MCOLEMBUSC OHIO oc ae ~ »! . , / y - : 7 ; j aa Met t { N Fs WAR j 4 co ai y ; : ; r ve i “2 yeu ey x ‘ ¢ Wy a \ teh ceas : } REVIEW OF THE WORK 19181920 PRESS : Sh _ THe Onto STATE REFORMATORY Ane R nb MANSFIELD git Bhs, THE BUREAU OF JUVENILE RESEARCH REVIEW OF THE WORK 1918-1920 HENRY H. GODDARD, Director. GERTRUDE H. TRANSEAU, Physician. FLORENCE MATEER, Psycho-Clinician. HARRY W. DERN, Superintendent of Cottages. dae ve we ey > i ee a THE BUREAU Henry H. Goddard, Ph. D., Director The establishment of the Ohio Bureau of Juvenile Research marks a new era in the treatment of delinquency. . For the first time in history a State has departed from the traditional view that the only problem connected with delinquency was how to mete out the right amount of punishment; and has proceeded on the view that there must be a cause for delinquency, ‘and just and proper treatment cannot be hoped for until the causes are understood. Moreover the causes cannot be discovered by merely asking the child why he didit. Careful scientific research is the only key that will open the door. “Without research no authorative work has been written, no scientific discoveries or inventions made.” Ohio has applied research to its problem of delinquency. This is progress. The Bureau has had the slow development usually expected of big enterprises under state auspices. Established in 1914 the first years were years of planning, preparation and poverty. The legislature not realizing what a husky child it had given birth to, failed to provide the necessary material for its growth. There were no buildings and no money to build any. Under these con- ditions the work done by the first Clinical Director, Dr. Thomas H. Haines, is remarkable. He accumulated data on some 5000 children, organized a system of records and made researches into conditions in the State and counties that are of far reaching significance. He started the Bureau! Whatever success the Bureau has had or may have is and will be largely due to the non-spectacular but solid work done by him during those years of beginning. Next came the period of building. With this period the present director has had chiefly to do. The legislature finally appropriated $100,000, for buildings and later some money for equipment and personal service. In the beginning the Bureau had been housed at the institution for the Feeble-Minded. This was unfortunate because it gave many people the impression that only feeble-minded children, or children suspected of being defective, were eligible for examination. Later the work was removed to the Board of Administation building. With money available for new buildings it was decided to start the work of handling court children and accordingly a house was rented where children could be kept for observation. This house was opened in February, 1919, and was occupied until January 21, 1920, when we moved to our new 2 Be eR buildings on West Broad Street. These consist of a laboratory 40 by 80 feet, two stories with basement; and two cottages each 100 feet front, one story and basement. On account of war prices the $100,000 of the appeoneale proved insufficient to finish the buildings in all details. Hence many months elapsed before facilities were at all adequate for handling children.. Even yet our hospital ward is not complete and our grounds are not graded. This will all come in time and is only referred to here to show the reader why the Bureau has not yet done all the work it has planned to do. In this connection we may refer to another difficult condition under which the Bureau has labored during the period of this report. One purpose of the Bureau as set forth in the law creating it, was to assist the Juvenile Court in its effort to place a child where his welfare and that of society would be best provided for. Approximately one third of the children that the court wishes to send to a State institution are feeble- minded. The Bureau should determine which ones are feeble-minded and assign them to the institution for the Feeble-Minded. But the institution for the Feeble-Minded is full and has a waiting list of eight hundred. Therefore the Board of Administration, to whom these cases are committed, can only order them returned to the court and the judge must provide for them as best he may. This is unfortunate but there is no help until the State provides adequate institutions for its defectives. Another group of children for whom there is no adequate provision is the psychopaths. These are children who though often of normal intelligence /evel are abnormal in function. They have committed their misdemeanors because they could not help it. Their brains do not work right. They cannot think straight. They cannot control their impulses as a healthy normal child can—and does. These cases need to be studied, treated and cured of their mental dis- turbance—if this is possible. A hospital for psychopathic children is a necessity, if we are to deal justly with these children and if society is to be permanently protected from their anti-social conduct. Figures and further discussion of this group will be found in the report of the Chief Psycho-Clinician. The material equipment of the Bureau is now capable—with some slight additions here and there—of handling forty children at a time. Since the average time of observation is about one week, this means that we can receive and discharge forty per week. This would take care of all admissions to the two industrial schools as now committed by the courts. On the personnel side we would need some additional employees. The possibilities of the Bureau as a State agency for handling the problem 2 ae of delinquency have been discussed by the writer in a small book entitled “Juvenile Delinquency” (published by Dodd, Mead & Co.) and need not be repeated here. . The accompanying reports of the chief psychologist and the physician will show not only what we have done during this “period of building” but will be found suggestive of what may and ought to be done by the Bureau for the children of Ohio, not only in the way of treatment after they get into court, but for the Arevention of delinquency. THE MEDICAL DEPARTMENT Gertrude H. Transeau, M. D., = Chief Anyone at all familiar with juvenile delinquents will recognize at once that the need for medical attention is great. It is probably conservative to say that 95% of all children received by the Bureau have some physical! disease or defect that needs care. The extent to which these abnormal physical conditions contribute to the delinquency may have been over-emphasized since the correction of these conditions has rarely produced a radical transformation of char- acter in the child. Nevertheless the psychologist needs to have all these unknown quantities removed or evaluated before he can be sure of his psychological analysis of the case. But we may leave the scientific aspect and put the matter on purely humanitarian grounds. The humane handling of these unfortunates requires the immediate attention to these abnormal physical conditions which are often painful and always handicaps. The medical department has done its best to clean up the physical defects of the children. There have been many handicaps, chief of which has been lack of funds. There is no provision for buying glasses for a child. There is not enough money to pay for removal of tonsils and adenoids of all children who need it. And sO in many other lines it is difficult or impossib!e to pay for the work that has to be done outside the Bureau medical department. The department has shared the difficulties experienced by the Bureau as a whole in getting started. The first work was done in September, 1918, when the present physician was appointed. Little or no equipment was available until February, 1919, when the physician was given an “office” in the house rented for the care of children. This office was consulting room, examining room, dispensary and operating room all in one. When the Bureau moved to its new buildings one wing (first floor) of the north cottage was set aside for the medical department. This is gradually getting equipped. Although thorough physical examinations have been made from the. ; 3 beginning, it is only recently that facilities have been adequate so that everything could be attended to. Even yet we cannot do all the surgical work that should be done. Our operating room is not equipped, hence all operations have to be done at one of the hospitals in the city. Many cases that are to be assigned to some institution are sent on with the recommendation that the work be done there. Many times it is not done. It would seem, all things considered, that all this work should be done at the Bureau before the child goes out, or that the Bureau should have authority to follow up and see that it is done somewhere. The most serious problem is the treatment of congenital syphilis. A large percentage of our children suffer from this disease. Very few are ever treated after they leave the Bureau. In regard to contagion we have been fortunate—and careful. We have had cases (one each) of diphtheria, scarlet fever (2), trench mouth and whooping cough. By efficient quarantine each disease has been confined to the first persons affected. The following is a list of the principal conditions found with the number of cases of each. 460 patients examined. 50 were knock-kneed. 177 had malnutrition. 166 were flat-footed. 175 had defective vision. 3 had a tic. 28 had defective hearing. 13 had epilepsy. 6 were totally deaf. 130 had abnormal reflexes. 243 had carious teeth. 37 had positive Rosenbach. 72 had had dental attention. 56 had positive Romberg. 174 had diseased tonsils. 10 had positive Babinski. 111 had had T. and A. removal. 1 had cardiac lesion. 7 had deviated septums. 20 had been circumcised. 9 had tubercular glands. 6 needed circumcision. 98 had enlarged thyroids. 1 had a nasal polyp. 2 had thyroid removal. 1 had a hemiplegia. 9 had heart disease. 313 throat cultures were made. 36 had bronchitis. 10 were positive. 6 had active tuberculosis. 38 Von Pirquet tests were made. 10 were pre-tubercular. 14 were positive. 35 had acne. 262 urinalyses were made. 10 had eczema. 14 ‘were positive. 16 had scabies. Of the 187 female patients examined. 36 had pediculosis capitus. 166 had vaginal smears made. 18 had speech defects. 13 were positive. 5 had operable hernia. 409 had blood Wassermanns taken. 1 had a brain tumor. , 67 were positive. 67 were rachitic. 28 surgical operations were per- 117 were round shouldered, formed. 29 had scoliosis. Four hundred and sixty children had a total of 2083 physical defects or an average of 4% defects per child. Moreover this is a minimum be- cause until we were well settled in our new buildings it was not possible to make the complete examination that we do now. 218 children admitted to the cottages have received 301 clinical baths and 219 clinical shampoos. 106 children have been ill in the Bureau hospital—a total of 347 days. 2712 medical and surgical treatments have been given. 