Cognitive changes in brain-injured children: A preliminary survey
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COGNITIVE CHANGES IN BRAIN-INJURED CHILDREN A PRELIMINARY SURVEY
A D iss e r ta tio n P resen ted
to
t h e F a c u l t y o f t h e D e p a r tm e n t o f P s y c h o l o g y The U n i v e r s i t y o f S o u t h e r n C a l i f o r n i a
In P a r t i a l F u l f i l l m e n t o f t h e R e q u ir e m e n t s f o r t h e D e g r e e D o cto r o f P h ilo so p h y
by Herman H a r v e y A ugust 1950
UMI Number: DP30403
All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.
Oisseftatie n Pubi
UMI DP30403 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code
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This dissertation, written hy
........................ Herman..Harvey.......................... under the guidance of h%3.... Faculty Committee on Studies, and approved hy all its members, has been presented to and accepted by the Council on Graduate Study and Research, in partial f i l l fillment of requirements for the degree of D O C T O R OF P H I L O S O P H Y -
Dean
C om m ittee on Studies
Chairman
TABLE OP CONTENTS CHAPTER I.
II.
PAGE
INTRODUCTION . . . . . . . . ..................... .
..............................
I
The p r o b l e m ........................................................................................
3
D e fin itio n s
........................................................................................
5
REVIEW OP THE LITERATURE.............................................................
6
C o n tr ib u tio n o f G o ld s te in
.................................................
6
F u r t h e r d e v e lo p m e n t o f c o n c e p t s b y W erner and S t r a u s s O th e r c o n t r i b u t i o n s III. IV .
.
.
.
• •.
..................................•
.
.• • • • • • • ♦ • • •
10 15
C R I T I Q U E .........................................................................................................22 RESEARCH PLAN AND RATIONALE FORTHE PRESENT INVESTIGATION .
. '................................................................................ 46
C r ite r ia fo r s e le c tin g
th e t e s t . . . . . . . .
48
The t e s t i n s t r u m e n t ..................................................................... 4 9 The d e s i g n
. . . . . . . ......................................................... 51
V.
PRELIMINARY T R E N D S ............................................................................... 55
V I.
SUMMARY AND CONCLUSIONS..................................................................... 77
B IB L IO G R A P H Y .......................................................# .................................................... 83 APPENDIX A
........................................................................
89
APPENDIX B
..................................................................................................................10 4
L IS T OF TABLES TABLE I.
PAGE S c o r e s on P r im a r y M e n ta l A b i l i t i e s
S c a le ,
P r im a r y Form . • • • • • • • . . . • * * • II*
S c o r e s on P r im a r y M e n ta l A b i l i t i e s E l e m e n t a r y Form
III.
S ig n ific a n c e
58
S c a le ,
•
59
o f D i f f e r e n c e s B e tw ee n N orm als
and D e f e c t i v e s on P r im a r y M e n ta l A b ilitie s IV*
S u b tes t s
+ • •
60
S u b t e s t I n t e r c o r r e l a t i o n s o f P r im a r y M e n ta l A b ilitie s
V*
• • • • • • • • #
S c a l e , P r im a r y Form, N orm al Group
' 62
S u b t e s t I n t e r c o r r e l a t i o n s o f P r im a r y M e n ta l A b i l i t i e s S c a l e , E l e m e n t a r y Form , Norm al Group
V I.
• • • • • • • • • • . • • • • • •
S u b test In te r c o r r e la tio n s A b ilitie s Group
V II,
S c a le ,
o f P r im a r y M e n ta l
P r im a r y Form, D e f e c t i v e
• « • * • • • • • • • • • • * • • •
64
S u b t e s t I n t e r c o r r e l a t i o n s o f P r im a r y M e n ta l A b ilitie s
S c a l e , E l e m e n t a r y Form ,
D e f e c t i v e Group V III,
65
S ig n ific a n c e
65
of D iffer en ce s of In te r c o r r e la
t i o n s o f S u b t e s t s o f P r im a r y M e n ta l A b ilit ie s S c a le , IX .
S ig n ific a n c e
P r im a r y Form
.
• .
. .
66
of D iffer en ce s of In te r c o r r e la
t i o n s o f S u b t e s t s o f P rim a ry M e n ta l A b ilitie s
S c a l e , E l e m e n t a r y Form . . . .
67
iv TABLE X.
PAGE C om p arison o f E n d o g e n o u s Group S c o r e s w i t h E x o g e n o u s Group on P r im a r y and E l e m e n t a r y Forms o f P r im a r y M e n t a l A b i l i t i e s
X I*
Age S c o r e
S c a le .
70
(M o n th s) D i f f e r e n c e s B etw een
C om parable S u b t e s t s o f P rim a ry and E l e m e n t a r y Forms o f P r im a r y M e n ta l A b ilitie s X II*
Age S c o r e
S c a le s
• • • • • • • • • . .
73
(M o n th s) D i f f e r e n c e s B etw een
C om parable S u b t e s t s o f P r im a r y and E l e m e n t a r y Forms o f P r im a r y M e n ta l A b ilitie s X III*
S c a le s
....................................................
C om p arison o f N orm al Group D i f f e r e n c e s
74
in
Age S c o r e s o f C om p arab le S u b t e s t s W ith T h ose o f D e f e c t i v e Group
.....................
76
CHAPTER I INTRODUCTION C l i n i c a l and t h e o r e t i c a l c o n c e r n w i t h t h e b r a i n in ju re d m e n ta lly d e f e c t i v e m a n ife sta tio n .
H ow ever, i t
c h ild is,
is a r e la tiv e ly recent a t t h e same t i m e , t h e
r e s u l t o f t h e c o n v e r g e n c e o f two r e s e a r c h a r e a s , e a c h h a v i n g an e x t e n s i v e h i s t o r i c a l d e v e l o p m e n t .
On t h e one
h a n d , many o f t h e p r e s e n t d a y c o n c e p t s a p p l i e d b r a in -in ju r e d
c h ild
to th e
h a v e e v o l v e d fr o m e a r l y 1 9 t h c e n t u r y
s p e c u l a t i o n r e g a r d i n g t h e n a t u r e o f m e n t a l d e f e c t and a p p r o p r ia te e d u c a tio n a l t e c h n i c s . B i n e t and Sim on ( 4 )
The d e v e lo p m e n t b y
o f th e i n t e l l i g e n c e
im p etu s f o r t h i s l i n e
o f d e v e lo p m e n t.
d e r i v e d fr o m i t s u s e i n
th e s e l e c t i o n
t e s t p r o v id e d W h ile th e b e n e f i t s
o f m e n ta lly d e f e c t i v e
c h i l d r e n and p r o g n o s t i c a t i o n a s t o a p h a s e o f t h e i r f u t u r e b e h a v io r are w e ll e s t a b l i s h e d , effects
of q u e stio n a b le
v a lu e .
i t was n o t w i t h o u t some The i n s t r u m e n t d e v e l o p e d
b y t h e s e w o r k e r s u n d o u b t e d l y c o n t r i b u t e d much t o t h e g e n e r a l i d e a t h a t m e n t a l d e f i c i e n c y was a c l i n i c a l e n t i t y c h a r a c te r iz e d m en t.
c h i e f l y by a r e t a r d a t io n o f m en ta l d e v e lo p
T h is t r e n d was a l s o r e f l e c t e d
in t h in k in g r e g a r d in g
th e n a tu re o f i n t e l l i g e n c e . O v e r e m p h a s is on t h e p r o b le m o f m e a s u r in g i n t e l l e c t u a l r e ta r d a tio n le d
t o n e g l e c t o f c r i t i c a l a n a ly s is o f the
p s y c h o lo g ic a l f u n c t io n b e in g m ea su red .
O n ly r e c e n t l y h a v e
p r o v o c a tiv e p o s t u l a t e s p r o v id e d by a s t a t i s t i c a l approach ( 4 1 ) g i v e n p r o m ise o f s u p p ly in g a d e q u a te c o n c e p tu a l t o o l s f o r d e a l i n g w i t h th e p r o b le m *
F urth erm ore t h e r e have b een
su g g e s tio n s
th a t m e n ta lly d e f e c t iv e
o f th e p o s s i b i l i t y
c h ild r e n e v id e n c e c h a r a c t e r i s t i c s and r e - e d u c a t i o n
im p o r ta n t f o r d i a g n o s i s
in a r e a s o th e r th a n t h a t o f i n t e l l i g e n c e ( 6 )
The a l t e r n a t e l i n e
o f d e v e l o p m e n t s t e m s fr o m l a t e
1 9 th c e n tu r y m ed ica l r e se a r c h r e l a t i n g c o r tic a l lo c a liz a tio n
t o t h e p r o b le m o f
o f p s y c h o lo g ic a l fu n c tio n s .
e x t e n s i v e summary o f d e v e lo p m e n t a l o n g t h e s e l i n e s
An is
to
b e f o u n d i n an a r t i c l e b y K l e b a n o f f ( 2 1 ) . The a c t u a l c o n v e r g e n c e o f t h e s e tw o p r e v i o u s l y autonomous* a r e a s o f r e s e a r c h a p p e a r s t o o c c u r w i t h t h e c o n t r i b u t i o n s o f G o l d s t e i n ( l l ) and H e a d ( 1 7 ) . W ork in g w i t h c a s e s o f h ead i n j u r y d u r i n g W orld War I , th e s e w orkers w ere con cern ed w ith th e n a tu r e o f n e u r o l o g ic a l damage s u s t a i n e d . what ap p eared
A t th e same t i m e t h e y w e re s t r u c k b y
t o be a c o n s i s t e n t p a t t e r n
im p a ir m e n t a s s o c i a t e d w i t h b r a i n d a m a g e .
o f p sy c h o lo g ic a l The c o n t r i b u t i o n
o f G o l d s t e i n i s , p e r h a p s ,m o r e s t r i k i n g b e c a u s e o f t h e t h e t h e o r e t i c a l fram ew ork h e s u p e r im p o s e d upon h i s o b se r v a tio n s.
H is s t u d y o f t h e r e l a t i o n s h i p b e t w e e n
c e r e b r a l tr a u m a -a n d p s y c h o l o g i c a l a l t e r a t i o n
i n t h e wounded
s o l d i e r h a s b e e n d u p l i c a t e d b y W ern er and S t r a u s s ( 3 8 ) w i t h
r e s p e c t t o a p a r t i c u l a r group o f m e n t a lly d e f e c t i v e c h ild r e n W h ile t h e c o n t r i b u t i o n s d e ta il la te r ,
it
is
o f t h e l a t t e r w i l l be c o n s id e r e d in
im p o rta n t t o n o te h e r e t h a t th e approach
o f G o l d s t e i n , a s w e l l a s t h a t o f W erner and S t r a u s s h a s t e n d e d t o v ie w t r a d i t i o n a l p s y c h o m e t r i c t e c h n i c s a s in a d e q u a te f o r t h e a p p r a i s a l o f th e p e c u l i a r s t a t u s o f th e b r a in -in ju r e d person*
S i m i l a r l y , b o t h a p p r o a c h e s show
s t r o n g G e s t a l t l e a n i n g s and a r e t h u s " h o l i s t i c a l l y 11 o r i e n t e d I.
THE PROBIEM
Work b e i n g d on e w i t h b r a i n - i n j u r e d
c h ild r e n to d a y i s
a lm o st w h o lly p a tte rn ed a f t e r th e p ro ced u res e s t a b lis h e d and d e s c r i b e d b y W ern er and S t r a u s s .
The t h e o r i e s and
c o n c e p t s c u r r e n t l y m o st p r e v a l e n t h a v e s i m i l a r o r i g i n s and are,
in e f f e c t , m e r e ly m odest m o d i f i c a t i o n s
o f h y p o th eses
fo rm u la te d b y G o ld s t e in a lm o st th r e e d e c a d e s a g o . The p r o b le m o f t h e b r a i n - i n j u r e d
c h ild
is
of
p a r t i c u l a r im p o r t a n c e t o t h e c l i n i c a l p s y c h o l o g i s t . A c c o r d i n g t o W erner and S t r a u s s , t h e n e e d f o r a d e q u a t e r e h a b ilita tio n
and r e - e d u c a t i o n h e r e i s more u r g e n t th a n
i n t h e c a s e o f t h e m e n t a l l y h a n d ic a p p e d c h i l d o r g a n ic ch a n g e .
w i t h o u t su c h
G iv e n a d e q u a t e m e a s u r e s and t e c h n i c s , t h e
c l i n i c a l p s y c h o lo g ist i s
in a u n iq u e p o s i t i o n
s o m e t h in g a b o u t t h i s u r g e n t n e e d .
t o do
In o t h e r w o r d s , p r i o r t o
t h e d e v e lo p m e n t o f a s p e c i a l e d u c a t i o n a l p rogra m f o r t h e
4 b r a in * in ju r e d c h i l d ,
t h e p r o b le m o f e s t a b l i s h i n g a
d i f f e r e n t i a l d i a g n o s i s m u st b e m e t .
In a l a r g e p r o p o r t i o n
o f c a s e s m ore th a n a r o u t i n e n e u r o l o g i c a l e x a m i n a t i o n may be r e q u ir e d .
B ecau se a d ia g n o s is
o f b r a i n damage d e p e n d s
upon b e h a v i o r a l c u e s a s w e l l a s s t a t i c
symptoms t h e c l i n i c a l
p s y c h o l o g i s t may h a v e much t o c o n t r i b u t e d e p e n d a b le d i a g n o s t i c p r o c e d u r e s .
to th e sea rch f o r
S im ila r ly ,
th e e s t im a t io n
o f p r e v i o u s , p r e s e n t , and p o s s i b l y f u t u r e l e v e l s ,
of
c a p a b ility rep resen ts h is p o te n tia l c o n tr ib u tio n .
To t h e
e x t e n t t h a t in fo r m a tio n i s d e s ir e d r eg a r d in g c o m p lic a tin g p e r s o n a lit y d y sfu n c tio n or s p e c ia l a r e a s o f d e f i c i t , se r v ic e
o f th e p s y c h o c lin ic ia n
demand and o p p o r t u n i t y ,
is
th ere i s
in v a lu a b le . little
W ith s u c h
w on d er a t t h e
i n t e r e s t t h a t th e s e w orkers have e v id e n c e d Som ewhat b e w i l d e r i n g , h o w e v e r ,
th e
in t h i s a r e a .
I s th e f a c t t h a t th e t o o l s
b e i n g d e v e l o p e d f o r work h e r e a r e c o m p l e t e l y l a c k i n g i n t h e p r e c i s i o n , q u a n t i f i c a t i o n and o b j e c t i v i t y w h ic h h a s c o m p r is e d t h e c o r n e r s t o n e o f t h i s d i s c i p l i n e . a v a ila b le
T hat
t e c h n ic s are in a d eq u a te f o r th e c l i n i c a l
e v a lu a tio n
o f th e b r a in - in j u r e d
H ow ever, t h e r e
c h ild
Is u n d e rsta n d a b le .
i s b a s i s f o r d o u b tin g t h a t th e in str u m e n ts
th a t have r e p la c e d
them p r o v i d e a d d i t i o n a l p r e c i s i o n .
In e f f e c t , t h i s
s t u d y r e p r e s e n t s an a t t e m p t t o
in tr o d u c e t e c h n ic s r e f l e c t i n g a str o n g q u a n t it a t iv e o r ie n ta tio n
i n t o th e a r e a .
