International Review of Research in Mental Retardation: v. 2

International Review of RESEARCH IN MENTAL RETARDATION VOLUME 2 Contributors to this Volume IVAR ARNLJOT BJORGEN J. C...

Author: Norman R Ellis

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International Review of RESEARCH IN MENTAL RETARDATION VOLUME 2

Contributors to this Volume IVAR ARNLJOT BJORGEN J. CHABANIER M. RAY DENNY FRANCES M. GREENE RATHE KARRER MELVIN E. KAUFMAN R. LAFON HERBERT J. PREHM BRYAN E. SHEPP MURRAY SIDMAN HERMAN H. SPITZ MANNY STERNLICHT LAWRENCE T . STODDARD FRANK D. TURRISI

International Review of

RESEARCH I N MENTAL RETARDATION EDITED BY

N O R M A N R . ELLIS DEPARTMENT OF PSYCHOLOGY UNIVERSITY OF ALABAMA UNIVERSITY, ALABAMA

VOLUME 2

CONSULTING EDITORS FOR THIS VOLUME

Sidney W. Bijou UNIVERSITY OF ILLINOIS URBANA, ILLINOIS

Neil O’Connor THE MAUDSLEY HOSPITAL LONDON, ENGLAND

Ivar Arnljot Bjorgen UNIVERSITY OF OSLO OSLO, NORWAY

Edward Zigler YALE UNIVERSITY NEW HAVEN. CONNECTICUT

1966

ACADEMIC PRESS A Subsldlery of Hercourt Brace Jovenovlch. Publlshers

N e w York

London Toronto Sydney S r n Frrnclmco

COPYRIGHT @ 1966, BY ACADEMIC PRESSINC. ALL RIGHTS W E R V E D . NO PART OF THIS BOOK MAY BE REPRODUCED IN ANY FORM, BY PHOTOSTAT, MICROFILM, OR ANY

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ACADEMIC PRESS INC. 111 Fifth Avenue, New York, New York 10003

United Kingdom Editiori published by ACADEMIC PRESS, INC. (LONDON) LTD. 24/28 Oval Road, London NWl

LIBRARY OF CONGRESS CATALOG CARDNUMBER: 65-28627

PRINTED IN THE UNITED STATES OF AMERICA

808182

9 8 7 6 5 4 3

List of Contributors Numbers in parentheses indicate the pages on which the authors’ contributions begin.

IVARARNLJOT BJORGEN, University of Oslo, Oslo, Norway (241) J . CHABANIER, Mtdecin Attacht h la Clinique des Maladies Mentales et Nerveuses. Hbpital Saint Charles, Montpellier, France (253)

M, RAYDENNY,Department of Psychology, Michigan State University, East Lansing, Michigan ( I ) FRANCES M. GREENE, Department of Psychology, University of Washington, Seattle, Washington (209) RATHEKARRER, Research Department, T h e Training School at Vineland, Vineland, New Jersey (57) MELVIN E. KAUFMAN,University of Wisconsin, Madison, Wisconsin (123) R. LAFON,Centre Hospitalier et Universitaire, Montpellier, France (253) HERBERT J . PREHM,School of Education, University of Oregon, Eugene, Oregon (123) BRYANE. SHEPP, Walter S. Hunter Laboratory of Psychology, Brown University, Providence, Rhode Island (85) MURRAY SIDMAN, Joseph P. Kennedy, Jr. Laboratories for Research i n Mental Retardation, Neurology Service, Massachusetts General Hospital, Boston, Massachusetts (151) HERMAN H. SPITZ,Research Department, Edward R. Johnstone Training and Research Center, Bordentown, New Jersey (29) MANNY STERNLICHT, Department of Psychology, Yeshiva University, N e w York, New York (279) LAWRENCE T . STODDARD, Joseph P. Kennedy, Jr. Laboratories for Research in Mental Retardation, Neurology Service, Massachusetts General Hospital, Boston, Massachusetts (151) FRANKD. TURRISI, Walter S. Hunter Laboratory of Psychology, Brown University, Providence, Rhode Island (85) V

This Page Intentionally Left Blank

Preface The main purpose of this serial publication is to provide a ready source of current information on research and theory development in the field of mental retardation. Moreover, it may serve as a stimulant or catalyst for future investigation. Although Volume 1 contained contributions deriving mainly from the United States, this one and those to follow will be international in scope. The chapters in this volume by Bjorgen and Lafon and Chabanier are not intended as technical descrip tions of research or theoretical treatises, rather their purpose is to suggest the extent and types of activities going on in the different countries, including research and service functions. As may be evident in Volume 1 and in this issue, problem areas treated vary widely. Although the focus is mainly on basic behavioral research and theory some more applied topics are considered. Also, biological, educational, and sociological issues may receive attention from time to time. Usually contributions are received by invitation; however, unsolicited manuscripts will be considered. I wish to express appreciation to the consulting editors and to the following for reading the manuscript critically: D. A. R. Peyman (Bryce Hospital, Tuscaloosa, Alabama) and H. C. Rickard and Paul S. Siege1 (University of Alabama). University, Alabama November, 1966

NORMAN R. ELLIS

vii


Contents List of Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

V

....................................................................

vii

Contents of Previous Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

xiii

Preface

A Theoretical Analysis and Its Application to Training the Mentally Retarded

M. RAY DENNY I. The Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ 1 11. Deficits of the Mentally Retarded . . . . . . . .............. 5 6 111. The Optimal Conditions ........................................ 9 IV. The Training Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . V. Future Directions . . . . . . . . . . . . . . . . . . . . ........... 19 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

The Role of Input Organization in the learning and Memory of Mental Retardates

HERMAN H. SPITZ ......

I. Introduction

....................

11. Symmetry-yrtemmyS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

111. Verbal Learn ......................................... ..... IV. Digit Recall ................................................... V. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..

29 30 34 48

52 54

Autonomic Nervous System Functions and Behavior: A Review of Experimental Studies with Mental Defectives

RATHEKARRER I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IV. Summary ............................................................ References ...........................................................

ix

57 58

75 79 80

Con tents

X

learning and Transfer of Mediating Responses in Discriminative Learning

.

BRYANE. SHEPPand FRANKD TURRISI I . General Procedures ................................................... I1 Theories of Discriminative Learning .................................. I11. Experimental Tests of Two-Stage Theories ............................ IV Experiments Involving Transfer of Both the Mediating and the Instrumental Responses .................................... V Some Methodological Problems in Transfer Studies .................... VI Summary and Conclusions .......................................... References ...........................................................

. . . .

86 92 97 104 113 116 120

A Review of Research on learning Sets and Transfer of Training in Mental Defectives

.

MELVINE KAUFMAN and HERBERT J . PREHM I.

.

I1

Learning Sets ........................................................ Transfer of Training ................................................ References ..........................................................

123 137 147

Programming Perception and learning for Retarded Children

.

MURRAYSIDMANand LAWRENCE T STODDARD

. . .

I General Methodology ................................................ I1 . The Circle-Ellipse Discrimination .................................... 111 The Circle-Ellipse Difference Threshold .............................. IV The Reversal of the Discrimination .................................... References ...........................................................

152 157 187 197 207

Programmed Instruction Techniques for the Mentally Retarded

FRANCESM. GREENE

. . 111. IV. I I1

General Surveys and Reviews .......................................... Research in which the Retarded Served as Ss .......................... Related Work ........................................................ Discussion and Evaluation ............................................ References ...........................................................

210 210 228 231 236

Some Aspects of the Research on Mental Retardation in Norway

IVARARNLJOTBJORGEN

. . 111. IV . V. I

Introduction

.........................................................

I1 The Retarded in Norway

.............................................

Research Possibilities ................................................. Some Aspects of the Research ........................................ Summary ............................................................

241 242 242 243 252

Contents

xi

Research on Mental Deficiency During the Last Decade in France

.

R . LAFONand J CHABANIER

. Introduction

I I1

. 111.

......................................................... 253 Research Dealing with the Education. Social Integration. and Treatment of the Mentally Deficient ............................ 255 Research Concerned with the Nature of Mental Deficiency . . . . . . . . . . . . . . 261 271 Bibliography .........................................................

Psychotherapeutic Procedures with the Retarded

MANNYSTERNLICHT

.

279

.

284 347 349

Introduction ......................................................... Specific Psychotherapeutic Procedures Available for Use with Retardates .................................................... 111 Conclusions .......................................................... References ...........................................................

I I1

.

........................................................

355

Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

363

Author Index


Contents of Previous Volume Volume 1

A Functional Analysis of Retarded Development W. BIJOU SIDNEY Classical Conditioning and Discrimination Learning Research with the Mentally Retarded LEONARD E. Ross The Structure of Intellect in the Mental Retardate HARVEY F. DINCMAN AND C. EDWARD MEYERS Research on Personality Structure in the Retardate ZICLER EDWARD Experience and the Development of Adaptive Behavior H. CARLHAYWOOD AND JACK T. TAPP A Research Program on the Psychological Effects of Brain Lesions in Human Beings RALPHM. REITAN Long-Term Memory in Mental Retardation M. BELMONT

JOHN

The Behavior of Moderately and Severely Retarded Persons E. SPRADLIN AND FREDERIC L. GIRARDEAU

JOSEPH

Author Index-Subject Index

...

Xlll


International Review of

RESEARCH IN MENTAL RETARDATION VOLUME 2


A Theoretical Analysis and Its Application to Training the Mentally Retarded M. R A Y D E N N Y DEPARTMENT OF PSYCHOLOGY, MICHIGAN STATE UNIVERSITY, EAST LANSING, MICHIGAN

I. The Theory

..........................................

..................... ............................. ................................

11. Deficits of the Mentally Retarded 111. The Optimal Conditions

IV. The Training Method A. Description of Apparatus ........................ B. General Procedure ............................... C. Procedural Notes and Precautions ................ D. Assessment ...................................... V. Future Directions .................................... Appendix ............................................ References ...........................................

1 5 6 9 10 11 16

18 19 20 26

Basically, this chapter will present a theory and attempt to apply its principles to the problem of training the mentally retarded. After a discussion of the theory, particularly as it applies to human learning, the deficits and processes peculiar to the retardate will be considered. This will be followed by a section on application which will refer to other techniques that have been used as well as to future possibilities for educating or training the retarded. 1. THE THEORY

T h e theory has been labeled elicitation theory (Denny & Adelman, 1955), but will go unlabeled from this point forward. T h e label has not caught on, the theory is not well known, and it does not seem to be very well understood by those who have heard of it. In good part this is because the original published treatment was brief and incomplete, and subsequent references to concepts and principles of the theory have been scattered and briefer still. 1

2

hf. Ray Denny

By and large, the approach is a comprehensive theory of behavior which borrows heavily from Hull, Guthrie, Tolman, and Skinner and hopefully represents a rapprochement or integration of the neobehavioristic schools (the author is aware that such “messianic” theories are n o longer in fashion but doubts that this is critical). On the contemporary scene there are certain similarities between this theory and theories of Premack (1959) and Amsel (1962). This general theory avoids the use of hypothetical concepts or intervening variables and depends on a continual, detailed analysis of stimulus and response for the explanation and prediction of behavior. T h e main abstract concepts employed are stimulus (S) and response (R) and the relationship between them, response tendency (S-R). Put bluntly, these constructs are the only ones involved in the statement of S-R laws and thus the only concepts needed in an S-R behavior theory. Put even more bluntly, intervening variables are considered to be expressions of either ignorance or indolence. Stimulus and response are defined a t considerable length in the appendix of this chapter, where, for the sake of continuity and efficiency, all of the major postulates and concepts of the theory have been relegated. At this juncture let us focus on those aspects of the theory that are most relevant for the task as outlined, namely, on the variables which facilitate the establishment or strengthening of a relatively permanent response tendency. I n a capsule, the theory is a contiguity position which emphasizes the importance both of incentives and the removal of incentives as consistent elicitors (unconditioned stimuli) of the to-be-learned response. Stated more formally, learning depends o n the consistent elicitation of a particular class of responses in close temporal contiguity with the stimulus(i) in question. When fully analyzed, this single statement has a number of important implications. (a) T h e learning of a diflerential response depends specifically on the elimination or minimization of competing responses in the presence of the cue stimuli. T h a t is, the response which is learned, or, put another way, the response which wins out over other possible responses only does so if it occurs to the relative exclusion of other responses. Let us take a rat learning a T-maze as a classic example. T h e maze is a novel stimulus situation which elicits exploratory behavior (alley traversal), but on this count alone n o portion of the maze elicits approach more than any other portion of the maze. Thus, no learning of a differential response occurs without the presence of an incentive in the goal box. When the rat is simply exploring, learning in the sense of cue familiarity (perceptual learning) doubtless occurs and follows from the postulates of the theory. Learning as we typically identify it in the laboratory, e.g., learning to

A THEORETICAL ANALYSIS

3

turn right in the T-maze, does not occur until a consistent elicitor such as food for a hungry rat has been introduced into the goal box at the end of the right alley. (b) Even with the incentive present, one might argue that the rat turns right and left about equally often over the early trials. So how is it possible to say that one response has occurred to the relative exclusion of the other? The answer to this question is that the initial stimulus situation with which we are concerned is the goal region. Here there is a consistently elicited response, namely, approach to the food. Thus, approach becomes conditioned to the cues just preceding arrival at the food tray. (c) When this has happened, the cues in the goal area serve as a functional UCS or elicitor of approach. Thus, approach in turn gets conditioned to the cues just preceding the functional UCS; after these cues (those near the goal but not in the goal area) have been conditioned to elicit approach, they in turn serve as a functional UCS to mediate the learning of approach responses to cues which are still farther away from the goal and so on and so on. In this “back-chaining” fashion (analogous to higher order conditioning) approach is soon conditioned all the way back to the cues on the right side of t,he choice point. (d) Up to this point in the analysis the response being learned is most appropriately classified as approach to the cues on the right side of the maze. As back-chaining continues through the choice-point area and down the stem, the relevant cues or SDs become kinesthetic in nature, and the rat ultimately starts to turn in the correct direction before arriving at the choice point. At this stage of learning, but not before, the differential response can be appropriately classified as a right turn response. An analysis of the events that are postulated to occur on the wrong end of the maze is also relevant. Presumably, avoidance of the wrong side of the maze gets conditioned in a similar back-chaining fashion. Here the original elicitor or UCS is the absence of the incentive in the wrong end .box (frustration instigation of escape-type behavior). Approach and avoidance summate to produce the total learned effect (Denny & Dunham, 1951). In this particular derivation of a learned differential response, the food incentive (reinforcement) is an essential variable. But the reinforcement is not functioning within the traditional Thorndikian framework. T h e reinforcer is not directly strengthening the bond or association between a prior response and the preceding stimulus situation. A reinforcement, if one chooses to use this term, does not act back in time, per the law of effect, but occurs simultaneously with the elicitation of the response. In other words, a reinforcer is effective because it is an incentive or ‘‘bribe,” not because it is a reward (the term reward refers more to past

4

M . Ray Denny

behavior, the term incentive more to future behavior). Put still another way, a reinforcement is important because it gets the organism to make the response that the experimenter (instructor) has designated to be learned. I n this connection, at least, the theory is like that of Tolman. From this analysis of reinforcement it is now possible to see why learning in lower animals seems only to occur when reinforcement is present. Since it is impossible to tell a rat (or a n elephant) what to d o or what to learn, we are left with the indirect. method of using incentives or reinforcers: the hungry rat goes to the right side of the T-maze consistently because that’s where the food is. T h e clear implication here is that learning can, and very frequently does, occur in human beings without “reinforcement.” And this is precisely the theme of this chapter. This is not to say that the consequences or contingencies of a response are unimportant but that the role of these contingencies requires retranslation. There is no real contradiction between the elicitation framework and the principle of reinforcement as it is applied, for example, by the operant conditioning group. T h e consequences of the behavior are frequently critical; the theoretical difference is that the operant response (bar-press, key-peck, right turn in maze), according to the present theory, is learned primarily because its attendant kinesthesis, particularly in the incipient phase, is a discriminative stimulus for the subsequent response in the chain. T h e subject, in other words, supplies himself with the relevant SD rather than having someone else do it, for instance, by turning a light on or off. I n essence, this is like saying that all instrumental responses are like observing responses (Wyckoff, 1952) except that the distinctive S D is usually interoceptive rather than exteroceptive. But this way of looking at learning does mean that new dimensions for learning are possible. Learning can proceed just as well on the basis of imitation. prompting, or instructions (Bandura & Walters, 1963; Stolurow & Lippert, 1964; Hawker, 1964). And instructions about the contingency of certain behaviors can, in concert with reinforcement, emphasize the discriminative role of the to-be-learned response and thereby facilitate the learning process, as observed by Ayllon and Azrin (1964) in modifying schizophrenic behavior. This theme may be extended by pointing out that many parameters of learning simply constitute ways in which the situation can be arranged so that the organism makes or continues to make the designated response. For example, distribution of practice can function this way in terms of reducing all kinds of satiation effects, preserving the integrity of the UCS or reinforcer by eliminating competing responses to “fresher” stimuli. Knowledge of results can be thought of as serving both to identify the correct response and to Keep the human subject motivated (re-


5

sponding or paying attention to the relevant stimuli). Other examples of such an interpretation of the function of certain learning parameters are embedded in later discussions. 11. DEFICITS O F THE MENTALLY RETARDED

Even though the mentally retarded appear to have a learning deficit [slower learning and poorer short-term retention than normals (Ellis, 1963)], it is important to point out that the mentally retarded can learn a variety of responses sometimes almost as well as normals of equivalent chronological age. In the same vein, there is little available evidence of an appreciable deficit in long-term retention when the mentally retarded are compared with normals, provided the two are matched on original learning (Denny, 1964). On the other hand, they clearly exhibit a number of deficits which relate both to learning and general functioning. One of the most basic deficits seems to involve duration of attention (Zeaman & House, 1963; Denny, 1964). Presumably, the retarded lack the self-initiated sets which typically make for consistent and continued responding in the normal. They tend to be more stimulus bound than the normal-more at the beck and call of each and every stimulus change (Denny, 1964). One apparent consequence of the attention deficit is a special kind of incidental learning deficit. When the mentally retarded are sufficiently well instructed or guided, as under intentional learning conditions, they often do not show a learning deficit. But when retarded children are unwittingly posed with a learning task which is not only incidental but requires responding to the same set of stimuli for 10 to 15 sec before the critical item appears and becomes learnable, then they show a marked deficit, whereas object or color identification which can be learned incidentally with a single glance may not show any deficit at all (Singer, 1964). Such a deficit could lead to large gaps in language development. When simply responding to the stimuli about them, as in the ordinary course of events, mentally retarded children would probably encounter special difficulty in learning the meaning of relational or prepositional terms such as behind, through, around, over, etc. A few seconds are required to walk around a tree or for a ball to roll through a pipe. Thus, unless attention were maintained with respect to the relevant stimuli, the meaning of such concepts could hardly be learned. In addition, the retarded appear to have a generalized deficit with respect to language behavior, which probably stems from the subtle character of verbal cues as well as from basic attentional and motiva-

6

M. Ray Denny

tional deficits. Both the attention deficit and the verbal (symbolic) deficit may in turn be related to what I call an inhibition deficit. T h e relative inability of the retarded to inhibit responses as exhibited in slow rates of extinction and special susceptibility to disinhibition (Denny, 1964) may, in part at least, account for short attention spans; since the mentally retarded cannot readily block out (inhibit) the eliciting effects of other stimuli they do not attend to any set of stimuli for an appreciable period of time. In language behavior, the inhibition deficit is especially prominent with respect to the mental retardate’s difficulty in following “do not” o r “don’t’’ instructions and may account for poor concept learning with respect to difficulty in learning to discriminate the common elements from the irrelevant elements. Other deficits which are consistently revealed i n the retarded include delayed response and simple reaction time. Theoretically, both of these can be related to a lack of ability to maintain self-initiated sets (attention deficit), and a deficit in delayed response can also be related to a deficit in short-term memory or speed of learning (little or n o learning in one trial). To sum up, the deficits of the mentally retarded include deficits in duration of attention, symbolic behavior, inhibition, and delayed response. T h e training methods which will soon be discussed represent a frontal attack on all of these, with a special emphasis on learning the meaning of relational terms. T h e retarded tend not to learn such terms incidentally, but they should be able to learn them intentionally, given optimal conditions. Concomitantly, many other skills and behaviors should be learned. 111. THE OPTIMAL CONDITIONS

T h e concepts and principles which are exploited in training the retarded are enumerated below in order of emphasis. OR 1. ELICITATION

SPECIFICATION OF THE CORRECT

RESPONSE

T h e main principle is to insure the eliciting of the to-be-learned response without evoking competing or wrong responses (keep wrong responses to a minimum). T h e liberal use of stimuli (“crutch cues”) for eliciting the correct response includes prompting, guidance, fading, and matching-to-sample. Once the correct response is established the crutch cues are eliminated and training is continued. T h e prevention of incorrect respcjnses early in learning is achieved by using barriers. With all response alternatives barricaded except the correct alternative, the child can only make the correct response. I n the early stages, when train-


7

ing the child to inhibit to “do not” instructions the same end is achieved by using the one barrier that prevents the child from making the incorrect response. All other alternatives are available.

2. IMMEDIATE KNOWLEDGE OF RESULTS Knowledge of results (KR) directly supplements the elicitation principle above and is probably most important in the later stages of learning when error is permitted. For the correct response, KR includes a light followed quickly by tokens and incentives such as candy, trading cards, paper money, gum, etc. T h e incentives, as well as the light and tokens, serve to indicate when a correct response has been made and thus specify the correct response for a given concept (verbal command). For the incorrect response, KR means telling the child “No” or “Wrong” and permitting him to correct his response until right. Correction of the wrong response has receiitly been shown to facilitate even the learning of normal children (Suppes & Ginsberg, 1962).

3. DIFFERENTIAL FEEDBACK T he learning of the meaning of certain concepts is based on the presence of immediate feedback which is directly relevant to the meaning being learned. Th e feedback can be any combination of kinesthetic, visual, tactual, and auditory stimuli. Such stimuli provide built-in KR to indicate whether or not the associated response was appropriate. For example, when the subject is learning the concept of behind he actually puts a pointer out of sight behind the stimulus object in question. Or when he learns the concept of through he actually pushes the response bar through colored tissue paper, hearing, seeing, and feeling the bar tear through the paper. During the early training stage for a particular concept, the experimenter may on occasion supplement the built-in feedback with such comments as “That is right, you just went through yellow,” just as might happen in real life. I n the late stage the experimenter might better ask the subject himself to verbalize “through yellow.” 4.

STIMULUS GENERALIZATION AND POSITIVE TRANSFER

Positive transfer is maximized by training the meaning of each concept in many different contexts (with a variety of teachers or experimenters, a variety of commands, a variety of object-stimuli present, etc.). Transfer is also promoted by using a wide variety of different versions of the same stimulus quality or object (e.g., several different shades and tints of green are represented by many different objects in different contexts). In concept training, the response that is generalized is actually inhibitory

a

M . Ray Denny

in nature; this means that the nonessential elements or contextual cues tend to remain irrelevant so that the cues relevant to the concept continue to elicit the appropriate response (concept). In the later stages of training, stimulus generalization can be mediated through the establishment of verbal mediators. This can be done by training the subject to verbalize the concept or verbalize about the concept he is using. This can also be accomplished when the subject verbalizes in order to delay a response successfully. 5. DISTRIBUTED REPETITION AND POSITIVE TRANSFER The retarded appear to benefit more from repeat,ed presentations (trials) during original learning (overlearning) than do normals, and like normals, this repetition gives the biggest return when it is fairly well spaced within a session and across sessions. Such a procedure permits many different stimulus elements to participate in the control of the appropriate response (meaning). With the repeated use of many different stimulus contexts, the effects of stimulus generalization are greatly increased, and transfer becomes possible. 6. STIMULUS RANDOMIZATION Only one aspect of the total stimulus situation should be a consistently relevant cue over a series of like commands. This means that all other possible cues such as position, shape or size of slot, etc., must be randomized (switched around). To repeat, i t is mandatory that the correct response occur in consistent association with one and the same cue over a series of like commands. (The only exception here would be the use of synonyms.) Otherwise, no specific meaning can be learned for the concept presented. In this connection it is clear that commands must also be unambiguous (refer to only a single possible alternative). A basic assumption of this training program is that the child must be given the clear opportunity to select the appropriate or relevant cue from a variety of irrelevant cues in order to learn the meaning of concepts. At this point the present recommendations may depart from conventional training methods with the retarded, at least as the present writer sees them. Traditionally, the learning situation has been made so simple that there is only one main cue, and each trial is just like the last one. Such a procedure merely reinforces the already concretized behavior of the retardate. Put the child in another situation or change the context and he is lost.

7. MOTIVATION (ELICITATION HIERARCHY) To get the child to make the appropriate responses and maintain these responses without making alternative responses (wandering atten-

A THEORETICAI. ANAI.YSIS

9

tion), he must be interested and remain interested in the task. Incentives such as candy, gum, trading cards, etc., can be user1 to help accomplish this purpose. Variety of stimulus presentation antl both variety and increased intensity of vocal command can be used to counteract boredom and keep motivation high (loud commands with dramatic gestures and the use of a megaphone or whistle are recommended when needed). See the concept of elicitation hierarchy in the appendix. 8. SEQUENTIAL BUILDING First things first; build in easy steps on what has already been learned, i.e., take advantage of positive transfer. T h e specific sequence selected is not particularly important so long as it follows the sequential precept. Where you start antl which direction you take will depend a great deal on the child. Start and proceed where the child finds i t relatively easy to learn. IV. THE TRAINING METHOD T h e various recommendations, strategies, and evaluations which are presented below and which round out the suggested training procedures are primarily a distillation of 10 weeks of working intensively with three mongoloid children (IQ approximately 20-30) during the winter and spring of 1961. Two of the retardates were girls, age 15 and 16, and the boy was 8 years of age. All three were then living in the Central Wisconsin Colony and Training School, Madison, Wisconsin, and were worked with there. I n addition, during the spring of the same year, I worked intensively for a period of 6 weeks with five noninstitutionalized children (age 6-9, IQ approximately 20-70). Most of these children were not mongoloid and all were attending “preschool” at the Child Development Center, Milwaukee, Wisc0nsin.l Finally, three severely retarded children (age 6-16) and one young adult girl have been worked with lairly intensively during the past year at Howell State Hoipital, Howell, Michigan.2 I n this current project I have not been personally involved in training any of the children but have supervised a number of undergraduate antl graduate students a t Michigan State University who, for one or more terms, have each devoted one morning or one afternoon a week to training these four retardates. Recently, eight more retarded childen have been added to the project, including lour matched control 1 The work in Wisconsin was supported by the Jewish Vocational Service, Milwaukee. Wisconsin, under the auspices of Michael Galazan, Director. 2 The work at Howell is being supported by the Human Learning Research Institutc, Michigan State University and Department of Mental Health, State of Michigan.

subjects who will not be trained but will be played with and talked to. To date, however, all of these studies are patently exploratory and have yielded little systematic or quantifiable data. Periodic tests of transfer and retention in real-life situations now being administered every 6 weeks are only gradually remedying this situation. I n general, however, we can assert that the majority of the children with whom the methods have been tried have learned and in most instances have retained and transferred what they have learned to markedly different real-life situations. A. Description of Apparatus

T h e teaching device is called a multiple differential response and feedback apparatus (MUDKAFA). A photograph is presented in Fig. 1.

FIG. 1. MUDRAFA with subject and two experimenters.

T h e boxlike structure is approximately a 2-foot cube with a crosslike aperture in the slanting front panel. Extending through the aperture is a movable bar (hollow rod). In its neutral position the bar is at, the center of the cross. T h e slots differ in length and width, and two of them are clear plastic along the length of one side. Such a structure provides conjointly for differential responding and differential feedback as de-


11

scribed below. I n the original device, the lower right-hand corner contained a light and directly below the light a reward tray. T h e light consistently came on immediately after the subject made the correct response and stayed on until a token or reward object tumbled into the tray. In the current device, the light is inside the large translucent plastic knob at the subject end of the bar, providing close spatial association as well as close temporal association with the correct response (or stimulus). T h e panel through which the crosslike aperture has been cut can be a flannel board (cross-panel) upon which all sorts of object-stimuli can be placed, either at the ends of the slots or along the sides of the slots, so that a variety of responding can take place; or the panel can be smooth and the stimuli readily attached or detached by using Tacki Wax either on the board or on the back of the stimuli. T h e subject can place the bar directly above a stimulus, directly below a stimulus, or right next to a stimulus, and go toward a stimulus, or from a stimulus. By means of a removable pointer attached to the bar, a subject can place the pointer in front of a stimulus or out of sight behind any stimulus which has been placed on one of the clear plastic surfaces. I n addition to traversing all four slots the bar may be pushed in or pulled out and in either the pulled-out or pushed-in position can be turned to the left or to the right. Again, this provides for a wide variety of responding to stimuli with a wide variety of placements, as, for example, permitting the subject to go behind a stimulus regardless of its position or placement. T h e cross-panel is independent of the rest of the front panel and can be rotated readily into any one of four orientations. This prevents the presence of any particular slot, such as the wide slot, from always being in a particular position, for instance, at the bottom of the board. Rotation can be facilitated by using a circular cross-panel which can be turned without removing it. Rotation of the board, however, does not have to be done too frequently, Once or twice a day (session) appears sufficient,. Crutch cues can be presented by the experimenter in a card-holding device above the flannel board or by means of a roulette wheel on the table. T h e latter device is operated by the subject (thus, on occasion the subject can in a sense determine what is to be practiced on the next trial). With most subjects the roulette wheel (subject-designated task) is used sparingly because the subjects respond better to clear, loud instructions. B. General Procedure

To begin with, the subject is kept with the apparatus for no more than 4 or 5 min. It is essential to quit before the subject is obviously losing attention or getting bored with the task. Ilf one continues until

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the subject is bored, all that can happen is for him to be conditioned to dislike or avoid the situation, the last thing desired. During the initial stages, each concept in a block is practiced a considerable number of times before going on to new blocks of concepts. T h e first block typically consists of only two concepts, such as instructing the subject on different trials to go u p and to go down, or to go right and to go left, or to push in and pull out. T h e crutch cues at this point include large printed arrows, gestures, or manual guidance. Thereafter, the experimenter can usually employ more than two concepts in a session, though never very many until most are well learned. T h e concepts or verbal commands are presented in a scrambled fashion to facilitate discrimination and minimize stimulus satiation (boredom). T h e commands are also repeated in a variety of ways, often as questions, and with a variety of intonations; there is no need in the early stages to work for mastery because all of the commands or questions are repeated many times in a variety of stimulus contexts later on. As the subject shows interest in MUDRAFA and in responding to the verbal commands, the time with the machine is gradually increased. If the subject shows clear interest, the session can be as long as 3 5 4 0 min. During the initial presentation of each concept, it is essential to control response specification, that is, a barrier must be placed at the entrance of each incorrect slot. When the correct response occurs with a fairly short latency, the other alternatives (slots) are opened up, one at a time, until finally the subject is able to respond in any one of four different directions; and as practice continues, the number of irrelevant stimuli on the board can be appreciably increased. If errors recur to any extent, the barriers are reintroduced and training proceeds accordingly. After the first few blocks of responses (up, down, push, pull, etc.), are fairly well learned, the experimenter proceeds to the next group of commands which usually involves the length and width of the slots of the cross pong versus short and wide versus thin (skinny o r narrow)]. Next may come learning to turn (rotate) the bar to the right or left. Interspersed during this period are commands from the previous blocks as well. After this last group of concepts is fairly well learned, the experimenter can probably turn to color concepts. Here the use of crutch cues or matching-to-sample is particularly important. T h e crutch C U P can be presented by either method mentioned above while the experimenter says, “ G o to red (green, yellow, blue), go to the one that looks like this (pointing to the sample).” T h e subject responds correctly by pushing the bar along the slot ending at a patch of color like the color of the sample, and initially this is the only traversable slot. If colors


.

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are difficult for the subject, which is often the case, discontinue their use until much later, and then train in a less concentrated fashion. Once the meaning of three or four colors or simple object-stimuli (pictures of domestic animals, birds, buildings, people, common household articles, toys, plants and trees, parts of the body, vehicles, et,c.) has been established or is already available, it becomes possible to focus on the prepositional concepts. Discriminated stimuli can now be placed on the front panel so that the subject can go between stimuli, under stimuli, next to stimuli, etc. In succeeding sessions, one or two new object-stimuli and one or two new prepositions are concomitantly introduced as the earlier prepositional concepts become learned. Fairly soon the meaning of the word stop, if not already present, must be established. This enables the experimenter to work more precisely with many prepositions in terms of such instructions as, “Stop between the trees,” “Stop behind the apple,” etc. I n training the meaning of prepositions, the following representative procedures are suggested. (a) For the concept of through attach colored tissue paper across a slot and place a patch of the same color at the end of another slot which the subject could also go to (toward). Tell the child, “Go through yeZEow (blue, red, green),” employing appropriate dramatic gestures and direct manual guidance if necessary. Such “crutches” may be needed on the first trial even though the barriers prevent incorrect responding. The purpose of the additional patch of color which the subject can also approach is to insure stimulus control by the word through rather than the color concept. This discrimination is further established with the removal of the barriers. Over many trials, various colors of tissue paper are fixed across several different slots in all four orientations (such a diversification of stimuli and contexts is, of course, carried out with all concepts). Feathers, fringe, and brush bristles fixed across a slot can be used to supplement the colored tissue paper. These in turn can be supplemented with pictures or drawings (in series and with arrows) to help teach the concept of through (pictures or drawings can be used to help teach all of the relational concepts). (b) For the concept of behind, the pointer or arrowhead is attached to the bar just in front of the cross-panel. When the bar is pushed in, the pointer fits behind the panel and can be moved along a plastic-edged slot until it disappears from sight (wholly or in part) behind the specified stimulus object. There the subject is supposed to stop the eointer. Obviously, the meaning of “push,” “stop,” and “turn” (right and left) need to be well established prior to training the meaning of behind. (c) The concepts of ofj and on, like a few others, represent a departure from responding mainly with the bar. The subject is instructed to take

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a particular stimulus ofl the board and to place a particular stimulus on the board, often from a pool of stimuli placed in front of him. On,in particular, lends itself to combinations with many other concepts: “on the bottom, on the right, on the board and beneath or beside the boy, etc.” (d) T h e concept of away from s e e m best taught by using only one alternative slot-the one which is directly opposite the stimulus (slot) which the subject is requested to move away from. (e) T h e concept of different from is in part taught by using three identical stimuli, one at the end of each of three slots, and one stimulus which is different from the other three (for all concepts, training is usually facilitated when identical multiples of each stimulus are available). Forms (square, circle, triangle, and cross) and other materials which permit tactual-kinesthetic exploration are also introduced. interspersed with previously learned mat.eria1. T h e tactual materials used include rough sandpaper and the same grade of sandpaper covered with clear plastic. This arrangement minimizes the role of visual cues and facilitates the training of the concepts of rough and smooth. T h e child rubs each stimulus on the cross-board with his fingertips and is then instructed to go to the one which is smooth (rough). I n the same way, hard objects, soft objects, slanting objects, flat objects, pointed objects, blunt objects, etc., can be used to teach the appropriate meanings. In this connection, stiff, fuzzy pipe cleaners (plain and colored) provide rich tactual feedback and make ideal stimuli for teaching such concepts as straight, crooked, curved, folded, slanting, straight u p and down, lying flat, bent, etc. Later on, if the subject reaches this level, letters (words) can be formed with pipe cleaners and thus tactually and kinesthetically explored by the subject. At about this point i n training, it is appropriate to initiate the verbal control of inhibitory responses. A set of similar stimuli, such as colors, are selected, and the subject is instructed “Don’t go to red,” “Do not go to green,” etc. During the early stages of this training, a barrier is placed across the slot that the subject is not supposed to enter. All other slots are accessible. If the subject selects any one of these alternatives or keeps the bar in the neutral position for about 3 seconds after the negative verbal command, the response is considered correct and the light goes on. T h e typical subject has difficulty inhibiting his responses, but progress occurs with sufficient training. I have found it interesting to train inhibitory responses for a particular set of stimuli (e.g., colors) and test for inhibitory verbal control in the next session with a n entirely new set of stimuli (e.g., position) with all alternatives accessible (transfer test). “What is missing,” “which one is missing,” and “where is it missing” can all be trained by using masking tape to cover part of a scene, object,


15

or person, so long as more than one picture contains a patch of tape. Such omission training is deemed critical to good discrimination learning. In much the same vein, parts of objects or pictures are often selected for study rather than the whole picture. For example, in a picture of a window, reference might be made only to the flower pot or the curtains. Natural relations are also concepts which appear difficult for the mentally retarded, that is, the functions, uses, and actions that are appropriate to the stimuli on the board. These can be trained by asking the subject such command questions as “which object do you eat,” “what do you drink,” “where do you sleep,” “which one is living,” “which bird is flying,” “which bird is standing still,” etc. The relations one can employ are dictated by the nature of the stimulus objects presented and the ingenuity of the teacher or experimenter. Later in the program, multiple commands can be given. For example, “go through red, but do not reach the house,” a combination of a positive and negative command. Or, “go first to the house and then to the store,” or “go to the policeman, go to the doll, and then go to the dog.” Next, it may be possible to introduce the concept of numerosity. One, two, or three object-stimuli are placed on the board at the end of the slots. Matching-to-sample and counting of reward tokens are typically used to help this training. A wide variety of identical stimuli or objects are eventually used. About this same time, training for delayed response and the use of verbal mediators may begin. For example, a stimulus is placed on the board, the subject’s attention called to its position, the stimulus removed, and, after a delay of, for instance, 10 sec., the subject is asked to go where that particular stimulus was. The limits to successful delay are determined by using a number of different delay intervals. Then, training for the use of verbal mediators to increase the length of a successful delay is begun. The subject is encouraged to specify aloud the position of the object “at the top of the board,” “at the bottom,” “to the left or to the right,” or “in the middle.” The last position is accomplished by presenting a row of three stimuli just above the short slot when the board is oriented with a short slot upward, so that the one in the middle, the one on the left, or the one on the right can be specified and appropriately responded to. The delayed response technique can be modified by having the experimenter point to one of three or four stimuli on the board, remove them, wait a short interval, represent them on the board in a different arrangement, and then ask the subject to go to the one that he had pointed to originally. Here again the potential use of verbal mediators is exploited: the subject is instructed to say aloud the name of the object to which the experimenter points. Such instructions can be re-

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peated periodically throughout the delay. T h e implicit use of verbal mediators is finally evaluated by omitting instructions to verbalize about the stimulus or its position, testing for the limits of delayed response, and comparing this with the initial determination. Eventually, numerals in combination with numerosity are introduced. That is, the number 2 is presented in association with two dots, the number 3 in association with three apples, etc. Numerosity, if learned, acts as a crutch cue for learning numbers. Finally comes the presentation of letters and simple words which may lead eventually to simple reading. Our experience, however, indicates that symbolic stimuli produce a definite drop in motivation. One must fill in many gaps in the knowledge of the retarded child or adult before one can feel confident enough to start with letters and words. It is also quite possible that any attempt at teaching reading by means of MUDRAFA must be preceded by reading aloud amusing and interesting stories, pretty much as the normal child proceeds. It makes sense that interest in words and language should be present before one embarks upon any sort of reading program. At this stage of training, even if reading is bypassed, attempts should be made to get the subjects to w e the concepts they have been learning by having them orally describe objects and pictures. Continue practice in this direction for a long time and reinforce the subject differentially; the more complete and extensive the description, the greater the reward. C. Procedural Notes and Precautions

1. Before each day’s training session, check the apparatus to see that everything is functioning properly, rotate the cross-board, check the supply of reward objects, and have all the stimuli that you intend to go through ready for use. 2. Never permit the object-stimuli on the board to remain in the exact same position for more than two or, at the very most, three trials. The stimuli must be moved around the board in a haphazard fashion so that the subject will not confuse position or type of slot with the specific command (cue) given. 3. The exact same set of object-stimuli should not be used for more than 2 or 3 min. Introduce periodically some new stimulus (stimuli) to prevent boredom or lack of attention. If a single new stimulus is introduced, it is wise on the next trial to refrain from giving a verbal command with reference to that stimulus, otherwise the subject may respond correctly simply because his attention has been drawn to the new stimulus. 4. On successive trials, it is often advisable to repeat commands, even a number of times, so that the subject does not learn simply to do something different each time. Such a procedure also tests for correct respond-


17

ing by chance. This precaution, however, does not take precedence over the more important rule of maximizing the diversity of stimulus presentation and the diversity of verbal commands. 5. Although working with MUDRAFA is considered to be playing a game, it seems to help calling it “going to school.’’ For the retardate, this seems to give it additional status. Maintain a relaxed, friendly attit,ude at all times in your association with the subject. 6. Work with the child in a room devoid of distracting stimuli so that his attention is directed at the machine. If the child shows the least lack of interest, stop training immediately. Never attempt to pressure him into continuing. 7. The types of incentives used can vary from trial to trial by having available large samples of paper money, trading cards, Christmas cards, candy, gum, etc. New objects or trinkets, and new types of candy, can also be introduced periodically. Miniature marshmallows have good incentive value for most children, and they are easily swallowed and not too filling. Such incentives are typically supplemented with verbal or social reinforcement such as “atta girl,” “that’s good,” etc. 8. At the outset, rewards are given after each correct response. Fairly quickly, for most subjects at least, this reinforcement schedule can be shifted to one reward for every two correct responses, and soon to one reward for every third or fourth correct response. After every correct response, however, the subject receives a token, a shiny 2-inch-square tile at the present time. The subject collects these, and the collection of a certain number of tiles prior to turning them in for a reward can help with the learning of numerosity. If a subject shows evidence of disappointment or an attention lag, the reinforcement density is increased (fewer tokens required per incentive). Our research at Howell, with the severely retarded, definitely suggests that the use of tangible incentives continues to be important even when training has gone on for a period of a year. This is true even if the subject is used to collecting 10 or 12 tokens before cashing them in. Another consistent observation made at Howell by one of the student experimenters3 is that the subjects’ latency for accepting the token which the experimenter hands to him is a good criterion of when it is feasible to introduce partial reinforcement of tokens. When the child takes the token immediately after i t is presented, he is ready to collect 2 or 3 tokens per incentive. 3. When training for the concept of numerosity, the identification of 1, 2, and 3 things is explored exhaustively and well established before 3

Mr. Stanley G.Smith.

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M. Ray Denny

other items are introduced, and then additional items or objects are only introduced gradually. 10. Guidance may be used to help the subject any time throughout the learning sessions. This may consist of actual manual guidance, including pushing, pulling, turning, etc., or of pointing toward the correct stimulus together with appropriate verbal assists-anything to get the correct or appropriate response from the individual at the appropriate point in time. Guidance should be dropped as soon as feasible so that the concept acquires independent behavioral control. 11. As previously mentioned, the subject is told “no” or “wrong” when he makes an error and is permitted to correct his error(s) until the correct response occurs. Basic research on the importance of this variable in the training procedure is soon to be initiated. 12. As mentioned previously, the command or question given to the subject should never be ambiguous. For example, when the subject is told to go to the crooked one, there should not be two crooked objects on the board. Special care is often needed to prevent the occurrence of ambiguit,y; the procedure required is very similar to conducting a good ex,periment. D. Assessment

The main objective of the training program is to establish better verbal control of the severely retarded child’s behavior in a wide variety of stimulus situations. Initially this must be assessed in a piecemeal fashion with respect to learning the meaning of specific concepts. I would estimate that at least 18 months of training would be required before a noticeable dent could be made in the general performance level. During the first 2 weeks of the program, many of the severely retarded subjects learn very slowly and show poor retention, but after an initial adjustment period learning usually proceeds at an accelerated rate. I n order to begin training at a level at which the child can learn and find out what he already knows, a considerable amount of pretesting must be conducted. The results of this pretesting are also used, at least in part, as a base line for evaluating subsequent progress. Pretesting may take many sessions and preferably should be conducted in the child’s ward or other familiar surroundings where subsequent tests could also be given. Pretesting in the new (experimental) situation is inadvisable because subsequent progress might be due to the child’s becoming more and more at ease in the training situation. For the same reason the original testing should not be hurried or in any way made unpleasant. In fact, pretesting in our current program is regularly preceded by a period of 2 or 3 weeks in which experimenters and children get to know each other.

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Even if this proved to be an insufficient period for a valid pretest, it would not be crucial. With a large number of repeated tests, each test can be compared with the subsequent tests. T h e pretesting and all subsequent testing occur in real-life situations. With this method minor variations in the tests occur from subject to subject and from test period to test period but, as such, these slight variations should not detract from the validity of the measurement. More than likely they add to the generality of the results and help rule out specific memory for what was done on the prior test, for instance, 6 weeks before. T h e meaning of each concept is assessed differentially by using at least three items per concept. For example, the child might be requested to put the penny under the palper, the ball under the chair, and one foot under the other foot. Evidence that the child can identify paper, penny, chair, ball, foot, or whatever object-stimuli are eventually used is also obtained. Assessment goes on each day as well. All experimenters in the current program keep a daily record of each child's progress, noting the exact concepts worked with and how well the child proceeded. Very soon in the current program, the MUDRAFA footswitch which operates the feedback light will also record both correct and incorrect responses on electric counters. T h e daily log also contains any unusual happenings, the child's reaction to t,okens or incentive, and anything else that might be of assistance to the next person who works with the subject. T h e log is especially helpful when there is a different experimenter each day of the week. A daily checklist of the stimuli employed is also important in order to maximize stimulus diversity. In this connection, the object-stimuli (pictures) are best stored according to common categories in a small, multidrawer file cabinet. V. FUTURE DIRECTIONS

T h e present method is by n o means an isolated attempt to train the mentally retarded by means of special devices and basic learning principles. It is, however, one of the very few attempts which is directed primarily at the severely retarded on a long-range basis. It is quite significant that the other workers in the area have met with success and are generally optimistic about what might be accomplished by the use of optimal learning conditions. This is nicely seen in the case histories and research reported by Ullmann and Krasner (1965) and Krasner and Ullmann (1965). Th e most recent unpublished work in this area by Arthur Staats, Sidney Bijou, and Charles Ferster, to mention only a few, is being viewed even more optimistically, providing additional backing

M . Ray Denny

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for the kind of program which has been described in this chapter. For the most part, these other investigators have emphasized the role of reinforcement-especially its immediacy and its magnitude-which in no way conflicts with the present recommendations. The present position just says there is a lot more about which to fret. Although the retarded child's future looks brighter than a few years back, our expectations should be guarded. The present methods need further validation and improvement; many more techniques must be developed and adequately assessed; and more basic research on learning and motivation needs to be done. But even given tested techniques, we are faced with the problem of how all of this can have much of an impact on, for example, 2,000,000 retardates, According to the methods which have been described, a trained teacher, at the most,, might handle a dozen children: and each of these children would spend several years in the program. One possible solution is to automate partially, using taped verbal commands. Then, perhaps, a teacher could monitor six to eight children at a time from a control console built on a dais. Or, the whole affair might be computerized, with someone circulating continually among the students to maintain interpersonal contacts (motivation) and monitor both the equipment and the students (8 to 10). For many retardates, however, the most efficient and direct strategy seems to be the following. Many parents of the severely retarded are eager to do something for their child. It would thus seem feasible to write a detailed manual for the use of MUDRAFA, establish 2-week workshops for training the parents, and have a program in which a learning specialist or psychologist consults periodically with each parentteacher to handle the many happenings which are not anticipated by the manual, ensure the maintenance of a relaxed, game like atmosphere, assess progress, supply new ideas, etc. APPENDIX

The following definitions, postulates, and qualifying elaborations constitute the formal theory at its present stage of development. In this framework, a stimulus (S) is not an external object or a form of physical energy per se. And response (R), the response of an S-Rlaw, is not a particular movement by a particular organism at a particular moment in time. Response is response class (approach, avoidance, aggression, seeing, hearing, perplexity, bar-pressing rate, etc.): the concept of response occurrence is reserved for denoting a specific behavioral event at the data level.


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Definition 1

Stimulus as described in the procedure of an experiment or as it appears in an S-R law refers to a set of relationships rather than to a thing. So conceived, S has four defining characteristics. (a) A particular object or event, including a response occurrence, can be identified. (b) A response occurrence, in a reliable fashion, has been contingent on the presence of this object or event somewhere in the life history of a particular class of organisms. (A stimulus is potentially capable of eliciting a response. Note, the concept of elicitation has not yet been defined.) (c) A particular class of organisms, as noted in (b), is involved. (A stimulus for one class of organisms is not necessarily a stimulus for another class of organisms; 50,000 cps elicits a response in a bat but not in a human being or a dog.) (d) Wherever the distinction between afferent and efferent is appropriate for the class of organism in question, the afferent nervous system, including the projection areas as well as in general some receptor organ, is always involved. For more primitive organisms, the whole organism is involved. (When only the efferent system or a muscle is involved, the excitatory agent is properly called innervation rather than stimulus. The laws of behavior for innervation are often not the same as for stimulus.) The above clearly implies that S has a constant meaning and is consistently called S whether or not it elicits a response on any particular occasion. In order to have S-R laws (statements of constancy), S must always be S, just as P, V, and T must always have the same meaning in the ideal gas law, P V = RT. If the expected response does not occur in the presence of S, this simply means that other S’s or other variables are present and need to be taken into account. It is also clear that S is inferred rather than directly observed. A bone is inferred as an S for a dog on the basis of general knowledge or past experience; black-white is inferred as a stimulus difference for an albino rat because many discrimination learning experiments since around 1904 indicate that black can readily be discriminated from white in this class of organism. This means that a particular response occurrence, (a) above, provides just as good a basis for inferring the presence of a kinesthetic S as “an inkwell” does for a visual S. A kinesthetic S, therefore, has the same logical status as any other S: all S’s are inferred. Definition 2

Response, qua response class, is defined primarily in terms of three sets of referents: (a) a set of response occurrences for (b) a particular class of organisms where the identification of the reponse class is based on (c) some recurrent aspect of the stimulus situation. For example, if a rat

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(b) is running toward a place (a) where it has previously found food (c), then R is classified as approach. If the same running behavior (a) is observed when the rat (b) is running from a place where there is an electrified grid (c), then R is classified as escape. Another example is the following. If a human being (b) is presented with a problem (c) and responds with relevant verbal report (a), we infer problem-solving response. Even though the definitions of S and R are dependent on common kinds of referents, the concepts when appropriately used in an S-R law are not circular. Whenever R is related to S, R is defined independently of this S and S is defined independently of this R. For instance, when rate of conditioning the eyelid reflex (R,) is related to the intensity of the air puff (S), the measurement of conditioning rate is not even dependent on the presence of this air puff (test trials), much less its intensity. Classifying an air puff of a particular intensity level as a stimulus (S) is defined by the unconditioned eye blink (RJ as observed prior to the onset of conditioning or in a prior experiment with diflerent human subjects. Another common definiens of response class is a set of mathematical operations. We often speak of the mean latency of response or median amplitude of response, Such operations clearly denote the abstract nature of the concept of response. Definition 3

Elicitation is a direct or immediate relationship between stimulus and response. This relationship is asserted whenever a class of response is contingent on a class of antedating stimuli. Definition 4

The property of a stimulus (S) to elicit a response (R) is called a response tendency (S-R). POSTULATE 1. THEELICITATION HIERARCHY (a) The satiation hypothesis. By definition, all stimuli elicit response. With continued or repeated presentation, however, all stimuli lose or partially lose the property to elicit response as a decay function of the duration or frequency of presentation. The slope of this decay function varies with the nature and intensity of the stimulus, i.e., some stimuli (food for a hungry animal, shock, etc.) are more resistant to adaptation than are other classes of stimuli. With the passage of time stimuli recover their capacity to elicit a response. (b) The hierarchy. At any moment in time all stimuli impinging upon an organism are arranged in an elicitation hierarchy. These stimuli con-


23

tinually exchange places in the hierarchy because of (a) stimulus satiation effects, (b) changes in the physical intensity of a stimulus, including the magnitude of incentives, (c) changes in deprivation level, (d) the use of set-producing instructions (in human beings), and (e) basic associative changes (acquisition and extinction). POSTULATE 2. ACQUISITION (a) When an R is evoked by an eliciting stimulus (S,) in the presence of an immediately antedating S, then S acquires the tendency to elicit this R (conditioning). (b) With each elicitation of R in the presence of S, there is an increase in the response tendency (the theory leans toward an incremental strengthening position though this is not crucial). Even so, it is assumed that more and more relevant stimulus elements are conditioned to R on successive occasions. (c) Thus, when S, elicits R consistently, the learning of a differential R is possible. Corollary 1 . If conditioning is to occur to a part,icular CS,the eliciting value of the CS at some time or another must be greater than the eliciting value of other concurrent stimuli (possible competing cues). Up to a point at least, the greater the eliciting value of the CS, the faster is the conditioning. [Making an initial orienting response to the CS appears to be almost a prerequisite for conditioning t,o occur to this stimulus (Maltzman & Raskin, 1965; Sokolov, 1963), and some CS’s are much better than other CS’s (Smith, McFarland, & Taylor, 1961; Spence, Haggard, & Ross, 1958).] Corollary 2. The greater the response involvement with respect to the elicited, to-be-learned response (frequently response involvement can be equated with the eliciting value of the UCS) the better is the conditioning (Colavita, 1965; Jaynes, 1950; Spence et al., 1958). It appears impossible, for example, to condition a single, isolated reflex such as pupillary contraction, whereas it is entirely possible to condition pupillary dilation where it is part of a larger response complex (Young, 1958; Gerall, Sampson, & Boslov, 1957). POSTULATE 3. STIMULUS GENERALIZATION

Stimulus generalization is the transfer of response tendency from one stimulus complex to another. T h e magnitude of the generalization is a direct function of the proportion of effective stimulus elements common to the situations under consideration. Thus, prior to differential training, when only a limited number of effective elements are likely to be

24

M . Ray Denny

changed when switching from one stimulus complex to another, transfer is practically complete, i.e., the gradient of generalization is relatively flat. If the altered element@) is (are) made discriminative so that the remaining elements become nondifferential or irrelevant, then the gradient of generalization for the discriminative element becomes relatively steep, as the type specified by Hull (1943). In other words, typical generalization gradients are the result of discrimination training which places the brunt of response specification (stimulus control) on a particular stimulus, though high initial saliency for a stimulus element could also mediate steep gradients. Definition 5

An element is an unanalyzable part of a stimulus complex. Definition 6

A change in a stimulus element can occur along one or more of the following parameters: spatial or temporal arrangement, some quantifiable dimension, and presence or absence. 7 Etfective stimulus elements are those elements which are exclusively conditioned to the response in question. Corollary 3. Because a number of stimulus elements typically share stimulus control (or are effective), some change in the total stimulus situation can often produce decrement in performance (generalization decrement). One main source of inhibition, including both the phenomena of forgetting and experimental extinction, is generalization decrement.

Definition

POSTULATE4. SECONDARY ELICITATION The omission of a consistent elicitor (S,) from an established behavior sequence elicits a characteristic class of responses and can thus mediate the acquisition of a new response tendency. Definition 8

Omission means either a temporary or terminal removal of the S,. Temporary removal occurs, for example, when an animal enters the cul-de-sac of a maze. Terminal removal means preventing the organism from having commerce with S, on any given trial or occasion. Definition 9

Established behavior sequence means that some minimal level of learning with respect to S , must occur before the omission of S, constitutes


25

a new eliciting stimulus (conditioned anticipatory behavior with respect to S, has been established). This is the reason for the use of secondary in the term secondary elicitation. Definition 10

A characteristic class of response refer; primarily to (a) avoidance or escape-type responses elicited by the omission of positive appetitive elicitors (frustration-instigation) and (b) relaxation-approach responses either elicited by the omission of the aversive stimulus in a situation in which the aversive stimulus had previously occurred or by the removal of conditioned aversive stimuli. (The termination of an aversive unconditioned stimulus, as such, is not an example of secondary elicitation, though the same class of response is presumably elicited, namely, relaxationapproach.) Relaxation has a dual role. It is assumed to mediate the conditioning of positive, approach value to the “safe” region or “safe” period as well as mediate subsequent extinction of avoidance if and when the aversive stimulus continues to be omitted (relaxation constitutes the competing response as specified in Postulate 5). POSTULATE 5. EXPERIMENTAL EXTINCTION The inhibition of performance which is not due to generalization decrement is the result of competing response tendencies being conditioned to similar stimulus situations. The response tendency (tendencies) pitted against the original response tendency produce singly, or in vector summation, a resultant reduced effect in the original tendency as a direct function of their relative strength and degree of incompatibility. No unhooking of responses, no absolute weakening of response tendency, and no intrinsic inhibition (inhibitory drive state) are posited. The conditioning of the competing response(s) during extinction is commonly produced by secondary elicitation (Postulate 4) so that the response(s) learned during extinction is (are) usually antagonistic to the original response. Note the emphasis above on similar stimulus situations. The omission of the US or reinforcement almost automatically means that there is a cue change when there is a shift from the acquisition to extinction condition (as to response-produced cues or stimulus aftereffects). Such an emphasis makes possible the derivation of spontaneous recovery and related effects without having to posit temporary inhibitory states.

TAG ENDS (1) The mathematization of the theory, were it to occur, would involve a probability calculus. The sampling of stimuli, the transient eliciting

M. Ray Denny

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properties of stimuli, and the alteration of stimulus elements all necessitate probability considerations. (2) One emphasis of the theory is similar to Logan’s micromolar analysis of behavior (1956), namely, that the exact nature of the response elicited at a given instant in time is crucial to the analysis. T h e analysis of what response class is learned in the T-maze, as discussed in the body of this chapter, is an illustration of this point. Other examples include the studies which indicate that learning to press a light bar for a rat is not the same as learning to press a heavy bar (Maatsch, Adelman, & Denny, 1954; Stanley & Aamodt, 1954) plus the evidence that a passive avoidance response is best learned to the aversive stimulation of light, whereas an active locomotor response is best learned to the aversive stimulation of shock (Schoenfeld, 1950). REFERENCES Amsel, A. Frustrative nonreward in partial reinforcement and discrimination learning: Some recent history and a theoretical extension. Psychol. Rev., 1962, 69. 306-328. Ayllon, T.. & Azrin, N. H. Reinforcement and instructions with mental patients. J . exp. anal. Behav., 1964, 7 , 327-331. Bandura, A., & Walters, R. H. Social learning and personality deuelopment. New York: Holt, 1963. Colavita, F. B. Dual function of the US in classical salivary conditioning. J. comp. physiol. Psychol., 1965, 60, 218-222. Denny, M. R. Research in learning and performance. In H. Stevens & R. Heber (Eds.), Mental retardation: A review of research. Chicago: Univer. Chicago Press, 1964. Denny, M. R., & Adelman, H. M. Elicitation theory: I. An analysis of two typical learning situations. Psychol. Reu., 1955, 87, 317-320. Denny, M. R., & Dunham, M. D. T h e effect of differential nonreinforcement of the incorrect response on the learning of the correct response in the simple T-maze. J. exp. Psychol., 1951, 41, 382-389. Ellis, N. R. (Ed.) Handbook in mental deficiency: Psychological theory and research. New York: McGraw-Hill, 1963. Gerall, A. A., Sampson, P. B.,& Boslov, G. L. Classical conditioning of human pupillary dilation. J . exp. Psychol., 1957, 54, 467-474. Hawker, J. R. The influence of training procedure and other task variables in pairedassociate learning. J. verb. Learn. verb. Behav., 1964, 3 , 70-76. Hull, C. L. Principles of behavior. New York: Appleton, 1943. Jaynes, J. Learning a second response to a cue as a function of the magnitude of the first. J. comp. physiol. Psychol., 1950, 43, 398-408. Krasner, L., & Ullmann, L. Research in behavior modification. New York: Holt, 1965. Logan, F. A. A micromolar approach to behavior theory. Psychol. Rev., 1956, 63, 73. Maatsch, J. L., Adelman, H. M., & Denny, M. R. Effort and resistance to extinction of the bar pressing response. J . comp. physiol. Psychol., 1954, 47, 47-50. Maltzman, I., & Raskin, D. C. Effects of individual differences in the orienting reflex on conditioning and complex proceses. J. exp. Res. Pers., 1965, 1, 1-16. Premack, D. Toward empirical behavior laws: 1. Positive reinforcement. Psychol. Rev., 1959, 66, 219-233.


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Schoenfeld, W. N. An experimental approach to anxiety, escape, and avoidance behavior. In P. J. Hoch & J. Zubin (Eds.), Anxiety. New York: Grune & Stratton, 1950. Singer, R. V. Incidental and intentional learning in retarded and normal children. Unpublished Ph.D. dissertation, Michigan State Univer., 1964. Smith, 0. A,, McFarland, W. L.,& Taylor, E. Performance in a shock-avoidance situation interpreted as pseudo-conditioning. J. comp. physiol. Psychol., 1961, 54, 154157. Sokolov, Y. N. Perception and the conditioned reflex. New York: Macmillan (Pergamon), 1963. Spence, K. W., Haggard, D. F., & Ross, L. E. Intrasubject conditioning as a function of the intensity of the unconditioned stimulus. Science, 1958, 128, 774-775. Stanley, W. C., & Aamodt, M. S Force of responding during extinction as a function of force requirement during conditioning. J. comp. physiol. Psychol., 1954, 47, 462-464. Stolurow, L. M., & Lippert, H. Prompting, confirmation and overlearning in the automated teaching of a sight vocabulary. In J. P. DeCecco (Ed.), Educational technology. New York: Holt, 1964. Suppes, P., & Ginsberg, R. Application of a stimulus sampling model to children’s concept formation with and without an overt correction response. J . exp. Psychol., 1962, 63,330-336. Ullmann, L. P., & Krasner, L. Case studies in behavior modification. New York: Holt, 1965. Wyckoff, L. B., Jr. The role of observing responses in discrimination learning. Part 1. Psychol. Rev., 1952, 59,431-442. Young, F. A. Studies of pupillary conditioning. J. exp. Psychol., 1958, M, 97-110. Zeaman, D., & House!, Betty J. The role of attention in retardate discrimination learning. In N. R. Ellis (Ed.), Handbook in mental deficiency: Psychological theory and research. New York: McGraw-Hill, 1963.


The Role of Input Organization in the Learning and Memory of Mental Retardates HERMAN H. SPlTZ RESEARCH DEPARTMENT, EDWARD R. JOHNSTONE TRAINING AND RESEARCH CENTFR, BORDENTOWN, N E W JERSEY

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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11. Symmetry-yrternmyS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A. Stimulus Symmetry . . . . . . . . . . . . . . . . . . . . . . . . . B. Response Symmetry . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111. Verbal Learning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A. Clustering in Free Recall . . . . . . . . . . . . . . . . . . . . . B. Paired-Associate Learning . . . . . . . . . . . . . . . . . . . . . . IV. Digit Recall ............ ........................ Every Little "Bit" Helps . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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v . Discussion References

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32 34 36 45 48 48 52

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1. INTRODUCTION

If a pebble is thrown into a quiet pond, waves of circles will spread radially from the point of impact. Why? Why not waves of squares or rectangles? When a child uses a bubble pipe, the bubble suddenly breaks loose into a beautifully tinted, floating sphere. T h e bubble must assume this spherical shape, because its elastic membrane is striving to contract. T h e air inside is squeezed into the smallest possible area, and the shape which has the smallest possible surface is a perfect sphere. Lines of force are arced and symmetrical, whether demonstrated by belts of radiation around the earth, iron filings around a bar magnet, or phosphene measurements of the spread of excitation in the human retina (Michaels, 1957; Motokawa, 1950). Many such examples of harmonic flow in natural systems can be given. If we define organization as the tendency to symmetry, grouping, and harmony, then we may say-just as we pronounce that nature abhors a vacuum-that certain self-distributing systems prefer organized to dis-

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Herman H . Spitz

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organized states. Put another way, organization will be preferred when certain material is in such a state that either organization or disorganization can occur. The central nervous system (CNS) may be described as a self-distributing system. It is not a mere point of hookup between stimulus and response. There is a mass of evidence from perceptual studies that the CNS acts on incoming stimuli, and that one of its major activities is the organization of sensory input. We are concerned in the present chapter not with perception but with learning, yet the evidence for a central organization of material to be learned and remembered is also impressive. It was recognized in 1885 by Ebbinghaus (1885), p. 50 when he noted the . extraordinary advantage which the combined ties of meaning, rhythm, rhyme and a common language give to material to be memorised.” Children use these aids when they learn the alphabet in rhythmic, rhymed groups, as ABCDEFG HIJKLMNOP, and adults use them when they recall: 30 days has September-April, June, and November. Anecdotal examples are suggestive but hardly sufficient for the behavioral scientist. Empirical evidence for a central organizing process, however, has been accumulating, given impetus by the development of information theory and by the contributions of George Miller and his colleagues (see particularly Miller, 1956a; Miller, Galanter, & Pribram, 1960, Ch. 10). According to these theorists, the amount of information (“bits” of information) we can handle in a given instance can be increased greatly by combining bits into chunks. The chunks are recodings of the bits into organized units, usually by means of certain strategies and mnemonic devices. A related approach has always been a part of the Gestalt movement (Koffka, 1935; Kohler, 1941; Kohler, 1947). I n their view, those factorssuch as proximity, similarity, isolation, and meaning-which favor perceptual organization are said to favor association and memory as well. Memory is enhanced when the material is separated and isolated from its surround and organized into separate cohesive units. To the Gestaltists, informational bits are not nearly so important in learning and memory as the organizational agents. I‘.

.

