THE MENTAL HYGIENE PROBLEMS OF SCHOOL ATTENDANTS By Frances V. Markey Mental Hygiene Clinic, Judson Health Centre and Columbia University
295 sc oo This paper presents an analysis of the problems of Mental Hygiene children referred to the Judson Health Centre Clinic during three years of operation. More than thiee-fourths of the total cases during this period were treated here. The remaining fourth consisted largely of children attending school and,
to some extent, of school attendants without Stanford-Binet I.Q. s. Chronological age, sex, school status, referral agency and leason for referral were obtained from the record forms of the 295 children.1 The tables below show the distribution of the eases according to referral agency and reason for referral in relation to the other factors mentioned. The referral agency is indicated on the clinic folders and may be classified under the headings indicated. In some in-
readily
stances, however, parents
are
the ultimate
source
of certain
cases
to the Centre for
classified
under Centre; that is, parents coming service in other health fields often discuss the mental hygiene problems of their children with the clinic personnel who in turn Less frequently, as may be seen in Table I, the parents themselves, knowing of the services rendered by the clinic, proceed directly to the mental hygiene personnel. For some cases the Bureau of Attend-
recommend the
ance
to the Mental
case
Hygiene
division.
division of the public schools) made recommenda' counted as school referrals. The heading Other subsumes miscellaneous social agencies, such as clinics,
(truancy
tions ; these
Agencies"
were
child placement agencies, hospitals, etc. The clinic folders- indicate also the reason for referral. The basic difficulties of the child may not correspond to the reason
given; however, as
the
problem
stated is the
the referral agency is concerned.
usually described
as
discipline-truancy,
1
source
of
difficulty
so
far
were
The truancy cases but in our classification
Case records of the clinic were made available through the generous cooperation of Mrs. Margaretta S. Levet, Assistant Director General of Judson
Health Centre.
277
THE PSYCHOLOGICAL CLINIC
278
truancy only is used since the word discipline is used, agents.
Enuresis,
on
the
whole,
public school's truancy terminology and masturbation were classified stammering, of the
to conform with the
neurotic. The headings "Backward" and "Vocational Guidance" are self explanatory. The miscellaneous cases include: suspected superiority (8 cases), mother epileptic (6), member of as
family of patient (5), referred to sight conservation class (4), scholarship aid (3), interested in art (2), referred for placement (2), glandular defects and epilepsy (3). A request for scholarship aid is in a sense a request for vocational guidance, but these cases are not classified as such since scholarship aid does not constitute a problem in job placement. The cases were drawn largely from the neighborhood immediately surrounding the Centre, a Latin-American area. Some of the schools were informed of the work done by the clinic and were invited to refer cases; educational work had been carried on with These facsecure cooperation with the clinic. tors were probably of significance in determining the kinds of cases the parents also to
referred. Table I shows that the most Type
frequent single problem
Table I Problem on Referral and Source (with Chronological Age and Sex)
of
of
for which
Case
Problem Backward
Neurotic
Source of Case Boys Girls
Centre N = 161 Mdn. C.A. 10. School N = 97 Mdn. C.A. 13.
17 10
21 9
27 10
10
10
9
11
2 10
11
20 9
Parent N = 27 Mdn. C.A. 10.
3 12
Other agencies N = 10 Mdn. C.A. 11. Total Boys 161 Total Girls 134 Mdn. C.A. 12.. Total 295
Boys Girls
4
4 10
Truancy Discipline
Boys Girls
Boys Girls Boys Girls Boys Girls
13 14
18
14
1 15
3 15
10
1
1
G
12
13
10
30 11
63
13
5 12
12
12 11
37 14
9
13 12 2 10 4 10
1 17
3 11
33 10
Miscellaneous
Vocational
30 9
34 10 64
10 14
18 15 28
21 10
36 9 57
18 9
13 12
37 14 50
33
MENTAL PROBLEMS OF SCHOOL ATTENDANTS cases are
discipline
if truancies are non-conformity in school totals
behavior; however,
referred is neurotic
added to the school
279
cases,
The Centre refers almost equal numbers of neurotics and backward children, the school refers more truants than other kinds of cases, but also refers many backward and discipline cases. neurotic cases more than any other, with Parents refer most.
