITIVITY; QUICKNESS OF OBSERVATION; FIDELITY OF R E PORT; APPERCEPTION 245

XIII.

DISORDERS AFFECTING SENSIBILITY AND THE INTAKE AND INTERPRETATION OF IMPRESSIONS IN VARIOUS ABNORMAL NERVOUS AND MENTAL TYPES; PSYCHOANALYSIS 265

XIV.

ATTENTION AND ATTENTION DEFECTS

XV. XVI.

IMAGERY AND MEMORY

.

.

815 334

SPECIFIC PATHOLOGICAL IMAGERY AND M E M ORY DEFECTS 358

X V I I . ASSOCIATIONAL PROCESSES

390

XVTII.

DISORDERS IN THE ASSOCIATIONAL MECHANISM AND METHODS OF INVESTIGATING EMOTIONAL DISTURBANCES, SUBMERGED COMPLEXES AND DECEPTION 417

XIX.

THOUGHT, LANGUAGE, SPEECH DEFECTS, AND REASONING 449

CONTENTS

xvii

PART m MOTILITY THE GENERAL LEVEL OF MOTOR COMPETENCY AND SPECIFIC MOTOR ABILITIES AND DISABILITIES XX.

T H E GENERAL LEVEL OF MOTOR COMPETENCY AND SPECIFIC MOTOB AND PSYCHOMOTOR TRAITS 483

XXI.

ABNORMAL AND BIZARRE MOTOR MANIFESTATIONS 523

PART IV EMOTIVITY THE STAGE OF EMOTIONAL DEVELOPMENT, AND EMOTIONAL, INSTINCTIVE, TEMPERAMENTAL, AND CHARACTER PECULIARITIES XXH.

XXIII. XXIV.

EMOTIONAL, TEMPERAMENTAL, AND CHARACTER TRAITS, AND THE METHODS OF INVESTIGATING THEM 541 MAJOR PROBLEMS IN THE STUDY OF EMOTIONAL, TEMPERAMENTAL, AND CHARACTER TRAITS .

569

PATHOLOGICAL DISTURBANCES OF AFFECT AND CHARACTER 591

APPENDIX: STUDIES OF THE RELIABILITY OF GROUP INTELLIGENCE TESTS 607 BIBLIOGRAPHY

613

INDEX

629

ILLUSTRATIONS 1. APPARATUS

USED

IN PSYCHOLOGICAL

AND PSYCHO-

EDUCATIONAL CLINICS

Frontispiece

2. D R . ROTCH'S RADIOGRAPHS OF THE HANDS OP CHILDREN

facing 22 3. D R . ROTCH'S RADIOGRAPHS OF THE HANDS OF CHILDREN,

continued

facing

23

4. SAMPLES O F T E S T S FROM T H E NATIONAL INTELLIGENCE

TESTS

186,187

5. M Y O P I C OR SHORT-SIGHTED E Y E

222

6. EMMETROPIC OR NORMAL E Y E

223

7. HYPERMETROPIC OR LONG-SIGHTED E Y B

.

.

.

8. G I R L WITH STRABISMUS

. 223

facing 225

9. WESTERN ELECTRIC PORTABLE 3-A AUDIOMETER FOR

INDIVIDUAL U S E

facing

10. W . H E A L Y ' S P I C T O R I A L C O M P L E T I O N T E S T

.

.

.

239 . 262

11. T H E AUTHOR'S CANCELLATION T E S T O FATTENTION A N D QUICKNESS AND ACCURACY O F PERCEPTION

.

.

.

. 322

.

.824

13. M E M O R Y O F R I G H T ASSOCIATES — ILLOGICAL S E R I E S

. 346

14. M E M O R I Z I N G T E N T H R E E - P L A C E N U M B E R S

.

.

.

. 348

15. SUBSTITUTION O R D I G I T SYMBOL T E S T

.

.

.

. 849

.

.

.

. 399

12. D O T - C O U N T I N G T E S T

16. T H E K E N T - R O S A N O F F S T I M U L U S W O R D S

.

17. S P E E C H D E F E C T S F O U N D AMONG 89,057 E L E M E N T A R Y A N D H I G H SCHOOL PUPILS I N ' O N E SCHOOL SYSTEM

.

.

. 455

xx

ILLUSTRATIONS

18. GRADE DISTRIBUTION OF LISPEBS AND STUTTERERS ACCORDING TO SEX

465

19. GRADE DISTRIBUTION OF LIBPERS AND STUTTERERS IRRESPHCTIVE OF SEX

466

20. TAPPING BOARD

494

21. T H E SMEDLEY DYNAMOMETER FOR MEASURING STRENGTH OF G R I P

499

22. Mosso's EBGOGRAPH FOR MEASURING MUSCULAR F A TIGUB

501

23. STEADINESS TESTER

505

24. H. C. LINK'S MANUAL-DEXTERITY AND SPATIAL-PERCEPTION TESTS

510

25. J. E. W. WALLIN'S PEG-BOARDS

511

26. T H E VINELAND-SEGUIN FORM BOARD

512

27. CURVES SHOWING AMOUNT OF YEARLY IMPROVEMENT IN SPEED OF REACTION, BASED ON THE SEGUIN FORM BOARD 513 28. G. O. FERGUSON'S GRADED FORM BOARDS

.

.

.

.

29. W. HEALY'S PUZZLE BOX

514 516

30. ASSEMBLING T E S T OF GENERAL MECHANICAL ABILITY 31. MAZE TESTS

.517 520

32. (A. H.) JUDGMENT OF INTELLIGENCE FROM PHOTOGRAPHS

facing 556 83. (W. H.) JUDGMENT OF INTELLIGENCE FROM PHOTOGRAPHS "

facing 556 34. (W. H.) JUDGMENT o r INTELLIGENCE FROM PHOTOGRAPHS

facing 5S7

TABLES 1. T H E A G E OF APPEARANCE OF VARIOUS STRUCTURES AND

ACTIVITIES 2. ORIGINAL

66-67 AND

DERIVED

CORRELATION

COEFFICIENTS

FOR PHYSICAL D E F E C T S AND ACHIEVEMENT 3. PERCENTAGE OF CHILDREN I N E A C H

OF

CHILDREN

IN

.

.

84

STANFORD-BINET

A G E W H O COULD R E P E A T F I V E D I G I T S 4. PERCENTAGE

.

.

EACH

.

.

.

852

INTELLIGENCE

CLASSIFICATION W H O COULD REPEAT F I V E D I G I T S

.

.

352

5. PERCENTAGE OF CHILDREN I N EACH B I N E T A G E W H O N A M E D AT L E A S T SIXTY WORDS I N T H R E E M I N U T E S

.

403

6. PERCENTAGE OF CHILDREN I N E A C H DIAGNOSTIC C A T E GORY N A M I N G AT L E A S T SIXTY WORDS I N T H R E E M I N U T E S

403

7. N U M B E R OF WORDS N A M E D I N T H R E E M I N U T E S BY C H I L DREN I N E A C H BINET-SIMON A G E (1908

SCALE) .

.

.

403

8. N U M B E R OF W O R D S N A M E D I N T H R E E M I N U T E S BY C H I L DREN I N E A C H INTELLIGENCE CATEGORY (1908

SCALE)

.

404

9. CHRONOLOGICAL A G E OF THE CHILDIVEN INCLUDED I N TABLE 8

404

10. N U M B E R OF W O R D S UTTERED DURING E A C H SUCCESSIVE MINUTE 11.

404

A G E I N Y E A R S WHEN CHILDREN OF VARYING GRADES OF INTELLIGENCE FIRST BEGAN TO U S E SINGLE W O R D S AND SHORT P H R A S E S OR SENTENCES

12.

THE

AVERAGE

SHOWN B Y (A)

AMOUNT

OP

453 RETARDATION

IN

YEARS

THJB SUBNORMALS COMPARED WITH T H »

xxu

TABLES NORMALS, AND (B) THB FEEBLE-MINDED COMPARED WITH THE NORMALS

454

13. INTELLIGENCE DIAGNOSIS OP SPEECH DEFECTIVES 14. COMPARING

SENSATIONS, PERCEPTIONS,

.

.

456

IMAGES, AND

CONCEPTS

478-79

15. COMPARISON BETWEEN INDUCTIVE AND DEDUCTIVE R E A SONING 16. COMPARISON OP CEREBRAL WITH SPINAL PARALYSES 17. STUDENTS' ESTIMATES OF THE MENTAL LEVEL OF A. (FIG.

480 . H.

32)

18. STUDENTS' ESTIMATES OF THE MENTAL LEVEL OF W. (FIGS. 33 AND Hi)

525

559 H. 559

CLINICAL AND ABNORMAL PSYCHOLOGY

• PART I INTRODUCTION CLINICAL EXAMINATIONS, DEVIATIONS FROM NORMS, AND GENERAL AIMS AND PRINCIPLES

CLINICAL AND ABNORMAL PSYCHOLOGY

• CHAPTER I CLINICAL EXAMINATIONS AND PSYCHOLOGY Manifold aspects of a clinical examination. A thorough clinical examination of a mentally deviating individual is highly complicated, for obvious reasons. A human individual is the most highly developed and complex of all living organisms. No phase of his complicated nature can be fully comprehended without a knowledge of related phases. Likewise his physical, mental, social, and moral development, whether normal or abnormal, is influenced by numerous factors. Since the mental abnormalities to which a human being is subject are as numerous and intricate as the factors which produce them, it is necessary, in order to understand them, to inquire into the dynamics of their causation. No mental abnormalities are exactly alike, and each requires the type of treatment which is adjusted to its pe>culiar nature. The modes of adjustment are as numerous as the nature of the deviations and the nature of the causation. The task of analysis is made more difficult by the fact that no inclusive measure of human competency has thus far been evolved. To obtain a comprehensive measure of the individual's capacities, the results of numerous observations and tests must be pooled. Experiments have demontstrated that single personality traits do net correlate significantly with Binet age, or with estimated mental, emo*.

4

CLINICAL AND ABNORMAL PSYCHOLOGY

tional, social, or educational maturity, and that reliable measures of general mental ability and physical fitness can only be obtained by combining many different single measurements. For these reasons, a scientific study of an abnormal individual demands a consideration of many phases of numerous "fields of inquiry." Six fields may be considered to be basic in the investigation of mentally deviating school children, namely: 1. 2. 8. 4. 5. 6.

A mental examination An educational examination and investigation An environmental investigation A physical examination A developmental investigation An hereditary investigation

Scope of this text. The conclusion was reluctantly reached that this text must be limited to a consideration of the first field of inquiry. This conclusion does not imply an underestimation of the importance of the other aspects of the study of the mentally abnormal, but to have considered them, even in cursory fashion, would have required the addition of one hundred and fifty or two hundred pages to the book, and this would have made the book too long. After all, the first field, dealing with clinical and abnormal psychology, is the least well known and in many ways the most important, and to this field this volume will be devoted. The attempt will be made in the introductory part to provide proper orientation for the discussions in the main body of the book (Parts I I to IV), by defining the field of clinical psychology and the type of phenomena with which it is primarily concerned, by describing the important aims and methods of psychoclinical examinations, and by laying down the rules and principles which should govern such examinations.

CLINICAL EXAMINATIONS AND PSYCHOLOGY

5

The mental examination of exceptional individuals. There are two fundamental phases of a mental examination, the psychiatric or psychopathological, and the psychological. The first embraces all the methods employed by the psychiatrist or psychopathologist in the examination of the mentally diseased or disordered and the psychopathic.1 The psychiatrist attempts, by means of interrogations, tests, and repeated observations and interviews, to discover the nature of the patient's mental peculiarities, and particularly the presence of delusional trends, illusions, hallucinations, obsessions, anxieties, complexes, conflicts, inhibitions, emotional and volitional abnormalities, and the like. Special methods of psychological analysis (for example, the method of psychoanalysis, so-called, and the association-reaction test), as well as numerous supplementary neurological and physical examination methods, are widely employed by many psychiatrists. The psychological method of conducting a meital examination is based on the procedures employed by the examining psychologist, and is applicable alike to the sick or the well, the abnormal or the normal, the subnormal or the supernormal, the young or the old. Elusive distinction between the psychiatric and psychological approach. The average psychiatrist places his main reliance on the method of psychological observation and the well-recognized medical and neurological examination methods, supplemented by standardized psychological tests. On the other hand, the chief reliance of the examining psychologist is on objectively controlled, standardized psychological tests, and standardized norms of performance, supplemented by data from the history of the case and the findings of the physical examination. Although this dis1 A mental disease is popularly and legally called insanity, and scientifically a psychosis. A psychiatrist in popular and legal parlance is an alienist.

6

CLINICAL AND ABNORMAL PSYCHOLOGY

tinction is true historically, the methods are tending more and more to overlap. The progressive psychiatrist frequently utilizes the standardized testing technique of the psychologist, while the well-trained psychologist supplements the method of experimental testing by the method of observation, in order to obtain a picture of the examinee's general attitude, behavior, emotional and instinctive tendencies, and personality make-up. Again, the psychiatrist has heretofore been chiefly interested in those deviations from mental normality which can be definitely classified as diseases (i.e., psychoses), while the psychologist has been chiefly interested in mental normality and those deviations which, in accordance with the law of probability, appear to be non-pathological departures from the type; namely, arrests of development or subnormalities, which, in the large mass, appear to be defective conditions :ather than active diseases, and excesses of development or supernormalities. Nevertheless, many psychiatrists have lately acquired a keen interest in the problems of mental defect (as distinct from mental disease) and in the mental hygiene of the normal mind as well as of the abnormal mind. The discussion of psychiatric procedures and results will occupy a position of subordinate interest in this book, the primary concern of which will be with psychological methods and procedures. This is a text in clinical and abnormal psychology, rather than in psychiatry. Psychological orientation. la order to obtain proper orientation for the discussions which are to follow, it is necessary to answer a number of preliminary questions: What is psychology? From what standpoints may the science be pursued? What is the standpoint of this book? What are the chief divisions or branches of psychology? With which branch does this book deal? What is the peculiar method of investigation employed by clinical psychology, and how

CLINICAL EXAMINATIONS AND PSYCHOLOGY

7

does it differ from other psychological methods? What is the distinctive field of investigation and service of clinical psychology? It is neither necessary nor practicable here to enter into an exhaustive discussion of all of these questions. A few brief statements regarding some of them will afford sufficient background for our purpose. Meaning and standpoint of psychology. The science of psychology has been variously denned, according to the predilections and point of view of the writers, as the science of mind, the science of consciousness, the description and explanation of the phenomena of consciousness as such, the systematic study of experience, the science dealing toith the interaction between living beings and their environment and the mental events produced by such interaction, and the science of behavior. Definitions of the science vary according to the interpretation of the basic terms employed—"mind," "mental events," "consciousness," "experience," or "behavior" — and the rdles attributed to them in the functioning of the organism. There are four well-recognized schools of psychologists— the structuralists, the functionalists, the behaviorists, and the motivists — each of which views the subject matter of psychology from a different angle. Psychological structuralism. The structuralist defines psychology as a systematic study of mental phenomena from the standpoint of their (momentary) constitution. The psychologist's task is to analyze the momentary or transient states of consciousness into their ultimate elements (" psychological atomism"), and to describe, classify, and explain mental structures. He attempts to recombine the elements into complex states, to arrange mental states into a system much as the chemist arranges and classifies chemical elements, and to discover the laws and principles governing the development of complex mental states from simple mental

8

CLINICAL AND ABNORMAL PSYCHOLOGY

states. Latterly, the Gesialt (configuration) theory, a reaction against psychological atomism and the stimulusresponse theory, has attained prominence through the writings particularly of Kurt Koffka and Wolfgang Kohler. According to this theory, separate sensations do not exist, but only "undivided, articulated wholes" which are called "structures" or "configurations." Unitary structures are the ultimate data of psychology, the mind's natural units, which cannot be resolved into constituent elements or part qualities. Structures are what they are by virtue of " their place in the whole; their essential nature being derived from the whole whose members they are." They do not result merely from the stimulus or merely from the accretion of discrete elements by a synthesizing activity of the mind. They are the result of both the stimulus and the reacting organism which has a constitution of its own. The perceptive process has its inherent constitution, shape, and patterns. Unitariness is an original property of perception. Mental development proceeds through the transformation of structures. The behavior of the organism in time shapes configurations. "Attitude is a readiness to carry out a structural process." Psychological functionalism and dynamism. The functionalist, who writes from the biological point of view, is concerned with the study of the significance of mental life as a process of adjustment rather than with its composition, while the "dynamic psychologist" is interested in mental phenomena from the point of view of cause and effect. The two terms are often used interchangeably. The functionalist, emphasizing the dynamic aspect of consciousness, is especially concerned with describing how the mind operates, how it is modified from moment to moment, and what purposes various mental states subserve. What are the uses of sensations, perceptions, ideas, memories, feelings, in-

CLINICAL EXAMINATIONS AND PSYCHOLOGY

9

stincts, emotions, or of any other mental process? Briefly, the biological function of mental processes is to mediate action, to adjust the organism to the environment by inhibiting, directing, or controlling movements. The mind is an instrument of adjustment in the struggle for existence. Psychological behaviorism, or objectivism. Behaviorism has in recent years become a term with which to conjure. The extreme behaviorist espouses a type of psychology or psychobiology which is exclusively objective, sans mind, sans consciousness, and sans all sympathy for the subjective approach to the study of mental phenomena. Behaviorism, starting with behavior as objectively observed, regards all behavior as a series of "conditioned reflexes," * or motor reactions to external stimuli. These stimuli are always provided by the external environment, or by the movements of the muscles, or by the changes in the secretions of the glands. The whole chain of events can be reduced to the following facts: first, movements aroused in the organism; second, adjustment of the nervous system; and third, some sort of reaction. Verbal substitutes take the place of everything bearing the faintest resemblance to consciousness. Thought becomes a "speech habit," and thinking becomes "implicit habit responses" (J. B. Watson). The behaviorist interprets all experience in terms of behavior. For him, there is no difference in kind between an overt act and what other psychologists would term the conscious act or consciousness. Psychological motivism. The fundamental tenet of the theory of motivism — a rather inept term employed by L. L. Thurstone — is that mental action originates in the actor rather than in the environment. Thurstone contrasts 1

Conditioned reflexes, which are produced by artificial stimuli which have been given in association with natural stimuli, are discussed in Chapter XX.

10

CLINICAL AND ABNORMAL PSYCHOLOGY

the points of view of normal and abnormal psychology by saying that the older, normal, or academic psychology simply regards a person as a responding, reflex machine, or a re* agent. It explains all mental action on the basis of the stimulus-response formula. It resolves every psychological problem into three components: first, the external stimulus, the starting-point, which provokes all psychic activity; second, the mind, or the central nervous system, consisting of certain bonds, pathways, or connections; and third, the behavior of the individual, which follows as a response to the stimulus and the interaction of the organism upon it. Behavior is interpreted as a mathematical function of the stimulus. Normal psychology is interested in momentary mental states, but seldom in the permanent hie interests of the individual. The stimulus is its starting-point, while conduct or behavior is its end-point. The newer psychology, the psychology of the abnormal, and psychiatry, on the other hand, assume that conduct has its starting-point and roots in the energies, life-impulses, cravings, aspirations, and purposes of the living self, while the stimulus occupies merely the rdle of a secondary, exciting, cause. The sequence of events is: the living, impulsive, purposeful person, the stimulus, and the behavior; instead of the stimulus, the reacting person, and the behavior. Behavior is primarily the result of the motives, appetites, anticipated satisfactions or dissatisfactions, and conflicts of the dynamic, living «>lf. "The stimulus is not primarily provocative of living mental life. We, ourselves, are." The primary data for abnormal psychology, psychoanalysis, and psychopathology are the basic and permanent human impulses, life-interests, wants, and motives, and the manner in which they express themselves. The environment is merely the modifier of behavior, and the means by which beings try to express their cravings and ambitions. The

CLINICAL EXAMINATIONS AND PSYCHOLOGY 11 primary formula is thus converted into impulse-response, or motive-conduct, in place of stimulus-response. Psychology begins with the life-impulse, or the unrest of the inner self. Only a few of the more important recent psychologies have been written from the exclusively structural, functional, or behavioristic viewpoints. The viewpoint of the present book differs in an important respect from that of many of the academic psychologies. It is written with the conviction that an adequate explanation of a psychological fact or of conduct in general requires an increased emphasis upon the experiencing organism. The experiencing organism constitutes the tertium quid, the connecting link, between the stimulus and the response, and determines the nature of the response. How the individual will react to a given stimulus depends, not only on the nature of the stimulus, but on the nature of the instinctive "drives " (It. S. Wood worth), appetites, aversions, conscious directing purposes, and personality make-up of the reactor. The unifying forces of the inner life are not blind, inexorable mechanism, but "drive" and "purpose," or the direction of the energies of the organism toward the realization of definite, purposed objectives. Without accepting the deductions of the extreme behaviorists, this book is sympathetic toward a behavioristic approach. It recognizes the importance of the structural and functional descriptions of mental processes as the necessary preliminary to any scientific consideration of psychological facts. Branches of psychology. So rapid has been the progress of psychological investigation that numerous more or less distinct divisions or branches of psychology have developed during less than half a century, chief among which are the following: 1. Physiological psychology £. Experimental psychology

1*

CLINICAL AND ABNORMAL PSYCHOLOGY 8. 4. 5. 6. 7. 8. 9. 10. 11. 12.

Educational psychology Child psychology Animal psychology Genetic psychology Social psychology Business or commercial psychology Racial psychology Criminal psychology Abnormal psychology Clinical psychology

While primarily designed as a systematic introduction to the study of clinical psychology, this book will touch upon some of the more important facts of abnormal psychology. It is important that the student should form at the beginning of this study a proper conception of these two sciences, and particularly clinical psychology, the younger of the two, which was so named less than a third of a century ago (in 1896) by Lightner Witmer, of the University of Pennsylvania. Abnormal psychology. Abnormal psychology is concerned with the study by introspective, clinical, experimental, behavioristic, or other methods of investigation of the mental changes due to diseases, disorders, or abnormal or unusual nervous or bodily conditions. In the broadest sense, it includes the systematic description and explanation of all sorts of strange, abnormal, pathological mental phenomena, such as dreams, hypnosis, automatic writing, mirror writing, crystal gazing, telepathy, illusions, delusions, hallucinations, disordered, deficient, exaggerated, or perverted sensations, perceptions, ideas, thoughts, memories, emotions, instincts, impulses, or conations, mental diseases, and mental immaturities, retardations, and deficiencies. It is more inclusive in its scope and methods of approach than clinical psychology. Indeed, clinical psychology could be considered a division of abnor-

CLINICAL EXAMINATIONS AND PSYCHOLOGY

IS

mal psychology, although probably not without protest from the founders of the science. Clinical psychology owes its genesis and development to others than the recognized abnormal psychologists. According to a popular contrast, abnormal psychology is a science — a pure science — rather than an art, while clinical psychology is an art rather than a science. This contrast, while not strictly true and more or less superficial, is not without some merit. Meaning of clinical psychology. The word clinical (from Greek roots meaning bed, bedside, and to recline) in medicine refers to the detailed, objective study of the living patient, at the bedside, or in the ward, the hospital amphitheater, the clinic, or the physician's private office. The student's observations are guided by the instructor's questions, descriptions, and demonstrations. In the best clinical courses typical specimens of disease are presented, and the students are required to make original observations and tests, to state and interpret theirfindings,and to outline the necessary treatment. This objective, concrete method of studying cases has been extended by R. C. Cabot (in his Case Teaching in Medicine) to include the critical study of a series of graduated exercises in differential diagnosis, prognosis, and treatment based on the recorded data on actual cases of disease, instead of on the examination of the living patient. The purpose of this procedure is to afford training in the inductive method on which all scientific work is based. The clinical case method has been widely applied in law, education, psychology, business, and other branches of instruction. C. C. Langdell introduced it into the Harvard Law School, about a half-century ago, for the purpose of developing the "power of legal reasoning, discrimination, and judgment," and training the students in the scientific or inductive method of studying law.

14

CLINICAL AND ABNORMAL PSYCHOLOGY

In law, the student is required to master the facts and legal principles embodied in representative cases, as adjudicated by the courts; to formulate the results in concise, logical principles and rules of law; and to apply the principles to similar court cases. He must analyze the cases, discriminate the relevant from the irrelevant details, compare them with other cases, state the conclusions of law, and be prepared to present the case before the class. Case-books used as texts contain only reports on actual law cases, arranged systematically with statements of the facts at issue, the arguments pro and con, the decision of the court, and the grounds upon which it was rendered. The case reports are to the law student what specimens are to the geologist. The merit of the method is that law is studied as a science consisting of a body of principles to be found in adjudged cases. In education the clinical method usually refers to the careful observation and study of the individual pupil by the teacher, and the adaptation of the instruction to his peculiar needs. W. P. Burris, however, has restricted the term " case method " to the critical study of adequate and accurate reports of lessons or school exercises which have been carefully selected and classified. The student is required to analyze the reports of individual teaching exercises, classify them, evaluate them from the standpoint of content, method, and the character of pupil material, point out conspicuous merits and defects, and show how the exercises connect with prior and succeeding exercises and how they exemplify or violate various principles of teaching. The method is based upon the concrete, inductive study of particular cases or examples of teaching, and is advocated as a supplement to textbook instruction, lesson-planning, observation of teaching, demonstration teaching, and practice teaching. Strayer, on the other hand, has applied the law case-study plan to pro* blems of educational administration.

CLINICAL EXAMINATIONS AND PSYCHOLOGY 15 In psychology, the terms clinical method and case method have been used synonymously, and refer to the detailed, objective study of the mental nature of an individual. The differentiating characteristic of clinical psychology is found in its method. Since the method employed is the concrete study of particular cases, clinical psychology might with propriety be called — as indeed it has been called — "individual," "differential," or "case" psychology. Difference between the introspective, statistical, and clinical methods of investigation. The clinical method differs in certain essential particulars from other well-known methods employed in psychology; namely, the statistical and the introspective methods. The method of introspection is the oldest method of psychological investigation. By an act of reflective selfanalysis or introspection (literally, looking within), the subject studies his own mental processes, thoughts, feelings, impulses, desires, resolutions, fears, conflicts, etc. This method is not objective, but individual and subjective; and therein lies its chief defect. The introspectionist meets two important obstacles. First, the method itself is difficult, and inescapably subjective. Second, the introspectionist finds it hard to resist the tendency to objectify subjective phenomena ("eccentric projection"); that is, to read into others what may be true only for himself. The behaviorists, who are committed to the exclusive reactionist or objective type of psychology, completely reject introspection as a scientific method. It is probable, though, that the method will always remain an indispensable supplement for verifying and interpreting the results of objective observation and experiment. Psychological data are ambiguous or relatively barren until they can be interpreted by our own intimate, vital, pulsating experiences. By means of the statistical (or group) method we may

16

CLINICAL AND ABNORMAL PSYCHOLOGY

study the mental facts of masses of people, with the aid either of the questionnaire or of laboratory tests. The questionnaire, a list of printed questions, answered on the basis of present knowledge or experience, or on the basis of reminiscence or retrospection, has been extensively employed not only in psychology, but also in education, sociology, economics, and other sciences. The laboratory method, in which standardized tests are given with the aid of testblanks or laboratory apparatus of varying degrees of intricacy and accuracy, is employed in experimental, educational, and abnormal psychology, and in experimental pedagogy. Thus, to measure speed of reaction, the subject may be required to tap as rapidly as possible on an electrically connected tapping board, each tap being registered by an electrical counter or recorded along a time line on the cmoked surface of a rotating drum. Whether the questionnaire or the laboratory procedure is employed, the statistical method, like the clinical, is objective and concrete, inasmuch as the object of study consists of definite reactions on the part of chosen reagents, and not the subjective or internal states of the experimenter. Concrete individuals or experiences and not abstractions are subjected to controlled investigation. Although all the data collected must necessarily come from the investigation of individuals, it is nevertheless true that when the statistical method is employed we are not concerned with individuals as such. The questionnaire investigator of " What Children Think About Clouds" is not particularly concerned with what Ada Jones thinks clouds are made of, where they come from, what makes them travel, or how they affect her. He is interested in discovering typical tendencies, and significant variations of such tendencies. The experimental psychologist, qua experimental psychologist, is not particularly interested in the memory peculiarities of Bobby Jones, but

CLINICAL EXAMINATIONS AND PSYCHOLOGY 17 he is interested in discovering the facts, relationships, and laws of memory, such as the memory differences between children of various ages, between children and adults, between males and females, between animals and humans, the most economical methods of memorizing, conditions of a good memory, and the defects of memory. The experimental psychologist is interested in the study of mental traits, not of one particular individual, but of groups of individuals, so that he may reach general conclusions, principles, and laws. On the other hand, the clinical psychologist is interested in the individual as an individual. He wants to discover the essential facts regarding the individual, to diagnose his condition, and to recommend measures which will remedy or mitigate the particular abnormalities which have been discovered. It is evident, therefore, that the standpoint of the clinical psychologist and the physician is the same. Since the aim of the clinical psychologist is to make an individual diagnosis, his investigation must be many-sided. In order to arrive at a rounded view or a detailed picture, he must explore manyfieldsand test many traits in the same individual. Not so the experimental psychologist. His investigations are confined to one trait, or a few traits, at a time. In order to establish averages, or standards of performance, or plot distribution curves, he makes a thorough investigation of one particular trait, or a series of particular traits, in one or more selected groups of reagents. Individuals with whom clinical psychology is primarily

concerned. The clinical psychologist may, if he chooses, study any individual whatsoever, be he adult or child, female or male, normal or abnormal, sane or insane, dull or bright. Hitherto, however, his interest in normal individuals has been largely restricted to the task of obtaining standards of comparison — norms of performance and measures of variability — for normal individuals or unselected groups of

18

CLINICAL AND ABNORMAL PSYCHOLOGY

individuals. It is possible that norms of mental performances valid for clinical use may have to be established by individual tests rather than by group tests, as experiments have shown that some children make higher scores when tested in groups than when tested alone, presumably due to the incentive derived from contest and rivalry. Others make inferior scores due to the tension and confusion engendered by the excitement of competition. Historically considered, the interest of the clinical psychologist has been largely confined to deviating or exceptional individuals, particularly children. While this book is chiefly concerned with deviating or exceptional juveniles, some consideration is given to the abnormal mental manifestations of adults, not only because most mental abnormalities are more fully developed in adulthood and therefore are more readily recognized, but because children are in the process of becoming adults, and it is only a question of time when many of them will suffer from the adult forms of mental disturbances. The student of psychology, education, and sociology should possess some familiarity with both juvenile and adult forms of mental malfunctioning. Meaning of exceptional child. A deviating or exceptional child is one who departs from the standard or type. He is an "atypical," or "off-the-norm" child. This distinction, however, is too broad, for all individuals vary more or less. No two leaves from the same tree, or two hairs from the same head, are ever exactly alike. Nor can two normal children nor two adults be found who are absolutely alike in their physical or mental traits, even when they are "identical twins." One will possess slightly more of some and slightly less of other traits. Diversity, rather than dead uniformity, is the rule of life. This fact is not without its redeeming features. What a dreary, monotonous world we should have if all people were just alike! Diversity adds

CLINICAL EXAMINATIONS AND PSYCHOLOGY 19 zest and piquancy to life. How consoling it must be to the "deviate" to know that all persons have some longs and shorts in varying degrees! From this patent fact it should be evident that the application of the term "exceptional" must be limited to children who deviate rather conspicuously or obviously, e.g., children who are noticeably backward or noticeably capable or alert. After all, these are the children who require the largest measure of discriminating educational, mental, and social treatment. Types of deviation. There are two kinds of variation from the normal, specific, and general or generic. Specific variations apply to individual or specific traits. They are specific abnormalities. A defective memory, poor visual imagery, blindness, deafness, defective number sense, and harelip constitute specific disabilities or defects; while unusual ability in music, reading, arithmetic, visualization, and memory, constitute specific abilities or talents. Generic variations are more or less all-round departures from the norm. There is a general discrepancy between the child's calendar age and his physical or mental development. For example, the child's height, weight, spirometric and dynamometric measurements, or his "general intelligence" may be less than they should be for a child of the same calendar age. Possible directions of variation. All deviations occur in one of two directions from the central tendency. Children who deviate mentally in the minus direction are referred to as retarded, arrested, subnormal, inferior, or deficient; while those who deviate in the plus direction are termed accelerated, gifted, bright, superior, brilliant, or precocious. The two chapters which follow will be devoted to a consideration of the features of human development which are subject to conspicuous variations.

