The mental growth of the pre-school child; a psychological outline of normal development from birth to the sixth year, including a system of developmental diagnosis

Front matter

THE LIBRARY i mt —

THE MENTAL GROWTH OF THE PRE-SCHOOL, CHILD

THE MACMILLAN CO. OF CANADA, Lt.

Preface

The scope of this volume is indicated by the subtitle. The basic data furnish an outline of the psychology of infancy, by bringing into systematic view cross-section behavior pictures of the ascending stages of development. The emphasis throughout is on the normal aspects of behavior. The application of norms of development to problems of developmental diagnosis and supervision is treated in the concluding sections.

The investigation on which this book is based was begun some six years ago and has put the writer under an increasing sense of indebtedness to many persons who have lent their assistance. The study is one which has required a considerable degree of codperation. We have been particularly fortunate in the amount and kind of codperation which we have received from numerous mothers—to say nothing of the several hundred children, whose contribution we hope is not altogether lost in the pages of this book.

The nurses of the Visiting Nurse Association of New Haven have been very helpful. We are also indebted, for various services, to the physicians of the or division of the New Haven Dispensary.

I wish particularly to mention my obligation to the graduate students and clinical assistants of the Yale Psycho-Clinic who were most closely identified with the investigation. Mrs. Margaret Cobb Rogers served as clinical and research assistant from 1919 to 1921 and did much of the work involved in gathering and organizing the data relating to the age groups from 6 months to 18 months. Her successor, Miss Elizabeth E. Lord, has rendered equally unstinted assistance and made a thorough study of our four-year-old group of children. Mr. Leonard Muntz, Miss Sara M. Holbrook, and Miss Isabel Kearny wrote their essays for the degree of Master

Vv vil PREFACE of Arts at the Yale Graduate School in the field of pre-school psychology. Mr. Muntz made a study of “Individual Differences among Two-Year-Old Children”’; Miss Holbrook made ‘“‘A Psychological Study of a Group of Three-Year-Old Children”; and Miss Kearny wrote on “The Mental and Educational Status of a Group of Kindergarten Children.”’ These studies, which were made under the direction of our clinic, have been consulted in the preparation of our data. Miss Elizabeth Lord and Miss Ruth Washburn, who has more recently become an assistant in the clinic, have both participated in the practical testing out of our diagnostic procedures on the problem and research cases which have come to the clinic. During the past year over one third of these clinical cases were of pre-school age.

The main body of this volume is devoted to a descriptive and normative treatment of data derived from a first-hand study of normal children. This part of the study has been supplied with illustrations and is so concrete that it may, perhaps, be of interest to the general reader, as well as to the parent or to the special worker who is directly concerned with the mental health and development of early childhood.

Much of the investigation described in the text was conducted incidentally to the regular activities of the Yale Psycho-Clinic. There have been some compensations in this, because our methods have been constantly put to the test of practical clinical application. They have had sufficient trial in actual clinical experience to warrant the belief that they will be useful to others.

The applied phases of the volume, we trust, will be serviceable to pediatricians, general medical practitioners, and mental examiners who are called upon to make responsible estimates of the developmental status of young children. The diagnostic norms and procedures have been presented in such a manner that they can scarcely be misapplied. The text lays ample emphasis upon the importance of trained observation and of clinical judgment.

PREFACE Vil

The subject of Chapter 2, “The Significance of Pre-School Development,” has been treated at greater length in the author’s previous volume on “The Pre-School Child: from the Standpoint of Public Hygiene and Education.’”’ A portion of Chapter 27 was printed in The Scientific Monthly of April and May, 1922. Otherwise the subject matter of the present volume has not been hitherto published.