It. SYMMETRY-YRTEMMYS

A. Stimulus Symmetry

Figures which have regularity, symmetry, and simplicity are called “good” figures by the Gestaltists, and these figures are said to be the most easily perceived and recalled (Koffka, 1935, pp. 110, 507). Experiments

THE ROLE OF INPUT ORGANIZATION

31

have given some support to these notions (see references in Spitz, 1964). and the Gestalt “laws” of perception have held u p well in studies in which there is a reduction of image motion on the retina (Heckenmueller, 1965). When images are more or less “stabilized” on the retina, the images tend to disappear. In such instances, the “good” figures-those that are smooth and round-are more likely to disappear and reappear as complete units than are irregular figures. Field symmetry and organizational effects are also noted, and the principles of closure, contiguity, and similarity receive support from these studies (Pritchard, Heron, & Hebb, 1960). T h e simplest and most symmetrical figures, after a circle, would be those that possess both horizontal and vertical mirror-image symmetry. It seems possible that in a chaotic, poorly classified world, where i t is difficult to find simplicity and organization in the mass of incoming data, retardates would be attracted LO symmetry and simplicity, and that such figures (which concomitantly have less information) would be more easily learned and remembered than more random-type figures. I n fact, it seems reasonable to expect the facilitative effects of symmetry and “goodness” to be relatively greater in retardates than in normals. Some studies relating to these problems will now be reviewed. Over the course of an experiment in which subjects made a free choice of stimuli, high-grade retardates tended more and more to choose the simple, symmetrical figures, while equal CA normals chose progressively more of the complex figures, and symmetry, rather than amount of information, appeared to be the important element influencing the choices of retarded males (Hoats, Miller, & Spitz, 1963). When a symmetrical figure was paired with an asymmetrical figure in a discrimination learning experiment, the solution was reached more rapidly when the symmetrical figure was the “correct” one. However, when the retarded Ss became experienced in a discrimination learning experiment, the superiority of the symmetrical figure no longer held (Spitz & Hoats, 1961). House (1964) carried out discrimination learning experiments using figures having “reflective” symmetry, i.e., figures with horizontal and vertical symmetry. A second type of figure possessed translatory or repetitive symmetry, i.e., the pattern formed in one quadrant was repeated in all four quadrants. House labeled this latter-type figure “asymmetrical,” although it has a certain symmetry to it. She found that when the discriminanda were pairs of “good” figures-those with reflective symmetry-retardates learned the correct figure significantly faster than when the two choices were “asymmetrical.” Once again i t was found that the type of symmetry, not the amount of information, was the crucial factor, further questioning the claims of some information theorists that redundancy plays a crucial role in symmetry (Attneave, 1955).

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Herman H . Spit%

Hyman (1965) used figures similar to those used by House and essentially confirmed her results, finding that the presence of a reflectively symmetrical pattern was an aid to the discrimination learning of retardates. However, numerosity appeared to be a stronger dimension than symmetry. In a dot pattern reproduction task, Spitz (1964) demonstrated that when the patterns were symmetrical in terms of a vertical mirror image, the retardates correctly reproduced as many patterns as did equal MA normals. However, when the patterns were asymmetrical-yet contained the same number of dots, thereby controlling numerosity-retardates correctly reproduced far fewer patterns than did normals. Time, which would allow for deterioration of the memory trace, was of no importance when compared with the crucial role played by symmetry. The results of these studies suggest that symmetry has an attraction for middle- and high-grade retardates, and that its presence in the material can facilitate their learning and recall. B. Response Symmetry

The outer structure of the human body is essentially bilaterally symmetrical. There are certain neurotic compulsives who must balance every act of their right hand by imitating with their left, and many normal children pass through a similar stage. There is some evidence that, under certain conditions, retardates respond with an exaggerated clinging to symmetry and simplicity. Gerjuoy and Gerjuoy (1964) separated institutionalized high-grade adolescent retardates into higher XQ (66-79) and lower IQ (46-61) groups. Ss were required to guess whether a “beep” or a “buzz” would sound each time E flashed a ready signal. Both IQ groups were split into a control group, receiving 100% reinforcement, and an experimental group, where Ss were differentially reinforced for various patterns of responding. Single alternation (e.g., beep-buzz-beepbuzz, etc.) was the preferred mode of response under 100% reinforcement, and whenever alternation was a possible solution the task was readily solved. The higher IQ group showed a slightly greater tendency to try other than alternation solutions under 100% reinforcement conditions, but reverted to alternation when not reinforced. Shusterman (1964) used as stimulus objects two identical black bottle tops 7+ inches apart in a modified Wisconsin General Test Apparatus. Ss were institutionalized retardates of mean MA 5.2 years 52, CA lO.l), 5.1-year-old normals, and 10.8-year-old normals. During the five pretraining and the first training trials for a subsequent probability task, selection of either stimulus was rewarded (100% reinforcement). Under

(m


33

these conditions, the majority of retardates responded with either alternation or perseveration (stayed on one side), 3-year-old normals (from another study) gave primarily perseverative responses] 5-year-old normals gave primarily response alternation, and 10-year-old normals demonstrated no one significant response tendency. Similar results were obtained by Gerjuoy and Winters (1965) using very large numbers of Ss. The stimulus material was quite different] consisting of a list of 20 simple three-letter English words, beneath each of which were two symmetrically placed, stylized Japanese characters. Under one condition] each pair of Japanese symbols was very similar; under a second condition the same symbols were re-paired to maximize intrapair differences. Ss were asked to circle the Japanese word which they guessed meant the same as the English word above it. The English words were read to all but college Ss. The amount of alternation ordered as follows: institutionalized retarded adolescents (CA range 12-18, IQ 34-92) and noninstitutionalized retarded children (CArange 8-18, IQ 50-74) alternated significantly more than normal children, who in turn alternated significantly more than college students. Actually, a group of institutional adults (CA range 18-45, IQ 22-83) alternated least of all, but this was because they perseverated far more frequently than the other groups. Even within this latter group, low IQ Ss perseverated significantly more than high IQ Ss. Only the college students showed any stimulus preferences, either under the similar-stimuli or dissimilar-stimuli conditions. Thus, the evidence indicates that as we ascend the IQ-MA scale, responses in a nonrewarded or fully rewarded binary choice situation move from perseveration to single alternation to more complex sequences, accompanied by greater attention to the stimulus. Perseveration, of course, is not symmetry (unless one argues that nothing is more symmetrical than a straight line), and it apparently holds a lower, more primitive position in the response hierarchy than does alternation, which we are here considering a “Symmetrical” response. When Ss are asked to guess the outcome of a coin toss, results do not differ. Berenbaum and Aderman (1964) compared 40 normals (CA 9-13 years) with 40 retardates (CA 10-15, IQ 48-75). The retardates displayed single response alternation significantly more than did normals, and both groups alternated significantly above chance. Gerjuoy and Gerjuoy (1965), again employing large numbers of Ss, used two sets of instructions: a pattern set, where Ss were asked to guess the predetermined “pattern” which determined which of 20 A-B pairs was correct; and a random set, in which Ss were told that the correct letters were randomly produced by coin tosses. Results showed that cojlege Ss alternated less than did fourthand fifth-grade normal children or institutionalized adolescent retardates

Herman H . Spitz

34

children, who alternated more under pattern set. However, the number of cyclic responses (the same pattern of responses repeated throughout the 20 items) did rise significantly from random- to pattern-set conditions for both normal groups, while the retardates remained unchanged. In other words, instructions did not move the retardates out of their set mode of response. It should be noted that retardates alternated less when no reinforcement was given, as in this study, than under 100% reinforcement, as in Gerjuoy and Gerjuoy (1964). Finally, Winters and Gerjuoy (1966) investigated temporal effects on left-right choice when Ss are asked to make size judgments of paired, tachistoscopically presented, equal-sized figures. Half the Ss were told to push the button on the side with the larger stimulus, half on the side with the smaller. No feedback was given. High-grade institutionalized retardates alternated significantly above chance when the pairs were presented every 10 sec, but not when the intertrial interval was increased to 30 sec, in line with results of many studies investigating “reactive inhibition.” Whether or not the retarded Ss alternated more under speed conditions because of the buildup of undissipated reactive inhibition or because under the stress of faster responding they reverted to a more primitive, “safer,” more established form of behavior-as did the retardates who ventured beyond alternation until they lost reinforcement (Gerjuoy & Gerjuoy, 1964)-remains a matter of interpretation. It is also possible that over the longer intertrial intervals Ss more frequently forgot their previous response. In any case, studies thus far reviewed suggest that in studying the learning process in retardates cognizance should be taken of not only the shape of the stimulus but also the tendency of retardates to follow certain types of response sequences, particularly perseveration and alternation. Stimulus and response symmetry appear to have a recognizable influence on retardates. 111. VERBAL LEARNING

It is questionable whether psychologists have succeeded in their long attempt to find completely meaningless material with which to study memory. In paired-associate learning most subjects will find some meaningful way of relating most of the pairs to be learned, even when nonsense syllables are used (Underwood & Schulz, 1960). This type of subjectively imposed organization is a frequent concomitant of the learning process. In other instances, however, as with perceptually symmetrical figures, organization appears to be more spontaneous, occumng without


35

conscious effort on the observer’s part (Kohler, 1958; Kohler & Adams, 1958). The formation of concepts may likewise take place at a conscious or unconscious level (Leeper, 1951). A situation in which such spontaneous organization is likely to occur can, of course, be created by the experimenter. Thus, in studies using serially presented nonsense syllables, the typical bowed learning curve can be broken into two bowed learning curves merely by presenting the syllables in the first half in black capital let,ters and those in the second half in lower case red letters. Furthermore, the entire list is learned more readily than when the same syllables are all typed in a single manner (Fischer, 1964; Wishner, Shipley, & Hurvich, 1957). Facilitative effects of grouping on the immediate recall of letters and numbers has also been reported (Krulee, Gapp, Landi, & Manelski, 1964). Studies such as these demonstrate the salutary effects of input organization on immediate memory. Such organization appears capable of counteracting, to some degree, the effects of proactive and retroactive interference, which are much more potent causes of forgetting than is simple decay (Mackworth, 1962; Mayzner 8c Schoenberg, 1965; Underwood, 1957; Underwood, 1964). When the area of mental deficiency is viewed within this framework, a number of intriguing problems spring to mind. In those instances where retardates demonstrate a learning deficiency, how much of this deficiency stems from a more rapidly fading trace (Ellis, 1963) and how much from a deficient ability to organize the material? Does intelligence interact with spontaneous as contrasted with imposed organization? That is, when retardates are given material that is already well organized, will they do relatively better, when compared with normals, than when the material is presented in an unorganized fashion? If, in fact, a major problem is the retardates’ lowered capacity to categorize incoming material, how much of a role is played additionally by defects in storage and retrieval, always assuming, of course, that the retardate is aroused and attending? In this regard Lipman, commenting on the findings of Johnson and Blake (1960), suggested that the . retarded Ss do not ‘store’ their associations as efficiently as do normals” (Lipman, 1963, p. 419). Stedman (1963), on the other hand, based on his experiments on free recall, believed that retardates have a retrieval, not a storage, breakdown. O’Connor and Hermelin (1963b, p. 88) proposed that the processing and retention of information of even middle-grade retardates is not qualitatively different from normals. Closer to Lipman’s thinking, the present approach stresses the retardate’s deficiency in input or “filing.” In any case, as long as we view human learning as a purely additive process, with a generally passive organism adding bits of information to storage, the difference between retardates and normals can only be conceived of as

“. .

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Herman H . Spitz

quantitative. Once we view human learning as being largely dependent on both imposed and intrinsic organization of the incoming stimuli, we must consider the possibility of qualitative differences, with retardates deficient in organizational capacity, not simple memory. It is clearly possible that retardates possess the physical ability to remember as well as normals, but because of a deficiency in categorizing the mass of incoming data into a few large chunks, they are simply overloaded.’ It has been shown that retardates do, in fact, demonstrate a deficiency in abstracting common elements (Griffith et al., 1959). I t should be emphasized that the question is not whether or not retardates group or organize materials, but rather under what conditions, in what manner, and how efficiently they display this capacity. Retardates may include too few stimuli in a category, or too many. They may overgeneralize, as well as undergeneralize. They may form concepts more readily on a concrete or functional basis than on a higher level, abstract basis. If they do, in fact, categorize inefficiently, they must inhabit an extremely chaotic world. Relevant research with retardates will now be collated within the above framework in an attempt to illuminate some of the problems posed. The primary focus is on immediate, short-term memory. A. Clustering in Free Recall In trying to recall a name which is on the “tip of our tongue” we frequently recall other names which are in some ways similar to the one we seek. This suggests that our memories are stored in categories. Empirical evidence for categorized storage is found in the experiments on clustering developed by Bousfield (1953). In these experiments, a number of words from particular categories, as for example animal words (i.e., pig, cat, horse, sheep), names of professions, and vegetable names, are read to the subject in random order. When subjects recall the list of words, they tend to recall groups or clusters of words from each category more frequently than would be expected by chance. That is, animal’ words tend to be recalled together, as are profession words and vegetable words. Tulving (1 962) extended the clustering phenomenon to a learning situation in which the words, unselected as to meaning, appeared to be unrelated. He found, nevertheless, that subjects impose a structure on the material, as revealed by the repeated grouping of certain words in recall. As with the usual clustering experiments with normals, a positive correla1 Physiological theories of memory, as for example the recent attempt to implicate ribonucleic acid in molecular concepts of the memory trace, must eventually take these other processes into account.


37

tion between amount of grouping and amount of recall emerged, and the degree of clustering increased with repeated exposures. These findings suggest that repetition may not be as important for embedding a trace as it is for providing the organism with a chance to group the materialand thereby increase the amount and stability of stored information (Miller, 1956b). That is, although one-trial learning has been demonstrated (Rock, 1957), it is well known that repetition of trials and overlearning facilitate memory. It has been assumed that this repetition cements the synaptic bond and thereby strengthens the memory trace. However, it is possible that in many instances repetition strengthens memory not by strengthening some S-R connection, but by giving the individual an opportunity to organize the material, and that the material stored in this well-organized state is more resistant to interference. T h e relevance of such storage facilitation to the learning capacity of retardates should be Self-evident.

CLUSTERING BY RETARDATES The measurement of clustering in free recall would seem to offer a means of examining the extent of spontaneous organizational behavior in the learning and memory of retardates. One ,might argue that it merely measures association strength, but this would not account for the increase in clustering over trials [see Cofer (1965) for a discussion of this problem]. Before reviewing studies with retardates, some of the problems in this area will be discussed. When Ss attempt free recall of the presented words, they frequently add words that were not in the original list (extralist intrusions), which may be from one of the same categories as those in the original list (categorical intrusions) or may be noncategory words (irrelevant intrusions). Also, words from the original list may be repeated (perseverations). All of these errors complicate the scoring procedure. For present purposes we will refer to “corrected clustering” only when the stimulus words are used in scoring. When extralist words are included in the scoring we will refer to “noncorrected clustering.” An additional problem is the need to take into account the number of words recalled. Thus, one S may recall only 2 of 20 words, both within a single category, and receive a clustering score of 100%. If he remembers a third word from a different category, his recall score rises, but his clustering score drops to 67%. Earlier measures did not take this problem into account, but it should be taken into account when testing retardates and children. Bousfield (1965; Bousfield & Puff, 1964; Dallett, 1964), however, has devised a formula which gives the amount of expected, or chance, clustering for the number of words recalled, whereas previous

38

Herman H. Spitz

measures of chance clustering were based on all the words presented. Our own studies, to be reviewed later, indicate that even high-grade retardates and 9- to 10-year-oldnormals do not cluster above chance until the fourth or fifth trial, and then only very slightly, a finding that has not been reported previously because of the unavailability of the formula. I n the earliest study, Weatherwax and Benoit (1957) used 12 pictures from four categories in six presentations and found no significant difference in the amount of noncorrected clustering of “organic” and “nonorganic” retardates. This finding was replicated by Osborn (1960) who, in addition, included a group of equal MA normals. Osborn presented three randomized series of 32 pictures from four categories-animal, body part, clothing, and food-after which Ss were given a single recall period. There were no significant differences between any of the groups in either amount of noncorrected clustering or in number of words recalled. During the recall period, however, the retardates clustered quite efficiently at the beginning, then suddenly decreased their clustering behavior, only to recover it again before they ran out of words to cluster. The normals, on the other hand, showed a rather smooth increase to a peak of clustering, followed by a smooth decline. Osborn related the retardates’ uneven performance to a “premature and temporary loss in organizational efficiency.” Whereas the above investigators presented pictures, Rossi (1963) read, and had Ss repeat, each word of a 20-word list, followed immediately by a recall period. This procedure was repeated five times. His results showed no differences between institutionalized retardates and equal MA normals on a noncorrected measure of clustering, primarily because retardates had significantly more categorical intrusions than normals. When these intrusions were eliminated by a corrected clustering measure, it was found that the normals did, in fact, cluster more than the retardat.es but-interestingly-did not recall significantly more words. Within the retarded group, MA was positively related to clustering primarily because of the very low subgroup which had a mean IQ of 48.3 and a mean MA of 4 4 years. The MA 7-3 and 10-0 retarded subgroups did not differ greatly from each other. With normals, on the other hand, an increase in MA from 5 to 8 to 11 years produces an increase in corrected clustering, the relationship between MA and corrected clustering being linear (Rossi, 1964). For both retardates and normals, recall and corrected clustering increased over the five trials, but at different rates for the different MA subgroups. Three further studies should be mentioned. Evans (1964) repeated Rossi’s procedure with high-grade (@ approximately 65, approximately 10-6) and low-grade ( I q approximately 47, MA approximately


39

7-6) institutionalized retardates, and in addition gave half the Ss in each group a material incentive. Using both corrected and uncorrected measures of clustering, the main significant finding was that Ss recalled more as trials progressed. T h e lower intelligence groups produced significantly more inappropriate responses over the last two trials, and material incentive tended to increase the number of inappropriate, or intrusive, responses. Once again, retardates of two different MA levels (7 and 10 years) did not differ significantly in amount of clustering. Stedman (1963) compared retardates with equal CA normals. He gave three different orders of 30 word pairs representing several different “semantic categories.” T h e normals both recalled and clustered (apparently a corrected measure) more than did the retardates-although the significance of the difference in clustering was only marginal-and there were differences between the groups i n categories most frequently clustered. Wallace and Underwood (1964), using a somewhat different approach, found that equal CA normals had higher corrected clustering scores than retardates. Studies of retardates’ clustering behavior, using measures which do not take into account chance clustering based upon number of stimulus words recalled, may be summarized as follows. There are no differences between so-called organic and nonorganic retardates. Retardates cluster and recall less than do equal CA normals, with recall positively related to MA within each group. Within the retarded population no significant relationship between clustering and either MA or IQ emerges unless extremely low MA Ss (4.5 years) are included. Retardates recall as much as do equal MA normals, but cluster less on a corrected measure of clustering. Because retardates bring a greater number of categorical intrusions into their recall, their uncorrected clustering score reaches the level of equal MA normals. T h e fact that retardates recall so well in spite of inefficient clustering suggests an extremely active storage and retrieval system, not a breakdown in these systems. Apparently they have substituted sheer rote memory for organizational devices which, in all probability, lighten the burden of recall. Instead of drawing from efficiently categorized “files,” they apparently draw from files badly mismanaged. In some instances there are too many misplaced entries in a single file (Rossi, 1962). I n other instances material which could be most efficiently stored i n one file is scattered over many. Other aspects of the previously mentioned Wallace and Underwood (1964) study are most relevant in this connection, and avoid some of the complications of clustering measures. They used four different lists

Herman H . Spit2

40

representing two types of learning (free recall and paired-associate learning) with low and high conceptual similarity for each type. T h e high conceptual similarity words for retardates were established by means of sorting tasks which were previously accomplished by the retardates, so that the concepts were clearly in their repertoire. Results indicated that when the list contained high similarity words, i.e., many words from a few categories, the equal CA normals recalled many more words under free recall than under paired-associate conditions, where high similarity interfered with learning. A slight contrary effect was found when the list was composed of low similarity words. It would appear that, under free recall, the freedom to cluster aided memory in normal Ss when the words were amenable to categorization. On the other hand, the conceptual similarity of the words influenced the retardates far less than i t did the normals. The retardates performed no better on free recall of a list containing high conceptual similarity words than on a list containing low conceptual similarity words. They apparently took no special advantage of material which lends itself to grouping for more efficient recall. Wallace and Underwood interpreted the results as indicating a retardate deficiency in “Implicit Associative Responses” (IARs) to conceptually related words, perhaps because retardates do not “spontaneously” produce IARs to verbal stimuli. In a follow-up study, Wallace (1965) compared 40 institutionalized retardates (I(160.5, 16.1) with 31 college students on a task in which S was required to indicate whether or not each word, as it was presented by tape, had or had not occurred earlier in the list. The list consisted of 100 words and included (a) words which were assumed to elicit particular associations, (b) some “experimental” words representing these associations, (c) control words presumed not to have been preceded in the list by any high association words, and (d) filler (neutral) words. Results showed that for retardates the difference between the experimental and control words was not nearly so great as it was for normals, who responded “yes” to a great many “association” words in the mistaken belief that they had occurred previously. However, the difference between the retardates and normals can be accounted for largely by words presented three times prior to the crucial antonym [association word as in (a)], which so many normals wrongly believed had been presented previously. The presentation of subordinate words (i.e., peach, grape, apple, pear) prior to the word fruit produced more false recognition of fruit by retardates than by normals, a result quite contrary to what would be expected. Because it seems to be assumed that retardates’ apparent clustering deficit is related to their poor performance on certain types of sorting tasks it was decided to test this relationship directly. In conjunction

a

41


with Irma R. Gerjuoy, the following experiment was performed by the writer, a. T h e Relationship of Sorting to Clustering. Outline pictures were drawn of words taken from Rossi (1963) and the pictures were placed on a table in the following manner: milk leg hat cat

(m

head coat sheep soup

bear cake nose hoe

dress horse meat thumb

bread mouth belt pig

Twenty high-grade 72.04, 14.49 years) and 20 low-grade ( 1 2 52.95, 14.52 years) institutionalized retarded males were split into two groups. One group of each IQ level received the picture task first. They were asked to name all the pictures, then to put the pictures that belong together into piles. Two weeks later they received all the above words in a regular clustering experiment, in which a different E read the words to them for recall, a procedure repeated five times. The second group also received both tasks in the reverse order, but no order effect was found. The results were very clear. Of the 20 high-grade retardates presented with the pictures, 14 grouped them into the four categories of food, clothing, animal, and body parts. Of the 20 low-grade retardates, only 2 succeeded in these four groupings, a highly significant difference. I n the free recall task, however, there was no significant difference between the two groups in either corrected clustering or recall and, consequently, no relationship between picture sorting and verbal clustering. This result is reminiscent of the Wallace and Underwood study, in which retardates sorted the words correctly, but apparently did not make use of this conceptual capacity in their free recall. Those of our Ss who possessed the concepts apparently made no use of them. T h e clustering and sorting tasks are, of course, different in many ways. In the sorting task, the pictures remain in view. In free recallespecially when Ss are retardates who do not write down their responses-all items, including those already recalled and presented, are relegated to memory. It is obviously hazardous to generalize a common element across the two tasks. b. Further Investigations of Clustering. It was at this point that Professor Bousfield kindly sent us a formula which measures expected (chance) clustering based on number of words recalled.2 Using this 2

The formula is as follows: ml2 E(R) =

+ m22 + m32.. .mR2 -1

n where E(R) symbolizes the total expected repetitions: m l , m2, m3, and mk are the

42

Herman H. Spitz

formula, we subtracted the expected from the observed clustering in all Ss, yet no differences between high and low IQ groups emerged. Furthermore, despite the fact that for these two groups combined the average recall score rises steadily over the five trials (7.20, 7.95, 9.43, 10.48, 11.80), by use of the new formula we found that not until the fifth trial do as many as 28 of the 40 retardates cluster above chance, and on trial five they cluster, on the average, only 12% of the maximum clustering possible. I n absolute terms, on the fifth trial the average number of words clustered above chance is -64,or less than one word. Thus, retardates show no significant relationship between recall and clustering, >nd it looks as though even high-grade retardates do very little clustering at all. On the fifth trial, the correlation between recall and clustering is a nonsignificant 30. 9.81 A control group of 19 equal MA normals (16 males, 3 females, years, Kuhlman-Anderson @ 107.32) also clusters very little, even though their recall rate approximates that of the retardates. Not until the fourth and fifth trials do as many as 13 of the 19 Ss cluster above chance. On the fourth trial this equal MA group is, on the average, clustering 12%, and on the fifth trial 15%, of the maximum they could cluster beyond chance. On these two trials the number of words clustered above chance is .53 and .88 respectively, also an average of less than one word clustered per S, and there is no significant correlation between clustering and recall on trial 5 (r = .28). Comparison between these groups on clustering and recall is shown graphically in Figs. 1 and 2. In order to determine how college Ss would fare on the new scoring measure, 20 college students (17 females, 3 males, F A 21 years) were tested. Although group testing was employed, Ss were required t.0 cover with cardboard each word they wrote down, so that their task was as comparable as possible to that given our retardates and equal MA normals. With college Ss clustering behavior finally emerged, and very lustily indeed. A significant number of college Ss were clustering above chance by the third trial. On the third, fourth, and fifth trials they clustered, on the average, 44%, 62y0, and 70y0 of the maximum possible clustering above chance. The average number of words clustered above chance and the average number of words recalled over the five trials are shown in Figs. 1 and 2. O n the fifth trial an unexpectedly high Pearson correlation of .85 was found between recall and above chance clustering. In other words, the lai-gest part of the variance in the number of words number of items which are recalled from the various categories; and n is the total number oE items recalled. Essentially this same formula is given by Dallett (1964) who also received it from Bousfield.

43


recalled is accounted for by clustering behavior. I t is obvious that college students quickly become aware, and take very great advantage, of the opportunity to cluster material to be recalled, while institutionalized retardates and normal 9 and 10 year olds do not, and this strategy of 70-

60-

? 0 z

Trials

Fic.. 1.

Mean clustering scores of four subject groups in clustering experiment. 18r

2

I

I

I

3

4

5

Trials

FIG. 2. Mean recall scores of four subject groups in clustering experiment.

grouping greatly aids recall. Were the lower MA groups capable of recognizing and utilizing the strategy of categorical grouping in recall, i t is very probable that their recall scores would rise accordingly. Finally, we tested a group of 14 equal CA normals (11 males, 3 females,

44

CA 14.70, Hennon-Nelson Test of Mental Ability

Herman H. Spitr

117) using the same procedure as was used with college Ss. As expected, their clustering above chance over the five trials falls between the college Ss and the retarded and equal MA groups. Unexpectedly, their recall scores were not significantly different from those of the college Ss (see Fig. 2), no doubt because of a ceiling effect. As with college Ss, there is a significant positive correlation between recall and amount of clustering above chance on trial 5 (r = .55). c. Raising Retardates’ Recall by Inducing Clustering. Since clustering aids recall, we should be able to increase recall by inducing retardates to cluster. One possible means of achieving this is to present the list already clustered (Dallett, 1964). That is, present the 20 words so that the 5 words of each category follow each other, randomizing both the order of the categories and the order of the words within the categories over the five trials. In this way, words would enter already clustered. We will call this method the presented clustered method. A second procedure would be to present the words as we normally would, but in recall ask S to “Tell me all the animals you remember froin the list,” and repeat this question for all four categories over each of the five trials. One might expect this procedure to result in the greatest recall, particularly since Ss may be guided in their guesses. We will call this method the requested clustered method. Both of these methods were tried on two new groups of institutionalized retardates (presented clustered: 10 females, 64, 14.57; requested clustered: 10 males, 65, fi 15.79). T h e results are shown in Fig. 3. As can be seen, both methods significantly increase recall over the regular procedure, and neither method differs from the other. It is interesting to note that when the input is organized, as in the presented clustered method, by the fifth trial the retardates are recalling an average of more than 14 of 20 words. Their dustering behavior is concomitantly increased, average clustering above chance being 1.24, 1.53, .77, 1.26, and 2.21 over the five trials. Furthermore, on the fifth trial the positive correlation between amount of clustering beyond chance and number of words recalled is now a significant .60.It is quite clear that presenting the words in an already organized state induces clustering and significantly raises recall. Inducing the retardates to organize the material, by whatever means, has a facilitative effect on recall. Just one final note before leaving this area. In these procedures the experimenter assumes that the best method of clustering is to group words according to categories. T h e material, however, obviously provides S with many different ways of grouping. For example, hat and cat were

45


sometimes grouped, as were meat and p i g or hat and head. These are perfectly good groupings, although they do not happen to correspond to those of the experimenter. For these reasons, the measure of clustering devised by Tulving should prove extremely useful, since it “. , . assumes no knowledge on the experimenter’s part as to the sources of organization . . .” (Tulving, 1962, p. 344).

Y

701 * I

I

2

3

Trials

4

5

FIG. 3. The effects of inducing clustering on the mean recall scores of retardates.

B. Paired-Associate Learning

Most people in most situations can be quite explicit about the manner in which they “think to themselves” as they learn. It is probably for this reason that some workers prefer to talk in terms of “verbal mediators” than in terms of “organizing processes.” A problem, however, arises when dealing with retardates, who frequently have difficulty in verbalizing concepts. For example, in a discrimination learning task, middle-grade retardates learned faster when the correct pictures all belonged to a certain class or abstract concept than when they were “rote” material, i.e., picture pairs arbitrarily chosen. Yet, only 2 of 20 Ss could verbalize the principle which mediated their choice (Hermelin & O’Connor, 1958). That there is some type of subjective organizing process, whether in or out of awareness, taking place in paired-associate learning has already been noted. Recently, Gruber, Kulkin, and Schwartz (1965) demonstrated that college Ss, who were instructed to form some connection between each pair of 20 words drawn from the Thorndike-Lorge ]-List, correctly recalled significantly more response words than Ss who were not so

Herman H. Spit%

46

instructed. Furthermore, there was a significant interaction between exposure time and instruction, suggesting that longer exposure time permitted more adequate development of mnemonic devices. At an exposure time of 1 sec there was little difference between the groups, but between 2 and 4 sec differences were quite large. Thus, although posttest inquiry revealed that even Ss of the control group spontaneously used mnemonic devices, the instructions to do so significantly enhanced the performance of the experimental group. 1. EQUALMA COMPARISONS

Do retardates use organizational devices, either consciously or unconsciously, to the same extent as do normals in paired-associate learning? The use of familiar pictures or material should more readily induce the spontaneous development of associations, while nonsense material would require more inventiveness by the subject. One would expect, in fact, that differences between normals and retardates would widen as we move from more to less easily associated material. The problem of ceiling effect, of course, becomes rather critical. First let us look a t studies where familiar objects or pictures were used in the pairs to be associated. Ring and Palermo (1961) used eight pairs of highly familiar pictures and found no difference between retardates and equal MA normals. Cantor and Ryan (1962) used six pairs of photographs of common objects, and no differences emerged. Iscoe and Semler (1964) found that retardates did not differ from equal MA normals when the pairs to be associated were actual objects from a single category (e.g., toothbrush-comb, pipe-cigar). On the other hand, normals were superior when pictures of these objects were used. When the pairs consisted of dissimilar objects (e.g., pipe-comb, doll-cigar) the normals displayed an even more pronounced learning superiority. It should be noted that Ring and Palermo, as well as Cantor and Ryan, used high-grade retardates with mean IQs in the 70’s. T h e mean IQ of the retardates used by Iscoe and Semler, however, was in the 50’s. Thus, it appears that high-grade retardates do not differ from equal MA normals when familiar objects and pictures are used, while middle-grade retardates do differ. This is given support by Jensen (1965) who found equal MA 58) when using familiar pictures in normals superior to retardates a paired-associate task. An exception occurs when very high association pairs of words are used (i.e., dark-night, man-woman), in which case retardates with IQs in the 40’s perform as well as do equal MA normals (O’Connor & Hermelin, 1963a).

(q

THE ROLF, OF INPUT ORGANIZATION

47

When we turn to studies where low association material was used or where meaningful objects or pictures do not constitute both members of the pairs, even high-grade retardates are at a disadvantage. Thus, when three pairs to be learned consist of color word responses to familiar pictures (Rieber, 1964) or consist of low association nonsense syllables (Johnson & Blake, 1960), retarded groups with mean IQs in the 70’s perform more poorly than do equal MA normals. In summing up, there is some evidence that, even within the retarded range, IQ interacts with the meaningfulness and association value (organizational amenability) of the pairs to be learned. That is, the lower the IQ, the more meaningful and more highly associable must the material be for retardates to approach the performance of equal MA normals (see Lipman, 1963, pp. 395-396, who makes this point well). Jensen has carried out a series of experiments which have shown, among other things, that organizational aids greatly improve the performance of retardates. In an early report (Jensen & Rohwer, 1963a) Ss were 20 adults 55) from a sheltered workshop. The material consisted of four pairs of pictures of common objects. Inducing mediation by telling the Ss to make up a sentence linking the two items of a pair (i.e., the hat is on the table) had a striking facilitative effect on pairedassociate learning. If E provided the mediator (sentence) for S, results were the same. These findings led the authors to suggest that retarded Ss do not spontaneously utilize such devices. Unfortunately, there was also some tentative evidence that retardates do not carry over the mediational set induced by E. Seven days later some Ss from the group in which mediation had been induced were given the usual nonmediation instructions and performed no better than Ss who had not previously been prompted to use the organizing principle (see also Jensen & Rohwer, 1963b). Of incidental interest is the fact that mediation did not facilitate serial learning, presumably because serial learning is less amenable to grouping techniques. In a later study, Jensen (1965) used the same techniques with eight pairs of pictures and found that retardates given the mediating context on the first trial only go on to perform significantly better than a matched group of retardates given no such aid. In fact, they made slightly fewer errors than did equal MA normals who were given no mediation instructions. As expected, the normals also perform significantly better when given mediation instructions. T h e facilitating effect of this organizational cue was far greater in the retardates than in the normals, but this was clearly due to a ceiling effect in the normals, most of whom reached criterion in only one trial in the mediation condition.

(m

Herman H. Spite

48

2. EQUALCA COMPARISONS One would expect that normals of equal CA would perform better than even high-grade retardates no matter what the nature of the material. This, however, is not always the case, possibly because of ceiling effects, as in the Eisman (1958) study. She used seven pairs of pictures of common objects and found no difference between Ss of retarded (1% 68), average, and superior intelligence. Berkson and Cantor (1960) found normals generally superior to retardates 70) when, using six pairs, colors were the responses to be associated to either pictures or numbers. However, no differences accrued when pictures were the responses to be associated with numbers. An equal CA superiority was only marginally significant in the Ring and Palermo (1961) study where the material was eight pairs of Stanford-Binet vocabulary pictures and the mean IQ of the retardates was 76. On the other hand, when nonsense materials (10 design-color name pairs) are used, normals are clearly superior to high-grade retardates (Blue, 1963), although there is some evidence that retardates improve when taught to give names to geometric forms (Jensen, 1963). Ford used 12 pairs of pictures and found no difference between retardates (@ 67) and normals in initial learning. He questioned the Ss and noted that retardates, as well as normals, tried to associate the pairs by finding some common property (Ford, 1962, p. 56). Thus, retardates may make an attempt to organize the material, but the question remains whether or not, and with what type of material, they succeed. The implication of the Jensen and Rohwer (1963a) study is that a great many do not succeed unless some organizational principle is provided by E. As yet unknown, and of prime importance, is whether or not it would prove worthwhile to teach retardates to utilize organizational (mediational) techniques not only in a single experiment but continuously, in the hope that they would become more efficient learning organisms.

(a

IV. DIGIT RECALL Every Little ”Bit” Helps

If retardates do not organize material as efficiently as do normals, they should improve a great deal when the material is organized for them, and this improvement should be relatively greater than it is with normals. Some support for this view has been presented, and it will now be further pursued. A “bit” of information is that amount of information necessary to reduce uncertainty by half. This rule can readily be applied to digits. There are 10 digits (0-9) in our decimal system. If we want to reduce

THE ROLF, OF INPUT ORGANIZATION

49

completely the uncertainty as to which digit a person is thinking of, we reduce the 10 numbers by half (i.e., is the number M?), then reduce the 5 numbers by half, and then the 2.5 numbers by half, leaving 1.25. We are now very close to finding the number. We have halved the numbers three times and we need not fully halve them again. In fact, we must halve 10 numbers only 3.32 times in order to reduce uncertainty to zero. This illustrates the general rule that the amount of information per item is the logarithm to the base 2 of the number of possible choices. Once we have this knowledge we can apply it to a number of different tasks. We can say that a person who repeats 7 digits is recalling 23.24 bits of information (7 x 3.32). How many bits of info&ation can retardates recall in an immediate learning task, and can the amount of information be increased by grouping? To shed light on these questions the following experiment was performed. AN EXPERIMENT WITH RETARDATES AND BRAIN-IN JURED CHILDREN Numbers were typed on cards and inserted into a loose-leaf desk calendar stand which permitted E to flip a card with numbers on it into view, or to flip a blank card over the stimulus. Two sets of numbers were used, with a grouped and ungrouped condition for each set. Grouped numbers were presented in pairs where possible, while ungrouped numbers were equally spaced throughout. For example, in the grouped condition five numbers were presented as I 3 96 4 while for the ungrouped condition they were presented as 1 3 9 6 4. E flipped the first card down, revealing one number, then flipped a blank card over it, and S was required to recall the number. Then E flipped down the second card, which had two numbers on it, and so forth, up to the final card of eight numbers or until S missed a single recall. The first two cards (with one and two numbers, respectively) were each shown for 5 sec before covering, cards three and four for 10 sec, cards five and six for 15 sec, and cards seven and eight for 20 sec, allowing ample time for Ss to group the material were they so inclined. No number was repeated on any one card, and zero was never used, although S had no way of knowing this beforehand. Ss were required to recall the numbers in the order in which they were presented. 14.63 years) and 33 equal MA normals Forty retardates 60, 8.60 years) served as Ss. Each group was divided into three orders. Order I received an ungrouped condition first, immediately followed by a grouped condition. Order I1 went from a grouped to an ungrouped condition, and order 111 went from an ungrouped to an ungrouped

(m

(m

Herman H . Spit%

50

condition. The two sets of numbers were counterbalanced throughout, and each S received one set on the first condition, the other set on the second. Only Ss who could read all the numbers, and could read double numbers (e.g., 73 as seventy-three), were included. Results are shown in Fig. 4. T h e normals do equally well on all conditions, while the retardates perform better on grouped than on ungrouped conditions. The largest difference occurred with those retardates who

Normals

Retardates

VI

.& .- 5.50V

L L

W

n

5

5.00-

al 0

I

4.50-

4.001

I

I

2

I Order

FIG.4. Mean number of grouped and ungrouped digits recalled by retardates and equal MA normala

received the grouped digits first. They fall from an average of 5.46 grouped numbers recalled, to an average of 4.77 ungrouped numbers recalled @p> .05). The slight, nonsignificant decrease in the ungrouped to ungrouped order suggests that fatigue and/or proactive interference may have affected the retardates on the second trial, lowering the difference in order I (ungrouped to grouped), and increasing the difference in order I1 (grouped to ungrouped). When the retardates' combined score on the two grouped conditions is compared with their combined score on the t.wo ungrouped condition of orders I and 11, the difference is highly significant (5.31-4.73, pI*

540-

I-35.

E30. 5 5 .

82c.

IS.

one with the circle on it. T h e actual brightness values are almost impossible to specify, but it is evident that 20 increments from darkness to full brightness represent a relatively slow process.3 After slide 40 it was necessary to insert a new slide tray into the projector; the line and arrows indicate the point at which we did this. 3 In the photographic piocess, Bourges overlays of varying degrees of opacity were placed over the incorrect stimuli. The degree of opacity was reduced to permit the brightness and contrast of the incorrect keys to increase. T h e process was thoroughly empirical. The actual brightness values are a function of such factors as: the brightness of the paper that formed the background; the type, intensity, and distance of the lights used in photography; the type of slide projector and projector bulb; the distance of the projcctor from the keys; the illumination in the experimental room; etc.

FROGRAMMING PERCEPTION AND LEARNING

163

T o minimize any disruptive effects of the interruption, the first few slides in the second tray reviewed brightness increments 14 and 15 before going on to the rest of the sequence. T h e record in Fig. 5 actually represents the second stage of the circleellipse program, but it serves to illustrate a perfect performance. This is the type of record toward which all of our efforts were directed, even with severely retarded children and with normal children no older than 3 years. As our efforts approached success, the records came to

-

ONE MINUTE

FIG. 6. T h e performance of a severely retarded subject o n the first circle-ellipse program. Th e numbered dots indicate the last slide of each successive brightness increment. a indicates the subject’s first error, followed by the reversal of the slide tray after he corrected his error. Each of the small marks, like the one at a, indicates an incorrect choice. T h e arrow shows the end of the first slide tray. Although C.M. made three errors on the first slide of the new tray (after the arrow), there was no backup from the first slide af the tray. An apparatus failure prevented the backup on one occasion in fading increment 14.

represent to us the actual progress of the child, moving upward step by step toward new achievement. One’s feeling for these upward steps as the actual climb of the child may be intensified by examining a record that shows the subject making errors on his way up. Figure G is the performance of our first subject, C.M., microcephalic and severely retarded. T h e figure also illustrates our procedure for handling errors. T h e numbered dots indicate the last slide in each successive increment of the fading sequence. For example, the first brightness level,

164

Murray Sidman and Lawrence T . Stoddard

in which the wrong keys were completely dark, contained four slides. The record has been cut into short segments and rearranged for more compact presentation; as in the previous figure, the progression is from bottom to top. If we look at the three segments at the bottom, we see that C.M. made no errors through the first six brightness levels. He worked very slowly during the first four brightness levels and then speeded up considerably during increments 5 and 6, as indicated by the shorter distance between steps in the third segment from the bottom. C.M. made his first error on slide 24, and the error is indicated by the small oblique mark on the record (identified by the letter, a ) , When he pressed the wrong key, nothing happened; the slide did not change and the stimuli remained exactly as they were. T h e next key he pressed was the circle, but then, instead of advancing to the next slide, the projector reversed and repeated slide 23. This is our standard procedure: when the subject presses a wrong key, the stimuli remain until he has corrected his error; when he finally presses the circle, the slide tray reverses and he is again exposed to the preceding array of stimuli. T h e slide tray advances only if the subject’s first choice on a given trial is correct. (See also Fig. 4B, at h.) An error, then, represents a step backward and shows up as such on the record.4 In spite of the anguish this causes us whenever it happens, the “backup” procedure has three advantages. First, if the subject comes to a difficult part of the program, his errors automatically return him to a less demanding level. Instead of leaving him to flounder, we gave him this extra help (Hively, 1964b). T h e second advantage of the backup procedure is that it helps us understand whether the subject’s error resulted from some inadequacy in the fading sequence-we did not adequately communicate what we wanted him to do--or whether the source of the error was relatively trivial, such as a temporary lapse of attention. If the error arose from unimportant sources, the subject will choose the correct key when that particular slide reappears. For example, after C.M. pressed a wrong key on slide 24, the slide tray reversed to slide 23; he made a second correct choice on that slide and when he was again presented with slide 24, he chose the correct key. Similar errors, which C.M. did not repeat after the backup, also appear on slides 30, 34, 35, and 38. On slide 46, however, we see a different kind of error. Our subject had climbed without error through slides 42, 43, 44, and 45, but on slide 46 he made two wrong choices before finally choosing the circle. The 4 The authors are indebted to James G. Holland for the backup procedure, which has become a standard feature of our programming techniques.

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tray reversed to slide 45 and again he made two errors, even though he had initially chosen the circle on his previous exposure to that slide. When he went back to slide 44 his first choice was again an error, and on slide 43 he made six errors before picking the circle. He was finally correct on slide 42, made two errors again on slide 43, went back again to slide 42, and again climbed successfully to slide 46. We have described here a most common and revealing phenomenon. It may be summarized by stating, “Errors create more errors.” [See Terrace (1963a,b) for the first unequivocal demonstration of the effectiveness of fading techniques in producing errorless learning.] After meeting a difficult slide, the subject backed down through the program, making errors where he had previously had no trouble at all. T h e reason for our anguish at this point was not simply that our subject slid backward, but that we were to blame for his difficulties. Our program had failed to communicate adequately to him what he was to do; perhaps our fading series was progressing too rapidly for him to follow our instructions. When he made his first error on slide 46, he was presumably using the criteria for selection that had been successful up to that point. However, the error showed these criteria to be wrong. Therefore, when slide 45 appeared again, he changed his basis for choice, and where he had previously been correct he was now wrong. He then continued to have trouble throughout brightness increment 13, oscillating up and down, occasionally recovering his performance but always meeting the same troublesome obstruction on slide 46. Eventually he passed through this difficult region but continued to have trouble when we increased the brightness of the incorrect keys a bit more (increment 14), and he made little progress through 15 (before the 1-hour rest). The processes involved here are thoroughly normal. Whoever our subject may be, retardate, normal student, or psychotic patient, if he finds himself inadequately instructed he will oscillate between alternative modes of action. Unless he happens by chance to hit upon a correct solution, he will show no further progress. When the backup procedure shows the subject making errors where he had previously been correct, we know where our program is inadequate and where we must revise it. A large part of our story is, in fact, a description of the successive revisions through which our program passed. The results of those revisions will substantiate our contention that inadequate performance is more likely to result from deficiencies in our techniques of evaluation than from deficiencies in the children (Bijou, 1964; Holland, 1961a). The third advantage of the backup procedure stems from its contribution to our basic understanding of the learning process. The traditional

166


practice of drawing learning curves loses its meaning when we revise o u r program and the subject then passes beyond a level at which his forward progress had previously halted (Hively, 1962; Moore & Goldiamond, 1964). We interrupted our first experiment and gave C.M. a rest for 1 hour. We then began again with the incorrect keys at brightness level 12, through which C.M. had previously passed relatively easily. This time he hatl more trouble and had even more difficulty at level 13 than he had the first time through. It is possible that the break in continuity made it difficult for him to recover his earlier performance. After oscillating for some time between slides 46 and 41, C.M. finally seemed to hit upon a n effective procedure. H e then passed through the remaining levels of the program with little difficulty, and actually made n o errors in the last two brightness increments. In the seven final slides the brightness cue hatl completely disappeared and C.M. consistently selected circles and rejected ellipses. M'e had mixed feelings about C.M.'s eventual success. We were pleased for him, and excited because it revealed a level of performance that was previously unsuspected. It also put us in a position to achieve our immediate goal, which was to assess his perceptual capacity by finding out how much we could make the ellipse look like a circle and still have him discriminate the two forms. But we were not at all satisfied with the number of errors our teaching program had created. If we were to make general use of this technique for perceptual evaluation, we would have to increase its effectiveness considerably. Can we evaluate our teaching program quantitatively? There are a numher of ways we might try to do this. For example, if we combine both parts of the session, before and after the rest period, we find that C.M. had a total of 183 trials. Of these, his first response was correct on 129, or 707". We might separate two types of errors, those which occurred the first time a slide was presented and those which occurred when a slide reappeared after an error. These errors arise from different sources antl it is legitimate to consider only the errors on a subject's first exposure to a slide as being a product of program inadequacies; subsequent errors are likely to be the result of preceding errors. 1,ooking at the session this way, we see that C.M. was exposed to 55 slides before the rest period antl 32 slides later, a total of 8 i . Of these S i , he was correct on 65, or i4%, the first time he was exposed to them. IVe could perhaps make a more accurate evaluation by taking into account the total number of errors the subject made o n each trial. Only one key was correct antl seven were incorrect per trial. If the subject were simply pressing keys at random, we could expect him to pick the

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correct key on one out of eight trials, or 121/2y0. If he eliminated a wrong key from consideration after pressing it, he would have only one chance in seven of picking the correct key on his second choice, one chance in six on his third choice, and so on. Therefore, when C.M. made only one or two errors on a trial, he still showed a much better performance than purely random selection would have produced. A single error indicates that the subject is far from being completely bewildered and that the program still carries considerable effectiveness. But when the subject makes several errors on a given trial, there can be no doubt that the behavioral control exerted by the program has broken down and needs repair. We did not feel it worthwhile at this point to carry out a sophisticated statistical analysis of C.M.’s performance. We were satisfied-or, more accurately, dissatisfied-that we did not have anything resembling a n adequate teaching program. Even though this particular subject was able to go on to more difficult perceptual tasks, we wanted a teaching instrument that was likely to succeed reliably with a large population of severely retarded subjects. Therefore, after taking a close look at the areas in which our first subject experienced difficulty, we revised the program. C. The Second Teaching Program

C.M. made his first error at brightness level 7, but this was not repeated and not followed by any wrong choices in level 8. However, he did make errors on the initial slide of increment 9, and then made at least one at levels 10, 11, and 12, finally exlperiencing great difficulty in levels 13-15. C.M.’s performance indicated that the early stages of the fading program were more than adequate, and so our first change was to shorten this portion of the program. Keeping the same number of brightness levels, we reduced the number of slides to two in levels 1 through 8. Since C.M.’s difficulties seemed to begin with increment 9, we inserted an intermediate brightness level between the former increments 8 and 9. These changes can more easily be followed by referring to Fig. 7. We see here that brightness increments (fading steps) 1-8 are identical in programs 1 and 2, but that the number of slides per increment has been reduced to two in the revised program. Level 9, a new fading increment (2 slides), now follows the old level 8, and the former level 9 now becomes 10, with four instead of three slides. Level 11 of the revised program is also a new facling increment, intermediate between former levels 9 and 10. Levels 12 and 13, corresponding to the old levels 10 and 11, remain unchanged. Since the slide tray of our automatic projector held only 40 slides,

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Murray Sidman nnd Lawrence T . Stoddard

we had to stop briefly after slide 40 to change trays. In the first program this change occurred after increment 11, Since we had reduced the number of slides in the early stages of the revised program, we were able to proceed to level 15 before having to stop and change slide trays. At this point we made another revision of the program. Reference to Fig. 6 shows multiple errors on slide 41, suggesting that the interruption of the procedure caused C.M. some difficu1t.y. In the revision, therefore, we backtracked at the beginning of the second slide tray and presented

CONSECUTIVE SLIDES FIG.7. Schematic illustration of the way the brightness increments (fading steps) changed on successive slides of the first four circle-ellipse programs. The programs are numbered consecutively from 1 to 4. The fading steps do not represent equal brightness increments.

additional slides of levels 14 and 15-levels the subject must have completed successfully to reach the second tray. This also had the effect of increasing the number of slides at these levels, giving the subject six opportunities at level 14 and seven at 15 (former levels 12 and 13). At this point in our thinking, we were still tied to the notion that mere repetition (with reward) would help the subject pass through a given step of the program. Our later work caused us to discard this timehonored notion but it was responsible, in the first revision of the program, for adding more slides in the final stages. We added four slides to level 16 (formerly 14), two slides to levels 17 and 18, and one slide to level 19. The final brightness increment, formerly 18 and now 20, contained the same number of slides as before. At this level, of course, the brightness difference between correct and incorrect keys had disappeared and the subject had to make his selection on the basis of circle versus ellipse, the performance toward which the program was directed. The revisions seemed relatively reasonable. The initial part of the


169

program, in which the subject could simply discriminate the bright key from the darker ones, became shorter; more steps were added to the intermediate parts of the program, where the basis for the subject’s

FIG. 8. The performance of a normal child, age 3 years and 8 months, on the second circle-ellipse program. The arrow indicates the change of slide trays. See text for explanation of letters. The numbered dots indicate the end of each consecutive brightness increment.

choice was beginning to shift from the bright-dark criterion to the circleversus-ellipse criterion. We added additional slides near the end of the program where the brightness cue had all but disappeared in order to give the subject more practice at each level. Figure 5, the record of subject N.S., a normal 4 year old, was obtained with the revised program. On this record, levels 9 and 11 are the new ones, the repetition of levels 14 and 15 is indicated at the beginning of the second slide tray, and the number of slides a t each step may easily be seen. Figure 8 shows the record of another normal child, P.C., 3 years and 8 months old. This child made no errors from level 1 through 15, the first 40 slides of the revised program. His first error (at a on the record) came in the second slide tray, on the repeated presentation of step 15, but this error caused him no subsequent difficulty. His second error

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came at b, the first slide of level 17. T h e subsequent return to level 16 helped the child get over this hurdle, and he progressed relatively rapidly through the remainder of level 17 with one more error (at c ) . His next wrong choice (at d ) also came on the first slide of a new brightness increment and again he was helped by returning to the previous level. P.C. made errors on six trials of step 18. Only at e , however, did he press more than one key per trial, indicating a relatively high performance in spite of the frequent errors. Two of the errors, at e and g, were on slide 66, and the errors at h and i were both on slide 68. T h e child then went through level 19 with only one error, at j , but had considerable trouble with slide 75, the second slide of level 20, the criterion performance. T h e third error on slide 75 (at rn) also led to an error on slide 74, on which the child had previously made three correct choices. T h e error on slide 74 (at n) caused the slide tray t o reverse back to level 19 and from this point on, P.C. completed the program with no more wrong choices. Level 18, on which P.C. experienced his first real difficulty, corresponds to level 16 in the original program. By the time C.M., our first subject, had reached level 16 he had overcome his major troubles with the program (Fig. 6). P.C., however, climbed rapidly through the early and intermediate steps, experiencing difficulty only when he was relatively near the end. At level 18 the brightness cue had become extremely difficult, if not impossible, to use, and we suspected that new factors were responsible for P.C.’s troubles at this stage. We had anticipated a possible satiation effect, and starting at the beginning of the second slide tray (after slide 40) we gave P.C. a candy for only 50% of his correct choices, in an irregular order. This did cut his candy consumption in half but may not have prevented satiation. Altogether, he received a total of 74 candies, 54 by the end of level 17. We shall have more to say about the problem of satiation later. Figure 9 shows a particularly interesting record. L.C. was a 5-year-old child who was diagnosed as autistic (Kanner, 1943; Kanner, 1944). Autism is by no means a well-defined disease, and it probably encompasses a number of different types of behavioral disturbance. An outstanding feature of autistic children is their lack of constructive interaction with their environment. Such children range from those who are almost completely unresponsive and inactive to those who are so highly overactive that they are a menace to their surroundings. L.C. fluctuated between these extremes. It was all but impossible to communicate with him, and we had no way of knowing whether he was actually incapable of constructive behavior or whether his failure to display such behavior


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was a function of our inability to make contact with him. On our circleellipse program, L.C.’s performance was somewhat disappointing, since he did not reach the final level of discrimination, but he did display more constructive behavior than we had seen from him up to this point. His record (Fig. 9) is remarkably like that of C.M. (Fig. 6). L.C. experienced his greatest trouble when he first met brightness increment 15, which corresponds to 13 for C.M. L.C., however, did succeed in passing through level 15 at the end of the first slide tray. Reexposing him to

’ONE MINUTE’ FIG. 9. The performance of an autistic 5 year old on the second circle-ellipse program.

levels 14 and 15 at the beginning of the second slide tray seemed to help, but he finally stalled completely at level 17. Unlike C.M., however, L.C. worked quite rapidly and relatively effectively up to the point where he first experienced great difficulty. With the reduced number of slides in the early part of the revised program, L.C. reached level 15 much more rapidly than C.M. had done. I n order to forest,all satiation, the intermittent schedule of reward was introduced for L.C. at slide 14 (the end of level 7). The failure to receive candy on some trials did not disturb him at this point, as his rapid progress through the next few steps indicated. Nonetheless, beginning with the last slide of level 13, L.C.’s behavior changed markedly. At this point, after having received 29 candies, L.C. seemed to lose interest in what he was doing. During the frequent long pauses after level 13, the child usually left his chair and played else-

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Murray Sidnzan and Lawrence T . Stoddard

where in the room, occasionally returning to the keys. The frequent occurrence of multiple errors on a trial indicates that even when he returned to the keys he seemed to press indiscriminately without paying much attention to what was on them. As in the case of P.C., we suspected some such factor as satiation or boredom. Encouraging as his performance was, it still did not go far enough. We were unable to establish the circle-ellipse discrimination that we needed to test his discriminative capacity. Before going on to describe our next revision of the program, we must present one more child, for he gave us the courage to make a radical revision. R.L. was another autistic child, older (8 years, 5 months) than L.C., but with much more severe symptoms. This child was so hyperactive that he had to be restrained to prevent him from destroying everything about him. He rarely spoke, and it had not been possible to engage his attention for more than a few seconds at a time. This seeming inability to hold still, together with the general inappropriateness of his responses to the social and physical environment, made it impossible to evaluate his behavioral capacity by any conventional means. When R.L. was brought to our laboratory and released from his physical restraint, he immediately began to dart about rapidly, without any apparent purpose to his movements. When he was offered a candy he knocked it from the experimenter’s hand and disregarded it. He then darted out the door, with the experimenter close behind. For the next 10 or 15 minutes the two of them, child and experimenter, ran together through the halls of the building, passing in and out of every door along the way, running upstairs and downstairs, never pausing for more than a few seconds in any one place. After a while the child became trusting enough to hold the experimenter’s hand during their travels, and it was possible gradually to lead him back to the laboratory. After passing through the door of the experimental room, the experimenter pressed the lighted key of slide 1, the chimes rang, and a candy fell noisily into the tray. The child immediately seized and ate the candy, sat himself down in front of the keys and went to work. His record appears in Fig. 10. R.L.’s performance was quite remarkable. He went through the program rapidly and accurately, making errors on only two slides-the first slide of level 17 and the third slide of level 19. At the end of about 25 minutes he had learned the circle-ellipse discrimination and, in fact, went on to other programs, working steadily for over an hour. We had taken the precaution of depriving R.L. of breakfast before bringing him to the laboratory. This undoubtedly contributed to the large number of candies, 82, he was willing to earn and eat.


173

A more extended report on R.L. will be prepared later, in conjunction with a longer series of similar children. At this point in our work, however, he demonstrated to us that we were on our way to developing a technique we could use both to teach supposedly unteachable children and to investigate the behavior of children with whom we could not communicate by ordinary means. We tried the first revision of our circle-ellipse program with seven children. Of these seven, only three reached the criterion performance,

FIG. 10.. The performance of an autistic child, age 8 years and 5 months, on the second circle-ellipse program. The record of trials 1-4 was lost through apparatus failure.

learning to discriminate the circle from the flat ellipses. One of the children who went all the way was a normal 4 year old who made no errors (Fig. 5); the second was a normal child, age 3 years and 8 months, who made errors on 9 slides the first time he came to them (Fig. 8). These first-time errors are the ones that concern us, for the errors a child makes on reversing back to a slide he had previously done correctly are probably a direct result of the earlier errors. The third child who went all the way through the program was an autistic child (Fig. lo), who made only two errors. One autistic 5 year old (Fig. 9) went through the program only to level 17; another normal child, age 3 years and 8 months, went through the program only to level 14. Our youngest subject, age 1 year and 11 months, went through only seven slides of

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Murray Sidman a n d Lawrence T . Stoddard

the program, with three errors, before stopping. The seventh child, a severely retarded 4% year old, did not even get started. This summary demonstrates that the first revision of our program still did not provide the instrument we needed. On the other hand, the results were encouraging enough in a few cases to make it appear worthwhile to continue our efforts. In the interest of making the program easier for the children, we had lengthened it in our first revision. T h e data made it look as though this was a mistake. Although the insertion of new steps did seem to produce relatively smooth performances through the first slide tray, a number of the children accumulated errors in the last part of the program. These errors at the end might have come from several sources. For example, the fading increments at the end of the program might have been too large, or the children might have become satiated or bored. Our first data (Fig. 6) suggested that once a child passed through the difficult intermediate steps of the program he would then go through the final few steps relatively easily; he would have learned the circle-ellipse discrimination even before the brightness cue had completely faded out. This was not true, however, for any of the other children except R.L. and N.S. T h e rest either stopped working before they reached the end of the program or made a large number of errors on the final few series of slides. A major indication that the source of the trouble was the decreasing effectiveness of the candy rather than the program itself comes from the fact that in the final few steps the children usually made errors not on the first slide of a new brightness increment but on subsequent slides, after they had already made some correct choices. If the increment were too large, we would expect the children to make an error on their first exposure to a new level. Our success with R.L., whom we had deliberately made hungry, was another bit of evidence that satiation was partly responsible for the children’s errors in the late stages of the program. Hively (1962) has also presented data leading to a similar conclusion. Admittedly, our evidence was inconclusive, and later we discovered additional explanations for the program’s inadequacy, but these were our reasons for the next step we took. In addition to adding a few intermediate steps to the program, we reduced its length drastically. D. The Third Teaching Program

A glance at Fig. 7 will show how the consecutive slides and fading increments of program 3 compare with the earlier versions. Program 3 had only one slide per brightness level, and the children reached the end in only 24 slides. This is approximately one-third the number of

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slides required in the first two versions of the program, Although several intermediate brightness levels were inserted in the later portion of program 3, some of the early levels were removed, so that program 3 had only one more fading step (21) than program 2. We hoped to give the children help where their errors showed they needed it. The youngest child who climbed all the way through program 3 was E.F.C., a normal 3 year old (Fig. 11). He made some errors at the very beginning while he was finding out, what we were asking of him, and

I

’ONE MINUTE

I

FIG. 11. The performance of a normal 3 year old on the third circle-ellipse program.

then went through the rest of the program with errors on only one slide. The brightness increments are no longer numbered on the record because there is only one slide per brightness level. The last three slides represent the criterion performance, in which all keys were equally bright. S.A.C., age 2% was the youngest child who tried program 3, and the program failed to carry him all the way through. His records on two different days appear in Fig. 12. The lower record of the figure shows S.A.C. “hanging up” badly at about brightness level 15, and finally his performance deteriorated almost completely. On his second try, he again reached level 15 but could proceed no further. The consistency

I I-

+ SAC.

c~~~

MINUTE

FIG. 12. Two records of a normal child, age 2& years, to whom the third program failed to teach the circle-ellipse discrimination.

Murray Sidirian orid Lnwrence T . Stoddard

176

of the data in these two sessions illustrates that the mere presence of a circle on the correct key was no guarantee that the child would observe and use the circle as his basis for choice. As long as the correct key was distinctly brighter than the incorrect keys, S.A.C. followed our “instructions’’ quite successfully. However, when the brightness cue began to fail him, he did not transfer the basis for his choice from brightness to the presence of the circle. .Among the children who tried program 3 was one hyperactive autistic girl, age 3 years and 3 months, who was described as “organically driven” byethe examining neurologist and was rated “probably of average intelligence” by the clinical psychologist who administered standard psychological tests. M.B.’s record appears in Fig. 13. She made errors on several slides, but until she reached level 16 the backup procedure seemed to

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,

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FIG. 13. The performance of an autistic child, age 3 years and 3 months, on the

third circle-ellipse program.

provide her with the extra help she needed. In spite of a long period of oscillation in the neighborhood of level 15, M.B. finally broke through and had little trouble with the final few slides of the program. More remarkable than the successful completion of the fading program was her persistence even through the levels she found difficult. It was not ordinarily possible to keep this child’s attention on any one aspect of her environment except through the most intense effort. In this respect she resembles the other autistic children who tried our program, and we wonder what heights they might reach if we carefully programmed their total environment for 24 hours each day instead of just the few minut,es our small program required (Ferster, 1961; Ferster & DeMeyer, 1961; Ferster & DeMeyer, 1962). All the children who failed to pass through program 3, or who completed it with many errors, ran into trouble at approximately the same place-somewhere bet,ween brightness levels 15 and 17, when the brightness cue became difficult to use. Eighteen children tried program 3. With one exception (see below) all the children above 4 years of age climbed through the fading increments either with no errors or only one error. Seven children were younger than 4 years. Of these, four reached the


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end of the program. The youngest was E.F.C., age 3 years (Fig. ll), and the next was 3 years and 2 months; both of these children made errors on only two slides. M.B., age 3 years and 3 months (Fig. l3), and one other child, age 3 years and 5 months, had similar difficulties but both did break through. The program was not adequate for the remaining three children younger than 4 years old. The one child older than 4 years (4G) who did not get through the program was severely retarded as a result of a rare metabolic deficiency. This child’s difficulty turned out to be an inadequate reward. M & M’s maintained his performance only for short periods of time and then he stopped working. The breakthrough came when we discovered that an effective reward for him was the opportunity to feed M & M’s into the experimenter’s mouth. When he could dispose of his candies that way, he went through the program quite successfully.

E.