CHAPTER II DEVIATIONS IN CHRONOLOGICAL, PHYSIOLOGICAL, ANATOMICAL, PSYCHOLOGICAL, EDUCATIONAL, AND SOCIO-INDUSTRIAL AGE Attributes subject to variation. What attributes or aspects of a child's nature are subject to retardations or accelerations? Probably every phase of his complicated make-up is subject to deviation. A child is a composite of different stages of maturity, or of different "ages." He is a multipleaged creature, each "age" depending upon the stage of development of a given attribute. Little has been affirmed regarding a child when he is said to be ten years of age. He must be considered as having not one age, but many ages, among which profound variations and discrepancies may be found. This will appear from a brief consideration of the variations which occasionally occur in six of his " ages.'* I. CHRONOLOGICAL AGE The chronological age, calendar age, or physical age refers to the child's actual life age, and is usually reckoned from the day of birth, rather than from the time of conception. In the nature of the case, the chronological age is exact, and does not admit of variation provided it is correctly reported. But therein lies the difficulty. It is often difficult to obtain the child's exact date of birth, either because the parents or guardians do not know, or because they deliberately misrepresent the age. Universal birth registration is the only remedy for this difficulty. Even this has its limitations, since people move from State to State and transcripts of the

DEVIATIONS IN DEVELOPMENT

81

birth records of migrants are difficult to obtain. The importance of obtaining the child's correct age cannot be too strongly emphasized. An error of a year or two in the recorded age, particularly of younger children, may lead to grievous errors in mental diagnosis. Therefore, in the psychometric examination of mentally deviating children, the first precaution is to verify the reported age. n . PHYSIOLOGICAL AGE Physiological age refers to the stage of maturity of the physiological functions which may show accelerations or delays. Included in this rather loose category are such traits as weight, height, dentition, the onset of pubescence, the change of voice, and the menopause. Extent of maturity differences. A few facts showing the extent of differences in physiological maturity may be cited. The typical infant is chubby. So is the prepubescent, but to a less degree. The skin of the mature youth is thicker and firmer. C. W. Crampton's investigation of the stages of pubescence in 3835 high-school boys showed that surprising maturity differences exist among boys of the same average chronological age (13.75). One third were immature (prepubescent), one third maturing (pubescent), and one third had passed through the pubescent state (postpubescent). The most precocious became pubescent at 12.5 years, and the most retarded at almost 18, giving a difference of over five years in pubescent maturity. In a tabulation of data on pubescent growth and pigmentation of fine hair of 3600 Baltimore boys partaking in athletics, and 1317 boys drawn from fourteen counties of Maryland, B. T. Baldwin and C. F. Pennington found that the state of prepubescence ranged from 8.5 to 16 years for the country boys, and form 9.5 to 17.5 for the city boys; the corresponding ranges for the pubescent stage were from 9.5

2g

CLINICAL AND ABNORMAL PSYCHOLOGY

to 15.5, and from 10 to 18, respectively; and for the postpubescent stage from 11.5 to 24, and from 12.5 to 24, respectively. These differences are larger than those reported by Crampton, possibly because a wider range of chronological ages was included. First menstruation in a group of 388 girls varied from 10 to 16, a difference of six years. The differences in teething are equally striking. Herbert Woodrow reports that the date of eruption of the central incisors, upper premolars, and canines showed a range of six years, and of the six-year molars four or five years. Among 100 children 7.5 years of age, the number of permanent teeth varied from one to sixteen, as recorded by Woodrow and Frances £ . Lowell. One of the advantages of the dentition criterion is that it can be applied from the end of the first half-year to maturity, while pubescence covers only a limited period. Deviation in physical traits. The extent of the deviation here may be shown by comparing the extreme anthropometric measurements in each age of 680 boys examined by the writer in a psychoeducational clinic, most of whom were mentally deficient and backward. The standing height was 1.7 times, and the sitting height 2.5 times, greater for the tallest than for the shortest boy of the same age. The heaviest boy was 3.8 times heavier than the lightest one; the strongest was 4.8 times stronger than the weakest one based on the right grip, and 3.4 times based on the left grip (as determined by the Smedley dynamometer); while the boy with the greatest lung capacity (as measured by the wet spirometer) had 3.9 times the vital capacity of the boy with the smallest lung capacity. Although based on abnormal cases, these ranges are not as abnormal as might be supposed. A similar comparison of 428 unselected eight-year boys (based, however, on the comparison of the extreme ten-percentiles instead of the extreme individual measurements), showed

Z O "' a > 55j w

M

•* '

^ o ȣ3. S o t>;

Q

« g 2H

3

DEVIATIONS IN DEVELOPMENT

«S

that those in the highest ten-percentile of the measurements, as compared with those in the lowest ten-percentile, were 1.% times taller, 8.4 times heavier, 3.4 times stronger as de* termined by hand grip, had £.6 times more vital capacity, and were able to perform 7.1 times more work, as measured by the ergograph. It is evident that children of the same chronological age may be many years apart in degree of physiological maturity as determined by weight, height, dentition, pubescence, strength of grip, or lung capacity. i n . ANATOMICAL AGE Measures of anatomical age. By anatomical age is meant the proportional development or stage of maturity reached by the structures of the body at any given time. The technique available for differentiating the successive stages of development in the cellular structures of the muscular, glandular, fatty, and nervous tissue is too crude to be of any value. On the other hand, it is now possible to differentiate with considerable accuracy, by means of the Roentgen or X-ray, the successive stages of ossification of the cartilages (gradual transformation into bony structure) and of the union of the epiphyses with the shaft. Figures 2 and 8 show radiographs of hands and wrists of girls and boys of various ages. The cartilage which in early life separates the epiphysis (a piece of bone separated from the shaft by a zone of cartilage) from the long bone gradually ossifies, so that the bones eventually merge. The surface area of the bones can be measured by the roentgenograph and the planimeter. The stages of ossification or union appearing in the eight carpal bones of the wrist, the metacarpal bones of the palm, the fingers, thumb, radius, and ulna are said to be representative of the skeletal development in general (T.*M. Botch and A. W.

24

CLINICAL AND ABNORMAL PSYCHOLOGY

George). Two or three carpal bones have appeared at the age of two, and six or seven at the age of six. The bilateral differences are not on the average sufficiently great to be important, according to the findings of a number of investigators. J. W. Pryor, in studies made between 1905 and 1908, described eleven stages, T. M. Rotch, in 1908, thirteen stages; and C. P. Bardeen, in 1921, eleven stages in the epiphyseal and osseous development of the hand. Rotch's stages do not correspond to exact chronological ages, for, on the one hand, one year of growth may cover three or four stages, while, on the other hand, one anatomical stage may represent as much as three years of growth. Bardeen found the same order of development^ Pryor, but the stages appear later, and are more nearly equal in time. He has added a refinement by differentiating four grades or degrees in the process of ossification. It may be said of all the above scales that the classifications of the degree of ossification or the stage of development (except where new bones appear) are based on inspection, and are, therefore, largely subjective. Objective methods of measuring carpal age. More objective methods have been followed for determining the stage of carpal growth. Baldwin measured by means of the planimeter the exposed areas of the carpals, irrespective, however, of the size of the hand. Woodrow and Lowell constructed a scale of anatomical development for ages five and a half to eleven and a half, by ranking the individual radiographs in each age from least to most developed, and taking the median as the standard. The ranking was based on the surface area of the carpals; the number, shape, and compactness of the bones; and the area of the bones relative to the total area of the wrist. Although the classification is, to some extent, based on general impressions, and therefore is more or less subjective, two rankings gave almost complete agreement.

DEVIATIONS IN DEVELOPMENT

85

With the use of the planimeter, and an "ossification ratio," Freeman and Carter determined the stage of development of the carpal bones. The ossification ratio represents the proportion of the total ossification (the sum of the areas of the carpal bones) to the "carpal quadrilateral." The quadrilateral, found by joining designated points at the extremities of the bones of the arm and of the hand, gives a measure of the general size of the individual, and makes it possible to obtain a measure of development uninfluenced "by an individual's size. By enlarging the radiographic areas twentyfive times, by means of a projectoscope, Prescott was able to measure with considerable accuracy by means of the planimeter the areas of the carpal bones, the distances between bones, and the diameter of the wrist. He utilized three objective ratios (denominated "anatomic indices") for determining anatomical age, all of which gave a correlation of .97 or above with subjective ranking of the radiographs. These ratios are: (a) the ratio of the sum of the diameters of the carpals to the diameter of the hand, showing the extent to which the bones of the wrist have developed; (b) the ratio of the sum of the distances between the carpals to the diameter of the hand, showing how far the bones still have to grow; and (c) the ratio of the sum of the diameters of the carpals to the sum of the intercarpal distances, showing the ratio of the completed to the uncompleted growth of the bones. The first ratio, the one used for economy of time, requires the smallest number of measurements, one for each of the eight carpal bones and one for the wrist, and is almost as accurate as either of the others. Based on the anatomical index of a limited number of cases, Prescott found that growth closes on the average between the ages of thirteen and fourteen for girls, and fourteen and fifteen for boys, the eight carpals having ossified at that time. The first bone (o* magnum) ossifies toward the end of the first

«0

CLINICAL AND ABNORMAL PSYCHOLOGY

year, while the amalgamation of the epiphysis of the radius occurs at the age of eighteen or nineteen. Alleged advantages of ossification method. Because of the refinement of the objective methods of measurement employed, the ossification method makes it possible to make finer differentiations in the stages of anatomical maturation. Moreover, the processes of ossification and epiphyseal development or union are said to be quite regular and stable, the bones developing in a fairly definite order. On the other hand, weight is subject to widefluctuations,depending on a variety of factors; height is more or less inconstant; while muscular development varies with the amount of exercise. Osseous development, it is alleged, is markedly affected only by abnormal changes in metabolism. Thus, it is delayed in hookworm disease (E. K. Strong). Nevertheless, underfeeding experiments on young white rats, calves, dogs, and cats show that the skeleton continues to grow while the weight remains stationary. Variations in anatomical maturity. The wide variations found in bodily maturity of children were strikingly shown in the X-ray pictures of the hands of 100 ten-year children from three Minneapolis elementary schools. S. O. Severson differentiated ten stages of carpal maturity, based on the size, number, and compactness of the carpal bones, on the styloid process and the epiphyseal union. The least mature child was equal to a girl of 6.7, and the most mature to a girl of 11.7 years of age in the Rotch scale. This gave a difference of five years in anatomical maturity for this group. Woodrow and Lowell report a difference of about six years in the carpal age for their group of seven-and-a-half-year-old children, while Prescott found a range of at least five and a half years among 162 boys of ages 6.2 to 6.6, the variability being greater for the boys than for the girls. Practical bearing of the doctrine of physiological and

DEVIATIONS IN DEVELOPMENT

«7

anatomical age. Some writers hold that the discovery of the child's stage of bodily maturity not only yields scientific information of intrinsic interest regarding retardations and accelerations in physical growth, but also affords a basis for the more scientific classification of children. They ask that not only the muscular activities, but also the literary instruction in school and the social accommodations of children be adjusted to their stage of physiological or anatomical maturity, rather than to their chronological age or even their intelligence level. They hold that an immature organ should not be forced, that the bodily mature child is stronger, more resistant, and more developed mentally than the immature child of the same age, and that there is a correspondence between physiological, anatomical, and brain maturity. Too vigorous exercise of an immature organ produces three primary results — excessive fatigue, overstrain, and loss of tone or vigor {atony), besides a host of ensuing sequelae, such as muscular atrophy, cardiac enlargement or lesions of an infective or mechanical nature, eyestrain, defective nutrition, disturbance of the digestive functions, spinal neurasthenia, structural and functional alterations of the muscle and nerve cells (exhaustion of nuclear material in the neurocytes), mental lassitude, chronic toxemia, and heightened susceptibility to infections. The time required to return to normal after overstrain, when at all possible, is much greater than the time of recovery from simple fatigue. Frequently an overstrained organ is weakened, so that it is less capable of responding to the needs of the organism. Overexertion may even lead to permanent stunting of its growth and development. Therefore, the immature child should not be compelled to compete with the mature child, nor should school classification or promotion be based solely on apparent or actual mental capacity. If, it is argued, a

88

CLINICAL AND ABNOBMAL PSYCHOLOGY

bright immature brain does not possess the same powers of resistance as a more mature brain, the precocious immature child should be held back in the literary subject matter instead of being advanced in accordance with his intelligence ability, and he should be given properly regulated, wholesome physical exercise. Unfortunately, this method of classifying children in their physical and educational activities has not thus far been subjected to extensive critical experimentation. Some favorable evidence is at hand, however. Experimental evidence. W. L. Foster reports that in the New York High School of Commerce there were 8.5 per cent less failures in eight entering sections of boys classified according to maturity of pubescence than in four sections classified in the usual manner. After two months' trial of homogeneous physiological grouping the reports of the teachers showed, in general, that the boys feel more at home, and that the methods of discipline and instruction can be more consistently adapted to the requirements of the whole class. Crampton found that about 40 per cent more of his group of immature prepubescent boys than of his postpubescent boys failed in their studies, while the postpubescents were farther advanced in their school work. Baldwin reports an average difference of ten months in the rate of school progress between a group of physiologically accelerated boys (those who were taller and heavier) and a group of physiologically retarded boys consecutively measured for periods varying from six to eighteen years in the Horace Mann and Francis W. Parker schools. Competition in athletic contests has been based on weight divisions rather than on chronological-age divisions in some Y.M.CA.s, and in a New York High School, apparently with gratifying results.

DEVIATIONS IN DEVELOPMENT

20

Sex differences. Classification on the basis of physical maturity would require the segregation of the sexes, or the education of chronologically older boys with chronologically younger girls, since nearly all investigators have found that the girls are more mature than the boys. According to It. B. Bean, American girls of eleven possess four more permanent teeth than boys of the same chronological age. H. Woodrow and F. Lowell found, in the eruption of permanent teeth, that five-and-a-half-year-old and nine-and-ahalf-year-old girls were, respectively, one and a half and two years in advance of the boys. Among seven-and-a-half-year olds, the girls had completed 70.6 per cent and the boys 68.1 per cent of their final height, based on the adult norms of the English Anthropological Committee. These girls were about a year ahead of the boys, while ten-and-a-half-year-old girls were about two years ahead, when the ratio of the growth completed was compared with the final height. In carpal development, girls of 7.5 and 10.5 were, respectively, about one and a fourth and two years ahead of the boys. According to Pryor's figures, girls are six months ahead of the boys in carpal ossification at 1.5, one year ahead at 5, and two and a fourth years ahead at 10.5. Prescott's methods revealed an advance of about eight months for the girls for the entire period from 6 years to 15 years. Freeman and Carter found that the girls' carpal development, in all ages from 5 to 17, was from one to two years ahead of the boys', the puberal acceleration coming one year earlier for the girls. On the other hand, girls excel the boys in height and weight only from the ages of 11 to 14, while they reach puberty about two and a half years earlier than the boys. In spite of these favorable reports, facts will be presented at the close of the next chapter which bring into question the practicability of classifying and promoting children in school on the basis of carpal growth.

SO

CLINICAL AND ABNORMAL PSYCHOLOGY IV. PSYCHOLOGICAL AGE

Mental development in juveniles may correspond to, be in advance of, or lag behind the chronological age. A child may deviate from the mental norm because he was "born short" or "born long," or because he developed mentally at a retarded or accelerated rate. The extent of the mental deviation among elementary-school children classified in the same grade frequently amounts tofiveor six years, while the extreme difference in mental level or mental potentials among adolescents or adults may reach twenty years or more. The brightest person is probably more than twenty times as bright as the dullest one. The methods of determining mental age — the "intelligence level," relative brightness, and stage of psychomotor and emotional development — will be considered at length in subsequent chapters. V. EDUCATIONAL OR PEDAGOGICAL AGE Types of school misfits. While many children fit satisfactorily into the grades designed for children of their own chronological age, an army of "pedagogical misfits" exists for whom the ordinary teaching methods and curricula are ill adapted, or who are not in the grades in which they belong according to their stage of educational competency ("pedagogical age"), or degree of educational potentials. Pedagogical retardates. Some of these children are " pedagogically retarded," either generically or specifically, or they are over-age for their grade for such reasons as lack of schooling, lack of application or ability, specific mental or physical handicaps, or specific deficiencies in school subjects, such as reading, spelling, or arithmetic. In the regular grades these pedagogical retardates are trouble-makers to the teacher, to other pupils, and to the school administrator. They clog the grades, particularly the lower ones, retard the

DEVIATIONS IN DEVELOPMENT

SI

progress of the normal and bright pupils, and lose interest in work which they cannot comprehend or which does not appeal to them. As a consequence they become inattentive, discouraged, and often mischievous pupils; then chronic absentees, and finally they drop out of school prematurely. The large amount of pedagogical retardation found in the elementary schools will be emphasized in a later paragraph. The significance of the problem of pedagogical retardation can be gleaned from the fact that the reeducation of retardates and "repeaters" in the same grades probably costs the taxpayers of the country considerably over $75,000,000 every year. Educational adjustments for retardates. Pupils who are pedagogically retarded because of mental deficiency, or grave mental or pedagogical backwardness, should be assigned to public-school special and ungraded classes, while those who are less seriously mentally backward, or who are retarded in their school work although mentally normal, should be assigned on full-time or part-time to slow sections, or should receive such special aid, individually or in small groups, as their specific difficulties demand.1 Pedagogical accelerates. Pedagogically accelerated pupils constitute another type of educational deviate. In this group we may include pupils who are promoted more rapidly than the average child, who are promoted beyond their ability to compass the work, who are under-age for their grade, or who possess the ability to do work in a higher grade than the one in which they are retained. The results of standardized educational and intelligence tests seem to show that children of superior ability are usually graded below their level of competency, because of the inevitable lockstep of mass instruction, or because they are not recognized 1 The training of handicapped children is discuued at length in the com* panion book. The Education of Handicapped Children, which wet

32

CLINICAL AND ABNORMAL PSYCHOLOGY

by the teacher, or, being recognized, are not promoted as fast as their ability warrants. In fact, some writers believe that the most retarded pupils are not the intellectually dull, who are frequently advanced beyond their deserts, but the capable, gifted children who, submerged by the army of mediocrities, are held back instead of being given the opportunity to progress at their optimal rate. These brilliant pupils are also misfits and often become " problem cases." Not being permitted to work at a healthy tension, they tend to form habits of indolence, loitering, and daydreaming, to become mischievous, and to drift into various forms of anti-social conduct in and out of school. The rapid extension of the testing movement has not only stimulated the scientific investigation of superior children, but has created a demand that the schools organize instruction to meet their peculiar needs. Thus far most of the energy seems to have been expended in discussions of the most effective means of meeting this demand. So far no general agreement has been reached. Methods of determining pedagogical status and compe-

tency. Four methods are in current use for determining whether a child is retarded, accelerated, or at age in his school work. 1. The curricvlar standard. The ordinary standard of measurement is the ability of the child to meet the requirements of the prescribed curriculum. This standard is based on the assumption that the child is correctly classified, and therefore that he cannot do work beyond the grade he is in. Thus the child who is in the second grade is rated as of second-grade competency. It is also assumed that the prescribed course of study correctly mirrors the educational capabilities and the pedagogical norms of development of the children of the standard age for each grade. This assumption has been frequently challenged since the first age-grade

DEVIATIONS IN DEVELOPMENT

88

aurvey was made in Camden, New Jersey, in 1906. This survey showed that 72 per cent of the grade pupils were retarded according to the age-grade standards employed (up to the seventh birthday for the first grade). Similar findings from numerous subsequent surveys have aroused the suspicion that the standards have been set too high for the average child. It is also doubtless true that the methods of instruction in the regular grades have been rigidly uniform, and as a result many children have failed who would have been promoted had appropriate methods been used. Moreover, the teachers are subject to appreciable errors in grading pupils. These facts show that this standard is inexact. 2. Objective statistical methods of measuring pedagogical retardation. Three statistical methods have been employed for determining the number of retarded pupils in a school system. (a) The age-gfade method. When an age-grade tabulation is made for a school system, a distribution table is constructed showing the number of pupils at age, over age and under age, based on an assumed normal age-standard for each grade. When this method was first employed age 6 years no month to age 6 years 11 months, inclusive, was adopted as the age standard for the first grade. Because of the enormous amount of retardation found by this rigid standard — often reaching 75 per cent — a leeway of a year was subsequently allowed for each grade. Thus the standard for Grade I is six years to seven years and eleven months; for Grade II seven years to eight years and eleven months, and correspondingly for the other grades. Even this more elastic criterion, based on the "run of the mine" of school cases, shows that about a third of the grade pupils in the public schools of the country are retarded. The number of retarded pupils is six or seven times as great as the number of the accelerated. The spread in pedagogical

84

CLINICAL AND ABNORMAL PSYCHOLOGY

status is very large, amounting to twelve years in an agegrade chart constructed by the writer for the white children in the St. Louis elementary schools in June, 1920 — from eight years of retardation to four years of acceleration. Had 173S pupils in special classes been included, the spread evidently would have been greater. For this school system the average difference between the youngest and the oldest child in each of the eight elementary grades amounted to ten years. This surprising spread in educational status apparently is not unusual, for only 23.5 per cent of the children in this system were retarded, and the retarded pupils were only about three and a half times as numerous as the accelerated. (b) The progress standard. According to the progress standard, the educational status of the pupil is determined by the amount of time spent in doing a unit of work, or the amount of work accomplished in a unit of time. A table so constructed would indicate the percentage of pupils who progressed, say 50, 75, 100, or 125 per cent. (c) Combined standard. This standard is a combination of the age-grade and the progress standards. Age-grade tabulations are very extensively published in the annual reports of boards of education, but little use is made of the second and third methods, in spite of their obvious merits. Value of statistical methods. These purely mass methods aid in enumerating the number of retarded, on-time, and accelerated pupils, and the number making slow, retarded or accelerated progress, but they do not tell us why particular children are retarded or advanced, or why they deviate to the extent that they do. They do not indicate what proportion of the retarded children are mentally deficient, allround backward intellectually, pedagogically retarded but mentally normal, or mentally normal but victims of educa-

DEVIATIONS IN DEVELOPMENT

85

tional or social neglect, mental inhibitions, emotional or nervous instabilities, or physical handicaps. The composition of a motley group of pedagogically retarded children can only be determined by an individual study of each child. Statistical methods of studying retardation are not clinical, and throw little light on the causes of pedagogical variations or anomalies. 8. Composite educational measuring scales. Few standardized educational measuring scales comparable to the Binet intelligence scale exist at present; that is, scales consisting of a variety of educational tests arranged in an ascending order of difficulty in either age-steps or grade-steps. This is strange in view of the obvious utility of such scales. It is frequently desirable to determine the approximate educational level in the fundamental school subjects of children examined in mental clinics. Owing to the length of time required to make an individual psychological examination, such scales must be so brief that they can be administered in a few minutes, and yet be sufficiently comprehensive to include the basic school arts. Among the few existing composite educational scales may be mentioned those of V. Vaney, H. Holmes, S. D. Porteus, and the writer, and the Philadelphia House of Detention and the Waverley scales.1 Vaney's "Scale of Instruction," worked out in collaboration with A. Binet, includes only three arts — reading, spelling, and arithmetic — for the five stages of instruction from the "preparatory" to the "intermediate-second" grades, and from ages G-7 to 10-11 (corresponding roughly, perhaps, to the first five grades in the schools of the United States). The qualitative differen1 The Stanford Achievement Test by T. L. Kefley, G. M. Ruch, and L. M. Tennan is a composite group test, embracing reading (comprehension of meanings of words, sentences and paragraphs), arithmetic (computation and problem solving), nature study and science, history and literature, uao of correct words, and writing from dictation.

86

CLINICAL AND ABNORMAL PSYCHOLOGY

tiation of the stages of reading ability is quite clever, but would not strictly apply in the United States, where the word and sentence methods of instruction are in common use. In the Vaney scale the reading in the preparatory class, ages six to seven, is characterized as " subsyllabic." The child hitches along from letter to letter or slowly reads syllables with numerous errors. In the first year of the elementary stage, ages seven to eight, pauses occur after each syllable, but the reading is fairly correct. The quality of the reading is characterized as " syllabic." In the next stage, second year elementary, ages eight to nine, the child reads words or groups of words, but makes too many pauses, making the reading "hesitant." In the next stage, intermediate first year, ages nine to ten, the reading is "fluent," the pauses being properly placed at punctuation marks, but the tone of voice is monotonous. The child attains "expressive reading" in second grade intermediate, ages ten to eleven. He shows that he understands what he reads by properly placing the pauses at the punctuation marks, and modulating his voice. Arthur Holmes has arranged a series of school exercises in a graded scale, extending from Grade II (eight years) to Grade V (eleven years), including reading, spelling of words in sentences and in columns, and oral and written arithmetic. Directions are supplied for giving and scoring the exercises, but no information is conveyed regarding the mode of derivation of the scale. The very brief test sheet of the school department of the Philadelphia House of Detention contains about five exercises in each grade from the first to the fifth, in oral and written addition, subtraction, multiplication, and division. The reading exercises contain certain test words in heavy type, 70 per cent of which must be read to pass a given grade standard. The comprehension of the reading is independ-

DEVIATIONS IN DEVELOPMENT

87

ently rated by the examiner. This "test sheet" also fails to reveal how the grade standards supplied were established. The Waverley "Record Sheet for School Tests," employed at the Massachusetts School for the Feeble-Minded (now known as the Walter E. Fernald State School) for the purpose of diagnosis and assignment to the proper school grade, consists of a variety of short tests for the eight elementary grades in reading, arithmetic, spelling, writing, and language. Brief directions are given for scoring the tests and assigning the children to the grades in which they belong. In none of the last three series of tests, so far as can be determined, have the grade standards been experimentally established. They are probably based on the course of study in use in different city school systems, or on exercises reported by classroom teachers as representative of the standard of competency reached in the various grades. In the two following scales, however, the grade scores or standards were experimentally established. In his "Educational Attainment Scale" for use with mental deficients, S. D. Porteus has provided a convenient system of scoring for tests in mechanical reading (word calling), reading comprehension (based on oral presentations and replies to questions), spelling, and numbers. Age and grade scores have, to a very limited extent, been supplied. The scale cdnstructed in the writer's clinic for the purpose of grading young or seriously deficient children, consists of a series of tests and exercises in writing, written language, reading, phonetic spelling, and arithmetic. Grade norms are supplied for the first three grades, based on the testing of 1066 pupils enrolled in these grades in two different schools. 4. Standardized achievement tests in separate branches, and standard scores. In contrast with the dearth of composite

58

CLINICAL AND ABNORMAL PSYCHOLOGY

educational scales, hundreds of so-called achievement or attainment tests have been published during the last few years conveniently arranged on blanks or in booklets for administering and for scoring, standardized as to method of administration and of scoring, and accompanied by "standard scores." Grade norms are supplied for these tests rather than age norms. While age norms have not been supplied for many American achievement tests, theoretical ageequivalents for the grade norms are not lacking for a large number of tests. These standardized tests now cover practically all of the elementary and many of the secondary and college studies, including both the instrumental or tool and the content studies. Many tests are strikingly similar. In some branches, such as reading, arithmetic, algebra, handwriting, grammar, and Latin, there are numerous tests available for determining competency in different phases of the subject matter. Several special "diagnostic" tests have appeared designed to reveal the nature or the cause of the child's specific difficulties. The recent bibliography of tests compiled by Margaret Doherty and Josephine MacLatchy, in cooperation with B. R. Buckingham, lists 382 achievement tests (vocational, intelligence, and miscellaneous tests excluded), of which 51 are in arithmetic, 45 in reading, 31 in handwriting, 28 in spelling, 26 each in history and composition, 21 in geography, 18 in Latin, 15 each in algebra and physics, 13 in grammar and punctuation, 11 each in chemistry and drawing, and 10 each in English and "vocabulary." Methods of expressing test results. A number of methods are in current use for expressing the child's educational status or potentiality as determined by standardized tests. The amount of retardation or acceleration for a child of a given age may be expressed in terms of the grade median,

DEVIATIONS I N DEVELOPMENT

SO

average, mode, standard deviation, quartile, or percentile * which m o s t nearly approximates his score. T h e " educational q u o t i e n t " (E.Q.), 2 obtained b y dividing t h e chronological age into t h e educational age, h a s come into vogue as a device for expressing t h e child's educational efficiency relative t o t h e educational status of pupils of t h e same chronological age. If t h e child has advanced faster t h a n normal, t h e quotient is above 100; if slower t h a n normal, below 100. O n t h e other hand, t h e "accomplishment q u o t i e n t " or "achievement q u o t i e n t " (A.Q.) is used t o

determine whether the child's educational attainments are equal to his mental capacity. The A.Q. is obtained by dividing the intelligence age, obtained from some intelligence test, into the educational age, which usually is obtained by translating grade scores in standardized educational tests into age equivalents. A child with an intelligence age of twelve and an educational age of eleven, has an A.Q. of 02. This shows that the child is accomplishing 8 per cent less than the average child of his intelligence age. The A.Q. is offered as a scientific device for comparing any pupil with a standard pupil, and for measuring the educative influences of the home, school, and teacher. The E.Q. and A.Q., because of their convenience and apparent mathematical exactness, have become very popular tools for measuring educational status and potentiality, but they are no more accurate than the scores on which they are based. As long as either the numerator or denominator is inexact, the quotients will remain crude and deceptive. P. M. Symonds has concluded that an A.Q. from a single test is "of the same order of reliability as ordinary school \ 1

For a discussion of statistical measures the reader should consult the references on statistical and graphic methods in the bibliography at the end of the book. * Quotients are usually multiplied by 100 to eliminate the decimal point

40

CLINICAL AND ABNORMAL PSYCHOLOGY

marks," but he believes it is a more accurate " unit for marking than the score is accurate for placing in the proper grade." W. C. McCall believes it is the best present measure of the efficiency of study, instruction, and supervision, and the best indicator of the pupils who need to be prodded, restrained, or left alone. Functions and objectives of standardized educational tests and scales. Standardized educational tests have been put to a number of definite uses, the most important of which are the following: 1. Survey function. From the beginning of the testing movement, educators have turned to the standardized educational tests, not only to measure the comparative achievement of pupils in different grades in the various branches of instruction, but also to compare school systems in different sections of the country and different schools in the same school system. S. A. Courtis employed standardized educational tests in 1911 in the New York School Survey, and most school surveys since that time have made some use of them. The data obtained in mass surveys must necessarily be somewhat crude and misleading, because of the hurried, sketchy, or inexpert manner in which the tests must frequently be administered, and because of the margin of error to which they are subject. Nevertheless, results obtained from extensive test surveys probably reveal, more accurately than do results from any other method, the comparative educational efficiency of different school systems. They probably furnish the most satisfactory basis for the establishment of more uniform standards of educational requirements throughout the country. • 2. Objective measures of teaching and teacher efficiency.

The efficiency of the teacher, on which rating and promotion are supposed to depend, is ordinarily determined by the marks or estimates supplied by the inspecting officials. The

DEVIATIONS IN DEVELOPMENT

41

only just basis of gauging the teacher's classroom efficiency is by the amount and character of the desirable changes wrought in the pupils as a result of her activities during a given period of time. Objective and impartial standardized achievement tests should furnish a better means of measuring progress in the curricular studies than the opinions of supervisors, which are subjective, partial, and influenced by irrelevant considerations. A good teacher should be able to show her superiority by her results, and tests supply a more accurate means of demonstrating what has actually been accomplished than do estimates. Therefore good teachers will, it is argued, be more fairly rated by verifiable, objective measures of pupil progress than by rumored success, or by the subjective estimates or opinions of rating officials. Tests, however, have not been extensively used for this purpose, possibly because of the hostility of the classroom teachers, actual or imagined, and because of anticipated difficulties. Obviously, the teacher's results do not depend wholly on her teaching efficiency. A good teacher in charge of a class containing a preponderance of dullards might not be able to achieve as good results as a poor teacher with a class containing a preponderance of gifted children, although the good teacher might be doing a higher quality of work. It is evident that allowance must be made for differences in the capacity of the pupil material. Gauging teaching efficiency by measuring results is not possible without accurate means of measuring pupil capacity. Such means, it is held, are now available through the use of intelligence and educational ages, I.Q.'s, E.Q.'s, and A.Q.'s. If the average A.Q.'s obtained by the pupils at the beginning of the year are the same as the average A.Q.'s obtained at the end of the year, the teacher is typically competent. If the final are lower than the initial A.Q.'s, the teacher is sub-average in efficiency, and if they are higher she is superior.

42

CLINICAL AND ABNORMAL PSYCHOLOGY

Assuming that the A.Q.'s supply an accurate measure of progress for pupils of all grades of ability — and the A.Q.'s are no more accurate than the scores on which they are based, as already emphasized — it is pertinent to point out that all the beneficent educative or social influences of the teacher cannot be measured solely by her skill in the formal teaching processes. Through subtle traits of personality and lofty ideals she may exert an influence on the children which may be more fundamental in the molding of character, or the development of moral, social, and civic efficiency than mere skill in the teaching of the curricular studies. There are no reliable tests available for measuring these intangible but basically significant influences of the teacher. At most, the results revealed by standardized tests measure the teacher's competency only in the formal process of teaching the prescribed subject matter. Certainly the worth of a teacher should not be measured merely by her ability in the formal processes of instruction. 3. Clinical function. The tests have been used far more frequently to determine the educational status and potentialities, the rate of progress, and the readiness for promotion of the individual pupils in the various branches. They have been employed for the purpose of ascertaining how much time the pupil should devote to a given subject, and what methods of instruction should be followed. In a word, the improvement of the instruction for each pupil is one of the basic aims of educational testing. In a derived sense, the clinical objective may comprehend the determination of the educational status of particular school systems, which is the dominant goal of the educational survey. The claim is set up that the child's actual level of competency, and his special abilities and disabilities, can be more accurately revealed by standardized tests than by the conventional examinations, or the teacher's judgment, because

DEVIATIONS IN DEVELOPMENT

43

the former are objective, are administered under controlled conditions, and are supplied with reliable interpretative grade- or age-norms of performance. Many standardized tests are designed to reveal, in considerable detail, the pupil's special abilities and disabilities, and thereby aid the teacher in planning the work to meet the needs of each pupil. The tests also supply the pupils with a means of checking up their progress from time to time, of discovering their special handicaps and talents, of acquiring new facts or applying old ones in varied situations, and of obtaining effectively motivated practice. By requiring pupils to plot curves of progress, the tests serve as powerful stimuli, inciting the child to put forth continued effort in order to equal or surpass his previous record. It is doubtless true that a well-trained, experienced teacher can determine the pupil's educational status — his educational assets and liabilities — as well as can be done by tests, and that the intelligent teacher will learn many things of vital significance for planning a child's work that tests do not reveal. Nevertheless, if properly used, standardized achievement tests will aid even the skilled teacher to arrive at a fuller or more rapid appreciation of the child's educational status. The tests probably will prove of the greatest clinical value to the army of inadequately trained and insufficiently experienced teachers, although many of these will be unable properly to interpret many of the findings. In the case of problem pupils, it is important that the educational tests be supplemented by intellectual and motor tests, by observations of emotional, temperamental, and conative traits, by a physical examination, and by a genetic investigation, including particularly the prior school history. 4. Diagnostic function. Closely related to the determination of the educational status of the individual pupil, or of a given school system, is the determination of the causes of

44

CLINICAL AND ABNOBMAL PSYCHOLOGY

deficiencies (or talents) in children, the causes of the differences in the educational attainment of pupils in different school systems, or the reasons for deficiencies or excellencies in individual school systems. The term "diagnostic" may be loosely applied to this function of the tests. The clinical and the diagnostic functions of tests are inseparable, and can be differentiated no more sharply in the field of education or of psychology than in the field of medicine. The clinical inevitably leads or should lead, to the diagnostic. It is just as important to find the reasons for existing defects or excellencies in individual children and in individual school systems as to discover them. The combined clinical and diagnostic data are valuable in planning the course of corrective training or special educational provisions which the child should receive. All tests are generically diagnostic in the sense that the child's score represents his educational status relative to the age- or grade-norm for the test concerned; but some tests are designed to be specifically diagnostic in the sense that they reveal the presence or absence of the specific abilities of which the total ability in a given subject matter is composed, the detailed nature of the child's errors, or the specific causes of low or high achievement in a given branch of study. The usual method of discovering reasons for failure is to observe the child's method of attack, requiring him to relate how he did the work, and to scrutinize the results of his efforts (for example, his objective performance in handwriting or spelling). The number of so-called "diagnostic tests," constructed for the express purpose of revealing the nature and causes of the child's errors, is fairly extensive; but the number of tests for revealing whether the child possesses the underlying mental, moral, or physical traits essential for success in a given type of subject matter is almost negligible.

