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F. . . . . . u . . .. . .7 -.. . . . . . . . . fl . . .... n ... M. .. - - . r v . . ...... . - . warms... ... . ...,u. . 3mm. fimfibfi $m...n..2.. .. 7.1 . .l'. I: u II’VxIlno‘én -1 1.550;. V I... at.|[,u.‘~‘ - .I .113. . .. . .-.!!g' II. II. %D . . ‘t v \ .. [M .L'V; . . . .. .I . THES'IS This is to certify that the thesis entitled AN INVESTIGATION OF THE NATURE OF CONCEPT . FORMATION IN CEREBRAL PAISIED SCHOOL CHILDREN presented by John Edward Jordan has been accepted towards fulfillment of the requirements for _Bh.D_ degree in Edamaizion ( Guidance and Couns eling) 1-1;. '/ ajor professor Date July 25, 1956 0-169 Jfl 04. AN INVESTIGATION OF THE NATURE OF CONCEPT FORMATION IN CEREBRAL PALSIED SCHOOL CHILDREN By John E3 Jordan AN ABSTRACT Submitted to the School for Advanced Graduate Studies of lichigan State University of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Administrative and Educational Services_ Guidance and Counseling Year 1956 JOHN E. JORDAN ABSTRACT The Problem This study was concerned with ascertaining some of the characteristics of concept formation in cerebral palsied school children. Its major objective was to determine the relationship of mental age to certain aspects of conceptu- alization. Specifically the study attempted to test two hypotheses: 1. There is a positive relationship between mental age and the various aspects of conceptual functioning in cerebral palsied children. 2. Concept formation ability is more highly related to mental age than to kind of cerebral palsy or degree of disability. The Sample The sample consisted of thirty cerebral palsied school children from the Lansing, Michigan Public Schools. They ranged in age from 4.6 to 20.1 with a mean age of 10.3 and a standard deviation of 3.10. The mental ages ranged from 2.8 to 17.1 with a mean of 8.44 and a standard deviation of 3.92. JOHN E. JORDAN ABSTRACT Procedure and MethodOIOgy Scores were obtained for all the subjects on the fol- lowing variables: 1. 2. 3. 4. 5. Mental Age. The Stanford-Binet Intelligence Scale was used to obtain the mental age of the subjects. The Columbia Mental Maturity Scale was also used as a check on the Binet scores. Concept Formation. A concept formation test of the sorting type was used Which permitted a maximum of six logical concepts to be attained. Physical Disability. The subjects were ranked for degree of physical disability by two physical thera- pists and an occupational therapist who knew the subjects well. The rankings were based on the medi- cal records and the muscle tests given.by the thera- pists. Speech and Language Disability. Fifteen of the sub- Jects were receiving speech therapy. They were ranked as to degree of speech and language disabil- ity: both remedial and developmental-wise; attempt- ing to rule out the psycholOgical factors. Kind of Cerebral Palsy. This was determined from the medical records and the professional Opinion of the therapists. JOHN E. JORDAN ABSTRACT Statistical analysis of the relationship of mental age to these variables was investigated by means of correlations or correlation-like statistics and tests for the significance of the differences. The statistics accounted for the small sample and the rank order of some of the data. 1. 2. 3. 4. Results Mental age was a significantly better predictor of concept formation ability, than was degree of physi- cal disability or kind of cerebral palsy as repre- sented by spasticity versus non-spasticity. Illegical conceptual responses were more character- istic of the spastic versus the non-spastic than were repetitive responses. Normal children were significantly superior to cere- bral palsied children in all aspects of concept for- mation ability. The cerebral palsied group were significantly more variable than the normal on the number of legical and bi-dimensional concepts achieved, and less vari- able on mean time per concept and on the number of non-functional concepts produced. AN INVESTIGATION OF THE NATURE OF CONCEPT FORMATION IN CEREBRAL PALSIED SCHOOL CHILDREN By ,- . x \ JOHN 1?."qu ORDAN A DISSERTATION Submitted to the School for Advanced Graduate Studies of Michigan State University of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Administrative and Educational Services Guidance and Counseling 1956 jAm/f7 ? /a45 ACKNOWLEDGMENTS The author wishes to express his sincere appreciation to Dr. Raymond N. Batch for his constant encouragement in this research as well as for his unfailing interest and guid- ance throughout the entire graduate prOgram. He is also greatly indebted to Doctors Walter F. Johnson, Donald Grumman,and Clyde Campbell for their assistance and constructive criticisms of the entire research. Special grat- itude is also expressed to Dr. Leonard Coleman for the use of his concept formation test. The investigator extends his sincere thanks to the ad- ministrative personnel of the Lansing.Board of Education for permissian to use the data of this study. Grateful acknowledgment is also due to Mr. Edward Norris, Chief Physical Therapist; Miss Shirley Kilcullen, Physical Therapist; Miss LaVonne Dalrymple, Occupational Therapist; and Mrs. Jean Feather, Speech Therapist, for their assist- ance in obtaining the ratings on physical, and speech and language disability. 11 John E. Jordan Candidate for the degree of Doctor of PhilosOphy Date of'Examination: July 26, 1956, 1:30 p.m., Room 116, Morrill Hallo Dissertation: An Investigation of the Nature of Concept Formation In Cerebral Palsied School Children. Outline of Studies: Major area - Administrative and Educational Services: Guidance and Counseling. Minor areas - Counseling Psychology, Educational Admin- istration. BiOgraphical Items: Birthdate - March 9, 1922. LOgan, West Virginia. ‘Undergraduate Studies - Michigan State University, A.B. East Lansing, Michigan Owosso Bible College, Th.B. Owosso, Michigan Graduate Studies - Michigan State University, East Lansing, Michigan - 1950-1956. ZExperience: Owosso Bible College, Owosso, Michigan - 1949-1951. Instructor in Psych010gy and Philosophy. Redmond Company, Inc., Owosso, Michigan - 1945-1946 and Preduction Supervisor. 1951-1954. Inspection Supervisor. Statistical Quality Control. Staff Assistant to General Production Manager. 111 JOhn E0 Jordan Candidate for the degree of Doctor of PhilosOphy Experience: (continued) Michigan State University, East Lansing, Michigan Graduate Assistant - 1954-1955. Counseling Clinics - Summer 1955. Instructor in Education - Summer 1956. Lansing Public Schools, Lansing, Michigan - 1954 - Present Psychologist - Diagnostic ' Counseling Psychologist - Orthopedic and Deaf and Hard of Hearing Division. Membership held in Psi Chi, Phi Delta Kappa, American Psycho- logical Association, American.Personnel and Guidance Association, Michigan Education Association, Michigan Psychological Association, Michigan Counselors Associa- tione iv Dedicated to my'Wife Artie TABLE OF CONTENTS Chapter I. THE NATURE OF THE PROBLEM . . . IntI’Oduction e e 0 Statement of the Problem . Definitions 0 e 'e e e 0 History of Cerebral Palsy Incidence . . . . . . . EtiOlogy O O O O 0 0 0 Classification . . . . Need for the Study . . . . Limitations of the Study . Organization of the Thesis II. REVIEW OF RELATED RESEARCH . . . Concept Formation . . . . . 0 Concept Formation and Brain Damage . Concept Formation and Cerebral Palsy Intellectual Measurement of the Cerebral Palsied . . . . Summary . . . . . . . . . . III. PROCEDURE AND METHODOLOGY OF THE STUDY Subjects . . . . . . . . The Experimental Tasks . . . The Conceptual Task . . . The Intelligence Test . . Diagnoses and Physical Disability Ranking . . . . . . . . Speech and Language Ranking Operational Hypotheses . . . Procedures for Analysis of the Data IV. ANALYSIS OF THE DATA . . . . . . V. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS smary e e e e 0 Conclusions . . . Recommendations . Implications . . vi 0 O O O O O 0 O O O 0 O O O O O O O O O O O O O O C Page ku- Hommqqm»UHH 32 33 35 35 37 39 4O 40 42 45 BIBLIOGRAPHY APPENDIX . vii Table I. II. III. VI. VII. VIII. IX. X. XI. XII. LIST OF TABLES Page Cerebral Palsy Classification (Phelps-Fay).................9 Objects Used in.Halstead's Study . . . . . . . 16 Summary of Results in Cottom's Sorting TeSt Situations I'XIII e e e e e e e o e e e e 20 Summary of the Results of Cottom's Light- Pattern Test . . . . . . . . . . . . . . . . 20 Summary of Results in Cottom's Comp- lation Test 0 O O O O O O O O O O O O O O O I 22 Summary of Results in Cottom's String- Pattern Test . . . . . . . . . . 22 Objects Used in Dolphin and Cruickshank's Test . . . . . . . . 26 O O O O O O O O O O o 0 Comparison of Number of Objects Used by the Cerebral Palsied and Normal Group With the Resulting ”t" Scores for Dolphin and Cruickshank's Picture Ob- JOCtTOSteee ........2'7 0 O O O O O 0 Clinical Diagnoses and Sex of Subjects . . . . 34 Tepographical Diagnoses and Sex of Subjects. . 34 Medical Diagnoses, Age, Sex, Grade, Binet Mental Age, I.Q., Physical Disability Rank, Speech and Language Disability Rank, Mean Time Per Concept in Seconds, Number of Illegi- cal Concepts, Number of Repetitive Concepts, and the Concepts Achieved For Individual Sub- JGCtaeeeeeeeeeeeo 46-47 Relationship Between Aspects of Cerebral Palsy, Mental Age and Selected Conceptual variables 0 e e e e 48 O O O O O O O O O O O O 0 viii Table Page XIII. Significance of Level of Relationship Between Aspects of Cerebral Palsy, Mental Age and Selected Conceptual Variables.................. 49 XIV. Relationship Between Mental Age, Physical Disability Rating and Selected Conceptual Variables With.Resulting "t" Scores and Levels of Significance of Difference . . . . 50 XV. Relationship Between Mental Age, Kind of Cerebral Palsy and Selected Conceptual Variables With.Resulting ”t“ Scores and Levels of Significance of Difference . . . . 51 XVI. Relationship Between Mental Age, Kind of Cerebral Palsy and Selected Conceptual Variables With Resulting "t" Scores and Levels of Significance of Difference . . . . 53 XVII. Level of Significance of Difference Be- tween the Means of the Normal and Cerebral Palsied Groups on Selected Variables . . . . 54 XVIII. Level of Significance of Difference Be- tween the Variance of the Normal and Cere- bral Palsied Groups on Selected Variables . . 54 XIX. Distribution of I.Q. Scores in Normal Child Population and In Cerebral Palsied samp 1° 0 O O O O O O O O O O O O O O O O O O 57 xx. Per cent of Certain Groups Falling Below anI.Q.Sc0reOf90............. 58 ix CHAPTER I THE NATURE OF THE PROBLEM Cerebral palsy is one of the many physical disabilities that American education is attempting to cope with today. Because of its many neuromuscular involvements, it presents a more complicated problem than do most other groups of phys- ically disabled children. No other single group of children need a greater vari- ety of professional help in habilitation and rehabilitation. Therapists, educators, psychologists, dentists, medical spe- cialists, seeial workers, nurses, and all who work with the cerebral palsied child must be sympathetic to the total needs of the child and must adOpt the philosophy of the team ap- proach in their efforts. No other group of disabled children presents to the school a situation Where a "meeting of minds” is more mandatory than does cerebral palsy. The most commonly accepted problem of cerebral palsied children is that of ambulation. However, the nature of the disability incurs many associated impairments in vision, au- dition, intelligence, seizures, perception, sensory discrimi- nation, or almost any other type of impairment. The treatment of cerebral palsied children has followed the medical pattern of most other physical disabilities. Most of the medical effort has been expended in devising methods of physical therapy, new techniques in corrective surgery, occupational therapy, and other reconstructive aspects of medicine. Only recently, as the neur010gical implications of cere- bral palsy have been made apparent, has the total area of in- tellectual functioning become a major problem. Even with this new awareness, most of the past investigations have been concerned with the intellectual aspects of learning the ac- tivities of daily living; which are a real problem to the cerebral palsied child. Relatively little investigation has been conducted with cerebral palsied school children on the nature of the higher mental processes, such as conceptualization, memory or rea- soning. However, therapists are aware that prOgress in phys- ical therapy depends to a large extent on the mental ability of the child to profit from the teaching aspects of physical therapy; i.e. to teach a child a three-point crutch gait is a learning process. Teachers have been baffled by the in- ability of cerebral palsied children to make satisfactory progress in school. Conceptualization is the intellectual process by which the environment is reduced to law and order by the mind of the child. Events are ordered and classified so that each "new" experience does not occur as a new one, but in rela- tionship to past happenings. In other words the child forms "classes of experiences" lor concepts and by their use is able to predict and