University of Southern California Dissertations and Theses

Prediction Of Therapeutic And Intellectual Potential In Mentally Retardedchildren

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Prediction Of Therapeutic And Intellectual Potential In Mentally Retardedchildren

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Content T h is d is s e r ta tio n h a s b e e n 64— 12,484 m ic ro film e d e x a c tly a s re c e iv e d M ILTO N , R o b e rt G ene, 193 0 - P R E D IC T IO N O F T H E R A P E U T IC AND IN T E L L E C T U A L P O T E N T IA L IN M E N T A L L Y R E T A R D E D C H ILD R EN . U n iv e rs ity of S o u th e rn C a lifo rn ia , P h .D ., 1964 P sy ch o lo g y , c lin ic a l U niversity Microfilms, Inc., Ann Arbor, M ichigan PREDICTION OF THERAPEUTIC AND INTELLECTUAL POTENTIAL IN MENTALLY RETARDED CHILDREN by Robert Gene Milton A J 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 (Psychology) June 1964 UNIVERSITY OF S O U T H E R N CALIFORNIA THE GRADUATE S C H O O L UNIVERSITY PARK L O S ANGELES, CA L IF OR N IA 9 0 0 0 7 This dissertation, written by .............Robert Gene .............. under the direction of /z .is ....Dissertation C o m mittee, and approved by all its members, has been presented to and accepted by the Graduate School, m partial fulfillment of requirements for the degree of D O C T O R O F P H I L O S O P H Y Dean Date ™r. I . ? . 6 4 ERTATION COMMITTEE c y < ? c - ~ Chairman / , T v ' . . . T . T . v . * ( Acknowledgments Usually when an idea for research strikes, it is a solitary moment with a solitary person. However, as the idea takes definite form, one is brought to realize that research is simply not possible without the interest and involvement of a large number of people. Therefore my thanks must go to the scores of individuals, who because of their involvement, made this study possible. First, my thanks to my Chairman, Dr. G. Seward, for the many hours of work in helping develop an idea for research into a workable project. My thanks also to Drs. A Jacobs, C. Lovell and C. Meyers for their helpfulness and willingness to serve as members of the Guidance Committee. My gratitude must be expressed to the entire staff at Pacific State Hospital for their cooperation. Special thanks are due to Jean Maas, Mary Fulton and Della Rebish, staff psychologists, for their immeasurable help in the administration, scoring and interpretation of tests and other data. My thanks also to Drs. A. Shotwell and A. Silverstein for their many helpful suggestions. Special appreciation must be extended to Dr. R. Hadley for his help and criticism of the statistical design. To Joan Morrow, a "secretary extraordinary" who willingly burned the midnight oil, a * ord of special thanks is due. Finally, my affectionate thanks must be expressed to "my boys" who willingly and energetically participated with me in the daily psychotherapy sessions. Table of Contents Page Acknowledgments ii Chapter I. BACKGROUND AND IMPORTANCE OF THE PROBLEM .............. 1 Introduction Theoretical Background of the Present Study Emotional Disturbance and Intelligence Rorschach "Form Level" a Correlate of IQ Psychotherapy with Mentally Retarded Children Purposes of the Present Study Hypotheses Tested II. REVIEW OF PREVIOUS STUDIES .............................. 19 Experimental Studies Suggesting that IQ is Depressed by Emotional Factors Experiments Suggesting that Form Level can be Used as a Predictor of Intellectual Potential Experimental Studies on Psychotherapy with Mental Retardates III. METHODOLOGY............................................. 29 The Subjects Instrumentation Procedure Statistical Analysis IV. THE RESULTS............................................. 48 Testing the First Hypothesis Testing the Corollary of the First Hypothesis Testing the Second Hypothesis Testing the Corollary of the Second Hypothesis Testing the Third Hypothesis Testing the Corollary of the Third Hypothesis Testing the Fourth Hypothesis Testing the Corollary of the Fourth Hypothesis iii iv Chapter Page V. THE DISCUSSION............................................... 59 Psychotherapy and Intellect Psychotherapy and Behavior Implications for Future Study VI. SUMMARY.................................... 74 Appendices.......................................................... 78 References....................................................... 86 List of Tables Table Page 1. Interjudge Reliability of Rorschach Form Level ..... 40 2. Inter judge Reliabilities of MACC.................... 41 3. Summary of the Factorial Design Indicating the Allocation of Degrees of Freedom ...................... 43 4. Summary of Analysis of Variance Results for Pretest Binet IQ Scores................................. 45 5. Summary of Analysis of Variance Results for Pretest MACC Rating............................ 46 6. Summary of Analysis of Variance Results for Posttest Binet IQ Scores ..... 49 7. Means of Binet Intelligence Test Differences of High and Low Form Level Ss in Therapy and Nontherapy Groups.................................. 51 8. Summary of Analysis of Variance Results for Posttest MACC Rating................................... 52 9. MACC Means of Younger and Older Ss in Therapy and Nontherapy Groups ................................. 55 10. MACC Means of Younger and Older Ss in High Form Level Groups and Low Form Level Groups............... 57 11. Subject Information Sheet--High Form Level ......... . . 78 12. Subject Information Sheet--Low Form Level ............. 79 13. Subject Information Sheet--01der Group (13-17) ......... 80 14. Subject Information Sheet--Younger Group (8-12) .... 81 15. Subject Information Sheet--Therapy Group ............... 82 16. Subject Information Sheet--Nontherapy Group ........... 83 17. Subject Information Sheet--Chronological Ages of Groups. 84 v List of Figures Figure Page 1. Schematic Representation of the Three- Dimensional Factorial Design Employed in the Experiment......................................... 36 2. Behavioral Rating Mean Differences Compared for the Eight Subgroups.................................. 58 vi CHAPTER I Background and Importance of the Present Study Introduction One of the major problems in dealing therapeutically with mentally retarded children is to determine and predict potential. It has often been noted that standardized intelligence test scores may be depressed because of severe or even relatively mild emotional difficulties. Sarason (1950) believes that in both theoretical and practical approaches to intelligence testing, insufficient attention has been given to the nature and strength of internal conditions which may facilitate or inhibit measurable intellectual behavior. He postulates anxiety as one of these conditions. He and his co-worker present a theoretical framework in a later article (Mandler & Sarason, 1952) suggesting that anxiety which manifests itself in terms of pathological or emotional disturbance can be considered as an inhibitor of intellectual processes. On the other hand, it has also been observed that often children may be selected for psycho therapy out of a "mixed category" (i.e., diagnoses of mental retarda tion compounded by emotional disturbances) only to find that the mental retardation is so basic that little or nothing is accomplished even in long-term intensive therapy. Because impressionistic or clinical judgments regarding the selection of potentially good patients out of a "mixed group" are not reliable, it seems reasonable that a more objective method should be devised. Klopfer, Ainsworth, Klopfer & Holt (1954) have long suggested that the concept of "form level" of Rorschach responses provides a measure of intellectual potential. They have also suggested that form level on the Rorschach may in some cases indicate potential more accurately than do the standardized intelligence tests. In their opinion this would be particularly true when extraneous factors such as emotional disturbances may depress performance on such intelligence tests. Apperson, Goldstein, 6c Williams (1963) have reported that Rorschach responses given by retarded children in fact fall in the lower levels of Klopfer's scoring system. However, they have also noted that occasionally a child testing at a low IQ level on a standardized intelligence test will give a response that "seems inappropriately well organized and detailed for that level." This seems to substantiate the possibility that Rorschach "form level" may predict potential where the latent intellectual level is being obscured on other tests by emotional factors. It seemed therefore, to this investigator, that a group of mentally retarded children with severe emotional disturbance as a diagnosis could be selected for the purpose of experimentally investigating these theoretical conjectures. Following selection of such a group, administration of the Rorschach and use of Klopfer's form level concept should theoretically make it possible to select and predict children in the group with higher "potential" than indicated by more objective intelligence testing. This potential, defined in terms of IQ scores and behavioral rating scores, should manifest itself after the intervention of psychotherapy with the goal of ameliorating emotional disturbance. Theoretically, those selected via Rorschach form level as being "high potential" should increase their IQ scores. Moreover, they should make significant changes in behavior as rated on behavioral adjustment scales when compared with control groups. In other words, there are two ways of defining success in terms of predicting potential in mentally retarded children. First, it can be postulated that there should be an increase in IQ scores because of the hypothesized alleviation of emotional difficulties via therapy. Second, success may be defined as a decrease in overt behavior difficulties as determined by the ward personnel who are in daily contact with these children. Theoretical Background of the Present Study Theoretical issues to be considered in the present study find roots in three relatively unrelated fields. The first and primary theoretical area concerns the effect of emotional factors, particularly anxiety, on intellectual functioning. The second is concerned with the use of Rorschach "form level" as a predictor of intellectual potential, and in tertiary position is the issue of the use of psychotherapy with mentally retarded children. Emotional Disturbance and Intelligence The major theoretical suppositions which suggest that emotional disturbance can depress intellectual functioning are in this study, largely furnished by S. B. Sarason and his co-workers (1946, 1949, 1950, 1952, 1958). Of particular note is the theoretical framework (Mandler & Sarason, 1958) which follows closely in the footsteps of Dollard & Miller (1950) in that anxiety (which may be manifested in the human organism as emotional or affective disturbance) is considered as a learned drive. They infer that organisms are required to face and cope with "life situations" which are analogous to structured "test situations." Sarason theorizes that drives fall into two major categories. First, the drives which are a function of the specific nature of the task or test situation. These are the drives which evoke responses which in turn satisfy the requirement set by the test situation. Theoretically, these drives are assumed to be reduced by test situation responses which lead to the completion of the task. The second drive category contains those learned anxiety drives which are functions of anxiety reactions previously learned as responses to stimuli present in the "test situation." The anxiety in this case is considered as a response-produced strong stimulus with the functional characteristics of drives as discussed by Dollard & Miller (1950). These anxiety reactions are generalized from previous "life-test situations" to the present "life-test situations." Theoretically, the anxiety drive elicits responses which tend to reduce that drive. These responses may be those which are not specifically connected with the particular task of "life-test situation." For example, these responses may be manifested as feelings of inadequacy, helplessness, or a generalized emotional disturbance. Sarason suggests that these responses are "self rather than task centered." On the other hand, in order to account for the fact that other theoretical propositions relating to anxiety and intellectual performance suggest that anxiety may facilitate performance, Sarason postulates that anxiety may produce "task-relevant responses" which reduce the anxiety by leading to the completion of the tasks. These anxiety response which are relevant to the completion of the task are not according to Sarason available in the response repertory of the individual but are evoked and learned in the course of the specific "life-test situation." Whereas anxiety responses which are not specifically connected with the nature of the task are readily available in the response repertory and are by the process of generalization readily evoked. Thus, individuals with a high anxiety drive and therefore a high number of anxiety responses (i.e., inadequacy, helplessness, and emotional disturbance) in their response repertory will tend to make more responses which are not relevant than individuals with low anxiety drive. As a result of further systematic investigations Sarason, Davidson, Lighthall, Waite, & Ruebush (1960), Lipman & Griffith (1960), Mayzner (1954), and Jolles (1947) theorize that children with subnormal mental abilities do indeed have a higher level of anxiety and therefore produce far more task-irrelevant responses which are coordinates of emotional disturbance and feelings of helplessness and anxiety than do normal children. In clinical settings it has long been acknowledged that personality disturbances, such as feelings of inadequacy and emotional turmoil, may influence to a considerable degree the intellectual functioning of given individuals. Jastak (1949, 1952) has noted that personality disturbances of various types may be of considerable influence in intellectual deficiency. He devised a technique for taking a kind of average of three top subtest scores on the Wechsler- Bellevue Intelligence Scale. This altitude quotient, as he called it, is obtained by converting the subtest weighted scores to equivalent IQ scores by multiplying each by five. The product is than used to look up the equivalent IQ score in the appropriate verbal or performance table. The three highest quotients are deter mined and the highest is multiplied by five, the next by three and the lowest by two. The three products are added and the sum is divided by ten, yielding an altitude quotient. He feels that an individual may be diagnosed as mentally defective only if all of his abilities are uniformly reduced to the lowest levels of a random population sampling. Even in the much criticized work of Schmidt (1946, 1947, 1949) there are suggestions of emotionality as a depressor of intellectual functioning. That is, the great majority of the homes of the subjects used in her research were noted to be culturally subnormal and riddled with internal emotional conflicts. Klopfer, Ainsworth, Klopfer & Holt (1954) independently support the assumption of the intellectually inhibiting effect of early environmental deprivation or emotional disturbance. Virginia Axline (1949) has suggested that the validity of IQ tests is not to be called into question when the IQ is raised after a therapeutic program. Her explanation is rather in terms of the child being freed from emotional constraint so that he can express his capacities more adequately. Further theoretical support for the suppression of the intellectual factors of memory and learning because of anxiety has come from both the behavioristic (Dollard & Miller, 1950; Mowrer, 1950) and the psychoanalytic (Fenichel, 1945; Rapaport, 1950) groups. Garfield, Wilcott, & Milgram (1961) discuss the difficulties of diagnostic differentiation. The effort to differentiate between mentally defective children and emotionally disturbed children is important in disposition and treatment because the two conditions are not identical nor are the treatment procedures necessarily completely compatible. Many times emotional overtones do depress intellectual functioning so that a child may be misdiagnosed as mentally retarded when he is in fact severely emotionally disturbed. Eisenberg (1958) refuses to think in the contrasting terms of either intellect or emotion. He feels that more recognition should be given to the interdependence of emotion and intellect as a fundamental fact in human behavior. Sarason & Gladwin (1958) in their discussion of the interrelationship of emotion and intellect add that it is not enough simply to state that there is a relationship but that a theoretical framework is needed to account for the interaction and to act as a springboard for therapeutic goals. Rorschach "Form Level" as a Correlate of Intelligence The second theoretical issue to be considered in the present study is that of the relationship between Rorschach responses and intelligence. The typical intelligence test is described as a structured test because a specific task is presented to the subject, and a specific response is expected. When the task is performed, the response is compared by standardized techniques with those of other subjects. In the case of a projective technique such as the Rorschach, the individual is asked to respond to a relatively un structured situation. That is, the projective technique is considered to be a highly permissive situation in which the subject is assured that he can construct responses through use of the material and that there is not a single set of right answers. Rorschach (1942) cited seven factors in the original test which he believed to be important in predicting an individual's intelligence. He did not specify whether these were to be differen tiated on the basis of potential or present functioning. The factors which he included in his intellectual estimation were form level, movement, whole responses, whole emphasis in the approach to blot perception, orderly sequence, low animal percentage, and optimal original responses. The estimate of intellectual potential from Rorschach projective performance is based primarily upon the level of perceptions as may be deduced from the verbal data given by the subject. These perceptions do not necessarily depend upon knowledge assimilated by the individual in structured or educative situations. Thus, it is assumed that vague perception reflects a relatively low level of capacity while a more refined, differentiated response would be suggestive of a higher level of intelligence. Klopfer, Ainsworth, Klopfer, & Holt (1954) suggest that the best response in terms of differentiation and integration reveals the highest level of perceptual potential and indicates the highest intellectual potential for the individual. On the other hand, the general level of response throughout a person's record indicates the level at which the intellectual resources are usually available. That is, the general response or the "average" response suggests the level at which the individual usually functions. Again, the worst response in the record may indicate the extent to which the individual loses his intellectual grip on reality and becomes incompetent in intellectual perception. This in turn may be described as emotionality interfering with intellectual function. Klopfer and his co-workers also state that "form level rating is the most important basis for intellectual estimate of potential." They further comment that "form level varies directly with intellectual ability." Klopfer & Kelley (1942) in the earlier volume on the Rorschach technique stated that "Rorschach results have been found to correlate as highly with intelligence test results as the results of different intelligence test correlate with one another." It was in this earlier volume that the authors first began to affirm 10 that Rorschach method was enhanced by its ability to differentiate between potential capacity and actual present functioning efficiency. Work with mentally retarded patients and the Rorschach actually began with Rorschach (1942) himself. When he first introduced his projective technique to the medical and psychological world in 1921, he included data which suggested that he had been using the Rorschach to estimate intelligence as well as general personality organization and adjustment. He presented responses to his ink blots from individuals of various intellectual levels from very superior to within the mentally retarded range. Unfortunately we do not know the criteria by which Rorschach diagnosed these levels of intelligence. It probably was not by means of standardized intelligence tests. Furthermore, Rorschach had only 12 mentally retarded or feebleminded individuals in his sample. His original study is of very limited use except to substantiate intellectual potential as a function of perceptual form level. Four years after Rorschach's original work, Pfister (1925) published similar results from a study of 59 mental retardates. He concluded that responses to the ink blots could be used as an estimate of intelligence. However, like Rorschach, he also failed to give any criteria for intelligence level or diagnostic categories. Another important early study with mental retardates was done by Beck (1932) who evaluated 69 protocols and found what he considered to be clues for estimating, by means of Rorschach signs, degree of mental retardation in hospitalized subjects. 11 A more recent attempt at defining degree of intellectual potential as determined by Rorschach form level was made by Ogdon (1956, 1959). In this study 60 mentally retarded subjects were selected with regard to age, sex, race, and diagnosis. His entire patient population had been examined by a psychiatrist and had been legally declared "feebleminded" by the court. With this mentally retarded sample he found the Rorschach form level significantly correlated with IQ. A still more recent study done by Fujimoto (1960) confirms Ogdon's finding. Numerous social, actuarial, clinical, and psychoanalytic theories have been used as springboards to predict potential (Riggs, 1952; Lawrence, 1953; Salvati, 1961). However, Ruth Munroe (1960) suggests that one of our best predictors may be found in the use of the Rorschach and acknowledges that "poor form quality in the Rorschach appears frequently in subjects of low intelligence." The present study was suggested by the fact that Rorschach responses given by mentally retarded children do in fact appear to fall at the lower level of Klopfer's scoring system for form level. However, occasionally a child testing at a low level on a standardized intelligence test will respond in a Rorschach interview with a well organized and detailed response which is just "too high" for his IQ score. This suggests the possibility of using the Rorschach protocols, and specifically "form level," to select cases where the potential is being obscured by emotional factors. 12 Psychotherapy with Mentally Retarded Children Because there has been a long-standing notion that mental defectives cannot be helped therapeutically, relatively few studies have been concerned with therapy of the mentally defective child. Maslow 6c Mittlemann (1941) and Alexander 6c French (1946) have expressed or implied their view that mental retardation is somewhat removed from an effective therapeutic influence. Even Carl Rogers (1942) once stated that "adequate intelligence for coping with life situations with an intelligence rating of dull normal or above is essential for meaningful therapy." However, he has recently (1961) revised much of his former thinking. The implications of his recent revision suggest that even the problems of the mentally retarded individual can be therapeutically handled in ways which have meaning for that individual. Sarason 6c Sarason (1946) suggested that patients who are classified as mentally retarded and who have the most severe emotional problems have test patterns similar to those with known cerebral damage. However, even the few experimental studies of mentally retarded children selected on the basis of absence of damage have failed to reconcile the diverging views concerning whether psycho therapy can be successful or not. There has been some suggestion in the literature, however, of favorable personality changes as a result of psychotherapy. If the mental retardation is to any degree a function of emotional adjustment and if a higher potential intellectual functioning is predicted by psychological tests, then psychotherapy should indeed be beneficial. Even without the above stipulated prerequisites therapy has been demonstrated to be of value with children classified as mental retardates. Bernardine Schmidt's (1946, 1947, 1948, 1949) now classic endeavor to demonstrate therapeutic value with retarded children is a case in point. On the basis of her five to eight year longitudinal study she concludes that children participating in the experimental school program showed significant changes in personal, social, and intellectual behavior and that these changes were more desirable than those found in a comparable group coming from different school environment. Kirk's (1948) critique of her work does not change the fact that the children were described and diagnosed as mental retardates and they did make objective improve ments. Even if there were only one case in point, as in the work of Kolburne (1953) in which after five years of intensive psychotherapy an apparently mentally retarded boy of 13 became a successfully balanced individual, every effort at investigating such possibilities should be made. Chase (1953) has pointed out that the use of psychotherapy in institutions for the mentally retarded can be gratifying and beneficial if the goals of such therapy are within the limits of reality. Abel (1953) relates that if one enjoys the individual with whom one works, has simple goals, and uses flexible techniques, then psychotherapy with mental retardates can come to be as effective as it can be with nonretardates. The problem, of course, is to accept the mental retardate as an "individual." 