A study of the organic basis for behavorial deviations in school children

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Content A STt DY OF T~ , ORG\NIC B IS FOR BE. !TCRAL DEVI TIO S II· C. dOOL C ILDREN by Harold rancis urks A • s tat on r te to t L 0/ G ~ -:)- #. T.~ ~c I 0 u. I 0 OJT ~ L A t al I lf' 11 ent 0 t e • l8 irem ts for t J r e CT _ F ·-r {.!,ducation) June 1 55 This disse1·tation, written by . ·········•·····························•···· ·················································································· - . unde,- t/ze direction of ..... ::> .. Guidflnce Co1nn1ittee, and app,-oved by all its menibers, lzas been p,·e sented to and accepted by the Faculty of the Graduate School, i11 Pllt·tial fulfillnie,zt of 1·e qui,·e1nents for tl,e degree of DOCTOR OF PHILOSOPHY . .. .. .... ......... .. ...................... -.................... . · •········································································· Dtan I Datt ..... ................... ................................. . I Guidc1nce Commitlc> • 0 -· p ,. ..,. I T T • • • .. 0 • ) - 0 C • r 0 • • • 1 • • n i....> • • • • • • • • • • . ,. ,. I. J • • , • I' • • • 1 ., • • • • • • • • • • • • ') • • • - ! ~ r 25 r.- i ...., • • • • -,- - L m~l J J. on 0 e to • r 0 -- • • • • I , '·, LI • • • • • ) I' • • • • _, ... ..., • I _ _, I • • . _,. _, ... • • _.., .• ) -r ... , , • .., ) • • ' ., I• (, ,,. • I TL11 , r • • • I, "'I ( . n ( , .c.· ·'. • 0 0 • -, - r , • ... • •• • . ., . • I . ,., ') • • • • • • • .. . ( • • • • ' • 4 ., J • PA ~ ,.J,. ~7 _, • ""< , , , , , , , / • • ' J. PT IJ. I • 07 l ,I I • • • ,I . I L • • • ... n • • • • • • • • t,.; • • • • • • • • .. • • • 1 .... J • J T \. . .. ,. ., .... Ac .,. 7 .,.. 7""1 lL. , -, -' 0 .., ,t • r J .... • J 0 r ... • • • • • • • • • • • e • • • • • • • • • • • • • • • • • • • • • • • • • • • • ••• V L I_J. • • • • I . , • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • - • • • • • • - • • • • T JI P rr--, e..., • • • • • _.,._ J • • • • • • • • • • • • . • • • • • • • • L E .L'"' rt l • v ,.,, 1 l l'l ffi: e. • • • • • • • 'J I • I • J • • • 0 • I L • • • • • o_ .. • {, • • • • ,I ( • l t • , • l p 0 .f • • • • • • • • .- • • l • TABLE children with 416 public school children • • • • • • • • • • • • • • XlV . A chis~ are behavior rating scale item study comparison of 60 rererred positive roup children with 82 xii PAGE 114 c ntrol group children • • • • • • • 124 X:V . Chi square be vior rating scale item s roup ch 1 ren ith 82 control roup c 1ildren • • • • • • • • • • • • • • XVI . A ran o er correl tion et1een referred positive roup and referred ne ative ro, p be v or rat so 1ale ite ranted accor in to statistica 1 port nee . • • • • • • • • • • • • • II . 1st ib t1on o tot 1 cores on The LJeh v or at1ng c le or 103 r erre ro pc ildr nan 2 con rol ro1 re acer in· to type of ,~G 125 126 trac ne • • • • • • • • • • • • • • • 127 .. III . istri tion of total I 1 s scores of The Cali ornia Test of ·~ ntal ,1aturit for 7/ r ferred ~roup children according to 7 £JG tracin • • • • • • • • • • • • 133 I • • • • ---- • r • , ' C_ .G . n ., ·o ,., t •..I . lC C / . • ., . .... '"'I .I .... 0 1 0 ' 0 0 C ,.J • -~ • • • .I...' _ e ' , .l -L C. :.a. o __ , I . ... e • • C r tt ,,. ,... · - - • C -. • • • • • ••• ;· i :t. 1. p of . . C. 0 ,2. l 1 • • • • • • • • • • ... • • • • • • • • • • • • • . 0 • • • • • • • • • • • • • • :'"\ -· .... - · - .... ,., ... .... . ' . '.) • • • • • • • • • .. T BLJ2J • . • .I .Ll t"'1 ,::i e cl.1 ,.., 't'"\ ~ u J... . , . • tt ,..., _,.., . ,... ., . -, v ..., .t. v.!.. .... ... .e c-. ")"') .. >J - "."\ • • - ., .... T ... 0 ') ,... .... • o..J - · t: ., 0 - • C C • • • • • C 0 0 • • • .(."> ,:, • • • o-~ C ,.. .. - • • • • • 0 .. "'I • • • -· \. • • ' • 8C • .L. L, • • • • C • :"' 1. V .!-J . .... V • 1 ,, • • • • • - I • • • • • • • • • • 0 6 • • • • - • • • • :. :,.V T LE PAGL • .. r"e I l t . Ol o: 1 J ...., ., "' e . "I , l ""1 a_..,,.t co_ t_o C ,.:.- en . 1..)u - -l / I • . .. ., . -- f') _; •. 1 ') G .!' ('.'I .. v ~ Ol" r- l I 0 "'I ll. J ... • • • • • • • • • • • • . .., . .. t . • _c . .,, .. , to t . I .n 0 • • • • • • • • • • • ·, J C C 1 I • • • • • • • • • • .. I • ., _ • . (") , ~ .., I 0 • • • • )I ·~ . • -... • . .,_ . I., . --. 0 C • • • • • • • • C PT Tjl .i...J \. I RO LF. DS:'I .ITI O_TJ - • t,1., , C J_ , • l ,:;) C L l C, a C L1 ., - ... 1 • 0 ( J_ • • - 1 0 e • 0 That this seemingly convenient dichotom~ may be indefensible on scientific grounds, has been ointed out by Cobb (22): It must be perfectlu clear to any p~ sician who vrill stop tot. ink about it t1at all disease is botl1 or anic and func ti na.1 because without or rranic disturbance there c n be no disturbance of function. The latter statement is obviously true because function is not an abstraction; it is the re~ lt of some or an in action; function cannot e;~ist \vitl1out an orcan ,vh_cl1 is ~nct1on1~~• (22:551) 2 For the ur poses o-P this study 1 t :-rill be con-ten .ed tha t the e is no 1 ear di 1 :ln lir .Le bet .1een the f nc tion- al and an .. c disorders. o,vever, c o niz nee ilill also be ta .. en or the fact that in o .. r resent state o i or nee tee i s see i 1. an on ration 1 basis fr c n 1 eri ce tin .ala or i li ~ o!'\ in 0 f rom tiss e st?~ ts as r in t in~ • r ~ t e life s ace n certr n oth rs a a tl1olo o- • • Tn r cent ears ncreased interest has een s1ovm in t :.e peculiar ehavi r hovm b certa · n .ndivi" a s. \ i th bett r m e ic .. ~ l i e o-nos1s it h s .. en p o s ble to ascertain rl. tl1 s _ me rel i abili t.. m n o ~ he e eo le suf er from pa tholo - involving cereb 1 tis s e, and that e- havior correlates see n Q'l ., ccom nr. • the ... ., ran isorder. It has beens om (2,3,2\ ,35) t t roun: chi 1 dren are . - arti cularl. "UsceAtible to central nervo s stem in t1r • 3 I • THE PROBLE?,! Stttement of the Problem ------ The pt1rpose of' this stud:v wt1s to investigate the possibility of or , nic brain dysfunctioL existing .mong school children, and to determine wl1at relationships t!1ere mi[·ht be bet,,een these dysfunctions and behavtor abnormal ties. Speci ically, two ~roups of pupils, one referred for id .nee because o ttn11sual behavior, and the other, a control gro p, ,ere exa~ined for evidence o cerebral tissue patholos reflected in electroencephalo rauhic tracing • 'i'his evidence ias t en compared ,d th those ins o~ aviate be vior patterns, knov,n to re, 1 lt from brain inj, rv, rhtch ere o'm b: n" o~ th se s bjects. tr us r d Le tie ( , ) refer to an exo~enous bran- n~ re (e or _.eno s) child is c o be ore, 1. rin or rter birth s rece ved an injur ·to or s 1 }ffer an infection o th . br in. .. s a res 1 t sue~ organ c impa r ent, e · ect~ the ne 1 0m tor s~stet mv be re~ent or absent; such a ch· .d mo.v s dist rbances in erce tion, thintin , an em otional b r, et er se. arat ~ l o in comb na t on. ( ccor n~ tote e nut.or-, the ~ollorlin ~our c t 0 1~ c nsJitute the basis or a brain inju 1. b • • . histor sho s evidence of injur7 to the brain trauma or inflanmator proce .., ses before, durln, _,., ,!he • '. ) ,.. ,.. • C .. ,. I ,.. e fact that ~n a ; .. ven case of suspected bra.in injury the bra·n wave recordine is the onl~ abnormal sign wist be ca,tiously evalnated because 13 por cent of a clinically n rmal population h s been found to have o.bnormal records." (89:51) Further.ore, "Lver1 ~rl.th. this added conf. rmation tl..e possibilitJ~ still exists that the n vid1al's per senti ~ s , ptoms -nd an abn rmnl brain wave recor~ are not necessaril related." (89:51) inall., t ·s same a t or e. /·presses t 1e bel ef' that nselecte sa.m les o" the opula tion 10 1 c ntain in i vi uo.ls "Vi l1ose in·tellec tual an soci la just ent s adeouate, tut in z hose ~isto es C }. 1 ·e t· • . , . . .'. c ce bra n ;_ r .. ) d for 1 1inimal brain t · ... e s spic i. n o _ t'1e re:J , _ ts .a. t 1 o ectroe cep lo --:ra. • • ex 1 1. n!:\ 1 on , atte .. " t < t t e fo lo,- in • · q s ti o s : 1. ·: ~t 1 t' inc . _ _ ence o no1 " t1a.l n · a 01., ,ial electro ce:1.alo .ra -r cincs r:on ro- n roup of o ..,_ er. e eh.a • or-pro le c • 1 c.ren as co~ pared 1·tL c ntrol ro of res1 abl~ non-beh vior- ... roble :.ldren? .. ., • C C , .J_c: I ~ ..... _ ~ • ~ 1 _(; ... ,,. ..... ... 1 .., .. '- • J_ ,..., "'"I - ~ t ·i_ C ,... e C( I •• 1 ..... . -f~ l .. .. . .. 1 ~ .;. . • • • . . - • • • .. • ... "'l • • .., 7 functional and or ~ anic :actors leading to human behavior disorders. Tl1e present stud;, ~ was primarily concerned wl tl1 behavioral _atterns as evinced by problem children in school nd the possible associated evidence of organic brain disfunction. ridge (10) has commented on th~ ia nos s of cere bral b rth njllries in ne\'lborn ba ·es. ·:estates that ce tain clin c,l sins are usuall _n ·i ence at h s earl sta . e o_ e eloprnent. e lso oe In a tin to thee obvio1 si, n in . in the vor. infant t e cl ren in 11 om t :ptoms are .1 b t n ne~he o br i bee so~ n? he th littl ide t r.ih e ven 1 n n t 1 s 11 o: n to sa--: of cerebr 1 m st be ot1er or transl nt e. " ; hat ·c1 n f ves n e -.ht n .1."a el to o:r ' oon o co to tl1ese a n est t d tor O bvi C lt 1 . r nt or pp on. fe.1 ci e s ... sta-~- c ... r .... ventlv tao " e., ne er o - · e 1 s ces e b "esse at n, 1 t· , ne a . licat·on o~ e 1 res • ( 1 O : 57 ) . in s 1 cc te _n t c e, _oi tin~ t t e existe ce o~ r l ter in- nee o m n 1 rain • n - t.r prev ousl rea ize. In this re pect en a ( ) s m e t 8 t he f ollov,in,.~ s ta te1nent : The infant m)rtalit-v stat-i_stics of the Ci.tr of ·~ Tew York, N. Y., for instance show that in 1910, 113 ne\vbor-n died ou.t ol' every 1000 births ; in 1 ,, 20 , ,5 ne ~1born lied out of t11e san1e nu.mber o irths . .. mong the en.uses o death "Con~~eni tal debili t.~ ~ and 1al fo1..,1na tions" ranked .~irst ,vi th a rate of 35. 3 per 1000 b·i r•th.s . Other ca11seG "aero : gas tro - intes tinal disorders , 16.4; respirator~ cisorders , 20 . 0 ; con- ta[;io s isease , 5.9. rin': the same p · .,iod the rate ~or castro- intestinal isor ers fell from 16. 4 to . 8 , that or t1 espi acor ~isorlers from 20 . 0 to 2. 7 • ..:>Uch spec tac .1la eclines in~icate a reo. t p ... o ,...,rcss in 1 e le l science . 1·0~1ever, 1 t l1as a tt acted lit ..,le attention that in the same p ..; "·od the rn ... ,talit rate c n en t 1 deb 11 t, an r:1nlro~1 (. tion has bean cut in hal • In 19 9 the ,1 -~talit7" rate for mal - fornat ons ell to 16. 3. Trms, !2_ __ born out o 1000 live births, ~h , as fate S 1 -~~ i-OR COngen~ta! actors, ___ in ...... __._• Ben a 1 plie~ tat n o these chil ren are l t 1th o n. c res s 11ich impede n r al develop- , ent . I t s r e rta • e states : r soc· et.. s not 7a e o • fa.ct c 11 ren tne~e re t least 6 10 h et n econ eed ere 11 " c tional u: t at 1. e~ t ,h . -· • s 4 eci c r tio n t e · r e ... ('\ti n, 1 , e 1e ic ~l u b 1"in c n 1 "\ . This 6 ... cent is serva i e esti- te chi 1 kel t be ~a jhe_ t an t o hl ·~ h . ( 3 :A.I II) c .tonal a con too lo o_ • e ._ c _ ion b cam e fective to - 'I rd t sence of' tee ce tional chil as~ e in evidence • . s truss a eh nen ( ) 1 ) oint out : A tc rme141.1 to the teacher v1as the gi-,01 of children who were not so deficient as to need nermanent in- ... stit1tionalization but who showed retardation of in- tellect ~al development. (99:ll) Hood (107) has pointe out that there are over two an one-hnlf .. il 1 ion bra.i n-inju1"'ed children in the T Jni ted tates, the m a jori t;r of t1hom are enrolled in the public schools. These children,i e e a), ..,e m 1 i a poor j st ent ince the. are not menable to the 1sL1 n.l kinds o inst~ "' c tion. ... ,. e dvocates special ed cational methods n techniq es in .ea in r· " Ii vh them. e ell ( 35) as l..s s to ssume t at ever~ child wl10 is orn 1 ve T s ilri te process: e eve iva t i on u on n ns the n versal ris~ o c rebr 1 in· r. ~1ven s . eci 1 s1 n 1cance to the b rth fact tha even b e ~ rods o ve s pronounce ·rsist n~ e feet nc t ion s ,ive :th it t e 1 c e , r a ies c n te 9 t • t e to n as ... 1 xia se · b ell-be om · far-re ~c cl n cal con- a be 1 v r r t he new rn o e I sens tive in c tor o_ his 7) (68 ) V n .ic n t l y o nts o t that those s ch ol c il ,.r n o n in l sse : Co t .. , ent 11 cl sses ~o r c il e iit be a r e . ~re e~ec t ive , or in rob e~s. I the are on nor al c l r n the a e o ten mi 1n e sto d. nt- If • l. e ·e· .1- l.t • C T) .:, l _ u t' "I . ,h ... ✓ -'- , ~~-1, • C ~-00 l,. C J.., .. ., , _.._ -a .... . or \.: ' .:. t 9) C ) 0 • , ... I • - Gtl • '- 8.11 , 4 l-- ('t t ~r I., C U'"l •.) Y• v . , • a .,e cl.r .ly t u. b ___ ., .... o . e _n ~la - o. .., ... ) ._, ..... , ·i l l, ') • .... 0 I ( ·1 , ?7 , 99 i - .., ., • • e • o :~._.,a '(, . -1 0:., ' r • 01 • 'co· _ CL,, ... • \.4 I Io ., () , on .. ., 10 , operate, students droppin~ out of school, fa ilies moving to otl1er dist~icts , personnel failing to complete school reco1"ds, and subjects ta ... inr: me __ ica tion, m '"' ke it impossible to obtain 11 of the bove nrormation on every c il in the t 10 ._ ,rou""9s. Th.e one exception to this is the E.·',, .,. tracin~, · ... ·.c11 ever/ cl...ild rec ive • Eno 1.1Mh Ci. ldren in e c~ ., i h 'i histories an tests t .ke on tl1e , ho"ever, to proviae s "icient u able ~ aterie.1 _or cm _ rat ve ur oses. In J n n t nce3 tab es of rt al : n u 11 e ho.to ert '"'e h t r n the . r sent st , "ff' re _ers to . , n b . c t ion, st icte · c 3c:tie ). ac ieve t ent, nc 1 , . e 1 n . ct and t j.1.ose cocn·t v S"1 cts 0 ~ or ren the eve • sch ol clas it- t t in • :nst nces call n f' r re- n se ,e circ - oci l z C ent ( e s r ent f' T 0 s V r er ~s 4 tho e . , l, e t t on.;, 1 .. no· :m as s c · · al .. e tio1 s, (!c ol ts • .iven t C •.l ers n lit . tests . on t nte 1- 1 o :ent of :s lit • to cr~o m certa n ta:..;ks . ...... , do .1 ·1 l i. t . L-~ . ] ,- -- I1 [) - •I , ... ,..., :. nci •·J • J .,.l , • l '-· "\ . "'."\ .. _ e C o_ .. n. 1 . l. ..... t e _ • • 0 ,., •"\ • 0 o_ D • ( / Cr .:1 • • • • 1., '"u ,._ k_,. Cr.,. 1 _ . '\ ... 0 / .r . • _ .. J.. O• o .... ..,, .1·. • • I .,..., I • • . t' ~l-. l D. • r,, , _ e ... .., - :) 2 . .0 on 3 . ., 0 ~o D J.. • v - r ) • ,) () :.. • • ., ~) ~ e ... d ., 11 0 a, nt ,l 0 f·" l · -- - 1 . C .;) • • '- . .1C .L 0 ., I • ·- .., - cl . • 1ot 1 - 0 "1 r:, 0 ,. • • .... • 1 . t :..,ea '"'L V . I .., • .,_·1~ 1 ·i t .. , j 1,. - - as . ..... I'. 13 non to rm 0.., mo_.,e ot c:: I ,; .J .I. 0. "') t • d , , ..J.. v 0 ,... ..,J •. ,t t .('\ J . t· e rt .... , C 1 e ~atholoGv thr uch th use of the clectroencephalo~ram. The principal method and the criterion used to determine normal or e.b11ormal brain function vras the lectroencenhalo- ... gram (EEG). 1 ltho erh the EEG has beon emplo::red _n this manner, it .as not ens .... estec that it ",l_l p ve to be the stick. T e c tion t' t 1 , ... tte· te t ans r,er evolve .. e t e iter t .. ea ,,t t' _ e res lts o~ ot r s ,L 1. :.;_ies ··' ·.c ' a : en avoured o s '"' · r at n. - ran bran p tholo~ . • These crit·cisrre concerno : t1 t e r ~11oa~n: 1. The "o ( t as ·o t cm~acte st cs ares in iv d als . r o .. m onl not t b r 2. mhe q es ·on as tote et nt rain-4n red in . t l ossess i tics. be :m oria ~n- nj red e ree t t c _ a ac ter- 3. he ncerta:nt a o t1e re _ ti I o s c nu 1al be a.vi r, , c. is re u bl.. es t of an or:-: n c bra.-n bnor lit,, to certain n ~ro- le ~c 1 s ns or or ner~ · nee on s cholo cal tests. t .. at ot er a I • • ra - 7Il in ~ 11 ~ 10. -T -~ l . _ le e SC t 1, lj_ t. , in the sense th.at t co ld a cJ o al in·tr o~ c 11 ave been th ,, it. · ·· t 1. n have led to res 11 t o In ore r to shed adcitional li cht on the p,oblems ... _. '- • I .1. L, C. ..,. ( , .. • r ., . ·- ,J , ,, • J. . · .L. IJ r.:' - ' 16 to certain behavior characteristics, (2) how the :E can assist in the dia.c;nosis of' cerebral patholo<:r._r, and how it correlates \vith other variables (i.e., sex and a'".,e). Chapter III gives the research backeround for the stl dy, sets forth t'1.e mate!'ials used in the rese rch, and describes so e of the ore ilnporta 1t proced res used. A sep rate cha. ter was considered necessar~r t sho\v the dev lopment o~ The Behavior Rat n 'cale (Chapter IV). The next S X Ct.'lapters ive the res1lts 0 .. the research. Chanter concerns ts .lf :1 tl1 tt~e elect_ o- - e cen lo ranhic exa ··nations o:.. the re crre . n C ntr 1 rou~s. ince J. 18 e ~ ti u cale escribe ev ate behcvior of a 1 .. nd th u.rrht to be ass c te rith brain in r , t as treated se ... ratel in Cha.a; te ~ .., I. ha ter VII s r zes t - re ult of co . '--ion sed nte1li •ence tests 0 an .n V al n 0 .,. mt r • The ext ha ter, C pter II f exa nes 1e • nd n s erive r .. the 1·c t · n o_ .n nte lirence test of 11 V S 1-rr-otor n t C t r I set .I"\ rt t r ts Of C . n ac 1 eve ent t _st • n 11 . ., , ot acto s ( t t ~ • • s) t t to b ass ci t d th n r _nc ·_ n r .,a • ·, C cereb.A.al pa "'holoz are tre te . in nter • J • T s t e t 1 rrica I... 1 ivide . o be r n t 1e . 0 '""in- C l q est n ~ a ted earli r., n mel t. or . , .. : ___ c C' --,.. '" . ... • ~ _,._ V .., ... ., -.., • I • V - · .. ? • ' --- I• ("" ~ 1 • e • PTE V OFT ., 0 • C 0 • -.. 0 II i- t • T'( _ffi l .J • .... I., • .,.., . . J' "Cl 19 l. "ll1n t is t 1e etiolo {_~ y of braln injury? 2. Jhat are the behavioral manifestations of brain injury? 3. ·Jh -t :ts the value o_ the electroence ... halo [.!'ra. in relation to braln in·urv? I n particular how does it: a. s , st in iar,no is? b. Rel te o be1avi .2 ch.a_ac ·'·e:,is-c·cs? c. CJrrelate u~th ot er variab. s? - (n tinen ( 9 , ) t - ra. n- n re 1 c 1 1. • J. ~ .: e f'ter h r c e : t v e a. _._ n · · 1 r.,.. -to or s ~ ere d a · rec t · . n o ~ t ' e n ." (a :l ) • - ·1 ., • t e -~ s ( 2 , 3 , , 7 , . 9 3 , 2 ) e st t e e i olo · c 1 factor le f n to oss be • e .. c or e tJ e ead11 s: 1. 8 Va fo r ) S On V t ~id c e cen its, nce_l 1·· tl1 t ., exanth r.?a t , · hoo _ i ~ c Cho (rhe mat·c ever) . 2 . r.ihe V i us n r\.1S 0 o,_ en c s t e nen · n,.,.ococc s ( ,., . th 1e ·n , st e tococc , lococc s; nee llB. . t · s s ·~ th scar r ra ·- r n on I 0 ost 0 • m .:.e o lrn C 1 ... o thies . , • T 1e tr c st t e s (n t h looath· es . c 1 • t·s ass ci tad :>~ e h . 's ence .. ha t ... S 1 C 1 1 t s), ne .ococc ls inc t n et .. eve , er - e n m s t • ., - t· • t -n tal) . 5. T~e c .rebral n s ( re att_it;-. (6:1_6) , 20 In summary, Cobb (22) has classified the patho lor1'ical processes that ma.J cause changes t.1ndeP four hean.inr~s: na r.iel ~, ( 1) tu1nor, ( 2) trauma, ( 3) inflar.una tion, and (4) metabolic. (22:5~~) Behavloral .1§3.nifest~tions ££ Drain .Qlju:r_.: In general m st writers c_asstf~ the ~f· iculties that br~in-injured c'J..ldren face ... nder che followin eadinn:s: (1) otor, (2) erce 4 t11nl qnd conce .. t1..1aJ, and (3) ~notional-~oci~l. /otor . Tho1nn on (10 ) notes th t the "01" J ni c driveness" .11ic . is etennined b-v n brain stem isorder, is ch racte~ize b, a hi~h de ree of h .erkinesis or an a 1 ~ os co. : lete in hil t.,?' to ma .nt .n att t es. ('1 • 1 Ver { ~ 2 ) s p e ks o · ':' a ' 0 r~a ni C s yn r O - e , It C 11. • n - c lu e t e · ':' 110~.- • • • ··e s 11-:-- e1" 'ine tlc i a restless ex lo,..., ve 1a , • 2 . • ru, t " nc -:e sho 'I ~ • C ,.. 1. C :, S f ne 3 M , act. o· tr . e s l. s ts 6. • or m.oclon c ,cv · e~ts. 1,, Cv ac · on in . scle tone ss, synl.. - as~ociate m vem ts, ants.on- oi tive re lex c~·vib. rsev ra ve pa · '-terns . av t, pla . 2~ ... . c- -) 1 t • t • ("'t t; • e ,~ l -rr • l"> .J.. e •.J 1 ' ;. " i • , .k , J l.; <.. • 0 l . ") _, fp ee "'I ... • 1c. (, J C O.r V , . ~· ,~ C (:\ , , ... 