control events in his environment. In the words of Strauss and Kephart: Not only is the concept based upon elements which are present in the immediate situations, but it also in- cludes those which have occurred in past situations. The concept involves elaborating this present organi- zation by the addition, also in an organized manner, of elements which we retain from experience of similar typ831nthepaSteeeeeeeeeeoeeeeeee Basic t the formation of concepts is generalization It is obvious that the formation of c ncepts invo ves an intricate organization of relations. ... Since the concept is the most complicated of the processes of organization which a child is required to make, it fol- lows that the brain-injured child would have particular difficulty in making these groupings. We have seen that, in most cases, the grouping or organization pro- cess is the one Which gives him the most trouble. It is therefore to be expected that here, where organiza- tion is at a premium, is where his difficulty would be most obvious (35:115, 124, 125). Thus, it becomes apparent that knowledge of the concep- tual processes of the cerebral palsied child would be of value in working with all areas of his disability. To date, very little research has been conducted on the higher mental processes, such as conceptualization, since cerebral palsy has been regarded more as an orthopedic than as a neurological problem. STATEMENT OF THE PROBLEM The purpose of the present study is to investigate the nature of concept formation in cerebral palsied children by analyzing how they perform on a grouping or organizational task, which as indicated above is their major area of diffi- culty. After a review of literature pertinent to concept formation in cerebral palsy and the intellectual testing of the cerebral palsied, a complete procedure and methodolOgy will be presented in Chapter III, whereby it is proposed to analyze the nature of conceptualization in cerebral palsied school children. The following hypotheses are offered in order to test some of the implications arising out of the previous discus- sion: Hypothesis I: There is a positive relationship between mental age and the various aspects of conceptual functioning in cerebral palsied children. Hypothesis II: Concept formation ability is more highly related to mental age than to kind of cerebral palsy or de- gree of disability. DEFINITIONS Cerebral palsy can be defined from.many viewpoints: as an orthOpedic condition, an educational problem, a neuro- lOgical defect, as an intellectual deficit or in terms of its social and economic implications. It is one of the most comp- licated afflictions of the physically disabled. Denhoff has stated: "There is still little correlation between causes, the physiology and pathology of cerebral palsy" (7:1). Cerebral Palsy. Due to the many ramifications and in- volvements of the condition, it appears that any ”total defi- nition" of cerebral palsy must encompass all the possibilities previously implied. The technical nature of much of the medi- cal information that follows is best expressed by direct quotations from the specialists in the field rather than by attempting to paraphrase it. Cruickshank and Hans have summarized as follows the rather definitive attempts of Denhoff to present an exhaus- tive definition of cerebral palsy: As a standard definition he (Denhoff) refers to Perlstein who says that cerebral palsy is generally defined as a 'condition, characterized by paralysis, weaknesses, in- coordination, or any other aberration of motor function due to pathOlOgy of the motor control centers of the brain.’ Herein cerebral palsy is defined solely in terms of its physical components. A still more limited defi- nition of cerebral palsy is one wherein it is conceived as 'a condition in which interferences with the control of the motor system arises as a result of lesions occur- ring from birth trauma.’ This definition may be criti- cized from two points of view: namely, (a) cerebral palsy is more than merely a "motor" problem, and (b) cerebral palsy, etiologically Speaking, is not limited to birth trauma alone. Thus the practical definition ... of Denhoff's ... warrants serious consideration. From such a point of view cerebral palsy is seen as one component of a broader brain damage syndrome comprised of neuromotor dysfunction, psych010gical dysfunction, convulsions, and behavior disorders of organic origin. In some cerebral palsied individuals only a single fac— tor may appear; other individuals may be character- ized by any combination of the factors mentioned. Closely related to the above definition is that of Swartz and his associates Who believe that cerebral palsy should be defined as an aggregate of handicaps; i.e., emotional, neuromuscular, special sensory and peripheral sensory, caused by damaged or absent brain structures. These latter definitions appear to be more nearly in harmony with the reality of the situa- tion in terms of the findings which recent studies have reported (6:1, 2). Thus, the condition of cerebral palsy is seen as an en- tity involving neural, muscular, sensory, social and psycho- logical components and implications. Denhoff's practical definition is especially desirable in a school situation where the cerebral palsied child must be viewed as more than an impaired physical organism, but rather as a person attempting to constructively develop his maximum potential. Concept Formation. As with Coleman, (3) for the purpose of this study, "concept formation" is defined as a process in which an individual, confronted with the task of classifying a group of objects, proceeds to discriminate the essential common properties of the various objects and to group them accordingly. This requires use of the processes of organi- zation and generalization. Intelligence. Wechsler's definition of intelligence as “the aggregate or global capacity of the individual to act purposefully, to think rationally, and to deal effectively with his environment" (46:3) is also acceptable for the pur- poses of this study. HISTORY OF CEREBRAL PALSY The condition of cerebral palsy was first described by William John Little (25) in a lecture before the Obstetrical Society of London on October 2, 1861. The condition has been called Little's disease, spastic diplegia, cerebellar ataxia, hemiplegia, cerebrospastics, et cetera. The term cerebral palsy was chosen and popularized by Phelps (11:180) because of its all-inclusive possibilities. It describes all types of paralysis, incoordination, psychological dysfunction, sen- sory and crippling effects that arise from aberrations in brain structure. It does not include spinal palsies, such as poliomyelitis or severing of the spinal cord, peripheral nerve palsies or muscle palsies. Incidence. Although cerebral palsy is established as a "non-fatal and non progressive" type of disease, its na- tional importance is indicated by Phelps (29) Who stated that seven new cases are added each year for each 100,000 population. The statistics indicated that one of these seven will die at birth so this would indicate a community incidence of eight-four for each 10,000 at age twenty-one. Linck (24) estimated in 1947 there were 350,000 children and young adults in America afflicted by cerebral palsy. While the New Yerk study (21) on the incidence of cere- bral palsy raised some questions as to the validity of the above estimates (their estimate being about two in 100,000), a later report said that a "very large percentage of the cere- bral palsied patients are in need of service at the present time (1953)." Etiology. Fay lists the rec0gnized causes of cerebral palsy as: (1) birth trauma; (2) effects of the RH factor; (3) anoxia due to increased intracranial pressure, asphyxia, edema, or hydrocephalus; (4) encephalitis, prenatal virus infec- tions; (5) meningitis; (6) tumors, cysts, hydromas, clots and abscesses; (7) congenital anomalies, angiomas, aneu- rysms; (8) defects in blood circulatory or spinal fluid mechanisms, Pacchionian filters; and subarachnoid path- ways; (9) systemic or miscellaneous factors that secon- darily effect the normal functions of an originally nor- mal brain organ (nephritis, drugs, toxins, etc.) (11:180). Classification. Such a complex etiology enables cere- bral palsy to be classified many ways. Perlstein classi- fies cerebral palsy according to: (l) the anatomic site of the brain lesion; (2) the qualitative nature of the clinical symptom present whether spasticity, athetosis, rigidity, etc.; (3) the topOgraphical involvement of the extremities; and (4) etiology (27:55). Tables IX and.X classify the subjects of this study ac- cording to sex, clinical and topOgraphical diagnoses. For the purposes of this study, it is not necessary to classify the subjects according to the anatomic site of the brain lesion or by etiOIOgy. Further, such information is often indefinite for a particular subject and difficult to ascer- tain in a definitive manner. . One of the most common systems of classifying cerebral palsy is that of Phelps which is given in Table I as adapted by Fay (11:182). NEED FOR THE STUDY The history of cerebral palsy, with its complex etio- logical and classification systems and the preceding discus- sion has pointed up the need for research in the intellectual functioning of the cerebral palsied. The acceptance of the importance of the neurological aspects of the brain damage in cerebral palsy has accentuated this need. Sarason included cerebral palsy in his rather compre- hensive treatment of the psychological problems of mental de- TABLE I CEREBRAL PALSY CLASSIFICATION (PHELPS-FAY) (ADAPTED FROM my) (11:182) ‘—_‘—:— Part of Diagnoses Brain Affected Spastic Paralysis Cerebral l. Non-spastic Paralysis 20 Atgfilic Type Athetosis Mid-brain l. Deaf 2. Tension 3. Non-tension 4. Hemiplegia 5. Tremor 6. Cerebellar Release 7. Emotional Release 8. Head, Neck, Arm 9. Shudder Type 10. Rotary Type 11. Dystonic Type 12. Flail Type Tremors and Rigidities Basal Ganglia 1. Parkinsonian Types 2.' Decerebrate Types Ataxia Cerebellum * l. Cerebellar 2. Kinesthetic High Spinal Spastic Medulla Mixed Diffuse a: According to Pohl (30) 10 ficiency. After a lengthy review of Cerebral palsy, he concluded that: From the time of Little's original work in 1863 until the third decade of the present century, research in cerebral palsy was largely the domain of the medical specialist. Problems of etiology and patholOgy re- ceived the greatest attention. Although the relation between brain damage and intellectual functioning had always been of major interest to many medical workers, the mental functioning of the cerebral palsied re- ceived scant attention (33:169). Thus, the need for the study becomes apparent. There has been little basic research on the intellectual func- tioning of cerebral palsied school children and even a smaller amount in the higher mental functions such as con- cept formation. The recent studies (18) indicating lower estimates of intellectual ability in the cerebral palsied also points to the need for research in conceptualization. LIMITATIONS OF THE STUDY The limitations of the study consist primarily in: l. The small number of subjects. However, large num- bers of such subjects are not available in any one school. A sample of thirty is large enough to war- rant the use of the statistical tools employed in this study. 2. The limited statistical inferences that can be de- rived from such a sample. As samples become larger and representative, they more nearly represent the parent population. However, the sample is hypothe- sized to be fairly representative of cerebral pal- ll sied school Children, which-is actually the parent population in this study. 3. The necessity of obtaining ranking measures of some of the variables due to the lack of any scaled measuring device. Ranking measures are not discrete and continuous data. They indicate direction better than degree. 