lllHl I l I 1 I \ l ,I. ‘ I: ‘ ll \ ‘ ‘1‘ II I \ Ill I EVALUATION OF CHANGE IN INTELLIGENCE; 300m BEHAVIOR, AND PERSONALITY OF A GROUP OF EIJOTIONALLY RETARDED CHILDREN. by Norman Walton Thomas August, 1958 a : i 3‘ afi :- qua-“9:0 "- r '9 ‘9 AN EVALUATION 0!‘ CHANG! I!" INTELLIGENCE, SOCIAL BEHAVIOR, AND PERSONALITY OF A GROUP 0? WIONALIIY RETARDED CHILDREEQ A Study of liva Childran in Family Cara Placement at Lapaar Stata Hana and Training School for tha butally latardad at Lamar. Inchigan by Roman Val ton Thomas A ".0ch? REPORT Submittad to tha School of Social work Inchigan State Univaraity 1n Partial Fulfillnant cf the Raqutrmnta for tha Dagrea a at mnwsocmm Auguat 1958 Approved: (7%“ A/ m Chairman, Raaaarch Go-tttaa giant“ of School V i}"‘;f‘“'.‘§ Regrcifully, I can mention only c few of *hc many pea 1e whose : v,. ' - . . f.‘ ' _' .. .. 1 \ . J. 1 ' guco.uce, 1nte1c t, :nd cnxalllng suglort, hc1,cc me to COUleLe tuxs IJrojoct. I wish to express my deep firstitude to the f.cu¢t7 of tne ”2 University School of Social nork, CSyCCially my project p. O )— 4 .— P. v i ?‘ ‘. C. H (I) h’ c 1 (“I connittcc, Dr. Lucille :arber(¢hairman), fr. fiyrtle Raul, and Er. nan- frcd Lillicfors, nhosc untiring effa'ts hc1,cd me to reach a ‘rofession- 31 level in social LGIk through his project. My sincere aggrcclztion is :ckaomlcdged to :he meticv Superin- {cndont of La“c;r Jt.te Tome Lao Trainng JcLool, fir. A. T. Rehn, a;oce an rovzl made tLis .rojcct possiglc. Finally, :hc deep infcrust of the L3;ccr Store noge and FrainLng Jenocl Jocial Service Begzrtmcnt and the {a Lly core stuff, especially ‘ ‘ - - - 1".‘.~.. I “‘ a t . . .o t ‘ .n ' H“ I l... 3- “‘.\ .v -- ‘ . .' -'-r.. .- tgc fibullf Uch Jh CLV190r. L. ocLyl plquQ' uno lup;?d 1 .or_cut l“- formztiou uuhcuitantly, hvs been inspiring and doc 1y ag recicted. ii MIWION To lb lifc. Ihoaa Inapiting ad Helpful Participation Iada lly hoiaaaional Training Poaaibla T ‘1 Y‘ ' I: '.-.‘-“I 4' Ltd \’l '1‘ ".1 _ ‘a nn " L‘a 'aJ [ '\ ’33» ' ..,:)1.?-.. \3 A1 «AK-J A.” \.’)o/L1AJ...0..0..00......0000.........I ~"’""‘ “‘~‘J“..............................0..... Lilia. tor I ‘.T"‘"- .-‘);‘-'“"~“'; ‘Y? . i‘t.s\u'“LLJKM‘OOOOIOOOO0.0.0000...O... II. iiI $17.17.} EL idlfiigiflviiq’i) {JD CU III. {-24.3033 BEL) "i‘t’llifllif‘xj 3... IV. 331177 'viii i‘.'..‘ii.=i€ (31" 3‘1": 1).. . . . . v I '1":“ ‘3'. uga ‘Il’y" . L‘LJLsu.~-:Ll‘- \I;\........... I .'.“"‘ I‘.“'?: ‘1“ (I. -'\J.L\~JLu-J.LL,.\J...0....0..o.C A.’L‘2£‘3-)IJ\’O0.0.0.00000000000000000to. 4231;}LIOGQJ‘M_:IY..g...-00000-0000aoo00. 1 "‘"r C'L; .u :54“ ...... 0..... "P: I I} .iui. 45 I'll; Iii CHAPTER I INTRODUCTIOI With incrouing okill in diagncaio. personal of institution oro booming concerned vith tho increasing number of committed children who oro not actually aontclly rotordod but onctionall: rotardod. For tho purpooo or thio otuiv. tho nationally rotcrdod child. io dotinod u a child oho fro- all clinical and poychclcciccl manifestation opponro aontall: rotordod. but my hovo normal or near noraol potontiol. Tho child io rotardod because of that com to ho o lack of oacticnol grcoth. Lopoor Stato 8cm and Tracing School. on institution for tho nontclh rotordod. initiotod a family caro program thirtoen yours ago for ooloctod potion“. M dotiniticn, ”tail: coro ia tho cm of patiocto who no moo of inotituticno or tho out..." inlhcaoo not their con. pay-oat boin‘ undo tor thoir oar-”.1 Binoo tho adaption at tho family ccro program thoro hcvo boon continuum offcrto to dotoct and hoot tho onctionolllrotcrdod child. '0 Guano-tic critoria hoo boon found. Whon notional roux-anion io mpoctoo. they oro plaood in o family caro hcao co o trootment nethod. ' Sinco tho validity of family ooro oo o trout-oat aothoo for tho oacticnolly rotardod child has not boon oatabliohod. tho prion-y yua- 1LT. Rohn, Etholbort Tho-no. ond m. 3.271 Biohop. jam ' . 1. .. 1 , ._ . J‘ -2- pooo of thio projoct io to dotornino if fail: ooro io on offoctivo troat- aont aothcd. rivo coooo of oppmnt notional rotordaticn he." boon oo- loctod froa tho family cox-o prom for thio purpcoo. Thio no dcno h: dotoxnininc if thoro had boon opporont pcaitivo chongo in tho orooo of intolligonco. social bohavior and pencnolity. Tho fivo coooo hm boon doocrihod in dotoil to illustrato tho pottorno of dovolcpnont. Although thoro io nood to mlnato footer cox-o trootnont for all 2. thin could not ho dcno hocouao of tho longth cf tino involvod. Tho notion- typoo of pationto who participato in tho family ccro prom our rotordod child on ooloctod boomoo natnrcl quooticn oriooo roari- inc tho offoot cf inatitutionolizoticn for a child who ia not actuolly nontoll: rotardod. and boo-coo of tho vrritor'o porooncl intmat. iloo. thio prohloo io tho ccncorn cf cthor ogoncioo on roll. Thooo childron nu ho found in ogoncioo placing noraol childron, hcopitola for tho nontolly ill. childron'o thoo. and training ochcclo for dolinquont ohildron. Printo counoolinc ogoncioo ond child guidonco clinico oloc loot thio prohlono fictional rotu'dotion io not o I" ccncopt. Rondo-footlo- nindodnooo ( or iconic—inbuility ) hoo boon o canon torn onyliod to thiokindoflinitodmncticninc. bctit ooooo tchooaonorol torn including non: oticlcgiool foctoro. Arthur}. Dcll‘. hiatus. and 2Boo ippondix,’ 5. 56:». Arthur. “Poondo-l‘oohlolindodnooo, " W 1-11 (00mm 1947) no 137-42- ‘nm A. non. 'l‘oohlonindodnooo Vorono mun-om Botcrdaticn." - -. . J: . LI (1mm. 1947).nn- 456-59. 5SAL. Bijou. "Tho Problon of tho Poondo-Ioohloaindod.‘ M W xxx (October, 1939), pp. 519-526. lllt \a. -3- Guortin6, have all described various etiological factors. Guertin menp ticna two, Fporsonality disorder", and ”delayed maturation". both of which seem to be similar to the presented tern of emotional retardation. However, A.D.B Clarke and A.M. Clarke7 maintain that the term pseudo- feeblemindedness should be applied only to those cases where an erro- neous diagnosis of mental retardation has been made, not where there is a lack of emotional growth. It will be assumed in this project, for purpose: of clarity, that emotional retardation is an etiological factor under the general heading of pseudo-feeblemindedness. There are further difficulties in clarifying emotional retardap tion because of other terms that are used (not necessarily in relation to the mentally retarded) such as emotionally disturbed, childhood schizophrenia and mental deficiency combined;. To illustrate the com- plexity of differentiation and the overlapping of symptomutology. several authors are quoted regarding some of the abovo groups. Lauretta Bender8 describes the schizophrenic child as follows: Thus, some schizOphrenic children are regressed, retarded. fixated, blocked, inhibited, mute, autistic. withdrawn, physically asthenic. puny, or under-developed, unsocial. unable to relate, concretistic in their thinking ... Such a child could behave as an emotionally retarded child. 6Wilson 3. Guertin, ”Differential Characteristics of the Pseudo- Foeblonindod," American goggnal 22 Mental Differential, LIV (January, 1950). PP- 394-93- 7A.D.B. Clarke. and 5.3. Clarke, NPsoudofeeblemindedness-Somo Implications, ”American Journal of Rental Qoficiencz, LIX (January, 1955). PP. 507-509- 8 Laurette Bender, "Schiz0phrenia in Childhood-Its Recognition. Description and Treatment,” American Journal of Orthopsxchiatgz, XXVI (July. 1956). pp. 499-506. . .I IIIIII -4... Bergman, Waller. and Hal-charm9 differentiate the defective child fro! the schisophrenic: lost reports suggest that the one fundamental difference between the defective child and the schisophrenic child is that the de- fective child gives evidence of retardation at birth or in early childhood. whereas the schiscphrenic enjoys s period of nests). efficiency superior to that which brings hi. to clinical atten- fiancee for the autistic child. tanner1 0states. During the past ten years. we have becoae acquainted with a circumscribed syndrome, now known by the acne of early in- fantile satin, which shows itself in eatrese withdrawal and obsessivoness beginning as early as in the first two years 0: life. lost of the autistic children are functional idiots when they are brought for examination at 3 or 4 years of age. may do not talk. do not respond to other people. have tesper tantrums when they are interfered with, have peculiar stereotyped actions. and are not accessible to any kind of testing. lisenherg and Kennel-nook. ”that the process antics was not one of Withdrawal fro. forserly existing participation' with others. as is true of the older sohisophrenio child... ", which would mks a differential dimosis very difficult. Druno “woman.“ ”apparent retardation" along numerous pat- terns such as usual disturbances, learning inhibitions. actor distur- vw v FV a a —v fifi— 9Hurray Bergman. Reins Waller. and John Karchsnd. "Schizophrenic Reactions During Childhood in Isntsl Detectives, " W W LII (March. 1947). pp. 79-85. who when! 'Ieehlssindednesss Absolute. Relative and Apparent. " W ml . October, 1948), pp. 365-397. union Eisenherg, and Leo Kanner. ”Early Infantile Autism," WM 1371 (July. 1956). pp- 556-66. 123mm Bettelheim, W (Glencce, Illinois: The Free Press, 1950), pp. 3-375. -5- banoes, insomnia, fears and anxieties, hyperactivity, obesity and overt eating, vocal-inhibitions, self-destructive tendencies, and thumb-sucking that are symptomatic of emotionally disturbed children. The five cases of emotional retardation which are presented in Chapter'LI, show very similar characteristics, but there are also some significant differences. The following quotations by Cassell15 sees. applicable to all terminology. He states that, ". . .the problem is what is feeblemindcdness and what is childhood schiZOphrenia. It is a gross understatement to say that we in the field do not agree as how to identify either condition". He concludes that the problsn.might be, "one of cause and effect where the one category gradually and imperceptibly shades into the other." It is hoped the presented cases in chapter‘;!.possibly will become useful in future attempts to identify some common characteristics of emotional retardation, and eventually provide a method for early'differb ential diagnosis from the types mentioned above, besides differential diagnosis between emotional retardation and actual mental retardation. , 13Robert H. Cassell, "Differentiation Between the Hental Defective aith.Psychcsis and the Childhood Schizophrenic Functioning as a Mental Defective, "Amerigag Journal 2f.Mental Defigien oz, LXII(July, 1957), pp. 103’107e Ihs hcticnelly Reterded Petient listerieelly, the eentelly reterded sees thought to be effected by «a mat. am with the deformed end nentelly 111. There were very poor facilities for the care of the eentelly reterded, if say, end there see no process of differentietion between them. During the first pert of mam history, mm- A. Meander“ stetes thet, menu: eu- tnrbed end feeble-einded patients—children es sell es sdnlts-oeers usu- ell: left with their fenilies end without speciel cers". With such edverse conditions end leek of concern for the patient, it would seen unlikely that the concept of .ctionel reterdstisn exist- ed st this ties. The fect thet eentel reterdeticn see considered heredi- terp brought shout such concern by Goddard. Il'his led to sociel esthsds of preventing reproduction. Since ebcnt World iiias: I, there hes been s (reduel change in thinking, end progress have been initieted to piece the eentell: reterded beck into the sensuality. Together tith this, there hes been lore individnelisetion end e deeper concern for e diagnostic evelesticn in order to determine effective treeteent. Beeeerch hes been done to dispel felse idses ebost‘ the esntelly fir f _— “mm A. mound». Wm (anal-nod Cliffs, lee Jersey: Prentice Hell Ino., Sept—her, 1955 . p. 85. -7- retarded, such as the studies by Marie Skodahls, end.Harcld I. Skeels and Irene Harms.16 These studies brought out quite conclusivehy that environment had a great deal to do with children born to mentally re- tarded parents, disproving that all children born to retarded parents are retarded. The specific problem of the etiology of the emotionally retarded child has appeared only within the last two decades. Probably the first systematic research was done by Harold M. Skeels and Harold B. Dye.17 They based their project upon a postulate of Binet, who wrote in 1909: Some recent philosophers appear to have given their moral sup- port to the deplorable verdict that the intelligence of an in- dividual is a fixed quantity, a quantity which cannot be aug- mented. We must protest and act against this brutal pessimism. We shall endeavor to show that it has no foundation whatsoever. Findings by Skeels and Dye, relevant to this project were: A change from mental retardation to normal intelligence in children of preschool age is possible in the absence of or- ganic disease or physiological deficiency by providing a more adequate psychological prescription. Conversely, children of normal intelligence may‘becone len- tally retarded to such a degree as to be classifiable as feeble-minded under the continued adverse influence of a relatively nonstimulating environment. An intimate and close relationship between the child and an interested adult seems to be a factor of importance in the mental develoPment of young children. The possibility of increasing the mental capacity of 'func— tionally' feeble-minded children should be considered as an essential objective in setting'up an individualised treatment 15Marie Skodak, ”Intellectual Growth of Children in Foster Homes," Child Behavior and Develo ment ed. Roger’Barker, Jacob Kounin and Herbert Bright, thraw-Hill Book Co. Inc., 1943), pp. 259-78. 16Harold M. Skeels, and Irene Harms, "Children with Inferior Social Histories: Their Mental Development in Adoptive Homes," Joggga; of Genetic Pszgholog, LXXII{lIay, 1948), pp. 283-94. 17Harold M. Skeels and Harold D. Dye, “A Study of the Effects of Differential Stimulation on Mentally Retarded Children," Proceedingg $34 Addresses of the American Association on Mental Deficiency, XLIV 1959 , PP. 23.240 4- end educational program in a school for feeble-minded. this study provided a basis for luily care as a possible treatment method. need-lain” points set M. interpretation of the sunset litera- ture cm the emotionally disturbed end pssadoofeebluimded child: lemeehildrenere unctiomsllydistnrbed that theyappeer ts be mentally retarded. Because their behavior is so closely skin to that of the severely retarded, some authorities say that the two conditions cannot and should not be differentiated. They point out that the leBhotic behavior of one of these children or the behavior which seems to be extreme frustration is also s consequence of mental retardation and that to assume normal - or superior intelligence is unrealistis. His personal opinion is that, "Pseudo-retardation snvircnentally ceased, in many cases, if caught in time can be corrected". "ht. poverty, notional problems, physical handicaps or simple educational problems can cause psudooretardaticn'. Itseusteeoertaiasatententhorshaveaooepteducticmalm as an important factor in mental retardation, bet there is some pessimi. toward the need of differentiation diepcetioally or in treatment betwe. the pseudo-retarded and those actually reterded. temdlyders Together with mentally ill patients, the ears of mentally handi- capped patients in private hues sons to has originated several sen- tnries age in heel, Belgium. this plan spread gradually to other countries but it did not come into existence in the United ltetes entil 1931 when the lewerk State School in low York state developed a pron. similar to the ”II-nu non-Hum. W (mm-19m: Lippincott, 1956), p. 20. . x u u A .