University of Southern California Dissertations and Theses

Psychoeducational status in relation to duration and quality of dietary treatment in early and later diagnosed and treated phenylketonuric children, adolescents, and young adults

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Psychoeducational status in relation to duration and quality of dietary treatment in early and later diagnosed and treated phenylketonuric children, adolescents, and young adults

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Content PSYCHOEDUCATIONAL STATUS IN RELATION TO DURATION AND QUALITY OF DIETARY TREATMENT IN EARLY AND LATER DIAGNOSED AND TREATED PHENYLKETONURIC CHILDREN, ADOLESCENTS, AND YOUNG ADULTS by Alan Mark Stern A Dissertation Presented to the FACULTY OF THE GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY (Education) April 1982 UMI Number: DP24846 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI DP24846 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code ProQuest’ ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 UNIVERSITY OF SOUTHERN CALIFORNIA T H E G RA DU ATE SCHO O L U N IV E R S IT Y PARK LOS A N G ELES. C A L IF O R N IA 9 0 0 0 7 This dissertation, written by under the direction of h.i.§.... Dissertation Com mittee, and approved by all its members, has been presented to and accepted by The Graduate School, in partial fidfillment of requirements of the degree of D O C T O R O F P H I L O S O P H Y Bine ffo.D. ALAN MARK STERN Dean Date DISSERTATION COMMITTEE TABLE OF CONTENTS LIST OF TABLES ................................................. Chapter I. INTRODUCTION ........................................... Importance of the Study Purpose of the Study Outline of the Research Limitation and Delimitation of the Study Definition of Terms Organization of the Remaining Chapters II. REVIEW OF THE LITERATURE .............................. Historical Background of Phenylketonuria Incidence The Disorder-Etiology Clinical Manifestations Diagnosis and Treatment Studies Related to the Effects and Efficacy Dietary Treatment Literature Relating to Psychoedu- cational Status III. PROCEDURE OF THE STUDY ................................ Subjects Data Collection Procedures Administration and Scoring of Tests Description of the Criterion Instruments Statistical Treatment of the Data IV. ANALYSIS OF THE DATA AND FINDINGS OF THE STUDY . . . . Findings Relative to Intellectual Status: Wechsler Intelligence Scale Findings Relative to Academic Achievement Findings Relative to Perceptual Motor Development Findings Relative to the Piers-Harris Self-Concept Scale Findings Relative to the Vineland Social Maturity Scale Chapter Page Findings Relative to School Data and Class Placement Findings Relative to Parent and Teacher Behavioral Rating Scales V. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS.......... 54 Summary Conclusions Recommendations REFERENCES 5 9 APPENDICES..................................................... 67 A. Parent and Teacher Permission and Request for Participation in the Study....................... 68 B. Health and Developmental History Interview Guide with Parents..................... 72 i C. Protocols of the Various Psychoeducational J Dependent Variates^ 77 j D. Behavioral Rating Scales Completed by Both Parent and Teachers of the Subjects................. 114 iii LIST OF TABLES Table Page 1. Distribution of Cases According to the Wechsler Classification of Intelligence ......................... 35 2. Distribution of Cases According to the Wechsler Intelligence Quotients ................. 35 3. Wechsler Subtest Scaled Score Values ...................... 37 4. Correlations between Dietary Quality, Duration, and Age Treatment Began with Indices of Psycho- educational Status ...................................... 38 5. Distribution of Cases According to the Types of Error Made on the Bender-Gestalt....................... 42 6. Piers-Harris Scales ....................................... 42 7. Distribution of Cases According to Class Placement..................... 46 8. Distribution of Cases According to School Facility................................................. 47 9. Distribution of Cases According to Retention vs. No Retention in School History ......................... 47 10. Descriptive Statistics and t^ Tests for Subjects Retained and Not Retained.............................. 48 11. Results of the Mednick-Baker Behavioral Rating Scale ............................................. 50 12. Correlations between Dietary Quality, Duration, and Age Treatment Began with the Mednick-Baker Behavioral Rating Scale and Subscales ................. 51 13. Comparison of the Means and Standard Deviations of the Mednick-Baker Scale.............................. 53 iv CHAPTER I INTRODUCTION Phenylketonuria is an inborn error of amino acid metabolism manifested by an inability of the body to convert phenylalanine to tyrosine. The disorder produces a clinical picture characterized by mental retardation, seizures, eczema, fair skin, and decreased hair pigmentation. Asbjorn Foiling, a Norwegian biochemist, first called attention to the condition which he termed "imbecillitas phenylpyruvic.1 1 The disease has been found in all parts of the world, although it is , rare among Blacks (Katz & Menkes, 1965; Graw & Koch, 1967), Finns (Palo, 1967), and Jews of Ashkenazi descent (Cohen & Kozinn, 1949). On the other hand, the condition is more common in Northern European * and Scandinavian countries and in the Celtic population (Carter & Woolf, 1961). As determined by screening programs, its frequency in the United States is approximately one in 14,000 (Berman, 1969). Phenylketonuric infants appear normal at birth. In the classic, older untreated patient, mental retardation is usually severe. In gen eral, the later the age when the diagnosis is made and treatment is instituted, the lower the subsequent intellectual ability. Seizures are common in the more severely retarded. Other than mentally retarded, specific neurologic abnormalities are rare. Microcephaly may be pres ent as well as a mild increase in muscle tone, particularly in the lower extremities. Older children are quite restless and hyperactive; 1 they are often prone to repetitive movements of body and hands. Autis tic features may be present. Menkes and Koch (1977) have observed intellectual deterioration in untreated patients up to about three years of age (Koch, Acosta, Fishier, Schaeffler, & Wohlers, 1967). The majority of untreated phenylketonuric subjects have abnormal EEG patterns (Paine, 1957) . Following the pioneer work of Bickel, Gerrard, and Hickmanns (1953) in England and of Armstrong and Tyler in the United States (1955), it is the general consensus that in the majority of cases, mental retardation can be prevented when phenylketonuric youngsters are placed on the phenylalanine restricted diet in early infancy (LaDu, 195 9). In a thorough review of treated cases, Knox (1960) was able to show that "five points in the final IQ are lost for each ten weeks of delayed dietary treatment" (p. 1). Importance of the Study The main feature of therapeutic intervention for phenyl ketonuria is the utilization of a diet restricted in phenylalanine. This therapeutic approach has been implemented since Bickel et al. (1953) demonstrated its effectiveness in ameliorating possible intel lectual deficiencies. Horner, Streamer, Alejandrino, Read, and Ibbot (1962) were the first to report on termination of a restricted diet. In the United States, diet therapy is terminated between four and six years of age. Kang, Sollee, and Gerald (1970), Koch (1964), and Brown and Warner (1976) have reported a preference to delay diet discontinu ation until adolescence or beyond. 2 The Collaborative Study of Children Treated for Phenylketo nuria at Childrens Hospital of Los Angeles (Koch, 1973) has initiated an evaluation of diet termination. This collaborative effort has in cluded approximately 200 phenylketonuria subjects treated in 15 clinics in 12 states . Preliminary results at the Phenylketonuria Collaborative Study Conference in 1981 suggested that youngsters who terminated diet may not be functioning as well educationally as those patients who remained on diet. Koch (1980) has called attention to youngsters with phenyl ketonuria of normal intelligence who despite early diagnosis and di etary treatment (phenylalanine restricted prior to 121 days), exhibit special academic and/or behavioral problems often requiring special education services . Purpose of the Study The present study was undertaken to investigate the relation ship of the psychoeducational status of early and later treated and diagnosed phenylketonuric youngsters, and the duration and quality of dietary treatment. The study attempted to answer the following question: In a sample of early and later treated and diagnosed phenyl ketonuric youngsters, is there a relationship between the psychoeducational status, and duration and quality of dietary treatment? The years of dietary treatment, diet restricted in phenylalanine and quality of diet, were determined by records on each subject at Chil drens Hospital of Los Angeles. 3 The following assumptions was basic to the study: that the various indices of psychoeducational status can be measured by the following instruments: the Wechsler Intelligence Scale for Children, Revised Edition or the Wechsler Adult Intelligence Scale, Revised Edition, the Wide-Range Achievement Test, the Piers-Harris Children's Self-Concept Scale, the Vineland Social Maturity Scale, and the Mednick- Baker Behavioral Rating Scale. Further, visual motor ability can be measured by the Bender Visual-Motor Gestalt Test, in terms of the Koppitz scoring system. Outline of the Research In the evaluation process, it has been found that no single test or instrument is powerful enough to give sufficient information i for making a psychoeducational evaluation. Rather, a wide range of | abilities must be assessed prior to making any conclusive statement regarding a subject's functioning (McCarthy & McCarthy, 1970). For this study on phenylketonuric youngsters, specific instruments were chosen to assess intellectual development, visual-perceptual develop ment, achievement, behavioral development, self-concept, social maturity, and school and class placement. Psychoeducational status was the dependent variate and in cluded the following: intellectual development, visual-perceptual development, achievement, behavioral development, self-concept, social maturity, and school and class placement. The duration of dietary treatment was defined by the number of years the subjects were on diet as indicated on their hospital records. The quality of dietary treatment was artifically dichoto- 4 mized into high quality, moderate quality, and low quality. High quality diet refers to blood phenylalanine levels maintained between one to ten milligrams percent. Moderate quality diet would be blood phenylalanine levels between 11 to 15 milligrams percent and low quality diet would be phenylalanine levels above 15 milligrams per cent (Koch, 1980). The collection of the data included two principal phases. Phase One consisted of an exhaustive review of the case records of phenylketonuric youngsters at Childrens Hospital of Los Angeles. Since this investigation was in part retrospective, it was necessary that these records be reviewed for a thorough collection of treatment parameters. Phase Two included the administration of the cited dependent testing instruments. All tests were administered individually to the subjects, as were interviews with the parents, teachers, and students. Because of the range of ages among the subjects at the time of test administration, raw test scores had to be converted into standard scaled scores that would allow for subject comparisons. The investigator was interested in determining whether there was a significant relationship in the psychoeducational status of early and later treated and diagnosed phenylketonuric subjects with varying duration and quality of dietary treatment. Since randomiza tion of the phenylketonuric adolescent population was not possible, the procedure in the study was retrospective in nature. The data were statistically analyzed by computing both nonparametric and parametric coefficients of correlation depending on the level of measurement of the variables in question. 5 Limitation and Delimitation of the Study 1. The study was limited to those students followed at Chil drens Hospital of Los Angeles whose parents granted permission for participation in the investigation. One subject, however, was fol lowed by UCLA Medical Clinic. 2. The study was delimited to those youngsters with a known diagnosis of classical phenylketonuria. Only those children who were actively being followed at Childrens Hospital at Los Angeles during the year of 1981-82 were considered. The 25 subjects were selected if they attended either a private or public school facility in grades four through 14 during the academic year 1981-82. 3. The study was delimited to Caucasian children who pres ently live in California and who have never been admitted to a state hospital for the mentally retarded. 4. The study was delimited to those subjects who were se lected only if their ages were between 10 years to 23 years at the time the various criterion measures were obtained. 5. The study was delimited to treated phenylketonuric sub jects who were positively diagnosed as a result of a statewide screen ing program. 6. The study was delimited to both early treated subjects who were diagnosed by or prior to 121 days as distinguished from later treated subjects who were diagnosed after 121 days. 6 Definition of Terms For the purposes of the present study, the following defini tions were applied: Phenylketonuria (PKU). These terms are used interchangeably and refer to an inherited disorder which is due to an autosomal reces sive gene for the phenylalanine hydroxylase enzyme in the liver which normally metabolizes phenylalanine, an essential amino acid. It is understood that a positive diagnosis of the disorder depends on per sistent elevation of serum phenylalanine to 20 mg percent or above with concurrent tyrosine levels below 5 mg percent. Classical Phenylketonuria. A diagnosis of classical phenyl ketonuria is generally accepted by the medical profession if the serum phenylalanine level rises from a normal level of 2 to 4 mg per 100 ml at birth to a persistently elevated level of 20 mg per 100 ml or higher by the end of the first week of life. Furthermore, the urine of per sons with "classical" phenylketonuria contains excessive excretion of orthohydroxyphenylacetic acid, phenylpyruvic acid, and other by products of phenylalanine metabolism as demonstrated by various tech niques after 4-6 weeks of age. Early Treated Phenylketonuric Children. This term refers to phenylketonuric youngsters whose diagnosis and inception of treatment occurred at or before 121 days of life. Later Treated Phenylketonuric Children. This term refers 7 to phenylketonuric children whose diagnosis and inception of treatment occurred after 121 days of life. Dietary Treatment. Medical treatment to limit the phenyl alanine levels in the blood of the phenylketonuric patient by restrict ing the intake of phenylalanine foods in the diet. High Quality Diet. Refers to blood phenylalanine levels main tained between 1 to 10 mg percent. Moderate Quality Diet. Refers to blood phenylalanine levels between 11 to 15 mg percent. Low Quality Diet. Refers to blood phenylalanine levels above 15 mg percent. Organization of the Remaining Chapters Chapter II is a review of the germane literature to this study and will be organized in the following fashion: historical background of phenylketonuria, incidence, the disorder-etiology, clinical mani festations, diagnosis and treatment, studies related to the effects and efficacy of dietary treatment, and literature relating to psycho educational status. Chapter III includes the procedure and questions to be an swered by the study. Chapter IV is the analysis of the data and findings of the study. The summary, findings, conclusions, and recommendations are all included in Chapter V. 8 CHAPTER II REVIEW OF THE LITERATURE Research in the area of phenylketonuria with respect to diet and subsequent educational, developmental, and psychological status has been voluminous. As recently as 1981, Skarin presented a thorough review of the literature regarding phenylketonuric children and visual perceptual development. Extensive reviews have also been reported by Dobson (19'68), Williamson (1970), Newberg (1970), and Coates (1975). The present review of the literature will focus on the historical background of phenylketonuria, incidence, the disorder-etiology, clinical manifestations, diagnosis and treatment, studies related to the effects and efficacy of dietary treatment, and literature relating to psychoeducational status. Historical Background of Phenylketonuria Phenylketonuria is an inborn error of amino acid metabolism characterized by an inability of the body to convert phenylalanine to tyrosine. The condition, if untreated, presents a medical clinical picture of mental retardation, seizures, eczema, fair skin, and im perfect hair pigmentation (Menkes & Koch, 1977) . Foiling (1934) was the first to identify this medical condi tion which he called "imbecillitas phenylpyruvicaThe first iden tified patients were diagnosed by Foiling after the patient's mother had detected a persistent and unpleasant odor in her two retarded children. She consulted Dr. Foiling because of his professional back ground in both medicine and biochemistry (Centerwall & Centerwall, 1963). Dr. Foiling tested for diacetic acid by utilizing the ferric chloride test. He found that this test revealed a strongly positive green color, and after excluding the presence of adrenalin that is often known to yield a similar green color, Dr. Foiling isolated phenylpyruvic acid, a metabolite of phenylalanine. In writing his findings, Foiling (1934) called attention to eight mental defectives who excreted large quantities of phenylpyruvic acid. He also noted a high prevalence of spasticity and dermatitis among these eight pa tients. Dr. Foiling administered phenylalanine to one of his patients and found that this increased the excretion of phenylpyruvic acid. This does not happen under normal circumstances. Foiling postulated an anomaly in the deamination of phenylalanine and in the oxidation of phenylpyruvic acid (Foiling, 1934). Six years later, Jervis isolated large amounts of phenylalanine in the cerebrospinal fluid (CSP) and the blood of these patients. Jervis further postulated that the disorder was transmitted as an autosomal recessive disease (Jervis, 1939). Jervis further isolated the metabolic error to be an inability to convert phenylalanine to tyrosine. Incidence Phenylketonuria has been reported in all parts of the world though it is rare in Jews of Ashkenazi descent (Cohen & Kozinn, 1949) 10 Blacks (Katz & Menkes, 1964; Graw & Koch, 1967), and Finns (Palo, 1967). Phenylketonuria i,s more prevalent in Scandinavian countries, Northern Europe, and in the Celtic population (Carter & Woolf, 1961). Berman in 1969 determined the frequency of phenylketonuria in the United States to be approximately one in 14,000 as determined by screening programs. Among institutionalized mental defectives in institutions, Jervis in 1954 determined that the frequency of phenyl ketonuria to be approximately one in 200. Jervis (1954) has studied and reported on the genetics of phenylketonuria. He found that of 1,094 siblings of phenylketonurics, 433 (40 percent were unaffected) When these data were statistically corrected for uncounted families of heterozygous parents with only normal children, the percentage of affected children of heterozygous parents was 27 percent. This would be a close approximation of the 25 percent expected for an autosomal recessive condition. The Disorder-Etiology Phenylketonuria, as previously mentioned, is an autosomal re cessive condition. Biochemical experts have proven that the metabolic defect that is responsible for phenylketonuria is the inability of the liver to convert phenylalanine to tyrosine (Jervis, 1947; Udenfriend & Bessman, 1953; Wallace, Moldave, & Meister, 1957) . The biochemical pathology that may contribute to the cause of the mental retardation has not been clearly substantiated (Menkes, 1967). Woolley and Van Der Hoeven (1964) have reported that the mental retardation may arise from a serotonin deficiency. These investigators 11 have reported that increased dietary intake of phenylalanine plus tyrosine reduces both the maze learning ability of newborn rats, as well as their cerebral serotonin concentration. Menkes and Koch (1977) posit that phenylketonuria may involve a number of enzymatic reactions that would include some leading to the synthesis of neurotransmitters that may function at a less than optimal rate. They further proposed that while a deficiency of these neurotransmitters may be responsible for seizures and other reversible neurological symptoms, the clinical picture indicates that the irreversible cerebral changes, specifically mental retardation, are of paramount importance for the prognosis in phenylketonuria. Menkes (1967) reported that no single factor may be responsible for the mental retardation, but rather that the impairment of amino acid transport across the blood brain barrier, defective pro- teolipid protein synthesis, impaired myelination, and low levels of neurotransmitters such as serotonin all contribute to varying degrees (Oldendorf, Sisson, & Silverstein, 1971; Oja, 1972) . Clinical Manifestations There is general agreement in the literature that classical phenylketonuria is an inborn error of metabolism expressed by the de fective functioning of the enzyme, phenylalanine hydroxylase, in the liver. The absence or inactivity of this enzyme is known to result in the accumulation of phenylalanine and its metabolites in body tis sues and fluids. Sustained high levels of phenylalanine in the blood are known to be related to impaired cognitive ability, although the 12 explanatory mechanisms of this relationship were unknown (Kaufman & Levenberg, 1959; Jervis, 1947; Jervis, 1952; Knox, 1960). In the untreated classic patient, mental retardation is usually severe. Overall, the later the age when the diagnosis is confirmed and treat ment initiated, the lower the later intellectual ability. Seizures are present in the more severely retarded. Phenylketonuric infants appear normal at birth. In the untreated patient, vomiting (at times projectile) and irritability are frequent during the first few months of life. By the time the infant is four to nine months of age, Part ington (1961) reported that delayed intellectual development becomes apparent. The child with seizure activity that usually