Excerpt from Admission and Discharge of Children: Monograph II; To Accompany Round Table Plan for Trustees of Institutions for Dependent Children

In order to decide just what treatment is needed by the child, it is necessary to make a diagnosis, and this diagnosis can only be made efficiently through a careful and intelligent case study. This case study must be made by a trained and competent observer with the assistance of experts in medicine and psychology. It will involve a study of the family history of the child, including grandparents, parents, brothers, and sisters, in order to determine the facts of heredity and of home and family influences affecting the child. It will involve also the environment, education, and training of the child himself.

Efficient case study requires a complete medical examination, quite as thorough as would be required for life insurance. It should include the condition of all of the organs and functions of the body including eyes, ears, nose, throat, skin, and teeth, and a complete record should be made of the results. For all children above the age of three years there should be a psychological examination by the use of the binet-simon tests for the purpose of ascertaining as nearly as possible the mental endowment of the child. These tests should be checked by the observations of superintendents, matrons, and teachers who may have had the child under extended supervision. In the case of older children it is desirable to use additional tests, which have been devised for the determination of border line cases.

Physicians and psychologists are learning to distinguish between those mental defects which are born with the child or are acquiredin early childhood and which constitute feeble-mindedness in some one of its grades, and those defects which result from neglect, cruelty, malnutrition, adenoids, imperfect hearing or vision, and which are presumably remediable by treatment. Psychological tests may reveal the existence of mental defects but do not determine their causes. While feeble-mindedness may be clearly and definitely recognized in the great majority of cases, there is a considerable number of cases in which the question can not be settled offhand but only after care ful and extended observation. Sometimes unpromising children make surprising development under favorable conditions. It is a great injustice to class a child as feeble-minded until all doubt as to his condition has been settled; on the other hand it is a great unkindness and a great extravagance as well to nag and worry a feeble - minded child in a fruitless efiort to develop in him mental faculties which he does not possess.

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