14 Burton (1954) presents a plea to bring back personality to the field of mental retardation. He feels that hospitals for the mentally retarded must be true treatment centers, attractive to psychotherapists who can pioneer new approaches. The retarded individual must not, in his opinion, be considered emotionally insensitive and therefore unamenable to learning social values. Many pioneering efforts, including group therapy techniques for mental retardates, have been until very recently neglected by therapists working within the narrow spectrum of "normality." However, Michael-Smith, Gottsegan, 6c Gottsegan (1955) have demonstrated that favorable results can be obtained using group techniques which "incorporate new modes of interrelating." The authors justify group therapy for retardates on the basis of motoric group activity and group language training. While they may not be precisely and explicit ly working with specified emotional content, nevertheless their efforts certainly can be considered as pioneering ventures in psychotherapy. The work of Gondor 6c Levbarg (1958) is appropriate to mention at this point. Their work on techniques and expressive therapy for mentally retarded children includes the free use of art, the playroom and the incorporation of small groups of mentally retarded children in social situations. The point of this latter discussion is that therapists and experimenters who have been willing to accept the mentally retarded child as an individual, integrating his personality with intellectual factors, have been successful in working therapeutically with these children. Their success, however, cannot be measured simply in terms 15 of IQ points. Social and emotional integration must also be evaluated. For this reason the introduction of a behavioral rating adjustment scale in the present study seems appropriate. Although psychoanalytic (Fenichel, 1945) as well as behavioristic (Hull, 1945, 1952) literature suggests that younger individuals are more amenable to change, the problem of how young is still open to question. More specifically, the question of the possible reversibility of intellectual deficit is more crucial to the present study. In a review of the literature concerning learning in infancy and childhood, Fowler (1962) concluded that early age is vital in the processes of conceptual learning, establishment of habit patterns, and interest areas. If these processes are more favorably established at early rather than later stages of the developmental cycle the benefits of psychotherapy may also be more favorable at early than at later stages in the developmental process. Purposes of the Present Study Persons classified as mentally retarded may fall into a number of diagnostic subcategories. One of these is a ’’ mixed" diagnosis, i.e. mental retardation compounded by emotional dis turbance. According to the theoretical formulations of Sarason and his co-workers (1952, 1958), one manifestation of anxiety is emotional disturbance, and furthermore, such anxiety-produced disturbance can inhibit measurable intellectual behavior. Thus it follows that there may be persons classified as mentally retarded by an intelligence 16 test who may in fact have a higher intellectual potential. As we have noted above there is considerable theoretical discussion in the literature to support the hypothesis that Rorschach form level indicates intellectual pptential more accurately than standardized intelligence tests. It has been suggested that this is particularly true when extraneous factors such as emotional disturb ances depress performance on such tests. However, there is a paucity of empirical evidence to support or validate such theoretical assumptions. If persons are chosen as candidates for psychotherapy from a group with a "mixed" diagnosis of mental retardation and emotional disturbance without differentiation between actual intelli gence test performance and intellectual potential, there will be those whose retardation is so basic that little can be accomplished, even in long-term therapy, as well as those who can benefit from therapy through their greater ability to comprehend and make logical associations. Consequently a study to validate a predictor of thera peutic potential would seem to be highly worthwhile. The practical purpose of this study is, first, to determine if Rorschach form level can be used as a predictor of intellectual potential in mentally retarded children and, secondly, to determine the effects of group psychotherapy as a method of improving performances measured by an intelligence test and a behavior rating scale in these same children. 17 Hypotheses Tested Subjects (Ss) referred to in the following hypotheses are all children who have been hospitalized as mentally retarded with a concomitant diagnosis of emotional disturbance. Hypothesis I Ss who receive group psychotherapy will show a greater increase in intelligence test performance than do Ss who do not receive group psychotherapy. Corollary of Hypothesis I The difference between the improvement in intelligence test performance shown by the Ss receiving group psychotherapy and the Ss not receiving group psychotherapy will be greater among Ss with high form level ratings than among low form level Ss. Hypothesis II Ss who receive group psychotherapy will show a greater increase in socially acceptable behavior ratings than those who do not receive group psychotherapy. Corollary of Hypothesis II The difference between the improvement in socially acceptable behavior ratings shown by Ss receiving group psychotherapy and the Ss not receiving group psychotherapy will be greater among Ss with high form level than among Ss with low form level ratings. 18 Hypothesis III The difference between the improvement in intelligence test performance shown by the Ss receiving group psychotherapy and the Ss not receiving group psychotherapy will be greater among younger Ss than among older Ss. Corollary of Hypothesis III The effects predicted in Hypothesis III will be greater among Ss with high form level ratings than among Ss with low form level ratings. Hypothesis IV The difference between the improvement in socially acceptable behavior ratings shown by Ss receiving group psychotherapy and the Ss not receiving group psychotherapy will be greater among younger Ss than among older Ss. Corollary of Hypothesis IV The effects predicted in Hypothesis IV will be greater among Ss with high form level ratings than among Ss with low form level ratings. CHAPTER II Review of Previous Studies Experimental Studies Suggesting That IQ is Depressed by Emotional Factors The literature is literally replete with experimentation suggesting that emotion interferes with intellectual performance. Few studies, however, have concerned themselves directly with mental retardation and emotionality. Fisher & Wolfson (1953) suggested that improvement in the mentally retarded group indicates that mental conflicts and neurosis of retarded children differ very little in kind or complexity from those of the normal child. In the same area of investigation, Wiener, Crawford, & Snyder (1960) attribute failure of a group of mentally retarded adolescents to do third grade work to the "impairing effect of anxiety." They also suggest that therapeutic approaches which are anxiety reducing might possibly prove extremely effective for mentally retarded children who otherwise appear destined for permanent illiteracy. They point out that possibly education of illiterate mentally retarded children could be improved by an approach designed to reduce anxiety responses which disrupt the learning process. Jolles (1947) in his experimentation with 66 mentally retarded children between the ages of 10 and 15 concluded that in every case Rorschach protocols suggested the presence of anxiety. 19 20 He summarizes his findings by asking the question, "Could it be that anxiety states and other emotional disturbances distort their personalities to such an extent that we are unable to discover their normal intellectual potential?" (Jolles, 1947, p. 186) Further experimental research by Sarason and his co-workers (1958b) has demonstrated that high-anxiety children were less efficient on learning tasks than low-anxiety children. This high-low anxiety was defined in terms of anxiety scales devised by Sarason and his co-workers. They further noted a significant negative correlation between IQ and anxiety and concluded that a lower IQ could reflect the impairing effects of anxiety. Lawrence (1953) reported a number of experimental studies which dealt with emotionality and mental retardation bearing on his own study. He found that individuals with emotional conditions which led to a diagnosis of mental retardation were unable to establish learning sets, in contrast to the successful performance of mentally retarded children who did not have an emotional involvement. He concluded that individuals who have emotional overtones playing a part in their mental retardation urgently require further investigation. Experiments Suggesting that Form Level can be Used as a Predictor of Intellectual Potential Most of the basic studies attempting to relate intelligence to Rorschach responses have been of the post hoc variety. However, a few have attempted to evaluate subjects both before and after the introduction of the experimental variable. One of these studies by Armitage, Greenberg, Pearl, Berger, & Daston (1955) was an experiment designed to determine the accuracy with which the level of intelli gence (defined as Wechsler-Bellevue IQ) of the individual patient could be predicted from the Rorschach. This was investigated in two ways. One was an objective, statistical approach and the other was a judgmental approach. The attempt to relate statistically single or composite Rorschach scoring variables to the Wechsler-Bellevue IQ failed to yield useful estimates of intelligence. However, clinicians using Rorschach psychograms alone tended to obtain somewhat greater accuracy of prediction. When the clinicians were given the entire protocol, fairly accurate estimates of intellectual functioning were obtained. Although form level per se was not spelled out as a specific factor in predicting intelligence, a question is raised as to what were the subtle indicators of intelligence in the judges' estimation. That form level may have been a major contributing factor is suggested by the fact that the findings showed accuracy of prediction to be in the (descending) order of: total protocol, psychogram, and objective analysis. Sarason, Davidson, Lighthall, & Waite (1958a) in their study of Rorschach performance and anxiety first asserted that Rorschach form level may be affected in a negative direction by children who measure high on anxiety scale. However, they finally concluded that other signs on the Rorschach are far more significant in the identification of anxiety and that when vague responses are taken into account differences between groups disappear with respect to form level. 22 Spiegelman (1956) sought to investigate the relationship between intellectual evaluation by means of Rorschach form level assessment and psychometric IQ assessment as given by the Wechsler- Bellevue Intelligence Scale. He used Klopfer's recent innovations with regard to determining form level and found a correlation of .55 between average form level and verbal IQ. Form level, then, appeared to be the best single predictor of verbal intelligence, and the most feasible to use, since it is relatively objectively arrived at via the Klopfer methodology. Ogdon (1956) considered the Rorschach relationships with intelligence among mental retardates as a problem for a doctoral dissertation. His experimental aim was to study the relationships between Wechsler IQ and Rorschach signs reported to measure intelli gence. In his study he found eight Rorschach signs of intelligence correlated significantly with IQ„ Form level was found to be the most significant. A more recent use of Rorschach form level as an indicator of potential in mentally retarded children has been reported by Apperson, Goldstein, & Williams (1963). The primary hypothesis tested in this experimental study was that Rorschach form level scores on the best response in any one protocol obtained according to Klopfer's scoring scheme would show a significant correlation with IQ level. This suggested the possibility of using Rorschach scores as a comparison measure which might indicate potential. This would be particularly true when the IQ might be depressed by impoverished background or emotional disturbance. A correlation of .44, significant beyond the .001 level, was obtained. In general it appeared that where a large discrepancy existed between Rorschach form level and IQ, this could be a clue to greater potential than was indicated by the standardized IQs. Following this suggestion led to the present study. Experimental Studies on Psychotherapy with Mental Retardates A general statement can be made from a survey of the published literature that there have been few well designed and effectively carried out experimental studies dealing with mentally retarded children and psychotherapy. A survey made of available literature on group therapy with children in general and with retarded children specifically also suggests a paucity of work in this area. Slavson's books (1947, 1950) are helpful, and more specifically Schiffer's (1947) contribution. The activity interview therapy to which Slavson and his writers refer was used by Fisher & Wolfson (1953) in their investigation of group therapy with mentally retarded children. Though it was more a broader investigation than a tightly knit experimental procedure, they did obtain some meaningful results. They concluded that retarded children can be helped by group procedure Denton (1959) carried out a rather elaborately designed study with mentally retarded children. Twenty children with a mean IQ of 60 were given both group therapy and individual therapy on a once-a-week basis. Therapeutic success was based on a criterion of: 1) freedom from original symptoms leading to commitment; and 2) adjustment to institutional life. The results led the author to be optimistic about the value of psychotherapy in cases of mild mental retardation. 