SCHEMA FOR THE CLINICAL STUDY OF MENTALLY AND 1DUCATIONALLY UNUSUAL CHILDREN J. E. WALLACE WALLIN, PH. D. Director-elect of the Psycho-Educat tonal Clinic in tin St. Louis Public Schools INO CHAPTER XIX OP THE MENTAL HEALTH OF THE SCHOOL CHILD pp. 429-450 SIEW HAVEN: YALE UNIVERSITY PRESS MDCCCCXIV EX LIBRIS THE UNIVERSITY OF CALIFORNIA _. \ FROM THE FUND ESTABLISHED AT YALE IN 1927 BY WILLIAM H. CROCKER OF THE CLASS OF 1882 SHEFFIELD SCIENTIFIC SCHOOL YALE UNIVERSITY A SCHEMA FOR THE CLINICAL STUDY OF MENTALLY AND EDUCATIONALLY UNUSUAL CHILDREN By J. E. WALLACE WALLIN, PH. D. l Director-elect of the Psycho-Educational Clinic in the St. Louis Public Schools BEING CHAPTER XIX OF THE MENTAL HEALTH OF THE SCHOOL CHILD pp. 429-450 NEW HAVEN: YALE UNIVERSITY PRESS MDCCCCXIV A/35 COPYRIGHT, 1914 BY YALE UNIVERSITY PRESS A SCHEMA FOR THE CLINICAL STUDY OF MENTALLY AND EDUCATIONALLY UNUSUAL CHILDREN. The scientific study of the educatienaily ^ex^e child should follow a definite plan of procedure and should be sufficiently comprehensive to include an investigation of all the important intrinsic and extrinsic factors which may mar his development. A complete investigation should include the study of the child's developmental, family, hereditary and school histories, an investigation of his past and present social and physical environment, and an examination of his present physical condition and anthropometric, educational and psychological status. A completely satisfying investigation thus requires the co- operation of the social and hereditary worker, the teacher, the medical expert and the psycho-educational clinician. The following schema is offered as a guide to the scien- tific examination of mentally abnormal children. It may be used in either of two ways. First, the various forms may be reprinted on separate blanks with appropriate vacant spaces, to be filled in by the investigator. The chief objection to this plan is probably financial: blanks are expensive, and in few cases will it be possible to fill out all the spaces, while in many cases it will not be necessary to do so. Second, the investigator may thoroughly familiarize himself with the contents of the various forms, and follow them as a systematic and comprehensive guide to his investigation; but instead of entering the data on printed blanks he may write up a 'running history,' giving the essential facts of the case, on blank sheets. Whether the one plan or the other is followed, it is desirable that every investigator should append a brief summary of his findings and recommendations. "Jt'}?annat;b;3; t,6d forcibly impressed upon social, field .and lajjpratory 'investigators of children that parents and V0U'tjv.(?g4- r 6i l -any; frctm., whom bio-social data are sought must be approached with much tact and judgment. Gathering hereditary, personal and social data is, at best, a very delicate undertaking, subject to many errors, and many investigators fail utterly to secure, or otherwise they pervert, the significant factors, either because they do not know how to approach parents so as to win their confidence and put them in a communicative attitude, or because they suggest answers by their indiscreet use of leading questions. While, therefore, a 'guide' will prove of the greatest value to child investigators, they must know above all else how to use the guide with tact, common sense and discriminating intelligence. Social and hereditary investigators must also be cautioned against drawing premature or unjustifiable conclusions from hearsay evidence. They must accustom themselves to weigh reports very carefully, and to verify them in every way possible. There is a large amount of work done today in heredo-biology, heredo-psychology and social investigation which is careless, unscientific and worthless. Do not conclude that someone was feeble- minded or insane simply because someone reported him to be 'slow,' 'stupid,' 'feebly-gifted' or as acting 'queerly.' Do not conclude that a child is feeble-minded simply because he appears stupid or feeble-minded to you, or because he happens to test three years, or even four or five years, retarded. Science cannot be founded on