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Full text of "The Forty-Ninth Yearbook Of The National Society For The Study Of Education Part II The Education Of Exceptional Children"

THE 

FORTY-NINTH YEARBOOK 

OP THE 

NATIONAL SOCIETY FOR THE STUDY 
OF EDUCATION 

PART II 

THE EDUCATION OF 
EXCEPTIONAL CHILDREN 



Prepared by the Society 1 s Committee 

HARRY J. BARER, W. W. CHARTERS, SAMUEL A. KIRK (Chairman), ELISE 
H. MARTENS, AND EDWARD II. STUL.LKEN 



Edited by 
NELSON B. HENRY 



Distributed by 

THE UNIVERSITY OF CHICAGO PRESS 

CHICAGO 37, ILLINOIS 

1950 



Published by 

THE NATIONAL SOCIETY FOR THE STUDY OF EDUCATION 
5835 KIMBARK AVENUE, CHICAGO 37, ILLINOIS 



COPYRIGHT, 1950, BY 

NELSON B. HENRY 
Secretary of the Society 



No part of this Yearbook may be reproduced in any form without 
written permission from the Secretary of the Society 



The responsibilities of the Board of Directors of the National 
Society for the Study of Education in the case of yearbooks 
prepared by the Society's committees are (1) to select the sub- 
jects to be investigated, (2) to appoint committees calculated in 
their personnel to insure consideration of all significant points 
of view, (3) to provide appropriate subsidies for necessary 
expenses, (4) to publish and distribute the committees' reports, 
and (5) to arrange for their discussion at the annual meetings. 

The responsibility of the Yearbook Editor is to prepare the 
submitted manuscripts for publication in accordance with the 
principles and regulations approved by the Board of Directors 
in the "Guide for Contributors" 

Neither the Board of Directors, nor the Yearbook Editor, 
nor the Society is responsible for the conclusions reached or the 
opinions expressed by the Society's yearbook committees. 



Published 1050 

First Printing, 0,000 Copies 

Second Printing, July, 1950, 5,000 Copies 

Third Printing, May, 1951, 6,000 Copies 

Fourth Printing, June, 1953, 5,000 Copies 

Fifth Printing, November, 1955, 4,000 Copies 

Sixth Printing, September, 1957, 5,000 Copies 



Printed in the United States of America 
ii 



OFFICERS OF THE SOCIETY 

1949-50 



(Term of office expires March 1 of the year indicated) 

WILLIAM A. BROWNELL (1952) 
Northwestern University, Evanston, Illinois 

HAUL R. DOUGLASS (1953)* 
University of Colorado, Boulder, Colorado 

FRANK N. FREEMAN (1951) 
University of California, Berkeley, California 

T. R. MCCONNELL (1952) 
University of Minnesota, Minneapolis, Minnesota 

RUTH STRANG (1951) 
Teachers College, Columbia University, New York, New York 

RALPH W. TYLER (1953)* 
University of Chicago, Chicago, Illinois 

NELSON B. HENRY (Ex-officio) 
University of Chicago, Chicago, Illinois 

Secretary-Treasurer 

NELSON B. HENRY (1950) 

University of Chicago, Chicago, Illinois 

* Re-elected for three years beginning March 1, 1950. 



ill 



THE SOCIETY'S COMMITTEE ON THE EDUCATION OF 
EXCEPTIONAL CHILDREN 

HARRY J. BAKER, Divisional Director, Psychological Clinic, Detroit 
Public Schools, Detroit, Michigan 

W. W. CHARTERS, Director, Research Service, Stephens College, Colum- 
bia, Missouri 

SAMUEL A. KIRK (Chairman), Professor of Special Education, Univer- 
sity of Illinois, Urbana, Illinois 

ELISE H. MARTENS, Chief, Exceptional Children and Youth, Office of 
Education, Federal Security Agency, Washington, D.C. 

EDWARD H. STULLKEN, Principal, Montefiore School, Chicago, Illinois 

ASSOCIATED CONTRIBUTORS 

WILLIAM M. CRUICKSHANK, Director of Special Education for the Ex- 
ceptional, School of Education, Syracuse University, Syracuse, New 
York 

ANNA M. ENGEL, Divisional Director, Department of Special Education, 
Detroit Public Schools, Detroit, Michigan 

F. H. FINCH, Professor of Education, University of Illinois, Urbana, 
Illinois 

RAY GRAHAM, Assistant Superintendent, Director of Education of Ex- 
ceptional Children, Office of Public Instruction, Springfield, Illinois 

WINIFRED HATHAWAY, Associate Director, National Association for the 
Prevention of Blindness, New York, New York 

BYRON O. HUGHES, Associate Professor of Child Development, Univer- 
sity of Michigan, Ann Arbor, Michigan 

CHRISTINE P. INGRAM, Associate Professor of Psychology and Education, 
Illinois State Normal University, Normal, Illinois 

EVELINE E. JACOBS, Research Analyst, National Society for Crippled 
Children and Adults, Inc., Chicago, Illinois 

WENDELL JOHNSON, Professor of Speech Pathology and Psychology and 
Director of the Speech Clinic, State University of Iowa, Iowa City, 
Iowa 

ELIZABETH M. KELLY, Director, Department of Special Education, 
Newark Public Schools, Newark, New Jersey 

SAMUEL R. LAYCOCK, Dean of Education, University of Saskatchewan, 
Saskatoon, Saskatchewan 



vi ASSOCIATED CONTRIBUTORS 

LAWRENCE J. LINCK, Executive Director, National Society for Crippled 
Children and Adults, Inc., Chicago, Illinois 

FRANCIS E. LORD, Director of Special Education, Michigan State Nor- 
mal College, Ypsilanti, Michigan 

BERTHOLD LOWENFELD, Superintendent, California School for the Blind, 
Berkeley, California 

DOROTHY NORRIS, Supervisor of Major Work Classes, Board of Educa- 
tion, Cleveland, Ohio 

CLARENCE D. O'CONNOR, Superintendent, Lexington School for the 
Deaf, New York, New York 

WILLARD C. OLSON, Professor of Education and Psychology, University 
of Michigan, Ann Arbor, Michigan 

WILLIAM G. PEACHER, Instructor in Clinical Surgery (Neurosurgery) and 
Associate Professor of Speech Pathology, Syracuse University, Syra- 
cuse, New York 

HENRY C. SCHUMACHER, Medical Director, United States Public Health 
Service, and Consultant in Mental Health Activities, Federal Secu- 
rity Agency, Region Ten, San Francisco, California 

JAYNE SHOVER, Special-Education Consultant, National Society for 
Crippled Children and Adults, Inc., Chicago, Illinois 

MILDRED B. STANTON, Consultant, Special Education, State Depart- 
ment of Education, Hartford, Connecticut 

HARVEY A. STEVENS, Superintendent, Southern Wisconsin Colony and 
Training School, Union Grove, Wisconsin 

GEORGE S. STEVENSON, Medical Director, National Committee for Men- 
tal Hygiene, New York, New York 

ALICE STRENG, Director, Division of Exceptional Education, State 
Teachers College, Milwaukee, Wisconsin 

MERLE R. SUMPTION, Associate Professor of Education, University of 
Illinois, Urbana, Illinois 

LEWIS M. TERMAN, Professor Emeritus of Psychology, Stanford Univer- 
sity, Stanford University, California 

VELMA YOWELL, Research Analyst, Illinois Commission for Handicapped 
Children, Chicago, Illinois 



EDITOR'S PREFACE 

Consideration of the desirability of a yearbook in the field of special 
education was initiated by a letter to the Board of Directors written by 
Dr. Harry J. Baker on behalf of the International Council for Excep- 
tional Children. Following a preliminary discussion of this suggestion at 
the meeting of the Board in April, 1946, it was decided to request Dr. 
Baker and his associates to prepare a formal proposal indicating the most 
useful kind of yearbook in this area from the point of view of the purposes 
and plans of the Council. The resulting proposal was presented to the 
Board of Directors at its meeting in June, 1947, by Messrs. Kirk and 
Stullken, who had been selected by the Council as a special committee to 
confer with the Board. The proposal was approved, and Mr. Kirk was 
requested to serve as .the chairman of the committee for the preparation 
of the yearbook. Mr. Charters was appointed a member of the committee, 
serving as the representative of the Board of Directors. 

Although prepared by recognized specialists in fields of study pertain- 
ing to different classes of atypical children, The Education of Exceptional 
Children will furnish valuable guidance to teachers in regularly organized 
classrooms, to school administrators and supervisors, and to the parents 
of children requiring unusual educational programs and facilities, as well 
as to the various professional workers having specialized training in the 
educational, psychological, or medical services which contribute to the 
improvement of the educational opportunities and the personal welfare 
of the children with whom this volume is concerned. It is also anticipated 
that the yearbook will stimulate further progress in the development of 
teacher-training programs designed to facilitate the work of all classes of 
teachers in dealing with pupils whose learning experiences are rendered 
ineffective by educational handicaps of different kinds. Earlier year- 
books of the Society have dealt with the educational requirements of 
particular classes of exceptional children and, in various connections, 
with the peculiar needs of some children in relation to specific learning 
problems. The present volume describes the appropriate procedures in 
all areas of special education and in various types of school situations. 

NELSON B. HENRY 



vii 



TABLE OF CONTENTS 

FAQ! 

OFFICERS OF THE SOCIETY FOR 1949-50 iii 

THE SOCIETY'S COMMITTEE ON THE EDUCATION OF EXCEPTIONAL 

CHILDREN iv 

ASSOCIATED CONTRIBUTORS iv 

EDITOR'S PREFACE vii 

INTRODUCTION TO YEARBOOK 1 

SECTION I. GENERAL CONCEPTS AND PROBLEMS 

CHAPTER 

I. BASIC FACTS AND PRINCIPLES UNDERLYING SPECIAL EDU- 
CATION 3 

THE YEARBOOK COMMITTEE 

Defining the Problem 3 

The Extent of the Problem 6 

Changing Concepts in the Education of Exceptional Chil- 
dren 7 

Extent of Educational Provisions for Exceptional Children 12 

Essentials of a Well-rounded Program 14 

II. ADMINISTERING THE SPECIAL SERVICES FOR EXCEPTIONAL 

CHILDREN 18 

RAY GRAHAM AND ANNA M. ENOEL 

Introduction 18 

Objectives of Special Education 19 

Principles of Sound Administration and Supervision in Spe- 
cial Education 20 

Organization of Special Education at the Local Level . . 22 

Organization at the State Level 31 

Conclusion 36 

III. IDENTIFYING AND DIAGNOSING EXCEPTIONAL CHILDREN . 38 
HARRY J. BAKER AND MILDRED B. STANTON 

Introduction 38 

Legislation and Authorization 39 

Group Surveys and Inspections 40 

Individual Diagnosis 43 

Summary and Conclusion 59 

ix 



X TABLE OF CONTENTS 

CHAPTER PAGH 

IV. GROWTH PATTERNS OF EXCEPTIONAL CHILDREN ... 61 

WlLLARD C. OLSON AND BYRON 0. HUGHES 

Introduction 61 

Units for the Description of Growth 61 

The Intellectually Gifted Child 62 

Sibling Resemblances in Gifted Children 65 

The Growth of Mentally Retarded Children .... 66 

Slow Growth with Apparent Glandular Disturbances . . 68 

Diversity in Level and Rate 71 

The Retarded in Speech 72 

Children of Lowered Vitality 74 

Affectivity and Growth 77 

Social Relations of the Exceptional Child 78 

Summary and Implications 80 

V. GUIDANCE FOR THE EXCEPTIONAL CHILD 83 

F. H. FINCH AND VELMA YOWELL 

Introduction 83 

Guidance and Personality Development 85 

Special Guidance Needed by the Handicapped .... 91 

The Counselor in the School 93 

The Contribution of Nonschool Agencies to Vocational Ad- 
justment 94 

VI. THE EDUCATION OF TEACHERS OF SPECIAL CLASSES . . 103 
FRANCIS E. LORD AND SAMUEL A. KIRK 

Introduction 103 

Teacher Training in Special Education 105 

Present Facilities 107 

State Requirements 109 

Qualifications of Special Teachers 110 

Program of Training Ill 

Recruitment of Students 114 

Summary Statement 116 

VII. PARENTS' PROBLEMS WITH EXCEPTIONAL CHILDREN . .117 
SAMUEL R. LAYCOCK AND GEORGE S. STEVENSON 

Introduction 117 

The Development of Attitudes in Parents 120 

The Development of Understandings in Parents . . . 122 

The Development of Skills in Parents 125 

Conclusion 133 



TABLE OF CONTENTS xi 



SECTION II. NATURE AND NEEDS OF SPECIFIC GROUPS 

CHAPTER PAGE 

VIII. TEACHING THE VISUALLY HANDICAPPED 135 

WINIFRED HATHAWAY AND BERTHOLD LOWENFELD 

Introduction 135 

The Partially Seeing 136 

The Blind 142 



IX. TEACHING THE ACOUSTICALLY HANDICAPPED .... 152 

CLARENCE D. O'CONNOR AND ALICE STRENQ 

Introduction 152 

Classifying Children with Hearing Loss 152 

Signs and Symptoms of Hearing Loss 154 

Finding Children with Hearing Loss 156 

Characteristics of Children with Hearing Loss .... 160 

Causes 162 

Needs and Education of Children with Hearing Loss . . 163 

A Look to the Future 173 

X. TEACHING CHILDREN WITH SPEECH HANDICAPS . . . 176 

WENDELL JOHNSON 

Introduction 176 

Types of Speech Defects 176 

Public School Speech Correction 184 

Concluding Considerations 192 

XI. TEACHING THE ORTHOPEDICALLY HANDICAPPED AND THE 

CARDIOPATHIC 194 

LAWRENCE J. LINCK, JAYNE SHOVER, AND EVELINE E. JACOBS 

Introduction 194 

Finding Crippled Children 195 

Classification of Crippling Conditions 196 

General Characteristics of Crippled Children .... 197 

Medical Needs 200 

Educational Provisions for Crippled Children .... 203 

Examples of School Provisions for Crippled Children . . 212 

Looking to the Future 215 



xii TABLE OF CONTENTS 

CHAPTER PAGfl 

XII. SPECIAL EDUCATION FOR THE EPILEPTIC, THE TUBERCULAR, 

AND CHILDREN WITH GLANDULAR DISORDERS .... 218 

WILLIAM M. CRUICKSHANK AND WILLIAM G. PEACHER 
Identifying the Children Who Require Particular Types of 

Special Services 218 

Epilepsy in Children 219 

Tuberculosis in Children 229 

Disorders of Glandular Function and Growth .... 232 

Needed Research 236 

XIII. SPECIAL EDUCATION FOR THE MENTALLY HANDICAPPED . 237 

ELIZABETH M. KELLY AND HARVEY A. STEVENS 

Classification of the Mentally Handicapped .... 237 

Discovering the Mentally Handicapped 238 

Characteristics of the Mentally Handicapped .... 239 

Educational Provisions for the Mentally Handicapped . 241 
Implementation of Remedial Programs for the Mentally 

Handicapped 244 

Trends in the Education of the Mentally Handicapped . 253 

XIV. SPECIAL EDUCATION FOR THE GIFTED CHILD .... 259 
MERLE R. SUMPTION, DOROTHY NORRIS, AND LEWIS M. TERMAN 

History 259 

Philosophical Considerations 260 

Identifying the Gifted 261 

Characteristics of the Gifted 263 

Providing Appropriate Education for the Gifted . . . 264 

Follow-up Studies and Their Educational Implications . 271 

Summary Statement 278 

XV. SPECIAL SCHOOLS AND CLASSES FOR THE SOCIALLY MAL- 
ADJUSTED 281 

EDWARD H. STULLKEN 

Introduction 281 

Socially Maladjusted Defined 282 

Identifying the Socially Maladjusted 283 

Characteristics of Socially Maladjusted Children . . . 286 

Special Needs of the Socially Maladjusted .... 289 

Educational Program for the Socially Maladjusted . . 291 

Teacher Personnel 297 

Principles of Good Practice 299 



TABLE OF CONTENTS xiii 
SECTION III. SOME FUTURE DEVELOPMENTS 

CHAPTER PAGE 

XVI. THE PREVENTION OF HANDICAPS IN CHILDREN . . . 302 

CHRISTINE P. INGRAM AND HENRY C. SCHUMACHER 

Introductory Statement 302 

Prenatal, Natal, and Postnatal Factors 304 

Prevention of Abnormalities and Disease 309 

Prevention of Sensory Defects 311 

Accident Prevention 312 

Prevention of Social Maladjustment 313 

Summary 318 

XVII. NEEDED PROJECTS AND RESEARCH IN SPECIAL EDUCATION 320 

SAMUEL A. KIRK 

Introduction 320 

The Number and Distribution of Exceptional Children . 321 

Organizational and Administrative Problems .... 322 

Diagnosis 324 

Projects and Research in the Specific Areas .... 325 

Concluding Statement 334 

APPENDIX 335 

INDEX 347 

INFORMATION CONCERNING THE SOCIETY i 

LIST OF PUBLICATIONS OF THE SOCIETY iii 



INTRODUCTION TO YEARBOOK 



SAMUEL A. KIRK 

Professor of Education 

College of Education, University of Illinois 

Urbana, Illinois 



PURPOSE OF YEARBOOK 

The purpose of the yearbook is to explain the nature of the problems 
with which the school and the community are confronted in connection 
with the education of exceptional children and to describe the procedures 
and special services which have been found effective in meeting the needs 
of exceptional children within a school system. The presentation of these 
problems will be directed to school administrators and teachers who are 
unfamiliar with the technical phases of diagnosis and the indicated 
therapy with reference to the seriously handicapped among the different 
groups of exceptional children rather than to the various specialists in the 
field. 

Busy administrators should find within the pages of this book answers 
to the problems which face them in promoting, organizing, and admin- 
istering special services for the various groups of exceptional children. 
They should find answers to both the general questions which apply to 
all groups of exceptional children and the more specific questions per- 
taining to particular types of exceptional children. 

Regular classroom teachers should find this book of great assistance 
in adapting instruction to the needs of pupils within their own class- 
rooms. It is important that the regular classroom teacher be sensitized 
to the problems faced by exceptional children, to know where to refer 
them, and to know what to do with the many borderline children who 
will always be found in the regular classrooms. A major purpose of the 
book is to acquaint the regular classroom teacher with the needs of ex- 
ceptional children, the attempts of our democratic society to meet these 
needs, and the procedures employed by the various specialists in the 
field. 

The teacher of a special class should receive invaluable assistance from 
the yearbook, not so much with the special techniques of teaching his 
particular area of specialization, but in broadening his knowledge about 
the specific problems faced by the children outside the classroom and 



2 INTRODUCTION 

in acquiring knowledge of practices for other groups of exceptional chil- 
dren. The teacher of the deaf, for example, would gain knowledge about 
the organization of classes for the deaf, information concerning other 
services for the deaf, and also an understanding of the problems of other 
types of exceptional children rather than techniques of teaching the deaf 
in his classroom. Even a class for the deaf has within its own organiza- 
tion children who are mentally retarded or accelerated, children with 
defective vision, or other handicaps. To this extent, the book as a whole 
should be of value to all teachers of special classes. 

In addition to administrators and teachers of regular and special 
classes, students in teachers colleges and universities who plan to embark 
on the career of teaching should find this book of service in orienting 
them to the problems of exceptional children. In this way the book could 
serve as one of the textbooks in an orientation course on exceptional chil- 
dren a course which should be required of all teachers in training. 

ORGANIZATION OF THE YEARBOOK 

The yearbook is divided into three sections. Section I attempts to give 
the reader an overview of the general concepts and problems relating to 
all groups of exceptional children. Each chapter in this section is con- 
cerned with the common problems of children who deviate mentally, 
physically, or socially. It orients the student to the basic problems com- 
mon to all rather than to problems which are peculiar to specific types of 
exceptional children. 

Section II of the yearbook consists of chapters written by specialists 
in the various fields. In this section the visually defective, the acoustically 
handicapped, the speech defective, the orthopedic and cardiopathic chil- 
dren, the mentally handicapped, the gifted, and the socially maladjusted 
are considered separately. 

Section III is an attempt to push forward the frontiers of the care and 
education of exceptional children by discussion of two problems that have 
not been emphasized sufficiently in the past, namely, the prevention of 
handicaps in children and the need for more emphasis on research in the 
field. 

The appendix includes a list of publications and agencies dealing with 
exceptional children. Workers in the field, including school administra- 
tors and teachers, social workers, psychologists, and others dealing with 
exceptional children, can obtain valuable assistance and information from 
these publications and agencies. 



SECTION I 
GENERAL CONCEPTS AND PROBLEMS 



CHAPTER I 

BASIC FACTS AND PRINCIPLES UNDERLYING 
SPECIAL EDUCATION 



THE YEARBOOK COMMITTEE 



DEFINING THE PROBLEM 
Educational Significance of Exceptional Traits 

In every school system there are pupils who, because they deviate 
markedly from the so-called "normal" child, require special skills and 
services on the part of teachers and other school personnel. These chil- 
dren cannot adjust to the school program without such special services. 
Some of them are physically handicapped blind, deaf, epileptic, or 
crippled. Some differ mentally to a significant degree, being either seri- 
ously retarded in intellectual development or exceptionally gifted. Some 
are emotionally disturbed or are unable to make a proper social adjust- 
ment in school and community; among these are children with serious 
behavior problems which may result in a disturbed personality or in de- 
linquency. 

All these are called "exceptional children," the term being used to refer 
to those who deviate from what is supposed to be average in physical, mental, 
emotional, or social characteristics to such an extent that they require special 
educational services in order to develop to their maximum capacity. Those 
special services may include a radical modification of the curriculum, spe- 
cial methods of instruction, special equipment, or an adjusted school 
schedule. Under present conditions of school organization, they can some- 
times be offered best through the medium of a special class or school; but, 
in many cases, they may be provided for individual pupils in a regular 
class. Whatever the type of exceptional condition and wherever the 
child may be, the important matter is that the child's needs be identified 
and satisfactorily met. 

The Responsibility of Public Education 

Inherent in the philosophy of democracy is the doctrine that every 
child is entitled to an education to the limit of his capacity. "All men are 



4 PRINCIPLES OF SPECIAL EDUCATION 

created equal" is a phrase so often used that it has become almost trite. 
Yet it is always meaningful. All are equal before the law, equal in their 
claim to freedom, equal in their right to learn if not in their capacity to 
learn. 

Democracy is, therefore, committed to the principle of education for 
all, regardless of race, creed, or abilities. It is committed to the education 
of all who are educable. The education of exceptional children represents 
an attempt on the part of the school to furnish equal opportunity to indi- 
viduals who differ in physical, mental, and social characteristics. It is a 
logical application of the truth that "all men are created equal." 

Another frequently quoted principle of democracy is that of the in- 
alienable right of the individual to "life, liberty, and the pursuit of hap- 
piness." It is not the accepted view that these rights are to be made se- 
cure for a select few, for those who are economically privileged, for those 
who have average intelligence, or for those who are physically normal. If 
the statement is taken literally, it means that everyone is entitled to se- 
curity in these respects. Moreover, by "everyone" we mean children with 
high intelligence, average intelligence, and low intelligence; children who 
are physically normal and those with serious handicaps; children who be- 
have as average children do, and those whose behavior is antisocial. All 
of them have an equal right to life's satisfactions. And it is the responsi- 
bility of public education to see that they get what they need. 

Objectives of Education for Exceptional Children 
The objectives of the education of exceptional children must be in ac- 
cord with these principles of democracy. They do not differ from the gen- 
eral objectives of education for all children. Exceptional children, like 
others, must become well-adjusted members of the family and the com- 
munity, must participate in the activities of the work-a-day world, and 
must assume responsibilities in keeping with their capacities as citizens 
in a democracy. 

The Educational Policies Commission has identified four groups of ob- 
jectives or educational purposes relating, respectively, to the person 
himself, to his membership in the family or community group, to his ac- 
tivities as a producer and consumer, and to his life as a citizen. The Com- 
mission defines these four groups as the objectives of (a) self-realization, 
(6) human relationship, (c) economic efficiency, and (d) civic responsi- 
bility. 1 

Every one of these applies to exceptional children. Self-realization is a 
universal need. The differences among people lie in the way in which that 

1 Educational Policies Commission, Policies JOT Education in American Democracy, 
p .189. Washington: National Education Association, 1946. 



THE YEARBOOK COMMITTEE 5 

self-realization is expressed. Everyone exceptional and average alike 
must have satisfying human relationships. Economic efficiency should be 
attained to the degree appropriate to each individual's interests and 
ability. Civic responsibility belongs to us all without exception. One 
other aim of education might well be added to these four, that of satisfy- 
ing spiritual experiences. For the seriously handicapped child, the inner 
life is often the major source of personal enrichment. Education must 
help to lay the foundation for the realization of such satisfying experi- 
ences. 

The Need of Special Education 

Exceptional children do not profit sufficiently from the group educa- 
tion techniques used in most of our schools for teaching children of aver- 
age ability. Society has not constructed enough classrooms, has not kept 
classes small enough, and has not provided enough highly qualified teach- 
ers. For this reason, it is necessary to furnish special services for excep- 
tional children, either in the regular classroom or in special schools and 
classes, if we expect them to grow according to their potentialities. 

A child with seriously defective vision requires different techniques of 
instruction than the child who has normal vision. So, also, a child with 
a marked hearing loss requires additional services and special instruction. 
The crippled child requires special facilities for his physical care and 
must have appropriate adjustments of his daily schedule if he is to make 
satisfactory progress. Even when all of these are provided, exceptional 
children in the same class with normal children and with the same teach- 
er, all trying to learn under the same methods of instruction, do not have 
equality of opportunity with others. Educational equality demands the 
consideration of individual differences and needs and the provision of 
special services to meet those needs. 

Contribution of Special Education to the Education of All Children 
All children in a school system profit from the special services provided 
for exceptional children. In the first place, handicapped children require 
more individual attention than the children who are not handicapped. If 
a regular classroom teacher is to devote adequate time to the exceptional 
child in a large class, he must often curtail the attention given to other 
children in the group. But when needed special services are provided for 
the handicapped child, the normal pupils may have the benefit of more 
of the teacher's time. 

In the second place, the methods that have been developed for excep- 
tional children have yielded gratifying results in the education of other 
children. There is an oft-repeated saying that we learn about the "nor- 
mal" from the "abnormal." Many educational practices for the correc- 



6 PRINCIPLES OF SPECIAL EDUCATION 

tion of social maladjustments in deviate children have proved to be ex- 
cellent preventive methods for all. Certain techniques that have been de- 
veloped for seriously retarded children are also good for those of average 
ability. Some pioneer educators, such as Montessori, Decroly, and Horace 
Mann, who began their educational work with exceptional children, 
found that the techniques which they developed were of great advantage 
to others. The activity movement, for example, in which it was empha- 
sized that the mentally defective could learn best "through doing," was 
later advocated as a general educational procedure. Programs for excep- 
tional children have thus provided laboratory situations leading to the 
development of new philosophies and methods, which in many cases have 
a universal school application. 

THE EXTENT OP THE PROBLEM 

From one point of view, of course, every child is exceptional, since 
every child's individual abilities and disabilities differ from those of every 
other child. In this discussion, however, the term "exceptional" is applied 
only to those who are so markedly different in physical, mental, emotion- 
al, or social traits that they need special educational treatment or 
services. 

No complete census of such exceptional children has ever been taken. 
As a result, authorities differ in their estimates of the percentage of a 
given school population that would be considered "exceptional." At the 
White House Conference on Child Health and Protection, held in 1930, 
it was reported that "there are more than 3,000,000 children in the ele- 
mentary schools of the United States who require special treatment and 
training to make the most of their possibilities. And this number does 
not include children who are suffering from malnutrition a number 
approximated as 6,000,000 and 625,000 more who have weak hearts." 2 

In a more recent publication issued by the United States Office of 
Education, it is estimated that 12.4 per cent of all school children require 
special services. 3 Baker reports that in Detroit, Michigan, 7 per cent of 
school children are receiving special education. Since there are waiting 
lists for special classes, he concludes that approximately 11 per cent of the 
total school population might need special education. 4 On the basis of 
these and other available findings, one might conservatively estimate 
that from 10 to 12 per cent of children of elementary- and secondary- 

2 White House Conference on Child Health and Protection, Special Education: 
The Handicapped and the Gifted, p. 7. New York: Century Co., 1931. 

8 Elise H. Martens, Needs of Exceptional Children t p. 4. United States Office of 
Education Leaflet No. 74, 1944. Washington: Government Printing Office, 1944. 

4 Harry J. Baker, Introduction to Exceptional Children, p. 458. New York: Mac- 
millan Co., 1944. 



THE YEARBOOK COMMITTEE 7 

school age would be considered "exceptional" and in need of special edu- 
cational services. The total number, according to the U.S. Office of Edu- 
cation report referred to above, 5 would approximate 4,000,000. 

These exceptional children do not, of course, comprise a single homo- 
geneous group. They include children with deviations in various areas. 
The different groups of exceptional children discussed in Section II of 
this yearbook include: 

1. Children with physical handicaps 

a) Crippled children those with poliomyelitis, cerebral palsy, con- 
genital deformities, and other orthopedic handicaps; also children 
with cardiac difficulties, sometimes called "crippled" hearts 

6) Children with impaired hearing the congenitally deaf, the adven- 
titiously deaf, and the hard of hearing 

c) Children with visual impairments the blind and the partially 
seeing 

d) Children with speech handicaps 6 

e) Children with other types of physical handicaps, such as tubercu- 
losis, epilepsy, and endocrine disorders 

2. Children with mental deviations 

a) Children of low intelligence, including both the feeble-minded and 
those who are less seriously defective in intellectual development 

6) Children with high intelligence, including both those with special 
talents and those who are superior in general intellectual abilities 

3. Children with emotional or social maladjustments, including those 
with serious behavior disorders or emotional disturbances 

The education of exceptional children, then, involves a program de- 
signed to further the growth of the 10 to 12 per cent of children who re- 
quire special facilities for their optimum development. As previously 
noted, the goals of education for them are the same as those for all chil- 
dren. The difference lies in the means or techniques by which those goals 
can be realized and in the way in which they find expression in the indi- 
vidual's life. 

CHANGING CONCEPTS IN THE EDUCATION 
OF EXCEPTIONAL CHILDREN 

Early Ideas of Custodial Care 

Through many centuries exceptional children have had the attention 
of the society in which they lived. During the pre-Christian era, the 



6 Martens, op. cit. 

8 Speech handicaps may be of either physical or functional origin. For purposes of 
state legislation providing financial support, these children are usually included 
among the "physically handicapped." 



8 PRINCIPLES OF SPECIAL EDUCATION 

handicapped were persecuted, neglected, and mistreated. Survival of the 
fittest was the code. With the beginning of the Christian era, certain so- 
cieties became interested in the custodial care of handicapped individu- 
als. There was emphasis upon the brotherhood of man and upon the re- 
sponsibility of the strong to protect the weak. As a result, it became the 
task of religious groups to care for handicapped children. 

During the Middle Ages the church continued as the responsible agen- 
cy. Institutions for the deaf, for the mentally deficient, and for other 
groups were established in Europe in the seventeenth and eighteenth 
centuries. Medical science then became interested. Itard, Seguin, Mon- 
tessori, Decroly, and Binet were all physicians or psychologists. These 
were some of the persons who made the early contributions to the edu- 
cation of the deaf and the mentally deficient. 7 

Early American Efforts 

In America, the first residential institution for handicapped children 
was the American School for the Deaf, privately organized in Hartford, 
Connecticut, in 1817. 8 In the years that followed, states began to recog- 
nize their responsibility, and by the middle of the century several state 
schools had become established. Today there are very few states in the 
United States that do not have residential institutions for the blind, the 
deaf, the mentally deficient, and the delinquent. 

Special classes in local school systems did not become widely known 
until the early part of the twentieth century, though some classes had 
already been organized in a few large cities before 1900. Today classes for 
all types of exceptional children are well-established parts of many local 
public school systems. 

Influence of Twentieth-Century Developments 
It was not until about the time of World War I that special educa- 
tion in local school districts made significant advancement. By this time 
compulsory school attendance had become widespread in the United 
States. The schools could no longer neglect children, and parents could 
no longer permit children to remain at home without official exemption 
from school attendance. In addition, the mental testing movement had 
become general in the United States and provided an instrument for the 
study of the educational potentiality of each child. The use of these tests 
led to greater recognition of individual differences among school children 



7 Merle E. Frampton and M. E. Rowell, Education of the Handicapped, Vol. I, 
History, p. 9. Yonkers, New York: World Book Co., 1948. 

8 White House Conference on Child Health and Protection, Organization for the 
Care of the Handicapped, Sec. IV, p. 35. New York: D. Appleton Co., Inc., 1932. 



THE YEARBOOK COMMITTEE 9 

and thus contributed to the development of special programs for those 
who were deemed exceptional. 

By 1930, sixteen states had enacted laws authorizing reimbursement 
to local school districts for the excess cost of the education of exceptional 
children. 9 The depression of the 1930's retarded progress, but statistics 
show that despite the depression there were more children enrolled in spe- 
cial classes at the end of the decade (in 1940) than at the beginning. 10 
This meant that school systems which had already established such pro- 
visions for exceptional children found the value of the work so great that 
they continued it, even though state funds for reimbursement had been 
decreased. Some local school systems began the work without state re- 
imbursement. 

World War II demonstrated that the handicapped are excellent work- 
ers when they are given the opportunity to produce. During the war the 
United States Civil Service Commission published data 11 showing that 
(a) there was less absenteeism among the handicapped than among the 
nonhandicapped; (6) there was less turnover among the handicapped 
than among the nonhandicapped; (c) there was a lower accident rate 
among the handicapped than among the nonhandicapped; and (d) the 
production record of the handicapped was higher than that of the non- 
handicapped. 

It was discovered, too, during the war that, in order to accelerate 
training and utilize all manpower, the Army must recognize individual 
differences among men. Approximately 300,000 men, out of about 
10,000,000 inducted into the Army, were placed in special-training units 
for illiterates or marginally literate men. 12 Thousands more went through 
reconditioning centers for the physically handicapped, to be prepared for 
active duty or for production in civilian life. In certain military camps, 
programs for the socially maladjusted were initiated in order to rehabili- 
tate men for duty. 

The military forces are not necessarily reform organizations. They are 
not educational institutions. Their task was to win the war as fast as 
possible with the least number of casualties. All training programs were 



9 Robert W. Kunzig, Public School Education of Atypical Children, pp. 26-27. 
United States Office of Education Bulletin No. 10, 1931. Washington: Government 
Printing Office, 1931. 

10 Elise H. Martens and Emery M. Foster, Statistics of Special Schools and Classes 
for Exceptional Children, 1989-1940, p. 6, Washington: Government Printing Office, 
1942. 

11 Untapped Manpower. Washington: United States Civil Service Commission, 
November, 1943 (revised edition). 

12 Information obtained from Adjutant General, United States Army. 



10 PRINCIPLES OF SPECIAL EDUCATION 

organized with that aim in view. It was a sound expedient for the Army 
to set up special educational provisions for men in the Army, in order 
that training might be accomplished and the war won as soon as possible 
with the least possible loss of men. 

This wartime program and the return of many handicapped men to 
civilian life after the war had a definite effect upon special education for 
exceptional children. The general public became more and more cognizant 
of the work that could be done with handicapped individuals. States 
which already had special-education programs in operation expanded 
their offerings. Many that had not made such provisions now passed laws 
and appropriated large sums of money for the promotion of work in the 
local schools. By 1948, forty-one states had enacted laws authorizing or 
requiring local school districts to make special provisions for one or more 
types of exceptional children. Thirty-four of these states have provided 
funds to help the local districts finance the program. 

Modern Philosophy of Special Education 

Exceptional Children Are Basically Like Other Children. It must always 
be remembered that the education of exceptional children has basic con- 
cepts and goals in common with the education of all children. The same 
principles of child development prevail. A deaf child is a child with a 
hearing handicap. As a child, he has all the needs, desires, and physical 
energy of children in general. Basically, the only way in which he differs 
from an average child is his inability to hear; and, because of this hearing 
handicap, he is unable to speak. This difference makes it necessary to 
plan his education with special consideration for his disabilities. The 
mentally retarded child, the child with a visual impairment, the crippled 
child, and every other exceptional child has fundamental motives and 
drives common to children in general; but along with those common 
characteristics there is in each case a specific handicap or exceptional 
condition that requires an adjustment or special service in his education- 
al program. That program should be designed with full recognition of 
(a) his likeness to normal children and (6) his speciallieeds. This, in brief, 
constitutes the modern approach to the education of exceptional children. 
Instruction of Exceptional Children Is Individualized. In view of the 
unique aims of the special-education program, it is necessary to provide 
for the individualization of classroom work with all exceptional children. 
Special classes for the deaf or the blind have enrolments of six or eight 
children, and a class for the mentally handicapped may number from 
fifteen to twenty children. By keeping the classes small and by securing 
adequately prepared teachers, instruction becomes individual. It is true, 
of course, that individual instruction for all children in regular classes has 



THE YEARBOOK COMMITTEE 11 

been advocated for many years. But to individualize instruction in a 
class of thirty-five or forty pupils of varying abilities and needs is a diffi- 
cult matter. The small size of classes in special education makes it pos- 
sible to achieve that aim much more readily. 

Diagnostic Services Are Provided. Children should be referred for spe- 
cial education only after adequate diagnosis of the physical or mental 
condition has been made by an appropriate specialist. Ophthalmologists, 
otologists, orthopedists, pediatricians, and psychologists are important 
people in conducting a school program for exceptional children, for it is 
only when a proper diagnosis has been made that appropriate school ad- 
justments can be planned. A correct diagnosis is, therefore, the first step 
in any school service for the exceptional child. Special education empha- 
sizes this procedure as a necessary element in the total philosophy under- 
lying the program. 

Class Placement Is a Flexible Matter. There has been considerable con- 
troversy over the policy of "segregation" of exceptional children from 
the normal school population. The modern concept of special education 
looks upon the special program planned for an exceptional child as com- 
parable to an arrangement made for any child when he needs to enter a 
hospital for a month or two months or a year. It is a special service made 
available to him when and while he needs it. It is not a matter of taking 
him away or separating him from something which he has a right to 
enjoy. 

Moreover, special education admits of various procedures and situa- 
tions. It may in some instances be brought to a child in the regular class- 
room, where the regular teacher or a visiting specialist will help him to 
make the needed adjustment. It may involve a limited period of extra and 
special help outside the regular classroom, as in speech correction or lip 
reading, while the pupil spends most of the day with his regular teacher. 
It may mean spending a large part of the day with a special teacher, as in 
sight conservation, and the rest of the day in regular classes. It may mean 
spending most of the time in a special class, with occasional or periodic 
participation with other children in selected school activities. In some 
cases it may mean continuing membership in a special day school or in a 
special residential school. 

All these are varying degrees or levels of special services, and each 
must be chosen according to the best interests of the child. If a child can 
be accepted by a regular class and can profit by instruction in the regular 
class, with needed special services brought to him there, he may well re- 
main there. If, however, his enrolment in the regular class is detrimental 
to his own development or that of the other children, then he should be 
placed where his growth can best be furthered. Thus, the education of 



12 PRINCIPLES OF SPECIAL EDUCATION 

exceptional children accepts special services in regular grades, special 
classes, and special schools as possible means for the appropriate educa- 
tion of each child. 

Special Education for the Handicapped Does Not Preelvide Measures of 
Prevention or Correction. It is a major responsibility of society to use the 
results of medical research and the social resources at its command to 
prevent handicaps and maladjustments among children. Workers in the 
field of special education would gladly see the need for such services 
eliminated. But while the need prevails, they must carry on, always seek- 
ing the ways and means of preventing further complications and correct- 
ing existing handicaps, and, when measures of prevention or correction 
have not proved effective, doing everything possible to bring about a sat- 
isfying compensation and adjustment. 

EXTENT OF EDUCATIONAL PROVISIONS FOR 
EXCEPTIONAL CHILDREN 

Enrolment in Special Schools and Classes 

Statistics gathered for the year 1947-48 indicate that approximately 
365,000 18 exceptional children were enrolled in special schools and classes 
or for home or hospital instruction provided by local school districts. In 
1940 the number so reported was 313,722. When one adds pupils attend- 
ing classes in residential schools for the blind, the deaf, the delinquent, 
the epileptic, and the mentally deficient, the over-all figure for 1948 was 
about 425,000 as compared with 385,000 in 1940 and 335,000 in 1932. Al- 
though there has been a steady growth in providing special-education 
facilities for exceptional children, we are still far from reaching the desir- 
able goal. If we accept the estimate that from 10 to 12 per cent of children 
of elementary- and secondary- school age are in need of special education- 
al advantages, the schools should probably be providing such advantages 
for three or four million children instead of caring for slightly more than 
400,000. This work must be done either in special schools and classes or 
through adjustments made in the regular classes. 

Adjustments in Regular Classes 

There is no way to determine the extent to which adjustments are be- 
ing made in regular classes for children who are "exceptional" as judged 
by our definition. There is no doubt that many capable and understand- 
ing teachers are attempting to apply the modern concepts of child devel- 
opment to meet the needs of exceptional pupils. When no special educa- 



18 From figures, as yet unpublished, gathered by the United States Office of Educa- 
tion. 



THE YEARBOOK COMMITTEE 13 

tional services are available, the teacher does the best he can, sometimes 
with effective results. 

It is obvious, however, that no one teacher can be expected to be a 
specialist in sight-saving techniques, lip-reading instruction, speech cor- 
rection, adjustments for the mentally deficient, and every other educa- 
tional service represented in special education. When there are several 
exceptional children in the same classroom, each representing a different 
type of handicap or exceptional condition, the only satisfactory way to 
give them the service they need is to secure the aid of persons who know 
their respective problems and who can either help the children directly 
or help the regular teacher to help them. This is the procedure followed 
in the rural schools of states where supervisors or consultants in special 
education operate on a county-wide basis and travel from school to 
school to assist teachers in identifying exceptional children and in making 
adjustments for them. There is no way of knowing how many children 
are actually being served in this way. 

State-wide Provisions 

The most dramatic growth in special education has taken place 
through the enactment of legislation stimulating the development of 
state-wide programs. Reference has already been made to the fact that 
forty-one states have laws authorizing or requiring local school districts 
to organize special schools or classes for one or more groups of exceptional 
children; and that thirty-four of these states have made appropriations 
to help local districts meet the excess cost of such service. 14 

It should be further noted that twenty-three states have enacted legis- 
lation providing supervisory or consultative service in special education 
through the state education department and that eleven more states have 
furnished such service under the general powers granted the chief state 
school officer. Since only sixteen states had supervisory personnel in spe- 
cial education at the state level in 1940, it is obvious that this phase of 
the program is growing satisfactorily. 

Another field in which the state has taken an active part is the area 
of teacher education. In chapter vi detailed consideration is given to the 
whole matter of the preparation of teachers. It need only be said here 
that never before have states encouraged the preparation of teachers of 
exceptional children as they are doing today. Such encouragement takes 
the form of special appropriations to selected teacher-education institu- 
tions for the development of a well-rounded program in special education, 



14 Elise H. Martens, State Legislation for Education of Exceptional Children and 
Youth. United States Office of Education Bulletin No. 2, 1949. Washington: Govern- 
ment Printing Office, 1949. 



14 PRINCIPLES OF SPECIAL EDUCATION 

co-operation with a number of teacher-education institutions in the state 
through partial payment of the salaries of selected staff members, or the 
granting of scholarships to teachers in service for summer-school study. 
University and college administrators are finding it necessary to increase 
their efforts to provide adequate personnel for a program which is grow- 
ing rapidly. Voluntary agencies, such as parent-teacher organizations and 
crippled children's societies, are joining in the recruitment program and 
are offering financial assistance. Through all these resources, the atten- 
tion of prospective teachers and of teachers in service is being drawn to 
the professional opportunities in the special-education field. 

ESSENTIALS OF A WELL-ROUNDED PROGRAM 

If a program for the education of exceptional children in a given state 
or community is to be complete, certain essentials of an effective program 
must be included. Each of these is discussed in greater detail in chapters 
that follow. They are briefly stated here in order to present the picture 
as a whole. 

There Must Be Special Services for All Types of 
Exceptional Children 

This means that no group can be neglected. The needs of each one 
must be considered just as important as the needs of every other. All 
kinds of physical handicaps, mental handicaps or intellectual brilliance, 
emotional disturbances, and social maladjustments are matters deserving 
of attention. Children in any one of these groups are in special need. 

There Must Be Services in Both Urban and Rural Areas 

Often cities can carry on programs of special education while rural 
areas go without them. There are various ways in which children in iso- 
lated areas and small towns can be served. They, as well as city children, 
have a right to special educational facilities. States and counties must 
see to it that every child in the state is given the kind of attention and 
services he needs. 

There Must Be Early Identification and Adjustment 

The earlier an illness is diagnosed, the more certain is the chance of 
recovery. So, too, with exceptional children. The earlier a handicap is 
identified and a proper adjustment made, the more hopeful can we be of 
a satisfactory life adjustment. This means that nursery-school education 
may be even more important for many exceptional children than for 
normal children. Early school entrance should be possible for all. 



THE YEARBOOK COMMITTEE 15 

Special Education Should Extend through Elementary- 

and Secondary-School Years 

Practice too often takes an exceptional child through the elementary 
years with a special-education program and then leaves him to shift for 
himself in high school. Frequently, he drops out of school altogether be- 
cause he cannot make the pace. The responsibility of the school is not 
fully discharged until the youth has found an adequate way of adjust- 
ment, with as much of a well-selected high-school program accomplished 
as he can handle. 

A Comprehensive Guidance Service Is an Integral 

Part of Special Education 

Guidance is recognized as essential in all school programs. For excep- 
tional children who have problems far beyond the ordinary, it is espe- 
cially important. Guidance should begin when the child enters school and 
should continue until he has found his way to life adjustment. This 
means primarily guidance for work that is in keeping with recognized 
abilities and limitations; but it means, too, guidance for all-round, well- 
adjusted living. This is the essence of special education. 

Special Education Extends beyond the School Building 

to the Home and to the Hospital 

Not all exceptional children can go to school. The school must come 
to them while they are confined to home or hospital or to a convalescent 
home or sanatorium for a period of time. Wherever the child is who has 
a special problem, there the school must serve him. 

The Parents of Exceptional Children Need Guidance 
Many parents do not understand the problems of their children or 
what the school is trying to do to help them. Nor does the school always 
appreciate the parents' feelings, fears, and frustrations. There should be 
a definite plan for school-home co-operation, mutual understanding, and 
mutual helpfulness. 

There Must Be a Program of Teacher Education 
Children with special problems require teachers with special skills and 
abilities. These do not come without much study and preparation. Pre- 
service education and in-service study are both important. No program 
of special education should be carried on in a school or school district 
without a plan for the improvement of instruction on the part of all 
teachers. No teacher-education institution should fail to consider the 
possibilities of special education as an area of service, nor should it 



16 PRINCIPLES OF SPECIAL EDUCATION 

graduate any teacher for the elementary or secondary grades without 
some orientation in the needs of exceptional children. 

School and Community Resources Should Be Co-ordinated 
There are many community agencies which deal with the adjustment 
of individuals. Various social agencies, private organizations, service 
groups, and state offices should be asked to help with the program. The 
school cannot do the job alone. Education, health, and welfare groups 
are all concerned. Through the co-operation of all of them, each working 
in its own area, the greatest results can be achieved. 

Nor should special education be isolated within a school or school 
system. It has too many problems in common with general elementary 
and secondary education to warrant independent and separate organiza- 
tion and procedures. It should have expert leadership but should consti- 
tute an organizational unit in the administrative plan of the school or 
school system. Close working relationships on the part of all units or divi- 
sions will reveal to each the resources that are available from the others. 
Exceptional children need them all. 

The Community, the State, and the Nation Are All Involved 
The community is where the children live, where the schools are, and 
where special education is carried on. But the community needs the 
state's support, its guidance, its financial help. And a state-wide plan of 
special education will be achieved only as the state gives guidance and 
financial help to all schools within its boundaries. So, too, the states look 
to the nation for help. The federal government carries a responsibility 
that is no less than that of the state. Only when maximum effort is carried 
on at all three levels community, state, and nation can we look for an 
adequate program of special education for exceptional children. 

REFERENCES 

1. BAKER, HARRY J. An Introduction to Exceptional Children. New York: Macmillan 
Co., 1944. 

2. "Education of Exceptional Children and Minority Groups," Review of Educa- 
tional Research, XI (June, 1941), 247-362. 

3. "Education of Exceptional Children and Minority Groups," Review of Educational 
Research, XIV (June, 1944), 197-281. 

4. EDUCATIONAL POLICIES COMMISSION OP THE NATIONAL EDUCATION ASSOCIATION. 
The Purposes of Education in American Democracy. Washington: National Educa- 
tion Association, 1938. 

5. FRAMPTON, M. E., and ROWELL, H. G. Education of the Handicapped. Vol. I. 
Yonkers-on-Hudson, New York: World Book Co., 1938. 

6. GULICK, LUTHER H. Education for American Life. Report of the Regents* Inquiry 
into the Character and Cost of Public Education. New York: McGraw-Hill 
Book Co., 1938. 



THE YEARBOOK COMMITTEE 17 

7. HECK, ARCH O. Education of Exceptional Children. New York: McGraw-Hill 
Book Co., 1940. 

8. MARTENS, ELISE H. Needs of Exceptional Children. United States Office of Educa- 
tion Leaflet No. 74, 1944. Washington: Government Printing Office, 1944. 

9. . State Legislation for Education of Exceptional Children and Youth. United 

States Office of Education Bulletin No. 2, 1949. Washington: Government 
Printing Office, 1949. 

10. MARTENS, ELISE H., and FOSTER, EMERY M. Statistics of Special Schools and 
Classes for Exceptional Children, 1989-40. United States Office of Education. 
Washington: Government Printing Office, 1942. 

11. Meeting the Needs of the Individual Child. Nineteenth Yearbook of the Depart- 
ment of Elementary School Principals, National Education Association. Wash- 
ington: National Education Association, 1940. 

12. WHITE HOUSE CONFERENCE ON CHILD HEALTH AND PROTECTION. Special Educa- 
tion: The Handicapped and the Gifted. New York: Century Co., 1931. 

13. . The Handicapped Child. New York: Century Co., 1933. 

14. WHITE HOUSE CONFERENCE ON CHILDREN IN A DEMOCRACY. Children in a De- 
mocracy. Washington: Government Printing Office, 1940. 



CHAPTER II 

ADMINISTERING THE SPECIAL SERVICES 
FOR EXCEPTIONAL CHILDREN 



RAY GRAHAM 

Assistant Superintendent 

Director of Education of Exceptional Children 

Office of Public Instruction 

Springfield, Illinois 

and 

ANNA M. ENGEL 

Divisional Director 

Department of Special Education 

Detroit, Michigan 



INTRODUCTION 

The area of greatest responsibility for the success of an educational 
program rests in the administration. There may be proven needs, ac- 
cepted philosophy, trained personnel, proper study and testing of chil- 
dren, sufficient funds, and available facilities and resources, but the 
development of an effective program depends on proper and efficient 
administration. It is the control center for determining the need and for 
creating, fostering, and extending the program. Without adequate admin- 
istration the entire organization is one of confusion, misdirection, and 
failure. 

It is axiomatic that local, state, and federally sponsored programs of 
special education succeed in direct proportion to the efficiency of the 
administration of such programs. The modern school, with its emphasis 
on individual differences among children, makes it imperative that the 
administrator develop a sound philosophy of special education for those 
children who need special educational advantages in order to succeed. 
It is his responsibility to provide the means for a study and diagnosis of 
their difficulties and the services and facilities necessary for their training 
and education. Only a small percentage of the handicapped children will 
need to be institutionalized. Unless some very unusual condition makes 
it impossible for a child to remain in the home, he will be best served in 
his own community. Where the parents and neighbors have accepted the 
child with a handicap, it is not too much to ask the school to also accept 

18 



GRAHAM AND ENGEL 19 

the child's limitation and to aid him in his growth and development. 
Although the progress may be slow, every child has the right to training 
suitable for him individually. Special education is justifiable in such cases 
merely from a mental-health point of view, because both the parents and 
the child will then feel that they have had the same consideration as 
other citizens of the community. 

Administrative practices have too often shown a negative attitude to- 
ward providing for special training for children with unusual needs, hand- 
icaps, or problems. Many school administrators avoid these responsi- 
bilities instead of accepting them. Their attitude is generally that they 
provide a regular school program for all children and, if any cases do not 
fit into that pattern, it is not the responsibility of the school. 

Other questionable administrative practices include: (a) refusing ad- 
mission of some types of children to school, (f>) encouraging parents to 
withdraw serious problem children from school, (c) allowing the child to 
work aimlessly, to run errands, to waste his time in other ways through the 
years of school attendance, or (d) providing custodial care in separate 
rooms or buildings without proper attention to the soundness of the 
educational program. 

It is unfortunate that laws and practices of special education in many 
areas have developed without the initiative and guidance of people with 
educational training and experience. A study of the history of state laws 
dealing with special education shows that these laws were generally 
written and promoted by private agencies and that schools have fre- 
quently found themselves with a program thrust upon them for which 
they were not prepared. 

OBJECTIVES OF SPECIAL EDUCATION 

The principles of administration in general education apply equally in 
the area of special education. But something more must be added because 
special education involves children with special needs, teachers with 
special training, and special equipment and services. The administration 
of such a program needs a special philosophy, special techniques, and 
special practices. 

All children are entitled to the best training possible to promote their 
growth and welfare. Schools have been established for that purpose. 
This means a recognition of the differences in children physically, men- 
tally, and emotionally and an awareness of those factors within the 
child or the school which need special consideration. Since children's 
needs are complex and diverse, sincere effort must be made to give them 
individual study and guidance and to provide them with an environment 
conducive to their growth and comfort. Therefore, the administration 



20 ADMINISTERING SPECIAL SERVICES 

must recognize the newer and broader social viewpoints that apply to the 
education of exceptional children. Prevention and correction should come 
before maintenance and custodial care. A justifiable program of special 
education must show returns to society in fewer commitments to institu- 
tions, in reduction of need for pensions for the handicapped, and in de- 
creased demand for adult vocational adjustment. The financial costs of 
special education should not be regarded as an additional burden, but 
rather as a valuable contribution to the efficiency of other programs which 
may prove to be economical in the long run. In a more positive way, 
special education should be able to justify itself by training individuals 
so that they are able to make an increased social and vocational contri- 
bution to society. Recognition must be given to the democratic and con- 
stitutional rights of all individuals not excluding those who are unable 
to assert their own claim to those rights. 

PRINCIPLES OF SOUND ADMINISTRATION AND 
SUPERVISION IN SPECIAL EDUCATION 

Out of policies grow principles; out of principles evolve practices. A 
sound administrative policy and organization for the entire educational 
program is the first essential in securing sound administration and super- 
vision for the special-education program. 

Most principles of administration and supervision of the regular 
school apply equally to special education. There are common goals for all 
children; but because special education of exceptional children has some 
special responsibilities and problems not generally found in the regular 
school, certain other principles are essential in administering a program 
of special education. 

1. The responsibilities for special education should be definitely fixed. 
It is often essential that special administrative provisions be made of 
special phases not included in any other part of the school program. 
These may be educational, medical, social, or psychological. It is impor- 
tant that some person have the authority to make decisions regarding 
policies, budgets, and buildings. Sometimes an assistant superintendent 
or director is responsible for the activities of special education and allied 
services for children. In smaller cities, the superintendent himself may 
define the policies and procedures. 

2. Parents should be informed regarding the nature and purposes of 
special-education programs. It is necessary that all concerned believe that 
special education means just that special training because of a handi- 
cap. It is not a punishment but a privilege to receive the extra service. 
The administration should also be responsible for instructing the princi- 



GRAHAM AND ENGEL 21 

pals and teachers that pupils should never be threatened with a transfer 
to a special class. 

3. Administrators must accept the fact that special educational serv- 
ices will mean greater expenditures of money on the part of the school 
district. Just as it becomes an obligation of the parent to spend more 
money and effort in caring for the handicapped child, it becomes nec- 
essary for the community or school district or state to do likewise in 
providing adequately for the education of handicapped individuals. 

4. It is the responsibility of the school administration to effect an 
organization for locating the exceptional child and for making a thorough 
study of his needs. It is necessary to determine which children need 
special services and also which ones do not need extensive special services. 
This requires trained personnel. The administration must encourage the 
medical profession, through the board of health, to help in the identifi- 
cation of those who are physically handicapped; it must secure the serv- 
ices of trained psychologists; and it must see that cumulative records 
give an adequate overview of the school performance. 

5. Administrators must make provision for special housing, equipment, 
and instructional supplies. These should be considered legitimate expend- 
itures even though they are costly. Since an exceptional child usually 
requires a larger share of the family budget, it is to be expected that his 
school training will also be more costly. 

6. The administration should have a definite policy for transferring 
pupils to special classes, and parents should be informed of the reason. 
In the same way, a definite procedure for releasing pupils should be 
established. At no time should schools promise that the children need 
attend special classes for a short time and leave at their own or their 
parents 7 request without the sanction of the person or agency responsible 
for the transfer. Regular grade principals and teachers must be kept in- 
formed of the policy of the administration regarding special education 
so that they can help the parents understand and accept the required 
program. 

7. Administrators should plan their program for the best interest of the 
whole child so that the placement of an exceptional child in a special 
class or his retention in a regular grade does not lead to more serious 
maladjustment. The physically or mentally exceptional child may easily 
develop personality, social, or emotional handicaps as a result of the way 
he is handled because of his basic handicap. 

8. The administration must set up a general plan to integrate the 
special class with the rest of the school. Sometimes teachers who already 
have large classes may resent the transfer of additional pupils from the 



22 ADMINISTERING SPECIAL SERVICES 

sight-saving or open-window classes. The regular grade classes in such 
cases might be reduced so that the additional special pupils would not 
increase the general class load. In Detroit, where enrolment is a basis for 
rating the size of schools, each special pupil counts as two pupils. 

9. The plans of the administrator must include provisions for parent 
education so that the program becomes one of teamwork toward common 
goals. The parent as well as the school must help the community to under- 
stand that, although children may differ greatly in physical and mental 
traits, all can work and play together if emphasis is put on the things the 
exceptional children can do instead of on their limitations. 

10. Administrators must place unusual emphasis on the social and vo- 
cational adjustment of the exceptional child. Such emphasis has particu- 
lar significance for the education of atypical children because they are 
unable to face their disabilities with sufficient composure to make the 
best use of their abilities. 

11. Administrators should recognize that a program of special educa- 
tion is designed to meet the individual needs, interests, and disabilities 
of each atypical child. This suggests the importance of continuous ad- 
ministrative attention to the activities planned for handicapped pupils. 
Various types of adjustments must be made for individual requirements. 
Just removing handicapped children from the regular grades to a special 
room is not enough. 

ORGANIZATION OF SPECIAL EDUCATION AT THE LOCAL LEVEL 
The justification of special schools, classes, and services for excep- 
tional children is to be sought in the benefits realized by the children in 
need of special consideration. It is obvious that the local school must 
accept the chief responsibility for the administration of direct and on-the- 
job services. The local board of education and its administrative officer 
are faced with definite and important decisions. The degree of successful 
adjustment and improvement among the children will be in direct 
proportion to the wisdom with which the program is planned. 

Placing the Responsibilities 

In small school districts the chief administrative officer may assume 
responsibility for directing the special-education program. As the size of 
the district increases, the program becomes increasingly complex. It is 
then necessary to delegate authority and responsibility. In large dis- 
tricts this may involve many individuals representing various phases of 
service. The best administration will result from training that enables the 
principals, supervisors, and teachers to develop a professional perspective 
of the special problems and how they may best be met. 



GRAHAM AND ENGEL 23 

Surveying the Needs of Exceptional Children 

The program of special education for exceptional children is based on 
fundamental social theories. It is the right of deviate children to have an 
educational program adjusted to meet their individual needs, interests, 
abilities, and limitations. It is the legal responsibility of the state and the 
local district to furnish this program. This is the American and dem- 
ocratic way of solving a problem. It is sound government planning to 
provide remedial and preventive programs for exceptional children in 
their formative years, and it is sound economy to spend rather small 
sums for these early training programs rather than much larger sums for 
pensions and custodial care in later years for those who cannot make 
appropriate adjustment to normal social situations. 

Available studies show that the child in need of special education is by 
no means rare. He appears in the schools in many types and degrees, and 
he is found in every community. Good administration will be interested in 
using all available means to meet the educational needs of such children. 
Principals and teachers realize that if special services are not provided 
for the exceptional children they will of necessity be enrolled in regular 
classes. It is important that all members of the staff recognize the values 
of the special-education program to the total membership of the school 
as well as to the handicapped children themselves. Building principals, 
regular classroom teachers, supervisors, counselors, and nurses all have a 
part in planning the program, in rendering the essential services, and in 
developing school and community understanding of the program. 

The administrator must determine what types of exceptional children 
are to be provided for, the programs to be made for those with varying 
degrees of handicaps, and the ages to be served. The program is incom- 
plete if any child is neglected or any service omitted. 

There are certain administrative directives necessary with respect to 
the age groups to be served. Some states have statutory regulations that 
must be considered. There are also educational factors based on observ- 
able stages of growth and development. Different procedures will be nec- 
essary if special services are planned for wide age ranges in the same class 
in contrast to age groupings. A complete program would provide for 
handicapped children of nursery-school age and also for those at the 
upper age limits. 

The administration must prescribe the method by which pupils may 
be referred for special-education service. A definite procedure should also 
be developed for a report to the school and to the parent when the final 
recommendation has been made. The administration should see that 
retests and rechecks are made from time to time so that pupils may be 
returned to the regular classrooms when they no longer need the special 



24 ADMINISTERING SPECIAL SERVICES 

services. This is true of mentally handicapped pupils as well as those with 
physical handicaps. 

It is important that the philosophy of special education in regard to 
segregation be explained to both teachers and parents. Segregation is 
not always a matter of separate rooms. It may be a matter of psycho- 
logical or social repression. A child cannot be more cruelly segregated than to 
be placed in a room where his failures separate him from other children who are 
experiencing success. The nonreader, the deaf, or the mentally retarded may 
be segregated by placement in a regular classroom where his needs are not 
understood or met. 

Class size may differ even in the special groups. Classes for the deaf 
enrol fewer pupils per teacher than most of the other types of classes. The 
administration should establish rules and regulations regarding class size 
and should inform the regular teachers of the reasons for smaller groups 
in special-education classes. The size of classes should be determined by 
the best thought concerning handicapped children, due consideration be- 
ing given to any regulations of the state department of education. The 
federal office of education is always willing to give advice and help in the 
development of a special program. 1 

Identification of Pupils 

The administrator can secure valuable help in determining screening 
procedures in his school system by consulting various special agencies. 
Clinics and other agencies have developed effective procedures for audio- 
metric and visual testing of school children. The school health depart- 
ment is especially alert in discovering and referring cases of physical 
disability. The administrator should use all of these resources and 
develop techniques of clearing cases with them. Many of the perplexing 
problems of the administrator are solved and many pitfalls avoided by a 
clearly defined process of identifying and referring exceptional children. 
The Detroit Public Schools, for instance, have developed a mimeo- 
graphed pamphlet giving definite direction to the many resources con- 
tributing to the program. 2 Group testing may be employed to locate 
various types needing further special study. Many schools use such tests 
in routine programs for determining mentally and educationally handi- 
capped children. The entire school staff is encouraged to refer deviate 
children as they are discovered in ordinary school progress surveys. 

1 Co-ordination of Effort for the Education of Exceptional Children, "Report of a 
Conference Called by the U.S. Office of Education." Bulletin of the United States 
Office of Education, No. 7, 1935. Washington: Government Printing Office, 1935. 

Bemice Leland, "The Psychological Clinic: A Handbook of Information and 
Directives for Examiners, Visiting Teachers, and Other Members of Staff." Detroit, 
Michigan: Board of Education, September, 1948 (mimeographed). 



GRAHAM AND ENGEL 25 

After the screening program has been concluded, careful study should 
be made of each pupil with serious defects, physical or mental. When 
necessary, he should be referred to a psychologist, otologist, ophthalmolo- 
gist, orthopedist, or other specialists. Their findings go much further than 
diagnosing the handicap. They give the school the essential data that 
will be useful in formulating the educational program for each child. 
The value of this phase of the program cannot be overemphasized. It 
not only locates the child who needs special attention and assists in 
formulating a sound program for him but also protects the normal child 
from being mistakenly assigned to special classes. 

Since special education is based on meeting the individual needs, in- 
terests, abilities, and limitations of the exceptional child, it is important 
that complete records be kept on each child. The case record brings to- 
gether the educational, medical, psychological, and family data which 
are essential in developing an adjusted program for the pupil. It is not 
enough that the clinic have the medical record of a given case. It needs 
the educational and social information as well. The school, likewise, needs 
the medical diagnosis, prognosis, and health suggestions so that it may 
best serve the child educationally. The administrator is not only faced 
with problems of making plans for securing these various data but also is 
responsible for filing them so that they may actually be used by all the 
staff involved in the program. 

Selecting the Staff 

It is important in any plan of providing for exceptional children that 
some minimum requirements be established for those who are to teach or 
serve them. Since these pupils are like average children except for certain 
abilities or disabilities, teachers should have had the fundamental train- 
ing required for the teaching of normal children with additional courses 
pertaining to the needs of pupils with particular handicaps. Teaching 
classes of normal children is a helpful, preliminary experience to the more 
exacting task of teaching exceptional children. 

Teachers appointed to teach special classes should have a regular 
state teaching certificate and twenty to thirty semester hours of special- 
ization. The special courses may have been included in the training lead- 
ing to the general teaching certificate or they may be in addition thereto. 
More specialized training is required for teaching some exceptional 
groups than for others, and teacher requirements should conform to the 
standards set up by the special-education staff in the state department 
of education. 

Training alone does not insure well-qualified teachers. Therefore, at- 
tention should be given to the matter of personality, interest in the spe- 
cial child, and sympathetic understanding of child problems. Since 



26 ADMINISTERING SPECIAL SERVICES 

exceptional children often have the same teacher year after year, it is 
important that only teachers with a hopeful attitude and genuine inter- 
est in such children be appointed to teach them. On the other hand, since 
many exceptional pupils remain in the regular classrooms, training 
courses for all teachers might well include orientation courses in special 
education. 

Supervision of Special Classes 

In small cities the supervision of special-education classes may be 
assigned to an assistant superintendent or to the primary supervisors. 
In very small schools, the superintendent may take direct charge. In 
larger cities, each activity should have its own supervisor trained in the 
particular field. The supervisor should have had teaching experience, 
additional courses in his area of specialization, and should have at least 
a master's degree in education. The functions of such supervisors are 
both administrative and supervisory. They should develop curriculum s 
and bulletins, prepare supply and equipment lists, authorize transfers, 
arrange teachers' meetings, co-operate with social agencies, evaluate 
pupil progress by means of tests and surveys, and carry on general super- 
vision of the classrooms. The administrator should require supervisors to 
keep him informed of the newest developments in the specialized fields 
and make appropriate recommendations for changes and improvements 
in the program. Principals of special schools need special training because 
they also have supervising responsibilities. Special schools should be 
staffed as adequately as the regular grade schools with special pupil- 
accounting devices adapted to the smaller classes. 

Since the teaching of exceptional children is a difficult and tedious 
process, many school administrators have offered a small bonus to 
special-education teachers. In the early days of establishing special 
classes, the teachers had to go to distant institutions for their training, 
and the courses were far in excess of the number required for regular work. 
Now, most large cities require that all teachers have at least a bachelor's 
degree in education, and the kindergarten teacher is probably as well 
trained as the high-school teacher. Many of these cities, especially those 
with a single salary schedule, have discontinued the bonus. The special 
services, however, which exceptional children require for their growth 
and development seem to justify some additional compensation. Special 
pupils usually come from a much larger district than a regular grade 
group, and their noon care and the fact that many home calls must be 
made to understand the conditioning of the child add many hours to a 
trying day. 

Special teachers, like other members of the school staff, should be 
responsible to the principal of the building. The teachers of these groups 



GRAHAM AND ENGEL 27 

should accept the same building responsibilities and duties as do regular 
grade teachers. The exceptional children, too, should be made to feel that 
there are no special rules for them and that, as far as possible, they may 
participate in all school activities. 

Until an adequate supply of specially trained teachers is available, 
the administration should provide for in-service training of teachers. A 
good elementary teacher with additional training may become a fine 
special-education teacher. Extension courses may be arranged with 
near-by colleges and, if necessary, the supervisor can teach the theory 
and techniques of special education in teacher's meetings and institutes. 
The supervisor should keep the teachers informed of the newest litera- 
ture in the field, and workshops should be organized so that the different 
members of the staff may work and learn together. 

The Guidance and Pupil Development Program 

The administration should accept the responsibility for providing a 
program for exceptional children which is comparable to that given 
normal children, with additional services to provide for their exceptional 
needs. Although these needs differ among the various classifications, the 
final goals are the same for all children good personal adjustment, 
ability to co-operate with others, acceptance of civic responsibility, and 
vocational efficiency. Since physical and mental handicaps tend to slow 
up the training process, extra, not less, time of school attendance should 
l>e required of exceptional children. If average and bright pupils find it 
necessary to remain in school long enough to get sufficient training, sure- 
ly the handicapped child would need more rather than less time for his 
developmental experiences. 

The educational program in each area should be determined and pro- 
vided upon a complete study of the individual child: (a) his physical 
condition, (fc) his capacity for learning, (c) his school record, (d) his 
social adjustment, and (e) his aptitudes and interests. The program will 
differ as the children differ, but some general classifications and group- 
ings are possible. Through parent education and the services of the medi- 
cal group, much can be done to remedy physical defects, teach better 
health habits, and establish conditions that will promote the physical 
development of children. Proper lighting, sufficient drinking fountains, 
adequate play facilities, and building insulation to decrease vibrations 
and noises tend to increase the efficiency of the school program. 

Although at times it seems necessary to place all handicapped children 
in one building, probably a better social adjustment results when the 
children of a given neighborhood can learn and play together. The 
normal children learn to make adjustments to the child who has to limp 



28 ADMINISTERING SPECIAL SERVICES 

along or the one who feels but does not see his way. The exceptional 
child finds self-satisfaction in belonging with his out-of-school pals. The 
need of expensive equipment, transportation problems, and certain 
building requirements such as ramps or elevators for crippled children 
make special buildings unavoidable at times. Parents will accept such 
adjustments if the program is well co-ordinated with the general school 
plan. 

The descriptive terms or symbols used in designating classes may con- 
tribute to misunderstandings and confusion. If such a title as "retarded," 
"mentally handicapped/' or other descriptive title is employed, it 
shocks the sensibilities of both parents and pupils and builds up a resist- 
ance to an acceptance of the class. Classrooms might better be labeled 
by a number, section, the teacher's name, or the term of "special oppor- 
tunity." The designation of sight-saving, Braille, speech improvement, 
and open-air or open-window classes is usually much more acceptable to 
both pupils and parents. Since there are variations of health and per- 
formance from time to time, specific labels should be avoided as much as 
possible and the terminology of technical classification of handicaps 
should only be used for budget purposes. 

The program in the special classes should be adjusted to the individual 
child and should represent a definite plan for his progress and promotion. 
Although he must spend much of his time with this special teacher be- 
cause of his disability, he should have contact with the regular classes 
whenever this is possible. Parents often complain that their children are 
being deprived of opportunities to participate in the activities they en- 
joy because the special teachers insist on extra time for academic sub- 
jects. Whenever possible, handicapped children should be included in the 
art, music, and health programs of the schools. Such training carries 
over into adulthood and makes it possible for exceptional children to 
share some of the common cultural patterns of their communities. Fre- 
quently the pupils in special classes come from several school districts. 
It is important that they be considered a part of the school in which the 
class is located and that the principal assume full responsibility for their 
membership in his school by providing an acceptable program and good 
working conditions. 3 This makes for increased security for both teacher 
and pupils. 

Some definite plan must be set up to measure the growth of special 
pupils. In some cities a yearly progress report is prepared by the teachers. 
The gain is measured by standarized tests as well as by subjective eval- 

8 William C. Reavis, Paul R. Pierce, and Edward H. Stullken, The Elementary 
School: Its Organization and Administration, p. 14. Chicago: University of Chicago 
Press, 1931. 



GRAHAM AND ENGEL 29 

uations of improvement in citizenship and interest. It is advantageous to 
have these progress reports prepared in duplicate, the supervisor or 
administrator receiving one copy and the teacher retaining the other. 
Such records provide objective evidence of the child's growth. There is 
still much experimentation to be done in developing a satisfactory 
scheme of classification for the mentally handicapped children. Super- 
visors of this group should be able to evolve a system based on age or 
years in special class or on units of work which would not characterize 
the work of the fifteen- or sixteen-year-old pupils as of only fourth- 
grade level. Since we know that many of these pupils make acceptable 
adjustment in the community when their daily work is not concerned 
with reading, spelling, and arithmetic, it is imperative for the child's 
mental and social well-being to find some way to decrease the discom- 
fiture or shame he experiences on account of his disabilities. 

Curriculum 

The administration should keep abreast of changing conceptions of 
education as they pertain not only to normal but also to exceptional 
children. The goals of education are the same for all children, but the 
curriculum for exceptional children needs to be specially designed be- 
cause of their disabilities. It is not, however, to be conceived of as a 
modified plan of regular education but as a unique program planned in 
terms of the needs of a particular group or an individual child. Such a 
program should be co-ordinated with the everyday living and needs of 
the pupils. 

The suggestion has been made that exceptional children should partic- 
ipate in regular grade activities. In a special group where there are many 
grades as well as a wide range of ages, it is impossible for the teacher to 
give them a complete program without some help from the regularly 
organized grades. Children are stimulated by taking part in group ac- 
tivities; they learn from each other. Therefore, the sight-saving pupil, the 
child physically under par, the child not too crippled to participate or too 
deafened to respond, and the speech defective will profit much by con- 
tact with regular groups of pupils. 

The special-class teacher has at least limited opportunities to make it 
possible for an exceptional child to function in a regular classroom. The 
sight-saving teacher may prepare lessons in large type when such ma- 
terials are needed or may demonstrate correct sight-saving procedures 
that will reinforce the pupil's learning experiences. The teacher of lip 
reading should contact the regular grade teacher to explain the child's 
need for individual adjustment as well as for instruction in speech read- 
ing. The speech correctionist may give training in improved speech 



30 ADMINISTERING SPECIAL SERVICES 

habits and patterns and should encourage teachers and parents to con- 
tinue this training in the regular classroom and in the home. 

There are, of course, curriculum adjustments which apply to specific 
groups. In most sight-saving classes, typewriting and manuscript writing 
are accepted practices; crippled children have a great deal of manipula- 
tive experiences, such as weaving, jewelry-making, and ceramics; and the 
deaf devote a large amount of time to language development. 

Housing the Special Programs 

Cities have met the problem of providing for exceptional children in 
various ways. Usually schools are remodeled or special schools are built 
because of needed safety measures and necessary adjustments for treat- 
ment and care of those who are crippled. Some cities also provide special 
buildings for open-air schools. The administration should consider care- 
fully the housing and special programs for exceptional children in terms 
of what is best for all children. The physical plant for special education 
should be as modern as that for the normal groups. Good lighting, good 
ventilation, attractive surroundings, and plenty of playground space are 
essential. The placement of exceptional children in old, elementary- 
school buildings is a mistake because neither the parents nor the children 
are happy over the transfer of special classes from a modern school to an 
old, out-of-date building. Parents rightly feel that the special school 
should include all of the facilities that are offered to children in other 
schools. 

It is considered good practice to organize special units in elementary or 
intermediate schools. The special pupils have their own specially trained 
teachers for their academic subjects but are included in the normal 
extra-curriculum activities of the entire school. It is recognized that 
conditions will vary in different communities. The only fair criterion is to 
make sure that the child has the best possible arrangement for his 
growth and development wherever that may be. If the child is the first 
consideration in planning for housing and care, few mistakes will be 
made in the building program. Usually, state departments of education 
are able to give excellent advice on building plans for special education 
and equipment. 

A program of special education brings special problems and special 
responsibilities to the administration. The lunch problem must be ade- 
quately met if pupils come from long distances. In large cities such 
lunchrooms are a part of the school program, but in smaller cities it may 
be necessary to develop plans involving the help of the parents. Since 
health is a great factor in school progress, every effort should be made to 
provide at least one hot, nourishing dish at noon. Additional milk may 



GRAHAM AND ENGEL 31 

be supplied without making the program too costly or too difficult to 
manage. The administration should keep abreast of changing conceptions 
in health education and make possible an extension and development of 
the program in terms of the most recent knowledge in the health field. 
Transportation to special-education centers must be provided, at least 
in the larger cities. Sometimes it may be advisable to purchase school 
buses; sometimes the local transportation system may be utilized on a 
mileage-cost basis. A careful study should be made of the available 
transportation facilities of the community, with due consideration for 
economy and safety. An adequate budget should be established so that 
regular school attendance of the handicapped is assured. 

Adaptations To Meet Needs of Smaller Communities 
Handicapped children living in sparsely settled rural communities 
or in isolated areas need special educational, medical, and social services 
as much as those living in cities. However, the problem of providing 
these services is much more difficult in rural areas. Medical services are 
often lacking and welfare and child-guidance resources are usually 
inadequate. It is extremely difficult to arrange special classes and ex- 
pensive services for one or only a few children. In some instances these 
children have no opportunities for adequate training except as provided 
by a state residential school. Due to the reluctance of parents to permit 
their children to be taken from the home, many handicapped pupils do 
not have the benefit of residential-school training. The problem has been 
solved in some areas by arranging for boarding or foster-home placement- 
in near-by larger cities where special-education facilities are available. 
Another method of meeting this difficult situation is to provide trans- 
portation from districts which are unable to provide special education to 
districts with established programs and adequate facilities. Although 
some disabled children are subjected to hardships in transportation, the 
child does enjoy the advantage of being permitted to live and develop in 
his own home. Considerable improvement in providing for those excep- 
tional children in isolated communities should result from the nation- 
wide trend toward reorganization of school districts into larger units. 

ORGANIZATION AT THE STATE LEVEL 

State Responsibility 

The federal constitution leaves to the states the rights and powers of 
education. Most states specifically recognize and accept the responsibil- 
ity in their own constitutions. 

Constitutional and Statutory Provisions. The state constitutions accept 
the responsibility of providing educational opportunities for "all the 



32 ADMINISTERING SPECIAL SERVICES 

children." There is no exclusion of the handicapped; no tempering or 
lessening of the responsibility as it may apply to the seriously handi- 
capped or those with very unfavorable prognosis. "All the children," 
then, means every child. 

The statutory provisions furnish the legal pattern for carrying out the 
mandate of the constitution. The school code determines how educa- 
tional funds shall be raised, how districts shall be organized, how officials 
shall be chosen, and in many other ways establishes the pattern for pub- 
lic and private school programs. The statutes provide the basis on which 
state, county, and district school offices are conducted. 

Studying the State Needs. In a complex and changing social order the 
chief state school officer is generally confronted with the responsibility 
for surveying and studying the educational needs and problems of the 
state. The state office is much more than an agency to administer exist- 
ing laws. The duties of supervision, integration, and leadership are 
equally compelling. 

The Legal Pattern 

Most states have found it necessary to provide definite legislation to 
encourage or establish special-education opportunities. This legislation 
then becomes a pattern for state departments and local districts to 
follow. 

The constitutions of most states with the accompanying statutory 
provisions for regular schools contain all the authority needed by local 
districts to establish special schools, classes, and services for exceptional 
children. Actually, however, it is observed that relatively few districts 
establish a special-education program until additional legislation is 
provided; and it seldom develops to any great extent until the state 
demonstrates a willingness to subsidize it. Along with the appropriation 
of state funds for special education there are always additional laws set- 
ting up regulations of programs that receive state aid. 

Defining the Exceptional Child. In formulating special legislation it is 
necessary to designate the type of pupils to be considered as the excep- 
tional children eligible for the program. This is most important. The 
states have not included the gifted child in this category when making 
extra funds available. Many states have provided for the physically 
handicapped, but some have limited the program to certain types, such 
as the orthopedically crippled and the cardiopathic, and made no provision 
for others, such as the epileptic or the children with low vitality. There is 
increasing interest on the part of many states in providing special legis- 
lation for the benefit of the mentally retarded, the emotionally and 
socially maladjusted, and those in need of remedial or special educational 
services in reading and other skills. 



GRAHAM AND ENOEL 33 

Definition should go further than naming the categories of exceptional 
children. There are dual and multiple handicaps in many cases. Educa- 
tors are agreed, for instance, that a suitable program for physically 
handicapped children with low mental ability cannot be satisfactorily 
developed in the same room with children of normal mental ability. The 
problem of educating deaf children is quite different from that of dealing 
with the hard-of-hearing. The aphasic child cannot be handled in the 
speech-correction class with those having only articulatory difficulties. 

Definition in the law is important to school administrators in setting 
the local pattern. 

Finding the Eligible Children. The ordinary school census is of little 
help to the administrator planning his special-education program. A 
simple enumeration of names, ages, and addresses does not tell how the 
child is handicapped, the degree of handicap, and other facts necessary in 
planning a program. 

No special-education legislation is complete unless it makes adequate 
provision for finding the children for whom special programs are needed. 

Making the Responsibility Mandatory. Although most state constitu- 
tions provide that educational opportunity shall be made available to 
"all the children," the history has been one of neglect of opportunity for 
many exceptional children until special legislation was enacted. Educa- 
tional opportunity is not available to the mentally handicapped child if 
he must compete on the same level with normal children. Educational 
opportunity for the deaf child is lacking if he does not have the skilled 
services of a teacher who understands the methods and techniques of 
helping him develop speech, language, lip reading, and social adjust- 
ments. 

If the responsibility of the state and local district is interpreted as 
merely permissive, there may be neglect and denial of opportunity to 
many children unless vigorous leadership is supplemented with adequate 
financial support. 

Establishing Classes and Services. Special legislation for the education 
of exceptional children generally sets the pattern for the educational pro" 
gram in the local district. Other legislation in most states provides for 
special educational opportunities in their state residential schools. But 
in both cases the resulting program is generally subject to direction by 
some state office that has the power to make regulations for putting the 
latv into practice. It is not enough to provide special classes and services 
without determining the standards for evaluating the services and realiz- 
ing the objectives of the legislation. 

Establishing special classes and services for exceptional children is not 
merely a matter of grouping children or removing them from the regular 



34 ADMINISTERING SPECIAL SERVICES 

grades but of actually providing facilities that will enable them to make 
the needed personal, social, and vocational adjustments. 

Providing Financial Assistance. The costs of special education vary 
from two to five times the cost of educating average children in regular 
classes. These costs are due to necessary small enrolments, special equip- 
ment and supplies, special teacher training, and other supplementary 
services not usually needed for normal children. The program is best 
fostered in those states that share the expense with the local district. The 
policy is generally one of assisting the district to the extent of the excess 
cost. The method of meeting the excess cost varies in different states. In 
some it is the appropriation of a specified sum; in others it is a partial 
contribution to the teacher's salary; in others it is based on a formula, 
for comparing the costs of special and regular education. 

It is considered sound educational planning to interpret state financial 
aid as a means of assisting the local district to furnish adequate educa- 
tional opportunity to its exceptional children. Without state financial as- 
sistance the permissive legislation will likely be ineffective. It should 
strengthen and not weaken the fundamental responsibility of the local 
district. 

Directing and Supervising the Program at the State Level. All states pro- 
viding special funds for supplementing district funds in a program of 
special education usually set up regulations for supervising and directing 
the program on the state level. These regulations provide for setting the 
standards of eligibility of pupils for admission to special classes as well as 
of teacher training, class load, and minimum special equipment and 
supplies. Also, the required reports and certain other factors in an ap- 
proved program are sometimes specified. 

The state function thus becomes one of helping the local district pro- 
vide special-education classes and services on a level of greater efficiency. 

Public Day Schools and State Residential Schools 
The first acceptance of state responsibility for the education of ex- 
ceptional children was expressed in most cases through the organization 
of state schools for such types as the deaf, the blind, the mentally handi- 
capped, and the epileptic. More recently there has been some develop- 
ment of state institutional training for additional classes of physically 
handicapped children. The last quarter of a century, particularly the last 
decade, has seen great impetus given to establishing special-education 
classes and services in the day schools conducted by local public school 
districts. It is most important to remember that both the state institu- 
tions and the local day schools are working for the same objectives. They 
have one and the same responsibility to help the exceptional child 



GRAHAM AND ENGEL 35 

develop so as to attain to a happy and useful membership in society. The 
two programs must not become competitive. They must be complemen- 
tary and part of the total program of education of the state. 

Recent educational and social philosophy has emphasized the fact that 
formal education is but one part of the total educational process. The 
right of a child to grow and develop in optimum family and community 
relationships is paramount. This is especially significant with handi- 
capped children who may be greatly hampered in achieving this normal 
relationship. Unless every effort is made to help them secure special 
opportunities, the formal educational program may only widen the 
breach between them and normal social relationships. 

On the other hand, the state institutions are usually able to provide 
types of services which are not often available in small day-school pro- 
grams. Pupils may be better grouped according to age, abilities, and 
needs. Medical, psychological, and social services are easier to organize 
for a large group than for a small one, and it is possible to provide a 
greater variety of vocational-training opportunities. 

In our complex social order, some children can be best served in a 
local school program and others in the institutional organization. The 
child will be best served when both agencies recognize this fact and co- 
operate in a policy of carefully studying each individual case to determine 
the best opportunity for each individual child. 

Administrative and Supervisory Services 

The interest at the state level in the program of educating exceptional 
children is expressed in the willingness to appropriate state funds to 
supplement district expenditures in meeting the increased costs of the 
program. Granting financial aid is accompanied by regulations to insure 
the best possible use of such money. 

The plan of designating the state authority for administering and 
supervising the plan varies in different states. In most cases the authority 
is placed in the state education office with responsibility for the super- 
vision of both the educational and the financial phases of the program. 
The chief administrative responsibilities at the state level are con- 
cerned with: (a) reports used in making applications for classes and serv- 
ices, claims for reimbursement, and forms for reporting required data for 
evaluating the program; (6) regulations concerning the eligibility of 
pupils and the manner of admission to special classes, the curriculum and 
qualifications of teachers, the size of classes, physical features of class- 
rooms, and special equipment and instructional supplies; (c) regulations 
pertaining to special features of the program, such as transportation, 
medical and psychological services, and time schedules. 



86 ADMINISTERING SPECIAL SERVICES 

Integration of State-wide Services 

All states now maintain a variety of services in the interest of excep- 
tional children. These are both publicly and privately supported and 
represent agencies interested in the care of children, including preventive 
and treatment programs, home visitation and advisory programs, and 
such other services as clinics conducted by public or private organizations, 
vocational rehabilatation, medical care, child guidance, camps for handi- 
capped, and health surveys. 

The state has a responsibility for the integration of these varied serv- 
ices so that the child in need of them can be served to best advantage. 

Teacher Training and Recruitment 

As local districts and states accept the responsibility for providing 
special education for exceptional children, the need of teachers with 
special training for these challenging problems becomes apparent. It is 
important that special education be regarded as a professional service 
and not as merely a device for more conveniently grouping children for 
instruction or for providing physical care. Special education becomes 
specialized only as persons trained in the special philosophies, methods, 
and techniques are provided for this task. This makes it necessary for 
universities and colleges to provide adequate teacher training in the 
various fields of special education. For teacher-training institutions sup- 
ported by states or for school districts in which special-education pro- 
grams are required by law, such training becomes an inviolable responsi- 
bility. Also, it is important to note that the problem of teacher training is 
closely related to the state regulations applying to special-education 
programs required in the schools. 

The problem of recruiting young people for service in the field of spe- 
cial education can be solved to a large extent by co-operative effort on the 
part of local school officials and teachers to direct high-school graduates 
into the field. Vocational-guidance leaders in high schools can help by 
becoming acquainted with the opportunities and requirements for spe- 
cial-education teachers. The problem of teacher training and recruitment 
does, however, require some direction and a great deal of attention at the 
state level. It cannot be separated from the other administrative and 
supervisory responsibilities of the state department of education. 

CONCLUSION 

The challenge to administration as we face the problems of special 
education for exceptional children grows out of those principles of Amer- 
ican democracy that recognize the rights and opportunities of all the 
children. Medical skill in the care of the handicapped must not be permit- 



GRAHAM AND ENGEL 37 

ted to outdistance the growth and adjustment services for them that are 
directed by the schools. The history of our schools is one of successful 
attack on the problems that concern the welfare of our children. The 
hand of school administration holds the throttle that will move the 
machinery of progress so vital to several million children who, with- 
out special education, will be denied their rightful heritage. The respon- 
sibilities of the school adminstrator are varied. A significant part of the 
administration rightly belongs to the exceptional children, and the ad- 
minstrative services should be proportionately directed toward the solu- 
tion of their educational problems. 

REFERENCES 

1. BAKER, H. J. "Administration of Special Education," Review of Educational 
Research, XIV (June, 1944), 209-16. 

2. BERRY, CHARLES S. "General Problems of Philosophy and Administration in the 
Education of Exceptional Children," Review of Educational Research, XI (June, 
1941), 253-60. 

3. EDUCATIONAL POLICIES COMMISSION OP THE NATIONAL EDUCATION ASSOCIATION. 
The Structure and Administration of Education in American Democracy. Washing- 
ton : National Education Association, 1938. 

4. HECK, ARCH O. "General Problems of Philosophy and Administration in the 
Education of Exceptional Children," Review of Educational Research, XIV 
(June, 1944), 201-8. 

5. MARTENS, ELISE H. State Supervisory Programs for the Education of Exceptional 
Children. United States Office of Education Bulletin No. 6, 1940. Washington: 
Government Printing Office, 1941. 

6. . Residential Schools for Handicapped Children. United States Office of 

Education Bulletin No. 9, 1939. Washington: Government Printing Office, 1939. 

7. . Co-ordination of Effort for the Education of Exceptional Children. United 

States Office of Education Bulletin No. 7, 1935. Washington: Government 
Printing Office, 1935. 

8. McCoRMiCK, HAROLD W., and OTHERS. Physically Handicapped Children in New 
York City. New York: Board of Education, 1941. 

9. Philosophies of Education. Forty-first Yearbook of the National Society for the 
Study of Education, Part I. Chicago: University of Chicago Press, 1942. 

10. REAVIS, WILLIAM C.; PIERCE, PAUL R.; and STULLKEN, EDWARD H. The Ele- 
mentary School: Its Organization and Administration. Chicago: University of 
Chicago Press, 1940 (third edition). 

11. REEDER, WARD G. Fundamentals of Public School Administration. New York: 
Macmillan Co., 1941 (revised edition). 

12. WHITE HOUSE CONFERENCE ON CHILD HEALTH AND PROTECTION. Special Edu- 
cation: The Handicapped and the Gifted. New York: Century Co., 1931. 



CHAPTER III 

IDENTIFYING AND DIAGNOSING EXCEPTIONAL 
CHILDREN 



HARRY J. BAKER 

Divisional Director, Psychological Clinic 

Detroit Public Schools 

Detroit, Michigan 

and 

MILDRED B. STANTON 

Consultant, Special Education 

State Department of Education 

Hartford, Connecticut 



INTRODUCTION 

A satisfactory plan for the education of exceptional children presup- 
poses a program of diagnostic testing. Since there are many kinds of 
exceptional children, many kinds of tests and testing procedures must 
necessarily be used. These measuring devices range from group survey 
tests and observation schedules which may be administered by persons 
with comparatively little training to complex and technical examinations 
to be administered by clinical psychologists, psychiatrists, and other 
medical specialists as, for example, ophthalmologists qualified to diagnose 
and to treat diseases of the eyes. The diagnostic testing is needed not 
only to find the children who need special types of training but also to 
prescribe various types of treatment for physical corrections or to inter- 
pret the proper educational procedures in the classes or schools for ex- 
ceptional children. 

The program of diagnostic testing is related to the testing programs 
for children in regular classes. The general health inspections for all chil- 
dren, the surveys by means of educational achievement tests or group 
mental tests, and the general mental-hygiene programs disclose the 
status of the school population in those areas. They also furnish some 
important clues for finding the exceptional children. This chapter outlines 
general survey procedures in these four areas. These procedures can be 

38 



BAKER AND STANTON 39 

carried out in the main by less thoroughly trained staffs than those to be 
described in the discussion of the problem of individual diagnosis. How- 
ever, the administration of educational and mental tests and the group 
personality and mental-hygiene programs should be under the general 
direction of a clinical psychologist with a staff of examiners trained in 
psychological testing. Nurses under a physician's direction should follow 
up and verify any health inspections conducted by teachers. 

In the discussion of the more detailed program of individual diagnosis, 
specialized types of tests or examination schedules are discussed which 
have been devised for the different types of exceptional children. Highly 
trained technicians, clinical psychologists, and medical specialists are 
needed for the various services involved in the diagnostic program. This 
discussion is of general interest to teachers and to school administrators 
because of the information it provides regarding the equipment and sup- 
plies and the trained personnel necessary for adequate individual diag- 
nosis. It is primarily a general guide to the trained testing and diagnostic 
personnel operating in these areas. 

LEGISLATION AND AUTHORIZATION 

All of the forty-eight states make some type of legal provision for the 
health examination of school children. The nature and extent of these 
services is described in a bulletin of the United States Office of Educa- 
tion. 1 Two states did not report, but the other forty-six reported having 
state laws either making health service mandatory or permissive, in 
which twenty-nine were mandatory, fifteen were permissive, and the re- 
maining four had combinations of such requirements. 

In fifteen of the states, joint responsibility was assigned to educa- 
tional and health authorities; in twelve responsibility was specifically 
assigned to education; in eight, to health; and in thirteen, there was no 
definitely specified responsibility in the law except that it be left for ad- 
ministration by local authority. In thirty-four of the states the local 
authority was primarily assigned to education, the remainder chiefly to 
health or to joint responsibility with health. 

In twenty of the forty-eight states annual examinations are indicated, 
three states have biennial examinations, two have three-year examina- 
tions, one provides for periodical examinations, and the remaining 
twenty-two states furnish no information. 



1 State A dministration of School Health, Physical Education, and Recreation. United 
States Office of Education Bulletin No. 13, 1947. Washington: Government Printing 
Office, 1947. 



40 DIAGNOSING EXCEPTIONAL CHILDREN 

The examining staffs represented a variety of agents or individuals as 

follows: 

Examining Staff No. of States 

Physician or health inspector 8 

Physician and teacher 11 

Physician and nurse 5 

Physician, nurse, and dentist 3 

Physician, nurse, and teacher 4 

Teacher 6 

Dentist 2 

Nurse 2 

Not listed 5 

Total 46 

The extent of examination specifically noted was limited chiefly to 
sight, hearing, teeth, mouth breathing, a few to general health conditions, 
and a few mentioned specifically only communicable diseases. The state 
of Pennsylvania has one of the most thorough plans with health exami- 
nations in the odd-numbered grades in all public and private schools. An 
appropriation of four million dollars was made to carry out these provi- 
sions with the law administered jointly by the departments of education 
and of health. 

It is also interesting to note that approximately one-half of the states 
had participated in the W. K. Kellogg Foundation project involving 
certain areas of these states in which the health examination was one of 
several important parts of a community project involving recreation, 
community planning, and allied activities. 

GROUP SURVEYS AND INSPECTIONS 

This section deals with group surveys of achievement or of intelligence 
and with inspectional procedures for the detection of gross physical and 
sensory defects. Four types of measures will be discussed as follows: (a) 
educational; (6) mental; (c) health; and (d) mental hygiene and per- 
sonality. 

Educational Achievement Tests 

It is a common practice, particularly in the larger cities, to give stand- 
ard educational tests to all elementary-grade pupils in the three-R sub- 
jects. Many school systems devise their own short survey tests of this 
type and use them for initial and final testing. From time to time some 
school systems make general surveys of educational achievement. The 
Stanford Achievement Test 2 and the Public School Attainment Scales 8 



* Available through the World Book Co., Yonkers, New York. 

1 Available through the Public School Publishing Co., Bloomington, Illinois. 



BAKER AND STANTON 41 

are among those commonly used. Comparisons are often made ^between 
school systems or between schools within the same system. 

The results of such tests have some significance in finding handicapped 
and other exceptional children, since both the low scores of many of the 
physically and mentally handicapped children and the high scores of 
gifted children are likely to attract attention. These group educational 
tests are only one of several means of finding exceptional children. Obvi- 
ously, the results must be verified by more detailed and scientific diag- 
nostic testing. 

Group Mental Tests 

Group mental tests are used in a similar manner for general surveys of 
school populations. The National Intelligence Tests, Otis Tests, Terman- 
McNemar, and Pintner General Intelligence Tests 4 are among those com- 
monly used. Many of the larger school systems, such as Detroit, construct 
their own group mental tests. 

During the school year 1948-49, eleven of the larger cities gave the 
language edition of the Pintner General Intelligence Test and the Stan- 
ford Achievement Test to all pupils in the beginning seventh grade. In 
addition to the establishment of more comprehensive norms, such test- 
ing programs stimulate the study of children as individuals. 

There is always an inherent danger that handicapped children will be 
rated incorrectly because of their handicaps, but if the results are cau- 
tiously evaluated and if they are used as a starting point for special study 
and attention to the needs of the children, their purpose will have been 
served. 

Health Inspection 

In the field of general health, including physical and sensory defects, 
most of the preliminary survey must be made by individual examinations 
rather than by group methods such as are employed with educational and 
intelligence tests. 

The chief exception to the individual method is the group test of hear- 
ing by the 4-A Audiometer. 6 Each pupil of an entire classroom is fitted 
with a pair of earphones and provided with paper and pencil. The 
phonograph audiometer transmits the human voice from an instrument 
similar to a Victrola, with gradually decreasing degrees of loudness. Num- 
bers are spoken from the audiometer first into the right ear, then the 
left ear, and each pupil is to record what he hears. The sound record 
presents first a woman's voice and then a man's, so that four tests are 
available. By scoring the papers it is possible to determine at what point 



4 Available through the World Book Co., Yonkers, New York. 
8 Available through the Western Electric Co., New York City. 



42 DIAGNOSING EXCEPTIONAL CHILDREN 

the hearing is no longer functioning successfully. The numbers are of 
short span so that failure would not likely be due to lack of mental ability. 
Of recent date a pure tone audiometer has been invented and is now being 
used for group testing. 6 These results do not furnish an exact diagnosis 
of hearing defects or of their causes, but they provide a potential list of 
suspected cases for further examination and diagnosis by more refined in- 
dividual methods. 

