Perceprrral and Motor Skills, 1975,40, 467-470. @ Perceptual and Motor Skills 1975
COMPARISON OF VISUAL-DISCRIMINATION ABILITY OF BRAIN-INJURED AND NON-BRAIN-INJURED CHILDREN OF NORMAL INTELLIGENCE DAVID G. WEIGHT1 A N D BERT P. CUNDICK Brighdnr Young Unive~sity
E. KENT PILLING2 While Pines Mental Heakh Center, Lewiston, Idaho Summary.-A set of 106 multiple-choice geometric designs were administered to 23 children diagnosed as minimally brain-damaged and 23 control children. All children were between the ages of 4 and 12 yr. and were matched for age and intelligence. Differences between the two groups suggest that, although rotation and reversal errors significantly discriminate the groups, factors which lead to distractions are more discriminative. The data suggest the possibility of an easily administered and objectively scored instrument which is relatively independent of motor development in children.
The diagnosis and treatment of minimal brain dysfunction continues to be of major concern to educators, clinicians, and parents. As a result many tests have been developed over the years in an attempt to identify this condition and facilitate its treatment. The visual discrimination of designs has been one fruitful approach which is most commonly associated with two frequently used teststhe Bender-Gestalt (Bender, 1938) and Memory-for-Designs tests (Graham & Kendall, 1960). Both tests require, in addition to visual discrimination, the motor ability necessary for reproducing each design. Recently Cundick and Robison (1972) reported a modification of this approach by developing a multiple-choice test which was shown to discriminate between brain-disordered and normal subjects. Such a test introduces the advantage of a more pure measure of visual discrimination not confounded by motor development. It also effectively eliminates subjectivity in the scoring system. Another advantage provided by such a test is the possibility of manipulating the choices available to subjects so that sources of error may be systematically studied. A recent study by Deutsch and Schumer (1970) called attention to the importance of studying brain-disordered subjects of normal intelligence. This group of subjects currently constitutes a great challenge to society because it represents such a sizable portion of the total population of brain-injured children By systematically studying the visual discrimination errors of brain-disordered children of normal intelligence greater generalization to the normal classroom might be obtained. The use of a test which is quickly administered, objectively scored and more specific to the visual discrimination modality has considerable 'Requests for reprints should be sent to David G. Weight, Psychology Clinic, 257 EDLC, Brigham Young University, Provo, Utah 84602. W o w at Calgary Mental Health Services.
468
D.G . WEIGHT, ET AL.
advantage in studying the components of visual dysfunction. The present study is an attempt to expand the multiple-choice approach and explore the discriminative ability of the various visual errors made by brain-disordered children.
METHOD Subjects were 23 children diagnosed as minimally brain-damaged and 23 control children between the ages of 4 and 12 yr. of age [control mean age = 7 yr., 4 mo. ( S D = 2 yr., 2 mo.); brain-damaged mean = 7 yr., 5 mo. (SD = 2 yr., 3 mo.)]. The children were individually matched as to age and intelligence scores obtained on the Wechsler Intelligence Scale for Children. The only exception was one 4-yr.-old pair who were matched on intelligence scores obtained from the Peabody Picture Vocabulary Test. The intelligence score mean for the control children was 103.6 ( S D = 5.0), while the intelligence score mean for the brain-damaged children was 101.7 ( S D = 5.6). In addition 19 of the 23 pairs were matched as to sex, though four pairs being of opposite sex. One recent study of brain-injured children of normal intelligence suggests that sex differences are not important in activity level and distractibility in such children (Kaspar, et al., 1971). All subjects came from middle-income, rural areas. The brain-damaged children were diagnosed by either a board-eligible or board-certified pediatric neurologist or psychiatrist. The neurological evaluation included a history and general neurological examination. Electroencephalograms, skull X-rays, and brain scans were available on many of the children. All the control children were considered to be normal by the public school or nursery school personnel who were caring for them. Each subject was presented 106 sets of geometric design cards. Each set contained a stimulus and a choice card. Each stimulus card had an inked geometric design drawn upon it. All of the designs were original ones except 12 selected from those used by Cundick and Robison (1972). Each choice card displayed four possible geometric designs drawn in ink, one of which duplicated the size, shape, and orientation of the choice-card design. The three alternate-choice designs contained either (1) other forms, ( 2 ) distortions in form size or shape, or ( 3 ) rotations or reversals of the original design. Sometimes the background of the choice card was also varied from the background of the stimulus card. For some card sets the choice card was a different color from the stimulus card. For other sets an overlay was used either for the stimulus or the choice card. For each administration the subject was shown the stimulus card for 3 sec. He was then shown the choice card and instructed to "choose the design that is shaped most like the one that you saw." Three trial cards were given to ensure the subject could follow the directions. The color of the stimulus and choice cards was different for two of the trials. Each of the four alternatives on the choice card was lettered a, b, c, or d,
VISUAL DISCRIMINATION OF BRAIN-INJURED CHILD
469
according to its position on the card. Subjects' choices were recorded on an answer sheet. Subjects were given credit when they chose the correct design from among the four. RESULTS AND DISCUSSION Fixed-effects analyses of variance were run for each comparison between the groups. Means and standard deviations for the brain-damaged and control groups are given, together with F and significance values in Table 1. The range of correct responses increased with increases in age. The low number of correct responses was 9 while the high number of correct responses was 94. Differences in the number correct favored the normal subject in all 23 matched pairs.