410 dispensary trips have been made, and 1140 treatments for syphilis—congenital and acquired. It will be noted that the number of cases treated does not equal the number of cases needing treatment. This is because, as stated above, there were no adequate facilities and-no money available. We had to rely largely on the generosity of local specialists and free clinics. Often the clinics were crowded and the specialists over run with work. There is only one way that this matter can be effectively handled and that is for the Bureau to have its own equipment and funds so that it can call in specialists as needed. A dentist could be kept busy all the time. Simi- larly an eye, ear, nose and throat specialist. DEPARTMENT OF CLINICAL PSYCHOLOGY Florence Mateer, A. M., Ph. D., Psycho-Clinician The work of the psychological department of the Bureau of Juvenile Research covered by this report began the lst of May, 1918, with the appointment of the present director. There were no other examiners until the 24th of June, but several cases were seen and various consultations were held during this early period. This work was largely in the nature of propaganda and no definite system of clinic hours or day was begun. An assistant psycho-clinician was appointed and began work the 24th of June, 1918. The position of psycho-clinician was filled the Ist of Sep- tember, and another assistant was appointed the 21st of November, and an associate the 20th of December. These positions were all that were established during the first of the two years included in this report. The clerical work had grown sufficiently during the early part of the fall, so that a clinical stenographer was appointed December 16, 1918. The growth of the department during the second year was rapid and favorable. One of the assistants was given leave of absence for work 5 abroad in June, 1919, anda worker appointed in her place over the summer. A second associate position was established September 1, 1919. The executive and clerical work of the department had in the meantime grown considerably and another stenographic position was established December 15, 1919, and the position of record clerk was established December 10, 1919. The Bureau moved to its larger quarters on Hilltop Jan. 21, 1920, and this brought with it a need for still more people and resulted in the establishment of the position of executive clerk, and the promotion of the former clinical stenographer to the position of commitment secretary. This completes the staff of this department of the Bureau as it stands to-day, giving usa psycho-clinician, two associate psycho-clinicians, two assistant psycho-clinicians, the commitment secretary, a clinical stenographer, a record clerk and an executive clerk. Besides this, the work of the psych- ological laboratory has spread out to handle several other lines of work. The educational department in which one teacher is employed is under the supervision of one‘of the associates who has been detailed to assume the responsibility for this work. A number of students have been trained in the laboratory during the two years. All in all we have had seven of these who have spent anywhere from six weeks to six months in the laboratory, and four who have been with us shorter periods, stimulating the professional ability they already possessed. Needless to say, at first the time necessitated for their training has hardly been equaled by the value of the work they coulddo, but after a couple of months of training, each and every one of them has repaid for all the time spent upon helping them. Moreover, all of them have gone out as workers who can decrease the work demanded of the Bureau through handling many problem cases locally and referring only the extreme cases. All of the students, with one exception, are employed somewhere in the State. Actual examining of groups of children began in July, 1918, although most of the work done up until the 1st of September wasin County Homes and in courts throughout the State, very few children being seen in the laboratory proper. The work of these two years may be said to have been fourfold in its aim. First of all there was the need for the standardization of methods and the establishment of an efficient system for handling the work. Nocliniccan make the most of its opportunities unless all data which it has gathered is instantly available when it is needed for reference. Secondly, the development of the clinic itself, the handling of cases and the making of diagnostic records is the greatest aim of a clinic and has been the chief interest of the psychological department. Thirdly, one might say that a definite attempt has been made at research work. This has been done through the use of research and experi- mental methods on all work on regular examinations instead of through 6 specializing on one or two problems and doing the rest of the cases as routine work. SECTION I. Altho the work of standardizing methods for laboratory records, et cetera, is a minor part of the work of the Bureau, yet it is impossible to run a large clinic without efficient and easily working, as well as easily understood, methods of filing and rendering available case records. The record is a secondary thing but until it has established itself in a state of utilitarian availability, it must be made a matter of actual importance and consideration. From the first of September, 1919, until the end of the first year of the clinic we had constantly on hand the work of standardizing methods and record blanks and of trying them out to see whether they worked. The second year saw less need for such work and to-day we have practi- cally finished this task. At present we have a standard method for enter- ing and recording case records and also standardized and easily utilized blanks for the making of such records. The work involved in this task has been far greater than appearsonthesurface. The blanks had to be adapted to the uses of this particular clinic and have been without precedent in clinic usage. They have had to meet the varying demands of rapid survey, intensive and prolonged observation, group testing and group selection. It might be well to call attention to the fact that the Stanford-Binet blank which is used is not original here but is one modified from that first evolved by the writer for use at Waverley. The Association Test blank has been completely remodeled to fit the needs of the examination instead of the needs of the publisher. The case summary and psychological record blanks have been worked out on the basis of former clinic experience to give in summarized form the most easily acceptable and self-explanatory record for those who are not technically interested in the examination itself. The front sheet of the case record is absolutely necessary from the stand- point of statistics and rapid handling of cases when consultations come in over the telephone. There are still several blanks which are not in printed form. ‘These are in the intermediate stage of standardization every day. All of the blanks now printed were first used in this form, being put into typewritten form on the letter press by the clinical stenographer after having been finally arranged. Every new blank as it is adopted is used in that form for at least three months in order to test it out before we go to the expense of printing. One of the filing systems in usage is that begun by Dr. Haines, being a numerically chronological arrangement of the records. The card system which acts as an alphabetical index for this case record system has also been kept up without any change, save that now the cards are written by hand instead of on the typewriter, being far less blurred and more easily (4 read. Besides this, we have had to organize, for the sake of efficiency of checking on work when so many are at work in the department, a chron- ological accessions book in which all cases are entered in the numerical order in which they come for examination. In this book are columns which check our handling for each case record in all necessary processes, namely, summary of examination, letters, cross references, card filing, jacketing, et cetera. In connection with this system we have also had to make a separate card system for the standardizing of our literacy test. This record book checks also the relative amount of work done by each examiner, the type of diagnoses used, agencies referring, ages, counties referring, and is a constant index of the work of the department. In our card system we have adopted a two-color card file which simplifies the work of looking up whether we have ever handled a child or not. Correspondence, et cetera, relating to cases never examined are entered in the same card file as cases examined but on a card of a different color. A geographical file has been begun and is almost ready for use. It enables us to tell at any time the actual amount of work done for any one county, city or town. The number of feeble-minded, insane or delinquent children we know to be at large in that community, can be ascertained at a glance. This file will undoubtedly provide our most convincing propa- ganda during the next year. Another device has been worked out which simplifies procedures a great deal. A blank book is kept by the telephones and in this is entered in brief form the gist of a telephone communication regarding cases, dated and signed by the person receiving the call. This book gives any one in the clinic the clue to recent case happenings in a minute or two. It also saves many a broken or forgotten connection in the handling of a case. These entries are automatically added to the proper case records before cases are filed and are then checked off ascompleted work in this telephone entry book. Regarding this part of our two years’ work, it seems sufficient to say that we know there will be necessary modifications and eliminations in the coming year but our present recording system works and adapts itself to case emergencies and demands. Following is a set of the principal blanks which have been made. during the two years and which are now in daily use for a maximum examination. At first glance it may seem that they are too voluminous and cumbersome for the end to be attained or suggest that assistants would object to the amount of work involved. As a matter of fact all blanks have been devised in response to the need of the laboratory and frequently upon the request of assistants. The blanks as used are letter size. 8 1919—P-4 BUREAU OF JUVENILE RESEARCH Ba JoRe NO sss ower cee NAME DATE AGE BORN SEX COLOR MENTAL AGE GODDARD BINET - STANFORD BINET ADDRESS PARENTS’ NAMES PARENTS’ ADDRESSES BROUGHT BY ON ADVICE OF FOR WHAT REASON SEND FINDINGS TO LEVEL DIAGNOSIS: FUNCTION RECOMMENDATIONS PROGNOSIS RELATIVES— HISTORY OF CONSULTATIONS SN —————————— OO DATE FORM REMARKS ones. kK BUREAU OF JUVENILE RESEARCH HISTORY OBTAINED FROM: 220... cee eae NAME AGE PHYSICAL RECORDS FAMILY HISTORY PERSONAL HISTORY HISTORY OF SCHOOL PROGRESS ECONOMIC ABILITY BEHAVIOR, social, moral, etc. EARLIER PSYCHOLOGICAL EXAMINATIONS 10 DATE 1921—P—11 BUREAU OF JUVENILE RESEARCH PERSONAL AND DEVELOPMENT HISTORY Name Age Date of birth Place of birth Was he born at full period? Any extraordinary circumstances attendant upon delivery? Breast or bottle fed? Is there any history of convulsions? Age of walking Talking What diseases of childhood has he had (age?) What hospital has_ he been in Where? When? How does _ he sleep? At what age did mental peculiarity manifest itself? . Cleanliness Personal habits { Masturbation Does he hide, break or destroy things? Does