It
i s an a t t e m p t t o t h i n k i n
term s o f a b i l i t y c h a n g e s in su ch p a t i e n t s r a t h e r th an in t e r m s o f n e u r o l o g i c a l s i g n s and s y m p to m s . in tr o d u c tio n to t h i s
c a se w ith t e s t i n g
th e
c l i n i c a l p r o b le m o f a s e r i e s o f t e s t s
d e sig n e d t o a llo w f o r th e e v a lu a t io n e x te n siv e s e r ie s
It rep resen ts
of a b ilit ie s
o f p o s s i b l y a more
th a n h a s h i t h e r t o b e e n t h e
in str u m e n ts.
It is
a ls o b e lie v e d
th a t
,
u s in g su ch in s tr u m e n ts in a d d it io n t o th e a p p l i c a t i o n o f sp e c ia liz e d
te c h n ic s
t o t h e d a t a t h u s d e r i v e d , may p r o v i d e
i m p o r t a n t l e a d s f o r r e - t r a i n i n g and d i a g n o s i s o f t h e b r a i n in ju re d c h ild * II.
DEFINITIONS
Exogenous d e f e c t i v e . w i l l be used
T hroughout th e p a p e r , t h i s
term
s y n o n o m o u s ly w i t h wb r a i n - i n j u r e d d e f e c t i v e 1* .
The te r m h a s r e f e r e n c e t o t h o s e c a s e s o f m e n t a l r e t a r d a t i o n , d e term in ed by th e a p p l i c a t i o n o f a p s y c h o m e tr ic in str u m e n t i n w h ic h t h e b e h a v i o r o f t h e p e r s o n can b e t r a c e d t o c e r e b r o v a s c u l a r c h a n g e s , c e r e b r a l t r a u m a t a , c e r e b r a l n e o p la s m s o r in fe c tio u s
In v a sio n s o f c e r e b r a l t i s s u e .
Endogenous d e f e c t i v e .
T h is term w i l l b e u sed
s y n o n o m o u s ly w i t h ” f a m i l i a l d e f e c t i v e 11 o r np r im a r y d e f e c t I v e tt It refers
t o th e c o n d it io n o f m en ta l r e t a r d a t i o n , a g a in a s
d e t e r m i n e d b y a v a l i d p s y c h o m e t r i c i n s t r u m e n t , w h ic h can be r e la te d d ir e c t ly to g e n e tic tr a n sm iss io n .
CHAPTER II REVIEW OP THE LITERATURE C o n tr ib u tio n o f C o ld a te I n .
W h ile p r e s e n t - d a y c o n c e r n
and s p e c u l a t i o n r e g a r d i n g e x o g e n o u s i n t e l l e c t u a l d e f e c t i n c h ild r e n
i s h i s t o r i c a l l y c o n t i n u o u s w i t h t h e m odern d o c t r i n e
o f c o r t i c a l l o c a l i z a t i o n w h ic h d e v e l o p e d d u r i n g t h e l a t t e r p a r t o f t h e 1 9 t h c e n t u r y , t h e c o n s t r u c t s and r a t i o n a l e w h ic h h a v e had t h e m o st e x t e n s i v e
c l i n i c a l u s e s t e m f r o m t h e work
of C o ld s te in (1 0 ,1 1 ,1 2 ,1 3 ) .
I n f l u e n c e d b y C e s t a l t t h e o r y and
d e p l o r i n g t h e m e n t a l t e s t i n g m ovem en t, G o l d s t e i n t h e i m p o r t a n c e o f an " h o l i s t i c " sp e c ia liz e d
stressed
a p p r o a c h and t h e u s e o f
te c h n ic s fo r th e e v a lu a tio n
o f c o g n i t i v e and
c o n a t i v e c h a n g e s i n t h e t r a u m a t i c d e m e n ts h e saw d u r i n g W orld War I *
^The c l i n i c a l e x a m i n a t i o n o f t h e b e h a v i o r
e x h i b i t e d b y s u c h p a t i e n t s l e d C o l d s t e i n and h i s c o l l a b o r a t o r s t o d i s t i n g u i s h b e t w e e n " a b str a c t* * and " c o n c r e t e "
ty p es
o f b e h a v io r . In " c o n c r e te " p e r fo r m a n c es a r e a c t i o n i s d eterm in ed d i r e c t l y b y a s t i m u l u s , i s aw akened b y a l l t h a t t h e In d iv id u a l p e r c e iv e s . The i n d i v i d u a l * s p r o c e d u r e i s som ewhat p a s s i v e , a s i f i t w ere n o t he who had t h e In itia tiv e . In " a b s t r a c t " p e r f o r m a n c e s an a c t i o n i s n o t d e t e r m i n e d d i r e c t l y and i m m e d i a t e l y b y a s t i m u l u s c o n f i g u r a t i o n b u t b y t h e a c c o u n t o f t h e s i t u a t i o n w h ic h th e in d iv id u a l g i v e s t o h im s e lf . The p e r f o r m a n c e i s t h u s more a p r i m a r y a c t i o n , and i t i s a t o t a l l y d i f f e r e n t w ay o f com in g t o te r m s w i t h t h e o u t s i d e w o r ld . The I n d i v i d u a l h a s t o c o n s i d e r t h e s i t u a t i o n fr o m v a r i o u s a s p e c t s , p i c k o u t t h e a s p e c t w h ic h i s e s s e n t i a l and a c t i n a way a p p r o p r i a t e t o t h e w h o le s i t u a t i o n . T r u e , t h i s p r o c e d u r e may h a v e v a r i o u s d e g r e e s o f c o m p l e x i t y .
7 S o m e tim e s t h e s i t u a t i o n dem ands n o t h i n g more t h a n a s i n g l i n g o u t o f one p r o p e r t y o f an o b j e c t , a s , f o r i n s t a n c e , when we a r e a s k e d t o s o r t o b j e c t s a c c o r d i n g to th e ir c o lo r s . In t h e h i g h e s t d e g r e e o f c o m p l e x i t y , we h a v e n o t o n l y t o a p p r e h e n d o b j e c t s b y m eans o f c e r t a i n sim p le c h a r a c t e r i s t i c s b u t t o ch o o se a s p e c t s f o r c o n s i d e r a t i o n in a c c o r d a n c e w it h a c e r t a i n t a s k w h ic h demands a c o n c e p t u a l o r g a n i z a t i o n . E ven In i t s s im p le s t form , h o w ev er, a b s t r a c t i o n i s s e p a r a te in p r i n c i p l e fro m c o n c r e t e b e h a v i o r . T h ere i s n o g r a d u a l t r a n s i t i o n fr o m t h e one t o t h e o t h e r . The a s s u m p t i o n o f an a t t i t u d e tow ard t h e a b s t r a c t i s n o t more c o m p le x m e r e l y t h r o u g h t h e a d d i t i o n o f a new f a c t o r o f d e te r m in a tio n ; i t i s a t o t a l l y d i f f e r e n t a c t i v i t y o f t h e o r g a n is m . . . R eal a c tio n is never a b str a c t; i t is a l w a y s c o n c r e t e . |T he d i f f e r e n c e b e t w e e n t h e tw o c o n d i t i o n s i s shown i n t h e d i f f e r e n c e b e t w e e n t h e p r o c e s s e s w h ic h p r e c e d e a c t i o n . In t h e c o n c r e t e s i t u a t i o n , a c t io n i s s e t g o in g d i r e c t l y by th e s t i m u l i ; i n t h e s i t u a t i o n i n v o l v i n g t h e a b s t r a c t , a c t i o n i s b eg u n a f t e r p r e p a r a t i o n w h ic h h a s t o d o w i t h c o n s i d e r a t i o n o f t h e w h o le s i t u a t i o n . ( 1 1 ) )
j
It
is
in te r e stin g ,
i f n ot a lto g e th e r p e r tin e n t to
\
o b s e r v e s o o u t s t a n d i n g an a d v o c a t e o f t h e B i n e t a p p r o a c h t o t e s t i n g a s Terman h a d , some t e n y e a r s p r i o r t o t h e c r y sta lliz a tio n d e fin e d
o f th e a b s t r a c t — c o n c r e te d ic h o to m y ,
in te llig e n c e a s , ” .
.
.a n
in d iv id u a l Is i n t e l l i g e n t
i n p r o p o r t i o n a s h e i s a b l e t o c a r r y on a b s t r a c t t h i n k i n g . ” (3 9 ) ( S u ch a c a p a c i t y f o r a b s t r a c t i o n , a s p o s t u l a t e d b y G o ld s t e in , i s n e c e s s a r y f o r th e fo llo w in g b e h a v io r : 1 . A s su m in g a m e n t a l s e t v o l u n t a r i l y . 2. S h i f t i n g v o l u n t a r i l y fr o m one a s p e c t o f a s i t u a t i o n t o a n o t h e r , m ak in g a c h o i c e . 3. K e e p in g in mind s i m u l t a n e o u s l y v a r i o u s a s p e c t s of a situ a tio n . 4 . G r a s p i n g t h e e s s e n t i a l o f a g i v e n w h o le i n t o p a r t s and i s o l a t i n g them v o l u n t a r i l y . 5 . A b s t r a c t i n g common p r o p e r t i e s , p l a n n i n g a h ea d
8 i d e a t i o n a l l y , a s s u m i n g an a t t i t u d e to w a r d t h e " m e r e ly p o s s i b l e 11, and t h i n k i n g o r p e r f o r m i n g s y m b o l i c a l l y * 6. D e t a c h i n g t h e e g o fr o m t h e o u t e r w o r l d . ( 1 2 ) C o n c d m ita n t w i t h b r a i n - i n j u r y , t h e r e o c c u r s a b a s i c change in b e h a v io r o r g a n iz a tio n
s u c h t h a t a more p r i m i t i v e
l e v e l o f c o n c r e te t h in k in g p r e d o m in a te s o ver th e p r e ~ tr a u m a tfc I a b s t r a c t l e v e l . I W h ile G o l d s t e i n i s e m p h a t i c i n h i s e m p h a s is upon t h e e s s e n t i a l l a c k o f c o n t i n u i t y b e t w e e n h i s p o s t u l a t e d a t t i t u d e s , t h e r e i s no c o n t r a r y i n d i c a t i o n t o v ie w in g t h a t w h ic h i s
c o n c r e t e a s t h a t w h ic h i s n o t a b s t r a c t .
For G o ld s t e in , th e b e h a v io r a l changes r e la t e d
to
b r a i n - i n j u r y i n v o l v e more t h a n t h e s h i f t fr o m a b s t r a c t t o co n crete a t t i t u d e .
In e f f e c t ,
t h e r e a r e n o t o n l y a number
o f f a c t o r s w h ic h c o n t r i b u t e t o t h e p r o d u c t i o n o f symptom** a t o l o g y b u t t h e same symptom may b e p r o d u c e d i n t o t a l l y d iffe r e n t w ays. referred
F i r s t , t h e r e a r e t h e d i r e c t sy m p to m s,
t o a s d e d i f f e r e n t i a t i o n b y G o l d s t e i n , ( 1 3 ) w h ic h
a r e , e s s e n t i a l l y , t h e " n e g a t i v e sym ptom s" o f H u g h li n g s J a ck so n (1 9 ).
T h is i s
t h e s y m p t o m a t o lo g y w h ic h i s t h e d i r e c t
co n se q u en t o f th e im p a irm e n t. fo r m o f a s i m p l e l o s s
Y e t , r a t h e r th a n t a k in g th e
o f p erfo rm a n ce r e l a t e d t o a s p e c i f i c
cereb ra l s i t e , d is in te g r a tio n
i n v o l v e s more c o m p le x
r e la tio n s h ip s as fo llo w sj 1.
I n c r e a s e i n t h r e s h o l d and r e d u c t i o n o f
r e c e p t i v i t y are con seq u en ts o f a l l r e g a r d le ss of s i t e .
c o r t ic a l in ju r y ,
2.
Upon a c h i e v i n g s t i m u l u s s t r e n g t h w h ic h i s
s u f f ic i e n t to o f f s e t th e r is e
o f th r e s h o ld , th e r e s u lt in g
s t i m u l a t i o n w i l l show b o t h ab n o rm a l s p r e a d and a b n o rm a l d u ra tio n . 3*
The o r g a n i s m 1s b e h a v i o r w i l l show i n c r e a s e d
d e te r m in a tio n by e x t e r n a l f a c t o r s . 4.
C o r r e s p o n d in g t o t h e d i s t u r b a n c e o f t h e f i g u r e -
g ro u n d d i s t u r b a n c e
in th e c e n t r a l n e r v o u s s y s te m , th e
i n d i v i d u a l s p e r c e p t u a l p e r f o r m a n c e s a l s o w i l l show an a lte r a tio n
in th e f ig u r e -g r o u n d
d istin c tio n s.
The s h i f t fr o m a b s t r a c t t o c o n c r e t e a t t i t u d e i s su ch e x p r e s s io n
of th is d e d iffe r e n tia tio n
one
of fu n c tio n .
A n o t h e r p h a s e o f s y m p t o m a t o lo g y i s a c c o u n t e d f o r on th e b a s is o f in d ir e c t e f f e c t s tissu e .
o f a le s io n
on i n t a c t n e u r a l
A s su m in g a - f u n c t i o n a l i n t e r r e l a t i o n s h i p b e tw e e n
any p o r tio n o f th e n erv o u s sy stem w ith th e w h o le , i t f o llo w s t h a t n o n - i n j u r e d p o r t i o n s d e p e n d e n t upon t h e i n j u r e d s u b s t r a t u m w i l l a l s o u n d e r g o c h a n g e and t h e r e b y c o n t r i b u t e t o t h e sy m p to m -co m p le x * r e fle x e s
T hus, th e a p p earan ce o f e x a g g e r a te d
in c a s e s o f b r a in - in j u r y n o t in v o lv in g th e p re
m o to r a r e a w o u ld b e a c a s e i n p o i n t . A g a in , i t
i s p o s s ib le to r e la t e a s ig n if ic a n t p o r tio n
o f d e v i a n t b e h a v i o r h e r e t o 11c a t a s t r o p h i c c o n d i t i o n s ” , i n e f f e c t a r e d u c tio n a sta te
in th e o r g a n ism ’ s c a p a c i t y t o m a in ta in
o f c o n s ta n c y in th e f a c e
o f an i n d e t e r m i n a t e m i l i e u .
10
] {
J
S u ch a r a t i o n a l ©
i s used t o a cco u n t f o r th e d is o r d e r e d
b e h a v i o r and a n x i e t y shown b y b r a i n - i n j u r e d p a t i e n t s * S im ila r ly , a p o r tio n t o a v o id
o f t h e b e h a v i o r r e p r e s e n t s an a t t e m p t
s u c h c a t a s t r o p h i c s i t u a t i o n s and i s
th e lo c a t io n
i !
in d ep en d en t o f
or e x t e n t o f th e in ju r y *
F u r t h e r D e v e lo p m e n t o f C o n c e p t s b y W ern er and S t r a u s s * In a d d i t i o n t o s u g g e s t i n g c r i t e r i a f o r a p p r a i s i n g t h e brain** i n j u r y syndrom e, G o l d s t e i n ’ s h o l i s t i c
approach c a l l e d f o r a
r e - a p p r a i s a l o f t h e t r a d i t i o n a l v ie w o f d e m e n t i a i n a u n it a r y form .