DEVIATIONS IN DEVELOPMENT

45

Among tests intended to be distinctly diagnostic may be mentioned L. C. Pressey's diagnostic tests in silent reading (in fact, practically every reading test), Douglas's standard diagnostic tests for elementary algebra, Hoyt and Peet's diagnostic progress scores in arithmetic, Courtis's standard supervisory tests in arithmetic, Lunceford's diagnostic number test, Monroe's diagnostic tests in arithmetic, the Cleveland Survey tests in arithmetic, Woody's arithmetic scales, Woody-McCall's mixed fundamentals, Charters's diagnostic language tests, Briggs's English form test, Freeman's chart for diagnosing faults in handwriting, Gray's score card for the measurement of handwriting, Vannest's modern European history test, Barr's diagnostic test in American history, Godsey's diagnostic Latin composition test, Seashore's musical talent tests, and Rogers's test for diagnosing mathematical ability. In the last mentioned an attempt is made to analyze the elements involved in mathematical ability, and to construct tests for their measurement. Genuinely diagnostic tests should reveal not only the exact educational condition, but the interlocking factors responsible for success or failure. While standardized educational tests will contribute valuable data (objective scores, E.Q.'s, A.Q.'s, and the like) for educational diagnosis, skill in diagnosing educational conditions requires more than familiarity with tests and test results. It requires a knowledge of the symptomatology and causes of educational and mental abnormalities, and of prognosis and remedial measures, as well as skill in the recognition and interpretation of symptoms and signs in individual cases. The background of experience and knowledge required for an adequate synoptic view of educational deviations cannot be secured from educational tests alone. 5. Homogeneous grouping for instruction. Extensive use is now made of educational tests for classifying children into

46

CLINICAL AND ABNORMAL PSYCHOLOGY

homogeneous groups or sections, so that those of similar attainments may be taught together, and for resectioning and promoting children from time to time. Many educationists believe educational age is of more significance in school classification than mental age, and that the real criterion for educational classification and reclassification must be the ability of the child to do the required work. While this is probably correct, there is no assurance that children of the same initial attainment level will progress at the same rate unless those whose intelligence age corresponds to their educational age are grouped in the same subsection. Frequently this cannot be done because of administrative difficulties. Moreover, the teacher may not always sense the pupils' educational possibilities without a knowledge of their intelligence level. Brilliant students may arouse the suspicion of dullness because of indolence. A completely satisfactory scheme of educational classification will take into account the children's educational and intelligence age levels, their specific educational and mental abilities, disabilities, and preferences, their potentialities for growth and development (as indicated by the I.Q.'s, E.Q.'s, and A.Q.'s), and possibly their physiological and anatomical stages of development. 6. Administrative function. Standardized tests may prove useful in planning curricula, and in determining the educational policies of the schools. Although the tests do not offer satisfactory solutions of questions relating to educational values and purposes, they indicate the standards of attainment which may reasonably be required in the different branches in the different grades and classes. As already suggested, they will prove useful in the development of a homogeneous national system of public schools. 7. Research function. Whatever objections may be raised against the exaggerated claims advanced in behalf of the use of standardized educational group tests — e.g., the

DEVIATIONS IN DEVELOPMENT

47

claim that good teaching even by competent teachers is impossible without standardized testing — no one has seriously questioned the service tests have performed in discovering new educational facts, relations, and principles, and in directing scientific study to vital educational questions which would otherwise have remained quiescent for years. The educational testing movement in this generation has stimulated educational research more than anything else, with the possible exception of the intelligence testing movement, and has produced a voluminous output of experimental memoirs and monographs, and texts in educational measurements. The bibliography at the end of this book contains publications which refer to the most important tests. Inherent limitation of educational tests. One of the serious limitations of educational tests is that they do not necessarily measure the child's inherent pedagogical capacity, or developmental possibilities, but only his educational attainments when tested. Nor do they necessarily indicate the causes of existing deficiencies. An educational test does not in itself show whether a child is retarded because of poor teaching, or because of lack of schooling, application, proper motivation, or the necessary underlying mental or physical capacities. The ideal requirement is to secure extensive sets of tests which reveal the presence or absence of specific educational potentialities, so that we may predict what educational abilities or deficiencies the child possesses, before he has been subjected to instruction, or at least before months or years have been spent trying to find out by the trial-anderror method. Tests of this character, however, are difficult to construct, because pedagogical competency is non-existent apart from experience or training. A child is not born with the actual ability to read, or spell, or cipher, but only with the possibilities of acquiring these school arts. Before being taught,

48

CLINICAL AND ABNORMAL PSYCHOLOGY

all children are illiterate. One child is born with the potential reading ability of an imbecile, another with that of a genius. The young illiterate potential genius is illiterate because of lack of reading experience, but the illiterate imbecile remains so because of lack of inherent reading capacity. Educational measures are not available at present for determining the potential ability possessed by a child in every branch of study, aside from the method of continuously subjecting him to the appropriate processes of instruction and periodically testing the results of such instruction. This learning-by-trial method has the merit of certitude that goes with "demonstrated experience," but it is cumbersome and expensive. Predictive tests devised to reveal the presence or absence of the traits underlying success in all the school arts and crafts would possess pronounced advantages over the ordinary achievement tests. Such tests would necessarily have to be based on mental, physical, moral, and social traits, and would have to be devised for each branch of study. Tests of this nature, as already stated, are almost non-existent at present. Psychological tests are, of course, more basic than educational tests, for they come nearer to supplying measures of inherent mental capacity. The psychological tests of most value for school classification at present are those of "general intelligence," or "general mental capacity" of the verbal and psychomotor types. It is frequently invaluable to supplement educational tests by tests of general mental capacity in order to interpret correctly the educational findings. Moreover, a comprehensive, synoptic picture of many educational deviations can scarcely be obtained without an adequate genetic "history of the case." Such a history must include full details regarding the amount of prior instruction, and the methods of instruction employed

DEVIATIONS IN DEVELOPMENT

49

Illustrative case. The following case illustrates the importance of obtaining a genetic view of educational cases. A girl of fourteen examined in my clinic in Pittsburgh was found quite imbecilic in educational accomplishments. She was practically illiterate, occupying a position near the zero scores in the achievement tests. The question of practical moment was whether the educational near-imbecility was due to educational neglect or mental imbecility. The educational test results supplied an inadequate basis for an answer, except as a matter of shrewd inference. The history indicated that she had just been admitted into a residential school in Pittsburgh from a secluded mountainous district in West Virginia, where she had been taught not over a year by an untrained, incompetent teacher. The psychological examination showed that she was neither an imbecile nor a mental defective, but merely a very backward child, rating ten years by the 1908 Binet. The pedagogical deficiency was due to educational neglect, plus mental backwardness. A part of the mental backwardness itself was, in all probability, due to educational, social, and physical neglect. VI. SOCIO-INDUSTRIAL AGE OR COMPETENCY LEVEL

Meaning of socio-industrial competency. Children differ in the rate of acquisition of various personal and social competencies, such as the ability to feed themselves, to hold the spoon, knife, and fork, to dress and undress, to wash, to acquire tidy habits, and to adjust themselves to the social conventions and practices of the home and the community. They also differ in their ability to acquire in early life various sorts of industrial and vocational competency, to learn to perform the various chores in and around the house and on the farm, and later the various vocations which they must master to become self-supporting. Wide differences exist among children in vocational aptitudes and competencies, probably as wide as the differences in mental or educational age. Of primary importance in this connection is the question whether the child possesses enough ability eventually to

50

CLINICAL

ND ABNORMAL PSYCHOLOGY

learn to care for and support himself. Indeed, the inability of the individual to lead an independent existence in society is the basic element in the concept of mental defectiveness. Methods of measuring socio-industrial age. Little has thus far been done toward establishing definite age-standards of personal, social, and industrial competency for normal children, nor is a technique available which is generally accepted as adequate. Ban's classification of the feeble-minded. The "educational " classification by M. W. Barr shows the educational and industrial possibilities of idiots, idio-imbeciles, moral imbeciles, imbeciles, and backward persons, based on his scheme of classification. Vineland industrial classification of the feeble-minded. The brief Vineland "Industrial Classification" gives the typical tasks which feeble-minded children (less than twentyone years chronologically) of each Binet level were able to do in the Vineland Training School. These industrialcompetency standards obviously would be inapplicable to normal children x of corresponding ages, and probably would not apply to extra-institutional mental defectives of similar Binet levels. Porteus's social rating scale for the feeble-minded. S. D. Porteus derived a numerical index of social sufficiency from the weighted ratings given institutional feeble-minded subjects on certain defects of the personality. The defects most indicative of social maladaptability are lack of planning capacity, suggestibility, irresolution, impulsiveness, excitability, obstructiveness, and moodiness. Pugnacity, bad temper, disobedience, cunning, slyness, and disrespect for 1 See The Education of Handicapped Children, p. 367. A more complete scale of possible industrial occupations for feeble-minded children of various Binet ages has been more recently constructed at the Walter E. Fernald State School.

DEVIATIONS IN DEVELOPMENT

51

authority had " no relation to estimated social sufficiency." Subjects with an index below 22 can get along in the community, while those from 36 to 44 require permanent custodial care, and are largely untrainable. Porteus's industrial rating scale for the feeble-minded. Porteus has also made a job analysis of occupations pursued by institutional mental defectives, which shows the different factors involved in each operation. Experienced industrial supervisors allotted ratings on a three-point basis for each factor of each operation in an occupation. The average of the supervisors' ratings represents the comparative difficulty of each operation. The factors of the difficulty of the operations on which the ratings were based were manual skill, judgment, value of the material which might be wasted, importance of the work, the nature of the tools or machines used, and the personal risk to the worker. The comparative ranking or "industrial index" for an occupation was based on the average ratings of all its operations. The "industrial rating scale" which resulted from this investigation contains the ratings and industrial-index values of the operations in needle work, woodwork, power-plant service, shoe repairing, dairying, orchard and vineyard tasks, truck gardening, farm work, poultry work, pantry and kitchen service, cooking, laundering, housework, dining-room service, basketry, broom making, and loom work. Army job analysis, personnel specifications, and trade tests; and psychomotor tests. A somewhat similar job analysis was made by " The Committee on Classification of Personnel" in the army, during 1917 and 1918, for 714 civilian trades and occupations. This analysis was supplemented by descriptions of the personnel qualifications needed by the applicants for each job. The committee also constructed a considerable number of verbal, pictorial, and performance tests for measuring the amount of skill pos-

52

CLINICAL AND ABNORMAL PSYCHOLOGY

sessed by applicants for jobs. These tests, according to report, proved very valuable in weeding out incompetent workers. Only a limited number of studies have since appeared on "vocational analysis," "occupational analysis," and "job analysis," but many "performance tests," "motor tests," and "mechanical-aptitude tests" have been devised for determining the child's motor ability. These will be considered in some detail in Chapter XX. Verbal intelligence tests. Extensive use has been made of verbal intelligence tests, such as the Binet, for determining the individual's socio-industrial capacity. Too much reliance must not be placed on such tests, however, unless the discrepancy between the test age and the chronological age is pronounced. Investigation has shown that a closer correlation exists between the child's industrial ability and his performance level, as determined by motor tests, than between his industrial ability and verbal-intelligence age. The industrial or vocational age is often appreciably in advance of the verbal intelligence age. It has been shown repeatedly that many individuals with a ten-year Binet age who, in consequence, have been classified as feeble-minded, have possessed enough industrial ability to support not only themselves, but also their families, and to live in accordance with the conventions and laws of society.

CHAPTER III CORRESPONDENCE BETWEEN THE DIFFERENT INDICES OF DEVELOPMENT THE natural supposition is that a correspondence exists between the physiological, anatomical, educational, psychological, and socio-industrial stages of development. Complexity of problem and unsatisfactory nature of data. To consider this question in all its ramifications would involve an exhaustive review of the experimental investigations bearing on the relation of a great variety of physical traits — such as height, weight, lung capacity, strength, dentition, pubescence, ossification, head-size, health, disease — to mental and educational traits, general intelligence, scholarship, and social status. In this book it is obviously out of the question to attempt anything beyond a brief resume of the more important studies of the relation of physical development to mental development and educational competency. There is a voluminous literature of dissertations on limited and unrelated aspects of the problem, but a conspicuous dearth of exhaustive investigations of the whole problem. Moreover, many of the conclusions reached are contradictory, probably due in part to the employment of indefinable and inaccurate units of measurement, and to disregard of the modifying factors of growth and development. The employment of faulty methods of measurement and inaccurate measures will not only produce discrepancies, but may even reverse the true relationships. Most inaccurate and ambiguous of the measures used have, of course, been those of mental, educational, and

54

CLINICAL AND ABNORMAL PSYCHOLOGY

social levels of competency. The measures of mental capacity have usually been based on the child's age-grade status, school marks, or the teacher's judgment. Investigations have shown that school marks may be notoriously misleading. The teacher's judgment is often fallacious because of lack of familiarity with the child, or because of the tendency to judge the intelligence of the over-age child in comparison with his younger classmates, which often results in the overestimation of the ability of the dullard. The state of nutrition represents a modifying complication of no small moment. Research has shown that assiduous application to studies may cause denutrition. E. Quirsfeld, in a study made in Bohemia, found that 25 per cent of six-year-old children made no gain, while 21 per cent actually lost weight during the first school year. K. SchmidMonard reports that, in Halle, girls lost weight during the first three months of attendance in the elementary school, while the seven-year-old children who attended school were lighter than those who did not attend. In Italy, according to Massa, prize-winning children weigh less than the less industrious ones. It is probable that bright, intelligent, nervously active children apply themselves more energetically and diligently than those who are dull, or phlegmatic, and thereby suffer loss of weight through cerebral denutrition. More exact methods may in future introduce harmony where discord now obtains. Connection between physical and mental superiority or inferiority in children. The preponderance of evidence indicates that, collectively, during the period of childhood, superior physical development tends to be associated with superior mental ability, while inferior physique and inferior mentality tend to go together. The mental superiority of physically superior children is probably due to superior health, higher functional efficiency of the biological organism

CORRESPONDENCE BETWEEN INDICES

65

and more mature neural development. For children a positive relation between physical development as determined (in most cases) by height and weight, and mental capacity as estimated by age-grade classification in school (or in a few instances by intelligence test scores), has been reported by many investigators. The results of two investigators may be briefly reviewed. A. MacDonald secured a positive correlation between the height and weight of two sets of white children (numbering 1074 and 16,473, respectively) and one set of colored children (5457) when classified as bright, average, and dull by the teachers. In general, the bright children were superior to the dull. The bright boys excelled the dull boys in standing height in eight of thirteen ages, and in sitting height and weight in all except three ages. Among boys of the nonlaboring classes, however, the relationship was reversed, the bright boys in general being inferior in these three measurements. Porter's study, based on the measurement of the height and weight of 34,500 St. Louis school children, has often been quoted as supplying demonstrative proof of the mental superiority of the taller and heavier children. What the study unmistakably shows is that, on the average, the pupils of every age who were above grade were taller and heavier than those of the same age who were below grade. For example, the weight of groups of eleven-year-old boys distributed in the different grades varied as follows: sixth grade, 73.3 pounds; fifth grade, 71.3; fourth grade, 69.2; third grade, 68.1; second grade, 65.4; and first grade, 63.5. The difference between those in the sixth grade (the bright) and those in the first (the dull) amounts to about ten pounds. Similar results were obtained for the other age groups. The widely accepted conclusions derived from this study are necessarily based on an assumption; namely, that the

56

CLINICAL AND ABNORMAL PSYCHOLOGY

brighter children had been advanced to the higher grades, and the duller children retained in the lower grades. Although this assumption is, in the main, warranted, it is a well-known fact that many bright pupils are not advanced in accordance with their ability, while retarded pupils are often promoted irrespective of their deserts. On the other hand, zero or negative correlations have been reported by J. A. Gilbert, C. M. West, and W. C. Bagley, the classification of the intelligence being based on class marks or the teacher's judgment. P. R. Radosavljevich likewise found little correlation between school brightness and standing and sitting height, weight, and six head measurements. Based on the examination of groups of pupils distributed from the fifth grade to the college Freshman year, E. M. Stalnaker concluded that there was no demonstrable relation between physical development as measured by height-weight ratios of certain accepted standards, and mental development as measured by various group intelligence tests and tests of attention, substitution, memory, and omissions and discoveries of printed letters. In fact, the underweight youths appeared to be relatively superior. The association of physical with mental and scholastic proficiency in older subjects. Among older adolescents and adults, most investigators have found negative, ambiguous, or unimportant correlations. No relation was found by F. Galton and C. Wissler between strength of grip and success in college work. No relation between vital capacity and college success or psychological test scores was discovered by Galton or S. Naccarati. Galton's study of 2000 Cambridge University students failed to reveal any connection between success in literary examinations and stature, weight, strength, or breathing capacity, and only a slight relation to visual acuity. A further study of students from

CORRESPONDENCE BETWEEN INDICES

57

the same university by A. Lee, M. A. Lewenz and K. Pearson revealed only slight correlations between intelligence and strength of pull, height, weight, weight per inch of stature, and athletic ability. For Columbia University students, J. McK. Cattell and L. Farrand failed to find any definite correlations between various physical and mental tests. The correlation between intelligence-test scores and efficiency in athletic events was found to be largely negative by H. M. Landis, H. E. Burtt, and J. H. Nichols. T). A. Sargent reports that "stipend scholarship men" at Harvard are among the shortest and lightest. Wissler's correlation of .53 between college standing and gymnasium work at Columbiti was appreciably higher than that found by Psyche Cattell. She determined, for about 1000 women students in the Sargent School for Physical Education, of an average age of 19.2, the correlations between physical ability (based on grades in the practice courses and skill in the gymnasium work), mental ability (based on the average grade in twenty lecture courses), and physical development (based on about a dozen anthropometric measurements). The correlation between the physical and the theoretical grades was .42, which was considerably higher than the correlation between "mental ability" and vital capacity (.12) or the strength measurements (varying from .05 to .17), or the correlation between either physical or mental ability and size (height, weight, and girths) which was negative. Inferiority of height, strength, lung capacity, and weight in the feeble-minded. It would seem reasonable to suppose that the relationships ought to appear most clearly when conspicuously inferior groups, such as the feeble-minded, are compared with normal groups of children. In point of fact, the feeble-minded, particularly the lower grades, are distinctly inferior in height, strength, and lung capacity, and

58

CLINICAL AND ABNORMAL PSYCHOLOGY

slightly inferior in weight. studies may be cited.

The results of a number of.

Compared with Gilbert's averages for normal children, 405 feeble-minded boys and 395 feeble-minded girls in institutions were found inferior in both weight and height by A. R. T. Wylie. The amount of inferiority is not stated in exact units, but the average for the feeble-minded approximated the minimum for the normal, and the maximum of the feeble-minded the average of the normal. The smallest difference occurred at the age of ten. Three hundred imbeciles and idiots examined by G. E. Shuttle-. worth averaged two inches below normal at ten years, and three inches below at fifteen years. G. G. Tarbell concluded from measurements of about 130 cases that "feeble-minded children (boys and girls) are about two inches shorter and nine pounds'' lighter than normal children of the same age." In comparing 288 feeble-minded boys and 141 feeble-minded girls with 236 normal, boys and 245 normal girls of the same age, C. D. Mead found that the normal boys averaged from two to five inches taller than the feeble-minded boys, the difference tending to increase with age. The difference between the girls was quite similar. After age ten the normal boys were consistently heavier, by from five to fifteen pounds, than the feeble-minded boys. With girls the weight differences were inconstant. Among the boys the imbeciles and idiots were shorter and lighter than the morons, but among the girls the curves were irregular. Only about 21 per cent of the feebleminded boys and girls reached or exceeded the average height of the normal children, while 29.6 per cent of the boys and 41.2 per cent of girls among the feeble-minded reached or exceeded the normal weight average. H. H. Goddard, in tabulating the heights and weights of 5923 males and 4921 females, submitted from nineteen American institutions for the feeble-minded, likewise found that the greater the degree of mental defect the greater the amount of divergence from the normal standards. The difference in weight between the feebleminded boys of all grades and normal boys (F. Burks norms) up to age fifteen ranged from no difference to eight pounds, at fifteen it was six pounds, and at sixteen, 11.6 pounds. Idiots weighed from about half a pound to over four pounds less than imbeciles up to age ten, and thereafter to age twenty-four from about half a pound to fifteen pounds less. Imbeciles averaged from hah* a pound

CORRESPONDENCE BETWEEN INDICES

59

to 5.5 pounds less than morons up to age ten, and thereafter to age twenty-four from about half a pound to 14.5 pounds less except at age eleven, where they were one and a half pounds heavier. The morons averaged more than the normals in most of the ages up to seventeen, but less thereafter up to the last age (twenty-four) affording a basis of comparison with normal boys. Idiot girls were distinctly lighter than imbecile girls, the differences varying from about a pound to thirteen pounds up to age twenty-four, the difference showing a tendency to grow larger with increasing age. The imbeciles trail slightly below the morons except in one age, thirteen, the differences tending to become accentuated with increasing age. Those classified as morons, however, are lighter in eight of the twenty ages compared, most of these being in the lower ages. After age seventeen the normal children excel in six of the seven ages compared. At birth all grades of the feeble-minded weifhed more than the normal, a result at variance with the writer's findings based on 179 non-institutional mental defectives, the only ones in a block of 872 successive clinic cases for whom reliable birth weights could be secured. The feeble-minded boys and girls averaged 10 per cent lighter at birth than the normal. The feeble-minded children also tended to weigh less with progressive increase of mental inferiority as measured by the Binet-Simon scale. The discrepancy between the two investigations regarding the birth weights may be due to inaccuracies in the recorded weighings or in the mental diagnosis, or to a difference between institutional and non-institutional cases of feeble-mindodness. Most of the institutional children probably had been committed without a mental examination. There is no distinct dividing line between the high-grade feeble-minded and the backward, and conservative diagnosticians would undoubtedly have classified many of the higher-grade institutional cases as backward. All of the writer's cases had been subjected to a manysided clinical examination. But most of those for whom weighings were available could not be included because the reported weights were obviously not based on accurately recorded measurements. The variation in height for feeble-minded boys of all grades ranges from no difference to 3.3 inches for the twenty ages compared (5 to 24 inclusive). Idiots, based on F. Boas's norms, vary from the same height to 2 inches shorter than the imbeciles to age 10, and then from 1.2 to 3.4 inches shorter to age 24. Imbeciles are

60

CLINICAL AND ABNORMAL PSYCHOLOGY

from .5 inch to 2.6 inches shorter than morons to age 10, with the exception of age 5, where the imbeciles are taller by .1 inch. Thereafter to age 24 they are from .1 inch to 4.2 inches shorter than the morons. The morons are close to the normals in height up to age 17, but thereafter, except in age 19, they are consistently shorter. Feeble-minded girls are from .1 inch to seven inches shorter than normal girls up to age 10, with the exception of age 1, where the feeble-minded are 3.5 inches taller than the normals. Idiot girls are consistently shorter than imbecile girls, the average difference up to age 24 being a little over 2 inches, varying from 0.2 inch to 4.9 inches. Imbeciles are shorter by from .3 to 2.9 inches than morons in every age except age 6, where the imbeciles are .5 inches taller. The morons are taller than the normal from ages 7 to 10, but above that the normals are taller for every age except 13. The writer has tabulated the anthropometric measurements of 992 consecutive cases,1 mostly from 4 to 16 years of age (696 being boys), according to chronological age irrespective of Binet age or intelligence diagnosis, according to intelligence diagnosis irrespective of chronological or Binet age, according to Binet age irrespective of chronological age or intelligence diagnosis, and according to the intelligence diagnosis in each chronological age. The physical measurements include sitting and standing height, weight, right and left dynamometry, and spirometry. Two hundred and sixtynine of these cases were diagnosed as feeble-minded, 113 as borderline, 36 as deferred, and 371 as backward, the diagnosis in all cases being based on all the facts gathered in the investigation of each child. For the purpose of emphasizing the larger differences, the data were retabulated into three major intelligence groups, (a) the combined "normal" (or "not feeble-minded"), including the "accelerated, normal, retarded, and backward" (574 cases); (b) the "subnormal," including the "borderline, deferred, morons, imbeciles, and idiots," and (c) the "feeble-minded," including the "morons, imbeciles, and idiots." Only a few of the results from this major grouping of the data can be cited here. Based on the means for all the children of all ages, the subnormal and the feeble-minded were superior to the normal in all the measurements except strength of grip. That this contradictory result is due to the fact that the subnormal and feeble-minded groups averaged one year older than the normal group, is suggested by a 1

The data have not yet been published.

CORRESPONDENCE BETWEEN INDICES

61

consideration of two circumstances. The first is that the subnormal group excelled the feeble-minded group, which was of the same average age in all the measurements, the differences being most marked in standing height and lung capacity. The second is the fact that when the comparison of the measurements of the normal, subnormal, and feeble-minded is restricted to children of the same chronological age, the normal are quite consistently superior to the subnormal, the subnormal to the feeble-minded, and, more particularly, the normal to the feeble-minded. This holds for all the measurements, although the differences are sometimes negligible. Generally the differences are greatest between the two extreme intelligence categories — the normal and the feeble-minded. In standing height, the differences in the different ages vary from .8 mm. (millimeters) to 481.8 mm. All the exceptions occur in the comparison between the subnormal and feeble-minded (in four ages *). In sitting height equally as many exceptions occur between these two categories, but the normals uniformly surpass both the subnormals and the feeble-minded. The differences between the ability groups vary from .5 mm. to 48.9 mm. The normal weigh more than the subnormal in all ages, and more than the feebleminded in all the ages except one, while the subnormal slightly outweigh the feeble-minded in seven ages. The extreme differences in any age vary from half a pound to 9.2 pounds. In spirometry the mentally superior groups excel in all ages except one in which the subnormals surpass the normals, and the feeble-minded the subnormals. The differences vary from 7.4 cc. to 5C8.4 cc. In strength, as determined by right- and left-hand grip, the mentally superior groups are consistently ahead, save for two or three insignificant exceptions between the subnormal and feeble-minded groups. The differences vary from the zero point to 11.8 pounds for the left hand and to 17 pounds for the right hand.

Ability differences and age. The differences between the three ability groups tend to increase with increasing age, but the increases are irregular and inconstant, and sometimes negligible. When the average differences are compared for ages 6 to 10, inclusive, with ages 12 to 16, inclusive, 1 Ages above sixteen and below six are disregarded because of the paucity of cases.

62

CLINICAL AND ABNORMAL PSYCHOLOGY

the only three exceptions to the rule are for lung capacity of the normal compared with the subnormal, and for sitting height of the normal compared with the subnormal, and of the subnormal compared with the feeble-minded. Between the extreme intelligence groups, the feeble-minded and the normal, the absolute differences are greater among the older pupils in all the measurements, indicating that the feebleminded develop at a retarded rate. While the average inferiority in absolute units of the older group compared with the younger group of mental defectives is not always pronounced, the inferiority when expressed in relative terms is appreciable in practically all measurements. Thus the inferiority of the older group (ages 12 to 16) compared with the younger group (ages 6 to 10) of mental defectives, based on the difference between normal and feeble-minded children, of corresponding ages, is 35 per cent greater in lung capacity, 44 per cent greater in right-hand grip, 55 per cent in left-hand grip, 73 per cent in weight, 13 per cent in sitting height, and 18.8 per cent in standing height. Based on Smedley's percentiles for normal children, E. A. Doll found that the feeble-minded (477 cases) were inferior to the normal in a number of physical attributes, the deficiency varying with the degree of mental defect. In standing height 30 per cent reached the normal standard, in sitting height 25 per cent, in weight 40 per cent, in right grip, 10 per cent, in left grip 15 per cent, in lung capcity, 8 per cent, in the average of the three physical measurements (standing and sitting height, and weight) 30 per cent, in the average of the three psychophysical measurements (right and left grip, and lung capacity) 7 per cent, and in the average for all six measurements 14 per cent. Ninety-three per cent of all the feeble-minded show a superiority in the physical measurements (referred to as "physical excess") as compared with the psychophysical measurements. The

CORRESPONDENCE BETWEEN INDICES

6S

coefficient of correlation with mental age was .30 for standing height; .40 for sitting height; .30 for weight; .70 for right grip; .64 for vital capacity; and .60 for all six measurements. Obviously the relatively low scores made in the psychophysical measurements are due, in part, to the subject's inability to comprehend the test, or properly to execute it in accordance with the instructions. Findings among epileptics. Our earlier study of epileptics showed that the strength of grip increased, but somewhat irregularly, from one Binet age to another. The difference was pronounced between the extreme Binet ages (ages 3 and 13), amounting to 12.9 kg. (kilograms) for the right hand and 15.3 for the left hand, and between the imbecile and moron groups the corresponding differences amounting to 11.6 kg. and 12.2 kg. Likewise the body sway, as measured by the ataxiagraph, was appreciably greater for the imbecile than for the moron group, although the decrease from Binet age to Binet age was irregular. Dentition, closing of fontanel, sitting, standing, walking and talking in the mentally defective. That the development of the mentally deficient child tends to be slower than that of the normal child in dentition and the closing of the fontanel, and in learning to sit, stand, walk, and talk, and that the amount of the retardation varies with the amount of the mental deficiency, appears clearly from a minute inspection of Tables 1,11, and 12, Chapter XIX. Space permits reference only to the outstanding facts based on the index of retardation ( /

=

~~TTy»

wn cn

i

compares the combined

normal (or not-feeble-minded group, consisting of the normal, retarded, and backward children) with the feebleminded group. The index shows that the feeble-minded develop perceptibly slower than the combined normal in all

64

CLINICAL AND ABNORMAL PSYCHOLOGY

the traits compared, the percentage of feeble-minded who were slower in their development ranging from 24 to 95 per cent. The retardation was least apparent in dentition (24 per cent) and the closing of the fontanel (32 per cent), and most pronounced in talking, amounting to 95 per cent in the ability to speak single words and 76 per cent in the ability to speak in short phrases or sentences. Correlations based on pubescent development. In Crampton's investigation of pubescent development among boys, a closer correlation was found between the stage of pubescence and height, weight, and strength than between pubescence and chronological age. Thus the postpubescents averaged 23 pounds heavier than the prepubescents. The mature boys also rated higher in scholarship, as noted on page 28. Parallel results were found among high school girls. Correlations based on the eruption of the teeth. Crampton also found a positive correlation between maturity of dentition and weight, height, and strength in a study of 934 elementary school boys, ten to twelve years of age. For example, those with a full set of permanent canines averaged from five to seventeen pounds heavier and from one half inch to three inches taller than those with none. R. B. Bean found that children from seven to fourteen who were in the modal grade (the grade having the majority of children of a given age) in the Ann Arbor public schools averaged eight tenths of a tooth less than those above, but nine tenths of a tooth more than those below the modal age. Lowell and Woodrow found that those above the modal grades possessed 1.6 teeth more than those in the modal grades and 2.5 teeth more than those below the modal grades, but when the data were tabulated separately for each sex and each school grade, the relationship, while still positive, became irregular and unimportant.

CORRESPONDENCE BETWEEN INDICES

65

Studies of carpal development. For a group of fifty-three girls and thirty-six boys, ages two to six, Baldwin and Lorle I. Stecher found coefficients of correlation of .89 and .86, respectively, between height and weight; of .88 and .92, respectively, between height and chronological age; of .78 and .77, respectively, between weight and chronological age; while, with age rendered constant by the method of partial correlation, the corresponding correlations between height and weight were .68 and .61, respectively. Obviously the older children were the taller and heavier ones, and the relatively tall ones were the relatively heavy ones, even when the effects of chronological age were eliminated. The corresponding coefficients of correlation of carpal bone area were: with height .83 and .77; with weight .81 and .72; and with chronological age .80 and .71. With age constant the corresponding correlations were: with height .45 and .42; with weight .49 and .37. The correlations between carpal area and chronological age were .25 and .01, respectively, with height constant, and .46 and .35, respectively, with weight constant. The correlations of carpal area with height, when weight and chronological age were kept constant, were .19 and .26, respectively; and with weight, when height and age were kept constant, .27 and .17, respectively. Apparently increase in carpal area was closely related to growth in height and weight, even when age was eliminated. Older children did not possess larger wrist bones unless they were also taller and heavier. A number of other studies of carpal development may be briefly summarized: >' For a group of 402 children selected at random, and ranging from 5.5 to 11.5 years of age, Woodrow and Lowell reported the following correlations of carpal development: with the number of permanent teeth, .20 for girls and .03 for boys; with the intelligence quotient (computed from the Binet), from .15 to .23 in the 7.5

66

CLINICAL AND ABNORMAL PSYCHOLOGY Q Q W U

»t-t- l o o ' s g o o n OOCD — eb —do « f «

c s o o f t->o

hi H O* 00 O

oi

*O — CO 00 f

t"» O CO 30

00 f

O*

O 00 CO t~ 00 "^

•* •* —"O e > « 4 to —c- o< —1> o n e

Il — W

OCV —

•*eooo

•ooo ooooo ooooo > f l f O t O O O >ooo o>ooo>

o o « o o —o — —— O « K

2«2

•+ O 00 «* 0& CO O O t > 00 0)10 oO eOnO COOO t-ooo — O O O O>

-" n » V} O V)

A O Ol

»o-f

ccoto

as o c a

«D>OCO tooo«

=2 1X1 m

35 GO S ' J c

oao —*

•o»o«o O f c

- f o»

oo

>6««

NTA LOS E

—o—

eot-'o oo«o« i-i"*"*

«

«

H

*

«p«oto «pcocp « o « ) e t - e t-ooao too-o cococ

o « O «

w K

s

g S25

•5.-5S Z.-T.-5 £-53 &-=3 R-^5 R-53 R-S3 g,-S3 ^ 3 nun nun nun nun nun nun nun nun nun

1 1 £ i i 1 J*

Ave.

n Q

No.