he run great risks for slight possible gain? At what age did he first attend school? Where did he attend school? What grades? What studies has he had and how far did he get in each? Deportment? Truancy? Civil state Teething’ Why? Years in each? CUPCHF OCC Vee Deeed cooesecoes BUREAU OF JUVENILE RESEARCH FAMILY HISTORY Name Age Date Brothers and sisters, with name and ages (Use |_| male, O female) including those who have died and miscarriages (Indicate w. d. and cause). Are any vot sound in mind or body? (Indicate above) Age of parents Father Birthplace Mother Birthplace Maiden name If not native born, years in U. S. A. Father Mother Health of parents at birth of child Father Mother Occupation of Father Salary Mother Salary Standing of parents in community. Consanguinity of parents. Characterize father. Characterize mother. Did the parents or relatives of this child ever show any peculiarity of mind or body, such as: (Indicate with an ‘‘x’”’ and relationship). Paternal Maternal Severe headache Extreme nervousness Deaf Blind Tuberculosis Paralysis (age of) Drug habitue Alcoholism Pauper Sexual promiscuity Syphilis Gonorrhea Criminals Convulsions Epilepsy (fits) Insanity Feeble-Mindedness Other facts regarding relatives of this child. BUREAU OF JUVENILE RESEARCH SOCIAL HISTORY AND REACTIONS Name Age Data Type of neighborhood; rural, sparsely settled, crowded, factory, slum, residence, Character of home: house, cottage, tenement, lodging, flat. size sanitary condition. Character of neighbors. Associates. Does he play with children of h own age? Is he teased by other children? Is he taken seriously by h companions? Amusements, interests and reactions. Attends what church? Has been confirmed? Is_ he obedient? Is he extremely quarrelsome? How does hespendh money? Whatish attitude towardh parents? brothers and sisters? Why have the parents or guardian felt it necessary at this time to havea diagnosis of mentality? Has he ever earned wages? Where? Wages rec'd. Kind of work? Quality? Reasons for leaving positions? What does employer think of h_ ? How much supervision does _ he require? If he has never earned wages, what kind of useful work is he capable of doing in the home or elsewhere? 13 1919—P-5 BUREAU OF JUVENILE RESEARCH SUMMARY OF FINDINGS Bo oRaNGaas eee NAME AGE DATE REACTIONS DURING EXAMINATION ANTHROPOMETRIC FINDINGS EDUCATIONAL ABILITY ORIENTATION PSYCHOLOGICAL FINDINGS — Goddard-Binet Stanford DIAGNOSIS RECOMMENDATIONS SIQNEG 6 ss SeNGes Seg es erawins JS ok a Ane cr ir ee 14 RECORD OF ASSIGNMENT OF CHILD BY THE OHIO BOARD OF ADMINISTRATION Gaeta So aii ca Mae eee ae tenets Superintendent, Datecone- ss. been committed by the court of .++++,+..County “to the care and custody of the Ohio Board of Administration, which Board thereupon becomes vested with the sole and exclusive guardianship of such minors’’ (General Code, Section 1841-1). SHE TG ME See se nee pk erie ae wy ea oaeTetea a wd having been examined by the Bureau of Juvenile Research whose recommendation is hereto appended, is hereby assigned tothe... ...... 0... cesseeceeeeseeeees to be held for said Board of Administration until further notice. You are hereby authorized to give said child such care and treatment as your institution is equipped to give as may be required in this case. When in your judgment said child is ready for parole or discharge or in your opinion requires trans- fer to some other institution under the direction of this Board, you will so inform the Board of Admin- istration who will take the matter under consideration and notify you of its action. THE OHIO BOARD OF ADMINISTRATION To the Ohio Board of Administration: Raprrcmie ais t sition CA sachs. ateatnsain claPae; aire las has been examined by this Bureau and as the result of Paid eXammation we recommend that said.s. 2.1 ......202 cceec cucu) deveestcceenns esas be assigned to La fe ae cepa it te oe a We append two copies of our findings in the case; one copy to be filed with his commitment papers and one copy to be sent to the institution to which he is assigned, BUREAU OF JUVENILE RESEARCH Director. 15 PAROLE PERMIT GRANTED By OHIO BOARD OF ADMINISTRATION To WHom It MAY CONCERN: Date BONES wera eat vetoes eeaiN a occ el Pon eee centr , formally committed to the Board of Administration at its Bureau of Juvenile Research by the Juvenile Court of.............4 Fe a abs ueS fais ae ee ats aan County, having been under observation in the Cottage of the Bureau of Juvenile Research since . ..+.,1S hereby paroled into the care and custody of comfortably placed .... .... Modification of these conditions without permission from the proper authorities, that is, from said Bureau of Juvenile Research, will be considered a violation of parole. Said sueier hcg een any nee fetes , hereby also agrees to return child to the Bureau of Juvenile Research in case of any further delinquency. In casetany such delinquency: ‘brings isaid vss) 0. <5. sckws canes doe oie) Gactemes within the jurisdiction of any court this parole permit should be presented to the Judge of such court as evidence of the guardianship held by the Board of Administration and request be made to the Judge to defer entence and to return the child to the Bureau of Juvenile Research for further study. Said guardian hereby also agrees to report the child’s behavior, progress and state of well GU At. ok ak ccipieatiictisls elas ie cee aerators intervals, first report being due.......... cs eeee eee eee eee cnes OHIO BOARD OF ADMINISTRATION 1919—C-4 The following tests are used: + Kent-Rosanoff Association Test Literacy test (Blank shown page 18) Goddard Revision of Binet-Simon Scale Stanford Revision of Binet-Simon Scale Minimum Performance Test (Blank page 20) Morphological Data (Blank page 21) Spelling Test Language Test Writing Test ' Geography Test oe JOR. Arithmetic Test General Orientation Test Record blank for the examination of infants 17 P-17—10-20— 1M LITERACY Fest NATIVE eee tec ha ctore he erates ona, Sete or re tae ee a GR. RET.= M.A.RET.= NG aCe Phe Sarr mee PARLOR 1 Acme riot arose DATE (OF BIRTH #, ¢..:.--s6 BE st ne Ae . SCHOOL GRADE COMPLETED—....... IN==...... : SCHOO ee te cisterns an bs sos yon orcas sees Po) Gah ae pena cron ODO S HOD UOT SCA OO Gry Rit. 76 DACRE metres do reides ance niloauhten thats aite dinate seraryan telat pe wena Do cats. Bark? os: cans NO: «exes Ie’ coal ‘blacks Aicc.wenss NO’ »« YES Olio Bureau of Juvenile Research Gan youseer fa... eee ee ee oe No Do men eat stones?...... -......- -No DOoDOys WKEtO Player tcc: | o Oo Totals These school cases are practically all selected cases, needing examina- tion and, in most cases suspected of feeble-mindedness. Yet the total per- centage of feeble-minded, potential feeble-minded, et cetera, found is 44.4, slightly less than the percentage found in the Children’s Home surveys. The diagnostic classification of the other cases is quite similar to the 1919- 20 Children’s Home findings.. The school survey work is the result of individual examinations made by eight different examiners and reflects less of the personal equation. During the last year we have evolved a brief group survey method which has been quite helpful in the selection of cases needing individual examination, although the standardization of method was not primarily for that purpose. The test used is our so-called Ohio Literacy Test which is reproduced with our other blanks. The child is given five minutes to answer, by scoring of the correct answer, as many as possible of the questions on the two pages. The right minus the wrong. gives a final score. So far we have used about 10,800 of these tests and, after the first 2000, have used the gradually modified percentile forms as a basis for the detection of backward and psychopathic 24 children. A worker can easily give the test to 500 or 600 children in a day and score sufficient rooms to have a list of those needing individual examinations ready for the next morning’s work. The method gives an immediate rank score also. We have had a number of demands for help on special children where neither teacher nor principal knew the children most in need of special study and have used the Literacy Test in these schools to good advantage. For instance, a school in one of the larger cities had about 100 children out of 500 who needed individual study according to the teacher’s report. The survey method showed these children to be no worse than the others in the school but the whole five grades (second to sixth inclusive) rated a grade below by comparison with similar grades in other schools. The '. district could not be said to account for it, but analysis of the school history showed so many substitute teachers and so many changes in the teaching staff that the children had undoubtedly suffered. Children entering third grade were just beginning to read. When the school’s comparative ranking was determined, the number of children deviating sufficiently to actually seem to need individual examining at once sank to the usual 10%. Asa matter of fact, 158 of the 507 children were actually examined, largely to determine the accuracy of our rating of the school. Consequently bright, as well as dull children were studied. The resultant percentage of feeble-mindedness for the school was 6% while our general average of feeble-mindedness detected in school systems is 6 to 7%. We have found in various schools that a teacher can readily give the survey test and send in the records for scoring with good results. Full percentile standardization of the Literacy Test for age, grade and mental age is in preparation. , The surveys requested by Courts have meant only a total of 81 chil- dren, yet the diagnostic distribution is interesting. CHILDREN EXAMINED BY REQUEST OF COURT (not committed cases) Num PER INTELLIGENCE LEVEL FUNCTION BER CENT AGE ‘Feeble-Minded Normal 31 38 3 Feeble-Minded Psychopathic 2 Aa) Feeble-Minded deteriorated 1 Mae Potential Feeble-Minded 3 3 8 Potential Feeble-Minded deteriorated 1 Liz Deferred 34 42.0 Borderline 1 its. Inferior psychopathic 1 12 Inferior Normal deteriorating 1 1.2 Inferior Normal psychopathic, syphilitic i! Lite Normal at present normal 1 1,2 Normal normal 4 po Totals 81 100 0 The miscellaneous surveys include selected groups done at the reformatories, for charitable organizations, etc. The group contains a far greater variety of cases than those referred by either Courts or schools. 