Current tendencies in child hygiene and education are bringing the pre-school years into a new perspective. There are scientific as well as practical reasons for giving special consideration to this foundational period of childhood. Our aim in the present volume is to give a systematic view of the entire pre-school period of development. We are conscious of the preliminary character and of the limitations of our data; but we probably have not over-emphasized the basic importance of the pre-school years of development. ARNOLD GESELL

YALE UNIVERSITY New Haven, Connecticut, —

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I www lk a ee ee et ee UV PART ONE—INTRODUCTION

CHAPTER 1—Introductory Summary . cag ae 3 2—The Significance of Pre- School DEveloprieat at: 9

4—The Scientific Study of Development . . . . 24

PART TWO—NORMS OF DEVELOPMENT CHAPTER 5—A Normative Investigation of Pre-School Development. 7 - 3 So ae o—Psychological Maer drat Aenaeatus ee ee 7 yllabus of Neommativewtems . .... . @& 8—Norms of Motor Development . . .. . ._ 68 9—Norms of Language Development .~ . . . . 89 10—Norms of Adaptive Behavior.. . . .-. . . 100 11—Norms of Personal-Social Behavior... . . . 135 12—Action Photographs . . . . ee 1S PART THREE—COMPARATIVE STUDIES OF DEVELOPMENT Ree ne Mocs (5 ee we ee BT 144—The Neonate . . ge ete a te 15—An Outline of Pre- School Serclonuicnt Aer Sone, Ipaelee 16—Comparative Cross Sections of Development . . 231 17—Four Months versus Six Months . . . . . 236 =—18—Six Months versus Nine Months* . .. . . 24! 19—Nine Months versus Twelve Months . . . . 246 20—Twelve Months versus Eighteen Months . . . 251 21—Eighteen Months versus Two Years. . . . . 256 22—Two Years versus Three Years . . . . . . 262 Zoe ree Yeats versus Four Yeats. . . . .«. +. 267 24—Four Years versus Five Years . . ea Bio 25—The Comparative Aspect of evelopment. 281 26—Research Applications of the Comparative Method 289 27—Developmental Correspondence in Twins . . . 299 zo—-rrecocity and Silperiornity <<... .+. . . 319

Z¥—Retardation and Inferiority. .. .. . . 330

PART

Table Of Contents

FOUR—DEVELOPMENTAL DIAGNOSIS AND SUPERVISION

30—Normative and Clinical Psychology

35—Personality Record and the Parental Interview .

36—Clinical Phases of Child Adoption 37—Developmental Supervision . j 38—Developmental Diagnosis and Medicum

Part One Introduction

HAPTER 1—Introductory Summary 2—The Significance of Pre-School Development 3—Development and Duration 4—The Scientific Study of Development

CHAPTER 1

INTRODUCTORY SUMMARY

The mental development of the pre-school child, when treated in an objective manner, becomes a subject with both familiar and scientific aspects. Our task is to bring the familiar and the scientific into closer relation.

We have attempted a systematic survey of the ordinary and normal behavior of infancy and early childhood. In making this survey it has been our purpose to formulate the findings with sufficient concreteness to make them suitable for at least partial application. The characteristics of infancy are so changing and so fugitive that orderly information becomes a practical necessity. 3

The plan of this book is evident from the section headings of the table of contents. There are four parts. Parts I, II, and III are mainly descriptive and interpretative. They lie in the general field of genetic and comparative psychology. Part IV deals with practical applications in developmental diagnosis and supervision. The bulk of the text deals in one form or other with the norms and evidences of mental development.

Since this book considers the principles as well as the problems of developmental diagnosis, with special reference to the pre-school period of childhood, our discussion has required a rather formidable array of chapters. A summary glance at the whole field covered, it is hoped, will assist the reader to understand the arrangement and relations of these chapters.

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For perspective we must grant, at the outset, that the pre-school period exceeds all other epochs in developmental importance. This period occupies approximately the first seventy months of the scriptural allotment of seventy years—only one clock hour, reckoning the entire span of human life as a day. But during that hour the major portion of the total stream of development flows under the bridge. This statement holds true even if, with Huxley, we make life and development coextensive terms. In a biological sense, at least, the first period of development must outrank all others in the wealth of phenomena displayed. |

This basic biological fact is a reason why any systematic treatment of the first five or six years of life must present a far-flung | outline. Chapters multiply because the range of development is so extensive. Even with simplification we must recognize in the first _ year of life at least three developmental intervals and devote atten- | tion to the stages of maturity presented at four months, six months, - and nine months. Including the neonatal period, this volume gives - separate consideration to ten successive stages of development.