Many school systems have programs of health and physical inspection 
which are conducted by individual methods. They are usually given to 
beginning pupils and periodically throughout the ensuing grades. 

The Detroit Department of Health has issued a guide for teachers. 7 It 
lists evidences of good health as follows: 

Growth suitable to body-build, showing a reasonable 

annual increase. 

Energy ample for individual needs. 

Skin clear, free from infection. 

Mucous membranes clear and definitely pink. 

Hair clean, lustrous, free from infestation. 

Eyes bright, clear, moving normally. 

Nose unobstructed in breathing. 

Teeth well formed, free from caries, clean. Gums 

firm and light pink with no tendency toward 

bleeding. 

Breath absence of disagreeable odor. 

Posture symmetrical position of the body on "standing 

erect," and good muscular co-ordination. 
Bones strong and well built. Head and chest well 

shaped, arms and legs straight. 

Muscles firm, capable of free movement. 

Subcutaneous tissue fat layer beneath skin, firm, good tone. 

Speech normal development, free from disorders. 

Nervous condition free from involuntary twitchings and other 

nervous signs or symptoms. 

Inspection is made in thirteen specific areas as follows: skin, nutrition, 
endocrine, tonsils, nose, teeth, cervical glands, heart, lungs, orthopedics, 
speech, vision, and hearing. 

The code for this screening process is as follows : 

Normal or no defect. 
00 Corrected. 
T Under treatment. 



5 See chapter ix for fuller description of testing procedures. 

'Guarding the Health of Students. Detroit: Detroit Department of Health, 1946. 



BAKER AND STANTON 43 

1 Slight deviation from normal. No follow-up is indicated. 

2 Defect severe enough that follow-up or correction is needed. 

A sample of the orthopedic inspection is as follows: 

Signs suggestive of orthopedic abnormality: 
Uneven position of shoulders or hips 
Peculiar gait, posture, or use of hands or feet 
Difference in size of arms or legs 
Muscular rigidity or inco-ordination 
Deformities of any kind 

The presence of one or more of these signs should be indicated, using code to 
show the extent that it is noticeable. For example: 1 Slightly noticeable, 2 
questionably noticeable. 

Mental Hygiene 

For many decades teachers have made lists of the pupils who have 
shown behavior and personality deviations. These deviations have usu- 
ally emphasized aggressive rather than recessive traits, although the 
latter are also known to have serious implications. 

Surveys based on the results of personality tests have been confined 
largely to children with known deviations instead of being administered 
to all children. Most other testing has been determined by the interest 
and initiative of individual classroom teachers. Much more extensive use 
of personality tests, case history, and individual interview techniques 
have been made on individual children. These will be described later in 
this chapter. 

INDIVIDUAL DIAGNOSIS 

Although the various group surveys and inspections listed above are 
valuable as initial steps in discovering exceptional children, the final diag- 
nosis should usually be done on an individual diagnostic basis. This 
program should be conducted by clinical and diagnostic personnel at the 
higher levels of graduate training, having the Ph.D. or an equivalent 
degree in the nonmedical areas and the M.D. degree for service in the 
area of the physical and sensory defects or in the area of mental diseases. 

The following sections of this chapter outline some of the chief indi- 
vidual diagnostic procedures in order to give school administrators some 
general guides to their thinking in these fields as well as to furnish a brief 
review to the trained personnel in these diagnostic areas. 

The four chief areas applicable to various types of handicapped and 
exceptional children include: (a) educational achievement tests; (6) psy- 
chological tests; (c) physical and sensory tests; and (d) mental hygiene 
and personality tests. In these discussions, emphasis will be directed in 
each area toward the principal type or group of pupils to which the tests 
or procedures are particularly applicable. 



44 DIAGNOSING EXCEPTIONAL CHILDREN 

Educational Achievement Tests 

Educational achievement tests for exceptional children are of value in 
initial educational diagnosis, as a partial guide to instructional procedure, 
and for measuring educational progress under programs of special educa- 
tion. Some types of handicapped children are capable of taking the regu- 
lar forms of available tests but others cannot do themselves justice in 
these examinations because of the nature of their handicap. Some of the 
latter will now be considered. 

The Visually Handicapped. There are various degrees of visual handi- 
caps, ranging from slight deviation from normal vision to complete 
blindness. Accordingly, educational achievement tests for the visually 
handicapped must vary as to both the method of test administration and 
the test format. For the partially seeing pupils, some of the standard 
tests are printed in large type. 8 Publishers are usually willing to grant 
permission for reproducing small quantities of their tests in large print. 

Dr. Samuel P. Hayes makes some interesting suggestions for group 
testing of blind pupils. 9 For example, he suggests the use of "C" and "I" 
instead of the traditional "T" and "F" to avoid copying. He considers the 
multiple-choice form much better than that of matching items and sug- 
gests that time can be saved and fatigue avoided if a good many tests are 
administered orally. 

In the Myers-Ruch High School Progress Test, 10 Hayes had the ex- 
aminer read the incomplete sentence and five possible choices. The pupil 
read these choices in Braille, then the examiner re-read the statement and 
the pupil indicated his choice. 

To save time on the Stanford Achievement Tests, intermediate and 
advanced series, a four-page pamphlet was prepared with embossed dots 
arranged in columns to correspond to the five possible answers for each 
question. Each question was read two or three times if necessary and the 
pupil drew a line through the appropriate dot. This, of course, automat- 
ically excludes the use of time limits. With all of these changes in proce- 
dure, we are faced with the question of the extent to which norms for 
subjects with normal sight are applicable to the blind. Hayes believes 
that the same norms can be used but that further studies should be made. 
At any rate, comparisons among blind children would be valid if Hayes' 
suggested procedures are followed. 

The Auditorially Handicapped. Theoretically it would be possible to 



8 The Stanford Achievement Test is published in large type. 

Samuel P. Hayes, "New Methods of Testing the School Achievement of Blind 
Pupils," Outlook for the Blind, XXXVII (1943), 277-82. 

10 Available through the World Book Co., Yonkers, New York. 



BAKER AND STANTON 45 

administer any standard achievement test to deaf children and make 
comparisons between the deaf and the hearing subjects. However, we 
must always take into consideration the fact that a language handicap 
does exist, and this fact must be taken into account when making such 
comparisons. For certain purposes it might be desirable to work out 
separate norms for the deaf; and still further, it would be desirable to 
construct tests for the deaf which would follow closely the curriculums 
of schools for the deaf. 

Many commonly used standard tests have been used to test the 
achievement of the deaf. Pugh studied the reading of acoustically handi- 
capped children, 11 using the Iowa Silent Reading Test and the Durrell- 
Sullivan Achievement Test. 12 The tests were administered to a large num- 
ber of deaf children with very good results. 

The Keys-Pedersen Visual-Language Tests were constructed specific- 
ally for the deaf and are intended to cover the earlier language achieve- 
ment of these children. Some progress has been made in developing 
standard tests of lip reading, but further experimentation in this area is 
needed. 

The Crippled. The handicaps of the crippled are so varied that no at- 
tempt has been made to set up special achievement tests for this group. 
Simple adaptations can be made to suit the needs of individual children. 

Other Types of Handicaps. Pupils of lowered vitality are usually able to 
take the educational achievement tests of their grade, if suitable rest peri- 
ods are provided as needed. The mentally retarded may be tested with ma- 
terials suitable to their grade and mental age. Since speech-correction 
cases usually receive their major educational instruction in regular 
classes, they are likely to be tested with their regular classes. The speech 
teacher may, however, give additional tests as a check on progress in 
speech correction. The behavior-problem pupils are particularly in need 
of suitable educational achievement tests since they seldom worked up to 
expected levels for their mental capacity before special study of their 
difficulties was undertaken. 

The Gifted. It is very important to give educational achievement tests 
to gifted children in order to determine the general level of their achieve- 
ment as well as to discover the areas of greatest strengths and weaknesses. 

Psychological Tests 

While considerable progress has been made in developing new intelli- 
gence tests or in adapting existing tests for use with various types of 

11 Gladys S. Pugh, "Appraisal of the Reading Abilities of Acoustically Handi- 
capped Children," Journal of Exceptional Children, XIV (October, 1948), 10-14. 

12 Both are available through the World Book Co., Yonkers, New York. 



46 DIAGNOSING EXCEPTIONAL CHILDREN 

physically handicapped children, current practices in the testing of 
handicapped children leave much to be desired. One basic principle in the 
selection of tests, which is too often violated, is that of the suitability of 
the test for the particular child to be studied. Many of our tests assume 
normal language development, yet many of our handicapped children do 
not develop normally in this area. The child who acquired a severe hear- 
ing loss at an early age has been deprived of a normal opportunity to 
learn language. The congenitally crippled child who has been hospitalized 
for a long time during the first three or four years of life may be consid- 
erably handicapped in this area, not because of inability to develop lan- 
guage skills but because his opportunity to learn has been limited. While 
the blind child learns language much as the seeing child does, he may be 
placed at some disadvantage if he must read directions or test items in 
Braille. 

Certain children with speech problems may have good language ability 
but be so handicapped in speech that oral responses are difficult or impos- 
sible. The performance test which is excellent for the deaf child or the 
child with a speech defect may be quite useless with the blind child and 
with certain crippled children. The problem becomes most complicated 
in the case of the cerebral-palsied child, who often suffers from several 
handicaps. 

Frequently, severe defects are so apparent that the examiner recog- 
nizes them easily. Yet in many cases the defect is not noticeable. Psy- 
chologists are not always sufficiently trained in recognizing symptoms of 
eye and ear defects, and unless medical findings and other pertinent data 
are available there may be unwise test selection. For example, a child 
who has a severe hearing loss but has learned to read lips well may appear 
to the uninitiated to have normal hearing and, therefore, be given a Binet 
test or some other highly verbal test without supplementary nonlanguage 
testing. The handicap of the partially seeing child may not be recognized, 
and, as a result, he may be given a test which he fails because of faulty 
vision rather than because of some other disability. 

The Visually Handicapped. Dr. Samuel P. Hayes has contributed 
largely to the testing of the blind. His early adaptation of the Stanford 
Revision of the Binet Scale has been followed by the Interim Hayes- 
Binet Intelligence Tests for the Blind. 13 This consists of a selection of 
items from Forms L and M of the Terman-Merrill Revised Stanford- 
Binet Scale 14 together with a few items from the earlier Hayes-Binet. 

As an alternative scale for blind adolescents and adults, Hayes rerom- 

13 Available through the Perkins Institute for the Blind, Watertown, Massachu- 
setts. 

14 Available through the Houghton Mifflin Co., Boston. 



BAKER AND ST ANTON 47 

mends the Wechsler-Bellevue Scale. 15 The five verbal tests and the 
vocabulary test can be used with the blind with practically no change. 

Because group tests for the blind must be embossed in Braille, they are 
so expensive and unwieldy that the individual tests are usually preferred. 
Fortner developed an adaption of the Kuhlman-Anderson Intelligence 
Test for Grades VI to IX. 16 The Otis Classification Test was used as the 
basis of a test designed by Sargent. 17 Hayes has similarly used the Pressey 
Mental Survey Test. 

Little has been published concerning intelligence tests for partially 
seeing children, although apparently a number of people have experi- 
mented with enlargements of some of the Binet material. The most care- 
ful study of such a plan is that of Pintner, 18 who tested 602 children in 
sight-saving classes with forms L and M of the Terman-Merrill Revision 
of the Stanford-Binet. Both standard and enlarged materials were pre- 
sented. Pintner concluded that some children in sight-saving classes may 
be handicapped by the standard test material and for that reason advises 
the use of enlarged materials. 

In the Detroit Psychological Clinic enlarged materials from the earlier 
Stanford-Binet have been used. At present certain nonvisual tests from 
the nineteen-test battery of the Detroit Tests of Learning Aptitude 19 are 
also being used. 

The Auditorially Handicapped. In 1915 Pintner and Paterson 20 at- 
tempted to use the Goddard Revision of the Binet-Simon with deaf chil- 
dren. As a result, they concluded that the inherent language handicap of 
these children makes it desirable to use test items which do not require 
the use of language. There followed a good deal of experimentation 
which resulted in the construction of the Pintner-Paterson Performance 
Scale, a shortened form of which has been used widely with deaf children. 
Others became interested in performance scales, and, at present, several 
are being used with deaf children. 



18 David Wechsler, The Measurement of Adult Intelligence. Baltimore, Maryland: 
Williams & Wilkins Co., 1939. 

"Ethel N. Fortner, "A Group Intelligence Test in Braille," Teachers Forum 
(Blind) XI (1939), 53-50. 

17 R. Sargent, "The Otis Classification Test," Teachers Forum (Blind), IV (1931), 
30-33. 

18 R. Pintner, "Intelligence Testing of Partially Sighted Children," Journal of 
Educational Psychology, XXX1I1 (1942), 265-72. 

19 Available through the Public School Publishing Co., Bloomington, Illinois. 

20 R. Pintner and D. Paterson, A Scale of Performance Tests. New York: D. Apple- 
ton & Co., 1931. 



48 DIAGNOSING EXCEPTIONAL CHILDREN 

The Grace Arthur Point Scale 21 is a direct off-shoot of the Pintner- 
Paterson Scale and has been used in a good many schools for the deaf. 
Amoss constructed the Ontario School-Ability Examination 22 with the 
deaf specifically in mind. It has been used successfully in Canada and is 
now used in a good many schools for the deaf in the United States. The 
Nebraska Test of Learning Aptitude is an individual psychological ex- 
amination constructed and standardized on deaf children by Dr. Marshal 
Hiskey. 23 The Wechsler-Bellevue is also useful for older deaf children, 
but the language part of the test needs careful interpretation. 

In addition to the individual tests, there are some group tests which 
can be used for screening purposes. Here again, Pintner took the lead 
with the publication of the Pintner Nonlanguage Mental Test. This is 
interesting primarily from the historical point of view. However, the 
Pintner General Ability Test, Nonlanguage Series, is a group test which 
can now be used from kindergarten through Grade IX. Tests have not 
been developed specifically for the hard of hearing, but a wise combina- 
tion of verbal and nonverbal tests should give a good measure of the 
ability of these children. 

In the Detroit program certain nonauditory tests from the nine teen- 
test battery of the Detroit Tests of Learning Aptitude are used. Various 
pages of the Detroit Group Mental Tests are used with unlimited time 
spent on understanding the directions, after which the usual timing for 
hearing children is used. 

The Crippled. Handicaps among the crippled group are so varied that 
it is impossible to prescribe tests for them as a group. Rather, one must 
appraise the physical handicap of the individual child and out of wide 
acquaintance with tests choose those most applicable to each particular 
child. 

The cerebral-palsied child presents the most difficult problem of all. 
One finds all degrees of variation in the individual's ability to respond 
manually or verbally. Often, there are visual or auditory defects as well. 
Many tests have been used experimentally, among them, the Stanford- 
Binet, the Goodenough, the Porteus Maze, and the Wechsler-Bellevue. 
Inherent difficulties are easily seen. In addition, we have the suggestions 
of Strauss and Werner concerning disorders of conceptual thinking in the 
brain-injured child. All this leads us to a position of extreme wariness in 
the reporting of mental test results for cerebral-palsied children. Surely we 
cannot report exact mental ages for severely involved cerebral-palsied 

21 Grace Arthur, A Point Scale of Performance Test. New York : Commonwealth 
Fund, 1930. 

22 Available through the Ryerson Press, Toronto, Ontario. 

28 Test available from author, Southern Illinois University, Carbondale, Illinois. 



BAKER AND STANTON 49 

cases. Sound practice would lead us to sit in conference the physician, the 
physical therapist, the speech therapist, the teacher, the parent, and the 
psychologist. Then, having pooled all the information thus obtained, we 
could make an evaluation of this child's needs and formulate plans for his 
care and education. 

Other Types of Handicaps. The same precautions as to language and oral 
response tests for the auditorially handicapped are also applicable to 
speech-correction cases. Likewise, the physical limitations of the lowered- 
vitality cases must be taken into account in psychological testing. The 
behavior-problem cases should be tested during periods when their emo- 
tional stresses are at a minimum. Many of them have psychopathic 
personalities; some are prepsychotic, and others are actually psychotic. 
Well-trained clinical psychologists are needed to evaluate the psycholog- 
ical diagnosis. 

The mentally retarded often exhibit irregular mental development 
which, in addition to their mental immaturity, causes further complica- 
tion of their learning problems. This condition is reflected in the "scatter" 
of mental responses over a wide range of mental ages on the Stanford- 
Binet Test and on the various parts of the Detroit Tests of Learning 
Aptitude. The presentation of these interpretations to teachers of the 
mentally retarded has proved very useful in helping them to understand 
the mental strengths and weaknesses of their pupils. 

The Gifted. Psychological tests in general use for testing the gifted 
children may be employed if the standards reach high enough to insure 
adequate measurement. In the clinical diagnosis of the gifted, unusual 
special talent may be discovered in some area in addition to the generally 
high rating in mental maturity. 

Physical and Sensory Defects 

The description of this phase of the program includes reference to 
schedules of informal observation and certain inspectional procedures as 
well as to the equipment and apparatus used by examining physicians in 
making a complete diagnosis. Such a program involves the co-operative 
planning of several services in any community. The observation of symp- 
toms may be reported by teachers, school administrators, parents, or 
others. The first screening tests may usually be given by teachers who 
have been briefed in the required procedures or by nurses or school phy- 
sicians when they are available. In many of the areas the final examina- 
tion and diagnosis are the responsibility of physicians specializing in partic- 
ular areas such as hearing defects. 

In carrying out these various phases of the program there must be 
mutual understanding and friendly co-operation among the members of 



50 DIAGNOSING EXCEPTIONAL CHILDREN 

the staff. Those who do the first sifting should understand that they are 
not giving a complete diagnosis. They should not be discouraged from 
further effort whenever the final diagnosis does not confirm their prelim- 
inary findings. On the other hand, those who make the final diagnosis 
should be fully familiar with the specialized school facilities that are 
available and with the existing programs of special education. 

The Visually Handicapped. In the field of diagnosis there are two 
kinds of eye conditions which need attention. One includes defects of ac- 
commodation such as myopia or short-sightedness; the second pertains to 
diseases and disorders of the eyes. The final diagnosis of these conditions 
is mainly in the hands of medical staffs. The ophthalmologist is a medi- 
cally trained person legally qualified to diagnose disorders of accommoda- 
tion and diseases of the eyes and to prescribe treatment for the conditions 
noted. The optometrist, as the term suggests, is authorized in some states 
to measure defects of accommodation but is not a man with full medical 
training. The optician is a technician engaged in the manufacture of 
glasses according to prescriptions furnished by optometrists and ophthal- 
mologists. Many of the larger optical manufacturing firms employ a 
consulting optometrist and some of them employ an ophthalmologist. 
School personnel should be informed regarding the diagnostic facilities 
that are available in their community. 

In the first general screening of children, the Snellen E-Chart is com- 
monly used. It has certain good qualifications but also some limitations. 
The chart is easy to understand and to administer and takes vciy little 
time per child. If the child fails to recognize the various sizes at the pre- 
scribed distances or is able to go beyond those limits, as in cases of hy- 
peropia or farsightedness, there should be further examination by more 
refined methods. 

On the other hand, there are many types of visual troubles which the 
Snellen chart does not diagnose. Children with some defects of accom- 
modation are able to strain their eyes sufficiently for short periods so as to 
appear normal when tested by the Snellen chart. Also, the chart does not 
measure the fusion of images from both eyes, and it neglects errors due to 
astigmatism or to strabismus. It cannot detect diseases of the eye. 

The Betts Telebinocular, 24 which has quite widespread use both in 
schools and in the offices of ophthalmologists and optometrists, discovers 
defects not only for accommodation but also in the measurement of 
astigmatism, strabismus, and fusion of the images from the two eyes. The 
Massachusetts Vision Test, as developed by the Massachusetts Depart- 



24 Available through the Keystone View Co., Meadville, Pennsylvania. 



BAKER AND ST ANTON 51 

ment of Public Health, 25 is designed to test keenness of vision and to give 
evidences of tensions with resulting fatigue, nervousness, poor concen- 
tration, and lack of fusion or binocular co-ordination. The authors of 
this test claim that it may be easily administered by persons who are 
experienced in handling children. 

A second area of screening or inspection, which relates to the partially 
seeing child, was studied by Hathaway. The following excerpt from the 
report of this study furnishes a description of some of the effects of 
defective vision on the behavior and health of the handicapped child. 26 
Behavior: 

Walks with extreme caution, looking closely or feeling with the foot for a step 

up or a step down or for small obstructions; trips or stumbles frequently. 

Holds reading material or other types of fine visual work close to eyes or at a 

greater distance from the eyes than is normal. 

Attempts to brush away blur; rubs eyes frequently; frowns; distorts face 

when using eyes for either distant or close work. Shuts or covers one eye; 

tilts head to one side or thrusts it forward. 

Fails to see distant objects and reading material visible to others. 

Is unduly sensitive to light. 

Is unable to distinguish colors. 

Is unable to estimate accurately locations of objects, hence, frequently runs 

into them or fails to place object properly. 

Fails to see objects not directly within the line of vision, which are clearly 

visible to the average person, while the eyes are fixed looking straight ahead. 
Appearance of eyes : 

Red-rimmed, crusted, or swollen eyelids. 

Frequent sties. 

Watery or red. 

Crossed or not functioning together. 

Discharge of pus. 

Bloodshot. 
Complaints due to use of eyes: 

Dizziness. 

Headache. 

Nausea. 

Pain in the eyes. 

Blurring of letters or objects. 

Double vision. 

Burning or itching lids. 

If there is discharge of pus or pain in the eyes there is need of immediate 

ophthalmological care. 

26 Instructions for the Massachusetts Vision Test. Boston: Massachusetts Department 
of Public Health, Division of Child Hygiene, 1941. 

"Winifred Hathaway, Education and Health of the Partially Seeing Child, pp. 178- 
79. New York: Columbia University Press, 1943. 



52 DIAGNOSING EXCEPTIONAL CHILDREN 

After these earlier stages of inspection have discovered the children 
in need of further diagnosis, referral should be made to ophthalmologists 
or to optometrists, depending upon the child's needs and the available 
services. For defects of visual accommodation, the diagnosticians have 
special equipment and apparatus such as trial lenses, orthoptic machines, 
and several others which are beyond the scope and function of school 
teaching staffs. The ophthalmologists are further qualified to diagnose and 
treat diseases of the eyes such as glaucoma, trachoma, and cataract. 

The Auditoriatty Handicapped. The auditory difficulties which make it 
necessary to provide special training for some pupils may involve defects 
or diseases of the ear. The general symptoms of hearing defects may be 
classified as follows: 

1. Physical symptoms: Failure to respond; says "What?" constantly; cups his 
hand to his ear, moves closer; has peculiar posture; tilts head at unusual 
angles to get better sound; mouth breathing; running ears, earaches, and 
noises in head. 

2. Speech symptoms: Defects in speech; peculiar voice, often high-pitched and 
without expression; lack of adequate flow of language; avoids talking to 
people. 

3. School symptoms: Poor general scholarship; poor oral work; generally slow 
and inaccurate in schoolwork; particularly poor in spelling where dictation 
methods are used; puts own incorrect interpretation on many questions and 
topics as a substitute for complete hearing and understanding. 

4. Social symptoms: Listless, uninterested in any group, sensitive, aloof, sus- 
picious, hard to accept as a cordial acquaintance. 

In addition to the checking of these symptoms, screening results from 
the group testing with the 4-A Audiometer or the group pure-tone audiom- 
eter should also be utilized. The cases of suspected hearing defect should 
be examined carefully with the individual audiometer. In this examina- 
tion each ear is tested for pitch from a high to a low range and for the 
keenness or acuity of hearing at the different levels of these ranges. It is 
also important that measures be made of the fusion of the hearing from 
the two ears when tested together. 

Among the diseases or disorders of the ear, stoppages of the Eusta- 
chian tube, such as deformities of the outer ear and unusual accumulation 
of wax in the ear, are often found to be causes of impaired hearing. Dis- 
eases and conditions which affect the middle ear are also quite common. 
There are also diseases and infections which impair the mechanisms of the 
bones of middle ear as well as the tympanum itself. In like manner, dis- 
eases such as meningitis and fevers may destroy labyrinth and canals of 
the inner ear. These conditons are subject to exact medical diagnosis by 
specialists known as otologists. It is important that teachers be aware of 



BAKER AND STANTON 63 

the evidences of these various conditions and that they know what types 
of diagnostic facilities are available in their communities. 

The Speech Defectives. Speech defect is often complicated by social and 
personality maladjustments since it is difficult for individuals thus 
afflicted to maintain normal relationships with their associates. (Diag- 
nosis in the field of speech disorders includes medical diagnosis for physio- 
logical abnormalities. A second area, primarily psychological, involves 
social analysis and the study of both family backgrounds and classroom 
conditions. A third type of investigation includes a carefully planned test- 
ing program for the discovery of specific errors in speech. In this third 
area, various school systems such as the Detroit Public Schools have 
developed whole series of pictorial or vocabulary tests designed to sample 
the initial, medial, and final sounds commonly used in speech, including 
letters and various combinations of letters as syllables. 

Wendell Johnson gives the following classification of speech and voice 
defects: 27 

1. Articulation (sound omissions, as in pay for play; sound substitutions, as in 
wun for run; sound distortions, as a "whistling" s, or slighted, indistinct 
sounds) 

a. Chiefly due to faulty training, or lack of proper stimulation (no significant 

organic cause) 
6. Chiefly due to organic conditions 

(1) Cleft palate 

(2) Faulty mouth structure, such as high and narrow hard palate, dental 
palate, dental irregularities, large tongue, etc. 

(3) Cerebral palsy (spasticity, athetosis, ataxia, due to damaged nerve 
cells) 

(4) Aphasias 

(5) Paralyses 

(6) Hearing loss 

c. Chiefly due to "psychological" conditions 

(1) Mental deficiency 

(2) Common maladjustments, such as infantilism, shyness, withdrawing 
personality, etc. 

(3) Psychoneurosis and psychoses 

2. Fluency anxiety problems 

a. Stuttering 

b. General nonfluency repetitive, jerky, slow, irregular, labored speech 

(1) Chiefly due to faulty training 

(2) Associated with psychoneurosis, psychosis, mental deficiency 

(3) Associated with organic pathology, such as cerebral palsy, aphasia, 
paralysis, etc. 

27 Wendell Johnson, People in Quandaries, pp. 474-75. New York: Harper & Bros., 
1946. 



54 DIAGNOSING EXCEPTIONAL CHILDREN 

3. Voice 

a. Pitch too high, too low, monotonous, patterned 

b. Loudness too high, too low, monotonous, patterned 

c. Rate, or timing, too fast, too slow, monotonous, jerky, patterned 

d. Quality defects: hoarseness, harshness, nasality, etc. 

(1) All of these may or may not be associated with organic pathology, 
hearing loss, maladjustment, or faulty training. 

4. Word usage 

a. Mispronunciations 

6. Faulty grammar 

c. Inappropriate or ineffective word choice 

5. Lack of knowledge and skill in special means of transmission 
a. Radio, television, telephone, movies, speech recorders, etc. 

The Crippled or Orthopedically Handicapped. Teachers and parents are 
able to observe some of the more obvious defects. The lesser defects have 
usually been known to parents before school entrance and should be re- 
ported by them to the schools. There is a generally accepted but errone- 
ous idea among teachers and parents that unless an orthopedic defect is 
so serious as to require crutches or wheel chairs the schools should do 
nothing about it. Actually such extreme cases are few but there is an 
urgent need to be aware of many lesser defects which merit diagnosis and 
possible physiotherapy such as is provided in modern orthopedic schools. 

Diagnosis and remedial prescription for the orthopedically handi- 
capped are matters for the medical profession, preferably orthopedic 
specialists including surgeons. In many communities such a physician is 
employed by the school system at least part time as consultant or is en- 
gaged on a fee basis. 

A type of case usually grouped with the orthopedically handicapped is 
that of the cerebral palsied. Because of the paralysis or debilitation of the 
nervous system in cerebral palsy, there is loss of muscular control and, 
hence, locomotion is so affected that these pupils are usually transported 
and housed with the orthopedically handicapped. Diagnosis in the areas 
of educational achievement and mental ability require unusual patience 
and tact because of the nature of the handicap. 

The Cardiopathic. Pupils with heart impairment are sometimes placed 
in classes with pupils of lowered vitality and sometimes with the ortho- 
pedically handicapped for the sake of convenience in transporting some 
of the more serious cases to school. Although diagnosis is the task of the 
medical profession, symptoms may be observed by teachers as follows: 
breathlessness from exercise; flushed or slightly bluish color to the cheeks, 
lips, or fingertips; easy fatigue; a frequent dry cough; a chest pain after 
active physical exertion. Some of these symptoms may be indicative of 
other conditions. 



BAKER AND STANTON 55 

The American Heart Association adopted the following plan for the 
classification of cardiographic and circulatory disturbances: 

Organic heart disease: 

Class I: Patients with organic disease, but able to carry on ordinary physical 

activity. 

Class II: Patients with organic disease, but unable to carry on ordinary 
physical activity (cardiac insufficiency). 

A. Activity slightly limited. 

B. Activity greatly limited. 

Class III: Patients with organic disease, but unable to carry on any physical 
activity, i.e., who must remain in bed or in a chair (cardiac in- 
sufficiency). 
Possible and potential heart disease: 

Class E : Patients with possible heart disease, not believed to be due to 
organic heart disease. 

Class F: Patients with potential heart disease. Patients without circulatory 
disease whom it is advisable to follow because of the presence of 
history of an etiological factor which might cause disease. 

Pupils in Class I as well as those in Classes E and F of the above classi- 
fications may usually attend regular schools. Pupils in Class II-A and 
some of Class II-B are selected for special classes. The more severely re- 
stricted cases of Class II-B and the less severe types in Class III may 
have home teaching. Other types of bed cases in Class III should prob- 
ably receive no instruction because of the severity of their illness. 

Lowered Vitality. In any school there are usually a few cases of lowered 
vitality. Evidences of this condition may be indirectly reflected in marked 
disorders of growth, the loss of appetite, disinclination to play, unusual 
drowsiness, and similar symptoms. Children who have been absent from 
school because of extended illness should be watched to see if a normal 
physical recovery occurs. 

In cases of malnutrition, puffiness under the eyes and an abnormally 
distended abdomen are ominous symptoms. A basal metabolism test 
conducted by medical technicians or nurses and interpreted by physi- 
cians is a good index of malnutrition. A second type of lowered vitality is 
found in cases of active tuberculosis. Contrary to popular opinion, tuber- 
culosis is a germ disease and, hence, in its incipient stages, is not nec- 
essarily associated with loss of weight or lowered physique, such as may 
be observed in later stages of tuberculosis. The Pirquet, or cutaneous, 
test and the Mantoux, or intracutaneous, test give some definite indica- 
tions, but the most reliable indicators are X-ray pictures of the chest. 

Some Minor Defects and Deviations. Most of the cases included in this 
group do not have special classes or schools provided for them, but, 



56 DIAGNOSING EXCEPTIONAL CHILDREN 

nevertheless, their defects or deviations are serious enough to warrant 
diagnosis by the staff and whatever treatment is indicated. 

The epileptics can be informally diagnosed at home or in school either 
from their actual grand mal seizures or by more careful observation of 
very short losses of attention in petit mal seizures. Since some types of 
epilepsy are hereditary, additional data can be obtained from the case 
history of the family. The examining physician usually supplements these 
informal sources with electroencephalographic readings of the character- 
istic patterns associated with the various forms of epilepsy. Recent ad- 
vances in medical knowledge give promise that epilepsy may be reduced 
so that most children can remain in their regular classes. 

A second very common physical defect is dental caries. It was noted 
earlier in the chapter that the health examination programs commonly 
include inspection of the teeth. In addition to the inconvenience from 
loss of teeth and the physical pain of toothache, infections from decayed 
teeth are likely to have the serious effect of spreading infection into the 
blood stream and eventually affecting the heart. 

Another group includes the comparatively rare cases of albinism, in 
which lack of pigmentation in the skin produces a pinkish tint that 
marks the individual as different from the norm. The lack of pigmenta- 
tion in the eyes makes them unusually sensitive to strong light and 
many of these children are enrolled in sight-saving classes because of 
this visual handicap. 

The type of individual deviation known as lateral dominance is be- 
ginning to receive much more attention than in former years. This inves- 
tigation involves not only handedness but also general dominance of one 
side of the body, of the feet, and of the eyes. It is, however, chiefly con- 
cerned with handedness or dextrality, because physical manipulation is 
conspicuously involved in daily activities both in school and outside of 
school. It is known that children with ambidextrous tendencies and those 
whose handedness has been forcibly changed are more prone to emotional 
tensions, to the error of reversing symbols in reading, and, in some in- 
stances, to speech disorders. Useful tests of dextrality have been em- 
ployed by Ojemann 28 and by some other investigators. Much of the 
trouble experienced by children with lateral-dominance tendencies could 
be averted if the true status of these cases were determined at the earliest 
possible age and appropriate educational adjustments made at once. 

The rate of physical growth and the size of the individual at any partic- 
ular age may have important social and psychological implications. 
Height and weight measurements should be recorded for all children at 

28 R. H. Ojemann, "Studies in Handedness: II, Testing Bimanual Handedness," 
Journal of Educational Psychology, XXI (1930), 695-702. 



BAKER AND STANTON 57 

intervals of one year in order that the course of these developmental 
characteristics may be studied to the best advantage. A more complete 
discussion of the significance of deviations from normal growth patterns 
is presented in chapter iv. 

There are many kinds of physical and sensory defects, and all of them 
are important from the point of view of educational diagnosis and correc- 
tion. Many of them operate in mild form but in combinations, in which 
case their effects may be as serious as though one major defect existed. 
In an ideal situation a complete record of all these potential defects 
should be on file in the records office in each school. Specialized class- 
room facilities and other special services should be so utilized that all 
these children may be successful in their school and social adjustment. 

Neurological and Behavior Disturbances 

It is unfortunate that many children afflicted with certain types of 
neurological disturbances are incorrectly classified as problems of extreme 
behavior deviations. Many children with chorea, nervous tics, sleeping 
sickness, postencephalitic conditions, various forms of epilepsy, and the 
early stages of mental illness are viewed or dealt with only from the 
standpoint of their disturbing behavior at home and at school. 

There are various informal observations which can be made if one 
looks behind the external manifestations of behavior malpractices on the 
part of children. Such observations may disclose a general lack of nervous 
stamina, twitching of the eyes, nervous tics, tremor of the hands when 
fingers are tensed, or flighty attention. A sound and thorough health and 
physical examination is the first requisite of a remedial program for all 
such cases. Proper diagnosis and treatment may materially reduce the 
number of pupils who otherwise would certainly come to be regarded as 
behavior problems. The diagnosis of such symptoms should be the joint 
project of the social worker, the psychologist, the neurologist, and the 
psychiatrist. 

Most of these cases should have a thorough examination by a compe- 
tent neurologist. In aggravated cases the examination should include an 
X-ray of the skull and the use of the electroencephalogram technique. 
The Wassermann and other blood tests are also a part of this battery of 
diagnostic procedures. Close co-operation between the school and the 
medical profession is obviously necessary in handling such cases. In the 
field of personality disturbances due to home background and other 
social factors, many methods of diagnosis are required. It should be real- 
ized that the behavior symptoms which are so eloquently described by 
teachers and school administrators are only considered as symptoms and 



58 DIAGNOSING EXCEPTIONAL CHILDREN 

are not actual causes. Moreover, they frequently have very little to do 
with the actual diagnosis. 

Personality Tests. In the past few years many personality tests and 
questionnaires have been developed. Some of them are self-administering 
while others are in the form of rating scales to be used by examiners or by 
trained teachers. A great amount of research was done in this field in 
connection with the training programs of World War II. Many of the 
tests are designed for adolescents and are not suitable for children of 
elementary-school age. The California Tests of Personality 29 may be 
used with the younger children. The Detroit "Telling What I Do" Test 
may be given as early as the third or fourth grade, and the Detroit 
"Things I Do" Test 30 may be introduced at about age twelve. The 
latter includes remedial materials or lesson sheets designed for use by the 
students. The results of these questionnaires should be used as a basis for 
interview and follow-up rather than as a means of setting critical scores 
below which cases are given up as hopeless. 

Case Histories. A second general method of behavior diagnosis is the 
case history, which should be developed by especially trained persons 
familiar with the field of psychology and social work. In many states 
trained visiting teachers or school social workers who can use case his- 
tories as a method of diagnosis are a recent addition to the staff. The 
case history includes the health and physical characteristics, personal 
habits and recreational interests, personality and social factors, the phys- 
ical aspects and cultural atmosphere of the home, and adjustment to 
school situations. It is obvious that a great amount of information must 
be secured in order to provide an over-all view of the problems of these 
exceptional children. 

Other Diagnostic Methods. \In the past few years there has been a rapid 
increase in the use of the Rorsdiach method of diagnosis^ This method 
involves analyzing what the child sees in a series of ink blots. In a recent 
number of the Review of Educational Research* 1 there is a review of the 
literature in this field, supplemented by a bibliography of 174 titles./The 
advocates of this rather highly technical method of diagnosis claim that 
many kinds of emotional and personality problems are brought to light 
due to the stimulation of the imagination of children by the requirement 
of an interpretation of the ink blots. Training schools and specialized 
courses in this method have been set up in various parts of the country/ 
The highly professional basis on which this experimentation has been 



29 Available through the California Test Bureau, Los Angeles, California. 

80 Both available through the Public School Publishing Co., Bloomington, Illinois. 

81 Review of Educational Research, XVII (February, 1947), 78-100. 



BAKER AND STANTON 59 

projected represents an encouraging movement in the field of scientific 
measurement. 

^ Along similar lines there are other techniques. For example, in play 
situations the child discloses some of his innermost problems; drawing 
and painting techniques are known to be effective in bringing out the 
deeper feelings and attitudes of children./ 

It is an interesting paradox that diagnosis and treatment are closely 
interwoven in the field of behavior and mental hygiene. This is due to the 
fact that disclosing the causes of difficulty frequently gives insight into 
the problem. In this field of remedial work there is considerable division 
of opinion as to the relative merits of directive and nondirective therapy, 
both of which are concerned with diagnosis. In the nondirective therapy 
the interviewer mainly seeks by skilful mirroring of the client's feelings to 
help him diagnose his own difficulties and suggest methods of treatment. 
In the direct method of therapy, or counseling, it is assumed that the 
patient needs guidance and interpretation on the part of the interviewer. 

In the field of psychology and social work the whole program seems to 
be in the midst of confusion with different schools of thought making 
very definite claims for the superiority of their particular methods. 
Eventually, there will probably emerge a few methods which have dem- 
onstrated their superiority over others but with the best points of all 
methods being integrated into one generally effective program. As a re- 
sult of research in the field of mental hygiene there will not only be diag- 
nosis and remedial work on the more extreme problem cases but the 
techniques of mental hygiene will be found valuable in the training of 
teachers and school adminstrators in the matter of children's personal 
and social relationships. 

SUMMARY AND CONCLUSION 

From the many items which have been discussed in this chapter it is 
evident that diagnosis is a very important initial step in discovering the 
magnitude of the problems relating to the education of exceptional chil- 
dren. After a comprehensive system of special education has been estab- 
lished, the diagnostic program should be continued for the discovery of 
additional cases among children in the regular classrooms. Further 
testing is also necessary for checking the progress of children who have 
been included for a period of time in the program of special education. 

REFERENCES 

1. BAKER, HARRY J. Introduction to Exceptional Children. New York: Macmillan 
Co., 1944. 

2. BAKER, HARRY J., and TRAPHAOEN, VIRGINIA. The Diagnosis and Treatment of 
Behavior-Problem Children. New York: Macmillan Co., 1935. 



60 DIAGNOSING EXCEPTIONAL CHILDREN 

3. BAKWIN, RUTH M., and BAKWIN, HARRY. Psychological Care during Infancy and 
Childhood. New York: D. Appleton-Century Co., 1942. 

4. DAVIS, HALLO WELL. Hearing and Deafness. New York: Murray Hill Books, Inc. 
1947. 

5. HATHAWAY, WINIFRED. Education and Health of the Partially Seeing Child 
New York: Columbia University Press, 1943. 

6. JOHNSON, WENDELL. People in Quandaries. New York: Harper & Bros., 1946. 

7. PINTNER, RUDOLF; EISENSON, J.; and STANTON, MILDRED. The Psychology of the 
Physically Handicapped. New York: F. S. Crofts Co., 1940. 

8. RAPAPORT, DAVID. Diagnostic Psychological Testing. 2 vols. Chicago: Year Book 
Publishers, 1945. 

9. SADLER, WILLIAM S. Modern Psychiatry. St. Louis: C. V. Mosby Co., 1945. 

10. STINCHFIELD, SARAH. Speech Disorders. New York: Harcourt, Brace & Co., 1933. 

11. SYMONDS, PERCIVAL M. The Dynamics of Human Adjustment. New York: 
D. Appleton-Century Co., 1946. 

12. TERMAN, LEWIS M., and MERRILL, MAUDE A. Measuring Intelligence. Boston: 
Houghton Mifflin Co., 1937. 



CHAPTER IV 
GROWTH PATTERNS OF EXCEPTIONAL CHILDREN 



WILLARD C. OLSON 

Professor of Education and of Psychology 

University of Michigan 

Ann Arbor, Michigan 

and 

BYRON O. HUGHES 

Associate Professor of Child Development 

University of Michigan 

Ann Arbor, Michigan 



INTRODUCTION 

The need for considering total development and personality and for 
adopting a philosophy of growth becomes especially urgent in working 
with the child who differs widely from his associates either by reason of 
injury or deprivation or because of very rapid or slow growth. 

It appears to the writers to be a wiser use of limited space to move 
directly to a description of some exceptional children and a discussion of 
major concepts rather than to attempt to achieve systematic complete- 
ness by a review of the literature and a presentation of alternative meth- 
ods for the description of growth. Comprehensive seriatim records have 
been collected by the laboratory school of the University of Michigan 
since 1930. In the course of the years many children have been encoun- 
tered who present unusual patterns of growth. They have contributed to 
an understanding of generalizations which were previously reported 
about the growth of children as wholes and which are developed further 
in the discussion of the cases that follow. 

Illustrations will be included here of the growth of gifted children, 
mentally retarded children, children of lowered vitality, children with 
apparent glandular disturbances, children with delayed speech, and those 
who are disturbed in emotions and behavior. Some implications and 
applications for the social psychology of the classroom and for educa- 
tional treatment will be included. 

UNITS FOR THE DESCRIPTION OF GROWTH 

The age principle has been used in the following pages to transform 
data collected in many types of units in a manner which will permit 

61 



62 GROWTH OF EXCEPTIONAL CHILDREN 

simultaneous description of the patterning and direction of growth. A 
manual 1 based upon published sources gives the investigator an age 
equivalent for any given height in inches, weight in pounds, number of 
teeth erupted, and strength of grip. X-rays of the hand and wrist are 
converted directly into carpal ages by matching with the samples of the 
Flory standards. 2 The manuals for the educational and mental tests give 
the age equivalents for scores for performance. The age units are used as 
a convenience in description, not as norms or goals. The results of peri- 
odic measures after conversion are plotted so as to give a general picture 
of the growth for the child as a whole. The quantitative materials are 
supplemented by medical histories and examinations and by cumulative 
records of behavior and of nurtural variations. 3 For some analytic pur- 
poses an average of all growth data is calculated at a point in time. The 
resultant value has been named organismic age. 4 The distribution of the 
separate attributes of growth about the central age is sometimes studied 
and measures of dispersion such as average deviation and standard 
deviation can be used to test the hypothesis of the unity of growth. The 
general method of description will become clearer in the consideration of 
selected cases. 

THE INTELLECTUALLY GIFTED CHILD 

The method of construction of the graphs is illustrated by the growth 
curves for an intellectually gifted boy (I.Q. about 140) as given in 
Figure 1. The chronological ages are plotted along the base line and the 
growth ages along the vertical axis. The straight diagonal line across the 
page represents one year of average growth for one year of life. In this 
particular case it will be noted that mental age and reading age are at a 
high level, followed in turn at the close of the record by grip age (G.A.), 
weight age (W.A.), height age (H.A.), carpal age (Ca.A.), and dental age 
(D.A.). 

Gifted children, in general, tend to be characterized throughout their 
life history by a highly individuated mentality and a corresponding lux- 
uriation of language processes, reading, and academic achievement. The 
physical attributes tend, on the whole, to lie above the averages typical 



1 Willard C. Olson and Byron 0. Hughes, Tables for the Translation of Physical 
Measurements into Age Units. Ann Arbor, Michigan: University Elementary School, 
1947 (temporary revised edition). 

2 Charles D. Flory, "Osseous Development in the Hand as Index of Skeletal 
Development/' Monographs of the Society for Research in Child Development, Vol. I, No. 
3, 1936. 

8 Willard C. Olson, The Behavior Journal: Manual of Directions for Use in School. 
Ann Arbor, Michigan: University Elementary School, 1948 (third edition). 

4 Willard C. Olson and Byron O. Hughes, "The Concept of Organismic Age," 
Journal of Educational Research, XXXV (March, 1942), 525-27. 



OLSON AND HUGHES 



63 



for children in general but tend to be less highly developed than the in- 
tellect which so often constitutes the chief basis for the identification of 
the gifted. If we were to select children who are gifted in height, other 
values such as mental age would regress toward the mean. 




36 48 



60 



132 144 156 166 



12 64 96 108 120 

Chronological Age 
FICJ. 1. High status and rapid growth in a gifted boy 

A gifted child, such as in this illustration, commonly confirms two 
generalizations concerning the growth of children, namely, (a) growth 
tends to be unified, and (6) achievement is a function of total growth. 
The statistical tests of these hypotheses need not be repeated here but we 
expect about 85 per cent of children to be more unified than the whole 
group of which they are a part. This still permits some children to appear 



64 GROWTH OF EXCEPTIONAL CHILDREN 

to be quite divergent in their growth, particularly if only superficial evi- 
dences are obtained at one point in time. Children of high intelligence 
who do not have a similar maturity in many other variables tend, as is 
sometimes said, "not to live up to capacity" in their school achievement. 

The individual cumulative folder for the child in Figure 1 is about an 
inch and a half in thickness, and there are similar folders for other mem- 
bers of the family. To give an adequate description of the boy as a per- 
sonality would require all the space at the disposal of the writers. It may 
be well, however, to indicate the direction in which a more complete 
description would proceed. 

The child was born at full term after a normal and comfortable 
pregnancy. Labor was short and easy, and the birth weight was seven 
pounds four ounces. The child went through the sitting, standing, walk- 
ing sequence at a slightly accelerated rate, had the first tooth at six 
months, and was somewhat accelerated in talking. 

The health history throughout has been good. The menarcheal age 
of the mother was eleven years, very accelerated, and we are prepared to 
find a tendency toward early maturity on the part of offspring. This is 
subsequently confirmed, and the boy in the illustration had the first 
appearance of pubic hair at about age eleven. 

Several types of evidence not plotted on the graph (Figure 1) indicate 
the general rapidity of development of the boy. At nine years and three 
months there was a retardation of ten months in developmental age 
based upon interest as measured by the Furfey Scale. 5 This quickly 
changed, and, by ten years and four months, he attained a developmental 
age of twelve years and eight months. At a chronological age of seven 
years and three months his social competence was appraised by use of the 
Vineland Scale, 6 and he was found to have a social age of ten years and 
five months. Nine consecutive annual ratings on the Haggerty-Olson- 
Wickman Behavior Rating Schedules 7 placed him always in the best- 
adjusted half of his age group according to the published norms. On a 
scoring for introversion and extroversion, he was in the ambivert area in 
three out of the four measures, with a slight tendency toward extroversion 
on one appraisal. 

The boy of Figure 1 had the good fortune of living with socially 
sensitive and highly educated parents. It is not surprising that the sub- 
sequent record in high school, based both on superior growth and su- 
perior nurture, is maintained at a high level. 

6 Paul H. Furfey, "A Revised Scale for Measuring Developmental Age in Boys," 
Child Development, II (June, 1931), 102-14. 

Edgar A. Doll, The Vineland Social Maturity Scale. Minneapolis: Educational 
Test Bureau, 1946. 

7 Melvin E. Haggerty, Willard C. Olson, and E. Koster Wickrnan, Behavior Rating 
Schedules. Yonkers-on-Hudson, New York: World Book Co., 1930. 



OLSON AND HUGHES 



65 



SIBLING RESEMBLANCES IN GIFTED CHILDREN 
The longitudinal, seriatim study of children opens new possibilities 
of research on designs for growing. Thus the boy of Figure 1 has two 
brothers, and the growth data for them can be compared, as in Figure 2. 
The child previously discussed is described in the various panels with a 
broken line. The striking similarity to an elder brother (solid line) and 
a younger brother (dotted line) is apparent at a glance. Only in carpal 



156 
132 
108 
84 
> 6 



II 



# 



MA 



*4. 



60 



RA. 



C.A 



132 
108 
84 



. 

7 



84 







HA. 



DA. 



36 60 64 108 132 36 60 64 108 132 156 36 60 84 108 132 

Chronological Age 

FIG. 2. Similarity in level and pattern of growth of three gifted children from the 
same family. 

age (Ca.A.) is there a substantial separation of the elder child from the 
younger ones. If the reader will inspect in detail, he will be impressed by 
the coincidence of flexion points as each child in turn becomes a given 
age. The tendency for the specific strands of a pattern to be similarly 
located in different members of a family comes out regularly in a larger 
body of sibling comparisons. Children such as these regularly seek diffi- 
cult and varied educational experiences as contrasted to those who are 
growing slowly or at an average rate. 8 ' 9 



8 Willard C. Olson, "Experiences for Growing/' Journal of the National Education 
Association, XXXVI (October, 1947), 502-3. 

9 Willard C. Olson and Sarita I. Davis, "The Adaptation of Instruction in Reading 
to the Growth of Children/' Educational Method, XX (November, 1940), 71-79. 



66 



GROWTH OF EXCEPTIONAL CHILDREN 



THE GROWTH OF MENTALLY RETARDED CHILDREN 
It appears probable that the pattern of growth in mentally retarded 
children has important relationships to their general behavior and ability 
to adjust in social groups. Such data as we have examined thus far sug- 

108 




48 



120 



96 108 

Chronological Age 
FIG. 3. Slow growth in a mentally retarded boy with cerebral damage. 

gest that feeble-minded children will, in general, have the mental age as 
one of the least individuated aspects of the total growth while other meas- 
ures will tend to regress toward the mean line and may reach or exceed it 
in individual cases. Total maturity as described by the measurement of 
multiple factors adds significantly to an understanding of the potentiality 
of the retarded. 

The child in Figure 3 entered school for the first time shortly after the 
age of seven. It will be noted that height and weight are near the line of 
average growth. Mentality and strength are the least highly individuated. 



OLSON AND HUGHES 67 

Carpal development and dentition are intermediate. At the age of eight 
years and ten months he was just getting a start in reading, with a read- 
ing age of six years and eight months. 

There was nothing particularly remarkable in the prenatal history of 
the child. He was born at term with a weight between six and seven 
pounds according to the mother's report. He was weaned from the bottle 
with much difficulty at eighteen months. He was delayed until sixteen 
months in walking and did not talk until four and one-half years of age. 
He still had a severe speech defect at the opening of the record shown. 
His first tooth appeared at twenty-one months. Bladder control was not 
established until age three. 

One of the significant features of this child's early history is otitis 
media accompanied by severe illness at eight months. There seems to be a 
high probability of brain damage in connection with his illness, confirmed 
by later neurological examination and by some spasticity in his move- 
ments. At the time of the beginning of the record, he was presenting many 
problems such as overactivity, easy fatigability, almost continual and 
somewhat unintelligible talking in a shrill voice, and automatic regurgita- 
tion of meat when eaten. The boy had a large head, poor musculature, 
and a childish gait. 

The case here described is sometimes classified as an exogenous type of 
mentally retarded child. The absence of a family history of mental de- 
ficiency and the evidence for cerebral damage is confirmatory. There is 
already some evidence in the literature 10 that such children will be less 
unified in total growth than the endogenous. 

It is of interest to contrast this case with that of a girl (Figure 4) of 
borderline mentality in which height, weight, carpal ossification, and 
strength have been effective factors in raising her total organismic status 
in a manner which leaves her a well-adjusted and socially useful young 
lady. There is less than average development in dentition, mental age, 
and reading age. One would have quite an inadequate picture of her as a 
functioning individual by a statement of her intelligence quotient, which 
has varied between 69 and 77. Her organismic quotient (organismic age 
divided by chronological age) has remained at 96 during the period of 
most intensive study. Developmental age as measured by the Sullivan 
Scale has hovered about the vicinity of her chronological age at three 
measurement periods. Her social age on the Vineland Scale was thirteen 
years and ten months at a chronological age of eleven years and seven 
months. Measures of problem tendencies reveal an average adjustment 

10 Alfred Strauss and Laura E. Lehtinen, Psychopathology and Education of the 
Brain-injured Child, p. 122, New York: Grime & Stratton, 1948. 



GROWTH OF EXCEPTIONAL CHILDREN 



in the social situation and measures of extroversion-introversion consist- 
ently show scores in the ambivert area. 

This girl's superior physical skill and ability in art and music were rec- 
ognized in the elementary-school period and continued subsequently to 
be an asset. Her achievement in more intellectual pursuits is at the low 
level to be expected from the pattern of growth. Her educational treat- 

204| 



192 



180 



168 



156 



r 

o 



132 



120 



108 



96 



84 



108 




V 




/ 




-A. 



y H A. 
/W A 



.-Co/ 



120 



132 144 156 168 ISO 

Chronological Age 

FIG. 4. Growth of a mentally retarded girl. (From Olson and Hughes, Childhood 
Education, October, 1944.) 

ment was based on the principle "capitalize on strength" rather than an 
emphasis on areas of weakness. No one observing this child as a whole 
would make the diagnosis of borderline mental deficiency. Although her 
system of growth curves is less unified than we have come to expect in 
such children, both her individual record and sibling history place her in 
the endogenous group. 

SLOW GROWTH WITH APPARENT GLANDULAR DISTURBANCES 
Children who are growing slowly, particularly in intellect and achieve- 
ment, often are segregated in special classes or handled by special adjust- 



OLSON AND HUGHES 69 

ments within the room. Some of these slow-growing children have a 
deficiency in glandular functioning as a prominent aspect of their total 
diagnosis. In such cases treatment aimed at the glandular condition is 
often instituted. It now seems probable that many persons have been 
overly optimistic about the amount of stimulation that can be expected 
in such children by the administration of special gland substances. It is 
possible that glands functioning at a low level often are simply another 
expression of the total picture of immaturity and that treatment is 
merely corrective of symptomatic conditions rather than fundamentally 
curative. A basic difficulty in evaluating stimulation through gland sub- 
stances is that one seldom has any type of control data on what could 
have been expected without the treatment. Children grow and mature as 
they become older and it is hard to separate this trend from the special 
effects that may be attributed to medication. A further difficulty is that 
a small initial reponsiveness decreases as antihormones build up within 
the system. 

The growth curves for the girl in Figure 5 are instructive. She was the 
daughter of a businessman and a nurse with an income level that made 
it possible to do whatever was necessary for her well-being. 

It will be noted that the girl's growth curves are substantially below 
the line of average growth. Her organismic age has been calculated at an- 
nual points and there is an average deficiency of about twenty-seven 
months during the period of the graph. In her early years, there was some 
fear that she might be heading for dwarfism. Treatment with antuitrin to 
compensate for pituitary deficiency appeared to produce some responsive- 
ness in the early years, but there was subsequently a suspicion that anti- 
bodies were built up which were actually detrimental to her growth. 
Note, for example, the period of plateau from eight to eleven years of age. 
A thyroid deficiency was also in the picture, and heavy doses of thyroxin 
were started at about 120 months of age. The curves tend to swing up 
shortly after 132 months of age and it will never be known whether this 
was because of or in spite of treatment, since no data on untreated sib- 
lings are available. From the point of view of familial resemblance, it 
should be noted that the child comes from a family which would be ex- 
pected to produce offspring below the line of average growth in size. 

In accordance with the trend expected with children of this type, this 
girl had her first tooth at twelve months, did not walk alone until two 
years, was delayed in bladder control and in the development of intel- 
ligible speech. Attempts at breast feeding were unsuccessful. Contrary 
to the general trend in slow-growing children, the mother's menstruation 
was early and the daughter's likewise. It should be recalled in all gen- 
eralizations that trends are overruled in specific details, and one is more 
impressed by lawfulness when appraising all types of data simultaneously 



70 



GROWTH OF EXCEPTIONAL CHILDREN 



than when trying to locate an unexceptional trend for a single factor. 

The development of the child's interests was more in accord with her 

growth age than with her chronological age. Thus, at a life age of twelve 



































































































































/ 
























/ 
























/ 
















LECI 


:NO 








/ ; 













































HA 

HA 






/ 


/ h 



















WA 
DA 




// 


/ 


I 






120 


























































































/ 


S\i 


y^ 


JP 




















^ 


'^f 


'f"> 


7 
















/ 


/ 




L^ 


// 
















/ 


/ 


r 


X 


x 


' 














/ 




' 


f 


x 
















/ 






" 


"" 
















J 


4 


B 61 


7 


I ft 


4 9< 


B K 


>8 n 


13 


Z K 


f4 If 


>6 





Chronological Age 
FIG. 5. Slow growth of a girl with glandular involvement 

years, her developmental age, based on interests as measured by the 
Sullivan Scale, was appraised at eight years and two months. 

Irrespective of complex causative factors, such a child presents impor- 
tant problems of management to the school. Behavior tends to be imma- 
ture for the chronological age of the child, although not for the growth 
age. Much effort is needed to control restlessness and inattention. If in a 
mixed group, it is essential for the teacher to insure that simple reading 



OLSON AND HUGHES 



71 



materials and other learning experiences are in the environment. Perhaps 
the greatest needs for the slow-growing child are, first, a program of con- 
tinuous interpretation to the parents by members of the staff and, 
second, a sensitive regard for readiness and careful attention to pacing 
practices on the part of the classroom teacher. 




60 72 64 96 106 120 132 144 156 166 160 192 

Chronological Age 

FIG. 6. Growth of a boy who was delayed in the maturing of secondary sex 
characteristics. 

DIVERSITY IN LEVEL AND RATE 

The boy illustrated in Figure 6 had a fairly unified growth picture be- 
tween the age of sixty months and ninety-six months. He then started to 
accumulate fat at a rapid rate and his weight-age curve became the 
highest of the measurements recorded. In the period from nine to 



72 GROWTH OF EXCEPTIONAL CHILDREN 

twelve years he is one of the relatively few cases that are exceptions to 
the generalization that children are regularly more unified than the 
whole group of which they are a part. In the period following that covered 
by the graph, his growth curves converged again. 

Medical study revealed a complex which probably involved the 
pituitary, the thyroid, and the gonads. For example, the testicles were 
still incompletely descended at 132 months of age, although this change 
normally occurs at or shortly after birth. The boy had a late maturing 
mother (menarcheal age 16), so there is a familial aspect which may be 
fundamentally more important than the observation of delay in individ- 
ual sex maturing. 

One would miss the significance of total growth in this boy to assume 
that the retarded progress in reading was a matter of curriculum and 
instruction. Much individual attention was given in reading, both by the 
teacher and by a psychologist during the period of the boy's plateau in 
reading. 

Growth such as that of the boy in Figure 6 is sometimes described as 
sex-inappropriate, i.e., it does not conform to the typical masculine 
pattern. Boys with this type of growth sometimes must be aided in 
personality adjustments since they become sensitive to the differences 
between themselves and their companions. 

THE RETARDED IN SPEECH 

Speech becomes of peculiar interest to the developmental psychologist 
as an individuation of part-behavior from the structures and functions of 
the total organism. A longitudinal record (Figure 7) from the laboratory 
school will serve to illustrate the problem of speech in relation to total 
developmental diagnosis. 

The growth curves describe a boy of slightly above-average mentality 
with growth curves in dental age, grip age, height age, and weight age 
which are in the vicinity of average development. The curve for reading 
age, however, over a period of seventeen months of testing shows a sur- 
prising degree of unresponsiveness to instruction. If one had this much 
information about the child, one might entertain the hypothesis that 
reading instruction was seriously at fault. If now, however, we add to the 
total picture an "articulation age 1 ' based upon four successive examina- 
tions of the pronunciation of consonant sounds, 11 we secure added insight 
into the reason for lack of progress in both oral and silent reading. The 
articulation ages range between thirty-six and forty months during the 
period shown on the graph. The separation from the other variables is 

u Irene Poole, "The Genetic Development of the Articulation of Consonant 
Sounds," Elementary English Review, XI (June, 1934), 159-61, 



OLSON AND HUGHES 



73 



probably exaggerated because of the unusual maturity of the select popu- 
lation upon which the provisional articulation-age scale was based. The 
boy was a premature baby weighing about three pounds and was delayed 
in talking until practically three years of age. 




36 



72 64 

Chronological Age 



96 



Fia. 7. Growth of a boy with marked delay in the development of articulation 
of consonant sounds. 

The unwholesome pressure placed on this child by his parents for high 
academic achievement and exemplary behavior appears to have been a 
further factor in deteriorating his social behavior, and he received ratings 
of problem tendencies placing him in the highest 10 per cent of the popu- 
lation in the undesirable direction. 

The child passed from our supervision. However, a follow-up study 
four years later revealed a twenty-six month's retardation in mental age 
and a fifteen month's retardation in reading, with some continuation of 
disturbed behavior which had become more aggressive. 



74 



GROWTH OF EXCEPTIONAL CHILDREN 



CHILDREN OF LOWERED VITALITY 

The writers have studied a substantial number of children presenting 
the condition commonly called "lowered vitality." Their records are 
particularly instructive in developing an understanding of the complex 
of nature and nurture involved in growth. 

For purposes of exposition here, we will present some details concern- 
ing a family of four. Pregnancies A and D (Table 1) terminated with the 
death of the child. Children B and C survived and will be the subjects 
of discussion. 

TABLE 1 

ORDER OF PREGNANCY, MATERNAL AGE, AND AGE AND 
WEIGHT AT BIRTH FOR CHILDREN OF FAMILY X 



PREGNANCY 


MATERNAL 
AGE 


AGE AT BIRTH 
(months) 


WEIGHT 


A 


23 


6 


Dead 


B 


25 


g 


5 Ibs 8 oz 


C . 


27 


7 


2 Ibs 4 oz. 


D 


28 


7 


Dead 











The subsequent growth of Child B and Child C is described in Figure 8. 
The growth of B is portrayed by a solid line and that of C with a broken 
line in the various panels. Their close resemblance in mental age, carpal 
age, height age, weight age, and dental age will be noted. Child B's 
growth in reading showed a spurt earlier than that for his younger 
brother. The spurt for C in reading, as shown in the chart, is actually too 
straight and even because of the absence of some tests at intermediate 
points. 

Statistical tests have been applied to the differences that exist between 
the two boys as compared to children drawn at random. Evaluating all 
the material from all the graphs simultaneously, the differences found 
are only 37.7 per cent of what would be expected among pairs selected at 
random. In chance matings of populations, sibling differences are ex- 
pected to be 50 per cent of nonrelated pairs. If we allow a loading of 
12.5 per cent for the tendency toward selective mating, we find the two 
boys show the amount of sibling resemblance that should be expected on 
the average in any similar comparison. In the case of weight, however, the 
difference is only 10 per cent of what would be expected by chance. 
The hypothesis is thus tenable that common nurtural factors have made 
for additional similarities beyond ordinary sibling resemblance in this 
more sensitive area. 

The tendency for a delayed onset of the cycles of puberty is confirmed 



OLSON AND HUGHES 



75 



by other material in the detailed record. Thus the mother's first men- 
struation occurred somewhat past sixteen years of age a substantial 
delay. Such a delay in the mother is known to be reflected in sons and 
daughters. 

It will be necessary to omit most of the numerous details concerning 
the environmental factors playing upon these boys. A few outstanding 
events may be noted. The mother spent two months in bed prior to the 



108 



MA. 

72 >4 9% (O't 



tOJ 120 132 



O 



HA. 



WA 



D.A 



72 84 96 108 120 72 



108 120 60 72 84 96 



Chronological Age 
FKJ. 8. Comparison of the growth of brothers with lowered vitality 

delivery of Child B. Morphine was given daily for two months. The de- 
livery was difficult and the baby was cyanotic. Breast feeding was un- 
successful; the baby appeared lifeless and had to be fed with a medicine 
dropper. There was heavy demand for rest and sleep during the first 
eighteen months. The child showed much fatigue and great excitability, 
with prolonged crying and a poor appetite. Subsequently there was 
evidence of allergic rhinitis, hypothyroidism, asthmatic bronchitis, and 
finally a positive tuberculin reaction. 

The mother had a similarly difficult time with the younger child. 
There was daily nausea, persistent vomiting, and repeated occurrences 
of false labor. These are not good conditions for the prenatal nurture of a 



76 GROWTH OF EXCEPTIONAL CHILDREN 

child. The child slept most of the time for two months after birth and 
was fed with a medicine dropper. Convulsions disappeared by age five 
and night terrors continued into the elementary period. As in the case 
of the brother, there was quick fatigue, high excitability, asthma, allergic 
rhinitis, hypothyroidism, and finally a positive tuberculin reaction. 

It is probable that the boys of the preceding illustration could not 
have been kept alive except for advances in modern medicine. As in all 
children, they have designs for growing which required nurture for their 
fulfilment. Many wise things were done in the course of their develop- 
ment to keep them alive and to assist them in fulfilling their designs. At 
one time, for example, Child B was found to be walking two miles at 
noon for an inadequate lunch. This is the period when his weight was 
declining, as shown in Figure 8, shortly after nine years of age. Elimina- 
tion of the walk and a hot lunch at school may have assisted in the re- 
sponse noted in the weight curve. 

In the case of these boys, it is clear that they should be treated as if 
they were actually younger than their life ages. Although their mental 
ages through the years of the record were in the vicinity of average 
growth, it is clear that their total competence was not up to it. Their 
immaturity was reflected in their disinterest, inattention, and lack of 
progress in reading. Their achievement in this subject was about what 
should be expected of them, all factors considered. 

Parent education becomes of unusual importance in connection with 
boys who grow like those in the illustration. With all the difficulties 
noted, the parents still put pressure on these boys for greater achievement 
in school. The resulting repercussions in behavior and personality, which 
appeared to be a complex of immaturity and reaction to frustration, 
were undesirable. It is probable that the teacher of children such as 
have been described should be unusually sensitive to factors stimulating 
particular types of behavior so as to avoid undesirable stress in an inade- 
quate organism. 

The writers would not wish to imply that all children of lowered vital- 
ity show the deficiencies in growth presented by the cases in the illustra- 
tion. They have in the files cases where growth has been at a high level 
and where the evidences for lowered vitality are found more largely in 
the amount of energy available to the organism for productive work than 
in actual registration in the growth process. 

In one sense then, the category "lowered vitality" is not too meaning- 
ful. The particular applications of principles of growth in an individual 
are unique and must be studied in a clinical context. Children of lowered 
vitality regularly confirm two generalizations applicable to all children, 
that total growth tends to be unified and that achievement is a function 
of total growth. 



OLSON AND HUGHES 77 

AFFECTIVITY AND GROWTH 

The hypothesis that there is a relationship between affective or emo- 
tional states and growth appears to be supported from both the point of 
view of internal need and of external requirements. It is expected that 
affective warnings will occur when all is not right in the homeostatic 
system. Where the requirements for self-regulation are not met, some 
affective awareness commonly occurs. On the other hand it has been 
demonstrated that environmental situations do alter circulation, metab- 
olism, secretions, mineral retention, etc. Such relationships have been 
the concern of psychosomatic medicine. 

Over the years, the laboratory school has accumulated records for 
some highly disturbed children. These are often the subject of study by 
the entire staff so as to secure the best professional help and to carry out 
whatever sensible recommendations might ensue. Seriatim records of 
growth were brought to conferences and it was noted that relationships 
exceeding chance appeared to exist between an exacerbation of emotional 
and behavioral symptoms and the pattern and rate of growth. Here, 
obviously, is an important problem of "process" on which only a begin- 
ning has been made. 

Mechem 12 studied associations between affectivity and growth among 
children in a laboratory school. She found a substantial relationship be- 
tween verbalized affective states and growth in a year interval between 
interviews. The change in a child's affectivity score was a more sensitive 
indicator than its absolute amount. The growth curves for the girl in 
Figure 9 illustrate, in the period between the heavy vertical lines, the 
sluggish growth that accompanied a large deterioration of 16 points in 
affectivity score. An accumulation of entries in the "behavior journal" 
for this case supports the interview material. The teacher, physician, and 
psychologist note dissatisfaction with school, trouble with associates, 
day-dreaming, depression, fatigue, fainting spells, and beginning of the 
menstrual cycle. Problem tendencies as measured by the Haggerty- 
Olson-Wickman Scale increased in amount between the interviews. 

It is, of course, unsafe to give a general formula for the treatment of 
the emotionally disturbed child in school. The factors are often so specific 
as to be revealed only by individual case study. There is an interesting 
"hen and egg" problem in the question of whether affective disturbances 
precede or follow physiological needs. It seems probable that these mat- 
ters are circular and multiple in causation and that a professional person 
might institute treatment at any point which affects the whole. There is, 
thus, a rational basis for programs in which food and rest and reduction 
of sensory bombardment are to the fore, for therapeutic measures in 

"Elizabeth Mechem, "Affectivity and Growth in Children," Child Development, 
XIV (June, 1943), 91-115, 



78 



GROWTH OF EXCEPTIONAL CHILDREN 




Fia. 9. Sluggish growth in the interval between interviews for a girl whose 
affectivity scores decreased. (Reproduced by permission from Mechem.) 

which the externalization of tension through much involvement in ex- 
pressive behavior is stressed, and for psychotherapeutic procedures in 
which individual analysis, interviews, and the progressive achievement 
of insight are prominent. 

SOCIAL RELATIONS OF THE EXCEPTIONAL CHILD 
While the discussion in the foregoing illustrations has centered on 
the development of structures and functions, it has been apparent that a 



OLSON AND HUGHES 79 

part of the problem of dealing with the exceptional child is concerned 
with his relationship to others in his surroundings. We will illustrate one 
way for the systematic study of this problem by using modifications of 
Moreno's sociometric techniques. 

The arrangement of the children in Figure 10 is based upon a question- 




FIG. 10.- Sociogram for Grade III. The choices for companions for work in school 
arc shown on a chart where the location of the children is determined by total social- 
status scores. Triangles represent boys, and circles represent girls. Children 7, 12, 14, 
and 17 receive many choices, while children 15, 16, 11, and 6 receive few. The arrows 
indicate the number and direction of choices. Diamond-headed arrows represent 
mutual choices. (From Olson, Childhood Education, March, 1946.) 

naire in which each child chose two others for each of three situations: 
going to the movies, for a luncheon companion, and for school work. To 
avoid confusion, the lines have been drawn to show only the number and 
directions of choices for companions for work in school. Such a diagram 
becomes of clinical interest to the student of the exceptional child when 
it is observed that children on the periphery have characteristics as 
follows: 



80 GROWTH OF EXCEPTIONAL CHILDREN 

ChOd Number 

6 . . Highest among girls in extroversion, second in problem tendencies, pronounced 

affective disturbances. 

10 . . Most able in intellect and achievement and most introverted among the girls. 
11 .. Most immature in organismic status in the group. 

15. .Highest extroversion and problem tendencies among boys. Also one of most 

immature in growth. Low in desirable affectivity. 

16. .Most immature intellectually in the group. 

The children in the center tend toward the reversal of these traits in 
varying combinations. A child such as number 3 is of special interest to 
the teacher of the hard-of -hearing. Some hearing loss followed a double 
mastoidectomy. Children do not enjoy going to the movies with him be- 
cause they must repeat things that he misses. He also talks too loudly, 
and they must raise their voices in speaking to him. However, he has 
high ability and is otherwise well adjusted and he secures choices for the 
luncheon situation. One ear now is practically normal, and his general 
status seems to be improving. 

A knowledge of the whole child in the total field would appear to be a 
necessary frame of reference for the professional worker with exceptional 
children, although at times specific procedures may be set up to nurture 
attributes of the whole. 

SUMMARY AND IMPLICATIONS 

Applications of modern, multivariable longitudinal techniques to the 
growth of gifted children, mentally retarded children, children of 
lowered vitality, children with apparent glandular disturbances, children 
with delayed speech, and those who are disturbed in emotion and behav- 
ior have been illustrated in the present chapter. The principles of growth 
which have been discussed appear to be the same for these as for all 
children. There tends to be some unity in the samples of structures and 
functions drawn from an organism. This unity is disturbed in cases of 
injury, deprivation, or disease. Children from the same family tend to 
have similar patterns for change with time and for the level of the various 
attributes of growth. 

Achievement in school (when fully nurtured) tends to be a function of 
the total growth of the child and of the family pattern. The importance 
of setting standards in terms of the individual child who is growing, 
rather than in terms of averages, is clearly indicated. The findings under- 
line the importance of techniques which allow for the full variability of 
the human material. 

Since personality is an emergent in the interaction between the poten- 
tialities of the individual and the expectations and the requirements of 
his environment, a sensitive regard for both is essential. The practical 



OLSON AND HUGHES 81 

problem in the education of the exceptional child thus becomes the con- 
sideration of the total child in a field of social forces. 

A philosophy of growth has in it much of value for the worker with ex- 
ceptional children: Each child is to be assisted in growing according to his 
stage of maturation without deprivation or forcing in an environment and 
by a process which also supplies a social direction to his achievements. 
How this is to be done is described in greater detail in subsequent 
chapters. 

REFERENCES 

1. DOLL, EDGAR A. The Vineland Social Maturity Scale. Minneapolis: Educational 
Test Bureau, 1946. 

2. FLORY, CHARLES D. "Osseous Development in the Hand as Index of Skeletal De- 
velopment," Monographs of the Society for Research in Child Development, Vol. I, 
No. 3, 1936. 

3. FURFEY, PAUL H. "A Revised Scale for Measuring Developmental Age in Boys," 
Child Development, II (June, 1931), 102-14. 

4. HAGGERTY, MELVIN E.; OLSON, WILLARD C.; and WICKMAN, E. KOSTER. Be- 
havior Rating Schedules. Yonkers-on-Hudson, New York: World Book Co., 1930. 

5. HUGHES, BYRON 0. "Educational Problems of Slow-growing Children," Uni- 
versity of Michigan School of Education Bulletin, XVII (December, 1945), 43-46. 

6. . "Implications of Heredity for Education," University of Michigan School 

of Education Bulletin, XVIII (December, 1946), 41-44. 

7. MECHEM, ELIZABETH. "Affectivity and Growth in Children," Child Development, 
XIV (June, 1943), 91-115. 

8. OLSON, WILLARD C. "The Improvement of Human Relations in the Classroom," 
Childhood Education, XXII (March, 1946), 317-25. 

9. , "How Children Grow," Journal of the National Education Association, 

XXXVI (September, 1947), 436-37. 

10. . "Experiences for Growing," Journal of the National Education Associa- 
tion, XXXVI (October, 1947), 502-3. 

11. m "Hazards to Growth," Journal of the National Education Association, 

XXXVI (November, 1947), 580-81. 

12. . "Human Relations in the Classroom," Journal of the National Educa- 
tion Association, XXXVI (December, 1947), 640-41. 

13. . "The Philosophy of Growth," Journal of the National Education Associa- 
tion, XXXVII (January, 1948), 28-29. 

14. . The Behavior Journal: Manual of Directions for Use in School. Ann 

Arbor, Michigan: University Elementary School, 1948 (third edition, revised and 
enlarged). 

15. . Child Development. Boston: D. C. Heath & Co., 1949. 

16. OLSON, WILLARD C., and DAVIS, SARITA I. "The Adaptation of Instruction in 
Reading to the Growth of Children," Educational Method, XX (November, 
1940), 71-79. 

17. OLSON, WILLARD C., and HUGHES, BYRON 0. "The Concept of Organismic Age," 
Journal of Educational Research, XXXV (March, 1942), 525-27. 

18. . "Growth of the Child as a Whole," Child Behavior and Development, 

chap. xii. Edited by Barker, Kounin, and Wright. New York: McGraw-Hill Book 
Co., 1943. 



82 GROWTH OF EXCEPTIONAL CHILDREN 

19. . "Concepts of Growth: Their Significance to Teachers," Childhood Educa- 
tion, XXI (October, 1944), 53-63. 

20. . Tables for the Translation of Physical Measurements into Age Units. 

Ann Arbor, Michigan: University Elementary School, 1947 (temporary revised 
edition). 

21. POOLE, IRENE. "The Genetic Development of the Articulation of Consonant 
Sounds," Elementary English Review, XI (June, 1934), 159-61. 

22. STRAUSS, ALFRED A., and LEHTINEN, LAURA E. Psychopathology and Education 
of the Brain-injured Child. New York: Grune & Stratton, 1948. 

23. SULLIVAN, CATHARINE. "A Scale for Measuring Developmental Age in Girls," 
Studies in Psychology and Psychiatry, Vol. IV, No. 3, 1934. 



CHAPTER V 
GUIDANCE FOR THE EXCEPTIONAL CHILD 



F. H. FINCH 

Professor of Education 

University of Illinois 

Urbana, Illinois 

and 

VELMA YOWELL 
Research Analyst 

Illinois Commission for Handicapped Children 
Chicago, Illinois 



INTRODUCTION 

The term "guidance' * is used in this chapter to refer to all those serv- 
ices rendered to the individual for the purpose of helping him develop the 
ability to (a) establish suitable goals for himself and (6) discover and 
organize the means by which these goals can be reached. More simply, 
guidance may be looked upon as services provided to help the individual 
develop the ability to make suitable plans for his own activities. While 
the various aspects of life are, in a sense, inseparable and can by no 
means be segregated into clearly independent categories, one may find it 
convenient to apply to certain phases of an individual's activity such 
descriptive terms as vocational, educational, recreational, civic, and 
social. The growth of the individual's ability to plan and to choose with 
respect to any of these areas of activity requires that he have opportuni- 
ties for a variety of experiences which may be regarded in a broad sense as 
educational in nature. Complete guidance service will include provisions 
for: (a) helping the individual to understand himself; (6) fostering in 
each individual the development of interests and aspirations which are 
socially acceptable and consistent with his potential capacity for achieve- 
ment; (c) furnishing him that information concerning his environment 
which he will need as a basis for his planning; (d) affording him extensive 
experience in planning and making choices in his day-to-day activities; 
and (e) helping him discover and gain access to opportunities for putting 
into action his long-range plans and for achieving his goals. 

While there is a basis for regarding guidance as a community responsi- 
bility in w T hich many agencies will share, it should be recognized that the 

83 



84 GUIDANCE FOR EXCEPTIONAL CHILDREN 

activities which make up a guidance program are, for the most part, 
essentially educational. Furthermore, the school is the one agency in this 
country which has extensive and regular contacts with practically all 
young people through that period of life during which there should be 
much progress toward achieving the objectives of guidance. Because of 
this, the school is strategically well situated to play a central role in 
guidance a role which no other existing institution can assume with 
equal effectiveness. While the traditional school, with its emphasis upon 
the three R's, did not go far toward providing services designed to 
develop the abilities of its pupils in the area with which guidance is con- 
cerned, during recent decades marked progress in this direction has been 
made, and society is currently demanding still greater emphasis upon 
guidance in the schools. 

The idea of extending education through elementary and secondary 
levels for everyone has very widespread acceptance in this country. This 
means, among other things, that exceptional children will generally be 
included among the clientele of both the elementary and the secondary 
schools. As a minimum, the schools might be expected to offer their ex- 
ceptional pupils guidance services equivalent to those generally furnished 
to all other pupils. Fortunately, the guidance needs of exceptional pupils 
are not wholly different from those of pupils who are less markedly 
atypical. Also, the fact that guidance services are, by the very nature of 
their purposes, necessarily kept mainly on an individual rather than a 
mass basis favors their adaptation to the peculiar problems of exceptional 
children both the handicapped and the gifted. In general, the school 
which has a highly developed guidance program will find its exceptional 
children assisted in many respects through the regular operation of that 
program. Little if any special provisions beyond this will usually be re- 
quired by the gifted members of the school's clientele. But there are 
many instances in which it is urgent that the school provide special or 
unnusual services for some of its handicapped pupils. Even when a 
school has gone as far as possible in its efforts to provide special guidance 
and related services to its handicapped pupils, the results may fall far 
short of an acceptable minimum. This is almost certain to be true in a 
school with an enrolment so small that children with any one type of 
handicap are encountered only at infrequent intervals. Schools with 
relatively large enrolments also often find it advisable to obtain the assist- 
ance of some outside agency in dealing with the more unusual problems 
presented by the severely handicapped. 

The foregoing comments lead to the classification of guidance services 
with which handicapped pupils should be provided under three headings, 
as follows: 



FINCH AND YOWELL 85 

a) Guidance services of the order that the schools should furnish to all who 

attend. 
6) Guidance services that handicapped pupils need especially because of the 

existence of their handicaps and that the schools can assume responsibility 

for furnishing, 
c) Guidance services that come best through the participation of an outside 

agency whose work can be closely co-ordinated with that of the schools and 

which has at its disposal special resources for the handicapped beyond 

those that the schools can supply. 

This chapter will be concerned mainly with guidance services belong- 
ing to the second and third of these three categories and will give little 
attention to those parts of the school's guidance services that should be 
generally available to all children. In other words, it will be devoted to 
guidance services that handicapped persons need because they are 
handicapped and that may be provided either (a) by the schools, (6) by 
some other agency, or, more frequently, (c) by the combined efforts of the 
schools and other agencies when they work together. 

GUIDANCE AND PERSONALITY DEVELOPMENT 

An individual's ability to plan for a well-ordered life, or for any one of 
the major life-activities in which he will engage, depends upon certain 
basic qualities of personality. Guidance services are concerned with and 
can make important contributions to the individual's personality devel- 
opment. A brief consideration of some of the factors that are involved in 
the growth of personality, with emphasis on those which operate with 
unusual force in many handicapped persons, may furnish a starting point 
for thinking about the nature of the guidance services which handi- 
capped persons require. 

Personality has been variously defined, and there is no single concept 
of personality upon which all psychologists agree. After examining fifty 
definitions of personality, many of which have a good deal in common, 
Allport offered his own definition as an improvement over those which he 
had reviewed. He says, "Personality is the dynamic organization 
within the individual of those psychophysical systems that determine 
his unique adjustment to his environment." 1 Whatever the person does, 
we may look upon it as an expression of his personality. All behavior 
everything that the organism does may be regarded as the organism's 
attempt to adjust to its environment. 

The adjustive process may be described in the following somewhat 
oversimplified fashion: (1) Every individual has inherent qualities which 



1 Gordon W. Allport, Personality: A Psychological Interpretation. New York : Henry 
Holt & Co., 1937. 



86 GUIDANCE FOR EXCEPTIONAL CHILDREN 

impel him to activity. These needs, drives, or motives are the basis of all 
behavior. (2) Behavior is directed toward goals, the attainment of which 
satisfies the needs or motives of the individual. (3) But, if progress toward 
a goal is thwarted, disorganization of the personality results unless there 
is (a) a new course of action in an attempt to overcome or by-pass the 
thwarting barrier and reach the goal, or (6) modification, shifting, or re- 
placement of the goal until satisfying progress toward a goal becomes 
possible. These processes go on persistently. Actions that result in 
satisfying achievement are repeated until the development of the organ- 
ism or changes in the environment require new action patterns. Actions 
that fail to bring the individual closer to his goals are abandoned (if their 
results are recognized) and replaced. Those instances in which complete 
blocking occurs in which the individual experiences repeated failures 
and finds no means of progress toward acceptable goals lead to the 
disintegration of personality. This description of the adjustive process 
does not emphasize sufficiently the fact that the needs, drives, motives, 
and goals of the individual change. They are constantly subjected to the 
combined influences of maturation and experience. Furthermore, there 
are usually a variety of ways by which any given need can be satisfied, 
and to this must be added another fact that is of prime importance 
the individual has the capacity for altering his level of aspiration up- 
ward or downward in the light of the degree of success he is experiencing. 
Thus, every person is confronted with the necessity of making repeated 
choices and evolving plans for action through which whatever choices he 
makes are to be achieved. This applies to all, no matter whether they have 
special handicaps or not, though the degree of freedom of choice open to 
any individual is partly determined by his own abilities or disabilities. 
A severe handicap of physique or intellect often imposes sweeping restric- 
tions upon the range of choices open to an individual. When such an 
individual finds his progress constantly impeded by barriers which can 
hardly be regarded as existing in the environment, because they are 
obviously characteristic of his own person, he is faced with an especially 
troublesome condition, so far as his personal adjustment is concerned. 
Consider, for example, the instance of the physically normal boy who is 
unable to lift a weight which he would like to lift. Knowing that many 
other boys are also unable to lift the weight, he can say to himself, "It 
is too heavy for me." By contrast, when the crippled boy fails at a task 
which he knows most other boys can perform, he is forced to admit to 
himself, "I am too weak to lift it." There is a severe personality threat 
inherent in the necessity of facing constantly a barrier which can neither 
be by-passed nor removed (e.g., a permanent physical disability) and 
which stands as an obstacle interfering with movement toward any one 



FINCH AND YOWELL 87 

of several goals, each of which has qualities that make it appear as an 
acceptable substitute for the goal that must be abandoned. 

Adjustment (guidance) problems which occur with undue frequency or 
severity among handicapped persons may be better understood if we 
consider them in the light of what is known about some of the basic goals 
toward which all persons strive. Important aspects of personality seem 
to hinge upon striking an acceptable balance between (a) security and 
(&) independence and satisfying modes of self-expression. 2 These may be 
regarded as fundamental in the life of every individual. The need for 
security leads to behavior directed toward self-preservation, obtaining 
the physical necessities of life, avoiding dangers and frustrations, estab- 
lishing and maintaining satisfying emotional relationships with family 
and friends, and generally gaining acceptance by one's social group. 
While this need is relatively stronger in children than in adults, it per- 
sists as a major element throughout the entire life span of the individual. 
But even in infancy, the need for independence is also strong. A very 
young child may struggle vigorously and exhibit rage when his bodily 
movements are restricted. Observation of the infant's first attempts to 
feed himself and of the protests he will make if an impatient mother or 
nurse offers to speed up the meal by using her own greater manipulative 
skill furnishes another example of the premium put on independent action 
at this early stage. As the months pass, the child rapidly extends his 
efforts to control and to show mastery over many elements of his en- 
vironment. As he grows up he gains great satisfaction from increasing 
his freedom of movement. The adolescent is notably concerned with 
demonstrating his independence, though he may also often astonish his 
parents by seeking from them support and security in ways which cause 
them concern over his apparent reversion to childish behavior. Mowrer 
and Kluckholn, 3 even though they speak of independence as an ideal of 
adulthood, emphasize the importance of maintaining a delicate balance 
between too little and too much independence. Apparently the individ- 
ual's adjustment (in occidental cultures, at least) is reasonably satisfac- 
tory only when he has a fair degree of both security and independence. 
But these two are in a sense antagonistic values, and the individual's 
efforts in the direction of either one of them may result in his partial 
loss of the other. 

The handicapped person encounters more than an ordinary array of 



2 A discussion of this point is available in P. M. Symoncls, The Dynamics of Human 
Adjustment. New York: D. Appleton-Century Co., 1946. 

8 0. H. Mowrer and Clyde Kluckholn, "A Dynamic Theory of Personality," 
Personality and the Behavior Disorders, Vol. I. Edited by J. McVicker Hunt. New York: 
Ronald_Press, 1944. 



88 GUIDANCE FOR EXCEPTIONAL CHILDREN 

factors that add to his difficulties in achieving and maintaining this bal- 
ance. The more obvious of these arise from limitations upon his ability to 
cope with environmental forces which affect his progress toward inde- 
pendence. Physical, sensory, and intellectual handicaps all tend to reduce 
the range of activities in which the individual can engage or to lower the 
level of his performance in some of the activities which he undertakes. 
Thus, unless his goals are especially appropriate to abilities which he 
possesses or can readily develop, he experiences frustrations with more 
than ordinary frequency and severity. But there is also another less 
readily apparent class of adverse influences to be taken into account. 
From the time when parents first realize that the child is atypical, ele- 
ments which may predispose toward personality difficulties enter the 
picture. While we have no authentic basis for estimating precisely the 
frequency with which parental rejection occurs in relation to handicapped 
children, there is evidence indicating that parents exhibit a good deal of 
anxiety when they feel that a child is "not average." 4 Hewitt and 
Jenkins, in their monograph on the dynamics of maladjustment, 6 ad- 
vance the view that unsocialized aggressive behavior grows out of early 
overt parental rejection. This is most likely to occur, they believe, 
"in children well equipped for successful aggression." The child who is 
deprived of an opportunity for the security which parental acceptance 
provides, and who is at the same time so limited in capacity that his 
attempts at direct aggressive activity regularly fail and result in frustra- 
tion, is in a position that favors the disorganization of his personality 
since he is at a disadvantage with respect to both security and independ- 
ence. In so far as the child's obvious handicaps increase the chances of 
overt rejection by his parents, we should expect to find a disproportion- 
ate occurrence of both aggressive and withdrawing personalities. And 
since'handicapping conditions, especially when severe, reduce the capacity 
for successful aggressive activity, the second of these two effects would 
most often result among severely handicapped children in those instances 
where rejection took place. 

The Hewitt-Jenkins position with respect to the effect of parental 
overprotection may also apply in a special sense to other problems of ad- 
justment that occur in the handicapped child. The presence of an obvi- 
ous handicap may lead the parents to devote an extraordinary amount 
of attention to the child. The mother may retain control over almost 
every detail of his life and offer him very little opportunity to make any 



4 J. Roswell Gallager, "There Is No Average Boy," Atlantic Monthly, CLXXXIII 
(1949), 42-45. 

8 L. E. Hewitt and Richard L. Jenkins, Fundamental Patterns of Maladjustment: 
The Dynamics of Their Origin. Springfield, Illinois: State of Illinois, 1946. 



FINCH AND YOWELL 89 

decisions for himself. While this kind of overprotection alone may or may 
not be sufficient to produce an overinhibited and dependent personality, 
in combination with limitations imposed by crippling or other major 
handicaps, it can create strong forces leading in this direction. The 
security afforded by this interpersonal relationship may be highly grat- 
ifying to the younger child, but the meagerness of his opportunities for 
developing independence creates a protracted problem for him. While the 
effects of overprotection may go largely unnoticed so long as the young 
child remains at home, as soon as he enters school his lack of security 
will immediately be disturbing to him. At the same time his social 
inadequacies will also be readily apparent to his peers. The frustrations 
he is likely to experience as a result of the probable failure of some of the 
unskilful efforts he may make in attempting to establish social relation- 
ships in the new group into which he has just been thrown will then 
operate to prevent him from gaining a broader base for the security he 
needs. Altogether, the overprotected child of limited ability encounters 
numerous negative influences with respect to the development of his 
personality. It is common for such a child one who has enjoyed the 
security which he found in his early family associations and who has ex- 
perienced unusual difficulty upon moving into larger social groups to 
remain an immature personality. Hypersensitivity, shyness, and with- 
drawing behavior in general are theoretically to be expected in children 
with this kind of background. 

The best evidence available from observations made upon physically 
handicapped persons is consistent with the preceding generalizations. 6 
Group comparisons between physically handicapped persons and persons 
free from physical disabilities show that personality problems occur with 
excessive frequency among the physically handicapped. And of the per- 
sonality deviations observed in physically handicapped individuals, 
hypersensitive, withdrawing, overinhibited behavior predominates. At 
the same time it should be noted that aggressive manifestations also 
occur with greater frequency than a chance distribution would lead us to 
expect. This does not mean that physical handicaps regularly result in 
major personality problems. It is clearly evident that knowledge of the 
individual's gross physical status does not afford a good basis for predict- 
ing the qualities of personality which the individual possesses or has the 
potentialities for developing. 7 There are large numbers of physically 



6 A comprehensive and critical survey of publications containing much of this evi- 
dence is available in Roger G. Barker, Beatrice A. Wright, and Mollie R. Gonick, 
Adjustment to Physical Handicap and Illness. Social Science Research Council Bulle- 
tin No. 55, 1946. New York: Social Science Research Council (230 Park Ave.), 1946. 

7 D. G. Paterson, Physique and Intellect. New York: Century Co., 1930. 



90 GUIDANCE FOR EXCEPTIONAL CHILDREN 

handicapped persons who exhibit no evidence of any special personality 
difficulties. Furthermore, essentially every quality of personality which 
occurs among the physically handicapped may also be found in persons 
who are without physical deficiencies. And finally, it often happens that 
two persons with closely similar physical disabilities exhibit strikingly 
different personalities. A recent report by Dreikurs 8 illustrates this 
point. The following sketches are condensed from descriptions based 
upon his observations of three hospitalized children, each of whom had 
a congenital paraplegia with severe atrophy of the lower extremities, 
caused by spinal bifida : 

D, age 19, responds readily, but in a curt way and not too frankly. He is most 
outspoken when he complains. And he complains easily, as he does not like 
anything around him. He is quite opinionated and is angered by those who take 
an opposite view. He shows distaste for children who cannot use their hands, 
while he can use his. He gloats if others have to wait for help and he can get 
what he wants. He enjoys seeing people in uncomfortable and embarrassing 
situations. He apparently has no friends. When asked about his relationship 
with other children, he talked about knowing all the nurses. He says he likes to 
listen to the radio, but finds fault with the one he has. He can read, but gets no 
pleasure from reading. He depends entirely on others and uses an exaggerated 
sense of helplessness to intensify his demands upon them. He has little social 
interest, no courage or self-confidence, and, when asked about his future, he in- 
dicates that he never gives it any thought. 

E, age 18, is extremely independent, an ambitious girl, and well adjusted 
except for a violent temper. In an interview she answered easily and fully, with- 
out hesitation and in a very pleasant manner. She refuses to have her wheel 
chair pushed and insists upon wheeling herself. She likes the hospital very 
much and feels that she gets a chance to do things and is treated like a normal 
person. Soon after graduating from high school she began a college correspond- 
ence course. She expects to go to college as soon as she uses crutches, but the 
physician is not certain she can do this. She has friends and feels that she is well 
liked. She does not want to get married, she says, because of fear of hereditary 
danger to her children. E has a great deal of ambition and courage, but less 
social interest. She has an obvious desire for superiority and likes to show her 
ability. She distrusts close relationships and compensates for her physical and 
social disabilities with her intellectual ambition. 

F, age 15, is frank and pleasant. He had a few friends before he came to the 
hospital, even though he could not go out, and now he has many more in the 
hospital, where he participates in many activities and is happy and well liked. 
He gets along well with everyone and does not complain about anything or 
anybody, except that he has unpleasant memories of his older sister, with whom 
he did not get along well when he was at home. F tries to conform and to obtain 



8 Rudolph Dreikurs, "The Sociopsychological Dynamics of Physical Disability: 
A Review of the Adlerian Concept/' Journal of Social Issues, IV (1948), 39-54. 



FINCH AND YOWELL 91 

his wishes by playing the role of a charming little being. He has sufficient social 
interest to get along in a friendly and sympathetic group, but his self-confidence 
and courage are limited, and he seeks protection from a hostile outside world. 

Variations as great as those described by Dreikurs can readily be found 
among persons affected by any one of many other handicapping condi- 
tions. One blind man may become highly dependent and accept almost 
no responsibility; a second may develop some aptitude as compensa- 
tion but, otherwise, be as helpless as the first; a third, grasping for inde- 
pendence, may carry his compensation to the extreme of attempting to 
perform without assistance almost every act which is expected of per- 
sons with normal vision; and a fourth may select in a realistic fashion the 
areas in which he can function with reasonable effectiveness and from 
which he will be able to gain the satisfactions of a fairly well-rounded 
though necessarily somewhat restricted life. In brief, perhaps the most 
appropriate generalization concerning the personality qualities to be 
found among physically handicapped persons will concern their great 
variety. 

SPECIAL GUIDANCE NEEDED BY THE HANDICAPPED 

While the preceding comments are not offered as a full explanation of 
personality development, they are sufficient to indicate in part the na- 
ture of guidance services needed by handicapped persons. Guidance in 
general must take into account the unique qualities of the individual. 
There are wide variations from person to person among the handicapped, 
so much so that in many respects a handicapped group is likely to be less 
homogeneous than a group of persons who are free from marked handi- 
caps. Therefore, careful diagnostic study which reveals the individual's 
unique qualities is of special importance for adequate guidance of handi- 
capped persons. It would be disastrous to base guidance practice for 
physically handicapped persons upon the false assumption that there is 
some common "psychology of the physically handicapped" in the sense 
that similar physical conditions produce or are accompanied by similar 
psychological traits. The school which assumes that gross physical condi- 
tion affords an index of the individual's psychological problems risks 
misunderstanding a very large share of all the children it serves. While 
we cannot completely disclaim a "psychology of the mentally deficient," 
guidance must always recognize that wide variations in personality also 
occur among mentally subnormal persons. Among men of I.Q. 65 to 70, 
for example, there are some who are steady, efficient workmen and who, 
in a relatively simple social environment, generally manage their affairs 
very well, while others of equal physique and the same intellectual level 
may be quite irresponsible. Here, as in the case of the physically handi- 
capped, the school finds it impossible to base any action upon a single 



92 GUIDANCE FOR EXCEPTIONAL CHILDREN 

class of data about its pupils but must, instead, employ extensive 
clinical study as a basis for diagnosis. 

While diagnostic study of a quality that requires the services of a 
highly competent counselor is desirable, there are many conservative 
steps that may be taken in the school which lacks these services. Among 
the measures suitable for use on some occasions the following examples 
may be mentioned: 

1. Introducing activities which the handicapped child may perform as effectively 
as his classmates 

2. Taking steps to assure recognition of the handicapped child's successes 

3. Providing opportunities for experiences which may lead to the development 
of new interests by the handicapped child 

4. Teaching motor, social, or other skills which will be prized by the child's peers 

5. Modifying group atmosphere through teaching for increased tolerance, ap- 
preciation for unusual qualities in others, etc. 