The Fourth Teaching Program

The third version of the program was still not as successful with the younger children as we hoped it would be, but it seemed to be at least

now

I

ONE MINUTE

FIG. 14. The performance of two normal siblings on the fourth circle-ellipse program. A.P.’s age was 2 years and 11 months; D.P. was 6 years and 8 months.

as effective in 24 slides as program 2 had been in 80 slides (Hively,

1964b). Emboldened by this, we shortened the program still further. As Fig. 7 indicates, we removed brightness increments 2, 4, 6, 8, and 10, thereby greatly increasing the rate at which the incorrect keys became brighter in the early part of the program. The rest of the program remained the same as the third version, The children now required only 19 slides to get through the program, and again the final 3 slides represented the criterion performance, with all keys equally bright. The youngest child who succeeded with program 4 was A.P., age 2 years and 11 months. She made no errors at all, and her record appears in Fig. 14. The upper record of the figure is her brother, age 6 years and 8 months. Both children gave perfect performances, the major difference between them being the greater time the younger child required to make her choices. Twenty-six children tried program 4. Of these, seven were younger

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than 4 years; five of these seven were less than 3 years old and one was less than 2 years. Only one of them, A.P., went all the way through the program. Of the 19 children above 4 years old, three failed to reach the end of the program. One of these was a child, age 4 years and 2 months, whose diagnosis was “retardation and juvenile autism.” He had no speech and was almost unrateable by ordinary psychological tests. H e was assigned. a mental age of 15 months on the Cattell Infant Intelligence Scale. W e saw this child five times. In his first session he managed to reach slide 11, with many errors and with much encouragement and demonstration. In the second and third sessions we were not able to get him past the first couple of slides. In the fourth session he reached slide 12 and in the fifth session he worked considerably more rapidly and reached slide 14. Again, while far from successful, the program did appear to go a long way toward making contact with an otherwise unreachable child. Our groups of children in programs 3 and 4 were certainly not comparable, but the data suggest that the more rapid program 4 might have been somewhat less effective than program 3. Neither, however, gave us the results we wanted-successful performance by children a t least as young as 2% years. Our guess was that if we could work successfully with normal children as young as 2% we would also have considerable success with older retarded children. Ou r dissatisfaction led us to reevaluate the procedures we had been using, and this reevaluation finally produced the program we were seeking. T h e review went all the way back to C.M., our very first subject, before we hit on a promising lead. C.M. had been given some preliminary experiences before he went through program 1. We had completely underestimated their importance and had neglected them with all subsequent subjects. I n programs 1-4 we tried to accomplish two things simultaneously. Starting with a circle on a bright key as the correct choice and seven dark keys as incorrect choices, we gradually increased the brightness of the incorrect keys; at the same time we gradually faded the flat ellipse onto the incorrect keys. C.M., however, had first gone through a program in which we gradually brightened the incorrect keys without superimposing any form on them. I n essence, C.M.’s task had been broken u p into two simpler parts, “background fading” and “ellipse fading.” All the other subjects had been asked to learn both components of the final discrimination at the same time. Therefore, in our next revision of the program, we separated these two aspects of the learning process. We realized at this time that the concurrent fading of both the background and the ellipse had an additional consequence that was probably

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responsible for many of our failures. Although the ellipse faded in gradually, it was clearly visible to the children long before its background brightness equalled that of the circle. Because of this, the children could continue to use the brightness cue long after the ellipse was clearly available to them. T h e children needed to look only for the bright key; they did not even have to observe the circle. Since it was possible for them to ignore the forms, we can assume many children did. T h e circle and ellipses were present, but irrelevant. We were, in fact, teaching the children to ignore them. When the background fading eventually made it impossible for them to use brightness, many of the children could already have learned not to pay any attention to the forms. Separating the background fading and the ellipse fading eliminated this deficiency in our program. Similar reasoning may help to explain C.M.’s difficulty with program 1. Although he had previously learned with ease to select the bright key with a form on it from equally bright keys without forms, program 1 reestablished a discrimination based on brightness alone. C.M. experienced great difficulty when brightness became difficult to use as a basis for correct choices. His previous learning may have helped him finally to attend to the forms again. T h e ease with which C.M. had gone through the original background-fading program encouraged us to divide the circle-ellipse discrimination into two stages. F. The Fifth Teaching Program

As before, the first slide of the new program presented the subject with a circle on one bright key and seven dark keys. During the first

A

C

D

FIG. 15. Schematic illustration of a few steps in the background-fading portion of program 5. T h e correct key always had the circle on a bright background. T h e incorrect keys were dark at first (A) and gradually became brighter (B, C, D).

eight slides we gradually made the incorrect keys brighter until they finally equalled the correct. key, but this time no ellipses appeared. Since no forms appeared on the incorrect keys during this phase we called it “background fading.” T h e incorrect keys gradually became as bright as the background of the correct key (Fig. 15). I n order to make

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a correct choice, the child had to look for the only key with a form (“something”) o n it. T h e next step was to teach him to look for a particular form (circle). Beginning with slide 9, we gradually introduced the flat ellipse on the fully bright incorrect keys. T h e ellipses were very faint gray at first, almost invisible even if one knew to look for them. T h e ellipses became darker from trial to trial and the contrast between ellipse and background gradually increased. By slide 17 the only difference between correct and incorrect keys was the form-circle o r ellipse. We called this phase “ellipse fading” (Fig. 16).

FIG. 16. Schematic illustration of a few steps in the ellipse-fading portion of program 5. The ellipses appeared gradually on the bright backgrounds of the incorrect keys. (The ellipses were not actually dotted: they were drawn that way here for convenience in reproduction.)

Six subjects went through program 5. T h e youngest, 2 years and 3 months old, made little progress, although he did get through the program after its next revision. Complete data for the other five children appear i n Fig. 17. T h e encircled numbers indicate those slides on which the children made “first-time errors,” that is to say, those slides to which they responded incorrectly the first time they reached them. Errors after a backup are not numbered, but there were few of these. T h e arrows at a indicate correct choices on slide 8, the end of background fading. At this point all keys had become equally bright but only the correct key had a form (circle) on it. Only one child, M.J.M., made an error in this part of the program. T h e arrows at b indicate the correct choice on slide 17, the end of ellipse fading. O n this slide the only way the child could make a correct choice was to distinguish circle from ellipse. Slides 18, 19, and 20, the final three, were simply repetitions of this criterion performance. Starting at the bottom of Fig. 17, the youngest child, T.E.S., was 2 years and 9 months old. T h e next two, F.P.R. and F.D.Z., were 4 years and 7 months and 4 years and 10 months, respectively; the two oldest children, M.J.M. and S.F.L., were 5 years and 4 months and 5 years and 9 months, respectively. All the children went through the two-stage fading process with little difficulty. However, the sample is small. An interesting observation is the consistency of the errors on slide 13. All but the oldest child made

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at least one error when they reached slide 13, and he made his error on slide 12. In no instance were the errors serious-none of the children “hung up”-but we had obviously created a difficult spot in the ellipsefading series. S.F.L., even though he did select the circle on slide 13, made a revealing comment, “Oh, no! All of ‘em! Wait a minute, there’s one?” S.F.L.’s comment suggested that he had not observed the ellipses until slide 13 came up, and at that point they seemed suddenly to appear on all the keys. It seemed reasonable to suppose that we had made too large a jump from slide 12 to slide 13 in fading the ellipse on to the

ONE MINUTE

FIG. 17. Thc performance of five normal children on the fifth circle-ellipse program. The arrows at a indicate the end of background fading; the arrows at b indicate the end of ellipse fading. The encircled numbers are the slides on which the children made “first-time” errors. See the text for the childrcn’s ages.

bright background of the incorrect keys. We therefore made a simple revision, inserting an intermediate fading increment between slides 12 and 13. At the same time, we removed one of the criterion slides from the end of the program. G. The Sixth Teaching Program

Program 6, then, was the same as program 5 from slides 1-8, the Imkground-fading series; ellipse fading now occupied slides 9-18 instead of 9-17. Slides 19 and 20 were simply repetitions of the criterion performance. Forty children went through program 6, and like the other programs, this one was highly successful with children over 4 years old. Of interest here is the performance of children younger than 4 years.

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Eight children younger than 4 went through program 6 . Of the eight, only one child, age 2 years and 4 months, failed to reach the criterion performance. All the others learned the circle-ellipse discrimination. Another child, also 2 years and 4 months, made nine first-time errors, two during background fading and the rest during ellipse fading, but a recorder failure prevented us from showing his record. T h e performance of all the other children younger than 4 appears in Fig. 18. T h e youngest

ul Y

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FIL. 18. The performance of eight childrcii on the sixth circle-ellipse program. n indicates the end of background fading, and b indicatcs the end of ellipse fading. The encircled numbers are the slides on which the childrcn made “first-time” errors. For tlctailq on the children see the text.

of these, W.J.B., was 2 years and 7 months; N.E.L. was 3 years old; M.F.R., 3 years and 1 month; P.L.F., 31/, years; J.D., 3 years antl 8 months; and J.M.N., 3 years antl 9 months. T h e two upper records in Fig. 18 are those of older children who are especially interesting, antl we sh;ill return to them below. Slide 13 was atltled to the program to make the ellipse fading more gradual a t a critical point; slide 14 in program G is the same ;IS slide 1.3 of Ilrogram 5. T h e addition of the new fading increment did 1101 reall) clear u p the children’s problem. Most of them made errors either on the

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same slide as before or on the new one. I n n o instance, however, did this cause mole than a temporary stumbling block to any child’s progress, and we felt that the difficulties involved in preparing an additional intermediate fading increment would be too great to warrant further revision at this point. T h e major finding here is that, for the first time, the program was almost 100% successful in teaching children younger than 4 years of age to discriminate circles from ellipses. Two of the children were, in fact, younger than 3, and N.E.L., who gave the best performance of all, was exactly 3 years old. A.J.M., age 4 years and 5 months, was one of a large class of physically and mentally underdeveloped children whose neurological and other medical examinations yield largely negative findings. When he went through conventional psychological tests, A.J.M. received a lownormal IQ, in the high 80’s. T h e psychologist who tested him reported, “He appeared not accustomed to working things through himself. H e could be persuaded to complete tasks but his inclination was to ask for help immediately when he found anything difficult.” A.J.M.’s rapid and almost errorless progress through the circle-ellipse program suggests that w i t h adequate reward for correct performance, and with a teaching method designed to ease the transitions from one stage of a task to another, he can avoid the obstacles that slow him down when he is asked to learn by conventional methods. D.M.’s record, the topmost one in Fig. 18, also suggests the potential effectiveness of our new program. D.M.’s medical diagnosis was ‘microcephaly and mental retardation.” H e was 8 years old, but standard psychological evaluation gave him a mental age of 4 years and 8 months and an IQ in the 50’s. On our program D.M. learned the initial brightness discrimination without any errors. He did make five errors-a large number-on his way to learning the circle-ellipse discrimination, but the backup procedure apparently helped him considerably. Furthermore, he learned to distinguish circles from ellipses in something less than 3 niinittes. We cannot, of course, predict how far children like D.M. might eventitally climb; this result suggests that hundreds of hours might not be too great an investment to apply toward developing teaching programs similar to oitr circle-ellipse program but more immediately relevant to the demands of everyday living.

H.

The Final Teaching Program

Il’e made only one additional minor change in our program for teaching children the circle-ellipse discrimination. This change was simply the removal of one slide from the background-fading portion of the program. Most children passed through this phase of the program without making

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an error. A closer look at the data revealed that no child ever made an error on slide 7 and very few picked a wrong choice on slides 6 and 8. W e therefore removed slide 7, leaving only seven steps in which the background illumination on the incorrect keys changed from dark to fully bright. We also removed one of the three criterion slides at the end of the ellipse-fading section of the program. From here on the program consisted of only 18 slides, at the end of which the children were able to discriminate circles from relatively flat ellipses. This is a far cry from our second program, which required 80 slides and was not nearly so successful. Of the next 30 children who went through the program, only 1 failed to learn the discrimination. Of these 30, 9 were younger than 3 years. T h e youngest child, 2 years and 2 months, made many errors, particularly near the end of the ellipse fading, but he did complete the program. T h e child who failed to complete the program was 23. Of the others, 2 were 2 years and 7 months, 2 were 2 years and 8 months, 2 were 2 years and 10 months, and 1 was 2 years and 11 months. T h e child to whom the program failed to teach the discrimination had so little behavior that she was rated untestable by the clinical psychologist. This child suffered almost continuous myoclonic seizures-brief but frequent small muscle spasms and jerks. Another of this younger group of children failed to go beyond the first few slides when we gave him candies for his correct responses, but when we changed the reward to small sips of water he went through the program with little difficulty. This emphasizes the close relation between the programming techniques and the consequences of the desired behavior. An effective reinforcement is necessary. It is our means for making it worthwhile for the child to follow the instructions our program gives him. But even with an adequate reinforcement, the child cannot behave appropriately unless we also give him adequate instructions. This is the function of the program. Without an adequate reward, therefore, the child has n o reason to follow our instructions; without adequate instructions, the reward will make n o contact with relevant behavior, and the child will learn to do something else, like pressing all the keys in succession until he finally hits on the correct one. I. Recapitulation

All the work we have described so far was devoted to the problem of teaching nonverbal children a simple visual discrimination. We have presented our methods in great detail became we believe it important for others interested in working along these lines not to be misled by the simplicity of the final product. T h e major part of the labor, however, is

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confined to the program designer-the teacher. Once developed, the program is time in the bank. With each child who uses it, time is saved -both his and the teacher’s. I n the process of developing the circle-ellipse program we learned a number of valuable lessons. First, consistent with everything we already knew about behavior in general, the necessity to reward the child adequately for desirable behavior was brought home to us again and again. It may even be necessary to deprive a child of food or water in order to establish an effective reward. T h e progress he makes and the information we secure compensates for the slight discomfort this may cause him. Given an adequate reward, we must then attend to the details of the task we want the child to learn. We must analyze this task into its component parts, carefully specify the end point we want the child to reach, and program the components in an orderly progression from simple to complex, always building on what we have already taught the child to do (Holland, 1960; Skinner, 1954). T h e technique used in the circleellipse program began with a simple brightness discrimination, which appears relatively easy for most children (see also Kellogg & Rice, 1964; Schlosberg & Solomon, 1943). By careful fading we gradually transferred control over the child’s behavior from the relative brightness of ‘the correct and incorrect stimuli to the circles and ellipses. At first we attempted simultaneously to fade out the brightness cue and fade in the ellipses. When this proved to be too difficult for some children we broke the task into two components. We first faded out the brightness cue and then faded in the forms. By separating the child’s perceptual task into these two components we succeeded in developing a successful program. We learned next that the teaching program should progress as rapidly as possible. If the children are given too much “practice” at a given point they are likely to become bored or satiated. Or if the cue we eventually want them to use is present as an irrelevant stimulus too early in the program, they may actually learn to ignore that cue and then be unable to use it when the alternatives become impossible. We also learned the utility of giving the child extra help by means of the backup procedure. When the child makes an error, the program automatically reverses to an easier section, giving the child another chance to get himself started on the correct course. Finally, we learned to use the children’s errors as an indication that we had programmed the task inadequately. By constantly revising the program, we were able to eliminate consistent errors that kept the children from progressing. All these ingredients are part of the repertoire of any good teacher. What we have done here is to combine them into one package, to use

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automatic equipment that has infinite patience and no lapses of memory or attention, and to have enough confidence in the methodology to persist until we arrived at a successful end product. I n none oE the preceding pages have we demonstrated rigorously that the program was necessary to teach any OE our children to discriminate circles from ellipses. This demonstration has been made and will be published more appropriately in a technical journal (Sidman & Stoddard, in press). We have shown that the program is an effective device for nonverbal communication. Without any other form of instructions we have communicated to our children that they are to choose circles and reject ellipses. T h e program can accomplish this task of communication reliably within 5 minutes o r less, with normal children as young as 2 to 3 years of age and with older retarded children. It does not matter that some of our children could talk or that some of them already knew the difference between circles and ellipses. Our ultimate interest is in preverbal or otherwise nonverbal children, with whom some other means of communication must be found if we are going to be able to evaluate their behavioral potential fairly. Because most of our standard intelligence tests, even the so-called “nonverbal” tests, depend heavily on verbal instructions, most children who cannot talk earn a low I.Q. We often doom these children to a n institutionalized or otherwise impoverished existence simply because they do not speak our language. T h e philosophy behind our persistent efforts to develop the circleellipse program can no longer be regarded as a n academic issue. It is a set of methods that work. We have found empirically that in order to teach effectively we must first prepare ourselves to learn from our children. Their errors are a lesson to us. They make mistakes because our teaching has been inadequate. T h e proof was the progressive elimination of errors as we revised our teaching program. With successive revisions the children made fewer and fewer errors, and more of them reached the point to which we were trying to get them. Are these statements too sweeping? After all, we have only taught our children to tell circles from ellipses, a performance which will hardly play an important role in their lives. We certainly do not propose our program as a substitute for I.Q. tests. We believe, however, that the methodology is general. It can be applied to areas of much more immediate consequence to the children. We shall expand on this notion below. Meanwhile, let us return to the problem we originally set ourselves. Teaching the children to discriminate circles from ellipses was only a preparation for a more precise evaluation of their visual perception. T h e sensory evaluation of children who cannot or do not talk is a vexing practical problem to neurologists as well as to teachers who want to know whether

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a child is capable of learning some of the things he is ordinarily expected to learn. T h e circle-ellipse program serves as a substitute for verbal instructions. It is our way of telling nonverbal children what to look for. We cannot say to these children, “Pick out the circle” o r “Press the round one.” But with our final set of 18 slides we accomplished the same thing without words. When they completed the program, the children were attending to the relevant stimulus dimensions just as well as children for whom verbal instructions are appropriate. We are now ready to determine how fine a discrimination they can make. 111. THE CIRCLE-ELLIPSE DIFFERENCE THRESHOLD

Teaching did not end with the beginning of our testing procedure. As we have done all along, we started by asking the child to tell us, nonverbally of course, something he already knew. We increased the difficulty of our questions in small increments, and we gave the child as much help as we could. Again, we used a “fading” technique. T h e child started by picking a circle and rejecting relatively flat ellipses, with rewards for his correct choices. From one trial to the next we gradually increased the vertical dimension of the ellipses, making them look more and more like circles. If the child made a mistake, picking an ellipse instead of the circle, the backup procedure returned him to an easier step, giving him a chance to start again with a discrimination he could make. Figure 19A shows the progression of ellipse sizes we used in our first program. T h e numbers beside each ellipse indicate the ratio of its vertical to its horizontal axis. As these numbers become larger, the ellipses look more and more like a circle. When a child gets to an ellipse that he can no longer distinguish from a circle he “hangs up” in the program, oscillating back and forth between slides on which he can tell the circle and ellipses apart and slides whose ellipses he cannot tell from the circle. T h e ellipse beyond which he no longer makes a correct choice is his “threshold.” Because of the backup procedure, the child can advance only one slide beyond his threshold. Figure 20 shows the record of a child who went through our first threshold program without an error. She was a bright 7 year old and her performance is not unusual. We present the record mainly to illustrate the program and indicate what an errorless performance looks like. Altogether we used 10 sizes of ellipses, each size appearing bn eight consecutive slides before increasing. T h e dots under some of the steps in Fig. 20 indicate the slide on which each pictured ellipse first appeared. This child made no errors as the ellipses became more like circles, although she did

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take more time to make her selections when she reached the slides containing the largest ellipses. With only a few exceptions, all the children went through the circleellipse program before we tested their threshold. As we indicated in Fig. 20, the original threshold series contained eight presentations of each of 10 ellipse sizes, making a total of 80 slides in that series. Added to the 72 A

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or 80 slides of our original discrimination programs, this constituted a lengthy procedure. As we became skeptical of the old maxim that “practice makes perfect,” and reduced the length of the discrimination program, we also reduced the length of the threshold series. We cut down the number of slides per ellipse size from eight to three. I n addition, we began to increase the ellipse sizes during the course of the fading program. We had found that children rarely made errors on ellipses whose axis ratio was .53 or less.

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Figure 21 shows the main features of the total series of slides and demonstrates a phenomenon from which we learned a valuable lesson. T h e record, made by a normal child, age 5 years and 2 months, will repay some detailed attention. T h e small arrows indicate the slide on which each pictured ellipse appeared. At the start of the fading program (program 3) the correct key was fully illuminated and contained a circle. T h e .31 ellipse, not yet visible, was gradually faded onto the incorrect keys. On slide 9, the gradually fading ellipse was changed to a slightly

Fic;. 20. The performance of a normal 7-year-old child on the first threshold program. The dots indicate the slide on which each of the pictured ellipses first appeared.

larger one, with an axis ratio of .39. On slide 17, when fading was almost complete, the ellipse ratio was increased to .46. By slide 22 the fading process was over, the ellipses were completely faded in, and the ellipse size increased to .53. This child, J.A.P., made no errors through the ellipse-and-background-fading program and went through the 3 criterion slides with no difficulty. T h e threshold series began on slide 25, with the positive and negative keys indistinguishable except for the presence of circles or ellipses. T h e .61 ellipse was introduced at this point. J.A.P. made her first error on slide 26, at a, returned to slide 25, and then moved rapidly to slide 28. On slide 28, at b, the ellipse size had jumped to .66, and the child’s

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error on this slide returned her to slide 27, which contained .61 ellipses. T h e child made three errors on this slide, having made none on her first exposure to it, returned to slide 26, and then moved successfully to the .74 ellipse. She made several errors at d , the third slide of the series containing .74 ellipses. At e, she made three errors on the first slide containing .79 ellipses, returned to the .74 ellipses, and then moved with little a 00 baa@

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FIG.21. T h e performance of a normal child, age 5 years and 2 months, o n the third circle-ellipse program and on the threshold series. T h e arrows indicate each slide on which the ellipse size changed, whether because the child advanced or backed up. Note that the ellipse sizes began to change even during the fading program: fading was complete on slide 22. T h e key matrix is schematically illustrated at the upper right, and the keys are numbered 1-9. T h e letters indicate those trials on which the child made at least one wrong choice, and in the upper section of the figure the numbers beside each letter show the succession of keys the child pressed. T h e final number on each line identifies the correct key on that trial.

difficulty to f, her highest point, which was the first slide containing .89 ellipses, At f, J.A.P. had advanced past the last slide that contained .84 ellipses; since she did not advance through the .89-ellipse step, her circle-ellipse threshold was 34. Starting with slide 40, at f, the child then made errors on 11 consecutive slides, backing down all the way to the .G6 ellipse, at p . She was able to


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retiirn to the .74 ellipse, at q, but continued to select this ellipse (r, s, t ) and was not able to pass beyond it. This record is not the first instance we have seen in which “errors create errors.” T h e trials from f to p , in which J.A.P. backed down through the program, making errors where she had previously been successful, are striking but by no means unusual examples. Additional details from this child’s record illustrate clearly what she was doing. I n the upper right portio? of Fig. 21 we have schematically illustrated the matrix of keys, numbered from 1 through 9. In the two columns a t the left of this illustration we have listed all the trials, from a through t, on which the child selected an ellipse at least once. Beside each letter we have indicated the sequence in which the child pressed the keys on that particular trial. T h e final key in each row is the correct key for that trial. For example, at a, J.A.P. first pressed key 6, an ellipse, and then pressed key 9, the circle. Note that keys 6 and 9 are adjacent. At b, the child pressed key 2 twice in succession before going to key 6, which was correct. At c, she first selected key 6-which was correct on the previous slide-and then selected three adjacent keys in succession, numbers 8, 7, and 4. Th e pattern of moving around the outside of the matrix, selecting adjacent keys until she came to the correct one, was already beginning to develop. At d, J.A.P. moved from key 7 to key 4, skipped key 1, and then continued in the same direction through keys 2, 3, 6, and 9. This pattern of responding became even more striking after the child reached her high point at f . At g she started on key 1 and moved along on consecutive keys, making six errors before arriving at key 3, which contained the circle. T h e child continued with similar patterns all the way down to p , at which point she jumped directly from key 9 to key 3, apparently finding i t easier again to use the difference between circle and ellipse as her basis for choice. O n trial k, the child made 10 errors before finally selecting the circle. This large number of errorsmore than the actual number of keys-occurred because J.A.P. temporarily abandoned her systematic exploration, jumping from key 8 to key 4, from key 1 to key 3, and from key 3 to key 9 before she finally returned to her old system of picking adjacent keys. O n trials I and 0, the child’s system worked quite well simply because the correct key happened to be adjacent to the one she had selected first. I n discussing the original circle-ellipse fading programs, we had to infer that the children’s errors came because they reached a difficult portion of the fading sequence. In the threshold series, this inference becomes more obvious. T h e positive and negative keys were actually becoming less discriminable as the child progressed, and the series was designed so that the child would eventually reach an ellipse he could no longer

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distinguish from the circle. When the child reached this point he found that his former criterion for choice no longer worked. It no longer sufficed to look for the circle or for whatever aspect of the forms he had been observing. All the stimuli had become “circles.” Reasonably enough, he changed his criterion. Two substitute criteria that we could easily see in the children’s data were (a) to select the key which had been correct on the previous trial, and (b) to develop a fixed pattern of moving around

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FIG. 22. The performance of a normal child, age 4 years and 5 months, on the fourth circle-ellipse program and on the threshold series. T h e arrows indicate each slide on which the ellipse size changed, whether because the child advanced or backed up. Note that the ellipse sizes began to change even during the fading program; fading was complete on slide 17. The key matrix is schematically illustrated at the upper right, and the keys are numbered 1-9. The letters indicate those trials on which the child made at least one wrong choice, and in the upper section of the figure the numbers beside each letter show the succession of keys the child pressed. The final number on each line identifies the correct key on that trial.

the keys until reaching the correct one. Not all children selected as efficient a pattern as J.A.P., nor was a consistent pattern always evident to us, but it is reasonable to suppose that some such substitute process was responsible for the frequent occurrence of errors on slides to which the children had previously respondecl correctly. The major point to be made here is that repetitive errors and “false” hypotheses are not necessary to the learning process. Careful programming can prevent errors from occurring, a t least until the child reaches the limits of his capability. Once the program produces an error, the child

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often responds by changing his strategy and no longer even observes the relevant cues until they again become so obvious that he can no longer ignore them. Figure 22 is the record of a child, age 4 years and 5 months, whose performance was strikingly similar to that of J.A.P. This child went through the threshold series after we had decreased the length of the original fading program (program 4). Her errors in the part of the threshold series that was difficult for her caused P.L.A. to abandon the circle-ellipse discrimination in favor of systematically exploring the keys. Like J.A.P., her threshold was at the .84 ellipse. Figure 23 is the record of a child, R.D.C., age 5 years and 3 months, who had considerably more difficulty than usual with the fading program .W .N .74

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their axis ratios.

(program 4) and who settled down to a relatively stable threshold performance without backing very far down through the series. We were not able to detect any systematic pattern of errors for R.D.C. She had no obvious neurological problem, but it may be of interest that she had been brought up in a remarkably destructive home situation and was eventually relocated in a foster home. Her finest circle-ellipse discrimination, the .74 ellipse, was considerably below our norms for her age level. It is possible, however, that this reflects a general behavioral deterioration rather than a basic perceptual deficit. I n the records we have just discussed (Figs. 21, 22, and 23) each ellipse in the threshold series appeared on three consecutive slides. Only when a child made an error on the first of a set of three slides did the backup procedure return him to a more discriminable ellipse. For example, in Fig. 22, P.L.A. made an error at a, the first slide on which she was exposed to the .74 ellipse. T h e error immediately returned her to the .66 ellipse, and this little bit of help sufficed to get her past the next step. However,

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at b her errors came on the third slide of the set that contained .84 ellipses. Her error returned her to the preceding slide, which contained the same ellipses, and she made four errors on this slide (at c), where she originally had had no trouble. I n this instance, she could receive no help from the backup procedure. T h e next change we made, therefore, was to reduce the number of slides in the threshold series to two per ellipse size. M'e also made some additional changes at this point: As we described earlier, (programs 5 and 6), we broke u p the fading program into two sections, first fading the bright background on the incorrect keys and then fading in the ellipses. We also eliminated the 3 1 ellipse and started with the .39 ellipse. I n addition to reducing the number of slides per step in the threshold program we also inserted some intermediate ellipse sizes

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FIG. 24. The performance of a normal child, age 5 years and 7 months, on the final circle-ellipse program and on the revised threshold series.

and added some that were closer in shape to the circle. These changes are illustrated under B in Fig. 19 on page 188. This figure compares the original and the revised threshold series. We added five elipses at the upper levels, with axis ratios going from .91 to .985. We also inserted intermediate ellipse steps at .57 and .70. In addition, from .74 to .89, we replaced the original four ellipses with a more gradually increasing sequence of six. Figure 24 shows the performance of a somewhat brighter than average child, age 5 years and 7 months, on the revised series. T h e arrows again indicate each slide on which the ellipse size changed, whether as a result of the child's progress through the series or as a result of the backup after he made errors. This child was not able to distinguish the .91 ellipse from the circle, but his threshold, at 39, was one of the highest achieved by any child at this age level. P.A.S. was extremely persistent and continued to oscillate around his threshold level even in the face of frequent errors. He actually went on for a considerably longer period of time, but we have


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not included the rest of his record. Most children ask if they can leave after making many fewer errors than P A S . did. This child’s long series of reversals back from the .9l to the .80 ellipses, a pattern also observed in the records of J.A.P. and P.L.A. (Figs. 21 and 22), illustrates anew the necessity for devising a teaching procedure that will eliminate errors or postpone them as long as possible. This is especially true when we are trying to test a child’s perceptual capacity. When the child makes errors, he abandons the perceptual task we have set for him and does something else instead. From that point on we cannot be sure of our test’s validity. T h e changes we made in the threshold series, as illustrated in the ellipse progression of Fig. 19 and the record of Fig. 24 (P.A.S.), produced results that strongly support the necessity for careful programming even in a testing procedure. After we made these changes our whole set of age norms for the circle-ellipse threshold had to be revised upward. For example, no child between the ages of 2 and 3 years who went through our original threshold series was able to go beyond the .79 ellipse. After revising the series, antl making the other changes described above, 50% of the children in this age range were able to go beyond the .79 ellipse. I n the 3- to 4-year range, the upper 50oj, of the children in the first series reached their threshold at the .79 or .84 ellipse; with the revised series, the upper 50% of the children in this age range attained thresholds ranging from 3 3 to .89. Similar changes OCcurred at successively higher age levels. We now have an experiment under way explicitly to investigate the effects of the rate of progression through the ellipse series. There is already considerable evidence in the literature that a more gradual progression actually produces finer difference thresholds. William James (1890) noted this phenomenon as long ago as 1890; Pavlov (1927) demonstrated it experimentally with dogs as subjects and circles and ellipses as stimuli; similar findings have been reported with human subjects and for other types of stimuli (Baker & Osgood, 1954; Lashley, 1938; Lawrence, 1952). We expect simply to confirm these findings under our particular set of conditions. T h e lesson has been available to us for a long time antl its neglect has undoubtedly been responsible for the underevaluation of many children’s sensory capacities as well as the abandonment of many children on the grounds that they could not be evaluated at all. We present one more record in Fig. 25, to illustrate the present state of our threshold series, with a subject who was able to progress almost through the whole series. Note that we now use only one slide for each of the first few ellipses in the threshold series. W.G.L. was a normal 16 year old who received pennies for his correct choices. H e was able to get through the .95 ellipse successfully but could not discriminate the .97

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ellipse from the circle. This young man did not need the brightness and ellipse fading programs-we could simply have told him to pick out the circle-but our program was designed as a means of nonverbal communication. We have referred briefly to age norms for the circle-ellipse discrimination. In their present incomplete form, the normative data indicate a rapid increase in discriminative ability from ages 2 to 6, and then only a slight increase above age 6. Does this mean that the circle-ellipse discrimination reflects a developmental process that is not complete until a child reaches 6 years of age? While many neurologists suggest that the

End of

W.G.L.

ONE MINUTE

FIG.25. The performance of a normal 16 year old on the final circle-ellipse program and on the final threshold series.

nervous system continues to develop even beyond age 3, there is n o conclusive neuroanatomical evidence in favor of this, particularly in the visual system. If a still-developing nervous system is not responsible for the finer circleellipse discrimination with increasing age, where else may we look for an explanation? Perhaps an answer is to be found by looking more closely at the behavior involved in distinguishing these two stimuli. O n what aspects of the two forms do the children actually base their discrimination? We have been calling the forms circles and ellipses, as if this were a sufficient specification. Perhaps, however, the children are looking at things other than the overall shapes. For example, the vertical axis, or height, of the circle is greater than that of the ellipse; the two stimuli also differ in area; the sides of the ellipse are sharper than the circles; the ellipses are flatter at the top and bottom. Children, and adults, may use any or all of these cues in making their discriminations. Perhaps the younger children fail to make finer discriminations simply because they have not yet learned to attend to such details of their environment as


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heights, areas, and degrees of curvature. Suppose we explicitly taught them these fine discriminations, devising programs not to teach the gross circle-ellipse discrimination, but rather to teach such discriminations as height, area, and curvature? Would this then increase their circle-ellipse thresholds? At present we cannot answer this interesting question, but it is important enough to form a major part of our future plans. T h e answers will not only clarify some basic relations between behavior and the developing nervous system, but will have practical results as well. For example, if a child performs at a lower than normal level in the circle-ellipse discrimination, does it mean he has poor vision, or has he simply not yet learned to attend to the fine details of his environment? Most of the institutionalized retarded children we have tested have scored well below the norms for their ages. Do they need eyeglasses or do they need more training in perception? We have described the development of a nonverbal technique for teaching children to discriminate circles from ellipses, and a combined teaching and testing procedure, still nonverbal, for determining the quantitative limits of their ability to distinguish these forms. It is now possible for us to secure information about visual function in children who are otherwise unreachable. While our methods have been applied only to a single aspect of visual perception, there is no reason why they could not be extended also to visual functions such as acuity, brightness thresholds, flicker fusion, etc. T h e techniques are potentially valuable not only for testing sensory capacities, but for teaching the children skills that are more relevant to their everyday necessities. I t should be possible to use letters, numbers, words, colors, sounds, etc., and thereby lay the foundation for programming more advanced materials (Holland & Matthews, 1963). IV. THE REVERSAL OF THE DISCRIMINATION

To demonstrate the generality of our techniques we set out to develop a program to teach the children, without verbal instructions, to reverse the discrimination they had already learned. We had taught them LO select circles and reject ellipses; our task now was to teach the same children to select ellipses and reject circles. If we could teach nonverbal children this discrimination reversal, and if they could learn the reversal without even making an error in the process, this would indicate the feasibility of wider application of our methods. Our plan involved two major stages. We would gradually transform the positive stimulus from a circle to an ellipse, and, conversely, we would

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gradually transform the negative stimuli from ellipses into circles. But if we did both of these simultaneously, there would be a stage in the program where the positive and negative stimuli would be exactly the same, and the chilclren would have no basis for a correct choice. Ther e had to be an intermediate step i n which either the positive or negative stimuli would temporarily assume some third shape, thereby assuring that the positive and negative stimuli were always different. To determine what this third shape should be, we performed a little experiment. T h e data of this experiment are also relevant to the problem we proposed earlier; namely, to what aspects of the circle antl ellipse are the children a ttentling? A. The Probe Series

O u r initial problem was to determine which stimulus to transform first, the positive circle or the negative ellipse. T h e second problem was to select an intermediate form to use in this transformation. If we changed the circle into something else, the new stimulus should be one to which the children would transfer their choice with little difficulty. If we were to change the ellipses, we should use a stimulus the children would reject easily. This is what Kluver (1933) called the problem of “equivalent stimuli.” What forms are equivalent to-substitutable for-the circle and the ellipse? We devised a series of slides almost exactly like the ones to which the children were already accustomed. We projected a circle on one key and ellipses on the other seven keys, and the circle was the correct choice. Every fourth slide in the series, however, was a probe. O n these probe slides we did one of three things: we substituted a new form for the circle and left the ellipses unchanged; we substituted a new form for the ellipses antl left the circle unchanged; or we substituted new forms for both the circle and the ellipses. None of the stimuli on the probe slides could be called correct or incorrect. Therefore, the child always advanced to the next slide no matter which key he pressed on a probe slide. We gave n o reward for the child’s response to the probe stimuli, nor did the chimes ring. T o prevent the lack of reward from giving him false clues we instituted a procedure of intermittent reward during both the probe series antl the preceding threshold series. T h e child received rewards for only 5OC& of his correct choices, and the trials on which he received rewards were schetlulcrl in an irregular sequence. T h e stimuli we used on each probe slide may be seen at the top of Fig. 26. T h e number 1 indicates the stimulus that appeared on only one of the keys, antl the number 7 indicates the stimulus that appeared on

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each of the other seven keys. T h e first four pairs of stimuli show the seven ellipses unchanged, but substituting for the tiicle were a square, a smaller circle, a triangle, or an X. I n the next three pairs we left the circle unchanged, but for the usual ellipses we substituted horiLonta1 but elongated ellipses, vertical ellipses, or squares. In the final three pairs of stimuli, we substituted, first, a square for the circle along with triangles for the ellipses; then, a triangle for the circle and squares for the ellipses; antl finally we simply reversed the original stimuli, substituting the ellipse

FIG. 26. Responses to the probe slides. Each set of initials represents one child, with his age indicated to the nearest full year. Each pair of probe stimuli is depicted at the top. T h e number above each form indicates the number of keys on which it appeared. T h e first four pairs of stimuli involved a change in the circle, with the ellipses remaining the same; the next three pairs invohed a change in the ellipscs. with the circle remaining the same; the final three pairs involved changes in both the circle and the ellipscs. T h e checkmarks show which stimulus each child selected on each probe slide. Double checks indicate that the child was exposed to the probe series twice. Question marks indicate data lost through apparatus failures. T h e upper number of each pair at the bottom of the figure shows the proportion of all the children who selected the form appearing on only one key-the odd form. T h e lower numher of each pair gives the same proportion, h u t only for those children listed below the broken line-all younger than 7, except C.M.

for the circle and circles for the seven ellipses. T h e probe slides were separated from each other by three of the usual circle-ellipse slides, on which the circle was the correct choice. T h e probe slides were presented to each child in one of two sequences, neither of which is indicated by the arrangement of Fig. 26. T h e ordinal number of each pair of probe stimuli, reading from left to right in Fig. 26, was: 1, 3, 6, 8, 2, 5 , 7, 4, 9, and 10. T h e second sequence was exactly the reverse of the first. T h e main feature of these sequences is that in one, the square antl ellipse (column 1) were presented first in the series antl the

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reversed ellipse-circle combination (column 10) was presented last. In the second series, the stimuli in column 10 appeared first and those in column 1 last. Each set of initials represents one child; his age, to the nearest year, appears beside his initials. T h e stars indicate three children with positively established neurological difficulties. T h e checkmarks are located beneath the stimulus the child selected on each probe slide. Double checkmarks indicate that the child was given both sequences of probe slides. T h e question marks indicate a few instances in which we lost the data because of apparatus failures. Beneath each column of checkmarks are two numbers. T h e upper number indicates the proportion of all trials on which the children selected the stimulus which appeared on only one key. T h e lower number indicates the same proportion, but only for those children whose data appear below the broken line, those younger than 7. C.M. was included in this group because he was so severely retarded that he was more appropriately classified with the youngest children. Several features of the data in Fig. 26 are worth noting. First, we see that when a large square was substituted for the circle, keeping the ellipses unchanged on the other seven keys, all children selected the square. This was true whether the children saw this probe slide first or last in the series. In other words, when ellipses remain on the seven incorrect keys, a large square is equivalent to the circle. We shall make use of this finding later in our reversal program. T h e second finding is that it seemed to make little difference whether we substituted the new stimuli for the circle (first four columns) or for ellipses (columns 5 through 7). Of special relevance is the probe slide in which we substituted large squares for the ellipses (column 7). T h e children younger than 7 were almost as likely to pick the square as the circle. T h e fact that there were seven squares and only one circle on the slide undoubtedly contributed to this tendency, but it is also consistent with the previously noted equivalence of the circle and square. T h e third notable feature is that almost all the children older than 6 made their choices on the basis of oddity rather than the specific formsthey selected the one stimulus that was different from all the others. At ages 6 and below, this tendency was not nearly so marked. Of the eight children older than 6, all but three used the oddity principle throughout the series of probe slides. Some might have learned to do this simply because of their exposure to the probe slides, but this was not always true. T.P.,age 10, and D.P., age 7, both selected the single ellipse over the seven circles (column 10) even though they were exposed to this pair of probe stimuli first. On the other hand, D.P., age 8, who also saw this slide first,


20 1

selected the old positive stimulus, the circle. From then on, however, he followed the oddity principle. S.D.E., the only one of the older group who did not show any systematic method of choice, was a child who suffered almost continual minor seizures. Of the children younger than 7 only N.S., whose data are incomplete, appeared to operate exclusively according to the oddity principle. T h e fact that N.S. selected the ellipse on the reversal slide (column lo), even though she was exposed to this slide first in the series of probes, argues strongly that she was using the more advanced form of behavior represented by the oddity principle. D.B. and, to a slightly lesser extent, R.P.L., appeared to be using oddity as a basis for choice; yet both of these children selected one of the circles on the reversal slide even though they saw this slide at the end of the probe series. They perhaps used both criteria, oddity and shape, selecting a circle whenever it appeared, but selecting the odd stimulus when there was no circle. Of the younger children, only two selected the ellipse on the reversal slide of column 10, as contrasted with six of the older children. T h e number of childen in our sample is small, but we may draw the tentative conclusion that children younger than 7 are more likely to base their selection on a specific form rather than on the more general oddity principle. This finding will become relevant when we look at the reversal program. A fourth general conclusion we may draw from the data of Fig. 26 is that children may use any of several aspects of the stimuli in discriminating the ellipse and circle. For example, their unanimous selection of the large square over the relatively flat ellipse suggests that the total area or the height of the stimuli is a controlling factor in their choices. T.E.S. selected the large square every time it appeared, and chose the ellipse when it was rotated so that it looked longer than the circle (column 6). E.F.C. selected the large square almost every time, selected the elongated ellipse twice, but selected the small circle twice when it was paired with the usual ellipse. A.P.’s data suggest that she was somewhat confused by the series of probe slides; she made six errors on the intervening circleellipse slides even though she had previously learned this discrimination well. Her selection of the triangle over the square in column 8, and the square over the triangle in column 9, suggests that she was tending to respond somewhat randomly, thereby selecting one of the stimuli that appeared on seven of the eight keys. C.M. showed a similar tendency. T h e data we obtained from the probe experiment permitted us to move on to our next goal, teaching the children to reverse their original circle-ellipse discrimination. T h e relevance of the probe data will become more apparent below.


202 8. The Reversal Program

Like o u r programs for teaching the children to distinguish circles from ellipses and for testing their discriminative capacity, the program for reversing the circle-ellipse discrimination went through several revisions before it finally carried its message effectively. W e shall not recapitulate how the children’s errors taught us to create a n effective instructional slide+

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FIG. 27. Schematic representation of the reversal program. The stimulus pairs are depicted beside the number of the slide on which they appeared. The numbers 1 and 7 show whether the stimuli appeared on one key or on seven kcys. With the exception of probe slides 5 and 43, the odd stimulus was always positive, and the stimulus on the other sewn keys was always negative.

device, for the story would be too much like the one we have already told. Figure 27 illustrates the program at which we finally arrived. With the exception of slides 5 and 43, which we shall explain below, the stimuli in the columns headed by the number 1 are the positive stimuli and those in the columns headed 7 are the negative stimuli. T h e numbers, 1 and 7, refer to the fact that the positive stimulus always appeared on only one key on a given trial, while the negative stimuli always appeared on seven keys. T h e numbers beside each pair of stimuli denote the consecutive slides of the program.


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I n the first four slides the positive choices are circles, and the negative choices are flat ellipses. Since most of the children had been tested for their circle-ellipse thresholds, the first four slides served simply to reestablish the old discrimination. Slide 5 is a probe. It presents the task that the reversal program was designed to teach; one key contains the ellipse and the other seven keys contain circles. If the child had already learned to make his selection on the basis of oddity, he would select the ellipse on slide 5, indicating that he did not require a special program to teach him to reverse the discrimination. Consistent with the data we had obtained from the earlier probe series, only a few of the older normal children selected the ellipse at this point. Since slide 5 was a probe, and not part of the teaching program, neither stimulus could be called correct or incorrect. Therefore, the child always advanced to slide 6 n o matter which key he pressed on slide 5. We gave no reward for the child’s response to slide 5, and we used the same procedure of intermittent reward for correct choices during the reversal program that we used with the probe series. Slide 6 marks the beginning of the reversal program itself. O n this slide, we began to square the circle, a process that was complete by slide 8. T h e probe data had indicated the equivalence of the square and circle, and in our first reversal program we had made an abrupt transition from circle to square. T h e substitution caused no problem for more than 95% of the children, but because a few had trouble at this point we made the change slightly more gradual by inserting slides 6 and 7. O n slide 8, then, the children selected the square and continued to reject ellipses. We were then ready to accomplish the first major part of the discrimination reversal, substituting the circle for the ellipse as the stimulus to be rejected. T h e process by which we accomplished this is illustrated in the second column of Fig. 27, which shows how, in slides 9-22, we gradually transformed the ellipse into a circle. I n slide 9 the children selected the square and rejected the ellipses; by the time they reached slide 22, selecting the square all the way, they had learned to reject the same circle that had previously been their choice. Half of the job was done by slide 22. T h e next task was to transform the square into an ellipse so that the children would end by selecting the ellipse while continuing to reject circles. T h e third column of Fig. 27 illustrates the first part of this process. T h e height of the square was gradually reduced until, on slide 33, it had become a narrow rectangle. T h e reversal was almost complete. Beginning with slide 34, in the last column of Fig. 27, the corners of the rectangle were gradually rounded. By slide 40 the rectangle had been transformed completely into an ellipse, and the children were now selecting the ellipse while

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rejecting circles. Slides 40, 41, and 42 represent the terminal performance toward which the program was directed. Slide 43, at the end, is another probe. I t was designed to help clarify what the children were doing at the end of the reversal program. We considered two possibilities: they might have learned to select the odd stimulus, i.e., the one key that was different from all the others; or they might have learned to select a particular form, the ellipse. Slide 43, like slides 1-4, had a circle on one key and the flat ellipse on the other seven keys. If, by the end of the reversal program, the children had learned to select the ellipse regardless of how many keys it appeared on, then they would also select one of the seven ellipses on slide 43. If, on the other hand, the children had learned the more general oddity principle, then they would shift from the ellipse on slide 42 to the circle on slide 43, picking the only stimulus that was different. Again, consistent with the data from the probe series, only a few of the older normal children selected the circle on slide 43. None of the younger normal children or the older retarded children who went through the reversal program indicated that they had learned the oddity principle. All of them demonstrated that they were responding to a particular form, the ellipse. Early versions of the reversal program were shorter than the one shown in Fig. 27. We have already noted the addition of two intermediate steps in the process of squaring the circle (slides 6-8). We also found it necessary to slow down the rate at which the negative ellipse changed into a circle (slides 9-22). This process occurred much more rapidly in our early programs, with larger jumps in the ellipse size from trial to trial, and, correspondingly, with more errors by the children. Additional research will clarify this process, but it seems likely that the children’s difficulties in this part of the program are intimately tied u p with their circle-ellipse thresholds. At some point in the series, depending on ‘the child’s age, the ellipse becomes indistinguishable from a circle. If the child’s threshold is reached after a sudden large increase in the size of the ellipse, he is likely at that point to recognize his old friend, the circle, and to select it in preference to the square. By changing the ellipse size more gradually throughout the series we prevented the sudden emergence of the circle, and with this more gradual transformation, more children continued to select the square and reject the ellipses. T h e series in the third column of Fig. 27, in which the square was gradually transformed into a thin rectangle, also had to be lengthened in successive revisions of the program. We found that the height of the rectangle had to be at least as small as the minor axis of the ellipse before we could start the transformation from rectangle to ellipse. And

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that final transformation also had to be slowed clown. Many more children made errors when we used only three slides to complete the transformation from rectangle to ellipse. We still have many questions to answer about the reversal program. There is no reason to believe that this is the only, or even the most efficient way to teach the children to reverse the circle-ellipse discrimination. We also have yet to evaluate the role played by the children’s errors in our program as compared with the errors they make in learning the discrimination reversal without help from any teaching program. We have, however, demonstrated that our program can succeed as a communication device, that children can learn to reverse their original criteria for choice without any other instructions. I n Fig. 28, the bottom record, A, is that of the youngest child, age 2 years and 7 months, who went through the reversal program without error. D.L.C., who had originally learned to pick circles and reject ellipses, ended by picking the ellipse and rejecting circles. On slide 5 she selected a circle, but she went through the program before we had added slide 43, so we do not know whether she learned the oddity principle. Record B in Fig. 28 shows another errorless progression through the reversal program. This record is of particular interest because R.W.F. was a 16-year-old mongoloid child who, when he was 13 years and 7 months old, earned a mental age of 3% years and a Stanford-Binet IQ in the low 30’s. R.W.F., who completed the program relatively rapidly, selected the circle on slide 5 and the ellipse on slide 43, indicating that he did not learn the oddity principle. Record C in Fig. 28 is that of a child, B.D., who made several errors on his way through the reversal program. B.D. was a 7G-year-old child who had earned a Stanford-Binet mental age of 3% years and an IQ in the low 40’s. Both the neurologist and the psychologist who examined him recommended special schooling and institutionalization. B.D. had his major troubles with slides 8 and 14 of the program and made one additional error on slide 23. H e was one of the few children who selected the ellipse over the square on slide 8. It is interesting to note that the ellipses on slide 14, where B.D. had considerable difficulty, had an axis ratio of .74, and that his circle-ellipse threshold was at .77. On the probe slide, B.D. also indicated that he had not learned the oddity principle. I t is possible that B.D. might have learned to reverse the discrimination just as easily if we had simply presented him with the reversal problem without the teaching program. This general question is currently under investigation in our laboratories with severely retarded institutionalized children as subjects. Although the data reported here do not demonstrate that our program

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is necessary to teach nonverbal children to reverse the circle-ellipse discrimination, they do indicate the utility of the technique. If a nonverbal child can be taught to reverse this discrimination, there is no obvious reason why a similar method could not be used to transfer the discrimination t o other materials as well. Starting, let us say, with numbers, we might teach a child to select the number 1 and reject each of the other digits; we might then transform the 1 into, let us say, a 7, and go through the process again. We could continue until the child had

FIG.28. The performance of three children on the reversal program. For details regarding D.L.G., R.W.F., and B.D., see the text. Errors were made by B.D. on slides 8, 14, and 23. The other numbers indicate the end points of subsections of the program (see Fig. 27).

learned to distinguish all of the numbers from each other. This discrimination is a prerequisite before the child can go on to learn the names and the uses of numbers. Other stimuli, like letters, colors, geometric forms, etc., could be taught i n the same manner. A major significance of our work with the circle-ellipse discrimination lies in the promise of the method as a generally effective teaching device for many kinds of material and for children with whom we are unable to make contact through conventional methods. C.M., our microcephalic subject who was the first to try the original circle-ellipse program, also succeeded in reversing the discrimination. It remains to be seen how far we can carry him and others like him.

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ACKNOWLEDGMENT T h e authors are indellted to several colleagues and assistants for their advice and help: Ronald Ray, Barbara Ray, George Toomey, Mary Carpenter, Julia Mount, Judith Klinger, Christine Palmer, Mary Evelyn Porter, Dudley Templeton, and Joyce Medverd. REFERENCES Baker, R. A., & Osgood, S. W. Discrimination transfer along a pitch continuum. J. e x p . Psychol., 1954, 48, 241246. Bijou, S. W. Systematic instruction in the attainment of right-left form concepts in young and retarded children. I n J. G. Holland and B. F. Skinner (Eds.), A n analysis of the helrariioral processes involrred in self-imtruction w i t h teaching machines. Harvard Univer. Teaching Machine Project, Final Report, 1964. Ferster, C. B. Positive reinforcement and behavioral deficits in autistic children. Child Develpm., 1961, 32, 437-456. Ferster, C. B., & DeMcyer, M. T h e development of performances in autistic children in an airtomatically conlrolled environment. J. chron. Dis., 1961, 13, 312-345. Ferster, C. B., & DeMeyer, Xi. A method for the experimental analysis of the behavior of autistic children. Amer. J. Orflropsychiat., 1962, 32, 89-98. Hively, W. Programming stimuli in matching to sample. J . exp. anal. Beliav., 1962, 5 , 2i9-298. Hively, W. A multiple-choice visual discrimination apparatus. J. e x p . anal. Behav., 1964, 7 , 387-389. (a) Hively. W. I’aramctric experiments with a matching-to-sample program. I n J. G . Holland and H. F. Skiliner (Eds.), A n analysis of the behavioral processes iniiolued in self-instruction with teaching machines. Harvard Univer. Teaching Machine Project, Final Report, 1964. (b) Holland, A. L., & Matthews, J. Application of teaching machine concepts to speech pathology and audiology. Asha, 1963, 5 , 454-482. Holland, J. G. Teaching machines: an application of principles from the laboratory. J. exp. anal. Behnv., 1960, 3, 275-287. Holland. J. G. Evaluating teaching machines and programs. Teach. Coll. Rec., 1961, 63, 56-65. (a) Holland, J. G. New directions in teaching-machine research. In J. E. Coulson (Ed.), Prograiirtned learning and contpi~ter-basedinstruction. New York: Wiley, 1961. (b) James, I$’. Principles of psyclioloa. New York: Holt, 1890. 2 vols. Pp. 505-515. Kanner, L. Autistic disturbances of affective contact. N e w . Child, 1943. 2, 215-250. Kanner, L. Early infantile autism. J. Prdiat., 1944, 25, 211. Kellogg, \V. N., & Rice, C. E. Visual problem-solving in a bottlenose dolphin. Science, 1964, 143, 1052-1055. Kliivcr. H. Belrarrior mechnnisins in ?,ionkeys. Chicago: Univer. of Chicago Press, 1933. Krasner. I.., & Ullmann, I.. P. Research in behavior modificntion. New York: Holt. 1965.

I.ashlcy, K. S. T h e mechaitism of vision: XI’. Preliminary studies of the rat‘s capacity for dctail vision. J. gen. Psycho/., 1938, 18, 123-293. I.arvrcnce, D. H. T h e transfer of a discrimination along a continuum. J . coinp. physiol. Psylrol., 1952, 45, 511-516. Lintlslcy. 0. R. Operant conditioning methods applied to research in chronic schizophrenics. P.ychiat. T-es. Rep., 1956, 5 , 118-139. Moore, R., 8: Goldiamond, 1. Errorless establishmcnt of visual discrimination using fading procedures. J. exl’. anal. Beliav., 1964, 7 . 269-272.

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Pavlov, I. P. Conditioned reflexes. (Translated by G . V. Anrep.) London and New York: Oxford Univer. Press, 1927. Schlosberg, H., & Solomon, R. L. Latency of response in a choice discrimination. 1. exp. Psychol., 1943, 33, 22-39. Siciman, M., & Stotldard, L. T. T h e effectiveness of “fading” in programming a simultaneous form discrimination for retarded children. J . e x p . anal. Behav. (in press). Skinner, B. F. T h e science of learning and the art of teaching. Haruard educ. Rev., 1954, 24, 86-97. Terrace, H. S. Discrimination learning with and without “errors.” J . exp. anal. Behav., 1963, 6, 1-27. (a) Terrace, H. S. Errorless transfer of a discrimination across two continua. J . exp. anal. Behav., 1963, 6 , 223-232. (b) Ullmann, L. P., & Krasner, L. Case studies in behavior modification. New York: Holt, 1965.

Programmed Instruction Techniques for the Mentally Retarded FRANCES M. GREENE DEPARTMENT OF PSYCHOLOGY UNIVERSITY OF WASHINGTON, SEATTLE, WASHINGTON

I. General Surveys and Reviews . . . . . . . . . . . . . . . . . . . . . . . . 11. Research in Which the Retarded Served as Ss . . . A. Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B. Arithmetic ...................................... C. Spelling and Writing . . . . . . . . . . . . . . . . . . . . . . . . . . . . D. Total Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E. Vocational Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111. Related Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A. Extrinsic Reinforcement .......................... B. Selected Studies with Normal Children . . . . . . . . . . IV. Discussion and Evaluation . . . . . . . . . . . . ., ...... ... A. Summary of Present Research . . . . . . . . . . . . . . . . . . . . B. Implications for Future Research . . . . References ...............................

210 210 211 22 1 225 221 228 228 228 230 23 1 23 1 233 236

T o date, the research carried out in the area of programmed instruction with the retarded is not extensive and in many cases the studies lack methodological sophistication. Of tbe 31 separate research projects discussed in this review, less than half have appeared in the literature. T h e rest exist in the form of unpublished papers and theses, progress reports, or references in secondary sources. T h e studies range from controlled experiments to anecdotal accounts of behavioral changes which resulted when programmed instruction techniques were used. Some have been carefully executed and reported. Others exhibit definite flaws; for example, adequate pretests and posttests were not administered, or the report itself contains discrepancies or omissions which make interpretation of the findings difficult. T h e present review consists of four parts. T h e first covers briefly some general papers relating to the area under consideration. T h e second is an account of the research in which the retarded served as Ss. T h e third is an account of some related studies. T h e fourth is a general summary and 209

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Frances M. Greene

discussion section in which a n attempt. is made to evaluate the work carried out so far and to indicate some probable directions that future research can be expected to take. 1. GENERAL SURVEYS AND REVIEWS

In a survey devoted primarily to work with normals, Silberman (1962) covered a number of studies in which the retarded served as Ss. A more complete account of research with the retarded is contained in a review by Stolurow (1963). Several other papers by the latter author are also of interest. One (Stolurow, 196Oa) is a general introduction to the field written for persons having little or no previous information about programmed instruction. A second (Stolurow, 1960b) covers the topic in greater detail and includes a n account of some of the earlier research. A monograph published in 1961 (Stolurow, 1961) also includes a review of research as well as a chapter on teaching machines and one on techniques and concepts of programming. Of general interest is a report published by the J o i n t Committee on Programed Instruction and Teaching Machines (1963) as a guide for prospective purchasers of programmed instruction materials. A number of the cautionary statements contained in the report can be applied to some of the published studies. For example, the paper recommends that the test manual (in this case, the research report) should present documentary ebiilence that achievement gains can be attributed to the program and not to extraneous causes, and that claims for effectiveness should be supported in terms of gains on appropriate criterion tests. 11. RESEARCH IN WHICH THE RETARDED SERVED AS Ss

T h e reviewer has chosen to classify the research primarily by subject matter. Within each subject-matter category, three principal types of studies have been identified: (1) investigations of program variables; (2) studies concerned with program evaluation (or development); antl (3) studies comparing one form of programmed instruction with another form, or comparing programmed instruction with a conventional teaching procedure. I n cases where a particular study focused on more than one question, it is discussed under the heading seen to be the more appropriate. For purposes of reference, the studies have been listed w.cording to this classification in Table 1. T h e table also includes information concerning the duration of the study, the number of Ss, antl their CA and IQ characteristics. Except in those cases where Ss from two different popula-

PROGRAMMED INSTRUCTION TECHNIQUES

21 1

tions were used i n the same experiment, the CA and IQ information is given in terms of the mean score or the range for all Ss who took part i n the experiment. A. Reading

Of the 17 reading studies listed in Table I, 6 are classified as program variable investigations, 8 as evaluation or development studies, and 5 as comparison studies. One study is classified under all three headings and another under two.

1. PROGRAM VARIABLES a. Prompting versus Confirmation. T h e prompting-confirmation controversy which claimed the attention of five investigators is largely inherited from research with normal adults (see, for example, Cook 8c Kendlar, 1956). I n the prompting procedure used with retarded children, the S is either shown a depiction of the word to be learned or is given an auditory cue before he responds. Thus, he is prevented from making errors. In the confirmation procedure, the S first responds and then is given the confirmation which informs him whether or not his response was correct. In two experiments, Koronakos (1960) found a confirmation procedure in which the S responded vocally to only the printed word to be superior to four other methods of teaching reading skills. T h e next most effective method was a prompting procedure in which the S responded to a wordpicture combination by pressing a button. Stolurow (1961), in whose monograph the work is described, pointed out that the absence of a reported test of statistical significance and the fact that the two methods called for different response modes makes a straightforward comparison between the methods of doubtful value. Stolurow, Peters, and Steinberg (1960) investigated the effects of the two procedures when the items were overlearned to a level of 12 or 24 consecutive correct responses. T h e prompt again was a picture of the word. During acquisition, the prompting sequence was found to be superior: confirmation-12 Ss required approximately seven times as many trials to reach criterion as prompting-12; confirmation-24 required approximately twice as many as prompting-24. O n recall tests of retention given 1, 7, and 30 days later, performance of the prompting12 group was still superior to that of confirmation-12 (50% and 21% correct recall, respectively). At the higher level of overlearning, however, the reverse was true, with confirmation-24 Ss recalling 75y0of the words and prompting-24 recalling 530/,. O n the basis of the findings, Stolurow suggested that while the prompt-

SUMMARY INFORMATION ON THE P R O G R A M M E D

Subject matter area and investigator Reading Blackman & Holden Blackman et 01. Davy Doehring & Lacy Ellson et al. I 111 IV V VI Fernandes Hawker et al. Hewett et al. Koronakosb Malpass Scottb Stolurow & Lippert Stolurow et a1.a

TABLE I INSIRUCTION STUDIES

IN W H I C H THE

Type of study Program Program Comparison variable evaluation study X

X X X

X

X X X X

Number of ss

CA @ o r range)a

AS SUBJECTS

(Xor range)a

IQ

Study duration 1 session 1 school year 1-2 school years

24 36 13 5

15-8 14-2 7-14 8-1 1

53

38 12 64 64 41 17 40 25

16-0 See text See text

54

-

X X

RETARDED SERVED

S characteristic

X X

66 33

X

21 25 40

See text 18-10 11-19 11-11 5.5-15 12-1 15-6 Adolescents 7 -4 -

54 43-70 51-73

-

5WO 40

5MO 7-14.50

5 w 74

-

1 session 4 weeks 3 weeks 3 weeks 1 session 1 school year 1 session 1 school year Up to30days 8 weeks

8 weeks

-

i:

? 2

3

Arithmetic Blackman el al. Cartwright Merachnik & Quattlebaum Price Smith & Kleiser Smith & Quackenbush Sprague & Binder Takeuchib Spelling and writing Naumann &Woods Malpass Parson & Naumann

X

X

x x

X

X X Xd Xd

X

Xd

X X

X

X X

X X X X

X X

36 40 10

14-2

54

1 school year

17-2 18-1 15-1 14-11

71 68 50 84

2 weeks 6 months

17-7 17-6 17-1

75 71 59

Second grade

Slow

6 66

13-1 12-1

59-74 50-80

33 14

15-6 8-13

65-90

9 weeks 8 weeks 8 weeks 3 weeks 1-3 years

7-145C

Total curriculum Birnbrauer et al.

X

27

10-4

63

Vocational training Neuhaus Devereux Foundation

X X

25

24-0 16-20

60-80

-

a

T o the nearest half year.

Information taken from a secondary source. MA. d Compared Ss using the program as a supplement. b

0

86 sessions 1 school year 1 school year 1 school year 4 weeks

33 8 8 23 15 50

60-90

-

3 yean

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Frances M. Greene

ing sequence is effective at first, it may, if used too long, prevent the formation of a strong associative connection between the printed word and the response. Certainly it is true that Ss in the prompting condition could have reached criterion without ever having attended to the printed stimulus. Simply identifying the picture correctly when a n overt response was called for would have satisfied the conditions of this particular procedure. A second study (Stolurow & Lippert, 1962) was designed to investigate different numbers and combinations of prompting and confirmation trials on acquisition and retention. T h e learning material was 25 nouns which were presented first by means of the prompting sequence and, varying numbers of trials later, by means of the confirmation sequence. No significant acquisition differences were found. Data from retention tests given 1, 7, and 30 days later, however, suggested that superior retention was associated with more prompting than confirmation trials u p to a total of 12. Blackman and Holden (1963) compared the performance of retarded adolescents on a support (prompting) and nonsupport (confirmation) program designed to teach four words. T h e words were presented by means of a fully automated audiovisual apparatus. Both visual and auditory prompts accompanied the material i n the support condition. These prompts were gradually diminished from the first to the final frame. Taped instructions told the Ss in both conditions when to respond. T h e S made his response by depressing one of four buttons, each corresponding to a word projected on the right side of the screen. T he appearance of a small green square and progression of the film strip to the next frame signaled that a response was correct. A small red square and the nonadvance of the strip signaled that a response was incorrect. No reliable differences were found between the two conditions on the 16 test frames with which the program ended, a posttest given immediately after training, or a retention test given 24 h r after training. T h e authors pointed out that the prompting program involved about twice as much time as the confirmation program and yet did not produce significantly better results, facts which should be taken into account by those considering the merits of the two procedures. I n a study by Hawker, Geertz, and Shrago (1964), 40 Ss were trained under either a confirmation or prompting procedure. Subjects in the confirmation group were shown a card on which a noun appeared above four pictures and were told to point to the picture which was the same as the noun. If correct, the S was verbally reinforced by the experimenter and told to point to the word and say it aloud. If incorrect, he was


215

required to continue responding until he had pointed t.0 the correct picture. The cards used in the prompting group were the same except that the correct picture was indicated by a large red arrow. The Ss were instructed to point to the picture, then to the word, and to say the word aloud. At the end of each two training trials a test trial was given on which the confirmation card alone was presented. T h e S’s task on this trial was to point to the correct picture and say the word aloud. There was no feedback. I n order to obtain a measure of learning, scores on the first three test trials were combined and compared with scores on the last three test trials. This comparison yielded no reliable differences in the number of correct responses for the’ two t,raining procedures. There were also no differences between procedures as measured by the number of correct responses on recognition tests given immediately after training and 1 and 7 days later. There was, however, a significant increase in the number of correct responses from the first to the last block of three test trials for the combined group of Ss. Moreover, there was no significant loss in retention after 7 days when the Ss were still responding correctly to approximately 50% of the items. b. Program Context. In a study reported both by Barber (1964) and Ellson, Engle, and Barber (1963),20-item lists containing varying proportions of known (reinforced) and unknown words were programmed and presented to different groups of Ss on four consecutive trials. The fifth trial was a test of immediate retention. On the basis of the finding that the number of words acquired was inversely related to the number of already known words included in the program, the authors concluded that a high proportion of reinforcement (as defined in these studies) is not necessarily beneficial to learning. Such a conclusion is dubious, however, in light of the fact that with lists of constant length, the number of words that the Ss could learn was necessarily fewer in the high reinforcement groups.