1

•1

atoooo s w o eooboo oo e t a o*o»a* t-i-ioo o « o >o

O OO 00 A OS 00 ^ I*" OO

Ave.

FIRST WALKED UNSUPPORTED

CORRESPONDENCE BETWEEN INDICES

*-i ^-.-•

io o ©

67

lit •=III ^

r- © oo »o ao o?

e

3

a 1^1 i,

Ave.

Od 00 »~« W ^ O

No.

O *"* *** W ^» Cb OO I*. O m o o ooo>t- oohO» O« r-i O» r - ~*

Ave.

00 1^* 00 00 CD QO ^ ^ h« *Q © ^ o

^\

^^

ii j

«

O>b>Cb t»90O> 0 0 9 0 0 00 00 ^ IO IQ to tD t* 09 t~t~C. J

04 v^

Ave.

o

Q4

No.

SITTING UNSUPPORTED

STANDING UNSUPPORTED

No.

si

1

« « «

Hi Hi -a

B

3

«» S -K

r-ct.(- o>c9«0

111 111 111 III I -I a " - 5 | g-2 F.-M.» ...

z3

moo nun « oa

,

g Bubnormal.... (Bo., Def.. M Imb., I d ) . . . Feeble-Minded (M.. 1mb., Id

Z f«

Normal or not'. (N., R., Ba.)

52

CWB

Z

1=11 ja

I is

*C C r^ «

68

CLINICAL AND ABNORMAL PSYCHOLOGY

year group, and from .30 to .41 in the 10.5 year group; and with height .14 for girls and .27 for boys in the 10.5 year group. The correlation between I.Q. and the number of permanent teeth was .12 for the boys and .21 for the girls in the 7.5 year group. The correlation between height and the I.Q. was "much lower" than between I.Q. and carpal development, while the correlation was small between school grade and either carpal development or the number of permanent teeth. The writers' conclusions are that the correlations are "disappointingly" small, that height cannot be substituted for carpal development as a measure of anatomical development, that dentition can be substituted for carpal growth as a measure of intelligence (neither being significant), and that Crampton's claim that "physiological age should be taken as a basis for all record and investigation, and pedagogical, social, or other treatment of children," cannot be vindicated. S. O. Severson found that the group of ten-year-old children most immature in carpal development had a Stanford-Binet age of about nine years, while those who were the most mature had a Stanford-Binet age of 10.9 years. In spite of this correspondence, the correlation between anatomical age and the Stanford-Binet age and the Stanford-Binet I.Q. was only .38 and .31, respectively. The correlation of carpal development with group intelligence and attainment tests varied from only .02 to .50, while the correlation with head circumference was only .08. In general, the StanfordBinet age correlated better than the anatomical age with group intelligence and attainment tests. The correspondence found in this investigation was not high enough to justify the substitution of anatomical age for chronological age in calculating the intelligence quotient. D. A. Prescott, while finding in general that levels of anatomical and mental growth agree, concludes that, in individual cases, stages of mental and physical development are to be found in all possible combinations. Normal, advanced, or retarded development in physical growth is not invariably accompanied by corresponding development in mental growth, nor is there any constant relationship between the amount of yearly increase of physical and mental growth. Mental age and chronological age give a higher correlation than do mental age and anatomical age, and partial correlations between anatomical index and mental age, when chronological age is kept constant, still remain very low. The feeble-minded were

CORRESPONDENCE BETWEEN INDICES

69

found to develop more fully physically than mentally. They were only about a year below normal in final anatomical development, while being much more retarded in mental development. Although cases were not lacking in which mental and physical development coincided, other cases are cited in which mental development was only one sixth normal, and the physical development was four fifths normal. One of the disturbing factors in this investigation is the derivation of the intelligence age from two group tests, which were supplemented by the Stanford-Binet only when there was "serious disagreement" between them. As will be shown on a later page, group tests at best give only approximate results, and are least reliable when the scores are low. Freeman and Carter also found a larger correlation between mental and chronological age than between mental and anatomical age (based on the ossification ratio of the carpal bones). With the chronological age constant, the correlation between mental age and the ossification ratio was zero. The anatomically precocious children were not the most intelligent ones when compared with children of the same chronological age. They therefore concluded that anatomical age does not give a superior basis for calculating intelligence, and that children cannot be classified in school on the basis of anatomical age. H. W. Smith in a study of the skiagrams of 914 students in the United States Naval Academy was unable to establish any definite ages at which the different stages of amalgamation between the epiphyses and shafts in the case of the radius, ulna, phalanges, and metacarpals should normally occur or set the normal limits of variation in men of the ages concerned (subadults from seventeen to twenty-three). Therefore the attempt to classify the students in the activities of the academy on the basis of anatomical age was abandoned. Conclusion. The only conclusion that seems warranted from this brief resume of the conflicting evidence from experimental studies of various kinds is that, although there is a positive correlation between physical and mental superiority, the correlation is not sufficiently constant or pronounced to justify us in attempting to classify children in their intellectual or literary tasks on the basis of the criteria

70

CLINICAL AND ABNORMAL PSYCHOLOGY

of physical maturity considered above. Some of these physical criteria doubtless are of value in the adjustment of physical tasks to meet individual needs. The problem should not be considered finally solved or incapable of solution. Practical applications of the doctrines of physiological and anatomical age must be cautiously made until more reliable knowledge is at hand.

CHAPTER IV AIMS AND METHODS OF A PSYCHOCLINICAL EXAMINATION I. AIMS OF A PSYCHOCLINICAL EXAMINATION A PSYCHOCLINICAL examination, a term suggested by the writer in 1914, denotes any clinical examination whose aim is to supply analysis, evaluation, and interpretation of psychological findings. There are two general and four specific purposes of such an examination. 1. General Purposes

The two general purposes represent the basic aims of every psychoclinical examination, and include the making of a . diagnosis and a prognosis. 1. The diagnosis. By diagnosis is meant, in general, the determination of the natuie of a disease, defect, or abnormality. It involves naming the abnormality, and describing and classifying it on the basis of the observed signs, symptoms, causes, and conditioning or concomitant factors. The examination may be based on the method of inspection, or the method of controlled laboratory tests, or both, supplemented by the personal history and family history (anamnesis). A "clinical diagnosis" is based merely on the symptoms, without reference to the pathology. 2. The prognosis. A prognosis is a forecast of the outcome, a prediction of the probable course of development, or the ultimate result, of a given disease or abnormality. A measurably complete or satisfactory diagnosis is always at the same time a prognosis. The physician makes a prediction, whether expressed or implied, of the probable out-

72

CLINICAL AND ABNORMAL PSYCHOLOGY

come of the disease under the conditions presented by the patient, and under the form of treatment prescribed. The psychologist attempts to make a similar prediction. A perfect diagnosis and an absolutely certain prognosis are ideals that may be approximated, but never fully realized. There is no guarantee that all the conditioning factors and complications have been discovered, and that the outcome will be precisely as anticipated. Too many variables and undiscoverable and uncontrollable factors influence the structural and functional development, and the integration of the human organism, to render perfect diagnoses and prognoses possible even in relatively simple affections. Some day it may be possible, by some sort of X-ray mechanism, to obtain a complete picture of the structural and functional condition of every organ of the body at any time. Until that happy hour arrives we shall have to continue to work with imperfect diagnostic tools. Reliability of psychoclinical prognoses. The prognostic uncertainties are no more obtrusive and perplexing in the field of clinical psychology than in the field of medicine, and possibly less so. The clinical psychologist can be fairly certain of the outcome of practically all of the grave or frank types of mental defect, but it behooves all examiners to maintain an attitude of judicious discretion in diagnosing and prognosing all other cases. It is better to play safe, and err on the side of conservatism, than to hazard venturesome surmises beyond the evidence. Diagnostic blunders may result in serious injury to the person involved. Stereotyped diagnoses based merely on test findings are to be deprecated. 2. Specific Purposes "While the twofold aim as stated above may satisfactorily describe the general purpose of an examination, the particu-

THE PSYCHOCLINICAL EXAMINATION

73

lar aims must be more narrowly and more specifically stated. At least four subordinate aims must be kept in mind in every psychoclinical examination. 1. A many-sided clinical picture. The first aim of a psychological examination is to furnish a description, as accurate and adequate as possible under the imposed limitations, of the mental condition or behavior of the subject at the time of the examination. How does the subject comport himself amid the incident stimuli of the clinic or laboratory? What is the nature of the mental deviations or disorders revealed by the examination? What are the functions which are involved, and what are the nature and the extent of the involvement of the specific traits which constitute any given function? What is the amount of the impairment or arrest, or of the overdevelopment or acceleration? Is the anomaly general or specific, or both? Is it qualitative or quantitative, or both? Always our first objective is to make an analytic inventory of the mental characteristics of the examinee. The adequacy and completeness of the clinical description will vary greatly according to the time available for the examination and the competency of the examiner. 2. Etiology. Our second quest is to discover the causative factors, or the conditions under which the deviations or disabilities have arisen. How did they originate? Which factors are of primary importance? Which are merely secondary, accessory, or contributory? Which are negligible? This type of inquiry — that is, the determination of the pathological and pathogenic factors — is very important in the type of cases in which the character of the causation may affect the treatment, and particularly in which a genuine cure depends on removing the underlying causes. If the causes of mental handicaps are external to the nervous system, it may be possible to remove them by appropriate

74

CLINICAL AND ABNORMAL PSYCHOLOGY

remedial treatment. If the defect is integral to the nervous system, ordinarily it can only be mitigated by proper psychological, educational, hygienic, or other type of treatment. Methods of discovering the etiological factors. How can the causative factors be located? Negatively, this cannot be done in most cases by means of a mere cross-section view, or flash-light clinical picture, of the individual's status prcesens. A survey of the condition of the patient at the time of the examination affords an inadequate foundation for etiological induction with mental cases, because it does not reveal the basic causes, which usually have been operative in the past history of the individual or the individual's forbears. The study of causation must be based on a longitudinal view instead of a cross-section view of the individual, on the anamnesis, the life history, the genetic view of the abnormality. The detailed chain of events leading up to the difficulty must be traced, for the causative factors may have been operative at various times in the past. Abnormal mental states and conditions are what they are because of their antecedents, and cannot be adequately understood or interpreted apart from their evolution or development. Another important reason why a mere flashlight picture may be quite inadequate for a satisfactory diagnosis, or clinical description, is the fact that the mental manifestations in some types vary from time to time. This is particularly true of epileptics, hystericals, neurotics, psychopathies, and certain types of psychotics who pass through alternations of depression and exhilaration, quiescence and psychomotor excitement, clouded consciousness and lucidity, or high and low efficiency. The intelligence level secured from only one testing of these types may be unreliable. A thirty-two-year-old epileptic when tested the first time had a Binet level of about three years, which seemed from my observation of his behavior in the cottage to be too

THE PSYCHOCLINICAL EXAMINATION

75

low. The record showed that he had had a number of severe seizures on the days immediately preceding the test. Three months later, following a period devoid of seizures, he had a Binet age-level of over six years. Fortunately, the uncomplicated types of mentally defective or backward children ordinarily do not vary to any considerable degree. Nevertheless, subnormal children, just like normal children, have their off days — their moments of gladness and sadness, of enthusiasm and inhibition, or of fitness and unfitness. Few persons can at all times command the same reserves of energy, or function on the same plane of efficiency. Factors to investigate. The most significant factors to investigate, in the attempt to trace the evolution and discover the causes of mental disabilities or disorders, would include the following: (a) Variow environmental conditions. These include vitiated air, deficient or insufficient food, use of narcotics, poverty, neglect, abuse, the exclusive use of a foreign language, and bad moral conditions and mental hygiene in the home; bad neighborhood conditions, physically, socially, morally, educationally, and intellectually considered; and excessive temperature, deficient humidity, incompetent instruction, excessive psychic tension, and poor mental hygiene in the schoolroom, including too frequent transfer from school to school. Inequalities in the environmental conditions may be responsible for rather wide mental (and particularly educational) variations among children. A wide difference exists between the cultural and mental stimulation derived from a city environment and a mountain section. The city urchin, familiar with urban street life and the life of the city, is "world-wise." He possesses a certain "street precocity," a knowledge of the "ways of the world," a wealth of contact, and audacity and readiness of response which are foreign to the country child of the lonely mesas or

76

CLINICAL AND ABNORMAL PSYCHOLOGY

the secluded mountain fastnesses. Wide variations in environmental conditions probably produce greater mental variations, even when measured by performance in accepted intelligence tests, than has generally been conceded. Two girls were required to go to work in cotton mills in Florida at the age of six and did not receive any formal schooling until they were sent to Pittsburgh, when almost thirteen and fifteen years of age. When tested at the age of 13 and 15.6, respectively, they had Binet ages of 10.8 and 10.2, and I.Q.'s of 83 and 65. To assume that the Binet retardation was wholly due to " defective native endowment," and that the educational neglect and lack of cultural contacts were negligible factors, imposes a considerable strain on credulity. (b) Disabling bodily conditions in infancy and childhood. Some diseases and defects obviously have no direct or appreciable influence on mentality. A mole on the back, webbed fingers, bowed legs, or an occasional twinge in a tooth or in a joint do not produce mental stagnation or disequilibration. On the other hand, some diseases, like the ordinary infections of childhood — measles, scarlet fever, diphtheria, typhoid fever — may infrequently produce mental dullness or disturbance, while other diseases, such as infantile paralysis and particularly cerebro-spinal meningitis, frequently do so. Physical defects, such as adenoids, diseased tonsils, nasal obstructions, diseased dentures, chronic foci of infection, and malnutrition, may impair the functional efficiency of the organism and may lead to premature bodily and mental dissolution. Grave sensory defects (blindness and deafness) always produce serious mental handicaps which can only be ameliorated by prolonged specialized training. (c) Bad mental and educational hygiene. Anomalous mental development is sometimes traceable to lack of ap-

THE PSYCHOCLINICAL EXAMINATION

77

propriate stimulation, of mental discipline, and of cultural influences in the home; the development of groundless fears; indulgence in outbreaks of temper and emotional tantrums; the acquisition of doctrinaire ideas, errors, misconceptions, and superstitions; the formation of habits of day dreaming, introversion, detachment from reality, unwholesome rumination, imaginary satisfaction of concealed desires, or uneconomical or injurious methods of memorizing, learning, and studying; inadequate or faulty instruction in school, irregular attendance, and lack of application and proper motivation; and the like. (d) Slow or arrested rate of development. A small proportion of retarded children may eventually catch up and reach the normal standard because they continue to develop longer, although at a slower rate, than do the normal children. The weight of opinion, however, is against this hypothesis. The examiner should keep in mind another possibility, namely, that the child's mental growth at the time of the examination may have stopped temporarily on a "resting plateau." Such plateaus, according to the theory, furnish an opportunity for the consolidation and integration into large units of numerous specific habits previously acquired. These neural integrations are regarded as essential prerequisites for making fresh advances and acquiring more complex forms of behavior. Errors of mental diagnosis might arise either from testing a child during a period of arrested or retarded growth, or during a temporary slump or incapacity. Some investigators report that there is no evidence from Binet testing that such rhythms or periodicities of mental growth actually occur. On the other hand, Baldwin and Stecher, on the basis of repeated StanfordBinet testing of the same children, find evidence of mental fluctuation associated with physical development. A prepuberal increase of mental development is particularly evi-

78

CLINICAL AND ABNORMAL PSYCHOLOGY

dent. It occurs earlier in superior than in normal children, and earlier in girls than in boys. (e) Cacogenic heredity. Various dysgenic factors should be investigated, both in the direct and collateral ancestral lines, and both in the immediate and remote ascendants. Of primary importance in the causation of native mental defects and anomalies are the so-called "neuropathic traits" — insanity, feeble-mindedness, epilepsy, neurotic constitution, and mental eccentricity — while such traits as parental alcoholism, infections, toxemias, vitiated blood supply, food and vitamin deficiency, syphilis, criminality, and immorality should always be noted, although usually regarded as of secondary or negligible consequence. The role of various causative factors in the production of mental inferiority has been discussed in Studies of Mental Defects and Handicaps, and in The Education of Handicapped Children, and cannot be considered in this volume. The investigation of the hereditary factors of mental abnormalities is highly important, but it is exceedingly difficult to obtain thoroughly reliable data, owing to the obscurity and intricacy of the mode of origin of many abnormalities, and the impossibility of discovering all the relevant circumstances affecting each case. The significant facts are frequently unknown, forgotten, or adroitly concealed. Where all the facts are obtained, it is no mean task to disentangle the irrelevant from the relevant, and to evaluate the role of each relevant factor. The investigator of heredity must not only be a technically qualified, critical scientist, but he must be a tactful sleuthhound who can scent promising trails and unloosen the tongues of those who know but are secretive. By skillful and tactful manoeuvering information can sometimes be elicited regarding neuropathic taints which could not be secured by direct questioning. It is profitable to observe

THE PSYCHOCLINICAL EXAMINATION

79

critically the general reactions of the parent or other relative accompanying the child to the clinic, particularly with reference to evidences of nervous and mental instabilities, and mental inferiority, but the tendency to make immediate or rash deductions from such observations should be curbed. Avoidance of hasty etiological diagnoses. Because of the obstacles involved — and they are often insuperable — the examiner must beware of precipitate etiological diagnoses, and must learn to resist the importunity of teachers, parents, and social workers for immediate, " right-off-the-bat" pronouncements. It should not be forgotten that a diagnosis of mental deficiency carries with it a prognosis of incurability and a tacit recommendation for assignment to a special school, commitment to an institution, or placement under guardianship, while a diagnosis of insanity is equivalent to a writ of court commitment. 3. Determination of the consequences of the mental abnormalities upon the subject's behavior. How have the individual's behavior, disposition, life attitudes, habits of thought and feeling, and conduct been modified by the defects or disabilities from which he suffers? Have they caused mental, moral, educational, or physical breakdowns, or failures of adjustment? In the case of mental deficiency, the consequences are clearcut and inescapable. They are invariably pedagogical, industrial, and social incompetency, ofttimes high suggestibility, excessive credulity, irresponsibility, and sometimes criminalistic proclivities. The profound alterations of the attitudes, beliefs, character, and behavior of the insane are apparent to the most cursory observer. The reactions of the mentally disordered, however grotesque and absurd they may appear, become quite explicable once the underlying mental mechanism is understood. A knowledge of the patient's delusions, hallucina-

80

CLINICAL AND ABNORMAL PSYCHOLOGY

tions, obsessions, rationalizations, or phobias will usually render his conduct intelligible to the observer. The murderous attacks of the paranoiac are the logical consequence of systematized delusions of persecution. The conduct of most psychotics becomes rational just as soon as the hidden springs to action are discovered. The extent to which the individual's behavior has been modified and distorted by his disabilities vitally affects the answer to the final phase of a psychoclinical investigation; namely: 4. Determination of the degree of modifiability of the mental defect or disorder. There are two aspects to this question: First, to what extent can the defect or disorder be overcome? Can it be completely corrected? Or, if ineradicable, to what extent can it be mitigated, or compensated for by the development of other traits? For example, what degree of amelioration is possible in a case of mental deficiency, backwardness, speech defect, epilepsy, hysteria, mental disorder, social delinquency, criminal propensity, reading disability, or spelling defect? The responsibility cannot be shirked, in any adequate psychoclinical examination, of forecasting the degree of orthogenesis which may be expected under the prescribed course of treatment, however erroneous such predictions may prove to be. Second, by what means can the disability be mitigated or eradicated? What is the process of orthogenesis? What corrective methods must be employed? In general, two types of remedial (orthogenic) measures are available for mental, educational, and social deviates. (a) Indirect, bodily treatment (orthosomatics, a term coined by the writer in 1912). We can attempt to set the mind right by first setting the body right, to normalize the mental processes by first normalizing the bodily functions,

THE PSYCHOCLINICAL EXAMINATION

81

to make the mind healthy and efficient by first making the body robust and efficient. This involves the removal of defects and foci of infection; the correction of organic malf unctionings or maladjustments; the cure of active diseases by means of surgical, medical, and hygienic treatment; and the development of the psychophysical organism by appropriate physical, sensory, and motor training. Discrepant claims of results of physical treatment. The amount of mental improvement or normalization which can be produced by somatic treatment is still in dispute. The evidence produced by H. A. Cotton and his followers seems to show that mental disorders can frequently be prevented or cured by the removal of foci of infection, and the detoxication of infected individuals. On the other hand, much of the mass of available facts bearing on the relation of mental inefficiency and mental deficiency to physical defects and diseases, and on the possibility of the raising of the intelligence level and the I.Q. by means of appropriate medical and surgical treatment, is rather ambiguous and contradictory and has been variously interpreted. References to the most significant studies may be found in connection with the brief discussion of the topic in the companion text, The Education of Handicapped Children, pages 83 ff. and 88. Whether or not the intelligence level, as determined by psychological tests, can be elevated by orthosomatic treatment — and the question must be left open for the present — numerous follow-up observations have convinced the writer that appropriate medical and surgical treatment will enable many mentally retarded children to apply themselves better, and to use the mental capital which they possess to better advantage. It can elevate their level of practical efficiency or competency, if not their intelligence-test level. It undoubtedly prevents the development of complicating diseases which may produce associated or contingent in-

82

CLINICAL AND ABNORMAL PSYCHOLOGY

efficiencies, and also tends to counteract premature deterioration and decrepitude. Experimental evidence of elevation of educational competency from correction of physical defects. In 1910 and 1911 appropriate hygienic oral treatment was supplied to a group of twenty-seven school children suffering from diseased dentures and gums, an insanitary oral cavity, and frequently defective nutrition. The regimen consisted of fillings, extractions, treatments of the gums, demonstrations of proper methods of brushing the teeth and gums, and of insalivating and masticating the food. Two demonstration meals were given as an aid in the development of correct eating habits. The results of the treatment during the experimental year were checked by physical reexaminations; detailed reports by the supervising nurse, the teachers, and the principal of the school; and by quantitative psychological measurements. Two of the six series of five sets of group psychological tests, devised by the writer and administered under his direction, were given before treatment began, two during its course, and two following its termination. The terminal tests Mere given almost a year after the initial tests. The investigation showed that many of the children, in the course of the experimental year, improved significantly in physical condition, scholarship, conduct, and performance in the psychological tests. Most of the members of this experimental squad were laggards and repeaters, pedagogically retarded from one to four years in their school work, but during the experimental year only one pupil failed of promotion, while six did thirty-eight week3 of work in twenty four weeks, and one boyfinishedtwo years of work within the experimental year. In the psychological tests the post-treatment scores were 57 per cent higher than the pre-treatment scores. Owing to the impossibility of testing a parallel control squad, which the writer tried in vain to organize, it cannot be determined with exactitude what proportion of the improvement in the psychological

THE PSYCHOCLINICAL EXAMINATION

83

tests should be ascribed to the factors of familiarity, practice, and increased maturity, and what proportion to the improved physical condition and working efficiency of the pupils, but there can be little doubt that much of the heightened efficiency evidenced was directly due to the oral treatment and hygienic regimen carried out during the year. J. N. Mallory has more recently measured the degree or coefficient of association (based on Pearson's association formula?) between five major physical defects (involving the tonsils, nose, teeth, eyes, and ears) and achievement scores in standardized educational tests in the case of .515 children, distributed through the elementary grades. The physical examinations were made by a registered nurse. The children were classified into four groups; namely, physical defectives with low scores and with high scores, and sound pupils (non-physical defectives) with low scores and with high scores in the achievement tests. Scores were regarded as high when above, and as low when below the 100 per cent average achievement score, each score having been reduced to a percentage of the class median for the test in question, thus affording a median per cent score. Intelligence was measured by the Illinois intelligence and the Holley picture tests. After freeing the results by partial correlations from the influence of intelligence, school attendance, and retardation (as determined by the educational quotient), the coefficients of correlation (Q.) shown in Table 2 were obtained. The figures indicate that there is a direct relation between physical defects and low achievement scores, the defects ranking in the following descending order: nasal obstruction, decayed dentures, defective hearing, defective tonsils, and defective eyes. The influence of eye defects and defective vision was almost negligible. (b) Direct mental treatment, or mental hygiene (orthophrenics). We can apply various kinds of psychotherapeutic

84

CLINICAL AND ABNORMAL PSYCHOLOGY

TABLE 2,

ORIGINAL AND DERIVED CORRELATION COEFFICIENTS FOR PHYSICAL DEFECTS AND ACHIEVEMENT (After Mallory)

Tonsils Vision Nasal obstructions Teeth Hearing , General defects

ORIGINAL Q

Q. WITH INFLUENCE 07 INTEI.I.UJEVCE ELIMINATED

Q. WITH INFLUENCE OF RETARDATION ELIMINATED

.138 .029 .799 .302 .351 .210

.222 .010 .811 .294 .266 .175

.110 .124 .814 .289 .262 .126

and educational influences for the correction of mental abnormalities. Such measures include the removal of obstacles, inhibitions, repressions, and feelings of inferiority; the freeing of the individual's energies, and the guidance and direction of his life forces into fruitful, healthy channels of endeavor; the engendering of enthusiasms for objective achievements; and the proper sanitation and adjustment of his mental mechanisms. Mental hygiene makes use of many psychotherapeutic devices, such as the subtle influence of presented examples and imitative models, suggestion, hypnosis, and psychoanalysis; relaxation, inculcation of correct conceptions, ideas, and ideals; the direction of behaviour by command; ridding the mind of superstitions, phobias, repressions, inhibitions, day-dreaming proclivities, and tendencies toward introversion; developing healthy habits of thought and action, and wholesome objective attitudes toward life's problems; the proper regulation and direction of the instincts, passions, emotions, and sentiments; supplying at the proper time a systematic course of remedial and corrective pedagogics; and surrounding the child with the right kind of physical, social, educational, and moral

THE PSYCHOCLINICAL EXAMINATION

85

influences in the home and neighborhood environment. The value of mental, educational, social, and moral hygiene, when intelligently adapted to the peculiar needs of the individual, is now recognized as basic in the improvement of mentally normal, deficient, disturbed, or disordered children, adolescents, and adults. Ultimate objective of clinical psychology. Clinical psychology is more a practical art than a science. Its chief mission is orthogenic — the restoration of the deviate, so far as possible, to mental normality. The clinical psychologist examines and diagnoses in order to give helpful recommendations and counsel regarding the educational, mental, and social care of the individual deviate. This is his highest function. The application of preventive and remedial measures is the ultimate objective of all psychoclinical examinations, as of all medical work. II. METHODS OF A PSYCHOCLINICAL EXAMINATION Objective approach. There is no mental X-ray machine by which one person can peer directly into another person's mind and observe the operation of his mental mechanisms. Every one's mind is a private, subjective, unsharable domain, forever closed to the direct scrutiny of outsiders. The only way we can gain information regarding the mental processes of others is by studying their behavior — their verbal, muscular, and glandular responses or lack of responses. For making such observations and studies the clinical psychologist employs two fundamental methods. 1. The Method of Observation Definition. The method of observation, as a method of scientific investigation in clinical psychology, may be defined as a careful, systematic inspection of all the personality traits of the examinee, as revealed by the sum total of the re-

86

CLINICAL AND ABNORMAL PSYCHOLOGY

sponses of the psychophysical organism. The aim is to observe carefully all aspects of the subject's behavior; what he does as well as what he fails to do. Among the more important features to observe during the clinical examination are the following: (a) Spontaneous behavior. Observe how the child comports himself when left undisturbed in the room. More valuable results will, of course, be obtained if the natural history method is employed, and the child is observed in his natural habitat, in which his playful and restless impulses and spontaneous interests may have full sway. What does the child do when left unmolested? How does he do it? How does he comport himself with the toys and paraphernalia of the playroom and playground, with the tools and implements of adult occupations, and with his playfellows? What are the things and activities which elicit and hold his attention? Can he make and keep friends? Can he cooperate, subordinate self, follow, lead, and control his emotions? What are the characteristics and peculiarities of his spontaneous speech? In order to observe spontaneous behavior, it is essential that the child be left free and unmolested. The child must be regarded strictly as an "experiment of nature," as an object of scientific observation to be studied objectively and impersonally, albeit sympathetically. Like all scientists, the psychologist must take pains not to interfere with his experiment. He should follow the example of the scientific observer of animal life in the wild who takes pains to conceal himself, often in a tree-like enclosure, in order that his presence may not affect the animals' spontaneous behavior. The psychologist often gets his truest glimpses of mental life by standing aside and observing the child when he is most truly himself, which occurs when he behaves naturally or spontaneously. His plays and playful activities mirror

THE PSYCHOCLINICAL EXAMINATION

87

most faithfully his spontaneous interests and natural modes of reaction. Every teacher should accustom herself to observe carefully the spontaneous and playful activities of her pupils. One of the significant contributions of Maria Montessori is her insistence that teachers must be trained, not only to instruct children, but — and this she regards as more important — to observe and study them scientifically. The importance of the careful study of the pupil material by the teacher had indeed already been emphasized by Jean Itard, Edward Seguin, Jean J. Rousseau, and John Locke. Certainly the teacher has far better opportunities for observing spontaneous activities than the examining psychologist, who can spend only a brief interval with the child in a set investigation and amid artificial surroundings. Teachers who refer cases to the bureau of examinations should include in the report the significant observations made of the child's spontaneous reactions. (b) Purposeful responses to definite situations. The examiner must arrange certain arbitrary situations, and note the character of the child's reactions. Observe whether he reacts intelligently, quickly, slowly, languidly, excitedly, calmly, deliberately, fretfully, clumsily, or skillfully. Note whether he lacks the necessary muscular coordinations for executing the required tasks, or the ability to express himself in speech or writing. Notice whether he observes, attends, analyzes, compares, associates, discriminates, criticizes, retains, and profits by his analytic observations; or whether he reacts by the hit-and-miss, trial-and-error method. Notice whether he learns slowly or rapidly, and whether interest wanes rapidly. Observe evidences of autocriticism, self-assurance, diffidence, self-depreciation, inhibited will, temperamental poise, emotional abnormalities, immaturities, instabilities, and moral obliquities. Needless

88

CLINICAL AND ABNORMAL PSYCHOLOGY

to say, it is difficult to arrange situations in the examining room which will evoke all of these responses and similar ones, even when plenty of time is available. When this method of observation is employed we are practically testing the child, as will become clear in the discussion of the experimental method. Ordinarily, however, the objective situations are less highly controlled and standardized when the child is merely " observed " than when he is tested. (c) Verbal responses. We should particularly observe the nature of the child's verbal responses, the characteristics of his spontaneous speech and his replies to questions, and the nature of any speech defects. Observe whether he replies willingly, quickly, sensibly, and clearly, or whether he seems hesitant, excited, baffled, or nonplused? Does he turn to the accompanying parent or guardian for hints or cues, as the mental deficient is wont to do? Can he carry on a conversation, talk voluntarily, make his wants known? Can he ask questions with one or more ideas? Can he repeat short or long questions or statements? Does he echo his own words or the final words or phrases spoken to him (echolalia) ? Can he name familiar and less familiar objects.'' Does he express himself in complete and correct sentences, or merely in phrases or single words? Is his articulation indistinct, halting, jumbled, or dragging, or does he lisp, slur, stutter, or stammer? Spoken language is the chief means of expression of civilized people, and the facial muscles are the key-board par excellence on which the inner impulses, feelings, sentiments, and thoughts express themselves. An intimate relation exists between intelligence and the development of speech, the power of oral and written expression, and the incidence of speech defects, as shown in Chapter XIX, and in The Education of Handicapped Children, pages 354 and 355.

THE PSYCHOCLINICAL EXAMINATION

89

(d) Negative responses. Equally important is the observation of failures to react and reply, and negativistic tendencies. Negativism, which is an exaggeration of the ordinary type of stubbornness observed in many children, expresses itself in some mentally disordered types in various forms, such as the refusal to respond to requests or commands, or to do anything whatever (for example, to eat or drink or attend to the bodily functions), or to do just the opposite of what is requested. (e) Attitudes and disposition. At the time of the examination, does the child appear to be cheerful, contented, buoyant, optimistic, enthusiastic, interested, cooperative, dejected, sullen, bitter, resentful, timid, apprehensive, excited, self-conscious, brooding, introspective (introverted), ruminating, calm, apathetic, indifferent, unresponsive, or unobservant? Observations of this character are particularly important in the case of the mentally disordered and the nervously unstable, and also delinquents who are often emotionally upset when examined, particularly if the examination occurs a short time after apprehension. Many mental deficients will be found during the examination to be rather apathetic, indifferent, unresponsive, disinterested, unobservant of their surroundings, and must be urged to respond. It is apropos at this point to direct incidental attention to the importance of discovering whether the child has been subject since early childhood to nervous and temperamental instabilities, emotional tantrums, outbreaks of violent temper, excessive impulsiveness, irritability, excitability, moodiness, seclusiveness, conduct disorders, inability to adjust himself to his environment or to get along with playfellows, and the like. Such infantile traits are in many cases the forerunners of mental disorders or instabilities in the adolescent or the adult. If they persist they may eventually develop into some form of psychosis.