The teacher in almost any elementary- or secondary-school environ- 
ment can ordinarily find ways for employing such simple procedures as 
these, even though she has little or no help from colleagues with more 
specialized training than she herself possesses. When more adequate 
diagnosis is possible, and when the results of treatment can be more 
cautiously evaluated by the combined efforts of the teacher and one or 
more specialists, the handicapped child may also be given more intensive 
forms of treatment. That these run through a considerable range, from 
the standpoint of the degree of intensity and also from the standpoint of 
the amount of responsibility that the school can accept for them, will be 
seen if one considers such practices as the following: 

1. Remedial instruction in basic school skills 

2. Corrective treatment for speech defects, crippling conditions, etc. 

3. The use of play therapy and similar methods in treating emotional problems of 
the child 

4. Re-education of parents through the use of psychotherapeutic techniques 

5. Placement in a group where deviations among the members are reduced or 
where conflicts are avoided (examples are found in the special class, the special 
school, and the foster home). 

Helping the individual to build up the ability to establish suitable 
goals for himself and to plan their attainment is the central task of 
guidance. Guidance should help the individual to understand himself and 
his environment to the point that he will be able to develop goals and 
aspirations in keeping with his potentialities for achievement. This is of 
special consequence for the handicapped person. Since his versatility 
his freedom of choice is more or less reduced by his handicap, an accu- 
rate understanding of his potentialities assumes more importance than 



FINCH AND YOWELL 93 

might be the case for the person with wider range open to him. By accept- 
ing limitations that cannot be overcome and developing attainable and 
satisfying goals within these limitations, the handicapped individual may 
be as well adjusted as anyone else. There is nothing to be gained by 
adopting a Pollyanna view of the ease with which this may be done. But, 
with good guidance, it is certainly possible even though the handicapped 
often face extraordinary difficulties. 

THE COUNSELOR IN THE SCHOOL 

The extraordinary problems of the handicapped suggest that their 
guidance requires a high order of clinical competence on the part of the 
counselor. Conditions which are likely to be misunderstood and seriously 
aggravated by treatment based upon misunderstanding occur with undue 
frequency. Because of this, there should be a special premium on thor- 
ough diagnostic work by the counselor of the handicapped. But the 
counselor's work goes beyond diagnosis, for, in working with handicapped 
persons, one must recognize special responsibilities which arise in an 
environment that includes many elements with which they cannot cope 
without special aid. It is true that guidance should aim toward making 
the individual independent, but, for the handicapped, progress toward 
independence often requires temporary partial support which the coun- 
selor may properly provide. This often means, among other things, 
modifying various environmental factors which affect the adjustment of 
the handicapped person. 

The school that is operating under favorable conditions can develop a 
program varied and flexible enough to provide the educational experi- 
ences necessary for most handicapped children. In a school that has made 
much progress in this direction, the counselor who is capable of under- 
standing the handicapped child and who is effective in helping the child 
to understand himself must also have a rather thorough understanding 
of the school and the ways in which it can be of greatest service to the 
child. If the school falls short of this standard, the counselor's task is 
even greater, for he will be successful only to the extent that he is capable 
of (a) contributing to the modification of the school's program or (6) 
finding resources outside the school. The majority of counselors who 
work with handicapped children will probably find both types of action 
necessary. The extent to which nonschool resources must be sought for 
the handicapped will vary as problems in different areas of living arise. 
Even though the schools may offer elaborate opportunities for educa- 
tional experiences from which the handicapped individual may select 
the most appropriate, participation in the activities of nonschool groups 
may often be beneficial. Examples of this kind will occur in the social, 



94 GUIDANCE FOR EXCEPTIONAL CHILDREN 

recreational, and civic areas. Some of the most acute cases of need for 
obtaining outside assistance with guidance problems of the handicapped 
are to be found in the vocational area. For this reason, and since impor- 
tant provisions for vocational guidance of the handicapped have grown 
up outside the school, the pages that follow will be devoted to this special 
problem. 

THE CONTRIBUTION OF NONSCHOOL AGENCIES 
TO VOCATIONAL ADJUSTMENT 

The individual who suffers any very marked disability commonly 
faces extraordinary problems of vocational adjustment. Because of this, 
even in those instances in which the school's facilities for vocational 
guidance, training, and placement have been developed to the point 
where the majority of the pupils are relatively well served, effective 
vocational guidance for pupils who are handicapped requires a special 
effort and often depends upon the mobilization of resources which the 
school cannot muster. At this point, the school finds it necessary to turn 
for assistance to agencies especially equipped to deal with problems 
peculiar to members of handicapped groups. 

Vocational rehabilitation agencies should offer the school strong sup- 
port so far as guidance for the handicapped is concerned. The basic pur- 
pose of vocational rehabilitation is the establishment of the handicapped 
person in a suitable occupation. The degree of success of any agency 
attempting to achieve this purpose will obviously depend in a large 
measure upon the quality of the vocational-guidance service which it 
renders. Agencies concerned with the vocational adjustment of handi- 
capped persons have made substantial growth during recent years. Work- 
ing relationships between these agencies and the schools have not kept 
pace with this growth. The pages that follow are devoted to a brief dis- 
cussion of the purposes and the operations of some of these agencies and 
to the consideration of means by which schools may appropriately draw 
upon them for help. 

Public Rehabilitation Agencies 

The Federal Security Agency includes a division known as the Office 
of Vocational Rehabilitation. This office is responsible for the develop- 
ment and improvement of standards for the rehabilitation services that 
each state provides as one of the functions of its state board for voca- 
tional education. Federal grants-in-aid for the support of vocational- 
rehabilitation work by the states are certified by the Office of Vocational 
Rehabilitation, which exercises a degree of supervision over all state- 
operated programs. Originally undertaken to assist with the vocational 
readjustment of persons with permanent physical disabilities resulting 



FINCH AND YOWELL 95 

from industrial accidents, publicly financed vocational-rehabilitation 
work has been expanded during recent years to provide services essential 
to the vocational adjustment of different classes of physically and men- 
tally handicapped persons. Consideration of the following eight steps, any 
or all of which may be requisite to the successful vocational adjustment of 
a particular handicapped individual, suggests working relationships that 
should be developed by the public rehabilitation agency and the school. 

Identifying the Handicapped. Publicly supported rehabilitation services 
should be accessible to all handicapped persons, youth and adults, who 
are susceptible of rehabilitation. The rehabilitation agency must depend 
upon co-operation of various other agencies through which it finds the 
handicapped persons it is to serve. Persons in need of rehabilitation may 
be referred by educational, health, labor, welfare, and other agencies 
operating on a broad front. Since the schools work with all children in the 
community, they have an important share in this referral process. Coun- 
selors in the schools should take the responsibility for identifying every 
young person who, by virtue of his handicaps, is in need of and eligible for 
rehabilitation service. Ideally, all handicapped youth will be referred to 
the rehabilitation agency long before they reach employable age so that 
each individual's vocational plans may be well developed prior to the 
time for initiating whatever specialized vocational preparation is 
necessaiy. 

Medical Examinations. Each applicant for rehabilitation service 
should be given a thorough medical examination. In earlier years, this 
was done primarily to verify eligibility for rehabilitation service; but, in 
the best modern practice, the results of the medical examination are 
recognized as of prime importance in determining what kind of job re- 
quirements the individual will be physically able to meet. While medical 
examinations generally will be provided by the rehabilitation agency, 
there will be many instances in which the school can supply the rehabili- 
tation counselor with useful records of the individual's physical develop- 
ment. 

Physical Restoration. "Never train around a disability that can be 
corrected or reduced." The rehabilitation worker holds this as one of 
his main maxims. Always, before vocational plans are completed, full 
consideration should be given to the possibilities for improvement of 
the handicapped individual's physical condition. Schools seldom have 
complete provisions for the physical restoration of pupils who are handi- 
capped. On the other hand, the vocational rehabilitation service (to- 
gether with another co-operating agency, the state's division of services 
for crippled children) accepts this type of work as one of its proper func- 
tions and maintains the facilities needed to carry it on. The rehabili- 



96 GUIDANCE FOR EXCEPTIONAL CHILDREN 

tation agency usually undertakes to correct or alleviate those physical 
conditions which can be successfully treated to reduce employment 
handicaps. It may provide whatever medical or surgical treatment or 
related services are necessary to increase the individual's work capacity. 
Prosthetic appliances may be supplied if they are a prerequisite to the 
proper occupational adjustment of the handicapped individual. 

Counseling. The importance of effective counseling in rehabilitation 
cannot be overstressed. Counseling may properly be regarded as the 
heart of the rehabilitation service. It should begin with the first inter- 
view and continue beyond the time when the individual enters upon a 
job until postplacement supervision is terminated. Effective counseling 
helps the individual to assess his own strengths and weaknesses, to clarify 
his goals, and to make plans leading to their attainment through develop- 
ing his potentialities to the fullest extent. It is through counseling that 
the individual is assisted in his selection of an appropriate occupational 
objective and in formulating his plans for its achievement. Along with 
the results of the medical diagnosis, the counselor considers the results 
of interest and aptitude tests, records of education and work experience, 
and various other facts which may be useful in evaluating the appropri- 
ateness of a rehabilitation plan for the disabled person. Since counseling 
must ordinarily extend over a period of years, the school and the rehabili- 
tation agency should accept joint responsibility for this task. During the 
period prior to entry upon vocational training, the young person who is 
handicapped in a manner that makes him a prospective rehabilitation 
client should be receiving help from a counselor in the school. In such an 
instance, the school counselor should assume essentially the same role as 
with any other pupil, except that the rehabilitation counselor should also 
be consulted to make sure that plans being tentatively developed at 
this early stage will not have to be revised radically in order to conform 
to an acceptable rehabilitation plan. As such a pupil approaches the time 
for entrance into vocational training, the rehabilitation counselor should 
take over the main responsibility so that the transition to specialized 
preparation for work may be made most readily. 

Vocational Training. The vocational rehabilitation service often 
i'urnishes vocational training as part of the program of preparing the 
individual for employment. If the secondary school offers vocational 
courses, the handicapped youth should use these facilities to the extent 
that they are suited to his needs. When the facilities of the secondary 
school fall short of providing the complete training program necessary to 
prepare the trainee for entering his occupation, the rehabilitation agency 
should assume responsibility for the remainder of the individual's voca- 
tional training. The rehabilitation agency does not ordinarily operate 



FINCH AND YOWELL 97 

vocational-training courses but, instead, usually follows the practice of 
contracting with a school or some other agency which can supply suitable 
specialized training. The school counselor must not overlook the fact 
that training can be considered as part of a vocational-rehabilitation 
program only when it is directed toward a definite vocational goal. It is 
particularly urgent that the counselor in the school and the rehabilitation 
counselor maintain a liaison which will assure the client's ready transition 
from the first to the second portions of the training program if it is to be 
divided in this manner. 

Essential Supplementary Services. The rehabilitation agency may fur- 
nish, under certain circumstances, any one of several types of supple- 
mentary service, in so far as this may be necessary to enable the client 
to carry out a rehabilitation plan in the most effective manner. Among 
these supplementary services may be included: essential living expenses; 
transportation; training equipment, material, and supplies requisite to 
the proper completion of the client's vocational-training program. The 
handicapped youth who is carrying on part or all of his vocational train- 
ing in a public school may receive one or more of these types of assistance 
from the rehabilitation agency. 

Job Placement. Successful vocational rehabilitation means establishing 
the handicapped person in a suitable occupation. Placement of the 
individual in such a way that he can make the best use of his skills and 
abilities on the job is one of the crucial steps in the rehabilitation process. 
Since few schools maintain effective placement services, this task ordi- 
narily falls to another agency although there are instances in which the 
school may undertake to render a service of this kind to handicapped as 
well as to other beginning workers. 

Follow-up. The rehabilitation service should not regard its work with 
the individual as being satisfactorily completed at the moment when the 
client goes to his first job. Instead, the final step follow-up through a 
period long enough to assure adjustment to the job is standard practice. 
The case is properly closed as successful only after this stage has been 
reached and the worker is being paid the prevailing wage for the job 
he is doing. The rehabilitation agency will ordinarily be able to maintain 
follow-up services without much assistance from the school. Co-operation 
between the school and the rehabilitation agency should be on a basis 
that will assure systematic reports to the school at the time of closing 
each case, successful or unsuccessful, which originated through school 
referral. 

No financial qualification is imposed in determining eligibility for 
vocational counseling, training, placement, and follow-up services fur- 
nished through a public rehabilitation agency. Most other expenditures, 



98 GUIDANCE FOR EXCEPTIONAL CHILDREN 

including those for medical treatment, prosthesis, living maintenance, 
and other supplementary matters, are restricted to those who are 
financially unable to meet expenses of these types. 

Public rehabilitation services were formerly available only to certain 
classes of physically handicapped persons. Under the Barden-La Follette 
Act (1943), federal provision was made for extending rehabilitation 
services to any person of employable age who has an occupational 
handicap imposed by mental or physical disability, provided the individ- 
ual can be rendered employable through rehabilitation services. Rehabil- 
itation programs are now being expanded beyond the point of providing 
for persons suffering from orthopedic and sensory defects to include 
cases arising from varied causes, including brain injuries, diabetes, 
epilepsy, glandular disfunction, cardiac ailments, psychoses, pulmonary 
tuberculosis, subnormal intelligence, and numerous others. In general, it 
should be noted that there are variations from state to state in policy and 
in the scope and quality of service rendered. The school counselor should 
familarize himself with the services provided by the rehabilitation agency 
of his own state and should make sure that handicapped persons who 
come through the schools have the opportunity to make appropriate use 
of public rehabilitation facilities. 

Private Rehabilitation Agencies 

Private organizations also provide a variety of services which may 
play a part in the vocational adjustment of handicapped persons, and, in 
many instances, the school should obtain assistance from this quarter. It 
is common for such agencies, especially those which operate in a single 
community and on a small scale, to emphasize some rather narrowly 
specialized service and, in many instances, to restrict their work to a 
single class of handicapped persons, such as the blind, the tuberculous, 
those who suffer from the residual effects of poliomyelitis, or some other 
well-defined group. The work of private agencies interested in the handi- 
capped may, in other cases, be specialized in the sense that only a partic- 
ular service is attempted. Examples of activities delimited in this manner 
may be seen in the work of placement offices for the handicapped, mar- 
kets for craft products turned out by handicapped workers, and other 
kindred enterprises. By way of contrast, there are other private agencies 
which are concerned with the problems of handicapped persons in 
general and which carry on comprehensive programs that go far beyond 
the area of vocational rehabilitation. 

There are, in the work of some of the private agencies operating in 
this field, programs that exemplify the application of a high type of 
vocational-guidance procedure. The possibilities for developing superior 



FINCH AND YOWELL 99 

services on a small scale in a private agency, and thereby demonstrating 
the effectiveness of techniques which might otherwise be applied only 
after much delay, if at all, may be seen in the work that has been done 
by the St. Louis chapter of the American Red Cross. Launched more 
than two decades ago because of the failure of the state to maintain 
vocational-rehabilitation services, this program was once concerned 
with providing vocational rehabilitation on a relatively inclusive scale 
for the physically handicapped persons of the community. A number of 
years later, after a state rehabilitation service had been fairly well estab- 
lished in Missouri, the local Red Cross chapter extended its counseling 
to various groups of nonhandicapped persons and, at the same time, con- 
tinued to provide a highly intensive and thorough type of service to a lim- 
ited number of handicapped persons. Through the use of consultation and 
group conferences, a staff of specialists, including a social worker espe- 
cially trained in rehabilitation procedures, a vocational psychologist, a 
consulting psychiatrist, and a physician, have co-ordinated their efforts 
for handicapped clients in a highly effective way. The working plan which 
has been evolved has integrated the activities of persons trained in dif- 
ferent areas to such an extent that each staff member has learned a great 
deal through working with his colleagues. While neither schools nor state 
rehabilitation agencies should attempt to transplant this pattern of work 
in its entirety, both can find in it much that will suggest means for im- 
proving their own services to the handicapped. 

The counselor in the school will find it beneficial to become acquainted 
with all the rehabilitation agencies, public and private, which function 
in his own community. He will want to discover what kinds of services to 
the handicapped can be best performed by each. From one he may ex- 
pect comprehensive services to all young persons who need assistance 
from the vocational-rehabilitation agency either before or after they 
leave school. He may turn to another only for some specialized type of 
service and perhaps for help with only the most unusual problems. A 
third agency may be able to offer him a most valuable opportunity 
to learn how he may improve his capacity for dealing with handicapped 
persons among his own clientele. 

There may be instances in which a young person still attending school 
needs services that require the pooling of efforts of a number of agencies. 
In such situations a counselor who knows all the agencies should serve 
as a co-ordinator of their work, in so far as their efforts directly affect 
the individual. This responsibility should usually be left to the counselor 
in the school while the child is in elementary school and so long as he is 
giving all or most of his time to general education in secondary school. 
With the approach of the time when the individual is to shift to voca- 



100 GUIDANCE FOR EXCEPTIONAL CHILDREN 

tional school or to some other special training agency, this co-ordinating 
function may properly be transferred to a counselor in the rehabilitation 
service. 

Supplementing the School's Vocational Training 

The typical school often finds its vocational-training facilities inade- 
quate for a handicapped pupil whose general educational program it can 
readily supply. In such an instance, suitable vocational training may 
require that the pupil eventually transfer to a trade school or some other 
school which offers specialized training that will lead to the individual's 
vocational objective. There will also be instances in which supervised 
on-the-job training affords the best available means for supplementing 
what the school can provide through its own resources. Whenever the 
public school program is to be supplemented by on-the-job training, 
the task of supervision requires careful attention. The history of part- 
time work-experience programs furnishes too many examples of the 
difficulties that may arise when the trainee's interests are not properly 
safeguarded. The relationship between activity that is justifiable in 
terms of its value as a learning experience and activity which is carried 
on for the sake of production of useful goods is a complex one. Work 
experience or on-the-job training is possible only under circumstances 
that produce goods (or render services), but on-the-job training dete- 
riorates rapidly if what the trainee learns is ignored in order that a 
product may be turned out more economically. Unless high-grade super- 
vision of on-the-job training is assured, there are strong arguments 
against its use as a means of supplementing vocational training which can 
be provided under direct control of the school. 

Vocational Placement 

Successful placement is one measure of the quality of vocational 
guidance. Throughout the history of the vocational-rehabilitation move- 
ment, placement has been a matter of major concern. Recent years have 
brought very encouraging progress in the development of procedures for 
placing handicapped workers. The method known as "selective place- 
ment" has grown out of studies conducted by the United States Employ- 
ment Service under the pioneering leadership of K. Vernon Banta. 9 

9 Descriptions of the selective placement process and its applications are available 
in such volumes as the following: 

Clark D. Bridges, Job Placement of the Physically Handicapped. New York: 
McGraw Hill Book Co., 1946. 

Arthur T. Jacobs, How To Use Handicapped Workers. Chicago: National Fore- 
man's Institute, 1946. 

U.S. Employment Service, Federal Security Agency, Selective Placement for the 
Handicapped. Washington: Superintendent of Documents, Government Printing 
Office, 1945 (revised edition). 



FINCH AND YOWELL 101 

Banta, who was concerned especially with placement of the physically 
handicapped, started with the assumption that a given job can be de- 
scribed in terms of the physical demands it makes upon the worker. 
Analyses designed to furnish job specifications in these terms have now 
been made for numerous occupations. The United States Employment 
Service provides this kind of information to all state employment service 
offices and encourages its use in staff-training programs. Some of the 
larger operating offices of state employment services now maintain 
specialists in the placement of handicapped workers. While there will be 
occasions when placement can be made directly by the school, an effec- 
tive working relationship between the school, the rehabilitation agency, 
and the public employment service is essential to the most effective 
placement of handicapped youth who are ready to enter the labor market. 

REFERENCES 

1. ALLPORT, GORDON W. Personality: A Psychological Interpretation. New York: 
Henry Holt & Co., 1937. 

2. BARKER, ROGER; WRIGHT, BEATRICE; and GONICK, MOLLIE. Adjustment to 
Physical Handicap and Illness. Social Science Research Council Bulletin No. 55. 
New York: The Council, 1946. 

3. BRIDGES, CLARK D. Job Placement of the Physically Handicapped. New York: 
McGraw-Hill Book Co., Inc., 1946. 

4. DREIKURS, RUDOLPH. "The Sociopsychological Dynamics of Physical Disability: 
A Review of the Adlerian Concept," Journal o} Social Issues, IV (1948), 39-54. 

5. DUNSMOOR, C. C., and MILLER, L. W. Guidance Methods for Teachers. Scran ton, 
Pennsylvania: International Textbook Co., 1942. 

6. ERICKSON, C. E., and SMITH, GLENN E. The Organization and Administration of 
Guidance Services. New York: McGraw-Hill Book Co., Inc., 1947. 

7. Federal Security Agency, United States Employment Service. Selective Place- 
ment for the Handicapped. Washington: Government Printing Office, 1945 (revised). 

8. GALLAGER, J. ROSWELL. "There Is No Average Boy," Atlantic Monthly, 
CLXXXIII (1949), 42-45. 

9. HEWITT, L. E., and JENKINS, RICHARD L. Fundamental Patterns of Maladjust- 
ment: The Dynamics of Their Origin. Springfield, Illinois: State of Illinois, 1946. 

10. JACOBS, ARTHUR T. How To Use Handicapped Workers. New York: National 
Foreman's Institute, Inc., 1946. 

11. MATHEWSON, R. H. Guidance Policy and Practice. New York: Harper & Bros., 
1949. 

12. MOWRER, O. H., and KLUCKHOLN, CLYDE. "A Dynamic Theory of Personality," 
Personality and the Behavior Disorders^ Vol. I. Edited by J. McVicker Hunt. New 
York: Ronald Press, 1944. 

13. PATTERSON, D. C. Physique and Intellect. New York: Century Co., 1930. 

14. SHARTLE, CARROLL L. Occupational Information. New York: Prentice-Hall, 
1946. 

15. STRANG, RUTH. Counseling Technics. New York: Harper & Bros., 1949 (revised). 

16. m Educational Guidance: Its Principles and Practice. New York: Macmillan 

Co., 1947. 



102 GUIDANCE FOR EXCEPTIONAL CHILDREN 

17. . The Role of the Teacher in Personnel Work. New York: Teachers College, 

Columbia University, 1946 (revised). 

18. SYMONDS, P. M. The Dynamics of Human Adjustment. New York: D. Appleton- 
Century Co., 1946. 

19. TKAXLER, A. E. Techniques of Guidance. New York: Harper & Bros., 1945. 

20. WAKTERS, JANE. High-School Personnel Work Today. New York: McGraw-Hill 
Book Co., Inc., 1946. 

21. WRIGHT, BARBARA H. Practical Handbook for Group Guidance. Chicago: Science 
Research Associates, 1948. 



CHAPTER VI 
THE EDUCATION OF TEACHERS OF SPECIAL CLASSES 



FRANCIS E. LORD 

Director of Special Education 

Michigan State Normal College 

Ypsilanti, Michigan 

and 

SAMUEL A. KIRK 

Professor of Special Education 

University of Illinois 

Urbana, Illinois 



INTRODUCTION 

There is a prevalent opinion that teachers of exceptional children 
should first be educated as regular teachers and have experience in 
teaching normal children. To become teachers of exceptional children 
they should then specialize in some area of the education of exceptional 
children. With regular classroom background and additional specialized 
training, they would then be qualified to teach the appropriate classes of 
exceptional children. The White House Conference recommended that 
" teachers preparing for special-class teaching should first have completed 
the regular course for teachers of normal children, preferably in the 
elementary grades, and also should have taught normal children for at 
least two years." 1 This recommendation was made in 1929, when most 
teachers held a two-year teacher-training diploma. The conference fur- 
ther stated that even graduates of three- or four-year teacher-training 
institutions offering courses in special education should have some teach- 
ing contact with normal children, at least in a practice-teaching situation. 

Although teaching experience before specializing in the education of 
exceptional children is desirable, there are practical limitations to the 
acceptance of this rule as a requirement in all instances. Some of the 
difficulties inherent in such a program are: 
1. Successful elementary teachers in many cases desire to remain in a teaching 

area in which they are secure because of their success. 

1 J. E. Wallace Wallin, "Trends and Needs in the Training of Teachers for Special 
Classes for Handicapped Children/' Journal of Educational Research, XXXI (March, 
1938), 506-26. 

103 



104 TEACHERS OF SPECIAL CLASSES 

2. Because of the shortage of elementary-school teachers, superintendents are 
reluctant to encourage successful elementary teachers to change to special 
fields. 

3. The areas of specialization are not the same for all groups of exceptional 
children, and the amount of training needed varies with different groups. 
Teachers of normal children may prepare themselves for sight-saving classes 
or for classes for crippled children in one or two summer sessions. On the other 
hand, speech correctionists and teachers of the deaf require from a year to a 
year and a half of specialized training before they are adequately prepared for 
such work. Very few teachers can afford to continue further specialized educa- 
tion for this length of time in order to prepare themselves for a new position 
in which the salary is not significantly higher than that for teaching regular 



4. Teachers who have changed from regular classroom teaching to special class- 
room teaching for sentimental rather than professional reasons have not 
always been successful as teachers of exceptional children. Others who are 
requested to change retain their "first love" of teaching normal groups and are 
not satisfied with their new positions. 

In general, however, teaching exceptional children is similar in 
many respects to teaching normal children. Although exceptional chil- 
dren may deviate in sensory, motor, mental, or social characteristics, 
they possess the same personality characteristics, the same drives, 
motives, and capacities as normal children, except in the area in which 
they are handicapped. 

To this practice of selecting experienced elementary-school teachers 
with additional specialized background, there is an alternate plan of 
teacher education which is now practiced by some teacher-training insti- 
tutions. This plan provides for a four- or five-year curriculum for the 
preparation of teachers of exceptional children, with a basic elementary 
curriculum including psychology, educational psychology, principles and 
techniques of elementary education, and some student-teaching with 
normal children. In other institutions the specialized courses for some 
areas of exceptional children are included in either a four-year or a five- 
year curriculum. Under this plan a student is educated in elementary 
education, has some practice in a regular classroom, and also obtains 
specialized training in some area of the education of exceptional chil- 
dren. Such a program has some advantages over the first plan mentioned. 
It will assure a supply of specially trained teachers for different classes 
of exceptional children. Moreover, it provides an opportunity during 
the training period for those who lack the interest or ability essential 
for success in a special field to change to some other field of study. 

In general, then, teachers of exceptional children should first obtain 
education and experience in teaching normal children (either practice 



LORD AND KIRK 105 

teaching or teaching in the field) and, in addition, should become special- 
ists in one of the areas of special education. Where the area of specializa- 
tion requires a long period of education, such as in the fields of speech 
correction and the education of the deaf, elementary education can be 
included in the regular teacher-preparation curriculum. Where the area 
of specialization can be completed in a summer session or two, such as for 
teachers of sight-saving classes where the curriculum is integrated with 
the regular grades of the school, it is more appropriate to select a teacher 
who has had teaching experience with normal children. 

TEACHER TRAINING IN SPECIAL EDUCATION 

Several patterns of educating teachers of exceptional children have 
prevailed throughout the United States. Apprenticeship training, or 
cadet training, has been a very common method of providing specific 
professional instruction. During the first quarter of the present century, 
cadet programs were widely used in state residential schools. Students in 
training usually spent a year in a residential school under a program 
which consisted of formal instruction by staff members, together with 
opportunities for observation and practice teaching. Frequently the 
trainee had intimate contact with the children during out-of-school 
hours by performing duties on the playground or in the residence halls. 
This cadet plan was applied most often to teachers of the deaf, mentally 
deficient, or blind. 

Two of the most widely known training programs were (a) the program 
for teachers of mental defectives at the Vineland Training School at 
Vineland, New Jersey, and (6) the program at Perkins Institution for the 
Blind at Watertown ; Massachusetts. 

Vineland Training School offered a six weeks' training program for the 
first time during the summer of 1904. The first three weeks were devoted 
to a study of f eeble-mindedness and the last three to methods of training 
and discipline. 2 The course grew in popularity and was later approved for 
college credit by Lehigh University and Rutgers University. A class of 
fifty-eight teachers received certificates at the conclusion of the 1918 
session. Many leaders in the field of education of retarded children had 
received special training at Vineland by the time this course was dis- 
continued in 1932. 

Perkins Institution for the Blind, through affiliation with Harvard 
University, has offered a training course for instructors of the blind since 



2 Helen Franklin Hill, "Vineland Summer School for Teachers of Backward and 
Mentally Deficient Children," Journal of Exceptional Children, XI (April, 1945), 
203-9. 



106 TEACHERS OF SPECIAL CLASSES 

1921. 8 The program includes methods courses, courses in psychology of 
the blind, and practice teaching. Many teachers of the blind in both the 
United States and other countries have received their training in this 
program. 

In recent years, cadet programs have either been discontinued or modi- 
fied by affiliations of residential schools with collegiate institutions. The 
residential school has become the laboratory center for well-organized 
professional study which leads to degrees and certification in an approved 
college. Examples of good programs of this sort are Clarke School for the 
Deaf, which is affiliated with Smith College, and Central Institute for 
the Deaf, which is affiliated with Washington University. 

Another pattern of training for special teachers which has been widely 
used is that of intensive study in summer schools. The American Asso- 
ciation To Promote the Teaching of Speech to the Deaf (now the Volta 
Speech Association for the Deaf) has sponsored such programs through 
the combined resources of a state school for the deaf and an affiliated 
college. The National Society for the Prevention of Blindness continues 
to promote summer sessions conducted in approved colleges and under 
the direction of institutions approved by the Society. 

Courses in professional training at teachers colleges and universities 
began to appear in the second decade of the present century. College 
departments of special education began to be established in the twenties. 
Representative collegiate institutions are: Milwaukee State Teachers 
College, Detroit Teachers College (now Wayne University), Michigan 
State Normal College, and Columbia University. 

The first report on the opportunities for the preparation of teachers 
of exceptional children in the United States was made in 1929 by the 
International Council for the Education of Exceptional Children. 4 At the 
time of publication of this report, forty-three institutions in the United 
States (including colleges and residential schools) and two in Canada 
were offering courses in this field. 

Schleier 6 reported in 1931 that ninety-nine colleges and universities 
were offering some courses on the mentally handicapped. These institu- 
tions, however, offered sporadic courses and made no attempt to organize 



Gabriel Farrell, "The Harvard-Perkins Course for Instructors of the Blind," 
Journal of Exceptional Children, X (April, 1944), 170-72, 179. 

4 See: Elise H. Martens, Opportunities for the Preparation of Teachers of Exceptional 
Children t p. 1. United States Office of Education Bulletin No. 17, 1937. Washington: 
Government Printing Office, 1938. 

6 Louis M. Schleier, Problems in the Training of Certain Special-Class Teachers, 
p. 69. Teachers College Contributions to Education, No. 475. New York : Bureau of 
Publications, Columbia University, 1931. 



LORD AND KIRK 107 

a curriculum. Schleier further reported that three teachers colleges and 
three normal schools had established departments of special education. 

A subcommittee of the White House Conference presented a report on 
special education the handicapped and the gifted. 6 The report in- 
cludes a chapter on teacher training and deals with (a) the need for 
trained teachers, (6) the extent to which the teacher-training institutions 
were attempting to provide trained teachers, and (c) the quantity and 
quality of education desirable for teachers of special education. Sugges- 
tive curriculums were formulated. This report has had a significant in- 
fluence on practices in teacher education and is often cited as a standard 
reference. 

In 1931 the United States Office of Education reported that seventy- 
two institutions offered courses on exceptional children. In a second re- 
port prepared in 1937, 7 118 institutions were recorded as offering at least 
one course to prospective teachers of exceptional children. From an 
analysis of the study by the United States Office of Education, the follow- 
ing information is provided: 

1. Between the publication of the two reports (1931 and 1937) there was an 
increase of 66 per cent in the number of institutions offering courses in the 
education of exceptional children. This increase was considered phenomenal, 
especially since it took place during the depression years of 1931 to 1936. 

2. Actually there were only six colleges in 1936 that offered three or more curric- 
ulums leading to a degree in the education of exceptional children. 

3. Forty-eight colleges and universities offered a sequence of courses in one or 
more fields of the education of exceptional children. 

4. Although single courses do not adequately prepare teachers of exceptional 
children, many of the rest of the 118 institutions offered only single courses or 
summer-school courses. 

PRESENT FACILITIES 8 

As this yearbook goes to press, a study is in progress of the existing 
opportunities for the preparation of teachers of exceptional children, 
made on the basis of data reported for the academic year 1947-48. This 
study is being carried on jointly by the United States Office of Education 
and the National Society for Cripplied Children and Adults, Inc. Pre- 
liminary findings indicate that, of the 688 colleges and universities which 
replied to the questionnaire sent out, more than 150 offered at least one 



G White House Conference on Child Health and Protection: Special Education. New 
York: Century Co., 1931. 

7 Elise H. Martens, op. dt., p. 1. 

8 This section adapted from a paper presented at the convention of the International 
Council for Exceptional Children, San Francisco, March 1, 1949, by Elisc H. Martens, 
Chief, Exceptional Children and Youth, Office of Education, Federal Security Agency. 



108 TEACHERS OF SPECIAL CLASSES 

course during the year 1947-48 to acquaint prospective teachers with the 
general problems of exceptional children. Sixty-six reported offering a 
curriculum or sequence 9 in at least one specialized area. Fourteen institu- 
tions offered curriculums or sequences in three or more areas. A general 
orientation or survey course in special education was reported by 110 
institutions. 

As one examines in greater detail the data accruing from this study, one 
finds that, of the fourteen teacher-education institutions in the United 
States which reported curriculums or sequences in three or more areas of 
special education, two are located on the Pacific Coast, five are in the 
Central states, and seven are in the eastern part of the United States. 
These fourteen institutions constitute what might be termed "officially 
recognized" training centers for teachers of exceptional children that 
have comprehensive programs under way. In all but two of them there is 
an organized division or department of special education with an ap- 
pointed staff member in charge. Their offerings for the year 1947-48 in- 
cluded, in the order of frequency, courses in the education of the speech 
handicapped, the acoustically handicapped, 10 the mentally deficient, the 
partially seeing, the orthopedically handicapped, the emotionally or 
socially maladjusted, the gifted, the blind, and the delicate. All fourteen 
institutions offered general survey or orientation courses in the education 
of all types of exceptional children. 

In addition to these fourteen institutions, one must recognize also the 
many others which reported a curriculum or sequence in one or two areas 
only. There were fifty-two of these, located in various parts of the United 
States but still predominantly in the central and eastern states. The 
specific fields for which preparation is most frequently offered by the 
total of sixty-six institutions are: (a) speech correction, reported by 
fifty institutions; (fc) education of the deaf and hard-of-hearing, reported 
by twenty-five; and (c) education of the mentally deficient, reported by 
twenty-two. 

If one asks whether these facilities for the preparation of teachers of 
exceptional children are adequate, one needs only to compare the number 
of teachers now at work in the field of special education with an estimated 
number required for the millions of exceptional children needing special 



9 A "curriculum" or "sequence" in a given area, as in the education of the mentally 
deficient, was arbitrarily defined as a progression of at least three courses dealing 
with that area. 

10 Most of the institutions reporting preparation of teachers of the acoustically 
handicapped offered courses for teachers of both the deaf and the hard-of-hearing. 
In a few instances, however, the courses offered in 1947-48 appear to have been limited 
to one or the other of these two groups. 



LORD AND KIRK 109 

educational services. In the year 1947-48 there were about 16,000 teach- 
ers reported 11 as working in special schools and classes for exceptional 
children. These teachers were serving approximately 450,000 pupils in 
residential and day schools. The statistical average number of pupils per 
teacher was, therefore, twenty-eight. If this average is applied to the 
estimated 4,000,000 exceptional children needing special educational 
services, 12 it seems that we would need far more than 100,000 teachers to 
serve the field adequately. With fewer than 20,000 at work now, it is 
obvious that the field of special education is wide open for professional 
service. More teachers must know more about exceptional children. 
Either the teachers of regular classes must be so prepared or there must 
be specially prepared teachers in the various areas of special education. 
The proper education of exceptional children calls for both. 

In this whole matter of the preparation of teachers of exceptional 
children, some very important questions arise as to institutional pro- 
grams and relationships. How should the teacher-education program be 
distributed within a state? Should the program be centered in and confined 
to one college or university? Or should several colleges co-operate, each 
offering courses in selected fields? What fields of preparation can be most 
effectively combined? What relationship should exist between the 
teacher-education institution and a residential school for handicapped 
children located in its vicinity? Are internships within residential schools 
a valuable part of the teacher's preparation? If so, what principles of 
accrediting should be established? How can the teacher-education insti- 
tution and the state education department work together most effec- 
tively in supplying teachers of exceptional children? What certification 
requirements should be maintained for the various areas? 

These are only a few of the many problems that need to be studied. 
The education of teachers of exceptional children must not be permitted 
to grow up without plan or organization. Neither would it be wise for 
every teacher-education institution in the United States to establish a 
curriculum of this kind. Within a given state or region the need can be 
measured against the supply in each area of special education. Active 
interest and co-operation on the part of all the colleges and universities 
concerned can result in a co-ordinated program that will meet the 

demand. 

STATE REQUIREMENTS 

States which provide financial support for special classes prescribe 
training requirements for teaching. These requirements take the form of 



11 From statistical data reported to the United States Office of Education by city 
school systems and residential schools. 

12 See chapter i for discussion of "The Extent of the Problem." 



110 TEACHERS OF SPECIAL CLASSES 

special certification or standards for approval enforced by the department 
of public instruction. Since such a department has supervision over the 
disbursement of funds, it has effective means for enforcing training re- 
quirements. These requirements vary slightly from state to state, but 
are similar to the requirements set forth in the following sections of this 
chapter. 

QUALIFICATIONS OF SPECIAL TEACHERS 

Many lists of the qualifications of successful teachers have been pre- 
pared. It is generally assumed that these personal qualifications are 
much the same for all teachers regardless of the specific position. Sym- 
onds 13 states, for example, that the teacher should (a) like teaching, 
(6) be personally secure, have self-respect, dignity, and courage, (c) iden- 
tify himself with the children, (d) accept aggression of boys and girls, 
laziness, slowness, etc., (e) be free from anxiety, and (/) not be self- 
centered or selfish. These traits or characteristics apply equally to 
teachers of exceptional children. With teachers of exceptional children, 
the following qualifications seem to be of increased significance. 

Capacity for Self-direction. Teachers of exceptional children are likely 
to be on their own more than regular teachers. They have less assistance 
and less supervision. In many situations the class they teach is the only 
one of its kind in the building. The principal and the elementary super- 
visor cannot be expected to give assistance in specialized areas of in- 
struction; therefore, the special teacher must have maximum capacity 
for self -direction. 

Patience and Perseverance. The exceptional children, especially those 
with sensory and learning disabilities, require patience and persistence on 
the part of the teacher. Learning takes place after great effort on the 
part of the teacher and the children. Things which normal children learn 
incidentally must be specifically taught. Teachers of exceptional children 
must be optimistic and imbued with the determination never to be 
discouraged. 

Experimentally Minded. All teachers need to be experimentally 
minded, but a teacher of exceptional children has fewer published ma- 
terials and fewer instructional devices at his disposal. Therefore, he must 
create special curriculum materials and work out unique approaches. He 
must be eager and willing to try out new and untried approaches. He 
must be objective and experimentally minded, be resourceful and willing 
to try uncharted methods. 

Physical Fitness. Teaching exceptional children in most cases is diffi- 
cult and trying. Physical limitations on the part of the teacher which in 

11 Percival M. Symonds, "Personality of the Teacher," Journal of Educational Re- 
search, XL (May, 1947),^654. 



LORD AND KIRK 111 

any way restrict his service to his children cannot be defended. Individ- 
uals who are themselves handicapped may become capable teachers of ex- 
ceptional children provided their handicap is not similar to the handicap 
of the children under their care. A teacher with impaired hearing should 
not be allowed to teach the oral deaf or the hard-of-hearing. An ortho- 
pedic defect, for example, need not necessarily interfere with a teacher 
who is engaged in speech correction or the education of the deaf by 
oral methods but may be a handicap in teaching crippled children. The 
main concern is that the handicap of the teacher not interfere in any 
way with the teaching of the children. 

Personal Adjustment. The teacher of handicapped children has to deal 
intimately with children and parents who are facing many personal prob- 
lems of adjustment. lie must be well adjusted to handle such problems 
successfully and to avoid being unduly influenced in his own adjustment 
by his relationship with the children and parents. Individuals who become 
morbid or oversentimental about exceptional children do not become 
successful teachers. Personal adjustment and security of the teacher of 
exceptional children is a "must" in qualifications. 

PROGRAM OF TRAINING 

Educating teachers of exceptional children, especially in a four-year 
curriculum, is a difficult task but is, for the present, the most practical 
solution. In general, the four- or five-year curriculum consists of four 
areas of education, namely: (a) general cultural education, (6) elemen- 
tary and secondary education, (c) courses related to and basic to the 
study of exceptional children, and (d) areas of specialization. 

General Cultural Education. This phase of the education of teachers of 
exceptional children corresponds to what is usually offered during the 
Freshmen and Sophomore years or during the first two years of junior 
college. It should include the major areas of knowledge required of all 
citizens and the knowledge required to teach the content subjects of the 
elementary school. This area is what is considered the "common learn- 
ings course." 

Professional Preparation in the Field of Education. Every teacher of 
exceptional children should be educated primarily in elementary educa- 
tion. The minimum requirements for this phase during a four-year 
course should include: 

1 . Principles of elementary and secondary education 

2. Techniques of elementary education 

3. Student-teaching with normal children 

Professional Preparation Relating to Exceptional Children. The follow- 
ing types of courses are of value to all teachers and are sometimes in- 



112 TEACHERS OF SPECIAL CLASSES 

eluded in the curriculum but are of special value to teachers of excep- 
tional children. These are: 

1. The psychology and education of all groups of exceptional children 

2. Mental hygiene and personality problems of children 

3. Educational psychology and/or principles of child growth and development 

4. Educational and mental measurement 

Professional Preparation in a Specialized Area of Exceptional Children. 
Since teachers of the various groups of exceptional children require 
different areas of specialization, the most common areas are listed 
below: 

1. Teachers of mentally handicapped children 

a) Problems of mental deficiency, 2-3 hours 

b) Speech correction, 2-3 hours 

c) Clinical and abnormal psychology, 3-4 hours 

d) Remedial reading, 2-3 hours 

e) Theories and methods of teaching mentally retarded children, 3-5 hours 
/) Arts and crafts, 4 hours 

g) Student-teaching with the mentally handicapped, 3-6 hours 

2. Teachers of deaf and hard-of-hearing children 14 

a) Phonetics, 2-3 hours 

b) Speech science physiology and acoustics, 2-4 hours 

c) Speech correction, 2-4 hours 

d) Speech for the deaf, 2-3 hours 

e) Language for the deaf, 2-4 hours 
/) Teaching school subjects, 2-3 hours 

g) Auricular training hearing aids and audiometric testing, 2-3 hours 

h) Speech reading, 2 hours 

i) Student- teaching with deaf children, 6-10 hours 

3. Teachers of crippled children 

a) Survey of orthopedic defects, 3-4 hours 

6) Organization and administration of schools and classes for crippled chil- 
dren, 2 hours 

c) Adjustment of classroom instruction, 2 hours 

d) Speech correction, 2-4 hours 

e) Practice-teaching with crippled children, 4-6 hours 

4. Teachers of speech defectives 18 

14 This curriculum prepares teachers of the deaf and those hard-of-hearing chil- 
dren whose language deficit is so extreme that they must be educated in a special 
class. When a less severe hard-of-hearing child is in the regular grades and requires 
special tutoring in lip reading and auditory training, the itinerant speech correction- 
ist, competent in the teaching of lip reading and auditory training, is capable of render- 
ing this service. 

15 The constitution and by-laws of the American Speech Correction Association 
[see Journal of Speech Disorders, VIII (March, 1943), 3-61] required that a clinical 
member have the following qualifications: (a) 18 hours in phonetics, anatomy, 



LORD AND KIRK 113 

o) Phonetics, 2-3 hours 

6) Speech science, including anatomy, physiology, and acoustics, 3-6 hours 

c) Audiometry and use of hearing aids, 2-3 hours 

d) Speech pathology and speech correction, 6-8 hours 

e) Lip reading and auditory training, 2-3 hours 

/) Clinical practice in speech correction, 4-6 hours (200 clock hours of clinical 
practice) 

5. Teachers of sight-saving classes 

a) Diseases and hygiene of the eye, 2 hours 

6) Organization of classes and instruction, 2-3 hours 

c) Materials and methods, 2-3 hours 

d) Student teaching, 2-3 hours 

6. Teachers of the Blind 

a) Disease and hygiene of the eye, 2 hours 

6) Special methods of teaching the blind, 4 hours 

c) Techniques of Braille reading and writing, 2-4 hours 

d) Observation and practice teaching, 2-4 hours 

Laboratory Facilities. To educate teachers of exceptional children it is 
necessary that there be adequate laboratory facilities for observation and 
student teaching with children who are exceptional. These laboratory 
facilities are represented by three types of centers. 

The oldest and probably least frequent today is affiliation of a college 
with an institution for the deaf, blind, or mentally deficient. Students 
obtain theoretical training at the college and do practice-teaching at the 
institution. 

The advantages of such an affiliation are found in the large number of 
children in one locality and in the opportunities the student-teacher has 
for obtaining a picture of the total life of the child in an institution. The 
disadvantages are found in the fact that the state institutions are not 
always close to the college or university and may not have children of the 
same degree of defect as those educated in the public school. If the insti- 
tution has not had adequate state support, the teaching staff may not 
have the qualifications needed for critic teachers. 

Another facility that has been available to teacher-education institu- 
tions is the use of public school classes for student-teaching. This method 
has the advantage of devoting funds allotted to a college, usually by a 
state, for college faculty and research personnel. It also has the advan- 
tage of utilizing a situation which is typical of public schools and prepares 
teachers for situations similar to what they will find when they complete 



physiology, physics of speech, speech pathology, correction, and therapy; (6) at 
least 12 semester hours in allied subjects such as education, psychology, etc.; (c) at 
least 200 clock hours of clinical practice under supervision; and (d) one year of clinical 
experience under competent supervision. 



114 TEACHERS OF SPECIAL CLASSES 

their education. It has the disadvantage of relying on the local public 
school systems, which in some situations have not made for ideal student- 
teaching conditions. 

The third method is for the teacher-training institution to organize a 
laboratory school for exceptional children in connection with the college. 
Although few institutions have such an arrangement, the advantages 
are that the college staff can supervise the school and set up an ideal 
student-teaching situation. Its disadvantages are that, when colleges 
create such a laboratory, much of their allotted funds for this work is 
appropriated for teaching staff for children, thus limiting funds available 
for college faculty and for research work. In general, this situation is 
necessary when the teacher-education institution is in a small community 
where special classes do not exist in sufficient numbers for student 
teaching. 

RECRUITMENT OF STUDENTS 

Many teacher-education institutions that have been interested in 
educating teachers of exceptional children have had difficulty in interest- 
ing students in these areas. A number of reasons for this condition may 
be surmised: 

(1) Most students graduating from high school enter universities and 
teachers colleges with a desire to teach their favorite high-school subject. 
They have just completed high school, and the teaching area foremost in 
their minds is secondary-school teaching. Fewer desire to major in elemen- 
tary education, and still fewer in kindergarten-primary education. The 
field of exceptional children probably is less familiar to them than any of 
the other teaching fields. 

(2) High-school counselors know more about the field of secondary 
education, and very few of them are familiar with the field of exceptional 
children. Hence, students receive very little, if any, information from the 
secondary-school faculty about the field of teaching exceptional children. 

(3) Educational institutions offering a complete curriculum for excep- 
tional children are relatively few. Hence most students do not have 
access to local educational institutions which offer a curriculum for the 
education of exceptional children. 

(4) There have not been sufficient college faculties to promote the field 
in colleges and to acquaint the students with the fields of exceptional 
children. Highly trained individuals, especially at the Doctors-degree 
level, are relatively rare. Hence, universities interested in organizing 
programs for teachers of exceptional children are having great difficulty 
in obtaining adequately trained personnel. 

A recent attempt was made to study some of the essential factors in the 



LORD AND KIRK 115 

recruitment of special-education teachers. 16 Four hundred and six teach- 
ers of handicapped children responded to questions regarding how they 
happened to enter the field, how satisfied they were with their work, and 
what suggestions they had for recruitment. The following significant 
facts were reported: 

1. Eighty-seven per cent of these teachers entered special teaching of their 
own accord; only 7 per cent were placed in the field of administration. 

2. One-third of the special teachers were influenced to enter the field by other 
teachers of exceptional children or by friends or relatives who were handi- 
capped. Another third were influenced by school visits or camp experience 
with handicapped children. 

3. Only 14 per cent stated that guidance instructors of college courses interested 
them in the field. 

4. Eighty-one per cent said they would refuse a transfer to regular grades if it 
were offered to them; 6 per cent would transfer willingly. Half the teachers 
replying had had some regular grade-teaching experience. 

5. In recruitment programs these teachers thought the personal satisfaction 
gained for special teaching should be pointed out and that steps should be 
taken to make the work of special education better known to the general 
public. 

It is apparent from this study that more or less accidental experiences 
with handicapped children played the major part in recruitment of 
special-education teachers. A guidance program which provides oppor- 
tunities for high-school students to have experiences through visitations 
to institutions and special classes would appear to be most effective. The 
fact that special teachers are satisfied with their work and feel a personal 
satisfaction for the good they do would seem to give guidance experts a 
good foundation for recruitment. 

To interest students in the field of exceptional children, it is necessary 
that both secondary-school and college teachers and counselors become 
acquainted with the area of exceptional children. They should know 
the requirements of the various fields, the opportunities that exist, and 
the nature of the shortage of personnel in this area. 17 In the experience of 



16 Merry Maude Wallace, "A Study To Determine Some of the Experiences That 
Influence Teachers Who Enter Special Education." Unpublished Master's thesis, 
School of Education, University of Michigan, July, 1948. 

17 The Illinois State Department of Public Instruction has issued posters and bulle- 
tins to high schools and has interested Science Research Associates, Inc., to publish 
occupational briefs in this area. Publications are: 

Here's a Job for Your Future: A Career in Special Education of Exceptional Children. 
Springfield, Illinois: Department of Public Instruction, Division of Education for 
Exceptional Children, 1949. 

Teachers of Exceptional Children. Occupational Briefs, No. 51. Chicago: Science 
Research Associates, liic. (228 South Wabash Ave.), 1949. 



116 TEACHERS OF SPECIAL CLASSES 

the authors, there were approximately three jobs for every graduate in 
the education of exceptional children during the depression years when 
there was a surplus of all kinds of teachers. Today, the shortage cannot 
be estimated, except to state that the demand will not be supplied by 
present educational institutions for a number of years. 

A second method of interesting students is to get information about the 
field to students in colleges, particularly to those interested in teaching. 
Introductory courses in education, psychology, and health education 
should include several lectures on exceptional children, preferably by 
experts in the field. Courses in introductory psychology could include 
several lectures in this area in relation to the discussion on individual 
differences. Better still, all students in education should have an orienta- 
tion course in exceptional children as a part of their education major. 
Such a procedure during their period of exploration for a field of interest 
usually informs many beginning students of the fields and of the op- 
portunities. 

SUMMARY STATEMENT 

One hundred thousand teachers of exceptional children will be needed 
to man the schools and classes of the nation. At present approximately 
16,000 such teachers are available. 

Teachers of exceptional children are educated by two major plans; 
namely, giving additional specialized education to experienced elemen- 
tary teachers or educating teachers in both elementary and special 
education in a four- or five-year curriculum. 

Facilities for the preparation of teachers of exceptional children are 
increasing. In 1936, forty-eight colleges offered one or more curriculums, 
and six colleges offered three or more curriculums. In 1947-48, sixty-six 
colleges offered at least one curriculum and fourteen offered curriculums 
in three or more areas. 

Teachers who enter the field of the education of exceptional children 
appear to be well satisfied with their choice of profession. Relatively few 
change to other fields of teaching. 

Recruitment of special-education teachers has been difficult because 
high-school and college counselors are not generally acquainted with the 
field and because centers for such training are not readily available. 



CHAPTER VII 
PARENTS' PROBLEMS WITH EXCEPTIONAL CHILDREN 



SAMUEL R. LAYCOCK 

Dean of Education 

University of Saskatchewan 

Saskatoon, Saskatchewan, Canada 

and 

GEORGE S. STEVENSON 

Medical Director 

The National Committee for Mental Hygiene 
New York, New York 



INTRODUCTION 

In the past two decades emphasis has been increasingly placed upon 
the co-operation of schoolteachers and parents in promoting the growth 
and development of all children. One evidence of this is the growth of the 
parent-teacher movement. In 1948 the National Congress of Parents and 
Teachers of the United States had five million members and the Cana- 
dian Federation of Home and School had one hundred and twenty-five 
thousand members, In addition, vigorous attempts have been made to 
change the traditional type of report card into a more effective means of 
parent-teacher co-operation. Provision for parent-teacher conferences 
has increased. So have facilities for liaison between home and school by 
means of visiting teachers, school social workers, home visits by teachers, 
and by means of bringing the parents into the school not only to observe 
but also to participate in its activities. 

This co-operation between schoolteachers and parents has, particu- 
larly in the past decade, spread to the field of special education and has 
developed beyond the usual means of parent-teacher co-operation to 
definite programs of parent education. There are many instances of this 
new trend. 

In Illinois the state schools for the deaf and blind conduct an annual 
two weeks' summer training school for the parents of deaf and blind 
children. The purpose of such schools is to help parents understand the 
problems of their handicapped children and to show them how they can 
best co-operate in the education of these children. 

The Bureau for Mentally Deficient and Epileptic of the Division of 

117 



118 PROBLEMS OF PARENTS 

Public Institutions of the Department of Social Security of the State of 
Minnesota published in 1945 a booklet 1 containing practical suggestions 
to parents for the training of the very slow-learning child. 

In New Jersey there was begun in 1943 by the Division of Classifica- 
tion and Education of the Department of Institutions and Agencies a 
home-training plan for mentally deficient children. The main purpose of 
this plan is to help the parents, mothers in particular, to train their 
children at home so that they will become less of a problem and, as a 
result, be accepted by other members of the family and community. 
Originally begun as a service to children who were on the waiting list for 
institutional placement, this plan has now developed into a definite form 
of parent education. 

The National Society for Crippled Children and Adults has long 
stressed the importance of parent education as an integral phase of its 
service program. This includes the stimulation of the organization of 
state councils of parents of cerebral-palsied children. 

In addition, the National Society for Crippled Children and Adults 
provides consultation services in child development and help in nursery- 
school organization, publishes The Crippled Child, and sends out each 
month thousands of articles, reprints, pamphlets, and leaflets to par- 
ents of crippled children. It also provides a film library which covers 
the various aspects and problems of handicapped children and a re- 
source file on facilities for handicapped children. 

The John Tracy Clinic for deaf children at Los Angeles deals with 
parent education through three mediums: (a) a small, experimental 
preschool for deaf children and their parents, mother and child entering 
as a unit, and the mother observing the teachers, helping on the play- 
ground, and assisting in the work of the clinic; (6) classes for all parents 
of deaf children of any age, to which all mothers and fathers of deaf 
children are welcome; and (c) the correspondence course, which covers 
a year's work with a preschool deaf child and includes the first lessons in 
lip reading, language, sense training, and speech preparation. 

All of the above examples are indicative of a new philosophy with re- 
spect to the education of exceptional children. This philosophy is that 
\ ^very child exceptional or otherwise has four sets of teachers. These 
v are his home teachers, his playmate teachers, his schoolteachers, and his 
community teachers. The latter consist of church organizations, Scouts, 
boys' and girls' clubs, recreational activities, newspapers, magazines, 
comics, radio programs, movies, casual contacts with adults on streets 



1 Teach Me: A Guide for Parents and Others Who Have the Care of Subtwnnal Chil- 
dren. St. Paul, Minnesota: Mental Health Unit, Division of Public Institutions, De- 
partment of Social Security, 1945. 



LAYCOCK AND STEVENSON 119 

and in public places, and the standards held by the adults of the com- 
munity. 

Of the above four sets of teachers, psychologists are agreed that the 
home teachers are the most important at all stages of a child's develop- 
ment even after he starts to school. The home teachers of any child are 
basically responsible for how he comes to feel about himself (worth 
while or inadequate) and how he comes to feel about others and to act 
toward them in a social or antisocial way. In addition, the home teachers 
lay down the basic patterns of family living. The most important pattern 
of a husband-wife relationship and of a parent-child relationship that 
boys and girls ever see is the one they see in their own home. 

Teachers of regular-class children are coming increasingly to realize 
that the homework done by parents both before the child comes to school 
at all and throughout his school career affects every aspect of his readi- 
ness to learn from learning to read to learning to co-operate with others 
in work and play. This is true, too, of exceptional children. The only 
difference is that the parent of an exceptional child is often less fitted for 
giving his child the necessary help at home since the parent is apt to rely 
on the general patterns of training children which he has absorbed from 
his own childhood home and from the general culture of the society in 
which he has lived. 

The education of all children is, therefore, primarily a partnership be- 
tween home teachers, schoolteachers, and community teachers. It can 
be most effective only when these partners have an understanding of 
each other as individuals and possess common purposes, understandings, 
and techniques. 

This chapter is intended to help teachers and other school officials who 
have to deal with exceptional children to understand the part which the 
parents of these children can play in the latter's development. It also 
plans to indicate some general methods by which parent-teacher co- 
operation can be secured in the education of such children. 

Teachers, and often school officials, should remember that they will be 
effective in helping parents only to the degree to which they can help the 
latter to be more understanding and successful in their share in the co- 
operative enterprise of developing exceptional children. Teachers must 
be careful that the parents do not merely become overanxious because 
they are unable to do a perfect job in carrying out all that is expected of 
them. If parents become so discouraged that they give up trying, or if 
their self-confidence is so undermined that they become ineffective, then 
the last stage will be worse than the first. It is important with parents, as 
with children, to start from where the individual happens to be in his 
development and to proceed from there. All those who work for the 



120 PROBLEMS OF PARENTS 

education of exceptional children must, therefore, endeavor to under- 
stand the problems of the parents of exceptional children and to co- 
operate with them in solving those problems. 

THE DEVELOPMENT OF ATTITUDES IN PARENTS 
Acceptance 

Those who work with handicapped children find that one of the 
greatest problems of parents of such children lies in being able to accept 
these children emotionally. It is vital for all children exceptional or 
otherwise that they feel secure in the affection of their parents. In the 
case of exceptional children this love by parents must not partake of the 
nature of pity or of the nature of an overcompensation for the parents' 
feelings of humiliation, guilt, or resentment at having such a child. 
Love, to be worthy of the name in any human relationship, consists of a 
sincere desire for the other individual's best good rather than mere self- 
indulgence of the one who gives the affection. With exceptional children, 
love cannot be a "reversal-formation" whereby parents shower a child 
with affection to cover up their unconscious rejection of him. In addition, 
every child needs not only to be loved but also to feel that he belongs 
that he is a desired and desirable member of a family group because of 
what he himself is and because of his possibilities. 

Parents, then, must accept their handicapped child emotionally, but 
they should be helped to be objective about the child's handicap. This is 
vital to the mental health of both the child and his parents. 

Physicians, psychiatrists, psychologists, social workers, and educators 
very frequently have to deal with parents who refuse to accept their 
child's handicap. Sometimes this retreat from reality is found in a re- 
fusal to take the child for medical or psychological examination; at 
other times the parent refuses to look facts in the face and to accept the 
considered opinion of the competent authority; at still other times the 
parent is bitter or tearful and has the attitude: "Why did I have to have 
a child like that?" 

Methods of Helping Parents to Acceptance 

There are many different methods which can be used in helping par- 
ents to accept their child's handicap in an objective fashion. 

One approach is to start with the parents' acceptance of themselves 
and of one another. Every human being has to get along with what he 
has. No one is at one and the same time a great scholar, a great athlete, a 
great public speaker, a great musician, etc. Indeed, most of us are not 
any one of these. All have to get along with what they have though many 
would like to be taller or shorter, more beautiful, more musical, more 



LAYCOCK AND STEVENSON 121 

brilliant, etc. It is one of the major signs of becoming an adult when an 
individual comes to accept himself as he is. 

Then, too, people choose wives, husbands, and friends not because 
they are paragons of beauty, intelligence, and special abilities but because 
they like them for what they are in spite of the limitations which all of 
them have. If human beings rejected family and friends because they 
were not perfect, such individuals would be isolated in a world with God 
and themselves as the sole occupants. 

Handicaps in children are, therefore, part of the general problem of 
human imperfections and limitations which all must face first of all in 
themselves and secondarily with all other human beings with whom 
they come in contact. 

Parents of exceptional children, then, should be helped to realize that 
their problem is not unique but a part of the general problem of all 
parents. Parents are continually being faced with accepting a child who 
is male instead of female, brown-eyed instead of blue-eyed, short instead 
of tall, plain instead of beautiful, placid instead of vivacious, and so on 
through a countless range of preferences. 

Teachers can help many parents to accept their handicapped children 
by discussing with them the democratic view of life, which has been dealt 
with in chapter i. 

Many parents approach life's problems from a religious point of view. 
They will be helped by being made aware of their belief that every hu- 
man being is a child of God and of infinite value in His sight. 

Many parents will be helped to accept their child emotionally and to 
take an objective view of his handicap if they can be shown that any 
other course adds to the child's handicaps and increases their own 
difficulties. This is a mixture of the unselfish and selfish motives which is 
characteristic of so much of everyday behavior. Such parents can be 
shown that it very frequently is not the handicap itself which hinders a 
child's adjustment but how he himself feels about his handicap. How 
a child feels about his handicap is likely to be, to a considerable degree, a 
reflection of the attitude of his parents. The handicapped child who is 
oversensitive or embarrassed about his handicap or who is depressed or 
resentful because of it is likely to develop defense mechanisms such as 
boasting, resentfulness, bullying, lying, and stealing; or withdrawing 
tendencies of extreme shyness, crying, oversensitiveness, and self-pity. 
Most parents sincerely desire to help their children rather than to handi- 
cap them further; a few will be influenced by the cogent argument of 
avoiding future trouble for themselves. 

Probably the best help that can be given parents of exceptional chil- 
dren comes from the understanding of the possibilities of their children 



122 PROBLEMS OF PARENTS 

which will be discussed in the next section of this chapter. Instead of con- 
centrating on the fact that the child will never walk, the parents of the 
crippled child should be helped to concentrate on the fact that the child 
can be taught to use his hands and to talk. After all, every parent must 
adjust to what his child can be taught to do. The bitterness of a parent 
who is disappointed that his son of average intelligence is not suited to 
become an engineer or an author is no different in quality, and often not 
in quantity, from that of a parent whose child is mentally deficient and 
who never will become a self-supporting citizen. All parents have to focus 
their attention on their child's unique possibilities rather than on their 
own ambitions if the child and they, themselves, are to be happy in the 
family in which they live. 

Parents of exceptional children who are gifted sometimes need as 
much help in accepting their child's talents as do the parents of handi- 
capped children. Indeed, if a child is extremely gifted, his deviation from 
the group may be considered a handicap. Such a child needs the emotional 
acceptance of his parents for what he is and for his possibilities. An ob- 
jective attitude toward the child's gifts is important for his best develop- 
ment. The gifted child will be injured in his development by foolish 
pride, overindulgence, or overdisplay just as the handicapped child is 
injured by embarrassment, rejection, or pity. 

THE DEVELOPMENT OF UNDERSTANDINGS IN PARENTS 
Many parents who are frightened or baffled by the problems they face 
in the handling of their exceptional children will need help from teachers 
and supervisors in understanding the situation with which they are 
confronted. 

Understanding the Exceptional Child's 

Similarity to Other Children 

, Parents of exceptional children need to understand that their child is 
/ fundamentally like all children everywhere that he is not a different 
kind of being, or "queer," or "a freak," but that he differs only in having 
a greater or lesser amount of the qualities or abilities possessed by all 
human beings. All children, exceptional or otherwise, are unique combi- 
nations of qualities and abilities. Every child is different. Every child is 
an individual, and all parents have to start from there. Teachers, prin- 
cipals, and supervisors can do a great deal with individual parents with 
respect to developing this point of view if they have this viewpoint 
themselves. 

Understanding the Basic Needs of All Children 
Teachers, other school officials, and social workers often need to give 
parents of exceptional children help in understanding that all children 



LAYCOCK AND STEVENSON 123 

have the same basic physical and psychological needs; that all children 
need an adequate and balanced diet, sufficient rest and sleep, a com- 
fortable temperature, and activity when well and rested; that all need to 
be loved and wanted, to have a reasonable independence in running their 
own lives and in making their own decisions, to feel a sense of achieve- 
ment that comes from making things and doing jobs, to win the ap- 
proval of others for what they are and do, and to feel that they are worth- 
while individuals who reasonably come up to their own inner standards. 
Helping children to find fulfilment for these physical and psychological 
needs is as much the task of the parents of normal children as it is of the 
parents of exceptional children. 

Understanding that Different Means Must Be Used 
in the Education of Exceptional Children 

Since the objectives of education for all children are those of self- 
realization, happy human relationships, economic efficiency, and civic 
responsibility, parents of exceptional children will have to be helped to 
understand that it is merely a matter of changing the means of attaining 
these objectives in the case of their children. To achieve similar ends for 
exceptional children, there must often be different curriculums and 
different methods used. Parents often fail to see that the education of 
their child is a part of the general problem of education. They need to 
know that they are not fighting a lone battle and that all parents are 
faced with the problem of helping their children to find fulfilment of their 
basic needs and to develop to the fullness of their capacities. 

Certain practical problems arise in persuading parents that, while the 
educational objectives are the same as those for all children, the means 
used in attaining those objectives must differ. The first of these may 
occur when they find that their child is excluded from public day school, 
and the second has to do with the parents' reluctance to enrol the child in 
a special class or special school. Both of these problems are tied up with 
getting the parents to accept their child's handicap objectively. In addi- 
tion, the teacher or school official must be able to demonstrate to the 
parent the great opportunity presented to the child in providing him 
with curriculum experiences, methods of teaching, and learning aids 
which have been specially developed for children who have his special 
handicap. 

It is very important that the teacher or other school official who deals 
with the parent be able to gain the latter's confidence. This is more likely 
to result if the school officer is able to approach the problem of the child's 
education from the standpoint of "searching together" with the parent 
in finding a solution for the child's best development. Such an attitude 



124 PROBLEMS OF PARENTS 

will often deter parents from going to the expense of sending their child 
to a private school. In addition, it will help them to accept the necessity 
of being on a waiting list for entering their child in a state institution. 

Understanding the Nature of the Parents' Contribution 
to the Education of Exceptional Children 

Teachers, supervisors, and others will need to help parents of excep- 
tional children to understand the relative roles of maturation and learn- 
ing in the development of children. The latter need to understand that 
"readiness" is important in the development of all skills and knowledge. 
They need to know the kind of "homework*' they can do to contribute to 
that readiness and when they must wait on the child's developing nervous 
system. They need to know that every child exceptional or otherwise 
has his own tempo of development (see chap. iv). They need to under- 
stand how their child's handicap will affect his "readiness" for learning 
different skills and knowledge. 

For example, parents need to understand how language develops in all 
children and the part which every parent plays in that development. In 
the case of parents of deaf children and mentally deficient children, they 
need to know that their part in developing language in these children has 
to be extended beyond what is the case with normal children but that the 
difference is essentially one of degree. This is an aspect of parent educa- 
tion in which the school must take the lead. Conferences between parents 
and teachers, supervisors, or principals are especially important in the 
development of adequate understanding of the part the parents play in 
the development of their children. 

Understanding the Importance of Co-operating 

with Their Child's Other Teachers 

In general education, it is being increasingly realized that the develop- 
ment of any child is a team job in which four sets of teachers participate 
home teachers (parents), playmate teachers, schoolteachers, and com- 
munity teachers. The phenomenal growth of parent-teacher associations 
is an evidence of this growing awareness of the need for co-operation be- 
tween a child's different sets of teachers. In particular, there must be 
close co-operation between home teachers and schoolteachers. All par- 
ents need help in developing techniques of co-operating with their child's 
schoolteachers. In the case of exceptional children this may seem to be 
more urgent and to need to be extended to physicians, social workers, 
and various community agencies. Parents of exceptional children need 
special help from teachers and educators in making this co-operation 
effective not only in the preschool period but in the school period as well. 



LAYCOCK AND STEVENSON 125 

Understanding the Exceptional Child's Possibilities 
Many parents of exceptional children are so overwhelmed by a sense of 
their child's limitations that they cannot get around to seeing his pos- 
sibilities. While it is important that they accept their child's limitations 
in an objective fashion, it is even more important that they be helped to 
understand his possibilities for development as a human being, as a 
worker, and as a citizen. They need to understand the general possibil- 
ities of individuals possessing their child's handicap and then the specific 
possibilities of their own child. The teacher is the key person in helping 
the parent to understand the child's possibilities. He is able to appreciate 
and to point out the child's assets and his potentialities. Parents are apt 
to pay much more attention to someone who knows and understands 
their child as an individual than to one who speaks in general terms. 

Understanding Their Own Reactions 

Parents of exceptional children need help in gaining insight into their 
own reactions to their child's handicap. Whether such parents manifest 
resentment, shame, embarrassment, rejection, pity, oversolicitude, impa- 
tience, or emotional acceptance of their child, it is important that they 
have help in understanding what lies behind their behavior. In all 
parent education it is very important for parents to understand their 
own behavior toward their children: It is urgent in the case of parents 
of exceptional children. Teachers can aid greatly in helping parents to 
understand their own reactions. This can be done through informal chats 
in which the teacher undertakes some nondirective counseling. It can also 
be effected through discussion groups with the parents of exceptional 
children where attention may be directly or indirectly focused on helping 
the parents to understand themselves. 

THE DEVELOPMENT OF SKILLS IN PARENTS 

In addition to developing certain attitudes toward their exceptional 
children and to acquiring certain understandings, there is the additional 
problem of helping the parents of these children to acquire certain skills 
so that they may be able to co-operate effectively with the children's 
other sets of teachers in promoting their best possible growth and devel- 
opment. Many parents whose attitudes are excellent and understandings 
good do not know how to help their children. 

Establishing the Child's Emotional Security in 

His Own Home 

Teachers and other educators need to help parents to realize just what 
factors hinder the development of a child's sense of security in his own 



126 PROBLEMS OF PARENTS 

home. This can be done through informal conferences with parents, 
through discussion groups with the parents of exceptional children, 
through parent-teacher meetings, and through bulletins which the school 
prepares and sends to parents. 

Parents should be helped to become aware of the threats to the emo- 
tional security of their exceptional children caused by undue quarreling 
and wrangling in the home, lack of agreement by the parents with respect 
to discipline, inconsistency in discipline, dominance or coddling of the 
children by the parents, and the playing of favorites by the parents. The 
last-mentioned includes favoritism for the exceptional child himself. His 
own best development will be injured by such a practice. 

From a positive point of view, parents need help in knowing how im- 
portant it is to the exceptional child to feel that he is a valued member of 
the household. He must feel that he is "no bother at all." Parents whose 
own emotional maturity is inadequate often pose as martyrs because of 
the extra care which is required by the exceptional child. This may be 
their bid for recognition from others even when they do love their child 
and are glad to care for him. Parents need guidance in understandng 
that this talking or complaining about their heavy responsibilities will 
injure their child as it would any normal human being. 

Teachers can do a good deal in helping parents to understand the im- 
portance of taking time to play with their exceptional child and to share 
in his fun. Children, like adults, count as their friends those who take the 
trouble to share their joys and sorrows and to have comradeship with 
them. 

Building the Child's Physical Health 

No matter what form the handicap takes, exceptional children need 
the best possible basis of physical health that they are capable of devel- 
oping. This is true of the deaf, the blind, the emotionally disturbed, 
crippled children, and mentally deficient children. Good physical health 
will enable these youngsters to put forth more energy in developing their 
possibilities. The school will need to give mothers of such children some 
special help in understanding how to provide an adequate and well- 
balanced diet and to make sure that their children have adequate rest, 
sleep, and exercise as well as have the benefit of correction of such reme- 
diable defects as defective teeth, tonsils, and adenoids. There will, of 
course, be children with serious health problems, such as cardiopathic 
conditions, which make it impossible to build up the child's health to a 
maximum degree. Teachers must be careful that parents of such children 
are not urged to attempt the impossible and are not made overanxious 
soncerning their children's health. Oversolicitude for any child's health 
is apt to hinder rather than to promote his best all-round development. 



LAYCOCK AND STEVENSON 127 

Those who would help the parents of exceptional children need to put 
them in possession of the best available knowledge of how to build up 
their children's physical health. 

The Development of Motor Skills 

Motor skills are important in meeting the physical and personality 
needs of all children. They are especially important in the case of excep- 
tional children. First of all, the problems of locomotion are important. 
Then, too, a huge range of activities in life depends upon skilled manip- 
ulation with the hands. 

Mentally deficient children often need help in learning to walk and in 
gaining motor control. Parents must be shown how to give them practice 
in walking up and down steps, in buttoning buttons, in lacing shoes, in 
overcoming clumsiness and lack of motor co-ordination. 

The Minnesota pamphlet, Teach Me, 2 gives concrete suggestions to 
parents as to how to teach the mentally deficient child such things as 
drinking from a cup with or without help, holding and using a spoon, 
using a fork, wiping the mouth, using a knife for spreading, pulling off 
shoes and socks, putting on hat and shoes, taking off coat and dress, un- 
buttoning, undressing entirely, going to the toilet, drying own hands, 
putting away toys, brushing teeth, using handkerchief, and bathing with 
some help. 

Parents need help in knowing that the development of such skills 
requires a very great deal of regular, systematic, and concrete practice in 
the case of these children as well as a great deal of encouragement for 
success and much patience on the part of the parents themselves. 

In the case of the cerebral-palsied child, the parent's responsibility is 
very great, indeed. As Gratke 3 points out, even if the parents live near a 
treatment center, the time spent there is a small percentage of the 
twenty-four hours of every day. The rest of the time the child's rehabil- 
itation is the parent's responsibility. 

St. James 4 points out that parents of cerebral-palsied children are apt 
to have undue respect for that which costs money and to fail to realize 
that their own hands can play a major part in the rehabilitation of their 
children. Under the direction of the physician, the trained physical 
therapist, occupational therapist, and speech therapist, parents can 
follow a home-treatment program that can be effective and worth while. 



2 Ibid. 

3 Juliette M. Gratke, "Cerebral Palsy Is a Challenge to Parents," Crippled Child, 
XXV (February, 1948), 14-15. 

4 Robertine St. James, "Help Your Cerebral-palsied Child," Crippled Child, XXV 
(February, 1948), 4-5, 26-27. 



128 PROBLEMS OF PARENTS 

Parents of cerebral-palsied children need help from physicians, physio- 
therapists, and teachers in learning how to play their part in the rehabil- 
itation of their children. They need to learn the importance of the sys- 
tematic and conscientious performance of the exercises and activities 
which have been ordered. They need to have an intelligent attitude to- 
ward braces when their use is ordered by the physician. Sometimes 
braces are used in a preventive or corrective way while the child is 
growing. Sometimes they are used to lend stability to the weight-bearing 
joints while walking. Sometimes braces are used only during the day for 
support and control. In any case the parents' attitude toward braces is 
likely to determine the child's attitude. It is, therefore, important that 
the parent know for what purpose the brace is used. 

Parents of the cerebral-palsied will need guidance in knowing how to 
use other special equipment such as special chairs, standing tables, the 
stabilizer, special kinds of tricycles and skis, etc. 

This type of child will need help from his parents in developing many 
kinds of simple motor skills used in feeding, dressing, and bathing him- 
self. 

Teachers, supervisors, and physicians will have to help parents of 
exceptional children to understand the value of the development of 
motor skills in the personality development of the child. It is not merely 
the practical advantage which comes to a child from being able to walk 
or to use his hands in the elementary processes of living. Rather, it is the 
fulfilment of the needs for independence, achievement, recognition, and 
self-esteem which accomplishment in these areas brings. 

The Development of Language 

Language is one of the most important tools in any child's develop- 
ment. However, this is doubly true in the case of several types of handi- 
capped children the deaf, the mentally deficient, the cerebral-palsied, 
and the blind. Teachers, principals, and supervisors will need to give 
specific help to the parents of such children so that they may participate 
effectively in the child's language development. 

In the case of the deaf child, the parents' participation in the language 
development is very urgent. It must start as soon as the child is born. It 
cannot wait until the child is ready to go to school not even until the 
child goes to nursery school, if one is available. 

It is vital, for example, that a deaf baby be exposed to the same con- 
stant flow of language from which hearing babies profit so greatly. 
Mothers of hearing babies talk to their children long before they can un- 
derstand, and such talk greatly contributes to the child's development. 
Parents of deaf children need to realize the urgent necessity of talking to 



LAYCOCK AND STEVENSON 129 

their child a great deal right from the first year. They need help in know- 
ing how best to do this. Tracy 8 suggests the following rules: (a) the child 
must be able to see the speaker; (6) the light should be on the speaker's 
face; (c) the speaker's face should be as nearly as possible on a level with 
the child's face and not too far away; (d) whole sentences and good lan- 
guage should be used never single words, broken phrases, or "baby 
talk"; (e) people should speak clearly and naturally, striving for good 
diction but without mouthing their words or exaggerating; (/) people 
should speak a little more slowly, pausing only where pauses would 
naturally occur; (g) the speaker should not move his head or hands while 
speaking; (A) the speaker should talk about something that happened 
yesterday or is going to happen tomorrow something immediate rather 
than something more remote. 

Parents of blind children need help in understanding how best to 
develop language in the blind child by talking to him a great deal about 
experiences, events, and objects, and providing a rich sensory experience 
for the child through the other senses, particularly touch and hearing. 

In connection with the home training of cerebral-palsied children, 
Gratke 6 says to parents: "If your child is working on mouth closure, 
lip use, or breathing exercises in his speech-training, you can offer much 
help to the speech therapist and thus speed up rehabilitation." 

The Development of Skill in Motivating Learning 
One of the lessons learned from the educational activities in training 
men for the armed services in World War II was the tremendous power 
of motivation. Young men who did not seem to be at all promising but 
who desperately wanted to be air crew made extraordinary progress in a 
short time. Eagerness to learn is a vital factor in learning. This is par- 
ticularly true of exceptional children. The stories of handicapped in- 
dividuals who have achieved greatness due to strong motivation are 
abundant in the history of the human race. 

It is important that the parents of exceptional children learn the skill 
of developing in their children an eagerness to learn and a persistence 
and patience in doing so. This is effected in many ways. First of all the 
child must have a secure base in emotional security in his own home. 
Second, his parents must believe in his possibilities. Third, he must have 
parents who encourage him to learn and who praise his efforts and. 
achievements. Fourth, he must have parents who have patience in help- 
ing him and who do not expect too much. 



6 Louise Treadwell Tracy, "New Avenues to Understanding," California Parent- 
Teacher Magazine, XXI (December, 1944), 8-9, 26. 
1 Gratke, op. ait. 



130 PROBLEMS OF PARENTS 

The problem of motivating learning is a universal problem shared by 
all home teachers, schoolteachers, and community teachers. That it is 
not solved at all adequately in ordinary life is seen in the case of so 
many children whose eagerness to learn in the preschool period has been 
effectively killed by the time they have spent some time in school. 
Parents of exceptional children need to be wiser than the parents of 
regular-class children in their ability to arouse and sustain in their chil- 
dren an eagerness to learn. Such parents can become wiser only if they 
are given help by the school. Specially prepared bulletins may be of 
some help in attaining this. Skilled teachers can demonstrate to parents, 
when they visit the school, the methods which are successful in stimulat- 
ing learning. Discussions in parent-teacher associations and in study 
groups could be of great help. Conferences between the parents and the 
teachers should be supplemented by visits to the homes by school 
social workers or visiting teachers. These visits are often necessary to help 
the parent to apply principles to the specific situation found in the home. 

The Development of Wholesome Emotional 
Patterns in Children 

Parents need skill in developing wholesome emotional patterns in 
their exceptional children. Growing up emotionally involves for all 
children learning to bear tension without blowing up that is, being 
able to meet the ordinary disappointments and frustrations of everyday 
life without resorting to temper tantrums, tears, pouting, sulking, self- 
pity, oversensitiveness, or neurotic ailments. 

It is important for the happiness and success in life of all children 
exceptional or otherwise that their parents learn the technique of a 
consistent behavior guidance which will help them to make progress in 
growing up emotionally. This involves firm discipline rather than lax or 
harsh discipline. For their exceptional children's sake, parents cannot 
afford to allow a handicap to interfere with the children's growth toward 
emotional maturity. Parents need to know that the basis for developing 
such maturity lies in providing for the child adequate satisfactions for 
his needs for emotional security, independence, achievement, recogni- 
tion, and self-esteem. Parents, therefore, need to learn how to use as 
many of the simple, practical principles of child guidance as are available 
to them. 

In the case of children who present emotional problems, these prob- 
lems usually grow out of the emotional climate of the home and are apt 
to be the result of the parents' own emotional problems and of their 
handling of their children. In such cases the school must use every means 
available to help the parents solve their own emotional difficulties and 



LAYCOCK AND STEVENSON 131 

improve their guidance of their children. Such means are likely to in- 
clude parent-teacher conferences, the services of visiting teachers and 
school social workers, the help of various types of school agencies, includ- 
ing child-guidance and mental-hygiene clinics, and such assistance from 
family physicians and clergymen as may be obtainable. 

The Development of Good Social Patterns of Behavior 

Whatever the exceptional child's handicap, it is vital for his happiness 
that he have as many contacts with others of his own age as it is possible 
for him to have. The majority of normal children hav^ such contacts 
with other children through associations in the home, on the playground, 
in the street, and at school. Sometimes parents of normal children inter- 
fere with the social development of their children by restricting these 
associations because of fear that their child will be injured physically 
or morally. The result is bad for the child. Growth toward social matu- 
rity involves the ability to make friends among one's age-mates. 

Because exceptional children may, as a result of their handicap, have 
their opportunities for contacts with their age-mates restricted, it is im- 
portant that the parents learn how to help the child to participate in 
normal activities so far as circumstances permit. 

Parents of exceptional children may need to invite other children into 
the home to play with their child. They may need to put up with the 
extra noise and inconvenience which this may occasion them. They 
must endeavor to keep from dominating the play or from interfering in 
minor quarrels and dissensions. They must give their handicapped child 
the chance to play host to his playmates. They must help to see that 
their handicapped child's playmates accept him in a matter-of-fact way 
and share in his activities. 

Parents must see to it that their exceptional child gets the same kind 
of guidance, instruction, and practice in the arts of making and keeping 
friends and of getting along with others as normal children get. They 
need to help their child develop a variety of skills for living, 7 among 
which social skills are highly important. 8 

Because of their handicap, the success of many exceptional children in 
life depends upon their ability to live and work with others. Many slow- 
learning and other handicapped children become useful and happy citi- 
zens because of qualities of co-operativeness, unselfishness, kindness, 



7 See S. R. Laycock, Skills for Living. School for Parents Series. Toronto, Ontario, 
Canada: Ryerson Press, 1947. 

8 See S. R. Laycock, The A rt of Making and Keeping Friends. Saskatoon, Saskatche- 
wan, Canada: University of Saskatchewan Bookstore, 1948. 



132 PROBLEMS OF PARENTS 

good manners, dependability, and honesty. Parents need help in knowing 
how to develop these qualities in their children. 

In the case of the exceptional child who is socially maladjusted, the 
school must, first of all, assess its own practices with a view to determin- 
ing how far its methods of handling such a child have contributed to his 
becoming exceptional. A careful review should be made of the school's 
practices with respect to the curriculum experiences, methods of teaching, 
methods of discipline, and school and classroom organization with a 
view to determining necessary modifications. Then the school will need 
to enlist the aid of the various community agencies health, recrea- 
tional, social, and religious in understanding the child's difficulties and 
in promoting his rehabilitation. Every effort should be made to take the 
parents into a partnership which involves the searching together of 
parents and teachers in understanding and rehabilitating the socially 
maladjusted child. 

Promoting Intellectual Development 

In helping exceptional children to realize their greatest possibilities 
parents need to assist them in developing their intellectual abilities to the 
utmost. One important aspect of this is the development of certain 
general intellectual habits and skills. In particular, this involves training 
children in such techniques as problem-solving and organized thinking. 
Every human being young or old, handicapped or normal meets 
scores of problems every day of his life. He may tackle these problems 
with an emotional approach or by a trial-and-error method or he may 
learn to tackle them systematically by the problem-solving technique, 
which involves an ordered approach of: "What is the problem?" "What 
is the present situation?" "What method shall be used in solving the 
problem?" The development of sound methods of solving the problems 
of daily living is a gradual process which begins in the preschool period 
and is one in which the parents participate long before a child ever sees a 
mathematical or other school problem. Teachers can assist parents in 
helping their handicapped child to use the problem-solving technique 
and other devices of good study and thinking at the level of development 
which the child has reached. 

Helping Children Find Suitable Vocational Outlets 

While schools play an increasing role in the vocational guidance of all 

children, it is important that parents of exceptional children know that 

they have a real part to play in such guidance. Their refusal to accept 

^motionally the kind of job which their child can do may nullify all the 

school's best efforts. Their co-operation in helping their child discover 

what is within his range of possibilities is vital. They have much to con- 



LAYCOCK AND STEVENSON 133 

tribute to any school counselor about the particular characteristics and 
background of their child, no matter how skilled and expert the coun- 
selor happens to be. The school will be well advised to take the parents 
of exceptional children into a complete partnership in helping these 
children discover and realize their vocational possibilities. Frequent 
consultation is the only safe method. 

The Development of Gifted Children 

Parents of gifted children need guidance in knowing how to help their 
children learn to suffer fools gladly, accept authority where necessary, 
and learn to co-operate with others. They need help in knowing how to 
stimulate their children's intellectual curiosity and their creative ability. 
They need skill in helping such children accept responsibility for leader- 
ship without thinking of themselves more highly than they ought to 
think. They need to see to it that their gifted child leads a reasonably 
balanced life in which physical development, social and emotional 
development, and intellectual development all have a due share. 

CONCLUSION 

In this chapter it has been suggested that, in the case of exceptional 
children, schoolteachers and school officials should make every effort to 
secure the co-operation and to increase the efficiency of their partners, the 
home teachers. 

In carrying out the above, the senior author 9 has suggested that the 
first step is for the teacher or supervisor to realize that parents are likely 
to be afraid of him for three reasons: (a) Parents are apt to carry over 
into their relationships with their child's teachers the fear or resentment 
which they themselves felt, in their school days, toward their school- 
teachers, (b) Parents are apt to think of teachers as omniscient beings 
and to stand in awe of them, (c) Parents are afraid they will be blamed 
for having such a child or for mistakes in handling him. 

The second step in parent-teacher co-operation is to develop the atti- 
tude that the teacher does not know all the answers but that he is 
"searching, together with the parent," for the right answer. 

The third step in effective parent-teacher co-operation lies in the 
teacher's making known at the first meeting that he likes the child and 
accepts him emotionally. 

The fourth step required of teachers is that they always stress the 
assets of the child and tell the parent about the child's good points and 
possibilities before they discuss his difficulties. 



9 S. R. Lay cock, Wanted! Skill in Co-operating with Parents. Saskatoon, Saskatche- 
wan, Canada: University of Saskatchewan Bookstore, 1947. 



134 PROBLEMS OF PARENTS 

The fifth step needed for parent-teacher co-operation lies in the way 
that the teacher both gives and receives suggestions. 

The sixth step lies in the teacher's realization that he and the parent 
really see different children. He must take into account that the parent 
of an exceptional child is often very emotionally involved. The teacher 
may see the child as a threat to his pride or his ambition or as a means of 
satisfying his own starved emotions, or as someone to dominate, or in 
any one of a dozen different ways. Only as the teacher is aware of his 
attitude will he be tolerant and understanding of the parent's attitude. 

Skill in helping parents in better attitudes and understandings of their 
exceptional children and in better techniques of helping them must be 
sought after by teachers, supervisors, and other school officials if they 
hope to be successful in promoting the best development of such 
children. 



SECTION II 
NATURE AND NEEDS OF SPECIFIC GROUPS 



CHAPTER VIII 
TEACHING THE VISUALLY HANDICAPPED 



WINIFRED HATHAWAY 

Associate Director 

National Association for the Prevention of Blindness 
New York, New York 

and 

BERTHOLD LOWENFELD 

Superintendent, California School for the Blind 
Berkeley, California 



INTRODUCTION 

Impressions of the world about the individual are received only 
through the senses. More impressions reach the brain for interpretation 
through the sense of sight than through all the other senses combined. 
It is evident, therefore, that any deviation from normal vision has impor- 
tant significance. Since no part of an organism can be affected without in 
some measure affecting the whole, visual difficulties may influence the 
life of the individual in its physical, mental, emotional, social, educa- 
tional, and vocational aspects. 

The first concern of all professional and lay groups and individuals is 
to prevent blindness and other visual impairment by finding the causes 
diseases, malformations, accidents, etc. and by discovering and putting 
into effect ways and means of eliminating them. The second responsibil- 
ity is to make adequate provisions for those already affected. 

Visually handicapped children may be classified according to one of the 
following groupings, but since sharp lines of demarcation cannot be 
drawn, the needs of each child must be considered individually. 

Growp 1. Children having deviations from generally accepted visual norms 
that are amenable to medical treatment or that can be so compensated for by 
optical aids that they may be included, educationally and vocationally, in the 
group of the normally seeing. 

Group 8. Children who have such serious visual impairment that even with 

135 



136 THE VISUALLY HANDICAPPED 

medical treatment and optical aids they cannot use advantageously the educa- 
tional media provided for the normally seeing, yet have too much sight to make 
appropriate use of the media provided for the blind. 

Group 3. Children who, after receiving all needed medical treatment and 
optical assistance, are educationally and vocationally blind. 

Since, with adequate attention, children in the first group can be in- 
cluded with the normally seeing, this chapter is concerned with the needs 
of the partially seeing and of the blind. 

THE PARTIALLY SEEING 

Partially seeing children are those who, although seriously handi- 
capped by visual impairment, have sufficient sight to make this sense the 
chief avenue of educational approach. In this group may be found : 

1. Children having a visual acuity between 20/70 and 20/200 in the better eye 
after all possible medical care and optical aid have been provided; 

2. Children with serious, progressive eye difficulties; 

3. Children suffering from diseases of the eye or diseases of the body that 
seriously affect vision; 

4. Children with normal mentality who, in the opinion of the ophthalmologist 
and the educational authorities, need and will benefit by the special equipment 
and opportunities provided for the partially seeing even though they do not 
fall within the above classifications. 

Discovering Partially Seeing Children 

The best method of discovering partially seeing children is by having 
all children given a thorough medical examination, including an oph- 
thalmological examination, before they enter school and at specified in- 
tervals throughout their school life. Where such procedure is not possible, 
visual screening may be undertaken by the school health service in order 
to discover children who should be referred for ophthalmological exami- 
nation. Such screening may be done by the school physician, the school 
nurse, or by a specially prepared technician or teacher in accordance 
with state and local laws and procedures. However, regardless of who 
does the actual screening, wherever possible it should be under the super- 
vision of the school health service. It is the responsibility of the school 
health service to select a screening device that will give most efficient 
service and to see that screening tests are conducted under correct condi- 
tions. Special attention must be paid to placement and illumination of 
chart, to observation of reactions of the child during the test and when 
using his eyes for close or distant vision, and to jsymptoms or complaints 
of eye difficulties. 

It is further the responsibility of the school health service to follow 



HATHAWAY AND LOWENFELD 137 

through on all referred cases in order that every necessary attention may 
be given. It is the obligation of parents to have their children examined, 
but, should they be unable or unwilling to do this, it is the function of the 
school health service to make every possible effort to see that the nec- 
essary attention is provided. 

Educational Facilities 

The best method of providing educational facilities for partially seeing 
children is through the establishment of special classes in public or 
private school systems. In general, the number of partially seeing chil- 
dren requiring special educational facilities is in the proportion of one to 
five hundred of the school population. It is, therefore, a simple matter for 
the educational authorities to judge, at least approximately, the number 
of such pupils in their school systems and to decide whether the estab- 
lishment of special classes for them is warranted or if other provisions 
must be made. Since one class may serve a school district or even a small 
community, the group will include children of several grades. A school 
must be selected that has grades corresponding to those represented by 
the children in the special group; a centrally located school will facilitate 
transportation. 

For partially seeing children living in rural areas or in communities 
too small to warrant the establishment of a special class, several possibil* 
ities may be offered. A class may be established in a consolidated school; 
a number of small communities may combine to make a class possible; 
children may be sent to a class in the nearest city and boarded there if 
necessary, and the state director of special education may give the 
needed assistance to a teacher in a rural area who has a partially seeing 
child in her class. If there is no state department of special education, 
county supervisors of schools may prepare themselves to give such assist- 
ance by taking advantage of courses offered by various colleges and uni- 
versities. Necessary educational material may be supplied by the state 
department of education. 

In any community with a sufficiently large school population to 
warrant the establishment of special classes there may be partially seeing 
children in all grades from the first elementary grade through the high 
school who need special facilities. The first class established is usually for 
elementary-school children because the sooner the partially seeing child 
is given the needed educational advantages the greater is the hope of 
success. However, it is a very short-sighted policy to deprive partially 
seeing pupils in the upper grades of the greatly needed help since the 
amount of close eye work required here is far gteater than that required 
in the elementary grades. 



138 THE VISUALLY HANDICAPPED 

Method of Conducting Classes for the Partially Seeing 

Since segregation is not in accord with modern educational principles, 
a co-operative plan has been developed by which partially seeing chil- 
dren do all their close eye work in the specially equipped classroom under 
the direction of a teacher adequately prepared to undertake this work. 
They join their normally seeing companions for all other activities, unless 
otherwise directed by the eye physician. 

Co-operation. It is evident that if the above plan is to be carried out 
successfully the responsibility for the education and health of the par- 
tially seeing child must be shared by all concerned the superintendent, 
the principal, the school health service, the teachers of regular grades, 
and the special-class teacher, as well as the parents and the child himself. 
In order that such co-operation may be most effective, it is essential that 
all understand the reasons for the establishment of a special class and 
that all have an appreciation of the many problems entailed and be 
willing to assume their full share of finding the best possible solution. 
Above all, perhaps, the partially seeing child must be made to feel 
equally welcome in the special class and in the regular grade in which he 
participates in the activities of his normally seeing companions. In order 
that the partially seeing child may succeed in overcoming his difficulties, 
all efforts should be directed toward helping him recognize and develop 
his latent abilities. 

Curriculum. The same curriculum is followed by partially seeing and 
normally seeing pupils, equivalent substitutions being made for activities 
requiring too intensive use of the eyes, such as sewing. Individual atten- 
tion given by the teacher to the partially seeing child according to his 
needs makes it possible to maintain standards so that he may participate 
with his normally seeing companions in regular grade work not requiring 
close use of the eyes. 

Special Educational Mediums and Equipment. 1 Because of serious im- 
pairment, the eyes of partially seeing children are unable to carry their 
full share of the complicated process of seeing. Therefore, the eye task 
must be made easier, and adequate attention must be given to illumi- 
nation. 

1) Educational Mediums. Educational mediums are on a larger scale 
than those provided for the normally seeing. Type is measured in points, 
72 points to the inch. For normally seeing children above the second or 
third grade, schoolbooks are printed in 10- or 12-point type; for the par- 
tially seeing, books are in 24- or 18-point type. The type selected is dis- 



1 A list of equipment that has been successfully used in classes for the partially 
seeing may be obtained from the National Society for the Prevention of Blindness, 
1790 Broadway, New York 19. 



HATHAWAY AND LOWENFELD 139 

tinct, wide rather than tall, and without unnecessary serifs; the printing 
is done with black ink on white, off-white, or cream-colored paper with 
ample spacing and margins, and with clear, easily seen illustrations 
having little detail. Maps and other educational material follow the 
same general principles. 

Pencils with thick, soft leads are used on large-size white, off-white, or 
cream-colored paper. Materials for arts and crafts are carefully selected 
in order that creative activities may be carried on without close eye use 
or fatigue. 

Mechanical devices, such as typewriters, recording machines, radios, 
etc., are used as widely as possible. The touch system of typewriting is 
taught in order that material may be prepared without eye use. 

2) Illumination. 2 Quality and quantity of illumination, both natural 
and artificial, are of the utmost importance for all children but especially 
for those with serious eye difficulties. It is recommended that classrooms 
for partially seeing pupils be equipped to provide in all parts of the room 
50 foot-candles of correctly diffused, distributed, directed, and con- 
trolled illumination without glare. In order to obtain the most efficient 
service from whatever system of illumination is provided, consideration 
must be given to the reflection factor of all surroundings. It is recom- 
mended that ceilings be painted in white, walls in light pastel colors, and 
woodwork in harmonious hues, and that floors and furniture be in light 
finish, all in mat surface to prevent glare. 

Gray-green chalkboards have a much higher reflection factor than 
blackboards and offer a good contrast for white chalk sufficiently soft to 
make a clear, heavy line. 

3) Furniture. Movable furniture makes it possible for children to use 
that part of the room that offers opportunity for the greatest eye comfort 
and efficiency. Seats and desks that can be adjusted to the growing child 
and desktops that lift to an angle desirable for correct eye focus are 
assets in encouraging good posture, which is essential both for general 
health and for eye health. Light-colored seats and desks not only provide 
higher reflection value but prevent an undesirable contrast between the 
paper and the desk or table top. 

Supervision 

Supervision of classes for the partially seeing includes the medical and 
educational supervision provided for all children and, in addition, special 
ophthalmological and educational supervision according to individual 
needs. 



2 For full details, see American Standards Association, American Standard Proc- 
tice for School Lighting (A-23). New York 10: Illuminating Engineering Society 
(51 Madison Ave.), 1948. 



140 THE VISUALLY HANDICAPPED 

Ophthalmological Supervision. Ophthalmological supervision may be 
under the direction of private or school oculists or may be provided 
through clinic service. Ophthalmological supervision of the partially see- 
ing should include more than examination of the eyes, check-up on 
general health, treatment of diseases of the eyes and of diseases of the 
body that may affect the eyes, and prescribing of lenses for refractive 
errors, The ophthalmologist should make medical and Ophthalmological 
records available to the school health service and to the special teacher 
so that they may be fully cognizant of the type of eye difficulty from 
which the child is suffering and of his general physical condition. Such 
report should give recommendations regarding the use of the eyes and 
regarding participation in physical exercises, particularly in gymnasium 
wor In cases in which glasses are prescribed, the record should state 
whether these are to be worn only for close eye work or constantly. Records 
should further state when the child is to return for another examination. 