4. The fact that the I.Q. distribution in the sample does not parallel that of the total cerebral pal- sied pepulation. While this limits inferences to the total cerebral palsied pepulation, it does not necessarily limit inferences to the cerebral pal- sied school pepulation as implied in number three above. ORGANIZATION OF THE THESIS This thesis is organized according to the following plan: Chapter I serves as an introduction to the nature of the problem involved in this study. Chapter II is a summarization of the most significant research related to this study. The research has been divid- ed into four major divisions: (l) concept formation in gen- eral, (2) concept formation and brain damage, (3) concept formation and cerebral palsy, and (4) intellectual measure- ment in cerebral palsy. Chapter III is concerned with the procedure and metho- dology of this study. It describes the sample, the experi- 12 mental tasks and the intelligence test. In addition, it describes the ratings of physical and language disability. The chapter concludes with an explanation of the statisti- cal procedures used in the analysis of the data obtained in the study. Chapter IV presents the results of the study in tabu- lar and explanatory forms. Chapter V presents a summary of the results with con- clusions and recommendations. CHAPTER II REVIEW OF RELATED RESEARCH CONCEPT FORMATION The total field of concept formation has always been of considerable interest to psychologists and others in- terested in the so-called higher mental pr0cesses. Coleman's (3) study contained an excellent review of the general literature on concept formation. His review was concerned with the types of concept formation Which have been investigated with reference to intelligence. He found eight types: namely, (1) concepts of time, (2) con- cepts of space, (3) concepts of number, (4) studies invol- ving form discrimination and form analysis, including the use of sorting tests, (5) concepts of causal relationships, (6) social concepts, (7) studies involving the use of ab- stract reasoning, including learning, and (8) studies in- volving specific intelligence tests and items customarily used in such tests. Coleman's hypothesis was that concept formation ability was more highly related to mental age than to chron010gica1 age. Using fifty children each at ages seven, nine and eleven, the Wechsler Intelligence Scale for children and a concept formation test of the "sorting type," he obtained significant differences on three variables: the number of l4 logical concepts achieved, the mean time necessary to pro- duce a concept, and the number of non-functional cancepts achieved. These variables were all significantly related to men- tal age and more highly related to mental age than to chron- ological age. CONCEPT FORMATION AND BRAIN DAMAGE The purpose of this review is to ascertain the nature of research that has been conducted on concept formation in cerebral palsied school children. Cerebral palsy is sub- sumed under the broader classification of brain damage. This review will not attempt to synthesize all the litera- ture dealing with brain damage and concept formation, but only that which is necessary to gain a historical perspec- tive on conceptualization in cerebral palsied brain-damaged school children. ’ Psychological research on brain-damaged individuals was in its infancy in the early part of the twentieth cen- tury. The work of Goldstein (14) gave added impetus to the area following World War I. His work also furnished a be- ginning theoretical basis for mental functioning with postu- lated cerebral correlates. , One of the early studies dealing with concept formation in brain-damaged adults was that of Halstead (15). Since it has set the direction of experimental thought in investiga- ting concept formation in cerebral palsied children, it will 15 be reviewed in some detail. The study was concerned with attempting to determine how alterations with the cerebrum affected the "higher” mental functions. Halstead's study was conducted on twen- ty-six ”carefully selected neurosurgical patients" at the University of Chicago Clinics in the late 1930's. Of these cases, eleven had a considerable lesion in one frontal lobe; one had an undetermined amount of cortial atrophy residual to removal of a small meningioma from the right frontal lobe: fourteen had lesions in the brain posterior to the frontal lobes, including one instance of cerebellar lesion. These patients ranged in age from fifteen to sixty-three. Eleven normal subjects were used as controls; ages twelve to fif- ty-six. The area and extent of the damage was ascertained by the following methods: (1) lateral X-ray plate in which silver clips outline the lesions, (2) Operative notes by the surgeon, (5) sketch of the operative field made by the surgeon at the time of the Operation, and (4) diagram of the operative field made by Halstead at the time of the ope- ration. Halstead's (15:1274) test objects, listed in Table II, consisted of sixty-two objects which differed in size, shape, color, brightness, weight, material, hardness and position. The objects were presented to the subject in a predetermined arrangement on the surface of a table (2' by 3' at a height of 30"). Good rapport was established before testing began. 16 TABLE II OBJECTS USED IN HALSTEAD'S STUDY (ADAPTED FROM HALSTEAD) (15:1274) W Objects Glass Bottle Labeled "Camphor" Glass Stopper House Key Wooden.Pulley colored Picture of a.Hooster Glass Bottle and Stopper Labeled ”Bergamot" Pink‘Yarn , Yellow‘Yarn Multicolored Cube Metal Whistle Colored Picture of a Bell Cancelled Foreign Postage Stamp Toy Metal Spoon Bone Chess Pawn Miniature Electric Light Socket Blue'Yarn Coarse Sandpaper Smoked Glass Lens~ Pipe Stem Playing Card Metal Jar Lid Small Cork Pipe Bowl Picture of a House Key Small Wax Candle Rubber-Covered Wire Lipstick Wax Crayon Metal Hairpin Red Wool Cloth Piece of Thianoundish Stick Abstract Design Ping-Pong Ball Pink Candle Holder for Cakes Bakelite Bracelet Rubber Grommet Red Paper Stock Small Padlock Red Poker Chip Card Labeled "Hairpin" Metal Thimble , Piece of Thick Roundish Stick Red Poker Chip Colored Picture of a Rabbit Black Wooden Cube Small Glass Jar Toy Metal Fork Small Metal Key Metal Pulley Blue Bakelite Earring Canvas Doll Slipper Toy Metal Knife Small Metal Key Miniature Electric Light Bulb Metal Puzzle Round.Wooden Box Lid Round Wooden Box Fine Sandpaper Card Labeled "Pipe" Blue Poker Chip Flashlight Bulb Colored Picture of a Dell 17 Speed or rate of performance was not mentioned or suggested as a factor. The testing time with the normal subjects varied between one and one-half and two hours, whereas the testing time for the cerebral injury patients averaged about thirty'minutes; necessitating as many as seven testing ses- sions to obtain the necessary information. The testing situation was divided into five parts (15:1274-1276): Part I was concerned with establishing the range of interest and familiarity of the subjects with the test-objects. The subject was asked: ”Have any of these things ever been of interest to you -- if so, pick them up one at a time.“ The examiner also as- certained if the subject knew the names of the ob- jects not chosen; looking for evidence for anemia at all times. _Part II was concerned with having the subject make a "spontaneous" grouping of some of the test-objects. The subject was told: Place those things tOgether which seem to you to belong together.” After five groups were achieved, the subject was allowed to rest for five minutes at the first pause or slowing in rate of progress. Part III was concerned with testing for recall of the test-objects by the method of imminent recall, i.e. at the end of the five minute rest period the arti- cles were covered up and the subject was asked to name the things he saw on the table. Part IV was concerned with testing for nominal equi- valence. The cover was removed from the objects and the subject asked why he had put the objects together in groups. The test objects were then randomly mixed, and the subject asked to group them another way. This was continued until no further ways of grouping could be ascertained by the subject. Part V was concerned with determining in a preliminary way the basis of equivalence of the test-objects in groups. The group of test-objects previously made by the subjects and five groups prepared by the examiner were used. The subject was asked if certain objects could be either removed or added to the group without disturbing its grouping principle. 18 The results of this experiment established what has since become known as the characteristic modes of response of brain-damaged individuals in conceptual behavior. Halstead's frontal lobe (his analysis is based on them a- lone) brain-damaged subjects used fewer test-Objects in their first spontaneous grouping (Part II). Rorschach exam— ination of these subjects also revealed evidence of constric- tion. When tested for recall (Part III) after five minutes, the frontal lobe subjects averaged fewer recalled Objects than did the normal subjects. The frontal lobe patients did not remember any more Of the grouped than ungrouped test-Ob- jects, whereas normal individuals tended to remember better those Objects they had grouped. This suggests that frontal lobe lesion can reduce or eliminate the effects of experi- ence: the learning hypothesized to have occurred from the previous grouping. The frontal lobe cases also produced a smaller number of groups despite the fact they took 50 per cent longer on the test than the other subjects. Further, the frontal lobe cases produced groups calling for a categorical attitude, which caused Halstead (15:1289) to question Goldstein and Weigl who had asserted that subjects with frontal lobe le- sions could not adopt such a conceptual attitude. 19 CONCEPT FORMATION AND CEREBRAL PALSY One of the first comprehensive studies attempting to deal with conceptual behavior in cerebral palsied children was that of Cottom. She stated that the literature to 1941: concluded that cerebral injury of ten results in a diminution of abstract behavior and a corresponding increase in more concrete responses to problem sit- uations, as well as in a loss in ability to shift, voluntarily, from one aspect or attribute of a prob- lem to another ... She raises the question ... would one find a lack of the development of such abstract behavior in cases of brain injury during infancy or immaturity? (4:27) Cottom also indicated that research has typed the brain- injured as being characterized by stereotypy and by impair- ment in the ability to perceive abstract relationships. Cottom used twenty-six "spastic school children” matched in sex, chronological age, and estimated mental age (estimated for cerebral palsied only) with twenty-six physically normal children. She administered a series of thirteen sorting sit- uations; a completion test involving concrete, pictorial and verbal material: a light pattern memory test and a string- pattern test. The tests were administered as follows: (1) Sorting Test: A group of thirty-two objects, fifty-four leather, glass and cardboard forms, and two lists of words, in differ- ent combinations constituted the thirteen sorting test situa- tions. Her results are contained in Table III. (2) Light Pattern Test: This test required the subject to repeat a patterned sequence of colored lights which could be varied and indefinitely increased in complexity. The test began 20 TABLE III SUMMARY OF RESULTS IN COTTOM'S SORTING TEST SITUATIONS I-XIII (FROM COTTOM) (4:54) Type of Response Spastics Normals 1. Total Classifications on the Basis of Color 40 19 2. Total Classifications on the Basis of Shape 70 98 5. Total Classifications on the Basis of Size 27 56 4. Total Classifications on the Basis Of Material 21 15 5. Total Classifications on the Basis Of Familiar Associations 42 43 6. Total Classifications on the Basis of Comprehensive Relationships* 65 99 7. Total Classifications on the Basis of Fantasy and Design 30 l A * These totals include some of the color, shape and mater- ial classifications totaled above. TABLE IV SUMMARY OF THE RESULTS OF COTTOM'S LIGHT-PATTERN TEST (FROM COTTOM) (4:35) 9—4. 1 u M _—.::—“‘ Type of Response Spastics Normals l. Successfully Completed Five- Light Patterns (Upper Limit) 0 2 2. Successfully Completed Four- Light Patterns 11 10 5. Successfully Completed Three- Light Patterns 8 9 4. Successfully Completed Two- Light Patterns 1 O 5. Exhibited "Stereotyped" Be- havior . 9 1 21 with two light patterns and continued until the subject failed five out of eight patterns of a certain complexity. Cottom's results are contained in.Table IV. (3) The Com- pletion Test: This test consisted Of three groups of ob- jects, three Of pictures and four of words, each group having in common the fact that something was lacking to complete it or to make it useful. Cottom's results are . contained in Table V. (4) The Patterned String Test: This test consisted of twenty patterns: four each.using two, three, four, five and six strings. Kindergarten children only were used for this test. A Life-Saver was attached to one string Which the child could pull toward him by finding the correct string and pulling on it. The results are con- tained in Table VI. Cottom summarized her results by saying: With one or two exceptions the spastic group differed demonstrable from the normal in three general respects: first, a wider range of individual differences in type Of response within any one test situation, with bizarre or fantastic responses found only among the spastics; second, a greater tendency toward more concrete types of response, with less ability to shift toward the more abstract forms of behavior: and, third, a greater ten- dency toward stereotyped responses no matter what the nature of the test situation. Consistency within the battery was the rule in nearly all the cases (4:42). Several other points of interest are noted in Cottom's analysis of the various tests. The spastics preferred color classifications, where normal subjects preferred shape. For both groups the concepts of color, size, and shape seemed basic, and they fell back upon it when unable to derive other grouping principles. 