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Problems of the Deaf and Hard of Hearing Ad, actions of other sorts); and the decision between the two tech- niques of presentation probably available; namely, by film record, which at present appears to be the more accurate, and by living facial expression. 3. That there be developed a, method of measuring the intelli~- bility of speech. One technique would be the use of a scaled series of words, phrases and sentences, well below the child's grade of reading ability, to be spoken by the child to a group of trained observers, who should rate the intelligibility of the child's speech. Another technique would be the mechanical recording of similar samples of the child's speech to be re- produced later and rated by trained observers. Such methods as wax recording or film recording or any other devices which might be invented should be thoroughly investigated as to their practicability. V. PROBLEMS OF INFANCY AND EARLY CHILDHOOD The Committee would point out that the auditorily deficient child, from birth to seven years of age, is at the present time virtually a closed book. This dearth of knowledge available about auditorily deficient children in these early ages indicates a field of research which is almost new. With but few exceptions, existing schools for the deaf take chil- dren at the age of seven or eight. When we consider the stress now being placed upon the significance of the early years in general develop- ment, and the increasing recognition throughout the medical, psy- chological and educational fields of the importance of adequate handling of the child in these years, it seems astounding that there should be such a great gap in our knowledge. We know little about methods of testing hearing at the early ages, little of the retardation effect of audi- tory deficiency upon general development, and relatively little of the significance of one or two or three years of partial hearing at early ages with reference to the later general development of the individual. There are, however, some scientifically established facts which indicate the importance of the' early period in the lives of the auditorily deficient. In the first place, after the average " deaf " child has been in a school for the deaf for a period of six to eight years, he can read no better than the average seven or eight year old hearing child. In other words, it requires about eight to ten years of instruction in special schools to bring the " deaf " child to the level which the ordinary child reaches within one or two years of schooling. In view of the indications that there is greater plasticity in the earlier years, we may well ask whether

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~4 Problems of the Deaf and Hard: of Hearing the slow improvement of the deafened child taken into the schools at the age of seven or eight years. is not due, in large part, to the fact that he is taken so late in his period of development. A second significant and interesting fact is revealed by the comparison of blind children and " deaf " children of the same ages on mental tests. Blind children are relatively slightly retarded in comparison with " deaf " children. In other words, " deafness " appears to be many times as great a handicap with reference to development as is' blindness. Further, there is some indication that " deadness '' retards the development of all proc- esses. It would seem to be an easy task for a person with vision to reproduce digits from memory when. such digits are presented visually. This is, howler, a task which is practically impossible for the " deaf " child, not because of any defect in vision, but primarily because of the failure of the associated language processes which make such visual memory possible. A third interesting point which should be taken into account arises from a comparison of progress of deafened children through schools for the deaf in relation to the age at which hearing was lost. The rapidity of progress is related quite directly to the length of time they had hearing. Children who are born deaf are much more handicapped than children who have had hearing up to the age of three. Children who have been deafened at the age of three seem to be much moire handicapped than children who have been deafened at the age of six. Although this relationship hats not, perhaps, been analyzed as adequately as it might, nevertheless, it points to a most significant relationship between early auditory stimulation and general development. A. A NURSERY SCHOOL FOR DEAF CHILDREN The Conference recommends the establishment of a nursery school for deaf children, as the necessary basis for a systematic and comprehensive study of the problems of the early period of life. i. Location and type. The nursery school should be located in a city and provision should be made for the care of boarding pupils as well as of day pupils, in order that a sufficient number of young deaf children can be assured for purposes of study and training. In the absence of material with reference to the frequency of auditory deficiency in very young children, and on the basis of the best information available with reference to the frequency of the deficiency among older children., it seems necessary that a school, if established, be located where considerable numbers of children will be available.

