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FINES will be charged if book is returned after the date stamped be1ow. ~ sure UNEVERSHY INSTRUCTIONA MATERIALS CENTEF ““595 0 Ducmou COMPARISON OF BEHAVIOR BETWEEN CHILDREN BLINDED BY RETROLENTAL FIBROPLASIA AND OTHER CAUSES By DENISE S. VANA KEN BURE‘H OF E / .'\‘ 2 6.”) \ ‘ I ---L- _. DURATIONAL RESEARCH . . {,IF EHJCJJEWON Mix; .zem 5mm Urd‘a‘ti-x’SITY LAS r LANSING, MICHIGAN A THESIS Submitted to the School of Graduate Studies of Michigan State University of Agriculture and Applied Science in partial fulfilhnent of the requirements for the degree of MASTER OF ARTS Department of Child» Growth and DeveIOpment 1955 ABSTRACT This study is concerned with the comparison of development in children who were blinded by retrolental fibrOplasia and those who were blinded by other causes. The areas studied were evidences of blindisms, intelligence scores, and reasons for failure to make individual progress in school. Six case summaries were studied using children in the kindergarten level. Three cases were premature blinded children and three were blinded by other causes. Early development, family background, and present school progress were compared. The study found a relationship with retrolental fibroplasia to school progress hampered by emotional immaturity, more. blindisms present, and family difficulty in accepting child. Intelligence scores were lower and early development was slower in retrolental fibro- plasia cases . ii TABLE OF CONTENTS CHAPTER PAGE I. THE PROBLEM AND DEFINITIONS OF TERMS USED .................... 1 The Problem ..................... 2 Statement of the problem .......... 2 Importance of the study ........... 2 Definitions of Terms Used ........... 2 Retrolental fibrOplasia ............ 2 Blindis.ms ..................... 4 Premature infant ................ 5 II. REVIEW OF THE LITERATURE ......... 7 Literature on retrolental fibrOplasia . . . 7 Literature on prematurity .......... 10 Literature on blindisms ........... 10 Literature on blindness and its effect on growth and deveIOpment ....... 12 Literature on development or undevelOpment of .vision ......... 13 iii CHAPTER III. A DESIGN OF THE STUDY ............. Introduction ...................... Procedure ....................... IV. A COMPARISON OF INTELLIGENCE SCORES IN PREMATURE BLIND AND OTHER BLIND ......................... Introduction ...................... Procedure ....................... V. CHILDREN HAVING DIFFICULTY IN MAKING SCHOOL PROGRESS ................ VI. A COMPARISON OF CASE HISTORIES ..... Case No. 1: M.F. ................. Circumstances during pregnancy and birth .................... Feeding.............. ......... Toilet training .................. Walking ....................... Talking ....................... Behavior patterns ................ Family background ............... Behavior at play-school, 1952o—Age 3 . . iv 17 17 18 20 22 22 22 23 23 23 23 24 24 25 CHAPTER PAGE Behavior at play-school, 1954--Age 5 . . 25 School progress-~1954-1955 ......... 26 Case No. 2: G.C. ................. 27 Circumstances during pregnancy and birth ....................... 27 Feeding ....................... 27 Toilet training .................. 27 Talking ....................... 27 Walking ...................... 28 Behavior patterns ................ 28 Family background ............... 28 Behavior at play-school--1952 ....... 29 Previous school eXperience—nl953-1954 . 29 School progress at the Michigan School for the Blind ................. 30 Case No. 3: L.W. ........... » ...... 31 Circumstances during pregnancy and birth ....................... 31 Feeding ...................... 32 T oilet training .................. 32 Walking ....................... 32 V CHAPTER PAGE Talking ....................... 32 Behavior patterns ................ 33 Family background ............... 34 School progress ................. 35 Case No. 4: C.F. ................. 36 Circumstances during pregnancy ..... 36 Feeding .............. 37 Toilet training .................. 37 Walking ....................... 37 Talking ....................... 37 Family background ............... 37 School progress ................. 38 Case No. 5: M.C. ................. 39 Circumstances during pregnancy ..... 40 Feeding ...................... 40 Toilet training .................. 40 Walking ...................... 40 Talking ....................... 40 Family background ............... 40. School progress ................. 41 Case No. 6: A.B. ................. 42 vi CHAPTER PAGE Circumstance 5 during pregnancy ..... 42 Feeding, toilet training, walking, and talking ..................... 42 Family background ............... 42 School progress ................. 43 VII. SUMMARY AND CONCLUSIONS . . .l ....... 44 Conclusions ...................... 45 LITERATURE CITED .......................... 47 vii LIST OF TABLES TABLE PAGE I. A Comparison of Presence of Blindisms and Retrolental Fibroplasia and Other Causes . . . 15 II. Percentages of Error ................... 16 III. The Significance Level of Difference ........ 17 IV. A Comparison of Intelligence Scores in Premature Blind and Other Blind ......... 18 V. Percentages of Error in Intelligence Scores . . . 19 VI. Level of Significance of Intelligence Scores . . . . 19 VII. Reasons for Difficulty in School According to Teacher's Opinion ................. 20 VIII. A Comparison of Cause and Reason of School Difficulty ..................... 21 viii CHAPTER I THE PROBLEM AND DEFINITIONS OF TERMS USED In recent years in the education and training of blind children the population of the children at the Michigan School for the Blind has risen steadily to where there was one kindergarten class two years ago, two kindergarten classes last year, three this year, and plans are made to have four kindergarten next year. The reason for this is not only due to an increase in birth rate, but due to the fact that medicine has been saving these babies whose birth weight is less than three pounds. Since approximately 1942, when premature babies who were blinded because of retrolental fibrOplasia were first noticed and treated, youngsters. grew old enough to receive training and education, and eventually came to the Michigan School for the Blind. These children appear different from blind children whose blindness is due to other causes from the standpoint of growth and development. I. THE PROBLEM Statement of the problem. It is the purpose of this study (1) to note if there are differences between premature blinded children and blinded children from other causes; (2) to note if retrolental fibrOplasia, per se, is the reason for differences in their growth and de velOpment. Importance; of the stud]. Due to the increase in the number Viv of these children, the education and training of them is of great concern to educators and parents of premature blinded children. If there are differences, further research may show the need for differing emphases in the kind of education and training they receive. Likewise, the training and advice given to parents of these children may be changed so as to better meet their needs. Certainly a better understanding of the growth and development of these children would be beneficial not only to educators. and parents, but likewise to them. II. DEFINITIONS OF TERMS USED Retrolental fibroplasia. This is the cause of blindness found in babies who are born prematurely in which some unknown factor was affecting development of the eyes in the prenatal period. This condition occurs three to six weeks after birth (1). Medical science has been saving babies whose birth weights are less than three pounds. In these children the incidence of