-...1 It e i . - I . D I . . l A . _ . “to .- ~9- Gheel sycteu.19 The literature on the whole reflects a favorable attitude toward fanily care but it is still in the exploratory and descriptive stage. There is no literature containing any real effort to measure the value. nor to determine what kind of patients can best profit from.sueh a prcsrnn. Despite knowledge of both the emotionally retarded child and of fam- ily care prograns there is no author within the literature covered who mentions the possibility of faeily care iteelf as a treatment nethcd for emotionally retarded children. In view of the historical perepeetive,it is important that a sum- nary of the development of Lapeer's fanily care program and its pumt structure (as of September. 1957) be given.becauas it is ecnoeivable that organisation. spirit. and staff develop-ant directly affects the person- ality. social behavior, and intelligence of a child. and the reporting thereof. The progrnn has now been in Operation for about thirteen.years. Free 1944 to 1950 the progran was carried on by a regular social service worker above and beyond the regular duties of the Social Service Depart- ment. (Assignment was based on whoever was covering Lepecr County for the institution.) There were no graduate workers in the department during this period. It was difficult for any worker to devote time to individual work with any of the children. Adjustment depended much.upon the child and the ability of the footer-care parents. In 1950, an experienced worker It. placed in charge of family'care on a full-time baais. is the caseload grew. this worker introduced the pceiticn of Family Care Worker, which was filled by a practical nurse 1glicratio‘l-X. Pollock. "Requisitee for the Further DeveIOpnent of Family'care of Mental Patients.” _; -;: .' . . :1 a ,1-- L (October, 1945)s PP. 325'290 -10. who was already employed at the institution and had experience in caring for mentally retarded patients. Kore workers were added in later years, all of then being familiar with the patients before assuming'their new role. There are a total of five at the present tine. The family care worker supervises the family-care homes. reports on the patients' progress. transports the patients to and from the inp etituicn when medical. dental. or Optometric care is needed, and works closely with the social workers to bring'both disciplines of nursing and social work together for the benefit of the patient. The social worker primarily investigates and licenses prospective family care homes and screens the referred children for placement. De- termined by head and time, the social worker may carry a shall caseload of children considered to have some potential for development. There were two social workers as of September, 1957. one coming during 1955. and the other in 1956. The worker who originally started on a full time basis administers the program at the present time.zo’21 fl W W fir— ffifi mlv;.I.Biehop, "Family Care. The Institution.” W W LIX (October. 1954). pp. BOB-16¢ 213.3.Biehcp, "Tamily Care: The Patients," W LXI (January. 1957). pp. 583-91. The five cases presented in thiestudy'eere chosen from a total of eight considered enoticnally retarded as this tern was defined in Chapter L. Rooms of the use of detail in the inetitutionsl records. n11 eiflt cases could not be presented in detail. Those selected were chosen'hy placing names of all eight children on concealed separate clips of paper and selecting five at random. Such a cnall number of cases cannot be statistically significant. The records on patients at the institution give a complete but general picture of growth and novenent. Only important event; are re- corded in detail. Also the work load for any particular observer may vary at different times. The cottage report-22m usually annual routine reports nude out by cottage supervisors to give er general picture of the child. Their validity may be questionable because of differences in observers and discrepancies in what a child can do and what the child is allowed to do. Tor example. the child may never have an opportunity to learn to cub his hair or take a bath. having this done routinely by the staff. Consequently. with these three variable conditions. the records vary in useful material for this project during the periods covered. Pereonality, social behavior and intelligence were selected as criteria. to illustrate emotional and intellectual growth. which is the *— M 225.. Appendix ‘e -11- -l2- , concern of thin project, as opposed to physical growth. Bacaueo of the abstract nature of those criteria, direct or statistical measurement will be imponbible, with the exception of intelligence whore there is standard- ination of p:.;rohometric examinations. However, even here tho-re are diffi- cultiea that arise. There are many variables in a testing situation and an LQ. is at cost only a good estimate of intellectual functioning. The patient new not feel well during the testing period or there may he entrees fear or the mating situation. The nature of the personality and orienta- ' tion of the prsychcmotrist in a concomitant factor elm). In the five cases chosen. there was no uniformity in giving these examinations, that is. one child may {we been touted ovary your, another child every two or three years; therefore, a continuing growth process in intelligence in QC. canes cannot be seen too clearly. The cchcol grades were used where possible to eupplonent the payche- netric examinations. Homer. the ranch cannot be considered an accurate eeceureaent because there are different attitudes among teachers and school ministrators in handling rentally retarded youngsters. Bole teachers nay mark sufficiently high to encourage the child. others as, treat the child the one as the rest. and still others because of their negative attitudes toward rentally handicapped children. nay purposely hark lee. Those one attitudes slay exist in adminietrative philosophy else. In regards to social behavior, the Iain difficulty lay in the area of teninelog since each observer-who're different-suing for-apar- tioulor descriptive torn. or a child's action my have different sensing to each of the observers. Also, there remains the possibility that s particular child reacts differently to different observers. tor this men it was felt that description should not be narrowed to a single -13- observer, but to all observers with definite reference to nurse, doctor, psychologist. social worker, teacher. foster mother, or natural parent where possible. inothcr difficulty in that many of the child’s actions are not fully described in the record. It was impossible to obtain more explicit information because the particular observer was unable to recall situations specifically. Other limiting factors are the veracity of reports about the child prior to admission. and the accuracy of reports from the cottages while the child is in the institution. Parents may be anxious to have their child admitted in order to relieve their responsibility. Other parents may continue to minimize their child's defect in the face of necessary commitment. Subjective opinions and comparison to normal behavior are often made together with overetatemente end/or understatemente of the child's ability. In the cottages at the institutions there is little possibility of individual observation because of the small number of staff to the number of patients. Personality is the most difficult to assess because it includes a wide variety of elements and in some ways intelligence and social be- havior can be considered part of the personality picture. The problem of including both within a structure of personality, and at the same time differentiating the personality growth process, was accomplished by taking into consideration the total picture of intelligence and social behavior and interpreting he possible inner feelings and attitudes toward situa- tions. In this any, personality actually becomes a soprrnte criteria because despite a gain in social behavior or intelligence (outward or sur- face criteria), there may be no gain or even a loss in personality growth. Explained another way, a child can show graciousnees and cooperation, but -14- it may he a defense against losing love and acceptance. The limitcticn to such an approach is that it is primarily assumption, and validity cannot be definitely established. The institution uses certain terminology in its reports. Untidy refers to the incontinence of the bowels and bladder, and tidy means the opposite. The cottage refers to the regular building that the patient occupies. The nursery is a special building for children usually fir. years of age and younger. Trainability means the patient is cspeble of training for some simple vocation such as housework, baking, turning. otcstera. Wherever the word foster appears, it refers to the family our! placement. A classification chart is included in Appendix A to define the diagnoses that are given.fcr each child. No information of the foster home or the character and personality make-up of other family care patients in the same home is given because such recording is not the purpose of this project. This report is in. terested only in what the child appears to be, without consideration for his total environment. Only in cases where the staff outright questioned the value of the foster home, was this mentioned. Meet of the statements in the data are directly from the records. It was necessary to obtain further data during the process of the study since more explicit infor- mation was necessary for interpretation. This information was obtained from the supervisor of family'carco It is assumed in this project that with these particular children there has been an emotional deprivetion<=nusing regression or retarded growth. After treatment, it must be remembered that it cannot be deter- mined whether a child who scores on I.Q. of 85 or 90 has actually this original biological potential or whether this is the effect that is left -15- from deprived circumstances. During the second emotional growth ac to epeek, much of the content, culture, and education of early life he: been missed. The preeentetion of data is divided into four periods. The ”Social History Prior to Commitment" includes the birth history and subsequent deveIOpment up to the commitment order. The section "Commitment cad Admiceion" covers the commitment order, the intervening period between commitment and admission, and the admission process which includes a soap oral observation of the child, a medical cremination, and a psychometric evaluation. The ”Inetitutional Period" covers the growth and development following admission up to placement on family care. The section "Family Care" includes all reports during each year up to either discharge Iran the institution or the present time, September, 1957. The evaluation of this data is given in Chapter*1§ "Interpretation". The conclueione follow in Chapter ’1. m1? manual or mm 3‘11: MW 4-11: 1- . um- ohm. born me 22, 1947. the firet child, with e brother born c m inter. 'l'he nether no the inter-Int. There no exoeuive waiting during the groan-no], other oneethetio at delivery, and twin hours lebor. on. delivery no ”cutaneou- eod the birth weight on cover pounds, three ounoee. There no no evidence of birth inaury. She one bottle ted until fifteen loathe of ego, toothed et ton Icnthe, eet without support ct eix Ichtho,to1hed in word- et three your, nlked clone et enteon loathe, end no toilet treined ct too undone-Wynn. Bhemuunbuulerutorherece. rheonly childhood dioeuo m leoolee. The father hit her, and yelled at her. Eelly toured her tether. Bornotherendtethoruredivoroedlhonsellymebout threeyeereet one, enormoh ehempleoedineboerdiuhoue. ,‘lheboerdingporente mldnctheephorheoeeee oheeriedolluidit. rho-oom- coo-editi- mm in Belly, but found it difficult to core for her children am the divorce. Belly not clan; with her brother end ell other children. hoopt for deetructivoaeee, her behovior honed good, Idth no two: tantra-e, roetloeaneee or over-utivity. She no effecticnote. Other hetero in the eooiel history included: to uneteble peternel -16- . -17- grendfether; a paternal uncle committed to an institution for the mentally retarded; a half-sister in the first grade at the age of eight; an emotions elly unstable paternal step-grandfather who was alcoholic, sexually demand- ing and lazy; and a father considered to be of no more than dull normal intelligence. Qcmmitment and Admission, -Sally was committed to Lapecr at age three end one-half. The commitment order read as follows: She cannot talk. Walks with difficulty. Cries constantly. She cannot feed herself. She is not toilet trained. Diagnosed...as mental retardation,...She does not act in any way like a normal child. ' Sally was admitted to Lapeer at the same age as commitment. Her 23 physical appearance was stocky. She was diagnosed as familial. She was a neat child, responded fairly well, was tidy, fed herself, ate very well, brushed her teeth, said quite a few words, played well with the other children, was very quiet, and easily managed. The doctor described her as a child with a slightly dull expression who was fairly cocperstive. She cried often, and was unable to respond to questions. SheIIs well nourished with no medical problems. The psychometrist described her as a defective looking child. She was able to follow simple directions and was fairly well develOped in language. During the testing situation, she was rather uncooperative and very hyperactive. It was only with difficulty that her attention was obtained and held. Her I.Q. was 65 on the Kuhlmann- Anderson Intelligence Scele, with a social quotient of 90 on the Vineland Social haturity Scale. Institutional Period. --Sally remained in the institution for one year and eight months. Six months after admission she was described as being e 23This is a diagnostic term.used by Lapeer. See Appendix A. -13- nest, clean end tidy child who spent her leisure tins pleying with other children. She nede friends eesily, was not destructive or ill tense-ed. She cculdnctseshherfece, brcehherteeth, teksebethcroonbher heir. She wee described es an ugly smearing child. One end one-half years after admission, Sally played with toys es well as other children. She could lees her shoes, but could not tie thu. She could put on her own clothing end button it. She could brush her teeth but could not wash her face, tehs e beth or conb her hair. She . slept end ete well. Belly continued to nets friends end to be nenepd eerily. She tclhed to ettrect ettention. Just before plecenent, she was described es s pleeeest child vith no temper tantrums or destructive tendencies. She pleyed well with other children. She ney have usturheted. [or speech was indistinct, end she did not are about her eppeennce. She neinteined strong ties to her ~— nether, end seemed to understend way she (Belly) could not stay with her. She tended to be clin‘ng to edults who paid ettsntion to her. The record consents thet there were ”eons inner feelings of hostility“. m-ofiellywespleoedcnfenilyemcneyeerendninensnths efter admissicnet fiveyeersendthrsenonthsofece. Sellyseenedto shew centimed identifioetions with the children at the institution. Durincthefirstysercfplecenent, Sellyreneinediehsrcrisinel hone. She shook run end dust nope, cleared the table efter heels, can; sense endrenesbersdsisnifioentorcutetendinceveets. Sheseenedhespyend contented, end needed 11m. entertei-ent. She wee well mm, but sly. Sheseaedtcheveephentesy life. Anotherchildinthshcne, plecsd