‘\ ‘I/aggxzwflmgg/Uflgyyflwiwmm “L to SE .4, 4 an; -~“ .v. ~ W "' 3" j ‘\ a ’ ‘ . , | .1 at‘fyt'. .1 m“ I. ‘3 ‘ " ‘ 9 “, I I PLACE ll RETURN Boxwmnwomhchockomflom yourncord. ' TO A ID FINES mum on or bdoro duo duo. " DATE DUE DATE DUE DATE DUE L__J Didi w lAnNfinnaflvoAction/EMO pponunny Mlm SOCIOCULTURAL FACTORS IN CHILDREN'S EMOTIONAL DISORDERS by Virginia Hituheock Pinner A PROJECT REPORT Submitted to the School of Social Work Michigan State University of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of MASTER OF SOCIAL WORK June 1957 Approved: . \- “‘Director of School - 38051:! ACKNOWLEDGMENTS To those who have guided and helped me with this research I owe a debt of profound gratitude. My sincere thanks go to my research committee; Professor Gordon Aldridge, Chairman, for encouraging me in this undertaking and giving me the benefit of his ideas; Professor Bernard Ross, for his thoughtful criticism; and Mr. Manfred Lilliefors for his careful examination of the data and his many pertinent suggestions I wish to express appreciation to the Staff of the Lansing Child Guidance Clinic, especially to Dr. Helen Lanting, Director, for permission to use the records of the Clinic and for her continuing interest; Dr. Frederick Bell, Chief Psychologist, for discussing with me some of the basic problems of my research; and Miss Ruth Koehler, for letting me benefit from the true casework supervisor's understanding during the stressful period of data collection and report writing. Some of my friends have also contributed their advice and specialized information, especially Mrs. Mary Leichty and Mrs. Betty Levinson. Finally, I wish to thank my husband and daughter for continued patience throughout the project; my husband also for his sympathetic encouragement and useful advice. ii TABLE OF CONTENTS Page ACKNOWLEDGMENTS . . . . . . . . . . . . . . 11 LIST OF TABLES. . . . . . . . . . . . . . . iii Chapter I 0 INTRODUCTION 0 o o o o o o o o o o o 1 Related Research . . . . . . . . . . 4 The setting 0 O O O O O O O O O O 0 11- II 0 NIET‘I-{ODOLOGYO O O O O O O 0 O O O I O 1-24 Selection of Cases for Study . . . . . . 14 Collection of Data . . . . . . . . . 15 Preparation of the Schedule . . . . . . 16 III. ANALYSIS OF DATA . . . . . . . . . . . 23 Characteristics of Sample . . . . . 23 Parental Orientations and Emotional Disorders 30 Parental Orientations and Socio- cultural Factors . . . . . . . . 43 Socio- cultural Factors and Children' s Disturbances . . . . . 51 Other Factors Related to Parental Orientations and Children' s Disorders . . 57 Direct Effects of Socio—cultural Factors . . 67 IV. SUMMARY AND CONCLUSIONS. . . . . . APPENDIX. 0 O O O O O O I O O O BIBLIOGRAPHY . . . . . . . . . iii _LIST OF TABLES Table Page 1. Children's Emotional Disorders--C1assification I by Children's Emotional Disorders-- Classification II. . . . . . . . . . 19 2. Types of Children‘s Emotional Disorders by Syrnptoms O O O 0 0 O I O I O O O 0 20 Children's Age by Sex . . . . . . . . . 23 4. Occupation of Primary Breadwinner by Children ' S I'Q . o o o o o o o o o o 24 5. Mothers‘ Education by Fathers' Education. . . 25 6. Occupation of Primary Breadwinner by Number of Siblings. . . . . . . . . . . . 27 7. Occupation of Primary Breadwinner by Children's Sex. . . . . . . . . . . 27 8. Parents' Religious Preference by Number of Siblings. . . . . . . . . . . . . 28 9. Mothers' Orientations toward Children by Fathers' Orientations toward Children . . . 3O 10. Mothers' Orientations toward Children by Disorders--Classification I . . . . . . 33 ll. Fathers' Orientations toward Children by Disorders--Classification I . . . . . . 35 12. Mothers' Orientations toward Children by Disorders——Classification II . . . . . . 36 13. Fathers' Orientations toward Children by Disorders--Classification II . . . . . . 37 14. Mothers' Orientations toward Children by Severity of Disorders . . . . . . . . 40 iv Table 15. l6. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 29. 30. Page Fathers‘ Orientations toward Children by Severity of Disorders . . . . . . . . 42 Occupation of Primary Breadwinner by Mothers‘ _ Orientations toward Children . . . . . . 44 Occupation of Primary Breadwinner by Fathers‘ Orientations toward Children . . . . . . 45 Fathers‘ Occupation and Education by Mothers‘ Orientations toward Children . . . . . . 47 Fathers‘ Occupation and Education by Fathers‘ Orientations toward Children . . . . . . 48 Mothers‘ Employment Status by Mothers‘ Orientations toward Children . . . . . . 50 Parent? Religious Preference by Mothers‘ Orientations toward Children . . . . . . 50 Parents‘ Religious Preference by Fathers‘ Orientations toward Children . . . . . . 51 Occupation of Primary Breadwinner by Disorders—— Classification I . . . . . . . . . . 52 Occupation of Primary Breadwinner by Disorders-- Classification II. . . . . . . . . . 52 Occupation of Primary Breadwinner by Severity of Disorders . . . . . . . . . . . 53 Fathers‘ Occupation and Education by Disorders-- Classification I . . . . . . . . . . 55 Fathers‘ Occupation and Education by Disorders-- Classification 11. . . . . . . . . . 55 Fathers‘ Occupation and Education by Severity of Disorders . . . . . . . . . . . 