begins prior to 18 months of age may cease spontaneously (Hackney, Hanley, Davidson, & Lin-Sao, 1968). Seizures during this period may take the form of j infantile spasms, later changing to grand mal seizures. The typical phenylketonuric child is blond and blue-eyed with normal and often pleasant features. The skin is rough and at times dry. Exzema may be present. A peculiar musty odor, attributable to phenylacetic acid may suggest the diagnosis. Significant neurologic abnormalities are rare. Microcephaly has been reported, as well as a mild increase in muscle tone. Older phenylketonuric children are quite restless and hyperactive. They may be prone to repetitive movements of body and hands. Autistic features have been reported in the untreated child. Menkes and Koch (1977) report observed intellectual deterioration in untreated patients up to about three years of age. The majority of 13 untreated phenylketonuric subjects have abnormal EEG patterns (Paine, 1957) . Untreated phenylketonuria is not always accompanied by intel lectual deficit. It is estimated that approximately 3 percent of phenylketonuric subjects exhibit all the biochemical parameters of the disease but are not mentally retarded. Blumenthal (1967) reports that there are no known clinical abnormalities in the individual who is heterozygous for phenylketo nuria . Although the incidence of spontaneous abortion is high among phenylketonuric women who have children, most of the offspring although heterozygotes showed pre- and postnatal growth retardation as reported in Fisch, Doeden, and Lansky (1969), microcephaly (Frankenberg, 1968); severe intellectual delay (Mabry, 1963; Fisch, Graven, & Feinberg, 1966; Mabry, Denniston, & Coldwell, 1966) and major congenital anoma lies (Stevenson & Huntley, 1967; Allen & Brown, 1968; Williams, 1968; Yu & O'Halloran, 1970) . Both Koch and Menkes report that it is highly likely that high phenylalanine levels in the pregnant phenylketonuric mother may damage the fetus. Mothers with persistent, mild phenylalaninemia have less risk of bearing abnormal offspring. Johnson (1972a) and Levy (1974) have suggested that once the blood phenylalanine levels during pregnancy rise above 10 mg percent, there is an increased likelihood that off spring will be defective. It is Koch's opinion that phenylketonuric women be advised against having children, unless they conceive while 14 on a restricted phenylalanine diet and maintain it during pregnancy (Koch, 1980) . Diagnosis and Treatment In California, routine newborn screening programs for PKU requires two determinations of serum phenylalanine level at or above 20 mg/100 ml by the McCaman-Robin1s fluorimetric procedure, from two blood specimens drawn at least 24 hours apart, and from the same blood specimens, two determinations of serum tyrosine level below 5 mg-100 ml by the Waalkes and Udenfriend procedure. Initiation of treatment begins as early as possible. The tentative diagnosis is then confirmed by positive results from a challenge. The challenge procedure may occur between one to two years of age. Patients are designated as having classical PKU, variant PKU, or hyperphenylalaninemia based on at least two of the following cri teria: patients with classical PKU had (1) serum phenylalanine values above 20 mg/dl on unrestricted diets (Blaskovics 6c Shaw, 1971; Blaskovics, Schaeffer, 6c Hack, 1974), (2) excreted large amounts of urinary phenylpyruvic and orthohydroxyphenylacetic acids (Cunningham 6c Day, 1969), or (3) were able to utilize no more than 20 to 30 mg/kg phenylalanine by three years of age without raising serum phenylalanine levels above 10 mg/dl (Guttler 6c Hanson, 1977). Patients with variant PKU had serum phenylalanine levels between 10 to 20 mg/dl on unre stricted diets, did not excrete phenylpyruvic nor orthohydroxyphenyl acids in infancy, and were able at age 2 to 3 years to tolerate phenyl alanine intakes of 30 to 50 mg/kg without raising serum phenylalanine 15 above 10 mg/dl. Patients with benign hyperphenylalaninemia had serum phenylalanine levels between 4 and 15 mg/dl on unrestricted diets. Most non-PKU individuals exhibit phenylalanine levels of 1 to 2 mg/dl. The present study included only those individuals with a confirmed diagnosis of classical PKU as distinguished from those individuals with variant benign PKU or benign hyperphenylalaninemia. Menkes and Koch (1977) point out that the distinction between phenylketonuria and phenylalaninemia is more than academic. Patients with the mild ("atyp ical") variants of phenylalaninemia dodnot appear to require dietary therapy to attain normal intellectual development. When these patients are placed on a low phenylalanine diet, their blood phenylalanine levels tend to fall precipitously, and side reactions such as hypogly cemia and symptoms of protein deficiency are more apt to develop. These abnormalities have been known to induce intellectual retardation and other neurological symptoms (Rouse, 1965). The most widely utilized and accepted treatment for phenyl ketonuria restricts the dietary intake of phenylalanine. A commercially available casein hydrolysate (in the United States, "Lofenalac") from which phenylalanine has been largely removed, is the major source of protein in the diet. Generally, patients tolerate this diet quite well, and within one to two weeks the concentration of blood phenyl alanine becomes normal (Menkes & Koch, 1977). Studies Related to the Effects and Efficacy Dietary Treatment Bickel et al. (1953) and Armstrong and Tyler (1955) were among the first investigators to report that a diet low in phenylalanine 16 produced beneficial changes in phenylketonuric children, and a modifi cation of this diet is now widely used. Initial clinical data pointed out that mental retardation could be prevented if the diet was started early in infancy. In response to the need for early diagnosis, wide spread screening programs were developed to allow identification and treatment during early infancy. Although the efficacy of the diet low in phenylalanine came under challenge by Bessman in 1966, proponents of the beneficial effects of dietary treatment posit that the majority of PKU children would compare with normal children in intelligence if treated from the early neonatal period. The difference in intelligence observed when the early and late treated children are compared is ex plained by a sampling error. BessmanLs position is that the research in the area of phenylketonuria up to 1966 was confounded by sample sizes and that there was a need for tightly controlled experimental research in the area of the beneficial effects of diet restriction in the treatment of phenylketonuria. This challenge to accepted therapy originated in part from the occasional identification of untreated phenylketonuric children with normal intelligence. The difficulty involved in conducting research on phenylketonuria is compounded by the low prevalence figures of the disorder, variability in clinical responses among those affected, and the complication of sociological factors (Dobson, 1968) . Armstrong and Tyler (1955) reported that older patients with classic phenylketonuria that are started on a low phenylalanine diet, have their seizures begin to disappear and the EEG tended to revert 17 to normal. Abnormally blond hair regains its natural color. Hanley (1970) reported on the various complications of dietary treatment. The complications were invariably due to an insufficient intake of phenyl alanine. Complications included X-ray evidence of osteoporosis, cup ping of the long bones, and spicule formation in the metaphyses (Fisch et al., 1966), hypoglycemia (Dodge, 1959), megaloblastic anemia (Royston & Parry, 1962), cutaneous lesions, and poor weight gain. There is suggestive evidence that prolonged nutritional deprivation during infancy interferes with intellectual development (Hanley, 1970). Literature Relating to Psychoeducational Status The effects on psychoeducational status are unfortunately less clearcut. Menkes and Koch (1977) report that studies prior to 1965 suggests that as a group infants whose treatment was started before six months achieved higher developmental quotients than those started at a later age (Knox, 1960). Approximately 30 percent of infants placed on a diet shortly after birth would be expected to have mild variants of phenylalaninemia that probably would not lead to mental retardation as mentioned earlier. Thus, this would represent a dif ferent population sample from the children who present for treatment at a later age with high phenylalanine levels and neurologic symptoms (Birch & Tizard, 1967; Cohen, 1969). During the past 18 years, the Child Development Clinic at the Childrens Hospital of Los Angeles has followed 85 patients with phenylketonuria and 39 patients with hyperphenylalaninemia. One-half of the phenylketonuric subjects are either in regular class placement or in a special class for slow 18 learners. In contrast, the group of patients with hyperphenylalanine mia show better overall progress, with only 25 percent in the school- age group requiring special class placement. When IQs are compared, the mean IQ for the phenylketonuric subjects is 79 (range 29 to 135); for patients with other forms of hyperphenylalaninemia, it is 107 (range 64 to 149). Fuller and Shuman (1969) have found that treated phenylketo nuric children fall into a trimodal distribution with respect to their Binet Intelligence Quotient or Gesell Language-Adaptive Quotient. In their experience, neither the age at which therapy was initiated nor the degree of dietary control determined into which of three groups a given child, would f all. In contrast, however * those patients who were started on treatment prior to six months, some of whom may have had benign hyperphenylalaninemia were represented only in the two higher performance modes. In most of the other studies, some deficit in IQ has been found in infants treated at an early age, as compared to their parents and unaffected siblings. When when treatment of phenylketo nuric patients was instituted during the neonatal period, the range of intelligence quotients was less than average. When the measured IQ is normal, more educational handicaps which resulted in poor school progress were encountered than would be predicted from the IQ alone (Hackney et al., 1968). Fishier, Koch, Donnell, and Graliker (1966) and Fishier, Donnell, Bergren, and Koch (1972) pointed out that sub jects experience difficulty with tasks requiring visual perceptual abilities. A recent study by Skarin (1981) shows that phenylketonuric 19 children show significant difficulty in the area of the development of visual perceptual development, particularly in eye motor coordination. Menkes and Koch (1977) summarize their experience with the outcome of dietary therapy with some caution. They posit that some instances of prenatal brain damage precludes a normal IQ even in the face of optimum therapy, while in a few normal intellectual development may be possible in the absence of any dietary management. These same investigators do point out, however, that the majority of infants respond beneficially to diet restriction when phenylalanine is maintained at sufficiently high concentrations to allow normal protein synthesis and below as yet an undetermined toxic threshold. Furthermore, they point out that in a few instances treatment may result in dramatic gains in developmental and intellectual levels even when instituted between 2 and 4 years of age. However, they caution that the evaluation of the effectiveness of treatment for older children is complicated by the placebo effect of increased medical and parental attention in a child who previously has been labeled "mentally retarded." In summary, the main feature of therapeutic intervention for phenylketonuria is the utilization of a diet restricted in phenyl alanine. This therapeutic approach has been implemented since Bickel et al. (1953) demonstrated its effectiveness in ameliorating possible intellectual deficiencies. Horner et al. (1962) were the first to report on termination of arrestricted diet. In the United States, diet therapy is terminated between 4 and 6 years of age (Kang et al., 1970). Koch (1964) and Brown and Warner (1976) have reported a preference to 20 delay diet discontinuation until adolescence or beyond. Koch (1980) has called attention to youngsters with phenylketonuria of normal intelligence who despite early diagnosis prior to 121 days and dietary treatment (phenylalanine restricted diet prior to 121 days) exhibit special academic and/or behavioral problems often requiring special education services. Newberg (1970) has pointed out a need for follow-up with phenylketonuric patients when they begin to emerge into adolescence. The present study was designed to begin to understand the correlates of the psychoeducational status with respect to varying degree of quality and duration of dietary treatment. 21 CHAPTER III PROCEDURE OF THE STUDY In this chapter, the process used in conducting the study is presented. The known characteristics of the subjects, the method of selection, and the process of testing will be discussed, followed by a discussion of the administration and scoring procedures of the various tests used. The major hypotheses tested are described as well as other variables which were explored through the use of per sonal interviews with the subjects, their parents, and teachers. Subjects The sample under study was restricted to youngsters with a known diagnosis of classical phenylketonuria. Only those youngsters who were actively being followed at Childrens Hospital at Los Angeles during the year of 1981-82 were considered (with the exception of one subject from UCLA Medical Center). The 25 subjects were selected if they had attended a private or public school facility in grades 4 through 14 during the academic year 1981-82. The sample was made up of Caucasian children who presently live in California and who have never been admitted to a state hospital for the mentally retarded. The subjects were selected only if their ages were between 10 years to 23 years at the time the various criterion measures were obtained. The group of early treated phenylketonuric subjects were positively 22 diagnosed as a result of the statewide screening program. The early treated children were diagnosed by or prior to 121 days and were dis tinguished from later treated children who were diagnosed after 121 days of life. Data Collection Procedures The collection of data included two principal phases. Phase One consisted of an exhaustive review of the case records of phenyl ketonuric youngsters at Childrens Hospital of Los Angeles. Since this investigation was in part retrospective, it was necessary that these records be reviewed for a thorough collection of treatment parameters. The following data were abstracted and recorded: Identification Information: 1. Sex 2. Date of birth 3. Present age 4. Present location Diagnostic and Clinical Manifestations: 5. Age of subject when dietary treatment was initiated. 6. Quality of diet as indicated by the phenylalanine blood levels to determine quality of dietary treatment. 7. Years of dietary treatment as recorded in hospital record. 8. Current health status of subjects. Family Constellation: 9. Number of siblings. 10. Number of phenylketonuric siblings. 11. Number of normal siblings. 12. Educational background of parents. Psychometric Status: 13. Previous psychometric testing. On the basis of the hospital records, all families with 23 phenylketonuric children of compulsory school age were contacted, requesting their cooperation in this investigation and asked for the name of the subject's present school and class placement and for a release of information. Three older subjects, one who was attending a community college and two who had graduated from high school were included. High school teachers who knew them well were contacted with the subjects' permission to rank their school behavior. The final sample included all those subjects who met the criteria for inclusion in the study. Phase Two included the administration of the cited dependent testing instruments. All tests were administered individually to the subjects, as were interviews of the parents, teachers, and students. Testing and interviewing was carried out by the investigator and two field workers, both licensed educational psychologists. Psychologi cal testing was principally carried out at the student's school or at home with the exception of those individuals who were concurrently scheduled for routine hospital evaluations. Interviews with the teachers were made at the convenience of the teachers and were conducted at the subject's school. When geo graphical locations of the teachers were of great distance, inter views were conducted by telephone. Interviews with parents were either conducted at the parents' convenience at their home or at the hospital. All test results were cross-checked by the investigator for possible scoring errors. In no instance, did the examiner know which individuals were rated as having high, moderate, or low dietary 24 control. Additionally, the investigator did not know the length of dietary treatment during the assessment process. Administration and Scoring of Tests Psychoeducational status was the dependent variate and in cluded the following: intellectual development, visual perceptual development, achievement, behavioral development, self-concept, social maturity, family social history, school and class placement. The duration of dietary treatment was defined by the number of years the subjects were on the diet as indicated on their hospital records. The quality of dietary treatment was artificially dichoto mized into high quality, moderate quality, and low quality. High quality diet refers to serum phenylalanine levels maintained between 1 to 10 mg percent. Moderate quality diet would be serum phenyl alanine levels between 11 and 15 mg percent and low quality diet would be phenylalanine levels above 15 mg percent (Koch, 1980). Description of the Criterion Instruments The Wechsler Intelligence Scale for Children, Revised Edition (WISC-R), was chosen as the instrument for use in the assessment of current intellectual level of functioning. This test was designed for children between the ages of 6 years and 16 years 11 months. For those youngsters in the sample who were 16 years 0 months, a compara ble test, the Wechsler Adult Intelligence Scale, Revised Edition (WAIS-R), was used. Both tests are scaled and interpreted in the same general manner. The WISC-R provides a global index of intelli gence to help differentiate between mental retardation and special 25 learning disabilities. The standardization included 2,200 children, 200 in each of 11 age groups. There are three main factors at each grade level: verbal comprehension, perceptual organization, and freedom from distractibility. The WAIS-R is an individually administered intelligence test for use with adolescents and adults between the ages of 16 and 74 years. The scale is a revision and complete restandardization of the 1955 Wechsler Adult Intelligence Scale (WAIS). The Wechsler Adult Intelligence Scale Revised Manual describes the revision and the national standardization sample in detail and provides complete direc tions for administration and scoring. Like its predecessor, the WAIS- R comprises six verbal and five performance tests. Scores in these tests are converted to verbal, performance, and full-scale IQs by reference to tables taking into account the examinee's age. The WAIS- R retains a substantial proportion of the content of the WAIS, but older items were eliminated or replaced if they were judge dated, culturally biased, or psychometrically weak. To assess perceptual motor maturation and development, the Bender Visual-Motor Gestalt Test was chosen for this investigation. The Bender Gestalt Test consists of nine geometric figures which the subject is to copy from stimulus pictures presented one at a time. The Bender Gestalt Test was originally assembled by Loretta Bender in 1938. For a full review of the interpretation of the Bender Ges talt profiles of children, the reader is referred to the manual by Aileen Clawson, the Bender Visual-Motor Gestalt Test for Children. In order to determine a mental age for the performance on the Bender 26 Visual-Motor Gestalt Test for this investigation, the Koppitz scoring system (Koppitz, 1963) was used. The Wide Range Achievement Test (WRAT) was chosen for use in this investigation to determine achievement level. The WRAT authored by Jastak and Jastak was revised in 1978 and it is an individual test used primarily for remedial and vocational purposes. The WRAT is a conventional tool for the study of the basic school subjects of read ing (word recognition and pronunciation), written spelling, and arith metic computation. It was designed as an adjunct to the tests of intelligence and behavior. Some of the primary uses of the WRAT are: 1. The accurate diagnosis of reading, spelling, and arithme tic disabilities in persons of all ages. 2. The determination of instructional levels of school chil dren. 3. The assignment of children to instructional groups progress ing at similar rates and their transfer to faster or slower groups in keeping with individual learning rates. The instrument is divided into three subtests. Each subtest is di vided into two levels: One and Two. Level One is designed for use with children between the ages of 5 years 0 months and 11 years 11 months. Level Two is intended for persons from 12 years 0 months to adulthood. In the 1978 edition, changes were made in the scaling of the arbitrarily assigned grade ratings, and in this edition the raw scores are scaled. The authors posit that this technique provides a better representation of differences in the separate development of reading, spelling, and arithmetic skills. 27 The Mednick-Baker Behavioral Rating Scale (1980) was utilized to assess the subjects' school behavior (academic), school behavior (psychosocial), psychophysical functioning, physical traits, parent interaction, and affective traits. Academic school behavior factors included: oral language skills, reading skills, mathematical skills, reasoning skills, work organizational skills, and concentration skills. Psychosocial school behavior factors included: participatory skills, inferiority feelings, emotionality, peer relations, adult re lations, aggression, withdrawal, and fearfulness. Psychophysical functioning factors included: hyperactivity, clumsiness, impulsivity, and speech problems. Physical traits included: personal appearance and athletics. The Mednick-Baker Behavioral Rating Scale consists of 106 items. The authors of the Scale reviewed the Child Behavior Rating Scale (Cassell, 1962), the Bristol Social Adjustment Guides (Stott), the Devereux Adolescent Scale, and the Burks' Behavior Rating Scales. From a factorial rotation procedure, academic school behavior, psycho social school behavior, psychophysical functioning, physical traits, parent interaction, and affective traits were determined. The Scale was completed by both the subject's parent and teacher. The subject's teacher included either his social studies, English teacher, or special education teacher at the junior high school level and for younger sub jects, the primary classroom teacher completed the Scale. 