guess- work. Gather all possible facts bearing on your case, and avoid hasty generalizations. It is rather for the trained specialist to supply the diagnoses. It need scarcely be said that when the same person gathers the developmental, hereditary and school data, it is not necessary to re-record on each blank the identical facts called for in the different blanks unless there is a discrepancy in the statements. FORM I DEVELOPMENTAL HISTORY No. Diagnosis Source of data Date Full name Age: date of birth yrs. mos. Address (with 'phone) Father's name Mother's name Guardian's name By whom referred for investigation (Underscore appropriate words, and fill in other data) CONCEPTIVE CONDITIONS: diseases, syphilis, gonorrhea, tuberculosis, scrofula, alcohol, drugs, health, overwork, starvation, fright, accidents, anxiety, excitement, aversion, etc., before or at time of conception in mother in father PREGNANCY CONDITIONS: above data for mother during pregnancy. Also pelvic diseases, attempts at abortion, 'maternal impressions,' legitimacy of child BIRTH CONDITIONS: premature (how much) full term, weight labor normal, prolonged (how long) or difficult; delivery with instruments or anesthesia; difficult animation, breathing or crying, cyanosis; injury or deformity (especially of head) or paralysis; inability to suckle GROWTH CONDITIONS: nursed (by whom, how long) Bottle fed (how long, what) What fed when weaned Sickly as baby or child First teeth, when (any fever or illness) Second teeth, when Fontanel, closed when First crawled, when Stood alone, when Walked (unsupported steps), when Walked well, when Ran well, when Supported head, when Talked single words correctly applied, when Short phrases, when Complete sentences, when Specific speech defects, what, since when, circumstances Able to hold or grasp well, when Control of fundamental reflexes (acquisition of tidy habits), when Beginning of puberty Of menstruation (difficult) DISEASES AND ACCIDENTS (age, attributed cause, severity, subsequent effects, recovery) : measles, smallpox, whooping cough, scarlatina, scarlet fever, mumps, diphtheria, cerebro-spinal meningitis, infantile paralysis, rickets, malnutrition, inanition, scrofula, swollen glands, adenoids, enlarged tonsils, nose, eyes, ears, nervousness, muscular twitches, where chorea, periodical headaches, fainting spells, convulsions (infantile or epileptic, with data) enuresis (nocturnal or diurnal), falls, injuries, orthopedic deformities, pubertal or menstrual troubles Vaccinated, when, effects Hospital or surgical record M. D.'s by whom examined or treated Diagnoses by different M. D.'s HABITS: sleep (past and present) : hours of retiring and arising sound, restless, insomnia (cause). Drinking: tea, coffee, wine, beer, whisky; drugs (how much, how frequently) Appetite: hearty, poor, capricious, gluttonous, food preferences, usual menu Chews or smokes: cigarettes, cigars, pipe. Excessive indulgence in sweets Masturbates, sexually immoral or perverse. MENTAL AND PHYSICAL PECULIARITIES IN INFANCY AND CHILDHOOD (age first observed, parents' explanation): queer or bizarre ideas, action, behavior, speech, disposition Fits of crying or laughing, with or without cause Outbreaks, tantrums, continuous or periodic Night terrors, sleep-walking Morbid fears Criminal, intemperate, immoral or destructive tendencies Running away Solitude or company preferred Shut-in, solitary disposition Playing or seeking younger or older persons or opposite sex Dull, stupid, lazy, indifferent, bright, talented, precocious (with facts) RECORD or DELINQUENCIES (with ascribed causes, institutional, court and probation records) : AGENCIES which have previously been interested in this child: ADDITIONAL REMARKS: RECOMMENDATIONS (by whom) : RESULTS OF FOLLOWING RECOMMENDATIONS (as reported later): SIGNATURE : FORM II FAMILY AND HEREDITARY HISTORY No. Diagnosis Source of data Date Full name Born, where Age: date of birth yrs. mos. Lives with at (street, with 'phone) Name, with birthplace, nationality and religion of father of mother Language spoken at home Order of child's birth no. of sisters, alive dead of brothers, alive dead Age of father at child's birth of mother Blood relationship between parents Parents living apart, together, divorced. Occupation and weekly earnings of father of mother of other children of child Health, morals, habits, diseases, sexual habits, etc., prior to birth of child, of father of mother (see Form I) i c t e. g l 1 s i 4 c fl en Jl Hsvasi p}2-j C^g P l| j < | * In courts, in t it 11- tions, or hospitals. | H> 'I ft w I-B J I : c C | Criminal |i r i < \ fi (. 