If the school system has the service of an ophthalmologist, the teacher 
of the partially seeing should have the opportunity of consulting him in 
regard to changes in eye condition that may require reconsideration of 
placement. The ophthalmologist should have the opportunity of visiting 
the special classroom in order to become acquainted with the conditions 
under which partially seeing pupils carry on their work. In particular, he 
should be conversant with educational opportunities for the partially 
seeing in order to advise parents regarding the best possible procedures. 

Educational Supervision. Educational supervision may be state or 
local. A state supervisor of special education has the responsibility of 
developing special educational facilities within the state not only through 
the establishment, in co-operation with other educational authorities, of 
special classes for the partially seeing but also through giving the nec- 
essary assistance to individual teachers who have a partially seeing pupil 
for whom no special class arrangements can be made. 

Many state and local supervisors have responsibility for the super- 
vision of all types of special classes. It is a distinct advantage if there is a 
special supervisor for the partially seeing who is adequately prepared and 
experienced to be able to meet the varied needs. Both state and local 
supervisors assist teachers in charge of special classes as well as those in 
smaller communities to solve educational and social problems and to 
make the adjustments necessary to insure desirable results. 

The Special Teacher 

Although the co-operation of all concerned with the child's welfare is 
necessary, a teacher specially prepared to undertake this work is most 
important to its success. Such teacher must have a basic knowledge of 



HATHAWAY AND LOWENFELD 141 

anatomy, of the physiology and hygiene of the eye, of refraction and 
refractive errors, and of common eye diseases. He must keep abreast of 
advance in medicine, illumination, physical equipment, and educational 
material and must be familiar with the most approved methods of 
teaching. 

The special teacher must recognize the possible psychological and 
emotional disturbances that may result from conflicts and inhibitions 
within the child himself and from the attitude of those with whom he 
comes in contact. In order that he may guide the child in making de- 
cisions and in developing resourcefulness, he must know not only the 
child's physical and mental possibilities and limitations but also his 
desires and interests pertaining to his present and his future under- 
takings. He must realize that, in addition to the problems incident to the 
growing-up process which all children must learn to solve, any marked 
deviation from normal growth and development may give rise to special 
problems. These will differ according to the types of eye difficulties from 
which the children suffer. Thus, a nearsighted child whose myopia is of 
sufficient concern to necessitate his placement in a special class may, be- 
cause of his limited range of vision, develop self-centered personality 
traits that affect not only his own life but also the lives of those with 
whom he comes in contact. The wise teacher, realizing this possibility, 
strives to provide interests and experiences that will be of the utmost 
assistance to the child in developing tendencies that may be the greatest 
asset to him in his educational, social, and vocational relationships. 

On the other hand, the child with marked hyperopia (farsightedness) 
must be assisted to conquer his handicaps in quite a different way. His 
problems arise chiefly from having to use his eyes at close range with dis- 
tinct discomfort. In such case the teacher, aware of the effort the child 
must make physically and emotionally, will provide experiences that 
entail very short periods of attention and will offer such interesting ma- 
terial that the child is willing to concentrate for gradually increasing 
periods as his ability develops. 

The child with high astigmatism is confronted with problems arising 
from blurred vision, resulting in the misinterpretation of symbols, and 
sometimes from the discomfort of seeing apparently wavering lines. The 
well-prepared teacher will use infinite patience and will develop the 
child's power to discriminate between letters and symbols that look alike 
to his blurred vision by presenting them in the clearest possible form, 
with adequate spacing between lines, words, and letters. 

The child with low vision may be able to distinguish words but not 
phrases; hence the teacher will appreciate the probability of his being a 
slow reader. The child with muscle imbalance may require special atten- 



142 THE VISUALLY HANDICAPPED 

tion because the possibility of seeing double images causes so much con- 
fusion that he suppresses the image in the deviating eye. Thus, the spe- 
cial teacher must have the ability to assist each pupil according to his 
individual needs. In order to gain the co-operation of parents, he must 
know community resources so that all aspects concerning the child's 
welfare may be given adequate attention. 

Vocational Guidance 

Educational guidance and vocational guidance of the partially seeing 
are closely related; the former must include the fundamentals upon which 
the latter is based. To be successful, educational guidance must take into 
consideration all aspects of the child's personality his physical and 
mental abilities and disabilities, his emotional balance, his inherent 
traits and tendencies, and his own desires. Furthermore, it is essential to 
know whether the child's desires have been unduly influenced by the 
opinion of those about him or if they are actually his own. Vocational 
guidance, likewise, must include consideration of all these factors. 

There is no reason why the partially seeing should be barred from pro- 
fessional life or from skilled or unskilled occupations if they are able to 
undertake whatever they are best fitted to do without hazard to them- 
selves or to others. Aptitude tests are of even greater value for the 
partially seeing than for the normally seeing; naturally they must be 
presented in accordance with the visual capabilities of the partially seeing 
child. 

In order that the partially seeing pupil may be given the best possible 
vocational guidance, it is necessary to have the co-operation of the pupil, 
his parents, the guidance counselor, the special teacher, and the physi- 
cian. If vocational training is to follow, all pertinent information regard- 
ing the pupil should be made available to the person responsible for de- 
ciding upon and initiating such training. Obviously, no one list of occupa- 
tions can apply to all partially seeing persons alike. As in the case of the 
normally seeing, the partially seeing youth must give careful considera- 
tion to all phases of vocational undertaking before determining what is 
best for him to follow. In addition, the partially seeing must take into 
account the difficulties that may arise from his visual handicaps. 

THE BLIND 
Definition 

Children are considered as "blind" for educational purposes when they 
have a visual acuity of 20/200 or less in the better eye with correcting 
glasses, or an equally handicapping defect in the visual field. The child on 
the optimum end of this visual deficiency range is able to use his sight to a 



HATHAWAY AND LOWENFELD 143 

very considerable degree in getting about, in working with his hands, and, 
last but not least, in observing, while the totally blind child must rely 
completely on his other senses. In between these two extremes are chil- 
dren who have enough sight to be measured by the Snellen chart, those 
who have what is commonly called "traveling sight/' those who have 
form or movement perception, and others who have only light perception. 
The ability to distinguish colors may be present in children with even a 
very low degree of sight. 

Causes and Degree of Visual Defect 

Eye conditions among pupils in schools for the blind have been re- 
ported for many years. For the school year 1945-46, 8 eye reports of 3,689 
pupils in schools and classes for the blind were included. Etiology was 
undetermined in 10.3 per cent, infectious diseases were responsible for 
19.8 per cent (ophthalmia neonatorum 9.4 per cent, syphilis 3.9 per 
cent), trauma for 6.6 per cent, poisoning for 0.2 per cent, neoplasms for 
3.7 per cent, and general diseases for 1.4 per cent. Prenatal origin, not 
elsewhere classified, is reported for 58.1 per cent. In recent years retro- 
lental fibroplasia, an eye defect occurring in prematurely born children, 
has contributed to an increase in the number of blind preschool children. 

The report also shows that, statistically speaking, among ten pupils in 
classes for the blind, four are totally blind or have only light-perception 
and almost two have vision of 20/200 or better. About 80 per cent of all 
pupils were either born blind or lost their sight before five years of age. 

Other Medical Considerations 

A child should only be considered as blind if an eye physician has 
diagnosed his condition as such. The wearing of prescribed glasses may 
improve the child's sight. Periodic re-examinations are necessary to de- 
termine whether the condition of the eyes has changed. The teacher must 
see to it that the glasses are worn by the children and kept in good con- 
dition. Children whose eyesight can be improved by an operation or who, 
for reasons of appearance, need surgical correction should receive the re- 
quired treatment. Since blind children must rely entirely upon their other 
senses, any physical defects that may interfere with the full employment 
of them (for instance, hearing or speech defects) should receive careful 
treatment and attention. 

Educational Facilities 

Under good parental guidance, which often can be achieved only by 
case-work assistance, the normal blind child is ready to enter school at 



C. Edith Kerby, "What Causes Blindness in Children?" Sight Saving Review 
(Spring 1948), 21. 



144 THE VISUALLY HANDICAPPED 

approximately the same age as a seeing child. At this time he should be 
able to wash and dress himself, take care of his physical needs, eat with 
Spoon and fork, go about by himself in familiar surroundings, and, of 
course, talk as freely as would be expected of any child his age; he should 
play by himself and also be able to establish social contacts with other 
children and grown-ups. Many parents report good results from sending 
their children to regular kindergartens where alert teachers, aware of 
certain special needs of the blind child, have been successful in helping the 
child in his adjustment to a new physical and social environment. 

For most blind children, "going to school" means admission to a 
residential school for the blind. In some communities they may be 
educated in public school classes for blind children (Braille classes). 
Fundamentally, the residential school and the Braille class are designed to 
assist the blind child, through the use of special methods and aids, in his 
adjustment to the world in which he must live as an adult. Residential 
schools provide an educational environment geared in its entirety to the 
needs of blind children who must spend the greater part of the year at the 
school. In general, they follow grade by grade the courses of study offered 
in the public schools.%Braille classes supply only such supplementary 
assistance as is necessary to enable the blind pupil to participate in 
regular classroom instruction, a program under which the child does not 
change his home environment.jBoth types can be successful in accom- 
plishing their objectives, as is exemplified by the many well-adjusted 
blind individuals in all walks of life. Social adjustment of the individual 
is a most important aim of education. Schools for the blind usually pro- 
vide for their pupils such social activities as dancing, scouting, and liter- 
ary and dramatic art clubs. Blind Children should also have as many con- 
tacts as possible with seeing boys and girls and with people in general. 
During holidays and summer vacations, which the children spend with 
their families, they should be given every opportunity to participate in 
the social life of their age groups and of the community. Some of the 
residential schools send their students to public schools for the last two 
or three years of their high-school work, which gives them the advantage 
of gradual adjustment to the world in which they will live after leaving 
school. 

Braille classes for blind children are established in public schools in 
many communities with a sufficiently large number of blind children. 
In a homeroom a specially trained teacher instructs up to ten or twelve 
blind children in those subjects in which blind pupils cannot follow 
regular classroom instruction. For the other subjects and activities, 
Braille-class pupils join in the regular schoolwork. Special provisions are 
desirable for handicrafts, physical education, and music instruction. 



HATHAWAY AND LOWENFBLD 145 

Braille classes receive appliances and books from the American Printing 
House for the Blind. In many states local school boards are reimbursed 
for any excess expenditures for the Braille class. 
S/A. successful pattern of combining residential school and public school 
services for blind children is practiced in the state of Oregon. It is based 
on the principle that no child should be segregated because of hifi handi- 
cap unless it is absolutely necessary. The residential school has one 
group of pupils who stay at the school until they have completed their 
training and another group who are there only for the purpose of being 
made educationally and physically fit for referral to public schools in 
their home communities. There they are supervised, and their teachers 
assisted, by a state supervisory program which also supplies them with 
the required books and other aids. 

In 1948, 5,344 pupils were being educated in 64 residential schools, and 
532 were enrolled in Braille classes in 24 cities. The state of New Jersey 
relies mainly on Braille classes and sends residential-school candidates 
to schools in neighboring states. The latter arrangement is also followed 
in a few other states that conduct no residential schools of their own. 

There are more blind children in the United States than those attend- 
ing the afore-mentioned training facilities. Some parents take it upon 
themselves, or engage tutors, to provide education for their children 
privately; others place them in local schools and assist them at home. 
Some postpone or neglect to provide any education for their blind child, 
often because of lack of knowledge about the available training facilities. 

Special Methods 

Although the visual handicap has a modifying influence on the devel- 
opment of the child and on the methods used in his education, it must 
be kept in mind that the blind child is, in most respects, a normal child. 
His growing intellect, his developing functions, his emotions, and his 
desires are fundamentally like those of all children. Therefore, anything 
that can be learned from child psychology and education in general will 
prove helpful in understanding the blind child's psychological and educa- 
tional needs. It should also be stressed that the degree of visual handicap 
varies from individual to individual. The child with even a small amount 
of sight will consider it one of his greatest assets. If the teacher does not 
recognize this and treats the child as blind, he may drive him into op- 
position and resentment. 

Teachers of blind children have observed that visual acuity is not 
always an indication of the child's visual efficiency. Often children with a 
small amount of sight use it to much greater advantage than those having 
considerably better sight. Intelligence, home environment, and probably 



146 THE VISUALLY HANDICAPPED 

inclination to certain types of imagery and learning (visual, auditory, and 
kinesthetic or haptic) may explain this fact. 

Blind children require for their education (a) special equipment and 
mediums as well as (6) the application of special principles of teaching. 

Special Equipment and Mediums. In their acquisition of knowledge, 
children who are deprived of the use of sight rely almost exclusively 
upon their senses of touch and hearing. Whatever they may achieve 
through these senses does not come to them as a compensating gift of 
nature but as the result of increased use of the normal senses and labori- 
ous effort. Since our educational program is largely based upon the abil- 
ity to read and write, instruction in Braille an ingenious system of 
embossed dots is the fundamental prerequisite for the blind child 's 
learning. Beginners are taught Braille Grade I, in which a single char- 
acter represents each letter of the alphabet. Gradually Braille Grade 
II, which uses contractions and word symbols, is introduced. Some 
teachers recommend the immediate use of the Grade II contractions. 
Braille reading is slow in comparison with ink-print reading. The use of 
the "talking book" (long-playing phonograph records) as a supplemen- 
tary reading medium enables blind children to cover more ground and 
acquire much needed additional information. Pictures of three-dimen- 
sional objects or scenes in raised outlines have no educational value for 
blind children. Talking books, however, can be "illustrated" with sound 
effects or dramatizations to give blind children some equivalent of the 
book illustrations which enhance the seeing child's reading. Braille has 
the singular advantage that it can be written as well as read by the blind. 
Children learn to write it with a stylus and slate or a mechanical Braille 
writer. Particular attention is also given to practice on the regular type- 
writer because it permits written communication with the seeing. 

In the teaching of mathematics, mental number work is stressed, but 
the children also learn to use an arithmetic slate for computation. In 
geometry, embossed diagrams are used. Although it is hard for blind 
students to keep pace with the course of study in mathematics which is 
followed in high schools, many of them surmount this difficulty. 

In the study of geography, relief maps and globes are used, and ex- 
cursions are taken to acquaint the children with their surroundings. 
Visits to museums and the use of specially prepared educational models 
provide additional experiences. In general, it may be said that practically 
all subjects can be taught to blind children, although in some of them 
modified methods are required. This is particularly the case in the study 
of the sciences, where demonstrations must appeal to the senses of touch, 
hearing, or smell in order to be meaningful to blind students. 

Blind children are, by the nature of their handicap, limited in the 



HATHAWAY AND LOWENFELD 147 

variety of outlets for their creative activity. Drawing and painting are 
possible only for those who have some vision. Modeling can very well be 
substituted for these arts. Many blind children show considerable talent 
in it and derive much pleasure from working with clay and plasticine. 
Dramatic art in all its forms, from the dramatizing of a fairy tale to the 
staging of a full-length play, is cultivated. It offers, in addition to the 
advantages which seeing children derive from it, opportunities for the 
correction of undesirable habits of posture, of standing and walking, and 
of speaking. Dramatic art also indirectly furthers social adjustment by 
improving poise and increasing self-confidence. 

The art which most people associate with the blind is music, and 
indeed there is practically no instrument which the blind child cannot 
learn to play provided he has the necessary talent. Obstacles are in- 
volved, however, which demand from him much greater effort in acquiring 
the techniques of instrument playing. Since the blind musician must read 
the Braille score with his fingers, he cannot at the same time use both 
hands in playing his instrument. "Sight reading" is, therefore, impossible, 
and the blind musician must rely upon his memory to a much greater 
extent than a seeing person. Singing, solo and choral, receives particular 
attention. Music is recognized as perhaps the most important art activ- 
ity of the blind and is also stressed as a possible vocation. Moreover, its 
importance as a social asset should not be overlooked. 

Blindness restrains the individual's physical activity. Therefore, 
gymnastics, corrective posture work, such sports as running, swimming, 
rowing, wrestling, and all kinds of outdoor activities form an important 
part of the physical-education program for blind children. 

Handicrafts of various kinds are being taught in schools for the blind, 
and the pupils may become skilful workers at the joiner's bench, with 
the turning lathe and the potter's wheel, in woodworking, metal-working, 
basketry or weaving, and in other forms of craftmanship. Homemaking 
and household arts are particularly stressed with blind girls. In addition 
to such prevocational training, blind students also must learn about ac- 
tual working conditions and get used to the real demands of a job. 

Blind students may attend regular colleges and universities or other 
professional schools and receive assistance from public funds, particularly 
for the payment of readers. Many books must be read aloud to them be- 
cause they have not been transcribed in Braille. Recent developments of 
sound-recording devices are proving valuable aids for blind students of 
all ages. 

The American Printing House for the Blind, 1839 Frankfort Avenue, 
Louisville, Kentucky, receives an annual appropriation by Congress of 
$125,000 to supply embossed books and tangible apparatus to pupils in 



148 THE VISUALLY HANDICAPPED 

residential schools and classes for the blind. It distributes catalogues of 
its publications and appliances. 

The American Foundation for the Blind, 15 West 16th Street, New 
York 11, New York, supplies information on all matters concerning the 
blind and lends books and publications from its library to all students of 
work with the blind. It also conducts educational and technical re- 
search. 

Special Principles of Teaching. Besides the modifications discussed, the 
teacher must apply certain educational principles which are based on the 
psychological effects of blindness. Although they are presented here 
separately, in practice they overlap and fuse. 

1) Concreteness. Only through tactual perception can the blind child 
gain a reality knowledge of the world around him. Hearing has the 
greatest value as a social contact medium and as a source of descriptive 
information, but an actual knowledge of objects and their spatial charac- 
teristics can only be gained from touch observation. Because of the in- 
herent necessity for direct contact with the object to be observed, the 
range of tactual observations is limited as compared with visual ones. 
Objects may be inaccessible, too large, too small, too fragile, or too 
dangerous to be touched. Also there can be no color perception without 
the use of sight. Instruction of blind children must give them as many 
concrete experiences as possible, either by letting them observe the 
object as such or by providing replicas on which they can observe the 
characteristic features. The teacher of blind children must understand 
that his pupils need to become acquainted with objects and materials in 
their environment and that this acquaintance should not be verbal but 
must be the result of direct observation. Concreteness will help the blind 
child to avoid falling into a pattern of unreality and verbalism which may 
interfere with his later adjustment to the requirements of living. 

2) Unified Instruction. Blindness puts the child at a serious disad- 
vantage in experiencing things and situations in their totality. The 
blind child gains many impressions: He may hear or smell something, 
he may feel air currents or temperature changes, and he may have touch 
contact with some part of an object or a situation. But all these impres- 
sions are discrete and scattered and remain so unless experience or teach- 
ing organizes and unifies them. Blind children, at least during the pri- 
mary grades, should be taught by the unit plan of instruction and not by 
unrelated lessons in formal subjects. Such a unit treatment must supply 
them with informational experiences which they cannot gain by chance 
observation and should help them to organize their experiences into a 
structured whole by insight. Topics to be presented as units of study for 
blind children should be taken from experiences of everyday life such as 



HATHAWAY AND LOWENFELD 149 

the grocery and other stores, the shoe-repair shop and other workshops, 
the post office and other public institutions, the farm, the city hall, 
etc. 

3) Additional Stimulation. The limitation in the ability to get about is 
considered the most serious effect of the handicap. As a result of it, the 
blind child cannot expose himself to the great variety of experiences which 
are a natural part of the seeing child's life. For this reason the teacher of 
blind children is confronted with an entirely different task than the 
teacher of seeing children; it is almost entirely up to him to provide 
opportunities for the experiences his blind pupils need. There are chiefly 
two ways in which this additional stimulation can be supplied : The pupils 
can either be taken to the experiences (study excursions, field trips, 
museum visits) or the experiences must be brought to them (museum 
loans, classroom visits by interesting people, radio programs). The 
effectiveness of these activities depends largely upon the preparatory 
and follow-up work connected with them. Efforts to supply blind children 
with educationally desirable experiences must also extend to improving 
the individual's own ability to get about and secure stimulation for him- 
self. Blind children should learn to move about with ease on familiar 
grounds and should acquire facility in the most efficient use of the cane. 
They should also know about all other possible aids in getting about, 
such as guide dogs, human aid, and all means of transportation. Exercises 
in mental orientation, starting with a mapping-out of the classroom and 
extending gradually to orientation in the streets and places of the com- 
munity, are an essential part of travel instruction. 

4) Self- Activity. The blind child is from his earliest days hampered in 
his activity. Lack of sight limits him in receiving activating stimulation 
from the outside world and makes imitation based on visual observation 
impossible. The blind infant, for instance, does not reach out or crawl 
toward objects, because they do not attract him; the blind child's 
learning is slower and more difficult because demonstration which can be 
tactually observed must be employed; conforming with the group is a 
greater problem because it cannot be learned by watching others. Thus, 
although the basic patterns of development are the same for blind and 
seeing children, it is to be expected that the rate of development in such 
areas as prehension, walking, talking, and socialization may be slower. 
The blind child must receive training and guidance which will encourage 
the development of his maturing functions. Self-activity is an essential 
part of his training because only by coping with his environment will he 
gain the self-confidence which will enable him to live as a blind person in 
the world of the seeing. It will also counteract a frequently found tend- 
ency to day-dreaming, inactivity, and "blindisms" (awkward behavior- 



150 THE VISUALLY HANDICAPPED 

patterns such as shaking the head rapidly or poking the eyes). The blind 
child must be encouraged to do as many things for himself as are desirable 
and compatible with a well-conceived time economy. 

The Teacher of the Blind 

Whether serving in a residential school for the blind or in a Braille 
class, the teacher of blind children must, first, be well prepared as a 
teacher and, second, have the special training necessary to'teach the 
blind. Some residential schools as well as public school systems recognize 
the required additional qualifications of teachers of the bliifrl by provid- 
ing a special salary increment. Teachers must also be aware of the emo- 
tional effects of blindness on the child and on his environment, partic- 
ularly as the latter expresses itself in the attitudes of parents toward their 
visually handicapped children. A spirit of eo-operativeness is essential; in 
residential schools teachers must work together with their colleagues, 
with housemothers, and with the parents; and in Braille classes the 
special teacher must be able to establish and maintain close co-operation 
with the regular classroom teachers and with the child's home. Educators 
of blind children must be aware of the threefold task set before them: to 
help the blind child gain a knowledge of the realities around him, to 
instil in him the confidence to cope with these realities, and to give him 
the feeling that he is recognized as an individual in his own right. 

REFERENCES ON THE PARTIALLY SEEING 

AMERICAN STANDARDS ASSOCIATION (Co-Sponsors: Illuminating Engineering Society 
and American Institute of Architects). American Standard Practice for School 
Lighting (A-23). New York: Illuminating Engineering Society, 1948. 

Fox, SIDNEY A. Your Eyes. New York: Alfred A. Knopf, 1944. 

HATHAWAY, WINIFRED. Education and Health of the Partially Seeing Child. New 
York : Columbia University Press, 1947. 

KIMBER, DIANA CLIFFORD; GRAY, CAROLYN E.; and STACKPOLE, CAROLINE E. Text- 
book of Anatomy and Psychology. New York: Macmillan Co., 1948 (twelfth edition). 

LAWSHE, CHARLES H., JR. Principles of Personnel Testing. New York: McGraw-Hill 
Book Co., Inc., 1948. 

MANN, IDA, and PIRIE, ANTOINETTE. The Science of Seeing (A157). Great Britain: 
Penguin Books, Ltd., 1946 (Distributors, Brown & Delhi, 70 Fifth Avenue, New 
York 11). 

A Program for Teaching about Light and Sight. New York: Better Light Better Sight 
Bureau, 1948. 

RAY, MARIE BEYNON. How To Conquer Your Handicaps. Indianapolis: Bobbs-Merrill 
Co., 1948. 

Sight Saving Review (published four times annually by the National Society for the 
Prevention of Blindness, 1790 Broadway, New York 19). 

Teaching about Light and Sight. Bulletin of the Research Division of the National 
Education Association. Washington: National Education Association, 1946. 



HATHAWAY AND LOWENFELD 151 

REFERENCES ON THE BLIND 

The Blind Preschool Child. A Collection of Papers Presented at the National Con- 
ference on the Blind Preschool Child. Edited by Berthold Lowenfeld. New York: 
American Foundation for the Blind, 1947. 

CUTSFORTH, THOMAS D. The Blind in School and Society: A Psychological Study. 
New York: D. Appleton & Co., 1935. 

FRENCH, RICHARD S. From Homer to Helen Keller: A Social and Educational Study of 
the Blind. New York: American Foundation for the Blind, 1932. 

HAYES, SAMUEL P. Contributions to a Psychology of Blindness. New York: American 
Foundation for the Blind, 1941. 

LENDE, HELGA. Books about the Blind: A Bibliographical Guide to Literature Relating 
to the Blind. New York: American Foundation for the Blind, 1940. 

LOWENFELD, BERTHOLD. "Effects of Blindness on the Cognitive Functions of Chil- 
dren," Nervous Child (January, 1948), 45-53 (Reprint). 

SOMMERS, VITA STEIN. The Influence of Parental Attitudes and Social Environment on 
the Personality Development of the Adolescent Blind. New York: American Founda- 
tion for the Blind, 1944. 

Outlook for the Blind and Teachers Forum (published in ink-print and Braille editions 
ten times annually by the American Foundation for the Blind, 15 West 16th 
Street, New York 11). 



CHAPTER IX 
TEACHING THE ACOUSTICALLY HANDICAPPED 



CLARENCE D. 0'CoNNOH 

Superintendent, Lexington School for the Deaf 

New York, New York 

and 

ALICE STRENG 

Director, Division of Exceptional Education 
State Teachers College 
Milwaukee, Wisconsin 



INTRODUCTION 

Impairment of hearing is found among several million persons in the 
United States. Loss of hearing may be present at birth or may be ac- 
quired at any period during a person's life span. The degree of loss may 
vary from slight to profound and the effect of the loss may manifest itself 
in varying degrees in personal, emotional, and social adjustment, in 
educational achievement, and in vocational stability. The earlier in life 
that loss of hearing is identified, the sooner the individual can be given 
the special medical and educational assistance he needs to help him 
assume his place satisfactorily in the society of which he is an integral 
part. 

CLASSIFYING CHILDREN WITH HEARING Loss 

Children with defective hearing fall into two main categories, the 
hard-of-hearing and the deaf. Socially, the significant difference between 
these two groups lies in the realm of communication. Hard-of-hearing 
children are able to understand and use speech and language, having 
learned them through the sense of hearing, defective though that sense 
may have been. Deaf children, on the other hand, have been deprived of 
the ability to communicate by means of speech and language because of 
the high degree of the loss and the early onset of the impairment. 

If the hearing of an individual becomes nonfunctional after the ac- 
quisition of speech and language, he is not to be considered deaf from the 
standpoint of his educational needs, though by all physical measurement 
he may have no usable hearing. 

No sharp lines of demarcation can be drawn between the normally 
hearing and the hard-of-hearing, or between the hard-of-hearing and the 

152 



O'CONNOR AND STRENO 153 

deaf. Many children fall into borderline groups between the main 
categories. 

The following groups, based on educational needs as well as on degree 
of hearing loss, are suggested only as guides in classifying children with 
hearing impairment. 

A. Children with slight losses. These children are on the borderline between 
normal hearing and significant defective hearing. 

B. Children with moderate losses. These are the hard-of-hearing children. 

C. Children with marked losses. These children are on the borderline between 
the hard-of-hearing and the deaf. They do not have enough hearing to learn 
language and speech with the unaided ear, but they have residual hearing 
which can be utilized in their education. 

D. Children with profound losses. These are the deaf children who do not learn 
speech and language through their ears even with benefit of amplified sound. 

Group A. Children with Slight Losses 

Children with average losses of 20 decibels or less in the speech range 
(512 to 2048 cycles per second 1 ) of the better ear as measured by the 
pure-tone audiometer generally show no educational maladjustment as a 
result of this slight hearing loss. This group usually needs no special 
consideration other than favorable seating in the classroom. 

Group B. Children with Moderate Losses 

Children with average losses of from 25 to 50 or 55 decibels in the 
speech range in the better ear may begin to show evidence of difficulty 
in personal, educational, or social adjustments because of hearing loss. 
Generally these children should be able to receive their education in 
classes for normally hearing children provided they are favorably seated, 
receive speech training if necessary, and learn speech reading (or lip read- 
ing, a synonymous term for speech reading). Those children whose loss is 
as great as or greater than 35 decibels 2 in the better ear should also be pro- 
vided with hearing aids and should receive auditory training. 

Special class services may have to be provided for the more severely 
hard-of-hearing in this group if their adjustments are unsatisfactory in 
the regular classroom. 

Group C. Children with Marked Losses 

Children whose hearing losses range from about 55 or 60 to 65 or 75 
decibels in the speech range in the better ear and who have had a sus- 



1 H. Fletcher, Speech and Hearing, p. 220. New York : D. Van Nostrand & Co., 1929. 

2 H. Newhart and S. Reger, Syllabus of Audiometric Procedures in the Administra- 
tion of a Program for the Conservation of Hearing of School Children, p. 10. American 
Academy of Ophthalmology and Otolaryngology, April, 1945, 



154 THE ACOUSTICALLY HANDICAPPED 

tained loss from very early childhood or babyhood do not learn language 
and speech through the unaided ear. The sense of hearing may become 
functional after training with sound amplification over a period of years. 
These children may be considered "educationally deaf" since they re- 
quire instruction especially designed to foster the acquisition of lan- 
guage and speech even when they make optimum use of their hearing 
with the help of a hearing aid. Given adequate educational opportunities 
they may acquire language and speech rapidly. Initially these children 
receive their education in schools for the deaf or in special classes from 
teachers especially trained to develop language and speech. After they 
have achieved fluency in the use of language and speech, their educational 
programs may very likely be patterned after those established for hard- 
of-hearing children. 

Group D. Children with Profound Losses 

Children whose hearing losses range from 70 or 75 decibels to in- 
ability to distinguish more than one or two frequencies at the highest 
measurable level of intensity in the better ear will not be able to under- 
stand speech and language through the sense of hearing even when 
sound amplification is provided. Such losses when sustained from birth or 
very early childhood typify deaf children who must receive their educa- 
tion from teachers trained to develop the communicative process through 
very specialized techniques. Educational facilities are provided for these 
children in schools or classes for the deaf. 

SIGNS AND SYMPTOMS OF HEARING Loss 

Totally deaf children can be recognized by their nonresponsiveness to 
near-by sound or speech. Hard-of-hearing children, on the other hand, 
do respond to sound and speech, and when judged on this criterion alone 
often pass as normally hearing children. Parents and teachers do not 
identify the heard-of -hearing child as readily as the deaf child because of 
this characteristic. Hard-of-hearing children themselves are often un- 
aware of their hearing losses since they have no standards by which to 
judge themselves as having deficient hearing. Following are some of the 
signs and symptoms which characterize varying degrees of hearing loss. 

Group A. Children with Slight Losses 

A slightly hard-of-hearing child may occasionally ask that a statement 
be repeated, or he may have difficulty in understanding faint speech at 
a distance. On the whole his hearing loss will not cause him any incon- 
venience in ordinary social or school situations. 

A child who has one normal ear and one in which there is a marked 
impairment may not be able to locate the sound source as easily as an 



O'CONNOR AND STRENG 155 

individual with normal hearing. The child with a loss in only one ear may 
turn his head to favor himself while listening. 

An acute middle-ear infection may cause a temporary loss of hearing. 
Such evident signs as earache, tenderness or swelling about the ears, and 
moisture or discharge from the canal should be referred immediately for 
medical treatment so that what may be only a temporary impairment 
may not become a permanent loss. 

Group B. Children with Moderate Losses 

A child with a 25 to 30 decibel loss in the speech range in the better ear 
may sometimes ask that statements be repeated. He may turn his head 
to help him hear speech which is distant and not distinct. 

A 35 decibel loss in hearing seems to be the borderline between being 
able to get along in social situations requiring the interchange of ideas 
and not being able to get along comfortably. 3 A child with this degree of 
hearing loss in the speech range in the better ear may be able to carry on 
a face-to-face conversation very well, but he will begin to have trouble in 
following speech when it comes from some distance. He may not be able 
to understand a person who speaks in a faint voice behind him or to 
follow a discussion which shifts rapidly from person to person, as it may 
in the classroom. As the degree of hearing loss increases, the individual 
will more frequently experience difficulty so that he may be continually 
asking that statements be repeated. The child may unwittingly misinter- 
pret what has been said because he has not heard correctly. He may not 
respond when called from the next room. 

Children who have severe losses in the speech range are apt not to hear 
certain high frequency sounds. The most frequently affected sounds are 
the sibilants (s, z, sh, ch, etc.); these sounds are often lacking or defective 
in the speech of hard-of-hearing children. If the loss is of long standing 
and severe in nature, the child's voice may also sound flat and un- 
modulated. 

Group C. Children with Marked Losses 

Normal conversation is carried on at a level of about 60 decibels. 
When a child's hearing loss equals or slightly exceeds 60 decibels in the 
speech range in the better ear, it is more than likely that speech and lan- 
guage will not develop through the sense of hearing. A child with a loss of 
60 or 70 decibels may be able to hear loud noises such as dogs barking, 
airplanes overhead, doors slamming, or horns blowing. He may even re- 
spond reflexively to loud voices at close range in test situations. However, 
since he does not hear speech at a conversational level, he will not learn 



8 H. Davis, Editor, Hearing and Deafness: A Guide for Laymen, pp. 156-57. New 
York: Murray Hill Books, Inc., 1947. 



156 THE ACOUSTICALLY HANDICAPPED 

to communicate orally or understand speech through his unaided sense of 
hearing. He is able to learn to use his hearing in the interpretation of 
language and speech if proper amplification is provided. 

Group D. Children with Profound Losses 

Profound loss of hearing in an infant is often not identified because the 
' deaf baby babbles and coos much as hearing babies do; but his vocal 
utterances do not develop into speech because he does not hear. Even- 
tually the babbles cease, but even then parents do not always identify the 
deafness. A deaf baby does not respond to sound near or behind him. He 
does not turn his face toward an evident sound source. If a child fails to 
respond to his name after the age of 6 months, deafness may be sus- 
pected. Lack of attention to spoken commands after one year and com- 
plete lack of development of speech and language by the age of two or 
three point to profound or at least marked loss of hearing. 

The children with the profound hearing loss from birth or early in- 
fancy become, because of almost entire lack of response to sound, what 
many people are wont to describe as "deaf and dumb." Deaf children are 
not "dumb." They have capacity to use their voices. They laugh and 
cry, but they do not speak because they have not heard. Even with the 
strongest kind of amplification they do not have sufficient hearing to 
enable them to understand speech, though they may learn to interpret 
and appreciate some sounds. 

FINDING CHILDREN WITH HEARING Loss 

It has variously been estimated that from 2 to 12 per cent of the school 
population suffer from some degree of hearing loss, the most generally 
accepted estimate being 5 per cent. 4 If 5 per cent of the approximately 
30,000,000 school children between the ages of five and eighteen 6 have an 
impairment of hearing, there are about 1,500,000 such children attending 
schools in the United States. 

Only the early detection of loss of hearing can insure the prevention of 
possible maladjustments and lead the way to early education of the 
children who have a hearing impairment. Therefore, it is imperative 
that the loss be determined at the earliest possible age. 

Tests for discovering hearing loss in babies and very young children 
are still empirical in nature. No tests of scientific validity have been de- 
vised to date. Physiological tests such as the galvanic skin response and 
the electroencephalograph may in the future prove to be of some value in 



4 Ibid., pp. 354-55. 

6 School Enrolment of the Civilian Population, October, 1947. Bureau of the Census 
Bulletin, Series P-20, No. 13. Washington: Government Printing Office, 1948, 



O'CONNOR AND STRENG 157 

determining hearing loss in babies and very young children. Behavioral 
clues can furnish a good deal of information concerning the hearing of 
individual children but cannot give a reliable measure of hearing loss. 

The efforts of Dr. and Mrs. A. G. W. Ewing of the University of 
Manchester, England, to assess the hearing of the young children have 
resulted in a testing technique that may prove helpful to parents and 
teachers in indicating educational procedures at the preschool level. The 
Swings' technique consists of training children to respond to such sound 
stimuli as are produced by percussion intruments, pitchpipes, and the 
voice. 6 

Accepted techniques for testing school-age children show wide varia- 
tion, but all include the use of the audiometer. Though there is a differ- 
ence of opinion among investigators as to the age at which a reliable 
audiometric test can be administered, it is the general consensus that be- 
fore the age of five or six an audiometric examination may not be 
reliable. 

An adequate program for finding school-age children with impaired 
hearing, generally referred to as a program for the conservation of hear- 
ing, includes periodic audiometric surveys of all children in the school 
system; and, for those children found to have significant loss, the initial 
screening should be followed up with a pure-tone diagnostic test, an 
otological examination, medical treatment where indicated, and educa- 
tional placement and service. 

The Program for the Conservation of Hearing 
A school system may be surveyed in several ways, either by means of 
the phonograph audiometer, by administration of the individual sweep 
check 7 on the discrete frequency audiometer, or by use of the group 
pure-tone audiometer. 8 

A quiet room is a prerequisite for an adequate survey, and every 
effort should be made to keep conditions favorable for a testing program. 
The following features of the program should be carefully considered 
before the survey is undertaken. 

Who Will Do the Testing. In urban areas where population is concen- 
trated, the school may best be designated as the agent responsible for the 



6 1. R. Ewing and A. G. W. Ewing, Opportunity and the Deaf Child, pp. 8-20. Lon- 
don: University of London Press, 1947. 

7 Meeting the Needs of the Acoustically Handicapped Child. Commonwealth of Penn- 
sylvania Bulletin 421. Harrisburg, Pennsylvania: Department of Public Instruction, 
1944. 

8 S. Reger and H. A. Newby, "Group Audiometer Pure-Tone Hearing Test," 
Journal of Speech Disorders, XII (March, 1947), 61-66. 



158 THE ACOUSTICALLY HANDICAPPED 

testing. If the health department undertakes the testing, every effort 
must be made to tie its work up with that of the educational administra- 
tion since rehabilitation of acoustically handicapped children is largely 
an educational process. Unless provision can be made for follow-up pro- 
grams, both medical and educational, it is a waste of time, energy, and 
money to try to find children with hearing losses. 

The testing of hearing in rural areas poses a more complicated problem 
than that for urban areas where equipment is more easily acquired and 
trained personnel is more apt to be available. In the rural areas and in 
smaller communities, the state department of public instruction may 
sponsor, support, or supervise the local programs; or the county health 
department may be the agency delegated to find children with hearing 
loss. Equipment may be borrowed by school districts from the state de- 
partment responsible for programs for exceptional children, and local per- 
sonnel may be trained by them. The children discovered are then given 
medical attention and educational assistance in the local community. 

The mobile speech-and-hearing clinic sponsored either by public or 
private social agencies has been used in some states to discover hard-of- 
hearing children in rural areas and in small communities. This clinic, 
staffed with trained testers and equipped with suitable instruments, 
surveys the rural areas of the state and advises local communities as to 
the educational needs of the children. 

Who Will Be Tested. Any child who is capable of understanding a 
specific test of hearing should have the privilege of taking that test. A 
child below the third grade cannot reliably take the pure-tone group test 
or the 4-C test without using the monitoring technique. The individual 
sweep check can be administered as low as the first grade satisfactorily. 
Some school systems find it impossible to repeat the test annually for all 
children. Most systems test alternate grades each year (1-3-5-7-9), 
thereby testing each child biennially. 

How Long It Takes To Screen One Hundred Children. With the 4-C pho- 
nograph audiometer, forty children can be tested in twenty to thirty min- 
utes. Unless machine scoring techniques are available, scoring these test 
papers requires another forty to sixty minutes. When the time required to 
set up and check equipment is added, the average amount of time con- 
sumed per child is about three minutes. One hundred children could be 
tested in about three to four hours. On the individual sweep-check test, 
an average of twenty-five to thirty children can be tested per hour. It 
would take four to five hours to test one hundred children. Using the 
group pure-tone audiometer, it would take about one and a half to two 
hours to test one hundred children, testing thirty children at a time. 
Who Will Be Referred for a Diagnostic Test. If the 4-C phonograph 



O'CONNOR AND STRENG 159 

audiometer is used in the screening survey, any child showing a loss of 
9 SU is referred for a second test. 9 If a child fails the second test, a third 
screening test is recommended. 

If the individual sweep check is used, any child who fails to pass two 
or more frequencies (set at 10 to 15 decibels above threshold, depending 
on the noise level of the testing room) is rescreened and referred for an 
individual pure-tone test. 

If the group pure-tone test is used, the child who shows a loss of 20 
decibels in one or more frequencies is selected for further screening and 
diagnosis. 10 

In all types of surveys about 10 to 15 per cent of children screened for 
the first time are likely to fail to pass the test for a variety of reasons 
immaturity, excitement, emotional instability, inability to concentrate, 
inability to understand directions, lack of rapport, lack of experience 
with the specific sound stimulus, and a real hearing loss. About 3 to 5 per 
cent of children may show a real hearing loss when the survey has been 
completed, but only approximately 1.5 per cent of the school population 
will need adjusted educational programs. 

Who Will Do the Diagnostic Testing. The individual pure-tone test 
should follow for all children selected for further study by the survey. 
This test should be administered in a sound-treated quiet room by a 
competent audiologist (a person trained in hearing problems). The agency 
delegated to assume the responsibility for the hearing-conservation pro- 
gram must provide the trained personnel. In urban areas services may be 
available as part of the community health program or provided in school 
hearing clinics maintained by boards of education in co-operation with 
boards of health. In rural areas a specially trained local technician may 
be assigned to do the individual auditory testing. The mobile hearing 
clinic is another possible agent which may be assigned to do the diag- 
nostic testing. 

A child showing a loss of 20 decibels in two or more frequencies in 
either ear on the individual test is to be referred to an otologist for 
medical examination and treatment where necessary. 11 

Who Will Furnish the Otological Service. In large urban centers, 
deafness-prevention clinics, staffed by otologists, are frequently main- 
tained as an integral part of the hearing-conservation program. Where 
there are no such clinics, children may be referred directly to otologists, 
designated by the local, county, or state medical society. In rural areas 

9 Meeting the Needs of the Acoustically Handicapped Child, op. cit. 

10 H. Newby, "Group Pure-Tone Hearing Testing in the Public Schools," Journal 
of Speech Disorders, XII (1947), 357-62. 

11 H. Newhart and S. Reger, op. cit. t p. 10. 



160 THE ACOUSTICALLY HANDICAPPED 

the mobile clinic may provide otological service where children are unable 
to come to urban centers for medical diagnosis. Interviews and counseling 
with parents to make use of medical service is frequently necessary to 
complete this part of the program. It is vital to the success of the con- 
servation-of-hearing program as well as to the individual child with 
lowered hearing acuity that every child selected for further study have a 
medical examination and that treatment be provided if the need is 
indicated. In some cases treatment can alleviate the causes of the hearing 
impairment and good hearing can be restored. In others, incipient 
losses or hearing impairment can be detected and loss prevented. Every 
effort should be made to see that all children receive medical attention 
before educational recommendations and referrals are made. 

Who Will Be Responsible for the Educational Program. The school has 
the responsibility for the educational program for children with hearing 
losses. Each child should be treated according to his individual needs. 
The factors to be considered in making educational adjustments for the 
child are the type and severity of the loss, the prognosis of the hearing 
loss, the child's intelligence, his school achievement, and his personal, 
social, and emotional adjustments. Well-trained teachers who under- 
stand the problems of hearing loss should be responsible for the child's 
education. 

CHARACTERISTICS OF CHILDREN WITH HEARING Loss 
A considerable amount of factual material concerning the charac- 
teristics of children with impaired hearing has been collected during the 
last quarter of a century. Many studies treat the deaf and the hard-of -hear- 
ing as a homogeneous group on the premise that hearing loss, no matter to 
what degree, results in certain characteristics. The characteristics of 
children with impaired hearing will here be reported separately, wherever 
possible, for the deaf and for hard-of-hearing children, since the two 
groups show such marked differences in educational needs. 

Intelligence 

The intelligence of children with impaired hearing has been investi- 
gated in a considerable number of studies. Pintncr reports that on per- 
formance tests (such as the Grace Arthur, Pintner-Patterson, Drever- 
Collings, Goodenough, Porteus maze, and the like) the approximate I.Q. 
for deaf children is about 91. 12 Lane and Silverman 18 contend that the 
general intelligence of the deaf as a group is normal when the use of lan- 

12 R. Pintner, J. Eisenson, and M. Stanton, The Psychology of the Physically Handi- 
capped, pp. 110-22, 189-92. New York: F. S. Crofts & Co., 1941. 

18 H. Davis, Editor, Hearing and Deafness: A Guide for Laymen, pp. 374-75. New 
York: Murray Hill Books, Inc., 1947. 



O'CONNOR AND STRENG 161 

guage is excluded. Myklebust 14 points out that children with auditory 
defects fall within the average limits of intelligence when standardized 
tests are used. 

There is a general consensus that the intelligence of hard-of-hearing 
children is equal to that of normal children on nonlanguage tests and 
shows only a slight difference in favor of the hearing as a group on tests 
which involve language. 

Educational Achievement 

All surveys conducted on the achievement of deaf children show a 
severe educational retardation. In terms of years of retardation, it would 
appear that the deaf are retarded from three to four years. In terms of 
quotients, the educational quotient for the deaf is about 70. 

The hard-of-hearing as a group show only a slight educational retar- 
dation. When individual hard-of-hearing children are equated with hear- 
ing children for intelligence, the difference disappears. 16 

Personality and Social Adjustments 

According to Brunschwig, a pioneer in the field of personality adjust- 
ments of deaf children, 16 there is a wide range of opinion concerning the 
personality structure of the deaf as a group but no consistent tendency 
which might describe or characterize the group. In controlled studies by 
various investigators 17 on school children, college students, and adults, 
the conclusion has been reached that the deaf are not separated widely 
from the hearing by any great differences of personality and adjustment. 
Small differences were found to exist, and it would seem safe to say that 
deafness has some influence on adjustment. The deaf find it a little more 
difficult to adjust to their environment; they are probably more unstable 
emotionally and a little more introverted and submissive. 

Hard-of-hearing children have been studied by Pintner, Habbe, and 
others. 18 Again no great differences were found between the hard-of- 
hearing and normally hearing children as to personality and adjustment, 
but slight differences in the areas of submissiveness and introversion 



14 H. Myklebust, "Clinical Psychology and Children with Impaired Hearing," Volta 
Review, L (February, 1948), 55. 

"Pintner, et al, op. cit., pp. 130-50, 192-95. 

16 L. Brunschwig, A Study of Some Personality Aspects of Deaf Children. Teachers 
College Contributions to Education No. 687. New York: Bureau of Publications, 
Teachers College, Columbia University, 1936. 

17 Pintner et al., op. cit., pp. 150-65. 

"Pintner et al., op. cit., pp. 195-204; Stephen Habbe, Personality Adjustments of 
Adolescent Boys with Impaired Hearing (New York: Teachers College, Columbia 
University, 1936). 



162 THE ACOUSTICALLY HANDICAPPED 

were noted. Hard-of-hearing children do not seem to feel quite so well 
adjusted as the normally hearing. 

Studies on the social competence of deaf children have been reported 
for children in an institution and in a large day school. Those in institu- 
tions were found by Bradway 19 to have a mean social quotient of about 
80, while those in the public day school were found by Streng and Kirk 20 
to have a mean social quotient of 96. Further study by Avery 21 of pre- 
school deaf children found them to be equal to normal children in social 
competence. The divergence in the results of the studies in the social 
maturity of deaf children in institutions and day schools may be the 
result of selection by the day schools of the brighter children. 

Aptitude and Motor Ability 

Investigation has brought out the fact that deaf boys are equal to 
hearing boys in mechanical aptitude. 22 Myklebust 23 has studied the re- 
sults of objective tests of mechanical aptitude given to deaf boys between 
the ages of twelve and twenty-one and has found them useful in a voca- 
tional-guidance program. 

Deaf children suffering from a specific type of hearing loss are known 
to have disturbances of equilibrium. The area of motor ability has not 
been sufficiently investigated, and its significance has not been deter- 
mined in the education of the deaf. 

CAUSES 

Impairment of hearing may be either congenital or acquired. The 
causes of congenital deafness, that which occurs before birth, are fre- 
quently obscure. Heredity seems to play a part, although no clear-cut 
pattern has been indisputably established as a result of studies in this 
field. There still prevails a strong trend in the belief that deafness is 
Mendelian in its incidence. 24 



19 K. P. Bradway, "The Social Competence of Deaf Children," American Annals of 
the Deaf, LXXXII (1937), 122-24. 

20 A. Streng and S. A. Kirk, "The Social Competence of Deaf and Hard-of-hear- 
ing," American Annals of the Deaf, LXXXIII (1938), 244-53. 

21 Charlotte Avery, "The Social Competence of Preschool Acoustically Handicapped 
Children," Volta Review, L (June, 1948), 256-57. 

22 M. Stanton, Mechanical Ability of Deaf Children. Teachers College Contributions 
to Education No. 751. New York: Bureau of Publications, Teachers College, Colum- 
bia University, 1938. 

28 H. R. Myklebust, "A Study of the Usefulness of Objective Measures of Mechani- 
cal Aptitude in Guidance Programs for the Hypacoustic," American Annals of the 
Deaf, XCI (1946), 123-50, 205-25. 

24 F. Lederer, Diseases of the Ear, Nose, and Throat, p. 288. Philadelphia: F. A. 
Davis Co., 1943. 



O'CONNOR AND STRENG 163 

Consanguinity 26 also plays a role in the etiology of deafness. It is 
generally accepted that children of related parents who were both born 
deaf will undoubtedly also be either born deaf or become deaf early in life. 

Infectious illnesses in the mother during pregnancy may be a contrib- 
uting cause to congenital cases of deafness. In recent years it has been 
learned that children of mothers who have had rubella (German measles) 
in the first three months of pregnancy are usually born with one or more 
physical handicaps, deafness and blindness being the most common. 26 
Typical congenital rubellas almost universally have the triple handicap of 
hearing loss, visual loss, and poor motor control a combination which 
presents a most complex educational problem. If German measles can 
cause this much damage, then it is probable that other infectious ill- 
nesses experienced by mothers during early pregnancy may similarly be 
responsible for many of our congenitally deaf children. 

The causes of acquired impairment of hearing are much easier to 
identify, since the hearing loss can usually be related to some illness or 
accident. Of the acute infectious diseases, epidemic meningitis is the 
commonest cause of acquired deafness, with measles rated second and 
scarlet fever and influenza next in frequency. 27 Whether drugs such as 
penicillin and sulfa will, in time, reduce the number of these cases, only 
the future will reveal. 

Repeated examinations of public school children have shown that 
adenoids recur in over 75 per cent of those whose adenoids and tonsils 
had been removed earlier. Nearly 40 per cent of these children had im- 
paired hearing for high tones alone or for all tones in the speech range. 28 
Since adenoids and tonsils indirectly cause loss of hearing by blocking the 
Eustachian tube, systematic examination of throat, pharynx, and ears of 
school children is indicated as a preventive measure. 

NEEDS AND EDUCATION OF CHILDREN WITH HEARING Loss 
Each child with impaired hearing is entitled to receive an education 
fitting his individual needs. These needs may be met by including the 
following special provisions in his program, as required : 

1 . Speech-reading instruction 

2. Auditory training 

26 H. Best, Deafness and the Deaf in the United States, p. 70. New York: Macmillan 
Co., 1943. 

26 L. Hopkins, "Congenital Deafness and Other Defects Following German Measles 
in the Mother," American Journal of Diseases of Children, LXXII (October, 1946), 
377-81. 

27 Lederer, op. cit., pp. 126-27. 

28 L. Bothman and S. J. Crowe, Editors, 1947 Yearbook of Eye, Ear, Nose and Throat, 
p. 411. Chicago: Year Book Publishers, 1947. 



164 THE ACOUSTICALLY HANDICAPPED 

3. Speech education 

4. Tutorial service in school subjects 

5. Training in establishing the communicative process 

Group A. Children with Slight Hearing Losses 
Children whose losses range from 15 to 20 decibels in the better ear, 
those who have quite marked monaural loss, or children whose slight 
impairment can be alleviated by medical treatment within six months 
do not generally need special educational service. They must, however, be 
watched and rechecked periodically so that any tendency toward progres- 
sive deafness may be noted and treated. 

Slightly hard-of-hearing children should be granted opportunity for 
favorable seating in the classroom. For example, the child with a hearing 
loss in one ear should be seated in such a way that the defective ear is 
turned toward the noisy side of the room if the room faces a busy 
thoroughfare. The good ear should face the side of the room from which 
speech emanates. These children should be allowed to move to the seat 
which suits their listening needs. This group of children makes up a very 
large portion of the estimated 5 per cent of school children who have 
hearing losses. 

Group B. Children with Moderate Hearing Losses 

Children with as little loss as 25 decibels in the speech range in the 
better ear and whose deficiency cannot be corrected by medical treatment 
may be introduced to speech reading (lip reading) as a means of facilitat- 
ing the comprehension of oral communication. They should remain in the 
regular classroom for all instruction other than lip reading. If speech 
therapy is indicated, provision should be made for its inclusion in the 
child's program. These children can well be served by the itinerant speech 
correctionist who has been trained in hearing rehabilitation. 

Children whose losses range from 35 decibels to 50 or 55 decibels in the 
speech range in the better ear should have the privilege of wearing hear- 
ing aids, if the hearing loss is the type that lends itself to improvement 
with an aid, and of learning to read lips. 

Hard-of-hearing children as young as two or two and one-half years 
of age have been successfully introduced to amplified sound. The first 
experiences in amplification may be through the medium of the desk- 
type aid. Some four- or five-year-olds have profitably used individual 
hearing aids. One cannot say categorically at what age a child should 
begin to wear his own hearing aid since many factors such as intelligence, 
maturity, and degree of loss will influence the decision to furnish the 
child with an aid. 

When a child appreciates and enjoys hearing, and when he can be 



O'CONNOR AND STRENG 165 

reasonably depended upon to care for an instrument, he should be 
supplied with this aid. 

It is the general concensus that a large majority of potential aid-users 
can wear any of the modern vacuum-tube hearing aids profitably. How- 
ever, there is a group among the hard-of-hearing for whom the selection 
of a particular aid is indicated. Hearing-aid selection service is offered in 
a number of clinics in colleges, universities, and schools, and in some 
chapters of the American Hearing Society. 29 These clinics are patterned 
after those operated by the armed forces during the war. At such a 
clinic an individual may try a variety of hearing aids approved by the 
American Medical Association 30 and may be helped to select one which 
best seems to suit his particular type of loss. 

Hard-of-hearing children must have training in the use and care of 
their aids and in the interpretation of amplified sound. When the child 
has been taught to use his hearing aid together with his sight in the inter- 
pretation of speech, he will have acquired a tool which will be the main- 
stay of his educational rehabilitation. 

Some children can naturally read lips better than others. Speech 
reading (or lip reading) is that skill which makes it possible for an indi- 
vidual to understand speech by watching a speaker's face, particularly 
the movements of his mouth. Speech-reading performance seems to be 
influenced by the visibility of the sounds making up the material to be 
read; the individual's familiarity with vocabulary and content; his 
ability to synthesize ideas; and a favorable attitude toward receiving 
speech. 

Investigation of the problem of lip reading at the Clarke School for the 
Deaf 31 brought to light the facts that great differences exist in lip-reading 
performance between children of the same chronological age and that 
differences between the scores of consecutive age groups are small. 
Children who rank high in lip-reading performance retain their rank over 
periods of several years. Individual differences, therefore, cannot be due 
to differences in length of training. Utley 32 came to the conclusion that 
lip-reading ability is not highly correlated with and cannot be predicted 
from school achievement. A program of lip reading, therefore, must be 

29 W. Fitch and L. Hedgecock, "Which Hearing Aid Shall I Buy?" Hygeia, XXVI 
(November, 1948), 816. 

30 List of approved aids may be secured by writing to the Council on Physical 
Therapy, American Medical Association, 535 N. Dearborn, Chicago, Illinois. 

31 Studies in the Education of the Deaf. Prepared by Psychological Division of 
Clarke School for the Deaf. Psychological Monographs, LII, No. 1. Washington: 
American Psychological Association, 1940. 

82 J. Utley, "Factors Involved in Teaching and Testing Lip-Reading Ability 
through the Use of Motion Pictures/' Volta Review, LXVIII (1946), 657-59. 



166 THE ACOUSTICALLY HANDICAPPED 

planned on the basis of children's natural abilities. In general, half-hour 
lessons twice a week for a year should give most children a good founda- 
tion in lip reading. Continuance will depend on the progress the child has 
made as well as his natural ability to read lips. 

If the hard-of-hearing child needs speech training and many hard- 
of-hearing children do such service should be included in his program. 

Most children in this group will be able to remain in their regular 
classrooms if they receive special instruction in lip reading, auditory 
training, and speech when such assistance is needed. This service may be 
rendered by itinerant teachers, or the child may be taken to a center 
where he can receive special help from a teacher trained in hearing and 
speech education. Certain classroom adjustments will also be necessary. 
Like the child with the slight hearing loss, the hard-of-hearing child 
should have the privilege of being seated near the sound source. Since the 
sound source is bound to shift in the modern classroom, the hard-of- 
hearing child should be allowed to change his seat to the most favorable 
position for him at any particular time. Besides this, the teacher, as well 
as the other children in the room, should be aware of the child's limita- 
tions in hearing and of his dependence on reading lips. They can help by 
facing the child while speaking and by standing behind the source of 
light rather than in front of it whenever possible. They should speak 
distinctly but not exaggeratedly, neither too fast nor too slowly. 

As the degree of loss in the better ear approaches 50 or 55 decibels, if 
the loss has been of long standing and if the child has not had the 
privilege of using amplified sound most of his life as a hard-of-hearing 
person, adjustment to a regular class may be too difficult for him. A 
child who is a slow learner, though not necessarily mentally deficient, one 
who is educationally retarded, one who seems to have poor ability to read 
lips, or one who is not well adjusted socially may need the more individ- 
ualized services of a special class. 

Another group of children for whom the special class is indicated are 
those who suddenly become deaf through illness or accident considerably 
after the time when speech and language patterns have been established. 
The period of adjusting to living in a world of utter silence frequently 
becomes a stormy one. These children, suddenly deprived of hearing, 
need the guidance and understanding they can receive in the special 
class. They, of course, will need training in lip reading and training of 
what vestiges of hearing there are. The voices and the speech of these 
children frequently show deterioration unless special effort is made to 
help them retain adequate speech patterns. Though they may be consid- 
ered physically deaf, their educational needs approximate those of chil- 
dren who are hard of hearing rather than of the deaf. 



O'CONNOR AND STRENG 167 

The special class should be located in a school in which a child can 
maintain contacts with his peers. At first the child may have to spend 
the greater part of the day in the special class where he learns to read 
lips, where he has the advantage of hearing amplified sound on a group 
hearing aid, and where he learns to use his own individual aid. The size of 
the class should be small enough to insure the individual attention he 
needs in helping him with his speech and with his own peculiar educa- 
tional and personal problems. However, the hard-of-hearing child ought 
always to participate in the regular school program wherever his capabil- 
ities permit. As his confidence in himself grows, and as his educational 
achievements progress, he may share increasingly in the activities of the 
regular class with which he should remain identified. It may be possible 
for him to return eventually to the regular class for the greater part of the 
day and to come to the special class only for speech correction, lip read- 
ing, and auditory training. 

The child should always be encouraged to participate fully in all 
school and extra-curriculum activities such as sports, assembly programs, 
scouting activities, and the like. He should be considered as much an 
integral part of the school community as any other child in attendance 
at the school. 

During the intensive phase of special-class experience, an important 
function which the teacher of the hard-of-hearing child performs is to 
help the child integrate his new tools for receiving speech namely, lip 
reading and the use of amplified sound with all his school activities. 
Every lesson in social studies, language, science, or spelling becomes a 
lesson in hearing, in lip reading, and in speech. The child needs this type 
of integration and he needs individual attention to prepare him more 
rapidly to return to the regular classroom. An occasional lesson in audi- 
tory training or speech reading will not be nearly so effective as the con- 
centrated program he receives from the teacher who is trained to meet 
his various needs. Assignments to special classes should be made only 
after careful consideration of each child as an individual. A re-evaluation 
of his needs must be made periodically so that the program will always be 
adjusted to him. 

The education of hard-of-hearing children should be guided by the 
same principles as those for normal children. Beyond the elementary 
level, hard-of-hearing children may be capable of going through high 
school and even on to college. Should they prefer careers in industry, 
vocational schools can round out their preparation and assist in their 
vocational choices. On the whole, hard-of-hearing persons can engage in 
as wide a variety of occupations as normal persons. Their vocational 
training should be based largely upon their aptitudes and interests. 



168 THE ACOUSTICALLY HANDICAPPED 

Loss of hearing may become a factor to be considered by the vocational 
counselor. For example, those who are sensitive to loud noises, as many 
hard-of-hearing persons are, may wisely be guided away from careers 
which involve working in a too noisy environment. On the other hand, 
many among these handicapped persons who are not sensitive to loud 
noises have the advantage over normal people when they work in noisy 
surroundings. These and other factors may help determine the choice 
of occupation. 

The background of a teacher for hard-of-hearing children should in- 
clude training in elementary education. He should understand children, 
have a well-adjusted personality, and be interested in handicapped 
children. His special training should include a thorough foundation in 
speech correction and in the problems and methods of hearing rehabil- 
itation, including lip reading and auditory training. In addition, he 
should have an understanding of remedial techniques in reading and lan- 
guage. Itinerant teachers of children with slight hearing losses who re- 
ceive all their education in the regular classroom should be well-trained 
speech correctionists who have had courses in hearing rehabilitation. 

Group C. Children with Marked Hearing Losses 
Children with marked hearing loss (55-60 to 70-75 decibel loss in 
speech range in the better ear) present a more complex educational 
problem than do hard-of-hearing children since they must be taught to 
communicate by specialized techniques designed to meet their needs. 
They have a truly great advantage over the profoundly deaf, however. 
Though "educationally deaf/ 7 they have some residual hearing that can 
be used in their education. The sense of hearing can become functional 
with amplification, though it can never be relied upon as the sole avenue 
through which speech and language are to be acquired. With the best 
quality of amplification available, these children will still experience dif- 
ficulty in understanding speech because their discrimination may remain 
defective as the result of the type and the severity of the loss of hearing. 
Even so, their residual hearing will help them enormously in receiving 
their education. Many of these children who started out as "educa- 
tionally deaf" may eventually be classified as hard of hearing because of 
the speed with which they can acquire speech and language. 

It is of particular importance that all children with marked or pro- 
found losses (Groups C and D) be discovered and diagnosed properly at 
an early age so that the methods of education which are of greatest 
value to them can begin at once. By the time a normal child is two or 
two and a half years old he has developed a sizable vocabulary and is 
learning to express himself orally. Unless a child with a marked hearing 



O'CONNOR AND STRENQ 169 

loss can develop an understanding of the communicative process by 
utilizing what hearing he has and by learning to read lips before the age 
of three, he will be at a distinct disadvantage for the rest of his life. 

Since most states do not make provisions for educating children below 
the age of three, parents must assume an important role in the preschool 
education of their deaf children. Increasingly since the turn of the cen- 
tury efforts have been made to help parents with the problems presented 
by their acoustically handicapped children. A great impetus was given to 
this movement by the establishment of the John Tracy Clinic 38 in Los 
Angeles in 1941. This clinic now offers a correspondence course to parents 
of deaf and hard-of-hearing children. Many state and private agencies 
have taken up the challenge and now offer courses for parents of young 
children in the hope that the important first years of the child's life will 
not be wasted. The Volta Bureau, 84 founded in 1887 by Alexander 
Graham Bell, also has materials of interest to parents of deaf children. 
The Volta Bureau furnishes information on deafness to anyone on request. 

The educational needs of children with marked hearing losses generally 
are best met in special classes or in schools for the deaf. These children 
should receive their basic elementary education largely under the tutelage 
of teachers trained to teach the deaf. These teachers understand the 
processes of developing language concepts and of correlating these con- 
cepts with oral and written expression. Continual practice with the tools 
of communication is necessary to establish correct language and speech 
patterns. 

It is entirely possible that children in this group who attend special 
classes in public schools and who progress rapidly in their acquisition of 
language and intelligible speech can participate in regular classroom 
activities to some extent. They might, for example, first join an art class 
with children of their own interests and abilities, or they might be a part 
of a physical-education class. Later they may add classes in arithmetic or 
spelling, and so forth. Just as the hard-of-hearing children participate 
in extra-curriculum activities, so should these children with marked 
hearing losses be given the same opportunities. 

Only about one-fourth of all children in the United States with marked 
or profound hearing loss receive their education in special classes, most 
of them being enrolled in schools for the deaf. In the larger schools for the 
deaf, children with trainable residual hearing are frequently segregated 
into groups known as "acoustic" or "aural" classes. These classes are 
provided with powerful group hearing aids and the emphasis in their 



83 John Tracy Clinic, 942 West Thirty-seventh Street, Los Angeles, California. 

84 The Volta Bureau, 1537 Thirty-fifth Street, N.W., Washington, D.C. 



170 THE ACOUSTICALLY HANDICAPPED 

programs is placed on the integration of the senses of sight and hearing in 
the process of learning to communicate. 

Their education beyond the junior high school level must be planned 
on the basis of their individual needs. The brighter children may want to 
continue on to high school or to college, while others may wish to enter 
vocational school and concentrate on preparation for careers in business 
or industry. There will always be need for adjusting the programs of these 
children, so the special-class teacher has an ever important role in guiding 
their education. 

Group D. Children with Profound Hearing Losses 
The education of the deaf must, in general, be carried on in special day 
or residential schools. Since the percentage of the school population hav- 
ing profound hearing losses is small, those falling in this group will be 
scattered in any community and must be assembled at one central point 
for special education. If a community has a large enough population, a 
central day school may be established. In areas where the population is 
not concentrated, it may be necessary for these children to attend a 
residential school. The larger the groups the more effective will be the 
program, for children with profound losses of hearing will need the con- 
tinous benefits of specialization. Unlike children with moderate or slight 
losses of hearing, they will not be able to adjust to the fast-moving 
activities of classes for the normally hearing. There are exceptions to this 
generalization, of course. Certain deaf children with unusual abilities and 
advantages may be able to fit into regular classes, but they are the 
exception and not the rule. 

Of the 18,843 children enrolled in schools or classes for the deaf in 
1949, 35 about 5,000 received their instruction in public day schools, of 
which there were thirty-three (with five or more teachers), or in public 
day classes or units, of which there were eighty-one (with one to four 
teachers). About 13,000 of these children were enrolled in the seventy 
public residential schools and twenty-five private or parochial residential 
schools which are so distributed that at least one such institution is 
found in every state except Delaware, Nevada, New Hampshire, and 
Wyoming. 

The first aim in the education of the deaf is the establishment of a 
means of communication, but the question of what the basic means of 
communication is to be remains unsettled to this day. 

One group of educators, the "oralists," believes that a deaf child must 
learn speech and lip reading so that he may take his place in a society 
whose chief medium of communication is the spoken word. They believe 



American Annals of the Deaf, XCIV (January, 1949), 6-26. 



O'CONNOR AND STRENO 171 

that the deaf individual who has a sense of belonging to the society in 
which he lives rather than the feeling of isolation from it has a better 
chance of making adequate personal, social, and vocational adjustments. 

A second group of educators believes that the "combined" method 
serves the needs of the deaf best. The "combined" method advocates 
that every effort be made to teach all young deaf children speech and lip 
reading but that, if after a reasonable time no progress in oral skills is 
made, instruction should be given mainly through the medium of finger 
spelling, together with some signs. In "combined" schools, most outside 
activities, religious instruction, and vocational training are carried on by 
the manual medium. The majority of the state residential schools for the 
deaf adhere to the "combined" philosophy, although more and more em- 
phasis is being put on teaching deaf children to speak and to read lips. 

The public day schools and a number of residential schools subscribe 
to and practice the "oral" method. They discourage the use of signs in 
order to assure the maximum opportunity for the deaf child to learn to 
speak and to read lips and to use effectively, in oral form, the language of 
the community in which he lives. All instruction and communication are 
carried on through lip reading, the use of residual hearing, reading, and 
writing. 

To start deaf children on the rough educational road they will have to 
travel, it is necessary to find and diagnose these children early. Research 
studies point out the extreme retardation of deaf children and give warn- 
ing that the years lost between babyhood and entrance into school can 
never be made up unless something is done about it early. 

Because educators are aware of the importance of early education of 
deaf children, the age of admission to schools for the deaf has been low- 
ered, many of them now admitting children as young as three years of age. 
Many schools also hold institutes or provide regular programs for parents 
of preschool deaf children where the mothers are oriented to the many 
problems that face their children and learn what role they can play in 
their educational and social growth. 

The first six or seven years of the deaf child's school life are given over 
to the difficult task of developing facility in the use of language. The 
deaf child must have guidance in associating his concepts with the sym- 
bols used in language. His understanding of language has to be built up in 
a systematic fashion, often by a slow and laborious process involving a 
great deal of repetition and drill. Deaf children must also learn to co- 
ordinate speech with the language they are learning. Since most deaf 
children have a modicum of residual hearing, attempts are made to 
train this hearing. In many of the larger schools for the deaf those children 
with usable residual hearing are usually taught separately in "acoustic" 



172 THE ACOUSTICALLY HANDICAPPED 

or "aural" classes in which the emphasis is placed on the integration of 
the senses of sight and hearing in the process of learning to communicate. 
Though the ability to interpret speech and language through the sense 
of hearing will always be fragmentary and incomplete for profoundly 
deaf children, they can learn to appreciate rhythm, to distinguish differ- 
ences in pitch, and to have an appreciation of the gross sounds in their 
environment. The size of the class best suited to the needs of deaf chil- 
dren is seven or eight pupils, although the average size of classes in 
schools for the deaf is closer to nine or ten. 

Since the deaf child has the tremendous handicap of having to learn 
language in an unnatural manner, it takes the average deaf child longer 
to achieve an elementary-school education than it does the normal 
child. The advent of nursery-school programs and the utilization of re- 
sidual hearing is helping to reduce this retardation factor. Today many 
deaf children are finishing the elementary program at the age of fourteen 
or fifteen as contrasted with the average age of sixteen, seventeen, or 
eighteen, twenty years ago. An increasing number are seeking secondary 
education. A number of the public residential schools now offer full or 
partial high-school programs, and more and more of the elementary 
graduates of both the day and residential schools attend public high 
school. Those who attend high schools for hearing children will need good 
intelligence, a good foundation in language and reading, good lip-reading 
skill, and a well-adjusted personality. They will also need the special 
help and interest of their parents at home and their teachers and fellow 
pupils at school. A number of large public high schools provide special 
educational counselors for the acoustically handicapped to help them 
make the necessary adjustments. 

Some of the deaf also attend colleges for the normally hearing. 86 The 
problems they meet at this level are, of course, merely an extension and an 
intensification of the problems on the secondary level. Most of the deaf 
who desire an education beyond high school attend Gallaudet College in 
Washington, D. C., which is supported by the federal government. This 
is the only college in the world maintained exclusively for the deaf. 

The majority of the deaf move in the direction of vocational training 
and employment in the later years of the elementary-school program. 
All residential schools for the deaf offer vocational training or industrial 
arts. Day schools offer industrial arts courses and utilize the facilities of 
the vocational schools of the public school system for many of their 
pupils. In the day-school programs, guidance by vocational counselors 



88 "Deaf Graduates of Schools and Colleges for Hearing Students," Volta Review, 
LI (January, 1949), 10-16. 



O'CONNOR AND STRENO 173 

may have to be supplemented by the services of a trained teacher of 
the deaf. 

Deaf workers engage in a wide variety of occupations and have 
proved themselves dependable, reliable, and efficient workers. They can 
achieve capably in any field of employment open to the normally hearing 
where hearing is not a primary requirement. The U.S. Civil Service Com- 
mission has listed 1,260 types of employment for which normal hearing is 
not considered important. 

The teacher of the deaf or of children with marked hearing losses 
should be a well-adjusted person and should have a good background in 
elementary education. He should know children and their needs and 
should be interested in handicapped children. He should have special 
training 87 which provides a thorough understanding of the problems of 
hearing rehabilitation: testing of hearing; educational diagnosis; lip 
reading and auditory training; speech development and correction; 
language development; reading techniques; and extensive practical ex- 
perience with deaf children. This special training can be secured in a 
number of training centers in schools for the deaf and in various colleges 
and universities. 

A LOOK TO THE FUTURE 

Though a great deal of progress has been made in recent years in 
gathering information about the problems relating to hearing losses, 
scientific data pertaining to some phases of the problem of deafness are 
amazingly lacking. We know comparatively little about testing the 
hearing of very young children or the age at which an audiometric test 
can be validly administered. We know little of the value of admission 
of the young deaf child to nursery-school programs for hearing children. 
We know very little about what lip reading is and how the skill is 
acquired. 

Significant progress in electronic amplification was made during 
World War II and, as a result, children with lowered hearing acuity 
have already profited from being able to use improved hearing aids. 
Though individual hearing aids are designed mainly for the adult who 
has lost his hearing, the individual aid must necessarily play a larger 
part in the education of children with deficient hearing than it has in the 
past. Such questions as whether there is a critical age at which a hearing 
aid is to be supplied to a child or what the actual value of a hearing aid is 
as a factor in educational achievement must still be answered. 

Investigations relating to the use of amplified sound with babies and 

37 E. Martens, Opportunities for the Preparation of Teachers of Exceptional Children. 
United States Office of Education Bulletin No. 17, 1937. Washington: Government 
Printing Office, 1937. 



174 THE ACOUSTICALLY HANDICAPPED 

very young children would be helpful from the educator's point of view. 
The importance of early detection, early medical treatment, and early 
systematic education demands that more be known about getting mean- 
ingful sound to all children with deficient hearing. 

The recent emphasis placed on enlisting parents of deaf and hard-of- 
hearing children as the child's first teachers has been the outgrowth of a 
felt need. More and more efforts are being made to train parents in the 
techniques of teaching their children at home in informal situations. 
Continuance and growth of preschool training programs for parents 
point the way to a fuller and richer education for deaf children. 

Besides developments in auditory aids, a new electronic visual aid for 
teaching speech to nonhearers has been devised at the Bell Telephone 
Laboratories. A sound pattern is visualized on a screen, each sound 
having a particular conformation. For deaf individuals who learn to read 
and interpret "visible speech," telephone conversation is made possible. 
The question as to the efficacy of using "visible speech" in the teaching of 
very young children has not been answered, though experiments on 
using visible speech with children are now being conducted. 

A severe shortage of teachers of the deaf was precipitated by World 
War II. However, with the recent establishment of a good many college 
and university centers for training teachers of the deaf and the resultant 
widespread publicity of the problem, this condition should soon be 
alleviated. 

Person-to-person contact has been largely responsible for attracting 
individuals into the profession of teaching the deaf. Acquaintance with 
the deaf person in the family or social group or proximity to a school for 
the deaf influenced most of the young people who entered the field. The 
recruiting of suitable persons as teachers of children with hearing loss 
ought not to be left to chance. High-school vocational-guidance coun- 
selors are all too frequently unaware of the fact that there are deaf 
people in the world waiting to be taught. High-school guidance into 
teaching the deaf should be encouraged. 

The actual training of these candidates must then be considered. The 
teacher of the deaf must be as expert in the teaching of language as is 
any teacher of a foreign language; moreover, he must be an expert in the 
developing of intelligible speech. The teacher's armamentarium of special 
techniques must be superimposed on a knowledge of elementary educa- 
tion and, above all, on a knowledge of children. To ask the candidate to 
become an expert in all these areas in the period of a four-year college 
course, or in a year beyond a liberal-arts degree, is asking a great deal of 
anyone. A program of in-service training would seem to point the way to 
getting better teachers of the deaf. 



O'CONNOR AND STRENG 175 

In the area of personality adjustment there is need of a great deal of 
investigation and of the standardization of psychological and achieve- 
ment tests which can give us deeper insight into the problems of the deaf 
and the hard-of -hearing. 

REFERENCES 

Books and Articles 

1. Acoustically Handicapped Children. New York: New York City Board of Educa- 
tion, 1941. 

2. BARKER, ROGER G.; WRIGHT, BEATRICE A.; and GONTCK, MOLLIE R. Adjustment 
to Physical Handicap and Illness. Social Science Research Council Bulletin 55. 
New York: The Council, 1046. 

3. BEST, HARRY. Deafness*jand the Deaf in the United States. New York : Macmillan 
Co., 1943. 

4. BRUNSCHWIG, L. A Study of Some Personality Aspects of Deaf Children. Teachers 
College Contributions to Education, No. 687. New York: Teachers College, 
Columbia University, 1936. 

5. BUNCH, C. C. Clinical A udiomdry. St. Louis: C. V. Mosby Co., 1943. 

6. Children with Defective Hearing. London, England: Board of Education, 1938. 

7. CLARKE SCHOOL FOR THE DEAF, CLARENCE W. BARRON RESEARCH DEPARTMENT. 
Psychology of the Deaf, No. 1. Psychological Monographs, Vol. LII, No. 1. Wash- 
ington: American Psychological Association, 1946. 

8. DAHL, L. A. Public School Audiometry: Principles and Methods. Bloomington, 
Illinois: Interstate Publishers, 1949. 

9. EWING, A. W. G., and EWING, I. R. The Handicap of Deafness. New York: 
Longmans, Green & Co. 1938. 

10. . Opportunity and the Deaf Child. London, England: University of London 

Press, 1947. 

11. FLETCHER, H. Speech and Hearing. New York: D. Van Nostrand & Co., 1929. 

12. Hearing and Deafness. Edited by Hallowell Davis. New York: Murray Hill 
Books, Inc., 1947. 

13. HEIDER, FRITZ, and HEIDER, GRACE MOORE. Studies in the Psychology of the Deaf, 
No. 2. Psychological Monographs, Vol. LIU, No. 5. Washington: American 
Psychological Association, 1941. 

14. HUDGINS, C. V., and NUMBERS, F. C. "An Investigation of the Intelligibility of 
Speech of the Deaf," Genetic Psychology Monographs, XXV (1942), 289-392. 

15. Meeting the Needs of the Acoustically Handicapped Child. Commonwealth of 
Pennsylvania Bulletin No. 421. Harrisburg, Pennsylvania: Department of 
Public Instruction, 1939. 

16. MYKLEBUST, HELMER R. "Research in the Education and Psychology of the 
Deaf and Hard-of-Hearing," Journal of Educational Research, XL (1947), 598-609. 

17. NEWIIART, H., and REGER, S. Syllabus of Audiometric Procedures in the Adminis- 
tration of a Program for the Conservation of Hearing of School Children. American 
Academy of Ophthalmology and Otolaryngology, April, 1945. 

18. PINTNER, R.; EISENSON, J.; and ST ANTON, M. The Psychology of the Physically 
Handicapped. New York: F. S. Crofts & Co., 1941. 

Journals 

The American Annals of the Deaf. 
The Journal of Exceptional Children. 
The Volta Review. 



CHAPTER X 
TEACHING CHILDREN WITH SPEECH HANDICAPS 



WENDELL JOHNSON 
Professor of Speech Pathology and Psychology 

and 

Director of the Speech Clinic 

State University of Iowa 

Iowa City, Iowa 



INTRODUCTION 

Speech defectives comprise the largest single group of handicapped 
school children. It is a significant fact that the degree to which they are 
handicapped depends upon the administrative policies, classroom pro- 
cedures, and teacher personalities by which they are affected. 

Children and adults, in school and out, do much more speaking than 
either reading or writing. Speech is the most used of all the language 
functions, and the most fateful, day in and day out, in the social and 
workaday relationships of people everywhere. What is done about speech, 
and especially speech disorders, in our schools is, therefore, of the ut- 
most importance to the pupils as individuals and to the society which 
they will help to create as they become adult citizens. 

TYPES OF SPEECH DEFECTS 
Functional Articulatory Defects 

The speech defect classified as articulatory is the most common 
type. The child who omits certain sounds, as in saying "pay" for "play," 
has an articulatory problem. So does the pupil who substitutes one sound 
for another, as in "fumb" for "thumb." And the youngster who distorts 
certain sounds, who whistles or mushes the s sounds or strikes some 
sounds so lightly that they are not distinct, also has difficulty in speech 
sound articulation. Misarticulations of sounds should not be confused 
with mispronunciations of words, reading disabilities, or grammatical 
deficiencies. 

Difficulties or errors in the articulation of sounds have two chief 
causes. The more important cause is simply faulty learning. The other is 
organic defect, such as mouth deformities or faulty hearing. The vast 
majority of cases have no organic defects. They need training in paying 
attention to speech sounds, in recognizing and discriminating them by 
ear, and in producing them correctly. 

176 



JOHNSON 177 

Children with functional (nonorganic) articulatory defects make up 
70 to 85 per cent of public school speech-correction cases. In about half 
the cases of this type, moreover, the s sound is defective, although 
other sounds, of course, are frequently misarticulated. The number of 
school children reported as having articulatory defects depends largely 
on the definitions used. At the age of six years the average child pro- 
duces correctly about 90 per cent of the sounds; the normal child, there- 
fore, misarticulates 10 per cent of his sounds and cannot reasonably or 
wisely be regarded, on that account, as a speech defective. Standards in 
speech, as in other things, should be no higher than the majority of 
children can readily achieve at any given age level. Practical speech- 
correction experience shows that 2 to 3 per cent of school children have 
serious articulatory defects, and another 2 to 3 per cent have less severe 
defects. In a school with an enrolment of 1,000 pupils, therefore, there 
are likely to be from 40 to 60 children who have functional articulatory 
disorders requiring speech correction, roughly half of whom will require 
individualized or intensive small-group instruction. 1 

Speech-correction principles will be discussed in later sections of this 
chapter. 

Stuttering 

Stuttering affects six to ten out of every thousand school children. 
("Stuttering" and "stammering" are, by current usage, synonymous.) 
It is a specific form of speech anxiety or fear. Outwardly it takes the 
main forms of undue hesitancy, speech blockage, and the repetition of 
words, phrases, or sounds. It involves tension and often, or even usually, 
some kind and degree of facial grimacing, eye-blinking, etc., with 
associated bodily movements. The child's fear of being unable to get 
started and to keep going fluently is the main feature of this particular 
speech problem. 

Stuttering is not to be confused with (a) the normal nonfluency of 
childhood, or even adult, speech, (&) motor incapacity affecting speech 
as found in some cases of brain damage, or (c) neurotic speech blockage 
with sudden onset under emotional pressure in adult life. Stuttering 
usually begins before school age; the average age of onset is about three 
years. The normal nonfluency of childhood is not a speech defect. The 
average child between the ages of two and five years repeats sounds, 
words, or phrases 45 times per 1,000 spoken words in free-play situations. 2 



1 See references at end of chapter. 

2 Dorothy M. Davis, "The Relation of Repetitions in the Speech of Young Chil- 
dren to Certain Measures of Language Maturity and Situational Factors," Journal of 
Speech Disorders, IV (1939), 303-18; V (1940), 235-41, 242-46. 



178 SPEECH HANDICAPS 

This is the average for normal children. It is not stuttering. Stuttering is 
mainly distinguished by tension and fear, not by easy, unself-conscious 
repetitions or hesitations. It is the stutterer's tendency to be apprehen- 
sive about and to struggle against the nonfluencies he does have or 
thinks he will have that is important. Normal speakers merely hesi- 
tate; stutterers hesitate to hesitate. 

There has been a relatively large amount of scientific research on 
stuttering. Over 150 physiological and biochemical studies have beer 
reviewed and evaluated by Hill. 3 Several of the more recent and crucial 
investigations have been discussed by Johnson. 4 The most defensible 
general conclusion to be drawn from this research, to date, would seem to 
be that stuttering is a specific form of learned anxiety-motivated be- 
havior. What appears to happen in the typical case is that the child's 
parents (in occasional instances, the child's teachers) become concerned 
about his normal hesitancies and repetitions. They show this concern in 
facial expression, postural tensions, tone of voice, or by actually calling 
the nonfluencies to the child's attention, asking him to "stop anJ start 
over/' to "take his time," to "stop and think out what he wants to say," 
or even, in rare cases, to "stop stuttering like that!" Some children can 
withstand a great deal of such disapproval, parental anxiety, and dis- 
turbing "helpfulness." Others cannot. In the representative case the child 
begins, after a few hours, days, weeks, or months, to speak less and to do 
the speaking he does more hesitantly and less confidently. With con- 
tinued usually intensified parental concern, the child begins to try 
harder to do better to please his parents. Slight effort and tension appear, 
blocking his speech all the more. Parental anxiety increases accordingly. 
The child tries harder to do still better, loses more confidence in the 
bargain, exhibits more blocking tensions, becomes more hesitant and dis- 
couraged; the parents worry all the more and so the vicious circle 
expands. 

This, of course, is the sketchy outline of a story that comes alive in 
actual cases with an abundance of detail and complications. For example, 
it involves a set of circumstances that seems to occur about four or five 
times more frequently, in our particular culture, for boys than for girls. 5 



8 Harris Hill, "Stuttering: I. A Critical Review and Evaluation of Biochemical In- 
vestigations," Journal of Speech Disorders, IX (1944), 245-61; "Stuttering: II. A Re- 
view and Integration of Physiological Data," Journal of Speech Disorders, IX (1944), 
289-324. 

4 W. Johnson, S. Brown, J. Curtis, C. Edney, and J. Keaster, Speech-handicapped 
School Children, pp. 179-257. New York: Harper & Bros., 1948. 

* Hildred Schuell, "Sex Differences in Relation to Stuttering," Journal of Speech 
Disorders, XI (1946) 277-98; XII (1947), 23-38. See also, by the same author. 



JOHNSON 179 

There is some little evidence, as so far accumulated, that the conditions 
which are conducive to stuttering are found somewhat more often in 
homes in the higher socioeoonomic levels, where standards tend to be 
higher and the competition for social status keener than in homes "on the 
other side of the tracks." There is some tendency for stuttering to run in 
families, but so far as is known scientifically it is not inherited. There are 
two reasons why characteristics run in families: biological heredity and 
family tradition. Eating with a fork, or with chopsticks, runs in families. 
So does the habit of voting the Republican ticket or of attending the 
Episcopalian church or the Buddhist temple. And so do certain speech 
standards, attitudes toward the imperfections of childhood speech, and 
anxieties about whether the family offspring will stutter. Once stuttering 
has "invaded" a family, the fear of its recurrence haunts in some measure 
the succeeding generations of parents. So it comes about that in some 
families the psychological and environmental conditions that make for 
stuttering are more likely to arise and take their toll. 

There used to be a popular theory, not yet put aside in all quarters, 
that forcing left-handed children to be right-handed would make them 
stutter. Recent research has discredited the theory. 6 There is this to be 
said, however: while changing a child from left- to right-handedness will 
hardly, in and of itself, cause the child to stutter, the sort of parent or 
teacher who would do such a thing might very well cause the youngster 
to stutter or to develop some other disturbance. So far from being forced 
to use the right hand, left-handed children should be given the special 
training they need in order to become gracefully left-handed. Right- 
handed writing instruction, for example, is not suitable for them. 7 The 
general principle involved here would appear to be that children should 
be permitted to be left-handed if they want to be, just as they should be 
allowed any and all other reasonable freedoms to develop their own 
natural inclinations. 



Differences Which Matter'. A Study of Boys and Girls. Austin, Texas: Delta Kappa 
Gamma Society, National Office, 1947. 

8 Harry Heltman, "Contradictory Evidence in Handedncss and Stuttering, "Jour- 
nal of Speech Disorders, VIII (1940), 323-35; W. Johnson et ol.,"A Study of the Onset 
and Early Development of Stuttering," Journal of Speech Disorders, VIII (1942), 
251-57; W. Johnson and A. King, "An Angle-Board and Hand-Usage Study of 
Stutterers and Nonstutterers," Journal of Experimental Psychology, XXXI (1942), 
293-311; E. J. Spadino, Writing and Laterality Characteristics of Stuttering Children 
(Teachers College Contributions to Education No. 837. New York: Teachers College, 
Columbia University, 1941). 

7 On the basis of extensive research, Dr. Warren Gardner has produced a handwrit- 
ing manual for left-handed children, or adults, that has proved to be very effective. 
Warren H. Gardner, Left-handed Writing: Instructional Manual. Danville, Illinois: 
Interstate Publishing Co., 1945. 



180 SPEECH HANDICAPS 

In general, then, stuttering is caused mainly, in the great majority of 
cases, by parental anxieties concerning the normal imperfections of child- 
hood speech and by the elaborate train of consequences which such 
anxieties tend to set in motion. Once started, stuttering can be aggra- 
vated by any and all factors that tend to make for maladjustment and 
lowered efficiency. The vast amount of research so far done has failed to 
demonstrate clearly any organic cause for stuttering. 

Voice Problems 

According to Curtis, "Estimates vary, but probably from 1 to 2 per 
cent of school children present significant voice problems/ 78 

The human voice can be well described in terms of its (a) pitch, 
(6) loudness, and (c) quality. Voice disorders, then, can be correspond- 
ingly classified. 

Disorders of pitch are those involving pitch levels that are too high, 
too low, or monotonous. There seems to be a "natural pitch level" for any 
individual, and a child or adult who habitually uses a tonal level that is 
too high or too low for his vocal organs not only impairs the effectiveness 
of his voice but may also damage his tone-producing mechanism. 

A voice that is defective with respect to loudness may be too loud, too 
soft, or monotonous. Disorders of loudness are seen chiefly in overly shy 
children who do not "speak up" and in children who feel a strong need 
for attention and recognition which they sometimes attempt to obtain by 
means of loud, arresting speech. Except in rare cases of chronic laryngitis 
and other conditions of medical concern, loudness disorders are chiefly 
psychological in nature. 

Quality disorders can for most practical purposes be grouped under 
the following four terms: nasality, breathiness, hoarseness, and harshness. 
In their extreme forms these vocal qualities are easily recognized. An 
important cause of nasality in school children without organic defect is 
the habit of speaking with narrow mouth openings and relatively inactive 
jaws and lips. To put it almost too simply, if the sound can't get out 
through the mouth it will go out through the nose. A breathy voice 
quality results from an excessive flow of air between the vocal cords dur- 
ing the production of vocal tones. This can be a symptom of stage-fright, 
or it may be due to faulty habits of tone production. Hoarseness arises 
mainly from inflammation of the larynx and vocal cords due, as a rule, to 
the common cold, laryngitis, or vocal abuse, such as excessive cheering 



8 J. Curtis, in Johnson et aL, op. tit., chap. iv. The full chapter, pp. 146-78, is 
devoted to a comprehensive discussion of voice disorders. See also Grant Fairbanks, 
Voice and Articulation Drillbook (New York: Harper & Bros., 1940), and Practical 
Voice Practice (New York: Harper & Bros., 1944). 



JOHNSON 181 

at games or speaking habitually with an unsuitable pitch level, espe- 
cially one that is too low. "Harsh voice is generally considered to be 
associated with excessive strain and effort in producing voice." 9 

Teachers are familiar, of course, with the phenomenon of adolescent 
voice change occasioned by relativley rapid growth of the larynx, or 
voice box. This is taken in stride by most youngsters, but good teachers 
are always sensitive to the possibility of serious emotional disturbance in 
this connection for certain children. 

Although serious voice problems are not common among school chil- 
dren, the problems that do occur are to be given unusually careful 
attention. Immediate referral to a medical practitioner, preferably an 
ear, nose, and throat specialist, is to be recommended in any case of 
hoarseness. Continued speaking without medical attention may have 
grave consequences. 

Organic Speech Disorders 

Speech defects associated with cleft palate and cerebral palsy are the 
chief ones to be considered under this heading. 10 

Approximately one child out of every 1,800 is born with a harelip or a 
cleft palate, or both. These anatomical defects occur as a result of a 
failure of fusion, during embryonic life, of the right and left portions of 
the tissues making up the upper lip and of the roof of the mouth and the 
soft palate. In cases of cleft palate, air passes freely between the oral and 
nasal cavities. Speech tends, therefore, to be nasalized. Moreover, 
difficulty is experienced in building up breath pressure for the stop- 
plosive sounds (p, &, t, d, fc, 0), so that some degree of "nasal snort" fre- 
quently results from the effort to produce these sounds. Other sounds, 
too, may be affected. 

Harelip is commonly repaired by surgery relatively soon after birth. 
Surgery is commonly used also to repair clefts of the hard and soft 
palates. When surgery is impractical or unsuccessful, obturators, 
roughly resembling "false plates" are commonly used to shut off the 
nasal from the oral passage. In any event, it is to be heavily emphasized 
that neither surgery nor an obturator will be sufficient, except in very 
rare cases, to eliminate the speech defect, for the simple reason that old 
neuromuscular adjustment habits will persist. Speech correction is 
necessary in practically every case. Moreover, the social handicap and the 
consequent tendency to develop personality maladjustment are to be 
given thorough attention in cleft-palate children. 

9 J. Curtis, op. cit., pp. 154-55. 

10 See S. F. Brown in Johnson et al. } op. cit. t chap, vii, for an extended discussion of 
organic speech defects. See also Robert West, L. Kennedy, and A. Carr, The Rehabil- 
itation of Speech, chaps, viii and xxiv. New York: Harper & Bros., 1947 (revised). 



182 SPEECH HANDICAPS 

Cerebral palsy is more popularly but misleadingly known as 
spastic paralysis. There are several types of cerebral palsy, three of 
which are worthy of special mention here. All are due to damage to cer- 
tain brain areas. The spastic type is characterized by a more or less con- 
stant state of excessive tension in the affected muscles. The athetotic 
type is distinguished mainly by exaggerated tremors or recurring move- 
ments, uneven and essentially involuntary, of the muscles involved. The 
ataxic variety involves mainly a disturbance in muscular co-ordination 
and bodily balance or equilibrium. Regardless of type, the extent of 
bodily involvement varies from restricted and slight to extensive and 
severe. In about 75 per cent of cases the speech muscles are affected. 
Approximately 75 per cent of cerebral-palsied children are educable so 
far as intelligence and physical fitness are concerned. Diseases, and pos- 
sibly dietary deficiencies, of the mother during pregnancy, birth injuries, 
and certain diseases of infancy appear to be among the causes of cerebral 
palsy, although there is much research yet to be done in this connection. 
The incidence of cerebral palsy is about the same as that of infantile 
paralysis or "polio." There are about 400,000 cases in the United States. 
They constitute an especially acute educational problem, and one that 
has been woefully neglected. 11 

In general, the speech of cerebral -palsied children is labored, slow, 
jerky, and indistinct. The voice tends to be monotonous or uncontrolled. 
The breathing muscles are frequently affected and this complicates the 
speech and voice disturbances. The problem is gravely complicated as a 
rule by the social and educational adjustment difficulties experienced by 
children with cerebral palsy. 

Speech Problems Associated with Impaired Hearing 
Speech defects are frequently associated with impaired hearing. The 
degree to which these defects are associated in given cases depends on the 
extent and type of hearing loss, the age at which the hearing impairment 
occurred, and other factors such as intelligence, general care and training, 
speech stimulation received in the home, etc. 12 These speech defects 
consist mainly of distortions of articulation and voice. We learn speech 
chiefly by ear, as it were, and the hard-of -hearing child is .handicapped 
in this fundamental respect. He imitates what he hears, and what he 

11 The National Society for Crippled Children and Adults, Inc., 11 South La Salle 
Street, Chicago, Illinois, publishes a magazine, The Crippled Child, that contains a 
wealth of up-to-date information of value to educators. The society also maintains a 
varied supply of authoritative and practical bulletins and books on cerebral palsy and 
other problems of handicapped children. 

12 Speech defects associated with impaired hearing are treated by J. Keaster, in 
Johnson et al, op. cit., chap, viii, and by West, Kennedy, and Carr, op. cit., chap. x. 



JOHNSON 183 

hears is not the speech that is heard by normally hearing children. 
Moreover, he cannot, in most instances, hear his own speech and voice 
sufficiently well to know whether he is producing sounds or vocal inflec- 
tions normally. 

Approximately 3 out of every 100 school children have educationally 
significant hearing losses, and another 5 per cent have impairments that 
call for medical attention and that may in some cases affect speech. 
(About 1 per cent of school children require the services of a speech cor- 
rectionist by virtue of a hearing loss.) A large proportion of childhood 
hearing losses result from upper respiratory infections associated with the 
common cold, influenza, and other common diseases. Effects are often 
permanent but early medical attention can, in many cases, lessen the 
threat of lasting damage and not infrequently results in restoration of 
normal hearing. 13 

Speech correction, training in listening that makes for most efficient 
use of available hearing, instruction in the use of hearing aids, lip 
reading, and intensified instruction in reading and writing are common 
essentials in any program of education adequate for the 3 per cent or 
more of school children with severe hearing problems. 

Retarded Speech Development 

In general, about 5 out of every 1,000 children in the early grades 
give evidence of retarded speech development, as gauged by reasonable 
and practical standards. The aspects of speech in which delayed devel- 
opment may be noted are: (a) amount of vocal play during infancy, 
(6) age of saying first words and first sentences, (c) articulatory correct- 
ness and general intelligibility, (d) average length of speech responses, 
(e) amount of talking, and (/) vocabulary, both use and comprehension. 
Extensive studies of speech sound development, relevant measures, and 
norms, for the period from birth to 30 months of age, have been developed 
by Irwin and his associates. 14 

The more common causes of delayed speech development are (a) men- 



13 C. D. Osborn, "Medical Follow-up of Hearing Tests," Journal of Speech Dis- 
orders, X (1945), 261-73. 

14 0rvis C. Irwin, "Infant Speech: Variability and the Problem of Diagnosis/' 
Journal of Speech Disorders, XII (1947), 287-89. 

Orvis C. Irwin and Han Piao Chen, "Speech Sound Elements during the First 
Year of Life: A Review of the Literature," Journal of Speech Disorders, VIII (1943), 
109-21. 

For data concerning articulatory correctness for ages two to six years, see Beth L. 
Wellman, Ida M. Case, Ida G. Mengert, and Dorothy Bradbury, "Speech Sounds of 
Young Children." University of Iowa Studies in Child Welfare, Volume V, No. 2, 
1931. 



