THE UNSTABLE CHILD THE UNSTABLE CHILD 
AN INTERPRETATION OF PSYCHOPATHY AS 
A SOURCE OF UNBALANCED BEHAVIOR IN 
ABNORMAL AND TROUBLESOME CHILDREN 
BY 
FLORENCE MATEER, A.M., Ph.D. 
SPECIALIST IX CORHECTIVE EDUCATION IX THE MENTAL HYGIENE 
SCHOOL, COLUMBUS, OHIO; FORMERLY PSYCHO-CLINICIAN IN 
THE OHIO BUREAU OF JUVENILE RESEARCH; SOMETIME 
PSYCHOLOGIST IN THE MASSACHUSETTS SCHOOL FOR 
THE FEEBLE-MINDED; AUTHOR OF “CHILD 
BEHAVIOR,” ETC. 
NEW YORK 
D. APPLETON AND COMPANY COPYRIGHT, 1924, BY 
D. APPLETON AND COMPANY 
PRINTED IN THE UNITED STATES OF AMERICA TO 
MY MOTHER AND FATHER 
WHO LIVE WITH A FIRM BELIEF IN 
That which is out of sight, 
That thread of the all-sustaining Beauty 
Which runs through all and doth all unite. PREFACE 
The last word on the significance of mentality and 
mental testing has not been said. Social problems are 
beset with a tangled mass of psychological studies and 
reports which leave the person who has actual children 
to handle tired, perplexed, and at sea. Twelve years of 
mental testing by modern methods lie back of us. The 
optimistic assurance of the first few years of such work 
still persists among novices. The making of a psycho- 
logical diagnosis is still considered in many clinics a mere 
matter of technical skill. But in the practical work of 
courts, dispensaries, and schools a new attitude of eager 
and critical questioning has developed. Managing the 
everyday problems of delinquent and troublesome children 
has definitely demonstrated the fact that a diagnostic 
classification or a mental age has little to do with the 
solution of our social and educational crises. 
Is mental endowment an important factor in the evolu- 
tion of the child who is potentially a law-breaker? Prob- 
ably it is, but all troublesome and delinquent children are 
not feeble-minded or even backward. The child whose 
mental defect may be easily demonstrated by the routine 
of mental tests is not a difficult individual to handle. 
The question of obtaining permanent provision and pro- 
tection for him may be difficult because of limited custodial 
facilities, but the individual himself presents no traits 
that are not easily understood and explained. It is the 
child who is bright but different, the child who gets along 
in his school work but who upsets the schoolroom by 
behavior which is exasperatingly unexpected, the child 
VII VIII 
PREFACE 
whose behavior needs immediate modification but whose 
peculiarities leave one in doubt as to how that change may- 
be produced that causes most of our worries. Operations, 
treatments of all sorts, better environments, industrial 
training, education, supervised recreation, and all the other 
advantageous resources of modern social service have not 
been able to eliminate such problem children. 
Nor is this the whole situation. Given two children of 
the same actual age, with similar mental ages, satisfactory- 
environments, suitable recreational facilities, and proper 
schooling, one will present every potential indication of 
becoming a good citizen, whereas the other will reflect 
all possible vagaries of unreliable behavior, wrong desires, 
and wrong principles. Even in most of the case studies 
available one finds no indication of the reason why such 
variability appears. There is a definite cause, however. 
Back and beyond the various factors which are usually 
enumerated in such cases there lies an aspect of mental 
endowment which the present era of mental-age determina- 
tion has sadly overlooked. Just as each individual has a 
certain mental level or quantity of intelligence available, 
so he has a definite quality of that quantity. This quality 
may be good or poor. No matter what the child’s mental 
level, that intelligence which he has may function effi- 
ciently, inefficiently, peculiarly, disastrously, or unpredict- 
ably, because of such difference of quality. This complicates 
matters exceedingly. Actually, a statement of the mental 
level of a child may be most misleading, for any child 
is apt to be the one in whom mental function, not mental 
level, is the determining factor in behavior. We often 
hear mental tests spoken of as a “measuring scale.” The 
consideration of mental function adds a third dimension 
to this measuring of the individual. 
The erratic behavior of the child who tests normal, 
the peculiar inability of some bright children, the tan- PREFACE 
IX 
trums of incorrigibles, the economic independence of some 
individuals who “test feeble-minded,” and many other 
discrepancies met in social problems find their explanation 
when one studies the variability of mental functioning 
rather than the mathematical determination of mental age. 
This statement is neither far-fetched nor unjustified. Most 
books are an expression of some fact or of data which 
have been discovered by the writer. This book does not 
claim such a reason for its existence. It is primarily the 
exposition of an attitude. Yes, there are facts presented. 
The facts presented are. They show the actual presence 
of mental variations and deviations in function in a group 
of troublesome children in whom the mental-age determina- 
tion had revealed no reason for delinquent tendencies. 
These facts were gathered with scientific impartiality. 
Their interpretation is probably less assured, for it is the 
result of the attitude assumed in dealing with these cases, 
namely, that back and beyond mental age lies the socially 
significant factor of mental function. It is this factor 
which correlates far more closely than mental age with 
our everyday social problems. It is wrong mental function, 
psychopathy, as we call it, which explains why a child acts 
as he does when heredity, environment, physical condition, 
and education give no clue. It is functional deviation 
which sounds a note of hope for the future. “Once feeble- 
minded, always feeble-minded,” promises nothing of hope 
for the future of those whose mental level is definitely and 
abnormally low. When, however, instead of inferior 
mental level we have a mentality which is disturbed, dis- 
eased, and functioning wrongly, the future is apt to be 
more promising. The diagnostic determination of wrong 
function is but a forerunner of corrective education, defi- 
nite mental hygiene, and therapeutic “punishment” in the 
proper kind of hospitals. Nor is this a rainbow vision of 
pure theory. The writer offers but one argument for such X 
PREFACE 
an attitude and for the functional interpretation of mental 
ability. It is the old trite reason, the interpretation has 
proved workable. The continued application of it to more 
children, more extreme types of delinquency, and more 
involved social problems has but strengthened the theorem 
which such work formulates for itself. . . . There is no 
such thing as a bad child. Either he does not know any 
better or else he cannot help it. 
F. M. CONTENTS 
PAGE 
Preface vii 
PART I 
THE UNSTABLE CHILD IN THEORY 
CHAPTER 
I. The Origin op Clinical Psychology .... 3 
II. Recent Tendencies in Clinical Psychology . 15 
III. Problems op To-day 34 
IV. The Future Laboratory op Clinical 
Psychology 55 
V. The Clinical Psychologist, Himself ... 63 
VI. Means and Methods 79 
VII. Verification op Results 102 
VIII. Results so Far Obtained 117 
IX. A New Angle: Psychopathy 143 
X. Methods of Determining Psychopathy . . . 163 
XI. Serepta, a Psychopath 193 
PART II 
THE PRACTICE OF PSYCHOPATHY 
XII. The Delinquent as a Deviate 215 
XIII. A Practical Study op Delinquents .... 235 
XI XII 
CONTENTS 
CHAPTER PAGE 
XIV. Children under Six Mentally 248 
XV. Children Six to Nine Mentally 259 
XVI. Children Ten to Twelve Mentally .... 299 
XVII. Normal, but— 328 
XVIII. Intelligence Plus Delinquency 359 
XIX. Generalizations 380 
XX. Congenital Syphilis 388 
XXI. Conclusions 432 
Bibliography 461 
Index 467 PART I 
THE UNSTABLE CHILD IN THEORY THE UNSTABLE CHILD 
CHAPTER I 
THE ORIGIN OF CLINICAL PSYCHOLOGY 
No new development in any field is properly understood 
unless one views it in the light of that from which it has 
grown. Only by keeping a perspective which relates the old 
to the new and, contrariwise, builds the new out of the old, 
can we properly evaluate, criticize, reject, or accept the new 
aspects of any movement. Psychological developments 
exhibit no exception to this need. Indeed, the very nature 
of the problems which confront the psychologist is such that 
he, more than most folks, needs to keep absolute balance and 
realism in his understanding of the changing aspects of 
his professional field. 
To review the whole field of psychology as it has grown 
to its present activity would be but of indirect use to us 
in a study of that special branch which we call applied 
psychology and of that division of applied psychology which 
we call by the various names of clinical psychology, mental 
measurements, or intelligence testing. We must, however, 
see the relationship of one division to the others. Psy- 
chology is a new branch of the scientific study of man. Less 
than fifty years have passed since the distinction of how 
a human being feels and thinks about himself was first 
thought sufficiently important to deserve separate attention 
as a line of special research. Such research as it first 
attracted was medical in character, later became more 
definitely physiological, and was finally differentiated into 
the independent branch of psychology. For ten, fifteen, 
3 4 
THE UNSTABLE CHILD 
almost twenty years practically the whole field studied was 
that of the sensations and the reaction times. This was the 
natural starting point, for the understanding of heat, cold, 
pain, pressure, and the other elemental sensations was defi- 
nitely related to the study of man’s body. The other side 
of the situation, the brain’s reception of the stimulation of 
such nerve cells, was at that time but a secondary matter. 
Research soon led to a better appreciation of the two-fold 
nature of the problem, and out of the study of this second 
aspect has grown present-day psychology—theoretical, 
experimental, and applied (one hesitates to say practical). 
Let us emphasize one point immediately. Although psy- 
chology has become a separate branch of the scientific study 
of man and other animals; although it has specialized itself 
as the study of behavior in definite relation to definite 
stimuli; it has never separated itself from that older study 
of man as an organism, from which present-day medicine, 
physiological chemistry, odontology, dietetics, hygiene, and 
all the other branches of the more or less exact study of 
human beings have evolved. They are all most interdepend- 
ent upon each other. 
Naturally any one such line of observation and study 
must have two aspects, first the research aspect or the search 
for facts, and second the application of these facts to relief, 
improvement of, or at least understanding of, the problems 
investigated. Usually the two go hand in hand. A partial 
truth glimmers through the study of one case or condition. 
More research on it proceeds by a cautious, necessarily 
experimental, usage of that data in the next instance. It is 
thus progress is made. But psychology has developed in a 
fashion that is rather different from these other humani- 
tarian sciences. The interest in it was, at first, largely 
speculative and philosophical. Little of practical value 
was apparent in the exact knowledge of how simple sensa- 
tions were felt. Whether an individual reacted to a certain ORIGIN OF CLINICAL PSYCHOLOGY 
5 
situation in one-fifth of a second or in three-fifths of a 
second seemed to have no practical significance. Even in 
the late nineties the study of ideas was counted a part of 
philosophic foolishness, well relegated to poorly paid chairs 
in a few universities. Out of this grew the generally 
accepted concept of fifteen years ago. The psychologist 
was an “arm-chair” scientist, absent-minded, of little 
importance in the solution of social problems, theoretical 
and easily befogged, a childlike individual, reading dustily 
and publishing tomes which none read. This very miscon- 
ception gave psychology the chance to grow unhampered 
into certain definite procedures, to gather a mass of reliable 
data from workers who were uninterested in fame, compe- 
tition, worldly success or immediate practical utility of their 
findings. Truth for Truth’s sake was the motive of all 
psychological laboratories here and abroad for some thirty 
years. 
Of course, we must recognize that during this earlier 
period there were many more or less successful attempts to 
apply psychological findings to practical problems. The 
field of abnormal psychology claimed most of these efforts, 
for there, and there only, could be found in abundance 
obvious deviations from modes of thought and ability to 
think as they are usually found in so-called normal indi- 
viduals. No complete system of psychological study was 
evolved. Instead, a quaint mixture of the primitive in 
psychology, the obvious in practical life, the useful in 
medical practice grew up into psychiatry. (Even to-day 
most psychiatric manuals devote half of their space to the 
formulation of known facts concerning the sensations and 
dismiss the emotions, learning, memory, and the higher 
thought processes in a few pages each.) Educators of this 
earlier period did a great deal, especially in the study of 
the learning process itself. A mass of facts was arduously 
compiled on the relation of many various factors in the 6 
THE UNSTABLE CHILD 
method of teaching to the value of learning. Through this 
developed the impetus to the laboratory study by modem 
psychologists of types of imagery, modality, types of learn- 
ing, fatigue, and the many related problems of recall and 
forgetting. 
But, in general, no great social demand was made upon 
the province of psychology until Binet’s inspiration showed 
how known facts might be more readily made to yield more 
scientific data and yet give practical service at the same 
time by using them to measure mental development or in- 
telligence. Less than twenty years ago his work took this 
form, and yet we hardly need to state the significance of 
what he accomplished for present-day education, sociology, 
medicine, psychiatry, legislation, philanthropy, and crim- 
inology, as well as psychology. 
Two things psychology had evolved which he incorpo- 
rated in his contribution: First of all, certain facts of 
human behavior or ability. But these could have been 
gathered in a few years, had they not been at hand. Sec- 
ond, and far more important, was the contribution brought 
by the rigorously enforced traditions and ideals of all 
psychological laboratories of the day. Since they were in 
search of truth, truth was the handmaiden, and exactitude 
became the constant measure of worth on all done. Exact 
procedure, not dependent upon the worker’s memory but 
written down, exact records of results, exact and definite 
terminology, exact impersonal statistical evaluation, these 
formed the basis which rendered possible the development 
of a method which studied individual deviations, and from 
such a background sprang into existence the measuring 
scale of intelligence. 
No unprejudiced person would claim that Binet based 
his accomplishment upon developments in psychology alone. 
A certain ingenuity in the use of modern statistics and of 
modern child study were also necessary, and only the de- ORIGIN OF CLINICAL PSYCHOLOGY 
7 
velopment of community interest in the individual with 
an honest desire to provide for inferiors could have given 
opportunity for the problem to he worked out. In other 
words, Binet succeeded in his attempts at measuring intelli- 
gence in a practical way because he reenforced the experi- 
mental findings of psychology of his day by his use of 
progress and development in related fields. The chief fac- 
tor in the demand for some sort of tests was a desire to 
eliminate definitely feeble-minded children from the gen- 
eral school classes of Paris. The educator viewed children 
from the angle of their trouble-making propensities in the 
school room, their linguistic ability, or some other special- 
ized function. The physician inspected them from the 
standpoint of gross physical indications of inferiority, that 
is, with especial consideration of their “stigmata of degen- 
eracy.’ ’ Neither of these methods solved the problem, so 
Binet developed a new set of criteria, “mental” in their 
purport, dependent upon actual ability and not upon age, 
sex, grade, physical ability, or special home training. 
The measuring scale as evolved by Binet had attributes 
which could not help but insure its successful application. 
1. The simplicity of the plan, which made it easy for 
those practically concerned to grasp the theory. 
2. The definite, exact directions for general and indi- 
vidual test procedure, enabling workers to quickly educate 
themselves in the giving of the tests. 
3. The brevity of the individual task and the variety of 
tests which kept the subject interested and lessened fatigue. 
4. In the year evaluation, the ease of relating the test 
findings to the child’s actual age and to that which a child 
of his age should do guaranteed successful interpretation 
of findings to parents and lay persons interested. No more 
valuable method of scoring tests in relation to norms has 
ever been developed than this, which groups tests definitely 
by their norm values. 8 
THE UNSTABLE CHILD 
The result of the introduction of such tests into the solu- 
tion of educational problems was at once far-reaching. It 
is barely thirteen years since the first brief translation of 
this scale was published in a little magazine in this country 
which had but a few thousand subscribers. For two or 
three years after that practically all usage of the scale was 
tentative and even skeptical. But use brought the best of 
proof. Although the tests were based upon imperfect and 
insufficient norms and did not fit American children in 
many details, yet they were so much better than any of the 
methods previously used that their widespread adaptation 
was limited merely by the number of individuals capable 
of giving the tests. Summer schools and winter classes in 
normals, colleges, and universities soon gave a sort of super- 
ficial training to hundreds of teachers and less well-pre- 
pared students. “Mental testing” became the rage, and it 
would be hard to find a group of individuals of any special 
character who have not been tested. Schools, prisons, re- 
formatories, colleges, professors, maids, tramps, Indians, 
negroes, whites, all have had mental-age ratings. With what 
result ? 
At first, practically all efforts were directed towards the 
detection of the feeble-minded in the various groups. This 
was not only natural but inevitable. Binet’s own purpose 
in developing the scale had been the detection of feeble- 
minded children in the school system. That was the only 
efficacy he really claimed for the method. In this country, 
due to the position and interests of the man who intro- 
duced the scale, usage was two-fold from the very beginning. 
Even before he had published an abstract translation of the 
scale, Goddard and his assistant in the psychological labora- 
tory at The Training School at Vineland, New Jersey, had 
applied the test to the whole population of the institution 
with unexpectedly favorable results. Those who are famil- 
iar -with the first year arrangement of the scale will recall ORIGIN OF CLINICAL PSYCHOLOGY 
9 
that the definite standardization runs only through the 
twelfth year, with an imperfect attempt at a group of thir- 
teen-year-level questions. None of the children in the in- 
stitution passed the twelve-year limit save one whom no 
one thought feeble-minded (physically handicapped). The 
findings were then tried out in a practical way. Lists were 
made up grouping the children according to mental age, 
and these were submitted to the supervisors, matrons, and 
other staff members who best knew the children. In gen- 
eral, they were willing to accept the group at any one 
mental age as being composed of children similar in ability. 
Here and there a person objected, seeing superiority or 
inferiority in a certain child, but usually some one else 
contradicted the discrimination, so that, on the whole, the 
test grouped the children in a fashion which agreed with 
the balanced total of experienced observation on them. 
Naturally the test at once became an objective criterion 
used to determine the admission rating of new children and 
consequently was soon utilized as an aid in the diagnosis 
of children brought for advice and consultation. This was 
undoubtedly a step of tremendous importance in the field 
of clinical diagnosis. Before that time the usual procedure 
was not a standardized one in any way. The experts on 
the diagnosis of feeble-mindedness were essentially the men 
in charge of the various institutions for the feeble-minded. 
They had the greatest amount of practical experience, and 
that meant, up until 1911, the greatest diagnostic ability. 
There was no standardized method of evaluating their ex- 
perience. Most superintendents placed a good bit of em- 
phasis upon the age at which walking and talking began. 
To some, the physical earmarks were the most final proof. 
Others devoted nearly the whole of their inquiry to a sen- 
sible, but haphazard, study of accomplishments. Of course, 
the low-grade children, the idiots and the idio-imbeciles, 
were too obvious to need any such careful scrutiny, but all 10 
THE UNSTABLE CHILD 
the time there came the higher-grade children whom it was 
not so easy to diagnose, necessitating the use of these indi- 
vidual methods of testing with emphasis upon the exam- 
iner’s experience as the basis of his clinical determinations. 
It was no unusual thing to have a child brought for study 
w'ho had been to every man of any repute within hundreds 
of miles, but, more than this, from all those consultations 
would come no specific data, no comprehensible rating of 
the child which made definite his condition to parents, 
teachers, or other diagnosticians. The introduction of a 
concrete rating into the clinical study of a child changed 
all this. Even though the details of an examination made 
by one person were not immediately known, or even com- 
prehensible, to another the final rating was brief, tangible, 
and far less influenced by any personal factor than other 
diagnostic phrases. “Somewhat feeble-minded,” “high- 
grade feeble-minded,” “high-grade imbecile” mean one 
thing to one person, another thing to another, but “seven 
years in mental age,” or “ten years,” means a particular 
stage of development and ability. It is not hard to see why 
the “mental age” soon became at least an important ad- 
junct to the majority of clinics dealing with the mental 
problems of children. A few months’ experience in apply- 
ing the test gave ability which in many instances, at least, 
balanced the painstakingly gathered ability of others who 
had acquired it by years of experience without precision 
of method and uniformity of tests. 
But by far the most radical change came in the immediate 
application of the tests to school problems. Goddard did 
not rest content with trying out the scale on children in the 
institution but followed it by a survey of the whole public- 
school system of the village of Vineland.1 In all, approxi- 
i Henry H. Goddard, “Two Thousand Normal Children Measured 
by the Binet Measuring Scale of Intelligence, Pedagogical Seminary, 
June, 1911, pp. 232-259. ORIGIN OF CLINICAL PSYCHOLOGY 
11 
mately 2,000 children were examined. The work cannot be 
given too high credit for its pioneer value. Nothing of the 
sort had ever been done before. The schools were submitted 
to an unusual demand; children, one after another, all from 
each room, from the first grade through to the high school 
were examined individually. The emotional strain of the 
work was high, for no one knew at what moment some 
hypersensitive parent might object and stop the whole pro- 
gram in some unforeseen manner. The survey was made 
in a fashion which would be commendable even to-day. A 
card index checked grades, names, ages, and teachers’ esti- 
mates. Experienced social workers, women of tact and 
training, were used. The testing was limited to school 
hours. No child lost his recess, stayed after hours, or came 
earlier. Binet’s atmosphere of comradeship, games, and 
praise prevailed. The test results were worth while, even 
though they would in no way meet our present standard 
for diagnostic work. The ease with which the children 
could be differentiated into feeble-minded, backward, nor- 
mal, and bright, and the agreement between this rating and 
the problems that such children presented to the teacher 
stimulated belief in the validity of the scale, although many 
minor discrepancies, such as special difficulties of various 
years and undue difficulty or ease of individual tests, ap- 
peared. 
Other comparative studies were soon made and the next 
six years may be briefly described as a period of mental- 
age determination and, almost, of mental-age diagnosis. 
The validity of the scale findings led to a non-scientific, 
practical acceptance of them as the whole method of intelli- 
gence study. Most tests were given for the purpose of de- 
termining the number of feeble-minded in a given group. 
The educational and legislative propaganda of the time 
stressed the vast number of feeble-minded and the need for 
provision for them. In a way this was an excellent thing. 12 
THE UNSTABLE CHILD 
We needed something to make us break away from the 
single educational prescription with which we had been 
dosing all children. Special needs were realized, and teach- 
ers, feeling the tremendous relief which came from knowing 
it was defect in the children and not in their own teaching 
which made some fail, became the most ardent supporters 
of Binet testing. Special classes began the relief provision, 
and increased institutional provision followed more grad- 
ually. Neither of these are now actually issues. They are 
accepted needs, depending in their development only upon 
the amount of education a community has been given or 
the weight which can be brought to hear upon a legislative 
body to make it see and plan appropriations. So far—so 
good. 
But there is another side to the whole subject. In gen- 
eral, there can be no doubt but that the introduction of the 
mental test as a means of determining the part intelligence 
plays in social, economic, and educational problems has been 
a tremendous advance over the personal evaluation methods. 
But the advantage gained has not been without tremen- 
dously important disadvantages. Early adoption of the 
scale was almost universal, and, in most instances, it was 
put into use without any accompanying checking-up or 
corroborative test. This is not so much the fault of any 
one person or place as it is a result of the great demand 
for the scale, although both factors must be considered. 
Some of those who should have known better claimed all 
possible things for the test. Of course, they were naturally 
quite content to have others use the scale regardless of 
their fitness through earlier training to understand the 
limits of a test and to guard its applications accordingly. 
With blind naivete they taught all they considered neces- 
sary of Binet’s system and theory in six-week courses and 
sent out their students ready to use only this one test but 
feeling sufficiently able to meet the demands of the situation ORIGIN OF CLINICAL PSYCHOLOGY 
13 
since they could use the Binet with slide-rule accuracy. 
A large group of “mental testers” resulted, a group who 
often claimed to be “psychologists” and whose ability 
training and presumption reminded one most forcibly of 
the medical assumptions of the graduates of some schools 
of chiropractic and herb-doctoring. To this group the whole 
question of diagnosis was one of mathematical simplicity. 
When a child tested at a mental age which approximated 
his actual age, he was “normal.” When his mental age 
was one or two years below his actual chronological age, he 
was “dull” or “backward.” Three years backwardness 
made him ‘ ‘ very dull ” or “ very backward, ’ ’ and more than 
that made him “feeble-minded.” In the same way a men- 
tal-age superiority of one or two years made him “bright” 
and more than that made him “very bright,” or “preco- 
cious.” There were no loopholes left to the imagination! 
In most instances there was no attention paid to family 
history, developmental history, school progress, or even 
physical handicaps, except the most serious. Even in the 
laboratories accepted as leading the movement, supple- 
mentary data were largely a matter of the research interest 
of the individual examiner. Excitement centered about the 
rate of examining, the number of children an individual 
examined in a day, and especially around the percentage 
of feeble-minded found. As a result, the individual was 
lost sight of in the swirl of the group to which he belonged. 
No room was made in this one-way scale of evaluations for 
the exceptions. They did occur. Goddard himself reports 
precocious and normal children in families where both 
parents and all older children were definitely feeble- 
minded.2 At the time, these few cases were considered as 
rather anomalous exceptions to the general expectation of 
Mendelian inheritance. With our knowledge of the fact 
that there is such a thing as a potentially feeble-minded 
2 Goddard, Feeble Mindedness: Its Causes and Consequences. 14 
THE UNSTABLE CHILD 
individual who does not show any retardation on intelli- 
gence tests until the age of seven or eight or nine this 
single testing report of such children is not sufficient in any 
way to leave other than an open question as to whether 
later examinations might not have shown that these children 
(six out of 482 living children in families where both par- 
ents were feeble-minded) just happened to be caught be- 
fore retardation was sufficient to be obvious in our intelli- 
gence test findings. In the same way the most amazing 
reports have been presented and gravely accepted as to the 
percentage of feeble-minded individuals in institutions of 
one type or another. For instance, Fernald in his report 
of the white-slave investigation of Massachusetts estimates 
at least fifty-one per cent of the girls as definitely feeble- 
minded after all doubtful cases had been counted as nor- 
mal.8 Yet this whole study, based upon the habit of con- 
firmed immorality, takes absolutely no account of the possi- 
bility of psychoses of a sexual nature, deteriorations due to 
the possible and probable presence of the disease especially 
courted by the very nature of their offense, that is, syphilis, 
and the possibility that confirmed psychopathia sexualis 
might, without being feeble-minded, have inferior levels on 
mental tests. The report of the percentage in this group 
affected by syphilis is handled independent of its bearing 
upon the intelligence or social factors of the situation. 
One could multiply indefinitely illustrations such as this, 
but the reader can easily supply them for himself. Indeed, 
the apparent simplicity of the measuring of intelligence 
proved the greatest drawback to the actual growth of the 
professional application of the method. 
3 Report of the Committee for the Investigation of the White- 
Slave Traffic, So-Called, February, 1914. CHAPTER II 
RECENT TENDENCIES IN CLINICAL PSYCHOLOGY 
Of course, American enterprise was not long content to 
rest using Binet ’s own scale and so, having been presented 
with the idea, soon evolved a number of other “scales” of 
varying complexity and value. The Goddard revision was 
the first of these and supplemented the original Binet in 
several ways, besides rearranging tests more in accordance 
with findings on American children. The Point Scale was 
the next revision of any importance. In it Yerkes attempted 
a test rearrangement which would meet the criticism the 
earlier scales evoked, namely, that all tests, easy and diffi- 
cult, scored the same number of points and that some 
ratings were consequently most unfair to the individual. 
By point weighting more difficult tasks, through giving 
them two, three, or six points of credit each, he totals 100 
points to the scale. In this revision he discards the year 
gradation evolved by Binet and so loses one of the most 
important contributions of the year scale. Any one, almost, 
could work out a set of test questions, give them to indi- 
viduals, and score successes and failures on them without 
having any very critical idea of the ability of the persons 
tested when all was done. The year scale is just such a set 
of tests, tut each test result is immediately converted into 
a critical statement of the individual’s level of ability in 
that respect. For instance, to know that a child, let us say, 
of the age of ten cannot draw a diamond is one thing; to 
know that he cannot draw a diamond and that this is a 
seven-year-level test is a far more definite criterion of his 
ability. It gives significance to each task as completed. 
15 16 
THE UNSTABLE CHILD 
This immediate interpretation of test performances is lost 
in the Point Scale. 
In all probability the most widely used revision of the 
Binet is the Stanford. There is every reason why this 
should be so. The scale is more accurately graded from 
age to age than any other before it, the tests range in ap- 
plicability from the three-year to the adult (16 yrs.) and 
superior-adult (19 yrs., 6 mos.) levels. One may question 
some of the extreme values, but, as a whole, the standardi- 
zation has been so thoroughly determined and the details 
so accurately established that it seems worth using exten- 
sively before presenting further complications of the field 
by introducing new mental-age substitutes. To the great 
majority of those who know a little about intelligence test- 
ing the Stanford revision is intelligence testing. All else is 
an excess of seldom-applied tests. Unfortunately, this atti- 
tude is not restricted to those whose psychological training 
has been limited to courses in mental testing. There are a 
number of laboratories purporting to run psychological 
clinics which are content to diagnose upon a Stanford 
mental age. Within the year, the writer has had personal 
experience with an assumptious individual whose pride has 
been ability to apply a Stanford Binet in twenty minutes 
and who contentedly diagnosed over eighty per cent of a 
group of environmentally handicapped children as feeble- 
minded, using only this one criterion. Worse still, these 
diagnoses were accepted, backed, and used by the laboratory 
chief under whom she was employed. This is but a mild 
example of the extent to which the fanatical belief in men- 
tal age efficacy has extended. Such an occurrence does not 
come out of the clear sky. It can only happen as the climax 
of a long pursued and well developed attitude or policy. 
The great value of the Binet scale has completely filled the 
mental horizon of most of those who have been applying 
psychology. At present the need is definitely for a per- TENDENCIES IN CLINICAL PSYCHOLOGY 
17 
speetive that gets far enough away from concrete testing 
demands to see mental age in its true relation to other 
factors. To achieve this, we must study another aspect of 
present-day practice in psychology. The general problem 
of intelligence testing and psychological diagnosis was most 
emphatically influenced by the World War. Whether psy- 
chological tests as a part of the program for the selection 
and study of recruits really had any effect upon the winning 
of the War, it would be hard to say. But there can be no 
doubt but that the war usage of tests had a tremendous 
influence upon psychological testing. We now know, at 
least, that intelligence level bears a definite relation to the 
selection of trades and occupations and success in them. 
There may be many exceptions to the general uniformity 
of this rule, but the tendency is one that has been specifi- 
cally proven. 
The median mental age as obtained by the army exami- 
nation of 1,500,000 men was approximately thirteen and a 
half years. Marked difference was found in comparing this 
with the level of negroes and foreigners. Needless to say, 
such an enormous number of men was not examined by 
any individual usage of the Stanford or any other test. 
Instead, the urgency of the situation demanded rapid han- 
dling of large groups of men, and group tests resulted. 
Most of the army ratings were based upon one or the other 
of several alternate group tests developed for this very pur- 
pose, the Army Alpha and Army Beta, as they are usually 
called. Sufficient work was done with the Stanford to 
correlate the ratings on the group tests with mental-age 
findings and to make possible a mental-age evaluation of 
the individual scores on the group tests. Such individuals 
as deviated in extreme fashion from the general group 
rating were then given the individual tests before their 
disposition was finally determined. Undoubtedly some such 
a plan was sufficient for the purpose. The aim was the THE UNSTABLE CHILD 
18 
study of a large group of men from whom the most 
probable deviates, the least reliable, had to be eliminated. 
Minor differences were lost sight of in the vastness of the 
enterprise. The whole movement was one in which the 
problem was viewed from the perspective of group results. 
Those in charge dealt not with men but with tables, distri- 
butions, frequencies, means, and variations. The individual 
was but a pawn, a symbol of the minimal unit, in a game 
of thousands and millions. True, no single person was 
eliminated without some consideration as an individual, but 
even that was given more as a means of establishing statis- 
tical and scientific validity than because of interest in him 
as a human being. 
In other words, just as war itself is an immolation of 
individuals, a sacrifice of units for the ideals and princi- 
ples of the whole, so psychological procedure during the 
War lost sight of the individual in the strenuous attempt 
to deal with the demands of such a vast group problem. 
If the problem had stopped there, it would have been bad 
enough, but the force of example and precedence of train- 
ing have followed the men so engaged back into civil life. 
To-day we are probably at the height of the aftermath of 
this period. Nearly all psychological interest and attention 
is focused upon group testing and new group tests. The 
sense of power which may be so readily gained from deal- 
ing with large numbers has made pleasurable the survey 
type of mental testing, made it possible to achieve striking 
results rapidly, lends itself to statistical treatment, throws 
no onus of blame on one if a case which does not fit is 
“discarded,” and leads us—where? To answer that ques- 
tion, we must see first what group tests have accomplished. 
The group test is no longer a single species in its develop- 
ment. This method of handling individuals in the hope of 
solving some of their problems has spread rapidly into 
every aspect of intelligence, psychiatric, educational, and TENDENCIES IN CLINICAL PSYCHOLOGY 
19 
vocational problems. In some of these fields there can be 
no doubt of its advantage and finality. We educate in 
groups, our aim is the general fitness of the group, the 
material presented and the methods used must serve the 
purpose of the greatest possible number in the group, so 
why should not a group test in any subject, history, for 
instance, show where the group stands, its characteristic 
weaknesses and good points ? The better and poorer scores 
may well help a teacher to an understanding of her pupils 
as well as to an impersonal measurement of what she has 
given them. Arithmetic, English, spelling, and reading 
tests are equally obvious in their application. But even 
the person little interested in educational problems can see 
the fallacy of giving such a history test to pupils who have 
not studied history or to adults successful in other ways, 
but actually disinterested or even uninformed on that sub- 
ject. Any such test has a specialized place and must serve 
a specialized purpose only, or its application becomes illogi- 
cal and even absurd. 
Of course, this seems easier to understand than when we 
apply the same principle of selective usage to the giving 
of mental or intelligence tests. But there is a radical dif- 
ference. True, intelligence is at the bottom of all we do. 
Because of this, we are, in a certain sense, justified in test- 
ing intelligence under any circumstance to get the part it 
plays in what the group is doing under existing conditions. 
Consequently, group tests of intelligence are as logical as 
arithmetic tests or history tests. In a certain sense, yes; 
in another sense, emphatically, no. To go back to our 
former illustration, when one gives a history test and finds 
one child far superior to all the rest and three or four 
hopelessly inferior, no one would ever think of diagnosing 
the future life success of the group in relation to the re- 
sults on this one test. At the most, we would predict that 
A might make a good historian, whereas D and E and Z 20 
THE UNSTABLE CHILD 
obviously would not. Yet we know that in history instruc- 
tion these children have fared similarly. 
Intelligence testing allows of even less generalization. 
Intelligence at any one time is a product value, and many 
factors enter into it. It involves every experience of the 
individual to date, his physical handicaps, his environment, 
heredity, earlier education, especially in habits of thought, 
his emotional life, particularly his feelings or attitude 
towards himself as an individual and as a part of the group. 
No two individuals can be found, no matter where we 
search, for whom all things in life have been equal. To 
measure a group of fifty on general intelligence, therefore, 
means measuring fifty sources of absolute variability. Yet, 
when results are obtained, the mere fact that we are trying 
to measure intelligence leads on to a more or less inferred 
translation of our results into diagnosis ratings. Not only 
this, but the ideas of feeble-mindedness on one hand and 
superiority on the other are seldom far distant. To a cer- 
tain extent such ratings are permissible, but it is the finality 
with which they are applied that must be criticized and, if 
possible, eliminated. Group tests applied in schools, uni- 
versities, or prisons are no more a measure of the individual 
than they were in their war usage. They measure indi- 
vidual ability to fit into a demand made upon a social 
group. This is a vital part of normality, if we may define 
it as the ability of the individual to direct his reactions to 
the accomplishment of a group purpose; but the study of 
intelligence really means far more than this. 
To begin with, not all human achievements are easily 
measured by an abstract type of test, and we must bear in 
mind the fact that it is highly probable that an individual 
scoring low on a certain situation or test demand may meet 
other equally significant situations well. Again, many nor- 
mal individuals do not do well under group conditions. 
Competition stimulates one, but distracts another. TENDENCIES IN CLINICAL PSYCHOLOGY 
21 
No one has really ever settled the question as to whether 
it is the individual who fits nicely into the demands made 
upon the group that is of the most value to humanity. It 
seems highly probable that he is not. The individual whose 
thinking, although precise, logical, and systematic, is dif- 
ferent, who achieves distant ends by efficiency of mental 
activity, and who has different ideas, may well fail in 
group tests where even the answers desired are indicated 
in a prescribed form, yet he would undoubtedly, other 
things being equal, have far more chance of contributing 
positively to human progress. The writer cannot but see the 
short-sightedness which leads to any attempt of diagnosis 
on such a basis. Group tests have their place, a very defi- 
nite, time-saving place, but, on the other hand, one with 
certain limitations which have been, up to the present, 
almost unmentioned. 
The group test of intelligence is but a telescopic method 
of getting the first survey of a situation. The obvious 
deviations from group performance will show up readily. 
These will be at both extremes of the range of ability. The 
final categorizing of any of even these marked exceptions 
is, however, not the proper function of a group test. The 
very name indicates the purposes to which such tests should 
be limited. They subserve the study of groups, relative 
ranking in the group, comparison with other groups, plan- 
ning for group handling, and may well indicate those who 
vary most and most need other explaining. So far, so good. 
But when the result of a group test is used to definitely 
determine the present and future disposition of an indi- 
vidual with finality, it is being used without bounds. The 
group test is a survey method, a means of getting broad 
relationships; its function might justly he related to social 
psychology. Diagnosis, the application in definite form of 
accepted terms which indicate the intelligence of the indi- 
vidual, is the function of clinical psychology, which might 22 
THE UNSTABLE CHILD 
definitely benefit itself were it to accept the protective 
designation of individual psychology. 
Individual. In that one word lies the keynote to all of 
the ideals of clinical psychology. The very term ‘ ‘ clinical ’1 
originally meant “at the bedside.” This, as one may 
rightly infer, meant individual observation. It has never 
borne any connotation which would justify the assumption 
that when applied to the province of psychology it should 
suddenly come to mean rapid-fire group handling. Clinical 
psychology is the psychology of the individual with atten- 
tion focused upon those attributes wherein he most markedly 
differentiates himself as an individual, with the goal-idea 
of more definitely understanding him and his behavior. 
The near future cannot help but bring a general realiza- 
tion of the fact that psychology must fit itself into a 
steadier, less spectacular, more tedious study of human 
problems if it is to achieve anything of lasting importance. 
A mariner climbs a mast and quickly sights a far-off shore. 
Yet that brief sighting knowledge does not advance him 
towards his goal. Hard painstaking sailing of his ship 
alone does that, although the sighting directs his course and 
makes each move more purposeful. It is practically the 
same with clinical psychology. Group tests may reveal 
problems. They cannot settle them. The solution lies in 
the careful study of the unit of problem-making—the indi- 
vidual. 
Perhaps it is best to realize right here and now the diffi- 
culty of that problem. To study an individual clinically 
is not a matter of a few minutes, not the simple application 
of one test or one test series, not the mere following out of 
procedures formulated and laid down in books. There are 
more possibilities in any one human being than can be 
classified through terms of mental age, and justice in han- 
dling him demands the searching out of all of these possi- 
bilities, so far as skill and time allow. This means, in brief, TENDENCIES IN CLINICAL PSYCHOLOGY 
23 
an understanding and intimate knowledge of the individual. 
Such knowledge is facilitated by tests one can apply, hut 
it is dependent primarily upon an open-mindedness which 
sees more than test findings. ‘ ‘ Too much time! ’ ’ you ex- 
claim. Is this actually a just criticism? Group tests are 
more rapid, handle more people. Do they settle the prob- 
lems presented by those in the group? Very seldom. The 
problem is an individual one, often overcome in group work 
because the individual is living up to the temporary demand 
made on him as one of the group. Only two groups of 
extreme deviates are apt to find this impossible. They are 
the definitely feeble-minded and the definitely insane. But 
what of others who do not belong in either of these groups ? 
What of the intelligent person suffering from fears or 
desires which practically negate purposeful living ? What 
of the chronically depressed individual who is making no 
use of definite ability because of some distorted idea which 
the simplest analysis might aid ? What of the high-scoring 
individual who is “immoral,” a “pathological liar,” a 
truant, a thief, a “brain-storm” disturber of community 
peace? What of the child who is “bright,” but annoys the 
teacher and disturbs the group because he “cannot con- 
centrate”? Do they need individual study and help? Is 
it worth while putting the time of a normal individual on 
them in the hope of salvaging a few for more normal living ? 
In every sense of the word, yes. The problem varies from 
case to case, yet the urgency for the study of the individual 
is always the same. The unit of trouble is always an indi- 
vidual. Perhaps a brief consideration of a few individual 
problems will reveal this more clearly. 
One of our most common problems is educational retarda- 
tion. Ten, twenty, thirty per cent of a school grade may 
be below what they should be doing by chronological age, or 
even by mental age. Yet the problem is not one to which 
we can apply any general recipe. Talking with the teacher 24 
THE UNSTABLE CHILD 
is sufficient to demonstrate this. Despite the multitudinous 
demands upon her, she sees plainly the variety of forces at 
work. It is only illness which has kept Margaret back. 
Henry has been handicapped by learning our language. 
James has had to lose a great deal through deafness. Sam, 
John, and Willie she cannot explain, they are just “slow 
learners.” Even such an unscientific investigation shows 
us the absolute necessity of handling these children with 
individual consideration of their own problem in relation 
to their peculiar handicaps and disadvantages. 
Dependency is a different matter, you suggest, and the 
truth of such a remark is obvious. We usually handle the 
problem as a family one, but nevertheless it is still an indi- 
vidual problem, individual in a two-fold way. First of all, 
the individual family must be handled according to its 
needs, not in some mechanical routine fashion. Dependency 
due to illness of the worker or to lack of occupation because 
of special trade conditions is a very different matter from 
dependency due to alcoholism, inability to hold a job, a 
habit of dependency, family desertion or any other of the 
many situations wdiich the practical worker can suggest for 
herself. But, nevertheless, the problem is individualistic 
beyond this point. A father who has failed to leave his 
address, a mother ignorant of any method of livelihood, a 
child needing nursery care, and two or three in school can- 
not be handled as a unit. It is a physical, let alone a prac- 
tical, impossibility. So once more we resort to the con- 
sideration of the individual as the final unit of our analysis, 
although we adjust our individual solutions so that they 
may form a coherent group which disposes of the problem 
for the whole family with the least possible duplication of 
labor and expense. 
Delinquency, too, may often be thought of as a problem 
of the group. A “gang” steals, breaks and enters, annoys 
the community. The offense is a group matter, justice in TENDENCIES IN CLINICAL PSYCHOLOGY 
25 
its blindness demands similar punishment for similar of- 
fenses and sentences all of the group alike; the individual 
is not obviously the court’s problem. Again, from the 
standpoint of offenses, delinquency is a group problem. 
Truants form one group, murderers another extreme, all 
degrees of offense against the law lie between. Laws mete 
out punishments for the groups, although some variability 
is allowed and individuality has won definite recognition in 
some instances. The murderer proven insane is treated in 
the light of his disease, not as the deed demands. The 
juvenile court more frequently recognizes this individual 
lack of responsibility, but even there such recognition is 
the exception, not the rule, although in the final analysis 
of even court procedure all cases must be handled as indi- 
viduals. Any gang has its leader, whose motives are his 
own. His followers may be sheer imitations or excited 
sympathizers drawn into anti-social behavior for one of 
hundreds of reasons. The feeble-minded member who most 
frequently gets caught (and who is caught because he is 
feeble-minded) deserves to be treated, not as an example to 
the rest, but in the light of his individuality. The proba- 
tion officer knows full well that the same probation condi- 
tions never fit two cases in exactly the same fashion. His 
practice recognizes individuality even where law does not. 
Let us generalize our viewpoint a little more and take 
the matter of diagnosis itself. The body is an intricate 
organism whose functions and organs are fairly well known. 
Physicians, working with such definite knowledge, must 
essentially diagnose each condition of each patient before 
attempting treatment or medication. To the best of the 
writer’s knowledge, their examinations are never other than 
individual. In times of great stress when hundreds must 
be examined, the end is achieved by the development of 
systematic efficiency in the handling of cases and the elimi- 
nation of all observations save those which are absolutely 26 
THE UNSTABLE CHILD 
necessary. The central nervous system, as compared with 
the body as a whole, is an uncharted sea. Its potentialities 
for variety of function, alternation of reactions, and abnor- 
malities of behavior are so much greater than those usual 
to the body itself that the condition in the individual can 
be predicted with far less certainty. How then can the 
study of it be other than individual? Only thus can the 
varying factors in the situation which have caused the 
behavior problem under analysis be evaluated with the least 
semblance of justice or accuracy. 
In the same way, corrective work must fit the individual’s 
needs as they have been diagnosed. One may rob Peter to 
pay Paul, but one cannot depend upon the diagnosis of 
Peter as of any aid in the treatment of Paul. Psychological 
treatment is not a matter of drugs or food. It is a matter 
of habits of learning and forgetting, of ideas and feelings. 
As such, it must build upon the structure there, relate to 
the environment in which recovery is expected, and keep 
its awareness of the everyday life experiences as it pro- 
ceeds. Nothing but individual work can meet such 
demands. 
The negative aspects of the problem are similar. Puni- 
tive measures must be individual if they would be at all 
successful. When positive measures, that is, direct reeduca- 
tion and rehabilitation, do not succeed, they must be reen- 
forced by deterrents. No two individuals respond in the 
same fashion to such methods. That which fits one case is 
useless in another. The subject calls to mind two boys of 
thirteen, delinquents. One, a chronic thief, feeble-minded, 
yielded to a single smacking of his hand followed by fifteen 
minutes in a corner. Never after that, during months of 
observation, was he other than happily obedient. The 
other, of the same mental age, also a thief, but not feeble- 
minded, yielded neither to praise, rewards, confinement, 
work, group disgrace or spanking, but attempted good be- TENDENCIES IN CLINICAL PSYCHOLOGY 
27 
havior and improved steadily in trying to live np to the 
manifold duties and the honor of the position of errand 
hoy. 
Even this brief mention of our chief problems reem- 
phasizes the thing we need at every turn. Not group tests, 
group reports, group ratings, but the understanding, anal- 
ysis, and diagnosis of individuals are essential. This is 
the task which confronts clinical psychology. We need not 
worry about its acceptance. There is widespread demand 
for it, but: The work done, to be of permanent value, must 
meet certain definite aims: 
1. It must be scientific. Work which does not live up to 
the best which psychology has to give is not acceptable. 
The trouble with most applied branches of any science is 
that, once the concrete procedure is evolved, the application 
of it continues in that form, disregarding new facts in the 
experimental field. Applied psychology dares not do this. 
Unless it keeps its course constantly corrected to meet the 
developmental changes in the experimental field, it will soon 
find itself untrue to what we know of human beings. It is 
almost needless to add that it must constantly correct itself 
by the findings in its own field, clinical psychology as 
proven in the clinic. 
2. It must be thorough. In the study of such an intricate 
problem as that a human being can present, nothing less 
than absolute thoroughness is sufficient. It does not do to 
take chances upon this or that being the significant factor 
in his problem. The whole tendency of trouble-saving 
humanity is towards generalization and singleness of out- 
look. Clinical psychology is one field where such a tend- 
ency handicaps to the point of failure. In certain cases 
there may be one point of such importance that handling 
it alleviates the crisis, but this is the exception. The great- 
est problems are apt to be those where no one big cause 
stands out asking for removal, but where a multiplicity of 28 
THE UNSTABLE CHILD 
small items, each so easily overlooked, makes the total sit- 
uation. 
3. Work of this sort must be preventive. It will not long 
content a busy world to have careful and even exhaustive 
studies of its bothersome members unless such studies pre- 
vent future bother to the same degree. Of course, the most 
valuable work is that which prevents recurrence of the 
event in the same individual, but if this is impossible, we 
must at least meet the demand of preventing other similar 
occurrences in other individuals. 
4. Whenever possible, the work must be corrective. This 
is not necessarily an outgrowth of the attempt at preventive 
work. For instance, one may prevent further development 
of delinquencies in an individual by shutting him up in an 
institution. Correction is an entirely different matter from 
a term in residence at any institution. Our constantly re- 
turning repeaters give definite evidence of this. Almost 
any corrective, disciplinary, or industrial school for delin- 
quents has cases who have been sent there three or more 
times. Corrective work means that our psychological study 
has in some way found the cause of the earlier disturbance 
and has handled it in such fashion that the probabilities 
of a recurrence are low. This is not always possible, but 
it is the next necessary step to be attempted when our 
examination shows that the individual is mentally respon- 
sible. 
5. The work must be educative. A diagnosis from a 
psychological laboratory, written or verbal, means abso- 
lutely nothing except statistics, or a nice annual report, 
unless the significance of that diagnosis is definitely lodged 
in the minds of the parents, guardians, teachers, probation 
officers or others necessarily involved in handling the indi- 
vidual. It would not be hard to state specifically from 
one’s own experience more than one instance wherein this 
point was absolutely ignored. Just recently, happening to TENDENCIES IN CLINICAL PSYCHOLOGY 
29 
be interested in a youngster involved in a rather unusual 
escapade, the writer helped make an opportunity to have 
the whole group mentally examined. The judge so ordered 
it. The examinations were made. Then the disposition of 
cases was settled before there had been any chance for the 
examiners to report the findings to the court. Need we 
point out that the clinic procedure, time, energy, interest, 
and expense were lost because the judge had not been suffi- 
ciently educated on this point? To most individuals prac- 
tically concerned with such deviates a diagnosis means next 
to nothing. What they need to know, what they want to 
know is what to do. The diagnosis is an abstract sum- 
marizing which may mean something to the psychologist 
but which has little of tangibility to the practical workers. 
They want the help on what is to be done now for this 
person, how to do it, with the least cost, the greatest amount 
of good, and the greatest chance of permanence. Then, 
they wish to know what shall be tried next in case the first 
plan fails. The psychologist must meet this educative 
demand. 
6. The handling of an individual must be economical. 
That is, it must be as rapid and inexpensive as possible. 
This means keeping one’s own perspective of essentials and 
non-essentials in each case, adapting to emergencies, keep- 
ing to the urgent trail in the midst of pleasant abstruse side 
problems. It means absolute knowledge of essentials and 
fundamentals in order to avoid non-essentials. 
Now, naturally, the work of any laboratory reflects the 
attitude that laboratory takes towards all of these problems. 
The probable success with which another laboratory may 
take up the same methods and study similar cases and 
achieve similar results depends upon the completeness with 
which this attitude, the steps by which the problem is 
attacked, the methods, etc., are known. To this end they 
must be available in research reports. The need for this is 30 
THE UNSTABLE CHILD 
rather urgent, for we have no such a statement, or even a 
summary of general principles of clinical psychology, which 
may he referred to as the basis of work which makes dif- 
ferent studies comparable, or wdiich may even be used as 
a basis for critical differentiation of method. 
Within the next ten years wTe may well expect much of 
conflict and difference of opinion on the same subject from 
workers in different laboratories and different localities 
attempting to work out clinical problems. Much of this 
will probably be due to the fact that there have been un- 
noted factors in the two instances which have differentiated 
the results obtained, but which have been disregarded as 
of concomitant value with the facts as reported. The only 
way to avoid a great deal of this is through refinement of 
technique, better training of workers, more detailed state- 
ment of conditions of research and study, with more com- 
plete presentation of data, and with a very distinct separa- 
tion of data from the interpretation thereof. To this should 
be added practical suggestions and self-criticisms on each 
study made, for the research worker should be by his own 
work the best fitted individual to critically suggest im- 
provements for the next worker who may attack a similar 
problem. 
It is for this reason that the writer feels it necessary to 
formulate in definite statements the attitude, methods, and 
principles upon which was based the work at the Bureau 
of Juvenile Research, Columbus, Ohio, which has given a 
goodly share of the data herein used. The whole problem 
of psychopathy as the concept has evolved through this 
work is so inextricably bound up with questions of method 
and technique that one could not, in justice, be presented 
without the other. Indeed, it may well be said that no 
detail in the handling of a laboratory of clinical psychology 
is too small to finally have its effect upon the character of 
the diagnostic and educational work done therein. TENDENCIES IN CLINICAL PSYCHOLOGY 
31 
Such a brief outline can but show up the immensity of 
the problem confronting us. If clinical psychology is to be 
other than Binet testing; if it is to live up to the possi- 
bilities it now presents and the handling of problems for 
which it is ready, we need to formulate in definite terms 
the ideals and principles which will answer the question 
“How?” There can be no question of the need or value 
of such work. Boger Bacon pointed out many years ago 
that one individual is of more account than all the uni- 
versal in the world. Psychology in its attempt to help 
social progress must inevitably recognize this and, formu- 
lating the task, can only repeat the question, “How?” 
The experiences and applications of psychology which 
have brought this question have also brought the beginnings 
of development which will answer it. The same war experi- 
ence which gave such tremendous incentive to group test- 
ing gave another less -well understood but valuable contri- 
bution to the experiences of those working at camp testing. 
The psychiatric division of examinations was usually run 
side by side with the psychological work. In some instances 
there was definite interrelation of observations. This could 
lead to but one thing—the realization by the psychological 
group that there was something else in the study of human 
intelligence besides the ascertainment of the level of intelli- 
gence. Mental disease became at last a practical possibility. 
To a certain extent this line of interest seems to have con- 
tinued since the dissolution of army diagnosis. Wood- 
worth has attempted a standardization of symptomatic ques- 
tions, and the newer literature bears frequent reference to 
“character,” “personality,” and “temperament” diag- 
nosis. Upon analysis, all of these studies seem to be rather 
definitely attempts to account for those factors left un- 
evaluated by mental age or other graded ratings. 
Nor is this the sole indication of discontent with or criti- 
cism of present-day test procedures. Perhaps the best indi- 32 
THE UNSTABLE CHILD 
cation of the psychological pulse may be found in the 
studies reported each year at the annual meeting of the 
American Psychological Association. Reviewing these for 
the last three years is most enlightening. There are not 
unqualified claims for test validity, no spectacular reports 
of age-old problems solved by the study of one aspect such 
as mental age. Instead, we find Gesell reports a boy with 
a seven-year mentality earning his living. Doll reports the 
mental age of successful army recruits as far below any- 
thing we had estimated. Bronner reports great variability 
of scores by the same child on various tests. We could 
enumerate indefinitely, but the illustrations given suffice. 
They mean that we have entered into a more rational period 
of critical testing. Attention is being focused more and 
more upon methodology and upon the validity of the find- 
ings in individual cases. More and more of our workers 
are coming to see the need for completeness in detail and 
breadth of vision in clinical work. 
A radical change? Yes, and one we may be very proud 
of, although it is not a matter of blame or condoning that 
it has taken ten, eleven or twelve years to see this need. 
In 1911 the laboratories for child study were few and far 
between; about seven well developed ones were located in 
America. Ideals were still largely influenced by what the 
experimental psychological laboratories attempted in their 
study of adults. Few "workers were trained sufficiently 
well to handle both their psychological procedure and chil- 
dren to whom it must be applied. The idea of research 
into heredity was in its first beginnings at Vineland, and 
still absent elsewhere. No practical value had come out of 
such laboratories so that the need of their help was not 
felt by courts or social agencies, and they consequently re- 
ceived no stimulus from these sources. Social investigators 
had not grasped the idea of studying heredity and family 
situations intensively in our present-day fashion. The TENDENCIES IN CLINICAL PSYCHOLOGY 
33 
tests which were used comprised the Binet, the Goddard 
adaptation of the Segnin formboard, the now-disregarded 
Norsworthy and DeSanctis series. Educational tests were 
largely a matter of future development. Medical research 
laboratories were but beginning experimental usage of such 
tests as the Wassermann. 
Is it any wonder that the results achieved were partial 
or faulty? Indeed, it is rather a matter of surprise that 
the work done was so fundamentally true in theory that it 
stimulated and provided a wholesome foundation for our 
present activities. The wTorst we can say of the work of 
these ten years is that it was narrow, bigotedly assertive 
of its own value, and often attempted by those entirely 
lacking in proper training for it, whose efforts were ac- 
cepted because they were better than nothing. 
Of course, all studies are always more or less one-sided. 
The teacher sees problem children as wilfully “not con- 
centrating.” To the physician, it becomes a matter of 
malnutrition or tonsils and adenoids. To the social worker, 
the same problem is explained by heredity, “his father is 
nervous. ’ ’ One probation officer finds environmental handi- 
caps at the bottom of his problems, while another blames it 
on the movies. The psychologist has added his explanation 
of many of these problems. His only fault has been in not 
having enough variety in his explanations and in making 
the few he had fit all crises which confronted him. 
Just now the wThole matter of clinical psychology or men- 
tal tests has reached such a state of complexity that no one 
individual can hope to know the entire field thoroughly. 
To even keep a just, yet critical, perspective demands a 
formulation of the subject in general. This is especially 
necessary if one is to attempt any correlation of the various 
test movements into a body of facts, beliefs, and theories 
which will be utilizable in everyday practice. CHAPTER III 
PROBLEMS OF TO-DAY 
The psychological clinic, in the sense that it is a diag- 
nostic agency, has so far reached no obvious goal. Perhaps 
it never will, for changing needs of the race may well make 
constantly changing demands upon it and thus perpetuate 
it with constant change of function. But regardless of 
this, the aim of clinical psychology will always be the same 
—the elimination of those problems upon which its exist- 
ence depends. In this it shares a common aim with other 
agencies of social service. Its own particular problems are 
different. That is its reason for being and for continuing, 
but like all social service, it aims at such perfection of the 
human race as will make its own existence unnecessary. Im- 
possible and idealistic though such an aim may seem, yet 
bearing it clearly in mind may often aid in the final deci- 
sion as to how a certain problem must be handled. Dis- 
tance of perspective enables one to rate more nearly at their 
true significance problems which, because of their imme- 
diateness, loom so large they seem more difficult to handle 
than they actually are. We cannot formulate in any way 
what the future of the race may be or what individuals may 
sometime become. Conscious direction of human develop- 
ment is therefore impossible. All we can do is elimi- 
nate faulty or wrong tendencies as they appear. The thing 
demanded of clinical psychology is a study of human de- 
viations, of behavior anomalies, with an explanation of them 
if possible, and an attempt at their correction and elimina- 
tion. Being partaker in a common aim means sharing that 
ideal with other agencies, indeed with all others who hold 
34 PROBLEMS OF TO-DAY 
35 
it. The clinical psychologist is not a perfect being, capable 
of settling human destinies alone. He needs the aid of 
the physician, the lawyer, the nurse, the teacher, parents, 
guardians, and institutions. Or rather, to place him meekly 
where he belongs, he must give his bit to help in the gen- 
eral solution of a problem where none may claim the final 
good achieved as his, but where all work together, losing 
the idea of claiming credit in the intensity of service de- 
manded. 
The problems needing solution are many, and we may 
well pause a moment to review some of them from the 
psychological standpoint. 
To begin with, there is but little doubt that for years 
to come we shall be confronted by a steady demand for 
mental-age rating. In many cases the social agent who is 
not a psychologist will not soon be ready to take up much 
more than this. Since clinical psychology itself needed 
from ten to fifteen years to partially assimilate this aspect 
of intelligence, we cannot expect related fields, using psy- 
chological findings incidentally, to grow as rapidly into de- 
manding other than readily grasped fundamentals. They 
must develop a more varied appetite for such findings. But 
despite this the ascertainment of mental age must sink grad- 
ually into a routine preliminary to more refined methods of 
studying the individual to determine his own special prob- 
lems. However, not even the detection of the feeble-minded 
should be determined simply by the application of any one 
such test method, for mental age inferiority is not by any 
means an infallible indicator of feeble-mindedness. Ac- 
tually, the subservience of mental-age findings has already 
begun. Several years ago it was no unusual thing to meet 
the educational need of the precocious or very bright child 
by promoting him to the grade where his mental age ranked 
him, regardless of the obvious lapses in his academic ac- 
quisition thereby involved. Such ventures are less openly 36 
THE UNSTABLE CHILD 
advocated to-day. Gillingham of the Ethical Culture 
School of New York, has pointed out some of the fallacies 
and consequent problems of such disposition.1 The bright 
child in advance of the group where he belongs by reason 
of his actual age is very apt to be poor in muscular control, 
inaccurate in details, lacking maturity of judgment, giving 
symptoms of a neurotic nature, and frequently presenting 
moral problems. Experience cannot but generalize these 
findings and gradually bring caution in applying mental- 
age findings. 
The more complex problems which clinical psychology 
must meet are numerous and deserve at lease enumeration 
before we formulate principles which must be broad enough 
to give us the right approach to them. 
For several years immorality and feeble-mindedness 
have been linked together as almost synonymous terms in 
much of our social-hygiene literature. A common, and yet 
spectacular, way of stating this has been, “How many il- 
legitimate children must a girl have before she has proven 
she is feeble-minded?” The answer has usually been in- 
ferred as “one.” But that does not tell the story of im- 
morality. The ten years just ending have seen the overem- 
phasis of the relation of mental inferiority to the problems 
of feeble-mindedness and immorality. There is a broader 
relationship which has been emphasized by the work of 
Jung, Adler, Ellis, and the Freudian school in general. 
An illegitimate child is but an episode in the problem of 
immorality. In itself a definite proof of the breaking over 
from conventional bonds, its cause can, in the individual 
case, be determined only after careful study. The over-love 
of father, mother jealousy, self-assertion, self-negation, hys- 
terical ideas of religious compensation, a deep-seated sense 
of inferiority, these are but a few of the possible reasons for 
i Anna Gillingham, “Superior Children—Their School Progress,” 
Journal of Educational Psychology, September, 1920, pp. 326-347. PROBLEMS OF TO-DAY 
37 
behavior which we call immoral. The illegitimate child is 
but an accidental expression of this abnormality of behavior. 
True, it may be that the girl of less intelligence is the one 
who is more frequently caught. Her more intelligent sister 
expresses her abnormality in a way less directly related to 
the natural act of intercourse and with less probability of 
resultant conception. Not all immorality is so obvious, so 
simple, so closely related to the problems of everyday liv- 
ing. Nothing in life is too far distant from the sexual 
urge to bear a definite relation to sexual needs and desires. 
Consequently, the abnormal in sexual cravings—immorality, 
as we call it—may well find its expression in the most re- 
mote type of thought disturbance, with later behavior symp- 
toms. Two years ago the writer had temporarily under her 
observation a girl wTho had been afflicted for over two 
years with seizures seemingly of an epileptoid nature. She 
was sixteen years of age and on all tests scored practically 
normal. There were no marked physical handicaps. The 
judge had sent her in for study. She had had no settled 
home but wandered from relative to relative and there was 
grave danger of her developing some actual delinquent 
tendency simply because she had the opportunity. A care- 
ful study of her association of ideas revealed definite sex 
interest dominating everything. Continued observation led 
to the revelation of the truth in the third interview. She 
had been immoral and her first “spell” had been coincident 
with the first sexual experience. Analysis eliminated the 
whole complex. Two later spells came at times when the 
desire to attract attention from boys had been thwarted, 
then even these ceased, and it has been a matter of nearly 
two years since there has been any such an indication. This 
does not mean that the girl is “cured.” The spells were 
simply the form of expression found by an unstable organ- 
ism in whom desires and laws conflicted and where there 
was sufficient intelligence to give a sort of realization of 38 
THE UNSTABLE CHILD 
what “thou shalt not” really meant. The tendency to 
immorality is but a symptom of something wrong, and 
this wrong is not necessarily feeble-mindedness and does 
not necessarily express itself in a fashion which is obviously 
conclusive. The symptoms of such cases must be studied 
and analyzed back into their motivation, and the reason for 
the motivation must then be subjected to a careful scien- 
tific scrutiny. The determination of mental age or any 
one other factor is not enough. 
Another problem which must engage our attention is 
that group of individuals whose distinguishing difficulty is 
a flight of some sort from the place where they are sup- 
posed to be. Truancy, nomadism, fugues, split personali- 
ties, some hysterical attacks, all are expressions of this de- 
sire. The group is heterogeneous in the extreme, yet there 
is, behind any and all such varied behavior expressions 
which the desire assumes, a similarity of cause that justi- 
fies the grouping. Clinical psychology should find an es- 
pecial interest in this field. In general, it is probably a 
sense of inferiority and inability to meet the situation which 
leads to flight, whether it be the actual headlong dash of 
the schoolroom failure into alleys far from the beaten track 
of probation officers, or the forgetting and partial living 
of a mind which dissociates those ideas, memories, and de- 
sires which distress it beyond endurance. In each and every 
instance the alleviation of the condition is by no means 
a medical, educational, or punitive problem, but first of 
all a search after the cause, the idea, or condition which has 
led to such distinctive and symptomatic behavior. Plenty 
of emphasis has been placed upon the child who is truant be- 
cause of his inability to learn, but we seldom think of the 
possibility that a bright child might resort to the same 
means of escaping from boredom which takes five hours a 
day to teach him that which he could easily assimilate in 
two. These latter two are mental-age problems, pure and PROBLEMS OF TO-DAY 
39 
simple, but that does not cover all the possibilities. A child 
may be so hypersensitive, tense, and nervous that the busy 
hum of the schoolroom is a rasping burden to his nervous 
system, and desperation may lead to any extreme in a search 
for peace and quiet. Again, a normal child, eager for the 
new and different, may philosophically weigh the chances 
and take the unknown path of truancy when a fortuitous 
combination of events makes this possible without too much 
premeditated planning. In like fashion, the wanderer, the 
runaway from home, the child who has spells of forgetting, 
the multiple-personality individual, all present problems in 
which the determination of motive is the keynote to han- 
dling and reeducation. The psychological aspect of the prob- 
lem is the primary one. It is needless to admit that the in- 
dividual exhibiting such behavior difficulties is probably 
handicapped by an unstable nervous system, that he needs 
building up and sanitarium or medical care. These are ob- 
vious possibilities. But the fact that the combination of 
body, nervous system, experiences, environment, and ideas, 
which make him the person he is, evolved this special way 
of reacting instead of some other very different one is the 
basis for our assumption that his primary need is psycho- 
logical investigation. 
The so-called temper cases are another group on whom 
no definite work has been done which in any way classifies 
them or explains the methods of handling them. Temper 
as a behavior symptom is undoubtedly dependent upon 
certain physiological changes, but aside from this the pre- 
cipitation of any one seizure or manifestation is undoubt- 
edly dependent upon exciting elements in the environment. 
It is consequently dependent upon the ideas aroused by 
such elements and is consequently a problem at least worth 
analytic research. The sudden venom of the attack of a 
paranoid personality is but an exaggeration of conditions 
we find everywhere from the back-fence freedom of vi- 40 
THE UNSTABLE CHILD 
tuperation in one district to the veiled and studiously polite 
hatred of a social feud in another. A temper outbreak is 
not a thing of ultimate consideration, but it is a symptom 
worth time put upon it for observation and study. 
More obviously in need of attention is the group of those 
who lie “pathologically,’’ who steal without need, and 
swindle with no idea of actual personal gain. Here no mo- 
tive comes easily to light which can explain the time, en- 
ergy, cunning, and self-troubling of a line of procedure 
which seemingly benefits no one. Healy reports the study 
of twenty-seven such cases in great detail.2 According to 
his report at least nineteen of the twenty-seven are normal 
in mentality. He concludes, 4 4 The person who is seemingly 
normal in other respects may be a pathological liar.”3 
Perhaps this might be considered a sufficient statement 
if one were studying the problem only from the standpoint 
of actual level according to mental tests. One cannot be 
sure of even this, for the study does not report mental age. 
In his summary, however, only four individuals are classi- 
fied as poor in ability, and one of these is later reported as 
normal when the physical condition has cleared up. A re- 
analysis of the data Healy presents does not so conclusively 
eliminate the question of normality of intelligence. The 
majority of the group are verbalists, seven out of twelve 
writing compositions and stories. There is insane heredity 
in six instances, alcoholism in six families, criminality in 
six, suicide in one, syphilis in two at least, epilepsy in one, 
and in only two instances is the stock reported as normal. 
Although these traits, largely subject to inheritance, do 
not raise the question of feeble-mindedness, they do give 
us the picture of unstable stock with a high possibility of 
erratic development in the offspring. Healy reports mas- 
2 William and Mary Tenney Healy, Pathological Lying, Accusa- 
tion, and Swindling, Criminal Science Monographs, No. 1, 1917. 
3 Ibid., p. 266. PROBLEMS OF TO-DAY 
41 
turbation in at least seven out of the nineteen eases and 
feels that it is a “very important feature in these eases.”4 
To the writer, the presence of this habit is but another 
indication of a disturbed and unstable nervous system. It 
is a behavior symptom to be rated, not as a cause of the 
lying or stealing, but as another indication of a far deeper 
instability, relief of which, if possible, will modify both the 
masturbation and the lying or stealing. It is rather definite 
proof of the need of these cases for careful psychological 
study and an attempt at psychoanalytic relief plus every 
possible type of medical relief and correction. If our mental 
tests reveal nothing which distinguishes such an individual 
from one who is seriously and normally leading his life as 
a non-disturbing member of the community, it does not 
prove that these abnormally acting individuals are normal 
mentally; they cannot be, by our very definition of nor- 
mality. It is definite proof, instead, of our need for more 
refinement in technique and for a definite extension of our 
psychological methods of appraisement. 
Another problem, which means years of research, but 
which promises full return when once we begin to solve it, is 
the recidivist, that is, the delinquent or offender who of- 
fends again and again. In all probability our judicial 
and law-enforcing system, crude as it is, fits the comprehen- 
sion of a great proportion of offenders and is sufficiently 
unpleasant, awesome, and threatening to scare many ven- 
turesome individuals back into the conventional lines of 
behavior. One can readily recognize the weight of a hear- 
ing before a judge, in all the formality of a court room, 
when the child is one to whom even scoldings or punish- 
ments have been rather rare. The child of fairly good par- 
entage who “chances” into delinquency takes no second 
chance. His deviation from paths of right behavior is a 
natural part of his development. The natural consequence 
* Ibid., p. 260. 42 
TIIE UNSTABLE CHILD 
is adaptation to his environment so that the unpleasant side 
of such behavior does not have a chance to occur again. 
The abnormal aspect of the matter confronts us when we 
find an individual to whom the deterrent, which is seem- 
ingly emphatic enough for the greater part of the social 
group, proves ineffectual and the wrong or undesired be- 
havior is repeated. Such an individual is abnormal in some 
way. He is non-adaptive or slow in learning, or low in 
ability to inhibit a habit once it is acquired, or else there is 
some ever-quelling source of stimulation to the undesirable 
form of reaction. Whatever one or more of these related 
reasons are fundamentally at fault in any one person, the 
need for psychological study is obvious. One need not 
spend much time considering the feeble-minded individual 
in relation to this problem. If the condition is one of un- 
complicated feeble-mindedness, the delinquency is usually 
so obviously the result of undue demands made upon an 
intelligence that cannot understand them, that the cen- 
sored act is the only logical reaction. A feeble-minded girl 
who did not yield to immorality under the bribe of money, 
clothes, or good times would be an anomaly. The imbecile, 
of any actual year-span, who did not steal when in need, 
would be equally rare. From the standpoint of the feeble- 
minded individual, delinquency is an accidental expression 
of his condition. The problem of delinquency as it involves 
relief, prevention, and rehabilitation of the delinquent is 
far more complicated a process than determining mental 
level. There is too much variability, over-lapping of deeds 
and the degree of their performance, too much erraticism 
unaccounted for when mental level is determined. Wil- 
liams has given us our best study of this problem.5 From a 
study of 470 delinquent boys, he concludes that it is the 
lower level of intelligence among delinquents which is “the 
b Harold J. Williams, “The Intelligence of the Delinquent Boy,” 
Journal of Delinquency Monographs, January, 1919. PROBLEMS OF TO-DAY 
43 
chief contributing factor in their delinquent conduct. ’ ’9 
He finds thirty per cent of his boys definitely feeble-minded 
and many others far below average-normal. He strength- 
ens his conclusion that feeble-mindedness is an important 
factor by adding that, “Any level of intelligence lower 
than that of the average-normal accounts in part for delin- 
quency, the extent to which it is responsible depending upon 
the degree of intelligence, which may be best expressed by 
the intelligence quotient.” Despite this conclusion, he un- 
doubtedly feels that there are other factors which must 
be taken into consideration, for he adds, “Delinquent con- 
duct in persons of average or nearly average-normal intelli- 
gence may in some cases be explained by the inability of 
persons, through inherent weakness, to inhibit certain nat- 
ural tendencies. ” It is this aspect of the non-feeble-minded, 
not-inferior-in-level delinquent which demands intensive 
consideration, especially when the delinquency repeats it- 
self. What causes it, what is the inherent weakness, how 
does it cause what it does, how can we determine it soon 
enough to prevent delinquency in the individual case, es- 
pecially in the case which promises, because of sufficiently 
high intelligence level, possible normality of life in the 
community if once started properly? 
It is the not feeble-minded, not insane, not definitely han- 
dicapped child making continued demand upon the com- 
munity for care, reprimand, inhibition, admonition, and 
repair of lawless damage, who is the especial challenge (and 
province) of the clinical psychologist. The individual who 
deviates so obviously from the group in which he lives that 
the average layman at least suspects his mental handicap 
is no serious problem from the diagnostic standpoint. He 
is one of the day’s incidents. The intensity of his symptoms 
makes for ease of discrimination. It is the deviate whose 
deviation is just sufficient to cause behavior disturbances 
6 Ibid., p. 181. 44 
THE UNSTABLE CHILD 
but not extreme enough to show readily the reason for his 
intolerable behavior who needs the most intensive study. 
So far, the whole tendency of clinical psychology has been 
to emphasize the spectacular problems which it has met. 
The lesser problems of the children in whom conditions 
have not gotten to a point where the abnormal tendencies 
completely overshadow the normal traits receive but little 
attention. It is these very cases on whom a brief period of 
helping means the most for recovery, and they are propor- 
tionately so numerous that their correction is important as 
being a definite benefit to the community. Every one who 
has worked with children will recognize the various prob- 
lem characteristics any group presents if they are but 
briefly enumerated. 
Perhaps the most common problem is the child who 
‘‘doesn’t concentrate.” This descriptive classification 
probably had its origin in the schoolroom, but the fitness 
of it is not limited to that aspect of the child’s day. As a 
matter of fact, such a child does concentrate. The whole 
trouble from the standpoint of those working with him 
or responsible for his behavior is that he concentrates on 
the wrong thing. The child who doesn’t concentrate, to 
use our identifying phrase, is usually one who is so excited 
by everything going on, so interested in what the other per- 
son (or class) is doing, so full of ideas that are only dis- 
tantly related to the subject in hand, that he is overactive, 
tense, nervous, fidgety, “into everything,” “never where 
you expect him to be.” Reprimands fall with blunted 
points upon his cheerful equanimity and his ready, logical 
excuses for his behavior leave the average adult helpless. 
He is the decisive factor in the home, needing a type of at- 
tention and consideration which can hardly be imagined by 
those who know only ordinary children. He is a bane to 
the mothers of the neighborhood in which he lives. His 
alertness, rapidity of thought, and adaptation make him a PROBLEMS OF TO-DAY 
45 
leader in his play group in many respects and under him 
the children lose their interest in peaceful, quiet occupa. 
tions and run, race, shout, and scream themselves into ex- 
treme fatigue. The “run-away mind” he has been called 
and, objectively, this is true. His mind literally runs. His 
rate of ideation is so extremely rapid that he has passed 
by the consideration of a subject before the ordinary indi- 
vidual has fully grasped it. Of course he pays the penalty 
for his rapidity. Detail is neglected and there is the proba- 
bility of much inaccuracy in what he does assimilate. He 
is usually a bright, even a precocious child, and the problem 
of saving him for a useful and normal maturity is conse- 
quently not only a relief measure to the community, but one 
highly justified by the child’s own potentialities. 
Another salvage problem is the bright trouble-maker, 
the child who without any excuse just seems to utilize his 
time to plan trouble. This attribute, too, is one which our 
school system usually detects before any other social agency 
has a chance to become definitely acquainted with the in- 
dividual in a way which would reveal the tendency. Such 
a child is apt to differ in several ways from the problem 
type previously mentioned. He is usually able to avoid 
scoldings about his lessons, getting them easily. Indeed, it 
is frequently the too great ease with which he acquires a 
superficial recitative ability that gives him a chance to be- 
come a mischief maker. The first ten minutes of a study 
period see him conscientiously employed, virtuous, ener- 
getic, attractive. The remaining ten witness his degrada- 
tion and the need for specialized attention from the teacher. 
The longer the period, the more spectacular is apt to be the 
result. Paper wads in the old-time country school, notes 
anywhere, pins in improper places, drawings of much sig- 
nificance but little art, talking, innumerable drinks, broken 
points to be sharpened, pinches, kicks, and fights are the 
result of idle time and usually of an idleness which 46 
THE UNSTABLE CHILD 
realizes that, because of lessons fairly well prepared, the 
danger of severe punishment is minimized. Dealing with 
the individual instances of this nature is a matter of school- 
room discipline, but analysis of the situation into the com- 
ponent parts and directing the substitution of good habits 
for those of trouble-making is a psychological task which 
will find ever-varying motives in the individual, and which 
must evolve the methods to be used in combating each spe- 
cial case. 
Another educational problem will rapidly find its way 
to the psychologist, that is, the problem of the child who is 
“bright, but” who fails in some peculiar fashion to make 
his grade promotions. To put one’s finger on the reason 
for this anomalous behavior is not a question of rule nor 
mathematical procedure. The probabilities are so numerous 
that it is almost impossible to predict with any assurance 
what may be back of the condition. Quite frequently the 
feeble-minded child has been described as the one who can 
get along passably on other subjects but who fails miser- 
ably on arithmetic. The non-feeble-minded child may have 
just this type of scholastic difficulty, the differentiation is 
not definite nor discriminative enough to be diagnostic. 
On the other hand, one meets frequently the problem of 
the child who is good in arithmetic but who fails in spelling 
or reading or who is handicapped by impossible writing. 
This condition is especially noticeable in some districts and 
seems to be definitely related to the methods of teaching 
reading used in the local school systems. Few teachers of 
the present day but have heard of the Aldine method of 
teaching reading, and many of them are enthusiastic advo- 
cates of it. From one standpoint there is every reason for 
this. The method teaches a certain text, verse, or story as 
a whole. The children gradually learn to identify the va- 
rious words in it and then to recognize the same words in 
other word groups or sentences. The only thing necessary PROBLEMS OF TO-DAY 
47 
for spectacular beginning success by this method is a good 
memory. Like Emmy Lou, reading is word perfect even 
with the book upside down! The difficulty lies in making 
the transference to actual constructive reading where new 
words must be worked out by letter values since the con- 
text is new. Many types of normal children have the 
greatest of difficulty at this point, whereas a child of the 
hyperactive group who cannot concentrate where the 
teacher demands is totally unable to learn to read. The 
memory habit not only does not spontaneously transform it- 
self into a habit of analysis and word sounding, but it stunts 
or inhibits such an adaptive reaction to the printed page. 
I have just handled a precocious child who spent three years 
in a school under such a system and was unable to read even 
words like it and has, but who easily made up that deficiency 
in three months when aided by proper methods. 
Naturally such a handicap means catastrophe so far 
as school advance goes. He who cannot read, cannot suc- 
ceed in arithmetic, language, history or anything else above 
second grade. In some instances the poor habits just result 
in passing marks which indicate no real ability to compre- 
hend the written page, and the result is an unhappy child 
in his teens with no foundation for any business or profes- 
sional training. This is merely a lengthy illustration of 
one possible factor in such problem cases. It by no means 
exhausts the possibilities. The school system may be re- 
sponsible, but this is not always the case. A small group of 
children, unimportant in numbers but definitely important 
as individuals, are undoubtedly true aphasia cases, that is, 
a printed word in one case, the spoken word in another, 
the written form in another has no meaning. The connec- 
tions between seeing or hearing or feeling the making of 
the word as a sensation and earlier experience which should 
associate with it in such a way as to give it meaning are 
simply not there. Most of these cases are only partially 48 
THE UNSTABLE CHILD 
handicapped so that the realization of their handicap is 
delayed and makes the matter even worse by putting the 
wrong sort of strain upon a nervous system which is al- 
ready definitely burdened. Again it is “poor memory” 
which is reported as back of the child’s difficulties. Whether 
this poor memory means wrong habits of study, insufficient 
or wrongly handled study periods, fatigue due to insuffi- 
cient sleep, poor feeding, overwork, or actual mental dis- 
ease, careful study and ease analysis alone can tell. The 
poorly oriented individual may be a miserable student in 
geography or history, yet succeed in life without this abil- 
ity. In other instances the deorientation is pathological. 
The school world is full of such problems. Their solution 
demands wide orientation in the educational field as well 
as in clinical psychology. So far, we have but skimmed the 
surface of the problem here and there. The solution of it 
lies not in group educational tests but in individual, and 
hence, clinical, analysis of the individual problem. 
Another problem, not so far fetched as it seems, is one 
of extreme interest which is only rarely referred to the 
psychologist, that is, the problem of the “lazy child.” The 
parent or teacher who refers such a child usually comes 
eager for aid and counsel of a disciplinary nature. This, 
of all things, is the last method that should be tried. A 
lazy child is a sick child. His body is not necessarily giv- 
ing any obvious indication of a wrong condition—and so 
the problem is seemingly one for intellectual solution. The 
writer has never found that a lazy child is other than a 
medical problem primarily, plus a need for the reeducation 
of child and family on this point and many others. Diet 
and medicine will not solve the problem unless the idea of 
laziness is effectively dispelled by the psychological ex- 
amination and proof of ability and willingness to do in ac- 
cord with actual physical ability are fully demonstrated. 
Nor is it only the lazy child who comes in this fashion to PROBLEMS OF TO-DAY 
49 
the clinic. The * ‘ obstinate, ” “ crying, ” “ always complain- 
ing,’’ the “clumsy,” the “slow,” are frequently referred 
in the same way by parents who can more easily tell some 
one else their problems than work them out day by day. 
Modern mechanical toys and methods of amusing chil- 
dren, apartment-house homes, and many other factors of 
present-day living have brought another problem of child 
management which is usually difficult of solution. This is 
the problem of the child who is usually described as “not 
having enough to do. ’ ’ Recently, the writer had the chance 
to observe two children, a boy of two and a little girl of 
five, throughout a hot, tedious railroad trip of four hours. 
Given a seat apiece in the half-empty car, they were left to 
their own devices. Their parents, across the aisle, kept 
casual watch over them in between reading, sleeping, and 
talking. The children amused themselves, yet they had 
no toys of any sort, save a small feather triumphantly 
found on the floor. They stood up, slid down the backs of 
the seats, looked out the windows, talked, quarreled, made- 
up, and at one station where the older child wished to look 
out the window near her parents she asked permission, add- 
ing voluntarily, before she crossed the aisle, that then she’d 
go back. A twenty-minute lunch interval was used, with- 
out whining or fussing, to eat the food provided, despite 
the strangeness of the whole environment. Yet these were 
not children used to much traveling. Their behavior il- 
lustrates what is so often a lost art in raising modern chil- 
dren—letting them alone. The child who is amused, played 
with, given everything imaginable with which to occupy 
himself seldom realizes the resources within himself. This 
is not confined to the family where there is but one child, 
although it is a more frequent problem in such an instance. 
There are families of two, three, four or more children 
where the main object of the mother’s day is to keep the 
children contented and as happy as possible. Naturally, 50 
THE UNSTABLE CHILD 
when this habit of dependence upon others for inspiration 
in play and the next move in the day’s occupation accom- 
panies a nervous irritability and physical instability, the 
resultant child behaves in a fashion that makes care of him 
little less than martyrdom, yet because such a parent sel- 
dom realizes that children may be reared otherwise, it 
takes time, parental education, gradual revision of the 
whole home attitude before relief becomes evident. The 
continual watchfulness necessary to avoid resumption of 
the old habits makes it even harder to keep parents follow- 
ing a procedure which will bring good results. If one could 
give a prescription of even sterile water to be taken every 
day, the orders would be followed somewhat conscien- 
tiously, but when one’s “treatment” lies in advising an 
hour of self-directed play, making the child responsible for 
his own belongings, making him help with home duties, 
punishment (through loss of privileges) for disregard of 
certain fundamental rules of behavior, it takes every type 
of experience and a careful psychological appreciation of 
the parent to achieve results. Of course, if a clinical psy- 
chologist sees his professional activity as restricted to 
merely making a decision of who is feeble-minded or pre- 
cocious, or if he is interested only in the case which brings 
a melodramatic story and lends itself to spectacular han- 
dling, he will find nothing pertinent in such a problem, al- 
though it actually offers a chance for preventive work that 
is more promising for permanency. 
A very different demand upon one is made by what we 
Inay call the morbid genius. A bright normal child is, if 
allowed natural development, a joy and pleasure. There is 
a definite group of children, however, who show their un- 
usual traits in a way which makes them a constant prob- 
lem and burden. Although they are unusually intelligent, 
that phrase alone is not enough to describe them. Instead 
they develop peculiar ideas, monomanias, specialized fears, PROBLEMS OF TO-DAY 
51 
queer solitary habits, moody habits of introspection and 
analysis. For instance, a child of three and a half who 
could read Eugene Field and enjoy him, who wrote and 
spelled correctly any word he had ever seen, and who tested 
over six mentally, centered all his energy for months on the 
fear that the world supply of paper would give out before 
he grew up. Another child of five, testing nine, expressed 
all of his lack of desire to live, his cynical attitude, his de- 
pression, in chants such as, 
Life is a dark hole, 
Life is a dark hole. 
In such cases, the multiplicity of symptoms of abnormal 
ways of thinking are often so great that there seems no pos- 
sible hope for normal adult life. In the case of the three- 
and-a-half-year-old mentioned above a diagnosis of infantile 
insanity was made by a prominent alienist. No hope of re- 
covery was given. To-day, at eleven and a half, the boy is 
to all practical purposes a boy like other boys, with his 
own maturity and widely-ranged interests unharmed and 
generalized past that baby stage where intelligence, un- 
propped by experience, threatened his normality and had 
actually stunted his body into extreme frailty. 
How the one grew out of the other was a matter of psy- 
chological aid and specialized education. The diagnosis 
in itself would have misled. It was the concentration upon 
possible alleviation of the condition that solved the prob- 
lem. Surely the future cannot help but demand more of 
this analysis of a diagnosis into things to do now! What 
the results in general may be, it is hard to tell, but until 
we know more of what may come in such cases, a psychol- 
ogist has no right to rest upon a diagnosis as a reason for 
neglecting all he can do for a child. The morbid genius, 
who is usually treated as a clinical curiosity, needs help 
rather than exploitation. If he can gain the necessary 
social consciousness which makes him able to relate his 52 
THE UNSTABLE CHILD 
special interest to humanity’s needs, his future is full of 
possibilities. 
A far more common problem, however, is the child who 
tests “at age,” but who, nevertheless, cannot learn, can- 
not get on in school and who often develops behavior diffi- 
culties about the same time as his other inabilities are dis- 
covered. Such children have given indications of the com- 
plexity of the problem from the very first time a group of 
normal children were reexamined on the Binet Scale. God- 
dard reported such findings in 1913.7 In general, however, 
this fact has been ignored in most of the studies made. The 
individual possibility was lost sight of in the statistical 
probability. Yet in clinical psychology each or any case 
that comes before one for study may be the exception to 
the generalized probability! Doll and the writer have 
both reported case studies of such cases.8 “Potentially 
feeble-minded” is the usual diagnostic term for them. 
These are the children on whom we realize the sad fact that 
our tests are not proof perfect of an individual’s status. 
The child who now tests “at age” may have reached the 
limit of his mental development. Next year may find him 
one year retarded, the next two years, the next three years. 
He has run true to what we know of the normal pattern for 
intelligence growth, so far as he goes. In these children 
any diagnosis is absolutely a matter of clinical refinement. 
“Potentially feeble-minded” is really not a diagnosis only, 
but diagnosis (he is not inferior enough to be called feeble- 
minded now) and prognosis (other findings indicate ina- 
bility to progress much further). The very need for, and 
formulation of, this term is sufficient proof of the inade- 
quacy of mental age as a diagnostic method and of the need 
for every possible refinement in our testing methodology. 
7 Henry H. Goddard, “The Improvability of Feeble-Minded Chil- 
dren,” Journal of Psycho-Asthenics, June, 1913, pp. 121-126. 
s Edgar A. Doll, “A Case Report of Potential Feeble-Mindedness,” 
Training School Bulletin, November, 1916, pp. 159-163. PROBLEMS OF TO-DAY 
53 
The writer can but reiterate an earlier conclusion;9 
There is something more significant than mere mental age or 
years of retardation, a something we seem to have missed in our 
numerically finished clinical studies. At two an idiot, an imbecile,, 
a moron, and a normal may all seem practically the same. Them 
the idiot drops out of the race, stays at that level. Somewhere,, 
in the next four or five years the imbecile falls behind, but the* 
moron may be even ten or eleven before he evidences any real 
deficiency on our present systems of tests. Yet the difference has 
been there all along. The moron was as feeble-minded, poten- 
tially, at the age of two, as at twelve. The normal child was as 
surely normal. There is an innate difference hard to describe but 
all who know defective and normal children often recognize this 
qualitative difference before any quantitative test has demon- 
strated its presence. It seems as though with some the evolu- 
tionary nisus has spent itself with the effort necessary to bring 
into being, with others there is no energy there to meet the de- 
mand for speech, with others concrete stimuli can evoke satis- 
factory responses but there is not enough motive power to meet 
the demand for response to the faint stimulations made by 
abstract ideas, theories, principles, etc. But the normal child is 
entirely different. He lives only as an incarnation of activity. 
He is activity, innate, flooding, spilling with every new stimulus, 
responding with growth to every new demand made upon him. 
But the mental-age relation to the diagnosis does no£ 
bear only this single aspect of deviation. There is also the 
child who tests below and who is nevertheless up to grade in 
school work. Nor does that end the problem. It is no un- 
common thing to find a child who tests two, three, or more 
years below and who makes up part or even all of this 
retardation in a spectacular fashion when the cause for his 
retardation is even partially eliminated. How is one to tell 
when a child who is retarded needs the opportunity and will 
use it in recovery and when he has reached his ultimate in- 
telligence height and is going to stay there? Our chrono- 
logical age—mental-age relationship, that is, the intelligence 
® Florence Mateer, “The Diagnostic Fallibility of Intelligence 
Ratios,” Pedagogical Seminary, December, 1918, p. 391. 54 
THE UNSTABLE CHILD 
quotient—looks and acts just the same in both instances. 
There can be no doubt but that there is some innate differ- 
ence impossible of detection by any such a measure. Only 
careful refinement of methods of observation will enable us 
to extend a statement of a child’s ability now, as indicated 
by tests, into a prognostic evaluation of his future. 
Closely related to this is the problem of the child whose 
mental age decreases. Clinic observation of this as an 
actual fact is a recent development. The history of a child 
having been far brighter than he is now has usually been 
taken with a large grain of salt, save in such cases as gave a 
definite paralleling history of physical symptoms. “The 
mother’s idea” has been the usual verdict. Kecent years, 
with the advantage of impersonal test observations, have 
shown us the possibility of such retrogression of develop- 
ment. A child may test two years now and one year in six 
months from now, or ten years now, when he is nine, ten 
when he is ten, and nine or eight or seven by the time 
another year or two have passed. Of course, such cases are 
rare, but they do occur and even if we found only one such 
instance it would be enough to upset any secure clinical 
applicability of mental-age findings in evolving prognoses. 
Mental-age findings are, as Binet himself definitely stated, 
a matter of the present moment; prognosis is reserved. 
And then another problem confronts us, so-called child 
hysteria. Just how much variability the quims and quirks 
of a definite hysteria may cause in test findings, only re- 
search will enable us to state. It is highly probable that 
most of the children who test low but who seem compara- 
tively normal in other ways may belong in this group. Is 
the hysteriac differentiated by mental age ? Emphatically, 
no. Can he be distinguished by other psychological meth- 
ods? Most certainly, yes. 
Just what do all these problems mean for the future of 
elinical psychology, itself? CHAPTER IY 
THE FUTURE LABORATORY OF CLINICAL PSYCHOLOGY 
The enumeration of some of the problems which now con- 
front a laboratory that claims to handle the mental and in- 
telligence problems of the human race is, in itself, enough 
to show us that there is a future, full of w7ork and promis- 
ing possibilities, before him who chooses that way. Clinical 
psychology is being given its chance to help solve not only 
the obvious problems of feeble-mindedness, delinquency, 
and school difficulties but many of the more or less related 
puzzles of human behavior. The clinical psychology that 
shall prove itself able to handle these chances must be some- 
thing else than a set of rules to govern the giving and 
evaluating of a few groups of tests. The very possibilities 
of the field and the opportunities it opens for future service 
emphasize the need of caution and conservatism in the use 
of tests, care in the making of diagnoses and in the inter- 
pretation of them into the handling of individuals. Con- 
fidence in the ease of the solution of psychological problems 
resolves itself into careful doubt and verification of findings- 
The very immensity of the field and the problems it pre- 
sents cannot but overawe the ego of the most efficient worker 
and make him seek the support of more thorough organiza- 
tion throughout his professional group. This means a de- 
mand for refinement of technique, broadened interrelation 
with other sciences, further development of methods, estab- 
lishment of the possibility of varying technique as condi- 
tions vary, and the encouragement of ever higher standards 
in the work of the profession. 
55 56 
THE UNSTABLE CHILD 
Since the quality of work done and the attainment of any 
practical and permanent goal depend upon the definiteness 
with which all other aims are made to subserve this goal- 
idea, it becomes necessary to formulate those things which 
we are most definitely seeking. 
Time so spent is by no means wasted, but serves in every 
way to promote later economy of time and energy. Just 
what needs most to be accomplished in clinical practice 
and how it is to be achieved must, of course, be formulated 
with a definite regard for practical issues. No one could 
hope to predict or outline in detail the work of the next 
twenty, or ten, or even five years. Any attempt made is 
necessarily partial and incomplete. The psychological 
clinician who feels himself capable of meeting the daily 
solution of the problems of his clientele will not recognize 
the need of such a formulation. Those who are still at- 
tempting more completely to organize their work and relate 
it to everyday demands will realize that practical issues 
need some such plan. Remember, however, the theories and 
practices suggested in any one formulation, such as this, 
may not meet the needs and beliefs of the individual reader, 
nevertheless they serve their purpose if they but form a 
basis for his differing, for he cannot differ logically unless 
he develops a plan and theory of his own. 
In the first place, it seems well worth while to put into 
words some of the aims of the clinic itself. A psychological 
clinic, or a laboratory for the clinical study of human 
minds must in itself meet certain conditions and fulfill 
certain ideals, if the work done therein is to be permanent 
and worth while. The fundamental aim of any such clinic 
is an attempt to study the individual so that three things 
may be determined about him: 
1. Whether or not he be capable of a normal reaction 
to the demands which are usually placed upon one of his 
age, sex, and environment. THE FUTURE CLINICAL LABORATORY 
57 
2. Why he does not give a normal reaction if he be capa- 
ble of it. 
3. What shall be done with him if his disability is due 
to a defect, and his abnormality is not to be dealt with 
through modification of his environment itself. 
If this three-fold aim is observed, the individuals studied 
in a clinic should, in every instance, be the better for hav- 
ing been studied, either becaase difficulties have been cleared 
up, or else because those who are responsible for them have 
been given help in the manner of caring for them, and the 
situation is, consequently, alleviated. Of course, there will 
be some cases where it will be impossible to change greatly 
either living conditions or the subject himself, but each such 
case should at least help in the general study of the problem, 
so that others may be better understood thereby. Allevia- 
tive and preventive work cannot help but follow in course 
of time. 