2. PROGRAMEVALUATION Ellson, Engle, Barber, and Kempwerth (1962) reported two experiments in which a picture program and a sentence program for teaching sight vocabulary were administered to retarded Ss. The procedure used in both studies was termed “programmed tutoring” since it required the presence of a tutor (whose role, however, was fully determined by the procedure) to reinforce and correct the student’s oral responses. T h e programs are branched, in that errors made by the S served as

216

Frances M . Greene

the occasion for the tutor to take certain steps. Following an error in the sentence program, for example, the tutor read the sentence, rearranged the words in a specified random order, and then required the S to respond again to each word. In experiment I, 19 Ss were given five trials on the 82 words of the picture program. On trial 1 the mean number of words read correctly was 20.9 and on trial 5 it was 32.7, a gain of 11.8 words. One month later the Ss correctly recalled 27.7 words. On a nonprogrammed word test administered before and after the five training trials, both the experimental Ss and 19 control Ss showed a performance gain. This finding led the investigators to suggest that some of the improvement shown by the experimental Ss may have represented a “. . . restoration of previously suppressed reading behavior” (Ellson et al., 1962, p. 13) rather than original learning. I n experiment 111, four normal first-grade children, four first-grade slow readers, and four institutionalized retardates were given eight sessions (extending over a period of 4 weeks) on the 165 words of the sentence program. At the end of training the three groups had gained 30.5, 20.0, and 19.5 words, respectively. (Tests of significance are not included.) Retention after 1 month is reported in the body of the paper to be near 90% for all groups, but Fig. 1 (in Ellson’s report) shows the groups to have performed better on the retention test than at the end of training. The figure also shows the normal first-grade readers to have identified approximately 10 fewer words on the first session of training than either the slow readers or the retarded Ss. Doehring and Lacy (1963) proposed to investigate the way in which the child‘s behavioral repertoire changes as he learns to read. T h e authors stated that the program (in which 46 sight vocabulary words were presented in the context of four-word sentences) was not offered as a new method of teaching reading, but rather was designed to serve as a systematic procedure for identifying performance deficits. Subjects were four normal children of kindergarten age and five retardates with CAs less than 11. The report includes a detailed analysis of each child’s progress through the program, or as much of it as he completed. (Only two retarded Ss completed all three parts of the program.) The study should be of interest to those concerned with the question of how the individual S responds to a particular instruction method. The account of the procedure and results, however, is complex and requires considerable effort on the part of the reader who would understand exactly what took place. Hewett, Mayhew, and Rabb (1965) described a 1-year experimental program designed to teach a 250-word basic sight vocabulary to 25 men-


217

tally retarded or severely disturbed children. T h e children had been enrolled in the program for periods of from 3 months to a year and they attended reading sessions three times a week. T h e words from a set of preprimers and a primer were programmed and presented by means of a manually operated teaching machine. At each session the child worked with both the machine and the book. As yet, only preliminary data are available but these indicate that the program is successful in bringing nonreading exceptional children up to first-grade reading level. Delinquent adolescent retardates were given daily reading instruction in a programmed learning classroom set u p within a special training and rehabilitation unit (Fernandes, 1965). Because the boys read at different levels at the beginning of the study, it was necessary to develop several reading programs. In one of these, 46 words used in describing various hall jobs were programmed and presented on a teaching machine. Many of these words appeared on a job board which contained information about daily work assignments. Thus, the boys had frequent opportunity to use the vocabulary outside the classroom. T h e author stated that nine boys who had little or n o reading skills at the beginning of the study have completed this particular program. Pretest and posttest data, however, are not cited. Davy (1962) used the Woolman Progressive-Choice method for teaching reading to retarded children. Although the method is not classified by Davy as a programmed instruction method, it has some features of programmed material. Essentially, the technique reduces the initial complexity of the reading task by introducing one letter at a time in a n order designed to maximize discriminability among letters. Each new letter is combined with those previously introduced to form simple words. Pretest data are not reported. Seven children who participated in the program for 1 year are said to have progressed from a nonreading level to recognizing and writing most of the alphabet letters and to using them in forming simple words. Th e three children who remained in the program for 2 years progressed from “no functional reading” to reading stories appropriate for first- to third-grade normals. Information concerning an additional three children who remained in the program for less than a full year is not given. Retention tests administered at the end of summer vacation showed the three children in the 2-year group to have retained 95%, 82%, and 58% of the 119 words taught during the preceding year.

3. COMPARISON STUDIES An extended project in which both reading and arithmetic materials were programmed was reported by Blackman, Capobianco, Hoats, East,

218

Frances hl. Greene

Forcina, Shepherd, and Saxton (1964) and by Blackman and Capobianco (1965) in a later published account. T h e present review is based primarily on the earlier, more extensive, report. The objectives of the study were (1) the development of an automated instructional device for presenting the two kinds of material, (2) the construction of programs, and (3) the comparison of achievement and behavior changes in retardates taught the material by machine and by a “traditional” classroom technique. The project covered 3 years, of which 18 months were devoted to the development of the apparatus and to methodological research on program writing, 6 months to program construction, and 1 year to evaluation. In the reading program, 20 units or 218 subprograms were constructed covering 311 reading words. The program was designed to take the student from single-word matching to the point where he answered questions based upon stories containing the programmed words. Because the Ss progressed more slowly than anticipated, however, only 55 of the 218 programs had been covered by the end of the study. Subjects were 36 institutionalized retardates. Half were assigned to the teaching machine condition and half to the control condition. Subjects in the latter group covered exactly the same material and maint,ained approximately the same pace as the experimental Ss, and the teachers who taught them also served as experimenters for the machine group. Performance of both the experimental and control Ss, as measured by two standard achievement tests and a special test designed to assess achievement on the programmed material, improved to a statistically significant extent over the course of the study. There were, however, no reliable differences between the two groups on any of the achievement scales. A comparison of the number of words, of the first 72 taught, which were correctly named at midterm with the number correctly named on a final examination given 3l/, months later showed essentially no retention loss for either group, and no differences between groups. The Survey of Educational Media Research in the Far East briefly describes a study by Scott (1963) designed to teach word recognition skills to 14 adolescent retardates attending an intermediate school in New Zealand. The S was shown a series of word pairs on a teaching machine. As soon as a pair appeared, one of the words was repeated over earphones from a tape recorder. The task was to push a button above the word that had been named. Following a correct choice, a color slide illustrating the word appeared on the screen. Following an incorrect choice, the word pair disappeared. Seven control Ss were taught to discriminate between the same words by “conventional methods,” which


219

are not described. At the time the survey was published, only preliminary results were available. These indicate that the machine group had gained an average of 20 sight words as compared with a gain of 4 or 5 words for the control Ss. Two comparison studies were carried out by Ellson et al. (1962). In the first (experiment IV in the report), 48 retarded Ss were given six sessions of reading instruction under either a programmed instruction condition, a standard classroom condition which is not described, or a procedure in which programmed instruction and classroom sessions were alternated. A fourth group of 16 Ss received no instruction. T h e pretest to posttest vocabulary gains were as follows: 32.9 (programmed instruction group), 18.1 (classroom), 37.6 (alternation), and 6.6 (control). Intergroup comparisons showed both the programmed instruction and alternation groups to have acquired significantly more words than the control group, and the alternation Ss to have acquired significantly more than the classroom Ss. Experiment V extended the preceding study by six sessions. Subjects in the programmed instruction group were given the additional training under the classroom procedure, while Ss in the classroom group were trained under the programmed instruction procedure. T h e conditions for the alternation and control Ss remained the same. T h e mean gains for the four groups, respectively, were 39.0, 37.6, 57.2, and 12.6. T h e report does not make clear, however, whether these gains were made from the beginning to the end of the study as a whole, or only during the second half. Gains made by the three experimental groups are reported to be significantly greater than those made by the control group. An investigation carried out by Malpass, Gilmore, Hardy, and Williams compared four approaches to teaching reading and spelling: a multiple-choice device, a typewriter keyboard, a conventional classroom, and a tutorial procedure. Accounts of this investigation are contained in two reports (Malpass et al., 1963; Malpass et al., 1964). Much of the information given in this review is taken from the first (unpublished) report. Subjects were 66 special education students enrolled in public-school classes and 33 institutionalized retardates. T h e members of each sample were divided equally among the first three experimental conditions. An additional 10 Ss from the public schools were given the tutorial training. T h e multiple-choice apparatus was a semiautomated teaching device. T h e S made his response by pressing one of three choice buttons. A green light, and buzzer tone signaled that a response was correct but no con-

220

Frances M . Greene

tingencies followed an incorrect response. To advance the program (which was printed on cards), the S operated a slide mechanism. On early trials Ss in the multiple-choice condition matched pictures to pictures, words to pictures, and pictures to words. On later trials they selected from among the three alternatives the letter missing from a word or the word missing from a sentence. In the typewriter condition the S typed his response on a keyboard containing 32 letters and numbers. T h e device was fully automated and the programmed material was projected on a screen above the keyboard. Following each correct choice the machine advanced and the response appeared, as though it had been typed, on the screen. Nothing happened following an incorrect choice. O n early frames the S typed from copy; on later frames he completed words from which letters were missing and sentences from which words were missing. The programs were designed to teach 72 reading words and to give spelling instructions on 18 of these. Pictorial representation and the order of word introduction were the same for both methods, but programming details were necessarily different. Subjects in all conditions were given daily instruction over a period of 8 weeks. Two of the research assistants who had supervised machine instruction gave individual instruction to the 10 Ss in the tutorial condition. T h e classroom procedures were not controlled. Teachers were simply given a list of the 72 words and encouraged to present these during their regular classroom sessions. TABLE I1 SUMMARY OF W O R D GAINS IN READlN@,b

Mean gain ~

Multiple choice

Keyboard

Classroom

Tutorial

Public school Pretest to posttest Pretest to 30 days

20.5 16.1

28.1 19.7

3.7 5.8

32.3 18.7

Institution Pretest to posttest Pretest to 30 days

15.7 15.3

14.5 11.4

.8

2.8

-

Sample

a

b

Seventy-two programmed words. From Malpass et al., 1963.

A portion of the reading results have been summarized in Table 11. (Spelling results are reported in a later section of the review.) All t-ratios between treatment means for the first three conditions in the table are statistically significant except for the two machine comparisons, pretest


221

to posttest and pretest to 30 days for the institutional sample, and pretest to 30 days for the public school sample. In a separate analysis, the performance of the 10 tutorial Ss was compared with that of a randomly selected 10 Ss from each of the other three groups. The only difference favored the tutorial condition over the classroom group on both the immediate posttest and 30-day recall. The fact that the gains made by the t.utoria1 group matched those made by the machine groups led the authors to conclude that the main advantage of automation is one of economy. The tutorial situations required a one-to-one relationship between teacher and student. A single adult, however, according to the author’s estimate, should be able to supervise the operation of as many as 10 machines running concurrently. There was a statistically significant relationship between the number of words known prior to the beginning of the study and the extent to which the S profited from instruction. Subjects who were able to identify 10 words or more on the pretest made the greatest word gain. This finding calls to mind Ellson’s suggestion (see Section II,A,2) that some word gains attributed to the program condition may simply represent a reinstatement of previously acquired material. B. Arithmetic

Of the nine arithmetic studies listed in Table I, t.wo have been classified as program-variable investigations, seven as evaluation or development studies, and seven as comparison studies. Six are classified under two headings. VARIABLES 1. PROGRAM Cartwright (1962) investigated the effects of systematic and unsystematic item presentation for teaching the concept of a fraction. T h e same set of steps were used in both presentations, but step order differed. I n the systematic sequence, the numerical values of the fractions were ordered consecutively, and a definite pattern unfolded from item to item. In the unsystematic sequence, the fractions were presented in mixed order and no pattern was apparent. The program called for a constructed response and was presented on a manually operated teaching device. Twenty adolescent retarded Ss were assigned to each condition. I n terms of achievement scores on a posttest administered directly after training, the two groups did not differ. On a retention test administered 3 weeks later, Ss in the systematic group scored higher than Ss in the unsystematic group. In general, the posttest, retention, and maximum gain scores of the systematic group tended to correlate with certain spe-

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Frances M. Greene

cific ability measures (e.g., arithmetic fundamentals), while those of the unsystematic group correlated with general measures such as IQ. In a study by Price (1963), adolescent retardates were given instruction in addition and subtraction under one of three conditions: an answerconstruct condition in which the S wrote the answer, a multiple-choice condition in which he selected and marked the answer, or a conventional classroom condition. Classroom Ss spent two semesters (130 class periods) studying arithmetic; the two programmed instruction groups spent approximately 86 class periods. In the latter two groups the material was presented by means of a manually operated teaching machine. No information is given concerning the classroom procedure. A test consisting of 43 addition and 24 subtraction problems, most of which were selected from the program, was administered to all Ss at the beginning and end of the experimental period. The mean gains from pretest to posttest made in addition were 5.50 (answer-construct), 8.46 (multiplechoice) and 6.80 (classroom). Subtraction gains for the same three groups, respectively, were 2.00, 1.82, and .80. The gains made by the three addition groups and by the multiple-choice subtraction group were reported to be statistically significant. In personal correspondence with the reviewer, the author reaffirmed the latter finding. It had been questioned because the answer-construct group, which contained one more S than the multiple-choice group, also had a higher mean gain score than the latter. The conclusion that “. . . a multiple choice presentation of programmed subtraction problems is more effective than either an A-C [answerconstruct] or conventional teaching,” (Price, 1963, p. 72) does not appear to be justified on the basis of the statistical analysis reported. The three methods were never actually compared with each other, and inspection of the data does not lead to a prediction that such a comparison would have favored the multiple-choice group over the answer-construct. 2. PROGRAM EVALUATION The lowest 50 students in arithmetic ability from a second-grade Tokyo elementary school were given programmed instruction in addition and multiplication (Takeuchi, 1963). The material, presented in book form, was reported to have been programmed according to Skinnerian principles. A “high degree of success on the post-test” was claimed but no actual results were given in the article. A portable multiple-choice device was employed in presenting elementary mathematics problems to 23 retarded adolescents over the course of 1 school year (Smith & Quackenbush, 1960). T h e primary purpose of the material was to provide practice in carrying out certain


223

arithmetic operations. No pressure was placed on the students to use the machines, but they were always available for anyone who wanted to use them as a supplement to regular classroom instruction. Over the course of the year some students completed several hundred problems, while others completed only a few. The problems were presented, eight per page, in a workbook which rested on top of the device. There were three possible answers for each problem, and the student depressed a button adjacent to the answer selected. A buzzer or a green light signaled that a choice was correct. No information was given following an incorrect choice. Over the course of the year students given this additional practice gained .51 of a grade level in arithmetic on the California Achievement Test. Gains in reading and in language, in which the students received no supplementary practice, were .25 and .24, respectively. For control purposes, these gains were compared to those made by 34 students in the previous year when the devices had not been available. For this group the gains were .19 in arithmetic, .26 in reading, and .24 in language. The arithmetic difference between the groups is statistically significant ( t = 1.68, one-tailed test). It is regrettable that the authors, rather than simply presenting a pooled gain score for the group as a whole, did not include information about the progress of Ss who had taken full advantage of the machine’s availability, and of Ss who had not. Smith and Kleiser (no date) described a demonstration project in which the same device used in the Smith and Quackenbush study (1960) was used in presenting programmed mathemat,ics material to retarded or emotionally disturbed students in four different classrooms. Only the performance of the two groups in which the mean I Q was less than 85 is reported here. The project covered 1 academic year. As in the Smith and Quackenbush study, the teaching devices were used only as a supplement to regular arithmetic instruction. The pupils were never actually required to use them, although they were given ample opportunity to do so. I n terms of mean difference scores in arithmetic reasoning and arithmetic fundamentals on the California Achievement Test, performance of the experimental Ss did not differ from performance of a group of “comparison Ss” composed of the rest of the students in the same classes. There was also no difference for either of the two experimental groups in final score or in gain score between arithmetic achievement and achievement in reading or in language on which no supplementary instruction was given. The only statistically significant finding was that

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time spent on the machine and total arithmetic gain were positively correlated. T h e final section of the report covers the replies given by the four teachers to a series of questions concerning the devices and the programmed material. T h e section is instructive. Points on which the teachers agreed were that the device was a useful adjunct in presenting review and drill work on concepts already introduced in class, that i t was most suitable for use with younger children, and that interest in Its use, though initially high, tended to level off over the course of the school year. 3. COMPARISON STUDIES Merachnik and Quattlebaum (1963) briefly reported a study in which five retarded adolescents were given programmed instruction in addition, subtraction, multiplication, and division over a 6-month period. A published program was used and the material was presented on a manually operated teaching machine. (It can be questioned that the program was wholly suitable for these Ss whose reported arithmetic achievement scores at the beginning of the study ranged from grade 3 to grade 6.) Five control Ss received instruction on the same material in small groups which made use of individual workbooks and teacher lecture presentations. At the end of the study, both groups showed some gains in arithmetic computation and arithmetic reasoning (as measured by the Met,ropolitan Achievement Test) and in arithmetic grade score (as measured by the Wide Range Test). They did not, however, differ significantly from each other on any of these measures. With so few Ss, an individual analysis of results would appear to have been more appropriate and informative than the group-comparison measures used. Blackman et al. (1964) developed an arithmetic program which was presented to the same Ss who took part in the reading half of the study (see Section II,A,3 for general information about procedures, apparatus, Ss, etc.). T h e program began with form discrimination and ended with simple division and basic fractions. Of the 175 subprograms developed, only 54 had been presented by the end of the study. Both the experimental (machine) and the control (classroom) Ss showed improved performance from beginning to end of the study, as measured by the Metropolitan, the Wide Range, and a special achievement test designed to cover the programmed material itself. Although there were no differences between the groups in mean scores as measured by the two standard achievement tests, on the special test the experimental Ss made significantly greater gains than the control Ss.


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T h e purposes of a project by Sprague and Binder (1962) were (1) the development of an automatic device to be used in programming arithmetic and (2) the determination of the relative efficiency of this method of teaching as compared to a conventional classroom procedure. T h e apparatus was a fully automated multiple-choice device on which any two-digit addition, subtraction, or multiplication problem could be presented. T h e machine advanced to the next problem only when the S had made a correct response, and it provided further visual feedback concerning the correctness or incorrectness of each response made. T h e programmed material consisted of 121 addition, 121 multiplication, and 66 subtraction problems. T h e slides containing the problems were placed in trays of 38 slides each and arranged within trays in the presumed order of difficulty. T h e S worked on a particular tray until he had reached a criterion of less than 25% errors on each kind of problem and then moved on to the next tray. Fifteen adolescent retardates served as Ss. Seven were given 12 training sessions on the programmed material. T h e remaining 8 were enrolled in a special class which met three times a week. T h e classroom condition was not controlled although a fairly comprehensive account of the procedures used by the teacher is included in the report. T h e California Achievement Test and a special test of 380 problems programmed for machine presentation were administered before and after training. No differences were found between the groups in terms of gain scores on the reasoning, addition, and subtraction sections of the California or on the programmed test problems. C. Spelling and Writing

Of the three spelling and writing investigations listed in Table I, two are evaluation studies and one is a comparison st.udy. 1. PROGRAM EVALUATION

Naumann and Woods (1962) reported a study in which six retardates were given training over a 9-week period on a spelling program developed by the second author (Woods, 1962). T h e program consisted of 62 words and was presented by means of a manually operated teaching machine. I n the published account of the work, the authors stated only that all Ss showed some spelling gains, as measured by the Gates Diagnostic Reading Tests administered before and after training. More complete information is included in an unpublished account (Naumann, 1961) where it is reported that, two children who were unable to spell any words on the initial test obtained grade scores in spelling of 2.5 and 2.2 at the completion of the study. Gains made by the other children ranged

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from one to five grade months. T h e unpublished account also contains information on the programming method used. In a study by Parson and Naumann (1964), 14 Ss enrolled in a special education class were divided into two work groups. T h e first group began each morning with a spelling program (Woods, 1962) and the second group with a cursive writing program (Parson, 1964; see also Parson & Naumann, 1963). T h e groups worked together in the same room and exchanged programs at the midpoint of a daily 40- to 60-min period. T h e experiment covered 3 weeks. T h e reader is given only meager information as to the way in which the material was presented or the way feedback was provided. Pretest data are also not reported. T h e authors stated that all the children learned to spell the 62 words and that each child learned to write as many letters as he had worked on during the 3-week period.

2. COMPARISON STUDY I n the Malpass et al. study (1963) already reported in Section II,A,3, Ss were given spelling instruction on 18 words. Public-school Ss received instruction under the multiple-choice, typewriter-keyboard, tutorial, or classroom condition. Institutional Ss received instruction under the multiple choice or keyboard condition only, On spelling frames, Ss in the two machine groups completed a word from which a letter was missing by depressing a button on the multiple-choice device or a key on a typewriter keyboard. TABLE 111 S U M M A R Y OF WORD GAINS IN SPELLINCOlb

Mean gain Multiple choice

Keyboard

Classroom

Tutorial

Public school Pretest to posttest Pretest to 30 days

3.0 1.2

5.8 2.7

.55

1.7

Institution Pretest to posttest Pretest to 30 days

7.8 7.0

9.63 7.09

Sample

95

-

-

a Eighteen programmed words. b From Malpass el al., 1963.

Table 111 summarizes the main results from this part of the study. Intercondition comparisons yielded three statistically significant pretest to posttest differences, all for the public school Ss: multiple choice versus classroom, keyboard versus classroom, and keyboard versus tutorial. T h e variance among scores was large; i n fact, the standard deviations


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exceeded the mean word gain for 9 of the 11 entries reported in Table 111.

D.

Total Curriculum

A series of papers describe a research classroom in which retarded children are taught basic academic skills almost exclusively by programmed instruction (Bijou, 1965a; Bijou, in press; Bijou et al., in press; Birnbrauer et al., 1965b; Birnbrauer et al., 1964). Located a t a state institution, the classroom has been in operation for 3 years and will continue for a fourth. The purposes underlying its operation are listed as (1) the establishment of procedures for motivating pupils to learn academic material] (2) the development of programs for teaching this material, and (3) the strengthening of supporting behaviors, such as good study habits (Bijou, in press). Classroom procedures are based on the premise of operant conditioning that behavior is strengthened or weakened depending on the consequences which follow. Correct answers and appr0priat.e social behaviors are followed by two main reinforcing contingencies-social approval from the teachers and token-reinforcers which can be exchanged for extrinsic reinforcers. (This aspect of the work will be discussed at greater length in Section 111,A.) T o date, 27 children have been enrolled in the classroom, 17 for 1 year, 6 for 2 years, and 4 for 3. The children attend class from 1 to 2 hr daily in groups of 4 to 6. Six children comprise what is known as the “Advanced Group.” These children are described as capable of working more or less independently during the time they are in class. Each completes as many as nine daily assignments, entering his answers as well as starting and completion times for the various tasks on the assignment sheet in his own workbook. Most of the material used in the classroom has been developed by the teachers following programmed-instruction principles laid down by Skinner (1961) and Holland (1960). The work that the pupil is given is planned for him each day on the basis of his previous day’s performance. Because learning failures are treated as failures in the program and/or motivation system rather than failures of something in the child (Bijou, 1965a), the programs and procedures are revised frequently on the basis of the performance of those attending the classroom. To date, the reports covering the work are mainly descriptive accounts of various general aspects of the project-the physical organization of the classroom, the curriculum, programmed material, reinforcement system, and daily classroom procedures. The most complete description of the programmed-instruction materials is contained in a recent account

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of the work (Bijou et al., in press). This paper also includes information on the academic achievement of the six children in the “Advanced Group.” E. Vocational Skills

Neuhaus (1964) reported the use of an audiovisual training method for teaching retardates employed in an electronics plant to solder wires to connectors. On the basis of a job analysis, the soldering skill was broken down into 216 independent steps, each illustrated by means of a single slide. Four retardates were trained at a time. Each carried out the soldering operations at his own work station which contained a n audiovisual machine. Feedback was provided by a supervisor who was present while the retardates were following the program. At the time of publication the program had been given only a preliminary try-out and no results are reported in the paper. T h e author stated, however, that the program appears to be a valuable aid in on-thejob t,raining and that related programs are being developed. A Devereux Foundation Information Bulletin (1964) outlines a %year project aimed at the development of programmed vocational training materials for Ss who are slow learners (IQ range, approximately 60-90) or of normal intelligence but emotionally disturbed. T h e programs, which are designed for use with four automated instructional devices, will cover both general training areas (e.g., job finding, banking procedures) and specific vocational areas (e.g., carpentry, homemaking). An extensive field test, including a comparison of the automated presentation with conventional instructional methods, is planned. 111. RELATED WORK

T h e following studies have been included because they were seen to have some relevance to the area of programmed instruction techniques for the retarded. Those in the first section are investigations into the role of extrinsic reinforcement in a programmed learning situation. Those in the second section are selected studies in which young normal children were given programmed instruction in academic subjects at a level roughly comparable to that in studies with the retarded. A. Extrinsic Reinforcement

Birnbrauer, Wolf, Kidder, and Tague (1965a) reported that social and intrinsic reinforcement were not sufficient to maintain appropriate classroom behaviors on the part of pupils attending a programmed learning classroom. Shortly after the beginning of the project a token reinforcement system was instituted in which colored stars and, later, check


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marks, were dispensed for satisfactory academic and social behaviors. These tokens could be traded for candy or trinkets, or saved for more valuable items. Fifteen Ss t,ook part in a study designed to evaluate the effectiveness of the reinforcement system. Eight were attending dass for the second year and 7 for the first. Tokens were introduced on the first day of school for all pupils and removed 2 months later for the afternoon class and 3 months later for the t,wo morning groups. They were reinstated for all Ss a week after Christmas vacation (35 or 21 days later). The study was a single-subject design, and the data analyzed were percent errors, total items completed, and time spent in an isolation room where the S was sent for highly disruptive behaviors. (The three measures are not, of course, independent.) For 5 of the children no measurable behavioral changes of any kind occurred during the no-token period. For 6 children, percent errors increased but number of complete items remained constant and the time-out procedure was not required. The remaining 4 children (all second-year students) increased in percent errors, accomplished less work, and became serious disciplinary problems. Following reinstatement of reinforcement, performance stabilized for all Ss, in most cases at a level of percent error lower than at any time previously. Interpretation of the findings is complicated by several factors. Two have been suggested by the authors. First of all, the classroom teachers (who believed in the efficacy of token reinforcement) may not have responded to the children in exactly the same way during both parts of the experiment. Second, teacher approval and being right, because of their frequent past pairing with tangible reinforcement, may have come to take on secondary reinforcing properties. Thus, the removal of tokens might have exercised relatively little effect for some time. An alternative to the last suggestion is that the children whose response to the change was the most pronounced may have been, to some extent, products of the system itself. That is, the deviant behaviors they exhibited may have been partly a reaction to the abrupt removal of something for which they had acquired an “addiction.” East, Capobianco, Hoats, and Gelof (1964) compared knowledge of results with tangible reinforcement in a study designed to teach four sight-vocabulary words to 30 adolescent retardates. The same apparatus and programming method described in Blackman et al. (1964) and Blackman and Holden (1963) were used. Ten Ss received one candy pellet following each correct response, 10 received a pellet for correct responses on a variable 25% ratio schedule, and 10 received no tangible reinforcement.

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No differences were found among the three groups in terms of performance on eight test trials inclilded within the program, or in mean number of correct responses to flash cards shown at the end of training and 24 hr later. One criticism can be leveled against the procedure, namely, Ss in the two reinforcement groups apparently received candy regardless of whether or not their first responses were incorrect. If this were so, the Ss needed only to keep pressing buttons until a reinforcer was dispensed. This general point will be discussed again in Section I1,B. I n the early stages of the reading project reported by Hewett et al. (1965) and reviewed in Section II,A,2, Ss were given reinforcers, such as candy and money, for correct responses. These were dispensed first on a continual and then on a periodic basis. Later they were replaced by check marks which the Ss traded for extrinsic reinforcers at the end of a lesson or series of lessons. As the children advanced in the program i t was found possible to discontinue extrinsic reinforcers, with no resultant decrement in performance. Hewett stated that imposing strict limits and providing negative consequences (not described) for errors often produced the most efficient learning. 8. Selected Studies with Normal Children

McNeil and Keislar (1963) investigated the value of requiring kindergarten children to respond orally during training to words in a sightvocabulary program. On a criterion test administered at the end of training, Ss who responded orally made significantly higher scores than Ss who had not been instructed to say the words aloud. There was some evidence, though not statistically reliable, that the greatest benefit accrued to Ss with IQs below 100. Keislar and McNeil (1962) compared two response modes in an autoinstructional program designed to teach a physical science unit to primary-grade children. Those in the overt response group selected the correct answer on each frame; those in the nonovert group merely observed the frame on which the correct answer was indicated. No performance differences were found between the two groups at the end of training. One of the suggestions to account for the no-difference finding was that Ss in the overt group may have been penalized by the difficulty level of the program. Forced to respond, they made errors on difficult frames, and these errors, even though corrected, counteracted the advantage which overt responding is expected to provide. Glaser (1962) briefly described a program used by Evans (1961) in which instruction given in one response mode resulted in improved performance in another. Children who were unable to construct numbers from a model, or else produced only very primitive forms, were


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given training on a number discrimination program in which they either circled the correct response or pushed an appropriate button on a multiple-choice machine. A posttest administered at the end of the program showed the Ss to have improved considerably on the original construction task. It was suggested that in learning to make correct discriminations, the Ss had gained the skill of monitoring their own constructed responses. Taber and Glaser (1964) described a program designed to teach the reading of eight color words. In the program, the color itself appeared with the words as a prompt on early frames and was gradually “vanished.” On the basis of results obtained with approximately 21 kindergarten and first-grade children, the authors concluded that the program functions adequately only when the child is already able to name the color correctly. IV. DISCUSSION AND EVALUATION

In this section an attempt will be made to summarize the major findings of the studies that have been reviewed and to consider some implications for future research. A. Summary of Present Research 1. PROGRAM VARIABLES

Although program variables were considered in eight studies, only the prompting versus confirmation question received the attention of more than one investigator. Among these investigators, no general agreement was reached as to which method is better for presenting sight-vocabulary material. Koronakos (1 960) found a confirmation procedure superior. Blackman and Holden (1963) and Hawker et al. (1964) reported no difference. Stolurow et al. (1960) and Stolurow and Lippert (1962) reported mainly interaction effects: for example, retention but not acquisition was superior for Ss who overlearned the material to 24 trials: superior retention was associated with more prompting than confirmation trials up to a total of 12. 2. PROGRAM EVALUATION I n most program evaluation studies the central question has been one of the following: does this program teach or how much does it teach? The typical procedure followed was for the investigator to develop a program, try it out on one or more groups, and report the performance changes which occurred. When groups of Ss were used, progress was usually measured in terms

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of an average gain score, pretest to posttest (Blackman et al., 1964; Ellson et al., 1962; Malpass et al., 1963; Price, 1963; Smith & Kleiser, no date; Smith & Quackenbush, 1960; Sprague & Binder, 1962; Takeuchi, 1963). When individual Ss were used, progress estimates were more often given in descriptive terms (Birnbrauer et al.. 1965b; Davy, 1962; Fernandes, 1965; Hewett et al., 1965; Parson & Naumann, 1964). With few exceptions (e.g., Ellson et al., 1962), investigators who worked with groups of Ss were not explicitly concerned with revising programs on the basis of S performance. On the other hand, with equally few exceptions (e.g., Davy, 1962), investigators who worked with individual Ss were concerned, to one degree or another, with program revision, T h e most comprehensive attack on this particular problem appears to have been made in the programmed learning classroom study (see, for example, Bijou et al., in press).

3. COMPARISON STUDIES T h e most carefully controlled study was carried out by Blackman et al. (1964). I n this study all Ss covered the same material and the same individuals served as both teachers and experimenters. Sprague and Binder (1962) also exercised some control over the classroom by requiring the teacher to keep a daily log of the subject matter covered. T h e remaining reports include little or no information concerning the classroom half of the experiment (Ellson et al., 1962; Malpass et al., 1963; Merachnik & Quattlebaum, 1963; Price, 1963; Scott, 1963, p. 151). a. Academic Achievement. In four of the six comparison studies on which relatively complete data are available, essentially no achievement differences were found between the programmed instruction and classroom methods (Blackman et al., 1964; Merachnik & Quattlebaum, 1963; Price, 1963; Sprague & Binder, 1962). I n the Malpass et al. study (1963), the two machine groups performed significantly better than the classroom group in both reading and spelling, but this difference was eliminated when Ss were tutored individually over the same material. In the Ellson et al. experiment (1962, Experiment IV) the program Ss and the Ss receiving program and classroom instruction alternately made greater gains than Ss in the classroom. There was no difference between the performance of the first two groups. b. Behauior Changes. Several investigators included informal reports of improved behavior on the part of students in the programmed-instruction groups: for example, reduction of negativism and hostility (Smith & Quackenbush, 1960); improved motivation (Merachnik & Quattlebaum, 1963); greater cooperation and fewer discipline problems (Parson & Naumann, 1964).


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A controlled attempt to measure behavior change is reported in the Blackman et al. (1964) and the Malpass et al. (1963) studies. In general, the results obtained in the first study favored the programmed-instruction group over the classroom group, and those obtained in the second favored the Ss who had made the greatest word gains over those who had made the fewest. Behavioral changes were also noted by Birnbrauer et al. (1965a). These, however, were attributed to the use and suspension of a token reinforcement system rather than to programmed instruction per se.

B.

Implications for Future Research

Eigen (1965), Lumsdaine and May (1964), and Stolurow (1962) have all advanced cogent arguments against the use of a research design in which programmed instruction is compared to a conventional teaching method. T he major argument is that the two variables are themselves too ill-defined to permit comparison. Just as there is no “conventional teaching method,” there is also no “programmed-instruction method.” For example, all of the investigators who carried out comparison or program evaluation studies in reading used a different program, and n o investigator used a published one. T h e ways in which the material was presented also varied widely and included a completely automated device (Blackman et al., 1964), a typewriter keyboard and a multiple-choice apparatus (Malpass et al., 1963), a vertical screen with an opening i n which the stimulus material was exposed (Ellson et al., 1962), a manually operated teaching machine (Birnbrauer et al., 1965b; Fernandes, 1965; Hewett et al., 1965), a machine “designed by the investigator” (Scott, 1963), and no machine (Davy, 1962; Doehring & Lacy, 1963). I n terms of CA and MA characteristics, Ss who took part in the several comparison studies often showed equally wide differences. From this one can conclude that the question “Is programmed instruction more effective than classroom instruction for teaching the retarded” contains not two but three badly defined variables. T h e effect of errors on subsequent performance is a question to which almost no attention has been given. When an S is working alone with one of the various automated devices, he may sometimes make a great many incorrect responses before pushing the one right button that advances the program to the next frame. T h a t making wrong responses before making correct ones has a deleterious effect on later performance is indicated in the work of Kaess and Zeaman (1960), Knight (1963-1964), and Peterson and Brewer (1963) with normals. If a high error rate is in fact disadvantageous to later acquisition and to retention, then the “infinite patience” and the “patience and tolerance” for which the teaching

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machine has been extolled (Malpass et al., 1963, p. 68; Stolurow, 1960b, p 439) may turn out to be a decided vice. The extent to which individual differences may require the use of individual programs has also received little attention. A study by Shay (1961) with normal fourth-grade Ss showed essentially no relationship between intelligence and step size on a program designed to teach Roman numerals. Shay concluded that his findings gave support to Skinner’s claim (1958) that a minimally small-step program is the most appropriate for all ability levels. Birnbrauer et al. (1964). on the other hand, found it necessary to develop five different forms of the same reading program to accommodate 17 pupils. Some of the pupils could assimilate only one new word a day while others could handle as many as six. The fact that Ss do not profit equally from the same program is also indicated in the study by Malpass et al. (1963). In the multiple-choice condition the number of words gained by 22 Ss ranged from 2 to 43 and in the keyboard condition from 2 to 46. As reported earlier, an analysis of these data showed the greatest gains to have been made by those attaining the highest scores on the pretest. One fact that stands out in many studies is that regardless of the subject matter or the method of programming, learning gains were modest. Although from the beginning to the end of the program reported gains were often statistically significant, they were rarely impressive. For example, in the Sprague and Binder study (1962), the experimental Ss solved 94.1 problems on the pretest and 102.6 on the posttest administered 4 weeks later, a gain of only 8.5 problems. I n the Price study (1963), which covered the equivalent of a school year, the group making the largest gain in subtraction solved 3.92 (of 24) problems on the pretest and only 5.92 on the posttest. Results of this type can, of course, be used to bolster the what-else-isto-be-expected view of learning in the retarded. Consideration of the studies in which only minimal gains occurred, however, leads to the conclusion that much of the problem may lie with the procedures used in presenting the material. Three assumptions appear to underlie the use of the typical automated or semiautomated teaching machine. (1) T h e S is reinforced by being right. (2) He is reinforced by moving ahead in the program. (3) He is attending to the task. T h e assumptions that knowledge of results and moving ahead in the program are reinforcing events can be questioned. Simply being right may not be reinforcing to the retarded S, or to the young normal S,


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especially when this information is conveyed by a buzzer or light. And whether or not moving ahead is reinforcing would appear to depend on what follows the session. If the S simply returns to a regular classroom situation which he does not particularly enjoy, he may dawdle (i.e., make errors) deliberately in order to prolong the teaching-machine session. If what follows is a playground period or the opportunity to leave school, inappropriate behaviors of this type could be expected to decrease. Equally questionable is the assumption that the S is attending to the task and that he is carrying out the specified operations in the intended way. Birnbrauer et al. (1964) have pointed out that the instructions given in many programs for elementary-school pupils may go largely unheeded because they exceed the child’s “listening span.” T h e directions which accompanied the reading frames in the Blackman et al. study (1964) are a case in point. On some frames of the program the S was given as many as seven “look-at” instructions which directed him to examine the various words and sentences appearing on the screen. A final instruction directed him to press a button signifying his choice. Although many Ss may have followed the directions exactly as given, it would nevertheless have been possible for an S to complete the program without ever having looked at the screen. All that was required was that he press one button after another, when the final instruction was given, until the confirmation light went on and the machine advanced. Sprague and Binder (1962) provided an amusing example of an S who apparently did take such an approach to the task. “From casual observation, it appeared that this S simply pushed buttons as rapidly as possible as soon as a new problem was presented. I n fact, it even seemed that this S ignored the arithmetic problems on the screen many times, devoting complete attention only to the pushbuttons” (pp. 21-22). I t would seem mandatory that those who carry out programmed learning studies with the retarded should make every effort to ensure that the S is attending to the task. In this connection, the work carried out by a number of investigators is of interest. Holland (1960, 1962) and Bijou (1965b) described a match-to-sample procedure in which the S’s task is to locate among four matches the one that corresponds to a sample stimulus appearing in the top window. T h e matches appear only after the S has made an attentional response by pressing the sample window. I n order to further reduce the probability that the S will move through the program simply by making a series of haphazard choices, progress is made contingent on correct first-choice matching behavior. Not only must the S correct each wrong response, he must respond a second time to the preceding item and then, once more, to the item originally missed.

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I n some match-to-sample studies (e.g., Heid, 1964) token reinforcers (traded in later for tangibles) have been paired with correct first choices. T h e S received a token if, but only if, his initial response to the item was correct. Staats, Finley, Minke, and Wolf (1964) used a modified match-to-sample procedure in presenting sight-vocabulary items. T h e S first made a n attentional response by pressing a button. This response resulted in the appearance of a word in the top window of a screen which the S faced. If the S failed to read the word, it was read to him by the experimenter. Following this step, the S echoed the name, pressed the top window, repeated the name, located the matching word in one of the three lower windows, and pressed that window. One final line of research is suggested by the literature-the use of the teaching machine as a research instrument. Stolurow (1 962) has pointed out that teaching machines have the potentiality of providing exact controls and reproducible conditions which have heretofore been impossible in classroom investigations. Methods and teaching sequences can be made explicit; teaching itself can be studied independently of the teacher’s personality. Hively (1962) has also suggested that teaching devices be used to control the conditions under which learning occurs in order to study learning. Investigations of this type would fall under the heading of what Popp and Porter (1960) call research programming, one purpose of which is to find out more about the basic principles of learning which will ultimately be used in practical programming. REFERENCES Barber, L. The effect of the reinforcement ratio on the acquisition of a sight recognition vocabulary. Unpublished manuscript, Indiana Univer., 1964. Bijou, S. W. Application of operant principles to the teaching of reading, writing and arithmetic to retarded children. New Frontiers in Special Education, Council of Exceptional Children, NEA, 1965(a). Bijou, S. W. Systematic instruction in the attainment of right-left form concepts in young and retarded children. In J. G. Holland and B. F. Skinner (Eds.), A n analysis of the behavioral processes involved in self-instruction with teaching machines. Title VII Project No. 191, Washington, D.C.: U.S. Office oE Education, 1965. Pp. 105-135(b). Bijou, S. W. Application of experimental analysis of behavior principles in teaching academic tool subjects to retarded children. In N. G. Haring & R. J. Whelan (Eds.), T h e learning environment: Implications for special education. Lawrence, Kansas: University of Kansas Press, in press. Bijou, S. W., Birnbrauer. J. S., Kidder, J. D., & Tague, Cecilia. Programmed instruction as an approach to the teaching of reading, writing, and arithmetic to retarded children. In S. W. Bijou & D. M. Baer (Eds.), Readings in the experimental analysis of child behavior and development. New York: Appleton-Century-Crofts, in press.


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Birnbrauer, J. S., Bijou, S. W., Wolf, M. M., & Kidder, J. D. Programed instruction in the classroom. In L. P. Ullmann and L. Krasner (Eds.), Case studies in behavior modification. New York: Holt, 1965. Pp. 358-363. @) Birnbrauer, J. S., Kidder, J. D., & Tague, Cecilia. Programing reading from the teacher’s point of view. Programed Znstr., 1964, S (7), 1-2. Birnbrauer, J. S., Wolf, M. M., Kidder, J. D., & Tague, Cecilia. Classroom behavior of retarded pupils with token reinforcement. J. exp. child. Psychol., 1965, 2, 219-235. (a) Blackman, L. S., & Capobianco, R. J. An evaluation of programmed instruction with the mentally retarded utilizing teaching machines. Amer. J. ment. Defic., 1965, 70, 262-269. Blackman, L. S., & Holden, E. A,, Jr. Support VJ. non-support in an autoinstructional word program for educable retardates. Amer. J. ment. Defic., 1963, 67, 592-600. Blackman, L. S., Capobianco, R. J., Hoats, D. L., East, M. J. M., Forcina, J. J., Shepherd, Margaret J., & Saxton, G. H. The development and evaluation of a curriculum for educable mental retardates utilizing self-instructor devices or teaching machines. Title VII Project No. 368. Washington, D.C.: U.S. 05ce of Education, 1964. Cartwright, G. P. Two types of programmed instruction for mentally retarded adolescents. Unpublished Master’s thesis, Univer. of Illinois, 1962. Cook, J., & Kendler, T. S. A theoretical model to explain some paired-associate leaming data. In G. Finch and E. Cameron (Eds.), Symposium on Air Force human engineering, personnel and training research. Washington, D. C.: National Academy of Science-National Research Council Publ. 455, 1956. Pp. 90-98. Davy, Ruth A. Adaptation of progressive-choice method for teaching reading to retarded children. Amer. J. ment. Defic., 1962, 67, 274-280. Devereux Foundation. Automation in vocational training of mentally retarded and/or mentally ill adolescents: Information Bulletin. Devon, Pennsylvania (about 1964). Doehring, D. G., & Lacy, Julia L. Programmed instruction in beginning reading: Part 1. A systematic analysis of several aspects of reading acquisition with a sight reading program. Unpublished manuscript, Indiana Univer., 1963, Pp. 1-51. East, M. J. M., Capobianco, R. J.. Hoats, D. L., & Gelof, M. Knowledge of results and tangible reinforcement in automated instruction. In L. S. Blackman et al., T h e development and evaluation of a curriculum for educable mental retardates utilizing self-instructor devices or teaching machines. Title VII Project No. 368. Wash. D. C.: U. S. Office of Education, 1964. Pp. 273-281. Eigen, L. D. Problems of research in programed instruction. A-V Commun. Rcv., 1965, 13, 38-43. Ellson, D. G., Engle, T. L., & Barber, L. Programmed teaching of elementary readinga progress report, Suppl. I. Unpublished manuscript, Indiana Univer., 1963. Ellson, D. G., Engle. T. L., Barber, L., & Kempwerth, L. Programmed teaching of elementary reading-a progress report. Unpublished manuscript, Indiana Univer., 1962. (Supported by USPHS grants M4786 (A) and M4989.) Evans, J. L. Multiple choice discrimination programming. Paper read at Amer. Psychol. Assoc. Conv., New York, Sept., 1961. Cited by Glaser (1962). Fernandes, K. A. Programmed learning classroom in an experimental unit for delinquent retardates. Unpublished manuscript, Rainier State School. Buckley, Washington, 1965. Glaser, R. Some research problems in automated instruction: Instructional programming and subject-matter structure. In J. E. Coulson (Ed.), Programmed learning and computer-based instruction. New York: Wiley, 1962. Pp. 67-85.

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Hawker, J. R., Geertz, U. W.. & S h r a p , M. Prompting and confirmation in sight vocabulary learning by retardates. Amer. 1. ment. Defic., 1964, 68, 751-756. Heid, W. H. Non-verbal conceptual behavior of young children with programmed material. Unpublished doctoral dissertation, Univer. of Washington, 1964. Hewett, F. M., Mayhew, D.. & Rabb, Ethel. An experiniental reading program for neurologically impaired, mentally retarded and severely disturbed children. Unpublished study, Neuropsychiatric Inst., Los Angeles, 1965. Hively, Wells. Programming stimuli in matching to sample. J . exp. anal. Behav., 1962, 5, 279-298. Holland, J. G . Teaching machines: a n application of principles from the laboratory. 1. exp. anal. Behav., 1960, 3, 275-287. Holland, J. G. New directions in teaching-machine research. I n J. E. Coulson (Ed.), Programmed learning and computer-based instruction. New York: Wiley, 1962. Pp. 46-57. Joint Committee o n Programed Instruction and Teaching Machines. Ciiteria for assessing programed instructional materials. 1962 interim report. Audiovisual Znstr., 1963, 8, 84-89. Kaess, W., & Zeaman, D. Positive and negative knowledge of results on a Pressey-type punchboard. 1. exp. Psychol., 1960, 60, 12-17. Keislar, E. R., & McNeil, J. D. A comparison of two response modes in an autoinstructional program with children in the primary grades. 1. educ. Psychol., 1962, 53, 127-131.

Knight, S. Programing for the retarded reader. Programed Znstr., 1963-1964, 3 , 3 + . Koronakos, C, A comparison of five methods of teaching basic reading skills to the mentally retarded. Paper read a t Allerton Park Conf. on Automation in Spec. Educ., 1960. Cited by Stolurow (1961). Pp. 128-130. Lumsdaine, A. A., & May, M. A. Mass communication and educational media. Research project supported by Educational Media Branch and the Cooperative Research Program of the Office of Education, 1964. McNeil, J. D., & Keislar, E. R. Value of the oral response in beginning reading: an experimental study using programmed instruction. Brit. J . educ. Res., 1963, 33, 162- 168.

Malpass, L. F., Gilmore, A. S., Hardy, M. W., & Williams, C. F. A comparison of two automated procedures for retarded children. Cooperative research project 1267. Washington, D. C.: U. S. Office of Education, 1963. Malpass, L. F., Gilmore, A. S., Hardy, M. W., & Williams, C. F. Automated instruction for retarded children. Amer. 1. ment. Defic., 1964, 69, 405-412. Merachnik, D. A., & Quattlebaum, B. Adaptation and usage of programmed instruction in arithmetic with mentally retarded. Res. Bull. (New Jersey Sch. Develpm. Council) 1963, 8, No. 2. Naumann, T. F. Principles of learning applied in automated instruction of handicapped pupils. Paper read at Res. Meeting on Ment. Hlth., Univer. of Washington, Oct., 1961. Naumann, T. F., & Woods, W. G . T h e development of an automated basic spelling program for educable handicapped children. AID, 1962, 2, 160. Neuhaus, E. C. Audiovisual job training for mentally retarded. Rehabilitation record. (Washington, D.C.: Vocational Rehabilitation Administration), 1964, 32-34. Parson, Bobbie N. Basic cursive writing: development of a self-instructional program. Unpublished Master's thesis, Central Washington State Coll., 1964. Parson, Bobbie N., & Naumann, T. F. Development and evaluation of a n automated learning program: Cursive writing for the slow learner. NSPZ I., 1963, 2, 4.


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Parson, Bobbie N., & Naumann, T. F. Programed learning for handicapped pupils. Paper read at Ment. Hlth. Res. Meeting, Western State Hospital, Fort Steilacoom, Washington, Oct., 1964. Peterson, L. R., & Brewer, C. L. Confirmation, correction, and contiguity. J. verbal Learn. verb. Behav., 1963, 1, 365-371. Popp, Helen M., & Porter, D. Programming verbal skills for primary grades. AV Commun. Rev., 1960, 8, 165-175. Price, J. E. Automated teaching programs with mentally retarded students. Amer. J . rnent. Defic., 1963, 68, 69-72. Scott, K. An investigation into aiding the teaching of word recognition to mentally handicapped children by means of a teaching machine. In B. C. Duke (Ed.), Survey of educational media research in the Far East. Washington, D.C.: U.S. Office of Education, 1963. Shay, C. B. Relationship of intelligence to step size on a teaching machine program. 1. educ. Psychol., 1961, 52, 98-103. Silberman, H. F. Self teaching devices and programmed materials. Rev. educ. Res., 1962, 32, 179-199. Skinner, B. F. Teaching machines. Science, 1958, 128, 969-977. Skinner, B. F. Why we need teaching machines. Haward educ. Rev., 1961,31, 377-398. Smith, E. A,, & Kleiser, J. R. Automated instruction in special education. Unpublished manuscript. The Devereux Foundation, Devon, Pennsylvania (n.d.) Smith, E. A., & Quackenbush, J. Devereux teaching aids employed in presenting elementary mathematics in a special education setting. Psychol. Rep., 1960, 7 , 333-336. Sprague, R. L., & Binder, A. Automated arithmetic instruction for the retarded. Progress report. PHS Grant M-5647 (A), 1962. Staats, A. W., Finley, J. R., Minke, K. A., & Wolf, M. M. Reinforcement variables in the control of unit reading responses. 1. exp. anal. Behav., 1964, 7 , 139-149. Stolurow, L. M. Automation in special education. Except. Child., 1960, 27. 78-83. (a) Stolurow, L. M. Teaching machines and special education. Educ. psychol. Measmt., 1960, 20, 429-448. (b) Stolurow, L. M. Teaching by machine. Washington, D. C.: U. S. Office of Education, Cooperative Research Monograph, No. 6, 1961. Stolurow, L. M. Implications of current research and future trends. J. educ. Res., 1962, 55, 519-527. Stolurow, L. M. Programed instruction for the mentally retarded. Rev. educ. Res., 1963, 33, 126-136. Stolurow, L. M., & Lippert, H. Prompting, confirmation and vanishing in the teaching of a sight vocabulary. Technical report. Cooperative Research Project Contract No. SAE 8370. Washington, D. C.: U. S. Office of Education, 1962. Stolurow, L. M., Peters, S., & Steinberg, M. Prompting, confirmation. overlearning, and retention. Invitational paper read at Illinois Council of Except. Child., Chicago, 1960. Cited by Stolurow and Lippert, 1962. Pp. 8-11. Taber, J. I., & Glaser, R. An exploratory evaluation of a discriminative transfer learning using literal prompts. In J. P. DeCecco (Ed.), Educational Technology. New York: Holt, 1964. Pp. 198-208. Takeuchi, Yasuyuki. An experimental study with programmed learning in arithmetic. In B. C. Duke (Ed.), Survey of educational media research in the Far Gust. Washington, D. C.: U. S. Office of Education, 1963. Pp. 151-152. Woods, W. G. Development of an automated basic spelling program for retarded children. Unpublished Master’s thesi8, Central Washington State Coll., 1962.


S o m e Aspects of the Research on Mental Retardation in Norway’ IVAR ARNLJOT BJORGEN UNIVERSITY OF OSLO, OSLO, NORWAY

I. Introduction ......................................... 11. T h e Retarded in Norway ............................ 111. Research Possibilities ................................. IV. Some Aspects of the Research ........................ A. Sociomedical Investigations ....................... B. Medical Treatment .............................. C. Morphological Examinations and Chromosomal Investigations in Mental Retardation . . . . . . . . . . . . . . . . D. Training and Activation of the Mentally Retarded E. Psychological Examination, Therapy, and Research F. Neuropsychological Examinations . . . . . . . . . . . . . . . . . V. Summary ............................................

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1. INTRODUCTION

It is, strictly speaking, too early to give a conclusive survey of the research on mental retardation in this country. Thus far there have emerged no special traditions or results that seem to warrant considering separately the Norwegian research in this field from a broader scientific community. By and large, the methods are traditional and the results do not become meaningful until considered in a wider relation. T h e research is still in its infancy and hardly merits special attention with regard to its qualitative characteristics. Such a limited geographical survey may nevertheless have a certain interest as a pendant to the more comprehensive reviews within the special fields. T h e problem of mental retardation involves many disciplines and is approached from many different angles. This “manysidedness” tends to get lost in the specialized literature. T h e contributions from the various disciplines and the interplay among the 1 This chapter is not intended to be a description of a systematic research program or a theoretical treatise. Rather, it purports to provide an overview of the general state of knowledge, treatment, and research pertaining to the retarded in Norway.

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fields of research differ from country to country. T h e present review will show some aspects of the research on mental retardation as practised in Norway today but does not pretend to place this research in relation to the sundry disciplines. It. THE RETARDED IN NORWAY

Like the other Scandinavian countries, Norway is characterized by high living standards and great demands are made for efficiency and adjustment. I t is not a heavily populated country-conditions are easily surveyed and every individual is important. I n such a society, control of any deviation becomes a natural thing; care nevertheless is taken to respect the rights of the individual. T h e optimal treatment of mentally retarded patients is a much debated issue, but there is general agreement that the subnormal have a just claim to the aid of the community even if the costs may seem out of proportion to the results. O n the other hand, care must be taken not to press the feebleminded too hard because of a desire for social rehabilitation and adjustment. Altogether, the interest accorded to the mentally retarded and their problems has been steadily growing, and a strong feeling of responsibility for this part of the population seems to prevail. What is lacking chiefly is knowledge of mental retardation-what can be done for the subnormal; what are the possibilities of training and treatment. So far there has been little systematic planning, even though the recording and institutionalization of the mentally retarded are at a fairly advanced stage. Both the authorities and the layman are awaiting results of research which would indicate what should be done and where the forces should be set to work. T h e reports that have appeared on the training programs of mentally retarded patients have not been very clear, nor does it seem likely that future results of research will be sufficiently convincing to solve the problem of how to treat the mentally retarded. T h e basic attitudes toward this problem will probably continue to be colored by sentiment as will be the decision of how much to stake on this work. As it is, rehabilitation is tried first and, if this meets with no success (reasonable measures having been taken), one has to resort to isolation out of consideration for both the retarded person and the community. Rut many are dissatisfied that greater efforts are not made for rehabilitation. 111. RESEARCH POSSIBILITIES In Scandinavia, as elsewhere, research on the mentally retarded has been sadly neglected until recently. T h e increased interest in this discipline, above all in the United States, has gradually spread, but in Scandinavia very little research is in progress, especially planned research, owing

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to a lack of opportunity for specialized training at the university level. Conditions are, however, changing for the better. A professorship in special pedagogics has been established in Finland (Jyvaskyla), and in Sweden there is a professorship in oligophrenia (Uppsala). I n Norway, a t the University of Oslo, a research project on mental retardation from an experimental psychological point of view has been in existence since 1962, and it is expected that, this will increase the amount of research done on the mentally retarded, Most of the Norwegian studies on mental retardation have originated from medical quarters. Consequently, the psychological, pedagogical, and sociological aspects have occupied a relatively modest place compared with, for instance, American research. Studies on behavioral patterns and investigations of separate functions within perception, motivation, and learning have been practically nonexistent i n Norway. Generally speaking, one may also say that there has been a random choice of problems and little collaboration. By the nature of its problems, mental retardation is a meeting ground for specialists recruited from many different disciplines. Internationally, the publications on mental retardation embrace a n enormous field, and the methods employed and findings revealed are heterogeneous. Such a situation may be inspiring for research, but it raises problems for practical survey. One cannot offhandedly eliminate differences in terminology and approaches. I n the research on mental retardation, coordination and teamwork are of particular importance. I n Norway such cooperation is still a desideratum-fruitful collaboration among specialists in the various disciplines is rare, at any rate in research circles. An added complication is that valuable and interesting studies are often reported in the most unexpected journals. As in any other field, research on mental retardation is expensive. This has not presented a grave problem in Norway thus far, as the need for research workers has been much more pressing. Grants for sociomedical investigations have been given by state institutions, and the Norwegian Research Council for Science and the Humanities finances the research project on mental retardation a t the University of Oslo. T h e Research Foundation for the Mentally Retarded was established i n 1964 for the benefit of research and the training of research workers. It will evidently be some time before the foundation has money to grant. IV. SOME ASPECTS OF THE RESEARCH

This paper will attempt to elucidate the current status of research and the principal problems that occupy Norwegian research workers today. Topics discussed have been chosen at random from a more comprehen-

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sive review of the Scandinavian research on mental retardation collected by Bjorgen and Hope in 1965 (see p. 252). T h e present survey also includes glimpses of the research in the other northern countries. Instead of covering as wide a field as possible, the author has tried to paint a relatively clear picture of a few research programs. A. Sociomedical investigations

Research projects have revolved around the tasks which are of importance in the daily administration of institutions. Naturally, sociomedical investigations have dominated this work. T h e need to survey mental retardation was great, and fairly comprehensive studies tabulating the distribution of the various syndromes, age and sex distribution, hereditary transmission, etc., have been carried out in all Scandinavian countries. Much of this research is of theoretical interest, but no investigation of specific theoretical problems has been undertaken in Norway. Studies of this type have been reported in Sweden; among other things, the possibility of mental retardation resulting from incestuous matings (Larson) and the role that social conditions play in the distribution and institutionalization of the mentally retarded (Akesson) have been investigated. 8. Medical Treatment

Fit-preventive drugs and ataraxic drugs for the treatment of aggression and agitation have long been used i n Norwegian institutions for the mentally retarded. T h e split-brain method (surgical splitting of the hemispheres) has also been employed, and Trilafon and Ponalid have been administered to children with cerebral palsy, though without convincing results (Skogrand). Furthermore, extensive metabolic studies have been carried out by both Swedish and Norwegian researchers owing, no doubt, to the fact that this is the field in which Norway has achieved international distinction because of Asbjorn Folling’s work on phenylketonuria or Folling’s disease which began in 1934. T he attempt at diet,ary treatment of phenylketonuria, undertaken at the Oslo Observation Center and Outclinic for the Mentally Retarded under the direction of Wehn and Vislie, is of particular interest in current research. Phenylketonuria, a recessive hereditary metabolic disorder, consists of a lack of ability to hydroxylate phenylalanine into thyroxine which engenders increased concentration of phenylalanine in the blood and spinal fluid. T h e further breakdown of the increased amount of phenylalanine leads to the formation of substances not normally present in the body and results in a lowering of intelligence during the early years of life. During the first several weeks or months the infants seem to


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deveIop normally, but then the symptoms of the progressive brain injury are manifested. The increase of phenylalanine is greatest from 6 to 12 months and seems to continue until about the age of 8 in all patients: no definite increase has been found after 14 years of age. The patients, whether children or adults, all have psychotic symptoms-marked hyperactivity, destructive tendencies (e.g., self-mutilation), autistic traits, and stereotyped movements. Other symptoms are a characteristic odor, pigment deficiency, increased deep reflexes without demonstrable change in muscle tonus, epileptic fits (in 25% of the cases), and a pathological EEG (in more than 25% of the cases). Enzymatic defect must be established in order to make a definite diagnosis because the clinical picture is not sufficiently characteristic. T h e deeper cause of the mental defect is under investigation; it is doubtful that it is caused by toxicity. Since 1959, Wehn and Vislie have attempted dietary treatment with 18 children, but in three of these cases the therapy had to be discontinued because of complications. The dietary treatment is meant to normalize the serum phenylalanine. As all normally occurring proteins contain about 5% phenylalanine, protein has to be given in the form of albumin in which the phenylalanine content has been artificially reduced to a minimum (acid-hydrolyzed casein). Because phenylalanine is an essential substance, a certain amount, individually adjusted, has to be administered: supplementary nourishment is also given. It is difficult and timeconsuming to arrive at the correct diet in each case. Although attempts are made to vary the diet as much as possible, the food is nevertheless unpalatable and monotonous, and causes great difficulty for some children. The treatment requires infinite patience and exactitude; in addition, acid-hydrolyzed casein is expensive-it is estimated that the therapy costs about 1.500 dollars per year per patient. Only two of the children were treated before they were 1 year old and only one before 6 months of age. The latter, who showed marked signs of reduced mental function, has improved strikingly, during the short period of observation. All the children placed on the diet before 3 years of age have shown marked improvement in motor function, and the frequency of epileptic fits and pathological EEG have decreased. Only one of the children entering treatment before 4 years of age failed to react favorably to nursing and sensory stimulation. Seven patients with marked psychomotor retardation but no clinical signs of gross organic brain injuries improved considerably following treatment for a few days or weeks. In cases where they had been passive, indifferent, and greatly lacking in attention span, and were autistic-seeming, tired, troubled by nocturnal restlessness, crying, and stereotyped movements, they now became active, interested, and communicative. It was particularly striking

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how quickly their ability to verbalize improved. T h e nature of the symptoms and the efficacy of the treatment seem to indicate that the psychic symptoms originate from changes in the consciousness due to the toxic influence of the abnormal metabolic products. There can be no doubt that these children have improved markedly; it seems likely that at least five of them will be able to function in special classes and one or two of them in regular classes. Only one of the children older than 4 years of age at the institution of the treatment reacted positively. This patient changed radically for the better with regard to nursing and general well-being despite the fact that no actual intellectual progress occurred. T h e improvement also continued after gradual discontinuation of the diet. Wehn and Vislie have maintained that the efficacy of the dietary treatment warrants its being tried with all children under 4-5 years of age and without fail, with all children under the age of 2. They believe that in most cases the treatment can be administered at home. T h e experiments clearly show the importance of instituting the treatment at the earliest possible date. C. Morphological Examinations and Chromosomal Investigations in Mental Retardation

T h e role of chromosomes has been studied extensively in medical research on mental retardation in both Sweden and Norway. Swedish (Forsman, Lehman, Thysell, and others) and Norwegian (Brogger, Mohr, van der Hagen, Vislie and Wehn) research workers have reported numerous observations of chromosome anomalies in the various types of mental retardation. Moreover, Swedish workers have reported valuable original studies (Rorjeson, Forssman, Lehman). D. Training and Activation of the Mentally Retarded

Faith in the possibilities of training the mentally retarded has passed through many phases during the last couple of decades. T h e optimism of the early 1950’s was replaced by pessimism when the results of the first training programs became known. At present the situation is characterized by what the Finish Professor Maki recently described as “critical optimism.” During the past 10 years, intensified building and care programs, to a large extent financed by subscriptions and private contributions, have made it possible to place the most severely retarded in institutions. These institutions provide a certain amount of training, but the planning of the instructional programs leaves much to be desired. In accordance with

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Norwegian law, all children have a right to training facilities. Children who have difficulty in adapting to regular classes are given special instruction-this applies to children with IQs of 70 or above. There is some available room in special schools for retardates with IQs of 50 or above, but planned training facilities for those with IQs of below 50 are deplorably limited. Some experiments in this area have been undertaken but the results are not yet known. An attempt was made to train intensively eight patients in the State Institution for the Mentally Retarded (Emma Hjorth’s Home) under the leadership of Munch. Retardates who would be likely to profit from such training were chosen to participate. They were from 16 to 24 years of age, and all were rather inactive and more or less unable to express themselves. The objects of the behavioral training were first, to teach the patients to take proper care of themselves, and, second, to improve their social contact and working performance. The program included a staff of 13 who took their meals with the patients and participated both in their daily life in the home and in all outside activitieswalks, going to the beach, and so on. The patients’ performances were evaluated in five main groups of activities: (1) toilet and care: (2) eating manners and domestic activity; (3) work activity; (4) spare-time activity; and (5) contact. A total of 39 activities were rated; they were divided into four categories which ranged from no activity to adequate activity. All patients had previously had periods of agitation and aggressiveness, but all improved considerably, particularly with regard to responsiveness. In conclusion, Munch stated that such training programs can be organized by the staff and do not necessarily require specialists. A far more comprehensive and systematic pedagogical project was started in the autumn of 1962 at Trastad Manor (the Institution for the Mentally Retarded of Northern Norway). The object of this program was to obtain suitable training facilities for children with particularly low intelligence levels or special mental handicaps. T h e Norwegian public school system does not provide for this type of pupil. It is hoped that the project will lead to an organized plan for such training, establish suitable teaching methods and requisites, and, above all, arouse the pupil’s interest in intellectual activities so that he may later be able to profit from regular training. Twenty-five of the 39 pupils involved had attended special schools but had been judged noneducable. The age of the pupils ranged from 7 to 37 years and their IQs from 30 to 57. They were classified into three categories: preschool training (one class, average age 7.7 years); theoretical-practical training (two classes, average age 14.8 years and 18.6 years, respectively); and practical-vocational training (one class, average age 19.1 years).