before 3.11:. see J‘eeleus of 5mm presence st first, but it weerepcrtedleterthettheysereedaustiutoeeshcther. luster-it‘s -19- learned that Sally played sexually with the other child at night. This activity stepped when Sally was placed in a separate bedrocn. However, there was a renewal of masturbatory practice. Toward the end of the first year Sally began to seek more and more attention and became upsetting to the other child. She natural.ncther kept in contact with the agency during this period. Sally did not attend school. During the second year of placement, Sally'was placed in her own home for one month upon the mother's request. The brother was Jealous when Sally first returned home. A good adjustment was reported soon after- ward. However, Sally was unable to remain at home because of household dif- ficulties. She was placed on family cars again upon her return.to the in- stitution, but in e different home. She colored between lines and the fee- ter mother was in the process of teaching Sally to reed, print, and count. She rebelled against orders, but responded to kindness. She played doctor with a doll, and also played mother to the other child in the home. She followed the foster mother like a shadow. She enched Sunday school. Her speech defect seemed to be disappearing. She made the beds and wiped dishes. She was forgetful. She played well with the other foster child. et least, there was no outward Jealousy. On the Standard Revision of the Stenford- Binet Intelligence Test-Porn L, Sally earned an I.Q. of 79. The psyche-e- trist indicated that her speech was becoming'distinct enough to be under- stood. Because of this, the psychometrist felt there was a better psycho- logical adJustment, together with an ability to concentrate and think better. She showed potential normal intelligence, but her speech defect suggested that her emotional problems were not entirely alleviated. During the third year, Sally was able to clean her room, wash and dry dishes, set the table, dust and sweep. She seemed to have ears pride in personal cleanliness and neatness. The other child missed Sally'when -20- Sally was in school. She began kindergarten at seven years of age and was doing fairly well as reported by the teacher. She colored well in her school books. During the next half year, she passed into the first grade. During the next year there was another child placed in the home. She "differentiated" the family care worker from the foster mother and was easily man 59d. he was not as forgetful. She played nicely with the other children as well as with neighbor children, but was shy with adults. She passed into the second grade with "B's” and ”C's" on her report card, and showed consistent improvement. Her speech was much improved. During the fifth year, Sally became a definite favorite with the foster mother. She passed into the third grade with an "A" average and went to her own home to live with her mother and step-father. She was sub- sequently discharged as not mentally defective. Mary Social histogy prior to Commitment. ~qhary is a white female child, born February 15, 1947. There was a sister born in 1949, a sister in 1950, a brother in 1951, and a brother in 1952. The mother and grandfather were the informants. There was a twelve-hour labor with a normal delivery. 8he gained well. She was breast-fed, weaned at one and one-half years of age (unknown whethrr from breast or bottle), and had all her teeth at two years of age. She contracted chicken pox at two years of age, and measles at three and one-half years of age. There was a convulsion for a period of two hours at age six and one-half years of age, with the following symptoms: starey eyes, apparent unconsciousness, inability to control urine, bitten tongue, and loss of leg control. This wes diagnosed as epilepsy. Another seinuro -21- followed soon after, with confusion, and inapprOPriate statements. During the following month, there were occasional mild seigures with confusion again. At a children's clinic no pathology could be found, and a diagb nosie of degenerative nervous condition was given. She was given a seda- tive and fed by a tube. At a children's hospital, about tie months after her first seisure, she was completely uncommunicative and out of contact with reality. Her movements were purposeless. There were athetoid move- ments of extremities. drooling, spasticity, and rigidity. Before this experience, Hary had normal play habits. She got along well with her brothers and sisters, taking responsibility for their care most of the time. She was considered normal in every respect until her first seizure. Her'mental age was above her chronological agemat three years of age. She lived with her parents in the paternal grandparente' home. It was described as filthy and cold. The food was inadequate. Her father was considered lasy. He also had a violent temper. Her mother seemed ignorant in household matters. Mary was placed in a boarding home for a short time at age two as a result of a neglect charge against the parents. Other factors in the social history included: A paternal grandmother who was lazy and alcoholic; a maternal unc1e_who was crippled and believed to be of low mentality; a father described as nearly alcoholic and of low mentality with anti-social attitudes and psychosomatic difficulties (that is he had complaints without apparent organic findings); and a mother who was rated very low average on an intelligence test. After Mary's admission to Lapeer all children were taken away fro-.the parents and placed for ediptisn. Committment and Admissigg. -Mary was committed to Lapeer at age six years and nine months. The findings of a children's hospital and a physician's -22.. report respectively are as follows: Our studies have revealed the presence of a severe degenerative central nervous systes disease for which there is no effective treatment. It is our feeling that she requires symptomatic end supportive care and that this can best be provided in en insti- tution for the care, custofl end tresuent of such sentelly diseased persons. ' This child has s severe type of degenerative central nervous disease which is promcsive end for which there is no cure. required 24-hour e day care and continuum sedation to control convulsions. She renains in s comatose state and is s custodial care patient ... lisry was admitted to Lspeer st six years, ten months of age. She wouldnct talk. hsdtohefed, endwouldnctnove, excepthersrnee- eesicnslly. She was untidy and would not do anything. i sediosl Jenn- instion two months after admission indicated her cooperation es nil, there use no speech, end only s prone posture. i psychometric test one nontheftsrednissicsindiestedthstshesequireduvhcursdsycere. ressined in s ccsetcse state, was totally unable to cooperate, end leg in a fetal position. in 1.3. of one was given arbitrarily fer stetieo ticsl purposes. W. o-Isry was in the institution newsmnonths. lathe first cottage report was four nonths after ednissien. She could not dress, or less and tie her shoes. She was bottle fed and given e sedative. the were diapers st ell tines. There had been no progress since admission. in the seventh south to the eleventh south, there was s noted change. Bhefiegsn‘toreepcsdtocnsnursewhcepentsmstdeelcftinetslung with her .a rocking her. she began to push herself into s sitting po- sition and later began to talk, saying words with an apparent association to her past. Her speech beeese ‘repetiticus ". Soon she began to notice things about her. She began to set for sisple things such so Juice. When her speech beonee sore fluent, she began to curse violently. rhea -23- she walked. m- was a period when she was quite difficult to snap. She bean to talk in unconce- and by the tenth nonth m was talking quite rationally. l ‘ social worker who booms quite interested in Diary after adnissia, noted the possibility of notional retardation because her eyes appeared wild and fearful, unlike the severely retarded child. “:- 1. medical report one year after admission described her as a child with pleasant facial expressions, good development, good cooperation, fast but. distinct speech and good response to questions. She was hyperactive and very irritable. it the tins of placement, she still had severe teaper tantrues. Althom she entered into play activity, she did not seen to involve her- self emotionally. iocording to the record, she seened to have sons inner feelings of hostility. mm.—lary was placed on 1"“in Care eleven eonths after edaissien at sevenyears, nine'sonthscfage. Sheresainedinthe scaehoneccn- tinuously. it first she did not {.91 she was responsible for even sini- tasks around the house. During the first year she naintained good rela- tionships with the foster parent's childru who were older than lat-y. She enJoyed the outdoors and the freedo- to run about. She displeyed a strong tenper and at tines was gruspy, stubborn and conanding. She talked briefly to the foster parents, about her past experiences and considered her parents as nean. \ She attended peer groups with the foster mother. Ber appearance changed to rosier cheeks and sparkling eyes. She bean gaining sore. confidence and. was able to enter genes with less fear of asking sis- takes. She began to take advantage of a perniesive has environment. She seemed secure and happy. She becene interested in learning words and began school on a part tine basis at the age of eight. During the si-er -24- she picked strawberries and wont swimming. She washed and dried dishes, set the table and node her bed. She enjoyed being sick because of the at- tention. During this period, Mary was visited by relatives when she had always liked. She related well to them. More of Mary's background was related to her and she seemed to have a good amount of understanding. On the Standard Revision of the Stanford-Binet lntclligence Test-Fora 3:, Mary earned an 1.6. of 87, but she felt she could have done better. The psychometrist felt she was upset during the test. On the Sender Gestalt pest, it was observed that she was highly disorganised and very infantile in her personality make-up. Also, she seemed to have a low frustration tolerance. On the Children's Apperoeption test, it was felt she was reach- ing out emotionally toward family living. She passed into second grade. During the second year she complained of aincr aches and pains cc- oasionally. There were no organic findings. She got along better with other children in school and did not talk as loudly in class. There were further contacts with the sane relatives to when she appealed very such. She passed into third grade. She was discharged fros the training school at eleven years of age as not sentally defective. Ema MWWWW 1- . rum roman child. born June 7, 1941. The mother, social agencies and hospitals were the infor- mants. Balsa was born at home, with a physician in attendance. Labor was normal, but she was premature with a birth weith of five pounds. Ma was in the hospital in an incubator for the first three months after birth. She remained at five pounds for the first four months be. cause she was unable to retain food. Later she was bottle fed and weaned at two years of age. She teethed at one year and sat without support at -25. . two years of age. She was described as a very listless, pale locking baby at eleven months of age. isms recognised the family members, but was annoyed, when cared for or handled. her only play activity was to look around the recs blsnkly. She had temper tantrums and was difficult to control. She was affectionate. Emma's parents were on relief when she was born. It was reported that her parents seemed interested in her welfare and the home was pleasant. The nether worked two nights a week to help financially. (It is not hnosn if this happened after Elna came home or not). lbr father was sent to prison when she was three years old. Her nether went to a sedical hospic- tal soon afterwards and Ema was placed in a ”nursing home“ until her ad- Iission to Lapeer. Other factors in the social history ineludedc d.paternal (plane father who say have had syphilis (mind "completely gene" according to the mother); a paternal grandmother who had syphilis; a maternal greatasunt who was mentally ill with a diagnosis of dementia praeeox, paranoid type; a maternal aunt who was mentally ill with a diagnosis of desentis.prsecox, eatatonic type; a.mother who had four miscarriages; and a sister who had been committed to an institution for the feeble-minded. Qgngij.g|1_gg§_§§gigg§ggt acEmla was committed to Lapeer at two yosrs and two scnths of age. The comitnent order and one physician's report re- spectively read as followsl This child, aged twenty-six acnths, shows considerable retarda- tion in physical growth and sental development. There is a aarked actor deficiency in the lower extremities: she cannot walk, stand, or creep. Her sental reactions are either hissing. or very sluggish. This patient has the typical facies of a aongolian idiot and her reactions and expressions are typical of that type. She is two years old and cannot walk and is incontinent of urine and feces. Her reactions toward her surroundings are abnormal. ~26- Emma was admitted to Lapeer at three years of age. The nurses ob- served her to be of average size, untidy, unable to feed herself, unable to talk, but imitative of sounds. She crawled and seemed to be learning to walk. There was,a noticeable stiffness in one leg. She was pleasant, sleeping and eating well. The doctor described her as poorly coordinated, and small for her age. She was well nourished and healthy. A psycho- metric test was not given at admission. institutional Period. -- Emma was in the institution one year and two months. She was classified as fanilial.24 Her mother visited occa- sionally. One year after admission,the psychometrist described her as attractive and tidy with understandable speech. She was accustomed to playing alone. She was able to feed and partially dress herself. She was inquisitive, alert, very careful of toys, and "submissive (asked to play with an object)". 