It is almost needless to add that all such clinical work 
should be carried out with the utmost regard for the scien- 
tific aspect of the procedure and with constant awareness 
of the significance of each task as a part of the big, general 
study of human beings which will sooner or later render 
available data that will influence the future welfare of 
the human race and facilitate its progress. Besides these 
humanitarian and scientific ideals, the laboratory should 
have a certain personality in and of itself. Of course, this 
is a matter of growth and depends upon those who are in 
authority. A definite philosophy is needed to evolve the 
best of personalities, or “atmosphere,” but much is largely 
a question of efficiency. The laboratory clinic must never 
forget that it is an agent of public welfare, for public usage. 
No matter whether it be an independent foundation en- 
dowed with many millions or a small, poorly equipped de- 
partment of some little college, or a part of the political 
machinery of a state, the need for this attitude is the same. 58 
THE UNSTABLE CHILD 
Clinical psychology handles social crises and problems of 
the social group. As such an agent, the clinic is depend- 
ent for its very life and material upon the good-will and 
approval of that group in which it is located. The unfor- 
tunate side of many college and university clinics is that 
they are established without this attitude or without the 
goal-idea of service to the community. They are primarily 
a chance for the student to get practice in testing so that 
he may go out better equipped to do actual work for him- 
self, or to teach other young men and women how to test 
in a similar establishment. An aim of helping the com- 
munity, even if it were merely through the cooperative 
instruction of the parents of the better class in the uni- 
versity neighborhood, could not but be a tremendous in- 
centive to thoroughness and accuracy in this practice diag- 
nosis. 
If one keeps the aim of social service in mind, many of 
the other problems of the clinic solve themselves. The ar- 
bitrary 1 of the professional expert modifies itself and 
stands in the attitude of offering help to the needy You. 
The urgency of the special demand over the telephone, 
the occasional request for testing on holidays, in unusual 
places, or at unusual hours are met with understanding and 
willing cooperation in actual proportion to the vividness 
with which such an ideal occupies the mind of the clinic 
worker. Gradually such bits of response to demand, or 
refusal to respond except according to the rules of the 
clinic, will develop up or down into the atmosphere of the 
clinic. 
One cannot emphasize this too definitely. The general 
atmosphere of many social agencies is one wherein all 
human feeling is submerged into the definite insistence 
upon the importance of that agency. What a travesty is 
the term social service when applied thus! Yet more or 
less of this is seen in all such institutionalized aids to hu- THE FUTURE CLINICAL LABORATORY 
59 
manity. Noon on Saturday ends the recognition of human 
needs until Monday morning. Five o’clock closes the ears 
of appeal until eight o’clock in the morning. Yet those 
most needing help can usually best give time to seek it in 
the evenings and on Saturday afternoons or Sundays. 
True service can know no such limitations. 
A psychological clinic is run for those who come to use it. 
Those who work in it are allowed to help with the problems 
demanding study. 
Those who are served are not necessarily the ones who 
pay salaries but those who furnish the work to be done, the 
public. It is more than essential that this attitude be en- 
forced upon those who in the abstraction of the search for 
ideas are apt to overlook the rights of the people in whom 
they search for them. 
In the ideal clinic, or laboratory of clinical psychology, 
there is no actual question of hours. They are a matter 
of necessity, but not a thing to be met as an absolute bar 
to working more hours for one’s own pleasure in the finding 
of some item that will help solve the problem for some case 
or condition. "Workers, to be able to live happily with 
such an ideal, will naturally sort themselves. The unfit 
will be uncomfortable and will search elsewhere. Propa- 
ganda will scarcely be needed by such a clinic, for each 
person helped will, with confidence, refer his acquaintances 
there when they need like service. Indeed, some families 
gradually develop the habit of coming, as to a friend in 
need, for general advice, or for reference to proper sources 
of other kinds of help, and, sometimes, they even come to 
try and pay back some of their weight of gratitude. 
The question of how large any such a laboratory should 
grow is a serious one. In one way it may be easily seen that 
the larger the group working, the more data there will be 
for generalization. Beyond a certain point, however, cen- 
tralization is difficult and seemingly a poor policy. The 60 
THE UNSTABLE CHILD 
writer believes that a fairly large city laboratory or clinic 
with moderate equipment can probably do far more good 
for the children in that city than a state clinic located a 
hundred miles away, or else, located in that city, yet, per- 
force, dividing its energies among many cities. A labora- 
tory should be easily accessible, for not all parents can 
afford to take a day to visit every time they really want to 
talk over Mary or James with the psychologist. More 
preventive work may be accomplished by this closer fo- 
cusing on the little problems of the cases near at hand than 
by study of the long-distance-brought incorrigible on whom 
environmental, family, and behavior data are difficult to 
obtain. 
In the same way it seems as though any such an institu- 
tion should be open with a good-sized staff on Sundays and 
holidays, even though it practically closes one or two days 
in the middle of the week. Cooperation with the home is 
an essential, and this may best be accomplished by having 
hours available when the parents can most easily plan to 
come to the clinic. Why not? Surely such work is as 
much for the betterment of the future men and women 
of the race as Sunday schools. 
One other subject really should be mentioned and that 
is the necessity for an attitude of leisure in the work done 
in the clinic. No one can do his best if he is constantly 
worried with the idea of a vast amount of work await- 
ing him when this “task” has been completed. There are 
some individuals so built that the mere fact that there 
is a large amount of work to be done renders them incap- 
able of doing anything but worry, regardless of whether 
or not there are a sufficient number of persons to share the 
work. Such an individual should never be placed in a 
position of authority in a clinic, nor should he or she be 
in such a position as to influence the attitude of others, for 
the psychic contagion of such an attitude is one of the THE FUTURE CLINICAL LABORATORY 
61 
worst things that can befall a clinic. It makes for hurried, 
slipshod work in the individual who is just partially 
trained, for chance diagnoses, lack of consideration of de- 
tails, overlooking of important items, misunderstanding of 
shy individuals, fatigue, and loss of nervous energy in 
workers themselves, and a constant atmosphere of irritabil- 
ty and tension. You have all of the time there is, is a splen- 
did motto to hang, at least figuratively, in each room. Quiet 
work is more sure, accurate, swift, and more pleasant. It 
is less fatiguing and less dangerous in its results. Let us 
encourage the laboratory attitude of research and freedom 
from American rush in our clinical laboratories, as well 
as in those devoted to academic and philosophic research. 
The psychological laboratory should be essentially a 
clearing house of social service. It is impossible for any 
organization of this sort to do more than exist unless it 
recognizes the forces in the midst of which it is working 
and seeks to cooperate with them. A definite part of 
such services is knowing what organization can do more for 
the individual than the laboratory itself, or which can best 
supply what the individual needs. The laboratory’s re- 
sponsibility may end with the giving of a diagnosis, but, 
ethically, the making of that diagnosis involves the respon- 
sibility of seeing that activities, treatment, education, and 
correction consequently needed are made inevitable. Oth- 
erwise the diagnosis is a useless bit of determination. It 
gains value only as it motivates care and becomes a deter- 
mining factor in the avoidance of the repetition of like con- 
ditions. 
One hesitates to discuss the trivial aspects of such a situa- 
tion which should seemingly be obvious enough to function 
properly without mention. Experience shows, however, 
that this is usually far from the case. The psychological 
laboratory, no matter how well equipped, no matter how 
well trained its examiners, cannot afford to ignore the effi- 62 
THE UNSTABLE CHILD 
cieney of modern business. Poor utilization of space, long 
distances between groups of equipment which are usually 
associated in an examination, erratic methods of case as- 
signment, poor methods of recording data, crude filing, in- 
ferior paper and ink, all take their toil from the efficiency 
of the finished work of the clinic and add to the difficulty 
with which it is done. 
Another item is often unconsidered. To many individ- 
uals the only contact with such an organization is through 
telephone or letter communications. Mere matter of form 
to keep these efficient ? Perhaps. There is no doubt, how- 
ever, but that a telephone clerk making appointments, with 
the idea in her head that she is, in this instance, dictator for 
a big organization, and so arrogantly viewing the individ- 
ual at the other end of the wire as a needy applicant, can 
undo all the socializing that the actual clinical staff of the 
laboratory attempts and more besides. The ideals of such 
an organization must, to reach any semblance of fulfill- 
ment, be understood, at least dimly, by every person in- 
volved in the work of the organization. Even the errand 
boy has imposed upon him a certain necessity of responsi- 
bility which is a part of the clinic for good or for evil. CHAPTER V 
THE CLINICAL PSYCHOLOGIST, HIMSELF 
For many reasons we cannot help accepting the clinical 
psychologist, himself, as the real center of the clinic, even 
though he be but an agent in achieving its actual goal of 
diagnosis and human salvage. The clinical psychologist 
makes or breaks that clinic which he directs. This may 
seem to be an exaggerated statement. Psychiatric clinics 
are not so completely vitalized or devitalized by change in 
a chief. In years to come the psychological clinic may like- 
wise find itself less dependent upon its director. At pres- 
ent the psychological clinic is young. There is no settled 
methodology, equipment, procedure, diagnostic terminol- 
ogy, or even system of case recording. If a clinic is new 
and unorganized, its very ideals depend upon the psychol- 
ogist’s ideals as he builds it. If it be fairly well estab- 
lished, he can either fit into its partially completed struc- 
ture and grow with it, or he can spend his time destroying 
what has been done. Unfortunately, the attitude of criti- 
cal professionalism is no more lacking in clinical psychol- 
ogy than in other fields. There is far too much of this 
destructive tendency. Actually, there must be some good in 
all careful work, whether we believe in its all-embracing 
efficacy or not, and so the acceptance of beginnings made, 
of suggestions based upon the experience of others, is one 
of the things we must require of him who would call him- 
self a competent clinical psychologist. In other words, 
he must be broad-minded enough to be willing to accept 
work done by others, and intelligent enough to accomplish 
its utilization. 
63 64 
THE UNSTABLE CHILD 
The question of training is a fundamental one. It is ob- 
vious that the danger is far more apt to be the acceptance 
of workers with too little training than with too much. 
This problem has so far had but little attention. Any one 
who has cared to do so has been able, in some group or 
other, to pose as an expert in diagnosis. Fortunately mat- 
ters will soon be otherwise. The Association of Clinical 
Psychologists, which has lately affiliated with the Ameri- 
can Psychological Association as a separate section, has 
been devoting most of its business meetings for several 
years to the correction of this condition. The probabilities 
are that the near future will see in actual practice the re- 
cently approved and organized certification of first-class 
psychologists as well as the partial recognition of those 
who are fairly well qualified to act as assistants. 
But any such certification is merely a guard against 
charlatans and fakirs. It is no more a guarantee of ability 
to do actually good clinical work than a physician’s license 
is a sign that he will be a successful practitioner. The 
things that can hardly be estimated in such a certification 
are of far greater value in the final rating of the worker 
as fit or unfit. 
The clinical psychologist can never have too much actual 
education. All knowledge which one may have acquired 
yields its full quota of help in any attempt one makes to 
understand human nature. Those lines of stud}' that deal 
directly with the psychology of the individual or the race 
in any of its forms are, of course, the direct foundation 
for such practice. A necessary concomitant is sufficient 
training in biology, and especiall}” in physiology and neurol- 
ogy, to give the proper apperceptive background for the 
constant need of relating one’s -work to the medical aspects 
of the problem. Probably the other most closely related 
fields are those of education, or the effect of training upon 
the mind of the individual and the group, and sociology, or THE CLINICAL PSYCHOLOGIST 
65 
the effect of the social group upon the individual. But the 
direct relation does not stop there. In the many ramifica- 
tions of the human mind to be analyzed, recognized, and 
appreciated, each bit of training or experience which the 
clinician has but adds another item to the probable points 
of contact he can make with the individual studied. 
He who knows mental tests and measurements as a course 
in the statistical rating of human beings by mental age 
has one aspect of the problem. If his one-track training has 
embraced nothing else, he can see the whole problem of hu- 
man behavior so clearly, that its very clearness makes him 
dogmatically refuse other explanations or opinions. For 
instance, to him human beings must fall into some simple 
serial classification such as very feeble-minded, feeble- 
minded, backward, normal, bright, very bright. Disposi- 
tion is then equally simple. Send the very feeble-minded 
to institutions, the higher-grade feeble-minded, too, in many 
instances. Let the dullards do the laborers’ work. Push 
the bright ones ahead. The multitudinous articles and 
books representing this view solve social problems with 
equal ease. Criminality is due to feeble-mindedness, pros- 
titution is due to feeble-mindedness. Most delinquents are 
feeble-minded. Slums are the homes of the feeble-minded. 
Just wThere the problems of the epilepsies, the psychoses, 
nerve breakdowns, and other equally serious mental condi- 
tions enter into such a scheme the writer is not sure. Un- 
doubtedly the individuals advocating and accepting this 
mathematical and quantitative theory of mental life, or 
intelligence, know and recognize the existence of state hos- 
pitals, psychopathic wards, the criminally insane and other 
pathological aspects of their problem; but this recognition 
is not followed by any attempt to assimilate into their con- 
cept such diverse and disagreeably difficult conditions. 
These diverse bits of information occupy watertight com- 
partments of their thinking life and run no risk of amalga- 66 
THE UNSTABLE CHILD 
mation. This is not an exaggerated statement of affairs. 
Any one who will search the mental-test literature of the last 
ten years can readily see how small a proportion of it even 
relates its subject matter to the question of mental disease. 
How can such a person, one with this limited view of in- 
telligence and the group mind, wisely handle a clinic where 
he must sooner or later meet these other problems? How 
can such a worker handle the acute mental disease which 
registers a low mental age ? What does the assumption of 
great artistic ability mean to him if the mental age is nor- 
mal? Can he see the possibility of a specialized defect 
making a child “test” feeble-minded when he is actually 
normal? Widened perspective is the result of great expe- 
rience or wider education. Ideally, the clinical psychologist 
should be as able to lay his finger on each individual trait 
and classify it in relation to development of the individual, 
to hygiene, disease, racial evolution, and social restrictions 
as a botanist is to analyze a flower and categorize it. But 
when one is dealing with such ever-varying, complex be- 
ings as boys and girls, men and women, no one mind can 
hope to accomplish the impossible. One thing we may de- 
mand, however. The education of the clinical psychologist 
should be broad, and whatever it comprises in actual knowl- 
edge, a definite attitude should be insisted upon. This is 
what William H. Burnham has so aptly called the attitude 
of “intelligent ignorance.” Let the clinician know thor- 
oughly some part of his problem. By comparison let him 
realize his comparative ignorance in other allied provinces. 
Then, one further stipulation, let him have the attitude of 
being willing to admit the limits of what he does know. 
Binet realized the necessity of such doubt as to one’s own 
diagnostic ability. Only the amateur is cocksure. Willing- 
ness to say “I do not know” is the definite test of the scien- 
tific attitude and of ability to serve efficiently. If we may 
insist upon this prerequisite of training and attitude, our THE CLINICAL PSYCHOLOGIST 
67 
clinical psychologist is, we may be assured, equipped with 
much of ultimate value for his success. But other often 
disregarded factors are sufficiently important to deserve 
consideration. 
The personality of the examiner is of constant signifi- 
cance. It minimizes or maximalizes all he attempts. It is 
far harder to describe an ideal personality than it is to 
enumerate types which are undesirable. In the writer’s 
opinion the most dangerous type of person in clinical work 
is the excitable, overemotional, verbalistic worker who ap- 
proximates the constitutional psychopath himself. Such an 
examiner, whether in charge of others or used exclusively 
for examining, is a source of constant trouble. The exam- 
iner’s excitability overstimulates patients, irritates them 
frequently, fatigues them by demanding an excess of ani- 
mation in minor situations. Unfortunately, this excitability 
is usually accompanied by excessive verbalism and quite 
frequently by a tendency unconsciously to exaggerate symp- 
toms due to the emotional apprehending of them. The re- 
sult is disastrous. Mental age fluctuates considerably both 
up and down. Symptoms of instability are reported in 
maximal form. The staff presentation of a case by such a 
personality means a constant need for reevaluating in the 
light of the examiner’s limitations. Of course, such high er- 
ror in findings is far more apt to lead to diagnoses of ab- 
normality than to diagnoses of uninteresting normality, 
and in the end it is the child who suffers. 
Another type of worker who is even more destructive in 
another way is the antagonistic, but usually phlegmatic, 
person who refuses to believe any of the symptoms found. 
Such workers always give the child the “ benefit of the 
doubt” even when there is no doubt. Children examined 
by such a worker are usually scored higher in mental age 
than general rating would place them. Their individual 
deviations tend to be minimized, and overconfidence in the 68 
THE UNSTABLE CHILD 
child leads to too frequent failure in handling him. The 
too-restrained, unemotional worker, indifferent to the case 
save as a part of the day’s work, concentrating on the mak- 
ing of a record, is no less an evil. Here we find all visible 
facts dutifully recorded, but they remain facts. The brain 
of the examiner never adds of itself enough to change them 
into the coherence, and unity, of a diagnosis. Usually the 
conscientiousness of these workers makes for engraving- 
like beauty in their written reports. The mechanics of the 
task absorb all their energy. 
A clinical psychologist of gratifying personality must 
exhibit less extreme a development of any one trait than 
any one of these three types described. The psychologist 
who wmuld devote himself to clinical work must see in his 
profession more than the recording of processes and images 
such as the pure experimentalist records. He must relate 
the tiny items of the individual’s behavior to the great and 
constant activities of the race itself. He must sense, under- 
neath the imperfect bit of behavior which he sees, the world- 
old motivation. He must fill in the gaps, see through the 
blurs, and, impersonally, hold the perspective of the child 
in his relation to the social group, and of the group in 
its relation to humanity in general. 
The child is “more generic, an oddly shaped bit with 
many angles and crevices which will later be smoothed into 
a sphere, the educated adult. Most of the extensions, the 
seeming irregularities, the deep scars in the child bit are 
not purposeless, but they are the growth of the ages he best 
represents. These features, usually so incomprehensible 
to the adult, must be the especial study of the clinician.”1 
How can one achieve this end ? The ordinary adult would 
find it a hopeless task. Perhaps the best word to describe 
the attribute needed is tact. The clinician must be tactful, 
i Florence Mateer, “The Psycho-Clinician: Personality and Train- 
ing,” unpublished A. M. Thesis. THE CLINICAL PSYCHOLOGIST 
69 
not in the sense of knowing what is nice, proper, and ap- 
plicable, but in the sense of being full of the ability to 
touch. He must explore, finding his way by delicate sense 
of contact into the utmost recesses of child nature. To do 
this he must in reality be plastic, mobile, able to flow around 
the child and to envelop him in a comfortable glow of cama- 
raderie. He will not be able to do this unless he has in his 
own person kept near to child nature. He must live deeply 
and well, be sensitive to the slightest indication of life in 
other? mature but not grown-up, unselfish in his interests, 
and have a certain faith in the evolution of man. All of 
this implies an actual love of or deep interest in children. 
His personality should attract children as well as adults. 
This by no means indicates the need for constant effusion 
over children. There must undoubtedly be a high degree 
of sensitiveness, but this must not develop into personal 
sensitiveness. What more there should be, it is impossible 
to state in terms of attributes themselves. They will show 
themselves as necessarily related to the work demanded of 
him. 
Beyond personality, there is the question of attitudes. 
The psychoclinician must hold or not hold certain defi- 
nite attitudes. He dare not be monomaniacal. Exclusive 
advocacy of any one thing spells failure in this field. Since 
he is handling human material, a variable something, he 
may not expect mathematical precision in the laboratory’s 
function. A variable case means varying times of examin- 
ing, varying completeness of findings, varying ease of diag- 
nosis. Nor will a remote, academic attitude succeed in any 
more marked fashion than an oversuggestive type of han- 
dling. The worst sin of attitude, when scrutinized from all 
angles, seems to be that of perfunctoriness. A parent bring- 
ing a child for examination feels it a vital matter. The 
disinterested perfunctory carrying out of the examination 
makes a diagnosis useless. The parents are already preju- 70 
THE UNSTABLE CHILD 
diced against the examiner and, naturally, against his find- 
ings, so that when he makes a diagnosis they are not willing 
to accept it. Surely sympathy and understanding should 
show somehow in such dealing with humans! 
Age and sex. Are they significant? Yes and no. The 
writer, perhaps prejudiced, feels that women, if equally 
trained, are far more apt to make good clinical psychol- 
ogists. Psychology itself assigns to the feminine mind the 
greater interest in details. Clinical work is all detail, dif- 
ficult to obtain and hard to patch together, needing seem- 
ingly just what women can best give. Besides this, there 
are the minor considerations of greater ease in handling 
children, the elimination of the sex attraction in adolescent 
girls, etc. Age has but one point on which it should be 
qualified. No matter how old or how young, the clinical 
psychologist should be one who knows how children and 
young people feel. 
One other attribute really needs emphasis, and that is 
the general ability of the clinical psychologist to obtain a 
fair perspective on a case situation. The immature worker, 
knowing a little about feeble-mindedness, sees feeble-mind- 
edness everywhere. The day she learns of epileptic equiva- 
lents she finds many such. This is a lack of critical per- 
spective. A good clinician must be able to see not only the 
child in relation to the test findings obtained, but both of 
these in relation to the case history, environment, parents, 
lines of corrective handling possible, the law, and the com- 
munity. Only in such a fashion may we hope to get a 
summarized perspective, that is a diagnosis, which embodies 
in it the possibility of remedying the condition or alleviat- 
ing the situation. 
The ultimate test of the clinical psychologist’s fitness for 
the responsibilities he assumes in attempting such work 
lies in his relation to the patient he is handling. Some 
workers claim that the clinician needs a “commanding per- THE CLINICAL PSYCHOLOGIST 
71 
sonality,” but this seems doubtful in so far as the phrase 
refers to the obvious appearance which impresses the child 
or adult just coming into the laboratory for examination. 
"Whether reserved, effusive, dignified, or natural, the great 
necessity is for the immediate development of a feeling of 
acquaintanceship and of mutual sympathy and understand- 
ing. The very worst thing that can happen from the stand- 
point of the examiner’s technique is to have an adult come 
into the room with the child and tell all his delinquencies 
or difficulties to the examiner in front of the child. The 
examiner should be at least impersonal, a just person, will- 
ing to hear and understand the patient, to see him in an 
unprejudiced frame of mind. Consciously or unconsciously, 
a patient is easily repelled or even antagonized by the fact 
that the examiner is pre-armed with the facts against him. 
Even reading a letter or report blank in the presence of a 
case should be avoided, for it is sufficient to make the estab- 
lishment of rapport more difficult. 
Perhaps the best test of this ability to handle the child 
is the examiner’s ability to make friends without the use 
of words. A smile which brings a recognizing smile in 
return is of untold value as a clinical asset. The reason 
any smile will not do is a rather mysterious thing, but chil- 
dren recognize a mannerism and differentiate it from an 
attempt at getting acquainted. Except with quite young 
children, some simple explanation is quite in order. Men- 
tal or intelligence tests are not actually “games,” and the 
adolescent sent in for a “nut” test before “court to-mor- 
row,” or “school examinations next week” knows full well 
he is being bluffed by the “game” idea. Far more cooper- 
ation and interest may readily be evoked if he sees that 
doing his best means a favorable report, recommendations 
in his favor, or the general betterment of his own future in 
some definite manner. 
Healy has said that adults fail to appreciate the vital 72 
THE UNSTABLE CHILD 
facts of childhood. Yet he places little emphasis upon how 
one is to learn to know this period. Books cannot give any- 
more than an additional mass of data just as incomprehen- 
sible as the child frequently seems. To the writer this 
seems to be due to a general fault of our modern educa- 
tional methods. We are content to have people know the 
words about things and this is as sadly true among workers 
with children as in any other field. The art of words is one 
recently acquired by the human race, and it means but 
little unless it carries with it the deeper connotation of 
being able to sense the thing without words. Knowledge 
of children must be of this latter sort if it be successful. 
It is very easy to handle a case and speak of it as a problem 
case or a complex case or a psychopathic personality or to 
say that the child’s behavior is or is not justly motivated. 
From the child’s standpoint all of this may mean nothing 
for his future if there is not the actual “set” of the indi- 
vidual into an imitative and understanding frame of mind 
and body. He who plays with a two-year-old and builds 
blocks must build them with his whole soul. The velvety 
texture of their sides, the queer attractiveness of their 
regularity of form, the color satisfaction, the extreme im- 
portance of getting them so placed that they will stay put 
and the great effort required to accomplish this must form 
the whole of the world of life for the time being, or one 
has not understood and so cannot be a successful playmate. 
The same holds true of the older child. One must throw 
out adult impressions and build up a mental world and 
make physical response to it at the child’s level, or he does 
not understand the child. The importance of a hair ribbon 
to an eight-year-old, the wonderful gemlike beauty of the 
marble that the seven-year-old took, the taunt of boys in 
long trousers to the undersized thirteen-year-old cannot be 
understood by words. Such experiences and attitudes 
must be lived and responded to in the clinician’s own mind, THE CLINICAL PSYCHOLOGIST 
73 
if he would rightly understand the human need he is 
studying. 
In the same way, it is an insult to a child’s intelligence 
to tell him constantly throughout the examination that he 
i3 doing splendidly. It is well to let him know failure in 
things actually above his level, to let him realize there are 
things he is not expected to know, and he should be urged 
to say when he does not know a thing. This ability to 
recognize his own ignorance is a diagnostic trait of great 
value. Minor failures should not be stressed. There arq 
undoubtedly cases in which the importance of the exami- 
nation must be emphasized if the child is to be roused to 
actually doing his best. In other cases, a sort of inertia 
needs constant prodding and stimulation. Whatever the 
needs may be, the case should be met on its own level. 
Indeed, mental examining is merely that. One question 
asked gives the examiner an indication of the subject’s 
ability in that direction. A second question asked modifies 
and readjusts this indication. The third, fourth, and suc- 
cessive questions each add a corrective item to the concept 
forming. The handling of the child should become propor- 
tionately more definite and exact until at last the examiner’s 
mental level should, in imagination, meet that found by the 
tests. Rote examining with no attempt to make such an 
evaluation of the subject is of little value. The examiner 
has, as a result, a mental age, but no real understanding 
of the individual. 
It should be needless to speak of such matters as the 
necessity for considering the fatigue or travel strain a sub- 
ject has had immediately preceding an examination, but, 
unfortunately, such factors seem to be more or less disre- 
garded. It is impossible to enumerate all the chance de- 
velopments that may grow out of the disregard of this 
factor. With young children the consideration of fatigue 
and best testing conditions should begin at the time the 74 
THE UNSTABLE CHILD 
appointment for an examination is made. The question of 
the child’s daily program should be related to the time of 
appointment. A child "whose nap is from eleven to one 
should naturally be studied either early in the morning or 
shortly after his nap. Another with a late-afternoon nap 
may be handled almost any time in the morning. Irregu- 
lar food before or during the trip to the clinic, early rising 
to catch a train, unusual surroundings themselves, fear of 
the clinic because of earlier unpleasant experiences with 
doctors, must all be carefully sought for and even more 
carefully evaluated. The clinician whose work is an ex- 
pression of his actual interest in the subject will not “for- 
get” to watch such factors, for he will envisage the indi- 
vidual he is studying in such a wholesome way that such 
oversights are impossible. 
One constant and perplexing source of difficulty is apt 
to be the case referred by local clinics or physicians. These 
often come without appointment, direct from the fatigue 
of a medico-physical examination. In general, such a case 
must have at least an initial examination to satisfy those 
bringing it that the clinic is interested and to insure further 
cooperation. However, unless the child is a definite or 
extreme type, it is not only dangerous to diagnose under 
such conditions, but it is also very unjust to the child. 
Most adults will readily see the justice of asking for a later 
period of study before making a diagnosis, and cooperate 
willingly, in spite of the extra time and effort. But this 
again depends upon the impression of the earnestness and 
fairness of the clinician which they gain. 
In general, the best rule is to begin an examination with 
the child in the room alone with the examiner. Some ex- 
aminers state it as a necessity that there must be no one 
else in the room. Such a regulation is a good thing, but 
the examiner must be wise enough to know when the final 
goal to be achieved is more easily reached by ignoring the THE CLINICAL PSYCHOLOGIST 
75 
regulation. For instance, almost any parent is more ready 
to accept the diagnostic statement about his child if he has 
seen at least a part of the procedure by which the psycho- 
clinician’s decision has been reached. Nor is the benefit 
all one-sided. As the psyehoclinician gains experience, he 
will often find it possible to drop remarks now and then 
which help prepare the parent for a diagnosis. For in- 
stance, as a certain test is passed or failed on, the level 
for which it is normal may be stated, or, if this is apt to 
affect the child, it may be noted on a slip of paper and 
shown in this way. It is especially advisable to explain 
failures on tests above the child’s actual age. The parent 
may be feeling that the tests are too hard. A simple state- 
ment such as “You did pretty well on that for a fifth- 
grade boy, that is a question we usually ask sixth-grade 
children,” has a favorable effect upon all concerned. 
The most economical procedure is to have the clinical 
historian take the history of the case while the clinician 
begins the examination. In making this arrangement the 
parent and child should both understand definitely that the 
parent will be welcome in the examining room after the 
facts of the case have been given, although ft need not be 
presented in just these words to the child. The parent 
usually feels more comfortable and cooperates more readily 
in giving the history and the child feels more at ease in 
leaving the parent. Sometimes one will find subjects who 
prefer to be examined alone and then their preferences 
should always be met. 
With young children one best begins an examination by 
doing anything but examining, if adults be with them. A 
child under six or seven may usually be handled far more 
effectively if he is allowed to adapt first to the room, then to 
test materials in evidence, and finally to the examiner. In 
such cases it is a wise procedure for the examiner to gather 
the history of the case himself during this adapting period. 76 
THE UNSTABLE CHILD 
His attention may be gradually directed towards the child, 
a single test may be ventured, a toy given, and finally the 
child, with curiosity satisfied concerning his surroundings, 
will voluntarily turn to the clinician for new objects of 
amusement and these the tests furnish. 
Some parts of the examination should always be given 
without observers. An older child usually gets en rapport 
more quickly when alone, and most children will give their 
own story more freely and willingly when no third person 
is within hearing. This does not complicate matters at all. 
The clinician must always feel free to request an observer 
to leave if necessity arises, or if the situation proves un- 
happy. 
There is, however, still more to be said upon the matter 
of having observers during the examination. Of course, 
the examining of a child is the focal point about which a 
clinic is built up, but there are other factors that have a 
tremendous influence upon the value of that examination. 
Of what use is it to pronounce the judgment of feeble- 
minded, or normal, or psychopathic upon a child unless the 
statement of the condition is going to help the child ? Such 
help is a social problem. It means the need for under- 
standing on the part of the family or other guardian. It 
means the city, county, and state provision of educational 
methods suited to the condition, and corrective institutions 
for handling the condition. This necessitates intelligent 
handling of legislation and all that phrase implies. This 
necessitates an understanding public. 
The education, according to his ability to understand, 
-of each adult personally interested in a child coming to the 
clinic is a necessary part of the clinic work and a part far 
too often neglected. The handling of the parent is far 
more delicate a task, and as important a problem, as the 
diagnosis of the case itself. It involves a practical diagnosis 
of that person and then his education in relation to the THE CLINICAL PSYCHOLOGIST 
77 
problem in hand. Such education is slow, but it is funda- 
mental and its effects are far-reaching. 
For the sake of the examiner himself, observers are a 
valuable asset. They are a stimulation to an exactness of 
methodology which is apt to lapse if self-consciousness is not 
frequently reinvoked by some such stimulus. A clinic from 
which parents come away saying, “She didn’t give my 
child a fair chance, ” “ He was afraid of her, ’ ’ or any simi- 
larly critical remark, is precarious in its reputation. 
One other characteristic must sometimes be evoked by 
particularly troublesome children, that is, firmness. The 
child should recognize authority in voice and manner, if the 
necessity arises. A good illustration of this necessity lies 
in the handling of hysterical imbeciles. Such a child will 
frequently wail and cry at the top of his voice, especially 
if brought to a resident clinic for observation. Sympathy 
exaggerates the noise. Neglect or seeming indifference has 
a similar effect. Getting out a simple performance test 
and ordering work on it will usually stop the spell. The 
whole seizure is merely the only way such a child has known 
to relieve fear or get what he wants. Negativisms need not 
be handled this way. Their depth and persistence are 
usually shown much more clearly by giving one’s directions 
in a fashion contrariwise to what one really wishes done. If 
the negation is simply contrariness, it may break down at 
this treatment, or all action may be temporarily checked, 
or the desired act may be the result. 
The successful psychoclinician needs no suggestion as to 
ways and means of handling these or similar problems. His 
education gives him the significance of them as behavior 
problems, his experience enables him to handle them with- 
out worry or annoyance, his interest in his professional 
activities enables him to receive only stimulation and new 
interest from the problems which confront him, his ideals 
of service make the possibility of helping a case sufficient THE UNSTABLE CHILD 
78 
reward for the work and fatigue involved. Whatever hap- 
pens in the day’s routine is not exasperating, worrisome, 
or a bother, but is transformed into increased information 
on the individual concerned. Whether a worker has this 
attitude or can gain it is the final test of his worth. CHAPTER VI 
MEANS AND METHODS 
Given a thoroughly trained clinician, the matter of 
laboratory equipment sinks into a question of relative in- 
significance. At the demand of necessity a thorough exam- 
ination can be made with practically no materials save 
paper and pencil. The ability of the examiner is called 
upon to compensate for the lack of objective aids. But 
such a procedure, although expedient in an occasional 
emergency, is by no means commendable at other times. 
Naturally, it is better to know what one can find out with- 
out equipment than to know nothing. It is not a foregone 
conclusion that the information gained thus is just the same 
or just as accurate as that gained by using standardized 
procedures with the standardized materials. Indeed, one 
of the best features about clinical psychology has been 
the general acceptance of standardized tests and test pro- 
cedures. This has made for a universal comprehension of 
examination results. All careful workers have been using 
more or less of the same procedures and so are talking a 
similar language when they report their findings. The 
earlier, and even the present-day, psychiatric examinations 
lack such universality. The personal experience of the 
psychiatrist has been made the big factor in his ability to 
handle cases, the means used in studying them have been 
individual and lacking in organization and standardization. 
The other extreme of overemphasis upon tests and test 
equipment must also be avoided. The inexperienced exam- 
iner is especially prone to collect an awe-inspiring group 
of puzzle boxes, boards, games, and tests for utilization on 
79 80 
THE UNSTABLE CHILD 
all cases. There seems to be a subconsciously motivated 
attempt to compensate for inferiority in experience by 
superiority in test equipment. Any clinical laboratory 
should be constantly working on the problems of tests and 
their usage, but this must be done in a systematic fashion. 
New tests should be carefully studied and analyzed as they 
make their appearance in the current psychological litera- 
ture. If they test some different angle of intelligence or 
mentality, they are worth being tried experimentally. If 
they prove of actual value they should then be incor- 
porated into the systematic test procedure carried out on 
all cases. 
Other tests may be very similar to those already in use 
but differ in ease of giving, ease of scoring, validity of 
norms, attractiveness, etc. These factors must all be 
weighed in their relation to the whole problem of the indi- 
vidual clinic’s needs before a test is accepted or rejected. 
The problem is not only one of adding new tests, else would 
it be simplicity itself to accept all new methods with liberal 
enthusiasm. The factor of the length of the examination 
constantly needs consideration. A child cannot stand more 
than a certain time length of examination without fatigue 
to the point where more testing is unwise. Two interviews 
are not always possible. On cases under resident observa- 
tion this difficulty is in part overcome, but again the length 
of examinations must be controlled. Our decision on any 
individual question that arises from this need should be 
made with a consideration of at least three principles. 
1. The knowledge obtained from time spent on a test 
must be wTorth that time. 
2. The time spent on a child must be proportionate to the 
demands made upon the clinic and the workers available. 
3. The time spent upon an individual child must be in 
due proportion to his and some other child’s need for such 
study. MEANS AND METHODS 
81 
'Another problem which confronts ns the minute we 
change the tests in use is that of comparability of results. 
If one is making a six- or ten-year study of the whole group 
handled in a clinic, the tests used throughout that period 
must be strictly comparable. Any changing of tests con- 
templated must have impartial and thorough consideration 
from this standpoint of the aims of the clinic itself. This 
handicap in changing tests is also one thing leading fre- 
quently to the addition of tests without any corresponding 
elimination, and, of course, such a procedure soon reaches 
a limit of practicability. 
No discussion of tests to be adopted for general usage 
can have other than a temporary value in so far as definite 
suggestion goes. Although certain tests are suggestively 
mentioned here, there is no reason why others should not 
replace them as a clinician wills. Any test may be used 
and be made more or less valuable to diagnostic work. 
Many tests must be used, if one would be fair to the child. 
What they shall be is, at present, largely a matter of opin- 
ion. But let us remember that not even many tests are 
a panacea for lack of experience or training on the part of 
the examiner. 
Undoubtedly a clinic of the present day needs as a part 
of its simplest routine examination one of the Binet re- 
visions. This will give a basis for comparison with the 
work of other clinics and a means for evaluating other 
tests. Since this series is so highly dependent upon lan- 
guage and gives a secondary place to actual performance 
tests, at least a moderate number of the performance tests 
which have been thoroughly standardized should be added 
to the minimal examination required on each and every 
patient. So far, the development of such performance 
tests has been somewhat disappointing. The standardized 
Seguin form board is definitely adapted to clinical work. 
The blocks appeal to the child, their size suits his need, 82 
THE UNSTABLE CHILD 
and the relative size of the different blocks makes a false 
placing impossible. The length of time required for the 
test is brief, the standardization is fairly good. The test 
itself reveals especially learning, training ability, form 
recognition, and motor control. Most of our other per- 
formance tests are so complicated they are hard to analyze 
into information clinically useful. The Knox tapping test 
is an exception, for it tests primarily an imitative, place 
memory which comes as near being a simple process as our 
tests reveal. The Goddard adaptation board tests this 
same place memory, throwing in a constantly increasing 
need for adaptability, or, as it can be more clearly stated, 
it adds a factor of change in position to the known situa- 
tion. The Porteus maze tests are another encouraging 
addition to this group of tests involving actual activity. 
One need not, however, evaluate them as highly and as all 
sufficiently as their inventor does. We need more tests, 
concrete, interesting, brief, generally applicable, for the 
study of the learning process itself, of adaptability, inhibi- 
tion, modified using, generalization, etc. 
Of course, educational tests should have a definite place 
in the clinical examination. They are necessary if we 
wish to insure justice for the child as well as for teachers. 
Any one with even a few months of clinical experience real- 
izes that there is no definite relation between the grade a 
child has attained in school and his actual acquisition of 
educational information. Promotion every two years re- 
gardless of success is frequently the rule for handling dull 
children. Other schools promote because the child’s size no 
longer fits the desk in the lower rooms. On the other hand, 
careless, inattentive children who “cannot concentrate” 
may prove to be far above the teacher’s estimate. Only the 
use of an actual examination on school subjects will show 
up such discrepancies between report and condition. The 
choice of such tests is difficult and any series used should MEANS AND METHODS 
83 
always be interpreted in the light of the school system 
from which the child comes. Until school surveys which 
grade schools themselves become a matter of course, there 
must naturally be a good bit of leniency in this interpre- 
tation. Every large school system has good and bad 
schools where grade requirements differ in enforcement. 
So far as possible, these local conditions must be woven 
into the final interpretation of the school tests. 
Another angle of the child’s development is still left un- 
explored when these three lines of examination have been 
completed. A Binet series shows how his intelligence com- 
pares with that of other children tested on situations which 
are identical for all of them, since they involve more gen- 
eralized experiences. Performance tests show intelligence 
attacking concrete visual situations by actual activity. 
Educational tests show what a child’s intelligence has ac- 
quired from an environment where he is offered the same 
opportunity as other children. There remains the informa- 
tion which a child has the opportunity to acquire because 
of his own unique individual experiences. This differs 
tremendously for even two children in the same family. 
The general information or general orientation of a child 
is tested by seeing what he has assimilated from the expe- 
riences he has had. Naturally, we are dependent upon 
questioning for our knowledge of the environment, but 
more of this later. 
Morphological tests such as the series used by Smedley, 
The Training School, etc., are to be considered rather seri- 
ously. Tests of grip, lung capacity, and ergographic ability 
are not physical tests. They test the mental ability to 
control the organism in the working demands made upon it. 
As such they are highly diagnostic. 
Any laboratory endeavoring to do diagnostic work 
should have at least the equipment required for such tests 
as have been enumerated. This is but little when all is 84 
THE UNSTABLE CHILD 
considered. A very definite equipment must, of course, be 
added for the special types of cases. A scale for testing 
the blind, one for use with the deaf, an infant scale, aussage 
equipment for cases needing it, additional tests for motor 
control, series for the study of association, aphasia, and 
play should surely be available. 
The examining rooms should be definitely lacking in all 
fearsome or suspicious qualities. The more informally 
they can be arranged, the better. Too attractive pictures, 
books, desk ornaments, or even files must be avoided. All 
material is best kept on shelves fitted with opaque glass 
doors or slides. The objects in them can then be used at 
will, and distraction is avoided unless one wishes to intro- 
duce it. Some attractive toys should be considered a neces- 
sary part of the equipment. Of course, one immediately 
meets the question of handling the child who wants to 
“take home” all he sees. There is never any difficulty 
with such an issue if a few rubber balloons be kept on hand. 
Almost any child will exchange another toy for a balloon ‘ ‘ to 
keep.” The examining room should be quiet, light, and 
there should be comfortable chairs for the children. 
Everything used should be of such a nature that it can be 
easily sterilized or replaced. There should always be on 
hand crackers and cookies, and it is well for the examiner 
to know, before an emergency occurs, where milk can be 
obtained. 
Blanks ? The blanks used in recording test findings are 
probably as important as any other part of a laboratory’s 
equipment. They should facilitate the recording of all 
work done in examining a child. They should never be- 
come so elaborate that usage of them distracts from ob- 
servation of the case itself. Nor should they be so inflex- 
ible that there is no possibility of recording the unusual 
reaction with ease. 
There should be definite uniformity in the handling MEANS AND METHODS 
85 
and filing of case records once the work on a case is com- 
pleted. The blanks should always be arranged in the same 
order in a case folder and this should be such an order as 
is most logical and as best promotes ease of consulting it 
later. 
Of course, the handling of case records necessitates filing 
systems, index files, and similar record forms. They should 
enable a worker to find out in not more than two minutes 
whether or not a case has been examined and is on record. 
A numerical system of case filing seems preferable. Of 
course, it can be used only in connection with a card index 
of names alphabetically arranged and indicating the case 
number. This makes a slight increase in the time needed 
to find a case record, but the other advantages of the sys- 
tem overweight this. A numerical system is, of course, 
also chronological. Hence, any one group of cases is filed 
together. The work of any one quarter, year, or of a longer 
period may be reviewed without disturbance of other rec- 
ords. There is less chance of error and greater ease of 
corrective checking for errors in filing. The out-of-date, 
and hence, seldom used, cases may be filed in a less easily 
accessible place, and the active file is constantly kept down 
to a size that renders it easy to handle. 
Every transaction on any case should be recorded accu- 
rately and in detail. Telephone calls, telegrams, visits from 
relatives or friends, interviews, observations while in the 
group, all types of history, should be definitely made a part 
of the case record. Perhaps the easiest way to do this is 
to have in the entrance office, near the telephone centrals, 
a good-sized composition book in which any telephone call, 
appointment, telegram, or visit is immediately entered, 
entries being dated each day by a clerk, and each single 
entry being signed as made. These can then be transferred 
in routine fashion to case records, attention of the patient’s 
officer being called to entry when it was not originally 86 
THE UNSTABLE CHILD 
made by him. Once transferred, it can be crossed out of 
the day book, thus leaving only a few pages of “active” 
memoranda at any one time. A worker, coming on duty, 
may at once acquaint himself with new developments re- 
lating to his work. A habit of such recording once acquired 
eliminates all such confusing incidents as appointments 
forgotten, children arriving unexpectedly, and the thou- 
sand and one vexations due to lack of system. 
Given equipment, test-record blanks, a pleasant and com- 
fortable examining room, what more need we consider in 
our brief reviewing of the clinic laboratory’s attributes? 
The question of the examination itself confronts us. How 
to examine, and the why of that how, are the most im- 
portant features in establishing the clinic’s reputation. 
Even if we assume that the clinic has determined upon the 
usage of certain tests and series, there remains the whole 
problem of clinical skill and methodology. When a mental 
examination of a child means the giving of some one test 
or test series, this question of methodology is not a serious 
one. The Stanford or Kuhlmann or Goddard-Binet may be 
given fairly well by just following the directions in the 
manuals. Extremes of fatigue, the relation of this test 
series to others, and the preference in time to be given one 
or the other are not marked questions. Suppose, however, 
that one is not working to obtain a mere mental-age rating 
but intends to examine the case as rapidly as it can be done 
with thoroughness, and to study all aspects of the child’s 
intelligence. It is not possible to run such an examination 
into an indefinite number of hours. Neither is it highly 
logical to carry the test through several days, for 
we have no way of knowing that the child is at all com- 
parable in his ability on successive days. This is even more 
apt to be true on abnormal cases than on normal children. 
Consequently, the problem is a rather complicated one, and 
even any suggested plan for handling a series of test pro- MEANS AND METHODS 
87 
eedures should always he modified according to the individ- 
ual child’s needs. 
It is well to begin the examining with some such ordi- 
nary matters as writing the name, address, school grade, 
school attended, the date, and other facts which seem so 
ordinary that nervousness or tension disappears. The de- 
mand for things such as those a teacher might ask is usually 
reassuring to the child. Even if he has been made nervous 
or tense by overhearing indiscreet conversations about the 
examination, this soon subsides. The absence of all that is 
fearful and threatening in the environment and the daily 
familiarity with the questions asked restore his confidence. 
Sometimes, however, one finds a case so full of grievance 
or antagonism or complaint that the only just thing to do 
is to encourage the confidence of the case. The tale may 
rush out or be drawn out only with difficulty, but it must 
be eliminated before a satisfactory examination can be at- 
tempted. Of course, such cases are comparatively rare, 
but it is all the more essential that one be constantly on 
the alert for their appearance. 
Because of its universality of application, some one of 
the standardizations of the Binet test should usually be 
given early in the examination program. The writer 
does not advocate the generally accepted method of giving 
these tests. Beginning with a year group of tests at or 
below a child’s level and working up to the year in which 
he fails is bad methodology and very poor from a psycho- 
logical standpoint. “Random” testing is also advocated 
by Terman and others as the only means of finding out 
where a child stands and the proper point from which to 
continue systematic work. The writer does not believe that 
Binet or Simon ever intended their tests to be used in such 
fashion. To begin with, their first scale was not an age 
gradation of tests. All of the sentences for repetition were 
grouped together, the comprehension tests were all in a 88 
THE UNSTABLE CHILD 
group, the digits for repetition and all other tests were simi- 
larly handled. Those of us who had used this arrange- 
ment did not see in the age-group revision other than the 
same tests newly placed so that their very placing showed 
their normal value. It was not as hard, consequently, to 
go ahead and give all similar tests under one set of direc- 
tions as it would have been to work through the year grad- 
ing of tests, hitting the same test series again and again at 
higher levels and repeating the directions each time. The 
serial method of testing is the logical one. It saves time; 
it orients the examiner very quickly to both extremes of 
his subject’s intelligence; it saves fatigue and renders pos- 
sible a great saving of both the examiner’s and the sub- 
ject’s energy and nerve strain. A brief study of the test 
series will illustrate this: 
Let us take, for instance, repeating digits forwards. If 
one is working serially, he gives the direction, or aufgabe, 
as we prefer to call it, in detail and starts with 2 digits. In 
most instances they are given correctly upon the first repro- 
duction. The clinician knows then that the directions were 
understood. He goes on and gives 3, 4, 5, 6, 7 and 8 digits, 
expanding to two or three trials, as required when he 
reaches the patient’s point of beginning failure. What has 
happened? He has begun systematically, not at random, 
and knows his test was understood and that failure is the 
result of actual inability. Moreover, the probabilities are 
that he has saved at least 2 or 3 wearying repetitions of the 
aufgabe, the child has had a longer period of associative 
thinking without need for constant readjustment to a new 
test, and we already know the upper limit of ability on this 
one series of tests. Diagnosis is begun, and formulates itself 
gradually throughout the rest of the examination. 
The test grouping was the basis of the Point Scale re- 
vision of the Binet, but the gain through having the tests 
all grouped by series was more than offset by the loss of MEANS AND METHODS 
89 
the mental-age placing of each test. Serial testing throws 
a little more work upon the examiner, but it adds the Point 
Scale efficacy to the age-scale value. Each series as fin- 
ished gives us a mental age on that group of processes. In 
fifteen minutes by such examining one knows practically 
the type-differentiation of his case. All of the widely vary- 
ing series are best given at the beginning of the examina- 
tion. The tests group themselves easily into some definite 
series and others, which, though closely related, may be 
easily modified. Some groupings are obvious. The digits 
forwards form one series. The digits backwards is not in 
any way a part of the same series. It tests adaptive usage 
of the first ability and is preferably given later in the ex- 
amination, for ability to repeat digits backwards undoubt- 
edly depends upon the memory span for digits forwards 
and the extent to which failure on the reversion should be 
expected may be partially gauged by the limit of success 
for the repetition forwards. In most instances one should 
surely not chance fatigue from too prolonged work of this 
character by giving these as consecutive series. Name, sex, 
age, parts of body, and knowledge of right and left fit to- 
gether well as an opening series for younger children, 
whereas with those more advanced, the date, months of the 
year, days of the week, make an equally successful opening. 
The following series are suggested because of the known 
ease with which the aufgabe or direction for one test drifts 
into the next: 
Repetition of sentences from the 3-year group up. 
All comprehension questions, beginning farther down than 
seems necessary. 
Eight-year similarities, 12-year similarities, 7-year-level differ- 
ences. (The natural tendency of the child failing at the 8- 
year level is to answer by difference when similarities are re- 
quested. This tendency cannot be differentiated from an auto- 
matic perseveration of what has been a successful type of answer 
to the 7-year-level questions, if these are given first, and the 90 
THE UNSTABLE CHILD 
resultant failure is consequently just that much harder to inter- 
pret and is not quite so fair to the child.) 
The definitions in 5 and 8, abstract definitions in 12 and dif- 
ferences between abstract terms in 16, may be related easily. 
Square, diamond, ball and field, design, paper-cutting, and 
then induction. 
Clock problems, then code, for both involve a very special 
imaginal factor. 
Construction of sentences in ninth and twelfth years. 
Counting 4, and on to 13 (for some examiners fail to realize 
that success on 13 covers success on the first four), number of 
fingers, counting backward, naming coins, making change, are 
logically related for lower levels, whereas making change, when 
the basal year is low, may well be used to introduce the 14-year- 
level arithmetic problems. 
The Eesthetic comparisons, missing parts, and pictures in 3, 
7, and 12 are coherent. 
The vocabulary test is best given all at one time. If it be left 
until fairly late in the examination, even an inexperienced ex- 
aminer will find giving it eased and facilitated by starting at the 
words which indicate the probable level of the child on the whole 
test series. If a child is testing about 10 years in level, it is 
easier to begin with the thirtieth word, search for his upper level 
of ability in the definitions and then relieve his mind by working 
backward from the twenty-ninth word. This gives the harder 
part of the test first and more nearly balances the difficulty of 
the task with fatigue on the task. 
Enough fables should be given at one and the same time to 
ascertain both the 12- and 16-year-level scores. 
These groupings may be varied considerably, and are by 
no means exhaustive. Each beginning examiner should be 
put through a definite drill of working up series that slide 
easily from one test to another similar task with minimal 
effort. Of course, all series are not needed on each case 
for a child of high intelligence level may not need to be 
tried on the lower, easier series. By the time the upper 
limit has been found on six or seven series, the examiner 
may well go ahead without guessing and 11 fill in ’ ’ the tests 
needed to complete various years. The proper place to MEANS AND METHODS 
91 
begin such filling in is tbe upper end of the scale and this 
should surely be a year at least above the highest serial 
success, higher if successes are scored therein. Then, grad- 
ually, the examiner should work back, reaching at last a 
basal year. 
Actually, the difference in such examining is of consid- 
erable value to the examiner. If he is testing 300 days out 
of the year and sees two or three children a day, the serial 
method of giving digits will save him an average of 2,000 
out of 3,000 probable repetitions of that one series of direc- 
tions. Perhaps this means but little to the reader, but it is 
the need for monotonous accuracy in the repetition of such 
directions which does more to wear out the nerve reserve 
of the examiner than all the problems of diagnosis put to- 
gether. We have so far paid but little attention to the 
question of the mental hygiene of the examiner himself, 
yet this is undoubtedly an issue which we will have to face. 
The writer knows of no other professional demand which 
makes as exacting and constant a drain as that produced 
through repetition of the same carefully monotonous test 
conditions. With serial testing, once the series is over, the 
examiner knows he will not have to repeat the same phrases 
again in the next ten or fifteen minutes. Moreover, he has 
longer periods between giving detailed directions. 
There is one superficial criticism of serial testing from 
the standpoint of the inexperienced examiner. It takes a 
great deal of time to learn the exact place in the whole test 
grouping at which the next member of a series appears. 
This is undoubtedly true, and in reality it is the greatest 
argument for serial testing. It necessitates an absolute 
knowledge of the scale and a finer, more discriminating, 
knowledge of the relation of tests to each other than can 
otherwise be obtained. 
From the standpoint of the child, there is undoubtedly 
much less fatigue. If the usual procedure is followed, and 92 
THE UNSTABLE CHILD 
each test at any one age is given as a discrete test, the child 
is constantly attempting to adapt to a new situation and, 
the more rapid his adaptation, the more quickly is another 
demand made upon him. With the test series, adaptation 
is far more gradual and complete change of the aufgabe 
occurs probably once in 3 or 4 minutes instead of once every 
30 or 40 seconds. One can make the test far more what 
Binet asked of it, that is, a game. The transition from test 
to test comes gradually. It is very natural to ask a child 
for the date after having had him write his name at the 
beginning of the test and then following that come very 
readily the months of the year and the days of the week. 
If the case is not a school problem and therefore not at 
odds with the school system, it is very easy to go ahead 
with another group of academic tests and to ask the making 
of change, counting backwards, counting 13, the naming of 
coins and, in the case of a psychopath where there is a long 
range of testing necessary, to say incidentally that we have 
to ask these easy things and go ahead with the problems in 
the 14-year level. 
Psychologically speaking, the serial method of testing 
renders the findings on any one test series available as a 
part of the immediate diagnosis the minute that series is 
finished. Each successful series adds to and modifies the 
diagnosis so far formulated. In a few months this cannot 
but help reflect upon one’s own knowledge of the tests used 
and make far more valuable to the examiner himself the 
actual testing experience which he has had. Let us illus- 
trate: Suppose we are about to examine Margaret, a 14- 
year-old girl, in first-year high school, who does not seem 
to get along in school and who has been brought to us as a 
problem on that account. After a few introductory re- 
marks, we give her the series—date, month, days of the 
week. She passes the series so far as the test requirements 
go but errs two days on the date of the month so that we MEANS AND METHODS 
93 
already have an indication of inaccuracy of knowledge at 
a 9-year level. We next give her the arithmetic series and 
find that she does the 14-year-level arithmetic problems with 
some confusion of reasoning but correctly within the time 
limitations and so passes at the 14-year level. This makes 
her normal in this series. Before giving her the induction 
test, we lead up to it naturally by giving the drawing series, 
and here we find marked evidences of motor disturbance. 
The girl has sufficient memory to gain credit for the design 
at the 10-year level, but qualitatively her performance is 
very poor; the corners meet in a straggly fashion, and the 
lines are irregular. Her performance on the ball and field 
is likewise peculiar, showing the same incoordination. She 
does the cut design in the eighteenth year without any ap- 
parent difficulty of reasoning or imaginal functioning, al- 
though, once more, there is marked negligence of perform- 
ance. Following this with the induction test, we find she 
has no difficulty in abstract working out of the rule so that 
from another line we corroborate the fact that her reason- 
ing is up to the 14-year level. Her work on the code fails 
because of a number of small errors. We finish the series 
on imaginal ability by giving the clock problems and cor- 
roborate our former findings of good ability in this respect 
by success on that test. We next give the repetition of 
digits and find that she cannot say more than 5 digits for- 
wards and she is therefore at least below the 10-year level 
on immediate rote memory. The repetition of sentences in 
series is given next, and here again she fails on the 10-year- 
level tests. The repetition of digits backwards is given 
next, and here she fails on the 9-year tests for 4 digits. 
Each additional series gives us a final judgment of the 
girl’s ability in some one type of performance. Each ad- 
ditional series modifies our concept of the girl as we have 
formed it tentatively on earlier performance. Our final 
concept of her as a psychopath or a non-psychopath, a nor- 94 
THE UNSTABLE CHILD 
mal, an inferior, a precocious, or a feeble-minded girl will 
depend upon the relation of these partial concepts to each 
other. To one who works with serial testing it seems im- 
possible to obtain the same knowledge of a child in any 
other way save by a prolonged and arduous reexamination 
of the test series after the whole test has been given in 
other fashion. Even then one is apt to find that outstand- 
ing abilities or disabilities have not been checked to the 
limit of the tests because one did not see any reason for 
giving the girl a test two or three years above the level at 
which she has failed on everything else. From the stand- 
point of personal experience, the writer is positive that the 
serial method of testing is a fundamental prerequisite of 
technique when one wishes to study test findings quali- 
tatively. 
The reversal of the usual procedure of getting a basal 
year first is necessary if one wishes to balance fatigue and 
the difficulty of tests given. The tests required for a basal 
year are so much easier for a patient than those at the 
upper end of his range that they are still easy for him as 
he gradually grows more tired. Moreover, if the harder 
tests are given earlier in the series, and gradually those are 
reached that are easier, the subject will gain confidence in 
himself and finish the examination in a happier attitude. 
Earlier failures are forgotten in later successes, and he is 
far more ready to go on with other series of tests. Of 
course, successes must alleviate failures even in the earlier 
part of the examination. The basal year should not be a 
single year of successes. Serial testing has shown the ex- 
treme irregularity of many cases which sometimes run as 
many as three different basal years with the years in be- 
tween showing failures. At least two successive years 
should be covered to establish a double basal. Of course, 
serial testing is almost impossible where one is using a 
record blank which is booklet in form. One cannot easily MEANS AND METHODS 
95 
turn a number of pages back and forth for scoring. A 
simpler, briefer blank is necessary, one that enables the 
examiner to see the successes and failures of the whole 
examination at a glance. It not only renders test 
recording easy, but enables one to see the whole test series 
in their relation to each other. One cannot use a manifold 
page record in any such simple eye-inspection fashion. The 
eye impression of one page fades as another is studied and 
the details presented are too numerous to amalgamate for 
one mechanically. 
Individual tests also gain significance through serial 
usage. Even though we are not consciously aware of it, the 
first tests a child does for us make the deepest impression. 
What he does later may be said to be an explanation of the 
possible mental ability of a child who has responded as 
this child has to our first tests. Such tests are really 
strengthening their norms in this way and indicating ex- 
ceptions at the same time. This is one reason why it is 
well to vary the order in which tests are presented. An 
examiner who always gives certain tests first, others next, 
is bidding fair to develop a nauseous distaste for the whole 
matter of mental tests. But aside from this reason from 
the examiner’s viewpoint, there is every reason for vari- 
ability of initial approach from the patient’s angle of the 
matter. The conversational method demands this. If a 
child is interested in books, let him do the reading test 
or look at pictures. If he wants to play with other blocks, 
get out the weighted blocks. If the pencils and paper 
interest him, begin on the drawing series. This is not 
psychological finesse, but mere common sense, and will have 
its immediate bearing upon gaining cooperation success- 
fully. 
After the mental age is ascertained, the most radical 
change possible in the examination should be made. Prac- 
tically all of the tests on the Stanford are verbal. The oc- 96 
THE UNSTABLE CHILD 
cupations involved are refined in size and, with the excep- 
tion of the carrying out of the three commands, there is 
no test which takes the child out of his chair. The per- 
formance tests may be used next for they create a real 
diversion of interest. The Seguin form board should be 
given with the child standing, for only thus can he have 
ease of muscle play sufficient to place all the blocks with 
maximal speed. The other performance tests may be done 
standing, kneeling, or sitting; let it be a matter of the 
child’s own decision. Of course, many older children and 
surely those of higher intelligence level and normal func- 
tioning will feel no great fatigue and will go on quietly 
and with interest through a long examination. If any of 
the tests of actual control, such as the grip and lung ca- 
pacity, are to be used, these may well make a break before 
the rest of the examination is carried out. Then one may 
go ahead with things which are less actual strain because 
they are the more familiar tasks, that is, tests of school 
ability. 
Unfortunately, most of our standardized tests to date 
do not directly test the child’s ability in its relation to 
the school work of his grade unless they are so long that 
their usage is impossible without absorbing long periods 
of time which are not always available. We need simple 
tests for each school year which are as definitely stand- 
ardized as counting 13 at 7 years of age, copying ‘ ‘ The little 
Paul” at seven years, writing “The pretty little girls” from 
dictation at eight. Ayres’ standardization of spelling gives 
us a very good group of minimal grade requirements in that 
subject. By using his lists of those words spelled by 100 
per cent of the children in each grade, we know that a child 
is below the minimal level of a grade when he misses even 
one word of such a list. Most arithmetic tests are too dif- 
ficult for the usual clinic case. They do not cover the 
work of the lower grades, nor the reasoning side of such MEANS AND METHODS 
97 
lower-grade problems. In reading, it is easier to pick a 
test that is nearer what one wishes. Throughout this part 
of the examination the aim should again be to see by ser- 
ial usage of tests of varying grades of difficulty just what 
the child knows. 
Association tests, especially the word-association series 
such as the Kent-Rosanoff,1 or the modified Woodrow-Low- 
ell2 list, are difficult to give. One must so place such a 
test in the course of his examination that it subserves the 
chief aim for its being given. The association test reveals 
complexes, fears, experiences. It shows up delayed reac- 
tions, fatigue, automatisms, and many other traits. The 
question is this: Shall the test be given near the beginning 
of the whole examination so that the child may do as well 
as possible upon it, or shall it be given towards the close 
of the whole examination so that the clinician may have, 
through it, a picture of abnormal tendencies maximalized 
by fatigue? The very factors which tend to prevent one’s 
getting a fair estimation of a child’s ability in other tests 
help one obtain more of an insight into his abilities and his 
disabilities on this test. The association series are not “in- 
telligence tests” in the accepted sense of the word. The 
intelligence test must give the individual every chance to 
show the height of his power and ability. The association 
test is a detailed study of the contents of one type of 
mental process. The literature on this subject is rather 
bewildering because it discusses both the intelligence level 
factor and the quality of the test findings in indiscriminate 
commingling. The question of similarity between the an- 
swers of adults and the answers of children is a serious 
one. Rosanoff found that after the age of eleven there 
was little difference in the general body of responses of 
1 Grace Helen Kent and A. J. Rosanoff, “A Study of Association 
in Insanity,” American Journal of Insanity, 1910, Nos. 1 and 2. 
2 Herbert Woodrow and Francis Lowell, Children's Association 
Frequency Tables, Psychological Monographs, 1916, No. 5. 98 
THE UNSTABLE CHILD 
children and adults, whereas the younger children gave an 
increased number of individual associations when checked 
on the adult norms.3 Romer finds eight is the lowest age 
limit at which children give predominantly a common type 
of reactions.4 It is also the upper limit at which normal 
children respond by phrases. Durea has analyzed some 
of the reaction frequencies in association for children of 
the 9-, 10-, and 11-year levels, but in none of these groups 
does he find a correlation with Stanford mental age, per- 
formance ability, or literacy that is high enough to he of 
any general significance.6 The difficulty with all of these 
studies is that they are anxious to bend every test symp- 
tom to a mental-age evaluation. The association test is a 
test of mental function regardless of the child’s level and 
it should be used as such. 
The aufgabe on this test is quite difficult to give with 
fairness to the child. The waiter, two years ago, had the 
following experience in teaching new examiners. A child 
was examined upon the day of his admission by the writer 
herself. The association test seemed to indicate a fair 
degree of intelligence, individuality, and some very definite 
instability. A day later the test was repeated by a stu- 
dent. To the writer’s surprise 97 out of the 100 reactions 
were automatic nonsense syllables and sound associations 
with the stimulus words. Believing it to be a matter of 
indifferent and unsuccessful aufgabe, the child was brought 
in and a new worker of very different type, not knowing 
what had happened, was asked to give the association series 
over. A series of answers approximating the writer’s re- 
3 Frederic C. Eastman and A. J. Rosanoff, “Association in Feeble- 
Minded and Delinquent Children,” American Journal of Insanity, 
July, 1912, pp. 125-141. 
4 Fritz Romer, “Associationsversuche an geistig zuriichgebliebenen 
Kindern,” Fortschritte der Psychologie und ihren Amoendungen, 
1914, Vol. 3, pp. 43-101. 
BMervin A. Durea, “Individual Variability in Test Performance,” 
Journal of Delinquency, March, 1922, pp. 86-98. MEANS AND METHODS 
99 
suited. Again the poorer examiner was given a trial at him 
with results comparable to her first series. Then she was 
reinstructed and obtained a series fairly like those of the 
other examiners. Of course, the child was unusual in type. 
If normal in adaptive learning, he would have carried over 
the proper set from the first examination, but he was a 
slow learner and highly suggestible. The experience is 
sufficiently enlightening. It needs no further discussion. 
Association tests should not be written. Even adults ex- 
perience great difficulty in keeping to a first reaction when 
writing their reaction. One should not expect it of a child. 
Intonation, delays, misinterpretations, repetitions, giggles, 
blushes, and all extraneous comments should be noted. 
They are at least as important as the reaction word. 
An association test may well be given a number of times 
if the child is kept under observation for more than 24 
hours. It is naturally permissible when later reexamina- 
tions are given. 
Tests on general information and orientation may be used 
conveniently at various intervals in the examination. 
Some of them may be used as an introductory conversation 
instead of just wasting time on purposeless remarks. But 
such information is far more likely to be given with free- 
dom towards the close of an interview. Moreover, one can 
work very readily from such questions about home, play, 
work, and hobbies to the reason for the child’s trip to the 
clinic. This usually brings the child’s own story in detail, 
and usually there is more or less emotional disturbance as 
the telling progresses. Such emotion interferes very defi- 
nitely with any further testing upon lines where perform- 
ances are standardized. It should consequently come, by 
choice, at the end of the interview. The child’s story should 
be recorded as nearly as possible in the form in which he 
gives it. Miscellaneous tests of other sorts may be worked 
in at different points. The whole problem is one of alter- 100 
THE UNSTABLE CHILD 
nating tests of various types so that the child’s interest is 
held and fatigue is thus temporarily minimized. 
When a child is under prolonged observation, the ques- 
tions of fatigue and sustaining interest are less serious. 
Certain tests may well be done on different days. Unstable 
children are very frequently as different on two days as 
though they were two different children, but the possibil- 
ity of this must be considered. If tests are divided between 
two days, at least one of the tests should be given both 
days for comparability. Any one series should surely be 
given in its entirety at one sitting. With unstable or er- 
ratic children, it frequently happens that their ability on 
certain tests varies tremendously from one examination to 
another just a day or two later. The mental age obtained 
may be exactly the same but the tests on which that mental 
age was obtained the second time may be the very opposite 
from those which gave credit the first time. Partial alter- 
nation is by no means rare. It frequently happens with 
unstable children that the repetition of a series such as 
the Stanford will bring, with the most comparable of 
efficient testing methods, variations of even a year or two 
in mental age, although the tests are but a day or two 
apart. This is quite unexpected from the standpoint of 
work reported on average children. 
No examination should be considered complete unless the 
examiner has recorded the attitude and behavior of the 
subject during the examination. Gestures, motions, pos- 
tures, mannerisms, attitude, emotional condition, moods, 
changes, should be carefully recorded at the time of the 
examination. Seemingly irrelevant remarks may be full 
of diagnostic value, simply because they are irrelevant. 
Lack of inhibition, over-affectionate advances, irresponsi- 
bility, disobedience, tantrums, are as valuable as any other 
form of data. 
Throughout the whole procedure certain fundamental MEANS AND METHODS 
101 
virtues of such work should be kept in mind. Truthful, 
that is, accurate recording, simplicity of statement—for of 
all verbosity, scientific verbosity is the worst—definite de- 
limiting of what is meant, conservatism, with radicalism of 
thought limited to one’s own personally recorded prog- 
nosis. These are fundamental prerequisites for work which 
is to be of concrete value. CHAPTER VII 
VERIFICATION OF RESULTS 
“Obvious need,” exclaims the scientist, and yet, peculiar 
as it may seem, the whole tendency of psychological diag- 
nosis has been to formulate and deliver diagnoses without 
checking the results. True, the month and the year values 
on the Stanford may be carefully checked, the I.Q. ’s proven, 
the values of all other tests be carefully established by 
comparison with norms, but this has practically nothing 
to do with “checking” the diagnosis. Such bits of work 
merely check the accuracy of the work done. The checking 
of the diagnosis is another matter. The test results plus 
the examiner’s experience lead to a definite formulation or 
concept of the patient’s condition. This concept is a psy- 
chological diagnosis which may be very definite or indefi- 
nite. Even in its most definite form it is not the sort of 
thing which should be passed out with finality as the last 
word upon the individual’s condition. A psychological di- 
agnosis is the scientific basis of a clinical diagnosis of the 
individual’s mental condition and ability, but it should be 
cheeked by every possible auxiliary type of information 
that can be obtained about him. 
A careful neuro-medical examination must undoubtedly 
be demanded. The presence of physical handicaps, whether 
organic, structural, or functional, and the possibility of 
correction and of having, as a result, a better human or- 
ganism to train or educate are of most vital importance. 
Such an examination can err only in incompleteness, al- 
though it is highly essential that the work be carried out 
with a perspective that sees relativity of importance and 
102 VERIFICATION OF RESULTS 
103 
can unbiasedly help determine the relation, or lack of rela- 
tion, of eye defect to school failure, adenoids to truancy, 
syphilis to immorality, or whatever else presents to its be- 
havior accompaniment. 
The history of the individual from the time he is born, 
his development, opportunities, and handicaps must all be 
taken into account if we would be fair to him and to our- 
selves. Then, too, even these facts must be related to his 
inheritance, the environment in which he has had to grow 
up, the schooling he has had, the way he has behaved, in 
school, at home, at play, at work. The use he has made of 
his opportunities is the biggest aid to reaching a final diag- 
nosis. If all of these findings can be logically fitted into 
the concept of the individual as we formed it from direct 
observation, then the tentative psychological diagnosis be- 
comes the clinical statement of him. If, however, facts 
found in the history prove to be extenuating in their bear- 
ing upon the situation, the original diagnosis must be modi- 
fied accordingly. Very often it is only data so obtained 
which will specialize a very general notion of the individual 
into a specific line of investigation, and, sometimes, more 
work must be done to amalgamate the findings from such 
diverse fields. It does not do to make a diagnosis that 
merely balances evidence against evidence and swings in 
favor of the greater amount. The various discrepancies 
must be analyzed until they fit together into a concept that 
explains them before one can be at all sure that the diag- 
nosis is correct. 
To enumerate in detail the facts which should be em- 
bodied into the history of an individual would be almost 
impossible. Any fact one obtains about a person helps one 
to understand him better. The limitation of what one can 
get is usually the limitation of what is acceptable. 
Concerning the individual himself every detail relating 
to pregnancy, birth, infancy, feeding, dentition, develop- 104 
THE UNSTABLE CHILD 
ment of -walking, talking, and playing, is important, either 
negatively or positively. The detailed history of the ill- 
nesses the child has had, not merely reported by name, but 
with a descriptive report of the child’s actual condition is 
most valuable. This will not be gotten spontaneously. 
Very often it takes a lot of gentle questioning before a 
mother or father remembers significant details. For in- 
stance, it does not do to reason that if the parent says 
there have been no convulsions at any time that this is 
actually so. The person giving the history may have an- 
swered truthfully according to his understanding of the 
situation, but if there is reason to suspect any disturbance 
of this sort, it is often necessary to ask not only for convul- 
sions, but also for “spells,’’ fainting spells, fits, “heart 
spells,” falling spells, seizures, etc. Eecently the history 
of actual convulsions was given the writer only when de- 
tailed questioning of the parent led to a statement that 
the child had had the “shakes,” which then resolved itself 
into a voluble description of petit mal epilepsy, the presence 
of which had seemed inevitable from the study of the child’s 
actual condition. 
The whole of the child’s school experiences should be gone 
over in detail with regard for extenuating as well as con- 
vincing circumstances. The age at school entrance, the 
type of school, the physical condition of the child at that 
time, harrowing experiences, severe punishments, poor 
teaching, removal from one educational system to another, 
quarantine absences, likes and dislikes in relation to school 
should all be investigated just as carefully as grade repeti- 
tion, truancy, and failure. The child’s own report of likes 
and dislikes in regard to school subjects, school teachers, 
and schools should be checked as fully as possible. 
The social life of the child, his behavior in relation to 
other members of the family, his obedience, disobedience, 
solitariness, affectionate manner, noise, quiet, games, plays, VERIFICATION OF RESULTS 
105 
interests, home duties, playmates, playgrounds, leadership 
when with other children, behavior with others should all 
be analyzed. If the subject has reached the teens, these 
questions take on a very special character, for the modifi- 
cation of all earlier behavior by sex consciousness is intro- 
duced. Economic value of the individual also becomes 
more important. The child of three who can dress him- 
self is gaining an economic value to the family group. 
Playing alone, that is, without constant parental super- 
vision, ability to run errands, to do little household chores, 
all add to this aspect of his status. The question of actual 
money earning bears a totally false relationship to such 
value, especially in homes of the better middle-class, where 
it is considered rather lowering to have the children work- 
ing for a few dollars a week but where this denial is more 
than balanced by the regular training into responsibilities 
at home. 
When an individual has once gotten to the point of try- 
ing to support himself, the details of the positions he has 
had, the wages earned, the length of time such positions 
have been held and the reasons given for leaving are diag- 
nostic in the extreme. It is no unusual thing for a feeble- 
minded boy to give up a job and rest supinely at home on 
the efforts of a worn-out mother because it is too hot to 
work in summer, or he gets too dirty on that particular 
job. His changes from one position to another are merely 
meanderings of chance. There is no definite motivation 
such as shorter hours and the same pay, more chance for 
advancement, or better wages. 
The place of religion in the everyday life and the amount 
of religious training should be ascertained in each case. 
Delinquencies, and social problems which make trouble 
for the home, or the school, or the group with whom he 
comes in contact, should be investigated in detail. Usually 
a careful searching back along the road of how the individ- 106 
THE UNSTABLE CHILD 
ual came to be examined at this time leads to this. Wor- 
ries, home crises, self-denials to overcome peculiarities, all 
of the pathetic strategies of striving to bring a child up in 
the way he should go will be innocently revealed to him 
who knows how to read. 
Having obtained a fairly complete picture of the child, 
the next thing to do is to refocus this in the light of what 
can be learned about the family. It is not enough to ascer- 
tain the intellectual and physical status of the father and 
mother and the other children in the family, the siblings 
as we usually speak of them. There is every possibility 
that it may be years before inherent traits in any or all of 
these develop to the point where they will fit into the pic- 
ture as a part of the conditioning of the patient’s disabili- 
ties. The farther our gathering of facts extends, the more 
probable is it that we would get the evidences of wrong 
predispositions were they present. The difficulty of ob- 
taining such data varies. In one instance a young adoles- 
cent, seemingly intelligent enough, one of a gang of suc- 
cessful young thieves, was sent to the writer as a problem 
serious of solution. A first interview with the mother gave 
the frank statement of three generations of insanity, in- 
volving all four grandparents. The father seemed normal 
save that he was despondent at times. One of his, the 
father’s, sibs has an “awful temper,” another is deaf and 
in very poor health and suffers from chronic headaches, the 
other is healthy and well. The father of this group, that 
is, the paternal grandfather of the boy studied, was insane 
and died at seventy of softening of the brain. His wife 
has insane spells of temper and comes from a family in 
which the females have fiery tempers and the only male 
sib was a wanderer, gone on one trip for thirty years. 
Beside our patient’s family, the only other known descen- 
dant from this family is a girl who is a paranoid dementia 
praecox under institutional care. The mother of our boy VERIFICATION OF RESULTS 
107 
is intelligent but highly neurasthenic and excitable. One 
of her two sibs is highly despondent at times. Neither has 
children. Her mother suffered from a paralytic stroke, 
her own mother having had three strokes. This maternal 
grandmother married twice. The grandfather of our boy 
was insane and epileptic and wandered off at times. Of 
his sibs, one died in the State Hospital for the Insane and 
another has a daughter there now. The others died too 
long ago for reliable information to be available. That 
inheritance of disturbances is not only from this maternal 
grandfather’s side is given us by studying the children of 
the grandmother’s second marriage. She had four chil- 
dren by this marriage. The first was normal, the second 
died at birth, deformed, the third died young of diphtheria, 
and the fourth was a girl, immoral and absolutely “no 
good” who deserted her two children, of whom the oldest 
is definitely feeble-minded and the other still too young to 
be definitely diagnosed. 
The sibs of our subject reveal a rather interesting patch- 
work reproduction of these various traits of their progeni- 
tors. The oldest two are normal girls, twins, who are highly 
intelligent and very nervous, tense individuals. The next 
is a sister who suffered from convulsions from the age of 
three to seven years and who seems to be all right now. 
The next is a man who had convulsions as a baby, and who, 
as he got older, was a definite problem because of his con- 
tinual running away and who, interestingly enough, has 
found an occupation wherein he legitimately wanders from 
place to place. The next son had convulsions of a grand- 
mal nature from the age of one to eighteen and is away 
from home working most of the time. The next is a girl 
who shows no signs of abnormality as yet. The next in 
order was a miscarriage, and then came our subject who 
began running away at the age of three, never returning 
until found. By ten he began stealing and has a record of 108 
THE UNSTABLE CHILD 
four years of such behavior interrupted only by periods 
of attempted reformation in the industrial school. With 
such a definite hereditary predisposition to a disturbed ner- 
vous system one views the delinquencies of the subject from 
a viewpoint differing greatly from that of the officer of the 
law who sees in him nothing but a chronic offender, a thorn 
in the side of the law. Nor does intelligence testing indi- 
cate that we are wrong to assume this attitude towards him. 
He tests sufficiently high to have enough intelligence to not 
do the things he does. The Stanford rates him at twelve 
years and five months mentally. 
His home environment and social opportunities have 
been such as to give him no excuse for anti-social behavior. 
The minor indications found in our examining are signifi- 
cant, but not significant enough to enable us to predict what 
is apt to happen until one views them in relation to his 
heredity. He is lacking in any definite emotional response 
to the situations in which his arrest lands him. A perpetual 
grin disfigures his really attractive face. He gives one the 
impression of having delusions of the most pleasant type, 
yet none can be elicited. His reaction times are irregular, 
his test findings indicate extreme irregularity, poor com- 
prehension, and reasoning inferiority much below where he 
actually scores. He admits masturbation and intercourse 
since the age of twelve. 
In this case the history is the decisive item which justi- 
fies the care for the boy which his psychopathic indications 
would suggest . . . that is, therapeutic, or sanitarium, care 
for his mental condition rather than punishment for that 
which he evidently cannot control. This is more evident 
when one recalls that he has experienced two incarcerations 
for attempted reform with less than two months of good 
behavior after each interval, although he was “corrected’’ 
for eight months the first time and ten months the second. 
It is not, however, as easy to gather such data as this VERIFICATION OF RESULTS 
109 
might lead one to infer. The nsnal case history gives facts 
which are less spectacular, and it offers fewer of them. 
Often, indeed, it takes two or three interviews to get signifi- 
cant material, for there must be established a definite con- 
fidence in the individual to whom family secrets are being 
told, and the better the family, the harder it is to get a 
statement of that which threatens their family reputation, 
integrity, or honor. Sometimes, indeed frequently, when 
one is working with problems of delinquency and depen- 
dency, it is impossible to obtain any definite family history. 
In a way this is perhaps the worst type of family history. 
The family is a social unit of many generations of social 
standing and acceptance. It is bound together by ties 
which are recognized everywhere. The obligation to the 
family is the elemental social obligation. In most normal 
families, even though there is little of financial resource 
and little chance of a better condition in the near future, 
blood ties mean obligation. Consequently, we are all fa- 
miliar with the poor family who make the effort to help 
the even poorer relative when the need comes. We all 
know the disgrace with which the average working man’s 
family views the poorhouse, charitable agencies, and free 
dispensaries. The honor of the family name and the repu- 
tation of the family as self-supporting and independent 
motivate every possible effort. Consequently, when we find 
a child abandoned, parents gone for parts unknown, rela- 
tives indifferent or even impossible to trace, we have the 
very best reason to suppose that there is a high probability 
that the family is one which did not measure up to accepted 
standards of family responsibility even in its days of com- 
parative comfort and lack of stress, or they would not have 
solved their obligation in such a selfish way. There is noth- 
ing insignificant in the study of an individual. The family 
that deposits a child on a doorstep and drops responsibility 
thereby has left an ineradicable statement of this lack of 110 
THE UNSTABLE CHILD 
family responsibility and social solidarity. The mother who 
can remember nothing about her child’s infancy detracts 
from our data on him in one respect, corroborates an heredi- 
tary handicap on the other. Even the voluminosity of 
the report from an agency handling a child has a definite 
bearing upon our consideration of him. Too often he is 
only an object about which to centralize reports. It is im- 
portant to know this. 
In general, the gathering of family and personal history 
is a way filled with difficulties. To begin with, one must 
accept items given in the light of the individual giving 
them. This means, practically, the psychological evaluation 
of the individual and often leads to the necessity of cross- 
referencing and investigations which mean deferring judg- 
ment and action for days and weeks. For instance, one 
Sunday afternoon several years ago a well-dressed, highly- 
intelligent looking man came stalking into the clinic with 
three small copies of himself trailing in step-fashion behind 
him. He wanted help and advice as to what to do with 
them. He gave a seemingly straightforward story. His 
wife, the mother of the three children, had died. He told 
of her jealous love, lack of desire for children, and loss of 
love for him wdien the children came and explained that the 
children had stopped developing rightly soon after her 
death. He confided that he had married again, but that 
his second wife was insane, and did not care for him, and 
he was going to try to have her committed. He told, with 
demand for secrecy (not noticing that this was not 
granted), that he was an inventor, and had been on special 
assignment to work out airship problems all through the 
War. His conversation was erratic and bombastic. He was 
absent-minded and lost track of the conversation at times. 
He told in detail his whole life history, including a definite 
description of illness symptoms which were such as would 
make one question beginning paresis. At this interview he VERIFICATION OF RESULTS 
111 
gave a “good” family history, with only one peculiarity, 
the report that nearly every individual in his own family 
had died of the same complaint, a “dropsical tendency.” 
His phraseology in giving these reports was the first clue 
to the unreliability of the data. Asked the cause of death 
of an aunt he said that he was not sure, but it was “pos- 
sibly dropsical.” In the same way another individual had 
‘ ‘ dropsical phthisis. ’ ’ 
Time necessitated closing the interview without comple- 
tion. The children were all abnormal, the younger two 
having some definite cretinoid symptoms and yet being 
atypical. They were brought back for resident observation 
the next day and, at this time, the father, being relieved 
of the strain of providing for them for a little while, be- 
came more confidential. He told how he had been watched 
by spies all through the War. At a third interview he was 
told that at least one of the children had congenitally ac- 
quired syphilis in an active form, although all three showed 
signs of it. He denied all possibility of being responsible 
for their condition, yet he gave us a good many of the 
diagnostic symptoms. He mumbled in talking, heard poorly 
at times, was ambiguous in conversation, bombastic, un- 
emotional save in attributing emotion to himself in his con- 
versation. His mannerisms were extreme, indicating his 
over-sexed nature in every possible fashion. He fabulated, 
was oversuggestible, fatigued very easily, intake was im- 
paired, yet he was plausible as a conversationalist. He 
gave a definite history of early headaches, visual and speech 
disorders, stomach disturbances, and girdling pains. Urged 
with having a Wassermann test made upon himself, he 
broke out into the following statement: 
There have been many mysterious things going on lately and 
I even had to go to the Secret Service once about it. They did 
not seem to think much about it, but of course you cannot tell 
whether they are investigating it or not. There were many mys- 112 
THE UNSTABLE CHILD 
terious events. I tell you lots of people knew things about me 
that nobody knew in town, and they must have been investigated 
by somebody, and whoever it was they were mighty clever and 
covered their tracks. It started back in 1914 before the War, 
before we were in the War we talked about the way Germany 
was going into Belgium over the boundaries and then a lot of 
mysterious occurrences began. 
Once there was a man came to the house when I was not there, 
and he told the housekeeper that my friends had asked him to 
investigate, and he said my children were playing on the railroad, 
and I was to see him at the hotel at some time that afternoon, 
and I went there and there was no man like the housekeeper 
said [his wife was living in 1914], Then nobody knew who the 
man was and the Board of State Charities said it was not one 
of their men, because they always tell who they are and this man 
would not. 
And I was awfully surprised at the things people would shoot 
at me. They would know things that I know they could only 
have found out of the past if they had investigated back into 
things for nobody in town knew them. This visitor mystified 
the woman and she was completely mystified. This woman, and 
now I will tell you something in the strictest confidence, she came 
to me in a mysterious fashion. I had a lot of trouble with 
housekeepers and then she came and she was young and buxom 
and she fell for me and made up to me and I fell for her, and 
she made a dupe of me and after it had gone too far she accused 
me of the worst thing a woman can accuse a man of and then it 
wasn’t true and then she tried to commit suicide. At least, she 
was unconscious and she told me afterwards that she had tried 
to commit suicide, and I think she was an agent of theirs. 
The only reason I think they were after me is because I was 
working on a war invention and they knew of it and tried to stop 
me. Yes, it did interfere with my work. No one can do think- 
ing work with so many worries and interruptions and there was 
a time when I was very much worried. 
I know there were visitors around the house. I never saw them 
but I knew they were there for I watched and there were always 
foot tracks around. They were as big as those of a very large 
foot, about a man that wore a number twelve shoe. They were 
in the flower beds and places. 
For a long time I thought I was marked. I don’t think I am 
the only man that is marked. There are a lot of people. Maybe VERIFICATION OF RESULTS 
113 
in every city in the country and they are all marked. They 
have a perfect organization. It may be all imagination but it 
is very mysterious. 
It is still a mystery to me. I would meet people on the street 
and they would be all right and then when I met them in a few 
days they would look as if to say, “Go away and get out of here” 
and in that way I knew the mysterious people were at work. 
I think they got the little children and gave them this disease 
with a mysterious inoculation. That is how they got syphilis. 
They tried to get me but I am too careful. Maybe they thought 
I would take it through the children. 
They were after me and they were Soc.. alistics [note pro- 
nunciation]. They must have told my wife things for she knows 
about things that happened before I knew my wife didn’t exist. 
They are antiganastic to me. These Socialists and Bolsheviks 
are not going it for themselves, they are just agents for this 
mysterious company. You mark my words there will be another 
war. 
Not a long time ago I was arrested for train clinging. It was 
on the work train and they arrested me and took me to jail. 
There was an order against getting on the train when it was 
going but it was very mysterious that I was the only one arrested 
and sent to jail when there were thousands hanging on the train. 
They are after me all the time but I notice that when we move 
they are better a little while and then they come back. The 
children’s development stopped in 1914 when they got after me. 
Writing to the local court and to the man’s physician 
and employers soon corroborated the evidence which he had 
so unwittingly furnished against himself. It brought the 
further evidence that he had tried to have his second wife 
probated as insane, and the matter had been dropped be- 
cause his own unreliability was recognized. The only rea- 
son that no step had been taken to control him was because 
he was still capable of earning enough to support his fam- 
ily! This is, again, a lengthy and extreme illustration of 
the dangers lurking in the literal acceptance of evidence. 
And yet, perhaps it is not so extreme after all. It is more 
than probable that a goodly number of our highly colored 
family histories have been partly “colored to order.” 114 
THE UNSTABLE CHILD 
Those giving the data have been aroused to pathological 
reports b}r the definite interest and enthusiasm in the family 
morbidity shown by social workers who expend their en- 
ergy on the compilation of records without stopping to 
check the validity of testimony given. A scientific worker 
checks all such information given from every possible 
angle. The nearby neighbor, the grocer, doctor, minister 
and school teacher may all lend splendid assistance in such 
attempts to validity items which are of extreme importance 
when they are to be used to determine our methods of 
handling an individual. 
One other item should be stressed. It is far better for 
the examiner himself, if he begins his work with a subject 
without any definite information as to the difficulty which 
has brought the child for examination. The openness of 
mind with which one attempts to solve the problem is then 
very different from the preconceived attitude which un- 
consciously forms itself if the whole history of the case has 
been obtained and assimilated beforehand. It is no diffi- 
cult matter to delay getting the history, if the examiner 
must get it for himself. Parents readily recognize the 
fairness of such a procedure and usually cooperate far bet- 
ter because fairness is insured. The writer’s own prefer- 
ence is to complete an examination on the individual, have 
time to assimilate it and work up the norms, and then have 
the necessary interviews at which history is obtained and 
related to the child’s condition as the full observation of 
him reveals him. This is really a time-saving method, for 
otherwise one has to get the history at an early interview, 
then examine the child, and then have another interview to 
give findings and plan handling the situation. When his- 
tory is taken after the examination the handling of the case 
can usually be discussed at the same time. 
To the reader this probably looks like a long and round- 
about way of reaching a diagnosis. It is, and yet it is the VERIFICATION OF RESULTS 
115 
only way to reach a diagnosis that will meet the scrutiny 
of time and bear the light of day a year or two after it has 
been made. An individual is expensive material, the most 
expensive raw material that a country produces. Salvag- 
ing him has a right to be proportionately expensive. A 
single wrong diagnosis, wrong in the sense that it leaves 
for custodial care, as a dependent, an individual who might 
have been saved for comparatively satisfactory self-support, 
is an extremely expensive error from the standpoint of the 
individual, the community, and, naturally, from the stand- 
point of the obligation of the psychoclinician. It pays to 
be conservative in diagnoses, and the checking of psycho- 
logical findings by data gathered on other aspects of the 
case is one of the best methods of promoting this conserva- 
tism. On the other hand, it is no unusual thing for the 
psychologist to have brought to him a child who is almost 
or entirely past the age where corrective work is possible 
and to find that the parents have been depending for years 
upon the optimistic diagnosis, “He will be all right when 
he reaches his teens.” This is no less opprobrious than the 
other extreme. In both instances one can see back of the 
diagnosis the desperation of an individual who actually 
did not know, and who fitted his insufficient bits of knowl- 
edge to the handling of a problem which lay outside his 
province. The worker who is seeking truth in what he does 
will again and again be confronted with cases in which he 
will not be able to settle the matter definitely, and in which 
the only honorable professional thing to do is to admit that 
he does not know, that the diagnosis must be deferred await- 
ing further developments, or, in some instances, referred to 
those who would be more apt to know. Until one can do 
this without self-consciousness, simply because it is the 
natural thing to do, he has not come into his own as a 
diagnostician. 
But even when one has made a clinical diagnosis, the 116 
THE UNSTABLE CHILD 
validity of it is not so efficacious, nor its significance so 
great, as usage had tried to make it. A diagnosis, be if. 
ever so good, is but a statement of the individual’s condi- 
tion at the time of the examination. In general, this must 
be differentiated from prognosis. In some cases, diagnosis 
naturally involves prognosis. In other instances, its usage 
thus can spell nothing but disaster. We may truthfully say 
that an individual who is once feeble-minded is always 
feeble-minded, assuming a correct diagnosis. We cannot 
say once insane, backward, dull, bright or psychopathic 
means always insane, backward, dull, bright or psycho- 
pathic. Prognosis as an exact prediction is still in its 
infancy. Following cases at present under observation for 
ten or twenty years will throw much light upon the accuracy 
or error of our handling and prognosing of them. In the 
meantime, prognosis is largely empirical and is based upon 
the experience of the clinician. CHAPTER VIII 
RESULTS SO FAR OBTAINED 
To many, an examination has been completed as soon as 
they have finished working with the child and have counted 
up the test scores. Even the calculation of intelligence 
quotients has been facilitated by the invention of slide 
rules and charts for that purpose. The application of the 
diagnostic terminology follows, with statistical ease, either 
when I.Q. ’s are used or when the mere relationship of men- 
tal and chronological ages is used. Most problems of intel- 
ligence evaluation are actually left untouched by such a 
concept. Many difficulties are actually raised by such 
singleness of outlook upon the matter of clinical diagnosis. 
It is well worth our while to review some of them. 
First, let us recall the concept of feeble-mindedness which 
was generally accepted in this country at the beginning of 
the mental-test era, that is to say, about 1910. A feeble- 
minded person was one who was incapable of living as 
others in the community because of lack of intelligence. In 
extreme cases he was not capable of even feeding or dress- 
ing himself. In less marked cases he was incapable of 
protecting himself from ordinary dangers, and in still 
less pronounced cases he was distinguished because of his 
inability to make good economically. The most widely 
accepted definition was that of Tredgold.1 He stresses the 
fact that feeble-mindedness is not merely inferiority such 
as could be described by a formula of normal amount of 
mind minus a certain quantity, but it is a definitely patho- 
logical condition which is produced by some disease and 
1 A. F. Tredgold, Mental Deficiency. 
117 118 
THE UNSTABLE CHILD 
which exists from very early age, if not from birth. He 
differentiates it definitely from dementias that are the re- 
sult of degeneration of the neurones and from the insani- 
ties which are manifestations in behavior of the functional 
disturbance of the nervous system. 
Perhaps a better definition is that of the Koyal Commis- 
sion of Great Britain, especially that section which relates 
to the higher grade feeble-minded. They describe him as 
“one who is capable of earning his living under favorable 
circumstances, but is incapable from mental defect existing 
from birth or from an early age (a) of competing on equal 
terms with his normal fellows or (&) of managing himself 
and his affairs with ordinary prudence. ’ ’ This is the 1 ‘ high- 
grade feeble-minded” individual. 
Before the era of mental testing, this high-grade feeble- 
minded person, whom the English called “feeble-minded,” 
the French debile, and for whom the American Associa- 
tion for the Study of the Feeble-Minded accepted the term, 
“moron,” was not a person of great importance in the 
study of social problems. He was considered rather an in- 
frequent anomaly, less in need of care and study than idiots 
and imbeciles. The discovery of the great number of such 
individuals must be credited to mental tests. It took some- 
thing impersonally ruthless, uninfluenced by a pretty face 
or glib words to accurately estimate the low level of men- 
tality of many cases who had formerly been considered 
purely social or behavior problems. Of course, the natural 
result was an extreme overemphasis of the intelligence as- 
pect of such cases. 