The criterion used in selecting these stages, and the general developmental significance of the whole pre-school sequence, are discussed in the chapter on Development and Duration (Chapter 3). An attempt is made, in this chapter, to give some expression to the relative dynamic value which the first sexennium appears to have when compared with other periods of equal length. The argument has bearing on the clinical importance of the pre-school phase of development.

Another introductory chapter:(Chapter 2) deals with the social significance of the pre-school period. Recent public health, educational, and sociological developments are pointed out to show that this field is assuming a new importance from the standpoint of public welfare. If society is gradually extending its supervisory solicitude to cover the developmental welfare of children of pre-school age, increasing diagnostic demands will be made upon physicians.

INTRODUCTORY SUMMARY 5

Children of school age have in general received a larger measure of legislative and social protection than pre-school children. The scientific development of general and applied child psychology has shown a similar emphasis on the school age. The methods of investigation which have been used in the study of infancy and early childhood are treated historically, but sketchily, in Chapter 4.

The main purpose of the present volume is to report the normative data gathered in the investigation related in Chapters 5 and 6. This study was begun in a restricted way in 1919, but soon came to embrace the ten age groups above referred to. Fifty normal (representative) children were examined at 4, 6, 9, 12, 18, 24, 36, 48, and 60 months of age. Over five hundred children (counting retests as new cases) were included in the investigation.

A psychological examination and an analytic survey of the child’s home behavior were made in each case. The results were codified into a set of “developmental schedules,” containing in all as many as 150 normative items. These items were assembled and classified in a syllabus, reproduced in Chapter 7. The reader is requested to regard this classification as one made chiefly for editorial and clinical convenience. No attempt was made by statistical methods to consolidate the items into a delimited and inflexible psychometric scale. Our purpose has been to devise an adjustable clinical instrument, suitable to the practical demands and difficulties peculiar to the examination of infants and children of tender age.

The procedure for the application of the various diagnostic items is described in Chapters 8-12, under the headings of Motor Development, Language Development, Adaptive Behavior, Personal- Social Behavior.

_ Inspite of the confessedly preliminary and approximate character of the normative data, we venture to call the combined schedules, ‘materials, and methods, a system of developmental diagnosis. ‘The procedure and devices as presented are the outgrowth of clinical experience with children of pre-school age, and have been tested out practically in the Yale Psycho-Clinic.

Chapter 12 assembles a large number of action photographs taken in the clinical laboratory by a Graflex, and some of them b a cinema camera. These pictures show our subjects in characteristic behavior situations, and are classified in such a way that they¥ may be put to normative and comparative uses. |

Part Three is entitled Comparative Studies of Development.§ This section is intended to furnish a concrete background for the} section on Clinical Methods and Applications. We wish to stress the importance of the comparative approach in both genetic and¥, clinical psychology. Chapters 13, 14, and 15 emphasize the con | tinuity of behavior development. Chapters 16-25 report the results of a comparative survey of nine developmental levels. Inj) this study we made observations of eight pairs of children, selected} to bring adjacent levels of development into immediate comparison . The comparisons provide a cumulative synopsis of pre-school de} velopment and also illustrate the application of various diagnosti¢ tests. |

The possibilities and the desirability of comparative research) are discussed in Chapter 26. Chapters 27, 28, and 29 contain comparative studies of developmental correspondence in twins, of | precocity, and of retardation. The chapter on Retardation and} Inferiority is supported with photographs and case studies, and is made as concrete as possible in order to illustrate the value o the comparative approach in clinical procedure. The significane of this approach is set forth in the chapter on Normative a Clinical Psychology (Chapter 30).

Part Four is mainly devoted to details of both general anc specific clinical procedure in the field of developmental diagnosis The use of the developmental schedules and normative summaries and the parental interview in this procedure, are indicated. Metk ods of recording and estimating personality traits are considered it

~ INTRODUCTORY SUMMARY 7

Chapter 35. The importance of supplementing objective measurements with clinical judgment is emphasized throughout. It should be repeated in this summary that our schedules and procedures for developmental diagnosis do not operate automatically. They are presented in such a way that they readily provide or permit approximate estimates of developmental status in terms of age level; they also facilitate concrete, descriptive, analytic records of development; but any responsible diagnosis should rest upon the trained judgment of the examiner.