MEANSAND STANDARD DEVIATIONS Score Total Number Correct Total Number Errors Rotations Reversals Card Color Change Stimulus Card Overlay Choice Card Overlay tFor 23 matched pairs. ' p
TABLE 1 BRAIN-DAMAGED A N D CONTROL SUBJECTS
FOR
Brain-damaged
< .001.
Control
Pt
M
SD
M
SD
38.1
20.0
67.7
19.9
25.2*
15.2
6.6 5.6 4.5
6.5 4.1
27.9
8.3
26.8
5.9
8.1 8.1 12.5 15.5 16.2
15.8*
13.4 23.6
6.6 9.2 7.5
15.4* 89.1*
47.3* 29.1*
It appears that brain-damaged children can be separated from controls on their ability to match geometric designs correctly. The data also support the frequent finding that brain-injured children have difficulty when designs they have seen are rotated or reversed (Kendall, 1966). It appears that brain-damaged children make the same kinds of errors even when the test is of a multiplechoice type and no motor response is required. The perceptual errors based on rotation and reversal of the designs were far greater for the brain-injured subjects, yet it appears that factors which might distract the subjects from attending to the most relevant dimensions of the forms were even more important in creating performance differences between the two groups. Of particular interest was the distraction which occurred when color was used. It may be that the educational problems of young minimally brain-damaged children are more a function of their distractibility than are perceptual or cognitive deficits. This study is consistent with the theorizing of Zeaman and House (1963) and Robinson and Robinson ( 1965) who place great weight on the role of distractibility as interference in learning by young children. Additional studies are now necessary to determine if children with specific forms of learning disabilities differ in the types of errors made on this test. In
D. G. WEIGHT, ET AL.
470
addition to differential diagnosis, approaches similar to the ones used in this study now open the possibility of resting children at younger ages who do not have the motor ability necessary for existing visual tests of organicity. Careful crossvalidation studies need to be undertaken. REFERENCES BENDER,L. A visual-motor Gestalt test and its clinical me. New York: American Orthopsychiatric Associarion, 1938. CUNDICK, B. P., & ROBISON, L. R. Per€ormance of medically diagnosed brain-damaged children and control Ss. Perceptual and Motor Skills, 1972, 34, 307-310. DEUTSCH, C. P., & SCHUMER, F. Brain-damaged children: a modality-oriented exploration of performance. New York: Brunner/Mazel, 1970. GRAHAM. F. K., & KENDALL,B. S. Memory-for-Designs test: revised general manual. Perceptual and Motor Skills, 1960, 1 1 , 147-188. (Monogr. Suppl. 2 - V l l ) KASPAR, J. C., MILLICHAP, J. G., BACKUS,R., CHILD,D., & SCHULMAN, J. L. A study of the relationship between neurological evidence of brain damage in children and activity and distractibility. Jourlaal of Consulting and Clinical Psychology, 1971,
36, 329-337. KENDALL,B. S. Orientation errors in the Memory-for-Designs test: tentative findings and recommendations. Percepisal and Motor Skills, 1966, 22, 335-345. ROBINSON, H. B., & ROBINSON, N . M. A mentally retarded child. New York: McGrawHill. 1965. ZEAMAN, D., & HOUSE,B. J. The role of attention in retardate discrimination learning. In N. R. Ellis (Ed.), Handbook of mental deficiency. New York: McGraw-Hill, 1963. Pp. 159-223.