The first couple of years of using mental examinations 
brought results that have never been fully explained or 
fully accepted. Overconfidence in the diagnostic perfec- 
tion of the earlier Binet series led to highly startling re- 
ports of the percentages of the feeble-minded found in 
various institutions for delinquents. Goddard and Gif- RESULTS SO FAR OBTAINED 
119 
ford found 66 out of 100 eases seen in the Juvenile 
Court in Newark, New Jersey, to be feeble-minded.2 They 
used four years of retardation as their criterion for differ- 
entiation of the feeble-minded. The fact that the scale 
used practically stopped at the twelve-year level was not 
considered any reason for limiting" its usage to children of 
commensurate age. No test other than mental age was 
applied. Pintner, using the same Goddard revision of the 
Binet, found 46 per cent of children in the Columbus, 
Ohio, Juvenile Court to be feeble-minded, and another 21 
per cent seriously backward.3 On the other hand, Bronner 
studied 505 delinquents in the Chicago courts and found 
less than 10 per cent feeble-minded.4 Undoubtedly the 
fact that she did not examine any children who were 
thought normal by officers and teachers greatly influenced 
her findings. Haines studied 1,000 delinquents in the two 
industrial schools in Ohio.5 By the Goddard-Binet, he 
found 57 per cent feeble-minded, whereas by the Point 
Scale he found only 29 per cent low enough to permit being 
diagnosed thus. Analysis of the differences showed that 
the Binet was too hard in its rating of older children. 
Haines undoubtedly felt the imperfection of the study for 
he concludes: 
What is most important to the judge and to other arms of the 
social service dealing with the delinquent adolescent—his ability 
to learn and to perform, his adaptability, the character of his 
loves and hates, and the tenacity of his purposes—must be 
2 Mrs. E. Garfield Gifford and Henry H. Goddard, “Defective 
Children in the Juvenile Court,” Training School Bulletin, January, 
1912, pp. 132-135. 
s Rudolph Pintner, “One Hundred Juvenile Delinquents Tested by 
the Binet Scale,” Pedagogical Seminary, December, 1914, pp. 523-531. 
4 Augusta F. Bronner, “A Research on the Proportion of Mental 
Defectives Among Delinquents,” Journal of Criminal Law and 
Criminology, 1914, pp. 561-568. 
6 Thomas H. Haines, “Mental Examination of Juvenile Delin* 
quents,” publication of the Ohio Board of Administration, 1914. 120 
THE UNSTABLE CHILD 
learned by further testing and study of the organization of his 
personality. 
Bluemel tested 200 delinquents in Judge Lindsay’s Juve- 
nile Court.6 Finding the tests inadequate for children over 
twelve, he considered the adult tests “as a whole,” and 
estimated “the general intelligence that the answers re- 
veal.” Using this method of evaluation, he still found 
26 per cent of the group mentally defective. He then at- 
tempted a comparison with normal school children and, 
trying to use Goddard’s criterion of “more than three 
years backward” as a means of determining feeble-minded- 
ness, fell into difficulties. He found that from Goddard’s 
own data 8.5 per cent of the children were “three years or 
more” retarded, although Goddard reported only 2 per 
cent. The difference undoubtedly lies in the fact that God- 
dard interpreted “more than three years” to mean four 
years, whereas to Bluemel it meant as little as one month 
over three years of retardation. 
But to what purpose do we recall these various and inci- 
dental reports of feeble-mindedness and their varying fre- 
quencies as found by different investigators! There is no 
need to enumerate the many other studies in detail save as 
they show other angles of the problem, for they have been 
most capably brought together by Williams in his recent 
study of the intelligence of delinquent boys.7 He follows, 
in his analysis of 470 cases, the I.Q. differentiation laid 
down by Terman and presents not only data on the Stan- 
ford-Binet, but supplements it by personal and family his- 
tory, medical data, conduct records, and home investiga- 
tions. His feeble-minded group contains 141 cases, or 30 
per cent of the group. “It includes cases who show indica- 
e C. S. Bluemel, “Binet Testa on Two Hundred Juvenile Delin- 
quents,” Training School Bulletin, December, 1915, pp. 187-193. 
7 J. Harold Williams, “The Intelligence of the Delinquent Boy,” 
Journal of Delinquency Monographs, No. 1. RESULTS SO FAR OBTAINED 
121 
tions either by reason of low I.Q. (usually below 75), or by 
social data, or by both, of being unlikely to develop suffi- 
cient intelligence at maturity ’ ’ to manage their own affairs.8 
Despite this seeming liberality of view, no child with an 
I.Q. under 70 was diagnosed as other than feeble-minded, 
and no child with an I.Q. over 93 was diagnosed as other 
than normal. Although he reports in his conclusion that 
4 of the 470 cases were insane and that “there are a num- 
ber of cases which border on insanity, ’ ’ this condition does 
not enter into the diagnostic classification. He also reports 
42 per cent of his cases as extremely nervous. One of his 
other conclusions is worth reproducing exactly. ‘ ‘ That de- 
linquent conduct in persons of average or nearly average- 
normal intelligence may in some cases be explained by the 
inability of persons, through inherent weakness, to inhibit 
certain natural tendencies.” 
Williams has given us by far the most painstaking of 
recent studies, but like the earlier contributions which are 
reviewed, he leaves us without a definite, comprehensive, 
and well-validated plan for the problems we meet in these 
cases. Goddard’s earlier work, Pintner’s, Haines’ and the 
multitude of other studies made between 1908 and 1916 or 
1917 were highly intensive, one-aspect studies. The tests 
worked with gradually improved, but even to-day the math- 
ematical concept of test usage persists. A discussion of 
three years backward or four years backward as the basis 
of the differentiation of a feeble-minded child from a non- 
feeble-minded one is absurd. Feeble-mindedness is not a 
thing dependent solely upon the relation of chronological 
and mental age. It is fundamentally a statement of social 
ineffectiveness and the probability is that we shall work 
many years more before we find a test which will exactly 
evaluate ability to just get on from disability. Williams’ 
idea of using collaborative data is right. One cannot hope 
s Ibid., p. 176. 122 
THE UNSTABLE CHILD 
to make a final diagnosis of a case without studying more 
than the intelligence level. Haines saw this in pointing out 
the need for studying other abilities. Nor has the striving 
for something more than mental-test level been limited to 
any one group. Healy’s whole emphasis of the delinquent 
as an individual is a recognition of the inadequacy of any 
one test, the only trouble being that he has individualized 
his case studies to such an extent that it is almost impossible 
for the lay reader to generalize them back into facts which 
will help his own work.9 
Kuhlmann is meeting the same difficulty of handling I.Q. 
diagnoses and prognoses.10 In a study of 600 cases exam- 
ined repeatedly at the Faribault institution for feeble- 
minded children, he finds 4.8 per cent who gain at more 
than normal rate of mental growth and 16 per cent who 
lose standing. Some children gain until “they attain an 
I.Q. of 100 or more.” There seems to be more deteriora- 
tion after the age of ten than before. Here again there 
enters a factor of uncertainty in applying tests for diag- 
nostic purposes. Unfortunately, case histories are not 
available for analysis or some light might be thrown upon 
these unexpectedly developing cases. 
A number of briefer studies also stress the point that 
there is something not entirely satisfactory in mental-age 
diagnoses. “When is a moron not a moron?” asks Jones 
in a brief article which stresses the need for other than 
mental-age criteria, for of those with low level in the army 
“a large percentage were meeting the social criterion for 
normality and consequently could not, by the most elastic 
use of the term, be considered as feeble-minded. ’ ’11 
e William Healy, The Individual Delinquent. 
10 F. Kuhlmann, “The Results of Repeated Mental Reexaminations 
of 639 Feeble-Minded over a Period of Ten Years,” Journal of Applied 
Psychology, September, 1921, pp. 195-224. 
11 Carroll T. Jones, “When Is a Moron Not a Moron? Journal of 
Delinquency, January, 1920. RESULTS SO PAR OBTAINED 
123 
Another aspect of the problem is added by Portens.12 He 
points out that mental age is not sufficient as a basis for 
diagnosis of feeble-mindedness, which is social incompe- 
tence, and which can often not be determined until the 
adult stage has been reached. He also brings in an objec- 
tion to tests on the basis that the high-grade feeble-minded 
may often support themselves “for a time,” “under 
specially favorable conditions,” citing as an instance of 
this the need for labor during the War. 
This reminds one of the work being accomplished by 
Bernstein without much sympathy, understanding, or even 
approval, from other institution heads. Under his inspira- 
tional care the custodial institution at Rome, New York, 
has become merely a central training home and clearing 
house for the proper industrial placing of many boys and 
girls whom others wTould consider hopelessly in need of 
permanent institutional care. Training, supervision, grad- 
ual independence have done much, even with such cases as 
courts will commit in a state where demand for admission 
far exceeds space to receive. How much might we not ac- 
complish with the less obviously feeble-minded? 
Clark concludes from a study of some socially irrespon- 
sible individuals that “formal intelligence tests alone can- 
not always be considered adequate criteria of defective 
mental development,” but that we also must weigh the 
ability of the individual to coordinate and make use of 
past experiences so as to meet successfully the problems of 
the present.13 As an illustration for this thesis he presents 
the case history of a woman in whom “mental deficiency 
cannot be demonstrated by the Binet-Simon scale,” but 
who, despite high-school standing, becomes immoral, is a 
failure as a wife, contracts syphilis, continues indiscretions 
12 S. D. Porteus, “New Definition of Feeble-Mindedness,” Training 
School Bulletin, March, 1921, pp. 7-10. 
is S. N. Clark, “The Criteria of Defective Mental Development,” 
Journal of Psycho-Asthenics, December, 1917, pp. 80-88. 124 
THE UNSTABLE CHILD 
and finally needs hospital care, proving untrustworthy 
when on parole. 
From an entirely different angle, Wells and Kelley pre- 
sent the same criticism of mental tests.14 They examined 
102 cases of mental disease. After demonstrating the vari- 
ability of I.Q. ’s in the group, they conclude with the state- 
ment, “Similar intelligence quotients appear in extremely 
differing personalities, and normal ones (I.Q.’s) in the 
presence of grave mental unbalance. The factors in mental 
adjustment are capacities for dealing with men, with things, 
and with ideas. Intelligence scales deal wfith the last of 
these.”15 This leads to their final statement, “Intelli- 
gence is without marked relation to the development of 
psychoses. ’ ’ 
From the educational field comes another criticism of 
the ability of mental age to determine what is going to hap- 
pen. Gillingham has been following the development of 
precocious children and relating it to their educational 
success.18 She concludes, “The possession of intelligence 
does not insure its steady and successful application. It 
may be the most important single factor in academic suc- 
cess, but it is not enough.” She enumerates as some of 
the difficulties met in some of the precocious children stud- 
ied, slowness or inaccuracy in muscular control, “lazi- 
ness,” that is, inertia in a self-projected task, inaccuracy 
in details with knowledge of principles and general rela- 
tionships, social immaturity, neuroticism, and the egocentric 
self-satisfaction that prevents social service. 
The meetings of the American Association for the Study 
of the Feeble-Minded may well be taken as a conservative 
index of experience molding professional opinion. Even 
F. L. Wells and C. M. Kelley, “Intelligence and Psychosis,” 
American Journal of Insanity, July, 1920, pp. 17-45. 
18 Ibid., p. 38. 
ia Anna Gillingham, “Superior Children: Their School Progress,” 
Journal of Educational Psychology, September, 1920, pp. 326-347. RESULTS SO FAR OBTAINED 
125 
there, the last couple of years have shown the critical atti- 
tude towards diagnosis developing in a constructive fash- 
ion. Beier reports a definite percentage of dementia-praecox 
cases among the inmates of the "Wisconsin institution for 
feeble-minded. Experience with these cases leads him to 
to the statement that despite our present test refinement, 
“we have not gone sufficiently far in our study of the con- 
dition, and that in this respect, our tests are, as formerly, 
inadequate.”17 Emerick, Bliss, and Murdock not only 
approve of this statement but add corroborative examples 
from their own experiences.18 Of course, these men are not 
clinical psychologists. 
Healy 19 and Fernald 20 are more interested in the rela- 
tion of diagnosis to delinquency, and add still other prob- 
lems to the present maze of test significance. Healy sug- 
gests that the whole situation suffers from overgeneraliza- 
tion and that many more elements need consideration. 
“The bare statement of an age-level rating in the usual 
way is weakly inadequate in many instances for the proph- 
ecy of what will or will not happen concerning the develop- 
ment of future delinquent tendencies.” He particularly 
urges consideration of special abilities, environment, and 
past experiences. Fernald emphasizes the fact that we 
need to do more for the defective delinquents who are 
“extra-institutional feeble-minded” . . . “not suitable cases 
for any institution, but are of a higher grade of intellectual 
ability than those found in the schools for the feeble- 
17 A. L. Beier, “The Incidence of Dementia Prsecox Among the 
Feeble-Minded,” Journal of Psycho-Asthenics, Vol. 24, pp. 89-98. 
is Report of the annual meeting of the American Association for 
the Study of the Feeble-Minded for 1919, Journal of Psycho-Asthenics, 
Vol. 24. 
is William Healy, “The Diagnosis of Feeble-Mindedness in Relation 
to Social Prognosis, especially Delinquency,” Journal of Psycho- 
Asthenics, Vol. 24, pp. 69-74. 
20 Guy G. Fernald, “The Defective Delinquent since the War,” 
Journal of Psycho-Asthenics, Vol. 24, pp. 55-64. 126 
THE UNSTABLE CHILD 
minded'’ . . . “who develop vicious tendencies." He rec- 
ognizes the need for psychiatric work with such cases. 
To any one reading over these brief citations of opinions 
and findings uncritically, they can but present an incoher- 
ent, ill-assorted mass of variables. But there is in and be- 
hind them a unity of causation. They are all, without ex- 
ception, expressions of one thing and of only that one thing, 
namely, dissatisfaction with or disproof of mental-age tests 
and of diagnoses upon the basis of mental-age tests. To 
summarize: Their complaints are that feeble-minded 
children sometimes test normal. People testing feeble- 
minded are capable of taking care of themselves. I. Q.’s 
do not always come anywhere near being prognostic. There 
are “defective delinquents" whom mental-age tests pass. 
There are precocious children who do not make good. In- 
sanity may be there regardless of mental level. And then 
there develops the suggestion for other lines of considera- 
tion—environment, experience, heredity, and the more re- 
cent suggestions for the concentration of psychological ef- 
forts upon “character study." 
But why the need for the study of character? Signifi- 
cantly, these suggestions come from the group who are more 
interested from the medico-psychiatric viewpoint than from 
the psychologist’s angle. What is character ? What is per- 
sonality? Where do they find a place in a behaviorist’s 
psychology? The earlier attempts at mental testing as- 
sumed that delinquency went hand in hand with inferior 
mentality and was really a social effect of the mental condi- 
tion. To a certain extent, the contention was and is true. 
However, it is the recognition of the not-feeble-minded-by- 
mental-age delinquent which has precipitated this demand 
for other lines of study or analysis. And how much easier 
to grasp the idea of studying some definite thing such as 
“character" than to resolve character back into its relation 
to mentality, especially when clinical experience seems to RESULTS SO FAR OBTAINED 
127 
show that the two differ independently. The writer has no 
desire to deviate into a discussion of temperaments, person- 
ality attributes, character or will-determinants. The 
philosophic energy of centuries has considered these mat- 
ters until the resolution of them into factors clinically 
analyzable is more than a brief aside could handle. On the 
other hand, for the writer, such an attempt would be use- 
less, for practical clinical experience has shown not even the 
remotest need for calling into existence any such attributes. 
It is undoubtedly the difference of the psychological prin- 
ciples under which various workers practice that brings 
such questions to the fore or eliminates them entirely. 
A working theory of clinical psychology must be essen- 
tially behavioristic. The clinician should by all means 
be able to introspect, for only by turning his gaze inward 
may he, through self-knowledge, know in part the workings 
of the minds of others. But he cannot expect reports upon 
the minds of others in the same way. Introspection is diffi- 
cult enough when one has a supposedly normal and trained 
mind. The clinician rarely gets a normal mind to study, let 
alone a mind psychologically trained. His work lies with 
those to whom living has brought problems they cannot 
meet, presumably because of an intelligence defect or devia- 
tion. Consequently, there is but one course open to him. 
Since he cannot know by report the actual “inwardness” of 
the situation, he must establish so far as possible an ob- 
jective way of measuring that mind’s social normality and 
social worth. In terms of everyday life, this thing to be 
measured is the individual’s behavior. It does not matter 
how delicate or how crude the structure, the evaluation 
must be made in terms of the achievement of the structure. 
But is a simple, yet coherent theory of human behavior 
upon such a basis possible 1 Not only possible, but in actual 
usage. Our mental-test series are tests of the behavior of 
an individual under certain standardzied conditions. We THE UNSTABLE CHILD 
128 
are able to rate him on these series only in terms of his 
accomplishment as it compares with the performance of 
others whom we have tried out under similar conditions. 
The behavior of the great majority of the group under a 
certain condition constitutes the norm or common type of 
behavior in response to that situation. The individual who 
responds otherwise is consequently a-normal, and sometimes 
abnormal, in that respect. 
Perhaps a brief outlining of the general theory of human 
behavior, or nervous-tissue response will give a better un- 
derstanding of this way of looking at the problem. 
When a child is born, he is an organism of potentialities 
and actualities. He is a highly complex structure with one 
marked attribute, that is, an ability to sense things from 
the world around him and react to them. This ability is 
not limited to sounds and sights but is, as we well know, 
a sensitivity to all sorts of stimuli. Perhaps the best word 
to express the general characteristic is that chosen by Ver- 
wrorn, irritability. We must not, however, in any way con- 
fuse this usage of the wTord with our much narrower every- 
day understanding of it. The child is an irritable organ- 
ism. Irritability is the normal behavior attribute of his 
whole nervous system. At birth some parts of this nervous 
system are all ready for definite activities. The nerve pat- 
terns of response have developed during uterine life. Suck- 
ing, grasping with the fingers, and crying are such patterns. 
Reflexes, we call them. These are nerve habits which have 
been determiners of survival for the race. A few other 
predetermined reflex patterns complete development after 
birth. These reflexes promote those habits of action which 
we designate from the psychological viewpoint as the 
instincts. 
This does not mean that a child’s future is determined in 
its specific characteristics at the time he is born. The 
greater part of his life’s activity will be, not reflexes and RESULTS SO FAR OBTAINED 
129 
instincts, but behavior which represents an end product 
of the relation developed between the demands the environ- 
ment makes upon him and the ability of his nervous sys- 
tem to meet that demand. Each and every detail in the 
environment of an individual may affect his behavior at 
any one time. Each later act in his life is definitely modi- 
fied by all behavior which he has experienced up until that 
very moment. 
Perhaps it will be well to explain a little more in detail 
just what this means in concrete situations. A baby cries 
when it is hungry. At first it may keep on crying, even 
when in the mother’s arms, until its mouth touches the 
breast. Soon, however, being lifted from its bed will change 
the hunger cry into a half-impatient, half-contented, gur- 
gling cry of anticipation. The association of change of po- 
sition with being fed has been established. Later, the mere 
sound of the mother’s voice may have the same effect. The 
actual hunger condition is not modified before feeding, but 
these other related factors have become what we call ‘ * con- 
ditioning stimuli, ’ ’ and the child’s behavior is not directly 
and completely the result of his physical state, but it is 
also modified or conditioned by these other factors. 
Gradually, as the child grows older and is subjected to 
many and varied experiences, all sorts of such series of 
conditioned acts arise. Our daily life is made up of them. 
It is because we da learn to respond to these indirect factors 
in our environment that we save the need for constant 
thought and anxiety over each detail of our lives. Not only 
does the direct reason for an act precipitate that act, but 
gradually each incidental factor in the environment at the 
time of the act takes on a certain ability to provoke the 
same response. This is associative learning. 
The principle of the saving of nervous energy through 
associative learning was first demonstrated by the Russian 
physiologists working under the leadership of Pavlov. 130 
THE UNSTABLE CHILD 
Although practically all of their early work was done on 
dogs, the principles have been found to hold true for chil- 
dren. Pavlov21 worked with the feeding reflexes, devoting 
most of his time to the study of factors influencing the se- 
cretion of saliva and gastric juice. The experimenters 
trained their animals to expect food at a certain arbitrary 
signal; it might be the sound of a bell, the glowing of a 
red light, the moving of a lighted figure. In all cases the 
repetition of this absolutely extraneous factor in relation 
to the feeding soon developed enough of a suggestive power 
to condition secretion of the gastric juice and saliva whether 
food were presented or not. The artifically selected stimu- 
lus had become a conditioning stimulus. Acts thus condi- 
tioned are usually spoken of as artificially conditioned re- 
flexes to distinguish them from acts conditioned by things 
naturally related to them. 
A queer way to approach behavior peculiarities of human 
beings is the thought that idly passes as one reads. And 
yet, the very fact that unbiased work in this field was not 
seemingly connected with our problem in any ulterior fash- 
ion makes it more fittingly and reliably used in our study 
of behavior. Pavlov and his followers were so uninterested 
in our problem that the applicability of their findings must 
be due to the fundamental soundness of their data which 
were gathered in a manner uninfluenced by any desire to 
make their findings solve our problem. 
Their principles of associative learning and indirect con- 
ditioning of reactions do apply to human individuals. Fol- 
lowing the work of Krasnogorski,22 the writer found it pos- 
21 Ivan V. Pavlov, The Work of the Digestive Glands, translated 
by W. H. Thompson. 
22 N. Krasnogorski, “Ueber die Bildung der Kiinstlichen Bedingungs- 
reflexe bei Sauglingen,” Russki Wratsch, No. 36, pp. 1245-1246; 
“Ueber die Bedingungsreflexe im Kindesalter,” Jahrbuch fiir Kinder- 
lieilkunde und physische Erzeihung, Vol. 19, pp. 1-24; Ueber die 
Grundmechanism der Arbeit der Groszhirn bei Kindern,” Jahrbuch 
fiir Kinderheilkunde und physische Erzeihung, Vol. 28, pp. 373-398. RESULTS SO FAR OBTAINED 
131 
sible to develop signs of the expectation of food in even tiny 
babies by the repeated presentation of some artifieal factor 
in relation to the actual giving of food.23 Not only do these 
conditioned reactions develop, but they fade, disappear, re- 
develop and persist with a law-like regularity. They in- 
fluence all realms of our everyday life. The child who eats 
only from a certain plate or with a certain spoon has devel- 
oped an artificially conditioned habit. The man who can 
write only with a certain pen or at a certain table has devel- 
oped a reflex artificially conditioned by shape, or size, or re- 
sistance in the first instance, by height, position, or light in 
the second case. Let us take a different type of situation. A 
Mr. Thuring was in the habit of eating breakfast in a res- 
taurant, with his newspaper propped before him. A change 
in the conditions of his work led to a much longer trip on 
the cars during which he read his paper. Arriving down- 
town he ate breakfast, as leisurely as usual, but without 
reading. Several weeks of this changed habit brought 
actual nervous indigestion resulting in sufficient discomfort 
to practically stop his professional work. Analysis of the 
condition revealing first a “lack of desire” for breakfast 
soon brought out the change of habit. The substitution of 
other reading on the car and the reestablishment of the old 
breakfast reading habit soon stopped the trouble. Appetite 
and digestion were definitely conditioned by the reading 
habit. 
Nor is the matter different with children. A baby is al- 
lowed to sleep in a lighted room several times. Soon it is 
impossible to put her to bed in a darkened room. A child 
learns that “please” is a necessary part of asking for a 
desired thing, another never has the conditioning formed. 
One small backward baby with whom the writer worked 
used to say ‘ ‘ Bah, ’ ’ for bottle when he was tired and wanted 
23 Florence Mateer, Child Behavior: A Critical and Experimental 
Study of Young Children by the Method of Conditioned Reflexes. 132 
THE UNSTABLE CHILD 
to go to bed. Last spring his physical condition necessi- 
tated the introduction of a daily dose of mineral oil to be 
given a half hour before he went to bed. In the third week 
of this new regime he very definitely surprised us by drop- 
ping his request for his bottle and substituting the word 
“oil.” He had formed the conditioned reflex even though 
the time element made the relation of oil to bed a distant 
one and, despite his extreme dislike of the oil, he accepted 
the relation, tired—oil—bottle—bed. 
But the effect of all in our environment upon what we 
do is not limited to such isolated items. It is the logical con- 
sequence of having an organ of economy, of energy, of in- 
telligence, a brain. Let us follow its application through 
some one phase of development common to us all. Speech 
itself is a series of conditioned reflexes. Speech is simply 
a practical utilization of the various sounds of the human 
voice. There is nothing mysterious about it. If we pause 
a moment we can easily imagine its early beginnings. A 
danger call, the child’s hunger call, a feeding call, a call 
for help, the mating call. Gradually, the specialization of 
sounds for the very special things of life and the imitative 
sounds for things heard came in. Gestures and intonations 
filled in the meaning and finally there developed the many, 
varied, more or less complete languages of to-day. But how 
does the child learn these? The ability to make sounds is 
one of his physical assets. The ability to make them cor- 
rectly depends upon his intelligence. The process is merely 
the setting up of a definite relation between an object and 
a certain group of sounds, or an act and a certain group 
of sounds. Out of the constant conversation that surrounds 
a baby, he grasps gradually one group and then another 
and imitates them. ‘ ‘ Water ’ ’ successfully, or even partially 
pronounced, brings that which quenches his thirst, other 
sounds bring food, beloved toys, beloved persons. “Go,” 
“up,” “jump,” and “bye” soon have definite associations RESULTS SO FAR OBTAINED 
133 
with certain acts. Because of these associations, the child, 
wishing a repetition of the act, will reproduce the sound for 
himself when no one else does, and speech in its elemental 
form is present. Those who have studied a new language 
by the natural conversational method will have no diffi- 
culty appreciating this. It was simply a matter of asso- 
ciating the sounds of the new tongue with familiar objects. 
The sight of an apple leads one to say “pomme” or “apfel” 
instead of the usual group of sounds. In varying complex- 
ity the whole task is just developing a group of new 
associations. 
Such conditioned associations are not limited to those 
which are formed between objects and actions. They form 
in relation to the feelings also. If one experiences a great 
emotional crisis or disturbance under certain conditions, 
many of the irrelevant factors in that situation will after- 
wards be as fully capable of arousing the emotion as the 
original cause itself. Indeed this tendency of the nervous 
system to make conditioned associations which may then 
function without any so-called consciousness of the reason 
for their activity is the basis for psychoanalysis and correc- 
tive as well as preventive mental hygiene. Every one has 
experienced this propensity for feeling to develop without 
apparent cause. One person cannot endure the fragrance 
of lilies-of-the-valley. Their presence in a room almost pro- 
duced hysteria until analysis brought back the memory of 
them as a sheet covering the casket of a dearly loved baby. 
A person troubled definitely with insomnia always sleeps 
well, free from depression, on a rainy night. Analysis re- 
veals the following situation. In early childhood, the indi- 
vidual suffering from this difficulty heard a denunciatory 
sermon picturing vividly the end of the world and general 
conflagration. For several years she was repeatedly subject 
to a vivid terrifying dream in which everything was burn- 
ing and would awake with an overpowering fear which 134 
THE UNSTABLE CHILD 
could only be eased by making sure that the sky had not 
turned red. Nights when it rained, her fears rested, soothed 
by the belief that the fire could not come when the earth 
was so wet. The incident dropped out of memory but the 
emotional setting remained, not understood until traced 
back by analysis. Even now, although this is definitely un- 
derstood, the pleasure of hearing rain at bedtime always in- 
sures a good night’s rest, undoubtedly a conditioning of 
sleep by factors not usually influencing it. 
But what bearing does all this have on the problems of 
clinical psychology? First of all, it emphasizes a totally 
different side of the matter from that stressed by mental- 
age theorists. To a certain degree mental-age problems re- 
late themselves primarily to the amount of intelligence and 
hence to the amount of mental development the individual 
has. The whole method tends to produce this attitude. 
Mental-age is a measurement of the amount, the level, or 
grade or stage of development. It is checked for its actual 
significance in the individual case by measuring it in rela- 
tion to the chronological age. Our customary evaluation 
of it is a mathematical ratio, the intelligent quotient. A be- 
havioristic attitude may well be held in the study of mental 
level. The mental-age is the indication of the ability to 
react or “behave” as children of a certain age do. But, 
there is another side of the whole matter which has been 
very much neglected heretofore. Clinics have studied 
children of all ages and adults. Mental ages have been 
computed for all sorts of groups from state hospital inmates 
to the draft army. But all of this computation deals with 
the problem of the amount of intelligence, or mentality, or 
neural response, that the individual has. 
There are other aspects of the problem that justly de- 
serve consideration. The army tests 24 showed that there 
2* Edgar A. Doll, “The Average Mental Age of Adults,” Journal 
of Applied Psychology, Vol. 3, 1919, pp. 317-328. See also “Psycho- RESULTS SO FAR OBTAINED 
135 
were many men of 9- and 10-year levels in the army who 
were fully capable of conducting their own affairs in a pru- 
dent fashion. Previous to this, 12 years had rather arbi- 
trarily been taken as the lowest level of intelligence that 
could well take care of itself outside institution walls. The 
institutions for the feeble-minded have great numbers of 
inmates who test 10, 11, 12. The writer has seen and exam- 
ined custodially committed and accepted cases with mental 
ages as high as 16 years. Yet these high-grade institutional 
cases are known failures, for it is their failure to meet so- 
cial, moral, or economic demands which has caused their 
commitment. These two facts, some individuals testing as 
low as 8 and 9 years mentally can get along in the 
community, other individuals testing 12, 14, 16 cannot, 
brought out by widespread usage of tests would in and of 
themselves be sufficient to disprove the validity of mental- 
age as an all-sufficient basis for the diagnosis of intelligence 
conditions, were we unaware of the various unamalgable 
findings summarized briefly at the beginning of this discus- 
sion. 
One tendency is to reply to this criticism by pointing out 
that feeble-mindedness is a social defect and so not exactly 
subject to intelligence analysis. This is merely a philo- 
sophic evasion of the situation. As a matter of fact, one’s 
reactions as a member of the social group are the reactions 
of his nervous system, and as such they are highly depend- 
ent upon the working ability of that system. But there is 
more to the working of a human organism than the mere 
study of the amount of its development. The ability to re- 
member, to imagine, to comprehend, to think, to decide are 
the intelligence attributes of the human organism as we 
study his behavior psychologically. 
Beyond this there is another possibility—one which the 
logical Examining in the United States Army,” compiled by Robert 
M. Yerkes, Memoirs of the National Academy of Science, 1921. 136 
THE UNSTABLE CHILD 
mental-age adherents do not seem to recognize, that is, the 
question of mental function. It is not enough to know how 
far an individual's mind has gone in its development, one 
must learn also how that mind, which he has, works. Per- 
haps the easiest way to differentiate these two phases of 
study is through the terms “level” and “function.” The 
study of the behavior of that intelligence which an indi- 
vidual has is not a very well-developed method from the 
psychological standpoint. And yet there seems to he no 
good reason why it should not be. As early as 1909, Binet 
published an article on feeble-mindedness and dementia 
paralytica.After making a detailed study of the test 
reactions of some dementia cases, especially of general 
paralytics, he points out means by which these cases may 
be differentiated from the imbeciles whom they so closely 
resemble when an advanced stage of the disease has been 
reached. It is really impossible to present the matter in 
better form than that which Binet uses. The need for this 
study, he argues, lies in the lack of clearness of conception 
used by psychiatrists themselves. Descriptive psychologi- 
cal terms they have used for a number of years, but “intel- 
lectual weakening,” “lack of mental synthesis,” “incoher- 
ence of the association of ideas,” are terms inexact and 
empirical Binet offers, instead, the exact examining of a 
case, by intelligence tests, with comparative study of im- 
beciles to determine the differences, if any, between these 
two clinical extremes. His experience in this field leads defi- 
nitely to the conclusion that there is a difference. He points 
out, however, that “one who relied solely upon the results 
of our measuring scale would not be able to grasp the 
mental differences which differentiate an imbecile from a 
general paralytic . . . two individuals may fail in the same 
20 Alfred Binet and Th. Simon, The Intelligence of the Feeble- 
Minded, translated by Elizabeth S. Kite (Training School, Vineland, 
N. J., 1916), pp. 216-321. RESULTS SO FAR OBTAINED 
137 
problems -without for that reason having similar mentali- 
ties; the practical consequence is that the efficacy of their 
mentalities is the same; but the mentalities may be dif- 
ferent . . . our scale gives the actual level of intelligence 
without analyzing it and without informing us as to the 
type of mentality. ’ ’26 He chooses as a theorem the idea 
that dements ‘ ‘ remain virtually in possession of all their in- 
telligence but that they have difficulty in making use of it. ’ ’ 
This difficulty of functioning is essentially pathological and 
“consequently it would only be by chance, by a wholly 
exterior resemblance, that the paralytic could be compared 
to an imbecile and especially to a child.” This hypothesis 
allows us to “foresee that children, imbeciles, and paralytics 
are alike in their inability to solve the same problems; they 
are stopped by the same obstacles so that we can attribute 
to them the same mental level; but the identity of the re- 
sults in no way implies the identity of mechanisms; the 
mentalities remain distinct.” 
His generalizations on this matter must needs be quoted 
verbatim :27 
It remains for us now to go a little farther and having ex- 
plained what a disturbance of functioning is, to contrast it with 
a lack of development, . . . Let us employ first of all some meta- 
phors. Let us take a watch. In the mechanism of the watch 
there are two things to consider: first, its degree of complexity; 
a certain watch indicates only the hour, another indicates the 
hours and minutes, another adds to this the seconds; second, we 
must consider the functioning of the watch, that is to say the 
regularity of its movement, its rapidity, the length of time it 
can go without being wound up, etc. It is this distinction, which 
is so clear for a watch or any piece of mechanism, that we are 
attempting to apply to an intelligence, because it seems to us 
to be a very convenient illustration by which to express the 
essential difference which exists between an imbecile and a general 
paralytic, and the numerous points in which the two resemble 
28 Ibid., p. 234. 
27 Ibid., p. 290. 138 
THE UNSTABLE CHILD 
each other. The imbecile has an intelligence but slightly devel- 
oped; it is, as it were, a rudimentary watch which indicates only 
the hours, but, so far as it goes, this intelligence functions well; 
every time this intelligence fails before a problem it is through 
lack of development. On the contrary, with the general paralytic, 
it is always the functioning which is at fault, that is to say, the 
intellectual work. Theoretically, this dement must be considered 
as an intelligent man who can no longer use his intelligence and 
whose intelligence betrays him at every moment. 
Utilizing this concept, Binet analyzes his own case data 
and shows that there are differences between dements and 
imbeciles which are clearly demonstrable by a qualitative 
analysis of test findings. As an end result the discovery 
of these differences gives, with dementia paralytica at least, 
a definite “weakening of the whole intelligence.” He 
points out that this is in absolute accord with the psychia- 
tric theory, but with this difference :28 
For clinicians the disturbance is global (general) because it 
is manifested in all the functions, memory, attention, judgment, 
etc., by means of observations in detail but without connection 
one with another; and because one makes in a way an addition 
of all these disconnected observations, and one sees that in the 
dement none of the faculties is spared, none functions normally. 
For us the disturbance is global, because we see that it results 
from a certain mode of functioning, always the same, which is 
found in the whole intellectual activity; for us it is an affair of 
psychological analysis and not an accumulation and a generaliza- 
tion of particular observations. . . . That which dominates the 
whole question is the mechanism of the errors produced by the 
dements. We replace the old conception then by a conception 
that is more precise. The old conception, according to which 
the dementia! states depend upon a quantitative dimunition of 
the intelligence or upon an injury of all the faculties, was a con- 
stant source of confusion. One had indeed the impression that 
there was something besides this; but whenever the diagnosis 
of dementia was doubtful, or when one attempted to determine 
exactly the constitutional elements, the ground that he believed 
28 IHd., p. 296. RESULTS SO FAR OBTAINED 
139 
solid gave way under his feet. To the vague and inexact affirma- 
tion of a global dimunition of the whole intelligence, must be 
added, and even substituted for it, the conception of individual 
errors of functioning, of defects of every sort, which by their 
multiplication lower the intellectual level and which present the 
two following characteristics: irregularity and extensiveness, 
relative to the level of the subjects. 
Of course, Binet’s discussion is limited to a comparison 
of two extremes and to merely one type at the demential ex- 
treme However, to any one knowing the mental-level 
gradations possible on mental-age testings, there is very 
little difficulty in extending the functional concept in paral- 
lel fashion. Mental level is a statement of the intelligence 
of the individual as it appears at the time of the examina- 
tion, and the problem that even mental age presents is far 
from simple. There is, first of all, the mental age commen- 
surate with the chronological age. The large mass of chil- 
dren so testing have been studied merely for the purpose of 
establishing norms of mental behavior. The earlier as- 
sumption was that if a child tested normal once he would 
test normal a second time, a third time, all his life in fact. 
It was not many years before exceptions to this assumption 
were definitely demonstrated. Children who had been 
tested and found normal stayed at approximately the same 
mental age through successive years. It was simply a mat- 
ter of time until they proved sufficiently retarded to be rec- 
ognized as definitely feeble-minded. On the other hand, 
backward children do not necessarily remain retarded, and 
children who test so low that they are regarded as feeble- 
minded may develop to normal level. Such cases are 
among those reported by Kuhlmann. Precocious children 
are just as uncertain. Experimental studies have shown 
that young colored children are superior in I. Q., when com- 
pared with white children of the same age and from the 
same type of community, although the reverse holds true 140 
THE UNSTABLE CHILD 
among the older children of the same group.29 What does 
this mean ? What can it mean save the earlier maturity of 
a more recently civilized race, with the general mental level 
lower because of the rapidity of maturing. Unfortunately, 
we cannot be sure this is the correct interpretation for so 
little work has been done on the subject, although the find- 
ings are at least suggestive. But there are other possible 
complications of this mental-age problem. If we have a 
child to whom visual sensations carry no meaning other 
than the simplest, we must necessarily expect failure on 
tests involving visual comprehension. This may lower the 
mental-age rating several years. There are many such 
special defects possible, yet their presence must not in any 
way lead one to infer inferiority of the individual, save in 
that special province. 
Aside from these cases we have the whole so-called de- 
mential group. Binet amply demonstrated the mental level 
inferiority of the cases with whom he worked. Wells and 
Kelley found that the insane may have almost any mental 
level.30 In general, the situation could not well be other- 
wise. Some neuroses bring definite limitation of mental ac- 
tivity, even to the point of seeming idiocy. Others leave 
the patient’s ability to think unimpaired so far as casual 
observation would allow one to judge. Just how much 
Binet’s interpretation of the inferiority of intelligence level 
of the dement as being due entirely to inability to function 
is correct, it would be difficult to say. The matter is at 
least open to criticism. It is quite possible that there are 
at least two types of neuroses, one in which functional disa- 
bility or functional value is disturbed and the other a de- 
teriorative condition wherein the loss is more than mere 
29 Ada Hart Arlitt, “The Relation of Intelligence to Age in Negro 
Children,” abstract of the Proceedings of the American Psychological 
Association, December, 1921, p. 14. 
so F. L. Wells and C. M. Kelley, “Intelligence and Psychosis,” 
American Journal of Insanity, July, 1920, pp. 17-45. RESULTS SO FAR OBTAINED 
141 
inability to evoke the inactive intelligence. Of course, in 
using such terminology, the psychologist is not limiting the 
term functional to the same meaning given it by physicians. 
Functional in the medical world means “without apparent 
organic lesion or loss. ’ * Function on the psychological side 
means the manner of behavior of the intelligence, without 
any presupposition of the presence or absence of brain 
lesions, toxicity, or anything else.” 
If, however, we accept the idea of functional disturbance, 
of variation in the responsibility of the intelligence which 
an individual has, then we must recognize more than the 
functional disturbance of the neuropsychotic, or insane 
group. There is no definite undisputed line of demarcation 
between a normal amount of intelligence and feeble-minded- 
ness. Neither is there any definite point of division between 
normality and abnormality of function. Indeed, each day 
sees the average member of the community swinging from 
normal function to more or less ineffective or abnormal 
function. In a way, fatigue is a normal thing, yet its pres- 
ence brings disturbances of the working of one’s intelli- 
gence which would be decidedly abnormal were one not fa- 
tigued. We forget names, numbers, write words with let- 
ters and syllables omitted, make mistakes on check-stubs, 
carefully misplace valuable data. Were such errata of 
behavior chronic in sufficient number in an individual, he 
would undoubtedly be abnormal, yet this would not be lack 
of intelligence but lack of function of a kind which sub- 
serves our goal-ideas. Functional disturbances range from 
such minute details to the gross incapability and inertia 
of extreme dementias. In the latter instance, we call the 
individual a dement, insane, a psychotic, depending upon 
the aspect from which we are studying the case. 
Psychologically, we need, and must have, an identifying 
term for describing those whose functioning is not normal 
but not abnormal enough to warrant their being placed in 142 
THE UNSTABLE CHILD 
the psychotic group. The term psychopath is probably 
the best fitted for this usage. A psychopathic individual 
would, with the adoption of this term, be one who from 
the psychological viewpoint deviates from the usual mem- 
ber of society in the quality of his mental activity or be- 
havior. He is functionally disturbed. He does not neces- 
sarily tend to become a psychotic, or ‘ ‘ insane, ’ ’ but the ex- 
treme limit to which a psychopath can deviate from the 
normal group brings him into the psychotic group. The 
term psychopathic is, in this sense, as generally applicable 
to the functional deviate as the terms backward and ad- 
vanced are to the level deviates. The study of such func- 
tional deviation becomes a thing apart and above the study 
of mental age. One studying such functional deviation is 
studying a separate, yet closely related, aspect of clinical 
manifestations—psychopathy. CHAPTER IX 
A NEW ANGLE : PSYCHOPATHY 
Just what is psychopathy? 
Mental-age testing is a cross-sectioning of the ability of 
the individual that gives us a statement of the amount of 
intelligence with which he is equipped at that particular 
moment. At the same time this mental-age estimate rates 
him rather definitely in relation to the rest of his social 
group. He has as much, more, or less, mentality than the 
average individual. We modify what we expect of him ac- 
cordingly. In other words, the mental-age test has given us 
a rating of his “level.” The psychopathy of an individual 
is a statement of the extent to which that intelligence with 
which he is equipped works normally, or abnormally. Per- 
haps a commonplace illustration may make the matter 
clearer. Every one knows the possible variety in the object 
meant when a man says, ‘ ‘ I have bought a car. ’ ’ He may 
have bought a Ford, a Marmon, one of the reputed French 
makes, or the most elaborate novelty shown at an automobile 
show. The variation in the refinement of mechanism and 
structure of the different types may well illustrate the dif- 
ferent levels of intelligence. Some are far more compli- 
cated and capable of far more complexity of action than 
others. No one using any one of these cars would refuse to 
admit that it might get more or less out of order. It may 
run irregularly, stall entirely, develop many varying diffi- 
culties. No one could well predict, in the individual case, 
just what would happen, when or how. The same is true of 
brains. No matter what a person’s intelligence, there is 
many a possibility that something may “go wrong.” A 
143 144 
THE UNSTABLE CHILD 
mind may slow down, accelerate unduly, break down, al- 
most stop, and yet no one would say that this is due to the 
fact that the individual possessed a certain level of intelli- 
gence. This disturbance of the behavior of that intelligence 
which a man has is a functional thing and may occur with 
any level of intelligence. Measured psychologically, we 
call such a disturbance psychopathy. 
To reiterate: The study of intelligence level is a study 
of our intellectual resources, our capital, or our raw mate- 
rial. The study of function is a study of the efficiency of 
the utilization of these resources. Mental-age ratings give 
us the presence of, or lack of, intelligence. Functional 
analyses give us the presence of, or absence of, disturbances 
of intelligence. Our final psychological estimate of an in- 
dividual’s ability is a summing up of how well he uses the 
mental equipment he has. 
This usage of the word is not identical with the psychia- 
tric application of the term psychopath. The “constitu- 
tional psychopath” of Ziehen meant a member of that 
group of individuals who were neither psychotic nor psy- 
choneurotic but who gave many and definite indications 
of suffering from psychic abnormalities, especially from 
those which meant abnormality of emotional expression.1 
The term very definitely assumes the correlated presence 
of “constitutional” inferiority in the sense of “physical” 
inferiority. This diagnostic phrase is used very widely and 
liberally by some clinics, is almost repudiated by others, but 
in general has met with psychiatric acceptance. To the 
psychologist the term psychopath or the descriptive adjec- 
tive psychopathic has no necessary relation to any assumed 
physical condition, save as physical denotes an acceptance 
of the theorem that we can have no behavior symptom with- 
out some underlying or concomitant reason therefor in the 
nervous system of the individual. The functional disturb- 
i Th. Ziehen, Die Geisteskrankheiten des Kindesalters. A NEW ANGLE: PSYCHOPATHY 
145 
anee of an individual’s intelligence and his indications of 
a minor or major amount of psychopathy may he consid- 
ered in relation to their physical substratum, with the in- 
ference of its probable etiological relation, or they may be 
observed independently in the psychological laboratory and 
related to other symptoms later in assembling all aspects 
of his make-up into a diagnostic concept of him. 
We have reviewed the accomplishment of the psycho- 
logical world in fifteen years devoted to the study of levels 
of intelligence. Is there anything but hope in the prospect 
of our being similarly able to throw some light upon the 
problem of instability of intelligence, of erratic, queer, pe- 
culiar intellectual processes, if we are willing to devote a 
part, at least, of the next fifteen years to this other aspect 
of the same problem ? The problem is not so new and for- 
eign a one as it may seem at first. We all see daily indica- 
tions of psychopathy in our friends and in ourselves. We 
all know psychopaths. The psychopath shows no trait 
that may not be observed in individuals whom we definitely 
know to be normal. The difference lies in the degree to 
which he manifests the trait and in his inability to keep it 
in effective subordination to his other normal attributes. 
The world in which we live is a world full of people who 
show tendencies toward such traits as excessive talking (so- 
called verbalism), mutism, irrational anger, extreme irrita- 
bility, or ease of acquiring a “grouch,” too easily aroused 
optimism, incoherence, irrationality, automatic habits, per- 
servative conversation on the same subject, too great in- 
terest in the subject of sex, overinquisitiveness, solitariness, 
lying evidently for the joy of it. One half of the world is 
constantly wearing out and using up energy needlessly be- 
cause of the irritating inconsequences of the other half. It 
is not obvious, glaring lack of intelligence that exasperates 
one so frequently in everyday life but the ‘ ‘ peculiarities, ’ ’ 
“mannerisms,” and “oddities,” too small to resent, too 146 
THE UNSTABLE CHILD 
great to accept without actual nerve strain. These are the 
indications of, and evidence of, tendencies from the normal 
or “common” modes of reacting which we see in our 
friends and casual acquaintances. 
It is not a foregone conclusion that the next step in our 
argument is that all such tendencies are abnormal. For 
some years the statement that we are all more or less feeble- 
minded has had a laughing acceptance which has rendered 
the bitter truth at least tolerable. It is time to add a corol- 
lary. We are all more or less psychopathic. The determin- 
ing factor is the degree of our malfunctioning. By imper- 
ceptible degrees the human race ranges from such complete 
vegetative idiocy that the subject does not even make known 
a desire for food, to such complete intelligence that almost 
no limit of ability seems indicated. In the same way there 
are innumerable gradations between normality of function 
of that intelligence which an individual possesses and such 
serious radicalism and inutility of intelligence functioning 
that the individual cannot be allowed freedom to do as he 
pleases. Between these two extremes, the vegetative calm 
of perfect (theoretical) normality of function and the wild 
disturbances which we call the psychoses, more commonly 
the insanities, lie the numerous instances of individuals 
with more or less seriously disturbed function, the psycho- 
paths. 
No one can truthfully deny that if we were to select any 
number of individuals of any given mental age there would 
still be sufficient difference between any one of the group 
and all the rest to enable us to recognize him as an individ- 
ual with “individual” differences. Such differences are 
the variation which we expect and learn to evaluate not only 
in the psychological laboratory but also in every activity 
of our daily life. There is a certain range within which 
we expect individuals to vary. They lack “character,” 
“personality,” “individuality” if they lack such individ- A NEW ANGLE: PSYCHOPATHY 
147 
ual attributes. It is not such indications that we mean to 
designate when we speak of psychopathy. Only when such 
an individual variation, or a group of such variations, 
makes an individual’s behavior deviate so definitely from 
what is done by the social group to which he as an individ- 
ual belongs that it is impossible for him to live as a member 
of that group, without definite discomfort to the group, or 
without violating the social code in such a way as becomes 
a menace to human progress, may we say that his condition 
is definitely psychopathic. In all probability the psycho- 
path may be said to fail and fall without this line of de- 
marcation in either one of two ways. He may have some 
one trait or disturbance of his intelligence functioning that 
is extreme enough to place him definitely as a social menace 
or he may have such numerous minor indications of differ- 
ence of functioning that he cannot live in contact with the 
group without mutual discomfort. To sum it up again 
briefly: minor indications of individual differences, minor 
disturbances of intelligence functioning are a part of the 
experiences of all of us. Definite allowance must be made 
for all such variations. The term psychopath should be lim- 
ited in its application to the individual in whom function 
is so definitely disturbed that the predisposition to unusual 
types of reaction interferes with his normal and efficient 
conduction of his own affairs, even though his intelligence 
is presumably sufficient to enable him to cope with them 
successfully. If the psychopathy evidences itself in such 
a gross form that the individual has ideas which prevent 
his keeping his place in the social group and lead to the 
necessity for hospital care and supervision, he has become 
a major psychopath, one of those definitely recognized as 
psychotic, or as “insane.” A word of warning—until we 
know, from definite statistical observations, we cannot say 
that a minor psychopathy in any individual case is neces- 
sarily a symptom of a later psychosis, any more than we 148 
THE UNSTABLE CHILD 
now believe that moronity foretells later imbecility or 
idiocy. 
The problem is not a simple one, however. For ease of 
contrast we have so far assumed that the intelligence show- 
ing indications of psychopathy is of a normal level. This 
is by no means a fact nor even a legitimate supposition. 
Deviation from the normal in intelligence level and devia- 
tion in intelligence functioning may, must, and do occur 
together in all possible variations. Any one who has worked 
with the feeble-minded knows that there are “good” feeble- 
minded. The imbecile in general is not the vicious, danger- 
ous creature that legislative propaganda has sometimes tried 
to make him. The imbecile whom life has not treated too 
unkindly may be a good-natured, plodding, efficient-to-his- 
level creature, as responsible as that level of intelligence can 
possibly be. On the other hand, another imbecile of the 
same mental level may be absolutely untrustworthy, subject 
to any type of behavior without seeming reason therefor, 
impervious to kindness, a case for the custodial ward. The 
first case is one who lacks intelligence but in whom the in- 
telligence which he has functious normally. The latter has 
the same degree of intelligence so far as we can measure 
it, but his economic and social value is far lower because 
of his instability of function, his unpredictability of action, 
or, as we choose to call it, his psychopathy. Nor is it only 
the imbecile in whom such disturbances of intelligence oc- 
cur. The excitable idiot is demonstrated in most institution 
clinics. Despite the extremely low level of such an indi- 
vidual, what little intelligence there is functions abnor- 
mally. On the other extreme, the precocious child may use 
his intelligence in such an efficient and happy fashion that 
he is a joy to his companions and an object of pleasure to 
the community. Unfortunately, this is not essentially true 
in every instance. The precocious child, too, may be so 
functionally unstable that his future value to the com- A NEW ANGLE: PSYCHOPATHY 
149 
munity or even to himself is a question doubtful in the 
extreme. 
Another complexity lies in the fact that the presence of 
a definite psychopathic tendency is apt to evidence itself 
in an actual lowering of the intelligence rating which a 
child can achieve. The writer does not believe that one 
can, with any justice to the individual, study the intelli- 
gence level of the individual without a consideration of this 
possibility. Just how this happens may vary from case to 
case, but, in general, the writer’s experience has led to the 
formation of the following concept. A psychopath has, let 
us suppose, a normal amount of intelligence according to 
all the probabilities of inheritance and developmental op- 
portunities. Somewhere, somehow, a factor has been intro- 
duced that means irregular or extremely individualistic re- 
sponse to the standard test situations which we present in 
giving ah intelligence test. What happens? No matter 
what efforts the individual makes, his responses now and 
then fall entirely without the possible range of creditable 
answers, even though he actually has sufficient intelligence 
to comprehend the situation. In some instances his over- 
abundance of feeling or emotion in connection with the 
subject matter presented keeps him from answering within 
prescribed times. In other instances his peculiarity of 
answers is caused by a misapprehension of the task. Such 
answers give a good indication of his own line of thought 
instead of indicating adaptation to what the examiner de- 
sires. Throughout, the effort to respond according to the 
test demands causes, because of his greater predilection for 
other types of reaction, and consequent greater necessity 
for constant self-judgment and inhibition of many traits, 
greater fatigue than is experienced by individuals more like 
the common group. As a result, failure enters into tests 
rather uncommon, but no rare thing, to find such an un- 
that are well within the upper limit of his ability. It is 150 
THE UNSTABLE CHILD 
stable child who will score the same mental age after a 
brief interval of a week or two, but whose test results are 
gained by success on a very different group of tests, and 
who fails on many tests done previously. Such frequent 
repetition of test series is not common and not advisable 
in the ordinary case. Yet in individuals who are markedly 
unstable and erratic, whose behavior is often unpredictable, 
the time spent on such reexamination is highly worth while. 
It has been suggested that such variation in responses with 
similar resultant mental ages is due to “chance” success 
and failure on tests that are actually a little too difficult 
for the case under observation and on which he * ‘ guesses, ’ ’ 
scoring a correct answer one time, a failure the next. Care- 
ful observation of the examinations of such a child does not 
bear out this explanation. For one thing, the alternation 
is not limited to tests in the higher year levels in which the 
child scores some successes, but may be scattered up and 
down the scale through the various levels. On the other 
hand, such a child may lose or gain as much as two years 
in a few months’ time. Indeed, such variability may even 
affect the basal year on a series such as the Stanford. We 
have plenty of proof that this is not the usual behavior with 
backward children. Doll’s analysis of a group of feeble- 
minded children examined repeatedly over a long interval 
of time is sufficient to demonstrate this.2 He has also given 
us the most careful statistical study of the individual ir- 
regularity of growth.3 We may do well to note his conclu- 
sion that “marked irregularities in the rates of growth of 
intelligence among individual children of feeble-minded, 
borderline, and superior children are demonstrated by 
growth curves covering long periods of time. The data 
are insufficient to indicate the periods at which intellectual 
growth is retarded or accelerated. ’ ’ 
2 Edgar A. Doll, Clinical Studies in Feeble-Mindedness. 
s Doll, The Growth of Intelligence, Psychological Monographs, Vol. 
29, No. 2, p. 128. A NEW ANGLE: PSYCHOPATHY 
151 
Before accepting psychopathy as a factor to be definitely 
weighed and evaluated in our diagnostic work, let us see 
whether such a concept fits into the problems we must neces- 
sarily meet. 
There can be no doubt but that the intelligence level as 
a cause of abnormal behavior leaves many of our social 
problems unexplained. Are we to attribute the rest to sheer 
perversity, wilfulness, and actual desire to do or be wrong ? 
Dullness, backwardness, stupidity, and brightness have de- 
veloped definite meaning as estimates of an individual be- 
cause of the possibility of interpreting them into mental 
ages. But what of laziness, slowness, solitariness, absent- 
mindedness, forgetfulness, and a hundred other partial 
characterizations? Medical examinations frequently show 
no cause for such symptoms. And then there are the whole 
group of actual behavior problems, the truant, the thief, the 
gambler, the prostitute, the murderer. Mental-age occa- 
sionally explains the actions of some of these, but what of 
the rest ? Is it even probable that a certain proportion of 
individuals are not responsible for their behavior “because 
they are feeble-minded” and that all the other not feeble- 
minded are responsible by very reason of their superior in- 
telligence level? The assumption of a mitigating or ex- 
tenuating factor in these other cases seems far more logical. 
If we were to list all the delinquent acts of the boys and 
girls brought into court throughout the country, we should 
not find anywhere in our list a single act but could be 
paralleled by behavior symptoms taken from the case rec- 
ords of insane adults in any hospital for the insane where 
complete records are kept. Such a hospital has under its 
roof the murderer, the liar, the thief, the immoral, the per- 
verted. Greediness, overgenerosity, egotism, revenge, 
cruelty, wandering, and other similar acts by the hundred 
are handled there as symptoms of the disturbed condition 
of the individual’s thought processes. Why should the at- 152 
THE UNSTABLE CHILD 
titude towards not feeble-minded individuals who are 
known to be not insane but who are delinquent or criminal 
be any less impersonal and scientific ? Why should we im- 
pose responsibility upon such persons until we know it is 
rightly theirs 1 
Practically, acknowledging the presence of possible men- 
tal disturbance, wrong functioning, mental disease, explains 
many problems. But are there other explanations? It 
seems to be quite a common tendency at present to attribute 
an individual’s antisocial traits as a “throw-back” to his 
earliest human ancestors, the cave-men. In such discus- 
sions the reason for the reappearance of such primitive 
traits is usually left as a vaguely assumed fault of the in- 
heritance. As a matter of fact, the probabilities that such 
a chance or sport inheritance would produce such numbers 
of extreme regressions is rather doubtful. To begin with, 
early civilization stringently enforced its law upon such 
deviates. Death, not philanthropic support, settled the 
problems of deviation until but a few hundred years ago. 
Punishment in its extreme form kept down the number of 
delinquents by eliminating them as breeders of more delin- 
quents. Actually, our present-day dependents and delin- 
quents are the waste, by-products, and mistakes of the last 
few centuries. Disease is probably much more important a 
factor in the production of such individuals than we now 
recognize. Indeed, the writer has wondered more than once 
whether our whole problem is not one of mental disease and 
whether feeble-mindedness is not a waste-basket term under 
which we classify those creatures in whom we see inferi- 
ority, but the disease cause of whose condition we cannot 
see, and about whom we know too little to offer help, or cure, 
or prevention. 
The introduction of the study of psychopathy seems in- 
evitable and imperative. Fifteen years ago at the most, 
the diagnosis of feeble-mindedness was entirely a matter of A NEW ANGLE: PSYCHOPATHY 
153 
experiential procedure. The only standardization in use 
was the conjumbling of questions on application blanks, as 
used for admission to institutions for the feeble-minded, 
and these varied according to the institution superintend- 
ent. The introduction of mental-age findings brought to 
light a great deal of unsuspected data. The moron is al- 
most entirely a revelation of test findings. He lacks the 
numerous physical stigmata so generally used to identify 
the imbecile. Even to-day it is almost impossible to get 
many courts to probate a feeble-minded girl of the eight- or 
nine-year mental level, if she is attractive or pretty. Other 
social problems have for the first time been definitely and 
statistically connected with the problem of intelligence level. 
Intelligence diagnosis itself from a perfunctory haphazard 
side-issue of the physician’s work has developed into a sep- 
arate occupation, although not always fully professional- 
ized. 
The study of psychopathy needs similar emancipation 
and standardization, especially in its relation to the diag- 
nostic handling of children and adolescents. The psychia- 
trist, the medical specialist in this field, has usually devoted 
his time largely to the handling and study of adults. His 
training seldom involves sufficient technical training in the 
handling and understanding of even normal children and 
their problems to give him a definite basis for the differ- 
entiation of the abnormal child, unless it is one whose 
deviation is extreme. Again, psychiatric methods lack the 
refinement of standardization that would enable a member 
of the profession to detect the first shadowy signs of dis- 
turbances and related intelligence level unless he adapts 
some of the accepted psychological procedures. Even then, 
because he has usually lacked intensive training in ac- 
curacy of technique with such materials, the results are 
apt to be far more highly variable than when used by a 
psychologist. There is a general tendency to regard the 154 
THE UNSTABLE CHILD 
whole problem of the disturbed mind, the psychopath, the 
psychotic, and the neuropsychotic as belonging for solu- 
tion and handling to the psychiatrist and the alienist only. 
The same attitude held about the feeble-minded some twenty 
years ago, and most states still have a remnant of this sover- 
eignty in the law that specifies certification of condition by 
physicians for admission to state institutions for the feeble- 
minded, although the psychologist has already received 
some recognition in this matter. The question of the limi- 
tation of the study of the individual with a disturbance of 
intelligence will undoubtedly pass in the same way, pro- 
vided psychology can make good and offer some help to the 
solution of the problem. Most of the contentions as to the 
relative limitation of the prerogatives and lines of research 
of medicine and psychology seem to the writer to be wars 
waged over the obvious. There is sufficient work for all 
interested in the study of human behavior, no matter what 
angle appeals most. Moreover, the problems of the dis- 
turbed, diseased, erratic, or psychopathic mind are the 
same for the psychiatrist and the psychologist, the lawyer 
and the layman, the educator and the social worker. Facts 
arrived at by one group are facts for all the other groups. 
If generalizations reached by one group are true, they will 
fit into similar problems met by the rest. There is no divid- 
ing line between what is essentially a problem for any group 
and what another group may find worth studying. Clinical 
psychology has contributed sufficiently to the impetus of 
social work and the solution of social problems to dare ex- 
tend its researches into new fields. The general develop- 
ment of experimental laboratories, the cooperative interest 
of educational psychology, the statistical training so gener- 
ally available for psychological students induce and en- 
courage such development. Far more important, however, 
is the fact that clinical psychologists have reached that 
point of critical dissatisfaction with their own work which A NEW ANGLE: PSYCHOPATHY 
155 
means they are ready for the consideration of new aspects 
of the problem. 
Let us briefly reexamine the studies summarized in 
Chapter VIII. The criticisms they evoke are explainable 
when one accepts the concept of psychopathy and admits 
the possibility that disturbances of intelligence functioning 
may influence test results that were originally meant to 
study intelligence level only. The high percentages of 
feeble-minded found by Haines, Goddard, and Pintner 
necessarily include all individuals in whom psychopathy 
had radically lowered the mental level of the individual. 
So far as present indications go there is a possibility that 
such lowering of the intelligence level is by no means per- 
manent, although no data are available which give any defi- 
nite answer to the question of the percentage who regain 
intelligence level when the cause of instability is removed or 
alleviated. Neither do we know whether such recovery is 
only partial or relatively complete in the majority of cases. 
Following psychopathic children for even a year will dem- 
onstrate to any psychologist that radical changes do occur. 
One item which seems highly significant in this connection 
is the report of Adler at the Prison Congress in 1920. He 
found that prisoners in the reformatories and penitentia- 
ries of Illinois uniformly gave higher testing ratings than 
were found for similar groups of men in the army. To the 
writer it seems most probable that the seeming discrepancy 
may be entirely accounted for by the introduction of the 
factor of minor psychopathies. The actually insane indi- 
viduals were properly identified and diagnosed in Adler’s 
study, but their number is relatively insignificant as com- 
pared with the number of more or less disturbed individuals 
sentenced to such institutions, who would successfully pass 
the psychiatric tests. Regular regime of institution living 
with the enforcement of proper hours of rest, and work, and 
recreation cannot but have a definite restorative effect upon 156 
THE UNSTABLE CHILD 
these cases. On the other hand, the army groups had, in all 
probability, a similar percentage of such potential de- 
viates. The strain of leaving home, adapting to rough group 
conditions, the anticipation of a prolonged period of such 
living with the prospect of injury or danger ahead would 
undoubtedly affect the same type of individual in just the 
reverse fashion. Moreover, the army tests were usually 
made at about the time of the maximum disturbance, be- 
fore the individual had time to adjust to the new conditions, 
whereas in the Illinois study the reverse is true. The dis- 
crepancy of the two sets of data may well represent the 
difference between psychopathic individuals under correc- 
tive conditions, stabilizing back into their maximal ability, 
and similar individuals who by force of adverse environ- 
mental conditions are depressed to minimal ability. 
The low percentage of feeble-minded found by Bronner 
is in all probability due to the fact that her group was a 
selected group. Children who were doing well according 
to the estimate of responsible members of their environment 
were not examined. This would eliminate a goodly number 
of those of inferior level who were functioning normally, 
or nearly so, at that level. Those left for examination 
would include a resultantly higher percentage of the more 
radically psychopathic individuals. This would throw the 
emphasis of test findings upon psychopathy. There would 
be more of those wrho are ‘ ‘ different, ’ ’ and this in turn may 
incidentally throw some light upon the overindividualiza- 
tion of cases which characterizes the work of both Bronner 
and Healy. Bluemel’s difficulty of personal evaluation of 
his cases would be simplified by a consideration of insta- 
bility or psychopathy. Williams’ study would find the 
nervous and insane child a definite part of the problem con- 
fronting him psychologically, if psychopathy were eval- 
uated in relation to other intelligence aspects. The 42 
per cent of his cases that show indications of extreme ner- A NEW ANGLE: PSYCHOPATHY 
157 
vousness would probably yield many other definite and ob- 
jective symptoms of their nervousness if their examinations 
were qualitatively analyzed for such irregularities. As it 
is, the diagnosis of nervousness was that of the physician 
and was not related to test findings. That this is not a 
special problem of a small part of his group is indicated 
by the fact that he reports that cases which “border on in- 
sanity” are found at all levels of intelligence. 
The problems presented by Kuhlmann’s report of chil- 
dren who make normal progress year by year although far 
below normal level when first studied, and by Bernstein’s 
ability to train institutional cases for successful community 
living may both be aspects of the situation underlying Ad- 
ler’s data. It is highly probable that it is the child of 
psychopathic tendencies who makes up lost ground wdien 
proper living conditions are assured. This would explain 
Kuhlmann’s cases, and it may explain a number of Bern- 
stein’s, although he is, in all likelihood, dealing, not only 
with that type, but also with the individual who is so 
thoroughly stable that once trained into right habits he 
persists in them because of his absolute stability or because 
he lacks sufficient intelligence to rationally determine other 
modes of behavior. 
The defective delinquent is undoubtedly a psychopath. 
The description of him is a description of traits of abnor- 
mal functioning in a mind of fairly high intelligence level. 
The term defective delinquent is actually a stopgap which 
recognizes the necessity of some other factor than intelli- 
gence defect as the cause of the behavior of the group so 
classified. The term is inadequate and not actually neces- 
sary if we recognize the probability of disturbance of in- 
telligence functioning without the necessity for accompany- 
ing lowered level to the point of so-called feeble-mindedness. 
In the same way, the generalized term mental defect is no 
longer of usage with this concept. One need not determine 158 
THE UNSTABLE CHILD 
absolutely whether an individual is feeble-minded or 
whether what is wrong with him is some other thing more 
vague and to be more safely classified under the term men- 
tal defect. Our two-fold concept gives us the right to a 
two-fold diagnosis, one of level and one of function. The 
static idea of mental defect may be left for the somatologist. 
These are but a few of the problems upon which the con- 
cept of mental level and mental function seems to throw a 
new light. From the standpoint of our theory of man as a 
functioning and behaving organism we must recognize the 
possibility of psychopathy. If an individual’s responses 
are modified, in varying degree, of course, by all in his en- 
vironment which he senses through the modality of any 
sense organ, then how can we avoid accepting the possibility 
of wrong action and abnormal behavior, even in a practi- 
cally normal organism, if the proportion of wrong stimuli 
in the environment becomes too great? The more normal 
an organism, that is, the stronger its tendencies to safe and 
normal response, the longer it would inhibit the tenden- 
cies to any abnormality of response, but with continued 
stress such wrong reactions are merely a matter of time. 
The probabilities are that such a situation as this hypothe- 
cates would lead in most eases to a nerve exhaustion or 
“mental breakdown.” The disturbance that can be elim- 
inated by analysis is frequently of this type. Is it possible 
to detect such conditions by psychological examinations? 
Undoubtedly so, but not by any rapid-fire use of a single 
test. 
Again—the acceptance of a study of intelligence function 
seems to save us any need for attempting so-called charac- 
ter and personality analyses. It takes care of these. What 
is character? It is the sum-total of an individual’s ideas, 
memories, and imaginings, especially as they relate to his 
assimilation of the behavior code of the group with which 
he lives (this is merely an aspect of his intelligence level) A NEW ANGLE: PSYCHOPATHY 
159 
plus the estimation of the reliability of his acting in ac- 
cord with this knowledge. This latter factor is a compos- 
ite of his functional stability and his past experiences, that 
is, habits of action. Frankly, there seems to be nothing 
more to it. At a certain moment a certain decision must 
be made. The past experience of the individual arouses 
certain tendencies to certain types of behavior. Every fac- 
tor in the environment which is old and familiar reenforces 
the tendency to earlier forms of action, or reaction. Asso- 
ciatively, the whole system is influenced in its pleasure- 
pain relation to the contemplated act. All that is dif- 
ferent in the situation tends to inhibit the act, and this, in 
turn, is accentuated by all the earlier conditioned associa- 
tions which, with their feeling tone, tend to inhibit the 
act. The result? Action or behavior predetermined by 
that group of reaction habits which is the stronger. The 
more stable the individual, the more predictable is such 
behavior, the more trustworthy any estimate of the indi- 
vidual’s character. The more psychopathic the individual, 
the less reliable is any such prediction. 
And personality, what is it? From the standpoint of 
the scientific study of an individual it does not seem to be 
the awesome, mysterious, unapproachable essence which 
many see in it. We must grant that fundamentally all in- 
dividuals are the same. Belonging to the human group, 
our perspective is so foreshortened that we usually over- 
look this, although all of our group activities are based 
upon the subconscious utilization of this very fact. What 
is personality then ? It is not the basal attributes of an in- 
dividual, but the superimposed accidents of his individual 
experiences, opportunities, and handicaps. It is the things 
wherein he is he and not Smith, Jones, or Brown. Funda- 
mentally, these personal attributes are habits of reaction, 
functional types of reacting. As such they are a composite 
of old experiences, hurts, fears, happinesses, successes. 160 
THE UNSTABLE CHILD 
They are not merely intelligence reactions, if one means by 
that products of the so-called conscious nervous system. 
Experiences make their mark upon the whole organism. 
The digestive system, the circulatory system, the ductless 
glands all feel the effect of each act of our everyday life. 
They feel it as it changes or does not change their mode 
of response. But, once such connections are made, they 
persist. The individual whose whole system has re- 
sponded to an injury by the realization of a sense of inferi- 
ority, differs so long as that feeling lasts. Striving, emula- 
tion, boasting, avarice, lying, melancholia, chronic irritabil- 
ity, are but a few of the attributes which develop out of such 
a feeling.4 The psychoanalytic world has been emphasizing 
such transformation of the personality for nearly twenty 
years. Therefore, until we have carefully explored these 
newly opened provinces, until we know the limitations of 
the explanations which psychoanalysis can give, until some 
definite demonstration of the effect of glandular changes 
upon the individual’s behavior has been worked out, until 
toxicity is eliminated as the probable cause of many things 
all the way from grouches to overexhilaration, why need we 
bring into the discussion a something these factors may ex- 
plain ? Character and personality, per se, are not subject to 
tests. An ethical test given under controlled laboratory 
conditions becomes a test of intellectual comprehension and 
of appreciation of the theoretically approved reaction. In 
real life the situations which reveal character and person- 
ality are not so-controlled. They have stressful emotional 
concomitants. They are crises, because the conditions are 
not controlled. The individual’s reaction to such situations 
becomes a matter of his intelligence, plus his experiences 
heretofore, plus his functional tendencies. The emotional 
4 Alfred Adler, The Neurotic Constitution: Outlines of a Com- 
parative Individualistic Psychology and Psychotherapy, translated 
by Bernard Glueek and John E. Lind. A NEW ANGLE: PSYCHOPATHY 
161 
factors of his functioning are a vital part in the determina- 
tion of his line of behavior. A controlled laboratory test 
has no way of awaking emotions in such fashion; conse- 
quently we cannot fully measure character by direct ethical 
tests. It seems wise consequently to devote one’s self to 
the study of those aspects of human nature that are cap- 
able of being studied in a scientific fashion. Personality 
yields before a functional analysis of the individual’s be- 
havior. 
The manifold aspects of probable research into the sub- 
ject of psychopathy cannot easily be formulated until ex- 
perience has vindicated or disproven the fundamental as- 
pects of the thing. One need not feel, however, that first 
attempts must be left until a complete statistical formula- 
tion of it has been made. Such an analysis is, in all 
probability, beyond the ability of any one individual or 
clinic group of individuals. The farther one goes into the 
problem, the greater become its ramifications and the more 
profound its significance. At least, such has been the ex- 
perience of the writer. Some will immediately raise the 
question as to how we mean to relate the intelligence or 
psychological symptoms of such disturbance to the behavior 
disturbances which make social problems. Undoubtedly, 
the study of groups of social deviates is the best method of 
ascertaining just the extent to which they are intelligence 
deviates also. Fortunately, we have some partially accept- 
able norms for control purposes, but there is a wider rela- 
tion of the two fields which needs a little more emphasis. 
The delinquent, according to the social code, is an individ- 
ual whose habit of response is unpredictable. He disregards 
threatened danger to himself, is self-centered, indulges ex- 
treme desires, feelings, and emotions. This behavior is 
usually regarded as a something entirely different from the 
picture of behavior granted by a psychological examination. 
It is not necessarily so. The psychiatrist has for years de- 162 
THE UNSTABLE CHILD 
pended upon even a personally evaluated estimate of a pa- 
tient’s behavior as the basis for mental diagnosis. The 
psychologist does not desire to do that but has a definite 
right to analyze behavior for its erratic, peculiar, unfore- 
seen qualities, and then attempt an analytic relation of 
these to his laboratory findings. We know from experience 
that social and economic failure may be predicted with abso- 
lute certainty for adults with a level below seven years 
mentally. The probability of such failure falls as mental 
age rises. We know that educational success is in the same 
way partially related to intelligence endowment. Is func- 
tional disturbance of behavior as definitely related to such 
disturbance of intelligence functioning as we can experi- 
mentally determine? As it happens, there have already 
been a number of minor contributions on this subject, so 
that we need not leave the question unanswered, although 
all methods are still in the experimental stage. CHAPTER X 
METHODS OF DETERMINING PSYCHOPATHY 
We cannot hope to accomplish the determination of a 
second aspect of an individual’s intelligence without some 
rather definite revisions and extensions of our present meth- 
ods for determining intelligence level only. The first need 
is for a general refinement of procedure. If one errs in 
the presentation of a certain test in the giving of a Stan- 
ford-Binet, the result is a mental age that is either two 
months too high or the same amount too low. On the higher 
levels the error increases proportionately, although the 
clinical significance is probably less, for there is less 
chance of the individual who does such tests being rated as 
feeble-minded. This holds by the mere fact that he is being 
tried on such superior-level tests. If one gets the presenta- 
tion wrong on two tests the error of rating of the individual 
is twice as great. More tests increase the error propor- 
tionately. But the fact remains that the examiner ends 
with a certain form of work completed which gives him a 
mental age. This may be a wrong rating of the individual 
and may score him one or two or three years from what he 
should be, but the examiner may still rest content in his 
ignorance of this fact for he has achieved a mental age. 
The diagnosis of psychopathy is entirely otherwise. The 
study of deviations means first of all absolute accuracy of 
the measurements made, else one has nothing stable from 
which to measure the deviation. Careless examining used 
for the twofold purpose of mental age and mental function 
determination is not merely twice as bad as when used for 
mental-age diagnosis, it becomes a fraudulent imposition. 
163 164 
THE UNSTABLE CHILD 
Nor is the matter of accuracy in applying tests an irrele- 
vant matter. Recently an instructor in a large university 
gave some demonstration tests using the Stanford. There 
was no effort made to use the prescribed forms of aufgabe 
or directions. The vocabulary test was successfully passed 
by the child who could give intelligent associative responses 
to the question, “What does orange make you think of?” 
This is a definite change of test difficulty from the correct 
presentation of the question, “What is an orange?” Yet 
this instructor, erring to a similar degree on tests through- 
out the whole performance, was training a group of gradu- 
ate students who were within a year of going out to try the 
practical application of what they learned. The illustration 
is not extreme nor isolated. 
Such work would be a most improper basis for functional 
analysis. The study of psychopathy necessitates absolute 
precision in the application of the tests, in the use of test 
materials, and in the recording of test results. Nor is this 
all. Every detail of the individual’s behavior under the 
test conditions is significant and should be watched and 
impersonally recorded. Indeed, the study of the points 
of individual difference in a subject is from all angles one of 
omnivorous attention to detail. But even with such atten- 
tion and precision we must insist upon what has usually 
been thought of as a matter of individual desire and deter- 
mination of method. The tests used must be multiform. 
No one test or series will give enough indications of disturb- 
ance of intelligence to enable one to make a secure diagnosis. 
The attitude during the examination must also be definite. 
There must be more emphasis upon how a child does 
what he does and less upon the achievement of an end result 
or rating. In other words, there must be more data gath- 
ered during the examination which will yield us information 
as to the quality of the child’s ability. The simple measure 
of how much he accomplishes, the measure of the quantity DETERMINING PSYCHOPATHY 
165 
of his performance, will not yield much information for 
the study of function. 
Perhaps it is unnecessary to point out some of the results 
of this change of attitude. Diagnostic work will be slower, 
longer periods of observation will be needed. The questions 
that the observation of different attributes raises will 
demand wider cooperation with other allied professional 
fields for their solution and more need for help from social 
agencies for corrections attempted. All of this looks like 
a serious handicap from the standpoint of American hurry 
and the continual emphasis upon cost as the important 
factor. As a matter of fact, the result will be more than 
wTorth while. Even though nothing more definite were 
learned about the child (and there is no reason for such an 
assumption), the emphasis is merely placed upon the kind 
of work that is ethically demanded of any psychological 
clinic and can mean but one thing—better trained 
workers or wider training of the workers employed at 
present. 
The concept of the psychopathic child is not new. It is 
merely the attempt to formulate exact psychological 
measurements for his peculiar attributes that is, of neces- 
sity, a recent development out of modern methods. Perhaps 
the best method by which to become more definitely 
acquainted wdth the problem that we wish to handle in our 
attempts to analyze individual deviations through formal 
tests is to form a general concept of a psychopathic child 
from out our various discussions. To begin with, he is 
usually identified by some much milder and less foreign 
sounding term. Nervous, unstable, different, erratic, 
peculiar, bright but queer, all right in school but different 
from other children, these are some of the terms which have 
been used to describe him. For several reasons any or all 
of these symptoms are not quite the same in children as in 
adults. Those experiences, diseases, and hereditary pre- 166 
THE UNSTABLE CHILD 
dispositions that will later, if nncorrected, develop into 
the acute mental disease or other extreme handicap of the 
adult’s life have, in the child, a much more vague, elusive 
quality. One deals not so frequently with a mania or a 
psychosis but with the shadow of it. The definiteness of 
outline, exaggerated symptoms, acutely disturbed behavior 
are blurred into a misty group of symptoms, and, only too 
often, the intelligently anxious parent, worried thereby, is 
laughed out of his worry and told that the child will out- 
grow it. Such a statement is merely a remnant of the 
general attitude regarding the details of childhood some 
forty or fifty years ago. The mistake lies in measuring the 
significance of such symptoms by comparing them with 
adult behavior instead of studying them as deviations from 
the behavior of children in general. It is this difference of 
symptoms that still makes a definite increase in the difficulty 
of studying the child in diagnostic fashion. The adult has 
achieved his final maturity physically and mentally. He 
has a more or less definite and already determined endow- 
ment. We can study him in the light of this. The child is 
immature. Many of his attributes are still mere potentiali- 
ties which only time will reveal. We have to deal with an 
organism which cannot even stop to acquaint us with its 
attributes. It struggles under the power of a force which 
changes even its very desires before they are known or fully 
expressed. Growth in body and intelligence, with a con- 
stantly changing attitude towards himself and the world, 
absorbs the time and energy of the child. He cannot help 
us, so our observations must be made under a constant 
handicap. Naturally, there are many variations, vexatious 
and troublesome, incidental to the mere process of growth. 
Some of these will reach their own solution with growth 
changes. It is from such symptoms that the tradition of 
outgrowing all difficulties arose. But it is problematical 
whether even such disturbances would not yield more DETERMINING PSYCHOPATHY 
167 
readily, to the individual’s greater efficiency and comfort, 
if expert help were given at the right time. 
Aside from these incidental disturbances, the symptoms 
of disturbance of the nervous system in children are many. 
The whole group of direct physical symptoms seems, at first 
glance, to bear no relation to the psychologist’s problem, but 
this discrete character disappears when they are studied 
more closely. Facial and body twitchings, spasmodic move- 
ments, speech defects, sleeplessness, night terrors, enuresis, 
lack of appetite, apathy, poor carriage, poor motor control, 
headaches seem to be definitely signs of bodily need or a 
disturbance of the nervous system which means tonic, rest, 
diet, any or all of the possible medical measures for correc- 
tion. The most difficult cases, however, are those in which 
the symptoms do not yield to such treatment but prove to 
have a “psychic” origin and may be readily eliminated 
by a common sense usage of psychoanalytic methods. 
Beyond this group of symptoms lies the true province of 
the psychologist as he is called upon to handle the study 
(and cure!) of the nervous or truly psychopathic child. 
The symptoms mentioned above are symptoms of a psycho- 
pathic tendency when their “psychic,” or mental, origin 
is determined. In other cases we must at present rest con- 
tent with describing them as symptoms of a neuropathic 
nature, although it is rather doubtful whether they ever 
occur independent of some signs of behavior disturbance. 
The psychopathic child may have many minor manifesta- 
tions of his condition or some one or two more serious indi- 
cations, or he may combine all sorts of signs. 
The psychopath is a psychopath simply because his intel- 
ligence functions wrongly. The only way such wrong 
function can show is in his behavior, that is, in both what 
he does and what he says. It is the observation of these as 
symptoms that enables us to classify him tentatively as a 
deviate. The intelligence which shows as present in, or 168 
THE UNSTABLE CHILD 
absent from, his behavior is not a measure of psychopathy 
but of his intelligence level. The psychopath may be a 
feeble-minded individual of moron, imbecile, or idiot level. 
He may be possessed of the average amount of intelligence 
or he may have more than the usual amount of endowment. 
The only effect it is apt to have upon his psychopathic 
tendencies is to make them more or less complex. One 
could not expect well organized delusions in an idiot. His 
level precludes that. In the same way, extreme anger is 
more apt to develop some complex behavior results in an 
intelligent individual, whereas the inferior takes it out in 
crude violence. In general, psychopaths present a large 
group of symptoms which are deviations both ways from 
the normal. They may dislike other children and be conse- 
quently solitary or they may hunt other children to tease, 
torment, and hurt them. In neither instance do they get 
along well with the group. They may be overalert, hyper- 
sensitive, unduly stimulated by all in their environment, or 
they may be apathetic, lack sensitivity, and present no sur- 
face reaction to what goes on. They may be overenergetic. 
very emotional, tense, easily aroused to extreme pleasure 
or pain. They may be just as lacking in all these traits. 
Most of them, when compared with other children of the 
same mental level, prove to be verbalists. They use language 
profusely, glibly, superficially. Usually, speaking about a 
thing is their last resort. They see little, if any, difference 
between speaking of doing and doing itself. Consequently, 
they seldom bring their verbal planning to the complete 
realization of deeds. They have violent loves and hates. 
They live at one extreme or the other of the emotional 
plane. Overexhilaration typifies one, chronic depression 
another, rapid alternation of emotional extremes a third. 
They have strong likes and dislikes even for food. They 
develop queer ideas about almost any conceivable object in 
their environment. They have monotonous plays, habits, DETERMINING PSYCHOPATHY 
169 
and subjects of conversation. The brighter ones are 
especially prone to fears. 
The behavior of psychopathic children is marked by such 
symptoms. As a result, it is usually far less predictable 
than that of the normal child. More supervision is needed, 
accidents happen more frequently to them, their toys, and 
their clothes. They do not play contentedly. Other chil- 
dren are not always safe with them. They do not get along 
well with children of their own age. They like the atten- 
tion they get by associating with adults, or, in some 
instances, they seek individuals who are far below them in 
actual intelligence. In all such cases, and frequently where 
this symptom is lacking, the social comprehension and the 
maturity of behavior are far below what one might 
definitely expect in a child of like age and mental age. The 
ego is the center of their world long after most children are 
aware of the need for observing the rights of others and 
practicing self-restraint. They exhibit all possible oddities 
of precision, overemphasis of neatness, cleanliness, and 
exactitude in details. They may be just as appallingly 
slovenly, careless, and dirty. 
The symptoms we have enumerated so far, although 
having a definite psychological significance, are not any- 
thing but the psychological side of general clinic symptoms, 
most of which must be gathered from the report of those 
who know the child’s daily mode of living and the problems 
he presents. Is it possible to correlate the presence of such 
symptoms with laboratory findings in such a way that we 
can determine the relation, if any, between such habit 
symptoms and deviations from the average, group reactions 
on the tests ? Theoretically, the two should be found in one 
and the same child. Are they? Do our tests test the 
processes that are disturbed in such a way that peculiar 
behavior results ? If they do, what are the test indications 
of this disturbance ? Fortunately, partial answers to 170 
THE UNSTABLE CHILD 
some of these questions are already available. The problem 
has been approached from a number of viewpoints so that 
the methods already evolved, although imperfect, are by 
no means one-sided. 
We owe the first work on this aspect of the problem to 
the same man of vision from whom came the idea of measur- 
ing intelligence level, that is, Binet. He not only realized 
the problem which he had been working on in his study 
of the inferiors in level but undoubtedly recognized the 
limitations of the methods applied in studying it. The 
relativity of present mental age to future possibilities of 
development, that is, to prognosis, the necessity for proper 
analysis of findings, and the whole problem of the first 
attempt to differentiate the mentally disturbed from the 
mentally inferior were a part of his interest and research. 
There is no doubt but that it wras his own concrete experi- 
ence which was largely responsible for the insight that 
enabled him to see the necessity for a study of the quality 
of an individual’s behavior on the test, as well as to ascer- 
tain his mental age. Stern emphatically urged the need for 
refinements of observation that would enable one to analyze 
the child’s behavior so as to ascertain the “qualitative 
coloring of his intelligence.” 
It was five or six years, however, before anything of a 
very definite nature was attempted in this country. Then, 
most of the wrork done was on the basis of tests that have 
since been discarded so that we, to-day, have but the statis- 
tical beginnings of norms for qualitative analysis. How- 
ever, these definitely resolve themselves into a certain group 
of points which have received confirmation from more than 
one practical source. 
1. The amount of variability on the Stanford-Binet as 
measured by the number of years above the basal year 
in which a child scores successes. For example, if a child 
has a basal year of 8 and succeeds in some tests in 9 and 10 DETERMINING PSYCHOPATHY 
171 
and does one other test in the 14-year group, his range is 
14 years minus 8 or 6. The child who does no tests above 
his basal age is so rare that he may rest unconsidered. The 
tests on the Stanford are grouped as the successes of the 
great majority of children studied place them. A child 
whose mental development has been a little more rapid than 
that of the group in some ways will be able to do tests 
above the general group level in that respect. The more 
unusual, the more in advance of the group an individual’s 
development, the higher will be his successes in certain 
lines. Roughly, this is measured by range of successes 
above the basal year. 
This aspect of test differentiation was one of the earliest 
pointed out. The first indications of this scattering were 
those reported by Goddard.1 He found that the inmates 
of a hospital for the insane had successes scattering through 
a number of years above their basal year, whereas “the 
normal child or the feeble-minded reaches his level by 
answering all the questions as they come, up to almost his 
final stopping place. ’ ’ Doll analyzed the scattering of nor- 
mal and defective children on the Goddard revision of the 
Binet.2 Since the arrangement of the scale was in itself 
imperfect, he overcame this difficulty by rearranging the 
tests in their order of relative difficulty. Following this 
with a statistical analysis, he finds the scattering 
for the median-age groups of normal and feeble-minded 
children indicated in the table on page 172. 
Very little work has been done to follow up this method 
of determining the probable limits of variability of chil- 
dren of different ages. Terman3 has reported the percentage 
1 Henry H. Goddard, “The Problem of the Psychopathic Child,” 
American Journal of Insanity, April, 1921, pp. 511-516. 
2 Edgar A. Doll, “ ‘Scattering’ in the Binet-Simon Tests,” Training 
School Bulletin, October, 1919, pp. 96-103. 
3 Lewis M. Terman, The Stanford Revision and Extension of 
the Binet-Simon Scale for Measuring Intelligence. 172 
THE UNSTABLE CHILD 
Scattering for the Median-Age Groups 
Mental 
Age, Basal 
Years Range 
above Basal 
Basal Age 
and Points 
Actual 
Mental Age 
Normal 
4 
3 
47 
5.4 
Feeble-Minded.. .. 
4 
3 
47 
5.4 
Normal 
6 
1 
63 
6.6 
Feeble-Minded.... 
4 
4 
412 
6.4 
Normal 
6 
2 
66 
7.2 
Feeble-Minded.. .. 
6 
2 
66 
7.2 
Normal 
7 
3 
77 
8.4 
Feeble-Minded.. .. 
7 
3 
76 
8.2 
Normal 
8 
3 
87 
9.4 
Feeble-Minded.... 
7 
4 
711 
9.2 
Normal 
9 
3 
97 
10.4 
Feeble-Minded. . .. 
8 
4 
811 
10.2 
of successes and failures of children of different ages on 
each individual test in his revision of the scale. From this 
it is possible to construct a table which gives the greatest 
probable range of success. This is as follows: 
Age 
Number 
of 
Children 
Bange of 
Successes 
Assumed 
Basal 
Lowest 
Failures 
Highest 
Successes 
Range 
Possible 
Highest 
3 
10 
2? 
3 
5 
3 
4 
51 
2? 
3 
6 
4 
5 
147 
21 
3 
7 
5 
6 
165 
3 
4 
8 
5 
7 
160 
4 
5 
9 
5 
8 
187 
5 
6 
12 
7 
9 
196 
6 
7 
12 
6 
10 
175 
6 
7 
14 
8 
11 
159 
7 
8 
16 
9 
12 
143 
8 
9 
18 
10 
13 
137 
8 
9 
18 
10 
14 
106 
9 
10 
18 
9 
Range of Success in the Stanford Revision 
From this we can get no direct statement of the probable 
range of successes of any one individual. All we know is 
the maximal range of the group to which he belongs. For DETERMINING PSYCHOPATHY 
173 
instance, since the total range of the whole unselected 
3-year-level group is only 2 years above the age 3, or 3 years 
above an assumed basal of 2, the individual must vary 
within these limits. His range cannot be more. The 
increasing range from year group to year group seems 
highly significant. Older children gain in ability to do the 
tests at the higher levels, but at each age a certain per- 
centage tends to remain unable to accomplish tests at lower 
age levels. We must remember that the children in these 
groups were unselected, so that the feeble-minded and the 
psychopathic are probably represented as well as normal 
individuals. Analysis of Terman’s own tables soon shows 
that it is a small percentage of the group at any one age 
which causes the wide range of variability. Let us take age 
8 for instance. This is the first age at which there is a pos- 
sibility of more than five years range above basal. The 
tables show that with the exception of the ball-and-field 
problem in the twelfth year no 8-year-old scores a success 
anywhere outside the ages 6 to 10. This means that, since 
only 17 per cent succeed on the ball-and-field problem, 83 
per cent of the group cannot have over a five-year range. 
In the same way, we can analyze the 9-year group down 
to at least 71 per cent who range only through the 4 
years of from 7 to 10. Since 25 per cent are reported as 
scoring successfully on the ball and field in the twelfth year 
and 4 per cent on that level vocabulary, not more than 29 
per cent in all score above the 10-year level. 
The 10-year level group contains 4 per cent who fail to 
pass one test in the 7-year level and not more than 2 per 
cent who pass the vocabulary test in the fourteenth year. 
Consequently, at least 96 per cent of the 10-year-olds have 
a range 5 years or less. 
"With the groups above this level the percentages are 
much more variable, and it is impossible because of such 
conflict readily to estimate probable variability. For 174 
THE UNSTABLE CHILD 
instance, the 14-year-old group includes 9 per cent who fail 
a test at the 10-year level. Hence, 91 per cent can have a 
possible range of only 12 to 18 years, or 6 years. Then of 
the whole group 30 per cent succeed in one superior adult 
test, 11 per cent in another, 25 per cent in another. If 
these are all different children, 66 per cent of all have a 
range of 6 years. But it is probable that some of these may 
overlap, or that some of our 9 per cent who fail in 10 
may succeed here. The number of factors becomes too great 
to handle as a matter of estimated probabilities. Data by 
mental age are presented for these ages, but as the mental- 
age groups are delinquents or unemployed they give no 
normal basis for comparison with other groups. 
The whole matter is tentative, but, nevertheless, the fact 
that from data not prepared for that purpose we can 
analyze out the variability of eight out of the twelve age 
groups as being not over 5 years, seems to corroborate 
Doll’s work so definitely that we may tentatively try out 
the presence of more than 4 years of variability above the 
basal as a definite indication of instability or variability 
which is more than that of the group as an average. The 
use of over four years as a criterion seems wise, for it 
safeguards analytic inspection of the 5-year range group 
who may border on the zone of abnormal variability. 
Jones reports from a comparative study of very bright 
and feeble-minded children that the feeble-minded indi- 
viduals scatter more, but he does not publish details, so 
that we have no definite aid on this point.4 Wells also 
finds marked scattering among the insane, and much more 
marked indications in general paralysis and dementia 
prfficox than in the manic-depressive groups.5 He reports 
4 Carroll T. Jones, “Very Bright and Feeble-Minded Children: the 
Study of Qualitative Differences,” Training School Bulletin, Decem- 
ber, 1919—February, 1920. 
o F. L. Wells and C. M. Kelley, “Intelligence and Psychosis,” 
American Journal of Insanity, July, 1920, pp. 17-45. DETERMINING PSYCHOPATHY 
175 
that, “various tests, however, do not have the same difficulty 
for the psychotic, as for the normal person of a given age.” 
However, he gives no year measure of this tendency. 
2. On the actual qualitative analysis of “scattering” or 
test variability we have much more data. Binet gave us the 
first facts for formulating this point of differentiation. 
When he compared the general paralytic with the imbecile 
of similar level, he found that the general paralytic was 
less consistent, his answers were erratically good or bad for 
his mental level. He failed in an “unjustifiable” manner. 
Further analysis revealed errors of all sorts which make 
one believe that the dement has actually lost his ability to 
comprehend more difficult demands upon his intelligence. 
Still finer analysis leads to the conclusion that the whole 
problem is one of functional disability which allows spo- 
radic test indications of former higher levels of ability. He 
notes especially loss of memory for content of things read 
or heard, delay in reaction time, delay in initial compre- 
hension of a task, errors in using information which they 
have. 
Since Binet’s time a good bit of work has been done that 
indicates the validity of his attempts. Wells finds a marked 
tendency for psychotic individuals to fail below their actual 
mental age on the serial arrangement of weights, rhymes, 
enclosed boxes, while “the vocabulary test appears least 
affected of all functions in the scale. Superior adult ability 
in vocabulary is associated with deficiency in remaining 
aspects of intelligence down to the upper limits of feeble- 
mindedness.”6 Formal memory tests are also passed far 
above actual level. The nine-year tests, except change 
making, the ten-year absurdities, reading, design, and digits 
are never passed save by individuals having a mental age 
up to their level. Tests that are never lapsed below mental 
age are the eight-year comprehension, and the stamp values, 
6 Ibid., p. 20. 176 
THE UNSTABLE CHILD 
whereas making change, abstract words, comprehension at 
the ten-year level, and dissected sentences at the twelve- 
year level are seldom failed. 
Jones reports that bright children surpass feeble-minded 
of the same level in immediate memory, ability to attend, to 
learn, and to form difficult associations. No definite test 
relations are presented. Pressey finds that, for the same 
mental age, alcoholics have greater ability than feeble- 
minded in comprehension of questions, recognition of 
absurdities, dissected sentences, and definitions of abstract 
terms.7 Psychotics are poorer than feeble-minded in sixty 
words in three minutes, construction of a sentence with 
three words, drawing design, and also somewhat poorer 
in comparing differences. They are definitely better 
than the feeble-minded in the definition of abstract terms. 