184 SPEECH HANDICAPS 

tal subnormality, (&) illness or physical disability, especially during 
crucial periods of speech development, (c) lack of sufficient speech 
stimulation, as in homes where there is little or no vocal play with the 
baby or where the adults are relatively quiet, (d) oversolicitous parents 
who anticipate the baby's wishes and wait upon him so zealously that 
he simply experiences no urgent need for speech, (e) overly strict parents 
who punish the child for falling short of speech standards that are be- 
yond the youngster's stage of development, and (/) intense shock, fright, 
or shame. Retarded speech has been discussed from the point of view of 
the speech-correction specialist by Van Riper 15 and from the point of 
view of the classroom teacher by Brown. 18 An article by Ruth Irwin 17 
describes in practical detail the procedures used in working effectively 
with a case of retarded speech development. 

PUBLIC SCHOOL SPEECH CORRECTION 
General Considerations 

There is one rule that should be consistently and strictly followed in 
dealing with speech disorders in the public schools: A speech survey 
should never be made unless it is to be followed immediately, or nearly so, 
by remedial work. 

The all-too-common practice of occasionally bringing outside special- 
ists into a school system, instead of establishing a speech-correction 
program, and having these specialists conduct speech surveys or one- 
day clinics that are not adequately followed up is to be thoroughly 
deplored. And the practice of introducing a speech-correction program 
by spending the first semester, or even the first year, surveying the entire 
enrolment before starting remedial work is also to be strongly disap- 
proved. The disadvantages and potential harmfulness of such practices, 
once examined, are obvious: 

a) Children are singled out as defective, and even though no official 
announcements are made, the children themselves, their schoolmates, 
their families and neighbors become vaguely aware of what they feel to 
be an unsavory and disturbing labeling. Then nothing constructive is 
done. They simply wait and worry. The simple fact is that branding a 
child as defective and then ignoring or neglecting him intensifies his 
problem, both for him and for his family. 

6) If a survey is done one semester, or one year, and remedial work is 



16 C. Van Riper, Speech Correction: Principles and Methods. New York: Prentice- 
Hall, Inc., 1947 (revised). 

18 S. F. Brown, in Johnson et al, op. cit., chap. vi. 

1T Ruth Irwin, "Speech Comes to a Five-year-old Boy," Journal of Speech Dis- 
orders, XI (1946), 197-203. 



JOHNSON 185 

not started until the next year, or semester, some children will have 
graduated or transferred to other school districts, or to other buildings 
within the same system, and some new pupils will have come into the 
system. Moreover, some of those found to have defects will have im- 
proved, possibly enough to have overcome the defects, and others may 
have developed more complicated or severe problems in the meantime. 
In any event, the children spotted in the survey who still need help will 
have had a year of uneasiness and worse than fruitless waiting. In many 
situations the speech correctionist who did the survey will have resigned, 
and either a new teacher will have to try to make rhyme and reason out 
of such paper records as remain of the survey or there will be no speech 
correctionist at all and the time and money will have been wasted, to say 
nothing of the train of complete frustration and general disappointment 
on the part of everyone concerned. 

c) A one-day clinic, to which selected pupils are referred with their 
parents, and in which examinations are made and recommendations 
given, raises unrealistic hopes and prepares the way for later disappoint- 
ment, or worse, unless adequate provision is made for supervision, re- 
checking, and general follow-up. If there is an on-going speech-correction 
program in a school system, considerable benefits are to be gained from 
having visiting consultants spend brief periods of time in the system for 
specific purposes that arise out of the school's actual experience with the 
program. But where such correction program is lacking, the services of 
the consultants may well be misspent. 

Regardless of the survey methods used, the examination and diag- 
nosis should be followed as promptly as possible by the beginning of 
remedial work. This means, in practice, that not only each building but 
even each grade or classroom should be served as a unit. Having selected 
the children who need speech correction in the first grade at Longfellow 
School, the speech correction they need should be planned and actually 
started before a survey is made of the second grade. And this means, 
moreover, that it will usually be clearly impossible to introduce a speech- 
correction program into a sizable school system in such a way as to 
serve all the grades in all the buildings equally, right from the start. The 
Minnesota state law provides that a speech-correction teacher may not 
carry a case load in excess of 75 speech-defective pupils; under no cir- 
cumstances is it wise for a speech correctionist to work individually and 
in small groups with more than 100 cases. The inauguration and develop- 
ment of a speech-correction program must be planned accordingly. 

If it is desired to have speech correction throughout a school system, 
enough special teachers must be employed to service the entire enrolment. 
There should be one speech correctionist to approximately every 4,000 



186 SPEECH HANDICAPS 

pupils. Estimating very conservatively that only 5 per cent of the pupils 
will be found to have significant speech problems, there will be 200 chil- 
dren needing speech correction among every 4,000 pupils. Some of them, 
possibly half, can be handled by their regular classroom teachers, with 
consultation and supervision by the speech correctionist. The rate of im- 
provement and dismissal will then tend to keep the load of individual- 
ized and small-group cases in an enrolment of 4,000 down to a number 
75 to 100 that one speech correctionist can handle efficiently. 

Having got the program under way during one school year, the speech 
correctionist will not need to make a complete survey the following year. 
He will need to recheck the pupils worked with the previous year and 
test all new pupils. He will have corrected and dismissed enough of the 
previous cases to be able to take care of the new cases in about another 
1,000 enrolment. 

The foregoing discussion implies that it will usually be necessary to 
make a rational selection of the pupils to be included in a new speech- 
correction program, since it will by no means always be possible to include 
the entire enrolment. A common policy is that of restricting the program 
to the lower grades, perhaps the first three and the kindergarten, extend- 
ing it upward grade by grade as the program is developed. From the 
point of view of the public served by the school system, this ordinarily 
makes more sense than limiting the program to certain buildings or to 
certain types of cases. 

The foregoing discussion also implies that the most desirable procedure 
for locating speech-defective children is that of having the speech correc- 
tionist himself check every pupil. The procedure should be carried out, 
however, with active co-operation by the classroom teachers. They should 
submit the names of all children in their classrooms whom they regard as 
speech-handicapped but these children should be checked by the 
speech correctionist. Depending entirely on referrals by classroom teach- 
ers is decidedly limited in its effectiveness, but dispensing completely 
with such referrals has the disadvantage of decreasing the interest and 
participation of the classroom teachers in the speech-correction program. 

The crucial consideration in setting up a speech-correction program 
has to do with the selection of properly qualified personnel. The profes- 
sional association in this field which has for many years provided na- 
tional leadership in defining standards of training and practice is the 
American Speech and Hearing Association (formerly the American 
Speech Correction Association). Its membership regulations constitute a 
tangible and experience-tested definition of a speech correctionist. 18 The 

18 The membership regulations may be obtained by addressing Professor George A. 
Kapp, Speech Clinic, Wayne University, Detroit, Michigan, the present (1950) 



JOHNSON 187 

various state certification requirements in the field of speech correction, 
as of 1946, are summarized in an article by Carrell. 19 The most advanced 
requirements are those of the Ohio State Department of Public Instruc- 
tion. 20 

Nothing said above is meant to imply that if specialists cannot be 
found nothing at all is to be done for speech-handicapped children. It is 
not possible to avoid doing something for or to them, and the only realis- 
tic question has to do with what can or should be done under the circum- 
stances that actually prevail. In the absence of a full-scale speech-correc- 
tion program, a great deal can and should be done by the regular school 
staff for the pupils who have speech problems. This point has been de- 
veloped in textbook elaboration by Backus 21 and by Johnson et al., 22 and 
many of its technical aspects have been discussed by Ainsworth. 23 

The most substantial single thing that can be done for speech-handi- 
capped school children, in the absence of special teachers or a speech-cor- 
rection program, is to insure so far as possible that all members of the 
school staff have at least an elementary knowledge of speech disorders, a prac- 
tical appreciation of speech-correction methods, and an understanding of the 
kinds of schools, classrooms, and teachers that are good, or bad, for children 
with speech defects. 

Every classroom teacher teaches speech Above all, from the speech- 
correction point of view, she creates an atmosphere, whether or not she means to 
do so, in which the child with a speech defect either is demoralized or is helped 
not only to improve his speech but also to live gracefully with his defect so long 
as it persists and to grow as a person in spite of it. 24 

In Iowa and a few other states, elementary teachers in training are re- 
quired to take an introductory course in speech correction. It would seem 
possible to offer such a course in every teacher-training college, and if this 
were done it would go farther than any other single measure to remedy 
the serious deficiencies of our public education program with respect to 
the most urgent needs of America's speech-handicapped school children. 



Secretary-Treasurer of the American Speech and Hearing Association. A permanent 
address is The Speech Correction Fund, 11 South La Salle St., Chicago, Illinois. 

19 James A. Carrell, "State Certification of Speech Correctionists," Journal of 
Speech Disorders, XI (1946), 91-95. 

20 Severina E. Nelson, "Training and Certification of Speech Correctionists," Jour- 
nal of Speech Disorders, XI (1946), 205-16. 

21 Ollie Backus, Speech in Education. New York: Longmans, Green, & Co. 1943. 

22 Op cit. 

28 Stanley Ainsworth, Speech Correction Methods. New York: Prentice-Hall, Inc., 
1948. 

24 W. Johnson, et al., op cit. f pp. 1-2. 



188 SPEECH HANDICAPS 

The schools themselves can, in many instances, provide in-service train- 
ing courses in speech correction for the classroom teachers. Certainly, 
such in-service training should be a basic part of any full-scale speech- 
correction program; the special speech-correction teacher should, as a 
matter of course, offer introductory instruction, adapted to the local 
working situation, concerning speech disorders and the handling of them 
in the classroom. Where there is no specialized teacher, it might prove 
possible in a great many situations to bring in qualified speech correc- 
tionists from near-by colleges or clinics to give in-service training 
courses. 

In any school system it can be made a matter of administrative routine 
to refer the parents of all speech-handicapped children to such clinics as 
may be within reasonable distance. The secretary-treasurer of the Amer- 
ican Speech and Hearing Association is prepared to provide on request 
the names and addresses of all the Association members within a given 
city, state, or area. 25 

Basic Principles 

The preventive and remedial approach to speech disorders reduces in 
the main to two aspects: (a) training, or retraining, of speech, as such, 
and (6) providing conditions that affect speech favorably. 

Most speech defects begin before school age. What there is to say, 
therefore, about the prevention of speech disorders in the public schools 
can be summarized essentially as follows: 

1. Voice problems are to be prevented, so far as they can be, through 
(a) discouraging vocal abuse, chiefly in game-cheering, (b) a good basic 
school-health program with special attention to upper respiratory infec- 
tions, and nasal obstructions, especially adenoids, (c) an enlightened and 
sympathetic attitude toward children who are going through the adoles- 
cent "voice change," and (d) constructive attention to the childhood 
maladjustments that make for the feelings of fear, insecurity, and shy- 
ness which are commonly reflected in weak and inexpressive voices. 

2. The prevention of speech and voice problems associated with hear- 
ing loss is best insured by preventing or arresting the hearing loss itself. 
Hearing tests are becoming routine in a rapidly increasing proportion of 
our schools. The Committee on the Conservation of Hearing of the Amer- 
ican Academy of Ophthalmology and Otolaryngology has drawn up rec- 
ommendations concerning public school hearing conservation, including 
audiometric testing. 26 The Committee favors tests of all school children 



26 See footnote 18. 

28 These recommendations have been summarized by the Committee chairman, 
Dean M. Lierle, in "The Otologists' Program for Conservation of Hearing," Journal 
of Speech Disorders, X (1945), 111-16. 

The subject of public school hearing conservation has been covered in detail by 



JOHNSON 189 

at least once every three years, together with the testing of all new en- 
rolees in any given school at the beginning of each term. The Committee 
further recommends that only the modern individual or group audiom- 
eters be used. Emphasis is placed on the importance of a comprehensive 
hearing-conservation program rather than a more narrow conception that 
includes hearing testing only. The value of early medical attention in 
cases of hearing loss, and the serious risks involved in neglect, are heavily 
stressed. 27 In cases of irreparable hearing loss, intensive speech training 
may serve to maintain articulatory correctness and voice quality that 
would otherwise deteriorate in time. Lip-reading instruction should be 
started as early as possible. 

3. In the great majority of cases, stuttering begins before the child 
enters school. In some cases, with later onset, however, classroom policies 
and practices are definitely suspect. Preventive measures, so far as 
stuttering is concerned, lie largely in a generally democratic, friendly, and 
rewarding school atmosphere, created by well-adjusted teachers, acting 
in accordance with school policies formulated by administrators who in- 
sist upon a wholesome respect for the personal worth and dignity of 
each individual child. The sorts of schools and teachers that promote the 
personal adjustment, happiness, and efficiency of the general run of so- 
called normal children are also the sorts of schools and teachers that are 
most likely not to produce or aggravate stuttering. 

There is one specific point to be made in this connection, and it should 
be heavily underlined. No classroom teacher or school administrator 
should ever diagnose any child as a stutterer. If the child's family, 
neighbors, other teachers, and associates do not regard him as a stutterer, 
there would be no useful point, and there would be extremely grave dan- 
ger, in labeling him as a stutterer. The chief cause of stuttering, as has 
been explained, lies in the perfectionistic and emotionalized evaluation of 
parents and teachers of the normal nonfluency so prominent in children's 
speech. This produces self-consciousness that tends to lead to the anx- 
iety tensions characteristic of stuttering. The most important specific 
preventive measure is simply that of accepting, without derogatory or 
disturbing evaluations, the normally nonfluent speech of children. 

In addition to these considerations regarding prevention, there are 
three remedial principles to be emphasized : 

Speaking Should Be Fun. Fifty years of increasingly refined research on 



Lorraine Anson Dahl in a recent book, Public School Audiometry: Principles and 
Methods. Danville, Illinois: Interstate Publishers, 1949. 

For a comprehensive discussion by leading present-day authorities, see Hallowell 
Davis, Editor, Hearing and Deafness: A Guide for Laymen. New York: Murray Hill 
Books, 1947. 

87 C. D. Osborn, op. cit. 



190 SPEECH HANDICAPS 

the psychology of learning has established in the main one fundamental 
principle: The amount of learning is proportional to the amount of re- 
warded practice. A child will learn to speak better, to correct a defect, 
just about to the extent that he is rewarded for trying, and the extent to 
which he is rewarded for trying is to be gauged chiefly by the degree to 
which he feels that speaking is fun. 

One of the most tragic by-products of our nation's classrooms is the all- 
but-universal handicap of stage fright to be found among the graduates 
of our schools. In a study of approximately 800 university Freshmen and 
Sophomores, Greenleaf 28 found that all but 10 per cent nine out of ten 
claimed some degree of stage fright or, as Greenleaf more aptly terms it, 
speech fright. One out of ten rated himself as suffering from a severe de- 
gree of speech fright. Case studies of some of the more serious cases indi- 
cated more or less clearly that classroom experiences were among the 
important causes. The common practice among teachers of criticizing, 
rather than approving, the speech performances of students was shown 
to be especially pernicious. 

When this critical attitude is applied to the performances of pupils 
with speech defects, the results are almost uniformly demoralizing. To 
paraphrase a line in one of the songs from the musical comedy, Okla- 
homa, the teacher and the pupil should be friends. 

The teacher of English or speech, or of anything else, who feels that 
there are certain standards of speech that are to be upheld at all costs will 
inevitably have an unfortunate effect on children whose speech is defec- 
tive. Under such a teacher they will slink about in the foreboding shadows 
of overt and implied disapproval, with ever deepening feelings of dis- 
couragement and insecurity. The teacher who would provide a situation 
in which speech correction is possible, in which a speech-defective child 
would feel motivated to try to improve, must accept the child as he is, 
speech defect and all. If he is to improve his speech, he must enjoy 
speaking find it rewarding and speech is never enjoyable when it is 
disapproved. 

Speaking Should Be Encouraged. The basic condition for learning, as 
we have noted, is rewarded practice. The first prerequisite for the im- 
provement of speech is speaking. The more the speech-defective child 
speaks, the better. It goes without saying, however, that such a child 
should never be forced to speak. That would be a clear violation of the 
principle of reward coerced speaking would practically never be enjoy- 
able. Rather, the pupil with defective speech should be encouraged to 
speak. He should be emotionally prepared to participate in the speech 

28 Floyd Greenleaf, "An Exploratory Study of Social Speech Fright." Unpublished 
Master's thesis, State University of Iowa, June, 1947. 



JOHNSON 191 

activities of the classroom. Such participation should be made attractive 
to him. The teacher should find at least a little time to talk to the 
youngster about his speech difficulty, to convey the feeling that it is a 
problem to be faced up to and worked on, and to arouse an interest in 
achieving the satisfactions to be gained from attacking the problem 
objectively. 

Obviously, the teacher who is informed at least to an elementary de- 
gree about children's speech problems will be the better prepared for 
motivating any speech-handicapped child to undertake a program of im- 
provement. Any such program will be effective, if it can be, to the extent 
that it involves practice. This is hardly the place to present the fine de- 
tails of speech-correction methods; it is sufficient to say that the more the 
teacher knows about these methods, the more helpful he can be to his 
pupils. And the advice or instruction the teacher gives, assuming its 
soundness, will make more beneficial to the child the speaking that he 
may do. The complex motor, psychological, and social skill that we call 
speech depends for its development, as do other skills, on rewarded prac- 
tice. And the more the practice is directed toward specific goals essential 
to the correction of the particular speech difficulties of any given child, 
the more rewarding it will be, and the more effective. 

Conditions Affecting Speech Adversely Should Be Minimized. The con- 
ditions in question are mainly those which frustrate speech, or make it an 
ordeal and a source of disappointment. The undesirable effects of speech 
disorders are minimized in a highly permissive situation which allows for 
the relatively free expression of feelings and opinions. 29 The key to the 
creation of such a situation in the classroom lies largely in maintaining 
as much informality and "classroom democracy" as are consistent with 
efficient teaching methods. 

The teacher who assumes anything more than a casual degree of re- 
sponsibility for doing something about the speech difficulties of a specific 
child will go beyond the walls of his classroom in an attempt to bring 
about a favorable set of cirsumstances for the child. He will talk with the 
youngster's parents, helping them to understand the problem and enlist- 
ing their co-operation. He will see to it that needed medical or dental 
care is obtained. If it is advisable, he will do what he can to get the child 
to a speech clinic for examination and advice or for a period of instruction 
in a summer program. He will in some cases enlist the services of child 
welfare agencies, recreation centers, Boy Scout leaders, clergymen, and 



29 For a systematic presentation of the permissive or nondirective approach to ad- 
justment problems see Carl Rogers, Counseling and Psychotherapy. Boston: Houghton 
Mifflin Co., 1942. The implications of this approach so far as educational policies and 
practices are concerned are obvious. 



192 SPEECH HANDICAPS 

other persons or agencies prepared to render a needed type of assistance. 
Finally, it goes without saying that he will call upon the school nurse, 
psychologist, music teacher, dramatics coach, and other staff members, 
including the child's other teachers, for information or help. Speech cor- 
rection is in large measure a teamwork proposition. 

In general, the conditions favorable to speech improvement in a given 
case include (a) sufficient information to make possible on the part of the 
child, his teachers, and parents a clear understanding of the speech prob- 
lem and of possible means of dealing with it; (fc) encouragement and re- 
ward for the speaking done by the child and for the work he does in trying 
to achieve improvement; (c) elimination of any correctible organic condi- 
tions, or compensations for them, such as hearing aids, that place a limit 
on the possibilities of speech improvement; and (d) social relationships, 
recreational activities, and personal adjustments conducive to satisfying 
speech and positive self-evaluations. In some measure these can be pro- 
vided in most cases by alert teachers and school administrators. 

The attempt to present a detailed description of speech-correction 
techniques, in handbook fashion, in a general discussion of this kind 
would obviously be inappropriate and impractical. The interested reader 
may best be referred to the list of references at the end of the chapter. 

CONCLUDING CONSIDERATIONS 

In this chapter we have discussed the various types of speech defects to 
be found among school children, the fundamental problems involved in 
dealing adequately with speech-handicapped school children, and the 
basic principles of public school speech correction. 

The more fundamental considerations are, first, that speech-defective 
children comprise probably the largest single group of handicapped 
youngsters in our schools. Second, for the most part they are normally 
educable and potentially employable aside from their speech defects. 
Third, in view of the substantial progress made in speech correction in re- 
cent years, the great majority of speech-handicapped children can be cor- 
rected or materially benefited. Fourth, much of the special attention and 
help they need can be given by the classroom teacher through judicious 
adjustment of teaching policies and methods, together with a little special 
instruction and personal attention that is not excessively time-consuming 
and can be given by any teacher who has had an elementary introduction 
to speech correction. Speech-correction courses in teachers' colleges and 
in-service training programs are of basic importance in this connection. 
This is to be stressed all the more in view of the fact that even in a school 
system where there is a full-scale speech-correction program, its fullest 
effectiveness depends upon the sympathetic and insightful co-operation 
of the entire school staff. 



JOHNSON 193 

Such speech-correction programs, supervised by professionally trained 
speech correctionists, who serve as consultants for classroom teachers, 
conduct in-service training courses, and give individualized and small- 
group instruction to the more severely affected children, are coming to be 
accepted as the best means of dealing with the problem. Speech correc- 
tion, in this sense, is to be found in a rapidly increasing proportion of our 
nation's schools. Even so, it is doubtful that more than 10 per cent of the 
school children who need speech correction are receiving it at the present 
time. This proportion will rise steadily and substantially during the years 
immediately ahead if present trends continue. It is coming to be more and 
more clearly appreciated that, for the large numbers of children who need 
it, our schools have nothing else to offer that is more rewarding and lib- 
erating than effective speech correction. 

REFERENCES 
Source materials in the field of speech correction are numerous and varied. 

The chief journal is the Journal of Speech and Hearing Disorders, published 

quarterly by the American Speech and Hearing Association; the business office of 

this journal at present (1949) is located at Wayne University, Detroit, Michigan. 

Commonly used textbooks and workbooks are the following: 

AINRWORTH, STANLEY. Speech Correction Methods. New York: Prentice-Hall, Inc., 
1948. 

BRYNGELBON, B., and GLASPEY, E. Speech Improvement Cards. Chicago: Scott, 
Foresman & Co., 1941. 

FAIRBANKS, GRANT. Voice and Articulation Drillbook. New York: Harper & Bros., 
1940. 

. Practical Voice Practice. New York: Harper & Bros., 1944. 

JOHNSON, W. (Editor). Speech Problems of Children. Prepared by the American 
Speech and Hearing Association for the National Society for Crippled Children 
and Adults. New York: Grune and Stratton, 1949. 

JOHNSON, W.; BROWN, S.; CURTIS, J.; EDNEY, C.; and KEASTER, J. Speech-handi- 
capped School Children. New York: Harper & Bros., 1948. 

McCuLLOUGH, GRACE. Work and Practice Book for Speech Improvement. Magnolia, 
Massachusetts: Expression Co., 1940. 

SCHOOLFIELD, LUCILLE D. Better Speech and Better Reading. Magnolia, Massachusetts: 
Expression Co., 1937. 

VAN RIPER, CHARLES. Speech Correction: Principles and Methods. New York: Pren- 
tice-Hall, Inc., 1947 (revised). 

. Stuttering. Prepared under the editorship of Wendell Johnson for the Ameri- 
can Speech and Hearing Association. Chicago: National Society for Crippled Chil- 
dren and Adults, Inc., 1949. 

WEST, ROBERT; KENNEDY, Lou; and CARR, ANNA. The Rehabilitation of Speech. New 
York: Harper & Bros., 1947 (revised). 



CHAPTER XI 

TEACHING THE ORTHOPEDICALLY HANDICAPPED 
AND THE CARDIOPATHIC 



LAWRENCE J. LINCK 
Executive Director 

JAYNE SHOVEK 

Special-Education Consultant 

and 

EVELINE E. JACOBS 
Research Analyst 

National Society for Crippled Children and Adults, Inc. 
Chicago, Illinois 



INTRODUCTION 

In the past two decades, new horizons have opened in health, welfare, 
and education. Penicillin, the sulpha drugs, and streptomycin with other 
and still newer developments in chemotherapy have saved countless 
lives. Practical application of psychiatry to everyday problems of child 
care has been made possible through a heightened popular understanding 
of factors leading to mental and emotional instability. And in education, 
where interest was formerly concentrated on the three R/s, a recognition 
of the school's responsibility in serving the "whole child" has grown. 

Out of the older formal and narrow concept of education has developed 
the philosophy of a school program in which every phase of the child's 
development physical, mental, emotional, social is now becoming the 
concern of the school. John J. Lee has described the comprehensive 
functions of a modern educational system as follows: (a) the developmen- 
tal function physical, emotional, social maturation, and adjustment; 
(6) the diagnostic function educational, mental, and social, as well as 
medical; (c) the remedial function correction not only of reading dis- 
abilities, speech defects, etc., but of emotional imbalance and social 
maladjustment; (d) the preventative and protective function early detec- 
tion of physical defects and emotional disturbances; and (e) the knowledge 
function not only the fundamental skills but the whole vocational 
field. Dr. Lee concludes: 

When we observe the responsibility levied upon our schools under the knowl- 
edge function alone, it is almost alarming. To develop essential skills, requisite 

104 



LINCK, SHOVER, AND JACOBS 195 

knowledge, and social insight necessary to live in our complex world when one 
social crisis follows another in rapid succession is a herculean task; for our schools 
must be continually preparing 27,000,000 children to become future citizens. 
Add to this the first four functions which are new since the turn of the century 
and we see the tremendously widened task and responsibility that are levied 
upon our schools today. 1 

This chapter is concerned with the orthopedically handicapped, in- 
cluding all children with defects in size and structure of bone or joint or 
with deviations in muscle strength, co-ordination, or control. The cardio- 
patbic, which are classified by some authorities as children with lowered 
vitality and by others as children with special health problems, are 
grouped here with the orthopedically handicapped. This has been done 
not only because they are handicapped by a muscle defect (the heart 
muscle) but also because the general type of activity restrictions and 
curriculum adjustments which need to be made for them correspond 
closely to those for the orthopedically crippled. 

FINDING CRIPPLED CHILDREN 

All across the country, the question is constantly asked, "How can we 
know how many crippled children and children with heart defects there 
are in our community ?" An approximate answer may be secured by 
enumerations and surveys, but a more useful method is to establish and 
maintain an effective reporting system. Only in this way is the necessary 
information available on a continuously up-to-date basis. 

Among the most important sources of information regarding crippled 
children are the public schools. Countless undiscovered or neglected 
handicaps have been reported by alert classroom teachers who have rec- 
ognized deviations in activity, response, or accomplishment and have 
related these to untreated physical handicaps. Among such deviations, 
for instance, are poor motor control or co-ordination of the cerebral- 
palsied child; the "day-dreaming" of the child with a hearing handicap; 
the restlessness and lassitude of the cardiopathic; the "inattentiveness" 
of the epileptic; the physical disability of the child who finds movement 
painful because of bone or joint defects, arthritis, and so forth. 

Alertness of the teacher, followed by insistence upon competent medical 
diagnosis and treatment, can be of priceless value to the child. For early 
discovery and treatment paves the way for maximum physical improve- 
ment, which may mean full restoration or at least, prevention of further 
crippling effects. Thus, it is not rheumatic heart disease but rheumatic 
fever which is of greatest concern; it is the presence of bone or joint 



1 John J. Lee, "Educating Crippled Children," Crippled Child, XX (December, 
1942), 87. 



196 ORTHOPEDIC AND CARDIAC CASES 

tuberculosis and bone cancers which must be discovered before the 
child becomes crippled. 

Elements in the school program which are highly effective in case- 
finding are: (a) a continuous census, carefully directed and supervised, 
and (b) school health programs requiring physical examination or the 
presentation of a physician's certificate upon entrance. 

Important and active as case-finding agencies are the public health 
nurses and the state crippled-children's services, which hold diagnostic 
clinics on a state-wide basis throughout the year in every state and in 
Alaska, Hawaii, and Puerto Rico. Other sources of information in the 
location of cases are physicians, medical societies, the clergy, and, finally 
the extensive private-agency programs, such as those of the National 
Society for Crippled Children and Adults and its various affiliated state 
and local organizations, the National Foundation for Infantile Paralysis, 
the American Heart Association, and the many local social service 
agencies, health agencies, and hospitals. 

The fullest development and effectiveness of these case-finding re- 
sources can be achieved only when teachers and school authorities realize 
their own strategic position and make every effort to further the estab- 
lishment of such services where they do not exist, to improve them 
where they are inadequate, and to utilize them to the maximum. 

CLASSIFICATION OF CRIPPLING CONDITIONS 

Most of the complicated medical facts relating to the scores of differ- 
ent crippling conditions are not within the realm of practical use by the 
teacher or school administrator. A general familiarity with crippling and 
cardiac disorders and with conditions leading to them is, however, indis- 
pensable for every classroom teacher. Not only does he have continuous 
need of such information as he works with the child and his family but 
such an awareness of the crippling effects of many infectious diseases 
and an alertness in seeking the existence of unrecognized multiple handi- 
caps will many times lead to seeking urgently needed treatment. Above 
all, he can help to forestall the development of the devastating psychologi- 
cal handicaps which so frequently accompany physical crippling. 
Briefly, crippling conditions may be classified as follows: 

1. Crippling due to infection (e.g., bone and joint tuberculosis, osteomyelitis, 
rheumatoid arthritis, syphilis) 

2. Cerebral palsy (spasticity, athetosis, ataxia, rigidity, tremors, or variations of 
these) 

3. Crippling due to birth injury (e.g., Erb's palsy, bone fractures) 

4. Cardiopathic conditions (e.g., congenital, acquired) 

5. Congenital anomalies (e.g., congenital amputation, congenital dislocation, 
clubfoot, torticollis, spine bifida, cleft lip and palate) 



LINCK, SKOVER, AND JACOBS 197 

6. Traumatic crippling (e.g., amputation, burns, fractures, joint contractures) 

7. Tumors (e.g., bone tumors, bone cysts) 

8. Developmental diseases (e.g., coxa plana, spinal osteochondritis) 

9. Other conditions (e.g., fragile bones, spinal curvature, postural foot conditions, 
muscular atrophy, muscular dystrophy, rickets) 

GENERAL CHARACTERISTICS OF CRIPPLED CHILDREN 
The extent and importance of the problem of the handicapped child is 
difficult to comprehend and is but vaguely understood by the layman. On 
December 31, 1946, the Crippled Children's Services of the United States 
Children's Bureau had already listed 449,545 children under the age of 
twenty-one on the registers of the forty-eight states, Puerto Rico, 
Alaska, and Hawaii. 2 And this is only part of the story, since wide 
variations among the states as to the definition of crippling, along with 
differences in case-finding efforts, have meant that the names of many 
handicapped children are not included on these registers. The rapid 
growth in enumeration that can be expected as crippling becomes more 
broadly defined, services expanded, and efforts at case-finding are in- 
creased is indicated by the addition of over 70,000 names to the register 
in the two-year period, 1944 to 1946. 

Sifting through the various estimates and surveys on crippling leads 
us to an estimate of 550,000 children with serious orthopedic impairments 
in the United States, or 1 in 100 persons under the age of twenty-one. 3 In 
addition, the Children's Bureau estimates that rheumatic heart cases 
among persons under twenty-one years of age number 500,000. 4 

Since handicaps range in severity from relative mildness to a degree of 
involvement which precludes school attendance, it is clear that although 
some highly individualized educational planning needs to be done, by no 



2 Report of Division of Statistical Reasearch, Children's Bureau, Federal Security 
Agency, January 26, 1948. 

8 These would be listed as: 175,000 cerebral-palsied; 100,000 with crippling effects 
from poliomyelitis; and 275,000 crippled from all other causes, including accidents, 
infectious diseases, nerve and muscle injuries leading to orthopedic defects, rickets, 
etc. The estimate of cerebral-palsy incidence is made on the basis of studies by Dr. 
Winthrop Morgan Phelps, Director, Children's Rehabilitation Institute, Cockeysville, 
Maryland. The estimate of crippling effects of poliomyelitis is based on statistics in 
Facts and Figures about Infantile Paralysis (New York: National Foundation for In- 
fantile Paralysis, 1947). Total figures on orthopedic handicapping are from Kessler, 
who makes an estimate of 3.72 per 1,000 general population. (Henry H. Kessler, 
Rehabilitation of the Physically Handicapped, p. 36. New York: Columbia University 
Press, 1947.) This estimate closely approximates that of 1 per cent of school children 
made by Elise Martens in The Needs of Exceptional Children (Washington: United 
States Office of Education, 1942). 

4 Report of Division of Statistical Research, op. cit. 



198 ORTHOPEDIC AND CARDIAC CASES 

means do all of these children require special educational facilities. The 
mildly handicapped should take their places in regular classes, while 
those with more serious physical limitations or multiple handicaps need 
adjustments varying from part-time special-class instruction up to bed- 
side teaching. 

There are some characteristics of crippled children which, known and 
recognized in advance, will markedly affect the planning for their educa- 
tion. In brief: (a) Many orthopedically crippled children have multiple 
handicaps; (6) a large number of orthopedically crippled children are 
over-age for their grade placement; (c) more boys than girls are crippled 
(d) proportionately fewer Negroes are in crippled children's schools; (e) 
there is a skewed distribution on the basis of intelligence quotient. These 
characteristics will be discussed briefly in the following pages, 
l Children with multiple handicaps present special problems. Defects 
of communication skills and serious motor disabilities are the handicaps 
which place the greatest obstacles in the way of the sharing and participa- 
tion which makes education meaningful j The child who has both sensory 
defect and physical crippling requires discerning and skilled teachers if 
he is to realize the maximum use of his assets. Poorly trained or unim- 
aginative teachers frequently mistake one defect for another, such as 
deafness for mental retardation, cardiac disability for low vitality, and so 
forth. 

In one study, two-thirds of those with multiple handicaps were cere- 
bral-palsied children who frequently had more than one accompanying 
defect, including impairment of speech, hearing, and vision and mental 
retardation. 6 

^he picture of the chronological-age distribution of children in special 
classes is rapidly changing from one which includes only children in the 
middle elementary grades to one which focuses attention also on the pre- 
school child and those in secondary schools^ Increasingly, emphasis is be- 
ing placed on the young child in therapeutic and educational programs, 
and schools are making attempts also to meet the needs of children of 
secondary-school age. (One study shows that almost three-fourths of 
orthopedically crippled children in school are from six to fourteen 
years of ageJJThis is highly significant for curriculum-planning, partic- 
ularly when it is noted also that, above the age of thirteen, there is a 



*Romaine Prior Mackie, Crippled Children in American Education, p. 30. New 
York: Bureau of Publications, Teachers College, Columbia University, 1945. 

6 Ibid., p. 32. In the Mackie study, 70.9 per cent of the total studied were in the 
age group fom six to fourteen, with the greatest number, 20.4 per cent, in the two 
years, ten and eleven. Only 3.3 per cent were under six, and only 0.5 per cent as 
young as three years. 



LINCK, SHOVER, AND JACOBS 199 

marked drop in the number of crippled children in school. Again, it is 
found that 80 to 90 per cent of crippled school children are in the elemen- 
tary schools, reaching a peak enrolment in the fifth grade. 7 

It would appear that an analysis of the reasons for this concentration 
in the lower grades would be most revealing. There could be named, for 
instance, the lack of facilities for the orthopedically crippled child of 
secondary-school age, architectural barriers alone forming a most serious 
obstacle. Then there are the lack of transportation facilities ta existing 
schools, the lack of curriculum adjustments to the mentally and educa- 
tionally retarded child, and the lack of resources for psychological guid- 
ance to help these children toward the social and emotional maturity nec- 
cessary for successful attendance at secondary schools. 

\he many orthopedically handicapped and cardiopathic children who, 
are over-age for their grade placement is another factor having a 'direct 
bearing on curriculum-planning. 8 This retardation is to be expected be- 
cause of interruptions in school attendance and classwork for medical 
and therapeutic treatments, hospitalization, and home confinement^ 

(There are more boys than girls among the crippled, a fact which is in- 
dicated in numerous studies. A ratio of approximately 55 boys to 45 
girls seems to be rather generally maintained. 9 The significance of this 
lies in the planning for vocational -training facilities, the development of 
recreational and interest projects, as well as other such phases of the 
school program./ 

vThe proportionately larger number of white children receiving the 
benefits of special education facilities 10 may be affected not only by the 



7 Ibid., p. 33. The study by Romaine Mackie reported approximately 80 per cent of 
the children in Grades I through VIII, 4.4 per cent in preschool classes, and only 
7.4 per cent in grades higher than VIII, while the U. S. Office of Education reported 
that 89 percent of 24,784 crippled children in city school systems were in the elementary 
grades. See: Emery M. Foster and Eiise H. Martens, "Statistics of Special Schools and 
Classes for Exceptional Children," Biennial Survey of Education in the United States, 
1938-40, Vol. II, chap. v. Washington: Federal Security Agency, Office of Education, 
1942. 

8 Mackie, op. cit., p. 37. One study, for instance, shows approximately two-fifths of 
crippled children over-age for their grade placement, and another shows more than 
one-half. Report of the Subcommittee on Orthopedically Handicapped Children, p. 35. 
New York: New York City Board of Education, 1941. 

9 Mackie, op. cit., p. 37. See also, Report of the Subcommittee on Physically Handi- 
capped Children, op. cit., p. 35; and White House Conference on Child Health and 
Protection, The Handicapped Child, pp. 121-22 (New York: Century Co., 1933). 

10 With respect to race, the proportion of 82.0 per cent white to 6.9 per cent 
Negro is reported in two studies: Mackie, op. cit., p. 43, and the report of the Com- 
mission for the Study of Crippled Children, The Crippled Child in New York City 9 
p. 19 (New York: The Commission, 1940). 



200 ORTHOPEDIC AND CARDIAC CASES 

variation in educational provisions for white as against Negro children 
and by indifferent case-finding efforts in Negro communities but may also 
be subject to variations in incidenc^Dr. Winthrop M. Phelps of the 
Children's Rehabilitation Institute, Cockeysville, Maryland, has offered 
the opinion on the basis of thirty years of work with the cerebral-palsied, 
for instance, that there is a lower incidence of this defect among the 
Negroes. 11 

Finally, among characteristics important to educational planning are 
the results shown by psychological testing of crippled children. The great 
majority of school systems, either by statute or by administrative ruling, 
have unfortunately designated an arbitrary limit in the form of I.Q. 
ratings to the boundary between acceptability and nonacceptability as 
students, although the fallacy of this procedure has long been recog- 
nized by psychologists. [Reports of individual and group tests indicate 
that many more scores fall below an intelligence quotient of 80 than fall 
above 120. 12 In interpreting the scores of crippled children, several factors 
must be kept in mind, namely, the lack of satisfactory testing techniques 
for cerebral-palsied children; the difficulty of testing children with mul- 
tiple handicaps; the unfavorable effect of long periods of hospitalization 
and bed confinement and limited social experiencesjThe intelligence of 
the cerebral-palsied child, in particular, has been the subject of much 
misunderstanding due to the difficulty of testing children with combined 
motor and sensory disabilities. Although studies by J. Thomas Mclntire 
show that two-thirds of cerebral-palsied children may be classified as 
normal in intelligence, 18 many of these unfortunate youngsters are fre- 
quently placed arbitrarily with the mentally deficient or are excluded 
from school. 

MEDICAL NEEDS 

Education cannot be isolated in the life of a child. Schools, textbooks, 
teachers, and lessons are only the formalistic, tangible phases of educa- 
tion. Health, home life, companionship, and a myriad of similar factors 
enter into the picture. 

When a child is handicapped, there are additional complications. 
Medical care and treatment and a whole complex of therapies have now 
become an integral part of the educational program for the handicapped, 

11 Winthrop Morgan Phelps, Testimony at hearings before the Committee on 
Labor, Subcommittee on Aid to Physically Handicapped, House of Representatives, 
Seventy-ninth Congress, First Session, Part 20, "Spastics," October 11, 1945, pp. 
2056-57. 

12 Mackie, op. cit., p. 44. 

11 J. Thomas Mclntire, "The Incidence of Feeble-Mindedness in the Cerebral- 
palsied," American Journal of Mental Deficiency t L (April, 1946), 494. 



LINCK, SHOVER, AND JACOBS 201 

with the realization that education and medical care must parallel each 
other in order to achieve maximum effectiveness in each. Without max- 
imum physical ability and co-ordination, the child is unable to secure 
all the benefits of the educational program, and, equally important, the 
child cannot benefit fully from medical care and treatment unless he is 
enjoying the mental stimulation, the satisfactions of achievement, and 
the delights of new worlds to conquer through books that come to him 
under the guidance of the teacher. Thus, it is inevitable that the teacher 
can be truly effective only if he understands the physical needs of the 
child and can help him toward the best use of his abilities and only if he 
knows how far and how fast the child should be urged to move. 

A school program for the cerebral-palsied offers an excellent example 
of teamwork in operation. Some schools in metropolitan areas, for in- 
stance, have a special kindergarten for preschool cerebral-palsied chil- 
dren. The diagnostic procedure itself, however, may include participation 
by the neurologist, the orthopedic surgeon, the ophthalmologist, the 
otologist, the pediatrician, the speech pathologist, the psychologist, and 
the psychiatrist. Following an assessment of the child's abilities and a 
prognosis for training and education, recommendations are made for 
treatment. 

It is at this point that the teacher comes into his own, for in school, 
where the child spends much of his active waking time, a program of 
treatment and education may be most effectively and efficiently insti- 
tuted. When fully informed as to the medical recommendations for 
therapy and the measures being pursued by the therapists physical, 
occupational, and speech the teacher can supplement their efforts, 
know when and where pressures need be applied, and what should be 
expected from the child, as well as how best to encourage these young- 
sters to use their abilities in school. Thus, no phase of the treatment 
program can be isolated. 

Some of the values arising out of this teamwork are greater teaching 
effectiveness, avoidance of duplication of effort, protection of the child 
from the anxiety of conflicting authority and the frustration of being 
faced with tasks beyond his accomplishment or from the perpetuation of 
an emotional immaturity resulting from overprotection. Again, it makes 
possible a greater use of available resources and a more consistent pro- 
gram for the child. 

It can, therefore, be seen that the view held by some that medical 
needs are not properly a part of a discussion of educational planning is 
not only short-sighted but distinctly contrary to the best interests of the 
crippled child. Teamwork is of primary importance. This cannot be em- 
phasized too strongly, for all who play a role in the child's education and 



202 ORTHOPEDIC AND CARDIAC CASES 

treatment are members of this team family doctor, medical specialist, 
physical therapist, occupational therapist, speech therapist, teacher, and 
parent. Whether the special-education services are offered at home, in the 
hospital, in a special school, or in a regular school, it is the co-ordination 
of these services that is important. The doctor needs to know the special 
demands of schoolwork and class attendance on the child so he can outline 
an activity program; the teacher needs to know to what degree the child 
is physically capable of maintaining sustained effort. 

In fact, the relationship between medical care and education of cere- 
bral-palsied children is so close that many authorities consider each to 
be of equal therapeutic value to the child. 14 Dr. Winthrop M. Phelps has 
stated: 

A child with cerebral palsy who is educated but given no physical training will 
make less progress in school than if he were also receiving physical treatment. The 
situation is the same if the child is getting physical treatment and no education. 
His progress physically will not be as rapid as if he were learning normally at the 
same time. The two fields interrelate and when carried out simultaneously, 
total rehabilitation is more successful. 15 

In more ways than one, the crippled child's future may lie in the hands 
of his teacher. Many times the success of surgical operations and medical 
treatment depends upon the teacher's skill and inspiration in guiding the 
child toward acceptance of his handicap and in stimulating him to earnest 
effort in the use of his physical and mental energies. 

There is a delicate balance to be achieved in stimulating a child to do 
his best and yet not making requirements of him beyond his capacities. 
Thus, there is a special need for constant medical supervision supervi- 
sion of physical activity, rest schedule, therapy, etc. Whether this is 
done through regular check-ups on the part of the family physician or by 
visits of a medical specialist retained by the school for this service, as is 
done in some cases, is a matter for individual decision. 

Physical therapy is an indispensable service in the crippled child's 
school program. When so offered, and correlated with other services, it 
saves time, effort, and energy on the part of child, teacher, and therapist; 
it serves to link more closely the educational and medical program; and it 
makes possible the greatest service to the largest number of children. 

Other dramatic changes have been made in recent years in school pro- 
grams for crippled children. Occupational therapy has come into its own 
in the training and rehabilitation of the handicapped, going far beyond 

"Earl R. Carlson, "Give Them Education," Crippled Child, XXV (December, 
1947), 4-5, 29-30. 

"Winthrop M. Phelps, "Questions Parents Ask: With Answers," Crippled Child 
XXV (August, 1947), 4^5. 



LINCK, SHOVER, AND JACOBS 203 

the craf twork to which it is limited in the thinking of so many. As Miss 
Spackman notes, the four main fields in which occupational therapy is 
called upon are "psychiatric, restoration of physical function, prevoca- 
tional, and diversional or preventive," 16 utilizing techniques in recrea- 
tion, industrial arts, education, and the creative arts. The place which 
these therapeutic techniques hold, then, in the educational program is 
high, for they touch upon development of the child's mental and emo- 
tional life, his motor co-ordination and control, his employment abilities, 
and his social life. 

Increasingly, therefore, special schools and classes for crippled children 
are adding occupational therapy to the physical therapy which has been 
a part of their programs for so many years. Nor is such service limited 
to large cities, since crippled children's societies in the many communities 
are underwriting its cost in order to demonstrate the value of occupa- 
tional therapy as an integral phase of the educational program of handi- 
capped children. Again, it must be stressed that both physical therapy 
and occupational therapy must be offered only under medical supervision 
and by qualified therapists. 

EDUCATIONAL PROVISIONS FOR CRIPPLED CHILDREN 
Whenever their physical abilities permit, orthopedically handicapped 
and cardiopathic children should attend regular classes with normal 
children, where they may have as many of the same kinds of experiences 
as possible and may learn to respond on the level that will be expected of 
them when they enter the competitive world. For those who are not 
physically capable of such a program, however, it is necessary to adapt 
staff, facilities, curriculum, and equipment so that all who can may re- 
ceive educational benefits. 

Organization of Educational Programs 

Three forms of educational provisions are made for orthopedically 
crippled and cardiopathic children the day school, the residential 
school, and teaching of the homebound. 

The day school, which accommodates by far the greatest number and 
variety of children with such handicaps, may include any of four types: 
special provisions in regular classes, special classes in regular schools, 
special centers for the handicapped in schools for normal children, and 
special schools, which may be for the orthopedically handicapped only or 
may include all types of exceptional children. 



18 Clare S. Spackman, in Advancing the Education of the Hospitalized Child, p. 61. 
Report of a conference sponsored by National Foundation for Infantile Paralysis 
February 26-27, 1948. 



204 ORTHOPEDIC AND CARDIAC CASES 

(Residential facilities include three types: institutions or sanitoria, 
convalescent homes, and hospitals. To these, special teachers are as- 
signed. Probably the greatest_value of such service to the child who is 
hospitalized br"cofifinea~aThome is the salutary effect on his mental and 
emotional well-being. The child who is kept busy, whose mind is occupied, 
and who has immediate and important goals toward which to work is 
happier and more relaxed and makes more rapid progress toward recov- 
ery than the child who is left to his own devices. Maintaining grade level 
has been relegated to a secondary place by those educators who consider 
this too narrow a concern and one which too often causes us to lose sight 
of the deep, personal needs of the child. 17 

^The third type of educational program, teaching of the homebound, is 
employed for the child who is too handicapped to be transported to 
school, for whom transportation facilities are not available, or who is ex- 
cluded from school for some other reason. 

Curriculum Provisions 

What are some of the dynamic teaching aids that will make education 
comprehensive, alive, and interesting to children? There are many, as 
will be seen in the following paragraphs. 

Use can be made of visual aids, including motion pictures, slides, 
stereopticans, and the still newer development of projected books, which, 
operated by a finger or a toe, enable the bedfast child to read. Ceiling 
projectors also bring the motion picture to the totally helpless. 

Recordings open other new worlds, offering a dramatic way of teaching 
and stimulating an interest in and love of music. Other auditory aids are 
telephone and radio. In Iowa, for instance, experiments with two-way 
electrical equipment has been successfully carried on, enabling the home- 
bound child to participate in class discussion. The potentialities of radio 
have not been even explored, much less utilized, although some hospital 
classes have used this method of dramatizing history, current events, and 
social studies. Television, now in its infancy, offers further field for spec- 
ulation as to its use as an educational tool. 

Page-turners for those who could not otherwise read books and elec- 
tromatic typewriters for children who cannot write due to lack of motor 
control and co-ordination are among other types of equipment which can 
be of invaluable aid in stimulating the crippled and cardiopathic to share 
in the world about them and to make their own contribution to it. 

Nor is a wealth of highly expensive equipment and educational aids 
required. Many times it is the homemade equipment, the makeshift ap- 

17 See comments by Dr. Alice V. Keliher in Advancing the Education of the Ho*- 
Vitalized Child, op. cit., p. 25. 



LINCK, SHOVER, AND JACOBS 205 

pliance, the practical use of everyday materials which is most effective 
in bringing out creative abilities and crystallizing interest. New realms of 
science can be introduced to children through imaginative use of simple 
magnets, bells, thermometers, and barometers. Chemical gardens, bulbs, 
and seeds are the nucleus for exciting the children's interest in botany 
and agriculture. Rocks, minerals, and fossils can provide a way of bring- 
ing to the child the thrill of discovery in geology and paleontology. Simple 
experiments in chemistry and physics offer opportunities for an entire 
hospital group to participate or for a whole class to rediscover the findings 
of Galileo, Newton, and the great chemists. 

Such learning experiences provide motivation in education, as opposed 
to the blocking, anxiety, and failure which so often result from efforts 
to stimulate through competition with others. 

Subjects in social studies are made vivid and realistic by the teacher 
who directs amateur construction projects in the sandpile or on the work 
table through use of plastics, tin foil, wood blocks, and toys. Three- 
dimensional pictures supplementing a story-hour or history lesson im- 
press the subject indelibly upon the pliable minds of children. Cutting up 
old magazines, the presenting of plays based on American folklore, and 
constructing puppet shows are not simply recreational projects but can 
be dramatic methods of teaching arts and science as well as history, 
civics, and social science. 

Group projects in art, venturing into story-telling, music, singing, 
finger-painting, and a myriad of craft projects offer endless opportunities 
to the imaginative, skilled teacher. The color and cheerfulness growing 
out of such an atmosphere provide an environment in which children are 
stimulated to make use of their creative abilities. 

Extra-curriculum activities, as well as classwork, need skilled guid- 
ance. Experiences which are closely linked with various phases of class- 
work and at the same time provide excellent means of outside social con- 
tacts include outings, school picnics, trips to zoos, museums, and fac- 
tories, visits to farms, and so forth. These, along with games and activ- 
ities requiring exercise within the physical capabilities of the children, 
can be scheduled in accordance with individual needs and limitations. 

Vocational and Personal Guidance Needs 

Since the two major aims of treatment and education of the handi- 
capped are to help them to be socially acceptable and to make them par- 
tially or completely employable, the importance of enrichment of the 
curriculum cannot be underestimated. 

The more that abilities rather than disabilities, and assets rather than 
liabilities, can be made the basis for formulating the crippled child's pro- 



206 ORTHOPEDIC AND CARDIAC CASES 

gram, the more it will be possible to develop those skills which can be 
made the basis of economic independence. Special training can be en- 
couraged, for instance, in watch-making, jewelry-making, typing, up- 
holstery, sewing, music, photography, industrial arts, and other such ac- 
complishments, any of which may become a source of income. 

The limitations which severely handicapped persons will have in 
achieving economic self-sufficiency are recognized, of course, but even 
when partial success is attained or when the severely handicapped can be 
made self-sustaining under sheltered workshop conditions, a desirable 
goal has been reached. Although the problem of the severely handicapped 
is one of a large-scale public function, the school unquestionably plays a 
highly important role in the approach to this task. 

Vocational guidance, education, training, and placement are thus in- 
tegral functions of the educational program. The need for vocational 
training earlier than is necessary with the physically normal child and the 
special needs of the physically handicapped in this regard are discussed 
in chapter v of this volume. 

The function of the schools in providing psychological service as one 
phase of guidance cannot be separated from an effective educational 
program. As is shown in chapter iii of this volume, it extends deep into 
the child's life social, health, educational, and vocational and, indeed, 
cannot stop there, for some of the most urgent guidance needs are those 
which must be met after graduation. Many schools have assigned to these 
duties a well-trained counselor whose function is above and beyond 
teaching and who continues contact with pupils until the best possible 
social and vocational adjustment has been achieved. 

One of the most important functions of the teacher is to aid in helping 
the child to accept his handicap, to prevent the psychological crippling 
which is so often more damaging than a physical handicap. This begins 
with personal friendliness, warmth, personal interest, patience, kindli- 
ness, and honest liking and respect for children, along with an under- 
standing and recognition of their handicaps. The teacher should know 
that a handicap from birth has an entirely different impact on the person- 
ality from one acquired later. Every effort should be directed toward 
assisting the child toward the greatest possible degree of self-acceptance, 
self-reliance, and adjustment to his limitations and toward a realization 
that he should not expect favors and concessions because of his handicap. 
It is in this area that the teacher should seek the guidance of competent 
psychological consultation. The objective should be not only to bring 
the child to accept his handicap but also to develop a philosophical atti- 
tude which will help him face the inevitable discussion of it, the mo- 
ments of being stared at, and other undesired attentions he will receive be- 
cause of his physical condition. To achieve this, he needs to gain as much 



LINCK, SHOVER, AND JACOBS 207 

knowledge regarding his handicap as his degree of maturity makes ad- 
visable; he must secure understanding of the reasons people react to 
handicapped persons as they do; and he needs to be given actual tech- 
niques of meeting unpleasantnesses arising from the reactions of others 
to him. 

Interpreting the handicapped child to his classmates to gain their un- 
derstanding and acceptance and to eliminate the nagging, teasing, and 
imitating of schoolmates is of paramount importance. Once successful 
steps have been taken toward achieving this aim, the way is paved for 
the handicapped child to share responsibilities and to participate to the 
extent of his ability in class activities as well as games and to gain the 
feeling of adequacy and personal worth so essential to emotional ma- 
turity. The child who has confidence in his acceptance by those whose re- 
spect he values, who has formed significant friendships, and who has a 
sense of belonging is not crippled by fears and inferiorities which find their 
outlet in undesirable compensatory behavior. 

Every child needs a balance of affection and achievement. Lacking 
the one, he will attempt to compensate by seeking too much of the other. 
All too frequently, the physically handicapped child is faced with rejec- 
tion and withdrawal of affection at home and its counterpart, overprotec- 
tion. Either type of handling is equally damaging, tending to increase the 
child's dependence, his fear of new experiences, his insecurity, and his 
exaggerated quest for affectional response. 

Although the teacher cannot correct at school or in the hospital class 
the defects of a child's home adjustment, he can help the child face his 
difficulties through offering him sufficient opportunities to progress to- 
ward achievement in those areas where his abilities lie as well as toward 
success in his relationships with other children. Thus, he will have that 
important measure of security which each child must find in satisfactory 
social contacts outside his home. 

Acquaintance of the teacher with the child's family is imperative, so 
that he can be equipped for a real understanding of the child. Through 
such a working relationship, too, he can serve as a liaison between the 
family and resources for child guidance and health services which are 
available the school psychologist, the behavior clinic, the child welfare 
worker, the public health nurse, college and university research centers, 
and others. 

As described above, the utilization of skills in arts and crafts, dra- 
matics, music, shopwork, arid hobbies offers the means of self-expression 
and of building self-confidence in achievement, thus helping the handi- 
capped child in growth toward social maturity and emotional stability 
and in the development of a richer personality. 

Finally, participation in group activities is basic in integrating the 



208 ORTHOPEDIC AND CARDIAC CASES 

handicapped child into community life. More effectively than any other 
agency, the school can provide these experiences which enable crippled 
children to share activities with normal children, even those activities in 
which their physical incapacity permits only limited participation. 
.^Special problems are presented by the large number of crippled and 
cardiopathic children who are over-age for their grade. Severe emo- 
tional upsets frequently occur during adolescent years because of lack of 
social acceptance and limitations in ability to participate in the activities 
of this age group. The need for extended opportunities, including expert 
educational counseling at the secondary-school level, cannot be stressed 
too greatjyjlt is, indeed, a sad commentary that the majority of ortho- 
pedically crippled children drop out before reaching high school. It is not 
to be inferred, however, that all the essential adjustments lie within the 
province of the formal school curriculum; for even the most excellent 
facilities cannot be effectively utilized by young people who are unpre- 
pared for the social world in which they must live. 

Although some phases of this personal growth can be developed 
through stimulating participation in Scout troops, clubs, and other in- 
terest groups, there is another and vitally important aspect. This is per- 
sonal appearance and good grooming. All too often the role played by 
personal appearance in the shaping of the personality of a handicapped 
child is overlooked. The feeling of personal worth, confidence, and secur- 
ity which is so frequently lacking in the child with a physical handicap 
particularly a handicap which is disfiguring or which makes the individual 
unprepossessing can be fostered best in the clean, well-groomed, well- 
dressed child. 

The discussion so far has taken for granted the existence of resources 
and facilities to meet these varied and special needs of the orthopedically 
crippled and cardiopathic children. There are many communities, how- 
ever, where such facilities are not available, and it is here that the contri- 
butions made by voluntary agencies and service clubs have proved so 
valuable. State societies for crippled children, local agencies, civic and 
service groups, and fraternal organizations have all participated in vari- 
ous communities to provide equipment for special orthopedic classes 
audiometers, station wagons, and aids, braces, and prostheses, to men- 
tion a few. These private groups have also contributed innumerable other 
types of support for school programs, including underwriting the salaries 
of special teachers, physical therapists, occupational therapists, and 
speech therapists and supporting adequate legislation for special educa- 
tion. Such programs, it should be made clear to all concerned, remain 
under school supervision and under the public educational control. 

The question of special services to certain diagnostic groups is one 



LINCK, SHOVER, AND JACOBS 209 

which frequently arises. There are some who believe that separate pro- 
grams should be designed for different types of handicapped children, 
such as the cerebral-palsied, the blind, and the cardiopathic, holding that 
such children should be placed with similarly handicapped children in 
order to avoid frustration and undue competition. 

Others believe, however, that all effort should be directed toward paving 
the way for close participation not only in the activities of other types of 
exceptional children but also in those of normal children. This viewpoint 
is supported by the fact that many children with physical limitations 
find it easier to accept their handicaps when they are in situations which 
help to emphasize those elements of superiority that they do possess. 
The ambulatory child, who can run an errand for one who cannot walk 
and, in turn, be helped by the child who perhaps cannot walk but has 
finger dexterity, finds it easier to adjust to his own limitations and gains 
a feeling of usefulness and worth. Early in life the handicapped person 
must face the reality of his ultimate entrance into a world peopled chiefly 
by the nonhandicapped. This is more easily done if the child has become 
adjusted to this reality by early and gradual experience than if he is 
faced with it suddenly after a relatively sheltered and protected school 
life. 

Some of these adjustments can be effected in preschool years through 
nursery-school experiences. The values of such facilities for orthopedically 
handicapped children are being stressed, more especially for the cerebral- 
palsied, because these children need early, consistent training. Since 
their lack of motor control and co-ordination is frequently complicated 
by defects of speech and hearing, it takes them much longer to acquire the 
skills necessary for classroom participation. Increasingly, pressures for 
broadening state Special-education provisions for young children are be- 
ginning to be felt. Among these is a movement to lower the entrance age 
for the handicapped child so that the parent, who is carrying the burden 
of care and training at this age, may have the benefit of guidance and 
supervision during those preschool years. Financial aid is usually avail- 
able to local school systems for services thus rendered. 

As one study states: 

The early years before the child would ordinarily enter school offer so much in 
the way of possibility for physical improvement and for promoting an intellectual, 
emotional, and social development which is as nearly normal as possible, that the 
best efforts should be concentrated on this period. 

By an adequate process of discovery, effective follow-up, and admission to 
school at as early an age as possible, the nature of the orthopedically handicapped 
group could be materially changed. Many of them could be so benefited that 
they could take their places in regular schools rather than in orthopedic schools, 



210 ORTHOPEDIC AND CARDIAC CASES 

and all would be in so much better condition to profit by their school experiences 
that the effectiveness of the schools would be increased manifold. Development 
of the possibilities that lie in the area from birth to the present minimum school 
age will pay large dividends to the individual and to society." 18 

Throughout the elementary grades, special remedial programs in the 
basic skills are necessary with the orthopedically handicapped and cardio- 
pathic, because of frequent interruptions in school attendance caused by 
absence for medical care and by difficulties many experience in gaining 
and maintaining necessary motor controls. Thus, the teacher must be on 
the alert to detect difficulties or failures on the part of these children to 
meet generally expected achievement levels which are related to inade- 
quate grasp of reading, writing, spelling, and arithmetic. For this and 
many other reasons, a fixed grading and promotion system is not an ap- 
propriate educational procedure with crippled children. Standards of 
grading should be flexible, based on the best a child can do, and promo- 
tions should be judged according to a wide range of factors. 

Closely linked with accomplishment in school is the degree to which 
nutritional needs of the child are met. Therefore, a vital phase of 
planning for the orthopedically handicapped is that of such dietary 
supervision as may be exercised by the school. Where school lunches are 
provided under a tax-supported program, special care can be given to 
proper food balance and adequate intake. This is particularly impor- 
tant in some conditions such as cerebral palsy of the athetoid type. The 
caloric intake of these children is tremendous, and their nutritional needs 
may be so disturbing as to affect their entire response to educational and 
treatment programs. 

Special Equipment Needed 

Children having handicaps which do not affect their locomotion are 
not in need of the special equipment and architectural adjustments that 
are required by the crippled. Some of the factors which need to be con- 
sidered for the orthopedically handicapped are as follows: 

Elimination of Architectural Barriers. If possible, the building accom- 
modating the orthopedically handicapped and the cardiopathic should 
be one story only. If this is not possible, elevators and ramps are needed 
to accommodate the wheel chairs and those children who cannot or are 
not permitted to climb stairs. There should be wide doorways to facil- 
itate the locomotion of persons on crutches and in wheel chairs. Acces- 

18 Services to the Orthopedically Handicapped, p. 12. Report of a Study Made under 
the Auspices of the Trustees of the Widener Memorial School for Crippled Children 
and the Board of Public Education, School District of Philadelphia. Philadelphia: 
Walther Printing House, 1942. 



LINCK, SHOVER, AND JACOBS 211 

sibility of exits, wardrobes, lavatories, toilets, and drinking fountains 
should be planned with care. 19 

Safety Factors. Recessed radiators, composition floors, and smooth 
walls are among essential prerequisites of safety. Railings, not only 
along hallways and stairways but also in the center of hallways to en- 
courage walking and self-help, are of primary importance. Safety factors 
are involved not only in equipment and facilities, however, for some in- 
volve the human element. For instance, the child with tubercular bones 
must be protected from bumps and bruises, and the cerebral-palsied child 
must be helped to maintain his balance and posture, to avoid painful falls. 

Factors in Relaxation 

There is little in the school program for normal children which does not 
apply with equal emphasis to that for the orthopedically handicapped 
and cardiopathic. Elimination of elements of strain and sources of dis- 
traction, important for all children, are doubly important for the handi- 
capped child. Among the factors in relaxation which should be empha- 
sized are soft color schemes, sound-absorbent walls and ceilings to 
prevent acoustic trauma, good ventilation and lighting, dull surfaces on 
walls and equipment to prevent eye strain, and even the color of the 
chalk used on the blackboard. It has been found that certain shades of 
yellow and orange are preferable to white chalk since they provide the 
desired contrast and at the same time are more restful to the eye. 

Finally, there should be well-ventilated rooms, with cots and blankets 
for those who require regular rest periods. Relaxation chairs for the 
cerebral-palsied and reclining rest chairs for the cardiopathic are highly 
desirable and, in many cases, essential. 

Special mention should be made of the fact that the orthopedically 
crippled and the cardiopathic spend much more time in the classroom 
than does the normal child and frequently completes most of his elemen- 
tary-school requirements in the same room. It is important, then, that 
this be a pleasant room and that it receive constant attention with re- 
spect to cleanliness, brightness, and cheerfulness. 

Special Equipment To Meet Individual Needs. Of primary concern 
with regard to special equipment is that for physical therapy. Due to 
differing needs of various types of handicapped children among the 

19 Within the past year, three highly informative articles have been published by 
the National Society for Crippled Children discussing the problem of architectural 
barriers: Warren Gauerke, "When You Build That School for the Handicapped/' 
Crippled Child, XXVI (December, 1948), 12-13; Christine Salmon, "Architects Can 
Help You Plan for the Handicapped/' Crippled Child, XXVI (June, 1948, and August, 
1948); Al Tudyman, "A Public School Plan for Special Cerebral-Palsy Classes/' 
Crippled Child, XXVI (February, 1949), 20-22, 29-30. 



212 ORTHOPEDIC AND CARDIAC CASES 

orthopedically handicapped and variations in emphasis upon kinds of 
treatment, such equipment is not standardized. Treatment tables, de- 
vices for corrective exercises or for encouragement in walking, and equip- 
ment for heat treatments and hydrotherapy are among the most fre- 
quently used. 20 Plans for pools and other types of costly installations 
should receive the most careful scrutiny before they are included in 
orthopedic-school equipment. 

Many times, the needed adjustments in equipment can be made by the 
school carpenter, under medical direction. A paramount need is for 
movable furniture, including movable desks adjustable as to height and 
having seats with needed attachments. For cerebral -palsied children, who 
so frequently have additional handicaps of speech, vision, or hearing, it is 
advisable to have sight-saving material and acoustic aids available. 
Tables, workbenches, tools and equipment for occupational therapy 
and handicraft, as well as equipment for a rhythm band should be in- 
cluded. In those school programs which include vocational training, 
additional equipment would be required. 

The individual needs of the homebound child are many times more 
difficult to meet, since the degree of handicap is usually greater and the 
equipment is seldom usable by more than one child at a time. Such elab- 
orate types of equipment as page-turners, wall and ceiling movie projec- 
tors, record players, and portable museum exhibits are all highly useful 
for teaching the homebound. It is such equipment that state and local 
crippled-children's societies, civic and fraternal organizations, and serv- 
ice groups can be encouraged to provide. 

One factor which is not a problem in the rural or suburban school but 
which may present difficulties in the urban center is space and facilities 
for outdoor play. In addition to ground space, an asphalt or concrete- 
covered terrace is needed for use by small children who operate tricycles 
and other wheeled vehicles as part of treatment procedures and recrea- 
tion. Sandboxes, push and pull toys, and other such types of equipment 
are of very real therapeutic value as well as means of gaining experiences 
in socialization and relaxation. 21 

EXAMPLES OF SCHOOL PROVISIONS FOR CRIPPLED CHILDREN 
There are some provisions for orthopedically crippled and cardiopathic 
children which must be made in the school over and above those which 



A brochure on equipment for treatment of cerebral palsy is in process of prepara- 
tion for publication by the National Society for Crippled Children. 

a See "Brief Outline of Suggestions for Setting Up a Therapeutic Day Nursery for 
Preschool Cerebral-palsied Children," Chicago : National Society for Crippled Children 
and Adulte, Inc., 1947 (mimeographed). 



LINCK, SHOVER, AND JACOBS 213 

are made for all normal children. These include medical supervision of 
treatment programs, physical and occupational therapy, speech therapy, 
and transportation, in addition to adaptations of regular routines to the 
needs of the physically handicapped. 

Medical Examination 

Routine health care, including physical examinations upon entrance 
and after each illness and nursing care during acute illnesses at school, 
is as urgently a part of the school program for the physically handi- 
capped child as it is of that for the normal child. Close co-operation is 
required with the family physician, the orthopedic specialist, the car- 
diologist, and others interested in the child's welfare and development. 

The Therapies 

Physical, occupational, and speech therapy are recognized as integral 
parts of the plan which has as its goal maximum educational and treat- 
ment benefits. Treatment centers have been established in co-operation 
with schools when other facilities in the community were not available 
or were financially beyond the reach of the crippled child from the low- 
and middle-income groups. In such centers, close co-ordination exists be- 
tween the medical and educational programs, with teacher and therapists 
following closely the recommendations of the medical specialist and 
working as a team. 

Second, provisions have been made in certain areas for itinerant 
physical and occupational therapists, so that children, for whom trans- 
portation is not available or for whom attendance at school would be 
difficult or impossible, may receive needed services under medical direc- 
tion. Such therapists have as a part of their responsibility the training of 
parents in carrying on the treatment program so that regular treatment 
procedures may be followed daily, thus hastening recovery and rehabil- 
itation. Mobile speech and hearing clinics and summer speech centers, 
established in co-operation with state universities and state societies for 
crippled children, are proving of incalculable benefit to children who 
would otherwise not have access to facilities for accurate diagnosis and 
recommendations for treatment. 

Encouragement of parent participation in school activities is of vital 
importance. Programs for discussion of problems of infant care, child de- 
velopment, and health education, as well as therapeutic procedures and 
other problems in the care of the orthopedically crippled and the cardio- 
pathic provide an excellent means of promoting such participation. 
Under proper supervision and guidance, the energy, interest, and en- 
thusiasm of parent groups can be channeled to take much of the burden 



214 ORTHOPEDIC AND CARDIAC CASES 

off the shoulders of teachers and therapists and, in addition, can help to 
create a better environment and home atmosphere for the child. 

Transportation 

Three types of transportation have been made available for crippled 
children who are unable to make their way to schools on public convey- 
ances. These are: special bus, taxi, and private automobile. There are 
considerable differences in the expense involved, and school districts 
cannot usually assume the cost of the latter two types. Factors to be con- 
sidered in bus transportation are: safety, comfort, time en route, econ- 
omy, and the availability of specially qualified and insured drivers. 
When a bus is used, careful and frequent checks on its condition are 
essential for the safety of the passengers. Since folding wheel chairs, re- 
laxation chairs, crutches, and other paraphernalia often need to be taken 
into the bus with the children, there may be added difficulties in making 
the children comfortable unless the bus is specially constructed. In load- 
ing and unloading upon departure from and arrival at school, each 
child can assist according to his abilities, thus providing one more 
situation in which each can demonstrate his capacity for self-help as 
well as for service to others. 

The character, personality, and resourcefulness of bus driver and at- 
tendant are of very real importance, as may be seen when it is considered 
that some children spend as much as two hours a day, or more than 
12 per cent of their waking hours, in the bus. This transportation time 
frequently can be shortened, with careful routing of the bus. 

Special Plans and Adaptations 

Special plans of assistance during fire drills can be formulated as soon 
as the physical abilities of the various children are determined at the be- 
ginning of the school year. Each child may be assigned a duty or respon- 
sibility at doors, stairways, or with reference to assisting some other 
child, and, in this way, remarkably quick time can be achieved in empty- 
ing the building during fire drills. 

Many schools have utilized the public address system to eliminate 
difficulties of messenger work and to speed the contact which can be 
made with the pupils in emergencies. The system can also be utilized 
effectively as an educational device and for lectures and announcements. 

Finally, various adaptations of plans to make library facilities avail- 
able to crippled children are necessary. Although it is preferable for each 
school to have its own library, this frequently is not the case; nor do all 
hospitals and institutions have adequate facilities. Therefore, co-opera- 
tive planning is required with the public libraries, county libraries, and 



LINCK, SHOVER, AND JACOBS 215 

central education libraries to insure maximum access to their resources. 
Many hospitals and convalescent homes have efficiently put into service 
circulating libraries which are wheeled to the children's rooms. For those 
who are homebound, the itinerant or mobile library is important when 
books cannot conveniently be taken from school to child. The library 
problems of the teacher of the homebound are especially critical if he 
must personally deliver books and source materials. 

Special help is required by those children who cannot utilize the reg- 
ular school library because of architectural barriers such as steps or 
narrow corridors. For those who gain access to the library, room has to be 
made for wheel chairs, tables must be maneuverable, and other adapta- 
tions need to be made to facilitate use of the books by the handicapped 
children. 

LOOKING TO THE FUTURE 

It has been seen, then, that the horizon of education of orthopedically 
handicapped children now extends far beyond the confines of its previous 
narrow bounds. Its future, it is hoped, will be yet broader, encompassing 
the long steps that can be taken after further research yields essential 
information. 

First of all, we look forward to a truly close co-ordination of the medi- 
cal and educational services, so that each may contribute its maximum to 
the welfare and development of the handicapped child. Closely linked 
with this is research into school health programs and education of the 
public in the prevention of crippling. 

We look forward to a co-ordination of mental hygiene efforts that will 
enable the everyday use of child-development concepts with children in 
school and at home, so that the greatest degree of mental health may be 
assured. 

The needs of rural areas must have attention focused upon them, and 
ways and means must be devised to meet these needs so that one-third of 
our nation's children may have the advantages they now lack. 

We look forward to the extension of services for the orthopedically 
handicapped and the cardiopathic so as to meet the vital needs of three 
groups who are now, for the most part, neglected: the preschool young- 
ster, those in secondary school, and the handicapped adult. This requires 
research into elimination of architectural barriers, development of new 
curriculum materials, and research in the broad field of counseling, voca- 
tional guidance, and placement. The handicapped veteran requires a 
whole new approach in curriculum-planning. The problems of his educa- 
tional advancement are of a kind which never before have been en- 
countered. 

An intensive program of public education must be undertaken to inter- 



216 ORTHOPEDIC AND CARDIAC CASES 

pret the needs of the handicapped, the task of the school in meeting these 
needs, and the role of the parent in the whole program. 

It is hoped that the futute will see an increasing emphasis on abilities 
rather than disabilities and that this may form the basis of broad and 
inclusive legislation for special-education provisions. 

Finally, we look forward to a better integration of the handicapped in- 
to community life, with the schools offering an important means of reach- 
ing this goal. This involves not only research into educational techniques 
and modernization of curriculums but also greater use of the school as a 
social center and fulcrum of community life. In this way, we hope to 
make measurable progress toward our ultimate goal for the crippled 
child to make of him a happy person and a good citizen, offering 
his fullest possible contribution to his family, his community, and his 

country. 

REFERENCES 

BOOKS AND REPORTS 

Advancing the Education of the Hospitalized Child. Report of a conference sponsored by 
National Foundation for Infantile Paralysis, February 26-27, 1948. New York: 
The Foundation, 1948. 

BARKER, ROGER G.; WRIGHT, BEATRICE A.; and GONICK, MOLLIE R. Adjustment to 
Physical Handicap and Illness: A Survey of the Social Psychology of Physique and 
Disability. Social Science Research Bulletin No. 55. New York: Social Science 
Research Council, 1946. 

"Brief Outline of Suggestions for Setting Up a Therapeutic Day Nursery for Pre- 
school Cerebral-palsied Children/' Chicago: National Society for Crippled Chil- 
dren and Adults, Inc., 1947 (mimeographed). 

The Crippled Child in New York City. New York: Commission for the Study of 
Crippled Children, 1940. 

DOLCH, EDWARD WILLIAM. Helping Handicapped Children in School. Champaign, 
Illinois: Garrard Press, 1948. 

Facts and Figures about Infantile Paralysis. New York: National Foundation for 
Infantile Paralysis, 1947. 

FOSTER, EMERY M., and MARTENS, ELISE H. Biennial Survey of Education in the 
United States, 1938-1940, Vol II, "Statistics of Special Schools and Classes for 
Exceptional Children," chap. v. Washington: Government Printing Office, 1942. 

FRAMPTON, MERLE E., and ROWELL, HUGH GRANT (Editors). Education of the Handi- 
capped (2 vols.). Yonkers-on-Hudson, New York: World Book Co., 1940. 

GARRISON, KARL C. The Psychology of Exceptional Children. New York: Ronald Press 
Co., 1940. 

HECK, ARCH O. The Education of Exceptional Children: Its Challenge to Teachers, 
Parents, and Laymen. New York: McGraw-Hill Book Co., Inc., 1940. 

KESSLER, HENRY H. Rehabilitation of the Physically Handicapped. New York: Colum- 
bia University Press, 1947. 

MACKIE, ROMAINE PRIOR. Crippled Children in American Education, 1939-4%. 
New York: Columbia University Press, 1945. 

. Crippled Children in School. United States Office of Education Bulletin No. 5, 

1948. Washington: Government Printing Office, 1948. 

NATIONAL CONGRESS OP PARENTS AND TEACHERS. Children Who Are Exceptional. 
Chicago. The Congress, 1945. 



LINCK, SHOVER, AND JACOBS 217 

PINTNEK, RUDOLPH; EISENSON, JON; and STANTON, MILDRED. The Psychology of the 

Physically Handicapped. New York: F. S. Crofts & Co., 1941. 
"Report of Division of Statistical Research." Washington : Children's Bureau, Federal 

Security Agency, January 26, 1948 (multilithed). 
SCHEIDEMANN, NOEMA V. The Psychology of Exceptional Children (2 vols.). Boston: 

Houghton Mifflin Co., 1937. 
Services to the Orthopedically Handicapped. A Report of a Study Made under the 

Auspices of the Trustees of the Widener Memorial School for Crippled Children 

and the Board of Public Education, School District of Philadelphia. Philadelphia: 

Walther Printing House, 1942. 

ARTICLES AND REPRINTS 

CARLSON, EARL R. "Give Them Education," Crippled Child, XXV (December, 1947), 
4-5, 29-30. 

CONNOR, CHARLES A. R. "Heart Disease in School Children with Special Reference to 
Their Care and Placement in School," Journal of Exceptional Children, VIII 
(April, 1942), 207-10, 235. 

"Education of Exceptional Children and Minority Groups," Review of Educational 
Research, XI (June, 1941), 253-329. 

"Education of Exceptional Children and Minority Groups," Review of Educational 
Research, XIV (June, 1944), 197-283. 

ELLIS, VIVIAN. "Some Changing Concepts in the Education of Physically Handi- 
capped Children," Journal of School Health, XVIII (November, 1948), 241-47. 

Facts about Rheumatic Fever. United States Children's Bureau Publication No. 297. 
Washington: Government Printing Office, 1946 (revised). 

GAUERKE, WARREN. "When You Build That School for the Handicapped," Crippled 
Child, XXVI (December, 1948), 12-13. 

KELLY, ELIZABETH M. "Curricuium-planning for Exceptional Children," Journal of 
Exceptional Children, XIV (February, 1948), 130-33, 152. 

LEE, JOHN J. "Educating Crippled Children : An Overview on the Purposes and Ob- 
jectives in Educating Crippled Children," Crippled Child, XX (December, 1942), 
86-87, 108; (April, 1943), 143-44, 163; XXI (October, 1943), 62-64. 

LINCK, LAWRENCE J. "Toward a More Adequate Program of Education for Crippled 
Children," Journal of Exceptional Children, XIII (February, 1947), 129-32, 160. 

MARTENS, ELISE H. The Needs of Exceptional Children. Washington: United States 
Office of Education, 1942. 

. "Where Does Your State Stand?" Crippled Child, XXV (February, 1948), 

10-11, 28-30. 

MclNTiRE, J. THOMAS. "The Incidence of Feeble-Mindedness in the Cerebral-pal- 
sied," American Journal of Mental Deficiency, L (April, 1946), 494. 

MESSELOF, CHARLES 11. "The School Child with Heart Disease," Journal of Excep- 
tional Children, XIII (March, 1947), 161-65. 

PIIELPS, WINTHROP M. "Questions Parents Ask: With Answers," Crippled Child, 
XXV (August, 1947) 4-5. 

. Testimony at hearing before the Committee on Labor, Subcommittee on Aid 

to Physically Handicapped, House of Representatives, Seventy-ninth Congress, 
First Session, Part 20, "Spastics," October 11, 1945, pp. 2056-57. 

SALMON, CHRISTINE. "Architects Can Help You Plan for the Handicapped," Crippled 
Child, XXVI (June, 1948), 8-9, 14; (August, 1948), 16-18. 

TUDYMAN, AL. "A Public School Plan for Special Cerebral-Palsy Classes," Crippled 
Child, XXVI (February, 1949), 20-22, 29-30. 



CHAPTER XII 

SPECIAL EDUCATION FOR THE EPILEPTIC, THE TUBER- 
CULAR, AND CHILDREN WITH GLANDULAR DISORDERS 



WILLIAM M. CRUICKSHANK 

Director of Special Education for the Exceptional 

School of Education, Syracuse University 

Syracuse, New York 

and 

WILLIAM G. PEACHER 

Instructor in Clinical Surgery (Neurosurgery) 

Associate Professor of Speech Pathology 

Syracuse University 

Syracuse, New York 



IDENTIFYING THE CHILDREN WHO REQUIRE PARTICULAR 

TYPES OF SPECIAL SERVICES 

While many phases of the education of exceptional children demand 
close co-operation between the medical and educational fields, the educa- 
tion, care, and treatment of a few distinguishable groups of exceptional 
children require closer affiliation of the two sciences than do others. This 
is particularly true in considering the education of epileptic children, 
those with tuberculosis, and certain individuals with disorders of glandu- 
lar functions. The problems involved in designing the special-education 
programs for children included in these three groups are both educational 
and medical in the sense that the contributions of the medical profession 
to the education of these groups are very important to the success of the 
educational program. The location of such children demands the full 
co-operation of private physicians, teachers, public health nurses, public 
and private welfare agencies, religious groups, and other civic leaders 
within the community. Surveys which enlist the co-operation of such 
diverse groups within a community bring to light many exceptional chil- 
dren who need special medical and educational attention but whose 
special needs have for various reasons been ignored. 1 



1 W. M. Cruickshank and E. Sprague, A Survey of Exceptional Children in Three 
School Districts in Onondaga County t New York. New York: Syracuse University, 1948. 
See also, Edward Bridge, Epilepsy and Convulsive Disorders in Children. New York: 
McGraw-Hill Book Co., Inc., 1949. 

218 



CRUICKSHANK AND PEACHER 219 

EPILEPSY IN CHILDREN 

Extent of the Problem 

Epilepsy is seldom recognized or understood as one of the major medi- 
cal and educational problems of our time. In spite of the advances of mod- 
ern medicine and psychology, misconceptions still surround the epileptic 
person. Accordingly, many epileptic children are not reported by their 
parents, and knowledge of their presence in society is largely accidental. 

It is estimated that there are about 700,000 epileptics in the United 
States. 2 It is assumed that the percentage of incidence among the popula- 
tion is fairly stable, for in both World War I and World War II the 
United States Army rejected about 5 per 1,000 drafted men because of 
epilepsy. It is to be noted, however, that the identified cases appear in 
strikingly variable proportions in different reports. During the first 
World War the number of men rejected because of epilepsy varied be- 
tween 1.20 per 1,000 in South Dakota and 12.72 per 1,000 in Vermont; 3 
whereas, although complete statistics have not yet been made available 
for World War II, a report published in 1941 showed that, from a group 
of 19,923 men, 2.0 per 1,000 were rejected as epileptic. A second survey, 
including 122,000 men, showed that 3.7 per 1,000 draftees were epileptic. 
A third analysis brought the incidence of epilepsy among draftees up 
almost to the rate reported in the first World War, namely 5.1 per 1,000 
men. 4 

It is difficult to generalize from these figures regarding the incidence 
of epilepsy among the general population within the country as a whole. 
The men included in the above figures came from an age level which did 
not include children. How the older age group which includes few epilep- 
tics and the younger age group which includes many epileptics should be 
weighted in comparison with the men of draft age is not definitely known. 
If these two groups tend to balance each other, then the previously men- 
tioned figure of about 5.0 per 1,000 individuals of draft age would be ac- 
curate. These data from army records apply only to males. Lennox, how- 
ever, states that epilepsy is equally prevalent among males and females. 6 



2 Paul H. Hoch and Robert P. Knight, Epilepsy: Psychiatric Aspects of Convulsive 
Disorders, p. 42. New York: Grune & Stratton, 1947. 

8 The Medical Department of the United Slates Army in the World War, p. 143. 
Washington: Government Printing Office, 1929. 

4 Physical Examinations of Selective Service Registrants during Wartime, p. 126. War 
Department, Medical Statistics, Bulletin No. 3. Washington: Government Printing 
Office, November 1, 1944. 

* William G. Lennox, "Epilepsy," Clinics, IV (August, 1945), 504-20. 



220 EPILEPTIC AND TUBERCULAR CHILDREN 

Causes of Epilepsy 

The causes of epilepsy are numerous and not thoroughly understood. 
Walker 6 lists three major groups of conditions in connection with which 
epilepsy may occur in adult life, namely, intracranial disturbances, in- 
flammatory processes, and general somatic diseases. According to the 
report of one extended study, the most common type of epilepsy in chil- 
dren is that caused by acute infection, which accounts for 33.4 per cent 
of the cases identified. Idiopathic epilepsy, or epilepsy of unknown origin 
covers 26.3 per cent of the cases studied, and cerebral trauma is said to 
explain the appearance of epilepsy in 14.2 per cent of the cases. 7 The 
cause of epilepsy in one child may not necessarily be the disturbing fac- 
tor for another individual. Shanahan 8 and Peterman, 9 for example, have 
ascribed convulsive disorders in children to a wide variety of causes such 
as heredity, disturbances of a prenatal environment, birth injuries, mal- 
development during infancy, infections in early life, allergy, malnutri- 
tion, rickets, and tetany. Fatigue has been suggested as an instigating 
factor by Weinberg, 10 while Robinson 11 advanced the theory that per- 
haps idiopathic epilepsy might be induced by ocular pressure after not- 
ing such a condition in one of his patients. Pituitary tumors, migraine, 
and rheumatic fever are but a few more of the pathological conditions 
which have been suggested as possible causes of epilepsy. Relatively new, 
rheumatic epilepsy was first discovered and discussed in France about 
ten years ago when the term was applied to those patients who have de- 
veloped convulsions following such diseases as rheumatic fever, chorea, 
or chronic rheumatic cardiovascular conditions. 

Heredity as a Factor in Epilepsy. The question of whether or not hered- 
ity is a leading and important factor in epilepsy has confronted geneti- 
cists and medical authorities for many years. Stein's report of an investi- 
gation of 1,000 institutionalized epileptics and 1,115 nonepileptic control 
subjects at the Monson Massachusetts State Hospital for Epileptics in 

6 A. E. Walker, "Convulsive Seizures in Adult Life," Archives of Internal Medicine, 
LVIII (August, 1936), 250-68. 

7 M. G. Peterman, "Convulsion in Childhood: Twenty-year Study of 2,500 Cases," 
American Journal of Diseases of Children, LXII (October, 1946), 399-410, 

8 W. T. Shanahan, "Epilepsies: Etiology and Symptomatology," New York State 
Journal of Medicine, XXX (November, 1930), 1359-64. 

Peterman, op, cit. 

10 M. H. Weinberg, "Fatigue as a Precepitating Factor in Latent Epilepsy," Jour- 
nal of Nervous andlMental Diseases, CI (March, 1945), 251-56. 

11 L. J. Robinson, "Induction of Seizures by Closing of the Eyes or by Ocular 
Pressures in a Patient with Epilepsy," Journal of Nervous and Mental Diseases, XC 
(September, 1939), 333-36. 



CRUICKSHANK AND PEACHER 221 

1933 typifies the thinking on this aspect of the problem. 12 Stein reached 
the following conclusions: 

1. Results do not justify the conclusion that the sympton complex known as ep- 
ilepsy, either per se or as migraine or as any other neuropsychiatric disorder, is 
an inherited condition. 

2. However, the higher incidence of neuropsychiatric disorders in the families of 
epileptics may well be explained on the basis of an existing potential or latent 
germ-plasm defect. It is likely that this defect or vulnerability furnishes more 
than usually fertile ground for the production of epilepsy by such known con- 
tributing factors as trauma, birth injury, alcoholism, etc 

3. It is difficult to escape the conclusion that this germ-plasm defect or vulner- 
ability appears in too large a proportion in the family histories of the patients, 
when compared with those of the controls, to be entirely accidental. 

Similar findings were observed by Dixon and reported in an un- 
published paper concerned with the social and emotional background 
of 1,000 epileptic patients admitted to the Michigan Farm Colony for 
Epileptics. 18 

Types of Epilepsy 

A number of different classifications of epilepsy have been suggested 
during the past few years. Thus, the different types of epilepsy have been 
distinguished on the basis of anatomical considerations, with reference 
to the cause denoted in the medical history of the subject or on a chrono- 
logical basis with respect to the onset of seizures. The various clinical 
groups of epileptics usually include the following four: fa) The grand mal 
type or generalized seizure is frequently referred to in the literature as 
the somatic (body) motor group. Jacksonian epilepsy and those typified 
by focal convulsions are also included in this group, (b) The sensory group 
consists of symptoms involving the function of the visual, auditory, 
olfactory, and somatosensory systems of the body, (c) The visceral type 
includes the autonomic seizure involving internal bodily structures, (d) 
The psychical group includes petit mal, dreamy seizure states, and 
psychotic states. The age of onset of the seizure is also of value from a 
diagnostic standpoint. For example, inflammatory conditions are asso- 
ciated with the childhood onset of epilepsy; the idiopathic variety with 
adolescence; trauma or tumor with adulthood; neoplasm, trauma, or 
vascular disease with middle age; and cerebrovascular disease with 
old age. 



12 C. Stein, "Hereditary Factors in Epilepsy: A Comparative Study of 1,000 Insti- 
tutionalized Epileptics and 1,115 Nonepileptic 'Controls," American Journal of Psy- 
chiatry, LXXXIX (March, 1933), 989-1037. 

18 Robert Dixon, "The Pre-epileptic Child," from Staff Papers of the Lapeer State 
Home and Training School Lapeer, Michigan: The School, 1937 (mimeographed). 



222 EPILEPTIC AND TUBERCULAR CHILDREN 

Methods of Differential Diagnosis 

The Electroencephalogram. The electroencephalogram was first intro- 
duced by Berger 14 in 1929 and is referred to commonly as the brain-wave 
test. Typical brain-wave patterns are produced in normal records which 
may show specific changes under various types of pathology. 15 Normal 
brain-wave tracings have been established in all age groups by Gibbs 
and Gibbs. 16 Perhaps the most comprehensive application of the electro- 
encephalogram has been in the study of idiopathic epilepsy. Ninety-five 
per cent of these patients demonstrate brain-wave abnormalities. 17 Even 
more important is the detection of cerebral disturbances in patients be- 
tween episodes. Abnormal brain rhythms have been observed to vary 
with the type of epilepsy such as grand mal, petit mal, and psychomotor 
seizures. 

Other Instruments of Diagnostic Value. X-rays of the skull may furnish 
valuable clues to the cause of the convulsion through such evidence as 
increased intracranial pressure in the presence of tumor, fractures follow- 
ing trauma, and other clinical observations. Pneumoencephalography, 
first described by Dandy, 18 consists of the injection of air or gas in the 
lumbar region in order to observe certain cranial features. The direct in- 
jection of air into the ventricles of the brain is known as ventriculography. 
These procedures are of value in the differentiation of the various causa- 
tive agents noted above and serve to supplement the electroencephalo- 
gram. Arteriographyj described by Moniz, 19 has been of value also when 
the suspected cause is vascular. It consists of the introduction of a radio- 
paque substance such as diodrast into specific arteries for the identifica- 
tion of cerebral vessels. Routine laboratory data including blood chemis- 
try, urine examination, and spinal fluid tests are performed as indicated. 

Psychological Examinations. Two avenues of psychological evaluation 
have developed recently which indicate the possibility of making a differ- 
ential diagnosis of epilepsy, at least in part, on the basis of psychological 



14 H. Berger, "Ueber das Elektrenkephalogram des Menchen: I, Mitteilung," 
Archievefiir Psychiatric, LXXXVII (1929), 527-70. 

18 F. A. Gibbs, "Electrical Activity of the Brain," Annual Review of Physiology, VII 
(1945), 427-54. 

16 F. A. Gibbs and E. L. Gibbs, Atlas of Electroencephalography. Cambridge, Mas- 
sachusetts: L. A. Cummings Co., 1941. 

17 M. G. Peterman, "Electroencephalography in Children," Wisconsin Medical 
Journal, XLIIII (July, 1944), 70&-9. 

18 W. E. Dandy, "Roentgenography of the Brain after the Injection of Air into the 
Spinal Canal," Annals of Surgery, LXX (October, 1919), 397-403. 

19 E. Moniz, "L'Encephalographie ArteVielle, Son Importance dans la Localization 
desTumeurs Ce*re*brales,' Revue de Neurologic, II (November, 1927), 72-90. 



CRUICKSHANK AND PEACHER 223 

tests. These two procedures involve (a) the use of the Rorschach test and 
(6) the concept of scatter and pattern analysis developed by Wechsler 
and Rapaport. The former has brought to light the most important in- 
sights regarding the psychological functioning and personality manifes- 
tations of the epileptic person. 

Rorschach in 1921, 20 after studying twenty epileptics, pointed out that 
certain findings permitted the examiner to make a diagnosis of epilepsy. 
The signs which Rorschach used were: many-color responses, a tendency 
to confabulation, inferior judgments of value, perseveration, emphasis on 
symmetry, description of color, counting and naming colors, meticulous' 
ness, slowness of associations, and personal references. Oberholzer later, 
in 1935, stated that generally genuine epilepsy can be discriminated from 
traumatic epilepsy without difficulty by means of the Rorschach test. 
For the most part Rorschaoh's conclusions have been confirmed by the 
subsequent investigations of Guirdham, 21 Arluk, 22 and Harrower-Erick- 
son. 23 Piotrowski, 24 however, has reported a study involving the use of 
the Rorschach test with epileptics, the results of which differ somewhat 
from those of the preceding reports. Piotrowski's findings are particu- 
larly valuable as a caution against the independent use of the Rorschacb 
test for differential diagnosis of epilepsy apart from medical diagnosis. 
While he observed most of the signs which Rorschach and others have 
noted, he did not find them typical solely of epileptics but, rather, to 
some degree also characteristic of psychoneurotic and other patients with 
organic involvements. Piotrowski points out that "none of the tabulated 
signs is pathognomonic of epilepsy" alone. He further states: 

The differential diagnosis between epilepsy and organic cerebral cases without 
convulsive seizures may not be possible (by means of the Rorschach test) in a 
large proportion of cases. In such cases it would be possible to determine that the 
personality deviation was caused by intracranial pathology, but the fact that the 
symptoms include convulsive seizures may not be deducible. However, if it is 
known that the patient is afflicted with seizures, and that the perceptanalytic 
findings indicate intracranial pathology, then the inference can be made that the 
seizures are not psychogenic but organic. 

20 Hermann Rorschach, Psychodiagnostics, p. 170. (Translation and English edition 
by Paul Lemkau and Bernard Kronenberg.) Berne, Switzerland: Hans Huber, 1942. 

21 A. Guirdham, "The Rorschach Test in Epileptics," Journal of Mental Sciences, 
LXXXI (October, 1935), 870-91. 

22 E. W. Arluk, "A Study of Some Personality Differences between Epileptics and 
Normals," Rorschach Research Exchange, IV (October, 1946), 154-56. 

28 M. R. Harrower-Erickson, "Personality Changes Accompanying Patients with 
Cerebral Lesions: II, Rorschach Studies of Patients with Focal Epilepsy," Archives of 
Neurology and Psychiatry, XLVII (June, 1940), 1081-1107. 

24 Hoch and Knight, op. cit., pp. 95-106. 



224 EPILEPTIC AND TUBERCULAR CHILDREN 

Wechsler 25 and Rapaport 26 have made extensive studies concerning the 
importance of characteristic patterns of responses given to items of in- 
telligence tests by individuals with organic involvement. Studies by these 
and other authors fail to give an unequivocal answer to the question of 
whether or not the scatter patterns described occur in convulsive dis- 
orders alone or whether they may be found in other conditions as well. It 
thus seems safe to assume that while certain familiar and clinically rec- 
ognized signs are observed to appear in the intelligence and personality 
test performance of many individuals later to be medically diagnosed as 
epileptic, at present the use of psychological tests with this group should 
be restricted to the following purposes: (a) making an initial referral to 
proper medical facilities for final diagnosis; (6) for corroboration of medi- 
cal findings; or (c) for the continuous evaluation of the psychological 
changes in the individual during the course of the observed condition. 
It is also important to note that psychological diagnosis should be made 
only in conjunction with medical diagnosis. 

Characteristics of Epilepsy 

Many investigations have been undertaken concerning the charac- 
teristics of epileptic individuals. The results of these studies will be 
discussed from the point of view of intellectual capacities and personality 
manifestations. 

Intelligence. Intellectually the epileptic child is not greatly dissimilar 
to the nonepileptic child. If given suitable opportunity, the epileptic 
child has nearly the same ability to learn as has a child who is physically 
normal. This fact has been found to be true in a number of research 
studies which have compared epileptic and nonepileptic individuals. 
Lennox and Collins 27 administered a series of intelligence tests to ninety- 
three sets of twins. Sixty-three twins were without any history of epilepsy 
or brain injury, whereas thirty had a history of seizures. The authors 
found that the average intelligence quotient for the nonepileptic chil- 
dren was 108; for the epileptic children, 96. 

Fetterman and Barnes 28 and Sullivan and Gahagan 29 found median 



26 David Wechsler, Measurement of Adult Intelligence, p. 146. Baltimore: Williams & 
Wilkins, 1944 (third edition). 

26 David Rapaport, M. Gill, and R. Schafer, Diagnostic Psychological Testing, 
Vol. I, p. 48. Chicago: Yearbook Publishers, 1945. 

27 W. G. Lennox and A. L. Collins, "Intelligence of Normal and Epileptic Twins, " 
American Journal of Psychiatry, CI (May, 1945), 764-69. 

28 J. Fetterman and M. R. Barnes, "Serial Studies of the Intelligence of Patients 
with Epilepsy," Archives of Neurology and Psychiatry, XXXII (October, 1934), 
797-801. 

29 E. B. Sullivan and L. Gahagan, "On Intelligence of Epileptic Children/' Genetic 
Psychology Monographs^ XVII (October, 1935), 309-76. 



CRUICKSHANK AND PEACHER 225 

intelligence quotients ranging from 74 to 92, indicating an ability range 
of the groups between high-grade mental retardation and low average 
intelligence. Baker reports that the majority of epileptic children en- 
rolled at the White Special School in Detroit during the period from 1937 
to 1940 had intelligence quotients between 70 and 99. 30 Lennox 31 reaches 
practically the same conclusion in a study of 4,958 epileptic patients ad- 
mitted to the Craig Colony in New York State over a fifteen-year period. 
Falk, Penrose, and Clark, 82 among others, point out evidences of the 
educability of epileptic persons. 