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Problems of the Deaf and Hard of Hearing ~5 a. AfFlia.tions. The school or schools should be organized as an in- depend.ent administrative unit. The most preferable auspices under which such a project could be placed would be a large University with extensive research facilities and personnel. Cm operative relationships should be maintained with any or all of the following: established institutes of child welfare, research nursery school organizations, and schools for the deaf. Since the problem of auditory deficiency is a problem which is related to almost every feature of the physical and mental life of young children, it is necessary that the school be located in an institution which already has upon its staff capable investigators in the various fundamental sciences who can cooperate on the projects outlined. While it would be possible to develop a school with a primary staff consisting of capable individuals in various scientific fields, such a procedure would involve the ex- penditure of great sums of money. If, however, these specialists are already available on the staff of a large institution, their services can be utilized with a relatively small expenditure and much more effective scientific work done. Such a school would need the services of a pediatrician, a psychologist, an anatomist, a dentist, an otola.ryngolo~gist, a sociologist, and a biom.etrician, in addition to general medical, hospital and laboratory facilities. The character and quality of the research done in such an organization depends in large part upon the scientific qualifica- tions of these affiliated experts. If the funds are to be expended so as to result in the greatest accomplishment, extreme care must be exerted in locating the school, in order that there be available for the school the most capable individuals possible. There are already in existence institutes of child welfare which have on their staffs, or affiliated thereto, capable research men from many fields, and which have brought together experts in the care and training of young children. The Conference in- clines to the opinion that there does not exist at the present time a school for the deaf or an institution for the care of deaf children which has a scientific staff adequate to the problems which are projected in later sections of this report. It further feels that it would probably be better to approach the whole group of problems from a general scientific point of view rather than from the viewpoint of a specific training or treatment pro- gram. As the whole project is exploratory, it should be so planned as to secure the maximum scientific and practical returns.

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26 Problems of the Deaf and Hard of Hearing 3. Organization. The school should be under a director selected primarily on the basis of scientific capability and administrative experience; and in the development of the school, the director should be given a relatively free henry The (~nf~rPnrm ~xrm.~1lA _ _ ~,.~..~, me ~ YV V ~ suggest the desirability, in setting up the organization, of de- veloping an advisory committee to be composed of representa- tives of the various departments which are affiliated with the school, if it is organized in cooperation with a university. The advisory committee should consist of specialists in the various scientific fields. Its primary function would be conferring with the director on the organization and functions. of the general program. This advisory committee, if included in the original plan for such a school, would make it possible for the director to secure cooperation immediately from various scientific fields, and would also make it possible for him to educate a selected group of scientific men, in the particular university in which it was located, as to the possibility and desirability of experimenta- tion and study of problems of auditory deficiency. Number of pupils. In contemplating the organization of such a school, the Conference has in view a minimum of at least thirty pupils and as many more as possible. It does not seem advisable to organize or start such a school if less than thirty pupils are available. Fifty is a more desirable number than thirty, but thirty represents a sound minimum. Age limit. No lower age limit should be set, and the upper age limit should be set at approximately six years, depending upon the educational opportunities available for auditorily deficient children in the community in which the school is located. The school should be effectively a nursery school with the emphasis J upon young children. B. S CIENTIFIC PROBLEM S The Conference proposes the following list of scientific problems as indications of the scope of the work which could be undertaken in a properly organized nursery school. ~. 1 Some of these problems are of a fundamental character, others are of a practical nature. They range over a considerable number of scientific fields, and in most cases represent problems to which answers.cannot be given at the present time. :. ~4 study of the hereditary relations of auditory deficiency, lo be made in two directions. In the operation of a nursery school there would have accumulated a considerable amount of data -