56 Parents‘ Religious Preference by Disorders-- Classification I . . . . . . . . . . 57 Children‘s IQ by Mothers‘ Orientations toward Children . . . . . . . . . . 59 Table 31. 32. 33. 31+. 35. 36. 37. 38. 39. vi Children‘s IQ by Fathers‘ Orientations toward Children . . . . . . . . . . Children‘s Age by Mothers‘ Orientations toward Children . . . . . . . . . . Children‘s Age by Disorders--Classification I . Children‘s Age by Disorders--Classification II. Children's Sex by Fathers‘ Orientations toward Children . . . . . . . . . . Children‘s Sex by Disorders-—Classification I . Children‘s Sex by Disorders-—Classification II. Mothers' Employment Status by Disorders-- Classification I. . . . . . . . . . Occupation of Primary Breadwinner and Mothers‘ Orientations toward Children by Disorders-— Classification I. . . . . . . . . . Page 59 62 62 64 64 65 66 68 69 CHAPTER I INTRODUCTION Social work, as most professional endeavors, has been subject to trends of fashion. Even a casual obser- vation of the profession‘s history will reveal alternating emphases upon the socio-economic and the psychological aspects of those problems with which the social worker is concerned. For many years social work appeared to be primarily philanthropic in nature, concerned with the economic needs of the underprivileged. Environmental manipulation only, proved to be inadequate and the treatment of personality difficulties began to be seen as indicated in many sit- uations. Mary Richmond, the most articulate spokesman of the developing profession, in 1922 focused on both aspects of the problem with her comment that'"the develop- ment of personality through the conscious and comprehensive adjustment of social relationships, and within that field the worker is no more occupied with abnormalities in the individual than in the environment, is no more able to neglect one than the other.“1 lMary Richmond, What Is Social Casework (New York: Russell Sage Foundation, 1922), pp. 98—99. l 2 When psychoanalytic knowledge became available a few years later, the profession, therefore, was well pre- pared to receive it. In fact, there generally seemed a tendency to overemphasize the new approach, frequently to such point that consideration of social factors was almost totally neglected. During the past few years the trend has been toward rediscovering the'"socia1," combined with an attempt to integrate psychoanalytic factors into a social work approach. The behavioral sciences, through personality-in-culture research, have begun to furnish scientific data concerning the individual‘s use of his environment and the impact of culture upon his personality.2 This theory favors an approach which considers the "whole person in his total environment" and serves as a strong reminder that people do notinteract and develop personality disorders in a social vacuum. The need for integration of social and psychological data in social work appears now to be generally recognized by the profession. Perhaps the most comprehensive investi- gation to date--and that most pertinent to the development of our study--is that of Otto Pollak and collaborators. 2For example: Ralph Linton, The Cultural Background of Personality (New York: Appleton, 1945); Erik H. ErikSon, *Childhood and Society (New York: Norton, 1950); Abram Kardiner, The Psyghological Frontiers of Society (New York: Columbia University Press, 1945). 3 This was an attempt, supported by the Russell Sage Foun- dation, to integrate social and psychological data and principles within a psychoanalytically oriented child guidance clinic.3 Dr. Pollak‘s central hypothesis suggests that the diagnostic and therapeutic capabilities in a child guidance clinic would be substantially increased by the effective application of selected social science concepts and ap- proaches. During the first phase of the investigation, the hypothesis was found to be sufficiently plausible to warrant further exploration of these approaches in the diagnosis and treatment of cases assigned to a special therapeutic team. The material secured during a second phase seemed generally to support the hypothesis. As a result of this study Pollak and collaborators found themselves constrained to modify both sets of concepts, those from social science and those from psychoanalysis and to develop a situational- interactional approach. The present study is a modest attempt to investigate the effects of environmental conditions on children‘s em— otional disorders. The setting is a child guidance clinic in a medium sized midwestern community. The study is based ___—_ _._. _‘ 3Otto Pollak and Collaborators, Social Science and Psychotherapy for Children (New York: Russell Sage Foun— dation, 1952); and Integrating Sociological and Psychoana- lytic Concepts (New York: Russell Sage Foundation, 19567. “Pollak and Collaborators, Integrating Sociological and Psychoanalytic Concepts, op. cit., pp. v-vi. 4 on case records of children who were subjects of a diagnos— tic study by the clinic during the year 1956. Inasmuch as extensive behavioral data were not systematically recorded and are therefore not comparable on a case to case basis, the study is necessarily limited to a consideration of such demographic data as are usually included on the face sheet, and