0n the test she reproduced simple block formations, named common objects,and pointed out pictures. She scored highest on picture memories. She placed the simplest puzzle together rapidly and was so enthusiastic ever play material that she ignored instructions, following her own ideas. The psychometrist felt she had ability beyond that shown'by the test if she had had the usual experiences. Her motor coordination was sufficiently good for her to receive credit for perfor- mance. Her I.Q. was 65 on the Cattell Infant Intelligence Scale and 69 on the Merrilquslmer Scale. L cottage report one year and one month after admission described her as healthy, tidy, able to feed herself, able to recognize food she liked or disliked, and able to dress herself. She played better alone than 24A diagnostic term used at Lapeer. See Appendix A. -27- with other children. She slept and ate well. She was a little stubborn at times. She talked and pretended to do all the things that were done in the hospital. She liked men better than women. At the time of placement, she was described as a docile, pleasant, agreeable, and submissive child. She internalized her hostile tensions and conflicts at moving into a family care home. She tendel to be soli- tary in her play activity. She valued materiel objects and repressed emotional feelings for relationships. Ermily Care. o-amma was placed on family care one year and two months after her admission at four years and three months of age. During the first three months, she seemed to be in a daze, reverted to baby talk, and was unrble to follow simple directions. She seemed to be tense in a close family relationship. However, she was likeable, well behaved, ex- ceptionally good natured, appreciative, happy and quite slert.t She feared being taken away from her foster home. She did not forget the institution, holding imaginary telephone conversations with the peeple of the institution. She dressed herself but could not tie her shoes or comb her hair. She was helpful by picking up things around the house. She helped the foster mother wrap her feet when the foster mother had arthritis. She would play by herself with toy dishes and imaginary friends. She did not enunciate clearly during this year and it was noticeable that she stuttered and stammered worse when excited. She talked quite fast. She was described by the psychometrist as attractive, responding readily, but with "indis- tinct speech as a result of baby talk". She still had a tendency to ‘ follow her own ideas rather than those of other people. She was unable to dress herself completely or wnsh her face and hands unassisted. She could care for her own toilet needs. She played scepuratively at the kinder- -23.. gerton level. On the swam Revision of the Stanford-Bind Intelligence Test-Porn L, she earned on 1.4. of ‘77.. She earned a social quotient of 94 on the Vinelend Social Maturity Scale. During the second year, there were few reports. It was indicated that she did not seem to stemmer and stutter so frequently. She was not a stiff-legged when she ran. She started school in kindergarten and re- ' pcrtedly liked it. During the third year, 0. picture of a human skeleton, sent her into hysterios. She claimed it use Seton. After one-half year in kindergarten, she was pueed into the first grade at seven years and six nonths of ago. She was able to print her name, copy some of the clphabet and a couple of words, and seemed to be doing well in school. he psychometrist described her as c pretty, curly-hired child who was friendly, cooperative, and very concerned about cleanliness. Ber ottention upon us short. During the examination, she too concerned about when she was going book to 31. foster home. She assembled the nenikin quite rapidly, She demanded con- stout reassurance and encouragement. 3h- corned on 1.61. of 95 on the Standard Revision of tho Stenford-linct Intelligence rut-For: In, and 3 physical quotient of 96 on the Grace Arthor Scclcol'on I. During the fourth year another child was placed in the hose. he received s Christmas card from her mother. he felt she had no friend. ct school. She lied, made up stories and “would go all to pieces when tensed“. She apparently masturbated until her genitals were sore. [It behavior and performance in the hone varied considerably tron week to not. he had o bed taper and her general mood determined her ability for the day. She did not got along too well with the children in school, but her academic work was good. She was second in her close in vent and phrceo recomtion, -29- and learned to color better. She got along with the other child in the home, and was able to go anywhere with the famihy. She was in the second grade during this year. The psychometrist described her as a neatly dressed, friendly girl who was able to speak alertly and distinctly. She was easily confused and exhibited a very unstable functioning ability. She was impulsive and quick with answers. She earned an I.Q. of 77 on the Standard Revision of the StanfordeBinet Intelligence Test-Form M, and grade 1.4 on the American School Achievement Tests. It was felt she should repeat second grade. During the fifth year Emma went into a new school situation. She liked school and was anxious to attend after the summer vacation. She helped her foster father with simple farm chores and earned money for this. She obtained a TD" in arithmetic but did fairly well in the other subjects, especially reading. She passed into the third grade. The psycho- metrist described her as attractive, friendly, well motivated and coopera- tive. There was evidence of "deep-seated" emotional problems, and she seemed to be denying her real status by taking the name of the foster parents. She had difficulty with space relationship items. Ber I.Q. was 75 on the Standard Revision of the Stanforquinet Intelligence Test-Form L. During the sixth year, there was another new school situation. She played outdoors considerably and got along well with other children. She started band and seemed musically inclined. The piano teacher was enthused by her ability to memorize as well as read music. She took six lessons during the year. During the middle of the school year, she received an average of "C" in her class. Two months later she received two"i's", twolflh's", and ”C's” in the remaining subjects. On the American School Achievement Test she received an over all 2.4 level, with a 2.8 level in -30- reading, a 2.2 level in language and a 2.6 level in spelling. She was pro- moted to fourth grade. I . During the seventh year, there was no report with the exception of the psychometric examination. §he seemed to have faulty reasoning ability on both pra tical and abstract planes of thinking. There was fairly good association in free and controlled situations, and she expressed herself quite well. Her memory span was relatively unimpaired. She earned an I.Q. of 80 on the Standard Revision of the Stanford-Binet Intelligence Test-Form L. She passed into the fifth grade. During the eighth.year, it was noted that she did not understand her connection with the institution, and did not know she had s.scther and sister. She would become overly disturbed by newspaper articles about polio epidemics, fires, and wrecks. She called the foster mother, ”mother", and her own mother,”the lady". She was growing very fast physically, but showed no interest in boys or in using lipstick according to the foster mother. However, the teacher claimed Elms was very much interested in boys and tried out lipstick away from home. She continued her piano les- sons with progress. The school requested her for band, but the foster mother refused. She attended summer camp. She did not,belong to any Girl Scout trooP or other group since the foster mother seemed resistant to this. She had her first menstrual period. She was doing very well in school, according to the foster mother. She had a remarkable memory, but she lacked insight and reasoning ability, according to the family care worker. 5he was promoted to the sixth grade. She achieved a grade level of 5.5 in reading and 4.9 in arithmetic on the American School Achievement Test. During the ninth year, and also during the last part of the previous year, there was a growing concern on the part of the2family'cars staff -51- toward the negative aspects of this home. It was decided to have Emma seen by a psychiatrist at the institution. However, treatment did not help. During this year,Emma's natural mother remarried and took her for a short vacation. Emma felt distasteful about visiting her natural mother, and it was felt by the family care worker and the psychiatrist that she was un- able to allow herself to express any true feeling. The foster home seemed to be pulling Emma away from her natural family. 5he passed into the seventh grade. She did not have friends except in the classroom. It was noted that she became a member of a Girl Scout troop against the wishes of the foster mother. During the tenth year, an attempt to work with the foster mother by the family care worker failed. Consequently, a decision was made to place Emma with her mother who had requested this plan. Emma seemed to have pon- siderable conflicts about this plan, but finally agreed to go. Subse- quently she was discharged as not mentally defective. Before discharge, however, plans were made tc.refer her to a children's clinicgbeoause of her personality difficulties. K a Chris Social Histogz P339; to Commitment. -Chris is a white female child, born February 5, 1941, an illegitimate birth. The mother and a finursing home” were the informants. Labor was eleven hours, with a breecheielivery. Her weight was six and three-fourths pounds. She was vigorous and lusty. Her head was markedly asymmetrical and her eyes conspicuously crossed. One was set forward in comparison with the other one. She was bottle fed. Chris was in the hospital until three weeks of age, at which time she was transferred to a ”nursing home”. She remained there until her admission -32- to Lapeer at age three years and six months. During the latter part of this period, she did not get along too well with othcr children in the "nursing home". She had temper tantrums and was difficult to control. She wrs affectionate. ' On the Cattell Infant Intelligence Scale, Chris earned a mental age of 4.6 months at 6.5 months of ago. On November 25, 1941 her mental age was considered to be five months through informal observation. [ommitment and Admission. -Chris was committed at three years and three months of age. Two physicians‘ reports follow: Is very sluggish in her mental reactions and responds mechani- cally well with no initive [sic] of her own. She is not fit for adoption and needs persistent training. Her psychoanalysis [sign shows her mental condition to be very low for her age of three and as compared to other children her age. She has spells of crying and pouting and is not interested in her environment. The subject is a 3-year old female who shows quite definite signs of mental retardstion...Psychometric examination on at least two occasions has rated her intelligence quocent [bid] as approxi- mately fifty-five. Chris was admitted to Lapeer at age three years and six months. She could not dress herself,wss believed to be tidy, talked a little, was quiet and friendly, and followed simple directions. The doctor described her as having a bright facial expression, well nourished and well develOped. She cosperated well and spoke a few short sentences. Five months after admission the psychometrist described her as an at- tractive blend haired child who was a "show-off". She related orperiences, however, her speech was marred by ”immature childish talk“. She dressed herself with help, fed herself, was tidy, and played cosperativexy. 0n the examination, her highest score was identifying objects, obeying simple commands, and comparing sticks. She seemed brighter than the examination -55- indicated. She earned an I.Q. of 69 on the Standard Revision of the Sten- ford-Binet Intelligence Test-Form L, and ugsooial quotient of 98 on.the Vineland Social Maturity Scale. She was diagnosed as familial.25 Institutional Period. o-Chris wee in the institution one year and eight months. A cottage report five months after admission described her as careful with things, cheerful, obedient and able to play well with others. a report one year after admission noted she was able to dress and feed herself. She was tidy, neat, and clean. it the time of pl cement she was described as a friendly, pretty girl with a "sweetness of personality", which was simple but eincero. She accepted her situation, Wes popular with the other children, and played well with them. She responded positively to being dressed up. Femill Care. -Chrie was placed on family care one year and eight nonths after admission at five years and three months of age. She was in her first home only one month. During the first six months, she sometimes paid no attention when spoken to. She was in the process of learning to dress herself. The other boarding children seemed Jealous of her. During the following year, she seemed happy, could dress herself and take care of her own personal needs except fer tying her shoes. She talked "quite a bit” (she was later described as an incessant talker) and made up to almost anyone who visited. She had difficulty in distinguishing between sexes. She went shopping with the family. She started kindergarten at the age of six. She was described as being well behaved in school. She Was not interested in books, but she learned songs and sang quite well. She learned to count up to 25 or 30, draw and color. During the second year, it was reported that the children in the hole v— 25This is a diagnostic term used at Lspeer. See Appendix A. -54- got along nicely. Chris seemed happy and adjusted. at age seven she was promoted to the first grade. It was recorded that she was helping another child in the classroom with her lessons. During the third year, she seemed to be quite a tomboy. She at- tended a new school and it was noted that she got lost coming home the first dayt At age eight she was promoted to the second grade. The psycho- metrist described her as attractive, healthy, friendly and a good conver- sationalist with more self confidence, who exhibited none of her former behavior difficulties. On the test, her vocabulary was at the six year level. She could not comprehend similarities and differences. Also, she failed to detect verbal absurdities. She achieved a reading grade of 3.1. Her I.Q. on the Standard Revision of the Stanford-Binet Intelligence Test- Form L, was 84. During the fourth year she made her own bed, cleared the dinner table, dried the dishes and put them away cooperatively with two of the other foster children. She are able to swim and to go on trips with the foster parents. She also attended a bible school during the summer. She preferred dresses to blue Jeans. Chris showed concern toward another child in the home who was not accepted for school. She seemed to have deep, sincere feelings for people. Those who met her wanted to take her into their home. According to the teacher, on one occasion Chris sat in school and stared blankly at times as if daydreaming. At other times, she talked to her neighbor stu- dent. She had difficulty in finishing her work. Later, it was reported, apparently by the same teacher, that she was well adjusted, and able to do average work in school. According to the foster parents, she wrs interested in school. Another foster child in the home who attended school, received higher marks than Chris. The psychometrist described Chris as a rather dull appearing child, small for her age, but friendly, cooperative, and alert in . ~55- responding to verbal items. She was slow in school work but persistent in her effort. She had good speech, good conversational qualities, and confi- dence in her undertakings. The psychometrist noted she was retarded approxi- mately a year in her school achievement, but there had been an increase of twenty months in mental ago since her last test. There was poor ability to analyze and organize situations, failure to detect both verbal and pictorial absurdities, and weakness in concentration and recall of digits. Her I.Q. was 91 on the Standard Revision of the Stanford—Binet Intelligence Tist- !onm h. She was promoted to the third grade at age nine. During the fifth year it was reported that she was not a leader with other children. She took an interest in what other children liked but had interests of her own as well. She learned to comb her hair. She had a very nice singing~vcice, and also began piano lessons. She attended a girl's camp. A new teacher was unaware that Chris was from the institution. She did well in school, but had to work hard for her grades. 