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Problems of the Deaf and Hard of Hearing ~7 with reference to auditory deficiency among young children in the general population. It should be possible to organize this material so that information would be obtained as to the sources of deficiency, if particular care is taken to secure information upon the antecedents of all the children with whom the school comes in contact. Later, a more intensive study can be made by securing complete data on the family background and the history of every individual child in the school. Such an inten- sive history, in addition to throwing light upon the particular individual child, might also throw into relief general problems which could be attacked on a wider scale. Record forms and methods developed in the school might be widely adopted in schools for the deaf. 2. The dez~elotwlent of adequate tests of hearing for young children: a. b. Tests of hearing should be studied in detail over a period of time to determine their reliability, consistency and accuracy. We should know whether there are day to day variations in hearing deficiency, and in what respect fluctuations in the individual from day to day affect the accuracy of such measurement. A host of problems are prospective in this field. By the use of the conditioned reflex method. The use of this method (or modifications of it) has been introduced into animal psychological laboratories for tests of sensory discrimination in rats, dogs and other animals, and has im- pressed some investigators as promising. Investigation of its possibilities with auditorily deficient children might well be undertaken. One of the characteristics of the method as it is presently used is that it requires considerable time to set up proper conditioning and to make tests. It is possible that through experimentation there might be developed shorter methods of more general applicability. The development of tests zuhich could be used as a basis for a di/ferential diagnosis between feeble-mi,~dedness and auditory deficiency.- The young deaf child is frequently thought to be feeble-minded, and is, with respect to his functioning, actually feeble-minded. If devices can be developed which will dis- criminate between constitutional feeble-mindedness and auditory deficiency, it might be possible to develop an adequate training program for the young " deaf " child as distinct from the young

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28 Problems of the Deaf and Hard of Hearing feeble-minded child. Unquestionably the figures with reference to the occurrence of feeble-mindedness in young children are vitiated in part by the inclusion of many cases of young children who are auditorily deficient. It is possible that a method of dis- crimination might be worked out on the basis of the conditioned reflex technique since there is some indication that conditioning takes place in the normal child in 'quite a different fashion than it takes place in the feeble-minded child. 4. An extensive study of the p~ossibiEties and limita.tions of hearing aids for the yo?~n.g auditorily deficient child. Here is perhaps the outstanding field for investigation on the practical side. When one realizes the relationship that exists between the onset of auditory deficiency and the amount of progress the child makes in subsequent instruction in a deaf school, and the tremendous acquisition of the hearing child between the ages of two and five or six years with its correlated effects. upon the development of all mental processes, it seems highly important that every effort should be made to study the possibility of meeting the hearing deficiency in this early period with every mechanical aid possible. It is doubtful whether any indirect method of instruc- tion through visual, manual or factual aid can in any way take the place of or meet the deficiency which results from a loss of the most important sensory inlet. A half year of hearing at the age of four may perhaps be the equivalent with respect to general development of four or Fire years of expert instruction later on. Any device which may give young auditorily deficient children some auditory stimulation deserves to be investigated to the fullest extent. 5. Corl*pa~ratizJe studies by anatowlists and dentists of the dezrelop- ment of the swath, jaws, teeth and throat structures, together with the general f acial skeletal d ewelotw~ent of normal and auditorily deficient children.-Apparently, no such studies. have been undertaken. They would seem to be of primary importance in determining the effect of hearing deficiency and attendant speech deficiency upon development of the speech and oral ap- paratus. Studies are already available on the development of the ears and associated sensory structures. We need similar studies of the development of the structures concerned primarily with speech response in auditorily deficient and in normal children. 6. ~ study of the basic motor reactions of the tongue, lips, dia- phra:gm and throat in normal and auditorily deficient children. Little is known about the accuracy, speed and variability of

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Problems of the Deaf and Hard of Hearing 29 tongue movements in normal individuals. Is there a relationship between tongue mobility, for instance, and the ease with which the individual picks up speech reactions ? We know that in the accuracy and ease in the movements of other parts of the body there are wide variations from individual to individual, some of which persist in spite of training, and some of which can be overcome by training. A study of the speech apparatus from this angle might reveal interesting and valuable material. 7. ~ comparc&t~ve study of language development in normal and auditorily deficient children.-Comparisons should be made be- tween normal and auditorily deficient children of the same age, and comparisons between normal children at early ages and auditorily deficient children at later ages under school in- struction. In the statement of an earlier problem we have emphasized the relationship between language development and general de- velopment. This study would undertake to compare the prog- ress of the hearing child and the deaf or partially deaf child. An interesting and valuable secondary study would be a study of the maximum vocabulary that could be acquired by a deaf child under skillful instruction between the ages of two and seven years, in comparison with the normal vocabulary acquisi- tions of the hearing child. 8. Studies of tile extent to which the dezreloLwlent of complex mental processes is affected by the absence of language stimula- [ior'.-There are a number of studies which should be undertaken under this general heading. The Conference cites the difference in the development of blind as compared with deaf children, which points to the importance of auditory stimulation as a factor in We development of complex mental processes. The Conference would also point to the investigations off sensory discrimination which seem to indicate that sensory discrimination is improved to a marked degree by the attaching of certain lan- guage responses to the material which Is to be discriminated, as contrasted with such discrimination when no such language responses are involved. Modern psychology attaches fundamental importance to the linguistic processes as important {actors in development. When we realize that the ordinary child at the age of six years has a vocabulary of between two and three thousand words, uses every form of sentence and every part of speech, and has the elementary mechanics of the language pretty thoroughly worked