24 Similar conclusions were made by Geller (1953), Heiser (1954), and Wiest (1955). Astrachan (1955) found that the most conspicuous change resulting from intensive psychotherapy with mentally retarded female adolescents was a reduction in the patient's feelings of isolation, shame, and fear. However, she, too, concluded that group psychotherapy has a place among treatment resources for institutional ized mentally retarded patients. This review of experimental literature would not be complete without the inclusion of studies suggesting negative results in psychotherapy with mentally retarded patients. Vail (1955) openly announced the title of his paper as "An Unsuccessful Experiment in Group Therapy with Mentally Retarded." However, just as open is the fact that he failed to diverge from the standard, classical, non directive therapeutic techniques. Specifically, this method seemed to involve insufficient control by the therapist of group membership and composition. Therefore, his experimental procedure should not be construed or generalized to mean that psychotherapy of a more dynamic and specific nature could not be successful with mentally retarded children. Another negative study was done by Bowman, Bower, & Ferguson (1957). This experimental study involved 144 female patients, and included both psychotherapy and tranquilizers. Pre- and posttreatment scores were gained from performance on a variety of intelligence tests and the Vineland, the Rorschach, and Behavioral Rating Scales. No significant.over-all differences in intelligence were found and medication appeared to be the variable leading to improved behavior. However, it should be noted that possibly the 25 interaction between medication and other parts of the total treatment could, in part, account for the results. Another well controlled experimental study by Subotnik & Callahan (1959) suggested negative results. However, the authors concluded that perhaps their expecta tions of changes did not include individual variations and that they may, from the beginning, have had unrealistic goals. It has been suggested that perhaps the most meaningful type of therapy for mentally retarded may be of a motoric and educative type. Schmidt's study (1946) would be a case in point. Others, also have tended to support the use of occupational therapy with mentally retarded children (Dewing, 1952; Charles, 1953; Satter & McGee, 1954). Kirk (1958) has given a detailed report of a five- year experimental study on the effect of a preschool educative program on the mental and social development of mentally retarded children between the ages of three and six years. He believes that school experience aids the progress of mental retardates, even those with organic disorders. He points out that mental retardation is not static; i.e., deprived environment may accentuate the retardation as the child ages. He feels that although educative processes may not cure they can improve the functioning level of many retardates if presented early enough. The general area devoted to the study of early intellectual stimulation has only in recent years been exposed to systematic study (Fowler, 1962). It has been suggested (Meyer, personal communication October 1963) that older children, diagnosed as mentally retarded with emotional disturbance, may be less amenable to treatment than 26 younger children with similar diagnoses. A search of the published literature in this field was unproductive of experimental studies to support this notion specifically. Recently a number of attempts have been made to use operant conditioning as a therapeutic technique with mentally retarded children. (Fuller, 1949; Orlando & Bijou, 1960; Ellis, Barnett, & Pryer, 1960) The use of operant conditioning has been very successful as a method training mentally retarded children to perform specific tasks. Fuller (1949) for example, was able to condition what he called a "vegetative organism." His primary subject was an 18 year old severely retarded male who was virtually unable to move. By the use of operant techniques, right arm movements were conditioned using a sugar milk solution as the reforcing stimulus. Operant techniques, because of their effects on behavior independent of higher reasoning processes and language, seem especially applicable with mentally retarded children. Ellis and his co-workers (1960) succeeded in establishing schedule control in severely retarded adult males. They also suggested the use of shaping techniques to toilet train and develop self-feeding behavior in severely retarded institutionalized patients. Even with mildly retarded persons, who may be conceived of as having a limited repertoire of effective responses, operant conditioning has been used to extend the repertoire. For example, Linde (1962) found that in a sheltered workshop situation mildly retarded subjects could be conditioned by operant techniques to work more efficiently and thus increase their production. 27 Girardeau (1962) was not successful in his operant condition ing experiment designed to demonstrate the establishment of secondary reinforcement in mentally retarded patients. (IQ range 12-48) Operant levels were obtained on four groups of male mentally retarded patients. This was followed by the administration of different secondary reinforcement schedules. However, no evidence for the establishment of secondary reinforcement was obtained. On the other hand, Ayllon & Michael (1959) reported considerable success in shaping the behavior of mentally retarded subjects by the use of social reinforcement. That is, through social reinforcement supplied by nurses, the frequencies of undesirable behavior were reduced. Obviously the possibilities and problems involved in the relation of operant conditioning to retardation have only been touched upon. However, even in this brief review of the current literature it seems obvious that behavioral changes do take place by the use of operant conditioning techniques. Notwithstanding, this writer would agree with Slavson (1947) that the term therapy has been inappropriate ly attached to such activities as attendance at moving pictures, working in machine shops, socializing in recreational clubs, and the administration of a reward for a specific type of motor behavior. It is felt that in order to achieve personality changes, relationships of a transference nature must develop. Also, there must be a degree of emotional and behavioral freedom, not ordinarily allowed. More specifically, Slavson feels that group therapy must include the specifications of a small planned group in order to establish a relationship and to gain insight. Slavson also specified 28 that activity groups should be balanced in that contrasts in intel lectual capacity should not be too great. Because activity groups have minor goals of sharing ideas and mutual stimulation, the imbalance of intellectual functioning would be an impediment to these goals. CHAPTER III Methodology The Subjects The subjects (Ss) for this study were drawn from individuals institutionalized a year or more at Pacific State Hospital, who also met the following criteria: a) Caucasian males between the ages of 8 and 17. b) Binet L-M full scale IQ between 50 and 69. c) Not incapacitated by physical disabilities such as blindness, deafness, or organically based brain disorders according to staff diagnosis. d) Staff diagnosis of "emotional disturbance." e) Family income between $4,000-$7,000 per year. f) No bilinguality. Instrumentation 1. Rorschach form level: The Rorschach was administered and form level was obtained from all subjects. Klopfer, Ainsworth, Klopfer, & Holt (1954) state that even one response of 2.5 form level is contraindicative of retardation diagnosis. The reasons for such an explicit statement come in the context of what determined form level. In estimating form level of response there are really three - ’ considerations to be taken into account: accuracy, specification, 30 and organization. The term accuracy applies to the fit of the con cept to the blot in terms of outline, shape, or form. In addition to the consideration of match of concept to the blot outline the response may be improved or spoiled by the extent to which the elaborations or "specifications" offered by the subject correspond to detailed structure of the blot area used. Thus, further elabora tion of the initial response are considered to be specifications. Finally, any procedure used by the subject to organize the various parts of the blot into a meaningful larger concept is recognized by an increase in form level rating. Such organization may be loose or well integrated. An attempt to organize by means of mere position of two concepts without any genuinely meaningful connection would not be justification for increasing the form level rating. Thus, it can be seen that incorporated in the basic concept of "form level" are three principles all of which could be construed and interpreted as intellectual in their meaning and content. About two decades ago Klopfer & Davidson (1944) were con cerned with objectifying one area of Rorschach interpretation, that being intellectual functioning as expressed in form level. The method was essentially a scaling device which was intended to supple ment the usual psychometric procedures which presumed to give an estimate of intellectual efficiency level. The method involved the quantitative evaluation of each response in a record on certain form level qualities, namely accuracy, specification and organization as mentioned above. Their scale ranged from -2.0 to +5.0 with intervals 31 of 0.5. The method allowed for additions and subtractions for accuracy, specification, and organization. Subsequent elaboration and refinement of their form level rating by Klopfer and his co-workers (1954) have resulted in a greater degree of reliability. It was this subsequent elaboration minutely spelled out with a scale of -2.0 to +5.0 that was used in this study. 2. IQ Data: The Binet, L-M, was administered (Terman & Merrill, 1960) and IQs determined. 3. Behavioral Ratings: MACC (Ellsworth, 1962) ratings were obtained of ward behavior. The MACC is a set of 16 rating scales for evaluation, by ward personnel, of the behavior of hospitalized patients. High scores on each rating scale represent the more "desirable behavior." Procedure Selection of Ss Hospital records were reviewed for all patients on the ward for "emotionally disturbed" patients. All patients on these wards had been diagnosed at a staff conference as having an emotional disturbance. Diagnostic agreement among staff members suggested that the staff recognized the emotional factors as being of primary significance. Such patients were placed on special treatment wards, (i.e., A resident psychiatrist is assigned specifically to the wards; ward personnel have special psychiatric training.) On the basis of hospital records, patients were selected as possible Ss who met the age and IQ requirements specified above. 32 The Question of IQ in the Selection, of Ss Admittedly, in spice of the fact that reasonable precautions were taken in the selection of the groups for this study, there may be ways other than Rorschach form level of differentiating groups of mentally retarded children who fall in the same IQ category. Sarason (1949) has argued that IQ scores neither describe nor explain the differences among individuals with identical IQ scores who are called mentally retarded. He also notes that no explanation is offered for the many similarities (and differences) among individuals with wide differences in their IQ scores. He is almost vehement in his de nunciation of the use of IQ scores as a blanket diagnostic criterion of mental retardation, particularly with individuals who fall in the mildly retarded range (IQ 50-69). He further denounces the common clinical practice of attributing to the individual the whole spectrum of characteristics usually associated with the label of mental retardation. However, the overlooking of behavioral differences, intellectual efficiency, physical characteristics, socio-economic and cultural factors, attitudes, motivation, the presence or absence of emotional factors, is common practice in the determination of an IQ score. In line with Sarason1s critique, Wechsler (1958) and others (Combs, 1952; Jastak, 1949) have questioned the basic validity of the IQ concept and feel that general intelligence must not be equated with specific task-oriented intellectual ability. They make an appeal to consider the total personality including drives, motives, and affective states in making general intellectual evaluations. 