the psychiatric, psychological, and social findings of clinic personnel. Related Research Studies relevant to our project may be divided into three categories: (1) those concerned with the relation of parental orientations to emotional disorders; (2) those dealing with the effects of socio—cultural factors on paren- tal orientations; and (3) those relating children‘s dis- turbances to socio-cultural factors. Among the first group of studies is that by Shirley Law5 based on data obtained at the Child Study Center, Institute of the Pennsylvania Hospital, Philadelphia. Law compared two groups of children and their mothers; a clinic group of disturbed children and a group of normal nursery school children. She found that the mothers of both groups demonstrated a capacity for love and warmth for their children; at the same time, both experienced difficulties 5Shirley Law,‘"The Mother of the Hap y Child," Smith College Studies in Social Work, XXV, No. 1 October, 1954), pp. 1’270 5 of one sort or another with their children. However, the mothers of children in the clinic group were blocked and limited in their acceptance of the child, and seemed unsure of themselves. The mother of the'"happy child" seemed, by comparison, more able to see her child as an individual, to take pride in his growth and achievements, and to feel comfortable in her role as a mother. Using a group of much more severly disturbed children, 6 James McKeown made a study of the behavior of parents of schizophrenic, neurotic, and normal children. He found that the parents of the disturbed children were distinguished by '"demanding-antagonistic" behavior. The parents of the normal children were much more encouraging and much less '"demanding—antagonistic"; they were 1eSS'"superficial" and '"protective—indulgent" than the parents of disturbed children.7 A well-known study of the second type——re1ating parental orientations to socio-cultural variables--is that 6James McKeown, "The Behavior of Parents of Schizo- phrenic, Neurotic, and Normal Children," American Journal of Sociology, LVI, 1950, pp. 175-179. 7See also Melvin L. Kohn and John A. Clausen, '"Parental Authority Behavior and Schiz0phrenia," American Journal of Orthopsychiatry, XXVI, No. 2 (April, 15567,'297- 1313; Nathan W. AckermanfiTDisturbances of Mothering and Criteria for Treatment,‘ American Journal of Orthopsychiatry, XXXVI, No. 2 (April, 19567, 252-263. 6 8 by Allison Davis and Robert Havighurst. These two investi- gators found, in a large city, significant differences in child rearing practices between parents belonging to the middle and lower classes as well as between white and Negro parents; the same class differences in child rearing prac- tices were found among both the Negro and the white groups. Middle class parents were more rigorous in their training of children for feeding and cleanliness habits. They also expect their children to take responsibility for themselves earlier than lower class parents do. Middle class parents place their children under a stricter regimen, with more frustratiog of their impulses than do lower class parents° The child rearing differences found to exist between white and Negro families related chiefly to the particular seg— ments of behavior which received the most attention from the parents. Negroes were more permissive in feeding and weaning, but more rigorous in toilet training. A study of attitudes of middle class fathers (which however lacks any comparison with fathers from other social groups) was done by David F. Aberle and Kaspar D. Naegele.lO They found that most of the middle class fathers expected their sons to stay within their own occupational status 8Allison Davis and Robert J. Havighurst,'"Social Class and Color Differences in Child-Rearing," American Sociological Review, II, No. 6 (December, 1946), 698-710. 91bid., p. 710. 10David F. Aberle and Kaspar D. Naegele,'"Middle—Class Fathers ‘Occupational Role and Attitudes Toward Children," American Journal of Orthopsychiatry, XXII,No. 2 (April,l952) 366-378. 7 class. Accordingly, their primary interest was in the socialization of the children, particularly the sons. Almost all of the fathers were concerned with securing obedience and were annoyed at disobedience. However, marked differ- ences were shown to exist in the fathers‘ expectations regarding boys and girls. Nearly all fathers desired their sons to be responsible, to show initiative, to be competent and to be aggressive and capable of handling competition. While these qualities were not considered undesirable in girls, they were much less important, and the fathers appeared to be much more interested in the girls‘ generally '"nice" appearance and behavior. Among the studies of the third type--dealing with the relationship between emotional disorders and socio- cultural factors--that by August B. Hollingshead and Fred— erick C. Redlichll dealt with the interrelationship between mental illness and class structure. The authors discovered that, in the community under study, various types of mental illnesses were unequally distributed among social classes. It was found that there was in the lower classes, a higher incidence of mental illness than in the higher classes. The higher classes tended toward phychoneuroses, the lower classes toward psychoses; and the proportion of schizo- prenics was larger in the lower than in the higher classes. llAugust B. Hollingshead and Frederick C. Redlich, '"Social Stratification and Psychiatric Disorders,"Mental Health and Mental Disorder, ed. Arnold M. Rose (New‘YorE: W. W. Norton, 1955), pp. 123-135. 