28 The Piers-Harris Children's Self-Concept Scale entitled "The Way I Feel About Myself," was utilized as a measure of the subject's self-reported perception of themselves with respect to their self- concept. This Scale was developed by Ellen V. Piers and Dale B. Harris in 1969 as a 15 to 20 minute self-report instrument designed for youngsters over a wide range. It can be administered and scored by responsible, educated non-psychologists, but should be interpreted only with the aid of someone knowledgeable in measurement and statis tics, psychology of adjustment, and self-theory. The 80-item Scale was designed primarily for research on the development of subjects' self- attitudes and correlates of these attitudes. Internal consistency: coefficients range from .78 to .93. The stability coefficients of .72, .71, and .72 were judged by the authors as satisfactory for a personality instrument. Six factors accounted for 42 percent of the variance. They are (1) behavior, (2) intellectual and school status, (3) physical appearance and attributes, (4) anxiety, (5) popularity, and (6) happiness and satisfaction. The Vineland Social Maturity Scale (Doll, 1935) was included in this study to assess the subject's independence, adaptive behavior, and self-help skills as perceived by the subject's parents. The Vine land Social Maturity Scale is a developmental schedule concerned with the individual's ability to look after his practical needs and to take responsibility. The scale covers a range from birth to 25 years old. It has been found to be particularly useful with the mentally retarded. The entire scale consists of 117 items grouped into year levels. The information required for each item is obtained not 29 through test situations but through an interview with an informant or with the subject himself. The scale is based on what the subject has actually done in his daily living. The items fall into eight categories: general self-help, self-help in eating, self-help in dressing, self-direction, occupation, communication, locomotion, and socialization. A social age (SA) and a social quotient (SQ) can be computed from the subject1s record on the entire scale. The Vineland Scale was standardized on 620 subjects, including 10 males and 10 females of each year from birth to 30 years. Validity of this scale was determined chiefly on the basis of age differentia tion, comparison of normal and mental retardates, and correlation of scores with judgments of observers who knew the subjects well. A re test reliability of .92 has been reported for 123 cases, the retest intervals varying from one day to nine months. The use of different examiners or informants did not appreciably affect results in this group, as long as all informants had had an adequate opportunity to observe the subjects. The following assumption was basic to the study: that the various indices of psychoeducational status can be measured by the above described instruments: The Wechsler Intelligence Scale for Children, Revised Edition, or the Wechsler Adult Intelligence Scale, Revised, the Wide Range Achievement Test, the Mednick-Baker Behavioral Rating Scale, the Piers-Harris Children Self-Concept Scale, and the Vineland Social Maturity Scale. Further, visual motor ability can be measured by the Bender Visual-Motor Gestalt Test in terms of the Koppitz scoring system. 30 Statistical Treatment of the Data Because of the range of ages among the subjects at the time of test administration, some raw test scores had to be converted into standard scale scores that would allow for subject comparisons. The investigator was interested in determining whether there was a significant relationship in the psychoeducational status of early and later treated and diagnosed phenylketonuric subjects with varying duration and quality of dietary treatment. Since randomization of the phenylketonuric population was not possible, the procedure in this study was retrospective in nature. The data were statistically ana lyzed by computing both nonparametric and parametric coefficients of correlation depending on the level of measurement of the variables in question. 31 CHAPTER IV ANALYSIS OF THE DATA AND FINDINGS OF THE, STUDY The purpose of this study was to investigate the relationship between the psychoeducational status of early and later treated and diagnosed phenylketonuric youngsters and the duration and quality of treatment. Specifically the study attempted to answer the following ques tion: In a sample of early and later treated and diagnosed phenylketo-j i nuric youngsters, what is the extent of the relationships between ' psychoeducational status and duration of dietary treatment, quality of dietary treatment, and age that dietary treatment was initiated? The years of dietary treatment, diet restricted in phenylalanine, and quality of diet were determined by records on each subject at Chil drens Hospital of Los Angeles. In one instance, one subject was drawn from the University of California at Los Angeles Medical Center and the same procedures were followed. In this chapter, the findings of the study are reported and discussed, incorporating the findings and impressions obtained from the personal interviews with the families. The sample of 25 classi cally diagnosed PKU subjects consisted of nine females and 16 males. Twenty of the subjects came from intact families while five subjects lived in single parent homes with their mother. The age range of the sample was from 10.00 to 22.11 years old (X=13.77, SD=3.213). The 32 grade placement of the subjects ranged from 4.02 to 13.06 with a mean grade level of 7.96 and a standard deviation of 2.73. The range of years in which the subjects were on dietary treatment was from 4 years 11 months to 14 years 1 month with a mean duration of 7.89 years and a standard deviation of 2.67. The age at which treatment began ranged from three days to 731 days (X=107.52, SD=205.87). Nineteen subjects were diagnosed prior to 121 days and 6 subjects were diagnosed after 121 days. The quality of diet was classified on a scale of 1 to 3. The designation of 1 represents a high quality diet that refers to serum phenylalanine levels maintained between 1 to 10 mg percent. The designation of 2 represents a moderate quality diet that refers to phenylalanine levels between 11 to 15 mg percent and a low quality diet was designated by the number 3 and refers to phenylalanine levels above 15 mg percent. Ten subjects were classified as following a high quality diet (40%), 8 subjects were classified as following a moderate quality diet (32%), and 6 were classified as low quality diet (24%). Of the 25 subjects, 5 were still on a phenylalanine restricted diet. The research question was examined by testing three sub- questions: (1) Is there a relationship between age at which dietary treatment began and present psychoeducational status of treated PKU youngsters? (2) Is there a relationship between quality of diet and subsequent psychoeducational status of treated PKU youngsters? (3) Is there a relationship between duration of diet and subsequent psycho educational status of treated PKU youngsters? Additionally, the in vestigator attempted to describe the patterns or profiles that best represent the psychoeducational status of PKU youngsters as a group. 32 , 1 Findings Relative to Intellectual Status: Wechsler Intelligence Scales Each subject was individually tested with the Wechsler Intel ligence Scale for Children-Revised Edition (WISC-R), with the excep tion of six subjects who were given the Wechsler Adult Intelligence Scale (WAIS-R). Findings Relative to Classification of Intelligence Table 1 presents the distribution of cases according to their classification of intelligence. Thirty-two percent of the subjects scored within the low average range of intelligence (IQ range 80 to 89). Twenty-four percent scored within the average range (IQ points between 90 to 109), and 20 percent of the sample scored in the bright normal range of intelligence (IQ points from 110 to 119). Only 16 percent scored in the borderline range (IQ points between 70 to 79) and only 8 percent, which represented two individuals in the sample, scored in the mental defective range (IQ points of 69 and below). Findings Relative to Intellectual Func tioning: Intellectual Quotients Table 2 presents the mean verbal, performance, and full-scale IQs, their ranges, and their standard deviations as measured by the Wechsler Intelligence Scales. The range of verbal IQs was from 69 to 120 with a mean of 80.80 and a standard deviation of 14.04. The range of performance IQs was from 57 to 129 with a mean of 94.68 and a standard deviation of 17.44. The verbal and perfor mance IQs differed by 5.88 points indicating that in this sample of 34 Table 1 Distribution of Cases According to the Wechsler Classification of Intelligence Males Females Total Classification N Percent N Percent N Percent Mental defective (69 and below) 2 16.5 0 0.0 2 8.0 Borderline (70-79) 3 18.75 1 11.11 4 16.0 Low average (80-89) 3 18.75 5 55.55 8 32.0 Average (90-109) 4 25.0 2 22.22 6 24.0 Bright normal (110-119) 4 25.0 1 11.11 5 20.0 Table 2 Distribution of Cases According to the Wechsler Intelligence Quotients Intelligence Quotient Mean IQ Standard Deviation Range Verbal IQ 88.80 14.04 69-120 Performance IQ 94.68 17.44 57-129 Full scale IQ 90.96 15.76 63-116 35 t PKU subjects they are able to function with near equal ability in both areas. The range of full-scale IQs was from 63 to 116 with a mean of 90.96 and a standard deviation of 15.75. Comparison of the Wechsler Subtests Table 3 reveals the mean scale scores, standard deviations, range, and the number of cases for 11 of the Wechsler Subtests. Only 19 subjects participated in the Digit Span Subtest. This was due to examiner error. Other than Digit Span, the other subtests were ad ministered to all 25 subjects. (Mazes, an optional subtest on the WISC-R, was also excluded.) By inspection of the table, one can readily see that as a group the PKU subjects did relatively well and showed an area of relative strength in object assembly and in picture arrangement. Object assembly purports to measure the ability to re produce familiar forms from memory and picture arrangement purports to measure the ability to analyze nonverbal social situations utiliz ing sequencing. In contrast, the PKU subjects as a group showed rela tive weakness in arithmetic reasoning. While there certainly was not overwhelming variability among the subjects on the Wechsler Scales,(there appeared to be sufficient variation among the subjects on the measures to permit computation of coefficients of correlation. Table 4 contains the correlation coeffi cients for the Wechsler verbal IQ, performance IQ, full-scale IQ, and their subscales. As can be seen from the table no significant rela tionships between duration, quality of diet, and age at which treat ment began and the Wechsler Scales or any of the subtests was found. 36 Table 3 Wechsler Subtest Scaled Score Values Subtest Mean Scaled Score Standard Deviation Range No. of Cases Information 8.00 2.87 4-15 25 Similarities 8.80 3.24 4-14 25 Arithmetic --- 7.40 2.83 3-14 25 Vocabulary 7.64 2.16 4-12 25 Comprehens ion 7.96 2.85 3-14 25 Digit span 7.79 2.04 5-12 19 Picture completion 8.88 3 .02 2-14 25 Picture arrangement 9.84 3.48 2-17 25 Block design 8.72 3.27 1-14 25 Object assembly 10.40 3.96 1-17 25 Coding 8.12 3.35 1-17 25 37 Table 4 Correlations between Dietary Quality, Duration, and Age Treatment Began with Indices of Psychoeducational Status Measures of Psychoeducational Status Quality of Diet Duration of Diet Age Treat ment Began Verbal IQ -.04 -.09 -.23 Performance IQ .04 -.01 -.27 Full-Scale IQ .03 -.04 -.26 Information Subtest .04 -.17 -.21 Similarities Subtest -.03 .02 -.38 Arithmetic Subtest .10 -.01 -.11 Vocabulary Subtest .11 -.23 -.31 Comprehension Subtest .07 -.31 -.25 Digit Span Subtest -.19 -.06 -.39 Picture Completion Subtest .32 .02 -.24 Picture Arrangement Subtest .17 -.02 -.17 “Block Design Subtest .01 -.16 -.20 Object Assembly Subtest -.04 .06 -.19 Coding/Digit Symbol Subtest -.02 .11 -.17 Reading Achievement .04 -.02 .07 Spelling Achievement -.17 -.05 .21 Arithmetic Achievement -.06 -.19 .07 Bender Visual-Motor Gestalt Test .08 -.07 .04 Piers-Harris Self-Concept Scale .44 .15 .16 Behavior -.08 -.01 -.07 Intellectual and School Status .09 .17 .25 Physical Appearance and Attributes -.06 .16 .29 Anxiety -.30 .19 .16 Popularity -.17 .26 .25 Happiness and Satisfaction -.01 .05 .21 Vineland Social Maturity Scale .24 .32 .25 Note. p < .05. ~ • t' " • —- • Age Treat ment Began Duration of Diet ' Quality of Diet Age Treatment Began Duration of Diet ..48 Quality of Diet ,-.19 -.14 38 While no significant relationships were obtained, there was a nonsig nificant tendency for the later diagnosed subjects to exhibit somewhat reduced intellectual functioning. Overall, the PKU sample is functioning within the low range of intellectual ability. However, while there is not wide inter-test variability between the subjects, there is considerable intra-test variability among each protocol on each subject. This may be indica tive of youngsters with learning problems . Findings Relative to Academic Achievement - The Wide Range Achievement Test (WRAT) was chosen to test aca demic achievement. The WRAT tests three skill areas: reading sight vocabulary, spelling, and arithmetic. The test was administered on an individual basis. The mean enrolled grade level of all the subjects was 7.96, essentially eighth grade, with a standard deviation of 2.73. The range of grade level scores on the reading portion of the WRAT was from 2.04 to 10.00. The mean grade level achievement in reading sight vocabulary was 5.9, approximately sixth grade with a standard devia tion of 1.69. Thus, the sample as a whole is achieving approximately two grade levels below expected enrolled reading sight vocabulary grade level. The standard score for the sample on reading was 91.88 with a standard deviation of 12.62. The mean average percentile in reading sight vocabulary was 33.96 with a standard deviation of 24.81. Spelling achievement as measured by the WRAT revealed a mean grade level score of 5.34 with a standard deviation of 1.65. Thus, the sample of PKU youngsters is under achieving approximately two-and- 39 a-half grade levels in spelling skills. The mean standard score on the spelling subtest was 89.88 with a standard deviation of 12.04 and the mean percentile was 29.96 with a standard deviation of 23.54. The arithmetic achievement of the PKU sample revealed a mean grade level score in arithmetic of 4.28 with a standard deviation of 1.23. Thus, the sample is achieving more than three-and-a-half grade levels below mean enrolled grade level in arithmetic skills. The stan dard score for arithmetic was 80.68 with a standard deviation of 10.79. As a group, the mean percentile was 15.20 with a standard deviation of 14.62. Thus, as a group, the PKU subjects show relative strength in reading sight vocabulary skills and relative weakness in spelling skills, and significant weakness in arithmetic skills. Table 4 reveals the correlations between quality, duration, and age of treat ment with the three subtests of the Wide Range Achievement Test. As can be seen, there are no significant relationships. Findings Relative to Perceptual Motor Development To assess the perceptual motor development, the Bender Visual- Motor Gestalt Test was individually administered to each subject in the sample to determine visual perceptual functioning. The Koppitz1 Scoring System was applied to the individual protocols. The Koppitz System has 29 scorable items for the nine Gestalt figures. Among these 29 items are seven specific types of errors. The seven types of errors analyzed included: (1) loss or distortion of shape, (2) disproportion, (3) rotation, (4) integration problems, (5) circles 40 for dots, (6) perseveration, and (7) angulation problems. The analysis of the types of errors committed often leads to meaningful interpretation of specific learning problems. For that reason, not only were perceptual ages determined but the Bender was also analyzed in terms of the types of errors made. Appendix C pre sents the criteria for the Koppitz Scoring System and error classifi cations. Five of the 25 subjects earned Koppitz scores that showed no perceptual errors and were above the norms. The range of errors was from zero to 14. There was a total of 112 perceptual errors committed among the remaining 20 subjects. The mean number of errors committed on the Bender Visual-Motor Gestalt Test was 4.5 with a standard devia tion of 4.04. Their perceptual age range was from below 5_years- ^ 0 months to 9 years 0 months. Thus, as a group, this sample of phenyl ketonuric subjects showed marked visual perceptual deficits. Table 5 depicts the distribution of cases according to the types of errors made on the Bender Gestalt Test. Of the 112 perceptual errors, the greatest percent of errors were rotations (33.03%). Angulation prob lems (20.54%) represented the second largest group of errors. The least number of errors were in disproportions (2.67%) and persevera tions (7.14%). Table 4 reveals the correlation coefficients of qual ity, duration, and age of treatment with the Bender Visual-Motor Gestalt Test. As can be seen from the table, no significant relation ship was found. 41 'Table 5 'Distribution of Cases Made on According to the Types of Error the Bender-Gestalt Type of Error Number of Cases Percent of Cases Loss of shape 12 10.71 Disproportions 3 2.67 Rotations 37 33.03 Integration 16 14.29 Circles for dots 7 6.25 Perseveration 4 7.14 Angulation problems 23 20.54 Table 6 Piers-Harris Scales Scale X SD I. Behavior 15.120 2.587 II. Intellectual and School Status 11.720 3.879 III. Physical Appearance and Attributes 7.0 2.872 IV. Anxiety 9.24 2.420 V. Popularity 7.840 3.171 VI. Happiness and Satisfaction 7.400 1.756 42 ( Findings Relative to the Piers-Harris Self-Concept Scale The PKU sample achieved a mean raw score of 57.44 and a stan dard deviation of 12.81 on the Piers-Harris Self-Concept Scale. The mean percentile for the group was 61.96 with a standard deviation of 29.48. That placed the group within a mean stanine of 5.84 with a standard deviation of 1.84. Overall, the PKU sample appears to be slightly above average with respect to self-concept. The Piers-Harris can be divided into six scales. As can be seen in Table 6, the sample showed their greatest relative strength in behavior and intellectual and school status. They seem to perceive themselves as well-behaved. Their second highest subtest was in their perception of their intel lectual ability and school status. This does come as a surprise to this investigator, given their actual school placement and inspection of school history. However, it may be that because of their special needs, school has been a place of relative perceived success for them. As a group, they do not appear to be high on the anxiety scale. In contrast, their three lowest scales were in their perception of their own popularity, their happiness and satisfaction, and their lowest area of self-concept was in their physical appearance and attributes. This last finding that they do not perceive themselves as either phy- ically attractive or of possessing those attributes that lead to at tractiveness is surprising in view of their teachers' and parents' ratings that these youngsters as a group are qftite attractive. Their low perception of their attractiveness may be that they do stand out relative to their siblings in their home environment because they tend 43 to be fairer in complexion, have lighter hair, and lighter eyes. In this sense, they may wish to conform more to the norms of the family's appearance and not to stand out as different. This, however, is purely speculative and future research in this area is needed. As can be seen in Table 4, there were no significant relationships between quality, duration, or age treatment began and performance on the Piers- Harris Self-Concept Scale or any of its subscales. Findings Relative to the Vineland Social Maturity Scale The Vineland Social Maturity Scale was administered to each subject with their biological parent as the informant. The rationale for using this scale was to counterbalance it with measures of intel lectual development and to explore the youngster's social development and self-help skills. The mean age equivalent scored by the subjects was 16.71 with a standard deviation of 3.24. Thus, the sample as a whole is functioning approximately three years above age expectancy on the Vineland Social Maturity Scale . The mean social quotient was 120.76 with a standard deviation of 18.59. One interesting finding of the study was that 11 subjects who were retained an extra year in their school history had slightly higher social quotients (X=129.09) than the 14 subjects who did not repeat a grade (X=114.21). Table 4 shows the correlations of quality, duration, and age of treatment with the Vineland Social Maturity Scale. There was no significant rela tionship between age treatment began and the Vineland age equivalent. However, there is a significant relationship between age treatment began and the Vineland Social quotients. 