'V t . . • ~ , C ::.1 . t~ ··; r . ... - ,_ • i ) i '.J .. t C - l ' • () 0 22 c ncernad ·wYith v ..:lunta.2.r motor activit;r and g ive rise to the pyramidal system o" neural fibers. Here, destructive lesions cause weakness of the face and extremities 8 ~ the contralateral side with inability to pe1.,· ,, or1:1 fine, coo1"'dina tee n1ove1nents . Irri ta ti ve lesions cause conv 1 lsive activit . • Destructive .. lesions of the lower aspect or the posterior portion of t l1e fro11·tal lobe in the dor inant he1nisnhere ( th.e left in r· ''l'ht-hande persons) 1nnv· result ln a · s turbc nee o~ speecl1 corulned to t h e ex )ressive spl1ere; not kno~- in :) ho,·, to speak, the .. a tient is inc a able o.a 0rfor ning the coopera · ive r1,ve nents indispensable for the pr•oduction o.L speech. (89: _ , _ 6) c omple te revie\7 of t' c .r . l ex ✓'unc J..i ons of tl1e vari us p rts of the brain n re ation tom tor activit ... is impractical f or the purposes o thi~ stud,, -. L· cas {76), ho~eve::;~ns e ve an excel ent esc i.ti no~ these pro cesses. _ erce ... i ve _ (J2 ) states that l e i te since he does n t see, hear, or eel the ~r r d the ·:a: ot rs o . heen (2) de o_ t rate t _ _ at .an at ents 11th or anic isease su : e var--:··ng de .. ::re s or time ··n s a • . ern r {112) s ors th t c ildren 1·th nt der·cienc lti ~r • • • are of'ten ~ n ble to inte rate re or J.n r ele · ts 0 1. the 1.0r.;»cnac est . tr .. (102) ~1 , that brain-inj red s a n ' , er er C j_l r n - V A. Il I .i or 8 .1. S C nceptu l thin :in ., en .L ev ar :; l .. ed, ., r inst r~e, to r'"ro object The~r • co t O 1 ten to for 1 m re gr .i.: s an f eq ntl r:- ve more uncommon responses. Their principal selection is often based on accidental or apparently insi gnificant details, and the,,. are markedly attracted by properties of objects which elicit motor responses. Zmotional-social. .ru ch or the be ha vi or o. t:I t e brain-inj red chilc seens to res~llt fro. his attempts to compensate .:'or or circ·1mvcnt l is problems. The bra n- 23 1n ·ured 1entall de_ective chil, accor ·n ... to trauss and ~ .. ern r (100) is c aracte r lzed b .., t 1.e fol1o,ring 1avi r: re 1. Porced res .: O !.siveness to s ti mil • The bra n in ·ured or -:-»·anis n is influenced to nn abnormall h ~h de ree b external stinmli. 2. Fixation and e severation. The brain-injured l e, rhe compared ~1th n nonbra n-inj re child, ma.ltes a si =>n • r icantl -rea ter number 0.1. ersev ~ra tions on senso i-motor tests. 3. Insta ilit~ or fl ctu tions of re ctions. - brain-injured child "cannot st·ck to the o nt." often unre listic nc tencs to tr nscend the re t e o the resent event. . • L.etic 1 lo ty an pedantr • T 1 brain-injured chi 7erstre ses or e_liness. 5. , ubsti~tte activi t .. • Th brain-inj re ch ld ten to en ens te ~ran ~m~aire _ f net· on b ... s bstit1tin .. a P net on r c ncit that he st_ l .__ reta:ns. lver (92) ha. stated that the eootional an s cial n e "-1a--be assi e nnd ith rawn or a O' . re s· e an n e k .L. 8t., c, al thn , .,.h there is r.re t ca~Jnci t T f r ident - ·- ~ ·cation an eep emo :onal actachments. • 24 The "catastrophic reaction" of the brain-injured child is described by Strauss and Lehtinen (99) as the reaction which usually takes the form of explosive crving when the child is conrronted with a difficult~ which to him appears insoluble. (99:8¼.) Accordin to these authors, daydreaming is another comtton feature in the behav or of these c. 1 ren. ss an ·.erner (101), c lttes in •.; ro'1.., djust ent ma~. occL1r beca sc _ ,.. na-tic .. 1.lar be vior ev .. ations. Tt _s ... ost 1 te t t t __ exo ;-;-en s ro p o.~ r . n-inj 'red c h_.l n _ e~~atic, nc r nated, uncont lle, ( ·s·n · bite~ , nd oc:a11~ 1nacce te, as c =- ... a.re ·,ith to en or- n · s ·ro . .A. 1hose ehav· · or in time is c o ~letcl .. p rt f r.i t e c on onl cce te J ctu· e or .,. o 0 anic ehav or. ance in an .. estat· n o" cerebral hav or t ro nent a ·in ( 2) • The e .rl un e in ch 1 ren, cco_ in to s .. ptoms incl d h er- kines s or h er otili t ,7h ch e 3 these children to c ntact -~1t r n, ~ore mple, over ttent n • a s voness. hn t .., r -re... 1 . e . '"' c-how u ... r ,.. • C U 1 ~ n Va ~ri n,,. d. ~xplos·ve o t, rst a .-· cc l_ { "s " a ge). r n- njured c 11 ren, accor lin .. to t his a1tlor, are 1 .. pulsive uith n . thought ,, C n 0 h t · l) e r., • , e l 1...:> • '""1 tl t att ~ tio • ..::, Cl ,.., .., O'•ts t . , .. • " .. ( 1) . ..., C . '0 .,.., . ~ o: 0 ..,c.-. l l • ,le ( ta · • l n - 0. P. ( f • ""\ • - ... o.,~ ~ C ) V J .L J. _., 1 - "- I., i.:,O 0 C • , - • - • • • a - 1 • a . f , 26 fiber is associated with a. measurable change in electric energy. V here the nerve net,vork is re :.a ti vely ~imple the problen1 of measure nent is corpespondine;ly uncomplicated. -~, t h . w ·,a er as given a of EEG apparatus. b1-aief l1istory lead.in::- to the development He points out that the Greeks larbely i 0 nored the existence of the brain. In the interven:ng two thousand years from the Greek to modern times little in- terest was ev denced in the ""ttd -. of th s or(san . round the time r. f 0halesneare the 1 . nato .ist ~..a. dis c vered the .. bra.in, anc as ·.:alter (110:42) s a,_ .,.s , "Dissection ras h. h a vent re in tl _se da~ s." m~ lest e n t 1 r~lisl1 ~ra · 'e spec 1 1la t:i.on o D .... avid -artl n l 7l. , in ·1 • c he ~:ta --e the st · rtJ ~ s1~eesti n tat h. t C . v •1e c ( v rat· ons ) : n the r 5-n #"f'. ve r se to " t 1 J.t is to a prec · a -e _ . _, e o .._• eina_ t: o __ Tartle .. 's oti ns. al vani, cc o ,.., n .... to ·. ·"a t r, ~ in 1790 a e eno ._ 11 el ct · cal eApe iments on ni4 a .s to con • ce tha m t t .. eo. form o-r elect1ic·i t der.:.ve - fror1 11 v n rr I'Ocesse • ,, - n 1970 Pritsc _ n tz ~ ttto e ic · 1 -~ · _ ,1. ·c -~~ o~ a ~r ss an ) I ,, • ,4 - r r, '· t ·'- e .ua "t e teste ,.1 t e e· •. ect 0.1. the l, ' • ·- vani c C 'lrent on t h , ex -'- os e • Q )_ 0 ... battle la - t·es. T-'- tAd ce~t • "' _ ea ted 't! ~ " !lt en __ n e ... e s ~ .... 1 ...._v ' nt to k l'-ce • t :-_e • • • .. the oor"'~ • e .. J. o_.,_OSl"Ce s e o ... • 27 Jalter ~oes on to state that an 3n,lish p~ysician, R. Caton, in 1 75 discovered that the brain itsel~ pro uces electrical currents . 7hen, as ·.·lalt r states , Hans .s>erger, in 1 1 29 , fo1nd a 1. ore precise met' od for invest~ - a tion of an electrical brain ctlvit •••• "Another majo1~ e rent in t1e nistor," of ph - e - h lo ... • l1a ta.ran .. l~ce . " ( 110 :51) ri ue SU , arized : Ians ercer, a s~chi tr st, fro ena, ~ 1as t 1 e i~st to find tat t electric l ctivit~ o~ the h rn n rain was 11 e S' a, le a.. that satis ·, actor recor~ co 1 ~., be mane t r u .. c !:h the nopened sl t .l an seal . • . rte ro t bccn , e c 1 e ant to im that in s.ite o tho·~ .lt nlic t~. r and couple .t .. of ne ve ce 1 ~anl e~ent int e bran t e 0u.1m~tion oft electri cal 1sclar es too the ~or or e~i t .atterns that ore lat onsh· to the state o"' th .tn .. vi ua • e _ e t c c n t • n 'IO.. . • e . v o 1 n t e ec t es o "b in st • " e es , ob"er o_ ened a or ,.t lo ep le s . • T c t e ·scover o t exten e 1 . . an a . 1. . e t e o .r t: e_ ctr:c ~ act:vitw o t~ an. C ie V .&. IJ e o:t. tne 0 -' , accor in to t wa (. s ve tr.1 te s of t ~ b ain, especiall r e.. 1 .. s • s _e s s: e ear t C 0,... t _ e ... et • t , 1 va · et. 1 7 a a tt _ th~ · .., 1 . a ... aia. ·n t. eco ;ni ion o~ .or cases and ml essenti _ e lens • he .. .. t . e ce O ;. t e lect oence :,'1alocra w . e - a d- pike rmat· ns so~ ·ht r ne rolo - 28 g·call~:- to ,)e norn1al pe1~sons is somevrhat difr c lt to 0xplain, except by ass1ming a Slbclinical epilepsJ. r. ost cl:_nicians d <. not co11sider the ,rave-an -spike al one to be evidence enou ~h for a dia~nosis . If a ce_ebral t1m r or ot er dest~1ctive process is super ficial on the hemisphere, it way occasionally be de monstr\.4ble solel b~ the electroencepho.lor.-ram. l1 ore often, t :ie ~:. n(1. nc:s a.re merel;T corroborative of localization.1 udequutel 7' establtshed b~.,. otl1.er clinical .ethods. Invest.t ations atter1pt· Tn., to relate tl1e 1,•1aves to s . eech. patholo ,..,.~ hnve not elicite l~ an-t, con -istent dif ere 1ces bet, 1 1ecn stutterer~ an 1 normal control s bjects. ( ~0 :303-30L.) This sa 1e a.1tht.., r po n"'s 0.1 t t at a tte .. 1:pts t o relate '1e c_oct_ oo ce ia.lo rn. to cere r 01n. · nance, intelli- ence , ps .-chose , ne roses, an" ot .er ps:cholo r:ical r~ctors, h e not be o tive th , t _e st t o tne resent ti e t est n i e a t1ons 11 1th n o he c ors. I"\ r ec e 1 t 1 n t s t t e .. e 11 s: s e t·• I a ... e ce h lo '"':ra o. • - e 1zes s b r 1 o~ bran- roe n I:" , a . a . eta n,,~c t ve 1 C n 0 th bra· n · o n C S lo n, ot' br ·n lo c are o te of pat bra·n ruction a • ( 25: + ) ~e . e ·st- rain n be c, lar value hich cannot w a brain le ion c n e lac te b n d c ibe b _ri e as oll s: ri th n ~ G • 29 ::2!lectricnl activit ... -r is absent in a cerebral scar or t,,n1or that conta·ns no living nerve cells. i~djacent to s· ch an nrea, however, the nerve cells are function inc in an abnormal way due to alterations in pressu~e relati nships, circQlation, and spinal fluid draina e. At a somewhat ~reater distance the disturbance is less marked and - ~tnally fades out completelv. If one electrode is place close to the .~ocus and t~,,o others on oppos~te s·des or it, one of the latter will sh w an tp\var . v,ave v,h.le tle other a downward one. Tl1 s phase revers l~ l is the evidence on Yh·ct~ the most exact localization o· lesions can be de. Local lesions are m st easily detectec if the~ are closo to the surface oi th . c, rtex. Central or basilar foci can be reco ,nlzed 1r ther rrect the str-ace t o ~h in: iltrat on, . ress1re relati ns _s, 0 1., con 1c t · · on at _wa rs . In add.: t ion if one or the ipolnr electrodes 1s place c on the lobe of the ear or in the na oph r , ~iterations - ~ . e rave led bttt are less strikin than in the case o~ s rrace 1 sions . upo o. ic s ... il..es ~ a. ,· ... ear, t ere m e nte rrn ttent 1 re 101 waves, or 1 re 1 ities in a . tude. s a Jneral rule ast ctl vit. n s ikes ·n ic te scha re~ fr . rt c 1 ce ls 1h le lar, e, lo·,wavs sall'"fra _se roms1bcr t clorbas· r .. ar s. . 1'.'I n the . if!.'\erences et en lea , the • .. ne 1 loc ti n o.... ee l i ,.., 1 s o ma . be reve - ed. (10:53;, ) 1 1 ( 50) oinv .... n n; to .. a t rat n ... r c e s or thn ano :-,hc1te ~t n. 111 t o .... t he J~G c.1a etc s s ""U .,l ard and vi ible • ,_ r:ns • r · nst ne e, e s a s "It is interest n t t t e t ueta r~ thrn, t e abnor litr ·n the a, lt p cho- pa , is so o nd in e ces s int e be a · or- 1 r be ---- chi d o· the sa 1 t ;-pe." Th t th e is relati n. ip e~Neen t e lectrical activit i th c rtex an the Jl ~r:J OA, 1 t, of 0 t l , r, 0 ') :1 ... OvC "' ~ .. .1. .... ~Y ...... .. b ("I !:\ _ .., r· • ., J Tf e ct · 1 .1, J t. L) ,., ' T ., e • ._._ •• ... ' t t 0 . -, 1 .... ..,... . e j . '"' ' I.I . V .J . OJ 1--. • .I- 1 t :_._ ... ~c "'I r.. o ... e n 'f') i 1. '.I L .&. .._, • ... , ♦ • ' ,_ ~l 0. n ("I ,.....,...,0 I , Jc. G r , ; t; o:r .. r""CI • l l J.., o ·-,s C ~ J ~- . 0 - l., - I ( .... ver . .., 1. J ) .. .L..1 C .,, .. J , • • v 'I'- J. • .I. 0 v • ..... ( - < m .. , 5 ) he: ) 1 ., .... :;:; • e - .. t- u J. .. ~ .,. n ..• ... • ~ "' .. r, c . • I ._ .J- ,J 0 0,: 'I ') • [ , .... ... _,, ... C. ) , C • a lLllv 0 0 • 0 ,. I - 0 ... ) . - _ ,., • t l • J . -~ J - · :t(:11 t _ C - • • t • . ,.. •.J '"'0 !. .l. · l, ; ... C 10 • G 0r , ... n . ., , . l ,- ,q .f' 5-8 , 0 ... s .I,; . .., 1 . ~ I • .lJ '"' tr·av l e o:: 2-5 p/ ( "'I c... I ( 3) a I C h., _., d b-1 - • • ro 1.- ~ ... l. ... ., ,. 1) . .7 ") I ( • - C ., 1 n - • - • • , o :_ " d t • l. • C • .r. .• '"' ,- .... .... - _., l'l 1 t t:P.c,. ~ --, ,.,_ ,0 ~ • e ) 1 1 eJ e .... ,.., -- ' .. ., ... ) • • • , .on ( 13) ;.,) tat:: ,c1 • ' .... l, I .. } . 1") J - \ r , .... ') - . . -. • YJ • - A ~l( i . ~ ("f 1_' .L • v ., "' t i. ' •.J r 32 ,..., t o.f 20 .. ,-,t j_ { 0 0 0 .. ...> ' ~ 1 ( ·- ;"'i CL.J I - I.I ' De I • .., ~ ..., .!.. l ...., J to · '. <1 ' r_..,_ • n • -;n, () ... --1 ot ., • l J • , • ♦ • ' • .. . , . • • • • t ( . t ,. . . .... • • ~'Y v r , , I ur . .... • ( 2< • ·, .. ' l , ·- ... 0.,. ,_ • .... '_J.. !"I .. •J .• u e C D. 'J • • ,. _,, _,, -, J l} • • C 1. 't ,. •J .... _ ., t () i ..(. v • ( 7) 0 • • 1 t; ,. - • • ' • • (• _, .- ) ] n ier r, f- C. 4 I I ... t ,_ '\ t t, C "1' e 1. e, ... ~ J of • .. , ll"'t ' s to 1- - . ) 1·- .. 1 ....iLU' \. • ~ .. )oc L .... .L ) 8_ I ·, !- • T . . 43 , k 0 ., (.A _0..L. - t n C , , • l 0 "' J. 1 ',n "' n • _, .., that there is a certain "choppy activity" wh1.ch. clearlv s11 Jstantin tes a genetically oriented organic concept or this PS:, "'C hosi s. In a gt 1d·J of 55 l1omosexuals at the 35 Prl. . nr--1_, 1 el ~ -t •i s ~ <.....) - • ! - · - .J 3ilve~m.c.n an ri .~d·cal Center for ~ederal Pr soners, sennf J.. (93) foi.. d .at1olo (. ic or borderline ESG tracings a.mo~ 7~ per cent or t e z ro .., . In n ::--'~G- evaluat on of _s.chopath c ers nal:t t - ~ott • n Gottlieb (62) ~o nd 5' 4 per ce t abnormal tracinzs o.r.iong 6 a~ults. In an thnr study (63), these sa,e a thor found that amon µ . ~ patients ar.nosed aD svchopathic per~ nalities 52 per cent .id not~ et th cr·terion or norm 1 in examination. Leonardo (66) calls tten· ~··on to the im lar- tv the ... . ·:'s nali tv cho.ro.cte . --is tics of' e ilept· · cs and s ~ho aths. T_i 1r te n tes that st ies have "~ovn • t bnorrn lities t1at re e fo1n n be i r-proble1n n ·.nvesti- • c i c. en ar -,a tion b s (-> ) co . es t nth t · e e to s a:i sl cni . - icant ,.., r ,ors a e cont olled the_ e are no nces to be o ~nd n t et~een crln n .s m c ntrol s bjects . In th s st1d~ ,52 prisoners vere c m ared wi tl1 1, ,32 contr ls. It is interestin·~ to note tl1a.t no t cor~el tion coul be o n bet·een t e ...., _, t ✓~ e of' c rit~inal ehavior. . , It ell-knovm thnt man ·nvestiqators (54,61) Ot ( +- • C IJ , • L, 0 J_ J... . (. ~ ,- e -, ~ .. 1 0 • ... 0 • .. 3 ., n . ,.., ... ., :, I ,.... r ... r., ....... . • 7 0 o::; • ;) .., ce C ... , ".) • • t 9 CL 0 in 1 TJ. _; n . 2 e l II n ~ • ... C ) ,., • 1 ... e I __, ..J ; ) ~ • .. t.., ·- • t (1 +-9 / 2 l") .. .. • • • < """>,.. .J,. . c.... l, C J. . l,1 - 0 t 37 degree of the difference can be made, and Lindsley notes that the difference in the frequency for sirls is only sli 0 htly hi c,:her than that of t1e bovs at 11 and 12 years o" age. :rottlieb, Ashb-v and Y.nott (}_12 } state that Llnder statistical analysis the kinds of E.r .!JG abnor1n 1. ties nere i.lnrelated to o.._,e and sex. I~ott n . rottlieb (62) arJ. ived at the same c ncl tsion in an e rlier st~1. : • ne · '"' J ,h most s tri kinv features "" t .e :'l ca ti of t 1.e - , - .... ,4 J is th . renter inci ence ot'\ o.bn r. it . nt cer- tn.in - e levels . G1"ecnb a tt ( ~.j 1- ) state.;.) t~ t i 1 t e - • r isa t 1 1 e fnc tor O.L a , e c nnot be o e loo ,- d • At bot 1 c~<:trer:1es o: life , accoI ~ · n ,.. to t' is o. ti or, t e_,,e is a ra.L i and ?inle • n 1.nc Pe ties, a.11 . t_ 1 a~ on ,,. . - t l . . :7"rs _. {91) fo.tn nee o . -, I I r • • a pro ;rescive increo. e c nda n no" 1a e ., "ease n _ 1"'rt'1 l rec r <:.s i t e in ,.. · e ( a :-: e s } ~ to 1 1.a 7 1. L· . ..._ cent a· no a es 1/ to 1~ 1 (: ' er .&- ) Lr cenv - ren pre ..... en . n· J be r , 4 ~-sor e:1s. _n :,e~ .:. ect ..L -f-' e bl 0~ t • V V ! l - re- .... a tion 1ip bet.1ecn t e :;:..,G- a!"l · · ntelli ~ence, t. e . " d data~ o i e little ..... tL t t i1e "· o are c rre,ate to nrv ( I ) disc vered n C ns co:,re et ·reen occi.:. ital al. fre u nc . at !1: s and 11 ear nclusive • • t S0 __ 0 D • ) l ... 1 t:. ... "\ ... ( • • • . · ( C 0 t , ,..., I . • . ! C . • • ..... • .... -1- V - • Ju ce C 0 J .JCT t . (.; I. • ~l ! t ,., _,, C~. t ..... ..... a I 0 ~ - • r-' ,-,, 0 ,- . . v • • • - - r • . c }Iill (50) stresses that the his tor of the case is most i111portant in orde1"' to pit the E ~!JG findi~:s in a proper settin e; (namel;t, no brain tumor can be diagnosed On the ~.1.. 1 J:.1 _ ~ .J, G trac inc. al on~ ) • (..) •4v 39 Inc rence Abnormalit,r. Lri l and ("1cide1:1ann (12) ----- -- ------ made an l!J,~G stud7_ r o: 100 children betv1een the ages of . n ll~ , 'wvho ,·,ere in ··• o od he alth, had e gat~ve clinical _isto_ies, had n oeh vi . r problems, and no history o~ e. • 1eps~. The effect o;' hyperventllation v;as partic11larly note • The res lts a1.,e ~iven in 1a le I. The atthors e o. t that n~er ci1lldrcn rem chm re likelT to de- " velop ads ht· :a 1n er hyperient:lation vhan 1e~e older c il ren. renn , abinovitch n ~exler (60) state that the norr.1 1 po la t:1. o sh. •ts f on 5 to 10 er cent abnormal n ,, ~ s on the ", tit t e re . n er nor 1al . essl .r, .!J • j, , le, ""'-;, Jvnns, anr 3holton (61) re ... ort a proxi tel t e s .. e I"'\ ce t 0 ,- ~ r al n n r 1 tracings. ro . the ..., lm t 4'9 :14 .,-- ( ,-9 ) re ... Ol"ts t at c ec r s on C e1 enr ca es ( .1 Aer ce .. t) 1ere .ed to 1.ftVe . • i~G' s • • ~ t 1 "'. t one • th I"" e- 10. V n,. o . C n ....,, -- .. e 0 ., ~n r. k ...... I • C s it .,as t ted at t' ie b inn_· _, of this chapter J the three nrinc:i.nal areas revie,ved in the literature v1ere ... ... as fo 110\7S : • sease 1. "~hat is the etiology oC' brain injur-,_ ,.? 2 . 1 ."lha t are the behavioral mnni ~es ta ti ons of brain injury? 3 . rhat is the value of the electroencephaloe;ran in relation to brain injury? In particilar how does it a . Assist in ias nosis? o • 'T:) e 1 a t e be ha vi r c ha r <;. c te r :. s t ;_ c s ? c . C r~elate w th othe variables? ori gin of brain injur\l was seen to 1 · e only in n ~ - t ra _ !la tic fa c t rs • ,Ian~ illnesses, _.articular- l those ~ ss ciate ._ wl th ence halitis , can .,. ro uce injuries resilts tf"'l t' e br .!n . :::; · 1 .. :larl , accide21ts , notaol tho c a sociate with birt~, can ~lso eave or anic res~d als . Tl1 s is articularl ., tru.e i t e brain ,;,,U 1 ners a d(")ficiency of oxvc. en . The beh vo ial resu ts o cerebra da \'tere f oun ma·nly in the mot r , perce .i: tttal , conce ... tual , n e·not: nal social areas . Certain · ndivi uul are m re a fecte ·tlth m tor ~.sail.ties if the injur is centered m re closel. to tho e art oft e brain ~~~ch are rec ncerned w th . t r ex .res s on t _ ot 1 rs . J. re complet de~c ~ nt. , n en - ven ·n tl s ection in the c,1. te !."• In the po~cep--- l - concept . 1 1 area it ,-as r tnd that Jrten t he rain-in ·ured {n ivi al es not see Ll or or ~anize his world as well as the non-brain- . njured person. 1 inally, in the emotional-nocial aspects of livi11.t.:- tl J.e brain-injured subject often finds hi·1self in difficul ties. The resultant behavior seems to come about because of the person ' s a tte1npts to overcome his problems . Tl1e literature seen1s to indicate that the EEG is a useful tool in the diagnosis of brain injury. This in strurnent hns been used on manv th usan s of sttbjects an t e tracinq-s ave been shown to correlate closel~ with .. knov,n kin s o~ cerebral d ~ e. At the same t· me it hns never been de nstrated that there is a one-to-one re lations 1ip . ume ... 1s studies re orted \Vh ch ten~ to s \V so e r 1 ti nsh:n o vhe ~ 1 G to beha ior isorde s . 00 .. 1 ._ ht ev dence ·as note 71 ·ch in ·cated that part cul r k nds o· wave rh thms we· e as ociated with behavior c aracter- ., is tics, but, n ::;cneral, onl r "'.ross abn rm 1: ties ~ere monstrated to 1ave anv real si ni~icance. .an research- ers have f o nd a lar ~,e percentage o.r be avior-pro lem child- ren to ve abnor1nal E'S tracin ,s. r·_\vever, it h ld be n te t~ at these c· ildron rere dr .:rn f.'rom populations in ps ch atr c cl nic, venile h _ls, an other in. t t tions s eci ~icallv set u to deal ~1th childre wh a e de n- strate sociall~ ... nacce te beha or. " .. .I.. n l., r •~ C, •') r ' (.., ,J ... -· . ··1 - I n (. s "' 1 s ;_, •") ~ j_l J. .. - . ·"'n· ., . C or l . Q I ~ 1 .J.. J -o , .., ~ · ::1. . (' v .., , ., .• . ., v ~ ... , , .. '). t • • .... . r, I . .. . .... -"'1 I.., . . ,.. • ., • .. . .. .l !. ~ ., L.... • . .. n i-. ( ~~ .., ("t ,.., ...... , ....,, , it ., • , vtl .c " ,.. ,., ·- -: , • . -, C\ . I ., r \... • :r r t , ~~ ... r-.--. . . . ( ~ ... . - ' t::'- r • ,.. ". ... .L ~ .. __ . , • ~ · c~ l1 • J. .