33 Criticisms such as mentioned above may certainly be applied to the group of mentally retarded children selected for this study since IQ scores were a basic part of the primary criteria for inclusion of subjects in the experiment. However, the selection of a large group and the fact that they were relatively homogenous with respect to the most relevant variables suggests that the results cannot be attributable in total to the variety of "other variables" which accompany IQ scores. The Question of Emotional Disturbance in the Selection of Ss In the selection of subjects for this study the prerequisite of emotional disturbance was also considered as a basic criterion. In this case emotional disturbance was determined by staff agreement. In reviewing the case histories of the subjects included in the study it was discovered that anti-social behavior, unpredictable moods, bizarre communication patterns, and feelings of inadequacy and helplessness were typically found as precursors of the "emotional disturbance" diagnosis. This is in line with the theoretical suppositions stated by Sarason (1952, 1958) and his co-workers (Waite, Sarason, Frederick, & Davidson, 1958; Mandler & Sarason, 1958) that individuals with a high anxiety drive will manifest a "high number of anxiety responses" such as helplessness, affective disturbance and communicative difficulties. Thus the consensually- validated staff diagnosis of emotional disturbance carries with it the inference that these children have a higher anxiety drive than other children not so diagnosed. More objective measures of anxiety 34 were considered, but since the majority of the children used in this study are incapable of reading, the usual tests of anxiety were bypassed. Interestingly enough, Spence (1964), in a rather extensive discussion of tests which purportedly measure anxiety in relationship to specific types of learning, points out that our present inability systematically to account for and control higher mental processes leads to some rather "unfortunate consequences." That is, the use of anxiety scales which are presumed to be indirect measures of drive state are in the final analysis only inferential tools and require large samples to be used in investigation of the function of anxiety so that confounding variables may be equalized. Thus as in this study, the use of staff diagnosis, and changes in intelligence and behavioral rating scales inferentially to suggest underlying anxiety can be just as meaningful as any other psychological tool inferentially used. Assignment of Ss to Groups The Rorschach test was administered individually by two clinical psychologists, other than the one who conducted the psycho therapy sessions, to all potential subjects selected on the basis of age and IQ records. Following the administration of the Rorschachs the protocols were scored by both clinical psychologists for form level according to the Klopfer method. Each psychologist scored the record without knowledge of the other's form level ratings. Following the example of Apperson, Goldstein, & Williams (1963), the highest form level occurring on any single response was used as an estimate of potential. A frequency distribution of highest form level was compiled for each of the two clinical psychologists evaluat ing form level. The highest and lowest 45 per cent of each of these distributions was defined as the "high" and "low" ranges, respectively. The patients placed in the "high" range by both psychologists formed the high potential group, while the patients placed in the "low" range by both psychologists formed the low potential group. The remaining patients were excluded from further consideration in the study. This resulted in the selection of 64 subjects, one half of whom had form level ratings of 1.5 or above and one half having form level ratings of 1.0 or below. The subjects in the high and low form level groups were assigned at random either to the therapy treatment or the nontherapy treatment. This was done by following the randomization procedure of Lindquist (1953, p. 384). It was noted that each of the four experimental subgroups was in turn approximately equally divided into two age subgroups-- Ss aged 8 to 12 inclusive, and aged 13 to 17 inclusive. In order to accomplish the addition of age as a dimension in the experiment, each of the four subgroups defined in terms of form level and therapy was subdivided as to age. Eight subgroups resulted. Each of these eight subgroups contained eight subjects (later reduced to seven, see p. 42). The design of this experiment is schematically represented in Fig. 1. Collection of Pretest Data If administered within the preceding 90 days, the Binet 36 13-17 With -12 Without Low High Form Level Therapy Fig. 1. Schematic representation of the three-dimensional factorial design employed in the experiment. 37 (L-M) IQ 011 record was used as pretest data. The Binet was re administered to those Ss who did not have Binet scores on record determined within the preceding 90 days. These Binets were adminis tered by a hospital staff psychologist other than the one who conducted the psychotherapy sessions. Each of two nurses completed MACC ratings of all the Ss. These nurses were assigned to the respective wards, and were thoroughly acquainted with the Ss. The mean of the two nurses' MACC ratings was determined for each S. Therapy The therapeutic procedure was that of "direct activity" as described by Slavson (1947, 1950). The therapy groups each contained seven members. Since these groups were randomly selected by the "testing" psychologists, the therapist did not know the form level, MACC ratings, or IQ scores of the Ss in the groups. There were 50 consecutive daily therapy sessions. The specific structure and goals of this therapy were in line with Slavson's (1947) concepts. Intellectual balance was achieved in that hospitalized mentally retarded children fall within specified IQ ranges and tend to have a very similar milieu in which to test out intellectual potentials. Thus the groups in this study were assumed to have a ready-made facility to identify with one another and thus have a therapeutic effect on one another. The groups, through the course of 50 daily sessions, x^ere supplied x^ith simple arts and crafts materials, tools, and group game materials which they used quite freely. In accordance with Slavson, no restrictions of any kind (within safety limits) 38 were imposed, particularly at the beginning of the treatment. It was a permissive environment. Limitations, controls, and denial arose naturally as members infringed upon the rights and convenience of other members and only at later stages in the treatment did the therapist introduce limits as they were needed. The purpose of these activities was to give substitute satisfactions through the free acting out of impulses and opportunity for sublimated activity. Acceptance from the therapist was a continual function of the therapy. The activity group therapy had as immediate goals, the discharge of drives, diminution of tension, and reduction of anxiety through physical and emotional activity in a group setting; secondly, the creation of a setting for unimpeded acting out (within the boundaries or personal safety) through free interaction with fellow members. Interpersonal and social relationships were assumed to be produced through expression of emotions and the discovery of limitations. Control Procedure During the time that the Ss assigned to receive therapy were in therapy, the nontherapy Ss received the same treatment as others on the ward who were not involved in the experiment. Collection of Posttest Data The Binet (L-M) was administered to all Ss by a hospital staff psychologist other than the therapist. Since the primary hypothesis concerned differences between control and experimental groups it was not deemed necessary to control for practice effect 39 since this effect would manifest itself in both groups. MACC ratings were made by the same nurses who made the pretest ratings. As with the pretest ratings, the mean of the two nurses' MACC scores was determined for each S. Statistical Analysis Reliabilities A Pearson product-moment correlation was determined between evaluations made by the two psychologists of form level of the Rorschach protocols. For each S the highest form level rating was recorded for each psychologist judge. The correlation between the judges' results was used to estimate the reliability of this datum. Similarly, a correlation between the two nurses' MACC ratings was derived from the pretest data about the Ss on each ward. The interjudge correlations obtained from the Rorschach and MACC form level data are presented in Tables 1 and 2. These reliabilities are all significant beyond the .001 level, and are comparable to similar reliabilities reported elsewhere (Spiegelman, 1956; Ellsworth, 1962). It is interesting to note that the Rorschach raters found higher agreement with the Ss classified as low form level (.95) than with the Ss classified as high form level (.79). This is understandable in that when a S's response was bad it was usually very "bad" and therefore very obviously in the negative range of form level ratings. On the other hand, when a S made a good response the quality of "good" took on wider variation in judgment. In spite 40 Table 1 Interjudge Reliability of Rorschach Form Level All Low Form Level High Form Level _____________________ Sub jects__________Sub jects_____________Sub jects_____ Rorschach Form Level .919 .950 .792 Table 2 Interjudge Reliabilities of MACC Pretest Posttest Data Data MACC .793 .840 42 of the fact that the total group had been matched with respect to age, IQ, and all other variables considered important to a study of this type, the total group was differentiated on the basis of form level responses. An examination of the data (See Appendices) reveals that the mean form level rating for the high form level group was 2.28 as contrasted with .47 for the low form level group. Analysis of Variance An identical three-dimensional factorial design (Lindquist, 1953, p.239) analysis of variance was applied separately to the pretest Binet data (IQ scores) and MACC data (total raw score-- average of two raters). This analysis was applied to the pretest data in order to test for differences among the experimental groups prior to the administration of the experimental treatment. Two Ss were eliminated from the MACC data because their pretest scores were so high (90th percentile or above) that any behavioral improvement which they might make would not be shown by that scale. Three more subjects were released from the hospital and Were therefore dropped from this research. In order to meet the requirements of proportionality of cell frequencies (Lindquist, 1953, p. 138), it was further necessary to eliminate one or two Ss from each of several subgroups, reducing the size of each subgroup to seven Ss. In each subgroup, these eliminations were made on a random basis. The allocation of degrees of freedom for this analysis is given in Table 3. Table 3 Summary of the Factorial Design Indicating the Allocation of Degrees of Freedom Form Level 1 Therapy 1 Age 1 Form Level x Therapy 1 Form Level x Age 1 Therapy x Age 1 Form Level x Therapy x Age 1 Within 48 Total 44 Table 4 presents the results of the analysis of variance applied to the pretest IQ data. The form level main effect was significant beyond the .005 level, and examination of the data indicates that the high-form-leve1 Ss had higher IQ scores at the beginning of the study than did the low-form-leve1 Ss. All other effects were nonsignificant; thus the data present no evidence of other significant IQ differences among the various subgroups at the start of the experiment. Table 5 presents the results of the analj^sis of the pretest MACC behavior ratings. The form level main effect was significant at the .01 level, and examination of the data reveals that the high- form-level Ss were given higher ratings than the low-form-level Ss. The therapy and age main effects were nonsignificant, with F ratios of less than 1.0, indicating that the behavior ratings of the therapy groups and of the age groups did not differ substantially at the beginning of the experiment. The form level x age interaction was significant at the .05 level, and examination of the data reveals that the difference between the form-level groups is greater among younger Ss than among older Ss. All other interactions were nonsignificant. In addition, the difference between pretest and posttest was determined for each S (separately for Binet and MACC data as above), and the same factorial-design analysis of variance applied to these difference scores. There were thus four applications of this analysis of variance in all--pretest Binet, pretest MACC, change 45 Table 4 Summary of Analysis of Variance Results for Pretest Binet IQ Scores Source ss df ms F P Therapy 20.6 1 20.6 <1.00 NS Form Level 274.6 1 274.6 12.40 .005 Age 8.6 1 8.6 <1.00 NS Therapy x Form Level 12.5 1 12.5 <1.00 NS Therapy x Age 1.2 1 1.2 <1.00 NS Form Level x Age 38.8 1 38.8 1.80 NS Therapy x Form Level x Age 23.1 1 23.1 <1.00 NS Within 1065.5 48 22.1 Total 1444.9 55 46 Table 5 Summary of Analysis of Variance Results for Pretest MACC Ratings Source ss df ms F P Therapy 28.6 1 28.6 <1.00 NS Form Level 423.6 1 423.6 7.88 .01 Age 10.4 1 10.4 <21.00 NS Therapy x Form Level 18.2 1 18.2 <1.00 NS Therapy x Age 77.7 1 77 .7 1.45 NS Form Level x Age 274.4 1 274.4 5.10 .05 Therapy x Form Level x Age 44.8 1 44.8 <1.00 NS Within 2580.3 48 53.8 Total 3458.0 55 47 in Binet, change in MACC. The two latter analyses are presented in Chapter IV. CHAPTER IV The Results For convenience the results will be presented as they relate to the eight hypotheses of this study. Testing the First Hypothesis This hypothesis stated that Ss receiving group therapy would show an increase in intelligence test performance when compared to Ss who do not receive group psychotherapy. Table 6 presents the results of the analyses of the changes, from pretherapy to post therapy, in intelligence test performance as measured by the Stanford-Binet Intelligence Scale, Form L-M. The Ss receiving group therapy do show an increase in Binet intelligence