retrolental fibroplasia is high (2). Rosalie May describes retrolental fibroplasia as . . . the congenital remains of the tunico vasculosa lentis, ' often bilateral and associated with micropthalmos and prematurity. It consists in an opaque membrane behind the lens; ciliary processes are often visible and retinal detachment maybe pres- ent. It occurs as a bilateral disease in premature infants of low birth weight before age of three months. The acute stage, characterized by dilation and tortuosity of retinal vessels, hem- orrhages, neovascularization, and transudation, subsides at the age of about three months. The following ciatricial stage of organization and contracture causes retinal folds or detachment. Spontaneous regression may take place in the active phase. The basic pathologic process is neovascularization which ex— tends from the periphal retina toward the vitreoies. [11] Dr. Theodore L. Terry who has done a lot of study with pre- mature blind infants classifies the causes of retrolental fibroplasia into two groups. In the first group he lists heredity, toxemia re- lated to pregnancy, illness during pregnancy, blood incompatibilities between mother and unborn infant, the use of medication not pre- viously available and the process which produces premature birth 4 are possible causes, but they do not consistently appear to be factors associated with retrolental fibrOplasia. The second group are factors after birth that affect the pre- mature infants. These infants are put on their own before all organs of the body can work efficiently. They cannot keep themselves warm enough, thus necessitating an elaborate incubator. The infant's temperature is maintained, through necessity some two or three degrees Fahrenheit below normal body temperature. Using a higher incubator temperature is to count disaster. This temperature difference must be considered as an important possible cause the incompletely developed glands of internal secretion cannot be expected to replace adequately the secretion normally supplied to the unborn infant by the mother's thyroid, pituitary, adrenal glands, and ovaries. The lungs are not fully ready for their task, as shown in many instances by the neces- sity of administering pure oxygen. Blood pressure is increased. The poorly developed digestive system cannot efficiently absorb fats, consequently, fat soluble vitamins, eSpecially Vitamin A, are not utilized. Lack of Vitamin A in pregnant swine and rats has produced a disease in the eyes of their offspring not unlike retrolental fibrOplasia, but occuring at a much earlier stage of development. The lack of Vitamin C in guinea pig prevents the reformation of aqueous humor once it has been withdrawn. Failure to form aqueous humor in premature infant could easily produce retrolental fibrOplasia. [15] Blindisms. "Blindism" or peculiar behavior pattern of the blind, is. described by D. Thomas Cutsforth in the following. Acts of automatic self-stimulation to be found among the blind are commonly known under the generic term of "blindisms." Children who have a very slight degree of vision usually adOpt the blindism that consists of fluttering the hands and fingers before the eyes so that the movement of light and shadow may be observed. Tactual stimulation takes the form of thrusting the fingers into the eyes, nose, or mouth, or manipulating appendages such as ears, nose, lips, or locks of hair. Kinesthetic stimulation is produced through bodily swaying rolling or tilting of the head, arm motion and shoulder shrugs, and exaggerated genuflections. Blindisms are popularly throught to be nervous habits of one sort or another. [3] Premature infant. There are many classes of premature in- fants but for a general definition D. Gesell says that a premature infant is one whose birth weight if less than 2500 grams or whose gestation period was less than 37 weeks. [6] However, birth weight is a very important factor. For ex- ample, varying degrees of prematurity are affected. Dr. Hess claims that birth weight is the major factor in detennining the growth curve during early childhood. Infants with a birth weight between 1500 and 2000 grams usually approximate the average full term infant by their third to their sixth year, while those between 100 and 1500 grams may require from five to eight years longer (9). 'The development of the premature baby is slower than a full term baby. His equipment to start life with is not completely matured to function efficiently. Thus, the utmost care is needed in helping the infant to life, eSpecially during the first few months. The development of cerebrOSpinal nervous system is relatively less complete than that of the autonomic system. This is most manifest in the musculature inertia of the infant. Many premature infants lie in a state of stupe or somnolence from which they must be aroused to be fed. External stimu- lation may result in 'only a weak cry and slight movement of body, movements are slower and child tends to relapse into a deep sleep as soon as the stimulus is removed. [9] In the families of premature children that Dr. Hess studied, he found them to come from slightly inferior, socio-economic troup, an amount of serious maladjustment, and an incidence of free ho Spital care (9). CHAPTER II REVIEW OF THE LITERATURE Liliiemtge on retrolental fibroplasia. The most recent study VVV on the cause of retrolental fibroplasia was done in a c00perative study conducted simultaneously in 18 hospital nurseries located in various sections of the country. The first findings were released by reSponsible investigators of the study as a part ;of the Symposium on Retrolental FibrOplasia at the last meeting of the American Academy of Ophthamology and Otolaryngology. Dr. V. Everett Kinsey, Assistant Director of Research of the Kresge Eye Institute was the head of the committee to coordinate the research. This study shows oxygen as the cause of retrolental fibro- plasia. The following are excerpts of what the committee found and were mimeographed for those attending the conference. Premature infants weighing 1500 grams and less (3 lb. 5 oz.) at birth were randomly assigned to two groups. One group received concentrations of oxygen in excess of 50 percent for a period of four weeks, a practice which was then current for lighter premature infants in most of the hoSpital nurseries concerned, and another group received oxygen in concentrations less than 50 percent and only on the basis of frank clinical need. All other factors concerned with the care of the premature infant, such as feeding, vitamins, lighting, temperature, and 7 humidity were kept similar for both groups. The total number of infants reported on for the first six months was 391, of which 68 were given routine use of oxygen and the remainder curtailed use of oxygen. Preliminary results of this study show that the use of oxygen is significantly associated with retrolental fibroplasia and that mortality is not affected by limiting the use of oxygen to that amount thought necessary for clinical emergency. Of the 53 surviving infants who received oxygen in the routine manner, 72 percent deveIOped the disease in some one of the five active stages, whereas of the 245 infants in the curtailed group, only 30 percent were similarly affected. Even greater was the difference in incidence when the ciatricial grade of the disease was used as a basis for comparison. In this instance, 25 percent of those infants who received oxygen routinely showed permanent ocular changes as compared to six percent in the group which received curtailed use of oxygen. The mortality (after the first 48 hours of life) in the group receiving routine oxygen