Personality. The patient's personality modifies the manifestations of 
epilepsy to some degree, as it does in other diseases of an organic nature. 
The literature contains no evidence in support of the view that epileptic 
seizures are a concomitant of any specific personality structure. One 
writer asserts: "There is no such thing as an epileptic personality that is 
specific for epilepsy." 33 The seizure may occur in all personality types and 
is a respecter of none. The so-called "epileptic personality/' referred to 
frequently in popular periodicals, if present, seems to result from the 
same factors which produce personality manifestations in persons with 
other forms of organic brain damage, i.e., the changes in cortical tissues 
of the brain produce personality traits which are not restricted to the epi- 
leptic child alone but which, to a large degree, characterize all individuals 
with brain damage. Frequently, outstanding personality traits may be 
observed in the epileptic child. However, if present, they need not 
be the direct result of the seizure but may be the indirect result of the 
patient's attempts to deal with increased problems of adjustment which 
he as an individual senses. 

Bleuler 34 feels that a spontaneously uneven and erratic type of mental 
activity is one of the outstanding characteristics of the epileptic child. 
He observed a wave-like, waxing and waning flow of ideas which were 
independent of attention fluctuations caused by fatigue and which were 
not specifically associated with the difficulty of the problem with which 
the epileptic was confronted. Harrower-Enckson 35 says that the person- 



80 Harry J. Baker, Introduction to Exceptional Children, p. 306. New York: Macmil- 
lan Co., 1945. 

81 W. G. Lennox, "Mental Defect in Epilepsy and the Influence of Heredity/' 
American Journal of Psychiatry, XCVIII (March, 1942), 733-39. 

R. Falk, L. S. Penrose, E. A. Clark, "The Search for Intellectual Deterioration 
among Epileptic Patients," American Journal of Mental Deficiency, XLIX (April, 
1945), 469-71. 

38 Jerry C. Price, "The Approach to Providing Service to the Epileptic/' Journal of 
Rehabilitation, XII (October, 1946), 5-9. 

84 E. Bleuler, Lehrbuch der Psychiatric. Berlin: J. Springer, 1930. 

15 Harrower-Erickson, op, cit. 



226 EPILEPTIC AND TUBERCULAR CHILDREN 

ality of the epileptic child is affected by the way in which the convulsions 
are incorporated into his normal experiences by the child himself. Other 
authors have observed traits of moodiness, egocentricity, rigidity, 
meticulosity, organic pedantry, sudden outbursts of temper, persevera- 
tion, tendency toward cruelty, desire for affection, expressions of anger 
out of all proportion to the cause, and other similar personality manifes- 
tations in epileptic children. The age of onset of the seizures determines 
in part both the degree of intellectual impairment and the extent of the 
personality disturbance which may be developed. Usually, the earlier 
the onset of the seizures the more pronounced the intellectual deteriora- 
tion and the more evident the personality disturbances. 

Programs of Education 

For many years public schools have accepted epileptic children, some 
of whom have experienced seizures in school. The Detroit Public School 
system was among the first to undertake the education of the epileptic 
child within the framework of a public school program. Numerous pro- 
grams for the education and care of the epileptic in state hospitals and 
farm colonies had antedated the Detroit venture. The latter program, 
eventually to be located in the White Special School, was opened in 
January 1935. In this special school the children were originally housed 
from Monday morning through Friday afternoon, but after 1939 the 
hospital plan was abandoned and the children were transported daily by 
school bus. While the number of seizures which occurred among the chil- 
dren during transportation was at first significant, they were greatly re- 
duced during subsequent years until, at the present time, the seizure dur- 
ing transportation is not a disturbing problem. The program for the edu- 
cation of epileptic children today is not significantly different from that 
which should be provided for all children. No special methods or materi- 
als are used save the best of those which would be used with children in 
any regular or special grade. The continuous evaluation of the suitability 
of the educational program to the needs of the epileptic child is, however, 
warranted. All epileptic children receiving any form of instruction 
should have competent psychological examinations at least once a year. 
Mental deterioration should automatically require revision of the curricu- 
lum being provided for such a child. In the Detroit school a nurse is in 
attendance continually at the school, and medical attention is available. 
A number of other public school systems in the United States have pro- 
vided similar programs for the epileptic. 

The epileptic child, if intellectually capable of benefiting from educa- 
tion, should be accepted into the school program. Studies cited above 
show that the majority of the epileptic children can profit from a program 



CRUICKSHANK AND PEACHER 227 

of instruction. However, a report prepared by Lennox, McBride, and 
Potter 86 disclosed that in 1,676 schools of higher education in the United 
States and Canada there was only one epileptic in each group of 2,000 
students enrolled. Fifty-five per cent of the schools replying to the in- 
quiry have no rule regarding the acceptance of epileptics, 27 per cent 
admit them conditionally, and 18 per cent deny them admission. It 
would appear that higher education of epileptics is apparently influenced 
by popular prejudice, misinformation, and fear; whereas, discriminating 
judgment with respect to each case on its merits would doubtless en- 
courage many others to enter college. 

The question of whether or not the child should be segregated into a 
special school or class or whether he should be admitted to a regular 
class with nonepileptic children has not been conclusively investigated. 
Some authorities feel that the epileptic child should be segregated into a 
special class within the public school program wherein his particular 
physical needs can be met. Medication, it is said, can be carried out much 
more readily if all such children are in a central location. Provision can 
be made for rest and recovery after seizures without the child's status 
being threatened if the children with epilepsy are grouped together. On 
the other hand, other investigators feel that with the discovery of new 
drugs and with complete co-operation of local medical groups, many 
epileptic children can be educated in the normal classroom situation. 
Such provisions must include the careful education of the remaining chil- 
dren in the grade group regarding the needs of the epileptic child. In con- 
nection with both plans for the education of epileptics, a thorough un- 
derstanding by parents and teachers of the impact of epilepsy on the so- 
cial and emotional adjustment of the child is most important. 

Whenever a teacher, principal, or superintendent of a school becomes 
aware that a child may be epileptic, the school authorities must be pro- 
vided with adequate and reliable diagnostic information. The medical 
officer should be responsible for seeing that an accurate diagnosis is made 
and, together with psychological and psychiatric counsel, should de- 
termine whether or not the child is physically fit to continue in school. 
It is, of course, important to protect both the afflicted child and his 
classmates against unnecessary interruption to the educational program. 
The appropriate administrative policy is reflected in the following state- 
ment: 

If either medical or psychological examination leads to a decision that a child 
should be excluded from school, temporarily or permanently, educational officials 
should accept and abide by this recommendation, subject, however, to additional 

86 W. G. Lennox, M. McBride, and G. Potter, "The Higher Education of Epilep- 
tics," Epikpsia, III (September, 1947), 182-97. 



228 EPILEPTIC AND TUBERCULAR CHILDREN 

medical evidence which would justify a change in ruling. . . . The occurrence of 
epileptif orm seizures per se should not necessarily exclude a child from school un- 
less their frequency, severity or duration interferes with the regular work in 
class. 87 

It is well for teachers to be aware of the fact that great differences 
are present among epileptic children. Not only are all the commonly 
recognized individual differences observable in epileptic children but 
differences in the extent of the influence of the epileptic symptoms are 
also present. Some children have very frequent attacks; some have at- 
tacks only infrequently. Some who have infrequent attacks present 
greater personality disturbances and more continual behavior manifesta- 
tions than do those who have frequent but milder seizures. It should also 
be recognized that some children who are under medical care will con- 
tinue to experience seizures. If, because of the frequency, duration, or 
severity of the seizure the child is unable to continue in school, he will 
frequently be able to benefit from home teaching which can be carried on 
as a part of the regular school program. The school's obligation is to pro- 
vide an educational opportunity for the epileptic child either within its 
day school facilities or within a special class or through individual home 
instruction. 

Sources of Information Concerning Epilepsy 

In recent years several national and state associations have been or- 
ganized to disseminate information concerning epilepsy and to serve as 
centers for the distribution of authoritative materials on the problem of 
epilepsy. The National Association to Control Epilepsy, Inc., chartered 
by the University of the State of New York, was established recently at 
22 East Sixty-seventh Street, New York City. One of its prominent fea- 
tures is the maintenance of the Baird Foundation Clinic which began 
operation in 1944. The clinic makes a total approach to the epileptic 
child, first medically helping the child to control his seizures, then as- 
sisting him to make the most of his abilities in social adjustment and 
vocational success. State affiliates of the National Society for Crippled 
Children and Disabled Adults, Inc., have recently become interested in 
the epileptic child. Such state associations as the Ohio Society for 
Crippled Children and Adults, Inc.; the Pennsylvania Society for Crip- 
pled Children and Adults, Inc.; and the Tennessee Society for Crippled 
Children and Disabled Adults, Inc., are examples. The American 
Epilepsy League, Inc., a branch of the International League against 



37 The Committee for the Study of the Care and Education of Physically Handi- 
capped Children in the Public Schools of the City of New York, Report of the Subcom- 
mittee on Epileptic Children, p. 59. New York: Board of Education, 1941. 



CRUICKSHANK AND PEACHER 229 

Epilepsy, is also active in this field and, as one of its services, publishes 
a valuable periodical, Epilepsia. 

TUBERCULOSIS IN CHILDREN 
Nature of Tuberculosis and Magnitude of the Problem 

Tuberculosis is an infectious disease caused by the tubercle bacillus 
to which all body tissues are potentially vulnerable, although it is the 
lungs which are most commonly involved. The disease is one which ap- 
pears in all areas of the world. In civilized countries the bacillus is so 
ubiquitous that almost every individual is infected prior to adulthood. 
Fortunately, this infection is ordinarily so light that an effective resist- 
ance is developed. The occurrence of the disease in activated form during 
adolescence or adulthood is usually a result of such factors as the lowering 
of normally developed resistance due to malnutrition, fatigue, other 
diseases, or infections. Such cases can be arrested and made quiescent. 

While tuberculosis is essentially a disease of early adulthood, infancy 
is recognized as the most susceptible age for its inception. In spite of 
the fact that the tuberculous infection has been reduced significantly 
during early infancy, approximately 5 per cent of the children born each 
year in the United States may be handicapped to some extent by the 
early start of the morbid process. It is estimated that between 15 to 20 
per cent of preschool and elementary-school children and between 30 to 
50 per cent of high-school, college, and university students react positive- 
ly to a tuberculin test showing that at one time or another in their lives 
they have experienced an episode of active tuberculosis. The incidence 
of tuberculosis varies greatly with racial and social status. The death rate 
in 1930 for unskilled workers was 185 per 100,000; for skilled workers, 72; 
for professional people, 26. The death rate for Negroes from tuberculosis 
is approximately 3.5 to 4 times as great as for the white population. The 
disease fluctuates geographically also as can be seen in the death rate for 
white residents of San Antonio, Texas, which was 162 per 100,000 per- 
sons; for white residents of Akron, Ohio, 31 per 100,000 persons; of Cin- 
cinnati, Ohio, 62 per 100,000. 88 

Diagnosis and Treatment 

The diagnosis of tuberculosis in school-aged children is chiefly a medi- 
cal problem, but it is one which demands the full co-operation of school 
personnel. The school can assist medical personnel in providing routine 
physical examinations of all children on a yearly basis. The school nurse 
or nurse-teacher will be the agent of the educational staff to serve most 
actively in this program, but the success of the undertaking will rest 

88 Clinical Tuberculosis. Edited by B. Goldberg. Philadelphia: F. A. Davis, 1942. 



230 EPILEPTIC AND TUBERCULAR CHILDREN 

upon the entire school faculty. Surveys for tuberculosis will usually take 
the form of X-ray examination together with general medical examina- 
tion and tuberculin tests. Treatment, for those cases which are discov- 
ered, is again a medical problem, the education program depending upon 
the decision of the responsible medical officer. The presence of tubercu- 
losis in children requires that each case be handled as a separate problem 
because children with pulmonary tuberculosis may transmit the disease 
to other children. It is frequently necessary that immediate segregation 
of the pulmonary cases be effected. 

Programs of Education 

Once a diagnosis is completed, the education of the tuberculous child, 
while always a responsibility of the public education program, will be 
conducted under medical supervision in hospital schools or special classes 
or through home-teaching programs. The nature of the tuberculous con- 
dition in each child will govern the amount of physical and mental ac- 
tivity to be permitted. For this reason the educational and occupational 
therapy programs will, while extraordinarily important, remain second- 
ary to the child's physical needs and will be prescribed by the physician. 
There is, however, no reason to segregate children into special classes for 
instruction if it is medically determined that such children are non- 
infectious and are physically well enough to assume the regular routine 
of the public day school. There are certain basic principles which must 
be evaluated in teaching all handicapped children. The relative good of 
relieving the child from the stress of competition of groups of physically 
well children must be weighed against the possible psychological harm 
which may be done by segregating them into small groups having similar 
physical handicaps. With this caution in mind and with the knowledge 
that most tuberculous children will have to be segregated, the importance 
of providing a healthy psychological environment for the child in the 
segregated situation and of providing a realistic educational program be- 
comes paramount. 

It is known that periods of prolonged convalescence and rest fre- 
quently provide opportunity for too much introspection and that psycho- 
logical maldevelopments often result. It is also known that for the tuber- 
culous child quiet, rest, and relaxation which involve long periods of 
convalescence are required in order to arrest the disease. The educational 
program which is provided must be formulated with this conflicting 
situation in mind. Activities should be made available which are within 
the threshold of tolerance of the child from a physical point of view and, 
yet, which are challenging enough to keep him interested and psycho- 
logically positively active. This is particularly important, if, as has been 



CRUICKSHANK AND PEACHER 231 

said, "all behavior, without exception, is completely determined by and 
pertinent to the phenomenal field of the behaving organism." 88 With 
basic human needs remaining unsatisfied, these unsatisfied needs become 
dynamic factors in the phenomenal field of the convalescing tuberculous 
child and become factors which force the child into adjustments which are 
unsatisfactory from the point of view of his self concept and which are 
maladjustive from the point of view of society. 

Educational programs must be provided for nonhospitalized children 
who are not well enough to participate in all the activities of the regular 
school. The subcommittee on the education of children with tuberculosis 
in the New York City public schools reported that noninf ectious children 
who are able to attend school but who are not able to engage in the full 
program should be placed on a lightened schedule in the public schools. 40 

Programs which include increased rest and restricted activity have 
been successfully tried in Boston, Massachusetts, and South Bend, In- 
diana. These programs have been found preferable from a psychological 
point of view, as well as from the standpoint of financial economy, to that 
of prolonged periods of hospitalization pending arrest of the disease 
process. 

Home teaching will be indicated for those tuberculous children who 
seem in danger of progression or who require more rest and restriction 
than can be provided conveniently under the school program. Bedside 
teaching in the home will serve to maintain the interest of the child in his 
recovery and will assist him to maintain a healthy psychological con- 
cept. Such teaching is particularly important in assisting adolescent 
children to begin immediate treatment while awaiting admission to a 
hospital or sanitorium. 

The Behavior of Persons with Tuberculosis 

The research which is available on the personality adjustment of in- 
dividuals with tuberculosis is very meager, particularly research which 
has been undertaken and has used acceptable standards of scientific 
investigation. The most complete analysis of such research was that un- 
dertaken by Barker, Wright, and Gonick. 41 On the basis of their investi- 



89 Donald Snygg and Arthur W. Combs, Individual Behavior: A New Frame of Ref- 
erence for Psychology. New York: Harper & Bros., 1949. 

40 Committee for the Study of the Care and Education of Physically Handicapped 
Children in the Public Schools of New York City, The Education of Children with Tu- 
berculosis, p. 12. New York: Board of Education, 1941. 

41 R. C. Barker, B. A. Wright, and M. R. Gonick, Adjustment to Physical Handicap 
and Illness: A Survey of the Social Psychology of Physique and Disability, p. 130. Bulle- 
tin 55. New York: Social Sciences Research Council, 1946. 



232 EPILEPTIC AND TUBERCULAR CHILDREN 

gation of the research in this aspect of the field, they arrived at the fol- 
lowing conclusions: 

1. A great variety of behavior is exhibited by tuberculous persons; there is no 
unique tuberculosis behavior. 

2. There are indications that some kinds of behavior are more frequent than in 
healthy populations, although exactly comparable data are not available. 

3. Anxiety, mild neuroticism, neurasthenia, and discontent are frequently found. 

4. Euphoria is infrequently reported, and when it is, investigators question 
whether it is genuine or in the nature of a protective mechanism. 

5. Data on the sex drive are inadequate; what there are do not support the theory 
of increased sex drive. 

6. The evidence upon intelligence gives no indication that tuberculosis has a re- 
gressive effect; the bulk of the data supports the tentative hypothesis that 
tuberculosis may be associated with a slightly increased level of intellectual 
functioning. 

Minor, 42 Brown, 43 Banister, 44 and others have noted additional factors 
which are important in considering the adjustment of tuberculous chil- 
dren. Kramer's recent discussion of this problem is very penetrating. 
The psyohopathology of the tuberculous child, according to Kramer, does 
not essentially differ from that of children who are not tuberculous. The 
"development of psychopathological symptoms docs not usually rest 
with the morbid process itself but with the attitude the child learns to 
take toward it." 45 As with most physically handicapped children, the per- 
sonality integration or disintegration of the tuberculous child will depend 
to a large extent upon the child and the adults in the situation. Kramer 
points out a truism which applies to all groups of children that "overpro- 
tection and overindulgence" of the tuberculous child "will produce emo- 
tional and mental immaturity which is especially harmful to a young indi- 
vidual who is confronted with the danger of physical handicap and a lack 
of communal socialization." These factors constitute real reasons for care- 
ful educational and psychological planning in an attempt to meet the 
needs of the child with tuberculosis. 

DISORDERS OF GLANDULAR FUNCTION AND GROWTH 
The psychological and educational significance of extreme variations in 
physical growth has not received the same amount of consideration as has 

42 C. S. Minor, "On the Psychological Handling of the Tuberculosis Patient," 
American Review of Tuberculosis, II (October, 1910), 459-69. 

48 L. Brown, "Mental Aspects in the Aetiology and Treatment of Pulmonary Tu- 
berculosis," International Clinics, III (1933), 149-74. 

44 H. Banister, "Psychology and the Tuberculous," Journal of State Medicine, 
XXXIX (1931), 267-74. 

45 H. C. Kramer, "Psychopathology of Childhood Tuberculosis," Nervous Child, 
VII (1948), 102-14. 



CRUICKSHANK AND PEACHER 233 

been given to the other types of physical handicaps which have been 
longer recognized by medical, psychological, and educational research 
workers. Research concerned with the physiological aspect of the problem 
is voluminous, and considerable understanding of the relationship be- 
tween glandular function and growth is to be seen. On the other hand, re- 
search concerned with the psychological implications of physiological dis- 
orders which result in growth dysfunctions is sparse. Moreover, it is 
doubtful that the findings of the few studies which are available give a 
true picture of the actual situation. 

Causes 

Endocrine Glands. The importance of the endocrine, or "ductless," 
glands in the life of the human organism has been known for many years. 
Within the recent years of modern medicine there has been a growing rec- 
ognition of their influence on physical growth, intellectual development, 
and emotional stability in human beings. The endocrine glands dispense 
their products directly into the blood stream, for the most part in the 
form of hormones. An example of such a hormone is insulin, which is pro- 
duced in the digestive gland, the pancreas. The glands which are now 
known to produce hormones are the pituitary, thyroid, parathyroid, adre- 
nals, pancreas, ovaries, testes, stomach, and intestines. Other organs 
which possibly exert the same influence as the ductless glands and have 
endocrine functions are the thymus, pineal, liver, spleen, and heart. The 
hormones produced by these organs individually and collectively exert a 
tremendous influence on the functioning of the total organism, not only 
on a physiological basis, but on a psychological basis as well. 

The most common disturbances of the thyroid gland observed in chil- 
dren include colloid or simple goiter, hyperthyroidism, and hypothyroid- 
ism. The colloid condition is now seldom seen in children due to the al- 
most universal use of iodized salt. 

Hyperthyroidism is relatively common during the adolescent period. It 
is characterized by loss of weight and strength, palpitation, nervousness, 
and increased appetite. Objectively, there is a fine tremor of the hands, 
increased perspiration, and an elevated basal metabolic rate. Medical 
management is always indicated. Hypothyroidism or myxedema may oc- 
cur in childhood and is due to a diminution or absence of thyroxine, the 
secretion from the thyroid gland. This may occur as a result of the atro- 
phy or the removal of the thyroid gland. It is characterized by a low basal 
metabolic rate, tissue changes, diminished physical and mental activities, 
and a characteristic facial expression. Since the deficiency occurs during 
the developmental period, there may be gonadal changes; puberty may 
be delayed with subsequent impairment of the menses; delayed develop- 



234 EPILEPTIC AND TUBERCULAR CHILDREN 

merit of the cranial bone structures, or even dwarfism may be a result. 
Cretinism, due to congenital maldevelopment of the thyroid gland, is now 
relatively rare, and the clinical picture of this condition is quite different 
from that of acquired hypothyroid deficiency which has been described 
by Benda. 46 A medical problem, deviations in the function of the thyroid 
require prolonged administration of thyroid preparations to insure ad- 
equate physical growth and intellectual development in all deficiency 
states. 

Disorders of the pituitary gland may take the form of hypopituitarism 
and hyperpituitarism. In the former, complete absence of function may 
occasionally occur with resulting retardation of growth, impaired gonadal 
function, lowering of the blood pressure, and other functional changes. 
Pituitary dwarfism may be included in this group and may be associated 
with impairment of thyroid function and of sexual development. Frohlich's 
syndrome is more common and is characterized by obesity, delayed pu- 
berty, and abnormal secondary sex characteristics. Hyperpituitarism, re- 
sulting occasionally in giantism or a tendency toward giantism, is due to 
the presence of certain pathological factors in the pituitary gland prior to 
the closing of the epiphyses during the normal course of physical growth. 
Frequently coupled with this condition may be factors generating from 
thyroid gland disturbances. A similar condition arising after puberty has 
been reached is called acromegaly. X-ray therapy or surgery is frequently 
indicated. Deficiencies associated with malfunction of the pituitary gland 
may be treated by medical personnel with suitable substitution therapy. 

Dysfunction of the gonads in males may result in hypergonadism and 
hypogonadism. The former is rarely encountered in clinical practice, but 
the latter is relatively common. The primary type is due to a local defect in 
the testis, the most common example being eunochoidism. If hypogonad- 
ism occurs prior to puberty, one may expect increase in length of the ex- 
tremities, vocal changes, and impairment of secondary sexual character- 
istics. Although stimulation therapy has not been uniformly successful, 
chorionic gonadotropin has been of some value in treating the condition 
medically. The most common type of secondary hypogonadism is 
Frohlich's syndrome mentioned in connection with hypopituitarism. 
With regard to females, hypofunction corresponds to similar dysfunction 
in the male. In both instances early diagnosis is important in order that 
substitution therapy can be immediately instituted. 

Undernourishment and Malnutrition. The estimate that there were 
6,000,000 malnourished children in this country in 1930 47 brings the prob- 



48 C. E. Benda, Mongolian and Cretinism, pp. 3&-50. New York : Grime & Stratton, 
1946. 

47 "White House Conference on Child Health and Protection," Special Education: 
The Handicapped and the Gifted Child, p. 5. New York : Century Co., 1930. 



CRUICKSHANK AND PEACHER 235 

lem of the undernourished and malnourished child to the attention of 
both the medical and the educational professions. This is the largest 
group among the commonly observed types of exceptional children. Un- 
dernourishment thus becomes one of the pressing problems with which 
the schools are continuously concerned. Malnutrition not only has a de- 
trimental effect on growth in young children, as has frequently been seen 
in the results of World War II, but also has an important effect on 
growth in older children who experience changes in food intake during the 
growth process. While the problems of undernourishment are practically 
universal in the United States, certain geographical areas show greater 
rates than others, and in some areas specific causes of malnourishment can 
be traced to prevalence of localized parasitic agents. For example, hook- 
wormy a common cause of malnutrition, is particularly common in the 
southern parts of the country and in those areas wherein there is heavy 
precipitation. Children are most commonly infected by hookworm, al- 
though the disease is found in persons of all ages. Malaria, particularly 
when found in children, is an important causative factor in malnutrition. 
Ascariasis, a parasitic disease which springs from the soil and which first 
develops in the intestinal tract, is also one which is found most frequently 
in the south and which is closely associated with malnutrition. The causes 
of malnutrition are exceedingly numerous, the three selected for mention 
here serving only as examples. 

With an adequate medical diagnosis, appropriate educational pro- 
grams for undernourished children can readily be developed within the 
framework of the public schools. Special classes for children with lowered 
vitality are to be observed in several large public school systems. Some- 
times these are called fresh-air classes, open-window classes, or by other 
designations, but always their goal is to provide an educational program 
supplemented by rest and nutritive feeding that will make it possible for 
the pupil to function within the limits of normal childhood living. 

Somatopsychological Significance of 

Disorders of Physical Growth 

Barker states that "while there is evidence of weak relationships be- 
tween physical measures of physique and personality and social behavior 
(relationships that are by no means negligible), methodological short- 
comings make it doubtful if this is a true picture of the situation." 48 The 
impact of physical disorders on the developing personality of children 
and youth has been pointed out by a number of writers. 49 and is evidenced 



48 Barker, Wright, and Gonick, op. cit., p. 21. 

49 W. M. Cruickshank, "The Impact of Physical Disability on Social Adjustment/' 
Journal of Social Issues, IV (Fall, 1948), 78-83. 



236 EPILEPTIC AND TUBERCULAR CHILDREN 

by such nonobjective sources as is contained in the attitudes expressed by 
society to differences which are apparent in the physical characteristics of 
specific individuals. Bruch, 50 Levy, 61 Bronstein, 52 and Olson 68 present 
data to show the effect of changes in physical growth on the psycholog- 
ical development of the individual. 

The treatment of such individuals may involve medical therapy in the 
case of endocrine disturbances such as have been noted, or it may involve 
only the careful observation of the child to ascertain the growth changes 
indicative of normal development that are being experienced. The educa- 
tional program must take cognizance of the reason for any growth dis- 
turbance observed, must be contributory to the psychological orientation 
of children who are experiencing such disturbances, and must provide an 
atmosphere in which the child may adjust to the limits of his capacity 
and be permitted to benefit from the medical therapy which is being 
employed. 

NEEDED RESEARCH 

Research of a truly scientific nature which deals with the educational 
and psychological development of epileptic children, with tuberculous 
children, and with those who have experienced dysfunction of endocrine 
glands is greatly needed. Particularly needed are studies which have to do 
with psychological therapy of a group or individual nature that will 
guide such children to a type of personality integration that will enable 
them to realize the maximum benefit from educational opportunities 
available to them. Because each type of exceptional child requires medical 
supervision, whatever research is undertaken should be carried out as a 
co-operative study with medical personnel in order to determine the in- 
fluence of both medical and psychological therapies in childhood adjust- 
ment. Controlled studies to determine the most satisfactory procedures 
to be used in the education of epileptics in the public schools are indi- 
cated; studies which are geared to the development of more adequate 
programs of education and mental hygiene for the tuberculous child dur- 
ing convalescence are needed; and growth studies which carefully note 
personality changes in children undergoing glandular therapy need to be 
undertaken. 



60 Hilde Bruch, "Obesity in Childhood and Personality Development," American 
Journal ofOrthopsychiatry, XI (July, 1941), 467-74. 

61 D. M. Levy, "Aggressive-submissive Behavior and the Frohlich Syndrome," Ar- 
chives of Neurology and Psychiatry, XXXVI (November, 1936), 991-1020. 

62 1. P. Bronstein, S. Wexler, A. W. Brown, and L. I. Halpern, "Obesity in Child- 
hood: Psychologic Studies," American Journal of Diseases of Children, LXIII (Febru- 
ary, 1942), 238-51. 

68 See chapter iv of this volume. 



CHAPTER XIII 

SPECIAL EDUCATION FOR 
THE MENTALLY HANDICAPPED 



ELIZABETH M. KELLY 

Director, Department of Special Education 

Newark Public Schools 

Newark, New Jersey 

and 

HARVEY A. STEVENS 
Superintendent, Southern Wisconsin Colony 

and Training School 
Union Grove, Wisconsin 



The problem of the child with retarded mental development assumes 
considerable importance in the general program of education. Adminis- 
trators as well as teachers are becoming increasingly concerned about 
those pupils who find it difficult to profit from the program provided for 
normal groups. In the absence of special provisions for the mentally hand- 
icapped, the problem becomes acute because the school curriculum, gen- 
erally, is not adapted to the needs and abilities of these pupils. Many 
schools are not organized to serve the exceptional needs of backward pu- 
pils, due to overcrowded classrooms and lack of equipment and materials 
necessary for the functioning of a well-designed program for such pupils. 
Teachers do not always have the training which would enable them to 
distinguish between a slow learner and a discipline case. School admis- 
trators also are sometimes lacking in the power to guide and direct the 
classroom teachers in the techniques of gearing their programs to the 
needs of children of different levels of ability. 

CLASSIFICATION OF THE MENTALLY HANDICAPPED 
In the past there has been considerable confusion as to what consti- 
tutes mental deficiency. Professional thinking today accepts the criteria 
Doll has suggested as the guides for an acceptable definition of mental de- 
ficiency. His definition is as follows: 

Mental deficiency is a state of social incompetence obtaining at maturity, or 
likely to obtain at maturity, resulting from developmental mental arrest of con- 

237 



238 THE MENTALLY HANDICAPPED 

stitutional (hereditary or acquired) origin; the condition is essentially incurable 
through treatment and unremediable through training except as treatment and 
training instill habits which superficially compensate for the limitations of the 
person so affected while under favorable circumstances and for more or less 
limited periods of time (14: 217). 

The appropriate designation to be given to the group which stands be- 
tween the mentally deficient and the normal is still a question. They are 
frequently referred to as the "slow learners." The classification of pupils 
in the early stages of school experience is important so that each individ- 
ual may more readily learn to respond to selective social treatment and 
educational training. As a practical procedure, the school might well be 
guided by the following criterion in determining those who will be classi- 
fied as mentally handicapped: pupils who are found by competent exam- 
iners to have potentialities which will enable them to respond to the ad- 
vantages of a special-education program designed to assist them in their 
efforts to succeed in the home, the school, and the community. The men- 
tally retarded child is more seriously handicapped than the slow learner 
and requires the advantage afforded by a carefully planned program such 
as is provided in a well-organized special class. The slow learners, al- 
though less seriously handicapped than the mentally retarded, usually 
find the traditional type of school program too difficult to handle without 
some modifications of the program to adjust requirements to their normal 
capacity for achievement. 

DISCOVERING THE MENTALLY HANDICAPPED 

Teachers may well serve as the key people in evaluating the reactions 
of their pupils, educationally and socially. Many teachers must first be 
oriented in the initial steps of critically gauging individual pupil progress 
with reference to the progress of the group as a whole, individual adjust- 
ment as compared with the maturational level expected of pupils of a 
given age, and individual physical efficiency which should be manifest for 
definite pupil-age groupings. 

Disregarding physical disabilities or emotional maladjustments as fac- 
tors in educational retardation, the second step is the application of a 
group intelligence test. This test should be judiciously selected; it should 
suit the purpose in every way. Many teachers, oriented as indicated in the 
preceding paragraph, are able to administer these tests themselves. They 
may, however, require guidance in the selection of the test and assistance 
in the adequate evaluation and proper utilization of the results for pur- 
poses of classifying the pupils and making their programs. 

The educational and physical cumulative records can serve as helpful 
guides in making these comparisons and in establishing a basis for further 



KELLY AND STEVENS 239 

and more extensive exploration. Brief case-studies which include perti- 
nent data on the background of the individual pupil are also of great 
assistance. 

Some of the specific characteristics which may be noted in determining 
pupil maladjustment are as follows: 

1. Educational 

a. He is not able to think abstractly or to handle symbolic material. 
6. He is significantly below the level of most children of his age in school 
efficiency. 

2. Social 

a. He may react to his educational inefficiency by social misbehavior. 
6. He indicates a definite immaturity by his nonacceptance of personal and 
social responsibilities. 

3. Behavioral 

a. His slow learning may be manifested by poor co-ordination and lack of 
flexibility or adaptability. Sensory defects in the visual, auditory, or motor 
areas may be concomitants of his slow-learning ability. 

When the findings on the survey test of individual pupils corroborate 
the school record of educational maladjustment, which was noted in the 
first instance, an individual psychological examination by a qualified psy- 
chologist is indicated. The clinician must be briefed on the pupil before 
the examination takes place. This the teacher can do by competently 
completing the referral blank with concise and meaningful information 
which will greatly assist the examiner in establishing rapport with the pu- 
pil to be examined and in evaluating his test performance. A competent 
psychologist is the proper one to diagnose the pupil as educable or un- 
educable. He alone is equipped to classify the pupil as mentally deficient, 
mentally handicapped, or slow learning. It is his responsibility to recom- 
mend how the educational program shall be structured and how it shall be 
implemented for the ultimate development of the child. 

CHARACTERISTICS OF THE MENTALLY HANDICAPPED 
The characteristics of the mentally handicapped found in either a met- 
ropolitan area or rural community are usually of the same composition, 
potentially speaking. Sometimes, in performance, these characteristics 
are reflected in patterns of behavior which appear to cast doubt upon the 
original diagnosis of mental retardation. Then again the reverse is true, 
and the mentally retarded individual performs below the level of his 
classification. Both of these situations are due to two groups of factors: 
one inherent in the individual, and the other contained within the envi- 
ronment. 

Considering first the personality factors, we note behavioral evidences 



240 THE MENTALLY HANDICAPPED 

of forces which direct the individual to the attainment of physical well- 
being; to the achievement of mastery and success; to the securing of rec- 
ognition, respect, and approval; and to the realization of being wanted, of 
being loved, and of belonging. These forces or drives merit consideration 
here in so far as they influence the behavior of the handicapped individ- 
ual. Questions immediately arise as to how to insure for those with re- 
tarded mental development the acquisition of properly selected drives. In 
normal individuals they are to be realized on the basis of socially accept- 
able selections, not according to the choices which the individual person- 
ally prefers or considers desirable. Therefore, the satisfaction of individ- 
ual drives is achieved to the extent that they are socially acceptable and 
contribute both to the individual's development and to the advancement 
of the welfare of all individuals. 

Second, when environmental influences are observed as being restric- 
tive and encrusting, all individuals are, to varying degrees, negatively 
affected. In such situations, some mentally handicapped individuals seem 
duller and more retarded than they really are. By the same token, an en- 
vironment which is overstimulating and demanding will not only speed 
up the tempo of normal individuals so that required demands may be sat- 
isfied but will likewise spur the mentally handicapped in their efforts to 
make necessary behavioral adjustments. Under such environmental stim- 
ulation, the normal individual may be able to adjust and to manage him- 
self acceptably, whereas the mentally handicapped more often than not 
will become disorganized and dislocated. The unsatisfactory performance 
of the mentally handicapped individuals is attributable to the fact that 
they lack the flexibility and the reserve power needed to combat heavy 
restraints, sudden changes, or undue pressures. 

The explanation of the variable pattern of behavior of individuals of 
different levels of intelligence is to be found in the efficiency of function- 
ing of the individual's intellectual capacity. However, defect of intellec- 
tual capacity and intellectual functioning is observable in varying de- 
grees, and variability may be related to the areas of activity in which the 
mentally handicapped participates. This fact is particularly high-lighted 
in the developing school years of the child since educational achievement 
is a major consideration in the clinical observation of pupil characteris- 
tics. During this period, the individual patterns of learning reveal more 
about the child as a whole than any other observable characteristics since 
the major portion of the child's experience is related to school activities. 
Caution must be exercised in prognosticating the over-all efficiency of the 
mentally handicapped when the framework for individual action is thus 
circumscribed. The problem of guidance is a weighty one for the educator, 
since the effectiveness of a school program which adequately taps the in- 



KELLY AND STEVENS 241 

tellectual potential of the individual and properly molds this potential is 
dependent upon skilful school-planning. 

In the field of physical education, where achievement in competitive 
sports is so important to young people, the problem of guidance for the 
mentally handicapped in the acceptance of a subordinate role or an infe- 
rior rating is a very real problem. This is particularly true when the 
handicapped more nearly approach their normal competitors in physical 
than in other attributes. The contrast between the normal and the men- 
tally handicapped is due, for the most part, to the fact that the former 
group experiences an automatic adjustment of natural physical exten- 
sions as a normal phase of the growth process. The latter group must ac- 
tually work toward such adjustments, sometimes approaching the ac- 
cepted goals but seldom attaining them completely. 

In the realm of emotions, it is generally believed that the mentally 
handicapped experience the same feelings as do normal individuals. Here 
the likeness terminates, however, since the expression of emotional reac- 
tions is dependent upon the capacity for intelligent response to a problem 
situation. Even the more stable individuals of this group require an inten- 
sive program of guidance in emotional adjustment. The direction of this 
guidance depends not only upon the status of the individual himself but 
also upon the nature of environmental influences. The guidance program 
for such pupils requires an intensity of application of properly chosen ad- 
justment measures, since experience has indicated that without consecu- 
tive, effective guidance the mentally handicapped fall prey to influences 
which lead to lives of disservice and maladjustment. 

EDUCATIONAL PROVISIONS FOR THE MENTALLY HANDICAPPED 
Feeble-minded 

When a child is found to be uneducable, i.e., unable to profit or adjust 
to the offerings of the public school program because of extremely low 
mental ability, he is usually excused or excluded from further public 
school attendance. 

There is, however, a group of educable boys and girls temporarily clas- 
sified within this area who are sociably feeble-minded. This group is to be 
differentiated from those permanently classified as feeble-minded. Broken 
homes and unfavorable environmental influences are factors which may 
temporarily interfere with the social adjustment of mentally deficient 
children. They are usually committed to residential schools where a well- 
conceived program of guidance skilfully administered can frequently 
effect a satisfactory degree of social adjustment. 

The educational provisions for those boys and girls falling into this 
temporary classification must be as carefully planned as for those who are 



242 THE MENTALLY HANDICAPPED 

in special classes in the public schools. The opportunity for greater inte- 
gration, on a residential basis, of everyday experiences with school pro- 
gramming is greatly enhanced. In fact, school programs in residential 
schools might well point the way experimentally for the development of 
more successful educational programs for all types of mentally handi- 
capped children. 

Mentally Retarded 

The large incidence of mental retardation in a metropolitan area eradi- 
cates many of the problems which beset the educational planning for this 
group in a smaller community. First, the need is more readily recognized 
in the larger community because of the greater incidence; and, second, 
since the planning can be done on a broad, rich, co-ordinated basis, the 
program is not isolating. When provisions for this group are planned with 
vision and thoughtfulness, the psychological barriers erected against such 
programming are never long lived. 

The educational provisions, then, for the mentally retarded, in any 
area, should be clear-cut in organization, in administration, and in super- 
visory direction. The physical appointments for housing must be as good 
in selection as for the regular school, if not better. The necessary school 
fixtures in the blueprint of construction should be modern and complete 
in every detail. The educational equipment, indicated as necessary for the 
fulfilment of the goals of the curriculum, should be readily available. 

The type of organization which is rapidly becoming common practice, 
whether in a large or small community, is effected according to a plan ap- 
proved by competent authorities. In the larger community the population 
is so concentrated that the pupils are accommodated in special classes in 
their own school districts, at least during the elementary-school years, 
and thereafter are assigned to a prevocational or junior high school pro- 
gram as their needs demand. The smaller community adheres to a re- 
gional type of planning for special classes on the elementary- and second- 
ary-school levels. 

Organizational planning on a district or regional basis for special 
classes based on a general 6-3-3 school plan follows the outline as pre- 
sented below: 

1. Classes for the Mentally Handicapped in Elementary Schools 
I.Q. Classification: 50-79 
a. One-room Unit 

Primary and Intermediate Group 

Chronological ages: 7 yrs. to 11 yrs. 11 mos. 
6. Two-room Unit 
Primary Group 

Chronological ages: 7 yrs. to 8 yrs. 11 mos. or 9 yrs. 1 1 mos. 
Intermediate Group 
Chronological ages: 9 yrs. or 10 yrs. to 11 yrs. 11 mos. or 12 yrs. 11 mos. 



KELLY AND STEVENS 243 

2. Prevocational Schools for Menially Handicapped 
I.Q. Classification: 50-79 

I. (Exploratory) Section A: 12 yrs. to 13 yrs. 5 mos. 

Section B: 13 yrs. 6 mos. to 14 yrs. 5 mos. 
Section C: 14 yrs. 6 mos. to 16 yrs. 
II. (Intermediate) Section A: 12 yrs. to 13 yrs. 5 mos. 

Section B: 13 yrs. 6 mos. to 14 yrs. 5 mos. 
Section C: 14 yrs. 6 mos. to 16 yrs. 
III. (Vocational) Section A: 12 yrs. to 13 yrs. 5 mos. 

Section B: 13 yrs. 6 mos. to 14 yrs. 5 mos. 
Section C: 14 yrs. 6 mos. to 16 yrs. 

After the age of 12 years or 12 years 11 months is attained, one of the 
avenues open for the further development of the mentally retarded is 
placement in a prevocational school. This is advocated if the individual is 
more inclined toward a program of activities. This type of organization, 
divided into three sections, has many advantages. Many mentally handi- 
capped pupils enter the program of special education after they have at- 
tained the chronological age of twelve. They are nonreaders. Such a situ- 
ation sometimes prevails among those advancing from the elementary 
special classes. This may be due to either of two factors, one being attrib- 
utable to low intellectual ability, another to the presence of an aggravated 
emotional condition in the individual. 

The groupings are based on chronological age and academic achieve- 
ment. The low or nonachievers, during their prevocational school 
life, proceed horizontally in organization in the Exploratory Division 
(through Exploratory B and Exploratory C). When underachievers of 
higher intellectual ability develop academically, they are moved on to the 
Intermediate Division. If their peak of academic achievement is reached 
in this division, they also proceed horizontally through Intermediate B 
and Intermediate C. Some others, who start as academic underachievers 
in the Exploratory Division, though being in the highest intellectual clas- 
sification of the school as a whole (70-79 1.Q.), sometimes develop rapidly 
as far as general over-all achievement is concerned and proceed diagonally 
from Exploratory A through Intermediate B to Vocational C. 

Placement of mentally handicapped pupils in the divisions of the pre- 
vocational organization is dependent upon age, adjustment, and aca- 
demic achievement at the time of enrolment. The plan for grouping on 
the basis of age is geared to the needs of the individual pupil. 

The prevocational schools, though terminal in organization, seize 
every opportunity of contact with the regular junior high schools in the 
matters of sports, intervisitations, socials, or competition of one kind or 
another. This leads to a better understanding of the prevocational pro- 
gram, particularly, and is conducive to better social adjustment of the 
pupils. When it is necessary to separate boys and girls on the prevoca- 



244 THE MENTALLY HANDICAPPED 

tional level because of program needs or limited physical facilities, a de- 
finite effort is made to bring these boys and girls together at every oppor- 
tunity. Lack of such effort makes for a superficial, unnatural, social de- 
velopment of both. 

3. Junior High School Special Classes 
I.Q. Classification: 65-79 

Section I: Chronological ages: 13 yrs. to 14 yrs. 5 mos. 
Section II: Chronological ages: 14 yrs. 6 mos. to 15 yrs. 5 mos. 
Section III: Chronological ages: 15 yrs. 6 mos. to 16 yrs. 

On the regional plan for rural areas where an intervening organiza- 
tional step (prevocational) is not possible, mentally handicapped boys 
and girls advance, after the attainment of chronological ages of 12 years 
6 months or 12 years 11 months, directly to the junior high school spe- 
cial classes. This practice may be adopted even in a metropolitan com- 
munity but should be established on a more refined basis in view of the 
higher I.Q. classifications for each grouping. 

When designated pupils from Division III, Section C (prevocational) 
achieve the minimum number of units for junior high school status they 
are transferred to a regular junior high school class. If acceptable progress 
is sustained, they are promoted with the regular junior high school group 
to a senior high school. 

In the extension of educational opportunity for mentally retarded pu- 
pils in the junior high school, the emphasis on total school participation 
maintained on the elementary level is observed. The divisions in the reg- 
ular program in which they are included are made up of pupils whose I.Q.'s 
are higher than those initially considered for special-class placement. 

IMPLEMENTATION OF REMEDIAL PROGRAMS 
FOR THE MENTALLY HANDICAPPED 

The needs of the mentally handicapped today are to a great extent 
being served by legislation; by teachers certified to teach in this area; and 
by the aid of personnel specifically trained in supervisory, psychological, 
psychiatric, and vocational services and therefore capable of dealing with 
the problems of the individuals of this group. 

Practically all states have provided both permissive and enabling leg- 
islation for the care, treatment, and training of mentally handicapped in- 
dividuals. A few states have provided for the care of such persons for 
nearly one hundred years. Legislative provisions for public school special 
classes are much more recent. Among the states which pioneered in insti- 
tutional or public school programs are Massachusetts, New York, New 
Jersey, Pennsylvania, Ohio, Minnesota, and Wisconsin. 

The laws of some states are more comprehensive than others. For ex- 



KELLY AND STEVENS 245 

ample, the Illinois law authorizes an extensive program which includes 
the following: adequate facilities for early recognition and diagnosis; pro- 
visions for opportunities for education and training, both through state 
schools and special classes in the regular schools; adequate institutional 
facilities, including colony care; extra institutional supervision of all men- 
tally deficient children who are cared for in their own homes; vocational 
guidance, training, and placement; planned teacher training; and con- 
tinuing research to determine more adequately the nature of the problem 
of mental deficiency and the needs, capacities, and welfare of the men- 
tally deficient (26). 

Federal legislation still leaves much to be desired as far as assistance to 
the mentally handicapped is concerned. The National Mental Health 
Act, enacted in 1946, will benefit this group only to the extent that their 
problems are related to the preventive measures being developed in vari- 
ous areas of mental health. Though the Vocational Rehabilitation Act 
(Public Law 113) was amended in 1943 to provide services for the edu- 
cable mentally handicapped, realistic planning for them can be expected 
only when trained personnel become available and when the needs of the 
adult mentally handicapped are accepted as a part of the educational 
responsibility of those concerned with vocational rehabilitation. 

Housing and Equipment 

A special class for the mentally handicapped in a regular school, ele- 
mentary or junior high, is more and more becoming a definite part of the 
regular organizational program, that is, the pupils are housed in the same 
school area with pupils of like chronological age. The same standards of 
light, ventilation, radiation, and seating that apply to any classroom are 
prescribed for the special classroom. The special-class pupils, as a group, 
also have access to the same school facilities and share them at desig- 
nated times with the school bod}' as a whole. 

When mentally handicapped pupils cannot be accommodated in their 
school districts, they are sent to those schools which afford the means of 
transportation, an enriched program of activities, and suitable recrea- 
tional facilities both indoors and out. Schools selected to receive these 
special-class assignments should be chosen with consideration also for 
their observance of the need for a participating program involving all the 
pupils of the school. 

In single unit classes, i.e., those providing instructional facilities for all 
age levels, or even for two-room units which allow for refined age group- 
ings, rooms much larger than regular classrooms are allotted because of 
the variety of activities conducted. Sometimes two rooms are provided 
for each group, one serving as a workshop. 



246 THE MENTALLY HANDICAPPED 

Special schools or centers of a prevocational type have already been es- 
tablished in most metropolitan cities, while in a few, special vocational 
schools have been organized. The activities and the learning situations 
are designed to provide experiences of the type the mentally handicapped 
will encounter in their daily living. 

In the matter of separate housing for special centers or vocational 
schools for mentally handicapped pupils of preadolescent and adolescent 
ages, consideration is given to the location and the type of construction of 
school buildings allotted for this program. Abandoned or condemned 
buildings do not suffice, neither will those in which the architectural fea- 
tures cause undue inconvenience. It is necessary to have the neighbor- 
hood placement of the school on a suitable cultural level so that the 
pupils flowing from all strata of society may feel secure in their special- 
school assignment. 

Curriculum offerings are planned on two bases, pupil needs (intellec- 
tual, emotional, cultural) and work opportunities of the community. 
Therefore, implementation of the program in a special elementary class or 
in a prevocational or vocational school necessitates adaptation of furni- 
ture and equipment to the requirements of a rich and comprehensive pro- 
gram. This is particularly true on the adolescent level where a wide scope 
of activities for mentally handicapped boys and girls requires equipment 
similar to what they will use in industry. 

Required Personnel 

Since chapter vii deals with the qualifications and training of teach- 
ers, it is sufficient to note here that the problem of teacher shortage and 
recruitment of acceptable teaching personnel is as great a problem in the 
area of the mentally handicapped as in any other division of teacher 
training. As the machinery for discovering the mentally handicapped is 
assembled and set in motion in more and more communities, the drive to 
secure well-trained teachers of the mentally retarded is being pressed 
with encouraging results. 

Suggestions for developing a co-ordinated training program for teach- 
ers of the mentally retarded are as follows: nation-wide standardization of 
qualifications for teachers of the mentally handicapped; nation-wide es- 
tablishment of special divisions in teacher-training institutions for the 
proper training of these teachers; nation-wide standardization of salary 
schedules for teachers in this field; national and regional registry of well- 
prepared teachers of the mentally handicapped; and a plan of sectional 
exchange of teachers prepared to teach in this field. 

Though the teacher is the key person in the educational program of the 
mentally retarded, the extraordinary needs of such pupils require the ad- 
ditional services of specialized personnel. The supervisor, the psycholo- 



KELLY AND STEVENS 247 

gist, the psychiatric social worker, and the vocational counselor consti- 
tute a suitable staff of specialists. 

The Supervisor. The supervisor serves as co-ordinator of all those 
forces which impinge upon the special teacher and special class. He also 
directs the in-service training program of the special teacher and inter- 
prets the procedures and directives which co-ordinate the functions of the 
special teacher and the special class with those of the school organization 
as a whole. He can assist the teacher by explaining what is meant by 
school management, by an integrated program, by pupil needs, by cur- 
riculum objectives, and by learning techniques. The role of the supervi- 
sor is a very important one in the education of the mentally retarded, for 
through his skilful guidance the teacher is made aware of the factors in- 
volved in stimulating the development of these children. These include 
consideration of the importance of initial performance, of carrying 
through, and of concluding a phase of an activity. The certainty of accu- 
rate repetition of such a performance by the mentally retarded is largely 
dependent upon the original approach. 

The Psychologist. The psychologist's work in the education of the men- 
tally retarded, as in the regular program, is clinical in nature. It covers 
many phases. He serves as interpreter to the teacher in regard to the pat- 
tern of pupil learning, he advises as to the proper psychological ap- 
proach in pupil classification from the educational point of view, and he 
guides the selection and organization of learning experiences so as to meet 
the individual needs of members of the special class. He counsels the 
teacher on the mode of referral for those mentally retarded pupils who 
are having learning difficulties and indicates the type of referral data 
which may help in finding a solution to the problem of each pupil. 

The Psychiatric Social Worker. The psychiatric social worker serves the 
school and the teacher through the medium of interpretive counseling. 
He analyzes the maladjustment of the mentally retarded pupil, explains 
his diagnosis to the teacher, and suggests a co-operative plan of treatment 
that may be made to aid the pupil in adjusting to the requirements of his 
training program. Also, he interprets the case to the principal of the 
school, particularly if the child is in difficulty outside as well as inside the 
classroom. He visits the home and explains the nature of the child's learn- 
ing problems to the parents so that all persons in the areas which closely 
surround the pupil's activities will be understanding and co-operative. 
Even the community at large may be included in this interpretive ap- 
proach to the social behavior of the mentally retarded. At all stages of 
progress, the psychiatric social worker carries on an intensive program of 
treatment with the mentally retarded individual himself for such period 
of time as individual treatment may be required. 

The Vocational Counselor. For the mentally retarded of adolescent age, 



248 THE MENTALLY HANDICAPPED 

a third trained worker, the vocational counselor, should be provided. His 
approach to the task of counseling the mentally retarded is on a co-opera- 
tive basis, striving to bridge the distance between the school and industry 
and to acquaint each area with the needs of the other. In its various as- 
pects, the program of the vocational counselor includes: vocational guid- 
ance, occupational analysis, personal counseling, the evaluation of vo- 
cational training, job placement, and follow-up. 

As one surveys the facilities that are available or can be organized in 
any favorable school situation, it is conceivable that mentally handi- 
capped children in general can be so educated as to enable them to as- 
sume their role as happy, competent adults in their respective commu- 
nities. 

Curriculum for the Mentally Handicapped 

Philosophy as a Basis for Curriculum Construction. Those who have pio- 
neered successfully in the education of the mentally handicapped have 
been experimentalists. This has been due to the necessity of continually 
exploring two aspects of the problem, namely, the needs of mentally 
handicapped pupils and the guidance to be given these pupils in order to 
equip them to better meet the demands of the environment. In other 
words, continual emphasis has been upon the recognition of the matura- 
tional level of this type of pupil and upon the guidance of each individual 
in those motivating experiences which assist in the development of better 
integration of his own purposes with the conditions and influences of his 
environment. 

This process of experimentation in the education of the mentally hand- 
icapped has extended through a number of years, partly because of the 
lack of a ready means of distinguishing sharply between feeble-minded- 
ness and mental retardation. Of more importance, however, is the con- 
tinued experimenting with standards of achievement on the part of the 
mentally retarded and with the selection of teaching materials with which 
to implement an effective program of instruction for the members of this 
group. Progress has been retarded by the attitude of educators who ques- 
tioned the place in the public schools of those unable to profit from reg- 
ular programs of instruction; and there has been a discouraging uncer- 
tainty of the possibility of the eventual adjustment of the mentally re- 
tarded to the normal social situations characteristic of community life. 
Some workers in this field have followed the narrow educational road. 
Their approach has been authoritarian and mechanistic in regard to the 
education of this group. The majority of the workers have, however, la- 
bored consistently and with confidence that scientific studies would fi- 
nally assist in the solution of the problems involved in the development of 
a curriculum adapted to the needs and potentialities of this class of hand- 



KELLY AND STEVENS 249 

icapped children. The present status of this phase of special education 
may be attributed in great part to psychological and educational re- 
search. This research has indicated the differentiation in mental pattern- 
ing of those who are regarded as deviating in some manner or in some de- 
gree from the normal course of mental development. The results have 
pointed the way toward more crystallized thinking; toward the improve- 
ment of methods of curriculum construction; toward the attainment of 
more effective teaching procedures; toward better organization of instruc- 
tion; and toward wholesome participation on the part of the mentally re- 
tarded pupils in the school program as a whole. 

As a natural consequence of these advances, an acceptable philosophy 
of curriculum development for mentally retarded pupils may be dis- 
cerned. The years when pupils in special classes and schools were en- 
gaged in such activities as brush-making, rug-weaving, chair-caning, and 
in making knick-knacks of wood, metal, clay, raffia, and leather without 
consideration for the need of integrative development of the individual 
through the co-operative social action of the group may be regarded as 
the subject-matter period. These activities were pursued for the discipline 
involved, and such a program was centrally controlled. The influence of 
this discipline approach was also seen in the teaching of the academic 
subjects, particularly the three R/s. Since the academic achievement of 
mentally handicapped pupils was not satisfactory when they were taught 
in the traditional way, the program emphasis was shifted completely to 
manual pursuits. The same narrowness and rigidity of the program was 
continued under teacher domination in much the same manner as was ex- 
perienced by these pupils while grouped with normal pupils in the regular 
grades. 

This evolving philosophy may be identified with the movements which 
mark the transition from the subject-matter curriculum to the more func- 
tional types represented by the experience curriculum and the core curric- 
ulum. It is a philosophy which requires that the curriculum for the men- 
tally retarded be such as to offer broad experiences to the pupil; that it be 
sufficiently flexible in scope to allow for complete pupil growth; and that 
it provide opportunity for development by the pupil for those processes 
which assist in critically evaluating his experiences. 

Curriculum Goals for the Mentally Handicapped. The general educa- 
tional goals for the mentally retarded pupil are the same as those indi- 
cated for the normal child and as set forth by the Educational Policies 
Commission (39). They are the achievement of self-realization, the devel- 
opment of proper human relationships, the attainment of economic effi- 
ciency, and the assumption of civic responsibility. Each of these general 
goals implies the attainment of certain specific ones such as attainment 



250 THE MENTALLY HANDICAPPED 

of a healthy body and spirit, acquisition of useful knowledges and skills, 
development of an integrated personality, appreciation of the arts, under- 
standing the proper uses of leisure time, and growth in social virtue. 
Incorporated in the specific goals are those which aim toward the attain- 
ment of self-development, self-control, self-adaptation, and the apprecia- 
tion of interdependence. 

Since mentally retarded boys and girls are limited in their progress to- 
ward the common goals of their age group, the educational program 
which is to serve as a medium for the attainment of these general and 
specific goals must be adapted to their needs and abilities. The frame 
work for supplying their needs is contained in one of two approaches, or in 
a combination thereof. The first, the experience curriculum, is based upon 
the interests of pupils, their felt needs, and their dominant purposes. The 
second, the core curriculum, is organized into units of experience based on 
significant situations, phases of life, or problems which pupils now face or 
will face in the future. The experience-curriculum approach covers the in- 
troductory phases of the program for the mentally retarded while the core 
curriculum points up the advanced planning for pupils of this classifica- 
tion. 

The experience curriculum serves as the basis of learning for the men- 
tally retarded, being geared to their felt needs. When the initial step has 
been accomplished, the admissible formal aspects of a problem may be in- 
troduced. This introduction is followed with concrete evidence, until the 
concept is grasped and assimilated. This type of approach is important in 
the presentation of all new concepts, not only in the fields of number and 
environmental science but also in learning to read and in written and oral 
expression, in learning historical, geographical, and scientific facts, and in 
creatively performing manual or aesthetic tasks. The development of 
these generalized skills has the same value for the handicapped as for the 
normal child. A difference is apparent, however, in the scope of content, 
the manner of acquiring this content, and the points of interest in the 
selection of content. The need of every child for achievement in all these 
activities stems from basic drives within the individual and from pres- 
sures of the environment. Individual growth advances through environ- 
mental interaction. The value of experiential learning, then, is that it 
provides for pupil purposing and allows for both the refinement of mean- 
ings and the integration of these meanings with the total goals which are 
envisioned by the core curriculum. Units of experience organized within 
the core curriculum stress the following developmental concepts: (a) the 
importance of the home, the members of the family, and the interaction 
of its members; (6) the value of utilizing community resources, of study- 
ing the place of the individual as a member of a social and industrial com- 



KELLY AND STEVENS 251 

munity; and (c) the development of the city, state, and country effected 
through the labors of many classes of people. The part which industrial 
and agricultural inventions play in the over-all growth of the country is 
emphasized. As the mentally retarded individual is able to make appro- 
priate adjustments within this sphere of socialization and increases his 
proficiency in such interaction, the goals of self-realization, acceptable 
human relationships, economic efficiency, and civic responsibility are pro- 
gressively realized. 

Problems in Curriculum Construction for the Mentally Handicapped. The 
task of constructing a curriculum for mentally retarded children is more 
complex than that for normal pupils because it is necessary to retain the 
basic elements in the curriculum for the regular groups as well as to adapt 
materials to the abilities of the special class. This requirement must be 
met if the mentally handicapped are to be guided to live successfully in a 
"one world' 7 plan during their lifetime. Many problems are presented in 
this undertaking. 

The first is concerned with the curriculum itself, which contains care- 
fully chosen experiences in order to meet the needs of the mentally re- 
tarded learner. This should be characteristic of the curriculum for all 
mentally retarded children from the youngest to the oldest, because the 
scope of experiences must fit the social age of this type of pupil while the 
understanding of those experiences are brought within his mental grasp. 

The second problem pertains to curriculum adjustment as indicated by 
the length of the individual school-life span in relation to pupil capacity. 
This problem covers three aspects: the age of enrolment of the pupil in a 
special class; the mental capacity of the enrollee; and the type of program 
to be offered the mentally retarded pupil during his years in school. Since 
the average age of referral and grade placement is eight or nine, it prob- 
ably means that only eight school years may be available for educational 
guidance. Therefore, not only must expediency be served in planning 
what can be offered in the allotted time but also the offerings must be 
continually adjusted to the mental capacity of the pupil and to his evolv- 
ing social needs. 

A third problem involves curriculum offerings as governed by class or- 
ganization. Since the social-age grouping of the pupils of the special ele- 
mentary class is usually wide, ranging in some instances from six to 
twelve, the opportunity for teacher emphasis on a wide scope of curricu- 
lum materials and for pupil assimilation and consolidation of acquired 
knowledge and skills will be limited. However, it should be possible to 
formulate what is offered according to a plan which makes the total offer- 
ing both balanced and complete. 

For those mentally retarded pupils who remain with one teacher for 



252 THE MENTALLY HANDICAPPED 

two or more years, every effort should be made to blot out situations 
which make for boredom or ennui. This is accomplished by a well-con- 
ceived plan of organization which includes a wide variety of experiences, 
so arranged that they permit a continuous flow of pupil developments. 
This approach may be employed for the individual who enters late or is 
just passing through, as well as for those who may remain in the same 
class organization the full span of school years. 

The fourth problem centers around the essentials of curriculum offer- 
ings and the determination of the depth and breadth of what will consti- 
tute the essence. The limitations of time and of pupil handicaps dictate a 
curriculum content that can be made realistic and consumable for the 
mentally retarded. At the same time, it is important to include in the list 
of essences, cultural phases dealing with the humanities and those offer- 
ing opportunity for the expression and development of aesthetic ideas and 
attitudes which will be reflected in the personality of the individual. 

A fifth problem has to do with the securing of materials to implement 
curriculum content. Though there is still a meager supply of generalized 
educational material suitable for the mentally retarded pupil, some ma- 
terials designed for extension of the scope of experiences provided for nor- 
mal children are helpful to some degree. Progressive school systems in 
metropolitan areas with a large concentration of special classes have been 
developing their own materials for the mentally handicapped or adapting 
for use those used with the regular groups. Supplementary educational 
materials are being developed from the units of experience organized es- 
pecially for the mentally retarded. These are particularly valuable since 
the vocabulary involved in them is suitable for the mentally retarded. 
The materials generally found in regular grade-school reading materials 
are not commensurable with the social interests of pupils of this classifi- 
cation. 

Audio-visual and kinesthetic aids have been found to be excellent not 
only in supplementing the educational material available but also in mo- 
tivating the pupil in various learning activities. 

When these resources are utilized to implement their needs, one finds 
mentally handicapped children learning considerably faster and retaining 
what is learned much longer. Wygant (63 : 23) prepared a list of modern 
educational equipment which is helpful for direct learning activities in 
classes for the mentally handicapped. 

The importance of implementing the curriculum by use of the afore- 
mentioned related activities must be emphasized. A wide variety of such 
experiences will greatly enrich the program and make the task at hand 
much more meaningful to the pupils* 



KELLY AND STEVENS 253 

TRENDS IN THE EDUCATION OP THE MENTALLY HANDICAPPED 
In the last decade and a half great progress has been made in the edu- 
cation of the mentally handicapped. Improved programs have been made 
possible by the enactment of federal and state legislation. The results of 
research on medical, psychological, and educational problems relating to 
this group have assisted in furthering these programs. 

Legislation 

In 1930 there were only eleven states with laws making special educa- 
tional provision for the mentally handicapped. By 1940 five additional 
states had, in like manner, recognized the needs of this group; and in 1948 
there were thirty-five states whose legislatures had declared their inten- 
tion of effecting a program of welfare and education for children who are 
recognized as retarded in mental development. 

The enacted legislation in nearly all states provides financial assistance 
to local communities making special provisions for mentally handicapped 
pupils. The financial aid is based, for the most part, upon the contingen- 
cies that (a) qualified clinical examiners shall certify the pupils who are to 
be classified as mentally retarded and make the necessary recommenda- 
tions for their welfare; and that (&) specially qualified teachers only shall 
be selected to guide the education of pupils of this group. 

Efforts are unabated toward the enactment of legislation in other 
states making suitable provision for the education of the mentally hand- 
icapped. Functional federal legislation in behalf of these groups is also 
progressing, examples being the National Mental Health Act and the 
Vocational Rehabilitation Act. 

Typical state-planning in the interest of mentally handicapped pupils 
includes such provisions as the following: 

a) Organization of regional special classes to serve all rural children of a partic- 
ular area. 

6) Transportation of children classified for a special-class program to a desig- 
nated special-class center. 

c) Placement of children selected for admission to a special class in a boarding 
home in a community maintaining a special class when furnishing transporta- 
tion is not feasible. 

d) Making available to teachers of both the smaller urban and the rural com- 
munities such consultants and special-class teaching services as can be pro- 
vided by metropolitan areas. 

e) Providing in-service training of regular teachers and school administrators so 
that they may be better informed on teaching procedures necessary for the 
educational guidance of the mentally retarded child. 



254 THE MENTALLY HANDICAPPED 

/) Assignment of technical and consultant assistance from the state department 

of public instruction or some other designated educational agency for both 

teachers and families of mentally handicapped pupils. 
0) Securing circuit-traveling teachers and special supervisors to help supervise 

the work of the regular teachers having mentally retarded children in their 

classrooms. 
A) Conferences with families, when necessary, by representatives of an accredited 

agency in regard to the desirability of seeking custodial care and training in a 

private or public residential school for certain types of mentally deficient 

children. 

The Contributions of Medical Science 

Research in the area of biochemistry, indicating possible improvement 
in the intellectual status of the mentally handicapped, is attracting the 
attention of large groups of professional and lay people, among them be- 
ing many research workers. 

The studies have been concerned with (a) the effect of benzedrine 
therapy on psychomotor retardation and apathy in the mentally handi- 
capped; and (6) the effect of glutamic acid on the general acceleration of 
performance of the mentally handicapped. The results of the efforts of 
these experimenters are tentative (2, 37, 64). Their work opens up chal- 
lenging phases, psychologically and educationally, and future experi- 
ments by these scientists will be followed with careful attention. 

Psychological Investigations 

In the psychological field there have been important research contri- 
butions relating to the mentally handicapped. Some of these studies have 
been concerned with the differentiation between primary and secondary 
characteristics in cases of mental deficiency and the measure of perform- 
ance of the individuals falling in these two classifications. The definition 
of the classifications, primary (endogenous) and secondary (exogenous), 
introduced by Strauss (45, 46, 47), have been extended through the find- 
ings of Doll (15) indicating that these investigations will be of invaluable 
assistance to educators, particularly, in planning educational programs 
for those mentally handicapped who are qualitatively and quantitatively 
classified. 

A type of psychological research, which has from time to time been a 
matter of great concern to workers in the field of special education, is that 
which has involved controversies growing out of the findings pertaining 
to the purported increases in intelligence rates due to environmental in- 
fluences. Some of these studies have been recorded by Freeman and 
others (20), Skeels (42), and Schmidt (41). 

The report of Schmidt's investigation has been evaluated by Kirk (29). 
This evaluation and other follow-up studies indicate that these data need 



KELLY AND STEVENS 255 

further checking before being finally accepted. Other phases of psycholog- 
ical research which have been of great value as an aid in the personality 
adjustment of the mentally handicapped in the school and the commu- 
nity have been reported by Doll (16), Brainerd (6), and Voelker (49). 

Research in Curriculum and Methods 

The literature on educational research pertaining to the mentally 
handicapped is more voluminous. Considerable emphasis is being given 
to research on programs for the preschool and adolescent mentally handi- 
capped and to those pupils in this classification who have other handi- 
caps as well. 

The Wayne County Training School studies (33, 51) on preacademic 
training for the mentally handicapped, together with the contemplated 
program of research on the preschool child at the University of Illinois, re- 
flect the growing interest in these phases of the problem and point to the 
possibility of expansion of these types of programs. Experimental pro- 
grams for the adolescent mentally handicapped on the secondary and 
vocational levels have been functioning for over ten years. These experi- 
ments (23, 24, 35, 36) have been so satisfying and productive that the ex- 
tension of school programs for this group is now assured. Another aspect 
of the study of the needs of the secondary-school groups which has given 
stability and f orcefulness to these experiments is the realistic curriculum- 
planning (3, 7, 25, 27, 32) for the mentally retarded that is being carried 
on in a number of centers. These curriculum studies have also resulted in 
fruitful vocational guidance and placement programs (5, 8, 13, 17, 18) in 
the postschool careers of pupils of this classification. 

Experimental programs for the mentally retarded who suffer addi- 
tional handicaps such as glandular disturbances or neurological impair- 
ments are very few in number. The Bureau for Children of Retarded 
Mental Development of the New York City Public Schools has been 
active in this respect, as has also the Department of Special Education in 
Detroit through a program (34) set up at the White School for Epileptics. 
The Department of Special Education in Newark has been experiment- 
ing since 1940 with a program of care for children with multiple handi- 
caps, as reported by Harrison (21). 

The aforementioned contributions to the literature on the mentally 
handicapped have been creditable but not sufficiently comprehensive. 
Research which would further stimulate the thinking and broaden the 
vision of those working in this field should include studies concerned with 
specific organizational and programming procedures to serve the needs of 
those in the endogenous-exogenous classification; with experimental work 
in curriculum-building which involves the humanities; with plans for fur- 



256 THE MENTALLY HANDICAPPED 

ther extending the opportunities of the mentally handicapped beyond the 
elementary-school level or outside the special classroom within the ele- 
mentary school; with rich curriculum outlines designed for the very- 
young mentally handicapped or for the handicapped individual who has 
a subject or speech disability; with the use or adaptation of techniques 
devised to assist in the personality adjustment of the mentally handi- 
capped; with experimental data on the community supervision and 
family care of school-exclusion cases; and, last, with suggestions for a 
school program co-ordinating community agencies in the current and 
postschool life of the mentally handicapped. 

REFERENCES 

1. ADE, LESTER K. Meeting the Needs of the Mentally Retarded. Bulletin No. 420. 
Harrisburg, Pennsylvania: Department of Public Instruction, 1939. 

2. ALBERT, KATHRYN; HOCH, PAUL; and WAELSCH, HEINRICH. "Preliminary Re- 
port on the Effect of Glutamic Acid Administration in Mentally Retarded Sub- 
jects," Journal of Nervous and Mental Diseases, CIV (September, 1946), 263-74. 

3. ANDERSON, META L. "Curriculum for the Mentally Retarded," The Training 
School Bulletin, XXXV (February, 1939), 210-14. 

4. BAKER, HARRY J. Introduction to Exceptional Children. New York: Macmillan Co., 
1944. 

5. BLAINE, LEO J. "Vocational Guidance for the Nonacadeiuic Boy," Journal of 
Exceptional Children, VIII (March, 1942), 190-94. 

6. BRAINERD, HELEN C. "The Social Rating Scale.,'' Bind Review, (November, 
1935), 8-22. 

7. BRYNE, MAY E. "Curriculum-planning for Exceptional Children," Journal of Ex- 
ceptional Children, XII (May, 1946), 231-34. 

8. BURR, EMILY. "Prime Factors in the Placement of the Below Normal," American 
Journal of Menial Deficiency, LI (January, 1947), 429-34. 

9. CASWELL, HOLLIS L., and CAMPBELL, DOAK L. Curriculum Developtnent. New 
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13. DE PROSPO, CHRIS A. "Vocational Implications for the Mentally Retarded," Oc- 
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KELLY AND STEVENS 257 

17. DOUGLAS, MABCBLLA. Four Boys and Their Jobs. Northville, Michigan: Wayne 
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258 THE MENTALLY HANDICAPPED 

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CHAPTER XIV 
SPECIAL EDUCATION FOR THE GIFTED CHILD 



MERLE R. SUMPTION 

Associate Professor of Education 

University of Illinois 

Urbana, Illinois 
DOROTHY NORRIS 

Supervisor of Major Work Classes 

Board of Education 

Cleveland, Ohio 

and 

LEWIS M. TERMAN 
Professor Emeritus of Psychology 

Stanford University 
Stanford University, California 



HISTORY 

Since early times men have recognized the existence among their fel- 
lows of individuals of superior intelligence. More than 2,300 years ago 
Plato speculated upon ways of telling which children were gifted so that 
they might be educated for leadership in the state. He believed that chil- 
dren should be trained to do that for which their abilities suited them. 
He was convinced that Greek democracy would be no better than its 
leadership and he wished to educate superior youth for this important 
task. 

The Romans later adopted some of Plato's ideas and gave special 
training to superior youths so that they might become leaders in war, 
oratory, and government. In the sixteenth century Suleiman the Mag- 
nificent sent emissaries throughout Asia Minor with instructions to ex- 
amine and select the most intelligent youth of the Christian population 
for special education. These talent scouts at regular intervals presented 
the Sultan with the fairest and brightest youths to be found. These indi- 
viduals were then trained for positions of leadership in the Empire. 

Organized education of gifted children almost disappeared during the 
seventeenth and eighteenth centuries. Here and there a few superior chil- 
dren were given special attention with remarkable results. Karl Witte 

259 



260 THE GIFTED CHILD 

was taught to read five languages before he was nine years old. His tutor 
had him ready for college at the age the average child learns to read. The 
degree of doctor of philosophy was conferred upon him when he was four- 
teen. Lord Kelvin, who was tutored tirelessly by his father, won distinc- 
tion at the University of Glasgow before he was twelve years old. 

These gifted children represented only isolated cases since few had 
such opportunities. The educational philosophy of the times insisted on 
the equality of all men. Hobbes, Jacotot, and Leibniz contended that all 
native intelligences were equal and differences come about through train- 
ing. Under such a philosophy special education of the gifted had no place. 

The earliest attempt to provide for gifted children in the public schools 
of the United States was probably that of William T. Harris in St. Louis, 
Missouri, about 1867. His effort consisted largely in introducing greater 
flexibility into the promotional system, thus allowing gifted children to 
accelerate their pace rather than remaining in the "lock-step" program. 
Variations of this procedure followed throughout the United States in the 
form of multiple-track programs which aimed at saving time for the 
superior pupils. 

Around the opening of the twentieth century, the multiple-track plan 
was found suitable for providing an enriched program without accelera- 
tion. By 1920 the public schools of three large cities, Cleveland, Los 
Angeles, and Rochester, were offering enriched programs to the gifted 
children. The emphasis on enrichment continued for over twenty years 
until the period of World War II. 

The marked acceleration characterizing war-time educational pro- 
grams raised the question whether or not precious time was being wasted 
in the traditional program. The evidence indicated that at the college 
level, at least, essential objectives of education could be accomplished in 
considerably less time than the conventional allowance. Students allowed 
to enter college on the basis of an entrance examination with less than 
four years of high-school training have been quite successful in college 
work. 1 

PHILOSOPHICAL CONSIDERATIONS 

The gifted child is both an asset and a responsibility. He is an asset of 
incalculable value to society. His potentialities for good are difficult to 
overestimate. Our socioeconomic structure, both national and inter- 
national, demands leadership of the highest quality and keenest intelli- 
gence. Where else may we look for this type of leadership except among 
those of intellectual superiority? 



1 S. L. Pressey, "Efficiency Engineering in the Educational Emergency/' School and 
Society, LXV (June 7, 1947), 426. 



SUMPTION, MORRIS, AND TERMAN 261 

Democratic education is founded on the ideal of equality of opportu- 
nity. Too often equality of opportunity has meant identical opportunity. 
Opportunity to be equal must be measured in terms of individual abilities 
and capacities to the end that all will be challenged to utilize their powers 
to the fullest. Society will reap a rich reward from such a policy. It makes 
possible the full development of individual capacities so that both the 
individual and the society which educates him may be mutually bene- 
fited. As John Dewey says: "If democracy has a moral and ideal meaning, 
it is that a social return be demanded from all and that opportunity for 
development of distinctive capacities be afforded all." 2 

There is nothing undemocratic in utilizing all social resources for the 
betterment of society. No people can afford to disregard the differences in 
human materials. Special education aims to prepare the child of low 
mentality for the place in society for which he is best fitted. Is it any less 
important that the child of superior mentality be prepared for social 
leadership? 

The report of a recent study 3 of the relationship of parental income 
and college opportunities presents an alarming picture of the waste of 
human resources caused by the limitation placed on the higher education 
of gifted high-school students by the economic factor. Dr. Goetsch found 
that over 90 per cent of the superior high-school graduates who came 
from families in the upper income bracket were attending college. Less 
than 20 per cent of the superior high-school graduates from the lower 
income bracket were attending college. It thus appears that lack of 
financial resources prevents many superior boys and girls from reaching 
educational maturity. Society loses accordingly. 

Society is injudicious in the extreme to neglect those children who 
possess the potentialities of high-quality leadership. It is the part of wis- 
dom to prepare these boys and girls for the important social responsibility 
which will be theirs. Today, as perhaps never before, we face problems of 
world magnitude which threaten the existence of society itself. Education 
is challenged to develop leadership for the tremendous tasks which lie 
ahead. Under such conditions, special education of the gifted is not only 
justified but is demanded by the lessons of history. 

IDENTIFYING THE GIFTED 

The identification of gifted children is not as easy as it appears at first 
thought. "Gifted" in the broadest sense includes both those who have 



2 John Dewey, Democracy and Education, p. 142. New York: Macmillan Co., 1916. 

8 Helen B. Goetsch, Parental Income and College Opportunities. Teachers College 
Contributions to Education. No 795. New York: Teachers College, Columbia Uni- 
versity, 1940. 



262 THE GIFTED CHILD 

high intelligence and those who have special abilities or talents in creative 
fields such as art and music. However, as the term is used in this chap- 
ter, it will refer to those of superior general intelligence and not to those 
who are specially talented. Such talents are often mistaken as indications 
of superior general intelligence. On the other hand, the lack of interest in 
classroom routine manifested by many gifted children has misled the 
teacher in many cases and caused her to regard them as dull or slow- 
learning individuals. Attitudes growing out of frustration have caused 
gifted children to be classified as delinquents and socially maladjusted 
cases. 

There is need for careful, systematic identification in all schools. Many 
schools make no effort to learn who the gifted are, and still others make 
the attempt in such haphazard fashion that the results have little re- 
liability and still less usefulness. There are three general methods of 
identifying superior children which supplement each other and which, 
taken together, provide an excellent program of identification. 

Standardized Tests 

Standardized tests used with good common sense are excellent means 
of arriving at the gross mass of gifted children. Such tests include group 
intelligence tests, vocational aptitude tests, academic achievement tests, 
and the like. If these tests are followed by a Stanford-Binet, after careful 
study of the child emotionally and socially, such procedures will come as 
near identifying the gifted as any other means. There are, however, some 
who, believing the total organism of the child to be a combination of 
physical, emotional, volitional, and intellectual traits, say that these 
traits operate so closely in an individual that it is impossible to measure 
them separately. For a more extended discussion of this concept, the 
reader is referred to chapter iv. It is true that emotional and social in- 
stability does keep a child from showing his true mental capacity. It is 
true, also, that fluctuations in intelligence quotient may come as results of 
emotional and social upsets. When one realizes fully the scientific con- 
struction of standardized tests, the objectivity of their administration, 
and the research which has gone into their standardization, he cannot 
help realizing their value as "instruments of prediction." Watching for a 
period of years hundreds of boys and girls being given opportunities com- 
mensurate with their predicted intelligence has led us to believe that the 
standardized individual intelligence test is the best single means available 
for prediction. Educators seldom think of intelligence in the abstract but 
concede that it is minutely interwoven in the organism of the whole child. 

Teachers' Judgments 

One is often reminded of Leta Hollingworth's story of the teacher who, 
when asked by the principal why she thought a child was bright, replied, 



SUMPTION, NORRIS, AND TERMAN 263 

"Because she can play the ukelele and sing so well." Special talents are 
often mistaken for unusual general mental ability. A clear idea of the 
nature of intelligence is little understood by the best of educators. 
Teachers, as people in general, are human and are capable of all the errors 
in judgment that "the flesh is heir to." Disregard for the age of the child 
is a common error in choosing a bright child. Over-aged pupils, doing 
excellent work with children chronologically younger, are sometimes er- 
roneously judged bright by teachers. Then, too, the child who follows 
directions implicitly, who has fine character traits, whose personal ap- 
pearance is flawless, and who behaves himself well surely makes a better 
impression than one who causes the teacher untold difficulty. Human 
judgment, being as it is, is not always reliable. It would seem, then, that 
a combination of teachers' judgments and the results of standardized 
tests is much better than the use of tests alone as a means of choosing the 
bright child. 

Classroom Performance 

It is difficult, indeed, to place much reliability on school marks. Cer- 
tainly, if the consensus of opinion of several teachers is that certain chil- 
dren rank high in their school subjects and if these children are not over- 
age for their grade, school marks then might be used as the basis of select- 
ing gifted children. 

School marks by no means tell the whole story, however. The writer is 
reminded of the forlorn-looking little fellow who made no progress at all 
in his new school. The principal, feeling that surely there was some ad- 
justment that could be made in the school work for this lad, decided that 
he would have a Binet test administered before recommending special 
work for him in a class for mentally retarded children. The resulting in- 
telligence quotient was 145. Judged by accomplishment, this boy could 
have been recommended for a class of mentally retarded children. If 
standardized tests are used as a basis for school marks, much more 
credence can be given the marks as far as predictive value is concerned. 
No one can deny, however, that good school marks usually indicate good 
intelligence. 

CHARACTERISTICS OF THE GIFTED 

That skill in thinking and superior mental organization are qualities of 
the gifted child is recognized by all investigators. Most apparent in his 
show of mental power is his superior reading ability. He is a more rapid 
learner than the average child. He has the ability to generalize more eas- 
ily, to recognize relationships, to comprehend meanings, and to think 
logically. 

His mental habits differ somewhat from those of slower pupils. He is 
less patient with routine procedures. He needs to learn efficient methods 
of study but is able to work better unhampered by too close supervision. 



264 THE GIFTED CHILD 

His versatility is shown in his wide range of human interests. Because 
of this, he finds a distinct advantage in the study of many widely differing 
subjects. These many interests, together with the desire to forge ahead to 
explore new fields, play a large part in forming his attitudes. His mental 
traits are usually rounded into an integrated personality for he is guided 
by a rather high degree of common sense, breadth of mind, and the power 
of self-criticism. 

The popular belief that the bright child is small and weak physically 
has no basis in fact. Leta Hollingworth 4 found the following to be true: 
"They tend to be tall and heavy and to maintain a high ratio between 
weight and height. In so far as this weight ratio indicates nutrition, they 
are very well nourished as a group." 

A number of observations concerning nervousness show that superior 
children are relatively free from nervous troubles. 

In their social attitudes, as Bentley 5 asserts, the gifted are above the 
average. They take part in much the same activities as other children and 
win recognition to a higher degree. They are usually honest and seem to 
be helpful and charitable. While desirable moral traits seem to be cor- 
related with intelligence, there have been many cases where clever minds, 
untrained in a moral society, have become a social menace. This points to 
the great need of developing in these children a sense of integrity and 
wholesomeness in meeting life's situations. 

It has been said that the maladjustment of the brilliant is one of so- 
ciety's greatest handicaps. And indeed, as we see the decreasing influence 
of the home, we realize that more responsibility is placed upon the school 
for the development of character. 

PROVIDING APPROPRIATE EDUCATION FOR THE GIFTED 

In Towns and Rural Areas 

Current reorganization and consolidation of school districts are bring- 
ing more and more pupils together within single administrative districts. 
This is a hopeful trend for special education in general and for education 
of the gifted in particular. Since the percentage of gifted children of the 
total student population is not large, school districts must have pupil 
populations of a thousand or more to enrol twenty to fifty gifted children. 
Consider further the fact that they will be rather uniformly spread over 
the age range of the group and the difficulty of special instruction seems 
almost insurmountable. 



4 Leta S. Hollingworth, Gifted Children,: Their Nature and Nurture. New York: 
Macmillan Co., 1929. 

John Edward Bentley, Superior Children. New York: W. W. Norton & Co., Inc., 
1937. 



SUMPTION, NORRIS, AND TERMAN 265 

In small school districts, individual instruction in a large measure 
may necessarily be the method adopted. Full-time special classes are 
ruled out by the circumstances. The difficulty of offering special indi- 
vidual instruction to gifted children is obvious. Regular teachers are 
seldom versed in the best methods and techniques of dealing with 
superior children. Proper materials are seldom at hand, and the teacher's 
time is taken up with the regular work of the classroom. 

One solution to the problem is probably the employment of a special 
teacher of the gifted whose job is to help identify the gifted, set up pro- 
grams of individual instruction for them, provide necessary materials, 
and assist the regular teacher in enriching the curriculum and in provid- 
ing proper instruction of the gifted. This teacher might be termed a su- 
pervisor of this phase of special education. He should provide stimulation 
as well as technical knowledge and skill. His work can go far to insure ade- 
quate educational opportunity for the superior child. 

One such teacher can serve a fairly large rural or town-centered dis- 
trict. He can develop a co-ordinated program of special instruction to 
individual students through their regular teachers with occasional field 
trips in groups. These field trips and certain co-operative ventures in 
which these children would participate as a group give them an oppor- 
tunity to compare notes and discuss their individual projects together. 
Plays might be produced, school papers published, and community sur- 
veys conducted to provide opportunity for united effort. 

Finally, the special teacher will recommend desirable acceleration for 
gifted students, being guided by an intimate knowledge of each student's 
interests and capacities. His judgment combined with that of the regular 
teacher should be a reasonably safe guide to the school administrator. 
Such a program, including individual instruction combined with group 
activities and curriculum enrichment, together with appropriate oppor- 
tunities for acceleration, has much to recommend it in town and rural 
areas and is not unsuitable for large cities. 

Where such a plan is impractical because of lack of personnel, the work 
outlined may be undertaken by the supervisors of the general program. 

In Large Cities 

In cities of a hundred thousand or over it is possible to establish special 
classes for the gifted of sufficient size at each grade or age level. Although 
the advisability of such classes is still debated, there is evidence to indi- 
cate their value. The following report of one successful program in- 
volving special classes for gifted children is taken from "The Major 
Work Class Handbook" of the Cleveland Public Schools. 

Through its "major work" classes, Cleveland attempts to meet the 



266 THE GIFTED CHILD 

specific needs of the bright child. The bright child masters the essentials 
of the regular curriculum in a shorter period of time than is usually 
allotted; therefore, he needs such additional activities as will encourage 
wholesome mental, physical, emotional, and social development. He 
needs challenging work in order to derive satisfaction from the accom- 
plishment of it and in order that he may develop good study habits. 

The fast learner needs the association of children of ability equal to his 
own to challenge him and to make him realize that he has many peers. 
This association will tend toward making him a better student and de- 
veloping within him a finer character. Furthermore, society has a special 
responsibility in the training of bright children because they possess 
powers and qualities which make them the potential leaders of tomorrow. 
The bright child needs special consideration in order that his latent abili- 
ties may be fully developed and that he may become a successful individ- 
ual and fulfil his promise to society. 

Objectives and Administration of the Cleveland Program. In the "major 
work" classes, where education is tailored to fit the needs of the mentally 
superior child, an enriched curriculum is provided. Among the objectives 
in these classes are: 

1. Increasing the range of knowledge and skills of the students 

2. Developing alertness 

3. Developing initiative and creative power 

4. Developing an attitude of critical thinking 

5. Developing power to work independently, to plan, to execute, and to judge 

6. Developing increased ability to share in undertakings 

7. Developing leadership 

Pupils of the "major work" classes are admitted on the basis of their 
intelligence ratings as determined by the individual Binet test. The re- 
quired intelligence quotient is 125 or above. Candidates for these tests are 
pupils who are usually outstanding in their work and are recommended 
by their teachers. Sometimes, however, they are pupils who seem mal- 
adjusted and troublesome. Frequently, when their tests reveal a high in- 
telligence quotient, it is a surprise to both teachers and parents. 

These classes are set up and administered to meet the particular needs 
of this group. The classroom itself is pleasant and informal. Fixed desks 
are abandoned to make way for tables and chairs. Bookshelves, curtains, 
pictures, plants, an attractive library corner, maps, globes, encyclopedia, 
and reference books are part of the equipment which provides an at- 
mosphere for enriched living and freedom from regimentation. 

Though these children are segregated, they are by no means isolated 
from the rest of the school's program and activities. Contacts with the 



SUMPTION, NORRIS, AND TERMAN 267 

other children are constantly being made through clubs, gymnasium, 
chorus work, orchestra, and playground. 

The Curriculum. Enrichment is the keynote on which "major work" 
class education is built. This means that these pupils accomplish more 
than the pupils in regular classes. Because of their ability to learn more 
quickly, they branch out on a richer program of work suitable to their 
ages and interests but not encroaching upon the work of grades beyond. 
Such enrichment is brought about by opportunities provided for worth- 
while activities and experiences and by the methods of instruction. 
Among these opportunities are special instruction in art, intensive work 
in language and literature, typewriting, writing and producing plays, 
making reports to the class, reviewing books, and writing stories, articles, 
and editorials for school newspapers. 

French is also studied. Beginning as early as the primary grades, these 
children, through games, songs, and dramatizations, secure a foundation 
for the more formal study of French in the junior and senior high schools. 
This early instruction in a foreign language serves as a tool in acquiring 
other languages later. Subjects other than French are not brought down 
to the lower levels of the elementary and junior high schools. 

Opportunities for learning by observation and direct experience are 
provided by trips to the museums, to symphony concerts, and to indus- 
trial plants. 

Learning to speak effectively and well is another objective for bright 
children. The five-minute daily talk-period gives each child many oppor- 
tunities to stand before the class and give a talk that he has prepared on a 
subject of his own choice. He knows he has certain standards to meet 
standards set up by the class by which his efforts will be judged. Usually 
these talks result from his own hobbies and experiences. Other oppor- 
tunities for speaking come in presenting reports in geography and history 
and in presiding as leader in the literature groups. 

Training in taking responsibility is important in the education of every 
child, but especially so in the education of the bright child, to whom so- 
ciety will look for leadership. No child is too young to be responsible to 
his group for the task he has undertaken, whether it be taking charge of 
library shelves, care of the library corner, or merely watering the plants. 
He is likewise made responsible for planning his own time. After a few 
failures to have his work ready at a specified time, he learns the need of 
budgeting his time and starting early. He is responsible for his part in 
group activities. He is responsible for collecting his own materials. He is 
taught how to use the facilities of the library, and his many needs give 
him experience in using them. 

The bright child is characteristically an able and assiduous reader and 



268 THE GIFTED CHILD 

delights in books. This is fostered and guided. He is encouraged to branch 
out in his reading interests toward books of science, history, biography, 
travel, informational fiction, and poetry. He learns what constitutes a 
good biography; he learns to enjoy poetry and to try his hand at making 
poems himself; he learns to take vicarious trips into the fields of science 
and history. He is kept in touch with the finest in children's books 
through his literature study group and by contact with the Literary 
Guild books of the month. 

Love of beauty is usually strong in this group, and special work in art 
and music is found profitable for them. Often special talent is discovered 
among these children through such work. The radio is likewise used to 
advantage in this field. 

Because the bright child must be educated to contribute to society, the 
school's efforts are directed toward his understanding of social obligations 
and his awareness of the world at large. Emphasis is therefore given to 
national and world affairs. These are dealt with as problems, chosen ac- 
cording to the age and understanding of the group. Something of the form 
and functioning of our government is also a part of current history work. 

Methods of Instruction. As to methods of class instruction, there is no 
one process used, but a combination of all the best methods of teaching 
gifted children is utilized. The socialized procedure is most used, with the 
teacher as an interested participant of the group. Informal discussion 
makes possible the practice of desirable social habits such as tolerance, 
patience, courtesy, respect for the talents of others, and learning to work 
together. The social procedure also gives the child a chance to use his 
abilities and to make his contribution to the group. 

The work is planned in large units, a suitable method for these children 
because of their longer interest span. The social studies, literature, and 
group projects lend themselves well to this procedure. Usually arith- 
metic, in which the pupils progress at varying rates of speed, is done on 
an individual basis. Drill is used when needed, though, on the whole, less 
is required than in the average classroom. Tests of various kinds are fre- 
quently used to measure progress. Independent study is required, and 
help is not given until needed. Such measures as these are used in order 
to throw these children upon their own resources and to develop self- 
reliance. 

Besides participating in group activities, each pupil has the experience 
of carrying on a piece of work (resembling research) along some line of 
his own special interest. This is finally presented to the class and is 
discussed and evaluated by the group. 

The last word has not yet been said on the best way to teach bright 
children, and probably never will be. The "major work" program, there- 



SUMPTION, NORRIS, AND TERMAN 269 

fore, is and must be flexible and experimental in order to fulfil its purpose 
of educating the child to think and of requiring from him the obligation to 
walk in his full stature. 

Evaluation. Some evidences of accomplishment of "major work" 
classes are determined by objective test results and some are judged by 
participation in school activities which require leadership and a sense of 
responsibility. "Major work" class philosophy recognizes intelligence but 
does not discount the basic element of personality and special talent. 
Intellectual pursuits represent but one aspect of well-rounded living. 
Psychological traits, including the dynamic and emotional phases of per- 
sonality, are of utmost importance in the appraisal of the individual. 
Temperament and intellect reacting to environment result in what we 
call character. 

Each year the school achievement of "major work" pupils is measured 
by carefully selected standardized tests. 

The average chronological ages of these classes are no higher than those 
of pupils upon whom the norms were established. This draws attention to 
the fact that the guiding philosophy for "major work" procedure is en- 
richment rather than acceleration. Every effort is being made to keep 
these pupils in groups where their physiological and social development 
corresponds to their chronological ages. It is of interest to note that the 
achievement of these pupils does not begin to approach their high mental 
ages. This does not mean that the teaching is inadequate or that subject 
matter has not been emphasized. It probably means that achievement 
levels which would coincide with the mental ages at this early chronologi- 
cal stage might result in developing unnatural child prodigies rather than 
developing happy, well-adjusted boys and girls. 

Each child has an individual record, kept in an especially planned 
folder. In this form the individual record is available for the evaluation of 
progress from the pupil's entrance into the "major work" classes until he 
completes the twelfth grade. A close correlation between his intelligence 
ratings and achievement marks usually exists. As stated before, tests are 
administered at least once annually. This procedure serves a double pur- 
pose. It provides a check on the individual achievement of the pupils and 
indicates where emphasis should be placed for future teaching. The stand- 
ard of the grade is set for the average child, but the bright child may 
work on other materials and interests after the requirements are met. In 
this way boredom is avoided. 

Boys and girls of "major work" classes are the leaders in many of the 
school's activities for which they have special abilities. They are mem- 
bers of the safety patrol, student council, choral groups, school orchestra 
or band; they are leaders in physical education; they edit and contribute 



270 THE GIFTED CHILD 

to the school newspapers or periodicals; they are winners in competitive 
activities such as poster and spelling contests; they are often the valedic- 
torians of their graduating classes, and they are recipients of scholar- 
ships to colleges and universities. 

The test results and the efficiency, leadership, and sense of responsibil- 
ity manifested by "major work" pupils in their participation in school 
activities are evidence that the philosophy and administration of "major 
work" classes is sound and practicable. 

The education of children who have abilities different from or above 
the average has passed through several stages: first, a period of recogni- 
tion of their special needs; second, experimentation in different curricu- 
lums, methods, and techniques in education to meet the needs; and, 
third, an attempt to evaluate the results obtained from the previous pe- 
riod. The time has now come for a fourth period a time of building upon 
the foundation previously laid, for strengthening weaknesses, correcting 
deficiencies, and for widening the horizon. 

Parents who send into the schools children decidedly above average 
are vitally concerned with the most expedient and advantageous use of 
their children's talents. The schools are constantly striving to improve 
educational environment, but they must understand the home environ- 
ment from which children come. School and home must meet in closer co- 
operation for a better perception and solution of the problem. 

Achievement tests administered from year to year in "major work" 
classes have shown consistent superiority in the academic subjects. With 
this as a foundation, attention may now be turned to other factors in- 
volved in highly successful living for superior people. The importance of 
personality traits in social adjustments, attitudes, emotional control, and 
stability and of other intangible phases of success in managing people and 
affairs calls for much investigation and analysis. Perhaps these children 
need more definite training for leadership based upon the knowledge of 
why people follow. 

Continued study of current affairs is of increasingly vital importance, 
due to the present chaos of world affairs and the closer relationships into 
which all people are being drawn. 

Vocational guidance for superior children with analysis of the specific 
problems and opportunities of various vocations in relation to their par- 
ticular endowments and abilities may lead to a more satisfactory adult 
life. More effort should be directed toward the discovery of special apti- 
tudes and talents, for example, in music and art. There should be pro- 
vided continuous acquaintance with current trends in the development of 
science and industry. 

"Major work" classes are seeking, as in the past, to foster in each pu- 



SUMPTION, NORR1S, AND TERMAN 271 

pil : the desire for achievement and service, because of the satisfaction it 
brings; critical thinking, in the hope that it will result in the rejection of 
that which is useless, harmful, or irrelevant; and the disposition to test all 
printed and spoken words by the facts rather than by the emotional 
power which they carry; in short, the ability to understand and utilize 
that which he has in common with his fellow men, and the desire to con- 
tribute to his environment the individual gifts which he possesses. 

Programs in Other Cities. Today, several large cities have programs for 
the gifted which approximate the one herein described. Not all are called 
"major work" classes; there are "opportunity groups/' "enrichment 
classes," "adjustment classes," and many others. One city has an entire 
elementary school devoted to gifted children and a selected grouping of 
gifted in the junior high school. Some city systems attempt to give en- 
riched courses to individual gifted pupils without special grouping. As 
time passes, more large cities are becoming cognizant of the problem of the 
gifted child. 

FOLLOW-UP STUDIES AND THEIR EDUCATIONAL IMPLICATIONS 
The Stanford study of gifted children, begun in 1921 and continued to 
the present, was not planned as a direct attack upon the educational 
problems presented by such children. Its primary purpose was two-fold : 
(a) to determine what physical, mental, and personality traits are typi- 
cally characteristic of gifted children; (6) to find out by means of long- 
range follow-up how such children develop and, if possible, what factors 
influence their later achievement. 

It was believed that an investigation of this type was necessary to pro- 
vide the basis for a more strictly pedagogical approach. If children of 
high intelligence quotient are, as many have thought, especially prone to 
be sickly, one sided, and socially maladjusted, plans for their training 
would have to take such characteristics into account. If they commonly 
regress to near-average when they grow up, then we should disregard 
differences in intelligence quotients and abandon special classes for high- 
testing pupils. It is proposed here to sketch very briefly some of our find- 
ings which throw light on these two questions. The reader who wishes to 
examine the evidence on which these generalizations are based is referred 
to the book, The Gifted Child Grows Up, by Terman and Oden. 