22 TABLE V SUMMARY OF RESULTS IN COTTOM'S "COMPLETION” TEST (FROM COTTOM) (4:56) Types of Response Spastics Normals 1. A11 Concrete Tasks Correct on First or Second Trial 15 15 2. All Pictorial Tasks Correct on First or Second Trial l4 l4 5. Three to Four Verbal Tasks Cor- rect on First or Second Trial 4 8 4. One to Two Verbal Tasks Correct on First or Second Trial 11 4 5. Exhibited Stereotyped Behavior 3 C 6. Consistently Guessed When in Doubt 4 7 7. Matched Items Instead Of Complet- ing the Series 1 S 8. "Gave up" When in.Doubt 4 5 9. Consistently Needed Second Trial 5 1 TABLE VI SUMMARY OF RESULTS IN COTTOM'S STRING-PATTERN TEST (FROM COTTOM) (4:58) Types of Response Spastics Normals A. Number of Patterns Correctly Solved on First Trial 1. Nineteen to Twenty 11 ll 2. Fifteen to Seventeen 5 4 3. Twelve to Fourteen 1 2 4. Nine to Eleven 1 l 5. Six to Eight 5 2 6. Three to Five 1 l B. Overt Movement Utilized In Obtaining Solution 1. Extensive Head, Trunk and Arm Movements 11 O 2. Extensive Finger Movements l 5 ? at“ W 23 The spastic children were markedly more deliberate than the normals. The spastics studied the situations lon- ger before beginning to respond. Halstead (15:1280) also noted the deliberate behavior of frontal lobe injured pa- tients. Cottom throughout her article has interspersed several statements which bear directly on the hypotheses stated on page four Of this study. They are: Mental age apparently has some rather definite connec- tion with the ability to reproduce the more complex patterns (4:55). Are unusual responses of spastics analogous to the type and severity of their disability? (4:58) Stereotypy (perseveration in present study) apparently has little relationship to the estimated mental ages of our subjects (4:40). These findings would indicate that a severe speech dif- ficulty was more often connected with stereotyped be- havior, with "fantasy" responses, and with difficulty with verbal (abstract) material than such categories as estimated mental age or type and severity of dis- ability in general (4:40). It is apparent that these statements of Cottom relate to the operational hypotheses stated in Chapter III, which assert that mental age is related more to difficulty in various areas of conceptualization than is degree of physi- cal disability or kind of cerebral palsy. A weakness in Cottom's study is the grouping tOgether of spastics and athetoids, whereas Holden's (19) study indicated they should be treated separately. There has been considerable speculation (56:64) as to the difference in concept formation between the brain-injured 24 mentally defective and the "garden-variety" mentally defec- tive. Strauss and Werner (58) conducted a study on this problem. Two groups of twenty children each were used. The first grOup was mentally retarded of the familial, he- reditary or endOgenous type. The second group showed evi- dence of brain damage: the so-called exogenous, brain dam- aged mentally defective. A further control experiment uti- lizing ten normal children was conducted. Strauss and Werner used an adaptation of Halstead's (15) test in their study and found several characteristics differentiating the brain-injured mentally defective from the non-brain-injured mentally defective. They are: (l) The brain-injured children selected more Objects than the children in the two control groups. (2) There was a significantly higher percentage of uncommon responses in the brain-injured group than in the control groups. (5) A principle of selection of objects made by brain- injured children seemed to be based particularly upon usual or accidental or apparently insignifi- cant details. (4) The brain-injured children were markedly attracted by preperties of objects apt to elicit motor re- sponse (58:168) The brain-injured were further characterized by: ‘(1) Arrangement of Objects in circumscribed unity. (2) Formalistic behavior (vis, meticulosity, organic pedantry, arbitrary patterning, etc.) (5) Dynamic-concrete grasp of relationship. (e.g., dramatization, animation of the situation). (58:168) One of the most recent studies dealing specifically with concept formation in cerebral palsied children is that 25 of Dolphin and Cruickshank (9). Because of the similarity of cerebral palsied Children to exogenous mentally retarded children studied by Strauss and Werner (58), Dolphin and Cruickshank were interested in testing for similarities in concept formation between the two groups. They devised their study as follows: two groups of thirty children each were selected; one cerebral palsied, the other physically normal. There were sixteen boys and fourteen girls in each group. The mean chronological age of the cerebral palsied was 10.026 and the normal children 10.175. The range of in- telligence quotients was from 78 to 129 inclusive with six- teen children in each group having I.Q. scores above ninety. The Picture Object Test was given to these sixty chil- dren individually. The test (9:587) involves determining relationships between life situatiOns as represented in pic- tures and in a collection of small objects. Two enlarged pictures were pasted on White cardboard and mounted on wood- en blocks. They were presented upright on the table before the child. Picture I showed individuals running away from a large wave which was breaking over a boardwalk. Picture II showed a large building which was on fire during the night. One hundred two small objects were arranged in random order to the left on the top Of the table. The pictures were facing the child at the rear of the table. The Objects used for the study (9:587-588) are contained in Table VII. Dolphin and Cruickshank's instructions to the child were as follows: 26 TABLE VII OBJECTS USED IN DOLPHIN AND CRUICKSHANK'S TEST (ADAPTED FROM DOLPHIN AND CRUICKSHANK) (9:587, 388) II Objects Glass Bottle colored Cube Sunglasses Wax Crayon Glass Stepper Paint Brush Cork Hairpin Metal Jar Lid Metal‘Whistle Metal Pulley House Key Padlock Playing Card Father Doll Mother Doll Brother Doll Sister Doll Baby‘Doll Lipstick Meta1.Fork Metal Spoon Pipe Bowl Paper Clip Pink‘Yarn Metal Thimble Rubber Band Scissors Bracelet Black cube Doll's Shoe D011 Dishes Toy'Hammer Toy'Saw Toy Augur Toy'Wrench Bed Cotton Chess Pawn Soap Bus Police Car Oil Truck Red Coupe Red Sedan Fire Engine Wire Rubber Hose Swab Nails Screws Yellow'Yarn Earring Pipe Bowl Chair Table Clock Stove Wash Stand Bathtub Metal Puzzle Colored Picture of a Rooster Rubber Covered Wire Colored Picture of a Ball Small Round Red Button Piece of Red Wool Cloth Card Labeled ”Ball" Card Labeled "Pipe" Cancelled Foreign Postage Stamp Card Labeled "Hairpin" Colored Picture of a D011 Colored Picture of a Rabbit Round Paper Box Lid Burned Matches Rubber Grommet C oarse Sandpaper Piece Of Cord Thick Round Stick Picture of a Key Small Wax Candle Toy Metal Knife Electric Socket Ping-Pong Ball Red Paper Stock Thin Round Stick Small Metal Key Red Poker Chip Blue Poker Chip Box of Matches Electric Light Bulb Toy Screwdriver Round.Paper Box Fire Chief Car Brown Glass Bottle Medium Size Stick Chest of Drawers Typewriter Eraser Flashlight Bulb Small Metal Spring Plastic Bottle Top Pink Candleholder for Cakes Cylindrical Wooden Piece 27 Do you see this picture? It is a picture of those children who are running from this wave which might drown them. Now this picture shows a building on fire. DO you see the smoke and the flames coming from the house? There you see a number of objects. Put before the picture of the children running from the water those things which go with that picture. Those things which go before the building on fire put over here, and those things which you are sure do not belong to either picture put over here. (9:588) When the child had finished putting all the objects in one of the piles, he was asked his reasOn for placement and verbatim responses were recorded. Table VIII is adapted from.Dolphin and Cruickshank (9:591), and compares the num- ber of Objects chosen by cerebral palsied and other children. TABLE VIII COMPARISON OF NUMBER OF OBJECTS USED BY THE CEREBRAL PALSIED AND NORMAL GROUPS WITH THE RESULTING "t" SCORES FOR THE PICTURE OBJECT TEST (ADAPTED FROM DOLPHIN AND CRUICKSHANK) (9:591) Cerebral Palsnyroup Normal Group Picture Picture Total Picture Picture ~Tota1 I II I . II (2) (3) (4) (6) ('7) (8) Mean No. of 8.26 27.655 55.9 4.05 15.55 17.56 Objects Used Stand- ard De- 6.771 20.260 26.260 2.851 11.50 14.12 viation t Scores Between Columns 2 and 6 2.2741 Columns 5 and 7 5.5255 Columns 4 and 8 5.5581 Per cent of Significance of t Columns 2 and 6 2 Columns 5 and 7 1 Columns 4 and 8 1 28 Table VIII shows a high degree of significant dif- ference between the number of Objects chosen by cerebral palsied and normal children. This agrees with the findings of Halstead (15), Cottom (4), and Strauss and Werner (58). There were other differences in Dolphin and Cruickshank's study besides the number of Objects used such as: The cerebral palsy group (1) made more selections Of objects based on secondary qualities of the objects, (2) chose a larger number of uncommon objects, (5) dramatized the picture in their selection of objects, (4) extended the pictures into space and time, (5) frequently rejected an object after having initially 'selected it, and (6) in some cases were unable to organize the pictures into a meaningful whole (9:592). INTELLECTUAL MEASUREMENT OF THE CEREBRAL PALSIED Holden (19) reviewed the psychological studies on cere- bral palsy between 1947 to 1952. His review was based on articles reported in the Psychological Abstracts. The re- view reported only seventeen articles for the fifteen year period between 1951 and 1946, but a total of ninety-one ar- ticles for the five year period between 1947 and 1952. Holden grouped the nature of the studies between 1947 and 1952 under four groups: namely, (1) new techniques in testing, (2) mental evaluation, (5) personality evaluation, and (4) basic psychological research in cerebral palsy. In his summary Holden stated that "most" of the articles were devoted to the problem of intellectual evaluation. Writers in the late 1940's and early 1950's were saying with.DenhOff that: 29 The basic need in the psychOIOgical evaluation of the child with cerebral palsy is the development of simple measures than can indicate educability and pregnosti- cate the ultimate level of intellectual attainment (7:9). The criticisms against the standard intelligence tests as a measure for the cerebral palsied have been aptly sum- marized by Hill as follows: 1. It is impossible to assess the intellectual capacity of the cerebral palsied. Therefore, the I.Q. has no meaning -- at least a different meaning -- when used to describe the intellectual status of children with cerebral palsy. 2. Present instruments are inadequate for use with the cerebral palsied. 5. Cerebral palsied children should be measured by tests standardized on the cerebral palsied population rath- er than the general population. 4. In many instances diagnoses are given by those who have little or no training in understanding the prob- lems of brain-injured children (17:591). While reCOgnizing the partial validity of all of these claims, the concensus of the literature reCOgnizes the de- sirability of using the standard measures of intelligence with adaptations and supplementary tests as necessary. (1; 25; 41: 19; 22; 25) The psychologists who worked with Hohman (18:285) used the Stanford-Binet Intelligence Scale, The Vineland Social Maturity Scale, The Merrill Palmer and the Cornell Cox as their intellectual criterion. They considered that 56 per cent of their 477 subjects reSponded satisfactorily to the tests, 54 per cent responded well enough to define a general range of intelligence and only 9 per cent were so disabled as to obviate the use of standard tests in intellectual test- 50 ing. Hohman's (18) article, which summarized the important studies in intelligence levels in cerebral palsied individ- uals, indicated that between 50 to 70 per cent are mentally retarded and that at least 50 per cent are seriously retard- ed and mentally defective. Only 5 per cent score an I.Q. of 110 or above, whereas 25 per cent of the normal child pOpu- lation will be above 110. The Columbia Test of Mental Maturity (2) is one of the most recent attempts to devise a special test standardized on a cerebral palsied population. It requires no verbal re- sponses and a minimum of motor responses. In its standardi- 'zation, correlations of .66 to .88 were obtained between various age levels of this test and the Stanford-Binet. Enough research has not yet accumulated to indicate the practical value of this test: but it appears to have much to offer because of its great adaptability to the handicapped child such as, its lack of verbal responses and its minimum requirement of motor responses. SUMMARY This review Of research reveals some rather definite trends. The studies to date on concept formation in cere- bral palsied children have been based on Halstead's (15) study which was conducted on adult Operative patients. The concept formation tests have utilized numerous Ob- jects with stimulus values that have been at odds with the rather well established factors in brain damage: (a) forced 51 responsiveness to stimuli, (b) perseveration, (c) dissocia- tion, (d) disinhibition, (e) and disturbances of the figure- background relationship (17:591). Studies with the cerebral palsied have used biased samp- les with respect to intelligence. Sixteen or 55 per cent of Dolphin's and Cruickshank's (9:587) thirty subjects had I.Q. scores above ninety; whereas