Accepted December 18, 1974.
COMPARISON OF VISUAL-DISCRIMINATION ABILITY OF BRAIN-INJURED AND NON-BRAIN-INJURED CHILDREN OF NORMAL INTELLIGENCE DAVID G. WEIGHT1 A N D BERT P. CUNDICK Brighdnr Young Unive~sity
E. KENT PILLING2 While Pines Mental Heakh Center, Lewiston, Idaho Summary.-A set of 106 multiple-choice geometric designs were administered to 23 children diagnosed as minimally brain-damaged and 23 control children. All children were between the ages of 4 and 12 yr. and were matched for age and intelligence. Differences between the two groups suggest that, although rotation and reversal errors significantly discriminate the groups, factors which lead to distractions are more discriminative. The data suggest the possibility of an easily administered and objectively scored instrument which is relatively independent of motor development in children.
The diagnosis and treatment of minimal brain dysfunction continues to be of major concern to educators, clinicians, and parents. As a result many tests have been developed over the years in an attempt to identify this condition and facilitate its treatment. The visual discrimination of designs has been one fruitful approach which is most commonly associated with two frequently used teststhe Bender-Gestalt (Bender, 1938) and Memory-for-Designs tests (Graham & Kendall, 1960). Both tests require, in addition to visual discrimination, the motor ability necessary for reproducing each design. Recently Cundick and Robison (1972) reported a modification of this approach by developing a multiple-choice test which was shown to discriminate between brain-disordered and normal subjects. Such a test introduces the advantage of a more pure measure of visual discrimination not confounded by motor development. It also effectively eliminates subjectivity in the scoring system. Another advantage provided by such a test is the possibility of manipulating the choices available to subjects so that sources of error may be systematically studied. A recent study by Deutsch and Schumer (1970) called attention to the importance of studying brain-disordered subjects of normal intelligence. This group of subjects currently constitutes a great challenge to society because it represents such a sizable portion of the total population of brain-injured children By systematically studying the visual discrimination errors of brain-disordered children of normal intelligence greater generalization to the normal classroom might be obtained. The use of a test which is quickly administered, objectively scored and more specific to the visual discrimination modality has considerable 'Requests for reprints should be sent to David G. Weight, Psychology Clinic, 257 EDLC, Brigham Young University, Provo, Utah 84602. W o w at Calgary Mental Health Services.
468
D.G . WEIGHT, ET AL.
advantage in studying the components of visual dysfunction. The present study is an attempt to expand the multiple-choice approach and explore the discriminative ability of the various visual errors made by brain-disordered children.
METHOD Subjects were 23 children diagnosed as minimally brain-damaged and 23 control children between the ages of 4 and 12 yr. of age [control mean age = 7 yr., 4 mo. ( S D = 2 yr., 2 mo.); brain-damaged mean = 7 yr., 5 mo. (SD = 2 yr., 3 mo.)]. The children were individually matched as to age and intelligence scores obtained on the Wechsler Intelligence Scale for Children. The only exception was one 4-yr.-old pair who were matched on intelligence scores obtained from the Peabody Picture Vocabulary Test. The intelligence score mean for the control children was 103.6 ( S D = 5.0), while the intelligence score mean for the brain-damaged children was 101.7 ( S D = 5.6). In addition 19 of the 23 pairs were matched as to sex, though four pairs being of opposite sex. One recent study of brain-injured children of normal intelligence suggests that sex differences are not important in activity level and distractibility in such children (Kaspar, et al., 1971). All subjects came from middle-income, rural areas. The brain-damaged children were diagnosed by either a board-eligible or board-certified pediatric neurologist or psychiatrist. The neurological evaluation included a history and general neurological examination. Electroencephalograms, skull X-rays, and brain scans were available on many of the children. All the control children were considered to be normal by the public school or nursery school personnel who were caring for them. Each subject was presented 106 sets of geometric design cards. Each set contained a stimulus and a choice card. Each stimulus card had an inked geometric design drawn upon it. All of the designs were original ones except 12 selected from those used by Cundick and Robison (1972). Each choice card displayed four possible geometric designs drawn in ink, one of which duplicated the size, shape, and orientation of the choice-card design. The three alternate-choice designs contained either (1) other forms, ( 2 ) distortions in form size or shape, or ( 3 ) rotations or reversals of the original design. Sometimes the background of the choice card was also varied from the background of the stimulus card. For some card sets the choice card was a different color from the stimulus card. For other sets an overlay was used either for the stimulus or the choice card. For each administration the subject was shown the stimulus card for 3 sec. He was then shown the choice card and instructed to "choose the design that is shaped most like the one that you saw." Three trial cards were given to ensure the subject could follow the directions. The color of the stimulus and choice cards was different for two of the trials. Each of the four alternatives on the choice card was lettered a, b, c, or d,
VISUAL DISCRIMINATION OF BRAIN-INJURED CHILD
469
according to its position on the card. Subjects' choices were recorded on an answer sheet. Subjects were given credit when they chose the correct design from among the four. RESULTS AND DISCUSSION Fixed-effects analyses of variance were run for each comparison between the groups. Means and standard deviations for the brain-damaged and control groups are given, together with F and significance values in Table 1. The range of correct responses increased with increases in age. The low number of correct responses was 9 while the high number of correct responses was 94. Differences in the number correct favored the normal subject in all 23 matched pairs.