8 A similar study is that by Robert M. Frumkin,l2 who investigated the relationship between occupation and inci- dence of major mental disorders. The study showed a high rate of mental illness among low income, low prestige and low socio-economic status groups. First admissions to Ohio state mental hospitals during the year 1950 were used to compute the relevant indices. Frumkin further found that, among the lower occupational groups, the onset of mental illness was due primarily to sociogenic factors; in the up- per occupations, psychogenic factors were more frequently responsible for mental disorders. Sylvia Stevens,l3 in a study of child guidance in- take in Chicago, investigated the relationship between income strata and those symptoms which had led to the child‘s referral. "Acting out" children were found to be evenly distributed among three income groups, while withdrawn children were found most frequently in the upper socio- economic group. In a highly suggestive article, Arnold W. GreenlZ1L describes the neuroses typical of the male middle class child. Green thinks that the middle class boy is caught in 12Robert M. Frumkin, "Occupation and Major Mental Disorders," Mental Health and Mental Disorder, ed. Arnold M. Rose (New York: W. W. Norton, 1955), pp. 136-160. l3Sylvia Stevens, "An Ecological Study of Child Guidance Intake," Smith College Studies in Social Work, XXV, No. 1 (October, 19547, 73-84. l“Arnold w. Green, "The Middle-Class Male Child and Neurosis," American Sociological Review, II, No. 1 (February, 1946), 31-41. 9 a dilemma which prevents his forming an adequate self- concept. He must placate his parents by compliant behavior in the home; at the same time, aggressive, competitive, achievement-orientated behavior outside the home is also expected of him. This conflict results in '"personality absorption," a neurosis consisting in‘"slavish dependence on the parents."15 While the studies cited in the foregoing paragraphs suggest the existence of some relationships between the investigated variables, very little can be saidebout the precise nature of such relationships. Neither the concepts nor the types of cases used by the various researchers are sufficiently similar to permit the development of general- izations. The only proposition asserted repeatedly in several studies is that middle class parents exert greater pressure to make their children conform and reach a high level of achievement. This is sometimes thought to generate a particular kind of neurotic reaction on the part of the child, but the specific nature of such reactions is not described. Researchers dealing with the more severe types of disturbances fail to establish categories comparable to those applying to less disturbed patients; that is, there is very little Similarity between the classification 15See also Paul Barrabee and Otto Von Mering, "Ethnic Variations in Mental Stress in Families with Psychotic Children," Social Problems, October, 1953, pp. 48-53. 10 systems used to describe disorders of varying degrees of severity. Consequently, it is not possible to generalize from findings which relate types of psychotic disturbances to socio-cultural factors. In 1949, Jules Henryl6 called for'"cultura1 objecti- fication of the case history"; by this he meant that the analysis of case records should be approached in a manner which would minimize the culturally generated prejudices of the investigator. Such analyses would yield a deeper insight into the workings of our own culture and into the hazards to mental health present in our society. Henry is not alone in making such pleas. Yet, the studies of cultural factors in mental disorders are still few in number; they are often limited in scope, segmental in prob- lem formulation, and idiosyncratic in the researcher‘s choice of categories. Under these circumstances, it was not possible to formulate precise hypotheses to govern this research. Instead, two broad questions can be formulated: 1. Is parental orientation, that is, the behavior and attitudes of parents toward their children, an inter- vening variable mediating between broad socio—cultural variables and children‘s emotional disorders? Or does the 16Jules Henry, "Cultural Objectification of the Case History," American Journal of Orthopsyphiatry, XIX, No. 4 October, 1949), 655—673. 11 culture, as represented by the child‘s entire social environ- ment, directly generate the types of disorders found in children? 