00

CLINICAL AND ABNORMAL PSYCHOLOGY

(f) Expression, features, posture, and gait. In the course of the examination, observe the child's passive or immobile expression, the facial appearance, poses, and attitudes when the muscles are quiescent. Is the facial expression intelligent, stupid, vacuous, spiritless, or in any way peculiar? Is the mouth open? Do the eyes appear shifting, furtive, anxious, strained, languid, or listless? Does the child affect any peculiar poses or mannerisms? Also observe the mobile expression, especially the facial features when the facial muscles are innervated or energized. Mental activity is most intimately expressed, externalized, or reflected in the play of the facial muscles. The flabby, enervated musculature of many mental deficients produces the vacuous, expressionless countenance so typical of this class of defectives. The face of many neurotics or psychotics presents a picture of overaction (hyperkinesis) and a panorama of rapidly dissolving effects. Observe the subject's gait when he enters, walks about, and leaves the laboratory. Is the gait slovenly, unsteady, waddling, shambling, disordered, or steady, coordinate, and energetic? Does the posture evidence normal or defective neuromuscular tonicity? Does the child stand steady and erect, or do the knees sag, are the shoulders stooped, and is the station unsteady? Common-sense picture. This type of observational examination furnishes a common-sense picture of the individual's behavior — how, in ordinary circumstances, he acts, stands, walks, talks, converses, answers questions, apprehends, responds to ordinary situations and events, manifests dominant attitudes and trends, and controls instinctive, emotional and temperamental tendencies. When the "manin-the-street" calls his neighbor a fool or a lunatic his judgment is based on observational data of this non-technical, common-sense kind. It is the type of examination which has

THE PSYCHOCLINICAL EXAMINATION

91

been used from time immemorial by the alienist in the study of the insane. The modern, technically trained alienist does not discard the method, but supplements it with a more refined neurological, psychological, and psychiatric technique. This method yields the clinical psychologist important data not readily obtainable by the method of laboratory experimentation. 2. Method of Experiment Definition. In a psychological experiment or test we observe mental traits under controlled and standardized conditions which can be duplicated. We study the facts of mental behavior with the aid of instruments of more or less precision, whether these instruments consist of expensive, elaborate, and delicate pieces of apparatus, or simple, crude, and inexpensive test blanks. The experimental ideal is always to obtain measurements in accurate units under described standardized conditions, so that the experiment or test may be repeated by any one for the purpose of verification, further standardization, or practical diagnosis, but no radical difference in scientific methods exists between the method of observation and the method of experiment, test, or measurement. A mental measurement is merely a controlled observation of an individual's reactions, whether verbal, motor, or glandular, to a given stimulus situation. There are two chief types of measurement employed in psychology. (a) Quantitative measurement. In a quantitative measurement we determine the quantity or the amount possessed by the examinee of any given mental trait or complex of traits. For example, how large is the child's observation, memory, or attention span? How many impressions can he apprehend during a momentary exposure? How many numbers can he reproduce from one presentation? How

92

CLINICAL AND ABNORMAL PSYCHOLOGY

many more words can he name in three minutes than the average child of his age? How much does he possess of any trait? Is any trait or function wholly lacking? Everything that exists exists in some amount, and is therefore measurable. It is believed that some daj' it may be possible to measure all kinds of psychical as well as physical quanta. Measurement in exact mathematical units is the soul of science, and the ideal which all scientific workers set out to attain. Mental measurements always are, or should be, made in terms of some constant unit of measurement, so that the results may be given an exact mathematical expression. Measurement of mental traits in quantitative terms is called psychometry. An example of a psychometric problem is the measurement of intelligence by means of the Binet-Simon scale. The use of this term is traceable to Galton, who employed the word "psychometric" in 1879. How to measure mental quantities. The question naturally arises, How is it possible to measure mental processes at all? Briefly, there is no mental measuring rod by which psychic phenomena can be measured directly. What we measure are stimuli and behavior reactions. The intensity of a sensation can be measured only by measuring the intensity of the stimulus. Any mental process is measurable only through its expression in muscular, glandular, and linguistic reactions. Only stimuli and behavior reactions are measurable in exact units. On the basis of measurements of overt actions, inferences of more or less reliability may be drawn regarding the psychic substrates or correlates. Necessarily, in psychological investigations the inferences are subject to the same kinds of errors of interpretation as in the physical sciences. (b) Qualitative analysis. We need not stop with quantitative measurements, which are the easiest to obtain, but may

THE PSYCHOCLINICAL EXAMINATION

93

proceed with the aid of tests to a qualitative analysis of various mental activities or functions. The qualitative investigation takes a different form. How do mental processes differ in kind or in quality? For example: What qualitative differences are there in the process of association of ideas in the mentally disease! as compared with the mentally normal adult? In what kind of memory is the epileptic peculiarly deficient, as compared with the normal? Does the defect affect mainly the logical or the rote form, or the immediate or the remote type of memory? Does the attention defect of the feeble-minded involve all forms of attention in equal degree? It is generally admitted that qualitative differences exist in sensation, perception, memory, association of ideas, attention, reasoning, and other mental processes, but the qualitative differences are also differences in amount and can in many cases, perhaps in all cases, ultimately be resolved into quantitative differences. A non-quantitative quality is incomprehensible and non-existent. Qualitative differences are, in the final analysis, quantitative differences. The qualitative differences are ultimate only in the sense of experiences which cannot be resolved into more ultimate categories. Purpose of the experimental study. The purpose of the experimental study is to obtain a more scientifically precise, accurate, and detailed clinical picture or diagnosis than can be obtained by the ordinary method of observation. Needless to say, a complete psychological examination is a complicated, many-sided affair, requiring considerable time, technical skill, and penetrating powers of psychological analysis. Many acquire the laboratory and testing technique who do not acquire the analytic and interpretative insight necessary for making adequate psychological diagnoses. The comprehensiveness of an analytic psychological diag-

94

CLINICAL AND ABNORMAL PSYCHOLOGY

nosis is limited only by the examiner's subtlety in analysis and by the time at his disposal. History of mental measurements. The outstanding incidents in the pioneer history of psychological experiments and mental testing are as follows: In 1834, E. H. Weber, the grandfather of psychophysics, announced, on the basis of tests conducted mainly with lifted weights, that the smallest perceptible difference between stimulus magnitudes is a constant proportional part of the original stimulus. Said he, "We perceive not the difference between the objects, but the ratio of this difference to the magnitude of the objects compared." G. T. Fechner, the father of psychophysics, through further experiments in various sense departments, formulated in mathematical terms the relation between the intensity of the stimulus and the intensity of the resulting sensation, the intensity of the latter increasing as the logarithm of the stimulus (S = K. log R, called Weber's law). To get a certain increase in the sensation intensity it is necessary to add a constant fraction of the stimulus, one third, one fifth, one fortieth, etc., according to the nature of the sense modality. Psychology is also indebted to Fechner for the so-called psychophysical methods, which he contributed to psychological measurements. He published his Elements of Psychophysics in 1860. W. Wundt, who founded the first psychological laboratory in 1879, in Leipzig, laid the foundation for the general experimental method in psychology. He adhered pretty closely to the experimental study of the elements of consciousness (sensations) through the measurement of reaction-time and the verbal reports of introspections, and discouraged the study of individual differences. Francis Galton, in the words of E. G. Boring, is "the father (in large part) of mental measurement, of individual

THE PSYCHOCLINICAL EXAMINATION

95

differences with respect to traits, with Fechner and Charcot of ideational types, and the originator of the questionnaire and of the theory of Eugenics." He studied mental imagery, weight discrimination, sensitivity to high pitches, association and reaction-time, introduced statistical methods into the science, the use of averages, measures of dispersion, percentile grades (from Quetelet), and correlations, and dealt Avith individual and racial differences, mental heredity, and eugenics.1 In 1884 he founded a laboratory for giving anthropometric and psychological tests, and in 1904 (or 1905, according to R. Pintner) a eugenics laboratory which bears his name. E. Kraepelin, as early as 1883, used association tests for making differential diagnoses of normal and psychotic individuals. In 1895 he proposed an extensive investigation, chiefly by means of simple arithmetical tests, of traits which he deemed basic in the characterization of an individual, such as adaptation, fatigability, recuperability, persistence of practice effects or general memory, special memories, and capacity to concentrate attention in the face of distractions. One of his students, A. Oehrn, in 1889 published results of the earliest experiments in mental correlation. The tests included counting letters, checking designated letters, noting typographical errors (perception), learning series of digits and nonsense syllables (memory), adding single-digit numbers (association), and writing and reading as fast as possible (motor functions). The same year, C. Rieger suggested a method of testing intelligence which appears not to have borne fruit. Two years earlier J. Jacobs had employed graded series of letters and digits for the measurement of auditory memory span. J. M. Cattell, who seems to have been the first psychol1

See his Hereditary Genius, 1869, and Inquiries into Human Faculty,

1883.

96

CLINICAL AND ABNORMAL PSYCHOLOGY

ogist *o employ the term "mental tests," emphasized the importance of the study of individual differences with the aid of standardized tests, in various articles appearing between 1885 and 1900. The examination schedule which he proposed comprised ten records, twenty-six mental measurements, physical measurements, and personality data. In 1896 Cattell (in cooperation with L. Farrand) published results of testing Columbia College freshmen for vital capacity, strength of grip, reaction-time, pain, memory, imagery, tactual and weight discrimination, pitch, color vision, color preferences, visual and auditory acuity, accuracy of movement, and time estimation. The psychological tests were restricted to the simpler sensory processes and reactions, because no suitable tests had been devised for measuring the complex processes. They also feared that the results of tests of such processes would be difficult to interpret. J. Jastrow, in 1890, gave a battery of individual tests, mostly sensory and motor, to students in the University of Wisconsin. About fifty minutes were required for the examination. The tests were supplemented by a questionnaire on personal and family characteristics. Three years later, in the exhibit arranged by Jastrow at the Columbian Exposition in Chicago, opportunity was afforded visitors to undergo a considerable variety of sensory, memory, and motor tests. In 1891, H. Miinsterberg described fourteen tests given to school children, which included tests of quickness of recognition and naming, addition, naming odors, immediate recall, estimation of lengths, and locating sounds. The results of Jastrow's and Miinsterberg's early schedules of tests, which were not constructed as intelligence tests, have never been published. In connection with an anthropometric investigation of

THE PSYCHOCLINICAL EXAMINATION

97

about 1500 school children, F. Boas, in 1891, compared the results of a digit-span memory test with the "intellectual acuteness " of the pupils, as estimated by the teachers. Such a comparison between test results and independent estimates of mental capacity had been suggested by Galton, but apparently had not hitherto been made. Two years later J. A. Gilbert made a similar comparison of the teachers' estimates of general ability of 1200 pupils, and the scores in tests of sensory discrimination, rapidity of tapping, simple and choice reactions, memory, and suggestibility. Measurements of weight, height, and lung capacity were also made. The experiment conducted by E. A. Kirkpatrick, in 1894, on pupils from the third grade to college on auditory and visual memory, and memory of words and objects, was followed the next year by the significant experimental contribution of the methods of testing memory by H. Ebbinghaus. Two years later Ebbinghaus, in an investigation of fatigue, devised his celebrated "completion test" as a "genuine test of intelligence," which is still extensively used in one form or another, and which will be described in Chapter XII. The events which proved of most significance in the development of measurements of general intelligence were the criticisms in 1894 and 1895 by A. Binet 1 and V. Henri of the use of simple tests of sensory discrimination and tests of special and limited abilities in the study of "individual differences," in which they had become vitally interested. Emphasizing that individual differences are less obvious in •simple sensory activities than in more complex activities, they addressed themselves to the task of devising tests of the "superior mental faculties," such as various kinds of 1

In 1889 Binet founded thefirstpsychological laboratory in France, at the Sorbonne. ,

98

CLINICAL AND ABNORMAL PSYCHOLOGY

memory, imagery, creative imagination, attention, description of objects, suggestibility, judgment, comprehension, synthesis, and aesthetic appreciation. The successful investigations of the more complex intellectual functions which they carried on prepared Binet for the task of constructing a scale of general intelligence to which, in cooperation with Th. Simon, he turned his attention a decade later, and which marks one of the most important events in the annals of clinical psychology. However, before the appearance of this well-known scale (which will be considered in Chapter VII), Witmer had started his psychological clinic in the University of Pennsylvania, in 1896, and in 1897 Th. Ziehen had proposed a scheme for testing defectives,1 while Blin seems to have been the first investigator to use "scores" (in 1902), in connection with a crude scale of tests, mostly scholastic, for measuring capacity in terms of units on a scale from 0 to 5. However, the tests were not properly graded and the scoring was largely subjective. Possibly this may be considered to be the precursor of the BinetSimon graded scale of intelligence. Reference will be made in later chapters to some of the studies based on mental tests which have appeared in profusion from the psychological laboratories, both before and since the appearance of this pioneer individual scale for the measurement of intelligence. Tests available for psychological diagnosis. It would be quite futile to attempt in this book to enumerate, catalogue, describe, and critically interpret and evaluate the mass of experimental data obtained from the use of the many hundreds of psychological tests now at the command of the ex1 The writer's plan for studving human efficiency in normal and abnormal individuals, proposed fourteen years later, was independent of Ziehen's. (See Pedagogical Seminary, 1911, pp. 74-84; or The Mental Health of Uu School Child, 1914, 166-81.)

THE PSYCHOCLENTCAL EXAMINATION

99

amining psychologist. Adequate descriptions and directions for giving and scoring all these tests, and discussion of results, may be found in numerous textbooks of experimental psychology and mental tests, and in innumerable articles and monographs dealing with group and individual tests and test results in intellectual, motor, emotional, and character development. For references to the literature, consult the references on tests at the end of the book. This book is not designed as a manual of tests which will supplant existing manuals, handbooks, and guides. All that can be profitably attempted within its limited compass is to discuss the fundamental purposes or phases of a psychological examination, to describe very briefly or illustrate some of the test procedures or tests employed in the investigation of the fundamental mental functions, and to review, in briefest possible form, some of the test results, some of the psychopathological or anomalous mental conditions found in various types of mental abnormals, and the therapeutic procedures in limited fields. To attempt more would encumber the book unduly, and remove the necessity for the supplementary exposition of the instructor. The instructor may find it profitable to supplement the discussions of the book with more complete descriptions and actual demonstrations of various test procedures, more detailed discussions of specific problems or debatable problems, and the outlining of therapeutic procedures which cannot be considered here. Tripartite classification of mental functions requiring investigation. For the sake of convenience the psychological examination may be considered under three main heads; namely, (1) the determination of the general level of intelligence and specific intellectual peculiarities; (2) the determination of the motor level, and specific motor and psychomotor peculiarities; and (3) the determination of the

100

CLINICAL AND ABNORMAL PSYCHOLOGY

stage of emotional development, and emotional, instinotivet temperamental, and character peculiarities. At the outset, it may be conceded that this threefold division is somewhat arbitrary, as is any classification based on psychological traits, for we never deal with isolated or independent mental functions. The mind always functions as a unity, a totality, an indivisible entity. All the mental processes are inextricably intertwined. Whenever the individual is engaged in any kind of psychic activity, the whole mind is active, and not merely an isolated section or fragment. The "stream of consciousness" at any moment of time is a complex of simultaneously operative functions. If this conception is correct, it is evident that, in strictness, it is impossible to test mental traits or functions in complete isolation. The next chapter will be devoted to a consideration of the general directions for making psychoclinical examinations, while the first phase of a psychological examination, the study of intelligence, will be discussed in Part II, and the other phases of a psychological examination in Parts III and IV.

CHAPTER V GENERAL DIRECTIONS, FACTS, AND PRINCIPLES TO OBSERVE IN MAKING PSYCHOCLINICAL OBSERVATIONS AND TESTS ALTHOUGH the following discussion of fundamental facts and rules of procedure pertains particularly to a Binet-Simon examination, it will doubtless prove of value as a guide to the novice in the use of all sorts of psychological examination methods. i. Psychological observations and tests are probing, not teaching, exercises. The purpose of a psychological examination is to scrutinize, to explore, to find out what the examinee knows, what he can or cannot do, how he executes given tasks, and how he comports himself in a given situation. It is not the purpose of the examination to teach the examinee anything — although highly educational results follow as a not infrequent by-product — or to criticize the performance by calling attention to errors, correcting mistakes, scolding, reproving, or manifesting signs of displeasure. This is emphasized because the consciousness of a poor performance tends to make the child self-conscious and timid. He loses interest, becomes confused, resentful, and, as a result, gives inferior responses. Naturally the examiner will recommend to parents and teachers measures to be taken to overcome the defects revealed in the examination, but signs of displeasure because of foolish or wrong responses should rarely be exhibited in the examinee's presence. Minor lapses should be consistently overlooked. If any attention is directed to more serious errors of fact or judgment it must be done with great tact, and in such a

102

CLINICAL AND ABNORMAL PSYCHOLOGY

spirit of extenuation as will encourage the subject to put forth augmented effort. 2. The psychoclinical examiner must approach his problem in a scientific, but also humanitarian, attitude. The psychological examiner must be imbued with the scientific attitude and point of view. He must view the examinee as a natural phenomenon, studying him impersonally, impartially, and objectively, in much the same way that a physical scientist studies any natural phenomenon. He must divest himself of all preconceptions and all prejudices toward the child, whether favorable or unfavorable. In order that he may not begin the examination with preconceived opinions, it is often advisable to test the child before scrutinizing the data recorded in the case history. If the examiner knows nothing at all about the subject he will have little or no bias to overcome. After he has reached an independent conclusion from his own examination he should scrutinize all the submitted data, revise, modify, or confirm the conclusion reached, and supplement the investigation by other inquiries if need be. There is another reason why the data should be examined after the testing has been finished. The silent reading of confidential reports in the presence of the examinee engenders a spirit of resentment in some subjects, particularly delinquents, as they feel that the case against them has been prejudiced. Sympathetic handling of cases necessary. However, while the function of the psychoclinical examiner is that of an unprejudiced, dispassionate, and alert observer of a human reagent, he must always be actuated by a deep, abiding, and unselfish interest in the welfare of unfortunates. Deep human sympathy is the indispensable prerequisite of success in all types of regenerative social service. Unless the public examiner has dedicated himself to serve the highest interest of unfortunates, all the technical skill whioh the

CONDUCTING PSYCHOCLTNICAL EXAMINATIONS 103 best laboratory training in the world can confer will make of him only an indifferent, rule-of-thumb taskmaster or academician, who is satisfied with the perfunctory performance of the day's work and who is interested in hours and pay checks rather than in bettering the lot of helpless defectives. Placed in a position of authority, giving his recommendations the force of an edict, which may make or mar human destiny, an aloof, arrogant, supercilious examiner, who is quite contemptuous of the inherent rights of the downtrodden, may inflict untold injustice upon defenseless handicapped minors, and upon adult dependents and wards. Before the psychological examiner should trust himself to make far-reaching recommendations regarding the control of defenseless unfortunates, let him visualize himself as the parent of the child and ask himself the question, "What would I recommend if this were my own offspring? " Viewing the situation from this intimate angle often serves as a powerful brake and corrective of precipitate, perfunctory, stereotyped methods of disposing of cases. The suggestion to students in the clinic course that they review their findings in the light of the query, "What would you recommend if this were your own child?" has more than once produced a transformation in attitude and point of view that is almost incredible. If all psychological examiners asked themselves that question, and if they had more of the "milk of human kindness," far fewer children of low mental potentials would be ruthlessly excluded from the privileges of public-school instruction. Perhaps the stipulation of parenthood should be the preliminary prerequisite for psychoclinical service. The psychological examiner must be much more than a coldblooded, analytic scientist; he must be a sensitive humanist, a profound philanthropist in the original and the best connotation of that word. If he is lacking in the elemental feelings of Gemuetlichkeit and comradeship, and in

104

CLINICAL AND ABNORMAL PSYCHOLOGY

enthusiastic devotion to the highest interests of mankind, and particularly of dependents and defectives, he will attain but mediocre success in the field of social service. Distinguished record of service is denied those who cannot, in a spirit of abnegation and dedication, devote their powers solely in the interest of those to whom they would minister. Without the right atmosphere the publicly supported psychological, psychopathic, and psychoeducational clinics are in danger of becoming despotic, bureaucratic institutions, functioning punctiliously like machines, but without heart and soul.1 There are wooden taskmasters in clinical psychology and psychiatry, just as in teaching. 3. The psychologist deals with an animate object whose reactive characteristics and output of energy depend not merely on the nature or efficiency of the subject's psychophysical organism, but on the attitude, demeanor, and personality of the examiner. In measuring inanimate objects the attitude and personality of the experimenter are matters of indifference, provided he possesses the technical skill necessary to do accurate work. It is immaterial whether the chemist or physicist fumes, scolds, or curses the objects of his investigations, provided the readings are correctly made and recorded. To curse, hit, or spit upon the board you are measuring makes no difference, but to hit, censure, upbraid, excite, or arouse animosity or resentment in the child you are examining makes a huge difference. A scowl, a "cut," or an unkind word may greatly modify the course of the child's "stream of consciousness," and disturb or alter his natural reactions. In dealing with living objects the responses of the reagent may depend as much on the attitude 1 The evils of bureaucracy will be accentuated by the evident attempt to concentrate mental examination work in central state bureaus of juvenile research and psychopathic institutes. The time is ripening for a process of decentralization in socio-civic activities

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 105 and disposition of the examiner as on the nature of the reactor. In New York City, a few years ago, a neurologist who did not possess the personal qualifications for psychological work was observed berating a boy who was shy or had become obstinate or embarrassed, and who refused to answer the intelligence tests. He was recommended to the juvenile court for commitment to a state institution as an imbecile. When this boy was later tested by an adaptable psychologist who had won his confidence, he rated almost normal in intelligence. The psychoclinical examiner must be a clinical diplomat, free from certain hampering personality defects. If he is antagonistic, repelling, irritating, impatient, abstract, unsympathetic, excitable, hyperemotional, unemotional, indifferent, or excessively restrained he lacks the natural qualifications needed to become a good examiner. Personality defects may, of course, be lessened by persistent self-discipline and cultivation of desirable traits. To work with the immature and unadjusted, one must have outgrown his own infantile reactions, and have become balanced and adjusted in his own personality. Necessity of evaluating responses. One of the most important things the psychologist must learn to recognize is whether or not he is receiving typical or normal responses from his subjects, or whether the responses have been blocked, perverted, or modified. Responses are frequently altered by resistiveness, resentment, deliberate deception, malingering, emotional disturbances, apprehension, worry, depression, homesickness and lethargy. They may be greatly affected by the influence of drugs, irritability supervening on the withdrawal of drugs, bad physical condition, malnutrition, a recent illness, excessive fatigue, or the sequelae of postencephalitis (such as indifference, inattention, and defective memory). Whenever an examinee has failed to

106

CLINICAL AND ABNORMAL PSYCHOLOGY

react properly, he should be reexamined at an opportune time. 4. The psychoclinical examiner must possess tact, knack, versatility, and judgment in addition to technical skill. The preceding discussion will make it unnecessary to dwell long on this topic. The possession of laboratory technique in superlative degree will not enable the tester to dispense with gumption or common sense. Even "fool-proof tests" must be applied effectively. The examiner must know how to adjust himself to, and how to deal with, varying types of examinees, and varying moods and dispositions, such as incredulity, fear, disgust, scorn, indifference, frivolity, sullenness, or anger. He must know how to reconnoiter and "wing his way" into the good graces and innermost recesses of his subject. He must be able to scent the situation quickly, so that he may apply just the proper stimulus at the psychological moment, whether it be the use of an encouraging word or nod, a sharp "attention!" issuing a request in an authoritative tone, appearing to be unconcerned with or unconscious of the child's presence, diverting attention at a moment of embarrassment by a pleasant aside, varying the order of giving the tests (where this is permissible), omitting tests which are too simple and which may engender a sneering or contemptuous attitude, and the like. Flattery and smiles sometimes arouse scorn or feelings of revulsion. All children cannot be bluffed or deceived by the statement that the tests are merely an interesting "game." With some children the "ice cannot be broken" with encouraging words or glances; more primitive arts of "inveiglement" must be employed. All personalities cannot be reached by the same formal, stereotyped mode of approach. Tact is required for the successful application of any system of psychological tests. All examiners must develop knack and adaptability.

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 107 5. Properly to understand a child and interpret his responses, the examiner must be able to assume the child's viewpoint and respect his personality. The necessity of getting down to the child's level, appreciating his attitude, and cultivating a sympathetic comprehension of his condition and his peculiar problems and limitations, is constantly emphasized as a prerequisite for successful teaching. The teacher who judges children from the adult point of view instead of from the standpoint of the child, cannot understand children or develop them intelligently, sympathetically, and efficiently. For attaining the highest success in the work of testing and studying children psychologically, it is also important to get the child's viewpoint, to be able to react on the child's level, and to understand and interpret correctly childish reactions in general, and responses to the tests in particular. The psychological examiner must know children and children's natural ways of responding, and respect their individualities, before he can establish delicate and comprehending contact with them. Only as the psychologist is able to establish such an understanding contact can juvenile delinquents be induced to make a " clean breast" of matters they are trying to conceal. A first-hand knowledge of child nature and imaginative insight are essential for a comprehensive view of child life and the clinical problems growing out of child behavior which will transcend mere test findings. 6. The examiner's initial function is to establish proper contact with the subject Before the subject can be expected to react properly, the examiner must win his confidence and cooperation, set him at ease, and remove the causes of groundless timidity, prejudices, misconceptions, and inhibitions. All that is needed in the majority of cases above the preschool age are a few words of greeting, couched in a properly modulated, appealing tone of voice, a winning

108

CLINICAL AND ABNORMAL PSYCHOLOGY

smile which is natural and not manneristic, hypocritical, or perfunctory, an unaffected manner, and a free and easy approach. To divert the child's attention from himself, overcome self-consciousness and shyness, and arouse interest, the examiner may direct attention to objects of interest in the laboratory or in the surroundings, or comment on matters likely to be of conversational interest, such as the child's plays, games, pets, and his school interests and activities. A few simple school tests are often valuable for establishing "speaking relations" with the examinee, and for effecting an easy transition to the less familiar clinical tests. Except in the case of children who are very young, uncommonly timid, or who have been frightened by the misrepresentations of playmates or others, by prior unfortunate experiences in doctors' offices, or by court procedures, it will require only a few seconds to establish the right attitude and proper responsiveness. In the case of very young children varying situations will confront the examiner. To study infants of two or three months of age does not ordinarily present any serious difficulties. They do not notice strangers particularly, and are not disturbed by their actions. They will respond naturally unless sleepy, fatigued, or hungry. To make a successful examination of youngsters ranging from six months to two or three years of age may require consummate clinical versatility. The examiner must be able to make clever use of ruses, tricks, subterfuges, cajolery, blandishments, or jingling or flashing toys. He must not assume disquieting or alarming attitudes, or seem to notice the child before he has become adjusted. He must be quick to take advantage of strategic opportunities. The skillful examiner who can establish rapprochement through clinical diplomacy and adaptability will not need to indulge in lengthy introductory manoeuvering to establish

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 109 cordial relations with most subjects. The formal testing, however, should not begin until the subject responds properly. The following admonition follows as a corollary of what has just been emphasized. 7. The examinee should be induced to function at his highest level of efficiency or his potential maximum. It is more important to know how well the child can do than how poorly he can do. Greater benefits are likely to accrue from grading a child up rather than from grading him down. Of course, there is a possible danger in attempting to follow the injunction to always secure the child's best record. Under the persuasive incitement of the examiner the child may put forth so much effort that a too favorable picture, an exaggerated rating, may be obtained. Even so, it is probable that less injury will befall the child from an overestimation than from an underestimation of his worth. A tendency is operative in many human beings to conform to or live up to expectations. Confidence breeds confidence. In any case, if this possible danger is borne in mind and proper allowance made, the statement remains essentially true. 8. The best specific for eliciting maximal effort is encouragement and commendation. In order to secure maximal attention and effort from subjects beyond the infantile period, it is justifiable, and almost essential, to bestow rather liberal praise, and to avoid references to inferior responses. Encouragement stimulates effort and augments the output of energy; criticism causes self-consciousness and embarrassment, and leads to repressions and inhibitions. The examiner should encourage the child to believe that he can respond properly. A certain amount of coaxing or urging is justifiable when it is apparent that failure to respond is due to shyness, inattention, or unresponsiveness, rather than lack of ability, but too much time must not be consumed in the attempt to drag answers from those who fail to respond

110

CLINICAL AND ABNORMAL PSYCHOLOGY

because of inability to do so. Questions should be repeated when permissible. Reward the child's efforts with rather fulsome praise, even when the responses are indifferent. Deceptions are justifiable when they arouse interest and attention, and increase effort. Nevertheless, to bestow lavish praise on responses which the subject realizes are absurd or incorrect would be the height of folly. Let us not deceive ourselves with the smug belief that we can deceive all examinees. Judgment must be used even in the bestowal of praise. Possible dangers. Some writers fear that the liberal bestowal of praise for poor performances will give the child an exaggerated opinion of his ability, and make him satisfied with inferior responses. For this reason the instructions in the Stanford-Binet provide that the bestowal of commendation must be deferred until the test is completed. In the writer's experience these dangers are less objectionable than the niggardly withholding of praise. The restrictions in the Stanford-Binet are unnecessarily severe. Praise is not always effective. There are a few obstreperous examinees who can only be induced to exert themselves by stern reproof or command, or by measures of coercion. The number of such refractory cases, however, in the ordinary run of juvenile-court cases or public-school laggards, is practically negligible. 9. It is essential that the examinees pay close attention to all the tests, and that external conditions be favorable. Maximum attention is necessary to secure genuine effort in unfamiliar tasks. Every psychological test is dependent upon the quality and quantity of the subject's attention. The validity of standardized tests depends upon the assumption that the conditions of attention are constant. Do not start a test until the subject's attention is secured. Watch for signs of waning interest, fatigue, illness, anxiety, and fear.

CONDUCTING PSYCHOCLINICAL EXAMINATIONS

in

Prevent all unnecessary interruptions and interferences with the examination, and remove all needless distractions from the external surroundings. Requisite external conditions. The examination room should be well-illuminated, cheery, comfortable, free from such noises and disturbances as the rumbling of cars, the honking of horns, shouting and laughter of children, and the passing of observers in and out of the room, and devoid of awe- and fear-provoking stimuli, such as the odor of drugs, or the sight of bright instruments suggestive of the physician's armamentarium. The presence of attractive pictures and strange laboratory apparatus may attract the attention of some children unduly, and also influence the responses in some tests, such as the verbal association test. When infants or very young children are tested the testing materials should not be left exposed within the child's reach. In conducting examinations in various kinds of buildings, the writer has found that a public-school building offers a very favorable location for a children's clinic, provided quiet rooms are available. A test given in school impresses the child pretty much as a part of the day's work. He views it as a modified school exercise. Among disturbing influences which can be readily eliminated, is the practice of staring intently at the subject. This practice tends to excite or embarrass many subjects, particularly when they are stared at while performing tests requiring great concentration (e.g., the memory-span tests), or very difficult tests. Occasional encouraging glances, however, are an aid, rather than a hindrance, to inducing lively responses. Only infrequently is it necessary for the examiner to take hold of the subject's hand and gaze fixedly into his eyes in order to rivet his attention. Long pauses between tests cause inattention and weariness. The child's mind wanders and interest flags. The

112

CLINICAL AND ABNORMAL PSYCHOLOGY

examiner should so place his test materials that no time may be lost in hunting for them. Every piece of test material should invariably be restored to its proper place and in its proper position. (The surface of some cards must not be left exposed to the light, or to the dust, or to the roving eyes of the examinee.) Because of the variety, novelty, and interest of the tests, and the necessary pauses between tests, fatigue does not greatly affect the results in the Binet-Simon testing, whether the examination is made in the forenoon or afternoon, unless the examination is unduly prolonged. If the child is unusually slow in responding, patently restless, inattentive, or fatigued, a ten minutes' intermission should be introduced, or the examination should be postponed to a more propitious time. 10. It is usually advisable, and sometimes necessary to examine the subject alone. It is frequently difficult to win the subject's confidence and cooperation, and induce him to respond naturally in the presence of visitors. Examinees are more at ease when examined in private. The presence of visitors, especially parents, caretakers, and teachers, often embarrasses the child and makes him nervous and resentful, or it may cause him to try to "show off" or "put on." It is difficult to examine a child in the presence of a parent or teacher who has followed the practice of nagging or scolding him because of his stupidity. Such a child will not respond naturally because of the fear that he may be rebuked or ridiculed on the way home because of foolish replies. Again, from the standpoint of the parents' wishes, it is usually advisable to exclude visitors. Parents expect the same privacy that they demand in a medical examination. The presence of spectators naturally embarrasses them when the child gives silly answers. Need of'privacyvaries with type. The necessity for privacy

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 113 varies greatly with the type of case. It is immaterial with idiots and imbeciles, and with young normal children from about six to ten, who are talkative and who like to show off, most of whom do as well in a public demonstration as in a private examination. The writer has examined numerous imbeciles and young responsive normals in demonstration clinics, who have acquitted themselves fully as well publicly as when they were examined alone. In fact, some have reacted even more energetically and vivaciously, possibly because the pleased appearance of the auditors has stimulated their vanity. It is also less important in the case of the higher grades of mental defectives, provided they are not inhibited by fears and repressions. Privacy is of importance particularly in the case of reticent, reserved, timid, self-conscious individuals of any age; high-grade and older individuals above eleven or twelve years of age, who are more reserved and conscious of their shortcomings; and delinquent or disciplinary youths. Persons who have just been apprehended and brought into court, or committed to an institution, are often reticent and resentful. Their confidence and cooperation are not easily secured, and they will only unbosom themselves in private to a confidant who has established friendly, cordial relations. In the case of infants and very young children, who are frequently shy and afraid of strangers, the parent or guardian must almost always be present in the room to make the child feel at home and get him to react naturally. In fact, contact in the clinic cannot be established with many youngsters who have never seen the examiner before, unless they are permitted to occupy the mother's lap. The lap of the mother or of the nurse is the natural seat of all infants up to the time they are able to walk about freely. The examiner must rely upon the comforting, reassuring presence

114

CLINICAL AND ABNORMAL PSYCHOLOGY

of the cooperating mother for obtaining natural reactions from infants of from about five to twenty months of age. Advantages of the -presence of spectators.