25 Totalling all the work done outside the laboratory, we have the following diagnostic distribution: Following is the diagnostic distribution: NuM PER INTELLIGENCE LEVEL FUNCTION BER CENT- AGE Feeble-Minded 44 40.0 Feeble-Minded and psychopathic 3 2.8 Feeble-Minded and Insane 2 18 Feeble-Minded syphilitic deterioration 2 18 Potential Feeble-Minded 9 8.2 Potential Feeble-Minded psychopathic 2 1.8 Deferred 22 20.0 Deferred, psychopathic g 1.8 Inferior Normal 1 09 Inferior Normal Insane 1 09 Normal on tests at present 9 8 2 Normal Normal 2 1.8 Bright Normal Normal 1 09 Psychopathic 1 09 Psychopathic, deterior- F F ating, syphilitic 2 18 Insane 6 5-5 Epileptic 1 0.9 Totals 110 100.0 NuM PER INTELLIGENCE: LEVEL FUNCTION BER CENT Feeble-Minded Normal 855 33.61 Feeble-Minded Psychopathic 35 1.38 Feeble-Minded Insane 3 12 Feeble-Minded deteriorated 2 08 Feeble-Minded deteriorated, syphilitic 4 16 Potential Feeble-Minded Normal 231 9.09 Potential Feeble-Minded Psychopathic if 28 Potential Feeble-Minded deteriorated 1 03 Deferred 854 Sd-a0, Deferred Psychopathic 45 ne Deferred deteriorated 1 03 Borderline 37 1.46 Inferior Psychopathic 5 -20 Inferior Normal 35 1.38 Inferior Normal Psychopathic 14 .56 Inferior Normal Psychopathic, deteriorated 1 .03 Inferior Normal Psychopathic, syphilitic 1 03 Inferior Normal Insane 1 .03 Normal at present 121 4.76 Normal at present Psychopathic 1 03 Normal 190 7.47 Normal Psychopathic 23 91 Bright Normal 39 1.54 Bright Normal Psychopathic Z 08 Bright Normal Psychopathic, Syphilitic 1 .03 . Psychopathic 25 99 Psychopathic, deteriorated 1 -03 Psychopathic, deteriorat- ed, syphilitic 2 .08 Insane 6 24 Epileptic 1 03 Totals 2544 100.00 , The increase in the number of diagnoses used in our survey work has been a gratifying one. The assumption has usually been that work done “in the field” is much less accurate and less reliable than work in a labor- atory. We have not found this true when we have had a well trained worker to send into the field. The general tendency is to send workers of less training to do such work. We have found that it does not pay to send any save the best, for the worker’s ability should offset the handicaps of the conditions under which work is done. Working from this stand- 26 point we have seen as much improvement in our field work as in our laboratory examinations. ; Of course the worker in the laboratory has a far better chance to check and correct a tentative diagnosis. There are usually far more “consultations” ona laboratory case. By “consultation” we mean all forms of communication and interview which add to our record on the case and, which, naturally increase the cost of diagnosis on the individual patient. Following is a table showing the number of consultations for the two years. It goes to prove that there is far more to running a clinic than examining the patients: CONSULTATIONS 1918-19 1919-20 Examinations 1901 1677 Re-examinations 116 539 Letters received 449 922 Letters sent ' 942 1697 Telephone calls received 575 811 Telephone calls made 154 188 Visits made 195 260 Telegrams received 9 44 Telegrams sent 13 47 Supplementary reports 11 69 Trips with children 34 Consultations special 6 Totals 4405 6254 This is the total number of consultations for all of our work and involves all demands relative to survey cases, clinic cases and observation cases. The number of consultation may not be averaged for the 3,578 cases however, for the survey cases average only one consultation, that one being an examination, while the clinic cases average five consultations each and the observation cases average twenty consultations each by the time they are assigned and they are constantly being re-referred for continued handling. One tendency of our clinic is indicated in the relatively high number of letters sent to people. We receive many telephone calls, for appoint- ments, giving data on cases, etc. We make few reports by telephone but try instead to give a simple yet definite written statement which is not so easily forgotten or misquoted. Under re-examinations are listed the repeated examinations of observa- tion cases and aiso the second or later clinic examinations of children seen in the clinic and on whom diagnosis was primarily deferred. These cases are recommended for re-examination at the time of the first examination. We have no way of insisting on their return and must depend upon our ability to educate the guardians to an appreciation of the need for further study. Because of this it is gratifying to note that cases are constantly and voluntarily being brought back. One might very well question whether there would or would not be found a great variation in the proportion of children diagnosed normal, feeble- 27 minded, psychopathic, according to the agency referring the cases. Because of this we have made a count for diagnostic classification of children accord- ing to the agency referring. We have used eight general classifications of agencies. “Court” indicates all cases referred by judges, probation officers, etc., as well as actually committed cases. ‘‘O. B.S. C.” indicates the wards of the Board of State Charities only. “Institutions” means cases referred by other State Institutions such as the School for the Deaf. “Children’s Homes” indicates surveys of all children’s institutions and also odd cases referred by officers of such institutions. “M. D.” indicates cases referred by hospitals and physicians. “Education” indicates all school surveys and individual cases referred by teachers, principals, etc. “Social agencies” indicates the cases referred by charitable agencies, relief associations, churches, etc. “Miscellaneous” covers a few cases coming on their own initiative, referred by friends or through newspaper propaganda. The following table gives the distribution of diagnoses under each type of agency. For meaning of abbreviations see next page. 28 DIAGNOSES ACCORDING TO AGENCIES REFERRING Soc. { : 'O. B. State; Ch. |M.D.! : Level Function Courtig” Cl) Inst. [Homes Hosp.| Ed. oe Misc.| Totals FM... rote 162 71 41 548 40 | 275 79 22 IVS chic akars ae 43 RSVeieis: Meee as 28 10 5 12 2 19 10 gl emi se TEBE, Reoeh AN pte CRN TOGO et AL EEC RSI an ee Ble tac v4 1 1 wn 1 r POM eh ctpyroilantn. PSVekotsine Taeosenans 4 4 és Red erorapiers ae ura 2 | ket FM esters oe Aches tae ek 5 3 seh pone nA 1 2 Luo eee 1 IN laces Oman cnet IDELGIISY caso tions. 10 3 1 1 i 1 hs St ieee (ELEPIN lancseics Bee Se ey eee ie eee a eae 18 9 1 165 ee 62 14 aie | Uae PE Mier cr, neces Sy he tioet og eaten 3 ao eae 4 Culms Ane 1 ete see Rieter eee prs | Nua ccs wrcainal Ug ubeehelanelits 1 ae oe? Olipae hires oe ies Se cane ess PR Nitin rce aa ests oe ee } ae Pa lncistess Bes : m4 |, totter 124 SAW (pees ERC rare Clio. 250.5 < teeies SM aidan a [ecxarsecpie reel eaten ae Coe | octet WRG eae I ee Ros ha linud: tote eos 85 59 11 570 9| 244 40 Sie iene IBISeS oa. Sees Psy . a ZN larasai 22 1 28 5 2 Wefersiee os aes LO (le ae ree ae Pa arts Salt eecas ae rae 1 Fr! Be i honmen eLetter: Letictoetey caiaures averon ora were: i any oul eee eee) 1 He nee shsteat Vg gneteatete Wee anceseahe ad 2! PSY Sines) «heme stores. 3 4 oi Wl fviicacat Ss a oe . SS | heath ete "Ranh e To hd br, aoe kee hl eet at a ew eee ena ane : Meee Ene ee si 1 1 Sal ae jByc hi tcc hee eee ree ARO et ere 5 4 he 36 5 nee 1 me | aes ee iB T6 Kd By resort ae ane ree Psy 4 a See area aia'e sae ee H - TACULR ay perience Deter. sions tans 7 ds wis AWergiiatoai Pee a 1 aoe dee oer Bal we peda. se | LeSV SY ] 1 P| actos ver Paes il Sees irae ee Backward seca 4 cl a dean at ae see 2 ae 1 : PANE heme Nite eee one ial Sem sete eee eee a one iy eae : ba : = Re Mie a eee Writtarcca yarn : 21 6 : 1 1 o 3 UM ats dae Inf.. (shellshock).......... Rete Spear i heed ee Sigh We 1 Site Saeee Cae ees Recess UL see OR Gani aie, Wee ae 3 ae xe ol br sire ak a eri HES Inf.. Psy Sy WE 4 W BS ae “fi ie il eo Ny eee Inf.. Detetian cin ee 2 3 eatiienntiecene ate ~ ais oath ns Riicratemtoe oars oe -ahera Sh Al Daa ean eerie ae Taner ial Meret ae i ereatcc cos ee os oer rah Ne Miah Gabel le Le elec eee AO ee 11 4 2 14 be 18 6 y) Inf N Psy |... 9 x tae hore 12 ae 2 SN eter AntiNeies faca cetacean PSY HvSases sn eace. Looe me ee il 1 Ne 43 eae, [Poco Inf N a] clef VeLES ceerieceee iene Oa leat Bes Porcrerese ren tS ii Ber N mea tane Pie W eae coantn se Deter due to Par...... 1 onl Lael awe ers Eos Hy ee itt Nitta eccte a 't Sw IST be ovoes emer ts 5 SLR ie Soe | ve cosa ks See dL Wee ats ll Peseta Af eee arecre eyo Aree. east ae ae : ar ; 2 Atel limi nee JSD eS eh dsc eeciici 85 hcl ne ACoA ae 3 3 2 104 2 6 u 2 131 Nears sseuia scans Rsyitolen aviary wawececrte “8 wae 1 a Ae oe ial | Peers INFfOT: race wrece aes. sade le atric pe ih eee ek Ware oes ur: 1 See Seater irenicme ee Meme UN ta cacagie Adelie issuance 13 9 3 112 5 78 9 9 238 (Noe eke cies Psy @:: 10 1 ate 5 1 18 3 Dales AN eerie ce oe ares IPSVaklySs cee ee uate 3 me BEON| aieere ae ie wi is eae tele eee Ns cis cece Psy Sy. 2 ake aoe : BO | eh Go| ars Sees Nigeeaite a) ae es, Pees 1 ie eS eee ak et bh tre eg ee Deter 1 S46 Roa Bene Pcl rece lee, A eae IB INGO: ests 2 he ois a ae ee om ae atl eee ae aN ee a = P ete Net Mae see Wo aee cunt, haieace 2 a ne 9 2 37 2 12 64 Biro sae PSy) 5 aaieesae core 4 te Bell Rees 1 2 1 Ds eee STAIN Wee ei ak Reva Vaat ee ietas nee ; oo 1 xe eas : aie Nee : SW taken garni) eax career 2 5 3 16 Z 13 6 ee Pe cial SVs Sas ee Se 1 at ee Sih ao. ee Laster et) cokes SRESV Geter Foc... cag we g we tee be bot Lil eres ee Psy deter 2 il St 1 i! Lite eee al ee Psy deter Sy --ckceey 5 2 De NAB ec il The Cottage was opened February 4, 1919, and from that time until the lst of July 1920, two hundred and seventeen different children have been admitted to it for prolonged observation. Twenty-five of these children after placing were readmitted for further observation, and four of these were admitted a third time. This makes the total number of admis- sions for17 months 246. Of these 217 children there are at present 23 in the Cottage, two of these being second admissions and the other 21 being first admissions. These children are still under observation and have not been finally diagnosed, consequently our discussion of the work on Cottage cases must deal largely with the 197 children who have been diagnosed and assigned or otherwise disposed of with a brief mention of the redisposition of the 25 readmitted cases. Altho we have just begun work, the use made of us by the Courts and others to obtain thorough study of their children has been rather wide spread. Of the 217 children admitted, 193 have been committed by the Courts. In all, forty counties have been represented through the Court commitments. Of the other non-committed cases, 7 have been left for observation by parents; 9 were temporarily placed with us for observation by the Ohio Board of State Charities; 1 was sent for observation and examination from the Sandusky County Infirmary; 3 were referred from County Children’s Homes, 1 by the Women’s Protective League; 1 by the Big Sisters; 1 by the local court and 1 as a parole violation case from the Boys’ Industrial School. Two additional counties are represented in this group of non-committed cases, so that in all, the 217 children who have been in the Cottage represented 42 different counties. 