was 22 percent, compared with 20 percent in the cur- tailed oxygen group. Actually, some cases of retrolental fibrOplasia occurred in infants who had received oxygen for one day or more (after the first 48 hours of life) throughout the whole range of stays in oxygen, thus permitting an analysis of the relation between the incidence of the disease, and the duration of stay in oxygen on a day to day basis. Analysis of these data showed that most of the risk of contracting the disease was incurred by exposure to oxygen in the first week of life. This important finding suggests that the mechanism of retinOpathy involves some initial insult which is associated with relatively short exposures to oxygen in the early days of life, and emphasizes the importance of restricting the use of oxygen even during the first week of life. [12] Recently, however, the Michigan Department of Health (14) has found cases of retrolental fibr0plasia in babies who have not received oxygen, Dr. Jane Hallenback, one of the few who has been studying these children, studied some 18 cases of retrolental fibroplasia. Out of these 18 all but three were totally blind, not having even light perception. She found retardation in motor development, reluctance to eat solid food, and many refused to give up the bottle. When first seen, children with retrolental fibroplasia appear similar to each other with their seemingly bulging fore- heads and small sunken eyes. At about one year of age, they begin to hold their hands to their eyes and poke at their eyes. This activity occurs especially at twes of stress. Hand- slapping, head banging, screaming, teeth grinding or biting and rocking back and forth. Often these children engage in twirling movements of their entire body. They show a preference for a position of opithotonos or enjoy hanging their head downward. These mannerisms are seen in better adjusted children to a less severe degree and with less persistence than in the more disturbed ones. Whether the blind child was the first in the family or had older siblings, the mother was slow to notice anything wrong with the child, and, often admitting it to herself, was eSpecially slow to seek medical confirmation of her fear. In each case at the time of premature delivery the mother was told that either she, the child, or both might not live. Following this introduction the children we re separated from the mothers for varying periods of time, as the children had to remain in the 1108p ital because of their small size. During the first month at home the children did not deve10p normally and give gratification to the mother by reSponding to her eagerly as a sighted child. Without exception at a later date, each mother was repeatedly told by professional personnel and by others who saw her child, that the child was mentally deficient or that the child has a ”brain disease" and would not live long. All factors-~a fearful delivery followed by separa- tion, a slowly developing child, the diagnosis. of mental deficiency-- 10 progressively interfered with the relationship between mother and child. Improvement of environment through psychotherapy for mother and child, and preschool teacher improved developmental steps forward and to lose or decrease their mannerisms. [8] Dr. Hallenback's conclusions from her study were retardation of general deveIOpment was due in part to an emotional basis, the need for early stimulation by handling and vocal encouragement, and mother's capacity to give attention and affection was below average, but the child's need for love and attention was above average (8). Literature on prematuiity. Dr. Gesell comments on the prob- lem of prematurity. He says: Prematurity is a medical diagnosis. Prematurity accounts for three-fourths of the deaths which occur during the first day of life and for about one sixth of the still born. Do the prematurely born infants who survive pay a de— veIOpmental penalty for their survival? Uncomplicated pre- maturity exacts no penalty. Prematurity of birth, however is associated with malformations, aSphyria, birth trauma, intra- cranial hemorrhage. Such complications if not lethal may pro- duce permanent defects and deviations. [6] Literature on blindisms. In Speaking of blindisms, Dr. Cutsforth attributes this behavior due to the handicap. The blind child must find his only stimulation within bodily reach. From this time on he constitutes the greatest part of his own environment. He finds in himself the stimu- lation and motivation to action that the seeing child finds in the visually objective environment. [3] 11 However, in having this attitude Dr. Cutsforth infers then that every child who is blind would have these behavior patterns. This. is not true. There are blind children who do not have these behavior patterns. These blindisms have been alikened to chronic fidgetiness or tic in norznal sighted children.- Chronic fidgetiness in children is a sign that a child is being frustrated. Either his anger has been aroused and he has not been permitted to express it or he has been refused satis- factions, that he feels he has been placed in a situation where his jealousy has been aroused or when he is being asked to con- form to impossible requirements. Such frustrating experiences make the child feel insecure and unhappy and as a reaction to these feelings he becomes chronically angry and has the urge to attach and annoy the persons in his environment. At such times he becomes restless because his desire to attack and annoy is greater than can be expressed through his actions. and the excess) energy flows over to innervate the general musculature producing unpurposeful motions. The more the desire to attack and annoy is prevented from being translated into the action the restlessness becomes fidgetiness Spreads throughout the whole motor system. [4] In the personality of a blind child, one facet of his person- ality is this passive—receptive attitude (2). It is the easy way out. The blind child does what he is told because he has no other alternative. However, in being frustrated and not Openly able to rebel, he withdraws into himself and many times in the form of blind isms. 12 Literature on Blindness and its effect on growth and deveIOp- ment. It has been the philOSOphy of educators of the blind that a blind child is a "normal" child who is blind. Gesell (7), in his study of the blind child, found this statement to be true. He found that this blind child met the norms of the developmental examination as fully as a seeing child. Blindness, per se, was not the causative factor in retarding growth. To a significant extent, the sequences of behavior devel- opment in the blind boy have been comparable to those of a seeing child. The blind child learned a great deal deSpite his handicap, but what he has achieved has always been delimited by the natural maturity of his growing action system. Vision, likewise, defers to maturation. The patterns of visual behavior patterns of seeing child are pervasively influenced and guided by vision; but they are not essentially products of vision, nor of learning by looking. [7] Characteristic behavior developmental that Gesell found most prominently in blind children were the face front posture and a tendency to creep backward instead of forward. This behavior is natural, as the lack of vision affords no reason to turn one's head without the torso, and there is more security in moving backward for it involves less action. To further amplify, Dr. Gesell studied a blind child and this is what he found to be true in the deveIOpment. By age of 27 months, M.F. was making excellent orienta- tions to the human voice. He listened to a person