0n the American “chool Achievement Test, her abstract reasoning ability was better than her practical concrete reasoning. She scored a 3.2 grade level in reading, 3.6 in language, 2.8 in arithmetic and s 2.9 in spelling. Her chronological age was ten years. She was promoted to the fourth grade. During the sixth year, Chris learned how to earn money by herself, and to use her own money to buy the things she wanted. She was able to buy lunch at school. She continued with piano lessons. Her I.Q. was 82 on the Standard Revision of the Stanford-Binet Intellimnce Test-form L, with in- consistencies in memory items and a somewhat limited vocabulary. She was promoted to the fifth grade at age eleven. During the seventh year there were no reports. During the eighth year, there were efforts to work with weaknesses of -36- this home. Chris showed happy emotion through tears. She picked out her own cost, paid the deposit herself and knew how much she had spent from her clothing fund. She continued to keep her sincere personality. She maintained s "C” average in school, and received and I.Q. of 89 on the Standard Revision of the Stanford-Binet Intelligence Test-Form L. The psychometrist described her as an attractive, soft spoken girl with clear speech who smiled rarely and needed to be encouraged to perform. She could not seem to get enough praise for performance. The psychometrist further stated that some of her failures were due, ”entirely or partially to emotional tension, reflecting how tension constricted her life”. Emotional difficulty was suggested by the examiner. However, at that time preparetion was being made not only for a transfer to another agency, but also to another home. The following'yeer, at fourteen years of age, she was discharged as not mentally defective. She was transferred to another agency. Ann 50015; Histogz Prior to Commitment. odihn is a white female child, born August 15, 1953, illegitimately. Information was obtained from hospital records and a child guidance clinic. 8he was a full term baby with e nor- msl delivery and labor. Her wbight was seven or seven and one-half pounds, but was considered §puny and fretful". There was a depression over the left orbit, and a prominence of the right frontal bone. The parietal and occipital bones vere symmetrical. ‘?he doctor indicated there was a congenital defect present at birth. Inn teethed at seven months. There was no apparent improvement in the rate of mental growth. it nine months, she could not adjust to other .37. children. At thirteen months of age, the following was observed by the child guidance clinic: there was marked underdeveIOpment of the legs and feet; she was indifferent to surroundings; she waved her hands at the wrist; she slapped her head; she rocked back and forth; and she had a mental age of eight months. (flame of test is unknown.) At twenty-seven months of age, the following was observed by the child guidance clinic: she was in- different to what was said; her motor coordination was poor; ehe teetered from side to side; she was unsteady on her feet; she could drink from a cup; she did not feed herself; and she had a mental age of fifteen months. On the Kuhlmann—Andereon Intelligence Scale. she was especially retarded in verbslizstion and social response. During Ann's first year, she use in an infant "nursing hone". Then she was transferred to a children's home in another area. She remained there until her admission to Lapeer on November 20, 1940. She became a court ward in March, 1939. Commitment and Admission. oosnn was committed to Lspeer at one year and four months of age. The commitment order and a physician's report re- spectively read as follows: Child was cared for one year by the ... Hospital under the super-\ vision of the court for most of that time and she has never de- veloped normally. 6he cannot swallow food as s child should end her head is mis-shapen and her develoyment is such that it sp- peare that institutional care will be necessary. Child is 14 months of age and is unable at this time to sit well alone, does not stand even with support, does not walk or talk. Her mental age according to tests is 6 months. She bangs her head back and Sorth in her bed, has purposeleso movements of her hands and is very difficult to feed. ~. Ann was admitted to aneer at age two years and three months. She appeared undernourished. She was able to walk, but unable to talk with the figép'tiofi‘i the word, "mem’2. She was unable to dress or feed-herself. -53. She was untidy. She sucked her fingers. She was ”tentatively diagnosed 26 The doctor described her as a dull as a ccngential cerebral anomaly”. and sickly child with poor deve10pment. She cried during the examination. The only medical findings showed an enlarged frontal lobe. A psychometric examination was not given. Institutional Pegigg. -Ann was in the institution four and one-half years. . There was no report in the record until two years and two months after admission. At this time, she was considered a fairly bright child, cheerful, very active. and able to play well with other children. She was kind and thoughtful to others. However, on occasion she had a Jealous temperament and was abusive to others. She tried hard to talk. Because or poor enunciation, she was difficult to understand. She was able to feed herself and help others dress. She was tidy. Four months later it was observed by nurses that she did not like to share her toys, and loved attention. She was quite stubborn at times. She was considered a child with limited.mentality. She received an I.Q. of 68 on the Gesell-Binst Scale, and 97 on the Merrilqualmer Scale. ten months after admission. At the time of placement she was described as a pretty girl with a "sweetness of personality". She wanted to belong to someone. She was neat and clean. Her functioning was limited in simple tasks. Fami C . o-Ann was placed on Family Care three years and six months after admission at five years and nine months of age. During the first year, Ann was considered to be talkative, affectionate, and in need of outward affection. She ccnversed about herself. She seemed happy and contented, played well with the other boarding child and considered the dog and farm animals her friends. Later she became demanding and willful. 26This is a diagnostic term used at Lapeer. See Appendix A. -39- She dominated the other boarding child but was fond of her foster parents. She attended church and learned simple church hymns. She could not pro- nounce all words clearly (observed by the family care worker). A psycho- metric examination two months after placement, described her as attractive, neat and clean. She repeated five digits in order, copied well and turned testing material into play material. She seemed to be alert to her sur- roundings, friendly and cOOperative. She made self-initiated play oppor- tunities. She received an I.Q. of 76 on the Standard Revision of the Stanford-Binet Intelligence Test-Form L. During the second year Ann was in the process of learning to help with simple chores about the home. She had improved in her social behavior but she was still"bcssy"toward her peers. She was described as having a fiery temper, but was learning to control it. There was no parental con- tact. The family care worker noted that she recognized signs along the road near the foster home, could read a little from her primer, count to 100, and print her name. it seven years of age, she attended kindergarten, earning a "B" average. She received and I.Q. of 84 on the Standard Revision of the Stanford-jinn Intelligence Test-Form L. During the third year Ann was described as a good dish-washer, a good helper with other simple chores and ambitious around the house. She liked to work. She could pin-curl and comb her own hair and helped comb the other child's hair. She was in the process of learning to iron flat pieces. The other child in the home tormented Ann. She began to sleep by herself because there was too much commotion with the other child. The foster mother did not know whom to blame. She like school and her dispo- sition was fair. She was promoted to the first grade at age eight. During the year she also went halfway through the second grade with good -40- marks. During the fourth year, Ann could do some ironing, dust, wash dishes, make lunches at home for herself (sandwiches), keep herself clean and dress herself. She did not need any personal attention. It took the whole year for Ann to complete the second grade at age nine. She was fairly good in arithmetic, forgot some of her spelling words, but had a good report card. During the fifth year Ann dressed nicely. She became involved in petty thievery from stores with other children in the neighborhood and accompanied another child in spending thirty cents stolen from the foster mother. It was not believed that Ann actually took the money. She Joined a group club and went swimming at an inside recreation pool with this group, although she did not know how to swim. Her behavior at school was good and everyone liked her. She was industrious in school but complained about too much work. She was promoted to the third grade. A psychometrist described her as attractive with beautiful brown eyes, neat, clean, alert and happy with her home. She responded well to questions, maintained a ' fast and accurate performance and had increased her ability in all mental tests. She received an I.Q. of 87 on the Standard Revision of the Stanford- Binet Intelligence Test-For- L. Her performance tests were within the normal range. She.defsnded herself, when asked why she was behind in school, by saying that she started late. The teacher considered the possi- bility of fourth grade during the first part of the year, but nothing was done about this. She received id's” in most things, two ”B's", and a "C" in citizenship. She was promoted to the fourth grade at age ten. During the sixth year, Ann was able to go downtown by herself to the store and post office. She mowed the lean, and earned fifty cents. She liked feminine-looting clothes. She seemed happy and had several friends -41- with whom she visited back and forth. Ann got along well with children older than herself. She seemed to be a very serious child, sensitive to other people's opinion. Other children continued to tease her. During the latter part of the year, Ann had an emergency eye examination. During transportation, characteristics of nervousness and insecurity were noted by the family oare'morksr. Ann referred to the other child in the home as her sister, claimed the name of the foster parents and was afraid that she would not be liked by other children. She was frightened during the eye examination. so pathology was found. Ann was glad to get back "home" after the examination. The worker feared emotional difficulty because of the competition at school. However, a good adjustment was reported at school after the eye examination. She received an WA” in arithmetic,hsndwrittng and citizenship. Her poorest marks were in elementary science and social studies. She was absent only ten days during the whole year. She was promoted to the fifth grade at age eleven. A psychometriet described her as attractive, clean, neatly dressed, of normal appearance, socially mature, alert in actions and speech, energetic and enthusiastic. She was able to recognize her limitations and did not try tests about which she was uncertain. Her comprehension, reasoning,and ability to detect incongruitics were poor, and her memory for stories, designs and sentences was weak. However, she did well on organising dissected words into meaningful sentences, and arithmetic. She was weakest in language and paragraph meaning. Shs read at s 5.7 grade level and had a 3.0 level in arithmetic. She took pride in her accomplishments. During the seventh year, replacement was considered because the ”emotional value” of this home had decreased for Ann. This was done, -42- though Ann expressed much fear of changing homes. When she was first placed in the second home,she would eat only cookies for a whole meal. Within.three months, however, she was beginning to eat small servings of everything. She continued to go swimming, camped out with the Brownie group, attended all the school events and visited friends, but had dif- ficulty with other children outside of the home. She acted to show off in groups. She cried frequently, pitied herself and seemed nervous, especially at night in her sleep (this was shown by her grinding her teeth). She did not act mannerly in stores and seemed to have no sense of money values. Later in the year, it was reported that she seemed less tense and happier. She was purposely placed in a Catholic school. She ?* was called ”teacher's pet" because she helped the Sister after school. She began taking instructions to become s Catholic. She seemed to be getting along fairly well in school except for her spelling, which was poor. in intelligence test so requested because Ann was using her eyes as an excuse when the sork became too difficult, and it was wondered if the competition in the fifth grade might be too strong. The psychometrist described herss attractive, alert, normal, able to converse well and ask questions intelligently, cccperstive, anxious to please and in need of reassurance on the test. Her total grads equivalent was 3.7 grades, with the highest scores in arithmetic, similarities and digit span. Her moms cry was superior, but her comprehension, vocabulary and information items were below average limits. She earned a full scale I.Q. of 85 on the Wechsler Children's Scale with a recommendation that she continue in the fifth grade. However, she was placed in the sixth grade at age twelve. During the eighth year Ann was able to mow lawns, baby sit, do her own bedroom work and keep herself neat and clean. She wanted to take on ‘D ‘ ,. K . 1’ up D m 4‘ -43- the responsibility of watching-children at the beach. She did not complain to the worker about everything, seemed more poised and mature and was liked by the children of relatives of the foster home. She asked to go rollcr skating with friends. She was promoted to the seventh grade at age thirteen. 