32 - The counties committing cases are as follows: FE- COUNTY MALES MALES TOTALS Allen 0 6 Athens Butler Clark Clermont Columbiana Coshocton Crawford Cuyahoga Defiance Erie Franklin Greene Hamilton Hancock Hardin Jackson Knox Licking Logan Lucas Mahoning Marion Medina Miami Monroe Montgomery Morgan Perry Pickaway Portage Scioto Seneca Shelby Stark Summit Tuscarawas Van Wert Washington Williams Totals 123 _ ren PROD HOD OOCW OR OOCH DH DOH OR HOWN Or DHODNONREWOrRD . _ SNR RE RRR EE ROR RON POOR RH OROCOOMOUOUNFrOAOrNONHO — RP RWNMANOR HE BRR ROR BN NODE MEH WD | | | ~~ Oo 193 The children committed have not been an homogeneous group but range in chronological age from 4 months to 27 years. The mode for the group lies at 15 to 16 years, the same number of children at each of these ages being sent in. The mode for the girls is 16 years while the distribu- tion of the boys presents two modes, one at 9 years and another at 14 to 15 years. Following is a table indicating the age distribution of all cases under prolonged observation. The number of boys studied has been nearly twice the number of girls. Distribution by age and sex: CHRONOLOGICAL AGE Boys GIRLS TOTALS Under 1 1 1 4 1 1 5 1 1 2 6 2 2 7 4 4 8 10 3 13 9 16 4 20 10 12 4 16 re re 2 9 12 16 6 22 13 LZ. 7 24 14 18 6 24 15 18 11 29 16 ul 18 29 17 9 15 18 1 2 5 19 1 1 2 27 1 1 Totals 140 77 217 33 An analysis of the “charges” under which these children have been sent in is interesting but by no means states the situation. Some chil- dren are committed merely as “delinquent,” the form of misconduct being left for us to drag out only through painstaking research. Quite frequently this takes several weeks and in some cases it has been months before we have been able to make those vitally interested give a frank statement of difficulties in handling the case. We are working on an analysis of aberrational and anti-social reactions in relation to psychological diagnosis but there must be much more work done before we may begin generaliza- tions. The charges under which the 246 admissions have been made are as follows: Stealing 47 12 59 Delinquent 19 18 37 Incorrigible 15 16 31 Immoral, sex offender 21 14 35 Dependent 13 9 22 Truancy 16 2 18 Runs away 14 Re-observation as advised Setting fires Juvenile disorderly person Peculiar, need study Lies Cruelty Neglected Unmanageable Violate parole Need advice re-disposition Feeble-minded Disorderly Escapes from other Institutions Vicious Threatened with revolver Sex ideas Has spells Needs medical treatment 1 Needs supervision Appears feeble-minded and degenerate Troublesome Unplaceable dle Profane Destruction of property Highway robbery Breaking and entering Concealed weapons Shot and wounded Murder 1 Totals 194 93 287 Although there are 22 children committed as “dependent,” there has been more to the case in most instances. Six had been such persistent delinquents in various child-caring institutions that they could no longer be kept there. There were 2 idiots, 2 imbeciles and a low grade moron, for whom the judges could plan no disposition. Two girls were brought in for study to see whether their charges, of rape, against their fathers came from normal and responsible minds. Five were most peculiar and unmanageable in the home. Two proved insane, a third was an epileptic, and the other two are probably beginning dementia praecox cases. One was apersistent delinquent, immoral and a thief with court record. Three 34 NOM Mr bo OW WWWONAIW | eR NOR RROMD aera) av Re ee bt ee SS NID WWW PE PANIC were true dependents. This will suffice to show the incompleteness and inaccuracy of the count presented, which is probably as true as that we find in most reports of analyses of delinquencies. On the other hand, we are sometimes forced to disprove the findings sent us by agencies handling the cases for the Courts. One little girl, sent in as the “worst child in northeastern Ohio,” proved to be merely feeble-minded and unable to do as she was asked because, being nine, she was asked to do 8 and 9 year old things, while her mind was that of a six yearold. In similar fashion a child said to be a problem because of extreme masturbation showed absolutely no trace of any such habit although she was watched in bed, at play, and at intervals through the night every night foramonth. The same fascinating analysis discloses secret stores of infor- mation hidden behind the other “stated” offenses. A very definite program has been adopted in handling these children. From the moment they come to us we begin morale work and then, if it seems possible, re-education is attempted. Before the child is sent to the Cottage he is given a preliminary “morale inoculation” and an introductory examination. The introductory examination is limited to as brief a hand- ling as is compatible with making a tentative estimate of the child’s mental level, functional normality, and potentiality as a discipline case in the Cot- tage. At present we are using for this purpose the Ohio Literacy test, the Kent-Rosanoff association series, the Porteus series when needed, and oc- casionally the Stanford-Binet. The “morale inoculation” so-called is a definite attempt to get the child’s attitude at that time and to then modify it so as to make for his welfare and comfort in the Cottage, as well as for the comfort of those with whom he lives. The child is told that his future depends upon himself. His stay with us is a privilege which few children are granted and that he is one of the children picked by the Judge as worth having another chance. We then explain that he makes his own record, that all he does is important from the standpoint of his own future well-being and that, in other words, he is responsible for what comes to him. He is told that he can bring his troubles and problems to his “officer” and that he will come to her for all examinations. Weemphasize the fact that his Cottage and school behavior are as importantas anything else that he does. For the concrete enforcement of this fact we use a weekly record of a child’s behavior and work. This record is called an OK slip and has been adopted: and modified from that used at The Training School, Vineland, New Jersey. On this slip the child receives an OK or signature for each task properly done during the day. If he is indifferent, careless or disobedient he receives instead a black mark in the proper space. If he is very disobedient he has a hole punched in the OK slip. 35 Of course such a system must be backed with privileges for those who have good record slips. Our parties are never open to a child with a punch in his OK. The errand boys and girls, those picked for special pieces of work, and those taken to moving pictures or on hikes, etc., are all picked through the use of the OK slip. Sometimes even such things lose their value and then we give some special prize or treat to the child who has scored best for the week. It is noteworthy that the prize which means the most is to be given street car tickets and money for a moving picture and five or ten cents to spend and to be allowed to go, thus equipped, “down town alone.”” We have never had a child abuse such a privilege. We have already obtained some interesting sidelights through the use of this system. The normal and the psychopathic children vie with each other for the greatest number of OK’s but the feeble-minded children are left hopelessly behind. Try as they will the other children get ahead of them and use their intelligence to gain them “extras”? which will add value to the week’s slip. The feeble-minded child sees the opportunity for such gain only through the example of the child thinking it out and thus he is always one stage behind. We have also had some feeble-minded children who failed to realize the abstract ideal represented by the OK and who thought getting the marks on the paper was the only thing and who consequently set themselves to forge a sufficient number without any idea of wrong-doing. A thorough entrance examination of a committed case is usually completed within the first forty-eight hours after his admission, unless he arrives ill or unfit, in which case it may go a little longer. The examination covers all that we can do in a two or three hour attempt to discover two things. First we attempt to ascertain the child’s mental level that is his relative normality or subnormality of mental age. We then attempt to estimate the normality or abnormality of the function of that amount of mind which he has. In other words, we examine him for quantity of mind and then for quality of that quantity. When we get too little in quantity the child is backward or may be actually feeble-minded. When we get wrong function we say he is psychopathic or even insane. One examination may do comparatively little to reveal the functional type but it always gives us a valuable estimate of mental level. Functional type may be dependent upon daily variability and may manifest itself only through prolonged observation. The study of the functional type of the child is one of the chief reasons, consequently, for his staying for prolonged observation. Our tests of functional disturbances, or “psychopathy” as we term it, are still immature and only partially standardized. Because of this it is necessary to check any tentative diagnosis in every way possible and very often the observation of the child as a part of the social group in the Cottage 36 is the most effective and definite contributions to our understanding of him. This means time, however. Most of the children who come ‘in behave well for a day or two and the attendants would never believe the truth of the records with which they have come in. With some extreme cases three or four days will show up the tendencies so carefully checked at first. With othersa month or more may be necessary to gather the necessary facts. The study of Cottage and School reactions is greatly helped by written daily reports from the Cottages and School, giving the unusual or troublesome items noticed during the preceding day. At the same time the childis kept constantly under the eye of his examiner in the laboratory through repeated examinations, interviews, and observation at parties, Sunday School and play. The comparison of successive examinations strengthens the reliability of the diagnosis and renders possible a finer differentiation of degrees and values of intelligence. During the repeated observations in the laboratory we make adefinite attempt to have the child tell us voluntarily his own story of how he happened to get into Court and thus to be sent tous. Sometimes it takes the question, “Well, how did you happen to get sent here?”’, but rarely more than that, to get the child’s side. This we take without offering corrections and without any more questions than those necessary for the development of a coherent tale. At a later interview the child is asked to harmonize any discrepancies between the tale he told and the history as reported by the Court. This gives a very definite opportunity for the beginning of moral re-education if the child has not previously told the truth. We then begin the development of an impersonal and critical attitude toward the child’s own behavior and try to have him analyze out the reasons for his behavingso. When possible we attempt to lead through this to the voluntary resolve to begin over and behave better than ever before. Of course comparatively little can be done with those children who are definitely feeble-minded and not high-grade but even these are made to contribute their share towards the development of attitude in the others. We explain that a boy who is bad and does not try to be betterand make a better record must be either feeble-minded or insane and so he cannot help it. Therefore if one of our boys misbehaves continually we think he must be feeble-minded and consider putting him where he can be looked out for, like a little boy, for the rest of his life. The fact that every week or so a child is sent out to one of the big institutions acts as a deterrent to normal children who might indulge in various tricks of misbehavior were they not trying proudly to prove that they are “not feeble-minded”. There is no doubt but that the attitude once developed works. One of our large