In e f f e c t ,
it
f o l l o w e d fro m G o l d s t e i n ’ s
h y p o t h e s e s t h a t d e m e n t i a , c o u l d n o t be v ie w e d a s a u n i t a r y a f f a i r b u t , r a t h e r , a s i n v o l v i n g nu m erous p a r a m e t e r s w h i c h , f r e q u e n t l y , w ere n o t e l i c i t e d e x a m in a tio n *
by a v a ila b le te c h n ic s
of
H a v in g b r o u g h t a b o u t a c h a n g e i n t h e c o n c e p t
d e m e n t i a , s e r i o u s c o n s i d e r a t i o n was g i v e n t h e p o s s i b i l i t y t h a t t h e same c l i n i c a l p r o c e d u r e s a p p l i e d t o c h i l d r e n m ig h t s e r v e t o change th e c o n c e p t o f a m en tia o r m e n ta l d e f i c i e n c y . I t was n e c e s s a r y t o a s k ; I f a m en tia o f th e ty p e fo u n d i n b r a i n i n j u r e d c h i l d r e n i s an a c q u i r e d d e f e c t , w ou ld i t n o t be b e t t e r t o d i f f e r e n t i a t e t h e s e c h i l d r e n a s ”e a r l y t r a u m a t i c d e m e n t s ” fr o m t h o s e w h o se a m e n t i a was a c o n t i n u a t i o n o f t h e I n f e r i o r endow m ents o f t h e i r p r o g e n i t o r s , w it h i t s o r ig i n t h e r e f o r e in vftw ? In o t h e r w o r d s , sh o u ld th e d i a g n o s i s b e m e n ta l d e f i c i e n c y , im p ly in g la c k o f i n t e l l i g e n c e , or sh o u ld i t be e a r l y t r a u m a t i c d e m e n t i a , I m p ly i n g l o s s o f i n t e l l i g e n c e ? W h a te v e r l a b e l s h o u l d b e a t t a c h e d t o t h e m , d i d t h o s e b r a i n i n j u r e d c h i l d r e n show t h e same p s y c h o l o g i c a l c h a r a c t e r i s t i c s a s t h e h e r e d i t a r y or f a m i l i a l t y p e o f m e n t a l l y d e f e c t i v e c h i l d r e n , or d i d t h e i r p s y c h o p a t h o l o g i c a l p a tte r n o f b e h a v io r r a t h e r r e se m b le t h a t o f t h e t r a u m a t i c d e m e n ts a s fo u n d b y Head and G o l d s t e i n ?
How c o u l d t h e s e i n f a n t i l e d e m e n t s b e d i a g n o s e d ? How w o u ld t h e y b e s e l e c t e d fr o m o t h e r t y p e s o f e a r l y m e n t a l impa irm en t ? ( 3 5 ) W erner and S t r a u s s ( 3 6 , 3 7 , 3 8 , 5 2 , 5 3 , 5 4 ) h a v e b e e n t h e o u t s t a n d in g w ork ers in th e a d a p t a t io n c o n c e p ts d e v e lo p e d by G o ld s te in d e fe c tiv e
c h ild r e n .
o f t h e t e c h n i c s and
f o r u se w ith m e n ta lly
W h ile , in r e c e n t y e a r s , th e t h in k in g
o f G o ld ste in
i n d i c a t e s a tren d
in th e d i r e c t i o n o f r e g i o n a l
lo c a liz a tio n
t h e o r y ( l O ) t h e G e s t a l t , W h o l i s t i c 11 s t r u c t u r i n g
e v i d e n c e d b y W ern er and S t r a u s s h a s b e e n l e s s y i e l d i n g * F o r t h e m o st p a r t t h e s e w o r k e r s h a v e c o n c e r n e d th e m se lv e s w ith a p a r t i c u la r group o f b r a in -in ju r e d
c h ild r e n
O r i g i n a l l y , t h e te r m **e x o g e n o u s type*1 had b e e n u s e d b y L a r s o n ( 2 2 ) t o d e s i g n a t e a n y m e n t a l d e f e c t i v e who e v i d e n c e d n e u r o p a t h o l o g y in a n y d e g r e e .
T h is was i n c o n t r a d i s t i n c t i o n
t o t h e ^ e n d o g e n o u s group** w h ic h m a n i f e s t e d s u c h d e f e c t a s a r e s u l t o f g e n e t ic tr a n sm iss io n *
W h ile W erner and S t r a u s s
s p e a k o f an e x o g e n o u s d e f e c t , t h e i r s m e a n in g *
i s a more s p e c i a l i z e d
R e c o g n iz in g th e r e l a t i o n s h i p betw een n e u r o l o g i c a l
d i s t u r b a n c e and m e n t a l d e f i c i e n c y ,
t h e i r p o in t has been
t h a t su ch d e f e c t i s a l s o c o m p lic a te d b y n eu ro p a th o lo g y * T h u s , a s w as a l s o p o i n t e d o u t b y D o l l ,
P h e l p s , and M e l e h e r ,
(6 ) m en tal r e t a r d a t i o n , a s w e l l a s o th e r a b n o r m a litie s b e h a v io r e x h ib ite d b y a b r a in -in ju r e d
c h ild
of
is not
n e c e s s a r i l y t h e d i r e c t r e s u l t o f b r a i n damage b u t may a l s o r e fle c t
i n a d e q u a t e m e n t a l d e v e lo p m e n t du e t o r e s t r i c t e d
12 l o c o m o t i o n and t h e c o n s e q u e n t r e d u c t i o n e x p lo r a to r y m aneuvers.
in sc o p e o f
As a c o n s e q u e n c e , t h e s e w r i t e r s
h a v e b e e n c o n c e r n e d e x c l u s i v e l y w i t h t h e c h i l d who sh ow s a marked r e d u c t i o n i n i n t e l l i g e n c e o f b ra in
in r e l a t i o n
to a h isto r y
i n j u r y b u t who d o e s n o t e x h i b i t a n y m o to r d e f e c t .
F o r W erner and S t r a u s s , t h e n , t h e c h i l d w i t h e x o g e n o u s d efect,
o r t h e f,b r a i n ~ i n j u r e d
c h i l d 11, i s :
. . . a c h ild w ho, b e f o r e , d u r in g , or a f t e r b ir t h has r e c e i v e d an i n j u r y t o o r s u f f e r e d an i n f e c t i o n o f t h e b r a i n . As a r e s u l t o f s u c h o r g a n i c i m p a i r m e n t , d e f e c t s o f t h e n e u r o m o t o r s y s t e m may b e p r e s e n t o r a b s e n t ; h o w e v e r , s u c h a c h i l d may show d i s t u r b a n c e s in p e r c e p t i o n , t h i n k i n g and e m o t i o n a l b e h a v i o r , e i t h e r s e p a r a t e l y o r in c o m b in a tio n . . . ( 3 5 ) N ot o n l y h a v e t h e s e w o r k e r s r e s t r i c t e d a tte n tio n
t o m e n ta lly d e f e c t iv e
th e ir
c h i l d r e n w i t h m in im a l o r n o
e v i d e n t n e u r o p a t h o l o g y , b u t a l s o t o c h i l d r e n s h o w in g m in im a l i n t e l l e c t u a l d e f e c t a s e v id e n c e d by s ta n d a r d iz e d i n t e l l i g e n c e sc a le s. le v e l,
B e ca u se o f th e f a c t t h a t , a t su ch a p sy c h o m e tr ic t h e l a r g e s t number o f e n d o g e n o u s o r f a m i l i a l
d e f e c t i v e s a l s o a r e t o b e f o u n d , t h e work o f W ern er and S t r a u s s h a s b e e n d i r e c t e d , p r i m a r i l y , to w a r d t h e e s t a b l i s h m ent o f c r i t e r i a f o r d i f f e r e n t i a l d i a g n o s i s b e t w e e n e n d o g e n o u s and e x o g e n o u s d e f e c t a n d , s e c o n d a r i l y , tow ard t h e d e v e lo p m e n t o f s p e c i a l e d u c a t i o n a l t e c h n i c s * f o r t h e exogenous d e f e c t i v e . w h ic h r e s u l t e d
T h eir s p e c i f i c
f i n d i n g s and p o s t u l a t e s
fr o m a s y s t e m a t i c a p p r o a c h t o t h e p r o b le m a r e
t o b e fo u n d i n n u m er o u s w o r k s . ( 3 4 , 3 6 , 3 7 , 3 8 , 4 9 , 5 0 , 5 1 , 5 2 , 5 3 ,
15 5 4 ,5 5 ,5 6 ) T hese s t u d i e s have p o in t e d t o th e g r e a t v a r i e t y o f b e h a v io r a n o m a lies e v id e n c e d b y b r a in - in j u r e d
c h ild r e n *
Some c h i l d r e n show p r im a r y d i s t u r b a n c e i n t h e p e r c e p t u a l fie ld ,
o t h e r s s h o w , r a t h e r th a n a p e r c e p t u a l d i s o r d e r ,
co n cep tu a l d istu r b a n c e s* o n l y marked d e v i a t i o n v a r ia tio n
T h e r e a r e a l s o c h i l d r e n who show
in g r o s s b e h a v i o r .
i n s y m p t o m a t o lo g y i s
W h ile s u c h
s t r i k i n g , W ern er and S t r a u s s
a tte m p t t o e s t a b l i s h a c l i n i c a l r e l a t i o n s h i p b etw een su ch f
d iv e r s e m a n if e s t a t io n s by p o s t u la t in g th e f o llo w in g s e r i e s o f c h a r a c t e r i s t i c s fu n d a m en ta l t o e v e r y o r g a n ic b e h a v io r d i s t u r b a n c e and fr o m w h ic h s u c h d i v e r s i t i e s
in th e c l i n i c a l
p i c t u r e em erge: 1.
F o r c e d R e s p o n s i v e n e s s t o S t i m u l i o r A b norm al
D ia tr a c tib llity .
The b r a i n - i n j u r e d
d is t r a c t e d by e x tra n eo u s s t i m u l i .
c h ild
is e a s ily
The c h i l d
f
cannot r e fr a in
fr o m a t t e n d i n g t o i n c i d e n t a l n o i s e s , i r r e l e v a n t d e t a i l s t h e p r o b le m s i t u a t i o n and a n y i n t r u d i n g d i s t r a c t i o n .
j ' r'-'
of
^
T h is
i s w h a t G o l d s t e i n h a s te r m e d ,,s t i m u l u s - b o n d e d n e s s ,, i n t h e case o f b r a in -in ju r e d a d u lts and, fu r th e r , bears s tr ik in g r e s e m b l a n c e t o w h a t Head te r m s " h y p e r v i g l l a n c e ” ( 1 7 ) . e x t e n t t h i s a c c o u n ts f o r a n o m a lie s in f ig u r e - g r o u n d
To an r e la tio n s
s e e n in such c h ild r e n * 2,
P a th o lo g ic a l F ix a t io n .
t h i s phenom enon t o b e c o n s i d e r e d .
T h ere a r e tw o a s p e c t s o f One a s p e c t i s
r e la te d
to
%
th e p r o tr a c te d d u r a tio n o f th e s tim u la tio n as e x e m p lifie d by th e p r o lo n g e d a f t e r - e f f e c t . as b e in g " in te r n a l"
The o t h e r a s p e c t i s d e s c r i b e d
i n n a t u r e and e x h i b i t s
its e lf
in t h e
i n e r t i a o f t h e o r g a n i s m , t h e i n a b i l i t y t o s h i f t f r o m .o n e " n e r v o u s a c t i v i t y 11 t o a n o t h e r .
R e la te d t o t h i s
c o n s p i c u o u s f r e q u e n c y w i t h w h ic h p e r s e v e r a t i o n th e b r a in -in ju r e d 3.
i s th e is
fo u n d i n
is
seen as a
c h ild *
t> is I n h i b i t i o n .
M otor d i s i n h i b i t i o n
c h a r a c t e r is t ic b e h a v io r t r a i t
in b r a i n - i n j u r e d c h i l d r e n .
C lin ic a lly , a part o f t h is
se en a s ex a g g era ted r e s t l e s s
is
^
n e s s and h y p e r a c t i v i t y . 4.
D isso c ia tio n .
By t h i s
i s m ean t, " th e la c k o f
in te g r a tio n
o f e l e m e n t s i n t o m ore c o m p r e h e n s i v e c o n f i g u r a t i o n "
( 3 7 ) and i s
sa id
of b r a in -in ju r e d
t o c h a r a c t e r i z e s e n s o r i- m o t o r p erfo rm a n ces c h ild r e n .
T h u s , i n p e r f o r m i n g upon t e s t s
w h ic h r e q u i r e c o n s t r u c t i o n o f m o s a i c - l i k e p a t t e r n s , w h i l e t h e p a t t e r n s may b e r e p r o d u c e d s e q u e n c e in c o n s t r u c t i o n
is
s u c c e s s f u l l y , t h e p e r fo r m a n c e
e r r a t i c r a t h e r th a n o r d e r l y
and i n v o l v e s t h e c h i l d f s jum p in g fr o m one p a r t o f t h e f i g u r e t o a n o th er q u ite u n r e la ted
one .
S u ch a c h i l d
cannot
com prehend t h e p a t t e r n a s a w h o le a n d , c o n s e q u e n t l y , p r o d u c e s fo r m s l a c k i n g c o n n e c t i o n . The f o r e g o i n g a r e t h e f u n d a m e n t a l f u n c t i o n a l c h a n g e s w h ic h t h e s e a u t h o r s r e l a t e
t o b r a in l e s i o n s in th e c h i l d .
I t i s e m p h a s iz e d t h a t s u c h phenom ena a r e n o t m e r e l y e f f e c t s
15 of d e fe c tiv e
i n t e l l i g e n c e , a s such a n o m a lie s a r e n o t e v id e n t .
i n e i t h e r n o r m a ls or e n d o g e n o u s d e f e c t i v e s m en tal a g e .
It is
fu r th e r p o in te d
o f c o m p a r a b le
out th a t r e s t r i c t i o n s
of
t h e more p o p u l a r s t a n d a r d i z e d t e s t s a r e s u c h t h a t o n l y t h e n a r r o w e s t se g m e n t o f t o t a l b e h a v i o r i s b r o u g h t u n d e r sc r u tin y .
For a d eq u a te u n d e r sta n d in g o f th e p e r c e p t u a l,
c o n c e p t u a l , and b e h a v i o r a l d i s t u r b a n c e s o f b r a i n - i n j u r e d c h ild r e n , s p e c ia l t e c h n ic s , d e sc r ib e d as " q u a lit a t iv e ” are necessary,
in o r d e r t h a t :
resp o n ses i s encouraged;
( 1 ) t h e o p p o r t u n i t y f o r a b n o rm a l (2 ) th e s tr u c tu r in g o f th e
e x a m in a tio n p ro ced u re be m in im a l, th e r e b y a llo w in g g r e a t e r o p p o r t u n i t y f o r " f r e e e x p r e s s i o n ” and c o n s e q u e n t e m e r g e n c e o f d e v ia tio n ; and, (3)
th ere
o p p o rtu n ity fo r s c r u t in iz in g
is
p resen ted a c l i n i c a l
t h e w ay i n w h ic h a n y c h i l d
a c h i e v e s a f i n a l b e h a v io r p r o d u ct r a t h e r th a n a g l o b a l s c o r e b a s e d upon a p a s s - o r - f a i l c r i t e r i o n .
S u ch s p e c i a l i z e d
t e c h n i c s have been d e v e lo p e d by th e s e w o r k e r s , d e s c r i p t i o n s o f w h ic h ca n b e fo u n d in p r e v i o u s l y c i t e d O th e r C o n t r i b u t i o n s .
sou rces.
O th e r l i t e r a t u r e p e r t i n e n t t o
t h e p r o b le m a t hand a p p e a r s t o f i t
in to a tw o -fo ld
c la s s ific a tio n : 1.