The concluding chapters suggest the broader social applications of developmental diagnosis. Child guidance, child placement, and child adoption all call for certain clinical safeguards and diagnostic ‘technique. Child adoption presents peculiar problems, which are discussed in Chapter 36.

The applications of developmental diagnosis are not, however, limited to special social situations like child placement, or to abnormal and subnormal children. Developmental hygiene always is a relative concept. Norms and standards of development concern children of every age, condition, or status. The chapter on Developmental Supervision (Chapter 37) considers the feasibility of gradually extending a consecutive, supervising type of developmental diagnosis to normal children of pre-school age. The current tendency of the mental hygiene and child health movements and even the present organization of child health work make such a policy of Developmental Supervision far from visionary.

If the field of developmental diagnosis is to undergo considerable scientific and professional cultivation, it will inevitably take a larger place in medical training and practice. This subject is briefly ‘considered in the final chapter.

Applied psychology is destined to extend its activities more and more into the domain of infancy; but artificial distinctions between mind and body will probably diminish with time; and the concept of development which unifies both will gradually be adopted. Development thus construed retains its place as a fundamental subject of medical science and becomes a basic discipline of Pediatrics, as well as of Psychology.

The interpretation of “the mind” in terms of behavior will inevitably bring the psychology of infancy into closer relations with neurology, physiology, and medicine. In the present volume we conceive behavior as the functional index of developmental maturity. A man may be as old as his arteries, but an infant is as old as his behavior. In the very nature of things an infant can do neither more nor less than the maturation and organization of his behavior patterns permit. An interpretation of developmental status in relation to chronological age and personal-social environment is the diagnostic basis for safeguarding the mental welfare of the pre-school child. Developmental diagnosis is essential to the -mental hygiene of infancy.

Chapter 2 The Significance Of Pre-school Development

Development is always dynamic and never discontinuous. It is, therefore, impossible to separate one period of development sharply and completely from any other period of development. The foetal period is continuous with the neonatal, the neonatal with the pre-school, and this in turn with the school period, pubescence, adolescence, and adulthood. Indeed the biologist goes still further. He does not even separate senescence from immaturity. Some of the most penetrating studies of growth and development have emphasized the fact that senescence and rejuvenescence are relative terms and that both processes may go on at the same time in one individual. As Child puts it, ‘‘The age changes in the organism are merely one aspect of Werden und Vergehen. The coming and passing away which make up the history of the universe.”’

Even though development be recognized as a “physiologically continuous process,’’ there are none the less biological and practical considerations which make the pre-school period of human development one of distinctive importance. The total period of maturation may be regarded as extending from birth to the middle twenties. This span may be further subdivided into four periods of approximately six years each. The first permanent molar divides the first two sexennia; the second molars come at the teens or at the beginning of the third sexennium. The wisdom teeth linger until about the age of twenty-four.

Now 'the front line of developmental advance is not a straight one and there is, of course, no localized point of time or space where maturity abruptly begins. Organs and systems do not develop at a uniform rate. It has even been suggested that sixteen years ordinarily marks the end of the period of intelligence development. ‘The pre-school period of development, however, holds an unambiguous and undisputed preéminence in the dynamic series. J/ comes first. This priority confers upon it a dominating influence. It is the most consequential period of development for the simple but decisive reason that it does come first. Science has confirmed the judgment of common sense in this matter. The earliest periods of development are always the periods of most rapid, most intense, and most fundamental growth.

The basic lines of both physical and mental organization are laid down during the formative pre-school years. How could it be otherwise? When a shipbuilder builds a ship, he lays down the timber first, the trimming and rigging come second—often after launching. What counts first, last, and most in the ship are her planking, her beam, her keel. How she will mind the rudder, how she will take the waves, and how she will weather the sea are fundamentally influenced by what happened when she was on the stocks. -

In a more profound way still, the pre-school years are fundamental to all the development that follows. This is when the individual is on the stocks. It is, therefore, not surprising to find that a general © survey of the pre-school epoch of childhood proves that this period has a peculiar significance both from scientific and from practical points of view. We may briefly indicate the practical considerations from the medical, from the mental hygiene, and from the administrative standpoints.*

Medical Significance. One third of all the deaths of the nation occur below six years. There are ten times as many deaths during the half decade of pre-school life as during the following full decade of school life. Even physical accidents like being scalded, burned, injured, and run over by automobiles, bear with special weight on the pre-school age. The susceptibility to infection is generally

*For extended discussion on this subject see the author’s volume on “The Pre- School Child: From the Standpoint of Public Hygiene and Education.” Houghton Mifflin Company, Boston, 1923.