girlsran away. The next day one of the older boys was in the laboratory and asked me in the middle of his examination whether “June” was feeble- 37 minded or crazy. When Iasked him why he thought she was either, he said, “Well, she ran away and there must be something wrong with her or she wouldn’t spoil her record that way”. ; In the same way we try to explain to the boys and girls who are sent to the Industrial Schools that they will be able to become good men and women if they can be helped to keep from their habits of bad behavior and that we are sending them to the Industrial School for training and help. No child is ever sent to any institution without being told where he is going and why. Any one who has lived in a big institution has seen numerous cases who have been sent there with lies as to where they were going and why. When one is trying to handle delinquents and has developed in them the idea that they must learn to behave better and be taken care of until they have learned this, it is more than foolish to break down any respect for, or faith in the person handling them through telling an untruth which they will soon discover. Such discovery can but undo any work which has been done towards a rehabilitation of behavior. We have also made an attempt to use our findings on the various children as a guide tothe work and privileges allowed them. From the: beginning the laboratory has picked the children for errand boys and for office boys, etc. So far we have not had a single runaway while a boy was going on an errand or working on privilege at any post. This is simply a minor bit of evidence but it does seem to point towards the fact that children are less apt to get into mischief if their minds are centered on something else, the center of attraction being chosen with an understanding of the individual’s limitations. 38 The diagnostic distribution of the 194 cases on whom we have for the time being completed our study is as follows: LEVEL FUNCTION Boys Grris TOTALS Feeble-Minded Normal 21 13 34 Feeble-Minded Psy. 19 6 25 Feeble-Minded Insane | : 3 a Feeble-Minded Psy., Epileptic | 1 1 Feeble-Minded Psy., deteriorating pe 2 Feeble-Minded Psy., deteriorating Syphilitic 10 11 21 Potentially Feeble-Minded 1 1 Potentially Feeble-Minded Psy. 2 a 3 Deferred 4 1 5 Deferred Psy. 8 2 10 Deferred PSYe SV: 3 3 Borderline Psy. 2 2 Borderline Psy., Sy. 2 2 Inferior Psy. alg (i 18 Inferior PSY OY et 11 7 18 Inferior Psy., deteriorating 3 3 Inferior Psychosis | 1 1 Inferior normal Psychopathic 6 1 7 Inferior normal Psychopathic, deter. if 1 Inferior normal . Psychopathic, deter., Syphilitic 1 1 Inferior normal Psychosis 1 1 N at present 1 1 Normal Normal 5 3 Normal Psychopathic 10 9 19 Normal Psychopathic hysteria 3 3 Normal Deteriorating 1 1 Bright normal Psychopathic 2 2 Psychopathic 1 1 Insane 2 2 Total 126 68 194 _Feeble-Minded. If we group together the 34 children diagnosed as feeble-minded with those diagnosed as feeble-minded psycopaths, insane, deteriorating or syphilitic as well as feeble-minded, we have 86 children or forty-four percent of the Cottage cases on whom observation has been completed. These 86 cases do not form a homogenous group, however. They divide very definitely into two groups, those who were just “straight feeble-minded” and those who were more difficult from the standpoint of behavior, disposition and diagnosis. The 34 feeble-minded are an obvious group. They “looked” feeble- minded, they acted feeble-minded and they tested obviously feeble-minded even upon first testing. Their delinquencies are definitely a part of their inferiortiy and simply show inability to adapt normally to established conventions. Nineteen of the 34 tested below eight years mentally, being definitely imbecilic or even idiotic. Delinquencies in this group are chiefly a matter of wandering aimlessly on the street or of doing wrong when so directed by a normal, or at least a brighter, mind. Six of the remaining fifteen were older girls sent in because of immorality and the other cases easily resolve themselves into delinquencies due to lack of mentality, such as not working, growing up in idleness, etc. Several of the girls were accused of stealing but the offense in each case was typically that of a feeble-minded child. They stole any little thing they wanted or liked regardless of its actual value. Another older girl was accused of murder. 39 If she did kill the man it was largely a matter of instrumentality rather than deliberate planning and again the crisis came in a situation growing out of her sex interests. Another feeble-minded girl was much younger, the one sent into us as the “worst child in northeastern Ohio.” She gave many indications of seeming stubbornness and obstinacy while with us, but an experienced observer could at once see mental inability behind each non-adaptive response. She was over nine years old and yet she was so © stupid she could not get out of a revolving door in which she was caught but went trotting round and round until a worker rescued her. Of the higher grade feeble-minded boys, one was sent in for stealing because he always took any watch he saw, and yet he was so feeble-minded that when he was praised for scrubbing a floor in the cottage he wanted to keep on scrubbing all Saturday afternoon and all day Sunday! Another boy was sent in for persistent truancy. He had been in the Boys’ Industrial School four times and yet he persisted in the one act which showed the truthfulness to self of seemingly irrational tendencies—he ran away from -that thing with which he did not have mentality enough to cope, namely, academic training. As many as possible of these feeble-minded children have been sent to the Institution for the Feeble-Minded but the over-crowded condition and long waiting list have necessitated our finding a makeshift sort of care for over half of the group. The feeble-minded psychopaths present a different problem. Of this group of 25, only 5 have a mental age of less than 8, and only 3 more have a mental age of less than 9. The delinquencies of this group are much more marked. The lower grade children are reported as vicious, incorrigible, and unmanageable. Their delinquencies are more serious, even the lower grade children setting fires, etc. The higher grade cases have, in practically every case, multiple delinquencies. Most of them steal, lie and are truant or run away. The older girls number four, and three of these have been persistently immoral. Because of lack of proper facilities in institutions, two or three of these children have had to be returned to the community where they are being taken care of with great difficulty. The three boys who were diagnosed as feeble-minded and insane, that is suffering from a definite psychosis, have all been placed under strict supervision. Their mental ages are all low, but they differ definitely from the straight feeble-minded children of the same mental age in the seriousness of delinquency. Two of thethree are pyromaniacs, one having set $91,000 worth of fires. The feeble-minded epileptic boy showed the typical epileptic syndrome and was easily handled when one understood his condition. He was assigned to the State Hospital for Epileptics. 40 The feeble-minded psychopaths who gave indications of deterioration, which could not be classified etiologically, were both girls in their teens, testing 8 and 9 respectively and definitely in need of institutional care. The one in whom the feeble-mindedness was the predominant characteristic was sent to the Institution for the Feeble-Minded. The other, in whom the psychopathy and deterioration were most evident, was sent to the Columbus State Hospital for prolonged observation and from there was transferred to Gallipolis. The feeble-minded cases, showing psychopathy, probably due to their luetic condition, have been the most difficult group to handle from the standpoint of discipline and disposition. This group ranges in mental age from 6 to 10, most of the cases having a niental age of 8 or 9. The delinquencies for which they have been sent into the Bureau are usually multiple and in all instances fall under some of the following categories, stealing, lying, immorality or sex abnormality and running away. With the girls the sex tendency seems to develop before the stealing. Withthe boys stealing comes first and homo-sexual or perverted practice follows much later. Some of these children have been sent to the Institution for the Feeble-Minded, but most of them have had to be assigned to one of the industrial schools for treatment and discipline. Three of them have been psychopathic to the point of an actual psychosis and have been sent to one or another of the State Hospitals for the Insane. The term potentially feeble-minded is used to designate cases who do not show sufficient inferiority on the formal tests to be definitely classed as feeble-minded but who because of the quality of their responses and because of general inability to learn and adapt will undoubtedly prove feeble-minded later. The potentially feeble-minded psychopathic is unstable as well as inferior. These children lack the determiner for continued mental develop- ment. One little mulatto girl of eight who came to us has been diagnosed thus. No one could doubt her inferiority after living with her in our Cottage for a week.. She was reported as incorrigible, a persistent masturbator, andaliar. We found aninferior mind lying only when suggestive questions were asked, but undoubtedly a case for permanent custodial care. Because of the over-crowded condition of the Institution for the F eeble-Minded she had to be returned to the Court for local care. These children are all less than 10 years old chronologically and their mental ages are within a year of their chronological age. One, 8 years old, testing 7, was sent in with the statement that she was incorrigible, lies, fights and blames other chil- dren, masturbates and instructs them in sex play and is destructive with clothing. These children are undoubtedly in need of permanent institutional care. The diagnosis “deferred’’, is, each time it is used, an admission of the fact that we need a longer period of observation before a final diagnosis 41 can be made. Frequently this longer period must be a growth period of several years and during that period living conditions must be made as normal as possible for the child. None of these children are normal and yet none are so far from normal but that the removal of wrong environmental conditions or the supplying of right conditions may make for normality. We may hope to at least correct wrong traits sufficiently to bring the ~ ability to get along as one of the social group. A tentative diagnosis has been given in some cases showing the direction in which most of the evidence points at the present time altho this evidence is not sufficiently strong to warrant permanent disposition based upon it. Consequently the placing of these children is a temporary one and the most expedient is not always the ideal disposition. We need an institution for just such cases. At present one of these children is in the Institution for the Feeble-Minded. Five of them are in the Boys’ Industrial School and two in the Girls’ Industrial School. Three are being handled by the Ohio Board of State Charities. Several are