44 _____________________________________________________________________________ I Findings Relative to School Data and Class Placement Table 7 shows a distribution of cases according to class place ment. Approximately 48 percent of the sample (N=12) was enrolled in a learning disability group, resource room, or in remedial instruction part-time. Thirty-two percent of the sample (N=8) was in a regular class with no adjunct assistance. Approximately 8 percent were in a regular class with private tutoring and approximately another 8 percent were in an educational handicapped full-day class. One subject repre senting 4 percent of the sample had been enrolled in an educably men tally retarded class, but had subsequently graduated from high school. Table 8 reveals the distribution of cases according to school facility. Approximately 56 percent of the sample (N=14) attended a secondary school in the seventh to twelfth grades. Approximately 32 percent of the sample was attending the upper level of elementary school (grades 4.2-6.5). One subject was a freshman in a public community college and two of the subjects were high school graduates not attending ad vanced schooling. With respect to private vs. public institutions, approximately 84 percent of the sample attended a public institution while 16 percent attended a private institution. As can be seen in Table 9, 44 percent of the sample (N=ll) had been retained at some time in their school history. In order to determine if those re tained vs. those who had never been retained showed any significant differences on the measures of psychoeducational status, a series of t tests were run. Table 10 presents the results of these analyses along with relevant descriptive statistics. As can be seen in the 45 Table 7 Distribution of Cases According to Class Placement Class Assignment Number of Cases Percent of Cases Regular class with no g 2 2 adjunct assistance Regular class with 2 ______________________ g private tutoring Learning disability group, resource room, or remedial 12 48 instruction (part-time) Educationally handicapped « q (full-day class) Educable mentally retarded ^ ^ class Table 8 Distribution of Cases According to School Facility Facility Number of Cases Percent of Cases Elementary level (K-6) 8 32 Secondary level (7-12) 14 56 Community college 1 4 High school graduates (not in school) 2 8 Private institution 4 16 Public institution 21 84 Table 9 Distribution of Cases According No Retention in School to Retention vs. History Number of Cases Percent of Cases Retention 11 44 No retention 14 56 47 Table 10 Descriptive Statistics and 1 : Tests for Subjects Retained and Not Retained Retained Group Not Retained Group Psychoeducational Status _(n=ll) _(n=14) Measures X SD x SD WISC -R/WAIS -R Verbal IQ Performance IQ Full-Scale IQ Information Subtest Similarities Subtest Arithmetic Subtest Vocabulary Subtest Comprehension Subtest Digit Span Subtest Picture Completion Subtest Picture Arrangement Subtest Block Design Subtest Object Assembly Subtest Coding/Digit Symbol Subtest WRAT Reading Achievement Spelling Achievement Arithmetic Achievement Bender Visual-Motor Gestalt Test (raw score) Piers-Harris Self-Concept Scale (stanine) Behavior (raw score) Intellectual and School Status (raw score) Physical Appearance and Attributes (raw score) Anxiety (raw score) Popularity (raw score) Happiness and Satisfac tion (raw score) Vineland Social Maturity Scale (social quotient) 92.18 14.32 86.14 13.74 1.07 100.09 14.80 90.43 18.68 1.40 95.55 13.72 87.36 16.78 1.31 8.45 2.88 7.64 2.93 0.69 9.27 3.38 8.43 3.20 0.64 7.18 2.52 7.57 3.13 -0.34 8.09 2.26 7.29 2.09 0.92 8.91 2.07 7.21 3.22 1.52 7.80 1.99 7.78 2.22 0.02 9.64 2.62 8.29 3.27 1.12 11.27 3 .66 8.71 2.99 1.92 9.00 3.49 8.50 3.21 0.37 11.91 2.39 9.21 4.59 1.76 8.18 3.76 8.07 3.13 0.08 5.77 1.42 6.03 1.91 -0.38 4.59 1.50 5.91 1.57 -2.12* 3.68 0.92 4.75 1.26 -2.37* 4.36 4.80 4.57 3.52 -0.12 5.09 1.70 6.43 1.79 -1.90 14.55 2.34 15.57 2.77 -0.98 10.36 4.25 12.79 3.33 -1.60 6.55 2.21 7.36 3.34 -0.69 8.73 2.72 9.64 2.17 -0.94 6.45 3.48 8.93 2.53 -2.06 6.91 2.07 7.79 1.42 -1.25 129.09 16.16 114.21 18.21 2.13* * p < .05. 48 table those subjects who had never repeated a grade had significantly higher WRAT spelling and arithmetic grade level scores. Additionally, those subjects who had never been retained had higher means on the reading sight vocabulary test but their mean scores were not signifi cantly greater than those who had been retained. Surprisingly, those who had been retained an Oextra year had higher Vineland social quo tients than those subjects who did not repeat a grade. Findings Relative to Parent and Teacher Behavioral Rating Scales The Mednick-Baker Behavioral Rating Scale was administered to both parents and teachers in order to rate the subject's academic and psychosocial school behavior patterns, as well as their psychophysical functioning, physical traits, parent interaction, affective traits. The factors are displayed in Table 11 and the correlation of these factors with quality of diet, duration of diet, and age at which diet was initiated are correlated and displayed in Table 12. With respect to the parents1 behavioral ratings of the sub jects, the subjects were rated significantly below average in work organizational skills (X=.35). Additionally, there was a significant relationship between work organizational skills and the duration of diet the subjects were on (r=.35, p < .05). Parents ranked their youngsters highest in personal appearance (X=3.56) and there was a significant negative correlation between personal appearance and duration of diet (r=.51, p < .05). Those individuals who were on diet a shorter period of time were ranked higher in physical appearance by their parents. Additionally, there was a significant negative cor- 49 Table 11 Results of the Mednick-Baker Behavioral Rating Scale Factors Parent Ratings M SD Teacher Ratings M SD School Behavior--Academic Oral Language Skills 2.98 .637 2.76 .903 Reading Skills 2.73 .753 2.44 .744 Mathematical Skills 2.52 .823 1.98 1.237 Reasoning Skills 2.64 .511 2.32 .988 Work Organizational Skills 0.35 .064 0.39 .146 Concentration Skills 2.91 .500 2.63 .838 School Behavior--Psychosocial Participatory Skills 2.91 .500 2.63 .838 Emotionality ____2.73 ___746 ----2.39 .933 Peer Relations 3.14 .542 2.74 .792 Adult Relations 3.57 .505 3.09 .947 Aggression 2.12 .833 2.07 .858 Withdrawal 2.77 .527 2.76 .752 Fearfulness 2.48 .660 2.65 .864 Psychological Functioning Hyperactivity 2.52 .884 2.92 1.124 Clumsiness 2.35 .677 2.71 .830 Impulsivity 2.96 .434 2.81 .807 Speech Problems 2.43 .581 2.23 .848 Physical Traits Personal Appearance 3.56 .712 3.44 .754 Athletics 2.99 .540 2.48 1.080 Parent Interaction 3.45 .378 3.56 .618 Affective Traits 3.04 .268 2.98 .368 Self-Serving Assertiveness 2.91 .461 2.78 .678 Inferiority 2.66 .450 2.79 .734 Social Responsibility 3.51 .648 3.48 .872 Note. Rating Scale: 1 = well below average 2 = below average 3 = average 4 = above average 5 = well above average 50 Table 12 Correlations between Dietary Quality, Duration, and Age Treatment Began with the Mednick-Baker Behavioral Rating Scale and Subscales Quality of Diet Duration of Diet Age Treatment Began Teacher Parent •Teacher Parent 1 Teacher "Parent Mednick-Baker Oral Language Skills .13 -.21 .21 -.19 .09 -.31 Reading Skills .33 -.12 -.00 .09 -.10 -.15 Mathematical Skills -.05 -.07 -.17 -.33 .09 -.15 Reasoning Skills .27 -.07 .06 -.03 -.23 -.26 Word Organizational Skills -.12 .18 -.07 .35* .18 .27 Concentration Skills .06 -.29 .19 .31 .22 .09 Participatory Skills .06 -.29 .19 .31 .21 .09 Emotionality .07 .19 -.04 -.17 -.02 -.23 Peer Relations .14 . .01 .07 .13 -.02 -.02 Adult Relations .32 .29 .20 -.16 .09 .06 Aggression .10 -.02 .02 -.28 .09 -.14 Withdrawal .25 -.11 .14 -.10 -.05 .14 Fearfulness -.02 .08 .41* -.38 .14 -.08 Hyperactivity .05 .12 -.24 .01 -.29 .05 Clumsiness -.23 .05 .08 .04 .15 .10 Impulsivity .13 .07 -.25 -.15 -.004 .11 Speech Problems -.11 .16 .22 -.17 .18 .01 Personal Appearance .09 -.21 .08 -.51* .17 -.27 Athletics -.18 .32 .006 -.17 .27 -.11 Parent Interaction -.13 .08 -.21 .10 -.07 .05 Affective Traits -.19 .28 .04 -.07 .03 -.26 Self-Serving Assertiveness -.14 .05 .03 -.12 .28 -.36* Inferiority -.18 .31 .26 -.20 .09 -.30 Social Responsibility -.11 -.04 .02 .12 .05 .16 Overall Teacher Ratings •01 .10 .09 Overall Parent Ratings •14 -.25 -.28 *p < .05 . 51 relation between self-serving assertiveness and age treatment began (r=-36 , p < .05). Among those subjects who were treated at a younger age, they tended to show more self-serving assertiveness as rated by their parents. While these correlations may have occurred by the operation of chance alone (due to the number of correlations that were undertaken), it is worth exploring and understanding the nature of the subjects' work organizational skills, personal appearance, and self- serving assertiveness with larger sample sizes with a wider range of variability. There was a significant correlation as rated by teachers be tween fearfulness and duration jDf^jdiet Cr=.41, p<i05)- The longef the subjects were on diet, the more fearfulness they showed on the Mednick-Baker Behavioral Rating Scale. One could speculate that as youngsters grow older and emerge into adolescence and are asked to be on a diet that is different from their peers, that this maturation may produce some fearful reaction in that they may not understand what is going on with them physically. With respect to the teachers' behavioral ratings of the sub jects, Table 11 represents the means and standard deviations of the various factors of the Mednick-Baker Behavioral Rating Scale. The teachers ranked the subjects above average in their parental interac tion with a mean of 3.560 and standard deviation of 0.618. Addition ally, they ranked the subjects above average in social responsibility with a mean of 3.480 with a standard deviation of 0.872, as well as ranking them above average in physical appearance with a mean of 3.440 with a standard deviation of 0.754. In contrast, the teachers ranked 52 the subjects as being significantly below average in work organiza tional skills with a mean of 0.392 and a standard deviation of 0.146. Additionally, the teachers rated the students as slightly below average in their mathematical skills with a mean of 1.980 and a standard de viation of 1.237. Both parents and teachers were in congruence in their below average ranking of the subjects' work organizational skills. Both parents and teachers were in agreement as to the subr jects' physical attractiveness. Overall, it may be noted in Table 13 that parents tended to rank their children slightly higher on most measures of the Mednick-Baker Scale (parents X=2.95, SD=.18 vs. teach ers X=2.86, SD=.30)• - As _can b e seen in Table 12, the correlation between dietary quality, duration, and age of treatment and overall I behavioral status was not significant for both parent and teacher ratings. Table 13 Comparison of the Means and Standard Deviations of the Mednick-Baker Scale Standard Mean Deviation Teachers 2.86 .30 Parents 2.95 • i —1 00 53 CHAPTER V SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS This chapter presents a review of the study. The summary section relates to the importance of the study, the statement of the problems, and the methodology. The research findings are summarized. Following the findings, is the section where the conclusions based on the findings are presented. The final section prevents recommenda tions for future research. --------------------- Summary Importance of the Study The main feature of therapeutic intervention for phenylketo nuria is the utilization of a diet restricted in phenylalanine. This therapeutic approach has been implemented since Bickel (1953) demon strated its effectiveness in ameliorating possible intellectual defi ciencies. Horner et al. (1962) were the first to report on termina tion of restricted diet. In the United States, diet therapy is terminated between 4 and 6 years of age. Koch (1964) and Brown and Warner (1976) have reported a preference to delay diet discontinuation to adolescence or beyond. The Collaborative Study of Children Treated for Phenylketo nuria at Childrens Hospital at Los Angeles (Koch, 1973) has initiated an evaluation of diet termination. This collaborative effort 54 included approximately 200 phenylketonuria subjects treated in 15 clinics in 12 states. Preliminary results of the Phenylketonuria Collaborative Study Conference in 1978 suggested that youngsters who terminated diet may not be functioning as well educationally as those patients who remained on diet. Koch (1980) called attention to youngsters with phenylketonuria of normal intelligence who despite early diagnosis prior to 121 days and early dietary treatment of phenylalanine restricted prior to 121 days, exhibit special academic and/or behavioral problems often requir ing special education services. Purpose^ of the Study The present study was undertaken to investigate the relation ship of the psychoeducational status of early and later treated and diagnosed phenylketonuric youngsters and the duration and quality of dietary treatment. The study attempted to answer the following ques tion: In a sample of early and later treated and diagnosed phenylketo nuric youngsters, is there a relationship between the psychoeducational status and duration and quality of dietary treatment? The years of dietary treatment (diet restricted in phenylalanine) and quality of diet were determined by records on each subject at Childrens Hospital of Los Angeles and one subject at UCLA Medical Clinic. Specific in struments were chosen to assess intellectual development, visual per ceptual development, achievement, behavioral development, self-concept, social maturity, and school and class placement. 55 Conclusions A relationship was not established between age at which dietary treatment began and resultant psychoeducational status of treated PKU youngsters. A relationship was not established between quality of diet and subsequent psychoeducational status of treated PKU youngsters. Additionally, duration of diet and subsequent psychoeducational status of treated PKU youngsters was not firmly established. Due to the re stricted range of this sample, one cannot generalize to the PKU popula tion as a whole. It appears that the sample that was studied was quite homogeneous not only in socioeconomic background but with respect to intellectual level. Seventy-six percent of the subjects were found to be functioning from the low average to the bright normal range of intellectual development. Academically, they showed relative strength in reading sight vocabulary skills and relative weakness in spelling skills and severe deficits in arithmetic skills. With respect to visual perceptual development, the phenylketonuric subjects as a group showed profound visual perceptual deficits. This has been supported by the recent research by Skarin in 1981 with PKU subjects under age 10. With respect to the subjects1 self-concept, overall they appear to have an average to above average self-concept as based upon the Piers-Harris Self Concept Scales. The sample showed advanced development with re spect to social maturity with a mean social quotient of 120.76 and a standard deviation of 18.59. There was a significant relationship between age treatment began and the Vineland Social quotients. With respect to school data and class placement, approximately 48 percent of the sample was enrolled in a learning disability group, resource 56 room, or in remedial instruction part-time. Thirty-two percent of the sample was in a regular class with no adjunct assistance. Approxi mately 8 percent was in a regular class with private tutoring and approximately another 8 percent was in an educationally handicapped full-day class. One subject representing 4 percent of the sample has been enrolled in an educably mentally retarded class, but had subse quently graduated from high school. Approximately 44 percent of the sample had been retained at some time in their school history. Be- haviorally, the subjects show relative strengths in adult, parent, and peer relations, personal appearance, affective traits, and social responsibility. In contrast, the subjects show considerable relative weakness in their work organizational skills. Recommendations 1. Further studies of school achievement and particularly perceptual development should be conducted using the teenage popula tion of PKU subjects between the ages of 12 and 18 who have been in good dietary control from birth. However, it is important to have a large sample size in conducting this research as a restricted range can result from small sample sizes . 2. It is recommended that multiple regression techniques be utilized with larger sample sizes. Particularly the Wilks' Lambda Procedure where indices of psychoeducational status are moderately correlated. 3. The visual perceptual difficulties manifested by the sub jects would warrant future educational remediation that focused on ability training. 57 4. A thorough task analysis of reading, spelling, and arith metic difficulties that PKU youngsters are having in school would be recommended. A program of remediation geared to this task analysis could be implemented. Pre- and posttesting to assess gains would be of benefit. 5. It is also recommended that school psychologists and special educators work closely in designing programs to meet the special learning needs of treated phenylketonuric youngsters. 6. Vocational and career counseling is indicated with the PKU teenage population. 7. Parent support groups focusing on the needs of the PKU adolescent and young adult population is highly recommended. 58 REFERENCES REFERENCES Allen, J. D., & Brown, J. K. Maternal phenylketonuria and foetal brain damage. In K. S. Holt 6c V. P. 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Prenatal and post natal developmental consequences of maternal phenylketonuria. Pediatrics, 1969, 3 7 _ , 979. Fishier, K., Donnell, G. N., Bergren, W. R., & Koch, R. Intellectual and personality development in children with galactosemia. Pediatrics, 1972, 5_0, 412. Fishier, K., Koch, R., Donnell, G., & Graliker, B. V. Psychological correlates in galactosemia. American Journal of Mental Deficiency, 1966, 71, 116. (Foiling, A. Uber ausscheislung von phenylbrenztraubensaure in den harn als stoffwechselanomalie in verbindung mit imbecillitat. (Excretion of phenylpyruvic acid in urine: A metabolic distur bance associated with imbecility ) Physiological Chemistry and Physics^1934, 227, 169. (F rankenburg, W. K. Maternal phenylketonuria: Implications for growth and development. Journal of Pediatrics, 1968, 7^3, 560. (Fuller, R. N., & Shuman, J. B. Phenylketonuria and intelligence: Trimodal response to dietary treatment. Nature (London), 1969, 221, 639. Graw, R. G., & Koch, R. Phenylketonuria in two American negroes. American Journal of Diseases of Children, 1967, 114, 412. Guttler, F., & Hansen, G. Different phenotypes for phenylalanine hydroxylase deficiency. Annals of Clinical Biochemistry, 1977, 14, 124-134. Hackney, I. M,, Hanley, W. B., Davidson, W., & Lin-Sao, L. Phenylketo nuria: Mental development, behavior and termination of low phenyl alanine diet. Journal of Pediatrics, 1968, 72^, 646. Hanley, W. B. Malnutrition with early treatment of phenylketonuria. Pediatric Research, 1970, 4, 318. Horner, F. A., Streamer, C. W., Alejandrino, L. L., Read, L. H., & Ibbot, F. Termination of dietary treatment of phenylketonuria. New England Journal of Medicine, 1962, 266, 79. Jastak, J. F., & Jastak, S. R, The Wide Range Achievement Test. Wilmington, Del.: Delaware Guidance Associates, 1978. 62 Jervis, G. A. Studies on phenylpyruvic oligophrenia. Journal of Mental Science, 1939, 85_, 719. Jervis, G. A. Studies on phenylpyruvic oligophrenia: The position of the metabolic error. Journal of Biological Chemistry. 1947, 169. 651. Jervis, G. A. Studies on phenylpyruvic oligophrenia: Phenylpyruvic acid content of blood. Proceedings of Society of Experimental Biology and Medicine (New York), 1952, 81^, 715. Jervis, G. A. Phenylpyruvic oligophrenia (phenylketonuria). Research Publication--Association of Research in Nervous and Mental Disease, 1954, 33, 259. Johnson, C. F. Phenylketonuria and the obstetrician. Obstetrics and Gynecology. 1972, 3_9, 942-947. (a) Johnson, C. F. What is the best age to discontinue the low phenyl- alanine diet in phenylketonuria? A presentation of some con tributory data. Clinical Pediatrics (Philadelphia), 1972, 11, 148. (b) Kang, E. S. Sollee, N. D., & Gerald, P. S. Result of treatment and termination of the diet in phenylketonuria. Pediatrics. 1970, 46, 881. Katz, H. P., & Menkes, J. H. Phenylketonuria occurring in an American negro. Journal of Pediatrics. 1964, 65_, 71. Kaufman, S., & Levenberg, B. Further studies on the phenylalanine hydroxylation cofactor. Journal of Biological Chemistry. 1959, 234, 2683. Kerlinger, F. N. Foundations of behavioral research. New York: Holt, Rinehart & Winston, 1973. Kerlinger, F. N., & Pedhazur, E. J. Multiple regression in behavioral research. New York: Holt, Rinehart St Winston, 1973. Koch, R. Letter to Vandeman. American Journal of Diseases of Children 1964, 107, 537. Koch, R. Collaborative study of children treated for phenylketonuria. In J. W. T. Seakins, R. A. Sanders, St C. Toothill (Eds.), Treat ment of inborn errors of metabolism. Edinburgh: Churchill and Livingstone, 1973. Koch, R. Personal communication, 1980. 63 Koch, R., Acosta, P., Fishier, K., Schaeffler, G., 6c Wohlers, A. Clinical observations on phenylketonuria. American Journal of Diseases of Children, 1967, 113, 6. Koch, R., Lenke, R.s Shaw, K., Tice, K., 6c Jew, K. Tyrosine sup plementation of the phenylalanine restricted diet during pregnancy of a woman with classical phenylketonuria. Los Angeles: Chil drens Hospital; USC School of Medicine; Lanterman Regional Center for the Developmentally Disabled, 1980. Knox, W. E. An evaluation of the treatment of phenylketonuria with diets low in phenylalanine. Pediatrics, 1960, 2j6, 1. Koppitz, E. M. The Bender Gestalt Test for Children, a normative study. Journal of Clinical Psychology. October 1960, ljS, 432-435. LaDu , B. N. The importance of early diagnosis and treatment of phenylketonuria. Annals of Internal Medicine, 1959, 5_1, 1427. Levy, H. L . Management of women with phenylketonuria. New England Journal of Medicine . 1974. 290 , 108 . - Mabry, C. C. Maternal phenylketonuria: A cause of mental retardation in children without metabolic defect. New England Journal of Medicine, 1962, 260, 1404. Mabry, C. C., Denniston, J. C., 6c Coldwell, J. B. Mental retardation in children of phenylketonuric mothers. New England Journal of Medicine.11966. 275 » 1331. McCarthy, J. J., 6c McCarthy, J. F. Learning disabilities. Boston: Allyn 6c Bacon, 1970. Mednick, B. R., 6c Baker, R. L. The Mednick-Baker Behavioral Rating Scale. Los Angeles: University of Southern California, 1980. Menkes, J. H. The pathogenesis of mental retardation in phenylketo nuria and other inborn errors of amino acid metabolism. Pedia trics . 1967, 3j?, 297. Menkes, J. H., 6e Koch, R. Phenylketonuria. Chap. 3, Handbook of Clinical Neurology. In P. J. Vunken 6c G. W. Bruyn (Eds.), Metabolic and deficiency diseases of the nervous system. Part III (Vol. 29). New York: North-Helland Publishing, 1977. Newberg, P. F . School achievement and perceptual and behavioral development in treated phenyIketonurics and children with learning disabilities. Unpublished doctoral dissertation, University of Southern California, 1970. 