I

HHII

”Will“

I
i n

M

w
I
n

i|

l
t

HI

I

(30.;
Mo 1|
N-l

THS

A STUDY 0? SCHOOL RETERRALS TO A CHILD

 

CUIDAICE CLIZIIC FOR THE YEAR, 1953+.
f f- W/V/é’fl 7
I II' III I' l “f?

.—

 

H a“"'>

1‘.’ N" n"

.. 0.- ‘
. - ; -

 

CI

‘0

A STUDY OF SCHOOL REFERRALS
TO A CHILD GUIDANCE CLINIC FOR THE YEAR, 1954

by
Jean Elizabeth Wright

A PROJECT REPORT

Submitted to the School of Social Work
Michigan State University
in Partial Fulfillment of the
Requirements for the Degree
of

MASTER OF SOCIAL WORK

June 1956

 
  
 

  

fl! ~

Approved: w-.,
Chairmanxqfesearch Committe

—‘__. Director of School

J‘Hzaitx‘

ACKNOWLEDGMENTS

The writer wishes to take this Opportunity to express her sincere
appreciation to the staff of the Lansing Child Guidance Clinic for

their help and guidance during her field placement there. That
experience provided the inspiration for this study and the results

are herewith dedicated to the staff of the Lansing Child Guidance Clinic.

The writer wishes to express her sincere thanks to Dr. Gordon J.
Aldridge, under whose constant supervision and unfailing interest
this investigation.was undertaken.

She is also greatly indebted to Mr. Manfred Lilliefors for his kind
guidance and valuable help in preparing the data.

Grateful acknowledgment is also due to Miss Frances Hetznecker, who
unceasingly attempted to inspire the writer.

The writer extends her sincere thanks to Dr. Helen Lanting,

Director of the Lansing Child Guidance Clinic, for her permission to
carry on the study, to use the materials contained there in, and for
discussing the project with the writer.

The writer deeply appreciates the assistance furnished by Miss Ruth
Koehler, Miss Sally Sell, and Mr. Ward Wood of the Lansing Child
Guidance Clinic in classifying the children.

Grateful acknowledgment is also due to Miss Ruth Koehler, Chief
Psychiatric Social Worker of the Lansing Child Guidance Clinic, and
Miss Gwen Andrew, Research Consultant of the Mental Health Department,
for their help in discussing and formulating the project.

The writer also extends her sincere thanks to Mrs. Johnson and Mrs.
Darby, secretaries of the Lansing Child Guidance Clinic, for their
assistance in locating records and other information needed for the
study.

Finally, the writer wishes to extend her thanks to her mother, Mrs.
Charlotte Wright, who patiently read the rough draft, contributing
helpful suggestions.

ii

TABLE OF

LIST OF TABLES . . . . . . . . .

LIST OF ILLUSTRATIONS. . . . . .

Chapter
I.
II.
III.
IV.

V.

NTRODUCTIOII . . . . . .
HISTORICAL BACKGROUND. .

PROCEDURES.......

CONTENTS

HESENI‘ATION AND DISCUSSION OF

SUIefl-ZARY AI‘ID CONCLUSIONS. . . . . . .

APEZIDHESOOOOOOIOOOOOOOOOO

BIBLIOGRAPHY . .

iii

Page

iv

vi

lO

25
27

61

Table

2.

5.

9.

10.

ll.

12.

15.

LIST OF TABLES

Community Locations of Schools Utilizing the Lansing
Child GUidance Clinic in 1954 o e e e e e e e e e o e e 0

Schools Utilizing the Lansing Child Guidance Clinic in

1952+. . O O O O O O O D O O O O O O O O O O O O I O 0 O 0

Parent Attitude Toward Clinic Contact in School Referrals
to the Lansing Child Guidance Clinic in 1954. . . . . . .

School PartiCipation in Staff Conferences in School
Referrals to the Lansing Child Guidance Clinic in 1954 .

Recommendations in School Referrals to the Lansing Child
Guidance Clinic in 1954 o e e e e e e o e e e e e e o e 0

Ages of Children Referred by the Schools to the Lansing
Child Guidance Clinic in 1954 . . . . ... . . . . . . . .

School Grades of Children Referred by the Schools to the
Lansing Child Guidance Clinic in 1954.. . . . . . . . . .

School Referrals to the Lansing Child Guidance Clinic in
1954 Classified with Respect to the Expression of
Hostility e e e e e o o o e e o o o o o e e e e o o e e 0

Symptoms Appearing in School Referrals to the Lansing
Child Guidance Clinic in 1954 Ranked in Order of Frequency
Of occmrence . . . . O C C C C C C O C . O O O O . O C 0

Symptoms Relating to Violation of School and Classroom
Rules and Regulations Appearing in School Referrals to
the Lansing Child Guidance Clinic in 1954. . . . . . . .

Symptoms Relating to Difficulty with Authority Appearing
in School Referrals to the Lansing Child Guidance Clinic
in 1954 e e o o e o e o e e e e e o e e e e e o e e e o 0

Symptoms Relating to Failure to Achieve School Work
Requirements Appearing in School Referrals to the Lansing
Child Guidance Clinic in 1954 . . . . . . . . . . . . . .

Symptoms relating to Difficulties with Other Children

‘ Appearing in School Referrals to the Lansing Child

Guidance Clinic in 1954 . . . . . . . . . . . . . . . . .

iv

Page

28

29

52

56

57

59

1+1

45

1+7

2+7

49

table

14.

15.

16.

17.

18.

19.

LIST OF TABLES (continued)

Symptoms Relating to Violation of General Standards of
Morality and Integrity Appearing in School Referrals
to the Lansing Child Guidance Clinic in 195# . . . . . .

Symptoms Describing Undesirable Personality Traits
Appearing in School Referrals to the Lansing Child
GuidanceClinicinl95l-l........cc.......

Other Symptoms of Emotional Disturbance Appearing in
School Referrals to the Lansing Child Guidance Clinic
in 1952+. . O C O O C O O O O O O O O O O O O I O O C O 0

Symptoms Appearing Most Frequently in School Referrals
to the Lansing Child Guidance Clinic in 1954 . . . . . .

Symptoms Appearing Mbst Frequently in Impulsive Children
in School Referrals to the Lansing Child Guidance Clinic

11119540000000.0-0000000eeeeeeeoe

Symptoms Appearing Most Frequently in Inhibited Children
in School Referrals to the Lansing Child Guidance Clinic
in 1954. O O O O O O O O O O O O O O O O O O O O O O O O

51

52

55

55

LIST OF ILLUSTRATIONS
Figure Page
1. NUmber of Referrals to the Lansing Child Guidance
Clinic from the Region Serviced by the Clinic in
1954 . O O O C O C O O C C O O O. O O I O O O O O O O O O C 51

2. Ages of Children Referred by the Schools to the
Lansing Child Guidance Clinic in 1954. . . . . . . . . . . 40

5. School Grades of Children Referred by the Schools
to the Lansing Child Guidance Clinic in 1954 . . . . . . . 42

vi

CHAPTER I
INTRODUCTION

The prevention of mental illness stands as the goal of the
mental hygiene movement. Study of mentally ill adults has shown that
many of their illnesses had their beginnings in childhood disorders.

It is generally agreed that the diagnosis and treatment of the child's

disturbance at a time when the personality is still in.the process of
formation provides a better pragnosis for the child's later emotional
well-being and reduces the likelihood of the need for more intensive
treatment at some later time. The dynamic concepts of personality
growth and development, from which mental hygiene principles derive,
provide the basis for this assumption. One important means then, to
realizing prevention of mental illness, is the early recognition of the
symptoms of emotional difficulties, particularly in childhood.

Since the early detection of symptomatic behavior rests largely
with parents, teachers, and physicians, the mental hygiene movement has
directed a significant portion of its work to disseminating knowledge
and information to those responsible for the care and upbringing of
children. Because of the school's unique opportunity for observing
almost all of the community's children, it also has the 'responsibility

of recognizing the physical and mental handicaps of children."1 The

 

1S. and E. Glueck, Preventing_Crime (New York: McGraw Hill
Book Co., 1956), 10.

2

emergence of educational philosOphies and theories considering the
"whole'I child has: encouraged the modern school to awareness of mental
hygiene and to a function of assisting 'the child to make the best
possible adjustment in all aspects of social living.’l

Inherent in the social structure of our modern community is
the division of services into specialized areas. As a social institu-
tion the school provides many services to children, but in addition
needs to call upon the other services available for specialized help
in certain areas. One specialized service available to the school on
a referral basis is the psychiatric diagnostic and treatment service
of child guidance clinics. Through such a service the emotionally
disturbed child may be referred for evaluation of his disturbance,
recommendations for alleviating the difficulty, and in apprOpriate cases,
treatment to help the child and his parents to a more fruitful relatione
ship. It would seem then to be important that the school and the child
guidance clinic evolve a working relationship for referral of emotionally
disturbed children to the clinic and a co-0perative approach toward
helping the emotionally disturbed child.

Literature in the child guidance area reflects a tendency for
schools to refer 'aggressive' or."impulsive'I rather than ‘withdrawn'
or ”inhibited“ children for psychiatric help. For the purposes of this
paper, "impulsive' behavior may be considered as that which indicates
an unacceptable release of impulse onto the environment, while 'inhibited'
behavior may be considered as that which indicates an internalization

of conflict. Some recent studies have noted a change in this tendency

 

1E. Pilzer, 'Disturbed Children Who Make a Good School Adjust—
ment," Smith College Studies in Social Work, ml (June, 1952), 195.

5

with a trend toward schools referring both I'impulsive'I and "inhibited’
children in certain localities. This study will investigate the use
made of the Lansing Child Guidance Clinic by the schools in the region
serviced by the clinic. The major concern of the study will be the
predominant mode of the expression of hostility in the children referred
by the schools. The study will test the hypothesis stated in the null
form that the schools do not tend to refer the "withdrawn'I or "inhibited“
child for psychiatric help. In addition the study will analyze the
symptomatology presented by the children at the time of the diagnostic
study to attempt to evaluate the significance of the symptoms in the
referrals. Factors involved in the use of the clinic by the schools
will also be examined, with a view to exploring clinic-school relation-
ships. The Lansing Child Guidance Clinic is a joint state and local
clinic Operated under the auspices of the State Department of Mental
Health. A local advisory board composed of representative citizens from
various types of population groups act as liaison between the community
and the professional staff. The clinic served until recently, a region
of six counties and it is from this region that school referrals were
made to the clinic.

In 1928, Wickman reported that teachers are inclined to regard
aggressive and antisocial behavior as the most serious forms of’malad—
justment. He concluded that nthe kinds of behavior which identify the
problem child to the teacher are just those active, overt disturbances
which frustrate the teacher's purposes, transgress their established

rules of order and routine, and violate their moral standards."1 In

 

1E. K. Hickman, Children's Behavior and Teacher Attitudes, (New
York: Commonwealth Fund, 19285, 61.

4
addition he suggested that it appeared that when.teachers were concerned
with withdrawn behavior, their attention was drawn to such traits as
shyness, oversensitiveness and daydreaming, all of which relate to fail—
ure in adapting to school work:requirements. In addition, these withe
drawn traits were rated by the teachers as being of little importance,
and it was therefore concluded that the teachers were little concerned
with.withdrawn behavior and its implications in personality adjustment.

However, a follow-up study published by Wickman in l9#2, pointed to the
fact that the understanding of teachers and mental hygienists was tend-
ing to reach a common ground.1

A study regarding the schools' use of psychiatric clinic services
in 1955 pointed out that in Cincinnati, Ohio, “the school is able to
detect both the obvious and more subtle manifestations of emotional
disorders."2 The cases analyzed in this study revealed an equal number
of withdrawn and aggressive children being referred for psychiatric
help by the schools.

Another recent study of school referrals to a psychiatric clinic
revealed that the following reasons for referral were prevalent in
New York:

Academic problems were the most frequent reasons for referral.

Personality problems were next in frequency and took precedence over

referrals made for unacceptable behavior. It was concluded there-
fore that teachers are able to recognize symptoms of disturbance

 

1E. K. Wickman, “A Study of Teachers' and Mental Hygienists'
Ratings of Certain Behavior Problems in Children,‘ Journal of Educational
Research, XXXVI (1942), 292-508.

2M. E. O'Hanlon, “School and Psychiatric Clinic: A Study of
Inter-Agency Relationships,“ Smith College Studies in SocialAWork, XXIII
(February, 1953): 179.

 

P

No

 

 

 

 

, 1 . . .
l 7 ' -
~ I. '
t .1 .
u b I
. A ‘ . ' I
I .‘
_ .
I l ‘
, .
‘ ’ u I-
.
, a
,
. .
e " ' '
‘ ..
,
. ~ I “ '-
‘ . . .J
‘1
l V I
lo
. , C
‘ "V ‘
. I ~e
.
_ ~ ‘ ‘ 3 . A(_ A' r“-
I ‘ I x - ‘ a)
. i ' '
V v . ‘. ( fi‘
’ . .
O
F . . I ‘
_ s
v . '_ . ‘,. x4 .
._ I .
,fi .
I
- I. r v
4 |
‘ - - u
1 ~ . ‘
D
r

5

that are not necessarily observable or disruptive in the classroom.1

These recent studies point to a continued growth of understanding of
mental hygiene principles by teachers.

One interesting factor to be considered in this or any study
of school referrals was pointed up by Pilzer in a study of "Disturbed
Children Who Make a Good School Adjustment.I It was concluded that
I'symptomatic behavior evident at home does not necessarily manifest itself
in school.'2 This is important from.the standpoint that the teacher's
awareness of the child's disturbance must come through the school
setting, and one must not hastily criticize the lack of an "appropriate“
referral without due consideration as to the way in.which the disturbance
manifests itself.

In considering a study primarily interested in ”aggressive”
or 'impulsive' and “withdrawn" or 'inhibited" children one is concerned
with the expression of hostility. ‘Realistically it is impossible to
classify children into pure groups of these two categories, and in
each one can be found an admixture of the symptoms of the other group.
However, for the purposes of this study the two extremes may be
classified in this manner.