who called to him across a long room, and he turned his steps in the ap- prOpriate direction, connecting his course as he went along, 13 listening to the voice and even countering with the question, "Where are you?" When he reached his goal, he stretched out his hands and established tactile contact. The foregoing behavior-event represents highly relevant behavior in four fundamental fields--motor, language, adaptive, and personal social. This quality of relevancy is extremely important in the appraisal of the developmental outlook of a blind child. Relevant behavior at a timely maturity level denotes a favor- able outlook. Blindness in itself does not produce a serious degree of retardation. It profoundly alters the structure of the mental life, but not the integrity of a total growth complea. [7] Literature on develOpment or undeveIOpment of vision. In studying this disease of the eye it is necessary to understand the eye mechanism and its development. Since retrolental fibr0plasia is a disease of the eye that appears at birth or in the fetus, or shortly after birth we are concerned with vision and its deve10pment. Dr. Gesell finds in the sighted child that it . . deveIOps at a remarkably rapid rate during the first few months of life. He stressed the intensity of visual hunger in normal infancy. By the age of 16 weeks, most of the infant's waking life is spent in avid looking,--looking at objects, person, lights, shadows, surroundings and at his own hands. [7] The blind child lacks this visual hunger. He has no motiva- tion to see the world about him. Without this motivation. to develop ‘ an outward personality, the blind infant is left to get pleasure from within himself. As Dr. Gesell describes it, the blind infant is "pressed into his own subjective self." (7) CHAPTER III A DESIGN OF THE STUDY I. INTRODUCTION Dr. Stimson in a lecture of a college class, Social Work, Personality and Culture, made the statement that the way in which one meets the anxieties of first two days of birth is the way in which one meets the anxieties of life. From the literature Dr. Cameron supports him by stating that, "the birth process itself is certainly hard on the baby." With this as the starting point, the hypothesis that there is a relationship between the premature birth and the emotional behavior pattern of blindisms in blind children was studied. 11. PROCEDURE There was a total of 73 cases that were studied. These cases were students of elementary braille classes of the Michigan School for the Blind, Landing, Michigan. The number of students whose blindness was due to retrolental fibroplasia was found and 14 15 also the number of students whose blindness was due to other causes. Then the number of students who were observed and found to have these behavior patterns were counted. Table I shows how the data were classified. TABLE I A COMPARISON OF PRESENCE OF BLINDISMS AND RETROLENTAL FIBROPLASIA AND OTHER CAUSES The number of cases of retrolental fibroplasia . . . 25 73 The number of cases of other causes .......... 48 The number of cases of retrolental fibroplasia who have blindisms ................... 21 or 84% The number of cases of retrolental fibroplasia who do not have blindisms .............. 4 or 16% The number of cases of other causes who have blindisms ...................... 16 or 33% The number of cases of other causes who do not have blindisms .................. 32 or 67% L f A percentage of error formula was applied to the data col- lected, with the percentage of error being equal to (PlQl/N1)(PZQZ/N2); P being equal to the percentage of times an event occurred, Q being equal to 1 minus P, and N equal to. the number of cases. In Table II the percentages are listed. 16 TABLE II PERCENTAGES OF ERROR Percentage of error or ratio between blindisms and retrolental fibrOplasia ..................... 1.08 Percentage of error of ratio between blindisms and other causes ............................ 9.62 The significance level of difference formula was also applied to the data in which the percentage of difference was divided by the percentage of error. The data proved to be significant as shown in Table II. In both cases the percent was less than one, which means that it would occur in 99 chances out of 100. TABLE III THE SIGNIFICANCE LEVEL OF DIFFERENCE AI; 1- Significance level of the figures between blindisms and retrolental fibroplasia . . 63.94 or less 1% Significance level of the figures between no blindisms and other causes ....... 3.52 or less 1% CHAPTER IV A COMPARISON OF INTELLIGENCE SCHORES IN PREMATURE BLIND AND OTHER BLIND I . INT RODU CT ION Accurate testing of blind children has been a difficult task. However, Geraldine Scholl, supervisor of the elementary classes at the Michigan School for the Blind, who has been doing a lot of testing with blind children, has been carrying out an extensive testing program at the Michigan School for the Blind. She has been doing some of her testing in conjunction with Samuel Hayes. The tests that have proven feasible with visually handicapped youngsters are the Hayes-Binet, Weschler-Bellevue, and the Vineland Social Maturity Scale in which a mental age can be found. Using the results of these scores, a comparison was made in an attempt to see if there was a relationship between these test scores and retrolental fibroplasia, the cause of premature blind children. 17 18 II. PROCEDURE A total of 109 test scores were tabulated. These scores were separated into two categories: those children who are premature blinded children and those who are not. Then these two categories were each broken into two groups: those whose scores were normal or above, and those whose scores were below normal. ' Table IV shows the breakdown of the data. TABLE IV A COMPARISON OF INTELLIGENCE SCORES IN PREMATURE BLIND AND OTHER BLIND 1 _ V—L J x Retrolental fibroplasias whose scores were normal or above .................... 11 28 Retrolental fibroplasias whose scores were below normal ...................... 17 Other blind whose scores were nonnal or above ........................... 37 82 nonnal .......................... 45 A percentage of error formula was applied to the data col- lected. The formula is the same aslthe one on page of this study. In Table V the percentages of error are listed. The percentage of error is noted to be somewhat greater in blind children‘s intelligence 19 scores who were blinded from other causes. However, the level of significance is still within the range where the probability of an occurrence of the results is 88 to 89 chances in 100. The occur- rence of anything that comes within the range of 80 in 100 chances is significant data. See Table VI for the classifications and signifi- cant level these data fall into. TABLE V PERCENTAGES OF ERROR IN INTELLIGENCE SCORES .__;: Percentage of error or ratio between intelligence levels and retrolental fibroplasia ............. 0.130 Percentage of error or ratio between intelligence levels and other causes ................... 0.773 13'“ = L Y A A—I TABLE VI LEVEL OF SIGNIFICANCE OF INTELLIGENCE SCORES Significance level of the figures between intelligence scores and retrolental fibrOplasia .............. 1.6 Significance level of the figures between intelligence scores and other causes ..................... 1.2 CHAPTER V CHILDREN HAVING DIFFICULTY IN MAKING SCHOOL PROGRESS Many children at the Michigan School for the Blind were having difficulty in attaining any success academicwise or otherwise in school. A study was made to see what was the reason for their inability to show growth and deveIOpment. The teachers of these various children were interviewed. They were asked for reasons for the children's apparent inability. The following table shows the breakdown. TABLE VII REASONS FOR DIFFICULTY IN SCHOOL ACCORDING TO TEACHER'S OPINION Reason Number Emotional immaturity ...................... 