8 2. Are there invariant relationships between types of environmental factors of a socio—cultural nature and types of disorders? And if so, are there general societal factors which have the same effects as do certain types of parental orientations? In View of the limited nature of the data available for this study, no complete answer to such questions can be expected. The present study is exploratory in nature, and we can hope for no more than certain indications which might make further researches in this area more fruitful. The Setting This study was made at the Lansing Child Guidance Clinic, a joint state and local project serving four counties, Ingham, Clinton, Eaton, and Livingston. The clinic is supported by the State Department of Mental Health and such various local agencies as community chests, boards, of education, and boards of supervisors. The Clinic, originally known as the Lansing Children‘s Center, Incorporated, was established in 1938 by the Ingham County Council of Social Welfare. It later became a part of the state mental health program with the function of providing services to children who are suffering from emotional disturbances. These services are currently 12 divided into two components, the diagnostic study and clinical treatment. During the year 1956, in the total Clinic case load of 486 cases, 257 children received diag- nostic study only and 125 received treatment. After a child has been referred to the Clinic, a diagnostic study is made of his personality and total en- vironment. His parents, who are interviewed by a social worker, furnish information concerning the child‘s past history and present situation, including much material covering their own personalities and motiyations in their relationship with the child. The child is interviewed by the psychiatrist and given psychological tests by a psy- chologist. Both of these interviews attempt to assess the child‘s problems and his capacity to gain help through treatment. The various facets of information described above, plus any pertinent material furnished by other sources'such as the school or physician, are pooled at a staff conference at which time the staff evaluates the nature of the difficulty and determines whether clinic treatment is indicated for the child and his parents. When a child and his parents are accepted for treat- ment, each is seen for weekly appointments. The child is helped bothtp satisfy his needs in the therapeutic situation and to learn to satisfy these needs in more socially acceptable ways. Parents begin to recognize their own l3 feelings and the way these affect their relationship with the child. If treatment is successful they become able to modify their feelings to the benefit of both the child and themselves. CHAPTER II METHODOLOGY Selection of Cases for Study In order that the study might be relatively current, material was drawn from cases opened (or reopened) during the period January-December, 1956. A total of 328 cases was opened. A sample of approximately 150 cases had been planned as it was hoped that such a number would be large enough to produce statistically significant results--although it was realized that such a small number would place severe limitations on the reliability of information drawn from any complex cross tabulations-~and yet not be too large to be handled within the allotted time. A sample of alternate cases on a monthly basis was selected. Both new and re- opened cases were included in the sample if a diagnostic study had been requested during the year 1956. A total sample of 168 cases was selected. Of these, twenty-four were later rejected: six because of insufficient information due to parental failure to follow through to the completion of the diagnostic study. The remainder were children living outside their own homes so that information concerning parental social status and orientations toward the children was not available. Adoptive children and 14 15 children living in a home situation with a step parent were included in the study since we considered the adoptive parents and step parents to be playing the parental roles. The final sample consisted of 144 cases. Collection of Data The data for this study were secured from the case records of the Lansing Child Guidance Clinic. Ideally, it should have been possible to secure all designated infor- mation from two sources within the case record, the face sheet and the staff conference notes. The face sheet was expected to supply the demographic data and the staff con- ference notes the material concerning parental orientations and the children‘s disorders. However, these two primary sources were frequently so incomplete as to necessitate the use of additional sources, especially the intake interview, the psychiatric evaluation and the psychological report. In a number of cases however, some of the designated material, eSpecially that of demographic nature, was not recorded any place in the case record. Consequently, de- sired information on specific points often could not be obtained. For some tables presented in this study, there- fore, the number of cases dealing with relevant information may be considerably less than the total sample. The data were coded directly on schedules or code sheets designed for International Business Machines [IBM] l6 processing. Coded information was then punched on IBM cards and tabulated by means of a counter-sorter. Preparation of the Schedule The schedule included 16 different items of infor— mation relevant to the study. The first four of these were concerned with the descriptive factors of age, sex, intel- ligence quotientl and number of siblings. The