3 >. ?-a 5l i i +j Health X Subject iii i ill I ill J & n $ ' <( s 1 1 1 i 1 1 i 1 1 1 1 i 6,a,c ^3 <*,2i2 ( 2 oo O pbwww9IX9lplO s a 3 -5 rf^S 1 g I a | 5 u O c -M o S - J3 53-2 3 S " 8 $ 8 *0 Q ft a 4 it i c bo a.s *C3 a? 3 S hl= C ^3 g ^ H H ^* *^ bo S 4> S 3 .S w ^sS r oll 2^ S2 III! iiai ee 15 llsrl 3 ^3 o "2 13 ?. n & s o rai or S ^ o ^ Wg f^i, lliiisg r lll! ^3 -O tfl FORM III HOME AND NEIGHBORHOOD ENVIRONMENT No. Diagnosis Source of data Date Full name Age: date of birth yrs. mos. Address (with 'phone) Lives with Parents' address, if different Father's name Mother's name Parents alive Parents living together If separated, divorced or deserted. Guardian's name and address Child's birthplace Language spoken in home Referred for investigation by Successive places of residence (with sanitary, hygienic and moral conditions of each) PRESENT HOME INFLUENCES (Underscore appropriate words, and fill in other relevant data) FINANCIAL: rich, moderate, poor, impoverished, proverty-stricken, charity case. Weekly earnings of father mother children Breadwinners, who Influence of financial conditions on child's care FOOD: quantity quality DRINKS: what how often how much No. of meals (typical menus) CLOTHING: ample, insufficient, shabby, soiled, tasteless, immodest (effect on child) BATHING: frequency HOUSING: flat, tenement, house; no. of rooms of bedrooms bathroom no. of lodgers in family of boarders Clean, bright, sunshiny, artistic, attractive, dark, dingy, damp, filthy, disordered, well or poorly ventilated. Garbage Sewerage Child's bedroom: quiet, good ventilation, light, sleeping companions, no. in room Hours of retiring and arising HOME LIFE: excellent, tranquil, religious, moral, refined, upset, dis- turbed, boisterous, raw, quarrelsome, brutal, fighting, vulgar, degrad- ing irreligious, immoral, bad. HOME TREATMENT: excellent, good, kindly, good care, indifferent, neglectful, poor care, parents away, petted, coddled, well or poorly disciplined, ridiculed, rebuffed, irritated, maltreated, whipped, frightened, abused, by father, mother, stepmother, siblings, guardians, etc. Overworked CHILD'S DEPORTMENT AT HOME: excellent, good, average, poor, bad; obedient, disobedient; mischievous, quarrelsome, fights, cruel to animals or siblings or playmates, incorrigible, destructive; cheats, steals, squanders money, pawns, gambles, plays craps, deceives, lies, untrustworthy; neat, careless, indolent, immodest, immoral; runs away. Attitude toward parents, siblings, playmates, strangers Toward reprimands and punishment How punished Deportment of siblings at home AMUSEMENTS AT HOME: what, cards, games, plays, singing, music, reading, proper, improper. How does child spend leisure time? Chief interests at home Vacations, when where spent WORK: complete record of jobs, with dates, how long held, hours, pay, success, reasons for changes or discharge Age on taking first job RELIGIOUS DISPOSITION: religious, irreligious or indifferent. Attends church, where, how often, willingly or reluctantly Attends Sunday school, where, how often, willingly NEIGHBORHOOD INFLUENCES PHYSICAL SURROUNDINGS: sanitary, insanitary, dark, smoky, filthy, shimmy, densely populated, foreign population, saloons, dance halls, gambling joints, picture shows, immoral resorts. SOCIAL ENVIRONMENT: character of chums or associates (boys, girls, adults), good, bad, vulgar, gamblers, crap players, immoral, corrupt, criminal, thieves. Belongs to clubs or gangs, as leader or follower, what kind (social, amusement, literary, predatory, criminal, etc.), effects of on child ^ Tendencies toward loafing, vagrancy, migration. Recreation facilities of neighborhood: playgrounds, public, private, supervised, unsupervised, streets, home yard, athletic field, gymnasium, social settlement house. Seeks what kinds of amusements (games, plays, loafing, running around, ball, gambling, crap playing, immoral practices, selling papers, theaters, picture shows, etc.). Plays with boys or girls, older or younger. Attends picture shows or theaters, how often What kind of shows preferred Effects of on child RECOMMENDATIONS : RESULTS OP RECOMMENDATIONS (from later investigations) : SIGNATURE : 10 FORM IV SCHOOL HISTORY TEACHERS' REPORTS ON PEDAGOGICAL, PSYCHOLOGICAL, SOCIAL AND MORAL TRAITS No. Diagnosis Reported by (with position) Date Full name Sex Age: yrs. mos. Birthday Address (with 'phone) Parents' or guardian's name (and address, if different from child's) and religion of father Language spoken in child's home Nationality, language mother By whom referred (Underscore appropriate words : once for 'moderate,* twice for 'marked,' and thrice for 'extreme' degree. Also fill in data in blank spaces.) ATTENDANCE RECORD: Age on entering first school (kindergarten included) Names of schools attended, in correct time order Location of School Time, from to No. of months in attendance Grades completed Grades repeated (1) (2) (3) (4) Repetition: number of months spent in each grade child has repeated Total time (years or months) spent repeating work Retardation: grade in which child should be according to age Present grade Amount of pedagogical retardation (yrs. and mos.) Attendance, regular or irregular, during past or present time (ascribed causes of irregularity) PAST RECORD: character of work, conduct, disposition, traits, etc., as reported from previous teachers or specialists PRESENT PEDAGOGICAL STATUS: School efficiency in general: excellent, good, fair, poor, very poor, total failure. Prospects of promotion: excellent, good, fair, poor, none. Poorest work in which branches Best work in which branches 11 Special aptitudes, what Greatest interests, or likes, in school work Greatest dislikes Pedagogical traits in which strongest In which most deficient Learning capacity: is child good or poor in ability to observe to concentrate to memorize (mechanically, logically, understandingly) to retain to express orally or in writing to form habits to adapt self to new or changing situations, conditions or emergencies to think, judge, reason, under- stand to do independent work to lead to direct to originate, invent to keep a level head (easily confused) Learns best by repetition, rote, memorizing, reasoning, imitation, reading, being told, doing or experimenting for self (hit or miss). Accomplishments: in reading; knows alphabet (letters not known) reads in what reader how well reads at sight, syllables, short words, long words, spells out words In arithmetic : counts, how far Ability in addition, subtrac- tion multiplication division problems How far advanced Best in concrete or abstract work In spelling: sample words child can spell Words child cannot spell In writing In drawing In grammar In language work In speaking, dramatizing In music In kindergarten In manual train- ing In shop work In domestic science In school gardening In gymnastics, games In history In geography Ability of brothers of sisters Reported defects or capacities of mother of father ATTITUDE TOWARD SCHOOL WORK: interested, willing, tries, indus- trious, energetic, cheerful, trustworthy, lazy, slovenly, careless, shirk- ing, despairing, diffident, non-persevering, easily wearied or fatigued, grows sleepy, dopey, disinterested, bored, inattentive, complaining. ATTITUDE TOWARD CORRECTION, REPROOF OR PUNISHMENT: heedless, resentful, headstrong, obstinate, talks back, abusive, sensitive, cries, indifferent. Very responsive, tries to improve, takes it with good grace. ATTITUDE TOWARD PLAYS AND GAMES: seeks or avoids games. Plays much or little. On playground Plays with boys or girls with younger or older children 12 Fond of what games or plays Plays make-believe plays ability to plan or lead games Gets confused in games Loses self-control Behavior in games MENTAL, MORAL AND SOCIAL TRAITS: Circumspect, deliberate, thoughtful, thoughtless, impulsive, careless, slothful, slovenly, lazy, inert, slow, dull, stupid, apathetic, unresponsive, taciturn, reticent, diffident, retiring, bashful, quiet Bright, talented, precocious, quick, responsive, talkative, loquacious, communicative, entertaining, boring Cheerful, good-natured, gay, humorous, kind, affectionate, sympa- thetic, helpful, generous, frank, obedient Moody, sensitive, despairing, fretful, cranky, resentful, malignant, defiant, angry, meddlesome, complaining, quarrelsome, trouble maker, brutal, fights, kicks, scolds, nags, spiteful, jealous, sullen, selfish, self-centered, proud, domineering, bossy, changeable moods, capricious disposition or character Graceful, artistic, neat, awkward, clumsy, poor gait, poor motor control, stumbles, falls, injures self Bold, reckless, heedless of danger, venturesome, blustering, noisy, fearsome, cowardly Restless, fidgety, nervous, scowls, twitching movements (of what) excessive movements, emotional, excitable, impulsive, passionate, violent Strange or peculiar actions, habits, speech (what) Sudden or capricious outbreaks of passion, anger, fear, destructive tendencies, love, gaiety, laughing, crying, tantrums, fits, fainting spells. Automatic actions (when excited or otherwise) Suspicious, solitary, seclusive, shut-in, avoids company, dreamy, observant Honest, truthful, pure, modest; dishonest, untruthful, steals, lies, profane, swears, obscene, lewd, masturbates, immoral Any sense of shame, of difference between right and wrong, of guilt, remorse, sorrow, reverence, religion Speech: stutters, stammers, lisps, lalls, indistinct, inarticulate, sluggish, mumbling, thick, incoherent, halting, jerky, rambling, point- less, labored; clear, fluent, logical, sensible, braggadocious, egotistical, gossipy; declaims, recites, sings Headaches, eyestrain, holds eyes near work, mouth open, poor hearing, takes cold easily, running nose, gets sick, tired Smokes, chews. Data from school medical record: 13 What special measures have been taken to overcome the child's pedagogical deficiencies ? To overcome his physical defects His moral or social shortcomings RESULTS or THESE MEASURES: RECOMMENDATIONS : RESULTS OF FOLLOWING RECOMMENDATIONS (from later inquiries): SIGNATURE : FORM V PHYSICAL AND ANTHROPOMETRIC EXAMINATION No. Diagnosis Examiner Date Full name Sex Birthday Age: yrs. mos. Address Parents' or guardian's name (and address, if different, with 'phone) Brought by Referred by (Underscore appropriate words: once for 'moderate,' twice for 'marked,' and thrice for 'extreme' degree. Supply all relevant data in blank spaces.) DEFECTS, DISEASES, DISORDERS AND STIGMATA (Anatomical, physiological, neurological) GENERAL APPEARANCE: Expression nutrition Fat, corpulent, lean, emaciated, fair, normal. SKIN: complexion; pallid, sallow, ashen, oily, moist, dry, leathery, wrinkled, baggy, florid, scars, birthmarks. TEETH: carious (number, degree) roots, tartar, impacted, irregular, malocclusion, rachitic, serrated, pointed, Hutch- inson's Gums TONGUE: thick, pointed, large, small, furrowed, enlarged papillae. THROAT: tonsils, enlarged, atrophied, submerged, pitted, soft, removed. Pharyngitis. Laryngitis. Mouth breather. Lymph glands. Thyroid, enlarged, atrophied. Adenoids. PALATE: cleft, V-shaped, arched, narrow. LIPS: normal, hare-lip, thick, thin, everted, fissured. NOSE: deflected septum, enlarged turbinates, polipi, rhinitis, broad base, sunken bones, squat, mongoloid, cretinoid. EYES: acuity, R L Astigmatism Small palpebral fissure, exophthalmos, choked disc, scotoma, hemiopsia, irregular or eccentric pupils, ptosis, oblique mongolian, epicanthus. 14 Nystagmus, strabismus, diplopia, accommodation to light to distance Argyll-Robertson Iris, color, R L Wearing proper or improper glasses EARS: acuity, R L Rinn6 Otitis media, R L Impacted cerumen, perforated drum, otorrhea. Large, small, Darwinian tubercle, lobule absent, fossae absent or irre- gular, pinna (size, shape) asymmetries FACE: immobile, mobile; forehead, Bombe", receding, low or narrow; prognathous jaws, asymmetries HEAD: hydrocephalic, macrocephalic, microcephalic, rachitic, syphi- litic, cretinoid, asymmetries. Hair: color coarse, dry, oily, scant, brittle. Pediculosis. SHOULDERS: round, square, stooped, asymmetrical. Scaphoid scapula SPIKE: scoliosis C D L lordosis, C D L kyphosis CHEST: flat, rachitic, pigeon, funnel, barrel-shaped, asymmetrical. Lungs Respiration, rate character UPPER LIMBS: LOWER LIMBS: Flat foot CIRCULATION: good, poor. Heart: dilation, murmurs, displacements. Pulse: volume rate rhythm pressure Veins Arteries Blood examination: red corpuscles white corpuscles hemoglobin color index Widal Wasserman ALIMENTATION: appetite digestion abdomen stomach intestines GENITO-URINARY SYSTEM: NEURO-MUSCULAR: tone, relaxed, flabby, tense. Corrugation, over- action of f rentals. Tremors, coarse, fine, unilateral, spastic, jerky, intermittent, rhythmical, of what parts Hand balance: relaxed, tense, drooping, asymmetrical, finger twitches Station: relaxed, unsteady. Head balance Gait: normal, lively, clumsy, shuffling, spastic, ataxic, waddling. Paralyses Contractures Fainting spells Tics Habit spasm Convulsions Chorea Epilepsy Hysteria Headache, migraine Anesthesias Reflexes: patellar, R L Clonus Babinski Other reflexes Defective speech OTHER DEFECTS OR STIGMATA: 15 ACTIVE DISEASE PROCESSES: record the diseases, and indicate whether slight or serious, of the integumentary, skeletal, muscular, nervous, nutritive, respiratory, circulatory, lymphatic, excretory and repro- ductive systems. HISTORY OF DISEASES, DEFORMITIES AND ACCIDENTS, WITH PREVIOUS MEDICAL DIAGNOSES: NAME OF EXAMINER: PHYSICIAN'S RECOMMENDATIONS: RESULTS OF RECOMMENDATIONS (as later ascertained) : Physician or hospital recommended: ANTHROPOMETRIC MEASUREMENTS Weight: Ibs. kg. Stature, net standing (mm.) Sitting Ponderal index Statural index Statural type Spread of arms Spirometry: 123 Chest girth (below level of axillae): maximal inhalation exhalation normal Vital index Dynamometry: Rl 2 3 LI 2 3 Head measurements: circumference height length (antero- posterior diameter) breadth cephalic index Other measurements FORM VI PSYCHOLOGICAL EXAMINATION It has been deemed wise to omit a schema for conducting psycho- logical examinations for the following reasons. First, a considerable number of graded scales for testing intelligence (particularly versions of the Binet-Simon scale) are now easily accessible in English. Second, hundreds of different psychological tests and experiments are equally accessible in the standard books dealing with psychological tests (e.g., the manuals by Whipple, Franz, Titchener, Sanford, Starch, Scripture). It would be futile to attempt to print a selected list of such tests here, because the expert experimental psychologist is qualified to make his own selection, while the inexperienced psychologist (physician, nurse, teacher) would scarcely be able either properly to conduct the experiments without technical training, or elaborate explanations, or correctly to interpret the findings. Third, there is little profit in outlining a comprehensive series of tests until reliable clinical norms are available. Unfortunately such norms are not yet available. The fact that this is so makes it all the more 16 necessary that the clinical psycho-educational examiner should possess very extensive first-hand experience with many types of mentally unusual children, so that he will be able to diagnose cases fairly accurately with the aid of a minimal number of tests. FORM VII PEDAGOGICAL EXAMINATION Until we have available a series of clinical pedagogical age-norms, in various school studies, established by objective tests given under standard and controlled conditions, possibly to individuals rather than to groups such as the Courtis scores in the fundamental mathe- matical processes, though these are group norms it would be of little avail to outline a schema for the pedagogical testing of the child. We have, to be sure, the pedagogical scales by Vaney and Holmes, but the former is very limited in range and not entirely appropriate to pupils trained by American school methods, while the latter has not been experimentally derived by objectively testing individual children of various ages (the method of derivation is not revealed). It is merely an abbreviated course of study for grades two to five which, it is assumed, represents the pedagogical accomplishments of normal children. Until we possess satisfactory pedagogical age scales of development, it will be necessary to use (but with discriminating judgment) the school record of the child (Form IV). FORM VIII SUMMARY OF IMPORTANT FINDINGS It is very desirable that social or field workers epitomize for the busy examiner the chief findings. This blank should be comprehen- sive, yet very brief: it should contain only the data which seem to have an important bearing on the case, which are important for diagnosis and prognosis. It may also include the chief results of the physical, anthropometric and psychological examinations, the final (or at least the provisional) diagnosis, the recommendations, a record of treatment, the results of treatment, and the final disposition of the case. The question naturally arises whether it is necessary or indeed desirable to make such an exhaustive investigation of each case as that contemplated by the above schema. 17 The answer is that it is usually desirable, but not always necessary or possible to do so. Unless the clinicist has at his command the necessary staff of assistants he must content himself with a far less thorough investigation. He should, however, at all times attempt to secure a certain minimum of data which bear significantly upon psycho- educational cases. Such a minimum is represented, I believe, by the following abbreviated record blank. It is reproduced from the routine blanks which have been in constant use in my clinic for several years. FORM IX ABRIDGED RECORD BLANK Child's name (with street and city address and 'phone) Parents' names (with address and 'phone, if different) Referred by Brought by Date Data secured from Recorded by Exact age: date of birth Age in yrs. and mos. Place of birth Nationality of father of mother Language spoken at home I. PEDAGOGICAL RECORD School now in All schools attended, in correct time order, with dates Age on entering first school (including kindergarten) Number of years (or months) in school Present grade In what grade should child be according to age Years retarded Number of years (or months) in each grade (including kindergarten) Grades repeated (indicate whether one, two or three years) Will child be promoted this year Attendance Greatest capacities, abilities or talents shown in school work (best subjects) Greatest interests Greatest deficiencies, worst faults, poorest school subjects Physical, mental and moral characteristics, disposition, deportment Other comments by teachers School medical inspection record School record of brothers and sisters 18 II. HOME AND ENVIRONMENTAL CONDITIONS Parents alive Living together Breadwinner (who) Financial conditions Home sanitary, well ventilated, clean In house, tenement, shack, apart- ment In good or bad (shimmy or immoral) neighbor- hood Social or moral conditions in home Home treatment (child neglected, cruelly or kindly treated, well cared for) What does child usually eat What does child drink Hours of retiring and arising Does child keep bad company III. CHILD'S DEVELOPMENTAL HISTORY Birth conditions: on time premature (how much) Labor, how long With instruments Birth injuries How nursed (length) Health as babe Infant and child diseases (state age, severity, after effects): Croup Whooping cough Chicken-pox Measles Diphtheria Scarlet fever Typhoid Pneumonia C.-s. menin- gitis Infant paralysis Spasms (describe) Enuresis Accidents By whom previously examined and diagnoses given First teeth, when (any illness) Fontanel closed First stood alone First sat up First steps unsup- ported First walked unsupported First used single words Short phrases or sentences Mental and physical peculiarities in infancy and childhood (age first observed): queer or unusual behavior, talk or ideas; emotional fits or outbreaks, fears, night terrors, destructive, disobedient, vagrancy, truancy, veracity, delinquencies, bad sex habits, social traits, play tendencies, stupid, sluggish, quick, bright IV. HEREDITARY FACTORS Health, habits, diseases, drink, etc., of father and mother before and during conception Pregnancy conditions (overwork, poor health, infection, drink, abuse, starvation, etc.) Age of mother at child's birth of father Parents related 19 |