32 Mentally retarded ......................... 25 Motivation .............................. 9 Lack of experience in braille .(newly blinded) ..... 3 Slow learners ........................... 2 Double handicap (both severe) 2 Total 73 20 21 These reasons were then divided into cause of blindness. Table VIII shows the cause of blindness and reason for their diffi- culty in school. TABLE VIII A COMPARISON OF CAUSE AND REASON , OF SCHOOL DIFFICULTY Cause Rea son Numbe r RLF Emotional immaturity ................. 13 RLF Mentally retarded ................... 3 Other Emotional immaturity ................. 18 Other Mentally retarded ................... 22 Other Motivation ......................... 9 Other Lack of experience in braille (newly blinded) . 3 Other Slow learner ....................... 2 Other Double handicap (both severe) ........... 2 Total 73 CHAPTER VI A COMPARISON OF CASE HISTORIES In noting if there were differences in premature blind children and children blinded from other causes many case histories were read. Six typical cases were chosen to note if a comparison could be made as to similarities in growth and behavior. The first three case histories are children who are blind because of retrolental fibroplasia. The latter three are case histories of children blinded from other causes. 1. CASE No.1: M.F. Born 9/12/49 Sex:. Male (a twin) Birthweight: Cause of Blindness: Retrolental fibroplasia Circumstances during pregnancy and birth. The mother carried M.F. for six months. She had made a 120-mile trip prior to this because of her mother's illness and death. She had bled about three or four times during pregnancy and went to bed for a week. The twins were delivered at six months after a pain lasting one week 22 23 by a Caeserean section. Both babies were in an incubator for two months. (M.F.‘s twin brother was born blind, too.) Feeding. M.F. had trouble with regurgitation of feedings for months. Finally a new formula was given and the regurgitation stOpped. The mother fed him until three years of age when she attended the Parent Institute for parents of blind children and learned othe rwi se . Toilet training. He was toilet trained by three years of age. Since he has been enrolled in school he has had difficulty with an infected penis which has not been circumcised. He also becomes constipated and is afraid to have a bowel movement as it hurts. He screams and cries when he has one. After commenting to the mother to have the child circumcised, she said her doctor told her it was not ne ce 5 sary. Walking. He walked when he was three years old, but it was very stiff and wobbly. He would not venture on his own very often. Talking. At the age of three years he used two-word combina- tions. Most of his Speech was hard to understand. His voice is high and the pattern of speech- is sing-songy. In the fall of 1954 when he entered school, he would only say "yes" or "no I don't want to" and 24 Speak of himself in the third person. This was very clear. A program of language development has been started with him, and he is now using complete simple sentences, follows commands, and the pattern of speech is losing its peculiar inflections. However, his speech is not very Spontaneous. Behavior patterns. When M.F. first came to play-school and kindergarten, it was noted that he rarely smiled, if ever. Now he is beginning to smile and laugh out loud.. He never plays with other children. He stands around and watches the sun rays, as he has a little light perception. He is just beginning to verbally notice other children. If something is suggested for him to do that he does not like, he says, "Let do it." He says "hi" and "good-bye" spontaneously to those around him. Blindisms are the habits of jumpting up and down and putting his finger in his eye. He often likes to fold up the upper eye lid. Family background. M F.'s parents both came from farms in Indiana. Both had two years of high school education. Since they have been living in Michigan, the father has been working in an automobile factory. M.F.‘s home is clean but meager. It has some of the modern c onveniences. 25 There are two other children besides his twin brother. Both are older--a boy and a girl. When the twins were born, the family physician knew that they were blind but didn't tell the parents until they were 20 months. The mother stated that the adjustment would have been easier if they had been told earlier. Until the blind twins entered kindergarten, the father felt that they would never learn anything. Behavior at play school, 1952--Age 3. The general comment 1 of the teachers who observed him at play school was that he was a very slow child. He didn't play with any of the toys or play equipment. He was very unsure of himself wmn he walked. His Speech was very difficult to understand. Behavior at play School, 1954-»Age 5. The comments of this year were these. He was not interested in any activity. He stood or sat when not made to move. He did not show any form of initiative and said very little. The things he said sometimes 1 Each year before school starts the Michigan SChool for the Blind holds an institute for parents of blind children where both parents and children attend. The parents go to classes which are held by experts in the various fields to help them raise their blind child. The children go to Play school where teachers observe them for a period of three days. 26 appeared intelligible and sometimes not. When mother came to get M.F. she would be trying to convince the teachers that he could do more than he apparently did. She seemed very fearful that he would not be given a chance for schooling. School progress-"19544955. Since he has been enrolled in kindergarten, M.F. has made progress. He has learned to travel by himself around the room and to the various buildings on the campus. He is playing with the toys in the room, when supervised. He strings beads, finger paints, builds with tinker-toys, and uses scissors. M.F.‘s speech has improved from the "yes" and "no" to full sentences. He asks questions, reSponds to other peeple and children around him. His most recent accomplishment is reading braille. Although M.F. has made a lot of progress, his total growth and development for his chronical age at this time is below the norm according to the Vineland Social Maturity Scale (which has been adapted for blind children). He now appears to have potential in comparison to his entrance in the fall, when he seemed severely mentally retarded. 27 II. CASE NO. 2: G.C. Born 6/24/48 Sex: Male Birthweight: Cause of Blindness: Retrolental fibroplasia Circumstances during pregnancy and birth. While carrying G.C., the mother threatened miscarriage at four months. At this occurrence she was hOSpitalized for one week. Then she delivered G.C. at six and one-half months. She delivered him while she was in oxygen. G.C. had oxygen too. He was in the hOSpital for four months. Feeding. At four he could manage a glass and something like a cracker or cookie by himself. He needed much help with a Spoon in feeding himself from a plate. Toilet training. At four, toilet habits had been started. His control still isn't good. At home and in school he has had difficulty with bowel movements. First he suffered from constipation. Then for about two months he would soil himself sometimes as many as five times a day. Talking. No definite data, but the mother states that he was two and one-half years behind her other children in developing. 