( ... _, -Cl l.1. . - r, ' 02 1 .l.. •r -i et' ( . .. .. - " • .. • Age 4 5 6 1 8 9 10 11 12 13 TABLE I EFFEC 1 rs OF HYPERVENTILATION ON ELECTROENCEPHALOORAMS OF 100 NORMAL CHILffiEN Questionable Abnormal No. l 4 l 6 4 8 4 4 2 s l Per cent 25 36 60 35 36 57 80 67 33 100 100 No. 0 4 s 3 3 5 0 2 2 0 0 2 Per C nt 0 36 25 18 27 36 0 33 33 0 0 No. 3 3 3 8 4 1 l 0 2 0 0 25 Per cent 15 27 15 47 36 7 20 0 33 0 0 CHA.PTB!R III R ESEARCH BACKGRO UND, UBJECTS , l1 l\. T-PRIAL, S, AND P?OCED U RES The pre sent chapter deals with those events which l ed to the formulation o"" the st.1dy . It is also concerned w. ·. th certa.:!. n ma te.,.,ial s and rocedLlre emnlo~ed in the in- t , vestigation . Because o~ the comulexit~ and • l .portance o The Dehavior natin~ 3cale , this instrument w· 11 be ealt w1 th in the ~ ollo . 11 ·in , c " a ... ter . The present invest· ~ation fa carrie out b ~ the wr~ter in two ublic sc ool distr cts , and one arochtal sc. o , ~~rin~ th years 1 51 to 1 5~ inclus ve . O e o t he ortant f tnct1ons of a ch ol ps~- ch lo -ist r -volves aro'.ln the problem ch 1 in t sc ool ro m , - 1 .se b 1a ior ev i ates to an nco , _ort ble e ~ree for 1 o" those · ho t he e _ upils ha e st ss ciat e ~ ith him. ~ st of 1,e or less ch onic condt ct istttr- b nces n , o ten s .. 'N .n uc h intrac ti b l t nd res st nee to sch loc ica. t a ... • Th takes an nvarrant- ed amo' nt o t he te a c h.er's ti .. e; is o ten in tr uble on t'e sc o 1 la. gro1nd or school bus ; an is the subject ,-J : .? of .., t:; e " l 0 f\., l ... .. ..,. ◄ . r I. • to e_ . .(:'I ,., • t. e '1'1 0 ~e "'_,,, "'e e 0' n ., , (. ., . ,..> ~ t .. 1 ,. "JOO ' 0 C t l"I , ..... C S ~ l <.-<.-~ I,;. '- , rt ,..... l... n • b ~ , J ...... 1.., . .l L ., . ., ., L) • 10 t .,,.,, ... ..I. .. '110 ... 1' <· q ·1 0 1 f • 0 l ) ,.. ., I • . 1- t_., ,I • o __ 0 " C ,-: • t::\ _. mo .., ..., e • ·o . ./ ·1 •t ... • +- ! .. .I - ., .. .. r 0 - ·;e , .. C .. ... I •'- '- , • .J. ") .. - • • ~ 0 l s ' 1 ., 1. 0 0 C 0 .:.. -- e • t • .... T .L '.!CL. < ; n . J .,._ 1 - ). • or , ., I ( - .. 0 ... ,J ve 0 , _ J .. "'I ... GO C , •• .i.O 1 • t ic t..le • C 0 "l ( :)C • to t"I ..., • . ! f'o - ... - ) P.. J ,... r.J '- .. 0 ,.., r C ., o.l ,. 01. 1 .. .. • C Ct0V r · ., d I I .,..., ,(,0 vO t ( 0 l <' ..L. to n e +-' .... V '"'ee b (_ Ou 8 0 • on .. . ,. J- . r' 0 e . , - .. ~ IJ ,_, 0 • .I. • s and the California Test of Mental Maturity Test (18) scores were tabulated for research purposes . Other information such as chronological age, and number of siblin~s was also tabled. It beca1ne increas n 1,r apparent that a control sam-: le of children v1as needed : or- compara t:t ve ,urposes . In or er -;o ans~ver manv f the ... roble~s ass c ated ,vith th s beh vi r-problem prop, the control sa~ le ha to have: 1. 1 ~G exam·.nnti~n one at the a1e hos . ital. 2. -1EG tro.cin,~s read b:" the sa e electroencephalo- rapher. 3. Come ro~ a eneral ponulation at least ro1hhlv co,,ara~ le to that fron 1hich t e behavior-problem children rou ie e derived. 4. Their te chers ate th cale. on The ehav1 r Rat· · no- 5. Co~parable ne1r lo ~ i 1 ad sch met ic ex am nations and fam 1~ histories ~ade on hem. Thr u h a ed cal .. ant, ·,as ss ble to have 1 children fro a ~arochia sch ol receive EEG ex , nations. Th~ s • ro 1 ... • was v 1 . nteere b., t e rents o. the re ect e ... chil ren inv lved. .... o s ecinl instru t ns ,,e e ven the . e pa en s as to the t'"' .. e o.,.. ch 1 ren v,anted or the c nntrol :rouD. This w~s one int h ~e t ~at a trul unselected po1 llla ti n v,oul e chosen. ~·hile at the hospit 1 (where the EEG 1 s rere ,, administere .) , t' _ _ e parents of the c 1il dren ,~,ere asked for a I edical historv and behavior evaluation oft wir child- ., ren. In t _ ose cases ,,here the -L. paren 0f.1 i<l not come to the hospital, a telephone cull elicited the necessar7 infor mation . All o~ the control children were ~iven the read incr section of The ~:·fide ... an:-::e Ac 1ievement Test ( _14 ), The Goo enou ;h Drav,-a-r.iran Test (] O), The 3inet Voca, ularv Test (105), and a lateral do~inance test. The teachers of the parochial school - ~!11 rated thei on The , ehav_or Ratin~ Scale . An atte ~ nt ,as Mace to see i . t.c c ntro l ~roup corre n n e, · n s ~ar as the r be .. 1 :tcr on th , ratin': scale v, s c _nce, ed, t t e ot. er pen n t1e so. · 10 sch ol . ht i ~ . DO tant ec 1 e it v,as osslb_e th t th 0 re t ha e be n certa n in _ ~:,n factors ·n luenclne; the pa ent o~ the c c•ntr 1 s n 1 e children ; h.ich mi ht later be re ~1ected in the a1 ~nt of aJnor ali.ties (or nor1alitl.,s) -:01nd i the I;_ 1 , tracings o ~ t l1e c • 1dren. It ·, as • OSS l e t ~e t · ti nal i~l rat·ngs rom one teacher on chil en w' o were not ·iv~n E~G exa, nation , ~n , these ratin s were use · or c o parative purposes. One earlier .evelopment sh 1ld be n ted . I an at e t to cet data 1 • r vali _ation D r oses ever chil · none scaool was rate on The Behavior attn~ 0cale b~ 49 his respective teacher. This was done in '?ebruar,r of 1954. Two months later each teacher was asked to rerate ten 1 upils in an atte r;1pt to arrive at some conclusion about the realiability o.r the scale. A total or 15 teachers rated 528 ( 263 bo~Ts and 26;5 girls). Thirteen of the te~c hers n1ade rera tine on a total of 121~ children. Subsequently, the data derived from the above school stud vrere -round to be 1seful as a measure against ~1hich the .a~ochia school ratings could be com ared. II. I U:3J~CT . !~e fevared ... "OUJ?, The 137 be'avi~r-n~oble chil r n are ere c assi f e as the re erred : rou, 1het.er t ev had nor al ~~G o-econ T e Cha ,ber of Commerce • in -. --·- one 0 the cu. , T. nit es (in mme of' 1954 ) reported the • ave a ·e inco e 0 a f . l'tT • l.n its rea to be ·.> 5500 per .,ear . The sa . e enc state the avera e family incotne for th.e other concerne co mmu it to be "a fe ~ h ndred ollars more . " The state.cnt was nl so mn e t at the e ti~e a ea, in re eral, was the ·xth h1~hest in the co ntr in tern of reta 1 sales. The fore~o ng data wold in icate t ._at the ct1 ldren cor.1 ... _ r in the refe1 ... red gro 1 p C e r e r• ...., I., ,... . , . r, ..;) . .J • • ,.. r , . ., e .. , -r 0 .., c • • , ,.. - .... u • .L . - l () 1 e . 1 , .., . ··r ... ' 1 C ,.., . : • C ' . ., • - - I . ' · r,o • • J- l ,J _. C" .. 1 , r "') .... ,... • ., • -r- ' v l .. .... .. 0 -, .· -- - .. ) • r· ..... - "') ...... ... .. .... .. · ,:-,. .. vt V . . ,, ;.,j . ' -. ,... .. ! . • ..., . 7 , . l +- • .• "\ V _, • I - - '\ ( • _, -, , •.J ,... ,... C • . ..., ... 1 v ,... , .J J c: . o·· . ,. . l • .. . , _,_ -, J r ... l ,,. - I • - -- ..I.. r. -r School A B C D E F G H I J K L N 0 p Q TOTAL TABLE II .. DISTRIBUTION OF REFERRED GROUP CHrLDREN AMONG 17 PUBLIC SCHOOLS Enrollment 400 Elementary Intermediate 400 Elementary Intermediate 300 Elementary 550 Elementary Intermediate 600 Elementary- 250 Elementary soo Elementary Intermediate 600 Elementary 600 Elementary 200 El mentary 1,000 Intermediate 900 Elementary 1,200 High School 500 Elementary 600 Elementary 550 Elementp.ry 850 Elementary 10,000 Number of Children 3 3 3 8 7 2 4 1 11 3 13 7 8 13 9 15 21 137 e f • ,:--- ' ) Li. C> ... ........ ( . ... ' .) ·o 7 0 • t .., ,.. t • • , l .. .., ., • - ~- - ..., 10, t , ., , ..I • ,... u , ~ . ~ • l. ..... .. • . l e ... _ ' • V . l. ... J~ r -l I C 0. .,_· J. L, 0 o ... fl +- ' oi • L, - J . ' 4 .... , 1..1 ., ... • .. .., • ') t t? II • ... ., .l. '1 0 nr" r- ( J.\ • ~ ... 7 I- • f' . ~ r n , .. n ·") __ ., '-" L, ,.::> <J- e • . J 1 .1-..,n C -., ·'"\ C ., - l.1 - \. , M •"'I ..,o_ I •r c:" .... ,., ~ ., .. - ' (. .. , t! •• - ... • ,~ __, .I • ~, 1t C ., V :.. .L. ~ -""'p "l( .., __ L, _., _ ., t r _. &..; ,... .... • .. ,, V •r ,: (' ,; ,., v L • l., Va. , ....1 4• . v ( .. I I m · _., • .... .L • le · l recored. 0 •.J V • l. nt C ~ ... e · :~cct • -'- • ::, -~e J.. T . , . 0 Cc.,_ I ...i. "--·- ...... .. • D Ot;.-..;;.i _c ,ln,., ~ b - ' ) e -· . ( .. I ...,. :'. '.L -- ., i 8 e _, • • ... C C i b l . __ ~ - 1e 0 n. cont ·· • n.e . .., ... -·..., .) -· -ct s::.. ts · '1s· .. ate s ve_ .,_a ,~.C o-- ' >J 0~ • ·1 '-J • J_ (:', ,..., eA.,, ... ,,J ., ., "' r,., .&.. • v ... • a oon, ,., - ... t' e 0 O_ C • ._ ··ro V > • lr.ia•r \.; . "' .... b '.101.. 3 .... , ,,,o, r ...,,. h ._ v J .I. ~ _; i;:; .. J. e ... - . S 2. 1C 0 ""'' t . C L, ... ..:.. e cc t_ .: • r- .., C. J-. • e u ·1 L, t:i ll-- er .... nt · _ o 2 ) • v - t :.ot ~ 0~ • ... 0 . a ~. 0 ~ • v -- -- t e 0 C 1 r• -. • ("'\ 3) , t c· 0' ,... , ... 1 • ·o "' .. so ., r - ' 0 .... (.,( 1 ~. • , • ,., 0 • • • r- • • • • ) 0 ' •• I. c. n 0 .... .J.. c; vO .! n .. I 1 ' t • I I ~ .• .J. -'- o ·:, ~ · .., ,. " te ,._ (-9: ("I · -> 0 , . 11: . "I .. 0 .,/ ... .1 _., ( ...... I , I , "I . vl 1"'1 - ,. ) . 1 I 0 r:'' J • '¥\"I r• I !H , • t I"\ ...-a '-~ ?1 ,, "lf I (.. I , O• ... n p 1 - I .. t"1 - 55 res £iration in t1e infant (together with any factors pre ventj_ne breathinE ~ , such as the cord about the neck, etc.), unnatural delivery (breech or Caesarean sectl n); (2) to state whether the cl1ild was full-term deliver.r or not (it \Vas arbitraril"".r assumed also that a child under 4- ~ pounds was to be considered pre 18.ture); (3) to describe in some detail childhood illnesses, particularly in relation to hi -- h fevers lastin for a number o-r days, and a possible association with delirilm and eonv1lsi ns; (4) to ment·on any illnesses or injuries to the other rin , the pre- natal perio; and (5) to furn~sh etails re ardin head inj ·1.ries art-tc.1larl .. those involv·n per .od o uncon scio1sness or cone ssi n. The a veer teria are loosel~ e . ned n no at- .. te ... t as 1 de .:.n the resent std"' to aint int at eorn- letel r - 1 ble data re lted in their use .,h n applied to the inv sti ation n hand •. s 0arason has o nte o t, narent 1 re ~orts cannot be c . ns dared ash 11. reliable wlen c rents are q estione about their children's early il esses. ( 9:55) Sim·larl Rea (84) has de cribed in etail h 1 t _ e 11 S I e :1olo r• cal" ai S r O n ing cl1il b rth m~ be r little rel tio s 1.ip to the ctnal sever t of the b rth. ar s n r~ s the concl lsion, "In the absence of' c ·.rr.ia t r e·vidence a mother 's report about the 56 experience of labor and effect on her child cannot be con sidered reliable." (89:53) In order to make the criteria more definitive the following limi ts have been set up for establishing when an event shall be considered of positive eti ological sig nificance wh·ch could lead t ~ cerebral in urv. A. Prenatal 1. Any history of injur tom ther that could effect fetus. Also histor. of measles to mother in irst three months of pre gnancy. B. Birth • 1. Long labor--over 15 hours, or mother was told bv doctor that labor was longer than average. 2. Preci itate birth--under one hour's labor or doctor told moth r that the bab arrived with abnormal quickness. 3. ee ho Caesar n birt h. • • I ea o . i nfa t ,rossl r miss ne at bi rt 11. 5. C. an s·s (bl e bab ), or an~ recor iven to ij t r that the ch_l ha d. _f i cult. breath inf. , a d ha d to be .. 1 ven s ec ial treat ent. 6. re at re b th--. m nths or earl _er, or c hi l d l es t han ~-?-po n s • 1. _ n-h f eve s l a s t n. ur or m re a ?'s v ii th or v,i t t c nva1s· ons or el r 1m, or a h s t or. of r c rent un x la _ ne fever. 2 . co Tr 1 C 0 1 t • C ... e • ss or concussion. nvolv.· n un- 57 Because of the difficulttes in decidinr when a mother has had an unusual amount of anesthetic, and in deciding when the use of forcep has resulted in injury, both of these factors have been left out of the etiolo~ical picture. ~~rhile it is difficult to decide vrhnt relationship the above factors play in the cau.sation of or .anic brain patholo ~, the important fact in the present investi ation is that both the referred and the control gro1p had the s me set of criteria, along with the limitations, applied to them. Dirth Order. That first-born chil ren are m re subject to cerebral injur h s been a commonl acce ted assumption. Strauss and Lehtenin sa, "As a r le the first-born is more in dan er b birth injurv than subse- q entl born children." (99:107) Furthermore , these same a, thors re ... ort that studies ha.ve sho .rn that traces of bloo co~ld be f ~nd in the spinal fluid obtained from nev-born infants, ~ ich in icated the existence o~ a birth trauma, and in irst-born ini'ants these serological find·ru shave een found to ea h~ 0 h as 60 to O ~er cent. (9/:112) ccordin~ to ~oldstein (38),the~e is a ten enc ~or the later born to have shorter duration of la or, a lesser incidence o_ labor co plications, a higher "l 0 re .., l .... .,._ '--· t, , V 0 0 J. 't") ... :, 11 .,L T - .I.. v • "\ ,_ v ..:> 0 • 0 t~ 1 ,._.., u_ ,o l . t · 1i r t .L 'i • f t ... • (116 • t . • .,,.,A :, t t":\ r A s , C - ( , ... ,......,(.. \,,I_, ( / ) • t- } J_ . • +- f ") .I s _ _ c ,.., .... v . ,., on, , ,. - • 201) • , . .. 0 ( e J • • -. . , . 0 , - .. ., .. of • ,7 __ _._ C }1 1 ~ on ' to ~ r.1u t e '"" , .Je L. 0 ., ., I :rt )1 .. , . ➔• ...... Uf[' <• G C:3 Y' ., ,. r C • I ' ,J d .. V• . 1, • I n. • • C ~ I 0 V ,.., ~,,. to • ·:, ) _, (J_ .I a r Tt • ... VI 0 - J 0 1 0 of' , t .L t., - --- L ., ., • n l"'\ .. ., r • .1 • , n e • • N ..., • .. u , ~ • J 60 kind o· ~ meas re of intelligence on the control group child ren in the limitel time available , The Binet Vocabulary Test (derived from The wtanford Dinet Intelligence 3cale for Children) was given . Terman (105} reports a high de ,.,.ree on correlation of the vocabulary test \Vi th the com plete 3tanford Binet battery. rreschler Int?_el.lif-ie.nce Scale for Chi1 dren (111). A limited ntmber of children in the referred r rou had had the T·. r - ,c test a inistered to them at one time or another. rone o_ tl1e control Jroup children were ~iven tis ex amination. In -rder to investi ate t e possib lit~ that t os c ildren au n t e re erred rou. who derive normal E 1-1 G tracinf, S ha si~ni..':'icantl, .ifferent kin s of profiles on t.. sL1btests of this scale, \vhen c mpare u ii tl1 th se ~ho de ived abnor,al trac n ... s, it was dec .. ded to 1nake a statistical anal sis on the av ilable 1I C tests. Achieve ent T sts a ministered as a roup test to most o tech ldren in the pub c ls o the istricts in question. Vh never pos ible a rca in~ .rade 1 cement a tab lated rrom those W , o h'.) c.... • r ceivo it in the re erre 0 • 1 ,·r . c :i , , ....., ~ l . ' ( . •1 0:.., j'""\ ' .., • 4 V ...J , , ~ .-, , •.J , • ,. \ . • C ... ' . .., .! • . 0~ • I ,. , <-~ f") • r ('' • . 1 ( ' • . . ~-, .. .,. ., • • 1 V . ~ ·1 · .., V • . • - C , v . • • C .. t. J . • . ... I l, 0u . L ( • 'J_ - J ( . ' • .... .• l .. . v .. · - V ( 0 I .. J ..... I r; ~ : ._, ..1.. a.. L, • ., ··- 1. • . 0 .. ' , .. ,..,. .. , ~ { ,. - ' • . ., • . e !) '. , Lt e I ( .. t, . • . ") f ·,- ·1 :::i C l { .. .. (' • . ")f J :-, (' ( ' .... ➔· .... ·1, .,, 1 J t_ .,, .. : • ... • i ) "'C L r, r- r ~ ., • t ' • ( -, ., 1 (' ' r ( ( - e • ... , J • Cl..e c.. · _1c ., l L, i..1. J - 0 . ., IV l 0_ T ( 2 ..... e ·,) . . • ,- ( r C S"') ( _, , ~<' a ., • ~ , _ e ' - ' .. t C - ., ~ • . ~o ( - ' • . ".!, t1 -, 1 "') . t . , • C I t t . - 1 . • .. ... ) .. .. .. 0 • ) ,- .L r v· . () e .. .. • ... l . ti . .... ... ,.., t • . l.U -. .1. ( • a I , - .., - 1 0 e l .. ,.. ,. , ,-J,.., ) ' rn { r ... , (., ., . • • ~ • a .. . ... I... - , - ♦ P.i...C - .j."'1 c;. ~- ·- - l,t_; 0 ,,o "' ' ., f· dl C r n ' ;_ _I_ ' ·' I • J. t l LI , . , ) , • ... ) ~· .t -, ' .L C .. I - ., I C • , . I • .I ) , J ' .. C ~ .I~ . 1..., l ) • . ·' 1 l . .. C't , A . . ' . r ~ . • ~ ,. ' "l - , . :, (: ~., , .10 0 '\ . • - ~ 0 ( • . l""' • "l () .... .... J..' r ~ . • t: i, I I· • I ,- ,..,_ ' l ...., -- ,.. '-J -, - r, .,. ] , · o . ' ..., ...,. - t () ( ( I .. '\ , .• n~ 1 • . , • ;) p .. l () ., - , ; r , .. , h l t ' .. ( • 67 by the teacher to rate students or by the nupils for ob- ta n1.ng self-ratings. Rasul ts of this scale can be emplo~r ed in preparin i~ a school behavior profile in locatlng ma.1 - adjuste•-. pupils and in discoverinc: maladjustment in various behavior areas. Conrad (26) , Richards on Powell (85) and Berne (8) have attempted to construct scales which would be descriptive of an~r and all s ocial-emotional beh.avior traits of nw significance ~o~ pre-school ch 1 ~en . It is interesti : to note that Tiichards and Powell used 30 traits after a ood deal of exper·mentation, thile Conrad was not satisfied with less tha 133. fter factor anal vsis of the inter-correlations bet reen rat._n s ade on rroup of n rser a e ch ldren .o nd st of the trait vari nee due to three factors, and as a res lt o these factors the • ves ~igator t eoe tlree q est~o s to ecide: namelv, (1) ~.Vha t is t ature ~ t e . on fact rs? (2) 1-Io 1 can each o · t J fact rs best be easl e n the individt l? ( 3) ·.1ha t s the rna,.,.ni tu e o ~ t e uni 1eness in each or the tr ts se? • a ious · ters ( fr care~~l c ns_deratio , 71., 7 ) hav-e stresse the need oft e eliabilit of such ratin scales. In eneral, their concl"tsion ca be summarized as follows: 1. Ju r.- ents ~or t,·1 c m arable rou s f observers • J C • ' . \ .8 c. • .I. t~ ., I .... "J.t,, ,; I ,..., ,-, I . , ( - ... .L. .. v ..J- • O..v 0 '--' 0 • : -, ..... 01 <"'f J • . n ' . i. , ..... . • l) ) (. • 0 ,. 0 , 0. ,... . ... ,, . r • ,, ·' .... • 1. L• - I ,1 0 _, l< rn,, J t • l~ • .. 11- .. ) ' • r . J ._, .I • ) • . ' , 0 t"'I e I •.J D. ' l .., 'l D ..... '/ '- "" . •• .... • .. . .J .. - ( -- , , ... .. ( .... c I .. C , ., . • C. L P, 70 If the post.J.late is accepted that the brain suffer- ing from an organic disorder will have results of this disorder reflected in learning difficulties, a behavior rating scale ,vhich attempts to measure characteristics of school children suffering from cerebral injury, should have items on it measuring achievement in actual school subject matter. Some such items have been included. Each item on Tl1e Behavior Ratinf'.; cale is discussed in some detail below. An attemnt has be . r made to indicate th.a so.1rces in the 11 terature ,ivhich discuss the particular kind of be1._avior _ ·_ n quest-ton. Ite. I. "Seeminr-1. n t a. fected b""' extremes of not or cold." 0arason in speaking of the t alarn s, describes it as b in,-. s sory in n ture nd c ncerned with a ,ross apprecia- tion of te mpera tltre . ( 9 :} _ 7) trauss and Lehten~n speak of th fre uent da~ ac e of the e trap ramidal s,rstem in birth inj r~ beca se o~ the part·c lar vulnerabilit of certain blood vessels , _ich s ~pl~ this brain rez i n. (99:115) Since toot_a a ~ sis one of th lar est .nglion-cell cen t rs in th extrapyr midal s stem it was thought des rable to include an item bearing on this area o: sensation. Ite 2 . ties { tra ss "Poor coor ination in lar .,e rrn.1scle activi .e, etc.)." n c Lehten n state, "Children M th malfor- i n o-P the brai . S' 11., sh w 00 ros . tor disturbances ." 71 (99:116) Anoth r writer, Lewis points out that i~ the injury to the bra.ln is severe enouGh 1 t 1na.r result in that con ition knovn1 as cerebral palsy. (68:14) o\vever, cerebral pals"".r is merely a label e;iven to one t7 pe of bra n injurr which is srossly noticeable to onlookers, and it is entirely possible tlat various de )rees of the same disorder may exist a~on .. ; the b'ehavior-disordered children abo 1.t whom thls stnd ,,,as . a e. ~TI!_)-!. "Conf 1sion in spell n and writing TJurilb-1 e d ) • " Due to a deficienc,r in visuomotor intergration the brain-injured child often has ~reat if c~ lt7 in writin ~. S~nce _ 1 1t·n · is a co . 10n f l nction in school, a.n item was c nstr lcte c.: whereb :r the teacher co 1 ld eva ua te l erception a d 1. otor coor · ·4 nation tl rough this activi t,;r. The de- ~icienc is - so re_lecte r in spellin ifficulties, be- ca1se perceptions - ~ 11.ch "_ ... re ath lo< icall: s bject to vacillation, ambi91itv, an . istortion. 11 (6 :102) Ite.11! 