64 Oja, S. S. Incorporation of phenylalanine, tyrosine and tryptophan into protein of homogenates from developing rat brains: Kinetics of incorporation and reciprocal inhibition. Journal of Neuro- chemistry, 1972, V 2 , 205 7. Oldendorf, W. H., Sisson, W. B., 6e Silverstein, A. Brain uptake of selenomethionine Se75: n # Reduced brain uptake of selenomethionine Se75 in phenylketonuria. Archives of Neurology (Chicago), 1971, 24, 524. Paine, R. S. The variability in manifestations of untreated patients with phenylketonuria (phenylpyruvic aciduria). Pediatrics, 1957, 20, 290. Palo, J. Prevalence of phenylketonuria and some other metabolic dis orders among mentally retarded patients in Finland. Acta Neuro- logica Scandinavica, 1967, 43, 573. Partington, M. W. The early symptoms of phenylketonuria. Pediatrics, - 1961, 27-, 465. — -------- ----- Piers, E. V., 6c Harris, D. B. The Piers-Harris Children’s Self -Concept' Scale, manual. Nashville: Counselor Recordings and Tests, 1969. Rouse, B. M. Phenylalanine deficiency syndrome. Journal of Pedia- j tries, 1966, 6 9 _ , 246. Royston, N. J., 6c Parry, T. E. Megaloblastic anemia complicating dietary therapy of phenylketonuria in infancy. Archives of Disease in Childhood, 1962, 37^, 430. Skarin, S. Sensory motor integration, school achievement and behavior of children with phenylketonuria. Unpublished doctoral disserta tion, University of Southern California, 1981. Stevenson, R. E., 6c Huntley, C. C. Congenital malformation in off spring of phenylketonuric mothers. Pediatrics, 1967, 40, 33. Udenfriend, S., & Bessman, S. P. Hydroxylation of phenylalanine and antipyrine in phenylpyruvic oligophrenia. Journal of Biological Chemistry, 1953, 203, 961. Wallace, H. W., Moldave, K., 6c Meister, A. Studies on conversion of phenylalanine to tyrosine in phenylpyruvic oligophrenia. Pro ceedings of the Society for Experimental Biology and Medicine (New York), 1957, 94, 632. Wechsler, D. Wechsler Intelligence Scale for Children, revised edi tion , manual. New York: The Psychological Corporation, 1974. 65 Wechsler, D. Wechsler Adult Intelligence Scale, revised edition, manual. New York: The Psychological Corporation, 1980. Williams, R. Maternal phenylketonuria. Medical Journal of Australia, 1968, 2, 216. Williamson, M. L. Treatment effects on physical growth and mental de velopment among phenylketonuric children. Unpublished doctoral dissertation, University of Southern California, 1970. Woolley, D. W., & Van Der Hoeven, T. Serotonin deficiency in infancy as one cause of a mental defect in phenylketonuria. Science, 1964, 144, 833. (a) Woolley, D. W., & Van Der Hoeven, T. Prevention of a mental defect with serotonin congeners such as melatonin or hydroxytryptophan. Science, 1964, 144, 1953. (b) Yu, J. S., & O'Halloran, M. T. Children of mothers with phenylketo nuria. Lancet, 1970, 1^, 723. 66 APPENDICES — ----------- APPENDIX a ---- PARENT AND TEACHER PERMISSION FOR PARTICIPATION IN THE AND REQUEST STUDY 4650 Sunset Boulevard * (213) 660*2450 • Mailing Address: P. O. Box 54700 * Los Angeles. California 90054 April 28, 1981 Dear Parent: As part of the care of your youngster with PKU, we would like your cooperation in a current research project. This study is part of a doctoral dissertation in educational psychology and has been designed to investigate the educational progress of PKU youngsters i n school. The study will require your youngster to participate in one to two hours of educational evaluation at Childrens Hospital and will require the parent to complete a questionnaire. Any information that is learned from this study with respect to your youngster will be shared with you and if any areas of educational need are identified, an appropriate form of remediation will be suggested and shared with you. If you are unable to come in to the hospital, home evaluation can be arranged. You will be contacted by telephone by Alan Stern, a doctoral candidate at USC, who will answer any questions you may have and with your permission, will arrange a time for your youngster to visit the hospital. His findings will help us provide better counseling and guidance for you. We thank you in advance for your continued participation in advancing the research in this area. S i ncerely, Richard Koch, M.D. PKU Clinic Di rector Childrens Hospital of Los Angeles . 6 . 9 . 4650 SU N SET BOULEVARD (213) 660-2450 MAILING ADDRESS: PO . BOX 54700 LOS ANGELES. CALIFORNIA 90054-0700 June, 1981 I give permission to Alan Stem and his assistant of the PKU department of Childrens Hospital of Los Angeles to interview ________________________ teachers and to inspect his/her cumulative school records for the purpose of educational research in this area. Signed, DATE PARENT /LEGAL GUARDIAN 4650 SUNSET BOULEVARD (213) 660-2450 MAILING ADDRESS: BO. BOX 34700 LOS ANGELES. CALIFORNIA 900S4-0700 TO: DATE: Re Birthdate: Thank you for participating in this Childrens Hospital Research Project. Please fill out Che racing 3cale Co che besc of your knowl edge and return Che completed form in Che enclosed stamped addressed envelope. All information will be kept confidential. Enclosed you will also find a signed permission form Co gather this information. Thanking you in advance for your prompt response. Sincerely JU Alan Stern Medical Genetics-PKU Unit APPENDIX B HEALTH AND DEVELOPMENTAL HISTORY INTERVIEW GUIDE WITH PARENTS HEALTH AND DEVELOPMENTAL HISTORY D a t e : Child's Name Address Child's birthplace. Birthdate Last First Middle Month Day Year History given by ____ Relationship _Telephone_ City Zip Code __________Name of hospital_ Name of child's present pediatrician or family physician_________ Addr es s T el ep hone. FAMILY: Father's Name. Mother's Name Birthdate Birthdate Age_ Age. Father's Occupation. List all children in order of birth Birthdate Mother's Occupation. Age Health Health Health Family history of diabetes, heart disease, nervous disorders, asthma, or blood disorder I 73 (Health and Developmental History) Page 2 PREGNANCY: Circle any of the following conditions mother may have had during this pregnancy and give month of pregnancy: Excessive nausea or vomiting_____________________- Specific illnesses Bleeding____________ _______________________________________________________________________ High blood pressure________________________________________________________________________ Accidents, injuries________________________________________________________________________ Surgery during pregnancy I Swelling of ankles, bands and face________________________________________________________ ! Mother's Rh factor What month did prenatal care begin?____________ i DELIVERY: 1 i Term______________ Premature_____________ Late______________ Birth_weight_______________ j Duration of labor_________________Presentation__________________ Caesaream s ection | (head, breech or other) Complications of delivery - before, during or after: Infection Cord around neck Hemorrhage (bleeding)______________________________________________________________________ Other comments regarding this pregnancy_________. _________________________________________ Baby at delivery: Baby's cry immediate (within three minutes) Yes______ No Don't know_ Resuscitation used (oxygen, drugs, incubator) Yes______ No______ Don't know_ Any obvious birth injuries or abnormalities?____________________________ • 74 (Health and Developmental History) CONDITION OF BABY DURING FIRST 30 DAYS OF LIFE: YES Incubator care Respiratory distress ________________ Jaundice ________ _____ __ Exchange transfusion ______________ Feeding difficulties ________________ Infection ________________ Convulsions ______________ Easy to care f o r ____________ NO Page 3 DON'T KNOW DEVELOPMENT - AGE OF OCCURRENCE: Held head up Sat alone Crawled Walked (alone) Talked (three-word sentence), _ Feed self with fingers AGE AGE Feed self with spoon Bladder trained (day) Bowel trained Ride tricycle Dress independently Tie shoes MEDICAL HISTORY - (check any of the following conditions child may have had and give age) AGE AGE Mumps Measles Meningitis Encephalitis- Allergies Serious illnesses Operations: (Type) (Type) Convuls ions High f eve rs Nervous condition Ear infections Head injuries Serious accidents Where and when ___ Where and when ___ Special Tests (EEG, etc.): Type_ Where and when 75 (Health and Developmental History) Page 4 BEHAVIORAL DESCRIPTION: _ Hyperactive Breath holding spells Sleep walking or nightmares Enuresis (bed wetting). Thumb-sucking, nail biting Distractibility Coordination: POOR GOOD AVERAGE Large muscle Snail muscle Hand dominance: Left Right Foot dominance: Right Left OTHER Any known vision or hearing problems? Does child take any medication?. Dosage What concerns you the most about your child? What pleases you the most about your child?. Any particular question you would like to discuss regarding your child?. 76 APPENDIX C PROTOCOLS OF THE VARIOUS PSYCHOEDUCATIONAL DEPENDENT VARIATES W A I S - R g § S B D WECHSLER ADULT INTELLIGENCE SCALE— ADD R ESS. REVISED MARITAL S E X AGE_______ RAC E ______________ STATUS_ O C C UPA TIO N ____________________ , ___________________ ED U C A TIO N . PLACE O F TESTING TESTED B Y . TABLE OF SCALED SCORE EQUIVALENTS* S c o --- ( A — ■ u o > a u to RAW SCORE S c a le d Score VERBAL TESTS PERFORMANCE TESTS Information D igit Span — c— o < 5 -C 2 e x E <3 Similarities | P ictu re | Completion i Vocabulary Arithm etic ; Picture Arrangement Block Design Object Assembly Digit Symbol 19 - 28 70 — 32 — - — 51 - 93 19 18 29 27 69 — 31 28 - — — 41 91-92 18 17 - 26 68 19 — - 20 20 50 - 89-90 17 16 28 25 66-67 — 30 27 - — 49 40 84-88 16 15 27 24 65 18 29 26 - 19 47-48 39 79-83 15 14 26 22-23 63-64 17 27-28 25 19 - 44-46 38 75-78 14 13 25 20-21 60-62 16 26 24 — 18 42-43 37 70-74 13 12 23-24 18-19 55-59 15 25 23 18 17 38-41 35-3S 66-69 12 1 1 22 17 52-54 13-14 23-24 22 17 15-16 35-37 34 62-65 11 10 19-21 15-16 47-51 12 21-22 20-21 16 14 31-34 32-33 57-61 10 9 17-18 14 43-46 11 19-20 18-19 15 13 27-30 30-31 53-56 9 8 15-16 12-13 37-42 10 17-18 16-17 14 11-12 23-26 28-29 48-52 8 7 13-14 11 29-36 8-9 14-16 14-15 13 8-10 20-22 24-27 44-47 7 6 9-12 9-10 20-28 6-7 11-13 11-13 11-12 5-7 14-19 21-23 37-43 6 5 6-8 8 14-19 5 8-10 7-10 8-10 3-4 8-13 16-20 30-36 5 4 5 7 11-13 4 6-7 5-6 5-7 2 3-7 13-15 23-29 4 3 4 6 9-10 3 4-5 2-4 3-4 — 2 9-12 16-22 3 2 3 3-5 6-8 1-2 2-3 1 2 1 1 6-8 8-15 2 1 0-2 0-2 0-5 0 0-1 0 0-1 0 0 0-5 0-7 1 •Q in icia n s who wish to draw a profila may ao so by locating me subject's raw scores on the table aoove and drawing a fine to connect them. See Chaptar 4 in the Manual for a discussion of the significance of differences between scores on the tests. ( $ ) THE PSYCHOLOGICAL CORPORATION HARCOURT BRACE JOVANOVICH. PUBLISHERS Copyright £ 1981.1955.1947 by Ths Psychological Corporation. Standardization Edition Copyright < 0 1976by The Psychological Corporation. No pan of this form mavbe coo»ed by any process without permission. Ail nghts reserved. Printed in U.SJL Yaar Month Day Date Tested Date of Birth Age SUMMARY Raw Sealad Scot* S c o t s VERBAL TESTS Information — — — — — -------------- -------------- -------------- Arithmetic — — — — --- Comprehension-------- ... --- -------- Verbal Score ______ PERFORMANCE TESTS Picture _____ _____ Completion Picture Arrangement Block Design — -------- -------- Object _____ _____ Assembly Digit Symbol -------- -------- -------- Performance Score _____ Sum or Scaled Scores IQ VERBAL -------- -------- PERFORMANCE _____ ---------- FULL SCALE _____ --------- 78 1. INFORMATION Discontinue after 5 consecutive failures. Score 1 orO 1. Rag 2. Ball 3. Months 4. Thermometer 5. Sun 6. Presidents 7. Weeks 8. Armstrong 9. Panama 10. Labor Day 11. Brazil 12. Hamlet 13. Civil W fc tr 14. Earhart 15. Clothes 16. Italy w -r \r- 18. Genesis 19. Sahara 20. Relativity 21. Yeast 22. Senators 23. Paris 24. Blood vessels 25. Temperature 26. Curie 27. Population 28. Koran 29. Faust Note: Be sure to Include score* for Items 1-4 in Total. Total Maz-29 2. PICTURE COMPLETION Discontinue alter 5 consecutive failures. Score 1 orO 1. Door 2. Tennis 3. Frog 4. Playing card 5. Car 6. Pitcher 7. Glasses 8. Pliers 9. Boat 10. Beach 11. Mirror 12. Crab 13. Violin •........... - 14. Sun 15. W&tch 16. Leaf 17. Man 18. Horse 19. Female profile 20. Woodpile Total Max*20 _ o n A U Discontinue after failure on BOTH TRIALS of any Item. d. U lu l 1 e r A N Administer BOTH TRIALS of each item, even It suOtect passes first trial. DIGITS FORWARD Pass- Fail Score 2, 1, orO DIGITS BACKWARD* Pass- Fail Score 2, 1, orO 1. 5 - 8 - 2 1. 2 - 4 6 - 9 - 4 5 - 8 2. 6 - 4 - 3 - 9 2. 6 - 2 - 9 7 - 2 - 8 - S 4 - 1 - 5 3. 4 - 2 - 7 - 3 - 1 3. 3 - 2 - 7 - 9 7 - 5 - 8 - 3 - 6 4 - 9 - 6 - 8 4. 6 - 1 - 9 - 4 - 7 - 3 4. 1 - 5 - 2 - B - 6 3 - 9 - 2 - 4 - 8 - 7 6-1 - 8 - 4 - 3 5. 5 - 9 - 1 - 7 - 4 - 2 - 8 5. 5 - 3 - 9 - 4 - 1 - 8 4 - 1 - 7 - 9 - 3 - 8 - 6 7 - 2 - 4 - 8 - 5 - 6 6. 5 - 8 - 1 - 9 - 2 - 6 - 4 - 7 6. 8 - 1 - 2 - 9 - 3 - 6 - 5 3 - 8 - 2 - 9 - 5 - 1 - 7 - 4 4 - 7 - 3 - 9 - 1 - 2 - 8 7. 2 - 7 - 5 - 8 - 6 - 2 - 5 - B - 4 7. 9 - 4 - 3 - 7 - 6 - 2 - S - 8 7 - 1 - 3 - 9 - 4 - 2 - 5 - 6 - 8 7 - 2 - 8 - 1 - 9 - 6 - 5 - 3 Total Forward Mas-14 Total Backward Max=14 “ Adm inister DIGITS BACKWARD even if subject scores 0 on DIGITS FORWARD. + = Max=28 Forward Backward Total 79 4. PICTURE ARRANGEMENT Discontinue alter 4 consecutive failures beginning with Hem 2. Arrangement Order Correct or Acceptable Order Score (Circle) Arrangement Order Correct or Acceptable Order Score (Circle) 1. House 60' 1 CAP 2 9 1. 6. Escape 90" HUNT 0 2 2 7. Hill 90" HELPS 0 2 2. Flirt 60" JANET JN A ET orA JN E T 2 0 1 8. Fish 90" ANGLER or ARNGLE AGNLER 2 0 1 3. Romeo 60" SHADE 0 2 9. Robber 120" LUNCH 0 2 4. Louie 60" ARGUES 0 2 10. Taxi 120" SAMUEL or AMUELS SALMUE 2 0 1 5. Enter 90” OPENS OENSP 2 0 1 Max=20 Note: Be sure to include acoiee tor Item* 1-5 in Total. Total 5. VOCABULARY Discontinue otter 5 consecutive failures- Score 2, 1, or 0 1. Bed 2. Ship 3. Penny 4. Winter 5. Breakfast 6^Repair---------------------------------— ---------- ------------------------ -------- ------------ -------------- ----------------------------------- --_ — 7. Fabric 6. Assemble 9. Enormous 10. Conceal 11. Sentence 12. Consume 13. Regulate 14. Terminate 15. Commence 16. Domestic 17. Tranquil 18. Ponder 19. Designate 20. Reluctant 21. Obstruct 22. Sanctuary 23. Compassion 24. Evasive 25. Remorse 26. Perimeter 27. Generate 28. Matchless 29. Fortitude 30. Tangible 31. Plagiarize 32. Ominous 33. Encumber 34. Audacious 35. Tirade Note: Be sure to include scores for Items 1-3 In Total. Total Max=70 80 6. BLOCK DESIGN Discontinue attar 3 consecutive failures. START Design Time Pass-Fail Score (Circle the appropriate score (or each design.) 1. 60" 1 2 2 0 1 2. 60" 1 2 2 0 1 3. 6a' 16-60 11-15 1-10 0 4 5 6 4. 60" A 16-60 11-15 1-10 0 4 5 6 5. 6a' fK 21-60 16-20 11-15 1-10 0 4 5 6 7 6. 120" 36-120 26-35 21-25 1-20 0 4 5 6 7 7. 120" $1-120 46-60 31-45 1-30 0 A G , ft 7 8. 120” . 76-120 56-75 41-55 1-40 0 4 5 6 7 9. 120" . 76-120 56-75 41-55 1-40 0 4 5 6 7 Ma*-51 Total 7. ARITHMETIC Discontinue attar 4 conaactatlv* (allures. Problem Response Score 1 or 0 Problem Response Time Score (Circle) 1. 15" 10. 60" 11-60 1-10 0 1 2 2. 15" 11. 60" 11-60 1-10 0 1 2 3. 15" 12. 60" 11-60 1-10 0 1 2 4. 15" 5. 30" 13. 60" 16^0 1-15 0 1 2 6. 30" 14. 120" 16-120 1-15 0 1 2 7. 30" Total Max-19 8 . 30" C J I q I i Not*: B* auto to Indud* score* tor Item* 1*9 In Total. 81 8. OBJECT ASSEMBLY Give entire teat to all subjects. Object Time Score (Circle appropriate score tor each object) 1. Manikin 120" 21*120 16-20 11-15 1-10 (1 1 2 3 4 i 5 6 7 0 1 perfect assembly 2. Profile 120" 36-120 26-35 21-25 1-20 0 1 2 3 4 5 6 7 8 i 9 10 11 12i perfect essemoiy 3. Hand 180" 51-180 35-50 26-35 1-25 0 1 2 3 4 5 6 i 7 8 9 10* perfect assembly 4. Elephant 180” 51-180 31-50 21-30 1-20 0 1 2 3 4 S 6 7 i 8 9 10 Hi perfect assembly Total Max >41 9. COMPREHENSION Discontinue attar 4 consecutive failures. Score 2.1.or 0 1. Clothes 2. Envelope *3. Foods *4. Child labor 5. Deaf 6. Borrow 7. Movies 8. License 9. Taxes 10. Forest 11. Prescription 12. Iron 13. Land 14. Brooks 15. Swallow 16. Press ♦ If the subject replies with only one idea, ask tor a second response. Rephrase the test item appropriately, saying, “Tell me another reason w h y_ _ Total Max-32 luauuqsiund—asiBjg > 1 . AB|d— ig o m ~z L anjeis—uuaod U jaiBM—j(v 0 1 - j j B t j o —a i q B j . 6 IsaM—qyoN L jaddiz—uo«ng g aiiqotuoinB—jeog > BUBUBq— 3 6 u b j o I- -swnim •Aiinswuoa » j»m« •nu)juoa«ia S3LLIbVllWIS ' I I 10. DIGIT SYMBOL SAMPLES 2 I3 7 2 4 C O 2 I3 2 I4 2 3 5 2 3 I4 5 6 3 I4 I6 4 2 /6 3 5 7 2 6 5 4 6 3 7 2 8 I 9 5 8 4 7 3 6 2 5 I9 2 6 3 7 4 S 5 9 4 0 0 3 7 2 6 I 5 4 6 3 7 9 2 8 I7 9 4 6 8 5 9 7 I8 5 IV ) 9 4 8 6 3 7 9 0 0 6 I 2 3 4 5 6 7 8 9 — JL □ L_ u O A X = WA IS- R Supplementary S heet ® N o m a _________________________________ E xam in e d b y____________________ D a te ________ Notes on the examinee's performance of particular test items, unusual behavior, or special conditions which may have influenced his results can be recorded below. If the back of the sheet is used for further notes, check here . . . | | over I Item Test N o. N otes i Block Designs: Sketch incorrect solutions offered by the examinee. N otes: O b ject A ssem b ly: For incomplete solutions, circle each X representing a connection for which the examinee receives credit. N otes: Copvnght© 198*1.1955 bvTne Psychological Corporation. P r in te d in U .S .A . 9 - 9 9 1 8 5 2 N opanotihissheetm aY becopiedbyB nyprocessw iihouiperm ission. All rights reserved. i s a e s a T a s i o t i »* a a c o t 84 WISC-R W echsler In te llig e n c e Scale fo r C h ild re n —R evised RECORD FORM NAM E. ADDRESS. PARENT'S NA M E. SC HO O L_______ PLACE OF TESTING- REFERRED BY______ .A G E . -SEX. .G R ADE. .TESTED BY. WISC-R PROFILE C lin icia n s w ho wish to d ra w a p ro file sh ould firs t tra n s fe r the c h ild 's scaled scores to th e ro w o f boxes be lo w . Then m o rk o n X o n th e d o t c o rre s p o n d in g to th e sealed score fo r each test, o n d d ra w a lin e c o n n e ctin g the X 's.* Scaled Score 1 ? 1 5 1 7 16 15 14 13 12 1 1 10 9 8 7 6 5 4 3 2 1 VERBAL TESTS PERFORMANCE TESTS !s ! ? £ E £ S £ 6 £{ Score 19 1 8 17 16 15 . 14 13 12 11 10 9 8 7 6 5 4 3 2 1 Scaled Score 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 *See Chopter 4 in the monuol fo r o discussion o f the significance o f differences between scores on the tests. Year Month Day Date Tested Date o f Birth Age NOTES Raw Score Scaled Score -) t. VERBAL TESTS Information Similarities _ Arithmetic Vocabulary _ Comprehension _ (Digit Span) (. Verbol Score _ PERFORMANCE TESTS Picture Completion _ Picture Arrangem ent__________ Block D e s i g n __________ Object Assembly _ Coding _ (Mazes) (_______ I t Performance Score _ Scaled Score Verbol Score ________ Performance Score ________ Full Scale Score ________ * Prorated from 4 test*, if nacessory. IQ Copyright © 1971, 1974 by The Psychological Corporation. I ) AH rights reserved- No part of this record form may bo reproduced in ony form of printing or by ony othor moan eluding, but not lim it'd to, photocooying. audiovisuol recording ond transmission, ond portrayal or duplication retriovoi tyiism, without permission in writing from tho publisher. See Catalog for further information. Printed in U.S.A. Tho Psychological Corporation, Now fork, N.Y. 10017 74 -1 0 3 A S 9 * 9 9 0 3 3 4 85 2 . PICTURE COMPLETION Discontinue offer 4 consecutive failures. Score 1 orO Scare 1 orO 1. Comb 14. Playing Card 2. Woman 15. Girl Running 3. Fox 16. Coot 4. Hand 17. Boy 5. Cat 18. Scissors 6. Mirror 19. Girl 7. Clack 20. Screw 8. Elephant 21. Cow 9. Ladder 22. Thermometer 10. Dresser 23. House 11. Belt 24. Telephone 1 2. Man 25. Profile 13. Door 26. Umbrella Total Max.=26 1. INFORMATION Discontinue after 5 consecutive failures. Score 1 arO 1. Finger 2. Eors 3. Legs 4. Boil 5. Nickel 6. Cow 7 . W eek 8. Morch 9. Bacon 10. Dozen 1 1. Seasons 1 2. America 13. Stomach 14. Sun 15. Leap Year 16. Bulb 17. 1776 18. Oil 19. Border 20. Ton 21. Chile 22. Glass 23. Greece 24. Toll 25. Baromefer 26. Rust 27. Las Angeles 28. Hieroglyphics 29. Darwin 30. Turpentine Totof Max.=30 3. SIMILARITIES Discontinue offer 3 consecutive failures. Scare 1 or 0 1. W heel—boll 2. Candle—lomp 3. Shirt—hat 4. Piano—guitar _ 1 Score 2, 1 , or 0 6. Beer—wine 7. Cat— mouse 8. Elbow—knee 9. Telephone—radio 10. Pound—yord 1 1. Anger—joy 1 2. Scissors—capper pan 13. Mountain—loke 14. Liberty—justice 1 5. First—last *1 6 . The numbers 49 ond 121 17. Solt—woter * lf the child gives o 1-point response to Item 16, soy, "H ow else ore the numbers 49 ond 121 a lik e ? " _ T otal M a x .=30 4 . PICTURE ARRANGEMENT D isco n tin u e o fte r 3 eonsecuhire fa ilu re s . Score (C ircle th e a p p ro p ria te score fo r eoch item .) A rra n g e m e n t .Tim e O rd e r Scale (SAMPLE) i ^ X Z 45* 2. Picnic 4 5 ‘ 3. Fire 45' 5. Burglar 45" 6. Sleeper 45" 7. Artist 45' 60' 9. Boot 10. G ardener 6 0 ‘ 60' 1 1. Bench 60" 12. Rain ’Give Sample item first.. ££Q2> 5. ARITHMETIC Discontinue after 3 comecuti*# failure*. Problem | Score fteioonse | 1 orO 1. 30" *2 . 3 0 " •3 . 3 0 " 4. 3 0 " 5. 3 0 " 6. 3 0 " 7 . 30" 8. 30" 9. 30" 10. 30" 11. 30" 12. 3 0 " 13. 3 0 " | 14. 4 5 " ( 15. 4 5 " j 16. 7 5 " j 17. 7 5 " j |1 8 . 7 5 " i * Problem s 2 and 3 ore 9»ven v, p o in t eoth if c hild mofces erro r but cor* Tofoi M ax.^l 8T 6 . BLOCK DESIGN D isco n tin u e a fte r 2 c o n te c u tire fa ilu re s . Design Time Poss-FoiJ Score -C ircle the a o o ro o ria te score fo r each desig n .) 1. 4 5 " 1 2 0 1 2 2. 4 5 " 1 2 0 1 2 3. 4 5 " 1 2 0 1 2 4. 4 5 " 21.4* 14-20 11-15 1-10 0 4 5 4 7 5. 7 5 " 21-75 14-30 11-15 1-10 0 4 5 6 7 6 . 7 5 " 21-25 14-20 11-15 1-10 0 4 5 6 7 7. 7 5 " 21-75 14-20 11-15 1-10 0 4 5 6 7 8. 7 5 " 26-75 2T-25 16-20 1-15 0 4 5 6 7 9. 120" i I 56-120 2.4-55 24-25 1-25 0 4 5 6 7 10. 120" 76-120 56-75 41-55 1-40 o 4 5 6 7 1 1 .1 2 0 " 41.130 54-80 41-55 1-40 0 4 5 6 7 T o ta l M a x .= 62 tff o u n d h o if-s c o re s u p w a rd . 87, 7 . VOCABULARY Discontinue after 5 consecutive failures. jj^ f°o rO 1. Knife | j 2. Umbrella j 3. Clock | 4. Hat S. Bicycle 6. Naii 7. Alphabet 8. Donkey 9. Thief 10. Join 11. Brave 12. Diamond 13. Gam ble 14. Nonsense 1 5. Prevent 16. Contagious 17. Nuisance j 18. Fable 1 9. Hazardous 20. M igrate 21. Stanza 22. Seclude 23. Mantis 24. Espionage 25. Beifry 25. Rivalry 27. Amendment j 28. Compel j 29. Affliction 30. O bliterate j 31. Imminent | 32. Dilatory Total M o * .=64 88 8 . OBJECT ASSEMBLY G iv o entire test to oil ch ild ren . f r n t r N u m b e r o f C o rre c tly Jo in e d C u n Score (C ircle the o p p ro p rio te score fo r oo ch item .) (0-5) 2. Horse 1 50‘ 3 . C o r 1 5 0 ' (0-15) 4. Face 180" 1 Sound half-scores upw ard. T o ta l 9. COMPREHENSION D isco n tin u e a fte r 4 consecutive fa ilu re *. Score 2. l. o r O 1. Cut finger 2. Find w allet - ------------------------------------- - ------ *3 . Smoke ’ 4. Policemen 5. Lose ball 6. Fight *7 . Build bouse *8 . License plates *9 . Criminals 10. Stamps 11. Inspect meat * 1 2. Charity 13. Secret ballot *1 4 . Paperbacks 1 5. Promise *1 6 . Cotton * 17. Senators *1f the child replies w ith only one idea, ask him lo r o second response, iep h ra se the lest item ap p ro p ria te ly, scrying. "T ell me another th in g to da (reason w hy, advantage o f)___ T o ta l M o * .