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~,4 Problems of the Deaf and Hard of Hearing stages of this disorder. It is possible that its origin is to be traced much farther back than it is at present supposed. An analysis of the hereditary factors involved would also be of some interest. V1. PROBLEMS OF EMOTIONAL AND SOCIAL ADJUSTMENT The Conference realizes that not only the so-called " deaf," but also those who are auditorily deficient in lesser degrees suffer seriously from their difficulties of social adjustment due to inferior means of com- munication. This difficulty cannot be entirely removed through even the highest use of compensatory devices, either of instrumental character or of substitutional nature (such as lip reading). Not only is the achievement of social values by auditorily deficient individuals hindered by this condition, but the emotional reaction upon the individual himself is of a grave nature, reaching in many cases the psychopathic level. Measures should be found for the amelioration of these conditions. Although the results obtained in carrying out the recommendations concerning the nursery school, and certain of the in- vestigations included in the educational group, will undoubtedly be of great assistance in this endeavor, we believe that certain other lines of research should be followed to this end. A. SPECIFIC PROBLEMS OF ADJUSTMENT Whether studied through a national institute, or by more indepen dent investigations, or both, there are definite problems demanding attention, of which the following are among the more obvious: I. The detailed emotional consequences of auditory deficiency.- The Conference especially recorn~nends systematic and detailed investigation of the specific emotional effects and changes en- tailed through auditory deficiency, such as timidity, suspicion, depression, feelings of inferiority, resentment, apathy, etc. Dif- ferential erects should be correlated with degrees of deficiency, age, period of incidence, training before and after incidence, organic conditions and cultural circumstances. Comparisons should be made with the recognized psycho- neurotic types, and the investigation might well be continued to the institutions for the mentally disordered in an effort to de- termine the incidence and types of psychoses among the audi- torily deficient. a. The rehabilitation of the auditorily deficient. It is reco~nrnended that the process of emotional and social readjustments be studied with reference to the {actors assisting and retarding such re

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Problems of tote Deaf and Hard of Hearing 35 habilitation. Emotional responses to different teaching methods, to differing supervisory conditions outside the classroom, to different personality types, to industrial conditions, to organ- ized play, to rhythmic and musical stimulation, are typical of the data to be sought. Attitudes of cordial persons toward the auditorily deficient.- It is recorded that consideration be given to the attitudes of normal persons, both children and adults, toward the deaf and the hypacousic of different ages and degrees of deficiency. In this connection, comparative studies of the social relations of the blind with those of the deaf may prove useful. Efforts should be made to discover means of improving the social set- ting of the auditorily deficient by increasing the friendliness, fraternity and cooperation between them and normal persons. B. A C:ENTRAL INSTITUTE FOR THE STUDY OF ADJUSTMENTAT~ PROBLEMS The Conference recommends that steps be taken toward the establishment of a research unit for the study of social and emotional problems of auditory deficiency. I. Type of research trait.-This unit would be either a part of a more general institute dealing with various of the problems recommended in this report, or a separate institute dealing pri- marily with social and emotional adjustment. 2. Location.-This institute should be located in a considerable center of population, where work for the deaf and hypacousic is already well organized, and where there are university and medical school facilities of adequate rank. New York, Chicago, Boston, and Baltimore would meet the requirements from these points of view. Proximity of important existing institutions for hearing disability, such as the proposed nursery school, Gallaudet College, or the Clarke School for the Deaf, would be an im- portant consideration. Organization.-The directing stay of such an organization should include an otologist, an experimental psychologist and a clinical psychologist. In the case material studied, the otologist would be responsible for medical history and diagnosis of con- dition, and for the medical factors in disposition. He should, therefore, have a sufficient general medical background as well as technical ability in his specialty. The experimental psychologist should be a man capable of conducting or directing research in that field, and should be 3.

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36 Problems of the Deaf and Hard: of Hearing able to organize the technique of experimental psychology in problems in other fields where they may be of help. He should be especially familiar with acoumetric methods, and methods which have been utilized in the attempts to gain insight into the emotional life as such. In general, such a man would probably represent the point of view of pure science in the psychological approach, as compared with the more applied tendencies as- sociated with the name of clinical psychology. The clinical psychologist would have the conduct or super- vision of the problems that come within the scope of social or educational psychology. He would need a first class type of train- ing and several years' experience in some portion of this field, though not necessarily one concerned with auditory deficiencies; and he must be a person of initiative and scientific resource. A number of the problems require a person trained in social work with the deaf, and the organization would hardly function properly without at least one such worker. To the directing staff might well be assigned a limited number of fellows or scholars, prepared to devote their major energies to some problem or group of problems under the immediate supervision of the proper authority in the organization. Its resources would also be open to students of affiliated graduate schools, who were interested in relevant problems. Able ap- plicants with hearing disabilities of their own should have con- sideration from the standpoint of their primary interest, and aptitude for personal contact with the case material. The remaining special personnel would include a secretary to take care of the business affairs of the institute, a clerk to look after record keeping and the posting of data for statistical use, and a mechanician responsible chiefly to the experimental psychologist. 4. Space. The space required would be about fifteen rooms, in- cluding an office and a small private laboratory or examining room each for the orologist, the experimental psychologist and the clinical psychologist; a general work room and four research rooms for fellows, scholars and graduate students; an office for the social worker; an office shared by the secretary and clerk; and a shop for the mechanician. The question of a library would depend upon location. In most locations otherwise suitable, the library requirements would be almost entirely met by the facilities of neighboring institutions.

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1 Problems of the Deaf andf Hard of Hearing 37 5. Clinical and teaching work. As practically necessary supple- ments to the research functions of such an institute, clinical work would lee carried on, and a small amount of teaching be made available, the latter organized in connection with a neigh- boring graduate school. It is understood that this teaching would be in research with the deaf, not in teaching the deaf in the ordinary sense, or in training their teachers in the established techniques. The unit would be specially useful as a training center in psychometric techniques for use with cases of hearing disability. The clinic would combine ameliorative with research functions, and would establish relations with neighboring insti- tutions having useful contributions to make in the management of individual cases. 6. Duration period. The appropriate duration of a research pro- gram in this field cannot be estimated by scientific considerations. The solution of all the problems here contemplated in five years would simply open up another set of probems, and so on. It is not even rational to talk of a point of diminishing returns. A five year program has some basis in tradition, and it is here probably sufficient, with vigorous prosecution by an interested personnel, to make enough progress to show where further progress can best be attempted. The chief reservation flows from the fact that data accumulated during such a period, on matters dealing with social adjustment, accumulate value with the length of the individual's life; so that, assuming the ter- mination of an intensive research program at the end of five years, provisions should be made for such follow-up work as is practicable of cases with whom the institute has worked, for a longer period-perhaps ten years more. The machinery for doing this could probably be provided through a neighboring permanent institution with an active social service department, the data being periodically reviewed from the background of clinical and social psychology. y. Designation of unit. A descriptive name for an organization such as described would be " Institute of Research in Adjust- ments of Persons with Hearing Disabilities." It is suggested that consideration be given to the establishment of the nursew school and this institute of research as coordinate institutions. As an alternative to the central institute plan, the Conference recommends consideration of the~establishment of fellowships in various suitable population and university centers, as qualified applicants appear. In principle this is a more economical means