The subjects studied included in all about 1,500, ranging in childhood 
intelligence quotient between 135 and 200, and averaging 152. They 
were selected by methods which insured that the group would be fairly 
representative of the generality of children who rate in the top 1 per cent 
on intelligence as measured by the Stanford-Binet scale or the Terman 
Group Test. What is true of this group should be true of gifted children 



272 THE GIFTED CHILD 

in general who have had comparable educational and cultural opportuni- 
ties. What were they like as children? 

In health and physique, medical examinations and anthropometric 
measurements showed them to be appreciably superior to the general 
school population. Character tests, personality tests, and trait ratings 
placed them definitely above control groups of corresponding age. The 
deviation of these subjects from the generality was found to be in the up- 
ward direction for nearly every trait, but the amount of deviation varied 
from trait to trait. It was greatest in those aspects of behavior most 
closely related to intelligence, such as originality, intellectual interests, 
and ability to score high in achievement tests. In school achievement the 
superiority was greatest in the abstract subjects and least in penmanship, 
spelling, and routine arithmetical computations. This unevenness was 
not appreciably greater for the gifted group than for a control group, but 
it was different in direction; whereas the gifted are at their best in the 
"thought" subjects, average children are at their best in subjects that 
make least demands upon concept manipulation. 

The interests of the gifted children were many-sided and spontaneous. 
They engaged in all kinds of childhood activities and had acquired far 
more knowledge about plays, games, and sports than the average child of 
their age. In a test of interest maturity they averaged more than two 
years above the age norms. 

In grade placement the typical gifted child was found to be accelerated 
only 14 per cent of his age, but in mastery of the subject matter taught he 
was accelerated about 44 per cent of his age. The net result was that a 
majority of the members of the accelerated group, during the elementary- 
school period, were kept at school tasks two or three full grades below the 
level of achievement they had attained. Surely this is one of the most 
challenging facts about the typical gifted child. Hardly less challenging is 
the fact that during the earlier years, at least, the school appeared to play 
only a minor role in the education of these children. This statement is 
based on the finding that among those of a given age, say ten years, there 
was not one reliable correlation between the number of months a child 
had attended school and his achievement-test scores in the various school 
subjects; this despite the fact that some children had attended more than 
twice as long as others. 

Such, roughly sketched, is the composite picture of the gifted child in 
terms of central tendencies. It will be understood, of course, that gifted 
children show wide variability in every trait and that no individual child 
follows the central tendency of the group in all his traits. Gifted children, 
like other children, display an infinite variety of patterns. Nevertheless, 
the method of composite portraiture is very useful as a basis for generali- 



SUMPTION, NORRIS, AND TERMAN 273 

zation. From the point of view of education, it is highly important to 
know what the typical gifted child is like. 

Inasmuch as it has been possible to follow the careers of more than 95 
per cent of the original group to 1946, when the average age of the sub- 
jects was about thirty-six years, it is now possible to give a tentative an- 
swer to our second question how gifted children turn out. 

In the first place, they show no tendency to die young; thus far their 
mortality rate is only four-fifths of the normal expectation. The insanity 
rate and the suicide rate approach the normal expectation more closely 
but are still slightly on the low side. The incidence of delinquency is ex- 
tremely low. 

The marriage rate equals that for the general population and is far 
above the rate for the generality of college graduates. Both marital ad- 
justments and all-round social adjustments compare favorably with those 
of less selected groups. 

Intelligence tests given them in 1940, when the average age of the 
group was thirty years, gave a mean score nearly a standard deviation 
above the average of college graduates and not far from the average for 
those holding the Ph.D. degree. Except in a minority of cases, half or 
more of such regression as had occurred could be accounted for in terms 
of errors of measurement and failure of the adult tests to measure exactly 
the same mental functions as were measured by the childhood intelli- 
gence quotient. As a rule, intellectually superior children become intellec- 
tually superior adults. 

This superiority is reflected in the occupational status of the group as 
measured by the Minnesota Occupational Scale. By 1945 half of the men 
were in Group I (the professions) and nearly a third in Group II (the 
higher business occupations). These figures are seven or eight times the 
normal expectation for a random group. At the other extreme, only 4 per 
cent were in the four lower occupational classes combined, as compared 
with half or more of the generality of employed males. The number of col- 
lege teachers (seventy-five), lawyers (eighty-two), and physicians (fifty- 
two) is in each case twenty or thirty times the normal for a random group. 

The educational records of the group also contrast strikingly with 
those of the general population. Almost 90 per cent entered college and 
almost 70 per cent graduated, each figure being about eight times the 
corresponding figure for the general population of their generation. 
Nearly a third of those who graduated did so with honors. Approximately 
two-thirds of those graduating continued for one or more years of gradu- 
ate work. The number who took graduate degrees beyond the M.A. is 
about 250. This is about one-fourth of those who graduated and nearly 
18 per cent of the entire group, including those who never entered college. 



274 THE GIFTED CHILD 

But good as the educational records were, they should have been far 
better. The figures given are more significant when they are read in re- 
verse. All of these subjects were potentially superior college material, yet 
more than 10 per cent never entered college, and more than 30 per cent 
never graduated. In a few cases college attendance was prevented by ill 
health and in several cases by the necessity of leaving school to help sup- 
port the family; in many more cases the high schools either failed to rec- 
ognize the gifted student's potentialities or failed to give the needed en- 
couragement and intellectual stimulation. 

For the mediocre or inferior work done by all too many who entered 
college, the college too must share the blame. During the period when 
most of these subjects were in their middle or late teens, there was rela- 
tively little effective counseling or guidance either in high schools or col- 
leges, and we are told that this is often true even today. On the basis of 
scholastic aptitude, at least twice as many members of the group should 
have graduated with honors as did so. Apart from reasons of physical or 
mental health, none who entered college should have failed scholastically. 
Actually fifty-three men and ten women flunked out in their undergradu- 
ate years, and five men and two women did so in their graduate years. 
The intelligence quotients of these ranged from 135 to 179, with an aver- 
age of 151, and their intelligence scores were still very high as adults. 
Nearly half of the men who flunked out returned to graduate later, and 
several took a graduate degree. 

The causes of failure or low grades in college are many, and in most 
cases more than one factor appears to have been involved. On this matter 
we quote the following passage in the volume referred to. 

The most common explanation given by the subjects was that in high school 
they had made high marks without doing any serious work and that in college 
they underestimated the amount of work necessary to secure passing grades. 
A few stated that in high school they had developed feelings of social inferiority 
because of being younger than their classmates, and that on entering college they 
decided to make good their deficiencies in this respect by going all out for popular 
activities and the pursuit of leadership. Some of these cultivated an adult 
swagger, lied about their ages, and affected complete indifference to scholastic 
marks. Both in high school and college some of the subjects developed an under- 
standable loathing for the reputation they had acquired of being intellectually 
high-brow and, in some cases, admitted to us that they had often feigned igno- 
rance in their classes in order to appear more like their fellow students. 

A few said that they became disgusted with college because of instructors who 
discouraged initiative and permitted no latitude of opinion on controversial is- 
sues. There were a good many instances in which the poor record could be ac- 
counted for by lack of proper guidance in the selection of a major field. On chang- 
ing their major to a field more in line with their interests such students often be- 



SUMPTION, NORRIS, AND TERMAN 275 

came outstanding in their achievement. Not infrequently the trouble could be 
traced back to the elementary grades where the average subject in our group was 
held back two or three school years below the level to which he had already 
mastered the curriculum.* 

A careful study of acceleration in the group was made in a search for 
factors that might be found associated with rate of school progress. Spe- 
cifically, the accelerates were compared with the nonaccelerates for differ- 
ences on such variables as childhood intelligence quotient, adult intelli- 
gence score, achievement quotients in the first eight grades, general 
health in 1922, 1928, and 1940, mental and social adjustment in 1922, 
1928, and 1940, age at puberty, scholastic record in high school, the pro- 
portion graduating from college, age at graduation, scholastic records in 
college, participation in extra-curriculum activities, occupational status, 
number of avocational interests, the incidence of marriage, age at mar- 
riage, divorce rate, and score on a test of marital happiness. 

On the basis of age at high-school graduation, the subjects were di- 
vided into three groups: those markedly accelerated (graduation before 
15| years); the moderately accelerated (graduation between 15 \ and 
16|); and those slightly or not at all accelerated (graduation after 16|). 
The respective numbers in the three groups were 62, 332, and 998. The 
mean ages at graduation were, respectively, 14.9 years, 16.0 years, and 
17.3 years. 

For the present purpose we have combined the first two groups (the 
accelerates) for comparison with the third group (the nonaccelerates). 
Mean age at high-school graduation was about 15.9 years for the 394 ac- 
celerates as compared with 17.3 years for the nonaccelerates. On the aver- 
age the accelerates have skipped about three half-grades, and many of 
them have skipped as much as three full grades. 

The first thing we note is that for the gifted group as a whole, with in- 
telligence quotients from 135 to 200, the amount of acceleration bears 
little relation either to childhood intelligence quotient or to adult intelli- 
gence as measured in 1940. On both tests the accelerates averaged a few 
points higher than the nonaccelerates, but the difference was too small 
to be very significant educationally. The difference between the two 
groups in accomplishment quotient, as measured in Grades II to VIII by 
the Stanford Achievement Test, was about seven points in favor of the 
accelerates. This difference, although statistically reliable, is in absolute 
terms so small as to indicate that skipping or not skipping was usually de- 
pendent on the whims of the individual teacher or principal rather than 



8 Lewis M. Terman and Melita Oden, The Gifted Child Grows Up, p. 157. Stanford 
University, California: Stanford University Press, 1947. 



276 THE GIFTED CHILD 

on the curriculum material the child had mastered or was capable of 
mastering. 

Consider now the later educational records of the two groups. In high 
school the accelerates, although nearly a year and a half younger on the 
average than the nonaccelerates, were a little more likely to graduate with 
15 or more "recommended" units. The proportion who graduated from 
college was about one-eighth higher for the accelerates than for the non- 
accelerates, and, despite their lower age, the accelerates made higher av- 
erage grades and more often graduated with honors. The proportion who 
completed one or more years of graduate work was more than one-fourth 
higher for accelerates than for nonaccelerates. Except in athletics, the 
two groups were about equally active and prominent in extra-curriculum 
activities during the college years. 

Vocationally, the accelerates had made a markedly better showing by 
1940; as compared with the nonaccelerates, about a sixth more of them 
were in one or another of the professions, and a third fewer were in the 
four lowest occupational classes in the Minnesota Occupational Scale. Of 
the men who graduated from high school before 15.5 years, 42 per cent 
were in the top fifth of all men for vocational success. The corresponding 
figure for men who graduated later than 16.5 years was 19.4 per cent, or 
less than half as great. 

Incidence of marriage is almost exactly the same for the two groups, 
but the mean age at marriage is about three-fourths of a year lower for 
the accelerates. Two criteria are available as indices of marital adjust- 
ment in the two groups: (a) the incidence of divorce, and (6) mean score 
on a test of marital happiness. On both criteria the accelerates make a 
slightly better showing, although the difference is not statistically signi- 
ficant. 

Physical health of all the subjects was rated in 1922 and 1928 on the 
basis of several items of information in the case-history material. At both 
of these dates the accelerates averaged slightly better, but the difference 
was reliable only for the 1948 ratings of the males. Self-ratings on general 
health in 1940 did not differ for the two groups. 

The subjects were also rated both in 1922 and 1928 for nervous symp- 
toms, again on the basis of several items in the case-history material. At 
both of these dates the accelerates rated slightly, but not reliably, better. 
The field workers' ratings of the subjects on general mental adjustment in 
1940 also showed a small but unreliable difference in favor of the acceler- 
ates. The subjects were rated in 1922 and 1928 on social adjustment, but 
no reliable difference was found between the two groups at either of these 
dates. Age of puberty, as reported by parents, averaged about three- 
tenths of a year earlier for the accelerates than for the nonaccelerates. 



SUMPTION, NORRIS, AND TERMAN 277 

Finally, a comparison among the acceleration groups with respect to 
their avocational interests and their interests in twelve specific fields was 
made. No significant difference was found in the frequency with which 
any given avocational activity was mentioned, in the total number of 
avocational activities, or in the self-ratings for interest in twelve fields. 
Even marked acceleration appears to have little or no lasting effect on the 
number of avocational interests and no narrowing effect on range of in- 
terests. 

The controversy on the advantages and disadvantages of acceleration 
hinges on the relative weight that should be given to intellectual and so- 
cial values in the educative process. If the child's intellectual welfare were 
the sole criterion, then promotion ought to be based primarily on mental 
age, since it is this factor that chiefly determines the intellectual difficulty 
of the school tasks one is able to master. 

Although children can, and often do, achieve remarkably in spite of be- 
ing denied the special promotions they have earned, a considerable pro- 
portion of those in the gifted group languished in idleness throughout the 
grades and high school and failed to develop the ambition or habits of 
work necessary to make them successful in college. The question is, how 
much risk of social maladjustment one can afford to take in order to keep 
the gifted child at school tasks difficult enough to command his attention 
and respect. The data here reviewed indicate that the risk of maladjust- 
ment in moderate acceleration is much less than is commonly believed. 

Often, however, in the traditional school the choice between accelera- 
tion and nonacceleration is unavoidably a choice between evils, each of 
which needs to be weighed against the background of the individual 
child's personality. No universal rule can be laid down governing the 
amount of acceleration that is desirable. Some gifted children are less 
likely to be injured by three or four years of acceleration than are others 
by one or two years. Important factors are the child's social experience 
and his natural aptitude for social adjustment. So far as physique is con- 
cerned, perfect health is probably less crucial than physical maturity or 
even mere size. 

Sumption's study 7 indicated that a program for the gifted based on en- 
richment produced superior results in comparison with the general school 
program. It is reasonable to assume that a combination of enrichment 
and moderate acceleration will produce best results in the majority of 
cases. 

The amount of enrichment possible is usually limited by lack of special 
teachers, a dearth of time and inventiveness on the part of the regular 

7 Merle R. Sumption, Three Hundred Gifted Children. Yonkers-on-Hudson, New 
York: World Book Co., 1941. 



278 THE GIFTED CHILD 

teacher, and lack of facilities on the part of the school. No cases of too 
much enrichment have been recorded. If a broadly enriched program is 
offered the child during his first six or seven years in school he will be 
challenged to build a background of experience which will stand him in 
good stead for future acceleration. Meanwhile, he will have an opportu- 
nity to mature socially and physically so he will not be at a loss to adjust 
as he moves ahead more rapidly in subsequent years. 

As has been indicated earlier, the typical gifted child will encounter 
little hardship in entering high school at the age of twelve or thirteen and 
graduating at fifteen or sixteen. The normal college course of four years 
leading to the bachelor's degree can be completed in three years and thus 
enable the gifted student to enter graduate school or begin his professional 
or vocational career at nineteen years of age. This conclusion is supported 
by the studies of Pressey and his associates. 8 

The addition to human resources and the elimination of educational 
waste possible under such a plan is incalculable. Three years could thus 
be added to the productive life of these boys and girls whose potential is 
so high. 

In the final analysis there is no conflict between enrichment and accel- 
eration. They complement each other in the best educational program 
for the gifted child. 

SUMMARY STATEMENT 

1 . For centuries society has recognized the value of providing exceptional educa- 
tional opportunities to gifted youth, but for the most part such provisions 
have been sporadic and inadequate. 

2. Equality of opportunity demands that each child be given the type of educa- 
tion which best meets his needs and capacities. This principle is violated when 
a gifted child is forced to accept an education which does not take into ac- 
count his superior ability and give him an opportunity to develop it. 

3. In terms of social welfare, the effective education of gifted youth is impera- 
tive. It is folly for society to fail to utilize its most able human resources. 

4. In general, gifted children do not cause trouble in school. Perhaps, unfor- 
tunately, they tend to adjust to the program set up for the normal child and 
work along with a minimum amount of effort and little opportunity to devel- 
op their full powers. Probably this is one factor contributing to the greater 
neglect of this type of child as compared to the mentally retarded, the speech 
defective, and the socially delinquent. 

5. The objectives in the education of gifted are the same as for other children. 
The difference lies in the greater emphasis placed on creative effort, intel- 
lectual initiative, critical thinking, social adjustment, social responsibility, 
and the development of unselfish qualities of leadership. 

6. The first problem for educators is to discover gifted children. This may not 

8 Pressey, op. dt. 



SUMPTION, NORRIS, AND TERMAN 279 

always be an easy task. At present a combination of standardized tests, 
teachers' judgments, and classroom performance probably offers the best 
means of finding them. 

7. The second step, that of providing an enriched educational program for the 
gifted, is more difficult than discovering them. Yet it is essential that these 
children have sufficient opportunities to develop their abilities above and 
beyond what is called for in the normal school program. 

8. Enrichment may be serviced through special schools, special classes, or indi- 
vidual attention as the demands of different situations dictate. The authors 
of this chapter recommend that wherever possible special classes be organized 
for the education of gifted children. In cases where the individual instruction 
plan is adopted, a specially trained supervising teacher is recommended. 

9. Moderate acceleration, particularly in high school and college, is not inad- 
visable when the individual is socially and physically mature for his age. 
Especially is this true where there are no enrichment opportunities for the 
gifted child. It is quite possible and desirable to save one or two or even three 
years of the individual's educational life when he is well advanced in social 
and physical maturity. Except in unusual cases, such acceleration should 
probably take place in the latter part of the educational program. 

] 0. No program of education for any type of exceptional child offers greater possi- 
bilities for the social welfare than does an effective educational program for 
the child with superior mental ability. 

REFERENCES 

BENTLEY, JOHN E. Superior Children. New York: W. W. Norton & Co., Inc., 1937. 

BOND, ELDEN A. Tenth-Grade Abilities and Achievements. Teachers College Contribu- 
tions to Education, No. 813. New York: Teachers College, Columbia University, 
1940. 

BRIGGS, LESLIE J. "Intensive Classes for Superior Students," Journal of Educational 
Psychology, XVIII (April, 1947), 207-15. 

CARKOLL, HERBERT A. Genius in the Making. New York: McGraw-Hill Book Co., 
Inc., 1940. 

COLLINRON, LESLIE. "Chronological Acceleration and Retardation at Junior High 
School Level." Contribution to Education No. 202 (abstract). Nashville, Tennes- 
see: George Peabody College for Teachers, 1940. 

DEWEY, JOHN. Democracy and Education. New York: Macmillan Co., 1916. 

GOETSCH, HELEN B. Parental Income and College Opportunities. Teachers College 
Contributions to Education, No. 795. New York: Teachers College, Columbia 
University, 1940. 

Handbook of Child Guidance. Edited by Ernest Harms. New York: Child Care Publica- 
tions, 1947. 

HOLLINGWORTH, LET A S. Children above 180 I.Q. Yonkers-on-Hudson, New York: 
World Book Co., 1942. 

. Gifted Children: Their Nature and Nurture. New York: Macmillan Co., 1929. 

LEWIS, WILLIAM D. A Study of Superior Children in the Elementary School. Doctor's 
dissertation, George Peabody College for Teachers, 1940. 

MARTENS, ELISE H. Curriculum Adjustments for Gifted Children. United States Office 
of Education Bulletin No. 1, 1946. Washington: Government Printing Offine 1946, 



280 THE GIFTED CHILD 

PREBBEY, S. L. "Efficiency Engineering in the Educational Emergency," School and 
Society, LXV (June 7, 1947), 425-28. 

SUMPTION, MERLE R. Three Hundred Gifted Children. Yonkers-on-Hudson, New York : 
World Book Co., Inc., 1941. 

TERMAN, LEWIS M., and ODEN, MELITA. The Gifted Child Grows Up. Stanford Univer- 
sity, California: Stanford University Press, 1947. 



CHAPTER XV 

SPECIAL SCHOOLS AND CLASSES FOR 
THE SOCIALLY MALADJUSTED 



EDWARD H. STULLKEN 

Principal, Montefiore Special School 

Chicago, Illinois 



INTRODUCTION 

While there is no single term which appropriately defines and de- 
scribes all the types of atypical children, the term "exceptional" has been 
selected as the most suitable. This term is applied to children who are 
"physically handicapped," "mentally different," or "socially malad- 
justed." This chapter is concerned with those who are "exceptional" be- 
cause of their notable failure to adjust themselves to the behavior pattern 
of ordinary school situations. There is somewhat greater confusion of ter- 
minology in this phase of special education than in those dealing with 
physically and mentally handicapped children. 

The problem of classifying the socially maladjusted is complicated by 
the fact that the reasons for their behavior deviations are frequently re- 
lated to physical handicaps, mental differences, or educational disabili- 
ties. The handicaps of children with physical and mental deviations are 
more distinct and clear-cut than are those which characterize the socially 
maladjusted. 

The failure of a child to make a proper social adjustment sometimes 
arises from conditions within the individual. At other times such failure 
is due to external influences, the effects of which are not known or under- 
stood by parents or teachers. Total blindness, deafness, or severe ortho- 
pedic crippling are obvious reasons for major deviations from normal be- 
havior. In contrast, the emotional and psychological factors in an appar- 
ently normal or nonhandicapped child who is socially maladjusted are 
neither readily seen nor understood. The public is likely to pity and make 
allowances for the child with a gross physical handicap, but the child 
who is a behavior case is more likely to provoke feelings of resentment 
and anger; and these may, in turn, further aggravate his lack of social ad- 

281 



282 THE SOCIALLY MALADJUSTED 

justment. As a result of recent research and the accumulation of informa- 
tion from years of intelligence testing, children who are classed as mental 
deviates are now receiving effective educational treatment and under- 
standing care. Child study methods must do as well in developing diag- 
nostic procedures and remedial treatment which will serve the same pur- 
pose in behavior and social diagnosis as that of intelligence and educa- 
cational tests or tests for visual and auditory acuity in their respective 
fields. 

SOCIALLY MALADJUSTED DEFINED 

Since "mal" means "bad," the term "maladjustment" has a negative 
connotation which is more directly related to ethical precepts than to so- 
cial or psychological concepts. Psychologists have insisted that all behav- 
ior on the part of an organism is an attempt to adjust by reducing the 
tensions that cause dissatisfaction. Hence, day-dreaming on the part of a 
child, although considered a symptom of maladjustment, is really a ten- 
sion-reducing mechanism. Likewise, aggressiveness, lying, and stealing 
are attempts to reduce tension. Thus, all behavior can be considered ad- 
justive behavior if it succeeds in reducing tension, even temporarily. 

One method of defining social maladjustment on the part of an indi- 
vidual is to think of it in terms of adequate or inadequate behavior. 
When a child's behavior does not interfere with his personal growth or 
with the lives of other people, we may consider that behavior adequate. 
When the behavior, such as extreme day-dreaming, interferes with his 
learning and interpersonal relations, or when it interferes with the lives 
of others, in the case of bullying or stealing, we may consider it inade- 
quate behavior, or a type of social maladjustment. Hewitt and Jenkins 1 
have identified three fundamental patterns of maladjustment. These are 
exemplified in the behavior of (a) the unsocialized, aggressive child, (b) 
the socialized delinquent, and (c) the overinhibited child. The unsocial- 
ized, aggressive child is defined as the child, more often a boy than a 
girl, who is aggressive toward all his associates, who shows loyalties to no 
one, and who has usually encountered an attitude of rejection on the 
part of his mother and perhaps others from early childhood. The social- 
ized delinquent, on the other hand, has had an initial acceptance but has 
been rejected later ; while aggressive to society and its accepted standards, 
he has strong loyalties to his gang or group. The overinhibited child is 
one who has been subjected to a very repressive environment and has 
had his life controlled by his mother or by both parents and has never 
had a chance to develop an individuality and to make proper social ad- 



1 Lester Eugene Hewitt and Richard L. Jenkins, Fundamental Patterns of Malad- 
justment: The Dynamics of Their Origin. Springfield, Illinois: State of Illinois, 1946. 



8TULLKEN 283 

justments. More girls are found in this group than in the first two types 
reported by Hewitt and Jenkins. The study has value because it points 
out the great importance of the influence of the early years of the malad- 
justed child's life and because it indicates the deep-seated nature of much 
of a child's maladjustment. 

Behavior of children may vary from minor disturbances to acts of vio- 
lence classified as crimes. The former often have no deep-seated causes 
while the latter are usually steeped in mental conflicts and severe emo- 
tional tensions. Probably the greatest contribution which the child study 
and mental-hygiene movement has made in this field of education is a re- 
alization on the part of teachers and others that the child who is a behav- 
ior problem or a socially maladjusted child should be considered an ob- 
ject for study rather than for punishment. Furthermore, in so far as a 
study of children will help, it is far wiser to prevent problems from becom- 
ing acute than to introduce clinical and other external correctives into the 
educational program after the problem child has become a truant or de- 
linquent. 

The term "socially maladusted" usually includes those children who 
are spoken of as truants, delinquents, incorrigibles, behavior-problem 
cases, predelinquents, and pretruants. Some authors include the emo- 
tionally unstable, the nervous, the psychotic, and the withdrawn, nega- 
tivistic child who does not fit into a social group. Most educators con- 
sider any child socially maladjusted who is characterized as a truant, de- 
linquent, or incorrigible. This chapter is concerned primarily with those 
who are so severely maladjusted that they need special educational serv- 
ices either in special groups or in the form of guidance from especially 
trained personnel in addition to that given by regular teachers. Among 
the more seriously maladjusted are truants and delinquents who often 
are educated in special classes, special day schools, or custodial schools 
and others who are potential truants and delinquents. Also, the children 
who can be defined as behavior problems and are known to be in need of 
the services of a special-education program are to be considered. Further- 
more, many socially maladjusted children suffer from severe educational 
disabilities, and the correction of such disabilities must be considered. 

IDENTIFYING THE SOCIALLY MALADJUSTED 

Finding the socially maladjusted children in a school or school system is 
a difficult problem. Surveys of the behavior-problem cases show consider- 
able variation in the percentage of the school populations which may be 
considered as in need of special educational provisions because of their 
failure to adjust to normal school life. Because of differences in opinion 
about the classification of children as socially maladjusted, survey re- 



284 THE SOCIALLY MALADJUSTED 

ports indicating the proportions in which the several types of exceptional 
children may appear in school populations are not entirely comparable. 
Variation in the percentage of cases will be found from city to city, de- 
pending upon the size of the community and the economic and cultural 
status of the population. The cases identified as maladjusted are not al- 
ways selected in accordance with the techniques recognized in the fields 
of psychology, psychiatry, and education. Only a small part of the total 
problem is studied in many school systems. In small communities and 
rural districts the problem is practically untouched. 

Distribution of Maladjusted Children 

Socially maladjusted children are found in all grades from kindergarten 
to the college, and their problems vary in some respects with the age of 
the individuals. There are likely to be misconceptions about the fre- 
quency of behavior problems at different ages because schools and parents 
are more aware of the extreme problems of older children and often over- 
look those of young children. Some types of behavior problems do not re- 
ceive special consideration for the reason that only those acts which are 
irritating or disturbing to the home or school are apt to be reported. A 
survey involving 1,357 children in Detroit elementary schools revealed 
that approximately 1 per cent of the total enrolment would be classified 
as behavior problems. It was also noted that about 85 per cent of the 
problem cases were boys. 2 There was an average of about seven behavior 
cases per school. When these pupils were rated on the basis of a selected 
list of twenty-six behavior characteristics, it was found that the average 
number of objectionable traits was 6.8 per pupil. There was also a pre- 
ponderance of aggressive behavior, such as fighting and defiance of au- 
thority, rather than of recessive traits such as seclusiveness or timidity. 

Selection of Cases 

Agencies within the community or school which have been established 
for the study of behavior and which are able to identify and diagnose 
socially maladjusted children are known by various names child study 
departments, psychological clinics, child guidance clinics, mental hygiene 
departments, and institutes for juvenile research. In all of them the em- 
phasis is upon the adjustment of children to their environment. School 
systems also provide the services of attendance departments, visiting 
teachers, school counselors, and others, with more emphasis upon school 
attendance and adjustment to school conditions. There is no adequate 



* H. J. Baker and V. Traphagen, The Diagnosis and Treatment of Behavior-problem 
Children, pp. 370-77, New York: Macmfflan Co., 1935. 



STULLKEN 285 

substitute for the professionally trained staff of a good child guidance 
clinic for identifying and diagnosing the difficulties of socially malad- 
justed children. 

The initial referral of cases needing study is the responsibility of 
teachers, principals, and other school workers. These pupils should then 
be studied by psychologists, psychiatrists, physicians, and neurolo- 
gists, according to their individual needs. These specialists are more in- 
terested in fundamental causes than in the behavior itself. For example, 
a pupil who disturbs a teacher by restlessness and constant annoyance 
may be found by an expert examining staff to offer no fundamental psy- 
chological or psychiatric problems. Nevertheless, such a case may be a 
real problem to a classroom teacher with thirty or more other pupils. On 
the other hand, a child who is of a retiring disposition may be a potential 
problem case in the opinion of the expert and yet, by reason of causing no 
disturbance in school, will not be considered a problem by his teacher. 
Teachers must accept the fact that, while there is much that they can do, 
they are not experts and must be willing to call upon specialists in behav- 
ior-problem cases in much the same way they would call upon a sur- 
geon in a case of physical difficulty. Furthermore, even though a scientific 
staff may find no basis for diagnosis or study, they should be willing to 
make recommendations in practical terms which teachers and lay educa- 
tors can interpret and apply in the correction of difficulties. 

Elements of a Program of Identification 

The important elements of a good program of diagnosis include: (a) 
providing means for the initial referral of cases by teachers or parents; 
(6) gathering the important data relating to the case; (c) evaluating the 
effects of observed conditions upon the child's behavior; (d) making sug- 
gestions of remedial measures to improve the child's adjustment; and (e) 
re-evaluating the case to see if the difficulty has subsided. Good diagnos- 
tic procedures for identifying socially maladjusted children must provide 
facts as to the child's intellectual capacity, for which purpose psychologi- 
cal tests will be required. In addition, personality and adjustment inven- 
tories should be made. No accurate identification of a socially malad- 
justed child is possible without using case-history methods. The case his- 
tory should contain personal data secured from the parents, the child, the 
school, and other sources, facts concerning the health and physical con- 
ditions of the child, information about his personal habits and recreational 
interests, teachers' impressions of the home atmosphere, and facts con- 
cerning the childs' school adjustment. Only when such facts in the indi- 
vidual case are known can they be effectively evaluated as to their effect 
on the child's behavior. 



286 THE SOCIALLY MALADJUSTED 

CHARACTERISTICS OF SOCIALLY MALADJUSTED CHILDREN 
Studies of the characteristics of socially maladjusted children indicate 
that there are many factors which affect their behavior. However, no one 
or two factors can account for the maladjustment. It is the combination 
of many factors within and without the child's individual personality, 
with the interplay and reaction of those factors on the life of the individ- 
ual, that produce the problem child. In general, maladjusted children 
differ from normal children less in the kind of deviation which marks 
them as exceptional children than in the degree of difference in personal 
characteristics. Their behavior depends upon the reaction of a particular 
kind of living organism to the impact of environmental forces which oc- 
cur at a time or in a manner likely to produce antisocial behavior. 

The earliest years of a child's life are of great significance in determin- 
ing his later social adjustment. The roots of much of a socially malad- 
justed child's behavior can be traced back to the days of babyhood, and 
those concerned with educating socially maladjusted individuals must be 
appreciative of the early childhood experiences of such persons. Most in- 
fluential in the early history of problem children is the life of the family, 
the relationships among its members, and their ideals. Very often the so- 
cially maladjusted child is one who feels unwanted, unloved, discrimi- 
nated against, unjustly condemned or punished, and unrecognized as an 
individual having rights and needs. The school, therefore, may increase 
or diminish the dissatisfactions that tend to produce maladjustment. The 
above facts are true for both city and rural children. Teachers must pro- 
ject themselves into the life situations of maladjusted boys and girls so 
that they can make a most sympathetic response to the needs of such 

children. 

Sociological Characteristics 

Neighborhood patterns play a part in producing socially maladjusted 
school children and are an indication that the school must reach out into 
the community if it is to adequately care for those who fail to adjust so- 
cially. Many problem children are also engaged in street trades. Shoe- 
shine boys, employees of bowling alleys, and newsboys, especially if em- 
ployed at late hours, are in greater danger of becoming problem cases 
than are other children. Some of the conditions that tend to make a child 
react in an antisocial way are the conditions of poverty, a broken home, 
the lack of church ties or of membership in other socially acceptable 
groups, the presence of vice and crime and other conditions that increase 
the hazards of a happy childhood, and affiliation with a minority or mar- 
ginal group of antisocial aims. Kvaraceus 3 reports that in both Trenton 

3 William C. Kvaraceus, Juvenile Delinquency and the School, p. 99. Yonkers-on- 
Hudson, New York: World Book Co., 1945. 



STULLKEN 287 

and Passaic, New Jersey, the number of children dealt with by the Bu- 
reau of Juvenile Aid varies in inverse ratio to the rental value of average 
dwelling units in the tract from which the child comes. In other words, 
the highest delinquency rates are to be found in the poorest neighbor- 
hoods. Psychiatrists are pretty well agreed that, while poverty may not 
be a direct cause of antisocial behavior, there are conditions which help 
prevent the well-advantaged child from becoming maladjusted. Children 
from homes with higher economic advantages have many ways of carry- 
ing out their aggressions without coming into conflict with society. Camp 
life, a place to run and play, and gadgets that invite manipulation all 
tend to cut down the amount of maladjustment in young people from 
good homes. If they do become behavior problems, they can be sent to 
private schools or given other advantages which obviate the need for in- 
tervention by the authorities. The broken home is a factor because it fre- 
quently has relatively few facilities for handling the problems of its chil- 
dren. Children lacking church ties or wholesome organizational ties of 
other kinds more readily fall under the influence of persons and agencies 
antagonistic to aims of social and individual welfare. 

Physical Characteristics 

The typical truant, incorrigible, or delinquent pupil is usually one of 
the early adolescent age. The adolescent is more vulnerable than his 
older or younger brother and is more easily affected by problems and 
stimuli. Maladjusted boys outnumber maladjusted girls something like 
four to one. Moreover, children's problems vary with the age level of the 
individuals considered. Sherman 4 notes that in young children the types 
are temper tantrums, negative behavior, babyish behavior, and pugna- 
cious tendencies. With adolescents the problems are likely to be feelings of 
inferiority, truancy, and acts which are antisocial in nature. Physical 
factors, in addition to age, which may characterize the socially malad- 
justed include glandular imbalance, oversize or undersize, and handicaps 
which prevent the child from taking part in all the activities of normal 
children of their age or which may make them unacceptable to their fel- 
lows or cause them to feel unwanted by the group. 

A study of problem boys enrolled in the Montefiore School of Chicago 
revealed that they suffered from more than the average number of physi- 
cal defects compared with an equal number of boys enrolled in regular 
schools living in the same neighborhoods. While there is not necessarily a 
causal relationship between poor physical health and poor social adjust- 
ment, the physical defects of the socially maladjusted individuals must 



4 Mandel Sherman, Basic Problems of Behavior, pp. 334-36. New York: Longmans, 
Green & Co., 1941. 



288 THE SOCIALLY MALADJUSTED 

be considered when the school attempts to educate them. It seems par- 
ticularly significant that the problem boys suffered more from hypertro- 
phied tonsils, adenoids, glandular disturbances, poor dental care, and mal- 
nutrition than the boys of the regular schools. It indicates at least that 
homes and neighborhoods producing more of the problem children also do 
less for the physical welfare of those children than is done for children 
living under more favorable circumstances. The school, therefore, in 
meeting the problem of educating socially maladjusted children must 
make more than the usual provision for the physical welfare of those who 
are problems because of their behavior. 

Psychological Characteristics 

While children of all levels of intelligence are found in the ranks of the 
socially maladjusted, studies of behavior cases 6 show the peak of the dis- 
tribution of intelligence quotients to be about 85, or in the dull-normal 
group. Types of social maladjustment are often found in school. In fact, 
school failure is frequently the main point of emphasis. The greater fre- 
quency of behavior disorders among the dull-normal pupils may be ex- 
plained by the fact that they are bright enough to know how to make 
trouble but not intelligent enough to foresee the possible consequences. 
Attendant circumstances may also explain why the dull individuals are 
more likely to become maladjusted; their social backgrounds are gener- 
ally poor, their homes have less favorable ideals, and, even though they 
are able to do the work of the regular classes, they do it with little satis- 
faction to themselves. As a result, they become discouraged and seek out- 
lets not socially acceptable to school and society. Other psychological 
characterstics are anxiety neuroses, greater susceptibility to nervous 
strain, hysteria, sadism, machochism, narcissism, an Oedipus complex, 
and homosexuality. 

Educational Factors 

Other characteristics of socially maladjusted children, especially those 
who manifest aggressive behavior, are that their school histories are 
filled with accounts of unwholesome, unsatisfactory, unhappy, and frus- 
trating situations. They usually have attended more than the average 
number of schools, have often transferred from public to private or from 
private to public schools, their retardation is often unusually high, and 
low school achievement and poor school marks predominate. Further- 
more, there is usually a dislike for school, a dislike for teachers, and a 
tendency to leave school as early as possible. No doubt many truants use 
truancy as an escape from their conflict with school practices and from 

5 H. J. Baker, Introduction to Exceptional Children, pp. 355-56. New York: Mac- 
millan Co., 1944. 



STULLKEN 289 

their repeated failures in school work. Moreover, socially maladjusted 
school children have great difficulty in achieving desirable social relation- 
ships in school. 

SPECIAL NEEDS OF THE SOCIALLY MALADJUSTED 
All children are alike in many ways, even though some of them have 
handicaps or lack the ability to make satisfactory adjustment to their 
environment. Socially maladjusted children need proper food, shelter, 
and clothing; they want to play, be recognized, be loved, and feel secure 
just as normal children do. Even though they do have the same basic 
needs, socially maladjusted children have special needs. Some of these 
are found in their environment and others in their own makeup. The 
number of cases in which there is a "family-child" conflict and in which 
the broken home is encountered suggests that the school should seek in 
its contacts with the child to make a thorough analysis of parent-child re- 
lationships to find some of these special needs. The fact that often other 
members of the problem child's family have court records and are known 
to more than the usual number of social agencies indicates special needs 
in the home environment. Some girls become problems and truants be- 
cause they cannot duress as well as their schoolmates; some boys become 
problems because they lack the means to do the things their fellow pupils 
do. The lack of spending money or the desire to drive a car as other boys 
do often leads to delinquencies to attain the means of becoming socially 
acceptable. Economic difficulties tend to create tensions which affect the 
family life and produce problems against which children often rebel and 
then express their antogonism by becoming antisocial. 

Special Needs in Meeting the General 
Objectives of Education 

The same general objectives of education that apply to all children ap- 
ply to socially maladjusted children. The Educational Policies Commis- 
sion has outlined the four main objectives of education to include self- 
realization, human relationships, economic security, and civic responsi- 
bility. Educators are challenged to meet and realize these objectives 
when special provisions are made for educating those who are problem 
cases because of their failure to adjust socially to the world in which they 
live. The behavior-problem child cannot reach the highest goal of self- 
realization of which he is capable because of defects of character and be- 
cause of conditions found in his environment over which he and his family 
have no control. Inasmuch as the maladjusted pupil may lack the very 
tools with which to attain self-realization, the significance of a program 
of special education suited to his needs and abilities is apparent. 

Eight human relationships cannot be established without friendship, 



290 THE SOCIALLY MALADJUSTED 

co-operation, and a sense of belonging. These basic factors are difficult to 
achieve if the individual feels rejected or if he is accepted only in an 
apologetic way. Thus, many of the things which are taken for granted in 
the education of the normal child for the establishment of good human 
relationships must be developed in socially maladjusted children before 
they can take their place in society. It is also difficult for the problem 
child to achieve economic efficiency. Too often he belongs to that group 
who are "last hired and first fired." His folks usually have a limited in- 
come; they "live on the wrong side of the tracks" and in areas where 
needs are greatest but resources most meager. 

For socially maladjusted children to attain the goal of civic responsi- 
bility is probably the most difficult of all the objectives of education. The 
very factors which produce social maladjustment often make it almost 
impossible to develop civic responsibility. Truants, incorrigibles, delin- 
quents, and behavior cases are all in active rebellion against society. 
Their behavior and personality maladjustments show evidences of such 
conflict even at an early age. Special education has the task of helping to 
change society's attitude toward the socially maladjusted child, to better 
the conditions in his environment, and to change his reaction toward life 
so that he can realize the objective of civic responsibility. 

Deficiencies in Cultural Background 

Some special needs of socially maladjusted children are found in their 
cultural backgrounds. It is a common observation that social problems 
occur with less frequency among families of skilled workmen and profes- 
sional people than they do in families of unskilled workers. Gainful em- 
ployment on the part of mothers also creates additional special needs on 
the part of children. Densely crowded conditions of living, inadequate 
space for living and play, and the lack of privacy are other conditions 
which underlie the special needs of the socially maladjusted. The fact 
that families of problem children tend to change their residence frequent- 
ly is also a significant factor in relation to their social needs. It deprives 
the child of a sense of stability and security, necessitates frequent trans- 
fer to a new school, and leaves the individual without a sense of belonging 
to any one group. 

In every community, resources exist which provide character-training 
to supplement and reinforce that provided by the family and the school. 
These are the church, which develops an appreciation of spiritual and 
ethical values, and recreation and group work agencies, which give oppor- 
tunities for sharing experiences and for developing a sense of co-operation 
and an appreciation of the rights of others. Any failure of these commu- 
nity resources to serve as an influence for good gives rise to special needs 



STULLKEN 291 

of problem children. Too often such needs are met by the formation of the 
neighborhood gang, largely a boy's institution, whose activities increase 
the amount of delinquency, truancy, and antisocial behavior. 

Special Psychological and Physiological Needs 
Other special needs are found in the psychological and physiological 
aspects of the child's life. When children find that they cannot compete 
with their fellows on equal terms because of physical handicaps, psycho- 
logical differences, or subject-matter disabilities, they often become prob- 
lem cases. If a child never experiences the feeling of success from partici- 
pation in the regular activities of the school, he frequently seeks relief in 
truancy or in attempts to gain recognition by committing overt acts of 
misbehavior. Without success, such a child cannot achieve even as much 
as his limited capacity permits. The needs of such children must be met 
in some special way by all schools and met early in the school experience 
if more serious problems are to be prevented. Special education and the 
school in general have a responsibility for compensating for the environ- 
mental and personal needs of children. The school must reach out into the 
community as well as down into the life of the problem child if it is to 
meet his special needs. 

EDUCATIONAL PROGRAM FOR THE SOCIALLY MALADJUSTED 
The agency in every community which has the capacity for dealing 
most effectively with the problems of socially maladjusted children is the 
school system. In the first place, schools and teachers of the present day 
are professionally concerned with individual children and their problems. 
Second, they are becoming increasingly democratic in their dealings with 
children, giving them practice in democratic citizenship and in learning 
the ways of living together in an acceptable manner. In common with the 
home, the church, and the social-service agencies, the school is directing 
its efforts toward the building of character in youth more than it did a 
generation or two ago when it was primarily concerned with the intellec- 
tual development of young people. 

Surveys of current provisions for socially maladjusted children in the 
schools reveal several general modes of attack. The different levels of op- 
eration from the simplest to the most complex type include the following 
personnel and services: (a) the work and responsibility of the regular 
classroom teacher in preventing and correcting social maladjustment; 
(b) the employment of a counselor to assist the teacher when she fails or 
does not know what to do; (c) the professional services of visiting teach- 
ers, school psychologists, and medical consultants; (d) the organization of 
a special class to try new and different techniques; (e) the establishment 
of special schools, such as are found in large cities like Chicago, Detroit, 



292 THE SOCIALLY MALADJUSTED 

and New York; and (/) the use of the custodial school, supported by the 
city or state. The values secured from the services enumerated depend 
upon the qualifications of the personnel employed, the curriculum modi- 
fications that are effected, the special facilities and equipment they are 
able to obtain, the types of records they keep, and the kinds of therapy on 
which they rely. 

Services of the Classroom Teacher 

Almost every teacher faces the responsibility from time to time of 
helping to identify the socially maladjusted child, since many of these 
children remain in regular classrooms for a year or more before their 
problems are recognized. The regular teacher can do much to give these 
children a chance to develop into good citizens, to learn the meaning of 
civic responsibility, to cultivate the spirit of tolerance, and to acquire a 
measure of economic competence. The classroom teachers have a respon- 
sibility for preventing as well as for correcting social maladjustment. 
They must see that it is the business of education not only to teach chil- 
dren what they would not otherwise know but also to help them behave 
in the way their families and friends expect them to behave. 

The organization of the regular classroom and the challenge it presents 
to the interests, activities, and loyalties of children and youth are impor- 
tant factors in the education of socially maladjusted children. For ex- 
ample, if dull or slow-learning pupils must meet fixed curriculum require- 
ments before promotion and if they are held back year after year until 
they are social misfits, truancy, incorrigibility, or some other type of de- 
linquency is apt to follow. On the other hand, if more individual instruc- 
tion and better teaching methods can advance such children with their 
social group, much trouble can be avoided. Teacher load, report cards, 
departmentalization, and pupil discipline are other factors in the regular 
classroom program which may influence the behavior of maladjusted 
children. 

The Counselor 

Whenever a regular classroom teacher fails or does not know what to 
do, provision is sometimes made for a counselor in the school system to 
assist the teacher in providing for the maladjusted child. The counselor 
may be a person who is especially trained for such work or he may be the 
principal, the superintendent, or a supervisor. The counselor may act as 
a consultant to teachers and parents in dealing with types of behavior 
which are indicative of maladjustment. He may also work directly with 
the children in helping them make choices and solve problems that arise 
in school life. The counselor plan, if properly organized and adequately 
supported, works well in rural areas and in smaller cities. The program 
recently developed in Illinois by the state department of public instruc- 



STULLKEN 293 

tion illustrates the advantages of using state funds in developing a pro- 
gram in areas where the number of maladjusted children does not warrant 
the establishment of a special class or school. 

Use of Specialized Services 

Special-school services that supplement and facilitate the work of the 
regular teacher are an important educational provision made by schools 
for preventing and correcting social maladjustment. By special-school 
services are meant the services of those departments, bureaus, divisions, 
or other organized services in a school or school system which provide di- 
rect assistance to pupils or to their teachers and parents. Among such 
organizations are child study departments, child guidance clinics, psy- 
chological bureaus, pupil personnel divisions and others. They employ 
pediatricians, psychiatrists, psychologists, school social workers, home 
and school visitors, and attendance supervisors. All these services sup- 
plement and support the instructional program and the activities pro- 
gram of the classroom or school. 

Child study departments and psychological bureaus usually assist with 
problems arising from learning difficulties, personality problems, and 
family maladjustments. The psychologist is particularly concerned with 
the adjustment of the curriculum to the mental capacities of problem 
children and with teaching techniques that will facilitate learning. 

Home-school visitors and school social workers try to bring homes and 
schools closer together in the effort to understand and to serve these chil- 
dren. This type of pupil-personnel service co-ordinates the social worker's 
case-work techniques and the teacher's point of view and knowledge of 
the school program. Through specialized training in social service, the 
social worker is prepared to help with the child's social and emotional 
problems. 

All special services should afford the school the services needed by 
teachers in helping children realize their maximum potentialities. Basic 
to any successful pupil-personnel program is a continuous census of all 
the children of a district, providing information concerning age, handi- 
caps, and special problems. Attendance officers, the first pupil-personnel 
workers to appear in schools, were concerned primarily with enforcement 
of attendance laws; and while some need for this service still exists, they 
are being replaced by the visiting teacher or school social worker who is 
interested not only in enforcing attendance laws but also in determining 
the reasons for absence and in removing its causes. The school doctor, 
dentist, and nurse are concerned primarily with the physical aspects of 
the maladjusted child's development while the psychiatrist concentrates 
his efforts on emotional growth. 



294 THE SOCIALLY MALADJUSTED 

All the large school systems provide something in the way of child 
study bureaus, attendance departments, and psychological services to 
aid teachers and administrators in dealing with problem children. The 
psychological clinics in Detroit, Los Angeles, and Philadelphia and the 
Bureau of Child Study in Chicago are typical of the clinical services 
available in the larger city school systems. Clinical Organization for 
Child Guidance within the Schools, published by the United States Office of 
Education as Bulletin No. 15, 1939, gives an excellent description of types 
of programs for child guidance in the schools. 

The Special Class 

The special class or special room in a regular school is another plan for 
educating the socially maladjusted. Such classes are among the oldest 
forms of school facilities organized to meet this problem. Special classes 
have sometimes been organized in order to relieve regular classroom 
teachers of their "bad boys and girls," the reason why a child misbe- 
haved being ignored. The special class should be so organized that it will 
make it possible for the special teacher to discover the causes of the mal- 
adjustment and to remove those causes. Such classes should not be 
called the "disciplinary class" but merely known as a placement class or 
other appropriate designation. Admission to such classes should be by 
transfer or school placement and not by formal commitment; and under 
no circumstances should transfer and placement be regarded as a matter 
of punishment. The size of such classes should be small and the group 
should be kept as homogeneous as possible, particularly with reference to 
the social ages of children enrolled. The school work to be done should de- 
pend upon the individual needs of the members of the class, and opportu- 
nities should be offered for pupils to try out various courses. 

The special class affords an opportunity for school systems to deter- 
mine the best procedures for dealing with the socially maladjusted by 
working on such specialized techniques of education psychotherapies, 
play therapies, nondirective counseling, and psychodramatics. In general, 
little has been done in these areas, and the organization of special classes 
for problem cases offers the opportunity for scientific studies that should 
yield notable contributions to progress in the education of socially mal- 
adjusted children. 

The Special School 

Some school systems within the past three decades, particularly those 
in the larger cities, have established special schools for socially malad- 
justed children. While at first thought it might seem that the behavior 
problems of such children would be intensified by transfer to a special 
school, it has been the experience of these schools that serious types of 



STULLKEN 295 

misbehavior are diminished. This is no doubt due to the fact that the 
special school concentrates on remedial measures, gives more attention to 
physical and mental health, and maintains a competent staff of teachers 
of remedial reading, social workers, psychologists, and other adjustment 
workers. The special educational program is adapted to the particular 
needs of maladjusted individuals, with emphasis upon activities that 
prove an effective antidote for emotional disturbances. Special schools for 
social adjustment usually enrol only pupils who are so maladjusted as to 
need careful mental and physical examinations. These schools make it 
possible for the maladjusted to enjoy success in school work instead of 
experiencing the accumulation of feelings of failure which characterized 
their work in the regular schools where their unusual needs could not be 
met. Such schools should not be called "truant schools," or "disciplinary 
schools" or "industrial schools." The last title does not properly describe 
the function of the special day school. At least industrial courses should 
not be emphasized to the exclusion of regular academic work. Such 
schools should be located so that they can be reached conveniently from 
all parts of the city and should not be placed in unfavorable neighbor- 
hoods. School transfer rather than court commitment should govern ad- 
mission. Placement should not be considered as punishment; rather, the 
decision to place a child in a special school should be based upon the fact 
that the evidence indicates that such placement will be of material bene- 
fit to him. 

Special schools should provide a variety of curriculum offerings. Aca- 
demic work is needed in English, mathematics, science, and social studies. 
Courses in woodwork, general metal work, electric shop, automotive 
shop, print shop, crafts laboratory, cartooning, and general mechanics 
are usually offered for boys. Homemaking, hairdressing, personal groom- 
ing, sewing, cooking, and typing are usually offered in the special school 
for girls. Other courses found in both boys' and girls' schools are music, 
art, and physical training. Teachers in such schools should have special 
training, wholesome personalities, and ability as instructors. Excellent 
craftsmanship should be a requirement for those who teach shop courses. 
All such schools must make provision for vocational, educational, and 
personal guidance. In fact, the special school for the socially maladjusted 
should be a combination of a special school and a child guidance clinic. 

The weakest point in most special-school programs is the lack of proper 
placement procedures and adequate follow-up of the pupils after they 
leave the school. Discipline in the better schools is no different than that 
found in the best elementary or secondary schools. Systems of penalties 
and merits or credits as bases for determining the length of stay in a spe- 
cial school are of no value because they imply placement in the school as 



296 THE SOCIALLY MALADJUSTED 

a punishment for wrongdoing. In addition to the regular and remedial 
work in school subjects and the special services for emotionally disturbed 
children, all special schools need more systematic provision for the reha- 
bilitation of the pupils, more study of the variety of causative factors 
that produce maladjustment, truancy, and delinquency, and better pro- 
vision for the child's re-entry into the normal life of society, including his 
return to the regular school. No special school can do these things if it 
does not make curriculum modifications, provide special equipment, in- 
cluding proper clinical office space, and keep adequate cumulative rec- 
ords of the work and interests of those enrolled. 

The probationary schools of New York City, the Moore School of De- 
troit, and the Montefiore School of Chicago are typical day schools for 
educating truant and problem boys and girls. The Montefiore School has 
an extended day program, operates for twelve school months, and has 
separate branches for boys and girls. It employs such specialists as psy- 
chologists, psychiatrists, social workers, and dentists as well as carefully 
selected personnel for teaching positions. The program of the school is en- 
riched and modified to fit the needs of problem boys and girls, and much 
attention is given to proper diagnosis and to remedial teaching. 

The Parental or Custodial Institution 

Parental schools or custodial institutions are of different types. A few 
of the school systems in the largest cities maintain parental schools; some 
counties maintain special residential schools; and many states have 
"training schools" for both boys and girls. Such institutions are used 
when it becomes necessary to remove children from the home and the 
regular school and whenever satisfactory foster-home placement is not 
possible. The parental or custodial school is an institution for lodging, 
boarding, and educating the most severe cases of social maladjustment. 
They are generally located on a farm some distance from the city, al- 
though the farm does not seem to be an essential feature in many in- 
stances. The parental school is managed on two different bases. One 
places the institution under the control of the city council or the county 
board of supervisors and makes the board of education responsible for 
providing teachers and school supplies; the other places the school en- 
tirely under the control of the board of education. Administratively a 
dual system of control is never desirable. Since the fundamental objective 
of such institutions is to provide a situation in which problem youths can 
be re-educated socially and since social, academic, and trade education 
must go hand in hand, the administration of such schools should be di- 
rected by educational authorities rather than by civil authorities. By the 
same token, state training schools should also be under the direction of 



STULLKEN 297 

the superintendent of public instruction although they are usually under 
the direction of the department of public welfare. 

Some parental schools and most state training schools require court 
commitments for all pupils admitted. Since the purpose of these schools is 
educational rather than penal, it is best to use the court commitment only 
as a last resort. Two methods of housing pupils in parental schools are 
used: (a) the cottage system, in which the school plant consists of a num- 
ber of buildings where children live in small groups of fifteen or twenty, 
each group having its own cottage; and (6) the congregate system, in 
which the entire plant is under one roof, the school presenting the appear- 
ance of a huge institution. There is a distinct trend in favor of the cottage 
system, but a good cottage system is dependent upon the careful selection 
of proper people to serve as housefathers and housemothers. The mini- 
mum essentials of the regular course of study are usually required of all 
pupils, and industrial work is given considerable attention. Much of the 
housework is done by pupils, and farming, gardening, and stock raising 
are often provided in addition to the regular shop work. Most of the pa- 
rental schools and state training schools try to classify their pupils as to 
age and social maturity and aim to keep the more hardened and vicious 
types of inmates apart from the merely mischievous and more innocent 
child. 

Good examples of parental or custodial schools are found in the Chi- 
cago Parental School for boys and girls, the Bellefontaine Farm School 
for Boys in St. Louis, the Boys' Farm at Hudson near Cleveland, and 
Blossom Hill School for Girls also near Cleveland. The Berkshire Indus- 
trial Farm is a representative private school located near Albany, New 
York. 

TEACHER PERSONNEL 

In chapter viii the general qualifications and training of teachers of ex- 
ceptional children are discussed. Teachers of socially maladjusted chil- 
dren require the same general cultural education, about the same experi- 
ence and training in regular class work, and the same knowledge of child 
development and mental hygiene as for teachers of normal children. They 
should be carefully selected and have special competencies for dealing 
with this class of exceptional children. 

Personality 

The type of person selected for work with problem children and the 
personality make-up of those selected is of the utmost importance. No 
amount of training can overcome fundamental defects of character in 
teachers who work with children and who are themselves defective in per- 
sonal adjustments. Children always learn more by example than by pre- 



298 THE SOCIALLY MALADJUSTED 

cept, and this is particularly true of those who are emotionally disturbed. 
The teacher assigned to a special class or a special school for maladjusted 
children must not be irritable, fussy, or infantile in his own emotional re- 
actions to the disturbed child's problems. He must have respect for the 
child's personality and must respect his rights as an individual. A good 
sense of humor and the ability to place people and events in their proper 
perspective are of great value. Adaptability and flexibility of mind are 
also essential because problem children always test teachers more severe- 
ly than do well-adjusted children. Likewise, the teacher should have a 
normal range of human contacts outside the daily task of working with 
problem cases. Teachers who have no wholesome outlets soon become 
problem cases themselves and are able to do little in helping children 
solve the problems which overwhelm them. 

Special Training 

Special training for work with maladjusted children is of extraordinary 
value to the special-class teacher. This training should include courses 
that will give a good background in mental hygiene. Studies in the psy- 
chology of the abnormal, in the psychology of childhood and of adoles- 
cence, and in guidance procedures for children and youth are necessary. 
Work in guidance should cover the educational, vocational, and personal 
aspects of such service. Understanding the growth patterns of children 
and the emotional effects of personal handicaps and educational disabili- 
ties will always be a help in teaching maladjusted children. Instruction 
and practice in testing and in case-work procedures should be included in 
the training of these teachers. Since much of social maladjustment in 
school is occasioned by the influences of home and community, there must 
be courses in understanding the social problems of the home and the com- 
munity. Social psychology and an understanding of the psychology of 
social-group life will be of assistance in this connection. Work in recrea- 
tional activities, crafts, hobbies, and in the guidance of leisure-time in- 
terests are likewise valuable. 

Experience 

The teacher of the socially maladusted profits, as do all teachers, by 
experience. Some writers believe that such experience should include at 
least some work in teaching normal children. Others believe that experi- 
ence with problem cases is sufficient. Experience in clinical procedures 
will help the teacher understand the causes of maladjustment, prevent 
maladjustment, treat delinquent behavior, and lead the children to make 
better personal adjustments. Practice in group-work procedures will also 
prove of value in all these tasks. 



STULLKEN 299 

PRINCIPLES OP GOOD PRACTICE 

In developing programs for educating socially maladjusted children, 
experience has shown that certain principles should be followed. Some of 
these have been suggested in the preceding pages. They are restated here 
for the sake of emphasis. The following statements will be found of value 
by those interested in the field of educating and caring for maladjusted 
children. They should be considered in connection with the task of or- 
ganizing a special-education program in this field. 

1. Socially maladjusted children are entitled to the advantage of a special 
educational program that will permit them to develop to the limit of their ca- 
pacities. All children must have the right to develop into self-respecting, 
useful citizens by the process of public education, and that right must 
not be abridged by a handicap of any kind which can be eliminated or 
mitigated through the facilities and resources of the schools. 

2. Segregation as commonly defined is not a necessary concomitant of the 
education of socially maladjusted children. School administrators should 
realize that an exceptional child may be more harmfully segregated when 
kept in a regular class which does not meet his needs than when assigned 
to a special class which meets his needs much better. 

3. In organizing and administering a program of special education for the 
socially maladjusted, school administrators must maintain a balance between 
the interests of pupils needing placement in special groups and the interests of 
the great majority of the school population. While these interests often con- 
flict, the conflict must be resolved for the best interests of all concerned. 
In general, placement of any child in a special group should not be made 
if that child may receive as good or better training in a normal group, 
even though it may be necessary to give special help and additional serv- 
ices over and above those which are usually provided. The exception to 
this rule is found whenever the detriment to the normal pupils out- 
weighs the benefit to the handicapped individual from his association 
with the regular group. Special groups, when organized, should be made 
as homogeneous as possible with reference to age, sex, intelligence, and so- 
cial maturity. 

4. The school administrator should be the final authority in the transfer of 
children to a special group or to a special program for socially maladjusted 
individuals. The school administrator represents the parent as well as the 
school and the co-operation of the parent must be secured if the child is to 
receive the greatest service from a special program or a special class 
placement. Accordingly, the school administrator should be qualified to 
interpret the findings of the specialists to parents and teachers. 

5. Schools must recognize the fact that a socially maladjusted child is one 
who may be normal within himself but yet be exceptional because of antisocial 



300 THE SOCIALLY MALADJUSTED 

home and community influences. The time has come when the state or the 
school should assert its right to protect its investment in the social adjust- 
ment of children from the inimical influences to which the child may be 
subjected outside the school. It would appear that the special education 
for the socially maladjusted must venture into the field of social service 
and that every teacher of socially maladjusted children will need to be 
trained as a social worker. 

6. The special-education program for socially maladjusted children should 
be a part of and not apart from the general educational program. The same 
general objectives for educating normal children hold for educating so- 
cially maladjusted children. The tendency to substitute specific trade- 
training for courses in general education is no more justifiable for problem 
children than it is for normal children. While recognizing the child's need 
for having something of value to a prospective employer, the school must 
see that he gets something more than special training to earn a living. 
Some school systems provide special schools, others special classes in reg- 
ular schools, and still others special services within regular classes. The 
particular organization is less important than the program and the phi- 
losophy upon which the program is based. 

7. School systems should provide for early identification and early diagno- 
sis of children who are maladjusted. School children become problem cases 
as a result of experience and at a much younger age than is often thought 
to be the case. While truants, incorrigibles, and delinquents become acute 
problems at about the time of adolescence, the years in school previous to 
that period should be considered years of opportunity for the school to 
make definite diagnosis and to institute remedial programs which will 
prevent the problems from becoming acute. 

8. The education of socially maladjusted children requires a broader basis 
than that of mere intellectual development. These children often have 
warped personalities, and, consequently, their feelings and attitudes are 
the object of more concern than their academic attainments. Educational 
programs for meeting the needs of the socially maladjusted should be sub- 
ject to a minimum of regimentation and should have more than yearly or 
semester opportunities for change. Too much of all education is still con- 
cerned with narrow intellectual development. Children who are deviates 
because of social maladjustment need a chance to develop emotional 
stability; they need personal, educational, and vocational guidance; they 
need to experience the sense of security that goes with a socially accept- 
able personality. Unfortunately, the school does not always bring to these 
handicapped children the sense of success that might move them to 
strive for the maximum of cultural attainment available to them. 

9. Any program of education for the socially maladjusted will be condi- 



STULLKEN 301 

Honed by the selection of properly qualified and trained personnel. The 
teacher must have personal qualifications suitable for the task in hand 
and should have training which is particularly adapted to the require- 
ments of working with problem children. Also, sufficient experience to be 
able to handle maladujsted children without becoming confused because 
of lack of familiarity with the mere mechanics of teaching is important. 

10. No program for socially maladjusted children is sound unless it recog- 
nizes the fact that the behavior of such children is symptomatic and purposive. 
Adverse behavior such as truancy, incorrigibility, and delinquencies are 
only symptoms of underlying conditions, the roots of which will be found 
in the environmental life of the child or in some physiological and psy- 
chological aspects of his personality. Teachers and school administrators 
must also recognize that the behavior of a child has purposive value to the 
child and that so-called abnormal behavior is sometimes to be regarded as 
logically normal when the behavior in question represents the manner of 
achieving a selected aim. An objective attitude on the part of teachers to- 
ward children's behavior may serve to prevent problem cases from de- 
veloping. 

11. Socially maladjusted children differ from normal children more in de- 
gree than in kind. There is no hard and fast line between normal and ab- 
normal adjustment. Problem boys and girls look no different than ordi- 
nary children. Too often problem children are not problems in their rela- 
tion to society. They are, in fact, only children with problems which they, 
their parents, and their teachers cannot readily solve. 

12. Teachers, school administrators^ and social workers should not initiate 
programs for educating or treating socially maladjusted children without 
first making a survey to determine the extent and nature of the local problem. 
Plans for a given school or school system should be made to meet the situ- 
ation revealed by the survey. Expert advice should be sought, and the 
program should be built on sound educational principles. Essential per- 
sonnel should be selected with regard for training and personal fitness for 
such service. The program must provide something over and above a reg- 
ular school program and contain something of particular value to the mal- 
adjusted child. In general, the program should be conducted for twelve 
months in the year and carry far beyond the doors of the schoolhouse. 



SECTION HI 
SOME FUTURE DEVELOPMENTS 



CHAPTER XVI 

THE PREVENTION OF HANDICAPS 
IN CHILDREN 



CHRISTINE P. INGRAM 
Associate Professor of Education 
Illinois State Normal University 
Normal, Illinois 

and 

HENRY C. SCHUMACHER 

Medical Director 

United States Public Health Service 

Consultant in Mental Health Activities 

Federal Security Agency, Region Ten 

San Francisco, California 



INTRODUCTORY STATEMENT 

Special education should embrace within its own program the germ for 
its ultimate extinction. Prevention must be one of its primary goals. The 
"germ of prevention" should be fostered to preclude serious childhood 
deviations and to promote well-rounded growth and development to so 
full an extent that ultimately there will be little, if any, need for special- 
education programs as we know them today. Although this may be a 
Utopian goal, research in ontogenesis, maturation, learning, and behavior 
in infancy and childhood as well as research in causes of congenital condi- 
tions, diseases, and accidents and their effects and in behavior and perso- 
nality disorders challenge and inspire those who are engaged in special 
education to attend to causes and means of prevention. Many of these re- 
search findings point the way to the control of adverse elements and to 
early treatment and new practices that would greatly reduce the nature 
and number of serious deviations found in childhood today. Special edu- 

302 



INGRAM AND SCHUMACHER 303 

cation, therefore, misses rich opportunity and defers responsibility when 
it fails to be insistent on the embodiment and promotion of preventive 
aspects in its program. 

In a broad sense, the whole area of child welfare, embodied in the 
standards o child health, education, and social welfare for all American 
children as set forth in the White House Conference reports of 1940, 1 
concerns workers in special education. Whatever betters the conditions of 
life for all families and all children should lessen the need for special-edu- 
cation programs. There is opportunity and need, however, to focus now on 
certain preventive measures, of which we now have knowledge that can 
aid in promoting normal growth for more and more children. 

Wherever and whenever programs are set up, such as those for diagno- 
sis of the mentally retarded and the establishment of classes, the dis- 
covery of the hard-of-hearing and provisions for lip reading, auditory 
training, and speech correction, or the study of serious personality devia- 
tion and a plan for therapy, there should be accompanying emphasis on, 
and provision for, early discovery of signs of deviation and for early pre- 
ventive treatment. There should be continuous attention to the causes 
for such deviations and to the promotion of conditions that will eliminate 
those causes. There is need also for research projects in the aspects of pre- 
vention. This chapter is devoted, therefore, to the consideration of this 
whole matter. 

Every year research in biological and medical sciences, anthropology, 
psychology, and social sciences, including education, is advancing knowl- 
edge of the extent and causes of handicapping conditions. As this knowl- 
edge is understood and applied, we can look for prevention and reduction 
of incidence, in not only the school-age population but also the total pop- 
ulation. The usual lag, however, between theory, knowledge, and applica- 
tion is present. 

Although statistical data in general are meager, the incidence of cer- 
tain handicaps could be greatly reduced if present knowledge of preven- 
tion were applied. In the area of visual disability, where much preventive 
study and field work have been carried on, it is estimated that 66 per cent 
of all blindness can be prevented. 2 The application of present knowledge, 
although incomplete, would greatly reduce the 90 per cent of cardiac dis- 
abilities in school-age children attributable to rheumatic fever. 8 

There are a quarter of a million children brought before juvenile courts 



1 Standards of Child Health, Education, and Social Welfare. Children's Bureau Pub- 
lication No. 287, 1942. Washington: Government Printing Office, 1942. 

2 Letter by Mason II. Bigelow, Sight-Saving Review, XVII, (Spring, 1947), 49. 

8 Louise Fry Galvin, "Preventive and Public Health Aspects of Rheumatic Fever in 
Children," Southern Medical Journal, XXXVI (February, 1943), llfr-21. 



304 PREVENTION OF HANDICAPS 

in this country annually, and at least three-quarters of a million come to 
the attention of police and school authorities but are not sent to court. 
The United States Children's Bureau states that recognition and treat- 
ment of incipient symptomatic behavior and unhappiness could have pre- 
vented serious social maladjustment for most of these cases. 4 

The present discussion will focus on medical knowledge, research, so- 
cial factors, health services, and educational programs that have a bear- 
ing on prevention of initial handicaps and will consider briefly measures 
medical, health, social, and educational that will prevent the occurrence 
or development of handicapping conditions. 

Briefly stated, the growth and development of the child stems from 
two forces. From the period of life in utero and from birth onward, the 
growth and development of the individual is determined by constitu- 
tional inheritance and by a multiplicity of influences which are designated 
by the generic term, environment. Environmental influences of housing, 
nutrition, clothing, exposure and reaction to accidents and disease, the 
family constellation, the school system, and the community center in 
which the child is reared, all play their part in the ontogeny or develop- 
ment of the individual organism. 

Consideration will be given first to constitutional inheritance, to causes 
operating during gestation and birth which bring about abnormal devel- 
opment, and to postnatal factors of disease and accident. Discussion of 
the prevention of social maladjustment and environmental influences 
will follow. 

PRENATAL, NATAL, AND POSTNATAL FACTORS 

Prenatal Factors 

Heredity. The role of heredity in disease is a moot question. Its influ- 
ence is best studied in developmental anomalies. The presence of the 
same malformation in both identical twins is not unusual, but it is almost 
unknown for only one identical twin to be afflicted or both fraternal 
twins to be affected in the same manner. Identical twins have the same 
heredity, and fraternal twins have a dissimilar heredity but, in general, 
the same prenatal influences. Hence, it is reasoned that the most impor- 
tant factor in such malformations is heredity. Such studies, moreover, 
stress the fact that congenital defects are dependent upon recessive rather 
than dominant factors. Two facts must be kept in mind. First, a symp- 
tom-free interval following birth is not to be interpreted as evidence that 
the later appearing anomaly is not due to developmental defect, since the 
structure upon which the symptom depends may not be functional for 
months after birth. Second, since the defect is dependent upon recessive 



1 "An Experiment in Child Welfare/' The Child, II (October, 1946), 70, 71, 79. 



INORAM AND SCHUMACHER 305 

factors, only a careful study of the family tree will show its hereditary 
nature. 

A second possibility remains to be considered, however. Developmen- 
tal defects can be produced by such procedures as pricking with a needle 
certain areas of a fertilized egg, placing it in solutions of different types, 
or keeping it in an icebox for brief intervals, thus producing changes in 
oxygenation. In view of such experimental evidence, it is thought that de- 
fects of development may occur in utero due to transient disturbances of 
embryonic metabolism. Defective placental implantation may be a factor 
in bringing about developmental defect. Roentgenological therapy of the 
pelvic region during pregnancy has been shown to cause defects of the 
nervous system. Maternal toxemias as well as extreme vitamin deficien- 
cies must also be considered. 5 ' 6 

Infectious Diseases. Congenital malformations following infectious dis- 
eases during pregnancy have been intensively studied in recent years. 
Rubella German measles appears to be particularly prone to cause 
congenital defects. Common among such defects are microcephaly, heart 
disease, deaf-mutism, cataracts, and mental deficiency. Other infectious 
diseases which may lead to defective offspring if they occur during preg- 
nancy are measles, mumps, chicken-pox, and scarlet-fever. 7 

The Rh Factor. In 1940, Landsteiner and Wiener 8 reported on an agglu- 
tinin, a substance capable of causing clumping or destruction of the cells 
which stimulated its production, which developed in rabbits by injecting 
blood from the Macacus Rhesus monkey. When tested with human 
bloods, this agglutinin demonstrated the presence of a new substance in 
human blood cells called the Rh (rhesus) factor. This factor is present in 
about 86 per cent of human bloods, and such bloods are designated as Rh 
positive. The 14 per cent of human bloods which do not contain the Rh 
factor are designated Rh negative. The agglutinin is called the anti-Rh 
agglutinin. 

This agglutinin is the destructive antibody responsible for manifesta- 
tions of erythroblastosis, a condition in which immature blood cells 

6 Frank R. Ford, Diseases of the Nervous System in Infancy, Childhood, and Adoles- 
cence, pp. 149-333. Springfield, Massachusetts: Charles C. Thomas, 1937. 

6 Alfred A. Strauss and Laura E. Lehtinen, Psychopathology and Education of the 
Brain-injured Child, pp. 106-17. New York: Grune & Stratton, 1947. 

7 Charles Swan, A. L. Tostevin, and G. H. Barham Black, "Final Observations on 
Congenital Defects in Infants Following Infectious Diseases during Pregnancy, with 
Special Reference to Rubella," Medical Journal of Australia, II (December 28, 1946), 
889-908. 

8 K. Landsteiner and A. S. Wiener, "Agglutinable Factor in Human Blood Recog- 
nized by Immune Sera for Rhesus Blood," Proceedings of the Society of Experimental 
Biology and Medicine, XLIII (1940), 223. 



306 PREVENTION OF HANDICAPS 

(erythroblasts) are found in the blood stream due to failure of their matu- 
ration in the bone marrow. Much remains to be learned regarding the 
Rh factor, but the evidence indicates that an Rh-negative wife of an 
Rh-positive man may, after the first pregnancy, unless she has had blood 
transfusions from an Rh donor previously, give birth to a child suffering 
from erythroblastosis foetalis. 9 

Treatment of the new-born suffering from this disease with transfu- 
sions of Rh-negative blood is saving a large proportion of infants who 
otherwise would have died. However, damage to the brain tissue may re- 
sult in neurological disturbance and in feeble-mindedness. 10 More re- 
search in regard to this is indicated. 

Endocrine Disorders. The effects of disturbed function of the glands of 
internal secretions in the pregnant woman are not too well understood. 
However, hypofunctioning of the thyroid gland in the pregnant woman 
leads to states of hypothyroidism and cretinism in the infant, a chronic 
condition due to the congenital lack of thyroid secretion and marked by 
arrested physical and mental development. Most cases of cretinism and 
hypothyroid states could be prevented by careful study of the pregnant 
woman. Routine basal metabolic rate and cholesterol determinations 
standard tests for determining normal functioning of the thyroid gland 
carried out in each trimester of pregnancy and treatment with thyroid 
extract when indicated would greatly reduce the incidence of hypothy- 
roidism and thus prevent many cases of arrested physical and mental de- 
velopment. 11 

Mongolian idiocy or Mongolism is less well understood than cretinism. 
Children suffering from this condition may be born to women without re- 
gard to social or economic condition or intellectual ability at any period in 
the reproductive age span. 12 According to Benda 13 a careful life-history 
study of the pregnant woman will call attention to the possibility of an 
abnormal pregnancy. An analysis of the cases cited by Benda reveals con- 
ditions and symptoms in the pregnant woman which the obstetrician can 
observe and upon which a rational treatment program may be under- 

9 L. M. Hellman and G. R. Vosburgh, "Role of Transfusion in Etiology of Eryth- 
roblastosis: Warning to Physicians," Journal of American Medical Association, 
CXXXVI (January 10, 1948), 79-81. 

10 Mary Louise Scholl, Warren E. Wheeler, and Lawrence H. Snyder, "Rh Anti- 
bodies in Mothers of Feeble-minded Children," Journal of Heredity, XXXVIII (1947), 
253-56. 

"Clemens E. Benda, Mongolism and Cretinism, pp. 115-20, 224-45. New York: 
Grune & Stratton, 1946. 

12 Clemens E. Benda, "Prenatal Maternal Factors in Mongolism," Journal of the 
American Medical Association, CXXXIX (April 9, 1949), 979. 

18 Benda, Mongolism and Cretinism, op. cit. 



INGRAM AND SCHUMACHER 307 

taken. Benda is convinced that Mongolism is not likely to be ameliorated 
in postnatal life. He believes that the main goal will remain the preven- 
tion of the development of Mongolism in the unborn baby. Much more 
research, however, remains to be done. 

Natal Factors 

The Birth Situation. Much brain damage is the end result of the birth 
situation. Premature birth, caesarean birth, long and difficult labor, pre- 
cipitate birth, dry birth, hemorrhage, pelvic malformations, anomalies in 
presentation, and twisting of the umbilical cord are factors of importance 
in the causation of brain damage. 14 Then, too, the improper use of forceps 
and of anesthetics and drugs contribute their share to the production of 
brain damage. 

Anoxia. Maternal toxemia not only contributes to premature labor but 
also to anoxia (insufficient oxygen in the blood) in the new-born. Forceps 
delivery, version, and caesarean section as well as the improper use of 
pituitrin, a drug used to promote uterine contractions, clearly contribute 
to the production of birth trauma and hence to hemorrhage, which in 
turn results in improper oxygenation. Analgesics, anesthetics, and drugs 
such as morphine result in increasing the danger of anoxia and asphyxia 
to which brain tissue is extremely vulnerable. 15 

Cerebral Palsy. "Cerebral palsy is a term used to designate any paral- 
ysis, weakness, inco-ordination, or functional aberration of the motor sys- 
tem resulting from brain pathology/' 16 Factors ranking first in impor- 
tance in producing cerebral palsy are those incident to labor and birth, 
with prenatal factors ranking second in importance, and postnatal third. 

Postnatal Factors 

Infectious Diseases. Infectious diseases, particularly whooping cough, 17 
measles, and scarlet fever during the first months of life, and meningitis 
and encephalitis at any time in childhood are factors producing brain in- 
jury after birth. Accidents during infancy and childhood are another 
source of brain damage. 

Epilepsy. Epilepsy, or the convulsive disorders, occurs in one who has 
a predisposition or a susceptibility to that disorder. However, brain dam- 

14 Edith L. Potter and Fred L. Adair, Fetal and Neonatal Death. Chicago: Univer- 
sity of Chicago Press, 1949 (second edition). 

16 Franklin F. Snyder, Obstetric Analgesia and Anesthesia: Their Effect upon Labor 
and the Child, chap. vi. Philadelphia: W. B. Saunders Co., 1949. 

18 M. A. Perlstein, The Problem of Cerebral Palsy Today, p. 4. Chicago: National So- 
ciety for Crippled Children and Adults, 1947. 

17 Sol Levy and H. A. Perry, "Pertussis as a Cause of Mental Deficiency," Ameri- 
can Journal of Mental Deficiency, LII (1948), 217-26. 



308 PREVENTION OF HANDICAPS 

age due to causes already discussed is the primary contributing factor. 
Emotional disturbances also may bring on a seizure. Disorders such as the 
common diseases of childhood and nutritional disturbances may further 
damage an already susceptible brain and bring on seizures. It is obvious 
that measures which reduce brain injury and emotional shocks in indi- 
viduals with a predisposition to convulsive disorders will aid in preven- 
tion and that early recognition and treatment of mild symptoms are 
implied. 

Poliomyelitis. In poliomyelitis, a disease which results in crippling con- 
ditions, research continues apace both as to epidemiology 18 and treat- 
ment. Infection with poliomyelitis virus is apparently as widespread as 
measles but often is so mild in symptoms that it is not brought to medical 
attention. 

Severe epidemics do not occur in successive years in the same commu- 
nity. The epidemic curve usually rises to a peak in about six to eight 
weeks and then declines over an eight- to ten-week period. The disease oc- 
curs at all seasons of the year, but the highest incidence is in the summer 
season. The disease is undoubtedly caused by a virus and, so far as now 
known, is a disease limited to man. 

Three hypotheses have been advanced as to the transmission of the 
disease: transmission through the respiratory tract, the intestinal tract, 
and through flies and mosquitoes. However, epidemics occur without re- 
gard to the distribution of water, milk, or food supplies, and spraying 
with DDT or other insecticides has no effect in shortening an epidemic. 
The high incidence of bulbar (brain-stem) cases among children on whom 
tonsillectomy is performed during an epidemic suggests entry of the virus 
through the nerves or lymphatics of the upper respiratory tract. The age 
distribution of the disease indicates that resistance is acquired with age 
and that it develops earlier in life in urban than in rural areas. 

The National Foundation for Infantile Paralysis has a program of 
medical research in causes and treatment. 

Rheumatic Fever. Rheumatic fever, which causes 90 per cent of child- 
hood cardiac conditions, is in some way related to infection caused by 
hemolytic streptococci. Fully 80 per cent of deaths from heart disease in 
children under fifteen are due to rheumatic heart disease. 

Whether rheumatic fever is increasing or decreasing is difficult to de- 
termine. About 5 per cent of the population are susceptible to the devel- 
opment of rheumatic fever. The first attack of rheumatic fever usually 
occurs between the age of four and puberty. The recurrence incidence is 
also much higher in this age group than after the age of puberty. 

"Gaylord W. Anderson, "Epidemiology of Poliomyelitis," Lancet t LXVII 
(January, 1947), 10-13. 



INGRAM AND SCHUMACHER 309 

Early detection and treatment may alleviate cardiac involvement. 
Early signs and symptoms which should direct attention to the possibil- 
ity of a rheumatic condition are: fatigue, irritability, anorexia, pallor, 
night sweats, spontaneous epistaxis, increased pulse rate, low-grade fever, 
and vague pains in the extremities, joints, and abdomen. 

Two recent developments have taken place in the public health as- 
pects of the disease. The U. S. Government has authorized grants-in-aid 
to the state governments for a rheumatic-fever program in connection 
with the program of services for crippled children. Several interested 
groups representing the medical profession, public health nurses, sociolo- 
gists, and others interested in the control of the disease, have organized a 
Council on Rhuematic Fever under the general supervision of the Ameri- 
can Heart Association. 

Adequate control measures 19 involve improvement of living conditions, 
more adequate medical care of patients suffering from respiratory infec- 
tions, and adequate facilities for the medical care of the rheumatic heart 
patient. In addition, more attention should be paid to social service 
follow-up care as well as to vocational guidance and job placement of the 
patients who have recovered from attacks. 

Tuberculosis. Through popular education, through case finding by the 
use particularly of mobile X-ray units for screening mass populations, 
and through discriminating treatment of persons infected with tubercu- 
losis, this disease has been moved from first place in the cause of death in 
1900 to seventh place today. The teen-age period is a dangerous age, par- 
ticularly for girls. Tuberculosis is spread through association with others 
who have tuberculosis. It is not inherited but "runs" in families, because 
it spreads through close contact with an infected person. At the present 
time vaccination against tuberculosis of the "tuberculin negative" child 
is receiving scientific attention. Large-scale vaccination programs are now 
in progress. 

PREVENTION OF ABNORMALITIES AND DISEASE 

Little is actually known about human genetics. However, if there is 
any question of marriage, the individual in whose family background 
there is a history of such disorders as Huntington's chorea or the heredi- 
tary neuromuscular disturbances should consult his physician in order 
that the situation be fully explained to him so as to prevent the continu- 
ance of such pathological strains. Sound judgment must be used, how- 
ever, in situations in which the family history records epilepsy or mental 
illness. 



19 Proceedings of Conference on Rheumatic Fever, October 5-7, 1943. Federal Security 
Agency, U.S. Children's Bureau Publication No. 308. Washington: Government 
Printing Office, 1944. 



310 PREVENTION OF HANDICAPS 

Of more importance is the early and continuous care of the pregnant 
woman. Many anomalies of development could undoubtedly be pre- 
vented were every pregnant woman to receive the full benefit of modern 
medical knowledge. Prenatal classes should be established in all commu- 
nities, and all pregnant women, regardless of socioeconomic status, 
should be encouraged to attend regularly. Attendance at such classes and 
competent medical attention from the onset of pregnancy would go far to 
insure an uneventful pregnancy and normal development of the unborn 
child. 

The prevention of natal injury demands sound obstetric care at the 
time of delivery. Every girl should be taught that pregnancy and labor are 
normal physiological processes. This would eliminate the unhealthy 
trend for the use of analgesics, anesthetics, and surgical interference. 
Anoxia, asphyxia, and hemorrhage would be greatly reduced. 

Pediatric care and attendance at well-baby conferences would insure 
normal development of the well-born baby. Immunization and vaccina- 
tion against many of the common diseases of childhood is not only possi- 
ble but eminently practical. Much research is under way to increase the 
number of diseases against which immune sera and vaccines will prove 
effective. 

Today there is in most communities no provision for well-child con- 
ferences beyond the age of two. Unfortunately, too, many parents fail to 
obtain medical care for the run-about child at the earliest signs of illness. 
Hence many disabilities, the outcome of nutritional disturbances, acci- 
dents, and diseases are not caught early and adequately treated. Much 
permanent damage, therefore, results. 

In many localities the school health service is but a school inspection 
service. Then, too, the health program is badly divided. Frequently sev- 
eral different groups of workers of varying backgrounds of training are re- 
sponsible for parts of the total health program. Too often there is little 
co-ordination and integration of the findings; hence, the whole child and 
his total needs are not evaluated and met. Consequently, neither preven- 
tion nor early treatment is satisfactorily achieved. 

The establishment of competently staffed local or regional public 
health units responsible for the health care of all the people, including the 
school children, is highly desirable for the proper carrying out of rational 
preventive and early curative services. Health education is a major factor 
in promoting understanding of health needs. In this area the voluntary 
health agencies have given yeoman service. Both the local health depart- 
ment and the school through its day-by-day classroom instruction in, and 
practice of, healthful living need to stress the value and advantage accru- 
ing from good health. 



INGRAM AND SCHUMACHER 311 

PREVENTION OP SENSORY DEFECTS 
Hearing 

Implementation of research findings in the field of hearing alone 
would insure normal hearing for great numbers of children who are now 
victims for lack of study and treatment. Although hearing surveys of 
school children are increasing in number and improving in quality, there 
are many thousands who do not get this service. State legislation, im- 
provement in audiometers, and increasing recognition of the value of the 
otologist's services are some of the factors which are stimulating school 
systems to provide methods for discovering incipient hearing loss and ear 
conditions that may, if untreated, lead to hearing loss. The border-line 
loss discovered by audiometric screening is often the first indication of ear 
trouble. 

Otitis media, one of the commonest aural infections in school-age 
children, often arises from acute throat infections. The sulfonamide 
group of drugs and penicillin are producing dramatic results in the con- 
trol of such infections. Other effective methods consist of surgical removal 
of adenoids and treatment by radium or X-ray of the lymphoid tissue in 
the nasopharynx. Early immunization against diseases known to predis- 
pose to middle ear infections whooping cough, diphtheria, small pox 
and the use of convalescent serum against measles, will do much to pre- 
vent otitis media and its complications. Early diagnosis and prompt 
treatment of cerebrospinal meningitis will diminish the number whose 
auditory nerves are destroyed by toxic neuritis. 

The classification of congenital deafness is not sufficiently defined in 
medical statistics. Hereditary nerve deafness, however, in which there is 
a predisposition for the sense organ of hearing and the auditory nerves to 
degenerate at an early age, has been established. Persons with this dis- 
ability should seek marriage counsel of a physician who is versed in the 
laws of heredity. Other causes of congenital deafness recently discovered 
are German measles (rubella), mumps, and influenza during pregnancy. 
This later discovery should considerably reduce the incidence of deafness 
in children. 20 

Vision 

Public health authorities have long waged a fight to prevent blindness 
due to ophthalmia neonatorum and have succeeded in reducing the num- 
ber of cases due to that cause in schools for the blind 23.6 per cent in the 
past ten years. 21 Research directed toward the prevention of this infec- 
tion by means of safer drugs is under way. 

20 Hallowell Davis, "Medical Aspects of Hearing Loss," Hearing and Deafness, 
pp. 67-100. New York: Murray Hill Books, Inc., 1947. 

81 C. Edith Kerby, "What Causes Blindness in Children?" Sight Saving Review, 
XVIII (Spring, 1948), 21-33. 



312 PREVENTION OF HANDICAPS 

Additional problems which face physicians are (a) the prevention of 
German measles (rubella) in early pregnancy which can cause cataracts 
as well as hearing loss and (6) the prevention of retrolental fibroplasia, 22 
a serious defect appearing in premature infants. Further research in as- 
sembling and studying records of family groups affected by serious heredi- 
tary eye disease is needed. Just as in hereditary deafness, persons from 
such family groups should seek a physicians' counsel on marriage. 

Safety education will insure further the prevention of eye injury. 
Prompt ophthalmological care in case of penetrating injury to an eye 
will tend to avoid development of sympathetic ophthalmia and blindness 
in the uninjured eye. 

ACCIDENT PREVENTION 

Few parents and educators realize that accidents hold the top-ranking 
position in the cause of death and disability in the school years. It is re- 
ported that 90 per cent of all accidents are preventable and that four- 
fifths of all accidents involving children are due to acts of omission or 
commission by adults. 28 While the accidental death rate in the school 
ages has declined sharply since 1930, it shows no such spectacular reduc- 
tion as do the death rates for infectious diseases in childhood and adoles- 
cence. Although there are far more variables in the control of accidents 
than those involved in the control of infection, there is reason to believe 
that public education and precautionary measures can markedly reduce 
accidental deaths and disabilities such as loss of vision or hearing and 
crippling conditions in the school ages. 

In School and Home 

Accident prevention calls for concerted community action, including 
education for parents as well as safety-education programs in the schools. 
First of all, in a mechanized age like the present, safety engineering must 
be employed to eliminate accident hazards in the structural aspects of 
home, school, and public places, including furnishings, and of thorough- 
fares. Second, schools must accept the challenge presented to them. That 
there is awareness of need over the nation is evidenced by state law or regu- 
lation requiring safety education in nearly three-fourths of the states and 
by provision for courses of study and teaching materials in a larger num- 
ber. 24 The subject of accident prevention in the home, at school, on 

22 V. Everett Kinsey and Leona Zacharias, "Retrolental Fibroplasia," Journal of 
the American Medical Association, CXXXIX (February 26, 1949), 572. 

28 Howard A. Rusk, "Accident Prevention Held Real Preventive Medicine," New 
York Times, January 4, 1948. 

24 "The Human Touch in Safety Education," Health Bulletin for Teachers (Metro- 
politan Life Insurance Co.), XIX (September, 1948),23. 



INGRAM AND SCHUMACHER 313 

streets, on highways, in motor vehicles, in recreational activities, and in 
industry is integrated with health and physical education, science, social 
studies, home economics, and vocational training. The introduction of 
driver-education courses to produce better and safer performance is one 
of the most recent additions to the high-school safety program. Some 
schools also include safety education in their adult programs. 26 Third, 
these efforts in the school must be supplemented and supported by the 
parents who, without overprotection, can aid the child in building safety 
attitudes and habits. Theirs is the responsibility to eliminate unnecessary 
physical hazards in the home and to guide the child from preschool years 
on toward independence in safely established routines and toward confi- 
dence in self-care. The serious results from head injuries in young children 
implies the need for parent education and parent responsibility in pre- 
vention. 

Recently emphasis has been given to the psychological aspects of acci- 
dent causation. Psychiatric investigation of accident-prone children and 
adults have in some cases revealed deep-seated emotional conflicts. Chil- 
dren who experience one accident after another will bear study. The acci- 
dent may be the means of escape from accepting certain responsibilities or 
a means of receiving the attention craved but obtained in no other way. 
These findings suggest the need for both parent and teacher to be alert to 
the "accident habit" as a symptom. 28 

Law enforcement is also a necessary ally, for example, in the control of 
age regulations in sale and use of dangerous weapons, of traffic, and of age 
limits for employment of youth in hazardous occupations. The National 
Safety Council has demonstrated a 25 to 40 per cent reduction of acci- 
dent rates over a period of five years in cities "where strong, continuing, 
over-all safety programs" embodying safety engineering, law enforce- 
ment, and education have been conducted. 27 

PREVENTION OF SOCIAL MALADJUSTMENT 

While prevention of disease and accident will significantly aid in the 
reduction of physical handicaps, mental retardation, and certain person- 
ality changes, school administrators and teachers need to be made more 
aware of the factors that are producing serious social maladjustments. In 
this section brief mention will be made of those environmental elements 
that will foster mental health and prevent conduct and personality prob- 
lems. For fuller discussions of personality development, social maladjust- 



., p. 24. 

26 Helen Flanders Dunbar, "Mind and Body: Psychosomatic Medicine," The Ac- 
cident Habit, chap. viii. New York: Random House, 1947. 

27 Rusk, op. cit. 



314 PREVENTION OF HANDICAPS 

ment, guidance, teacher training., and parent education, the reader is re- 
ferred to other chapters of this yearbook. 

The Family and Mental-Hygiene Needs 

That human relations and the feelings and emotions attached thereto 
are of paramount significance in the development of a well-adjusted per- 
sonality and the achievement of mental health has been conclusively 
proved by research. The family setting is, therefore, a prime source in 
the development of a healthy personality. The first essential for mental 
health for all children is security in the parental relationship derived 
from the parents' affection and care of the child. A second essential is the 
parental acceptance of the child for what he is and parental willingness 
for him to grow up according to his own patterns. 

Many children today, however, do not have these needs met. Due to 
the change in the structural form of the family from the kinship group to 
the emphasis on the immediate family, family relations and, in particular, 
parent-child relations are intensified. 28 The child today is more depend- 
ent upon his immediate family for training, care, and affection than was 
the case in the kinship family group. Yet, at the very time when the 
child has a greater reliance upon his immediate family, it is increasingly 
breaking up through separation, desertion, and divorce. 

The change of emphasis from the kinship group makes the family more 
susceptible to advertising, the radio, the cinema, fashion magazines, etc., 
because of the emphasis given to material success and conformity. The 
parents want the child's home and his possessions to be as good as those 
of the neighbors. The child himself is compared with other people's chil- 
dren. The pressure to conform creates the drive to achieve, to get ahead, 
both materially and in social status. But out of this sort of competitive 
pressure grows a sense of uncertainty, of insecurity, and of inferiority for 
both the parents and the child. Failure to achieve affects both parents 
and child and may cause parental rejection rather than acceptance and 
nurture of the child's potentialities. 

The School and Mental-Hygiene Needs 

At school the child enters another social group made up of adults and 
of large numbers of children of different ages. The school is a society 
which has its own program and frame of reference to which the child 
must adjust. The school, however, feels the impact of our changing cul- 
ture, as shown by the growing emphasis on the immediate family, the 
shifting population, parental aspirations for social acceptance and suc- 
cess of their children, and the effects of increasing stimuli due to modern 

28 Margaret Mead, And Keep Your Powder Dry. New York: William Morrow & Co., 
Inc., 1943. 



INGRAM AND SCHUMACHER 315 

methods of communication. Out of all this grows the popular demand for 
school personnel to re-evaluate, change, and improve school programs. 

Certain mental-health needs of the school child briefly stated in terms 
of school-life are (a) the need for success and achievement, (6) the need 
for recognition and approval from others, (c) the need for belonging to a 
group, and (d) the need for adventure and new experience. Certain ele- 
ments in the school setting have their effect on these needs and the emo- 
tional well-being of the child. There is, first, the teacher-pupil relationship 
in which, for example, the child is accepted for what he is and helped to 
experience success or is rejected and made to feel inferior because he does 
not meet the teachers' expectations. 

There are, second, the social and working groups or so-called grades in 
which pupils are organized. Their size as to numbers, their age span and 
interests in respect to the individual, and their goals are significant as an 
aid or deterrent in developing group acceptance and recognition for the 
individual. It is evident that average class size should be reduced if the 
teacher is to have opportunity for fuller understanding and guidance of 
her pupils in group situations. One of the goals of the N.E.A. Victory 
Program 29 adopted in 1948 is stated as follows, ". . . the N.E.A. recom- 
mends that class enrolments should not exceed 25 or 30." 

A third element is the curriculum. Made up of varied experiences 
suited to the physical, mental, social, and emotional maturity of the chil- 
dren, where initiative, creativity, and democracy as well as the mastery of 
necessary skills can have sway or made up of formal subject matter and 
teacher-dominated activities it will have its effect in fostering or inhib- 
iting emotional well-being and security. 

Parent Education and Teacher Training 

Mental-hygiene needs, in home and school, imply an understanding of 
the principles of mental hygiene and of children on the part of youth, 
parents, and teachers. Programs of parent education in colleges and in 
public school systems staffed by professional workers trained in child 
development and nursery-school procedures are needed. High-school 
courses in human relationships, family relationships, mental hygiene, and 
child care should precede the college and parent level. 

Teacher-training institutions have a large role to play in the improve- 
ment of school programs for all children and youth. First, there should be 
selection of students for teacher training on the basis of intelligence, per- 
sonal adjustment, a sympathetic interest in children, and a desire to un- 
derstand them. This selection needs to be followed by continuous per 

"The Victory Action Program," NEA Journal, XXXVII (September, 1948)* 
361. 



316 PREVENTION OF HANDICAPS 

sonnel work during training and cadet experience. Second, the curriculum 
should consist of courses in broad study of our changing American culture 
and realities of life, thorough study of growth characteristics by labora- 
tory methods and experience with children, school health, mental-hygiene 
principles, a survey course of the nature and needs of exceptional children, 
and the formulation of a basic educational philosophy. Such training 
needs to supplant much of the work in traditional subject matter still 
listed in teacher-training courses. It is unbelievable that many states in 
which there is legislative provision for the education of exceptional chil- 
dren have, to date, no program for mental-hygiene courses or survey 
courses in the education of the exceptional child for all administrators 
and teachers. 

In-service training courses in mental hygiene and the understanding of 
children are very much needed and are in progress in many school sys- 
tems. Detroit, for example, reports on a "School Mental-Health Pro- 
ject." 30 A project, jointly planned by representative school people and 
psychiatrists, led to the offering of courses in education for mental health 
for school personnel. The courses are sponsored jointly by the schools, the 
University of Michigan, and Wayne University. 

Child Health and Guidance Services 

Adequate health and child-guidance services from the prenatal period 
through adolescent years will go far toward prevention of social malad- 
justment. Maternal and child-care centers, well-baby clinics, and pri- 
vate pediatric service offer a regular schedule of examination and treat- 
ment. Parent complaints of incipient behavior problems such as temper 
tantrums, breath holding, refusal of food, night terrors, masturbation, 
and so on, as well as abnormal physical conditions should receive prompt 
recognition and treatment. 

Schools should have available the services of well-qualified public 
health nurses and physicians who will give thorough medical examina- 
tions at entrance, at three-year intervals, and at such times as children 
are in need. Screening techniques for vision and hearing should employ 
the most recent equipment and methods to insure detection of early 
signs of deviations in any child. Unrecognized sensory defects can cause 
serious maladjustment. All teachers should be trained to observe children 
and to detect any signs of illness, sensory or motor strain, or unusual be- 
havior. Teacher-nurse-doctor conferences now employed in some school 
systems on individual children provide a setting for the study of behavior 
in relation to mental and physical health. 