4. "Inclined to become coni'use in n unber process; gives illo!tical re ponses ." As ~trauss an Lehten n ( / ) point out: The evelopment of a number concent or n schema for viewing the world in quantitative terms appears to be anther expre sion of inherent or~anizational tend encies an the c pacit r for abstraction. Indeed so intimate is the associat on between the nerce tion of 4 ... numerical relationshi sand the abilit to reas nan t abstract that lack o the former has be n cons dered diagnostic o deficienc- in the latt er. (99:11~7) 72 The diffict1ltles the brain-injured individual ex- pe~iences with abstraction has be en enumerated in detail by Goldstein and .::>cheerer. (39) A~ithmetic is a common school activity involving the abilitJ to use abstraction. Any deficiency in this aoility is apt to be noticed quickly b"t a teacher • ., I,te.11!. 2. "Reading is poor. u .. Bakv,in (2) reports that one o~ the syn1ptoms of cere- bral damao-e i n inabilit~ to learn to read. Similarly, Strauss and Lehtenin stato, "Failure or partial fatlu.re to master rea j_n 0 processes is an erperience shared by larr e num bers of brain-injure ch ldren." ( 99 :16 ) Teac ers were o.sked in th s '03l''t i c lar item to 1 na.a:e a ... d rect eval Qation of the e g "ee of r ea Ite l 6. eract :!.ve an restle ss." ne o th m ost pers·stent s toms noted b writers (5,6,68, 9/ ) has been t e er stent na ility of br in injured ndividuals to inhibit h sical move .ent. It was felt that te a c '1.ers -,o 11 note ten enc::. es t ver-activeness s·.nce t l s c aracteristic o. te i mpe es t _ e learnin sit ation. Item 7 • " e l1a. vi or . es · n c ?c 1 es • " The inc n stenc er.L ort ance is a symp tom of the brain-injured child ccordin to Lewis: 73 One day, he may build a house out of blocks. The next day , he cannot. Another day, he plays quietly and coopera.t:lvely with other chi- ldren. On another, he upsets the game , th1.,o,rs the bucket and shovel ou.t of the sandbox and rt1shes off in all d1 rections at once. He is thrown off stride by subtle events which scarcelv bother the normal child. Chan es in the V weather may do it. He is sensitive to rising or falling baromet ic pressure. For this reason, it is not wise to start him on a new task or lesson before a storm. In sum, he is unpredictable to all but those who know him well. His unpredictabilit~ is a symptom of his general con ition. It is a major but not ins1r mountable dirr ·cult~ in mnna 0 in him successf lly. (68:48) Item 8 . "Qualit.,r of v1ork ma vary from day to da. •" This item attempts to measure n re definltivel~ the behavior enti oned in Iten 7. Item f • "Da ,·drea. in"' alternating with hyper a'c tiv ty." · Silver points out about the brain-injured ch ld tat 11 h s re c t 1 n m . "r b e as iv e n , ·thdrawn, or a ~~ressive an h erlrinetic. 11 ( 92 : 17) Le\vl s, in ch the sane vein sa s, "T'J.e c 1 1 s variabilit in mod and performl nee is aston sh n .,• ,ne da he see . s to lea ahead in his school work. The next he ap 1 ears d.111 and listless, unable to recall, see 1, in n:l r, 1hat he learned so rea il the day be.fore, 1s irrita le an unres.i;onsive ." (65:105) Item 9 endeavors to eas re is t e of conduct. Item 10. "Excessivel meticulous , exacting, :formalistic or pedantic." 74 Various writers (68,92,99) have indicated that the person with cerebral damage, in an apparent attempt to structure his environment and thereby gain security, will often exhibit the behavior mentioned in this item. ~lerner (113) mentions the characte -.,,istic of met·i culous be havior bein~ prominent in renlies on the ~orschach Test. Item 11. "~rratic , fli ht; or scattered behavior." tallin reports that one of the symptoms of brain injury is erratic and fl . ht~ behavior. (109:4~6) Sim ilarl , Stra1ss and rJerner (102) re: ort the characteristic reactions of the brain-injured child to be unstable or fluctuating. 0xtoby (81) likewise renorts vhe behavior to be typicall manifested b~ al c. or coherence and inte ra tion. Item 11 attem ts to measure this disoriented beha.vi<r. Item 12. "Lacks a variet., of res onses, repeats hi self in man situations." In the portra al of the brain-injured or ,anism perseverative cond ct is most noticeable. Strauss and Lehtenin sa~: Th. s to "erse veration" has been clin·call rec ,n ze ~or a lo time in the behav·or of ps chotic patents and ad lts with r an·c brain d·soase. -tis de ined as "t e ers· stent re et _ _ t·'i n or c ntin nee o an actj_v t , once bee;un." In Goldstein's o inion 1 erseveration is a r.mnifestat n -r a.n "bn r a b nd" or "force re onsi veness" f the organisrn to s ti 1li. It occ rs freq entl , ter a •. o . erf r . nee has be n achieved; The or ~ an·sm then c n ronted 1th a net task c ntinues to repeat the old per~ormance. (99:50) This item endeavors to measure one aspect of behavior related to the s ._ rmptom of perseveration. Item lJ. "Easily distracted, lacks continlli ty of' eisrort and perseverance." The characteristic of distractlbility is another 75 outstanding symptom of brain patholo~y. It is generally accepted by most investigators (68,92,99) to be a result of the or anism's inability to istinguish pertinent ~rom non-essential stimuli. Consequentl, any events make demands fort he attention of the subject. ince god attention is usually demanded by teachers a de ect in this characteristic ou ht to be noticed quickly b. them. "Cries of ten and eas 1 • " • T1e "catastr oph c" reaction has een described b.,. ~trauss an, Lehtenin: ( /9 ) Fore am le, the brain-injured atient is con.fronted th a task wh_ cl1 is be"1"ond his a ili t. an ·rhich he cannot er~orm, he na . ex_erienc a stron react! n of ra e, despa r, a ·et, or eAt e1e de re ssion, 1th all t'e ace m anyi bod reacti ons o er in, chanuing c lor, tre ilil i · an o on; ~oldste n calls this react on the "catastro h·c reaction" or a bra··n-injured or anism. (99:24) Thi e noti onal b1--ea om ~ht be mote s·1 seen n school situati ns in he form of fre ent d unto\1ar cr.-in • tn_re . :ctable behav. or." This t e of oeha · or c aracter sti c s been es- scri e as a lack of bra c ntr ol ue to certai n s nec1 1c dysfunction of integrating eJements between the old and the new brain. According to Strauss and Lehtenin,who report: In the lov,er animals the extrap·yramidal system or the old brain comprised the largest part of the central nervous system. The nev, brain is a comparat:tve1y recent acquisition of the animal series, present only on the higher phylogenetic levels and as a hishly developed organ only in man. {99:20) The same authors elaborate further by stat·nE that as the ch· : ld grov,s older "the new brain develops more and more a softening and inhibi tin povrer" and "remove or dimin ish the inhibiting effect of the new brain by a disruption of connections or by an impair1nent of this bal ncing power and the old brain acts unchec .. ed; excessive emotional reactions and hyperactivit:"" are the res1lt." (99:23} Item 16. ... . . - b L uni shr.ie nt ." This i te .... v1as ncl1..:,ed since one o: the be vorial characte::-istics o" the bra n-disturbed 0.1.n ster is his inabilitv to perce·ve an conce_ve the ature o "ood" conduct. As Le'ris writes: Disciplin·nr" in ibiti - T~ie Other Child are i portant feat1res in his develo_ ent s·nce t e are direct methods of enablin , him to un erstand s cial req ire1nents in livin in the far.1 • 1.,, . Punis ent yields onl ne ative re3ults, since it tends to .a e more ~ st11rbed throu~h a feelin o reject on and since he us all oesn't 1nderst n c. w he s being pu11 shed. (68:79) Item 17. "Upset b in rot1t ne." ecause o the bra n-in ure child's poor a 1 it,, to 77 pattern his environment, changes in the daily schedule are likely to upset him. Verner (113) speaks of th.e "pathological rigidi t:t" of children with mental deficiency resultinf from brain injury. The scho l program is largely dependent 1pon routine and disturbances in routine ou .ht t have consequent effects on the behavi r pattern of those children s f erinr, fr m or _,anic bra.:.n dysfunction . "Confused in f!"'llo,.v1n d .rec ti on." Le\vi s vrri te s : Perceptuall, the brain-injure child does not "get the picture 1 (or ima e as the ps c olo ists sa~) as normal children do . He sees an entirely f erent picture nnd reacts in a different ~a,y. (68:Jl) In the re~ular classrooc the aoilit to follow directions should be a relativel .ood eas re of the a o nt of erce~ tual cont sion that s resent. Ite.1 12• "Tends to be destruct ve, espec all of.' the \Vo·rk O others•" Leiis h s ~o nte o t (6 :76,77) tat t :n · 1red child I s inabi lit,; to rasp the func t · · o bra:.n- . simple ob ·acts like to..,.s, an his tendenc. to oe d:stracte a a ro t ~ " holeness" of the ob act, revent. hi from nder- ~t n in thA men n the object c rr: es th t for m st persons . In his c sion an frustration he a~ destro t e object. Th s se s to be artic1l rl t e or oun er c ildren. • • 78 Item 20. uDemands much attention." As indicated by ,!:!al lin, many of these brain-injured children "tend to be hyperactive, disinhibi ted, explosive, etnotionally unstable, noisy, careless, and they may some times do things at breakneck speed." (109:456) Silvers notes: He ma~ be clin~in, or strive to hide his motor disabilities with clownin ~ , boisterous behavior, or with ri id compulsive defense, and bee me robot-like in his ri p-idi t, • Scl1ool, with 1 ts emphasis on learn in, lways accentuates his bewilderment. (92:18) All o~ this dev·ate cone ct tens to ma e these children t _ e subject o cens re by those aro nd them, which s n ther a. of s i Iter 21. " · ,a t e need 11D.lch ttent 1 on. evidences of st bb rn nco erative be r." Thos behavior trait iters (5,22,6 ,99) who ve dealt wi tl1 this oint out that it results a~ain from the • child's 1nab111t to un erstan hi~ envirorumnt, ch in n 1 e to erceptual and conce tual fficulties. e at vis is one o :' the fe., denens ve techni s th t these ch ren kno an ca e .lo. Item 22. " r ten 1 t d actlvit1es; ure ers to s q ic rl from ork b self." roup Str s n t n sa: t 1 t ,, 1 r I ot rs n _la in~ or ~th n xt om nt their irrit b m res lt ·n a uarr lo o thee children t help the r 1 s ons, b t 1 the lit~an 1 c of inhibit on • bl o ~s • ( 9 : 9 7 ) • 79 Due to a tendency to become overstinnilated in group play, and due to the handicaps resulting from percept,.1al and motor difficulties (which often prevents a complete understanding of roup pla-y) the brain-injured child may tend to pull out of the group. Item 23. "Cannot seem to control self (will speak out o"r jump out of seat, etc.)." This item was included as a more definitive measure o those p .viousl . 1entioned characteristics denotin the inabili t"'.,. o~ the brain-inj red child to maintain quiet bod at ttt de or t in bite otionnl reactions. Item 21 ~. "Constant if icult .. w th other children anc f,/or ad1lts (apparentl purposeless)." Lewis expla·ins t e characteristic enti cned in this ite in the following manner: Sometimes The Other Chi ld shows sins of extreme a ressiveness. In a group of children, he cannot seem to resist shovinc, pushing or punching the others, 1nd1scr1minatel • e m a u trample the mud pies other children hnve care:f'u.11 patted into shape or pull down their castles of sand. This behavior is dif icult to explain to parents. The stimulation of the presence of other children ex cites him to the point vhere he makes an exa gerated and often uncontrolled resnonse. Or, he atte ts in a dramatic a , {to him to gain attention. (6 :42) Item 22• " hallo ~ , .feelin for others." ..:>tr '. ss an Le 1tenin ra se the question whether the em t onal allo ness seen n brai n-injured chil ren ma r 80 point out, "The brain-injred child ma:"" display depth and intensity of feelins which is brief and fleetinz, lacking the endurin - qua.1ities of a normal e1notio11." (99:97) Again this type of reaction is probably due to the child's in ability to comprehend the full im act of an emotional situation. Item 26. "Seems generally unhappy." Silver writes, "ecause of disru tion in the pat te:1n: ·.n of his nor . 1 1 impulses, and beca se of h-ts inabil i t"'~ to inte rrrate the confused perceptions he receives, th~ OI',...anic child is basicall frustrated and an ious." (92:17) This ap_rehension ou 0 ht to be reflecte in outward signs that can e noted b '1is teachers. Item 27. "Confused and apprehensive about ri '-'ht nes -·or res.onse; indecisive." Another facet of behavior which teachers ou Jht to be able to perceive is the or anicall disturbed child's trepidition when confronted b a problem. s has been pointed o t. n7 times the brain-inj red chil is or~an- icall nable to employ good perceptual and conce tual processe. h s, in turn. ten ~ --s to nake hi ca,1 t o~s. I te 28 . "O ften tells izarre stor es." Lewis noints out the ten enc ~ 0 the ban-injured C i t o c n~ se fact an ·ction, w ·c o ten lead him to n l ~ e in more f ant s·es than t he normal child. (6 :26) 81 Ite~ .~2• "Classroom comments are of ten 'off the track ', or peci1.liar." The experiments by Strauss and nerner (102) indi cate the brain-injured children have many disorders of conceptual thinking. Thus it is that they often "miss the point". This deviate behavior might possibly be shown in classroom discussions. Item to• "Difficulty reasoning things out lor;ical Iy wi fi others." This last item is nu.ch like the previous one in that it deals with the abilit~: to handle abstractions. Te work o C'oldstein and Scl1eerer (39) has cl arl .r pointed to the dif iculties that brain-injured individuals experience in attemptin' to deal with conceptual thinking. These, then, are the rationales for the items on The Behavior Ratin 1 Scale . Each item is checked a ainst a rive point scale. The points on the scale are graduated accordinc tote de rees of the behavior noted, goin from the least to the rentest noticed. Each of the five points is accompa ied b a descr ptive phrase. The are ~iven be lo 1: 1. You have not noticed this be avior at all. 2. You have noticed the bel-iavio1~ to a sli ght de,ree. 3. You have n t ced the behavior to a considerable de ee. 1 ~ . y ha e noticed the beh vior t an 1nco - ~ort- able de gree. ' 5. Y u j,1.ave notice the behavior to a very lare;e de ree. 82 The rater is given spaces at the top of the pase to fill in the name, age, and grade of the child, a space to designate his school, a space to enter the date determin ing the time at which the rating was made, and a space for the rater's name. A preliminary statement instructs the rater as follo,vs: Please rate each and every statement by putting an X in the appropriate square after the statement. The squares are numbered from 1 to 5 and represent the de ree to wh.tch you have noticed the descr bed be havior. The bases or makin a judgment are given below. The crite ia set up by Lucero and .e.rer (77) for an a equate be vior scale seem to hav ~ been met in the present lnstr ent: 1. It sho~ld be usable b rel tively untrained raters. Any tra ning necessar to achieve optimal realiabil it~ should be minimal . The raters in the present investi ation were untrained in the use of The Behavior Rating cale, and no attempt w s made to instruct them in its use be ond what was ~iven in the preliminar instructions, and to sa that the rater was to judge the particular subject in relation to other ch11 ren his own a~e. It was n ted that the reat majority or the raters accepted the 11 ~ted instruct ons with no corments and see ed to have 83 no difficulty in filli~~ out the forms. As has been previo~sly pointed out (45), the critical question to be asked about such a ratin scale is its re liability. Unless the instrument can be shown to have at least a fairly good reliability no confidence can be felt about its emplovment. In order to arrive at an answer to this question some additional research was instigated. The entire stt1dent bod f an elem entar.,r school ( grades 1 to 6) was rated on The Behavior Rating Scale b the teach ers ok that school. A total o~ 52 , children (263 boys and 265 irls) com.A; rised the relie.'bili t , , C ..'.) r up in q estion. A breakdown b , teacher, ~rade, sex, and n1mber c n be seen in Table ITI. The raters 1ere ~iven t e instr ctions for usin~ The ehavior .L atinrr Scale that have previousl~· been outlined. A tot 1 for eac rou. wa derived b. arbitraril as. i .nin _ , a sc ore to each o the five 1nts n the con- t nttum: namely, (1) "Yo have not noticed th s behavior at all" w s iven one point; (2) "You have noticed the behavior to a sl i ht de ree" t,vo oints; ( 3) "You have noticed the bel1avior to a considerable de ree" three points; ( 4 ) "You ha ,e noticed the be vi or to an uncomfortable de e,;ree" four points; an ( ) "Yo have noticed the behavior to a ver lar a-e de rrree" five points. ach child, the~ had an in- ividual total score and these individual scores were added 84 to make a classroom group score . An analysis of variance was made on the means of the groups and the result of this analysis appear in Table IV . The results of this statistical measure indicate that the means among the teachers differed significantly. From this it might be concluded that the individual teachers rated p1pi ls more or less strlne;ently according to their charac teristic attitude toward the students . It is also possible that cert in classrooms contained more children showin a severe decree of t he behavior traits ~entioned on t e scale. te Tvr ;iont' _ s later each teacher was asl·ed to r rate ls in her ~e~.ecti e cl ass oo s. These raters ad been uiv n no revi us nt ~ . ation ta t 'he ,o 1 be asled or rera tings. Tl1irteen o~ t r1e .ri c;inal tea.c e 1 s c m l i ed rith t he req.1est to con 1 .. lete 124 rerat ::. n s (6 ch.il r e1 ha be n dropped from the rolls) . The na_ . es or t h grou to be rerated had n t been selecte at ran o . due tot .e ~act that earl all o~ the L rst ratin shad receive _, lo · tot l scores, and i t see ed desira ole to have a .reater sprea in ·ndivi ual total scores . To this end, n atte pt 1as deb the inve sti ~ato to cnoose ch.ldren amo each clas room ro p who had a wide ran e o~ total sc ores. The t ot a l scores on The e avior Ratt n c le were 85 compared with the total reratin scores by means of the chi square technique and the I'esults of this comparison appear in Table V. No statistically significant differance was demonstrated. In neither instance did the teachers tend to place many ratings in the 3, 4, and 5 cate~ories of the behavior continuum. Do the in ividual items on The uehavior Rat·ng cale remain constant (in respect to Nhere the teachers ass ~n them on the continu1m for ind ividual pupils) over the two m nths peri d? Tl ·sq estio ·s : mnortant to ansrer,because, in n el ~sed period of time , or according to the t·i e in the school :·ear in "J1 ich the ratinrr is made, an i te m r-~ ht tend to be marked s i ,n ca.ntl noorer or . bett r b u the te nc er~. The ~ ;nm st rovide at least a~ rtial n wer to the proble~ an the results are shown in Table VI. ._"fue each i te was c ons · · ered in relation to 124 ratings on t at i te , an the rera tin 0 s two non ths later, only 3 ite . s (5,20, and 25) 1ere shorn to d ffer s gniricantlv over this ner od of tim . tern 5, "11ead·ng is poor," (signi~icant at the 1 er cent level) was arked more lenientl . on the rerate scales. Item 20, "De ands much attention, 11 (si n ficant at the 5 per cent level) was a so ... a rl,.ed more le . • ntl"TT, a .ras Item 25, u ha l lo, feel - . in or ot ers, n (si3n. ficant at the 5 ner cent level). .J- 0 ..... . 1 .lE· ", '--' I ... . v ..... J .. +· . - 0 .... ') vO -.. • . r:. ·, 0 ·- >J - · ..i.. n .. ., • . 'Y t c_ . " - ._1 " J ., - .. -- I , ' .·, I • '1 l") I { . } _,. ,,... . C. ,... ... • a .... ... - n '-' C c· ... ... . . . • .. ~ .. r, c; .. • .. " ~ 10 f"'I w, "-J • l- . .., • . . ) r (", . ,.. ,.. .... u . , co .... ..., r-, ., . ~ • t.. . , . L, ,... '-' V ... .. -.. ,... .. r ... •.J . ... • " l"\ - u .... - "' .. ·~ .• C !") - "lo ·J . .1 c -1 r . - • ,) . ( ., +- ( ft J. ') • ., ,.J V " 0 I e .L - ~ ". c' . ~ · .. . \J f" .. ; "' I,,. ..... v 'C . .. .. { . 1 n '-J .. P' ~ r r, ,... r- ,.. r, . -c; ''"' " .. ,., .. I. ,.. ... () SJ -' () n tc t , .. ' • .. .,_ -- ' ~ . (' ,.) ... -, _!