Hohman's (18:287) study indi- cated that only 16 per cent Of cerebral palsied children score at or above ninety. The literature also indicated (17:52) that, in most in- stances, it is possible to secure a valid test of intelli- gence on the cerebral palsied with the standard tests of in- telligence. The reliability and validity of such testing depends on the ability of the examiner to make such modifi- cations as are necessary without doing violence to the test standardization, at the same time using special tests or pro- cedures when the specific disability of the cerebral palsied child necessitates such. CHAPTER III PROCEDURE AND METHODOLOGY OF THE STUDY It is evident from a review of the literature that con- cept formation has not been adequately investigated in cere- bral palsied school children. The studies that have attempt- ed to deal with the subject have used methods which penalize the cerebral palsied child because Of his specific learning difficulties, his mental ability and his restricted experi- once. A decade ago workers in the field of cerebral palsy were assuming there was no intimate connection between the disability and proficiency in concept formation. It was as- sumed that with increasing chronolOgical age and experience, the child would grow out of his deficit in concept forma- tion ability. Recent studies such as HOhman's (18), which have investigated the intellectual ability of cerebral pal- sied children, have caused a.downward revision in the esti- mate of their intellectual potential. Coleman's (5) study showed a positive relationship be- tween mental age and conceptualization rather than between chronological age and conceptualization. To a large degree this study is patterned after that of Coleman's. The identical experimental tasks are used for the’ following reasons: their accessibility to statistical treat- ment, their relative,freeness from cultured and experiential 33 factors, their wide range of difficulty and their adapt- ability to testing some hypotheses in cerebral palsied brain- damaged children. The identical experimental tasks were fur- ther used in order to facilitate making comparisons between ”normal" and cerebral palsied children. Coleman's study, on normal children, was conducted in the same geOgraphical area within a year previous to this study. SUBJECTS The subjects were thirty cerebral palsied children en- rolled in the orthOpedic units of Walnut Street Elementary School, Pattengill Junior High and Eastern High Schools in Lansing, Michigan during the school year of 1955-1956. Scores on the concept formation task, the Stanford-Binet In- telligence Scale and the Physical and language disability rank were obtained for each subject with the results indi- cated in Table XI. . The obtained I.Q. scores ranged from extremely mentally defective through average, bright average and superior lev- els: ranging from 27 to 138. The high degree of overlap of mental ages from grade-to-grade should be noted. The ages of the subjects ranged from 4.6 to 20.1 with a mean of 10.3 and a standard deviation of 3.10, while the mental ages of the subjects ranged from 2.8 to 17.1 with a mean of 8.44 and a standard deviation of 5.92. Finally, the sample was composed of sixteen boys and fourteen girls. Tables IX and X contain the clinical and topographical diagnoses of the subjects. 34 TABLE IX CLINICAL DIAGNOSES AND SEX OF SUBJECTS Diagnoses Boys Girls Totals Spastic 12 11 23 Athetoid 1 3 ' 4 Ataxia 1 1 Tremor-Ataxia l 1 Spastic-Athetoid (Mixed) l 1 Totals 16 14 60 TABLE X TOPOGRAPHICAL DIAGNOSES AND SEX OF SUBJECTS r ,_-— Diagnoses Boys Girls Totals Hemiplegia - Right 4 4 8 - Left 4 l 5 Paraplegia 1 4 5 Quadriplegia 7 5 12 Totals l6 14 30 55 THE EXPERIMENTAL TASKS The Conceptual Task; This task is identical to that of Coleman's (3). It consists of a series of plastic pieces (one-eighth inch thick) of three different forms (circle, equilateral triangle, and square), three different colors (red, yellow, and green), and three different sizes (1 1/8, 1 9/16 and 1 7/8 inch circles; 1, 1 3/8 and 1 11/16 inch squares; 1 1/2, 2 3/16 and 2 9/16 inch equilateral triang- les), for a total of twenty-seven pieces. According to Cole- man, the different forms of the same size were made equal in size by equating surface areas. It was determined that if the sides of the figures were equated, the resulting percep- tual differences between the sides were so great as to vir- tually force a classification according to this dimension. By equating areas rather than sides, the size difference is still well above the threshold, but requires the perception of relationship rather than absolute size. A standard set of directions for administration was de- vised by Coleman. (See Appendix) After it is certain that the child knows the names of the colors involved, he is asked to place all of the pieces into different groups so that a common principle governs his placement of the pieces. In other words, the subject is told to place all of the pieces into piles so that all of the pieces in each pile belong together in some way. Essentially the same directions are repeated with systematic hints until 36 the subject can no longer classify the pieces in any way. The concept formation test was constructed and used for the following reasons: 1. 2. 3. 4. 5. 6. It provides a range of difficulty from simple to complex. It has more than one solution in a problem which is potentially solvable by individuals with a wide range of ability. It makes possible illegical or inappropriate solu- tions. It is relatively free from the effects of past ex- perience. The results are easily quantifiable in various di- mensions. It lends itself to an Operational definition of concept formation. The concept formation test is scored on six different variables: 1. 2. Score for time. The mean time necessary to achieve a concept is Obtained by dividing the total time by the number of legical concepts achieved. Number of legical concepts. With the twenty-seven pieces of the concept formation task, six logical concepts are possible: classifications based on color, shape, and size, each yielding three group- ings, and combinations of these such as, color-shape, color-size, shape-size, each making nine groupings. 37 The first three concepts are referred to as unidi- mensional since they require a single common prin- ciple, and the second three are referred to as bidi- mensional since they require a double principle in their solution. 3. Number of unidimensional concepts. The concepts of color, shape and size requiring a single grouping principle. 4. Number of bidimensional concepts. The concepts of color-shape, shape-size and color-size require a double grouping principle. 5. Number of illogical or alOgical concepts. These are defined as those concepts which do not conform to the instructions, in that pieces are misplaced, or there are other than three or nine groupings. .6. Number of repetitive concepts. During the course of the administration any concept which is repeated is called a repetitive concept. Numbers 2, 3, and 4 are called functional concepts, while numbers 5 and 6, for this purpose, are termed non-functional concepts. The results of the concept formation test are sum- marized in Table XI. The Intelligence Tesg; The Stanford-Binet Intelligence Scale: Form L (46) was used as the intellectual criterion for the following reasons: 1. The test is now in wide clinical use with cerebral palsied children and much work has been done on its 58 applicability to these children (18; 22; 25). 2. The test has a low basal mental age (two years) which is necessary for the children of this study. 5. The test has high motivational qualities at the lower ages which is especially necessary for brain- damaged cerebral palsied children. 4. The mental age scores are readily used in statisti- cal analysis. The Stanford-Binet Intelligence Scale: Form L has been standardized on children from age two through the Superior Adult III level or from the mental age of two years through twenty-two years and ten months. A review of the literature shows that with slight adaptations, which in no way invali- dates the test, the Binet test can be used with most cerebral palsied children. This proved to be true in our sample. Table XI contains the data from the Binet intelligence test. As a corollary measure the Columbia Mental Maturity Scale (2) was also given to twenty-four subjects who had al- so been given the Stanford-Binet. This is a relatively new test and one which has been standardized on cerebral palsied subjects in New'York. This test was given as a further check on the Stanford-Binet scores and also to further research on the test. It is new yet indicates promise in the field of cerebral palsy. Since the main hypotheses of this study are to test the relationship of mental age to certain other variables, mental age scores are used rather than I.Q. scores. Further, our 59 population has a relatively wide age range and age is a fac- tor in the I.Q. equation. Diagnoses and Physical Disability Ranking. Table XI gives the medical diagnoses and rank of disability of each subject. The diagnoses were obtained from the medical re- cords of the children whenever possible, and supplemented by the professional opinion of two physical therapists and an occupational therapist. These therapists had worked with the children intensively and were intimately acquainted with them. The subjects were ranked from one to thirty as to degree of total physical disability. The subject receiving a rank of “one" is most disabled. Each subject had been given mus- cle tests as used in physical and occupational therapy. This test grades the use of the muscle in six categories: normal, good, fair, poor, trace, zero. The ”physical disability rating" attempted to consider the total individual: both upper and lower extremities, am- bulation with and/or without support, and general physical incapacity. The ranking attempted to disregard the "func- tional disability" of the subject, as this is influenced hea- vily by intelligence and learning. The results of the muscle test and medical reports indicated some subjects should be able to walk unaided, but were unable to do so. This would be regarded, in our present state of knowledge of cerebral palsy, as a functional disability and this subject would rank as less physically disabled than another who might be 4O walking with some degree of proficiency. Speech and Language Ranking. The speech therapist ranked the subjects who receive speech training from one to fifteen according to degree of severity. The subject re- ceiving a rank of "one" is most severely affected. Only fifteen of the thirty subjects were receiving speech ther- apy. The rankings are presented in Table XI. This rating included total language disability, both remedial and de- velopmental. Cerebral palsied children often have remedial speech needs, such as faulty articulation and sound substi- tutions, as well as a lack of speech development due to many physiological and psycholOgical factors. The speech thera- pist attempted to rule out the intellectual factors, as far as possible, in ranking the children in order of speech handi- cap. This was done in order that the language handicap could be correlated with the intellectual as well as physical im- pairment. This necessitated that the intellectual component be ruled out of the speech and language rating. Table XII shows the correlations between speech and language, physical disability, kind of cerebral palsy, mental age and concept formation ability. OPERATIONAL HYPOTHESES With reference to the procedure and general hypotheses stated on page four, the hypotheses may now be stated in operational terms. 1. The number of logical concepts produced is more 2. 5. 4. 5. 6. 41 highly related to mental age than it is to: (a) de- gree of physical disability, (b) kind of cerebral palsy. I The degree of speech and language disability is more highly related to mental age than it is to: (a) degree of physical disability, (b) kind of cere- bral palsy. The mean time necessary to produce a concept is more highly related to mental age than it is to: (a) de- gree of physical disability, (b) kind of cerebral palsy. This is an inverse relationship. _ The degree of dimensionality of the concept produced is more highly related to mental age than it is to: (a) degree of physical disability, (b) kind of cere- bral palsy. Dimensionality is defined as a measure of the number of factors in a concept, such as color or color-shape. The formation of illogical concepts is more highly related to mental age than it is to: (a) degree of physical disability, (b) kind of cerebral palsy. This is an inverse relationship. The formation of repetitive or perseverative con- cepts is more highly related to mental age than it is to: (a) degree of physical disability, (b) kind of cerebral palsy. This is an inverse relationship. 