The potential for hostility exists in all children. By the
time they are ready for school, most children have learned how to
express their hostility in socially acceptable ways. The hostility is
confined and regulated by behavior controls. Theoretically, these

variations in the expression of hostility are determined by the quality

 

1R. Braver, 'School Referrals to a Child Guidance Clinic: 1940
and 1950 Compared," Smith College Studies in Social Work, XXV (JUne,

1955): 56.
2Pilzer, op. cit., p. 207.

6
of the relationships between the child and his parents. Because the
child fears loss of love, which to the child might be equated with
actual somatic survival, and takes comfort from approval, he learns
to postpone immediate gratification and to find acceptable ways for
expressing his angry feelings. The pre-school experience with the
parents is generally the source of later deviations in the ability to
express and to control hostility.

A closer examination of these variations in the expression of
hostility might reveal the 'inhibited' child to have a history of
“frequent complaints about aches and pains, fears of other children
and animals, and exemplary behavior in school."1 The impulsive child
on the other hand, might present a history of Idifficulties in getting
along with parents and siblings as well as other children, temper tan-
trums, and disobedience."2 Considering the parent-child relationship
as the source of‘these deviations in the expression of hostility,

the determining factors might be found in the nature of this

relationship, the kind and degree of affectional deprivation as
evidenced by the inconsistency of contact with the parent figure
or the inability to achieve acceptance from the parent figure.5

Several factors have been regarded as significant in depriving
a child of the intra-familial experiences which would enable him to
learn how to control his angry feelings. Beeler pointed to 'the lack

of a consistent adult love-object in the infant years, the degree of

early gratification, and the standards set for the child by the parents."4

 

1S. Beeler, “Angry Girls: Behavior Control by Girls in Latency,"
Smith College Studies in Social Work, XXIII (June, 1955), 205.

21bid.
51bid., 206.

41bid., 206-207.

7
The lack of a consistent adult love-object in the infant years might

arise not only out of physical separation from the mother, but from the
unpredictability of the adult response as well. This could result from
constant contact with an immature and inconsistent mother, as well as
from the lack of contact found in an institution or the varied close
contacts with a series of foster mothers. The developing child needs
a consistent pattern with which to identify. The second factor to be
considered is the degree of early gratification. If children receive
too much frustration and too little gratification there may be little
incentive to learn controls and the child may see little to lose in
giving full vent to his emotions. On the other hand a child may receive
so much gratification that there has been no experience with frustration
and no need to develop controls. Finally the standards set for the child
by the parents must be considered. The degree to which the parents'
standards are in accord with those of society affects the child's
evaluation of when controls are necessary. The child needs motivation
before he is willing to establish controls and IIthis motivation comes
as the child establishes a love relationship with someone meaningful
enough so that he wishes to maintain or improve it."1

Beeler examined parental personality patterns of the parents
of 'inhibited' and I‘impulsive" children and pointed to 'the preponder-
ance of inhibited mothers and fathers in the inhibited group and the
inconsistency among the parents of the impulsive group.‘2 The
inhibited child tends to have parents who are themselves overcontrolled.

They tend to maintain stability though there are frequently relationships

 

11bid., 225.

21bid., 215.

8
characterized by apathy and avoidance. In addition there is a consistent
pattern with which the child may identify. Impulsive children tend to
have parents who differ in their control patterns with the likelihood
of one parent being impulsive. There is marked inconsistency creating
difficulty for the child to learn about acceptable behavior because of
the lack of a consistent pattern with which to identify. In addition
family relationships are likely to be characterized by conflict and
overt hostility. The trend for the impulsive child may be toward
varied and interrupted contacts with parent figures. Thus it may be.
seen that the 'inhibited“ child is offered an Opportunity-to establish
a type of meaningful relationship with the parent whereas the |'impulsive"
child does not have the opportunity to establish a relationship impnrtant
enough to motivate willingness to establish controls.

These factors may be integrated into the psychoanalytic theory
of personality development. The structure of the id, ego, and super-ego
established by Freud provides a theoretical base for a control system
for the personality. The id might be referred to as the'impulsive
system“ including all urges, impulses, strivings, desires, and needs
which seem to push in the direction of gratification, goal attainment, or
expression at any one time. The 'control system" of the personality
composed of the ego and the superéego holds in check this reservoir of
impulses of the id. It is the function of the super-ego to remind us
of value issues that arise in daily living through the ego. The ego
is supposed to keep us in touch with reality and act as a moderator
between the id and the super-ego. It is the function of the ego to find
acceptable ways for the gratification and expression of impulses which

will satisfy both the demands of the reality, social situation and the

' \p‘
.
u , .
I t ‘-
h .
. . .
n.‘ .. , V. ,.
.- .
s I!
, .
, l .
,, ». ,J _ V.
.
v‘ A
‘- ' "‘nu i
L-
. .
\
e
‘ , - .
. . _
v
C
.
" V
..
V
.

... .

9

inner voice of the super-ego. If a child evidences a lack of control
in his behavior it may be due to an upsurge of aggression too great for
his controls to handle, or on the other hand it may be because his
"control system" is deficient and unable to handle relatively normal
impulses. The impulsive child because of’many of the factors mentioned
in the preceding paragraphs has developed a weak ”control system.“ 1
Within consideration of the above framework this study was
made in an effort to examine the nature of the personality patterns,
with respect to the expression of hostility, of the children referred

to the Lansing Child Guidance Clinic by the schools in the area serviced

by the clinic.

1F. Redl and Dg‘Wineman, Children Who Hate (Glencoe, Illinois:
The Free Press, 1951), 59-61.

CHAPTER II
HISTORICAL.BACKGROUND

The mental hygiene movement or mental health movement as it
is frequently referred to today, historically might be divided into
three broad phases. Its first efforts were directed toward hospitali-
zation and treatment of the mentally ill. “The earliest mental health
activities were directed toward removing the patients from workhcuses,
almshouses, and jails, and placing them in.mental hospitals.‘1 During
this phase Dorothea Dix's crusade in the 1840's and 1850's resulted
in improved care and additional hospital facilities for the mentally
ill. The termination of this period was marked by the establishment
of the National Committee for Mental Hygiene in 1909 following the
efforts of Clifford Beers to promote interest in mental health.

The development of the second phase of the mental health
movement received impetus from the establishment of the National
Committee fer Mental Hygiene. At Adolph Meyer's suggestion to Beers
this committee established a program aimed at the prevention of mental
illness and broadened its efforts to include activities outside of
hospitals. ”This second phase of mental health activity was highe
lighted by the establishment of child guidance clinics in the early

1920's."2 These were a logical development in the line of prevention

 

1J. V. Lowry, 'Mental Health,‘ Social Work Year Book (New York:
American Association of Social Workers, 195#), 5R6.

21bid.

10

 

..o

s
A . .1
0 ‘ t
‘ Ah ‘I
. . 4 -
.
s , '
g .
V k
u .

 

 

not

 

—~.-

11
to minimize serious emotional disturbances in later years. Because

of these events the patient in the clinic became the concern of the

(psychiatric social worker and the clinical psychologist as well as of

the psychiatrist and the nurse. In 1950 the National Association for
Mental Health.was established to succeed the National Committee for
{ental Hygiene. A more effective citizen organization is being built
by coordinating this association with the various state mental health
associations.

Within the past few years the third phase of the mental health
movement began and concerns itself with 'the fostering of mental health"1
by encouraging the development of healthy personalities and the mainten-

ance of mental health. The broadening scope of the mental health.move-
ment is evident and the larger social implications involved in this

movement are pointed up by James Lowry.

As the child grows out of the early infancy stage, the influences
on the development of personality enlarge to include various institu-
tions-the family, the neighborhood, the nursery school, the school,
the church, and so forth. These institutions are organizations of
people, and their importance at different life periods will vary.

Ebw they function influences the mental health of the persons with
whom they have contact.2

Thus we see the child guidance movement emerging from the
broader mental hygiene movement. Three factors, culturally speaking,
which contributed to the rise of child guidance clinics were mental
disease, delinquency, and an increase in scientific understanding.
“William Healy and associates inaugurated the first co-ordinated effort
in child guidance in 1909 in connection with the Chicago Juvenile Court.

There is only one predecessor known, the Philadelphia Psychological

A

11bid.. 547.
2Ihid.

12
Clinic which was established in 1896."1 This was begun by Lightner
Witmer at the university of Pennsylvania. 'The work of both Witmer
and Healy produced overwhelming evidence of the vital importance of
the child's emotional life and his maladjustments and delinquencies."2
This was also consistent with the findings of psychoanalysis which
indicated that the first five or six years of the child's life were
exceedingly important in the formation of later character traits, and
stressed the importance of childhood adjustment. The year 1912 saw the
establishment of a clinic at the Boston Psychopathic Hospital and the
following year the establishment of the Henry Phipps Psychiatric Clinic
in Baltimore.

In 1921, the Commonwealth Fund, a private foundation established
in 1918, gave its support to the National Committee for Mental Hygiene
which established the first demonstration child guidance clinic in
St. Louis in 1922. The purpose of this was to stimulate the interest
of many localities in the child guidance movement. The demonstration
method seeks to convince communitiesof values which these communities
can then appropriate and utilize for themselves, and to ultimately
encourage the community to take over full responsibility. This marked
the turning point in the growth of the child guidance movement.

The National Committee for Mental Hygiene established demonstration
clinics through its Division of Delinquency which reflected the original
purpose of the child guidance clinic: to reach the problems of juvenile

delinquency by concentrating upon the child referred by the juvenile

 

1E. Harms, Handbook of Child Guidance (New Yerk: Child Care
Publication, 1951), 22.

2A. E. Fink, The Field of Social work (now York: Henry Holt
& 00., 19149) 282s ‘

 

 

.
e
e ‘

13
court. However, it was soon realized that if preventive service was
to be offered it would have to be done long-before the child was
brought to the juvenile court. When the Commonwealth Fund withdrew
its support in 1927, it arranged for an advisory service to clinics.

By 1950, the pattern of the clinic structure and function had
been formulated. Referrals continue to be made by juvenile courts,
schools, and other social service agencies, but it has been observed
that year by year the percentage of referrals from the juvenile court
has been decreasing. This may be in part due to a recognition by the
courts that the service of the clinic is a preventive one. This trend
evidences an increasing awareness by nonrcorrectional agencies that
the clinic is an integral part of the social services of the community.
'It is perhaps this trend toward acceptance of the child guidance clinic
as a community service that is the most striking development since 1950."1
Along with this changing source of referral there has also been a change
in the nature of the presenting problems. At first there was a demand
that the 'incorrigible' child be made over which has shifted to a
request for help in getting the child over or past some difficult area
in his develoyment.

There continues to be a growth of interest in the establishment
of child guidance clinics. At the present time, except where state-
wide service is provided by traveling clinics, or through periodic
psychiatric examinations by mental hospitals, properly staffed clinics
are found mainly in the larger cities. Small cities and rural areas
rarely have such services available on an adequate scale. This decade

will probably bring greater uniformity as well as more complete coverage.

 

w

11bid., 286.

i
_ .
,
‘ s!
O
. .
. .
.
. .
n l ‘ - 7
l ‘ I
I
O 'r ‘ ‘ ‘
| .
‘ i
n
A \
s~ ‘ i.
. .
I . ‘ . . r
.
. .
s v I
s . v
' I
.
‘ ,.
v V
l I < I
c ‘ " i .
e
.
.
‘ .

 

 

 

 

I. . I ., '
V .
< s
s ' i >
>
_ e
. L
v n
o
. o. , ‘ '
a \ ' I
z , A ' .
l
v ' A ~
" g ‘ I."
l
s ‘ I
. . J
t ‘ ‘
. . ' _ e.
s
1 ‘ ~ I a ‘
u ‘ ‘ .
. u
s .I ‘
l u t '
1
- .
. .. ‘
t ‘ .
‘ i
. , w
I -
. ~ _ .
_ ~ s.
. . .
. “
. I
u
v
|
v ' ‘
. ‘ ' '
.l - ’ ' A. _.

J
I

 

14

Turning to the Michigan scene it is interesting to note that
as early as 1925 child guidance clinics were mentioned in state
legislation. Public Act 151 of 1925, created a State Hospital
Commission and defined its powers and duties. Among the powers
delegated to the hospital commission by this act was the authority
to establish child guidance clinics, to appoint child guidance clinic
directors for clinics they might establish, and to appoint a Mental
Hygiene Director who would administer the state program. However,
at this time no appropriations were made available for the establish-
ment of such clinics.. ‘

0n.April 11, 1929, the Children's Fund of’Michigan was estab-
lished by Senator James Couzens, 'to promote the health, welfare,
happiness, and develoPment of the children of the state of Michigan,
primarily, and elsewhere in.the world.‘l This fund consisted of an
initial gift of 310,000,000, supplemented in 1954 by a donation of
32,100,000. It ... stipulated that this entire sum be dispersed in
the period of twenty-five years. “One of the main.purpeses of the Child-
ren's Fund was to fill the gaps in.remote places where wealth does not
exist and where services for children had not been developed."2 The
Children's Fund joined with others and aided in the formation.of the
Michigan Society for Mental Hygiene. This society was designed to
arouse and guide public opinion for the stimulation of a sound expansion
of state services in.the field of'mental health.

The Children’s Fund established the first child guidance clinic

 

1Children's Fund of Michigan Annual Reports (Detroit, Michigan,
1955-1955). '

21hid., Seventh Annual Report (Detroit, Michigan, 1955-1956). 7.

 

 

e
‘ r
v i
i
.
Iv
’ , .
a
- s
e
. a.
- .- . _ .

 

 

r‘.v
4
i
‘.
a
c

7e-..-

 

15
in Michigan in Detroit in 1950. This was an educational and promotional
device to stimulate the development of the child guidance movement in
Michigan. Hugo A. Freund, president of the fund, stated the following:
We are looking forward then, to a spreading enlightenment among
adults of an understanding of mental and emotional needs of children.
....Certainly we should press on in this field until thl good
derived from it is firmly cemented in the public faith.
At the present time Michigan has seventeen child guidance clinics
located throughout the state. These clinics are operated under the
auspices of the State Department of Mental Health and are financed
jointly by state and local funds.