T h ose s t u d i e s c o n t a i n i n g d e s c r i p t i o n s o f and
s u g g e s t i o n s f o r new t e c h n i c s w h ic h a r e b e l i e v e d f r u i t f u l fo r c l i n i c a l e v a lu a tio n
o f th e b r a in -in ju r e d
S e e m in g ly w ith o u t e x c e p t i o n ,
c h ild .
such t e c h n ic s a re su g g e ste d
16 w i t h i n t h e fra m e w o r k o f t h e G e s t a l t , h o l i s t i c 11 s t r u c t u r i n g s t r e s s e d b y G o l d s t e i n and f u r t h e r d i f f e r e n t i a t e d b y W ern er and S t r a u s s * (a )
The w ork o f M eyer and S i m m e l( 2 7 ) i s ,
p e r h a p s , m ost r e p r e s e n t a t i v e o f t h i s g r o u p . o n ly r e f l e c t th e t h e o r e t i c a l o r ie n ta tio n
T hey n o t
of
G o ld s t e in , b u t a l s o th e W ern er-S tra u ss d i s s a t i s f a c t i o n w ith s ta n d a r d iz e d e x a m in a tio n p roced ures*
In t h e i r own w o r d s :
S in c e t h e e n d -p r o d u c t in t e s t i n g , a c o r r e c t o r i n c o r r e c t r e s p o n s e , may b e t h e ou tcom e o f m ore th a n one t y p e o f p r o c e s s o r l e v e l o f fu n c tio n in g , i t i s o ften n ecessa ry to ng o b e h i n d 1* t h e t e s t r e s p o n s e . O n ly an i n t e n s i v e s tu d y o f t h e c h i l d * s p ro ced u re in s o l v i n g g i v e n t a s k s c a n , we b e l i e v e , g i v e u s th e in fo r m a tio n r e q u ir e d f o r a b e t t e r d ia g n o s is and p r o g n o s i s . W h ile t h e s e w o r k e r s h a v e a l s o e m p lo y ed s t a n d a r d i z e d p r o c e d u r e s w h ic h c a l l f o r s h o r t v e r b a l r e s p o n s e s and a u t o m a t i s m s , e . g . ,
id e n tific a tio n
of p ic tu r e s,
and o b j e c t s , c o u n t i n g o f o b j e c t s , r e p e t i t i o n d ig its, e tc .,
of
such q u a n t i t a t i v e p ro ced u res have
s u p e r im p o s e d upon them a more q u a l i t a t i v e and d e sc r ip tiv e
o r ie n ta tio n .
I d e n tific a tio n
T h us, in t h e P ic t u r e
T e s t o f t h e S t a n f o r d - B i n e t , one i t e m
i n v o l v e s t h e e x a m in e e ’ s p o i n t i n g t o t h e p i c t u r e w h ic h b e s t a n s w e r s t h e q u e s t i o n : i n t h e t r e e ? 1*
f,Which one s i n g s
An e x a m p le o f s u c h a m o d i f i c a t i o n
is
17 g iv e n in th e f o llo w in g s . . . ( c h ild ) p o in ts q u ic k ly to th e c o r r e c t p ic tu r e . The f o l l o w i n g m o d i f i c a t i o n i s in tro d u ced s The e x a m i n e r s a y s , MYou a s k me n o w . I w i l l g u e s s . 11 P a t i e n t , MW hich b i r d s i n g s i n t h e t r e e ? ” . . . th e c h i ld c o u ld n o t d i s s o c i a t e h e r s e l f f r o m t h e i n t e n d e d o b j e c t and t h e r e f o r e in c lu d e d v e r b a l l y in h e r q u e s t io n th e o n ly p o s s i b l e s o l u t i o n w h ic h s h e w a s t r y i n g t o o b t a i n . T h u s , a t e c h n i c fr o m w h ic h i s u s u a l l y d e r i v e d a s c o r e i n t e r m s o f a p a s s - f a i l c r i t e r i o n now b e c o m e s one b y w h ic h t h e p a t h o l o g i c a l f i x a t i o n o f th e b r a in -in ju r e d
c h ild
c h a r a c te r istic
i s d em o n stra ted .
B e n d e r (2 ,3 ) has a l s o been r e s p o n s ib le f o r G e s ta lt o r ie n te d
c o n t r i b u t i o n s in t h i s a r e a .
For th e
m o st p a r t , h o w e v e r , B e n d e r h a s been c o n c e r n e d w i t h t h a t t y p e o f e x o g e n o u s d e f e c t w h ic h r e s u l t s fro m j u v e n i l e e n c e p h a l i t i s a n d , in su ch c a s e s , h as p la c e d s i n g u l a r s t r e s s upon d e v i a t i o n s i n t h e v i s u o - r a o t o r sp h ere a s i n d ic a t o r s o f such n e u r o p a th o lo g y . 2.
S tu d ie s in v o lv in g th e u se o f sta n d a r d iz e d
t e s t in g p ro ced u res, p r e v io u sly con stru cted f o r use areas of in v e s tig a tio n ,
in o th e r
i n an e f f o r t t o d e t e r m i n e t h e i r
v a l i d i t y in d i f f e r e n t i a t i n g
t h e e x o g e n o u s fr o m t h e
endogenous d e f e c t i v e . i
(a )
T h e ^ fir s t a ttem p t t o u se sta n d a r d ize d t e s t
p r o c e d u r e s in t h e c l i n i c a l e v a l u a t i o n o f t h e b r a in ii n j u r e d c h i l d w as t h a t b y D o l l , P h e l p s and M e lc h e r (6 ).
T h is s t u d y was r e s t r i c t e d
to c er eb ra l p a lsy
18 c a s e s due t o b i r t h
in ju ry *
For u s e w ith th e tw e lv e
s u b j e c t s chosen f o r stu d y , th e t e s t s th e S ta n fo r d -B in e t
s e l e c t e d w e re
( 1 9 1 6 ) , t h e M yers M e n ta l M e a s u r e ,
t h e G oodenou gh D r a w in g T e s t , t h e H e a l y P i c t u r e C o m p le t io n T e s t I I , t h e P o r t e u s M a z e s , t h e W itm er Form B o a r d , t h e O hio L i t e r a c y T e s t , and M organ*s M e n ta l T e s t .
Upon a n a l y s i s
of th e t e s t r e s u l t s ,
t h e s e a u t h o r s fo u n d t h a t t h e B i n e t was t h e o n l y t e s t w h ic h g a v e a w id e d i s t r i b u t i o n
o f s c o r e s and
on w h ic h a l l s u b j e c t s w e r e a b l e t o o b t a i n a d e f i n i t e n u m er ica l s c o r e .
On e v e r y o t h e r t e s t a t l e a s t t h r e e
p a t i e n t s w ere u n a b le t o o b ta in an y s c o r e * One o f t h e m o st i n t e r e s t i n g a s p e c t s o f t h i s co n cern s th e c o n c e p t o f d e la y e d d e v e lo p m e n t.
stu d y I t was
n o t e d t h a t t h e a v e r a g e I .Q * o f s u b j e c t s b e l o w f i f t e e n y e a r s o f a g e ( N * 5 ) w as 5 1 w h e r e a s t h e mean f o r t h o s e above f i f t e e n
years
(N « 6 ) was 7 9 .
The a u t h o r s u s e
t h i s f i n d i n g in su p p o rt o f t h e i r b e l i e f t h a t th e m e n ta l d e v e lo p m en t o f th e b r a i n - i n j u r e d c o n t i n u e t o a l a t e r a g e th a n o r d in a r y fe e b le -m in d e d
c h ild
r,may
i s t h e c a s e w ith
s u b j e c t s and w i t h t h e a v e r a g e
n o r m a l su b j e c t U s in g a s i m i l a r p o p u l a t i o n and a l s o e m p l o y i n g t h e S t a n f o r d - B i n e t ( 1 9 5 7 L ) , S a r a s o n and S a r a s o n { 3 1 ) fou n d t h a t
in t h o s e
i n s t a n c e s w h er e t h e s u b j e c t
19 e x p e r i e n c e d d i f f i c u l t y i n t h e d r a w in g o f t h e diam ond c a l l e d
f o r in th e S t a n f o r d - B in e t ,
e le c tr o e n c e p h a lo g r a p h ic rec o rd s in d ic a te d d e f i n i t e c o r t i c a l p a t h o l o g y and R o r s c h a c h p e r f o r m a n c e p o i n t e d in th e d i r e c t i o n
o f an flo r g a n i c r e c o r d 11 •
T hey
c o n c l u d e t h a t marked i n a d e q u a c y on v i s u o - m o t o r t a s k s i s a s s o c ia t e d w ith c o r t i c a l d y s f u n c t io n . S u ch a t r e n d i s a l s o
in d ic a te d
H o a k l e y and F r a z e u r ( 1 8 ) ,
in th e s tu d y b y
H ere, t o o , th e p erfo rm a n ces
o f b r a i n - i n j u r e d and n o n - b r a i n - i n j u r e d d e f e c t i v e c h ild r e n
on t h e 1 9 3 7 r e v i s i o n
Form L , ( 4 0 ) w ere c o m p a r e d . r e v e a le d a s t a t i s t i c a l l y
o f th e S ta n fo r d -B in e t,
The o n l y i t e m w h ic h
s ig n if ic a n t d iffe r e n c e
b e t w e e n t h e tw o g r o u p s was t h a t o f t h e diamond d r a w in g , U s i n g t h e G ra c e A r t h u r P e r f o r m a n c e S c a l e
(1)
in
a s i m i l a r p r o c e d u r e , F r a z e u r and H o a k le y ( V ) fo u n d t h a t , f o l l o w i n g an e q u a t i n g
o f g r o u p s on t h e b a s i s
o f t o t a l age s c o r e , no s t a t i s t i c a l l y s ig n if ic a n t d i f f e r e n c e s b e t w e e n b r a i n - i n j u r e d and n o n - b r a i n in ju re d
retard ed
c h ild r e n c o u ld b e f o u n d ,
-H u m o ro u s s t u d i e s
in v o lv in g s i m i l a r e x p e r im e n ta l
d e sig n s but u t i l i z i n g
l e 3 s p o p u la r t e s t i n g
in s tr u m e n ts have been u n d e r ta k e n .
A lm o s t i n v a r i a b l y
th e r e s u l t s f a i l t o r e v e a l d i f f e r e n c e s betw een t h e s e
20 c lin ic a l groups.
Sum m aries o f t h e s e s t u d i e s a r e t o
h e fo u n d i n r e c e n t w o rk s b y W a l l i n ( 4 8 ) and S a r a s o n ( 3 0 ) . M ost r e c e n t h a s b e e n t h e a t t e m p t t o u s e t e a t s
of
fa cto r v a lid ity fo r c lin ic a l d iffe r e n tia tio n .
A
s t u d y b y C a s s e l and D a n en h o w er ( 5 )
in v o lv e d th e u se
o f t h e P r im a r y M e n ta l A b i l i t i e s S c a l e , A g e s 5 - 6
(46).
A lth o u g h t h e s e a u th o r s o v e r lo o k t h e n e c e s s i t y f o r a p p ly in g s t a t i s t i c a l m easures in d e te r m in in g th e sig n ific a n c e
of d iffe r e n c e s,
i t w o u ld a p p e a r fro m
t h e i r c h a r t s t h a t e x o g e n o u s d e f e c t i v e s p e r fo r m on a s i g n i f i c a n t l y lo w e r l e v e l
i n t h e m o to r and s p a c e
a r e a a . th a n _ e n d o g e n o u s . d e f e c t i v e s . In a d d i t i o n
to th e u se o f v a r io u s t e s t i n g
in s tr u m e n ts in t h i s a r e a , t h e r e have b een a tte m p ts to r e la te
i n t r a - t e s t p a t t e r n s su ch as s c a t t e r
a n a l y s i s t o t h e p r o b le m o f c l i n i c a l d i f f e r e n t i a t i o n . The u s e
of s c a tte r a n a ly sis
in c l i n i c a l d i a g n o s i s
a p p e a r s t o h a v e f a s c i n a t e d p s y c h o c l i n i c i a n s w i t h an i n t e n s i t y c o m p le t e ly ou t o f k e e p in g w it h th e r e l a t i v e l y n e g a t i v e r e s u l t s f o r t h c o m i n g fr o m s t u d i e s i n w h ic h e f f o r t s h a v e b e e n made t o a c h i e v e an ad eq u ate e q u a tin g o f g r o u p s . o f th e l i t e r a t u r e
on s c a t t e r
An e x t e n s i v e summary is
t o b e fo u n d i n an
a r t i c l e b y H a r r i s and S h a k o w ( 1 6 ) .
The t r e n d o f
t h e l i t e r a t u r e up t o t h e t i m e o f t h i s r e v i e w , a s w e l l
as fin d in g s
s in e © t h a t t i m e , a p p e a r s t o s u p p o r t
t h e c o n t e n t i o n t h a t , when g r o u p s a r e e q u a t e d f o r m en tal a g e , s i g n i f i c a n t d i f f e r e n c e s
in s c a t t e r
b etw een c l i n i c a l g ro u p s do n o t ap p ear*
J-U
CHAPTER I I I CRITIQUE I n r e f e r r i n g t o an o s t e n s i b l e i n t e l l e c t u a l d e f e c t in c h i l d r e n a s an exogenous d e f e c t , we a r e e n g a g i n g i n more t h a n t h e mere e x e r c i s e o f a c l a s s i f i c a t i o n b a s e d upon a s u p e r f i c i a l d e s c r i p t i o n o f b e h a v i o r a l phenomena.
A ctu ally ,
we a r e u t i l i z i n g h y p o t h e s e s w h ich h a v e e x t e n s i v e i m p l i c a t i o n s f o r b o t h p s y c h o c l i n i c i a n and p s y c h o b i o l o g i s t . |^ F o llo w i n g t r e n d s i n t h e more p o p u l a r l i t e r a t u r e r e l a t i n g t o ex o g e n o u s d e f e c t ,
t h e r e i s t he i m p l i c a t i o n t h a t t h e d e f e c t
of th e b r a i n - i n j u r e d c h i l d , w h ile g l o b a l l y analogous to th e endogenous d e f e c t i v e , i s q u a l i t a t i v e l y d i f f e r e n t in r e s p e c t s t h a t a r e i m p o r t a n t , f o r p rognosis.-.and r e t r a i n i n g .
The f e e l
i n g a p p e a r s t o be t h a t , a l t h o u g h t h e a p p l i c a t i o n o f suc h s p e c ia liz e d e d u c a tio n a l te c h n ic s i s a strenuous procedure, t h e p r o g n o s i s i s u s u a l l y more h o p e f u l and t h e r a p e u t i c b e n e f i t more e x t e n s i \ Somewhat l e s s e x p l i c i t l y , howeverx, one„_:U3—aJLao-^saymg^ t h a t a n e c e s s a r y and s u f f i c i e n t c o n d i t i o n f o r t h e b e h a v i o r anom aly e v i d e n c e d by t h e e x o g e n o u s d e f e c t i v e i s a l e s i o n o f the c e n t r a l n erv o u s sy stem ^
There i s e x p re s s e d , f u r t h e r ,
t h e i d e a t h a t c e n t r a l n e r v o u s s y s t e m i n j u r y , on a p h y s i o l o g i c a l c o n t i n u u m can b e e q u a t e d w i t h b e h a v i o r a l change on a p s y c h o lo g ic a l continuum .