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SIGNIFICANCE OF PRE-SCHOOL DEVELOPMENT 11 greater, the younger the child. Over eighty per cent of all cases of diphtheria and of all deaths from diphtheria occur below the age of five. Malnutrition, likewise, is more prevalent among pre-school than among school children. Rickets, a disorder of nutrition, is almost as common as dental caries and is essentially a pre-school disease. Approximately fifteen per cent of 3,000 pre-school children clinically examined in Gary, Indiana, showed bony effects of rachitic origin. With few exceptions the typical physical defects of school children, like malnutrition and nose and throat conditions, are more prevalent among pre-school children.

This disproportion of mortality and morbidity in the pre-school period is not a result of chance. The concentration of development in this period carries with it an increase of developmental hazards and this increase of hazards carries in its train death, disability, and distortion and makes the period as a whole a relatively critical one in the physical development of the child.

Mental Hygiene Significance. What is true of general physical development is true of mental and nervous development. The brain grows at a tremendous rate during the pre-school age, reaching almost its mature bulk before the age of six. The human cerebral cortex, according to Donaldson, attains it full thickness at about fifteen months of age and he remarks: “‘All this shows that the important events in the postnatal growth of the nervous system occur early in life, and this in turn emphasizes the paramount importance of favorable conditions during the first three years of childhood.”’ | |

The mind develops with corresponding velocity. The infant learns to see, to hear, handle, walk, comprehend, and talk. He acquires an uncountable number of habits fundamental to the complex art of living. Never again will his mind, his character, his spirit advance as rapidly as in this formative pre-school period of growth. Never again will we have an equal chance to lay the foundations of mental health. From the standpoint of mental hygiene the pre-school period, therefore, appears to have no less significance than it has for physical vigor and survival.

Normal mental growth is not a matter of complete predestination, even in infants. Defects, handicaps, deviations, many of them preventable, occur. Practically every case of mental deficiency is present and recognizable during the pre-school years. Three fourths of all the deaf, a considerable proportion of all the blind, one third of all the crippled, and over three fourths of all the speech defective come to their handicap during the pre-school period. Numerous cases of mental abnormality, of perversion, of faulty habit formation, and of conduct disorder have their roots in the pre-school years. Our kindergartens and nurseries must reckon with many problem children, manifesting serious errors or defects in behavior development. One fourth of all our school beginners fail of promotion at the end of the first year in public school. Retardation, abnormal prematuration, normal precocity, superiority, and normality all tend to reveal themselves well before the child cuts his sixth-year molar.

Social and Administrative Significance. For all the reasons suggested above our practical outlook upon the pre-school period is undergoing rapid and significant changes. These changes have already begun to crystallize themselves into new social legislation — and new public and semi-public provisions for children of pre-school age. The World War has stimulated these changes and the whole field is now in an extraordinary state of ferment and formativeness.

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The social status of the pre-school child is undergoing nothing © less than a revolutionary change comparable to that which in an earlier generation altered the status of the school child and the youthful wage earner.

The Fisher Education Act, passed by the English Parliament in 1918, contains this significant passage:

“The powers of Local Education authorities . . . . shall include power to make arrangements for supplying or aiding the supply of nursery schools

SIGNIFICANCE OF PRE-SCHOOL DEVELOPMENT 13

(which expression shall include nursery classes) for children over two and under five years of age, or such later age as may be approved by the Board of Education, whose attendance at such a school is necessary or desirable for their healthy physical and mental development . . . ”

Partly under the stimulus of this law, nursery schools have multiplied in England. They are also being established in this country. The nursery school, however, is still in the experimental and demonstration stage of its development. It does not have the established place in our traditions and public school administration which the kindergarten holds.