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so Problems of the Deaf and Hard of Hearing out, and when we further realize that the child of eight years is, in comparison with the adult, virtually at the completion of his language development except for the addition of more words and a few more involved forms, we begin to realize something of the handicap which the auditorily deficient child has borne in comparison with the normally hearing child. The public school receives at the age of six in a hearing child, one who is already very far advanced in the basic manipulation of linguistic processes. The school for the deaf, taking a child at the age of eight, receives a child who has made virtually no progress, and at the best adds but a few words a year to the child's vocabulary in comparison with the tremendous acquisi- tion made by the normal child at the age of two, three and four. It is no wonder, then, that the whole development of complex mental processes in the auditorily deficient child are affected. 9. ~ study of the role auditory stimulation plays in the spontaneous beAcz~ior of children.-There seems to, be a general agreement that the deaf child is usually apathetic and listless as compared with the average hearing child. It is true that occasionally deaf children show outbursts of uncontrolled motor energy and present a picture quite the opposite, but taken as a whole, the contrast with normal children is marked. Nevertheless, the spontaneous motor behavior of a child plays a very important part in his general development; a part which is increasingly recognized. A study should be undertaken to determine the re- lationship between auditory stimulation and such behavior. It is possible that a practical outgrowth of such a study would be the development of devices by means of which partial com- pensation could be made. In connection with this study (and perhaps of sufficient importance to be accorded a separate place) would be a quantitative study of the development of motor reflexes in the auditorily deficient. We find little material avail- able. We do not know whether the general bodily tone of the deaf is lower than that of the normal, whether their reflexes are sluggish or accelerated; whether the reflexes appear at the same time as, or later than, in normal children. lo. Studies on the effect of auditory deficiency upon the dezrelop- ment of other senses and upon wtotor ability.- There are many problems which come under this general head, and which can be attacked with profit by a variety of methods. First, by the use of tests on groups of children; second, by the placing of chil- dren in specific learning situations not directly connected with

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Problems of the Deaf and Hard of Hearing 3~ the learning of speech; and third, by the experimental isolation and study of single sensory and motor fields. Studies should be undertaken on the extent to which com- pensatory reactions develop or fail to develop in other sense fields. It is true that investigations on older children and adults have revealed little evidence of such compensatory reactions. It is possible, however, that in young children attempts are made in this direction with varying degrees of success. Studies should be made on speed of tapping, steadiness of motor control, accuracy of movement, perception and discrim- ination of size and shape relationships, development of eye and hand coordination, development of general motor coordination, and so on. There are a host of problems upon which we have relatively little information about auditorily deficient children. There is some evidence that the handicap on the motor side is not so great as is the handicap in the field of complex mental processes. If so`, it might be possible to develop methods of instruction in the motor fields that would tend to eliminate or reduce the gen- eral handicap. Similarly, studies should be undertaken of the learning off the auditorily deficient in conventional learning situations, such as those offered by mazes, target experiments and other motor situations. It is possible that through such studies practical methods for facilitating development might be demonstrated. There is evidence that early training, and the opportunity for practice, affects to a considerable degree the acquisition of motor skill. At. ~4 study of the erect of auditory deficiency upon personality arid the social relations of young children. This, too, is a topic on which a number of specific studies could be undertaken, one of the first of which might be a study of the effects of young auditorily deficient children associating with other auditorily deficient children as compared with benefits of association with hearing children. The study should, however, go much farther. It should be realized that the individual begins his social train- ing almost at birth; and that through his relations and inter- actions with his fellows he builds up a whole complex series of reactions which are of utmost importance in adjustment and later development. The effects upon the personality and social development of the child, due to his isolation from one of the primary sources of sensory stimulation; the sources of the