= 3 4 10. CODING Tim« Score A (for children under 8) 12 0 " (0-50) B [for children 8 & older) 120" X (0-93) C O O IN G A S carp In c lu d in g Tim a Bonus fo r P e rfe c t P e rfo rm a n ce Time in .Seconds Score 111-120 45 101-110 46 91-100 43 11-90 4* 71-40 49 1-70 50 1 1. DIGIT SPAN (Optional) D iscontinue a fte r fa ilu re a n b a th tria ls a f o n y item . A d m in is te r b o th tria ls o f each item , even if c h ild passes firs t tria l. DIG ITS FORW ARD T rio l 1 Pass-Fail T rio l 2 Pass-Foil Scare 2 , 1 ,o r 0 1. 3 - 8 - 6 6 - 1 - 2 2 . 3 - 4 - 1 - 7 6 - 1 - 5 - 8 3 . 8 - 4 - 2 - 3 - 9 5 - 2 - 1 - 8 - 6 4 . 3 - 8 - 9 - 1 - 7 - 4 7 - 9 - 6 - 4 - S - 3 5 . 5 - 1 - 7 - 4 - 2 - 3 - S 9 - 8 - 5 - 2 - 1 - 6 - 3 6 . 1 - 6 - 4 - 5 - 9 - 7 - 6 - 3 2 - 9 - 7 - 6 - 3 - 1 - 5 - 4 7 . 5 - 3 - S - 7 - 1 - 2 - 4 - 6 - 9 4 - 2 - 6 - 9 - 1 - 7 - 8 - 3 - 5 A d m in is te r D IG IT S BAC K W A R D even if c h ild scares 0 an D IG ITS FORW ARD. T o ta l F o rw a rd M a x .= l D IG ITS BAC KW AR D T ria l 1 Pass-Foit T ria l 2 Pass-Fail Score 2 , 1 , a rO 1. 2 - 5 6 * 3 2 . 5 - 7 - 4 2 - 5 - 9 3 . 7 - 2 - 9 - 6 S - 4 - 9 - 3 4 . 4 - 1 - 3 - 5 - 7 9 - 7 - S - 5 - 2 5 . 1 - 6 - 5 - 2 - 9 - 8 3 - 6 - 7 - 1 - 9 - 4 6 . 8 - 5 - 9 - 2 - 3 - 4 - 2 4 - 5 - 7 - 9 - 2 - 8 - 1 7 . 6 - 9 - 1 - 6 - 3 - 2 - 5 - 8 3 - 1 - 7 - 9 - 5 - 4 - S - 2 T o ta l B a ckw a rd M a x .= 14 Forw o rd B a ckw a rd I 1 12. MAZES (Optional) D iscontinue a fte r 2 consecutive fa ilu re s . M a ze M axim um Errors Errors Score (C ircle th e a p p ro p ria te >core fo r each m aze.) S A M P L E X X ^ x T ^ > < C ^ X C 1. 3 0 " 1 1 Error 0 Erron 0 1 2 2 . 3 0 " 1 1 Error 0 Erron 0 1 2 3 . 3 0 " 1 1 Error 0 Erron 0 1 2 4 . 3 0 " 2 2 Errors 1 Error 0 Errors 0 1 2 3 5 . 4 5 " 2 2 Errors 1 Error 0 Error* 0 1 2 3 6 . 6 0 " 3 3 Errors 2 Errors 1 Error 0 Errors 0 1 2 3 4 7 . 1 2 0 " 3 3 Errors 2 Errors 1 Error 0 Erron 0 1 2 3 4 8 . 1 2 0 " 4 4 Errors 3 Error* 2 Errors I Error 0 Errors 0 1 2 3 4 5 9 . 1 5 0 " 4 4 Errors 3 Error* 2 Errors 1 Error 0 Errors 0 1 2 3 4 5 T o ta l M a x .= 3 0 90 □ V o V \ > * 7 V £> □ V / " “N s w ,- . ’ _i 11 □ n C_p o V-."- V □ O- V r i >1? □ □ o o □ V o <3 ■V *5 □ & V □ o # | V ■<? □ O rid* vs & ED m s i 01 i i 0 i y a w b a s a i l j Lj V __, . . S A M P L E__ , ___ ! 2 l I 1 4 ! 6 ! 3 ! 5 | 21 ! 3 | 4 j 2 i 1 1 31 1 2 1 31 ! 4 i 2 l 5 l 31 1 2 5i 1 1 M 1 s . ! t I 5 i . . U_L _ L . 1 J i 1 i G J C D 9 l 2 5 8 1 4 1 7818 1 7 1 5 1 4 86 l 943 lilt M I J.J 1 ! I 1 . 1 1 1 1 i 1 8i29 i 7 l 6 l 2 ! 54 | 7 l 36 1 85 ! 9 l 4i 1 6 1 6 1 937514 L 1 ! ! 1 ! ! 1 1 __i __I __ 1 i ! ! I 1 1 1 9 ! 1 ! 5 ! 8 l 7 i S ! 9 i 78 l 2 i 4 i 8 3 i 5 ! S l 7! 1 91 4 30279 3i 1 ! i I I 1 1 1 J JLU 1 91 ASSESSMENT SYSTEMS 1978 EDITION WIDE RANGE ACHIEVEMENT TEST Joseph F. Jastak. S id n ey W. Bijou. S arah Jastak N a m e . D a te _ Sex; M. F. A g e . S c h o o l. Grade. R eferred b y- Page 1 E xa m in e r. Spelling, Level I & Level II Reading S pelling A rith m e tic — I / \ o X J V H 4- A t > □ |u V □ n i I Name. 9.. 1 0 .. 11.. 12 .. 13.. 14. IS IS . 17. 18. 19. 20. 2 1.. 22. 23. 24.. 25.. 26. 27.. 28.. 29. 30.. 31.. 32.. 33.. 34.. 35.. 36.. 37.. 38.. 3 9 - 4 0 - 4 1 - 4 2 - 4 3 - 44.. 4 5 - 4 6 - Level !. Raw Scores (RS) and Grade Ratings (GR) Level II, Raw Scores (RS) and Grade Ratings (GR) T CS» Copying C u m u i. RS GR RS GR RS GR RS G R RS GR RS GR T e s t C u m u i. | RS GR RS GR RS GR RS GR RS GR S co re 0 N - . D 5 22 1 7 33 3.3 4 j 5.9 5 5 7.3 S c o re | 0 K.2 10 3.3 20 6 2 h r. 0.9 * N 5 I K..G 23 1.9 34 3.5 45 6.2 56 7.5 Copying 1 K 5 • . 1 3 6 2 ' a 4 31 8 7 42 1 2 ?c 2 N 6 '3 K.2 24 2.1 35 3 7 46 6.3 57 7.7 2 | K.5 :2 3 9 22 5 7 52 3 9 43 1 4 ia 3 N .r ■ K .5 25 2.2 36 3.9 47 6.4 58 7.9 •£ 3 3 •3 4 1 23 6 9 22 9.1 44 1 7 < j N.S • 'z K.7 26 2.4 37 4 1 4c 6.5 59 8.1 I 4 1.6 14 4 z 24 7 7 54 9 2 45 • . 9 13 ! 5 p i 16 K 3 27 2 5 38 4.3 49 6.6 50 8 3 ’ o r* * - | 1.8 15 4 8 25 7 5 35 ? 5 45 2 i 20 6 p 2 , 17 1 0 28 2.6 39 4.5 50 6.7 51 a.s Spoiling “ | 5 2 i 16 5.2 25 7 7 36 9 7 47 2.2 j r P.4 <c 1 1 29 2.7 40 4.8 51 5.8 52 8.7 5 i 7 2 4 1* 5.4 27 7 9 3 ‘ •9 9 43 2 5 C p 5 20 2.S 41 5.0 52 6.9 63 8.9 U P * to | s 2 7 *•8 £ 7 28 3 1 3S '•0.2 49 2 7 :o ^ 9 P 6 20 1.4 3 i 2 9 - 2 5 4 53 7.0 64 9.2 51 1 9 3.0 19 6.0 29 5 3 39 10.5 50 2.9 *5 ’ 0 P 7 21 7.5 3.1 43 5.7 54 7.1 65 9.5 40 10 ~ 51 3 : B A S E A L L IN T E R P R E T A T IO N S O N S T A N D A R D S C O R E S , P A G E S 1 6 T O 42 O F M A N U A L 92 WIDE RANGE ACHIEVEMENT TEST j a s t a k Page 2. Arithmetic, Level 1 Oral Part • • » 9 O • 9 • • • • • • 9 • V V L I 9 S C 3 Fingers. 8 fin g e rs, 9 o r 6 ? 42 o r 28? 3 f 4 armies'? 9 m a rb le s, lose 32 Written Part 3 2 6 5 2 4 4 x 2 = 2 3 2 9 7 5 1 + 1 = + 2 - 3 + 4 0 x 3 - 1 8 + 8 4 — 1 = 4 5 2 1 1 hr = m in. 1 3 7 S 6 2 .0 4 2 6 )9 6 8 + 2 4 5 e 2 = - 5 .3 0 T + T = 15 7 5 “ 9 5 8 2 3 s ’ “ ■ k 9 6 4 L 6 3 — i - of 3 5 = 3 + 2T jyd. = in. I t = T 5 3 ye x M u ltip ly : 7 . 9 6 2 7) 3 8 4 2 - 1 1 4 0 3 0.8 3 TT 3 to a 0 N 1 1 1 W h ich is m ore? F ind th e ave rage of; W rite as a p e rce n t -L o r 21 8 15 24. 18. 21. 26. 17 T = 4 f x 3 f - Ans. Ans. W rite as d e cim a l: 3 3 8 s 1 Q x T * T = 2 _ 20 % of 120 = . .... 3 62 = 8 . 2 ) 6 2 . 7 0 3 C h a n g e to fa m ilia r nu m era ls: M C X L I I = _____ ( - 5 ) { + 9 ) =. Find in te re st on S300 at 4 y °.o for 7 mo. Ans_________ __________ Solve: y + ( 9 - 8 y ) = 65 Find sq u a re ro o t' y 3 3 4 8 9 R a w S c o r e s (R S ) RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR a n d G r a d e R a tin g s ( G R ) n ; ' 6 N .? ’ 10 P ' j ■ 0 & 15 15 K 9 1.1 29 21 2 .1 26 2.9 3 1 3D 31 J .l 36 4 9 5 1 40 41 6.3 t r l i o " i = 2 M L - 7 r 2 * '2 K.2 17 22 2.5 3 3 4.3 37 5.3 42 5 6 43 53 54 “ 6 4 n * ” 2 SEE MANUAL FOR NORMS 3 N 6 J c - P 4 } 13 K 4 ia 1 7 23 2 5 20 3.5 33 4 5 3B 5.5 43 6.3 49 53 55 3.3 : 6 5 1 ’ 8 'j : ' ? R 6 14 19 9 24 2 7 29 3 " 34 4 7 39 5.8 45 7 l 50 5 5 57 1 5 2 : 62 " 9 9 3 JASTAK WIDE RANGE ACHIEVEMENT TEST Page 3, Arithmetic, Level II Oral Part 1. C o u n ts 1-5 2. C o u n ts 6-15 3. R eads 3 4. R eads 5 5. R eads 6 6 . R eads 17 7. R eads 41 8 . P enn ie s 3-1 9. A p p le s 3 - 4 10. M a rb le s 9-3 W ritten Part 4 3 + 6 9 4 - 6 4 S 4 . 9 5 x 3 7 2 6 - 3 4 9 2-r - It- = T O f 3 0 = . 2 2 9 5 0 4 8 5 3 + 13 8 1 A dd: 9 ) 4 5 2 7 1 - ft. =. 2 - ________ 8 0 9 x 4 7 W rite as p e rce n t: 4 2 = . S u b tra c t: M u ltip ly : 6 . 2 3 Find average: W rite as d e cim a l: I 1 2 .7 2 . 9 ) 3 0 8.8 5 | 1 o - 34. 16, 45. 39. 27 5 2 ? % = i 2 W rite as percent: i 1 Ans I II rh jro i A dd: 3 ft. 6 in. M + 2 = 5 W rite as co m m o n fra c tio n 5 ft. 5 in. M = 6 x 3 4 - - in InwPRt terrris' 075 = 8 ft. 11 in. T h e c o m p le m e n t of an a n ale of 30c = 2x = 3 X = 1 5°k o f 175 = .25 — 1A =. If a = 7. b = 3: a- + 3b = _____ f% o f 60 = 66 sq. ft. = _ Solve: 7 - f6 * 8 ) = A dd: - x - y - 23 x - y + 22 .sq . yd. Factor: r; - 25 - I0 r Ans, r2 - 5 r - 6 r f 1 Ans. C h a n g e to fa m ilia r nu m e ra ls: M D C X C I = ______________ Find in te re s t on S 1.200 at 6% fo r 70 days. A ns. ___________ 3p - q = 10 7 2 ax = 6 2p - q = 7 x = _ _ P = q =. Find sq u a re root: 7 6 7 0 8 lo9io(joo) lo g5 5 j~ 5 A n s _______ A n s . R educe: A ns. k- - k . 3k - 3 k- k: - 1 Find root: 2 x : - 36x = 162 A n s . Raw Scores (RS) and Grade Ratings (G R ) SEE MANUAL FOR NORMS RS GR RS G R RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS G R RS GR 0 P.3 ; 3 K .o | !0 2.3 i is 3.9 j 20 5.6 1 25 7.2 | 20 1 P 6 i 6 1 1 I 11 2.7 • ‘5 4 3 ! 21 5.9 ! 26 7.6 ' 31 2 P 9 , 1 * ' 12 3 0 3 k ; j c i.7 j 13 3.2 | !6 £.0 I 4 K.5 i 9 2.1 ! 14 36 i 19 5.3 ! 24 5 9 I 29 84 • 1 6 ■ 22 6.2 ■ 27 7 2 i 32 25 10 4 i 40 12 0 | 46 11.0! 42 11 2 ! 43 94 WIDE RANGE ACHIEVEMENT TEST JASTAK Page 4 Reading, Level 1 A R Z H 1 Q S E B O 1 0 Tw o letters in name < : > A B O S E R T H P I U Z Q 2S c a t see red to big w o rk b o o k e a t w as h im h o w 3o th e n o p en le t t e r ja r deep even spell a w a k e b lo c k size 4 , w e a th e r s h o u ld lip fin g e r tr a y fe lt s ta lk c liff la m e s tru c k a p p ro v e p lo t h u g e q u a lit y s o u r im p ly h u m id it y u rg e 64 b u lk e x h a u s t ab u se c o llap se g lu tt o n c la r ify 70 recessio n th re s h o ld h o riz o n re s id e n c e p a r tic ip a te q u a r a n t in e 76 lu x u rio u s re s c in d e d e m p h a s is a e ro n a u tic in tr ig u e r e p u g n a n t 83 p u ta tiv e e n d e a v o r h e re s y d is c re tio n a ry p ersevere a n o m a ly SS r u d im e n ta r y — — m is c r e a n t - ------u s u rp — n o v ic e ______ audacious^ m ito s is *4 s e is m o g ra p h s p u rio u s id io s y n c ra s y it in e r a r y p s e u d o n y m a b o rig in e s 1 0 0 L e v e l 1. RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR RS GR R a w S c o r e s ( R S ) 0 N .7 9 P.6 S K.p 27 36 2.3 45 2.3 54 3.5 c3 51 72 6.6 31 7 6 5 ' S.3 a n d G r a d e R a t in g s ( G R ) 1 N.S 2 N.9 1 P 7 P .3 19 20 K.7 K.3 28 29 1 ! 37 38 2.4 2.4 46 47 2.3 2.5 56 3.9 4.0 64 66 73 5.7 82 82 7 9 92 9.0 9.2 3 P. 0 12 P 9 21 K.9 30 1 8 39 2.5 48 3 0 57 4.1 66 5.7 75 7 C 84 8 0 94 9.3 - ? 1 13 K 0 22 1 0 31 1.9 4 C j 2.5 49 3.1 53 4 2 67 5 9 75 7 - i 85 95 9 4 SEE M A N U A L FO R N O R M S 5 P.2 14 K .l 22 1 32 2.0 4 1 2.6 S C - 3.2 59 4 5S 6.0 77 7.2 36 3 96 9.5 5 P. 3 15 K.2 24 1.2 33 2.1 42 2.6 51 3.3 60 4.5 69 6.2 75 7.2 5 4 97 9.6 7 PA IS KA 25 i .3 34 2.2 45 2.7 52 3 4 61 4 70 6.4 "9 7 56 3 9 c 9 7 3 P.5 K 5 A itS ' 1 35 2.2 44 2 2.6 4.9 6 5 •50 75 39 * - 99 : 5 Reading, Level II Tw o letters in name c > A B O S E R T H P l U Z Q n t ■ « m ilk c ity in tre e a n im a l h im s e lf b e tw e e n c h in s p lit fo r m 2 ; g r u n t s tre tc h th e o r y c o n ta g io u s g rie v e to u g h e n a b o a rd t r iu m p h 3 2 c o n te m p o r a r y escape e lim in a te t r a n q u i llit y c o n s p ira c y im a g e e th ic s j o d e n y ra n c id h u m ilia t e b ib lio g r a p h y u n a n im o u s p re d a to ry alcove 4 7 scald m o s a ic m u n ic ip a l decisive c o n te m p tu o u s d e te r io r a te s tra ta g e m 5 4 b e n ig n d e s o la te p r o tu b e ra n c e p re v a le n c e re g im e ira s c ib le p e c u lia r ity s i p u g ilis t e n ig m a tic p r e d ile c tio n co veto u sn ess s o lilo q u iz e lo n g e v ity a b y s m a l m in g r a t ia t in g o lig a r c h y c o e rc io n v e h e m e n c e s e p u lc h e r e m a c ia te d evanescence c e n tr ifu g a l s u b tle ty b e a tify s u c c in c t re g ic id a l s c h is m e b u llie n c e s ; m is o g y n y b e n e fic e n t d e s u e tu d e e g re g io u s h e in o u s in te r n e c in e s y n ec d o c h e L e v e l II, R a w S c o r e s ( R S ) a n d G r a d e R a t in g s ( G R ) SEE M A N U A L FOR N O RM S THE PIERS-HARRIS CHILDREN’S SELF CONCEPT SCALE (The W ay I Feel A bout M yself) b y ELLEN V. PIERS, Ph.D. and DALE B. HARRIS, Ph.D. Published by Counselor Recordings and Tests BOX 6184 ACKLEN STATION NASHVILLE, TENNESSEE 37212 96 THE W AY I FEEL ABOUT MYSELF N A M E ............................................................................................. A G E ....................................................................GIRL OR BOY G R A D E ......................................................... .... S C H O O L ......... D A T E ............................................................................................... © E llen V. Piers and Dale B. Harris, 1969 Here are a set of statements. Some of them are true of you and so you will circle the yes. Some are not true of you and so you will circle the no. Answer every question even if some are hard to decide, but do not circle both yes and no. Remember, circle the yes if the statement is generally like you, or circle the no if the statement is generally not like you. There are no right or wrong answers. Only you can tell us how you feel about yourself, so we hope you will mark the way you really feel inside. 1. My classmates make fun of m e .............................................................yes no 2. I am a happy person...................................................................................yes no 3. It is hard for m e to make frien d s ...............................................yes no 4. I am often sad.............................................................................................. yes no 5. I am sm a rt.................................................................................................... yes no 6. I am s h y ................................................................ yes no 7. I get nervous when the teacher calls on m e ....................................yes no 8. My looks bother m e ................................................................................. yes no 9. W hen I grow up, I will be an important p e rs o n ............................... yes no 10. I get worried when we have tests in school......................................yes no 11. I am unpopular............................................................................................yes no 12. I am well behaved in school................................................................... yes no 13. It is usually my fault when something goes w ro n g ....................... yes no 14. I cause trouble to my fam ily...................................................................yes no 15. I am s tro n g ............................................................ yes no 16. I have good id e a s ..................................................................................... yes n0 17. I am an important m ember of my fam ily ............................................yes no 18. I usually want my own w a y .....................................................................yes no 19. I am good at making things with my h a n d s ......................................yes no 20. I give up e a sily............................................................................................yes no 21 . I am good in my school w o rk ................................. , . . yes no 22 . I do many bad th in g s ................................................ no 23. I can draw w e ll............................................................ no 24. I am good in music . : ................................................ no 25. I behave badly at h o m e ............................................ no 267 I am slow in finishing my school w ork.... . .- . . . . .yes no 27. I am an important m em ber of my class............... . . . . yes no 28. I am nervous................................................................. no 29. I have pretty e y e s ...................................................... no 30. I can give a good report in front of the class — yes no 31. In school I am a dream er......................................... no 32. I pick on my brother(s) and s is te r(s )................... no 33. My friends like my ideas........................................... no 34. I often get into trouble............................................... no 35. I am obedient at hom e................................................ . . . . yes no 36. I am lu c k y ...................................................................... no 37. I worry a lo t..................................................................... , yes no 38. My parents expect too much of m e ....................... , , . . yes no 39. I like being the way I a m ....................................... yes no 40. I feel left out of th in g s ................................................ ___yes nc 9 9 41. I have nice hair..............................................................................................yes no 42. I often volunteer in sc h o o l...................................................................... yes no 43. I wish ! w ere d iffe re n t...............................................................................yes no 44. I sleep well at night..................................................................................... yes no 45. I hate school yes no 46. I am among the last to be chosen for gam es..................................... yes no 47. I am sick a lo t ................................................................................................yes no 48. I am often mean to other people yes no 49. My classmates in school think I have good id e a s yes no 50. I am unh ap p y............................................................................................... yes no 51. I have many frie n d s ...................................................................................yes no 52. I am cheerful yes no 53. I am dumb about most th in g s yes no 54. I am good looking yes no 55. I have lots of p e p ......................................................................................... yes no 56. I get into a lot of figh ts...............................................................................yes no 57. I am popular with boys...............................................................................yes no 58. People pick on m e yes no 59. My family is disappointed in m e yes no 60. I have a pleasant f a c e yes no 100 61. W hen I try to make something, everything seem s to go w rong. yes no 62. I am picked on at h o m e .............................................................. yes no 63. I am a leader in gam es and s p o rts yes no 64. I am clum sy..................................................................................................... yes no 65. In gam es and sports, I watch instead of p la y yes no 66. I forget what I learn ...................................................................................... yes no 67. I am easy to get along w ith ........................................................................yes no 68. I lose my tem per ea s ily..............................................................................yes no 69. I am popular with g irls ................................................................................yes no 70. I am a good re a d e r yes no 71. I would rather work alone than with a g ro u p ......................................yes no 72. I like my brother (s is te r) yes no 73. I have a good figure yes no 74. I am often afraid yes no 75. I am always dropping or breaking th in g s yes no 76. I can be tru s te d yes no 77. I am different from other p eople yes no 78. I think bad th o u g h ts yes no 79. I cry easily yes no 80. I am a good p erso n ...................................................................................... yes no Factor Structure of the Scale N=457 6th graders Factor 1 Behavior No. Item Loading * 22 1 do many bad things . 66 35 i am obedient at home - .6 4 25 I behave badly at home .62 34 1 often get into trouble .6 0 14 1 cause trouble to my fam ily .5 5 78 1 think bad thoughts .5 4 76 1 can be trusted - .5 3 80 1 am a good person - .5 0 12 1 am w ell behaved in school - .5 0 48 1 am often mean to other people .48 31 In school 1 am a dreamer .4 5 56 1 get into a lot of fights - .42 64 1 am clumsy .3 8 67 1 am easy to get along with - .3 7 13 It is usually my fault when something goes wrong .36 59 My fam ily is disappointed in me .35 ( V I ) 32 1 pick on my brother(s) and sister(s) .31 4 1 am often sad Factor II Intellectual and School Status .3 0 21 1 am good in my schoolwork - .6 6 5 1 am smart - .6 3 53 1 am dumb about most things .56 70 1 am a good reader - .5 5 66 1 forget what 1 learn .53 26 ! am slow in finishing my schoolwork .51 30 I can give a good report in front of the class - .4 8 42 i often volunteer in school - .4 6 11 1 am unpopular .43 ( V ) 49 My classmates in school think 1 have good ideas - .4 3 (HI) 16 1 have good ideas -.4 0 7 1 get nervous when the teacher calls on me .39 (IV) 27 1 am an important member of my class - .3 9 (111) 33 My friends like my ideas - .3 8 ( V ) 17 1 am an important member of my fam ily - .3 2 9 When I grow up I w ill be an important person -.3 1 12 1 am w ell behaved in school - .3 0 ( 1 ) 57 I am popular with boys - .3 0 (in) *Parentheses indicate that item loads on one or more other factors 102 __ I Factor 1 1 1 Physical Appearance end Attributes (related also to status and popularity) N o. Item Loading * 54 1 am good looking - .7 4 60 I have a pleasant face -.6 1 41 I have nice hair - .6 0 73 I have a good figure - .5 6 29 I have pretty eyes - . 52 15 I am strong - . 41 63 I am a leader in games and sports - . 40 8 My looks bother me . 40 (IV ) (V I) 27 I am an important member of my class - .3 6 (11) 49 — My classmates in school think I hove good Jdeas____________ - . 35 ( II) ( V ) 55 I have lots of pep -.3 1 (IV) 57 I am popular w ith boys - .3 3 (11) ( V ) Factor IV Anxiety 79 I cry easily - .5 7 37 I worry a lot - .5 7 74 I am often afraid - .5 5 7 I get nervous when the teacher calls on me - .5 4 A M ale sex . 51 28 I am nervous - .4 9 10 I get worried when we have tests in school - . 47 40 I feel left out of things - .3 8 ( V ) 6 I am shy - . 35 8 M y looks bother me - .3 3 (III) (V I) 20 I give up easily -.3 3 44 I sleep w ell at night .3 0 55 1 have lots o f pep .3 0 (111) * Parentheses indicate that Item loads on one or more other factors. Factor V Popularity .62 .61 .5 5 .5 6 .4 9 (IV ) .^7 ( | | ) .4 0 . 40 .3 7 (1 1 ) .3 5 .3 4 (1 1 ) Factor V I Happiness and Satisfaction 2 I am a happy person . 65 50 I am unhappy - .6 2 39 I like being the way I am .6 0 43 I wish I were different - . 5 7 52 I am cheerful .4 2 59 M y fam ily is disappointed in me - .3 9 ( I ) 8 M y looks bother me - . 3 5 (III) (IV ) 38 M y parents expect too much o f me - .3 3 36 I am lucky .3 0 ♦Parentheses indicate that item loads on one or more other factors 58 People pick on me 46 I am among the last to be chosen for games 3 It is hard for me to make friends 51 I have many friends 40 I feel le ft out o f things 11 I am unpopular .— 1 _ - M y classmates make fun o f me 49 M y classmates in school think I have good ideas 33 M y friends like my ideas 77 I am different from other people 57 I am popular w ith boys 69 I am popular w ith girls 104 KOPPITZ SCORING SYSTEM Distribution of Bender Mean Scores and Standard Deviation Mean Standard Plus/Minus Age Group N Scores Deviation S .D. 5-0 to 5-5 81 13.6 3.61 10.0 to 17.2 5-6 to 5-11 128 9.8 3.72 6.1 to 13.5 6-0 to 6-5 155 8.4 4.12 4.3 to 12.5 6-6 to 6-11 180 6.4 3.76 2.6 to 10.2 7-0 to 7-5 156 4.8 3.61 1.2 to 8.4 7-6 to 7-11 110 4.7 3.34 1.4 to 8.0 8-0 to 8-5 62 3.7 3.60 .1 to 7.3 8-6 to 8-11 60 2.5 3.03 .0 to 5.5 9-0 to 9-5 65 1.7 1.76 .0 to 3.5 9-6 to 9-11 49 1.6 1.69 .0 to 3.3 10-0 to 10-5 . 27 1.6 1.67 .0 to 3.3 10-6 to 10-11 r 31 1.5 2.10 .0 to 3.6 Source: Elizabeth M. Koppitz, The Bender Gestalt Test for Children, a Normative Study, Journal of Clinical Psychology, October 1960, 16(4), 432-435. 105 KOPPITZ SCORING SYSTEM AND CLASSIFICATION OF TYPES OF ERRORS Scoring Criterion Classification of Error Type Figure A. 1. Parts of Figure excessively distorted or misshapen; extra or missing angles. 