28 Walking. Same as above. Behavior patterns. G.C. is a timid child. He gives in to any one who chooses to boss him. If another child is being scolded, he takes their side and tries to help them so they will not get into any difficulty. His Speech is hesitating. Although he knows what he wants to say, he blocks and cannot express himself. As for blindisms, he puts his fingers in his eye and keeps his head down as though he were afraid. Family background. G.C.‘s father is a carpenter. He did not finish high school. The mother graduated from high school and had some nurses' training. There are four siblings; one sister is married, two brothers and a sister are in high school, and one sister is about nine years old. Both parents had little hope that G.C. would succeed in school. At the beginning of school he was marked mentally re- tarded. He was to be given a trial period. Since then G.C. has been developing. Cooperation with the parents was sought and received during G.C.‘s week ends at home. They have taken a definite interest in the child to give him new eXperiences at the suggestion of the teacher. 29 In a more recent conference with the parents they expressed their delight in G.C.‘s success at school. They noted a difference in him at home. They said that he asks more questions, and for the first time, actually plays with his toys where in the past he would just throw his toys across the room. The mother did express a fear for her son during the summer vacation. She felt that he would go back into the state he was without the stimulation of school. Behavior at play school-~1252. Observing teachers write that G.C. was extremely retarded. He could not express himself. He parroted what everyone said when talked to. For the most part of his play he picked up a small stick or stone and patted it onto his other hand. When‘ Spoken to he would often scream or say, "Sylvia." He was not toilet trained completely. The mother's attitude was one of disinterest. She had seemingly given up with G.C. She stated that she just did not have the time to work with G.C. Previous school exRerience-m1953-l954. G.C. was enrolled in a kindergarten class in a regular public school near his home. He was enrolled with sighted children. 30 During the first semester the teacher noted individual growth. He learned to dress and undress himself. He stOpped parroting, answered simple questions, learned to play on the equipment in the room and to string beads. He had to ride a school bus and was able to get on and off by himself and find his own room. Something happened during the second semester. Just what it was is not known. G.C.‘s behavior changed. He refused to co- operate in dressing himself. He never did play with other children. G.C. was absent most of the last semester and said he was not in- terested in school. The teacher's comment on the mother's attitude was that she "tries but finds it difficult, she babies him so." School progress at the Michigan School for the Blind. His Span of interest is short during sitting down, working with hand activities. He is able to work puzzles, string beads, build with the various block sets with some quality and understanding of what he does. He has begun a reading readiness program in braille. There is definite understanding of differences in the braille combinations used. 31 He sings nicely. He enjoys rhythm band and does well. He participates in group games but feels inadequate. G.C. is improving since the beginning of the year. He has difficulty talking and telling about his experiences. There has been improvement but the teacher has to go to extremes in' providing a climate for giving him full confidence. He is beginning to play with other children. He usually likes to play with only one at a time. It is usually a more aggressive and imaginative child than himself. His favorite game is riding a bike and playing "greyhound bus." G.C. has potential. When he feels sure of himself he shows surprising intelligence. His extreme emotional instability is defin- itely slowing up his growth and development. He is not working up to the level of a six-year-old. III. CASE NO. 3: -L.W. Born'1/30/49 Sex: Female Birthweight: 2 lbs. 6 oz. Cause of Blindness: Retrolental fibroplasia Circumstances during jfiregriancl and birth. When L.W. was delivered into the world, she was a footling presentation. There were no other difficulties. L.W. remained in the hOSpital for approximately three months after birth. She had dysentery and an 32 asthmatic bronchitis condition which disappeared after she was about a year old . Feeding. There were no difficult problems. The only diffi- culty L.W. has in chewing stringy meats such as beef. This is true of the other members of the family as meat is seldom served in the home, the mother said. At present in the dormitory she is a good eater. She manages her Spoon adequately and diSplays table man- ners. Toilet traing. The mother stated there were no problems. In school and the dormitory, she asks to go to the bathroom and finds her way with no help. Walking. L.W. began walking in a peculiar fashion. She would arch her back with her hands, feet, and head on the floor; the. head was used as a sort of a feeler. When she was about 15 months she began to walk upright. At present, she is a good traveler. She finds her way about the room and to and from school by herself. Talking. The time when L.W. began talking is not known. However, it is surmised that it would be within the normal range. At present she talks in full senmnces and can tell short experi- ence stories. 33 BehaviOI: patterns. While a baby, L.W. seldom slept. Her sleep was very restless. At present during rest periods, her body is in constant motion. She often gets in the arched position as when first learning to walk, and sways in a sideways fashion. Her mother stated she plays noisily. Although most of her play is verbally creative and constructive, it does not involve much movement. Usually if She plays with a toy, it is just held and flipped back and forth. Recently she is beginningto build with blocks and boxes and use a doll buggy, wagon, or bike in carrying several toys in her play. She can partially dress herself. She cannot work buttons, snaps, buckles, or tie her shoes. She shows a desire to learn and tries very hard at these motor skills. L.W. is a nervous child. She cannot sit completely still. When Sitting in a chair, she wiggles so much that she and the chair move several feet in five to ten minutes When standing, She either jumps up and down or sways from one foot to the other. Her hand coordination is still immature. She can string beads after much difficulty. She always forgets how to hold scissors. She does love to paste or. work with wet, pliable sub- stances such as dough, baking clay, and paper mache. She cannot 34 mold things very wekk with her hands, but loves to pick at it and make small pieces. She can work simple puzzles. Family backjground. The mother of L.W. completed ten grades of school. After leaving school She was soon married. After she became pregnant her husband asked for a divorce. She refused, but later he went ahead and moved to another state and re- ceived one. The child was a girl. Then she met L.W.‘S father and married. She first had a son and a year later L.W., and the following, another son. Two years later She and her second husband were separated. His wereabouts at present are unknown to her; how- ever, he does send money to support his three children. Her first husband sends support for his girl. The social worker who visited the home related that they live in government housing which is clean and well kept lawns. The mother is a good housekeeper and the children were all well clothed and mannerly. In talking to the social worker about her blind daughter, she stated that she never babied her. The child very easily went to strangers and chattered with them. When questioned about the father's attitude toward the child, the mother only said that his feelings would be difficult to explain and stepped there. 