They vary in almost all ways from normal individuals. 
Later work shows that the definitions of concrete and 
abstract terms, comprehension of absurdities, dissected sen- 
tences, and drawing the design are the most highly differen- 
tial tests. Curtis not only reports similar findings but has 
made a qualitative analysis of some individual tests which 
shows that the insane have less memory ability as this is 
indicated in the reproduction of drawings and of selections 
read than have the feeble-minded or normal, but “there is 
no evidence that the insane give responses in the memory 
span for digits or sentences which are markedly different 
from those given by normal persons of the same mental and 
chronological age.”8 Doll finds tests which “put a pre- 
7 S. L. Pressey, “Distinctive Features in Psychological Test 
Measurements Made Upon Dementia Prsecox and Chronic Alcoholic 
Patients,” Journal of Abnormal Psychology, 1917, pp. 130-139; also 
Pressey and Luella Cole, “Irregularity in a Psychological Examina- 
tion as a Measure of Mental Deterioration,” Journal of Abnormal 
Psychology, 1918, pp. 285-294. 
s J. N. Curtis, “Point Scale Examinations on the High-Grade 
Feeble-Minded and the Insane,” Journal of Abnormal Psychology, 
1918, pp. 97-118. DETERMINING PSYCHOPATHY 
177 
mium on memory processes or experience ’ ’ are easy for the 
feeble-minded while those that involve adaptation and 
abstract judgments are relatively hard.9 
This is about the total of our information on the signifi- 
cance of individual tests. Unsatisfactory though it may 
be, it proves the possibility of qualitatively sorting out 
individuals further than our mental-age differentiations by 
attention to the tests that determine that mental age. Per- 
haps the only points on which there are sufficient data to 
give us any generalization are that psychotics are relatively 
good in rote memory, comprehension, absurdities (?), and 
use of abstract terms, whereas they are definitely poor in 
memorial content, as on reading reports and in reproducing 
designs, and are relatively poor in rhymes, reaction time 
and 60 words, the weights, constructing sentences from 3 
words, solving enclosed boxes. 
3. The quality of the individual response on the Stan- 
ford is also significant. This is true not only for tests that 
are successfully passed but is even more spectacularly found 
in the tests failed. Indeed, the failure may be due to the 
individuality of the response. There is a different quality 
in the verbal replies of a dement from that found in the 
replies of an imbecile, asserts Binet. The dement has a 
certain “residue,” or sign of his earlier ability. One can- 
not improve upon Binet’s facile description of the experi- 
ence which the psychoclinician receives from studying such 
individuals. Such residues ‘ ‘ consist in the shade of expres- 
sion and gesture, the form of language, the turn of a phrase, 
the choice of words which are in harmony with a rather 
high intelligence which to-day is lost. As a result of this 
we, the observers, meet with a host of slight perceptions 
more or less conscious, often badly confused, which reveal 
the contrast between what the dement actually is and what 
he once was.” Such indications are monotonously lacking 
9 Doll, loc. cit. 178 
THE UNSTABLE CHILD 
in the imbecile. Binet illustrates this thesis with a series of 
observations upon the retention of language forms, entirely 
unexpected for the general intelligence level found. For 
instance, he reports that a four-year-level dement, speak- 
ing of her past, said, ‘ ‘ I was very beautiful, I assure you. ’ ’ 
He also reports diffuse, incongruous answers, or irrelevant 
ramblings added to a correct answer. 
Foster reports that “in certain types of insanity there 
are significant responses not indicated in the score, such as 
extreme size and irrelevant detail in the case of the memory 
drawings, and numerous errors and additions in the reports 
of the paragraph selections.”10 The case with a mental 
age of 11.5 or over on the Point Scale may be expected to 
have correct drawings if not-insane, or if testing feeble- 
minded. The drawings are elaborated in dementia-prgecox 
cases, and in the syphilitic and paranoid groups, but are 
sketchy in the manic-depressive and the alcoholic groups. 
The general tendency in a psychotic patient is to enlarge 
the size of the drawing in the reproduction. The syphilitic 
psychoses average 5.3 cm. as contrasted with 3.8 cm. for 
average size in feeble-minded and not-insane subjects. The 
other psychoses in no instance average over 4.4 cm. She also 
reports definite differences in the report of the content of a 
paragraph read. There are no additional irrelevant details 
in the report of feeble-minded and non-insane individuals, 
but there are a few in all psychoses studied and many in 
the syphilitic psychoses, who, in proportion to the others, 
give the fewest number of correct details. Wells adds to 
our information on this attribute of insane cases. He 
reports that the scale gives scope for perseveration through 
irrelevant continuation of a satisfactory response to ques- 
tions where it will not apply correctly; perverted responses 
of dementia praecox in interpreting the pictures; complex 
io Josephine C. Foster, “Significant Responses in Certain Memory 
Tests,” Journal of Applied Psychology, June-September, 1920. DETERMINING PSYCHOPATHY 
179 
indications in vocabulary tests, especially the tendency to 
self-destruction; stereotyped replies; ability to react in a 
specialized form but not according to general test require- 
ments, as, for instance, ability to write responses but 
inability to talk, which is a special indication of non- 
adaptation, not of lack of intelligence. Although there is 
practically no other mention of this feature in the current 
literature on tests, yet the significance of it is easily recog- 
nized. The unusual usage of a word that indicates superior 
intelligence is often the only indication of this type found. 
In other individuals the tendency to diffuse, elaborated 
rambling, half-coherent replies is more marked. Sometimes 
it is only the fact that an examination has taken such a 
long time that makes one realize how many such minor 
digressions have been present. In other cases the answers 
are startling by their peculiarity and yet not actually witty 
nor wise. They resemble more a thing that has been taught 
a clever parrot and are as incongruous in the light of the 
rest of the examination. The use of nonsense syllables or 
automatic perseverative phrases in the 60 words in 3 min- 
utes, the personal application of all conversation to 
self as its subject, the interpretation of definitions, sen- 
tences, fables, absurdities, and many other tests from the 
standpoint of the “I,” unexpected delay or acceleration in 
the general type of response, monosyllabic answers where 
more is necessitated by the character of the question, all are 
unusual and indicative of the need for further research into 
the reason for their presence. 
Two other indications of instability or individual varia- 
bility may be determined from the analysis of the findings 
on the Kent-Rosanoff association series. Since this series 
is less well-known than the Stanford, a brief description is 
necessary. The association test is a list of 100 words, modi- 
fied from several of those which have been definitely used 
for analytic work here and abroad. This list of 100 words 180 
THE UNSTABLE CHILD 
is given to an individual with directions somewhat similar 
to the following (which is the writer’s standardization for 
verbatim use with children) : 
Now I am going to say some words to you. I shall say them 
one at a time. Each time that I say a word I want you to answer, 
just as quickly as you can, with the first word that my word 
makes you think of. Eor instance, if I said candy, you might 
say chocolate, or good, or eat, or buy, or any one of a great many 
words. Now any one of these words would be right, for I want 
to know what you think. Remember, you are to say only one 
word and say it as quickly as possible. Now what would you 
say if I said gun? 
Then, if the trial word brings a response which means 
that the individual understands the situation, one proceeds 
to give the regular list. In the Kent-Rosanoff study of this 
test, 1,000 supposedly normal adults were given the whole 
series of words. The reactions of the 1,000 individuals to 
each stimulus word were then studied and arranged in tab- 
ular form. For instance, the first word of the list is table. 
The 1,000 responses to this word include the reaction chair, 
given 267 times, cloth, given 57, wood, given 76, whereas 
words like ugly, snow, and street do not appear. One can 
see that the latter are not indicators of normal associations 
with the word table. In general, the whole tabulation of 
the responses given by normal individuals is a listing of the 
majority of responses one would expect from normal indi- 
viduals, that is, from individuals who do not show any 
signs of mental disease. 
After one has given the test to any individual, it is pos- 
sible quickly to evaluate his reactions from the tables of the 
so-called normal reactions. One looks up his reaction to 
the first word in the table of reactions to that word and 
gives his reaction the numerical value of the frequency it 
has in that table. If the word does not appear in the list 
but some other derivative of the same root does appear, his DETERMINING PSYCHOPATHY 
181 
reaction is listed as doubtful. If it does not occur in any 
form, he is given a zero, which means that the reaction is 
“individual.” But comparison does not necessarily stop 
there. Kent and Rosanoff have found the average distribu- 
tion of the reaction values given by a number of individuals 
measured on this test. To this end they group individual 
reactions, questionable reactions, reactions given by one 
individual out of a thousand, those given by from 2 to 5 in- 
dividuals, those of a frequency from 6 to 15, 16 to 100, and 
those that occur more than 100 times in 1,000. Their norms 
have been established for 100 college graduates, 100 per- 
sons of common school education, and for 78 children of 
school age. The writer, with the aid of an assistant, Miss 
Louise Wood, analyzed the frequency tables that Kent and 
Rosanoff present, in order to establish the same frequency 
distribution for the 1,000 individuals grouped therein. Of 
course, in doing this it became necessary to change fre- 
quencies of 1 to individual frequencies and to reduce the 
evaluation of each frequency accordingly. Following are 
these various frequency distributions: 
Frequency of Values of Reactions 
Sex 
Number 
of 
Cases 
Values 
0 
? 
1 
2-5 
6-15 
16-100 
100 
plus 
M 
60 
9.2 
1.3 
5.2 
9.7 
11.0 
27.8 
35.5 
College 
F 
40 
9.5 
1.3 
3.9 
9.8 
11.7 
28.9 
33.4 
Both 
100 
9.3 
1.3 
4.7 
9.7 
11.3 
28.2 
34.4 
Common- 
M 
50 
5.8 
1.6 
3.6 
8.3 
10.2 
31.6 
38.7 
School 
F 
50 
4.6 
1.3 
3.3 
7.1 
9.4 
32.0 
42.1 
Education 
Both 
100 
5.2 
1.4 
3.5 
7.7 
9.8 
31.8 
40.4 
Children 
M 
33 
5.9 
0.8 
4.2 
8.7 
10.6 
28.5 
38.5 
under 
F 
45 
5.6 
1.9 
4.6 
9.8 
11.6 
30.1 
36.7 
16 
Both 
78 
5.7 
1.4 
4.5 
9.3 
11.2 
29.4 
37.4 
General 
Average 
Both 
Sexes 
1,000 
6.8 
1.5 
4.2 
8.7 
10.8 
30.5 
37.5 182 
THE UNSTABLE CHILD 
Two tendencies will be noticed, if one inspects this table 
carefully. College graduates give fewer common reactions 
than children. Children give fewer common reactions than 
adults of common-school education. Although the differ- 
ences are slight, the relationship seems to be true, for it 
iolds for both sexes in all three groups. The reverse 
"relationship also holds. The college graduate has the 
greatest number of individual reactions, the children come 
next, the adults of common-school education have the 
fewest. 
Unfortunately, we do not have variability tables for these 
data. The original report gives a variability of from no 
individual reactions to over 30 per cent of individual re- 
sponses, but this deals only with adults. The writer, having 
the kindly consent of the authors, carefully investigated the 
original data, with the hope that a moderate amount of work 
would make it possible to establish these extremes, but the 
task would be so voluminous that it seemed inadvisable to 
attempt it. New data, gathered now, could avail itself of 
much more exact information regarding the individuals 
furnishing the special test results. Norms so established, 
although perhaps not covering so many cases, would be far 
more valuable for the time spent on them. 
Several changes from the procedure of the authors seem 
to be advisable in using this test. After the series has been 
given, the custom has been to repeat all stimulus words to 
which a patient has reacted with a phrase or by silence. 
This brings in a problem of variability which it is impos- 
sible to evaluate from case to case. The phrase or the 
silence, on the other hand, are just as good indications of an 
individual’s personal variation as a test can show. A cor- 
rect single-word response on the second or third trial is, 
instead, a measure of his final, but slow, adaptability. The 
phrase is an indication of the loss from consciousness of the 
directions given. The failure to respond at all denotes DETERMINING PSYCHOPATHY 
183 
either ignorance of the stimulus word or inhibition due to 
an emotional situation which inhibits response. If one 
wishes to use the test in definite relation to norms or to 
analyze the individual himself, it is necessary to account 
these symptoms as an actual part of the test and not cover 
them up with second chances. They are far more diagnostic 
than the words of common significance and high frequency 
that are apt to replace them. Of course, the repetition of 
the stimulus word may also be used if there is no desire to 
keep the individual uncoached for later examinations. 
Eastman and Rosanofii later used this same test in a study 
of 253 backward children, of whom the majority were also 
delinquents. Of these children, 233 were between 11 and 
17 years of age. The only criterion of their selection was 
“backwardness in studies.” The group gave 13.2 per cent 
individual reactions, 2.2 per cent doubtful reactions, and 
84.6 per cent common reactions. (They find that the 
insane give 26.8 per cent individual reactions, 2.5 per cent 
doubtful reactions, and 70.7 per cent common reactions.) 
Abnormal assoeiational tendencies also appear, although 
not uniformly. There were 382 failures to react, many 
non-specific responses, and some usage of particles. The 
accompanying table, giving the distribution for two groups 
of normal children, 15 in each group, is well worth 
reproducing. 
Frequency of Values 
Type 
of 
Reactions 
Normal Children 
Under 8 
Years 
Over 10 
Years 
Specific 
59.7 
85.5 
Non-Specific 
2.9 
6.3 
Doubtful 
3.6 
0.8 
Individual 
22.9 
6.6 
Failures 
10.9 
0.8 
One may not take this report at its superficial value. 
There is every possible reason for deferring judgment as 184 
THE UNSTABLE CHILD 
to the actual feeble-mindedness of many of the children 
examined. They may have been inferior, unstable indi- 
viduals in whom the instability is evidenced by the delin- 
quency. Woodrow and Lowell have recently made an 
extensive study of the same problem, but their work is not 
comparable with the findings reported here.11 Their tests 
were given in written form. This brings in another factor. 
The subject has plenty of time to revise an association and 
substitute another while beginning to write any one word. 
Such an opportunity tends to increase the number of 
common reactions and lower the number of individual 
responses. A few cases of experimentation with normal 
adults on any of the association series will definitely prove 
this to the reader’s own satisfaction. 
From this summary of the test’s attributes it is not hard 
to see that two general lines of analysis may be easily 
evaluated. These are both points that reveal deviation from 
the general type of response and hence may measure 
psychopathy. 
4. The number of individual reactions given by a subject 
is significant, at least so the present norms would indicate, 
if the individual is ten years old or more, and if his indi- 
vidual reactions are more than 10 out of 100. The general 
average for children given in the Kent-Rosanoff standardi- 
zation is 5.7. Although no upper limit of variability is 
given, we can easily estimate that this could not be more 
than approximately twice the average in the great majority 
of cases. This would give us a range of from none to 11.4 
individual reactions. However, in the later study of East- 
man and Rosanoff the average is again given as 6.6 for 
children over 10, so that the indications are that an allow- 
ance of 10 individual reactions as the probable limit of 
normality of variation is at least fair. For the child under 
ii Herbert Woodrow and Francis Lowell, “Children’s Association 
Frequency Tables,” Psychological Monographs, 1916, Vol. 22, No. 5. DETERMINING PSYCHOPATHY 
185 
ten much greater allowance must be made, how much, we 
cannot determine until we have better norms. 
5. Even when we have evaluated the number of indi- 
vidual reactions as significant or non-significant, there is 
left the same type of problem as when we attempted an 
evaluation of the quality of individual responses on the 
Stanford-Binet, the test quality has not been determined. 
The association test is peculiarly apt in the demonstration 
of the presence of complexes, no matter what their type. 
This seems to be no less true with children than the whole 
analytic school have found for adults, save that the type 
of indication is often less complex, abstruse or involved. 
Automatisms, perseverative answers, neologisms, sound 
reactions, article and numerical responses, phrase interpre- 
tations, alliterative reactions without regard to the stimulus 
word, reactions produced by the simplest stimuli in the 
environment are all found abundantly in children, as well 
as other indicators of emotional or nerve disturbance such as 
giggling, blushing, twitching, misapprehension of the stimu- 
lus word, delayed reactions, accelerated superficial reactions, 
monotony of expression, etc. Of course, one cannot take 
an examination record in which the examiner has failed to 
watch for such signs and vindicate these statements, but the 
symptoms are there for him who seeks them. It is im- 
possible to think of attempting corrective work with its 
refinement of using clinical indications unless such signs 
have been watched for and the underlying possibilities 
determined. 
6. Performance tests give another very definite group of 
individual variations. In general, the use of performance 
tests has been a development out of the need for a non- 
verbal test by which foreigners, the mute, and the deaf 
might more readily and more fairly be rated in a fashion 
comparable with the mental-age rating of English-speaking 
individuals to whom the Stanford or a similar scale is given. 186 
THE UNSTABLE CHILD 
The Stanford gives a high rating to the verbalist, a low 
rating to the child who cannot think in words. The general 
assumption has been that the performance test is fairer to 
the non-verbalist than a test in which language plays a 
large part. Goddard reported the efficacy of the Vineland 
revision of the Seguin-Norsworthy formboard in estimating 
intelligence as early as 1912.12 The value of this board in 
later work carried out by the Vineland workers at Ellis 
Island undoubtedly gave Knox the incentive to the develop- 
ment of a whole scale suitable for such work.13 A later 
scale evolved by Pintner and Paterson gives much more 
satisfactory age norms for various tests.14 Throughout all 
of this work, however, very little attention has been paid 
to a problem which is a very real one if a clinician is con- 
scientiously attempting to study individuals from all pos- 
sible aspects and applies performance tests as well as some 
one of the other age series. There is, in a great many 
children, a discrepancy of many years between mental ages 
on performance tests and mental age on the Stanford, nor 
is the advantage always in favor of the performance tests as 
giving the fairer score. Durea finds that delinquent chil- 
dren of 9,- 10,- or 11-year level by the Stanford range in 
mental ages on performance tests all the way from the 
5-year to the superior-adult level.15 Nor is the scoring con- 
sistent from test to test in the performance group. Nor do 
test results on the performance tests correlate at all highly 
with the Stanford findings. The two must be measures of 
different aspects of ability. Since this is so, the perform- 
i2 Henry H. Goddard, “The Formboard as a Measure of Intel- 
lectual Development in Children,” Training School Bulletin, Vol. 9, 
1912, pp. 49-52. 
is H. A. Knox, “A Scale Based upon the Work at Ellis Island for 
Estimating Mental Defect,” Journal of the American Medical Asso- 
ciation, March 7, 1914, pp. 741-747. 
14 Donald G. Paterson and Rudolph Pintner, A Scale of Perform- 
ance Tests. 
15 Mervin A. Durea, “Individual Variability in Test Perform- 
ance,” Journal of Delinquency, March, 1922, pp. 86-98. DETERMINING PSYCHOPATHY 
187 
ance tests give another angle to the understanding of an 
individual. Theoretically, the child whose development is 
well rounded and well balanced will probably score at 
approximately the same level on performance and mental- 
age tests. There must be definite exceptions of course. 
A child who tests above his actual chronological age on the 
Stanford cannot well be expected to measure as high on 
performance tests in general. Most performance tests are 
largely dependent upon hand and eye coordination and 
general muscular control. This is partly a matter of intelli- 
gent control but much more largely a matter of physiologi- 
cal development. The bright child will, in all probability, 
reflect in his performance tests the lack of balance. In the 
same way, the defective or feeble-minded child whose actual 
physical development is far in excess of his mental age will 
have such an excess of muscle, eye, and hand experience 
that he is apt to score higher on performance than on verbal 
tests. This is exactly the state of affairs found by Jones 
when he compares bright and feeble-minded children of the 
same mental age. Pressey in comparing psychotic and 
feeble-minded cases finds the feeble-minded are superior. 
Patients who grade relatively high in mental age “fre- 
quently give a performance on these puzzles which can 
be matched only among the low grades of the feeble- 
minded.”16 
This gives us so far but little basis for any finality of 
statement. In general, the factors of age and mental age 
must be considered in connection with mental age on the 
performance tests themselves, if we wish to discriminate 
the low rating of the functionally unstable from the average 
performance of the normal and the good performance of 
the feeble-minded child. In all probability an average 
rating on performance tests that gives a mental age that 
differs as much as 4 years from the Stanford mental age 
16 S. L. Pressey, loc. tit., p. 11. 188 
THE UNSTABLE CHILD 
needs further analysis, at least to determine the factors 
back of the variation. 
7. Another aspect of the general intelligence of the 
individual surely deserves consideration in any intensive 
clinical study of him. Binet gave us our first statement on 
this aspect of differential diagnosis, too. One may examine 
an individual and ascertain his intelligence level, his level 
on performance tests, scrutinize his tendencies on the asso- 
ciation test, and yet leave untouched several whole fields of 
ability or disability. The general information or practical 
knowledge of an individual is one of these fields. Binet 
found that the dements were superior to imbeciles of the 
same mental age in this knowledge which is gained from 
experience and the everyday surroundings of an individual. 
A psychiatric examination usually includes a careful esti- 
mation of the extent to which an individual retains that 
information which he should have because of his experience, 
not in spite of it. Franz has gathered a group of such 
questions covering the various aspects of orientation 
towards one’s family group, home, current events, prac- 
tical values, one’s environment, work, interests, etc.17 In 
general, aside from the attempt to measure deorientation 
from time and place in psychotic individuals, there have 
been few statements of what one may expect the ordinary 
individual to achieve in this respect. Fernald from a com- 
parison of children of various types seen in his outpatient 
clinic finds that children who are not feeble-minded are 
usually good in general information, 95 per cent of them 
passing Franz’s series of questions, or an easier series 
adapted from Binet, whereas only 15 per cent of the feeble- 
minded children pass the same series.18 Psychopathic cases 
it Shepherd I. Franz, Handbook of Mental Examination Methods, 
Nervous and Mental Disease Monograph Series, No. 10. 
is Walter E. Fernald, “Standardized Fields of Inquiry for Clinical 
Studies of Borderline Defectives,” Mental Hygiene, April, 1917, pp. 
211-234. DETERMINING PSYCHOPATHY 
189 
are much better than the feeble-minded, about 75 per cent 
of them passing the test. They are not, comparatively, as 
good as not-feeble-minded individuals, who are not psycho- 
pathic. 
The norms for passing a general information test are 
more vague than any of our others. An individual who 
obviously fails in knowledge that he should have because 
of experiences he admits having fails on this test. One 
frequently finds here the first indications of deorientation 
for time or place, or loss of practical judgment. In like 
manner psychopaths may give verbalistic, superficial re- 
sponses which actually evade the answer in an ambiguous 
fashion. 
8. In the same way, it is only fair to determine definitely 
the subject’s ability on educational tests. One cannot take 
a statement of the school grade he has reached as a measure 
of anything. Children are only too frequently passed on 
because of age or size. There are plenty of standardized 
tests of school subjects that will definitely aid in a fair 
evaluation of the child’s ability, although tests for lower 
grades are still few. Binet found that psychotic individuals 
had a remnant of academic form but had lost the significant 
content of the subjects, so that they did poorer work than 
children of the same mental age, when examined on some- 
thing else than mere form or such matters as writing, gram- 
matical construction, and rate of reading. The author 
found that children of the mental ages of 5 to 9 who were 
definitely feeble-minded could by no means parallel the 
achievement of normal children of the same level on school 
subjects.19 The learning process is definitely slower in the 
feeble-minded. 
Jones found the learning process better in normal chil- 
i9 Florence Mateer, “Some Differences between Normals and De- 
fectives not Indicated by Intelligence Tests,” Report of tbe American. 
Psychological Association, December, 1916. 190 
THE UNSTABLE CHILD 
dren and grade work achieved more easily. Terman gives 
definite proof of the relation of normal intelligence to nor- 
mal school progress.20 Fernald finds that over 80 per cent 
of the not-feeble-minded cases he studied succeed in doing 
as well in school subjects as their actual age would demand. 
Only 6 per cent of feeble-minded children were doing well 
in school. It is highly probable that these were younger 
cases. The psychopathic case almost always succeeds in 
school, about 20 per cent scoring below the grades they 
should cover. The test findings on school work are not 
sufficiently diagnostic to differentiate an individual unless 
the ratings are compared with mental age and other aspects 
of his ability, but there is a definite indication that, when 
mental age is fairly normal and school tests are low, the 
probabilities are three to one that the case is “psychotic” 
(as Fernald designates it), or psychopathic rather than 
normal. 
9. The writer knows of no one except Healy who places 
much importance upon the child’s own story as he tells it 
without interruption or criticism. Yet no one other feature 
of learning to know an individual holds such possibilities 
for understanding and giving aid. The mere fact that a 
child assumes the attitude of a hero, or of one persecuted, 
or that he laughs off unpleasant happenings, identifies him 
in a way nothing else can. If he faces the situation nor- 
mally, that means one thing. If he lies his way out or 
ignores his share in untoward happenings, we know so much 
the more what he is. The points he stresses, logical coher- 
ence, irrelevance, ambiguity, disproportionate statements, 
lack of plausibility, wrong sequence, forgetfulness, emo- 
tional expression, all tell their tale. The significance is none 
the less for its being a child’s tale. Delusions, myths, ideals, 
all make themselves known and can be better adjudged 
because of their story setting. The normal child tells a 
20 Lewis M. Terman, The Measurement of Intelligence. DETERMINING PSYCHOPATHY 
191 
plain story, usually a plain statement of facts. Quite often 
he somewhat slights his responsibility in minor escapades. 
The feeble-minded child tells less of a story, less well, with 
the need of more prodding. The psychopath opens to one the 
doors of a world of bewildering motives, thrills, wrongs, 
brave deeds. 
10. The behavior of an individual while being examined 
should be closely observed and the details noted before they 
are forgotten. Experience has shown that the best way is to 
have a definitely indicated place on the record sheet for 
such observations. These first-hand impressions, actual 
behavior data, are highly valuable. They are more imper- 
sonal than a parent’s report can be, yet they help one 
understand his report on one hand and actual test findings 
on the other. Wells emphasizes, through illustrative usage, 
the importance of such observations.21 Binet utilizes each 
and every detail of this type in his case analyses. Psychia- 
tric procedure readily admits the high value of such 
observations. Distractability, nervousness, wandering 
around the room, irrelevant acts and remarks, peculiar 
postures, movements, and gestures, queer facial expres- 
sions, laughter, giggling, obstinacy, mutism, temper spells, 
crying, swearing, banging, throwing, and innumerable other 
signs are all an aid in the better understanding of the indi- 
vidual. The normal child usually shows but few such 
peculiarities and they are easily investigated and explained 
away when they do appear. The feeble-minded child shows 
peculiarities that signal his stupidity. To the psychopath 
must be attributed the majority of such unpredictable 
indications. 
The ten aspects for qualitative analysis of an individual 
which we have outlined are by no means final, exclusive, nor 
permanent. They are by no means similar in value. The 
individual’s behavior in the clinic, his story, the qualitative 
2i Wells and Kelley, loc. cit. 192 
THE UNSTABLE CHILD 
analysis of the association reactions and the similar analysis 
of individual tests on the Stanford appear, at present, of 
most importance to the writer. They all need statistical 
evaluation and interpretation. It is not the most common 
variation on tests which is the most significant, but just 
reverse. That variability which is least common is the most 
significant, for it indicates a variation in an attribute in 
which the group, as a whole, is more stable. What the 
qualitative analysis of an individual means as an aid in 
understanding him only case study can show. The study 
of intelligence level is a study of our resources, our capital, 
or our raw material. The study of function is a study of 
the efficiency of the utilization of these resources. Mental- 
age ratings give us the presence of, or lack of, intelligence. 
Functional analyses give us the presence of, or absence of, 
disturbances of intelligence. Our final psychological esti- 
mate of an individual’s ability is a summing up of how well 
he uses the mental equipment he has. Case study, itself, 
will best illustrate this. CHAPTER XI 
SEREPTA, A PSYCHOPATH 
The telephone rang, and after a moment or two spent in 
making necessary explanations, the writer promised at least 
to begin the study of Serepta that afternoon. The child 
had been brought into town early that morning and had 
just completed going through a thorough physical exami- 
nation at one of the diagnostic clinics. The physician found 
“practically nothing wrong,” so wished to have a psycho- 
logical examination to complete the study, for the reason 
that she “seemed to be a mental problem.” The mother 
could and would, if necessary, stay until the next day to 
give whatever time was needed for a full examination. 
A few minutes later, having stopped for lunch on the 
way, Serepta and her mother arrived. The child stumbled 
up the steps and came into the room rather unwillingly, 
clinging closely to her mother and looking around suspi- 
ciously. The usual remarks about the trip, the day, lunch, 
and fatigue brought no real trace of friendliness to her 
face. Instead, she maintained a defensive manner, edging 
away from the examiner, watching every move, listening 
intently to every remark made, and adding her own com- 
ments, now and then, in the mature fashion of an adult and 
with every indication that she expected to be treated in 
adult fashion. Actually, she was a rather tall, fairly well- 
nourished, scowling child of seven and a half. One could 
see that there was a possibility that she might, under other 
conditions, be at least as attractive as the average child, 
but there was no actual redeeming feature in her appear- 
ance at that time. Dark-circled eyes, a pouting mouth, 
193 194 
THE UNSTABLE CHILD 
drooping lips, veiled antagonism in every glance, self- 
assertion in every move and seeming confidence in her 
ability to make the mother do as she desired made her an 
interesting case rather than an interesting child. 
The statement of the case. The problem was soon 
stated. For weeks and months there had been increasing 
trouble in handling her. She would not go to school, 
nor would she stay at home. The indecision that would 
not let her decide either wajr and be happy led day 
after day to screaming and crying spells, at home, 
at school, or on the way to school. She could not 
sleep at night, even large doses of sedatives having hut 
little effect. The same tjTpe of indecision as affected her 
going to school affected other problems as well. She would 
want to go somewhere hut, when told she might, would cry 
at the prospect. Crying was not the only result, however, 
but was usually a mere preliminary to screaming, throwing 
herself down, kicking, hitting, striking, and fighting. Since 
she was getting so large and strong, the mother had great 
difficulty in handling her and feared that she would ac- 
tually injure herself or some one else. The child seemed 
to have a definite fear that something would happen. There 
have been family situations that may have caused this 
worry or fear. 
After being in the laboratory for a few minutes, Serepta 
definitely stated her desire to go home that afternoon. Since 
she had slept only under codein the night before and gotten 
up at four o’clock to make the trip into the clinic; since 
she had had a most exhausting experience in the medical 
clinic, resenting with all her might every effort made to 
examine her, a psychological examination without rest and 
sleep would have been worse than useless. Telling the 
mother that they would have to stay until the following day 
precipitated a “typical” tantrum. She screamed and cried 
and threw herself against the mother and kicked, yelling SEREPTA, A PSYCHOPATH 
195 
over and over again, “I’ve got to go home, I’ve got to go 
home, I’ll die if I don’t go home.” In an interval when 
she was getting her breath the fact was forced upon her 
that the last train had gone (a fact), and she would have 
to wait until the next day. Her cry immediately changed 
to “Give me something to eat, I’ll die if I don’t get some- 
thing to eat,” with more screams and kicks emphasizing 
the extreme need. A cracker was forthcoming, and the sur- 
prise of having her demand so unexpectedly granted 
brought an immediate cessation of all disturbances. Inside 
of five minutes, having eaten but half of her cracker, she 
was playing contentedly with a doll house while the mother 
gave some more data on her. 
Another day of work gave us the following information. 
Further complaints. The child is always tired A feel- 
ing of nausea comes when she is tired but never causes act- 
ual vomiting. Sleep is erratic and poor, codein being neces- 
sary, under the doctor’s directions. Temperature ranges 
from 99° to 102° without apparent reason. 
At present the child has a spell of stumbling and falling, 
runs aimlessly into objects in the room and walks poorly. 
During the last year she developed a hatred of the only sis- 
ter but is now excessively fond of her. She has more re- 
cently gone through the same alternation of attitudes to- 
wards the mother. She is afraid to go places alone. She 
cannot decide the simplest things for herself and is un- 
happy when a decision is made. 
Although she is not quite 7 years and 6 months old, 
Serepta has a mental age of 8 years and 4 months 
on the Stanford-Binet. This gives her an I.Q. of 112, 
which places her in the superior-intelligence group, a rating 
reached by about one child out of ten and usually by those 
of a superior type of home surroundings. The qualitative 
analysis of the Stanford rating gives no indication of any 
peculiarity. She has a basal year of 7, passes all of the 196 
THE UNSTABLE CHILD 
8-year-level tests, except the vocabulary, and scores 6 
months credit at tests in the 9- and 10-year levels. There 
is no abnormal indication in any one of the test responses. 
Her drawings are precise, neat, and well done for a child 
of her intelligence age. Performance tests reveal unex- 
pected abilities. On the Seguin formboard she scores the 
average time for a 10-year-old child. The Knox imitation 
series rates her at the 14-year level. The Goddard adapta- 
tion board is passed at a 7-year level. The Healy pictorial 
completion score is 469, which is between the 11- and 12-year 
median scores. On the Porteus maze series she scores 9 
years, 6 months. All of these tests are done with a mini- 
mum of error and with the best type of skilful, unhurried, 
efficient movements. The Porteus lines, however, reveal 
numerous fine tremors. 
Her general information is far in advance of that gener- 
ally exhibited by even an 8- or a 9-year-old. She talks in 
serious fashion about any and all of the family problems. 
Her knowledge of expenses, household needs, community 
gossip, school situations, her own condition and needs, her 
mother’s problems, the father’s behavior, is little short of 
pitiful. She has had no carefree childhood. 
In school work, despite the fact that she has been out a 
great deal, she does just about what second-grade children 
should do. She scores up to third grade on the Ayres 
spelling test. On the Ohio Literacy she reaches the second- 
grade median score (it is only the third month of school.) 
She does all of the second-grade requirements in combina- 
tions and reasoning problems in arithmetic, knows her 
tables, and writes and counts numbers to 100. Her writing 
scores to 30 on the Ayres scale. She is slow in handwork, 
but the results are of exceptional value for accuracy and 
neatness. In school with a special group of nervous chil- 
dren on the morning of the full examination, she showed no 
actual tendency towards peculiarity of action. She was a SEREPTA, A PSYCHOPATH 
197 
little more shy than children as capable as she usually are, 
hut responded well to commendation and suggestion. 
The Kent-Rosanoff association series showed very definite 
disturbances of associations. The test was done at about 
an 11-year level. The number of individual reactions given 
was seventeen. This is not excessive for such a young child. 
Qualitative analysis of these seventeen individual responses 
revealed the abnormality of practically all of them. They 
indicated a very definite complex which had in it the ideas 
of men, man, bed, cruel, mean, and afraid. Other reactions, 
although apparently what one might expect in response to 
the words given, reflected these same ideas that center 
around a night fear of something mean and cruel which is 
attributed to some man or men. The complex was indicated 
by delayed reactions, pallor, hesitant speech, averted face 
and the parenthetical use of “why,” followed by a rather 
explosive pronunciation of the reaction word. 
The psychological findings removed at once any doubt 
of the normality of intelligence level. Serepta did more 
than one would demand of any child of her age on the in- 
telligence tests, performance series, general information and 
educational series. It was merely the quality of her re- 
sponses on the association series, perhaps the distribution 
on the same series, the slowness of written work, the be- 
havior in the laboratory and the shrewd wiseness of her 
knowledge about herself that led to a diagnosis of a psycho- 
pathic condition with the association tests definitely indi- 
cating the need for analytic work as a possible means of 
relieving some of the repressions. It was necessary to see 
what further evidence could be obtained to corroborate or 
modify this diagnosis. 
Personal and developmental history. Serepta is the 
third of three children. The mother was well during preg- 
nancy and under no definite strain, doing her own work on 
the farm but quite well enough to stand it. The birth was 198 
THE UNSTABLE CHILD 
normal and at term. The child weighed 111-2 pounds and 
was a blue baby. She gave indications of this condition 
until she was 14 months of age. She was artificially 
fed. She seemed half-starved for the first 5 months, no 
food actually agreeing with her. After that, she got along 
all right. At that time they noted that she was always 
screaming. She held up her head at 7 months, sat up alone 
at 9 months, got her first teeth a little before this, whis- 
pered “papa” over and over for a whole day at the age of 
8 months, said it aloud the next day and gradually and 
regularly added other sounds. She never crawled, but 
walked at 14 months, although she was very heavy. 
At one year of age she had measles and chickenpox, scarlet 
fever at one and a half years, and whooping cough at 2. 
When 2 years old, she had some disturbance that was 
thought to be infantile paralysis. Her neck was stiff, the 
left arm was paralyzed, speech affected, and she would sud- 
denly become very hoarse when trying to talk. Improve- 
ment began in four or five days, and she could use her arm 
a little in about two weeks. About the age of three and a 
half she was so troublesome and nervous that she was put 
on desiccated thyroid and has been kept on it until the 
present time. The mother feels that she would be impos- 
sible to handle without it. She had a tonsil and adenoid 
operation a month ago and has not been real well since. 
Has been troubled with nocturnal enuresis at times to date 
and with diurnal enuresis until about the age of 6. 
School history. Serepta began school a year ago last 
September. She passed first grade successfully last year and 
seemingly had none of these behavior difficulties. She is 
in the second grade, is very fond of her teacher and is 
anxious to go to school. She regrets especially missing 
days on which they have art and music lessons. She had a 
general grade average of 87 in passing from first grade, 
with a deportment grade of 95. The teacher reports that SEREPTA, A PSYCHOPATH 
199 
she is never any trouble when there and can easily get 
along on part time attendance if this is necessary. 
Behavior. The family lives in a small town where 
Serepta has a big yard and plenty of shady lots and walks 
to play on, if she wants to go away from her own yard. 
The porch at her home is the center of attraction for the 
little neighborhood group and has had as many as seventeen 
children playing there on a warm evening. Serepta is very 
fond of her dolls. She likes to play school and house, sew 
for her dollies, and, in general, imitate everything that is 
done in the home, but the imitation must have practical 
worth. She wants to make real pies and cakes, cook real 
food, sew things of some actual worth. Her mother has 
found time to meet and help this desire until the child is 
fully as capable as many girls in their teens. Lately she 
cannot play without coming in crying wuth some cause for 
complaint. She seems to think the other children do things 
to her. The mother says, “Actual happenings have an 
exaggerated importance.” She is very affectionate and 
usually obedient, save in spells such as she has had the last 
few months. 
Family history. There have been three children of whom 
Serepta is the youngest. The oldest is a girl of 16 
who is in the third year of high school. She is seemingly 
healthy, but has had asthma this last year. She gets very 
nervous and tense at times, worrying especially over this 
younger sister of whom she has taken charge a goodly part 
of the time. The second child died at three and a half 
months of ‘ ‘ bowel trouble; the doctor said she had tubercu- 
losis from being nursed and not getting enough nourish- 
ment.” Serepta was born five years later. 
The father “has never been healthy.” He has always 
suffered from nerve strain, a goitre, liver trouble, and the 
like. He was a farmer, farming in a small but comfort- 
able way, when, several years ago, he was assaulted by an- 200 
THE UNSTABLE CHILD 
other man and rather badly bruised and beaten. It was a 
case of “mistaken identity” in a neighborhood feud. Ac- 
cording to the medico-legal expert to whom the case was 
referred for investigation, the man walked around for sev- 
eral days and did not suffer any apparent injury, more 
than a few cuts and bruises. By that time interested in- 
dividuals had gotten hold of him and, justifying their solici- 
tude (?), he developed a definite paralysis. For months 
he was unable to walk, then gradually learned to make his 
way around with crutches. With the aid of the same kindly 
people he instituted a suit for damages and was awarded 
the full amount claimed, $10,000, although the medical ex- 
pert called to testify as to his condition refused to testify 
to anything but hysteria, since he walked with one type 
of ankle clonus in the courtroom and another outside! 
Throughout this time, as he was gradually getting well, 
numerous other symptoms arose. He was angry and irrita- 
ble over little things, took pleasure in being cross with this 
child when there was no reason for it, became suspicious 
of poison in his food, thought his wife was untrue to him, 
and, later, when he was working again, refused to give any 
of what he earned towards the upkeep of the house or table, 
although his wife had only a small checking account in the 
bank upon which to depend. At last he started divorce pro- 
ceedings, making all sorts of charges against his wife, none 
of which he was able to substantiate. Before the wife was 
granted a divorce he tried to get Serepta to go off with 
him and even threatened to take her away where she would 
never see her mother again. This definitely scared the 
child. His whole family has a reputation in their home 
county of being “peculiar.” No definite items to this effect 
have been obtainable, for after he married his wife held 
him up to the standard of living to which she was accus- 
tomed, and this meant very little contact with his family. 
The mother is uncommonly intelligent and in most ways SEREPTA, A PSYCHOPATH 
201 
an unusual illustration of common sense. She is highstrung 
and nervous, but takes most situations with a humorous 
philosophy that enables her to make the best of the situa- 
tion. She is energetic, industrious, alert, progressive, a 
born manager. The only trait which makes it at all diffi- 
cult to work with her is a tendency to resort to patent medi- 
cines but even this is not as marked a habit as one usually 
finds it in the small town family. Her own family seem to 
be normal, self-respecting people who stand by each other 
and have definite ideals of what they mean to reach, al- 
though this is largely a matter of comfortable income, get- 
ting a new car, better furniture, living better, etc. They 
are a typical family of the American working class. The 
maternal grandmother of our child suffers from a definite 
and constant head tremor. (No other neuropathic symp- 
toms have been found, although most of the family have 
been seen and the others investigated since the time of this 
first interview.) 
Medical findings.1 
Anatomical: developmental. At present the child weighs fifty- 
six pounds. Last May she weighed 62 pounds, her great- 
est weight. 
Habits. Her diet is a general one except that she refuses milk 
and eggs. 
Physiological 
Gastro-intestinal Tract. No masses or sores in mouth or 
throat. Appetite is fair, irregular. Tongue is not coated. 
No. P.C. pains. Nausea when hungry or tired, does not 
vomit. Bowels are regular. No hernia. Has abdominal 
pain. 
Urinary Tract. Has frequency. Nocturnal enuresis re- 
cently. Small. Incontinence at times, no difficulty start- 
ing stream, no dribbling, no pain, no edema. 
Heart. Always has rapid heart. No dyspncea at rest. 
Hands and feet not cold, no pallor. 
1 Acknowledgment is due Drs. Dodd, Forman, and Gordon for this 
intensive and accurate report. 202 
THE UNSTABLE CHILD 
Locomotive Apparatus. Complains at times of aching all 
over the body. 
Physical Examination. Patient is well developed child appar- 
ently, seven years old. Is very resistant to examination. 
Head. 
Scalp. Normal, hair brown. 
Eyes. Sclera and conjunctive good color, pupils react to 
light and distance, ocular movements normal. 
Ears. Normal. 
Nose. Normal. 
Mouth. Upper gums thickened by the descent of perma- 
nent incisors which are about to be erupted. Mucous 
membrane of good color, gums in good condition, teeth 
fair. 
Throat. Tonsils have been recently removed. 
Neck. No adenopathy, thyroid not enlarged. 
Chest. Well developed, well nourished. 
Lungs. Fremitus normal, resonance clear throughout, breath 
sounds vesicular, no rales. 
Heart. Normal in size and position, rate 120, rhythm regular, 
sounds of good quality, no murmurs. 
Abdomen. Contour normal, no tenderness, no rigidity, no tumors 
or masses. 
Bones, Joints, and Extremities. Spinal column normal, no 
ankylosis, no deformities, function normal. 
Reflexes. Patellar, pupillary and abdominal normal. Romberg 
normal. 
Blood 
Count: 
Hemoglobin (Dare) 100 per cent 
Red blood cells 5,120.000 
White blood cells 7,700 
Differential count: 
Polymorphonuclears 70 
Lymphocytes 22 
Mononuclears 7 
Eosinophiles 1 
Basophiles 0 
100 per cent SEREPTA, A PSYCHOPATH 
203 
Wassermann: 
Technique: 
Icebox fixation 18 hours (6° C.) 
System Anti-sheep hemolytic 
Result: 
Negative 
X-ray Observations. Fluoroscopic examination only reveals: 
1. A normal bony cage 
2. Clear lung fields 
3. Cardiac shadow that is normal in size 
4. Supracardiac shadow is also normal 
5. The diaphragm is free and unrestricted in its movements 
Summary. It is not difficult to see that the family his- 
tory, although limited to the immediate family group, in- 
dicates a neuropathic predisposition that almost predicts 
what may happen to Serepta. The father not only has a 
definite neuropathic tendency but this, probably precipi- 
tated by accidental shock and suggestion, takes a form of 
expression that is definitely psychopathic, if not actually 
psychopathic to the point that he was suffering from a 
psychosis. The mother, too, bears a heritage of nervous- 
ness, or at least of a neuropathic diathesis, which accen- 
tuates the heritage from the father The oldest child bears 
her symptom, asthma. The second dies, the third, Serepta, 
reproduces more nearly the father’s instability. Her early 
history shows behavior disturbances from the time of the 
paralysis on. The present crisis seems to be entirely a 
mental one, although it is probably accentuated by the over- 
stimulation of such constant thyroid feeding. The imme- 
diate need is for relief of the mental symptoms. The com- 
plex indicated in the association series shows the approach 
to this through psychoanalysis. Although the child was 
going out of town the very day these data were ascertained, 
it seemed worth while to attempt at least one analytic in- 
terview. Children sometimes gain great relief from a 
modicum of such attention, and at the same time one in- THE UNSTABLE CHILD 
204 
terview leaves one definitely informed as to the need of 
such work and the probable relief to be gained from it. 
Analysis. The mother went into the next room, pre- 
sumably to rest, but where she could gain an idea of the 
method and procedure so that she might be able to carry 
out some further work. It did not take long, beginning 
with a little discussion of her father’s illness, to see what 
the trouble was. Serepta had always been the father’s fav- 
orite. He had always stood first in her affection. After 
he was ill, he was cross to her, tormented her, did things 
to make her feel bad. The mother stood by her, protected 
her, was in danger herself of being hurt by the father. 
Her intelligence made her feel that she must think most 
of her mother who took care of her, but her actual habit 
of affection made her want to keep the father in first place. 
An issue in which it became necessary to obey the mother 
against her own inclination would at once bring up this 
other desire to care rather for the father. The indecision 
of mind that resulted brought a regression from the whole 
situation back to babyhood kicking, crying, and screaming. 
Intermediately, spells were made up for by unusual affec- 
tion. Money worry, since the father did not provide, and 
fear of being left alone if something happened to the mother 
added to the problems that worried her. The older sister 
is a surrogate for the mother and so is viewed in the same 
way. 
This is all that was accomplished in the first analytic 
interview except that the suggestion was given that the 
father was ill and did not mean what he said and did. This 
explanation will ease her own suffering and pave the way 
for tolerance of being separated from him as she grows ac- 
customed to the situation. 
Recommendations. After a summarizing of all findings 
available, the only thing possible seemed to be bringing 
the child to C for a continuation of analytic work. SEREPTA, A PSYCHOPATH 
205 
This recommendation was made. The mother did not feel 
it possible to arrange things thus. Giving the oft-repeated 
argument, “You can’t understand because you aren’t a 
mother, ’ ’ she asserted that it would be worse than a crime 
to have the child here away from her, and that seemed to 
end the matter. 
Subsequent history. The clinic examination trip was fol- 
lowed by a few days of high temperature, and then the 
child was reported as doing better. Six weeks passed. 
Without any warning Serepta and her mother, bags, bag- 
gage and dolls, walked in one morning. They had come 
“to stay.” Serepta seemed worse in every way save one. 
She was not so apt to stumble or bump into things as she 
was at the time of the first interview. She was nervous, 
fidgety, and seemingly indifferent to all around her. She 
had “had no thyroid since she was here before, but she 
had had to have a sleeping medicine regularly and codein 
every night or two since she was here.” About a week 
before this trip her tantrums reached a climax. She wanted 
to go to her grandmother’s for the day. The grandmother 
was going to take her, and the mother was going after her. 
She got to the station all right and then became very much 
excited. She wrung her hands and cried and said she did 
not know what to do. In the train she cried and clung to 
her mother, but when her mother told her she did not have 
to go she said she wanted to. Finally, the train pulled out 
with her still crying but she stopped (the decision being 
made) and was talking cheerfully by the time they were 
outside the town limits. She said during the spell that she 
“felt something would happen.” 
The mother reported: 
Lately she fixes her mind on something and then she tries 
everything to get it. When we came home from her grand- 
mother’s, she went into the ten-cent store with me and saw a 
doll’s carriage which she wanted. Now she has a fine carriage 206 
THE UNSTABLE CHILD 
at home, and yet she wanted this one and fussed because I would 
not get it. Then we came out of the store and her hat blew off. 
She fussed and yelled and would not put it on again and I had 
to carry it. When we got to the house she did not come in 
although it was dark, but stayed on the porch alone. After about 
five minutes she came in and was all right. 
The day before they came to C to stay the father 
tried to get two doctors to see Serepta and say that she did 
not need to go away. The mother’s physician was off on 
a country trip and could not be reached until late after- 
noon. She managed to avoid the interview until his return. 
By that time it was so late the other physicians used that 
as an excuse and did not come. Of course, Serepta heard 
all about the matter and for two hours cried and yelled and 
had to be held and rocked. 
The mother seems to have a definite medication complex. 
She says that before Serepta had thyroid she used to stand 
and refuse to come into the house if called, but that she 
never does this now( ?). When they went back home from 
their first trip to C she went to the doctor and 
told him Serepta would never get well without medicine. 
She suggested that he give her some “digestion” medicine 
so that she would be happy. 
All of this detail having been given, the mother arrived 
at the real reason for her precipitate arrival. For ten days 
or more Serepta has been threatening suicide. She gazes 
into the well and the cistern, talks about death and asks 
many questions about how it feels to drown. 
The mother has promised her that she need see no doctors 
while in C She also agrees not to give her any 
drugs unless a special emergency arises. 
Despite the fatigue from the trip, analytic work was 
begun with Serepta that very day. An association test was 
given first. This revealed a group of complex indicators 
practically identical with those given in the earlier exam- SEREPTA, A PSYCHOPATH 
207 
inatioii. To ease the immediate crisis, work was begun that 
invited confidence on the question of dying. Definite inhi- 
bitions were manifested before the subject was actually 
broached, so we turned easily to the subject discussed at 
her earlier visit, the father’s behavior and condition. The 
next day she came into the room and began a spontaneous 
analysis of her own condition before she had taken off her 
wraps. This led, without any help, to a discussion of the 
question of suicide and her desire to die. The idea had 
come from being taken to the funeral of a woman who had 
committed suicide. (Later questioning of the mother on 
this point brought the statement, “Since it was a Catholic 
funeral and she had never seen one, I thought I better take 
her.”) Needless to say, the suicide idea was but another 
form of the escape motive that had dominated Serepta’s 
whole life. The telling gave some help. Conscious reen- 
foreement of the desire to live, through telling the ancient 
folk-tale of the lost souls who wander forever through dark- 
ness because they dared make the godlike decision that they 
had lived long enough, was most effective. Further work 
built up plans for things to be done in the future, as she 
grew up, and this phase of the matter seemed completely 
annihilated when she spontaneously announced on the third 
day that she was going to live and ‘ ‘ grow up and marry and 
have children, about six or eight, and maybe if I marry be- 
fore Dora [her sister] mother will give me the piano in- 
stead of her.” This was an overdetermination of the wfill 
to live, for she later discussed the question of having chil- 
dren with her mother and decided two or three were enough. 
The very night of this relief the child slept over eight 
hours with no drugs. From that time on she seemed hap- 
pier. She played in solitary fashion, ignoring other chil- 
dren in the mental-hygiene group she was with each morn- 
ing. After three weeks, the mother, satisfied that the 
method of approach was the right one, planned to leave 208 
THE UNSTABLE CHILD 
her in C indefinitely, in a boarding home. This 
exaggerated symptoms to some extent, but even then no 
tantrum appeared. Indeed, there have been none since 
the day before she came to stay in C Analytic 
work fell into a matter of spontaneous conversation, at first 
each day, gradually at longer intervals, although she was 
seen each day, continuing in the special class for nervous 
children. At first she did no school work, and none was 
urged on her. Typewriting spelling interested her so she 
asked to have spelling lessons. Then language was added— 
to write letters home. A week later she spontaneously 
joined the reading group. In six weeks she was carrying 
everything a child of her age should, arithmetic, reading, 
writing, language, spelling, stories, hygiene, play, cooking, 
sewing, drawing, geography, and woodwork. At the same 
time, as her fears were analyzed out, she came alone to 
school, went errands alone, sang and played alone, became, 
in fact, a happy, healthy, contented little girl, whose face 
grew rosy and whose eyes were bright. After four months 
she returned home, bearing the shock of the old environ- 
ment fairly well, but developing some worry tendencies 
again. These she managed and analyzed spontaneously. 
At this time she was reexamined. She was just 8 
years old and scored 9 years, 4 months on the Stan- 
ford. This was a growth of twelve months in mental-age 
in 6 months. Her school work was passing for second 
grade in all subjects and for third grade in spelling. Writ- 
ing measured 50 per cent on the scale whereon she had pre- 
viously scored 30 per cent. Performance tests showed a 
uniform gain of one or two years. Her general informa- 
tion was much more varied in so far as it concerned things 
of interest to children—games, stories, the zoo, circuses, 
movies, matinees, shopping, clothes. City life in general 
had given her interests and knowledge. Her association 
test was much more normal in distribution and indicated SEREPTA, A PSYCHOPATH 
209 
no complexes. Her physician reported a healthy child with 
normal temperature and with a heart rate down within 
normal limits of variation. 
The long-drawn-out divorce tangle drew her into its 
meshes and, despite all that could be done, she was sub- 
poenaed and taken into the courtroom. Even this dreadful 
experience precipitated no tantrums, but merely a crying 
spell. Once the experience was over it seemed to give a 
permanency of relief that was most gratifying. The psycho- 
pathic reactions had been rather effectually eliminated by 
her nine months of right living wherein they were given 
no chance to reappear, and even such an unusual strain 
was normally withstood. 
But the neuropathic substratum was still present. It 
was just a year from the first symptoms of clumsiness, 
walking queerly, tripping, and dropping things; just eight 
months from the time analytic work was definitely begun, 
when, ushered in by a prodromonal period of high tempera- 
ture, the same signs reappeared. Observation during their 
presence gave a definite diagnosis of chorea, or St. Vitus’ 
dance. Repetition of the psychological examination at this 
time showed no ideational content of worry or distress. 
The association test gave a distribution similar to that given 
at the first examination ten months previous and to that 
obtained eight months before, the day analytic work was 
begun. The increased number of individual reactions in 
this test was not, however, qualitatively like the reactions 
in the earlier group. There were none of the same complex 
indicators present. Instead, the individual reactions 
seemed to be due to extreme rapidity of fatigue which led 
to a use of the most superficial type of associations, chiefly 
those suggested by the environment and recent chance ex- 
periences. For instance, seeing a messenger boy on the 
street as she came to the office was, she explained, the rea- 
son for her response of message to the word street. 210 
THE UNSTABLE CHILD 
This episode of physical handicap through chorea lasted 
practically five months. The attack was much more serious 
than the former one and kept her completely helpless in 
bed for five or six weeks. Naturally, the expectation of all 
concerned was that she would redevelop some of the earlier 
propensities to tantrums and naughtiness. Nothing of the 
sort occurred. Her superior intelligence and good sense 
carried her through the whole trying experience in a most 
gratifying fashion. There were several days of depression 
to the point of crying, but the only thing to be wondered 
at is that there was not far more of such behavior. Five 
months from the onset of the spell she was again fairly well 
but easily fatigued and not back in school. Another two 
months brought complete recovery, interest in all of her 
old toys, new friends, desire to do what other little girls do 
and a tentative trial in school. 
Three months after this period of complete recovery the 
onset of hot weather brought some recurrent symptoms of 
nerve disturbances. Poor sleep, rapid fatigue, some loss of 
motor control and general irritability were reported by the 
mother. A thorough re-study of the case was made, in an 
attempt to gain a new perspective on the situation. For 
the first time in the whole period through which the writer 
had worked with Serepta her symptoms grouped themselves 
in such fashion that the tentative diagnosis of congenital 
syphilis seemed plausible. A medical reexamination was 
consequently made, but all laboratory tests were again nega- 
tive. Only one suspicious new finding was present—the 
upper middle incisors had finally appeared and were very 
widely spaced. The psychological findings of lack of motor 
control, superficial verbalism on many tests, irregularity on 
exact language tests, diffuse, sketchy drawings, meandering 
here and there, and a marked egocentric tendency led to 
the recommendation of provocative treatment. 
She was given bichloride of mercury, gr. .01, three times SEREPTA, A PSYCHOPATH 
211 
daily. Within a few days a slight intestinal npset necessi- 
tated the reduction to two doses a day. This amount she 
has been able to assimilate with no untoward symptoms. 
Two months have passed. The general nervousness and 
lack of finer motor control are disappearing. Serepta has 
gained rapidly in height and weight and has had only 
one afternoon of irritability in that time. Her association 
tests indicate a more stable, normal condition than at any 
earlier period. Her play interests reflect the change in 
motor ability. The last two weeks have seen the develop- 
ment of complete absorption in sewing for her tiny dolls. 
Their outfits reflect exact planning, careful cutting, fitting, 
and sewing. Her present need for supervision is limited to 
just one point, she has to be kept from doing too much. 
Prognosis. We have here a child who has had a neuro- 
pathic diathesis. This is a matter of inheritance. It has 
already evidenced itself in many ways. We actually know 
that she is a neuropathic individual, for her past holds 
several neuropathic episodes. But this is not all. The 
mental strain of family conflict the last two years was too 
much for her poorly endowed system and provoked psycho- 
pathic symptoms also. These have been cleared up by 
analysis and corrective education, but the nerve instability 
has evidenced itself as a physical symptom again. Neither 
medical nor psychological methods taken separately will 
ever be enough to handle this child successfully. The lat- 
est episode has been as purely a matter for medical care and 
treatment as the one a year previous was for the psychol- 
ogist to eliminate. The probability is that Serepta will 
never be “cured.” Strain, unusual fatigue, worry, the 
stress periods of adult life will tend to produce some lapse 
of function in the weakest part of her organism, that is, 
the nervous system. All that we can hope to do is to an- 
ticipate such strains and build up as healthy and strong a 
body as possible, accustom it to right habits of activity 212 
THE UNSTABLE CHILD 
and to those only, and then reenforce this tendency towards 
normality by constant training of the superior intelligence 
with which we have to deal. Fears must be sublimated and 
find their expression in learning and doing. Worries must 
be faced and analyzed out into parts that can be handled 
easily. Corrective mental hygiene is our only means of 
salvaging this individual for a future that holds possibil- 
ities of great good to the community. 
It would be much easier in many ways to have presented, 
as an illustrative case, a story of an individual whose prob- 
lems have been solved, difficulties eliminated or corrected, 
and whom we can report as living happily ever afterwards. 
There are such cases. But they are the spectacular excep- 
tions. The clinical psychologist should not complain if he 
sees but few of this type, if he has to be content with bits 
of improvement in impossible individuals. It is the neces- 
sity for the continued struggle against overpowering ten- 
dencies and the possibility of gaining the victory through 
just such bits of alleviation that form the real problems of 
the practical psychologist. The partial solution is the 
everyday problem in any clinic. The fact that it is only 
partial makes the need for it even more urgent. It is as an 
illustration of this partly-to-be-helped type of case that 
Serepta lends her story. PART II 
THE PRACTICE OF PSYCHOPATHY CHAPTER XII 
THE DELINQUENT AS A DEVIATE 
Why must we have delinquency? Juvenile courts, hu- 
mane societies, playgrounds, dispensaries, and hospitals 
do their part. Schools, day nurseries, and relief agencies 
of every sort lend constant aid. Yet delinquency continues. 
Quite frequently it is even asserted that delinquency in- 
creases. At least we know that it is none the less. Why? 
There must be a reason. There must he some cause at work 
that predisposes certain human beings to undesirable be- 
havior no matter how hard we try to discourage it. There 
must be some factor that is more powerful than the fear of 
law, more insidious than our social workers realize, more 
persistent lhan the emphasis school training gives to right 
doing, too deeply seated to stand revealed in any superficial 
effort to locate it. All of our attempts at social betterment 
seem to have no appreciable effect upon the frequency of 
delinquency nor upon the gravity of offenses committed by 
juveniles. There must be a cause which is so subtle that it 
evades the efforts usually made to detect and eliminate it. 
It hides behind the wrong act itself in the courtroom, es- 
capes detection beneath wrong environmental conditions 
when we seek it in the delinquent’s home, challenges the 
parent who combats it, and continues producing delin- 
quency. 
It cannot be any one specific or definite thing which may 
be studied, described, and concretely fought against. If it 
were, the preventive attempts of the last ten years would 
have produced a more effective decrease in the problems to- 
day confronting those who deal with delinquents. It is no 
215 216 
THE UNSTABLE CHILD 
individual thing that causes delinquency. Too many years 
have been spent following individual causes of delinquency 
in will-o’-the-wisp fashion, without sufficient returns. The 
idea that we may hope for any such solution must be given 
up. In other words, it is not tonsils and adenoids, malnu- 
trition, poor housing, lack of schooling, unattractive homes, 
poverty, or wealth which brings its aftermath of delin- 
quency. Delinquency knows not the boundary laid down 
by the presence of any one such condition or group of con- 
ditions. Children with diseased tonsils are not necessarily 
social or moral problems. All those suffering from adenoids 
do not pass through the hands of the law. The poorly nour- 
ished child may be no source of trouble. Crowded homes 
and illy ventilated rooms have produced masters of men. 
Those whose education has been limited so that they neces- 
sarily “make their mark” are not the inevitable home of 
evil thoughts. Children frequently run away from good 
homes and steal without any regard for actual need. 
Why do these things happen ? Delinquency must follow 
some law. There must be some underlying similarity in the 
various traits of children who act outside the conventionally 
prescribed limits of behavior for “good children.” The 
“bad” child’s behavior is in response to some motivation 
or principle that is fundamental. It shows itself independ- 
ent of any one set of factors, either physical or environ- 
mental. It is dependent upon something much more gen- 
eral and less tangible, shall we call it a predisposition? 
That is what it really is, a predisposition, or tendency to- 
wards, a foundation for certain types of behavior, a po- 
tency for developing with great ease reactions which we 
recognize as undesirable or “wrong.” With such a pre- 
disposition any or all of the factors mentioned above may 
readily lead to delinquency, but their relative unimpor- 
tance is well shown by the fact that delinquency may exist 
without their presence. THE DELINQUENT AS A DEVIATE 
217 
What is this predisposition? The effect of the child’s 
environment ? How could it be ? If this were the case, it 
would be a simple statistical problem to identify on a map 
the localities from which come our penitentiary, reforma- 
tory, prison, and industrial-school inmates. Cleaning up 
these districts would, then, eliminate the problem. The en- 
vironment undoubtedly plays a part in delinquency, a large 
part in some cases, but a very small part in others. The 
difference in its influence is a matter of the difference in the 
individual experiencing the situation. Immediately one 
meets the question as to why there are more children from 
the poor districts than from the good districts in the juve- 
nile courts in most cities. The inference is usually made 
that the slums are directly responsible for the anti-social 
behavior of these individuals. We may not assume this. 
Slums are not a part of Nature’s plan. They are man- 
created devastations. If one could eliminate all the slums 
of a large city and begin over again with the same popula- 
tion, there would be slums, of the same sort, in a few 
months. The slum is merely a concrete, visible expression 
of indifference to dirt, flies, filth, and herd-like contact. 
It voices torpitude of body and soul. It advertises igno- 
rance, defeat, and defect. If one studies them carefully, one 
usually finds at least two distinct classes of slum residents. 
There are the great group who are living thus without any 
real effort to change their habits of living. Then there are 
those who are struggling to overcome their surroundings 
and to reach such a plane of economic independence that 
they may live differently. These two groups are radically 
different in their ideals, modes of living, industry, and pur- 
pose. The latter type lives in the slums but is not of them. 
The former type is the slums. They are inferior mentally, 
incapable, inert. Is it any wonder that their children are 
delinquent ? The group has made its environment and the 
children bear the outward as well as the inward sign of 218 
THE UNSTABLE CHILD 
their parents’ deficiencies. It is impossible for us to blame 
their behavior upon only one of these inheritances, and 
that the lesser, secondary, outer one. We are probably deal- 
ing with something that results from both of these happen- 
ing together. Their constitutional or inherited predispo- 
sition to inferior mentality and functional inefficiency 
means that they give in more readily to wrong tendencies 
if in surroundings that present opportunity for such re- 
sponse. 
Truly we may say that certain environmental conditions 
make for delinquency more readily than others, but unless 
we were to find that all children suffering from those envi- 
ronmental conditions had become delinquent, we have proved 
nothing. Oh, yes, we have proved a minor point. Given 
the fundamental predisposition, environmental factors may 
prove to be the exciting or determining cause of delin- 
quency, and they may thus contribute in considerable fash- 
ion to the situation. But we must remember that they can 
do nothing unless they have the right sort of material upon 
which to work. What is the right type of material ? What 
is this predisposition or tendency which makes so readily 
for behavior which we are prone to call delinquent? To 
answer this question we must turn to the study of the child 
himself, for only in him, as an individual, may we hope 
to discover the thing which makes him delinquent or non-de- 
linquent, whatever the conditions under which he has 
lived. 
But what is this thing we call delinquency? A mother 
cat buffs her kitten sharply when it tires of lying in wait 
for a mouse, its first one, of which it can have no actual 
anticipatory image. Deep in the nervous system of that 
mother there must be a concept, simple though it may be, 
of how that kitten should have acted. A mother duck 
pushes her chance chicken offspring into the water, and 
they drown. It must surely be a mystery to her, for she, THE DELINQUENT AS A DEVIATE 
219 
too, must needs have some ganglionic concept of how her 
young should react to the presence of a body of water. 
Was the kitten delinquent? Were the young chickens 
incorrigible? In a certain sense, yes. Their activities led 
them into conflict with the reflexive group of inherited 
tendencies to which their conduct should have been true. 
Long ages of the struggle for survival have eliminated 
from the animal mind all save certain successful patterns 
of response to situations which mean life, food, or death. 
Certain habits of response are ingrained. Even the ma- 
ternal response to wrong response in the offspring is rather 
definitely determined. The individual chick who deviates 
too widely from these general patterns dies. The individual 
kitten who cannot respond in true form is apt to go hungry 
until he adapts. 
Is the problem any different when we come to handling 
human offspring? No, except that the situation is so many 
times more complex. We know to-day but little of the life 
of primitive man. Just what he demanded of his children 
it is even harder to determine. Was development rapid or 
slow, similar in most children or very different? We can- 
not say. But some things were necessary if the child was 
to survive. Ability to cling fast to the mother as she trav- 
eled, to keep from whimpering in time of danger, to trail 
closely, to endure hunger, to scent and see quickly, these 
were surely fundamental virtues. But man did not stop 
there. Instead of developing special organs of defense, 
warmth, flight, and physical superiority, he developed an 
organ of adaptation, the brain. Birth ushers in his off- 
spring more helpless, dependent, and farther from their 
final stage of development than any other newborn crea- 
tures. They are unequipped with specialized means of 
meeting situations, and must, instead, learn to use this com- 
plex means of planning to meet new situations. Such en- 
dowment offers, not only every promise of superiority when 220 
THE UNSTABLE CHILD 
properly developed, but gives, also, a multiplicity of chances 
for deviation and defect in the course of development. 
From the moment he is born a child begins the lifelong 
effort to adapt. Often his very food provokes a struggle 
that uses all of his vitality for months. Changes of tem- 
perature, artificial and partial restraint from clothes, 
strange rockings and tossings, light when it should be dark, 
multitudinous noises, all lay their tax upon him. Grad- 
ually he meets the need for speech and adapts his tongue 
and throat to this new usage. Then comes the adaptation 
to that strange place where he learns those essentials to 
successful living that are not ingrained in his nervous 
system—school. Meanwhile he has had to meet another 
need. His conduct must constantly adapt itself so that it 
achieves first, the approval of the family, later, that of his 
increasing group of acquaintances, then, the ideals of the 
school and, finally he comes to realize that he is subject 
to the approval of his race as a whole, for he must meet the 
sanction of their written opinion of what his and other 
men’s behavior should and should not be—that is, law. 
It is not to be wondered at that there are a certain num- 
ber of children who do not adapt readily to that which is 
expected of them, but who show instead tendencies that 
lead adults to classify them as “delinquents.” The brain 
is an organ that is comparatively young in its complexity 
of development as compared with the evolutional develop- 
ment of the body as a whole. Its mechanism is the most 
delicate and sensitive in structure and function that one 
can imagine. The demands made upon it by each genera- 
tion grow greater, not less. It should consequently cause 
us no surprise when we meet a child with a brain that is 
not able to respond in the desired fashion to the demands 
which his generation makes upon him. If one believes in 
evolution and consequently takes the genetic attitude to- 
wards the whole problem of human life and ability, the THE DELINQUENT AS A DEVIATE 
221 
presence of the delinquent is in rational accord with the 
belief that the human race is improving, advancing, or de- 
veloping beyond what it was many centuries ago. In sym- 
bolic fashion we may picture man’s development as the 
adding of new stages of demands and achievements. From 
the standpoint of the study of mind, that man is the most 
intelligent who has added the most stages, and who uses 
his total equipment most efficiently. Accidents, disease, 
shock, and probably many other things have prevented the 
full development of numerous individuals, or have caused 
regression from development actually gained. Such indi- 
viduals cannot be expected to live up to the highest stand- 
ards of human activity, standards evolved by those not so 
handicapped. As a result, they act far more in accord 
with what we would expect of our early ancestors than in 
agreement with present-day modes of living. This does 
not mean that through countless ages there have persisted 
families which have not advanced or gained development 
beyond what they then had. “Cave men” probably had 
their own defectives and delinquents. The only difference 
is that life was much more severe in those days, and the 
unfit did not survive. Our present inferiors are probably 
largely a result of the last few hundred years of lenient 
support of the unsuccessful and the dangerous. It is not 
necessary to posit a continuum of defective creatures from 
past ages as a basis for asserting that we have defectives 
to-day, for m the same way as the higher levels of intelli- 
gence are probably the most recent achievement of mankind, 
they are the most susceptible to disturbance, defect, and de- 
terioration. Once they are undermined, that which we have 
left approximates more and more, as the disturbance is 
more severe, primitive man. 
For countless years our ancestors wandered here and 
there, adventuring as adventures came, living a life of 
chance and unexpectedness. Is it any wonder then, that 222 
THE UNSTABLE CHILD 
children occasionally revert to the ease and joy of going 
where they will and doing as they please instead of sitting 
in uncomfortable school seats for hours, bored with facts 
and figures that seemingly have no real relation to life? 
Yet such a child is a “delinquent/’ a “truant.” Do we 
stop even long enough to wonder whether he is a truant 
because he has dimly sensed his inability to measure up to 
the level of the others in the school group and assimilate 
that which the school offers? Yet this is frequently the 
case. Is such a child actually delinquent, and if so, what 
does delinquency mean ? Again, long ages ago, man thought 
only of himself and his safety. It was prowess to he able 
to steal. Indeed, there was no such thing as stealing. Ex- 
istence meant the ability to acquire and keep in one’s pos- 
session the necessities of life. Those who could not accom- 
plish this did not survive and did not, of course, leave off- 
spring. With this trait developed as a necessity for many 
generations is it any wonder that children sometimes steal 
and hoard ? Such behavior finds its justification in the cell 
memory of the individual’s nervous system. 
Nor is the effect of the tendencies of our forebears lim- 
ited to these illustrative types of behavior. Almost any act 
of any child can be analyzed to show the part played in its 
motivation by his inheritance of general human tendencies. 
He does not inherit the pattern of any one specialized act, 
but he inherits a nervous system which has the potentiality 
for many such varied acts. Let us consider even that prev- 
alent and serious present-day problem, immorality. The 
sexual desire is Nature’s own provision for the continua- 
tion of her creations. It is a desire second only to the desire 
for self-preservation and is so closely related to it that the 
two are sometimes hard to differentiate. Restriction of 
mating, that is, restriction of the satisfaction of the sexual 
desire, is a recent thing. Even more recent is the super- 
imposed group sanction to mating, while the legalization of THE DELINQUENT AS A DEVIATE 
223 
mating' is so recent that we still recognize the “common- 
law"’ marriage as moral and honest. And so our communi- 
ties are filled with those who, because of inferior ability to 
sense the group code (inferior intelligence), or who be- 
cause of inability to maintain in true perspective the rela- 
tive values of things or to properly utilize their desires and 
feelings (malfunctioning), or who because they see things 
in distorted fashion because of wrong training, yield to im- 
morality. 
One must recognize, without condoning disregard for the 
law, that there is something more than mere law-breaking in 
the episodes that fill our court dockets. The group we 
recognize as delinquent must be looked at from an imper- 
sonal, non-vindictive, non-troubled standpoint, if we are 
to accomplish anything of permanent value in our study of 
the matter. If man is to maintain that supremacy which 
he has achieved by virtue of a complex nervous system; if 
he is to continue in domination of the world because he has 
become an organism motivated by intelligence; if his de- 
fense of his superiority lies in adaption to changing condi- 
tions; then only those who meet by adaptive behavior the 
everyday problems of their own lives are fit to survive and 
pass on their potentialities to another generation. 
The problem is not a simple one, however. We cannot 
enumerate certain acts and omissions as delinquencies per se 
and then study the children in whose behavior they occur. 
Life is far too complicated for that, and our own ideas vary 
too much to allow such a procedure. Ask half a dozen 
people what they understand by delinquency, and the 
probability is great that you will be rewarded with a half 
dozen answers all of which vary greatly. The dictionary 
defines delinquency as “failure, omission, or violation of 
duty.” But duty, itself, is a dry thing of obligation and 
superficially imposed ideals which, in the very mentioning, 
is quite apt to make us feel sympathy for the reprehensi- 224 
THE UNSTABLE CHILD 
ble youth who has disregarded it. There should be some- 
thing more vital and more directly appealing to the individ- 
ual that is violated before we speak of delinquency. The 
whole scheme of society which expects a child to take such 
a puritanical and non-emotional attitude towards life is 
wrong. 
But perhaps we are not right in assuming that the Ameri- 
can people as a whole are represented by such a definition. 
What do parents themselves call delinquency? What does 
the term mean to social workers? Is the judge’s idea the 
same ? Do probation officers agree ? Not even between the 
different workers in any one of these groups are we apt to 
find a consensus of opinion. Unfortunately, in the practi- 
cal handling of delinquents we meet a tendency which is 
only too prevalent in many other fields. I mean the tend- 
ency to assume that because we are using the same terms in 
talking about a certain thing we mean the same thing. 
There is a certain glibness in shuffling words which fre- 
quently covers differences of meaning and even lack of 
meaning. We must analyze below this if we actually wish 
to accomplish anything. This holds when we speak of de- 
linquency. 
A parent admits that his child is “bad” or “trouble- 
some.” The admission means but little until we know the 
ideals of the parent, the social status of the family, the 
perspective and intelligence back of the statement. One 
family has the court habit and hales even the four-year-old 
Jerome in for scolding because it is easier to have him liv- 
ing under the fear of a visit from the probation officer than 
to slowly build up in him respect for the word of a spine- 
less mother. Another family robs itself even of comforts 
as well as pleasures and stints the normal-behaving members 
of the family before it will admit that John is too much 
for them to handle in a responsible fashion. Yet, in many 
of these latter cases the constant supervision and care have THE DELINQUENT AS A DEVIATE 
225 
prevented any acts that might be construed as actual of- 
fenses. Surely it is evident without any further discussion 
that these two ratings of behavior must be revalued upon 
some less personal basis before we have data which may 
be used for generalizations. In the one instance, pride of 
family, name, and reputation lead to sacrifice and the for- 
getting of self. It is the mass of families such as this from 
which our social fabric has been built. They protect their 
inheritance of ideals and customs with their very life. On 
the other hand, we have those who feel no such responsi- 
bility and who lack even family shame. Indeed, one some- 
times feels that they have considerable pride in their no- 
toriety. Their appreciation of social agencies, such as the 
court, lies only in their appreciation of it as a sort of 
troublesome foster parent which is to be tolerated because it 
assumes responsibility for the quirks of their young and 
has the power to enforce some sort of a terror-induced 
“goodness.” 
Is it otherwise with social agencies ? I mean those agen- 
cies of practical organization wherein men and women 
spend their lives acting as props to families with weakly 
developed regard for the ordinary demands of hygiene, de- 
cency, and morality. Here one will find a group of work- 
ers whose patience seems never-ending. The child who does 
not fit into one situation is tried in another and in still an- 
other, encouraged, rewarded, given medical attention, fitted 
and refitted to situations with the hope that something 
may be done for him to solve the difficulties. Another 
agency is content with a brief trial in poor surroundings, 
and little supervision is given. Naturally, the children who 
are finally classed as delinquent by these two agencies will 
be as different as night and day. Of course, there are all 
degrees of intermediate variation. Judges, probation offi- 
cers, teachers, and preachers, are not so different we must 
needs discuss them separately. No matter what the group 226 
THE UNSTABLE CHILD 
dealing with children, we can usually divide the extremes 
of opinion into the same categories. We find those who see 
facts, that is to say, delinquencies or items of behavior. 
Fortunately, we also find those who see reasons for the 
facts. 
Delinquency will always mean one and the same thing if 
we drop our own personal relation to it and study it from 
the genetic viewpoint, that is, from the viewpoint of the 
development of the race. Delinquency is a sign and a warn- 
ing, the red flag which should call our attention to the indi- 
vidual at just that time. Unfortunately, although we heed 
the warning, our interpretation of it is usually wrong. We 
are too short-sighted. A child does wrong. He did as he 
wished. We must deter his further tendencies to similar 
behavior by making the act unprofitable because of the un- 
pleasant consequences connected with it. These after-ef- 
fects must outweigh the pleasantness which the desired act 
brought with it. So far, so good. The law of balance and 
compensation works. Sometimes good results may be 
achieved in this fashion. But we have not gone far enough. 
What made the child wish to do what he did ? Did he know 
it was wrong ? Why did he act that way, anyway ? Usually, 
until a child is ten years of age, the law holds the parents 
responsible, not the child. The delinquency is considered 
an indication of neglect, poor supervision, or lack of home 
training. Unfortunately, most courts make no attempt to 
remedy this lack. It is easier to reprimand the parent or 
send him to the workhouse than to become an educative ad- 
junct to the home. 
As a matter of fact there is no logic in such a procedure. 
The tenth birthday (an earlier one in some states) bears 
within its 24-hour limits no actual potency for devel- 
oping a dormant sense of responsibility in the child who has 
been irresponsible theretofore. Parental failure to disci- 
pline and the child’s delinquent acts may be due to one and THE DELINQUENT AS A DEVIATE 
227 
the same cause. The workhouse or a reprimand does little 
to enlighten either generation, and it surely gives no aid 
in determining the cause of such behavior. Of course, the 
usual argument is that the court has a multiplicity of de- 
mands upon it which prevent its handling the individual 
in any other way. This may be so, but the court as a puni- 
tive agency has no business dealing with children. It is a 
remnant of our earlier religious attitude which regarded 
wrongdoing as the work of the devil which would disappear 
when punishment was severe enough to chase him out. 
Delinquency is a natural phenomenon. It is as much a 
part of the growing and changing race as deserted cities, 
obsolete weapons, and discarded ways of living. It is the 
result of the mental residuum of former stages, and of im- 
perfect attempts to produce individuals who can live nat- 
urally in the present stage of development. It is hard to 
achieve a perspective that enables one to see this readily. 
The individual situations of individual delinquents lead us 
to feel that surely this is the cause of such behavior in one 
case and that in another. To a certain extent we are right, 
but those immediate causes are merely the accidents that 
start the machinery of a certain act. There is something 
back and beyond this condition that merely “shocks” the 
child into such behavior. To assign to the accidental factor 
the whole responsibility for the act is as absurd as to stand 
upon one of the small peaks in the western part of America 
and say, ‘ ‘ This hill is the Rocky Mountains. ’ ’ This genetic 
attitude should not actually prove difficult to accept, for it 
is of itself the explanation of much that is otherwise 
hard to comprehend in the working of the child mind. 
Man’s development is a thing so radical and continuous 
that we cannot but be proud of it. Why should we then re- 
fuse to accept the corollary, that “accidents will happen” 
and that it is absurd to expect that none will suffer, develop 
imperfectly, bear the after-effects of disease, develop ir- 228 
THE UNSTABLE CHILD 
regularly, or more slowly ? The biologist naturally accepts 
atavisms and regressions. How can we help accepting the 
recognition of similar “remnants” of progress from the 
standpoint of function or behavior? It is just the other 
side of the same biological manifestation. 
Let us work out a practical illustration. Take the mat- 
ter of food itself. Primitive man ate uncooked food. If 
we may infer any of his habits from observation of the 
great simian family in general, he ate a very different diet 
from even primitive races of to-day. Meat, fruits, cellu- 
lose matter, bitter and acid roots and tubers, salty-tasting 
weeds, fish, mussels, all according to chance finding and in 
chance proportion were his lot. Starch foods are largely 
a matter of the discovery of fire, the development of a 
simple form of sowing and gathering of crops and of a 
consequent change from a wandering type of life to one 
wherein the family recognized a more or less permanent 
home-place. Earlier eating was far more a matter of taste 
and mouth preparation. Cooking removed the necessity 
for such prolonged mastication. In a way it also dulled 
the sense of taste. Cooking was for the group, whether it 
was a family, in our sense of the word, or a small clan. The 
sense of security roused by eating as one of a friendly group 
undoubtedly eliminated the need for constant alertness of 
taste. Food was accepted as non-dangerous, even if not 
always highly palatable. The tongue’s ability to discrim- 
inate was reserved more and more for the purpose of selec- 
tion of the most pleasurable tastes. At this stage it became 
an agent of indulgence, not of actual discrimination of food 
with the grim purpose of maintaining life. Sweets ap- 
peared in diet only in natural forms, ripe fruit (when fruit 
was plentiful enough to be allowed to ripen), and occasional 
finds of honey. 
To-day, food undergoes such elaborate maceration and 
cooking that mouth duties are less than ever. The bulk of THE DELINQUENT AS A DEVIATE 
229 
food assimilation now falls upon the stomach and intestines. 
The food as it reaches the stomach presents different charac- 
teristics from that of ages ago. There is no doubt but that 
this brings a new and different type of food-self-conscious- 
ness. With this there is all of the metabolic instability due 
to an attempt to support an organism developed by cen- 
turies of feeding on certain foods through giving a supply 
that differs radically. But what psychic effect are we apt 
to receive from this situation? Carlson has aptly reviewed 
and summarized the experimental work on this point.1 
To-day the consensus of opinion seems to be that hunger ac- 
tually increases the reflex excitability of the central nervous 
system and causes definite and actual restlessness. Ir- 
ritability, inability to fix attention for a long period and, 
in some instances, headache and nausea are also definitely 
found. As Carlson points out, however, we must remem- 
ber that “the precise degree of this central effect will de- 
pend on the intensity of the hunger contractions, the ir- 
ritability of the afferent gastric nerves, and the stability of 
the central organization.” 2 
This condition is well described by the German word 
angst, or anxiety. There is in hunger an actual nervous- 
system anxiety, with concomitant expressions of this in 
restlessness and general excitability. What more natural 
than that these symptoms should show themselves in a child 
whose body, poorly developed, is nearer the old than the 
new functional ability. This angst, or craving, makes the 
individual restless. He wanders aimlessly here and there. 
By chance he finds food, probably left easy of access. By 
chance he eats. Temporary quiescence and ease follow. It 
is easy to meet the recurrence of the restlessness in the same 
way a second time. Each cell affected gives motivation. As 
the child’s intelligence develops he uses it to subserve this 
i Anton J. Carlson, The Control of Hunger in Health and Disease. 
2Ibid., p. 87 (italics ours). 230 
THE UNSTABLE CHILD 
growing demand which pervades his whole life. The con- 
scious reflex of food-eat-pleasure has been developed. It 
is by no means difficult to add the next link. The time 
comes when the child hunts food but finds it not. He hap- 
pens to find money. His experience accepts the substitu- 
tion and we have the additional link in the associations 
formed—money-food-eat-pleasure. It does not take any 
actual exercise of the imagination to see even the next, more 
round-about method of obtaining the objective of actual 
bodily comfort. Money is not forthcoming, but something 
that can be sold is and we have object-sell-money-food-eat- 
comfort or pleasure. The acceptance of this habit of reac- 
tion depends entirely upon whether its early development 
formed without correction. If it chanced that the three-or 
four-year-old evaded supervision successfully and helped 
himself without any penalty to the contents of the sugar 
bowl, the cookie jar or the candy box, he has developed into 
a potential thief. Pennies will prove easily accessible. His 
thievery is a habit before it is discovered, and it is definitely 
ingrained into his nervous system, for it has back of it 
the vital urge of continued bodily pleasure, the urge of 
self-preservation itself. No one can wonder at the strin- 
gency of authority, the extreme severity needed to “cure” 
such a habit. The thing that breaks down the habit must 
be as vitally connected with the individual’s future well- 
being as food itself. Nor is this a theoretical illustration. 
Stomach neuroses of this sort are frequent enough among 
problem children. The only reason they are not more fre- 
quently found is that there are not enough people analyzing 
behavior back to its actual causes. 
One mother whom the writer saw in clinic work gave 
the history of her little boy, aged eight, having been a con- 
stant problem because of such stealing until the age of 
7. As the child was markedly inferior in every way, testing 
at a 5-year level on most tests, a red-haired anomaly in a THE DELINQUENT AS A DEVIATE 
231 
family of very dark children, there seemed every reason 
for investigating her method of cure. With tears in her 
eyes she told how she had whipped, bribed, scolded, talked 
to him, put him in bed, “tried everything.” Nothing 
helped. Finally, she took him right after he had stolen 
some food and scolded his hands and then “pricked every 
finger until it bled.” He never stole from that day. Al- 
though one would not naturally think of or advocate such 
methods, it is evident that the punishment menaced self- 
preservation in a fashion sufficiently real to make him 
forego the reassurance which food brought. 
In similar fashion one can see that the same angst or 
unbalancing of metabolism may find other chance modes of 
expression. For instance, there is no food to be discovered 
or used as an angst-sedative. Instead, motor activity con- 
tinues to increase. Gradually, this very activity brings 
its own sedative of actual fatigue and consequent ease. 
This activity may take the form of throwing, breaking, 
smashing, beating, and hitting. It may merely express it- 
self as inability to stick to any one occupation or game. It 
may lead to wandering and hence to running away, nom- 
adism, truancy. These activities are probably reenforced by 
subconscious traces which centuries of wandering and rest- 
less living have left upon our nervous systems. In other 
words, the individual easily regresses to an “escape” atti- 
tude. This is a type of motor rather than cortical adjust- 
ment to difficult situations and is a logical reaction in one 
who is in any way unstable or unfit. 
Maladjustment. In that one word lies expressed the 
whole problem. The normal child just grows and, as he 
grows, adjustment to changing situations and to emergen- 
cies, to demands made upon him and restraints enforced, 
simply comes. Everyday experiences of all sorts are the 
material out of which he builds his ideas, aims and behavior. 
But with imperfect organisms the problem is very differ- 232 
THE UNSTABLE CHILD 
ent. Situations are frequently too difficult for them to as- 
similate into their regular living. That which another 
meets with merely temporary fatigue or depression spells 
actual catastrophe to them. Meanings of things may not he 
readily seen. On the other hand, they may acquire habits 
with pernicious ease and find them unmodifiable no matter 
how they try. From the social standpoint we are apt to 
say that these individuals do not adapt readily. This lack 
of adaptability is the cause of their difficulties with society 
as well as of society’s difficulty with them. Non-adaption is 
the keynote to incorrigibility, delinquency, ineducability, 
our chief problems in dealing with childhood. They are 
problems so closely related they are practically one and 
the same in many ways. When one studies the problem 
from this viewpoint, it does not take long to realize that 
there is a reason for the non-adaptation of these children 
and that it is one whieh eliminates all question of their 
self-responsibility. 
The basis of all actual intellectual growth in the indi- 
vidual is learning. In its simplest form this is rote memory. 
In its more complex forms it may extend to the highest 
type of abstract thought, such as that necessary to develop 
a concept. But from one extreme to the other it is the 
learning process which is essential. However, since we live 
in the midst of changing and growing things and people, 
one learning is not always sufficient. A situation changes 
just a little bit. Our learning of the essentials which fitted 
its earlier conditions must now be modified. This changing 
of a thing learned is adaptative learning, or as we usually 
say, adaptation. Now adaptation to a situation can come 
in only twro ways, that is, either through cessation of the 
earlier response to the situation or through a change of 
response. But, suppose we have an individual whose 
ability to learn is limited, or one whose ability to learn is 
seemingly sufficient but who cannot unlearn or relearn in a THE DELINQUENT AS A DEVIATE 
233 
modified fashion with any satisfactory result? We have 
then a condition of non-adaptation and more, we have the 
potent basis of social defect, call it delinquency or some- 
thing else as you will. 
If we accept any such line of reasoning, there is but one 
attitude left for us to assume in our work with children 
of any type—There is no such thing as a had hoy or girl. 
Either the child does not know any better or else he cannot 
help it. It is with this attitude that the research reported 
in later chapters of this book has been carried out. 
Such an attitude naturally influences the work one does 
with the child whose acts are anti- or a-social. It is not 
enough to assure one’s self that the child actually has per- 
formed the act with which he is charged and to recognize 
extenuating circumstances in the environment or in his 
own physical or educational handicap. If one assumes 
that the child is not bad, not inherently doing things to 
disturb law and order because he is “a regular imp,” then 
the whole situation must be intensively studied to deter- 
mine whether it is his lack of knowledge and hence the 
responsibility of his older associates which causes his 
troublesome behavior, or whether it is some innate defect, 
peculiarity, or mental attitude which is to blame. 
Such study is not to be accomplished in a few moments 
or a few hours, and it will always meet with difficulties, 
but on the other hand it promises much. If we can begin 
analyzing delinquency back to its causes instead of con- 
tenting ourselves with generalized applications of discipli- 
nary institutions, there is some hope of getting control of 
the problems that confront us to-day. 
We condemn the delinquent when we hold ourselves as 
part of a righteous group that represents society as a whole. 
We condone his offenses and pity him when we realize 
that he cannot help what he does; our attention is focused 
then upon the reason for the act. 234 
THE UNSTABLE CHILD 
We accept the act as a symptom of the child’s need when 
we are able to discover the cause. 
In this last situation we are just as eager to avoid any 
repetition of the act, but there is some scientific basis for 
the action we take, not merely custom and ancient law. 
The result is a far more hopeful state of affairs than we 
have heretofore experienced. No, I do not believe we can 
eradicate delinquency. So long as the human race con- 
tinues changing and developing; so long as customs are 
modified, discarded, or newly developed; so long as we do 
not have under our control all of the possible diseases; 
so long as humans marry as humans now do, just so long 
shall we have delinquents. In other words, we shall con- 
stantly have those who fall by the wayside of human prog- 
ress, and, in all probability, we shall have an increasing 
proportion of such inferiors. But, if we know the condi- 
tion, we can deal with it far more successfully. Much of 
the defect of the inferior may be turned at least into medi- 
ocrity of ability. Much of the repeated handling of the 
same individual for the same offense can be eliminated. 
Some individuals can probably be saved entirely. More- 
over, each year of such corrective work will bring the 
proper perspective, that of the next preventive step. 
We shall always have delinquency, delinquents, the 
necessity of handling them. The question is: Are we 
going to handle them as a logical result of our civilization 
and its imperfections, or are we going to lay the blame 
upon them, already the unfortunate ones ? They are waste 
material. Have we not seen enough of the utilization of 
waste material in industrial fields to spur us on to the 
analysis and utilization of this most expensive of all waste 
material—human beings? CHAPTER XIII 
A PRACTICAL STUDY OF DELINQUENTS 
Holding such a perspective, it is necessary to attempt 
a practical application of it before one can be at all sure 
that it is not merely a sentimental way of relieving one’s 
own worry over a problem of social conditions for which 
each and every adult must feel some responsibility. There 
is no such thing as a bad boy or girl. Either the child does 
not know any better or else he cannot help it. Does such 
a concept work ? Is it possible to see back and beyond each 
and every child’s aberrant acts a justification which makes 
his act the only logical result of his physical, mental, and 
environmental endowment! The only way such a concept 
may be justified is to accept the task of studying a group 
of “delinquents” in the proper attitude, with as careful 
and impartial methods as are available, and see what may 
be learned from them. 
Such an opportunity was available in the reorganization 
of the Ohio Bureau of Juvenile Research which was begun 
in the fall of 1918. It is not necessary to state in detail the 
technicalities of the establishment of the Bureau. This, 
with a statement of the perspective and previous history 
of the movement, as well as with an outline of the ideal 
planned for the future of the Bureau, has been fully de- 
scribed by Goddard in his recent volume, Juvenile Delin- 
quency. The writer was fortunate in being given full 
authority for the development of the psychological study 
of the children to be handled under this reorganization. 
It is this psychological study which interests us in relation 
to our formulated concept of the delinquent child. What 
235 236 
THE UNSTABLE CHILD 
chance did the reorganized Bureau give for the formulation 
of methods and carrying out of intensive studies which 
could modify, or check, or change such a concept and so 
throw some impersonal light on the problem of the de- 
linquent ? 
The Bureau had been organized under a law of 1914. 
But no money was available for its organization. Gradu- 
ally a small staff was secured, and the first work done was 
largely that of acquiring a perspective of the actual state 
problem as presented by the delinquents in the two state 
schools for such children. This meant the examination of 
some 1,500 or 1,600 children, chiefly adolescents. Gradu- 
ally, other types of children were studied. A first acquaint- 
ance with the state’s problem in the handling of blind and 
deaf children was made. Some children at the school for 
the feeble-minded were studied, and the state grew to know 
its new institution, although the institution had no head- 
quarters which might justly be called its own and was 
rather a personnel than a thing of permanence. The 
situation was not far different when, with a certain appro- 
priation, the new group of workers began interpreting their 
work as a Bureau in 1918. There were offices, but this did 
not allow any assumption of the chief function of the 
Bureau as authorized by law. Juvenile courts were author- 
ized to commit juvenile offenders to the Board of Adminis- 
tration for study and proper disposition, and the Board 
might delegate such study to the Bureau. But the Bureau 
had no place to hold a child even over night. How then 
could proper study of him be scientifically made? He 
might come in tired from a trip half-way across the state, 
with wrong food as a part of the trip, and with only two 
or three hours for study before he would have to be sent on 
somewhere, merely because he needed a place to sleep. As 
it happened the law had definitely stated three powers of 
the Bureau: A PRACTICAL STUDY OF DELINQUENTS 
237 
1. The study of children assigned to it by the state authorities. 
2. The study of state wards from other institutions. 
3. The study of children referred by any charitable agency or 
by any individual. 