I t i s perhaps h ere th a t the
23
p s y c h o b i o l o g i s t e n t e r s a s an e a g e r p a r t i c i p a n t f o r i m p l i c a t i o n s o f c l i n i c a l h y p o t h e s e s now, when s u f f i c i e n t l y e x t e n d e d , a p p e a r t o r e l a t e r a t h e r d i r e c t l y t o t h e g e n e r a l p r o b le m o f t h e r e l a t i o n s h i p b e tw e e n n e u r o p h y s i o l o g y and a m o la r l e v e l o f b e h a v i o r . Yin e f f e c t , t h e c o n s t r u c t s d e v e l o p e d by G o l d s t e i n i n r e s p o n s e t o t h e demands o f a c l i n i c a l s i t u a t i o n h a v e an i m p o r t a n t b e a r i n g upon p s y c h o b i o l o g i c a l i n v e s t i g a t i o n .
Thus,
t h e “r u l e s o f G o l d s t e i n ” p r e v i o u s l y su m m arize d , a r e r e p o r t e d as ap p ly in g r e g a r d le s s of the s i t e of th e le sio n *
It
f o l l o w s t h e n t h a t i n s o f a r a s t h e phenomena s t u d i e d by G oldstein a re concerned, the r a th e r s t r i k i n g h i s t o l o g i c a l
*
d i f f e r e n t i a t i o n of th e c e r e b r a l c o rte x i s i r r e l e v a n t to behavior.
The “h o l i s t i c ” o r i e n t a t i o n e v i d e n c e d by G o l d s t e i n
and a d a p t e d by W erner and S t r a u s s i n t h e i r w ork w i t h c h i l d r e n , would a p p e a r t o s t r i k e t h e p r e s e n t - d a y p s y c h o b i o l o g i s t ^ I r T ' m u c h t h e same way i t d i d G e r a r d ( 8 ) . I t r e m a i n s s a d l y t r u e t h a t m o st o f o u r p r e s e n t u n d e r s t a n d i n g o f mind would r e m a i n a s v a l i d and u s e f u l i f , f o r a l l we knew, t h e c r a n i u m w ere s t u f f e d w i t h c o t t o n w adding. . . . Somewhat more e x t r e m e t h a n t h i s h a s b e e n t h e o p i n i o n e x p r e s s e d by an a n a t o m i s t who c l a i m e d t h a t p s y c h o l o g i s t s th in k of th e b r a in a s having a l l the f i n e r s t r u c t u r e of a b o w l f u l o f p o r rid g e .-* '
^It for th is . i n : Hebb, John W i le y
h a s n o t b ee n p o s s i b l e t o s e c u r e t h e e x a c t s o u r c e I t i s t o be f o u n d , s i m i l a r l y l a c k i n g i n r e f e r e n c e , D.O. The O r g a n i z a t i o n o f B e h a v i o r . New Y ork: & S o n s , I n c . , 19 5 9 .
I t i s ev id en t th a t th e re is c o n sid erab le overlap b e t w e e n some p r o b l e m s o f p s y c h o l o g y and some p r o b le m s of n europhysiology.
Such o v e r l a p i s m o st a p p a r e n t when t h e
c l i n i c a l p sy c h o lo g ist concerns h im se lf w ith the d ia g n o s is and t r e a t m e n t o f t h e b r a i n - i n j u r e d o r g a n i s m .
I f the
r e s e a r c h of su c h a w o rk e r were l i m i t e d t o t h e d e v e l o p m e n t o f r u l e - o f - t h u m b axiom s -#or—the-^im prov9ment’-^f-HE,u ^ e ^ > f ^ thumfe--axl'Oms- f o r t h e im provem ent o f t h e r a p e u t i c t e c h n i c s , t h e e v a l u a t i o n o f h i s c o n t r i b u t i o n would be l i m i t e d t o t h e assessm en t of the dem onstrable t h e r a p e u tic g a i n s .
However,
b e c a u s e he a l s o I n t r o d u c e s h y p o t h e s e s h a v i n g i m p o r t a n t i m p l i c a t i o n s f o r t h e o r e t i c a l p s y c h o l o g y and n e u r o p h y s i o l o g y a more r i g o r o u s a p p r a i s a l o f h i s p r o c e d u r e s i s n e c e s s a r y . The s e t t i n g i n w h ic h t h e c l i n i c i a n s e c u r e s h i s date^ i s n o t a l w a y s c o n d u c iv e t o t h e d e v e l o p m e n t o f c o n c e p t s and h y p o t h e s e s c h a r a c t e r i z e d by t h e c o n s i s t e n c y and t e s t a b i l i t y r e q u ir e d of g e n u in ely s c i e n t i f i c c o n s t r u c t s .
In a d d i t i o n
th e i n t r o d u c t i o n of such c o n s t r u c t s m ight f a c i l i t a t e th e d e v e l o p m e n t o f more e f f i c i e n t d i a g n o s t i c and t h e r a p e u t i c tech n ics. s p e a k i n g , m o st o f t h e work c o n s i d e r e d In th e p re v io u s s e c tio n ^ h a s involved th e a p p l i c a t i o n of v a rio u s t e s t i n g p rocedures to groups of c h ild re n c l a s s i f i e d as b e l o n g i n g t o one o f two c l a s s i f i c a t i o n s , e x o g e n o u s or endogenous.
-
■
B-1
B e c a u se t h e m a jo r c o n c e r n a p p e a r s t o h a v e been
25
th e v a l i d a t i o n of th e t e s t i n g in stru m e n t the c l a s s i f i c a t i o n of a c h ild as to endogeneity or exogeneity has p receded, r a t h e r than fo llo w ed , t e s t a d m i n i s t r a t i o n . p u rp o ses, the value of the t e s t i n g
For c l i n i c a l
instrum ent is d e fin e d
i n t e r m s o f t h e e x t e n t t o w h ic h t h e p e r f o r m a n c e d i f f e r e n c e s w h ic h a p p e a r a s a r e s u l t o f i t s u s e c o i n c i d e w i t h t h e d i f f e r e n c e s im plied in th e o r i g i n a l c l a s s i f i c a t i o n o f th e ch ild ren .
In e v a l u a t i n g t h e s e s t u d i e s , t h e n , i t would
a p p e ar im p o r ta n t to c o n s i d e r c a r e f u l l y (1) th e c r i t e r i a used in e s t a b l i s h i n g th e p r e - t e s t c l a s s i f i c a t i o n of th e c h i l d and ( 2 ) t h e n a t u r e o f t h e t e s t i n g i n s t r u m e n t . E v alu a tio n of C r i t e r i a ,
W hile t h e r e a p p e a r s t o h e
f a i r a g r e e m e n t a s t o t h e e s s e n t i a l meaning- o f t h e t e r m s ex o g e n o u s and e n d o g e n o u s , t h e c r i t e r i a u s e d i n c l a s s i f y i n g a c h i l d a c c o r d i n g t o t h e f o rm o f d e f e c t v a r y c o n s i d e r a b l y * & s u r p r i s i n g l y l a r g e number o f s t u d i e s om it m e n tio n o f c r i t e r i a used in c l a s s i f y i n g the c h i l d ,
C a s s e l and
D ane nhow e r( 5 ) , i n t h e i r s t u d y o f p s y c h o l o g i c a l d i f f e r e n c e s b e t w e e n exog enous and en d o g e n o u s d e f e c t i v e s , d e s c r i b e t h e i r c r i t e r i a fo r d eterm in in g the presence of b r a i n - i n j u r y in t h e f o l l o w i n g m a nner:
w, , • o n l y t h o s e c h i l d r e n f o r whom
t h e e t i o l o g i c a l d i a g n o s i s was d e t e r m i n e d by t h e c l i n i c a l p s y c h o l o g i s t t o be r e a s o n a b l y c l e a r were c o n s i d e r e d . b a s i s f o r t h e ju dgm ent was a n a m n e s i s and p s y c h o l o g i c a l c lin ic a l e v a lu a tio n ,n
The
The c r i t e r i a u s e d by D o l l ^ i n d e t e r m i n i n g w h e t h e r a c h i l d s h a l l be c l a s s i f i e d a s en d o g e n o u s o r e xoge nous a r e ^ s tr ik in g ly sim ilar:
uOur c l a s s i f i c a t i o n s a r e made on t h e
b a s is of c l i n i c a l p sy c h o lo g ica l e v a lu a tio n s , u s u a lly w ith out b e n e f i t of s p e c if ic n e u r o lo g ic a l e v a lu a tio n s except as t h e s e may be p a r t o f t h e a v a i l a b l e h i s t o r y * ” I n t h e l i t e r a t u r e t h e r e a r e n u m e rous r e f e r e n c e s t o the c r i t e r i a
e s t a b l i s h e d by S t r a u s s ( 3 3 ) .
A ccording to t h i s
f o r m u l a t i o n , m e n t a l d e f e c t i n a c h i l d may be c o n s i d e r e d a s b e i n g o f e x o g e n o u s o r i g i n i f ( 1 ) t h e r e i s no e v i d e n c e o f m e n t a l d e f i c i e n c y i n t h e members o f t h e im m ed ia te f a m i l y , and (2) t h e r e i s h i s t o r y o f p r e n a t a l , n a t a l ,
or p o s t n a t a l
i n j u r y t o t h e b r a i n , e i t h e r o f a t r a u m a t i c n a t u r e or due t o an i n f l a m m a t o r y p r o c e s s , o r ( 3 ) t h e p r e s e n c e o f n e u r o lo g ic a l signs of a b ra in lesion* R e f e r e n c e t o t h e W e r n e r - S t r a u s s s t u d i e s , h o w e v e r, in d icate th a t,
in p r a c t i c e , c o n s id e r a b le l i b e r t y i s ta k e n
in the a p p l i c a t i o n of such c r i t e r i a .
I n s e l e c t i n g e xoge nous
c h i l d r e n f o r s t u d y , d e t e r m i n i n g t h a t an i n f l a m m a t o r y p r o c e s s e x i s t e d b e f o r e , d u r in g , or s h o r t l y a f t e r b i r t h i s u s u a l l y a c c o m p l i s h e d by means o f an e x a m i n a t i o n o f t h e h i s t o r y o f the c h ild .
In a d d i t i o n , S t r a u s s ,
i n more r e c e n t s t u d i e s ,
r e f e r s t o ws l i g h t n e u r o l o g i c a l s i g n s ” w h ich i n d i c a t e a o
P e r s o n a l co m m u n ic a tio n f r o m t h e a u t h o r .
27
brain le sio n . _JIhe~--iis©’ o f a c a s e - h i s t o r y t o d e m o n s t r a t e t h e p r o b a b l e
\^o
e x i s t e n c e o f n e u r o p a t h o l o g y ^ w o u l d a p p e a r t o 'h a v e c e r t a i n disadvantages.
P a r t i c u l a r l y i f th e anam nestic d a ta are
d e r iv e d from t h e p a r e n t of a c h i l d ,
th ere is freq u en tly
good r e a s o n f o r d o u b t i n g t h e d e p e n d a b i l i t y o f t h e m a t e r i a l . F o r e x a m p le , i f t h e m o th e r o f a d e f e c t i v e c h i l d r e p o r t s a d i f f i c u l t and p r o l o n g e d l a b o r , t o w h a t e x t e n t i s t h e clin ician ju stifie d
i n a s s u m in g a c a u s a l n e x u s ?
A long t h e
same l i n e s , w h at d o e s t h e i n f o r m a n t mean by " d i f f i c u l t la b o r"?
,
1
/v -e ^ . J r J & L
c-
cv A*
c l 6* — A
- 4 e v i a t i o n -is r e l a t e d , t o i t . A ctu ally , S trau ss,
-
in h i s r e c e n t work(35) has
f a i l e d t o show t h a t t h e c r i t e r i a employed t o e s t a b l i s h t h e exogenous o r i g i n of m e n t a l d e f i c i e n c y a r e n o t j u s t a s c h a r a c t e r i s t i c o f t h e g r o u p he d e s c r i b e s a s e n d o g e n o u s .
I t i s q u e s t i o n a b l e i f an o b s e r v e d s i m i l a r i t y i n b e h a v i o r o f a d e f e c t i v e c h i l d and t h a t o f s.ome b r a i n - I n j u r e d a d u l t s i s s u f f i c i e n t b a s i s f o r c o n c l u d i n g t h a t su c h ^exogenous f u n c t i o n i n g ” i s an e x t e n s i o n o f b r a i n - i n j u r y •
I t s h o u l d be
n o t e d t h a t s t u d i e s o f b r a i n - i n j u r e d a d u l t s h a v e come f ro m i n d i v i d u a l s whose d e v e l o p m e n t and f u n c t i o n i n g w ere n o r m a l u n t i l a w e l l - d e f i n e d c e n t r a l n e r v o u s s y s t e m l e s i o n was sustained*
Such f i n d i n g s m ust be d i s t i n g u i s h e d from t h o s e
c a s e s i n w h ic h r e t a r d a t i o n h a s b e e n e v i d e n t fro m b i r t h . j\The s t u d i e s c o n s i d e r e d h e r e h a v e a t t e m p t e d t o c o n t r a s t t h e c o g n i t i v e and c o n a t i v e p a t t e r n s e v i d e n c e d by c h i l d r e n o f ex o g e n o u s d e f e c t w i t h t h o s e o f endoge nous o r fam ilial d efect.
However, i t i s i n t e r e s t i n g t o n o t e t h a t ,
a l t h o u g h e m p h a s i z i n g c r i t e r i a t o be u s e d i n s e l e c t i n g t h e exogenous p o p u l a t i o n , l i t t l e
c a r e h a s b ee n e v i d e n c e d i n
d ev e lo p in g c r i t e r i a f o r s e l e c t i n g the c o n t r a s tin g p o p u la tio n • W h ile i t was n o t e d t h a t s t u d i e s o f ex o g e n o u s p a t t e r n s o c c a s i o n a l l y lack ed w e ll - d e f in e d c r i t e r i a f o r s e l e c t i n g th e b r a i n - i n j u r e d c h i l d , th e om ission of such c r i t e r i a f o r s e l e c t i n g t h e endoge nous p o p u l a t i o n seems a l m o s t t o b e t h e rule*
By and l a r g e , t h e p a t t e r n a p p e a r s t o be one o f
s e l e c t i n g t h o s e c h i l d r e n who m e et ex o g e n o u s c r i t e r i a and so l a b e l i n g them*
Those who f a i l t o m eet t h e s t a n d a r d s a r e
t h e n te r m e d e n d o g e n o u s .
W hile p r e s e n t - d a y know ledge o f
30
g e n e t i c p r o c e s s e s l e a v e s much t o be d e s i r e d f o r an u n d e r s ta n d in g of the f a m i l i a l tra n s m is s io n of m ental d e f e c t , i t i s d o u b t f u l w h e t h e r t h e a b s e n c e o f even m i l d i n d i c a t i o n s o f n e u r o p a t h o l o g y can be t a k e n a s d i r e c t e v i d e n c e o f t h e o p eratio n of g e n e tic p ro c e sse s. The c r i t e r i a u s e d i n t h e Werner and S t r a u s s s t u d i e s f o r d e t e r m i n i n g t h a t t h e d e f e c t was o f an e n d o g e n o u s n a t u r e were ( 1 ) a b s e n c e o f s i g n i f i c a n t f a c t o r s i n t h e b i r t h and d e v e l o p m e n t a l h i s t o r y a c c o r d i n g t o t h e c a s e r e c o r d , and ( 2 ) a b s e n c e o f n e u r o l o g i c a l s i g n s . W h i l e , on o c c a s i o n , t h e r e i s m e n t i o n made t h a t t h e p r e s e n c e o f m e n t a l d e f i c i e n c y among members o f t h e im m e d ia te f a m i l y s e r v e s t o s u p p o r t t h e p o s s i b i l i t y o f e n d o g e n e i t y , none o f t h e s t u d i e s i n d i c a t e s t h a t s u c h a c r i t e r i o n h a s been used in s e l e c t i n g th e p o p u latio n *
A
s t u d y i n w h ic h t h i s h a s b e e n made e x p l i c i t i s t h e one by S a r a s o n and S a r a s o n ( 3 1 ) .