There are, of

course, certain positive advantages in having the parent witness the examination. The child's performance in the tests will often convey a clearer impression than lengthy explanations of his mental status, and of the considerations on which the psychologist bases his diagnosis and recommendations, but parents must be forewarned by the reception clerk before entering the clinic that they must reserve all comments until the examination has been concluded. Unless this is done parents will, more or less innocently and naively, slip in comments or suggestions which may spoil some of the tests, or aid the child, or distress or excite him because of implied rebukes. Brief, and apparently trivial comments — e.g., "Johnny, you certainly know what a table is for " — may ruin many tests. When parents, teachers, assistants, or other spectators are admitted, the precaution should be taken to seat them behind the child, preferably in the rear of the room, so that they cannot stare at him or distract his attention. An incidental advantage of having a spectator in the room is that listless, indolent, perfunctory, or irritable testers will be more thorough, efficient, and genial in the discharge of their duties. I I . All scientific work must be done with the highest degree of accuracy which the subject matter allows. It is important to realize that different fields of investigation do not permit of the same degree of accuracy. Astronomy, physics, and chemistry are illustrations of highly exact sciences. The linear extent of an area can be measured very accurately if a measuring scale with a very fine unit of measurement is applied by a skilled observer, but even in a simple problem of linear measurement absolute objective accuracy is not pos-

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 115 sible when a fine measuring unit is used. Different measurers will obtain slightly different measures, owing to the "individual equation." In astronomical investigations it was long ago noted that different observers did not give exactly the same time report for the transit of a star. This led to the psychological investigation of one of the first psychological problems proposed for experimental solution; namely, individual differences in the rate of perception and reaction, and the discovery of the " individual equation." Individual differences are, to a certain degree, ineradicable, while the degree of inaccuracy of some observers is so large that it is quite hopeless to attempt to train them for accurate scientific work. Accuracy to the point of precision is only possible in the science of abstract mathematics, which represents the acme of scientific exactitude. Among the sciences which fall far short of mathematical precision may be mentioned meteorology, medicine, and psychology. Inaccuracy of unaided judgments. Unaided by objective criteria or instruments of precision, psychological opinions, judgments, and attested depositions or testimony, are inaccurate and unreliable. In courts of law, witnesses are often asked to testify regarding the interval of time which elapsed between two occurrences, e.g., the interval between a shot and a cry. The amount of inaccuracy in time estimates is amazing. Since 1912 the writer has accumulated data from successive classes of students on the pure mental estimation of thirty seconds (half a minute), without the aid of objective criteria. The estimates have ranged from four to fifty-nine seconds, a difference of almost 1400 per cent. The smallest difference for any one class, a small group, amounted to over 70 per cent, from ten to seventeen seconds. Most of the estimations have been underestimations. A trivial experiment like this will demonstrate to the student how fallible common-sense judgments are, and will render

116

CLINICAL AND ABNORMAL PSYCHOLOGY

him less dogmatic and bigoted. Similar inaccuracies could easily be demonstrated in other fields of experience. Observations rendered maximally accurate by measurements. Because the psychologist is dealing with a living, pulsating reagent, psychological observations cannot be made as accurate as physical or chemical measurements, but we must insist on making them maximally accurate. This we can do not merely by using trained observers, but by using various kinds of measuring devices — either laboratory instruments of precision or standardized test blanks, by making use of norms of performance, and by expressing our results in mathematical terms whenever possible. "Numerical precision," in the words of Herschel, "is the soul of science," and can only be attained by counting and measuring. Clinical psychology cannot attain a high degree of precision unless observation is supplemented by the use of standardized tests and measurements. There are psychological clinics in which too much reliance is placed on interviews and observations, and too little use is made of the laboratory procedure, just as there are clinics which make a fetish of tests, scores, and quotients. 12. The examiner must know the essential conditions of successful testing. He must not only possess the knack of inducing children to function at their highest level, as already emphasized, but he must be thoroughly skilled in the use of the instruments of precision. He must know how to give the tests accurately and expeditiously, how to test and calibrate the apparatus, how to detect and exclude sources of error, how to score the results, how to rate the performance in terms of the available norms, and how to determine the degree of validity and reliability of the experimental findings. No one is a thoroughly competent tester until he can administer the tests automatically in complete compliance with the prescribed test procedure. Fortunately most of the

CONDUCTING PSYCHOCLTNICAL EXAMINATIONS 117 tests in use in the psychoclinical laboratories require no elaborate experimental technique, but even the simpler instrumental tests may be inaccurately calibrated or standardized, are likely to get out of order, and may be used erroneously. To illustrate: The writer has used several Smedley dynamometers, but none has been very accurately calibrated throughout the whole range of the dial. Many sources of error exist in the use of so simple an instrument which must be detected and excluded, such as applying the pressure at either side of the stirrup instead of in the middle, squeezing with a spasmodic jerk instead of with a continuous energetic pull, pulling with the arm flexed instead of extended, or with the palm turned downward instead of upward.1 Many similar errors must be known so that they can be guarded against in measuring height, lung capacity, cranial capacity, and in fact in making any anthropometric, psychophysical, or psychological measurement. The laboratory worker must be a skilled technician. Paramount need of accurate norms. Standards of performance are now available in profusion. Nevertheless, it would be presumptuous to maintain that any considerable number of the available norms for clinical tests are thoroughly reliable and satisfactory. Most investigators are inclined to spend more time devising or testing out new tests than in standardizing old tests on so many cases that the work will not have to be done all over again. The dreary, routine work of standardization is less spectacular than the invention of a new measuring tool. One of the most urgent needs at the present time in the field of tests and measurements is a minute, painstaking restandardization of age and grade norms of performance. Until this has been done, many of the existing norms must be used with reservation. 1 See Experimental Studies of Menial Defectives, p. 63 f.

118

CLINICAL AND ABNORMAL PSYCHOLOGY

13. In using standardized tests the examiner must adhere strictly to the prescribed testing technique. The examiner's initial task is to familiarize himself thoroughly with the method of administering the tests. His next obligation is to follow the administrative procedure with utmost fidelity, whether he approves of it or not. Obviously, the moment the administrative procedure is modified standardized tests and norms lose their significance, for the effects of alterations in the procedure cannot be estimated. Even apparently trivial changes may modify the outcome and render the norms of questionable value. One need scarcely urge the consideration that it would be manifestly improper to state results in terms of standardized procedures when the procedures have not been followed. Novitiates should always be admonished to follow the prescribed directions with meticulous care, and the trained psychologist will do well never to make any alterations without urgent reasons. Notorious violations of the rule. The injunction not to vary the method has been egregiously ignored in the past. Even now, after all that has been written on the subject, it is occasionally violated with impunity. It is not strange that untrained amateurs, who do not comprehend the meaning of scientific precision, should consider minor, or even major variations, as trivial and inconsequential. On one occasion, at a demonstration clinic conducted by a teacher who had studied the Vineland 1911 procedure from a pamphlet, the writer noted nineteen variations in twenty minutes of testing — mostly minor ones, it is true. It is, however, surprising that scientifically trained workers should show equal contempt for the "rules of the game." On another occasion, in another State, it was noted that a psychologist who had several years of graduate work in psychology to his credit read the Binet reading selection to the child, first having explained that he would be asked to reproduce the contents.

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 119 This procedure, of course, had little in common with the prescribed method of administering the test. A psychologist in charge of a municipal psychological clinic, in yet another State, never spends more than a few minutes on a Binet examination, never keeps any record of the responses, and yet issues Binet age-ratings. The Binet tests are sometimes given by persons who test so few cases that they cannot be thoroughly conversant with the Binet technique. Unconscious variations and injected remarks. Often the procedure is unconsciously varied by the injection of supplementary explanations and comments. Obviously, remarks which modify or add new elements to the permissible explanations are out of order. There is no objection to the injection of irrelevant remarks and pleasantries, which have no bearing on the tests and do not affect the procedure in giving them, for the purpose of keeping the child interested, cheerful, cooperative, and properly "keyed." Every skillful examiner will resort to innocent by-plays and asides whenever the situation demands it. Prohibitions and rules are no substitute for common sense, but remarks which produce variations in the administrative procedure of standardized tests are invariably contra-indicated in practical clinical work, or in group testing conducted for the purpose of securing comparative ratings. Justifiable alterations. Contingencies, however, may arise when it is essential to introduce alterations. Manifestly, the Stanford-Binet cannot be given to a blind, deaf, or nonEnglish speaking child without making certain adaptations in the procedure. In all such cases an exact record must be made of all changes and adaptations. It is quite obvious that in research work existing methods must be modified and new procedures drvised, but in psychological and psychoeducational clinics, and in bureaus of tests and measurements, the administrative procedure must be followed with meticulous exactitude.

120

CLINICAL AND ABNORMAL PSYCHOLOGY

14. To acquire the ability to give the Binet tests accurately, expeditiously, and efficiently requires much practice. Until the tests have been practically automatized, the Binet scale, simple as its tests are, cannot be given with accuracy, ease, and dispatch, without suffering tedious delays, with that measure of confidence which will inspire confidence and willing cooperation in the examinee. Just as the surgeon cannot perform operations skillfully until he can handle the knife automatically, so no one can give the Binet tests skillfully until he can completely dispense with the manual of directions. It is very rarely that mastery can be attained by sheer, memoriter learning of the entire administrative procedure. Motor mastery can be secured only through practice. Ordinarily the attainment of automatic mastery of the Stanford-Binet will require an apprenticeship with from thirty to fifty cases, although the period of training can be reduced by pursuing an efficiently organized and supervised laboratory course. The method pursued in the writer's psychoclinic practicum is substantially as follows. The instructor demonstrates the tests by examining one or two clinic cases. This is followed by a discussion of the administrative and scoring procedure for each test. Then the student is required to memorize the procedure verbatim from the writer's condensed guide, and to test as many cases as the time allows in the presence of the class and the instructor, referring to the guide whenever necessary until the procedure has been automatized, in order not to spoil the administration of the tests. At the conclusion of each examination, the child is dismissed and the student observers are called upon in turn to criticize the procedure. The instructor concludes the critique with his own comments. No interruption is permitted during the course of the testing. The ablest students under this system of training can give the tests (at least to

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 131

and including age twelve) with automatic precision at the end of the course. No matter how well the student may have learned to give the tests, he will soon grow rusty and forget the nice details in the testing procedure unless he is constantly testing cases. In the absence of continuous practice, habits of all kinds tend to disintegrate. The retention of skill in mental testing, no less than in pianoplaying, or ball-playing, is dependent upon incessant repetition. The examiner who tests only a few cases a year will soon become incompetent. Fortunately the time required to relearn the procedures is much shorter than the original learning time. 15. Psychological tests are frequently influenced by the order in which they are given. Too little attention has been given to the order of succession in which tests are presented. Among the factors of time which inevitably influence the tests more or less are: familiarity, adaptation, novelty, interest, warming-up, practice, fatigue, malaise, and boredom. The performances in G. O. Ferguson's form boards or the writer's peg boards will be greatly influenced by the order in which the boards are introduced. In both series the more difficult tests will not be done so well if they are presented first instead of last. Practice on the easier boards prepares the child for a better response to the more difficult ones. No one has made an exhaustive study of the influence of the order of succession in Binet testing. The unskilled Binet examiner readily adopts the suggestion to begin with the tests a year below the child's life-age, and advance year by year until the child fails to do the tests. This method is easy to follow, but it is amateurish, and sometimes inefficient because it is inflexible. It does not allow of any adaptation to individual requirements. To give the tests in a discriminating order requires insight, a thorough know*

122

CLINICAL AND ABNORMAL PSYCHOLOGY

ledge of the scale, and an automatic command of the procedure. Suggested order of giving Bind tests. In general, begin by asking the child's name, age, date of birth, address, school grade, and various simple items of school information if necessary to establish proper rapport. Begin with easy rather than difficult tests, with motor rather than verbal tests, and with tests of knowledge of objective rather than of abstract relations. However, it is not advisable to bunch all the difficult tests at the close, nor to disregard the special peculiarities and interests of the individual in selecting the tests with which to lead off. It is often advisable to begin with a verbal test with linguistically inclined children, and with a picture test or a drawing test with those interested in pictures and drawings. It is inadvisable to begin with linguistic tests in the case of pronounced speech defectives. It is preferable to intersperse easy and difficult tests and to shift to easy ones whenever the examinee balks or becomes embarrassed by a difficult test. Memory and attention tests should be given in the first half, rather than in the second half of the period; however, they should not be introduced until the examinee has become somewhat adjusted to the ordeal. Tests which are similar should be given in series to economize time, to take advantage of the child's mental set or adaptation, to avoid wearisome repetition of practically identical instructions, and to minimize the incident strain and fatigue on the part of both the examinee and the examiner. Most important among these serial tests are: repetition of sentences and digits forward and digits backward, enumeration, description, and explanation of pictures, discrimination of weights (when necessary to give the test in both ages), comprehension of questions, definition of words, and noting similarities. The picture-interpretation

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 123 test cannot be effectively given unless a direct transition is made from the seven- to the twelve-year procedure in the case of each picture, unless the twelve-year procedure is adopted as the initial form, which is not advisable except with examinees who rate at least nine or ten years mentally. Before this fact can be known it is necessary to give a sufficient number of tests to obtain the approximate test level. Not more than three memory tests should be given in succession, however. The difference test and similarities test should not be given in immediate succession. 16. Thoroughness is essential in clinical examinations. There is little excuse for hurried, slipshod, superficial testing. The issues are too vital to tolerate preventable errors due to the indolence, hurry, carelessness, and indifference of the examiner. A comparison made by the writer of narrow-range with wide-range Binet testing, based on 1181 clinic cases, showed that the children who were given about twice as many advanced tests earned, in most of the ages, more than three fourths of a year of advance credit more than the others. Abbreviated testing scales should never be used except when it is impossible to give a thorough examination. The lowest range of testing permitted by the rules governing the Stanford-Binet extends from the year yielding but one failure to the year yielding only one success. The writer's practice is to employ the range from a basal age containing nothing but successes to the two ages containing nothing but failures, exceptions being made only in the case of the ages above twelve (age twelve counting as eleven and twelve), and in the case of tests which experience has shown are the most likely to be failed. The Binet tests should, of course, be supplemented by as many other tests as time and circumstances permit. 17. A careful written record of all significant observations, scores, test-results, and findings should invariably be made.

124

CLINICAL AND ABNORMAL PSYCHOLOGY

Do not trust to memory. It is notoriously treacherous. After a brief interval the facts in regard to a given case will be forgotten, misremembered, or confused with the facts from other cases. Detailed written records are just as essential in social investigations, clinical examinations, and routine consultation work as in research activities. Detailed verbatim records are the ideal, but they are not practical unless a recording stenographer (seated in a properly concealed recess) is available. By the use of test blanks, plus and minus signs, symbols, abbreviations, and the omission of unimportant words which can be easily supplied from the context, it is not difficult to record all the essential facts. It is not necessary to use an expensive, elaborate recording booklet of a dozen pages. The two sides of the writer's record sheet have proved quite adequate when use has been made of interlineations, insertions, deletions or cross-outs for omissions, plus and minus signs, ? for uncertain responses, ? + and ? — for responses which should, respectively, probably be scored plus and minus, and abbreviated verbatim entries. Parts of tests should always be scored, and the scoring should always be made immediately after the test has been given. The right hand when recording should be concealed with the left hand, the writing movements should be executed quietly and inconspicuously, and the stopwatch should be held inconspicuously in the palm of the left hand (out of view when possible), so that the recording and the timing will not distract the examinee. The recording (always in ink) should be done rapidly, in order to avoid disturbing delays. 18. Successful psychoclinical examiners must possess acute powers of observation, and the ability to draw judicious conclusions from a careful consideration of all the available data. Some one has remarked that " children in general and untrained adults are poor observers." They notice only the

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 125 unusual, extraordinary, striking, pleasant, and unpleasant experiences. The capacity to observe quickly and discriminatingly is a prerequisite for success in all types of scientific research, whether scientific detective work, the study of rocks, snails, stars, and plants, or the investigation of the reactions of animals and human beings. Unless the student possess this prerequisite, he may never aspire to eminence in the field of scientific investigation, although he might become a successful textbook writer or rehasher of the discoveries of the research workers. The basic importance of the capacity to observe was recognized by L. Agassiz, who, according to report, instead of using the conventional scholastic entrance examination, tested the student with respect to his ability to observe a fish or an animal and describe what he had seen. Variability in observational capacity. Observational capacity differs enormously in different persons. Some seem to be congenitally deficient in the capacity to observe. Some who possess acute powers of observation of objective phenomena are poor subjective observers: they can " extrospect" but not introspect. Others are accurate subjective, but not objective, observers. Some are so lacking in basic observational capacity that, apparently, they can never be trained to become superior observers. Others acquire the knack by training and experience. Some seem to be "born observers," manifesting the possession of acute and accurate powers of observation in early life. Qualifications of psychoclinical observers. The clinical psychologist and mental tester must be a good objective observer. He must be able to take in many things rapidly, and especially to note symptomatic and diagnostic signs. He must be able to pick out symptoms of pathognomonic significance. Moreover, he must form the habit of making a systematic scrutiny of the examinees. In a general medical

126

CLINICAL AND ABNORMAL PSYCHOLOGY

examination the physician follows a systematic and not a haphazard plan of physical inspection. The psychologist should follow a definite, systematic plan of observation and investigation. This book represents an attempt to outline what such a systematic plan should involve. Interpretative skill. Many examiners are satisfactory observers and testers, but poor interpreters. They do not sense adequately the consequences of their findings. They do not draw the correct inferences or deductions, or make the proper diagnoses from all the data in hand. They do not seem to be able to synthesize the accumulated data into a rounded, synoptic picture of the case. They are inferior diagnosticians. To be able to gather data skillfully, test correctly, and obtain accurate test scores, is one thing; to reach judicious conclusions from an analytic and synthetic study of all the facts, is another matter. In a diagnosis all clinical evidences must be weighed, evaluated, and interpreted. The remedy for deficiency in interpretative skill, so far as any exists, will be considered in the next section. A judicious interpretation may be positive or negative, or a suspended judgment. The cautious diagnostician will frequently defer his conclusions until further information has been gathered. In human relationships we deal with probabilities rather than certainties. The more dilettantish and superficial the examiner is, the more inclined is he to be cocksure, bigoted, and dogmatic. The real scholar modestly refrains from indulging in glittering generalizations which transcend the evidence. 19. A broad background of technical knowledge and extensive first-hand, case-experience are the prime requisites for proficiency in the examining and diagnosing of mental and educational deviates. A broad foundation of scientific information will require intimate familiarity with the best * hat has been written on every important phase of the pro-

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 127 blems with which the clinical psychologist must deal, but no amount of book study or reading will take the place of extensive, concrete experience with a great variety of mentally, socially, and educationally abnormal types in schools, institutions, and courts. It is just as easy to read yourself into a successful surgeon as to read yourself into a successful clinical psychologist. An eminent physician is reported to have said: "The study of patients without up-to-date books and journals is like a ship at sea without a sail. But the study of books without patients is not going to sea at all." This is just as true in psychology as in medicine. In the experience of the writer at least two or three years of firsthand study of many types of cases is needed before the psychological examiner is competent to make adequately exact differential diagnoses of mentally, socially, and educationally abnormal types. Without a thorough acquaintance with the worth-while literature on these types, on tests, clinical procedures, and case-history work, and an adequately comprehensive clinical experience, the psychologist will blunder along with a mixture of happy hits and unfortunate misses. The training required by the psychological diagnostician should be just as thorough as the training required by the physician. Nature of training required by clinical psychologist. The following excerpts from earlier discussions will indicate, in general, the nature of the required training: A common preparation will no longer suffice to qualify the student for efficient practical service in all the domains of psychology. The 6trictly professional training — i.e., the training beyond the basic psychological and scientific training — which will qualify a psychologist for skilled work among the psychotic, will not qualify him to diagnose and direct the educational treatment of feebleminded, backward, speech defective, alexia — or dyslexia — or merely pedagogically handicapped school children. Nor will the training which qualifies one for efficient work among these types of

128

CLINICAL AND ABNORMAL PSYCHOLOGY

Handicapped school children produce an expert on the selection of successful salesmen, or on the proper placement of army recruits, or on the direction of courses of instruction for supernormal children. The different fields of clinical psychology have their own special and unique problems, the proper handling of which requires special study and skill in the particular field concerned. Doubtless the technical differentiation of psychological specialties will so develop that in future we shall have some psychologists who will specialize on feeble-minded children and adults, others will specialize on backward and specifically handicapped school children, others on delinquents, others on bright and talented children, others on the selection of employees, etc. This is not the place in which to attempt to outline the kind of differential training which clinical psychologists working in different fields should have, but we may indicate briefly, by way of illustration, the training which we believe workers must have who would render skilled service in the psychological examination of mentally and educationally handicapped school children, and in the supervision of educational work in their behalf. The suggestions here offered are based primarily upon the needs which have become apparent as the result of many years' examination of the types of misfit children which are sent to a psychoeducational clinic maintained by a public-school system or by universities primarily interested in serving school children. We shall here only indicate the kind of courses which should be pursued, and not the amount of time which should be devoted to each course. 1. Certain preliminary courses to be pursued by all kinds of applied psychologists, including the usual undergraduate and graduate courses in general, functional, genetic, educational, physiological, and experimental psychology, mental and anthropometric tests, child study, biology, human anatomy, physiology, and hygiene. 2. Special courses in clinical psychology, including a detailed study of the psychoclinical methods applicable in individual examinations, and the practical examination of at least 200 cases. In addition, an institutional interneship of one year affording opportunity for the many-sided first-hand observation and study of the feeble-minded, epileptic, and insane, is recommended. 3. Certain preliminary pedagogical courses, including particularly a study of standardized educational tests and scores, a study of primary methods of teaching, especially the methods of

CONDUCTING PSYCHOCLINICAL EXAMINATIONS 129 teaching reading, spelling, and numbers, and the methods of the kindergarten, and courses in school supervision and educational sociology. 4. Courses dealing with the psychology and pedagogy of the various types of mental deviations or anomalies met with in school children, including backwardness, feeble-mindedness, visual aphasia and dyslexia, reading, writing and number defects, sensory defects of the eye and ear, speech handicaps, delinquency, etc.; courses dealing with the curriculum for special and ungraded classes, including practical courses in the various types of handicraft to be offered feeble-minded and backward children. These courses should include the observation of the teaching of various types of defective children. It would be well if a certain amount of cadet or practice teaching could be included with selected cases. 5. Social pathology, including a study of the social, vocational, and criminal aspects of mental deficiency and defect. 6. A minimum amount of medical work, including courses in physical diagnosis, pediatrics, nose, throat, eye and ear disorders, orthopedics, mental deficiency from the physical point of view, and neurology and psychiatry (particularly the nervous and mental disorders of children). The practical case work should include the study of the patient's individual and family history. The purpose of the medical study is not to qualify the clinical psychologist to become a skilled physical examiner, so that the services of the physician may be dispensed with.1 Rather the aim is to give him proper perspective in his work and a sufficient background of medical procedure and knowledge to enable him to refer at least the most obvious cases needing physical examinations to proper medical examiners, and to enable him to understand the medical reports which come to him and to interpret his own findings in the light of the medical data. This may seem like a pretty large contract, but if the student begins to specialize in his senior year in college, he should easily find it possible to complete the above outline of work in the time now required to take the Ph.D. degree, with the possible exception of the year's interneship. The responsibility of the work and the eventual returns for the adequately qualified workers are such that 1 Physicians who desire to specialize in this phase of psychological and educational service should secure a similar preparation in psychology, education, and sociology.

130

CLINICAL AND ABNORMAL PSYCHOLOGY

we are justified in making the requirements equal to the highest present-day standards for medical training.1 The well-trained examining psychologist should receive compensation equal to that of the well-trained psychiatrist.

Mental testers. The clinical psychologist requires the assistance of properly trained mental testers, Binet testers, or examiners for doing the routine testing and working up case histories, just as the physician must have the assistance of properly trained nurses to assist in the examinations, to take pulse and temperature readings, and to carry out the treatment. It would be impossible to carry out the necessary basic routine work in the field either of psychological or medical service without competent assistants. An assistant can do the routine testing as well as the clinical psychologist, provided she is adaptable and trained to give the tests skillfully and to score the results accurately. The training required to make a competent tester is, of course, far less exacting than the training required to produce a competent clinical examiner. The mental tester is not competent unless she is able to make an adequate and reliable report on her experimental and observational findings. Like the nurse, or the laboratory medical technician, she should not attempt to diagnose cases until she has become adequately trained and experienced to undertake this more difficult type of service. 1 See "The Field of the Clinical Psychologist and the Kind of Training Needed by the Psychological Examiner," in School and Society, 1919, pp. 463-70; and "The Field of Clinical Psychology as an Applied Science," in The Journal of Applied Psychology, 1919, pp. 81-95;and The Mental Health of the Scliool Child, 1914, pp. 114 f., 134, 136, 210, and 216 f.

CHAPTER VI THE LEVEL OF GENERAL INTELLIGENCE The nature of intelligence. The first part of the intelligence examination is the determination of the subject's "intelligence level," or "degree of intellectual development." Does the child have the normal amount of intelligence, or is he retarded or advanced? In case he deviates from the norm, what is the extent of the deviation? As indicated in Chapter IV, this is a psychometric problem. The determination of the level of general intelligence is one of the most important, if not the most important, aim of the examination of mentally backward, deficient, and superior children, and sometimes of delinquents, because of the vital importance of intelligence as a mechanism of adjustment. Definition of intelligence. But what is meant by intelligence? It must be admitted at once that the examining psychologists have been measuring an alleged something which they call intelligence without being greatly concerned about defining it, just as the physicists and chemists have been explaining physical phenomena in terms of invisible and indivisible atoms, electrons, and protons l without having previously demonstrated the existence of these hypothetical entities, or without knowing exactly what they are. The physicist has never seen an electron, radium ray, or Xray, nor has the physiologist seen an antibody. All that 1 Electrons, the smallest units of negative energy, are regarded as the mobile constituent of the atom, and protons, the smallest unit of positive electricity, as the stable constituents. It is thought that the atoms of different elements differ only in the number, arrangement, and motions of electrons and protons. Atoms are supposed to evolve into the molecular type of organization.

134

CLINICAL AND ABNORMAL PSYCHOLOGY

they have beheld are certain manifestations of hypothetical electrons, ether waves, or antibodies. Nevertheless, these abstractions, have proved serviceable as working hypotheses to explain facts. The psychologists have been employing a similar abstraction rather naively without prior attempt at definition. Intelligence testing, however, has now reached the stage of critical reflection, and technical publications are now brimming over with discussions concerning the nature of intelligence. A review of all these discussions, to which elaborate books and monographs have been devoted, and which reveal a welter of discordant views, is out of the question here. All that the limited space permits is a bare recital of the more important views which have obtained currency at one time or another, including a brief exposition of the author's use of the term, and a suggestion regarding its more cautious use in connection with test findings. Intelligence has been identified with knowledge, cognition, intellect, a particular aspect of intellectual functioning (such as attention, discrimination, synthesis, judgment, or reasoning), with the sum total of traits which may be regarded as intellectual in contradiction to instinctive, emotional, temperamental, or volitional traits, and with general mental adaptability as determined by the objective criterion of successful adjustment to external situations. Thomas Aquinas's conception of intelligence as the active exercise of the faculty of intellect, is not without a modern analogue in L. F. Ward's definition of intelligence as "intellect coupled with the product of its operation," or "intellect plus knowledge." Both E. L. Thorndike and C. Spearman use intelligence and intellect as synonymous terms. Binet's conception. Binet, to whom we are indebted primarily for the intelligence-testing movement, did not leave any systematic exposition of his doctrine of intelli-

LEVEL OF GENERAL INTELLIGENCE

135

gence. The attempt to present his views in a few sentences is beset with difficulties because his conception apparently passed through a process of rapid change. Intelligence is not a "single, indivisible function," but a sum total of mental functions. In his earlier thought the emphasis was placed on the simpler ingredients. Intelligence is "formed by the combination of all the minor functions of discrimination, observation, and retention." In later writings the emphasis was placed on the higher mental processes, attention, adaptation, judgment, direction of thought, comprehension of abstract relations, invention, and censorship. "Intelligence manifests itself in the best possible adaptation of the individual to his environment." It is the "fundamental organ of the mind," and "the basic factor in intelligence is judgment, otherwise spoken of as good sense, practical judgment, initiative, the ability to adapt oneself, to judge well, to comprehend wrell, to reason well, these are the essential activities of intelligence." With good judgment a person could not be feeble-minded no matter how little he knows. Intelligent action requires the voluntary direction of attention to the problem, keeping the problem in mind, selecting the proper means for attaining the chosen end (adaptation), and the evaluation of the reactions, in order to determine whether they are adequate (auto-criticism). The behavior of the very young child or defective is unintelligent because he cannot maintain a fixed direction of thought and cannot make the necessary adaptations or select the means required to reach his objectives. He cannot comprehend abstract relations, or distinguish the incidental from the essential, nor is he able to criticize the quality of his responses. Apparently the assumption on which the Binet-Simon scale of intelligence is based is that success in apprehending, responding to, judging, and criticizing the material contained in the scale is proportional to success in dealing with other types of

136

CLINICAL AND ABNORMAL PSYCHOLOGY

material. It is noteworthy that the tests in the scale are not limited to the measurement of judgment or the four activities referred to as the "primordial functions of intelligence" (direction, comprehension, invention, and criticism), but include perception, weight and color discrimination, attention, memory, imagination, and information or knowledge of various kinds. Ebbinghaus's view. According to H. Ebbinghaus, intelligence is a relating or "combining" activity — a view shared by T. Ziehen and E. Meumann. It synthesizes fragments into a unitary whole. Its essence consists in a formal combining activity, a "bringing together of a multitude of independent concomitant impressions into a unitary, meaningful, or in any way purposive, whole." Ebbinghaus measured this power by the ability to supply missing syllables or words in passages of mutilated text ("completion method"). The implication was that a person who possessed the ability to combine textual fragments into a unitary, meaningful whole would possess proportional ability for combining other types of material. Biological definition. Intelligence has perhaps been most frequently defined biologically or functionally in terms of the purpose which it subserves in the economy of life. It is ability to learn, or to adjust one's self to the environment. According to H. Woodrow, it is the "capacity to acquire capacity"; according to W. F. Dearborn, "the capacity to profit by experience"; and according to J. Peterson, " a mechanism of adjustment or control." Sometimes it is limited to a restricted type of learning. Thus W. Stern defines it as "general mental adaptability to new problems of life," or the "general capacity of an individual to adjust his thinking to new requirements." Stated more briefly, it is the ability to deal with novel situations. Thurstone's theory. L. L. Thurstone has elaborated at

LEVEL OF GENERAL INTELLIGENCE

137

great length a biological interpretation of intelligence. Mental life emerges from the vague feelings of unrest of the inner self which manifest themselves in consciousness as impulses and instincts. "Consciousness is the life impulse in the process of becoming conduct"; it is "unfinished action." "The conflicts of impulses that are rather well specified constitute consciousness in a functional sense." Mental life is "action in the process of being formulated." "Every mental state is biologically to be conceived as unfinished action." Mental states are ideomotor, i.e., they tend automatically and impulsively to express themselves in action. A percept is almost ready to precipitate in action; ideation, conception, imagination, and the higher mental processes are only loosely formed and need further definition before they can issue into overt action. "Intelligence is defined, according to this point of view, as the capacity to live a trial-and-error existence with alternatives that are as yet only incomplete conduct." Its development is marked by the capacity to select fruitful adjustments without trying incomplete actions in overt form. An "intelligent adjustment is one that is executed only after having been anticipated mentally." The basic function of mind is the anticipation of experience. There are various degrees of intelligence: (1) overt, random, trial-and-error reactions, without conscious guidance; (2) control of reactions by perceptions—" perceptual intelligence"—the primary functions of the sense organs being to "enable the organism to deal with incomplete behavior, to select among tentative actions before they are completely expressed"; and (3) control of reactions by noting common elements and general principles, that is "ideational or conceptual intelligence." Phylogenetically, intelligence begins with the perceptual intelligence of animals. In man it reaches the stage of the "imaginal anticipation of experience." The highest

138

CLINICAL AND ABNORMAL PSYCHOLOGY

form of intelligence involves conceptual thinking, or thinking in terms of universals. Its genesis is traced to the "differentiation of the exploring function of the receptors." It proceeds "from particulars to universals." But the "intelligent act," the "intelligence at work," always proceeds from "universals to particulars." Intelligence is a capacity "superimposed on the ideomotor tendency." It "implies the inhibition of a motive at an undefined stage in order to make it focal in its incomplete form." It inhibits and modifies our instinctive behavior and unifies our reactions. It is "the capacity to make impulses focal at their early, unfinished stage of formation." It is "the capacity for abstraction, which is an inhibitory process." Its development results in increasing control of future action and increasing protection to the organism. Rational behavior involves "deliberate trial-and-error choice by anticipating the consequences of overt fulfillment of the impulse." 1 Freeman's elaboration. In an attempt to render the functional conception more definite, F. N. Freeman defines intelligence as "the capacity for successful adjustment by means of those traits which we ordinarily call intellectual," such as quickness of learning and of apprehension, and the ability to solve new problems and to perform tasks presenting intellectual difficulties. "Intelligence is measured by the facility of pattern formation among ideas, or facility in the organization of thought." The intelligent person "can both break up old ways of thinking and develop new ways of thinking in adjustment to the demands which the situation makes upon him." This definition aims to give due weight to various factors of intelligence, such as memory, discrimination, analysis, synthesis, and learning. Thorndike's extension of the multifactor theory. Ac1 Quoted with permission from L. L. Thurstone, The Nature of Intelligence, Harcourt, Brace & Company, Inc., 1924

LEVEL OF GENERAL INTELLIGENCE

189

cording to the multiple-factor theory of E. L. Thorndike, "the mind is a multitude of particular capacities, all of which may be highly independent of each other." It follows, therefore, that intelligence can be measured only by an assortment of tests. In a recent critical review of various conceptions of intelligence, Thorndike points out that intelligence can be measured by any kind of materials — real objects, real or imagined qualities or relations, acts, words, ideas — because intelligence can be tested by any products of its operation. It may be measured by the difficulty of the tasks it can perform, by the number of tasks it can do at each level, and by the speed of performance. High level of performance is more important than speed, or than wide range on an inferior level. He calls particular attention to the fact that "selective, relational, generalizing, and organizing abilities " are as important as the principles of the educing of relations and correlations, which Spearman, as will be noted presently, considers possess the highest claims to the name of intelligence. From the standpoint of its function, intelligence enables the individual to make correct, good, or successful responses. "Intellect is concerned with facts, being the ability to see and learn the truth, to get true knowledge and use it to the best advantage." "The good or the correct response will be obtained by the better intellects more often than by the poorer." Kohs's analytic-synthetic theory. The functional definition tells us what intelligence does, not what it is, while the combination theory overemphasizes the synthetic activity at the expense of the analytic, according to S. C. Kohs. Intelligence is both an analytic and synthetic activity in every stage of manifestation. It is "the ability of an individual to analyze and synthesize." More basic activities than adaptation, "analysis and synthesis are the mechanics of intellectual behavior — adaptation to changing situations is but one of the many results."