discipline
and backward children next in order. This distribution implies that the emphases of parents, schools and health agencies aie harand mental mony of parent-child relationships, conformity to rules more often clinic the to health, respectively. Boys are brought ratios for all the and truancy, than for
girls, especially being 1.5 to 1 and
discipline
for truancy 3 to 1 (approximately). Girls on the other hand are referred more often for neurotic behavior, indicating perhaps that adults show greater concern over neurotic symptoms in girls. Table I shows also that girls are referred to the clinic at a slightly later age than boys, except when truants; this suggests that receive attention earlier for exceptionalness
cases
of any kind. sooner
clinic than
boys
Truant
girls,
the other hand, may be apprehended Children are recommended to the the Centre personnel and by parents
on
because of inexperience. at an earlier age
by
the school authorities, pointing perhaps to lack of sensitivity on the part of the school to problems in mental health. Table II shows that the median Intelligence Quotient of the girls is lower in all but the discipline and truancy cases; however, the age-grade retardation is less for the girls in almost all types ?f problems no retardation less
by
(in computing age-grade status, than one-half year was counted; our figures place the children in a more favorable light than would be the case if the one-half year cases had been included). There seems a tendency for girls to present problems when slightly retarded in age-grade status as compared with more retarded boys. Girls, although less intelligent, are less retarded; this tendency has been observed in other studies. The group as a whole, it may be noted, tends to be subnormal in
intelligence; the children referred by the school are somewhat more retarded than those referred by the Centre and by parents. The age-grade status of the school cases is considerably lower on the average than Centre and parent cases. Summary In general, the analysis shows that mental hygiene cases from this particular area are slightly retarded in intelligence. Health
THE PSYCHOLOGICAL CLINIC
280
Table II Median I.Q.
and
Average Age Gbade Retardation of 295 Cases According to Problem, Sex and Source of Case Backward
Neurotic
Vocational
Discipline
Truancy
Miscellaneous
Boys Girls
Boys Girls
Boys Girls
Boys Girls
Boys Girls
Boys Girls
Source of Case
Centre Mdn. I.Q. 86... Av. Age Grade 0.9 School Median I.Q. 83 Av. Age Grade 1.8 Parent Mdn. I.Q. 96... Av. Age Grade 0.8
72
71
95
89
94
83
89
96
103
2.0s
1.2
0.9
0.9
1.2
0.8
1.3
0.9
0.1
77
69
82
97
82
75
94
90
87
87
97
2.0
2.2
1.5
0.0
2.0
2.3
1.9
1.2
2.0
1.5
2.0
82
82
101
127
97
2.7
0.7
0.5
0.7 |3.0
0.0
0.8
89
67
82
86
1.0
3.0
1.0
1.5
Other Agencies Mdn. I.Q. 84... Av. Age Grade 1.4 Mdn. I.Q. 86... Av. Age Grade 1.3
112
74
72
94
91
94
81
2.1
1.4
0.9
0.8
0.9
1.4
* 2 cases attending ungraded class counted t Boldface indicates acceleration.
1.4 as
99 0.1
97
127
112
0.7
2.0
0.5
94
87
87
104
0.9
2.0
1.5
1.0
97 0.8
2 years retardation.
workers at the Centre are relatively more sensitive to neurotic traits, school personnel to disciplinary difficulties, and parents to discipline as mental hygiene problems. Girls are referred to the clinic at later ages than are boys for most problems. Girls when referred are more retarded intellectually than boys but less retarded in age-grade status for most problems. Children referred by health workers are somewhat brighter and younger than children referred by school officers, on the whole. School cases are predominantly cases of non-conformity to school regulations; nonconformity is emphasized more than intellectual retardation or even school retardation by school authorities in recommending children to a mental hygiene clinic.