In s e l e c t i n g t h e i r p o p u la tio n
f o r s t u d y , t h e c a s e s w ere d i s t r i b u t e d a c c o r d i n g t o f a m i l i e s as fo llo w s: six cases,
One f a m i l y w i t h s e v e n c a s e s , one f a m i l y w i t h one f a m i l y w i t h t h r e e c a s e s , and t e n f a m i l i e s
w i t h two c a s e s .
However, t h i s was a s t u d y o f endo g e n o u s
d e f e c t only, although a s i g n i f i c a n t p ro p o rtio n of cases w i t h i n t h i s g r o u p gave s o - ^ c a l l e d t e s t e v i d e n c e o f o r g a n i c damage • A ctu ally ,
i t a p p e a r s t o be q u e s t i o n a b l e w h e t h e r
31
c r i t e r i a can b e f o u n d by w h ic h f a m i l i a l t r a n s m i s s i o n can be made t h e b a s i s f o r c l a s s i f i c a t i o n .
The f a c t t h a t many
h e r e d i t a r y d e f e c t s c a n n o t be r e c o g n i z e d when t h e c h i l d i s b o r n b u t become a p p a r e n t o n l y a f t e r s e v e r a l y e a r s c o m p lic ate s the d i f f e r e n t i a t i o n c o n s id e r a b ly .
In s u c h a
c a s e t h e r e i s , o s t e n s i b l y an u n e v e n t f u l b i r t h and e a r l y developm ental h i s t o r y w ith only subsequent i n d i c a t i o n of a m e n t i a when one r e l i e s h e a v i l y upon d a t a made a v a i l a b l e in th e case h i s t o r y .
Such l a t e m a n i f e s t a t i o n o f r e t a r d a
tio n i s probably f r e q u e n tly i n t e r p r e t e d as having a t r a u m a tic or inflam m atory b a s i s .
R elevant to t h i s p o in t,
P e n r o s e ( 2 8 ) c o n t e n d s t h a t 90$ o f a l l m e n t a l d e f e c t i v e s appear norm al a t b i r t h .
T his appears to c o n t r a s t r a th e r
s h a r p l y w i t h t h e view o f G e s e l l ( 9 ) who c o n t e n d s t h a t t h e i n f a n t * s i n t e l l i g e n c e can b e d i a g n o s e d w i t h r e l a t i v e a c c u r a c y a t b i r t h o r w i t h i n a few m onths t h e r e a f t e r , u s i n g sta n d a rd iz e d behavior o b s e rv a tio n s . th is,
In c o n ju n c tio n w ith
i t s h o u l d be n o t e d t h a t a t s u c h an e a r l y a g e t h e
b e h a v i o r w h ic h I s i m p o r t a n t t o t h e e x a m i n a t i o n c o n s i s t s m a i n l y o f m otor i t e m s .
Such i t e m s do n o t c o r r e l a t e w e l l
w i t h t h o s e o f a more a b s t r a c t n a t u r e w h ic h a p p e a r t o be i m p o r t a n t com ponents i n i n t e l l i g e n c e t e s t s f o r o l d e r c h i l d r e n o r even w h ic h a p p e a r f u n d a m e n t a l t o s c h o o l adjustm ent.
I n f a c t i t would a p p e a r t h a t such t e s t i t e m s
n o t o n l y show a poor c o r r e l a t i o n w i t h more a b s t r a c t i t e m s
32
b u t a l s o w i t h o t h e r m o to r ite m s* e . g . , t h e r e i s c o n s i d e r a b l e s p e c i f i c i t y i n t h e r e a l m o f m o to r b e h a v i o r . Even i n t h o s e i n s t a n c e s w here im p a ir m e n t h a s n o t become m a n i f e s t u n t i l some a c c i d e n t o r d i s e a s e p r o c e s s h a s o cc u rred , th e re i s / ^ t i l l c o n s id e ra b le q u estio n as to t h e j u s t i f i c a t i o n f o r r e g a r d in g th e d e f e c t t o be exogenous. I f , as W allin(48) has in d ic a te d ,
tfI t I s g e n e r a l l y c o n c e d e d
t h a t n erv o u s system s burdened w ith n e u r o p a th ic h e r e d i t y a r e l e s s r e s i s t a n t and more s u s c e p t i b l e t o t h e r a v a g e s o f ex tra n eo u s n e r v e - d e s t r u c t i v e f o r c e s than a re those of n o r m a l h e r e d i t a r y p o t e n t i a l s 1*, i t
i s p o s s i b l e t h a t i n many
in s t a n c e s of s o - c a l l e d exogenous d e f e c t th e r e i s a c t u a l l y an en d o g e n o u s d e f e c t w i t h b r a i n - i n j u r y . In a d d i t i o n t o t h e p o s s i b i l i t y o f f a m i l i a l d e f e c t b e in g e r r o n e o u s ly diagnosed as exogenous,
i t a l s o seems
p o s s i b l e t h a t many c a s e s o f w h a t S t r a u s s would l a b e l endogenous a r e ,
In e f f e c t ,
exoge nous*
Recent in fo rm a tio n
re g a rd in g th e p re v a le n c e of c e r e b r a l anoxia in n e o n a te s p r o v i d e s b a s i s f o r c r i t i c a l l y e x a m i n i n g even t h o s e h i s t o r i e s w h ic h a p p e a r t o be l e a s t s u s p i c i o u s f ro m t h e .sta n d p o in t of e a r ly p o s tn a ta l d i f f i c u l t y .
Lund(25), f o r
ex a m p le , c o n t e n d s t h a t some 25$ o f n e o n a t e s s u f f e r f ro m some d e g r e e o f a s p h y x i a . W ith w h a t seemed t o be i n s u r m o u n t a b l e p r o b le m s in e s t a b l i s h i n g c r i t e r i a f o r d i f f e r e n t i a t i n g endog enous fro m
33
ex o g e n o u s d e f e c t i v e s , one m i g h t a s k how i t
is th a t s ig n i f i
c a n t b e h a v i o r a l d i f f e r e n c e s w e r e shown by W erner and S t r a u s s a s th e r e s u l t of th e a p p l i c a t i o n of t h e i r s p e c i a l i z e d exam ination t e c h n i c s . I f , because of d i f f i c u l t y in d i f f e r e n t i a t i n g the t y p e s , t h e ex ogenous g r o u p c o n t a i n e d many c h i l d r e n whose d e f e c t w ere endo g e n o u s i n n a t u r e a n d , s i m i l a r l y , t h e g r o u p t o b e c l a s s i f i e d a s endo g e n o u s h a d many c h i l d r e n o f ex o g e n o u s d e f e c t i n c l u d e d , i t
should fo llo w t h a t th e
b e h a v i o r a l d i f f e r e n c e s b e t w e e n th e two g r o u p s s h o u l d be m i n i m a l and any s i n g l e c l i n i c a l c h a r a c t e r i s t i c show m axim al o v e r l a p .
T h i s , h o w e v e r , h a s n o t b ee n t h e c a s e .
T h e r e i s e v i d e n c e t h a t a w e l l - d e f i n e d ex o g e n o u s syndrome e x i s t s and t h a t , w h i l e t h e r e i s o v e r l a p i n t h e s p e c i f i c I
symptoms o f t h e syndrom e, i t
is su ffic ie n tly re s tric te d
to be of c l i n i c a l v alu e. A ctu ally ,
in s e l e c t i n g th e p o p u l a t i o n which
s u b s e q u e n t l y w i l l be l a b e l e d e x o g e n o u s , t h e r e i s some q u e s t i o n a s t o w h e t h e r t h e s e l e c t i o n h a s b e e n made on t h e b a s is of the c r i t e r i a
s e t f o r t h o r on t h e b a s i s o f
b e h a v i o r a l c h a r a c t e r i s t i c s shown by t h e c h i l d w h ic h r e s e m b l e f e a t u r e s o f t h e b r a i n - i n j u r e d a d u l t d e s c r i b e d by G -oldstein.
I f t h i s proves to be the c a se,
in e f f e c t w hat
i s b e i n g done i n v o l v e s l i t t l e more th a n making a s u p e r f i c i a l c l i n i c a l o b se rv a tio n as to g ro ss b e h a v io ra l f e a t u r e s
34
and t h e n p r o c e e d i n g t o c h e c k s u c h o b s e r v a t i o n by means o f a n o t h e r t e c h n i c w h i c h t a p s t h e v e r y same f e a t u r e s i n v o l v e d i n the previous o b se rv a tio n .
The f a c t t h a t an i m p r e s s i v e
c o r r e l a t i o n i s d e r i v e d m ig h t w e l l be i n t e r p r e t e d a s e s t a b l i s h i n g a r e l i a b i l i t y o f r a t i n g s r a t h e r t h a n any c a u s a l — n exu s#
A l t h o u g h t h i s w i l l be c o n s i d e r e d a g a i n s h o r t l y f r o m a n o t h e r p o i n t o f v ie w , t h e r e a p p e a r s t o be s e r i o u s q u e s t i o n a s t o t h e v a l u e o f t h e e x o g e n o u s - - endogeno us dichotom y.
B e ca use o f e q u i v o c a t i o n i n v o l v e d i n e s t a b l i s h
i n g c r i t e r i a f o r i d e n t i f y i n g a c l a s s o f phenomena w h ich •pr-uportedly ste m f ro m b r a i n - i n j u r y , t h e r e i s , a t b e s t , o n l y t h e y a g u e s t i n d i c a t i o n o f w h at t e s t s v a l i d a t e d a g a i n s t such c r i t e r i a a r e a c t u a l l y ta p p in g .
In a d d i t i o n ,
s u c h a d i c h o t o m y i m p l i e s t h a t lo w e r e d n e u r o p h y s i o l o g i c a l e f f i c i e n c y r e l a t e d t o n e r v e c e l l i n j u r y i s d i f f e r e n t f ro m t h a t r e s u l t i n g f ro m n e u r o l o g i c a l a g e n e s i s , an i m p l i c a t i o n n o t y e t s u p p o r t e d by c l i n i c a l n e u r o l o g y .
One w o n d ers w hat
i s g a in e d , c l i n i c a l l y or t h e o r e t i c a l l y , a t - t h i s
s t a g e , by
t h i n k i n g o f a d e f e c t r e s u l t i n g f r o m o r g a n i c b r a i n damage. I f th e d i f f e r e n c e im plied in th e d i s t i n c t i o n a c t u a l l y makes n o d i f f e r e n c e , t h e r e r e m a i n s , a t t h e p r e s e n t t i m e , little
e l s e b u t t o view t h e s o - c a l l e d e xoge nous d e f e c t a s
an I n s t a n c e o f r e t a r d a t i o n w i t h an acco m p a n y in g b e h a v i o r syndrome o f a p a r t i c u l a r v a r i e t y .
/ \ ^ V E v a l u a t i o n o f t h e T e s t i n g I n s t r u m e n t ./ The c l i n i c a l s tu d ie s thus f a r considered appear to dem onstrate unanim ity on a t l e a s t one p o i n t :
Such g l o b a l m e a s u r e s of i n t e l l i +-[u
^ t
\i'e c K s ’ et-
(Ivue. eic .
g e n c e a s t h e S t a n f o r d -B in e 1 ^ 'a n d —G^aco—A r t h u r a r e u n s u i t e d t o t h e t a s k of g a i n i n g a s u f f i c i e n t u n d e r s t a n d i n g o f t h e b r a i n - i n j u r e d c h i l d to allow e i t h e r f o r the a p p l i c a t i o n o f p r o m i s i n g r e m e d i a l t e c h n i c s or t h e e s t a b l i s h m e n t of c l a s s c h a r a c t e r i s t i c s n o t s h a r e d by c h i l d r e n o f c o m p a r a b le d e f e c t b u t o f endo g e n o u s e t i o l o g y .
I n e f f e c t t h e u s e of
such procedures f a i l s to c o rro b o ra te th e c o n te n tio n th a t b e h a v i o r a l d i f f e r e n c e s b e tw e e n one e x o g e n o u s d e f e c t i v e and a n o t h e r i s l e s s t h a n t h a t w h ic h e x i s t s b e tw e e n any end o g e n o u s d e f e c t i v e and an y e x o g e n o u s d e f e c t i v e .
But,
h a v i n g e v i d e n c e f r o m o t h e r s o u r c e s w h ic h a p p e a r s t o s u p p o r t th e ir p o stu lated d is tin c tio n ,
t h e f e e l i n g a p p e a r s t o h av e
b e e n t h a t s u c h t e c h n i c s * can be d i s p e n s e d w i t h .
I t is d Uo
u n f o r t u n a t e , how ever, t h a t th e t e c h n i c s s u b s t i t u t e d a re l a c k i n g even- t h e —mod-i-cum—o f p r e c i s i o n and o b j e c t i v i t y , o f —th o s t x ^ d h s c a r d e d .
A l t h o u g h G o l d s t e i n , Y/erner and S t r a u s s , Vv
A
^
and o t h e r w o r k e r s o f s i m i l a r o r i e n t a t i o n h a v e d e v e l o p e d .
,
p r e th o r a - ^ o f, p s y c h o l o g i c a l t e c h n i c s f o r u s e w i t h t h e b r a i n i n j u r e d o r g a n i s m , t h e r e i s no i n d i c a t i o n t h a t an y o f them hs■"a n c h o r e d —i n —even - a —s e m b la n c e ^ o f some- s t a n d a r d i z a t i o n -procedure or t h a t t h e r e I s s u f f i c i e n t o p p o r tu n ity f o r q u a n t i f i c a t i o n o r o b j e c t i v i t y and c o n s i s t e n c y i n
a d m i n i s t r a t i o n t o j u s t i f y p r o g n o s t i c a t i o n . {^What seems to. h a v e been overlo o k ed i s th e f a c t t h a t any t e s t sco re i s a f u n c t i o n o f ( 1 ) t h e p e r s o n * s a b i l i t y i n t h e a r e a t a p p e d by t h e t e s t , and ( 2 ) t h e e x t e n t t o w h ic h t h e ' t e s t t a p s t h a t a r e a ( 1 4 ) . The f a c t t h a t p e r f o r m a n c e u p o n " S t a n i - o r d - B i n e t - o r ^bhe^i*a'C'e~ftrthuh d o e s n o t s u p p o r t an assumed d i c h o t o m o u s c l a s s i f i c a t i o n i s n o t n e c e s s a r i l y an i n d i c t m e n t o f e x t e n s i v e q u a n t i f i c a t i o n in t e s t c o n s tr u c tio n , but r a t h e r ,
eith er
( 1 ) r e f u t a t i o n o f s u c h a c l a s s i f i c a t i o n , o r ( 2 ) an i n d i c a t i o n t h a t t h e p s y c h o l o g i c a l a r e a s t a p p e d by th e i n s t r u m e n t do n o t u n d e r g o change a s a r e s u l t o f b r a i n - i n j u r y and t h a t a r e a s t h a t do u n d e r g o d e t e r i o r a t i o n a r e n o t t a p p e d by t h e i n s t r u m e n t , or (3) s u g g e s tiv e of the p o s s i b i l i t y t h a t an e r r o r i s made by i n f e r r i n g a u n i t a r y a b i l i t y f r o m m e r e l y o b s e r v i n g t h e p e r f o r m a n c e o f some t a s k .