140

CLINICAL AND ABNORMAL PSYCHOLOGY

Spearman's cognitive conception. C. Spearman, in a searching dissection of cognition, in which various conceptions of intelligence are criticized on the score that they do n o t " define genuinely any psychological processes at all" and that no actual use is made of the definitions provided, develops the view that the definition of intelligence must be based on the psychology of cognition. All cognition originally springs from experience — that which is immediately "lived, undergone, en j oyed,'' or apprehended (affecti ve, cognitive, and conative acts of a conscious agent), and that which is educed from the apprehended characters. It can be reduced to three fundamental principles, to wit: (1) Any lived experience tends to evoke immediately a knowing of its characters and experiencer. (2) Experience of two or more characters " tends to evoke immediately a knowing of relation between them," whether the relation be real (such as cause and effect, space, time, or identity) or ideal (e.g., likeness and difference, the chief resource of numerous well-known mental tests). (3) "The presenting of any character together with any relation tends to evoke immediately a knowing of the correlative character." The latter is "educted" or educed from the very nature of the characters initially presented. Many tests employing "thoughts" are based on the eduction of correlates, such as the supplying of opposites or analogies, completing sentences, answering questions, and applying rules, methods, and maxims. An indefinite number of relations and correlatives can be derived from a character and its relations. The genuinely experiential form of learning is represented by the first principle, but the non-experiential form, the educing of relations and correlates, represented by the second and third principles, is the most important from the standpoint of the modification of behavior. All cognitive operations resolve themselves into these three primary or

LEVEL OF GENERAL INTELLIGENCE

141

qualitative principles (supplemented by five quantitative principles) which have been identified with the processes of perception, the apprehension of relations between objects, and the transition from the idea of an object and a particular form of relation to an idea of a second object. The essence of intelligence, however, consists in the apprehension and employment of relations and correlatives.1 "Stimuli," "environment," and "situations" constitute only a portion of the cognitive field. Ogden's Gestalt theory. Somewhat allied to Spearman's conception is the configuration theory of R. M. Ogden, who finds that "the nature of intelligence is revealed by the contour and articulations of experience." Experience of any type whatever is "intelligent in the degree in which it is articulate, compact, sharply outlined, and therefore precise and effective." Intelligence "is always something which can be described as a figure or pattern of consciousness and behavior, appearing completely and uniquely under the 1 According to the earlier two-factor theory of H. Hart and C. Spearman success in any intellectual performance depends on "specific ability" for the particular performance in question, and " general ability." The general factor corresponds to the efficiency of the entire cortex and the common fund of nervous and intellectual energy, while the specific factor corresponds to the activity of a particular group of neurones or area in the brain. The above quotations have been made, with permission, from C. Spearman, The Nature of Intelligence and the Principles of Cognition, Macmillan and Company, Limited, 1923. Since the above was written, J. J. Strasheim has come forward with a "new method of mental testing" of a verbal character based on Spearman's principles of the evocation of relations and correlations. A determination is made of the ability of the examinees to adapt themselves to situations similar to three imaginary situations, to learn the solution of twenty maze tests arranged in four stages, and to perform a series of cancellation tests in which the relations grow increasingly complicated. Based on the examination of a limited number of young children, the writer concludes that eduction is the process which distinguishes intelligent from dull children. Many of the latter are unable to transcend the level of associative reproduction.

142

CLINICAL AND ABNORMAL PSYCHOLOGY

conditions appropriate to its arousal. A good test of intelligence is a set of conditions under which various individuals produce or fail to produce the clearly defined pattern which the conditions have warranted." "A 'good' response is good because it conforms to a norm of complete behavior, and it is at the same time true and factual because truth and fact are both measured in terms of norms which the experience of behavior dictates." However, in contradistinction to Spearman, "the apprehended unit is from the start an organized whole." It is "capable of further organization through a definition of its contour and inner articulation," but only by "an integrative principle of organic membership" inherent in the data and not by a "mysterious act of eduction." Cognition and intelligence are "processes involving the constructive membership implied by a figured whole." In the view of the Gestalt school, the world to the infant consists not of isolated sensations, but of elementary figuies or configurations upon vague backgrounds. Starting with an elementary understanding of the situation, the solution of problems by animals and humans is essentially a process of forming new mental configurations. Once a configuration is set up, it is more or less permanent. The author's conception. The view expounded by the writer since 1912, in the lecture course on which this text is based, is that intelligence is a complex of lower and higher cognitive activities which are more or less closely interrelated and interdependent because of similarity of processes and the integrative activity of the neural mechanism. These cognitive activities aie initiated, modified, and directed by non-intellectual factors of an affective and conative nature. Intelligence begins with the awareness of qualities (attributes) in the environment, and of the conditions of the body and their relations, proceeds to the formation of concepts (conceptualization) and judgments, and culminates in the

LEVEL OF GENERAL INTELLIGENCE

143

application of conclusions to new situations, and in rational responses to non-instinctive and unaccustomed situations. In the hierarchical progression of intellectual operations from perception through ideation to critical evaluation and reasoning the same intellectual processes are operative in varying degrees: focalization of attention, perception, recall of earlier experiences, comparison of present with past experience, apprehension of resemblances and differences, analysis of totalities into parts, synthesis cf elements into wholes, and the selection (decision and criticism) and organization of the data of experience into a consistent, unified system. Intelligence represents the sum total of all such "intellective" activities, some of which, obviously, are of more importance than others. In any given situation, the less reliance placed on instinctive, habitual, or accustomed reactions, the greater is the demand made on the intelligence. Therefore to deal successfully with a novel situation requires a higher order of intelligence than to deal with a familiar situation. Likewise, the more difficult the task or the adjustment, the greater is the demand made on the higher powers of intelligence, the more "intellectual is the response, and the more intelligent" is a successful adjustment. The more quickly the solution is mastered, the more intelligent is the learner. Illustration of intelligent behavior. The following illustration has been employed to indicate the complex nature of a typical act of intelligence at a higher level; namely, the solution of a difficult problem. Let us suppose that a pedestrian approaching a stream finds that the bridge has been swept away. What would be involved in an intelligent attempt to surmount the difficulty? First, the apprehension of a unique situation, the absent bridge. Second, the recall (association and memory) of the old elements of the situation, a bridge at this particular place in the road which had hitherto enabled the traveler to cross

144

CLINICAL AND ABNORMAL PSYCHOLOGY

the stream. Third, the envisagement of means of crossing the stream. The act of envisagement technically constitutes an act of imagination or re-presentation, in which the stream is imaginatively spanned in various ways. Fourth, active search for anything in the immediate neighborhood which will serve the purpose of a bridge. This involves, in addition to processes of perceptual discrimination and association, processes of assimilation of the new elements in the attempted solution with the old elements. Fifth, this preliminary activity must terminate in constructive action: active planning, the marshalling of the forces of the psychobiological organism, the adaptation of means to ends, the production of the new adjustments needed to meet the new situation. The final result of this activity is an intelligent solution of a difficult and novel problem, say, the felling of a tree athwart the stream, and walking across with due care to avoid falling into the water. Varying levels of adjustment. Innumerable solutions of everyday problems are made in a trial-and-error fashion, without careful analysis or conscious guidance, or are executed as a result of instinct or habituation. Even such random or semi-automatic actions involve a modicum of intelligence. Simple actions like crossing a bridge in an accustomed manner require the apprehension of certain relations, and the association of ideas. But to cross the stream in an unaccustomed way requires alert observation and attention, higher powers of analytic discrimination and apperceptive synthesis, consciously controlled selection and adaptation of means to ends, the breaking-up of habitual associations, and the formation of new ones. Intelligence, then, is a complex of functions, including perception, memory, association of ideas, attention to ends, imagination, analysis, the assimilation of old with new, of old with old, and new with new elements, an understanding of situations, whether

LEVEL OF GENERAL INTELLIGENCE

145

ideal or real, selection, adaptation of means to ends, invention, the manipulation of symbols or things, the apprehension of manifold connections and of possible solutions, critical evaluation, and reasoning. While the relative importance of these intellectual processes varies enormously, intelligence cannot be restricted to any one of them. Moreover, while certain tests afford a better measure of intelligence than others, a comprehensive, composite scale will probably afford the best measure of intelligence. Kinds of intelligence. Although intelligence is a general capacity and talent a specific capacity, there may be different manifestations of intelligence. Thorndike recognizes three kinds: social intelligence, or the ability to get along with people; manual or mechanical intelligence, or the ability to deal with things; and verbal intelligence, or the ability to comprehend language and to express one's self in spoken or written words. One might, similarly, speak of concrete and abstract intelligence. These distinctions, however, refer to phases or aspects of intelligence rather than to separate types of intelligence, and do not affect the basic concept. Suggested restricted usage of the word in connection with test findings. Because of its ambiguity and the varying connotations ascribed to it by different authorities, the meaning of the word "intelligence" when employed in connection with "tests of intelligence" should be restricted to "tested intelligence," as determined by the sum total of the scores made in a given test. Since the intelligence age will vary according to the test used, it is in the interest of clarity and accuracy to supplement the vague generic expression "intelligence age" or "intelligence level" with the designation of the specific test used in arriving at the age determination, such as "Stanford-Binet age" or "Porteus performance level." The expression "mental age" is ordinarily used as

146

CLINICAL AND ABNORMAL PSYCHOLOGY

the equivalent of intelligence age, although it is obvious that the word intelligence is not synonymous with mental. This designation ought to be discarded. Mental age can, in strictness, only mean intelligence age plus motor age plus emotional age plus other possible types of mental age for which no single, common measure exists. Nor is it likely that any such comprehensive measure will be discovered in future. Importance of determining general level of intelligence. A serious defect of general intelligence will gravely influence the functional efficiency of the individual. Intelligence, whatever the nature of its inner constitution, is a basic instrument of control, and a fundamental mechanism of adaptation to the changing requirements of life. Therefore the most important preliminary purpose of a psychological examination is the determination of the general level of intelligence by some accepted measuring device. Sometimes this is also the chief aim, for the determination of the individual's stage of intelligence development supplies the most essential datum for the successful handling of the case. This applies to individuals in whom there is a radical defect of intelligence, such as idiots and unquestioned imbeciles. A test of general intelligence — the term throughout is used in the restricted sense explained above — constitutes the basal psychological test for feeble-minded, backward, and gifted children. In an exhaustive investigation the general intelligence examination must be supplemented with an investigation of various specific intellectual functions, in order to discover specific abilities and disabilities. A graph in which the scores obtained in various tests of this sort are properly plotted has been called a psychological profile by G. Rossolimo. Native and acquired intelligence. In formulating the aims of intelligence testing distinction has usually been

LEVEL OF GENERAL INTELLIGENCE

147

drawn between native and acquired intelligence. In testing intelligence we are less concerned with discovering the stage of the examinee's intellectual accomplishments or acquisitions than with determining his inherent or native intellectual capacity. What we want is a measure of his inborn intellectual strength or potentialities, which will furnish an index of his probable degree of intellectual development. However, as will be reemphasized on a later page, strictly speaking we can never in practice measure pure native intelligence except at life's beginning, but only intelligence as affected by accumulated experiences and the ability to profit by such experiences.

CHAPTER VII INDIVIDUAL MEASURING SCALES OF INTELLIGENCE T H E earliest intelligence tests to appear were systems of individual tests for use in the clinical examination of children. A brief resume of the individual measuring scales of verbal intelligence which have been published during the last two decades is suggestive of the productivity which has obtained in this particular field of applied psychology. De Sanctis tests. S. de Sanctis, director of a day school in the city of Rome for mentally deficient children and professor in the University of Rome, constructed, in 1906, one of the earliest batteries of tests. The de Sanctis progressive series of developmental tests consists of a brief scale of six simple tests arranged in an ascending order of difficulty. The tests include memory of color, recognition of form and size, ability to count, attend, and make adaptations to various situations, judgment of distance, reasoning about the relations of absent objects and their properties, generalization, and the formation of abstract ideas. This system of tests, although found useful by several early investigators for grading children with respect to degree of intelligence development and grade of mental deficiency (idiocy, imbecility, and high grade defectiveness), never came into general use, largely because of the great popularity of the Binet-Simon scale after the appearance of the 1908 edition. The De Sanctis scale is now merely of historical interest, although some of the tests could with profit be incorporated in other scales. The Binet-Simon scale. The boldest attempt to construct an objective, graded scale for "measuring intelligence" and for assisting school authorities in identifying and

MEASURING SCALES OF INTELLIGENCE

149

selecting pupils suspected of mental deficiency, was made by A. Binet and Th. Simon in 1904. At that time a French Commission was appointed by the Minister of Public Instruction to inquire into the education of deficient children. It was realized that the school medical inspectors, whose duty it was to diagnose mental defectives, did not follow uniform methods. Binet, therefore, was invited to become a member of the commission, and to devise a scientific method of diagnosing such children. In cooperation with Simon, he undertook the development of a scientific method of selection which would be simple, uniform, easily administered, objective, and free from personal bias. The 1905 edition. The original scale, which merely consisted of thirty tests arranged in an ascending order of difficulty, did not enjoy extensive use. The tests were designed to explore the important phases of intelligence, such as memory span, attention, initiative, comprehension, ability to form associations, judgment, reasoning, and adaptability. The 1908 and 1911 revisions. While thirty-three new tests of the same general nature were added in the 1908 scale, the significant advance was the grouping of the tests into agesteps from ages three to thirteen, the age-norms being based on the testing of school children who were at age in their studies. The 1911 revision marked no advance in principle. It seems to have been prepared in response to the criticisms directed against the 1908 scale. Tests criticized as "schooly " were omitted, twenty-six tests were transposed, four new ones were added, ages eleven and thirteen were omitted and age fifteen and tlie "adult" stage added, the number of tests in each age (except age four) was made uniform, and the method of counting was changed. Translations, versions, and revisions in English. Numerous translations, versions, and revisions have appeared in English (and in many other languages as well) in rapid

150

CLINICAL AND ABNORMAL PSYCHOLOGY

succession, among the best known of which are the following: The translation of the 1908 scale and revision of this translation in 1911 by H. H. Goddard (the "Vineland scale"). The latter is based on the testing of American children by a group of summer-school teachers, and contains numerous transpositions and several new tests. The Vineland scale enjoyed a very extensive circulation for several years, over 30,000 copies having been distributed up to the present time. An adaptation of the 1911 French edition for use in England, by Katharine Johnston, in 1911. A guide for administering the 1908 scale, containing more precise and complete directions for giving the tests, by the author of this book, prepared in 1910 and published in 1911. The revision and extension by L. M. Terman and H. G. Childs, in 1912, in which certain tests were eliminated, some rearranged, and various new ones added. The revision by W. H. Winch which appeared in England in installments during the years 1913 and 1914. The Point Scale by R. M. Yerkes, J. W. Bridges, and Rose S. Hardwick, which appeared in 1915, marks a vital modification of the scale. Following a suggestion of E. B. Huey, varying numbers of points are assigned each of the twenty tests which comprise the scale (all except one from the Binet). The valuation or weighting of the tests is, however, arbitrary. Two points are assigned for arranging the five weights, nine points for interpreting the pictures, and fifteen points for the memory tests, an extravagant weighting. The point credits do not represent equal units along a linear scale. Proportional credits are given for partially correct responses. A credit of 100 points represents a perfect score. The point system of scoring, while possessing certain advantages, ultimately resolves itself into an age system, for in order to interpret the test findings, the point score must

MEASURING SCALES OF INTELLIGENCE

151

be transmuted into its equivalent chronological age. In the final analysis the interpretative or diagnostic score becomes an age score. The original point scale was deemed by its authors to be particularly valuable with children between three years and seven months and twelve years, although the boy of fourteen years, of English-speaking parentage, of grammar-school education, with from medium to poor environment, has not quite attained the maximum of mental ability as measured by the Point Scale. The 1923 revision by R. M. Yerkes and Josephine C. Foster supplies corrected norms for this preadolescent scale whose results are most reliable "from the ages of 6 or 7 to 12 or 13." Norms are supplied for an abbreviation of the scale which yields a maximum of 50 points, while two supplementary scales are provided, a tentative adolescent-adult scale of twenty tests, and a tentative infant scale of twentytwo tests for children from three to seven. The Stanford-Binet, prepared under the supervision of L. M. Terman and published in 1916, contains 90 tests, including the alternates, six in each age from three to ten, and varying numbers in ages twelve, fourteen, sixteen, and eighteen. Of the tests in the original Binet, thirty-two were relocated and three eliminated, while thirty-six new tests were added. The tests are so placed that the median mental age corresponds to the median chronological age. This revision won instantaneous favor, and since 1916 has been regarded as the standard American version. In the 1920 edition of the Stanfoi d-Binet by S. D. Porteus and Helen F. Hill, many tests have been transposed, some omitted, and others relegated to the position of alternate tests, in order to increase the accuracy of the age assignments. In the case of some tests, the administrative procedure and the method of scoring have been altered. C. Burt's version, for use in England, published in 1921,

152

CLINICAL AND ABNORMAL PSYCHOLOGY

and containing all of the tests in Binet's 1908 and 1911 editions, and four- and six-digit memory tests, or a total of 65 tests, adheres closely to the original procedure of the French authors, although the tests are arranged in a revised seriation. The scale extends from ages three to sixteen. Data on 3500 normal and abnormal children were available for the restandardization.1 The revision by J. P. Herring, which appeared in 1922, contains 38 tests, most of which are similar to those in earlier Binet scales. The scoring is based on the number of elements credited as correct in each test, and mental age equivalents are provided according to the number of points earned for five groups of tests. Group A includes tests 1 to 4, B tests 1 to 13, C tests 1 to 22, D tests 1 to 31, and E tests 1 to 38. Apparently the scale was standardized on the basis of the Stanford-Binet — the "mental ages have the same meaning as the Stanford-Binet Mental Ages." The Australian revision, prepared by G. E. Phillips, which appeared in 1924, is standardized on the basis of an equal number of boys and girls, ages three to fifteen, selected from the school children of Sidney from three districts, the purely industrial, the purely residential, and the intermediate districts. Summary of outstanding criticisms of the Binet scale. As 1 One foreign modification of the Binet scale by F. U. Saffiotti, of Italy, must be noted. The modifications involve the grouping of the tests both by age and school grade, and the grading of the children qualitatively rather than quantitatively. On the basis of three sets of tests, easy, medium, and hard, provided for each age, children are classified as dull, average, and gifted. By giving corresponding tests in higher ages, the groupings may be subdivided into finer grades, nine in all, such as dullest of the dull (dD), average dull (mD), or brighter dull (fD). Florence L. Goodenough has supplied a 51-point scale for the "measurement of intelligence by drawing" the human figure which seems to correlate well with the Stanford-Binet, certain group intelligence tests, and the school classification, and which is applicable to children from four to twelve.

MEASURING SCALES OF INTELLIGENCE

153

an individual measuring scale of verbal intelligence, the Binet scale, after withstanding years of trenchant criticism, continues to occupy a position of conceded preeminence. Having gone through a host of revisions, and a flood of criticism at the hands of competent psychologists, the scale ought to have reached perfection. This is far from being the case, however, due partly to the inherent difficulty of constructing comprehensive and valid instruments for measuring intelligence, and partly to the limitations under which the revisions have been made. The following is a summary of some of the more important criticisms of the Binet scale. 1. The age-norm^ are not maximally accurate. It has been maintained that the accuracy of the age-norms in the Stanford scale has been amply demonstrated, and that in the Vineland 1911 revision it is as great as is possible of attainment between the ages of three and twelve. The writer has shown at length in several publications that the number of cases tested or the methods of revision followed do not justify the implicit confidence frequently reposed in the absolute accuracy of these two scales, probably the best thus far produced. The number of children in each age of both sexes on which the Vineland revision was based varied from six to two hundred and twenty-two. In four ages the number was less than one hundred. An exceedingly narrow-range system of testing was followed, the number tested in a school day varying from twelve to thirty at the beginning. The Stanford revision is based on the testing of only ten children in age three, seventeen in age four, fifty-four in age five, forty-six in age thirteen, and fourteen (or twenty-one) in age sixteen. The number does not exceed forty-six in one third of the ages, while the average number of children of both sexes tested in each age is only seventy-one. Our suggestion made in 1913 was that, in order to secure

154

CLINICAL AND ABNORMAL PSYCHOLOGY

thoroughly reliable age norms, it would be necessary to test " a t the very minimum one hundred boys and one hundred girls at each age by years and also by half-years in the earlier ages. It would be better to set the number at five hundred or a thousand for each age." This ideal, which has not yet been realized, met with the objection that the excessive labor involved in such a survey would be superfluous, as a smaller sampling of undistributed children would give equally reliable results. But the intelligence examination in the army has since demonstrated that considerable difference in the level and distribution of intelligence may exist between different cantonments even when each cantonment contains many thousands of soldiers. It has for years been generally admitted that the lower age-standards are too easy and the upper age-standards too difficult in the Vineland revisions. The Stanford norms, in the judgment of the writer, based on many years of practical utilization of this scale as well as the 1908 and 1911 scales, tend to be too difficult in most of the ages — while the administrative procedure for some tests is unnecessarily cumbersome or prolix. From the tabulation of Porteus's data the age-standards appear too easy for ages five and six, slightly so for age seven, slightly too difficult for ages nine and ten, and perceptibly too difficult for the higher ages. Examiners using the Stanford revision for purposes of practical diagnosis must make due allowance for the super-difficulty of the scale, at least in the upper range of ages. F. N. Maxfield has proposed a corrective formula to be used with the Stanford-Binet above chronological age ten. He multiplies the Stanford-Binet I.Q. by 1.01 for an eleven-year-old, by 1.02 for a twelveyear-old, and by 1.18 for a sixteen-year-old and an adult. That is, the I.Q.'s for a sixteen-year-old and an adult are increased 18 per cent. 2. The scale is said to be one-sided: the tests are too limited

MEASURING SCALES OF INTELLIGENCE

155

in character. Three defects have been particularly emphasized. The first is that the scale is too intellectual. We are told that we must investigate the whole personality, the emotional, instinctive, and motor development, and temperamental and character traits, as well as the intelligence. True, the Binet scale does not probe all aspects of the personality. It purports to be only a scale of intelligence. Only 17 per cent of the Stanford-Binet tests require motor responses and test practical ability, while none of the tests explore emotional development. However, it is possible to construct independent motor or performance scales, while the emotional, temperamental, and character peculiarities can, and should, be observed and investigated independently. The second criticism is that the scale is too restricted a measure of intelligence. Specifically it is too literary, linguistic, or verbal; it contains too many tests of language. The chief capacity tested in half of the Stanford-Binet tests is language development, such as comprehension of sentences, range of vocabulary, description of pictures, definitions, naming of words, and the like. Seventy-seven per cent of the tests require oral responses, while twelve per cent are tests of arithmetical ability. Hence, the Binet scale is largely a test of verbal intelligence. While this cannot be denied, two important considerations should not be forgotten in this connection. (1) Verbal intelligence is an important type or phase of intelligence. Language development is an important index, perhaps the most important single index, of intellectual development, as pointed out in Chapter XIX. Moreover, verbal intelligence, particularly as measured by the Binet scale, correlates well with ability in the literary studies in the elementary school, as shown by the high correlations frequently obtained. To cite the results of a few studies:

156

CLINICAL AND ABNORMAL PSYCHOLOGY

The correlation (Pearson formula) of the Stanford-Binet I.Q, with the quality of the school work done by 504 pupils when classified into five scholastic groups by the teachers was found to be .45 by Terman. V. E. Dickson reports a correlation of .72 (Pearson formula) between the Stanford-Binet age and the classification by the teachers of 149 first-grade pupils into five proficiency groups. Burt reports a correlation of .73 between the Binet-Simon I.Q. and the scores in tests of reading, writing, dictation, arithmetic, and composition for 689 children varying from seven to fourteen years of age. The following correlations between the Stanford-Binet age and standardized educational tests given to about seventy-five pupils at the same interval of time are reported by A. I. Gates and Jessie LaSalle: Reading comprehension (Thorndike-McCall) Reading rate (Courtis and Burgess) Arithmetic (Woody) Spelling (60 words from the Ayres list)

74 65 77 60

Twenty months later the Binet correlated with scholastic achievement as well as when the tests were given at the same time. For forty-eight children, R. H. Franzen found the following correlations between Stanford-Binet I.Q.'s and standardized educational tests: Woody-McCall's Mixed Fundamentals in Arithmetic. . . .73 Thorndike Visual Vocabulary 83 Alpha 2 Reading 75 Kelly-Trabue Completion Alpha 82 While the Binet scale is of undoubted value in the classification of backward grade-pupils, it is important to emphasize that verbal intelligence does not comprehend all kinds of intelligence, and that the Binet tests afford only a segmental view of the child's abilities. (2) As already noted, independent tests of motor ability, or practical and industrial capacity may be given. In fact, tests of psychomotor capacity should frequently supplement the Binet scale, because the Binet rating correlates more closely with the child's ability in the literary branches than

MEASURING SCALES OF INTELLIGENCE

157

with his practical, industrial, or vocational ability. Many children who have been found "feeble-minded" from the standpoint of verbal intelligence, as determined by the Binet scale, have possessed sufficient practical ability and gumption to earn their living and lead an independent existence. In the case of linguistically handicapped children it is particularly important to supplement the scale by motor tests. F. C. Walters concluded that thirteen-year-old children of foreign-speaking parents suffer a language handicap in the Stanford-Binet of from six to eight months. The third objection is that the scale contains too many memory tests. Almost half of the questions in the StanfordBinet involve mediate or deferred memory; fully 20 per cent are tests of immediate memory span. Overemphasis on memory tests is deprecated because tests of memory capacity are not regarded as important or useful tests of intelligence. This objection has its merits. The memory level of the mentally defective, for example, is on a higher plane than their intelligence level. Many persons with tenacious power of retentiveness are not conspicuous for alertness, initiative, or enterprise. However, many of the memory tests in the Binet scale are not tests of retentiveness or recollection of acquired knowledge or information, but of memory span. Memory span tests are largely tests of range of attention, and ability to concentrate attention. They correlate fairly closely with intelligence, and possess considerable prognostic value, as will be shown in the discussion of memory. Instead of eliminating such tests, the number may well be augmented so that there will be tests for every age-level in which a demonstrable advance occurs, and so that there will be tests of visual memory span and memory for objects, in addition to the present auditory memory-span tests of digits and sentences. S. The selection of the tests is not based on any definite

158

CLINICAL AND ABNORMAL PSYCHOLOGY

psychological principles. The Binet is not a logically constructed or afinelybalanced system of tests, designed systematically to explore the fundamental intellectual functions. No attempt was made to systematically analyze intelligence, nor to inventory all the important intellectual traits which should be tested, nor to establish norms in every possible age-level for the same kind of traits, with certain conspicuous exceptions (e.g., the repetition of identical types of memory tests in a number of age-levels). This criticism, in the main, is well taken. In a measure, the scale is an adventitious, empirical construction. What A. Binet did was to investigate children's responses to a random assortment of tests of various kinds. Those tests which, in his opinion, proved most successful were retained and arranged in a graded age-scale, in accordance with the experimental findings. Largely the same empirical hit-andmiss procedure has been followed by the later revisionists. Nevertheless, when the haphazard nature of the scale and the simplicity of the tests are considered, the practical utility of the Binet scale within its limits of accuracy is remarkable. 4. The number of tests in each age is too limited. The number in the different ages in the 1908 scale varies from three to eight, while the number in the Vineland 1911 revision is five except in ages four and fifteen. When the writer in 1912 and 1913 suggested that the number should be increased to ten in each age, the objection was raised that considerably more tests than this are now given with existing scales, owing to the necessity of testing a child two or three years above age, and possibly one year below age. Therefore, the number of tests need not be increased in each age. Nevertheless, because of the fact that individuals of the same age and training (even those considered normal) vary considerably in different traits, more information would accrue

MEASURING SCALES OF INTELLIGENCE

159

from giving ten tests of ten different traits in a given age than from ten tests in two age-levels, half of which explore the same mental functions. The number of tests has been increased to six in most of the ages in the Stanford revision, and to eight in another more recent revision. The additional time needed to make an examination is, of course, a serious practical objection to increasing the number of the tests. Testing an older child of high-grade mentality takes from fifteen to twenty minutes longer by the Stanford-Binet than by the 1911 scale. The counter-tendency to condense the scale to two or three tests per age has, fortunately, not been enthusiastically received. 5. The scale is too limited in its vertical scope, or range of ages. An inclusive scale, applicable to all individuals, must extend from the first months of life to the period of intellectual maturity for the various traits or functions tested. Neither the 1908, 1911, nor the Stanford scales provide any tests under age three; the 1908 has none above age thirteen; the 1911, while having tests for age fifteen, has none for ages eleven, thirteen, and fourteen, while the Vineland 1911, which has tests for age fifteen, has none for thirteen or fourteen. Attempts have been made to supply tests for the period of infancy and the period of adolescence and adulthood, but the standardizations have, in most cases, been based on too few cases to make the tests thoroughly reliable. In the writer's guide, the three easiest tests from the 1905 series were used for age one, and the three next in difficulty for age two, but the accuracy of the standardization is questionable.1 1 The recent experimental studies of preschool children by Baldwin and Stecher, and Gesell will furnish excellent groundwork for the extension of the scale downward. Baldwin and Stecher have supplied tentative norms for numerous standardized tests of motor capacity, perception, apperception, association, memory, learning, language, aesthetic appreciation, e t c .

160

CLINICAL AND ABNORMAL PSYCHOLOGY

The Stanford revision extends the upper range of the scale, by supplying tests for ages fourteen, sixteen (average adult), and eighteen (superior adult). But the standardization is based on an insufficient number, or a questionable selection of cases, and the age-norms are concededly too difficult. Unquestionably the tests in the existing Binet scales are most unsatisfactory for the period of infancy and the period approaching the stage of intellectual maturity. Facts to be borne in mind in attempting to extend agescales, (a) A year's difference is not a uniform unit of measurement of intelligence. It does not have the same significance in different levels of the scale. One year of difference in early life is greater than one year of difference in later childhood or in adolescence. The mental difference between two- and three-year-old children is appreciably greater than that between seven- and eight-year-old children, and the difference between the latter is markedly greater than the difference between fourteen- and fifteen-year-old children. Apparently, therefore, the chronological intervals or steps in a measuring scale of intelligence should not be the same throughout the scale. During the first years of life whole-year steps are too large. Half-year or quarter-year steps are needed. A " two-year test" is too gross a gauge for measuring the intelligence level of, or the difference in the level between, a child who is two years, and one who is two years eleven months, even though the two-year norm corbased on 105 normal and superior children from two to six years of age. Gesell's ten development schedules, enumerated on a later page, are based on numerous behavior items and tests of narrative and descriptive value in four fields of behavior; namely, motor (muscular capacity and coordination) language (vocalization, speech, and auditory comprehension), adaptive (the capacity to exploit the environment and adapt to situations impersonally), and personal-social (personalized responses in personal situations). Fifty normal or representative infants and children were examined at each stage by the method of clinical and comparative observation, and by crude, unstandardized, and standardized testa.