3h. talked and chattsred in class when she was supposed to be quiet,hut was not considered a major problem. She maintained a “C" average, the first half of the year. it the end of the year she received an "A” in arithmetic, o. "B" in Lnglish and handwriting, the rest were "C's“. During the ninth year, Ann's conduct in the hone became excellent. Uhe studied at night with another girl, ironed her clothes and did other small household chores well. She attended school dances, went to local movies, went with girl—friends to baby sit and learned to sing in Latin,She was resentful of correction. She was promoted to the eighth grade at age fourteen. During the tenth year, Ann verbalized her loyalty to her first home and town. She baby-sat regularly, seemed to have more self-confidence, did not seem to resent supcrvision so much in school and confided in the Sister when she was in doubt. She was obedient, responsible, and dependable. She maintained a ”8" average. She was promoted to the ninth grade at age fifteen. During the eleventh year, Ann was placed in another home because this home was not allowing her ”to grow". She painted the ceiling and helped with the housework. The family care worker felt that she acted and appeared more like my normal girl her age. She showed an extraordinary capacity to make decisions for herself. She could manage her allowanoo satisfactorily and expressed her like: and dislikes. During this year relatives were found, but they did not visit her. -44- At the present time Ann 13 in high school and will graduate in June, 1958. She seemed to be capable of choosing the right kind of friends. She was able to establish ”feeling relationships" with people. She seemed to huve made an emotional adjustment to her natural family. She has a respectable boy-friend. She recognizes her responsibility to support hereelf. She will be discharged from the institution as not mentally' ietarded and as self supporting ugon graduation. CHILPTLR V IN‘l‘fliPRETATIOH Sally Intelligence. -A psychometric examination was not given Just befors placement. However, Sally'earned an I.Q. of 63 at three and one-half years of ago, one year and nine months before placement. She began kindergarten at the age of seven, two years late considering the average child attends at age five. She passed into the first grade the follow- inggysar, and during the second half of the first grads, she received “Q's” and "C's” on her report card together with a report of improvement. She was promoted to second and third grades during the following two years. She was receiving an WA" average at the third grade level. At the age of seven she received an I.Q. of 79 on the Standard Revision of the Stanford-Binet Intelligence Test-Porn L. She showed normal potential intelligence. She was discharged as not mentally de- fective two years later. There was a definite rise in I.Q., but it is not known how much of this increase can be attributed to family care because there was no measure of intelligence at the time of placement. Ber improvement in school was remarkable. Sggial Behavior. o-Sally w:s no behavior problem when first placed on family care. She played well with other children and did not have tem- per tantrums. She functioned well as she readily accomplished simple -45- 9 8| -45- tasks. She was pleasant in manner to adults, but strong interpersonal relationships may have been somewhat marred because of her speech defect. ‘Ipparantly she had no concern about her appearance. Sally's behavior seemed to be more of a continuous growth process, rather than a change. her speech was much improved, and the fact that she became a favorite with the fostzr mother suggests improvement in her interpersonal relationships with adults. Progress in functioning was ex- hibited by gradual accomplishments of more difficult tacks. She seemed to have more pride in personal cleanliness and nontness. Personalitz. -At the time of family care placement, Sally gave some evi- dence of emotional difficulties in that she masturbated, had indistinct speech, did not care about her appearance and tended to be clinging to adults who gave her attention. Sally seemed to be masochistic in char- acter. There was also an indication that she seemed to have inner hosti- lity. She seemed unable to accept herself. Sally continued to show an identification with the institutional childrentafter placement. Sally seemed much improved in her emotional difficulties at dis- charge. Her speech defect disappeared, and there was no further mention of continued masturbation or a clinging type behavior. Her consistent improvement in school, her inorease in intelligence as measured on stan- dardised tests, and ability to concentrate better suggests an alleviation of tensions within. Her pride in personal cleanliness and neatnees, and the fact that she became the favorite of the foster mother suggests she had begun to accept herself as a person. The fact that she ens discharged as not mentally defective is evidence of positive personality change. Intglligencg. g-A psychometric examination was not given just before place- ment, however, Mary earned an I.Q. of one at approximately seven years of age, eight months before placement. During the first year on family care she earned an I.Q. of 87 on the Standard Revision of the Stanford-Binst Intelligence Test-Form L. She began school on a part-time basis at the age of about eight, three years late considering the average child attends at age five. At the age of nine years and six months, she began second grade work. She passed into the third grade the following year, and was subsequently discharged as not mentally defective. A great deal of Mary's intellectual deveIOpment may have taken place at the institution. However, her successful participation in school and her ability to function successfully outside the institution indicates positive growth in intelligence. How much growth can be attributed to family care is not known because there Its no measure of intelligence at the time of placement. Sggial Behaviog. oqhary seemed very weak generally in her interpersonal relationships at the time of placement. She did not include herself in play activity, was still fearful of strangers and strange situations, and had a low frustration tolerance with peeple. She displayed a strong temper and at times was stubborn, grumpy, and commanding. She was described as eating like a pig. She did not feel responsible for any household duties. She talked loud in school classes and exhibited obnoxious behavior with other students. it discharge from the institution,she had changed in nearly all areas. She seemed happy in assuming certain responsibilities. She attended peer BL.- lull n‘h‘ -48- groups and was beginning to learn how to make friends in a normal way. She got along better with other children in school and did not talk as loudly; in.olass. Her temper tantrums diminished and she did not become unset as easily. She developed better esting'manners. Apparently her interpersonal relationships became stronger as it was felt she was reaching out emotion- ally toward family living. Personalitx. unit the time of family care plscement, Mary seemed to be still quite distrustful, fearful, anxious, and lacking in self confidence. She was tense and was described as highly disorganized and infantile in her personality makeup. She seemed to have considerable inner hostility, and expressed this hostility in unconventional ways, such as temper tantrums, and stubbornness, together with a commanding or domineering attitude. Upon dischsrge, her interpersonal relationships, as so have seen, seemed to be stronger, and she seemed to be a nore secure and less anxious child. She changed to more conventional ways of expressing hernelf,verbally. Her total personality seemed more wholesome. She began to accept herself . as a person and the other people around her. Emma Intelligencg. oehmne earned an I.Q. of 65 about two months before place-ant. Sometime during the first year of placement she earned an I.Q. of 77. During the third year her I.Q. was recorded as 95. The fifth and seventh years showed an I.Q. of 75 and 80 respectively. Her intelligence quotient was erratic throughout family cars. but there was a substantial increase in her intellectual growth. oci ehsv r. -EMns was described at time of placement as a pretty child who res docile, pleasant, agreeable on the surface and submissive. She had -49- good speech before placement, but she began baby talk after placement. Her outward behavior toward adults seemed good, but she tended to be soli- tary in her play activity. She seemed dazed for the first three months in her placement end apparently found it difficult to function adequately. Her social quotient was given as 94 sometime during the first year of placement. At discharge it was noted that Emma had no friends except in the classroom and attended very little group activity. She seemed to have good behavior in the home and in school. Her speech became distinct. There was no specific information concerning her functioning in regard to smell tasks, but with her rise in intelligence quotient and continuous promotion in school, it seems possible to assume there was progress. Porscnnlitz. -At the time of placement, Emma apparently internalized hostility, tension and conflicts which revolved around movinginto a fam- ily care home. Apparently such a move was very fearful for her because she was in a daze during the first three months, and baby talk was evident after placement. She seemed to be tense in a close family relationship. home tended to value external objects, repressing emotional feelings to- ward people. She seemed weak generally in her interpersonal relationships. At discharge Emma had overcome her initial reaction to a foster home but apparently had developed different emotional maladjustments. She was seen by a psychiatrist, who felt Emma to be unable to express any true feeling. She did not have friends except in the classroom. She became overly identified with the foster family. Even though she was dieoharged as not mentally defective, she wee referred to a children's clinic because of personality difficulties. There seemed to be no positive chanje in personality. -50- Chris Intelligencg. -The only intelligence quotient given before placement was at eleven months of age, at which time Chris was four months retarded. in approximate I.Q. of 55 was given on the commitment order, but there was no indication that this was obtained by proper testing methods. Two months before discharge, Chris received an I.Q. of 89 at fourb teen years and six months of age. There was a steady and consistent im- provement in her intelligence quotient rate, as well as with her grade level throughtachievement tests. She began kindergarten at age six, and went continuously through the seventh grade. There were no marks reported, but her grades were considered average. There was substantial intellectual growth. Social Behavigg. -Chris seemed to have good social behavior at the time of placement. There were no behavior difficulties. She was clean and responded to being dressed up. She played well within groups, and seemed popular with other children. However, it was indicated that she would not respond some- times when spoken to. The institutional report indicated she was able to dress herself, but the family care report indicated she was in the process of learning. There might have been a regression. Without further informa- tion her true functioning at this time cannot be evaluated. Chrie' behavior seemed to be more of a continuous growth process, rather than a change, because her behavior totally seemed good in the be— ginning. There was growth especially in functioning because she learned to swim, play the piano, sing, do simple tasks around the home, earn money, and spend it wisely. There were no behavior difficulties in school or at home at the time of discharge. Her interpersonal relationships seemed well Isis tablished. She apparently got along well with children in school and her -51- teachers. She attended group activities. She impressed people consid- erably since they desired to have her in their home, and one teacher was unaware that she was from the institution. -. Personality. -Chris was described at the time of placement as having a "sweetness of personality", which was simple but sincere. She accepted her situation and seemed to have no severe emotional problems. Her social behavior totally was good. Her lack of response sometimes when spoken to, could have indicated a defense against insecure feelings, or on inner feeling of hostility. There is not enough specific informa- tion to confirm this. it discharge the psychometrist noted emotional difficulties, however, this examination was taken at a crucial time in her life; she was being moved from this home and discharged to a normal child placing agency. Without further information it is difficult to know how much effect this may have had upon the examination. Emotional difficulties are contra- indicated in her continuous growth of functioning, behavior, and intel- ligence. Also, it is indicated that Chris continued to hold on to her own simple and real personality, not following others. She seemed to be well liked and was not considered an institutional child. Placement with a normal child placing agency suggests growth in personality. yrsn this evidence it seems there was continuous growth in per- sonality, but such a statement is guarded because of the psychometric elimination Just before discharge. Ann 'Lgfigllzggggg, -A psychometric examination was not given Just befbre place- ment, however, Ann earned an I.Q. of 68 three years, eight months borers -52- placement. During the first year of placement, she received an I.;. of 76. During the second, fifth and seventh years, she received I.£.'s of 84,87, and 65, respectively. She maintained about a VB" average on her last report in school, and was expecting to graduate from high school. There was a substantial increase in her intelligence quotient, but it is not known how much of this increase can be attributed to family care because there was no measure of intelligence at the time of placement. her intelligence quotient remained consistent, and the fact that there was con- tinuous progress in school, together with her apparent ability to complete high school, indicates family care to have been a positive factor in her intellectual growth. Social Behavior. -There seemed to be few behavior difficulties at the time of placement on family care. She played well with other children, but did not like to share her toys, and was stubborn at times. She loved attention and was affectionate. Ber functioning seemed to be limited. She did, however, keep herself neat and clean. it the end of the report, Ann had made tremendous progress in func- ‘ticning. She could baby sit, mow lawns, iron, do her own bedroom tork, date boys, and was expecting to graduate from high school. In other areas there was similar progress. She attended all kindsof group activi- ties and achieved an excellent degree of social ability. She acted and appeared more like any normal girl her age. Her conduct, dependability, and courteousness were excellent according to graded reports from school. 5he recognized her responsibility to support herself and the institution was planning discharge because she was so capable. Peggonalitz. oaAt the time of placement, Ann had a "sweetness of person- ‘ ality”. There were some behavior problems, but no outward symptoms of .5}. severe emotional difficulties. Her functioning seemed to be retarded. it the end of the report, there was no doubt that Ann had deveIOped considerably in personality. She was capable of making good decisions and choceing the right friends. Most important of all, she had learned to establish a feeling relationship with people. She maintained her in- dividuality and made an emotional adjustment to her natural background. Che recognized her responsibility to support herself, and the institu- tion is planning to discharge her as not mentally retarded upon gradua- tion from :high school next year. CHAPTLR VI SUHIARY. CONCLUSIOstpAND excommunnnrlons The purpose of this project was to determine if family care is anfieffec- tive treatment method for children admitted to Lapeer State Home and Qraining School who are considered emotionally retarded. This was done by determining if there was apparent change in intelligence, social behavior and personality in five emotionally retarded children who had been placed in family care homes. Intelligence. social behavior and personality were chosen as critia beCause they seem best to illustrate emotional and inp tellectual growth, as opposed to physical growth. There was no quantitative method of measurement used in interpreting the data. Interpretation was based on evaluation of facts recorded in each child's record. The lack of specific information in records was found to be a limiting factor for the interpretation or the data. The results showed a positive change in the five children considered. four of them were discharged from the institution as not mentally retarded. One will receive her discharge following graduation next year, since she is capable of self-support. Positive change was more apparent in intelligenoeand social behavior than in personality. Part of this was due to the lack of a. clear picture of personality, however, it did seem that needs for personality development were greater than for intelligence and social behavior; The personality picture could become more apparent with further study'of each foster home in relation to the child. -54- -55- It can be concluded that family care was beneficial in bringing about positive change with the five children under consideration in intelligence, social behavior, and personality. However, further re- search is needed to determine the nature of the contribution of the family' care program more precisely. It is recommended: (1) An evaluation should be made of the recording methods in family care. This would mean adjusting recording techniques to meet both the institutional and family care needs. (2) More specialized and intensive service should be given in the area of personality develop- ment. 