I n s t e a d , i t ca n
be s u g g e s t e d t h a t a d e q u a t e p e r f o r m a n c e o f t h e same t a s k c a n be a c h i e v e d on d i f f e r e n t o c c a s i o n s by ' tfu s i n g _tt~ d i f f e r e n t ab ilities. We p r e v i o u s l y h a v e c o n s i d e r e d t h e f i r s t p o s s i b i l i t y and s h a l l do so a g a i n s h o r t l y .
S upport f o r the second i s
v d e p e n d e n t upon i n f o r m a t i o n a s t o w h a t such t e s t s a c t u a l l y m easure.
McNemar(26) p e r f o r m e d a f a c t o r a n a l y s i s o f t h e
1937 r e v i s i o n o f t h e S t a n f o r d - B i n e t b a s e d upon i t e m i n t e r c o r r e l a t i o n s from s c o r e s of th e s t a n d a r d i z a t i o n g ro u p . He c o n c l u d e d t h a t t h e r e i s j u s t one common f a c t o r a t e a c h
37
l e v e l stu d ied *
J o n e s ( 2 0 ) h a s c r i t i c i z e d McUemar’ s f a i l u r e
t o r o t a t e t h e c e n t r o i d a x e s and h a s a p p l i e d r o t a t i o n a l p r o c e d u r e s t o t h e c e n t r o i d a x e s f o u n d by McNemar a t age l e v e l s 7 , 9 , 1 1 , and 1 3 . 1.
He c o n c l u d e s :
The s e p a r a t e i t e m s i n t h i s t e s t do n o t
measure
a u n i t a r y g e n e r a l f a c t o r b u t in volv e group f a c t o r s , each c o n t r i b u t i n g t o th e t o t a l sc o re or I .Q . 2. of the
The b a t t e r y o f i t e m s i n c l u d e d a t one age l e v e l
t e s t i s n o t f a c t o r i a l l y i d e n t i c a l w ith the
b attery
of item s a t o th e r age l e v e l s . T h u s , i t w ould a p p e a r t h a t t h e r e i s much n e e d f o r c a u tio n in i n t e r p r e t i n g th e I.Q .
I t i s e v id e n t t h a t the
I . Q . on t h e S t a n f o r d - B i n e t , a t l e a s t ,
rep resen ts a
c o m p o s i t e s c o r e c o n s i s t i n g o f m e a s u r e s of v a r i o u s a b i l i t i e s , sp a ce, r e a s o n in g , m otor, e t c .
C o n s e q u e n t l y , knowing t h a t
two m e n t a l a g e s a r e i d e n t i c a l ,
o r e v e n two I.Q,* s c o r e s ,
one i s n o t j u s t i f i e d of b a s ic a b i l i t i e s
i n a s s u m in g c o m p a r a b l e e q u i v a l e n c e
involved in th e p erform ance.
To
u t i l i z e th e S ta n f o rd - B in e t only f o r a s i n g l e , t o t a l sco re ( M .A .) , a s a p p e a r s t o be t h e g e n e r a l r u l e ,
i s to overlook
i m p o r t a n t m a t e r i a l r e l a t i n g t o co m p o n e n t a b i l i t i e s . B e c a u se t h e i t e m s a r e u s u a l l y s c o r e d on a p a s s - f a i l b a s i s , t h e r e i s c o n s i d e r a b l e l i m i t a t i o n in t h e v a r i a t i o n t h a t can be d e m o n s t r a t e d in a n y s i n g l e a b i l i t y a r e a .
N evertheless,
a c o n t e n t a n a l y s i s b a s e d upon a f a c t o r a n a l y s i s r a t h e r t h a n
38
t h e a p r i o r i m e th o d s h e r e t o f o r e u s e d , m ig h t w e l l r e v e a l s i g n i f i c a n t d i f f e r e n c e s i n p e r f o r m a n c e upon p a r t i c u l a r i t e m s by a b r a i n - i n j u r e d g r o u p .
Were v a r i o u s i t e m s w e i g h t e d w i t h
r e s p e c t to t h e i r lo ad in g in a p a r t i c u l a r f a c t o r or f a c t o r s , th e n even t h e com posite p i c t u r e m ight r e v e a l im p o r ta n t trends* I n c o n s i d e r i n g t h e t h i r d manner o f a c c o u n t i n g f o r th e f a i l u r e of Stanfordr-B inet t e s t r e s u l t s to su p p o rt th e p o s t u l a t e d d ic h o to m y f o r m e n t a l d e f e c t , on© m i g h t a s k w hat i t i s t h a t t h e " q u a l i t i a t i v e t e s t s ” u s e d by e x o g e n e i t y advocates are a c t u a l l y ta p p in g .
By f o r e g o i n g t h e p r e c i s i o n
made a v a i l a b l e by v a r i o u s m e th o d s o f q u a n t i f i c a t i o n , t h e r e is l i t t l e
l e f t b u t t o h y p o t h e s i z e o r i n f e r some f u n c t i o n a s
a r e s u l t o f, a t b e s t , s u p e r f i c i a l o b se rv a tio n of the behavior o f t h e p a t i e n t i n t h e c o u r s e o f h i s p e r f o r m a n c e upo n t h e problem .
Thus, becau se o f d i f f i c u l t y in v o lv e d in h a n d l in g
p a r t i c u l a r item s of a t e s t , G o ld s te in i s i n f e r r i n g t h a t t h e r e h a s b e e n an i m p a i r m e n t o f a p o s t u l a t e d a b i l i t y or fu n c tio n he c a l l s " a b s tr a c t io n ” .
However, s e v e r a l
q u e s t i o n s m i g h t be a s k e d r e g a r d i n g such a p r o c e d u r e : ( 1 ) Does " a b s t r a c t i o n ” h a v e a c t u a l e x i s t e n c e a s an a b i l i t y o r d o e s i t r e p r e s e n t a way o f co m p re h e n d in g b e h a v i o r a l phenomena?-
(2)
Is " a b s t r a c t i o n ” a u n i t a r y a b i l i t y or i s
i t t h e end r e s u l t o f t h e i n t e r a c t i o n o f s e v e r a l more f u n d a m e n t a l p e r a m e t e r s of a b i l i t y ?
39
A c t u a l l y , t h e s e a r e p r o b le m s t h a t a r e n o t p e c u l i a r to th e approach of G o ld s te in b u t a r e fundam ental to the very n a tu re of sc ie n c e .
I t is im portant to d i f f e r e n t i a t e
b e t w e e n n a t u r a l phenomena and t h e c o m p r e h e n s 1on o f n a t u r a l phenomena.
The a p p r o a c h o f s c i e n c e i n v o l v e s t h e c o m p re
h e n s i o n o f a l i m i t l e s s number o f phenomena by t h e p o s t u l a t i o n and u s e o f a l i m i t e d number o f c o n s t r u c t s . But i t i s i m p o r t a n t t o r e c o g n i z e t h a t t h e s u b s i s t e n c e o f a c o n s t r u c t can a t n o t i m e be t a k e n a s e v i d e n c e f o r t h e e x is te n c e of i t s r e f e r e n t .
R a t h e r , we h a v e imposed upon
n a t u r a l phenomena our own o r g a n i z a t i o n .
One, t h e n , c a n n o t
j u s t i f y th e use of a c o n s t r u c t or h y p o th e s is in term s of its
^tru th fu ln ess”•
In stead ,
i t m u st be e v a l u a t e d i n
t e r m s o f w h e t h e r or n o t t h e c o n s t r u c t s a r e a s few and f u n d a m e n t a l a s p o s s i b l e , i n o r d e r t h a t a maximum number o f phenomena may be I n c l u d e d u n d e r a minimum number of explanatory p r in c ip le s .
In o th e r w ords,
i t is necessary
t h a t a c o n s t r u c t have few er d e g re e s o f freedom than th e phenomenon t o w h ic h i t r e f e r s , f o r i t th a t p red ictio n is p o ssib le.
i s o n l y i n t h i s way
A pplying t h i s t o th e a re a
o f b e h a v i o r , we f i n d a p p l i c a t i o n o f s u c h p r i n c i p l e s i n T h u rs to n e fs(45 ) sta te m e n t, I f a b i l i t i e s a r e t o be p o s t u l a t e d a s p r i m a r y c a u s e s of i n d i v i d u a l d i f f e r e n c e s in o v e r t accom plishm ent, then th e w id ely d i f f e r e n t achievem ents of in d iv id u a ls m ust be d e m o n s t r a b l e f u n c t i o n s o f a l i m i t e d number o f reference a b i l i t i e s .
40
In th e a r e a of b e h a v i o r ,
then,
i t m i g h t be o f
c o n s i d e r a b l e v a l u e t o t h i n k o f t h e v a r i e g a t e d phenomenon, b e h a v io r , in term s of c o n s t r u c t s , r e f e r e n c e a b i l i t i e s ,
the
u s e o f w h ic h w i l l p r o v i d e o p p o r t u n i t y f o r b e h a v i o r a l p r e d i c t i o n i n a r e l a t i v e l y l a r g e number o f o s t e n s i b l y variab le situ atio n s#
In c o n t r a s t w i t h t h i s a p p r o a c h one
w o n d e r s a b o u t t h e r a t i o n a l e of t h e s o - c a l l e d " h o l i s t i c ” approach#
To u n d e r s t a n d t h e " t o t a l o r g a n i s m ” , i t would
seem, i m p l i e s t h e u s e o f c o n s t r u c t s w h ich h a v e t h e same number o f d e g r e e s o f f r e e d o m a s t h e phenomenon t h e y a r e purported to ex p lain # But we h a v e s e e n t h a t G o l d s t e i n h a s , p o s t u l a t e d suc h a r e f e r e n c e a b i l i t y ,
in a sense,
"ab stractio n ”#
One
m ight th en a s k i f such a c o n s t r u c t s a t i s f i e s th e r e q u i r e ment o f h a v i n g f e w e r d e g r e e s o f f r e e d o m t h a n i t s r e f e r e n t . B e c a u s e o f t h e s e t t i n g i n w h ic h s u c h a c o n s t r u c t o r i g i n a t e d , t h e r e i s l i t t l e way o f k n o w in g .
In p r a c t i c e , t o s e c u r e
s u c h a c o n s t r u c t , one b e g i n s w i t h q u a n t i f i e d r e p r e s e n t a t i o n s o f p e r f o r m a n c e s i n a number o f a r e a s a n d , f r o m t h e r e , p r o c e e d s t o e s t a b l i s h t h e f e w e s t number o f v a r i a b l e s w hich can ac co u n t f o r v a r i a n c e e v i d e n t in th e e n t i r e m a t r i x . T his, e s s e n ti a ll y ,
i s the purpose of f a c t o r a n a l y s i s .
It
i s i n t e r e s t i n g to n o te t h a t the a p p l i c a t i o n of t h i s te c h n ic t o th e perform ance of norm al p e rs o n s , f a i l s
to e l i c i t the
" a b s t r a c t i o n ” f a c t o r p o s tu la te d by G o ld s te in (1 1 ,1 2 ,1 5 )• Nor i s i t a q u e s t i o n o f m e r e l y r e f e r r i n g t o t h e same
41
f u n c t i o n in a d i f f e r e n t manner.
I t i s p o s s i b l e , how ever, t h a t
i t i s n o t a f u n d a m e n t a l a b i l i t y b u t ca n b e a c c o u n t e d f o r i n t e r m s o f o t h e r more b a s i c f u n c t i o n s .
The f a c t , t h e n , t h a t
such a f u n c t i o n i s com prised of s u b - f u n c t i o n s r a i s e s s e v e r a l im portant is s u e s .
T h u s , g i v e n two i n d i v i d u a l s who
evidence a lo s s of th e " a b i l i t y ” to a b s t r a c t ,
i t is p o ssib le
t h a t s u c h a l o s s h a s come a b o u t i n a number o f w a y s .
F or
d i s t u r b a n c e o f any o f t h e s u b - f u n c t i o n s p o s s i b l y w i l l be e v i d e n c e d by c h a n g e s i n a b s t r a c t i o n .
There i s a l s o th e
p o s s i b i l i t y , now, t h a t a number o f o t h e r c o n d i t i o n s a r e s u f f i c i e n t f o r producing changes in p s y c h o lo g ic a l f u n c t i o n ing p r e v i o u s l y r e l a t e d only t o th e se q u e la e of b r a i n - i n j u r y . S t r a u s s 1( 3 5 ) a d m i s s i o n t h a t f r e q u e n t l y endogenous d e f e c t i v e s show d i s t r a c t i b i l i t y and h y p e r a c t i v i t y r e l a t e d t o psychogenic f a c t o r s i s a case in p o i n t . A c tu a lly ,, the f a i l u r e to d e a l w ith adequately d efin e d re fe re n c e a b i l i t i e s i s n o t lim ite d to the c l i n i c a l situ atio n .
L a s h l e y 1s ( 2 3 ) ♦ e x p e r i m e n t a l d e v e lo p m e n t o f t h e
e q u i p o t e n t i a l i t y c o n c e p t may w e l l i n v o l v e a s i m i l a r e r r o r . Thus, in r e l a t i n g c e r e b r a l l e s i o n s to p s y c h o lo g ic a l changes, he f o u n d t h a t s u c h b e h a v i o r a s m a z e - l e a r n i n g o r maze r e t e n t i o n bore no r e l a t i o n to th e s i t e r a th e r to i t s
ex ten t.
of the l e s i o n , b u t
In i n t e r p r e t i n g such r e s u l t s ,
L a sh le y c o n c lu d ed t h a t v a r i o u s c o r t i c a l zones ( a p a r t from m o to r and s e n s o r y a r e a s ) showed e q u a l p s y c h o l o g i c a l
42
p o ten tial.
I t i s im p o rta n t t o n o t e , how ever, t h a t a lth o u g h
p r e c i s © m e a s u r e s w ere u s e d i n t h e d e t e r m i n a t i o n o f t h e s i t e o f t h e l e s i o n , s u c h was n o t t h e c a s e w i t h r e s p e c t t o d e v e l o p i n g u n i t a r y p s y c h o l o g i c a l a b i l i t i e s • y / The t a s k o f m a z e - l e a r n i n g w o u ld a p p e a r , on i n s p e c t i o n , t o be a t a s k t h a t f a c t o r i a l l y i s q u i t e c o m p le x .
T hus, p e r h a p s a good
d e a l o f v i s u a l i z a t i o n i s i n v o l v e d , p e r h a p s one or more o f t h e memory f a c t o r s ,
etc.
L e t u s assume t h a t t h e r e i s
l o c a l i z a t i o n of th e r e g i o n a l s o r t , b u t w ith in each re g io n t h e r e i s a p u n c tifo rm l o c a l i z a t i o n c o r r e s p o n d in g t o such irredu ceable fa c to rs .
The e x t i r p a t i o n o f c o r t i c a l t i s s u e
a t a g i v e n p o i n t may i n v o l v e t h e k n o c k i n g o u t o f a p o r t i o n o r a l l o f t h e f a c t o r w h ich s te m s f ro m t h e s i t e .
However,
i t i s p o s s i b l e t h a t t h e f a c t o r r e d u c t i o n may o n l y s l i g h t l y a f f e c t t h e end p e r f o r m a n c e of t h e m u l t i - f a c t o r t a s k . /^ T h e r e /
a r e i n d i c a t i o n s ( 1 5 ) t h a t t h e f a c t o r c o n t e n t o f a t e s t may change w ith d i f f i c u l t y l e v e l .