The restriction of the study of wards assigned to the 
Bureau naturally led to the more rapid development of the 
two latter types of work. The study of wards in other 
institutions could be fairly well carried out by sending 
workers to those institutions. This was the type of work 
done before 1918. The study of children referred by pri- 
vate agencies and private individuals naturally meant 
simply clinic consultations. The number and source of 
such consultations depended largely upon the value of the 
work done and the gradual education of the public to 
the use of such a clinic. Enough work was soon available, 
however, to enable the workers to formulate a definite plan 
for complete examination. Six months of everyday experi- 
ence with such a tentative plan gave a practical basis for 
the formulation of a procedure for examinations and 
research, which was put into routine practice when the 
opening of a small cottage, capable of housing about 25 
delinquents, at last gave an opportunity for the study of 
one of the most interesting phases of our civilization—the 
child who has been delinquent in the eyes of society and 
adjudged so by the court. In the two years from February, 
1919, to February, 1921, 369 such boys and girls were 
studied under the direct supervision of the writer. The 
number seems small. But it must be remembered that the 
study of the children had to be worked out in connection 
with the many problems incidental to the establishment of 
a new institution. The work done was definitely experi- 
mental, and the writer believes that it has a definite value 
from the scientific standpoint. It was far from ideal, how- 
ever. Once it was determined that a child needed medical 
correction, limited means, politics, and lack of understand- 238 
THE UNSTABLE CHILD 
ing of the big principles of the movement meant waiting 
until free or practically free help could be obtained for the 
child. Once the decision was reached that he should be 
placed in a home and given a trial, the whole machinery 
of departmental responsibility had to be threshed out. 
Having found a free home for a child, the money to pro- 
vide him with clothes, which the placing agencies required, 
became a matter of vital importance, since the whole origi- 
nal budget for clothing for the Bureau was limited to $100. 
In one instance, getting clothing took nearly two months. 
During that time the child took up a bed and care in the 
cottage which should have been devoted to other new chil- 
dren. In other words, the work done on these children 
was done under the usual conditions in such institutions 
when the urgency of the problem leads to an attempt to 
offer relief before conditions are really livable. Even 
though there was an appropriation of $100,000 for build- 
ings and equipment, this did not mean even ideal equip- 
ment. The clothing used was state made, the dormitories 
were equipped with beds and chairs only, the dining room 
had the barest essentials. A school-living-room had chairs, 
tables, a bookcase, a blackboard, a few necessary textbooks, 
a few story books which were donated, a victrola similarly 
obtained after a year of effort, a small supply of tools, 
raffia, old lumber, pint cans of paint, in fact the barest 
essentials for occupation. The statement of such details is 
given in order to emphasize the fact that it is far from 
necessary to have ideal equipment in order to do scientific 
work. These 369 children who at one time or another dur- 
ing those two years stayed in the Bureau cottages were 
studied under conditions that made it highly probable that 
the study of their behavior was not unduly influenced by 
having them under conditions which made it easy for them 
to be good. The absence of quarrels, night escapades, fre- 
quent escapes was far more a matter of the mental handling A PRACTICAL STUDY OF DELINQUENTS 
239 
of them than of the actual physical conditions. Moreover, 
the people in charge of them were selected from such as 
would apply for a similar position of attendant at any of 
the other state institutions, for no extra salary was allowed 
for the difficulty of handling delinquent or problem 
children. 
These children are an ideal group for study in one way, 
an exceptional group in another. Since the housing capacity 
of the institution was limited, the value of the study on 
such cases undemonstrated, and since courts were not offi- 
cially notified that cases could all be committed to the State 
Board of Administration and sent to the Bureau, most of 
the courts sent practically all of their children who seemed 
to need institutional correction directly to the industrial 
homes for boys and girls. 
Now and then an unusual problem would confront the 
judge. This was usually considered a good chance to test 
out the worth of the Bureau. Consequently, the children 
who were sent in were actual problems, not chance or 
incidental delinquents. Instead, they were the repeaters 
who had had every type of help the local agencies, the 
courts, the industrial schools had been able to give. In 
other instances, the children were up before the court for 
the first time, but the case would be so definitely peculiar 
or so obviously in need of special consideration that the 
child would be sent on at once. In a few instances, nearby 
courts would first send a child for a clinic examination and, 
in case sufficient evidence of abnormality or peculiarity was 
found, would then commit the child to the proper authori- 
ties and turn him over to the Bureau for further study. In 
general, the group represents the opinions of the varying 
state districts as to children who actually needed observa- 
tion. The symptoms are probably more extreme in these 
cases than in the general run of court cases in any one dis- 
trict or town. On the other hand, so far as any information 240 
THE UNSTABLE CHILD 
can be gained, no one was able to differentiate these children 
from those who would not be repeaters when they had first 
appeared in court. 
Undoubtedly any state has similar cases and similar 
problems. There is every possibility that any individual 
juvenile court could duplicate most of the cases. This but 
shows the extent and serious nature of the problem. 
It is said that there are laboratories in this country where 
the examination of any individual who comes through the 
door is carried out with a detail which is absolutely pre- 
determined. The remarks made, the seat taken, the order 
of even casual conversation is carried on by rule-of-thumb. 
No such attempt was made at the Bureau. The children 
came in from all sorts of trips, from detention homes and 
jails, brought from parole to parents, from the courtroom 
itself. They came in after trips varying in length from 
fifteen minutes in an automobile to four, five, six, or seven 
hours on trains. They came in clean, dirty, filthy, hungry, 
tired, sullen, crying, apathetic, mad, revengeful, silly, and 
stupid. They came at all hours of the day, and sometimes 
at night. Consequently, the first consideration was the 
fitting of the child into the living program of the institu- 
tion. Before he was sent to the medical department for a 
bath and general inspection, an attempt was made to fit him 
mentally for the situation in which he found himself. This 
morale work was undertaken as a definite part of the 
psychological study of the individual. He was met with a 
friendly interest, acquaintanceship was begun, name, home, 
schooling, and occupation ascertained. Then he was given 
a more or less simplified statement of why he had been 
brought to the Bureau, with the precaution that he was first 
asked if he knew why he had been brought there. Usually 
he had no idea that his fate differed any from what it would 
have been if he had been sent to one of the industrial 
schools. He was told that coming to the Bureau meant A PRACTICAL STUDY OF DELINQUENTS 
241 
another chance. The workers there were supposed to study 
each boy and girl that came in and decide whether or not 
he seemed able to behave properly, if given a chance. Then, 
too, he was told, the way he behaved there would be impor- 
tant. The fact that a boy could make a good record would 
count in his favor when the time came to decide what was 
to be done with him. Of course, a poor record would count 
in just the opposite fashion. At this time the child would 
be given an OK slip. This slip, reproduced on page 242, was 
gone over and explained in detail. The fact was impressed 
that privileges, such as posts of special honor, errand-boy 
positions, office boy, attendance on movies and parties were 
entirely a matter of recompense for good OK records. 
This talk was always interspersed with a few preliminary 
tests, one to determine approximately the mental level of 
the individual and the other to determine to a certain 
extent his functional normality. Then he would be sent 
over for general cleaning up so that he might meet the next 
meal of the institution in clean clothes, understanding what 
was expected of him, and with the beginning of an attempt 
to make a good record concretely before him in the signa- 
tures on his OK slip, given for cooperation in the psycho- 
logical and medical examinations. 
Of course, such morale attempts must be concretely 
followed up. The fellow who would break regulations 
necessarily went to bed at party times each Thursday night, 
until it was found that going to bed was considered a 
chance for fun with the nightwatch, then working at some 
definite task under supervision was naturally substituted. 
In the same way, the idea was encouraged that all work 
was a privilege. The child who made trouble was not 
allowed to work. Only the best boys could turn the ice- 
cream freezer so that it made good ice-cream. Down-town 
errand boy was a post of the highest honor next to telephone 
assistant. There were always children ready for any task OHIO BUREAU OF JUVENILE RESEARCH 
OK SUP 
Name. Week beginning.. ,,, 
— - , 1 T 1 w j T .E 
Rising 
BREAKFAST 
Dormitory work 
Cottage cleaning 
Kitchen 
Dining-room 
Laboratory cleaning 
Cottage -errands 
Sewing 
DINNER 
Care of Grounds 
Gardening 
Weaving 
Cottage School 
SUPPER 
Play 
Letter writit\& 
LABORATORY 
Examination 
Special work 
Errands 
DOCTOR 
Examination 
Medicine 
Cleaning 
Errands 
Special ' 
Public School A. M. 
Public School P. M. 
NOTICE! 
1. You are responsible for your cava OK slip. 
2. All privileges depend upon a good OK slip. 
H. H. GODDARD, Director. A PRACTICAL STUDY OF DELINQUENTS 
243 
or errand, -willing to carry out the idea of winning worth 
through service. Party night meant, of course, something 
to eat, with a few games and occasional prizes thrown in to 
enhance the value of good OK’s. Even at our parties the 
industrial incentive was recognized. One of the favorite 
forms of amusement was a “contest.” Groups or pairs 
contested for honor or prizes at such tasks as sewing on 
buttons, darning stockings, paring potatoes, dusting chairs, 
making beds. In every instance the test was a practical one 
made in full formality with judges and a stopwatch before 
the rest of the “good OK” children. So far as possible the 
whole institution was run on such a privilege regime. The 
day after admission, unless a child was found to be ill or 
definitely upset from his trip, we began the definite work 
of obtaining as complete as possible a picture of his intelli- 
gence level and functioning. The tests used in this study 
consisted of a required minimal and as many auxiliary lines 
of study as were applicable and could be given in the time 
we had for study of him. There was frequently a break 
in the examining after the first full series was given, for 
medical needs would take him away to a hospital or leave 
him with drops in eyes, or some other handicapping 
treatment. 
The minimal examination of a resident case consisted 
of observation from the ten aspects discussed in detail in 
Chapter X. To determine these points it is necessary to 
examine the individual on the following tests: 
The Kent-Rosanoff association series. This was given the day of 
admission and again the following day at the beginning 
of the test procedure. 
The Ohio Literacy Test. Given the first day and temporarily 
used as a basis for evaluation of the child’s mental age, 
since percentiles for chronological age, mental age, and 
school grade are all available.1 
i Violet H. Foster, The Ohio Literacy Test. 244 
THE UNSTABLE CHILD 
The Stanford-Binet. 
The Seguin formboard, Goddard adaptation board, Knox imi- 
tation or tapping series, Healy Pictorial Completion, No. 
1. Porteus maze series. 
A modification of the Blin-Damaye and Franz general informa- 
tion and practical knowledge series. 
A series of arithmetic tests on the fundamental processes, frac- 
tions, interest, etc., made up in accord with local syllabi for 
grade promotion. Language and geography tests simi- 
larly worked up. Courtis arithmetic tests, Brown reading 
series, Ayres spelling and writing tests. 
The anthropometric measurements used in Smedley’s study. 
At least one talk with the child in which an attempt was made 
to get his own story and to understand his viewpoint, 
ideals, and desires. 
Besides these tests, any of a large group of auxiliary tests 
were used as occasion warranted and the development of 
the child permitted. The group used in our minimal series 
was not ideal but consisted of those tests which, at the time 
this study was begun, best stood the demands for tests 
which could be given with high accuracy, little effect of the 
personal equation, rapidity, general applicability, interpre- 
tation into good norms, significance when interpreted. For 
instance, there is probably less significance in a series 
of school tests than in any other type of examination. 
The things taught cover such a wide field of information 
and so many discrete principles, and vary so much from 
even village to town that it is almost impossible to gauge 
how much is due to the child’s inability to grasp or retain 
what he has been taught, and how much is due to his lack 
of opportunity. Consequently, the time spent on such tests 
was constantly restricted, more work of other types seeming 
preferable. 
One of the first problems by which one is confronted in 
attempting to present the data obtained in such a study 
is the problem of presenting it so that not only are the facts 
recorded but so that the actual experience gained from the A PRACTICAL STUDY OF DELINQUENTS 
245 
gathering of such facts is as graphically available for other 
workers as possible. 
It is useless to present an analysis of the whole group fir 
a unit. The range of ages is from babyhood to the upper 
limits of minority. The range of mental ages is equally 
great. The offenses vary from incorrigibility, meaning 
inability to understand commands in one instance, to the 
same charge meaning lying, stealing, temper spells, and 
assaults in other instances. The problem is still further 
complicated by the presence of both sexes, some colored 
children, a few foreign-born, a few who were merely prob- 
lems because of some definite physical or neural handicap. 
Any worker will meet all of these contending and over- 
lapping problems in the course of several years’ work. The 
problem of aiding such a worker’s disposition of cases 
through making it easy to compare his problems with those 
met in this study means that the group must be subdivided 
in such fashion that the individual problem to be compared 
fits into a grouping which is of practical worth because it 
facilitates handling the new case and determining his 
future. The chronological age grouping is of no great value 
for such purposes. Chronological age automatically closes 
certain avenues of handling a child and opens others. It 
determines the necessity for some sort of nursing care, or 
schooling, or vocational training. It determines the possi- 
bility of admission to industrial schools in some places, the 
availability of orphanages, day nurseries, specialized hos- 
pital care, and the like. But such items are incidental, and 
the information gained by this factor must be utilized in 
relation to the greater problem of why certain kinds of care 
are needed. The practical worker might readily suggest 
that the proper division is one of mental or psychological 
diagnosis. But this removes us too far from the everyday 
world of those who handle delinquents. A psychological 
diagnosis is, it seems necessary to restate, far more than a 246 
THE UNSTABLE CHILD 
mental age or similar ascertainment. It means lots of time 
for its determination and the probability of only tentative 
formulation, at that, in 10 to 30 per cent of the cases. 
Most delinquents do not have the opportunity of a thorough 
examination psychologically. However, since the problem 
is one of behavior, and consequently of mental activity, it is 
even needless to suggest the use of a medical diagnosis as 
the basis for classification and suggested disposition. The 
medical findings are a factor in disposition and treatment 
in many cases, but they must be related to the factors of 
primary importance, those which have motivated behavior 
directly, and which are apt to motivate it in the near future 
at least. 
Perhaps the best we can expect, in most instances, is a 
study of the child by one of the mental-age scales. The 
need for this is so great that any suggestion for solution 
of the problem of any one delinquent without such a pre- 
liminary test must be avoided. Delinquency is a behavior 
symptom. Behavior symptoms are mental symptoms. They 
are resultants of certain combinations of heredity, disease, 
and experiences upon the nervous system. They imply fac- 
tors of comprehension, volition, ideals or desires, planning, 
directed action. As such, the primary analysis of them, in 
any attempt to correct or modify them, is essentially an 
analysis of intelligence or mentality. The use of the mental- 
age scale is an introduction to such analysis. But just how 
shall we use such data once obtained? The common prac- 
tice is immediately to interpret such a mental age into an 
intelligence quotient. This in turn is interpreted into a 
diagnostic phrase, helpful in some instances, but grossly 
misleading in others. It leaves both of the factors of 
chronological age and mental age to be reintroduced as side 
factors in determining the situation. Moreover, the possi- 
bility of change in the mental age and the I.Q. are left out 
of this consideration and so, what is merely a temporary A PRACTICAL STUDY OP DELINQUENTS 
247 
classification of the individual, in many instances, becomes 
the working basis for handling him for the rest of the years 
of his minority. Williams’ study of delinquent boys is 
made from this basis. It necessitates in every group the 
recurrent consideration of the possibility of change. On 
the other hand, a grouping by mental age allows one to keep 
more definitely in mind the probability of simultaneous 
mental growth, chronological-age increases, and physiologi- 
cal growth. Moreover, it avoids classing a child wrongly 
in a group where mentality is supposedly normal or where 
it is so low that the inference is that no improvement can 
occur. The mental age, not the I.Q., is the first logical 
point of division of children when we wish to consider their 
responsibility for the situation in which we find them. This 
one classification cannot solve our problems, yet it will do 
much to simplify certain aspects of the problem and to ren- 
der further analysis profitable. Let us at least see what it 
yields us in this group of cases. 
A further point needs emphasis. Averages are mislead- 
ing. Statistical reports may be accurate, yet all accuracy 
be lost in gross misinterpretation. This study has been 
worked out with minute statistical evaluations, yet the 
writer can see in presentation of more than a minimal 
amount of such data merely a chance for misunderstanding. 
The statistical data presented are deliberately an attempt 
to demonstrate the probable variability of any individual 
studied away from the general tendency of the group to 
which he belongs. One must use norms to measure this 
variability, but once it is measured the norms become 
relatively insignificant, and practically a handicap. CHAPTER XIY 
CHILDREN UNDER SIX MENTALLY 
Is it possible that children with less mentality than that 
of the average child when he begins school can be delin- 
quent? In many ways the answer to this question cannot 
help but be no, yet the child whose mind is that of a 5- or 
4- or 3-year-old may well be a most serious behavior prob- 
lem. The usual tendency is to ignore this group either as 
too young to bother with or as too low-grade to need more 
than the necessary steps leading to institutional care. But 
some young children who are not feeble-minded need con- 
sideration, and some who are feeble-minded must have 
adjustment made to home or community care, since we have 
insufficient institutional room for all of them. For these 
reasons of practical demand, not to mention the scientific 
interest such cases awake, it behooves us to study them 
carefully when chance permits. 
Less than 1 year mentally. The group studied at the 
Bureau included only one child, a little girl 4 months of 
age, who belonged in this group. On the Binet-Simon 
infant scale, the Kuhlmann infant series, and on other 
series she scored normal or above normal in level. Her 
commitment was as a dependent with her feeble-minded, 
unmarried mother. The father is an unknown quantity. 
Medical findings are negative. The baby’s behavior shows 
no abnormalities, no difficulties of adjusting to the prob- 
lems of eating, sleeping, and growing. Habit training is 
taken easily. 
Despite such innocent seeming findings, diagnosis on such 
a case can but be deferred. The mother’s inferiority is so 
248 CHILDREN UNDER SIX MENTALLY 
249 
marked, the child’s endowment so probably affected by 
this, that final diagnosis must be deferred. After two 
months had passed, the baby showed but little change in 
its relative ability. Is it a case of potential feeble-minded- 
ness? Will it be a simplex normal getting along on the 
ragged edge of independent existence? It is such cases as 
this, inadvisedly adopted, whieh make so much of heart- 
ache and trouble as they grow older. Let us give such 
children every chance for development, but not at the 
expense of normal families. We need to follow many such 
cases twenty years or more, so that the various problems 
of inheritance, delinquency, and dependency may become 
more clearly understood. 
Between 1 and 2 years mentally. Two children of this 
level were committed, the one as a neglected, the other as 
an incorrigible, child. Both were boys, 6 and 8 years of age 
respectively. The anthropometric measurements showed 
marked inferiority in all respects in one case and in all but 
standing height and weight in the other. The former case 
bore physical indications of inferiority such as scaphoid 
scapula*, rachitic bones, etc. The latter was practically free 
from all such signs. Laboratory tests were negative on 
both. The former was merely a problem for care and per- 
manent provision, the latter was a problem because of anti- 
social tendencies such as running away, temper spells, and 
destructiveness. The successes and failures on the Kuhl- 
mann and the Binet-Simon scales were different in that the 
former obeys directions better, whereas the latter, although 
disobeying, can draw a circle, comprehend more, and take 
care of himself in a way the other child cannot. 
Diagnoses are feeble-minded, of idiot level in the first 
case, and feeble-minded, seemingly of idiot level, but im- 
provable and excitable in the second case. 
Both of these children are necessarily institution cases. 
The probabilities are that the excitable case will improve 250 
THE UNSTABLE CHILD 
to the point that he will reach a low imbecile level. Six 
weeks’ observation of him practically showed that he could 
be taught to talk, while in that time his habits improved to 
the point of daytime cleanliness, and he was also taught the 
obedient carrying out of a simple command. Because 
of the difficulty of handling the excitable cases in private 
homes, and also because of their earlier and greater 
response to training, it seems fairly clear that, other factors 
being equal, an excitable, or psychopathic child should have 
first chance at institution training. 
Between 2 years and 2 years, 11 months mentally. Only 
two children, a girl of 10 years and a boy of 29 months 
belong to this group. The boy scored 30 months on the 
Stanford. His commitment was for observation and train- 
ing to aid general recovery from paralysis. His medical 
findings were negative throughout, save for the one definite 
handicap. The mother was a frail, ineffective girl about 
to marry for the third time. Observation a year later 
showed the child retarded and lacking in the normal desire 
to get around and to be as active as his physical condition 
made possible. 
The girl was nearly 11 years old, yet scored only 26 
months and failed on all performance tests. Medical find- 
ings showed disturbed reflexes, round shoulders, prominent 
abdomen, wide-spaced teeth, negative laboratory tests, many 
minor stigmata. The child is one of 12 children. One 
other child of the same family, a sibling, as we say, is feeble- 
minded. The mother is at least very inferior. The father 
is “but little better.” The child is said to have been nor- 
mal until two years of age. There has been no behavior 
problem in either instance. 
The first case is obviously a home problem, to be taken 
care of as best they can. However, one may not feel at all 
sure that the child has been disposed of with any degree of 
permanency. The mother has the “agency” habit. Better CHILDREN UNDER SIX MENTALLY 
251 
than any other lesson has she learned the lesson of how to 
get others to do her worrying for her. The best we can 
do is handle each demand so as to give the child the best 
opportunity for future normality. Moreover, this must be 
done as expeditiously as possible, throwing the responsi- 
bility again and again on the mother. The second case is 
more definite. The child has already been dropped upon 
the county for care by an irresponsible family. In a chil- 
dren’s home she was found impossible. This impossibility 
is entirely due to her lack of mentality, which means she 
cannot work, learn, take care of herself. She is truly a 
state custodial care case. The tryout in a county home, 
although it may not be fair to some normal children, has 
been more than fair to her. If paid workers cannot train 
her as one of a small group of children, many of whom are 
backward, there is no use giving her the chance to spoil a 
private home that wants to take a child, when a more hope- 
ful child might well succeed. Her deviation from the 
normal is too extreme to make her a case that can be 
socialized. 
Between 3 years and 3 years, 11 months mentally. Three 
children belong here. None of them was committed as 
delinquent, although the youngest, a little girl exactly 
4 years of age, was incorrigible. The other two have been 
social problems because of their need for special care. 
Elsa, the youngest of the three, exactly 4 years old, tests 
3 years, 6 months on the Stanford. Her successes in the 
tests do not go above the fourth year. On performance 
tests she scores from 4 to 6 years. She is markedly superior 
in physique, but is lacking in psycho-motor control. Medi- 
cal and laboratory findings were all negative. Her mother 
is feeble-minded and delinquent. The father is said to 
have been an intelligent business man. The child is illegiti- 
mate. Social observations of her indicated marked tenden- 
cies to negativism and self assertion. Part of this seems 252 
THE UNSTABLE CHILD 
to be a definite attempt to compensate for a feeling of 
inferiority. Needless to say, diagnosis was deferred. Re- 
observation two and a half years later shows beginning 
retardation and increasing instability of function, with 
diagnosis still deferred. Her behavior is getting to be more 
of a problem all the time. She does not learn well in 
school, cannot be managed well anywhere. Yet so attrac- 
tive is she that only the good sense of the agency handling 
her has prevented adoption. 
Cora, aged 11, tests 3 years, 8 months on the Stanford. 
“She cannot learn.” Her range on the Stanford is from 
a basal of 2 through the seventh year. Her performance 
tests show formboard ratings which vary from 8 to 10 years 
in level. The physical examination reveals a constitutional 
inferior, with poor hearing, high palate, scaphoid scapulae, 
flat feet, but with negative laboratory tests. Morphological 
measurements place her as about average in standing 
height, low in sitting height, poor in manual control, but 
good in lung capacity. Her behavior was unexpected, 
peculiar, and changed readily as her attention was dis- 
tracted now this way, now that, by any incidental happen- 
ing. She is not only feeble-minded but, for her mental 
level, quite psychopathic. 
The third child of the group, Jasper, is one of three 
brothers, brought in by the father for advice regarding 
placing. He is over 6 years old and tests 3 years, 2 
months. With a basal of 2 he does some of the tests 
through the seventh year. He is poorest in rote memory 
and best in verbal ability. He scores below the lowest 
norms on all performance tests. He is in the lowest 10 per 
cent of 6-year-olds when compared with the norms for 
height and weight and psycho-motor control. The medical 
examination shows exaggerated reflexes, spaced incisors, 
broad and flat nose, winged scapulae, protuberant abdomen, 
and negative laboratory tests. He has a marked speech CHILDREN UNDER SIX MENTALLY 
253 
defect. His general appearance is cretinoid. The next 
older brother gives a positive Wassermann. Socially, the 
child is very helpless even for his actual mental age. He 
has a violent temper. He is undoubtedly feeble-minded, 
psychopathic, and a syphilitic. 
These three cases, by chance, illustrate three entirely 
ditferent needs of children of such a mental level. Elsa is 
so nearly normal in her intelligence level that she must 
have every chance to develop normally, and this means a 
home. The functional aspect of her intelligence is at fault. 
She is so stubborn, so resourceful in a hysterical way in 
gaining her end, so egotistical and unmanageable, that her 
future can but be a matter of speculation. One must advise 
placing her but without adoption. The second case is one 
of the well-known extremely inferior individuals who, it 
would seem, can almost be diagnosed at a glance. She 
demands institutional care not only because of her obvious 
inferiority but more emphatically because of the erratic 
and unpredictable behavior that accompanies it. Our third 
case is not only feeble-minded and unstable, but also a 
diseased case and, theoretically at least, in need of treat- 
ment. Although he does not give a positive Wassermann, 
he is a younger sib of a known syphilitic and presents 
numerous stigmata. There is little doubt but that he is one 
of those cases in which the blood Wassermann findings 
must be disregarded. 
In these three cases one begins to see the value of other 
data besides chronological age and mental age. The heredi- 
tary handicaps of one type or another modify our diagnosis 
in all three of the cases. In the last case disposition will be 
partly determined by the need for medical treatment, and 
the necessity for further work in the family—to ascer- 
tain the number infected and to educate to prophylaxis— 
becomes a part of the responsibility of the social worker. 
Social, educational, and home observations, with prolonged 254 
THE UNSTABLE CHILD 
experimentation, are slowly working out some of Elsa’s 
problems. 
Between 4 years and 4 years, 11 months mentally. This 
mental level gives the first really delinquent children. Only 
4 tested at this level. Three of the 4 were definitely feeble- 
minded. Three of the 4 were psychopathic. One of the 
psychopaths had seizures which were epileptoid in charac- 
ter. Another was a congenital syphilitic. Briefly reviewed, 
these cases were as follows: Eva, 6 years, 11 months old, 
scored 4 years, 2 months. Her range is from 3 through 6. 
She fails on the lowest level for all performance tests. She 
is too low to do any other tests. Medical examination 
reports reflexes diminished, poor teeth, poor development, 
laboratory tests negative. She masturbates. Has spells in 
which she screams and falls. Diagnosis: Feeble-minded, 
psychopathic, and epileptoid. 
Earl is 7 years, 7 months old and tests 4 years, 3 months. 
He scores 4 or 5 on all performance tests, has accomplished 
nothing in school, fails on all school tests. Tests on the 
Stanford range from 3 through 7, being qualitatively nor- 
mal. He is rachitic and gives a positive Romberg. His 
behavior is that of a babyish child. He was sent in as 
needing medical care. Diagnosis: Feeble-minded. 
Rob, aged 17, scores 4 years, 3 months, with a range from 
2 through 8. He is vicious, cruel, idle, runs the streets. 
He scores 8 or 9 on all performance tests, yet he does noth- 
ing in school tests. He is totally deaf (tests were evalu- 
ated). Reflexes are normal except that eyes are sluggish to 
light. Other medical findings are negative. His behavior 
while under observation showed that his obstinacy was 
largely a matter of not comprehending the situation. 
Diagnosis: Feeble-minded, somewhat psychopathic. 
Dick, aged 5 years, 1 month, tested 4 years, 6 months. 
His tests have a range of from 3 through 8. Marked 
superiority is shown in verbal tests and definite inferiority CHILDREN UNDER SIX MENTALLY 
255 
in memory and motor control. Performance tests rate him 
below 5 years, with failure on the Healy completion and 
barely a 3-year level score on the Porteus. His blood 
Wassermann was 2 plus. There is a history of anti-syph- 
ilitic treatments through practically his whole life. The 
mother is no longer able to handle him because of violent 
tantrums and screaming spells. Besides this he lies, runs 
away, steals, and is viciously cruel to other children. Ob- 
servation fully corroborated this behavior history, yet he 
seemed trainable and soon showed considerable improve- 
ment. Diagnosis: Deferred. 
He seems almost normal in level at the present time, but 
is so psychopathic, and has such a definite handicap in his 
syphilitic infection, that one can only wait and watch. 
Prognosis must be definitely deferred. This case illustrates 
beautifully the error that lies in prognosticating future 
development from present ratios of intelligence to chrono- 
logical age. Dick is struggling against an active and devas- 
tating force. Treatment has so far been able to do almost 
nothing to check even the physiological effects of the disease. 
Can it hope to check the nerve affects, or will they continue 
producing these behavior manifestations and result later in 
such aberrations as mean mental inferiority also ? Or will 
present conditions continue with little change? Do we 
know enough to determine this now ? Decidedly not. 
The first three cases are definitely those where the delin- 
quencies are the result of too much freedom and too much 
responsibility given to individuals who cannot use them. 
This fourth child has, instead, a positive behavior manifes- 
tation of an abnormal nerve activity. The environmental 
changes stimulate a behavior reaction in the first three 
which is normal for their level. If the environment is bad, 
their reactions are accordingly disgraceful. With Dick the 
excitation to irritable, anti-social behavior lies within 
the organism itself. 256 
THE UNSTABLE CHILD 
Between 5 years and 5 years, 11 months mentally. Four 
children test at this level. Even at the risk of becoming 
tiresome, it seems well to summarize each case briefly. 
Walter, aged 9 years, 6 months, tests 5 years, 4 months. 
With a basal year of 5 he does none of the tests above the 
6-year level. His performance tests range from 4 to 7 
years in level. He is in first grade in school but accom- 
plishes nothing. Medical examination reveals a pretuber- 
cular condition. Reflexes are absent. Romberg positive. 
Morphological measurements indicate marked inferiority. 
In play he shot and wounded a little girl. His behavior 
is inoffensive, ineffective, easily controlled. Diagnosis: 
Feeble-minded. 
Helen, 17 years old, scores 5 years, 2 months. Tests 
range from 4 through 8. Ability to count backward and 
to tie a bowknot add two years to the range of her tests. 
Performance tests range from 5- to 8-year levels. Despite 
the report that she reached the fourth grade in school, she 
does absolutely nothing on school work. Physical examina- 
tion is negative save for the report of numerous stigmata 
of inferiority. She was sent in for stealing. The child’s 
own consciousness of guilt brought only the admission that 
she had stolen a lead pencil, yet she had taken things that 
were far more valuable. The stealing is a chance conse- 
quence of her inferiority of comprehension. Diagnosis: 
Feeble-minded. 
Thomas, 9 years old, tested 5 years, 4 months. He is 
much like his brother Jasper, reported among those of the 
3-year level. He is especially good on verbal tests and poor 
in memory and motor control. On all performance tests he 
scores 5 to 8 years. He has never been able to do more 
than kindergarten work in school. He is broad-nosed, 
cretinoid, short, with exaggerated reflexes, and a 4 plus 
Wassermann. Morphologically, he measures in the lowest 
10 per cent of boys who are 9 years old, save in lung CHILDREN UNDER SIX MENTALLY 
257 
capacity where he registers 90. He has a marked capacity 
for getting into trouble. Diagnosis: Feeble-minded, psycho- 
pathic, syphilitic. 
Nardo, 13 years old, scores just 5. His range is from 
3 through 7, with verbal ability testing highest. All per- 
formance tests place him at a 4-year level, save the Seguin 
formboard on which he scores 6 years. He has been in first 
grade in school but has done nothing. Morphological 
measurements rate him in the lowest 10 per cent. He has 
an inflammation of the joints of the hands which is referred 
to congenital syphilis. He has other marked stigmata of 
congenital syphilis, including sabre tibiae, disturbed re- 
flexes and teeth anomalies. All laboratory tests are negative. 
An older brother suffers from a similar condition. The boy 
was referred for placing obstructions on the railroad track. 
He is difficult to handle, erratic, and seemingly untrainable. 
Diagnosis: Feeble-minded, psychopathic, syphilitic. 
Here again we see a group wherein the mental age in its 
relation to the chronological age is an important factor in 
determining the diagnosis but where the other aspects of 
the case accentuate or modify one’s decision as to disposi- 
tion. Sex emphasizes the importance of institutional super- 
vision for Helen. The chance form play activities took in 
Walter and Nardo are indications of their lack of proper 
home supervision and hence of their need for custodial 
care. The fourth child needs not only care but treatment. 
To many, these children are one and all straight feeble- 
minded children. They are feeble-minded, but they are 
more than that. They are erratic and unstable in their 
defect. 
Glancing briefly over these low-level cases cannot but 
emphasize the manifold varieties of problems confronting 
the worker in the field of clinical psychology. Not all of 
these young children are hopeless. Some of them have 
definite possibilities. Some of them will probably stay 258 
THE UNSTABLE CHILD 
much, as they are now for the rest of their lives. Can we 
definitely say which? If not, then even these low-level 
cases need more time and study than most of us are giving 
them. CHAPTER XV 
CHILDREN SIX TO NINE MENTALLY 
Although the division of the group studied is rather 
arbitrary, yet it has a real significance. The children who 
tested less than 6 on a standard scale were those who came 
under observation in a more or less haphazard fashion. 
They divide definitely from those testing 6 or over, who 
form a real group both in numbers and the problems they 
present. These children are all mentally comparable with 
what we expect of school children, the former group were 
not. The division between 9 and 10 is not quite the same. 
The age of 9 has seemed to be one indicating the height of 
delinquency problems in a number of studies. It delimits 
those who may be, if they do not develop more ability in 
later years, permanent problems for institutional care. It 
also includes that group that is mentally under the limit 
for self-responsibility set in most states by law. Although 
we may not approve of making a child responsible for his 
own misdemeanors and delinquencies, yet it is well to take 
cognizance of such issues. The children in this group are 
in many instances over 10 chronologically, yet mentally 
they lie in the stage of development which the usual child 
has passed by the time he has reached his tenth birthday. 
With them we shall have the same attitude as the court, 
they are not liable to institutional segregation or similar 
punishment for they are not sufficiently developed to 
assume responsibility for their behavior. Let us see 
whether analysis of the group confirms, weakens, or 
strengthens this attitude. 
259 260 
THE UNSTABLE CHILD 
Between 6 Years and 6 Years, 11 Months Mentally 
This is the lowest level at which there is anything more 
than a chance group of highly variable individuals whose 
commitment was largely a matter of accident. In all, 18 of 
the 369 children studied test at this level. The chrono- 
logical age of the group varies from 7 years, 1 month to 
16 years, 1 month. In a classification by mental level, con- 
sequently, the diagnoses would range from normal in level 
to feeble-minded, for the I.Q.’s range from 93 to 42. Five 
of the group are 9 years of age, 4 are 10 years old, and only 
3 are above this age. Only 4 of the group are girls. One 
boy and a girl are negroes. 
Delinquency charges. The offenses upon which these 
children were sent into court and then to the Bureau are 
varied. Nine are unmanageable or incorrigible, 6 are thieves, 
4 have perverted sex habits, 1 is actually immoral, 3 set 
fires, 4 run away constantly. A few are reported as having 
temper and yelling spells, being profane, attempting stab- 
bing, the destruction of elothes and property, and indulg- 
ing in extreme tantrums. In all instances but one, there 
were at least twofold charges. 
School grades. One of the children has never been in 
school because of an offensive physical condition. Eight 
of the others have never gotten beyond first grade, 4 are in 
second grade, 2 are in third, 2 in fourth, and 1 is in fifth 
grade. 
Stanford range. Eleven of the 18 have a basal age of 4, 
3 have a basal of 3, and the others find it at 5. The suc- 
cesses above the basal range through at least 3 years in all 
instances but one. The mode is a range of 5 years above 
the basal, whereas the average range is 4.6 years. In 5 
of the cases there are double basals, with a year intervening 
in which there are definite failures. Only one child of the 
group of 18 successfully completed a test above the tenth CHILDREN SIX TO NINE MENTALLY 
261 
year, that being the ball and field test in the twelfth 
year. 
Stanford distribution. The most marked failure in the 
lower-level tests is the patience in the fifth year. This is 
missed by 8 out of the 18 children, although no other test 
at that level is missed by more than 3 individuals. The 
discrimination of right and left is the hardest at the 6-year 
level and is failed by 10 out of the 18. The repetition of 
sentences is next in difficulty. The seriousness of this last 
failure is corroborated by the number of failures on the 
repetition of digits in the seventh-year tests, 10 of the 18 
falling down in these attempts. The other tests are passed 
with a much higher frequency. None of the failures above 
the seventh year stand out as peculiarly difficult, except the 
vocabulary in the eighth year which is failed by the entire 
group. In the same way, every test in the ninth-year group 
has some successes except the making of change, on which 
all fail. 
Stanford quality. There are only a few indications of 
very peculiar reactions which may be taken as other than 
normal. The majority of symptoms which make for abnor- 
mality in higher level groups are but remnants of test 
qualities frequently found in lower levels but not to be 
highly evaluated there. There are poor motor control, some 
perseveration in answers, automatisms, irrelevant answers, 
but beyond that the interpretation is dubious in value. 
Association distribution. This test was not feasible in 
4 instances and met with failure to understand the direc- 
tions in 2 others. There were phrase reactions in 7 of the 
12 successful cases, but they are numerous in only 5 of 
these cases. Individual reactions range in frequency from 
1 to 97. 
Association quality. There are many complex and 
experience indicators. Individual peculiarities are revealed 
in almost every case. From the standpoint of learning to 262 
THE UNSTABLE CHILD 
know the individual, the test is well worth a trial, even 
at this low level. 
Performance tests. The Seguin formboard gave an 
average mental age of 6.8 years with a mean variation 1 
of 1.1 years. Some of the children score as low as 5-year 
rating, whereas others reach an 11-year score. There is 
some relationship between chronological age and success 
on this board, but it is not a controlling or decisive factor. 
The average score on the adaptation board is identical, 
6.8 years, with an identical variation, 1.1 years. However, 
the ratings of individual children on the two boards are by 
no means identical, although they tend to be similar. Some 
children rate as much as 2 years higher on the adaptation 
series, whereas others rate 4 years lower on this test than 
on the formboard. The year ratings on the two tests agree 
in only 3 of the 18 cases. 
On the imitation series the average mental age was 7.3 
years, with a mean variation of 2.1 years. The scores range 
from 4 to 14 years. In only 5 of the cases does the rating 
given by this test agree with that given by either the form- 
board or the adaptation series. In 2 cases all 3 of the 
ratings are identical. 
The Porteus was given to only 12 of the group. The 
average score was 6.5 years with a mean variation of 1.5 
years. In general the performances ranged from a score 
of 3 years to one of 8.5 years. 
Thirteen of the group were given the Healy pictorial 
completion board. Six of these made scores which lay 
below the lowest standardization. The others varied in 
score from a 5- to a 9-year rating. 
i Throughout this discussion the mean variations are presented 
without the repeated usage of the term “plus or minus.” A mean 
variation is an average deviation from an average. It is the study 
of a fluctuating factor which may, in individual cases, vary either 
way from the group average or mean. It has seemed simpler to 
remind the casual reader of this and then leave the text less compli- 
cated by reiteration of a constant quality of the mean deviation. CHILDREN SIX TO NINE MENTALLY 
263 
School performance. Half of the 18 were too low in 
school training to read any of the literary test. The rest 
ranged in scores from —1 to 13 points. This highest score 
is an average third-grade performance. None does any 
second-grade work in any other subject, and in most, 
instances these children do but little on the first-grade ele- 
ments. 
General information. The group as a whole has far more 
intelligence and shrewdness on matters of everyday experi- 
ence than one could well imagine. On the other hand, most 
of them lack all of that pleasant nicety of detail which a 
child of good environment has when he begins school. 
Own story. The group cannot tell what has happened 
to them nor why they have come where they are. They tell 
bits of experiences; it may happen that the bits are relevant, 
it may happen otherwise. The items given are valuable as 
reflections but not as information. 
Behavior under observation. Six years of mentality is 
sufficient to bring out abnormalities of behavior under 
institution care. There are some of the group who fitted 
nicely into the humdrum routine of such living. Others 
submitted to it only when they could not find a means of 
escape. They reflect definitely the charges which brought 
them to the Bureau. 
Medical findings. The group, as a whole, is physically 
inferior. They bear definite stigmata of maldevelopment 
and have numerous minor physical defects. The reflexes 
are abnormal in 8 instances, eye defects are present in 
several of these and 6 others. Four cases give positive 
Wassermanns, whereas a fifth case is undoubtedly syphilitic 
despite a negative Wassermann. Nearly all have carious 
teeth and enlarged tonsils and adenoids. 
Morphological measurements. Nine of the 18 are above 
average standing height, but only 5 are even up to average 
for sitting height. Seven are above average weight for 264 
THE UNSTABLE CHILD 
their age and height. In grip and lung capacity only 3 are 
up to average for their age. 
Diagnosis. Nine of the 18 are undoubtedly feeble- 
minded. Of these 9, 1 is actually so unstable that he is best 
classified as insane. Two others are exceedingly psycho- 
pathic. One of these 2 is of a deteriorative type, is the 
oldest member of the group, and a congenital syphilitic. 
Four others are potentially feeble-minded, so far as present 
indications go. Of these 4, only 1 is an uncomplicated case 
of intellectual inferiority. The other 3 are not only in- 
ferior in level but the quality of their performance on 
various tests indicates a high degree of instability. Their 
behavior is not only a-social but anti-social. The other 5 
cases are inferior in level but not sufficiently so to indicate 
that there is any high degree of probability that they are 
permanently retarded and will be feeble-minded later on. 
All 5 of these children are definitely psychopathic. The 
signs of their instability are numerous. Three of them are 
congenital syphilitics. All of the 5 came under observation 
because of behavior which made them impossible in the 
community. They set fires, are unmanageable, scream aloud 
in school, steal, and run away. 
Generalizations. The 6-year-level group is not a highly 
complex one. Most of the cases are definitely abnormal. 
Their abnormality of behavior is obvious from the sum- 
mary of their delinquencies. Their abnormality of per- 
formance on intelligence tests varies tremendously, yet 
there is not one thoroughly normal child in the group. 
They vary as greatly on concrete performance tests as on 
the Stanford and school tests. They are physically inferior 
and subject to anomalies of development. 
The mere fact that a group which is so young can pre- 
sent so many and such varied social problems is evidence 
that we are dealing with more than mere intelligence 
inferiority. A careful analysis of the individual cases in CHILDREN SIX TO NINE MENTALLY 
265 
the light of the problems they present, even when under 
institutional supervision, indicates that they are a group 
that needs custodial care for many years at least. The most 
promising two are younger children who naturally have 
fairly high intelligence ratios. Both of these are handi- 
capped by definite traits of a psychopathic nature which 
seem to indicate that they are but justifying their inherit- 
ance—both come from families with marked cases of 
psychoses needing hospital care, and these are in the direct 
line from which our cases are descended. 
Our present institutions for the feeble-minded and de- 
linquents fail to provide the type of care needed by at 
least half of this group. As a result, most of this not- 
feeble-minded group are being taken care of in boarding 
homes or under parole conditions in their own homes, with 
tremendous effort on the part of a large number of normal 
members of the community. Naturally, this type of care is 
but a temporary expedient, yet lack of proper facilities 
makes it almost a permanent drain upon all concerned. 
Our study of older delinquents, suffering from similar ab- 
normalities and indulging in similar delinquencies, will 
prognose the future of this group better than any 
speculation could. However, the early age of disturbance 
in most of these individuals, the low learning level, the 
marked type of their disturbances, their general physical 
and neural inferiority, all indicate that there is very little 
hope of corrective or reedueative work being possible with 
this group. 
Between 7 Years and 7 Years, 11 Months Mentally 
The possession of a mentality of this level seems to be 
sufficient to make a child at least appear intelligent. As 
a result, most individuals hold him responsible for his be- 
havior. A mental age of 7 is evidently sufficient to enable 266 
THE UNSTABLE CHILD 
its owner to imitate a great many of the behavior charac- 
teristics of normal boys and girls who are actually far more 
intelligent. The physical peculiarities that so often mark 
the imbecile are seldom apparent. Instead, the child pre- 
sents to the judge, the social worker, and the teacher a 
problem of “moral depravity,” “wilful misbehavior,” or 
“weak will.” In all, 42 of the 369 children studied 
scored at this level. Their ages ranged from 7 to 19 years, 
with 21 of the 42, either 8, 9, or 10 years old. Six boys 
and 2 girls are negroes and there is a mulatto girl. 
I.Q. If one attempts to rate them according to intelli- 
gence quotients, the groups ranges from feeble-minded to 
average normal level, for the range of quotients is from 98 
to 44. Here again, as in the 6-year-level group, there is 
no child who scores absolutely up to age or who has an 
intelligence quotient of 100. 
Delinquency charges. This group really presents a com- 
plex problem. At least 32 of the 42 have multiple charges 
against them. Of the other 10, one was sent in for study 
in an attempt to avoid physical, mental, and behavior traits 
such as had developed in an older brother. Another was 
“too nervous for school.” The other 8 were committed 
either under a general incorrigibility charge or because 
of one serious offense, such as rape. There seems to be no 
definite delinquency which belongs to this mental level 
alone or which characterizes it. There was a total of 75 
charges against the 40 actually delinquent children. Fif- 
teen of these were for incorrigibility or unmanageableness 
in some form. Eight lied pathologically, 17 were charged 
with stealing, 12 were truants. Nine were sex offenders, 
usually in some perverted fashion. Seven set fires. Besides 
this there are minor charges of cruelty, profanity, and 
viciousness. One thing we may be sure of from these data. 
A mentality of 7 years is sufficient, given the right condi- 
tions, to create a true delinquency which is dangerous to CHILDREN SIX TO NINE MENTALLY 
267 
the community. Moreover, the problem of handling these 
children in constructive fashion is not a simple one. Al- 
though these children are of a “7-year level,” that rating 
bears but little therapeutic significance and does little to 
explain the problems they present. It is not the problem 
of the high-grade imbecile whom institutions assimilate into 
their routine of bed-making, floor-polishing, simple hand- 
work, and dormitory living. It is not the problem of the 
second-grade school child as each teacher knows him. There 
are some feeble-minded individuals in the group, and these 
must be handled one way. There are normal-testing chil- 
dren who must have other methods, and there are the in- 
between group who are not simply backward or dull but 
also “vicious,” unmanageable, and bad-tempered. There 
is evidently another factor besides mental age itself that 
provokes these symptoms. 
School grades. We have mentioned the difference of the 
group from the average 7-year-old with his little well- 
ordered 7-year mind, going and coming as a member of the 
second-grade group in any school system. These children 
vary in school performance from first- to eighth-grade 
work. Two have not gotten beyond first grade, 16 are in 
second grade, 12 are in third grade, 6 are reported to be in 
fourth grade, whereas 1 is in fifth, 3 are in sixth, and 1 is 
in eighth grade. One has been in special class. Of course, 
this progress is definitely related to chronological age, but 
even then it is absurd to suppose that the ordinary 7- to 
8-year mentality can do fourth- or fifth- or higher-grade 
work successfully. Again we find that the group is not 
doing or being what one would expect when he says “men- 
tality—7 to 8 years. ’ ’ 
Stanford range. In a way, analysis of the Stanford is 
unnecessary. The whole of our study of this group is an 
analysis of differences under the general Stanford classi- 
fication of 7 years to 7 years, 11 months. But a great 268 
THE UNSTABLE CHILD 
deal of this is revealed by a study of the Stanford-Binet 
material itself. Eight have a basal year of 7 itself, 14 have 
a basal of 6, 12 fall to a basal of 5, 7 have a basal of 4, and 
1 has a basal of 3 years. Only 3 of the children do tests 
above the tenth year. Each of these gains credit for one 
test in the twelfth year, 1 doing the similarities and 2 pass- 
ing the pictures. Only 1 child does not do any tests above 
the eighth year. The average range above basal is 4.0 
years. 
Stanford distribution. Of the individual tests them- 
selves several stand out as peculiarly difficult. Of those 
with a basal year below five, 5 fail on the patience puzzle, 
and only 3 on any other test. The repetition of the sen- 
tences in the 6-year group is far harder than any one other 
test having nearly twice as many failures as any other 
6-year-level test. The diamond is the hardest in the 7- 
year group. The most spectacular failures are on the ball 
and field and the vocabulary in the eighth year. Either 
17 or 18 out of the 42 succeed on each of the other 8-year- 
level tests. This indicates that there is a fair chance that 
success will accompany 1 out of each 2 trials of different 
children on these tests if the individuals score 7 to 8. The 
ball and field is done by only 10 out of 42 and the vo- 
cabulary test is passed by only 3 out of 42. Above this 
level the most marked failure is on the lifted weights. 
Stanford quality. The diamonds exhibit peculiar twists; 
meandering endings, additional tremors, and patchings in 
10 out of the 42 cases. The design and ball and field re- 
flect this same tendency, which is by no means correlated 
with failure to pass the test. The quality of the action 
seen in the pictures is unusual in 6 cases. There are other 
individual findings just as marked, perhaps more so be- 
cause of their lack of frequency. 
Association distribution. The association test was given 
in 36 of the 42 cases. Three of the 36 failed in it because CHILDREN SIX TO NINE MENTALLY 
269 
of inability to comprehend the directions and adapt to the 
demands made. The other 33 gave more or less cooperation. 
However, only 6 of the 33 were able to give the whole 
100 reactions without resorting to phrases. In almost 
all of the cases many of the responses are highly individual 
and do not occur in any norms. These individual responses 
range in frequency from 8 to 97 out of the 100 reactions. 
Common reactions are proportionately infrequent. 
Association quality. Aside from the individuality of re- 
sponses there are a number of qualitatively abnormal re- 
sponses. These are present in 28 of the 33 cases. Persever- 
ation, automatisms, repetition of the stimulus word, con- 
stant usage of the same reaction, and nonsense syllables 
oeeur again and again. These, with the exception of non- 
sense syllables, that is, neologisms, were not found in the 
responses of the 6-year-level cases. The children are too 
young mentally to be rated on this one test alone, but there 
is every reason for its use. Analysis reveals complexes, 
fears, habits of training, ignorances, and many other de- 
tails, a knowledge of which is fundamental to a complete 
study of the individual, although they are not essentially 
a part of a classifying diagnosis. 
Performance tests. On performance tests the same vari- 
ability shows. The Seguin formboard gives an average 
mental age of 8.4 years with a mean variation of plus or 
minus 1.7 years. As a matter of fact, the group ranges 
in ability from an average 5-year-level to the 14-year-level 
time. The mode is a 7-year-level performance, 11 children 
scoring at about that rate. The general variability is 
greater than that reported by Sylvester for 7-year-old 
normal children, yet the number of cases is less. 
The adaptation board gives an average age of 7.4 years. 
The mean variation is only .4 years although some children 
score as low as a 4-year-level. The mode is 8 years. Un- 
fortunately, we lack a test with which to supplement the 270 
THE UNSTABLE CHILD 
adaptation test in the higher levels. Many and most tests 
involve adaptative learning, but they test it in relation 
to other, far more complicated mental processes than this 
test involves. 
On the Knox imitation this group ranges from an av- 
erage 5-year performance to a 15-year ability. The mode 
is a 10-year performance, and the average is 9.1 years. 
The average deviation is 2.4 years. 
The Healy completion board gives an average mental 
age of 7.4 years with some children doing less well than 
the average 5-year-old and others scoring as high as adults. 
The mean variation is 1.8 years. 
The Porteus reveals about the same situation. The per- 
formances for individual children range from 5 to 13 
years, the average being 8 years, with a mean variation of 
1.7 years. There is no actual mode! Exactly the same 
number of children score at the 5-, 7-, 8- and 9-year levels 
on this test. 
School performance. Most of these children are too low 
in intelligence to score on educational tests other than read- 
ing. Nine of the 42 cannot read. Of the other 33, the 
average score is 9.9 points, or a 60 percentile rating for 
second grade. The mean variability is 4.9 points. The 
mode is 12 points which is almost average for third grade 
and is a rating reached by only 10 per cent of the usual 
second grade. Some of the scores range as high as 20 
points, which is between fourth- and fifth-grade work. No 
child rates high enough to be considered above this grade. 
The boy who was said to have reached eighth grade does 
about fourth-grade work. 
General information. Nine of the 42 had a range of 
practical knowledge which was surprisingly good for their 
mental level. The others had scanty, incomplete items to 
report and had gained but little from their everyday ex- 
periences. CHILDREN SIX TO NINE MENTALLY 
271 
Own story. Five could tell no story of their own be- 
havior as it had led to their arrival at the Bureau. Four- 
teen gave brief but truthful and fairly accurate statements. 
The others ranged between these two extremes. In one in- 
stance delusions and folk superstition were firmly amalga- 
mated. All varied more or less from the truth, usually 
more. 
Behavior under observation. Their behavior was, to 
say the least, varied. One examination period was enough 
to show irritability, nerve tension, ease of distraction, 
apathy, grandiose ideas, or great depression in over half 
of them. One ran an acute monomania. In the cottages 
they were definite problems. They fought, lied, stole, ran 
away, proved generally incorrigible, even as in the com- 
munity. 
Medical findings. The physician’s report on this group 
shows that it is comprised chiefly of constitutional inferi- 
ors. Eighteen of the 42 have some definite disturbance 
of the nervous system with increased or diminished reflexes. 
Speech defects, marked eye defects, stigmata of the skele- 
tal system, and disturbances of the circulatory system oc- 
cur again and again. Seven have positive Wassermanns, 
and 3 others are younger sibs of known syphilitics. Two 
others are marked definitely by one or more of the Hutch- 
inson triad of syphilitic stigmata. 
Morphological measurements. The group is surprisingly 
good in some respects. In standing height they average 
well up in the 60 percentile when compared with the Smed- 
ley norms.2 In sitting height they are very variable but 
average only in the 30 percentile. Weight places them in 
2 A percentile rating means that all individuals in the series have 
been arranged in order according to their measurement on that 
series, the lowest being ranked 0, the highest 100 per cent. A rating 
in the 60 percentile, or of 60 per cent, means that the group or 
individual measured scores as high as 60 per cent of the group with 
which he is compared. He ranks “average” if he scores 50 per cent. 272 
THE UNSTABLE CHILD 
the 50 percentile. In grips they rank in the 40 percentile 
but lung capacity rates them only 30 per cent. 
Heredity. Undoubtedly inheritance plays an important 
part in the formation of this group. The family data gath- 
ered are too scanty to tell us the real significance, but, 
even so, they present the same mental pictures as are shown 
by these children. 
Diagnoses. Six of the 42 are definitely feeble-minded. 
Their delinquencies are of less significance than those of 
the rest of the group, being running away, unmanageable- 
ness in a home w'hich did not see the problem as it is, im- 
morality and illegitimate children on the part of the girls. 
Eight other cases are of feeble-minded level but so erratic 
and unstable that they deserve the additional classificatory 
term, psychopathic. Another child is feeble-minded and 
so inferior in physical function that it is this aspect of his 
make-up which has made him a delinquent. He has a heart 
which is too bad for punishment by even a severe scold- 
ing to be advisable, yet he is delinquent in the extreme. 
Four others are of feeble-minded level, as unstable as the 
above group, but in addition to this they give indications 
of deterioration. They show remnants of ability at far 
higher levels than those at which they are now living. 
Whether they are now feeble-minded as a result of dete- 
rioration or whether they were true feeble-minded who 
have now reached a lower level because of this addi- 
tional handicap, it is impossible to say, for neither history 
of earlier years nor the period of first observation is 
such that the differentiation can be made. Three others 
are of feeble-minded level and have definite psychoses. One 
indulged his mania for fires, set with a precision of detail 
which was the same each time, until the cost to the com- 
munity was $91,000. Another is paranoid in type, and 
the third is seemingly a case of dementia prascox. Six oth- 
ers, because of the quality of their responses and the gen- CHILDREN SIX TO NINE MENTALLY 
273 
eral history, have been diagnosed as potentially feeble- 
minded. Three of these are markedly erratic, unstable, 
peculiar, different from the run of so-called feeble-minded. 
On 5 the diagnosis has been deferred. Another group of 
6 are markedly inferior in intelligence level and are also 
psychopathic. In every instance their delinquencies place 
them in the group of the most serious offenders. Just what 
will become of them later it is hard to say, for they have 
not the stable usage of that mentality which is theirs, and 
behavior is apt to be very much dependent upon the chance 
effect of the environment. Two other children must be 
mentioned together and apart from the rest of the group. 
These two are brothers 13 and 10 years of age, of a known 
syphilitic parentage. The older brother has been diag- 
nosed as a case of Marie’s cerebellar ataxia. The disease 
has progressed to the point of almost complete inability to 
walk, with convulsive seizures many times a day, and all 
of the incidental dependence. Despite his physical handi- 
cap, this boy steals, so far as his opportunity permits, tak- 
ing things from pockets. The younger brother is nervous 
and delicate, frail and fretful and fearful. He does not 
give any signs of abnormality to the chance observer, yet 
he shows the beginnings of all of the motor defects of the 
older brother and is “like the brother was at his age,” ac- 
cording to the father. Both of the boys test at the 7-year 
level and do practically identical work on all tests given, 
considering, of course, that there are some tasks which the 
older brother can no longer perform. These cases are ac- 
tually feeble-minded in present level, yet they have been 
normal. They are going backwards and so are not only un- 
stable and not-to-be-counted-upon in type, but they are de- 
teriorative. They are splendid illustrations of the ineffi- 
cacy of the I.Q. per se as a diagnosis! There remains one 
other case at this level, this is one of the highest I.Q.’s and 
is a little girl diagnosed as a normal psychopath despite 274 
THE UNSTABLE CHILD 
the history of constant incorrigibility in one good home 
after another. She has had the advantage of every possible 
medical attention and of the best of educational chances. 
Observation a year later shows her still testing as normal, 
but developing her incorrigibility into a definite child hys- 
teria, with simulation of illness, headache, disinterest, and 
over-affection. 
Generalizations. One can hardly draw any conclusion 
from the study of such a group of cases. It is the compari- 
son of the various groups with each other and the recor- 
roboration of findings from various aspects which makes 
for finality of statements which must be true. Neverthe- 
less this group does give us some indications of the problem 
we are approaching. It is not simple feeble-mindedness, 
nor simple environmental lack that picked these 42 chil- 
dren out of many thousand of the same mental level for 
commitment and study. There is another factor, the fac- 
tor which we have recognized by the use of such descrip- 
tive terms as queer, different, erratic, and unreliable. On 
the tests this shows in the wide range of posible per- 
formances on a given test, the variability from test to test, 
and the fluctuation of other test ratings which are now 
up, now down, from the Stanford ascertainment. The ex- 
treme verbalism, with the poor performance on formal vo- 
cabulary tests, and yet with good comprehension of written 
forms, is one such fluctuation. On the association series it 
shows in the presence of symptoms that we recognize as 
definitely abnormal in older individuals. In the observa- 
tion of these children while at the Bureau the instability 
showed in the frequent breaking away from any morale 
influence, in attempted escapes, in fights, sex episodes, 
grouches, tantrums, and perpetual renewal of discipline 
problems. 
A mentality of 7 years means anything from feeble- 
mindedness to normal intelligence. It means, also, every CHILDREN SIX TO NINE MENTALLY 
275 
possible need from care in an institution for the feeble- 
minded, or care in a hospital for insane or epileptics, to 
parole, boarding, medical correction, psychoanalysis, and 
reeducation. 
Between 8 Years and 8 Years, 11 Months Mentally 
The group whose lowest limit of mentality is 8 years and 
0 months is one that presents the beginnings of our real 
social problem. There are feeble-minded of this level in 
most institutions for the feeble-minded. There are also 
individuals with no more than this amount of intelligence 
who are getting along in the community without any spe- 
cial supervision. The feeble-minded of this level was about 
the highest type formerly recognized. The higher levels of 
institution cases are those which have been discovered by 
mental tests. We have, in consequence, reached the level 
where we may expect far more complication of findings and 
more open disagreement of data from the economic and 
behavior sides. 
Age and sex. There were 43 children who scored mental 
ages between 8 years, 0 months and 8 years, 11 months. 
This group is composed of 33 boys and 10 girls. Three 
boys and 2 girls are of colored blood. All of the rest are 
American-born children, although of foreign parentage in 
4 instances. The ages range from 7 years, 9 months to 
16 years, 8 months. In general, the distribution through- 
out the various ages is rather regular. There were more 
children at the ages of 9 and 12 sent in than at any other 
ages. The average chronological age for the whole group 
was 12 years with a mean variation of 2 years, 3 months. 
I.Q. The statement of chronological age variation gives 
its own intimation of intelligence-quotient variability. The 
I.Q.’s range from 50 to 110. There is, however, only one 
child whose I.Q. is up to or over 100, although there is 276 
THE UNSTABLE CHILD 
a group in the nineties. This boy, who rated 110, was 
definitely a social menace at the time of the first observa- 
tion. Later examinations have shown a continued develop- 
ment of intelligence with no cessation of delinquency. He 
began running away from home and riding streetcars, 
begging for money to buy food when he wanted it. By 
the time of his examination, when 7 years, 9 months of age, 
he was a persistent beggar and truant from home and 
school, protecting himself from maximum punishments 
everywhere by his wit and attractive originality of blarney. 
Recently, when just past his tenth birthday and conse- 
quently old enough to be sent to an industrial school, he 
was sentenced there for stealing an automobile. Every 
type of persuasion, temporary imprisonment, punishment, 
reward, and correction has been tried, save taking him 
away from a weak-willed mother who gave only this simple 
history of the boy’s origin, “I went with a man and he 
fooled me. He fooled another girl, too, but she was smart- 
er than me and got him to marry her. ’ ’ 
Delinquency charges. The charges against this group 
are multiple and varied. The definite offenses number 97 
for the 43 children. Only 5 do not have more than a single 
charge against them. The outstanding offenses for this 
level are truancy from home and school, which was the 
trouble in 26 instances, and stealing or breaking and enter- 
ing which occurred in 24 cases. These 2 offenses number 
over half of the reported difficulties and are, in almost 
every case, qualified by the descriptive term, “persistent.” 
The next most frequent trouble comes from lying, which 
approximates false accusation in several cases and occurs 
in sufficiently serious fashion to make 11 children impos- 
sible in the community. Homosexual and perverted prac- 
tices occur 4 times and immorality in 6 cases. Other of- 
fenses are practically individual and range all the way 
from threats to kill to extreme cruelty to other children, CHILDREN SIX TO NINE MENTALLY 
277 
destruction of railroad property, and incorrigibility. There 
is a certain relation of one or two offenses to the mental 
condition. The most marked homosexual is a feeble- 
minded psychopath; the definite cases of immorality are 
feeble-minded girls; the other perversions are deteriorative 
and psychopathic cases, all below normal level in intelli- 
gence rating. 
School grades. The school ranking of these children 
is far more in accord with their mental age of 8 than the 
average chronological age of 12, although a brief glance 
at the following table shows that the actual situation is an 
unsatisfactory compromise of the two factors. 
Grade 
1 
Number in 
Grade 
2 
2 
7 
3 
16 
4 
11 
5 
4 
6 
3 
School Hanking 
The greatest group are where they should be by mental 
age, or below. Some of our later analyses may help explain 
the 18 who are definitely in advance of what we would ex- 
pect them to be doing for their mental age. These are 
mostly older children. 
Stanford range. The basal year in most of these cases 
is about what one would expect. Twenty-four of the 43 
have a basal of 7 years. Ten have a basal of 6, 4 have a 
basal of 5, 2 go back to the fourth year, and 3 have a basal 
of 8 years. The number of years above the basal through 
which successes are scored ranges from 2 to 8. The great- 
est number, 19, have a range of 3 years, although the aver- 
age range is 4 years, with a mean variation of 1.2 years. 
Three children pass a test in the fourteenth year. 
Stanford distribution. An analysis of the individual 
tests on the Stanford is illuminating. The cause of a basal 278 
THE UNSTABLE CHILD 
year of 4 in 2 individuals was failure to do the three com- 
missions in one case and inability to name the colors in the 
other. A basal year of 5 resulted from failures on all tests 
in the sixth year in about the same proportion, except that 
none failed on naming coins. The hardest test in the sev- 
enth year is the diamond; 6 out of 40 fail on this although 
it is well below their actual level and their chronological 
age. None fails on giving the number of fingers on the 
hands or in giving action in the pictures but there are 2 
or more failures on all other tests. In the 8-year-level 
group, again, none of the children fail on naming coins, 
but there are failures on all of the regular tests in this 
group. The vocabulary test is the hardest, for 26 of 40 
fail on it. Seventeen out of 40 fail on the ball and field and 
on the similarities, the failures on the other tests being 
much fewer. In the ninth year the reversed digits is the 
hardest, the rhymes next. The weights is next hardest, 
but they are passed by 73 per cent of the children. The 
10-year vocabulary is passed by only 1 child, the compre- 
hension by only 7, the absurdities by 10, and the design by 
12. The 12-year tests are entirely too hard for this level, 
although a few successes are scored on all tests at this age 
except the vocabulary, the abstract terms, and the fables. 
Three children out of 18 succeed on the repetition of 7 
digits in the fourteenth year level but fail with the others 
on all other tests. 
Stanford quality. Seventeen of the 43 children show 
peculiar traits when one investigates the individual test 
reactions. Perhaps the most striking instances of this are 
the drawing tests. Twelve of the group show erratic and 
peculiar completion of the diamond, 5 show familiar de- 
viations on the design, and there are some like interpola- 
tions on the ball and field. Nonsense syllables frequently 
appear in the rhyming. Reaction times are delayed in 
some instances. Negativisms are found in a case testing CHILDREN SIX TO NINE MENTALLY 
279 
normal. Forgetting’ the aufgabe before the test can be done 
also appears. 
Association distribution. Only 34 of the 43 children are 
able to understand what was wanted well enough to coop- 
erate and complete the test. This is no better than the 
percentage of 7-year-level cases succeeding. Of those who 
fail, some can give no adequate response, whereas others 
try repeating what the examiner gives, and one of this 
group found the happy solution of giving the plurals of 
each stimulus word as his reaction word. Of the 34 who 
could adapt to the test, there are only 11 who did not give 
some phrases, that is, 23 of 34 answer with some phrases. 
The number of phrase reactions ranges from 1 to 70, with 
an average number of 10 and a mean variation of 13. The 
number of individual words given varies from 5 to 93, 
with an average number of 27.5 and a mean variation of 
13.8. Of course, the number of common reactions varies 
in reverse proportion to the number of phrases and indi- 
vidual reactions given. 
Association quality. Of the 43, we may well count the 
reactions of the 9 who cannot cooperate and pass the test 
as abnormal. They are a minority of inadaptives even 
in this selected group. No analysis by age, sex, color, or 
other known attribute explains the reason for their fail- 
ure. Of the other 34 who adapt to the test, 29 give some 
sort of pathological reaction. The reactions are extremely 
slow in 20 per cent of the cases. Perseverative reactions 
occur frequently. One individual uses nice as a reaction 
37 times and good 36 times. Another uses good 27 times 
and big 22 times. Another replies by neologisms in 96 
instances out of 100. Another answers by such words as 
one, the, it. This is a conscientious picture of his lack of 
associative ability. One can almost see the emptiness of 
thought that makes him give the bits of words which he has 
had drilled in so constantly in school. 280 
THE UNSTABLE CHILD 
Performance tests. The Seguin formboard shows a 
range of performance rating from 7 to 13 years. The av- 
erage performance places this group at about 9.7 years 
with a mean variation of 1.3 years. The modal score is 
11 years and the median 10. There is some slight indica- 
tion that more of the higher scores tend to be made by 
the older children. The exceptions to this are numerous. 
The imitation series gives a range in score of from 7 
to 17 years. The mode and median scores are 10 years, but 
the average is 11.4 years, with a mean variation of 3.1 
years. There is no evidence that increased age increases 
this performance rating, for the extreme value of 16 years 
is scored by a 7-year-old and the highest value, 17 years, 
was scored by a 10-year-old. Nor is there any reverse re- 
lation evident. 
The Goddard adaptation series rates the group from 5 
to 8 years. The greater number of the group, 32 out of 
the 43, pass with an 8-year score. This makes the failures 
of the others more significant. The lowest score is made by 
only 1 child and a score of 6 by only 2. Significantly, the 
2 that score at 6 years are known syphilitics, and the score 
at 5 years is a suspect on whom the data is insufficient to 
confirm the suspicion. 
The Porteus was given to only 26 of the whole group. 
These range in score from 5 years to 12.5 years. The aver- 
age performance is 9.2 years. There is a mean variation 
of only 1.3 years. The mode of performance is an 11-year 
score. 
The Healy pictorial completion shows a variability of 
scores which range from a 5-year to a 15-year level. The 
mode and median scores are 8 years, but the average is 
only 7.6 years, with a mean variation of 1.8 years. 
School performance. On the Ohio literacy test the indi- 
vidual scores range from —1 to 24. The mode of perform- 
ance brings a score of between 11 and 15 points, with a CHILDREN SIX TO NINE MENTALLY 
281 
median of 14 points. The average is 13 points, with a 
mean variation of 4.8 points. A score of 13 is exactly 
median for third-grade school work, and is 60 percentile 
for 8-year-old children. According to this, the group aver- 
age is normal, but the variants reach all scores from low 
first-grade failure to a median score for sixth grade. The 
highest scores are not made by children w7ho have reached 
that high a grade but by younger members of the group in 
second and fourth grades. The score on this test is the 
number right minus the number wrong. In the directions 
the child is told to skip any individual test he does not 
know and not to guess. The inspection of some 10,000 
records indicates that the normal child obeys this direc- 
tion fairly well. In this group the percentage of error is 
very high, ranging from 0 to 60 per cent, with a mode of 
10 to 20 per cent and an average of 18.3 per cent. The 
mean variation is 9.6 per cent of errors. This is an indi- 
cation of probable instability in the delinquents. 
On arithmetic tests 23 per cent cannot do more than the 
counting and writing of numbers demanded of first-grade 
children, 62 per cent can do second-grade work, 15 per 
cent do about third-grade work. 
The spelling rates them at all levels from first to sixth 
grades. Only a very few, about 15 per cent, do more than 
fourth-grade spelling. Again ability does not definitely 
relate to the grade gained. 
On formal language work none of them can do more 
than the simple sentence formation demanded of second- 
grade children save 2 girls, aged 12 and 16, who do fair 
fourth-grade work. These are both psychopaths. 
None of the children in this group accomplishes anything 
in geography. 
General information. In this aspect of their ability the 
group ranges all the way from sheer stupidity to the 
precocious forcing of information which intimacy with 282 
THE UNSTABLE CHILD 
street life in a big city often gives. At one extreme there 
is a girl of 16, who has been immoral and has an illegiti- 
mate child, from whom it is almost impossible to obtain 
any data on even her own experiences, although she tried' 
conscientiously to give what was wanted. She cannot re- 
member and is deoriented for time relation of events and 
deals in so much circumlocution that one makes no head- 
way in the general search for information. On the other 
extreme is a 12-year-old girl who knows every sort of life, 
who describes in good, coherent English her experiences 
on runaway trips where she has sold flowers, sung for 
money, made her way about restaurants, evaded the ways 
of the law, and in general managed her own wilful affairs 
with more than ordinary prudence and foresight. So far 
as knowledge of the human qualities of other individuals 
goes, trust the psychology of the wandering delinquent! 
Twenty-one per cent of the group show some pathological 
symptom in this aspect of their examination. 
Own story. The general quality of their stories may 
almost be described in the phrases used to describe their 
general information. Twenty-seven per cent of the stories 
show incoherence, deorientation, or monomaniacal ideas in 
such a way that one feels the child is abnormal. Of course, 
the tales are rather brief in one way, diffuse in another, 
but this is a general characteristic of the group at that 
level, so far as we know. However, when a child enlarges 
being kept sitting in a seat in school after hours until a 
probation officer comes for him into a tale of being beaten, 
gagged, and tied with a rope, one has a pretty definite 
margin of safety in assuming that, granted he knows what 
he is telling and the reason, there is some abnormality in 
his mental condition. 
Behavior under observation. Forty-two per cent of the 
group showed some abnormality of behavior during the 
psychological examination. Overtension, exaggerated CHILDREN SIX TO NINE MENTALLY 
283 
statements, ignoring of test conditions, irrelevance of con- 
versation, delayed reactions, initial delay on comprehend- 
ing tests, melancholia and crying, and many other minor 
symptoms are numerous. Masturbation was noted in sev- 
eral cases. The cottage life of these individuals was about 
the same as that of the 7-year-level group. 
Medical findings. It would take an analysis of many 
pages to enumerate in their proper relationship to each 
other all of the physical abnormalities found in this group. 
Eleven of the 43 have positive Wassermanns. Eight of the 
11 bear marked stigmata of this condition in eyes or teeth 
or skeleton. Fifteen suffer from definite disturbances of 
the central nervous system such as would be indicated by 
exaggeration, or absence, of the deep reflexes. Two show 
fundus indications of syphilis. Nine have a definitely 
positive Romberg. Six, at least, have enlarged glands. 
Knockknees, round shoulders, scoliosis, scaphoid scapulas, 
and flat feet are common. Hearing is impaired in 2 cases, 
teeth need attention in almost all, eyes need refraction in 
many instances. Two are probably epileptics. 
Morphological measurements. The anthropometric find- 
ings are rather interesting. Arranging the group in order, 
according to their percentile rating on the Smedley norms, 
shows that they are comparatively tall in standing height. 
Fifty per cent score over 70 on the percentiles. In sitting 
height they are lower. Only 12 per cent score as high as 
70, and over 40 per cent score below 20 per cent on the 
norms. This may be an indication of retarded physiologi- 
cal development. Nor is malnutrition a general problem, 
for 50 per cent score at least 70 in weight. The right grip 
shows 70 per cent of the group scoring at least 50 per cent, 
and this holds good for left-hand grip. Lung capacity evi- 
dently tests a more complex function, for, although there 
are 50 per cent scoring 50 or over, there are also 38 per cent 
scoring less than 20 per cent. Evidently, the group does 284 
THE UNSTABLE CHILD 
not fit into the picture which Doll gives of feeble-minded 
individuals.3 
Heredity. Although in general no extensive investiga- 
tion of families was possible in this study, yet the indica- 
tions from what has been gathered are that the children 
at the Bureau are not showing, in their delinquencies, a 
new or unknown aspect of the families from which they 
come. Five families are type cases of inherited feeble- 
mindedness. In 2 cases there is epilepsy, insanity is pres- 
ent in 3, alcoholism in 4, criminality in 2, deteriorated 
conditions in 2, immorality in 3, syphilitic infection in at 
least 5, not counting direct infections of the 13 children 
whom we know to be syphilitic. The families of 9 chil- 
dren are inferior, 5 being foreign to this country. Other 
conditions, such as divorce, desertion, cruelty, illegitimacy, 
unwillingness to work, play their part, and there is only 
one family of the 43 that is definitely known to be normal. 
Diagnoses. Three of the 43 individuals are feeble- 
minded. In general, they have fewer offenses than the 
other individuals. They are in for immorality, stealing, 
and truancy respectively. There are 11 other feeble-minded 
individuals who are also psychopathic. These are not only 
inferior on intelligence-level ratings, but there are indica- 
tions of their functional disturbances also. They are in- 
corrigible, violent, sullen. It is from this group the gross- 
est crimes are reported—rape, profanity, forging, vulgar- 
ity of every type, wandering, incorrigibility. This group 
of 11 are all older than the average. All except 1 of them 
are over 13 years of age, and that one is 12. There are also 
5 other feeble-minded individuals who are psychopathic, 
and in whom the problem is definitely complicated by the 
presence of congenital syphilis. Of these, the youngest is 
12 years of age. They, too, are major offenders, more given 
to temper and other periodic episodes than the not-known- 
3 Edgar A. Doll, Clinical Studies in Feeble-Mindedness. CHILDREN SIX TO NINE MENTALLY 
285 
to-be-syphilitic group. One feeble-minded psychopath who 
is syphilitic should be mentioned separately; there is an 
additional factor in this case, for in him definite indica- 
tions of deterioration have made their appearance. Three 
younger individuals are much like the feeble-minded group 
but are too young for the intelligence retardation which 
they have to definitely rate them as feeble-minded. They 
are potentially feeble-minded. These three are liars and 
thieves. One other potentially feeble-minded individual 
is a psychopath and has been a constant community prob- 
lem for several years. He has 5 charges against him. 
There is a group of 8 inferior individuals who are also 
psychopathic. There are 3 congenital syphilitics in this 
group. The sum total of examinations and observations 
on this group are insufficient to enable us to determine 
whether they are going to be more deficient and end as 
high-grade feeble-minded individuals, or whether they 
are going to be just inferior enough to be a drag on the 
community and yet avoid institutional commitment. One 
other individual is inferior, but the sum total of the indi- 
cations of his condition leads us to classify him as an 
inferior normal who is psychopathic. Diagnosis is de- 
ferred on 5 cases. Three of these are retarded somewhat 
and are also syphilitic. One hesitates to say what the 
presence of that disease may, or may not, do to handi- 
cap their development. One other is deferred because 
of handicapping home conditions, another because he 
is a negro, and there seems a possibility of his measur- 
ing up to the norms of his race. Besides these, the 
group contains an inferior normal boy who suffered 
from a general neuro-muscular deterioration and who 
has since died from this condition (his crime of rape fits 
into the picture of his deterioration) ; a mental deteriora- 
tion case in whom mental age is becoming progressively 
lower as she grows older; a child who tests normal in level 286 
THE UNSTABLE CHILD 
but who is undoubtedly a predement with paranoid atti- 
tudes, ideas and behavior, not yielding to analysis; a nor- 
mal psychopathic girl who has a well marked tendency 
toward hysteria; a bright normal psychopathic mentioned 
above. These complete the group. 
Generalizations. Just what does the data presented on 
this 8-year-level group teach us ? To begin with, although 
it is nearly 4 years since the first corrective work was done 
on any of this group there is, so far, not one member of this 
group who has made good for a long enough time to be 
called a cured case. Some of the more recent releases 
are making good but those handled first have resolved them- 
selves into chronic problems. Eight years of mentality 
is too low a mental age to make good in the community 
if there is any additional handicap, and once the habit of 
abnormal behavior is started, the intelligence is too low to 
easily break its tendency and establish a new habit, even 
with marked external incentives. The 8-year-level offender 
whose 8-year-level mental age is a sign of marked retarda- 
tion is in all probability a candidate for continued supervi- 
sion and institutional care. How much may be done for 
supervised paroling of such individuals after they have had 
a long and thorough period of corrective training into 
habits of work, and no chance for delinquency, it would be 
impossible to say. The problem is not a hopeful one. 
This does not mean that all delinquents testing at an 
8-year-level are hopeless. The children in this group are a 
selected group, an wth degree of delinquency. The signifi- 
cance is rather this: the more serious delinquencies met in 
any court are the acts of boys and girls who are sorely in 
need of expert care and prolonged supervision. A court 
hearing, a reprimand, probation, a suspended sentence, a 
year in an industrial school cannot even touch the cause of 
their behavior—they are mental problems in need of defi- 
nite, intensive, prolonged, careful rebuilding of their whole CHILDREN SIX TO NINE MENTALLY 
287 
manner of living, thinking, and doing, combined with the 
utmost medical hygiene can do to make them fit. 
Between 9 Years and 9 Years, 11 Months Mentally 
In this group of children whose mentality is indicated by 
a general level of from 9 to almost 10 we have a problem of 
even greater social interest than in any of the groups 
previously discussed. Here, for the first time, there seem 
to appear cases whom one may definitely hope to save for 
normal social lives, without the doubt of unnumbered 
years of mere experimental attempts. Needless to say, the 
increasing endowment of each group adds to the probable 
variations to be found in that group, and the 9-year-level 
group is no exception to this general tendency. 
Age and sex. The ages of the group range from 8 to 18. 
The average age is 13 years, 8 months, with modes at 14 
and 15. The ages of 12, 13, and 16 are about equally rep- 
resented, and out of a total group of 61, there are 12 
who are less than 11 years of age. There are 5 negroes 
in the group, all of them being males. In general, the 
group consists of 37 males and 24 females. The distribu- 
tions in age are similar for the two with the exception that 
there are 9 girls in the group who are 16 years or over and 
only 2 boys as old. This is a general feature in the selec- 
tion of cases sent to the Bureau. The older boys were re- 
garded as more definitely in need of correctional care and 
were far more frequently sent directly to reformatories 
or the industrial schools. The girls were considered more 
of a social problem, and the Bureau was given a chance to 
study, if not to solve, their needs. 
I.Q. The intelligence quotients of the group range from 
56 to 107, with a median of 64. Such a low median is, of 
course, the mathematical indication of the fact just pointed 
out, the large group of social problems over the age of 16. 288 
THE UNSTABLE CHILD 
There are 18 out of the 61 who have an intelligence quo- 
tient of 75 or over, but only 4 of these reach 100. 
Delinquency charges. In all, there is a total of 147 
charges against the 61 children. This is by no means a 
true picture of the problem they have been to society. It 
is rather a picture of the extent to which their behavior 
has been so impressed upon the judges and the court offi- 
cers that the offenses have been recorded on the actual com- 
mitment paper. In many instances the accompanying his- 
tory sheet adds details that double the seriousness of the 
situation. One cannot begin recording and calculating 
these in any definite manner, however. They are so vari- 
able in fullness and explicitness for even different chil- 
dren handled in the same court that they muddle rather 
than clarify our concept of the situation. It is well to re- 
member, however, that stealing in these cases seldom means 
a single court offense, but more likely a continuation of 
thefts during several years. Truancy, incorrigibility, or 
any of the other more common charges is a word picture 
summing up months and years of ineffectual attempts to 
check the condition. Thirty-two of the 61 were charged 
with truancy from school or home or both. The absences 
vary from a part day at a time to prolonged periods of 
tramping and wandering. Twenty-nine were thieves. 
Eighteen were heterosexually or homosexually immoral, the 
homosexual cases being all males. Nineteen of the children 
lied to such an extent that it was a definitely important fac- 
tor in handling them, one case bringing false accusations. 
Sixteen were designated as generally incorrigible. The 
other delinquency charges involve destructiveness, profan- 
ity, setting fires, temper spells, cruelty, laziness, attempted 
suicide, and recognized “nervousness” as the basis of poor 
conduct. 
School grades. The history as obtained shows that the 
school grade reached ranges from second to eighth. The 289 
CHILDREN SIX TO NINE MENTALLY 
average number of school grades completed is 4.5, with a 
mode and median of 4 grades. Only 2 have a history of 
reaching seventh grade and 2 of finishing eighth-grade 
work. All 4 of these cases are girls who have definite his- 
tories of having, at an earlier period, been more responsible 
and “brighter” than they now appear. 
Stanford range. In 5 instances these children who test 
but a little more than 9 years of age had a basal of 9 with 
full success on all tests below that age. One of these did 
no tests beyond the tenth year, 3 completed tests in the 
twelfth year, and 1 scored as high as the 14-year level. This 
last individual is chronologically much older than the 
other 4. Twenty-one have a basal of 8, with a range 
through 10 in 9 instances, through 12 in 10 instances, and 
through 14 in the other 2 cases. All of the rest save 8 
have basals of 7. These 8 fall back to basals of 6. One 
of this group is the only one wTho scores a success above the 
14-year level, and he scores a success in the eighteenth year. 
This makes a total range of scattered successes through 
12 years above his basal year. He is one of the children 
formally testing normal, but he is slow in school, queer and 
solitary, getting into trouble for minor delinquencies, 
physically fairly well developed but a known congenital 
syphilitic. The ranges above basal year average 4.3 years 
for the group. The modal range is 5 years above the basal, 
and the median range is 4 years. 
Stanford distribution. The easiest tests that this group 
misses are the repetition of the digits in the seventh year, 
which is failed 4 times, the diamond, which is failed twice, 
the description of pictures in terms of action, which is 
failed twice. Those with a basal of 7 fail most frequently 
on the ball and field in the eighth year, and next in diffi- 
culty seems to be the vocabulary test. The comprehen- 
sion series is almost as frequently failed upon. None of 
the other tests is failed more than half as frequently. In 290 
THE UNSTABLE CHILD 
the tests of the 9-year level the weights, the repetition of 
digits backwards and the rhymes are by far the hardest. 
The 10-year group of difficulties corroborates the difficul- 
ties at the lower levels, the vocabulary, design, and com- 
prehension tests being missed most frequently. Above 
this age the easiest tests stand out best. The interpreta- 
tion of pictures in the twelfth year, the induction, clock 
problems, difference between president and king, repeti- 
tion of digits, the fables, and the cut design are each passed 
by 1 or 2 children. No child passes more than 1 of the tests 
above the 12-year level. 
Stanford quality. Here again, as at the lower levels, 
the inspection of quality is easiest and, consequently, is 
most accurately rated on the drawing tests. Twenty-one 
of these individuals who score at least 9 years mentally are 
unable to complete the diamond without peculiar idio- 
syncrasies cropping out. They overlap corners, add extra 
side lines, are unable to get a line that does not wave ir- 
regularly or show fine tremors. In only 2 instances was 
the actual eye-hand coordination too poor to give a dia- 
mond which deserved credit so far as form goes. In the 
same way the design shows even more marked disturbances 
in 24 cases out of the 61. There are only one or two marked 
abnormalities on the ball and field. Delayed reactions, un- 
related interpolations, erratic additions to verbal test find- 
ings occur in at least 25 per cent of the cases. 
Association distribution. All children of this level were 
able to complete the test. Despite the aufgabe to the con- 
trary, phrases appear in the reactions in 69 per cent of the 
cases. They range in frequency from 0 to 86 out of the 
100 reactions. However, only 7 of the 61 cases give more 
than 10 phrase reactions, the average number for the group 
being 7, with a high variability. The mode is 0 phrases, 
and the median is only 1 phrase. The number of individual 
reactions is highly variable, ranging from 4 to 100. The CHILDREN SIX TO NINE MENTALLY 
291 
average number is 22, with a mean variation of 14 and a 
median of 16. 
Association quality. At least 37 of the 61 give one or 
more abnormal reactions, and there are doubtful qualities 
in the responses of 7 others. In 13 instances the reactions 
were markedly delayed. One case averaged a reaction time 
of 12 seconds and 5 others averaged a reaction time of 10 
seconds. Perseverations, automatisms, and negativisms 
occurred. The most frequently noted deviation was the 
use of a superficial reaction, something suggested by a 
chance sound, a recent experience, an object in one of the 
rooms the case had come through. 
Performance tests. The performance of this group on 
the Seguin formboard ranges from the average score for an 
8-year-old to the average 14-year level time. The average 
gives them a rating of 10.7 years, or a year higher than 
their Stanford rating. The median score on the test gives 
a 10-year rating, with the mode at an 11-year rating. There 
is no indication that the higher rating is apt to be made 
by the older children, for division according to age gives 
exactly the same average for the younger and older halves 
of the group. 
On the imitation series they range in score from 6 to 
17 years. The average score is 11.9 years, with a mean va- 
riation of 2.3 years. Even the lower extreme of the mean 
variable leaves a rating as high as the group’s Stanford 
rating! The median performance is 10 years, but the mode 
is 14 years. On this test there is some slight indication 
that the older children tend to score more highly. 
The Goddard adaptation series, although having an up- 
per limit of 8 years, is applicable to this 9-year-level group. 
One child scores only the 4-year-level move. Two score 5 
years, 3 score 6, and 13 score only 7 years. This gives the 
group an average rating of 7.5 years, although the mode 
and median performance are, of course, both 8 years. 292 
THE UNSTABLE CHILD 
The Porteus was given to 41 of the group. The ratings 
range from 5 to 13.5 years. The average performance is 9 
years, 7 months with a mean variation of 1 year 5 months, 
which coincides more closely with the Stanford mental age 
than any of the other performance test ratings. The me- 
dian is 9.5 years, and the mode of performance is 9 years. 
This is poorer work, when one considers their higher men- 
tal level, than that of the 8-year-level group. The mode 
of performance is lower by 2 years. Undoubtedly this 
means that the Porteus reveals some other capacity than 
one which we should assume an individual has by virtue 
of his mental age and chronological development. These 
children average a year higher mentally and are 1 year, 
8 months older in average chronological age than the 8-year 
mentalities, yet they score an average rating only 5 months 
higher, and the modality is lowered. 
The Healy board shows a variability of scores ranging 
from failure to 15 years, with an average mental age on the 
successes of 8.4 years and a mean variation of 2 years. The 
mode and median scores are both 8 years. On this test, 
again, the group as a whole is nearer what the 8-year level 
did than one could rightly expect. The modes and medians 
are the same, the average is 0.8 year higher, and the varia- 
bility is greater in the 9-year-level children. 
School performance. On the Ohio literacy test the scores 
range from 5 to 29. The modal performance is a score of 
16 to 20. The median score is 20. The average is 19, with 
a mean variation of only 4.2 points. The average and 
median scores are about right for fourth-grade perform- 
ance. Of course, the individual scores vary tremendously, 
ranging from inferior first-grade to average eighth-grade. 
The percentages of inaccuracy are lower than with the 
8-year-level children, the average error being 12 per cent, 
with a mean variation of 7 per cent. The individual 
inaccuracies range all the way from 0 to 40 per cent. CHILDREN SIX TO NINE MENTALLY 
293 
In arithmetic, several children can do nothing at all. 
Seven per cent do fairly good fourth-grade work. The 
mode of success is a completion of second-grade work, 53 
per cent accomplishing that. Third-grade wTork is done 
by 31 per cent. 
In spelling, the variability of the memorial aptitude of 
these children becomes more apparent. They range in 
grading from first to eighth grade with a mode and median 
of fourth-grade ability, but with 36 per cent doing sixth- 
grade work or belter. 
In language, they are definitely low. They may speak 
well, even glibly, but formal application of such verbal 
ability is poor. Fifty per cent do about average third- 
grade work, and 21 per cent do less than that. None does 
over sixth-grade work, but there are 8 per cent of the chil- 
dren who can do good work on the formal grammatical 
requirements of sixth grade. 
In geography, they have no actual orientation save to the 
simple problems of physical geography which are taught 
in story fashion to lower-grade children. 
General information. The greater part of this group 
have only that small bundle of facts and practical under- 
standing of affairs which would classify a child of 8 or 9 
as normal. They know their own affairs fairly well and 
sometimes can give a number of parrotlike observations on 
matters of greater importance. In general, however, they 
show the same lack of perspective and comprehension for 
things beyond their ordinary experience as the 8-year-level 
group. There are marked exceptions, however. The 
younger children are better informed, talk more coherently, 
have a wider range of general knowledge and, in some 
instances, show marked superiority. Several boys in their 
teens seem absolutely normal in this respect, and it takes 
one’s experience and belief in tests to demonstrate, after 
painstaking research, that the superiority in this ability, 294 
THE UNSTABLE CHILD 
rather than the inferiority in other lines, is the deviating 
symptom. 
Own story. The stories told by this group are far more 
interesting than those of the lower mental levels. They 
begin to have a coherence that is lacking in the items given 
by younger children. There is still very little relating of 
cause to effect and no use of a logical order of happenings. 
There is naturally a slighting of the personal aspect of 
responsibility in the troubles which have come the narra- 
tor’s way. But when one questions, this group can give 
clear pictures of their past, their homes, their own daily 
lives. They know things in a more detailed and exact way. 
Of course, there are definite exceptions, and some cases are 
almost completely deoriented or else lie with such fabrica- 
tion that none of their statements means anything. 
Behavior under observation. Twenty-one of the 61 
showed signs of peculiar behavior while under examina- 
tion. In 4 other eases the behavior might have been 
interpreted that way, but the basis for such assumption 
is not absolutely certain. The 21 showed extreme nervous- 
ness, inability to sit still and attend for even a brief time 
to the test conditions, hysteria to the point of laughing and 
crying, extreme desire for petting, moodiness, automatisms, 
weeping, depression, and apathy with sitting staring into 
space. This group yields far more readily to morale work 
while under residence. 
Medical findings. .These children give a composite pic- 
ture of physical inferiority, at least in functional ability. 
Eighteen of the 61 are congenital syphilitics, with positive 
laboratory findings. At least 2 others have definite stig- 
mata, and there are 3 other suspects, unproven. Twenty- 
nine of the 61 have some disturbance of the reflex arcs. 
Two have gonorrhea. There are indications of rachitis, 
scaphoid scapulae, scoliosis, or other structural anomalies in 
40 cases. Glandular changes are definitely present in 8. CHILDREN SIX TO NINE MENTALLY 
295 
Three have had some sort of “spells” in chronic fashion. 
Many have poor eyes, poor teeth, poor hearing, hernias, 
malformed toes, and other marked handicaps of like 
nature. 
Morphological findings. On the Smedley norms this 
group shows up as above the average in standing height. 
Fifty per cent score above the 60 percentile, whereas 25 per 
cent score above the 90 percentile. There is not a double 
mode or distribution. Only 5 per cent score in the lowest 
decile. On the other hand, the group is low in sitting 
height. They are not so low as the 8-year group, for 30 
per cent score 60 per cent or over, but 18 per cent score 
in the lowest decile. This distribution is a double one. In 
weight, the group again scores high. Less than the expected 
number, for a regular distribution of the group, appear in 
the 10 and 20 percentiles. Little excess appears at any 
point of the distribution until we reach the 50 percentile, 
which has the normal number. There are 38 per cent of 
our group who score above 70 per cent in weight. The grip 
ratings place them below average, between the 30 and 40 
percentile in right grip and about 40 in left grip. Lung 
capacity averages about 50 per cent, with heavy groupings 
at both extremes, over 15 per cent falling in the lowest and 
also in the highest decile. This is not a picture of a straight, 
unmixed group, but of inferiors and normals mingled, with 
a great number of variants. 
Heredity. There are 4 families in this group in which 
there is no reason why we should doubt the normal quality 
of the members on both sides. Five families show heredi- 
tary feeble-mindedness, 4 show insanity, 2 show epilepsy, 
5, alcoholism, and 5, criminality. At least 19 other families 
have definite indications of hereditary neuropathic traits. 
Seventeen families are absolutely unknown; the children 
are adopted or state wards or are in minor institutions 
in some county. Other deteriorative traits, illegitimacy* 296 
THE UNSTABLE CHILD 
tuberculosis, paralysis, inferiority, shiftlessness, and the 
like appear throughout the picture. 
Diagnoses. Nine of this group of 61 are definitely morons. 
Of these, 5 are girls who were sent in for being immoral. 
Immorality is feared for another. One other, a boy, is a 
persistent masturbator and teaches other children this 
habit. Two others of the 9 were sent in because of stealing. 
Sixteen others are undoubtedly feeble-minded, but they are 
also psychopathic. They are “wild, queer, profane, abusive, 
violent. ’ ’ They are homosexual, attempt assaults, refuse to 
work, run, steal, and lie. Seven others are not only feeble- 
minded psychopaths, but they are congenital syphilitics. 
They seem to be a group similar to the above-mentioned 
group of feeble-minded psychopaths but are more definitely 
delinquent and yield a higher percentage of sex cases. All 
of these psychopaths tend to be institutional problems until 
they have been assimilated into the routine of the insti- 
tution. There is also one feeble-minded psychopath who 
is an epileptic and another who is feeble-minded, a psycho- 
path, and whose psychopathy takes the form of psychic 
equivalents of epilepsy. In these spells he has extreme 
temper spells and prolonged fugues. One other individual 
of feeble-minded level now is definitely insane, and, as no 
history can be obtained save that he has wandered from 
place to place for some years, it is impossible to tell what 
his early condition may have been. There are three very 
inferior psychopaths. They are chronic delinquents with 
many offenses against them. Just what there may be in 
them for future development it is hard to say, but all 3 are 
definitely in need of prolonged custodial care and training. 