35 School progress. L.W.‘s physical development is average in comparison with blind kindergarten children. She plays actively, using the large muscles of the body. She uses the slide, jungle gym, climbing steps, et cetera. She participates in lively games and story plays. She participates in rhythmic activities involving use of whole body (running, skipping, jumping, hopping, etc.). In coordination of finer muscles of wrists, fingers, and hands she is able to paste, finger paint, work with clay, string beads, manipulate rhythm instruments, cut with scissors. She enjoys all of these and has average skill. She likes best of all to paste or work with clay. In both activities she becomes very messy. She has learned where and how to go to the toilet, bring food up to her mouth instead of her head to the plate, hang up clothes on a hanger. She still doesn't manage zippers or snaps. In social and emotional development, she is. learning to play cooperatively. She chooses the brightest girl to play with most of the time, Theirplay for the most part when unsupervised is rock- ing in the rocking boat. In intellectual development, L.W. is able to tell things that have happened to her or around her in prOper sequence. She can make up stories and answer questions about the stories read to her. Learning songs comes easily for her and she has a good voice. She 36 has begun a reading readiness prOgram where braille is introduced. She is able to find likenesses and differences. Very recently she has been introduced to a small reading vocabulary--"look," "oh," "Dick," "1," "can," and "go.” She is able to known them when written in braille. L.W. reads braille with her middle finger on her left hand. Braille is mostly read with both index fingers. In total growth and development L.W. has grown to be a good kindergarten child. The stimulus of school has helped her to mature so that she meets all the requirements of a good five- to six-yearnold on the Adaptation of the Vineland Social Maturity Scale for Use With. the Visually Handicapped Pre—school Children. In the fall of 1954 she showed the maturity of a four-and-one-haIf-year-old. Of all the retrol6ntal fibrOplasia cases in the author's room, she is one of the best as far as total growth and development is concerned. IV. CASE NO. 4: C.F. Born 2/23/50 Sex: Female Birthweight: 7:1bs. Cause of Blindness: Congenital catarracts Circumstances during pregnancy. C.F.‘s mother had not dif- ficulty during pregnancy except during the seventh month, when slight bleeding was evident and the mother went to bed for a few days. There was a normal delivery. 37 Feeding. There were no difficulties. At present she feeds herself with apparent ease. Toilet training. She was toilet trained to go to the bathroom by herself at one and onechalf years of age. We have had no dif- ficulty with her at school. Walking. At less than a year, this child was walking by her- self. During the school year she was the first to learn to travel by herself from the school building to the dormitory. For a kinder- garten, totally blind child, this is considered to be good. Not only does it show hearing and travel skill, but the desire to be self- sufficient and independent. Talking_. The mother stated that .she started verbal language at one year old. Mother also commented that C.F. was much faster developing than her normal sighted son. Famifl background. C.F. comes from comparatively young parents. Both father and mother are attractive looking. The father works in a factory, but keeps his three children and his wife and himself nicely dressed. They live in an upstairs apartment. C.F. plays with sighted children most of the time she is home. 38 C.F. has a brother a year older than she, and a five—month baby sister who presented a threat to her before she was born. Since birth, after the mother was given some advice as to how to handle the situation, C.F. has adjusted and now workships "her" baby. Schggl progress. In physical deveIOpment, C.F. uses all large muscle equipment such as jungle gym, slide, running, skipping, hOpping, jumping, imitating animals and movable objects, and such manipulative equipment as hollow blocks, playhouse furniture, tricycles, large balls, and sand box toys. Coordination of finer muscles of the wrists, fingers, and hands such as clay, pasting, cutting, hammering, sawing, and working puzzles, C.F. has definite ability in handling and using such material logically and creatively. She can manage zippers, buttons, hangers, buckles, and tie head scarfs. She can dress herself and make her bed. Anything that involves the hands she does well. In social and emotional develOpment she compares with a good sighted kindergarten child. The only time she showed any emotional difficulties was just before her mother delivered the third child of the family. 39 The intellectual development of C.F. indicates that she can compare with good five-year-olds in regular public schools. She has number concepts including counting, comparing, Spacial relation- ships, simple concepts of time, discriminating between heavy and light, She can relate incidents, tell stories, pretend and make up stories, is able to express herself adequately before the group, and participates in and enjoys all forms of music. In the reading readiness program, she is able to distinguish differences in braille and other materials used. She can read easily these reading vocabulary words--"loo-k,” "oh," "Dick," "Jane,” "can," "go," "I," "like," and "see." She has good technique in feeling braille. C.F. has one bad habit, and that is to stick her fingers in her eyes. In every other way she can compare satisfactorily with sighted children her age. Her eyes are her only difference, and she may be psychologically poking them out so as not to show, so to speak, the difference. V. CASE NO. 5: M.C. Born 10/14/49 Sex: Male Birthweight: 7 lbs. 9-1/2 oz. Cause of Blindness: Retinal blastoma 40 Circumstances during pregnancy. It was a normal pregnancy and delivery . Feeding. He never ate very much, the mother states, before he started school. He was fussy about the kinds of food he ate. However, he was able to feed himself. Now he manages his food well. His manners are very good and he is very neat. He seldom Sp ills . Toilet—training. He was toilet trained at 18 months, but then he went to the hospital a month later to have his eye enucleated and had to be retrained when he got home. He was two years old then. Walking. He started walking at 13 months. Now he travels about the room and to the dormitory independently. Talking. M.C. was 15 months when he started talking. Now he has a good vocabulary and is able to tell things he‘s seen or done . Family background. M.C. is an only child; however, he soon will have a new brother or sister. His parents are young. His father is a fanner. Until M.C. reached school age, the family made their home in another state. They moved to Michigan so that M.C. would be able to attend the Michigan School for the Blind. 