in their own homes under constant visiting and supervision and several have been returned to local courts. These children test practically at age and range in actual age from 9to16 years. Some of them grade above actual level. Their delinquencies are probably not as marked as those of some of the other more readily diagnosed groups. Most of them are stubborn or incorrigible. About half of them steal, some of them are destructive and cruel, or run to extreme tantrum spells. Three of the group are syphilitic psychopaths, but we cannot tell what the future is going to bring for them. Most of them give marked indications of psychopathy although we defer the final diagnosis as to what they are going to be. All of this group would be called “true’’ delinquents by the average probation officer, yet there is none but has his mental peculiarity or abnormality which is at least correlative with delinquency if not actually causative. One of the smaller boys is normal in mentality and most lovable, yet he steals and runs away continually and nothing has proven a strong enough incentive to stop him. He rests now at the point from which emanate paths leading towards feeble-mindedness, normality, insanity and psychic-epilepsy. None of us dares say now which way he will go, but every effort is being made to do preventive work. The diagnosis “borderline” plus a statement of psychopathy is really simply another fashion of stating the fact that diagnosis is actually deferred and that only time will state what is going to happen. These borderline cases are high enough grade mentally for us to know now that they have eliminated themselves from the possibilities of potential feeble-mindedness. The group diagnosed as inferior psychopaths is one that includes children who are more delinquent than any of the groups we have mentioned except perhaps the syphilitic psychopathic feeble-minded. This group has more mentality on the average than the feeble-minded groups and the 42 mentality seems to be used merely as another asset in the encouragement of delinquency. Some of these children have had to be placed back in the community because there is absolutely no institution in the State which can handlethem. Two of the girls have been sent to one of the State Hospitals. Three other girls have been sent to the Industrial School and five of the boys were sent there in the hope that the discipline and regular living would minimize psychopathy and re-enforce that which was good in the child. The inferior psychopathic syphilitics have been even a more serious problem, for the providing of treatment complicates the whole matter. We have not had any case in which the home has been able to supervise anti- syphilitic treatment and handle the child properly. Nine of the eighteen cases have been experimentally placed and only one of them has been at all possible inthe community. As a result five of them are to-day in State Hospitals for the Insane, six are in the Industrial Schools, two are being handled under the local courts and one is at the State School for the Deaf, and two are being taken care of by the Board of State Charities. The inferior psychopaths of deteriorating type are all probably pre-dementia cases with sufficient mentality to get along in the community but with such disturbance of functional use of that mentality that the cases are practically imbeciles in the kind of supervision they need. All three of these cases show cycles of disturbance. The case diagnosed as inferior insane is simply a greater problem of the same type. It is interesting to note that this child who had reached a point of actual delusions of persecution, who attempted suicide, who stole, ran, swore, and had violent temper spells, and was yet most attractive, has improved 21 months in mental level during 9 months of institutional care and is now showing every indication of regression of mental disease. The placing of the boy has been most difficult and he has been, at different times during the past two years, in the Bureau, at home, in the State Hospital and is now in the Industrial School. All that has been said of the inferior group in its varying aspects may be said of the group of inferior normals, with this difference; the inferior normal is of sufficiently high level and positive characteristics that we can emphatically state that there is a normal amount of intelligence there even though it may not be functioning efficiently. Again this group is more delinquent than the more inferior group. The things stolen are more valuable, the stealing is more persistent and there is more definite planning of delinquency in most of thecases. The mental endowment is simply used to make delinquency more effective. Three of these cases are actually suffering from a psychosis while most of the others may prove to be dementia cases later on. The normal group with its variations has given us some of our most interesting problems. The cases have had more prolonged study because 43 there has been less obvious reasons for their aberrant conduct. The longer we study these cases the more significance we feel justified in attaching to the minor indications of mental disease or psychopathy, which evidence themselves during the study of thecase. In this group, consisting mostly of cases 13 years or more in age, there are hysteria cases which have been capable of modification through psycho-analysis, complex cases, resisting every attempt at analysis, regression cases, with all the peculiarity of infantile desires, and cases superior in function in many ways and yet decidedly unbalanced and many of them with shut-in personalities. Asa whole, this group needs prolonged observation in a State Hospital for psychopaths. The more we work with them, the more we feel definitely sure that their delinquency is the first behavior indication of a seriously disturbed nervous system, and we are getting every day more definite reasons for believing that most of these cases will help to fill our State Hospitals later on. Of course, they are individual but a generalized study of them reveals characteristics which are common to most all of them. It will take 5 years of following these cases to enable us to justify any prognosis, but the indications are that there is no such thing as delinquency save as an accidental result of low intelligence, wrong environment or as a sympton of mental disease. The few cases which we have studied who have proven psychopathic or psychopathic to the point of having actual psychosis simply corroborate this belief. Disposition and redisposition of these cases has been made as follows: Boys GIRLS TOTALS Paroled to parents 36 fe 43 Paroled to work 2 2 Returned to Courts 26 ri 33 Returned to Co. Children’s Homes 3 3 Assigned to I. F. M. 16 14 30 Assigned to Col. S. H. I. 17 11 28 Assigned to Cleve. S. H. I. 1 1 Assigned to Massillon S. Hosp. I. 1 1 Assigned to Gallipolis 1 1 Assigned to State Sch. for Deaf 1 1 2 Assigned or returned to O. B. S.C. 14 4 18 Assigned to private institution 1 1 Assigned to Boys’ Industrial School 32 32 Assigned to Girls’ Industrial School 26 26 On temporary parvle 1 1 Discharged to parent out of State 1 ¥ Totals 149 74 223 It may be worth while to make an analysis of two of the group of twenty-five children who have been returned to the Bureau after once being disposed of. The group is not one of feeble-minded children. 44 The diagnostic distribution is as follows: LEVEL FUNCTION Boys GIRLS TOTALS F. M. Insane 1 i P.FM. 1 1 Deferred 2 2 Deferred Psy. Z ye Borderline Psy., Sy. 1 1 Inferior Psy. 1 1 2 Inferior Psy., Sy. 2 1 3 Inferior Te 1 1 Inferior Psy. 2 2 N. - 1 1 N. Psy., 1 3 4 N. Psy. Hys. 1 2 3 Br. N. Psy. 1 1 Psy. 1 1 Totals 18 7 25 Their return is largely due to the fact that there are not sufficient places of the right sort in the State, to which such children may be sent. This necessitates unwise emergency paroling and substitution of the best institution available for the right institution. One child comes back at regular intervals for medical care. Five are persistent problems because of instability due to congenital syphilis, keeping us constantly working to provide some place where they can be treated. Six came in for new delinquencies because automatically released from industrial schools at the end of a year, still as unstable and irresponsible as ever. Eight have been sent now here, now there, in an effort to find a substitute for a hospital for psychopathic children who are too sane for our State Hospitals, too insane for other placing. Three must wait until they are ten years old to be given the disciplinary care they need, for the Industrial Schools will not take them before that age, and meanwhile they are forming most persistent habits of delinquency. One needs hospital care in a hospital for crippled children and one came in to be disciplined thoroughly for running away. Nota one is really making good on second placement, although some of them are being kept from new delinquencies by constant watchfulness. SECTION III. The third division of the work of the laboratory during the past two years has been research work. We have completed few problems but can definitely report a measurable amount of work in this line. In a sense, all of our work has been research work, and datas are accumulating which will allow us numerous specialized studies within the next year or two. The experimental attitude in all that is done was one of the principles assumed as fundamental for successful work in such a clinic, and it has justified its assumption. As a matter of fact no child is handled and no work is done on any individual with other than experimental attitude. The first result of such an attitude comes in the way the case itself is handled. If one is doing an experimental piece of work, one naturally 45 assumes time and leisure sufficient to study the case from all angles. There is, as a result of this feeling of sufficient time, a leisure, even in the stress of unusually heavy work, which makes for a much higher quality of work than could otherwise be obtained. We do not allow any child to be examined simply for the sake of examination, nor is there tolerated any preliminary assumption of the child’s defect or inability. This attitude permeates readily all work that is done in a clinic, and the busiest days are free from rush and worry, tense nerves and unnecessary fatigue, because the scientific attitude prevails. In beginning our work we did not decide a priori just what our clinic should be, the methods to be used or the technique to be approved. Instead regulations and customs and habits of work have been evolved as the work itself demanded with a consequence that our laboratory may be said to have a personality of its own. The final aim of the laboratory as a whole is the most efficient meeting and supplying of demands made by the public. The idea of service is emphasized throughout. Despite the immense amount of work necessary for the establishment of the laboratory, there are already several well developed problems which will soon present for publication some of our findings. A brief statement of these lines of work is permissible. As referred to before we are standardizing brief survey test. Theoretically, we assume that a survey test, to be highly efficient should be as short as possible, easily scored and readily applied and should not test an enormous number of factors but some one of the more general intelligence attributes. The Ohio Literacy Test is the result of our work so far. It gives an easy method of detecting the obviously unfit in any school room or school system regardless of one’s personal knowledge of the children. The test was modified from a discarded army test. An examiner can easily give 500 tests in a day and can score the results and have ready by the next afternoon a list of the obviously defective children in that system. At present we are working out percentiles and percentile reliability for children of each age and grade from 2nd grade through high school. We have also begun a definite correlation with mental age and function. The problem has involved some constructive work on the interpretation of percentiles themselves and is being handled by our class in pyscho-physics. A second line of research has led us into the field of tentative standardization of psychopathies. Anyone who has worked in a clinical laboratory realizes the significance and handicapping influence of the personal equation in clinical diagnosis. Perhaps in no part of the clinic is this felt more than in the subjective impressions and reports on the presence or absence of psychopathy in children and adults whose minds are not functioning normally, but who are by no means suffering from an active 46 psychosis. The only way of decreasing such personal variability is through the careful weighting of the factors which have been allowed expression through individual formulation. Nothing has made for better understanding of the various clinical workers by each other than this tentative standardization. In a general fashion we have taken certain variabilities and have formed with them a tentative scale of normal or abnormal function in fashion similar to that used by Binet in his early work. In tne same way our norms are progressively perfected. At present we believe it is possible to standardize the variabilities of function of that intelligence which an individual has just as definitely“as intelligence levels have been standardized. (See article—Journal of Delinquency, January, 1921). One of the methods which we have been applying generally in the detection of psychopathy is the Kent-Rosanoff association method. We have worked out a curve distribution of the individual’s responses, which is far simpler and far more grafic and more expeditious than our earlier methods of analyzing the association series. The differentia] usage of this method is not simple, for the results are inter-related with such factors as mental level, professional training, specialized interest, language handicap, Sex, age, race, etc. At present we are working out new norms onall data for variability of the normal group. The association test by itself is not pathognomonic, yet it is the most satisfactory and helpful of the individual tests which we use. A good bit of work has been done on the differentiation of the various psychopathies. There are so many and such conflicting views as to what psychopathy is that it may be well to state our concept of this problem briefly. Our argument is as follows: Army usage gave us the first generalized statement of the probable levels of the mass of humanity. The army tests found many who were below the 10 yéar level but who were seemingly normal and had been getting along in the community without supervision. On the other hand in the Institutions for the F eedle-Minded there are many who have alevel above 10 years and who have been proven incapable of directing their own affairs in society. Evidently then, the mental level in itself is not at all sufficient means for discriminating the fit from the unfit. There must be other factors which modify the conclusions gained by the use of mental age only. Recent studies point to the significance of mental disease or wrong mental functioning as a factor which may determine differences in people of the same mental level. Function may be wrong at any level. This means any mind may suffer from ill health or so-called mental disease. 47 ! Wrong function renders a person’s mind inferior to what we would expect it to be for his mental level, as we have ascertaned it. When function is disturbed we may expect possible inferiority of level and besides this we must expect that the individual will be different from other people at that same mental level. The person whose function is disturbed tothe point that it interferes with his conduct and social efficency may be called a psychopath. When psychopathy reaches such a point that the individual has ideas which prevent his keeping his place in the social group and when he needs restraint or systematic hospital care we call him insane. Not all psychopathies lead to insanity. Some disappear of their own accord. Some disappear under right treatment. Some are permanent. Some become insanities. There is aneurological basis for all disturbance of function. The neurological basis is increased or decreased activity of the neurones with consequent change in the way the group of neurones act together. In other words the neurone patterns are wrong and the units in the pattern are working wrongly. When a neurone is working properly we say it has normal irritability and when it functions wrongly it is either suffering from too great irritability or from too little irritability. Psychologically speaking, these changes in the child are changes in memory, and in ways of associating. As memory and association are the basis of higher thought processes, or so-called actual thinking, we find marked disturbances of thought in psychopaths. SUCH DISTURBANCES OF THOUGHT ARE PSYCHO- PALLY, There are undoubtedly different causes for psychopathy and at present we have been able to outline four various types of factors which may cause psychopathy, as we find it in cases referred to the Bureau. 1. Hereditary predisposition, which means the possible inheritance of an unstable organism from parents or grandparents with the possible taint of insanity or epilepsy or minor nervous disturbances. 2. The.toxic effect of various diseases which may be able to poison the system and so disturb the irritability of the neurones. We do not know all of the possible causes in this group, but among those that have been connected with psychopathy we find some kidney disturbances, diph- theria, goitre, teeth infections, infected tonsils, lack of balance of mineral salts, intestinal disturbances, and tuberculosis. 3. Effects of inherited diseases. The only one at present accounted for is syphilis. 4. Thepsychic shock of an extreme experience or a dreadful environment. This type is usually curable. 48 The most interesting thing which we have found is that the mental symptoms or intelligence symptoms of various types of psychopathies differ tremendously, and there seems to be some definite relation between the etiology of a psychopathy and the characteristics found in that individual by careful psychological examining. Most of our work to date has - been done on the psychopath who is a congenital syphilitic. Our data up to this time show that congenital syphilis is probably the cause of a definite mental and behavior syndrome. Indeed, this is so definite that in many cases later stages of behavior and of mental characteristics may be predicted simply because we know we have a syphilitic to work with. We have under process of analysis profiles for psychological characteristics of the syphilitic psychopath and, comparatively, of the other toxic psychopaths. Needless to say, there are years of work to be done before we can prove our present thesis that mental or so-called intelligence functioning is simply the finest expression of the organism as a physical and neurogical entity and that it must consequently give, if we study it correctly, indications of all bodily disturbances or diseases. SECTION IV. It may seem over emphatic to call propaganda and education of the public a definite line of work for a psychological laboratory, but our experience of these past two years has made us believe more and more definitely that the most important part of the work done in a laboratory of clinical diagnosis is not the handling of the cases themselves, but the handling of the normal persons in the community who must deal. with the abnormal cases brought to the clinic itself. The diagnosis of an idiot, an imbecile, an epileptic, a precocious norma] child, of a case of incipient or extreme mental disease is worthless unless it is possible to stimulate some normal person to the point of interest where he will utilize the information available because of the clinic examination. Many feeble-minded individuals can very well get along in the community when thosenormal peoplewho have to handle them have been educated to the point of supervising the individual] sufficiently and of not demanding too much from him. ‘The same is true of a case of mental disease. Even more emphatically is it necessary to stimulate and arouse the interests and intelligent cooperation of the nor- mal individual when there is necessity for active treatment such as that needed by all syphilitics. It does no good to examine a hundred children in a school system or to do 5000 survey tests in a city system unless some benefit is going to accrue to the children surveyed because of the utiliza- tion of the facts as found. The worse thing that can happen to a labora- tory is to have the public get the idea that all the laboratory does is diag- nose children as feeble-minded. The best thing that can happen to a laboratory is to have the individual members of the public feel that itis a 49 place to which they can bring problems for help and possibly for solution and at least for intelligent and sympathetic discussion. Because of our belief of this function of the laboratory and clinic, we try to make each case a reason for the education or instruction of all people concerned in that case. This means numerous interviews, long telephone calls, many letters and repeated handling of the same problems. Our justification for such a procedure in the’ Bureau lies in the fact that the demand for our help is constantly greater than our ability to supply it. This demand has come without any advertising or propaganda other than this mouth-to-mouth appeal. A real test of the valuation set upon our work was incidentally incurred when our laboratory was moved from the center of the town to the outskirts.: Fo: the best of our ability we have not been able to discover any diminution of work orany lessening of clinic appointments or of visits and consultations because of extra three quarters of an hour’s ride necessary to reach. us. ‘Whether we are able to help an individual or not our attitude wilt continue to ‘he willingness to try and help those who wish our work, leisurely discussion and explanation of results obtained, willingness to be called on at any time for further help, frankness in stating when we do not know, or cannot help the case, and a real interest in every problem child brought to us. 50 ‘ ed DS ; 5 ae | = = ; 1a = os a me ae || J a nN WAY | iN Ml HHI i ; | | \M | } | I l\ I\ ] || YHONHN ANAL WH i M(H NK | ih II i Wil | NI Hi WU NIN NI WM Mil \iN | | | || WAT NH | y Wh i} Ml Hl} | AANA Hi Ml |