2. Disproportion between two parts of Figure, one must be at least twice the size of the other. — ■ 3. Rotation of Figure or any part thereof by 45 degrees or more; rotation of stimulus card if then copied in rotated position; rotation of card and paper and then copied in correct position not scored. 4. Failure to join two parts of Figure; curve and adjacent corner more than 1/8" apart; this applies to overlap. Figure A. 1. Loss of Shape 2. Disproportion 3. Rotation 4. Integration F igure 1. 5. Five or more dots converted into circles; enlarged dots or partially filled in circles not scored. 5. Circles for dots Rotation of Figure or any part thereof by 45 degrees or more; rotation of stimulus card if then copied in ro tated position; rotation of card and paper and then copied in correct position not scored. 6. Rotation 7. Perseveration, more than 15 dots in a row. 7. Perseveration Scoring Criterion Classification of Error Type Figure 2. 8. Rotation of Figure or any part thereof 8. by 45 degrees or more; rotation of stimulus card if then copied in ro tated position; rotation of card and paper and then copied in correct posi tion not scored. 9. One or two rows of circles omitted, rows 9. of dots of Figure 1 used as 3rd row for Figure 2, 5 or more circles in majority of column. 10. More than 14 columns in a row 10. Figure 3. 11. Five or more dots converted into cir;-__ 11. cles; enlarged dots or partially filled in circles not scored. 12. Rotation of Figure or any part thereof 12. by 45 degrees or more; rotation of stimulus card if then copied in ro tated position; rotation of card and paper and then copied in correct position not scored. 13. Shape of design lost; conglomeration 13. of dots. 14. Continuous lines instead of dots. 14. Figure 4. 15. Rotation of Figure or any part thereof 15. by 45 degrees or more; rotation of stimulus card if then copied in ro tated position; rotation of card and paper and then copied in correct position not scored. Rotation i Integration Perseveration Circles for dots Rotation Loss of Shape Loss of Shape Rotation 107 Scoring Criterion Classification of Error Type 16. Failure to join two parts of Figure; 16. curve and adjacent corner more than 1/8" apart; this applies also to overlap. Figure 5. 17. Five or more dots converted into 17. circles; enlarged dots or partially filled in circles not scored. 18. Rotation of Figure or any part there- 18. of by 45 degrees or more; rotation of stimulus card if then copied in rotated position; rotation of card and paper and then copied in correct position not scored. 19. Shape of design lost, conglomeration 19. of dots. 20. Continuous lines instead of series 20. of dots. Figure 6. 21. Three or more distinct angles 21. substituted for curves. 22. No curves at all; one or two 22. straight lines. 23. Two lines not crossing or crossing 23. at the extreme and of one or both lines, that is, less than %" from end of line, two lines interwoven horizontally. 24. Perseveration; six or more sinusoidal 24. curves in either direction. Integration Circles for dots Rotation i Loss of Shape Loss of Shape Angulation problem Angulation problem Integration Perseveration 108 Classification of Scoring Criterion Error Type Figure 7. 25. Parts of Figure excessively dis torted or misshapen; extra or missing angles. 25. Angulation problem 26. Disproportion between two parts of Figure, one must be at least twice the size of the other. 26. Disproportion 27. Rotation of Figure or any part there of by 45 degrees or more; rotation of stimulus card if then copied in rotated position; rotation of card and paper and then copied in correct position not scored. 27. Rotation Figure 8. 28. Hexagon or diamond excessively mis shapen; extra or missing angles, diamond omitted. 28. Angulation problem 29. Rotation of Figure or any part there of by 45 degrees or more; rotation of stimulus card if then copied in ro tated position; rotation of card and paper and then copied in correct position not scored. 29. Rotation Source: Elizabeth M. Koppitz, The Bender Gestalt Test for Children, a normative study. Journal of Clinical Psychology. October 1960, 16(4), 432-435. 109 AGS BY EDGAR A. DOLL, Ph.D. NAME.......................................................................................... Sex............Grade.............Date...................................................... L a s t F ir s t Y e ar M onth Day Residence.................................................................................. School.................................. Bom...................................................... Y e a r M onth Day M.A......................I.Q.....................Test Used.................................When......................... Age........................................................ Y ears M onths D ays Occupation.......................................................................... Class.....~ .Years Exp.........................Schooling...................... Father’ s Occupation.......................................... Class................ Years Exp..........................Schooling...................... Mother’ s Occupation................................................................ Class....~ Years Exp.........................Schooling...................... Informant,....,,^, r ........,................ — ........ -......... Relationship...............................................Recorder............................................. Informant’ s est............................................... — .................................................................................Basal Score4............... Handicaps.......................................................................................................................................Additional pts..................................... REMARKS: Total score......................................... Age equivalent................................... Social quotient................................... Age Periods LA Categoryt Score* Items O - I Mean C 1. “Crows”; laughs ....................................................................................................................................... 25 SHG .............. 2. Balances head ............................................................................................................................................25 SHG .............. 3. Grasps objects within reach ....................................................................................................................30 S 4. Reaches for familiar persons....................................................................................................................30 SHG .............. 5. Rolls over-..................................................................................................................................................30 SHG .............. 6. Reaches for nearby objects........................................................,.............................................................35 O .............. 7. Occupies self unattended........................................................................................................... 43 SHG .............. 8. Sits unsupported ....................................................................................................................................... 45 SHG .............. 9. Pulls self upright................................................................................... 55 C 10. “Talks”; imitates sounds..................................................................................... 55 SHE .............. 1 1 . Drinks from cup or glass assisted ...........................................................................................................55 L 12. Moves about on floor .............................................................................................................................. 63 SHG .............. 13. Grasps with thumb and finger...................................................................................... 65 S 14. Demands personal attention ....................................................................................................................70 SHG .............. 15. Stands alone ..............................................................................................................................................85 SHE .............. 16. Does not drool ......................................................................................................................................... 90 C 17. Follows simple instructions ....................................................................................................... 93 t K ey to categorical arrangem ent o f items: S H G — Self-help general C — Com m unication L — Locomotion ^ M ? ^ Se,ff He .iP dre-SS,ng ^ ? Self-direction O -O c c u p a tio n AMERICAN GUIDANCE SERVICE. INC. b H E — Self-help eaimg S — Socialization ■ 1 For method o f scoring see "Th e Measurement o f Social Com petence." PUBLISHERS' BUILDING. CIRCLE PINES. MINNESO TA 55014 1 1 0 I-II L .............. 18. Walks about room unattended ......................................................... .............................................. 1.03 O .............. 19. Marks with pencil or crayon............................................................. .............................................. 1.10 SHE .............. 20. Masticates food................................................................................... .............................................. 1.10 SHD .............. 21. Pulls off socks..................................................................................... .............................................. 1.13 O .............. 22. Transfers objects................................................................................. SHG .............. 23. Overcomes simple obstacles ............................................................. O .............. 24. Fetches or carries familiar objects.................................................... .............................................. 1.38 SHE ..______ 25. Drinks from cup or glass unassisted................................................ .............................................. 1.40 SHG ........ 26. Gives up baby carriage ...................................................................... .............................................. 1.43 S . . ...... 27. Plays with other children .................................................................. .............................................. 1.50 SHE .............. 28. Eats with spoon ................................................................................ ............................................. 1.53 L .............. 29. Goes about house or y ard..................................... ............................ .............................................. 1.63 SHE ............ 30. Discriminates edible substances ....................................................... .............................................. 1.65 C ............. 31. Uses names of familiar objects......................................................... ...................................;......... 1.70 L . . ............ 32. Walks upstairs unassisted................ ................................................ .............................................. 1.75 SHE .............. 33. Unwraps candy................................................................................... .............................................. 1.85 C .............. 34T * Talks in short sentences ................................................. !................. ............................................. 1.95 II-III 1 SHG .............. 35. Asks to go to toilet.............................................................................................................................. 1.98 1 O .............. 36. Initiates own play activities ................................................................................................................. 2.03 SHD .............. 37. Removes coat or dress .................................................................................. 2.05 SHE .............. 38. Eats with fork.................................................................................. 2.35 SHE .............. 39. Gets drink unassisted ....................................................................... 2.43 SHD .............. 40. Dries own hands .................................................................................................................................. 2.60 SHG .............. 41. Avoids simple hazards ....................................................................................................................... 2.85 SHD .............. 42. Puts on coat or dress unassisted........................................................................................................ 2.85 O .............. 43. Cuts with scissors ................................................................................................................................ 2.88 C .............. 44. Relates experiences..................................................................................................... 3.15 iii - rv L 45. Walks downstairs one step per tread................................................................................................. 3.23 S 46. Plays cooperatively at kindergarten level ......................................................................................... 3.28 SHD .............. 47. Buttons coat or dress ......................................................................................................................... 3.35 O .............. 48. Helps at little household tasks .......................................................................................................... 3.55 S 49. “Performs” for others .......................................................................................................... 3.75 SHD ............. 50. Washes hands unaided ....................................................................................................................... 3.83 I V -V SHG .............. 51. Cares for self at toilet......................................................................................................................... 3.83 SHD .............. 52. Washes face unassisted ...................................................................................................................... 4.65 L 53. Goes about neighborhood unattended............................................................................................... 4.70 SHD .............. 54. Dresses self except tying .................................................................................................................... 4.80 O ........... 55. Uses pencil or crayon for drawing ................................................................................................... 5.13 S 56. Plays competitive exercise games .................................................................................................... 5.13 1 1 1 V - V I O ................ 57. Uses skates, sled, wagon ................................................................................................................... 5.13 C .............. 5S. Prints simple words............................................................................................................................ 5.23 S ................ 59. Plays simple table games................................................................................................................... 5.63 SD ................ 60. Is trusted with money........................................................................................................................ 5.83 L ............... 61. Goes to school unattended ............................................................................................................... 5.83 VI-VII SHE ............... 62. Uses table knife for spreading ....................................................................................................... 6.03 C ............... 63. Uses pencil for writing .........................,....................................... 6.15 SHD .............. 64. Bathes self assisted ............................................................................................................................ 6.23 SHD .............. 65. Goes to bed unassisted ................................................... 6.75 VII - VIII SHG .............. 66. Tells time to quarter h o u r................................................................................................................. 7.28 SHE .............. 67. Uses table knife for cutting....................... 8.05 S .............. 68. Disavows literal Santa Claus............................................................................................................. 8.28 S .............. 69. Participates in pre-adolescent play .................................................................................................. 8.28 SHD .............. 70. Combs or brushes hair ..................................................................................................................... 8.45 VIII-IX O ................ 71. Uses tools or utensils..........................................................................,............................................. 8.50 O .............. 72. Does routine household tasks .......................................................................................................... 8.53 C .............. 73. Reads on own initiative................................................................................................... 8.55 SHD .............. 74, Bathes self unaided............................................................................................................................ 8.85 IX -X SHE .............. 75. Cares for self at table ....................................................................................................................... 9.03 SD .............. 76. Makes minor purchases ................................................................................................................... 9.38 L .............. 77. Goes about home town freely.......................................................................................................... 9.43 X - X I C .............. 78. Writes occasional short letters.......................................................................................................... 9.63 C .............. 79. Makes telephone calls....................................................................................................................... 10.30 O .............. 80. Does small remunerative work ........................................................................................................ 10.90 C .............. 81. Answers ads; purchases by mail ................................. .................................................................... 11.20 XI - XII O .............. 82. Does simple creative work .............................................................................................................. 11.25 SD .............. 83. Is left to care for self or others........................................................................................................ 11.45 C .............. 84. Enjoys books, newspapers, magazines............................................................................................. 11.58 XII - XV S .............. 85. Plays difficult games ......................................................................................................................... 12.30 SHD .............. 86. Exercises complete care of dress................................ 12.38 SD .............. 87. Buys own clothing accessories ..................................................................................................... 13.00 S .............. 88. Engages in adolescent group activities............................................................................................. 14.10 O .............. 89. Performs responsible routine chores ............................................................................................... 14.65 1 1 2 xv - xvm C .............. 90. Communicates by letter .......................................................................................................... 14.95 C .............. 91. Follows current events ....................... ................................................................................. 15.35 L .............. 92. Goes to nearby places alone.......................................................................................................... 15.85 SD 93. Goes out unsupervised daytime...................................................................................................... 16.13 SD 94. Has own spending money.............................................................................................................. 16.53 SD 95. Buys all own clothing..................................................................................................................... 17.37 XVIII-XX L ....... ....... 96. Goes to distant points alone ......................................................... ................................................ 18.05 SD ....... ....... 97. Looks after own health................................................................. ................................................ 18.48 O .. ...... 98. Has a job or continues schooling.................................................. ................................................ 18.53 SD ....... ....... 99. Goes out nights unrestricted......................................................... ................................................ 18.70 SD ....... ....... 100. Controls own major expenditures................................................ ................................................ 19.68 SD ....... ....... 101. Assumes personal responsibility................................................................................................... 20.53 SD ....... ....... 102. XX-XXV Uses money providently .......................................................................... ..................................... 21.5 + S ....... ....... 103. Assumes responsibility beyond own needs.............................................. ..................................... 21.5 + S ....... ....... 104. Contributes to social welfare..................................'................................. ..................................... 