The Lansing Child Guidance Clinic has the distinction of being
the first child guidance clinic in the state of Michigan.tc be established
under the auspices of the State Hospital Commission. After much deliber-
ation about how tomake the child guidance clinic a permanent structure
in Michigan the directors of the Children's Fund concluded that they
must join with the Michigan mental Hygiene Society and others in convinc-
ing the state that its State Hospital Commission should develop a preven-
tive Mental Hygiene Department which would blanket the state with child
guidance clinics as part of its service. The directors of the Children's
Fund felt that this was the most logical plan for it would be the most
economical method, and would guarantee control by a group skilled in
the sciences that are used, practical in their approach, and sympathetic
to the plan. Looking toward that end, a sum of money was offered to
the State Hospital Commission for a demonstration child guidance clinic
under its auspices to be located in some town.that would make a local

contribution to the project as evidence of its interest. The city of

 

11bid.

 

-
,- .
i
s
‘.
s
s

- ‘ , . _ , . ,
a
5 U '
y a
. . . . - ‘ . s

e.
. y ‘
e . A
_ _ . . e
.
- . , .
. u
. D ‘ ‘-
. ‘ I r e A
-.-
r' I ' ,~
. - , . .
.. . , s ._ \
. ‘ .
' i s 1‘ - e
' I
.. . . f
‘.
a ‘ ‘
4 A . . _
F> I g V ‘
e u .
I I
.
.
, .
. « . , - ,
. . . .
.
‘ . ,
. . . V
.
.
,. , .
_ n
a r
. . J y"
o y i
s .
A , ‘ _. es . .V ‘
.

 

..
~ s
s
a.
e _..
l.
A
, .
'k
k .
n
t K
, v .
e
‘ I
o
(
. n
-. .

 

16

Lansing met the requirements.1

The Inghmm County Council of Social Welfare had for several
years evidenced an interest in child guidance. In the spring of 1956
the Child and Family Welfare Division of the @ouncil proposed that the
Council assume a special interest with projects relating to dependent
and delinquent children. In December of 1956 Herbert P. Orr, Vice
Chairman of the Michigan State Crime Commission, addressed the Ingham
County Council of Social Welfare on the subjects Attacking Crime
Through Child Guidance Clinics. The importance of early detection and
treatment of children was stressed with a view to preventing the
development of the I'essentially criminal'l adult. In addition child
guidance clinics were cited as an economy measure in that the cost
of preventive treatment was minimal as compared to the cost of maine.
taining prison inmates.

In February of 1957, consistent with its interest in delinquency,
the Council assumed sponsorship of’a survey of probation needs. A
special Juvenile Probation Committee was established and arrangements
were made for a representative from the National Probation Association
to come to Lansing to conduct the survey. One recommendation coming
out of this survey was that a mental hygiene service available to courts,
schools, and social agencies be established, and it was SUggested that
the services of the Children's Fund be requested in establishing a
demonstration child guidance clinic. Later during the same year a
Committee for the Study of Juvenile Delinquency was formed and this

committee was later transformed in the Child Guidance Committee. It

 

1Ibid., Eleventh Annual Report (Detroit, Michigan, 1959-19h0),

 

15-11!“

. t
I
I
‘ I
a
l ( . +
I . ‘ N‘ - ‘
I A
. .
. - '
I
s . .
a .\ I v ‘ ‘
‘ - - ‘1 s . v
e
I
, . ’
u
A .3 I I -
’ ,
. ‘ —
. \
‘ v
4 ‘ '
‘I \
u . - '
‘ ' I . h.
. ‘ i I O - v
i r ‘ 1,} ' ' v
I ‘1 '
‘ I
r ~
I | ' ‘
.‘ I- ’ ‘
. .
. ~ ‘
I . I," .
. I
'
a
, - ‘ l . .
. . ’ '
r ‘ .
, ‘7 7 . <
‘ I
‘ ‘ ' -
. .

 

 

 

a. s 9 ‘ - y
i .
I ‘ ' ‘ I. h
) .
. .
.'
V ‘ '
~ I
‘ t
. Y H
i ‘ . e I I‘
A ,
-l
. . - . . .. - . -
. ' .
. . . I I
. I
I l . ‘ I‘ ‘ I ~-
. V ‘ i
‘ H > ‘
K
- ~ \-
I
s ‘ I
\ I (L I I ‘ ’
I . . 'I a
. . ’ ‘ ‘ h“.-
. I ' V
. . h . > A
a I >
.I y I
I. ‘
_ I l
I
I
‘ ’ D
‘ .
a ‘ v ‘ . v
‘
. I '
, 7 l . I
I . ‘ ‘ - . -~ -
I
II ‘
,
. I "
.s, I ~‘ -‘
e ' '
4 | ‘ \' I ‘ .
s _ a y j
I
O V 4 ~
. l
7‘ . I A .
.
. I (I. ,_ t
.. L ‘ ~-
‘ I
v ." I --
‘ I
. I
. U
- I

‘I
I
is

‘V

17
is interesting to note that, as in other areas, the forerunner of child
guidance in Ingham County was concern with delinquency.

By April of 1958 the Juvenile Delinquency Committee had held

two conferences with.Dr. Joseph Barrett, Director of the State Hospital
Commission, to discuss the possibility of establishing a child guidance
clinic in Ingham County. The State Hospital Commission had expressed
an interest in supplying the personnel for a clinic if the community
assumed responsibility for overhead and clerical expenses.

By May of 1958 the committee had consulted the National Mental

Hygiene Association in an effort to obtain helpful information. This
association.recommended the following:

The child guidance clinic funds should come from the state
provided the clinic was under local control. The personnel should
consist of one psychiatrist, one psychologist, one psychiatric
social worker, and one secretary. The average case load of a clinic
with the above personnel would average from 200-350 yearly. The
control should be in the hands of a board of directors which should
have certain goals such as stimulating the schools to undertake a
visiting teacher's program. It is advisable for the community to
take over the financing of the clinic as soon as possible, suggesting
a 5-year reducing plan, if it is not possible to plan to do so within
a year. It is important to have a well trained social worker whe
will make for permanency in the local clinic set-up. She is to act
as liaison person between the psychiatrist and the community and to
interpret the program of mental hygiene to the community as well
as the schools.1

Also during this month, Dr. Barrett reassured the Juvenile Delinquency
Committee that the State Hospital Commission would be in a position to
supply personnel for a clinic providing the committee was interested in
the project. It was recommended that there should be an effort to inform
more people in.the community regarding the project. In addition a survey

of the needs in'the community for the service was suggested.

 

V...

1Minutes of the Juvenile Delinquency Committee of the Ingham
County Council of Social Welfare, May 12, 1958.

Med bed eeiflsmoo goneupatled eftnean ed: 8331 to 111511 v.8 " ‘
IsflqeoH stem ed: '10 103-39110 .Jie-z'rea dqescl .10 ditw seene'xomo d
coast»: 03 bids 3 guidatidssae "lo :JII. tdtsaoq er‘t aauostb 6.! “will“

beoae-que bad notastmmoo isflqsofi 933338 ed? .‘girxuois madgnl at eh“

gunmen ed: it otntI-o s to? hammer; 3dr gntgiqqua at new

.4
.seamequ isotzeio has beedwevo moi gitIidtanoqsex 5

Issue)! Imotte’d ed: befiusnoo bed seditmoo ed: 3&2}. to yet! {8

i 3.31

sth .noid'smo'tm‘. Iu“)qiefi ntnido of .t‘xo‘i'ie‘ae u: notesrooad one”
:gmiwotlo‘i ad: hebooswooe'x notht _‘

edicts ed: m'fl emoo Moon's sham static cor-.‘ebftug biido ed’l'

Mitosis Imsteq ed? .Io'wnoo [seal 1.9wa sew static and bebtvo'q'
otmteidoxsq one .ieigelodogaq one .Jeiaietdogsq cue to ieisaoo'
static-s to boo! ease egs'xevs eri‘l‘ .v'tefo'vcec onc bne .mesi'row [aioosf
od'l‘ .tiusfiz O'C‘Q-OOS m‘fi egsxovn 01'ch famoe'zeq (weds ed} 532w
Minds :1on stores-115 to breed 2 '11: ahead add u}. ed bloods teams
s 015me st sIoodos en'iL gmieiumid'a. as done. eieog ates" '29:: end

of 13mm» ed: mot eidsotvbe a: *I .mesgo-zq a'tedzmw- antitoiv
nausea“ .ofdtoosq es noes as stat! 9 («H “to gaionwl'I ad: more mist
chitin es be e! 1:qu o: eidtsooq Jon s; it it .nqu gntaubex meg-f s
ed)! flaunt .[eioos banter: Itew 3 ever a: weexoqmt c‘r :I .Iee'z 5
his» 03’ It d8 .qu-Jes oldie Leon! edt ru': (phenom-seq 10“ sales: III!
o3 his gimme 063 has intxd‘si'dovso adJ‘ neewdeo' mosses; (waist! so
flow on when» ed+ o: enetgvri Issues: IO canon: ed: ie'xq'xem
.sIcodca ed? as“

' hear an ,1

    
 
  
   
  

touwpnliefl eitaevut. ed: bewaeeei antenna .13 .anom am: 3:1th
04’ fieldinq .e at ed bIQow aoieetmmo’) Ied‘iqsoI-i sues ed: insist so.”
n1 bohe‘tod’lt sew Bedtime or}: mibivo-tq starts .0. 'ml Iermos‘zeq {In
saint 03 310110 M ed bloods e'zedt isn't betznemooe'! new .31 .J'oetoq
forms 13 notflbhs n1 ..fcete-xq an: gate-13391 .fgtrvusmoo ed: a: elqosq

.bed'segaue sew sotvsoc mi: 10': gd’immmoo as: a sheer: d:

M,——v —-msv~o—r-

 

 

Maul ed: “to eeittmoo '(oeeuontlec eiine’WL edd’ “Io «snail-«II
,anDf :95 vat“: .su'tféw 1131008 ‘10 liat'onC Y

 

18
In June of 1958 several leading citizens spoke favorably of
establishing a child guidance clinic. Among them were Judge John McClellan,
Judge Sam Street Enghes and Prosecuting Attorney Thomas Bailey. The Junior
Service League also supported the project. Dr. Barrett re-emphasized the
need for the Juvenile Delinquency Committee to stimulate the community's
interest in the subject and warned that unless a much larger group were
interested the project could not be successfully carried on. Also during
this month the Juvenile Delinquency Committee was changed to the Child
Guidance Committee and the committee's function was defined as follows:
1. Deve10p a child guidance clinic available to courts, schools
and social agencies.
2. Develop a child guidance program in the community.
3. Develop and take the leadership in co-crdinating the activities
of social agencies in their work with pro-delinquents.
4. Develop a central clearing and consultation bureau in the
referring of delinquents to the proper agency for service needed.1
By July of 1958 the Child Guidance Committee had established
special committees to carry on the planning and work of organization,
maintenance, education and fund raising for establishing a child guidance
clinic. The community was to assume responsibility for the housing
maintenance and stenographic force.
By September of 1958 the Children‘s Fund had made an appropriation
of $11,000 to the State Hospital Commission for the child guidance clinic
project. The Child Guidance Committee was cautioned that requests from

other cities had been received for the funds so that it was essential
for Lansing to secure money for maintenance expenses right away. The
committee on fund raising then began actively to attempt to interest

service clubs in financing a child guidance clinic and Dr. Barrett was

 

1Minutes of the Executive Committee of the Ingham County Council
of Social Welfare, June 10, 1958.

19
reassured of the committee's interest in the project.

The grant fi'om the Children's Fund was on the basis of one year
to be renewed only after careful consideration of the program. It was
stipulated that the local community must adequately furnish maintenance
costs. The terms of the grant also advised that it was essential that
an advisory committee of local people with one representative from the
Mental Hygiene Association and one representative from the Mental Hygiene

Comnittee of the Michigan Medical Association be established. Personnel

for the clinic were to be approved by Dr. Barrett and by the directors
of the Children's Fund, and the clinic was to be incorporated. The
directors of the Children's Fund further stated that it was expected that
the State Hospital Commission would secure a grant from the legislature
to finance the project in the future.
By October of 1958 the fund raising committee was attempting

to interest some thirty to fifty organizations in financing a child
guidance clinic and some pledges had been seem-ed. In addition
consideration was given to continued financing in the event that the
Children's Fund or the State Hospital Commission should fail to

contribute funds after the first year's operation. An interesting side-
light was mentioned by Mr. John Hardy, a former member of the State
Hospital Commission. According to Mr. Hardy,_the State Hospital
Commission unanimously favored sponsoring a state system of child
guidance clinics and had no question of abandoning the project of the
Lansing clinic. ApproPriations for financing were, of course, dependent
upon the legislature, but the commission was active in attempting to

secure appropriations for child guidance from the legislature.1 Also

 

 

_—‘ V _

1Statement by Mr. John Hardy, personal interview.

20
during October the Child Guidance Committee was authorized by the
Ingham County Council of Social Welfare to incorporate a separate
agency to supervise a child guidance clinic in Lansing and the abuncil
also moved that it be invited to join.the council as an institutional
member. .

Dr. Kirkpatrick, the first director of the Lansing Children's
Center, as it was formerly called, arrived in Lansing on November 15,
1958 and was instrumental in engendering additional interest on the
part of the community in a clinic. By December housing for the clinic
had been secured and it was planned that the clinic would be opened by
December 20, as staff had been employed. The articles of incorporation
as well as the constitution and bylaws had been drawn. The Children's
Fund supported the Lansing Children's Center for four years. During
the fiscal year 1945-1944, the state legislature appropriated enough
money to finance the Lansing Children's Center, three other established
clinics in Saginaw, Huskegon, and Kalamazoo, and to develop a fifth
clinic in the northern peninsula at Mhrquette.