MEASURING SCALES OF INTELLIGENCE

161

responds to the typical two-and-a-half-year-old. The suggestion made by the writer in 1911 that fractional agenorms be established for the earliest years remained infertile for many years. In his recent study of the developmental levels of preschool children, Gesell estimates that "the proportion of development attained during the first sixennium of life is treble that attained in the two succeeding sixennia." His normative developmental schedule of items and tests is arranged in unequal steps as follows: (1) one month (descriptive data); (2) four months; (3) six months; (4) nine months; (5) twelve months; (6) eighteen months; (7) twenty-four months; (8) thirty-six months; (9) forty-eight months; and (10) sixty months. The disparity between these intervals was most marked between four months and six months, and least marked between four years and five years. One month of retardation during early infancy may be predictive of a whole year of retardation after the first birthday. The development of even four-months-old infants is so rapid that weekly increments of growth can be detected. In the upper part of the scale the one-year age-steps may be too small because of the diminishing difference in intelligence between two successive ages. Indeed no scale has ever supplied norms for each successive age above twelve. The Stanford revision has tests for every other year. It remains to be seen whether the two-year intervals are superior to the one-year steps for the early adolescent years. While smaller step intervals would entail more overlapping, they would probably possess compensating advantages. (b) Reliable standards will 'probably be more difficult to establish for the highest ages, particularly the adolescent years, not only because of the indiscernible differences between the successive years, but because of the greater variability between older than between younger children of the

162

CLINICAL AND ABNORMAL PSYCHOLOGY

same chronological age. This increase in variability is attributable, in the opinion of the writer, to the increasing influence of the factors of experience, training, or acquisition. The longer the child has lived, the greater the modification wrought by the incident forces of the physical and social environment. Children who for years have been diligent and studious, and who have enjoyed the best cultural advantages and the best hygienic care, should have progressed more rapidly and developed more broadly than children who have either neglected their opportunities or had none, who have been neglected or abused, who have indulged in dissipations, or who have suffered from uncorrected disabilities. If tests of acquisition could be completely excluded from intelligence scales, the degree of variability among older and younger children might be the same, since the variability would then depend solely on native intelligence which, according to assumption, has remained the same since birth. But tests of acquisition cannot be wholly eliminated, for the reason that native intelligence cannot be tested apart from its modification by experience, as pointed out below. Presumably the extent of the modification will vary roughly with the length, as well as the character, of the experience. Evidence of accentuated overlapping in later ages. The alleged augmentation of variability with increasing age and modification of native ability by experience have, indeed, been stoutly denied. Evidence, however, exists in support of the assumption. O. Bobertag found that the amount of overlapping in the Binet test was almost twice as great between eleven- and twelve-year-old boys as between six- and seven-year-olds. L. M. Terman reports that the interquartile mental age range was twice as great for twelve-yearolds as for six-year-olds (20 vs. 10 months). F. N. Freeman found more overlapping between the mental ages of the

MEASURING SCALES OF INTELLIGENCE

1G3

upper years in the Binet, but this did not hold for group intelligence tests. C. Burt reports the same sort of difference for educational ability (based on the standard deviation). Normal children of fifteen varied by nearly 1.5 years above and below the average, but ten-year-olds by only 1.1 years, and five-year-olds by only .55 year. These experimental findings justify the belief that reliable age-norms will be more difficult to establish for older children because of the heightened variability found among them. 6. The scale has been criticized as being too "schooly." Proficiency in many of the tests is intimately dependent upon education or schooling. It is argued that the only tests which should be included in the scale are those of native intellectual ability, or of congenital endowment, and that tests of acquisition or accomplishment are not such tests. In response to this criticism, Binet eliminated from his 1911 scale various obviously scholastic tests, such as writing, reading, and naming the days of the week. Subsequent revisers also have eliminated tests which are most clearly scholastic. Nevertheless, some critics contend that the scale is still dominantly educational in nature. Thus Burt made a study of over 300 pupils of ages seven to fourteen, involving a critical analysis of partial correlations between age, intelligence, school attainments, and the age rating obtained from some "present version of the BinetSimon scale." He concludes that of the gross rating " one ninth is attributable to age, one third to intellectual development, and over one half to school attainment." "In determining the child's performance in the Binet-Simon scale, intelligence can bestow but little more than half the share of the school, and age but one third the share of intelligence." David Wechsler, from a study of the relative amount of variability (based on Pearson's coefficient of variability) of

164

CLINICAL AND ABNORMAL PSYCHOLOGY

Binet age with increasing chronological age, as revealed by the data on which Terman's and Burt's revisions are standardized, has concluded that intelligence as measured by the Binet scale is affected by formal education only after the age of ten. Burt's data show significant changes of variability after but not before this age. Terman's data, which do not show any significant differences except in age fourteen, are rejected on the ground of "insufficiencies of the Stanford standardization." Wechsler's conclusions find some support from Hugh Gordon's results. In an investigation of gypsy and canal-boat children in England of little or no schooling by means of the Stan ford-Binet and Ballard's standardized tests of the speed of reading, adding, and subtraction, Gordon found that the older the child the less his intelligence and his scholastic ability. "An increase in age is found to be associated in the same family with a decrease in mental ratio." The younger children do better in the Binet tests because the tests for the early years do not depend on schooling. " Without the mental effort or mental exercises associated with schooling it would appear that there has been very little mental development on the intellectual side." Gordon concludes " that the mental tests used do not measure native ability apart from schooling except in the case of very young children," and that the "low average 'intelligence' of the children . . . is not due to heredity, seeing that the youngest children test more or less normally." That Gordon's conclusions follow from his premises may be doubted. As long ago as 1916 the writer called attention to the tendency of the I.Q. to fall with increasing chronological age, or to increase with decreasing chronological age, irrespective of the mental level or the intelligence diagnosis of the child. This conclusion was based on the analysis of about 800 Binet records from the 1908 and 1911 scales.1 In 1919 attention was again 1 Sec Problems of Subnormality, pp. 2G7 S.

MEASURING SCALES OF INTELLIGENCE

165

called to the same phenomenon based on the analysis of 411 consecutive Stanford-Binet records.1 Since our decreasing mental ratios were based on children who were attending school, the phenomenon cannot be attributed to lack of schooling. Moreover, Wechsler's conclusion finds no support from Helen T. Woolley's Stanford-Binet testing of children from two and a half to five years of age. One third of forty-three children admitted to the Merrill-Palmer Nursery School, who are supplied with a developmental program from nine to mid-afternoon, increased twenty I.Q. points or more in the retest, while only 6 per cent of thirtysix children on the waiting list of equal intelligence (who did not receive the advantages of the superior Merrill-Palmer environment) increased twenty points or more. Only 10 per cent of the Merrill-Palmer group decreased twenty points as against 16 per cent of the waiting list group. A later retest of the school pupils showed less favorable results. The writer concludes that a superior cultural environment may produce striking gains which, however, are maintained at a receding level. The demand that tests of learning be excluded from intelligence scales is excellent in principle, but unrealizable in practice. As emphasized by the writer, rather prematurely, in 1911: " I t would be fatuous to attempt to construct a scale for the measurement of pure native capacity, for pure native capacity after the first few months of life, is a pure figment of the imagination. Only by excluding the physical and social environmental influences would there be any possibility of measuring native endowment independent of acquired capacity." "Nature and nurture are mutually interacting and reciprocating factors in the development process, whence it is idle to attempt to sharply separate tests into 1 See "The Value of the Intelligence Quotient for Individual Diagnosis," Journal of Delinquency, 1919, 109-24.

166

CLINICAL AND ABNORMAL PSYCHOLOGY

those which measure nature's dower and those which measure the contribution by the environment. The environmental factors begin to influence the individual at the very portal of life." After life's beginning mental processes can be measured only as influenced by experience. Mental traits do not develop in a vacuum, and, in the words of Burt, "growth deprived of opportunity is barren." Even though experience may not appreciably modify the inherent strength of many mental traits, it does supply the opportunity for their functional activity, which renders the pathways of response permeable, and enables the child to use the powers he possesses more skillfully. Let it not be inferred from the preceding discussion that tests related to, or dependent upon, experience are wholly valueless as tests of intelligence. On the contrary, the fact that a child has acquired knowledge shows he possesses the ability to learn, which depends to a considerable extent on "general intelligence." The most intelligent children ordinarily profit most from the opportunities of the environment. All other things equal, children of equal intelligence will profit to the same extent from the same opportunities. In practice they do not always do so because all the other conditioning factors of learning are not equal, such as industry, enthusiasm, emotional stability, and rate of maturation or growth. If this view is correct, the important question is whether there is sufficient uniformity in different environments throughout the country to insure equal educational and cultural opportunities to all children. For example, from the standpoint of the school environment, is there sufficient similarity in the elementary curricula throughout the country to insure equality of educational opportunity for children from six to fourteen? Probably no one would claim that there is more than approximate similarity. Differences

MEASURING SCALES OF INTELLIGENCE

167

in environmental stimulation to mental growth and development create almost insurmountable difficulties for the construction of a universally valid measuring rod of native intelligence under practicable conditions of measurement — that is, the measurement of native intelligence as modified by experience. 7. The Binet scale contains a number of "coachable" tests, which the examinee may learn to do from imitation or instruction. The point to this objection is that tests which measure momentary capacity to acquire, memorize, and retain are not good tests of intelligence. Typical among tests of this nature are constructing a sentence containing three designated words, giving rhymes, and answering various problem questions, such as " What's the thing for you to do when you have broken something which belongs to some one else?" The subject can learn the answers to such questions before taking the test. The reply to the author's observation in 1911 that he had found indubitable evidence of coaching among high-grade epileptics, was that the danger was trivial because children could not be coached to do tests above their mental level. While it is doubtless true that acquisitions and skills beyond the subject's capacity are not permanently assimilated, nevertheless they may be retained long enough to enable the subject to secure a passing score. The recognition of this fact has led to the elimination of some of the tests which are more patently coachable, and particularly to the construction of duplicate tests or scales of equal difficulty. The writer's group tests of intelligence, constructed in 1910, and the Army Alpha tests, constructed in 1917, contain six sets of tests of approximately equal difficulty. 8. The Binet system of scoring is not wholly satisfactory, because, being based on the "all-or-none principle," partial credits are not given for partial successes. The tests are

168

CLINICAL AND ABNORMAL PSYCHOLOGY

scored as complete failures unless all the requirements are completely fulfilled. Thus subjects giving thirty instead of the required sixty words in the word-naming test in age X, get no credit at all, whereas they ought to be allowed half credit. An equitable scheme would permit credit according to the quality and quantity of the response. Partial credits are indeed authorized in a few tests in the original, and in some of the revised Binet versions. Some tests occurring in several age-levels (immediate memory span, weight discrimination, and response to pictures) are also credited in accordance with the amount of the performance. Nevertheless the rule of partial credits for partial responses might well be more widely extended, as has been done in the Point Scales. 9. It is hazardous to draw final conclusions regarding a child's intelligence level from one Binet-Simon examination. Possibly the child may not have done himself justice in the first test owing to excitement, stubbornness, fatigue, illness, depression, or other hindrances. This danger applies particularly to the shy, diffident, temperamental, and nervously unstable, to those who have just been apprehended or brought into court on charges, and to those to whom the examination has been misrepresented for the purpose of intimidation. Granted; but one of the essential qualifications of a competent examiner is that he be able to judge whether he is getting good cooperation and a typical, representative performance from the subject. If there is reason to suspect that this is not the case, the examination and diagnosis should be deferred to a later occasion. Questionable or unstable cases should be retested. Needless to emphasize, this alleged defect is not inherent in the scale itself, but pertains to its efficient administration. Normal variability between successive testings and variability due to practice. While all this is doubtless true, it is

MEASURING SCALES OF INTELLIGENCE

169

found that even when the tests are skillfully given and the subjects respond properly, an appreciable amount of variation does occur between successive testings. The variation between successive Binet testings ordinarily amounts to from four to six I.Q. points. Changes, however, varying from fifteen to thirty points, either in the positive or negative direction, are known to occur, as shown in Chapter IX. We must remember that mental traits are variables. The efficiency of one's mental functions does not remain absolutely constant, but fluctuates more or less from time to time. The fluctuations which occur normally do not disastrously affect the predictions based on one or two findings. But the abnormal fluctuations may lead to grave errors of diagnosis. The changes produced in tested intelligence level by practice may be of considerable significance. In the experiment of Katherine B. Graves, the influence of direct training on the Stanford-Binet tests (practice in giving the correct answers) from ages six to ten (or twelve in one school), and of training on materials similar to, but not identical with, this Stanford-Binet material was studied. The subjects were selected alphabetically from the second grades in two schools of similar home environment and from families which had been in this country at least four years. One group received direct training on the Binet tests (coached group), one group was trained on similar tests (similar group), while the other group served as a control group. The training covered a two weeks' interval. Retests were made at varying intervals by five trained examiners following a wide-range method of testing.1 The results showed 1 That wide- and narrow-range methods of testing often give markedly different ratings has been shown by the writer in "Wide Range versiu Narrow Range Binet-Simon Testing," Journal of Delinquency, 1917, pp. S15-30. (See also page 123, this book.)

170

CLINICAL AND ABNORMAL PSYCHOLOGY

that less than three hours of coaching on the Binet tests given a week before the first retest produced an average gain of 23.1 for the six- to ten-year-olds tested, and 31.7 months for the six- to twelve-year-olds tested. The gain after an interval of three months still amounted to nineteen months for the first group (or about a year and a half more than for the control group), and 17.5 for the second coached group after an interval of four months. The group practicing on similar material during about eighteen hours gained only a little over three months beyond what would be expected merely from the repetition of the tests. At the end of a year much of the improvement had been lost. The directly coached group showed a gain of nine months and the group which had practiced on similar material five months, which is only one month more than the control group gained beyond the growth normally to be expected after an interval of twelve months. That the gain in group tests from practice on material similar to the Army Alpha may be very considerable is shown by H. N. Glick's experiment. He provided approximately seven hours of practice during daily trials for a month to groups of students from the seventh grade to the university on material similar to, but not identical with, the sub-tests of the Army Alpha. During the course of the experiment five forms of the Alpha were given at irregular intervals. One series was given without and the other with coaching. In the coaching series the principles of the tests and the shortcuts for doing them were explained. Incentives were employed to secure maximum effort. The results showed that most of the subjects doubled their initial scores and the limit of practice had not been reached at the end of the fourth week. The groups receiving practice with coaching made greater gains in the accuracy but not in the rate scores.

MEASURING SCALES OF INTELLIGENCE

171

If the cases destined to show excessive variability could be accurately identified from the outset, the difficulty would be minimized. Although evidence points to heightened variability among neurotics, emotional unstables, psychopathies, certain types of psychotics, and epileptics, judicious caution is still needed in making predictions from single examinations. The evidence regarding the variability of these types is still fragmentary and such cases cannot as yet be diagnosed with certainty in early life. 10. The scale is too frequently used by amateurs without sufficient training or skill in properly administering and scoring the tests, and in interpreting the test findings. Of the prodigious mushroom growth of Binet testers which flourished in America prior to 1915, the majority were neither trained Binet testers nor professional psychologists. The situation to-day is greatly improved, although the criticisms which brought about the improvement often provoked ill-concealed resentment. The requirement that Binet testers, as well as all other psychological testers, must be properly trained, and must possess a knack for mental testing, is now very generally recognized, as was emphasized in Chapter V. 11. The scale is being used too often as an absolute, allsufficient means of diagnosing feeble-mindedness, on the basii of certain fixed standards of intellectual retardation as determined by the scale. Some writers have insisted that nothing beyond the Binet scale is needed for the diagnosis of feeblemindedness in the majority of cases. They have almost converted the scale into a "diagnostic automaton," defending its use even by "novices," or "untrained or wrongly trained " examiners. The warning against the practice of having diagnoses of mental defectives made by rule-of-thumb methods by amateur Binet testers, who possessed no training for mental

172

CLINICAL AND ABNORMAL PSYCHOLOGY

diagnosis beyond studying the manual of instructions, was so flagrantly disregarded between 11)10 and 1915 that the writer was impelled to utter repeated protests. These early criticisms, at first unheeded or misrepresented, and later trenchant criticisms from the pens of L. Witmer, K. Pearson, D. Mitchell, G. A. Jaederholm, and others, gradually bore fruit. In 1915 the American Psychological Association adopted a resolution prepared by G. M. Whipple and the writer, to the effect that "whereas psychological diagnosis requires thorough technical training in all phases of mental testing, thorough acquaintance with the facts of mental development and with various degrees of mental retardation, . . . Be it Resolved, That this Association discourage the use of mental tests for practical psychological diagnosis by individuals psychologically unqualified for the work." In 1917 steps were taken to organize the clinical section of the American Psychological Association for the express purpose (although not the sole purpose) of "encouraging and advancing professional standards " in the field of clinical psychology. To obtain the professional recognition which membership in this section confers, "a psychologist.. . must have as a minimum requirement: (1) The Ph.D. degree in the various branches of psychology; (2) a record of special preparation in some field of clinical psychology; (3) published or prepared for publication a contribution of importance to the literature of mental tests or of clinical psychology." Exception to these exacting eligibility qualifications is countenanced only in the case of "specially qualified persons" without the Ph.D., "who have done distinguished work in clinical psychology." In 1919 the National Eduation Association adopted the following resolution: "the diagnosis of the degree of mental defect and the classification of children upon such diagnosis should be in the hands of highly qualified psychologists only."

MEASURING SCALES OF INTELLIGENCE

173

The New York Mental Deficiency Law of 1919 establishes minimal qualifications for psychologists (and physicians) authorized to sign "certificates of mental defect" and papers for the commitment of "mentally defective persons." The psychologist "shall have had two full years of postgraduate study in psychology at an incorporated university or college and three years of actual clinical experience." The demand that psychological diagnosticians must be adequately trained is no longer a controversial question. The nature of the training required has been outlined in very brief form in Chapter V. Directions in which the Binet scale is useful. In spite of the imperfections and defects of the best existent versions, the Binet scale possesses elements of undoubted value, of which the following are worthy of special mention: 1. A serviceable measure of intelligence level. The scale affords an approximately correct measure of a child's "verbal intelligence age," that is, his level of capacity, retardation, or acceleration as determined by a test which is predominantly linguistic or verbal. The mistake to avoid is the exaggerated claim that the scale is "fool-proof," "amazingly accurate," or well-nigh infallible. It is not an infallible automaton, capable of transforming any one who can use it into a diagnostic wizard. But it is swifter and more accurate than unaided observation, pedagogical examinations, or educational tests. As much may be learned regarding the verbal intelligence level from an hour's Binet examination as from weeks or months of daily observation of school activities. 2. A comparable and uniform, objective measuring instrument. By the Binet scale homogeneous groups of individuals may be classified with relative accuracy, because all are graded in terms of the same objective measure. Irrespective of whether the age-norms are highly accurate, the scale pro-

174

CLINICAL AND ABNORMAL PSYCHOLOGY

vides a uniform, objective, mental yardstick by which all the inmates of an institution or the pupils in classes for the mentally deficient or in the regular grades can be classified with comparative accuracy. In contrast with subjective estimates and judgments, which may vary with the mood of the rater, the Binet rating, because obtained through an objectively standardized procedure, is uniform and consistent within the limits of its reliability. 3. A device for securing a uniform nomenclature in grading deficients. By means of the scale a definite, invariable connotation can be attached to the customary sub-classifications of the feeble-minded. In the 1905 scale Binet classified as idiots those who could not go beyond the second test, and as imbeciles those who were able to pass the third to the fifth tests. The following classification of the feebleminded based on Binet age-levels, tentatively adopted by the American Association for the Study of the FeebleMinded in 1910, has been widely followed in the United States. CLASSIFICATION

Idiots

[ Low | Middle [High

Imbeciles Middle

High Morons

BINET

Aat

Under 1 1 2

5

{•

\ [9 In the classification above, the subdivisions for the morons and the Binet levels from ten to twelve have been omitted, because of doubt as to whether subjects who have

MEASURING SCALES OF INTELLIGENCE

175

reached these levels of ability should be considered feebleminded.1 The employment of a standardized psychological measuring rod, like the Binet, whatever its present imperfections, or whatever the differences of opinion regarding the limits of the subdivisions, will make for accuracy and consistency in the employment of technical terms and national uniformity in the classification of mental deficients. Before the advent of the scale there was no assurance that superintendents in Indiana, Oregon, or New Jersey meant the same thing when they classified 20 per cent of the inmates of their institutions as idiots, 40 per cent as imbeciles, and 40 per cent as morons. The probability is that they were following subjective standards of diagnosis which had no common basis of comparison. But no means were available for ascertaining this with any degree of definiteness. On the other hand, when adolescents and adults are classified by means of the scale as idiots of a two-year intelligence or as imbeciles of a fiveyear Binet age, the classifications, being in terms of a common denominator, possess approximately the same significance. 4. A supplement to other types of classifications. As a system of grouping or classification of mental cases, the Binet system is an invaluable supplement to other types of classification, such as the pathological, the physical, the psychiatric, the socio-industrial, or the educational. A measurably exhaustive classification will incorporate data from all significant fields of inquiry. Every additional characterization adds to our knowledge of the examinee. The Binet rating adds one more bit of information, which is exceedingly important in the case of all intellectual deviates. Much is 1 Data hearing on this question have been presented in The Education of Handicapped Children, pp. 69 f., 101, and 285, and La Problems of Subnormality, especially chap. u.

176

CLINICAL AND ABNORMAL PSYCHOLOGY

learned regarding a child when he is classified as a mental defective; more is learned when he is classed as a Mongol mental defective; and still more when it is discovered that he is a Mongol mental defective of imbecile grade with a five-year Binet age. 5. Educational value for schools and institutions. The scale possesses undoubted value for the educator, trainer, and caretaker. Mention has already been made of the superiority of the scale from the standpoint of economy of time and the accuracy of the determination and the significant positive correlation between the verbal intelligence level in terms of the scale and proficiency in the literary branches in the elementary grades (pages 156 and 173). The scale constitutes a valuable aid in the classification or grouping of pupils according to ability, and in the adjustment of the school tasks to meet individual requirements. This is particularly true in the case of intellectual deviates. The Binet rating, in the case of obviously retarded or advanced pupils, indicates to the teacher the quality of work which she has a right to expect of a given child. A child cannot be expected to do work which obviously transcends the limits of his ability. A fourteen-year-old child with a nine-year mentality should not be required to do the work of the normal fourteen-year-old. Examination of all school entrants. Under ideal conditions every pupil ought to be subjected to a thorough individual examination at the time of entering school by competent psychological and medical examiners. This would enable the school to locate at the outset many of the abnormal children who require special aid, instruction, and physical treatment, and to make appropriate educational provisions for them at the very beginning of their school career, instead of waiting until years of failure and discouragement compel the attention of the authorities. After having

MEASURING SCALES OF INTELLIGENCE

177

pointed out this desideratum it is pertinent to sound a note of caution. Avoidance of mistaken classifications. While many mentally abnormal children unquestionably can be mentally classified with considerable accuracy in early life, discretion must be exercised in attempting to provide differential training. Snap-shot diagnoses are to be deprecated, because of the injury which may result from an erroneous classification. The science of psychological and educational diagnosis has not yet reached the point where incontestably accurate or adequate classifications can be made of many psychological and educational deviates. The retardation of many children is less apparent at five than at ten. Most retarded children slow down very gradually in their mental development, while some seem to develop fairly normally up to a certain point, and then slow down or stop abruptly. Some children who appear to be mentally defective prove later not to be so. Nor can all pupils, particularly the older ones, be satisfactorily classified for instruction on the basis of intelligence age or intelligence quotients alone. Specific psychological and educational defects and talents, special interests, prior educational advantages and disadvantages and accomplishments, must be considered. Differentiations based on group intelligence tests particularly must be critically scrutinized, because they are subject to a larger margin of inaccuracy than individual tests, and are usually administered by non-expert examiners. " Self -diagnostic tests" have not been developed to the point where they can serve as substitutes for expert knowledge of mental and educational abnormalities. Benefits of doubt to child. In view of all these facts, it is not amiss to emphasize that in attempting to differentiate, classify, and segregate children for instruction, great care must be taken to avoid doing injustice to any child. The

178

CLINICAL AND ABNORMAL PSYCHOLOGY

interests of the individual pupils will ordinarily be conserved if the rule is rigidly followed, that the benefit of the doubt should always be accorded the child. Children not clearly mentally deficient should be assigned to ungraded or adjustment classes for borderline and backward pupils, rather than special schools for the mentally deficient, while young low-grade children should be given an adequate probationary trial in a special school before being deprived of public instruction. The schools must not ruthlessly exclude unfortunate children who are the victims of conditions beyond their control. On the other hand, young backward children should be given every advantage of skilled instruction in the literary branches in ungraded or adjustment classes before being given a dominantly manual type of training. These, and other important principles of differential instruction, are treated at length in the companion volume on The Education of Handicapped Children. Uses in institutions. The scale possesses similar value for institutional workers, particularly those laboring among feeble-minded, dependent, delinquent, and epileptic children. An hour's examination will frequently indicate approximately the degree of the verbal-intellectual development and of the trainability of the new entrant. It will furnish valuable data in determining whether the entrant is a proper candidate for custodial care, for literary or industrial training in the school department, or for trade training or labor assignment in the employment division. To attempt to determine the proper assignment of new inmates exclusively by the ordinary method of trial-and-error, results in much wasteful experimenting. 6. Criminologlcal value. Intelligence scales are of value in determining the degree of responsibility of offenders, but only to the extent that social, civic, and moral responsibility is dependent upon, or intimately associated with, intel-

MEASURING SCALES OP INTELLIGENCE

179

ligence. The law and social practice have always recognized the attainment of a certain minimum chronological age as essential for legal responsibility. Children below a certain life age have not been regarded as responsible. In the Jewish code, the " sins go on the parents " until the child is thirteen years of age, after which he is considered responsible in a spiritual sense. Nevertheless, the parents continue to exercise complete control over his life until marriage (according to the tenets of the Talmud and the Mishnah). In the old English law, a child could not be punished for crimes before the age of seven. The Illinois criminal code fixes the age of responsibility at above ten years. In Tennessee "the law presumes that a person over fourteen is responsible." In Missouri " a sentence of death for murder was passed upon a boy under sixteen" and "it was upheld by the supreme court." The Juvenile Court laws enacted in American States since the early part of the century,1 usually apply to children up to the age of sixteen. The probable assumption on which these laws are based is, not that children up to the age of sixteen are wholly incapable of assuming any social or civic responsibility whatever, but that, because of immaturity and lack of experience, they are not capable of the same degree of responsibility as older minors or adults. They are also more amenable to preventive, corrective, and reformatory treatment, and, therefore, should receive a different type of treatment. Social responsibility a junction of mental development. Granting the correctness of this principle of jurisprudence, it is germane to point out that chronological age is not the only factor, nor indeed the chief factor or condition, of legal and moral responsibility. Some children of twelve have the intellectual and physical maturity of sixteen, while others 1

The first juvenile court was established in Cook County, Illinois

(Chicago), in 1900.

180

CLINICAL AND ABNORMAL PSYCHOLOGY

may have only the development of a seven- or eight-yearold. The child's grade of intelligence (and emotional maturity or poise) is sometimes of fundamental significance. Some children are so intellectually defective that they will always be incapable of appreciating moral situations, or of inhibiting anti-social impulses. Their irresponsibility is due primarily to intelligence defect, and not to viciousness or criminalistic proclivities. But the exact amount of intelligence defect which will render a child morally irresponsible, or legally incompetent, has not been determined. A few years ago the statement was made, and widely accepted, that "every feeble-minded person is a potential delinquent," and that the majority of the feeble-minded are, in point of fact, delinquent, due to their defective intelligence. At that time the upper limit of feeble-mindedness was drawn at the twelve-year level. On this standard 47 per cent of the white, and 80 per cent of the colored soldiers examined in the late United States Army, would have been feeble-minded, and therefore irresponsible. In 1915, on the basis of numerous observations and studies, the writer fixed the upper boundary line of feeble-mindedness at the nineyear intelligence level (in terms of the Binet). But further study has shown that many individuals of Binet nine possess the ability to form acceptable moral judgments, to distinguish between what is right and what is wrong in the ordinary relationships of life, to choose to do what is right and to do it, to resist anti-social impulses and to conduct themselves in accordance with the accepted social conventions and practices of the community. Obviously the amount of intelligence needed for social, moral, and industrial responsibility and self-determination, will vary more or less with the nature of the environment. A degree of intelligence, judgment, and competency which is adequate in a simple environment, might not enable the individual to

MEASURING SCALES OF INTELLIGENCE

181

cope with a more complex, intricate, or difficult environment. One who could live successfully among honest folks in a rural section, might not be able to resist the demoralizing influences of the city slums. It could with truth be said that every normal person is a potential delinquent if the provocations are sufficiently serious, while it would be no exaggeration to say that many mental defectives, because of inertia, unresponsiveness, or timidity, are even less criminally inclined than many normal persons. Some feeble-minded persons admittedly are aggressively criminalistically inclined, but they are the exceptions. Whether the average feeble-minded individual becomes a violator of the conventions and laws of society depends in large measure upon the temptations, opportunities and restraints afforded by the environment. Making due allowance for the exaggerated, propaganda character of many of the claims regarding the criminalistic impulses of those of limited intellectual endowment, it remains incontestably true that deficiency of intelligence is not a negligible factor in moral irresponsibility. A certain degree of intellectual development is essential for the apprehension of moral and social relations and obligations, and for the inhibition and proper direction of the individual's instincts, impulses, and desires. 7. Diagnostic value. The Binet scale is an indispensable aid for making an intelligence diagnosis, particularly as affects intelligence of the linguistic type. It is not a "be-all or end-all," and should not be permitted to become an idol or a fetish. It is only one among many available aids. It is not desirable, justifiable, nor necessary to base conclusions exclusively on the Binet findings. The scale should be supplemented by other tests, medical, physical, psychological, intellectual, sensory, affective, and motor. Nor should conclusions be based purely on test findings. A "history of the

182

CLINICAL AND ABNORMAL PSYCHOLOGY

case" (the contents of which were briefly indicated in Chapter IV) should always be obtained for mentally abnormal cases. This frequently yields significant information for the interpretation of test findings, and for the confirmation or modification of provisional diagnoses. It is just as true now as when the statements were made in 1912 that "the function of the Binet-Simon, or any other graded scale of intelligence, is to give us a preliminary and not a final survey or rating of the individual. The Binet-Simon testing is not to be regarded as a finality, but merely as a point of departure for further diagnosis. It gives us the first and not the final word about an individual's mental status." Difference between testing and diagnosing. A recital of empirical test findings is one thing; a diagnosis, or the synoptic interpretation of all findings, and the deduction of practical conclusions therefrom, is quite another. No one should attempt to make diagnoses of mentally and educationally abnormal children which involve grave practical consequences except examiners (such as clinical psychologists and psychopathologists) who have been thoroughly trained in testing procedure and in the underlying sciences of mental diagnosis, and who have had extensive experience with a wide range of mental deviates. An adequate mental diagnosis involves a careful analysis of an intricate network of contributing factors, often obscure and multifarious, and an evaluation of the relative role of the different factors. A mistaken diagnosis may involve serious maladaptions of the educational or social care given the child, and everything possible should be done to avoid it. The objectives of mental testers who are not diagnosticians should be to test the child skillfully and accurately, and submit an accurate report of the test findings and of the observed behavior during the examination. The value of this type of service, to which attention was called in Chapter V, should not be underestimated.

CHAPTER GROUP TESTS OF INTELLIGENCE History of group intelligence testing. A set of Group Serial Tests for Measuring the Rate of Mental Growth and Improvement was devised by the writer in 1910,1 for the measurement of the orthophrenic effects of oral and dental hygiene, and the differences in mental development between bright, normal, dull, and epileptic school children. The tests included measurements of rapidity of perception, immediate and remote memory, recognition, spontaneous and controlled association, range of observation, recall of associated sequents, word and sentence construction, addition of one-place columns, imagination, and speed of reaction. But this set of tests was born prematurely. Psychologists apparently were so convinced that the measurement of intelligence or intellectual traits by means of group tests was futile, that practically no use was made of this pioneer measuring scale, nor of any others that may have been in existence at the time (e.g., Norsworthy's eight "class tests" of efficiency, covering perception, memory of related and unrelated words, ability to form abstract notions, ability to appreciate relations, and control of associations, given to groups of feeble-minded subjects). The call to arms in 1917 forced upon psychologists the necessity of devising some expeditious means of measuring 1

The demonstration of these tests in connection with a clinic conducted by the writer in Buffalo at the Fourth International Congress on School Hygiene in August, 1913, seems to constitute the first public demonstration of the testing of the intelligence of children by means of group tests. The publication of the greater part of our investigation with these tests was delayed until 1923, and all the experimental data are not yet in print.

184

CLINICAL AND ABNORMAL PSYCHOLOGY

the intellectual ability or "alertness " of large masses of men. Since the Army Alpha was devised in 1917 1 by the joint effort of a group of psychologists, a prolific harvest of group tests of intelligence of various kinds has appeared, conveniently printed on blanks or in folders or booklets. A prodigious output of experimental memoirs and monographs, and treatises on intelligence and intelligence measurement has also resulted. The list of intelligence tests compiled by Margaret Doherty, Josephine MacLatchy, and B. R. Buckingham contains 105 titles, but some of these are duplicates, many are not group intelligence tests, while some omissions occur. This is not the place in which to describe the tests, to review the literature, or to attempt to give even the briefest analysis or summary of results. For critical and expository discussions and summaries of a more or less popular nature, the reader should consult the references to the texts or treatises at the end of the book. Our discussion is limited to a brief characterization of group tests, and a statement of their value for clinical psychology. Brief characterization of group intelligence tests. Compared with the crude prototypes of the earlier part of the century, the more recent tests mark a decided advance in ingenuity and technical refinements of construction, in methods of scoring, and in methods of computing total or pooled indices of efficiency. Most tests are now so constructed that they can be answered by crossing out, checking, or underscoring certain words or symbols, such as " y e s " or "no," "true" or "false," when statements made are judged correct or incorrect, by checking words sustaining analogous relations to supplied antecedents, or by supplying certain numbers or symbols (such as S. or D., for "same" 1 A. S. Otis had already begun the construction of a system of group tests similar to the Army Alpha.

GROUP TESTS OF INTELLIGENCE

185

or "different"). Tests of this type require little writing of words or sentences, and usually can be scored rapidly. Some can be scored almost automatically with mathematical precision by pupils or clerks by means of perforated stencils, whose perforations fit over the spaces in which the responses are recorded. Practically all tests are provided with detailed printed instructions forgiving and scoring, with standardized age scores, and sometimes also with grade scores. Range of applicability of tests. Tests are now available for pupils in all ages or grades from the kindergarten to the senior year in college. Most tests are intended for use in one grade only, or in a limited number of grades or classes, such as the kindergarten, the primary grades, the upper elementary grades, the high school period, or the college years. Types of tests. The tests may be classified according to the character of the presentations and the nature of the required responses. When given in oral or written form, and when the responses are written words, the tests may be classified as exclusively linguistic or verbal, or as language tests. When the instructions arc given by signs or gestures, and the responses are non-verbal, they may be referred to as exclusively performance tests. Gesture presentations are usually based on the pantomimic performance of similar tasks with the aid of enlarged representations on the blackboard or on charts. A variety of non-verbal responses are employed, such as the making of various checks, or the drawing of lines through symbols, mazes, or mutilated parts. Sometimes lines must be drawn to connect the pictorial representations of objects which belong together. Some writers restrict the application of the term "performance test" to the individual motor, psychomotor, or mechanical ability tests in which the subject manipulates objects, such as form boards, construction puzzles, or construction pro-

186

CLINICAL AND ABNORMAL PSYCHOLOGY

jt

—

2 ^5 5

n> mi

-3

I15 ISs

d

5

5

+>

.a 5 two

O a

-^

I el 5-

5