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The pupils in the preschool class receive 36 hr of training per week consisting of habit formation (dressing, order, manipulation of tools), muscle training (hand and finger exercises, rhythmic play, modeling, finger painting), sensory training (listening and smelling games, hide-andseek, memory exercises), speech exercises, reaction exercises, and training intended to improve conception, perception, imagination, and social adjustment. The pupils in the theoretical-practical classes are trained 33 hr per week. The theoretical subjects are Norwegian, writing, arithmetic, religion, and geography. The practical subjects are more or less the same as in the preschool class. The pupils in the practical-vocational class receive 37 hr of training per week in the following subjects: weaving, needlework, knitting, woodwork, painting, music, and singing, and, in addition, reaction and perception exercises. The project is now entering its fourth year. Thus far there have been no outstanding results. This is no doubt due, in part, to the fact that most of the time and work has been directed toward solving the practical problems of setting up the operation. The project is, nevertheless, an interesting demonstration of the changing attitudes toward the mentally retarded, and the reports from the teaching staff are optimistic. In view of the somewhat disappointing reports of similar programs in the United States, however, it would perhaps be wise not to expect too much. In Denmark, attempts have been made by the so-called LillemosegArd project (Grundtvig Christensen and co-workers, 1964) to train severely subnormal patients whose mental ages ranged from 2.6 to 6.4. T h e training consisted mainly of practical exercises such as cutting, drawing, sorting, etc. Following 2 years of training, all of the 12 patients showed improved MA (mean rise 1.2 years) and adjustment. A broad follow-up study of the subsequent adjustment of children who attended special schools has been carried out in Sweden. The investigation included all children who had attended special schools during 1935-1939 -a total of 1940 pupils. The data were collected by means of questionnaires and comprised personal appearance, education and skills, work status, self-supporting ability, social adjustment, and general behavior. In an overall evaluation of their adjustment, 80% of the students were rated very satisfactory or satisfactory. T h e men rated higher than the women, and there was a slight lowering of IQ. Furthermore, the investigation showed that the pupils had met with a great many difficulties in their endeavors to adapt themselves to society, and that little had been done by the community to facilitate the life of this group.


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E. Psychological Examination, Therapy, and Research

Oligophrenia occurs in many pathological pictures, a circumstance which makes treatment all the more difficult. In addition to treating intellectual defects, therapy is often necessary to treat other effects of the disorder. Psychological complications may accentuate the retardation and make it worse. Many examples of apparently feebleminded patients who have suddenly overcome a state of aphasia and made rapid progress have been reported. In the more specific types of oligophrenia, there is always the possibility that a therapeutic approach can be used. Therefore] it is very important to pinpoint the injury as precisely as possible, and research is needed to do this. Little psychometric research relevant to the mentally retarded has been undertaken in Norway. Some experiments on children with cerebral palsy (Landmark, Grinde) have been carried out using the Bender and Goodenough tests, but there is still a great need for psychological diagnostic tests. Experimental psychological research on the mentally retarded has been a t a low ebb in Norway, and a project under the leadership of Bjorgen and Lie was begun at the University of Oslo in 1961 in order to stimulate work in this field. The purpose of the project was to investigate a series of psychological phenomena from experimental psychology and to determine along which dimensions and under what conditions differences between the mentally retarded and normal controls emerge. Owing to the multifarious symptomatology associated with the various types of mental retardation, the investigations have concentrated on mongolism (Down’s syndrome). Despite this limitation, perhaps the most frequent and striking observation has been the remarkable variation in performance. This finding raises doubt about the usefulness of employing group data in the comparison of controls and the mentally retarded, and research has been focused on methodological problems to a considerable extent. It is often difficult to find normal control groups for comparison with mongoloid patients. Objections may be raised against using both age and mental age as a basis for the matching. Therefore, in a series of discrimination tests employing approximately the same standards (learning set in a Wisconsin apparatus) the performance in the first discrimination test was used as a basis for the matching; a mongoloid patient was paired with a normal control, each being given equal opportunity to reach a workable solution. The performances of 10 such pairs were followed through a series of discrimination tests. From a logical point of view such an operational matching basis does not seem unreasonable, but it did not work out in practice. Systematic examination revealed that there was no

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connection between the initial score (number of attempts in the first test) and the performance in the subsequent tests. There was greater variation for the mongoloid patients than for the normal controls. (The latter were evidently a good deal younger and ranged from 3 to 6 years of age, which approximately corresponded to the mental-age range of the mongoloid patients.) It is, however, possible through closer analysis of the presolution phase in the first of a series of discrimination tasks to predict, with a certain amount of accuracy, behavior in the subsequent tests. The performance in the subsequent tests is not determined by the number of attempts needed to reach the solution nor by the fact that one patient is mentally retarded while the other is normal; rather, the performance seems to be determined by the patterns used to solve the problem. By analyzing the tendencies in the presolution phase (position, alternatives, shape preferences, perseverance, etc.), it is possible to make fairly reliable predictions of behavioral approach in subsequent situations. This type of analysis also reveals interesting differences between the mongoloid patients and the normals with which they are matched. T h e most typical differences involve the sequence of the reaction tendencies (mongoloid patients start out with position tendencies whereas normal controls often have a predilection for shape), the number of response tendencies in the repertoire (the normal controls have a larger and somewhat different repertoire), and the flexibility of the tendencies (the number of attempts made for each selection is higher for the mongoloid patient who also has difficulty in switching from one to another-perseveration). Harlow’s concept of “learning set” has been widely discussed in connection with these experiments and has been adopted for critical study by Andersen. As is known, the concept predicts improved performance from one problem to the next (when approximately the same type of problem is used) supposedly because the individual benefits from experience in perfecting his approach. However, Harlow obtained evenly falling curves of error when using the Wisconsin apparatus in experiments on monkeys, but Bjorgen and Lie observed sudden drops in the learning curves after the learning criterion had been reached. Andersen advanced the following hypothesis. In such a series of discrimination tasks there is only one problem, namely, that the subject discover that there is always a reward in conjunction with choosing the correct object. This problem solved, the subject will immediately reach the criterion. The hypothesis was tested using a somewhat more difficult modification of the Harlow method (1949). The subject did not learn the first discrimination to a certain learning criterion but progressed to the next problem after six


251

attempts. According to Harlow, mastering the solution came gradually, but Andersen found that her mongoloid patients reached criterion at different times (some after three problems, others after six, and so forth, and some never) but that once criterion was reached, the error curve dropped to a nearly perfect score. Because the subjects reached criterion at different times, however, Andersen also obtained an evenly falling learning curve for the group as a whole. Heggelund investigated motor learning in mongoloid patients and normal controls using two traditional situations (pursuit-rotor learning and mirror-drawing) in which the performances of the normals were vastly superior to those of the mongoloid patients. Analysis of the differences revealed special noteworthy features in the learning process in addition to the direct difference in performance. The score curves for the mongoloid patients were far more variable, the mongoloid patients had no recall following the resf period, and, while the normal controls tried to find more effective approaches and easily acquired a rhythmic movement, the mongoloid patients needed constant encouragement, were restless, and had difficulty concentrating on the task.

F.

Neuropsychological Examinations

Neuropsychological investigations are not often included in the literature on the mentally retarded, but it seems likely that this branch of research will come to play an important role in oligophrenic research in the future. Behavioral studies on brain-damaged animals at the University of Oslo have revealed findings that seem relevant to the problems associated with mental retardation. Norwegian research workers (Kaada, Ursin) have investigated behavioral tendencies which closely resemble those observed in learning experiments on the mentally retarded including response perseverance, active and passive avoidance, various memory defects, and so forth. Lesions in an inhibiting area in septum subcallosum resulted in defective passive avoidance in both cats and rats. The fact that cats have difficulty in restraining reactions was expected to act as a check on reverse learning, and this proved to be so. Ursin held that this “perseverance” is due to loss of response inhibition. In the psychological theory of learning, the concept of inhibition has practically disappeared, but now neuropsychologists may be able to infuse the concept with new meaning. Even though perseverance and attention defects are typical phenomena in the mentally retarded, one must evidently be wary of transferring conclusions from neuropsychological experiments to the field of mental retardation. The fact that brain lesions in animals may give rise to behavioral patterns similar to those found in mentally re-

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Zvar Amljot Bjorgen

tarded patients is, however, undeniably interesting. I t opens up new perspectives which may stimulate research on both mental retardation and neuropsychology.

v.

SUMMARY

Mental retardation is, theoretically, an interesting object of study in many fields of research. Formerly, research on ment,al retardation consisted of scattered efforts, but now more permanent projects have been formed within the fields of pedagogics, genetics, psychology, physiology, and so forth, and in this way the early experiments have benefitted the cause. Furthermore, this research was previously done by investigators in other disciplines, investigators for whom mental retardation represented a secondary interest. T h e new educational projects, with their main emphasis on mental retardation, will undoubtedly add importance and provide systematization to this particular branch of research. There is still little coordination among ,the various disciplines and no joint planning. The interest of the Norwegian public in mental retardation, however, has been aroused, and research, though scattered and insignificant, is making headway. References have been omitted as most of the studies referred to are still incomplete. Instead, the addresses of some principal research institutions in Norway are indicated below. Oslo Observasjonshjem og Poliklinikk for Andssvake, Kyrre Grepps gate 11, Oslo Statens Hjem for Andssvake (Emma Hjorts Hjem), Emma Hjorts vei 1 , Sandvika pr. Oslo Nord-Norges Andssvakehjem (Trastad Card), Kvaefjord i Troms Psykologisk Institutt, Universitetet i Oslo, Karl Johansgt. 47, Oslo Nevrofysiologisk Laboratorium ved Anatomisk Institutt, Universitetet i Oslo, Karl Johansgt. 47, Oslo

Research on Mental Deficiency During the Last Decade in France R. L A F O N CENTRF. HOSPITALIER I T UNIVERSITAIRE

MONTPELLIER, FRANCE PROFESSEUR DE CLINIQUE DES MALADIES MENTALES ET NERVEUSES

A

LA F A C U L ~

DE M ~ D E C I N E DE MONTPELLIER, FRANCE

AND

J. CHABANIER’ M~DECIN

ATTACH^ A

LA

CLINIQUE DES MALADIES MENTALES ET NERVEUSES H6PITAL SAfNT CHARLEg MONTPELLIER. FRANCE

I. Introduction ...................................... Mental Deficiency or Feeblemindedness . . . . 11. Research Dealing with the Education, Social Integration, and Treatment of the Mentally Deficient .............. A. Teaching the Mentally Deficient . . . . . . . . . . . . . . . . . B. Special Rehabilitation Programs .................. C. Vocational Training of Oligophrenic Children . . . . D. Possibilities for Medical or Surgical Treatment of Mentally Retarded Persons ...................... 111. Research Concerned with the Nature of Mental Deficiency A. Research Employing the “Organic” Approach . . . . B. Research Employing the “Psychological” Approach Bibliography .........................................

253 254 255 256 257 258 26 1 261 26 1 265 27 1

1. INTRODUCTION

This paper does not purport to either sum up or discuss all investigations that may have been undertaken in France during this decade on the subject of medical research concerned with mental retardation. Even if the authors had intended to do so, it would have been difficult, for despite the number of workers doing research in this field, the methods 1 Research Attache to 1’Institut National de la Santb et de la Recherche Medicale (INSERM).

253

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R . Lafon and 1. Chabanier

are in most cases still at an empirical rather than a systematic stagehence, the fragmentary nature of the data presented in this paper. The research in our country does, however, follow two distinct trends. The first is concerned with the problem of educating the mentally deficient. From this viewpoint mental deficiency is considered an established condition, our knowledge of which, based on methods currently available, is not yet sufficient to permit the really successful education of patients and their integration into society. Thus, this trend of research is mainly concerned with the question of how, on the basis of what is known about mental deficiency, to provide a place for such persons in the community and how to induce them to fill it. Their education in vocational schools has been investigated, as well as possibilities for therapeutic or surgical treatment. These studies have centered around the operation of and the results obtained in institutions for the rehabilitation of the mentally deficient. The second trend of research has a different approach. Here the main purpose is to determine the very nature of mental deficiency and the main question is what is mental deficiency? It goes without saying that different investigators use different methods to investigate this problem. There is a trend toward a “psychological” approach in studying mental retardation employing the techniques of conventional psychometry, social psychology or actual sociology, and psychoanalysis. Others employ a more “organic” approach to problems of mental retardation, taking into account possible organic factors. This type of research deals with familial diseases, EEG tests and their results, and specific organic etiology. We shall review these different trends. For the sake of clarity we shall also mention the common official definitions of the various degrees of mental retardation (Department for Maladjusted Children of the General Planning Board). Mental Deficiency or Feeblemindedness

It is expedient to use the intelligence-quotient (10)concept, inasmuch as it does provide some measure of intelligence. This system, however, has a rather wide margin of error (10 and more). The results can vary depending on the testing conditions (personality of the person who administers the test and reactions of the child) on the one hand, and, even if the IQ test is carried out with the utmost objectivity, on other important elements such as social factors, emotional problems, and disorders other than mental which may influence the condition of the child (superhandicaps) on the other.

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In the light of the above statement the following classifications are proposed: (1) A threshold or marginal category, important but particularly difficult to define, including children who are not defective but are unable to at,tain the average level of their classmates. These are children with a limited intelligence representing, so to speak, the lowest level of normal intelligence. They are characterized by a certain slowness in performing their school work and they have serious difficulties in conceptualization. As a rule they are at the bottom of their class. Their IQ lies between 80 and 100. They are only unadapted within the academic framework which distorts the current educational structure. (The so-called “transitional classes’’ experimentally set up by the National Board of Education in 1961 were devised for children in this category.) (2) Persons with a mild mental deficiency (IQ 65 or above), capable of an independent life and adjustment to a working community. (3) Persons in whom a mild mental deficiency is complicated by associated disorders. These children are not, strictly speaking, intellectually inferior to those of group (2), but the “extra burden” they carry makes their social adjustment more difficult. (4) Moderate mental deficiency (minimum IQ 50). Comparative independence and adaptation to simple work is possible after rehabilitation, but ,these cases usually require special care throughout their lifetime. (5) Severe mental deficiency (IQ 30-50). This “semieducable” group is capable of some social adjustment in a sheltered environment. (6) Profound mental deficiency, “profoundly retarded” group (IQ less than 30). These cases are educable only very slightly or not at all, and their adaptation to group life is doubtful and risky. 11. RESEARCH DEALING WITH THE EDUCATION, SOCIAL INTEGRATION, AND TREATMENT OF THE MENTALLY DEFICIENT

Here, an a priori definition of mental deficiency is that cited at a recent UNAR2 (National Union of Regional Associations) Congress by Dr. Kohler, and introduced in 1942 by the French Commission on Nomenclature and Classification of the Young Inadaptable Persons under the direction of Professor Lagache, to the effect that “feeblemindedness” includes states of mental disorders characterized by comprehensive character, predominance of intellectual insufficiency, a precocious or congeni.ta1 nature, slow and subnormal mental development, insufficient development, or lesions of the cerebral cortex. 2

Union Nationale des Associations Rkgionales.

2 56

R . Lafon and J . Chabanier

Based on the above conditions, the aims of rehabilitation are as follows: a very relative social adjustment, the aim being primarily to erase antisocial reactions and secure financial and occupational independence; and, above all, what Dr. Kohler terms “personality development,” or the greatest advance possible toward a certain maturity. This branch of research will deal with the following problems (in the order given): (1) teaching the mentally deficient; (2) special rehabilitation programs; (8) vocational training; and (4) possibilities for medical treatment (drugs, surgery, etc.). A. Teaching the Mentally Deficient

The mentally deficient child benefits from the training received from different adults. T h e training and the tasks of such personnel were discussed at the fifth, sixth, and ,twelfth UNAR Congresses. T h e fifteenth UNAR Congress discussed the results of the projects undertaken and the methods employed. Excellent general papers were submitted by Dr. Berthier and Dr. Kohler. The general theory underlying the practical education of such children in institutions emphasizes the need for team work involving a combination of techniques. Such programs must be initiated early in the individual’s life and continued almost throughout his lifetime in the form of assistance or, for those more susceptible to it, training. These ideas were summarized by R. Lafon in a paper at the Second Kennedy Foundation Symposium (February, 1964), the Federal Provincial Conference on Mental Retardation in Ottawa, Canada (October, 1964), and the Inaugural Session of the Congress of the National Union of Regional Associations in Paris (November, 1964). Most investigations of the problem of education of mentally deficient children have demonstrated that: (1) children slightly retarded are capable of learning and may attain an educational level equal to the first or second year of secondary school;* (2) children with a severe mental deficiency seem ,tobe incapable of learning on a school level; their performance is “automatic” and has no practical value; and (3) children with a moderate deficiency are either unable to learn and should be classed with the severely deficient or are susceptible to learning, but not at a level above the first or second year of elementary school.4 All 3 Secondary school (age bracket: 9-11; duration: 2 years) teaches fluent reading, spelling (elementary grammar), multiplication tables, division of 14 figures, percentages, fractions, and decimals. 4 Elementary school (age bracket: 7-9; duration: 2 years) teaches arithmetic (multiplication and division of 1 figure, counting from 1 to 1000, price problems), slow reading and spelling (names, verbs, adjectives).

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of these findings are discussed in the papers of Brauner, Kohler, and Lang. We should also like to mention the papers of Garaudet and Charlin, which emphasized that teaching methods must be adapted to the needs of each individual case. Royer stressed the influence of the environment on learning and introduced the idea of an academic achievement based on a ratio of the knowledge quotient to the aptitude quotient. Pomme and Girard noted that, scholastically, children with a moderate deficiency may be grouped with either the severely deficient who are unable to learn or the slightly deficient who may acquire some knowledge. Arriving at the same results, Chabanier raised the question: is our method of teaching these children on a school level adapted to their mental deficiency? Furthermore, the author contended that social integration is in no way affected by scholastic failures and that these children can be perfectly well integrated under proper supervision. Mathis and Miss Maurer emphasized that these children should be grouped as far as possible with others of similar intellectual level and similar needs for increased self-respect. B. Special Rehabilitation Programs

Study of mental deficiency has shown the importance of specific defects such as motor or speech deficiencies and disorders. 1. MOTORREHABILITATION Research in this area is mainly concerned with the application of clinical rehabilitation methods including analytical exercises (Swedish method), the natural method (developed by Herbert), and methods involving special relaxation and rhythm exercises. Many investigations have been devoted to this problem, and most of them report and generalize the findings obtained by special teachers trained in physical education. These papers describe improvements in personality development attributable to a specific natural environment, physical exercise, and the student-teacher relationships possible under such conditions. These still fragmentary studies have broadened the concept of motor rehabilitation from the simple original notion of corrective exercises aimed at improvement of motor reflexes to a program of progressive training that teaches the mentally retarded to make use of his body (proper breathing, moving around, good posture, etc.) and thereby learn to know his body, attain a state of gnostic and praxic awareness, and understand the body rhythm. Thus, we pass from pure motorization to knowledge and efficiency.


258

On the basis of observations gained in handling mentally retarded children, Tosquelles emphasized the significance of games and manual occupation for the development of imagination. He concluded that an educator must not be blind to the value of these techniques or abandon them in favor of psychomotor training, but must use them to gain a better knowledge of the child. Experience of this type at the Medical and Social Institute of Psychopedagogy (I’MP)of the University of Montpellier has been described in several papers.

2. SPEECH REHABILITATION Speech impediments are considered very important: first, because the mentally deficient child cannot compensate for this defect by himself; and second, because this type of disorder increases the mental infantilism and weakness of symbolic function characteristic of oligophrenic children. I t is for these reasons that the experimental schools where such children learn by handling concrete objects have had such encouraging and surprising results. The Batipaume Center (Agde-Hdrault) is one such school; a practical and diverse course of study is taught around primarily solid, actual objects, well-leavened by related games and play, thus promoting personality development in feebleminded children. Children taught in this fashion seem more receptive to classic teaching later on. Speech rehabilitation is just as possible in oligophrenic children as in normal children if the child is capable of generalization (a normal child reaches this stage by approximately 30 months of age). The orthophonist corrects speech defects by exercises in articulation and sentence making. H e helps language understanding by emphasizing the meaning of words. He improves language understanding and then child will make the transition turns to the written word, so that the from the world as perceived to the organized world, where he is a selfconscious, rather than a purely existing, being, through the medium of language” (Kohler). ‘I.

..

3. REHABILITATION OF PHYSICAL EXPRESSION Finally, we mention briefly the more specific research attempting to develop physical expression and a dramatic sense in severely retarded children. This type of project is being undertaken in Strasbourg and Montpellier (Tosquelles, in Bulletin Croix Marine). C. Vocational Training of Oligophrenic Children

This problem is well covered in the report on the vocational teaching techniques discussed at the last UNAR Congress by the ARERAM team (Association for Psychomotor Rehabilitation of Children and Voca-


259

tional Adjustment for Workers with Psychomotor Disorders) under the supervision of Dr. Jolivet. T h e vocational training and employment of young handicapped persons was the theme of the UNAR Congress held in Toulouse in 1956. T h e report is the result of a survey of almost 4000 cases where all categories of handicapped children were observed. Although vocational training varies widely from institution to institution, two basic trends may be distinguished: polyvalent vocational training and more specialized training for, and including most, individual trades. Most techniques of vocational training are based on two methods: that of Mme. Ramain and that of the ANIFRMO (National Intertrade Association for the Rational Training of the Labor Force), the latter method being employed by Dr. Bize in his work. T h e Ramain method was developed in order to provide a basic background which can be adapted to any trade; this background consists of an “active attitude,” i.e., response (responsive attitude, cognition, etc.), as well as an understanding of the task at hand, the capacity for selfexamination needed to organize the actions required to complete the task, and finally the ability to carry out these actions properly. Madame Ramain has worked out a set of progressive exercises based primarily upon the “interest attitude,” or the child’s desire for personal progress. T h e child advances another step as he completes each successive exercise. T h e FPA (Adult Vocational Training), or ANIFRMO method, has evolved from the work of Dr. Carrard, based primarily on Cartesian theory. T h e principles of this method are as follows: to treat each student as an individual and get to know him as a person; to break down the course of study so that only one new thing is introduced at a time, progressing from simple to complex concepts; never to tackle a new problem before the preceding one has been mastered; to disregard the time factor, i.e., to aim for excellence rather than speed; to emphasize specific instruction; and to create a feeling for work well done. Both of these methods have been put into practical application. We note briefly that ARERAM has obtained good results in its various centers through the application of the Ramain method. Also worthy of mention are the vocational improvement classes instituted by the Department of the Seine and the work being done in the Ecole de Perfectionment in Ronneuil sur Marne and in the Rhone Medico-Vocational Institute of Unskilled Labor (Institut Medico Professionnel de 1’Oeuvre Lai‘que du RhBne; Mme. Dubosc-Pacaud). T h e program for severely deficient adolescents and adults initiated by the Denis Cordonnier workshops in Lyon is another promising original project. This project

260

R . Lajon and J . Chabanier

consists of a workshop open to workers of both sexes, some of whom board at the school. Beaujard and Raymond have noted the following on the basis of their experience in this institution: the possibility of emotional development in profoundly retarded cases (some even attain real autonomous efficiency in their work after a certain period of working in a team on a collective achievement) and the possibility that such instruction may have a constructive psychotherapeutic effect. T h e obvious improvement in deportment and the effect of this improvement on the family have been the most tangible results of such training. T h e Kennedy Foundation has set up a similar project at the Kennedy Workshop in Montpellier under the direction of R. Lafon, one of the authors of this paper. Other projects concerned with the vocational training of profoundly retarded cases are also noteworthy. Lecuyer and Horsley have reported results obtained in a live-in workshop providing occupational therapy for mentally handicapped persons (overhauling separate automobile parts, gluing, and minor assembly work). They stressed the value of rehabilitation through work, as it lends a human dimension to socialization and removes anxiety with respect to personal relationships and group life. Ferre investigated possibilities of vocational rehabilitation of mentally deficient persons in a rural environment and established the necessity for early agricultural training and orientation. Doussinet’s approach to the problem is more general; he believes that the recuperability of a mentally retarded person can be assessed on the basis of certain elements and environmental conditions. On the basis of their survey of 292 students (slightly retarded and upper-medium defective) in a national remedial school, Bugniot, Lalisse, and Kevorkian concluded that the goal of such teaching must be twofold: to provide a happy environment for the adolescents in which they will acquire confidence in themselves and a practical approach to life and to teach them to work without confining them to any particular trade. T h e aim of such training is to teach them the basic movements they will require within the framework of an activity approximating as closely as possible their potential employment. T h e survey showed that 78y0 of the former students of the school hold a manual job and earn at least a subsistence wage. T h e care and moral protection of such students after they leave the school, however, still present a problem. In an excellent paper presented at the 1957 UNAR Congress, Lang reviewed the working conditions required for the employment of semieducable, mentally retarded persons: steady, adequately remunerated employment not demanding excessive physical effort; group living facilities; and strong administrative and legal support. Laurent and Philo-


26 1

menko determined the distribution of 633 oligophrenics by vocation: 31% were employed in construction; 23% in some job requiring simple manual labor; 14% worked with metal or machines; and a small percentage worked as artisans, tradesmen, domestic servants, and farmhands. Similar results have been reported by Henne regarding the employment of profoundly retarded persons in a psychiatric environment (St. Venant Psychiatric Clinic). RCmy Lafon has started an adult workshop with an original program of vocational assistance for cases of mongolism, where it has been determined that these cases, as a group, can produce 60% of the output of normal adults, in marked contrast to the individual ability of slightly and moderately retarded people. D. Possibilities for Medical or Surgical Treatment of Mentally Retarded Persons

Since papers on the use of different drugs are presented at every meeting of the Society of Child Neuropsychiatry and it would be impossible to mention them all, discussion i n this section will be kept to a minimum. Briefly, possibilities include: treatments intended to improve mental or psychomotor efficiency in retarded children by means oE hormonotherapy, glutamic acid (Lafon; Faure; Bascou), dietetics, implantations of fresh animal glandular tissue (Girard), and acetylcholine (Heuyer); and symptomatic treatment by means of various drugs, depending on the nature of the condition-depression and autism are treated with psychoanaleptics and IMAO (Revol), severe pictures of imbalance in deficiency can be helped by phenothiazine derivatives (Vermeylen), instability by mild tranquilizers such as meprobamate, and hallucinations by the butyrophenones. Direct surgical treatment of brain lesions causing the mental deficiency is also possible in some cases and may range from excision of a cortical scar to hemispherectomy (Coquet, Gros). 111. RESEARCH CONCERNED WITH THE NATURE OF MENTAL DEFICIENCY

These investigations have been based on the notions that the actual nature of mental deficiency is still unknown, and that the question is not solely a quantitative one but that a qualitative difference is present in cases of mental retardation. A. Research Employing the "Organic" Approach

This section will discuss: (1) etiological factors in mental deficiency; (2) electroencephalographic investigations of mental deficiency; and (3) the genotypic aspect of mental disease.

262


1. RESEARCH DEALING WITH ETIOLOGICAL FACTORS

Most etiological factors generally believed to promote mental retardation have been investigated. Constantinides has investigated the effect of hereditary factors in the development of mental retardation. Kohler has been concerned with the aftereffects of encephalitic syndromes (with Mme. Levin-Pacaud), the incidence of congenital cardiopathies (with Bret) and tuberculous meningitis (with Mme. Simon), the role of attempted abortion (with Mme. Tremaux), the influence of alcoholic ascendants (with Lachanat, Pasquier and Mlle. dAdhemar), the effect of infantile toxic conditions (with Jeune and Guidicelli), and the role of protracted pregnancy (with Mme. Ramel). Schachter has studied the effect of toxemia of pregnancy and premature birth on the neuromental development. Drath has been concerned with the neuropsychiatric sequelae of obstetric and fetal trauma. The work of the Montpellier team (Lafon et al.) has established the symptomatology of an organic syndrome indicating the presence of an organic neurological disorder. A classification of mental deficiencies which is still in use (Lafon and Faure) was drawn up on the basis of this syndrome of psychometric, clinical, and electroencephalographic signs. The Montpellier team has also provided valuable data on certain forms of congenital craniocephalic defects (Lafon, Labauge, Cadilhac, and Robinet) and certain thyreomuscular syndromes (Lafon, Minvielle), in addition to their work on the problem of infantile atrophic encephalopathies, which is discussed in a paper by Professor Labauge. 2. ELECTROENCEPHALOGRAPHIC STUDYOF MENTALLY RETARDED PERSONS

Many authors have studied the electroencephalograms of mentally deficient patients. Some of their papers discussed personality and behavioral problems in retarded children, cases in which the EEG showed disturbances of various degrees u p to and including paroxysmal episodes. Heuyer, Nekhorochef, and Lelord have studied the EEG aspect of personality and behavioral disorders; Michaux, Duche, Launay, Blanc, and Narbouton have also studied this problem. Certain EEG patterns characteristic of bioelectric immaturity have been demonstrated; a predominance of slow rhythms and the presence of posterior slow waves showing a marked sensitivity to hyperventilation were the principal signs reported. The comparative maturational, psychological, and EEG pictures in mentally retarded patients were discussed by S. Netchine. Certain patterns of paroxysmal discharges with an ill-defined background activity and poor spatial differentiation have been distinguished in retarded cases, which Lairy has interpreted as an


263

indication of a deficiency of psychomotor adaptation. Fessard has made a specific study of the correlations between the EEG and motor aspects. These studies were extended further by Lairy, who analyzed peculiar patterns of background rhythm and the spatial organization of the latter. The spatiotemporal features of the EEG of mentally deficient patients have been analyzed in relation to psychological development by S. and G. Netchine. Other authors have used the EEG to indicate conditioning to certain stimuli presented in the Pavlovian fashion (Heuyer, Popov, Lelord, Agat ton, and Michaux). Beley, Sevestre, Lecuyer, and Leroy investigated electroclinical correlations with respect to the EEG in cases of mongolism. In the case of adult oligophrenia, Chabanier noted that the presence of character disorders of an explosive and aggressive nature are frequently accompanied by a dysrhythmia (often irritative), while the development of a psychotic process such as schizophrenia or the various types of delirium evokes no changes in the EEG. Most authors, however, believe that once the brain reaches maturity there is no correlation between its intellectual efficiency and electrical activity (with the exception, of course, of the EEG signs of a specific organic lesion responsible for mental retardation). Puech, Lelord, Lalisse, Richet, and Tetard, on the basis of observations made on 250 mentally retarded children at a psychiatric clinic, concluded that there is a statistically significant connection between certain clinical variables (sleep, motor activity, etc.) and EEG variables (presence and character of spontaneous or evoked paroxysmal discharges, amplitude of background rhythm, presence of fast rhythm). 3. THEGENOTYPICAL ASPECT OF MENTALDISEASE

Variable work in this area has been under way for several years at the Genetic Institute of the Department of Medicine of Paris (Chair of Fundamental Genetics) under the direction of Professor Lejeune. T h e discovery in January, 1959, that a chromosomal anomaly was responsible for mongolism, a disorder clinically well-documented, stimulated research in this field. Mongolism had already been the subject of a great many papers. Lecuyer (These MCdicine Paris, 1958) has provided a review of the problems arising from this disease, together with a personal contribution, based on clinical, biological, and EEG data; he also introduced the relational aspect with regard to the families of mongolian idiots. We will not elaborate the different chromosomal anomalies subsequently described in various papers and now well known (mongolian trisomy 21, the trisomy 13-14-15,and the trisomy 16-17-18 described by Patau et d.),

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nor the structural chromosomal anomalies (breakage and amputation or breakage and translocation). These chromosomal anomalies correspond to morbid features whose clinical manifestations are so typical that the pediatrician can diagnose the disease by a standard examination. Hoffman and Gratadour described a new form of neurogenic dermatosis in which symmetrical adenoma sebaceum is combined with mongolism. Schachter’s studies of mongolism in the black and yellow races and his clinical description of complex congenital malformations are of interest, as are those of Bernard which deal with the chromosomal picture in infantile encephalopathy with complex malformations. As further review of these by now classic syndromes seems unnecessary, let us turn instead to the present objectives of cytogenetic research. Analysis of chromosomal complements and aberrations does not serve a merely academic purpose. As Lejeune has stressed, modern research aims beyond the discovery of the cause and mechanism of the development of a disease; the prime target is the biochemical mechanism affected (accelerated or inhibited) by these chromosomal changes. The discovery of this mechanism will offer real possibilities for therapy in certain types of retardation via alteration of these biochemical changes. While the authors just cited have concentrated on finding biochemical changes associated with chromosomal anomalies responsible for mental retardation, other authors have approached the problem from the opposite direction, considering a state of retardation as secondary to metabolic disorders, Most important in this connection is the work of Christiaens and co-workers on states of mental retardation secondary to metabolic diseases. These investigations have dealt with phenylketonuria; a case of familial observation has been described by Christiaens in collaboration with Gautier and Briet. This disorder, whose incidence in France is increasing, was the subject of a thesis by Picaud-Bellemain (Lyon; a review paper), papers by Delay, and papers by Christiaens et al. All have been concerned primarily with the detection, by means of relatively simple tests, of heterozygotes carrying the defective genes, so that preventive measures may be applied where necessary. Tribut (Paris, 1960), Rouget (Paris, 196l), Debrd, Breton, Sacre et al., Gerard-Lefebvre et al., and Chaptal and Jean have published papers on the Lowe syndrome. Gargoylism has been discussed in numerous papers, including a thesis by Mme. Duquennoy-Vanheuverswyn (Lille, 1963). T h e authors of the present paper have contributed data on Bourneville’s disease and on a complex ectomesenchymal dysmorphism related to the Bonnevie-Ulrich syndrome.


B.

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Research Employing the "Psychological" Approach

1. THESOCIOLOGICAL ASPECT The sociological aspect will be mentioned only briefly here. T h e medicosocial problem of the maladjustment of mental defectives was discussed by Dr. Lang in his book on maladjusted children and by Chombar-Delauwe in his book on the psychopathology of the maladjusted child. The authors of the present paper have conducted a number of investigations on this problem (a study of the habitat, neighborhood, and town in relation to juvenile maladjustment and a study of the effects of the invalid condition and of the influence of observation centers on parental alcoholism). They also have investigated various types of relationships (between parents and the teaching staff, between individual parents and teachers, between individual children and teachers, between parents and maladjusted children, and between parents and children with personality problems). 2. PSYCHOMETRIC TESTS Noteworthy among investigations employing the classic psychometric tests are those of Moor and Penot studying the perception of mental deficients by means of the Rey Picture Completion test, Pichot's study using the social maturation test, and Hurtig's experimental studies of trained and untrained minds in normal and retarded children. Hurtig showed how the results of different tests could change when the tests were given several times in a row. The difference between a spontaneous performance and the performance of a trained mind is more marked in the case of pseudoretardation; a genuinely retarded mind will display the same weakness every time a test is repeated despite the thorough explanation following each application of it. Mullen has used projective tests (Rorschach and TAT) to investigate the personality of mental defectives. It is, however, the work of Zazzo et al. which has given rise to a completely new theory of mental deficiency. Challenging Ribot's theory of the homogeneity of the pathological and the normal, Zazzo asserted that deficiency is accompanied by actual qualitative, probably structural, change. T h e mental age of a mentally deficient person is inferior to his chronological age. The rate of mental development thus differs from that of physical development, so that the whole equilibrium is different; this is the hypothesis underlying the theory of heterochronism. Zazzo proposed that the mental structure of a retarded individual differs from that of a normal child of the same mental age. True deficiency

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may take a variety of forms, depending on the etiology. Results of a battery of tests designed to distinguish the profile type of deficiency have given rise to the notion of dysharmony (lower level in some tests, higher level in others), according to which the deficient child develops at a rate which differs in different psychobiological areas of development (area of spatial orientation seems to be one of those most frequently affected). In their studies on the motor activity of retarded children, Irene Talan and Claire Dunrat stressed the fact that the speed of the retardate’s movements is disproportionately high in relation to the precision; they do not seem to have the degree of control over the speed of a motor action that corresponds to their mental age. In line with the concept of heterochronism, Perron and Pecheux suggested the inferior state of the deficient child as a basis for research; the demands made on him by his physical and social environment are a function of his chronological age and exceed his capacity for adaptation. Thus, for the study of mental deficiency, the relationship between the demands made on the patient and his capacities is important. In this connection, the technique of a priori evaluation of the degree of success with which the patient will accomplish the different tasks he is set is of value. The approach of these authors is an interesting and original one. Within the framework of the psychobiological experimental work in progress at the Henri-Rousselle Hospital, Stamback and Chiva have recently analyzed the intellectual mechanisms involved with respect to the problem of a possible defect in the area of spatial orientation in oligophrenic children. Chiva has also investigated conceptual thought and perseveration phenomena in retarded children.

3. PSYCHOANALYTICAL APPROACH In connection with the notion of evolutional dysharmony, Diatkine and Lebovici have stressed that maternal reactions to the narcissistic trauma presented by infantile encephalopathy, or an evolutional dysharmony, could have a pathogenic, even psychotogenic effect, because of communication difficulties at the preverbal level between mother and child, on the one hand, and because of the reactions released in the mother by the narcissistic trauma inflicted by the evolutional dysharmony, on the other hand. Mises and Barande have prepared a general review of the problem of the relationship between infantile encephalopathy and psychosis. It is, however, the work in child psychotherapy carried out by the Armentikres and Thiais groups which has given rise to an actual structural concept of mental retardation. Castets and his Armentikres team defined this structural concept as a peculiar and pathological form of personality


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organization. Intellectual inadequacy is an indication of this pathological organization of personality. The role of organic neurological lesions varies according to their nature, extent, and influence on the patient’s relationship to society. Thus, the significance of an anatomical lesion lies primarily in its effect on the relationship of the patient to society, a fundamental factor according to these authors. Cast,ets believes that the fact that an oligophrenic can neither grasp what others attempt to communicate to him nor communicate himself to others, i.e., their “mutual unintelligibility,” lies at the root of the behavioral disorders seen in cases of mental ret,ardation. Indeed, according to Castets, there is no specific symptom of mental retardation, just as there is no possible anatomic or clinical definition of it. It is merely a question of a type of personality different from the psychotic type. In fact, mental retardation becomes evident at the earliest stages of psychomotor development, and the development of a retarded child is continuous, as opposed to that of the psychotic child which occurs in spurts. From the beginning, the retarded child displays a twofold retardation-both in psychomotor development and in structuralization of the “ego.” From its onset this twofold retardation conditions the relationship of the child to society, as well as his entry into the world of language, inasmuch as it inhibits the process of identification necessary for verbal expression. Consequently, the transition from sensorimotor comprehension to discursive intelligence is blocked. According to Castets, the disparity between the physiological and mental ages is another peculiar element characteristic of mental retardation; this hiatus might be explained on the basis of Zazzo’s notion of heterochronism or on the basis of Ajuriaguerra’s hypothesis that a disparity between the various levels of motor development is responsible for psychomotor disorders. Moreover, besides this more or less complete incapacity for verbal expression, i.e., signalization, the emotional input necessary for the transition to verbalization seems to be equally lacking. This emotional input, the prerequisite for any type of learning, is analogous to what Pichon calls “the law of appetition.” The lack of emotional input in the early stages of signalization is thus an important element. Four types of mental retardation are described by Castets: mental retardation incidental to congenital or acquired degenerative diseases of the central nervous system, where the organic equipment required for signalization input is lacking; mental retardation due to instrumental deficiency, where a physical defect (such as deafness) hinders the transition to signalization, a condition which though initially curable, is aggravated by the relational emotional reaction to the handicap and con-


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ditions the structuralization of the child (the distinctive feature of this group would appear to be the fact that the condition is to some extent curable at the onset and the fact that the aggravating element is the relational emotional element); purely structural mental retardation brought about by the modalities of the mother-child relationship; and, finally, secondary mental retardation, more exactly a psychological and psychomotor regression (as a result of cranial or encephalitic trauma). Besides its “dynamic” approach, the most notable component of this concept is its insistence that a retarded child be recognized as an individual, as “another person.” Teaching on this basis is only possible, then, in a relational modality where “. . the desire of the child is recognized in its dual acceptation of desire for another and the wish to be desired by another, to quote Castets.” Another important notion set forth by Castets is that this relationship “. . be defined in terms of a Law, such as the Law of the Father, which rules what is allowed and what is forbidden.” Thus the child is taught to govern himself, not by the interpretative methods of psychotherapy, but by the established conventions of a normal scholastic training. “The child must be allowed to express his desires, but only in an acceptable form.” Regardless of the disadvantages of this concept and the difference in its interpretation by different psychiatrists, it does stress the importance of the relationship between the mother and the retarded child on the one hand, and between the teacher and the child on the other. T h e resident neuropsychiatrist of the institution is the only person qualified to handle this relationship. As Dr. RCmy Lafon has stressed, the most important task of the resident psychiatrist is to check neurotic countertransference on the part of his co-workers in relation to the children in their care. In connection with the psychoanalytical approach to retardation and in line with the distinction between true and pseudodeficiency, Maud Mannoni, attempting to determine the standing a mental deficient may hope to win in his family, came to the following conclusion. Unconsciously, the child tends to have the same attitude toward his handicap as his parents. “A child‘s life is often cast in the mold of maternal fantasy.” Mannoni’s work is rather specialized in that she only studied cases in which the parents had consulted a psychiatrist, and thus her work constitutes “a purely psychoanalytical elucidation” of the problem of mental retardation. Whatever its cause, a defect in a child is an affront to the mother’s self-love, and the absence of any basis for identification (with its corollary of possible impulsive behavior) engenders a state of panic “in the face of this image of herself which she can neither recognize nor love” and

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forces the mother to live her anguish in terms of what has marked her own history (oral, anal, phallic), so that she will live the real-life drama as an echo of the ordeal she has already experienced on the fantasy level. In the words of Mannoni, “The mother meets the demands of her child with her own fantasies.” However, there is more to it. The child himself will influence his mother in a certain way, inducing her to adopt a sadomasochistic-type of attitude toward him; this type of relationship will have been experienced by the mother in her own history and will remind her of something very remote, elusive, and primitive, something above all “destructive,” which has never been symbolized (it cannot be put into words since it lies without the framework of “The Law”). Thus, Mannoni states, the child will “lose his status as an autonomous being and become an object that must be looked after.” The purpose of psychotherapy is to restore to the child his status as an autonomous person. The essential purpose of this type of research is thus at present not a radical revision of our techniques of education and rehabilitation, but rather an attempt to achieve general recognition of the fact that “. . any human being, no matter how debased, can always be given the benefit of the doubt; he will always profit from being considered as a person motivated by his own desires rather than as an object to be looked after.” As Maud Mannoni concluded at a recent UNAR Congress, “A research project undertaken by a combination of teachers and physicians working in close collaboration could gradually bring about a revision of our own attitudes with respect to retarded children, which can do much to help them overcome the barriers imposed by their disease.” A study group composed of neuropsychiatrists and psychologists has recently been organized in France for this purpose and is at present attempting to work out a practical program. In his review of the results obtained during a 5-year period of psychotherapy at the Edouard Claparkde Institute in Paris, Scalbert concluded that it is essential to organize homogeneous and stable psychotherapeutic teams which will be responsible for the formation and adjustment of the relationship of the child with his environment. The necessary psychotherapy will be outlined by the consulting physician and carried out by a psychotherapeutic team consisting of a physician who will guide the parents (the consulting physician himself, in the simpler cases), a record keeper (literally, the secretary of psychotherapy), and the psychotherapist. This discussion of the psychoanalytical approach is best concluded by reference to the report presented by Dr. Faure at the recent UNAR Congress on the present state of the psychoanalytical approach to the problem of mental deficiency.

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Dr. Faure’s first point was that we are all concerned with the problem of mental retardation, which by its very existence is an affront to our self-love as human beings, and thus constitutes a metaphysical problem. Its effect is strongest, of course, on the parents of retarded children, particularly the mother, who is subjected to a continuous narcissistic ordeal by the mere fact that she cannot recognize herself in what she has made. This ordeal is perpetual and sometimes gives rise to aggression, inevitably accompanied by guilt and ambivalence and generally expressed by defensive denials. These ,feelings may subtend the elements of a more or less masochistic fixation, as observed in specific cases by Mannoni; these elements also sometimes subtend “pseudojustification” attitudes such as the often compensatory overprotection. T h e father generally tends to retire from the scene, although many are actively helpful. The second point stressed was the problem of mental retardation itself. As a psychoanalyst, Faure pointed out the danger of overpublicizing experimental psychoanalytical studies, the inevitable result of which would be the development of a new, more idealistic form of denial of mental retardation. This hazard was pointed out earlier by Launay, who stated . psychotherapy cannot be expected to achieve any effect in mental retardation that would be comparable to the effect of fresh cells.” That an actual deficiency exists must be accepted: then and only then may the psychoanalytical approach be applied with the aim of determining the alterable factors overlying and aggravating the existing deficiency -in other words, the task of psychoanalysis is to attempt to define what, in each individual case, has been imposed on the retarded child by his mother, his relatives, the physician, and society and, via the experience of the IMP, to proceed, in the words of Remy Lafond, “from the subjugated to the subject.” When nothing remains but the actual deficiency, educability and occasional contact are always possible, if only on a certain level. What, then, is the position of the analyst? At present, in view of the shortage of analysts trained in child psychoanalysis, he will be a consulting member of the team, essentially an observer who will appraise, insofar as he remains outside the case, the action taken by the teachers and, occasionally, by the neuropsychiatrist. I n some cases he will work as a therapist, occasionally with the children but more often with the parents, the mother in particular. Such psychoanalytical projects have made clear the necessity that the child “be a person,” even within the framework of an institution, and that the father be actively involved with him (Mannoni, on the basis of Laqan’s findings, also emphasized the symbolic importance of the father). Faure also raised the question of the sexual life of a mentally retarded ‘I.

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MENTAL DEFICIENCY DURING THE LAST DECADE I N FRANCE

27 1

patient and the moral problem of sterilization versus the laissez-faire attitude, which leads to the procreation of ineducable children. He concluded his report by emphasizing that at the present state of affairs, violent tactics of analysis must be strictly avoided, i.e., any brutal attack on certain defenses of the parent or teacher that might only increase their resistance or revive despair, This is the spirit of our current project, the Research Alliance (I'Unitk de Recherches) initiated by the National Institute of Health and Medical Research and entrusted to us at Montpellier, which will be a multidimensional study of mental retardation examining the problem from every aspect so as to distinguish the overlying factors and study the actual deficiency at the core of the retarded state, particularly its aspect of perceptive integration, which, once we have discovered how these children learn, will then tell us how they act and, consequently, enable us to educate them according to their educability. For the Montpellier team, . . this is the utilization, but also the sacrifice of our knowledge. . . .We are confronted with the choice of either continuing our work in this way or not continuing it at all." I'.

BIBLIOGRAPHY This is not a complete bibliography of the general works dealing with mental deficiency during the last 10 years in France, but it does include the different points of view discussed in this chapter. GENERAL PROBLEMS With regard to the general problems of equipment and personnel and of techniques of readjustment, education, and treatment of mentally deficient people, the special issues of Sauuegarde de Z'Enfance, which contain the integral reviews of the annual congresses of UNAR,. can be consulted profitably. Fifth UNAR Congress, Rennes, 1953. Equipment and personnel required by the Child Protection Services. Suuvegarde d e Z'Enfunce, 1964, Nos. 1-3. Sixth UNAR Congress, Montpellier, 1955. Personnel of child protection agencies; activities and norms. Sauuegarde de Z'Enfance, 1964, Nos. 1-3. Fourteenth UNAR Congress, Lyon, 1962. Evolution of child and adolescent rehabilitation techniques, Sauvegarde de I'Enfance, 1963, Nos. 1-3. Fifteenth UNAR Congress, Paris, 1964. Training and treatment in mental deficiency: review of findings and methodology; outlook for the future. Suuuegarde de I'Enfance, 1963, Nos. 1-3.

SPECIALREHABILITATION TECHNIQUES Special rehabilitation techniques were discussed in numerous publications and were summarized in a general report published in a special issue of Revue de Neuropsychiatric infantile. Psychopedagogy and rehabilitation techniques, 1962. Nos. 1-2. + National Union of the Associations for Childhood Safeguard, an organization whose responsibilities include the equipment, personnel, scientific research, and coordination of the various associations dealing with mental retardation. Sauvegarde dc I%nfance is the review published by UNAR.

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R . Lafon and J. Chabanier

SCHOOL WORK OF MENTALLY DEFICIENT CHILDREN Brauner, Franqoise. & Brauner, A. Educational treatment of mentally deficient children. Revue de Neuro-psychiatrie infantile, 1962, No. 10, pp. 88-104. Chabanier, J. Investigation of academic learning and social integration i n a group of 63 medium deficient young girls. Publication Monographs Annie 1964, INSERM.. Chabanier, J. A comparative evolution of IQs in academic learning and sociability as observed in two groups of medium-deficient children representing either an organic syndrome or a dominant affective syndrome. Publication Monographs Annie 1964, INSERM. Charlin, J.. & Garaudet, L. In Journies Dijonnaises sur I'Adaptation Scolaire et Professionnelle des Dibiles Mentaux. Dijon, 1960. Pomme, B., & Girard, J. Discussion of the problem of admission and the degree of educability (partial or academic) in medium mental deficiency. Revue de Neuropsychiatric infantile, 1963, Nos. 9-10. Querel, R. Teaching in slight and moderate deficiency. Cahiers de I'Enfance inadaptie, 1963, No. 6, p. 1. Royer, J. Research on academic performance in moderately retarded children. Revue de Neuro-psychiatric infantile, 1963, Nos. 9-10, p. 527.

VOCATIONAL TRAINING AND PERFORMANCE AT WORKIN MENTALLY DEFICIENT PATIENTS Bugniot, F., Lalisse, A., & Kevorkian. J. Vocational orientation i n Semieducable defectives. Revue de Neuro-psychiatrie infantile, 1963, Nos. 3-4, p. 197. Dubost, Marie. Problems involved in the training of the mentally deficient. Journies Dijonnaises sut I'Adaptation Scholatre et Professionnelle des Ddbiles Mentaux. Dijon. 1960. Ferre, A. Vocational rehabilitation in rural defectives. Cahiers de I'Enfance inadaptie, 1957, No. 4, p. 17. Kohler, C., & Dubost, Marie. The young mentally deficient person in the modem working world. Sauuegarde de I'Enfance, 1960, Nos. 4-5. Laurent, P., & Philimenko, A. The mentally deficient person in the working world. Bulletin d u CE.RP., X, 1961, No. 3. WORKING PERFORMANCE I N MENTAL DEFICIENCY Beaujard, M., & Raymond, M. Assistance workshops for the employment of seriously affected deficient patients. Revue de Neuro-psychiatrie infantile, 1963, Nos. 9 and 10. Lafon, R h y . Employment and performance of profoundly deficient adults. Sauvegarde de I'Enfance, 1963. Lecuyer, R., & Horsley, A. Certain types of industrial work suitable for profoundly deficient adolescents. Revue de Neuro-psychiatrie infantile, 1962, No. 10, pp. 515526. Raymond, R. Two and a half years of experience in the Denis Cordonnier Work-shop in Lyon. Nos Enfants inadaptdes, 1963, 2nd trimester. MEDICALTHERAPY I N MENTAL INSUFFICIENCY Brauner, F., & Pringuet, G. Therapeutic treatment of mentally deficient children. Revue de Neuro-psychiatrie infantile, 1963, Nos. 9-11.

SURGICAL THERAPY Wertheimer, P. Surgical measures possible in mental retardation. L'Enfance inadaptie. Special issue on current problems. National Institute for Health and Medical Research.


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INVESTIGATIONS OF DIFFERENT ETIOLOGICAL FACTORS Kohler, C., & Bret, J. Neuro-psychiatric incidences of congenital cardiopathies in the child. Socitte de Neuro-psychiatrie mddico-sociale de la rdgion Lyonnaise, May 25, 1956. Kohler, C., Jeune, H., & Guidicelli, G. Neuropsychological findings in 100 infanta treated for and cured of a “toxic state.” Annales medico-psycologiques, 1961, July. Kohler, C., Lachanat, R., Pasquier, N., & d’Adhemar, I. Investigations of alcoholic ascendance in mentally and character-deficient children and adolescents. Revue de Neuro-psychiatrie infantile et d’hygilne mentale d e I’Enfance, 1961, March-April; Pediatrie, 1961, No. 11. Kohler, C., & Pacaud, Marie. Neuro-psychiatric sequelae of encephalitic syndromes in the child. Pediatrie, 1955, Vol. X, No. 4. Kohler, C., 8: Ramel, Marie. Observations of the psychomotor development in children I U midecine ~ Lyonnaise, April 5 , 1962. born after a protracted pregnancy. ~ O U T ~ de Kohler. C., Robert, J., & Roche, M. Investigations of the familial origin of mental deficiency in a community of adolescents. Congres International de Psychiatrie de I’Enfant, Rome, 1963. Kohler, C., & Roche, M. Methodological difficulties i n the investigation of etiology in encephalopathies. Congres des AliCnistes, Lyon, 1957. Kohler, C., & Simon, Marie. A revision of neuropsychological sequelae of tubuculous meningitis in the child. Journal de mtdecine Lyonnaise, October 5, 1959. Kohler, C., & Tremaux, M. The possible role of etiology in abortion attempts in infantile encephalopathies. Congres des Aliknistes, Lyon, 1957. Labauge, R. Atrophic encephalopathies in infants. Medical thesis, Montpellier, 1963. This is a review. Lebovici, S. Current state of the concept of infantile encephalopathy. Revue de NeuroPsychiatrie infantile, 1955, Nos. 11 and 12, pp. 524-529.

THECLINICAL STUDY OF MENTALLY DEFICIENT PATIENTS

Faure, J. L. Forms of mental deficiencies in children, pp. 729-747. Reference is also made to issues 9 and 10 of Sauuegarde de I’Enfance, devoted to “Current Views of the Problem of Mental Deficiency in the Child,” and to the following articles in particular. ELECTROENCEPHALOGRAPHIC INVESTIGATIONS A complete review of articles concerned with the problems of the relationship between electroencephalograms and intelligence is found in: Netchine, S. T h e electroencephalogram and intelligence. Annie psychologique, 1959, 59-11, 427-428. T h e following articles also deal with electroencephalographic investigations. Beley, A., Sevestre, P., Lecuyer, M., & Leroy, C. Contribution to the study of E.E.G. in mongolism. Revue neurologique, 1959, 101, No. 3, 457-459. Chabanier, J. On the E.E.G. test in mental retardation. Publication Monographs Annde 1964, INSERM. Fessard, A. E.E.G. correlations in motricity. Revue Neurologique, 1959, 101, No. 3, pp. 336-369. Fishgold, H., Dreyfus-Brisac, C., Monod, M., Samsondolfuss, D., Kramarz, P., & Blanc, C. T h e electroencephalography during cerebral maturation-physiological aspects. Report to the XVIIth Congress of the Association of French-language Pediatricians, Montpellier, October 12-14, 1959.

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Heuyer, G., & Popov, Catherine. Schizophrenic evolution in certain types of retardation: clinical, psychologic and E.E.G. conditioning aspects. Revue de Neuropsychiatrie infantile, 1957, Nos. 7 and 8, p. 383. Lairy, G . C. E.E.G. and infant neuropsychiatry. Psychiatrie de I'Enfant, 1961, 5, No. 2, 525-608. Lairy. G. C., & Netchine, S. The clinical and psychological significance of spatial patterns of the electroencephalograms in the child. Revue Neurologique, 1960, NO. 4, pp. 380-388. Lairy, G. C., & Netchine, S. Differential study of E.E.G. maturation curves according to certain psychological traits. First European Congress of Pedo-Psychiatry, Paris, September 16-20th, 1960. Michaux, L., & Lelord, G. Reading the E.E.G. conditioning. Entretiens de BichatMedecine, Expanded ed.. 1961. Of psychopathological interest. Narbouton, R. Contribution to the study of behavioral disorders in the child. Medical Thesis, Paris, 1958. Investigations of E.E.G. correlations. Netchine, S., & Lairy, G. C. Brain waves and mental level. Enfance, 1960, Nos. 4 and 5. Netchine, S., & Netchine, Gaby. Psychologic and spatial-temporal organization of E.E.G. in mental retardation. Revue Neurologique, 1962, 107, No. 3, 217-218. Netchine, S., & Netchine, Gaby. Psychologie and maturative organization in the E.E.G. of mental defectives. Revue Neurologique, 1962, 107, No. 3, 218. Netchine, S., Taman, I, Lairy, G. C., & Zazzo, R. The electroencephalogram and the mental level. Annie psychologique, 1959, 59-11, 355-373. A study of a population on a low mental level. Passouant, P., Cadilhac, J., & Ribstein, M. T h e E.E.G. during cerebral maturation. Montpellier mddical, 1960, 57, 2. Popov, Catherine, & Heuyer, G. Contribution to the study of deficiency by E.E.G. CNRS Conditioning Laboratory, CNRS Monographs. Puech, J., Lelord, C., Lalisse, P., & Richet-Tetard, A. Profound mental retardation in children with E.E.G. anomalies; a study of electro-clinical correlations. Revue de Neuro-psychiatric infantile, 1963, Nos. 9 and 10. INVFSTIGATIONS OF GENOTYPICAL DISEASES

Breton, A., Francois, P., Gaudier, B., Ponte, C., Poingt, J.. Walbaum, R., Lepen, S., & Guyon, P. Lowe syndrome, a clinical, biological and genetic study of new findings. Pediatrie, 1963, XVIII, No. 6, 627-369. Chaptal, J., and Jean, R. Clinical and biological study of a child afflicted by Lowe syndrome. Archives Francaises de Pidiatrie, 1959, 16, No. 6. 849-850. Christiaens, L., Gautier, B., & Briet, B. Phenylketon, comments on a familial investigation. Pediatrie, 1953, XVII, NO. 6, 718-721. Christiaens. L., Walbaum, R., Farriaux, J. P., & Cuvelier, R. Study of Hurler's disease in an infant, cytological and biochemical investigation. Pediatrie, 1964, XIX, No. 2, 231-237. Copelman, L. S. Congenital malformations in child neuro-psychiatry. Revue de Neuropsychiatrie infantile, 1962, 10, Nos. 5 and 6. De Grouchy, J., Arthuis, M.,& Thieffry, S . Cat-call syndrome. Annales d e GCnCtique, 1964. 7 , No. 1. De Grouchy, J., Lamy, M., ThieRiy, S., Arthuis. M., & Salmon, C. On complex dysmorphism with oligophrenia: deletion of short arms of chromosome 17-18. Proceedings of the Academy of Science, Puris, 1963, 256, 1028-1029. Duquennoy-Vanheuverswyn, C. Gargoylism in the child. Thesis, Lille, 1963.


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Gerard-Lefebvre, G., Biserte, M., Woillez, M., Traisnel, M., Gosselin, J., & Combaud, A. Clinical genetical and biological study of Lowe syndrome. Pediatrie, 1957, No. 5, pp. 527-534. Hoffman, R. S., & Gratadour, P. On an unpublished form of neurogenic dermatosis in association with symmetrical bilateral adenoma sebaceum and mongolism. Presse mtdicale, 1962, 70, 40. Lafon, R., & Minvielle, J. Myopathy-hyperthyroid condition+mcephalopathy association. Montpellier mtdical, 3rd series, XLIX. Lecuyer, R. Mongolism. Medical Thesis, Faculte de Medecine de Paris, 1958, No. 124. Lejeune, J. The karotypes of trisomy 21. Revue de Practicien, 1964, XIV, No. 1. Lejeune, J., Gautier. M., Lafourcade. J., Berger, R., & Turpin, R. Partial deletion of a short arm of chromosome 5; 5 cases of the cat-call syndrome. Annales de GCnnCtique, 1964, 7 , No. 1. Lejeune, J.. Lafourcade, J.. Berger, R., Vialatte, J., Boeswillwald, M., Seringe, P., & Turpin, R. Three cases of short arm deletion of chromosome 5. Proceedings of the Academy of Science, Paris, 1963, 257, 3098-3102. Lejeune, J., Lafourcade, J., De Grouchy, J.. Berger, R., Gautier, M.,Salmon, C., & Turpin. R. Partial deletion of a short arm of chromosome 5, individualization of a new morbid state. Semaine des Hopitaux de Paris, 1964, 40, 1069. Mongolism. Special issue of Revue d u Praticien, 1964, XIV, No. 1. Nodot, A. Genotypical mental deficiency. Revue de Neuro-psychiatrie infantile, 1963, No. 9-11. This paper is a general review of these diseases. Picaud-Bellemain, S. Phenylpyruvic oligophrenia. Thesis, Facult6 de MCdecine de Lille, 1963. Rouget, C1. The Lowe syndrome. Medical Thesis, Facultk de M6decine de Paris, October, 1961. Schachter, M. Mongolian retardation, investigations of recent data. Archives hospitalidres, Paris, 1959, 31-3-55-62. Schacliter, M. Oligophrenia, spasmodic and congenital paraplegia in prematurely born children (Sjogren Larsson syndrome). La mtdecine infantile, 1961, December, 4751. CHROMOSOME INVESTIGATIONS Bernard, R. Current trends in chrornosomic investigations in congenital encephalopathies with complex dysmorphism. Marseille mldical, 1962, 99, 7. Lafon, R., Gros, G., Labauge, R., & Vlahovitch. B. Heterotopic and supernumerary lobe during cerebral hemiatrophy. International Symposium on Congenital Cephalic Malphormations, Paris, March 28-30, 1957. Lafon, R., Labauge, R., Cadilhac, J., 8c Robinet, J. Major cranio-encephalic dysmorphism of congenital origin. SociCtC des sciences mCdicales ct biologiqucs, Montpcllier, Dec. 16, 1965. Lafon, R., Pages, P., Labauge, R., Ribstein, M., Barjon, Marie-Claire, & Navarro, M. Three observations of Bourneville tuberous sclerosis. Socittt des sciences mtdicales et biologiques, Montpellier, June 21, 1957. Lejeune, J., Turpin, R., & Gautier, M. Investigation of somantic human chromosomes, techniques in vitro fibroblast culture. Revue &Etudes cliniques et biologiques, 1960, 5, 406-408. PSYCHOMETRIC RESEARCH. We are not in a position to list all the investigations that have been carried out and indicate only the following. +

For an overall picture of the work carried out by R. Zazzo and his group, see

“A Group Study of Mental Deficiency,” Enfance, 1960, pp. 335-364.

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Chiva, M. Contribution to the study of the conceptual idea and perseveration phenomena in mental deficiency. Proceedings of the International Copenhagen Congress on the Scientific Study of Mental Retardation, 1965, Vol. 1, p. 366. Hurtig, M. Experimental study of the possibilities of intellectual training of deficient and normal children. Enfance, 1960, Nos. 4 and 5. Kohler, C., & Cuche, Marie. Study of Rorschach psychograms in vocational training center for adolescents with true mental deficiency. Socittt d e Neuro-psychiatrie, nrtdico sociale, Lyon, January 17, 1960. Kohler. C.. & Gatier, G., The elaboration of the results of a psychological examination in diagnosis work. Revue de Neuro-psychiatrie infantile, 1954, Nos. 3-4. Moor, L. Psychometric investigation of mentally deficient persons. Revue de Neuropsychiatrie infantile, 1962, Nos. 1-2. Moor, L., & Fenot, A. M. Contribution to the study of perception in deficiency by means of the Rey Lacunar Figure Test. Revue de Neuro-psychiatric infantile, 1961, 9, Nos. 9-10. Moor, L., & Jolivet, B. Profiles of rehabilitable psychomotor deficiencies. 1957, 12, 718, 815-853. Mullen, F. A. An inductive method for the determination of significant aspects in the responses of mentally deficient children to the T A T and the Michigan Picture Test. Revue de psychologie appliqude, 1961, 11, 4. Perron, R. Personality problems in mental deficiency. Enfance, 1959, Nos. 4 and 5; Levels of tension and activity control. CNRS, 1961. Perron, R.. & Pecheux, M. G. Are the mentally deficient aware of their handicap. Proceedings of the International Copenhagen Congress on the Scientific Study of Mental Retardation, Vol. 2, 120. Experimental data on the self-estimation of personal ability. Stamback, M., & Chiva, M. Contribution to the study of the conceptual idea and and perseveration phenomena in mental deficiency. Proceedings of the International Copenhagen Congress on the Scientific Study of Mental Retardation, 1965, Vol. 1, p. 405. PSYCHOSOCIAL INVESTIGATIONS Chabanier, J. On socio-familial factors and disorders of emotional evolution in a “medium” mentally deficient group. Essay concerned with the comparative evolution of IQs and the sociability in emotional disorders. Department Monographies, Paris. Chombart de Lauwe, M. Social environment and child psychiatry. Revue de Neuropsychiatric infantile, 1956, No. 4, pp. 5-6. De Ajuriaguerra, J., 8: Garrone, G. T h e concept of mental deficiency and its effect on the social adaptation of the child. Mtdecine et Hygiine, 1962, No. 562, pp. 691694. Doussinet, 0. The semi-educable profoundly deficient patient; evaluation of possible recovery. Infortnations sociales, 1958, Nos. 9-10, p. 73. Henne, M. Future possibilities of intellectually deficient persons. L’Hygiine mentale, 1964, LIII, No. 2. Kohler, C. Psychological and social problems raised by mentally deficient children and adolescents. Annales me‘dico-psychologiques, 1955, 1. Merlet, Lucette. Perception of others and sociometric structures in mentally deficient adolescents. Enfance, 1962, No. 3, p. 300. Techniques for the investigation of professional and social adaptation of mentally deficient adolescents.


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Pichot, P., Haim, A., & Perse, J. Mental deficiency, adaptation and social adaptability, experimental study. Revue de psychology applique'e, Paris, 1957, 7.1.

PSYCHOANALYTIC INVESTIGATIONS Castets, B. T h e concept of mental retardation. L'Evolution psychiatrique, 1962, 111, 379. Castets, B. Principles of a structural conception in mental retardation. Annales mtdicopsychologiques, 1964, 1, No. 3. This paper summarizes the author's conception. Dolton, Franqoise. Psychoanalysis and pediatrics. Edition de la Parole, Paris, 1961. A basic work concerned with the problems of child psychoanalysis; includes clinical case histories. Mannoni, Maud. T h e retarded child and the mother. I n J. Lacan (Ed.), Collection le Champ Freudien. Paris: Seuil, 1964. This small book summarizes the original approach of Maud Mannoni. Tosquelles, F. A contribution to the investigation of educational techniques in profound deficiencies. Znforrnation sociale, 1958, Nos. 9-10, p. 50.