One of the 3, an adopted child who has been given every 
advantage was found to be a congenital syphilitic giving 
a 4+ Wassermann. There are 10 cases on whom diagnosis 
is actually deferred. One of these is backward, but he is 
a psychopathic child who, until the last year, has had con- CHILDREN SIX TO NINE MENTALLY 
297 
vulsions, and who now for the first time is free from their 
constant handicap. Five others are slightly inferior but 
are too young to be definitely diagnosed. Their difficulties 
seem to be largely a matter of getting the right handling 
for them. Four others are normal in level and psycho- 
pathic, but are likewise hopeful cases for reeducation. All 
but 2 of this group of 10 have been improving under care- 
ful handling, physical correction of defects, good super- 
vision, and regular schooling. Two inferior psychopaths 
were actually psychopathic to the extent of having definite 
psychoses. There are 9 other children, normal or slightly 
inferior in level, who are congenital syphilitics. All of 
these have been under treatment. Three of them are mak- 
ing good in the community, the others have become more 
difficult to handle as adolescence has developed. One other 
child who tested normal gave marked evidence of physical 
deterioration. Treatment has seemed to check this and has 
brought general improvement. One other normal psycho- 
path has developed epileptic equivalents, fugues, and spells 
of amnesia which are now approximating a mild psychosis. 
He gives negative findings, but history definitely places him 
as a third-generation syphilitic. 
Generalizations. Evidently a mentality of 9 is not only 
sufficient to get into trouble but also sufficient to render 
reeducation possible. The children who come into court 
and test at a 9-year level will present many types of prob- 
lems. They will be diseased in a goodly part of the 
instances, they will need physical correction frequently, 
about 30 per cent will need custodial care indefinitely, 
another 10 or 20 per cent might well have such care. On 
the other hand, immediateness of understanding may well 
send a good percentage of them back for local handling. 
The question of treatment, of hopefulness, or hopelessness, 
of their future is not entirely a one-sided thing. The chief 
fact to be stressed is that the putting of any of these chil- 298 
THE UNSTABLE CHILD 
dren on their feet is not a matter of a few days, but of 
weeks, and months, and even years, and then one may fail. 
After any length of time a child may well prove unable to 
maintain self-control, may fall back into being a social 
problem. Again, cases for whom there is no definite place 
in the state system may well be handled by intermittent 
home and institutional care, the institutional care being 
according to immediate need and urgency. This can well 
be done when parents or guardians are of sufficiently high 
level to be taught to cooperate. The 9-year-level group 
brings us real deteriorates, real psychoses, real criminals, 
hopeless material of all sorts, as well as those with whom 
one can work optimistically. CHAPTER XYI 
CHILDREN TEN TO TWELVE MENTALLY 
It is almost useless to go on describing the various 
attributes of the individual age groups, so far as it will 
give, or may be expected to give, any help in the handling 
of an individual case. The description shows some of the 
various possibilities of the children at each or any age, but 
it is far from being a guide to simplification of diagnosis. 
Indeed, the whole purpose of presenting the many varia- 
tions of the groups from so many different angles is just 
that: to show the need for the extension of work with 
individuals and with groups, since diagnosis is a matter of 
knowing all possibilities and picking out the right one. 
Because of this, it is worth while to have at least a general 
concept of the possibilities that one may meet at any one 
age. 
Between 10 Years and 10 Years, 11 Months Mentally 
The children in this group range in age from 10 to 19 
years, with an average of 14 years, 5 months. The modal 
age is 13, and the median is 14 years, 2 months. There are 
61 children in all, 40 boys and 21 girls. The age distribu- 
tions of the two are not at all alike. There are only 2 girls 
under 13 years of age in the group, whereas there are 14 
boys. The older groups are practically equal in number 
at the various ages. This actually means that, in relation to 
the total number committed, there are twice as many girls 
sent to the Bureau in the later years of adolescence as there 
are hoys. There are 4 colored children in the group, boys 
of 11 and 13, and girls 13 and 15, respectively. 
299 300 
THE UNSTABLE CHILD 
I.Q. The intelligence quotients of the group cannot, of 
course, run below 63. As a matter of fact, the range is from 
63 to 107. There are only 3 children who score an I.Q. of 
100 or more and only 3 who have intelligence quotients 
in the nineties. A conclusion that because of low I.Q.’s a 
large part of the group is feeble-minded would not be cor- 
rect, however, unless certain additions and reservations 
were made. The group is inferior, in many instances, to 
the level of feeble-mindedness, but there are other factors 
to be considered and many of them. 
Delinquency charges. There are a total of 153 charges 
against the group of 61 children. Twenty-nine are accused 
of incorrigibility, 29 steal, 27 are truant from home or 
school or both, 20 are sex offenders, 8 being markedly homo- 
sexual. There are 6 who have attempted murder or suicide. 
Sixteen are problems because of lying. There are a minor 
number of charges of violence, cruelty, extremely bad tem- 
per, profanity, setting fires, destructiveness, and the like. 
School grades. The school grade reached ranges from 
third to ninth. The average number of grades completed 
is 5.6, with a mean variation of 1 grade. The mode and 
median achievements are both 5 grades. One individual 
of the 61 has not been in regular grades but in a special 
class, without grading being given him. 
Stanford range. The range is naturally dependent in 
part upon the height of the basal achieved by each indi- 
vidual. The basals for this group range from 6 to 10, only 
one individual having a 10-year basal. The mode and the 
median achievements are a basal of 8 years. The range 
above basal varies from 2 to 11 years. The average range 
is 6.3 years. This is greater than the average range of the 
lower mental levels and seems to indicate that, although 
this group has increased ability to do higher tests, it does 
not, in proportionate fashion, eliminate failures on the 
lower years, for only through low-level failures can range CHILDREN TEN TO TWELVE MENTALLY 
301 
increase markedly. The mode and median ranges are both 
6 years. There are only 11 individuals that have a range 
of 4 years or less, and only 5 that have a range of 3 years 
or less. 
Stanford distribution. A similarity of distribution may 
be noted if we compare this mental-age group with the 
younger groups. Of course, in general, the failures are at 
higher levels. Those who go back to a basal of 6 years fail 
either on the repetition of 5 digits, drawing the diamond, 
or tying a bow-knot. Those who have a basal of 7 fail in 
the eighth year, on the ball and field in most instances, 
9 out of 52 failing on this test, whereas not more than 5 
fail on any one other test. The vocabulary and the com- 
prehension of practical questions come next in difficulty. 
In the 9-year-level group the rhymes are by far the most 
difficult task. This is a significant failure, for the percent- 
age of failures is as high as it was in the 9-year-level group, 
although decidedly lower than for the 8-year-level group. 
The reversed giving of 4 digits comes next in difficulty, 
and the lifted weights and the date are next. In the 
10-year level the same type of failures are markedly most 
common, namely, the repetition of 6 digits forwards, the 
vocabulary test, and the reproduction of the design. In 
the 12-year level, vocabulary tests, both for the vocabulary 
list and for the definitions of abstract terms, are most diffi- 
cult and the reversal of digits comes next. The interpre- 
tation of emotional situations in the pictures is by far the 
easiest. The vocabulary, digits forwards or reversed, and 
comprehension tests are hardest in the upper levels, al- 
though several children succeed in the repetition of 8 digits. 
The most frequent success in the eighteenth year is the 
correct reproduction of the cut design. 
Stanford quality. The tests show about the same peculi- 
arities as those reported in the 8- and 9-year-level groups. 
There is the same type of difficulty with the quality of 302 
THE UNSTABLE CHILD 
handwork in drawing the diamond, the design, and the hall 
and field. More elaboration seems to appear in the designs 
than at the lower levels. The diamond is erratically done 
by 46 per cent of the 37 to whom it was given. Only 2, 
however, are so poor in the form used that they do not get 
credit for the test. The design is peculiarly done by 25 per 
cent and the ball and field by about 15 per cent. The 
rhymes show every possible type of sound and sense 
alliteration. Reaction times are disturbed in many cases. 
This is so marked that in some individuals the time neces- 
sary to complete even a Stanford was as much as two and 
a half hours. 
Association distribution. There are no failures on the 
association test at this level. The group responds well to 
the aufgabe. Phrases are given by 76 per cent of the cases, 
but in only 13 per cent of the cases do they give more than 
JO reactions of this character. The range of the number of 
phrases given is 0-64. The average number of phrases for 
an individual of this group is 6, with a mean variation of 6. 
The median number of phrases is 2, but the mode for the 
whole group is none. Individual reactions are given by all 
of the group. The number ranges from 3 to 57, with a 
median number of 14, a mode of less than 10, and an aver- 
age number of 16, with a mean variation of 7. 
The number of common reactions given by any one indi- 
vidual depends largely upon the number of individual and 
phrases reactions which he does not give. In this group the 
greatest number give between 20 and 29 common reactions 
\fith values over 100. But there are almost as many who 
give between 40 and 49 common reactions. In general, the 
group curve follows the curve of the norms for children 
under 16, but there are definite individual anomalies. 
Association quality. Over 80 per cent of the group show 
some abnormality of quality on this test. Delayed and 
accelerated reactions, complex indicators by the score, CHILDREN TEN TO TWELVE MENTALLY 
303 
emotional lack, automatisms, perseverations, superficial 
environmental or sound reactions appear again and again. 
There are 25 per cent, at least, who give enough indica- 
tions for the test to be a definite basis and starting place 
for analysis and corrective education. 
Performance tests. On the Seguin formboard the 
10-year-level group ranges in individual scoring from a 
median 6- to a median 14-year-level performance. The 
mode of performance, as well as the median, is 11 years, 
but the average is slightly less, 10.9 years, with a mean 
variation of 1.2 years. There are almost as many scoring 
at a 10-year median as at an 11-year median, but there 
are more who score above 11 than there are who score 
below 10. 
On the imitation series the range is from scores of 7 years 
to scores of 18 years in two instances. The modal perform- 
ance gives a rating of 14 years. The median coincides with 
this, and the average is 12 years, with a mean variation of 
2.8 years. 
On the adaptation series the range is from 6 to 8 years. 
Although the upper value of the test is so limited, yet there 
are 9 out of the 61 children to whom a perfect score is 
impossible. This is a significant failure at a 10-year level. 
The average score is 7.8 years, with a mean deviation of 
0.3 year. 
Only 42 were given the Porteus series. The scores range 
from 7.5 years to 14 years. The group is so well distributed 
in its performance that there is almost no perceptible mode. 
If grouped in performance of those who score a whole year 
and the additional six months with it, then we have a mode 
at the scores of 10 and 10.5. The average score is 11 years, 
with a mean variation of 0.3 year. 
On the Healy performance the possibility of low scoring 
with high mental age on other series is even more per- 
ceptible. The “mental age” scores on this test range from 304 
THE UNSTABLE CHILD 
5 to 15 years. The mode and the median performances are 
only 8 years, although, because of a large number who score 
at the 15-year level, the general average is 9.9 years, with a 
mean variation of 2.7 years. 
School performance. On the literacy test the scores 
range from 0 to 32. The modal performance is a score of 
from 21 to 25, which is fifth- to sixth-grade work. The 
median score is 23, and the average is 22, with a mean 
variation of 4 points. Although there is one score of 0, 
this is not due to lack of opportunity to learn but is a spe- 
cialized defect. None of the others scores below 9 points. 
The percentage of inaccuracy on this test ranges from 
0 to 40. The mode is less than 5 per cent, the median is 14 
per cent, and the average is 13 per cent, with a mean varia- 
tion of 8 per cent. The high percentages of inaccuracy 
assume more individual significance when we compare them 
with these general tendencies. 
In arithmetic, the group ranges in ability from poor 
first-grade ability to good sixth-grade accomplishment; 42 
per cent score successfully as far as third grade and no 
farther, whereas 37 per cent score less than this. Only 
4 per cent score above fourth-grade work, and those are 
younger children fairly well up in school. 
In spelling, the range is from second grade through 
seventh. The modal and median performances are sixth- 
grade, but 13 per cent score as low as second grade. 
In geography, the ability ranges from second- to fifth- 
grade performance, with the mode at third-grade work, 
49 per cent scoring at that level. 
In language, the general rating is about third-grade, with 
a range of from second- to fifth-grade. Just 51 per cent 
score at the third-grade level, being able to form simple 
sentences correctly, but ignorant of all save guessing 
methods of punctuation, and knowing nothing of construc- 
tion beyond the sheer inelegant statement of a fact. CHILDREN TEN TO TWELVE MENTALLY 
305 
General information. Here the group varies as greatly 
as in other respects. There are 26 who have what would 
be a fair amount of general knowledge for their mental 
level; 14 more might be said to have good general informa- 
tion. In 2 instances the accomplishment is surprisingly 
good. In 5 it is poor, and in 2 more very poor in general. 
In 3 there is deorientation for place, in 5 there is deorien- 
tation for time, and in several for events. Besides these 
overlapping deorientations of some specialized phase, there 
are 2 who are in a definitely confused state, and 4 who have 
marked delusional content no matter how or what the 
subject matter approached. 
Own story. In 25 instances the story told by the indi- 
vidual shows phases of his difficulty and abnormality, and 
of his individuality. Of course, this group includes the 
group of 6 who are so deoriented as to have delusions. 
Most of the others who are even partially deoriented reflect 
their handicap in their story. The thing that strikes one 
is the similarity of tales told again and again. It may or 
may not be true—that is a matter for speculation—but the 
greater number of this group assert that they are not 
the responsible individuals, merely the helpers, or aides, or 
innocently enticed, and unsuspectingly-caught “buffers” 
for confirmed desperadoes. 
Behavior under observation. Twenty-nine of the group 
give definite indications of peculiarity even during the 
periods of laboratory examination. These 29 are recorded 
as being verbose, apathetic, very forgetful on the tests 
themselves, listless, slovenly in work, sullen, unemotional, 
confused, nervous, flighty, hypersuggestible, extremely 
slow, fidgeting to an extent bringing interference with work. 
Just as marked reports are made of the favorable qualities 
in the other cases, so that the records are not one-sided. 
Medical findings. Out of the group of 61, 14 are known 
congenital syphilitics according to laboratory findings, and 306 
THE UNSTABLE CHILD 
4 others are congenital syphilitics from definite stigmata of 
skull, fundi, etc. In 26 of the group the reflexes are abnor- 
mal. In 23 instances there are poor eyes, whereas ears are 
defective in 7 cases, and 21 have palpable or definitely 
enlarged glands. Two are choreic, and 4 have had some 
sort of spells. Rachitis, scoliosis, scaphoid scapulas, round 
shoulders, flat feet, knockknees are present in many of them. 
The individual peculiarities are numerous. 
Morphological measurements. The comparison with 
Smedley’s norms shows that we have a group that averages 
58 in the percentile groupings. There are 38 per cent of 
the group wTho are above the 80 percentile in standing 
height. In sitting height the average shows inferiority of 
development, being only 45. The weight of the group indi- 
cates a good general state of nutrition, being 60 on the 
percentile rating, with 39 per cent rated above 80 per cent. 
In right and left grip the group scores 45 and 40 per 
cent respectively, and there is much more individual irregu- 
larity of scoring. Lung capacity on the spirometer gives 
an average performance of 50. The total group is inferior 
in these respects, but throughout there is one sub-group 
that scores high, another that scores consistently low, and 
a group that varies up and down, back and forth. 
Heredity. Only 2 of this group come from families that 
contain individuals who are definitely known to be feeble- 
minded, but 9 have definitely established insanity in the 
line of direct ascendance. At least 9 other families are 
definitely neuropathic. In 9 families there is criminality, 
in 16 we find alcoholism, and in 18 there is marked immo- 
rality. The history is indefinite in 2 families and definitely 
normal in 4 others. In all of the rest we find some signs of 
marked inferiority, laziness, tempers, pauperism, cruelty, 
wanderers, and paralysis. 
The family of the 10-year-level individual is inferior, 
but the condition seems to be a complication of minor CHILDREN TEN TO TWELVE MENTALLY 
307 
tendencies to abnormality, or to abnormality of function, 
instead of a straight and uncomplicated lack of sufficient 
intelligence. In other words, the families of these indi- 
viduals show disease, nerve instability, and psychopathy, 
not feeble-mindedness. 
Diagnoses. Only 3 of this group of 61 were definitely 
diagnosed as feeble-minded without any additional handi- 
cap being ascertainable. There wrere 16 others who are of 
feeble-minded level, but where the diagnosis was one 
of feeble-minded in level now, and further handicapped, or 
motivated to abnormality of behavior, by some functional 
disturbance: 11 of this group are definitely psychopathic, 
2 others are psychopaths who are definitely deteriorating, 
but no cause for the deterioration was ascertainable. In 
another instance a deteriorating psychopath was definitely 
syphilitic; moreover, the mental changes were paralleled 
by actual physical signs of deterioration. Two others were 
psychopathic to the point of actually suffering from psy- 
choses. One of these was a deteriorating case. One other 
child seemed to be a potential case of feeble-mindedness, 
and he was also a psychopath. There are 31 of the children 
who are inferior in mentality but not inferior enough to be 
called feeble-minded or for one to feel that, so far as mental 
level goes, they might not make good out in the community. 
All of this group are more or less psychopathic. In 4 the 
psychopathy is deteriorative in type. In 1 it is syphilitic. 
In another case the condition is one of predementia, another 
is actually a dementia praecox, whereas another is an 
epileptic. Four of the children are slightly inferior, but 
with instabilities of such a type that there is evidently 
chance for favorable as well as unfavorable change. In 
these 4 instances diagnosis is actually deferred. In 2 other 
cases, subject to epileptiform seizures, the outcome is a 
matter of watching and waiting. There is 1 individual in 
the group who seems to be thoroughly normal and whose 308 
THE UNSTABLE CHILD 
behavior has been corrected by analytic work extending 
over a number of months and accompanied by definite 
reeducation. One bright, normal individual gives marked 
indications of a deteriorative psychopathy. This child 
gives negative laboratory findings but has stigmata of 
syphilis. 
Generalizations. Such a group report as this seems to 
mean utter discouragement if one would attempt corrective 
or reformative work. We must remember, however, that 
these children are extreme cases and represent the maximal 
type of problem with which wre have to deal. Even a casual 
glance over the summary can but impress one with the fact 
that the delinquent, however serious his delinquency, has a 
reason for his being delinquent. He is unstable, neurally 
and psychically, as well as poorly endowed physically, and 
with hereditary handicaps instead of potentialities. 
Between 11 Years and 11 Years, 11 Months Mentally 
The 50 individuals composing this group are even 
more interesting than the members of any of the groups 
previously discussed. These 50 are probably highly repre- 
sentative of most of the troublesome factors in our social 
fabric. There are only 3 of foreign parentage. In only 
1 of these instances is there any known abnormality of 
family conditions. In this case, the people seem normal 
enough, but they have left the boy to shift for himself in a 
way that is entirely incompatible with their general atti- 
tude towards most things. There are 3 mulatto children 
in the group, 1 boy and 2 girls, but they have all had good 
homes and wise attempts at preventive education. There 
is 1 negro boy. The others are white children, American- 
born, with 2 or more generations of American living back 
of them. They come from all sorts of homes, the very best, 
the very poorest. Some have been under state guardian- CHILDREN TEN TO TWELVE MENTALLY 
309 
ship or local charity protection since earliest infancy. 
There are ‘ ‘ only ’ ’ children and those who come from large 
families. The majority of the group seem to belong to 
self-supporting middle-class families, but a detailed investi- 
gation reveals the same type of causes and reasons for 
instability of behavior as we have seen in the children who* 
test at lower levels. 
Age and sex. There are 30 boys and 20 girls in the 
group. The range of ages is from 9 to 18. None of the 
girls referred is below 11 years of age but there are 3 
younger, bright boys in the group. There are, on the other 
hand, only 2 cases over 18 and these are both girls. The 
modal age of the boys referred to is 13, of the girls 17. The 
group as a whole has a double modal of 16 and 17. The 
average age is 14.5 years. 
I.Q. The range of I.Q.’s for this group is from 69 
to 126. There are 5 children, or 10 per cent, who have 
intelligence quotients over 100. Eight other children have 
I.Q.’s of 90 or over. Twenty-one of the group have I.Q.’s 
under 75, yet there is absolutely every reason to believe 
that but few of these children are definitely feeble-minded. 
In the first place, reexaminations after a brief period of 
proper living and working have revealed marked changes 
in many of the most problematic individuals. One boy 
who tested 11 years, 3 months at the time of first examina- 
tion, and who was then 16 years, 6 months of age, scored 
14 years, 2 months after 8 months of supervised working 
and earning his own living. At that time the repetition 
of his original offenses again brought him into the labora- 
tory for study and actual mental disease evidenced itself 
for the first time. This may be considered the logical 
evolution of the case, for both the mother and his brother 
are insane, and the father of the boy has extreme psycho- 
pathic tendencies. In other cases these lower I.Q. children 
are now doing well, normally, in fact, in the community. 310 
THE UNSTABLE CHILD 
In other cases, seemingly more hopeful than the average 
of the group, the passing of time, continued care, and 
experimentation have brought nothing but disappointment 
and the further evolution of the abnormal tendencies. The 
group does not impress one as stupid or even dull. They 
are rather overwise, overconfident, crafty, and fending for 
their own interests, regardless of society’s regulations. 
Delinquency charges. There are 107 formal charges 
against the 50. Of these, 19 are for persistent lying, 
whereas 27 cases steal, the thieving usually being a serious 
matter. There are 21 who are chronic truants from home 
or school, with the wandering sometimes lasting for days, 
and 15 who are immoral. Besides this, the group contains 
1 case of actual murder, 2 of threatening murder, a single 
case of gambling, and a minor number of incorrigibles, 
temper cases, fire-setting incidents, refusals to work, and 
cruelty. Six of the group have had one or more terms 
at the industrial schools before the time of the offense that 
brought them to the Bureau. 
School grades. The school accomplishments vary from 
a minimum of 3 grades to a completion of the ninth grade 
of public work. The mode have completed 5 grades, but 
the median number of grades completed is 6. The average 
number of grades is 6 with a mean variation of 1.2 grades. 
The two children who had finished only 3 grades were a 
child of 9 who had made his grade each year in school, and 
a mulatto of 11 who is a wanderer. The only child com- 
pleting the ninth grade was an inferior psychopath, a 
pathological liar, and a wanderer, who is also immoral. 
Stanford range. The average range in number of years 
above the basal, through which tests are done, is 6.6. The 
median number of years of range is 6, but the mode is 7. 
There is 1 child who has a range of only 2 years, 1 with a 
range of 3 years, and then, on the other hand, there are 4 
with a range of 11 years above their basal. These 4, CHILDREN TEN TO TWELVE MENTALLY 
311 
although they test above 11 years mentally, fall hack to 7 
for a basal year and score successes through the 18-year 
level. Of course, in order to gain an 11-year level, tests 
must be done into the 12-year level at least. The wide 
range of successes indicates the need for, or presence of, a 
low basal year. One child goes back as far as a 6-year 
level, 12 have a basal of only 7, 15 have a basal of 8, 19 
have a basal of 9, and 3 have successes in all tests through 
the 10-year level. There are 5 children out of the 50 who 
have full years of successes at a higher level than the basal 
used, but they fail on tests below this complete year. 
Stanford distribution. The distribution of tests indi- 
cates that the group is poor in motor control. The diamond 
is the only 7-year-level test missed. The ball and field has 
24 per cent of failures at the 8-year-level, the counting 
backward ranks next with only 8 per cent, and no other 
test is failed, save the vocabulary, and in it only 2 per cent 
fail. The digits backward are difficult at all levels where 
they appear; 19 per cent fail in this at the 9-year level, 
56 per cent fail at the 12-year level, and 98 per cent at the 
16-year level. The digits forwards are comparatively diffi- 
cult, 24 per cent failing on 6 digits at the 10-year level, 
79 per cent on the 14-year level repetition of 7 digits, 
whereas 98 per cent fail to repeat 8 digits. Only 1 child 
scores up to a 14-year-level vocabulary, whereas 78 per cent 
fail to score at the 12-year level. Forty per cent cannot 
do the 10-year-level design. The group is good in the 
comprehension questions, similarities, fables, logical prob- 
lems, and, comparatively, on the cut design. 
Stanford quality. The tests show a certain tendency to 
peculiar reactions. This is very marked in some instances 
and much less so in others. In spite of the fact that the 
test is passed, some of the diamonds show peculiar line 
tremors, etc. The ball and field, the design, and cut design 
show the same tendencies. There is usually a fairly definite 312 
THE UNSTABLE CHILD 
attempt at cooperation in the group, but even that does not 
rule out frequent loss of the task idea before the task is 
completed. Perseverative continuation of one set of direc- 
tions on to the next task, verbalistic failures, delayed reac- 
tions, egocentric interpretations of tests, and like idiosyn- 
crasies appear in a number of the cases. 
Association distribution. None fails on the test. Indi- 
vidual reactions range in frequency from 2 to 46. The 
average number is 13, the median 12, but the mode is less 
than 10. There are phrases present in 66 per cent of the 
cases; their frequency ranges from 1 to 43. The average 
number per individual is 4, the median is 2, and the mode 
is no phrases at all. Only 2 give more than 10 phrases, 
only 5 give over 5 phrases. 
Association quality. In 39 of the 50 cases (78 per cent) 
the qualitative analysis of the tests gave definite pathologi- 
cal symptoms. In 10 per cent of the cases the complex indi- 
cators were a sufficient basis for beginning psychoanalytic 
work. Delusional concepts were nicely revealed in 2 cases. 
In the other 64 per cent of the cases with some pathological 
condition revealed, the indications were similar but were 
less marked. The test gave no help in 22 per cent of the 
cases. 
Performance tests. The Seguin formboard gives a range 
of credits from that equal to the average for 8-year-olds to 
the 14-year-level average. The mode and median perform- 
ances give an 11-year score, whereas the average score is 
11.3 years. The mean variation is only 1.1 years. One must 
remember in studying this test with children of a higher 
level that, like the Goddard-Binet, it stops short of possible 
standardization at higher levels, although a good bit of 
this is due to the inability of any organism physically to 
accomplish the task in less than a certain minimum amount 
of time. The Sylvester standardization, used in this study, 
stops at the age of 15. The fact that the 11-year group CHILDREN TEN TO TWELVE MENTALLY 
313 
gives a secondary mode of 16 cases who score at the 15-year 
level indicates that the group is ‘ ‘ 100 per cent efficient, ’ ’ in 
respect to the demands of this test. 
The adaptation test shows some failures. Two children 
are unable to score more than the 6-year level on this test, 
and 2 others score only 7 years. The other 46, or 92 per 
cent, have perfect scores. Naturally, the mode, the median, 
and the average scores almost coincide in such a series. The 
significant cases are those that fail. 
On the imitation series ability ranges from scores of 7 to 
18. The mode is 14 and 15 years, with a median at 14. 
The average is 13.5 years, with a mean variation of 2.6 
years. 
On the Porteus the variability is proportionately as great. 
There is an actual range in ability from 7 years to 13.5 
years. The mode, median, and the average are 10.5, 9.75, 
and 10.7 years, respectively. There are 17 who score under 
11 years on this test, hut there are only 13 who score 12 
or over. Peculiarity of behavior and poor manual-motor 
control are often definitely revealed by this test. 
On the Healy performance test for comprehension the 
range of scores is from 6 to 15 years. The mode is 15 years, 
hut the median is only 10 years, whereas the average is 
11.1, with a mean variation of 3.0 years. 
School performance. On the Ohio Literacy test the group 
shows as great a variability as on the performance tests. 
The individual scores range from 7 to 39 points, which is 
equal to variability from second grade to college ability in 
this respect. The average is 25 points which is equal to a 
60 per cent rating for sixth grade, or 30 per cent for 
seventh grade. The inaccuracy on this test is rather high. 
The mode is less than 5 errors, but the average is 10 with a 
mean variation of 5. 
In arithmetic, the achievement is much less. There are 
34 per cent who do not do more than second-grade work, 314 
THE UNSTABLE CHILD 
and 52 per cent who do only third-grade work, so that only 
14 per cent accomplish as much as fourth-grade require- 
ments. Only 1 does fifth-, and 1 does about sixth-grade 
requirements. 
In spelling, ability ranges from second- to eighth-grade 
ability. The average rating is sixth-grade with a mean 
variation of 1 grade. 
In language, the range is from the lowest measurable 
ability to achievement that would mean completion of the 
regular grade requirements. The mean performance is 
fourth-grade with a mean variation of 1 grade. 
In geography, the variation is a little less. None seems 
to fail in those elementary ideas which are usually acquired 
in third grade, but none does much above poor seventh- 
grade work. The mean is fifth grade with a mean variation 
of less than a year. Of course, such a test definitely 
involves orientation, and a disability in this respect would 
naturally show on the geographical score. 
General information. Only 20 per cent of this group 
show any abnormality in the orientation series. There 
seems to be no general type of disturbance. Some are 
deoriented for time, others show marked difficulty in the 
comprehension of actual happenings, others are dissociated 
for family and individual experiences. In others it seems 
to be more the judgment side, the criticism of happenings, 
which is lacking. This handicap shows no regular relation 
to age, sex, or color. 
Own story. Some abnormality in the tales of their own 
experiences before coming to the Bureau shows in 36 per 
cent of the cases. They are ambiguous, ramble on inco- 
herently, are depressed unduly, focus on the wrong and 
non-essential factors. Some become so filled with self-pity 
that they cannot tell their tales without great emotional 
strain. Others are highly irritated at the situations and 
enlarge on the tales so that two, three, and even four tellings CHILDREN TEN TO TWELVE MENTALLY 
315 
are necessary before the truth reveals itself by the perma- 
nency of details. The majority of individuals of this level 
are, however, quite ready and willing and able to tell their 
own story simply and accurately. A normal tendency to 
slight their own responsibility in the affair shows but little. 
They can be readily trained into an impersonal attitude of 
telling it as a group of symptoms which must be handled 
and recognized as a part of the problem, if they are to have 
“another chance.” 
Behavior under observation. Fifty-two per cent of the 
group show abnormal symptoms when under observation 
in the laboratory. The greater number of these exhibit 
great ease of distraction, delayed or accelerated reactions, 
emotional lack or emotional excess, or that type of nervous- 
ness which means twitching, inability to sit still, and keep 
at individual tasks. There are 5 who seem to have delu- 
sional content as a basis for suspicion, haughtiness, distress, 
and antagonism. Needless to say, this is a conservative 
count, for there are doubtless others in whom the ascer- 
tainment of such complexes could not be expected unless 
observation had been much longer than that allowed under 
the exigencies of the situation. 
Medical findings. Out of the 50 there are 10 known 
congenital syphilitics. Of these, 7 give positive Wasser- 
manns at one time or another, whereas the other 3 have 
conclusive bone or teeth stigmata of the condition. There 
are also a few children who give suspicious signs, but these 
were not definite enough to make the cases other than 
questionable. In 46 per cent of the group there was defect- 
ive vision, and 9 per cent had defective hearing. The deep 
reflexes are abnormal in 44 per cent, and 22 per cent give 
positive Rombergs. In 42 per cent the glands are palpable 
or definitely enlarged. Chorea has affected 10 per cent 
at some time or other, and 4 per cent have convulsions. 
There are individual cases of hypospadias, acromegaly, 316 
THE UNSTABLE CHILD 
undescended testicles, otorrhea, deformed toes, and two 
cases each of paralysis, gonorrhea, and hernia. There are 
numerous instances of scaphoid scapulas, rachitis, knock- 
knees, round shoulders, and scoliosis. 
Morphological measurements. In standing height the 
group is above average for the age of the individuals com- 
posing it. The mode of the distribution gives a rating of 
60 per cent. There is, however, a group of 18 per cent who 
score over 90 per cent on the scale. In sitting height we 
again have a group who are inferior; 26 per cent score in 
the lowest 10 per cent of the norms, and only 6 per cent in 
the highest decile. The average score is between 30 and 40 
per cent. The group gives a double curve distribution. In 
weight we seem to have again a mingling of two groups. 
There is a mode at 50 per cent and a double mode at 80 
and 100 per cent. In other words, 44 per cent score over 70 
on the weight rating. In grip the group is decidedly 
inferior, 18 per cent score in the lowest decile, and the 
average is about 40 per cent. The distribution in left-hand 
grip is more nearly that of the norms. In lung capacity 
there is a reversed situation; 22 per cent score over 90 on 
the norms, and 46 per cent score 70 or more. 
Herediiy. There is not a case of known feeble-minded- 
ness in the families of this group. On the other hand, 
there are only 4 cases where we have definitely normal 
families. There is direct, insane inheritance in 18 per cent 
of the cases, epilepsy in 4 per cent, alcoholism in 16 per 
cent, and criminality in 16 per cent. There are 20 per 
cent of the families in whom immorality is definitely 
known, and 18 per cent in whom neuropathic traits are 
unmistakable. There is a history of syphilitic infection in 
12 per cent, cruelty in 8 per cent, paralysis in 10 per cent, 
and occasional instances of “degeneracy,” wanderers, 
desertion, laziness, divorce, low forms of living, and ques- 
tionable behavior. CHILDREN TEN TO TWELVE MENTALLY 
317 
Diagnoses. In general, 11 years of intelligence seems to 
be enough to get along with, if the full amount of intelli 
gence thereby indicated works as it should. The trouble 
with these individuals is not that they are too dull to under- 
stand, but that their understanding, or comprehension, or 
willing and deciding follows some devious path, instead of 
the predictable path taken by most minds as intelligent as 
they. 
Only 2 of this group of 50 seemed definitely stupid 
and were diagnosed as simply “feeble-minded.” Only 4 
others were diagnosed as feeble-minded and psychopathic. 
Of these, one was epileptic, and another was a congenital 
syphilitic who seemed to be deteriorating. Exactly 40 per 
cent of the group were diagnosed as inferior psychopaths. 
This is not a permanent rating or diagnosis. The one thing 
hopeful about a psychopath is that he has so many chances 
of improving and becoming markedly more capable and 
intelligent. This is not so much a matter of actual later 
mental growth as it is an acquiring of ability to use his 
original endowment, as he becomes more stable and reliable. 
The mental level of a psychopath is always lower than his 
actual type of functioning, but the value of his type of 
functioning is lower than his actual mental age, because of 
his irregularity and undependability of behavior. There 
are in this group 2 other inferior psychopaths who are of 
a deteriorative type and 1 who is definitely hysterical. 
Four were actually insane. Besides these individuals, the 
group included 1 on whom diagnosis was deferred, 5 in- 
ferior normals who were more or less psychopathic, and 8 
who were definitely normal but markedly psychopathic. 
There were also 2 bright normal psychopaths and an 
arrested case of dementia prsecox. This last was a con- 
genital syphilitic. One of those testing normal was a con- 
genital syphilitic, as were 1 of the insane group and 6 of 
the inferior psychopaths. 318 
THE UNSTABLE CHILD 
Generalizations. It seems almost impossible to summa- 
rize this group. They should be followed intensively for a 
number of years. One cannot feel about many of them 
that they will make good in the community. Several cases 
out of the 50 yielded definitely to psychoanalysis. The 
rank heresy that immediately comes to mind is whether 
they would not have recovered anyway. Of the rest, there 
is little to be said that is favorable. Two cases of foreigners 
who were not properly adjusted to situations in this coun- 
try are as hopeful as any. The majority make one feel that 
the reformatories, the jails, the dispensaries, the homes for 
unfortunate girls, the penitentiaries, and the insane hos- 
pitals will know them soon and well. A few are getting 
along at home. This is more a matter of home tolerance 
and increased ability in handling them than of improve- 
ment on the part of the children. A psychopath of an 
11-year level is a potential menace and burden, far worse 
than a definitely feeble-minded individual. His activities 
are less predictable, because they are far more apt to be 
abnormal and eccentric. His range of activities is wider, 
his apprehension more difficult. Yet, properly provided 
for, the chances of helping him are far higher. 
Between 12 Years and 12 Years, 11 Months Mentally 
Twenty-four individuals scored at this level when first 
studied at the Bureau. Chronologically, they range from 
12 to 16 years of age, with an average age of 14.8 years. 
The mode and the median ages are also 14. There are a mu- 
latto boy and a mulatto girl in this group and also a negro 
girl. There are only 7 girls and 17 hoys in the group. In 
intelligence quotients they range from 75 to 106, with a me- 
dian of 83. This places the group at the upper limit of 
known feeble-mindedness, where we find the so-called “ bor- 
derline” group. About half of the group would, by virtue CHILDREN TEN TO TWELVE MENTALLY 
319 
of their age, fall into such a classification. Yet a study 
of them does not indicate such borderlinity, unless one 
uses the term merely in its social sense of their being cases 
who may or may not make satisfactory citizens. However, 
the failure or success in this matter does not often, to the 
person who works with them, seem to be the result of insuffi- 
cient intelligence, but of other factors, less readily evalu- 
ated in a mathematical sense. 
Delinquency charges. There are a total of 60 charges 
against the 24 individuals in this group. The most fre- 
quent charge is stealing; 17 have offended in this fashion. 
The thieving of most of the group is of the professional 
type. They are adept as pickpockets or at breaking and 
entering. One of the boys has so persistently been sen- 
tenced for this sort of offense that he has averaged only a 
month or two of each year of his adolescence in the com- 
munity. With 16 of them, running away, or truancy from 
home and school, is the charge. Of the rest, 3 are immoral 
and 2 are homosexual; 1 is obscene both in language and 
actions, 1 threatens others, 1 threatens suicide, 4 give way 
to definite temper tantrums which are varied and exciting, 
9 of them lie to the point that they cannot be trusted to 
help on their own case. 
School grades. In school they have reached any grade 
from fourth to tenth. Only 1 stopped in fourth grade, 
and only 1 reached tenth grade. The mode and the median 
for the group is 7 grades of school work, since 10 of the 
24 have finished this amount of school work. 
Stanford range. On the Stanford alone this group shows 
almost an innumerable lot of variations. There is none 
who does not succeed in tests at least as high as the 14-year 
level, whereas all but 4 do tests in the 16-year-level group 
and succeed on tests in the 18-year-level group. On the 
other hand, there is none but fails on tests in the 12-year 
group, and all but 4 fail on tests in the 10-year group, 320 
THE UNSTABLE CHILD 
whereas 10 fail on tests as low as the 7- and 8-year levels. 
The mode is a basal of 9, with successes through the 16- 
year level, but this is true only of 25 per cent of the cases. 
Stanford distribution. If relative frequency of failures 
means anything, then this group is superficially verbal in 
its achievements. There are more failures on the ball and 
field at the 8-year level than on any other test that low. 
The weights, at the 9-year level, are missed by 5 out of the 
22 individuals on whom tests at that level were tried. Only 
2 missed the date, and no other test at that level was missed 
by more than 1 individual. At the 10-year level the design 
is the most significant failure, being missed by 9 out of 
the 24. The next most frequent failure is the giving of 
60 words in three minutes which is failed by 5 (21 per 
cent). No other failure is more than half as frequent as 
this last. In the 12-year-level group there appear to be 
several tests which are decidedly easier than the others. 
These, peculiarly enough, are the definitions of abstract 
terms, the fables, and the dissected sentences. The vocabu- 
lary, the 5 digits backwards, and the ball and field are 
the hardest of the whole series, but difficulty on them is 
approximated by difficulty on the interpretation of pictures. 
Above this level the successes stand out as more significant 
than the failures. At the 14-year level the logical problems 
seem to be the easiest, with the repetition of 7 digits next 
in order, and the induction test and clock problems next. 
The vocabulary is the hardest of all at this level, being 
passed by only 3 out of the 24. The only tests at the 16- 
year level that are successfully done more than once or 
twice are the fables and the code. There are 14 per cent 
who succeed on the 8 digits in the 18-year group, whereas 
33 per cent succeed in drawing the cut design, but all fail 
on all other tests at that level. 
Stanford quality. Inspection of the individual answers 
on the Stanford reveals just about the same tendency to CHILDREN TEN TO TWELVE MENTALLY 
321 
peculiarity and abnormality as was found in the groups 
of lower mental levels. There are fewer reactions of the 
type that show perseveration and automatism, but more 
that reveal queer types of association and delays of reac- 
tion. Seven out of the 24 give such abnormal indications 
in marked fashion. Most of these give some indication of 
their difficulty in the performance of the drawing tests. 
Association distribution. None of the individuals at this 
mental level fails on the association test, but all are capable 
of more or less accurate following of the directions. They 
are not all capable of reacting by single words, for 15 of the 
24 give phrases. However, only 6 individuals give over 
5 phrases. The mode is no phrases, the median is 1 phrase, 
and the average is 4 phrases, with a mean variation of 4. 
The number of individual reactions given is also less than 
at any of the lower levels. The number of individual 
reactions ranges from 2 to 26, with a mode of between 
5 and 10, and a median of 9. The mean is 11 individual 
reactions, with a mean variation of 6. 
Association quality. In 16 out of the 24 cases there was 
a peculiarity of responses inviting further research into 
its reason for being. This was indicated in the reaction 
time in a few instances but was largely a matter of 
abnormal tendencies in the reaction word itself. 
Performance tests. On the Seguin formboard the group 
ranges in ability from the average 8-year-level performance 
to the average 12-year-level score. The mode, median, and 
mean are all 11 years, with a mean variation of 1.2 years. 
In other words, on this test where the group are approach- 
ing the upper limit of its standardization, their perform- 
ance is a year below what we would expect for their mental 
age by the Stanford. 
On the adaptation series we have 1 individual who cannot 
score above a 4-year level, 4 who score a 7-year level, 
whereas the other 19 complete the whole test. The test is 322 
THE UNSTABLE CHILD 
highly significant when we meet with a failure, and the 
failures are frequent enough to warrant the regular giving 
of the test to all individuals of this level. An individual 
of 12 or more, who cannot do more than a 4-year-old does 
on a simple performance test, although scoring at 12 years 
in many forms of mental activity, is anomalous. His 
failure on an adaptation test enables us to see why his 
social adaptation might be poor enough to lead to delin- 
quency, or maladaptation. 
On the imitation test the scores range from 8- to 18-year 
levels. The mode and median performances are 15 years, 
with a mean of 13.9 years and a mean variation of 2.0 
years. However, there are only 2 who score as low as the 
8-year level, and 3 who score at the 10-year level. Yet these 
low scores are highly significant, more so because of their 
infrequency. 
On the Porteus series the scores range from 8.5 years to 
13.5 years. The mode is 10.5 years, and the median is 
identical with it. The mean is 10.7 years with a mean 
variation of 1.6 years. Evidently, ability on this test is 
no more highly correlated with that indicated by mental 
age, than is success on the other performance tests. 
On the Healy completion board the scores range from 
8 to 15 years. The mode is an 8-year-level performance, 
but the median is 10 years and the mean is 11.1 years, with 
a mean variation of 2.5 years. Out of the 24, there are 13 
scores of less than 11 years on this test and 2 scores at 
age. The remaining 8 score 13 to 15 years. Another indi- 
cation of another line of variation! 
School performance. In literacy, the scores range from 
16 to 33 points, which is equal to a range from low fourth- 
to high eighth-grade performance. The mode is a score 
of between 31 and 33. The median score is 27, and the 
mean is 26.8, with a mean variation of 4 points. There 
is a variable amount of inaccuracy in the results, with a CHILDREN TEN TO TWELVE MENTALLY 
323 
range of from 3 to 29 per cent of the work done. The 
mode is less than 6 per cent of inaccuracy, and the mean 
is 11.3 per cent with a mean variation of 6.1 per cent. 
In arithmetic, the group varies just as much; 2 do no 
more than the simplest second-grade work, whereas 2 have 
been proven capable of the intricate problems demanded of 
seventh-grade pupils. The modal and median scores are 
3 grades of work accomplished, but the mean is 4 grades, 
with a mean variation of 1.2 grades. 
In geography, ability ranges from third to eighth grade, 
with a median performance of 5 grades, double modes at 
fourth and sixth grades, and an average accomplishment 
of 5.3 grades, with a mean variation of 1.3 grades. 
In language, the range is from second to seventh grade, 
with a mode of 4 grades, a median of between 5 and 6 
grades, and an average of 4.3 grades, with a mean variation 
of 1.4 grades. 
In spelling, the range is from third- to eighth-grade abil- 
ity. The mode, median, and average agree, being 7 grades, 
only 6 children falling below this level. 
General information. In general information, the group 
is fairly good. Only 7 of the 24 show any abnormalities. 
The peculiarities of this group of 7 are not identical but 
they are similar in 6 of the cases. One individual has such 
a superior type of information and general knowledge that 
this very fact, entirely out of relation to her history, 
behavior, and advantages, was in itself an indication of 
abnormality. She had reached her present low level by 
regression but maintained some of her superior aspects. 
The other 6 may be characterized as “shut-in.” They had 
narrow range of interests, and even narrower ranges of 
information and comprehension. Time, itself, was not fully 
appreciated or understood. Current events of their own 
immediate environments had but little significance. Values, 
means, methods, and practical matters of earning and 324 
THE UNSTABLE CHILD 
spending meant far less than they should to a 12-year- 
level intelligence. 
Own story. Nine of the 24 give evidences of their pecu- 
liar twists in telling their story. Two of these were defi- 
nitely grandiose in their manner, exaggerating everything 
that exalted their personalities, minimizing or ignoring all 
to the contrary, making up tales to suit the situation. Two 
definitely revealed delusions of persecution. In both cases 
these tales were logical and definitely related to the past 
experiences of the individual. The one centered around the 
father’s neglect of the child, the other was built up on the 
fact that the boy was a mulatto. A sense of inferiority had 
been compensated for by a belief in his actual and unrecog- 
nized superiority and the determination to demonstrate it. 
Within a month this had developed into a most violent 
psychosis. One other individual out of our 9, who was 
much younger, suffered from a toxic goitre, and his condi- 
tion will require a longer time for its final evolution. In 
the other 4 individuals there was incoherence, deorientation, 
forgetfulness, delay, and sullen silence. The stories they 
told were far from complete or even circumstantial. 
Behavior under observation. Just half of the group 
showed abnormal tendencies under observation. These 
symptoms ranged from simple exaggeration or chronic 
lying in some cases to actual spells in others. One child 
insisted upon having spells whenever he was in any way 
slighted. These spells had been constant for several years. 
They yielded to being excluded from motion-picture parties 
and fudge treats; when he once definitely understood that 
he would never be included in either of these if he 
“fainted,” he never had another seizure. One child made 
a series of delinquency charges against another boy, for- 
tunately known to be innocent, and the breaking down of 
these charges took two days of constant analytic work. 
One of the girls told spectacular tales of having been a CHILDREN TEN TO TWELVE MENTALLY 
325 
white slave, yet her actual commitment was to prevent the 
possibility of any immorality. The group, as a whole, rep- 
resents a factor that was never stable or reliable while under 
observation. One attempted to incite a whole group to 
make a “getaway.” One persecuted any child or animal 
he could get in touch with, when out of sight of an attend- 
ant. One alternately wept, laughed, and fought, and came 
to the laboratory for help in “being good.” Sex interests 
made watchfulness a matter of constant thought. Stealing, 
passing sex notes, attempted sex incidents of a homosexual 
nature were numerous. 
Medical findings. The group has physical excuse for 
some of its behaving. Four are known congenital syphi- 
litics ; 13 have disturbed reflexes; 6 have had, or now have, 
convulsions of some nature; 5 have palpable glands, and 4 
others have definitely enlarged glands. Ten have bad eyes; 
2 have chorea. Rachitic symptoms are present in 2, 2 have 
scoliosis, and 6 have scaphoid scapulae. Many other symp- 
toms are shown by one or two. 
Morphological measurements. Compared with the Smed- 
ley tables the group shows a wide variability, but there 
is one group of average standing height and another well- 
grown group above 80 on the percentile ratings. In sitting 
height we have a very short, poorly matured group and 
another group of average height or better. In weight the 
group, with three exceptions, reaches at least the 40 per- 
centile, and many reach that sign of good nutrition—the 80 
percentile. In grip we have a poor group and a very good 
group. The same holds in lung capacity, all distributions 
showing at least the two modes, and sometimes a third 
where the two group distributions cross. 
Heredity. The cause of this group is not far to seek. 
Five families have a definite hereditary tendency towards 
insanity; 3 have the epileptic tendency. Four families, 
besides these, are definitely neuropathic. A syphilitic his- 326 
THE UNSTABLE CHILD 
tory is clear in 2 instances, and there is paralysis in 3 
instances. The families boast criminals in 6 cases, con- 
firmed alcoholics in 7. There are 2 instances of feeble- 
minded individuals but in neither case in a line of direct 
descent. The history is absolutely unknown in three 
instances. 
Diagnoses. One of the individuals was definitely called 
a feeble-minded psychopath. Nine were classed as inferior 
psychopaths and 2 as inferior normal psychopaths. Seven 
were normal psychopaths. One normal psychopath had 
epileptic equivalents, another was a deteriorating case, 
whereas 2 others were actually insane, and 1 was a pre- 
dement. Following these cases gives but little reason for 
changing the diagnosis. Of the normal psychopaths several 
have absolutely made good. 
Generalizations. This group presents a true problem of 
psychopathy. The writer has no doubt but that twice and 
thrice the work done on the 24 cases would be necessary to 
obtain all of the information necessary to solve the prob- 
lems of causation and corrective education for all of them. 
In some instances no amount of work could accomplish 
this. Those who have the normal tendency seem to turn out 
normal with little attention, those who do not, no amount 
of work brings right. 
The last statement emphasizes another complexity of the 
problems presented by the psychopath. There are psy- 
chopathies and psychopathies. Some are frequent incidents 
in the life of normal individuals, others definitely indicate 
a pathological condition. The children in this group of 
mentalities, 10, 11, and 12, give us a general idea of diffi- 
culties to be met. At these three levels we find a gradually 
decreasing percentage of the feeble-minded, and a con- 
stantly increasing number of the not-feeble-minded, but not- 
normal, who are almost always psychopathic in their make- 
up. Increasing mental age definitely eliminates one prob- CHILDREN TEN TO TWELVE MENTALLY 
327 
lem only to bring in another, a more difficult one. Does 
this hold for higher levels, or is the psychopath especially 
a transition problem appearing most frequently in the zone 
of doubtful ability and dubious futures? A study of 
higher mental levels will best answer this. CHAPTER XVII 
NORMAL, BUT— 
A diagnosis of “normal in mental level” on any child 
below a mental age of 12 or 13 is one which cannot help but 
be hazardous, if made from the standpoint of mental age 
alone. It is based upon the assumption that the future 
development of the individual diagnosed is to be in propor- 
tion to his development heretofore. That is the principle 
upon which the I.Q., or intelligence quotient, is based. It 
is a calm mathematical method of prognosis, very obvious, 
very fair, easy to explain, but—hazardous. The eases the 
writer has presented so far are sufficient to show that. 
Some children develop at a seemingly normal rate until 
they reach 8, 9, 10, or even 11, and 12 years of age, then 
they stop abruptly and remain indefinitely at the level 
achieved. Even this is not the only possibility, for regres- 
sion and actual deterioration may, and do, occur. It is 
not necessary to discuss this statement in detail, for the 
matter has been analyzed with statistical completeness and 
thoroughness by Doll.1 Such possible variability has been 
considered again and again as a factor weighting our 
determinations in this study up to this point. 
In this group the mental level achieved is high enough 
to eliminate any discussion of the probability of future 
development reaching or not reaching normal-adult level. 
In other words, this is a group of cases who are not poten- 
tially feeble-minded, not inferior, or even potentially bor- 
i Edgar A. Doll, The Growth of Intelligence, Psychological Mono- 
graphs, 1921, Vol. 29, No. 2. 
328 NORMAL, BUT— 
329 
derline, for their mental level is high enough to throw them 
above the plane where any such things are possible. 
The army tests have been cited so often as the final proof 
of the intelligence level of the general public, that the 
plea of triteness alone suffices as an excuse for not discuss- 
ing the findings on them in detail. To summarize briefly: 
The reports of the psychological tests on 1,500,000 soldiers 
showed that the mental level most frequently achieved by 
the average human being was that graded C on the tests. 
Interpreted into mental age this means 13 to 14 years. 
This, then, is probably the mental level of the great mass of 
people, normal people, whom we meet very day. In gen- 
eral, one does not expect such individuals to prove unable 
to handle the affairs of everyday living, and they justify 
this lack of expectation. The group at this level forms the 
social solidarity which sustains our democracy. They vote 
and think little. They work, marry, raise families without 
philosophizing. They maintain balance, they are the intelli- 
gent part of the so-called masses. 
Such a level is surprisingly low to those who accepted 
unquestionably the Stanford revision of the Binet-Simon 
scale, which placed average normal-adult achievement at 
the mental age of 16. However, in general, we must accept 
the army findings. The statistical validity of the work 
supervised by Yerkes and recently reported in detail by the 
Academy of Science is overwhelming.2 He points out that 
the level of the group studied may be a little lower than 
that of the general public, since men of higher intelligence 
became officers, and formed the greater part of the group 
of professional and business experts who were exempted 
because they were essential to industrial activity. 
On the other hand, feeble-minded, epileptic, and insane 
individuals were also eliminated and were probably almost 
2 Psychological Examining in the United, States Army, compiled 
by Robert M. Yerkes, Memoirs of the National Academy of Science, 
1921, Vol. 15. 330 
THE UNSTABLE CHILD 
equal in number to those of higher intelligence level who 
were exempted. As a result, the distribution is probably 
not so unequally balanced as it might seem at first. The 
actual intelligence of the principal sample of the white 
draft is reported by Yerkes to be 13.08 years, or, roughly 
speaking, 13 years. 
Such a definite fact necessitates a revision of one’s ideas 
of “normality,” or, rather, of intelligence level in its rela- 
tion to normality. One can no longer look upon the indi- 
vidual who tests 13, or 13 plus, as a person who is “border- 
line” or “inferior normal” in level. He has a mental-level 
endowment equal to that of the vast group of human beings 
around him, and handicapping or disqualifying factors 
must needs be sought elsewhere. 
Does this same condition hold for adolescents? It is 
unfortunate in the extreme that no concentrated effort has 
been brought to bear upon this problem. So far, interest 
in the critical side of tests and text-findings is limited to 
one or two individuals. Doll reports the results of examina- 
tions on 514 public school children in Trenton, New Jersey, 
and of 480 delinquent boys at the State Home for Boys at 
Jamesburg, New Jersey.3 In both these groups he finds 
“average development is complete at about 13 years, since 
the median scores of ages above 13 do not materially exceed 
those at 13, and in fact at some ages are below.” In the 
normal group the mental age reached is 13, but in the 
delinquent group the mental age reached is much lower. 
Doll does not interpret this to mean that there can be 
no mental change after 13, or that that mental age is nec- 
essarily the end of achievement, but, “on the average, or 
for 50 per cent of presumably unselected cases, intelli- 
gence growth is practically complete at 13 years.” In a 
later study 4 he corroborates this finding and states that for 
s Edgar A. Doll, “The Average Mental Age of Adults,” Journal of 
Applied Psychology, 1919, Vol. 3, pp. 317-328. 
4 Doll, The Growth of Intelligence. NORMAL, BUT— 
331 
feeble-minded children, at least, mental age is less apt 
to increase the older the child becomes, and significant 
increase is rarely, if ever, to be expected after the age of 13. 
As it happens, 23 of the 369 delinquents reported in this 
study have mental-age levels of 13 or of some value between 
13 years, 0 months and 13 years, 11 months. This would 
undoubtedly qualify them for admission into the group of 
“average mental level.’’ The group is chronologically 
younger than the army group, but it compares favorably 
with Doll’s groups. 
These 23 are, with one exception, delinquents. Of that 
there is no doubt. They have reached a mental level equal 
to that of the community in which they have lived. In fact, 
some of them have, since the time of this first rating, 
reached a much higher level—all of them are above that 
plane of development where one can attribute their delin- 
quencies or misdemeanors to lack of intelligence. We may 
discard that factor in studying them. We must analyze 
beyond it for traces of the motivation to wrong-doing. We 
are confronted in this group with the old argument that 
bright or intelligent men are wilfully criminal. Is it so? 
Eliminating our 1 non-delinquent leaves us 22 delinquents 
who test 13 years to 13 years, 11 months. Can our knowl- 
edge of these 22 normal-level cases give us any clue to the 
difficulty? Are they “moral imbeciles”? 
Rather than tempt the credulity of the reader who cannot 
estimate mere figures or tabular statements back into clini- 
cal handling of individuals, we shall attempt to present 
the material in detail by succinctly recapitulating, in ab- 
stract, our findings on each and every one of these 23. 
Conclusions may then be formed more justly. The abstracts 
are arranged in the order in which the cases chronologically 
presented themselves for study. Summary of Findings in Cases of 23 
Name Marie E. Naomi L 
Age, Color, Sex 19 W F 17 W F 
Family History Unknown, save that Good family on mother’s 
mother is inferior. side. Mother died. 
Father good workman, 
indifferent to child, 
alcoholic, and igno- 
rant. 
Developmental Data . .. Negative. Negative. Spent part of 
her time in a convent 
school in Russia. 
School Achievement . . . Reached 6th grade. Learned English and 
passed 7 grades in 7 
years. 
Behavior Teaches children immor- Sex accusations against 
al practices. Is im- men. Incapable of 
moral. Cruel, stub- housework because so 
born, lies. Left her unclean in methods, 
husband. Saucy, lies, careless in 
dress. 
Medical Findings Negative save for toxic 1918, all tests negative 
goitre which was re- and full correction 
moved. done on eyes, etc. 
1919, has exaggerated 
reflexes, positive Rom- 
berg. 
Psychological Findings.. Stanford, 13 yrs., 5 mos. Stanford, 13 yrs., 9 mos. 
Very irregular in sue- Slow and patient in 
cesses on all tests. answers. Sex, reli- 
Pathological associa- gion, and art com- 
tions. Grandiose ideas. plexes. Reactions slow. 
Thinks she is a poet 
Poor motor control. 
Observations Impudent, unmanage- Seems dazed by the mul- 
able. Disciplines other tiplicity of demands 
children well. Sex upon her. Great de- 
interests rampant. sire to paint. 
Diagnosis: Level Normal. Normal. 
Function..., Constitutional psycho- Psychopathic. Either a 
path, probably af- delusion of ability or 
fected by toxicity. real esthetic tendency. 
Disposition No change in irascibility Believe worth trying 
after operation. Sent a brief time in art 
for continued care to school. Placed. 
State Hospital. 
Prognosis Poor. Instability and Deferred. 
old habits mean delin- 
quency if allowed free. 
Subsequent History .. . After a year at hospital, In a week given free tu- 
test on Stanford is ition because of abil- 
14-3. Little stabiliza- ity. Converted many 
tion. Seems old and times second year, 
worn. Gave up art. Deori- 
ented. On edge of 
self-support. 
332 Delinquents of Adult Mental Level 
Nettie L. Gbant I. Thomas S. 
16 W F 18 W M 13 W M 
Inferior stock. Been a state ward for Negative. 
some years. No data 
on family. 
Negative. Little known. Lived in Normal in all details. 
foster homes. Had mastoiditis, no 
other illness. 
Reached 8th grade. Reached 6th grade in Reached 8th grade. 
State School for Deaf. 
Insolent, saucy, uncon- Lies, steals, spends Steals from relatives, 
trolled sex interests. money foolishly. Very Father is very stern 
Fear will become im- fond of girls. Writes and can make him tell 
moral. Lies. Cannot grandiose letters to his delinquencies, 
hold position. them. Stubborn and 
antagonistic. 
Slight hyperplasia of Deaf mute. Wassermann Reflexes on reenforce- 
thyroid which has been 4+. Been treated a ment only. Von Pir- 
treated. Otherwise number of years. quet positive. All 
normal. Eyes bad. Six-year other indications nega- 
molars give specific tive. 
signs. Reflexes nega- 
tive. 
Stanford, 13 yrs., 1 mo. Stanford, 13 yrs., 4 mos. Stanford, 13 yrs., 3 mos. 
Very irregular. Qual- Much irregularity after No marked irregular- 
ity peculiar. Lacks allowance made for ities. Inferior motor 
emotional tone. Arith- deafness. Poorly ori- control. Inaccurate in 
metic only 2nd grade. ented. Poor motor school tests. 
control. Fair educa- 
tion. 
Delusions. People watch Excitable. Gets angry Pleasant, well-behaved, 
her. Tells things be- very easily. Sex in- reliable on errands 
fore she does them. terests marked. Re- where stealing is pos- 
Depressed spells. De- sents supervision. sible. 
oriented for recent 
events and so seems 
to “lie.” 
Normal. Normal. Normal. 
Extremely psychopathic Psychopathic, with psy- Deferred. Tests give 
and deteriorated. Pre- chotic indications. De- little reason for trou- 
dement? lusions of wealth and ble. 
grandeur. 
Advised State Hospital, Assigned to State Hos- Not committed, so place 
but as not committed, pital for treatment. with good supervision 
placed under splendid advised, in country, 
visitor. 
Poor. Poor. Good supervision, Dubious. 
special training and 
medication have not 
helped. 
Found impossible. Seeks More deterioration shown Not placed in country, 
men. Readmitted as on later tests. Ran Stole auto. Sent to 
committed case. Stan- away, stole, arrested, Industrial School. Pa- 
ford, 12-7 only 2 mos. and returned. roled. Stole another, 
after other examina* Returned to School, 
tion. Sent to State 
Hospital. 
333 Summary of Findings in Cases of 23 
Name Henry G. Queed Y. 
Age, Color, Sex 12 W M 16 W M 
Familv History Father high tempered, Excitable Russian Jew- 
very religious. Mother ish family. Patient is 
nervous. 5 sibs. One a twin, other died at 
died in infancy. Two birth, 
have “terrible tem- 
pers.” 
Developmental Data ... Negative. Born at 8 mos. Con- 
vulsions at 2 and 6 
years of age. 
School Achievement ... In 7th grade; repeated Has reached 9th grade. 
6th. 
Behavior Has stolen since 6 years Keeps jobs a few hours. 
of age. Ran accounts Runs away. Has gone 
at grocery, taking 600 miles to relatives, 
money meant for pur- Steals money for 
chases. shows. Loafs. 
Medical Findings Eyes have marked refrac- Refractive error. Minor 
tive power and fundus stigmata. Wassermanu 
disturbance. Teeth spe- 4+. 
cific. Bone anomalies. 
Small. Tests negative. 
Psychological Findings.. Stanford, 13 yrs., 10 Stanford, 13 yrs., 1 mo. 
mos. Poor motor re- Verbose, erratic asso- 
production and poor ciations. Easily dis- 
memory. Inaccurate tracted. Delayed reac- 
school work. Over- tions. Poor memory, 
inhibition. Poor motor control. 
Delusions, walking dic- 
tionary, inventor, and 
other personalities. 
Observations On first admission was Annoys all by his won- 
exemplary. derful tales of his 
achievements. 
Diagnosis: Level Normal. Normal. 
Function.... Constitutional psycho- Constitutional psycho- 
path with stomach path with actual psy- 
neurosis. Congenital chosis. Congenital 
syphilis? syphilitic. 
Disposition Paroled. State Hospital. 
Prognosis Good. Poor. Non-productive, 
no aid to the commu- 
nity. 
Subsequent History .. . Stole again. Returned. Ran away. Gone 
Lied. Fought, stole. months. Parents re- 
Sent to Industrial fuse to return to Hos- 
School. Now paroled. pital. Future trouble. 
334 Delinquents of Adult Mental Level—Continued 
Roswell X. Ida H. Andrew Y. 
17 W M 15 W F 15 W M 
Father nervous, irritable, Whole family socially Mother dead. Bedridden 
verbose, ungovernable parasitic for food, from rheumatism and 
temper, grandiose. work, medicine. Fa- dropsy. Father alco- 
Mother nervous. Pa- ther was alcoholic tu- holic, and has rheu- 
tient is first child. bercular and inferior. matism. 2 sibs had 
Then 4 miscarriages, Brothers steal. Sibs repeated terms at In- 
1 stillborn, and 1 have had convulsions. dustrial School. 2 are 
neurotic child. normal in behavior. 
Refused food at first. Little known. Has lived Unknown, except had a 
Nervous, irritable ba- with sisters last few few children’s dis- 
by. Perverted prac- years. Married re- eases, 
tices at 12 years. Be- cently. 
came infected with 
syphilis. 
In 9th grade. Always Reached 8th grade. Stopped when in 6th 
was a truant. grade, but had never 
repeated a grade. 
Some truancy. 
Has always lied, stolen, Immoral before and Earns $24 a week. Stole 
and run away. Tern- since marriage. Hys- food, etc., at home and 
per spells. Irrespon- terical, lies, careless, finally over $100 from 
sible. Wanders away. queer. father. Quarrels at 
home. 
Refractive error. Blood Nutrition poor. Defect- Negative save for a 2-f- 
Wassermann and spinal ive vision. Reflexes Wassermann. 
fluid positive. Treated exaggerated. Gonor- 
but still positive. Loss rhea. Other tests 
of bowel control. negative. 
Stanford, 13 yrs., 4 mos. Stanford, 13 yrs., 3 mos. Stanford, 13 yrs., 9 mos. 
Wide range. Poor Unbalanced in sue- Wide range. Reason- 
memory. Poor on cesses. Poor in vo- ing poor. Inferior 
performance tests. cabulary and on all performance tests. 
Dissociated, diffuse, learning. Erratic as- Careless in detail and 
over-suggestible. Poor- sociation. delayed in reactions, 
ly oriented. 
Nervous, restless, talk- Sullen. Tries to act su- Much interested in girls, 
ative, over communi- perior to the situation Violates many rules, 
cative. No trouble. by lying about all Silly, quarrels, temper, 
Depressed spells, wor- sorts of minor misde- cruel to small boys, 
ries over his condition. meanors. impudent. 
Normal. Normal. Normal. 
Psychopath. Deteriorat- Psychopathic, probably Psychopathy of the type 
ing. Believe acquired an inherited combina- found in congenital 
syphilis was on basis tion of traits. Hys- syphilis. Some signs 
of congenital syphilis. teria. of Oedipus complex. 
State Hospital. Returned to local care Industrial School, with 
for gonorrhea treat- treatment advised, 
ment. Then advised 
State Hospital. 
Poor. Only a question Poor. Should be kept Poor. This is type of 
of time and whether from bearing children. boy that crowds re- 
treatment may retard formatories. 
progress of disorder. 
Taken home. Said to be Sent for gonorrhea treat- Recently paroled. 
“doing nicely” under ment and released, 
treatment. 
335 Summary of Findings in Cases of 23 
Name Opap G. Yates N. 
Age, Color, Sex 13 W F 18 W M 
Family History Mother immoral. Child Paternal grandfather suf- 
illegitimate. Maternal fered from bad head- 
aunt and uncle epi- aches. 
leptic. 
Developmental Data . .. Delayed walking. Con- Birth, early develop- 
vulsions from age of 2 ment, and health nor- 
yrs. on. About 10 a mal. Has seemed 
yr. hard to handle since 
4 years of age. 
School Achievement ... In 8th grade. A truant. Began school at 5 but 
Backward in arithme- is only 8B in a spe- 
tic and grammar. cial vocational school. 
Behavior Fights, swears, runs Always told big tales, 
away, immoral. but last 2 years lies 
incessantly. No basis 
in fact. Steals. 
Lazy. Stays out 
nights. No shame. 
Medical Findings Palpable thyroid. In- Has had good medical 
creased tendon re- care, but has frequent 
flexes. Minor stig- headaches. Tendon re- 
mata. Epilepsy. flexes diminished. All 
laboratory tests nega- 
tive save urinalysis. 
Chronic nephritis. 
Psychological Findings.. Stanford, 13 yrs., 10 Stanford, 13 yrs., 1 mo. 
mos. Range through Erratic in tests. Fa- 
10 yrs. Poor memory tigues very easily, 
and reasoning. Er- Good reasoning, good 
ratic associations with motor control. Asso- 
phrases. Delayed reac- ciation test is irregu- 
tions. lar, slow in reactions. 
Observations Tells wild tales of her Reported lazy. (Un- 
“fellows.” Profane. doubtedly a physical 
Steals food. Lies. basis.) Irritable, more 
Walks in sleep. so just before a bad 
headache. 
Diagnosis: Level Normal. Normal. 
Function.... Constitutional psycho- Somewhat psychopathic, 
path. Probably on probably due to physi- 
hereditary basis. Ep- cal condition, 
ileptic. 
Disposition Industrial School for dis- Paroled for placing in 
cipline and transfer to country. 
Hospital for Epileptics 
if necessary. 
Prognosis Poor. Constitutional Favorable. At least, 
makeup, habits, poor there is hope, 
training mean trouble. 
Subsequent History .. . None available. Getting along very well. 
Old trouble reappears 
when he stays home in 
the city long. 
336 Delinquents of Adult Mental Level—Continued 
Agnes U. David T. Truman Z. 
14 W £ 12 \V M 16 5 M 
Father shiftless, lazy. Father’s family un- Mother immoral. Father 
profane, of a poor known. Mother’s side unknown. Child ine- 
quality family. Ma- includes mental defect gitimate. 
ternal family is intel- and insanity as well 
ligent. Oldest sib is as people of high in- 
neurotic. (elligence. 
No untoward features. Had infantile paralysis Nothing known. 
Has always been hys- at 15 months. Little 
terical. else is known. 
Began at 6 and is in the Began at 5 and reached Reached only 6th grade 
7th grade. Failed last 7th grade this year. in special classes and 
year and this. Failed promotion this Industrial School, 
spring. 
Disobedient, quarrelsome, Lies, steals, incorrigible. Has 8 years of court 
disrespectful. Truant Truant from home and record. Persistent 
from home and school. school. thief, taking anything 
Associates with im- from food to bicycles, 
moral persons. Has Two terms at Indus- 
been under court care. trial School. 
Carious teeth, attended Teeth suspicious but not Stutters. Mitral regur- 
to. Tonsillectomy. typical. Hutchinson- gitation. Enlarged 
Tests negative in every ian. Eye reflexes cervical glands. Had 
other respect. slow. Remnants of gonorrhea 3 years ago. 
paralysis. Tests nega- Scoliosis and scaphoid 
tive. scapulas. 
Stanford, 13 yrs., 5 Stanford, 13 yrs., 5 mos. Stanford, 13 yrs., 3 mos. 
mos. Association tests Quality poor. Irregu- Poor in comprehen- 
peculiar. Quality of lar on performance s i o n. Performance 
tests most significant. tests. Very inacou- tests and school work 
Giggles, emphatic in rate on school work. surprisingly good, 
speech and manner- Superficial associa- Psycho-motor control 
isms. Dramatic. tions. very poor. 
Responds well to insti- Egotistical. Quarrels. No insight into his delin- 
tution discipline. A Stubborn, rude, and quencies. Some of his 
problem at first. Lies. saucy. ideas may be either 
racial superstition or 
delusions. Sees vi- 
sions. 
Normal. Normal. Normal. 
Practically normal. Be- High degree of psychop- Somewhat psychopathic, 
havior may be result athy. Constitutional basis for 
of environment. this. 
Paroled to sister for Assigned to Industrial Escaped from Bureau, 
work. School. 
Questionable. Staff of Poor. Dubious. Not fit to 
divided opinion. meet complications of 
modern life. 
Gave up good position, Not long enough period Stole and caught. Sent 
lazy, careless, impu- to give definite report. to Industrial School 
dent. Returned and again, 
found immoral. Sent 
to Industrial Home. 
337 Name Ireland L. Oma T. 
Age, Color, Sex 16 W M 14 W F 
Family History Maternal family is tu- Father deserted, had 
bercular, alcoholic and lapses of memory, 
immoral. Paternal Mother could not sup- 
family tubercular. port family, so placed 
Older sib used to run children with the 
away. Younger sib State. 
“dull.” 
Developmental Data . .. Instrumental birth. Nor- Nothing known. 
mal development but 
many children’s dis- 
eases. Has had tuber- 
culosis. 
School Achievement ... In 8th grade. Did 2 Reached 7th grade. 
grades in a year in Stopped to go to work, 
open air school. 
Behavior Steals constantly from Left home to work. 
home. Truant from Mother could not con- 
home and school. Lies trol her. Has been 
fluently. immoral. 
Medical Findings Nutrition poor. Tuber- Defective vision. Teeth 
cular predisposition. give specific indica- 
Maldevelopment. Sea- tions, Wassermann 
phoid scapulae, round weakly positive. All 
shoulders. All labor- other tests negative, 
atory tests negative. 
Psychological Findings.. Stanford, 13 yrs., 5 mos. Stanford, 13 yrs., 9 mos. 
Poor on any test in- Range through 11 
volving actual concen- yrs. Imaginal tests 
tration. Poor mem- good. Healy test 
ory. Irregular per- scored only 8 yrs. 
formance tests. Poor Reacts slowly. Defi- 
quality associations. cient in motor control. 
Motor control low. 
Observations Adapts to institution Poor comprehension of 
life. No insight into her social status, 
his own obligations to Tries to meet boys, 
his family. Egocen- Lies. Good worker, 
trie. 
Diagnosis: Level Normal. Normal. 
Function.... Somewhat unstable. Of- Constitutional psycho- 
fenses taken too easily path on a basis of con- 
by family. genital syphilis. 
Disposition May be able to get along, In a private training in- 
sent to Industrial stitution. Not eom- 
School. mitted. 
Prognosis Poor. Questionable. Little 
chance for socializing. 
Subsequent History . . . Has not been tried with- 
out supervision as yet. 
Summary of Findings in Cases of 23 
338 Delinquents of Adult Mental Level—Continued 
Ned K. Samuel. N. Orma S. 
18 M M 14 W M 16 W F 
Mother epileptic and im- Father alcoholic, immor- Father high-tempered, 
moral. Father un- al, had gonorrhea. but easy going, infe- 
known. 6 sibs. At Mother has a goitre. rior, in debt. His sib 
least one steals. 3 children died young, insane. Mother is of 
1 miscarriage, 1 sib neurotic, immoral 
had convulsions. Pa- stock. Divorced, 
tient was first born Father remarried and 
and only one alive. wife cruel. 
Convulsions at age of 2. Early development nega- Negative so> far as 
Been under State care tive. Masturbated ex- known, 
for some time. cessively at 8 years of 
age. Circumcised. 
In 7th grade when he In 7th grade. Failed to Has reached 8th grade 
stopped at 14. pass. Began school at in country school. 
6, but sent home as 
“too young.” 
No definite trouble. Habitual truant. Runs “Boy-struck.” Accused 
Wished study before away from home. of shooting step-mother 
placing. Picks bad associates. with intent to kill. 
Steals. Has 3 court Lies. Immoral, 
records. 
Incomplete. Negative so Nutrition poor. Carious Refractive error. Needs 
far as ascertained. teeth. Enlarged thy- dental care. Nervous. 
Laboratory tests nega- roid. Treated. Un- Deep reflexes in- 
tive. der size and weight. creased. All labora- 
Teeth and bone ano- tory tests negative, 
malies. Laboratory 
tests negative. 
Stanford, 13 yrs., 4 mos. Stanford, 13 yrs., 10 mos. Stanford, 13 yrs., 9 mos. 
Memory very poor and Wide range, good mem- Success and failure 
interferes in many ory, careless work. mingled. Fails on 
tests. Poor motor con- Only 8 yrs. on Healy reasoning and lang- 
trol. Quality poor in board. Association guage tests. Variable 
association series. value very low. For- on performance tests, 
gets directions. 
Good record in every Comprehends what he is Good reports in all de- 
way. to do with difficulty. partments. 
Loud, boisterous, seems 
inferior in behavior. 
Normal. Normal. Normal. 
Some psychopathy. He- Psychopathic on a con- Slightly psychopathic, 
reditary predisposition. stitutional basis. Has heredity, physique, 
Syphilitic? and experience as a 
basis. 
Try placing. Industrial School. Returned to local court. 
Rather difficult to tell as Poor. A social depen- Questionable. Too short 
observed only one dent not a social men- a period of observation 
week. ace. to judge. 
Under institutional care. 
339 340 
THE UNSTABLE CHILD 
Summary of Findings in Cases of 23 
Name VlEG1L N~ 
Age, Color, Sex 18 W M 
Family History Forced marriage of parents. Father 
deserted. Mother’s family alcoholic 
and stupid. Mother a nagger. 
Step-father good. 
Developmental Data Normal. Always somewhat deaf. 
Peculiar since influenza, 2 years 
ago. 
School Achievement Reached 9th grade. Has failed in 
a good bit of work. 
Behavior Indolent, lazy. Arrested for exhibi- 
tionism and making wrong sug- 
gestions to little girls. 
Medical Findings Defective vision and hearing. Pigeon 
breast, scoliosis, lordosis, scaphoid 
scapulas. Laboratory tests nega- 
tive. 
Psychological Findings Stanford, 13 yrs., 4 mos. Wide 
range. Performance variable. 
Reasoning poor. Learning slow. 
Quality poor. 
Observations Good worker. No trouble in any 
way. 
Diagnosis: Level Normal. 
Function Somewhat psychopathic. Hereditary 
predisposition. 
Disposition Paroled to farm work. 
Prognosis May do well if trained three or four 
years. 
Subsequent History Has been getting along well. Happy. 
These outlines are fairly indicative of the problems which 
the members of the group present, but in view of the fact 
that the individual who tests so high is apt to be held 
definitely responsible because of this level, despite the indi- 
cations of the other findings on him, it seems wise to discuss 
several of the cases in complete detail. This may make 
them seem more like the individual problems met by the 
reader. As a matter of fact, such cases are individual, NORMAL, BUT— 
341 
Delinquents of Adult Mental Level—Continued 
Helen N. Xandbrs I. 
17 W F 14 W M 
Mother -was immoral before birth of Parents of foreign birth. Poor 
child. Maternal uncle was in- home. Brother of 10 has been in 
sane. Father is a drug addict. court twice. Parents cooperative. 
Was insane 3 times. 
Not known save that the child was Negative so far as known, 
indulged and “spoiled.” 
Reached 10th grade and then left In 7th grade, 
school. 
Immoral. Filthy in tendencies Incorrigible. Temper which makes 
when angry. Ran away from him almost insane. Stays out late 
home. Tried to commit suicide. nights. Been at Industrial School. 
Defective vision. Hyperplasia of Negative save for minor defects, 
thyroid. All other tests negative 
except Rosenbach which is posi- 
tive. 
Stanford, 13 yrs., 5 mos. Poor rote Stanford 13 yrs., 4 mos. Poor vo- 
memor’y. Poor generalizations. cabulary (origin). Good imaginal 
Verbalist. Irregular performance ability. Poor memory. Associa- 
tests. Quality poor. Irregular tion test somewhat inferior, 
school work. 
Suspicious, intolerant, cries a great No trouble. Adapts well. Does all 
deal, dreamy. required of him. 
Normal. Normal. 
Constitutional psychopath with duplex Some psychopathy but probably du« 
determination. to irregular and poor living. 
Temporary commitment, so returned Industrial School as it would give 
to court. Advised careful placing. better training than his home. 
Poor. Some paranoid traits now. Know too little to say. 
Not out long on probation. Parents are moving to farm to givo 
boy better chance when he leaves 
School. 
varying constantly in the cause of their trouble, the way it 
manifests itself, and the possibility of helping it. 
David T. 
David T. is a rather short, stocky, Russian Jewish boy, 12 
vears and 1 month of age. His face holds one’s attention for it 
gives that impression of a mind alert, living, and doing, which 
always appeals. His shortness and stockiness may be partially 
related to his limping, a definite remainder from infantile 
paralysis. 342 
THE UNSTABLE CHILD 
Attitude. Throughout our work with him he was coopera- 
tive, overanxious to be right in his tasks, showing a good deal of 
concern about his record’s being up to what it should be. This 
was a verbal attitude only and was unaccompanied by any actual 
show of anxiety. More concern, to him, meant more verbosity. 
Family history. His father died 4 years ago. Nothing is 
known concerning his family. His mother died 9 years ago. 
Her brother states that she was unusually imaginative and loved 
the sensational. One of her sisters is of such low mentality that 
she is unable to care properly for her family. Two of this fam- 
ily have been tested and found to be subnormal. A brother of 
the mother is said to be “kept in seclusion on account of his 
mental condition.” Two other brothers are successful profes- 
sional men of good standing. 
Developmental data. Little is known. David lived with a 
sister’s family until a year or more ago, then he came under the 
jurisdiction of an uncle. He has stayed with first one relative 
and then another, being shifted back and forth as a burden of 
constantly increasing incorrigibility. He insists upon coming 
and going as he pleases, sometimes staying out all night. His 
meals are consequently irregular. He has reached seventh grade, 
having failed promotion because of inattention and misbe- 
havior. 
Economic history. He has never earned money. He makes 
the complaint that his aunt treated him like a girl and made him 
wash dishes and dust. 
Behavior. Besides the irregularity of living, mentioned above, 
the boy is occasionally truant from school. He steals and then 
lies about the origin of his possessions. All toilet waters or per- 
fumes must be kept under lock and key, for he insists upon 
perfumed baths. He constantly wears his uncle’s best ties and 
when one, a very expensive one, was found beneath his mattress, 
he calmly explained that he thought he might need it some day 
for a party. He has never stolen money, although it has been 
purposely left in his way. He has taken clothing and tools which 
he knew would not be used or missed for a long time. Some of 
these he admits selling but refuses to tell what has become of the 
rest. He has stolen clothes from the home of a little girl whom 
he calls his sweetheart. He knows, evidently, all there is to be 
known about sex and talks about it freely. He is unusually 
vain, spends much time before the mirror, and “cried almost an 
entire day when his uncle threatened to cut his hair.” If crossed, NORMAL, BUT— 
343 
he becomes stubborn and will stay away from home a day or 
two. He is generally thought to be peculiar but bright. 
Earlier examinations. The court psychologist reports that 
although only 12 years of age he tests 13 mentally, passing many 
of the 14-year tests. 
Medical examination. Eyes accommodate slightly. Middle in- 
cisors notched (not typically Hutchinsonian). Lateral incisors 
pointed. Has had infantile paralysis. Right side partially 
atrophied and right tendon reflex missing. Scaphoid scapulae. 
Laboratory tests all negative. 
Psychological findings. On the Stanford-Binet David scores 
13 years, 5 months. His work is irregular. Although he has a 
basal year of 8, he barely passes the diamond in 7. He misses 
the weights in 9, design in 10, reversed digits in 12, and does the 
induction test, logical problems and differences in 14. In 16 he 
interprets the fables and succeeds on the abstract differences. 
Peculiarly enough, he succeeds on 6 digits backwards although 
he missed on 5. His answers are lengthy and verbally overade- 
quate, yet his definite vocabulary rating is only 46 words. 
Performance tests give him various levels. On the Seguin 
formboard his ability is average for 11 years. The Knox imi- 
tation series rates him 15, and the Healy completion gives him 
an adult level. 
Anthropometric measurements indicate height, both standing 
and sitting, in the lowest decile for 12-year-old males, weight in 
the third decile, but grips and lung capacity proportionate to 
each other, and averaging 50 to 60. 
Educational acquisition rates him variously. He is low seventh 
grade in literacy with a high percentage (21%) of inaccuracy. 
In language he is up to grade, geography is good, spelling is 
minimal seventh grade. In arithmetic, he has methods, but he 
is very inaccurate in calculations. 
His general information seems almost unlimited, and details 
are quite accurate. The Kent-Rosanoff association test given 
on the day of admission is decidedly abnormal. Although he 
grasps the aufgabe readily and uses it correctly at first, it is 
soon lost. Consequently, irrelative words appear and the mono- 
verbal answer is replaced by phrases. The is a frequent response 
at first, and 49 other responsives are adjectives of general com- 
plementary but non-specific type, such as good, large, dark, and 
wooden. His all-pervasive sense of his ego crops out in reac- 
tions such as foot—his, trouble—his. The average word value 344 
THE UNSTABLE CHILD 
for this series is only 40.5 Repetition of the series after adjust- 
ment to institution life shows little adaptability, persistence of 
the same type of superficial, non-specific associations, and de- 
crease in word value to 35. 
Observation. Although David seemingly adapts to the exi- 
gencies of the situation and takes his part of the work cheerfully, 
his lame leg is made the excuse for refusing other than routine 
tasks shared by all boys. He “gets tired” very quickly. How- 
ever, when one sees his energy at play in this tired state, the idea 
will creep in that it is probably more psychic tiredness than 
actual bodily fatigue. He is stubborn, a born leader in starting 
trouble, and fully capable of using all his intelligence to avert 
thoroughly deserved reprimands. He attempted to tell the boys 
in the cottage their diagnostic status, having stolen a confidential 
memorandum absent-mindedly laid down in the office by an im- 
portant visitor. He is rude, saucy, annoys smaller boys, tries to 
start fights in the dormitory, resents all discipline. 
Diagnosis. Bright normal in level with 8 of 10 indications of 
psychopathy. A well-developed case of Narcissism Avhich would 
usually be diagnosed as an epileptic personality. The self-ad- 
miration, self-adornment, stealing confined largely to articles of 
adornment, frank sex interest, emphatic idea of his own impor- 
tance, resentment of feminine household tasks, all indicate this 
type of complex. Some minor indications point to its being a 
compensatory development for his physical handicap. Its 
growth has been furthered by his actual superiority of intelli- 
gence which has never been conquered or even well-directed. It 
has been impossible to find an instance where the boy has been 
actually mastered in a way which has brought any realization 
of the relation which should, and must, exist between him, as an 
individual, and the social group. After the incident of his giving 
so-called diagnoses to the other boys, the writer definitely at- 
tempted to impress him with the adult view of his behavior. He 
had claimed his superiority over the other boys. He was shown 
his inferiority in doing such a thing, proof positive lying in the 
fact that he was so easily caught. After a long interview, 
chagrin and mortification made their appearance. This Avrought 
5 This value is obtained by adding together all of the values for 
the frequencies of the individual words, and then dividing the sum 
by 100. The value does not exactly agree with the qualities indicated 
by a curve distribution, but it is highly useful in evaluating the 
changes in the test reactions of any one individual upon successive 
examinations. NORMAL, BUT— 
345 
such a change in his general attitude that it confirmed the recom- 
mendations already made tentatively, namely, assignment to the 
Boys’ Industrial School for disciplinary training. 
Prognosis. Poor. There is undoubtedly a constitutional 
psychopathy present which no discipline or analysis can elimi- 
nate. The family history indefinitely confirms this. The ap- 
pearance of Narcisstic tendencies is an epiphenomenon largely 
due to the combination of physical handicaps and an environment 
filled with opportunities for such expression. Good habits of 
orderly living, recognition of authority and a consequent modi- 
fication of his own attitude are all we can hope to achieve at 
present. If there were a hospital school for psychopathic chil- 
dren, where the above features were combined with psycho- 
analytic therapy, we would consider David ideally provided for. 
Even then one could not be too optimistic in this case. The ques- 
tion is one of whether habits can stabilize him sufficiently to over- 
come present tendencies and to insure normal behavior in the 
social crises he must meet, as he later attempts taking his place 
in the community. 
Henry G. 
Henry G. was first seen when 12 years and 10 months of age. 
He was very small and on first glance would have passed for a 
child of 9 or 10. He carried himself poorly, looked imbecilic, 
shambled hesitatingly into the office. 
Attitude. His conduct on this day was stupid (despite test 
results). He wrote with a lead pencil on the examiner’s desk, 
lost his way between adjoining offices and needed help in ad- 
justing to simple apparatus. He had a senile look, his skin 
was coarse-looking, hair stiff and rather sparse, his eyes slanted 
slightly, his upper middle incisors were widely spaced. 
Family history. The family is Scotch and came to this coun- 
try when Henry was almost 6 years old. The father is rather 
high tempered, very religious, strict, but kind. The mother is 
quiet, gentle, extremely nervous, and subject to occasional severe 
headaches. They are buying their own home which, though 
small, is well-kept, convenient, and comfortable. Henry is the 
second born of 6 children, of whom 5 are living. One sister, the 
first child, died when 2 days old, cause unknown. History on 
the other 4 sibs is negative, save that John, 10, and Helen, aged 
8, have “terrible tempers.” 346 
THE UNSTABLE CHILD 
Developmental data. History of pregnancy and birth are 
negative. He walked alone and said his first words at 9 months 
of age. Age of teething is forgotten. Had whooping cough 
when a baby, measles and scarlet fever at 5, chicken pox at 6. 
Peculiarity, that is stealing, was first noticed by parents at the 
age of 8. He began school at 6 and has just reached seventh 
grade, having repeated sixth. He has always been exceptionally 
well-behaved in school and was never truant but once. 
Economic history. Living in a small village, opportunities for 
earning were limited,but he has cut lawns, run errands, sold papers. 
Behavior. He chums with boys slightly older than himself 
and is normal in his play and sport life. He is respectful to his 
parents, kind to his sibs. He can be given responsibilities. The 
only difficulty is his stealing. He has stolen, but only from home. 
This last winter he has run up a bill of $26 at the grocery store, 
appropriating the money his mother gave him to buy groceries, 
and charging the articles bought. This was possible because of 
the good standing of his parents. 
Earlier examinations. None, but the principal of the school 
feels he is a bright boy. 
Medical examination. Eyes show marked refractive error. 
Fundus examination: “Disc of each nerve has hazy margins, 
vessels full and entire retina shows islands of pigmentation. 
Degenerative state—disturbance in central nervous system. Stig- 
mata rather than disease.” Six-year molars are peg-shaped, 
middle incisors spaced. Knoekkneed, flatfooted. Enlarged knee 
and elbow joints. Reflexes normal, Romberg not taken. Ton- 
sillectomy. Vision corrected. Teeth attended. Provocative 
treatment was incomplete. All laboratory tests negative. 
Psychological findings. At the time of the first examination 
Henry scored 13 years, 10 months on the Stanford-Binet. In 
this test he has a basal year of 9 and does all of the 10-year-level 
tests except the design, which is not drawn incorrectly but prac- 
tically “forgotten.” In the 12-year group he misses the ball and 
field and the 5 digits backwards. He passes all of the 14-year- 
level tests save the logical problems, in which he declares a snake 
hangs from the tree and the man rides in an auto. He passes 
the 16-year-level interpretation of fables and the problems of 
enclosed boxes. His answers are brief, and usually accurate. He 
admits ignorance when he does not know. His drawings are care- 
less and poorly finished. 
Performance tests mark him as inferior in those where motor NORMAL, BUT— 
347 
control is involved, for he scores only 9 years on the Seguin 
formboard and 10 on the Knox series. The adaptation series is 
passed without error. The Healy completion is done in adult 
fashion, and yet he scores only 9 years on the Porteus mazes, with 
poor quality of performance. 
The anthropometric measurements place him in the lowest 
decile for standing height, below the minimal measurement for 
sitting height, weight proportionate to standing height, and grips 
and lung capacity showing fifth decile rating, that is, 50 per 
cent, or average ability. His head is meso-cephalic. 
Educationally, his ability seems below what a boy ready for 
seventh grade should be able to do, although his literacy score 
rates him at high-school level. He cannot do multiplication by 
more than one number, and he fails on even simple short division 
problems, but does long division correctly, and passes almost any 
kind of reasoning problem involving money values. 
His general information is detailed, accurate, and shows a wide 
range of orientation. 
On the Kent-Rosanoff association test he gives a rather sur- 
prising distribution. There are only three individual reactions 
and a proportionately low number of others of low value whereas 
there are 48 with a value over 100. Thirty-nine of these ara 
non-specific adjectives, but aside from this there is no peculiarity. 
The average value is 149. Reexamination gives a curve which 
gradually shows less of the most common reactions, approximat- 
ing the norm for boys of his age one month after the first ex- 
amination. 
Observations. This boy soon became a cottage favorite. He 
was reported as helpful, polite, earnest, and as spending all his 
spare time reading. A day or two soon changed the behavior 
characteristics noticed at first. He was no longer stupid but 
bright, alert, eager to help and please. He was soon made down- 
town errand boy and proved most efficient. 
Analytic data. Henry’s seeming earnestness and his co- 
operation were sufficient justification for an attempt at analysis. 
Gradually he traced his stealing back to his life in Scotland. 
He associated it with his grandfather’s always coming on Sat- 
urday and bringing a big bag of sweets, and he wanted more of 
them than his share. He recalled in this connection taking 
fruits and such sweet things from home. Also, when sent to 
the store he’d tell his mother he lost a bit of the money, and 
would buy candy with the embezzled funds. Again and again this 348 
THE UNSTABLE CHILD 
idea of the desire for sweets came as the last of a train of ideas 
relating to stealing. When he came to this country, he con- 
tinued taking things to eat, and gradually, as he found it pos- 
sible, he took money, usually buying candy, sweets, and cigarettes, 
then spending the rest on movies, dime novels, and “trash.” 
He has had five cents a week spending money, but it “wasn’t 
even enough to go to the show.” However, he justly states that 
he didn’t expect any more, for his parents were paying for their 
home, and his father’s work is irregular. 
Diagnosis. Bright normal in level with 4 of 10 indications 
of psychopathy. The stealing seems to be definitely related to 
a stomach neurosis. Considering the boy’s retarded physical de- 
velopment and various physical handicaps, it is not hard to 
believe that his own recall is the truth as he has lived it. The 
metabolic need led to the habit of taking when he was too small 
to know right or wrong. The habit, ingrained and reenforced 
by continued metabolic demands, continued and developed as he 
gained intelligence and “scope of action.” Of course, this 
disturbance is in itself but a symptom, and psychologically the 
boy resembles our known congenital syphilitics, although only 
minor physical indications corroborate this. 
Recommendations. To a family of such strict ideals of living, 
Henry’s month at the Bureau was a severe punishment. The 
boy himself had this attitude, consequently it seemed well to 
consider parole. He had been put into good physical condition, 
tonsils and adenoids had been removed, eyes refracted, teeth 
filled. He had gained in weight. Morale work had been 
analytically reenforced and it seemed well to give him another 
chance, especially as the original complaint was not from the 
court but from the father. 
Disposition. Paroled. He was to camp with Boy Scouts and 
work at his garden when home. Spending money of 25 cents 
a week was provided. He was to be returned upon first indica- 
tion of delinquency. 
Readmission. Exactly two months later he was returned in 
good faith by the father. He stole cabbages from another boy’s 
garden, because, so he claims, the boy stole his watermelons. 
Later we found he had probably taken money given for school- 
books and spent it. He also ran several small accounts at stores. 
We determined to observe him over a prolonged period, for no 
change in mental status evidenced itself at this time, save that 
the boy’s attitude was much more like that reported at the first NORMAL, BUT- 
349 
interview. He was significantly unaffected by the disgrace of 
his return. Indeed, he seemed only glad to be back with us, 
although he reported a lot of pleasant home happenings. The 
association curve at readmission still approximated the norm. 
We entered the boy at once in seventh-grade public school, keep- 
ing him living in the Bureau cottage. Good behavior lasted 
one month (length of first observation), then trouble began. 
He objected to work in the cottage, preferring to read. He 
struck smaller boys, called names, destroyed combs, etc., in the 
lavatory, developed carelessness about his glasses, leaving them 
anywhere. Finally he began not returning from school and 
errands in time for meals. He told, at this time, a great tale 
of being hit and tied to a basketball pole in the school yard by 
big boys. He said no one passed while he was tied up. The 
next day (guilt?) he voluntarily brought another boy to confirm 
his story. He said to the matron that he wondered if his officer 
would believe him. Investigation proved he was, in fact, at a 
boy chum’s house, across town, a privilege he could have had 
for the asking. Unfortunately, his troubles did not stop there. 