25 + SD 105. Provides for future ................................................................................... ..................................... 25 + O ....... ...... 106. XXV+ Performs skilled w ork............................................................................... ..................................... 25 + O ....... ....... 107. Engages in beneficial recreation ............................................................. ..................................... 25 + O ....... ....... 108. Systematizes own w ork............................................................................ ..................................... 25 + S ....... ....... 109. Inspires confidence ................................................................................... ...:................................. 25 + S ....... ....... 110. Promotes civic progress............................................................................ ..................................... 25 + 0 ....... ...... 111. Supervises occupational pursuits............................................................. ..................................... 25 + SD ....... ...... 112. Purchases for others ................................................................................. ........................... ,........ 25 + O ....... ...... 113. Directs or manages affairs of others....................................................... ..................................... 25 + o ....... ...... 114. Performs expert or professional w ork..................................................... ..................................... 25 + s ....... ...... 115. Shares community responsibility............................................................. ..................................... 25 + o ....... ...... 116. Creates own opportunities........................................................................ ..................................... 25 + s ....... ....... 117. Advances general welfare .......................................... ............................. ..................................... 25 + AMERICAN GUIDANCE SERVICE, INC. Publishers' Building, Circle Pines, Minnesota 55014 C o p y rig h t. 1936. T he T r a in in g School a t V in e la n d . N ew J e rs e y . C o p y rig h t, 1965, A m e ric a n G u id an ce Service, Inc. 113 APPENDIX D BEHAVIORAL RATING SCALES COMPLETED BY BOTH PARENT AND TEACHERS OF THE SUBJECTS MEDNICK-BAKER BEHAVIORAL RATING SCALE Name o f c h i l d : ____________________________ - How lo n g h ave you known t h e c h i l d ? (N o . o f y e a r s ) ! W h at d id you t e a c h t h e c h i l d ? Math__- E n g l i s h ________ O t h e r _________ ! Did t h e c h i l d a t t e n d a n o r m a l c l a s s ? Yes No D o n ' t know ^ D id th e c h i l d e v e r r e m a in an e x t r a y e a r in one g r a d e ? j Yes No D o n ' t know | , D id t h e c h i l d r e c e i v e any k i n d o f r e m e d i a l i n s t r u c t i o n ? ! I Yes No D o n ' t know ........ — — —— —— —— I I f th e a n s w e r . t o t h e a b o v e q u e s t i o n i s y e s , in w h ic h s u b j e c t ? | M ath E n g l i s h O t h e r ( s p e c i f y ) j I A t t e n d a n c e d u r i n g s c h o o l y e a r ( e s t i m a t e d ) ; I E xcused s i c k d a y s __________ U n e x p l a i n e d d ay s a b s e n t _ _ _ _ _ _ _ j T o t a l d ay s a b s e n t __________ P l e a s e i n d i c a t e how you w o u ld d e s c r i b e t h e c h i l d w i t h r e g a r d to t h e f o l l o w i n g s k i l l s , a b i l i t i e s and p e r s o n a l i t y t r a i t s . Base each r a t i n g on a c o m p a r is o n o f t h e c h i l d w i t h n o r m a l same—aged p e e r s . P l e a s e c h e c k o ne o f t h e f i v e p o s s i b l e a n s w e r p o s i t i o n s f o r ea c h o t h e i t e m s on t h e s c a l e . The f i v e a n s w e r p o s i t i o n s s h o u ld be i n t e p r e t e d as f o l l o w s : 1 = w e l l b e lo w a v e r a g e 2 * b e lo w a v e r a g e 3 = a v e r a g e 4 = a b o v e a v e r a g e 5 = w e l l ab o ve a v e r a g e 1. U n d e r s t a n d s m a t e r i a l p r e s e n t e d o r a l l y by o t h e r s 1 2 3 4 5 2 . O r a l l y e x p r e s s e s i d e a s and c o n c e p t s c l e a r l y .......................... 1 2 3 4 5 3 . C o n c e n t r a t e s w e l l on c o g n i t i v e t a s k s ................................................. 1 2 3 4 5 4 . C o n c e n t r a t e s w e l l on m a n u a l t a s k s .......................................................... 1 2 3 4 5 115 5. S o lv e s p r o b le m s i n a l o g i c a l m a n n e r ...................................................... 1 2 3 4 5 6 . V o c a b u l a r y o r w ord p o w e r - . 1 2 3 4 5 7 . R e a d in g c o m p r e h e n s i o n ................................................................................................. 1 2 3 4 5 U. R e a d in g s p e e d .......................................................................................................................... 1 2 3 4 5 9. Can t h i n k a b s t r a c t l y .............................................................................. L 2 3 4 5 1 0 . U n d e r s t a n d i n g o f m a t h e m a t i c a l c o n c e p t s ............................................. 1 2 3 4 5 1 1 . N u m e r i c a l and c o m p u t a t i o n a l s k i l l s ......................................................... 1 2 3 4 5 1 2 . Has a good a t t e n t i o n s p a n ..................................................................................... 1 2 3 4 5 1 3 . Works up t o l e v e l o f a b i l i t y ............................................................................ 1 2 3 4 5 1 4 . Work p r o d u c t s a r e o f good q u a l i t y ............................................................ 1 2 3 4 5 1 5 . Work i s w e l l - o r g a n i z e d .............................................................................................. 1 2 3 4 5 1 6 . Work p r o d u c t s a r e n e a t ............................................................................................. 1 2 3 4 5 1 7 . Q u a l i t y o f w o r k i s v a r i a b l e .................................................................. 1 2 3 4 5 1 8 . W orks w e l l i n d e p e n d e n t l y ................................................................... 1 2 3 4 5 1 9 . Needs s t r u c t u r e i n l e a r n i n g s i t u a t i o n s ............................................. 1 2 3 4 5 2 0 . F u n c t i o n s w e l l in u n s t r u c t u r e d l e a r n i n g s i t u a t i o n s . . 1 2 3 4 5 2 1 . P a r t i c i p a t e s e f f e c t i v e l y in g ro u p d i s c u s s i o n s o r a c t i v i t i e s ................................................................................................................................. 1 2 3 4 5 2 2 . Does h i s s h a r e o f w o rk in a g r o u p ........................................................... 1 2 3 4 5 2 3 . R e s p e c t s o p i n i o n s o f o t h e r s ............................................................................... 1 2 3 4 5 2 4 . I n t e r a c t s w e l l w i t h t e a c h e r s . ......................................................................... 1 2 3 4 5 2 5 . I n t e r a c t s w e l l w i t h a d u l t s .................................................................................. 1 2 3 4 5 2 6 . C o n t r o l s e m o tio n s w e l l .............................................................................................. 1 2 3 4 5 2 7 . S eeks a p p r o v a l fr o m a d u l t s .................................................................................. 1 2 3 4 5 2 8 . T a l k s b e f o r e h i s i d e a i s f o r m e d .................................................................. 1 2 3 4 5 2 9 . G iv e s up on t a s k s e a s i l y ........................................................................................ 1 2 3 4 5 3 0 . A c ts i m p u l s i v e l y ................................................................................................................. 1 2 3 4 5 116 3 1 . C a n ' t w o rk on one a c t i v i t y f o r v e r y l o n g .................................... 1 2 3 4 5 3 2 . F i d g e t s and moves a r o u n d .in s e a t ............................................................. 1 2 3 4 5 3 3 . C o m p la in s f r e q u e n t l y o f p h y s i c a l a i l m e n t s ................................. 1 2 3 4 5 3 4 . M a n i f e s t s n e r v o u s h a b i t s , e . g . , b i t i n g n a i l s , t i c s o r t r e m b l i n g 1 2 3 4 5 3 5 . I f a n g e r e d , e x c i t e d , o r d e p r e s s e d , r e m a i n s in t h e e m o t i o n a l s t a t e f o r a lo n g t i m e 1 2 3 4 5 3 6 . I s e a s i l y d i s t r a c t e d .................................................................................................. 1 2 3 4 5 3 7 . O f t e n d a y d r e a m s ................................................................................................................. 1 2 3 4 5 3 8 . B e h a v i o r i s u n p r e d i c t a b l e ............................................... 1 2 3 4 5 3 9 . I s o f t e n m o o d y .................... 1 2 3 4 5 4 0 . Has v i o l e n t o u t b u r s t s ........................................................................ 1 2 3 4 3 4 1 . A p p e a r s to be v e r y s h y ........................................................................................... 1 2 3 4 5 4 2 . Does n o t i n i t i a t e c o n t a c t w i t h p e e r s ................................................ 1 2 3 4 5 4 3 . I s a f r a i d to i n t e r a c t w i t h o t h e r s . . . ................................................. 1 2 3 4 5 4 4 . P r e f e r s t o be a l o n e ..................................................................................................... 1 2 3 4 5 4 5. I s o f t e n t e a s e d by o t h e r c h i l d r e n .......................................................... 1 2 3 4 5 4 6 . H i g h l y s e n s i t i v e t o c r i t i c i s m o r t e a s i n g .................................... 1 2 3 4 5 4 7 . W o n ' t s t i c k up f o r h i m s e l f w i t h p e e r s ............................................. 1 2 3 4 5 4 8 . A c t s y o u n g e r th a n h i s a g e ..................................................................... 1 2 3 4 5 4 9 . P r e f e r s to be w i t h y o u n g e r c h i l d r e n .................................................... 1 2 3 4 5 5 0 . Changes f r i e n d s f r e q u e n t l y ................................................................................ 1 2 3 .4 5 5 1 . Has many f r i e n d s ............................................................................................................... 1 2 3 4 5 5 2 . I s p o p u l a r w i t h p e e r s ............................................................................................... 1 2 3 4 5 5 3 . Is i d e n t i f i e d as a l e a d e r by p e e r s ....................................................... 1 2 3 4 5 5 4 . I s i n t e r e s t e d i n o p p o s i t e s e x ....................................................................... 1 2 3 4 5 5 5 . D r e s s e s p r o v o c a t i v e l y ............................................................................................... 1 2 3 4 5 5 6 . I s awkward o r shy w i t h members o f o p p o s i t e s e x 1 2 3 4 5 117 5 7 . B u l l i e s o t h e r c h i l d r e n ................................................................................ 2 3 4 5 5 8 . F r e q u e n t l y g e t s i n t o f i g h t s ................................................................., . . . 1 2 3 4 5 5 9 . I s a f r a i d o f new o r u n f a m i l i a r s u r r o u n d i n g s ............... 2 3 4 5 6 0 . I s a f r a i d o f p h y s i c a l i n j u r y .............................................................. . . . 1 2 3 4 5 6 1 . Moves i n an aw kw ard m a n n e r ................................................................... , , . 1 2 3 4 5 6 2 . O f t e n ru n s i n t o c h a i r s , d o o r s , e t c ..........................................., . . . 1 2 3 4 5 6 3 . I s w e l l - c o o r d i n a t e d ......................................................................................... . . . 1 2 3 4 5 6 4 . I s n e a t and w e l l - g r o o m e d .........................................................................., , , , 1 3 4 5 6 5 . I s p h y s i c a l l y a t t r a c t i v e ........................................................... . . . 1 2 3 4 5 6 6 . H e i g h t ............................................................................................................................... 2 3 4 5 6 7 . W e i g h t ............................................................................................................................... . , , , 1 2 3 4 5 o 8 . Has good a t h l e t i c a b i l i t y ......................................................................, . , . 1 2 3 4 5 6 9 . P a r t i c i p a t e s w e l l i n i n d i v i d u a l s p o r t s . - ..........................., , , , 1 2 3 4 5 7 0 . P a r t i c i p a t e s w e l l i n team s p o r t s .................................................. . . . 1 2 3 4 5 7 1 . S t u t t e r s , s t a m m e r s ............................................................................................ 2 3 4 5 7 2 . M i s a r t i c u l a t e s ......................................................................................................... 2 3 4 5 7 3 . R e l a t i o n s h i p w i t h p a r e n t s seems g o o d .................................... 2 3 4 5 7 4 . P a r e n t s seem c r i t i c a l o f c h i l d ....................................................... 2 3 4 5 7 5 . P a r e n t s seem to be t o o s t r i c t w i t h c h i l d ........................ 2 3 4 5 7 6 . C h i l d seems f e a r f u l o f p a r e n t s ..................................................... 2 ■ j 4 5 7 7 . P a r e n t s seem c o n c e r n e d w i t h c h i l d ' s p r o g r e s s . . . . . . . . 1 2 3 4 5 7 8 . P a r e n t s seem t o be o v e r i n d u l g e n t w i t h c h i l d ............. . . . . 1 2 3 4 5 7 9 . L a c k s s e l f - c o n f i d e n c e ................................................................................ , . , , 1 2 3 4 5 8 0 . A b s e n t - m i n d e d ......................................................................................................... 2 3 • * 5 8 1 . U n e m o t i o n a l ....................................................................................................., 2 3 4 5 8 2 . D o m i n e e r i n g ..................................................................................................... 2 3 4 5 8 3 . Ambi t i o u s .......................................................................................................... ___ 1 2 3 4 5 118 8 4 . Comoe t i t i v e .............................................................. ........................................................... 1 2 3 4 5 8 5 . S u b m i s s i v e ................................................................. 2 3 4 5 86. P o i i t e ............................................................................. 2 3 4 5 8 7 . D e p e n d e n t .................................................................... 2 3 4 - 5 8 8 . Resoons i b i e .............................................................. ........................................................... 1 2 3 4 5 3 9 . H o n e s t ............................................................................. ........................................................... 1 2 3 4 5 9 0 . I r r i t a b l e .................................................................... ........................................................... 1 2 3 4 5 9 1 . E n e r g e t i c ................................................................... 2 3 4 5 9 2 . S t u b b o r n ....................................................................... 2 3 4 5 9 3 . N e r v o u s .......................................................................... 2 3 4 5 9 4 . O b e d i e n t ....................................................................... i 2 *3 4 5 9 5 . F r i e n d l y ....................................................................... 2 3 4 5 9 6 . R e s t l e s s ....................................................................... 2 3 4 5 9 7 . H a p p y ................................................................................. ■ i 2 3 4 5 9 8 . H e l p f u l ........................................................................... 2 3 4 5 9 9 . L o n e l y .............................................................................. 2 3 4 5 100. P a s s i v e .......................................................................... 2 3 " 4 5 101. A g g r e s s i v e ................................................................. 2 3 4 5 102. I n d e p e n d e n t .............................................................. 2 3 4 5 103. C o n f u s e d ....................................................................... 2 3 4 5 104. C r e a t i v e ....................................................................... 2 3 4 5 105. A r t i s t i c ....................................................................... 2 3 4 5 106. I m a g i n a t i v e ....................................................... 2 3 4 5 119 / MEDNICK-BAKER BEHAVIORAL RATING SCALE (Blueprint) Background Information A. Name of child__________________________________________________ B. How long have you known the child?___________________________ C. What did you teach the child? Math English Other___ D. Did the child attend a normal class? Yes_____ No_____ Don't_know____ E. Did the child ever remain an extra year in one grade? Yes_____ No_____ Don't__know____ F. Did the child receive any kind of remedial instruction? Yes_____ No_____ Don't_know____ l G. If the answer to the above question is yes, in what subject? Math_____ English_____ Other specify______________ H. Attendance during school year (estimated) Excused sick days _____ Unexplained days absent _____ Total days absent_________ _____ School Behavior - Academic I. Oral Language Skills .79 A. Understands material presented orally by others B. Orally expresses ideas and concepts clearly II. Reading Skills .90 A. Reading comprehension B . Reading speed C . Vocabulary or word power 1 2 0 III. Mathematical Skills .95 A. Numerical and computation skills B. Understanding of mathematical concepts IV. Reasoning Skills .88 A. Solves problems in logical manner B. Can think abstractly V. Work Organizational Skills .88 A. Needs structure in learning situations B. Functions well in instructured learning situations C. Work is well organized D. Work products are neat E. Work products are of good quality F. Quality of work is variable G. Works up to level of ability VI. Concentration Skills .83 A. Is easily distracted B. Has a good attention span C. Concentrates well on cognitive tasks D. Concentrates well on manual tasks School Behavior - Psychosocial VII. Participatory Skills .81 A. Does his share of work in a group B. Works well independently C. Participates effectively in group discussion or activities D. Respects opinions of others 1 2 1 VIII. Emotionality .86 A. Highly sensitive to criticism and teasing B. Is often moody C. If angered, excited or depressed, remains in the emotional state for a long time D. Manifests nervous habits: e.g., bites nails, has tics, or trembling E. Complains frequently of physical ailments IX. Peer Relations .75 A. Often teased by other children B. Has many friends c. Popular with peers D. Changes friends frequently E. Is identified as leader by peers F. Prefers to be with younger children G. Acts younger than his age Adult Relations .93 A. Interacts well with adults B. Seeks approval from adults c. Interacts well with teachers Aggression .81 A. Frequently gets into fights B. Has violent outbursts C. Bullies other children 1 2 2 XII. XIII. XIV. XV. XVI. XVII. Withdrawal .76 A. Appears to be very shy B. Does not initiate contact with peers C . Often daydreams D. Prefers to be alone Fearfulness .81 A. Is afraid to interact with others B. Is afraid of physical injury C. Is afraid of new or unfamiliar surroundings Psychophysical Functioning Hyperactivity A. Can’t work on one activity for very long B. Fidgets and moves around in seat Clumsiness .81 A. Moves in an awkward manner B . Is well coordinated C. Often runs into chairs, doors, etc. Impulsivity .87 A. Behavior is unpredictable B. Acts impulsively C. Controls emotions well Speech Problems .78 A. Misarticulates B. Stutters, stammers C . Talks before his idea is formed 123 Physical Traits XVIII. Personal Appearance .79 A. Is neat: and well-groomed B. Is physically attractive XIX. Athletics .91 A. Participates well in team sports B. Participates well in individual sports C. Has good athletic ability XX. Parent Interaction .72 A. Relationship with parents seems good B. Parents seem to be critical of child C. Parents seem to be strict with child D. Parents seem to be overindulgent with child E . Child seems fearful of parents F. Parents seem concerned about child's progress XXI. Affective Traits .89 A. Absent-minded B. Unemotional C . Domineering D. Ambitious E. Competitive F . Submissive G. Polite H. Dependent I. Responsible 124 J. Honest K. Irritable L . Energetic M. Stubborn N . Nervous 0. Obedient P . Friendly Q. Restless R. Happy S. Helpful T . Lonely U. Passive V. Aggressive W . Independent X. Confused Y . Creative Z. Artistic AA1. Imaginative XXII. Self-Serving Assertiveness .75 A . Domineering B . Ambitious C . Competitive D . Energetic 125 XXIII. Inferiority .84 A. Submissive B . Dependent C. Lonely D . Pas s ive E. Confused XXIV. Social Responsibility .90 A. Polite B. Responsible C. Honest D. Obedient E. Friendly F . Helpful 126

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University of Southern California Dissertations and Theses

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Asset Metadata

Creator Stern, Alan Mark (author)

Core Title Psychoeducational status in relation to duration and quality of dietary treatment in early and later diagnosed and treated phenylketonuric children, adolescents, and young adults

Contributor Digitized by ProQuest (provenance)

Degree Doctor of Philosophy

Degree Program Education

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag education, educational psychology,OAI-PMH Harvest

Language English

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c26-509258

Unique identifier UC11246001

Identifier usctheses-c26-509258 (legacy record id)

Legacy Identifier DP24846.pdf

Dmrecord 509258

Document Type Dissertation

Rights Stern, Alan Mark

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA