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No Dearly Defined Neurological Abnormalities

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No Dearly Defined Neurological Abnormalities I DOCUMENT RESUME ED 022 269 EC 001 078 By-Lambert, Nadine; Grossman, Herbert PROBLEMS IN DETERMINING THE ETIOLOGY OF LEARNING AM) BEHAVIOR HANDICAPS;REPORT OF A STUDY. California State Dept. of Education, Sacramento. Pub Date 64 Note-162p. EDRS Price l4-S0.75 HC-S6.56 1 Descriptors- ACHIEVEMENT GAMS, BEHAVIOR PROBLEMS, CLINICAL DIAGNOSIS,EDUCATIONAL DIAGNOSIS, *EDUCATIONAL NEEDS, *EMOTIONALLY DISTURBED, ETIOLOGY, *EXCEPTIONAL CHILDRESEARCH, GROUP ACTIVITIES, GROW COUNSELING, *IDENTIFICATION, *LEARNING DISABILITIES, MEDICALEVALUATION, NEUROLOGICALLY HANDICAPPED, PSYCHOLOGICAL EVALUATION, PSYCHOLOGICALTESTS, SPECIAL CLASSES, SPECIAL PROGRAMS Iduntifiers-Bender Visual Motor Gestalt Tests, Draw A Person Test Medical factors were assessed in 20 children (grades 1 to 10) withbehavior and learning problems, and an educational program was subsequentlyoffered. AN 20 had their case histories taken, were given pediatric and openelectroencephalograph examinations, and were evaluated by psychological tests.One team of physicians found no dearly defined neurologicalabnormalities; another team rated 10 of -the 20 records as evidencing neurological impairment. Two pairs ofpsychologists also differed in their diagnoses. The ratings of the medical and psychologicaldiagnoses were found to differsignificantly (p=.01). The educational program included the folowing: a special class, with individualized instruction for eight to 12 children,taught by a regular teacher assisted by a mental health specialist and theschool guidance and curriculum staff; a learning disabilities group, providing a specialist's instructionin remedial work for two to eight children; an activity group, structured as a clubwith craft and play sessions, conducted after school for six to eight children;and group counseling for the junior and senior high school students in groups of 10.Reading and achievement scores taken over a 2-year period indicated an average gainfor the group as a whole exceeding what would beexpected from pupils in regular classes. (JW) PROBLEMS IN DETERMINING THE ETIOLOGY OF LEARNING AND BEHAVIOR HANDICAPS REPORT OF A STUDY CALIFORNIA STATE DEPARTMENT OF EDUCATION MAX RAFFERTY, Superintendent of Public Instruction *SACRAMENTO, 1964 - '" Se"), U.S. DEPARTMENT OF HEALTH, EDUCATION & WELFARE OFFICE Of EDUCATION THIS DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED FROM THE PERSON OR ORGANIZATION ORIGINATING IT.POINTS OF VIEW OR OPINIONS STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDUCATION POSITION OR POLICY. PROBLEMS IN DETERMINING THE ETIOLOGY OF LEARNING AND BEHAVIOR HANDICAPS REPORT OF A STUDY PREPARED BY NADINE LAMBERT Research Consultant Bureau of Special Education California State Department of Education HERBERT GROSSMAN, M. D. Departments of Medicine (Neurology) and Pediatrics School of Medicine University of California, Los Angeles FOREWORD California schools are highly successful in providing equal educational op- portunities for all.And although they are not totally successful in making it possible for all to profit fully from these opportunities, they spare no effort in their endeavor to do so.They maintain regular education programs that are strong and that meet the needs of most pupils; extended and enriched programs, for the gifted; and special programs, for the mentally retarded, the physically handicapped, the cerebral palsied, and the culturally deprived. But these pro- visions are not adequate to meet the needs of every pupil who enrolls in the schools as evidenced by dropouts and by failures. The study, "Problems in Determining the Etiology of Learning and Behavior Handicaps, " was undertaken to determine how pupils who are unable to profit fully from their educational experiences because of emotional problems might be helped. The results of this study should be of special interest to school ad- ministrators and others who are concerned with the problems of the emotionally disturbed pupil, especially those who are seeking ways to eliminate the prob- lems or at least to hold the undesirable effects of these problems to a minimum. Superintendent of Public Instruction PREFACE California provides specialeducational help for a variety of handicapped pupils. At the present timethere are programs for severely andmoderately retarded pupils and for all typesof physically handicapped pupils.Children with learning and behaviorproblems who do not qualify for any ofthese types of programs but whose emotionaldifficulties handicap them from profitingfrom existing educational provisions face aschool life punctuated with difficultiesin learning, unsatisfactory peer andadult relationships, dropping out orexclusion from school, and eventual possiblecommitment. Increased public concern over thepublic and private costs of emotional and social breakdown places greateremphasis on the school as the institution responsible for early identification,help, and referral. In order for theschool to fulfill this role, theprocedure for early identification anddiagnosis of par- ticular learning or behavioraldifficulties is a first step in establishingeduca- tional programs to assist suchpupils with their problems.Effective identifi- cation procedures require that allthe factors that influence a child'sschool problems must be surveyed todetermine (1) the nature of the difficulty;(2) the specific role of the school in assistingthe child; and (3) evaluation of the edu- cational provisions which should bemade available.Medical, psychological, social, and educational areas comprisethe fields of investigation in a typical diagnosis of a child with school problems. This study is one of several conductedby the staff of the State Depart- ment of Education to evaluate thestatus of pupils identified asemotionally handicapped. The purpose of this report is toilluminate some of the problems inherent in making a medical diagnosisof related organic impairments in a sample of pupils identified as emotionallyhandicapped with severe learning and behavior problems in school. This project emphasizes the factthat there is no simple, clear-cut ex- planation of the causes of thecomplex problems which face pupils who areunable to profit from existingeducational provisions. In the etiologyof the learning and behavior problems of aparticular child, as great a varietyof pertinent in- formation as possible must becollected, and the data must be related to a planned educational program forthat child. So far, we cannot point to anyetio- logical pattern upon which a specificeducational program can be based. Diag- nostic labels, which explain anindividual pupil's problems withoutspecifying an educationalplan to meet the pupil's particularlearning needs, offer false security. We must continue tofind ways to assist the pupil withproblems to be successful in school. FRANCIS W. DOYLE CHARLES W. WATSON Deputy Superintendent of Public Chief, Bureau of Instruction; and Chief, Division Special Education of Special Schools and Services ACKNOWLEDGMENT not have beenprepared without the generousparti- This publication could and psycho- cipation of personnelfrom several schooldistricts, physicians, individuals were involvedin the project; logists.Specifically, the following research. They the positions listed arethose which they heldat the time of the willingness to contributetime to a projectwhich are to becommended for their of learning aimed to clarify someof the problems indetermining the etiology and behavior handicapsin children. William J. Brodsly,Director of SpecialServices, EnterpriseCity Elementary SchoolDistrict, Los AngelesCounty Los Angeles, Herbert Grossman,M.D.,University of California, School of Medicine of Los Angeles John W. Howe,Consultant, Researchand Guidance, Office County Superintendentof Schools Mrs. Berdine J. Jones,Consultant, Researchand Guidance,Office of Los Angeles CountySuperintendent of Schools Carol P. Lundberg,Psychologist, EnterpriseCity ElementarySchool District, Los AngelesCounty Robert H. Oyler,Psychologist, ClaremontUnified School District Bruce H. Peppin, Director,Guidance and SpecialEducation, AlhambraCity Elementary and CityHigh School District Jack Rouman, Director,Guidance, MontebelloUnified School District California Sch9ol of Medicine Robert Sedgewick,M.D.,University of Southern Richard Walter, M. D.,University of California,Los Angeles, School of Medicine Kenneth Zike, M.D.,Harbor GeneralHospital, Torrance,California California Ir la Lee Zumnerman,Psychologist, privatepractice, Whittier, vi CONTENTS Page For eword iii Preface v Acknowledgment vi CHAPTER 1. Introduction 1 Background of the Project 3 Purpose of the Project 4 The Sample 5 Procedure 5 CHAPTER 2. Results of the Comparative Study of Two Diagnostic Teams Reviewing Records of Emotionally Handicapped Pupils 8 Results of the Medical Examinations and Comparison of the Medical Ratings 11 Summary of the Ratings of Personal History and History of the Problem 11 Summary of the Ratings of Family History 13 Results of the Pediatric Examination 16 Results of the Electroencephalographic Examination 16 Final Medical Diagnosis Based on Review of All Data 18 Results from the Review of Psychological Test Data 19 Summary of Ratings on the WISC 20 Summary of the Ratings on the Draw a Person (DAP) Test .. 23 Summary of Ratings on the Bender Visual Motor Gestalt Test 25 vii Summary of Comparative Judgments Madeby Physicians and Psychologists 26 Estimated Frequency of Neurologically Handicappedin a Sample of Emotionally Handicapped Pupils 27 CHAPTER 3. Comparison of Diagnoses of RandomSamples of Emotionally Handicapped
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