_ • ~ I • . ... • 7 "'t .., ,.. .I. I • ..... l. t ('"I - , .., C ,., l __ e r, J- I , ... C • , .. .., • .. - . (') I · 101 • , . . , ,J • . . · - ... .• , , C . , C .. • J f. I T 'J • .. ,; J ( . . • . , ..I.. ,t - - • I I ( - ' ( V • • r J_ L, • l C .e ' . V r ,. ., ... ..... -..., ("\ i 'I • .1. J_ u r .. • J.... .. V ~.,a. • .J. (' '"' -. ("1 ' (: • .J.. ~ v • . . ( • ' . - • .I.. , ·- ... V ( . . • t ., .. , ,., t •;. L, ,I .. ( . • r. "'\ I I J. J. .: J.. C C . • .- L . .. ' . I. !!1, Teacher A B C D E F G H I K L M N p p TOTAL TABLE III DIS'ffl.IBUTION ACCORDING TO GRADE AND SEX FCR . THE BEHAVIOO RATING SCALE RELIABILITY GROUP Grade 6 s s 4 4 3 3 2 2 2 1 1 1 K K K K Numb r or Boys 16 20 19 17 21 17 15 12 15 13 12 15 12 17 12 14 15 263 ,I Number of Girls 19 15 15 21 18 19 20 15 12 14 15 12 16 16 10 19 9 265 TABLE IV AN ANALYSIS OF VA.i.-ciIANCE FCR TOTAL MEAN RATINGS ON T-H1~-<8EHA VICR RATmG SCALE MADE BY TEACHERS IN THE RELIABILITY GROUP SUm of squares Mean square F ratio F: 8.42 I ✓- Means Within 108.2 6,569.82 6,678.02 12 6.138 6.150 F•95(12 ° 0 ) • 1.75* TOTAL * Sign"ficant 1 per cent level. Rate Rerat TABLE V A CHI SQUARE COMPARISON OF TOTAL BEHAVIOR RATING SCCRES WITH TOTAL RERATING SCORES FOR 124 RELIABILITY GROUP CHILIREN 30-49 98 1 Total Rating Scores 19 17 70-89 5 1 2 1 Chi Square .977* TABLE VI SIGN TEST RESULTS FOR 30 ITEMS ON T'.dE BEHAVIOR RATING SCALE FCE. 124 RELIABILITY GROUP CHILDREN Item l 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 N 13 36 35 42 39 27 36 45 27 20 32 25 49 16 21 18 27 41 12 .30 22 27 33 20 11 12 23 7 15 19 * s· ificant at 5 percent level. -)8} Significant at l percent level. R 4(}) 12(-) 17(-) 17(-) ll{f) ff 13(-) 18(,l -) 16(-) 13(-) 6(-) 15(-) 12(,') 19(f) 4(.~) 8(,£) 7(-) 13(/.) 20(-) 6(/. -) 9(,') * 11(,') 12(-) 16(-) 6(/.) l(,') * 5(,') 11(-) 2(~) 7(/.) 9(-) ; Indicates in the direction of a more favorable rer, ting. - Indic tes in the direction of a lesser favorable rerating. _, CIIAPTEn V ELEC 1 rno:cr1cEPlL\LOGRAJ, i RESULTS For the present study the electroencephalogram (EEG) was chosen t be the cr·terion for or~anic cerebral dis function. This, it was conside1"ed important to examine the results of the examinations .i.n order to see how the vari us t rpes of tracin s 11ere is t 1 bttte . one.. thn re , erred an~ cont 1 c;roup subjects. ach ro 4 was fir t com. are on e or abn r a, noi mal, and border - line trac·n s; secon l, eac ~ eroup 1as brcken ;vn accord- · ng to a e di st~ib- tion; and t h r 1, , each roup ·1 s b o e11 down accordin t o e, sex, and t ., e o"" abno ,al tracing. s ·1 s revi s 1 1ent ne in pter I, EEG trachlgs shofi n a cerebral dysr thmia 1ere clas sified as parox s 1 non-f ocal , parox s 1 f ocal, dif non- ocal, and diffuse f ocal. e t o the 11 te d numbe, bor erline records ~ere n t so class fied. ~ G records sho1·n nod. srh thmia ere cl s e as normal. Table VII ives a breakdown showin a .e an sex istr·bution an t pe 0 tracin or the - "err e rou • tota of 7 ( 56 •. per C nt) of the trac- ins ere n r • a t t a 0 2 ( 3 1 .o ... er cent) were , r m • an_ a total 0 .i. 7 ( .5 .1 er cent) ere borderline. , 95 Table VIII gives a breakdown of the control group indicating the t~pe of EEG tracing accordin to sex and age. A total of 9 (1.6 per cent) of the tracings were abnormal; a total of 80 (85.1 per cent) of the tracings were normal; and a total of 5 (5.5 per cent) were borderline cases. Statist_cal Com arisen or E~G Results ------ --------- - ------ The 13 7 referred roup children were compared with the 94 control roup children on the basis of whether the ~G tracings were abnormal, normal, or borderline. The res lts 1ere treated statisticall w th the chi sq are techniq eth d). (see Cha ter VI or a fuller descri _ tion of this he e 1its a ear in Tabler: . m he nt 1 h othesis is re·ected since t ~s test of si nif icance o 1s t ese t o ouns to be ver, erent in resp ct to the ist ibution of these types of tracings. It as inte~est n" to note that al tho ha majorit o t he referred roup iere shown to have abnormal tracin s, there 1as still a lar te n mber who received normal tracin s. n t other hand,there as a small roup of abnormal trac n s a on the c ntrol rou, and it was decided that t he char cteristics of th s small f,roup ould later be x ined f 01" s to so~ brain njur~. Ag~ Distribution Table X gives the percentage breakdown of the types of EEG tracings for 137 referred group children falling within 3 age levels. It can be seen that the group between the ages of 5 and 8 had ap roximatel 67 per cent abnormal tracings, 24 . er cent had normal tracings, and 9 per cent had borderline tracings. The group between the ages of 9 and 12 had 5c per cent abnormal tracines, 38 per cent had normal tracin,.s, and 4 per cent borderline tracings. Finally, it was noted that the roup falling between the a es of 13 and 16 had 32 er cent abnormal tracin -s, 68 per cent n rmal, and O per cent borderline. A s .mi.lar t rpe of b reakdown for the c ontrol . roup ch· ·1aren r1as .·iven in Table I. It can be seen that the children between the ~es of 5 and ha a ~roximatel~ 17 per cent abnormal tracin .s, 73 per cent normal tracines, and 10 per cent borderline tracings. The ; oup between tea es of 9 nd 12 had 7 per cent abnormal tracings, 89 per cent norm 1 tracin3s, nd 4 per cent borderline trac ings. The gro ~p between the a res of 13 and 16 all derived normal tracings. The tren sin both t he referred and control groups were t . us seen to be the sa1 ne, that is, the older the child the less likelihood of a q estionable tracing . These 97 findings are in essential agreement with those reported by Brill and Seidemann (11) who,in an E3G study of 100 children between the ages of L~ and 14, found that youn er children were nn.ich more likely to develop dysrhythmia under hyperventilation than were older children. ~YP.~ ~ !racing Distribution As was stated in Chapter~ four classi icatton of dysrhythmia were era loyed b the electroencephalo rapher who originally read the tracings. Tables VII and VIII ive a breakdown accordin . to these type of d srhythmia, and for the normal and borderline tracin ,s for 117 re erred an ""or 9 I - c ntr 1 children, on an at,e and sex basis. eca~se there are so fe abn rr.ial tracines a . on the control -roup ch. 1 .ren nod stinct trends can be een. o ever, tt i o some inte est t note that 5 out of the ~ or 55.5 per cent o. the abn rmal trac n -s r this roup .. were non-focal diffuse, while for the rererre group onl 5 out of 78 or 6.4 per cent had tracings of an abnormal nature fittin this cate 6 or. The majority of quest enable tracin s on the referred group were actuall. seen to lie in a non-focal aroxysmal classi ication. It may be o~ some sign ficance that almost the exact percenta eon borderline tracin s were found for the referred and control roups (5.l per cent and 5.3 per cent respectivel .). "' r ' • rl, ti j_ - • "\ . ... ·1 . .l L ~ .!. ,0 • . r' J • 'I ., ~ !;,1 ~ Q • .,I • .., I 0 (" . I ,r. I , - .,. -~ ,. ., .... .,_ t V - .., 1 • . ) 0 ,( - - () • 99 borderline tracings with the referred having a very significantly greater percentage of abnormal trac incrs. 2. Both groups showed a similar trend in that the older the child was the less probability of an abnormal tracine. 3. The referred group had a much lower percentage of non-focal diffuse tracings than id the control group . 4. The majority of abnorm~l tracings amens the referred group were of a non- ocal narorysmal vari et, • 5. Both roups received al~ost identical per centa es of bor erline tracinl s. 6. Prel minar study indicated that no significant va · iables could be ounr that woul dif ereLtiate the ~ro ~s r·th i~ferent t-rnes of abn rmal trac ine;s, anl the refe r red an c ntrol grou _ s ,,ere clas"'- r e under t re headin s; namel .. , ( 1) :pos5_ ti ve (abn : 1 r .al), (2) ne i _ative (normal) and (.3) borde.line. TABLE VII G s ISTRI CCORDIKG TYPE OF i:LG '1R.ACING FOR 13 7 REFltJIB.ED GROUP CHILDREN g , : % = = ·- g 1 I • I ,. : --,,, &¥&1#1& I LI ; : : 111:c::•:t•r I2::c:21:== : n r r , + r: Focal Non-focal paroxys- parcxys- Focal Non-focal Border • .nn diffuse Normal l ine Total e : Ma.Le lt'emaLe Nale lt'emai.e !1aJ.e 1t·ema.te }la.1 e Femal e· Male Female Male Female Male Femal e 5 0 0 2 0 0 0 0 0 3 0 l 0 6 0 6 3 0 5 0 0 0 0 0 2 l l 0 11 1 2 0 2 l 1 1 0 0 4 0 l 0 10 2 8 2 2 7 0 2 0 0 0 1 0 1 0 13 2 • 9 1 0 2 0 4 0 1 0 9 0 1 0 18 0 1 0 9 2 3 0 0 0 4 0 1 0 18 2 0 8 0 0 0 0 2 7 1 0 l 17 4 2 0 4 0 0 0 l 0 6 l 0 0 13 1 0 0 1 0 0 0 1 0 5 1 0 0 7 l 1 0 3 0 0 0 0 0 1 l 0 0 5 1 0 0 0 0 0 0 0 0 4 0 0 0 4 0 0 0 0 0 0 0 0 0 l 0 0 0 1 0 1 AL l !i 2 43 3 10 1 3 2 47 5 6 1 123 14 I.E VIII A G SE X r I O N ACCORD ING TO TYPE OF ro CING FO R 94 CON'l'ROL GROUP CHILDREN ocaJ. rJon-f ocal oxys- Focal Non-focal Bercier diffuse diffuse Normal line Total • .Ma.Le .t4· ema.1e uaJ.e r·emale Male: !t"e inale l.iale Feiiiile Male F emale A ita.le l'emale Male Female • - 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 6 6 0 l 8 10 0 0 0 0 0 0 0 0 7 3 0 2 7 5 9 1 0 0 0 0 0 0 3 8 6 0 1 0 10 10 0 0 0 0 0 0 0 0 5 4 0 0 5 4 11 0 0 0 0 0 0 0 0 1 5 1 0 2 5 12 0 0 0 0 0 0 0 0 10 8 0 0 10 8 1.3 0 0 0 0 0 0 0 0 5 3 0 0 5 3 lh 0 0 0 0 0 0 0 0 1 2 0 0 1 2 TCYI'AL 1 1 1 1 0 0 1 4 43 37 1 4 47 47 J TABLE ll A CHI SQUARE COMPARISON OF 13 7 REFEAAED GROUP CHILIREN WITH 94 CONTROL GROUP CHILDREN ACCORDING TO TYPE OF EEG '!RACING Ref rr d Group Control Grou POSITIVE EEn 78 9 Sign·r cant 1 percent level. ... NEGATIVE BCRDERLINE EEG Em 5 7 5 CHI SQUARE - GE: 5- 8 9-12 3-16 ( . TABLE X A PERCENTAGE BRF..AKDO~/N OF TYPES OF EEG READINGS FCE 137 REFERRED GROUP IlDREN AND 94 CONTROL GROUP CHILDRE FALLING ITTHIN THREE AGE LEVELS POSITIVE NEGATIVE EEG B RDIBLINE TOTAL O. EEG F SUBJEC efer ed 66.7 2 •Q 8.9 45 Cont 16.6 73.7 10.1 30 Ref ITed 57.5 38.~ 4.1 73 Con rol 7.5 8.7 3.8 53 efexr d 31.6 68. o.o 19 Contr > l o.o 100.c o. 11 CF T1IE VIOR RATI I r , 0' • 0 .. .,. • V • 1. .. I I .. ( '. I • ( • J. . . .. . • . .. ( '; " c .. L , .o ( (-> .., ,.. T ..L V ) • ,_' "! - ·- V - I . r '. ro ,.. . • 1( C r'\ . ,_ . . .' l . ' l, l ' ·; l , ' t!>, ._]_(., 1 l . the· .l. •ro :' ... ( • C • 'J • , .. 0 1,) ( 0 v ·- · t • t , -r• .J ,... ( ~ ., e-- 1 - r' . ., I ?• .. ·- r, J ,· .. t .I ~ _, • , J 0 e r ·o 1 .n .. f I ( 0 . P. . .J , .... ' • "'I .,o • i ,... J f; • .L v , . ,, - . • • l ,· ,. _ ,.., v., - • l ('l 7 '· ,..I.. ( ") ( . .... n i ' l t • n .... ( ., ( 0 I -r '1 . -, .. ') ' .. (' , , ( • p • ( .. .... . - 7 V ( • r •, "' ., ,I J I ' , I v • • - I 1 , ... • • t I . ' :t ) , • 1 ' .. ( ., • I ) J r • • r r J. • • . , ~ - ) r f t· t C r::' ., - .. , v,a ( • l ,I • I ( , • ( ... 1 ., • • f - ,., - / I . .} .0 • e • • ., ' ··• ( I • ... , , ,-J • . • , , 1 ; t ...... ("I l .. 1e ., .,. .. ., .!. ,L,;: •J --- • "r ,_ I ) ._ r ' t; • H:, .., , t.. • I 11 I I .-. ,, .. ..J ~ \ J 1 ' , I II I - ..... •r • .... , . , ) .. < .) • • l ... • .... ( 0 )' r- f_. <l '") - ' ~ 1 . 1 ,.., ... ~ i . . ' • J.. ., (,t - . l • I 'l e , .. ,. • l '\ ~ l i-; . ( • , ,. • '' ...., ' ,_ , • . • i. ·P.: ,., ';) t. r1 , I t ' . - w ., • • • .I 1 r , TABLE XI A CHI SQUARE COMPARISON OF CONTROL GijOUP TOTAL RATINGS MADE 00 THE BEHAVIOR RATING SCALE CONTINUM OF ELEMENTARY GRADE GmLS WITH PRIMARY GRADE GIRLS, EI,EMENTARY GRADE BOYS WITH ffiIMARY GRADE BOYS, AND ALL-GRADE BOYS WITH ALL-GRADE GIRLS Primary girls Elementary girls Primary boys Elementary boys All-grade boys All-grade girls * Not significant. Ratings ot 1 &. 2 533 578 537 593 1,130 1,111 Ratings of 3, 4 & 5 67 22 133 97 230 89 Chi Square f- • 0 1 !"I l, :1 1 (> c, .. .,,... ., . 0 ., J • 1""' c: 1 •l v ,r ( ~ I .; • • t'1. ~ I- ~ l ""'I F 0 o· ... ~ V . . ,.. . , () t · - • 1. 'I' I '> ..J \.• I I I ,,.. 1 , , ( ' ,'"'l ·G t I • 1 • ., 1 r. '") I' .. I \ C - ., ., ·-. • •• .l I,. ·~ -- l t) . , ... ·- t· I f ~ • .. ' 11 l r , , . ' I () I ·- ~ r • t ' . .,. • ... • t • J :"\ I . '- l • J V () -, C ' I I ( , - . +- .! .. , ,... • l ' ,, 1 . - . • . • • , J , . . . I, r, I ' .L . ·11 ., ,, 112 the hospital for EEG examinations. Foweve~, it is possibl~ on the other han, that better behaved children were delib eratel~ chosen for the examinati ons. The onl~ eridence in- .. .. dicating that this was n, t so is the fact that the overall rat· ng scale I'esul ts fro1n the parochial scli ol did not d f er s j_ 0 ni ficantl~r .from the overal 1 results i. ron1 t,:ie nublic school. Similari t,;r to Public . 3cliool St dents in Bes ect to The - ------ ----- - --- Since t ere erred rou. was co ._osed of ublic school ch.ldren lho 1ere rated on The ehavior nat·n b"r .. ublic scho 1 teachers, it ias deemed im ortant to cover if t e C ntrol ,ro \Vas rated . t e roe ial teacher s in 1uch t e sa. c manner, as '/ere the ener 1 cale s- schx>l popu- lation or t e u 1 C SC 0 ls. To th ten , the C ntr 1 rat- • 1.n s ~ere COI'.!l are t _ t ra .._i~j s o_ ltl .. lb ic SC 1 child- re • Table rIII s ws t h . c n i on an"' .. e1n nst a tea that there \:·as no stat· st· · call si ,ni cant , ference . It c n b e n, te , h ie er, that t ' a oh~ 1 ro tended t . be iv n f"\re , l1~, and S rat n s b the na oc io.l teachers. The ehavior In an effort to discover t ose items h·ch most clearl i _ferent·ate the referre s ects fr m t he con- TABLE XII A CHI SQUARE BEHAVIOR RATING SCALE COMPARISON OF TEN SIXTH GRADE CONTROL GROUP SUBJECTS WITH TEN SIXTH GRADE FELLOW STUDEFl'S Control group Fellow students Ratings of 1 & 2 436 413 * Significant l percent level. Ratings of 3, 4 & 5 14 3S ..., .... Chi Square TABLE XIII A CHI SQUARE BEHAVICR RATING SCALE COMPARISON OF 82 CONTROL GROUP CHILDREN WITH 416 PUBLIC SCHOOL CHILDREN Control Public school * Not significant. Ratings or 1&2 2,153 12,290 Ratings or 3, 4 & S 301 130 Chi Square 1 ~ - t ► . .... 1 ' . r vi e r, t n 1 r - t. ~ ... • .. .lnl 'I om 1 ,..l • ... ..,.. 0 ,. ~ ( • ('\ ,~ I ("• Cl • , D .., --- ' ., • ... • Lt , ., .J I ~ • .. ' l "\ pr • 2 ,t y,, J .--. C< ") c-. l \. ., ("\ 1 ·h .,.) r M t ~ . , t:_ . , ... • - · ,, ~ ... • 1 <. . -4 . .., r-1 ,. - l J . .. . ... ( I (' ('; , 23. 6. 22. 116 Cannot seem to control self (will speak out or jump out of seat, etc.). Hyperactive and restless. Often withdraws quickly fron1 group activities; per·. ers to work by self. Erratic , flighty or scattered behavior. Behavior e;oes in cvcles. Man _ _ ,. evidences of stubborn, u1-icooperative bel1avior. Tends to be destructive; especiallv of the uvork o.n others. Da _ rdrea, in , alternating v,i th hyperac ti vi ty. Seemingly not effected bv extremes of hot or cold. hallow feeling for others. ften tells bizarre stories. The followin 0 item was significant at the 5 per cent level of co. nf idence : 10. Excessively meticulous , exactin, ormalistic or pedantic. The total results shov1 The Behavior Rating 0cale clearly differentiate the r ferre pos tive groun sub jects from the c ntrol grottp subjects inasfar as the kind o-r behavior described in this was concerned. In all cases t{1e ratings ""or the referred rou_ shov;ed man/ m re 3, 4, and 5 rat~ngs. A s n·~lar c m ::-. a r ison was 1 na e between the , 26 re ferred grou.p su.bjects an the 82 control •roup sub ·ccts, and t ~ e res lts a ear in Ta. le XV . The results sho the f ollo\Vi,ng i te !lS to be sig nifican.t at the l per cent level of confidence. They" are ran. ed as before accordin . ., to s ta tis tic al im ortance: "'I r I • • • ,... ,,., .. • • • ., .., 10. Excessivel~ r1eticulour, exacting, or formalistic or pedantic. 118 Thus, it can be seen that v,i th the exception of l i te. ~1 The Behavior Rating 0cale siBni · icantly differentiates the referred ne ative group fr m the control group on the basis of the behavior traits described in The Behavior Rating cale. In all cases the ratin s wee poorer or t '.'le ref erred 1._ roup. One of the most str ki~ , features of the above item lists is the seemin lack or correlation between the two rank or<ers. In order to establish w at ~elati n, i~ anJ, t ~ere is a ran or er c relation s ca. ~tla ted a the re lts a_ ear in Talle II. It can be seen from the scovere correlation of f.O t t t ·s means that thee is ract·c 11 no relationshi wh toe er • • Cne other statistical proce ~re was carried out. It was dee ed i ~ p rtant to discover wh·ch items ifferentiated the ref erre ositive from th ~ referred ne~at·ve #roup. Te chi sq are techn qu was used and the ollow n - items were iscovere that co 1 . ke th·s distinction: Ite s: 9. Da. drea 1in-, alternatin ~ith h eractivit (si ificant at 1 . er cent level. Ratin ~s poorer or referred ne ative ,roup). 15. ~xpl sive and unpre ictable behavior (si _ n·r1- cant at 1 per cent level. atin po rer or referre ~ ne ✓ativ ro ). 2 • ,.., ·- • t I { .. ( , • • • ( t l • • ., ., ' l l ., J ,I - .. . .J' .., ..... .. rn : I_ (; ••• - I Vf,. _. - ~ .., J I p ., , ) . li •' t l I '· I V . • , ; ,, f 'fl _7 • J_ , - 'l ) l ...) ) () v ' :i ... ., ' .., ·c " , ( ' 1, .. • _, ,I , ... ~ ,, I ~ • ( . ,- ) l • r ., , t ~: t . ., t. .n , ( ,,, , ( l - .,. .. . ~ l., ' 1 ' • . • 1 -! "G I ., ( 1 "1 8 . • ..,_ ( .... I .. ,.,. ') ' I I , ( .. • ,- ) . ... ... "tl . '1 r., r, , ( , t _, • ~ ' . 1 . ( .... I • rj ,(. ' .... , ") nl co . I • t. . I' 1 ..I , 0 ..._ I 2, , ' I n t . J. ' , . r 1 ,. ( ✓ ,., l , ( ., . ,J: • I • . • :':l t, ,- t,, . ..... ., r,,., • r ; ' .. , 'l'" ·.'r; i:•n i- .. . . ~ • r , (' .. •t .. ,... ~ • ., r . , • • 1 I • ( J. C ., • l I . 1' fl , ~ 0 C ~· - . ' n 1 ... 1 :r ... • I • 0 • " •r • I , r• ! I• r • .. "" " l , l · ·r-- 1-, ~ } ' . ..., , ' ~ .. , l "I n J ., , ... .. ( _,, t ,., . A r '"' ·J . • " ,I ., ,, ~ (l - . • 1 ">• l I , . , ( . t: 1 ' . ( . ' ' ... ( . 1 " ( 0 .- C,,i.J • .l 1( • I i () r-- .... • . l ( ., . ., l . ,I l. • 0 ., ,I ' ( l, . '· • .. r L. (~ 4 r ;i . rr·0l . .; , ' .) l· ' ' C 'tL 0. l' J_1fl l . . ..., ... • _. ,, .... . L "" 0 l · - , ., ... ... . l • • ,, ( ,! l C ·r • • ' . ,, ,... ,..,. ( 1 C • J.., l, • ,._ ' . !I ) , .. .. • _,.. '! , I ~ • n ., . 1. " , · ! I. ... . • • I , • ! J ,., .. r 1 • I.. . L, , • • ' • • l I, ' • ( .,_ J r • ' ,. ., ... • ( .. .. ,-. < I , • . TABLE XIV A CHI SQUARE BEHAVIOR RATING SCALE ITEM STUDY COMPARISON OF 6o REFERRED POSITIVE GROUP CHllDREN WITH 82 CONTROL GROUP CHll,DRF.N Item: Re?erre ~ontrol l 43 8o 2 30 79 3 12 69 4 17 65 5 12 65 6 17 59 7 23 6S 8 21 n 9 28 69 10 43 76 11 18 61 12 20 71 13 9 57 14 41 80 15 27 74 16 31 79 17 22 79 18 15 69 19 42 19 20 16 66 21 33 73 22 31 76 23 20 68 24 22 77 25 28 78 26 29 80 27 23 69 28 43 78 29 27 78 30 25 72 * Significant l percent level. ff Significant 5 percent level. Ratings of 3, 4 & 5 Referred Control 14 2 28 3 45 1.3 40 17 39 17 41 23 35 17 35 11 28 13 1.3 6 38 21 37 11 51 2, 13 1 33 8 28 3 36 3 44 13 18 3 35 16 26 9 24 6 32 14 37 s 27 4 21 2 34 13 13 4 31 4 33 10 Chi Square 14.2* 36.7* 52.8* 31.9* 31.1* 22.9* 21.1* 47-4* 16.9* 5.BH- 22.6-- 37.1* 39.2* 43.a.. 32.8* 35.a* 54.8* so.1* 17.0. 30.0if. 18.1-JC- 23.6* 25.1* 49.~ n.1* 31.1* 46.°* 8.1* 40.0N- 29.1* TABLE XV A CHI SQUARE BEHAVICR RATING SCALE ITEM STUDY COMPARISON OF 26 REFERRED NEGATIVE GROUP CHILDREN WITH 82 CON'lROL GROUP CHILDREN Item: Ratin~s of 1 & 2 Referre Control Ratings of 3, 4 & 5 Referred Con~ro! Chi Square -------- ---- ------- ----- --- --- - -------- - - - - -- - - - - ---- -- - - - --- - - ---- - - - 1 17 80 6 2 11.l* 2 8 79 14 3 38.3* 3 10 69 16 12 18.7* 4 10 65 16 17 13.6* 5 9 65 10 17 6.9* 6 4 59 20 23 21.3* 7 5 65 18 17 24.2* 8 3 71 18 11 39.1* 9 4 69 20 13 36.3* 10 17 76 7 6 1.9H 11 4 61 21 21 2$.0if. 12 11 71 14 11 17.1* 1.3 3 57 23 25 24.6* 14 l4 81 6 1 16.6"- 15 5 74 21 8 46.S* 16 8 79 18 3 50.1* 17 12 19 14 3 33.8* 18 6 69 19 13 Jl.8* 19 12 79 14 3 33.8* 20 6 66 14 16 17.4* 21 7 73 19 9 46.2* 22 9 76 16 6 34.1* 23 4 68 16 14 28.6* 24 6 77 20 5 48.9* 25 8 78 18 4 46.4* 26 9 80 11 2 35.1* 27 11 69 15 13 15.5 28 13 78 12 4 24.7* 29 9 78 17 4 42.b* 30 8 72 18 10 30.5-tt- * Significant 1 percent level. ~ Not significant. TABLE XVI A RANK ORDER CCRRELATION BETWEEN REFERRED POSITIVE GROUP AND REFmRED NEGATIVE GROUP BEHAVIOR RATING SCALE ITEMS RANKED ACCORDING TO STATISTICAL IMPORTANCE Item: 1 2 .3 4 s 6 7 8 9 10 11 12 1.3 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Referred Positive Group Rank Order 27 12 2 15 10 20 23 s 26 30 22 11 9 7 14 13 1 3 25 17 24 21 19 4 28 16 6 29 8 18 Rank order con-elation= ;.04 Referred Negative Group Rank Order 28 8 22 27 29 21 20 7 9 30 17 24 19 25 3 l 12.