The kindergarten is in a sense the most official agency of pre-school child welfare which we possess. The first kindergarten was established in this country in 1855 and has had such a notable development that one child out of ten children of kindergarten age is now reached by this important institution. With the cumulative emphasis which will be placed upon systematic parental guidance -and upon the educational welfare of pre-school children, the kinder- -garten because of its strategic position is destined to wield increasing influence. ae

The Federal Children’s Bureau since its establishment in 1912 has emphasized constantly the importance of hygienic and welfare measures relating to the pre-school period. The Sheppard-Towner Act of 1921, for the promotion of the welfare and hygiene of maternity and infancy, has crystallized some of its recommendations. The Smith-Hughes Act recently has provided grants of federal aid for vocational training in Home Economics, including training for parenthood. Within the last decade practically every state in the Union has established a separate department of child hygiene, New York leading in 1914. These departments, as well as the large voluntary national organizations like the American Child Health Association, have systematically emphasized the importance of continuous protection of the developmental welfare of pre-school children,

In 1892 the first Infant Welfare Center recorded in history was established in Paris by Dr. Budin. This simple social invention proved to be one of basic importance and has been adopted in ~ every civilized country in the world. Infant welfare and child health centers are multiplying at a rapid rate. Such devices promise in time to be almost as pervading and far reaching as present provisions for public elementary education.

Even a sketchy summary is sufficient to convince one that the hygiene of the pre-school child is gradually coming under systematic social control. How this control is to be worked out administratively is a question which does not concern us in this chapter. It is evident, however, that our administrative procedure can be sound only if it is based upon more adequate knowledge of the pre-school period of child life.

Chapter 3 Development And Duration

This chapter deals to some extent with theoretical questions relating to the measurement of development. The discussion is, however, inserted here because of its practical bearing on the preceding chapter. The dominating developmental significance of the pre-school period is due to certain interesting relations between development and duration.

Development is conditioned in a basic and almost curious manner by the factor of time. Only in mythology does a fully formed, fully fledged creature spring from the forehead of a god. In nature time is necessary for the production of an organism. Little as we know about the phenomena of development, it appears that the relation between time units, developmental life cycles, and periodicities is of a lawful character.

The difference in longevity between various species bears some lawful relation to biochemical laws which themselves were probably established through evolutionary processes. Abderhalden compiled a table in which he arranged the following species in order: man, horse, cow, goat, pig, sheep, cat, dog, rabbit. In another column he arranged the number of days required for each species of animal indicated to double its weight after birth. The figures range in descending order from 180 in man to 7 in the rabbit and these diminishing differences were in turn correlated with differences in the constitution of the mother’s milk. The rabbit’s milk contained a protein percentage of 10.4, the human a percentage of 1.6. The evolutionary prolongation of infancy likewise denotes an important correlation between the’ time factor and developmental mechanics.

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There are very fundamental interdependencies between development and duration which further investigation will clarify. Observable differences between individuals of the same race, between different races, and between normal and abnormal individuals have indicated the existence of important developmental laws.

The chief reason why it has been impossible thus far to formulate these laws with precision lies in the fact that we really have no absolute units for the measurement of development. Development is such a complicated and dynamically conditioned phenomenon that it does not lend itself to any simple forms of linear measurement. The growth of an organism, to be sure, expresses itself in an increase of length or height and an augmentation of bulk. Such increases can be measured by absolute units and comparative interpretation of growth curves has, therefore, given us some clue as to the rate of growth. Very suggestive biological interpretations of these studies of growth have been made by various biologists, notably by Charles S. Minot.

Minot emphasizes particularly the marked decline in the growth power which takes place in the earliest periods of development. Assuming the germ to weigh .0006 gramme and the child at birth 3200 grammes, he calculates that the percentage of increment is 5,400,000. Assuming the weight of a man of twenty years to be 130 pounds, the increase after birth would be as 1 is to 16. Even in the first year of life the swift decline in the rate of growth asserts itself. In the neonatal month the percentage increment is 23 per cent; in the twelfth month it has fallen to 2.8 per cent. On the basis of this and other evidence Minot formulates two laws of age as follows: (a) The rate of growth depends on the degree of senescence. (b) Senescence is at its maximum in the very young stages and the rate of senescence diminishes with age.