Psychotherapeutic Procedures with the Retarded M A N N Y STERNLICHT DEPARTMENT OF PSYCHOLOGY, YESHIVA UNIVERSITY, NEW YORK, NEW YORK

I . Introduction . . . . . . . . . . . . . . . . A. Definitions ....................................... B. Outcome Goals .......................... 11. Specific Psychotherapeutic Procedures Available for Use with Retardates ...................................... A. Introduction ............................... B. Individual A ions .......................... C. Group Applications .............................. D. Novel Psychotherapeutic Techniques . . . . . . E. Psychotherapy with Parents of Retardates . . . . . . . . . . 111. Conclusions .......................................... Refcrences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

279 281 282 284 284 288 299 325 331 341 349

I. INTRODUCTION

This chapter will review those research studies dealing with psychotherapeutic procedures with the mentally retarded. Major emphasis will be placed on those studies reported from 1955 to the present. T h e relative paucity of material in this area attests to the frequently cited tendency to disclaim or seriously question the effectiveness of psychotherapy with the retarded. In the comprehensive review that follows, it will be noted that not more than 50 original investigations into the efficacy of psychotherapeutic techniques with retardates appear; this total was abstracted from several thousand dealing with mental retardation. Why has the retardate, the grandfather of psychological measurement, become the stepchild of psychological treatment? T h e answer would seem to lie in the conceptual frameworks of various theories of personality which have militated against the introduction of psychotherapy for use with the mentally retarded. One such viewpoint, which has a long tradition, dates back to the often reiterated statements by Freud and 279

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Fenichel which rule out psychoanalysis for retardates on the grounds that interpretations are central to psychoanalysis and that normal intelligence is prerequisite to the acceptance of such interpretations. NeoFreudians, who relegate interpretation to a lesser position of importance, still require their patients to experience insights into their behavior patterns, and they maintain that such insights can spring only from the fertile soil of an intelligent mind. Contemporary theoreticians, Rogers (1 95 1) by far the most articulate, discouraged any form of psychotherapy with mental defectives. Their arguments may be summarized as follows: Certain intellectual and social abilities are inherently absent in all mental retardates which precludes the effective application of psychotherapy with them. These include verbal ability and the ability to abstract and deal cognitively with actingout impulses. T h e retardate is unable to accept socially appropriate substitute activities in the face of frustrations and restrictions, view objectively the behavior of others, adjust or want to adjust to the needs of others, and realize the sources and consequences of his behavior. Some group therapists, too, feel that the retardate’s inability to verbalize, become aware of the interpersonal nature of his problems, create an adequate therapeutic relationship, or understand the purposes of the individual offering it makes him unsuitable for psychotherapy. In his criteria for the selection of members of potentially successful groups, Slavson (1955) advocated the foregoing theoretical points of view. Freedman and Sweet (1954) exhorted group therapists to eliminate “emotional illiterates,” i.e, people lacking cultural backgrounds which value introspection and communication of feeling. Thus, according to them, even if a prospective patient or client were of somewhat normal intellectual capacity, he might still be ruled out for group psychotherapeutic treatment if his cultural limitation seriously impaired his ability to articu1at.e and profit from verbal relationships. Finally, the mentally subnormal have long been considered unsalvable due to the viewpoint that the disorder is caused by brain tissue damage. Their doom was considered sealed, since neurologicaI tissue does not regenerate and cerebral defects are essentially irreversible. Furthermore, psychological treatment which is functional has never proposed, except in psychosomatic instances, to effect structural changes. Despite these arguments, most clinicians and research workers in the field recognize that mental retardates are subject to emotional trauma and difficulties incidental to their intellectual limitations and that they respond, in varying degrees, to psychotherapeutic assistance (Abel, 1953; Cowen, 1962). According t.0 Kaldeck (1958), most retardates are incapacitated more by their emotional problems than by their low intellectual

PSYCHOTHERAPEUTIC PROCEDURES WITH THE RETARDED

28 1

functioning, and therefore psychotherapy with this group is of vital importance. Burton (1954) would employ a psychotherapeutic regimen with retardates to make possible the use of such intellectual capacity as is available by freeing them from emotional conflicts and anxiety. A review of the literature made by Sternlicht (1962b) revealed some studies which reported conflicting results when workers were “counseling” or “doing therapy” with mental defectives. A few of these studies have been reprinted in a compilation by Stacey and DeMartino (1957). In those studies which reported positive results, many employed training and counseling methods which cannot properly be subsumed under the term psychotherapy and which may actually have been vocational guidance, speech therapy, occupational rehabilitation, and special education. In addition, a good number of those studies reported techniques for counseling the parents of mental defectives. Nevertheless, even ruling out the training methods and parent-counseling studies, a small number of studies claimed to have achieved positive results with various forms of psychotherapy applied to mental defectives. Theoretical arguments contradicted one another, with some of the arguments taking on a wishful-thinking tone of “where there’s life, there’s hope.” A semantic and logical analysis of these various studies revealed that much of the confusion was due to a lack of definition of actual outcome and present goals, in addition to hazy communication between investigators in these areas. A definition of terms and a theoretical exposition of psychotherapeutic outcome goals follows. A. Definitions

Very few workers in the field would argue with the definition of “mental retardation,” given by the American Association on Mental Deficiency, . subaverage general intellectual functioning which originates during the developmental period and is associated with impairment in adaptive behavior” (Heber, 1961). However, an unequivocally acceptable definition of psychotherapy is difficult to come by. English and English (1958) have defined “Psychotherapy” as “The use of any psychological technique in the treatment of mental disorders or maladjustments.” Since “psychological technique” is vague and imprecise, a more practical definition might be that offered by Leland and Smith (1962), to the effect that . in general we can say that any planned attempt based on a close interpersonal relationship to create behavioral change in the patient, regardless of the materials or procedures used, should. . be considered psychotherapy.” The “effectiveness” of psychotherapeutic procedures refers to the extent to which such

“. .

“. .

.

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desired behavioral changes have been accomplished. It is important to ascertain whether the behavioral changes are the consequence of the psychotherapy or of fortuitous or other circumstances.

B.

Outcome Goals

In an attempt to relate psychotherapeutic outcome with preset goals, Sternlicht (1964a) has postulated a theoretical model for the psychological treatment of mental retardation, as follows: “. . . in order to properly approach the question of the effectiveness of psychotherapy with retardates, we must first ask the following questions. 1. What are the etiological conditions which are generally responsive to intensive psychotherapy? 2. Have these conditions been ascertained in the patient? 3. If, in response to questions 1 and 2,we decide that psychotherapy is indicated, what should our pre-set realistic goals be? 4. After the goals have been set, can we operationally measure the anticipated modifications; can we set up a control situation, so that the outcome of this experience can be published as an encroachment on our vast ignorance in this field? “Looking at our Etiological Model (Table I), in answer to the first question, we have already ruled out the use of psychotherapy as a modifier of neurological deficit per se, on the grounds of ineffectiveness. We also have ruled out the use of intensive psychotherapy as a modifier of cultural deficit on the grounds of relative inefficiency. However, the psychogenic etiology of mental retardation is in the province of psychotherapy. Psychotherapy has been reported to be effective as a modifier of personality in certain types of patients. If one will grant that mental retardation can be a function of an emotional cause, and that psychotherapy treats emotional causes, can we not expect the intellectual deficit to be eliminated to the degree that the patient’s emotional integrity is restored? The logical conclusion of this agreement is that when the primary cause of mental retardation has been established as an emotional cause, it becomes a condition amenable to psychotherapy, In this case, the IQ can be expected to be raised to the degree that the cause is truly emotional. Where there are familial, neurological, and/or cultural influences in addition to the primary emotional cause, our expectation should be less ambitious, such as perhaps a slight increment in IQ, proportional to the emotional cause. “We have assessed the value of psychotherapy as a raiser of IQs. There is a second, more obvious area of mental retardation which is theoretically amenable to psychotherapy. That is, the secondary, or ego-reactive, area. Here, psychotherapy, as it is employed to treat the distress of anyone

F!

TABLE I A SCHEMATIC ETIOLOGICAL MODEL OF MENTAL RETARDATION: A P R O C N O ~INDEX IC

cd

Symptomatological syndrome: manifestations

Etiological influences

Expected outcome of psychotherapy, proportional to etiological influence

Prognostic decision by goals

M C

cl

i; cd

Intellectual deficit (IQ below 85)

Neurological deficit (hereditary. prenatal, brain damage) Cultural deficit (low sodoeconomic status, subcultural emphases) Emotional disturbances (disturbed childhood. severe environmental stress)

Personality maladjustment

Emotional reaction to existing intellectual deficit and concomitant limitations (familial rejection, school failure, job failure, institutional limitations, awareness of inferiority)

None

Not indicated

ZI

8

M

tr

s Insigni6cant

Not indicated

1. Raised IQ

Indicated

(possible total cure) 2. Resolution of personality maladjustments

Indicated

1. Personality adjustment

2. IQ unchanged

Indicated Not indicated for this purpose

% gU

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who feels the existence of a very real handicap, can be applied to the patient who feels his intellectual handicap, and all of the unique concomitants which this handicap embraces, such as social and familial rejection, the restriction of freedom by institutionalization, the impulsive disinhibition resulting from cortical inefficiency, t,he sexual restrictions, the lack of ego-ideal, the social-psychological influence of a subnormal culture, and so on. If psychotherapy can help the non-retardate to achieve better adjustments in the face of reality, it should be capable of doing so with mental retardates, without necessarily increasing the IQ. Here we have our greatest support from the empirical 1it.erature. “Based on our etiological model, we have been able to prognosticate for which goals and under which circumstances psychotherapy is indicated and for which it is not.” II. SPECIFIC PSYCHOTHERAPEUTIC PROCEDURES AVAILABLE FOR USE WITH RETARDATES A. Introduction

Many of the conflicting studies in the sphere of psychotherapy with the mentally retarded (conflicting both in terms of results as well as in terms of orientation) at first may appear to demonstrate the inconclusiveness of research in this area. Actually, they indicate the need to assess more accurately the varying needs of the mentally retarded and to bear in mind that a variety of circumstances generally determine how these patients may best be served. Furthermore, those processes not presently fully understood or experimentally validated need not be a deterrent to our applications, inasmuch as we are dealing with a behavioral science with all of its inherent difficulties in controlling all pertinent variables. Aft,er sifting, analyzing, and classifying the data, however, what once appeared as a chaotic mass actually emerges into an orderly, “gestalt” pattern. Far from being paradoxical, the variety of procedures available serves to provide the researcher and clinician with a choice of therapeutic tools appropriate to the specific task at hand. Most therapists in the field are agreed that mental retardation offers an obstacle to change in personality dynamics, but they are likewise convinced that therapy can surmount these difficulties and provide a suitable outlet for the release of tensions and anxieties which handicap behavioral functioning. The exponents of verbal procedures presuppose an intellectual level of functioning in the patient in which conceptual communication is possible. The nonverbal adherents feel that the limited intellectual functioning of a good many patients seems to favor the adoption of nonverbal procedures.


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Several authors, among them Berger (1958), Sternlicht (1965), and Winick and Holt (1962) offer theoretical support for the use of nonverbal techniques with the mentally retarded. They enumerate areas of nonverbal communication and alert the clinician to the existence and applications of these procedures. Reik (1962) has declared that "Gestures are a means of communication, originally as important and even more important than words. . . ." The importance of such forms of communication as gestures, grimaces, and mannerisms in effecting therapeutic changes has been highlighted by Ruesch and Kees (1956) via the utilization of silent films taken of therapy sessions. Berger (1958) saw a greater interest in, and utilization of, nonverbal therapy as valuable for both the patient and the therapist. Used as an adjunct in therapy, he felt that it would result in self-realization, . . that dynamically knowing self which inherently implies accepting of self with and without understanding." Areas of nonverbal communication include resistance, silence, body language, transference, countertransference, group atmosphere, the therapist's nonverbal communication, acting out, prejudice, art, and growth. It was Berger's hope that the therapist will make use of the myriad forms of nonverbal communication to reduce both the pain and the time involved in psychotherapy. Winick and Holt (1962) also reported on various nonverbal communicative gestures evidenced in groups undergoing therapy. The eye and face movements are, as it were, an unspoken language. Looking for approval, looking away, not looking, lining up objects and persons, winking, looking as withdrawal, looking up as inferior gaze, looking at objects, a tilt of the head and mouth, etc.,-all these are very revealing. Sternlicht (1965) has outlined a host of nonverbal techniques which can be applied directly with the retardate. He also felt that many therapists may resist the notion of nonverbal therapy, inasmuch as they may have invested much time in the development of verbal and verbalized skills. On the other hand, there are studies which offer rationales for the utilization of verbal communication. Astrachan (1955) found interview or discussion therapy to be useful in the habilitation of retarded adolescents and young adults. She found that the verbalization of their difficulties enabled the (retarded) participants to work out their problems, especially those concerned with sibling rivalries, authority figures, and the dependency needs inherent in their retardation. Similarly, Wilcox and Guthrie (1957) demonstrated the effectiveness of discussion group therapy with female retardates. The girls were encouraged to share their misgivings and fears and ventilate their feelings of insecurity, inferiority, and hostility. The authors suggested that thera-

".

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Manny Sternlicht

pists can produce change in groups of institutionalized defectives by employing primarily verbal therapy and by assuming responsibility for group leadership, at least initially. Verbal communication in a noninstitutional setting has been described by Hormuth (1955). The program was designed to help retardates make a better adjustment to community living. The Adult Social Activity Group Program combines a therapy program with an activity program and club meeting. Topics discussed during the course of therapy range from problems with parents to feelings about the retardate’s own limitations, dating, sex, etc. I n addition, group sessions are held with the parents of each group in order to emancipate the retarded individuals from their parents’ overprotection. This therapy program under the guise of a “club” meets the needs of the retardate which the community is not providing-that of companionship and socialization. Obviously, retardates living in the community are capable of better intellectual functioning, accounting for the effectiveness of a verbal approach. An experimental study with retardates of limited intelligence who display aggressive behavior “using very brief psychotherapy of a simple nature and in simple language” has been reported by Rudolf (1955). He described five cases of female defectives who received seven group sessions preceded by individual interviews. The Porteus Maze Test was used at intervals to evaluate the patient’s behavioral improvement. All are said to have shown progress. A follow-up by the therapist showed that four of the five patients had been discharged and were living in the community. Here, too, the capacity of the patients seems to have been instrumental in the employment of the verbal approach. A difference of opinion exists, too, on the question of the utilization of a directive or nondirective approach with retardates. The majority of published studies have employed either a nondirective or a mixed approach, with varying results. Positive findings were observed by O’Connor and Yonge (1955) using the nondirective principle, but negative findings were reported by Vail (1955) and Gorlow, Butler, Einig, and Smith (1963). Sternlicht (1962a) and Thorne and Dolan (1953) stressed the use of directive therapy because of the retardates’ greater dependency needs and intellectual deprivation. A study operating on the assumption that the retardate’s limited intellectual functioning prevents him from being aware of alternative behavior, with consequent need for suggesting alternatives to him, was that by Wanderer and Sternlicht (1964). Despite these favorable results, directive therapy is still a debatable issue because of the undesirable dependency needs that it may engender (upon the therapist by the patient). The following survey will illustrate the variety of available psycho-


287

therapeutic techniques that may be employed with the mentally retarded. These procedures can be utilized within either a primarily directive or primarily nondirective or basically eclectic approach. (1) Projective techniques have been employed as facilitators of therapeutic communication. As an example, Abel (1953) elicited early traumata by the repetitive use of figure drawings over long periods of time, while grunts have evolved into stories by retardates who had been persistently exposed to Thematic Apperception Test pictures. (2) T he fine arts (art, music, dance) have been integrated into therapeutic programs. Success has been reported by Kadis (1957) with finger painting, where the patient expressed his problems together with his productions, while McDermott (1954) has outlined the value of art therapy for retardates. Heimlich (1960) has reported on the beneficial effects of music therapy as a means of working with children who have communicative problems, while Murphy (1957) observed the favorable responses to music by institutionalized mental retardates. T h e utilization of dance therapy, with its emphasis on muscular expression, as a means of reducing tensions and providing an outlet for expression of emotional conflicts has been described by Rosen (1954). (3) T he performing arts, at least indirectly, have provided media for therapeutic expression. Catharsis, or the reduction of tensions through some form of related, substitutive activity, has been experimentally demonstrated to be valid for therapeutic use with the mentally retarded (Sternlicht & Wexler, 1965). A major nonverbal cathartic technique is play therapy, an exposition of which has been offered by Cowen (1962). Mundy (1957), in an experimental support, obtained “very significant” gains in IQ and social behavior with a program of play therapy, as had Axline (1948) and Maisner (1950). Several different types of play therapy for use with emotionally disturbed mentally retarded children have been devised by Leland and Smith (1962). Psychodrama represents another form of cathartic activity. Lavalli and Levine (1954) have reported success with this technique as has Abel (1953) who employed psychodrama with puppets. Arnholter (1955) also recommended sociodrama for retardates, as both a cathartic activity, in terms of its tension releasing aspects, and a practical learning experience, in terms of the new modes of response and interpersonal adjustments gained. (4) Relationship therapy has been labeled by Neham (1951) as one of the successful techniques in use with the mentally retarded. I t is quite possible that the success of any therapeutic or rehabilitative venture may be primarily the consequence of the sense of importance that a patient feels when an intact stranger is sufficiently concerned with him to spend valuable time and energy for the patient’s benefit. Oliver (1958) noted

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significant increments in intelligence test performance with a program of physical conditioning, increments which he attributed to the “effects of feeling important.” Ego-supportive therapy (also favorably reviewed by Neham) may be considered as a type of relationship therapy. I n much of psychotherapy, it is hoped that the patient will (unconsciously) identify with the therapist and consequently incorporate him as a new self-image. Stevenson and Knights (1962) have written about “social reinforcement” and the influence of the sex of the clinician. (5) Educational therapy has attempted to improve the functioning of the retardate by teaching him appropriate responses, especially social skills. Many emotionally disturbed retardates who are unable to accept their need for therapy often readily participate in therapeutic programs under varied educational guises (e.g., going to school, remedial speech assistance, crafts work, etc.). Praise is lavished freely, whether earned or not (Thorne, 1960), and rote memory is emphasized. Motivation is considered to be fundamental to a favorable outcome. Kaliski (1955) pointed out that the stage has to be set for learning, while Thorne specified “conditions conducive to learning.” Conditioning therapy, which operates on learning principles, has been employed successfully by MacMillan (1961). (6) Group therapy, which can incorporate nearly all of the aforementioned techniques and approaches, has been utilized extensively with the mentally retarded. It is a form of therapy which requires a great deal of (mental) activity on the part of the therapist, as well as a careful screening of the participants so as to secure an etiological balance (Astrachan, 1955). Many therapists have reported on the successful applications of group psychotherapy with retardates, of which those by Wilcox and Guthrie (1957) and Snyder and Sechrest (1959) are especially notable. Because group psychotherapy will be discussed in greater detail later in this chapter, it will suffice at this juncture simply to mention that Neham’s critical review of the literat,ure fully supports the use of group psychotherapy with mental retardates. B. Individual Applications

Speculation as to the appropriateness of psychotherapy with the mentally retarded left the realm of theoretical conjectures and entered that of scientific inquiry when actual implementation of psychotherapeutic procedures with retardates commenced. Probably the hostile, aggressive, acting-out behavior of some mental defectives rather forced the issue, so that any action was taken to reduce tensions in the retardate


289

and rest,ore harmony in either the home or the institution. Thus, psychotherapy with the mentally retarded had its auspicious beginnings, and the therapists often were as surprised as their patients to learn of positive results. The literature on the varied techniques employed with retarded individuals shows one factor common to all of these studiesnamely, the importance of effective communication. Kniest’s study (1962) stressed the therapeutic value of toys precisely in this area-communication. Working in a training center for handicapped children, he concluded that toys had a valid place in a rehabilitation, treatment, or training center for disabled children, especially as a means of communication and as an aid in improving social skills. Seven particularly important concepts concerning the value of toys were listed: “. . . 1. Toys can help to free a child from many of the limitations of his handicap; “2. Toys can help a child realize a sense of achievement that will aid in developing his personality; “3. Toys can help a child achieve satisfying social contacts and peer status: “4. Toys can help a child discover and use latent abilities: “5. Toys can help a child adjust to the limitations of his environment; “6. Toys can help a child express his feelings in a constructive manner and release negative feelings that trouble him; “7. Toys can help a child work out some of his problems at his own speed, problems he may not be able to share with anyone.” These findings are highly significant since they present strong support for the use of play activities in a therapeutic program for retarded children. One interesting study dealing with play therapy is that by Gondor and Levbarg (1958). The authors described the play room at the Flower Fifth Avenue Hospital Clinic for Retarded Children. The room, which is utilized for individual and group therapy, also “serves as a place for the children to relieve their tensions and anxieties while awaiting the initial and subsequent visits to the pediatrician.” The trained therapist guides the retarded child, through dramatic play, toward an understanding of, and adjustment to, reality. One aspect of this report that also should be mentioned is the use of art in gaining an understanding of the feelings, problems, and emotions of the child. The child’s drawings often pinpoint his confusions and difficulties, thus assisting the therapist in better understanding and evaluating his charge. Furthermore, the therapist, by means of a pictorial explanation, can aid the child in his adjustments via such graphic expressions.

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King (1954), too, pointed out that drawings, in this instance of human figures, are important and useful in psychotherapy. He introduced the “Draw-A-Person”procedure in the second year of therapy with an obsessive-compulsive 20-year-old nonretarded male. T h e drawings helped to bring out the patient’s basic confusion concerning his sexual identity. Another form of therapy which involves expressive motor activity is that of the dance, Rosen (1954) reviewed the rationale for the use of nonverbal forms of creative expression in psychotherapy and stated: “The most important common denominator of many . . . therapeutic methods is the utilization of the constructive forces of interpersonal relationships within the framework of the creative activity.” She went on to describe studies using modern dance in the treatment of the mentally ill which employ the “basic assumption . . . that the body itself can serve as an instrument for social communication of conflicts and forbidden drives.” The author concluded that the “modern dance seeks to extract from the known, purposeful movements of everyday living its essential aspects-space, direction, dimension, force and tempo. I t seeks to re-create the essential core of functional movement, to capture its quality. . . . Creative dance provides the opportunity to bring out emotionally charged communications in a social form where they are appropriate to the content.” Closely allied to Rosen’s study was Kratter’s (1959) investigation of music therapy for the mentally retarded. The author’s findings indicate that music too exerts a “therapeutic influence on emotionally unstable defectives, enabling them to shed some of their tensions and aggressive trends and to develop a sense of rhythm to increase group cooperation and teamwork.” Music serves as a link between the patient’s id and ego. The selection and the presentation of music follows a standardized sequence in form of rhythm, melody, harmony, and pictorial association. The music’s initial speed and quality must be related to the mood and tempo of the retarded patient. Here, too, the retardate has the opportunity to communicate nonverbally and overcome the language barrier. Psychodrama is another effective technique, as both a learning procedure and an avenue for communicating the retardate’s experience. Blake (1955) described the use of the psychodrama to understand “how the child discovers himself in relation to the external world of people, animals, inanimate objects and supernatural beings.” The goals are phrased both in terms of social learnings and simply in terms of having fun. The author, nevertheless, regarded this technique as comparable to


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that of Piaget, Gesell, and Klein, and concluded that it is not inconsistent with these other methods as an instrument for diagnosing, analyzing, and effecting change in the child. The use of dramatics as a form of teaching social skills was reported by Bryer and Wagner (1963). The authors described the study as an exploration of the relative effects of a program of academic training supplemented by an ancillary social-experience teaching procedure which employs “role-playing as teaching methodology with a cumcular content of daily living skills.” Sixteen male retardates with IQs of 48-90 were divided equally into eight experimental and eight control groups. The experimental group was given a series of realistic situations to be acted out, while the control group engaged in no role-playing experiences. The SAT was administered before the experiment and again in 12 weeks. The results showed “significant achievement increases for the experimental group (over the control group) on the language test.” A more nondirective approach which, similarly, resulted in marked improvement in language development was reported by Mundy (1957). The experiment was conducted with mentally and physically handicapped children in a mental deficiency hospital. Treatment was started with the hypothesis that the most potent factor in psychotherapy is emotional rather than intellectual comprehension and that the success of psychotherapy depended more on the necessary emotional processes to take place than on their verbalization. Interpretation of a simple but deep-going kind was attempted, and it was found that this was understood more often than might have been expected at the apparent mental level in some cases. Resistance to individual psychotherapy hardly exists with these subnormal (young) institutionalized children because of their starvation for affection contacts. Consequently, a sound transference situation can be established with great ease in a very short time. “Non-directive play therapy, modified by an analytically oriented therapist, with emphasis on the transference situation” was the method employed. Whereas play material was found suitable for the older children, another method w a s necessary for younger and for mute children, i.e., “scientific mothering” (a physical contact). Of the 23 children, who were seen over a period of 9 months to a year, 15 demonstrated considerable progress in language development and social behavior, which seemed to be due to the reduction of anxiety. The findings seem to indicate that sufficient comprehension existed down to the 40+ IQ level for individual therapy to effect change in an emotional adjustment. Cases with impairment due to organic causes did not profit from therapy to a large extent. Mundy concluded that psycho-

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therapy can “bring about a change from imbecility to educability,” thus justifying the use of psychotherapy with retardates. A contrary view, however, was presented by Glass (1957), who reported on therapy with a 18year-old retarded boy. The boy, who had been diagnosed as an idiopathic epileptic and who had earned IQs ranging from 60-78, demonstrated behavioral difficulties both at home and at school. His aggressive and acting-out destructive tendencies at the training school led to a recommendation for psychotherapeutic treatment, with the limited goals of reducing his aggressive and destructive behavior at school. His feelings of rejection by his family led to his desire to hurt and be hurt in return. The description of the therapy began with a physical attack upon the therapist by the boy. The patient’s behavior, however, gradually evolved into more positive and friendly directions, with the retardate endeavoring to get close to the therapist. This was followed by a distinct improvement in the lads behavior in school and with his cottage parents. At this point, his parents terminated treatment, because of the financial burden involved. Following this premature termination, the aggressive acts recurred. The author used this case history to illustrate how limited our knowledge is of just what psychotherapy with the retarded involves. He noted that virtually no interpretations were attempted by the therapist. An emotional outburst of some length of severity occurred, but he questioned whether this was abreaction in the analytic sense. He further proposed that this therapy might be termed “relationship therapy,” but he was aware that this designation does little to define any unique term of treatment. Significant from the standpoint of psychotherapy with the retarded is a concluding comment from the author that . . there was the nearly complete absence in the entire therapy series of interpretations, clarifications of feelings and other intellectualized verbal exchanges. . .” A completely different picture involving individual therapy with a retardate manifesting behavior problems has been presented both by Friedman (1961) and Dichter (1962). I n Friedman’s study, the patient, who scored various IQs from a low of 51 to a high of 72, was rated as “incorrigible” by the staff of the institution. Initially diagnosed as “disorder of personality due to epidemic encephalitis,” this diagnosis was subsequently revised to read “psychopathic personality with sexual deviations, compulsive type, possibly associated with organic encephalopathy.” A very permissive atmosphere created by the therapist for the first 6 months resulted in improved behavior and courtesy toward the therapist. During the second 6 months, the patient’s behavior continued to improve, but the therapist became the object of extreme hostility and

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aggression. Later, the patient became more friendly and open, and therefore quite amenable to counseling. His performance outside the therapy room likewise showed remarkable improvement. A period of visits to his home followed, and the boy gradually adjusted to his family. Both IQ tests and projective tests confirmed the progress made. The concluding period of therapy showed continuing remarkable improvement which resulted in the patient finally being placed in the community. The author concluded that “contrary to other reports in the literature, prognosis can be favorable” for such defective delinquents. The implications are that institutions should make use of psychotherapy for borderline or mildly retarded cases and that it is important to continue extensive counseling after release. In Dichter’s account, a 10-year-old with an IQ of 72 was referred for psychotherapy because of emotional difficulties. Dichter’s findings parallel those of Friedman, beginning with the highly permissive play therapy sessions for the first 6 months and followed by more intensive interview therapy later on, with resultant improvement in self-esteem, communication skills, and behavior. The cooperation of the dassroom teacher contributed to the child’s progress, but his parents were involved only in a limited way. The author felt that the goals of therapy with a retarded child should be a more adequate perception of reality and a “safer environment” resulting from the child’s identification with the therapist. Success was achieved by White (1959) with a 4-year-old retarded child by involving the parents in therapy. Observations of the child in play sessions seemed to indicate that the child was really slightly retarded and that his relationship with his mother added to his difficulties in realizing his potential. A case worker then began seeing the mother, utilizing the psychologist’s observations in her work. At the same time, the father joined a parent group; although he seemed rather well adjusted to the fact of having a retarded child, the group experience was, nevertheless, profitable for him. The mother also joined the group and gained clearer recognition of her problems as a result. This coordinated treatment plan benefited the whole family-the child, through being able to function more comfortably at his own pace resulting from the greater understanding of his mother; the mother, through the clarification of her problems and a more realistic evaluation of them; and the father, through his assuming a more helpful and supportive family role. The group therapy given was act,ually a compromise between actual therapy and educational lectures with the limited goals of helping the parents to gain understanding about their own feelings in being parents of retarded children. There were at most 10 members and they met

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1 G hours for 10-15 weekly sessions. T h e mother joined a different type of group which was designed to discuss more individual problems and within which she expressed herself openly. By providing this “breadth of service” along with the diagnostic and individual therapy of the child, a form of treatment was evolved which took cognizance of the importance of the family’s role in the child’s adjustment. An illustration of a technique useful in conjunction with more intensive, therapeutic procedures is that of doll play, described by Mann (1957) as ideal for children because of its “third person” approach. Doll play is defined as “a technique of inducing modifications in behavior through their rehearsal in doll play.” The patient stages a drama in which his problems are said to be those of the doll surrogate. He is then persuaded to modify the doll’s behavior in order to satisfactorily solve his problem. The author felt that this technique might induce modifications of behavior where attempts at direct persuasion fail, since it is suitable for children who, because of emotional resistance or physical handicaps, are unable to benefit from standard therapeutic procedures. He was aware, however, that this is primarily a “symptomatic therapy” which will motivate the child but not let him resolve his problems as he might in a more dynamic, insightful approach. All of the studies reviewed thus far seem to bear out the trend of securing modifications in behavior through the use of some form of play therapy. A book which recognizes parental involvement and which attempts to help them in their understanding of the goals of play in the retardate’s development is Play Activities for the Retarded Child by Carlson and Ginglend (1961). As the title implies, play activities are outlined which will aid the retarded child in growing and learning. The importance of play for the retarded child in the areas of mental health, physical development, language development, and intellectual development is stressed. The remaining studies of individual psychotherapy with the retarded have been grouped together because of their emphases on learning or teaching “correct” behavioral responses. Several investigators have dwelt u a n the reeducation of the retardate to assist him in realizing his potential and to aid him in functioning more appropriately. Kaliski (1955) declared that the approach of the educational therapist is therapeutic in that he must set the stage for learning and growth. T h e task is one of reconstructing fundamentals of learning in dealing with perceptual disturbances, disorders in conceptualization, and behavioral difficulties in brain-damaged children. T h e author offered some techniques for the remedial work in the area of perceptual disturbances, as well as specific teaching methods. Emphasis was placed on a consideration


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of the “total child” within the framework of his medical and family history, and treating and teaching him on an individual basis, with the group serving as a background for socialized experiences. A stress, too, was placed upon properly motivating the child by creating incentives and reducing undesirable stimuli. Whatever the method, however, the author felt that it is ultimately the therapist-his manner, approach, and resourcefulness-who will influence the outcome of the therapy. Thorne (1960), like Kaliski, acknowledged that the functional intelligence of the mentally retarded might be greatly improved if the retardate were to be “taught” properly appropriate responses and if attention were to be paid to his individual needs, T h e procedure recommended was that of tutorial education and counseling, with the stress placed on learning by rote memory. Since the retardate cannot be expected to “think it out for himself,” teaching must create “conditions conducive to learning” (i.e., motivation, as in Kaliski). A friendly, accepting, tolerant, and supportive teacher-counselor illustrates that type of favorable atmosphere. The author believed that praise should be dispensed profusely, whether earned or not, in terms of normal standards. Drills, long practice periods, and “overlearning” are all part of the program in teaching the retarded to acquire high social skills and to cope successfully with frustration, hostility, and aggression. One aspect of this study which should be underlined is that the tutorial relationship is one of directiveness, stressing the authoritarian, superior role of the tutor. The patient, it is hoped, will recognize his self-inadequacies, accept the authority, and seek assistance from “those who know more.” Vail (1956), to be discussed later in this section, also made the point that the retardate is bound to be dependent on society and must learn to accept this role. The third illustration of an educational form of therapy was that proffered by Knight, Ludwig, Strazzulla, and Pope (1957). The case of a child who presented problems of retardation and hyperactivity was given to depict the manner in which such varied therapies as occupational, music, speech, and remedial reading therapy are cojointly utilized by the staff at the Solomon Clinic for the Rehabilitation of Retarded Children in Brooklyn, New York. The patient-subject was a boy of 11, functioning at about the 8-year level, who entered the rehabilitation program. At the same time, his parents were enrolled in a guidance program at the same clinic. The goals of the varied therapies were then presented, and they may be summarized as follows: Occupational Therapy: (1) to translate theoretical estimates of the child‘s potential into an evaluation of his ability to perform specific

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activities; (2) to evaluate sensory and motor deficits; and (3) to develop training techniques for circumventing those deficits that exist. Music Therapy: (1) to strengthen voluntary inhibition of motor acts; and (2) to offer the child a series of successful experiences. Speech Therapy: (1) to determine the child’s level of communication; and (2) to help the child to develop to his maximum language potential by exploring in detail his immediate environment, by listening to and analyzing noises and sounds and words, and by helping him to communicate with others about himself through the use of gestures, pictures, sounds, speech, etc. Gains in the last area were followed by a remedial reading program. T h e learning experiences in each of these areas was carefully detailed. Basic to this entire program was the joint cooperation of both the school and the family. T h e findings indicated that the boy was educable and capable of acquiring vital school skills and remaining in the community. T h e authors defined their technique as: “1. A specific analysis of the areas of disability. 2. An integrated, coordinated program with the direction of each lesson clearly indicated and routed toward the therapeutic goal. 3. The development of one concept at a time, explored through as many different avenues as possible. 4. The provision for a successful experience a t each level, which can be evaluated as such by the child. 5. The emphasis on positive, experiential training in the formation of constructive work habits.” The implications to be drawn from this study are that a rehabilitation program of this sort might be instituted in our institutions, the private schools and the public-school special classes. An opportunity to demonstrate on a large scale the feasibility of such a program would clearly present more solid evidence for its effectiveness than this isolated study. Schneider and Vallon (1955) feLt that a program of speech therapy could be integrated into almost any educational training program for moderately and severely retarded children. Working with mentally retarded children who exhibited language difficulties, they obtained “gains” in the children’s ability to communicate. MacMillan (1961), using Pavlovian concepts, evolved a type of conditioning therapy. He presented the case study of a child who had delayed development when brought for therapy at the age of 2%. T h e clinical diagnosis was possible retardation and emotional disturbance. The parents were maladjusted, and the child had early feeding problems-factors which probably prevented the child’s normal development in the area of emotional relationships, especially with his mother. It was felt that the lack of stimulation accounted for his retarded


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development. The hypothesis, based upon Pavlovian concepts, held that “unresponsiveness was the expression of a negatively induced, cortical inhibitory state, due to the unlimited nature of the cautionary component of the subcortically located defensive reflex.” Based on this premise, the therapeutic program was designed to expose the child to additional stimulation, which, hopefully, would lead to the development of normal, investigatory behavior and to the disappearance of exaggerated fears. Specific symptoms were not treated; the therapeutic program consisted, rather, of an initial discussion with the parents, play therapy with the child, and counseling interviews with the mother. Results of less than a year of therapy, plus 22 months during which the mother telephoned the clinic five times, showed the boy to be no longer unresponsive, no longer engaging in repetitive play, no longer afraid of new people and new situations or of making social and play contacts, and no longer unable to speak. His toilet training and his self-feeding skill, as well as other habits, were almost normal, including his intellectual level of functioning. Such astounding results are naturally suspicious and lead this reviewer to the belief that the child may have been incorrectly diagnosed initially and that this may be a case of pseudoretardation. Also, Pavlov’s basic assumption, that conditioning reflects underlying brain processes, cannot be accepted without question. None of the preceding studies have dealt specifically with the problems inherent in dealing with an institutionalized child. Copeland (1962) wrote of the “devastating effects” of institutionalization, owing to the child‘s divorce from his family and the community, but not necessarily owing to the merits of the institution. He cautions us, too, not to fall into the “generalization trap” in referring to retardates. The negative influence of regimentation on communication must be appreciated so that stimulation to verbalize is part of the therapeutic procedure. T h e need to help the retardate to develop behavior which is appropriate to the community to which he may return-not to the environment in which he may exist-was the battle cry of this author. Three remaining studies which, while perhaps under the general heading of educational therapy, emphasize the complications resulting from institutionalization are those of Heiser (1954), Gunzberg (1957), and Vail (1956). Heiser reported on the progress of 14 children involved in a program of individual therapy at the Training School in Vineland, New Jersey. The children were selected based upon their need for therapy, their prospects of improvement, their etiology, and their parents’ ability to pay a special additional fee. Of the three groups of familial, organic, and

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psychogenic children in the school, the therapy cases included 1 familial, 6 organic, and 7 psychogenic. Findings showed that at the end of 1 year, 11 showed improvement (1 familial, 4 organic, and 6 psychogenic) 4 of which showed IQ increases as well. Of the others, all 3 were diagnosed as having both encephalopathy and personality disorder. While these findings seemed quite clear, their interpretation was not. Why did some groups improve more readily than others? Is the improved IQ an accurate measurement? There were no controls and the selection of subjects was very imprecise. Nevertheless, several aspects of this study are noteworthy, among them the author’s evaluation of the institutional setting. Heiser felt that although the institution is a favorable setting for psychotherapy because of its control of the environment, several factors present problems: namely, (1) attitudes and expectations of parents; (2) attitudes and cooperation of cottage parents; (3) institutional pattern or hierarchy of authority and goals; and (4) the status of social case work. It was also reported that thus far 1 familial and 1 psychogenic case have been returned home with considerable improvement shown, 2 others have gone home slightly improved, and 9 of the remaining 10 have shown significant improvement. T h e author believed that individual psychotherapy is thus of great benefit in an institution, despite several problems which have yet to be solved. Gunzburg (1957) likewise stressed the ability to live in the community. “The observation that defectives are capable of earning living wages . . . and can work satisfactorily alongside the general working public, as well as the realization that they can survive socially with a little s u p portive help” has changed the concept of the institution from a custodial place to one that has an active treatment program comprising both vocational guidance and therapy aimed at personality adjustment. A training program such as this was reported as existing in Birmingham, England. There, a training program existed alongside an educational program. Occupational training, psychological therapy, and counseling constituted the general procedure. What is significant is that although achievement is important, stress was placed upon ability to live in the community. T h e course of treatment showed repeatedly that “intellectual factors may complicate the problem of the defective, but that the personality factors determine his fate.” Closely allied to the two preceding studies in their emphasis on environmental manipulation and their goals of successful community adjustment by the retardate was Vail’s investigation (1956). H e reported on therapy performed with institutionalized retardates which utilized “milieu therapy”-“treatment by the environment, by benevolent manip-


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ulation and control of the environment.” The team approach utilized the services of the physician, the psychologist, the social worker, the industrial therapist, the recreational aides, and the cottage charge attendants. The philosophy of treatment was “based on the premise that the uncured mental defective is bound to be dependent upon society as we know it and that he must learn to accept this role.” The special problems of reaching the retardate owing to his limited verbalization means that the therapist must use other, less sophisticated therapeutic tools. Milieu therapy was thus seen as important for effecting real results in improvement of attitudes, behavior, and performance of patients. The essence of this program was summarized as consisting of “sincere interest in the individual.” C. Group Applications

The bulk of the literature in psychotherapy with the mentally retarded deals with group therapy, doubtless because of many retardates’ institutionalization and consequent forced group living as well as because of the shortage of funds and personnel in these institutions (Sternlicht & Wanderer, 1963a). Toys and play material are used extensively in the diagnosis and treatment of retardates. Ginott (1960) presented a rationale for the selection of toys in play therapy, emphasizing that a treatment t,oy should “. . . facilitate the establishment of contact with the child; evoke and encourage catharsis; aid in developing insight; furnish opportunities for rea1it.y testing; and provide media for sublimation.” T h e author stated that an appropriate toy should make it easier for the therapist to understand the meaning of the child’s play, so that it becomes his obligation to provide materials which will “elicit acting out related to the child’s fundamental problems,” and avoid those that evoke “diffuse hyperactivity.” The toy that provides the child with material involving exploration of himself and others is highly desirable since it is felt that play materials should allow symbolic expression of the child‘s needs. That therapy not based upon toys but rather upon unstructured material might better meet the needs of certain mentally retarded children was the philosophy of Leland and Smith (1962). The authors reported several types of play therapy they had developed for children who feel a contradiction between the hospital as a therapeutic community and the hospital as a verification of their rejection by their families. One example cited was “U-UPlay Therapy”-a therapy involving materials which could be developed into certain reality objects with the help of the child’s imagination. The therapist’s role was to allow completely free expression of the child‘s feelings and desires in play.

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Three primary therapy goals were described for the emotionally disturbed, brain-damaged, and/or retarded child: (1) recognition of self; (2) understanding that impulses can be controlled; and (3) learning to live within social boundaries. Basically, the “reconditioning” of former behavior, or “rehabilitation,” was the goal for all patients, with conditioning expected to occur by selective reinforcement. T h e therapist’s interaction was thought to be along the lines of cognitive stimulation, reward, and avoidance of reward (punishment). Specific needs of many institutionalized, retarded children were considered to be best served by this type of unstructured situation, with the therapist’s “intrusion or lack of intrusion” into the patient’s play activities seen as the key to progress during the therapy session. T h e authors were actually not in disagreement with the use of toys for therapy since they prefaced . whether or not it intheir study with the comment that therapy volves toys, should be dictated by the specific needs of the child. .” An illustration of precisely this need for individualizing therapeutic procedures was offered in the investigation by Chess (1962). After first being classified psychiatrically, 37 children were chosen for a program of experimental group psychotherapy. All of these mentally retarded youngsters manifested varying behavior disorders. Nineteen children (ages 4-16) who received six or more sessions were reported on. Each child’s behavior was observed and described, after which a n individualized therapeutic plan was devised, taking into account the diagnosis, the child’s mental age, his attention span, and his ideational interests. T h e child’s intellectual level generally determined whether a conceptual level of communication was possible o r whether conditioning, or new, appropriate forms of behavior, or relationship therapy was preferable. T h e author felt that “some success in at least alleviating the anxiety and fear may be possible with any child, no matter how limited his intelligence, and that psychotherapy could lead to the inclusion of a defective child i n some facsimile of normal family life where it had heretofore seemed impossible.” T h e author thus acknowledged the benefits of therapy for all retarded children, stressing the need to individualize the goals and cautioning that therapy, except with pseudoretardates, will not eliminate functioning on a retarded level. Most of the investigations of group psychotherapy with retardates can be subsumed under two broad major orientations, either primarily directive or primarily nondirective. Such a classification is not without its problems. T h e difficulties inherent in categorizing a study as either directive or nondirective (where the investigator either omits mention of this aspect or else only vaguely hints at it) can be demonstrated by a study by

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hlcDermott (1954), whose emphasis was actually on the value of art therapy for the severely handicapped. T h e author, after discussing the advantages of art therapy (i.e., its not being limited by verbal inadequacies) and its forms (diagnostic, analytic, self-expressive, and all of these), then discussed the content of a r t as “directive,” although he was aware of the ostensible freedom in the method. Art was viewed as “creating, but with guidance and direction.” Thus, although “the essence of this therapy is permissiveness, i t is . . . directive when it comes to the what and the when.” Using this study as a guide, especially for classification of the creative therapies, art, music, dance, and drama will be considered directive when instruction or training is involved and nondirective when completely free expression or just listening or viewing is involved. For further clarity and ease of reference, the studies in this section also will be dichotomized into those that deal with institutionalized patients and those concerned with noninstitutionalized ones. At the conclusion of the review of the works in this sphere, a hypothesis regarding those conditions necessary for a favorable outcome in group therapy with the mentally retarded, which has been formulated by this reviewer, will be proposed. Neither suspense nor dramatic effect has been a motive for the presentation of this theoretical view at the close of this section. Rather, it is felt that an objective presentation should not prejudice the reader at the outset with subjective interpretation. Furthermore, inductive reasoning on the part of the reader is considered a task required of him, just as it is the task of the reviewer to bind together the data as a cohesive unit, even if by so doing he may occasionally find himsellf a subject of controversy. 1. INSTITUTIONAL GROUPTHERAPY

a. Directive Procedures. Appel and Martin (1957), Fine and Dawson (1964), and Kaufman (1963) all offered reports on group therapy where the focus was upon the preparation of retardates for return to the community. Appel and Martin (1957), aware of the need for a program to help retardates adjust to a noninstitutional environment, reported on a democratic discussion and experience group. T h e authors felt that the demands and expectations of a normal community presented one of the most serious obstacles to the retarded, and that, within the framework of the institution modes of behavior, social attitudes and beliefs could be modified. An important implication of this study is its application of criteria, or “guiding principles,” in therapy of this nature. These requisites are

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provision for: ( 1 ) a fertile democratic atmosphere; (2)small, near normal community composition of group; (3) study and experience to be drawn from real and potential areas of environmental conflict; (4) adequate time for the absorption and digestion of group conclusions; and (5) supplementation or group discussion by as many different pertinent sense experiences as possible. The authors reported their attempt to see the groups twice weekly. The beginning Group I was guided toward the stimulation of “thinking and action along the lines of self-orientation and improvement within the confines of the institution proper.” Group 11 (mainly graduates from I) encompassed the transitional state between residence in the institution to ultimate release from the institution, while Group I11 (mainly graduates from I and 11) explored the “complexities of living and working as a productive and contributing member of the noninstitutional community.” Patients who had “graduated” and were living in the community reported on the usefulness of these group experiences to them. A concomitant result was the better understanding that had developed between the institutional staff and the patients. The authors felt that the participants developed more self-confidence, poise, and self-esteem. T h e provision for emotional outlets enabled the patients to develop more realistic modes of social behavior. In conclusion, the authors reiterated their belief that this type of program is valid and essential in alleviating one of the institutionalized retarded child’s most serious problems. Fine and Dawson (1964) reported on essentially the same type of therapy. In an attempt to meet the problem of rehabilitation of behaviorally disturbed, hyperactive retardates, so as to enable them to return to the community, a comprehensive patient-care and psychiatric treatment program had been instituted. The subjects of this study were 15 30-year-old institutionalized retarded girls (IQs of 50 or greater) evidencing no severe physical or psychological handicaps that would prevent a return to the community. T h e intention was to provide an “open door environment,” an intensive program embracing as many practical experiences as possible (including school, recreation, and socialization aspects) as well as formal psychiatric treatment programs. T h e patients were divided into groups for 1-hour sessions of group therapy weekly. The results of the program indicated that considerably more patients were able to leave the hospital than had been the case without the program. A social worker stated that this was the result of the “richer staffing, specific planning and program organization, and a special selection of patients” as well as of cooperation between the hospital and the community. The utilization of community agencies


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would seem to be an important factor in facilitating the retardate’s adjustment to the outside community. Kaufman (1963) described the use of group psychotherapy to prepare long-term patients for their return to the community through the development of “social and emotional attitudes considered necessary for successful community placement.” Eight male patients, aged 18-25, with relatively high WAIS IQ scores (61-77) and with n o gross neurological involvement or physical defects, all of whom were candidates for community placement, were interested i n meeting to discuss their problems. They met once a week for a period of 1 year. Chaotic initial sessions led the therapist to adopt a more structured approach. Responding to another need, that of the patient’s minimal contact with the world outside the institution, the therapist supplemented these sessions with trips to the community twice a month. During these trips the patients became acquainted with situations similar to those they would encounter after their discharge from the institution, such as shopping, eating a t restaurants, riding buses, etc. T h e author reported that he was able to identify four aspects of the group process: namely, “catharsis, transference, new impetus to learning, and social pressure of the group toward conformity.” After 1 year, the changes appeared to be mainly i n the direction of increased socialization. Six of the eight patients had received permanent discharges from the institution and had been placed in the community. Since in most cases adjustment to the institution is the more prevalent situation, several experimentally oriented studies reported on the outcome of group therapy taking place there. T h e goals were different, and usually the IQ range was lower. An author expressing the problems inherent in therapy with retardates for whom release from the institution is not possible was de Palma (1956). T h e author felt that involuntarily institutionalized patients present special problems to the psychotherapist from the beginning. T h e restrictions and coercions of institutional life, which permeate the patient’s daily life, would seem to denigrate psychotherapy from the outset. T h e contradiction is evidenced in the therapeutic procedure itself, since permissive therapy seems to make the patient more difficult to control outside of the therapy sessions, resulting in the patient’s self-indulgence rather than his self-denial. T h e verbally oriented sessions reported by the author covered areas such as habit training, occupational adjustment,, domestic relations, budgeting, sanitation, sexual education, religion, moral habits, emotional stability and maturity, temper tantrums, quarrels, impulsivity, anger, and fears, many of which often arise out of actual behavior difficulties. Since the goal of release is not available to most of these patients,

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however, the author felt that psychotherapy “eventually reaches a stalemate.” Surprising understanding on a verbal level was evidenced with the groups studied, which included imbeciles and low-grade morons. Five groups were reported on, with eight in a group; 141h was the average CA of the one adolescent group, 22 the average CA of the four adult groups. Twenty sessions of 45 minutes each had been the extent of the treatment at the time of the report, and these revealed to the investigator that some success can be achieved, as indicated by later work histories, popularity group therapy, and self-confidence. These measurements, however, are imprecise for evaluation. T h e author was unconcerned with the success or failure concept per se, but rather was aiming toward successful integration of the institution’s facilities with the amelioration of the patient as well as with corresponding improvement in outpatient facilities and education of the outside community. The demands made by the institutional environment were demonstrated further in a study by Dentler and Mackler (1961), whose purported therapeutic aim was socialization, but whose goal was actually conformity. The authors reported on the manner in which aides in a state school socialized newly arrived children toward the adoption of institutionally acceptable patterns of behavior during the first 2 months after they entered the school. Socialization was defined as “the process by which the children are trained toward compliance with the demands made by agents in a particular environment.” Twenty-nine boys, ages 6-12 with a mean IQ of 56, and aides in one cottage were observed all day for 3 weeks. In addition to these observations, sociometric tests which they had devised were employed. T h e organizational character of the school was described in detail as well as the routines to which the subjects of the study were exposed. There also was a description of how the aides conducted socialization, mainly during the first 3-month orientation when much time was unoccupied for the children. Socializing their charges toward increased control, the aides used the techniques of deprivation and seclusion and occasional placement in the psychiatric unit, as well as physical directives. Some aides used these methods or others including delegating authority, showing physical affection and reward, and controlling by use of drugs to obtain the desired results. The severe initial control over the interpersonal relations of the child broke down the social responses he brought with him, and he was “obliged to accept his peer as well as adult relations on terms specified completely by the institution.” The authors felt that the system succeeded in establishing basic routines and maintaining them indefinitely. The end product was seen ideally as a “quiet, well-mannered, even sub-


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dued young adult, demonstrably independent and able to earn a living.” They felt that although the institution could attain the goal of efficient management and rehabilitation toward limited participation, the goal of maximum fulfillment of individual potentialities could be realized in this manner and under these conditions. Heller (1955), in attempting to secure environmental adaptation of the 20 female patients of his study, did not, however, aim at submissiveness. Rather, the group psychotherapy program started a t the hospital 2 years previously was designed to help the patients regain self-confidence and adapt socially, in some cases for community placement. All of the subjects were retarded, and their ages ranged from 15 to 55. T h e 30 l-hour sessions over a period of 10 months included drawing and painting with colored crayons, story telling by the patients and by the therapist, discussions of personal and general problems, individual and community singing, recitation of poems, and the playing of parlor games. As can be observed, the variety of techniques utilized exposed the subjects to many therapies, the effects of which’were not specified. In a second period, a male group was added, with the female group meeting for 14 sessions, the male group for 16. Simple questions were asked in the second period to ascertain what degree of social adjustments and selfsufficiency in employment would be possible if the patients were released. T h e males appeared to be more interested in matters of life in general, while the females were more concerned with listening to stones. Results in terms of alertness, attention, attitudes, fluency of expression, interest in the subjects, judgment, knowledge, memory, sense of humor, and understanding were good in both groups, which led the author to conclude that “group therapy with mental defectives is useful.” Besides giving the therapist a very good opportunity to observe, therapy increased, in a limited number of patients, their adaptive ability and trained discipline and patience. He concluded by suggesting that group psychotherapy be adopted as a regular feature in any advanced institution for the mental defective. Astrachan (1955) and Wilcox and Guthrie (1957), working with female retardates and using a verbal approach, had successful experiences in group psychotherapy. An important aspect of both these studies is their emphasis on proper grouping. Astrachan experimented with different kinds of groups until she found one suitable for therapy. Wilcox and Guthrie found that group heterogeneity is essential to therapeutic progress. T he mixed group, containing passive and aggressive subjects, yielded favorable results for therapy. Astrachan (1955) found interview or discussion group psychotherapy to be useful in the habilitation of retarded adolescents and young adults.

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Her group, which was an open one, consisted of eight patients who manifested mixed disorders (schizoids, depressives, paranoids) and whose mean CA was 19 and mean IQ 64. Membership was voluntary, and the group met for 1 hour, twice a week, in a program which continued for 21/2 years. In the early sessions there were few interactions among the group members, and the content was mostly criticism of the hospital personnel and topics related to food and clothing. The goals and problems of these mentally retarded patients had to be identified repeatedly. Thus, although the author hoped to be completely passive, she had to intervene directly on many occasions, which accounts for this study’s appearance under “directive” therapy. It was mentioned that the therapist had to direct the patients’ attention to their interpersonal relations to eventually become a “group” form of therapy, in the true sense of that term. The results showed that this therapy was especially beneficial for those presenting problems associated with depression, passivity, and mild paranoid trends. The group experience also facilitated the recognition of the dependency needs which play an important role in the personalities of many institutionalized mental retardates. I n the Wilcox and Guthrie study (1957), 97 female retardates were divided into three groups, one aggressive, one passive, and one mixed group. As previously indicated, the mixed group proved amenable to therapy. Four therapists saw the patients in their groups three times a week for 1 hour, for a total of 25 sessions. T h e goals of therapy were (a) to reduce the suspiciousness the girls felt toward outsiders, (b) to release aggressions, (c) to encourage feelings of self-confidence and selfworth, and (d) to develop in the girls a feeling of responsibility for their actions. If they could progress through these four stages, it was felt that they then would develop an increased frustration tolerance, which in turn would permit them to become more socially competent. The girls were encouraged to share their misgivings and fears and to ventilate their feelings of insecurity, inferiority, and hostility. The therapist offered reassurance, clarification of feelings, and interpretation. Through the group discussions, the therapist tried to help the girls develop more mature ways of meeting their personal needs. Perhaps most important for the therapeutic procedure was the girls’ feeling of acceptance as worthwhile individuals. At the beginning of therapy, the subjects showed little understanding of their problems and little ability to deal with them, Their IQs ranged from 53 to 90, which suggests that overly limited intellectual functioning was not the reason for their poor response. T h e lack of progress seemed to stem from the nondirective approach employed. The therapists found that when the therapy became more directive, the sessions became


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more productive. The therapists’ role included taking the lead in bringing up topics for discussion, encouraging general participation, and holding the group to a topic until the members seemed “talked out.” The girls visibly welcomed the therapists’ leadership. I t was thus concluded by the investigators that a therapist who contemplates work with a group of retardates be prepared to take the responsibility of leadership of the group until that time when some of the group can assume this responsibility. A rating form divided into the categories of (1) care of self and social responsibility, (2) interpersonal relations, (3) self-control, and (4) work and recreation indicated that the experimental group showed improvement and led the authors to conclude that primarily verbal, directive therapy is effective in producing change in groups of institutionalized mental retardates. Utilizing verbal procedures, albeit under different conditions, the following five investigations concurred in offering, in effect, a rationale for the use of directive group therapy with institutionalized retardates. Kaldeck (1958) reported on a group psychotherapy program which involved 104 patients, in groups 10-14 each, whose CAs were between 1 7 4 0 and whose IQs were close to 50. Therapy was maintained over a period of 30 months. The author felt that most institutionalized retardates could function in the community if they had “appropriate and effective psychotherapy” to remedy their emotional difficulties. T h e group technique had to be modified by changing the therapist’s role from a passive and permissive figure to an active and supportive one. There was a lot of initial resentment, griping, and profanity. Although the therapist adopted a nonpunishing attitude he left no doubt that certain kinds of behavior were unacceptable. Thus, the therapeutic climate was one in which the patients were not reprimanded, but rather encouraged and supported (whenever socially acceptable behavior was exhibited). The program attempted to relieve the anxiety, withdrawal, and hostility of the patients through open group discussion. T h e results were quite encouraging, in that the retardates’ tensions were alleviated and their interpersonal relationships were improved. In the study by Snyder and Sechrest (1959), the role of the therapist was that of a guiding, manipulating leader who interacted minimally, but who did not hesitate to structure and organize when necessary, at times even instructing in a truly didactic fashion. The experimental design consisted of having three homogeneous groups, one given group therapy, one meeting on the same schedule as the therapy group but. given no therapy (placebo), and one a notreatment, control group. T h e groups, each consisting of 16 male re-

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tardates, mean CA of 19, mean IQ of 62, met once weekly for 1-hour sessions for a period of 13 weeks. Each of the sessions began with a predetermined topic selected on the basis of its concrete applicability to the lives of the inmates. As is typical of such groups, the initial sessions were largely given over to testing limits and vilification of authorities. I n later sessions, all of which were planned, improvement was noted in at least the immediate institutional environment of the patients. T h e experimental group subjects received a significant increase in the number of positive comments on their housing reports and they made fewer appearances in behavior courts for more serious violations. Aside from this statistical evidence for the efficacy of group therapy, the observations of the therapist indicated that the group therapy members became freer in their relations with the clinical staff, sought guidance more readily, and disseminated the information gained in the therapy sessions to other inmates. Thus, the aim of improving the patients’ adjustment to the institutional program was realized. T h e favorable results were attributed to the procedure of utilizing concrete material in a permissive climate with a directive approach. T h e study specifically identifies group therapy as a desirable adjunct to a comprehensive treatment program for institutionalized retarded delinquents. Wanderer and Sternlicht (1964) presented exploratory findings on a procedure designed to assist the retardate in reaching acceptable behavior patterns. T h e retardate was viewed as having a limited repertoire of adaptive behavior as a result of his intellectual limitations, his institutionalization, or both. A modified, directive approach was suggested to avoid overdependency upon the therapist by the patient. This approach consisted of a discussion of behavioral alternatives in the therapeutic relationship. Since the retardate lacks the proper resources, i t was felt that a directive approach was necessary, but in offering the patient choices, the final decision became his own. This form of therapy will be discussed more fully under Novel Techniques (Section 11,D). Brevity characterizes Rudolf’s study (1955) in group therapy with mental defectives. Five female retardates, ages 20-34, with IQs of 59-79, met for 7 sessions, which were preceded by individual interviews. This very brief therapy was of “a simple nature and in simple language.” All five patients, who were diagnosed as displaying a n overemotional condition with overt aggression, were said to have shown progress, with encouraging results despite the brevity of the treatment. This is all the more impressive since the cases had been selected on the basis of their being the most difficult in the institution. Follow-up by the therapist showed that four of the five patients had been discharged and were living in the community.


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Tavris (1961), in reporting an experimental investigation of five male severely retarded patients (19 under 40), ages 19-29, stressed the need to view antisocial behavior as a symptom of deep personality disturbance, and, as such, an ineffective object of direct attack. The subjects of this experiment had moderate-to-severe speech impediments and manifested adjustment difficulties. They were selected on the basis of their need for therapy, their compatibility in the group, and their minimal functioning level. The therapy sessions took place once a week and continued for a period of several months. The therapist began by asking questions about past or projected socical events. He found that the patients‘ verbal insights had only limited value because of their inability to deal with language effectively. Attitudes, however, were transmitted quite readily on a nonlanguage basis, and it was this nonverbal communication that the author speculated may have produced the beneficial results. Also, this therapy necessarily encompassed a form of relationship therapy, in that the patients’ “. . . feeling tones (are) understood and accepted by the therapist.” The author saw the failings of the therapeutic process in the insufficient learnings (“. . . more specific bonds tying together cause and effect must be established”) and in the incompleteness of the procedure, which “should go much farther than verbal communication of certain principles in the therapy room” by including varied forms of experience. It was held that effective group therapy involves reeducation. T o properly evaluate the success of therapy, the author suggested as valid criteria the reduction of antisocial behavior, the reaching out to one‘s environment, and improved test performance. Utilizing these criteria, certain highly pragmatic tests to evaluate the progress of the group should be devised, coincidental with psychological tests, reports of hospital personnel, the patient’s ability to work and learn more effectively at the job and at school, and the therapist’s observations. In this limited study, it was found that not all members of the group could be reached with equal facility. One of the implications to be drawn from the preceding study is that therapists should be aware of the nonverbal communicative aspects of the therapeutic procedure. The remaining three studies utilized nonverbal procedures in the institutional setting. Sternlicht (1966), in working with delinquent, female adolescent retardates, found that when verbal methods were relied on, “. . . such difficulties were encountered that (he) could not effectively work with that group.” His study will be discussed fully under Novel Techniques in the next section. Sarbin (1945) reported his preliminary observations of the application

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of Moreno’s spontaneity training to approximately 14-22 boys and girls of ages 16-28 with IQs 57-84 at a state school in Illinois. This facility had previously sponsored a disciplinary regime which stifled spontaneity and expression. The author organized a group which met for the purpose of “taking roles,” e.g., psychodrama, as an attempt at social reeducation. From this limited experience (three times a week for 2 months), the author suggested that “morons can be stimulated to meet intelligently the social situations through the use of psychodrama and spontaneity training methods.” More dramatic results were obtained in stimulating brain-damaged patients through the use of music by Fields (1954). Twenty-eight severely disabled patients (CAs 15-52, IQs 70-1 10) participated in the 3-year study. Four of these are discussed, one a spastic quadriplegic with severe impairments of both lower and upper extremities, another a spastic quadriplegic with an IQ of 70, the third an athetoid quadriplegic with some spasticity, and the fourth a diffusely brain-damaged patient (caused by cerebral thrombosis). All had been terminated by other therapies on the assumption that maximum benefit had been achieved. T h e treatment was based on the theory that undamaged faculties can substitute for damaged ones with training. The author felt that the use of music therapy must be preceded by (1) knowledge of the pathology and prognosis for improvement of the patient; (2) knowledge of the components of music and ancillary disciplines that can be manipulated to meet specific problems; and (3) cooperation of a treatment team. The treatment itself helped to promote muscular activity and purposeful movement through participation with the therapist by the use of simple rhythm instruments and notes on a piano keyboard. Some psychological characteristics encountered were distractibility, disassociation, perseveration, and reversal field tendencies. Since the use of music therapy was limited to the observable and quantitatively measurable results, it could definitely be reported that the subjects were able to increase their capacity for purposeful movement. The author felt that the improved coordination of patients previously thought to have reached the “final plateaus of efficiency” suggests the value of music as an adjunct in the treatment for selected brain-damaged retarded patients in the area of coordination and motion. Perhaps the key word here is “selected.” The results of music therapy would appear to be highly dependent upon the appropriate screening of group members. Perhaps an analogy can be seen in the slogan of T h e New York Times, “All the news that’s fit to print,” where one doesn’t question so much the “all the news” but where one may quibble with the determination of what is “fit to print.”

