18
MENTAL WELFARE.
Dulness in Rural Children. By G. A. Gordon Johnstone, M.A., M.D. Cantab., D.P.H., Assistant County Medical Officer, Lanes, (late of Wilts.) The early diagnosis increasingly important, tion where
we can
and certification of
but make full
we use
Mentally
Defective
cases
is
becoming posi-
still a considerable distance from the of the Mental Deficiency Act.
are
Generally speaking, it would be true to say that practically all mental defectives should be diagnosed whilst they are of school age. The great majority of them are in attendance, at some time, at our public elementary schools. There is no difficulty in recognising the Idiot, Imbecile and the low-grade Feebleminded groups, but it is not easy always to distinguish the high-grade FeebleIn the first place, the possibility of mental deficiency has not minded children. occurred to the teacher and, in the second, it is not always possible for a case of this type to be recognised by its behaviour during the ordinary routine medical inspection held at our public elementary schools. When we remember that the present definition of Feeble-minded Persons is persons in whose case there exists from birth or from an early age, mental defectiveness so pronounced that they require care, supervision, and control for their own protection or for the protection of others," etc., it will be appreciated in dealing with a feeble-minded adult brought to notice for anti-social( behaviour, that it is important to be able to refer to some earlier part of the person's life for information which, if satisfactorily obtained, may enable the case to be dealt with by the more humane machinery of the 1913 Act than by the ordinary penal code. "
School Medical Inspectors have been using, to an form of standardised scale of test questions, which makes the work of diagnosis more easy and more accurate, but these scales must, of course, be reg'arded only as one of several methods of diagnosis, much in the same way as a stethoscope is of value in the diagnosis of a case of
During recent increasing extent,
years,
some
pneumonia.
would diagnose a borderland case of mental deficiency by a standard but the more we know about the use of a scale the fewer the miswe shall be likely to make, and the more clearly we shall realise the limitations of its use.
Nobody
scale takes
alone,
Work with the aid of a scale has hitherto been chiefly done1 in urban areas. The following figures are, however, derived from observations on elementary school children in one of the most sparsely populated counties in England, and apply only to Dull and Backward children?cases which are just above the level of certification, unless they have exhibited any marked features such as mental
instability
or
anti-social
behaviour,
etc.
In this series of cases, by means of the Stanford Revision of the Binet Simon the mental breakage points have been ascertained, that is to say, in each individual case those years have been taken in which the child has begun to fail in his answers. For instance, let us suppose that we are dealing with a dull child of twelve years of age, whose mental age is found to be nine-and-a-half years? with an intelligent quotient of approximately 80. In the scale tests, the child will probably be found to miss one or two questions of the eight-year-old group,
Scale,
.Mental welfare. Lonc or two in the ten yesr the nine year sToup. perhaps o nnCftWpr onlv one record of these tilree The ? group, and to fail completely been noted, and the has ? years in which there was a gr, y For convenience, the group has been results have been combined and analysed ^ limited to children whose intelligence qu ncrPc virv from six to fourthe figures 69 and and 80, *
more
ia
?
in
?
f
asinJfailure,
^en.en^^ g? ^
?-
struct^^bhTwhich'demonstrat^ "he gradual breakdown further and further behind in their failures with
the
the dull children
as
question
.
STAMFORD REVISION. 10
Age Group
12
20
62
157 288 390 480 470 403
155
No. answered correctly
17
42
110
188 249 255 277 202
51
Percentage
85
67
70
62
No. of questions put
...
answered correctly
53
63
the
59
various
50
33
17
17
J
in
age groups will, however, be more instructive to consider and their nature. individual points the breakage notice and to detail, number of observations During the first year age group, owing to the small definite
It
more
no very relatively slight deviation from normal of the children^in the four year that worth noticing features are shown. It is, perhaps, just four digits (one out o tiiree could children ten repeat of out three group only aiten ion trials). The successful performance of this test depends large y upon are
MENTAL WELFARE.