295 sc oo This paper presents an analysis of the problems of Mental Hygiene children referred to the Judson Health Centre Clinic during three years of operation. More than thiee-fourths of the total cases during this period were treated here. The remaining fourth consisted largely of children attending school and,
to some extent, of school attendants without Stanford-Binet I.Q. s. Chronological age, sex, school status, referral agency and leason for referral were obtained from the record forms of the 295 children.1 The tables below show the distribution of the eases according to referral agency and reason for referral in relation to the other factors mentioned. The referral agency is indicated on the clinic folders and may be classified under the headings indicated. In some in-
readily
stances, however, parents
are
the ultimate
source
of certain
cases
to the Centre for
classified
under Centre; that is, parents coming service in other health fields often discuss the mental hygiene problems of their children with the clinic personnel who in turn Less frequently, as may be seen in Table I, the parents themselves, knowing of the services rendered by the clinic, proceed directly to the mental hygiene personnel. For some cases the Bureau of Attend-
recommend the
ance
to the Mental
case
Hygiene
division.
division of the public schools) made recommenda' counted as school referrals. The heading Other subsumes miscellaneous social agencies, such as clinics,
(truancy
tions ; these
Agencies"
were
child placement agencies, hospitals, etc. The clinic folders- indicate also the reason for referral. The basic difficulties of the child may not correspond to the reason
given; however, as
the
problem
stated is the
the referral agency is concerned.
usually described
as
discipline-truancy,
1
source
of
difficulty
so
far
were
The truancy cases but in our classification
Case records of the clinic were made available through the generous cooperation of Mrs. Margaretta S. Levet, Assistant Director General of Judson
Health Centre.
277
THE PSYCHOLOGICAL CLINIC
278
truancy only is used since the word discipline is used, agents.
Enuresis,
on
the
whole,
public school's truancy terminology and masturbation were classified stammering, of the
to conform with the
neurotic. The headings "Backward" and "Vocational Guidance" are self explanatory. The miscellaneous cases include: suspected superiority (8 cases), mother epileptic (6), member of as
family of patient (5), referred to sight conservation class (4), scholarship aid (3), interested in art (2), referred for placement (2), glandular defects and epilepsy (3). A request for scholarship aid is in a sense a request for vocational guidance, but these cases are not classified as such since scholarship aid does not constitute a problem in job placement. The cases were drawn largely from the neighborhood immediately surrounding the Centre, a Latin-American area. Some of the schools were informed of the work done by the clinic and were invited to refer cases; educational work had been carried on with These facsecure cooperation with the clinic. tors were probably of significance in determining the kinds of cases the parents also to
referred. Table I shows that the most Type
frequent single problem
Table I Problem on Referral and Source (with Chronological Age and Sex)
of
of
for which
Case
Problem Backward
Neurotic
Source of Case Boys Girls
Centre N = 161 Mdn. C.A. 10. School N = 97 Mdn. C.A. 13.
17 10
21 9
27 10
10
10
9
11
2 10
11
20 9
Parent N = 27 Mdn. C.A. 10.
3 12
Other agencies N = 10 Mdn. C.A. 11. Total Boys 161 Total Girls 134 Mdn. C.A. 12.. Total 295
Boys Girls
4
4 10
Truancy Discipline
Boys Girls
Boys Girls Boys Girls Boys Girls
13 14
18
14
1 15
3 15
10
1
1
G
12
13
10
30 11
63
13
5 12
12
12 11
37 14
9
13 12 2 10 4 10
1 17
3 11
33 10
Miscellaneous
Vocational
30 9
34 10 64
10 14
18 15 28
21 10
36 9 57
18 9
13 12
37 14 50
33
MENTAL PROBLEMS OF SCHOOL ATTENDANTS cases are
discipline
if truancies are non-conformity in school totals
behavior; however,
referred is neurotic
added to the school
279
cases,
The Centre refers almost equal numbers of neurotics and backward children, the school refers more truants than other kinds of cases, but also refers many backward and discipline cases. neurotic cases more than any other, with Parents refer most.
discipline
and backward children next in order. This distribution implies that the emphases of parents, schools and health agencies aie harand mental mony of parent-child relationships, conformity to rules more often clinic the to health, respectively. Boys are brought ratios for all the and truancy, than for
girls, especially being 1.5 to 1 and
discipline
for truancy 3 to 1 (approximately). Girls on the other hand are referred more often for neurotic behavior, indicating perhaps that adults show greater concern over neurotic symptoms in girls. Table I shows also that girls are referred to the clinic at a slightly later age than boys, except when truants; this suggests that receive attention earlier for exceptionalness
cases
of any kind. sooner
clinic than
boys
Truant
girls,
the other hand, may be apprehended Children are recommended to the the Centre personnel and by parents
on
because of inexperience. at an earlier age
by
the school authorities, pointing perhaps to lack of sensitivity on the part of the school to problems in mental health. Table II shows that the median Intelligence Quotient of the girls is lower in all but the discipline and truancy cases; however, the age-grade retardation is less for the girls in almost all types ?f problems no retardation less
by
(in computing age-grade status, than one-half year was counted; our figures place the children in a more favorable light than would be the case if the one-half year cases had been included). There seems a tendency for girls to present problems when slightly retarded in age-grade status as compared with more retarded boys. Girls, although less intelligent, are less retarded; this tendency has been observed in other studies. The group as a whole, it may be noted, tends to be subnormal in
intelligence; the children referred by the school are somewhat more retarded than those referred by the Centre and by parents. The age-grade status of the school cases is considerably lower on the average than Centre and parent cases. Summary In general, the analysis shows that mental hygiene cases from this particular area are slightly retarded in intelligence. Health
THE PSYCHOLOGICAL CLINIC
280
Table II Median I.Q.
and
Average Age Gbade Retardation of 295 Cases According to Problem, Sex and Source of Case Backward
Neurotic
Vocational
Discipline
Truancy
Miscellaneous
Boys Girls
Boys Girls
Boys Girls
Boys Girls
Boys Girls
Boys Girls
Source of Case
Centre Mdn. I.Q. 86... Av. Age Grade 0.9 School Median I.Q. 83 Av. Age Grade 1.8 Parent Mdn. I.Q. 96... Av. Age Grade 0.8
72
71
95
89
94
83
89
96
103
2.0s
1.2
0.9
0.9
1.2
0.8
1.3
0.9
0.1
77
69
82
97
82
75
94
90
87
87
97
2.0
2.2
1.5
0.0
2.0
2.3
1.9
1.2
2.0
1.5
2.0
82
82
101
127
97
2.7
0.7
0.5
0.7 |3.0
0.0
0.8
89
67
82
86
1.0
3.0
1.0
1.5
Other Agencies Mdn. I.Q. 84... Av. Age Grade 1.4 Mdn. I.Q. 86... Av. Age Grade 1.3
112
74
72
94
91
94
81
2.1
1.4
0.9
0.8
0.9
1.4
* 2 cases attending ungraded class counted t Boldface indicates acceleration.
1.4 as
99 0.1
97
127
112
0.7
2.0
0.5
94
87
87
104
0.9
2.0
1.5
1.0
97 0.8
2 years retardation.
workers at the Centre are relatively more sensitive to neurotic traits, school personnel to disciplinary difficulties, and parents to discipline as mental hygiene problems. Girls are referred to the clinic at later ages than are boys for most problems. Girls when referred are more retarded intellectually than boys but less retarded in age-grade status for most problems. Children referred by health workers are somewhat brighter and younger than children referred by school officers, on the whole. School cases are predominantly cases of non-conformity to school regulations; nonconformity is emphasized more than intellectual retardation or even school retardation by school authorities in recommending children to a mental hygiene clinic.