test scores (mean scores listed in Appendices). Thus Hypothesis I is supported by this analysis. Testing the Corollary of the First Hypothesis According to the corollary of the first hypothesis the difference between the improvement in intelligence test performance shown by Ss receiving group psychotherapy and the Ss not receiving group psychotherapy, will be greater among Ss defined as high form level than among Ss defined as low form level. As indicated in Table 6 the therapy x form level interaction was significant at the 48 49 Table 6 Summary of Analysis of Variance Results for Posttest Binet IQ Scores Source ss df ms F P Therapy 87 .5 1 87.5 7.35 .01 Form Level 52.0 1 52.0 4.37 .05 Age 18.2 1 18.2 1.53 NS Therapy x Form Level 41.2 1 41.2 3.46 .10 Therapy x Age 0.1 1 0.1 <1.00 NS Form Level x Age 0.8 1 0.8 <1.00 NS Therapy x Form Level x Age 18.2 1 18.2 1.53 NS Within 572.4 48 11.9 Total 790.4 55 50 .10 level. This indicates a trend in the predicted direction although the difference involved is not statistically significant. The means of the four subgroups given by the double classification of form level and psychotherapy are given in Table 7. Examination of these data reveals that the high form level subjects receiving psychotherapy showed a gain in mean intelligence test scores, while all other subgroups showed a decrease. The mean difference between the high and low form level groups in therapy was significant at the .01 level, indicating that subjects with high form level did increase their scores to a highly significant level when compared with subjects in therapy who have low form level. Also significant was the difference between subjects with high form level in therapy as compared with such subjects who were not in the therapy. Wliereas the general over-all prediction as stated in corollary of the first hypothesis was not supported in the analysis of variance data, a trend was suggested and significance tests between the means of the high and low form level subjects show that the corollary is supported. The indicated significance tests were performed according to the method given by Lindquist (1953, p. 214). Testing the Second Hypothesis This hypothesis stated that Ss receiving group psychotherapy would show an increase in socially acceptable behavior ratings as measured by the MACC scale when compared to Ss who do not receive group psychotherapy. Table 8 presents the results of the analysis of the changes in MACC ratings from pretherapy to posttherapy. None 51 Table 7 Means of Binet Intelligence Test Differences of High and Low Form Level Ss in Therapy and Nontherapy Groups High Form Level Low Form Level Difference Therapy 2.28 -1.43 3.71** Nontherapy -0.86 -1.64 .78 Difference 3.14* .21 2.93 * Significant at .05 level. ** Significant at .01 level. 52 Table 8 Summary of Analysis of Variance Results for Posttest MACC Ratings Source ss df ms F P Therapy 0.00 1 0.05 <1.00 NS Form Level 0.00 1 0.05 <L.OO NS Age 30.00 1 30.00 2.91 NS Therapy x Form Level .09 1 .09 <1.00 NS Therapy x Age 85.50 1 85 .50 8.30 .010 Form Level x Age 141.50 1 141.50 13.74 .001 Therapy x Form Level x Age 128.50 1 128.50 12.50 .005 Within 492.60 48 10.26 Total 878.19 55 53 of the main effects were significant. Thus, this analysis suggests that the Ss receiving group psychotherapy did not improve behaviorally when compared to Ss not receiving group psychotherapy. Therefore Hypothesis II is not supported. Testing the Corollary of the Second Hypothesis This corollary predicted that the difference between improvement in socially acceptable behavior ratings shown by Ss receiving group psychotherapy and nontherapy Ss will be greater among the Ss with high form level ratings than among Ss with low form level ratings. As indicated in Table 8 the therapy x form level interaction was not significant. Thus the corollary of the second hypothesis is not supported. Testing the Third Hypothesis According to the third hypothesis the difference between the improvement in intelligence test scores shown by the therapy Ss and the nontherapy Ss will be greater among Ss between 8-12 years of age than among Ss between 13-17 years of age. As noted in Table 6 the therapy x age interaction was not significant and thus, Hypothesis III is not supported by this analysis. Testing the Corollary of the Third Hypothesis This hypothesis predicted that, the effects suggested in Hypothesis III will be greater among Ss with high form level ratings than among Ss with low form level. The analysis shown in Table 6 54 demonstrates that the therapy x form level x age triple interaction was not significant. Therefore, this corollary is not supported. Testing the Fourth Hypothesis This hypothesis predicted that the difference between the improvement in MACC ratings shown by therapy Ss and the nontherapy Ss will be greater among younger Ss than among older Ss. Table 8 presents the results of the analysis of the changes in MACC behavioral ratings from pretherapy to posttherapy. The therapy x age interaction recorded in this table was significant at the .01 level, thus supporting Hypothesis IV. Examination of the data indicates that the difference between the therapy and nontherapy groups was opposite in direction for the younger and older Ss. Young Ss receiving therapy showed greatest improvement in their ratings, while among the older Ss, those without psychotherapy showed greater improvement than did those receiving psychotherapy. Table 9 presents the means of the four subgroups given by the double classification of psycho therapy (vs. nontherapy) and age. The indicated significance tests were performed according to the method given by Lindquist (1953, p. 214). Testing the Corollary of the Fourth Hypothesis This corollary stated that the effects predicted in Hypothesis IV would be greater among Ss with high form level than among Ss with low form level ratings. The analysis shown in Table 8 indicates that the form level x age interaction was significant at 55 Table 9 MACC Means of Younger and Older Ss in Therapy and Nontherapy Groups Age 8-12 Age 13-17 Dif ference Therapy 22.14 18.21 3.93** Nontherapy 19.86 20.86 -1.00 Difference 2.28 -2.65* 4.93 * Significant ** Significant at the .05 at the .01 level. leve1. the .001 level. Examination of the data reveals that among the younger Ss, those with high form level show greater positive change than those with low form level while the reverse is true among older Ss. Table 10 presents the means of these four subgroups. The significance tests were performed accoi'ding to the method given by Lindquist (1953, p. 214). Further analysis of Table 8 indicates that the therapy x form level x age triple interaction was significant at the .005 level. The means of the eight subgroups contributing to this interaction are shown graphically in Fig. 2. It is noted that the changes in MACC ratings were roughly comparable for the four nontherapy groups, but that the four therapy groups are spread widely as to mean MACC changes. It is also clear that the low-form- level Ss show relatively little difference between therapy and nontherapy groups, while the high-form-leve1 groups show a significant difference. The younger, high-form-level Ss, as predicted in the corollary of Hypothesis IV show a greater degree of positive behavioral change with therapy than without. Thus the corollary of Hypothesis IV is supported. It is of interest to note ’ that the older high-form- level Ss showed more positive change in MACC ratings without therapy than with therapy, or stated another way, the older high-form-leve1 group receiving therapy demonstrated a very significant decrease in their behavioral rating scores. 57 Table 10 MACC Means of Younger and Older Ss in High Form Level Groups and Low Form Level Groups Age 8-12 Age 13-17 Difference High Form Level 22.57 17.93 4.64** Low Form Level 19.43 21.14 -1.71 Difference 3.14* -3.21* 6 .35 Significant at the .05 level. Significant at the .01 level. 58 28 27 26 25 24 23 22 21 20 19 18 17 16 15 Nontherapy Groups Therapy Groups 0 Older Group X Younger Group Low Form Level High Form Level Fig. 2. 3ehavioral rating mean differences compared for the eight subgroups. CHAPTER V The Discussion The present discussion has as its focal point the implica tions of psychptherapy x^ith groups of mentally retarded children. Psychotherapy and Intellect It was found that all the subjects who participated in group psychotherapy did improve with respect to intelligence test scores when compared to subjects not in therapy. One of the basic goals of Activity Group Therapy (Slavson, 1947) is to allow the child a permissive atmosphere in which he may give vent to feelings, particularly those of failure and inadequacy, and thus theoretically relieve the total personality from the intel lectually constricting influences of anxiety (Sarason, 1950; Sarason & Gladwin, 1958; Sarason & Mandler, 1952; Sarason, Mandler, 6c Craighill, 1952; Sarason, Davidson, Lighthall, Waite, 6c Ruebush, 1960). To accomplish all this, the child is provided with a tangible social reality (the group) with which he deals in accordance with his existing and expanding abilities. Through his experiences in this environment, modifications in personality occur, anxiety is reduced and the individual begins to counteract his deflated self-evaluation, and in turn gains new strength and facilities for dealing with the outer world of life-test situations. The clinical impression gained from the observation of all the groups during and after the Activity 59 60 Therapy sessions, was that through the activities in the group setting there seemed to be a pervasive overcoming of fears. The infantile and overprotected child became more self-reliant while the aggressive child became more seIf-activating in imposing self-limits. Following the principles laid down by Slavson the therapist became a source of support and acceptance. Clinically it was observed that this rather tolerant attitude seemed to be adopted by the group members toward each other, and this general tolerance in turn seemed to produce a dimunition of anxiety in the children and greater tolerance toward each other. It may be that the theoretical suppositions, which suggest that anxiety reduction may facilitate intellectual abilities, can account for the increased scores. However, the question of attitudes and motivation cannot be overlooked. The therapy subjects were given special attention and on occasion special privileges. For example, if certain assigned tasks had not been completed when the group therapy hour began the child was released from the task responsibility. This was not at the request of the therapist, but seemed rather to be a function of the feeling on the part of ward personnel that group psychotherapy took precedence over other activities. Nevertheless, the general air of belonging to a special group was obviously apparent after the first week of treatment. The opposite effect may have been felt by the control groups. That is, since they were not a part of the "ingroup," they may have been experiencing a type of rejection. Examination of the data (See Appendices) suggests that the significant difference in mean 61 IQ score between these two major groupings (i.e. therapy-nontherapy) is a function of a very slight increase in score for the therapy group and a very slight decrease for the nontherapy group. The slight decrement in scores for the nontherapy group may have been a function of feelings of rejection and therefore lack of motivation or it may be considered in terms of negativistic set for intelligence testing. One of the testing psychologists reported that one of the control subjects upon seeing the Binet kit, put his hands in the. air and literally screamed, "Oh God, not again!" It may also be, as Siegman (1956) has suggested, that the testing of institutionalized subjects by individuals who may represent authority within the institution to these subjects is likely to produce stress. Furthermore, this stress has been found to be more likely to increase task-irrelevant responses which would tend to lower scores on intelligence tests, more in high than in low anxiety subjects (Lucas, 1952). Thus it may be that the mere,association with one of the "authority figures of the institution" (the therapist) may have resulted in a decrease in stress when the subjects were again faced with an institutional authority figure (another psycholo gist). The decreased authority produced stress would in turn theoretically decrease the number of task-irrelevant responses. This latter may account for the increase in scores among the therapy groups but would still not account for the decrement found among the nontherapy groups. 