In 1945 the legislature abolished the State Hospital Commission
and created in its place a State Department of Mental Health. The
department consists of a commission of five members appointed by the
governor with the consent of the senate for staggered terms of five
years. A director is appointed by the commission and the governor.

The director appoints an executive with the commission's consent for
each of the three divisions: business administration, hospitals, and
mental hygiene. The child guidance clinics come under the mental hygiene
division of the Ibpartment of mental Health.

Clinics are set up on a regional basis serving several counties.

21
The Lansing Child Guidance Clinic serves Ingham, Eaton, Clinton and
Livingston counties. Until July of 1955, when a full clinic was
established at Jackson, Michigan, the Lansing clinic also served
Jackson county through a branch office located in Jackson, and
Hillsdale county. The Lansing clinic is located in Michigan's
capitol city. The local scene is influenced by industrialization,
state offices, and by the presence of Michigan State University in
East Lansing. There is a fairly stable employment picture with the
absence of outstanding incomes, the median income for Lansing being
about $6,6C0 per year and for East Lansing about 311,000 per year.
Thus this community offers a stable setting for the Lansing Child
Guidance Clinic in that it may be assured of the continuity of
community support.

The clinic is a joint state and local project supported by
the State Department of mental Health and local agencies such as
boards of supervisors, boards of education, and community chests. As
an example of this joint financing, during the fiscal year l955-195h,
the State Department of Mental Health provided about fifty percent of
the funds for operation of the Lansing Child Guidance Clinic.
Approximately twenty-four percent was supplied by local tax sources
with about half of this amount being furnished by the schools. The
additional funds amounting to approximately twenty-four percent of
the total funds were provided by local private sources, primarily
community chests.

The clinic has an advisory board composed of representative
citizens from various types of pOpulation groups who are actively

interested in the program.

 

 

 

l . D
.a 3.
I. .
» . s
I. .
. . u «
v r
z . . \J
v ‘.\
. .
, o . a
t u
. j .
. _ . . . t
, . r
U
. . J
.
I
.. l A .
.u _.
2 .,
a i . _ .
. e
y N
. i
I I
u A
. ,

.
.
0‘ i
. .
.
..
.4.
d
I. .—
, n . ,
. .
. . .. ..
1 l‘
. . .
w . r v.
.
o .
1 w s r.
e
, . .A
. o
4
.
. P
I ,I.
1“
.3 .
.
_
u .
n
.
\

 

 

22

The function of the advisory board includes that of providing
community money necessary for clinic Operation. It further acts
as the liaison body between the clinic and all other community
agencies, institutions, individuals and officers. It assists in
determining clinic policy related to local problems and conditions
and it continually provides the Department of Mental Health with
the assurance that community cooperation and participation will be
complete and continuous.

The function of the Lansing Child Guidance Clinic is stated

in its sixteenth annual report.

In general the clinic tries to improve and protect the mental
health of the children in the community. It does this not only by
providing psychiatric and psychological service to families where
children have emotional problems, but also by its consultative and
participant relationship to all other health, welfare and educational
agencies. The mental health of children is a community responsibility.

The clinic shares this responsibility with all other agencies in the
community that deal with children.2

The clinic at present has a staff composed of a psychiatrist-
director, two psychologists, three psychiatric social workers, one
administrative secretary and one receptionist. The continued growth
of the clinic was evidenced by the addition ot two new staff members,
a psychologist and a psychiatric social worker, during the summer of
1955. Future plans include more adequate housing facilities with long
range plans of building a clinic especially designed for psychiatric

services to children.

 

1Michigan Program of Child Guidance Clinics (Lansing, Michigan:
Department of Mental Health, June 1955).

2LansinggChild Guidance Clinig,_Sixteenth Annual Report (Lansing,
Michigan, 19 5A?

 

 

 

 

 

. d ..
. I
\
v v
. v r . f . t
\u I is n . r
v s u e c.
. I i. 1 I» .
t, . u
.. a v.
I v
a _
.
y .
.
e .
t .
n
.
.
a . .
a. . v .
.
. .
. . .
a t a .
y
.
u
V v t
.t i
I
4 t
.
. a
.
.
_ . t
t
,
a A
. . O a
It
.

 

.‘i4fl

CHAPTER III
PROCEDURES

In this study the emphasis was placed on the mode of expression
of hostility of children referred to the Lansing Child Guidance Clinic
by the schools in the area serviced by the clinic. The two extremes of
the expression of hostility were classified as "impulsive” or I'aggressive'
and 'inhibited' or 'withdrawn.‘ ‘
Behavior which indicated a release of impulse onto the environ-
ment, at the same time being unacceptable to family, school, and
cammunity, was regarded as "impulsive.'I When.the behavior indicated
internalization of conflict, at the same time maintaining harmony
with the environment, it was considered as “inhibited."1
The children in both groups--'impu1sive' and "inhibited" were
selected from the files of the Lansing Child Guidance Clinic. The cases
chosen for examination were those listed as school referrals in clinic
statistical books for the year 1954. The original group of cases
consisted of forty-one cases. It should be mentioned that many referrals
actually stemming from school interest may not be listed as school
referrals in the clinic statistical books. Clinic policy prefers
parent referrals and many school personnel cooperate with the clinic
on this basis by encouraging the parents to seek help from the clinic.
Hence, many of these referrals might be listed as parent referrals.

The cases were then pulled from clinic files and in this process it was

discovered that two cases were from Jackson County and therefore the

 

1Beeler, op. cit., 210.
25

24
case records were not available as Jackson County cases have been
filed in Jackson since the beginning of the Jackson Branch of the
Lansing Child Guidance Clinic. In addition one case was not a
school referral and these three cases were deleted from the original
group leaving thirty-eight cases.

The records were then examined in order to determine the basic
level of intelligence of the children. It was thought necessary to
rule out the possibility of defective intelligence in the children since
the ability to grasp and to adjust to reality depends to no small extent
on the individual's level of intelligence. In this process three cases
were withdrawn from the sample because of the possibility of defective
intelligence. In addition it was discovered that one case record cone
tained only an intellectual evaluation requested by the school during
summer months when school psychological services were not available.
This case was also withdrawn from the group of cases to be examined
on the basis that it did not contain enough information.regarding the
child to classify him adequately into either of the two groups of
“impulsive“ or “inhibited.“ Thus a group of thirty-four cases
remained to be examined.

A committee of three professional persons from the Lansing
Child Guidance Clinic was utilized to classify the children into one
or the other of the two groups of “impulsive" or "inhibited.' This
committee was composed of three psychiatric social workers: Miss Ruth
Koehler, Miss Sally Sell, and Mr. Ward Wood. Committee members were
provided with a schedule containing the definition of 'impulsive' and
”inhibited" as defined for the purposes of this paper, a listing of the

children's names, and an appropriate space to mark their decisions

25
regarding the child's mode of expression of hostility.1 The children
were classified according to the predominant mode of adjustment
recognizing that each individual utilizes both defenses of withdrawal
and aggression.

A schedule was drafted for the purpose of abstracting infor-
mation related to the study from the diagnostic study in the case
records.2 This schedule was designed with a view to gathering
identifying information regarding the cases in the sample, factors
relating to school-clinic relationships, and the symptomatology
presented by the child at the diagnostic study, The writer consulted
with Miss Ruth Koehler, chief psychiatric social worker at the Lansing
Child Guidance Clinic, regarding the composition of the schedule and
Miss Koehler offered helpful suggestions. In addition the study was
discussed with Dr. Helen Lanting, director of the Lansing Child Guidance
Clinic, who discussed some background of school-clinic relations with
the writer and granted permission for the use of clinic records in
the study and the use of professional staff time to function as a
committee for the study. [wring the process of abstracting the material
from the case records it was discovered that it was not possible to
identify the school system involved from the case records. In addition
it was felt that a more inclusive listing of symptoms would be helpful.
A new list was devised with the purpose of later combining these symptoms
into a more compact presentation.3

Interviews were held with Mr. Eugene Richardson and Miss Esther

 

1Appendix A
2Appendix B

5Appendix C

26
Belcher of the State Department of Public Instruction in an attempt to
gain identifying information regarding the schools involved. Mr. John
Hardy, a former member of the State Hospital Commission discussed
historical information regarding the development of child guidance
clinics in Michigan with the writer, and the minutes of the Ingham
County Council of Social Welfare were explored regarding the develop-
ment of the Lansing Child Guidance Clinic.

Some recognition must be given to the limitations of the data
from which the findings and conclusions of this study were drawn.
First, the quantity of data differed from record to record. Further,
althOUgh an attempt was made to remove bias from the study by the use
of a committee in deciding on the children's mode of expression of
hostility, the remaining schedules were filled out by the writer alone,
introducing the possibility of bias in the selection and interpretation
of record material. It was not possible to provide any check on the
reliability of this part of the data, and the findings which follow

must be read with this in mind.

 

CHATTER IV
PRESENTATION AND DISCUSSION OF DATA

When a child is referred to the Lansing Child Guidance Clinic
a diagnostic evaluation is arranged to aid in understanding the child
and his milieu. During the course of this evaluation, one or preferably
both parents are seen.by the social worker in order to obtain the social
history, evaluate family relationships and the family's ability to
utilize the services offered by the clinic. ‘The child is seen both by
the psychiatrist for clinical evaluation and by the psychologist who
administers tests as indicated in the particular case. A staff conference
is held to plan for the child and his family, and the parents are again
seen by the social worker to plan accordingly for the child.

Referrals to the clinic are received from a wide variety of
sources: schools, physicans, courts, social agencies, and parents.
This study is concerned with school referrals to the Lansing Child
Guidance Clinic from the schools in the area serviced by the clinic.
As previously mentioned, clinic policy favors parent referrals and this
group tends to form the largest number of referrals to the clinic.
However, school referrals generally comprise about twenty per cent of
the total referrals and form the second largest group of referrals to
the clinic. Thus it may be seen that use of the clinic facility by
the schools is important in an overall picture of use of the service
by the community.

The schools utilizing the Lansing Child Guidance Clinic in 1954

27

a.

 

 

28
represent varying resources and structures. Some of the schools are
located in small rural communities. some in small cities, and others
in large urban communities. Related to the size of the community are
the number of administrative staff employed in the school system, the
number of schools in the community, the number of children attending
the schools, and the number of teachers employed. In addition the
schools represented possess varying degrees of financial resources.
TABLE 1

COMMUNITY LOCATIONS OF SCHOOLS UTILIZING THE
LANSING CHILD GUIDANCE CLINIC IN 1954.

 

 

 

 

Community POpulationF Number
Referrals

Total..... eeee 51+
Hartland....... 225 2
Okemoleeeeeeeee 500 2
SuninIdeeeeeee #00 1
Mulliken....... 411 1
Haslett....u.. 750 1
Helteeeeeeeeeee 85o 5
Litchfield..... 882 1
Laingsburg..... 942 l
Jonesville..... 1,594 1
Maeoneeeeeeeeee 5,511+ 1
Howell......... 14.555 1
Ste JOhnseeeeee 4,950 5
Charlotte...... 6,606 1
East Lansing... 20,525 #
Lansing........ 92,129 11

 

 

 

I"1950 Census
It was interesting to note that the school referrals to the
Lansing clinic came from a wide variety of sources. No more than two
referrals came from any one school, and in a majority of instances there

was only one referral from a particular school. This was also true in

-Au

-..\ .u.\.-'.

~'.. .

OH...

O

29
the Lansing sshpolshwhiehfpessesirtheLeesviseseefviilitingfitedchsrl.9o
Even combining the schools serviced by one visiting teacher indicated
In addition.various

no more than three referrals in these groupings.

communities in each county served by the clinic were represented.

TABLE 2 ’

SCHOOLS UTILIZING THE LANSING CHILD GUIDANCE CLINIC IN 1954.

 

 

 

Community School“I Number
Referrals
TOtaleeeeeeeee 0000- 54

 

Hartland......... Hartland Consolidated School
Okemos........... Okemos School
Sunfield......... Sunfield School
Mulliken......... Mulliken School
Haslett.......... Haslett School

HoltOOOOOOOOOOOOO

Holt School
Midway School
North School

LitChfieldeeeeeee LitChfield SChOOl
Laingsburg....... James Couzens School
Jonesville....... Jonesville School

Mason............
Howell...........
St. JOhnBeeeeeeee
Charlotte........
Eaat Lansingeeeee

Lansing..........

 

Jefferson School
Stone School

St. Johns Elementary School
Elementary School
Bailey School

Nerble School

Red Cedar School
Barnes School
Elmhurst School
Foster School
Maplegrove School
Maplewood School
North Street School
Northwestern School
Valley Farms School
Willow Street School

HHHHNHHHNHNHHHHHHHHHHHHHHNH

 

 

‘In all cases the exact name of the school was not
In some instances the schools are not part of the city school
system of the city mentioned.

available.

     
        
   
     
  
  
   
   
    

--. -
$.-

  

’ ‘-.é;

--A

Y ‘ '.’ _ j“

—. w
.~ ”.PW—

J-.-
- b—
a-
.::r

 

’6
- --
-- ‘ w~a

- “.4 ." '
-;=£._

H.
”—‘3‘

' ...-Q, 1
" -+—4‘. -—o

1'}:
e *‘v
“1

  

uc.’ _
--

T“. I. ‘i‘ I‘—

      

-}

4

1...‘ m -

.ib’... _‘1 f
WM MM_

   
    
     

.‘V.‘-e-'V'-

.

-

gum.

.. .4 -

."§ws?4.

1
’;—~4.‘
h‘f”!
aims

l O _

—-.-——a

uweiaantwnw‘huiquu. .
beiscibat 1edcse: gniiisiv sac yd beetvges cicadas ed: gatotk'
suctmev acttibbs nI

.beJneequer stew skulls and vd bevvee {Sauce dose at soft?

.RQI KI ammo SWAGIUO GJIHO anew sh- mmnm aroma.