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b. Nondirective Procedures. As mentioned previously, it often is difficult to precisely pinpoint a study as directive or nondirective; hence the use of the qualifying word “primarily.” This problem is especially apparent in music therapy, because so much is dependent upon the degree of guidance involved in this essentially self-expressive, creative therapeutic form. Jahnson (1959) offered valuable insights on the role and structure of music therapy. She characterized music as an excellent therapeutic tool because of its low failure potential, its variety in range (“from passive participation in music appreciation to the performance of music and to the creation of improvised or composed music”), its nondirective and directive aspects, (“breadth of structure . listening to music without motor activity . to music performance and composition”), its role-playing potential, its ability to combine with other therapeutic procedures, its disguisability, and its usefulness as a source of diagnostic information. The direct effects of music therapy were classified as emotional catharsis, ego growth, and superego growth. In providing catharsis, music therapy was seen as permitting socially acceptable expression of the “instinctual unlearned strivings for pleasure which are considered to constitute the Id.” Ego growth was achieved by developing skills “for traffic with the world of reality,” by, combined with dance, developing a body image, and by promoting realistic appraisal of one’s self and of others. The growth of superego or conscience was considered fostered by music therapy, wherein rules, controls, and standards were more readily accepted than in conflict-laden areas. Because music is less emotionally charged, an indirect effect of music therapy was seen as the retardate’s willingness to allow himself to be vulnerable, the ensuing success a “buffer (to) the threat of failure elsewhere.” Finally, another indirect effect was increased socialization and interpersonal contacts of formerly antisocial patients. Emphasis was placed on the therapeutic relationship itself, with the author maintaining that only with a therapist who understands the needs and conflicts of the child and who uses music for purposes of personality modification (which differentiates it from music education) can the desired results be attained. Murphy (1957; 1958), Joseph and Heimlich (1959), and Heimlich (1960), illustrated music therapy in a primarily nondirective setting. Murphy (1957) reported on a nondirective music therapy program using 64 subjects who were later divided into two groups (32 subjects in each) of low- and middle-grade male retardates, which included an evaluation of the results. The author was able to isolate subjects expressing rhythm with spontaneous rocking movements (“rockers”-average mental age 11

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months) and those responding to rhythm with a conventional clapping of hands (“clappers”-average mental age 3 years). T h e rockers represented a solitary, self-absorbed, infantile level of social-emotional development and a primitive gross motor maturational level, while the clappers represented an early childhood level of development. T h e implications were that the latter appeared to be capable of engaging in group activity and deriving benefit from a therapeutic procedure. A program aimed especially at low- and middle-grade institutionalized retardates incapable of participating in formal, organized activities was reported by Murphy (1958). About once in 4 weeks, two musicians performed for each cottage, this program consisting of popular songs, western songs, marches, familiar hymns, folk songs, and original songs, all of which were designed to stimulate group rhythmical expression. T h e results showed the program as apparently promoting relaxation as well as eliciting spontaneous participation. T h e author suggested that the reactions of the patients to the selections were dependent upon the interpretation of the musicians rather than upon the pattern of the selection itself, and that tonic effects might follow the stimulation induced by the music. As a large-scale therapeutic technique] the live music program was felt to be perhaps beneficial in promoting developmental learning in the social-emotional, motor, and language areas. Music therapy was considered, too, a partial solution to the problem of what to offer those retardates incapable of deriving benefit from participation in trainable classes and occupational-recreational group therapeutic activities. Joseph and Heimlich (1959) described a music therapy program with retarded children who are unable to relate satisfactorily to adults and to their peers, who are aggressive, and some of whom are unable to accept psychotherapy. Children were put into groups of three (preferably two withdrawn and one hyperactive) and met 30 minutes twice a week. T h e children enjoyed “direct, safe and constructive discharge of emotion through sound” as well as “actual tension and release involved in rhythmic activity plus the gratification of group activity.” Music gave the children the opportunity to relate to an adult and to their peers, and it also may have evoked memories of past experience. T h e rationale for the use of percussion instruments was given. After citing several case histories to demonstrate the therapeutic effects of therapy, the authors concluded that “music therapy as a specific psychotherapeutic discipline is effective as a n adjunct to other forms of treatment or as a substitute when others have failed.” Heimlich (1960) described the same program, emphasizing the use of music as a communicative tool especially with treatment-resistant chil-


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dren. Case histories were given of three types of children helped by music therapy: a timid, repressed girl; a hyperactive, anxious boy; and an overcontrolled, conforming boy. T w o studies conducted in institutions utilizing another nonverbal procedure (that of play therapy) with conflicting results, complete the review of nonverbal, directive procedures. Leland, Walker, and Taboada (1959) described a program of group therapy with eight boys ranging in age from 4 years and 9 months to 9 years and 6 months, with IQs 50-75. Four of the group demonstrated hostile and destructive behavior, while the remaining four exhibited passive and withdrawn behavioral sympt,omatology. After the first week, the entire group was seen together every day, for an approximate total of 90 hours of group play therapy for slightly more than a month. The boys were observed in free play by the therapist, who sometimes played with them or permitted them to use him as part of their free activities. As the therapy proceeded, a more directive posture on the part of the therapist was assumed with the consequence that additional play responses were more easily elicited. T h e subjects were then evaluated, and the results demonstrated better adjustment on the part of six of the group (four who were withdrawn and two who were aggressive), who no longer exhibited behavioral difficulties. The other two boys, however, were considered worse, manifesting even more hostile behavioral functioning. Although no major changes were noted in the boys’ level of social maturation, the authors felt that the therapeutic experience had activated some of their intellectual potential, potential which could not be tapped prior to the experiment,al program. I n the study by Subotnik and Callahan (1959), eight boys, 8-12 years old, who were considered unable for emotional reasons to participate constructively in the overall program of the school, were given 16 45-minute play therapy sessions twice a week. The boys had IQs ranging from 53 to 88. Tests were administered at 8-week intervals-at the beginning of the %week therapy period, at the end of the therapy, and after an 8-week follow-up period. The tests included such items as the Children’s Anxiety Pictures, the Auditory Memory Span for Digits, the Ratio of Digit Span to WISC Vocabulary, the Bender-Gestalt Test, the Draw-A-Person Test, and behavior ratings. The hypothesis that subjects would show greater improvement, as defined by the scoring and judgment procedures, after the therapy period than after the control period, and that these gains would be maintained or increased after the follow-up period, was not borne out. The authors saw a need to assess psychotherapy for “better theoretical formulation of the goals of psychotherapy,” as reflected in

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selection of subjects for treatment, more holistic methods of evaluation compatible with the complexities of personality, and more sophisticated expectations of change which would allow for individual variations. Of the following seven studies utilizing verbal, nondirective procedures, only the first two report success, Yonge and O’Connor (1954) actually hypothesized that no success would result in their therapy program, which consisted of group discussions with seven institutionalized male retardates, ages 16-20, IQs 52-77, who were considered to have severe behavior problems. The subjects were seen twice a week for a total of 32 sessions over a 6-month period. Control groups were also selected. This approach did not consider the need for treatment or the degree of potential rapport with the therapist, two procedures usually deemed necessary for favorable prognosis in psychotherapy. T h e group method, however, was thought to have distinct advantages. T h e nondirective approach was used, with the therapist assuming a permissive, though not a passive, attitude. Objective assessments of change were made by analyzing the sound recordings of the therapy sessions on the basis of a checklist of defined attitudes. The results, both in regard to attitude change and workshop performance, showed definite indications that the hypothesis was wrong and that the therapy was beneficial. A similar experimental procedure was reported by O’Connor and Yonge (1955) in an experiment which evaluated the effects of group psychotherapy on high-grade institutionalized retarded boys who were unable to hold jobs because of social maladjustment and emotional instability. Three groups, matched in intelligence, age, and behavior disorder, were selected. One was given workshop training plus group psychotherapy (two sessions a week for 6 months), the second was given just workshop training, and the third continued the normal hospital routine. The boys, whose ages were 16-21, earned IQs of 63-104 on the Matrices Test and 52-89 on the Wechsler Verbal Scale. A checklist and psychological test showed changes in the experimental group that did not often occur in the workshop or other control group. The improved verbal intelligence scores of the experimental group and the significant changes in workshop behavior and performance matched the changes in attitude observed in the therapy sessions. Probably the most important feature of the therapy was the suppression of hostile attacks on the therapist; they seemed to reflect a willingness to approach him, with the implication for support from him and a dawning realization that the therapist had support to give. Ringelheim and Polortsek (1955) discussed the group therapy project at Lincoln State School, which was designed to determine the value and desirability of such a project in the institutional routine. T h e meth-


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odology was eclectic and based on psychoanalytic and nondirective therapeutic principles together with counseling techniques. Seven male retardates, 16-38 years of age, with IQs 65-86, and diagnosed as having personality disorders with overt anxiety, were given 30 1-hour therapeutic sessions over a period of 7 months. The sessions fell into three divisions: (1) organizational (primarily concerning problems of a personal nature); (2) intermediate (personal problems with increased verbalization and group participation); and (3)integrative (common difficulties encountered in everyday institutional existence were discussed, with the therapist becoming an active participant). The experiment reached a point of diminishing returns with the patients, but the intent was to continue the project using scientific controls. The authors felt that the group revealed no self-reflective insight and little capacity to offer solutions or interpretations of a meaningful nature. Group therapy was viewed as an “outlet for the release of situational anxiety produced by institutional living,” which also offered “a social situation in which the inability to form adequate interpersonal relationships can be relieved.” Although the therapy program was not rated as successful, some growth did occur, in terms of a strengthening of group interrelationships. The group, in their discussion of institutional problems, apparently disassociated the therapists from their usual authority role. The therapists were used as both a sounding board for grievances and a source of information for the patient. Vail(l955) reported on a pilot study using group therapy with mentally retarded adolescent boys. A nondirective method was used in the 1-hour sessions which were held twice a week for 71/2 months. Four to 10 patients attended each session, with “bizarre and constantly changing patterns of attendance.” The subjects were 12-37 years old, had I@ of 35-72, and were basically unstable, aggressive, and disturbed. A follow-up 1 year after the termination of the therapy pointed to no fundamental effects on psychological structure or dynamics or emotional problems. The author believed that the nondirective therapeutic method is at fault because of the emphasis on verbal communication and insight. The author felt that disturbed retardates simply cannot work therapeutically without repeated gratifications of (oral) needs as they arise. The failure is felt to be related to “insufficient divergence from standard, classical nondirective techniques.” Specifically, this refers to insufficient control by the therapist of the group membership and composition, and inadequate attention to the oral needs of the patients. D’Angelo (I 962) likewise found no measurable differences between experimental and control groups who received a program of group

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therapy. T he experimental group, consisting of 26 retarded girls, was given therapy 1 hour a week for 6 months. T h e participants were rated before and after for changes in behavior and adjustment. Tests used included a self-concept scale (devised by the author), Barron’s Ego Strength Scale (modified), Inventory of Affective Tolerance, a teen-age opinion questionnaire (also devised by the author), an adjustment rating scale (designed specifically for this study), and a n equally specially drafted symptom rating scale. These tests’ results failed to reveal any changes in the participants’ adjustments, although it was noted that the experimental group evidenced greater realism, introspection, concern, and brooding. Thus, although the program did make for some improvement, the small margin of difference made it impossible to ascertain to what degree the results were fortuitous or the consequence of the therapy. Gorlow et al. (1963) presented a study designed to determine the changes in self-attitudes and behavior resulting from participation in group therapy. Forty-two females, 15-23 years of age, with IQs of 50-80, were divided into groups of 7 each and given 1 hour of therapy three times a week for 13 weeks. A control group of 37 others pursued normal, institutional routines. Ratings were made in terms of Wilcox’s Behavior Rating Scale and the Laurelton Self-Attitude Scale. T h e therapy procedure consisted of allowing the participants to express themselves freely, while enabling them to experience the interest and warmth of a generally permissive, accepting, encouraging adult. T h e goal of helping the patients develop more mature ways of coping with their problems was not realized, as test results showed no differences in the ratings of the experimental and control groups. Stubblebine (1957) reported on a study that employed group therapy with six patients to see if this type of treatment could draw the patients into a closer contact with their environment and counteract some of their feelings of resentment and depression (due to real or imagined social inadequacies). T h e sessions lasted for a period of 22 weeks, 1 hour each, twice weekly. T h e course of the therapy was described, with the results indicating no universal or common improvement in all of the patients during or after treatment. T h e author viewed intelligence just as Ringelheim and Polortsek did, as a factor in determining the outcome of therapy. T h e author felt that “the greater the patients with decreased intellect, changes can occur, but only over a longer period of time, and the changes will be less pronounced and dramatic.” Nondirectiveness by the therapist was suggested as the procedure of choice, with the therapist being permissive but not passive. The author suggested that group therapy is helpful in better socialization


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of the more intelligent patients who seem to profit from the therapeutic process. Time spent with the patients by sympathetic, noncritical, supportive adults constituted the keystone of the treatment program. T h e two concluding studies in this subsection focus on the problems presented by institutionalization as an obstacle to a successful therapeutic program. Stubblebine and Roadruck (1956) wrote of the creation of ‘‘a ward atmosphere” to enable the patients to make as adequate a social adjustment as possible, as determined by their intelligence, personality attributes, and degree of maturation. T h e study dealt with 65 13- to 20year-old boys, with IQs of 48-88, who exhibited unacceptable behavior. T h e problem was attacked by creating a “milieu conducive to emotional growth and using the lay staff of psychiatric technicians. T h e maturation of the patients was directly proportional to the earnestness and effectiveness with which the adults about them obtained some measure of personal insight .” T h e implication to be drawn from this study is that institutionalization itself is a variable which may account for the success or failure of a therapy program. Similarly, McKinney and Keele (1963), in their study demonstrating the significance of maternal deprivation (which is an institutional characteristic), implied that therapy done in an institutional setting works under greater handicaps, this deprivation being an important one. T o circumvent this shortcoming, surrogate mothers, chosen from the mildly retarded women and girls at the school, were assigned 2 boys each. T h e subjects of this study were 48 severely retarded boys, CAs 8-18, IQs of 30 or below, who were divided into experimental and control groups of 24 each. Both groups were treated exactly alike, with the exception of “mothering” (visiting at least 4 hours a day, playing, teaching new skills, expressing affection, caring for them). These procedures were performed under the supervision of a nurse. Results were measured in terms of a behavior list which included 80 variables. Eight factors were identified from these variables-purposefulness, lack of restraints, self- (bodily) stimulation, age, social interaction, neuromuscular control, and verbal and emotional maladjustment. Significant changes occurred in 4 of these. Purposefulness and verbal behavior increased, while asocial behavior and random activity decreased in the experimental group. Also, the retardates’ behavior became more goal-directed. T h e conclusion pointed u p the obvious benefit, to severely retarded children of emotional interaction with a mother surrogate. This factor, and others, perhaps explains partially the completely successful results reported in studies occurring in a noninstitutional setting. Certainly, there may be failures, and not all programs have been reported, but it would be a fairly safe assumption to say that the greater handicap

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of institutionalization may make for increased difficulties in the therapeutic relationship.

2. NONINSTITUTIONAL GROUP THERAPY a. Directive Procedures. The five studies to be placed at the begining of this section actually could be subsumed under nondirective therapy as well because of their special nature. Chess (1962) in her investigation based on 19 4- to 16-year-oldsubjects of varied levels of retardation, noted that goals, and consequently procedures, should be individualized. Her findings, mentioned at the beginning of this section, were significant in their stress on adjusting procedures in accordance with diagnostic findings. Michal-Smith, M. A. Gottesgen, and G. B. Gottesgen (1955) conducted an experiment consisting of two levels of therapy-motoric group therapy (a nonverbal, nondirective procedure) and oral language training (a verbal, directive approach). T h e authors felt that specialized group therapy is essential for aiding retardates in their adjustment to society. This program was designed to meet the needs of mental retardates, which are defined as: “1. Stimulization and socialization; 2. Development of ego strength; 3. Improvement of selfconcept; and 4. Integration of fantasy and orientation to reality.” T h e groups consisted of 6-10 retardates, 18-27 years old, and they met once a week for 2-hour periods, for a total of 30 sessions. The motoric group activity was broken down into three stages of transference development: (a) therapist-child identification relationship: (b) child-therapist-other child identification relationship; and (c) childother child-therapist identification relationship. The authors described their technique as “geared to the reintegration of the body self and social development.” The results of this type of therapy were seen as greater social development and better utilization of personal endowments toward dealing with social relationships, family situations, and the fact of retardation (with a more realistic appreciation of the inherent limitations). Hormuth (1955), like Chess and Michal-Smith et al., acknowledged the need for a variety of activities (and consequent variety of techniques), but he was more specific in locating the source of a good deal of the noninstitutionalized retardate’s problems-the community’s unconcern. To remedy this deficit, the author recommended a program such as the one at the Association for the Help of Retarded Children. The author contended that the retardate has so many unmet basic needs (e.g., socialization, vocational skills, companionship) that a therapy program must meet these before the therapy itself can proceed. Thus, he stated that a


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therapy program must, of necessity, be a school program, a training program, a recreation program, a work program, etc. Specifically, this paper described p&t of the Adult Social Activity Group Program which had been in operation for 4 years. Its purpose was to help the members make a better adjustment to community living by providing a setting in which there is a club meeting, a therapy program, and an activity program. The therapy consisted mainly of group discussions (“gripe sessions”) with topics ranging from problems with parents to feelings about their own limitations, dating, sex, and so forth. Group sessions were also held with the parents of each group to emancipate the retarded individuals from their parents’ overprotection. The author stressed that a therapy program without a framework within which other needs of an individual can be met has little or no meaning, and he felt that the manner in which AHRC used its therapy program had proven effective. A study similarly concerned with the rehabilitation of the mentally retarded, with the emphasis on social maturity and interpersonal relationships, but concerned, in this instance, with vocational interactions was that by McDaniel (1960). This study reported on the use of sociometric techniques to detect and alleviate problems in group relationships among a group of retarded 16-32 year olds with a mean IQ of 52. T h e sociometric test was administered, after which a therapeutic group was formed on the basis of the data obtained. The group was given two sessions of group therapy weekly, and at the end of 6 weeks a second test was administered. The therapeutic group w a s then enlarged. The results of the second test showed noticeable changes in some characteristics of the population in that socialization had sharply increased. It was concluded that this had resulted in an improvement and increase in the quality and quantity of interpersonal relationships. The author also concluded that some increase in group cohesion had taken place, as revealed by changes in the sociometric structure. Thus, the manipulation and reorganization of activities through sociometrics appears justified as a method of making group relationships more meaningful and beneficial in the vocational rehabilitation of mentally retarded young adults. In a similar vein, Gootzeit, Lombardo, and Milner (1960) defined their “situational therapy” as “a technique in which the social relationships and the physical environment are used to bring about a therapeutic effect. Diagnosis is made by observing the individual’s reactions to his physical environment, to his peers, to authority, to the job, and to himself. Therapy is effectedby manipulating the environment, or . . . the physical setting . . . within the social structure of the situation.” Real life situa-

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tions gave clues to the observer who noted such symptoms as hostility, aggression, episodes, daydreaming, etc. From the evidence accumulated, plans were made for manipulating the environment. T h e contacts with others gave many patients their first opportunity to express themselves, and thus to grow physically, emotionally, and socially. The procedure was viewed as essentially group therapy in which the patient participates without being aware that he is being treated. The individual was carefully observed, as evidenced by the case histories presented in this study. The authors concluded by saying that “Situational therapy should be explored by other facilities . . . as a psychosocial technique for the treatment of non-verbal, handicapped groups.” Of the remaining studies in grorip therapy, all of which employ nonverbal processes, a great emphasis was placed on communication and socialization. Music therapy, which has been used successfully in institutional studies, has been applied in clinics with equal success. Tyson (1957), Weigl (1959), and Alvin (1959) described experiments involving music therapy, the latter dealing with most severely retarded subjects. Tyson (1957) reported on a special project established to explore the role of music therapy in the rehabilitation of retarded children. T h e therapist worked with an average of 85 children seen individually, in pairs, or in groups, for 150 sessions during the course of a month. No t,otal number was mentioned, nor was IQ specified. T h e project set out to demonstrate to the clinic staff the different applications of music, with the result that music was then prescribed as part of the total therapy of the child. Music therapy was used to aid in diagnosis, provide successful experiences for the child, temper erratic behavior associated with hyperactivity, improve motor skills (especially helpful in relaxing or strengthening muscles of handicapped children), stimulate children to verbalize and communicate, and help them participate socially in a group. The diagnostic aspect consisted of the recording of the therapist’s observations of each child, with the findings subsequently used to facilitate or confirm the previous diagnosis or to suggest a new treatment approach. Regarding successful experiences, the music program was manyfaceted and flexible, so as to enable the child, in the course of a single session, to master some activity and achieve some feeling of satisfaction. Used to counteract hyperactivity, the music program required the child to inhibit random responses and to produce, instead, predetermined responses to stimuli created out of the structure of melodic themes and rhythmic patterns. Music precipitated motor response, which was utilized to lead a child into some planned activity, such as games involving manipulation of


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objects, or activities calling for regular rhythmic motions (clapping, skipping, jumping, conducting, walking, marching, and dancing), all of which were accentuated by the use of the drum. The speech therapist worked along with the music therapist, using music as a stimulus to help the children explore their environment and identify objects and activities. Songs and descriptive storytelling at the piano were used to elicit speech, especially familiar songs containing recurrent rhythmic, emotionally stimulating words. In the area of communication, it was found that music aided in transmitting concepts such as time, motion, numbers, and opposites. Finally, music therapy provided the ideal setting for the child to progress from awareness of other children to active social contact with them. I t was concluded that retardation is not a barrier to musical response, and, in view of its achievement of the objectives outlined above, it has a definite place in the treatment scheme for retarded children. Weigl (1959) cited the use of music as both a soothing and a stimulating tool and corroborated Tyson’s findings that the mentally retarded can benefit from its use. The author used the term “functional music” to describe the therapy, a term she defined as “music used not for any aesthetic value, but for its effectiveness in reaching practical, therapeutic goals outside of music itself.” The paper proceeded to describe the experiences in a structured situation of systematic group music classes, which consisted of 5-15 subjects whose IQs ranged from 40 to 75. The therapist played the piano and the assistant sang and encouraged the children to participate. Rhythmic movement was encouraged in clumsier children, while humming, choral speaking, or singing was encouraged in those with speech impediments. Aspects of the program that were highlighted were body coordination, stimulation of attention, and participation in rhythm band. Progress reports revealed that the child’s attitude toward his peers and toward adults was greatly improved: improvement was likewise noted in the child’s emotional and social level of adjustment and in his posture, muscular control, rhythmic coordination, and speech. Since music was considered one of the few areas in which achievement is attainable without intellectual requirement that is often beyond the reach of the retardate, the child’s participation in a music therapy program was seen as strengthening his feeling of security and self-respect. Alvin (1959) described an experiment aimed at reaching severely retarded children (IQs 22-50). The study was designed as an attempt “to reach the children’s consciousness . . . to observe and study the influence of live musical performance . . . to provoke some reaction . to awake a desire t o . . . participate . . . to make the children keep attentive

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. .. to develop sense perception . . . to establish communication.”

Twentyfour children, ages 7-16, were present at 34 live cello recitals (with accompanist). After each concert, the children were invited to make a sound themselves on the instrument. T h e length of the musical numbers was gradually extended. Concerts were given 4 weeks in March and April, with two more given in May. Simple, melodic, and rhythmic selections were played. The children responded to the tone color, the simple dance tunes, and the melodic pieces which contained repeated bass rhythm. The teachers observed each session, and felt, at the end of the series, that a definite group reaction had emerged, that social integration was gradually taking place, and that communication with each of the children had been established. The children were divided into an older group, a younger group, and a day-care group. Once communication had been established between the child and the performer, the retardate became integrated into the listening group. T h e author concluded that results had been achieved in terms of increased communication, sense perception and attention span, social integration, and physical, verbal, and emotional responses. Pilkey, Goldman, and Kleinman (1961) and Long (1959) employed dramatic techniques to arrive at (basically) the same goals as the preceding investigators. The study by Pilkey et al. attempted to alleviate the retardate’s basic difficulty in the area of interpersonal relations, so that he might become a happier, more useful, and productive individual. To accomplish this goal, the authors wished to ascertain if the empathic ability of retarded adolescents could be improved through the use of psychodrama. They also wished to determine what changes might occur in self-assessment following this therapy program. Sixteen subjects, 8 in the experimental group and 8 in rhe control group, aged 13-16, with IQs of 58-79, were employed in this study. T h e experimental group was given 1 hour of psychodrama training twice a week over a 4-week period. A situation to be role-played was set up, the children were assigned roles, and the situation was then acted out. A discussion period followed, after which the situation was reenacted, this time with an attempt to incorporate the material from the discussion. A rating scale was developed to determine the child’s empathic ability. The retardate was to rate himself and then predict the test-taking behavior of 5 other members o€ the group. Results showed a general tendency for the experimental group to predict more accurately five of the eight traits on the rating scale. Six weeks after training, their predic-


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tive ability showed an increase on all eight traits. Furthermore, the experimental group exhibited a greater change in self-rating on five of the traits. T h e authors felt that these findings somewhat supported the statement that empathic ability and self-assessment of the retarded adolescent can be improved. Long (1959) presented an exploratory study on the introduction of role-playing into the curriculum of an experimental day school for severely retarded children in Michigan. T h e aim was to develop spontaneity in the children and to develop another teaching technique or “effective channel of communication” for the training of severely retarded youngs ters. Five brain-damaged, Mongoloid children, ages 5-17, with IQs less than 50, attended 15 sessions. From this brief exposure, the author concluded that: (a) there was evidence that children need a certain degree of maturity to best profit from the program; (b) the participants seemed to enjoy the sessions and their teachers reported that a good deal of spontaneity was achieved; (c) the teachers could utilize it as a teaching technique, with a great deal of practice required for the severely retarded child; and (d) parents reported more favorable home behavior. T h e experiment was thus considered to have achieved its goals. Ricker (1963) reported a study utilizing audiovisual methods for the training of the mentally retarded. T h e project was an attempt to determine whether or not feedback of visual information to a client about his own behavior in selected situations can improve his emotional adjustment. T h e program had been conducted for 1 year, with the anticipation of continuing the research by replicating the findings several times. T h e experimental design was of extremely high quality and precision. T h e program had been refined in an effort to make the results as experimentally valid as possible. T h e findings u p to the time of the report indicated that the premise-that audiovisual aids in conjunction with group counseling will result in a n improvement in social skills and emotional maturity of the subjects-had been validated. This experiment will be more fully discussed under Novel Techniques (Section 11,D). b. Nondirective Procedures. Bevan (1960) and Scheidlinger, Eisenberg, King, and Ostrower (1962) represent the only reported group therapy investigations of a noninstitutionalized nature under this classification. Bevan (1960) cited clarification, or reflection of attitudes, as the key to the technique of nontlirective activity in the therapeutic approach to mental retardates. This technique involved the teacher’s “reflecting the statements and feeling tones (of the students) and refraining from making suggestions and interpretations, rhus allowing the reflections to be ‘pondered on’ to assure ‘better understanding by both of the feeling

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expressed‘, and i t also ‘gives the student the feeling that his teacher is really interested’.’’ In reflecting the attitudes of members of the class toward each other, a purpose was served-that of releasing emotions, lowering defenses, and permitting more realistic self-appreciation and self-understanding. The author felt that this approach fosters self-sufficiency, as contrasted, it is assumed by this reviewer, with the dependency inherent in a more directive approach. Two activity projects, the construction of a shooting gallery and the performance of a Christmas play, decided on by the pupils themselves, were described in terms of the problems involved and the gains to the pupils. T h e author stated that this activity program was most successful in changing behavior in social situations, but it did not improve academic work. He concluded that the process as a whole provides the child with a great opportunity to acquire insights needed to effect relearning and reexperiencing behavior patterns. It also helps focus attention on the pupil and his inner world. It should be noted that the author was speaking of a teacher-pupil relationship within a psychotherapeutic context. The implication of the therapeutic possibilities in the classroom situation are tremendous, but it is questioned whether this constitutes a true therapeutic relationship. Scheidlinger et al. (1962) employed activity group therapy with a 10year-old-boy with marked physical and emotional pathology for whom individual therapy proved unsuccessful. Activity therapy who used because it was felt that his basic pathology was closely related to problems of self-image (body ego) and to his limitations in the ability to develop any self-awareness. His IQ at the time was 74. The first year observations of the therapy sessions were reported, as well as continuing observations during 4 years of therapy, and a year of follow-up. It was concluded that the treatment for this child and his specific problems had resulted in psychological growth and better adaptation to this organic deficiency, although the IQ had not increased. This completes the review of group therapy with mental retardates. An analysis of the data, in terms of such relevant variables as sex, age, IQ, and type of patient (institutionalized or noninstitutionalized), primary therapeutic emphases, and duration and degree of success or failure of the therapy programs, has led this reviewer to a formulation of the following hypothesis regarding those conditions necessary for a favorable psychotherapeutic outcome: In group psychotherapy with the mentally retarded (be they children, adolescents, or adults), assuming that (a) the group is balanced and (b) the therapy is of sufficient duration (at least 1 hour per week for at least

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a 6-month period), successful therapeutic results (in terms of elimination or modification of personality difficulties) will best be achieved by a combination of a nonverbal and a directive psychotherapeutic approach. Some degree of success, however, can be attained if either one of these approaches is operant. Where neither approach is utilized, then failure will most likely ensue. This hypothesis is especially relevant with more severely retarded subjects. In addition, none of the studies dealing with a noninstitutionalized population reported any failures, a factor already cited as being possibly indicative of the significance of the home and family life on a favorable therapeutic prognosis. D. Novel Psychotherapeutic Techniques

Some investigators have reported the use of psychotherapeutic techniques which, either because of their deviation from the traditional therapeutic pattern or because of their truly original design, have been subsumed under the heading of “novel techniques.” Wiest (1955) felt that the changing emphases in philosophy at institutions for the mentally retarded, revolving around their aim of returning the individual to the community, require a corresponding change of emphasis in the types of treatment techniques to be employed. He advocated the development of noninsightful, nonverbal therapeutic procedures with the emotionally disturbed retardate. “We know that expdrience molds and modifies unconscious motivations without insight on the pant of the individual (so) why can’t these children reach stability within their limits without insight if they are provided the healthful emotional climate? . . Unconscious motivations of children at this functional level may be modified without verbal communication . . . (and) transference, catharsis, definite limits, feelings of acceptance, belongingness, and security feelings can be experienced. Reality can be made sufficiently appealing so that the child automatically gravitates toward it.” The use of hypnosis with the retarded has been reported by McCord (1956), Spankus and Freeman (1962), and Sternlicht and Wanderer (1963b). McCord (1956), working with seven institutionalized severely retarded mongoloids, found a correlation between “generally cooperative” behavior and hypnotic susceptibility. Five of his seven Ss went into “light trances,” while the remaining two were nonsusceptible to hypnotic induction. He theorized that hypnotherapy may be employed effectively with mongoloids. Hypnosis was attempted with 19 cerebral palsied patients by Spankus and Freeman (1962). They found these Ss difficult to hypnotize, and only four showed improvement as a consequence of the hypnotic work. Some

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personality gains were noted in the four, together with mild physical increments in their abilities to walk, talk, and write. While no adverse effects were recorded, it was felt that the general gains obtained were not remarkable. T h e meaningful, interpersonal relationships which developed during the sessions were viewed as probably as important in the patient’s improvement as the hypnotic state itself. It is felt that further study with this type of therapy is needed. Sternlicht and Wanderer (1968.b) reported on an experiment to determine the hypnotic susceptibility of mental defectives. Twenty children, 7-15+ years old, with IQs ranging from 37-68, were the subjects of this experiment. Since most hypnotic induction techniques rely heavily o n verbal instructions and suggestions designed to evoke images, an ambiguous situation resulted from the mental retardate’s lack of verbal skills concomitant with his reliance on imagery. T h e “progressive anesthesia” technique of induction was used, a method reported to yield rather deep hypnotic states with normals. T h e scale ot hypnotic depth was from 0 to 10, with the subjects required to respond, according to this scale, as to how deep a sleep he was in. Twelve of the 20 subjects were found to be hypnotizable, with the mean depth of the trance reported at 7. T h e use of a subjective scale as opposed to the traditional objective scoring system was explained as preferable for retardates because of its lesser complexity and lesser verbal emphasis. Caution, however, was suggested in interpreting these subjective evaluations. T h e hypnotizable Ss were able to comprehend the suggestions of the induction method and to understand the requirements of the subjective rating scale. Significant correlations were obtained between MA and hypnotic depth score (HDS) and between IQ and HDS. Thus, the authors concluded that their findings rule out “the classical position that relatively unintelligent people are not susceptible to hypnosis.” Age regression under hypnosis, however, was not accomplished by any of these Ss, and it might have been beyond the capabilities of the retardates in this particular study sample. T h e authors heralded the call for more experimentation in the area, and they regarded their results as “provocative, rather than conclusive.” “Shadow therapy” was the therapeutic technique devised and reported on by Robertson (1964). I t was defined as a method of focusing o n anxieties which the subject could control in the daytime but which might overwhelm him at night. I n a dark room, the child safely repealed his conflicts and the shadows accelerated the therapeutic process. I n the darkroom, a projector light created three types of sliadows-free shadows (cast by the subject), controlled shadows (cast by silhouettes which the


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therapist or the subject controlled) and static shadows (environmental). Most of the subjects, despite being physically enclosed, appeared to be psychologically free. The subjects were 12 retarded children, from 4 to 12 years old, with marked behavioral disturbances. Each child was given five lbminute individual sessions per week following regular play therapy sessions. One 6-year-old boy’s experiences over a period of 5 months were described in detail. At the conclusion of therapy, the child showed almost continual reality contact rather than spasmodic reality contact; his mood swings were hardly perceptible, whereas previously they had been marked; he passively accepted affection from his peers, having previously ignored them; and he occasionally sought affection from adults, having previously rejected or passively accepted brief contacts from them. Other subjects, too, were reported as having shown regressive behavior followed by “transcendental behavior.” The author felt that this technique was especially effective with disturbed children who had become almost completely indifferent to their environment. I t was effective as a means of stimulating subjects to reveal previously hidden conflicts, since “reality and unreality levels are controlled by the subject.” The muting of the environment appeared to facilitate the functioning of withdrawn, disturbed subjects who could then both “transcend and regress” in their behavior. The four concluding investigations utilizing novel therapeutic techniques with retardates again demonstrate the great variety of procedures which are available to the imaginative therapist who wishes to explore new, effective means of ameliorating emotional disturbances in the mentally retarded. Sternlicht (1964b) reported on a program of group psychotherapy with several groups of institutionalized mentally retarded male adolescents who were presenting serious acting-out behavioral difficulties. A total of four different groups was seen, each group consisting of from 8 to 18 subjects, ages 14-18, and IQs from 38 to 68, who shared in common poor verbal facility and severe destructive, aggressive, uninhibited impulsive behavior, some having even attempted homicidal acts. Attendance was obligatory, and sessions were held on a weekly basis for 1 hour each. Acting on the premise that the first few sessions are crucial in establishing a positive, working relationship between the patient and the therapist [a view supported by Mehlman (1953) and Gadpaille (1959)], the author employed an unoxthodox technique to establish rapport, having previously experienced failure with two of the groups. T h e new technique proved very efficient and was used in succeeding groups. The technique consisted of first conducting a series of fighting matches

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to determine the “strongest” member of the group; the viator then engaged in an Indian hand-wrestling match with the therapist, who, by employing leverage, that is, by making certain that his arm is on a higher plateau than the patient’s, assures himself of victory and thereby demonstrates his physical superiority. T h e group response of awe and admiration allowed a rapid, working therapeutic relationship to be developed. The therapist was active in this program, and although authoritarian, was nevertheless permissive, in accordance with Reger and Reger’s definition of the term (1963). T h e Indian hand-wrestling technique aIso could be used in subsequent sessions, should it become necessary to regain control of the group. “The procedure is seen as having served two goals (in addition to that of being able to introduce appropriate limits). On the one hand, it permitted an ‘authority-dependency transference’ to develop with the greatest rapidity, and, on the other hand, it also served to make the patients emotionally aware that they could obtain certain (valuable) knowledge from the therapist.” Suggestions of alternative modes of behaving, which might lead to more socially satisfying goals, were made, in accordance with the alternative guidance approach (Wanderer & Sternlicht, 1964), to be elaborated below. Wanderer and Sternlicht (1964) called their findings exploratory but felt they were worthy of dissemination because of the limited research in precisely this area-that of psychotherapy with the mentally retarded. The patients were screened by this writer; the 38 selected subjects, whose CAs ranged from 9 to 54 years, and whose IQs ranged from 40 to 72, were seen for hourly sessions once a week in a period from 3 weeks to 18 months in individual therapy. Then group therapy was instituted with 11 groups of 9-15 patients, totaling 143 patients, thus making the sum total of patients seen in therapy over a 2-year period 181. The authors reached the conclusion that the negative aspects of directive counseling (fostering of dependency and the destruction of the patient’s self-image) could be eliminated, while still bearing in mind the limitations due to the patient’s retardation, by having the therapist offer the patient a series of alternatives. By allowing the patient to choose a solution, the therapist could facilitate realistic attitudes, and consequent adaptive behavior, on the part of the patient who lacks the resources to do it himself. T h e authors felt that although the patient might not choose the best solution, it was nevertheless valuable, inasmuch as the choice was his own. “More than a compromise, alternative guidance is a synthesis, retaining the best elements of the therapy relationship while filling an objective need for the patient. Our experience has been that this simple device did enhance the therapeutic atmosphere with several highly dependent patients.” Patient readiness is regarded as prime consideration in its use. There were

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no reports of this procedure producing negative effects, but the extent of its effectiveness is yet to be ascertained. In the same institutional setting, but with groups of female adolescent retardates, Sternlicht (1966) employed a few new techniques specifically created for this group, in addition to various traditional nonverbal techniques (play therapy, finger painting, and socio- and psychodrama in pantomime). T h e “silence-insult” procedure, which entails the therapist’s maintaining silence until the group has ceased its loud and raucous behavior and then explaining that his silence is his way of insulting the group, was used in the first session and produced rapid, therapeutic movement. I n later sessions, full length and smaller mirrors were used in an attempt to illustrate how the retardates’ actions appear to others and to demonstrate behavioral improvements. Balloons were used in various therapeutic ways. They served as a diagnostic and therapeutic tool in enabling the therapist to determine, and to point out to the patients, their degree of aggressiveness, their need for structure, and their need for testing the limits, all of ‘the preceding based upon the subjects’ blowing up and breaking balloons. Balloons were also used artistically, with the view that the creation of different objects and animals with balloons is a skill that can easily be taught and which, consequently, can serve to strengthen the retardate’s sagging self-concept. Furthermore, balloons were used as a tension-reducing instrument by means of having the patient rub a balloon against his cheeks. These innovations and the traditional nonverbal procedures combined to produce behavioral improvement. The three groups utilized, with 10-14 in each group, had C A s of 14-20 and IQs of 37-70. Two groups were seen for 1 year, and the other for 15 months in 90-minute sessions, once a week. In the control group where verbal methods were relied on most heavily and where no innovations were introduced, no improvement was noted. In the other two groups, utilizing the “new” techniques in combination wi,th the nonverbal procedures, behavioral improvement was noted (according to physicians’ and ward-personnel ratings). The study employing perhaps the best experimental design in this section on “novel” techniques was that by Ricker (1964). Working on the assumption that self-perception will effect behavioral improvement (basically the same premise employed by Sternlicht in the preceding study in using mirrors to reflect actions most emphatically), the author described rhe use of audiovisual feedback in improving the social skills of menftally retarded young adults. The author regarded social immaturity as the paramount stumbling block for the mentally retarded adolescent and young adult, and he saw

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this factor, rather than the retardate’s difficulty in learning job skills, as a clet,errent to the educable mentally retarded person in obtaining and holding a job. I n an effort to help the mentally retarded “client” at the Sertonia Sheltered Workshop (of the MacDonald Training Center i n Tampa, Florida) to improve his social skills, and thus his employability, research using sound films as a training technique was instituted. T h e project involved a comparison of three methods of teaching better social skills to groups of young adult retardates. Those in the experimental group (Group A) received the “Robert Burns approach” in that they received group counseling on improving social skills in conjunction with an audiovisual aid-sound movies of their own social behavior. l h e subjects of the first control group (Group U) received group counseling o n improving social skills in conjunction with an audiovisual aid-sound movies of retarded people (not themselves, however) in social situations. l h e subjects of the second control group (Group C) received group counseling on improving social skills but did not view any films. I t was predicted that Group A would show the greatest degree of iinprovement i n social and emotional development, thereby proving the accuracy of Kobert Burns’ poetic hypothesis-“. . . To see oursels as ithers see us!/It wad frae many a blunder free us.” T h e three groups were matched on all pertinent variables, including talkativeness. Group sessions (the experiment is currently still in a n ongoing phase) take place 4 days a week for 4 months, preceded and followed by a month of intensive psychological evaluation. Each of the groups is filmed in social situations (such as group discussion, eating lunch, recreation, and work) on Monday and Wednesday of each week for 15 minutes. O n Tuesday and Thursday, Groups A and B meet for 45 minutes for group counseling with an audiovisual aid, and Group C meets for 45 minutes of group counseling only. All three groups are filmed, and the films will be rated for improvement in social skills by an inclependent film analysis team. This rating is an addition to the pre- and postevaluations mentioned. Group leaders and test administrators are rotated to allow for the statistical evaluation of these effects. Each group met for a total of 17 weeks, or 68 sessions. T h e experiment is to be replicated three times. At this time, the N is not considered sufficiently large to permit meaningful statistical analysis. However, the raw data seem to suggest the following trends: “All three groups showed increases in WAIS IQs (practice efects and increased test sophistication are certainly factors in this) with Group A showing the greatest gain. Group A demonstrated gains of one scaled score unit o r more on Arithmetic, Similarities, Picture Completion, Block Design, Picture Arrangement, and Object Assembly. Group 13 demon-


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strated similar gains on Digit Span and Digit Symboy. Group C showed such gains on Vocabulary and Object Assembly. “On the Vineland Social Maturity Scale, Groups A and B showed gains in mean social age of 8 and 10 months, respectively (during the 4 months of group sessions) with resulting slight increases in mean social quotients for the groups. Group C showed n o increase in social age.” An important feature of this research is the care that is taken throughout to minimize the effects of extraneous variables. Each of the four group leaders is required to appear one time in each of the three treatment conditions in order to statistically evaluate them and test administrator effect. To eliminate unconscious experimenter bias, the independent film analysis team will view and rate the film segments in a random, nonsequential order, because it was felt that if a given rater followed a client on the screen from one session to the next in sequence, he would find it difficult to overcome halo effects. For this reason too, the team is not being told of provisional results. Finally, the project has been refined to include the Vocational Capacity Scale before assigning the subjects to the various groups, because it is felt that even if more clients from the experimental (feedback) group subsequently obtain employment than clients from the other two groups, the hypothesis that feedback is helpful would not necessarily be supported since no prediction of the subject’s vocational capacity had been made. Although this study is not as yet completed, the hypothesis appears to be well grounded that the subject who views himself in maladaptive behavior will be more highly motivated to improve his social skills. All the innovations reported underscore the opportunities available to therapists to fully utilize their imaginative capacities in order to aid the retardate to realize fully his potential. E. Psychotherapy with Parents of Retardates

T h e novel techniques just discussed have been shown to be significant in adding a useful new dimension to orthodox psychotherapy, a sort of vertical extension of the scope of psychotherapy, as it were. Similarly, a horizontal dimension can be added by incorporating the therapy of parents of retardates into the “child’s” therapeutic program. In treating the maladjustments of nonretarded children, many psychotherapists, and i t is the practice of many child guidance clinics, will not see the child until the parents are seen in treatment first. There are at least three reasons for this practice: (1) presumably the cause of the maladjusting behavior frequently is traceable to some psychological abuse by either one or both of the parents; (2) the home environment

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must be made conducive to the growth of the child; and (3) the child is dependent on his parents for his necessities. It seems to this writer that psychorherapy with a mental retardate should be approached i n the same manner, since in fact he is as dependent as a child on his parents, or if institutionalized, on his doctor and the ward personnel (and, extramurally, on his parents as well). Perhaps, then, an important aspect of any program with a disturbed retardate should be the counseling and/or treatment of those on whom he is dependent for care. It is generally acknowledged that the parents of a retarded individual need help in recognizing, accepting, and coping with the many problems inherent in their situation, and that this “help” will reflect favorably on their child’s development. White (1959) emphasized the “breadth of service” aspect of the therapeutic program, which he reported on, as being instrumental in the success of the treatment. The child was seen as functioning better, largely as a result of his mother’s greater insight. Although the investigators concur in their feeling that the child derives beneficial effects from parental therapy, they disagree on the stress placed on parental involvement. Some studies view parental therapy as “helpful” and others view it as “essential” to a successful therapeutic program for the child. And there are others who make no point of the child’s improvement at all (although it is usually implied), their prime consideration being the retardates’ parents themselves. Blatt (1957) felt that “most children couldn’t derive maximum benefit from the school without simultaneous help for the parents to understand their own feelings and attitudes toward the children.” Beck (1959) saw retardation as “a family problem,” and Begab (1956) stated he would treat the guilt feelings so often engendered by the birth of a . . in order to help the child as well as the parent.” defective child Barsch (1961) stated that the “obligation of professional workers is toward parents since they require as much help as the child.” Although there is no dispute over the beneficial effects accruing to the retarded child when his parents are in treatment, rhere is a difference of opinion as to what therapy with groups of parents entails. T h e difficulties that arise appear to this writer to be primarily semantic ones, stemming from a lack of clarification of terms. For nowhere is rhere a clear definition of what is meant by therapy in working with parents of retarded children. To be sure, there are indications as to what course therapy should take or should not take, as, for example, the possible danger of too intensive probing, Auerbach (1961) stated that the leader should not attempt to explore the “unconscious psychic drives,” but should, rather, be a supportive figure. Sternlicht and Alston (1964) I‘.


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found that when therapy became more intensive, several parents dropped out. It has not been determined precisely just what therapy with parents should consist of, and until this has been done, it seems premature to propose the services of any professional person for any very specific program. If psychological damage can result from deep probing, it seems to be essential for group leaders to be aware of the danger. Actually, the fact of the matter is that for some parents there is chis danger, whereas for others there is none. Blatt (1957) suggested the use of different groups, with parents possessing sufficient ego strength participating in the deeper, more intensive type of group situation. It would appear, then, that parents of retardates should be screened to determine whether they have the ego strength necessary to engage in this deeper form of therapy. To avoid confusion resulting from the use of terms such as “counseling,” “education,” “discussion group,” and “therapy” interchangeably, the outline proposed by Blatt (1957) may be considered as a guide. The three groups he proposed are “I. Educational Group Counselling: to include those parents whose defenses are fragile and brittle. This group would have as its core matter the techniques of child rearing and development. “11. Group Counselling: to include those parents whose ego strength is sufficiently strong to explore their attitudes and feelings as related to the child. “111. Group Psychotherapy: to include those parents who indicate a desire to delve into their own emotions and feelings. This would only incidentally be related to the child.” Some investigators (Goodman and Rothman, 1961), recognizing the ambiguity of terms, recommend individual therapy of an analytic nature for the parents to supplement the group “therapy,” which in many cases is not therapy at all. Ideally, there would be two (or more) groups available to parents. Parents, who although psychologically capable of engaging in therapy but reluctant to do so, should have an option of choosing another group. What they may require is information. Just as in the often cited anecdote about the child asking where his brother came from and being given a long detailed description of the sexual processes whereas all he wanted to know was the name of the town, so, too, in the group experience, parents may wish just understanding or advice, and not therapy. The group should be able to meet the varying needs of the parents. Related to this aspect-that is, the varying needs of the parents-a good many investigators take note of the individual differences in person-

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ality structure with the conclusion that not all are suitable for therapy. This brings up the matter of group composition, an element usually overlooked in the group experiences described, perhaps because of the exigencies of the situation. This is not to say that the authors are not aware of the problem but that they may not be in a position to do anything about it. Many state specifically that although the parents have a common problem, they bring a sum total of resources particular to themselves. There is general agreement that the personality structure of the parent will determine his ability to cope with his problem. Cummings & Stock (1962) stated he would differentiate between those parents “. . . who can use therapy sessions profitably and those who cannot.” This reviewer would qualify this statemen t to read-differentiate to see who can use a particular type of therapy! Given the case where resources, economics, or other factors prevent giving the parents an option, i t may very well be the case that the one type of group available is not suited to the parents and hence they certainly could not profit from it. T h e final consideration before coming to an actual discussion of specific studies in this area is that of measurements. There is a vagueness about the extent of improvement and a consequent need for a greater accent on the development and use of measurement instruments. Perhaps the most logical jumping-off point on any discussion of group therapy lor parents is the experiment by Shapiro (1956) provocatively entitled, “Is Group Parent Education Worthwhile?” T h e experiment was designed to measure the effects of a series of group discussion meetings, led according to a well-defined methodology, upon the child-rearing attitudes of the 25 parents who participated. Before the group was selected, they were given a questionnaire consisting of 115 items which explored their attitudes toward children, their child handling practices, and their reaction to varying situations. T h e questionnaire enabled the investigators to classify the responses into parental authoritarianism versus parental permissiveness, parental possessiveness versus parent-child integration, and parental rigidity versus parental flexibility. T h e same questionnaire was used after the discussion groups were completed. T h e subjects attended from 1 to 17 meetings in the series. T h e method employed in the discussion groups followed the pattern outlined in Neubauer’s “Technique of Parent Education, Some Basic Concepts.” T h e findings showed that the participants in the experimental groups modified their child-rearing attitudes in the predicted direction to a statistically significant degree. It was found that those attending at least four meetings showed the greatest change, leading to the conclusion


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that the time interval is a determinant in effect of change. The results led the author to conclude that exposure to a group discussion technique will modify parental child-rearing attitudes in a predetermined direction and that this modification is positively related to the amount of exposure to the group discussion. One implication of this study is that an “education” type of group may produce change in a particular area of the participant’s life, but that no basic change in personality structure can be expected to take place. A second implication is that “success” in any therapeutic procedure will be dependent upon the participant’s personality structure. It would also appear that an attainable goal of parent groups would be the teaching of desirable child-rearing techniques. No experimental study on changes resulting from group psychotherapy appear. Actually, it appears to be infrequently used, judging by what is reported. Although objective measurement of the changes reported in the literature would seem to be essential, the fact is that few studies report their use. Most of the research indicates the scope and the direction that the therapeutic or educational procedures should take or has taken; only four-Appell et al. (1964), Bitter (1963), Sternlicht and Alston (1964), and Thurston (1960)-report any objective measurement of the findings reported. Appell et al. reported a study which employed 21 mothers of retarded children who were enrolled in the Day Care Center in Rochester, New York. The mothers were divided into two groups, each of which met for approximately 60 sessions over a period of 2 years. A modified form of the Thurston Sentence Completion Form was administered before the sessions began and again at their conclusion. The results showed that the modified TSC was a valid instrument for determining changes in parent attitudes brought about through group counseling. The date of the study indicates how recent research of this nature is and likewise points to the need for further substantiation of findings in research to come. The authors’ conclusions are likewise significant in pointing out the parents’ growth which resulted from counseling. Counseling is seen as cathartic for parents, a view generally accepted but not hitherto experimentally validated. The parents were found to be better able to accept the diagnosis of mental retardation after counseling, which led to a better understanding of the condition on their part as well as that of the retardates’ siblings. Also, the parents understood that others were sympathetic, and they looked upon the Day Care Center as a helpful resource.

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Closely allied to the Appell study was Bitter’s investigation of the attitude change of parents of mentally retarded children resulting from group discussion (1963). Seven monthly parent education sessions, of 2 hours each, were held for 16 parents of children with IQs under 55. Four instruments for measuring change were administered both before and after the program-Parent Attitude Research Instrument, Form IV, Semantic Differential, Child Character Trait Questionnaire, and a fifty item true-false test (concerning facts on mental deficiency), T h e author concluded that the results indicate that the sessions were effective in changing the parental attitudes to more positive ones toward the child and toward the family problems occasioned by the retardation. T he focus of the Sternliclit and Alston (1964) study was the description of the group dynamics involved in the group sessions, and not on a n experimental verification of the results. Included in the paper, however, was mention of a sentence-completion questionnaire employed after 6 months of therapeutic sessions. In response to the sentence-completion that “Failure in therapy may be expected when . . . ,” completions such as “one doesn’t want to help himself” and “a person does not permit himself to say what he thinks” were obtained. T h e authors felt that these responses indicate the group’s entry into a therapeutic phase. Experimental validation of the parents’ need for therapy rather than a measurement of the changes effected through its use was reported by Thurston (1960). He reported the results of a questionnaire sent to over 600 parents, using the Thurston Sentence Completion Form to express their reactions to their neurologically impaired, cerebral palsied children. I n general the responses indicated that most parents had not been able to make the adjustment to their situation and that they were in considerable emotional turmoil. Consequently, the author stressed the need for effective counseling methods to be developed for these parents. Thurston went on to say that three major stages of counseling are (a) acceptance of the disability; (b) setting long-range plans; and (c) counseling parents about attitudes and feelings. What this counseling consists of was not outlined, but it was doubtless a cathartic ventilating type of group discussion. T h e author saw the need for a “mature, highly trained and experienced counselor” to lead this group. On this point, Begab (1956) likewise recognized the effect that the stigma society attaches to having a retarded child has o n the parent. T h e rejection of the retarded child by the community was seen as causing the parents either to become overprotective or to turn upon the child as the cause of all their problems. Those parents who send their children to state institutions were


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described as harboring feelings of frustration, anxiety, and guilt, all of which must be explored and fully ventilated during counseling. Again, the question of attitudes was stressed as significant in the parent-child rela tionship. This study is in the nature of a guide to parental counseling. T h e environmental factors (the institutionalized or noninstitutionalized child) discussed above highlight the need for adapting the counseling techniques to the particular situation. T h e stigma of having a retarded child is seen to be more distressing to the parent who keeps the child at home although the parent who is forced to send the child away has greater guilt feelings. I n line with this, Hersh (1961) wrote that “The family whose child is at home presents the sharper need for help, because their problems are more immediate.” Parents are seen to encounter difficulty in accepting the retardate’s prolonged and indefinite emotional and physical dependency and immaturity along with his limited achievement potential. But acceptance of these conditions along with the expression of accompanying feelings of guilt and hostility are viewed as necessary both in terms of the child and the parents. An important aspect of this study is the recognition of factors relating to the parents themselves. “In mental deficiency, as in other problems, parental adjustment is facilitated or retarded by the sum total of physical, social and emotional resources which they can bring to bear in coping with the situation.” Begab (1956). Other studies bear out this trend. Blatt (1957), Cummings and Stock (1962), Hersh (1961), and Mahoney (1958) all emphasized that the parents’ psychological functioning predetermine their ability to cope with the problems of retardation and, consequently, to derive any benefit from group counseling or therapy. Blatt reported about the counseling and therapy program initiated for the parents of the mentally retarded children at the Shield of David Clinic Day School. T h e program was designed to meet the parents’ needs, since it was found that most children could not derive maximum benefit from the school program without simultaneous help for the parents. T h e group consisted of couples who met for 18 hours once a week for a total of not more than 20 weeks. T h e underlying principle of the therapeutic program was that helping the parents understand their own feelings and attitudes toward their retarded children would result in the children’s improved functioning. T h e goal was to help the parents realize that their own emotional status, attitudes, and feelings affected the child-parent relationship, which in turn affected the growth of the child.

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An important result of this program was the author’s observation that some modifications had to be made in the program. T h e leader found it difficult to adhere to the goal because some parents wished to explore their personalities apart from their children and others, who had difficulty in externalizing their feelings, could not even explore the childparent relationship. It was therefore concluded that more careful screening is necessary to “weed out” parents who could not benefit, since often the problems of the parents transcended the immediate problems with the child. What differentiates this study from others which indicate that some parents are unsuited for therapy is, as mentioned earlier, its suggested grouping according to the individual need. T h e implications of the grouping are manifold. One implication seems to be that the program for parents should strive to meet the varied needs of the parents, so that there is really no such thing as a “bad” candidate, but rather a “bad” organizational structure. Another implication is that the present nomenclature is unsatisfactory and ambiguous. Furthermore, the study seems to indicate that no one particular method is superior to another, and that “educational” technique is no less respectable than a “psychotherapeutic” one, but that the choice is dependent upon the makeup of the group. Cummings and Stock (1962) found that some mothers were better able than others to deal with their problems, and they considered it vital to determine which can profit most from the therapy, supposedly to “weed out” some, even as Blatt would have us do. Where no facilities exist for the far-reaching program that Blatt proposed, it is imperative to eliminate those who cannot derive any benefit from the group sessions and who may, in fact, impede the progress of those who can. I n direct contrast, in that it was in a residential setting and also that it was on a long-term basis, casework with parents of retarded children was reported by Hersh (1961). As in the preceding two studies, the author felt that not all parents can be expected to accept the handicap and it is u p to the caseworker (psychologist, therapist, or whoever may be involved) to differentiate between those parents who are motivated for change and can use active help and those who “must proceed in the darkness, always warding off anyone who seeks to help them change.” This conclusion and others have been reached as a result of the experience of the author at the Woods Schools in Pennsylvania, where it has been found that a 2- to 3-year period of seeing parents of retarded children, with periodic follow-ups, is most helpful for parents to work out their own feelings. T h e philosophy of casework has been directed toward helping parents use the information about their child with sympathetic


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understanding of their need to develop certain natural defenses such as denial or avoidance. The unique problems of these parents have been found to be (a) d i s ruption of normal ego functioning of parents and therefore disruption of normal family life routines; (b) development of excessive and unusually intense feelings of guilt and personal inadequacy; (c) excessive and long-standing dependency burdens that cause emotional draining of parents; (d) friction in connection with siblings because of stigmata and untenable goals which the family has set for itself; (e) distorted perceptions of the child; and ( f ) distorted projections on the child. As mentioned previously, not all parents could cope with these problems to the same degree. The author noted that fathers have been found to be more reserved, less emotionally involved] more objective, and less expressive of their feelings, thus making it more difficult to understand them and to help them acknowledge their role as fathers. However, as with mothers “at a similar point in their development* the ability to carry through in their own role depends a great deal on how liberated they are and feel.” The author observed that the family whose child is being cared for in a residential school strives to find a part-time relationship t.0 the child, in which both they and the child can derive satisfaction from one another. The family whose child is at home, as noted earlier, presents the “sharper need for help because their problems are more immediate.” They come to identify their community outpatient service as a source of support and direction. A study treating with the parents’ psychological structure was that by Mahoney (1958). The paper attempted to point out some differences among parents of retarded children] in the hope that counseling efforts would gain from the recognition of these differences in that the counselors would relate to parents as individuals as well as parents of retarded children. A different therapeutic situation was presented by parents who had previously been adjusting, responsible members of society with a good relationship to each other and by those who had previously been unable to effect a personally satisfying adjustment to themselves and others. The author postulated that “the more intense the defense reaction toward the child (by the parents), the more probable has (he) become an integral part of the parents’ total psychological functioning.” The parent who was previously maladjusting thus was viewed as probably undergoing severe personality disturbance which would involve the retarded child in his own psychological functioning. The author further postulated that “the greater the shift of sympto-

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matic behavior in the parent from previous external referents to the retarded child, the less can counseling be realistically oriented toward the needs of the child and the parent will need intensive treatment.” It was thus concluded that the better adjusting parent previous to the birth of the retarded child experiences a temporary trauma which can be helped through supportive counseling, but that the maladjusted parent will more likely need intensive psychological therapeutic help. These conclusions are highly significant in a consideration of the effectiveness of counseling or therapy with parents. It would seem essential, judging by the findings, that any therapeutic procedure consist initially of a screening of candidates about to enter that process. Actually, most of the studies either implement the screening process or indicate the shortcomings of a program unable to d o so. Yates and Lederer (196l), in reporting on their program of short-term, undirected group sessions with parents, stressed that among the criteria for joining the group was having a child with the same diagnosis (mongolism), being able to attend sessions, and being able to derive benefit from the program-that is, “not being so severely disturbed about the diagnosis as to need special individual help.” This was a clinic-situated program with a maximum of four couples that was held only three times in 3 months. T h e emphasis was on sharing of experiences, in an attempt to assist the parents to find their equilibrium more easily and to handle more appropriately their feelings about what had happened to their child. T h e staff participants functioned mainly as “sponsors” who only started rhe discussion going and kept it along the lines dictated by the limited goals. T h e authors concluded that these sessions were quite helpful and useful, this limited approach being most effective for people who have some ability to verbally express their feelings. T h e parents appeared to become better able to consider the next steps in planning, so that these sessions seemed to aid the parents in their adjustment in the period following interpretation. It should be noted that the question of those crucial times when parental counseling is most needed has just been hinted at: the impact of certain, critical stages would seem to be significant, although therapy at any time is necessary and beneficial. Goodman and Rothman (1961) stressed this aspect in their paper. I n reporting on services offered to retarded children and their families, the group counseling program for parents was found to be constructive when used at any time. T h e program at that time, however, was to use group counseling primarily for two categories: mothers whose young children had just been evaluated, and those whose children were entering adolescence. For the first group, the impact of the diagnosis could


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be softened, and for the second, the parent’s concern and ability to deal with the child could be treated. Nadal (1961), too, described a program for parents consisting of group and individual counseling, with the paper describing only the parent counseling aspect. But in this group setting, the emphasis was again on a differentiation of groups, showing the author’s recognition that parents differ and that group leaders should vary their approach in accordance with this difference. Set in a day care center for handicapped children, the aim of the parental counseling part of the program was to improve the parents’ social functioning and to involve at least one parent and the child in the agency’s program at an earlier time (children under 7) than had previously been possible. T h e selection of two groups of parents and children was based on the dual assumptions that the parent’s role performance and competence was affected by having a retarded child and that counseling was an appropriate service to the parent under these circumstances. The differentiation of the two groups was based upon the retardate’s condition which resulted in some imbalance. Initially, the mothers were so anxious and awkward in the group setting that the group leader found it necessary to “foster group cohesion and group structure.” It was found that feelings of inadequacy in handling the child as, for instance, in the inability to set proper limits and to discipline the child, predominated. Overprotection was a particularly complicated question. An important feature, and hence an advantage of a clinic setting, was that the parents’ observation of the child in a group enabled many of them to understand and act toward their child as ‘*adeveloping personality, in his own right.” Discussion centered, too, on the effect of having a retarded child in the family. T h e hostility that many mothers felt toward professional agencies, and toward professional persons with whom they had come in contact, also was explored. The principal aim of the leader was described as the improvement of the functioning of these mothers “by relieving their anxieties, offering them alternative suggestions on child-rearing, increasing their repertory of possible solutions to the problems they face, and modifying their destructive attitudes and behavior.” The leader’s role was essentially that of a nonthreatening person who focused on the mothers’ questions about current experiences and problems. An important aspect of this study was the leader’s role. In the primarily inarticulate and incohesive group, he was very supportive, allowing free ventilation of feelings; in the more anticulate, better informed

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group, he had to give scope and direction to what the members themselves brought up. I n connection with this point, a study by Ruzicka (1958) suggested the use of the school psychologist to counsel p a r e m of mentally retarded children. Among the reasons given were his training and/or experience in psychology and education in dealing with exceptional children, as well as i n dealing with parents and teachers. Although implied, there really are a variety of roles that the therapist-counselor is required to play. Thus, when Ruzicka wrote of the school psychologist informing the parents of their retardate’s diagnosis and advising them about available social services, this would be in the nature of social casework, guidance, or psychology-the undefined “highly trained professional person” depicted by Thurston. When the role is that of an organizer of group therapy or discussion-group programs, the services of the school psychologist are seen to be valuable. Without wishing to detract from the services possible by the use of the school psychologist, i t also should be emphasized that no definitive study has been made on the characteristics and qualities essential for such a leader, and presently, it would appear that, unless specified as intensive therapy (as in 111, Blatt), which requires a trained therapist, the other functions can be handled by educators, social workers, and other professional people in this area. Returning to Nadal’s study, the leader, who had to work differently with each group, apparently only went as far as I1 (Blatt). For psychotherapy, individual counseling was recommended, based on several criteria: the current effect of the child upon the family, the lack of acceptance of the child’s condition, and the child’s adjustment difficulties in school. T h e results showed that genuine improvement was made in such areas as attitudes toward the child, child-rearing practices, ability to handle the child, and in the general level of the mother’s communication of her concerns and problems. This emphasis on the child’s deriving beneficial effects from the parents’ therapy also was indicated by Begab (1956), who viewed the interests of the child as intimately involved with those of his parents, making it necessary to investigate the parents’ feelings i n order to facilitate the adjustment of the child. To treat a retarded child, Beck (1959) would help the parents. Blatt (1957), too, found that the children could not derive maximum benefit from the program a t school without involving the parents in some form of psychotherapeutic program. Bennett (1957), in describing his work over a 3-year period in helping parents of preschool, deaf children, stated that the program of education of the parents was specifically designed to aid the children. T h e parent classes


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met three evenings a month for a 2-year period. The basic principle is that “what we do is determined not so much by what we know as by how we feel.” The program aimed at giving the participants the opportunity to become “the kind of people who can find their own answers.” As the parents learn to sort out the irreverant, leftover feeling of the past from the realities of the present, they become more available to their children’s needs, more acceptant of their children as they are. The first year of the program was called group therapy in a parent education class, and it consisted of lectures on child development, play materials, the nature of intelligence, concepts of adjustment, etc., with discussions of the material. This appears to be I under Blatt’s outline; that is, an educational form of counseling. The second year was called group therapy. Since the emphasis was on the rehabilitation of the handicapped children, this therapy would fall under 11, group counseling. Rankin (1957) reported on a group therapy experiment, of 21 l&hour sessions over a 6-month period, with 11 parents. The study aimed generally at being “exploratory, expressive, ventilative, cathartic, and qualifiedly interpretative.” The latter aim seems to indicate that an attempt at I11 (psychotherapy) was made, but that generally group counseling (11) was the procedure followed. Some signs of improvement in the parents’ adjustment were noted, but these are vague. T h e study suggested that the difficulty that parents have in dealing effectively with the problem of mental retardation comes largely from two sources: first, from the internal “psychic conflicts reactivated or reinforced by the problem,” and, second, from the inability to find an acceptable course of action to pursue on behalf of the child. The author added that the parents’ pathological defenses can best be dealt with by the agency in which the diagnostic study is made, a view shared by Cummings and Stock (1962), where the treatment setting was distant from the agency treating the child. The study concluded with a p r o posed ideal setting-the agency as part of an integrated community plan, including medical, neurological, and psychiatric services, visiting nurses, as well as educational, training, and workshop facilities for noninstitu. tionalized and institutionalized retardates. Within this integrated program, the author felt that group therapy for parents should be included among the services offered. This idealized vision of the community as receptive to providing for retardates is indicative of the trend to expand facilities for the retarded, In such a program, treatment for parents will be greatly expanded. The concluding four studies, with their emphasis on a supportive form of

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therapy, are thus significant in being the forerunners of the programs planned in that they stress possible pitfalls to be avoided. Auerbach (1961) reported on the program over the past 10 years of training selected social workers, psychologists, educators, and nurses in parent group education. The goals were viewed as different from those of group therapy (111), in that the leader must direct group thinking toward those aspects of ego functioning that will develop ego strengths. The members of the group must be helped to explore all aspects of the situation, in order to gain greater knowledge and understanding of their children’s physical and emotional development, of their own roles as parents, and of the complexity of parent-child relations. The program of training social workers for work with parents of handicapped children grew out of a general program of education of parents of children having specific physical ailments. Included in the training program was a study of the principles of child growth and development. Linked to this, was a study of the many distortions created by parents unaware of growth possible in these various disabilities. Another topic was the parental concerns common to all parents, as they are colored by the nature, prognosis, and special meaning to parents of their children’s handicaps. The training program likewise included a presentation of the principles, goals, and techniques of parent group education as applied to the needs of parents of handicapped children. Special problems for leaders arose from the difficulty of handling the intensity of feelings which often pour out during group sessions. Essentially, the approach to the parents of the handicapped is the same as that applied to other parent groups, with cognizance of their special needs. These would appear to be a greater need for support and a tendency to avoid probing deeply in exploring the unconscious. I t is specifically an educational procedure but with many counseling undertones (I and 11). The results of group programs thus far tend to favor groups which focus on children with similar disabilities. Barsch (196 1) described a program precisely geared to parents of children with a similar disability, that of brain damage. The author maintained that the brain-damaged child is a social being, and that a full understanding of his problems is dependent upon viewing him in his social setting as well as in his test experiences; the obligation of professional workers is also toward the parents, however, since they “require as much help as their children.” A need was seen for a specialized program for these parents on a practical level. The author reported on the development of an evaluation, training, and counseling program for these children and their parents. Parental


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counseling was on both an individual and a group basis. T h e mothers were between the ages of 25 and 40, and they evidenced no severe emotional problems. A comfortable group setting in which the parents could discuss their problems with a professional person was provided, with the objectives of: (a) altering of the parents’ perception of the braininjured child; (b) teaching the parent the principles for understanding and guiding the child’s behavior; (c) correcting the parents’ misconceptions; (d) acquainting the parents with the present knowledge in growth and development of the child; (e) teaching parents to recognize cues in children signifying their needs; and ( f ) teaching the parents a method for aiding the development of organized response patterns in the child. T h e program did not attempt to change the personality structure of the parent and discouraged revealing of interpsychic conflict. T h e method was essentially that of a give-and-take question and answer session between the individual mother presenting the problem and the counselor, with the mother reporting back. Gradually group interaction developed, so that the counselor’s role became less directive. H e then helped keep the discussion to the point, offered cues, and remained sensitive to group dynamics. T h e general therapeutic process was supportive and educative, egostrengthening and helpful on a practical level. T h e author felt that parents of brain-injured children must be considered an integral part of the organization of the child’s behavior. They can be helped, through counseling, to perceive their children differently and to deal more effectively with the problems presented. Beck (1959), through the use of casework, likewise aimed at ego support and adjustment to reality for the parent. Viewing retardation as a family problem and diagnosis as family diagnosis, parent counseling becomes one of the most effective treatment tools in terms of the child. Parents are seen as needing help in working through their own feelings, in making an adequate adjustment, and also in getting practical advice in regard to their everyday problems. Th e author stressed the importance of following up the diagnosis immediately with a treatment plan for the parents. T h e patterns chat each case seemed to fall into were: (1) initial period during which diagnosis is made and treatment goals and methods are selected on the basis of ego strength, family strength, environmental and cultural influences, degree of handicap, and parent’s understanding of it; (2) treatment itself-level, type, and method (individual or group); (3) a tapering-off period; and (4) a follow-up period (contact easily maintained at a clinic where the parents continue bringing the child). T h e author emphasized the emotional and practical help which can be offered

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these parents through counseling by helping them achieve their optimum functioning to meet their responsibilities for the treatment of their child. Although the varied treatment methods themselves were not amplified, it may be assumed that I and I1 in Blatt were envisioned. What is important is that consideration is given to the different needs of the parents, and that their needs are directly related to the child. Ego support is stressed because of the weak ego strength usually associated with parents in these situations. Sternlicht and Alston (1964), working with one group whose composition later changed, found that the leader had to be sensitive to the “phases” of counseling engaged in. Initially, the leader promoted a supportive, permissive milieu in which the parenlts could feel free to ventilate their problems and to emotionally abreact. Some didactic-like advicegiving was employed, in terms of offering the parents several behavioral alternatives. This may be viewed as I (educational counseling). T h e group leader, feeling that the ego strength of the parents warranted it, then proceeded to I1 (group counseling), with an exploration of feelings related to the child. In the final stage, rhey went to I11 (group psychotherapy), where the focus was no longer on the problems of mental retardation, but rather on the parents’ own problems. Although greeted enthusiastically at first, the depth of the therapy proved threaltening to some parents and was subsequently dropped. The new emphasis was on a combination of lectures and discussion (I and 11). This phase was viewed as a final evolutionary one in the history of this parents’ group. T h e problems inherent in working with one group were manifested in this study. Although it is important to be aware of phases in any group process, it would be preferable to divide the parents into the proper groups which would proceed at their own pace rather than to adopt a middle-of-the road course. The limited numbers and finances doubtless made this impractical, but it is conceivable that another organizational procedure might have permitted the psychmherapy to continue. This review of the research on therapy with parents of retarded children (and occasionally other handicapped children) indicates general agreement on the value of such a program, both for the parents and the children, and the need to screen the candidates for the program. Definitions proved elusive, with Blatt’s outline a valuable aid for classification. I t was never specified who should lead a therapy program with the parents, although Ruzicka proposed the use of a school psychologist. T h e writers didn’t limit the field of professional activity, so that conceivably psychologists, psychiatrists, educators, social workers, or any professional person could counsel these groups.