62 Regardless of the explanatory point of view adopted, the results do show changes for children in group psychotherapy as opposed to nontherapy children. The administration of the Rorschach and classification of the subjects on the basis of form level resulted in two groups called high form level (HFL) and low form level (LFL). It was found that the difference, between improvement in intelligence test perfor mance shown by subjects receiving group psychotherapy and the subjects not receiving group psychotherapy was significantly greater (.01 level) among the subjects classified as HFL than among subjects classified as LFL. These results seem to counter the rather prevalent assump tion that mentally retarded children when classified according to IQ scores represent a homogenous group. The fact that form level seems to select children out of a larger group as being different, at least in terms of being affected by therapeutic procedures, suggests that there may be other aspects of the total personality of the child classified as mentally retarded which make them much more heterogenous than previously supposed. Lawrence (1953) for example, found that children in a single retardation classification could be differentiated in terms of endogenous and exogenous by their responses to a specific task. It may be that HFL and LFL scores are another way of making this same differentiation. The endogenous retardate would demonstrate a more pervasive limitation in all areas of functioning and would thus have a higher possibility 63 of being classified as LFL. The exogenous retardate, on the other hand, most frequently identified in terms of a brain damage factor would be expected to have areas where higher functioning would be possible. These individuals would be more likely to be rated as HFL. Of course the endogenous-exogenous typology has long been recognized (Sarason, 1949) to have considerable overlapping and therefore extremely limited as a reliable index of differentiation. While the results suggest that form level does indeed predict potential to benefit from psycnotherapy, it may be that form level just happens to be a correlate of other factors which are in reality the predictors of therapeutic benefit. The concept of form level suggests that the subject be required to differentiate as well as integrate on a perceptual level. Higher levels of perceptual integration and differentiation are suggestive of higher intellectual potential for that individual (Klopfer, Ainsworth, Klopfer, & Holt, 1954). This in turn suggests that those who can organize at a higher level perceptually can also derive greater benefit from therapy through their ability to comprehend and make logical associations. It is the latter concept which may be the most relevant in terms of benefit from psychotherapy. If one child has a slightly higher ability to make more logical associations and generalizations than another (and this ability is in the present study demonstrated by higher form level), then that child should be able to make better use of the psycho therapeutic experience. Thus, in line with the theoretical supposition stated by Sarason and others (1952, 1958), this child may experience 64 more of a reduction in anxiety because he can make more of the therapeutic setting. These extrapolated concepts regarding individual differences within a specified group seem to be supported by Heath (1956) . His work was done under Mandler but based on the Sarason hypothesis regarding the inhibition of intellectual functioning by anxiety. Heath's results support the general proposition that severe anxiety interferes with intellectual performance, but he also found that there are wide individual differences with respect to thresholds of anxiety. He concludes that the Mandler-Sarason (1952) thesis must be extended to include the results of his experimental work. He found that higher abstract conceptual ability seemed to act as a defense against anxiety and that the maintenance of a set and the ability to use abstract concepts may actually facilitate the suppres sion of strong affective responses to anxiety situations. If form level could be interpreted as a cue of potentially higher abstract conceptual ability, it may well be that the subjects in this study chosen because of their higher form level have higher individual thresholds to anxiety than the individuals with low form level ratings. Thus, the abstracting ability necessary for higher form level conceptualization may be the determining factor with respect to increased intellectual functioning by the higher form-level groups. The implications of such theoretical suppositions are in line with Kanner's (1952) unequivocal and forthright declaration that every person who happens to fall into a lower than average IQ range must have the right to be studied as an individual. This means that full attention should be given not only to the genetic, physical, and intellectual determinants of the particular case but that cultural, economic, and a wide range of emotional determinants should also be explored for the individual. In line with the results of Heath (1956) it might also be added that the individual in any specified IQ range should also have the right to be studied with full attention to the specific intellectual aptitudes such as abstract reasoning and conceptual ability. The results for age and form-level interaction were not significant; that is, the younger children were not more amenable to intellectual change as a result of therapy as opposed to older children. In line with the work of Abernethy (1936) and Dearborn (1941), no information has come to light in this study regarding the acceleration or deceleration of intelligence with age. These nonsignificant results may well have been because the age of signifi cant reversibility of intellectual and emotional deficit may be much earlier. Goldfarb (1955) suggested that early emotional deprivation in impersonal, though nutritionally and hygienically correct orphanages, produced severe damage to the personality \-7hich appeared to affect test intelligence. His group of orphanage-reared infants obtained a mean IQ of 69 later in life while the control group, children cared for in foster homes, obtained a mean IQ score of 96. The foster home children were taken from the orphanage during the first year of life. It may be that the theoretical assumptions 66 regarding change with respect to age may be more dramatically illustrated with a group at a much younger age than specified in this study. The fact that the activity group psychotherapy was restricted to 50 consecutive daily sessions and not spread out over a longer period of time may have weakened the results with respect to age and therapy. That is, one would suspect that over a longer period of time, because of the leveling-off process of older children, more dramatic results would be seen with the younger group. For example, it has been clinically observed that mentally retarded children approaching adolescence progress to a kind of intellectual plateau earlier than normal children so that their increasing chronological age tends to lower the statistically calculated IQ scores. On the other hand the younger groups still in the process of incremental steps regarding chronological age tend to either increase or at least remain relatively stable as a function of the statistically calculated IQ scores . Fowler (1962) has suggested that endeavors be undertaken to utilize the now relatively untapped "preschool” years for cognitive and abstract kinds of education. He feels that this simply makes available more years of childhood to absorb the increasingly complex technology of modern society. He also points out that it is evident that perhaps conceptual learning tasks involving abstract learning may be more favorably established at these earlier stages than during later stages. It would seem then that the use of groups at a much 67 earlier stage in the developmental pattern might be of benefit in studying therapy as a function of age factors before conclusions are reached regarding this matter. Psychotherapy and Behavior The second hypothesis predicted that individuals receiving group psychotherapy would show an increase in socially accepted behavior ratings as measured by the MACC scale when compared to subjects who did not receive therapy. This hypothesis was not supported by the analysis of the data. The therapy groups when considered as a whole did not improve behaviorally when compared to the nontherapy groups considered as a whole. However, it will be seen that a large segment of the therapy subjects actually decreased their ratings on the behavioral scales. This resulted in a cancelling out of beneficial effects seen in other segments of the therapy groups. This same effect could be applied in the analysis of the data con cerning the corollary of Hypothesis II which predicted that the differences between improvement in MACC ratings shown by subjects in therapy and subjects not in therapy would be greater among the high form level subjects than among subjects with low form level. Again the cancelling effect of the therapy subjects whose behavioral ratings worsened would account for the fact that the corollary of Hypothesis II was not supported. The fourth hypothesis predicted that the difference between the improvement in MACC ratings shown by the therapy subjects and the nontherapy subjects would be greater among younger subjects than 68 among older subjects. Analysis of the statistical results indicated that the younger subjects receiving group psychotherapy demonstrated greatest improvement in the ratings, while among the older subjects those without group psychotherapy showed greater improvement than did those receiving group psychotherapy. A corollary of Hypothesis IV stated that effects would be greater among subjects with high-form-level ratings than among subjects with low-form-leve1 ratings. Again the analysis of the data indicated that the younger subjects with high form level showed a greater positive change in behavioral rating scale scores than those with low form level. However, among the older subjects those with high form level behaved in such a way as to produce results which showed a decrement thereby suggesting that their behavior had worsened during the process of therapy. There were no significant changes in the MACC ratings for the four nontherapy groups regardless of form level or age. The younger high-form-level subjects as predicted in the corollary of Hypothesis IV showed a significantly greater degree of positive behavioral change with therapy. These results supporting the corollary may be better interpreted in light of the results obtained with the older high-form-level subjects. The fact that the high-form-level groups changed behaviorally as compared to low-form-level groups indicates that the high form level may be measuring some quality in the individual's capacities which allows or permits change. Klopfer, Ainsworth, Klopfer, & Holt, 1954) have stated that high form level is suggestive of higher 69 intellectual potential particularly in the areas of generalization and abstracting ability. This in turn indicates that patients belonging to the high-form-leve1 group would gain more from a therapeutic setting. That is, they would be able to make generaliza tions and could abstract from the emotional content of the sessions that which would have meaning for them as individuals. Thus far the discussion has centered on the fact that high form level suggests that the individuals are amenable to change but the discussion has not stipulated whether this change is positive or negative. When we introduce age as a variable we must deal with behavioral change with respect to positive or negative actions. It may be that the younger high-form-level therapy subjects change behaviorally in a positive direction because they were able to grasp more readily what was expected of them in terms of behavior. The older high-form-level therapy subjects, while they too were able to grasp what was expected of them, may have been intrigued by the permissive atmosphere because of the different developmental stage they were in and therefore began to "act out." One of the first concepts to come to mind is that of physiological changes which may be occurring at this age level. Changes in metabolism and in glandular structure may be contributing factors in accounting for the differences between age groups. Although it is true that some startling high correlations have been reported (Hinton, 1939) between metabolic rate on the one hand and behavior and IQ on the other, these correlations tend to become less 70 significant as children enter puberty. Yet clinical experience suggests that these kinds of changes much not be overlooked in accounting for behavioral nonconformity. Perhaps a more meaningful explanation for the above results might be found in examining the psychological developmental process through which the two age groups presumably are passing. While the younger subjects were actively seeking a signifi cant figure with whom to identify and use as a mechanism of what might be called "externalized super-ego," the older subjects' con flicts centered around quite a different area. They were actively seeking to establish themselves as individuals and continually in the process of testing limits to determine just how far they could go. Thus in the permissive group psychotherapy setting (Slavson, 1947) the older subjects found that they were able to "act out" with virtual impunity. It seems very likely that this "acting out behavior" carried over into the ward setting. It is a well known fact that such behavior is not well tolerated in a hospital ward setting. Thus the ward personnel responsible for rating the older subjects un doubtedly encountered this "acting out behavior" and subsequently downgraded their rating scales for these boys. Such downgrading, however, does not necessarily imply that the group psychotherapy was not beneficial. The very antithesis may well be the case. An alternative explanation comes in the context of adolescent identification in terms of the group itself rather than in terms of an authority figure. It was clinically observed that in the older 71 groups there seemed to be