QS

SAZJSIT

.sgaiqu013 seed: at sIsvveieu sets: ssdJF"_r

 

 

 

xedmuh
sIsmxdiefl

‘Ioodee

 

$6

1

rebsPtF~VIF~h~h~V>hwvoharnhahthth~k~rthshtr~htvastness

 

Ioodce beisbtlosaco haeitusfi
Ioodca someflo

Ioodca bietlnua
Ioodca uefllIIuM
Ioodoa JJeIaaH
Ioodoa iIoH

Ioodoe {swbiM

[Ochoa dJTOH

Ioodca bieiidotid
Ioodoa aaesuoo comet
Ioodca eiiivsenot
Ioodoa aoevetiet
Ioodoa emote

Ioodoa vtsmuemelfl shoot .18
Ioodoa {mainemeifi
Ioodoa velisfi

IoodoB eIdteN

IoodoB asbeD hefl
{codes seo1s8

Leases tsxudmifl
Iocdca votes?

Ioodoe svevgeiqu

_ Ioodoa boowqusM
Ioodea ieevda ditch
Ioodoa~a1edaewdtxofi
Ioodaa smvsfi veIIsV
Iocdea decide wcliiw

a .....pstsnal :

 

......OOOIBnT "

     
   
      
  

.........basI31‘l 5
...........sollI-5

eeeeee...b£9 1» p }
.........nuflt11 .
eeeeeeeeeeJ:°I. - g

.............inflr.fl

.W

eeeeeeeblottd331¢?T,

Oeeeee.3"b’d.8fl£‘li
eeeeeeeaIII".flԤ;fiw '

eeeeeeeeeeeeao.‘

eeeeeeeeeeexlom"?1fl
eeeeeeeeafldo‘ m“...

ebeeeeeeunl

...:
..........3nttnlq5:
"TI:

.

.

..fi
'

 

v— . ——v—
- p

. .eIdsIIsvs 30a esw Ioodos ed: To emss Jesxe ed: seaso [Is “1”}
. . rod” ‘31:, edd' is d'taq Jon 9‘13 election so: seonsssst em' ..
.benoiinaa {its and To med. ‘;

  
 

. . v

V
I.)

50
However, it will be observed on the spot map on page thirty-one that
proximity to the clinic making the facilities more accessible does
appear to be a factor involved in utilization of the clinic by the
schools. This would correlate with findings regarding utilization of
the clinic based on the total caseload.1 The annual reports also
indicate that the majority of referrhls come from Ingham County with
a high percentage from Lansing.

Referral involves an understanding of the function of the
agency to which a client is referred, interpretation of the need of
referral to the client, interpretation of how the agenpy to which thg
client is referred may help him, and in many instanCes preparation
over a period of time to gain client readiness for the referral.
Timing is, Of course, important in the client's acceptance and use of
referral and in some instances it must be accepted that the client is
neither ready nor able to use referral. It would be impessible to
completely evaluate the method of referral in the cases involved in
this study because of limitations imposed by the data. However,
impressions may be gained as to the nature of the referrals. The case
records were not kept with a view to evaluating referral method and
the impressions which follow must be read with this in mind.

It will be observed in TABLE 3 that the parents in nineteen
cases of those examined were clearly interested in coming to the
clinic. There appeared to be evidence of positive preparation for
the referral, and the parents seemed to have a good idea why they

were coming to the clinic. In only one instance when the school made

 

I'Differential Utilization of the Facilities of a Michigan Child
Guidance Clinic,“ (Lansing, Michigan: Michigan Department of Mental
Health Research, Report NO. 17), p. 4.

K

(13' °*
" r". as: sue-gram: egsq no‘qam dogs may? hem,“ . .'
7"";4 each eidtsseecs eves: schflies‘l eds aunt. ctstle . .‘ .1
ed: to static ark? 'Io seiisdiitu at BevIevul ssh: .- r: . .. 1'.
‘le aeflssfltw garb-mgr: cgnlhun dstw calories blue-c -‘..".
eels sJ'xqu'x Lamas etiT [Jamison Latte: add no .I s --:: ~":-'.:-
dflw vmseo msdgn‘l marl ance sin-rein is whop- e i w. . --
.3atssed soft s
ed: ‘10 (terrorist! ed: ‘10 gnlbnsde'xehau as sewievat '
is been if ‘ic netdsd'exqvem .be'nete-I e1 JIOIIO !- ' -.-. . -
sdidoidw oa‘vouegs ed: wet! “to noltsie'sqiednt ,ssello --.' - ' i -- -
aetisuqe‘sq occasion}: wants at has .niri sled vets be» - v: 2. :'
.Is'ne‘ie-z ed: 10‘} seestbse‘: mono sis; a: as): : '- ~ -.: '. '

'ie can has eonsoqscos e'metIo ed! at mmqmi‘ gent-M ’ - .3

0'.

3.3

st Justin «it in” hedges” ed sum it ee‘eastast ems .: '

.03 efdtsueglt ed quow 31 .Isr‘xe‘i‘e'x sex: ed aids ~'- . 5': w: 1‘. .-

st bevlcvai cease ed: at Isne’ke': 10 bodies: en: en." . -: .
.mevewoii .so‘sb eds wed beseqmi mettsflmilic es. 1“! -.

sees ed'l' .BIJ‘I‘IO'IQ‘I add '10 suites ed: at u beaksg ed .' - .- ~ v

has bodies: Isne'le'x guanine of wetv 9 mm Sqeil . .

Jain at am: dilw bse'! ed isms onIo'i doidr ..- ' .' .. .--.

        

 

 

  

necrosis at ease-inc ed: Jedi-E W! at bev'reedo at . --. -.
'7- ed: 03 antenna mt behesmi {Lucie new beams)" ' . ' ~
‘i .
:1 wit: me? mildews-sq adding 'to ecnebtvs ed e: 5231st _ t -. ..
IKE" ' zed: fiw-sebt boog s end oi helices sinetsq ed: 5- - .' --‘1 .w
.yofs‘ “reflel st“ sedw 0011313111 9:10 vino aI .ohllIo as" ‘ w '. -
l‘."L ' ..‘fi “" """"'
5'; huge " ' -' at s to sou-titan“! ed: “to actisalliw Intent .
1f; , . "'1' ' to anaemia neatdom magnum .yxtmal) ‘. ' .
i E‘- ’ .$ .q .(YI .dfl Jaeqefi , -‘ .-

51
FIGURE 1

NUMBER OF REFERRALS TO THE LANSING CHILD GUIDANCE CLINIC

FROM THE REGION SERVICED BY THE CLINIC IN 1951+.

 

St. Johns

Laingsb g
CLINTON

 

 

' Mulliken Lansing 7.: Ha'slett
Sunfield ‘ IliEast Lansing

‘ol

.. Okemos

Holt

Charlotte Mason

 

 

EATON' INGHAM

Bertl d

we

Howell

LIVINGSTON

 

 

Jackson Branch Clinic

JACKSON

 

 

 

Litohfield

Jonesville

 

 

Lg HILLSDALE

 

. - 1 referral

 

...

L,.fl‘

v u5v

3.30.
.x

52
an appointment for the parents at the clinic without informing the
parents about it, were the parents angry about referral arrangements.
In this instance the parents did maintain interest in clinic contact.
The parents in five cases appeared interested but didn't follow
through with clinic contacts at some point in the diagnostic study.
There is insufficient information in these case records to clearly
evaluate the reasons for discontinuance of service. One family moved
during the course of the diagnostic study and consequently changed
schools. This did appear to be a factor in the family's discontinuing
TABLE 5

PARENT ATTITUDE TOWARD CLINIC CONTACT IN SCHOOL REFERRALS
TO THE LANSING CHILD GUIDANCE CLINIC IN 1954.

Parent ' Number
Attitude Referrals

Total 0 O O O O O O O O O O O 0 2h

Interested. . . . . . . . . . . . . . . . 19
Appeared interested but did

not follow through . . . . . . . . .
Interested in diagnosis; not

interested in treatment. . . . ... .
Not interested; hostile . . . . . . . . .
Highly succeptible to

community pressures. . . . . . . . .

NWU‘IW

service with the clinic although its implications remain uncertain. It
is known, however, that this child was a seriously disrupting factor in
his classroom before moving and the school's concern about him may have
influenced the parents in coming to the clinic. In only one out of
these five cases was there evidence of hostility on the part of a
parent. In this instance the hostility appeared to be more related to
the parent's feelings of inadequacy and guilt rather than having been
engendered during the process of referral, however the interest of these

parents in the clinic remains questionable. They might have been.more

55
interested in seeking help for their child had the school involved

responded to the request by the clinic to jointly plan for the child.
Because the school's help in this case was considered vital it was some
time before the parents were offered an Opportunity fer interpretation
and they did not respond to this communication. Another one of these ‘
five cases is now in a reopened status, the parents having returned to
the clinic for help.

In five cases the parents were interested in diagnostic services,
but not interested in treatment. Hewever, only two children out of
these five cases were considered to be in need Of psychiatric treatment.
In one instance the possibility of treatment was considered dependent
upon the child's adaptation in the future, and in the other two cases
it was recommended that only the parents be seen for brief consultation
regarding understanding and bringing up children.

In three instances there was evidence Of hostility regarding the
referral. One child was referred at the time a sibling was being seen
for diagnosis. Theparent did not feel this child was in need Of referral,
but did consent to a diagnostic evaluation. In one instance the intake
interview was arranged by the school without considering this with the
parent. The parent was hostile concerning the interview and did not
follow through.with further appointments. In the third case the parent
was not interested in the services Of the clinic, did not feel the clinic
could be Of help and stated that he came only at the insistence of the
school. This family was willing to complete the diagnostic evaluation
but unwilling to consider further service when treatment was recommended.
In these last two situations it is impossible to know whether the

hostility of the parents was engendered primarily by the referral method,

54
whether they needed more preparation for referral, or whether the life
situations of the parents created a more basic hostility in their
personalities.

In two cases it appeared that the parents possessed little in!
sight into family difficulties and were highly succeptible to community
pressures. While one of these parents tended to appear interested at
first it was not felt that this interest was genuine and that they
came because Of the school's concern for the child. The other family
did not appear interested and expressed hostility toward the school.
It would be probable that these two families might be periodic clients
of the clinic or other social agencies at times of community concern
and pressure.

In the majority Of cases it appeared that the schools were
adequately preparing families for clinic contact. In considering
those cases where it appeared that something was lacking in the referral
method it should be remembered that there will always be a percentage
of referrals, no matter how sensitively handled, that will prove
unsatisfactory because of other factors in the situation. In addition
it must also be remembered that projected hostility toward the school
because of a parent's own feelings of guilt and inadequacy is not an
uncommon response in a clinic setting.

Referral also implies a working relationship between the
referral source and the agency receiving the referral. One method
employed by the clinic to facilitate this relationship is that of
inviting school personnel involved to attend the staff conference.
This Offers an Opportunity for the school to present a picture Of the

child's adaptatiOn in that setting and for the clinic to Offer help to

 

 

 

 

 

55

the school in understanding the child in light of his personality
development, as well as an Opportunity for joint planning to help the
child involved. In addition the clinic regularly requests helpful
information from the schools regarding the child's academic, social
and emotional adjustment in that setting. As a rule clinic personnel
prefers verbal contact with the schools in lieu Of written contact as
this facilitates better understanding. Due to this preference for
verbal communication clinic records do not always contain an exact
accounting of school-clinic communication. Therefore it should be
remembered that this is not a comprehensive analysis of school-clinic
communication as these data do not lend themselves to this task.

As illustrated in TABLE 4, in eighteen of the cases examined
a school representative participated in the staff conference. In one
of these eighteen cases the school representative participated in a
special conference rather than the regular conference. In addition
in all of these cases there was some other communication in the form
of a written and/er verbal contact either from the school involved to
the clinic or from the clinic to the school. These eighteen cases
represent eight different communities of varying distances from the clinic.

In four cases examined the staff conference occurred during summer
months when the schools were closed. Therefore there was no Opportunity
for a school representative to participate in these conferences. There
was, however, evidence in all cases of other communication between the
school involved and the clinic.

In seven cases although the staff conferences occurred within the
school year the schools involved did not participate in the staff

conference. In three of these cases the schools were located some

 

vaifanosxeq aid 30 :dgi
ed: and o: galanslq into;
‘ Iuiqlad stevpex vaeiug
[stoos .olmebeoe s'biido
Isaaosxeq stalls e131 s eh .
Is sensuoe netdtxw do not! r
163 soue1elexq std: o: e .
inane as nietnoo avswie
ed blvods :1 esoie1edT .
static-loade- To atsvlens e .

sins: std: o: sevleame;'

beatmexe seseo add is need):

use all .esne'xe‘moa
e at betsqlsttxsq evtistn.
«51:155. 51

”1 ed: at noiJsoinumoo '

s: hevlovmt Ioodos ed: Ins-fl -.

lease neemgle eledT 01L

.otauo ed: on seeaststb guinea-

Esds a"

. oone'te‘lnoo v: .

an.

s
.

«mean-11w!) bassoon oars-rem: " ..:

vtmrxoqqo on new axed: e-ro‘te‘
sud?

add-seewted lbtdeeinuumec 7m

06.? 511532! bonuses sooaeio’laoe
1133! Id! at edsqtalitsn

III. boneoI 019w BIOOdOL

daemon-moo and: n1 -. ‘

- sand: in

r {stoog-

J ' 'II “I

'-"§1w 3'1.

1 a"

to . '
3-?

I V .4;

.-te

' 0

J- -l' a.

'a'-’ {a

56

distance from the clinic. In one instance notice was received by the
clinic that the child's teacher would be unable to attend the staff
conference due to illness. In four of these cases there was evidence
of other contact between the school and the clinic. In one case
although information was requested from the teacher, there was no
indication of a reply in the record. In addition, in one instance
although the school was contacted twice regarding a conference with
the clinic there was no response from the school. Also this school
sent no information regarding the child other than to request that he
be seen at the clinic.

TABLE 4

SCHOOL PARTICIPATION IN STAFF CONFERENCES IN SCHOOL REFERRALS
TO THE LANSING CHILD GUIDANCE CLINIC IN 1951+.

School Number
Participation ReferraIS‘

Total . . . . . . . . . . 5h

Participated. o o e o o o o o e 18
Summer conference . . . . . . . 4
No participation. . . . . . . . 7
No conference . . . . . . . . . 5

In five of the cases examined there was no staff conference
due to an incomplete diagnostic study. In these cases the parents
did not follow through with clinic appointments at the time of
evaluation. In all of these cases there was evidence of other communi-
cation between the school and the clinic. It would be interesting
although not within the scope of this study to analyze school-clinic

communication. This type of information might lend insight into where

school-clinic communication is strong or weak.

Out of the thirty-four cases examined, some type of psychiatric

treatment was recommended.i11eighteen cases (see TABLE 5). Out—patient

 

57
treatment was recommended for fifteen children and their families. Three

of these children are now in treatment and seven are waiting treatment.
In addition one of these seven children attended Fresh Air Camp. One
child whose case was discontinued in 1954 and reopened in 1955 is to
be placed and receive treatment whereever he is located. In four cases
the parents were not interested in treatment and these cases have been
closed. In addition, Fresh.Air Camp was also recommended in one of
these four cases, but the parents were not interested. This family was
Seventh Day Adventists and felt that the child would be unable to participate
in the religion of his preference at the camp. In two other cases brief
treatment was recommended for the parents only; hewever, the parents
were not interested and these cases have been closed. In still another
case it was recommended that the child receive inrpatient treatment and
several facilities were investigated unsuccessfully. By the time
arrangements were finally completed the parents were not interested as
they felt the child was getting along better.

TABLE 5

RECOLMENDATIONS IN SCHOOL REFERRALS TO THE
LANSING CHILD GUIDANCE CLINIC IN 1951».

Recommendation Number
Referrals

Total.............2h
15

2

1

2

7

Outpatient treatment.
Parental counseling .
In-patient treatment.
Placement . . . . . .
Interpretation. . . . .
Vocational training and

O O O O
O O O O O
O O O O O
O O O O O
O O O C O
I O O O O
O O O O O
O O O O 0

simple education. . . . . . . 1
Additional diagnosis. . . . . . . . . 1
No recommendation . . . . . . . . . . 5

In the sixteen remaining cases some recommendation other than

eede .eeiiimei
.dsemjsewt acid

060 .qmeO 1%.

ed si CE?! n' - a.
: seeso Inc! cl .
I need evsd seas
t‘. ‘io one at b
E sew vlimel sth .
F . erqloidxsq Oi eidsnu
F ‘let'xd eeseo Tedd: : i '

i; smeuq ed: . .

E‘ 1 tedious Hits a. . . ‘

.,§.

kI‘ ';! ”I: add. VJ- -. .
i
5

as beiseseiai

WHO-9
C
O
O
O

and: 1edte no

 

has tnemdsetr 3r ' -.

I - a g
I u
s i v. '7
g 2 - Q a .. - ~ I. J
In. 'e 0‘ ‘ . C
I.
‘ I
O .z ‘ I. is .I I a ‘9 fl...
e
1
O“ I t I q. t
t e“. 3 0“ .
. P- i ”‘3
a C!
. ‘ ‘ ‘ . . 0‘
N . C C
c J O l ‘
I P 'I- x
.P 0's} '-
e t , .3
I
g t . 'a.“ R I
C O
t
e' i
O J - ‘z
’ .A ' '1
Q 0 O O O O O .
0 e
I D O O s
e, -
. U C O I- O
. I.
e e e e t
e e e e O C e O O ‘
C O O O O O O
C
‘
e e e ’
e e e e '
5 I
I O . C O
C ‘.

.~

I
.e-

as ‘5.

58
treatment was indicated. In two cases placement was recommended and in
one this was achieved with an Older brother. Before placement could
be arranged in the other case the child had been committed to Boy's Voca—
tional School. These cases were subsequently closed. Seven other cases
were closed following diagnosis pending the child's future adjustment .
It was recommended that the needs of these children be interpreted to
the parents and that the parents keep in contact with the clinic and call
if concerned. In two of these seven cases the school has done much.to
put into effect the clinic's recommendation that the environmental
situation be improved and stablized. Vocational training and a simple
educational experience were recommended for another child and following
interpretation to the school this case was closed. In one case additional
diagnostic services, remedial reading, and Fresh Air Camp were recommended,
however, the parents did not came for interpretation. In the five
remaining cases there was no recommendation due to incomplete diagnostic
services. One of the children in this last group of five did, however,
attend Fresh Air Camp.

It is interesting to note that of those children now receiving
treatment and those waiting for treatment, nine are from Ingham County
and one is from Clinton County. At least part of the significance of
this appears to be that the majority of referrals came from this area
which is easily accessible to the clinic.

It would appear from these data that the school and clinic have
in the majority Of cases evolved a good working relationship and participate
jointly in planning for the child involved. Only in a minority of cases
was there any great evidence of the lack of communication between the
school and the clinic and/Or the lack of an appreciation of the involve-

ments in referring a child from the school to the clinic.

59

Of the thirty-four cases examined twenty—eight were boys and
six were girls. while generally males are proportionally more numerous
among clinic clients than in the general population, it appears from
these data that the schools refer a larger proportion Of boys than
found in the total case load. While approximately 1 in 6 school
referrals were girls, about 1 in 5 clients in the total case load were
girls. Explanation of this factor is not within the scape of this
-study; however, it might prove an interesting factor to investigate.
It is interesting to note that all six girls referred were from Ingham
County, thus approximately 1 in A Ingham County school referrals were
girls corresponding more nearly with figures from the total case load.

The thirty-four referrals showed that the school recognizes
symptoms of emotional disturbance in all age groups with a heavier
concentration upon younger children (see TABLE 6 and FIGURE 2). Early

TABLE 6

AGES OF CHILDREN REFERRED BY THE SCHOOLS TO
THE LANSING CHILD GUIDANCE CLINIC IN 1954.

 

 

 

 

 

 

 

 

 

COUNTY AGES
Total 5 6 7 8 9 10 11 12 15 14 15
Total 54 2 5 2 5 6 5 2 4 2 l 2
Clinton 4 l l l 1
Eaton 2 l
Hillsdale 2 l l_
Livingston 5 l l l
Ingham 25 2 5 2 4 h 4 1 5

 

 

 

 

 

 

 

 

 

 

 

 

 

referral is a factor of great importance in the use of child guidance
facilities. The earlier it can be recognized that a child is having

learning difficulties and emotional problems, the greater is the

40
FIGURE 2

AGES or CHILmEN REFERRED RI THE SCHOOLS TO THE
LAIBIN} CHILD GUIDAICE CLINIC IN 1954.

 

"|.' we -. ‘4',

‘5: ’ka‘u!‘ tau-rm. .245- Ana-gm: ......“ him-9...- - »-:‘; ..

'v‘ "T’ ,u.~1.~-—_‘r~” '- :‘fifl‘l \‘7'0'4 I
.. . _ ., .. -V :9

..e-oX" at ."’

Ages .‘ ““memw

 

Vi>3§3
11+

GT 2'“ an 4
15

 

1 2 5 h 5 6 7

Number of Referrals

 

Ingham County

Ill! .Lansing

 

..\.

.,,-._.-

 

 

1+1

possibility Of successful treatment and of less damage to the personality
of the individual. A majority Of clinic clients are in the seven-teethirteen
year age group and it would appear from these data that the majority of
clients referred by the schools also tend to fall in this age range. It
is interesting to note however, that all Children in the five-toe seven year
age range were referred from Ingham County and the majority of children
in the six-eight year age range were from Lansing. This would appear to
indicate a greater appreciation of early referral in the Ingham County
schools. In addition it should be noted that Clinton and Hillsdale county
schools referred only children in the eleven-togfifteen yeargagezrange.'xThus
it would appear that these schools are not utilizing clinic services most
fully or in a truly preventive way.

Analysis of the school referrals showed that all referrals came
from elementary and junior high schools with the majority coming from
elementary schools (see TABLE 7 and FIGURE 5). This would appear to

TABLE 7

SCHOOL GRADES OF CHILDREN REFERRED BY THE SCHOOLS
TO THE LANSING CHILD GUIDANCE CLINIC IN 1951+.

 

 

 

 

 

 

 

 

 

COUNTY GRADES
Total K 1 2 5 4 5 6 7 8 9
Total 54 5 5 '5 5 7 34 H'4 4 ‘1-
Clinton 4 1 1 2
Eaton 2 1 l
Hillsdale 2 1 -wler
Livingston 5 1 1 l
Ingham 25 5 5 *2 4 5 '2 ‘5 1

 

 

 

 

 

 

 

 

 

 

 

 

34 grades were unknown and estimated by the child's
age. The numbers that might be affected are
indicated.

 

2‘39! 4 . «arr

_

u .u‘
u . .
«In/'0 ‘
. s:

..

. 45..

. e

A.»

v

I. a .
.... I J Eta-is. re... in!
. . .. a
.. .. .t .
011.1...41 .1....-......r....
- . .
. .1. . e.
, .21
.

.
4! ..tlb steiderrlua

«

.

v I

.

g o.

. .
_

.d . ..
M
n

. i
a

. _

n

u .

[.5‘.

v
n

«

.. - arr

‘t’ tin. ..\ uue‘r'e

..-“

.

1.66.: ..p ,V'fltu In..." else?!

-.-0

42
FIGURE 5

SCHOOL GRADES'OF CHILIREN REFERRED BYTHE SCHOOLS
TO THE LANSING CHILDGUIDANCE CLINIC IN 1954.

Grades 4

 

1 2 5 1+ 5 6‘7

Number of Referrals

a Total

G! Ingham County

E Lansing

 

u.

 

 

. I . . - . ,
. . . .. _.
,
-I , l -l - .
‘ .
I . . -
. .
. .. .v .
. _ . .
< 1
h I ‘ s v. A
Q i
- . u v
y ‘ . .. .. ,. »
- u . 4 e .- e. w
A ' ' I
. e -‘ ‘- 'b.'
. . , . o- ,, -. r \
, . I ~ I . ....
q ,
I . . . 7 ...‘1. . .
' e A
S
- x
”n- \ . .. -. ... - s
. ‘ ‘ A ‘ e
I . . » A. r‘ - .
. . e
e ,
\ e u
e
. . . , -.

 

u
..
a.
... -.

 

45

reflect a positive use of clinic facilities. However, it is evident
that several of the older Children in this group are not so far advanced
in school as could be expected from their ages. Again, correlating with
the age factor, it was the Ingham County schools which referred the
majority of children in the lowest grades.

The major concern of this study is the expression of hostility
of children referred to the Lansing Child Guidance Clinic by the schools
in the region serviced by the clinic. Literature referred to in Chapter I
indicated that in the past there has been a tendency for schools to refer
the aggressive or impulsive child who disrupts the classroom rather than
the withdrawn or inhibited child. There have been recent indications that
this trend is changing in certain localities. The children referred to
the Lansing Child Guidance Clinic were classified as impulsive or inhibited
on the basis of behavior controls. “Impulsive” behavior was classified
as that which indicated an unacceptable releaSe of impulse onto the
environment, while ”inhibited” behavior was classified as that which
indicated an internalization of conflict. As illustrated in.TABLE 8

TABLE 8

SCHOOL REFERRALS TO THE LANSING CHILD GUIDANCE CLINIC IN 1954
CLASSIFIED WITH RESPECT TO THE EXPRESSION OF HDSTILITY.

 

 

 

 

County Total Impulsive Inhibited
Total.... 54 14 20
Clinton..... 4 5 1
Eaton....... 5 1 2
Hillsdale... 2 O 2
Ingham...... 22 9 15
Livingston.. 5 1 2

 

 

 

 

 

 

44

the thirty-four cases analyzed revealed that the majority of school
referrals to the Lansing Child Guidance Clinic were predominantly
"inhibited" children. Thus the hypothesis stated at the beginning
of this study that the schools do not tend to refer the "withdrawn" or
"inhibited“ child is disproven.

From these data it would appear that the earlier criticisms
of Hickman that teachers are inclined to regard aggressive and
anti—social behavior as the most serious forms of maladjustment do
not apply in the region serviced by the Lansing Child Guidance Clinic.
It is impossible to gain an impression as to whether the referral
source is a significant factor in the selection of the presenting
problem to be referred because in most instances only one case was
referred from a particular source.

The cases were further analyzed by the symptoms presented by
the children at the time of the diagnostic study. The symptoms
include those described by both parents and school as well as those
observed by Clinic personnel during the diagnostic study. The symptoms
therefore do not represent only the school's description of the children
or the school’s reasons for referring the children to the clinic.
However, it is likely that those symptoms which would be evident in the
school setting are representative of the school's reasons for referring
the children. In addition it should be mentioned that it is probable
that each child's behavior was not completely described as the quantity
of information varied from record to record. However, it is likely that
the symptoms presented are those which the parents and school were most
concerned about. Also these children, because of the long waiting list

during the period of this study and the resultant difficulty of referring

1+5
TABLE 9

SYMPTOMS APPEARING IN SCHOOL REFERRALS TO THE LANSING CHILD GUIDANCE
CLINIC IN 1954 RANKED IN ORDER OF FREQUENCY OF OCCURENCE.

Total Number
51 . e . . .
26 . . . . .
14 . . . . .
15 . . . . .

12 O O O O O

11 . . . . .

10 O O O O O

of Cases 24

Inability to adjust to other children

Learning difficulty

Defiance; Disrespect to authority

Fighting; Disorderliness-mischieviousness; Shyness

Bed-clothes wetting; Temper; Restlessness; Lack of
concentration

Physical complaints; Feeding problem; Depressed,
unhappy

Disobedience; Nervous mannerisms; Bullying, cruelty
Lack of self-confidence; Inattention; Lack of effort
Speech defects; Domineering; Failure to enter group

Plays by self; Picked on by others; Stealing;
Fearfulness; Oversensitiveness

Teasing; Sleep disturbance; Destructiveness; Nail
biting; Lack of interest

Preference for younger children; Stubborness;
Forgetfulness; Truancy; Day-dreaming; Unc00perative

Annoying others; Contrarinese; Crying easily; Lying;
Sex problem; Carelessness; Irresponsibility

Quarrelsomeness; Solitary interests; Assuming deafness;
Hyperactive; Irregularity in attendance; Procrastination-
dawdling

Attempts to buy friends; Inability to compete;
Disposition to argue; Self-consciousness; Fear of
failure; Inability to adjust to new situations;
Irritableness; Finger sucking; Extreme neatness;
Obesity; Excessive fatigue

Tardiness; Swearing; Lack of bowel control;
Suggestibility; Listlessness; Resentfulness;
Forwardness-overbearing

46
children to the clinic, may be considered as representative of those
behavior disorders considered most serious by the school.

The symptoms presented in this study might be exhibited by
most children at one time or another. It may be assumed, however, that
the children in this study exhibited the symptoms in an extreme degree.
In addition it should be remembered that the children in this study
were classified as predominantly “impulsive” or 'inhibited', and an
admixture of symptoms indicating both “impulsive“ and "inhibited”
behavior was found in most of the children. I

TABLE 9 presents the symptoms exhibited by the children in
this study. It will be observed that inability to adjust to other
children and learning difficulty appear to be the outstanding difficulties
exhibited by these children. The category of inability to adjust to
other children.takes into consideration all types of difficulty with
other children and was used because some case records merely indicated
that the child was having difficulty in this area and did not describe in
what way.

The following tables classify the symptoms exhibited by the
children in this study within several major headings in an attempt to
clarify their significance within the school setting. TABLE 10 presents
those symptoms relating to violations of school and classroom rules and
regulations. It will be observed that disorderliness, mischievousness,
and restlessness are the outstanding difficulties in this category. It
is interesting to observe that truancy played a more important roll in
the difficulties of the impulsive children, while irregularity in
attendance played a more important roll in the difficulties of the

inhibited children. Tardiness appeared to be of little or no significance.

 

[Ilbfll it”

 

47
TABLE 10
SYMPTOMS RELATING TO VIOLATIONS OF SCHOOL AND CLASSROOM RULES

AND REGULATIONS A?PE£RING IN SCHOOL REFERRALS TO THE LANSING
CHILD GUIDANCE CLINIC IN 1954.

 

 

 

 

 

 

 

 

Symptom I Total Inhibited Impulsive
NUmber of Cases 54 20 14
Disorderliness,

mischievousness.. l5 4 9
Restlessness....... 12 5 9
TruanCYOOOOOOOOOOOO 5 1 A
Irregularity in

attendsnce....... 5 5 ---
Tardiness.......... 1 --- 1

TABLE 11

SYRPTCMS RELATING TO DIFFICULTY WITH AUTHORITY APPEARING IN
SCHOOL REFERRALS TO THE LARSING CHILD GUIDANCE CLINIC IN 1954.

 

 

 

 

Symptom Total Inhibited Impulsive
Number of Cases 54 20 l#
Defiance,,,,, 1G 8 6
Disrespect to

authority.. 14 5 9
Temper....... 12 5 9
Disobedience, l2 5 9

 

 

 

 

 

'7']

.JD

Symptoms relating to difficulty with authority (see
TABLE 11) played a rather important role in the difficulties
of these children. However, as might be expected, the impulsive
children exhibited far greater difficulty in the area than the
inhibited children. Approximately one out of every two impulsive
children displayed trouble with each symptom in this category.
It was interesting that defiance was the symptom in this category
exhibited to a rather significant degree by the inhibited children.
Symptoms relating to failure to achieve school work re-
quirements are presented in TABLE 12. These symptoms are all

quite related in their effect upon a child's performance in school.

, TABLE 12

SYMPTOMS RELATING TO FAILURE TO ACHIEVE SCHOOL WORK REQUIREMENTS
APPEARING IN SCHOOL REFERRALS TO THE LANSING CHILD GUIDANCE
CLINIC IN 1954.

 

 

Symptom Total Inhibited Impulsive

 

Number of Cases 54 20 _ 14

 

Learning difficulty...
Lack of concentration.
Inattention...........
LaCk 0f effort........
Lack of interest......
Day-dreaming..........
Uncooperative.........
Carelessness..........
Irresponsibility......
Procrastination,
dawdling...........

HID

\x kkwmouowmo‘
\N \NW-p-Jr-l-‘Oxm O\\JI
HHHHNV-‘z—Oxr-I

 

 

 

Some form of learning difficulty is the most outstanding symptom

within this group and appears to have great significance in a

I'll-Ir

III?

v§ N
O
. .T .
,
.
.
e
o a
u
e s
i
D
. .
c. C
C O
n
It
.
T .. srv ..
.
,
.
e
.. .
u
.
,
.e...4. o 41. a.)
_
.
.
o

O'.

49

child being referred for psychiatric help by the schools.

TABLE 15 presents symptoms relating to difficulties

with other children. This table illustrates that nearly all

of the children,referred by the schools for psychiatric help

suffered some impairment in their ability to form satisfying

relationships. As one might anticipate, the impulsive children

TABLE 15

SYMPTOI-‘IS RELATING TO DIFFICULTIES WITH OTHER CHILIREN
APPEARING IN SCHOOL REFERRALS TO THE LANSING CHILD GUIDANCE

CLINIC IN 1954.

 

 

Symptom

Total

Inhibited

Impulsive

 

Number of Cases

5#

20

It

 

Inability to adjust

to other children...
Fightingeeeeeeeeeeeeee
Bullying, cruelty.....
Failure to enter groups
Plays by self.........
Picked on by others...
Teasing...............
Preference for younger

children............
Annoying others.......
Quarrelsomeness.......
Attempts to buy

friends.............
Inability to compete..

predominantly exhibited fighting, bullying and cruelty while the

inhibited children exhibited failure to enter groups, playing by

 

J

51

....
\N

...;
NM \N-PUT CAN-<00

 

l

NNN

NH

themselves and allowing others to pick on them.

14
10

...:
WNW \NNNUO

..e

 

l

 

. .
. . . ,
I a . t I
, , a y .
O . e . I
o C .
e o C .
_ . .
. . , a e . . e a . _.
. -
n . . . o . . . . _
d I n c I O I
. I . I v I - I
_
, - O . I . e p 0 e u
1 I ‘ I I r e C I
r
.
. . I u 0 k a a ._ I I a
, . O c O . I v . O I D O
o c e e e p . I I e a
V . . . , . . ,
.( v . . rt .5 ... .llt . .1 wt» .... 1.. l «\q.. 3.19 ...-i .. t v
I I r
. 4
I I . I c I
,. .
.
. t .1 c l , . - , I.
. . w .... {1 . . a a. . I 15.! .121 A... at . r a...» inf-IV" y
.y
.
.
. .
.
.
.. , i.- .u - p. I . ..t‘ Z .7, ‘.H..b..\ (13...). )I A. .e ,. y. . .3 r3... av . .53., v y. a.
l .
.
a o r

5O

Symptoms relating to violation of general standards of
morality and integrity are illustrated in TABLE 14. As might be
expected these symptoms were more prevalent in the impulsive
children. It will be noted that stealing was the major symptom

lTABLE 14
SYMPTOMS RELATING To VIOLATION OF GENERAL STANDARDS OF MORALITY

AND INTEGRITY APPEARING IN SCHOOL REFERRALS TO THE LANSING CHILD
GUIDANCE CLINIC IN 1954.

 

 

Symptom ‘Total i Inhibited Impulsive

 

NUmber.of Cases ‘ 54 a 20 I 1#

 

Stealing............
Lying...............
Sex Pr0b1°meeeeeeeee
Cheating............
Swearingeoeeeeeeeeee

HN-h'k-d
hah)n>h>
HHNNU

 

 

 

 

in this category. Cheating, a factor closely related to school
work, appeared to be relatively insignificant.

TABLE 15 presents symptoms describing undesirable person?
ality traits. It will be observed that three of the most signifi-
cant symptoms in this category, shyness, depressed-unhappy, and
lack of self-confidence, are those symptoms one would expect to be
exhibited by inhibited children. While these were more frequently
observed in the inhibited children they were also observed to a signi-
ficant degree in the impulsive children. The traits of domineering-
dictatorialness, destructiveness, and contrariness were predominant
in the impulsive children and seen to a far lesser degree in the

inhibited children.

 

I... I.

0.0

C'-

3".

v..-

5‘;

51
TABLE 15

SYMPTOMS mschsING UNIESIRABIB PERSONALITY TRAITS APPEARIR}
IN SCHOOL REFERRALS TO THE LANSING CHILD GUIDAID! CLINIC IN 1954.

 

 

Symptom Total Inhibited Impulsive

 

NUmber of Cases 3# 20 lb

 

Shyness................ 13 1
Depressed, uhhappy..... 11
Lack of self— H

\O

confidOUCQeeee eeeeee
Domineering,

dictatorialness.....
Oversensitiveness......
Fearfulness............'
Destructiveness........
Stubbornness...........
ForgethInOBB. ee e e e e e ee
Contrariness...........
Disposition to argue...
Self-consciousness.....
Fear of fhilure........}y
Inability to adjust

to new situations...‘
Irritableness..........
Forwardness, i

overbearing.........
Resentfulness..........i
Listlessness...........
Suggestibility. . . . . . . . .‘

N:WHNO\NM\’| \JI kw

NNN-b'WUIOx-d‘lm

N [0
I
I
N

HHHH
H
I
I
I

 

 

 

A

T

 

Other symptoms of emotional disturbance are illustrated
in TABLE 16. It will be observed that several of these symptoms
would not necessarily be observable in the school setting and that
their significance within.that setting weuld be minimal. It was
quite interesting that in this piticular group of impulsive children

speech defects were one of the more significant symptoms. Approximately

52

one out of three impulsive children displayed some difficulty in
this area while only one out of seven inhibited children exhibited
this symptom. Physical complaints and nervous mannerisms were
relevant symptoms in the inhibited children while bed-clothes
wetting and feeding problems were observed to a significant degree
in both groups of children.

TABLE 16

OTHER SYMPTOMS OF EMOTIONAL DISTURBANCE APPEARING IN SCHOOL
REFERRALS TO THE LANSING CHILD GUIDANCE CLINIC IN 195A.

 

 

Symptom Total Inhibited Impulsive

 

14

g

NUmber of Cases

 

Bed-clothes wetting.... 12
Feeding problem........ 11
Physical complaints.... 11
Nervous mannerisms..... 10 . . 1
Speech defects.........
Sleep disturbance......
Nail biting............
Crying easily..........
Hyperactive............
Assuming deafness......
Solitary interests.....
Obesity................
Excessive fatigue......
Extreme neatness.......
Finger sucking.........
Lack of bowel control..
Pulling hair out.......

JrCh~J

mmmwmmwbue-woqwm
HA)“

I

|

1
he

IHIHIOIUPOPO\N\N\N4>CRCRCD
he

I

I

l

 

 

 

 

TABLES 17, 18 and 19 present the symptoms appearing most
frequently in the school referrals--TABLE 17 in the total group,

TABLE 18 in the impulsive children, and TABLE 19 in the inhibited

53
TABLE 17

SYMPTOMS APPEARING MOST FREQUENTLY IN SCHOOL REFERRALS
TO THE LANSING CHILD GUIDANCE CLINIC IN 1954.

Symptom NUmber
Referred
Numbar Of CESGSeeeeeeeeoeeeeeeeoo 5#

Failure to achieve school work

requirements.
Learning difficulty.............. 26
Lack of concentration............ 12
Inattention...................... 9
Lack of effort................... 9
Violation of classroom rules and
regulations.
Eisorderliness, mischievousness.. 15
Restlessness..................... 12
Difficulty with authority.
Defiance......................... 14
Disrespect to authority.......... 14
Temper........................... 12
Disobedience..................... 10

Violation of general standards of

morality and integrity.
Stealing......................... 7

Difficulty with other children.
Inability to adjust to other

children.............. 51

Fighting......................... 15
Bullying, cruelty................ 10

Failure to enter group........... 8
Picked on byothers............... 7
Plays by Selfeeeeeeeeeeeeeeeeeeee 7

Undesirable personality traits.
ShYnBBSOOIOOOOOOO0.0.0.0000...... 15
D8preSFed, unhaPPYeeeeeeeeeeeeeee 11

Lack of self-confidence.......... 9
Demineering, dictatorialness..... 8
Oversensitiveness................ 7
FearfUlness...................... 7

Other symptoms of emotional disturbance.
Bed-clothes wetting.............. 12
Feeding problem.................. 11
Physical complaints.............. 11
Nervous mannerisms............... 10
Speech defects...................

children. These symptoms are significant in that they represent

those symptoms which might be considered most important by the

 

54
TABLE 18

SYMPTOMS APPEARING MOST FREQUENTLY IN IMPULSIVE CHILDREN IN
SCHOOL REFERRALS TO THE LANSING CHILD GUIDANCE CLINIC IN 195#

Symptom Number
Referred
Mber Of cases. 0 C O O O O O O O O 0 O O O O O O O O O O O O 0 1h

 

Failure to achieve school work
requirements.
Learning difficulty..................... 1
Lack of concentration...................
Inattention.............................
Lack of effort..........................
Violation of school and classroom rules
and regulations.
Disorderliness, mischievousness.........
Restlessness............................

TruancyOOOCOO00............OOOOOOOCOOOOO

Difficulty with authority.
DisrespeCt to ‘utharityeeeeeeeeeeeeeeeee
TemperOOOOOOOIOOOOOOOOI......OOOOQQOOOOO
DiBObOdi.nCeeeeeeeeeeeeeeQeeeeeeeeeeeeee
Defiance................................

Violation of general standards of

morality and integrity.
Stealing................................ 5

Difficulties with other children.
Inability to adjust to other

children................