He became more impudent, refused to work, lied about minor 
offenses, was unduly interested in the girls, fought on the slightest 
provocation. Stealing did not manifest itself seriously although 
there was some opportunity. 
Reexamination. At this time, 5 months after the first exami- 
nation, he was 13 years, 3 months of age. On the Stanford- 
Binet he scored 15 years. He passed all of the tests through 
12 except the ball and field, all of the tests at the 14-year level, 
the same tests as before in the 16-year level, and the code in 
addition. The quality of his answers is like that in his earlier 
examination. 
Performance tests show similar improvement, with formboard 
score 11 instead of 9 years, and imitation 14 instead of 10, but 
in the adaptation series he drops to a 7-year-level performance. 
Anthropometric measurements give him a curve similar to the 
earlier one, although it is now compared with the measurements 
of 13-year-old boys. 
The association series showed more individual reactions (8) 
and fewer common ones (34). The quality of the series seems 
normal. The average word value is 93, or practically identical 
with the normal. 
Diagnosis. Earlier diagnosis confirmed. The question is, what 
to do with the boy. Regular food and living have been decreasing 350 
THE UNSTABLE CHILD 
the malnutrition, but there is a conditioning of behavior which 
has been so deeply ingrained that only a long period of training 
will overcome it. The boy’s attitude is such at present that send- 
ing him to the Industrial School will but cause resentment and 
a feeling of injustice, yet no emotional affect has been obtainable 
through any type of privilege, scheduling, analysis, argument, 
or punishment. Something must make a contact between his 
intelligence and his emotions to “motivate” right activity. Phys- 
ical handicaps have been corrected, parole tried and failed, spend- 
ing money does not stop stealing, public school with institutional 
supervision gives too much chance for delinquency, analytic re- 
education is ineffective, because all impressions made seem to be 
merely rationally comprehended with no effect upon conditioned 
lines of behavior. Finally the writer decided that this seemed 
to be one of those cases where fear might make the educational 
appeal which nothing else could. So one morning while Henry 
sat, apparently overlooked, in a far corner of the office, a letter 
Avas dictated asking the advice of a great surgeon on a peculiar 
case—that of a boy, intelligent, able, of good home and good 
family, who persisted in stealing and was developing other 
behavior difficult to tolerate in one who was surely “not feeble- 
minded.” We asked whether this might not be a case for a 
“brain operation,” to try and save him for wholesome manhood, 
stating that we realized the gravity of such an operation but felt 
it was our last resort. An immediate reply was requested. Then 
the actors in the scene left the room. A few moments later an 
assistant “discovered” Henry, found no one Avanted him, and 
sent him to the cottage, where he was closely watched, by special 
request, although attendants did not know the Avhy and wherefore. 
That afternoon Henry came in, presumably for an examination, 
and in a few moments showed that he was nervous, tense, and, 
for the first time, worried. He opened the subject himself and 
begged for another chance. Then calmly and impersonally his 
chances and failures were outlined, with the frank statement that 
it would take a long period of good behaAuor before any one 
could trust him again, and we could not keep him that much 
longer at the Bureau. Voluntarily he begged for a chance to 
make good at the Industrial School. This plea was received 
dubiously, and finally the privilege of asking it at Staff was 
granted. The next day in Staff the whole matter was presented 
by and with Henry. (So solemn was the discussion some of the 
Staff asked later about the type of operation!) Henry Avas dis- NORMAL, BUT 
351 
missed, the therapeutic steps reported and assignment to the 
Industrial School approved. There he was sent, and made good 
in his record. It is now over a year since he went out on parole, 
and he is living at home, attending school, and still making good. 
Home conditions are even better than before, for his father has 
bought a small farm which keeps the boy employed outside school 
hours, and he is farther away from village gangs. 
Prognosis. How much value our arousing a feeling of per- 
sonal responsibility and a definite determination to make good 
by calling into aid fear as a motive has had, we cannot say. It 
may be the fortunate combination of all we tried to do for Henry 
which has made him one of our few cases getting along success- 
fully. Even then it will take five years or more before one may 
feel sure the old tendency will not reappear. The behavior on 
admission and readmission was peculiarly like that of a de- 
teriorating dementia, yet no definite indications of such a con- 
dition are found in the long periods of observation or in the 
examinations themselves. 
The predisposition or diathesis which led into the first diffi- 
culty is still there, whether hereditary in type or merely con- 
genital we know too little to say. The writer’s own opinion is 
that the boy is a congenital syphilitic who will sooner or later 
give definite evidence of his instability. One point, however, this 
case does emphasize clearly—there is far more to the study of 
an individual than the application of a few tests. 
Yates N. 
Yates N. was a tall, rather sturdy looking boy, one glance at 
whose face gave one an impression that something was wrong. 
He was one month under 14 years of age. He seemed tired and 
depressed and yet did not act so. He cooperated well through- 
out the examination yet seemed emotionally indifferent to the 
whole experience. 
Family history. The family history was gone over carefully 
with the mother, but little of etiological significance was found. 
Yates is the oldest of three children. The other two have been 
no trouble. The paternal grandfather has severe headaches. The 
father is well, works regularly, is a railroad man. The maternal 
grandfather was alcoholic. The mother is intelligent and co- 
operative. The home is good in every respect. 
Developmental data. Birth and early development were nor- 
mal. The child was never ill save with measles and whooping 352 
THE UNSTABLE CHILD 
cough. At 4 years of age he began telling wild tales. He began 
school at 5 years and has reached 8B in a special vocational school. 
Behavior. He has always told the wildest yarns imaginable. 
The “lies” do not necessarily depend upon fear of punishment 
but are often without seeming provocation. He cannot be trusted 
with money and is never shamed by discovery of his thieving. 
He respects his father but has lately been insolent to his mother. 
Truancy has developed this last year. Yates plays little with 
other boys but spends most of his time reading, or playing the 
violin, on which he performs quite well. 
Earlier examinations. None. 
Medical examination. Nutrition good. Hemoglobin 80 per 
cent. Refractive error has been corrected. Has had mastoid in- 
fection in left ear. Incisors spaced but shape normal. Has had 
tonsillectomy. Reflexes are diminished and unequal. Rosenbach 
is positive. All laboratory tests are negative except urinalysis. 
Chronic nephritis? 
Psychological findings. On the Stanford-Binet Yates scores 
13 years, 1 month. With a basal year of 9, he fails only the 60 
W’ords in 10. In 12 he fails on the ball and field, interpretation 
of pictures, and similarities. In 14 he does only the vocabulary, 
induction test, and the alternate repetition of 7 digits. Above 
this he interprets the fables, repeats 8 digits forwards and 6 
backwards. 
The performance tests in general he passes with ease, scoring 
14 on Knox series, passing all of the adaptation series, making 
a perfect score on Healy completion, but falling down to a 12- 
year level on the Seguin formboard. This is entirely a matter 
of speed and not of deficient ability in form comparison. 
Anthropometric measurements show him to be almost as tall 
as the tallest 13-year-old but with low sitting height. Weight is 
proportional to standing height and psychomotor control is pro- 
portionate to them both. 
On literacy, he rates at the 50 percentile for tenth grade. His 
arithmetic is below third-grade performance on the Courtis tests. 
Spelling rates him at sixth grade. Language and geography are 
about up to grade. 
His general information is about average for a boy of his age 
and social level. 
The association series shows quite a high number of individual 
associations. By the use of even a good imagination some of 
them cannot be classed as normal, for instance, spider—ink, NORMAL, BUT— 
353 
carpet—fruit. Sound associations also appear. Repeated exami- 
nations show the same tendencies. 
His story illustrates his attitude. He admits stealing, says it 
is usually when he has a headache and feels bad all over, about 
every two months (confirmed). Says he is not ashamed for the 
things he has done “because it doesn’t do any good.” As for his 
tales he “never saw a boy who didn’t do that.” 
Seven weeks later he was reexamined. He then scored 15 years, 
4 months. He passed all tests through the twelfth year, all above 
that that were done before and in addition, the logical problems, 
clock, cut design, and 7 digits backwards. The Stanford is done 
with far better quality and greater ease. The fatigue incident 
to earlier work is less marked. 
On literacy and association series there is no change. 
Observations. Most of the time Yates reads, but when so 
inclined he becomes very troublesome. He defies authority, fights, 
torments younger boys, sulks if made to perform any tasks. 
Care has been taken to see that work was not assigned when he 
felt badly. 
Diagnosis. Normal in level. His function is somewhat psycho- 
pathic but this has decreased even in the short time he has been 
in the Bureau. As there is the physical handicap which surely 
accounts for his “laziness,” we must give him the benefit of the 
doubt and see whether continued care, with regular living, will 
not decrease the other symptoms. 
Prognosis. Fair. 
Disposition. Paroled home to be kept under observation of a 
specialist for kidney disturbances and to be placed on a farm. 
Subsequent history. Has been getting along well on grand- 
father’s farm. Was tried at home a short time during the winter 
but played truant, or refused deliberately to attend school, so 
went back to the farm where he does nicely. His physical develop- 
ment has been very rapid, and he seems well and strong, although 
he “occasionally” has headaches. Although the parents planned 
to have him receive a much more extensive education, they have 
met the situation wisely and are encouraging his liking for farm 
life and work. 
Agnes U. 
Agnes U. was not a very attractive girl when first brought in 
to us. You have seen her like on any Main Street in the small 
town, and in the nonfastidious movie of the big: city, gum chewing, 354 
THE UNSTABLE CHILD 
slouchy, slangy, with extremely dressed hair, and an “effect” of 
clothes which is but partly achieved, because of the need for 
better food, regular bathing, wholesome work. Washed and 
shampooed and dressed in a plain blue chambray dress, a second 
day’s inspection was still disconcerting. Then she looked like a 
worn-out, starved monotone of what a girl of 14 should be. Her 
own discomfort in the change showed in her ill-at-ease giggle 
with an assumption of bravado now and then. Agnes—could 
reconstruction justify her name? 
Family history. The hereditary handicap reported was not 
light. The father is a shiftless, lazy, profane man, a miner by 
occupation, who feels no parental obligation. His whole family 
is reported as of “doubtful mentality.” The mother is dead. 
Her family is said to include professional people. The grand- 
mother is reported as having been a good practical lawyer (?). 
An uncle is a captain in the army. The sister who is 24 is 
married and runs her own home. She is rather neurasthenic and 
impresses one as weak-willed. Three brothers of 18, 12, and 9 
have given no trouble. 
Developmental data. Agnes had an uneventful childhood. She 
had most of the minor diseases but no serious illness. She has 
always seemed careless, rather destructive, and “hysterical,” 
according to the sister. Her school life began at 6, and she 
reached the seventh grade without difficulty, but failed to pass 
it both last year and this. She has been truant through these 
last two years. 
Behavior. If truancy were the only complaint there would be 
little difficulty in adjusting matters, but the girl leaves home 
without the consent of her father. She spends her time Avith per- 
sons known to be immoral who have a bad influence on her. She 
is idle and resents any supervision. The local court tried parole 
supervision but it was ineffectual. 
Medical examination. An entrance medical examination showed 
good nutrition, carious teeth, adherent tonsils, chronic conjunc- 
tivitis, knockknees, flat feet. A neurological examination was 
negative. All laboratory tests were negative. Teeth were X-rayed 
and attended to. 
Psychological findings. The psychological examination dis- 
closed a mental age of 13 years, 5 months. All tests up to and 
through the tenth year were done readily, but she missed the ball 
and field and similarities in the twelfth year. In 14 she missed 
the vocabulary, induction, and clock problems. Above this level NORMAL, BUT- 
355 
she does the 6 digits backwards and repeats the content of 
selection read (18-year level). Her tests show no peculiarity of 
quality. 
The performance tests show no disturbance in that aspect of 
ability. 
Anthropometric measurements place her in the highest decile 
for standing height, but only in the third for sitting height, and 
the fourth for weight. Both grips are fourth decile in value, but 
lung capacity, despite short body, is up to ninth decile. 
School tests show about fourth- or fifth-grade ability in Eng- 
lish, spelling not above minimal sixth-grade achievement, geog- 
raphy entirely satisfactory for seventh grade, literacy average 
for eighth grade. Arithmetic is rather inaccurate but almost up 
to average for grade. 
General information is fairly good but limited in range. 
The Kent-Rosanoff association test shows inability to retain 
the aufgabe, with consequent usage of phrases. Aside from this 
the reactions are most common and of high value, the average 
value being 152. 
Repeated tests show little variability. 
A month later the Stanford was re-given with a mental age of 
13 years, 7 months. The distribution is similar to that of the 
earlier examination, but she fails on both 5 and 6 digits back- 
wards this time, and on the arithmetic problems in 14. She 
shows gains on the enclosed boxes, the ingenuity problems, and 
the similarities. 
Observations. She chooses the worst girl in the cottage for 
her bosom friend. She is surly, churlish-natured. She does not 
like to work, but soon adapts, and becomes a trustworthy helper. 
Does not get along very well with girls. 
Agnes’ story is as follows: After her mother died her father 
was cruel to her, made her work too hard, would not let her have 
any girl friends, cursed her, and refused to buy her proper 
clothing, although he had money to do so. She wore the same 
dress to school all last year, and when it was soiled had to wash 
it out at night. Her aunt came to keep house, and as she and 
her father quarreled constantly, Agnes was between Satan and the 
saltwater. “How could I mind when I had two or three bosses 
all pulling in opposite directions ?” She knew disobedience might 
mean the Industrial School but “anything would be better than 
home.” She declares she likes best to go to church and wants 
to be a missionary or a nurse! 356 
THE UNSTABLE CHILD 
Diagnosis. Normal in level with function practically normal. 
Minor indications of psychopathy are not sufficient to modify 
disposition. 
Recommendations. There seems to be good reason for giving 
the girl the benefit of the doubt. Her delinquency has appeared 
since the home lost the mother, and there is enough against the 
father to justify the girl’s interpretation of the situation, although 
the artistic touch of wanting to be a missionary or nurse shows 
her tendency to plausible lying. The sister wants to try her in 
her own home, so we will give parole opportunity to make good. 
Prognosis. The pessimism (?) of part of the Staff leads to 
the statement that there is little chance of her succeeding for any 
length of time. 
Subsequent history. Seven weeks later Agnes returned. The 
sister had refused to keep her any longer. Agnes had had a good 
position but could not hold it. She was impudent, saucy, boy- 
struck, sought wrong companions. The physical examination 
made at this time revealed definitely that she had been immoral. 
Full corrective work which could not be afforded before was now 
done, eyes refracted, and tonsillectomy performed. 
Psychological examination. On the Stanford-Binet she scores 
14 years, 1 month. She shows even lessened ability in rote repeti- 
tion of digits, missing 7, and fails on the comparison of President 
and King, which was formerly done. Her gain comes, because 
of repetition probably, on the arithmetic problems, the fables, 
and the cut design. Performance tests show lessened ability. 
Seguin score is 11 years instead of 13, Porteus score is only 10. 
Anthropometric measurements show increased weight and im- 
provement in both grip records. 
The association test has even more common reactions than 
before. The average word value is now 153. This is the type of 
distribution we have sometimes found in beginning deteriora- 
tions, and that is the tendency here, correlated as we find it with 
decrease in rate and actual ability on performance tests, and 
dropping down on rote memory tests on the Stanford. The test 
attitude is also different. The girl is spiritless, quieter, somewhat 
“tired” seeming. The association curve continued gaining in 
common reactions until at the end of our study the average value 
was 200. 
Observations. Agnes seemed so capable, potentially, that de- 
spite the sex history we decided to keep her indefinitely, fitting 
her into one of three positions wre were allowed for keeping NORMAL, BUT— 
357 
children and paying them a small wage. At first she did fairly 
well. She was scheduled half time as cottage helper and half 
time as relief on a simple switchboard in the office. Soon dubious 
reports began coming in. She was careless in her work, not 
thorough or neat. She told wild tales of her future plans. She 
bragged in the cottage about her special office privileges (with- 
out basis), and was cross to small children. Lied. Fought con- 
stantly with lesser employees (of about her own mental caliber). 
Time and again she was reprimanded, corrected, privileges re- 
moved, but trouble continued until she used every opportunity 
possible to make acquaintance with men on the outside. She even 
contemplated eloping. After repeated trials for four months, 
the Staff agreed it was not right to give her any further chance 
when more hopeful cases were in need of the limited service we 
could give. 
Disposition. Assigned to Girls’ Industrial Home. 
Prognosis. Poor. 
The thought can hardly help passing through the reader’s 
mind, “These are the most interesting and unusal cases of 
the group,” hut indeed it is hard to choose between those 
reported in detail and those not. We have the spectacular 
case of Naomi who came in suspected of feeble-mindedness 
and had won a year’s free fellowship at a good art school 
within a few weeks thereafter, purely on the merits of her 
own untaught efforts. Yet to-day Naomi is far from a 
successful case. She has had periods of mental confusion 
and dependency, through which only the kindly personal 
efforts of those who were responsible for her as a juvenile, 
but whose responsibility was definitely removed by her 
twenty-first birthday, have kept her supervised until she 
could gain health to go on a little while again. There is 
Marie who writes poetry and lives a life of romantic atten- 
tion to every man she sees; Queed, whose wanderings as a 
living dictionary have taken him half the distance across 
the continent; Roswell, a chance victim of society’s toler- 
ance of vice; Ida, whose own experiences equal any tales 
one wishes to hear of dependency, immorality, and sodden 358 
THE UNSTABLE CHILD 
married life. What more could one meet in everyday life ? 
The group represents the level of the group among whom 
we have to live. It represents also the handicaps, trage- 
dies, romance, sordidness, glamours, and the humor of the 
world we know. Let us emphasize the significance of this 
group. They test normal. They are abnormal, or a-nor- 
mal. How can the two statements be reconciled? Merely 
by a recognition of the fact that mental age is not in itself 
any guarantee of normality. Beyond mental level lies 
the whole field of functioning, of efficient usage, of prob- 
able disturbances and deviations. This is the reason we 
find those who are normal, but—. CHAPTER XVIII 
intelligence plus delinquency 
The individuals who score above 14 on the Stanford are, 
so far as there are any statistical criteria, above the av- 
erage rating of the social group. In this study there were 
available a total of 369 children. Of that number but 23 
scored between 13 and 14 years in level. These individuals 
have been reported in detail. Thirty-one others scored 
even higher on the intelligence ratings. These 31 are, be- 
cause of their higher level, more certainly normal in the 
amount of intelligence with which they are endowed. The 
person who refuses to acknowledge 13 years as average 
adult endowment has less cause to complain of the classi- 
fication of this group as “normal.” Yet this very group 
forms the quintessence of the difficulties which the 369 
cases managed to demonstrate in court, in homes, in the 
community, and under institutional regime. 
Between 14 Years and 14 Years, 11 Months Mentally 
There are 12 who scored at this level. They are all be- 
tween 13 and 17 years of age, and 5 of the 12 are girls. 
There are none but native-born whites in the group. 
I.Q. Their intelligence quotients range from 111 to 83, 
with all but 4 of them over 90. 
Delinquency charges. The offenses enumerated against 
this group include stealing in 6 instances, immorality in 
5, incorrigibility in 3, and forgery, cruelty, and laziness in 
individual instances. Additional delinquencies appear as 
the cases are investigated, but these were not in the original 
charges. These accessory indications of trouble are more 
359 360 
THE UNSTABLE CHILD 
apt to be wandering from home and persistent pathological 
lying than anything else. 
School grades. There is none of the group who has not 
reached at least seventh grade, whereas 2 have finished 
tenth grade. The average is 8.3 grades of accomplishment, 
with a deviation of less than a grade. 
Stanford range. On the Stanford this group is not capa- 
ble of very high basals. There are 5 with a basal of 9, and 
5 with a basal of 10. One goes back to 8 for a basal, and 
1 has a basal of 12. All but 3 do tests in the 18-year level, 
and these 3 do tests into the 16-year level. Consequently, 
the number of years of range above basal averages 8, with 
a deviation of less than a year. 
Stanford distribution. The tests failed on vary some- 
what in their relationship to each other from what we find 
in the groups testing below 13. The weights is the only 
9-year-level test missed. The design and the reading are 
hardest at the 10-year level, the ball and field at the 12- 
year level. In the 14-year group of tests the comparison of 
President and King, and the repetition of 7 digits are 
both missed 8 times out of 12. The vocabulary is the next 
in difficulty, whereas the induction test is the easiest of 
all. Vocabulary is the hardest test at the 16-and 18-year 
levels, and the fables and the cut design are the easiest 
at their respective levels. 
Stanford quality. The quality of the test performances 
is not as markedly abnormal as with lower level groups. 
The intelligence of these individuals is too high for the 
tests to make difficult enough demands upon it to bring 
out abnormalities in any marked degree. However, there 
are motor-control difficulties in drawing the diamond in 4 
instances, and abnormality in design production in 6 in- 
stances. Similar trouble shows in the code and the cut 
design occasionally. Verbal tests bring out idiosyncrasies 
in several instances. INTELLIGENCE PLUS DELINQUENCY 
361 
Association distribution. Of course, all of this group 
succeed in meeting the conditions of the association test, 
although there are anywhere from 1 to 20 phrases in the 
reactions of two-thirds of the group. Individual reactions 
range in frequency from 2 to 14, with only 3 individuals 
giving over 10. 
Association quality. The association quality is of far 
more importance. In practically every case it was a re- 
liable and definite mirror of the complexities and difficul- 
ties of the individual’s life. As such, it was tentatively 
taken as one guide to common sense analysis. Unfortu- 
nately a great deal of such work could not he done, even 
in the cases which needed it most. This was not so much 
a matter of the limitation of time of observation, as a mat- 
ter of the inability of the individual to cooperate. Despite 
the general warning of analysts that certain types of in- 
dividuals cannot be analyzed, no such an inability was as- 
sumed in handling any case, but a practical test of his in- 
ability was itself made the basis for giving him such aid or 
withholding it. In other words, each child giving indica- 
tions of the presence of complexes was analyzed to the point 
where lying, hysteria, inability to comprehend, or indiffer- 
ence prevented further work. As a result, much time may 
be said to have been wasted, but it was wasted with the re- 
sult that the examiners definitely knew that the limiting of 
further work was justified by the limitations of the indi- 
vidual himself. 
Performance tests. On performance tests this group 
varies considerably. The Seguin formboard shows a varia- 
tion in score of from a 9- to a 14-year level. None fails to 
complete all of the moves on the Goddard adaptation board. 
The imitation series places one at an 8- and one at a 10-year 
level and all of the rest at from 14 to 16 years of level. 
On the Porteus the range of ability is from 8 to 12.5 
years, with an average age of 11 and a mean variation 362 
THE UNSTABLE CHILD 
of a year. On the Healy completion board the scores range 
from that equal to a 5-year level to an adult performance. 
The average performance is 11.5 years with a mean varia- 
tion of 2.9 years. 
School performance. In school work the group varies 
as greatly as in other tests. The literacy scores range from 
21 to 45, with an inaccuracy ranging from 0 to 25 per cent. 
In arithmetic, all save 2 do about fifth-grade work as a 
minimum. These 2 do but poor third-grade work. None 
does less than seventh-grade language work save 1, whose 
reactions are so delayed and inhibited that tests are of 
dubious value. This individual does about fourth-grade 
geography, and the 2 who are so poor in arithmetic do 
about fifth-grade in that subject, all of the rest scoring 
sixth- to eighth-grade. In spelling, none scores less than 
seventh-grade, save the same 2 who are inferior in other 
branches. 
General information. In general information, the group 
has a normal record with one exception. This is a girl 
who has had the chance to learn a great deal but who seem- 
ingly absorbs nothing to which she is exposed. The failure 
on this test is indicative of her failure on everything in 
which she has been tried. 
Own story. Their stories are indicative of some disturb- 
ance in all but 2 instances. Persecutions, adventures, mys- 
teries, and crimes abound in them. Investigation reveals 
that without a doubt the owners have made use of their full 
quota of intelligence in interpreting their past experiences, 
for lurid and hectic reports fall into commonplace ex- 
periences when impersonally determined. 
Behavior under observation. While under observation 
this group was seemingly normal in behavior. An attend- 
ant, or a matron of the usual level of intelligence would 
report most of them as well-behaved and cooperative. The 
observation of their actual deviations from good behavior INTELLIGENCE PLUS DELINQUENCY 
363 
required a trained individual. The group may be charac- 
terized as being verbally acquiescent. They seemingly fit 
into the situations they meet. Their intelligence enables 
them to veil their own deviating desires. They are not fre- 
quently caught, and when they are, they still have a re- 
source for escape, their superior ability to explain away 
their behavior. 
Otto X. 
Otto X. is perhaps the best example of this which the group 
of 12 affords. He is only 13, up to grade in school, above normal 
level on the tests. He is attractive, well developed, really hand- 
some, with his enormous dark eyes, long black lashes, and a 
normal pallor seldom found save in Jewish children. His man- 
ners are those of a courtier. He introduces his mother to the 
Staff with an ease adults might envy. His conversation is intelli- 
gent, and he assumes adult views and expresses them in a way 
that holds one’s attention. A stranger meeting him for the first 
time would not suspect that he was other than a normal boy of 
superior intelligence. One person working with him day in, day 
out for several weeks was misled by his casual explanations of 
most troublesome behavior. In all he says and does, however, 
there is present an egotism that is the secret of the difficulty in 
handling him. He has always proven self-sufficient. Although 
he has a real love for his mother and habits of respect which a 
good home has drilled in, yet he is contemptuous when she tries 
to discipline him, and tries to evade issues by verbally acquiescing. 
Such episodes do not modify his behavior fifteen minutes later. 
A lawyer might well admire his linguistic ability which so often 
appeases wrath, is taken to mean promise of atonement, and 
which yet leaves him untrammeled by any actual disciplinary 
measure. This is a functional disturbance which precludes nor- 
mal adult life unless it is checked and corrected. 
The other eleven have more or less resemblance to this 
case. Some have come under public care because they are 
more menacing in their proclivities, and not only protect 
themselves and their acts with agility, but extend their 
stories into the field of accusation of others. In a way, a 364 
THE UNSTABLE CHILD 
goodly part of the other offenses of the group grow out of 
this tendency to superficial and verbal adaptation to life. 
The boy who forged merely put onto paper his assumption 
of power he did not possess. At least 3 of those who stole 
felt it a justified need. They could not carry out their at- 
titude of superiority, since they needed objects to confirm 
it or strengthen it. These they acquired by stealing. In 
general, the delinquencies of the whole group seem to be 
the expressions of inferiorities felt and compensations at- 
tempted. From the standpoint of the community the group 
seems less troublesome than the 13-year and lower level 
groups. The stealing is confined to the home in most in- 
stances. The home made the original complaint in most of 
the cases. In at least half the cases, the families are well- 
meaning and cooperate in handling the child. The higher 
mental level of the cases has a tendency to mean more self- 
control. Even though it is superficial, it is enough to 
enable the individual to appear as the rest of us, in the 
ordinary contacts with the group. This superficial compli- 
ance with convention and law finds no counterpart in the 
child’s actual life. Camouflaged and evasively indulged in, 
his abnormality is just as definite and serious as that of a 
more candid lower level offender. Indeed, it is more 
serious. The intelligent offender evades suspicion and de- 
tection for a longer time. He has a longer time to develop 
his wrong habits. He gains more confidence in his ability 
to evade detection and punishment. His wrong-doing de- 
viates farther and farther from right behavior. At last a 
major offense brings him to justice, too late for his own 
good, too confirmed in wrong habits of thought and wrong 
behavior to be easily remodeled into a good citizen. 
Medical findings. Physically, the group gives indications 
as marked as those found in the lower level children. These 
12 are not well-balanced, well-nourished, ‘ ‘ sound ’ ’ individ- 
uals. Two of the 12 are known congenital syphilitics. One INTELLIGENCE PLUS DELINQUENCY 
365 
of these has been immoral, but the presence of structural 
stigmata indicates that this behavior is more apt to be a 
result of the instability, due to the presence of syphilis, 
than that the syphilis is a result of the immorality. These 
congenital syphilitics have marked disturbances of the 
patellar reflexes and poor teeth. One case has very poor 
vision and is deaf. The other 10 have decreased or increased 
patellar reflexes in 8 cases, defective vision in 2 instances, 
bone abnormalities in 2 cases, and minor stigmata of in- 
ferior development in practically all of them. 
Morphological measurements. Anthropometrically, the 
group is not homogeneous. There is a sub-group that is 
barely up to average height and another group which is 
above average in this respect. The whole group is low in 
sitting height, although here again there is a double distri- 
bution. In weight, grip, and lung capacity the same dual 
tendency is discernible. 
Heredity. The heredity of this group is not “ clear. ” In 
2 instances the insane diathesis is direct and definite. In 2 
others there are reliable histories of syphilitic infection 
with its effect upon the whole family group. Four other 
families are definitely neuropathic, with nervous difficult 
mothers, irascible or peculiar fathers, and epileptoid quali- 
ties in some members of the family. In 2 of these cases 
the father has died, and the mother has to meet the needs 
of her family alone. One family has a definite criminal 
record, another is inferior throughout, and in one instance 
both parents are dead. The other family has a doubtful 
history of intermingling tuberculosis and alcoholism. 
Diagnoses. How could one diagnose a group such as this ? 
They are normal in level, but in each and every instance 
a qualifying phrase must be added. One boy seems to be 
without any mental instability but he has been poorly 
handled and needs definite help along lines of reeducation. 
Five show marked indications of psychopathy, marked 366 
THE UNSTABLE CHILD 
enough to make correction dubious. Two show numerous 
indications of some type of deterioration. Both of these 
cases have been worked with intensively without improve- 
ment. One gives a 4 plus Wassermann, and the other is a 
syphilitic suspect, although all tests have been consistently 
negative. One case is practically a pathological liar with 
a marked sex and family complex, yet it does not yield to 
analytic treatment. Two others are psychopathic and of 
the type which we recognize as predements. They have 
mild delusional content but it is unorganized, and not en- 
tirely without a suggestive basis in their own experiences. 
They are hysterical. One is highly euphoristic, the other 
is paranoid. Both are entirely undependable. The group 
is not a hopeful one in any way. 
Between 15 Years and 15 Years, 11 Months Mentally 
When we turn to a study of the 15-year-level group, we 
find a highly similar condition. Thirteen of the 369 tests 
at this level, 8 boys and 5 girls. The group does not seem, 
when one views them in the light of experiences with them, 
to be much more intelligent than the 14-year-level group, 
and they are equally troublesome, if not more so. To briefly 
summarize the findings with them: 
Age, sex. In age they range from 13 to 18 years with an 
average of 16. One boy is a mulatto, but all of the others 
are whites of native American stock. 
l.Q. Their intelligence quotients range from a lower 
limit of 93 to a score of 115. 
Delinquency charges. The delinquency charges for the 
group are serious and manifold. It seems wise to enumer- 
ate them in detail. 
1. Runs away. Steals. Writes vile and immoral notes. Poisoned 
a valuable dog. Rides freights. Threatens people. Tried 
to shoot up the town with a revolver. Has been at INTELLIGENCE PLUS DELINQUENCY 
367 
industrial school three times and each parole his “con- 
duct is more grievous.” 
2. Sly. Lies. Steals. Runs away. Thinks he is an electrical 
genius. 
3. Lies. Steals. Forges. Hysterical and immoral. Tried 
suicide. 
4. Stole auto. Incorrigible. Other stealing charges. 
5. Immoral and also homosexual. Seeks men everywhere. 
Acknowledges promiscuity. 
6. Steals. Stubborn. Actually uncontrollable in the community. 
Runs away. Very quarrelsome. Lazy at times. Not 
dependable for any sort of work. 
7. Stayed away from home over night. Immoral. 
8. Always been obstinate. Truant from home and school. 
Numerous thieving episodes. Industrial School three 
times. Lies. 
9. Victim of rape. Girl appealed for help, of own accord. 
10. Immoral. Diseased. Runs away to be with men. Obstinate. 
Temper. 
11. Steals. Lies. Ungrateful and unmanageable. Stays out 
late nights. 
12. Runs away from home and schools. Married a practically 
strange girl recently. Is a minor. Steals. Grandiose 
ideas. 
13. Steals all sorts of effeminate articles. Homosexual and has 
been accustomed to perverted practices. Thinks he is an 
artist. 
School grades. The group ranges in school accomplish- 
ment from sixth to eleventh grade. The average is 9 
grades finished. 
Stanford range. The range on the Stanford is propor- 
tional to that of the lower mental levels. Only 3 pass all 
tests through the twelfth year, 4 have a basal of 10, 3 have 
a basal of 9, and 3 have basals of 8 years. All but one do 
tests through the eighteenth year. 
Stanford distribution. The distribution of failures is 
not highly significant. Below the twelfth year they are 
scattered. The ball and field and the reversion of 5 digits 
are the most difficult for these higher level cases. The vo- 368 
THE UNSTABLE CHILD 
cabulary and the repetition of 7 digits are the most diffi- 
cult of the 14-year-level tests, although they are nearly 
equaled by the scores on the differences between President 
and King and the problems of the reversed hands of the 
clock. The vocabulary at 16 is passed by only 1 child, and 
the next most difficult task is the repetition of 6 digits back- 
wards. At the 18-year level the only noteworthy facts are 
the ease of the cut design and the repetition of the thought 
from passages read. The first of these is passed by 8 of 
the 13 children and the latter by 7. 
Stanford quality. The quality of performance on this 
series is practically normal throughout, although drawing 
tests give one or two indications of pathological trend. 
Association distribution. The association test is given 
successfully to all of the group. Eleven of the 13 give 
phrase reactions. The number given varies from 1 to 14. 
All of the group give other single word reactions which are 
individual. These range in frequency from 3 to 25. 
Association quality. The test shows practically every 
one of the individual traits of the various individuals. In- 
feriority, sex interest, pessimism, ideas of persecution, sul- 
lenness, discouragement, race complexes, are all revealed. 
These were a tremendous help in corrective work. 
Performance tests. In performance tests some of this 
group show significant defects. On the Seguin formboard 
there is a range from 8-year to 14-year scores, with an av- 
erage performance of 12 years. In the adaptation test all 
score perfect except one who can do only the 6-year-level 
turns. On the imitation series the scores range from 
a 7- to an 18-year level, with an average score of 14.4 
years. Only one individual scores below the 10-year level, 
and this is the girl who scored only 6 years on the adapta- 
tion series. On the Porteus series the performance ranges 
from 11.5 years to a 14-year level. In some of the cases 
the quality of the performance is very erratic and peculiar. INTELLIGENCE PLUS DELINQUENCY 
369 
In the Healy completion test the scores range from a 6-year 
level to an adult level, the variation being so widespread 
that an average is misleading. 
School performance. On the literacy, the group ranges 
in score from 29 to 39 points. The general inaccuracy is 
low, ranging from 0 to 16 per cent, with only 3 scoring over 
10 per cent of errors. They are much poorer, however, 
than even the 14-year-level group in arithmetic. One can 
barely do second-grade combinations, 3 barely pass third- 
grade work, 1 does fourth-grade work, and the rest would 
be credited with full-grade accomplishment. In geography, 
all achieve at least a fifth-grade average and the mode of 
performance would give them credit for the completion of 
eighth grade. Language is somewhat poorer with a range 
of ability from fourth to eighth grade, but with an aver- 
age achievement of only 6 grades. In spelling, they range 
in ability from fifth to eighth grade with an average of 7 
grades of work accomplished. 
General information. With three exceptions the general 
information and orientation of the group are good. These 
three individuals were all too definitely psychopathic to be 
in any normal relationship to their own environment. 
Own story. In telling their own stories, 7 of the 13 give 
marked pathological indications. Paranoid ideas, grandi- 
ose loquacity, extreme affectation, perverted sex manner- 
isms, lack of affective tone appear in obvious form, as well 
as actual delusional content. 
Behavior under observation. Under observation the 
group is difficult to handle. They are intelligent enough 
for working with them to become a daily battle of wits. 
They aim at their own satisfaction, and have no code of 
honor to be violated in achieving it. They are egoists in 
all but one or two instances. 
Medical findings. The medical findings reveal little 
wrong with most of them. One was a marked case of vago- 370 
THE UNSTABLE CHILD 
tonia and delayed maturity which yielded remarkably to 
the feeding of testicular extract. Two were congenital 
syphilitics, one with a positive Wassermann, the other nega- 
tive but with a definite history and laboratory tests cor- 
roborating the father’s condition. Two others had small 
goitres. 
Morphological measurements. Measurements indicate a 
group which is well above the average in its standing 
height, about average in distribution for sitting height, 
definitely above in weight, and, with two or three excep- 
tions, equally superior in grips and lung capacity. 
Heredity. The heredity cannot be blamed or eliminated 
in some of the cases. In one case nothing is known save 
that the boy inherited syphilis. In another case the family 
tree is clean save for the early youth infection of the father. 
Three histories indicate families of doubtful standing, but 
certainly inferior in some ways. Three families have an 
inheritance of insanity, and three others are neuropathic to 
a high degree. Criminality is present in one family, and 
little is known of the other two. 
Diagnoses. This group may be definitely diagnosed as 
normal in level on the Stanford-Binet, and most of them 
are fairly normal on the majority of the other tests given, 
but the behavior, the quality of the test findings, the orien- 
tation defects, the tales of their own experiences, point 
away from a plain unmodified diagnosis of “normal” in 
most of the cases. The girl who appealed for help of her 
own accord is undoubtedly normal. The boy who was under 
gland feeding seems to be becoming normal. Two others 
have reached the stage of permanent commitments to state 
hospitals. The others have been sent to industrial schools, 
handled here and there in an effort to give them what the 
state does not provide—prolonged treatment as psycho- 
paths. None of them seems to be surely on the road to 
future normality. Perhaps a story of a case will best illus- INTELLIGENCE PLUS DELINQUENCY 
371 
trate the complexity of the problem as each and every one 
presents it. 
Opha Y. 
Opha Y. was perhaps the most interesting case the Bureau 
ever handled. For one thing, Opha’s whole personality seemed 
so different, to the casual observer, from what her history would 
lead one to expect that that alone made her worth studying. 
At the time she was committed she was 16 years and 8 months of 
age. She was tall, slender, graceful, and extremely well-dressed. 
Her face was rather piquant and rendered striking by the care- 
fully thinned and highly arched eyebrows, the wonderfully coiled 
and waved hair, the skilfully applied rouge. In manner she 
might have been a society woman of forty, with the hauteur 
which comes from a knowledge of exclusive position, money, 
prestige. Her voice did not spoil the picture. When she was 
taken to our cottage and introduced to the matron, she grasped 
the poor woman’s moment of blank amaze and kindly assured 
her that she was sure they would be good friends! 
Heredity. The father, himself, placed the original court 
charge against the girl, over two years ago, when they found it 
impossible to handle her. He is a well-meaning, skilled laborer 
and is much interested in Opha. He has recently been divorced 
by the woman. He drinks but shows little effect of the liquor. 
He is reported as high tempered and quarrelsome. At the Bureau 
he told varying stories to various people, was hypersuggestible, 
easily excited, temperamental. He was sensible but not stable! 
The mother was supporting herself at this time. Significantly 
enough, despite her husband’s very high wages, she had been 
unable to secure any alimony. She has since married again. 
She does not understand the seriousness of the girl’s behavior 
and constantly harps upon having her home. Her letters to the 
girl are very emotional and highly sentimental. She admitted 
to a responsible probation officer, three months ago, that she and 
her husband had syphilis before this child was conceived, and 
the baby was covered with sores. Now she says this was gonor- 
rhea. Our physician believes the child’s condition was merely a 
temporary illness. There is one other daughter, two years older 
than Opha. She was a stenographer and held a good position. 
She since married. Nothing else is known concerning the family, 
save that the maternal grandmother was tubercular and her hus- 
band alcoholic. 372 
THE UNSTABLE CHILD 
Developmental data. Opha walked at 14 months, talked at 2 
years. At 3 years of age she was badly frightened. She caught 
fire and had several serious burns. She has had mumps, chicken- 
pox, and diphtheria. The mother thought she was all right until 
12 years of age; was lovable and attractive until that time. 
School progress. Opha completed the grades but did not like 
school very well. Would have had to repeat seventh and eighth 
grades if she had not gone to summer school. Had some business 
training after completing eighth grade. 
Economic history. Opha has held many positions and has been 
found unsatisfactory wherever placed. She has forged working 
certificates again and again, giving her age as 19 or more. She 
was examined by one of the psychological laboratories in C . . . . 
and placed in one of their own offices. There she forged signa- 
tures to records and erased entries on her own case record, ex- 
plaining that the entries were not true, and she knew they wanted 
only the truth. She “lost” important data, later discovering it 
in bad condition. There and elsewhere she has been a constant 
annoyance because of boasting. She claimed to be married, 
showing a wedding ring. She blued circles under her eyes, 
blackened her forehead to simulate a bruise, had spells of weak- 
ness. At Christmas she gave away dollar merchandise orders 
freely although earning only $7 a week. She changed sales 
checks and proved incompetent as well as unreliable. 
Behavior. Opha’s real trouble is said to have begun a little 
over three years ago. She fell against a chair and hit her breast 
and blames that for her heart trouble. About that time she tried 
to commit suicide by turning on the gas in the bathroom, and the 
physician summoned to attend her reports that she was actually 
as much of a problem then as now, and that her mother did not 
know how to manage her. Two years ago she ran away from 
home, stayed at hotels, and allowed a man whom she “was think- 
ing of marrying” to pay her bills. She went to a neighboring 
city with another man and admits attempted intercourse with him, 
hut all the details of the hotel, location, and man’s name have 
been proven absolutely fictitious. She worked spasmodically, and 
finally, by the father’s efforts, was returned to her home and then 
placed in a resident school. In a few days she -was sent to a 
hospital because of her heart symptoms. From there she was 
sent to a convalescent home from which she was discharged as 
a disturbing element. Back once more in the community she 
sought excitement. She published her own death notice, sent INTELLIGENCE PLUS DELINQUENCY 
373 
herself telegrams, carried a revolver for protection, worked under 
various aliases, bought clothes and charged them under an as- 
sumed name, sent herself gifts, wrote letters supposed to be from 
a French girl, addressed envelopes filled with blank paper to 
soldiers, stole many things, had frequent spells on the streets 
necessitating being taken home in taxis, constantly tried to look: 
dissipated, and proved to be a most persuasive and persistent liar. 
Earlier examinations. Ten months before admission, at the- 
age of 15 years, 10 months, Opha tested 15 years, 1 month. With; 
a basal year of 12 she failed the logical problems and the clock 
problems in 14, and the vocabulary, code, and 6 digits backwards 
in 16. She passed the digits forwards in 18. She was later 
examined by the court psychologist and psychiatrist and diag- 
nosed as a case of hysteria. This diagnosis has been made at 
four different times by different workers. 
Medical examination. Stokes’-Adams condition of extra-auric- 
ular beat 2 to 1 of ventricles. Respiration of right side of chest 
is twice that of left side. Fluoroscope showed extra systole. 
Throat positive for diphtheria. Purulent vaginal discharge. 
Quarantined. Treated. All laboratory tests negative except that 
a second examination showed she had gonorrhea. 
Psychological examination. On the Stanford-Binet Opha 
scored 15 years, 3 months on admission. This time she fails on 
5 digits backwards in the twelfth year. She gains on the logical 
problems in the fourteenth year, the code in the sixteenth year, 
and the design in the eighteenth year, but loses the differences 
of abstract terms and the enclosed boxes in the sixteenth year. 
In performance tests she is fair in comprehension, but not above 
a 12-year level in control, and at only 10-year level in imitative 
learning. On academic tests she scores high-school level in 
literacy, but barely sixth-grade performance for English and 
geography, whereas arithmetic is about fifth grade. Her asso- 
ciation test value is 176. The reactions are delayed and cover 
complexes seemingly related to sex. Despite this, the tqst shows, 
on repetition, a constant and increasing tendency towards dis- 
sociation. She is deoriented for earlier experiences. 
Opha was willing, demure, and pathetic in manner during the 
examination, but she was too willing to agree with the examiner, 
and varied her statements time and again in an attempt to meet 
approval. She was so evidently motivated by a group of com- 
plexes that an attempt was made at psychoanalysis. This suc- 
ceeded for five interviews, and then she began to offer resistance, 374 
THE UNSTABLE CHILD 
showing marked antagonism towards the analyst. In three more 
interviews this antagonism grew to such a point she could not 
make a truthful statement, even about things she had discussed 
openly at earlier interviews. Work was continued but each bar- 
rier broken down revealed another forming itself. Her major 
•complexes gave an infantile attitude towards the mother, which 
was ramified into a masochistic desire for petting and scolding 
from all women. With this was an expressed hatred of her 
father—and of all men—hence, of marriage. Besides this there 
was a philia for trees, developed to such an extent that she dreams 
of a tree lover. She clung closely to her feeling of physical in- 
feriority because of her heart condition—it evidently justified 
her attitude of dependence upon the mother. If one were to 
stop here, the case seems far from complicated, but, as a matter 
of fact, her hysteria hides itself deeply below these apparent 
difficulties. She actually wants to get married but has been seem- 
ingly disinterested because of the fear of childbirth. An antag- 
onism towards all people whom she has known more than a short 
time is quite marked. She feels neglected, abused, hurt, and very 
much depressed according to her statements, yet those very state- 
ments will be made with a very cheerful smile on her face. Her 
accusations are vague and without any basis in fact, for corrob- 
oration has been attempted. She has crying spells in which her 
face becomes greatly flushed and tears flow freely, yet in a mo- 
ment or two she is laughing and happy. She undoubtedly has 
no definite relation between her actual bodily innervations and 
her statements of well-being or depression. Her antagonism 
towards the examiner increases in proportion to the refusal of 
opportunities (artificially created) to assume the maternal role. 
Even slight interest or rebuke or assumption of authority de- 
creases her discomfort. She loves all those who do not force her 
to an adult assumption of reality. 
Behavior under observation. Life with Opha is not monot- 
onous. She tries many and varied ways to obtain the attention 
she desires. She makes clandestine arrangements to meet the 
next-door neighbor. She simulates lack of appetite and uses 
children of inferior mentality as dupes to obtain for her the food 
she desires. She blues beneath her eyes, on her lips, even on her 
finger-nails. She tells “accidently” of fainting spells when no 
one was near. She simulated a fever by a careful exposure of 
the thermometer to an electric heater beside her bed. Tore up her 
own credit record, thus losing a week’s privileges, to be able to INTELLIGENCE PLUS DELINQUENCY 
375 
blame an employee who did not cater to her. Accused people of 
spying on her, of having other children spy on her and on the 
one young boy whom she liked. When kept in bed because of 
her heart condition, she ran away and was gone all night, leaving 
a note in which she accused the physician of making an invalid 
of her and of not realizing that she was being deceived. She 
was no worse physically for the exercise. 
Diagnosis. Level: normal. Function: psychopathic of the 
type which is usually diagnosed as hysteria. There are certain 
paranoid tendencies, however, and an alternate depression and 
exaltation which is almost an artefact, for it lacks the proper 
affective toning. These facts, considered in the light of her social 
history, practically confirm a tentative diagnosis of paranoid 
hysteria of syphilitic origin, such as is described by Kraepelin. 
Recommendations. Continued observation was desired and she 
was sent to a state hospital, but her diphtheretic infection neces- 
sitated quarantine. As there was no state institution under whose 
care this could be given for an indefinite length of time, she was, 
of necessity, returned to the local court. 
Prognosis. She will be one of those people who make the 
round of institutions and agencies throughout their whole life. 
Subsequent history. She W’as discharged from the hospital 
wherein her throat was treated. After this she drifted over the 
state from one corner to another. She was on the stage. Finally 
she married a man as unstable as she, who was committed to a 
state hospital within a few months. Shortly after this the girl 
simulated an abortion. At intervals she works rather quietly. 
She has drifted back to visit several times and her lies are never 
less, nor less conclusively delivered. 
The individuals who test 16, or over, number only 6. 
Three of these score a mental age of 16, and the others 
score over 17. The number is so small that the generaliza- 
tions are impossible. There is no reason to believe that this 
group of 6 in any way represents all of the possible types 
that may or might be found in larger groups of cases, or if 
those studied were less definitely the more unusual prob- 
lems confronting a court. No two of the group are at all 
Mentality Above 16 Years 376 
THE UNSTABLE CHILD 
alike, and one can easily imagine numerous cases, which 
vary indefinitely from the attributes embodied in this 
group, without necessarily presenting many new factors. 
One of the 17-year-level group gives a plus Wassermann. 
She happens, also, to be the individual who shows least 
response to corrective attempts. Two of the others, al- 
though they give negative laboratory findings, have minor 
physical stigmata and reliable histories of parental infec- 
tion. One of these belongs in the 17-year-level group, the 
other at the 16-year level. The latter has become psycho- 
pathic enough to be sent to a state hospital. All of the 
others in this group are psychopathic, but just what the 
outcome will be, it is hard to say. One case history will 
suffice as an illustration of the difficulty of the problem in 
general. 
Benjamin S. 
Benjamin is a tall, lithe, pleasant-faced boy. He is highly 
courteous, pleasant in conversational manner, responsive, seem- 
ingly trustworthy, and yet a little effeminate. When admitted, 
he was just 17. 
Heredity. Little is known about the family. The mother is a 
nervous, high-strung woman who has had the care of the boy 
and who has been indulgent rather than sensible in raising him. 
The father was a heavy drinker who consorted with women of 
all types. The parents separated when he insisted upon living 
with another woman. The mother, herself, and her married 
daughter have bad reputations. There were four conceptions 
from this mating. The first was the daughter mentioned above. 
Benjamin was the next child. The third resulted in a miscarriage, 
and the fourth in a child who died when 2 days old. 
Developmental data. Benjamin was born at 7 months. The 
mother attributes this to “red measles’’ from which she was 
suffering. He developed the same disease one week after birth. 
Growth seemed normal and uneventful until teething began, then 
he developed convulsions. They persisted at irregular intervals 
until he was about 3 years old. At 4 years he had typhoid fever 
and had to relearn walking. Nocturnal enuresis persisted until 
14 years of age. He has always had headaches and flighty spells. INTELLIGENCE PLUS DELINQUENCY 
377 
At times he gets depressed and will stay in the house for a week 
and speak scarcely a word. Other times he is very happy and 
sings. 
School grade. Benjamin entered school at 7 years and finished 
the first eight grades. He never failed, but he did not like school 
work. 
Economic history. He has worked in a railroad shop and 
before commitment was working in a shoestore, earning $3 a day. 
Delinquency charges. His first court record was just four 
months ago. He went joy-riding with two boys who had stolen 
a motorcycle and with them stole an auto. They then drove out 
to a village where they tried to burglarize a store but were fright- 
ened away. Upon their return to C they had an accident 
and the car was damaged, and several of the boys were injured. 
Since Benjamin had never been in court before, he was given a 
suspended sentence and put on parole. Three months later he 
violated this parole and stole the day’s cash from the shoestore. 
He had watched where the man hid the money in an empty shoe- 
box and then hid when the store was closed for the night. About 
$300 in cash and checks were taken. 
Medical examination. A medical examination revealed the 
following facts. Benjamin was over-height and under-weight. 
He had carious teeth and needed tonsils and adenoids removed. 
These were attended to. He was round-shouldered and had flat 
feet. The deep reflexes were exaggerated, and his pupils reacted 
irregularly to light and accommodation. Vision was very poor. 
All laboratory tests of both blood and spinal fluid were negative. 
A fundus examination gave no indication of lues. The only 
suspicious symptoms, aside from the disturbances of reflexes, 
were notched lower incisors and the history of an abscess which 
had developed at the age of 12 days, suppurated for 8 months, 
sloughing off the seventh and sixth ribs, and leaving a marked 
depression and scar. 
Psychological examination. On the Stanford-Binet he had a 
mental age of 17 years, 2 months. He had a basal age of 12, 
succeeded in all of the 14-year-level tests, thus securing a double, 
dependable basal, passed all of the tests in the 16-year level 
except the code and the vocabulary, and gained credit for the 
digits forwards and backwards at the 18-year level. He also 
did the ingenuity tests successfully. This was the first time he 
had ever been tested so that there was no possibility of a knowl- 
edge of the tests being partly to blame for the high score. On 378 
THE UNSTABLE CHILD 
the performance tests he did lower and more variable work. 
The Seguin board gave a score of 14 years, the imitation series 
rated him 16, and the Healy board placed him at an adult level. 
The Porteus series showed his disability, for he scored only 10 
years. 
Anthropometric measurements placed him in the most superior 
group of 17-year-old boys so far as height goes, but he rated 
only 70 per cent in sitting height, and 60 per cent in weight. 
His grips gave him 60 and 70 per cent respectively, and his lung 
capacity was 90 per cent. 
Academic tests gave us little help. He passed all grade re- 
quirements in all subjects save that his arithmetic was slightly 
faulty and inaccurate when we came to eighth-grade require- 
ments, and that his geography was too poor to rank him above 
third-grade performance. His literacy score placed him in ninth 
grade, both in accomplishment and accuracy. In general infor- 
mation he would undoubtedly rate as an average normal adult. 
His range of interests is circumscribed, and he knows little of 
even local community affairs. During the examination he covered 
these defects with a free and easy off-hand fashion of dismissing 
the subject from the conversation. Association tests gave definite 
indications of psychopathy. These decreased slightly during the 
2 months he was at the Bureau. The characteristics remained the 
same. There was a certain perseverative type of response to the 
preceding stimulus word, as well as a constant alliteration with 
the stimulus word. 
Behavior under observation. The boy was very helpful from 
the first day he was in the cottage. He was soon trusted in every 
way. He went on errands all over the city, never having any 
difficulty in carrying out the multiplicity of requests made upon 
him. He would stick to a piece of work until it was finished. 
He resented any discipline, however, and if he had to be spoken 
to for some small fault, would readily fall into a grouch which 
would last all day. He had an immense idea of his own impor- 
tance. He assisted the teacher in school and within a few days 
he was giving advice as to how she should run things. He de- 
lighted in getting up extravaganza bits for entertainments, and 
seemed in the highest state of happiness when getting attention 
in this fashion. He realized his own weakness and that he had 
a suspended sentence to the Industrial School hanging over him. 
He had no false ideas about making good if he immediately went 
back into the environment from which he had come. Because of INTELLIGENCE PLUS DELINQUENCY 
379 
this he asked the privilege of going honorably to the Industrial 
School. 
Diagnosis. Superior normal level with psychopathic function. 
Prognosis. Doubtful. The boy’s insight into the situation is 
good. This is the most hopeful sign. What will happen when 
he gets out from under institutional care is unpredictable. 
Subsequent history. Each day at the Industrial School 
brought increasingly good reports of this boy. Within a week 
he was trusted, and he was soon put in charge of a small group 
of other boys. He was placed on parole in the minimum time. 
Due to the shortage of work at that time he had some difficulty 
in getting a job. Finally his mother bought a small restaurant 
and ran it to keep him under her own supervision. This failed, 
and the outfit was seized for debts. A comment on her discretion 
in choosing a thing she could not handle! About this time 
Benjamin married. His wife was not such as one would expect 
a superior mentality to choose. She had been going with other 
men before their marriage, and even now it is a question whether 
the child that has been born is his or some other man’s. The very 
week this baby was born another man stepped in and began, 
without remonstrance on Benjamin’s part, paying her attention. 
Since then she has left him, and is living, openly and without 
divorce, with some one else. Benjamin regrets that she took the 
child but has done nothing to regain it, or to establish his right 
to it. He is working steadily, and that is all we can say for him. 
His tale shows everything but mentality. He has fallen down 
so far as society demands he uphold its convention, he has been 
indifferent to serious violations of the moral code, he had been 
negligent in a crisis demanding that he assume the obligations 
of a parent, he was unwise in his marriage in the first place. 
What has his 17 years and 2 months of mentality done for him? CHAPTER XIX 
GENERALIZATIONS 
Glancing back over the detailed summaries of the cases 
presented, one might well ask, ‘ ‘ What is it all about ? ’ ’ A 
mass of items, a group of delinquents, now testing normal, 
now testing definitely feeble-minded. They all seem more 
or less in need of institutional care. Here and there a 
single hopeful case is reported. There are a few facts that 
indicate the possibility of corrective education. It is im- 
possible to classify the group thoroughly and exhaustingly 
under any one category. Sex? Boys and girls alike pre- 
sent the problems of anti-social conduct which we are 
studying. True, more boys than girls are represented in 
our group, but there are many reasons for that. Boys are 
usually allowed much more freedom than girls, and at an 
earlier age. They have more opportunities for such esca- 
pades, more chances of making wrong acquaintances, for 
finding wrong types of experiences. When we reach the 
age where sex offenses are common, the number of girls in- 
creases greatly and even exceeds the number of boys of the 
same mental level who are sent in for study. Age ? Is this 
really a factor in delinquency? Within certain limits, and 
only within those. The child of 5 or 6 may, in extreme 
cases, be as great a behavior problem as his older sibling 
of 10 or 15. The chances are that we will not find a num- 
ber of such delinquents which is anything like as great 
as the number of delinquents of more mature years, but 
age alone is not the controlling factor. Race ? Most of the 
group we have studied are native-born Americans. They 
380 GENERALIZATIONS 
381 
have not the excuse that laws and customs are foreign to 
them. 
* ‘ Ah, it is mental age which solves the difficulty, ’ ’ is the 
exclamation we meet from social workers and educators, but 
again the conclusion is wrong. Mental age has something 
to do with delinquency. Age has something to do with it. 
So have sex, environment, education, heredity, health, and 
physical handicap, as well as each and every experience of 
the individual. Each factor that has helped make him the 
individual he is, has, in some way, because of the depth 
or weakness of its impress upon him, helped to make for 
wrong or undesirable behavior. But no one of these is un- 
equivocally the cause of all delinquency. 
Behavior is a word of so many meanings we must defi- 
nitely qualify or explain it when we would use it in any 
certain fashion. Earlier in this discussion we reviewed 
briefly what is meant by the behavior of an individual. 
From the technical or psychological standpoint, it means 
all that takes place, consciously, between the time that he 
receives an impression and the time that he reacts to it. In 
a certain way subconscious elements become a part of this 
‘ ‘ behavior. ’ ’ The resultant activity, verbal, motor, or func- 
tional, is actually a part of this reaction. To the lay reader 
it is usually the whole of the behavior. The two are insep- 
arable. There can be no behavior or activity of the indi- 
vidual as a working organism, without antecedent and 
motivating nerve action or behavior. The trouble with our 
whole study of delinquency for many years was that we 
neglected the study of this inward nature of the problem 
confronting us. Then came the time "when workers con- 
gratulated themselves upon their intelligence in having 
realized that the individual’s intelligence, or his mental ac- 
tivity, had something to do with his behavior. The intro- 
duction of intelligence tests brought the realization that a 
fair number of those whom we call delinquent are actually 382 
THE UNSTABLE CHILD 
feeble-minded. But the problem was not actually simpli- 
fied. There were, instead, a number of mysterious prob- 
lems roused by the usage of mental age. The fact that some 
of the individuals who tested feeble-minded were sly, clever, 
cunning and that they carried out definite plans for their 
misdeeds was a drawback to the widely circulated idea that 
many or most individuals who were delinquent were ac- 
tually feeble-minded. The result has been the declaration 
that delinquency is a character defect, and a whole con- 
stellation of studies following this theory. 
Let us, however, approach the problem in the light of 
the children we have studied. To begin with, many of these 
cases, although only 6, 7 and 8 years old, give manifold in- 
dications of being true delinquents. What does this mean ? 
Is character formed that early, is its deviation definitely 
determined at such a tender age ? Let us look at these de- 
linquent acts from the social standpoint. What are they? 
Merely the expression of decisions arrived at under certain 
environmental and physical conditions. They are the end 
phrases of lines of thought and decision. In some cases the 
behavior has been repeated so frequently that one may 
practically think of the delinquencies as habits of thought. 
Now what lies back of these end phrases f What motivates 
to behavior? There must be the amount of memory, com- 
prehension, reasoning, and choosing which we associate 
with consciousness or awareness. In some instances a brief 
examination of the individual shows him so short of these 
elements necessary for any logical behavior, that we can 
readily judge him feeble-minded. We then see in his lack 
of equipment the reasons for his wrong behavior. But this 
is not true in any sufficient number of instances to allow us 
to settle down complacently and say “We have found the 
cause of delinquency.” The feeble-minded individual who 
achieves delinquency does so because of the lack of balance 
existing between his ability and society’s demands upon GENERALIZATIONS 
383 
him. The man with a 6-year-level mind, who is treated 
as a 6-year old, and put at 6-year-level tasks, does not be- 
come delinquent. The girl of 10-year-level ability, given 
10-year-level incentives and tasks, is no problem. When 
the imbalance between the level necessary to meet social 
demands and the level of the individual’s comprehension 
becomes noticeably great, something is going to happen, 
and does happen. Sometimes we call it a catastrophe, some- 
times a crime; it depends entirely upon what happens. 
But granted that the individual has sufficient mentality 
to enable him to meet the demands of the world around 
him, we may not feel sure that his endowment is sufficient. 
Normality as a member of the social group means more 
than ability to comprehend, learn, reason, and remember. 
It means more than a normal level of intelligence. It 
means ability to use the intelligence one has. Not only 
that, it means ability to use one’s intelligence rightly. If 
one’s ideas group themselves into orders similar to the 
groups in which they were expressed; if ideas of law and 
its demands prevail; if the recognition of family, group, 
and public approval has its rightful place in an individ- 
ual’s thoughts; if losses and bitternesses, the gain of oth- 
ers, and the continued existence of those hated are prop- 
erly associated with their causes and consequences; if pleas- 
ure and happiness are rightly related to work and worth; 
then there is no delinquency, no social problem. But when 
a petty minor grievance finds itself a counterpart in im- 
portance with memories of the World War; when chance 
desires are recognized as masters to be obeyed and no more 
altruistic ideas inhibit them; when queer dazed beliefs in 
ability replace chagrin and knowledge of failure; when 
lack of home and parents causes daydreams of luxurious 
care, and realities become as dim as these dreams; then 
acts of the organism as a whole are apt to fall under the 
category of “delinquency.” 384 
THE UNSTABLE CHILD 
Cause and effect as we know them in everyday life, that 
is, as experience has taught us to recognize them, and the 
agreement of word and deed lie outside the understanding 
of these individuals. Some accident or chance has made it 
impossible for their mental behavior to be similar enough 
to that of the rest of the social group for the rest of the 
group to “depend” upon it. In their consideration of 
such an individual as a member of the group they class 
him as unreliable, erratic, queer, and undependable. In 
other words, such delinquents have minds which do not 
function like the minds of the rest of the group. The dif- 
ference of function is one which has deleterious effects for 
the rest of us. To some, such difficulties of action are ex- 
plained when they have been designated as character de- 
fects. But just what do we, as scientists, gain from such 
added explanation? The act is a matter of willing. The 
thing willed is a matter of the final balance, one way or 
another, between ideas for and against the act. In the so- 
cial group at large these ideas are so generalized that we 
recognize them as principles or rules of behavior. The dif- 
ference with the delinquent, whose delinquency is a matter 
of erratic mental behavior, is that the principles on which 
he works are not predictable. They are not the accepted 
commandments of everyday behavior. Instead, he forms his 
behavior bit by bit from his general tendencies to behavior, 
which are either wrong in themselves or wrongly put to- 
gether. 
In any and all of us, will is now yea, now nay, as the 
ramifications of associations, ideas, physiological effects, 
and pleasure or pain are stronger on this or that side. 
Character is but the tenacity of associations between cer- 
tain ways of behaving and the stimuli which may be re- 
lated to this behavior, or to its opposite. In all probabil- 
ity, this tenacity of reaction is largely a matter of being 
able to disregard the pleasure-pain side of affairs. Here GENERALIZATIONS 
385 
we meet that much mooted question of when an individual 
does, or does not know, the difference between right and 
wrong. As a matter of fact, the probabilities are great that 
many minds, which comprehend these differences between 
right and wrong, and yet do wrong, cannot, in their own 
eases, see what certain acts are wrong. A mind with ab- 
normal associations may see it right to shoot an individual. 
The justification may involve the highest type of abstract 
thinking. Yet the thoughts involved are abnormal. A man 
of superior intelligence may motivate his whole life to con- 
ceal a group of ideas which, futile in content, have be- 
come abnormally associated with extreme emotional dis- 
turbance, or with more general physiological disturbances. 
This man’s functional level and his value to society are 
determined by the way his mind functions, not by his in- 
telligence level. 
If we eliminate the chance group of feeble-minded delin- 
quents, the ten to thirty per cent of our offenders who pay 
the penaltjr for society’s negligence concerning them, what 
have we left? A group of more or less responsible individ- 
uals whose chief difficulties lie in the way they use that 
ability which they have. The detailed analysis of groups 
on our various tests serves its purpose if it emphasizes this. 
TVe do not in practical life and practical work with de- 
linquents meet the lecture-platform type of individual. 
The world is not made up of men and women, boys and 
girls, who are 1, 2, 3, 4, 6, 7, 8, or more years in mental 
level and who differ on this basis, forming nicely varying 
groups that can be handled as groups. The human organ- 
ism is a variant. The average individual so often spoken 
of figuratively is never found. Moreover, the individual 
traits vary independently. A child tests 6 in one ability, 7 
in another, 8 in other aspects, 14, perhaps, in others. The 
next child testing the same on the first test does entirely 
different things on other series. These facts mean a tremen- 386 
THE UNSTABLE CHILD 
dons number of formulas of mental endowment. Besides 
this variation in level on different attributes, there enters in 
the greater variations brought by disease, physical handi- 
caps, and experience. The factor of deviation in function 
is much greater, more widely significant, and more variable, 
than the factor of feeble-mindedness itself. It involves not 
only inferior minds but those of normal and superior levels. 
It brings a third dimension into the puzzle of intelligence 
studying. 
In the delinquent we see the factor of deviation in one 
of its forms of practical significance. The instability of 
function naturally produces instability of action. The in- 
stability of action is but the end-term, the easily seen por- 
tion of a general reaction of the organism, that is, the indi- 
vidual, to the given situation. Not all unstable reactions 
are caught in the mesh of the court and the law. The 
divorce court bears its brunt to the full. The social agencies 
meet it in all of its misleading alliances with inferiority of 
intelligence. The manufacturer meets it in the mob inciter, 
the agitator, the capable type of employee who breaks and 
damages without seeming excuse of inability, and in the 
great number of accidents wherein it has been sudden 
action, and not sheer stupidity, which brought the trouble. 
The teacher finds in the unstable child, the verbalist, the 
nervous, excitable, mischief-making child. The general 
public finds the deviate a pest in his plausible begging and 
avoidance of work. The newspapers make their living from 
him. Deviation and instability lie back of suicides, freak 
escapades, masquerading men and women, slashers, odd 
offenders, queer murders, mobs, and the like. The further 
complication of the problem comes from the deviate’s pos- 
sibility of varying an indefinite amount. He may be in- 
sane, he may be just '‘a little queer.” 
Now that we know we have him, the problem is, or seems 
to be, what is to be done with him ? The unstable individ- GENERALIZATIONS 
387 
ual, the psychopath, is not naturally a hopeless problem. 
There are many possibilities for his care and many poten- 
tialities for his future. Rightly to judge what these are 
we must know first of all what causes the psychopathy in 
the individual case. All psychopathies are not alike. The 
matter of causation is one of vital importance in determin- 
ing even the temporary disposition of the individual. But 
what do we know about the causation? Not much. And 
yet, in some lines, we have made a beginning. The writer 
has been fortunate enough to have stumbled onto what 
seems to be a factor definitely related to a certain type of 
psychopathy. The relation of what that investigation has 
revealed seems a logical means of illustrating what is 
meant by the need for knowing the cause of the condition. CHAPTER XX 
CONGENITAL SYPHILIS 
It is worth while to review the attitude with which the 
delinquents brought to the Bureau were studied. The 
findings herein reported are undoubtedly due to this atti- 
tude, and their presentation would be illogical and out 
of place unless this is kept in mind. Briefly, the situation 
was this: Earlier studies had proven (1) the invalidity 
of the intelligence quotient as a basis for differential 
diagnosis; (2) the need for observation of each individual 
from manifold viewpoints; and (3) that quality rather 
than quantity was the puzzling factor in studying problem 
children. The test series established as a basis for this 
research was consequently worked out with the desire to 
overcome these criticisms. The tests used were manifold, 
the most practical for application and interpretation of 
those then available. The attitude assumed was: gather 
all information possible on each child, whether it seems 
irrelevant and unnecessary or not; deal with him according 
to the best of the laboratory’s ability; and, gradually, new 
truths cannot help but show themselves. Practical work, 
scientifically done, aiming at a solution of actual social 
problems, must, sooner or later, bring its gist of generalized 
truths. 
Some four or five months after the beginning of this 
program the use of the two-fold diagnosis spontaneously 
developed. It was easier than what we had been using, 
which was a statement of mental level (involving conse- 
quent diagnostic classification), with the addition of a 
paragraph of corrective and suggestive findings made from 
388 CONGENITAL SYPHILIS 
389 
an analytic examination of the quality of all the data gath- 
ered on a child. From these analyses gradually evolved, 
for tentative and working usage, a list of points of qualita- 
tive deviation. These were neither permanent nor of equal 
significance, but they codified the method of qualitatively 
analyzing where a youngster stood and made it possible for 
the Staff to use the assistance of imperfectly trained and in- 
experienced examiners while they were being trained. The 
evaluation of these points we finally began to call the esti- 
mation of the child’s “psychopathy,” or his “functional 
deviation.” The study of psychopathy soon became the 
keynote to all of the clinic work, one and all naturally fall- 
ing into the attitude that mental-age determination was a 
preliminary and necessary part of the study of a child, but 
that it was merely preliminary. Some eight months after 
the Bureau work had been put upon this basis, and so about 
four months after a first organization of a method for 
evaluating psychopathy, the writer had a most unusual ex- 
perience while examining a girl, not a committed case, but 
one who had been sent in just for a clinic examination. No 
history had been reported, although, since the girl had 
been sent in by the interdepartmental social-hygiene 
worker, the probabilities were that she was a behavior prob- 
lem of some sort. After the Stanford had been given and 
a certain minimal number of other tests completed, the ex- 
aminer found herself developing a definite attitude of diag- 
nostic certainty concerning the girl. This was unusual. It 
was contrary to the attitude of impartial observation al- 
ways striven for—it was not a thing definitely the result of 
ascertaining the girl’s mental level and her performance 
rating. The diagnostic phrase, “congenital syphilitic,” 
would creep into consciousness, in spite of every effort to 
avoid it. Careful inspection revealed in the girl none of 
the marked stigmata then known to the examiner. Nor was 
the girl like any special case or group of cases, known to 390 
THE UNSTABLE CHILD 
be of specific origin, with which the examiner had pre- 
viously worked. Instead, the diagnostic phrase traced back 
to the quality of the tests done, the girl’s superficial atti- 
tude, the relation of successes and failures. This experi- 
ential phase of the diagnosis was sufficiently vivid to lead 
to the insertion, in the letter to the agency, of a phrase 
saying that the girl seemed to be like the congenital syphi- 
litics in her reactions. No medical examination was made 
as the agency took care of those matters itself. Three days 
later a telephone call from them reported that the blood 
Wasserman was 4 plus. The infection was of the con- 
genital type. 
Needless to say, this incident opened a vast field of specu- 
lations. The girl had been somewhat inferior, testing 11 
years, 11 months on the Stanford, although her academic 
ability was of high-school level. Other tests corroborated 
this lack of balance in development and function. The 
question of chief interest was, naturally, whether or not 
there was present, in the tests in use, a sufficient basis for 
the differentiation of individuals suffering from different 
types of neural handicaps. The concrete question evoked 
was whether congenital syphilitics, some congenital syphi- 
litics at least, are different from other children in the 
quality of their performances, or in the grouping of their 
abilities and disabilities. The probability of ascertaining 
the presence of such an infection from a psychological 
study of the individual seemed wildly speculative. Yet, if 
this were so, would it not be consequently logical to assume 
that other etiologieally different groups might show other, 
equally distinct, groups of symptoms ? Might this not mean 
a probable tendency to special types of delinquencies, ac- 
cording to the factor which had caused the individual’s un- 
stable condition? Might it not mean that prognosis could 
be much more definite, being related to the etiological clas- 
sification of the individual’s psychopathy? Would this ac- CONGENITAL SYPHILIS 
391 
count for the difference between one or two indications of 
psychopathy in one individual, and the same number of 
differently arranged symptoms in another? Could cases 
be more understandingly held custodially or paroled with 
a higher chance of success if this additional factor was 
taken into consideration ? These are a few of the concrete 
questions that immediately confronted the clinic. They 
wTere valuable scientifically, yet far more valuable practi- 
cally. 
A first task was naturally the review of the individuals 
having congenital syphilis who had been examined up to 
that time, with the especial purpose of finding out whether 
or not there was any basis, in the peculiarity of their tests, 
for this chance impressionistic diagnosis. Of course, the 
number of cases handled had been small, and even then a 
number had to be eliminated because of the dubious quality 
of the history, incomplete physicals, physicals done by other 
agencies which had not included Wassermanns, etc. But 
inspection showed several favorable indications. The ten- 
dency was for congenital syphilitics of similar mental ages 
to fail and succeed on practically the same tests. Not only 
that, but the subjective impressions and the behavior ob- 
servation records on this group were similar, although not 
so full as reexamination of the data showed to be necessary. 
The one thing that stood out clearly on tests of all levels 
was the distinct motor inability of the congenital syphilitic. 
He was usually several years inferior in this respect to his 
successes and failures on other tests and performances. 
This same condition showed in the writing of most of these 
cases, being the most marked symptom in some instances. 
There was an angularity of line, a tremor throughout the 
copy, a vague overlapping and adding of fringes of un- 
necessary detail. Another attribute that was indicated is 
less easy to define. There was a superficial verbalism in 
most of the cases. This was not a thing that showed on 392 
THE UNSTABLE CHILD 
actual vocabulary ability or tests where verbal ability plus 
something else meant success. The verbalism was rather a 
matter of profuse talking without an appropriate percent- 
age of ideas in the conversation. Stimulations arouse men- 
tal activity, but in the congenital syphilitic this activity is 
an immediate verbal response, without reflection, or work- 
ing over, or criticism of the topics discussed. It is, in a 
mild, shadowy fashion, similar to the genial verbosity of 
the paretic himself, yet it has in it more of the fatigue 
hyper-excitability of a manic-depressive of excited phase. 
With this there goes a comfortable overevaluation of the 
individual himself. He is, can do, and will do well, all 
that man could wish ... in his own estimation. 
With these two groups of attributes as a key, the work of 
the Bureau continued its attempt at analysis and classifica- 
tion of the symptoms of deviation of function, that is, psy- 
chopathy, presented by the delinquents sent in for study. 
The work was greatly facilitated by the hundreds of cases 
that were annually sent in for mere clinic examination. 
Although such cases had to be handled too casually to give 
data of high scientific value, yet the work with them gave 
a chance for much wider practice in the application of the 
principles of clinical interpretation, which seemed to glim- 
mer out from the vast and unlighted provinces of juvenile 
psychopathies. Naturally, since it was the first clue to the 
possibility of such methods, the work on congenital syphilis 
received constant attention and was made the basis for a 
specialization of research. There seemed to be a definite 
possibility that it, rather than fainter clues, might quickly 
bring the answer, to some of the problems so vividly and 
acutely haunting each day of clinic work. So far, the work 
done is not final, but it has been more than worth while in 
the returns which even a couple of years of investigation 
have brought. Indeed, it is so promising that it seems 
worth while to summarize in a rather comprehensive fash- CONGENITAL SYPHILIS 
393 
ion a number of the aspects of the problem of the congenital 
syphilitic as the following of a psychological clue revealed 
them. 
To begin with, the frequency of congenital syphilis is a 
thing of much uncertainty. Various clinics report such 
different situations that no one could in a priori fashion, 
suppose or hypothecate it as a serious factor in the social 
problems presented by juveniles. The condition literally 
hits one in the face. No one working with children in a 
fashion which ascertains the presence of the disease needs 
to develop any exaggerated idea of its frequency. The con- 
dition is there, it appears stalking as a pale ghost in front 
of, beside, or behind many other conditions of dependency 
and delinquency. Practical workers dealing with those 
problems related to it have too much to do, and are too well 
accustomed to it, to see its significance for others. Those 
outside the field of such practical -work do not see it all. 
Again, the relation of delinquency to feeble-mindedness has 
somehow led to the inference that the relation between de- 
linquency and syphilis is similar to that said to exist be- 
tween syphilis and feeble-mindedness. There the general 
opinion seems to be that the relationship is one of chance. 
Fernald, of the Massachusetts School for the Feeble- 
minded, reports 6 per cent of the inmates of his institution 
as suffering from this condition, according to a Wasser- 
mann census of the institution. This would make syphilis 
no more frequent among feeble-minded individuals than 
it is among the general public. It is impossible to cite the 
various authorities as to such frequency. A typical modern 
report is that of a children’s clinic in Norfolk which takes 
routine Wassermanns on all cases coming to it for any 
sort of treatment.1 For white children they report an in- 
i Lawrence P. Royster, “Routine Wassermann for Children,” Vir- 
ginia Medical Monthly, April, 1921. Abstract in Social Hygiene, 
June, 1921. 394 
THE UNSTABLE CHILD 
cidence of 7.04 per cent while for colored children it is 
15.47 per cent, giving a general average of 12.5 per cent 
for their first 1,000 cases. Tredgold counts it merely among 
the minor causes of incidental feehle-mindedness, claiming, 
“There are also other diseases, such as rickets and syphilis, 
which rarely produce mental deficiency.” 
If we search for definite statements of the relation of 
congenital syphilis to delinquency we find even less writ- 
ten. Southard and Solomon in their most extensive study 
of neurosyphilis confine themselves to the statement that 
“We should not dogmatically say that there is a relation 
between early delinquency and syphilis. Still, it is not 
unusual to find emotional disorder and instability, as well 
as delinquency, in congenital syphilitics.”2 They urge the 
differentiation of and recognition of the congenital group 
of neurosyphilitics. While the distinction is “on theo- 
retical grounds, hardly defensible. On practical grounds, 
however, the juvenile neurosyphilitics do form a group 
having special relations to feeble-mindedness, epilepsy and 
the like.”3 
One may interpret the relationship between syphilis and 
delinquency in a number of modern studies, but such an 
assumption of facts beyond the statements actually made is 
hazardous at least. One also meets, in such studies, the 
difficulty of determining whether the workers have taken 
into account the relationship of primary infection to con- 
genital infection and have ruled out all but those cases 
where the inheritance seems clear. Taken all in all, there 
is little known about the general social aspects of congeni- 
tal syphilis, its frequency, significance, and treatment. 
Even the matter of determining the frequency of syphilis 
in the group of cases herein reported was and is not an 
2 E. E. Southard and H. C. Solomon, Neurosyphilis: Modem Sys- 
tematic Diagnosis and Treatment, p. 299. 
3 Ibid., p. 438. CONGENITAL SYPHILIS 
395 
easy matter. The taking of a single blood Wassermann is 
by no means sufficient. The Bureau is located in a city 
where there are, fortunately, two public laboratories, yet 
even specimens sent to both of these do not by any means 
solve the problem of infection, for now one and now the 
other reports positive findings, when the alternative report 
is negative. One meets at once a number of related prob- 
lems ; the accuracy and reliability of the Wassermann tests, 
the need for corroborative data, the determination of the 
significance of stigmata, the relativity of family and de- 
velopmental history. In general, Southard’s rule has been 
used in interpreting the Wassermann reports in this study. 
“Positive indicates syphilis, except very rarely in acute 
febrile conditions such as malaria and pneumonia. Nega- 
tive does not exclude syphilis. In obscure conditions a 
series of less than three negatives has little diagnostic sig- 
nificance. Doubtful suggests syphilis. ” 4 In attempting to 
interpret the practical data on the case a conservative me- 
dium has been striven for. With due regard for the possi- 
bilities, Hericourt’s claims for syphilis as the basis for 
rachitis, tubercular predispositions, backwardness, feeble- 
mindedness, idiocy, epilepsy, hysteria, and dementia prae- 
cox have been taken conservatively.5 When in doubt as 
to interpretation, the general practice has been to weigh 
the data on the side of the absence of infection. In cases, 
however, where the stigmata meet the conditions of ap- 
proval from such men as Hutchinson and the Fourniers, 
the case has been accepted, at least tentatively, as syphilitic. 
Generally, the acceptance of such indications has meant a 
reenforced prosecution of investigations of family history, 
developmental history, and earlier medication, in the hope 
of validating the assumption. Needless to say, one does 
4 Ibid., p. 479. 
5 J. Her {court. Les Maladies des SociStSs: Tuberculose, Syphilis, 
Alcoolisme, et Sterility. 396 
THE UNSTABLE CHILD 
not wish to, and even cannot, carry out such investigations 
persistently in the face of family denial, unless the individ- 
ual has given sufficient reliable evidence of the condition 
to eliminate the danger of “insulting” or worrying an 
innocent family. 
It may be that some will raise the objection to any as- 
sumption of a relation existing between syphilis and delin- 
quency, if the assumption is based upon the mutual coin- 
cidence of syphilis and delinquency in a certain number of 
cases. Such an objection is undoubtedly justified unless 
we can show that there is more than a chance relationship. 
The first indication of such an actual correlation is in- 
dicated by the frequency of congenital syphilis in our group 
of delinquents. The total number of children studied was 
369. Of this number 73, or 19.8 per cent, give positive 
Wassermanns. This was by no means the first Wassermann 
in all cases. In some of the individuals as many as 5 or 
6 were taken before positive findings were reported, yet 
these were cases where the other physical indications al- 
most undoubtedly pointed to the presence of syphilis. Be- 
sides these 73, there were 26 children definitely diagnosed 
as congenital syphilitics by a combination of psychological, 
medical, and history findings. Six of these were younger 
children in families where the older siblings were known 
syphilitics. Fifteen of the others showed definite stigmata 
which were incontrovertible. Only cases with Hutchinson 
teeth or other bone malformations such as sabre tibiae, or 
fundus indications which yielded to treatment, and marked 
retardation of growth were considered. Six of the cases 
gave definite familial history. In one instance the case 
was traced back through a father who had only physical 
stigmata to an infection from the grandfather. In another 
case a negative "Wassermann was definitely explained by 
obtaining a history of an early four plus with years of 
treatment. In 12 of the 26 cases the psychological diag- CONGENITAL SYPHILIS 
397 
nosis of syphilis preceded medical findings. Of course, 
there could be no such precedence where marked stigmata 
hinted at the diagnosis when the child was first seen. In 
all, 99 of the 369 children were definitely diagnosed as con- 
genital syphilitics. This is 26.9 per cent of the whole 
group. One of these 99 is not only a congenital syphilitic 
but has also acquired syphilis anew, or gained renewed ac- 
tivity of symptoms. 
The accompanying table shows the relation of the con- 
genital syphilitics to the not-known-to-be-syphilitics at the 
Number of 
Cases 
Positive 
Wassermann 
Mental 
Age 
Number 
Syphilitics 
Percentage 
Syphilitic 
1 
1 
0 
0 
0 
1 
2 
0 
0 
0 
2 
2 
0 
1 
50 
3 
3 
0 
1 
33 
4 
4 
1 
1 
25 
5 
4 
1 
2 
50 
6 
18 
4 
5 
28 
7 
42 
7 
12 
29 
8 
43 
11 
13 
30 
9 
61 
17 
20 
33 
10 
61 
14 
18 
30 
11 
50 
7 
10 
20 
12 
24 
2 
4 
17 
13 
23 
5 
5 
22 
14 
12 
2 
2 
17 
15 
13 
1 
2 
15 
16 
3 
0 
1 
33 
17 
3 
1 
2 
67 
Totals.... 
369 
73 
99 
26.9 
Fbequency of Congenital Syphilis 
various mental levels. Although the phrase is awkward, it 
is only fair to speak of the comparison in this fashion. In 
this small group of 369, besides the 99 known cases of con- 
genital syphilis there are, with the most conservative of es- 398 
THE UNSTABLE CHILD 
timates, 54 others who have rather definite symptoms of 
congenital infection, yet they are not marked enough and 
their history is not definite enough, and observation has not 
been long enough, to make for scientific certainty. Conse- 
quently, in this study they are simply indicated as a doubt- 
ful group, but in general they are counted in with the not- 
thought-to-be-syphilitic group. This has but one effect. 
It makes the group of syphilitics definite, an assured fact, 
a minimum number of those affected, not the estimated 
maximum number of possibly infected individuals. As a 
result, all that we say about them is conservative in the ex- 
treme, and may be taken as more than actually determined. 
There is in this high percentage of congenital syphilitics 
a seeming relationship between syphilis and delinquency. 
But we can go even farther than this. The work of the 
Bureau has given us data on another selected group of chil- 
dren who may be classed as dependents. Two hundred and 
sixteen of these have been examined in routine fashion dur- 
ing the time the 369 committed cases were studied. Techni- 
cally, this group of dependents is a selected group. They 
come from local agencies where they have been taken care 
of because of some breaking down of the family ability to 
provide for them. This is a thing that seldom happens in 
our stable middle class. If something happens to such a 
family, the individuals who stand nearest in relationship 
try to care for the children. When families sink to such 
a level that they leave their children for the state to sup- 
port, desert them, or are separated from them because of 
poor care, we undoubtedly have inferior family stock from 
which to start. But, otherwise, the group are no more se- 
lected than our delinquent group. They have a distribu- 
tion which is similar in age, sex, color, and racial distribu- 
tions. They are not even selected for behavior but come 
in as they need care—good, bad, and indifferent. The 
medical work for the group is done by the agency’s own CONGENITAL SYPHILIS 
399 
physician so that we have in this change of personality an- 
other check on the reliability of the work done by the Bu- 
reau on delinquents. The laboratory work is done at the 
same laboratories. Of this dependent group of 216, 28 or 
12.9 per cent are congenital syphilitics and give positive 
Wassermanns. Besides this, there are 20 young children 
who are the younger siblings of the known syphilitics, who 
do not as yet give positive laboratory indications of the 
disease, although most of them are stigmatized. Together, 
these total 48. or 22.2 per cent of the dependent group who 
are syphilitic. Out of this group of 216, there are 51 who 
are reported as delinquent in some way. Of this 51, 32 are 
non-syphilitic and represent 19 per cent of the non-syphi- 
litic group. The other 19 are syphilitic and represent 
39.6 per cent of the syphilitic group. Delinquency is twice 
as common among the syphilitic children of this group as 
among the non-syphilitics. 
But the matter is not even as simple as this seems to be. 
Let us analyze the group a little more according to their 
actual age. There are 41 children under 7 years of age, 
10 of them being syphilitic. In this whole group there is 
only one delinquent, and this proves to be merely a case of 
very high temper which makes the child unmanageable in 
a foster home. There are 41 other children between the 
ages of 7 and 10. Of this group, 14 are syphilitic. Six of 
the syphilitics and 4 of the other children in this age group 
are delinquent. This means 42 per cent of the syphilitics 
are already giving trouble before the age of 10, although 
less than 8 per cent of the other children are troublesome. 
Above the age of 10 there is a total of 134 children. 
Twenty-four of these are syphilitics and 110 are not. 
Twenty-six of the non-syphilitics are showing delinquency, 
whereas 13 of the syphilitics are troublesome to the same 
degree. This is a matter of 24 per cent of delinquent non- 
syphilitics as contrasted with 54 per cent of syphilitics who 400 
THE UNSTABLE CHILD 
are delinquent. This leaves 9 syphilitics above the age of 
10 who are not showing delinquency tendencies. An analy- 
sis of these cases reveals the fact that they fall under one 
of three categories. They are either very low in mentality, 
or suffering from some major physical handicap which 
keeps them under constant surveillance, or they have spent 
the whole of their lives under the regime and regularity of 
institution homes. This same classification by no means 
applies to the non-syphilitic group. 
In general, this brief analysis of the dependent group in- 
dicates a high probability that syphilis is not present with- 
out at least helping in the development of traits which make 
for delinquency. The final scientific test of the presence 
or absence of any effect from congenital syphilis which 
differentiates this type of a ehild from others is an analy- 
sis, step by step, of his mental make-up, and a comparison 
of his abilities with those of the not-known-to-be-syphilitic 
individual. 
The task of such an analysis for differential features is 
almost impossible. The prerequisites remind one of the old 
recipe for robin-pie: “first, catch a sufficient number of 
robins to serve ye guests.” One knows something definite 
and delimiting when one has laboratory, medical, and fam- 
ily findings that determine with finality that the individual 
is affected with syphilis. The case is not so simple when 
the individual is non-syphilitic. In the group wherein 
we get negative Wassermanns and no definite history of 
syphilitic infection, no definite stigmata, there are sure to 
be congenital syphilitics of second, third, and even fourth 
and fifth generations, bearing anomalous signs of their con- 
dition. They are anomalous because we know so little of 
wThat they mean. We do not even know w’hat signs we may 
expect in the healthy children of healthy parents. We 
have the incidence of certain symptoms, but such exact data 
are few. How can one clinic decide the significance of a CONGENITAL SYPHILIS 
401 
multitudinous group of symptoms, -when individuals spend 
their lives trying to determine whether some one thing, such 
as rachitis, is of syphilitic predisposition or not ? How can 
one determine the normality or latent infection of the 
individuals who are physiologically retarded in develop- 
ment, who suffer from glandular anomalies, have extreme 
eye defects, show again and again scaphoid scapulae, 
scoliosis and kyphosis, deafness, marked eye defects, ex- 
treme disturbances of the reflex system, speech hesitancies, 
voice signs of all sorts, modified mongolism, and scores of 
minor stigmata of eye, ear, skin, and hair? The best that 
we can do is use a system of encroachage. Briefly, such a 
method is this. The group which is definitely syphilitic is 
compared with the group which is not known to be syphi- 
litic, including in it the doubtful cases. The syphilitic 
group encroaches on the other group simply because there 
are syphilitics in that unsorted mingling. Because of this, 
differences between the two groups are undoubtedly less 
than they would otherwise be, but they are also undoubt- 
edly more definitely true as differences. A further refine- 
ment is possible. The doubtful cases may be excluded, and 
the two extreme groups compared. Even then, there is no 
doubt but that some syphilitics will remain in the general 
group. The doubtful cases can then be compared with the 
other two groups, and the probability of their proper re- 
lationship be determined by the manner in which they re- 
semble one group more than the other. However, for any 
such a refinement of method the number of cases at any 
one chronological age or mental-age level must be far 
greater than in any of the groups available for this study. 
Even for the general type of comparison which is sug- 
gested for use here, the work done on the cases at hand 
has been almost too meager. Could one do as Hall would 
suggest and follow 20 cases a lifetime, the information 
gathered would undoubtedly pay far more than that on 402 
THE UNSTABLE CHILD 
twenty times twenty. In this case, however, there was no 
choice. The study had to be made within the time and 
under the working conditions offered by the state institu- 
tions. 
To present such a matter in detail is entirely without the 
province of this discussion, which is merely a first study or 
exposition of the possibilities of the matter. It will suffice, 
for purposes of illustration, to analyze in detail one of the 
mental-age groups. In most situations we have overempha- 
sized the value of the statistical side of clinical psychology. 
The true inwardness of diagnosis lies in an ability to grasp 
the principle of right or wrong action which typifies a 
certain sort of abberant individual, and to recognize this 
principle, in the irregularity of its functioning, wherever 
it appears. Fernberger has recently demonstrated in prac- 
tical form the error of assuming a definite validity for 
differences such as can be pointed out statistically in the 
study of intelligence attributes.6 The error of interpreta- 
tion comes from the great degree of variability within the 
various groups. The averages can mean but little. It is 
the fact that we have such high degrees of variability that 
promises well for clinical advance. One may and should 
keep in mind the general trends of groups, but must always 
consider that the individual studied at that moment may 
be the most extreme of the variants in his group, rather 
than an average member of a group to which he statistically 
belongs. With this in mind, let us try to see where, in 
general, the syphilitics of a given mental age differ from 
the not-known-to-be-syphilitics. 
The 9- and 10-year mental levels represented the two 
largest groups, 61 testing at each level. The 10-year level 
has one disadvantage more than the 9-year level in this 
6 Samuel W. Fernberger, “Statistical and Non-Statistical Inter- 
pretation of Test Results,” Psychological Clinic, 1922, Vol. 14, 
Nos. 3-4. CONGENITAL SYPHILIS 
403 
study; there are in the group more cases which were ques- 
tioned as being congenital syphilitic and which could not 
be proven. This might well mean that the differences 
between the known group and the not-known group would 
be considerably less clear than in the 9-year group, which 
naturally presents itself as more favorable for study. 
Following the same type of analysis as that used in 
reporting our groups, in general there are a number of 
definite differences between syphilitics and non-syphilitics 
evident upon even a first inspection. The syphilitics num- 
ber 20, the non-syphilitics number 41. The syphilitics have 
a lessened age range, which may be due to the smaller 
number of cases. They vary in age from 9 to 16 instead 
of from 8 to 18. The median age for both groups is the 
same. The mode for non-syphilitics is 12, for the others a 
triple mode of 13, 14, and 15. The average age of the 
syphilitics is 13 years, 3 months as contrasted with 13 years, 
10 months for the rest of the group. The number of colored 
children is only 5 in the total group, and 2 of these are in 
the syphilitic group. So far as such small numbers go this 
is about a due proportion. I.Q.’s range the same for both 
groups. Offenses seem to yield but few differences, yet 
these are significant. Forty per cent of the syphilitics are 
sex offenders, and only 24 per cent of the non-syphilitics 
have the same charge. Moreover, the more serious charges 
are without exception against the syphilitic cases, and 
include rape, and extreme homosexual practices. The other 
marked difference is in the charges of extreme and gen- 
eral incorrigibility. Here, for the number of cases, there 
are half again as many charges against the syphilitics 
as against the non-syphilitics. All of the charges of queer- 
ness, seeming to grow worse, deterioration questioned, and 
suspicions of mental fitness happen to be placed against 
the syphilitic group. The number of charges for each 
individual seem less for syphilitics, but they are quali- 404 
THE UNSTABLE CHILD 
tatively more serious. Besides this, there are recorded, 
in the detail histories of the syphilitics, more numer- 
ous minor irritating behavior incidents which make 
their general behavior problem far worse. There is 
no great difference in school grades accomplished, save that 
the range of accomplishment is less in the syphilitics, being 
3 to 7 grades, whereas the others range from 2 to 8 grades. 
The average syphilitic grade accomplishment is slightly 
higher (4.8 as compared with 4.6 grades), but the mean 
variation is also greater. 
The range of possible basal years on the Stanford is 
identical for the two groups. The modal and median basals 
are also the same. The range of successes through years 
above basal is less in the syphilitics, so far as the modal 
range and the median range go but the actual variability 
of the group is a range of from 2 to 12 years as contrasted 
with 1 to 8 years in the not-known-to-be-syphilitic group. 
The average range for syphilitics is 4.4 years above basal, 
for others 4.3 years, with means variations of 1.5 and 1.3 
years respectively. In other words, the syphilitic usually 
has a lesser range than other psychopaths, but the varia- 
bility of his group is much greater. 