42 PROCEDURES FOR ANALYSIS OF THE DATA Since the Operational hypotheses on pages 40-41 express a stronger relationship between conceptual ability and men- tal age than between conceptual ability and disabilities due to cerebral palsy, it is necessary to secure measures to show the relationships of all these variables. The factors of mental age, physical disability rank, spasticity vs non-spasticity and affected topOgraphical area (these latter two being "kinds" of cerebral palsy) must be related to measures of concept formation (number of logical concepts, mean time per concept, degree of dimensionality of concept, number of illegical concepts and repetitive concepts) and to degree of speech and language disability. The analysis of the data must also test the hypothesis that the correlation with mental age is higher than with mea- sures of cerebral palsy difficulty. The data are of several kinds: 1. Enumeration data - mental age, number of logical concepts, mean time, i.e., any counted or scaled data. 2. Ranked data - physical disability rating, and speech and language disability rating. 3. Dichotomous data - spastic vs non-spastic. 4. Trichotomous data - hemiplegia, paraplegia, quad- riplegia. These differing kinds of data make it impossible to use the same measure of relationship for all comparisons. A so- 43 lution to this difficulty can be resolved, when correlating, as follows: 1. Enumeration vs enumeration data use product moment correlation. 2. Enumeration vs ranked data use rank order correla- tion. (convert enumeration data to ranked) 5. Enumeration vs dichotomous data use point-biserial correlation. 4. Enumeration vs trichotomous data use contingency coefficient. 5. Ranked vs ranked data use rank order correlation. 6. Ranked vs dichotomous data use White's T test. 7. Ranked vs trichotomous data use the Kruskal - Wallis H Test. The rank order correlation coefficients were corrected for bias by applying formula 11.45 from Walker and Lev (45:282). No correction for bias is available for the contingency coefficient. It is not a very satisfactory estimate of the correlation coefficient, but was used because it was the only available measure. The next step in the analysis of the data is to test the significance of the difference between the measures of rela- tionship with the Binet vs conceptual ability and the mea- sures of degree and kind of cerebral palsy vs conceptual a- bility. 44 Since the usual Z transformation technique assumes in- dependent random samples, another test was used. Walker and Lev's formula 10.60 (45:25?) requires the three corre- lations and the number of cases in the sample. Although the test is designed for use only with product moment corre- lations and the data included rank-order, point-biserial and contingency coefficients, no other test known approached use- fulness in this situation. These latter correlations all ap- proximate the product moment correlation and the assumption is made that the formula is useful in this instance also. CHAPTER IV ANALYSIS OF THE DATA The basic data of the results of this study are con- tained in Table XI. It lists, for every subject, the chron- olOgical age, sex, grade, Binet mental age, I.Q., physical disability rank (P.D.R.), speech and language disability rank (S.L.D.R.), mean time per concept in seconds, number of illogical concepts, number of repetitive concepts, and the individual concepts achieved. Tables XII-XX are based on the data from Table XI. All of the data are based on a sam- ple of thirty, except in those places in the tables where a lesser "N" is indicated. Only fifteen subjects were receiv- ing speech therapy and three subjects had no repetitive con- cepts: reducing those respective samples to fifteen and twenty-seven. From-Table XI and also Table IX it will be noted that the sample was composed of twenty-five spastics, four athe- toids, one ataxia, one tremor-ataxia, and one mixed spastic- athetoid. 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U- 48 jects in kindergarten, four in grade one, five in grade two, three in grade three, three in grade four, three in grade five, two in grade six, one in grade eight, two in grade nine, one in grade eleven, and one being designated as special.' It will also be noted that I.Q. scores are given in Table XI al- though the hypotheses of the study deal with mental age. The I.Q. scores are given to furnish an index of intellectual a- bility as they take into account the age of the subject, where- as a mental age score alone does not indicate such. TABLE XII RELATIONSHIP BETWEEN ASPECTS OF CEREBRAL PALSY, MENTAL AGE ' AND SELECTED CONCEPTUAL VARIABLES Spastic Affected Mental P.D.R. vs Non- Area (H. Variables Age (8) Spastic P.Q.) (7) No. of logical concepts .709 (l) .176 (2) -.455 (5) .476 (5) Speech and language disability (n=15) -.556 (2) -.197 (2) x.s. (4) .272 (6) Mean time (Seconds) .090 (1) .255 (2) -.547 (5) .457 (5) Degree of dimen- . sionality .222 (1) -.095 (2) .194 (5) .161 (5) No. of illogical concepts -.544 (l) -.l77 (2) .540 (5) .455 (5) No. of repetitive concepts (N-27) .295 (l) .582 (2) -.545 (5) .415 (5) (l) Product-moment correlation (5) Contingency coefficient (2) Rank-order correlation (un- (6) Kruskal-Wallis H Test corrected for bias in rho) (7) Hemiplegia, paraplegia, (5) Point-biserial correlation quadriplegia (4) White's T test (8) Physical disability rating 49 Table XII gives the statistical relationship between the measures of concept formation and speech and language disability when contrasted against mental age, degree of ' physical disability and kind of cerebral palsy. It will be noted that the kind of statistic applied for each of the re- lationships is indicated. TABLE XIII SIGNIFICANCE OF LEVEL OF RELATIONSHIP BETWEEN ASPECTS OF CEREBRAL PALSY, MENTAL AGE AND SELECTED CONCEPTUAL VARIABLES W m:— Spastic Affected Mental PeDeRe V8 Non“ Area- (Hope Variables Age (1) Spastic Q.) (2) No. of logical ' concepts .01 N.S. .05 .02 (5) Speech and Lang- uage disability (N315) N.S. N.S. N.S. N.S. lean Time (Seconds) N.S. N.S. .05 .02 (4) Degree of Dimen- sionality N.S. N.S. N.S. N.S. No. of illOgical concepts .01 N.S. N.S. .02 (5) No. of repetitive concepts (N'Z?) N.Se N.S. e01 NeSe (1) Physical disability rating (2) Hemiplegia, Paraplegia, Quadriplegia (5) P more than H more than Q (4) Q more than H more than P (5) H more than P more than Q Table XIII gives the results of the null hypotheses test which assumes that the correlation will be zero. The corre- 5O lations between number of logical concepts and mental age as well as the number of illOgical concepts and mental age is significant at the l per cent level. Kind of cerebral palsy, as expressed by spasticity vs non-spasticity was related to the number of lOgical concepts produced at the 5 per cent level and to the number of repetitive concepts produced at the 1 per cent level. Affected topOgraphical area (hemiplegia, paraplegia, quadriplegia) was related to the number of logical concepts at the 2 per cent level, to mean time per concept at the 2 per cent level and to the number of illogical concepts at the 2 per cent level. The degree of physical disability was not statistically related to any of the aspects of concept formation as was stated in hypothesis one in chapter three. TABLE XIV RELATIONSHIP BETWEEN MENTAL AGE, PHYSICAI.DISABILITY RATING AND SELECTED CONCEPTUAL VARIABLES WITH RESULTING "t" SCORES AND LEVELS OF SIGNIFICANCE OF DIFFERENCE L ‘— r T Signifi- Mental P.D.R. t Variables Age (2) Score L9333°° No. of lOgical gooncepts .709 .18 (l) 2.82 .01 Speech and language disability (N‘15) -.57 (1) -.20 (l) .445 N.S. lean Time (Seconds) .090 .24 (l) -.551 N.S. Degree of Dimen- sionality .222 .10 (l) 1.18 N.S. No. of illogical concepts -.544 -.18 (l) -1.59 N.S. No. of repetitive concepts (N927) .295 -.40 (l) -.599 N.S. (1) Corrected for bias in rho (2) Physical disability ratng 51 Table XIV employs the "t" test for the significance of a difference between mental age and physical disability rating when compared against aspects of concept formation and speech and language disability. The table reveals that the number of logical concepts produced was related more to mental age than it was to physical disability at the 1 per cent level. None of the other aspects of concept formation were related signifi- cantly more to mental age than to physical disability. TABLE XV RELATIONSHIP BETWEEN MENTAL AGE, KIND OF CEREBRAL PALSY AND SELECTED CONCEPTUAL VARIABLES WITH RESULTING "t" SCORES AND LEVELS OF SIGNIFICANCE OF DIFFERENCE t‘ k ‘__.__ t J S astic Si nifi- Mental VB N-SpaS. t fiance Variables A89 (5) Score Level No. of logical concepts .709 -.455 6.67 (l) .01 Speech and Language ‘ , Disability (N-is) .37 N.S. (4) -— -- Kean Time (Seconds) .090 -.547 -.907 N.S. Degree of Dimen- sionality .222 .194 .096 N.S. No. of Illogical concepts -.544 .540 -4.94 (2) .01 No. ofoepetitive Concepts (N=27) e293 "e545 4e34 (3) .01 (1) If signs were disregarded t would be 1.45 (N.S.). (2) If signs were disregarded t would be 1.15 (N.S.). (5) If signs were disregarded t would be -l.51 (N.S.). (4) Used White's T test. Cannot make a "t" test on unlike statistics. (5) Kind of cerebral palsy. 52 Table XV indicates the statistical relationship between mental age and kind of cerebral palsy (spastic vs non-spastic) when contrasted against aspects of concept formation and speech and language disability. The ”t" test was used to test the significance of the differences. The table shows three significant differences. The number of logical, illOgical and repetitive concepts produced was related more to mental age than to spasticity vs non-spasticity at the l per cent level. However, if signs are disregarded they are not signifi- cantly different. The relationship between mental age and number of illegical concepts was numerically higher than be- tween spastic vs non-spastic and number of illogical concepts. The relationship between mental age and number of repetitive concepts was numerically lower than that between spastic vs non-spastic and number of repetitive concepts. Correlations'were also obtained between mental age and the following variables: 1. Degree of physical disability («.072). 2. Spasticity vs non-spasticity (-.505). 5. Affected topographical area (.106). In other words, as mental age increased physical dis- ability and spasticity decreased. Table XVI employs the "t" test for the significance of a difference between mental age, kind of cerebral palsy (topo- graphical area) as contrasted against aspects of concept for- mation and speech and language disability. The table reveals that neither mental age nor kind of cerebral palsy, as indi- 53 cated by affected topographical area of the body, was signi- ficantly related more than the other to concept formation. TABLE XVI RELATIONSHIP BET‘.‘. EN MENTAL AGE, KIND OF CEREBRAL PALSY AND SELECTED CONCEPTUAL VARIABLES WITH RESULTING "t" SCORES AND LEVELS OF SIGNIFICANCE OF DIFFERENCE A Togograph- Signifi- Mental cal Area t canoe Variables Age (1) Score Level No. of legical Concepts .709 .476 1.57 N.S. Speech.and Language Disability (N=15) -.57 .272 .200 N.S. Mean Time (Seconds) .090 .457 -l.61 N.S. Degree of Dimen- sionality .222 .161 .249 N.S. No. of Illogical Concepts ’e544 . e455 0553 Nose No. ofoepetitive Concepts (N=27) .295 .415 -.511 N.S. (1) Kind of cerebral palsy The analysis of Tables XVII and XVIII demands some ex- planation as to how the information was obtained since the data reported by Coleman (5) are not directly comparable to that of the present study. Since the present study desires to make comparisons to his study, an effort was made to com- pare both the means and the variances of the two studies. The mean scores were compared by the "t" test. Since the "t" test assumes that the variances of the two groups are the same, an F test was applied to these two measures. 54 TABLE XVII LEVEL OF SIGNIFICANCE OF DIFFERENCE BETWEEN THE MEANS OF THE NORMAL AND CEREBRAL PALSIED GROUPS ON SELECTED VARIABLES -— m— -_—L_ Signifi- 3! Means t cance Variables Normal Palsied Score Level Mental Age (Months) 125.15 101.55 2.68 .05 No. of Legical Con- cepts 5.05 1.85 5.96 .01 Mean Time (Seconds) 577.91 167.67 8.78 .01 No. of Non-functional Concepts 4.51 4.81 -5.51 .01 No. of uni-dimension- al Concepts 1.61 1.10 2.91 .01 No. of bi-dimensional Concepts 1.42 .75 4.57 .01 TABLE XVIII LEVEL OF SIGNIFICANCE OF DIFFERENCE BETWEEN THE VARIANCE OF THE NORMAL AND CEREBRAL PALSIED GROUPS ON SELECTED VARIABLES *— Standard _ Signifi- Deviations p cance Variables Normal Palsied Score Level Mental Age (Months) -- 47.95 -- -- No. of Logical Con- cepts 1.18 1.60 1.885 .01 Mean Time (Seconds) 244.00 72.02 11.258 .01 No. of Non-functional Concepts 1.61 .41 15.104 .01 No. of Uni-dimension- al Concepts .88 1.02 1.578 N.S. No. of Bi-dimensional Concepts 065 e81 1e592 e05 55 In the one case where the null hypothesis, as to the equality of the standard deviations of the two groups, was accepted, the usual F test (9:255 - formula 15.9) was ap- plied. In the cases where the preceding null hypothesis was rejected a "t" test, (9:255 - formula 15.7) which does not make the assumption of equal variances, was used. In one case, mental age, no estimate of the variance in the control group (Coleman's) was available. Consequently, a weaker hypothesis was used: that a group with the mean of the normal group could have been drawn from the cerebral palsied population. The estimates of the means and variances in the normal group were obtained as follows: Means 3 (50 times mean of seven year olds plus 50 times mean of nine year olds plus 50 times mean of eleven year olds) divided by 150. Variances = 50 times 8 squared for seven year olds plus 50 times S squared for nine year olds plus 50 times S squared for eleven year olds plus the sum of (group mean of seven year olds squared plus group mean of nine year olds squared plus group mean of eleven year olds squared) minus the (total of the three means) squared and di- vided by the number of groups. (5) All of the foregoing divided by N(150). 