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'l l C . l CLINICAL OR ETIOLOGICAL CLASSIFIQATION (continued) 69 Congenital cerebral maldevelopment due to prenatal infec- tions (specify). 70 Congenital cerebral maldevelOpment - other forms (specify). 71 Congenital cerebral maldevelopment - non-specific 72 Progressive neuronal degeneration (specify). 73 Hypothyroidism. ' 74 Kernicterus (iso-immunization; other) 75 Due to convulsive disorder. 76 Psychogenic 77 Other post natal forms (specify). 78 Unkown. 79 Unclassified. 60 - Familial: 'This category depends on multiple causative mechanisms of which the most distinctive is an inherited sub~average intellectual status or adequacy. All evidence tends to indicate that the genetic mechanism is polygenic, and repre- sents either in a qualitative or quantitative sense, an accumulation of those items of the polygenic ”intelligence" transmitting factor which determines the lower parts of the normal distribution curve for intellectual capacity. In other words, we are dealing here , with "normal” or physiological genes involved in the inheritance of intelligence. It differs from other hereditary conditions associated with mental retardation in that the latter represent, as a rule, clearly abnormal or pathological genetic factors, arising originally through mutations, and not present in the normal population, genetically speaking. It is infrequently the sole factor determining the presence of the mental retarda- tion: Most commonly, other associated factors, add to the causative mechanimm. These include factors such as: Personality and behavior disorders, environmental inadequacy, physical defects, etc. The diagnosis is based on the presence of a relatively similar degree and type of sub-average intellectual status in one or both parents and in most of the siblings. In most cases, it is the relative intellectual incompetence of the parents with the resulting environmental in- adequacy which combine with the child's sub-average intellectual status to produce the clinical state of mental retardation. 'The mental level is usually in the borderline or mild category. 61 - Cerebral trauma _1specify): This category includes those cases in which the mental retardation is pri- marily the result of cerebral injury occuring during the birth process. It may and usually does involve multiple pathogenic mechanisms such as vascular occlusions, hemorrhages, anoxia, direct tissue destruction, etc. 62 - Cerebral infection, post natal 1specify) This category refers to cerebral abnormalities following infectious processes directly involving the brain, and occuring at any time postnatally. It includes all types of encephalitis, whether suppurative or non-suppurative, whether focal such as brain abscess, or more generalized such as that associated with the various meningitides or encephalitides. It does not include the brain abnormalities resulting from prenatal infections such as toxoplasmosis, Gbrman Measles, or congenital syphilis. However, cerebral lesions resulting from acquired syphilis - 7 - 1!, «a. (‘4 ‘4 n] ‘mould belong in this category. It should be mentioned that serological evi- chmnce of syphilis in a mentally retarded person does not necessarily imply a causative relationship. Specific evidence of a syphilitic cerebral involvement should be required. These eight categories include all conditions, acting at any time during prenatal life, which have interfered with the normal development of the central :nervous system and thus are directly responsible for the mental retardation. Except for the category "non-specific", previously designated "undifferentiated" by many, all of the categories are readily recognizable, either on the basis of 'physical appearance or on the results of special tests and studies. 63 - Congenital cerebral maldevelopment with Mongolian: 64--Congenital cerebral maldevelopment wifih cranial anomalies (specify): This category includes the craniostenoses (premature closure of cranial sutures such as oxycephaly, scaphocephaly, etc.) hypertelorism, congenital 'hydrocephalus, macrocephaly, etc. Many of these conditions are genetically determined while in others, the etiology is either variable, or not established. 'This category also includes primary microcephaly, a hereditary abnormality of the brain associated with a characteristic cranial appearance. It must be differentiated from the secondary or symptomatic microcephaly which is a common accompaniment of many kinds of cerebral abnormalities, otherwise categorized. Similarly hydrocephalus may be due to various etiological mechanism and should be so classified. 65 - Congenital cerebral maldevelopment with phenylketonuria: This is a condition easily recognizable by the presence of phenylpyruvic the urine which can be identified by a simple laboratory test. The condition is genetically determined, the responsible genetic factor being autosomal and recessive. 66 - Congenital cerebral maldevelopment with ccngenitglflectodermoses (specify): This category includes three conditions, namely tuberous sclerosis, neurofibromatosis, and cerebral angicmatosis. They are grouped together because they have considerable in common, i.e., genetically determined, cerebral dysplasia, tendency to tumor formation, involvement of many structures of the body including the skin, and a great variability of clinical manifestations.‘ 67 - Congenital cerebral maldevelopment with cerebral_palsy: This category includes all cases with prenatal cerebral abnormalities 22E due to known causes, and presenting as one of the manifestations, a defect in motor function resulting from the cerebral defect. Cases of cerebral palsyf due to such trauma, post natal infection, etc. would not be included in this category, but.p1aced in its respective group as indicated by the etiological factor involved. .- ,-, ' .¢ I . . . . I... \_ .I -I,, r' .JTI .x-. s . r: 'o--.’ .3 . 7.: . . . ’0. . ‘ - .. ‘2. . . '.' ."' ' ~ ' l ..- l A . f... . \ . . u ; ‘.\ q n . , , . . ‘,‘ ,0 v 'i r "1. I' .3“!- . . I, _ , I' u l . J 7.4 .‘ ' -' l‘ ' p... 1.1, . .. “_1 ‘J" II ‘, A .‘ 1' .. n ., OK “ v . , .l -4-- . 'n' . I , 5 s - I - .1 — ‘ ‘ ...” I ,. ~ . .1“ . .. . . . -~.“ -.., _ ‘0“ (l . a ‘ - . . . I Q: ‘ ,,.- '- '.~ .I '4 .‘ ...‘. " .. v .I n r I I ‘r 6‘ o " .' J ' . . -' I . ' a'.\.J .. I F t . I, . . : . .4 f. 7 l ...... K in 1 ‘ .' u 1- ‘ . . . ‘ i l .I ’ u . '- .... I 7 . V. ' ) ‘. . .. t . . —. n “o- -.. . . . . -..~ .. .r ,,. .. . . ~ . , . . . r’ ,‘ .0 -'I l v -, . _ . I. ‘ . . - ‘ . . . . . a .\ a 8 .r‘ . I? .I . ..4 . .2 . - .’ I ' ' -. .. ., O l ... ‘n 'v . .- .5 r -' A4§'—~*u .- .- V.’ ‘- A ‘I -o _.‘ . . ‘ylt . ‘.,.. ‘ J. a. .a , . \ . ... ‘ .au. ! t .I_ I'i L. .’ - . . A . o . . . .‘ . . , ‘.' ‘. , . ‘:2“_. . t u .- I o A . r, I . .. . . -~-:.. . u ...-.. u ' .. . I, o ’I- ° ‘ o . . , . . . v r . I I . . . .. . . . . A .. . .u . - r. ...- .1 r " o. . , ; x . . ., '- . ...,_ .. .. .. | ‘ I ‘. V . .. . ' I . ‘1 . 4 '- ‘0. A4 n- . l . . . I u .- . . . c , o . '. a l "‘ > ‘ . Q , . ' I . o . ‘ U , . . I u ' a . r n 5': \ a a u , . , . .. ~- I ' o l ‘. a , u ‘u I v o ' a . ‘ ., ' I . ‘ , I 1 .. . . n , . I , . - ‘ - . .. (I I . v'. ‘ ' _V 1 I >1 ' ' . . , .I . .1 - .. ~ .I . ,_. . s § - g l . I a O f. V I z . i - . .k . ,’ - ‘ .. .t o I s .» . -: . . ." '\ . ,\ I) . .’ .. . , :‘ " -7 ' ' - n- .. .' -.- o- l .1 - , ‘ Q n. 7 U .' > ' ~, .. i. .' , \ - . ’ _ ." . .' - J . .- . ' 1 - ‘, z - ‘u . . ‘ u V, l '.‘ a, ., .- . - 5-. _. '. , s . ' . 4 ‘J . - .c‘ ... ‘; - I I t , I . . , . '. I” . . . , . t A I . g ' ‘~ ’ I p. v. v " I ' ‘ . ‘ I . .. ~ J . - . . .1 ‘ J a . . .I _ .' a . v .I um... ‘!—.--.'-..i' U. I- A in “'.~.‘~...~-‘.v¢~.nd~iw . , .. _ , ., . 5 . . . ' . -’ ' . ~ . I ‘ ‘ . ‘. -) J. . 3; é' v,- .-. - . .- ...-...... -.--—-‘IJ~‘--~r~cl q. , . t -. "...-.-.. A ." - _‘ . . '~ A I“ ~ > m. .I . ‘ a. ' ' n - - . - ' . o. —- M" .. ».- . .- . I. . . . . . u. n V . s ' -.‘. '. ‘ , . L. . I‘l.. .. . I.l‘.v‘.:. ‘ ..I. . i .- . -. ‘. .- - o ‘u ‘ -o x. '» ( . - . . . s '. ' 4- .. . not. _ ‘ . - m . . . . . .. ‘ .. . " x .a I . . - . - I . o , a I. It ‘. A . ' 2 . ... ..J v n . , . , , f . . I‘ . ‘ a . ‘ . , I. ! . .V _. ' ‘ ' - .1 . ‘ ...; . ° . ~ . .A . . . I I u 0) ~ :_I. . ‘ ' , . l c. I ’ u .l - . ‘ . } , u ' . . . . .w I. . '. ; I‘ I. . . .. - ., , . 'I _ a - .- - , I 'o I . ' . -, - . . ~ - ' . . . ‘ I . . v . . . . , . .. . . _, . o . ‘ . ~ . , . v ’1 q . ,1 .' 4' -... .'. H;I'.“'- - a I -..JI~.WQ-v'.o‘ - ....'o. . -- - .- .. '.,'-4-..‘...fi-:..s. > . ' . . ' ‘ . ' . . x. ‘ ~ I l . . . > .- ’ u . .g . . '. . - I. . , . . n .. , . . .. u I . . . v. . .. .' - . - ., ' a. .3 u . . ' . s I - ‘ ‘.‘ , I. ; is 4 ....- . I ‘ II o , . ‘. ‘ , 1 . Q '. . ' u o , - ' l . ; w . . v ' , . . I - n" o l ‘ ._, a. cum 0 ,. . . ..-.. .- ... -..--, . ...... .. .. .- . J ‘ . , J .. ‘ ‘ ' , .I, I. . , . . " J . . ~ - . ' d . . ~ . s. . a . . ' . . . - u . ‘ d . ‘ "- ‘ ' s .- -- c ' . . ‘ . ° . - _ - .,) .. v I . . . . .c . ' - . j . , .. I o . ; . . . . ..¢ .. .- . ... u _, . .1 . a O Q- ' l .- . - V'. - , o ‘ IV. -. . .' , 1“ . lJv I‘ .§ ' - I .~ 9 '. r, , l m - I. ‘ ' J - ..~ . ' ’ . . , "‘ ' -" - '-- M“ ‘- ~‘ ”no iwur 4": w-o- -..- an .- . . .. . . a n. .A . . . I t . . . _ . . . ’. 1 , ' s v A . . . f . ~- ~ . J." .' ‘. .3 p I _-.-.. ..e.. l‘ I - .- ‘~ I* -‘ul-“-I O ' r. . " . , . . I ' . ‘ .; ' u I , ~ - ‘ r ' ' .. '.- , I _ . r . ...~ - . ~ '. , . n -. Iv I _ 1- , , v. > ‘ .‘ .. . It I z ‘ u d ,u a . . _‘, ~. I V. J _. 69 - gongenital cerebral maldevelgpment due to prenatal infections (specify); This category includes those cases in which cerebral abnormalities resulted from such prenatal infections as German measles, congenital syphilis, and toxoplasmosis. Although these three are the most commonly mentioned, the possibility of other prenatal infections should be considered. The type of infection should be specified. 70 - gongenital cerebral maldevelopment - 0 her forms fispecifiy}: This category is designed to include the conditions which are pre- natally determined, specifically diagnosable, many of known etiological basis, but sufficiently rare, so that a separate category for each would be impractical. Among the clinical conditions that can be considered for this category are: fetal irradiation, hereditary mental retardation not other- wise categorized, possible maternal intoxications, eclampsia. Hereditary idiocy includes those cases due to a specific recessiVe genetic factor, in which the only abnormal manifestation is a severe degree of mental retardation. The absence of pathog nomonic findings make the diagnosis possible only if another sibling with similar degree and type of defect exists. Maternal intoxications as a cause of cerebral defects of prenatal origin is probably of rare occurrence and difficult to prove. It may conceivably include maternal poisonings due to such things as lead and other heavyHmetals; mternal carbon monoxide poisoning; possibly severe vitamin ' depletion such as described experimentally by Warkany and others, etc. These conditions and others as yet unknown or unproved will probably enlarge this ‘ category as our knowledge of etiology eXpands through research and clinical experience. 71 - Congenital cerebral maldevelopment - non-specificjundifferentialtedz This category represents one of the largest in the classification, representing more than 30 per cent of institutionalized mentally retarded. It may be defined as those conditions which are definitely prenatally determined, but with no differentiating, clinical characteristics, and of unknown etiolgoy. It will, therefore, include all cases of congenital cerebral defects not classifiable in any of the preceding or following categories. Where the available information concerning a case is inadequate or determining whether the condition is prenatal in origin, it should not be placed in this category but rather in that labelled "Unknown". Many of the cases previously diagnosed as "undifferentiated" will probably belong in this category. It differs from the older grouping which represented a wastebasket or undefined - conditions, some congenital, others postnatal and some even due to environ- . mental factors. 72 - Progressive neuronal degeneration (specify): This category includes a number of specific conditions having in common the presence of a degenerative process involving any part of the central nervous system. As a rule, these conditions are genetically deter- :nined and probably represent complicated defects in cerebral enzymatic processes. Included in this category are the Tay-lachs group of cerebral lipiodoses, the cerebral form of Gaucher's disease, Neimann-Pick's disease, gargoylism, etc. Also included are the less well characterized demyelina- ting conditions such as Schilder's disease, the cerebral scleroses of Pelizaeudeerzbacher, Bchols and Krabbe, and other varieties of white matter 4 ‘0 .I P . . . . . . . . . ,. . . . . . . , . . . . .. . _ . . ... . . . . ... . .... . a .. . . I. . . . . . . . .I . . I . . . . . . .3. Q. .I‘ . l . . . . I. . p .c I... . x . . . . .tl . I. . I . . .... . . x J . . . . s . . . . .. v . “.. . ‘\ o ...I . I It s .. .I. ll. . I . .. . . . I I . . .. , I .. . r . .I I I. . . . I I .. .I .. .II. , V . . p I 3 . .z I . . . I . . . .I ... . II . . . . . o I! u u . I . s s r! . ... I, . {I . . ... . I v . ... . .,. I. I ... . .. I I. I I . . . _ . . x o . I . . t . . . f I o . ' IIJ ‘l .I v I. 4 § 4 . | I I 0:. u .. i I I I . . I . . . I: . n .I I . . . l .. . . . . i n .. I I. . s . . . . . . . ,r I II... I . I . .a .l. . .. . . . x \l I- I I . I I I . . .. I O I . . ..U I I . 1., r . .I I .\ f . m . . .. . . . A . . . ..II T. ... . .I I .. r . 4 a I. II . w . o \ I. u I: . I . . . . . . . .e . s n . . x . . ... .. . . . . l. .v I! v c . J .I . . O. . I .4 a 4 y . . ~ I. p. . D -l_ 5' I P. I. — I I. I 7 .- .'. . n .h ... .. I . . . / p . .I . .. I . c. . A a . . I I . .rx. II; . . . LIA I I . a 91. . . I. . . . . h . I . . . . I . . a . I . I ... . . . J I I I . . . u A .hl I a . .I. . I I I" . V . ... I . ... , I» II: ..I . . o. ..— l I I. I I . y . ... .. I a \. HI. I. . II- , ... l . . . . I . I .I ... » . I . \ a . . . x .\ .. I . . I I» , I .. .I. .. . l n . O . -.. . . . I . . I . \ .1 I. I. I. 1 I III I . t _ .. I. v V. . . a“ .00.- . (I I.) , ... . . . I . I . . I . I\. 7 .. i . I I . u . I. . I . I It I . I . I (I Y I n ,‘ I I . . . . . I I . . . I. .. . . . V . . _. . I. I I . . l . I I ... . . . . . . . I .4 k. .u f , . .I . a . . . . . . . . . . . ._ f I . . . I . I. u hI .. . . . I I .II .5 . . . .o. . . . . I. . ~I . I. I I I . -l . I . I. . . In I . . . I . . . . I U I .II I . . I II I . .I Is I. J . . . . I .u . . .. . I V .I . I . .. I . V I . . I. . . .. I J .. . I .. . . n . . I H . I!” I . ...i . I . I V ..l .. . . . I I . I I ,. Ia . .I .. Ir . . . a .0 . . A . . . I . o . . . .. .I. I . . I I. . . . .v I. . ... . ; u a . . I . . I . . . n I I I. I . I . . .II . . I I . . . , . . . .. . . . . . . . . .1. .. a .F . . . . . . . I v . I . I . . . a- . . . . I .