age breaks used were thosecustomarily employed by the Clinic in its statistical reports. IQ was classified according to the Wechler Intelligence Scale. When the IQ was recorded descriptively, for example,'"dull normal," we coded it in the appropriate numerical category. The number of siblings category was divided into only child, one sibling, more than one sibling, as a more detailed classification did not appear indicated for purposes of this study. In classifying children‘s emotional disorders and parental orientations we have made every effort to adhere as closely as possible to the diagnoses and judgments of the clinicians and to avoid injecting our own evaluations. Only in a small number of cases in which the records did not directly refer to categories used in this study were we forced to interpret appropriately the language of the record. Classification of the children‘s emotional distur- bancesvas made originally in two different ways. The first consisted of the simple and frequently employed dichotomy lHereafter referred to as IQ. 17 of "acting out" in which the child‘s symptoms appear to center in socially unacceptable behavior and'"withdrawn" or personality reactions. However, as the schedule was tested we found that the behavior of some of the children seemed characterized by a combination of actingcnu3followed by a period of withdrawal. Since alternating acting out- withdrawn behavior seemed to occur when the child was more severely disturbed this characteristic was added as a third category. Also, a three point'"degree of severity" scale was added as a separate item. The degree of severity was deter- mined from material in the psychological report and the psychiatric evaluation. A child who seemed to be reacting to an unfavorable environment while remaining generally healthy was coded as "essentially healthy." Children whose grasp on reality appeared tenuous, either through with- drawal into fantasy or through inability to control their actions were coded as "severely disturbed." All of those cases in which hospitalization was recommended were coded as 3‘s. The number 2, or mid point included the majority of children whose behavior disturbances appeared primarily reactive. In order not to weight unduly the number 3 position on the scale, those children for whom hospital- ization was recommended because of defects due to organic injury or mental deficiency, were placed in separate code categories. 18 The second classification of emotional disturbances was based on the American Psychiatric Association classi- fication of primary behavior disorders: habit disturbances, 2 Habit distur- conduct disturbances and neurotic traits. bances include suchsymptomatic manifestations as thumb- sucking, nail biting, masturbation, enuresis, tantrums. Conduct disturbances include such anti-social acts as destructiveness, cruelty, disobedience, setting fires, stealing, etc. Neurotic traits, include such symptoms as stammering, overactivity and fears. Since we believed the majority of children to be referred to the Clinic because of either habit or conduct disturbances, these two cate- gories were employed as defined by the American Psychiatric Association. The category ‘"neurotic traits" however, was expanded, for purposes of this study to include additional nonsurface symptoms, for example, psychosomatic manifes- tations, and designated in the schedule as "nonsurface symptoms." Moreover, since we knew that many of the child— ren referred to the Clinic displayed more than one type of symptom, categories consisting of combinations of the above simple classifications were added. There was necessarily a great deal of overlap between the two classifications of children's emotional disorders. 2American Psychiatric Association, Diagnostic and Statistical Manual (Washington: American Psychiatric Association, Mental Hospital Service, 1952). 19 The extent of this overlap is shown in Table 1. TABLE 1 CHILDREN'S EMOTIONAL DISORDERS CLASSIFICATION I BY CHILDREN'S EMOTIONAL DISORDERS CLASSIFICATION II (in per cent) Disorders-Class I Acting Out Disorders-Class II Total* Asting ' dWith' Withdrawn (N=l34) (NE62) (gfiwg) Alternating ‘ “5 (N=20) Nonsurface 7 2 15 O Habit 6 3 11 0 Conduct 7 16 O O Nonsurface and habit 24 5 58 O Habit and conduct 24 37 4 35 Nonsurface and conduct 21 26 8 4O Nonsurface, habit, conduct 10 11 4 20 Not ascertained** l O O 5 Total 100 . 100 100 100 *Seven defective children and three whose disorders were not ascertained have been omitted from this table. **Hereafter referred to as N. A. '"acting out" According to these data, children described as most frequently have a combination of habit and conduct disturbances and, in order of decreasing frequency, com- binations of nonsurface and conduct disorders or conduct disturbances alone. Children described aS'"withdrawn" have mostly a combination of nonsurface and habit disturbances, 20 and much less frequently nonsurface or habit disturbances alone. The observations yield some insight into the meaning of "withdrawn" and "acting out" in terms of somewhat more concrete symptom complexes. The decisive element in the clinician‘s decision to describe a child as "acting out" or '"withdrawn" seems to be the extent to which