one or two subjects who were continually at odds with the therapist or with one or two of the other subjects. These subjects are referred to by Slavson (1947) as "a focus of infection" in the group. The infection undoubtedly spread, particu larly among the high form level subjects. It became the modus operandi to "act out" because such behavior was not threatened with extermination by the therapist. Glass (1957) in discussing his case study of a mentally retarded patient, suggests that acting-out is merely one of the early features in the therapeutic process. He found that as therapy continued this behavior diminished and another feature developed (i.e., nearly a complete absence of exchange, hostile or otherwise). It may be that the therapeutic procedure in the present experiment continued just long enough for the loosening of defenses (observed as an early feature) but not long enough for new defenses to be established. Implications for Future Study ' \ The most significant finding in the present study seems to be that high form level subjects are indeed more amenable to. change. However, even if the experimental data did show a perfect correspondence with subjective observation, there is far from universal agreement that increased "acting out" or decreased "acting out" or increased sociability or decreased sociability or higher or lower MACC ratings are categorically a sign of therapeutic gain or loss. There is no universal agreement that the withdrawn child is better adjusted because he later enters into more social activity or that 72 the formerly constricted child is better because he later expresses emotion more freely. Further research to determine the meaning of intellectual and behavioral gains or losses for mentally retarded children is recommended. This would include follow-up work to study therapeutic evaluation over a longer chronological period. In this same general category, follow-up studies to implement the present study in terms of extending the length of therapy as well as to examine the permanency of the above mentioned changes would seemingly also be worthwhile. Further studies which would incorporate groups at a much younger age level as well as groups at older age level would be of value with respect to form level ratings and potential therapeutic benefit. The study of form level as a defense or coping correlate would be meaningful in lieu of Haan's (1963) recent discussion which suggested that coping is generally related to IQ acceleration and defense to deceleration. A study involving a female mentally retarded population might be productive with respect to the relationship between form level and potential therapeutic gains. It has been suggested (Sarnoff, Lighthall, Waite, Davidson, & Sarason, 1958) that our culture makes it more difficult for a boy than for a girl to admit fear or implicit anxiety. Still another implication of the present study is to be found in the further examination of what constitutes form level. If it is a factor predictive of a "high order" type of intelligence, (i.e., abstraction and generalization) and if this type of intelligence 73 is a determinant of change in psychotherapy, it may be that techniques such as factor analysis could select the specific factor required. Thus it is conceivable that a short "specific-factor" test might be used to predict therapeutic success. Finally studies such as this, in spite of their inconclu siveness, add to our general knowledge of the impact of personality variables on intellect. Thus it is hoped that it will help individ ualize the study of mental retardation. It is felt by this Experimenter that any study which will help crumble the old tradi tions which have for so long assumed that "an IQ score" is the final word with respect to potential, is worthwhile. Further if it demon strates even to an infinitesimal degree that the assumption of homo geneity among mentally retarded groups is outmoded and obsolete, it has been of value. CHAPTER VI Summary The general purpose of this study was to investigate the use of Rorschach form level as a predictor of intellectual and therapeutic potential in mentally retarded children. Supplementary problems included the question of group psychotherapy benefits and the influence of age. Subjects were selected from a diagnostic category of "mental retardation with emotional disturbance." Subjects selected were considered to have intellectual potential inhibited by emotional pathology. It was assumed that if the emotional disturbance which was considered to be a manifestation of anxiety, could be ameliorated the subjects should function at a better level as measured by intellectual and behavioral rating scales. Rorschach form level ratings were used to predict intellectual potential not manifested on standardized intelligence tests, because of the inhibiting effects" of emotional disturbance. It was hypothesized that subjects participating in group psychotherapy would show a greater increase in IQ and behavioral rating scores than those not participating. It was predicted that the difference between the improvement in IQ and behavioral rating scores shown by the therapy group and the nontherapy group would be greater among subjects with high form level (HFL) than among subjects with 74 75 low form level (HFL). It was hypothesized that differences between improvement in IQ and behavioral rating scores shown by the therapy group and the nontherapy group would be greater among younger than among older subjects. Finally, it was predicted that the effects predicted above with respect to age would be greater among subjects with HFL than among subjects with LFL. The subjects were 56 male, hospitalized mentally retarded children, ranging in age from 8-17 who were matched with respect to IQ, diagnosis, and socio-economic factors. They were differentiated by Rorschach form level into two groups (HFL and LFL), and randomly divided into therapy and nontherapy groups. Further division was made with respect to age, resulting in eight groups. The Binet (L-M) was administered to all subjects by a psychologist other than the one conducting psychotherapy. Each of two nurses completed MACC ratings of all subjects and a mean of the two ratings was determined for each subject. Therapy groups contained seven members and continued for 50 consecutive daily sessions. Since these groups were randomly selected by the "testing" psychologists, the therapist did not know the form level, MACC ratings, or IQ scores. The nontherapy groups received the same treatment as others on the wards not involved in the experiment. Following the 50 sessions the Binet (L-M) was administered to all 56 subjects by a psychologist other than the therapist. MACC 76 ratings were made by the same nurses who made the pretest ratings, and a mean score was determined for each subject. The results suggested that subjects receiving psychotherapy made slight increases in IQ scores but not in behavioral rating scores. The HFL therapy subjects made significantly better IQ scores than did LFL therapy subjects. But again, they did not improve with respect to behavioral ratings. However, the difference between the improvement in behavior ratings shown by therapy and nontherapy groups was greater among the younger subjects than among the older. When the dimension of HFL and LFL was added to the above findings it was found that while intelligence scores were not significantly affected by the age x form level x therapy interaction, behavioral ratings were dramatically and unexpectedly affected. The results suggested that behaviorally the younger HFL subjects improved in behavior ratings while the older HFL subjects worsened. The results were discussed in terms of institutionalization and authority figures, retarded ego development, identification problems, adolescent acting-out behavior and the lack of homogeneity among mentally retarded groups. Suggestions for further investigation were offered. APPENDICES 78 APPENDIX A Subject Information Sheet--High Form Level Age IQ MACC Therapy Pretest Posttest Pretest Posttest 14- 6 62 60 67 66 No 16- 5 50 49 60 57 Yes 12- 9 50 44 52 51 No 15- 5 61 61 69 68 No 13- 5 54 54 62 50 Yes 13- 4 61 66 66 58 Yes 12-11 58 62 51 56 Yes 15-11 50 50 74 74 No 14- 6 52 51 56 60 No 16- 6 62 67 70 59 Yes 11- 3 50 50 54 59 Yes 10-10 57 62 58 61 Yes 12- 6 64 57 66 63 No 12- 4 55 58 57 54 No 13-2 65 65 60 60 No 11- 9 67 71 63 66 Yes 13-7 60 61 60 58 Yes 10-11 55 56 70 70 No 14- 3 63 67 65 59 Yes 10- 1 57 56 64 62 No 14- 2 61 61 69 69 No 11- 3 50 58 64 70 Yes 11- 2 . 50 56 64 66 Yes 15- 5 63 57 67 71 No 16-11 56 54 57 54 Yes 8- 6 61 62 49 47 No 10- 4 62 60 63 68 No 11- 2 50 50 53 60 Yes Total = ! 606 1624 1730 1716 Mean 57.36 58.03 61.79 61.29 79 APPENDIX B Subj ect Information Sheet--Low Form Leve 1 IQ MACC Age Therapy Pretest Posttest Pretest Posttest 13- 3 52 54 50 48 Yes 13- 6 50 50 49 50 No 8- 9 55 55 58 54 Yes 10- 9 52 52 60 62 No 14- 2 51 54 43 49 Yes 16- 9 56 43 53 56 Yes 8- 6 52 50 51 50 Yes 16- 7 50 42 66 64 No 14- 3 50 46 62 54 No 10- 0 55 53 56 54 Yes 10- 7 52 50 52 53 No 13- 6 61 60 62 59 No 9- 8 54 55 60 58 No 9- 3 52 50 67 68 Yes 13- 5 51 54 45 49 Yes 9- 9 52 53 70 70 Yes 12- 1 53 54 60 56 No 14- 2 50 51 54 55 Yes 12- 4 50 49 42 44 No 13- 6 61 61 66 69 No 9- 1 50 " 50 46 46 Yes 11- 4 50 48 57 56 No 15- 7 50 49 42 49 No 15- 0 52 50 50 58 No 15- 5 51 50 59 60 Yes 9- 0 62 62 72 72 Yes 12-11 58 58 62 62 No 15- 8 50 48 62 59 Yes Total = 1482 1451 1576 1584 Mean = 52.92 51.82 56.29 56.57 80 APPENDIX C Subject Information Sheet--01der Group (13-17) Therapy IQ MACC Form Level Pretest Posttest Pretest Postu. ^t No 62 60 67 66 + Yes 62 67 70 59 + No 63 57 67 71 + Yes 51 54 43 49 - No 61 61 66 69 - Yes 60 61 60 58 + Yes 50 51 54 55 - No 52 51 56 60 + Yes 50 49 60 57 + Yes 56 54 57 54 + Yes 50 48 62 59 - No 50 50 74 74 + No 61 60 62 59 - Yes 61 66 66 58 + Yes 63 67 65 59 + No 50 42 66 64 - No 50 50 49 50 - Yes 52 54 50 48 - No 65 65 60 60 + Yes 51 54 45 49 - Yes 54 5< 62 50 + No 50 49 42 49 - Yes 56 43 53 56 - No 61 61 69 68 + No 52 50 50 58 - No 50 46 62 54 - No 61 61 69 69 + Yes 51 50 59 60 - Total = 1555 1535 1665 1642 Mean = 55.54 54.82 59.46 58.64 81 APPENDIX D Subject Information Sheet--Younger Group (8-12) Therapy IQ MACC Form Level Pretest Postte st Pretest Postte st No 50 49 42 44 Yes 50 50 46 46 - Yes 52 50 67 68 - Yes 50 56 64 66 + Ye s 55 55 58 54 - Yes 50 50 54 59 + No 62 60 63 68 + No 64 57 66 63 + No 54 55 60 58 - Yes 52 50 51 50 - Yes 58 62 51 56 + Yes 57 62 58 61 + No 52 50 52 53 - Ye s 50 58 64 70 + No 61 62 49 47 + No 50 44 52 51 -h Yes 55 53 56 54 - No 58 58 62 62 - No 55 58 57 54 + Yes 62 62 72 72 - No 57 56 64 62 + No 52 52 60 62 - No 50 48 57 56 - No 53 54 60 56 - No 55 56 70 70 + Ye s 67 71 63 66 + Yes 52 53 70 70 - Yes 50 50 53 60 + Total = 1533 1541 1641 1658 Mean = 54.75 55.03 58.61 59.21 + = High Form Level = Low Form Level 82 APPENDIX E Subject Information Sheet--Therapy Group Age IQ MACC Form Level Pretest Posttest Pretest Posttest 10-10 57 62 58 61 + 13- 5 51 54 45 49 - 13- 3 52 54 50 48 - 9- 3 52 50 67 68 - 14- 2 50 51 54 55 - 16- 5 50 49 60 57 + 10- 0 55 53 56 54 - 13- 7 60 61 60 58 + 16- 6 62 67 70 59 + 8- 9 55 55 58 54 - 14- 2 51 54 43 49 - 12-11 58 62 51 56 + 11- 2 50 56 64 66 + 9- 9 52 53 70 70 - 9- 0 62 62 72 72 - 11- 9 67 71 63 66 + 13-5 54 54 62 50 + 14- 3 63 67 65 59 + 15- 5 51 50 59 60 - 15- 8 50 48 62 59 - 16-11 56 54 57 54 + 11- 2 50 50 53 60 + 11- 3 50 58 64 70 + 14- 4 61 66 66 58 + 11- 3 50 50 54 59 + 16- 9 56 43 53 56 - 9- 1 50 50 46 46 - 8- 6 52 50 51 50 - Total = 1527 1554 1633 1623 Mean 54.53 55.50 58.32 57.96 + = High Form Level — = Low Form Level 83 APPENDIX F Subject Information Sheet--Nontherapy Group Age XQ MACC Form Level Pretest Posttest Pretest Posttest 15- 5 61 61 69 68 + 10- 1 57 56 64 62 + 13- 6 61 60 62 59 - 14- 2 61 61 69 69 + 15-11 50 50 74 74 + 13- 6 61 61 66 69 - 9- 8 54 55 60 58 - 16- 7 50 42 66 64 - 14- 3 50 46 62 54 - 15- 5 63 57 67 71 + 15- 0 52 50 50 58 - 10-11 55 56 ' 70 70 + 12- 1 53 54 60 56 - 10- 7 52 50 52 53 - 14- 6 52 51 56 60 + 10- 4 62 60 63 68 + 12-11 58 58 62 62 - 11- 4 50 48 57 56 - 12- 4 55 58 57 54 + 10- 9 52 52 60 62 - 12- 6 64 57 66 63 + 8- 6 61 62 49 47 + 13- 2 65 65 60 60 + 14- 6 62 60 67 66 + 13- 6 50 50 49 50 - 15- 7 50 49 42 49 - 12- 4 50 49 42 44 - 12- 9 50 44 52 51 + Total = 1561 1531 1673 1677 Mean 55.75 54.68 59.75 59.89 + = High Form Level Low Form Level APPENDIX G Subject Information Sheet Chronological Ages of Groups Group Mean Range Older Therapy- 14.80 13-3 to 16-11 Older Nontherapy 14.60 13-2 to 16- 7 Younger Therapy 10.30 8-6 to 12-11 Younger Nontherapy 11.22 8-6 to 12-11 REFERENCES REFERENCES Abel, Theodora M. 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Creator Milton, Robert Gene (author)

Core Title Prediction Of Therapeutic And Intellectual Potential In Mentally Retardedchildren

Degree Doctor of Philosophy

Degree Program Psychology

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

Tag OAI-PMH Harvest,Psychology, clinical

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Seward, Georgene H. (committee chair), Jacobs, Alfred (committee member), Lovell, Constance (committee member), Meyers, Charles Edward (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-340470

Unique identifier UC11359129

Identifier 6412484.pdf (filename),usctheses-c18-340470 (legacy record id)

Legacy Identifier 6412484.pdf

Dmrecord 340470

Document Type Dissertation

Rights Milton, Robert Gene

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