When we come to a qualitative analysis of the Stanford 
we find that the distribution of successes and failures is 
quite different in the two groups. Only syphilitics fail in 
the 7-year-level description of pictures and repeating the 
days of the week. The quality of the diamond drawing is 
peculiar in 53 per cent of the syphilitic trials, but in only 
26 per cent of the non-syphilitics. At the 8-year level the 
difference is most marked on the ball and field. Thirty- 
seven per cent of the 9-year-level syphilitics fail this test 
as contrasted with only 18 per cent of the rest of the chil- 
dren. At the 9-year level the discrepancy between the two 
groups is more marked. The percentage of failures in the 
two groups are: CONGENITAL SYPHILIS 
405 
Percentage of Failures in the Stanford at the 9-Yeab Level 
Test 
Syphilitics 
Not-Known-to- 
Be Syphilitic 
Date 
10 
24 
Weights 
45 
21 
Change making 
0 
20 
Reversing digits 
47 
38 
Making sentences 
0 
13 
Rhymes 
20 
44 
Months 
13 
32 
Stamps 
0 
9 
Verbally analyzed, the syphilitics are more than twice as 
apt to fail on the lifted weights and are a little poorer 
on reversing digits hut aside from this are more apt to 
score successes at the 9-year level on all other tests, being 
definitely better in the rhymes, the date, and making change. 
Above this level the significant differences in percentage 
of failures are as follows: 
Percentage of Failures in the Stanford Above the 9-Yeab Level 
Test 
Syphilitics 
N ot-Known-to- 
Be Syphilitic 
10-year absurdities 
63 
34 
Quality on design 
70 
25 
Reading test 
26 
59 
Ball and field at 12 
89 
65 
Above the 12-year level the syphilitics succeed on only 3 
tests, the logical problems, the fables, and the cut design. 
There are only a few successes on each of these tests, but 
they are all failed on by all of the non-syphilitics although 
they, by contrast, succeed occasionally on other tests 
through the 14-year level, and never above that level. 
In general, the syphilitics are better on the tests involv- 406 
THE UNSTABLE CHILD 
ing imaginal functioning, superficial verbal ability, and 
academic training but poorer on all tests involving motor 
control and kinsesthetic appreciation. Poor quality on the 
diamond and design, plus difficulty on the plan of the ball 
and field, plus failure on the weights, plus difficulty with 
the absurdities, yet with the possible variation of one of 
these groups of failures, occur in 60 per cent of our group 
of syphilitics but not in the others. In the same way, suc- 
cess on the date, the change-making and rhymes, asso- 
ciated with failure on the absurdities, and good reading 
quality is a combination met only 3 times in our group 
of 41 non-syphilitics, yet 8 times in our group of 20 syphi- 
litics. When these groups of failures are criticized in the 
light of other quality differences of the two groups, we 
find none of the non-syphilitic group which meets the 
formula of successes and failures so common among the 
syphilitics. Let it be understood, however, there is every 
possibility that the addition of even one case might give us 
the case who would amalgamate, or at least connect, the 
peculiarities of the two groups. But the Stanford analysis, 
bear it in mind, is but one of a group of criteria in which 
the syphilitics tend to differ from the non-syphilitics. 
The association tests show no marked difference between 
syphilitic psychopaths and psychopathic delinquents in 
general, so far as distribution goes. There is a tendency to 
the use of phrases in only 53 per cent of the syphilitic 
group as contrasted with 77 per cent of the others. The 
average number of phrases is the same but the mean varia- 
tion is greater in the syphilitics (10.4 as compared with 
8.8). In the words of individual value, the frequency 
varies from 5 to 100 for syphilitics as contrasted with a 
variation of from 4 to 71 among the non-syphilitic group. 
The average number of individual reactions is 25 with 
a mean variation of 18, whereas the non-syphilitics average 
only 20, with a mean variation of only 11. A qualitative CONGENITAL SYPHILIS 
407 
analysis of the association test reveals much more of a 
tendency to superficial neologisms and to complex indica- 
tors, revealing the importance of the ego in the syphilitics. 
Repeated tests on the association series show less tendency 
to variability in the syphilitics than in the other children. 
That is, they are more stable in their variability, once it 
is determined. 
The performance tests show still further differences. 
The formboard gives the syphilitics an average mental age 
of 10.4 years with a mean variation of 1.1 year, whereas 
the non-syphilitics score an average of 10.8, with a mean 
variation of 1.3 year. The imitation series gives the 
syphilitics a mode and median of 10 years, whereas the non- 
syphilitics score at 14 in both respects. The syphilitics av- 
erage 10.8 years, with a mean variation of 2.2 years. The 
non-syphilitics score an average of 12.5 years, with a mean 
variation of 2.9 years. The scores on the adaptation series 
are identical. On the Porteus, the syphilitics range from a 
score of 6 to one of 13.5 years, the other group ranges 
from 5 to 13.5 years. The syphilitic mode and median are 
8, the others have a mode of 9 and a median of 9.5 years. 
The averages are 9 years, 7 months for the syphilitics, with a 
mean variation of 1 year, 5 months, for the others an aver- 
age of 9 years, 11 months with a mean variation of 1 year, 
6 months. On the Healy completion test, the ranges, 
modes, and medians are identical, but the average for the 
syphilitics is 8.1 years, with a mean variation of 1.6 years, 
whereas for the other group it is 8.6 years, with a mean 
variation of 2.1 years. 
There is also some difference in the school tendencies 
of the two groups. On literacy, the comparison is rather 
significant. The syphilitics range from 12 to 26 in score, 
the others from 5 to 29. The median for the two groups 
is identical. The mean is 19.5 for the syphilitics as con- 
trasted with 19.0, the respective variations being 3.7 and 408 
THE UNSTABLE CHILD 
4.2. On this test the inaccuracy of the syphilitics ranges 
from 5 to 37 with an average of 13 per cent and a mean 
variation of 6.8 per cent, whereas the rest range from 0 to 
30 with a mean of 11.6 per cent and a variation of 6.7 per 
cent. In arithmetic, the syphilitics have a mode of third- 
grade performance, as compared with a second-grade per- 
formance as modal for the rest. The distributions are simi- 
lar. Both groups have a mode of third-grade work in lan- 
guage, but no syphilitics score below this level. The syphi- 
litics average over half a grade higher in this work. In 
geography, a similar difference in performance appears, 
but the syphilitics are a grade in advance of the others. In 
spelling the syphilitics average barely fourth-grade work, 
whereas the others average four-and-a-half grades of work. 
Yet the range of accomplishment for the non-syphilitics ex- 
tends both lower than the syphilitics and higher. 
In general information, the syphilitics have a certain su- 
perficial conversational ability which enables them to make 
a much better impression, although much difference can 
not actually be demonstrated on the tests. 
The stories of the syphilitics are more vague, deoriented, 
misty, more woven around with fancy. In many instances 
the individual seems to lie definitely and persistently and to 
have definite lapses of memory concerning episodes of bad 
behavior. The continued observation of a number of such 
cases justifies the belief that they are not actually lying in 
many instances. Instead, there is a slight but persistent 
tendency to amnesia, with at least a tendency towards de- 
lusions. From this combination come the difficult situations 
which the cases make for us. They do troublesome things, 
remember part of them, and act in accord with what others 
do to them, which usually seems to be punishment or disci- 
pline entirely out of proportion to what they feel they have 
done. The non-syphilitics do not present these character- 
istics. CONGENITAL SYPHILIS 
409 
While under observation this syphilitic group yields more 
of drama, excitement, and more frequent demands for dis- 
ciplinary or corrective handling than the non-syphilitici 
group. They are the talebearers, the sneak fighters, the 
temper-tantrum cases. They have every proclivity to, and 
desire for, homo- and heterosexual experiences. They are 
so plausible, so polite, so superficially acquiescent, that the 
ward attendants are unsuspicious and shower them with 
privileges, until some serious episode reveals the real nature 
of the individual. 
Medically, the group can hardly be separated from the 
non-syphilitics. They have, of course, some of the typical 
aftermath of the syphilitic infection, but few of the cases 
show progressive sensorial deterioration or active lesions 
of any type, not one, in fact, of this 9-year-level group. 
Anthropometrically, the group is not to be separated 
from the non-syphilitic. The measurements of this group, 
at least, do not confirm the general opinion that congenital 
syphilitics are undersized. Nine of the 20 have a standing 
height in the highest decile. 
Their heredity is about as mixed as that of the rest of 
the group. Syphilis may enter as an additional, compli- 
cating factor in almost any type of a family. The normal, 
the feeble-minded, the insane, the epileptic, the alcoholic, 
and the criminal are represented in both groups. 
The diagnosis of a congenital syphilitic is a rather com- 
plex thing in its consequences. We not only know his 
level and his functional disturbance, but we know the 
presence of a complicating factor which may speak defi- 
nitely against his future development, or may turn his 
behavior towards the psychotic end of the scale. The syphi- 
litics are feeble-minded in some cases, and psychopathic as 
well. They are merely inferior and psychopathic in other 
instances, normal but psychopathic in other cases, and one 
of this group is definitely psychotic. There is one condi- 410 
THE UNSTABLE CHILD 
tion present in two of the syphilitics not present in any 
others of this group, although we have found similar condi- 
tions in non-syphilitics at other levels. This condition, for 
want of a better name, we have called a deteriorative form 
of psychopathy. The individuals show a certain group of 
lacunae or mental vacancies where one feels absolutely sure, 
from what they do on other tests and from their histories, 
as well as from the presence of vestiges of earlier ability in 
language, that they are now functioning far below where 
they had formerly lived mentally. In some such cases, 
even observation for a few months is sufficient to give com- 
parative results indicating the lowering of ability. 
So far, what have the comparisons indicated? With the 
same mental level, this fairly good-sized group of syphi- 
litics and those not known to be syphilitic give definite but 
minor indications of differences, which are similar in trend 
in different test series. The syphilitic seems to be more 
variable than the non-syphilitic. He is found at both ends 
of most distributions on test values, except where academic 
acquisition enters in, and there his lower extreme tends to 
be higher than that of other groups. This does not mean 
that he is a less variable creature, but that he is an indi- 
vidual who has had ability to learn more, or at least retain 
more, than the others of the same mental level. The proba- 
bility seems to be that it is his extreme variability which 
pulls him down to the 9-year mental level. As a group, 
the indications are he has more mentality than others of 
the level. He is poor in motor control and all that it in- 
volves, be it Seguin formboard, drawing a diamond, lifting 
and comparing weights. His memory seems to be rather 
poor for the type of demand made in the imitation test, 
his spelling shows a similar defect, and his behavior tenden- 
cies definitely confirm this, -when one studies him critically. 
He is verbal in inclination, fairly well informed, less vari- 
able in his information and the general type of associa- CONGENITAL SYPHILIS 
411 
tion of ideas than the rest at his level, but his variability or 
instability tends to be more constant. He is naturally low 
on performance tests. His tendency seems to be to get into 
court a little younger than others of his level, and his of- 
fenses are of a chronic nature rather than those which sud- 
denly loom into being. He may come from any type of a 
family. The future of the group is rendered additionally 
doubtful because of the disease handicap. 
A similar analysis of all varying mental-age groups is 
imperative for actual clinical handling but is out of place 
here. It must suffice to say that, so far as the number of 
cases at the various levels justifies even tentative conclu- 
sions, the differences at other levels are at least as marked 
as at this level. There is no doubt but that one with a 
knowledge of the congenital syphilitic as a mental problem 
can recognize such cases through their behavior on stand- 
ardized tests in the time usually given to such cases in a 
psychological laboratory of good standing. Many other 
items of information concerning the congenital syphilitic 
have been found in the case studies reported in earlier 
chapters. In but a few of these instances are there enough 
cases to make any deduction of a general principle. But, 
until more extensive data are available, even the actual 
occurrences are of sufficient importance to be reported 
briefly, with simple illustrations. Naturally, one cannot 
estimate the prevalence of such occurrences. 
1. Congenital syphilitics are not necessarily delinquent. 
Of course, those reported in this study of delinquents are 
there because of behavior difficulty. The congenital syphi- 
litic, carefully raised, carefully disciplined, carefully edu- 
cated has a good chance for a non-delinquent career, as 
good as any other psychopath has under the same condi- 
tions, so far as we know. Many of such cases come for 
examination because of their very queerness, or instability. 
Others seem to pass through to adult life with little diffi- 412 
THE UNSTABLE CHILD 
culty. One may well raise the question as to the type of 
infection in such cases. Has it affected the musculature, 
some restricted neural tract, some definite part of the skele- 
ton, the glands, some other internal organ? We must re- 
member that psychopathy means an affected neural system. 
2. The question of whether an individual is a congeni- 
tal syphilitic cannot be definitely settled by a blood Was- 
sermann. Although 99 of our 369 children were syphilitic, 
yet only 73 of that 99 gave positive Wassermanns. More- 
over, on that 73, the positive Wassermann was not a first 
Wassermann in every case. For instance: 
Paul 
Paul, aged 15 years, testing 10 years, 7 months, and showing 
some psychopathy, was sent in for observation because of temper 
spells. He remained several months. All necessary corrective 
work was done. His behavior being exemplary, he was paroled 
to his sister. At this time he was 15 years, 2 months old and 
tested 11 years, 2 months. Thirteen months later he was returned 
as unsuccessful and too difficult to manage. At this time, 16-3 
and testing 11-3, he gave a 2 plus Wassermann, and, simulta- 
neously, the sister’s physician reported that he had diagnosed her 
as a congenital syphilitic and had begun treatment. This boy’s 
first test was made before the beginning of our attempt at the 
psychological differentiation of syphilitics, but analysis shows 
it to be fairly typical for the age group to which he belongs. 
His symptoms grew steadily more marked despite treatment, until 
at the age of 17-0 he was sent to the Industrial School, because 
the type of living there seemed better for him than state-hospital 
care. Reports from there show him to have become even more 
seriously anti-social. 
Karl 
Karl gave a 4 plus Wassermann when examined by his agency 
9-24-18, a 2 plus on 10-21-18, a 3 plus 8-6-19, and a negative 
3-23-20. He had not been given any treatment at any time. At 
the time of this last finding he was 10 years, 6 months of age and 
tested 9 years, 4 months. He runs away, is destructive, cuts new 
clothes to pieces, sets fires, and has extreme sex interests. A year CONGENITAL SYPHILIS 
413 
later his condition was unimproved, but his blood Wassermann 
remained persistently negative. 
Harold N. 
Harold N. gave a negative Wassermann on admission at the 
age of 9 years, 9 months. At this time he scored a mental age 
of 8 years, 8 months. He was definitely psychopathic. His 
behavior was extreme. He was cruel to other children, stole, 
and lied constantly. A Wassermann taken 2 months before had 
been negative. Two months later a blood test was reported as 
4 plus. About 20 months after this, he was readmitted. The 
findings at this time were likewise plus. He was unimproved in 
any way, behavior was much worse, and his psychopathy was 
much more marked. At this time he was 11 years, 5 months old 
and tested 10 years, 3 months. Treatment brought no seeming 
betterment. This boy was undoubtedly as much a congenital 
syphilitic the first time he was tested as when he gave a positive 
laboratory finding. 
Joan 
Joan was examined when exactly 14 years of age. She scored 
a mental age of 10 years, 4 months at this time, with many indi- 
cations of instability. She seemed to have plenty of ability but 
could not use it efficiently. Had a history of temper spells, run- 
ning wild, of escape from local institutions, and lying. Psycho- 
logically, her tests resembled those of the syphilitic group. Five 
Wassermanns taken during the next two months were negative. 
Tonsils and adenoids were then removed, and ten days later a 
Wassermann was positive. One physician reported no stigmata 
of syphilis, but the psychiatrist reported, “Retarded puberty, 
numerous stigmata, Hutchinson ear symptoms, scaphoid scapulae.” 
History indicated that the father was “wild,” suffered from a 
first paralytic stroke at the age of 27, and finally died of the 
third. The mother has “running sores” on her leg, cannot be 
cured. Under corrective treatment the girl developed surpris- 
ingly in the next three months, finally scoring 13 years, 1 month 
on the Stanford when 14 years, 6 months old. Behavior con- 
tinued as difficult as ever. Stabilized by a year at the Industrial 
School, later reports said she was doing fairly well. 
3. Etherization seems to excite latent congenital syphilis. 
The question of the change of a Wassermann after an 414 
THE UNSTABLE CHILD 
etherization is illustrated in the cases of Harold and Joan, 
summarized under 2. Both of these had tonsil and ade- 
noid operations ten days before the positive finding. There 
is a certain tendency to discount such positives as acci- 
dental. In the case of Harold, this is impossible. One 
may be sure that the effect of such an operation would not 
persist for a year and a half. With Joan, history partially 
confirms the finding. In some ways this matter is one of 
the highest interest. Given a latent syphilitic infection, 
why should it not find its potentiality accentuated by the 
chance handicap which the operation has placed upon the 
individual’s constitution? There are a number of other 
cases in our group in which the first symptoms of disturb- 
ance can be traced back to the period shortly after some 
such minor operation. Of course, we have no data as to 
the condition of any of these individuals before this op- 
eration, that is, no laboratory findings, save in the two 
cases mentioned. 
4. The positive Wassermann after operation is closely 
paralleled by the seeming traumatic precipitation of aber- 
rant conduct in a syphilitic. This, again, is by no means 
infrequent. The only reason why we so seldom recognize 
the condition is because the accident and the resulting 
trauma are usually given credit for the changed condition 
without recourse to a full physical examination, including 
a blood Wassermann. 
John 
John was brought for study at the age of 14, testing 9 years, 
4 months. He was markedly unstable in his test ratings. Five 
years ago he fell 25 feet from a roof and fractured his skull. 
All of his trouble is said to date from that time. He steals con- 
stantly. Careful investigation of the situation reveals the fact 
that he actually had begun making trouble the year before this, 
and happened to fall from a roof because he was running around 
with other delinquent boys. His first Wassermann reaction was 
negative, but the next was 2 plus. The developmental and CONGENITAL SYPHILIS 
415 
family histories corroborate the laboratory findings. This case 
is seemingly one of traumatic precipitation, but the story becomes 
dubious when investigated. It is typical of the clinic reports 
one meets day by day. 
William 
William, on the other hand, presents a clearer instance of such 
shocking into activity of a latent condition. Yet even here we 
have an additional factor which makes the shock theory a doubt- 
ful one. Bathing in the river, he was mistaken for an animal and 
hit with a bullet. A right monoplegia resulted. The boy was 
normal until that time, and ready for high school. He went on 
to high school but could not make good, and began to complain 
of “having lost his senses.” He threatened the man who shot 
him with a revolver. Examined at the age of 15 years, 10 months 
he tested 10 years, 5 months. He gave evidence of deterioration. 
The Wassermann was positive. Under treatment, symptoms of 
irritability, irresponsibility, and inertia decreased. He has since 
been able to earn his own living, paroled to the care of his father, 
who is himself a 4 plus case and evidencing deterioration. We 
have, of course, in this case, the possibility of continued absorp- 
tion from the bullet, lodged in the brain. The relapse of symp- 
toms under treatment rather negates this, however. 
5. Some congenital syphilitics evidently never give a 
positive Wassermann. This could not be stated dogmati- 
cally as more than a probability. However, the possibility 
of it must be kept in mind if one is not to be lured off into 
the assumption of the absence of syphilis when repeated 
negatives are given. 
Gordon 
Gordon, 14 years old, testing 9 years, 2 months gave marked 
indications of psychopathy. Although he was so constitutionally 
inferior that he had many and marked stigmata, yet he gave 
repeated negative Wassermanns even under provocative treat- 
ment. The history as given at first was negative. The psycho- 
logical findings were so definitely like those of the congenital 
syphilitics that an emphatic demand was made that the father 
submit to a blood Wassermann. He dreaded this so that a com- 416 
THE UNSTABLE CHILD 
promise was effected. At his suggestion, he gave, instead, a 
detailed and actual history of the case. He had had an infection 
before marriage, “with treatment which cured.” Following this 
history and its corroboration in the major details, the boy was 
put on treatment. The therapeutic value of the treatment soon 
evidenced itself in the marked physical change in the boy, his 
increased alertness, loss of grouches, moping, and sullenness. 
Cessation of treatment due to an involuntary parole brought 
renewed physical symptoms, a return to the Bureau because of 
new delinquencies, and a return of the old mental symptoms. 
There had been a total of five widely spaced negative Wasser- 
manns in this case. 
6. Both negative blood and negative spinal fluid find- 
ings may be present in a congenital case. 
Sawyer 
Sawyer was first examined when 8 years, 11 months old. He 
then tested 8 years, 4 months. He had been stealing from the 
age of 7. There was marked psychopathy, with a superficial 
inhibition of all activity which made him seem like a very shy 
normal child. Observation covering a year brought nothing but 
negative medical findings, including repeated blood Wassermanns 
and a spinal-fluid study. Yet the psychological findings indicated 
the syphilitic type. After 11 months a family history was ob- 
tained in detail. This gave the usual history of miscarriages 
followed by the birth of living children. Sawyer was the first 
living child born. There was also a history of a period of in- 
ability on the part of the father, serious enough that the physician 
wished to probate him. He had delusions about inability to work, 
had also “had a fall” before this. A blood Wassermann obtained 
from him at this time was 2 plus, although the mother’s was 
negative. On page 417 are typical diamonds and designs drawn 
by Sawyer. The amount of qualitative disturbance is minimal for 
syphilitics. 
7. The family denial of infection is sometimes so know- 
ing that one seems to be justified in reading behind the 
lines. The experienced worker knows this, but for the 
sake of those who meet these conditions less frequently it 
seems well to furnish an illustration. ATTEMPTS AT DRAWING MADE BY SAWYER AT TIME OF FIRST EXAMI- 
NATION, WHEN 8 YEARS, 11 MONTHS OLD AND 
TESTING 8 YEARS, 4 MONTHS. 
ATTEMPTS MADE BY SAWYER AT SIXTH EXAMINATION, WHEN 9 YEARS, 
8 MONTHS OLD AND TESTING 9 YEARS, 9 MONTHS. 418 
THE UNSTABLE CHILD 
Rachel 
Rachel was sent in by her foster parents. She had been taken 
because of their inability to tolerate seeing such a promising 
youngster living in squalor and neglect. Her real mother had 
been insane, and the child was born in the State Hospital. The 
first laboratory examination revealed a 4 plus Wassermann. A 
letter to the father brought the following reply, copied verbatim: 
I am certainly surprised to hear the condition Rachel is in. There 
has never been anything of that kind on either side so she must have 
gotten it recently. I should think if she had had it for any length 
of time, it would have show up on her body or face before now. 
I would like for you to find out if you can, where she got it; by 
making her tell. 
Can you tell By a examination whether she contracted it by inter- 
course or not, and how long it has been standing? If so please 
answer immediately. 
This indicates a fairly clear idea of the disease for a man of 
the lower level of mechanics. Unfortunately, the mother was 
discharged from the hospital before the time blood Wassermanns 
were in vogue. Other cases spoil their denial absolutely by their 
emphatic statement that they never had the disease, while all the 
time they are calling it familiarly by some one of its common 
street designations, unknown save in certain disreputable quarters 
of the community. 
8. The grandiosity of manner and the underlying en- 
largement of ego of the syphilitic are usually accompanied 
by a handwriting that portrays it. Note the case of 
Harry D. This case, by the way, gave negatives four years, 
and then a positive. 
9. The handwriting of many syphilitics has a character- 
istic angularity. With this there is a misspelling of accus- 
tomed words in even such well-known items as the individ- 
ual’s own address. The tendency to misplace or duplicate 
letters is much more marked in individuals of this type 
than in other unstable individuals of the same mental level. 
Bianchi reports this.7 It seems well to quote his findings 
on the syphilitic exactly. 
7 Leonardo Bianehi, A Text-Book of Psychiatry for Physicians and 
Students, translated by Janies H. MacDonald, pp. 791, 793, 804. CONGENITAL SYPHILIS 
419 
When he writes he leaves out letters or syllables in the forma- 
tion of words, or entire words in the composition of phrases. . . . 
Tremor is one of the most important of the somatic phenomena. 
. . . This tremor is not manifested in a state of repose, but 
during voluntary movements, and especially at the very beginning 
of a movement. ... It is particularly in the most delicate and 
complex movements, such as writing, that the tremor is apparent. 
HANDWRITING SPECIMENS OF HABRY D. 
10. There seems to be a definite relationship between 
congenital syphilis and glandular disturbances. The most 
marked case of this was Gladys. 
Gladys 
Admitted at the age of 14 years, 11 months, she tested 10 
years, 3 months. The type of psychopathy indicated congenital 
syphilis. She was incorrigible, with mild delusions of persecu- 
tion, unpalatable food, mistreatment, etc. Physically, her lack 
of development, slant palpebral fissure, and short fingers gave 
the diagnosis of mongoloid. The Staff disagreed on this, since 
the major signs of Mongolism were missing. She was not highly 
imitative, did not have typical walk, head shape, fissured tongue, 
or thick hands. Laboratory tests were negative. Later X-ray 
findings indicated a skull condition which was “undoubtedly 
syphilitic.” EVEBYDAY SCHOOL WORK OF MACK, 11 YEARS, 9 MONTHS OLD, TESTING 12 YEARS, 3 MONTHS. UNSTABLE AND SYPHILITIC 
AND UNABLE TO KEEP UP IN SCHOOL WORK FOR THE LAST TWO YEARS, BUT NOW DOING WELL BECAUSE OF, OR SINCE, 
INTENSIVE ANTI-SYPHILITIC TREATMENT. WASSERMANNS WERE NEGATIVE, EVEN UNDER PROVOCATIVE TREATMENT, 
BUT THE FATHER DIED OF GENERAL PARESIS SHORTLY AFTER HIS BIRTH, HAVING HAD INFECTION BEFORE MARRIAGE. CONGENITAL SYPHILIS 
421 
11. Treatment may affect certain mental attributes and 
not others. 
Naomi C. 
Naomi C., mentality 7, actual age 9. Marked episodes of run- 
ning away and some stealing and temper spells were her trouble. 
Wassermann was 4 plus, and treatment was begun. She was 
under observation at intervals for a year, treatment being super- 
vised. Mental level changed but little, save that it showed a 
cycle, the successive tests being 7-0, 7-6, 7-2, 7-0, 7-6. On the 
behavior there was no perceptible change. On the association 
series, however, there was a definite and constant change for the 
better. The actual value of her responses about doubled in the 
year. The change was gradual and evidently not due to learning 
as successive tests, given at short intervals, were similar. 
12. Treatment may have no sudden effect upon behavior. 
The general hope in treating a syphilitic is that the social 
problem will thereby be alleviated. If we could prove this, 
state appropriations for such treatment would undoubtedly 
be forthcoming. The fact is, however, that one dares not 
be too hopeful. To illustrate: 
Donald 
Donald was a 17-year-old boy referred because of stealing an 
automobile. Physical diagnosis was not difficult. He gave a 
4 plus Wassermann, his father had died in a state hospital of 
general paresis. Mentally, he tested 11 years, 8 months and 
seemed to have sufficient intelligence to get along in the world, 
if his psychopathy could be eliminated. He was put under inten- 
sive neo-salvarsan treatment. After a prolonged period of ob- 
servation, corrective education, and the medical treatment, he was 
paroled home but could not get along. Returned, treatment was 
resumed, but he ran away. He has since wandered over a good 
bit of the country, was in the army a while, and has recently 
been committed to the State Hospital for Insane. 
Harold 
Harold is a younger example of the same tendency. At 14 
years, 7 months he tested 13 years, 5 months. Extreme irri- 422 
THE UNSTABLE CHILD 
tability was indicated in tests and behavior. Intensive neo- 
salvarsan treatment was carried out at the Bureau, and treatment 
was continued at home. One year later he was readmitted with 
more marked behavior and mental symptoms, yet the Wasser- 
mann had become negative and continued so. At this time he 
was sent to the State Hospital. 
13. There is a possibility that some of our etiologically 
unclassified mental diseases may be syphilitic in origin. 
Samuel 
Samuel was admitted to the institution diagnosed as a case of 
Marie’s congenital cerebellar ataxia. The symptoms were typical 
for that condition. All laboratory tests were negative. A younger 
brother of the boy is beginning to show the same motor symptoms. 
Mentally, the two boys had almost identical mental distributions 
and levels, yet one was 14 and the other 10. The older child has 
had repeated blood and spinal-fluid examinations which are all 
negative. Yet, the father tells a straightforward story of infec- 
tion and treatment before marriage. Is it not possible that we 
may have, in such instances, non-spirochetic persistences of 
syphilis ? 
14. Younger siblings of matings where older children 
are definitely known to be syphilitic may give negative 
Wassermanns. In our group of delinquents we have no 
opportunity to generalize on this phase of the matter, for 
there are only half a dozen instances of such relationship. 
They are enough, however, to show the possibility. 
Gerald 
Gerald was one illustration of this. He belonged in the syphi- 
litic group according to psychological test findings, yet all labora- 
tory tests were negative, and there were no pathognomonic stig- 
mata. A year later his older sister was brought in, for clinic 
examination only, and was found to be a congenital syphilitic, 
with positive laboratory findings. The drawings made by this 
boy were highly suggestive. 
Ten such family groups were numbered among the 216 
children studied as dependents. Psychologically, these DRAWINGS MADE BY GERALD, AGED 9 YEARS, 0 MONTHS, TESTING 
7 YEARS, 6 MONTHS. PSYCHOLOGICAL DIAGNOSIS OF SYPHILIS 
CONFIRMED BY FAMILY DATA A YEAR AFTER THE 
TIME OF EXAMINATION. 424 
THE UNSTABLE CHILD 
younger children give indications which are similar to those 
given by their older siblings who have positive Wasser- 
manns. The case that does not show such symptoms is yet 
to be found, and the writer is about ready to adopt the be- 
lief that the child of a syphilitic is never normal, func- 
tional disturbances or imbalances will occur, and there is a 
constitutional tendency to psychopathy. 
15. There is some reason to believe that early and per- 
sistent treatment of congenital syphilitics may have in it 
sufficient power to bring alleviation of the condition and 
enable the individual to adapt normally to social demands. 
David 
David came under the care of a state society at the age of 
9 years. When examined the next week, he scored 7 years, 10 
months on the Stanford. Physical examination revealed a 2 plus 
Wassermann, a specific iritis, and other complicating minor 
symptoms. He was put under treatment and has been under 
treatment, with proper rest periods, since then, combined neo- 
salvarsan and mercury being used. At the age of 10 years, 3 
months, he tested 9 years, 2 months on the Stanford. He had 
begun being troublesome in his boarding home. Repeated obser- 
vations paralleled the treatment and supervised care in boarding 
homes. The delinquencies were definitely serious and continued 
several years. At the time of the last examination he was 11 
years, 9 months old and scored 9 years, 2 months on the Stanford. 
Mental development seems to have ceased. Other tests have not 
changed noticeably in quantity or quality save that he is better 
on academic accomplishments. Since this last examination there 
has been a definite improvement in his behavior and he is now, 
at the age of 14, reported as getting along and causing absolutely 
no trouble. Note that the delinquency was coincident with the 
time that mental development was stopping. 
16. One must not forget that there is a possibility of 
congenital syphilis being complicated by a renewed infec- 
tion. Our 13-year-level group has in it the one case we have 
in whom this is a possibility. Clinics thought him a pe- 
culiar case because of the rapidity of the deterioration. A CONGENITAL SYPHILIS 
425 
substratum of a predisposed organism seems to offer a 
reasonable explanation of why this happened. The family 
history, carefully investigated, reveals many corrobora- 
tions of this possibility. The boy bears some stigmata. 
Fournier notes such occurrences. 
17. There seems to be a general tendency in our group of 
syphilitics to meet, at least halfway, any homosexual oppor- 
tunity. One cannot help but wonder whether there is not 
a possibility that a syphilitic infection, by its very nature, 
affects that part of the system which, in its abnormal func- 
tioning, makes more certain the continued opportunity for 
the disease to flourish. Is it not possible that such selec- 
tive evolution is one reason why the disease continues? 
The syphilitic, of primary or congenital infection, tends to 
sex abnormalities or indiscretions. He thus safeguards the 
future of the disease from which he suffers. The extremely 
rapid deterioration of Roswell X. might be explained by 
some such hypothesis. The organism, already affected by 
the disease, yields more readily to a renewed onslaught. 
Even if we grant an infection four years back, what made 
him abnormal enough to incur that infection? 
18. There are a number of cases where the medical find- 
ings are entirely negative, but where the condition is indi- 
cated by the psychological findings. Of course, since the 
diagnosis by such psychological symptoms is in its infancy, 
actual determination of the ease condition must wait until 
further evidence decides the case one way or the other. 
Clarence 
Clarence is a good illustration of this and also of the fact that 
treatment to the point of a negative Wassermann does not mean 
cure. Clarence was 11 years, 11 months old, when sent in for 
attempted rape. He scored 9 years, 2 months on the Stanford. 
His psychopathy was marked, and distribution and quality on 
tests were similar to those of known syphilitics. The medical 
findings, including spinal fluid, remained persistently negative. 
After the child had been disposed of, the history came in from 426 
THE UNSTABLE CHILD 
the Clearing Bureau. He had been a 4 plus ease in 1916, and 
treatment had been continued until the blood tests were con- 
sistently negative. Yet the psychological findings indicated the 
same condition as in untreated cases! 
19. The psychological diagnosis of congenital syphilis 
is a logical development of modern tests. The criticism has 
been made that it is insane to think it possible to diagnose 
syphilis by psychological tests. If by “insane” the critic 
would be willing to agree to the definition “not thought of 
by the ordinarily sane, ’ ’ the writer, too, would agree to the 
criticism. The possibility was one that could not rationalize 
itself out of clinical training in psychology. It took open 
mindedness in the study of cases to get the suggestion for 
such analysis. But is it illogical ? Neurologically or 
physiologically, no. 
The physiological basis for any such assumption is not 
hard to develop. All of the medical and physical studies of 
congenital syphilis show that there is very apt to be a dis- 
turbance of the reflexes. The most common of all neuro- 
logical tests because of this significance is the patellar re- 
flex. According to the stage, kind, and location of attack 
the congenital syphilitic may show exaggerated, diminished, 
or normal reflexes. 
Let us leave this fact and return to it later. 
The Russian physiologists have been working with the 
artificial development and inhibition of reflexes. Their 
studies have been developed chiefly upon animals, but there 
have been some applications, showing the similarity of con- 
ditions in humans. There are a number of their findings 
that are of especial interest to psychologists. The reflex 
is the primary type of nerve action and in its ultimate form 
is inherited, ready to function under the proper stimula- 
tion, when the creature or human being is born. All other 
neural response is but a complication of such simple re- 
sponses, or simple reflex action with the addition of one or CONGENITAL SYPHILIS 
427 
two more neural links, so that instead of stimulation, con- 
duction, response, we have stimulation, conduction through 
a, b, and perhaps n areas, before we elicit response. These 
more complicated patterns of nerve action are not prede- 
termined, that is, their stimuli may be varied. Pavlov has 
shown definitely that any stimulus from the external world 
may be made the exciting cause of any type of reaction, 
even of that which we think of as purely autonomic or re- 
flex. The Pavlov school has also shown that these stimuli 
work under certain definite laws. There is no chance 
effect from any chance affect. When a reflex is conditioned 
or caused by some definite item in the external world, that 
reflex is called a conditioned reflex. Conditioned reflexes 
are the basis of our experiential development. They are 
our neural life. They are subject to changes, they form 
through experience, become more definitely fixed through 
repetition, lose strength through disuse, may be inhibited 
through the development of other reflexes, or may be re- 
enforced through them. Psychologically speaking, these 
conditioned reflexes form the sum total of our learning, 
remembering, forgetting, and relearning to modified condi- 
tions, that is, adaptive learning. These processes are the 
basis of our mental life. Speech itself is a group of condi- 
tioned reflexes with the finest of motor differentiations for 
differences of the sum total of conditioned reflexes active at 
that time. 
What bearing has this upon our problem of congenital 
syphilis ? 
If congenital syphilis is severe enough in its affects to 
manifest itself through disturbance of the primary reflexes, 
why would it not manifest itself through a disturbance of 
these less stable, more variable, less predetermined condi- 
tioned reflexes? The same delay or acceleration or nor- 
mality of response should be found, all of it exaggerated 
and increased by the fact that there are more neurones in- 428 
THE UNSTABLE CHILD 
volved and hence a greater chance of more of them being 
“abnormal.” All that any psychological test can obtain, 
on any case of neural disturbance, is merely an aggrandize- 
ment of the symptoms grossly present. But, because of 
the refinement of approach, symptoms may be found when 
they do not show through standard physiological tests. 
The paretic has mental symptoms, so has the neurosyphi- 
litic. Whether a case of bone or organic syphilis has is a 
matter to be determined. The probabilities are that we 
have all manners and degrees of involvement, and that the 
various strains of affection from syphilis are so complicated 
that years of work may be needed to analyze any of them 
into definite facts. But, the fact remains, syphilis, con- 
genital syphilis, has its effect upon the intelligence. It dis- 
turbs function and consequently level. Our present tests, 
carefully applied, carefully analyzed, studied without 
prejudice, reveal these traits. 
One thing must be emphasized. Syphilis is present in 
many delinquents. Its presence seems to mean a certain 
type of psychopathy. Nevertheless, syphilis does not cause 
delinquency. It causes psychopathy. The aftermath of 
that psychopathy is delinquency when there is not sufficient 
constantly alert supervision. Yet, fundamentally, the 
syphilis is to blame. Knowledge of who is syphilitic, pre- 
ventive treatment, corrective treatment, supervision, and 
understanding will finally have their effect upon delin- 
quency, since they will modify or safeguard psychopathies 
that are merely opportunities for delinquency. 
Can the syphilitic be cured? None knows. But recog- 
nized and understood, he can be handled preventively. The 
recognition of him has undoubtedly been a problem of ex- 
treme difficulty. The development of the Wassermann 
technique and other laboratory procedures has greatly in- 
creased the ease of detection. It has done away with the 
idea that there is no congenital syphilis without sores and CONGENITAL SYPHILIS 
429 
terrible malformations. Solomon has done a tremendous 
amount to emphasize the frequency of syphilis in the chil- 
dren of syphilitics.8 Yet his work is entirely too conserva- 
tive, for it depends upon the ability of laboratory tests to 
indicate the presence of the disease. 
The congenital syphilitic, the child who does, or does not, 
give a laboratory sign of his condition, has, in many cases 
at least, mental signs that are as unmistakable to the ex- 
pert as a Wassermann reaction. A few such scattered 
psychological findings on cases of original infection have 
been mentioned in the summary of test analyses. In gen- 
eral, however, but little has been done to determine the 
mental attributes of the congenital syphilitic. There is at 
hand a facile pen picture of him, drawn with the ink of 
experience by the man to whom too much credit for work 
on congenital syphilis cannot be given, Edmond Four- 
nier.9 He groups the symptoms of congenital syphilitics 
under three heads. First of all, there is the neurasthenic 
form which occurs as an auxiliary form of true hysteria. 
The chief characteristics of such cases are nervous ex- 
haustion, general depression, weakness, dejection, and ir- 
resolution. These symptoms are commonly known and 
frequently met. Secondly, there is the group of true hys- 
terias. There are undoubtedly hysterias which are purely 
syphilitic in origin. And last, there are those who are 
affected in such fashion that it is their behavior which 
describes the disease. They suffer from a degenerative 
condition of intellectual, moral, and emotional attributes. 
Fournier claims that this group is more numerous than 
either of the others. These individuals suffer from a 
psychic ataxia. They are different, extreme in views, fan- 
8 Harvey C. Solomon and Maida H. Solomon, “The Effects of 
Syphilis on the Families of Syphilitics,” Social Hygiene, October, 
1920, pp. 469-487. 
s Edmond Fournier, Recherche et Diagnostic de VHeredo-Syphilia 
Tardive; Syphilis Hereditaire de VAge Adulte. 430 
THE UNSTABLE CHILD 
tastic, unbalanced, flighty, easily distracted, only half sen- 
sible. They suffer mental lacunae, they are half-intelligent 
on many subjects. They are lacking in conscience, dull in 
moral appreciation. They are without definite aim or pur- 
pose. They are mentally unstable, overadaptive, lack bal- 
ance. Their ideas are “ataxic.” 
If such subtle descriptions of the mental process of con- 
genital syphilitics could be given by one whose work ended 
about the time modern clinical psychology developed, how 
much more definitely should we now be able to work out 
the exact description of the same condition? The future 
of clinical psychology lies in the study of just such prob- 
lems. Congenital syphilis is but one factor behind psychop- 
athy. It is premature to suggest what others may be, yet 
all nephritis cases studied do seem alike, tubercular chil- 
dren have symptoms that differ but which seem similar 
for their group, thyroid cases put one through the same 
round of exasperation again and again. Is it impossible to 
analyze these vague similarities back into clinical facts? 
There is no reason why we should think so. Psychopathies 
may be incidents in normal individuals and resolve them- 
selves into nothingness. They may be actuated by shock, 
worry, or disease. Their clinical differentiation is a prob- 
lem that challenges the modern psychologist. For the 
writer, the syphilitic psychopathy is an entity, now rather 
easily identified in most cases. Corroboration on the physi- 
cal side is often slow and difficult, yet it can usually be 
obtained. The findings in this group have been helpful 
enough in the work on later cases to repay for any effort 
expended in the attempt at identification of the congenital 
syphilitic. Not only that, but the results obtained are more 
than enough to motivate further study. The investigation 
of psychopathy demands open-mindedness, accuracy, and 
thoroughness in work, impartial consideration of all as- 
pects of each case. Given these, any laboratory, any CONGENITAL SYPHILIS 
431 
worker may feel sure that time and work will bring to light 
explanations of the problems so constantly demanding our 
attention—inferiority, dependency, psychopathy, delin- 
quency. CHAPTER XXI 
CONCLUSIONS 
To attempt the deduction of conclusions from this study 
is, in one sense, almost absurd. In view of the limited part 
of the subject covered, no conclusions can be reached that 
are not merely tentative, partial, and suggestive. What 
seem to be final issues now should, with further study, prove 
to be but the first indications of the larger aspects of the 
problem in general. They will, let us hope, lead to a wider 
perspective from which the whole subject may be studied 
anew. To find that the presence of a means the probable 
presence of b is probably a determination well-pleasing to 
the individual who is interested in the practical usage of 
this relationship in the applied professions, but to the 
scientist there is a more enticing side of the matter. When 
a is present, the presence of b is certain, in a certain per- 
centage of all cases. But, from other sources he knows that 
the presence of b means the probable occurrence of c, r, s, 
or some other term. He also knows what the presence of 
some of these terms is apt to mean. What happens ? As a 
result of the determination of even the partial relationship 
of a and b, there opens out before him the whole expanse 
of the multiple relationship of all of the terms. His work 
is stimulated by the infinity of possibilities. Speculation 
invites and leads him on to necessitous research, for the 
adventure of discovering new relationships awaits him. 
To the writer, the experience of this study has been just 
that. The narrow and wearisome treadmill of applied psy- 
chology as it meant the faithful application of tests given 
again and again, with diagnoses waiting inevitably accord- 
432 CONCLUSIONS 
433 
ing to the quantity of ability found, has changed into a 
fascinating, if bewildering, challenge of many possibilities. 
Items formerly of unimportance become full of significance 
if one studies them with the eye of the microscopist. Quali- 
tative analysis adds just that much to the significance of 
our present tests. To realize this in more practical form, 
let us briefly summarize the “catch phrases,” or the steps 
of presentation of this study, strip them of their arguments 
and illustrations, and see where they lead, what they sug- 
gest, what they mean for everyday usage. 
The keynote to an understanding of clinical psychology 
is perspective. Any such applied branch can be compre- 
hended only when one has a true vision of its source, its 
aim, and its relationship to other matters of life and living. 
Psychology is a recently developed branch of biology. 
Its first aspects were physiological. Far more recent are 
its introspective, educational, economic, and social inter- 
ests. 
Its origin tended to foster an attitude of pure research 
with emphasis upon extreme refinement of technique and 
accuracy in its application. These are the qualities which 
have made its work as successful as it has been. 
From the very first, psychologists studied human deviates 
intensively. The earlier forms of study were psychiatric 
in procedure and centered about the problems of the in- 
sane. 
Less than twenty years ago the first definite attempt to 
study individuals scientifically, yet practically, was made 
by Binet. 
His success was undoubtedly due to his ability to cor- 
relate scientific methods with practical aims and to adopt 
both to the immediate demands and needs of the social 
group. 
The Measuring Scale of Intelligence revised the whole 
world’s attitude towards psychology. Its praiseworthy THE UNSTABLE CHILD 
434 
traits were simplicity, brevity, statistical method, and prac- 
ticality. 
The rapid adoption of the method had its unfortunate 
consequences. 
1. The acceptance of poorly trained workers. 
2. The overexploitation of the tests. 
3. The temporary assumption that mental age was the whole of 
the problem of mental diagnosis. 
As a result the detection of the feeble-minded received 
tremendous impetus. Then the appalling number of feeble- 
minded revealed by the tests led to widespread campaigns 
for the provision of institutional care for such cases. As 
a result, the public is fairly well instructed in the “social 
primer” of the needs of such cases. 
The rapid acceptance of the tests in clinic procedure 
followed. Revisions and supplementary series of tests ap- 
peared in increasing numbers. 
At present the Stanford revision is probably the best for 
American usage. Although it is not perfect, yet it seems 
wise to use it long enough to solve some of the problems 
raised by mental-age tests, before we complicate interpreta- 
tion of findings by changing the method of determining 
mental age itself. 
There is still a general acceptance of the idea that some 
such scale is the whole of clinical psychology. Workers 
who hold this attitude are handicapping child welfare, edu- 
cation, social provision, and clinical psychology itself. The 
psychologist needs the orientation which comes from study- 
ing all aspects of the problem confronting him, instead of 
living wrapped in a small portion of it. 
The army usage of tests gave a tremendous incentive to 
the development of such methods of diagnosis. To a cer- 
tain extent it revealed the relation of mental age to indus- 
trial and social efficiency. The value of this relationship CONCLUSIONS 
435 
justified the practical usage of tests after the war. At the 
same time, the war usage of tests sponsored the use of group 
tests in a way which has handicapped much of the work 
done since then. The trouble is that the average mental 
examiner knows so little of his field that he sees no differ- 
ence between the application of group tests, and the inter- 
pretation of their results, and the clinical study of individ- 
uals by other methods. The group test is a preliminary, 
survey method, valuable as a means of indicating those who 
need further, more intensive, individual observation. It 
has a definite purpose and value, but it can never replace 
the individual test in clinical value. The fallacy lies in 
trying to interpret a group-test rating into the finality of a 
diagnosis. Even more wild is the prognosis based upon 
such information. 
Clinical psychology is the study of an individual. It is 
not limited to a study of his mental age or mental rating 
on any one test series. It is the study of the individual 
with attention directed to his attributes, as they make him 
the person he is, and differentiate him from others. Its 
aim is a true understanding of him and his behavior. Be- 
hind this study lies a purpose, all too seldom recognized, 
the desire to help him in preventive or corrective fashion. 
When clinical psychology settles down to painstaking, 
detailed, comprehensive study of and help of individual 
persons; when it places the spectacular, thrilling, large- 
number survey at its outer door as a mere card of introduc- 
tion ; then it will have partially grown past its adolescent 
flurries and instabilities. 
Clinical psychology as a study of the individual is slow, 
difficult, non-exciting, but it accomplishes something. 
Group tests give a hint of the presence of feeble-minded, 
psychopathic, and psychotic individuals, but clinical psy- 
chology in its proper guise determines with definiteness the 
existence of these conditions. Moreover, it also deals with 436 
THE UNSTABLE CHILD 
the backward, the delinquent, the nervous, the special de- 
fect cases, any and all problems of mind, acting. The unit 
of any human problem is always the behavior of an indi- 
vidual. Corrective work is also a matter of the individual. 
Correction is a matter of habits, of ways of learning and 
forgetting, of feelings and their usage. This holds whether 
the problem is one of education, dependency, or delin- 
quency. 
To meet the demands made upon it the practice of clini- 
cal psychology must be scientific, thorough, preventive, cor- 
rective, and at the same time it must educate the public. 
Moreover, all of this must be done in an economical fashion. 
This means the need of better methods, better technique, 
self-instituted improvement in all the clinical psychol- 
ogist does. The time is favorable. Present-day reports 
and studies show that mental age is a fallible quantity. 
Variability is much more prevalent than any one has be- 
lieved. Consequently, there comes the demand for detail 
and depth of study. Of this demand we may well be proud. 
The obvious thing is to meet it. Just what do we know 
that will help in this fashion ? 
The psychological clinic as a diagnostic agency has 
reached no final goal. Its aim is the elimination of the 
problems it handles. So far it has not even recognized 
many of the tasks justly belonging to it. Mental-age de- 
termination will undoubtedly be in constant usage for many 
years to come. This usage will gradually become more of 
a preliminary routine, and the time of the expert will be 
devoted to methods involving more refinement, a wider un- 
derstanding of human beings, and a greater utilization of 
other scientific aspect of human observation. Feeble- 
mindedness will not be considered the primary root of all 
evil. High intelligence quotients will not be made a basis 
for pushing children into social and educational groups 
wdiere they do not fit. CONCLUSIONS 
437 
Clinical psychology must study such problems as im- 
morality, fears, flights, truancy, temper, pathological lying, 
and stealing, from their genetic aspects. Delinquency, too, 
must be viewed as something other than an expression of 
intelligence inferiority. It is the child who is not normal, 
not feeble-minded, not insane, not seemingly handicapped, 
but who is yet a problem in the community, that furnishes 
the supreme challenge to the efficiency of clinical psychol- 
ogy. 
In this group are many of the problems of everyday life. 
There are the child who “lacks concentration,” the bright 
child who is “generally troublesome,” the bright child who 
fails on some one school subject, the aphasias, the “lazy” 
child, the clumsy, the slow, and the obstinate children. Nor 
should one overlook the cases that are potentially capable 
of developing into psychopaths, psychotics, or feeble- 
minded. 
There are differences between feeble-minded and normal 
individuals which do not show on tests, so far as any quan- 
titative evaluation can indicate them. The slide rule effi- 
cacy of the I.Q. has startling exceptions. Any case in a 
clinic may be that exception. Consequently the I.Q. and 
other mental-age forms of rating intelligence indicate 
merely the present condition of the individual. Something 
more is needed before one can predicate or hypothecate his 
future. 
The laboratory of clinical psychology that wishes to 
build up a successful future for itself must emphasize con- 
stantly improvements in methods, technique, the quality 
of work done, and cooperation with other agencies. 
Diagnoses are but the beginning of service. The deter- 
mination of corrective or preventive methods must follow 
immediately, or the diagnosis is useless. There is no ser- 
vice to society without this. Any clinic that realizes this 
practical need and tries to meet it will develop a personal- 438 
THE UNSTABLE CHILD 
ity of its own, a characteristic manner of dealing with the 
problems confronting it. Only when permeated with an 
ideal of self-denying service, felt by the least important 
member of the organization, will the best type of work be 
done. 
The clinical psychologist makes the personality of that 
laboratory in which he works. It is dependent upon him 
for its formulation of the ideals wrhich shall control its 
advance lines of work. He must, to further his own work, 
be broadminded and as broadly educated as possible. His 
specialized training should include more than the modes 
and methods of his special work. He must be intelligently 
ignorant, sympathetic but impersonal, not overemotional 
nor yet unemotional, capable of holding a critical perspec- 
tive. He must be tactful and in sympathy with his pa- 
tients. His relation to them should be one of evoking con- 
fidence. He must be widely enough trained to be auto- 
matically cogrfizant of and plan for all sorts of chance 
clinic problems, such as fatigue, hunger, antagonism, shy- 
ness, illness, and difficult parents. He must naturally com- 
bine the handling of the patient with the education of those 
responsible for him. He must always be fair, just, patient, 
repaid for all effort made by his interest in the individual 
handled. Perfunctoriness is the final test of clinical unfit- 
ness. 
The matter of clinical equipment is one of relative im- 
portance only, and is relatively insignificant. The usage 
of standardized tests is a general essential. Standardiza- 
tion has been a fundamental reason for the success of clini- 
cal psychology. However, tests cannot compensate for un- 
trained workers. Tests used should gradually be changed 
as new methods are evolved. Each test used should first be 
critically weighed from the standpoint of the value of 
results obtained from it, their reliability, the time needed 
to obtain them, the fatigue and expense involved, and the CONCLUSIONS 
439 
possibility of practical utilization of tbe results. Only 
when it meets these criteria should it be adopted. 
No tests are infallible. Which tests shall be used is- 
largely a matter of the prevailing opinion of psychologists 
at the time they are adopted. Many tests must be used. A 
tentative program for present-day examining should un- 
doubtedly include some one of the Binet revisions, per- 
formance tests, educational achievement tests, a general 
orientation series, and probably a morphological series, 
with special equipment for special types of individuals, 
such as the blind and deaf. 
Surroundings, blanks, files, record systems, should all be 
modern, complete, economically self-checking, and effi- 
cient. 
The examination itself is the reason for the existence 
of the clinic. Need one stress its consequent importance? 
Skill in gaining rapport with the patient, in maximizing 
results while minimizing effort, fatigue, and time are the 
chief requisites. The difference between haphazard and 
serial methods of giving a mental-age test series is a good 
illustration of efficient economy. Care must be taken to al- 
ternate the types of demand made upon the subject. The 
purpose of the test must partly decide the place that item 
holds in the general procedure of an examination. The 
value of some tests is enhanced by fatigue, whereas the 
value of others is negated. It is a matter of knowing what 
one wishes to determine from the examination and adapt- 
ing accordingly. When all is said, the technique, and 
hence the efficiency of an examination, is dependent upon 
the intelligent adaptation of the test materials to the prob- 
lem in hand. It is therefore a direct result of the intelli- 
gent adaptability of the examiner. 
The demand for clinical accuracy necessitates a verifi- 
cation of results obtained. This proving of the findings is 
more than a mere mathematical checking of the accuracy 440 
THE UNSTABLE CHILD 
of test scorings. The psychological diagnosis of an indi- 
vidual becomes a formal clinical diagnosis only after the 
tentative psychological estimate has been verified, modified, 
or accentuated by correlating it with all other known data 
on the case. These data should, in the ideal case, cover all 
of the important phases of heredity, conception, pregnancy, 
birth, infancy, childhood development up to the present 
time, educational experiences, social reactions, ethical, 
moral, and economic aspects of his behavior, and his pres- 
ent physical condition. Sometimes the data so obtained en- 
able one to emphasize more strongly the condition found 
in the psychological examination. In other cases the psy- 
chological findings are explained by extenuating items in 
these other fields. Sometimes it is only clinical skill and 
psychological familiarity with abnormal tendencies that 
prevent the acceptance of information that is distorted 
because the informant, himself, is in a pathological condi- 
tion. 
Having evolved a conservative diagnosis which relates all 
known facts about the case to each other, its usage must be 
conservative. A diagnosis is a statement of the present 
condition of the individual. With accurate diagnoses, a 
feeble-minded person is bound to remain feeble-minded. 
This is the only diagnosis in which the present condition 
unequivocally indicates the future, the prognosis. In all 
other conditions prognosis is a tentative extension of the 
diagnostic findings into the indefinite future. A prognosis 
is not certain, assured, or definite, but, until we have 
many more years of scientific observation of individuals, 
it must remain valuable only when it is pronounced by an 
expert. 
Even a brief survey of the literature convinces one that 
examiners as well as psychologists are beginning to realize 
the evanescent character of results so far obtained. Chil- 
dren testing normal do not stay normal. Feeble-minded CONCLUSIONS 
441 
children improve, even to a normal level. Precocious indi- 
viduals cannot live up to their level. 
Many and varied suggestions have been made. Study 
all aspects of a case, concentrate on character analysis, em- 
phasize the individuality of the child, recognize exceptions, 
stress industrial tests are a few of the suggestions which in- 
dicate a restless desire for something more than present 
clinic procedure accomplishes. 
Binet pointed out the most feasible line of psychological 
development many years ago in his work on the study of 
function. His years of experience in evolving the mental- 
age series gave him the perspective which our later-gained 
experience is now bringing to us. It is not intelligence 
level but intelligence function which differentiates the im- 
becile and the dement. It is a difference of function that 
keeps individuals of the same mental level from being simi- 
lar in ability, behavior, and personality. One succeeds, an- 
other fails; one adapts, another resists. Their functional 
condition, not their mental level, determines their activity. 
It is the study of function, cross-sectioning our present 
mental-age studies, that will relieve us by solving problems 
which mental age can only raise. Disturbed mental func- 
tion, or psychopathy, has its psychological aspects just the 
same as disturbed mental level has. Mental level is the de- 
termination of how much intelligence a person has. Mental 
function is the analysis of how effectively that intelligence 
works. 
Mental level gives one a knowledge of feeble-mindedness, 
backwardness, brightness, and their concomitants. 
Mental function gives one a knowledge of the reliability 
or unreliability of the mind studied, whatever its mental 
level. 
Mental level varies from a development barely equal to 
that of a newborn child up to superior-adult level. 
Mental function varies from normality to insanity. 442 
THE UNSTABLE CHILD 
There is a possibility that function may sometimes be even 
more efficient than normal, and that in such individuals 
the unusual efficiency is an important factor in their un- 
usual superiority. 
All or any variable quality of function may occur with 
any amount of intelligence, that is, at any intelligence level. 
Psychopathy, when conceived as a variability of func- 
tional efficiency, helps to explain many of the problems and 
difficulties which clinical psychologists seem to be finding. 
It throws light on the reason for people being lazy, nervous, 
and queer. It suggests a reason for irregularity of devel- 
opment and behavior. It gives a clue to character defects. 
It explains variability of ability and responsibility in those 
testing at a similar mental level. It is the analytic report 
on individuals whom the synthesis of test findings has given 
a rating in level. It is the qualitative study of a quanti- 
tatively determined condition. 
The first necessity in studying psychopathy is precision. 
Tests used must be used uniformly and with strict adher- 
ence to standard methods. The next requirement is the 
giving of a multiplicity of tests to each subject. The third 
need is for an impersonal recording of all of the details 
of behavior incidental to the examination. 
Such a study of an individual will necessarily be much 
slower than a simple mental-age rating. 
The psychopathic child is not a newly discovered sort of 
human being. The newness lies in the fact that his insta- 
bilities are easily studied in the psychological laboratory. 
They are almost as readily ascertained as is his intelligence 
level. Clinical psychology is ready for such research, and 
is more easily able to handle his peculiarities than is 
psychiatry. The symptoms of the psychopathic child are 
only as shadows when compared with those of actually psy- 
chotic adults. The clinical psychologist has been trained 
to deal especially with the child mind, however, and to him CONCLUSIONS 
443 
these dim, shadowy tendencies are entities easily recog- 
nized. 
The old theory that sneh traits as those exhibited by 
psychopathic children will be “outgrown” is a pernicious 
handicap to early mental and educational hygiene. Even 
if some children might eliminate such symptoms without 
external aid, it seems foolish to let them grope along so 
handicapped. 
Although from the earliest years of mental testing Binet, 
and then Stern, urged the qualitative analysis of test find- 
ings, it took a decade of testing before there was any defi- 
nite attempt at such study in America. The results are 
still but partial and scanty, but they suggest the directions 
which may repay further investigations. 
The Bureau found ten lines of psychological estimation 
which gave information as to the qualitative aspect of the 
subject’s intelligence. These are: 
1. The range above the basal on the Stanford 
2. The distribution of successes and failures on the Stanford 
3. The quality of individual responses on the Stanford 
4. The distribution of the word reaction values on the Kent- 
Rosanoff association series 
5. The quality of the individual responses on the Kent-Rasanoff 
association series 
6. The presence of imbalance on various performance-test rat- 
ings, and the relation of such scores to the Stanford 
mental age 
7. The educational ability of the individual viewed in the light 
of his mental age on the Stanford 
8. The general orientation of the individual 
9. The patient’s own story of himself and his experiences 
10. The behavior during the examination, supplemented by re- 
ports of behavior while under institutional living 
These ten points are not absolute, final, all-inclusive, nor 
of equal significance. 
The more frequent a seeming deviation, the less probable 444 
THE UNSTABLE CHILD 
is its extreme pathological significance. The less common 
a deviation, the more significant it is apt to be. 
We need intensive and extensive work before any final 
statement of what is or is not significant as an indication 
of psychopathy can be determined with finality. Practical 
experimentation and observation are needed. 
Delinquents give a basis for such practical and scien- 
tific study. Delinquency is a behavior problem. Behavior 
is a mental problem. An individual acts as he does because 
of certain ingrained tendencies. These tendencies or at- 
tributes of his nervous system are due to inheritance, dis- 
ease, experiences, or to his intelligence itself. They may 
be affected by anything or everything in his environment. 
The delinquent is a social deviate. His deviation is a devia- 
tion of his nervous system. His behavior varies because 
of the presence of some factor in him as an individual 
which makes him different. He is fit material for the 
study of such differences. 
Just what does a study of delinquents such as that re- 
ported in this book reveal? One fact is self-evident. No 
study of just one or two factors in the situation will ever 
solve the problem. The mere fact that a delinquent is a 
delinquent determines that. Of course, there is a relative 
importance of each and every item of an individual’s at- 
tributes, but no one of these has a preponderance of power, 
such as can cause delinquency in a whole group of cases, 
or prevent it in another group. A brief review of several 
individual items will make this more explicit. 
Age is no precludant of delinquency. Children who are 
only 4, 5, or 6 years old may be, and are, as definitely be- 
havior problems as those who are in their teens. The type 
of behavior disturbance is different, but the trouble aroused 
by the younger child is often more difficult of solution. 
Again, age bears no relation to mental age, when we are 
considering the possibilities in an individual case. The CONCLUSIONS 
445 
probabilities are higher that an older child will have a 
higher mental age, and can hence be treated as more nearly 
responsible for his behavior, but in the individual case 
this does not hold true. For instance, in the group studied 
in this series of observations, one 17-year-old had a mental 
age of only 4 years, another tested 5, and others tested at 
almost every mental level. There is no way of determining 
the probable value of one factor from the definite ascertain- 
ment of another. In a practical clinic, each individual 
confronted may be the exception to all known rules, regula- 
tions, and scientific observations. 
Sex does seem to bear some relationship to the problems 
of delinquency. There are far more girls in the later teens 
sent to the Bureau than boys of the same ages. The reason 
is not the one superficially indicated, namely, that girls 
are more frequently delinquent than boys. Instead, it 
seems to be a part of the attitude of the court towards girls 
and their offenses. Boys of the same age are thought ob- 
viously in need of corrective care, and are sent to correc- 
tional institutions. Far more young boys are received than 
girls, the number being about in proportion to their fre- 
quency in the juvenile court. Practically all of the older 
girls are suspected of being immoral, if the offense against 
sex is not a definitely determined fact. Aside from these 
indications which cannot be but sketchy, since the number 
of cases is so small and so selected, sex seems to have very 
little to do with delinquency. 
The factors of race, foreign parentage, and mixed blood 
have no real bearing upon this group for the numbers so 
affected are very small in proportion to the size of the 
group in general. Nor does analysis show any of these 
individuals standing out as different from his mental-age 
group, save perhaps that, subjectively, the writer cannot 
but help feel that the mulatto cases were by far the most 
difficult to understand and handle. 446 
THE UNSTABLE CHILD 
The delinquency charges against the groups show no 
clearly demarcated tendencies. Children under 6 years of 
age or who have a mental age of less than 6, but who are 
chronologically older, usually get into court charged with 
incorrigibility or other offenses due entirely to their in- 
ability to take care of themselves. A baby 3 years old runs 
away and no one thinks very much about it. A boy of 16 
with a mind of a 3-year-old runs away and is garnered into 
the court. But even with children who are only 4, 5, or 6 
years of age there are occasionally acts which place them 
in the same group of offenders as their older brothers and 
sisters. 
Mental age is usually regarded as the final solution of 
all of the complicating situations found in delinquents. A 
feeble-minded child is delinquent because he is feeble- 
minded. In a certain sense this is absolutely true, in an- 
other sense it is just as false. Feeble-mindedness is by no 
means a cause of delinquency. That is to say, the mere fact 
that an individual is feeble-minded does not mean that his 
mind naturally turns to wrong-doing or evil. The feeble- 
minded individual is frequently delinquent because the dis- 
crepancy between what he understands and can do and 
what is expected of him is too great. It is feeble-minded- 
ness, plus opportunity, minus right training in sufficient 
intensity that makes a delinquent moron or imbecile. 
Mental age is one of the determiners of delinquency, but 
this determination is not limited to the cases in which 
mental age is inferior to the point of feeble-mindedness. It 
applies just as regularly to any situation in which there 
is no balance between ability and demands made upon 
ability. If school demands more than a child can give, he 
is provoked to truancy. If school offers too little to keep 
the bright child occupied, he is the most troublesome per- 
son in the schoolroom. If force of inducements from a 
higher level intelligence is greater than respect for the ab- CONCLUSIONS 
447 
stract ideas of right and goodness, the wrong thing hap- 
pens. But from the child’s standpoint such behavior is 
■normal. From the scientist’s angle it is incidental. Given 
a statement of the other factors, delinquency could be pre- 
dicted. It is only the social viewpoint which establishes our 
concept of such a thing as delinquency in these cases. But 
there are other cases where no one could justify the be- 
havior, anticipate the event, or explain away the lack of 
apparent causes for it. These are the true problems of de- 
linquency. They are the acts unjustified by environment, 
mental level, or example. They are the indications of a 
functional disturbance, which finds motivation to anti-so- 
cial activity, where the normal-functioning mind would see 
none. 
Mental age bears no very definite relationship to the ac- 
tual delinquencies in this group of cases. There were no 
children threatening to murder or commit suicide in the 
groups with mentalities less than 7, although one 5-year- 
level boy did shoot a playmate accidentally. These threats 
are not numerous, but they occur at all levels up to that 
of the 17-year mentalities. In the same way, stealing, lying, 
and running away continue manifesting themselves at all 
levels. Mental age has an influence upon the character of 
these offenses. With higher mental levels the stealing be- 
comes more subtle, objects of greater value are taken, the 
desire is inhibited until the time seems most favorable for 
avoiding detection, and plausible explanations for the dis- 
appearance of the stolen goods are often used. The ulti- 
mate refinement of stealing leads into forgery, buying and 
charging under assumed names, and all of the well-known 
methods of adults whom we call criminal. In a similar 
way, other changes occur. Bunning away gives place to 
elopements, stealing automobiles in which to go, getting 
arrested and giving names of other offenders who are 
wanted in distant cities, to gain free transportation. But, THE UNSTABLE CHILD 
448 
in the individual case, mental level does not determine the 
type of delinquency one is apt to meet. Of one thing we 
may be sure. The higher level case will be one in whom 
craft and cunning render detection more difficult, convic- 
tion less certain, and correction more doubtful. With chil- 
dren of a mental level above 12 or 13 clinical work and 
correction become a struggle of wits. 
The group of 369 children reported throughout this book 
ranged in age from 4 months to 19 years. Fourteen of 
them were either very young or low-grade dependents, or 
the siblings of known delinquents on whom preventive work 
was attempted. The 355 troublemakers ranged in age from 
4 to 19 years. From one extreme to the other their offenses 
were actually serious from the social or community view- 
point. In mental age these troublesome ones varied from 3 
years to 17 years. There were 281 who tested between 7 
and 12 years of age, with more testing at 9 or 10 than at 
any other levels. 
This does not give very much information that means 
anything in a practical fashion, save that it emphasizes the 
variable possibilities. Feeble-minded individuals were 
found at every level up to a mental age of 12. Normal- 
testing individuals were also found at all levels from 6 
up, and in a few of the lower mental-level groups. In be- 
tween these two extremely different sorts of children lay 
many of questionable ability. This wide range comes with 
each and every mental level studied. Only one thing is 
constant in the group, whatever the ability, whether the 
child was feeble-minded, inferior, dully normal, normal, or 
bright, he was always definitely delinquent. In other 
words, mental age is not a factor which differentiates nor- 
mal-behaving children from delinquents. 
If, however, one examines other aspects of the intelli- 
gence of these individuals, the situation changes. The de- 
linquent gives psychological indications of his condition. CONCLUSIONS 
449 
The following ten points show up on the results of standard 
tests. 
1. The range above basal on the Stanford is far greater 
for this group than in Terman’s cases. Comparing the es- 
timated highest possible range for each of his age groups 
with the maximal range for this delinquent group gives the 
accompanying table. 
Comparison of Range Above Basal of Children Studied by 
Terman and Delinquents Studied at the 
Bureau of Juvenile Research 
Mental Age 
Maximal Range, 
Terman Data 
Maximal Range, 
Bureau Data 
Average Range, 
Bureau Data 
3 
3 
5 
3.7 
4 
4 
6 
4.5 
5 
5 
5 
4.5 
6 
5 
8 
4.6 
7 
5 
7 
4.0 
8 
7 
8 
4.0 
9 
6 
12 
4.3 
10 
8 
11 
6.3 
11 
9 
11 
6.6 
12 
10 
11 
7.0 
13 
10 
10 
7.3 
14 
9 
10 
8.0 
This means that in all of the groups of delinquents, ex- 
cept the 5- and 13-year-level groups, the known variation 
of range above the basal age is greater than the greatest 
probable range as estimated from the Terman material. 
These two groups are of those levels at which a variation 
might be expected, because the number of cases handled in 
the delinquent group was comparatively very small. There 
is a similar tendency in the range variations at different 
levels. With Terman’s group the age of 14 shows a lessened 
range. This means that greater ability and greater general 
intelligence preclude failures as far down as they occur 
with less intelligent children. The upper limit of the scale 450 
THE UNSTABLE CHILD 
is so near that variability is inhibited. This restraint is 
noticed at the 13-year-level group with the delinquents. 
Their variability is enough greater that they reach maxi- 
mal variations when still inferior in intelligence to Ter- 
man’s group. The averages of the data on variation among 
the delinquents indicate that the whole group does not feel 
this restriction in the same way. Throughout, variability 
increases as mental age increases. These children do not 
fill in lacunae at lower levels as well as normal children do, 
nor as quickly. Of course, it is possible that some of the 
variability may be due to the use of a serial method of ex- 
amining on the delinquent group. Analyzing the years 
through which successes and failures are scored in the two 
groups rather eliminates this possibility. It seems as 
though the greater part of the increased variability of the 
delinquent group lies in more failures in lower mental-level 
tests, and in levels farther below their actual mental age. 
2. The delinquents can be sorted out into definite sub- 
groups which have varying tendencies to “scatter’’ in their 
successes and failures. There is one group that is similar 
to those reported by Wells. They fail on rhymes, weights, 
and enclosed boxes. They succeed, just as his psychotic 
cases did, on vocabulary and digit tests. Their verbal abil- 
ity corroborates the earlier findings of Binet. 
There is another group that fails on digits and all mem- 
ory tests anywhere near their general level in difficulty. 
They do superficially well on the verbal tests but fail on all 
exact vocabularies and definitions. A certain group seems 
to do especially well on the absurdities, the comprehension 
tests, the fables, and the logical problems. The findings on 
these individuals agree with those of Pressey on psychotic 
individuals. Some of the group have unusual ability in 
visual imagery of a concrete form, or else in some other 
type of imagery which substitutes for it in efficient man- 
ner. This group succeeds on the cut design in the eigh- CONCLUSIONS 
451 
teenth year, the code, the enclosed boxes, and the ingenuity 
tests, sometimes without any very close relation to their 
actual mental level. All in all, the peculiar attributes of 
test distribution found in this group agree with all re- 
ported findings on psychotics. There are also typical 
feeble-minded distributions which agree with those found 
by Jones and Doll. 
3. The quality of the test findings on the Stanford is dis- 
tinctly a-normal in over half of the delinquent group. 
Residues of higher levels of intelligence, superior language 
and grammatical constructions are often found. The dis- 
turbances of technique on the drawings are similar to those 
reported by Foster, but they seem to be even more fre- 
quent and more marked. Disturbances of writing similar 
to those described by Bianchi are also present. The quali- 
ties described by Wells are found again and again. Be- 
yond these symptoms there are present egocentric interpre- 
tations of data, grandiose interpretations, delayed reac- 
tions, rambling, incoherent, and diffuse explanations, and 
many signs of automatisms, perseveration, inhibition, nega- 
tivism, and a host of other well-known minor perversions of 
speech. 
4. The association distributions are highly significant. 
The test proved applicable to most children of even a 6- 
year level and to some below that level. Some above the 8- 
year level failed to cooperate. Phrases and individual reac- 
tions predominate in the test responses of the younger chil- 
dren but grow steadily more infrequent with the increase 
of mental level. The tendency to use an occasional phrase 
appears at all levels, but the average number of phrases 
used by any one individual is less than 5 for all children 
with a mental age of 9 or over. This tendency is a direct 
violation of the directions given, but occurs again and 
again in repeated tests with the same individuals, despite 
specific warnings against reactions of more than one word. 452 
THE UNSTABLE CHILD 
Individual reactions also decrease in number with in- 
creasing mental age. They reach an average of 7 at the 
mental age of 13 and remain practically constant above 
that. Even so, the average number is definitely above the 
average for children under 16 as it was determined by 
Rosanoff, his being 5.7. The discrepancy is greater rather 
than less if we group all of the delinquents from 10 to 16 
in mental age. They average 13.3 individual responses 
which is over twice the number found by Rosanoff and 
nearly twice the number found by Eastman and Rosanoff 
for children of the same ages (6.6). Undoubtedly the de- 
linquents are less adaptive, follow test directions less well, 
lose the aufgabe more readily, are more irregular and indi- 
vidual in their associative thinking. 
5. The quality of the performance on the association 
test gave marked indications of abnormality in 208 of the 
353 children to whom the examiners tried to give it. Their 
individual reactions and the phrase reactions reveal per- 
sonal characteristics most strikingly. They stand out as 
individuals overwhelmed with grievances, with feelings of 
inferiority, with actual apologies for being alive, with 
phobias, philias, phantasies. There are remnants of every 
sort of experiences in their responses. Their wishes and 
beliefs are easily understood. The test gives most valuable 
indications of their need for correctional work, both edu- 
cational and social. They are functioning wrongly. They 
need mental hygiene. 
6. Performance test findings merely accentuate what 
other tests have already shown. These delinquents are not 
well-balanced, their test ratings from series to series vary 
so that nothing is predictable. Some who test at a 6-year 
level on the Stanford score as high on performance tests 
as others who have Stanford ages of 15, 16, or 17. There 
is a gradual improvement in ability on the formboard, 
when we compare the successive mental-age groups, but CONCLUSIONS 
453 
the individual variability means that the range of possibil- 
ities for children at all mental levels is practically the same. 
It is not only on the Seguin formboard that this is true. 
The adaptation series is perfectly done by some 6-year- 
level children, whereas some children at every level through 
12 years fail to sjcore successfully. 
There are some complete successes on the imitation series 
by children who test 10. There are some complete suc- 
cesses at all mental levels above 10; yet even at a 17-year 
level one individual cannot score more than 10 years on 
this test, whereas children with mental ages of 13 go back 
to a 7-year score in this respect. The scores at other levels 
are equally “out of relation” to the mental ages of the 
individuals making them. In general, the average mental 
level on the imitation series increases each year through the 
Stanford mental-age groups, but the increases are irregular 
and the deviations are extreme. These are well worth re- 
producing as an illustration of the general tendency to 
discrepancy of test findings. 
Scores on the Knox Imitation Series bt Children of 
Different Mental Ages on the Stanford 
Stanford 
Mental Age 
Average Mental 
Age on Knox 
Range of Scores 
on Knox 
6 
7.3 
4-14 
7 
9.1 
5-15 
8 
11.4 
7-17 
9 
11.9 
6-17 
10 
12.0 
7-18 
11 
13.5 
7-18 
12 
13.9 
8-18 
13 
14.1 
5-18 
14 
14.4 
8-16 
15 
14.4 
7-18 
16 
16.0 
14-17 
17 
14.7 
10-18 
The Porteus findings merely accentuate the lack of bal- 
ance in the group. Children whose mental ages differ as 454 
THE UNSTABLE CHILD 
much as 10 years may score the same on this test. Similar 
irregularity appears on the Healy ratings. 
7. School tests bring out another angle of the extreme 
irregularity of the group. No one expects a child with a 
mental age of 6 or 7 to do more than first- or second-grade 
school work and do it well. Yet some of the individuals in 
this group, who score only 6 years in mental level, score 
third-grade on literacy. Children who test at 7- and 8-year 
levels, only, are capable of doing fifth- and sixth-grade 
work in comprehension of written matter, in spelling very 
frequently, and sometimes in language and geography. 
All of the mental-age levels contain such deviates. The 
irregularity of school ability and accomplishment definitely 
places this whole group as unstable. 
8. The type of general information findings has been 
reported in detail at each mental level. There are signifi- 
cant pathological indications in the responses of 94 out of 
the 355 delinquents. This is making due allowance for 
level and limitations of experience. 
9. Their stories reveal the peculiarities of an abnormal 
mental condition in about half of the cases. A 6-year-level 
case can barely give a few items, there is no story. A 7- 
year-level youngster gives a few items, but they are so 
vague one hardly dares to evaluate peculiarity or deviation, 
unless the condition is extreme. Above this level it is 
usually a simple matter to evaluate and interpret the tale 
as it is given. Just as an insane person reveals his delu- 
sions, hallucinations, fears, and beliefs, in his conversa- 
tion, these children show their attitudes and moods. These 
are just as significant for the worker with children as the 
tales of the insane are to the psychiatrist. They indicate 
another phase of child activity, afford an estimation of its 
irregularity or reliability. 
10. The final point of observation used, the behavior of 
the individual while under laboratory observation, is per- CONCLUSIONS 
455 
haps the most valuable of all. It gives an observation that 
lies halfway between community behavior and mental be- 
havior as indicated on other tests. The evidence gathered 
in this field is unmistakable. There were 160 out of the 
355 who gave symptoms marked enough to classify them as 
outside normal limits in their manifestations. They were 
nervous, hysterical, threatened murder, suicide, and non- 
specific revenge. They were moody, depressed, overexhil- 
arated, religious, ecstatic, went through paranoid rages, 
and frequently wept without cause. They lied, malingered, 
tried to steal. Masturbation, exhibitionism, neurological 
disturbances of all types, seizures, spells, and personality 
changes were incidental to the study of these cases. Other 
cases were just as delightfully normal in every respect. 
A summary of these ten points leads to just one concept, 
however we express it. These delinquent children are dif- 
ferent. They are highly variable in their qualities, most 
inconsistent in their abilities and their disabilities, sur- 
prisingly able, surprisingly stupid, erratic, and queer. 
They are over-quick and very slow, non-adaptive and non- 
persistent, forgetful, laboriously remindful. They are psy- 
chopaths. 
The medical findings indicate their inferiority physically, 
their disturbed nervous systems, their stigmata of imperfect 
development. They live under the handicap of poor eyes, 
poor hearing, poor teeth, with many types of functional dis- 
turbances, bearing the additional burden of inherited dis- 
ease in many instances. 
Their family histories tell why they are as they are. 
They merely reflect the condition of their parents in many 
instances. Feeble-mindedness, insanity, neuropathic dia- 
theses, and all they imply, have had an important share in 
furnishing these children. They are not willful delin- 
quents. They are psychopaths, the unstable children of 
the unfit. 456 
THE UNSTABLE CHILD 
Delinquency meets its explanation in the psychological 
laboratory. Feeble-mindedness causes some of it. Lack 
of right training and right opportunity causes its share. 
But the chief reason for wrong behavior is the wrong work- 
ing of the delinquents themselves, their diseased, disturbed, 
unreliable modes of mental behavior. The understanding 
of them lies in the study of their psychopathy. But psy- 
chopathy itself demands an explanation. The solution of 
its existence leads back to the physio-medical study of the 
individual. In some instances, such study seems to explain 
the psychopathy, but where further research of this type 
will lead, one can scarcely say, but surely into the fields of 
medical and social hygiene, as well as into the province of 
mental hygiene. 
The future of the whole problem is overwhelmingly full 
of possibilities. So far, we have barely touched the surface. 
But of one thing we may be sure. The only permanent 
method of attacking the problem of psychopathy is to trace 
each individual case back towards its source. When we 
once know the cause of the condition, even in some few of 
its forms, treatment will become preventive as well as cor- 
rective. 
Some eases will always remain unsolved, but gradually 
a larger and larger proportion will yield to analysis and 
study. 
The two years spent in studying this group of delin- 
quents indicated the significance of congenital syphilis as 
a factor in the causation of such behavior problems. All of 
the congenital syphilitics found in the group were psy- 
chopaths, many of them from presumably stable families. 
Such syphilitics have not always been easily detected 
Blood Wassermanns are not always convincing. Family 
history is not always full, true, or even available. Stig- 
mata may not evidence themselves, or may be ambiguous 
in their presence. CONCLUSIONS 
457 
The mental characteristics of many of these congenital 
cases seem absolutely symptomatic. In a number of in- 
stances the psychological indications have been the only rea- 
son for prolonging research into the smallest detail of the 
case history. Time is adding constantly to the reliability 
of the psychological indications, for it sometimes takes a 
year or more to verify the tentative psychological diagnosis. 
To reiterate: congenital syphilitics as they were found 
in this group of delinquents were all psychopaths. More- 
over, their psychopathy has its own characteristics, differ- 
entiating it from the non-syphilitic psychopaths. This 
psychopathy is the groundwork out of which delinquency 
grows. The two are definitely related. Even though the 
disease is so terrible in its significance, yet the recognition 
of its presence means the possibility of alleviation, as well 
as a more definite knowledge of the future of the individ- 
ual. The only safe prognosis must be based upon, and 
related to, the etiology of the condition. 
Further research will undoubtedly reveal other groups 
of psychopaths, differentiate them from the general group, 
identify their symptoms, determine their special causation. 
Hope lies in that direction. 
In the meantime, a working creed seems possible. These 
delinquents we have analyzed and commented upon have 
their reason for being as they are, They are feeble-minded 
in some instances, but a far greater proportion of them are 
psychopathic. In a number of these individuals the two 
conditions exist side by side, The group is not bad. There 
is no such thing as a bad boy or girl. Either he does not 
know any better or else he cannot help it. He cannot help 
environmental handicaps. He cannot predetermine the 
type of a community or family into which he shall be born. 
He cannot check his feeble-mindedness nor eliminate his 
own psychopathy. 
Psychopathy can be helped, but the help is not self-help. 458 
THE UNSTABLE CHILD 
Neither can a court sentence or a term at a correctional 
institution do much, when carried out without the under- 
standing of, and professional handling of, the condition. 
Punishment? What can it do to cure? It will merely add 
another layer to the mental difficulties from which the 
child has built up a structure of wrong behavior. It may 
inhibit the wrong act. And then what happens ? The indi- 
vidual has already been overrepressed, overwhelmed by his 
poorly understood complexes, fears, and desires. His de- 
linquency has been his attempt at compromise between them 
and what society wishes him to do. We check his reactions, 
add another load of fear, worry, shame, resentment, more 
inferiority, and new grievances against all in authority. 
We remove for a little while the chance of indulgence in 
the same type of behavior and have done our duty as a 
state. It is only the elasticity and resiliency of the child 
mind which keeps any of them from a reenforced and more 
extreme type of delinquent behavior. 
All psychopaths are not delinquents. The delinquent 
psychopath has had some motivation to wrong behavior 
which is stronger than in the non-delinquent. His handling 
must appreciate this. Whether a delinquent psychopath 
whose delinquency has assumed a chronic form can ever 
be rehabilitated, only time will tell, but the indications are 
that his condition can be alleviated to a considerable extent. 
The psychopath needs a health regime. Regular living, 
regular meals, nourishing food, regular sleep, regular rest 
and work. He needs habits of healthful living so firmly 
ingrained that they will withstand the shocks and irregu- 
larities of everyday life. He needs a long period of such 
living, with regular demands impartially enforced. The 
problem is one of morale and habit formation. Just sym- 
pathy, and firm, yet sympathetic, justice must lead him into 
the honorable government of his own affairs. To benefit by 
his opportunities he must be in good physical condition. CONCLUSIONS 
459 
This is a prerequisite, whereas physical hygiene is a neces- 
sary daily accompaniment of any scheme of rehabilitation. 
The mere fact that so many delinquents are deviates, or 
psychopaths, and not merely dull, stupid, or feeble-minded, 
is a promise for the future. Psychopaths, as a group, have 
never been very intensively studied, hut enough has been 
done to make it clear that at least some of them will gain, 
stabilize, normalize under the right kind of care. Given a 
chance to study them in their earlier years, much more pre- 
ventive work may be done and less corrective work will be 
necessary. 
The psychopath is a chance waste product of our at- 
tempts at civilization. He will not grow less numerous. 
He is with us to stay. It is our duty and our privilege to 
study and to help him. He feels intensely, lives exceed- 
ingly. He is a bundle of contradicting desires, abilities, 
and defects. He has potentialities. What he needs is 
early detection, long years of training, supervised parole 
without stigma, and a chance to make good. He will repay 
such care as no feeble-minded individual can. He is like 
the desert sands, and like them he needs an understanding 
and all powerful master to be made fertile and productive; 
left undirected, only evil and waste result. No individual 
can supply that mastery. We need institutions, hospital 
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Ziehen, Th., Die Geisteskrankheiten des Kindesalters (Reuther 
und Reichard, Berlin, 1903, and later). INDEX 
Accuracy, 163 
Adaptation, 220, 232 ff., 439 
board, 244; see also Perform- 
ance testa 
verbal, 364 
Age, chronological, 245, 260, 266, 
275, 287, 299, 309, 318, 359, 
366, 380, 402, 448 
Agnes U., 337, 353 
Analysis, qualitative, 433; see 
also Mental function 
Analytic data, 347, 373 
Andrew Y., 335 
Angst, 229, 231 
Angst-sedative, 231 
Anthropometric measurements, 
244 
Anxiety, 229 
Aphasia, 47 
Army, tests in, 329 
Association tests, 97 ff. 
distribution, 261, 268,279,290, 
302, 312, 321, 361, 368, 406, 
452 
individual reactions, 184 
quality, 185, 261, 269, 279, 291, 
302, 312, 321, 361, 368, 406, 
452 
value, 344 
Atavisms, 228 
Attitude, 66, 69, 100, 164, 233 
genetic, 227 
Aufgabe, 88, 98 
“Average” individual, 385 
Basal year, 91, 94, 150 
Behavior, 100, 381 
during tests, 191 
measure of, 127 
of psychopath, 169 
symptoms, 151, 159 
theory of, 128 
under observation, 263, 271, 
282, 294, 305, 315, 324, 362, 
369, 409, 454 
Benjamin, 376 
Binet Scale, 7, 11, 81, 433 
inadequacy of, 119 ff. 
Blanks, 84, 94 
Brain, 220 
Bright trouble-maker, 45 
Bureau of Juvenile Research, 30, 
235 ff. 
Character, 126, 158, 384 
Charges, 446 
Child who is— 
“at age” on tests, cannot learn, 
52 
below in tests, can learn, 53 
bright but fails, 46 
clumsy, 49 
erratic, 165 
idle, 49 
lazy, 48 
nervous, 165 
not concentrating, 44, 82 
obstinate, 49 
peculiar, 165 
precocious, 124 
queer, 165 
slow, 49 
unstable, 165 
Child’s story, 190 
Clarence, 425 
Clinic, 58 ff., 80, 237 
psychiatric, 63 
Clinical psychologist, 63 ff., 154, 
438 
Clinical psychology, 4, 22 ff., 27, 
44 ff., 127, 436 ff. 
467 468 
INDEX 
Case history, 103 ff. 
Cave men, 221 
Compensation, 226 
Conditioning stimuli, 129 
Content, 243 
Convulsions, 104 
Cora, 252 
Correction, 436 
Criminality, 65 
David, 424 
David, T., 337, 341 
Defective delinquents, 125, 157 
Delinquency, 24, 42 ff., 125, 
216 ff., 226, 428 
charges, 260, 266, 276, 288, 
300, 310, 319, 359, 366, 403, 
447 
Delinquents, 65, 118 ff., 126, 152 
Dementia paralytica, 136 
Dementia praecox, 125 
Dependency, 24 
Dependents, 152, 398 
Deorientation, 48 
Deterioration, 221, 298, 328; see 
also Diagnoses 
Deviates, 18, 215 
Deviation, 389 
Diagnoses, 
case findings, 264, 272, 284, 
296, 307, 317, 326, 365, 370, 
409, 456 
Diagnosis, 13 ff., 20 ff., 25 ff., 52, 
58, 74, 92, 102 ff., 114, 117, 
245, 248 ff., 388, 402, 440 
Dick, 254 
Earl, 254 
Education, specialized, 51 
Elsa, 251 
Emotion, 99, 160 
Eneroachage, 401 
Environment, 129, 217 
Epilepsies, 65 
Equipment, 62, 79, 83 ff., 438 
Etherization, 413 
Era, 254 
Examination, 6, 67 ff., 80 ff., 242, 
439 
Excitability, 227 
Failure, 73 
Family history, see History 
Fatigue, 73, 88, 141 
Fear, 167, 350 
Feeble-mindedness, 14, 20, 35, 42, 
65, 118, 136; see also Diag- 
noses 
Feeble-minded, potentially, 13, 
52 
Filing, 84 
Flight, 38 
Food, 228 ff. 
Fugues, see Truancy 
Function, 141, 144, 158, 163; see 
also Mental function 
General information, 83, 99, 188, 
244, 263, 270, 281, 293, 305, 
314, 323, 362, 369, 408, 454, 
Generalizations, 264, 274, 286, 
297, 308, 317, 326, 366, 410 
Gerald, 422 
Gladys, 420 
Glandular disturbances, 420 
Goddard adaptation board, 82; 
see also Performance tests 
Gordon, 415 
Grant I., 333 
Group tests, 17 ff., 27, 31 
Growth, 166 
Habit, 131, 230 
Handwriting, 418 
Harold N., 413 
Harold, 421 
Healy Pictorial Completion, 244; 
see also Performance tests 
Helen, 256 INDEX 
469 
Helen N., 341 
Henry G., 334, 345 
Heredity, 272, 284, 295, 306, 316, 
325, 365, 370, 409, 455 
History, 109 
case, 75 
educational, 104 
family, 106; see also Heredity 
Hysteria, 54, 77 
Ida H., 335 
Ideals, 57 
Idiot, excitable, 249 
Immorality, 14, 36, 222 
Individual, 21 ff., 24, 27, 56, 105, 
122, 402, 435 
Infantile insanity, 51 
Instability, 386 
Instincts, 128 
Intelligence, viii, 20, 134, 136 
quotient, 54, 120 ff., 124, 126, 
260, 266, 275, 287, 300, 309, 
318, 328, 359, 366, 388, 403, 
437 
rating, 149, 155 
Introspection, 127 
Ireland L., 338 
Irritability, 128 
Jasper, 252 
Joan, 413 
John, 414 
Karl, 412 
Kent-Rosanoff association test, 
179, 243; see also Associa- 
tion 
Knox Imitation Series, 82, 244; 
see also Performance tests 
Learning, 5, 26, 129 ff. 
Level, 144, 148, 158, 163; see 
also Mental level 
Maladjustment, 231 
Marie, E., 332 
Masturbation,40 ff. 
Mean variation, 262 
Medical findings, 263, 271, 283, 
294, 305, 315, 325, 364, 369, 
409, 455 
Methodology, 32, 79 ff. 
Mental, age, 11, 35, 54, 140, 246, 
381 
disease, 31, 166 
function, 98, 139 ff., 143, 441 
hygiene, 91, 133 
level, 139, 143, 441 
testing, 8, 12 
Morale, 240 ff. 
Morbid genius, 50 
Morphological measurements, 
263, 271, 283, 295, 306, 316, 
325, 365, 370, 409 
tests, 83 
Moron, 118 
Naomi C., 421 
Naomi I., 332 
Narcissism, 344 
Nardo, 257 
Ned K., 339 
Nervous system, 222 
Nettie L., 333 
Neuroses, stomach, 230 
Nomadism, 231; see also Truancy 
Nonadaption, 232 
Normality, 20 
Chio Literacy test, 243 
O. K. slips, 241 ff. 
Oma T., 338 
Opal G., 336 
Opha Y., 371 
Orma S., 339 
Otto X., 363 
Own story, 99, 244, 263, 270, 
282, 294, 305, 314, 324, 362, 
369, 408, 454 
Parents, 76 
Paul, 412 
Pavlov, 130, 426 ff. 470 
INDEX 
Rob, 254 
Roswell X, 335, 425 
Run-a-way mind, 44 
Running away, see Truancy 
Samuel, 422 
Samuel N., 339 
Sawyer, 416 
School grades, 260, 267, 277, 288, 
300, 310, 319, 360, 367, 404 
performance, 263, 270, 280, 
292, 304, 313, 322, 362, 369, 
407, 454 
tests, 244 
Seguin formboard, 33, 81, 96, 
244; see also Performance 
tests 
Serial testing, 87 ff., 439 
Serepta, 193 
Sex, 257, 260, 266, 275, 287, 299, 
309, 318, 359, 366, 402, 445, 
448 
offenders, 403 
Sleep, 134 
Slums, 15, 217 
Social agencies, 225 
Special defects, 140 
Speech, 132 
Spinal fluid, 416 
Split personalities, 38 
Stanford-Binet, 16 ff., 244 
distribution, 175, 261, 268, 277, 
289, 301, 311, 320, 360, 367, 
404, 450 
quality, 177, 261, 268, 278, 290, 
301, 311, 320, 360, 368, 406, 
451 
range, 170, 260, 267, 277, 289, 
300, 310, 319, 360, 367, 404, 
449 
Stealing, 40, 222 
Syphilis, congenital, 14, 253, 255, 
257, 388 ff., 456 
Tact, 68 
Technique, 30, 40, 153 ff. 
Performance tests, 96, 185, 262, 
269, 280, 291, 303, 312, 321, 
361, 368, 407, 452 
Personality, 67 ff., 120, 126, 159 
Perspective, 70 
Placing, industrial, 123 
Planning, 219 
Point Scale, 15, 88 
Porteus maze, 82, 244; see also 
Performance tests 
Potential feeble-mindedness, see 
Diagnosis 
Procedure, 237 
Prognosis, 52, 54, 116, 328, 440 
Promotion, 36 
Prostitution, 65 
Provision, vii, 265 
Psychiatrist, 153 ff. 
Psychiatry, 5, 79 
Psychic ataxia, 429 
Psychology, 4 ff., 56 
Psychoanalysis, 133 
Psychopath, 67, 145, 165, 167 ff., 
458; see also Diagnosis 
Psychopathy, 30, 141 ff., 147, 
152, 155, 387 
points of, 170, 179, 243, 443 
Psychoses, 65, 124, 298 
Public, education of, 237 
Punishment, 152 
Quality, 388; see also all test 
discussions 
Queed Y., 334 
Race, 380 
Rachel, 418 
Rapport, 71 
Recividist, 41 
Recording, 85 
Reflexes, 128, 130, 426 ff. 
Regime, 243 
Regressions, 228, 328; see also 
Diagnosis 
Results, 81 
Retardation, 23 INDEX 
471 
Temper, 38 
Tests, 7, 10, 16, 33, 79 #., 87 #., 
96, 100, 121 #., 125#., 189 
Thomas, 256 
Thomas S., 333 
Traumatic precipitation, 414 
Treatment, psychological, 26 
Truancy, 25, 38, 222, 231 
Truman Z., 337 
Understanding the child, 72 
Variability, 247 
Verbalism, 363 
Virgil N., 340 
Walter, 256 
War, 17, 329, 435 
Wassermann, 33, 395#., 412; see 
also Medical findings 
William, 415 
Xanders I., 341 
Yates, N., 336, 351 
Year grading, 15