56 For the means, the data were treated as though all seven year olds were at the mean for the seven year olds, all nine year olds at the mean for nine year olds, and the same idea for the eleven year olds. This should yield the same value as if the original data were used. In obtaining the variance, use was made of the theorem that states: the total sum of squares, equals the within groups sum of squares, plus the among groups sum of squares. Analysis of Table XVII reveals there is a statistically significant difference between the normal and cerebral palsied group on the means of all the variables: mental age, number of lOgical concepts produced, mean time per concept, number of non-functional concepts, number of uni-dimensional concepts, and number of bi-dimensional concepts. They were all signi- ficantly different at the 1 per cent level except mental age which was significant at the 5 per cent level. In other words, the cerebral palsied group was of lower mental age, produced fewer legical concepts, took less time per concept (factor of disinhibition and forced responsiveness to stimuli), produced more non-functional concepts, a fewer number of uni-dimensional concepts, and lesser number of bi- dimensional concepts. All of these mean differences were of statistical significance. Table XVIII contains the F scores and significance levels between the amount of variance in the normal and cerebral pal- sied group on the variables of number of legical concepts, mean time per concept, number of non-functional concepts, num- 57 ber of uni-dimensional concepts, and the number of bi-dimen- sional concepts. It will be noted that no test could be made on the vari- ance of mental age, as the variance for the nOrmal group could not be ascertained from Coleman's data. The cerebral palsied group was more variable on the number of logical and.bi-dimen- sional concepts achieved and less variable on mean time per concept and on the number of non-functional concepts produced: all these variances being at a statistically significant level. TABLE XIX DISTRIBUTION OF I.Q. SCORES IN NORMAL CHILD POPULATION AND IN CEREBRAL PALSIED SAMPLE -..—....“— .... ..m—......_‘ . Per cent I.Q. Normamild CerebraI Palsied Classification Population Sample Below 50 -- 3 Below 70 5 50 70-89 22 50 90-109 52 16 110-129 22 16 150 up 1 5 Totals 100 98 Table XIX presents I.Q. scores in certain classifica- tions for the normal child pepulation and the cerebral palsied children of this study. Inspection of the table reveals that greater percentages of cerebral palsied children were in the lower 1.0. ranges, especially at the mentally defective level. 58 TABLE XX PER CENT OF CERTAIN GROUPS FALLING BELOW AN I.Q. SCORE OF 90 1.0. Group Per cent Below 90 Normal Child Papulation 25 Dolphin and Cruickshank (21) 47 Present Study 65 Cerebral Palsy Estimate (18) 75 Table XX compares the per cent of children falling below an I.Q. score of 90, the accepted lower limit of normal in- telligence. It will be noted that, for normal children, only 25 per cent will possess less than normal intelligence, 47 per cent of Dolphin and Cruickshank's (9) cerebral palsied chil- dren were below average intelligence, and 65 per cent of the children in the present study were below average intelligence. It is estimated (18) that 75 per cent of children in the total cerebral palsied pepulation will be below average. This comparison indicates that the present cerebral pal- sied sample more nearly represents the cerebral palsied pOpu- lation than did Dolphin and Cruickshank's study. The differ- ence between the percentages in the present study and Hohman's estimate for the cerebral palsied population was largely in the two tails of the I.Q. distribution. Hohman indicated only 5 per cent above an I.Q. of 110, the present study had 19 per cent above this level. Hohman further indicated 75 per cent below average intelligence and the present study had 65 per 59 cent below average. This was accounted for by the nature of the sample. All the children in the present study were pub- lic school children. The cerebral palsied children of ex- tremely low intelligence were not in public schools; being either at home or in some type of custodial situation. The clinical evidence in the field of cerebral palsy also indicates that, as a class, the higher I.Q. levels are also less physically handicapped. Since Hohman's sample was drawn from hospital cases, he obtained less cases from the higher in- tellectual ranges. Further, since the lower range of intelli- gence was excluded from the sample of cerebral palsied school children, the percentage value of the cases in the upper ranges assumed higher numerical value. CHAPTER V SUMMARY, CONCLUSIONS AND RECOMMENDATIONS The purpose of this study was to investigate the rela- tionship between conceptual ability, mental age, and degree and kind of disability in cerebral palsied school children. The study attempted to test the following hypotheses: 1. There is a positive relationship between mental age and the various aspects of conceptual functioning in cerebral palsied children. 2. Concept formation ability is more highly related to mental age than to kind of cerebral palsy or degree of disability. The sample for the study was composed of thirty cerebral palsied school children from the orthopedic classes of Lansing, Michigan. The ages of the subjects ranged from 4.6 to 20.1 with a mean of 10.5 and a standard deviation of 5.10 while the mental ages of the subjects ranged from 2.8 to 17.1 with a mean of 8.44 and a standard deviation of 5.92. The sample was composed of sixteen boys and fourteen girls. It was also com- posed of 76 per cent spastics versus 24 per cent non-spastics, 45 per cent hemiplegia, 16 per cent paraplegia, and 40 per cent quadriplegia. The Stanford-Binet was used as the mental age criterion. It was judged to be a satisfactory measure of mental age in 61 the cases of this study. The Columbia Mental Maturity Scale was administered to twenty-four of the thirty subjects with a resulting correlation of .886 between the two measures. The following measures were secured on the subjects: 1. 2. 5. 4. 5. 6. 7. 8. 9. Medical diagnoses Mental age Physical disability ranking Number of legical concepts Mean time per concept Degree of dimensionality Number of illOgical concepts Number of repetitive concepts (N'27) Speech and language disability rating (N015) The analysis of the results revealed the following re- lationships to be statistically different from zero: 1. 3. 4. 5. The number of lOgical concepts produced was posi- tively related to mental age at the l per cent level. The number of illogical concepts produced was nega- tively related to mental age at the l per cent level. The number of logical concepts produced was nega- tively related to spasticity versus non-spasticity at the 5 per cent level. The mean time necessary to produce a concept was ne- gatively related to spasticity versus non-spasticity at the 5 per cent level. The number of repetitive concepts produced was nega- tively related to spasticity versus non-spasticity at the 1 per cent level. 6. 7. 8. 62 The number of lOgical concepts produced was positive- ly related to affected topOgraphical area at the 2 per cent level. The mean time necessary to produce a concept was positively related to affected topographical area at the 2 per cent level. The number of illegical concepts produced was posi- tively related to affected topOgraphical area at the 2 per cent level. The significance of the difference of the previous eight relationships was investigated with the use of the "t" test. The following significant differences were obtained: 1. 2. The number of legical concepts produced was related more to mental age than to physical disability at the 1 per cent level: as mental age increased so did the number of logical concepts, the correlation being .709. As physical disability rank increased (becoming less severe) so did the number of legical concepts. The number of legical concepts produced was related more to mental age than spasticity versus non-spasti- city at the l per cent level: as mental age increa- sed, the number of logical concepts produced in- creased but as spasticity versus non-spasticity in- creased, the number of logical concepts produced de- creased. 65 5. The number of illOgical concepts produced was re- lated more to mental age than to spasticity versus non-spasticity: as mental age increased the number of illogical concepts decreased and as spasticity versus non-spasticity increased the number of illogi- cal concepts increased. 4. The number of repetitive concepts was related more to mental age than to spasticity versus non-spasticity at the 1 per cent level: as mental age increased so did the number of repetitive concepts (correlation is low but positive) but as spasticity versus non- spasticity increased the number of repetitive con- cepts decreased. It will be noted in point number three above that, as spasticity versus non-spasticity increased, the number of illegical concepts increased. Thus, illogical responses were more characteristic of spasticity than were repetitive reaponses. The following results were obtained when the means and variances of the thirty cerebral palsied and Coleman's (5) 150 normal subjects were tested for significance of differ- ences by the "t” and F tests. Means - "t" test: 1. The cerebral palsied had a lower mean mental age. (5 per cent level) 2. The cerebral palsied produced less logical concepts. (1 per cent level) 5. 4. 6. 64 The cerebral palsied took less time per concept. (1 per cent level) The cerebral palsied produced more non-functional concepts. (1 per cent level) The cerebral palsied produced fewer uni-dimensional concepts. (1 per cent level) The cerebral palsied produced fewer bi-dimensional concepts. (1 per cent level) Variances - F test: 1. 2. The cerebral palsied were more variable in number of lOgical concepts produced. (1 per cent level) The cerebral palsied were less variable in mean time per concept. (1 per cent level) The cerebral palsied were less variable in number of non-functional concepts produced. (1 per cent level) The cerebral palsied were more variable in number of bi-dimensional concepts produced. (5 per cent level) conclusions. The data appear to justify the following conclusions, subject to the limitations of this study: 1. Mental age was a significantly better predictor of concept formation ability than was degree of physi- cal disability, or kind of cerebral palsy as repre- sented by spasticity versus non-spasticity. The affected topOgraphical area of the body was not 5. 65 significantly related to concept formation ability. The correlation between mental age and number of logical concepts produced was .709 whereas the cor— relation between mental age and degree of physical disability was -.072. Thus, for practical purposes, the correlation was zero between physical disability and mental age but relatively high between mental age and conceptualization. IllOgical conceptual responses were more character- istic of the spastic versus the non—spastic than were repetitive responses. The correlation between illogical concepts produced and spasticity versus non- spasticity was positive while the correlation between repetitive responses and spasticity versus non-spas- ticity was negative. Thus, as spasticity increased the number of illegical concepts increased, but as spasticity increased the number of repetitive con- cepts decreased. Normal children were significantly superior to cere- bral palsied children in all aspects of concept for- mation ability. The differences in the ten groups were significantly different on the means and vari- ances of all the conceptual variables. The normal group produced more logical, uni-dimensional, and bi-dimensional concepts, less non-functional concepts, and took less time to work on each concept than did the cerebral palsied group. 66 4. The cerebral palsied group was significantly more variable than the normal on the number of logical and bi-dimensional concepts achieved and less vari- able on mean time per concept and on the number of non-functional concepts produced. Thus, the cere- bral palsied group was more variable on the "higher” or more abstract aspects of conceptualization; i.e., number of logical and bi-dimensional concepts achie- ved, and less variable on the "lower" or less abstr- act aspects of conceptualization; i.e. time per con- cept and number of non-functional concepts produced. Thus, hypotheses 1 (a), 1 (b), 5 (b) and 6 (b) in Chapter III were proved. All of the hypotheses were in the direction hypothesized except number three which concerned mean time per concept. The cerebral palsied took less time per concept than did the normal subjects. RECOMMENDATIONS AND IMPLICATIONS The results of this research have further confirmed some of the previous findings in conceptualization in the cerebral 'palsied. It adds to the literature the first investigation, of concept formation ability in cerebral palsied school chil- dren, that has utilized a rather direct and culture-free con- ceptual test. Recommendations. The following general recommendations are offered for further research: l. 2. 