conduct distur- bances are apparent. This can be seen more clearly in Table 2, which shows percentages of children displaying non- surface, habit and conduct symptoms irrespective of whether these symptoms occur alone or in combinations with other symptoms. TABLE 2 TYPES OF CHILDREN‘S EMOTIONAL DISORDERS BY SYMPTOMS (in per cent*) Alternately Disorders Acting Out Withdrawn Withdrawn and Acting}Outg Nonsurface 44 85 6O Habit 56 77 55 Conduct 8O 16 95 *Percentages add to more than 100 since many children had more than one symptom. Among the children who were acting out, 80 per cent displayed conduct disturbances either alone or in combination with other symptoms. Ninety-five per cent of the children who alternated between withdrawn and acting out episodes had the same symptom. But only 16 per cent of the children 21 classified as withdrawn had some conduct disturbance. While the highest proportions of nonsurface and habit problems occur among the withdrawn children, the differences between this and the other two groups are not nearly so large. It would appear, then, that clinicians tend to classify a child as "acting out" if he displays some conduct disturbance. The two items,'"father's orientation toward child" and "mother‘s orientation toward child," indicate in general terms the principal parental attitudes toward the child. These categories were developed as concepts of those atti- tudes described in the case records, and were derived from such material as the child‘s perception of his parents as shown in his responses, as well as the social worker‘s im- pressions of the parental attitudes based on the intake information. The category "accepting" covers those orien- tations in which the parent seems to have warm feelings toward his child as an individual and accepts the child‘s right to be himself. “Rejecting" implies that the parent does not like or want the child. '"Permissive" as we are using the word may be equated with overindulgent. The 'Sontrolling" parent is one who seems to need to regulate his child according to a specific pattern without considering the child‘s particular personality and needs. The category '"inconsistent" refers to any combination of the four cate- gories described above. The remaining seven items, primary breadwinner, Father‘s and Mother‘s occupation and education, parents‘ 22 religion and ethnic identification, were those cultural factors of the child‘s family environment most available for examinatial '"Primary breadwinner" identifies the major source of income to the family. In order that our cate— gories might be large enough to test for statistical signi- ficance the second occupational group was expanded beyond that of the census classification to include all "white collar" personnel who would not fall into the professional and managerial classification, and also persons employed in public or quasi-public service. The category'"blue collar" includes all non-white collar factory employees and those persons doing comparable work in other settings. Skilled and unskilled workers are generally classified separately; however, such a division could not be considered in this study as detailed occupational information was rarely available in the case records. CHAPTER III ANALYSIS OF DATA Characteristics of Sample The sample included 106 boys and 38 girls. In age, these cases varied from pre—school children to high school students. In three of the five age groups, boys constituted about 80 per cent of the total; but in the group of 6-8 year old, boys accounted for only two-thirds of the total, and in the 15-18 year group, the number of boys only slightly exceeded that of girls. [See Table 3] TABLE 3 CHILDREN'S AGE BY SEX (in per cent) Age Sex Total 1—5 648’ 9-11 12-14 15-18 (N=144) (N=22) (N=33) (N=37> (N=35) (N=16) Male 74 82 65 78 8O 56 Female 26 18 35 22 2O 44 Total 100 100 100 100 100 100 The children's intelligence quotients ranged from defective to superior. In 46 cases the I Q was below aver- age, in 48 it was average, and in 29 above average. Table 4 shows a positive relationship between the IQ‘s of children 23 24 and the social status of the family as described by the occupation of the primary breadwinner. For the 3 x 3 table from which all cases not ascertained have been excluded, chi-square is 20.0, which is significant beyond the .001 level. fmwacontingenqycoefficient is .39 (the upper limit of the coefficient for the 3 x 3 table being .87). TABLE 4 OCCUPATION OF PRIMARY BREADWINNER BY CHILDREN'S IQ (in per cent) T t Professional Clerical Blue Collar Other IQ (NeliA) Managerial Sales Farmer & N.A. “ (N=22) (N=36) (N=73) (N=13) Below Average 32 10 23 42 39 Average 33 36 28 36 31 Above Average 20 46 3O 8 15 N. A. 15 9 l9 14 15 Total 100 101 100 100 100 Almost all of the children were white of European descent; only two of the children were Negro, and two American Indian. Parental occupations varied from professional to chronic unemployment, and education from grade school to postgraduate college training. There tended to be a fairly close relationship between the educational levels reached by husbands and wives, as can be seen in Table 5. The 25 00H ooH ooa ooH mm HOH o ooH Hooch me o m s m me 0 am .a .z m me am e m o o NH oposoowm omoaaoo m Ha m s m o o m omoHHoo psom m Ha 4m Am ma me 0 ma oowsoowm Hoohoa that m 0 ma mm om ma 0 ma Hoorom swag osom m o o S rm mm O OH bosom new m o o NH ma , mm o S compo sow than when 8.5 $1: RTE amaze ale Aflmv :33: Ammnzv oposvmhc owoaaoo opwdomhc Hoonom ovohc GdnB Hopes soapwodom _mho£pmm .