Dulness in Rural Children. By G. A. Gordon Johnstone, M.A., M.D. Cantab., D.P.H., Assistant County Medical Officer, Lanes, (late of Wilts.) The early diagnosis increasingly important, tion where
we can
and certification of
but make full
we use
Mentally
Defective
cases
is
becoming posi-
still a considerable distance from the of the Mental Deficiency Act.
are
Generally speaking, it would be true to say that practically all mental defectives should be diagnosed whilst they are of school age. The great majority of them are in attendance, at some time, at our public elementary schools. There is no difficulty in recognising the Idiot, Imbecile and the low-grade Feebleminded groups, but it is not easy always to distinguish the high-grade FeebleIn the first place, the possibility of mental deficiency has not minded children. occurred to the teacher and, in the second, it is not always possible for a case of this type to be recognised by its behaviour during the ordinary routine medical inspection held at our public elementary schools. When we remember that the present definition of Feeble-minded Persons is persons in whose case there exists from birth or from an early age, mental defectiveness so pronounced that they require care, supervision, and control for their own protection or for the protection of others," etc., it will be appreciated in dealing with a feeble-minded adult brought to notice for anti-social( behaviour, that it is important to be able to refer to some earlier part of the person's life for information which, if satisfactorily obtained, may enable the case to be dealt with by the more humane machinery of the 1913 Act than by the ordinary penal code. "
School Medical Inspectors have been using, to an form of standardised scale of test questions, which makes the work of diagnosis more easy and more accurate, but these scales must, of course, be reg'arded only as one of several methods of diagnosis, much in the same way as a stethoscope is of value in the diagnosis of a case of
During recent increasing extent,
years,
some
pneumonia.
would diagnose a borderland case of mental deficiency by a standard but the more we know about the use of a scale the fewer the miswe shall be likely to make, and the more clearly we shall realise the limitations of its use.
Nobody
scale takes
alone,
Work with the aid of a scale has hitherto been chiefly done1 in urban areas. The following figures are, however, derived from observations on elementary school children in one of the most sparsely populated counties in England, and apply only to Dull and Backward children?cases which are just above the level of certification, unless they have exhibited any marked features such as mental
instability
or
anti-social
behaviour,
etc.
In this series of cases, by means of the Stanford Revision of the Binet Simon the mental breakage points have been ascertained, that is to say, in each individual case those years have been taken in which the child has begun to fail in his answers. For instance, let us suppose that we are dealing with a dull child of twelve years of age, whose mental age is found to be nine-and-a-half years? with an intelligent quotient of approximately 80. In the scale tests, the child will probably be found to miss one or two questions of the eight-year-old group,
Scale,
.Mental welfare. Lonc or two in the ten yesr the nine year sToup. perhaps o nnCftWpr onlv one record of these tilree The ? group, and to fail completely been noted, and the has ? years in which there was a gr, y For convenience, the group has been results have been combined and analysed ^ limited to children whose intelligence qu ncrPc virv from six to fourthe figures 69 and and 80, *
more
ia
?
in
?
f
asinJfailure,
^en.en^^ g? ^
?-
struct^^bhTwhich'demonstrat^ "he gradual breakdown further and further behind in their failures with
the
the dull children
as
question
.
STAMFORD REVISION. 10
Age Group
12
20
62
157 288 390 480 470 403
155
No. answered correctly
17
42
110
188 249 255 277 202
51
Percentage
85
67
70
62
No. of questions put
...
answered correctly
53
63
the
59
various
50
33
17
17
J
in
age groups will, however, be more instructive to consider and their nature. individual points the breakage notice and to detail, number of observations During the first year age group, owing to the small definite
It
more
no very relatively slight deviation from normal of the children^in the four year that worth noticing features are shown. It is, perhaps, just four digits (one out o tiiree could children ten repeat of out three group only aiten ion trials). The successful performance of this test depends large y upon are