41 Both parents are high school graduates and are comparatively young. They have done a good job of raising M.C. so that he has not been spoiled or neglected. They provide him with many experi- ences that involve muscle activity and intellect. School progress. M.C. is very active in playing with all types of equipment in the room and on the playground. His hand coordina- tion is especially good. He handles scissors with amazing dexterity. Building blocks, using the saw and hammer, working puzzles, et cetera. He shows understanding of how such equipment is used and has high, sustained interest in participating in these play activities. He is the most p0pular child in the classroom. When several children demand that he play with each of them, he diplomatically allots his time so that each can have a turn. The observer heard him saying to one child that he was sorry he couldn't play with her now, but that on Tuesday he would play with her. He is courteous and generous, but when necessary, will stand up for himself. He is emotionally stable and has good habits of thinking and working. He doesn't have any peculiar behavior mannerisms. He can be left alone with something to do and when the teacher returns, he is still doing what he is supposed to. 42 VI. CASE NO. 6: A.B. Born 10/6/51 Sex: Female Birthweight: Cause of Blindness: Degenerative pigmentation of retina Circumstances during pregnancy. It was a normal pregnancy and birth. Feeding, toilet training, walking, Ed talking. There is no record as to exact time when the child Egan walking, talking, feeding, and taking care of her own toilet needs. However, at three years of age, when her mother visited Parent Institute, the child was completely independent. A.B. seemed very capable of taking care of all her own needs, as observed by a qualified instructor. Family baggroimd. The home that A.B. comes from is an average, clean home. The mother is interested in her four children and has accepted her blind child. The three siblings range in age from seven years to eight months. The children accept their blind sister and they play together quite normally. Very recently, however, tragedy struck the family. The mother was in a serious automobile accident and was. unable to care for the blind child's needs so she was entered this Spring in the nursery school program at the Michigan School for the Blind. 43 School progess. A.B. adjusted to school and dormitory life deSpite her young age very easily. She appears aggressive and is constantly busy. She is learning to adjust to a group school situation in which such periods require sitting-down activities and listening to others and expressing herself before the group. She uses all the play and manipulative equipment in the room. Her teacher states that she will be able to function well in more formalized schooling as she gets older. CHAPTER VII SUMMARY AND CONCLUSIONS In studying the problem of whether there are any differences in premature blind children and those children who are blind from other causes, it was found in the elementary children enrolled at the Michigan School for the Blind that children having retrolental fibrOplasia were different in school progress, which in turn was af— fected by the immature emotional development as compared to children blinded from other causes. In intelligence test scores they were below the norm. In a comparison of mannerisms present in the behavior of the child, there was more evidence of blindisms occurring in the premature blind than other cases. Emotional immaturity was the reason given for most of the retrolental fibroplasia cases who were not making individual school progress. as contrasted to mental retardation being the largest number of other blind children. The case summaries of children who were blinded from other causes showed more normal deveIOpment comparable to asighted child from zero to five years old. School achievement and adjustment 44 45 were easier. here was more emotional family difficulty in the pre- maturely blind children than in those families of other blind. 1. CONCLUSIONS These differences in retrolental fibroplasia blinded children in the author's vieWpoint from observing and working with pre- mature blind children are due, for the most part, to the fact of the prematurity affecting the growth and develOpment, at least in the early years. The starting point or birth came earlier and the physiological limit, or maximum growth, at that time was less than that of a full tern baby. The rate of growth and development seems slower. Therefore, the ability to grow and develop of such an infant who starts out life weighing less than three pounds takes much longer to complete at least the first cycle of the growth period. Them children are not old enough to determine what happens at the end of the second cycle, nor to determine exactly when they begin the second. The emotional impact that the family receives, eSpecially the mother with her guilt feelings present for producing the baby pre- maturely, thus reSponsible for the visual defect, affect the child. Then the period of incubation and long separation from the mother BUREA;l OF EDUCA'HONAL RESEARCH (Viki-'53:? ffF EDUCATEOI‘J Niven“). .N SUCH E Ua‘th'fiiiSITY EAST LANSING, MICHIGAN 46 and family, the expense of hospital care, and the apparent slow rate of growth and develOpment in comparison seem to affect the emo- tional climate in which he is growing and developing. Thus, the apparent cause of emotional immaturity. Since there is an increasing incidence of this condition in the causes of blindness in children, the eXpectation in school achieve- ment should be geared lower. Help should be given immediately to parents, along with understandings of pathology, incubation, physical and emotional growth and effects of prematurity as to expectation and needs of the child; that is, the relationship between the cause of blindness and all its by-products need to be considered in interpreting the child to the family and environment, and conversely, family and environment to the child. 10. LITERATURE CITED Cameron, Norman. Psychology of Behavior Disorders. Houghton Mifflin Co. New York. Pp. 5, 6, 21. 1947. Chevigny, Hector, and Sydell Braverman. Adjustment of Blind. Yale University Press. New Haven. P. 185. 1950. Cutsforth, Thomas D. The Blind in School and Society. American medation for the Blind, Inc. New York. P. 6. 1951. English, 0. Spurgeion, and Gerald H. J. Pearson. Emotional Problems of Living. W. W. Norton and Company, Inc. New York. P. 231. 1945. Cy, L. P., J. T. Davis, and J. T. Lanrnan. Ophthalmosc0pic Finding During First Two Weeks of Life. American Journal of Ophthamology. 36:85-99. January. 1953. Gesell, Arnold and Amatruda. Developmental Diagnosis. Hoeber. New York. P. 293. 1952.. Gesell, Arnold, Francis Ilg, and Glenna Bullis. Vison: Its Development in the Infant Child. Pp. 264, 293. Hallenbeck, Jane. Pseudo-Retardation in Retrolental Fibro- plasia. New Outlook for the Blind. 48:301-302. November. 1954. Hess, Julius H., and Evelyn Lundeen. The Premature Infant Medical and Nursing Care. Second Edition. J. B. Lipponcott Co. Philadelphia. Pp. I3, 18, 315. 1949. Kerby, E. Edith. Blindness in Preschool Children. Sight Saving Review. 24:22. Spring. 1954. 47 11. 12. 13. 14. 15. 48 May, Rosalie. Manual Diseases of the Eye. Twenty-first Edition. Waverly Press. Baltimore, Maryland. Pp. 203, 229, 304. 1953. Mimeographed Summary of the Findings of the Committee of Research at the Symposium on Retrolental Fibroplasia. January. 1955. Scholl, Geraldine. Personal Communication. Stiznson, Paul R. Personal Communication. Terry, Theodore. A Visual Defect of the Prematume Born Infant. Outlook for the Blind. .392211-213. October. 1945. MlCHfG/a-N STAJ'E L111: f 7:; J”: r INSTZUC EQHAL MAT-{RALS C£:“.‘f£5. ceuf-ee OF ELMCAI we Fta as?! 00 Not Take Frail DTS:Vanaken . 19 5 5 . H- A . 3’ .\ .. ‘4 i .7 ‘2’ . ’Q .- ? '3 MICHIGAN STATE UNIVERSITY Ll RARIES II I II "III I 3169 58 I II I! 3 1293