MEANSAND STANDARD DEVIATIONS Score Total Number Correct Total Number Errors Rotations Reversals Card Color Change Stimulus Card Overlay Choice Card Overlay tFor 23 matched pairs. ' p
TABLE 1 BRAIN-DAMAGED A N D CONTROL SUBJECTS
FOR
Brain-damaged
< .001.
Control
Pt
M
SD
M
SD
38.1
20.0
67.7
19.9
25.2*
15.2
6.6 5.6 4.5
6.5 4.1
27.9
8.3
26.8
5.9
8.1 8.1 12.5 15.5 16.2
15.8*
13.4 23.6
6.6 9.2 7.5
15.4* 89.1*
47.3* 29.1*
It appears that brain-damaged children can be separated from controls on their ability to match geometric designs correctly. The data also support the frequent finding that brain-injured children have difficulty when designs they have seen are rotated or reversed (Kendall, 1966). It appears that brain-damaged children make the same kinds of errors even when the test is of a multiplechoice type and no motor response is required. The perceptual errors based on rotation and reversal of the designs were far greater for the brain-injured subjects, yet it appears that factors which might distract the subjects from attending to the most relevant dimensions of the forms were even more important in creating performance differences between the two groups. Of particular interest was the distraction which occurred when color was used. It may be that the educational problems of young minimally brain-damaged children are more a function of their distractibility than are perceptual or cognitive deficits. This study is consistent with the theorizing of Zeaman and House (1963) and Robinson and Robinson ( 1965) who place great weight on the role of distractibility as interference in learning by young children. Additional studies are now necessary to determine if children with specific forms of learning disabilities differ in the types of errors made on this test. In
D. G. WEIGHT, ET AL.
470
addition to differential diagnosis, approaches similar to the ones used in this study now open the possibility of resting children at younger ages who do not have the motor ability necessary for existing visual tests of organicity. Careful crossvalidation studies need to be undertaken. REFERENCES BENDER,L. A visual-motor Gestalt test and its clinical me. New York: American Orthopsychiatric Associarion, 1938. CUNDICK, B. P., & ROBISON, L. R. Per€ormance of medically diagnosed brain-damaged children and control Ss. Perceptual and Motor Skills, 1972, 34, 307-310. DEUTSCH, C. P., & SCHUMER, F. Brain-damaged children: a modality-oriented exploration of performance. New York: Brunner/Mazel, 1970. GRAHAM. F. K., & KENDALL,B. S. Memory-for-Designs test: revised general manual. Perceptual and Motor Skills, 1960, 1 1 , 147-188. (Monogr. Suppl. 2 - V l l ) KASPAR, J. C., MILLICHAP, J. G., BACKUS,R., CHILD,D., & SCHULMAN, J. L. A study of the relationship between neurological evidence of brain damage in children and activity and distractibility. Jourlaal of Consulting and Clinical Psychology, 1971,
36, 329-337. KENDALL,B. S. Orientation errors in the Memory-for-Designs test: tentative findings and recommendations. Percepisal and Motor Skills, 1966, 22, 335-345. ROBINSON, H. B., & ROBINSON, N . M. A mentally retarded child. New York: McGrawHill. 1965. ZEAMAN, D., & HOUSE,B. J. The role of attention in retardate discrimination learning. In N. R. Ellis (Ed.), Handbook of mental deficiency. New York: McGraw-Hill, 1963. Pp. 159-223.
Accepted December 18, 1974.