5. 67 This study should be duplicated on a larger sample as a check on the results and conclusions offered above. Future studies in concept formation in cerebral palsied children should attempt to sample the cere- bral palsy population in preportionate percentages of each I.Q. classification as well as the percen- tages in each medical diagnostic category. In studies of conceptualization, the spastic versus the non-spastic should be treated separately in sta- tistical analysis. Implications. The results of this study pose several implications concerning conceptualization in cerebral pal- sied school children. 1. The intellectual testing of the cerebral palsied is of extreme importance in their educational planning. Since the most significant finding of the entire study was the relationship between mental age and the num- ber of logical concepts produced, rather than in re- 1ation to degree or kind of cerebral palsy, it is more important in educational planning to know the child's mental ability than it is to know how ser- iously he is disabled. The conceptual abilities of the spastic cerebral palsied were more impaired than the non-spastic. This finding has many implications for the educa- tion of the spastic cerebral palsied. They will 4. 68 need more specialized teaching methods that will help them develop abilities in generalization and abstraction. The cerebral palsied were more distractable than normal children. They reacted in an impulsive, dua- inhibited fashion, being unable to exhibit deliber- ate and controlled ideation which would result in "good" organization of incoming stimuli. This means their learning environment must be relatively free of distracting events and that they should not be expected to respond to several competing stimulus objects at the same time. The study implied that illOgical ideational behavior may be more characteristic of cerebral palsied than perseverative behavior. The literature on brain- damaged children in general has emphasized the pre- valence of perseverative ideation. 1. 2. 5. 5. 6. 7. 8. 9. SELECTED BIBLIOGRAPHY Bice, H. W., ”Two Steps Toward Improvement of Psycholog- ical Services for the Cerebral Palsied,” American Journal of Mental Deficiency, 54: 212-217, 1949. Burgemeister, B. B., Blum, L. H., and Large, 1., Colum- bia Mental Maturity Test and Manual, Yonkers on 'Efidson: World Book Company, 1954. Coleman, L., "An Investigation of the Relationship Be- tween Categorizing Behavior and Intelligence In School Children," Unpublished Doctor's Disser- tation, Michigan State College, East Lansing, Michigan, 1955. Cottom, C. A., "A Study of the Reactions of Spastic Children to Certain Test Situations," Journal of Genetic Psychology, 57: 27, cont., 1941. Crowell, D. E., Crowell, Doris 0., "Intelligence Test Reliability for Cerebral Palsied Children,” Jour- nal of Counseling PsycholOgy, 18: 276, cont., 1954. Cruickshank, W. M., Raus, G. M., Cerebral Palsy, Its Individual and Community Problems, Syracuse Uni- versity Press, 1955. Denhoff, E., "Needs in the Field of Psychologic Apprai- sal of Children With Cerebral Palsy," New England Journal of Medicine, 245: 524-527, reprint 1-10, 1950. Doll, E. A., "Mental Evaluation of Children With Cere- bral Palsy," Crippled Child, 50: (1), 67, cont., 1952. Dolphin, Jane E., Cruickshank, W. M., "PatholOgy of Concept Formation in Children With Cerebral Palsy," American Journal of Mental Deficiency, 56: (2), 586-592, 1951. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 70 Edwards, A. L., Statistical Methods for the Behavioral Sciences, New York: Rinehart and Co., 1954. Fay, Temple, "Cerebral Palsy, Medical Considerations and Classification," The American Journal of Psychiatry, 107: 1804183, 1950. Fay, Temple, "Desperately Needed Research in Cerebral Palsy," Cerebral Palsy Review, 14: (5-4), 4, ll, 13, 15, 1953. Garrett, J. E., (Ed.), Psychological Aspects of Physi— cal Disability, Washington, D.C., U. S. Govern- ment Printing Office, 1952. Goldstein, K., The Organism, New'York: American Book 000’ 1939. Halstead, W. 0., "Preliminary Analysis of Grouping Bea havior of Patients With Cerebral Injury by the Method of Equivalent and Non-Equivalent Stimuli," American Journal of Psychiatry, 96: 1265, cont., I945. Heilman, Ann, "Intelligence in Cerebral Palsy, ... A New Interpretation of Research Studies," Crip- _pled Child, 30: (2) 11-13, 28, 1952. Hill, A. 8., "Cerebral Palsy, Mental Deficiency and Terminology," American Journal of Mental Defici- ency, 59: 587-594, 1955. Hohman, L. B., ”Intelligence Levels in Cerebral Palsied Children," American Journal of Physical Medicine, 32: 282-290, 1953. Holden, R. E., ”A Review of Psychological Studies in Cerebral Palsy; 1947 to 1952," American Journal of Mental Deficiency, 57: 92-99, 1952. Holden, R. E., "Improved Methods in Testing Cerebral Palsied Children," American Journal of Mental Deficiency, 56: 549-555, 1951. 21. 22. 23. 24. 25. 26. 27. 28. 29. 50. 51. 71 Joint Committee to Study the Problem of Cerebral Palsy, "Report to the Legislature of the State of New York," Legislative Document No. 55, Albany, New 'YQrk, 1949. Katz, Elias, “Can The Mental Ability of the Cerebral Palsied be Measured," California Journal of Edu- cational Research, 6: 5-8, 1955. Katz, Elias, "Success on Stanford-Binet Intelligence Scale Test Items of Children With Cerebral Palsy as Compared With Non-Handicapped Children," Cerebral Palsy Review, 16: (1), 18-19, 1955. Linck, L. J., National Society for Crippled Children and Adults, Bulletin, Oct. 50, 1947. Little, W. J., "On the Influence of Abnormal Perturi- tion, Difficult Labors, Premature Birth, and Asphyia Neonatorum, On the Mental and Physical Condition of the Child Especially in Relation to Deformities," Transactions of the Obstetrical Society of London, 15: 1861. McGaughran, L. 3., "Predicting Language Behavior From Object Sorting," JOurnal of Abnormal and Social Psych010gy, 49: 185-195, 1954. Perlstein, M. A., "Infantile Cerebral Palsy: Classifi- cation and Clinical Correlations," Journal of the American Medical Association, 149: 50-54, 1952. Phelps, W. M., "General Management of the Cerebral Pal- sied Problem,” Cerebral Palsy Review, 15: (11), 3-4, 9, 1952. Phelps, W. M., "Recent Trends in Cerebral Palsy,“ Archives of Physical Therapy, 25: 252, cont., 1942.. Pohl, J. E., Cerebral Palsy, Saint Paul: Bruce Pub- lishing Company, 1950. Precker, J. A., "Toward a Theoretical Brain - Model," Journal of Personality, 22: 510-525, 1954. 52. 55. 54. 55. 56. 57. 58. 59. 40. 41. 72 Richardson, Elizabeth J., Kobler, F. J., "Testing the Cerebral Palsy Child," Exceptional Child, 21: 101-109, 1954. Sarason, S. B., Psychological Problems In Mental De- ficiency, New'York: Harper and Brothers, 1955. Shapiro, M. B., "An Experimental Investigation of the Block Design Rotation Effect: An Analysis of the Psychological Effect of Brain Damage," British Journal of Medical Psychology, 27: 84-88, 1954. Strauss, A. A., Kephardt, N. C., Psychopathology and Education of the Brain-Injured Child, II: New York: Grune and Stratton, 1955. Strauss, A. A., Lehtinen, L. E., PsychopathOIOgy and Education of the Brain-Injured Child, New York: Grune and Stratton, 1947. Strauss, A. A., Schuessler, Karl, "Socialization, LOgical Reasoning, and Concept DevelOpment In the Child," American Sociological Review, 16: 514-525, 1951. Strauss, A. A., Werner, B., "Disorders 0f Conceptual Thinking in the Brain-Injured Child," Journal of Nervous and Mental Diseases, 96: 155-172, 1942. Strauss, A. A., Werner, 3“ "Experimental Analysis of the Clinical Syndrom. Perseverations" in Mentally Retarded Children," American JOurnal of Mental Deficiency, 47: 185, cont., 1942. Strauss, A. A., Werner, B., "The Mental Organization of the Brain-Injured Mentally Defective Child," American Journal of Psychiatry, 97: 1194, cont., 1941. Strother, C. R., "Evaluating Intelligence of Children Handicapped by Cerebral Palsy," Crippled Child, 25: 82-85, 1949. 42. 45. 44. 45. 46. 47. 48. 75 Symposium, Psychological Problems of Cerebral Palsy, National Society for Crippled Children and Adults,.l952. Terman, L. M., Merrill, Maude A., Measuring Intelli- gence, New York: Houghton Mifflin Co., 1957. Vinacke, W. E., "Concept Formation in Children of School Ages," Education, 74: 527-554, 1954. Walker, Helen M., Lev, J., Statistical Inference, New York: Henry Holt and Co., 1955. Wechsler, D., Th91Measurement of Adult Intelligence, Baltimore: Williams and Wilkins, 1944. Weider, Arthur, Contributions Toward Medical Psychol: _3gy: Theory and Psychodiagnostic Methods, New York: Ronald Press, 2 vols., 1955. Yates, A. J., ”The Validity of Some Psychological Tests of Brain.Damage," PsycholOgical Bulletin, 51: 359-379, 1954. APPENDIX 75 APPENDIX DIRECTIONS FOR ADMINISTRATION OF THE CONCEPT FORMATION TEST The blocks are scattered randomly in both color and shape before the subject. Do you know what color this is? (Show large red triangle.) And What color this is? (Show medium yellow circle.) And this? (Show small green square.) I want you to put these pieces into different piles so that all of the pieces in each pile are the same or belong together. Ybu may do this any way that you like, but be sure that all of the pieces in each pile are the same as each other in some way. ‘Use all of the pieces. These same directions may be repeated if the subject does not understand, or if he fails to respond. After the first concept is achieved, regardless of kind or quality, say: That's very good. Now tell me why you put the pieces into those piles. What about each of the piles is the same? Why are all of the pieces in each pile the same? This procedure is used after each concept and the re- sponse is to be written as verbatim as possible. After the first concept is achieved, and the reason for such is obtained, the pieces are again scattered randomly. That was very good. Now I want you to put the pieces into piles again, but this time make the pieces belong together in a different way; make the pieces in each pile the same but in a different way than you did it before. These directions are repeated if the subject produces 76 the second concept, and they are used as long as the subject continues to produce a new concept. As soon as he repeats, cannot respond after a reasonable length of time, or pro- duces an illegical concept, then Hint I is presented. If a concept is forthcoming, then the above directions are re- peated until the subject cannot respond, and Hint II is pre- sented. This is continued until either six concepts have been achieved or all the hints have been presented. If the subject fails to produce a concept with the a- bove directions: Last time you put all of the pieces of the same color (or appropriate sort) in one pile, and all of another color {or appropriate sort) in another pile. This time I want you to put the pieces into piles so that the pieces are alike in another way. Repetition of the directions and hints are presented as described above. Hint I: Place src,1 mgs, and lyt in a row in front of the subject. Place pieces six inches apart on this and sub- sequent hints also. Put all of the pieces into piles like this. Remember, all of the pieces in one pile should be the same, but don't make them the same as you did the last times. Hint II: If the first concept was color, or color and shape, place lgt, mgs, sgc in front of subject. 1 The designation “arc" means small red circle. The first letter refers to size, the second letter to color, and the last to the shape. 77 Put them into piles like this. Use all of them. If the first concept was shape, or shape and size, place lys, mgs, srs in front of subject. Put them into piles like this. Use all of them. If the first concept was size, place 1rt, lyc, lgs in front of subject. Put them into piles like this. Use all of them. Hint III: If the first two concepts were color and shape, or combinations of these, place lgs, mgs, sgs in front of subject. Put the pieces into piles like this. Although you can put them into three piles, you can also put them into more than three piles. Use all of them. If the first two concepts were color and size, or com- binations of these, place sgt, sgc, sgs in front of subject and repeat directions. If the first two concepts were size and shape, or com- binations of these, place lgt, lyt, 1rt in front of subject and repeat directions. When all of the directions have been presented and/or the hints have been exhausted, and the maximum number of concepts has not been produced, a final set of general di- rections is presented: Now let's try it once more. Put the pieces into dif- ferent piles so that all of the pieces in each pile are the same or belong tOgether in some way. Remem- ber, make them belong tOgether in a different way than all the other times you have done it. . . to" \ 0.1 53.2 fat-ELY 93 03142 3753 \llll‘llfllwwHI(HIHIIHIIIIHIIUlllllllHlllHWWI