\ . . I . . . . J . ... . . . . . . . . I. a i. . O o . , I Ilr . . . . . . r . H ... . I. .0 . . sf... . . . . . sl. . I . .. I . I I . A I ... . . I o. u . ‘.§ . I . I l . . . . r I n . I. < I I I q . .. .. . .- I 4 4 I .. I 0 Ah. I I I. I II . I. . . . I . . i I c . . r . . II I . v . s l I .~ I I l I ’I 0’ ' II t . . . I . . . . n u l . a . . I . . ~ . . . . \ ... I I . I w . I * . . I . . . I I .I l I 4 . I _ p I I. I I I — I l u . O . ... I . I .. . -I ~ I . . I o. I ‘ I . . i. , i . . . . . . w . . . . . a o I I I 4 A I D II 1 l v ‘I I I II A . I . . . I I . . I I .. . . . . . . o I . I . . I . . . . . I . . a .. . . 4 . . .‘ I I I II I V . I c I. ~ I A I . . . I .| .. I I . I . , . . . . . . . . . . I . . u . I .. . . . I II I a I I I - I \ . . . . . . . I . I . . u I A I ll I . ' I . I . . g r . . . I . I g . I . . . . . . u . . . . . t ‘. . I e V I I. ~ . . . . . . .. r. . 4 o . . . . . . a . l . . . I . . u , . I \ \r . I . . , . I I . . . u ~ . . 4 4 I . . . . . _ I w i . . I . . . . i . . . I a I o I . . . p l t . I c v . . .. . I .a I . . . , . ,- . . .. . . I . . _ .. . . . y . . . i I . . I . I . . u .— . . a} . , . .. . . .. _. Z . . -. . . . . . .. I I - . . . . . s . I. .I . .. . 4 . . 4. . . . r . . u . , I I I . I . - I I I l l I I I I '.I_ t 4 I I I I . . I 1 I I C. I I t . u . . I. . . . . . . u I 0 l {to I, I I u I k I . . . . . . . . .. s. . . . .. .I I. . . I . . . . I. I . . ... , . . I - . . . . I . y . . I I . I . . I i . . , I . . . . o . I . . y . . . . .. . . y . ‘I . n I I I . . .. u , . . . L . I. . .. . I .. .. . . . .I ~‘ I I 1 I ,u I. s I I. I I I . . .. A u. ... I . - .. . I . . . . I .A o . . . I I . . . . . I ‘ . v I . . . c I I I I I s O . . I . I I I . . .l . o I . II . l I. V l a. I 4 . .I II Q a I I u . o . 1 . . . I . \ . r. . .. I‘ .l .. I . o \ .IU _ I .. .- 1 I . . .. . . c . . . f . . . ..I ._ . I t ... I I ...... t . . II . (It. I . . . . . I I. t . . I I. . . . m . . I \ . . . .. In II . . ... .I . I I . . . . I. . . .. Ia . I I . I I . - . I II I. I s I I l I I 4 I a . II. . . u m . I o a y . I . .. . . .I . . .. u . . Io ‘d . . I . . . . V. . I .I I. I . . I .I .I I I . .. . . . . . in. . . .. . . .Iv . . . , A . .. . . .1 2 4). . . . . o I. I II .. . . . \ . I .I . .. . I a . . ~ . I q . I . . r) . .I. I I I .. . . .I .I. I. I . l. I . ... I. o . . I . 4 I .. . . . I ..I. I . u . r . . _ . . . u I I). J I I. I . I I. O I I 4 o I . 4 II I . ‘Ic ‘ a . I . .4 .. I . .f‘ 1!. I .l. I ..u ... f r. ... . . I... (3 . . v . . .f. I... . ... O . s.- I I I .. I . I 0 \o . I . \ _ I O . I . I I\ . s I v 2.5 I Ii- . I It. . I I . it I I .\ . a .I . Ir. I. . . II I I . . _ .a o. I . I . I V I . O . I I I I 1 I n I I. I. .l . , .. I . . . .. . I . I .. J I I . . . . ... . I . I!) ..l. . as l a , I .Oa I . I . I . .. I. a a e .. _. . . .. _ . . . . . Ilr . I I I . I I . c'I .- ; n .(J .u... .ol 0 I ..1 I s.‘ I a I II. I ,. ,II II . n . I I I . I. . . I . 6 . ... . Iv, . . 4 .. .1. I. . . 7)., I . ... ... . I . I I O. . I . I I , .1 ‘J .1... .. I (I a II . II I. . p In. . I .10. . . .. .. 3 I n a II.. ’J II.‘ .II II ha I . .I r 1. . a . .. . I! . . A I .I . WI ~ I . . .I .. I _ l. a . .. . a degeneration whether diffuse of focal; also various degenerating processes of a selective nature such as hepato-lenticular, Huntington's chorea, Friedreich's ataxia, etc. If possible, a specifying term should be included in the category designation. 73 - Hypothyroidism: This category includes those cases of congenital cretinism and myxedema. It should be used only where the hypothyroid state can be considered causatively related to the mental retardation, rather than as an associated condition. The latter is almost always the cause when other endocrine deficiencies are'present and explains the absence of a specific category for endocrine defects. 74 - Kernicterus Ajiso~immunization;=g§her); Kernicterus is actually a term originally used to describe a pathological cerebral picture. It has, however, been incorporated into clinical usage to describe the cerebral abnormalities resulting from.iso-immunization due to the Rh or other blood factors, and to a variety of neonatal conditions, usually in premature and always associated with relatively high levels of bilirubinemia. The clinical manifestations of the surviving children ‘may include in addition to the mental retardation various types of cerebral palsy, both of the hypertonic and hypotonic kinds, convulsive disorders, cranial nerve defects and aphasias. 7S - Due to convulsive disorder: Epilepsy is frequently found as an associated clinical manifestation in most of the previously described conditions. In these, the epilepsy is either the result of the same cerebral abnormality responsible for the mental retardation or represents an added handicap due to other causes. There are, however, factors in the epileptic state itself that may, individually or collectively, lead to mental retardation. These include, the many psychological insults and deprivations stemming from the diffi- culties in social adjustment to which the epileptic individual is con- stantly exposed; the misuse of anticonvulsant drugs with resulting over- sedation or unrecognized drug toxicity; and in certain cases, frequent head injuries due to falls associated with the spells. 1Moreover, while not generally accepted, there are some who believe that the cerebral dys- rhythmia or the convulsions themselves may actually induce physiological or even organic brain changes which may result in temporary or permanent Inental retardation if the convulsive state persists over an extended period. - Regardless of the mechanism involved, whether one ccnsiders it an adjustment reaction, or a pathological cerebral state, this category has been set aside to include those cases in which it is felt that the presence of the convulsive state per se, represents the causative agent determining the mental retardation. While in most institutions accepting all types of Imentally retarded individuals the incidence of epilepsy is probably over 15 per cent less than ten per cent of these will be found to fit into this category under discussion. n u . ' _ 1 .I v A I c . .- .. .,. ‘A .o 1., ' ,v. . - ‘ ‘ . .- 4 ' ' o - v \a- u . . ...-0 ~ . , u u ‘ u v“. . o - . «.- . ' . I . . i . - ‘1 U I "J I I .- ( . .. ‘ o ‘ . t . .. .. z . . . . x I '1 . a . o . . '1 ‘ I ,... ..a~ .' . 4 v. . O u 4. . . . D v . . . ‘ . . . . . ._J ... X '_ . u , . ‘, .. u 5 § . ‘ -.1 I' - ... ~ ~ ,. ' .' i a . I K .. I {i h I- , . .. I. . . I- ..‘ 2 . h 113' . '51 N ‘J 76 - Psychogenic: This category includes those cases in which the mental retardation is basically a functional manifestation of maladjustment due to environmental factors, which may be psychological, sociological, or even physical, such as in the hard of hearing or the blind. This condition is without clearly defined physical cause or structural change in the brain. While these factors may, and frequently do play a role in most of the previously described conditions, they are essentially a secondary nature. In this category, however, they represent the primary causative agents which determine the exhibition of the symptom, mental retardation. On other words, we are dealing here with individuals, in which there is adequate genetic endowment as regards intelligence, no evidence of prenatal or postnatal cerebral injury or maldevelopment, and normal cerebral dynamics, physiologically speaking. They have previously been designated as the “pseudo-feebleminded" or some similar meaning term. 77 - Other post natal forms (specify): This category includes diagnosable conditions, postnatally determined, *many of known etiology, whose incidence is too infrequent to make a separate category practical. This includes those cases due to cerebral injuries resulting, usually, from some physical force directly or in- directly applied to the skull, occurring at any time after birth. In this category also should be placed such cases as those with lead encephalo- pathy, the encephalopathy resulting from carbon monoxide ~poisoning, cerebral changes associated with drowning or other types of asphyxoa, cerebral injury due to electrocution, prolonged insulin hypoglycemia, etc. The specific condition should be included in the diagnostic classification. 78 - Unknown: This category includes those cases above in which the available knowledge is too meager or inadequate to allow for placement in any of the above designated categories. 79 - Unclassified: This group includes those cases which may be classified in one of the stated categories when the study is completed, or reclassified as not mentally retarded. It should be considered only as a temporary category. i.’<.l ~4— ‘- .0 v . -. ...--.--. .. . 2 i... ... . . . v . . (l. . v ... . . . . C . I‘D .I I . 1. IL .vJ ... J u . '. -’\ u ., n . u . .x. l v .- . . w I " w t t J n f. 3‘ .i. o a . . . . . . , . r, . . ,1 c .— q . . no; .. . t. . ..I w .u 7 K . J . . .b- I. v. . . I :4 t ‘ ’ I. 4~ It . . I . . . V . . .. , o u . . . . I I .. . ..-a . . . .. Q ...... \I‘ .1 I . 4 . IIv wr. ... I. :I I . n r . . r . . .9; . .. . . .. . l . . x . -.. .. . I I . a . . ... w l a 0:: I ... . ) . —. u . . I. l I I A I . . l . ..‘ | . n ..J . .\. n . . . .— x; . A. I . 1 . I . . n . ... . .3 .. U u . .. .l V I . f . II t . ‘1 n I. . ‘ .re. . .r . r. ... . u . . . 9. . ~ y , u I. . I! n V I I u > n _ l . I u - . r . y . a .I I l \ . i ii . v . a. , n. . .a . — ’- s. . . . 4 . - vv n l a I. 1‘ .. u c .(P . an . 1' c'. . n n l . L l ..v I) .r. I J . ». . e . l o . s. . a I . I I. n. . i n u n - ~ I, I .o la a. us! 0 o. a. u. . . o l!- . . .. .c .. . u . ‘ 0-. f. o .-.. a. . o . v ‘ 5\ ll — I a a. . . .. m .. .. . . ‘A o, - 1‘ v. . 2. It II .. . . . . . . .n . . a a . A . ' ‘\ u .n. . . o . n I... u’ A. u I, . a4 f I 1.. ... )‘H- QUESTIONAIRE- COTTAGE REPORT NO. 1 Form No. 10-217 Date M Name Number Age Religion INTERESTS : How does the patient spend his leisure time? CARE OF PERSON Dresses Self Laces shoes? Ties shoes? Put on clothes ?__Buttons clothing What type of clmhing does he wear? Eats well? ' Sleeps well? PERSONAL HABITS Washes face?_Cleans teeth?__Takes own bath?__Combs hair?_Oders___Clean___ Clean in toilet habits Day 7—— Night Soil Wet Appearance Careless? ' Neat SEX ACTIVITIES Self? With others? Not observed GENERAL PHYSICAL MAKE-UP : Luetic? Chronic Gonorrhea? Seizures? Deaf ?___Mute? Spastic Blind?_Crippled?____Describe Is the patient frequently ill?_______Explain Frail Behavior Doe the patient make friends easily with the other patient? What does the patient do to attract attention to himself? Does patient yell and scream frequently?____ Does patient take from others? is patient destructive? ls patient ill-tempered? ls patient easily managed? Is it necessary to restrain patient t s it injury to self? . vcr‘t injury to Others? \Vh. . .t tude ( f the family toward the patient? W h ixil'CSQ r is m =mt shown in the past year? Mig s n: titnt DC cosidered for school or training? Do - 4K this patient is suitably placed in your building? __ DOL’ \- w M>lSl with cottage work? Ex F ' — - "K -3 '- QULSTIONAIRE-COTTAGE REPORT! (No. 2) Form No. 10-218 Date .\l .-\ame Number Age Religon DAILY PROGRAM School Part time? Full day? Industrial Work? Under whom? Cottage work What? Day work? No. days a week? Does no work because of physical handicap? INSTITUTIONAL ACTIVITIES: .‘vl owes? Dance? Sports? Religious Service? lNTRESTS: What does the patient: do in his spare time? CARE OF PERSON: Does own laundry ?_______Does the patient keep clean without having to be told? \EX ACTIVITIES: \‘lasturbation Never ? ____Occasionally ?_..____Frequently ?____Unobserved? Homosexual praCtics: Never? Occasionally? Unobserved? Hetrosexual practics: Never? Occasionally? Unobserved? GENERAL PHYSICAL MAKE-UP Frequently? Frequently? Body Cleanliness :Odors?__Clean ?________Appearance Careless?___Neat ?______ Luetic? Ski n disease? Chronic Gonorrhea ?_ Deaf ?___Mute ?__Spastic? DefeCLive vision ?__Crippled ?h Describe: is the patient frequently ill?___ Explain: Behavior: Does patient have “chums” of his own sex? How does the patient get along with other patient in his Cottage? Does the patient like to fight and quarrel? Does the patient Steal? N ho are the patients friends? is the patient destructive? Is this patient a problem in the Cottage? If the answer is yes Explain- What does the patient do to attract attention to himself? Does patient appear satisfied in the cottage? Do you think this patient is suitably placed in your building? What progress has the patient shown in the past year? -\Vhat do you media for the patient in the future? What is the patient attitude toward his family? |What is the attitude of the family toward the patient? What is the patient’s attitude toward cottage employees? l . . . . . 115 the patient satisfied With his institutional work program? Might this patient be considered for day work? )VIV ._. :n—didIO ow‘dH‘J-‘b Books m #9.. a Barr, i-ioxtin ti. Eientzil Defectives: Their “1.812013 y, TEC"‘.tZ.l'_"l‘lt and Train- ln". yhiladelphia: B. ulekiston‘s Son &.Co., 1 o4. Jerry, Richard James Arthur. The fientcl Defective. flew York: McGraw— Hill Book 00., Inc., 1931. Bettelhcim, Bruno. Love Is Hot linouiriz. Glencoe. Illinois: The Free gross, 1950. ...:urt, C. The :Lacltz: z-rd ' ‘2 ..‘tei d. 'i ed. r~'.’1e(..l. London: Oxford Luiversity :ress, 1940. . The :3u.:.:‘iormr_l .‘Liud. 3d ed. revised. Lenion: Oxford Univer- ity AYCSS. 1937. Clark, Leon .’ierce. The :{rtttrc and Treztzttmt of ."Jimzttia. bal‘tiz.:ore: i‘i’. Hood and 00., 1).)3. Friedltmder, halter A. Introduc ion to Sonic-.1 ..olfare. Jingleood Cliffs, NON JCIqC y: treat—ice 1.;ill. 1116.. 1955. doddard, Henry Ecroert. Fee;lc-Nindedncss: It?” Iousos rnd Consequences. New York: me I.lac;.tillan Co” 1914. Kanner, Leo. A miniature Text-ook of Fccslcnlndcdness. New Jerk: Child Care Publications, 1949. Kleinoerg, 0. Social rsycnology. new York: usury Holt &.Co., 1940. q 1 Levinson. iur.h“' The Lmnt'lly fictaraec Child. New York: J. Day Co., 1952. i-iichnl-tiuith, Harold. The limits-11y Rctcrttct toxic-11:. .‘lziltdelpitia: Lippincott Co., 1950. O'Connor, 0.. and Tigtrd, J. The Social Pro 1am of ficntel Deficiency. New York and London: To: :amon .re3s, 1950. Sherlock, 2. 3. Tie Pecule-‘Zi iticd. Sew Iork: The Naomillan 00., 1911. Shuttlcuorth. G . 5., and Potts, H. A. .gcntally Deficient Children. Philadelphia: 3. Blakisten's don t 00., 1910. -66.. q. .iilio*tc-hy(con't) firticles nr thur, Grace. "us e -do-Feeolemindedness," [mericrn jo:rn:1 of Bent: Deficiency, LII(Octo er, 1947). sender, Laurette. ”Schizophrenia in Childhood-Its. Recognition, Des- cription, and Trertoeut," American journal of Orthogsychiatgx, 3391(ju1y, 1956). nergman, Murray, Waller, heinz, and Merchand, john. "Sch' gophrenic Re- actions During Childhood in Mental Defec 2i"es," fizmriccn journg_ of-fientri~9efieiene73 L11(flarch, 1947). Settelheim, ;runo. "Schizophrenia as a Reaction to fix reme situations," American journal of Ort401‘szchietrx, AXVI(*u1y, 133:), Bijou, S. 1. "Tue iro;:1em of tuC Lseneo-Tee--eu1n\ed " fix::nal of} ca ional ;sycholo;}, 4.1(Oc10 er, 1939 ). Bishop, E. beryl. "Family Care: The Instigution," flr‘ric:.n journal of Mentcl 9efieiencz, LIX(Octoper, 1954). . "Family Care: The :atients," fine LiC:11_journz-l of “eatsl De- ' Eicienc , XI(janucry, 1957). Casscll, Robert H. "Differentiation .etxeen ;he Monte Defective with ysycLosis and the :hilcnood SChiZO‘hl C;iC 111111L“:13 rs a Hen- tal Defective," :ne icm 31 jo rnal of .zentc 1 ‘m:nt, Lditcd by I