¢.z owoaaoo osom Hoosom swam swam osom how much Coapmoscu m.po£poz . Apcoo mom Gav 20HaHmmHEhom anz : .mQHonoom who: mgogpos on» :ngz SH momoo OH moOdHocH eponpO=* OOH OOH HOH OOH OOH OOH Hmpoa 3 3 :H O W O m m .< .2 mm NH N O O m o>HpoomoQ mm mH mH mH mH :H msaomswoon sathQOHBIIOSO mchod SH mm mm om mm mm ssoworpaz 4H s: mm mm m ms poo wcaoo< Abuzv AmHuzv Admuzv A3muzv Ammuzv A:#Hflzv H .mmmHU I mEOOQOmHQ .¢.z *honpo psopmHmCOocH wcHHHowpcoo wCHpoomom Hmpoe “[W 'IIIWM u #114! all Apcoo hon CHV H ZOHB¢OHMHmm¢HU WMMQMOMHQ wm ZMMQHHEO QMdBOB mZOHB¢BZMHmO .mmmmfioz OH mHm¢B 34 inconsistently treated by their fathers, 61 per cent are acting out, 14 per cent are withdrawn, and 21 per cent alternate between withdrawing and acting out. But there is no clear predominance of the withdrawing or acting out re- sponses among children whose fathers‘ orientations are re- jecting or controlling. As Table 10 shows, about half of the children with rejecting or controlling mothers were likely to withdraw, while about one—third of them tended to act out. here is a slight indication in Table 11 that children of controlling fathers similarly tend to withdraw, but this is not true for children of rejecting fathers. As in the table relating maternal orientations to children‘s disorders, the differences in proportions of withdrawing and acting out children are significant (most of them at the l per cent level), as between the inconsistent group on the one hand and each of the other two groups on the other. When we consider the relationship between parental Orientations and more specific symptoms of emotional dis- turbance in children, the observed differences are much smaller in magnitude. As Table 12 shows, the children of inconsistent mothers tend to display a combination of habit and conduct disturbances, while overly controlled children are more likely to suffer from nonsurface and habit distur- bances. In either case, something over one-third of the Children are affected by these particular combinations of E32mlptoms. Table 13 shows that the same prevalence of the .pcompm ohms mpogpmm map BOHQB OH OH Ono mmogpoo o>HmmHEpoQ szz : .mQHpmooow ohms mmonpom on» QQHQB GH momma :H moOSHosH ano£p0=* mm 00H OOH HOH HOH ooH Hmooe E) 3 . , o o o m m m .a .z w z z m m m o>HpoomoQ m OH Hm 0H m :H wchmnpopHo czwpongsnupSO wchod mm m: 3H H: mm mm osmwoson mm m: Ho mm a: me too msHooe mHuzv mmuzv Ammuzv ‘ ‘ Asmuz Ammuz ranz . A.¢.z “torso occomHmsoowH moHHHowwsoo msHpoonm AH309V H omoHo . awoowoon All III-III]. IF- A 11h“ I IF Apcoo nod ch H ZOHBmw wm zmmqumO Qm¢3OB mZOHB Om Sm mO mm OS OophOpmHO SHopmwoOoz O O O O S sspHmor SHHprobmmm O Hui STE smug: 1%qu ASSHuzO Shasta *ponpo pampmHmcoocH OCHHHOHpcOO wchoo mm pr09 .mmmmBOZ 41 than one-third were severely disturbed, and among children of inconsistent mothers, less than one-quarter. The dif- ferences between the rejected and the inconsistent group are significant at the l per cent level of confidence. Those between the rejected and the controlled group are significant at the 5 per cent level. The effects of paternal orientations on the severity of children‘s disturbances are not as clear as those of maternal orientations. [See Table 15.] Slightly over one- third of the children rejected or inconsistently treated by their fathers show severe disturbances; and where the fathers‘ orientation is controlling less than one-quarter of the children have severe symptoms. The significance of the difference between the rejected and the highly con- trolled children here does not quite reach the 5 per cent level of significance. On the basis of this evidence, we are inclined to think that the mothers‘ orientations to the child probably have greater bearing upon the emotional disturbances of the Clinic children than do the fathers‘ orientations. The reason that rejection by the father does not produce as much disturbance as rejection by the mother is evidently that children who cannot be accepted by their father may receive some support from the mother, even if inconsistently; for about half of the children rejected by the father are not rejected by the mother. This may account for the fact that .HH OHOOB op opoppoow coma 42 Am OOH OOH HOH OOH HOH OOH stoe O S O m O H .< .2 SH HH 3 O OH HH m>Hpoomom mm Om Om mm Om mm ooowspmHo Swo> Om mm Om NO SS OS OopwsomHO SHopwwooo: O SH HH m m S SOOHmos SHHmecoomm Huz muz muz Smnz Omuz Huz <.zv “mospw oOMMmHOWoosH OO%HHowwsoO Omeoomom Amusoev Spro>om Anzac pom CHV mmmququ mo SaHmm>mm Sm zmmaHHmO nmO£ OOQHOOHOOOO no: mommo .QOHpOHSpr man 809% OmppHso smon UGO mpsopmm psomnw no o>HmmHshmmwwchmmoom OOH: mmmmo* OOH OOH OOH OOH OOH Hmpoa mH SS m: mm H: OBOHOSOHB mO mm OO O: mm OGHpmzhmpHd QSOHOBBHB. mw IOLHo OOHPOHH Has to OOHOOHH . Omnzv Ammuzv Owl: wfiHHowpsoO Omuzv OsHHHoBsoO A SOHuzv pampmHmcoocH Ocm wchOmHmm pcopmHmcoocH Odd wchomHmm *Hmpoa .mmOHOIOHmOpomHQ hOHHoo osHm . QOHHOO opan JHHLH H OZOHEHEzmHMO AOGOO pom GHV H ZOHB