80 Paul T. Rankin and John M. Dorsey, "Detroit School Mental-Health Project, 
Progress Report, April 7, 1948." Detroit, Michigan: Board of Education, 1948 (mime- 
ographed). 



INGRAM AND SCHUMACHER 317 

There should be available child-guidance service, staffed by a psycholo- 
gist, a psychiatrist, and one or more visiting teachers who are trained so- 
cial workers. Their function is to discover those conditions, physical, 
psychological, and environmental, that are causing the child's maladjust- 
ment. They aid in interpreting behavior to the end that the school and 
the home may create a more wholesome environment for children. These 
staff members will also discover the child who is not functioning up to his 
ability and who appears mentally retarded due to emotional blocking and 
frustration. 81 Research studies with the use of projective techniques re- 
port findings that suggest that apparent mental retardation may be a 
symptom of deep-seated emotional disturbance. 

Since this whole area of prevention of social and emotional maladjust- 
ment is so broad in its scope, it is timely to follow this necessarily brief 
discussion with mention of the National Mental Health Act and its 
implications. 

The Mental-Health Act 

The Seventy-ninth Congress passed Public Law 487, also known as the 
National Mental-Health Act. It became effective July 3, 1946. 82 Three 
major programs were authorized training, research, and community 
mental-health programs through grants-in-aid to states. Trained per- 
sonnel psychiatrists, clinical psychologists, psychiatric social workers, 
and psychiatric nurses must be increased at least four-fold in order to 
meet the needs of public service alone. It will take many years of training 
to supply this need. Research into the causes, diagnosis, treatment, and 
prevention of mental illness is a pressing problem. Total expenditures for 
fundamental research have never exceeded twenty-five cents for each 
case of mental illness as compared with one dollar per case of poliomyeli- 
tis, a disease much less prevalent and far-reaching in effect. 

Community mental-health programs are essential both to educate the 
public about the facts of mental health and to provide early diagnostic 
and treatment facilities. Most mental clinics today are to be found in the 
larger cities, but even there the staff and time is relatively limited. Each 
community must evaluate its own needs for service. In some communi- 
ties, work in conjunction with the clinics operated by the health depart- 
ment prenatal, well-baby, and pediatric clinics, school health clinics, 
etc. will be the most feasible. In other communities, it may be best to 
establish facilities operating directly under the school system or in the 
juvenile court. In still other communities, the establishment of an all- 

81 Isaac Jolles, "The Diagnostic Implications of Rorschach's Test in Case Studies of 
Mental Defectives," Genetic Psychological Monograph, XXXVI (1947), 80-197. 

82 R. H. Felix, "State Planning for Participation in the National Mental-Health 
Act," Public Health Report, LXII (August 15, 1947), 118&-91. 



318 PREVENTION OF HANDICAPS 

purpose mental-health clinic serving both adults and children would be 
most desirable. It follows, therefore, that each community ought to make 
a complete survey of its mental-hygiene needs and facilities and then 
plan accordingly. Best results will be obtained when health, welfare, and 
educational organizations co-operate in both planning and carrying on 
educational and treatment activities to the limit of their resources, train- 
ing, and experience. 

SUMMARY 

This chapter has considered handicapping conditions, knowledge of 
prevention, and need for preventive treatment to the end that children 
may be saved from disabilities. Legislative provisions for extending spe- 
cial-education programs with specialized services for the handicapped are 
being increased. Training programs to provide personnel for these serv- 
ices are being extended. At the same time, equal attention should be given 
to prevention. Wherever preventive programs in medicine, health, child 
guidance, and education are existent, there will be fewer children in need 
of special education. The national provisions for mental health and rheu- 
matic fever cited are indicative of public support of research and preven- 
tion. 

In summary, attention has been called to the following areas of preven- 
tion: First, there are factors during the prenatal, natal, and postnatal pe- 
riods which, if adequately controlled, diagnosed, and treated, will effect 
prevention of certain physical and mental handicaps. More research is 
needed in this area. Second, there are abnormalities and diseases which 
can be controlled to a greater degree if immunization, medical diagnosis, 
and medical treatment are instituted at the proper stages in the life of the 
mother and of the child. Third, there are sensory defects of eye and ear 
which can be prevented by immunization, screening procedures, medical 
diagnosis, and treatment. Fourth, safety education and concerted com- 
munity action can reduce markedly sensory and orthopedic handicaps re- 
sulting from accidents. Fifth, healthy human relationships in home and 
School which lay the basis for satisfactory social adjustment can be fos- 
tered through parent and teacher training, improved school curriculums, 
and guidance services, including mental-hygiene clinics. 

General medical practitioners, pediatricians, psychiatrists, nurses, so- 
cial workers, psychologists, school administrators, and teachers comprise 
the team of workers in the community whose services should be enlisted 
in programs for better child health and for diminution of handicaps. 
While education alone cannot achieve these goals of prevention, educa- 
tion can be a potent force for their extension. Education at state and local 
levels cannot afford to set up special-education programs without recog- 
nition of the need for prevention and the promotion of provisions for the 
carrying out of preventive measures. 



INGRAM AND SCHUMACHER 319 

REFERENCES 

1. ANDERSON, GAYLORD W. "Epidemiology of Poliomyelitis," Lancet, LXVI (Jan- 
uary, 1947), 10-13. 

2. BEND A, CLEMENS E. Mongolism and Cretinism. New York: Grune & Stratton, 
1946. 

3. DUNBAR, HELEN FLANDERS. The Accident Habit. New York: Random House, 
1947. 

4. FEDERAL SECURITY AGENCY, SOCIAL SECURITY ADMINISTRATION. Proceedings of 
Conference on Rheumatic Fever. Children's Bureau Publication, No. 308. Washing- 
ton: Government Printing Office, 1943. 

5. FELIX, R. H. "State Planning for Participation in the National Mental Health 
Act/' Public Health Report, LXII (August 15, 1947), 1183-91. Washington: Gov- 
ernment Printing Office, 1948. 

6. FORD, FRANK R. Diseases of the Nervous System in Infancy, Childhood, and Adoles- 
cence. Springfield, Illinois: Charles C. Thomas, 1937. 

7. GALVIN, LOUISE FRY. "Preventive and Public Health Aspects of Rheumatic 
Fever in Children," Southern Medical Journal, XXXVI (February, 1943), 116-21. 

8. Hearing and Deafness. Edited by Hallowell Davis. New York: Murray Hill Books 
Inc., 1947. 

9. KERBY, C. EDITH. "What Causes Blindness in Children?" Sight Saving Review, 
XVIII (Spring, 1948), 21-33. 

10. MEAD, MARGARET. And Keep Your Powder Dry. New York: William Morrow & 
Co., Inc., 1943. 

11. PERLSTEIN, M. A. The Problem of Cerebral Palsy Today. Chicago: National Soci- 
ety for Crippled Children and Adults, 1947. 

12. RUSK, HOWARD A. "Accident Prevention Held Real Preventive Medicine," New 
York Times, January 4, 1948. 

13. SCHOLL, MARY LOUISE; WHEELER, WARREN E.; and SNYDER, LAWRENCE H. 
"Rh Antibodies in Mothers of Feeble-minded Children," Journal of Heredity 
XXXVIII (1947), 253-56. 

14. STRAUSS, ALFRED A., and LEHTINEN, LAURA E. Psychopathology and Education of 
the Brain-injured Child. New York: Grune & Stratton, 1947. 

15. SWAN, CHARLES; TOSTEUIN, A. L.; and BLACK, C. H. "Final Observation on Con- 
genital Defects in Infants Following Infectious Diseases during Pregnancy, with 
Special Reference to Rubella," Medical Journal of Australia, II (December 28, 
1946), 889-908. 

16. WHITE HOUSE CONFERENCE OF 1940. Standards of Child Health, Education, and 
Social Welfare. Children's Bureau Publication, No. 287. Washington: Govern- 
ment Printing Office, 1942. 



CHAPTER XVII 

NEEDED PROJECTS AND RESEARCH 
IN SPECIAL EDUCATION 



SAMUEL A. KIRK 

Professor of Special Education 

University of Illinois 

Urbana, Illinois 



INTRODUCTION 

In reading the various chapters of this yearbook, one is impressed by 
the wide range of information that is available on human abilities and 
disabilities. The reader is also impressed by the gaps in our understand- 
ing of the children who differ from normal children in developmental 
traits. What is not known and what is offered only as opinion will be ap- 
parent to the critical reader. 

Special education for exceptional children has existed in some form for 
centuries. The increase in provisions for the handicapped from decade to 
decade in the history of American schools represents the growing interest 
of the public in the care and education of such children. But this public 
interest and support should not lull those who work with exceptional 
children to a feeling that they have arrived at final solutions for the many 
perplexing problems dealt with in the chapters of this yearbook. This 
yearbook will serve its purpose if it can help to stimulate progress through 
new approaches to these problems. This can only be accomplished 
through the initiation of new and different projects and more extended re- 
search in the field. 

As in many other practical disciplines, workers in this field have drawn 
upon the resources of psychology, biology, medicine, sociology, and other 
basic sciences for knowledge and methods that are useful in the care and 
education of atypical children. The research that is available from related 
sciences provided the foundation for the advances that have been made. 
For example, contributions of psychology in the field of mental measure- 
ment facilitated the discovery of the mentally retarded and the gifted 
children enrolled in the schools. Medicine has been basic to the diagnosis 
of the physically handicapped otology for the deaf, ophthalmology for 

320 



KIRK 321 

the blind and the visually defective, orthopedics for the crippled, neurol- 
ogy for the aphasic, epileptic, and other defectives, and psychiatry for 
the emotionally disturbed. The science of acoustics has advanced the field 
of the education of the auditorially handicapped through better audio- 
metric diagnosis and the continuing improvement of hearing aids. In- 
deed, most of the facts which are now being used in the education of ex- 
ceptional children are products of research in these and other basic sci- 
ences. There actually has been little research directed toward the prob- 
lems encountered in the education of exceptional children. Some of the 
reasons for the paucity of research in this area are: 

1. The original work in this field was spearheaded by promoters and 
humanitarians and not by scientists. Funds were made available for serv- 
ices rather than for scientific research, since, in general, parents, teachers, 
welfare agencies, and other lay groups were first interested in providing 
needed services for the exceptional children. 

2. Custodial institutions and special schools established for the care 
and training of exceptional children have not usually been equipped for 
research pertaining to the problems and needs of these children. 

3. Relatively few research foundations direct their efforts toward the 
study of the education of exceptional children. 

4. Universities, where research in many other areas is carried on, have 
been slow to recognize the need for research in the education of excep- 
tional children in general and but few of them even now have a special- 
ized staff to design and organize research projects and to train specialists 
in this field. The only exception that has figured at all prominently in uni- 
versities is speech correction, and much research has been carried on in 
that area. Universities have relied upon the basic sciences to furnish data 
in this field but have not appointed staffs to spearhead the program or to 
draw upon facts from the basic sciences. 

5. Field personnel, such as state or city directors of special education, 
have more than a full-time job carrying on the service functions of their 
departments and have had little time for research activities. 

THE NUMBER AND DISTRIBUTION OF EXCEPTIONAL CHILDREN 
The authors of several chapters of this yearbook have reported esti- 
mates of the percentage of the pupils probably belonging in specified 
classes of exceptional children. Usually the available estimate was ad- 
mittedly based on a partial survey, on teachers' opinions in some commu- 
nity, or on a study of limited scope. In planning programs for exceptional 
children it is necessary to determine the numbers of each group of excep- 
tional children with some degree of accuracy. School superintendents and 
state legislators have sought such information for consideration in finan- 



322 NEEDED PROJECTS AND RESEARCH 

cial and administrative planning. It has often been difficult to secure in- 
formation because of the inadequacy of studies of the distribution of ex- 
ceptional children in the school population. 

The difficulty with most surveys is that they are not made from the 
point of view of the educational program and facilities to be provided. In 
the field of mental retardation, for example, the estimates vary from .5 
per cent to 10 or 15 per cent. The criteria and tests used sometimes deter- 
mine the percentage of children with low intelligence. The school adminis- 
trator is interested in ascertaining the number of individuals in a popula- 
tion who are custodial or uneducable cases, since these will not be in- 
cluded in the special-education program of the local school system. But 
he must also know how many can profit most from special-class placement 
and how many should have some sort of a differential curriculum in the 
regular classrooms. With reference to the acoustically handicapped, the 
estimates vary according to the conception of different investigators con- 
cerning the degree of physical defect that calls for a particular kind of 
training program. The school administrator needs to know how acousti- 
cally handicapped children are distributed among the different groups: 
those whose hearing loss is so great that they have been unable to develop 
adequate speech and language skills and who require special-class or spe- 
cial-school placement; those whose needs can be met with hearing aids; 
those who require only speech and auditory training; and those who can 
be cared for by reseating them in the classroom. 

An adequate survey in 'one community, although of some value to 
other communities, would not actually be an accurate index of the situa- 
tion for all communities. One community may have more mentally defi- 
cient children than others. Another community, due to an epidemic of 
meningitis, may have more cases with hearing or vision handicaps than 
another. An epidemic of poliomyelitis may leave an abnormal percentage 
of crippled children in the community affected. 

ORGANIZATIONAL AND ADMINISTRATIVE PROBLEMS 
There have been few research studies on the organizational and admin- 
istrative problems of the school in dealing with exceptional children. Usu- 
ally the administrative plan used is one which does not require any major 
changes in the existing organization of the school system. That is, when 
such classes or special services are introduced into a school system, they 
are made to fit the existing organization. There are many difficulties in- 
volved in organizing special-education programs, and sometimes expedi- 
ency overrides principles. Lay organizations have frequently sponsored 
the introduction of special programs for exceptional children in city 
school systems. The manner in which these programs were originally or- 



KIRK 323 

ganized and administered was not always guided by experimentation or 
by the experience of other school systems. 1 

Some of the projects and research problems which could be carried 
out in this area may be stated as follows: 

1. The question of the desirability of educating exceptional children in 
the regular-grade rooms or in special classes, semispecial classes, or special 
schools needs investigation. This has been a subject of controversy for 
many years, but, to date, very little evidence exists for any point of view. 
Arguments have been based upon evidence from individual cases for 
which one organizational procedure has proved beneficial or some cases 
for which the organization has been detrimental. Research is needed in 
this area to determine the types and degrees of handicaps for which the 
special school, special class, semispecial class, or regular-grade program is 
most beneficial. In addition to experiments involving control groups, 
longitudinal studies would provide useful information on this problem. 

2. Special education has been undertaken chiefly in large cities. No one 
has yet devised an acceptable program for exceptional children in rural 
areas. The stimulation of widespread efforts in small towns and rural 
areas still awaits the demonstration of an effective program for such 
schools. 

3. Financing special-education programs is being done in different ways 
in different states. The most efficient form of state aid is yet to be deter- 
mined. Considerable study is still required to determine whether the 
"excess-cost principle" is the best basis for the distribution of state aid. 
No studies have been made to determine the relative advantage of using 
the child, the class, or the teacher as the unit of measure of a district's 
share of the state subsidy for special-education programs. 

4. There have been relatively few studies dealing with the social psy- 
chology of children to determine how normal children can learn to ac- 
cept atypical children. Moreover, there is not a clear understanding of the 
real attitudes of adults toward the handicapped children in their homes 
or in the community. Attitudes of sentimentality, of pity, and of rejection 
have not been adequately studied. Although there has been a great deal of 
publicity since the war regarding opportunities for employment of the 
handicapped, we have few studies on the attitudes of other workers and of 

1 For recent reviews of viewpoints on administration see John S. Haitema, "Ad- 
ministrative Research Necessary for Special Education," Journal of Educational Re- 
search, LX (April, 1947), 628-37; Charles Scott Berry, "General Problems of Philoso- 
phy and Administration in the Education of Exceptional Children," Review of Educa- 
tional Research, XI (June, 1941), 253-60; Arch O. Heck, "General Problems in Philos- 
ophy and Administration in the Education of Exceptional Children," Review of Edu- 
cational Research, XIV (June, 1944), 201-8; and Harry J. Baker, "Administration of 
Special Education," Review of Educational Research, XIV (June, 1944), 209-16. 



324 NEEDED PROJECTS AND RESEARCH 

the employers toward handicapped persons with whom they are associ- 
ated in their regular work. 

5. The optimum class size has not yet been determined for the instruc- 
tion of exceptional children. How many children should the administrator 
assign to a teacher of the deaf? to a teacher of the mentally handicapped? 
to a teacher of speech correction? It is also important that we know the 
case load that can effectively be carried by a social worker, a psycholo- 
gist, and a remedial teacher. 

DIAGNOSIS 

There has probably been more adequate research in the field of diagno- 
sis than in any other field, some of the basic sciences having made notable 
contributions to this phase of the study of exceptional children. The medi- 
cal profession has devoted much time to diagnostic and therapeutic meth- 
ods for physically handicapped children. Otologists have contributed to 
the diagnosis of hearing defects and to the treatment and prevention of 
impaired hearing. Ophthalmologists have made like contributions to the 
solution of educational problems resulting from defective vision. Psycho- 
logists are continually refining their instruments of mental measurement 
and devising diagnostic procedures which are useful in the study of per- 
sonality. Projective methods of diagnosis are, at the present time, devel- 
oping as rapidly as were the instruments of mental measurement some 
thirty years ago. 

1. The field of diagnosis as related to and affecting educational proce- 
dures is still in its infancy. We can measure the intellectual level of the 
child, but we are still searching for the means of securing an adequate 
differential diagnosis. Not all mentally retarded children whose intelli- 
gence quotients are below 70 are alike. Not all can profit by the same edu- 
cational procedures. Research in this field will attempt to determine ma- 
jor qualitative differences in children and will devise specific educational 
procedures to fit each child's qualitative abilities or disabilities. Such an 
attempt was made by Strauss and Lehtinen 2 in adapting special educa- 
tional procedures to children with brain damage. 

2. There is great need for more accurate diagnosis of various kinds of 
exceptional children. For example we know very little about the mental 
functioning of the different types of cerebral-palsied children. To educate 
them all by the same procedures would indicate a lack of knowledge of the 
differential effects of cerebral palsy among the different individuals whose 
handicaps are attributed to these effects. 

3. Why some deaf children learn to speak while others do not is a ques- 
tion for diagnosis and research. Why some children incidentally pick up 

1 Alfred A. Strauss and Laura E. Lehtinen, Psychopathology and Education of the 
Brain-injured Child, p. 206. New York: Grune & Stratton, 1947. 



KIRK 325 

lip-reading while others seem unable to acquire this skill is another prob- 
lem which is puzzling to research workers and teachers. 

4. We know that gifted children in general are superior to average chil- 
dren in the performance of school work, but we have not studied exten- 
sively their modes of learning and generalization. Our educational system 
will not be able to determine the most effective techniques of instruction 
until we are able to make these differential diagnoses and adapt instruc- 
tion to the special abilities of different kinds of gifted children. 

5. Many forms of psychotherapy and many forms of environmental 
manipulation are being suggested for socially maladjusted children. The 
reason for the divergence of opinion in this field is that we are unable to 
make diagnoses on the basis of established principles of group dynamics. 
The vagueness and differences in treatment methods cannot be remedied 
without substantial progress in the study of this aspect of human experi- 
ence. 

PROJECTS AND RESEARCH IN THE SPECIFIC AREAS 

There are many common problems for all groups of exceptional chil- 
dren. For the purpose of clarity, however, and in spite of possible repeti- 
tion, it may be well to consider separately the projects and research 
needed for specific groups of exceptional children. The problems will be 
stated as briefly as possible because of the lack of space for further discus- 
sion of them. Experimental designs necessary for solution of these prob- 
lems must be left to the individual research workers. 

The Visually Handicapped 

Some of the pertinent research problems relating to visually handi- 
capped children may be stated as follows: 3 

1. There is still some doubt concerning the most adequate visual- 
screening procedures which can be made for all school children in a public 
school system. What is needed is a quick and efficient method that can be 
used by classroom teachers for detecting children with visual defects so 
that they can be referred to ophthalmologists. 

2. Research is needed in the area of auditory aids for visually defective 
children, both partially seeing and blind. With new wire and tape record- 
ers and advances in radio and in ease of transcribing programs, research is 
needed to determine the most effective means of using these aids in the 
education of visually defective children. 



8 For a review of the literature on research see Berthold Lowenfeld, "Research in 
the Education of the Blind," Journal of Educational Research, LX (April, 1947), 583- 
91; Henrietta Kornitzer, "Problems for Research in the Education of Partially Seeing 
Children," Journal of Educational Research, LX (April, 1947), 592-97; and Christine 
P. Ingram, "The Visually Handicapped, the Delicate, and the Crippled/' Review of 
Educational Research, XI (June, 1941), 315-29. 



326 NEEDED PROJECTS AND RESEARCH 

3. Very little research in the field of personality and personality ad- 
justment is available in relation to the visually handicapped. The de- 
termination of the effects of poor sight or blindness on personality ad- 
justment has not yet been achieved. The values of psychotherapy or of 
different methods of counseling and guidance with the visually defective 
are still to be demonstrated. A study of this aspect of the education of 
the blind and partially seeing is greatly needed. 

4. There has been a tendency on the part of teachers and supervisors of 
sight-saving classes to exclude from classes children whose intelligence 
quotients are below 70. Since it is believed that these children, because of 
a double handicap, are uneducable, projects in research to determine the 
most desirable provisions for this group are necessary. It is possible that 
an exaggeration of auditory aids for this group, rather than an attempt to 
instruct them by means of specially prepared visual materials, might pro- 
duce results which would aid them in becoming partially or wholly self- 
supporting citizens. 

5. A comparison of blind children educated in day schools and blind 
children educated in custodial institutions has not yet been made, due to 
the scarcity of day-school classes for the blind. Similarly a comparison of 
the progress of children in sight-saving classes with the progress of par- 
tially-seeing children now in residential institutions is also needed. It is 
necessary that we determine the comparative effects of both types of edu- 
cation in order to adequately organize services for these children on a sci- 
entific basis. Some residential schools for the blind send their promising 
high-school students to regular day schools. Some states, such as Oregon, 4 
have developed a program which integrates the residential school with 
the public schools by keeping children in their community schools under 
supervision. 

6. Continued research on instructional procedures and materials is also 
necessary for partially seeing children. The size of type, the degree of il- 
lumination necessary in the classroom, cheaper processes of reproduction 
of clear-type materials to make them more available are also needed for 
the instruction of partially seeing children. 

7. The measurement of intellectual and educational ability has been 
done for both the partially seeing and blind children. The adaptation of 
the Binet-type test by Samuel P. Hayes has served a purpose. It is impor- 
tant, however, that we construct tests specifically designed for the blind 
and the partially seeing and compare the results with scores of normal 
children to determine whether the sensory defect produces compensa- 
tions in other areas in mental and educational fields. Lowenfeld says 
"the need for better motor skills tests and for better measures of general 

'Berthold Lowenfeld, "The Oregon Plan," Outlook for the Blind, XL (March, 1946). 



KIRK 327 

mental ability and of emotional and personal adjustment is empha- 



8. There is considerable emphasis on preschool and parent education of 
blind children. It is assumed that the lack of sight causes retardation in 
sensory functions and their co-ordination and in the growth of behavior 
patterns such as postural control, locomotion, language, and socializa- 
tion. It would be important for educational programs to determine in 
which ways blindness retards development. 

9. Lowenfeld 6 has pointed out that physical activity on the part of the 
blind consists of mental orientation and physical locomotion. Research 
should be directed toward determining how obstacle perception can be 
taught. Although existing research has shown that aural stimulation is re- 
sponsible for obstacle perception, more research and experimentation are 
needed on the development of mental orientation. 

The Auditorially Handicapped 

There has been considerable research on the education of deaf and 
hard-of-hearing children as reviewed in chapter ix. Some of the important 
projects and research that are still needed in this field are: 

1. There is considerable emphasis on the education of the preschool 
deaf or hard-of-hearing child. The hypothesis behind this emphasis is 
that, since speech develops at the age of two or three with normal-hearing 
children, it is probably advantageous to begin speech training and lip 
reading and the other forms of communication with deaf children at this 
age level. To wait until a child reaches school at the age of six may be too 
late since at that time he will have developed substitute forms of com- 
munication. Research in this area is badly needed to determine not only 
whether this is possible but whether residual hearing can be utilized with 
modern amplification to aid in the development of speech and language. 
An evaluation of the effects of preschool training on language and speech 
development, using as controls those who did not have the opportunity 
for such training, would be a significant research project. 

2. To determine whether preschool training with amplification in- 
creases the sensory acuity of the children or the auditory perceptional 
process has been delayed because of the lack of accurate audiometric de- 
termination at the lower age levels. The construction of a more accurate 
preschool audiometric test through the use of the psychogalvanic skin re- 
flex, electroencephalograph, or other devices would be a fruitful area of 
research. 



6 Ibid., p. 589. 

8 Berthold Lowenfeld, "Effects of Blindness on the Cognitive Functions of Chil- 
dren," Nervous Child, VII (January, 1948), 49-50. 



328 NEEDED PROJECTS AND RESEARCH 

3. Methods of diagnosis of mental abilities of deaf children would assist 
workers in adapting educational procedures to the needs of these children. 
Although some general mental tests have been developed, tests for differ- 
ential diagnosis of children who can or cannot learn speech, speech read- 
ing, and language are necessary for the proper planning of instructional 
programs for these children. 

4. Controversy over the relative advantages of day-school education 
and residential-school education is one that requires more adequate re- 
search than has yet been produced. Entrenched interest in this field has 
retarded accurate and objective studies. With refined methods of audio- 
metric determinations, better mental measurement, better means of edu- 
cational evaluation, and better means of social, vocational, and personal- 
ity evaluation, it is now possible to compare results of day-school and 
residential-school methods. In addition, there may be some children for 
whom residential instruction is preferable, whereas others may be more 
effectively educated in day schools. It is necessary, therefore, to deter- 
mine those characteristics requiring differences in education. It is possible 
also that some can profit most from manual instruction while others can 
profit most from speech instruction. Unless we have better methods of di- 
agnosis and more accurate methods of evaluating educational procedures, 
this problem will remain in the area of opinion and prejudice. 

5. Research on hearing aids should be supplemented with refined meth- 
ods and controlled experiments in auditory training. Although auditory 
training has been attempted for some time with the severely hard-of- 
hearing and slightly hard-of-hearing who have been using hearing aids, 
this field still offers excellent opportunities for research and experimenta- 
tion from an educational point of view. 

6. New methods and experimentation in language development, 
speech development, and reading development should be emphasized. At 
the present time the methods which have been evolved have been con- 
structed by good teachers in the field but have not been adequately anal- 
yzed and evaluated. A contribution to the education of the deaf and the 
serverly hard-of-hearing will require an extensive evaluation of these 
methods of communication. 

7. Research among the adult deaf is needed to determine the social and 
vocational adjustment of these individuals. Whether they are to be asso- 
ciated mainly with other deaf individuals or with hearing people has 
been left to chance. Research in this field should be directed toward the 
determination of the kinds and types of education that should be estab- 
lished for children in order to insure the best social and vocational adjust- 
ment of deaf individuals. 7 



7 For a review of research in this field, see Wendell Johnson and Warren H. Gard- 
ner, "The Auditorially and Speech Handicapped," Review of Educational Research, 



KIRK 329 

Speech Re-education 

Chapter x of this yearbook gives a concise statement of the problems of 
speech-handicapped children and of appropriate plans for their educa- 
tion. Speech correction has been the object of more scientific research 
than is characteristic of other procedures employed in the educa- 
tion of exceptional children. This fact not only emphasizes the impor- 
tance of speech but also indicates that research interests of universities 
and other agencies have been more concerned with the problems of speech 
improvement than with other types of handicaps that impede the educa- 
tional progress of children and youth. The frequency of speech disorders 
is greater than that of most other handicaps. Some of the educational 
problems presented by speech disorders consist of: 

1. In what way should a superintendent utilize the services of a speech 
correctionist? Should he use the speech correctionist as an itinerant 
teacher? Should he establish a center for children with major speech de- 
fects? Should the speech correctionist devote full time to assisting teach- 
ers to improve speech in their classrooms? Research on the problems of 
organizational procedure would be of great value to school systems. 

2. What kinds of speech defects in a school system can teachers handle 
in a classroom situation? Controlled experimentation on the improve- 
ment of certain kinds of speech defects in a classroom situation by the 
classroom teacher under the supervision of a speech correctionist, as com- 
pared to correction of defects by speech correctionists alone, would throw 
some light on this problem. 

3. Studies on the effect of psychotherapy on psychogenic speech defects 
such as stuttering are at the present time worthy of emphasis. Con- 
trolled experimentation on this problem is needed. 

4. Studies on the effects of speech correction in groups versus speech 
correction given individually should also be conducted. 

5. The most effective frequency of speech-correction lessons has not 
yet been determined. Is it more efficacious for a child to receive speech 
correction every day for six or eight weeks or once or twice a week for a 
longer period of time? Answers to such questions can be given only on the 
basis of careful experimentation. 

The Physically Handicapped 

The physically handicapped cases here referred to are exclusive of the 
deaf and hard-of-hearing and the visually handicapped, which have al- 
ready been considered. 



XIV (June, 1944), 241-63; Christine P. Ingram and Rudolph Pintner, "The Auditori- 
ally and Speech Handicapped/' Review of Educational Research, XI (June, 1941), 
297-305; and Helmer R. Myklebust, "Research in the Education and Psychology of 
the Deaf and Hard-of -Hearing, "Journal of Educational Research, LX (April, 1947), 
598-607. 



330 NEEDED PROJECTS AND RESEARCH 

Although a great deal of research has been done on the medical and 
physical aspects of crippling conditions, one is impressed by the scarcity 
of research reports dealing with the education of these children. There is 
much less research on problems of social adjustment, educational organi- 
zation and administration, and special methods and techniques as applied 
to the education of physically handicapped children. 

Among the important research projects needed in relation to the edu- 
cation of crippled children are the following: 

1. No one has yet studied the personality development of crippled chil- 
dren in schools where special programs and facilities are provided for 
crippled children as compared to similar children in smaller communities 
where they are enrolled in the regular classrooms because of the lack of 
special classes. Some believe that crippled children should be taught in 
the regular grades if at all possible. Since the advantages of this procedure 
cannot be substantiated by present knowledge, carefully designed experi- 
ments along this line should be conducted to determine the relative value 
of different procedures on the social-adjustment patterns of such children. 

2. In many cases methods and techniques of education have been 
adapted to the physical abilities of the child in a classroom. It is possible 
that different kinds of cerebral-palsied children may react to learning ex- 
periences differently, yet there is very little differentiation in educational 
procedures employed with the athetoid, the ataxic, and the spastic. Quali- 
tative analyses of mental abilities of these brain-injured children may 
give us some leads concerning more adequate educational procedures. 

3. The social adaptability of the physically handicapped and the effect 
of handicapping conditions on vocational adjustment have engaged the 
attention of some research workers. Because of the complexity of this 
problem and the numerous variables involved, more research will be 
needed in this area before we are able to define more clearly the educa- 
tional and vocational guidance programs for the handicapped. A sum- 
mary of the studies in this field has been made by Barker and others. 8 

4. Psychological tests for the cerebral-palsied have not yet been de- 
vised. Adaptations of other intelligence tests are frequently used. A re- 
search program keyed to an evaluation of mental abilities of cerebral- 
palsied children would be of great value in determining their potentiali- 
ties. At present, their educability is appraised on the basis of the opinion 
of clinicians and other specialists in the field. 

5. Tests of the motor proficiency of crippled children have not yet been 



8 Roger G. Barker, Beatrice A. Wright, Mollie R. Gonick, "Adjustment to Physi- 
cal Handicap and Illness," A Survey of the Social Psychology of Physique and Disability. 
Social Science Research Council Bulletin 55. New York: Social Science Research 
Council, 1946. 



KIRK 331 

devised. Research workers have concentrated on motor tests for normal 
adolescents and adults. At present there are no tests that utilize the more 
fundamental physiological determinants in evaluating the motor-profi- 
ciency level of crippled children such as has been attempted by Oseret- 
sky 9 in studies of other children. 

6. The determinants of personality structure may, in part, be the result 
of limitations imposed by physical handicap. Studies in this area are rare 
and sporadic. Thorough case histories of physically handicapped individ- 
uals and the use of projective techniques with a large number of such in- 
dividuals may assist in determining the effects of various forms of physi- 
cal handicaps on personality development and personality structure. 
With the exception. of descriptions based on experience with individual 
cases, for example, we do not know the differences or similarities in per- 
sonality among cases of the grand mal, petit mal, and psychomotor forms 
of epilepsy. We do not know, with any degree of assurance, the differences 
in personality and emotional reactions of the athetoid, the spastic, or the 
ataxic forms of cerebral palsy. 

The Mentally Retarded 

The field of mental deficiency or mental retardation has been studied 
by sociologists, physicians, endocrinologists, psychologists, psychiatrists, 
and educators. There is a vast literature in this field, especially in physi- 
cal, social, and mental diagnosis. Some of the areas that need further in- 
vestigation are the following: 

1. It would be desirable to study the effects of maximum educational 
opportunities at the preschool age on the social and mental development 
of mentally handicapped children. These children are usually offered spe- 
cial educational facilities only after they have failed in school. Such an ex- 
periment would be, by its nature, a long-time study, directed toward the 
investigation of the educational factors affecting social, emotional, and 
mental growth of young children with low intelligence. 

2. A study of the most efficient means of educating the adolescent 
mental-defective for social and vocational adjustment is a much-needed 
project. The existing programs in this field are of a patchwork nature, 
with little follow-up on the effects of such efforts. What is needed is ex- 
perimentation with several types of instructional programs with follow- 
up studies to determine the results of the various plans. 

3. The level of aspiration of the mentally handicapped and the means 
of educating these children to adapt their aspirations to their abilities 
present another major problem worthy of investigation. Educational pro- 



9 The Oseretsky Tests of Motor Proficiency. Edited by Edgar A. Doll. Minneapolis, 
Minnesota: Educational Test Bureau, 1946. 



332 NEEDED PROJECTS AND RESEARCH 

eedures for such children are partly contingent upon their purposeful 
interest. 

4. There is much discussion about the potentialities of children whose 
school work continues at a low educational level and whose ratings on in- 
telligence quotients are low even though it is suspected that they are nor- 
mal in intelligence. It is assumed that in some cases the low performance 
on intelligence tests is a result of emotional factors. There is urgent need 
for an extensive study of the effects of play-therapy and other forms of 
psychotherapy on selected groups of children who are classified as men- 
tally handicapped to determine the effects of such treatment on intellec- 
tual and educational performance. 

5. Since many brain-injured children are classified as mentally handi- 
capped, further research is needed to determine the characteristics of 
such children and the value of selected educational techniques in promot- 
ing their progress in school. 

6. The effects of retaining mentally handicapped children in the regu- 
lar grades should also be studied by some sort of sociometric technique. 
Are these children accepted by the social group of normal children? How 
do other children react to them in the classroom? What behavior charac- 
teristics appear to affect acceptance of them by other children? 

Gifted Children 

The studies on children with superior intelligence are extensive in the 
area of the measurement of mental, physical, and social characteristics. 
There are practically no studies on the effects of different educational 
procedures. With the exception of the study by Sumption, reported in 
chapter xiv, we are still in the stage of opinion with respect to such prob- 
lems as acceleration, special classes, enrichment of curriculum, or some 
combination of these procedures. Some of the research projects necessary 
for the advancement of knowledge in this field are as follows: 

1. If the regular classroom activities are not suitable for gifted children, 
what are the reasons for the failure to meet the needs of these children? 
Before we enrich the program or change the program for them in the regu- 
lar grades, we must first determine wherein the present program is not 
adequate. There is considerable speculation on this problem but no accu- 
rate data upon which to base decisions. The oft-repeated phrase, "our 
schools neglect gifted children/' should be substantiated by adequate re- 
search which will also determine the kind and extent of the neglect. 

2. Gifted children are quantitatively superior to average children in 
practically all mental performances. One of the questions that has been 
raised is whether there are some qualitative differences between the 
gifted and the normal, or among different groups of gifted children. Do 



KIRK 333 

they have something different in kind or just more of the same thing? Re- 
search on this problem would help to determine a satisfactory organiza- 
tion of educational procedures for these children. 

3. How does a gifted child learn from an ordinary textbook in a regular 
grade? How fast can he learn the materials presented? How long would it 
take him to cover the same material by short-cut methods? These are 
some of the questions that should be answered through research. 

4. A study of gifted children who are not making adequate progress in 
the regular school may reveal the factors which retard progress. Unfor- 
tunately, many of these children are not known to be gifted because their 
academic achievement is not superior to other children. 

The Socially Maladjusted 

The research previously discussed is, in a sense, research on the so- 
cially maladjusted, since the program for the education or rehabilitation 
of all types of exceptional children is an attempt to prevent social malad- 
justments in children who deviate physically, mentally, or emotionally. 
Studies in this area are numerous. 10 Controlled studies on diagnosis and 
treatment of maladjustment are rare, but the literature in the field ex- 
tends into all areas of the study of human behavior. Psychiatry, clinical 
psychology, and social work have developed extensive bodies of literature 
in the field. Some research problems which require further investigation 
are: 

1. Delinquent children have been committed to institutions as a last re- 
sort. As a consequence, the custodial institutions have been organized for 
children who have already committed numerous or serious delinquencies. 
What would be the effect of early institutional care of these children as 
compared to later treatment? Since many delinquent children come from 
relatively unwholesome environments, the removal of potential delin- 
quents from such environments before delinquent-personality patterns 
become firmly established might prove to be the most effective program. 
Such investigations require controlled studies which are expensive and 
difficult to administer. 

2. A study of the effect of different forms of school treatment in the 
area of prevention or correction of delinquent behavior would be a 
worthy project. Are special classes for the socially maladjusted in public 
school systems beneficial or detrimental? Can the school counselor or the 
school social worker do as well or better than the results achieved by spe- 



10 See J. Harold Williams, "The Socially Maladjusted," Review of Educational Re- 
search, XI (June, 1941) and XIV (June, 1944); also, Juvenile Delinquency and the 
Schools (Forty-seventh Yearbook of the National Society for the Study of Education, 
Part I. Chicago: University of Chicago Press, 1948). 



334 NEEDED PROJECTS AND RESEARCH 

cial classes? Such studies would help the schools determine the most effec- 
tive organization for the rehabilitation or prevention of social maladjust- 
ment in children. 

3. Psychotherapy with socially maladjusted children is a costly pro- 
gram. Before school boards and the public will pay for such expensive 
service, someone must, through adequate research procedures, demon- 
strate the efficacy of psychotherapy in the correction of social maladjust- 
ments in children. 

4. A common practice today in many communities is to establish com- 
munity councils for the improvement of the community and for the pre- 
vention of delinquency. Studies in the social psychology of such councils 
and the effects of such organization on the prevention and treatment of 
socially inadequate children are needed. 

CONCLUDING STATEMENT 

Research results now available which serve as guides to the education 
of exceptional children have been primarily by-products of research in the 
basic sciences of medicine, biology, psychology, sociology, and related 
disciplines. There have been few extended research studies on the admini- 
strative and educational procedures for the various groups of exceptional 
children. 

This chapter has attempted to suggest some of the research studies 
that are needed to improve educational procedures for children who are 
handicapped or gifted. Further effort in the direction of utilizing facts 
discovered in related sciences should be made. In addition, educational 
research on the problems of these children should be made the object of 
concentrated efforts on the part of workers in this area. The professional 
staffs find themselves overwhelmed with the service functions of pro- 
grams developed for the benefit of exceptional children. Since there are so 
few specialists in the field, and since there will always be a great deal of 
service to render, it is important that educational institutions and state 
departments of education accept increased responsibility for stimulating 
types of research which will insure the progress that is expected of the 
schools in meeting the extraordinary needs of different classes of excep- 
tional children. 



APPENDIX 1 

AGENCIES AND ASSOCIATIONS 

GENERAL 
FEDERAL SECURITY AGENCY, CHILDREN'S BUREAU 

Division of Health Services 

Federal Security Building 

Washington 25, D.C. 

Purpose: To administer federal aspects of joint federal-state programs of 

crippled children's services. 
FEDERAL SECURITY AGENCY, OFFICE OF VOCATIONAL REHABILITATION 

Federal Security Building 

Washington 25, D.C. 

Purpose: To administer federal aspects of joint federal-state programs of 

vocational rehabilitation of disabled persons. 

GOODWILL INDUSTRIES OF AMERICA, INC. 
744 North Fourth Street 
Milwaukee 3, Wisconsin 

Purpose and activities: To encourage the establishment and development, in 
various centers, of Goodwill Industries for the religious, cultural, educational, 
social, industrial, and economic welfare of the handicapped. It conducts re- 
search in the interest of providing increased service for the handicapped and 
of increasing the usefulness of discarded materials. 

INTERNATIONAL COUNCIL FOR EXCEPTIONAL CHILDREN 
Office of Treasurer 
Saranac, Michigan 

Activities: The Council is an international organization which has as its 
purpose the promotion of the education and welfare of exceptional children 
the handicapped and the gifted. 

NATIONAL HEALTH COUNCIL 
1790 Broadway 
New York 19, New York 

Purpose and activities: To co-ordinate the activities of its member organiza- 
tions; to carry on joint projects in the field of public health, such as program 
on the prevention of congenital syphilis. 

NATIONAL REHABILITATION ASSOCIATION, INC. 
900 Bauch Building 
Lansing, Michigan 



1 The committee is indebted to Miss Jane Bull, Executive Director, Illinois Com- 
mission for Handicapped Children, Chicago, Illinois, for the preparation of the ma- 
terials here presented regarding agencies and publications dealing with exceptional 
children. 

335 



336 APPENDIX 

Purpose and activities: Vocational rehabilitation is a service administered 
jointly by state and federal governments to restore and conserve to the 
fullest possible extent the working usefulness of the handicapped. This service 
is comparable to public education, public health, and other activities for the 
welfare of the people. Employment is always the final goal of vocational re- 
habilitation. 

NATIONAL SOCIETY FOK CRIPPLED CHILDREN AND ADULTS, INC. 
11 South La Salle Street 
Chicago 3, Illinois. 

Purpose and activities: To organize and develop state societies for the welfare 
of crippled children and the physically handicapped; to establish necessary 
state and federal legislation for the care, education, and rehabilitation of the 
physically handicapped; to co-ordinate the program in all its phases for the 
best interests of the physically handicapped. A cerebral-palsy service was es- 
tablished in 1946 for the purpose of organizing and developing a nation-wide 
program of assistance for spastics. 

SHUT-IN SOCIETY, INC. 
221 Lexington Avenue 
New York 16, New York 

Purpose and activities: To give cheer and comfort to chronic invalids, crip- 
ples, and the blind who are members of the society. Correspondents are 
supplied who act as friends and advisers as to health, ways to earn, hobbies, 
etc. Shut-ins are also provided with sickroom supplies and materials for handi- 
work. 

VISUALLY HANDICAPPED 

AMERICAN ASSOCIATION OP INSTRUCTORS OF THE BLIND 
Overbrook School for the Blind 
Sixty-fourth Street and Malvera Avenue 
Overbrook, Pennsylvania 

Purpose: To provide a means for consultation concerning problems relating 
to the education of the blind and to foster and promote movements having 
as their aim the improvement of such education. 

AMERICAN ASSOCIATION OF WORKERS FOR THE BLIND 
Winnetka, Illinois 

Purpose and activities: To consider and promote the education, employment, 
advancement, and general welfare of the blind of North America and the 
American dependencies through such measures and agencies as may be 
deemed best adapted to their needs. 

AMERICAN FOUNDATION FOR THE BLIND, INC. 
15 West Sixteenth Street 
New York 11, New York 

Activities: The Foundation is an organization for the promotion of those inter- 
ests of the blind which cannot be advantageously handled by local agencies. 
Its activities include the following: research in education, statistics, legisla- 



APPENDIX 337 

tion, mechanical appliances, and publishing methods for the blind; assistance 
to state and community agencies in the organization of their activities and in 
the promotion of legislation; special departments for service to the deaf- 
blind; special services to blind individuals; scholarships for a limited number 
of promising students; and a special lending and reference library. 

AMERICAN PRINTING HOUSE FOR THE BLIND 
1839 Frankfort Avenue 
Louisville 6, Kentucky 

Purpose and activities: To provide literature and appliances for the blind 
on a nonprofit basis. Embossed books, talking-book records, and tangible 
apparatus for educational purposes are provided through a federal appropria- 
tion and are distributed on a per-capita basis to all the free educational in- 
stitutions for the blind throughout the United States and its territories. 
Periodicals and books are manufactured at cost for organizations which pro- 
vide free literature for the blind. 

BRAILLE INSTITUTE OF AMERICA, INC. 
741 North Vermont Avenue 
Los Angeles 27, California 

Activities: These include consultation by correspondence and personal 
interviews; home instruction in the use of Braille and Moon type, and in handi- 
crafts and homemaking; invention of appliances, such as a portable Braille- 
writer; and experimental work in the field of electronics. The Institute prints 
and publishes books and periodicals in Braille and Moon embossed types on 
a nonprofit basis, including a student dictionary. The Institute sells to the 
blind at cost, or donates appliances, games, and supplies. It maintains one 
of the twenty-six regional free lending libraries of the Library of Congress. 

NATIONAL COUNCIL OF STATE AGENCIES FOR THE BLIND 
1060 Broad Street 
Newark 2, New Jersey 

Purpose: To make possible an interchange of views on professional standards, 
policies, and administrative matters affecting agencies with state-supported 
and state-wide programs of services for the blind; and to furnish a medium 
for such agencies to co-ordinate their points of view with reference to federal 
legislation and other common problems. 

NATIONAL INDUSTRIES FOR THE BLIND 
14 West Sixteenth Street 
New York 11, New York 

Purpose: To standardize and promote the sale of blind-made products on a 
nonprofit basis and to act as the allocating agency for orders for blind-made 
products received from the federal government. 

NATIONAL SOCIETY FOR THE PREVENTION OF BLINDNESS, INC. 
1790 Broadway 
New York 19, New York 

Purpose and activities: To study causes of. blindness or impaired vision, to 
advocate measures leading to the elimination of such causes, to serve as a 



338 APPENDIX 

clearinghouse and stimulating agent for professional groups directly or 
indirectly responsible for saving sight, and to disseminate to the public in- 
formation about eye care and protection. The Society assists health, welfare, 
education, safety, and other related agencies to incorporate appropriate con- 
servation-of -vision activities into their major programs. 

ACOUSTICALLY HANDICAPPED 
AMERICAN HEARING SOCIETY 
1537 Thirty-fifth Street, N.W. 
Washington 7, D.C. 

Purpose and activities: The Society is devoted to the cause of better hearing. 
It provides special information service for deafened veterans, aids in the edu- 
cation and economic and social adjustment of the severely hard-of-hearing, 
and promotes the early discovery and correction of hearing loss in children. 
It encourages the use of hearing aids and the study of lip reading, stimulates 
scientific efforts in prevention of deafness and conservation of hearing, and 
promotes the organization and efficient operation of local societies. 

AMERICAN INSTITUTE FOR THE DEAFENED 
122 East Twenty-second Street 
New York, New York 
Purpose: To normalize and rehabilitate the deafened. 

AMERICAN SPEECH AND HEARING ASSOCIATION 
Office: Care of Wayne University 
Detroit, Michigan 

Purpose: To stimulate more intelligent interest in problems of speech cor- 
rection; to raise standards among workers in speech correction; to secure public 
recognition of the practice of speech correction as an organized profession; 
to furnish the profession with responsible and authoritative leadership; to 
make leadership respected by means of scholarly research, publicity, and ad- 
ministrative skill. 

NATIONAL ASSOCIATION OF THE DEAF, INC. 
School for the Deaf 
Columbus, Ohio 

Purpose and activities: To improve, develop, and extend schools for the deaf 
throughout the world, and especially in the United States; to eliminate unjust 
liability, compensation, and traffic laws; to establish state and national labor 
bureaus for the deaf ; to remove barriers against the deaf in civil service and 
other employment. 

VOLTA BUREAU 

1537 Thirty-fifth Street, N.W. 

Washington 7, D.C. 

Purpose and activities: Center of information about deafness. Maintains 

library on deafness. Serves as headquarters of the American Association To 

Promote the Teaching of Speech to Deaf. 

VOLTA SPEECH ASSOCIATION FOR THE DEAF 
1537 Thirty-fifth Street, N.W. 
Washington 7, D.C. 



APPENDIX 339 

Purpose and activities: To assist schools for the deaf in their effort to teach 
speech and lip-reading, to provide information for parents of deaf children, 
and to maintain a reference library on deafness. 

SPEECH DEFECTIVE 

AMERICAN SPEECH AND HEARING ASSOCIATION 
Office: Wayne University 
Detroit, Michigan 

Purpose: To stimulate more intelligent interest in problems of speech correc- 
tion; to raise standards among workers in speech correction; to secure public 
recognition of the practice of speech correction as an organized profession; to 
furnish the profession with responsible and authoritative leadership; to make 
leadership respected by means of scholarly research, publicity, and adminis- 
trative skill. 

OUTHOPEDICALLY HANDICAPPED AND CARDIOPATHIC 

AMERICAN HEART ASSOCIATION, INC. 
1790 Broadway 
New York 19, New York 

Purpose and activities: To gather facts relating to heart disease and dis- 
seminate information as to its prevention and care; to develop and apply 
measures which will prevent heart disease; to encourage and assist in the de- 
velopment of new centers for cardiac work; to co-ordinate the work of centers 
for the prevention and care of heart disease; and to arouse the public to its 
responsibility and opportunity to combat heart disease. In 1944 the American 
Council on Rheumatic Fever, consisting of representatives of all national, 
medical, nursing, and public health associations concerned with rheumatic 
fever, was set up as an integral part of the Association. Its activities include 
aid to local communities in the organization of rheumatic fever programs, 
sponsorship on research, and promotion of lay education. 

NATIONAL FOUNDATION FOR INFANTILE PARALYSIS, INC. 
120 Broadway 
New York 5, New York 

Purpose and activities: To lead, direct, and unify the fight on every phase of 
infantile paralysis. The Foundation supports laboratory and clinical research 
in infantile paralysis, establishes standards for after-care, conducts educa- 
tional programs, and supports public health authorities in efforts to combat 
outbreaks of the disease. Most of the nation's counties are covered by Founda- 
tion chapters which furnish funds for medical treatment and care of patients, 
co-operate with medical authorities during epidemics, and conduct local 
educational activities. 

OTHER HANDICAPPING CONDITIONS 

AMERICAN CANCER SOCIETY, INC. 
Empire State Building 
New York 1, New York 



340 APPENDIX 

Purpose and activities: To serve the American people in the control of cancer 
by collecting funds and developing a program of service, education, and 
research on a national basis. 

AMERICAN CHAPTER OF THE LEAGUE AGAINST EPILEPSY 
Illinois Neuropsychiatric Institute 
912 South Wood Street 
Chicago, Illinois 

Purpose: To co-ordinate the activities of those doctors who are interested in 
the better care and treatment of epileptics and to stimulate interest in the 
social and scientific aspects of the disease. 

AMERICAN EPILEPSY LEAGUE, INC. 
130 North Wells Street 
Chicago 3, Illinois 

Purpose and activities: To spread up-to-date information about epilepsy, in- 
cluding the publishing and distributing of pamphlet material, and to en- 
courage more substantial public support of research investigations in the 
field. It is interested in furthering ways and means of securing permanent 
employment for epileptics. The League conducts a referral service of physi- 
cians, hospitals, clinics, and educational and training opportunities for persons 
with epilepsy. 

AMERICAN SOCIAL HYGIENE ASSOCIATION, INC. 
1790 Broadway 
New York 19, New York 

Purpose and activities: To inform the public about the national program and 
needed community action; to combat syphilis and gonorrhea as dangerous 
communicable diseases; to prevent the loss of manpower due to venereal 
disease; to improve community conditions which lead to sex delinquency 
among young people; to promote, from childhood on, sound sex education and 
training for marriage and parenthood; and to protect and improve the Ameri- 
can family as a basic social institution. It promotes both educational activities 
to instruct the population about syphilis and gonorrhea and medical activities 
to provide early disinfection in cases of exposure and early discovery and 
medical aids in cases of infection. 

AMERICAN SOCIETY FOR CONTROL OF CANCER 
350 Madison Avenue 
New York, New York 

Object: To collect, collate, and disseminate information concerning symptoms, 
diagnosis, treatments, and prevention of cancer; to aid voluntarily indigent 
cancer patients in securing adequate diagnosis or treatment in connection 
with accredited physicians. 

CAPPER FOUNDATION FOR CRIPPLED CHILDREN 
Topeka, Kansas 

Purposes and activities: To assist unfortunate crippled children whose parents 
are unable to provide necessary surgical and medical ministration, so as to 



APPENDIX 341 

restore them as far as possible to normal health and physical ability to take 
care of themselves. 

INTERNATIONAL CANCER RESEARCH FOUNDATION 
Lincoln Liberty Building 
Philadelphia, Pennsylvania 

Purpose and activities: To further research into the causes, prevention, 
control, relief, and cure of those diseases commonly called cancer. Several 
health-maintenance and cancer-prevention clinics have been sponsored by this 
Foundation. 

NATIONAL ASSOCIATION To CONTROL EPILEPSY, INC. 
22 East Sixty-seventh Street 
New York 21, New York 

Purpose: To build an informed public opinion about epilepsy and to dis- 
tribute up-to-date information to physicians, medical technicians, libraries, 
and the public ; to promote and assist in the formation of local clinics, camps, 
and educational programs throughout the country by offering counsel and 
co-operation, plus financial grants for special projects when possible. 

NATIONAL TUBERCULOSIS ASSOCIATION 
1790 Broadway 
New York 19, New York 

Purpose and activities: To study tuberculosis in all its forms and relations, 
to disseminate knowledge concerning the causes, treatment, and prevention 
of tuberculosis; to stimulate, unify, and standardize the work of the various 
antituberculosis agencies throughout the country, especially the state and 
local associations; to co-operate with all other health organizations in the 
co-ordination of health activities; and to promote international relations in 
connection with health activities in the study and control of tuberculosis. 
The Association serves as a clearinghouse for research, information, advice, 
and literature dealing with tuberculosis work. 

MENTALLY HANDICAPPED 
AMERICAN ASSOCIATION ON MENTAL DEFICIENCY 
Washington Crossing, New Jersey 

Purpose and activities: To study the causes of mental deficiency and sub- 
jects pertaining to the instruction and welfare of the mentally deficient. The 
following are among the specific aims: a complete census and registration of 
all mentally deficient children of school age, extra-institutional supervision of 
all defectives in the community, parole for all suitable institutionally trained 
mentally defective persons, and special provision for defective delinquents. 

GIFTED CHILDREN 

AMERICAN ASSOCIATION FOR GIFTED CHILDREN 
Harold F. Clark, President 
Teachers College, Columbia University 
New York, New York 



342 APPENDIX 

SOCIALLY AND EMOTIONALLY HANDICAPPED 
AMERICAN FOUNDATION FOR MENTAL HYGIENE, INC. 
1790 Broadway 
New York 19, New York 

Activities: The Foundation seeks gifts and bequests in order to give financial 
aid, in so far as its resources permit, to research and other work which will 
help conserve mental health, reduce and prevent nervous and mental dis- 
orders and mental defect, and improve the care and treatment of persons 
suffering from such disorders. 

NATIONAL COMMITTEE FOR MENTAL HYGIENE, INC. 
1790 Broadway 
New York 19, New York 

Activities: The Committee works for the conservation of mental health; 
reduction and prevention of mental and nervous disorders and defects; im- 
proved care and treatment of persons suffering from mental diseases. 

NATIONAL MENTAL HEALTH FOUNDATION 
P.O. Box 7574 

Philadelphia 1, Pennsylvania 

Purpose and activities: To conduct a national mental health program of pre- 
vention, education, and improvement. The Foundation, a nonprofit organiza- 
tion, is an outgrowth of the former Mental Hygiene Program of Civilian 
Public Service. 

PUBLICATIONS 

GENERAL 

AMERICAN JOURNAL OF OCCUPATIONAL THERAPY (Bimonthly) 
739 Boylston Street 
Boston 16, Massachusetts 
ARCHIVES OF PHYSICAL MEDICINE (Monthly) 

Official journal of American Congress of Physical Medicine 
30 North Michigan Avenue 
Chicago 2, Illinois 

ARCHIVES OF PHYSICAL THERAPY (Monthly) 
American Congress of Physical Therapy 
30 North Michigan Avenue 
Chicago 2, Illinois 

THE CRIPPLED CHILD (Bimonthly) 

Official organ of National Society for Crippled Children 
11 South LaSalle Street 
Chicago, Illinois 

THE CRIPPLED CHILD BULLETIN (Monthly) 
National Society for Crippled Children 
11 South LaSalle Street 
Chicago, Illinois 



APPENDIX 343 

HANDICAP (Monthly) 

1017 Fifteenth Street, N.W. 

Washington, D.C. 
JOURNAL OF EXCEPTIONAL CHILDREN (Monthly) 

International Council for Exceptional Children 

A department of National Education Association 

Saranac, Michigan 
JOURNAL OF REHABILITATION (Monthly) 

Official organ of National Rehabilitation Association, Inc. 

1114 Fifty-sixth Street 

Des Moines, Iowa 

NATIONAL SOCIETY FOR CRIPPLED CHILDREN AND ADULTS BULLETIN ON CUR- 
RENT LITERATURE (Monthly) 

11 North LaSalle Street 

Chicago, Illinois 
OCCUPATIONAL THERAPY AND REHABILITATION (Bimonthly) 

American Occupational Therapy Association 

Mt. Royal and Guilford Avenue 

Baltimore 2, Maryland 

PHYSICAL THERAPY REVIEW (Bimonthly) 
4741 North Paulina Street 
Chicago, Illinois 

SPECIAL EDUCATION REVIEW (Quarterly) 
Board of Education Office 
Newark, New Jersey 

UNDERSTANDING THE CHILD (Quarterly) 
National Committee for Mental Hygiene 
1790 Broadway 
New York 19, New York 

THE CHILD (Monthly) 

Division of Reports, Children's Bureau 

Superintendent of Documents, Government Printing Office 

Washington 25, D.C. 

VISUALLY HANDICAPPED 
EYE HEALTH AND SAFETY NEWS (Irregular) 

Organ of National Society for Prevention of Blindness, Inc. 

1790 Broadway 

New York 19, New York 

FIELD OF VISION (Quarterly) 

New York State Commission for Eliad 

State Department of 

205 East Forty-second Street 

New York 17, New York 



344 APPENDIX 

OUTLOOK FOR THE BLIND AND THE TEACHERS FORUM (Monthly except July and 
August) 

Organ of American Foundation for the Blind, Inc. 
15 West Sixteenth Street 
New York 11, New York 

SIGHT SAVING REVIEW (Quarterly) 

National Society for Prevention of Blindness 
1315 Cherry Street 
Philadelphia, Pennsylvania 

ACOUSTICALLY HANDICAPPED 
AMERICAN ANNALS FOR THE DEAF (Bimonthly) 
Gallaudet College 
Washington 2, D.C. 

HEARING NEWS (Monthly) 

Official organ of American Hearing Society 
817 Fourteenth Street, N.W. 
Washington, D.C. 

HEARING SURVEY QUARTERLY (Quarterly) 
1209 Grenshaw Boulevard 
Los Angeles, California 

JOURNAL OF SPEECH AND HEARING DISORDERS (Quarterly) 
American Speech and Hearing Association 
University of Illinois 
Urbana, Illinois 

VOLTA REVIEW (Monthly) 
Volta Bureau 

1537 Thirty-fifth Street, N.W. 
Washington 7, D.C. 

SPEECH DEFECTIVE 

JOURNAL OF SPEECH AND HEARING DISORDERS (Quarterly) 
American Speech and Hearing Association 
University of Illinois 
Urbana, Illinois 

ORTHOPEDICALLY HANDICAPPED AND CARDIOPATHIC 
AMERICAN HEART ASSOCIATION NEWS LETTER (Irregular) 
311 South Juniper 
Philadelphia, Pennsylvania 

BRACES TODAY (Monthly) 

Official organ of Pope Foundation, Inc. 
197 South West Avenue 
Kankakee, Illinois 



APPENDIX 345 

OTHER HANDICAPPING CONDITIONS 
AMERICAN JOURNAL OF DISEASES OF CHILDREN (Monthly) 

American Medical Association 

535 North Dearborn Street 

Chicago, Illinois 
AMERICAN REVIEW OF TUBERCULOSIS (Monthly) 

American Trudeau Society 

National Tuberculosis Association 

1790 Broadway 

New York, New York 
AMERICAN SOCIETY FOR CONTROL OF CANCER BULLETIN (Monthly) 

350 Madison Avenue 

New York, New York 

EPILEPSIA (Annually) 

130 North Wells Street 

Chicago, Illinois 
THE GREEN LIGHT (Quarterly) 

National Association to Control Epilepsia 

22 East Sixty-seventh Street 

New York 21, New York 
NATIONAL CANCER INSTITUTE JOURNAL (Bimonthly) 

Federal Security Agency 

U.S. Public Health Service 

Superintendent of Documents 

Washington, D.C. 

THE NERVOUS CHILD (Quarterly) 
Child Care Publications 
Mt. Royal and Guilford Avenue 
Baltimore 2, Maryland 

SPASTIC REVIEW (Monthly) 
1751 North Fairmount 
Wichita, Kansas 

MENTALLY HANDICAPPED 

AMERICAN JOURNAL OF MENTAL DEFICIENCY (Quarterly) 
372-74 Broadway 
Albany, New York 

OCCUPATIONAL EDUCATION (Monthly) 

Association for New York City Teachers of Special Education 
224 East Twenty-eighth Street 
New York, New York 

TRAINING SCHOOL BULLETIN (Monthly) 
Training School 
Vineland, New Jersey 



346 APPENDIX 

SOCIALLY AND EMOTIONALLY HANDICAPPED 
JOURNAL OF NERVOUS AND MENTAL DISEASES (Monthly) 

64 West Fifty-sixth Street 

New York, New York 
MENTAL HYGIENE (Quarterly) 

National Committee for Mental Hygiene 

1790 Broadway 

New York, New York 



INDEX 



Acceleration of educational progress of 
gifted children, 260, 275-77 

Acceptance of handicapped children, 
methods of helping parents toward. 
120-22 

Accident prevention, 312-13 

Achievement tests, use of, in identifying 
exceptional children, 40-41 

Acoustically handicapped children : 
characteristics of, 160-63; classifica- 
tion of, 152-54; identification of, 156- 
60 

Adjustment of educational program for 
exceptional children in regular classes, 
12-14 

Administration of special education pro- 
grams, principles of, 20-22 

Affectivity as related to growth of chil- 
dren, 77-78 

Allport, Gordon W., 85 

American Hearing Society, 165 

American Heart Association classifica- 
tion of cardiographic and circulatory 
disturbances, 55 

American Medical Association, 165 

American Printing House for the Blind, 
145, 147 

American Speech and Hearing Associa- 
tion, 186, 188 

Articulatory defects: functional types of, 
176-81; organic forms of, 181-84 

Attitudes of parents toward exceptional 
children, 120-22 

Audiometer, use of, in group testing, 41, 
52, 159 

Auditorially handicapped children, re- 
search problems pertaining to, 327-28 

Auditory aids, types of, 173-74 

Baker, Harry J., 6, 225 

Bannister, H., 232 

Banta, K. Vernin, 101 

Barden-LaFollette Act, 98 

Behavior disturbances, diagnosis of, 57- 
59 

Benda, Clemens E., 234, 306 

Betts Telebinocular, 50 

Blind children: Braille classes for, 144- 
45; characteristics of, 142-43; educa- 
tional facilities for, 143-48; qualifica- 



tions of teachers for, 150; residential 
schools for, 145; special methods of 
instruction for, 145-49 

Bradway, K. P., 162 

Braille classes for blind children, 144-45 

Brown, L., 232 

Brunschwig, L., 161 

Canadian Federation of Home and 
School, 117 

Cardiopathic children : characteristics of, 
197-200; guidance services for, 205-10 

Carrell, James A., 187 

Cerebral-palsied children, medical care 
and education of, 200-205 

Clarke School for the Deaf, 106, 165 

Cleveland plan for education of gifted 
children, 265-71 

Cluckholn, Clyde, 87 

Conservation of hearing, program for, 
157-60 

Counselor, importance of clinical compe- 
tence of, 93-94 

Crippled children: characteristics of, 
197-200; classification of, 196-97; edu- 
cational provisions for, 203-15; guid- 
ance services for, 205-10; medical 
needs of, 200-203; special equipment 
for, 211-12 

Curriculum enrichment for gifted chil- 
dren, 260, 265-71, 277-78 

Curriculum for exceptional children, ad- 
ministration of, 29-30 

Detroit Department of Health guide for 
physical inspection of pupils, 42-43 

Detroit Psychological clinic, 47 

Diagnosis of exceptional children, 43-59; 
research problems pertaining to, 324- 
25; training of personnel for, 43; use of 
achievement tests in, 44-45; use of 
psychological tests in, 45-49 

Doll, Edgar A., 237, 254 

Dreikurs, Rudolph, 90 

Educational Policies Commission, 4, 249 
Educational program for exceptional 

children, essential features of, 14 
Educational provisions for exceptional 

children, extent of, 12-16 



347 



348 



INDEX 



Emotional patterns in children, role of 
parents in development of wholesome 
types of, 130-31 

Enrichment of curriculum for gifted chil- 
dren, 260, 265-71, 277-78 

Epilepsy: causes of, 220-21; diagnosis of, 
222-26; incidence of, 218-19; sources 
of information about, 228-29; types of, 
221 

Epileptic children: causes of conditions 
affecting, 220-21; characteristics of, 
224-26; educational program for, 
226-28; needed research pertaining to, 
236 

Exceptional children: census of, 6-7; 
changing concepts of education for, 
7-13 

Feeble-minded, educational provisions 
for children temporarily classified as, 
241-42 

Gallaudet College for the Deaf, 172 

Gibbs, F. A., 222 

Gifted children: characteristics of, in 
relation to growth and development, 
62-64; follow-up studies of, 271-78; 
general characteristics of, 263^64; 
history of educational provisions 
for, 259-60; identification of, 261-63; 
philosophical considerations related to 
education of, 260-61; providing ap- 
propriate educational programs for, 
264-71; research problems pertaining 
to, 332-33; sibling resemblances in, 65 

Glandular disorders: causes of, 233-34; 
educational significance of, 232-33; 
somatopsychological significance of, 
235-36 

Glandular disturbances, slow growth of 
children affected by, 68-72 

Gratke, Juliette M., 127, 129 

Greenleaf, Floyd, 190 

Group surveys and inspections for identi- 
fying handicapped children, 40-43 

Growth ages, use of, in describing total 
development of exceptional children, 
62 

Growth of exceptional children: im- 
portance of considering total develop- 
ment and personality in study of. 61; 
units for description of, 61; use ot age 
principle in description of, 61-62 

Guidance and personality development, 
85-91 

Guidance services for exceptional chil- 
dren, 27-29; classification of, 84-85; 
functions of, 83 

Habbe, Stephen, 101 



Haggerty-Olson-Wickman Behavior Rat- 
ing Scale, 64, 77 

Handedness, effects of forcible change of, 
56-57 

Hathaway, Winifred, 51 

Hayes, Samuel P., 44, 46, 326 

Hayes-Binet Intelligence Tests for the 
Blind, 46 

Hearing loss: causes of, 162-63; children 
classified according to degree of, 152- 
54; educational needs of children with, 
163-73; symptoms of, 154-56 

Hollingworth, Leta, 262, 264 

Housing requirements of special educa- 
tion programs, 30-31 

Identification of exceptional children en- 
rolled in schools, 14 

Intellectual development of exceptional 
children, role of parents in promotion 
of, 132 

International Council for the Education 
of Exceptional children, 106 

Irwin, Ruth, 184 

Jenkins, Lester Eugene, 282 
Jenkins, Richard L., 282 
Johnson, Wendell, classification of speech 
and voice defects by, 53-54 

Kellogg Foundation project in recreation 
and community planning, 40 

Keys-Pederson Visual Language Tests, 
4-5 

Kirk, Samuel A., 162, 254 

Kvaraceus, William C., 286 

Language, parents' participation in de- 
velopment of, 128-29 

Lee, John J., 194 

Legislation pertaining to the education of 
exceptional children, 32-35, 39-40 

Lehtinen, Laura E., 324 

Lennox, William G., 219 

Lowenfeld, Berthold, 327 

"Major-work" classes for gifted children 
in Cleveland public schools, 265-71 

Massachusetts Vision Test, 50 

Mclntyre, J. Thomas, 200 

Mechem, Elizabeth, 77 

Mental-health needs of school children, 
314-15 

Mental tests, use of, in identifying excep- 
tional children, 41 



INDEX 



349 



Mentally retarded children: character- 
istics of, 239-41; classification of, 237- 
38; educational provisions for, 241-44; 
growth of, 66M>8; identification of, 
238-39; legislation pertaining to, 244- 
45; planning the curriculum for, 248- 
52; research relating to education of, 
255-56, 331-32; special services and 
personnel for, 246-48; trends in edu- 
cational procedures for, 253-55 

Michigan Farm Colony for Epileptics, 
221 

Minor, C. S., 232 

Monson Massachusetts State Hospital 
for Epileptics, 220 

Montifiore School of Chicago, 287, 296 

Motor skills, instructions to parents of 
handicapped children regarding de- 
velopment of, 127-28 

Mowrer, 0. H., 87 

Myklebust, H., 161, 162 

Natal factors causing handicaps which 
affect education of children, 307 

National Association to Control Epi- 
lepsy, 228 

National Congress of Parents and Teach- 
ers, 117 

National Mental Health Act, 245, 317-18 

National Society for Crippled Children 
and Adults, Inc., 107, 118, 196 

Nebraska Test of Learning Aptitude, 
standardization of, on deaf children, 48 

Objectives of special education, 4-5, 19- 
20 

Ojemann, R. H., 56 

Ontario School-Ability Examination, use 
of, with deaf children, 48 

Organization of special education pro- 
grams: at local level, 22-31; state re- 
sponsibility for, 31-37 

Orthopedic handicaps: characteristics of, 
197-22; classification of, 196-97; defi- 
nition of, 195; educational needs of 
children with, 203-15; medical treat- 
ment of, 200-203; research problems 
pertaining to, 329-31 

Osoretsky Tests of Motor Proficiency, 
331 

Parental schools for socially maladjusted 
children, 29.6-97 

Parents' attitudes toward handicapped 
children, 120-22 

Parents' contribution to education of ex- 
ceptional children, 124 



Partially seeing children: characteristics 
of, 136; conducting classes for, 138-39; 
educational facilities for, 137; identifi- 
cation of, in school situations, 136-37; 
special teachers of, 140-42; supervision 
of instruction for, 13940; vocational 
guidance for, 142 

Pennsylvania state program of health 
examinations in public and private 
schools, 40 

Perkins Institution for the Blind, 105 

Personality as related to growth of excep- 
tional children, 61 

Personality tests, use of, in diagnosis of 
behavior disturbances, 57 

Peterman, M. G., 220, 222 

Phelps, Winthrop M., 200, 202 

Physically handicapped children, re- 
search problems pertaining to, 329-31 

Pintner, Rudolph, 48, 161 

Postnatal factors contributing to handi- 
caps which affect education of chil- 
dren, 307-9 

Prenatal factors involved in physical or 
mental handicaps affecting education 
of children, 304-7 

Prevention of abnormalities and diseases 

which affect education of children, 

309-10 
Prevention of social maladjustment, 313- 

18 
Psychological tests, use of, in diagnosis 

of exceptional children, 45-49 
Pugh, Gladys S., 45 

Rate of growth of children, diversity in, 

71-72 
Rehabilitation agencies, services of, to 

handicapped persons, 94-98 
Research problems related to types of 

educational programs for exceptional 

children, 323-34 

Residential schools: for handicapped 
children, 34-35; for socially malad- 
justed children, 296-97 

Rorschach, Hermann, 223 

St. James, Robert, 127 

Schleier, Louis M., 106 

Schmidt, Bernadine, 254 

Selecting staff for special education pro- 
gram, 25-26 

Shanahan, W. T., 220 

Sherman, Mandel, 287 

Sibling resemblances in growth of gifted 
children, 65 



350 



INDEX 



Slow-learners, definition of, 238 

Snellen E-Chart, 50 

Social relations of exceptional children, 
78-80 

Socially maladjusted children: character- 
istics of, 286-89; definition of, 282-83; 
educational needs of, 289-91; identi- 
fication of, 283-85; planning the edu- 
cational program for, 291-97; prin- 
ciples of education appropriate for, 
299-301; research problems pertaining 
to, 333-34; residential schools for, 296- 
97; special day schools for, 294-96 

Spackman, Clare S., 203 

Special classes: enrolment in, 12; quali- 
fications of teachers of, 110-11; super- 
vision of, 26-27 

Special day schools for socially malad- 
justed children, 296-97 

Special education: contribution of, to 
education of all children, 5; diagnostic 
services in, 11; history of, 7-13; indi- 
vidualized instruction in, 10-11; in- 
fluence of wartime experiments on, 9- 
10; modern philosophy of, 10; neces- 
sity for, 5; objectives of, 45; relation 
of, to prevention of handicaps, 12 

Speech, delay in development of, as re- 
lated to growth characteristics in gen- 
eral, 72-73 

Speech correction: basic principles of, 
188-92; establishing school program 
for, 184-88; research problems per- 
taining to, 329 

Speech defects: relation of, to impaired 
hearing, 182-83; types of, 176-84 

Speech development, causes of retarda- 
tion in, 183-84 

Stanford University study of gifted chil- 
dren, 271-78 

Stein, C., 221 

Strauss, Alfred A., 324 

Streng, Alice, 162 

Stuttering, 177-80 

Supervision of special classes, 26-27 

Surveying the needs of exceptional chil- 
dren, 23-24 

Teacher-training in special education, 
105-7; present facilities for, 107-9; 



recruitment of students for, 114-16; 
types of programs for, 111-14 

Teachers of special classes: qualifications 
of, 110-11; state standards for, 109-10 

Teaching experience as related to train- 
ing for service in special education, 
103-5 

Tracy Clinic for deaf children, 118, 169 

Tracy, Louise, 129 

Transportation of crippled pupils, 214 

Tuberculosis in children: diagnosis and 
treatment of, 229-30; educational pro- 
cedures necessitated by, 230-32; in- 
fluence of, on behavior, 231-32; nature 
and effects of, 229 

Understanding the nature and needs of 
exceptional children, problems of par- 
ents in, 122-25 

United States Department of Labor, 
Children's Bureau, 197, 304 

United States Employment Service, 101 

United States Office of Education, 7, 39, 
107 

Utley, J., 165 

Van Riper, C., 184 

Vineland Training School, 10.5 

Visually handicapped children: classifica- 
tion of, 135-36; research problems per- 
taining to, 325-27 

Vitality as related to growth character- 
istics, 74-76 

Vocational adjustment of handicapped 
individuals, contribution of nonschool 
agencies to, 94-101 

Vocational Rehabilitation Act, 245 

Vocational training of handicapped pu- 
pils, services of rehabilitation agencies 
in, 100 

Voice disorders, 180-81 

Volta Speech Association for the Deaf, 
106 

Walker, A. E., 220 

Wechsler-Bellevue Scale, use of, with 

deaf children, 48 
White House Conference on Child Health 

and Protection, 6, 8, 103, 107, 303 



INFORMATION CONCERNING THE NATIONAL SOCIETY FOR 
THE STUDY OF EDUCATION 

1. PURPOSE. The purpose of the National Society is to promote the investigation 
and discussion of educational questions. To this end it holds an annual meeting and 
publishes a series of yearbooks. 

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9. YEARBOOKS. The yearbooks are issued about one month before the February 
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Chicago 37, Illinois 



PUBLICATIONS OF THE NATIONAL SOCIETY FOR 
THE STUDY OF EDUCATION 

NOTICE: Many of the early yearbooks of this series are now 
out of print. In the following list, those titles to which an 
asterisk is prefixed are not available for purchase. 



POSTPAID 
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First Yearbook, 1902, Part I Some Principles in the Teaching of History. Lucy M. Salmon 

*First Yearbook, 1902, Part II The Progress of Geography in the Schools. W. M. Davis and H. M. 

Wilson 

*Second Yearbook, 1903, Part I The Course of Study in History in the Common School. Isabel 

Lawrence, C. A. McMurry, Frank McMurry, E. C. Page, and E. J. Rice 

*Second Yearbook, 1903, Part II The Relation of Theory to Practice in Education. M. J. Holmes, 

J. A. Keith, and Levi Seeley 

Third Yearbook, 1904, Part I The Relation of Theory to Practice in the Education of Teachers. 

John Dewey, Sarah C. Brooks, F. M. McMurry, et al 53 

Third Yearbook, 1904, Part II Nature Study. W. S. Jackman 85 

Fourth Yearbook, 1905, Part I The Education and Training of Secondary Teachers. E. C. Elliott, 

E. G. Dexter, M. J. Holmes, et al 85 

*Fourth Yearbook, 1905, Part II The Place of Vocational Subjectsin the High-School Curriculum. 

J. S. Brown, G. B. Morrison, and Ellen Richards 

*Fif th Yearbook, 1906, Part ly-On the Teaching of English in Elementary and High Schools. G. P. 

Brown and Emerson Davis 

Fifth Yearbook, 1906, Part II The Certification of Teachers. E. P. Cubberley 64 

"Sixth Yearbook, 1907, Part I Vocational Studies for College Entrance. C. A. Herrick, H. W. 

Holmes, T. deLaguna, V. Prettyman, and W. J. S. Bryan 

*Siith Yearbook, 1907, Part II The Kindergarten and Its Relation to Elementary Education. Ada 
Van Stone Harris, E. A. Kirkpatrick, Marie Kraus-Boelt6, Patty S. Hill, Harriette M. Mills, 

and Nina Vandewalker 

Seventh Yearbook, 1908, Part I The Relation of Superintendents and Principals to the Training 

and Professional Improvement of Their Teachers. Charles D. Lowry 78 

Seventh Yearbook, 1908, Part II The Co-ordination of the Kindergarten and the Elementary 

School. B. J. Gregory, Jennie B. Merrill, Bertha Payne, and Margaret Giddings 78 

Eighth Yearbook, 1909, Parts I and II Education with Reference to Sex. C. R. Henderson and 

Helen C. Putnam. Both parts 1 .60 

*Ninth Yearbook, 1910, Part I Health and Education. T. D. Wood 

*Ninth Yearbook, 1910, Part II The Nurse in Education. T. D. Wood, et al 

*Tenth Yearbook, 1911, Part I The City School as a Community Center. H. C. Leipziger, Sarah E. 
Hyre, R. D. Warden, C. Ward Crampton, E. W. Stitt, E. J. Ward, Mrs. E. C. Grice, and C. A. 

Perry 

*Tenth Yearbook, 1911, Part II The Rural School as a Community Center. B. H. Crooheron, 
Jessie Field, F. W. Howe, E. C. Bishop, A. B. Graham, O. J. Kern, M. T. Scudder, and B. M. 

Davis 

*Eleventh Yearbook, 1912, Part I Industrial Education: Typical Experiments Described and 
Interpreted. J. F. Barker, M. Bloomfield, B. W. Johnson, P. Johnson, L. M. Leavitt, G. A. 



interpreted, j. r. >arK.er, ivi. .uiuomneiu, . TT . ijuuuauii, r. tiuuuauu, 

Mirick^ M. W. Murray^ C. F\ Perry, A. L. Safford, and RB. Wilson . 



Eleventh Yearbook, 1912, Part II Agricultural Education in Secondary Schools. A. C. Monahan. 
R. W. Stimson, D. J. Crosby, W. H. French, H. F. Button, F. R. Crane, W. R. Hart, and 
G. F. Warren 

*Twelfth Yearbook, 1913, Part I The Supervision of City Schools. Franklin Bobbitt, J. W. Hall, 
and J. D. Wolcott 

"Twelfth Yearbook, 1913, Part II The Supervision of Rural Schools. A. C. Monahan, L. J. Hani- 
fan, J. E. Warren, Wallace Lund, U. J. Hoffman, A. 8. Cook, E. M. Rapp, Jackson Davis, 

and J. D. Wolcott 

Thirteenth Yearbook, 1914, Part I Some Aspects of High-School Instruction and Administration. 

H. C. Morrison, E. R. Breslich, W. A. Jessup, and L. D. Coffman 85 

Thirteenth Yearbook, 1914, Part II Plans for Organizing School Surveys, with a Summary of 

Typical School Surveys. Charles H. Judd and Henry L. Smith 79 

Fourteenth Yearbook, 1915, Part I Minimum Essentials in Elementary School Subjects Stand- 
ards and Current Practices. H. B. Wilson, H. W. Holmes, F. E. Thompson, R. G. Jones, 8. A. 
Courtis, W. 8. Gray, F. N. Freeman, H. C. Pryor, J. F. Hoaic, W. A. Jessup, and W. C. Bagley .85 
Fourteenth Yearbook, 1915, Part U Methods for Measuring Teachers' Efficiency. Arthur C. 

Boyce 79 

"Fifteenth Yearbook, 1916, Part I Standards and Tests for the Measurement of the Efficiency of 
Schools and School Systems. G. D. Strayer, Bird T. Baldwin, B. R. Buckingham, F. W. Ballou, 
D. C. Bliss, H. G. Childs, S. A. Courtis, E. P. Cubberley, C. H. Judd, George Melcher, E. E. 
Oberholt>er, J. B. Sears, Daniel Starch, M. R. Trabue, and G. M. Whipple 

"Fifteenth Yearbook, 1916, Part II The Relationship between Persistence in School and Home 
Condition*. Charles E. Holley 

"Fifteenth Yearbook, 1916, Part III The Junior High School. Aubrey A. Douglass 

iii 



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"Sixteenth Yearbook, 1917, Part I Second Report of the Committee on Minimum Essentials in 
Elementary-School Subjects. W. C. Bagley, W. W, Charters, F. N. Freeman, W. S. Gray, 
Ernest Horn, J. H. Hoskinson, W. S. Monroe, C. F. Munson, H. C. Pryor, L. W. Ilapeer, 
G. M. Wilson, and H. B. Wilson 

"Sixteenth Yearbook, 1917, Part II The Efficiency of College Students as Conditioned by Age at 
Entrance and Size of High School B. F. Pittenger 

Seventeenth Yearbook, 1918, Part I Third Report of the Committee on Economy of Time in Edu- 
cation. W. C. Bagley, B. B. Bassett, M. E. Branom, Alice Camerer, J. E. Dealey, C. A. 
Ellwood, E. B. Greene, A. B. Hart, J. F. Hosic, E. T. Housh, W. H. Mace, L. R. Marston, 
H. C. McKown, H. E. Mitchell, W. C. Reavis, D. Snedden, and H. B. Wilson $0 8, r ) 

"Seventeenth Yearbook, 1918, Part II The Measurement of Educational Products. E. J. Ash- 
baugh, W. A. Averill, L. P. Ayers. F. W. Ballou, Edna Bryner, B. R. Buckingham, S. A. 
Courtis, M. E. Haggerty, C. H. Judd, George Melcher, W. S. Monroe, E. A. Nifenecker, and 
E. L. Thorndike 

"Eighteenth Yearbook, 1919, Part I The Professional Preparation of High-School Teachers. 
G. N. Cade, S. S. Colvin, Charles Fordyce, H. H. Foster, T. S. Gosling, W. S. Gray, L. V. 
Koos, A. R. Mead, H. L. Miller, F. C. Whitcomb, and Clifford Woody 

Eighteenth Yearbook, 1919, Part II Fourth Report of Committee on Economy of Time in Educa- 
tion. F. C. Ayer, F. N. Freeman, W. S. Gray, Ernest Horn, W. S. Monroe, and C. E. Seashore 1 . 10 

Nineteenth Yearbook, 1920, Part I New Materials of Instruction. Prepared by the Society's 

Committee on Materials of Instruction 1 . 10 

*Nineteenth Yearbook, 1920, Part II Classroom Problems in the Education of Gifted Children. 
T. S. Henry 

"Twentieth Yearbook, 1921, Part I New Materials of Instruction. Second Report by the Society's 
Committee 

Twentieth Yearbook, 1921, Part II Report of the Society's Committee on Silent Reading. M. A. 
Burgess, S. A. Courtis, C. E. Germane, W. S. Gray, H. A. Greene, Regina R. Heller, J. H. 
Hoover, J. A. O'Brien, J. L. Packer, Daniel Starch, W. W. Theisen, G. A. Yoakam, and 
representatives of other school systems 

Twenty-first Yearbook, 1922, Parts I and II Intelligence Tests and Their Use. Part I The Na- 
ture, History, and General Principles of Intelligence Testing. E. L. Thorndike, S. S. Colvin, 
Harold Rugg, G. M. Whipple, Part II The Administrative Use of Intelligence Tests, H. W. 
Holmes, W. K. Layton, Helen Davis, Agnes L. Rogers, Rudolf Pintner, M. R. Trabue, W. S. 

Miller, Bessie L. Gambrill, and others. The two parts are bound together 1 .60 

Twenty-second Yearbook, 1923, Part I English Composition: Its Aims, Methods, and Measure- 
ments. Earl Hudelson 

Twenty-second Yearbook, 1923, Part II The Social Studies in the Elementary and Secondary 
School. A. S. Barr, J. J. Coss, Henry Harap, R. W. Hatch, H. C. Hill, Ernest Horn, C. H. 
Judd, L. C. Marshall, F. M. McMurry, Earle Rugg, H. O. Rugg, Emma Schweppe, Mabel 
Snedaker, and C. W. Washburne 

Twenty-third Yearbook, 1924, Part I The Education of Gifted Children. Report of the Society's 

Committee. Guy M. Whipple, Chairman 1 .75 

"Twenty-third Yearbook, 1924, Part II Vocational Guidance and Vocational Education for Indus- 
tries. A. H. Edgerton and Others 

Twenty-fourth Yearbook, 1925, Part I Report of the National Committee on Reading. W. S. 
Gray, Chairman, F. W. Ballou, Rose L. Hardy, Ernest Horn, Francis Jenkins, S. A. Leonard, 

Estaline Wilson, and Laura Zirbes 1 . 50 

Twenty-fourth Yearbook, 1925, Part II Adapting the Schools to Individual Differences. Report 
of the Society's Committee. Carleton W. Washburne, Chairman 

Twenty-fifth Yearbook, 1926, Part I The Present Status of Safety Education. Report of the 

Society's Committee. Guy M. Whipple, Chairman 1 .75 

Twenty-fifth Yearbook, 1926, Part II Extra-curricular Activities. Report of the Society's 

Committee. Leonard V. Koos, Chairman 

Twenty-sixth Yearbook, 1927, Part I Curriculum-making: Past and Present. Report of the 

Society's Committee. Harold O. Rugg, Chairman 

Twenty-sixth Yearbook, 1927, Part II The Foundations of Curriculum-making. Prepared by 
individual members of the Society's Committee. Harold O. Rugg, Chairman 

Twenty-seventh Yearbook, 1928, Part I Nature and Nurture: Their Influence upon Intelli- 
gence. Prepared by the Society's Committee. Lewis M. Terman, Chairman 1 .75 

Twenty-seventh Yearbook, 1928, Part II Nature and Nurture: Their Influence upon Achieve- 
ment. Prepared by the Society's Committee. Lewis M. Terman, Chairman 1.75 

Twenty-eighth Yearbook, 1929. Parts I and II Preschool and Parental Education. Part I 
Organization and Development. Part II Research and Method. Prepared by the Society's 

Committee. Lois H. Meek, Chairman. Bound in one volume. Cloth 5 . 00 

Paper 3.25 

Twenty-ninth Yearbook, 1930, Parts I and II Report of the Society's Committee on Arithmetic. 
Part I Some Aspects of Modern Thought on Arithmetic. Part II Research in Arithmetic. 
Prepared by the Society's Committee. F. B. Knight, Chairman. Bound in one volume. Cloth 5 .00 
Paper 3 .25 

Thirtieth Yearbook, 1931, Part I The Status of Rural Education. First Report of the Society's 

Committee on Rural Education. Orville G. Brim, Chairman. Cloth 2 .50 

Paper 1 75 

Thirtieth Yearbook, 1931, Part II The Textbook in American Education. Report of the Society's 

Committee on the Textbook. J, B. Edmooson, Chairman. Cloth 2 . 50 

Paper 1 .75 

Thirty-first Yearbook, 1932, Part I A Program for Teaching Science. Prepared by the Society's 

Committee on the Teaching of Science. S. Ralph Powers, Chairman. Cloth 2 .50 

Paper 1.75 

Thirty-first Yearbook, 1932, Part II Changes and Experiments in Liberal-Arts Education. 

Prepared by Kathryn McHale, with numerous collaborators. Cloth 2 . 50 

Paper 1.75 



PUBLICATIONS v 

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Thirty-second Yearbook, 1933 The Teaching of Geography. Prepared by the Society's Com* 

mittee on the Teaching of Geography. A. E. Parkins, Chairman. Cloth $4 .50 

Paper 3 .00 

Thirty-third Yearbo9k, 1934, Part I The Planning and Construction of School Building*. Pre- 
pared by the Society's Committee on School Buildings. N. L. Engelhardt, Chairman. Cloth 2.50 
Paper 1 .75 

Thirty-third Yearbook, 1934, Part II The Activity Movement. Prepared by the Society's Com- 
mittee on the Activity Movement. Lois Coffey Mossman, Chairman. Cloth 2 .50 

Paper 1 .75 

Thirty-fourth Yearbook, 1935 Educational Diagnosis. Prepared by the Society's Committee on 

Educational Diagnosis. L. J. Brueckner, Chairman. Cloth 4 .25 

Paper 3 .00 

Thirty-fifth Yearbook, 1936, Part I The Grouping of Pupils. Prepared by the Society's Com- 
mittee. W. W. Coxe, Chairman. Cloth 2 .50 

Paper 1 .75 

Thirty-fifth Yearbook, 1936, Part II Music Education. Prepared by the Society's Committee. 

W. L. Uhl, Chairman. Cloth 2.50 

Paper 1 .75 

Thirty-sixth Yearbook, 1937, Part I The Teaching of Reading. Prepared by the Society's Com- 
mittee. W. S. Gray. Chairman. Cloth 2.50 

Paper 1.75 

Thirty-sixth Yearbook, 1937, Part II International Understanding through the Public-School 

Curriculum. Prepared by the Society's Committee. I. L. Kandel, Chairman. Cloth 2.50 

Paper 1 .75 

Thirty-seventh Yearbook, 1938, Part I Guidance in Educational Institutions. Prepared by the 

Society's Committee. G. N. Kefauver, Chairman. Cloth 2 .50 

Paper 1 .75 

Thirty-seventh Yearbook, 1938, Part II The Scientific Movement in Education. Prepared by the 

Society's Committee. F. N. Freeman, Chairman. Cloth 4 .00 

Paper 3 .00 

Thirty-eighth Yearbook, 1939, Part I Child Development and the Curriculum. Prepared by the 

Society's Committee. Carleton Washburne, Chairman. Cloth 3 .25 

Paper 2.50 

Thirty-eighth Yearbook, 1939, Part II General Education in the American College. Prepared by 

the Society's Committee. Alvin Eurich, Chairman. Cloth 2 .75 

Paper 2 .00 

Thirty-ninth Yearbook, 1940, Part I Intelligence: Its Nature and Nurture. Comparative and 

Critical Exposition. Prepared by the Society's Committee. G. D. Stoddard, Chairman. Cloth 3.00 

Paper 2 .25 

Thirty-ninth Yearbook, 1940, Part II Intelligence: Its Nature and Nurture. Original Studies 

and Experiments. Prepared by the Society's Committee. G. D. Stoddard, Chairman. Cloth 3.00 

Paper 2 .25 

Fortieth Yearbook, 1941 Art in American Life and Education. Prepared by the Society's Com- 
mittee. Thomas Munro, Chairman. Cloth 4 .00 

Paper 3 .00 

Forty-first Yearbook, 1942, Part I Philosophies of Education. Prepared by the Society's Com- 
mittee. John S. Brubacher, Chairman. Cloth 3 .00 

Paper 2.25 

Forty-first Yearbook, 1942, Part II The Psychology of Learning. Prepared by the Society's 

Committee. T. R. McConnell, Chairman. Cloth 3 .25 

Paper 2 . 50 

Forty-second Yearbook, 1943, Part I Vocational Education. Prepared by the Society's Com- 
mittee. F. J. Keller, Chairman. Cloth 3 .25 

Paper 2.50 

Forty-second Yearbook, 1943, Part II The Library in General Education. Prepared by the 

Society's Committee. L. R. Wilson, Chairman. Cloth 3.00 

Paper 2.25 

Forty-third Yearbook, 1944, Part I Adolescence. Prepared by the Society's Committee. Harold 

E. Jones, Chairman. Cloth 3 .00 

Paper 2.25 

Forty-third Yearbook, 1944, Part II Teaching Language in the Elementary School. Prepared by 

the Society's Committee. M. R. Trabue, Chairman. Cloth 2 .75 

Paper 2 . 00 

Forty-fourth Yearbook, 1945, Part I American Education in the Postwar Period: Curriculum Re- 
construction. Prepared by the Society's Committee. Ralph W. Tyler, Chairman. Cloth 3 .00 

Paper 2 .25 

Forty-fourth Yearbook, 1945, Part II American Education in the Postwar Period: Structural Re- 
organization. Prepared by the Society's Committee. Bess Goodykoontz, Chairman. Cloth . . 3 .00 
Paper 2.25 

Forty-fifth Yearbook, 1940, Part I The Measurement of Understanding. Prepared by the 

Society's Committee. William A. Brownell, Chairman. Cloth 3 .00 

Paper 2.25 

Forty-fifth Yearbook, 1946, Part II Changing Conceptions in Educational Administration. Pre- 
pared by the Society's Committee. Alonzo G. Grace, Chairman. Cloth 2 .50 

Paper 1-75 

Forty-sixth Yearbook, 1947, Part I Science Education in American Schools. Prepared by the 

Society's Committee. Victor H. Noll, Chairman. Cloth 3 .25 

Paper 2.50 

Forty-sixth Yearbook, 1947, Part II Early Childhood Education. Prepared by the Society's 

Committee. N. Searle Light, Chairman. Cloth 3 .50 

Paper 2.75 



vi PUBLICATIONS 

POSTPAID 
PRICE 

Forty-seventh Yearbook, 1948, Part I Juvenile Delinquency and the Schools. Prepared by the 

Society's Committee. Ruth Strang, Chairman. Cloth $3 .50 

Paper 2.75 

Forty-seventh Yearbook, 1948, Part II Reading in the High School and College. Prepared by the 

Society's Committee. William 8. Gray, Chairman. Cloth 3 .50 

Paper 2.75 

Forty-eighth Yearbook, 1949, Part I Audio-visual Materials of Instruction. Prepared by the 

Society's Committee. Stephen M. Corey, Chairman. Cloth 3 . 50 

Paper 2.76 

Forty-eighth Yearbook, 1949, Part II Reading in the Elementary School. Prepared by the So- 
ciety's Committee. Arthur I. Gates, Chairman. Cloth 3 .50 

Paper 2.75 

Forty-ninth Yearbook, 1950, Part I Learning and Instruction. Prepared by the Society's Com- 
mittee. G. Lester Anderson, Chairman. Cloth 3 .50 

Paper 2.75 

Forty-ninth Yearbook, 1950, Part II The Education of Exceptional Children. Prepared by the 

Society's Committee. Samuel A. Kirk, Chairman. Cloth 3 .50 

Paper 2.75 

Fiftieth Yearbook, 1951, Part I Graduate Study in Education. Prepared by the Society's Board 

of Directors. Ralph W. Tyler, Chairman. Cloth 3 .50 

Paper 2.75 

Fiftieth Yearbook, 1951, Part II The Teaching of Arithmetic. Prepared by the Society's Com- 
mittee. G. T. Buswell, Chairman. Cloth 3 .50 

Paper 2.75 

Fifty-first Yearbook, 1952, Part I General Education. Prepared by the Society's Committee. 

T. R. McConnell, Chairman. Cloth 3 .50 

Paper 2.75 

Fifty-first Yearbook, 1952, Part II Education in Rural Communities. Prepared by the Society's 

Committee. Ruth Strang, Chairman. Cloth 3 .50 

Paper 2.75 

Fifty-second Yearbook, 1953, Part I Adapting the Secondary-School Program to the Needs of 

Youth. Prepared by the Society's Committee. William G. Brink, Chairman. Cloth 3 .50 

Paper 2.75 

Fifty-second Yearbook, 1953, Part II The Community School. Prepared by the Society's Com- 
mittee. Maurice F. Seay, Chairman. Cloth 3 .50 

Paper 2.75 

Fifty-third Yearbook, 1954, Part I Citizen Co-operation for Better Public Schools. Prepared by 

the Society's Committee. Edgar L. Morphet, Chairman. Cloth 4.00 

Paper 3.25 

Fifty-third Yearbook, 1954, Part II Mass Media and Education. Prepared by the Society's 

Committee. Edgar Dale, Chairman. Cloth 4 .00 

Paper 3.25 

Fifty-fourth Yearbook, 1955, Part I Modern Philosophies and Education. Prepared by the 

Society's Committee. John S. Brubacher, Chairman. Cloth 4.00 

Paper 3.25 

Fifty-fourth Yearbook, 1955, Part II Mental Health in Modern Education. Prepared by the 

Society's Committee. Paul A. Witty, Chairman. Cloth . 4.00 

Paper 3.25 

Fifty-fifth Yearbook, 1956. Part I The Public Junior College. Prepared by thr Society's 

Committee. B. Lamar Johnson, Chairman. Cloth 4 .00 

Paper 3.25 

Fifty-fifth Yearbook, 1956, Part II Adult Reading. Prepared by the Society's Committee. 

David H. Clift, Chairman. Cloth 4 .00 

Paper 3.25 

Fifty-sixth Yearbook, 1957, Part I In-service Education of Teachers, Supervisors, and Adminis- 
trators. Prepared by the Society's Committee. Stephen M. Corey, Chairman. Cloth . . 4 .00 
Paper 3 .25 

Fifty-sixth Yearbook, 1957, Part II Social Studies in the Elementary School. Prepared by the 

Society's Committee. Ralph C. Preston, Chairman. Cloth 4 .00 

Paper 3 .25 

Distributed by 

THE UNIVERSITY OF CHICAGO PRESS, CHICAGO 37, ILLINOIS 

1957 





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