T h u s , a same t e s t may t a p
d i f f e r e n t a r e a s a t d i f f e r e n t tim e s , depending, a t l e a s t , upon t h e d i f f i c u l t y l e v e l .
F o r t h e p u r p o s e s o f our
d i s c u s s i o n h e r e ,/ w e m ight ex ten d t h i s t o th e c o n t e n t i o n th a t i t
i s p o s s i b l e t o a d e q u a t e l y p e r f o r m on a g i v e n t a s k
u s i n g somewhat d i f f e r e n t a b i l i t i e s .
T h u s, i n t h e L a s h l e y
stu d y , the re d u c tio n of a s in g le f a c t o r w i l l perhaps i n s i g n i f i c a n t l y a f f e c t the t o t a l .
The r e d u c t i o n o f an
a d d i t i o n a l f a c t o r , by e n l a r g i n g t h e e x t i r p a t i o n , m i g h t
p r o d u c e a somewhat g r e a t e r e f f e c t upon t o t a l p e r f o r m a n c e b e c a u s e we h a v e e l i m i n a t e d t h e us© o f a n o t h e r component a b i l i t y , and s o on*
A c tu a lly , th e n , as the e x tir p a tio n
becomes l a r g e r , t h e t a s k e f f i c i e n c y i s r e d u c e d , e r r o n e o u s l y p r e s e n t i n g a p i c t u r e o f e q u i p o t e n t i a l i t y w h i l e we h a v e , in e f f e c t , p u n ctifo rm l o c a l i z a t i o n e r e
i s a need to
r e p e a t t h e w o rk o f L a s h l e y i n an a t t e m p t t o r e - e x a m i n e t h e concept of e q u i p o t e n t i a l i t y .
The e v i d e n c e f r o m n e u r o
h i s t o l o g y p o i n t i n g to w a r d l o c a l i z a t i o n i s o v e r w h e lm in g .
A
c r u c i a l ex am ination of th e r e l a t i o n s h i p between n e u r o l o g i c a l a r e a and p s y c h o l o g i c a l f u n c t i o n i s d e p e n d e n t upon t h e developm ent of e m p i r i c a l l y d e f i n e d r e f e r e n c e a b i l i t i e s . E n c o u r a g i n g i n t h i s r e s p e c t h a s b ee n a summary o f w ork on f a c t o r a n a l y s i s o f a n i m a l b e h a v i o r by R o y c e ( 2 9 ) a s w e l l a s t h e f o l l o w i n g by L a s h l e y ( 2 4 ) i n h i s e v a l u a t i o n o f t h e f a c t o r a n a ly s is approach: I t i s d i f f i c u l t to d e sc rib e th ese v a ria b le s except i n t e r m s o f t h e t e s t s fro m which t h e y a r e d e r d v e d , f o r t h e y do n o t c o r r e s p o n d t o any f a m i l i a r c l a s s i f i c a t i o n o f f u n c t i o n s . They do seem, h o w e v e r , t o c o r r e s p o n d t o f u n c t i o n s w h ic h may be i n d e p e n d e n t l y l o s t a s a r e s u l t of lo c a liz e d b ra in in ju r y . Im portant f o r our d is c u s s io n h ere i s t h e p o s s i b i l i t y t h a t b r a x n - i n j u r y may i n v o l v e , n o t n e c e s s a r i l y a m a n i f e s t change i n t h e i n d i v i d u a l ' s p e r f o r m a n c e upon a m u l t i - f a c t o r t a s k b u t th e changes in r e f e r e n c e a b i l i t i e s w hich he b r i n g s t o th e s o l u t i o n of such a t a s k .
U sing s t a t i s t i c a l t e r m i n
o l o g y , one m i g h t s a y t h a t t h e r e c o u l d be a s i g n i f i c a n t
44
ch a n g e In t h e f a c t o r l o a d i n g s o f a t a s k a s p e r f o r m e d by a b ra in -in ju re d person.
P r e v i o u s l y , m e n t i o n was made o f
D o l l ! s s t a t e m e n t ( 6 ) t h a t t h e b r a i n - i n j u r e d c h i l d may c o n tin u e w i t h i n t e l l e c t u a l developm ent t o a l a t e r s t a t e t h a n i s t h e c a s e w i t h e i t h e r endogeno us d e f e c t i v e s or norm als.
I n k e e p i n g w i t h our a p p r o a c h h e r e , one m i g h t sa y
t h a t t h i s i s t o be e x p e c t e d and a c t u a l l y i n v o l v e s a l e a r n i n g p r o c e s s w hereb y t h e b r a i n - i h j u r e d c h i l d a t t e m p t s t o perform ta s k s w ith v a rio u s com binations of r e f e r e n c e a b i l i t i e s or f a c t o r s s t i l l a v a i l a b l e t o him . In t r y i n g t o d i s t i n g u i s h t h e b r a i n - i n j u r e d c h i l d , I t i s p r o b a b l y more m e a n i n g f u l t o s p e a k i n t e r m s o f s u c h ab ilities.
W ith t h i s ,
i t i s p o s s ib le to p r e d i c t the
p e r f o r m a n c e of a c h i l d i n a w ide a r e a o f s i t u a t i o n s p r o v i d i n g s o m e th in g i s known o f t h e f a c t o r demands o f t h e situ atio n .
In a d d i t i o n ,
a re forthcom ing.
im portant le ad s fo r re -e d u c a tio n
T h u s , t o s p e a k o f ,!s t i m u l u s - b o n d e d n e s s !f
and Tfd i s t r a c t i b i l i t y n a s b e i n g c h a r a c t e r i s t i c o f t h e o r g a n i c syndrome m i g h t w e l l be a c c u r a t e .
But h a v i n g
e s t a b l i s h e d su c h a common e l e m e n t , t h e r a p e u t i c p r o g ra m s a r e d e c i d e d l y l i m i t e d t o t h e r e d u c t i o n o f s u c h symptom ato lo g y .
In e f f e c t , when S t r a u s s (35) s p e a k s o f t h e
r e - e d u c a t i o n o f t h e b r a i n - i n j u r e d c h i l d , he i s r e f e r r i n g t o a s e r i e s o f p r o c e d u r e s employed f o r t h e p u r p o s e o f r e d u c i n g t h e s e v e r i t y o f s u c h a s p e c t s of t h e syndrome a s
45
d istra c tib ility ,
p e r s e v e r a t i o n , e t c * , r a t h e r than p ro v id in g
s u b s t i t u t e t e c h n i c s f o r th e s o l u t i o n of problem s.
The aim ^
o f t h i s s t u d y i n v o l v e s , u l t i m a t e l y , an e x p l o r a t i o n o f t h e la tte r p o ssib ility .
CHAPTER IV RESEARCH PLAN AND RATIONALE FOR THE PRESENT INVESTIGATION The p r e s e n t p l a n o f s t u d y h a s e v o l v e d o u t o f e a r l i e r
i
p e r s o n a l c o n c e r n w i t h t h e p r o b le m o f r e t r a i n i n g t h e b r a i n In ju red d e f e c t i v e
c h ild *
W h ile ,
in th e c o u r s e o f c l i n i c a l
p r a c t i c e , t h e r e a r e o c c a s i o n a l i n s t a n c e s In w h ic h a d i a g n o s i s o f e x o g e n o u s d e f e c t c a n b e made w i t h a minimum o f d o u b t , one f i n d s t h a t i n d i c a t i o n s a s t o t h e p s y c h o l o g i c a l m anagem ent o f t h e c a s e a r e n o t a s c l e a r l y e s t a b l i s h e d * thou gh i t
is
a lw a y s p o s s i b l e
Even
t o p r o c e e d w i t h an a t t e m p t t o
r e d u c e t h e s e v e r i t y o f t h e more s t r i k i n g a n o m a l i e s o f g r o s s b e h a v io r , th e u ltim a te b e n e f i t o f su ch a procedure i s q u e s tio n e d . tren d
t o be
W h i l e t h i s a p p e a r s t o b e t h e m ain t h e r a p e u t i c
in t h i s a r ea t o d a y , e . g . , a ttem p ted r e d u c tio n o f
stim u lu s-b o n d e d n e ss, p a t h o lo g ic a l f i x a t i o n , p e r s e v e r a tio n , / e t c * , now here i s e v id e n c e p r e s e n t e d th is
is p o ssib le
in d ic a tin g th a t e ith e r
o r t h a t , when a c h i e v e d , t h e u l t i m a t e
a d ju stm en t o f the c h ild
is
w ere p o s s i b l e t o a l l e v i a t e
th ereb y enhanced.
E ven i fr ±t~
such g r o s s m a n i f e s t a t i o n s ,
v a l u e o f s u c h an e f f o r t w o u ld a p p e a r a f u n c t i o n r e la tio n sh ip
th e
o f th e
t h a t s u c h s y m p t o m a t o lo g y b e a r s t o t h e a b i l i t y ,
a s p e c t o f th e syn drom e.
T hus, i f
d i f f e r e n c e b etw een c h ild r e n endogenous d e f e c t c o n s i s t s
t h e e s s e n t i a l and o n l y
o f e x o g e n o u s d e f e c t and t h o s e o f o f su ch r e a d ily observed a s p e c ts
o f b e h a v i o r , t h e r e w o u ld a p p e a r t o b e c a lle d th a t,
s y m p t o m a t ic t r e a t m e n t .
ju s tific a tio n
H ow ever, i f
it
f o r so«*
ca n b e shown -
in a d d i t i o n t o su ch sy m p to m a to lo g y , t h e r e i s a l s o
e v id e n c e o f im p o r ta n t, c h a r a c t e r i s t i c c h a n g e s in a b i l i t y p a t t e r n s , th e th e r a p e u tic d ir e c t io n e sta b lish e d .
If,
i s not q u ite as w e ll
on t h e on e h a n d , c h a n g e s in a b i l i t y a r e a s
s t e m d i r e c t l y fr o m s u c h sym ptoms a s d i s t r a c t i b i l i t y ,
th ere
a r e s t i l l n o c o n t r a i n d i c a t i o n s t o p r o c e e d i n g w i t h s y m p t o m a t ic trea tm en t. gross
If,
on t h e
o th er hand, b o th a b i l i t y
c h a n g e and
s y m p t o m a t o lo g y s t e m fr o m a more b a s i c c e r e b r a l p a t h o
l o g y # s u c h an a p p r o a c h c a n o f f e r It
o n l y m in im a l b e n e f i t .
i s e v id e n t , th e n , th a t a retu rn t o a c o n sid e r a tio n
o f a b i l i t y c h a n g e s p r o v i d e s an a p p r o a c h o f n o l i t t l e
v a lu e ,
a t l e a s t fr o m a t h e r a p e u t i c and e d u c a t i v e p o i n t o f v i e w . S im ila r ly ,
s o l o n g a s we a r e c o n c e r n e d w i t h e s s e n t i a l
c l i n i c a l d i f f e r e n c e s w h ic h p r o v i d e a b a s i s f o r e f f e c t i v e t h e r a p y , i t w ou ld a p p e a r t h a t we a r e c o n c e r n e d , a t t h e same tim e , w ith e s t a b l i s h i n g u n e q u iv o c a l d ia g n o s t ic c r i t e r i a . I t s h o u ld b e p o i n t e d stan d t h i s v a r ia b le s
out th a t th e a ttem p t to under
c l i n i c a l e n t i t y in term s o f ch a n g es in fu n d a m e n ta l of a b ility
i s n o t new .
P r e v io u s a tte m p ts t o
e s t a b l i s h p e r f o r m a n c e d i f f e r e n c e s b e t w e e n e x o g e n o u s and endogenous d e f e c t i v e s
on t h e S t a n f o r d - B i n e t and t h e G ra c e
A rth u r s c a l e s a r e e s s e n t i a l l y d isa p p o in tin g r e s u l t s
su ch e f f o r t s .
o f such s t u d i e s i s
The r a t h e r
due, perhaps, not
c
48 s o much t o t h e n a t u r e o f t h e a p p r o a c h a s n a tu r e o f th e t e s t i n g
it
is
t o the
i n s t r u m e n t and t h e i n a d e q u a c y o f t h e
s t a t i s t i c a l tr e a tm e n t o f d a ta d e r iv e d from i t s u se * I*
CRITERIA FOR SELECTING TEST
In c o n s i d e r i n g t h e t y p e o f t e s t i n g used
in a s t u d y o f t h i s
i n s t r u m e n t t o be
s o r t , th e f o llo w in g fe a tu r e s are
deemed e s s e n t i a l : G roup a d m i n i s t r a t i o n *
B ecau se o f th e s t a t i s t i c a l
p r o c e d u r e s t o be u sed in t h i s e x p l o r a t i o n , t h a t l a r g e nu m bers o f c h i l d r e n be e x a m in e d * course, fa c ilita te d
by th e use
it
is necessary T h is i s ,
of
o f a t e a t w h ic h ca n be
a d m i n i s t e r e d t o l a r g e g r o u p s o f c h i l d r e n a t t h e same t i m e * If p o ssib le ,
it
is
d e s i r a b l e t h a t su ch a t e s t a l s o len d
i t s e l f t o i n d i v i d u a l a d m i n i s t r a t i o n f o r u s e in t h o s e i n s t a n c e s w here c l o s e
su p e r v isio n
o f th e s u b j e c t 's
resp on ses Is d e sir a b le * E m p h a s is u p o n pow er r a t h e r t h a n s p e e d *
T h is
f a c t o r I s p a r t i c u l a r l y im p o r ta n t in th e c a s e s o f b r a i n i n j u r y w h er e m a jo r m o to r d e f e c t i s v a r io u s
in e v i d e n c e , su ch a s th e
ty p es o f c e r e b r a l p a l s y . 3 •
T a p p in g a s w id e a s e r i e s
as p o s s ib le *
The p r e v i o u s f a i l u r e
G ra c e A r t h u r t e s t s
to e l i c i t
o f fu n d a m en ta l a b i l i t i e s o f S t a n f o r d - B i n e t and
a d i f f e r e n c e betw een t h e s e
c l i n i c a l g r o u p s may b e due t o t h e f a c t t h a t t h e y c o v e r a r e l a t i v e l y narrow range o f a b i l i t i e s
and t h a t t h o s e
49 a b i l i t i e s w h ic h a r e t a p p e d a r e n o t p e r t i n e n t t o t h e t a s k o f c lin ic a l d iffe r e n tia tio n * S im p le * o b j e c t iv e
te c h n ic s
o f a d m in istr a tio n *
B e c a u s e o f t h e l a r g e nu m bers o f c h i l d r e n n e c e s s a r y t o
th e
s t u d y , a number o f d i f f e r e n t e x a m i n e r s w i l l b e a d m i n i s t e r i n g th e
tests
to d if f e r e n t g r o u p s.
A t e s t h a v in g t h i s f e a t u r e
can b e a d m i n i s t e r e d w i t h a minimum o f v a r i a t i o n fr o m one e x a m in er t o th e n e x t . 5*
Breakdow n o f s c o r e s on com p on en t t e s t s *
A
sh o r tc o m in g o f p r e v i o u s l y u sed t e s t s h a s b e e n , in p a r t , th e ta p p in g o f a r e l a t i v e l y narrow range o f a b i l i t i e s .
An
im p o r ta n t a s p e c t o f f a i l u r e , h o w ev e r, h as p r o b a b ly b een th e a v e r a g i n g o f s c o r e s t o s e c u r e a t o t a l o r g l o b a l s c o r e w h ic h o b s c u r e d t h e e x a m i n e e ’ s p e r f o r m a n c e upon i t e m s w h ic h t a p p e d p a r tic u la r a b i l i t i e s . II.
THE TEST INSTRUMENT ,