FightingOOOOOOOOODOOOOOOOOOOOOOOOOOOOOOO
Enllying..............o.................
ToaSingOOOO000......OOOOOOOOOOOOOOOOOOO.
Failure to enter group..................
Preference for younger children.........

Undesirable personality traits.
Destructiveness.........................
Lack of self-confidence.................
Domineering, dictatorialness............
DGPressed, unhappyeeeeeeeeeeeeeeeeeeeeee
Shyness.................................
Contrariness............................

Other symptoms of emotional disturbance.
Bed-clothes wetting.....................
Feeding problem........... .................
SpeeCh defects............................
Physical complaints.....................

(MVDVDVD ¥AO‘O \NJPCAh‘

Para
Cik‘

he
-#\fi€h~4 ‘va-k\flVfl0\ \x\fl\fl()

schools. In addition the symptoms are arranged within the various

categories to illustrate their significance within the school setting.

 

55
TABLE 19

SYMPTOMS APPEARING MOST FREQUENTLY IN INHIBITED CHILDREN IN
SCHOOL REFERRALS TO THE LANSING CHILD GUIDANCE CLINIC IN 195A.

Symptons Number
Referred
Number of 0‘89. .....QOOOOOOOOOOOOO 20

 

Failure to achieve school work
requirements.
Learning diffiCUIty................ 1
Lack of concentration..............
Lack of effort.....................
Inattention........................
Lack of interest. .................
Day-dreaming.......................
Uncooperative......................
Violation of classroom rules and
regulations..
Disorderliness, mischievousness....
Difficulty with authority.
Defiance...........................
Disrespect to authority............
. Difficulties with other children.
Inability to adjust to other
children..................
Failure to enter group.............
Plays by self......................
Picked on by others................
Undesirable personality traits.
Shynesaeeeeeeeeeeeeeeeeeeeeeeeeeeee
Depressed, unhappy.................
Oversensitiveness..................
Fearfulness........................
Lack of self-confidence............
Forgetfulness......................
Other symptoms of emotional disturbance.
Nervous mannerisms.................
Physical complaints................
Bed-clothes wetting................
Feeding problem....................
Nail biting........................
Sleep disturbance..................
Crying easily......................

##«k‘U‘ O\O\\fi

U10)

....

...:
##WU'INO \IIU‘IUIN

...;

«P-P'U'IU'IVIN 0

By analyzing the symptoms appearing most frequently in
the children it may be seen that a wide variety of symptoms is pre-
sent in all areas. However, a re-examination of the individual
schedules revealed that all of the children, with the exception of

two who were quite disruptive, exhibited some symptoms related to

 

D- C I

56

failure to achieve school work requirements. This would seem to
indicate that this was the most important area of maladjustment re-
vealed in this study. Considering then that these are school
referrals it would appear that this area of difficulty is considered
very serious by teachers.

Analyzing separately the symptoms appearing most frequently
in impulsive and inhibited children, it would appear that the im-
pulsive child while exhibiting failure to achieve school work reé
quirements, exhibits important difficulties in many areas which
might be described as primarily disruptive and aggressive behavior.
The inhibited child, on the other hand, exhibits outstanding diffi-
culties with other children and failure to achieve school work I
requirements.. All inhibited children, except one, exhibited some
symptoms related to failure to achieve school work requirements and
in this instance there was considerable admixture of symptoms so
that the child while predominantly inhibited was also considerably
disruptive. It may be assumed that not all inhibited children will
exhibit difficulty in this area and the question might be raised
as to whether teachers are aware of and concerned with these children?
A question might also be raised as to whether the symptomatic behavior
of inhibited children who do not exhibit failure to achieve school
work requirements is manifest in the school setting? It would appear
although teachers in this area do tend to refer inhibited children
that their concern with inhibited behavior is primarily that of
failure to achieve school work requirements. This is related to
Wickman's earlier findings regarding the few inhibited children who
were referred at that time. However, it is also posible that this

is the type of inhibited behavior to which teachers accord most

 

57

significance as these cases should tend to represent those
considered most serious by the schools. It will be remembered

that Wickman's first study indicated that teaChers accorded little
significance or importance to inhibited behavior and that his second
study noted a change in this attitude toward giving more import to
this type of behavior. Considering the number of inhibited children
which was referred by the schools in 1954 it seems probable that the
teachers do accord significance to inhibited behavior. However, it
does appear that inhibited behavior must be combined with failure to
achieve school work requirements before a referral for psychiatric
help is considered. It would be interesting to investigate teacher
attitudes regarding emotional disturbance in the area serviced by
the Lansing Child Guidance Clinic. Information gained by the use
of a rating scale of symptoms such as that used by Wickman in his
studies would give a clearer picture of the significance accorded

to inhibited behavior by teachers.

CHAPTER V
SUMMARY AND CONCLUSIONS

School referrals to the Lansing Child Guidance Clinic
represent a wide variety of sources. No more than two referrals
came from any one school, and in a majority of instances there was
only one referral from a particular school. In additiOn it appeared
that in the majority of cases the parents were interested in clinic
services and that the schools were adequately preparing families
for clinic contact.

It would appear from these data that the school and clinic
have in the majority of cases evolved a good working relationship
and participate jointly in planning for the child involved. Only
in a minority of cases was there any great evidence of the lack of
communication between the school and the clinic and/pr the lack Of
an appreciation of the involvements in referring a child from the
school to the clinic.

Males appear to be more numerous in school referrals than in
the total case load. Also it appears that the school reCOgnizes
symptoms of emotional disturbance in all age groups with a heavier
concentration upon younger children. The majority of children in
this group of referrals fell in the seven to thirteen year age range.
In addition all referrals came from elementary and junior high schools
with the majority coming from elementary schools. Ingham county

schools tended to refer both younger children and children in lower

58

59
grades which might appear to indicate a greater appreciation of
early referral in the Ingham county schools.

The majority of school referrals to the Lansing Child
Guidance Clinic were predominantly inhibited children. It was
impossible to gain an impression as to whether the referral source
is a significant factor in the selection of the presenting problem
to be referred because in most instances only one case was referred
from a particular source.

Failure to achieve school-work requirements appears to be
a very significant area of difficulty in the children referred to
the Lansing Child Guidance Clinic by the schools in 1954. Both
impulsive and inhibited children exhibit this diffiCulty. It would
appear that the impulsive child while exhibiting failure to achieve
school work requirements exhibits important difficulties which
are observed in many areas which might be described as primarily
disruptive and aggressive behavior. The inhibited child, on the
other hand, exhibits outstanding failure to achieve school work
requirements and difficulties with other children. It would appear
that although teachers in this area do tend to refer inhibited
children that their concern is primarily that of failure to achieve
school work requirements and that they do not refer inhibited
children who do not exhibit this difficulty for psychiatric help.
However, considering the number of inhibited children which were
referred by the schools in 1954 it seems probable that the teachers
do accord significance to inhibited behavior. It does appear that
inhibited behavior must be combined with failure to achieve school

work requirements before a referral for psychiatric help is considered.

60

Further areas of study might be suggested from this study.
Among these would be an analysis of school-clinic communication
concerned with the source and nature Of contact and the integration
achieved in bringing help to the child. A fUrther area of interest
might be to investigate school referrals in relation to sex. While
generally males are prooortionally more numerous among clinic clients
than in the general pOpulation, it appears from these data that the
schools refer a larger proportion of males than found in the total
case load. In addition a study of teacher attitudes regarding
emotional disturbance might be helpful in providing a clearer picture
of the significance accorded to inhibited behavior by teachers.
A rating scale of symptoms such as that used by Hickman in his

studies might be employed in such an investigation.

APPENDIXES

A. SCHEDULE FOR CLASSIFYING THE CHILDREN

IMPULSIVE INHIBITED
Behavior which indicates a release Behavior which indicates interna-
of impulse onto the environment, at lization of conflict, at the same
the same time being unacceptable to .time maintaining harmony with the
family, school, and community. environment.

(Classification into one or the other of the two groups
made on the basis of the symptoms presented by the child
at the time of the diagnostic examination.)

truancy daybdreaming
destructive acts depression

temper tantrums shyness
disobedience physical complaints
fighting speech defects
stealing inability to adjust
lying to other children

over-competitiveness

(Recognizing that all children will utilize the defenses
of withdrawal and aggression, the scope of this study
would consider the predominant mode of adjustment.)

 

CHILD‘S NAME IMPULSIVE INHIBITED

 

 

61

62

B. SCHEDULE FOR ABSTRACTING INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

CASE NAME NUMBER
RURAL____

TCNN...... COUNTY URBAN____

REFERRAL DATE INTAKE DATE

AGE SEX

STATUS OF CASE AT PRESENT: closed‘____j treatment_____; waiting___

BASIC LEVEL OF INTELLIGENCE

NAME OF SCHOOL GRADE

GRADE SCHOOL OR HIGH SCHOOL

SCHOOL SYSTEM (township, city, etc.)

 

DOES THE SCHOOL HAVE THE SERVICES OF A VISITING TEACHER
SCHOOL PARTICIPATION IN STAFF CONFERENCE

DIRECT CONTACT WITH CLINIC

 

CORRESPONDENCE WITH CLINIC

DID PERENTS WANT TO COME TO CLINIC 0R DID THEY COME BY AUTHORITY
REQUEST OF THE SCHOOL (where available)

 

 

PRESENTING PROBLEM: inhibited 3 impulsive
RECOMMENDATION
SYMPTOMS: truancy shyness

destructive acts day-dreaming
temper tantrums speech defects
disobedience nail biting

l
l

 

 

 

 

 

 

 

 

 

 

 

 

 

fighting feeding problem

stealing finger sucking

lying sleep disturbance
over-competiveness physical complaints
boastfulness bed—clothes wetting
selfishness exceptional brightness

sex problem learning difficult

bullying lack of bowel control
excitability slowness in learning to do things
restlessness inability to adjust to other
depression children

preference for younger other

 

children

 

65
C. SCHEDULE FOR ABSTRACTING SYMPTOMATOLOGY

 

 

 

 

 

 

 

annoying others swearing

cruelty smoking

fighting disobedience

teasing disrespect for authority
bullying defiance

punching impertinence

tattling slowness in obeying instructiomi
quarrelsomeness remsal to do things when asked
sadistic tendency refusal to do things for self
inability to adjust to other children sassy

preference for younger children truancy

failure to enter group tardiness

 

irregularity in attendance
disorderliness(petty behavior)

plays by self
others pick on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

irritable restlessness

stubborn interruptions
contrary whispering
disposition to argue inattention

impudence lack of concentration
forwardness short attention span
domineering indifference
dictatorialness lack of interest
shyness carelessness
withdrawn irresponsibility
oversensitiveness lack of pride in.wark
self-conscious lack of effort
forgetting dawdling

destructive acts procrastination
temper lack of initiative
unhappy day-dreaming
depressed uncooperative
resentful loitering
listlessness learning difficulty
fearful slowness in learning to $3
boastfulness feeding problmm t ings
over-competiveness sleep disturbance
inability to compete bed-clothes wetting
excitability lack of bowel control
fear of failure ‘ finger sucking
hyperactive physical complaints
suggestibility speech defects

lack of self—confidence nail biting

feelings of inadequacy nervous mannerisms

m ischievous obesity

stealing excessive fatigue
lying solitary interests
cheating constricted
fabrication poor judgment

exaggeration extreme neatness
sex problem inability to adjust to new
assuming deafness situations

anxious

 

 

 

 

 

 

BIBLIOGRAPHY

Beeler, Sara, "Angry Girls: Behavior Controls by Girls in Latency,“
Smith College Studies in Social Work) XXIII (June 1955), 205-226.

 

Braver, Rhoda, "School Referrals to a Child Guidance Clinic: 1940 and
1950 Compared," Smith College Studies in Social Work, XXV (June

1955): 55-56.

Children's Fund of Michigan Anaual Report, Detroit, Michigan, 1955-1955.

 

 

Compiled Laws of Michigan, Ann Arbor, Michigan, The Ann Arbor Press, 1948.

 

"Differential Utilization of the Facilities of a Michigan Child Guidance
Clinic, “(Unpublished Report), Lansing, Michigan: Michigan
Department of Mental Health Research, Report No. 17, pp. 54.

Fink, Arthur E., The Field of Social Work, New York: Henry Holt &.Co.,
1W9.

Glueck, Sheldon & Eleanor, Preventing Crime, New York: MCGraw
Hill Book Co., 1956:?

 

 

Harms, Ernest, Handbook of Child Guidance, New York: Child Care
Publication, 1951.

 

Lansing Child Guidance Clinic, Sixteenth Annual Report, Lansing, Michigan,
1954.

Lowry, James V., 'Mental Health', Social Work Year Book, New York:
American Association of Social Workers, 1954.

 

 

Michigan Prqggam of Child Guidance Clinics, Lansing, Michigan: Department
of Mental Health, June 1955.

 

Minutes of the Ingham County Council of Social Welfare, Lansing, Michigan.

O‘Hanlon, Margaret E., 'School and Psychiatric Clinic: A Study of Inter-
Agency Relationships,“ Smith College Studies in Social Work,XXIII

(February 1955), 178-179.

Pilzer, Elizabeth 'Disturbed Children Who Make a Good School Adjustment,‘
Smith College Studies in Social Work,XXII (June 1952), 195-210.

 

 

Public Acts of Michigan, Lansing, Michigan, Franklin DeKleine Co., 1925
1957
1941
1944
1951
1952
1954

s‘.

 

 

65

Redl, Fritz, and Wineman, David, Children Who Hate, Glencoe, Illinois:
The Free Press, 1951

 

Stroup, Herbert, Social Work: An Introduction to the Field, New York:
American Book Company, l9fi8

Hickman, E. D., "A Study of Teachers' and Mental I'ngienists' Ratings of
Certain Behavior Problems in Children,‘ Journal of Educational
Research, XXXVI (1942), 292-508.

Hickman, E. K., Children's Behavior and Teachers' Attitudes, New York:
The Commonwealth Fund, 1928.

 

M IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

 

N A; w. in; \g A u, my ,1 NAN mm mm