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Problems of the Deaf and Hard of Hearing attitudes of submission, timidity, and negativism which we as- sociate with auditory deficiency; the magnitude, qualitatively and quantitatively of the loss that the deaf child experiences; these are vital problems. z. Inz~estigations into the comparative values f or young children of the different methods of teaching. Investigations into the comparative values of the different methods (oral, manual, etc.) elsewhere recommended, should be carried down to the early ages, where perhaps the problems find their greatest importance. In the young child, the factors of interference of different methods, and the transfer of training from one to the other, should receive definite consideration. There should be undertaken a study in the values of rhythm and amplified music in the training of young auditorily de- ficient children. In our modern training of young children, rhythm and music play a very important part. Any devices which could be developed or utilized that would give similar training to the young auditorily deficient child would undoubtedly be of considerable value. In connection with the study of methods of training young deaf children, a survey should be undertaken of play activities among them, both from the standpoint of the present activities ire which such children engage and possible activities in which they might engage. In this connection, a surrey of the play equipment available in the home of the child should be under- tal~en; a study in the nursery should be made of the types of activities in which young deaf children spontaneously engage, the educational values of such activities, and the manner in which such activities can be made to have greater educational value. We no longer look upon play as wasted effort. It is now considered ~ vital and significant part of the educational process and many of our modern procedures for handling young children are based upon modifications of play situations and play devices. I3. ~ Study of auditorily deficient children who reman in their own homes should be made over a considerable area, and should concern itself with a description and analysis of the type and kinds of treatment which the child receives from its own parents. A study undertaken in this fashion would be a valuable con- trol upon the studies undertaken in the nursery school of the progress of auditorily deficient children under expert guidance.

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Problems of tile Deaf arid Hard of Hearing 33 It would also reveal the nature and extent of parental in- adequacies in the handling of such children, and lead directly to the formulation of a positive program of parental education for the parents of such children. It is obvious that for many years to come not all the young deaf children cart be placed in institutions. It is equally obvious that once we develop ade- quate methods for the measurement of the hearing deficiencies in young children, such methods, in view of the modern interest in the pre-school child, will be applied over a wide area to many thousands of children. One need only bear in mind the pre- schoo1 surreys which are now conducted in almost every section of the country and which result in the physical examinations of hundreds of thousands of children. With the application of test devices in such situations, hundreds of auditorily deficient children will be discovered, and the question of their effective handling will come directly to the fore. The individuals in charge of the nursery school project, and the National Research Council should envisage this future possibility and in setting up its program look toward the meeting of this situation. . A study of the pathological factors leading to' the causation of auditory deficiencies in young children.-Very little is available at present, obtained by modern methods, with reference to these causative factors; and the knowledge available stands in need of revision, since most of the data are based upon the results obtained by a few examiners who have worked in schools for the deaf, and who used the material, chiefly older children, avail- able in such schools. A school set up in the fashion prescribed above might undertake such a survey, and in addition, through observation over a period of years of individual children, obtain valuable material with reference to the progress of such path- ological factors. Among the disorders suggested for study are: a. Lues: many of the studies now available in the literature were made before the development of the Wassermann tech- nique, and need revision. b. Tuberculosis. c. Contagious diseases. d. Endocrine disturbances. ~5. A study of the development of progressive deafness in young ~r~diuidu~ts. Usually, progressive deafness appears at about the age of twenty, though individual cases are recorded in which it appears much earlier. Little is known about the beginning . .. . ~+ ~r 1 1 ~