~ 14 12.s 2.3 s 11 16 2 4 10 26 18 6 lS TABLE XVII DIS'lRiaUTION OF 'IDTAL SCORES ON THE BERA VI<R RATING SCALE FCR 103 REFERRED GROUP CHILiREN AND 82 CONTROL GROUP CHILDREN ACCORDING TO TYPE OF El?n TRACING Abnormal Normal Borderline Range: Ref erred Control Referred Control Ref erred Control 130-139 120-129 110-119 100-109 90- 99 80- 89 70- 79 60- 69 50- 59 40- 49 30- 39 Mean s.o. 2 6 6 8 11 5 6 10 6 4 2 0 0 0 0 0 0 0 0 2 .3 4 41.3 8.2 0 2 3 8 s 3 7 1 2 0 0 92.0 19.4 0 0 0 0 0 2 6 s 6 16 3.3 0 0 0 0 2 0 0 0 0 0 1 0 2 0 l 0 0 0 0 1 0 4 ,,. ... .. ,. . • .... ( .. . ' ( . .. , . ... I • ' ..,- c• jl J r, l I I r - r r r 129 had not made it a practice to give group tests. In order to arrive at some basis for cstimatlng the intelligence level of the control group,The Binet Vocabulary Test (105) was administered to each child at the time of the EEG ex aminations. Some mentlon has been made of The l~'fechsler Intelli _ )ence Scale for Children ( 111). A small number of the re ferre group sub·ects had been given this test. The Cal ·.r rnla Test of ental f\iaturi tv - An exmnination of the cumulative records revealed that the referred rou pupils had been given The California Test of ,ental ,. t rit at one t me or another. Table VIII gives a breakdown of IQ's according to ,roped data at ten point intervals and classified accord in to hether t~ corres _ ondinf: EEG' s ,vere abnormal, bor derline or n rmal . Tne median I . for the total referred rou a ound to be .9. The re erre ne ative group as n to have a med an IQ or 101.2, while the referred ositiv .ro ha a sl htl lmver median IQ of 95. 8. This call ferred sc ool rence in th an I ., 1a o nd to be statlsti- ns . ,n_ ican , ( see mable ~ IX). A r n of com,ar son can be e bet een the re- o s an too en ral sch ol population o the two str cts b~ re erri t Table XX. ,)1 -- -. 1 t . .1.0 ~ . ) \ r, .... c-, ., -; - .. - , ... , ... -. . . . . . ) ,.. :_c. .I. -; -· r ·1 _ .1 , ,;,i - et .. C ' ,. . 7 t ~ () ) . .-, c-, 0 r-, r' ..... ... \. J - , I O' .l.. 1 .• _(, ....... ,,_ ( ' • .,. ,. ~ ,' )'} .... e .., -· c_ • J. ;1c :_ l1 C . ... ...... . , •.J V t:; ..:..> • f , _n l ~ -.- • s .... __ \,;_ "l r , n ,.., . ' ~ e 0 .- ... . or '"' C ~ ..... "" t! ., ri-~ ..., -- ,-, • .J . J f s ./ 0 ~ /'."':I l , _ l 1 <,;.;.. t 15 . / • ..L ~ r . ,_ . 1. ., t L,l: 0 .,. . ... ,.. C ...... ~ V • .. . ,, , n ., C\ r • ) .. , ..., ~ . ) . "I ,., _A • ... .. . . . ,., . .. . . ., .. ~ . ..,., .. . . . --: " ,c. .. . ') ,.... . ., - ... '- . G ., "- • 'Y' ("I • .. ,I "t ..,, .L , • .., .1. .. .. ., • J ., V ..., 131 prove a valuable tool for the evaluation of ability pat- te~ns amonc the subjects used in the present study. Un fortunately, too few tests existed at any one age level to make valid comparisons with the published standardized data of this test by \"echsler (111). Preliminary studies have indicated, however, that t;he referred positive group child ren (l}+ subjects) show a strong tendency to have mor•e diff1- ct1l ty w th the verbal subtests than d the referred nega tive grou children {13 subjects). Both roups apparently have diff iculty with the Arithmetic and Codin subtests. VII • CID PTETI ::,Uf\'Il\ RY The present chapter reported the results of certain intelli ence tests. Althou . h it has been reported by Henry (49) that there has been little or no correlation ro n bet veen I ~ and el ec trocortical tracings, 1 t was t l ou~ht desirable to invest gate the possib111t~ that the t otal I Q's or the kinds or refiles makin u the intelli- ence te t, m· ~ht have some diagnostic value in different iat i n the roups whi ch have been class fi ed accordin to EEG tracin ,s. , om e t _ nn- tende cies ere noted hich o 1 see ,._ to s bsta tia t e then tian that the above h othesis was valid. It ~old see~, or instance, that the r ererred r,• ..., 1_ e () ·1 .J.. .,.- • . , ., . l e 9 .. ,_ ~ ' r, 1 , 0 , , _. J - ., .J.. ~- . • .... .., - • I , , ( - .t ., 7 ' 1 n '! . . Abnormal Borderline Normal Total TABLE XVIII DISTRIBtrrION OF TOTAL IQ 1 5 SCCRES ON THE CALIFORNIA TEST OF MENTAL MATURITY FCE. 79 REFERRED GROUP CHILDREN ACCCRDING TO EEG TRACING 6o- 70- 80- 90- 100- 110- 120- 130- 69 79 89 99 109 ll9 129 139 Median s.~. 0 6 19 0 0 0 0 9 2 1 1 4 8 4 4 3 o 95.a 12.9 l 1 0 - - 8 3 o 101.2 1s.1 1 6 10 27 15 13 _._,...._. ________________ _________________ -- --------- TABLE XIX SIGNIFICANCE OF THE DIF'F'ERFllCE BETWEEN '!HE MEDIAN IQ OF '!HE REFERRED POSITIVE GROUP AND THE MEDIAN IQ OF THE R EFIBRED NEGATIVE GROUP 00 1.HE CALIFCRNIA TEST OF MENTAL MATURITY Referred positiw group Referred negative group Difference Standard error of the difference= * ot significant. Medi.an 101.2 , -✓ I s.n. TABLE XX INTELLIGENCE QUOTIENT AVERAGE OF DIS'lRICT "A" AND DIS'IRICT "B" SIXTH GRADE PUPILS ON CALIFORNIA TEST OF MENTAL MATURITY FOR 1953-54 SCHOOL YEAR District "A" District "B" Total Students Number or Pupils 485 365 aso Average IQ 107 llO 108 .. ... ,-J s.n. TABLE XXI SIGNIFICANCE OF THE DIFFEll.ENCE BETWEEN THE ,mDIAN IQ OF 'IRE REFERRED POSITIVE GROUP AND THE MEDIAN IQ OF THE REFERRED NEGATIVE GROUP ON TEIB CALIFORNIA TEST OF MENTAL MATURITY Referred group 5th and 6th grade group Difference Standard eITor of the difference 1.6~- * Significant. Median 98.9 107.2 a.3 s.D. TABLE XXII DIS'ffiIBUTION OF INTELLIGENCE QUOTIENT SCORES ON THE BIN~T VOCABULARY TEST FOR 94 CON' IROL GROUP CHILDREN ACCORDilJG TO TYPE OF EEG '!RACillG 60-69 70-79 80-89 90-99 100-109 110-119 120-129 lJ0-139 14,0-149 150-159 160-169 Abnormal Borderline ormal Total 0 0 0 0 0 0 l l 0 0 4 4 Average Intelligence Quotient llS.6 Standard Deviation 16.1 0 0 9 9 2 2 14 18 2 0 26 28 3 1 8 12 1 1 10 12 1 0 6 7 0 1 l 2 l ' , f • l 0 0 1 1 r CI-IAPTER VIII THE GOODENOUGH-DRAvv-A-1\iiAl'I TEST RESULTS Althou hit has been shown that many tests for brain damage are inconclusive, and in some instances inadequate, there have been a few which have proven of value, particularly those of a visual-motor variety. The Goodenou ,h-Draw-a-Jan T st (LO) wo11~ seem to be a test of th s nattre ,:.ince it requires a r:·ood deal or e,re-hand co r nat·on and visual perception. A substantial nunber of children from both the re ferred and the c ntrc l ro :ps were c ven the '}oodenou .. h test. An index o_ I ras derived from the drawin sac cordin to the scori , scale set u by Goodenou h. The referred children com.ared with the c ntrol children on the bas s or th IQ ratin. These grou~s were also com- pared 1th eac other on the basis or coord nation and proportion skills. Th -- enough-Dra -A- ~an Test total o referred ro1L s b·ects and O control rtic1lar test. ach o the 1 "a · • n s e r e co , e -. - t ook ----- · a_n _t 9-. ------- _.: _rn •ti ~ s ( l ro) and a r v d . Th._ , n tu n, was 139 related to the chronolo , ical age of the subject and an IQ was calculated. '1 1 able XJ III showed the distribution of these I 's for the referred positive, referred negative, and c ntrol ~roups resnectively. T ratios were calc1lated in an attemnt to find si nificant differences between these thre rou ~s in respect to tre distribution of the IQ's, and tne resu1ts of these statistical comuutations appear in Table XXIV . It vas · 1n·· that the control 1.7roup was s · , .n: ·_ficantl:· bette""' than the .,e e~ red osi t_ve r ou and ver. si -nificantl better than the referred neuative .rou~ in this res ect. lo n ~icant ifference was oun be- . twe n the re e red pos tive an the r -~e red ne~ative )roup. In s ort, the re:'erred ro p , as a \Yhole, was si nificantly lo11er as meas~ 1red b , The G oodeno h-Draw-a-I,.an Test, but .. --~ the two refe red ~r ps were n t differe t from each other. uince man lir· ters have claimed that brain-in ured s 1b · cts ha or nat on an m e than sual if c lt in e.e-hand co _th erceut·on in eneral, it was tho , ht desirable to a alvze the draJin~s in resnect t thee n of p in ts 1e ._ e t al, z n t ... e 1 p t scale, two cl sters (6 :1 3-106) i ... n b lo : 12a. n-ht to s re t es factors best. T ose n ·nts, ass ate • t'" e .. 11 1 are P o .l. ort· n: F ea :, • Re ire. ent: ea. o :... t he d n t . or than one-half or less than one tenth that of the trunk. Score rather leniently. 12b. Proportion: Arms. Requirement: Arras equal to the trunk in lengtl:1 or slir.htly longer, but in no case reaching to the knees. 7idth of arms less than that of the trunk. 12c. Legs. Requ~renent: Len -th of the legs not less than the vertical measuren1ent of tho trunk, nor 0 reater than twice that measurement. .7idth of the legs less than that of the trunk. 12 • . eet. _ Req1 ~r ~ient: The reet and legs mlst be s1own in two dimensions . The feet must not b~ "clubbed"; that is, the length f the foot must be - ·reater than its height fr .. m s le to instep. Thelen th of the foot must be not more than one third or less than one tenth the total len . . th of the leg. The point is also ere .ted in full -face drawin~s in which the oot is shown in perspective, pr vided t . at the ·"'oot is separa ce in s 01ne way from tie est of the lef in these drawi~3s. • 1 "-~a. .- otor coordi nation. Lines • i?equire.1 e nt: 11 lines reas onabl. firm, or the most art meetin each oth r cleanly at points on j 1nction, without marked tendency to cross or overlap, or to leave ans between the ends. 1 b. ,otor coordinati _n. Lines B • . e 1 re ent: All lines firmlJ drawn with correct jo n ng . Th·s point is based upon a much m re ri id interpretation of the rules ven for the scorin of the _recedin point. O bvio~sl it c n never be credited unle s lI a • is 1 o cred ted. The score is in ad,1i tton to t ! t ~or l ta• ~c rin s1ould be ver strict. l ~c • . tr coordination. H nd outl ne. I ne ·rem ent: O utline of head v1ithout obviouslv ,, nintent·onal irre ~ u arities. Te p~·nt is ere ite onl in th se drar~n sin whic~ the shape cf the he ad has developed beyon the first crude circle or ellipse, so that conscious control of the movement of the hand is necessary throu~hout. Scoring should be rather strict. 14d. !v lotor coordination. Trunk outlines. Requirement: Same as for the proceding point, but here with reference to the trunk. Note that the primitive circle or ellipse does not score. Motor coordination. Requ rement: Arms ties as above, and ing at the point o B th arms and le s Arms and le s. an legs with ut irregulari without tendency to narrow- , junction with the bodv. must be in two dimensi ,ns. l ]~f . I ~fotor c ra·nation. Tjleat1res . Ren 1l re ., ent : Featu es S'Vl7lnletr c . 0 1 in all re pects. The total n mber of oints that each ero ~ (referred positive, re erre ne ative, and control) could ~et on the above uoints was calculated. Ther1 the total n1 1m er of points each roup actua.11"{ received ia.s tabulated. These istr·butt on were then used to make u tables of chi squares. It was decided to divide each o· these roups in two on the basis o~ a ge. 11 chil ren n ne ears of a e and beloi re r e grou e, as were all children ten , ears of a e an above. This was one because The _ roodenou . . h- Draw a-] an Test was considered an excellent ~ easure of ensori mot r maturation, an < · t ras th u· ?ht that any possible d·rr erences am n ro so one children mi ~ht not be ' ons. ... • .L n l ... T ' l 1-· 1 • ., • ... . C -· ,. . ( .. ,... n ( r , . ( ,_ . ..... • I ) ., '"I ... , t I • , • ., .. • I ' ·r (' , .. .. .. . ( .. • I ♦ I - ... • 1 .) .... . 1- . ,-,-- ~ I ' .l () l r .., ( '· .L .: ~ . r - • ' .., -· " 0 TABLE XXIII I.Q. DIS'IRIBUTIONS FOO. REFERRED AND CONTROL GROUP SUBJECTS Otl THE GOODENOUGH DRAVi-A-MAN TEST 50 60 70 80 90 100 110 120 130 140 1.50 160 170 Median 59 69 79 89 99 109 119 129 139 149 1.59 169 179 I.A. S.D. Control Group - 7 10 19 19 11 12 7 2 2 - - 1 94.7 20.7 Referred Positive Group 2 6 s 12 8 4 3 1 2 - - - - 87.1 19.2 Referred Negative Group 3 3 8 6 6 2 2 1 - - - - - 82., 17.3 - ,- TABLE XXIV T RATIOS OF SIGNIFICANCE FOR I.Q. DIS'IRIBUTIONS ON THE GOODElJOUGH DRAW-A-NJ.N TEST Control Group vs Referred Positive Group Control Group VS Referred Negative Group Referred Positive Group VS Referred Negative Group * Significant 1 percent level. -H Significant 5 percent level. T Ratio 2.09-H- TABLE XXV CHI SQUARE COMPARISONS OF CON'IROL SUBJECTS WITH RBF.raRED SUBJECTS FCR OOORDilJATION MEASURES ON THE GOODENOUGH DRAVI-A-MAN TEST 9 years and below: Control group (48 subjects) Referred Positive (18 subjects) Control (48 subjects) Referred Negative (14 subjects) Referred Positive {18 subjects) Referred Negative (14 subjects) 10 years and abovet Control Group (42 subjectC!) Referr d Positiv (25 subjects) Control Group (42 subject~) Refened Negative {17 subject) Referred Positive (25 subjects) Referred egative ( 17 ~tbjects) Points Scored 49 9 49 6 9 6 72 24 72 24 24 24 * Significant 5 percent le el. ~~ Not significant. - Points Not Scored 239 99 239 78 99 78 18o 132 180 78 132 78 Chi Square 4.07* 4.28-M .OOlH- 5.39 .696H- 2.12¼! TABLE XXVI CHI SQUARE COMPARISONS OF CON'mOL SUBJECTS WITH REl4"'ERRED SUBJECTS FCR PROPORTION MEASURES ON THE GOODENOUGH DRAW-A-MAN TEST 9 years and below: Control Group (48 subjects) Referred Positive (18 subjects) Control Group (48 subjects) Referred Nega ive (lh subject) Re£ rred Positive (1 subject) Referred egative 10 year and abov • • Contro Gr u (42 ject) Refer d Positi e (25 aubject) Contr 1 Group (42 subjects) Referr d • ega 1 (17 ubjects) Ret rre 0 iti (25 subject ) R fe egati e (17 subjec ) Points Scored 79 16 19 12 16 12 126 47 12 32 47 32 * Si ificant l percent le el. s·gnificant 5 pe ent vel. iL' ot significant. Points Not Scored 113 S6 llJ 44 S6 44 42 53 42 36 53 36 - Chi Square 7 • .36* s.a2~~ -~ 20.29 15.93* .OOif-:n~ - J · T.1 P 1 , A -, T ...) TL l ' o· • , • L , l - .J - C l"l • r ., ( () ... ,.. .. .,. ( r I , • j • r . . . I I ' ·- .. ( • J• • • ' • .. . 150 the grade pl~cement he derived from this readi~ test, and the group total average gain or loss, according to whether the correspon in~ E8G traci~~ was abnormal, borderline or normal, is iven in Table JL IX. These children did well on this examinatj_on since e.11 groups were vre11 above actual -rade placements. Th control negative gr up ,,as plus J ~ .9 m nths advanced on the averao-e, the c , ; ntrol positive chi.ldren were advanced plus 8.6 m nths, and the bor erline c ntrols vere a ~vanced plus 9.4 months. It was n t ossible to c ~nare these c ntrol roup subjects with the referred roup subjects on the basis or reading achievement since the two ~ro ps were me ~sured on different kinds o achieve ent tests . It should be no nted .. 01t that The 1 llide- ange Readin~ Achievement Test merel re uires the s1bject to reco ,nize a 1ord. He d es not have to co rehend it • On meanin - . ... the bass 0 the ab ve res.ilts, t Q l 1 seem that th c ntr 1 r ou chil ren ha e ., c llent w r attac techn os. XI . RY en t ere erre st e an r ~e red ne t ve ro s iere c m_ ared with ne nother on the basis of ... rea in achiev ment, it 10. iscovered that the ref rred ositive rou~ as ore e1erel retarded in thi subject. " • , ( ., ., , ., ( . . ' . , ., ., . , ' - -·--- . . ' , TABLE XXVII TOTAL READING SECTION TEST RESULTS FOR THE CALIFORNI.A ACHIEVEMENT TEST FOR DISTRICT "A" AND DISTRICT 11 B" FIFTH GRADE PUPILS FCR 'IHE 1953-54 SCHOOL YEAR Average Test Grade Placement Actual Grade Placement No. of Cases District "A" District "B" 481 398 TABLE XXVIII AVERAGE NUMBER OF MONTHS RETARDATICN OF THE TOTAL READ:rnG SECTION OF THE CALIFCRNIA ACHIEVEMENT TEST FOR 62 REF!'lmED GROUP CHilDREN IN RELATION TO TYPE OF EEG '!RACING Average Retardation Actual Grade No. of Referred Negative RefeXTed Positive - 9. 7 months -13.6 months Placement Range Cases 3 to 8 .3 to 6 22 40 TABLE XXIX AVERAGE NUMBER OF MONTHS ACCELERATION ON THE READING SECTION OF THE WIDE-RANGE ACHIEVEMENT TEST FOR 93 CONTROL GROUP CHILDREN IN RELATION TO TYPE OF Ero '!RACING Average Acceleration Actual Grade Placement Range No. of Cases Control Negative Control Positive /.4.9 months /.8.6 months l to 8 1 to 3 78 9 /\ T .,. 1' I/ - I I .,. ) (" p l l ( . . , l "" , . .L J l _, ' • ., ' - .. ., ( ( ) ( n, L. .. "') ( • '· ' . . ( '' I • - -. . - , .. ,. oys .. I ( ., ( ·- ... 157 evenly apportioned, 50 per cent in each sex of the 94 children. ize .£!: E:amilX It was uossible to tabulate the number of siblin .s that each of 103 referred ron chil -ren had, and Table xx_xr ives a breakdown accordinP,; _to number of ch ldren er fa 1 in rela tton to t~~pe or EEG trac n s. The avera e number of children for the referred pos tive f'am lies was fo1nd to be 2.1; ~or the referred negative families it was 2.4; and for the referred borderline families it was 2.3. The avera .,e nLl.mber or chil ~ren f r the entire referred ro ... ~as o 1n to be 2.4. 0 the control rou 5 famil e too, ch ldren for ~ G ex inations. nee so fe ch·.1aren in his group bad abnormal or borderline tracin s, it was th u ht desirable rel. t calc 1la te the avera e num er o children or the entire roup • ich as 2.9. Table X ~I ives a break on ... acco din to amil r size. .. The sizes of families for the ref rred ro .. s, heth- er e .. h ed abn rmal, normal or borderline trac:.n , r er: • m lar, n ·eating in all ro ab 1 t . t t this fact as 0 inconseq ential si ni~icance. Alth u . h the c ntr 1 r .&I ! • 1 ies h d on an avera e re children per fa 11 , it 0 e f ic lt to kn hat si ni icance Age: 5 6 7 8 9 10 ll 12 l.3 14 15 16 Total e an Age TABLE XXX AGE DIS'IRIBUTION OF 137 REFERRED CROUP AND 94 CONTROL GROUP CHILDREN Referred Control Male Female Male • Female 6 0 0 0 11 l 0 0 10 2 8 10 13 2 7 s 18 0 9 10 18 2 5 4 17 4 2 5 13 1 10 8 1 1 .3 5 l 1 2 4 0 0 0 1 0 0 0 123 14 u.o TABLE DCCI NUMBER OF SIBLINGS IN 103 REFERRED GROUP FAMILIES AND 58 crnTROL GROUP FAMILIES 1 Number of Children in Family 2 3 4 5 6 ? 8 Referred Positive 16 27 12 3 4 0 0 0 Referred Negative 5 15 11 2 0 0 1 0 Referred Borderling 0 4 2 0 0 0 0 0 Total Referred 21 46 25 4 0 l 0 Control 11 17 14 10 3 2 0 0 Average 9 Nmnber 1 2.33 0 2.44 0 2 • .33 1 2.41 1 2.96 ( .n f • -r . ) . ... ,. .. • .. .I • .... • ' ' I , . , • • J ) .:.a d e }_ 1".) ' • ., • , - . ,'l {' ., 1 ,, 1'. 1 . • 'f'l ( I e ? T . - ., " ... . I ' . "') • . I '. ._. - ) -· .,... J - - • ' ,_ .. ,: I rt . (_ • ' ,. 0 ....... ... (_, r• .l ' • .L • ... . , ( • r 1., , ( .. p () .. , . • • ,.., I t:_ I I • () • (_; ( . , ... . . .. . I, ( • t ,. • .. ,. r .. ( .,. ., ., J. ,.., 162 the three bodily fu- nctions. "Itiixed" dominance was the descriptive phrase ap ~lied to those subjects who sho1ed one bodily function to be lat _ .rally different from the other t,~o . Table X.1 XIII sh ,vs a c omnarison betvreen the referred nositive ,r ~ D and the c n tro l c,-re1 t • .4 The test of cance (cb.i square) s : ov1s t1e t\tO er u :)s n t to be si nifi cantl di_ : erent on this c aracter·stic . Table ~ III shows a stm .lar t -~e of c rn a r isen be tie n t he referre , nen;at ve r o.1 an tho control proup. _he res lts aaain de nstrate that t ese t,o ro s are also somevhat simi. r on tlis unction . 1 fhile t e ab ve c a isons do not show· sta t · stical s c nee i t h 1 be noted that there is ate .enc., nor the referred roups t w re "m xe "dor:iinance . 1 edical Risto ------ - here wa s a me ica histor one ch o the re- erre .rou c ,. ldren . n t e e ere r r r A .t.. 0,.. t e "OUp C ren , ere roterre .L ne ~ .'.,at·vc ch·1 ren, ve e re e re bor er n .r ch 1 r • T1.e et lo • cal • • • • • t t schen ta o 1tl ed n .. n s are C s ie a.cc , r l , .> b tra ss anl Le te in ( :119 ) an ear in .abl It s s . ". n. L. can t n te th t 2 0 t f the 50 s b ec ts and 21 0 t of the 37 s 1 bjects f rom th'"' referred positive group and the referred negative group , respective ly, had pathognomonic s gns in their medical histories when the criteria outline in Cha_ ter III were ap lied. - A total of 85 control group children had comparable medical histories recorded on them. The results are class ified in Table XJG~IV . Out of tl e .5 sJ.b.:ects in thls group 35 shnvre nos : i. ti v ... clinic al signs leadinc to possible nervous s . stem in urr. 1 1 · rhen the re erred p si tive r u· r s 1 ts vi,ere com- ... ared with the c ontrol --rrou res' 1 ts ( see Table : - .✓v) the:-,e was aver~ s n ficant differenc . found . In sh rt, the re~erre~ ositive ro i su ects sho~e a ~ in .re seve _ e clinic ls ns i the r me ical ·stories. Ont' other ban , rhen t ere tlts fr m the re ferred ne ative ~r u sub·ects and the c~ntrol ~rou s b- re tee ni ue, tist·cal si-n icance co 1 be i covere w ch o · - sta indi - cate th tone r 1ad m ore a verse ed .cal h stori s than t : e t er ( see T , l ) • I s 1.0 be n te , ~ ever, t .. ... t both r s . a.n C ,, r n it r tor es . Th. f act bear s t th nte .. ti ( 34 ) that a h· · - .ercenta ~ e o 11 to the _ n ( e o"" c rebral d .. a ) , ... artic, 1 rl b·rth rocess . 1 s- e b Gesell : hen the inc dence o at olo ical sins in the histories of the referred positive group subject were c 1 m·ared with the incidence in the histories of the re ferred negative group sub.iects, no st"'tistically signifi cant findings we __ .,e in evidence (see Table XXXV). The literature was found to c vntain many references to cert in "events" alleged to be m re cornmonl" oun in the h stories of brai1 - · njured · bjects than in the hj_stor ies of non-brain-injure in ivi uals. The present chapter dealt with the results o_ atte t tosee what actual relat· n ·p existe part c 1 rt~ e o bet een thee st ted variables 1itn a EEG traci .. . It 1as found earlier n ChaJter V that the . o r1t~er th ch.ld as,the more likel ood there a ~ran bn rmal , •G tracin - . Th s s tr th for the re err a r t .e c ntrol ro ch ldren. R ar less ~ti ~act,the .e ian a e o~ t, e rofo re ~ ro ~ 1 re ind to be o er r • ears o... .e. Th s me ns that 1n re ch 1 ren ere re red ~or d nee el :ho exh b te these rt~c lar b 'a or nifestat· n t a o it -ra e I , tha. for an. ot er ra elev 1. It is oss·ble t tat this a e children e e e re a li t t em, in an cade .ic sense, t o oth r 1 ren at ther a ·e levels. The median a e • .J ... , • n ., ,... , s . .., • ,: -. 0 .. - · _ .. ... 0 .. r ... • • . .. . l. L, ,.j ... .. ,. "' .. .!- I (, • ... .. .. io: ,_ l ... L, ' . ' G V 1 J -· ·- ' V- ..,,_ Y"I .t... "" ., . L, -· J . ., "' J . . v . - C ~ J- • .. V • 166 Althou~h there was a distinct tendenc~ for more of t. the referred ,rou children to shovv 11 mixed 11 dominance than those of the control group children, no statistical signifi cance could be found in this difference. Thus it mi 0 ht be assumed that a test of lateral dominance is probably of questionable value in the pr diction of or anic brain disorder. Aver s nificant difference was fond when the referred ositive roun was cm.are 1·.th t ~e c ntrol r-rou on t e ba -· s of a th lo (..)ic al events occurr· · n , n the me teal h:sto AS. o such s ni icant ind n s co 1~ be isc vered wen the re erred neat ve r p was com ared ~th th c ntrol ro • owe e _, all p.ro s, hethe re e ed or c ntrol, ~er t have ah h ! ercentaae of events in the r h·storiJs. hus the o o t n t or .. n / ch·l en t c ire brain i. ur·es seems to exist. TABLE XXXII BmTH CRDER CLASSIFICATION OF 101 REFERRED GROUP CHILDREN ACCORDING TO TYPE OF EEG '!RACING Abnonnal .ceg Normal Eeg Borderline Eeg Total Percentage 1 25 19 4 48 47.5 2 26 9 2 31 36.6 Birth Order 3 4 8 0 1 0 0 1 1.0 5 0 l 0 1 1.0 6 1 0 0 . I • 1 1.0 TABLE XXXIII CHI SQUARE COMPARISONS OF REFERRED GROUP CHILDREN WITH CONTROL GROUP CHILDREN 00 LATERAL OOMINANCE Referred Positive (47 subjects) Control (93 subjects) Referred Negative (26 subjects) Control (93 subjects) * ot significant. Pure Mixed 26 21 61 32 13 13 61 32 Chi Square ,, TABLE XXXIV SIGNIFICANT ETIOLOGICAL FINDINGS APPEP.RING IN Tlfil ~ ifEDICAL HISTORIES OF 98 REFERRED GROUP AND 85 CON'IROL GROUP CHILffiEN CLASSIFIED ACCORDING TO THE RESP :;3CTIV1J TYPE O:F' EID TRACING Abnormal EEG Re- Normal EFD Borderline EID Re- Re- ferred Control ferred Control ferred Control Birth Injury 22 2 12 25 2 1 Premature Birth 3 0 4 1 0 0 Meningitis or Encephalitis 13 0 2 6 0 0 Prenatal Trauma 0 0 1 0 1 0 Postnatal Trauma 4 0 2 0 0 0 Etiology Unlmown 16 7 16 40 0 3 Total 58 9 37 72 3 4 .. TABLE X..XX:/ CHI SQUARE COJPA11ISONS OF SIGNIFICANT ETIOL, CGICAL FINDillGS APPEA.1 ING IN THE M EDICAL HISTORIES OF REFERRED AND COOTROL GROUP CHILIREN Referred Positive (58 subjects) Control Group (85 subjects) Referred Negative (37 subjects) Control Group ( 85 subjects) Referred Positive (58 subjects) Referred Negative (37 subjects) .. Pathological Findings 42 35 21 35 42 21 * Significant 1 percent level. ff- Not significant. "Unknown" Findings 16 so 16 16 16 Chi Square 1.9~ CHAPTER XI SUNTI.ii.ARY o_ , ~ cir !IDI N G s This cha1ter will review the setting of the studv and summarize the results. The Problem This st d _ , ~ \Vas n ertaken with the rirnary pur ose in mind of investi ating the relat ve incidence or cerebral dvsrh thmias amon behavior and non-behavior-problem child ren, an of' discoverin .. , the p s sible re ~ tionships between dea ~nosed or anic bran dvsf1ncti n and (1) behavi ral character st cs and (2) other incidental fac tors. ehavior-problem children ere ori nall re e red ~or electroence halo ra. hic (E 7 T) examinat ons if the sho ed vid.nce of ittin one or re or the r llo rlng criteria: 1. ist I"" o br n nj, r thr 1 : h tra1ma or in.['la unat r . roce ses. . - 2. 01· ht neu olo ;ical sins nd ct v of bran lesi ns. 3. 3evere . s. ch lo ical t ical o th chil 's s nc s that are n t : ~ • The . esence o.:. ina eq 1 te er ~or . ance on s cho .. et ic tests. In the ast certain criticisms have been mde about thee cri teria s·nce it has n t een de 1atel demonstr 'loo V - ~r t (' ,. . ' ·stion ... ..... C 0 r• ( . I , f . , • n i , . n ··-\.,., ,..; , r-- ,_ .. ,. • ,. ( .L. r r • , "':--, J. ..... ' . l ( ·, . ., 11 ,, 1.• .-. \.., l. i • V . ... .... ~ ') I C . .I- .. • . t - ,~' • I . , .. ., ., (! ' · 1 I t ... l . . ..... t . • ., • '- . r • • • l ., I• • - ( • > ·o., ( , l .,, ... I , • I • ., .. 1 • • 'I , ( ' , .. n , 1 !1 . • ' - ' . .... . ,_ . . - ., . ,. : J_ • T .. . , • n ,... • 0 t.. • , .., ..L 7 . \J ' ' -.- J I I - , 1 0 • p -· .I ,.. , , "t r r ( , ( ,. ~ l • . l • - • .. . ' J 0 1 0 1 0 ,.. . I • .. . , ,.., ., ( • ... , , 1 ' ' .. t O" 1 t, L, .. • ,, ' 1 ... J., - C ., . ( r j .-, .... .. . (. .., ) () .. _, C 0 . • • J_ , ; I r ,.. t I I J - • 0 I . . n • ( , ·- • ( -, ... .. C. - J 178 able to distinguish the groups , it can onlv be assumed that the distribution of total scores for these groups would also be significantly different. Fsycholo~ical Test esults In rr er to investigate the relationship of a par ticular tyne of E~G tracin to an adequate performance on certa:n ps cholo ical tests, variou -rou and individual psychometric results were anal zed. The refe ~red roups when com~ared with the control grou and with the local p1blic school po ulation, sh. ~ed a s i nificantl "'7' lo er eneral intelli ;,ence on group tests. It was als n te - that the re erred sitive r u mea red lo . ?er on The C 11 rn a Test o~ r:.ental l!aturit , b t not on The roodeno~ h-Draw-a-.an Test. On The r roodenou h- raw-a- . an Test both the referred os t ve and the r erre negative ro1 s ~ere sin ficantl .. low I ~ dfstrib t :on, s co are th t e control ( roun. .o si ,,.ni-ricant ~ .. f f erence was oun to ex:i.st between the tro referred ·r ups . oth referred ~rou s ere si nificant- ... 1, poorer than the control rou ~ in the ab lit· to make • . o d Pro~ortions and t exhibit ~o d coordination on this test. The i. 1 cations were that the behavior-~roblem c 11 ren had more visual motor dif~ic 1t·cs. n Tl1e .,echsler Intelli ence cale ~or Ch. ldren soroo 179 · trends were noted which vrould indicate that the refe-r-red positive roup children had more difficulty with verbal tests on this scale than did the referred negative group children. The results of this stud~ were not given in detail beca~se of small sam~les at various age levels. The reading achievement results were foun1 to indi cate that the control ~roup was advanced in this school s1bject, while th referred negative grou _ was moderately retarded, an c t ere erre s tive rou was ver. retarded in this part.icular accompl · shn1ent. In ~ -.eneral, t e above results rere considered to have indtcated that the referred r ups were 1ore similar to eac other t 1 .an the were t o the control .. rou • Other ariables and ~esults --- - An attemp t was ma e to show the rel tionship of certain arables int e 11 eh stories of the various ,roup sub ·ects ,vith a iv n type o tra.cin • As was r ported int e lite r ture, twas discovered t at the ,r~un- 1 er t : e c - ~ld the more likelihood there was . for a bn r~al EET tracin to be ~ound. This ·act was foun to e t e .,. r ot the referred and t e control Lro -he e .. s~e ed in the case o~ the rere red rou. e ... u i. te nl7 10 per cent o this ,. .. rou ,1ere _:-- irls . mhe control ;;ro u ... , ... rob bl;r as 180 a natural out~1.,owth or the method of selection, ccnta.ined as manv girls as boys. Little or no evidence was uncovered whcih would sub stant-tate the notion that the nlmber of sibli.ngs ho. would in.fluence the type of EEG tracing he received. Birth order was d scovered to have no appa ent re lationship to the incidence o~ re ·~rrals for behavior dif ficulties. Althott,)h the literature has indicated that first-born ch._ ldren v1ere m re likel:r to slJ.ffer injur." at birth, no evidence was found which ~oul1 substant ate this belief for the roups studied in th s invest: ation. '"/hile the referred roup children tended to show more n xe lateral m n ce, the r sult .i n~t ho them to be si n~ficantl • 1 rerent fr the c t 1 r o ... ch ldren in t. is respect. In brie , th nr ups all s oved m re "pureu dor:1in _ ce where e e, ban_ , an f t "or.iinance rere un.1. la tet'al. On the basis o. a . . verse e e ts ap .. ear · n in he edical h·stor•los , a si gni icant d·rr er nee was fou d ihich i ferentiated the efe1"red posit·ve -rou frou the control group . lo such signif cant iff e ences were discovered wen the referred neGative ro VI S C ared ith ,._he c ntrol roup. H wever, a 11 rou.ps were .f'o nd to 1 :1ave a hi ,h percenta e f such events. .... _I -r J. j T f I ) ' , ., J ' . - . .. - . • • .. • • viousl\ . . Ql 0 0 • r • .... . • .• • • C u l r ,... • • • - .... .. ,I' ,I' , . .., ... I __ o ... ,io • •• • , J..., 0 • . - CI., .. . . ( . , . .,. 1 e .. J • • e .... .... .. c_, .L. - e • :- J , i ... '-' ...... . . • J . , 4 vt., , I _, .. .., )' ..._ ._ l - J. ._ '."\ ., t,j •·· '.., , ,.> ~1 V J. ~C Vi. ~ v r::i __ .. t . .... -L ··o . ... C "l "- v . . .. . J. V I- 1 v IL -c e _ • • i ., ~- • . .L ) ·1 r . -. . ,. . L ., ..... • ..., 1. ... 0 . .., I. , ~-., • .. • 1- . . r-.·. 1 ~ ·- . • . . l,, .. • C V) • b •- ": . -- I .. ,., l . C - ., - _., l t~J. (:-> t t"'I C '-' J. t ,,, \ ... ' P •. , '"' . ~., C o· , .,_ '-' (.• l o· r 0. I. 191! ... Ct +· _, . C u V -..., V J_ . . C ' l J. ' .::C .., ... IJ ., V • J ➔• • ., ( . "1 -~ • .&. I. r, ., ": ' .~ , ~ . , . i ... ,., o .. , J.. V ,, • - - • . · • C -, • "lt J '"' n • C: - · - .... . .. . .... ' r . ., - •• • • • . ' 1"' .. 0 , • .J t • motor function, academic achievement, intellectual level, emotional disturbance , and social difficulties, both groups look ver~ similar . This raises various possibilities. Is the electrical dvsrh-vthmia shO\"tn on P .'., tracin ;,- s • necessaril related to brain patholoP-~? The evidence ac cu. ul - ·. ted in the ~ast would seem to make 1 t necessar"'- to sa ,r yes to th s question. As Lindlse (69) has nointed 0 t: Clinical apT1 ica t on of the <~G began earl. with the 7ork of ~er er . Its 1sefulness as an adjunct to the clin cal neurolo ical exa1~nation soon became evident, first , in c nnec tion \v·. tl1 e le~s; and rel ted d s orders and sub equ ntly in the discrimination and localization o~ brain tumors ad oth Jr ty es o~ brain atlolo y . l t onl, has the -~ r prove use ul as a su ... _ lerientar.· tool r t e ne rolo .)1st and th.e ne re s r ,eon, b tit h s bro ht . orth nformat on rhich h s urovoked ne ~ c nc tions Ol. brain nc tion a ne was of envisa n brain isor ers . (69:106 -1 6) Is the E Gan unreliable tool? The ans er seem to be no . L_n lse (6 ,. :2J,_7) a ain n a co hensive rev · literat1re on th s s ~ect re .o t _nt a - n u 1 var ... a lit. te t be smnll . Other :n· st· ~ators e a oft traciru .. s tal .. n on the s ne in i vi u~ ls, ev n over lon er er ds of tie . t ob e -r ch· 1 _ :-,en wit n rm 1 r;•:, ' s 1.0 ot fact rs in corn: n uc as a ., e r soci - con • l. C status that v, u influence the t e o E~r traci ? A I, • ~ V 0 ..i. ,_ ' t .. . • • .L • .L ,-::-1- I , ,- t l, ,, • C ~-· . ~- ,,. l ,J_ ( 1:. .• J ,. : . V J t t"'I ·~ ... .- I I ... . ... ·o o ..... -r ,-:. _; LJ ., ,: • •..J , ,.. .. , (. - I..) . ··- .,. n I -,- ,.,, u • ~ 0 .... {J _e . ... - J. a: . ) t;:; .J C' ,.. . . 'I . ., ,...., --. }(:) r, ,.t. -.J .... n 0 l .L - ~ -.e_ J - L, . ,.., - c.-.. .... - .• t", • . - .. . C ' .l '. .,, . ... • ., ~ o· . ,, ,. , 6 - . .., ; . ., _.._ f' I ,_, . r, t...J • ..... ,.J .J ... _, .L .. ,.J • - on . ., __ r) C (. . l., v • .:_ C r. .... u , ..... 1 J ·- 186 organic brain .athology, when it could be demonstrated that this was so only in a little over half of the cases. In essence, this would mean that there were other causes which could lead to the sarne kinds of patterns of behavior that had previ 1sly been shown to be associated with or ganic brain dysfunction. The postulate that other causal factors are at work seems to be an untenab e one, since no other ps. 7 chiatric group has ever shol~n (at least according to evidence reported) these atterns to the degree and con s stenc~ rhlch the brain-inj red roup demonstrates. The roblem is intenslfied when it is considered ho unreliable and inconsistent findin shave been whe - ever an ttempt has been made to relate personalit traits t the ~G . Lin sle (6) h re orte some o these efforts. (6 :10 9-1053) Do the r ferred f r nc s n behavi or ne ative o children? at s i ht a s s as.er to this 1est on. os tive ro . 1p chil ren hov1 an hen com ared ·: th the referred It ~ou. be rh p s well to look icant trends we rsuin an T. s hoe nos gn ficant trends in eas re of lateral _minance or in rder of birth that o f re t te them. The r ferre ositive ch 1 ren sh wed m re total 187 pathognomonic signs in their medical histories than did the referred negative children. II0\1ever, there was a some what -reater proportion of children sho1ing birth injuries among the referred ne ative roup. There was a sli~ht ten enc! . or the referred ne~a tj_ve -ro1 p to s 1 v, a higher mean intelli p:ence quotient. 1 n rea r n ac1ievcment there was quite a startl nc if erence •,ind et een th t,1 'O s ti ve » "'O sh win~ s c:nificantly lov,e.. ach eve1 ient, in spite o an av ra e • The ~e sti ns. · or Rat n~ Scale res lts ose some interes~ ~or in tance, since the tw , re- ferred osi ti ve an re erre ne at· ve, 1ere es sent· · all ar on so n. other as . ects o~ beha ior, ~hy were so e terns so m ch ore ~1 ni cant for on ~ro than th ot h r, an vice ve sa? The rank or er o~ s . ~n icance rove to be aston ·n. 1 d ss i ar . n act n sign icant corre- lntion bet1e n the t--, or ers co ·. e fo 1n • This ck of C rrelat on arran f rth .., r tt nti. n t see if an patte • ts hie 1- : nl • t : e phen n exi e 1n n n. ... The first 6 te s liste • n t l rder 0 • m ... orta ~e accor n~ t the e . re to wh ch t e t ms d fferenti ted t ~ e re er""e d as f l _o\vs: sit ve ro t fro the c ntr 1 ro . were ., '"' •,J ~,,.. .... .L .> ,.., -· ~ J I • 3. • Cc Cc 'i I I ..., . ... ,. ' c.. i • C - . , ., ( , -- 0 Cl.. ,1 • • • L •• ,. , _. . • • • • ----. u • - / ' - · . • ... n v ~ . ...., .,, ,! - ,. '°' \JL ,I .. ' ~o . .. . .._ , .. I_, ('I , .. ... 1: 0 ,.., . \-.. -. ... • !. . .., , ... . - • \t ... ... . -· Q __ in e • .• •1 ,_ • l I l j _... , r ~ ...... ., • , ., I ..... . .... -·- ..... _ ... _ 2 • . · . . -, ~ . ("'\ ·- ~ - .._,, ~ ... . ., -- .1. . ·- ..... .. . .. .t:'l' - · I. • v ., ,... .. ' ·~ oJ .., . ..,,... .. , ... ' l -.1 , . . • ... . J. -:i -. J!" ) - ... -, . U ·in • .,_.l - to . J_ v ....... -. .., .. er • "'l .L l,in. .... ..... • ot ni r.) '"' ..., - . . ~ • D~ :, , r *r ~ • I.:.; I .. t ' ( ,.., ... .1. • . • ( ·'- . v C • f ri J. - _,._ __ t· :"}C n O. ,-. ....... , ,.. .• .1. .... V C! J ~, •,.-, -· ",) r , - v .. ' • 1 i" ,:, ,.. .t:\ • t, t ''°' .L ·.; 0 0: ~ • 11 J • ... I. e l:.,c..1 • J.., L, .... 1 .I.. . L, • • v _ , ... ' ~-0 ., . . V 0 I I 01~ ... • • f ,.,, f - . •v - . . .. ·'. 1:1~ .... r .. .., .... +- ve .... • .,. a· C .t a -- ("1 r- .., r1 '\ l C • J C ' ,-.. - ,,. c. .. V \I • J.. t .v ., ,., • J 1..., J. • .I. r ...., .. ,., ,.,- ., ... . ' ,, e_ , .. _ 0 L, • I J ,J .. , 1 ' t ., • . J- -v u p er .• . ,.. ... • ... - . .. .. .., · ; . .,., "' I • ., ,I e ' ,.. C • ,. • n ' .J- .• ... !. . ·, .... , • C ... ' ,... ,.J • e e t ,.. '"' 'I,., , ' • • . ... ~ "l ... t ,.., , I t..,.; '. C • • f 1, t , ,... 0 ., .• - ol • V ( ., C r, - . , ( C '"\ ,,_ , ~· ( ) ,&. .&.. ... . 2. .:18 ' ,.., .. .;: ~ ..... t. . ,.. l ' t ~ , 0 , .l C ,.., .;A. ., u-.. i ~ - -, 'J .. . - ., • ., "I'"\ v . .!.O ,.. ,, . \ . · ,. I C , \j . • . , , -1-n • r, ~ "' - \,) V . - t •.,P ...., .i , .. V u .,; -- . • C ,... .. .. ... ,. --, ra - v. C . e~- . - 0 ·- v . I . l .• , ... .. l . ., ,.... . l .• "'le . ' .. ,. ... n I • 0 ""l .L ~ :~~ !. <=.- .... r ,_ .J ..,_ V ;.1, I V '- • ,. ._, - ~ ., - ... 1 I ' - .• ? .... ,.. V ,_ 1 · l.1 . ,. - ..... , ,.. ,., ..., v "'I .,.. ., I - o""' • ~ · ·~ .i- v I • '-" ,J .. I ' ~ ..... "o _ _ .... . Ct . , . ., .C l 7 .. . • , .., .,. .L • C .. • ..,. . , 'C . .., .. .. - C -., .... - · . ,_ ...,Ll .J 0~ .. . , J. ri · - .. ,I • ...... :o (:I ... ...... I ,..., ·- - .. .. 0...>v l' .. t - .I. ... ., .... l_ -. "'\ 'j - .. , ,.. .. ., ,... ·- ,. ..., ,... . ,_ L, ., J • • .. • .,. J . I • ..... V - I.I ~ 'i ... ... - .L 0 .1. 