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Most of the studies were exploratory and served as guides to future research in the area. Only a handful reported the use of any objective measurement. Some studies suggested the use of individual therapy in addition to group therapy, perhaps because of the tendency of “therapy” to be counseling. On the other hand, there were those who felt that group psychotherapy was inappropriate and should not be attempted, that what was needed was an ego-supporting group leader to discuss problems as they arise. They considered psychological damage to be the result of intensive probing into the unconscious of the parents. I t would appear to be necessary to determine which kinds of parents are capable of psychotherapy (as has been shown in a limited way) and then to postulate on the qualities of a good leader of a therapy program based on this information. T h a t is, if psychotherapy is required, a trained therapist would be indicated. If a lecture, counseling, or educational form of “therapy” is desired, a qualified “expert” (teacher, social worker, nurse, etc.) would seem to be satisfactory. Adequate information is not available on what the training program $tomake these leaders qualified would involve; Auerbach did provide an outline for some educational and counseling procedures. If the importance of parental involvement to the child is as great as some researchers indicate, it would appear necessary to experimentally validate this fact, and, if proven, to incorporate the group therapy of parents in every program with the retardate. T h e possibilities for exploration are many, as there are so many unanswered questions. Research efforts, hopefully, will help provide some of the answers. 111. CONCLUSIONS

During the past decade, we have witnessed a tremendous upsurge and interest in the field of mental retardation, the emphasis on research resulting in an occasional revision of previously held concepts. T h a t changes in our ways of thinking about mental retardation have occurred is perhaps best illustrated by the inclusion of this chapter in the present survey-a study unheard of 20 years ago, and even presently considered somewhat of a nontraditional departure. T h e pendulum of mental retardation can be said to have swung full way. What was, until very recently, a muted plea for aid has become a loud, insistent demand for assistance. T h e history of science’s concern with the problems of mental retardation seem almost to have undergone the therapeutic stages of the parents of retarded children-from a refusal to recognize the problem, to an eventual acceptance of it, and, finally, to a search for “solutions.” Today all our media is saturated with material

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on mental retardation, From daily newspaper accounts to television and radio coverage, and even to a study by the Presidential Council on Mental Retardation, we are confronted with the problem that now may be said to have assumed national significance. As a consequence of all this attention, several innovations in the approach to mental retardation have been attempted, with more doubtless to follow. One interesting aspect, worthy of mention because of its implied relation to this study, is work on the establishment of an apartment building on the west side of New York specifically designed to provide housing for employable mentally retarded adults (The New York Times, 1965). The rent system is unusual. For the 47 single rooms, occupants pay a total lifetime rent of $13,500, and for the 41 double rooms, each occupant pays $10,500. A $5000 down payment is required, with the remainder payable over a 5-year period. All applicants are to be between the ages of 18 and 35 and employed. Men and women will live on separate floors and each floor will have a professional counselor for advice or emotional guidance at any time. A guidance center will also offer speech counseling, employment counseling, job training, and occupational therapy in an adjacent building. Whether this test project will eventually become the established procedure with employable retardates remains to be seen. Certainly it is a step in the right direction. The project recognizes the problem of “bright” retarded persons who live sheltered lives with their parents and who, when their parents die, end up in an institution even though they have the ability to make nearly normal adjustments to everyday life. This plan is noteworthy in its recognition of the need for guidance and therapy for the retarded tenants. With its adoption the need for institutions to adopt programs aiming at community placement will become more apparent. Thus, it is seen that the emphasis on community placement will require a different orientation in many existing institutions. Psychotherapy will come to be recognized as an important adjunct, both in the institution and in the “life outside.” Institutions will have to modify and improve conditions, where possible, so that their emphasis will be more toward rehabilitation rather than on regimentation. There is a great challenge in the field of psychotherapy with retardates. With the absence of clearly defined paths to follow, the possibilities seem to be many. The review of research in this area pointed out the need for greater clarification of terms. Individual psychotherapeutic studies were reported with most promising, although not definitive, results. I n the analysis of group psychotherapy, some interesting questions are raised


349

relating to the possibilities of conditions for “success.” Novel psychotherapeutic techniques were outlined. T h e therapeutic work in this field, however, still lacks sufficient theoretical and empirical bases. A major shortcoming in this area is effective research dealing with the outcomes of psychotherapeutic treatment. Specificially, we are still awaiting the answers to such questions as “How effective is psychotherapy with retardates” and “What specific techniques are most apropos” and “Why.” ACKNOWLEDGMENTS T h e author wishes to express his gratitude to Mrs. M. Seide, for her assistance in gathering some of the data, Mrs. M. Sternlicht, for her help in the preparation of this manuscript, and Mra J. Watson, for her invaluable secretarial aid. Thanks, too, are expressed to the Americun Journal of Mental Deficiency, for permission to quote from two articles contained therein. REFERENCES Abel, Theodora M. Resistances and difficulties in psychotherapy of mental retardates. J. clin. Psycho!., 1953, 9, 107-109. Alvin, Juliette. T h e response of severely mentally retarded children to music. Amer. 1. ment. Defic., 1959, 63, 988-996. Appel, Evelyn, & Martin, C. H. Group counseling for social adjustment. Amer. J. rnent. Defic., 1957, 62, 517-520. Appell, M. S., Williams, C. M., & Fishell, K. N. Changes in attitudes of parents of retarded children effected through group counseling. Amer. J . ment. Defic., 1954, 68, 807-812. Amholter, E. Social drama for retarded adolescents. Except. Child., 1955, 21, 132-134. Astrachan, Myrtle. Group psychotherapy with mentally retarded female adolescents and adults. Amer. 1.ment. Defic., 1955, 60, 152-156. Auerbach, Aline B. Group education for parents of the handicapped. Children, 1961, 8, 135-140. Axline, Virginia M. Some observations on play therapy. J. consult. Psychol., 1948, 12, 209-216. Barsch, R. H. Counseling the parent of the brain-damaged child. 1. Rehabilt., 1961, 27, 26-42. Beck, Helen L. Counseling parerits of retarded children. Children, 1959, 6, 225-230. Begab, M. Factors in counseling parents of retarded children. Amer. J. ment. Defic., 1956, 60,515-525. Bennett, D. N. Therapy wtih parents of handicapped children. Except. Child., 1957, 25, 154-159. Berger, M. M. Nonverbal communication in group psychotherapy. Znt. J. group Psychother., 1958, 8, 161-178. Bevan, J. Non-directive activities for the mentally handicapped: freedom, reflection of attitudes help pupils grow, learn. Chicago Sch. J., 1960, 41, 379-384. Bitter, J. A. Attitude change by parents of trainable mentally retarded children as a result of group discussion. Except. Child., 1963, 31, 173-177. Blake, R. R. Experimental psychodrama with children. Group Psychother., 1955, 8, 347-350.

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Blatt, A. Group therapy with parents of severely retarded children: a preliminary report. Group Psychother., 1957, 10, 133-140. Bryer. S. S., & Wagner, R. The didactic value of role-playing for institutionalized retardates. Group Psychother., 1963, 16, 177-181. Burton, A. Psychotherapy with the mentally retarded. Amer. J. ment. Defic., 1954, 58, 486-489. Carlson, Bernice W., & Ginglend, D. R. Play activifies for the retarded child. New York: Abingdon Press, 1961. Chess, Stella. Psychiatric treatment of the mentally retarded child with behavior problems. Amer. J . Orthopsychiat., 1962, 32, 863-869. Copeland, R. Therapy considerations for the institutionalized mentally retarded. Train. Sch. Bull., 1962, 59, 53-58. Cowen, E. L. Psychotherapy and play techniques with the exceptional child and youth. In W. W. Cruickshank (Ed.), Psychology of exceptional children and youth. (rev. ed.) Englewood Cliffs, N. J.: Prentice-Hall, 1962. Cummings, S. T., & Stock, Dorothy. Brief group therapy of mothers of retarded children outside of the specialty clinic setting. Amer. J. ment. Defic., 1962, 66, 739-748. D’Angelo, Rita Y. An evaluation of group psychotherapy with institutionalized delinquent girls. Diss. Abstr., 1962, 32, 306-307. Dentler, R. A., & Mackler, B. The socialization of retarded children in an institution. J . Hlth hum. Behav., 1961, 2, 243-252. de Palma, N. Group psychotherapy with high grade imbeciles and low-grade morons. Delaware St. med. J., 1956, 28, 200-203. Dichter, A. Psychotherapy for the mentally retarded. Pathways in Child Guidance (Bd of Educ., City of N . Y.), 1962, 4, 11-12. English, H., & English, Ava C. A comprehensive dictionary of psychological and psychoanalytical terms. New York: Longmans, Green, 1958. Fields, Beatrice. Music as an adjunct in the treatment of brain-damaged patients. Amer. J . phys. Med., 1954, 33. 273-283. Fine, R. H., & Dawson, J. C. A therapy program for the mildly retarded adolescent. Amer. J. ment. Defic., 1964, 69, 23-30. Freedman, M., & Sweet, B. S. Some specific features of group psychotherapy and their implications for selection of patients. Int. J . group Psychother., 1954, 4, 355-368. Friedman, E. Individual therapy with a “defective delinquent.” 1. clin. Psychol., 1961, 17, 229-232. Gadpaille, W. J. Observations on the sequence of resistances in groups of adolescent delinquents. Znt. J . group Psychother., 1959, 9, 275-286. Ginott. H. G. A rationale for selecting toys in play therapy. J. consult. Psychol., 1960, 24, 243-246. Glass, H. L. Psychotherapy with the mentally retarded. A case history. Train. Sch. Bull., 1957, 54, 32-34. Condor, E. I., & Levbarg, M. Techniques and expressive therapy integrated into the treatment of mentally retarded children. Amer. J. ment. Defic., 1958, 63, 60-63. Goodman, L., & Rothman, Ruth. The development of a group counseling program in a clinic for retarded children. Amer. J . ment. Defic., 1961, 65, 789-795. Gootzeit, J. M., Lombardo, A. J., & Milner, S. Situational diagnosis and therapy. Amer. J . ment. Defic., 1960, 64, 921-925. Gorlow L.,Butler, A., Einig, K. G., and Smith, J. A. An appraisal of self-attitudes and behavior following group psychotherapy with retarded young adults. Amer. J. ment. Defic., 1963, 61. 893-898.

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Gunzburg, H. C. Therapy and social training for the feebleminded youth. Brit. J. med. Psychol., 1957, 30, 42-48. Heber, R. Modifications in the manual on terminology and classification in mental retardation. Amer. J. tnrnt. Defrc., 1961, 65, 499-500. Heimlich, Evelyn P. Music as a therapy with emotionally disturbed children. Child Welf., 1960, 39, 7-11. Hciser, K. Psychotherapy in a residential school for mentally retarded children. Train. Sch. Bull., 1954, 50, 211-218. Heller, A. D. Group therapy with mental defectives. Ment. H l t h , Lond., 1955, 14, 97-99. Hersh, A. Casework with parents of retarded children. SOC. Wk., 1961, 6, 61-66. Hormuth, R. 1’. T h e utilization of group approaches in aiding mentally retarded adults adjust to community living. Croup Psychother., 1955, 8, 233-241. Jahnson, Shirley M. Cultural and psychological features of music therapy. Bull. nat. Ass. music Ther., 1959, 8, No. 2. Joseph, H., & Heimlich, Evelyn P. T h e therapeutic use of music with “treatmentresistant” children. Amer. J. ment. Defic., 1959, 64, 41-49. Kaclis, Asya. T h e use of finger-painting in psychotherapy with mentally deficient children. Paper read at tlie annual meeting, Amer. Ass. Ment. Defic., May, 1951. Also in Stacey & DeMartino (1957). Kaldeck, R. Group psychotherapy with mentally defective adolescents and adults. Znt. I. group Psychother., 1958, 8. 185-192. Kaliski, Lotte. Educational therapy for brain-injured retarded children. Amer. J. ment. Defrc., 1955, 60, 71-76. Kaufman, M. E. Group psychotherapy in preparation for the return of mental defec. tives from institution to community. Ment. Retard., 1963, 1, 276-280. King, F. W. Th e use of drawings of the human figure as an adjunct in psychotherapy. J. clin. Psychol., 1954, 10, 65-69. Kniest, J. H. T h e therapeutic value of toys in a training center for handicapped children. Rehabilit. Lit., 1962, 23, 2-7. Knight, D., Ludwig, A. J., Strazzulla, M., & Pope, L. Th e role of varied therapies in the rehabilitation of the retarded child. Amer. J. ment. Defic., 1957, 61, 508-515. Kratter, F. E. Music therapy for the mentally retarded. Amer. J. Psychiat., 1959, 115, 737-738. Lavalli, Alice, & Levine, Mary. Social and guidance needs of mentally handicapped adolescents as revealed through sociodrama. Amer. J. ment. Defic., 1954, 58, 544-552. Leland, H., & Smith, D. Unstructured material in play therapy for emotionally dis. turbed brain-damaged mentally retarded children. Amer. J. ment. Defic., 1962, 66,621-628. Leland, H., Walker, J., & Taboada, A. Group play therapy with a group of post-nursery mental retardates. Amer. J. ment. Defic., 1959, 63, 848-851. Long, Wilma J. A n exploratory study of the use of role playing with severely retarded children. Amer. J. ment. Defic., 1959, 63, 784-791. McCord, H. T h e hypnotizability of the mongoloid-type child. J. d i n . exp. Hypn., 1956, 4, 19-20. McDaniel, J. Group action in the rehabilitation of the mentally retarded. Group Psychother., 1960, 13, 5-13. McDermott, W. H. Art therapy for the severely handicapped. Amer. J. ment. Defic., 1954, 59, 231-234. McKinney, J. P., & Keele, Tina. Effects of increased mothering o n the behavior of severely retarded boys. Amer. J. ment. Defic., 1963, 67, 556-562.

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Mahoney, S. C. Observations concerning counseling with parents of mentally retarded children. Amer. J. ment. Defic., 1958, 63, 81-86. Maisner, Edna A. Contributions of play therapeutic techniques to total rehabilitative design in an institution for high-grade mentally deficient and borderline children. Amer. 1. ment. Defic., 1950, 55, 235-250. Mann, L. Persuasive doll play; a technique of directive psychotherapy for use with children. J. clin. Phychol., 1957, 13, 14-19. MacMillan, M. B. Pavlovian principles in the treatment of an unresponsive, seemingly retarded, pre-school child. Anier. 1. ment. Defic., 1961, 65, 440-447. Mehlman, B. Group play therapy with mentally retarded children. J. abnorrn. SOC. Psychol., 1953, 48, 53-60. Michal-Smith, H., Gottesgen, M. A., & Gottesgen, Gloria B. A group therapy technique for mental retardates. Int. /. group Psychother., 1955, 5, 84-90. Mundy, Lydia. Therapy with physically and mentally handicapped children in a mental deficiency hospital. J. clin. Psychol., 1957, 13, 3-9. Murphy, Mary M. Rhythmical responses of low grade and middle grade mental defectives to music therapy. J. clin. Psychol., 1957, 13, 361-364. Murphy, Mary M. A large scale music therapy program for institutionalized low grade and middle grade defectives. Amer. J. ment. Defic., 1958, 63, 268-273. Nadal, R. M. A counseling program for parents of severely retarded pre-school children. SOC. Casewk, 1961, 42. 78-83. Neham, Sara. Psychotherapy in relation to mental deficiency. Amer. J. ment. Defic., 1951, 55, 557-572. The New York Times. Housing is planned for mentally retarded. March 14, 1965. O’Connor, N., & Yonge, K. A. Methods of evaluating the group psychotherapy of unstable defective delinquents. J . genet. Psychol., 1955, 87, 89-101. Oliver, J. N. The effect of physical conditioning exercises and activities on the mental characteristics of educationally subnormal boys. Brit. J . Educ. Psychol., 1958, 27, 155-165. Pilkey, Lorraine, Goldman, M.. & Kleinman, B. Psychodrama and empathic ability in the mentally retarded. Amer. J. ment. Defic., 1961, 65, 595-605. Rankin, J. E. A group therapy experiment with mothers of mentally deficient children. Amer. J. ment. Defic., 1957, 62, 49-55. Reger, i Janice. Setting limits for children in institutions. Ment. Hospitals, Reger, R., ? 1963, 14, 400-401. Reik, T. Jewish wit. New York: Gamut, 1962. Ricker, L. H. Use of audio-visual feedback in improving social skills of mentally retarded young adults. Paper read at Annu. Conv., Amer. Psychol. Ass., Phila., Sept. 1963. Ricker, L. H. Three afiproaches to group counseling involving motion pictures with mentally retarded adults. Progr. Rep., MacDonald Train. Center, Tampa, Florida, March, 1964. Ringelheim, H., & Polortsek, F. Group therapy with a male defective group. Amer. J. ment. Defic., 1955. 60, 157-162. Robertson, Mary F. Shadow therapy. Ment. Retard., 1964, 2, 218-223. Rogers, C. R. Client-centered therapy. Boston: Houghton Miffiin. 1951. Rosen, Elizabeth. Dance as therapy for the mentally ill. Teach. Coll. Rec., 1954, 55, 215-222. Rudolf, G. An experiment in group therapy with mental defectives. Int. J. SOC. Psychiut., 1955, 1, 49-53.


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Ruesch, J.. & Kees, W. Norrverbal communication. Los Angeles: Univer. of Calif. Press, 1956. Ruzicka, W. A proposed role for the school psychologist: counseling parents of mentally retarded children. Amer. J . menl. Defic., 1958, 62, 897-904. Sarbin, T. R. Spontaneity training of the feebleminded. Sociometry, 1945, 8, 389-393. Scheidlinger, S., Eisenberg, M. S., King, C. H., & Ostrower, R. Activity group therapy of a dull boy with severe body ego problems. Int. J . group Psychother., 1962, 12, 41-55. Schneider, B., & Vallon, J. The results of a speech therapy programme for mentally retarded children. Amer. J. mcnt. Defic.. 1955, 59, 417-424. Shapiro, I. S. Is group parent education worthwhile? A research report. Marriage Fam. Living, 1956, 18, 154-161. Slavson, S. R. Criteria for selection of patients for various types of group psychotherapy. Int. J . group Psychother., 1955, 5 , 3. Snyder, R., & Sechrest, L. An experimental study of directive group therapy with defective delinquent. Amer. J. ment. Defic., 1959, 64, 117-123. Spankus, W. H., & Freeman, Linda G. Hypnosis in cerebral palsy. Int. J . d i n . exp. Hypn., 1962, 10 135-139. Stacey, C. L., & DeMartino, M. E. (Eds.). Counseling and psychotherapy with the mentally retarded. Glencoe, Ill.: Free Press, 1957. Sternlicht, M. Client-centered counseling with mental retardates. Paper read at annual meeting, East. Psychol. Ass., Atlantic City, N.J., April 1962. (a) Sternlicht, M. Psychotherapeutic techniques with the mentally defective. Invited Paper, Inst. on Ment. Retard., Johnstone Train. and Res. Center, Spring, 1962. @) Sternlicht, M. A theoretical model for the psychological treatment of mental retardation. Amer. J . ment. Defic., 1964, 68, 618-622. (a) Sternlicht, M. Establishing an initial relationship in group psychotherapy with delinquent retarded male adolescents. Amer. J . ment. Defic., 1964, 69. 39-41. @) Sternlicht, M. Psychotherapeutic techniques useful with the mentally retarded: A review and critique. Psychiat. Quart., 1965, 39, 84-90. Sternlicht, M. Treatment approaches to delinquent retardates. Int. J . group Psychother., 1966, 16, 91-93. Sternlicht, M., & Alston, Toni. Evolution in group work with parents ,of retarded children and adolescents. Paper read at the annual meeting, Amer. Ass. Ment. Defic., Kansas City, May, 1964. Sternlicht. M., & Wanderer, Z. W. Group psychotherapy with mental defectives. Paper read at the annual convention, Amer. Group Psychother. Ass., Wash., D. C., Jan., 1963. Reviewed in J . Amer. Med. Ass., 1963, 11(5), 45. (a) Sternlicht, M., & Wanderer, Z. W. Hypnotic susceptibility and mental deficiency. Znt. J. din. exp. Hypn., 1963, 11, 104-111. @) Sternlicht, M., & Wexler, H. K. Cathartic tension reduction in the retarded: an experimental demonstration. Paper presented at 36th annual meeting, East. Psychol. Ass., Atlantic City, N.J., April, 1965; Amer. J. ment. Defic. 1966, 70, 609-611. Stevenson, H. W., & Knights, R. M. Social reinforcement with normal and retarded children as a function of pretraining, sex of E,and sex of S., Amer. J. ment. Defic., 1962, 66, 866-871. Stubblebine, J. M. Group psychotherapy with some epileptic mentally deficient adults. Amer. J. ment. Defic., 1957, 61, 725-730. Stubblebine, J. M., 8~ Roadruck. R. D. Treatment program for mentally deficient adolescents. Amer. J . ment. Defic., 1956, 60. 552-556.

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Subotnik, L., & Callahan, R. J. A pilot study in short-term play with institutionalized educable mentally retarded boys. Amer. J. ment. Defic., 1959, 63, 730-735. Tavris, E. Some notes on group psychotherapy for severe mental defectives. Delaware Med. J., 1961, 33, 301-307. Thorne, F. C. Tutorial counseling with mental defectives. J. din. Psycho!., 1960, 16. 73-79. Thorne, F. C., & Dolan, Katherine M. T h e role of counseling in a placement program for mentally retarded females. J. d i n . Psychol. Monogr. Suppl., 1953, No. 9, 1-8. Thurston, J. R. Counseling the parents of the severely handicapped. Except. Child., 1960, 26, 351-354. Tyson, Florence. Music therapy in the rehabilitation of the retarded child. Newsltr Musicians Fund, 1957, 3 , 1-4. Vail, D. J. An unsuccessful experiment in group therapy. Amer. J. ment. Defic., 1955, 60, 144-151. Vail, D. J. Mental deficiency: response to milieu therapy, Amer. J . Psychiat., 1956, 113, 170-173. Wanderer, Z. W.. & Sternlicht, M. Alternative guidance: a psychotherapeutic approach to mcntal deficiency. Znl. ment. H l t h Res. Ncwsltr, 1964, 7 , 13-15. Weigl. Vally. Functional music-a therapeutic tool in working with the mentally retarded. Amer. J. ment. Defic., 1959, 63. 672-678. White, B. L. Clinical team treatment of the mentally retarded child and his parents: Group counselling and play observation. Amer. J. ment. Defic., 1959, 63, 713.725. Wiest, G. Psychotherapy with the mentally retarded. Amer. J . ment. Defic., 1955, 59, 640-644. Wilcox, G. T., & Guthrie, G. M. Changes in adjustment of institutionalized female defectives following group psychotherapy. J. clin. Psycho[., 1957, 13, 9-13. Winick, C., & Holt, H. Eye and face movements as nonverbal communication in group psychotherapy. J. Hillside Hosp., 1962, 11, 67-79. Yates. Mary L., & Lederer, Ruth. Small, short-term group meetings with parents of children with mongolism. Amer. J . ment. Defic., 1961, 65, 467-472. Yonge, K. A., & O’Connor, N. Measurable effects of group psychotherapy with defective delinquents. J. ment. Sci., 1954, 100, 944-952.

Author Index Numbers in italics refer to pages on which the complete references are listed. Aamodt, M. S., 26, 27 Abel, Theodora M., 280, 287, 349 Adams. P. A., 35, 55 Adelman, H. M., 1, 26, 26 Aderman, M., 33, 54 Alston, Toni, 332, 335, 336, 346, 353 Alvin, Juliette, 320, 321, 349 Arnsel, A., 2, 26 Appel, Evelyn, 301. 349 Appell, M. S., 335, 349 Armstrong, M. D., 72, 80 Arnholter, E., 287, 349 Arthuis, M., 274 Asch, S. E., 76, 80 Astrachan, Myrtle, 285, 288, 305, 349 Attneave, F., 31, 54 Auerbach, Aline B., 332. 344, 349 Axline, Virginia M., 287, 349 Ayllon, T.. 4, 26 Azrin, N. H., 4, 26 Baer, D. M., 86, 120 Baker, R. A., 195, 207 Bandura, A., 4, 26 Ilarber, L., 215, 216, 219, 232, 233, 236, 23 7 Barjon, Marie-Claire, 275 Barnett, C. D., 138, 147 Barsch, R. H., 332, 344, 349 Ikiumcistcr. A. A., 66, 68, 71, 80, 141, 142, 147

Beaujard, M., 272 Beck, Helen L., 332, 342, 345, 349 Beedle, R., 71, 80, 141, 142, 147 Bcgab, M., 332, 336, 337, 342, 349 Beley, A., 273 Bcnda, C. E., 73, 80 Bennett, D. N., 342, 349 Benoit, E. I>., 38. 56 Berenbaum. H. L., 33, 5 4

355

Berger, M. M., 285, 349 Berger, R., 275 Berkson, G., 48, 54, 59, 62, 63, 66, 68, 72, 78, 80, 81 Bernard, R., 275 Bevan, J.. 323, 349 Bialer, I., 138, 147 Bijou, S . W., 86, 120, 165, 207, 227, 228, 232, 233, 235, 236, 237 Binder, A., 225, 232, 234, 235, 239 Birch, H. C., 72, 73, 80 Birnbrauer, J. S., 138, 147, 227, 228, 232, 233, 234, 235, 236, 237 Bitter, J. A., 335, 336, 349 Blackman, L. S., 214, 217, 218, 224, 229, 231, 232, 233, 235, 237 Blake, K. A.. 35, 47, 55 Blakc. R. R., 290, 349 Blakemore, C. B., 143, 147 Blanc, C., 273 Blatt, A., 332, 333, 342, 350 Blue, C . M., 48, 54 Blum, A., 127, 134, 141, 142, 148 Boeswillwald, M., 275 Boslov, G . L., 23, 26 Bourne, L. E., Jr., 103, 120 Bousfield. W. A,, 36, 37, 54 Bower, B. D., 74, 80 Bowes, Ann E., 126, 127, 147 Braun, H. W., 125, 127, 130, 136, 149 Brauner, A., 272 Brauner, Franqoise, 272 Bret, J., 273 Breton, A., 274 Brewer, C. L., 233, 239 Brian, 2.. 88, 120 Briet, B., 274 Brown, P., 111, 121 Bryant, P. E., 115, 120, 139, 140, 146, 147 Bryer. S . S., 291, 350

356 Buchwald, A. M., 65, 81 Bugniot, F., 272 Burch, N. R., 62, 80 Burke, C. J., 92, 120 Burton, A., 281, 350 Butler, A., 286, 316, 350 Butterfield, G. A,, 63, 80 Cadilhac, J., 274, 275 Callahan, R. J., 313, 354 Campione, J., 98, 99, 106, 120 Cantor, G. N., 46, 48, 54 Capobianco, R. J., 217, 218, 224, 229, 232, 233, 235, 237 Carlson, Bernice W., 294, 350 Carrier, N. A., 65, 70, 80 Cartwright, G. P., 221, 237 Castets, B., 277 Cawte, J. E.. 72, 81 Chabanier. J., 272, 273, 276 Chaptal, J., 274 Charlin, J.. 272 Check, 145, 148 Chess, Stella, 800, 318, 350 Chiva, M., 276 Chombart de Lauwe, M . , 276 Christiaens. L., 274 Claparede, E., 62, 81 Clarke, A. D. B., 143, 147 Clausen. J., 59, 61, 64, 67, 68. 70, 71, 78. 79, 81, 82 Cofer, C. N.. 37, 54 Colavita, F. B., 23, 26 Colby, M., 88, 120 Collman, R. D., 59, 61, 63, 64, 73. 81 Cook, J., 211. 237 Cookson, M., 143, 147 Copeland, R.. 297, 350 Copelman, L. S., 274 Corah, N. L.,62, 81, 88, 120 Cowen, E. L.. 280, 287. 350 Cromwell, R. L., 72, 81 Cuche, Marie, 276 Cumings, J. N . , 72, 81 Cummings, S. T., 334, 337, 338, 343, 350 Cuvelier, R., 274 d'Adhemar, I., 273 Dallett, K. M., 37. 42, 44, 54

Author Index Dameron, L. E., 63, 68, 69, 71, 81 D'Angelo, Rita Y., 315, 350 Davenport, R. K., 62, 80, 81 Davis, R. C., 65, 81 Davy, Ruth A., 217, 232, 233, 237 Dawson, J. C., 301, 302, 350 De Ajuriaguerra, J., 276 De Grouchy, J., 274, 275 de Haan, H. J.. 131, 147 DeMartino, M. F., 281, 353 Demb, H., 72, 73, 80 DeMeyer, M., 176, 207 Denny, M. R., 1, 3, 5, 6, 26, 26 Dentler, R. A., 304, 350 dePalma, N.. 303, 350 Descoudres, A.. 88, 120 Dichter, A., 292, 350 Dickerson, D. J.. 98, 99, 108, 120, 134. 138, 147 Dingman, H. E., 145, I 4 8 Dwhring, D. G., 216, 233, 237 Dolan, Katherine M., 286, 354 Dolton, Franqoise, 277 Doussinet, 0.. 276 Dreyfus-Brisac, C., 273 Dubost, Marie, 272 Dunham, M. D., 3. 26 Duquennoy-Vanheuverswyn, C . , 274 Durling, D., 74, 81 Dutch, S . J., 73, 82 East, M. J. M.. 217, 224, 229, 232, 233, 235, 237 Ebbinghaus, H., 30, 54 Edelberg, R., 60,81 Eigen, L. D., 233, 237 Eimas, P. D., 88, 98, 99, 100, 101, 102, 103, 105, 115, 120, 121 Einig, K. G., 286, 316, 350 Eisenberg, M. S., 323, 324, 353 Eisman, B. S., 48, 54 Ellis, N. R., 5, 26, 35. 54, 59, 63, 68, 73, 78, 80, 81, 82, 125, 128, 129, 130, 138, I47 Ellson, D. G., 215, 216, 219, 232, 233, 237 Engle, T. L.. 215, 216, 219, 232, 233, 237 English, Ava C., 281,350 English, H., 281, 350 Esen, F. M., 74, 81 Estea, W. K., 92, 120

Author Index Evans, J. L., 230, 237 Evans, R. A., 38, 54 Farriaux, J. P., 274 Faure, J . L., 273 Fein, A., 69, 82 Fenot, A. M.. 276 Fernandes, K. A., 217, 232, 233, 237 Ferre, A., 272 Ferster, C. B., 176, 207 Fessard, A., 273 Fields, Beatrice, 310, 350 Fine, R. H., 301, 302, 350 Finley, J. R., 236, 239 Fischer, G. J., 35, 54 Fishell, K. N., 335, 349 Fishgold, H., 273 Forcina, J. J., 217, 224, 229, 232, 233, 235, 237 Ford, J. H., 48, 54 Foshee, J. G., 72, 81 Francois, P., 274 Frankman, R. W., 65, 81 Franks, C., 72, 81 Franks, V., 72, 81 Freedman, M.,280, 350 Freeman, Linda G., 325, 353 French, G. M.,133, 147 Friedman, E., 292, 350 Friedman, G. B., 112, 120 Furth, H. C., 99, 101, 102. 105, 113, 120, 121 Gadpaille, W. J., 327, 350 Galanter. E., 30, 56 Gapp, A., 35, 55 Garrone, G., 276 Garaudet, L., 272 Gatier, G., 276 Gaudier, B., 274 Gautier, B., 274 Gautier, M., 275 Geertz, U. W.,214, 231, 238 Gellhorn, E.. 58, 62, 78, 81 Gelof, M.,229, 237 Gerall. A. A., 23, 26 Gerard-Lefebvre, G., 275 Gerjuoy, H., 32, 33, 34, 54 Gerjuoy, I. R., 32, 33, 34, 56

357 Gilmore, A. S., 219, 220, 226, 232, 233, 234, 238 Ginglend. D. R., 294, 350 Ginott, H. G., 299, 350 Ginsberg, R., 7, 27 Girard, J.. 272 Girardeau, F. L., 125, 128, 129, 138, 147, 148 Glaser, E. M., 69, 81 Glaser, R., 230, 231, 237, 239 Glass, H. L., 292, 350 Goldiamond, I., 166, 207 Goldman, M.,322, 352 Condor, E. I., 289, 350 Goodenough, F.. 88, 120 Goodman, L., 333, 340, 350 Goodwin, W. R., 90, 93, 95, 120 Gootzeit, J. M., 319, 350 Gorlow, L., 286, 316, 350 Corn, W.,61, 63, 81 Gottesgen, Gloria B.. 318, 352 Gottesgen, M. A., 318,352 Gratadour, P., 275 Cregor, A., 61, 63, 81 Greiner, T. H.,62, 80 Griffin, J. P., 69, 81 Griffith. B. C., 36, 55 Gnngs, W. W., 63, 68, 69, 71, 81, 82 Gros, G., 275 Gruber, H. E., 45, 55 Guidicelli, G., 273 Gunzburg, H. C., 297, 298, 351 Guthrie, G. M., 285, 288, 305, 306. 354 Guyon, P., 274 Haggard, D. F., 23, 27 Haim, A., 277 Hardy, M.W.,219. 220, 226, 232, 233. 234, 238 Harlow, H. F., 123, 128, 129, 13G, 148 Harrow, M., 112, 120 Harter, Susan, 125, 130, 148 Hawker, J. R., 4, 26, 214, 231, 238 Hawkins, W.F., 66. 80, 141, 142, I47 Heal, L. W..112. 115, 120, 121 Hebb, D. O., 31, 56 Heber, R. F., 77, 81, 127, 148, 281, 351 Hedtenmueller, E. G., 31, 55 Heid. W. H., 236, 238 Heimlich, Evelyn P.. 287, 311, 312, 351

358 Heiser, K., 297, 351 Heller, A. D., 305, 351 Henne, M., 276 Hermelin, B., 35, 45, 46, 55, 56, 59, 60. 63, 68, 72, 73, 80, 82 Heron, W., 31, 56 Hersh, A., 337, 338, 351 Heuyer, G., 274 Hewett, F. M., 216, 230, 232, 233, 238 Hively, W . (also Hively, Wells), 156. 164, 166. 174, 177, 207, 236, 238 Hoats, D. L., 31, 55, 56, 217, 224, 229, 232, 233, 235, 237 Hoffman. R. S., 275 Holden, E . A., Jr., 214, 229, 231, 237 Holland, A. L., 197, 207 Holland, J. G., 156, 165, 185, 207, 227, 235, 238 Holt, H., 285. 354 Hormuth, R. P., 286, 318, 351 Horsley, A,, 272 House, B. J., 5, 27, 31. 55, 87, 88, 90, 93, 95, 96, 98, 99, 100, 101, 103. 104, 108, 112. 113, 117, 118, 120, 121, 129, 131, 135, 14s Hull. C. L., 24, 26 Hunt, W . A., 63, 82 Hurtig, M., 276 Hurvich, M . S., 35, 56 Hyinan, L. M., 32. 55, 98, 99, 106, 120 Irion, A. L., 137, 148 Irwin, 0. C., 60, 83 Iscoe, I., 46, 55 Jahnson, Shirley M., 311, 351 James, W., 195, 207 Jayncs. J., 23, 26 Jean. R., 274 Jensen, A. R., 46, 47, 48, 55 Jeune, H., 273 Johnson, G. O., 35, 47, 55 Jolivet, B., 276 Joseph, H., 311. 312,351 Kadis, Asya, 287, 351 Kaess, W., 233, 238 Kaldeck, R., 280, 307, 351 Kaliski, Lotte, 288, 294, 351

Author Index Kanner, L., 170, 207 Karrer, R., 59, 61, 64, 67, 68, 70. 79, 81, 82 Katz, P. J., 145, 148 Kaufman, M . E.. 126, 128, 129, 132, 133, 137, 148, 301. 303, 351 Keele, Tina, 317, 351 Kecs. W., 285. 353 Keislar, E. R., 230, 238 Kellas, G., 66, 80 Kelleher, R. T., 109, 111, 113 120 Kellogg, W . N., 185, 207 Kempwerth, L., 215, 216, 219, 232, 233, 23 7 Kendler, H. H., 93, 94, 95, 107, 109, 110, 111, 119, 120, 121 Kendler, T. S., 93, 94, 95, 107, 109, 110, 111, 119, 120, 121, 211, 237 Kevorkian, J., 272 Kidder, J. D., 227, 228, 232, 233, 234, 235, 236, 237 King, C. H., 323, 324, 353 King, F. W., 290. 351 Klausmeier, H. J.. 145, 148 Kleinman. B., 322, 352 Kleiser, J. R., 223, 232, 239 Kluver, H., 198, 207 Kniest, J. H., 289, 351 Knight, D., 295, 351 Knight, S., 233, 238 Knights, R. M., 288, 353 Kodman, F., 69, 82 KGhler, W., 30, 35, 55 Koffka, K., 30, 55 Kohler, C., 272, 273, 276 Koronakos, C., 211, 231, 238 Kramarz, P., 273 Krasner, L., 19. 26, 27. 155, 207, 208 Kratter. F. E.. 290. 351 Krulee, G. K.. 35, 55 Kulkin, A., 45, 55 Labauge, R.. 273, 275 Lacey, B. C., 61. 62, 64, 76, 82 Lacey, J. 1.. 61, 62, 64,66, 67, 70. 75, 76, 77, 82 Lachanat, R., 273 Lacy, Julia L.. 216, 233, 237 Lafon, K., 275 Lafon, RCmy, 272 Lafourcade. J., 275

Author Index Lairy, G. C., 274 Lalisse, A., 272 Lamy, M., 274 Landi, D. M., 35, 55 Landis, C., 63, 82 Lashley, K. S., 195, 207 Laurent, P., 272 Lavalli, Alice, 287, 351 Lawrence, D. If., 90,93, 95, 120, 195, 207 Lebovici, S., 273 Lecuyer, M., 273 Lecuyer, R., 272, 275 Lederer, Ruth, 340, 354 Leeper, R., 35, 55 Le Febvre, G., 274 Leiderman, P. H., 61, 82 Lejeune, J., 275 Leland, H., 281, 287, 299, 313, 351 Lelord, G., 274 Lelord, P., 274 Lepen, S., 274 Leroy, C., 273 Levbarg, M., 289, 350 Levine, Mary, 287, 351 Lindsley, D. B., 78, 82 Lindsley, 0.R., 152, 207 Lipman, R. S., 35, 36, 47, 55 Lippert, H., 4, 27, 214, 231, 239 Lockhart, R. A., 63, 68, 69, 71, 81, 82' Logan, F. A., 26, 26 Lombardo, A. J., 319, 350 Long, Wilma J., 322, 323, 351 Loos, F. M., 135, 144, 149 Lourie, R. S., 60, 65, 73, 82 Ludwig, A. J.. 295, 351 Lumsdaine, A. A., 233, 238 Luria, A. R.,62, 66, 69, 78, 82 Maatsch, J. L., 26, 26 McCord, H., 325, 351 McDaniel, J.. 319, 351 McDermott, W. H., 287, 301, 351 McFarland, W. L., 23, 27 McGeoch, J. A., 137, 148 McIntire, M. S., 73, 82 McIntyre, R., 145, 148 McKinney, J. P., 317, 351 Mackintosh, N. J., 106, 12I Mackler, B.. 304. 350 MacMillan, M. B., 288, 296, 352

359 Mackworth, J. F., 35, 55 McNeil, J. D., 230, 238 Mahoney, S. C., 337, 339, 352 Maisner, Edna A., 287. 352 Malpass, L. F., 65, 70, 80, 219, n0, 226, 232, 233, 234. ?Y.a Maltzman, I., 23, 26 Manelski, D. M., 35, 55 Mann, L., 294, 352 Mannoni, Maud, 277 Marsh, G., 111, 121 Martin, C. H.,301, 349 Martin, W. E., 127, 134, 141, 142, 148 Mason, W. A.. 62. 80 Matthews, J.. 197, 207 Mautner, H., 74, 81 May, M. A., 233, 238 Mayhew, D., 216, 230, 232, 233, 238 Mayzner, M. S.. 35, 55 Means, J. R.,138, 149 Mehlman, B., 327, 352 Merachnik, D. A., 224, 232, 238 Merlet, Lucette, 276 Michaels, R. M., 29, 55 Michal-Smith, H..318, 352 Michaux, L., 274 Miller, G. A., 30, 37, 53, 55, 56 Miller, M. B., 31, 55 Milner, S., 319, 350 Minke, K. A.. 236. 239 Minvielle, J., 275 Mittwoch, U.,72, 81 Mixson, A., 69, 82 Monod, M., 273 Moor, L., 276 Moore, R.,166, 207 Motokawa, K., 29, 56 Mowrer. 0. H., 77, 82 Mullen, F. A., 276 Mundy, Lydia, 287. 291, 352 Murphy, I. C., 74, 83 Murphy, Mary M., 287, 311, 312, 352 Nadal, R. M., 341, 352 Narbouton, R.,274 Naumann, T. F., 225, 226, 232, 238, 239 Navarro, M., 275 Neham, Sara, 287, 352 Netchine, Gaby, 274 Netchine, S., 273, 274

SGO Neuhaus, E. C., 228, 238 Nodot, A., 275 Obrist, P., 67, 82 O’Connor, N., 35, 45, 46, 55, 56, 59, 60,63, 64, 67, 68, 69, 72, 73, 77, 80, 82, 83, 286, 314, 352, 354 O’Doniiell, J. P., 132, 149 Ohlrich, E. S., 112, 121 Oliver, J. N., 287, 352 Orton, K. D., 65, 70, 80 Osborn, W. J.. 38, 56 Osgood, S. W., 195, 207 Ostrower, R., 323, 324, 353 Pacaud, Marie, 273 Pages, P., 275 Palermo, D. S., 46, 48, 56 Palk, B. E., 72, 81 Pilkey, Lorraine, 322, 352 Parson, Bobbie N., 226, 232, 238, 239 Pasquier, N.. 273 Passouant, P., 274 Patton, R. A,, 125, 127, 130, 136, 249 Paul, C., 106, 121 Pavlov, I. P., 195, 208 Pecheux, M. G., 276 Perron, R., 276 Perse, J., 277 Peters, S., 211, 231, 239 Peterson, I,. R., 233, 239 Peterson, W. M., 128, 132, 133, 137, 148 Philimenko, A,, 272 Picaud-Bellemain, S., 275 Pichot, P., 277 Plenderleith, M., 132, 148 Poingt, J.. 274 Polortsek, F., 314, 352 Pomme, B., 272 Ponte, 274 Pope, L., 295, 351 Popov, Catherine, 274 Popp, Helen M., 236, 239 Porter, D., 236, 239 Premack, D., 2, 26 Pribram, K. H., 30, 56 Price, J . E., 222, 232, 233, 234, 239 Prideaux, E., 59, 63, 82 Pringuet, G., 272 Pritchard, R. R., 31, 56

Author Index Pryer, M. W., 125, 128, 129, 138, I47 Pryer, R. S., 59, 63, 73, 82 Prysiazniuk, A. W., 134, 148 Puech, J., 274 Puff, C. R., 37, 54 Quackenbush, J., 222, 223, 232, 239 Quattlebaum, B., 224, 232, 238 Querel, R., 272 Quilter, R. E., 62, 83 Rabb. Ethel, 216, 230, 232, 233, 238 Ramel, Marie, 273 Rankin, J. E., 343, 352 Raskin. D. C., 23, 26 Raymond, M., 272 Raymond, R., 272 Reger, Janice, 328, 352 Reger, R., 328, 352 Reik, T., 285, 352 Restle, F., 102, 103, 220, 121 Ribstein, M., 274, 275 Rice, C. E., 185, 207 Richet-Tetard, A., 274 Ricker, L. H.,323, 329, 352 Rieber, M., 47, 56 Ring, E. N., 46, 48, 56 Ringelheirn, H., 314. 352 Ringness, T. A., 65, 70, 82 Riopelle, A. J.. 135, 145 Roadruck, R. D., 317, 353 Robert, J.. 273 Robertson, J., 88, 120 Robertson, Mary F., 326, 352 Robinet, J.. 275 Roche, M., 273 Rock, I., 37, 56 Rogers, C. R., 280, 352 Rohwer, W. D., Jr., 47, 48, 55 Rosen, Elizabeth, 287, 290,352 Ross, L. E., 23, 27, 112, 121 Rossi, E. L., 38, 39, 41. 56 Rothman, Ruth, 333, 340, 350 Rotman, C. B., 144, 148 Rouget, CI., 275 Rouse, S. T., 144, 146, 148 Rowe, R., 61, 62, 83 Royer, J.. 272 Rudel. R. G., 141, 148, 249 Rudolf, G . , 286, 308, 352

Author Index Ruesch, J., 285, 353 Ruzicka, W., 342, 353 Ryan, T. J., 46, 54 Salmon, C., 274, 275 Sampson, P. B., 23, 26 Samsondolfus, D., 273 Samuels, I., 62, 82 Sanders, B., 112, 121 Sarbin, T. R., 309, 353 Saxton. G. H.. 217, 224, 229. 232, 233, 235, 237 Schachter, J., 61, 62, 83 Schachter, M., 275 Scheidlinger, S., 323, 324, 353 Schlosberg, H., 185, 208 Schneider, B., 296, 353 Schoenberg, K. M., 35, 55 Schoenfeld, W. N., 26, 27 Schulz, R. W., 34, 56 Schwartz, P., 45, 55 Scott, K., 218, 232, 233, 239 Sechrest, L., 288, 307, 353 Semler, I. J., 46, 55 Semmel, M. I., 62, 82 Seringe, P., 275 Sevestre, P., 273 Shapiro, D., 61, 82 Shapiro, 1. S.. 334, 353 Shay, C. B., 234, 239 Shepherd, Margaret J., 217, 224, 229, 232, 233, 235, 237 Shepp, B. E., 98, 99, 100, 102, 103, 121 Shipley, T. E., Jr., 35, 56 Shrago, M., 214, 231, 238 Shusterman, R. J., 32, 56 Sidman, M., 186, 208 Silberman, H. F., 210, 239 Simon, Marie, 273 Singer, R. V., 5, 27 Skinner, B. F., 185, 208, 227, 234, 239 Slavson, S. R., 280, 353 Sloan, W., 59, 81 Smith, D., 281, 287, 299, 351 Smith, E. A., 222, 223, 232, 239 Smith, J. A., 286, 316, 350 Smith, M. D., 138, I49 Smith, 0. A.. 23. 27 Snyder, R., 288, 307, 353 Sokolov, Y. N., 23, 27

36 1 Solomon, R. L., 185, 208 Spain, C. J., 68, 80 Spankus, W. H., 325, 353 Spence. K. W., 23, 27, 85, 92, 93, 94, 121 Spiker, C. C., 88, 121 Spitz, H. H., 31, 32, 36, 53, 55, 56, 78, 82 Spradlin, J. E., 138, 147 Sprague, R. L., 225, 232. 234, 235, 239 Staats, A. W.. 236, 239 Stacey, C. L., 281, 353 Stamback, M., 276 Stanley, W. C., 26, 27 Stedman, D. J.. 39, 56 Steinberg. M., 211, 231, 239 Stern, J. A., 62, 81 Sternlicht, M., 281, 282, 285, 286. 287, 308, 309, 325, 326, 327, 328, 329, 332, 335, 336, 346, 353, 354 Stevenson, H . W., 129, 132, 149, 288, 353 S t d , Dorothy, 334, 337, 338, 343, 350 Stoddard, L. T., 186, 208 Stolurow, L. M., 4, 27, 210, 211, 214, 231, 233, 234, 236, 239 Stone, A. A., 62, 83 Strazzulla, M., 295, 351 Stubblebine, J. M., 316, 317, 353 Subotnik, L., 313, 354 Suchman, R.G., 88, 114, 121 Suppes, P., 7, 27 Sunvillo, W . W., 62, 83 Sutherland. N. S., 90,93, 95, 99, 113, 118, 121 Swartz, J. D., 129, I49 Sweet, B. S., 280, 350 Taber, J. I., 231, 239 Taboada, A., 313, 351 Tague, Cecilia, 227, 228, 232, 233, 234, 235, 236, 237 Takeuchi, Yasuyuki, 222, 232, 239 Talbot. F. B., 74, 83 Taman. I., 274 Tavris. E., 309, 354 Taylor, E.,23, 27 Terrace, H. S., 165, 208 Thieffry, S., 274 Thorne, F. C., 286, 288, 295,354 Thurston, J. R., 335, 336, 354 Tighe, L. S., 111, 121

362 Tighe, T. J., 111, 121 Tizard, J., 135, 144, 149 Tong, J . E., 74, 83 Tosquelles, F. A., 277 Trabasso, T., 88, 114, 121 Tremaux, M., 273 Tulving, E., 36, 45, 56 Turpin, R., 275 Turrisi, F. D., 100, 102, 121 Tyson, Florence, 320, 354 IJllmanii, I.. P., 19, 26, 27, 155, 207, 208 Underwood, B. J,, 34, 35, 39, 56 Urquhart, D., 71, 80 Vail, D. J., 286, 295, 297, 298, 315, 354 Vallon, J,, 296, 353 Venables, P. D., 59, 82 Vialatte, J.. 275 Vinogradova, 0. S., 66, 69, 82 Vlahovitch, B., 275 Vogel, W., 63, 68, 70, 83 Wagner, R., 291, 350 Walbaum, R., 274 Walker, J., 313, 351 Wallace, W. P., 39, 40, 56 Walters. R. H., 4, 26 Wanderer, 2. W., 286, 308, 325, 326, 328, 353, 354 Weatheiwax, J., 38, 56 Weigl, Vally, 320, 321, 354 Wells, D., 109, 110, 121 Wenger, M . A,, 60, 83 Wertheimer, P., 272

Author Index Wexler, H. K., 287, 353 White, B. L., 293, 332, 354 Wicijowski, P. J., 134, 148 Wiest, G., 325, 354 Wilcox, C . T., 285, 288, 305, 306, 354 Wilder, J.. 68, 75, 83 Williams, C. F., 219, 220, 226, 232, 233, 234, 238 Williams, C. M., 335, 349 Williams, T. A., 61, 62, 83 Winick, C., 285, 354 Winters, J . J., Jr., 34, 54, 56 Wischner, G. J., 125, 126, 127, 130, 131, 132, 136, 147, 149 Wishner, J., 35, 56 Wolf, M . M., 227, 228, 232, 233, 236, 237, 239 Wolfensberger, W., 64, 67, 69, 77, 83 Woods, W. 6..225, 226, 238, 239 Wright, D. J., 60, 81 Wyckoff, L. B., Jr., 4, 27, 93, 121 Yates, Mary L., 340, 354 Yonge, K . A., 286, 314, 352,354 Young, F . A., 23, 27 Youngs, E. A., 111. 121 Youniss, J., 99, 101, 102, 105, 113, 120, 121 Zazzo, R., 274 Zeaman, D., 5, 27, 87, 88, 90, 93, 95, 96, 98, 99, 100, 101, 103, 104, 106, 108, 112, 113, 117, 118, 120, 121, 129, 131, 135, 148, 233, 238 Zigler, E. F., 132, 149

Subject Index Acquisition, 23 Activation, 246-248 Arithmetic, programmed instruction of, 221-225 Arts, as psychotherapy, 287 Autonomic nervous system, methodology and, 75-76 speculations conccrning, 76-79 Autonomic nervous system functions, conditioning and, 71-72 differences between subcategories of defectives and, 72-74 fluctuations during rest and, 61-62 habituation and, 68-70 latency and, 68-70 patterning of, 70-71 reactivity and, 62-68 recovery time and, 68-70 resting levels and, 59-61 Behavior sequence, 24-25 CA. paired-associatc lcarning and, 46-47 Ceiling effect(s), learning sets and, 130 Change, 24 Chromosomal investigations, 246 Clustering. free recall and, 37-45 raising recall by inducing, 44 relationship of sorting to, 41 Condition@) for training, optimal, 6-9 diffcrential feedback and, 7 distributed repetition and positive transfer and, 8 elicitation of correct response and, 6-7 immediate knowledge of results and, 7 motivation and, 8-9 sequential huilding and, 9 stimulus generalization and positive transfer and, 7-8 stimulus randomization and, 8 Conditioning, autonomic nervous system and, 71-72

Defectives, differences between subcategories of, 72-74 Deficiency, mental, see Mental deficiency Deficit($ learning and, 5-6 Difference threshold, circle-ellipse discrimination and, 187-197 Discrimination, circle-ellipse, 157-187 discrimination threshold and, 187-197 teaching programs and, 159-187 concurrent, learning sets and, 132-133 conditional, learning sets and, 133 object-quality, 124-127 amount of pretraining and, 125-126 etiology and, 127 incentives and, 127 institutional and noninstitutional patients and, 126-127 learning sets and, 124-127 length of problems and, 124-125 oddity problem, learning Sets and, 133134 Discrimination reversal, learning set and, 131-132, 197-207 probe series and, 198-201 reversal program and, 202-207 Education, 255-261 as therapy, 288 rehabilitation and, 257-258 vocational, 258-261 Electroencephalographic study, nature of deficiency and, 262-263 Element, 24 Elicitation, 22 secondary, 24 Elicitation hierarchy, 22-23 Error factors, learning sets and, 128-129 Etiology, nature of deficiency and, 262 object.quality discrimination and, 127 Extinction, 25

363

364

Subject Index

Feeblemindedness, 254-255 Feedback, differential, training and, 7 Genotype, nature of deficiency and, 263-264 Habituation, 68-70 Incentive, object-quality discrimination and, 127 Institutionalization, object-quality discrimination and, 126127 therapy and, 301-318 IQ. learning set formation and, 129-130 Knowledge of results, immediate, training and, 7 Latency, 68-70 Learning, conceptual, effect of ,training on, 138141 deficits and, 5-6 discriminative, dimensions and stimuli and, 87-89 shift and, 89-92 theories of, 92-97 optimal conditions for, 6-9 differential feedback and, 7 distributed repetition and positive transfer and, 8 elicitation of correct response and, 6-7 immediate knowledge of results and,

7 motivation and, 8-9 sequential building and, 9 stimulus generalization and positive transfer and, 7-8 stimulus randomization and, 8 paired-associate, 45-48 equal C A comparisons and, 46-47 equal M A comparisons and, 48 programmed, see also Programmed instruction circle-ellipse discrimination and, 157187 difference threshold and, 187-197 general methodology for, 152-157 reversal of discrimination and, 197207

symmetry and, 30-34 theory of, 1-5 verbal, 34-48 clustering in free recall and, 37-45 Learning set@), 123-137 ceiling effects and, 130 concurrent discrimination and, 132-133 conditional discrimination and, 133 discrimination reversal and, 131-132 error factors and, 128-129 formation of, M A and IQ and, 129-130 minimum stimuli and, 135 object-quality discrimination and, 124127 amount of pretraining and, 125-126 etiology and, 127 incentives and, 1%’ institutional and noninstitutional patients and, 126-127 length of problems and, 124-125 oddity-discrimination and, 133-134 retention and, 130-131 spatial relationships and, 135 stimulus characteristics and, 131 Learning theory(ies), two-stage, 97-104 conditions affecting transfer and, 99-104 transfer of mediating responses and, 98.

99 Length of problem, object-quality discrimination and. 124-125

MA, learning set formation and, 129-130 paired-associate learning and, 48 Mental deficiency, activation of retarded, 246-248 chromosomal investigations of, 246 education and, 255-261 rehabilitation programs, 257-258 vocational training, 258-261 medical treatment of, 244-246, 261 morphological investigations of, 246 nature of, 261-271 “organic” approach, 261-264 “psychological” approach, 265-271 neuropsycholngical investigations of, 251-252 psychological examination. therapy and research and, 249-251, 266-271, 287347

Subject Index social integration and, 255-261 rehabilitation programs, 257-258 vocational training and, 258-261 sociomedical investigations and, 244 treatment of, 244-246,255-261,287-347 Morphological examinations, 246 Motivation, training and, 8-9

365

Reading, programmed instruction in, 21 1221 Recall, digits and, 48-52 “bits” of information and, 48-49 retardates and brain injured children and, 49-52 free, clustering in, 37-45 Neuropsychological examinations, 251-252 raising by inducing clustering, 44 relationship of sorting to, 41 Paired associate learning, see Learning, Recovery time, 68-70 paired associate Rehabilitation, Patterning of functions, 70-71 motor, 257-258 Percept ion, programming, physical expression, 258 circle-ellipse discrimination and, 157speech, 258 187 Reinforcement, extrinsic, programmed indifference threshold and, 187-197 struction and, 228-230 general methodology for, 152-157 Relationship therapy, 287-288 reversal of discrimination and, 197-207 Relaxation, 25 Preference, dimensional, transfer and, 113- Repetition, distributed, training and, 8 114 Response(s), Pretraining, object-quality discrimination correct, training and, 6-7 and, 125-126 instrumental, transfer and, 104-1I3 Programmed instruction, 210-233 mediating, transfer and, 98-99,10.1-113 comparison studies of, 232-233 transfer of, see also Transfer extrinsic reinforcement and, 228-230 shifts and, 104-113 normal subjects and, 230-231 Response class, definition of, 21-22 program evaluation and, 231-232 Response tendency, definition of, 22 program variables and, 231 Rest, spontaneous fluctuations during, 61retarded subjects and, 210-228 62 arithmetic, 221-225 Resting levels, 59-61 reading, 211-221 Retention, learning sets and, 130-131 spelling and writing and, 225-227 Reversal, transfer of responses and, 107vocational skills, 228 113 Projective techniques, 287 Psychoanalysis, nature of deficiency and, Satiation hypothesis, 22 266-271 Sequential building, training and, 9 Psychological examination, therapy and Set(s), learning. see Learning Set(s) research, 249-251 Shift@), Psychometric tests, nature of deficiency discriminative learning and, 89-92 and, 265-266 reversal vs. nonreversal, 109-113 Psychotherapy, see also Therapy transfer of responses and, 104-113 definitions of, 281-282 Social integration, 255-261 novel techniques, 325-331 rehabilitation programs for, 257-258 parents of retardates and, 331-347 vocational training for, 258-261 procedures available, 284-347 Sociological aspect of deficiency, 265 group applications, 299-325 Spatial relationships, learning set and, 135 individual applications, 288-299 Speech therapy, 296 theoretical model for, 282-284 Spelling, programmed instruction of, 225Reactivity, 62-68 227

366 Sociomedical investigations, 244 Stimulus, characteristics of, learning sets and, 131 definition of, 21, 24 discriminative learning and, 87-89 effective. definition of, 24 minimum, learning sets and, 135 Stimulus generalization, training and, 78, 23-24 Stimulus randomization, training and, 8 Stimulus symmetry, 30-32 Symmetry, 30-34 response, 32-34 stimulus, 30-32

Subject Index sequential building and, 9 stimulus generalization and positive transfer and, 7-8 stimulus randomization and, 8 perceptual-motor transfer and, 143-144 stimulus generalization and, 23-24 theory of, 1-5, 21-25 behavior sequence and, 24-25 change and, 24 element and, 24 elicitation and, 22 extinction and, 25 omission and, 24 relaxation and, 25 response and, 21-22 response tendency and, 22 secondary elicitation and, 24 stimulus and, 21 transfer of, perceptual-motor, 143-144 school-like situations and, 149.146 transposition and, 141-143 vocational, 258-261 Transfer, conditions which affect, 99-104 overtraining, 99-101 type of problem, 102-104 dimensional preferences and, 113-114 mediating and instrumental responses and, 104-113 mediational, amount and direction of, 114-115 perceptual-motor, 143-144 positive, .training and, 7-8 reversal and shifts and, 107-113 shifts and, 104-113 training and, see Training, transfer of two-stage learning theory and, 98-104 Transposition, transfer of ,training and, 141-143 Treatment, 244-246, 255-261, 287-347 medical, 244-246, 261 psychotherapy, see Psychotherapy, Therapy rehabilitation programs for, 257-258 vocational training and, 258-261

Teaching programs, see also Programmed instruction circle-ellipse discrimination and, 159187 Therapy, see also Psychotherapy education as, 288 group, 288, 299-325 institutional, 301-318 noninstitutional, 318-325 institutional, 301-318 directive procedures, 301-310 nondirective procedures, 311-318 music as, 296 noninstitutional, 318-325 directive pryedures, 318-323 nondirective procedures, 323-325 occupational, 295-296 projective techniques for, 287 relationship, 287-288 speech, 296 Training, 246-248 acquisition and, 23 effect on conceptual learning, 138-141 elicitation hierarchy and, 22-23 future directions for, 19-20 method of, 9-19 apparatus for, 10-11 assessment of, 18-19 procedure for, 11-18 optimal conditions for, 6-9 differential feedback and, 7 distributed repetition and positive transfer and, 8 elicitation of correct response and, 6-7 Vocational skills, programmed iilstruction of, 228 immediate knowledge of results and, 7 Vocational training, 258-261 motivation and, 8-9

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