191 should not be forgotten. However, the group that were behavior-problem children, and who had abnormal EEG 1 s seem to consistently show a more severe degree of one kind of pattern of behavior, which involves the learning processes, while the behavior-problem chil ren ,nho had nnrmal EEG 1 s evidently suffer more from an inability to control emotional behavior in social situations. Strauss and Lehtenin (99) emphasize the f ncti nal difference bet~een the old and the new brain. The old brain (diencephalon) is at birth a completely developed functioning unit . As with ~trauss and Lehtenin in their discussion or brain pathology, the pre ent nvesti ation is not concerned with fine neurological differentiation, n mel ,(a dencri tion o the vari us islands of nerve cells n the b ain). It is concerned it the overall eneral erect on behavior contributed b, t ese two major areas of the bra n. The aut' ors say: A 1 or or emotions, estures, an expres ve move me ts are r J,1lat d to a great extent b. the old bran, the aMe ce 1 str ct1re w _ ich in an mals are res onsi- bl r acti ns or n er, fear, a ressiveness, and t the n rm 1 functi nin~ of the ol brain d en t e e If orn child's s·n 1 ng ex_ ression or con tent ent and his cr'71ng in discomfort. Even all mental roce ses o~ erce. tion and thou, ht have in the 1 brain an nderl in matrix of em tional factors and d. amic rces; the old brain is constantl in~luencing a 1 recesses ori inat:n in nd controlled b the new brain. Th kn ledge of these mutual uncti ns 0 4 old and ner brain sh uld be kept well in m nd to un erstand the patholo ical behavior caused b ~ their disintegra tion -..1 en lesions are present. (90:23-2L_ ) 192 These same authors stress the immaturity of the new brain at birth. This lack of development prevents the new brain (cortex) from rea~ting and conducting stimuli to and from the brain in a well or anized manner. How this general area of the brain ma t'llres is explained as follows: Thlring rowtli tb.e development of the cortex is com pleted; certain areas becomes ecialized for particular neurological and psycholo ical functt ns, others lack s- ch well de ined specializations. Certa. n areas o the cortex are thou ht to be ce ters for movement or sensation, f r t e ex re~sive si e o l r' n _, 10. .e, or the rece tive side or lanp-uage, for wr __ tinh, for read ng , .ror vis on, etc. (90:20) ~trauss an Lehtenin in s peak n of th behavior disor ors of bra· · n-inj re, c h ,.l ren e , . size that certa .n k nds o s chomotor dist, r ances are ·n str·ki contract to the intel ect al b lit.. as e 1 nee b i tel11 ence t, t t • The . • • ince t~ e«"' s tro cho , ot r dis tur" ances • a ent rt o b havi on bra n- n •1r c n, 1 r~ to cu. s br e 1 . the ne ro- ~ ich best rets then . c- t t or, e. t a flnct n of e a , e r .. est an 1 on-cell ce t rs x a l st a non rev ews a number -. c r t ob e vat on ~l ch hois e · n ex r n nlts r r . cti.on r the c r c nt r, t am .c . oc a 0 1 rce o: rfecti e iences, nd t bcort·cal rons 'do !Ot re ire eta le n1ervati n fr m above ·n ; r er to oe r·v n ·nto action •••• e·n r lease or act on s r ma c n i t on~ r their service to he bod -t . e then ~is are rec u tatel an intens 1 ." . - ; "These po r im ulses ori. ,·nat n a r ~ion o~ the ai . t c·ate ith co~ ·t v consc:o sness am aro sing, t e""e or, in n obsc' e an unrelated manner the tron ., f el n s of m t · · onal excitement ex la: n the • • 193 sense of being seized, possessed, of being controlled by an outside force and made to act without we~ghing of the consequences. "Everyone who has observed brain injured children in their states of hyperactivity or driveness can readily accept the statement that their reactions are so extraordinarilv intense and dis- .. inhibited that they are released without control • • Cannon's theory also agrees with anatomical r:ndin Js w~ich ve shown that t.he lesions or birth injurT or earl , trauma. are most frequentl.r found in the extra pyramidal s . . s te1n and 1 -a rtict1larl ~ in the thal m c regi n. It has een ar~ued that the release of thalamic ene~-·i s in en·\tions mi,ht be controlled b cort·cal - . r cesses. In a s la.r wa7T the h peractivi t · and r·veness o tn brain-in·~red chi . d decreases ith the · nc reased rune tion :T_ng o_ h. r,her . ntal procer-ses. : 21) An interest n:~ bit o~ ev·dence nc vered n the resent in rest· t · n ind c te t~e re: rred neat v -ro~ chil ren to have o. ro~ort ~n tel~ renter n ' er of possible birt n· ries, as com re 1th oth r causal r ctors, t n o th referred . o t c rou c ildren. (see abov brai to t able J ~ XVII) 'I1he q estion m ell be as <ed : ·. at tin the C n o-r t nct·ons oP t h ol th h V , to t 1 -ore • ent invest tion? artial ns er • esJ..ion be f in _ $ mav n too tat 1ent b . n 1 ~· ,, . e r str cte 1 ·n he ca o e 1 t1m r or the n o~ the bra tem, , h h:,rsis, anr orth. L s1 ns in these , a be re .lect din ect. cort·cal abno ma ties, n r 1 1ce n o c1 r cterist··c c . n ,es o ,r , les incre se int ac ania ress re s ~resent , r ~ c or thal mo-c rt cal tract are _n lve. D rs r-ma 11. ue to b sa. an . ia lei n~, as n . r lr is a, itans, rent rea il re flected th , ~ Gan throw little li~ht on the at re 194 of the dischar es responsible for the peripheral motor tremors and other involuntary movements characteristic of some of these diseases. (71:1078) A cautious hypothesis is advanced in the present study. It is possible that the brain disorder of the ab norn1al refe1..,red group children are chiefly centered in the cortex, where it woul be more easil~ reg·ste~ed in the EEG , whereas the disorders , f anv, of the rererre ... ne ..,ative rou a~ ... b . located in the enc~ halon, where it is os s :t bl :n re :.i f'f :.c !.ll t for t he ~ i'E<1 to re-1 s ter the elec tri- •.• ca d srh, thia . t e referre ne tive .ro as s o ·1 n a severe d e-ree ch t~ e teacher~ r chil ren rated t ese children r ctivit alte nnt~n ·,1th da dre mi , 1,:,ul sis . T s beh v or is urther sup o t t e oove h othe- m _l r i ppearance to mild epileptic ttack • .r cc r inr: to rid es (10), the site o ori in or the etit m 1 ~ave actlvit n 11 robabilit • lie int es be rt c 1 re ions of the brain, artic larl in the th __ am1s . .. ~ rther e nee noted b the te che s that points t _ a . f ncti ni. . t ~ mic are , c es fr m the other item th t a _,,e s i 17 n. _ ic ntl .· rse or th n ~mal referred • • . ...... ... - . . .,_ . ro p . T ·ea her t t thee r .... explosive un nt oll ble c nd· ct t o .ether with ~ch uncoo erative behav or. n 195 One item, "often tells bizarre stories," 1 Nhich is constantlv rated worse for the referred negative group, at first glance seems difficult to explain . However , there may be a logical relation with defective old brain function . As Strauss and Leh.tenin (99 ) point out , "Excessive emotional reactions may res~lt when the new bran cannot exert its proper inhib ting effect over the old brain" . (99 : 23) The resent invest ator has ften n t·ced the fantas7 e ployed b~ t e behavior- roblem chil .ren • . chizo hren a is a s~chiatric d sorder where n - ~ uch fa.ntas is c, .. onl e lo. ed . L .... ndsle~T {72) has re orted st ies ih·. ch os 11 te t t "the lack or c rt. · cal ener . od ction in schizo hrenia is due rinci all to a con- stitutionall , ina uate dienc halon . " (72:1081) s for the referred ositive ro p children who sho mor i _icultie in the 1 arn n aspects of behavior (not that the re~e red neat ve roup o not also , but merel to a lesser de ree) there 1s evidence hic1 oints to a d srh th a in the cortical areas . Walter (110) ha adva ced an interesting conce tin h·ch he includes all behavior in a learntn theorv . This V lea n·n theor, is e endent upon certa . n functions that the b r · n r:11 t ~e r~ ,.,m. these o erations . Th rain v,aves lay , imuortant art in v. r.; ter ha ost 1 ted seven o era- tional s te .. s the brain m st take bef -re learning can take place. The seven steps of learning are summarized below. Vvalter (110) has further elaborated, " ••• and all of these sta .es are essential; if any of trnm 1s left out our Box (brain) will imagine vain things--or nothing." (110:177) Step. 1. The necessity to make a differentiation between the conditioned and unconditioned stimulus. 2. The need to determine whether the c nd. tioned and uncond:tioned stimulus are significantl~ related. Th s decision is based on t L e time ralation betwe n the tw st· mul 1 and u on the n unber o t-l_ mes the hav been ass ciated. 3. The need to ad up all nreas of coincidence that hnve been observed sot tac nsol datec asire can be form le ted • • mh necess·t . to ake dec .si nth t th re 1 a "siGni icant" de ree o co nc dence n t be'r 0 4 series o: obse~v tions o th c ~ n :tioned arxi uncon itioned st m 11. In t er a "t res - h ld" must be dee de on. 5. The need ~ _ r an "act vation" lave , th t is to sa the n rmatt n {th t the c: n ~toned a un c nd .tioned are elated) is trans. tted t a ~~nd of lo, te m stora ~ e r iste ic1 in o selves "make corres on i th the arenes so l ethin bei learned, or ith" ettin the knac of s problem." (110:176) 6. The need f r an oneration "- ·ch reserves t inrormation of coincidence {memor ). 7. The rncessit . o~ combining the L1emor vrith a ne1 sarn_le of the, ncondit·oned stim~lus. This step is necessar~ to make our learnin effect e or in other ords the conditionin rocess s be com ... leted. In t~1e author's own ords, "To s mma.rize, t e first two o th seven steps r om chance to eanin ~ are strictly 197 selective; the second two are temporarily constructive; the fi · th is a trig,3er; the sixth a. . reservntive; and the seven th e.f ec ti ve." ( 110: 177) dalte has been impressed with the abn .,rmal electri cal dis char )es found in the bra. : ns of man:r ind: vi duals. These dischur :es prove "aston:t shin 1 intractable to con d ti on· ng • " ( 110 : 1 5 ) e po nts out: h The bn rm 1 e . ects m 7.,. bes· Ins o!' -:31sor er or weakness n the parts o_ the brain res . ons . ·. ble f r the th~r an ro rth opera.tins o earni , them .ing an s 1 mma ti . n o s e c if c n e tra l t j .• 1 i • I t s is S "' nn t ra 1 T' the ne s . o ca act vi t7r th t ca not be c n · ti _ned i a ~a1 tin tl c _n ~~ti n 1ec i ... is • c nn t learn not t learn. ( 110 :1 ) n t er into cstinu asp ct o t' ~een resent~ b : alt r (110). ern ng p ce s str sses the ig- f · cance atte r • r.i e rain c nst ntl seek t esta- blish o "er o t o~ the tre h s s: re sente to it. atte n , the, a e efin d s an se uence of event in tlme, o_ any set o~ o ·ects s ace, is- tin. i h ble r"'rom r c .m)ar ble ~.r·th a other se uence or set. irst s .n·:' cant attr ,ute of o. attern s th.at .-ou can remem er it an c om .. re it \Vi th another pattern . _s ·s ·;,ho.t ·stin , • ishes it fro rando events or chao • Ti1or the ti n o_ random-anoth r i . orted wor lost t the o c lan , a es-implies that · sorder s be .. on com . .. r. ris n; u can.not remember chaos o cm re one c aos Nit nether; there is no pl r e o~ t e 1ord. P ttern is it~ _ familiar tings an : fan·1i~r thi s are co th s. It - - . is !, ch nearer t e truth to sa th t m n abh. rs c. os • th( t at re abhors a vacu· . • ! · o.n se 1, atte ns r h1. m.f rt an . , in •nr;lis at least , can b ast 1 mself a nttern-mnkin ~n 1. (11 :6 _.,69) ,- ... J . • I")., v.L . . I t f", J . . ·r • C <-• 1 0 , • ... . .. . : . ,.. .. • '") .., .., - r, -1 - .L. ,"':\ "l">,.., l, V ._, - J. .~ ·- C v ~ .... r, I V . , . ... l - ,... "') .., t .. t 8. ..., rt,, , .. .. • . _, .., ,e .... ,. J . . ,. .., • <1-~r., r • .• e .. cc c ~ ..L _c. ~.. ..., J. " o :... ~ . • 1'=' t - 1.e ) ~ 1 • ·' . - .• ,... ,.., c:: -- J. ,.. l"' .. .( , - '·,- • • ,J '\ ·- '..J ... • C • I • . ... C C - - r J.. - · .. ,... ,..,. L'I • .. .... • • r ., r • • . ) 199 brain tlss1e destroyed in n area ~ay be responsible for t i~ impairment or deficit of a 1 artlcular psychological 1ncti on, rather th n the destruction o a sharply define brain territory. Further1n re, since all bra: :. n lesions l'lherever localized are fo llo,,red b a s 1 nilar kind o is- ordere behavior, this fact a ain cannot be ex lained oy tle old localiz ton theory." (9 : :20) The bch vior pattern is of utm st im ortance. esell has emp1asized that in in ~ w t 1 cases o · · ma1 cerebral injur th foll owin point sho ld be kc. t t t t t i r i n e 1 in • • .. nos is orte ce ~bra th st s rest t 1 to~ a ns , els ,, er , one l • st t e .. e tu_e in~ cc 1 nt n~ m1 ot reco c cceJsive e t n~ . ~ven en e s birt. : tor thic 011 eem bl t ev. tat:n or l Jc s , it is 1e 1 to plac t on let e. (1,:2 0) . e :le t e c 1a ..., ' .a. i c tur e i o rimar im, o t ce ce eoral ath lo , oth r acto s of 1 3 ortance ma sti. 1 contribute tot cl inlcal .. im ress on . It een ee th t t , r n e in nte qt tien n ch .. eve ent scores ~ ch 1 ren. Ther fore , little d ;n ~st c valu can b e .; .!-a ' ·'· • e :::c 'it • .. 1 en J .. , '"\ ;:1,._, . .,_ <'."I 'r - ., r, !]\; --. e n T "l ,8 -1· ~r v -- ...,J I. v .., ' u l. or ..1- . 0 ... 1 . p7, ,,.... ~r c::. - 1 .-, n ., I . . . I,; .J ... _ . ~ ...:> - ., . ..1.. . .t. . t .. - I • .'. .• l: ' - . ,. ·.1 r I • ("< C c; 'l L, . - (, :1C 0 ., , V ,J .• ,II• ti . , .: ~ • .! .J .. • , 7 0 0 .. c .L - 1 .,. , r• (' , .;_ . . , e· .... - •- J __ V .L .., .... .,, J • ::ii- J. t . ' - ,_ ~ .., ., • . .., ,... - ,., '"') E,_ , . ,-- D .. c, l ( . ., ,C lC .... J - "" ...., - .J t,., - ..,) ..., __ ,... , (' .... 1 rt • . ... • l- ., ~ ,., . I • l . ~ -- -·· ....... ..... I • - . - V . . t • .. ... .. - .; • ~ V ., I • ... ... s r e ,,. .L .. - .t.. • ~ -- ... r .... ... ,... v • • .,_ . , . . . . C r ) . .., ·'- ... ( ,. C ·» - ., .. V .. ..,, _,., • r- ,.. • • IO •-, . .. .. ., ,I ... _, - ( C"1 .. .., . . • - , • • t"I . · • ~ ... ., . . ,) V ., 0 '- . J. - . .• C ,,.. ·- . -f . .. V J T ,....,.. .i... j'l .., e, L, , ., ) • 201 r.inimal injuries may be so deep-seated that they affect the synergy and smoothness, albeit mildly, of all motor co-ordinations. One then finds sli~ht evidences of inco-ordination in gross m tor reactions as well as in fine m tor behavior. uuch deep-seated impairment, ho\vever r.1ild, may be permanent and in superable. (35:247) The striking inability of the referred roup sub- jects to sho,v 0 00d coordination and a sense o proportion on The ,. oodenou ._,h-Draw-a-I,fan Test is one 1nore indication o~ p or vis1al-m tor control, an. bears o t the contention made by many wr ters that bro.in-injure d individuals s :t fer unusual di ic lt es in this area. A oss bl ex ..... lanati n for the 1n ve_ salit , o-<- de- fective tr c ntrol seen in bra n-inju eds bjects lies n the fact t at nearl all art o th b n re involved n a c om le:-: nner i -Pin a r ross m tor inte ration. It is n tr a ble to .o nt t s ncas (76), h 0 1eve, uescri tin o~ t e s e ~ cesses . eta 1 t ritten nether positive s· n leadi.n • to a • .- a .. n sis f\ I min mal bran in 1r7 is histo o abn r a irt or s ve . e e ce h litis. ev0r, as esell(J5) po nts out t e absen-.;e o· these fact s in the deve o mental his to es n t reel de t e rcsence of 1c~ mi 1 inj r • In t e resent stud, it is p rtic1l rl~ sin fica t to note t l e 1ch r eater inc~dence Oi ~re ture births amo , C ( . ., . -= • . ' ' ,., .. c_ . .,. ( -.J • -- • "I ,j, J. • ,.. -. ., .. '· . .1..' V t..:, t __ e .. I t ,.., ff .... . - I -- ( ·~ 0 • I". C .... ... } ':" ..., . .., 0 ., 0 u 1 - ... 0 . ,., .. t .... .... , C ., "" ... . • ., J"'I 0. ':I.,, ... ") .. ... ,---. :..-,- ('\ ,-.. t ., • .i... ' '"'J. :\ vi1 • I J) C ,-- "":·,,; .. ""': ., ,... 0 ..., t. P,..., . ( ') C ., "!.. C. r-- • ,..., .. .. . . . -: .: .. ) '~ ·.~ e e ... c..- ' ... ., , .. ... ~ •-' , .. . t 0 . , ,, .. . v t "'l ,,.. . ,., ., . ' 1 . ).. _ I.., .. . . . ·1 . "\ .. ( ( .J , -'- . ' t s . ) ''l L C oen. 0 ·1 -- ,.., -✓ "L, .•...., - l • - .• -· ' ~10 (' , ~ _c 7 j"') •:) «-• 0 .,e ..., ✓ •J \.' ·- - -.. ·"' . t • . ..., T ..,. _, .n • . ., .-- v i ' >S Cr., - n Gr "'0: "I ►) ~ • I I l I) ,._ '-' ...... ~ . • J_ 1 ~ J_ ... • 'l ' L. _. . , ....... ·r L, .... ,., O~ - 9. _ _ o c , . ~ ,J ' _, . 1· . ' J • -- r C .., v C r or r• C ..... •.) . ' ' ., - r ec ~ ~.:o • , • ...._ .. • • ('\ ..r, ,,_ 0 - c.. 1 . . I . . • . • C • t,.J .. u .. • . - C • V ..., • - "l J • . . ,., l ., •J ., . . ,.. . .., 0 ... , ' .. . ~ ' ,. · .r l., • ,.. , ... C a -. .... •.> _, .., C C ..,. ... - • •r d .. . • • -o -- . (''> l; .J a ... C ., . 'J ,_ r, ,_ V . .. .J ) C • V ... r. . - J. ~ • , . .., O· • • L, .., ,. , h .. , . . , .Jl - . . . ,... ., ,- . I ,,.. . ' ..., ... .. "' . ... -- . . ~ ...... "\ • ·, 7 • ( ..., . ... .... "" V V 7 "\ .. ,. • 1· 1 .,_ v a. .J. r- 1 .10 .... 7 V .1- • ~ , .. .I • . .. ~ a -r . t .. .... ,... C ... ,,.. J V , .... ,. ._, ' V ... e ' OL ·' -. r-.. • V • o.n t • • 205 determine them st critical areas of affected mental func tion on group tests to see if the~e is a typical kind of mental test profile associate with a partic; _ lar ki_nd of E trac ine;. 3. Since the character sties or poor readers is in man resnects similar to the symptoms of the behavior roblem children reported in the resent st dy, a follow up invosti ation or retarded reLders should be made in an e~rort to determin i~ the ma oritv of these chi dren , S\ fer rom m nimal oreanic brain d..:rsfunction. 1 • n inq ir~r sho 1 , be m de int the .. o sible ersonality de iciencies ass ciated th nor an c bra. n injur • Th_s in est· ation sh ld center around th ex- ess on these lt s th ~ are e in eit tio • 1 is, n tur, coul lead to extende st' c1 ol 0 e cat onal ethods and techniques that m : t(!ht b en lo d in n rrort t bene ~it t ese children tot fullest extent in t re : l r classr oc environment. 5. follow- p st <1 .r o the a~fect o:' var· ot e i ~ tions on the ~ difica tions o:' b a i r 1 s n . .... ica ted, since t h s been n . ... ted that man" roblem-children cond1ct themselves in am ch more acce table .ann r ~hen medical treat ent of this n""' ture has been i ven. 6. su ve of home actors,fh ch mi ht possibly .L . -4 e ., _c ., "I :., IJJ. \o.-- - • ' , c• C .• •. t ,., w J ..... - . . 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Time ne , "Jvte i cine", October, 1 5 • pg. 55. 10. --- ;, lker, C. -' ., and • • I{irkpatr ck;'Dilantin Treat ment f r Behavinr Problem Ch ldren u1i th bn r1nal ·lectroence h lo,.,.rams," .. mer can «Tot n 1 of P. s ~c. q ·.at r , .. , 10 : ! J • - 1 9 2, 191 . 6 •■ • • - _ :i , T • • , h:· . d re n vi t d ·caps, 1,.ew Pren , I , 9. 110 • . 1 te r, ., • ,. , re:-, ' he ... ort n .. om an,· 111. 1 2 . 113. 11 + . en, e _ rk , -----.J~~- . , . ·· erner, • , u ) Ared ranhs, C e , n 31 :_53-110, • . erner, ., ·ent b Ps 11, t ..... 1 e iron ~ra. n-in r t1ve ~ 1 ren: n 7 x e 1 ental orschach Techni ue," enet hs, 31 : 51- 110, 1 __ .....,,--■-11.__ , utu C Test , ; 1 in. ton, Charle L. 0 • 'i~ cox, • : ., "The ar ner ehav or Chart," _J_o __ l 2.£ is , 9 : R74- 83o, 19l~2. 116. : · 1e , I ., and ea 1 r , " avis, "The ersonalit 1 tin of irth to •dited b C. Kl ck olm and II . -·~ 1rra. , ., , ..... /4 • • Knapf Co an , • Name of Child Teacher APPENDIX A BEHAVIOR RATING SCALE School Age Grade --- --- Date Please rate each and every s - atement by putting an X in the appro priate square after the statement. The squares are nwnbered from 1 to 5 and represent the degree to which you have noticed the des cribed behavior. The bases for making a judgment are given below: (1) You have not noticed this behavior at all. (2) You have noticed the behavior to a slight degree . (3) You have noticed the behavior to a considerable degree. (4) You have noticed the behavior to an uncomfortable degree. (5) You have noticed the be: avior to a very large degree. R tinf Scale 1. Seemingly not affect d by extremes of hot or cold. I _______ _,. ____ _.. 2. Poor coordination in large muscle activities (games, etc.) 3. Confusion in spelling and writ ing ( jwnbled) • 4. Inclined to become confus din number processes; gives illogical responses. 5. Rea ing is poor. 6. Hyperactive and restless. 7. Behavior goes in cycles. 8. uality o ork may vary from day to day. 9. aydreaminr-r alternating with hyperactivity. 10. Excessively meticulous, exact ing, formalistic or pedantic. 11 • .Errat·c, flighty or scattered behavior. 12. Lacks a variety of responses, repe ts himself in many situations. 13. Easily distracted, lacks con t·nuity of effort and perseverance. f F - 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 25. 26. 27. 28. 29. 30. Cries often and easily. Explosive and unpredictable behavior. Often more confused by punishment. Upset by changes in routine. Confused in following direc tions. Tends to be destructive; es pecially of the work of others. Demands much attention. Many evidences of stubborn un cooperative behavior. Often i thdraws quickly fror.i group activities; prefers to ork by self. Cannot seem to control self (will speak out or jwnp out of seat, etc.) Constant difficulty with other children and/or adults (ap parently purposeless). all feeling for others. Seem generally unhappy. Contu ed an apprehensive about rightne s of response; in- dec· sive. Often tells bizarre stories Classroom comments are often "off the track" or peculiar. Difficulty asonin thing out logically ·th others. Rati~ Scale I C 1 > I < 2 > j 7J i Ot4L r • I t csr i -

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Creator Burks, Harold Francis (author)

Core Title A study of the organic basis for behavorial deviations in school children

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School School of Education

Degree Doctor of Philosophy

Degree Program Education

Degree Conferral Date 1955-06

Publication Date 05/01/1955

Defense Date 05/01/1955

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University of Southern California Dissertations and Theses