Integrating The Handicapped Child Into The Community Center
Samuel A. Weiss, Ph.D.
This is a review of three papers based upon a research project conducted at the Associated YM-YWHAs of Greater New York, by Douglas Holmes, Ph.D., Research Director
In the belief that orthopedic-ally handicapped children benefit from participation in community activities, the Associated YM-YWHAs of Greater New York have been carrying on a program since 1961 to integrate such children into play groups at their community center. From 1963 to 1965, a demonstration and research project to evaluate the program was undertaken with the aid of a grant from the Children's Bureau. In his three papers, Douglas Holmes, Ph.D., principal investigator for the project, describes some of the techniques used to implement the research project and some of the preliminary findings.
Evaluating Individual Change Accompanying Participation in Social Groups
In his classic clinical studies, as he observed his patients' distorted perceptions, Sigmund Freud became aware of the striking phenomenon of transference. Patients were not seeing him as he was in reality, but as a lopsided personification of early parent or sibling figures. As depth analysis developed, Freud and others became even more painfully aware that unless they rigorously controlled their own psyches, they could distort the image of their patients in terms of their own needs, drives, and resultant misperceptions-their own counter trans ference.
Since then, observers have felt dislodged from a supposedly secure, Olympian throne from which they could scrutinize their patients with an omniscient equanimity. For we now know that we often selectively apprehend what our own drives, needs, and defenses allow us to perceive. Thus in determining the extent to which both handicapped and normal children might change as a result of their group experience, the availability of an objective and reliable measuring instrument was of primary importance in the present study. To meet this need, Dr. Holmes and his associates developed an observational schedule, consisting of 20 numbered items, each of which represents one interaction. Each child was watched by a trained observer for a 20-minute period at various intervals during the course of the program. The observer checked off the relevant behaviors manifested by the child during one interaction. As soon as the interaction was terminated, the observer moved on to the next column, and so on.
The observers used in the program, mostly graduate students, first underwent a two-week training period in which they used the schedule to rate interactions of children in groups on moving pictures and tape recordings. Only when the test-retest and inter-rater reliabilities reached an appropriate level (r=.73) were observers assigned to actual subjects.
Dr. Holmes illustrates the merits of this objective reporting procedure by a comparison between three reports as to what took place during a 20-minute period involving children in a play group on their way to a park. The first two reports were of the narrative type, written by a social group worker and a caseworker. Both were highly trained and both had been employed together on the project for a year. The third report was based on the observational procedure in the hands of a young undergraduate student who had been trained in the use of the schedule but who had no other formal social work education.
Some very definite discrepancies, both of omission and of commission, appeared in the narrative reports. For example, when the children stopped to play on some monkey bars, the caseworker noted that the handicapped child did not participate in the game played by the other children and did not even seem to understand what they were doing, while the caseworker said the handicapped child was very involved in the game. Each worker appeared to view the interactions among the children from the vantage point of her own discipline-the caseworker's narrative mentioning more intrapsychic factors and the group worker's concentrating on the children's interpersonal behavior.
On the other hand, Dr. Holmes reports, rigorous statistical evaluation of the observational schedule has shown its reliability to be high. Further, the schedule provides all descriptions in terms of a basic common denominator, while the narrative reports vary widely in orientation and content. Also, such narrative reports make it difficult to estimate changes in behavior taking place over time. The objective schedule, however, provides highly specific baseline data on the frequency and the nature of social interactions from which inferences can be drawn with ease.
The Use of a Structured Observational Schema in Evaluating the Impact of Integrated Social Experience Upon Ortho-pedically Handicapped Children
Using the observational technique described in the previous paper, Dr. Holmes presents an analysis of observations made upon 17 orthopedically handicapped children who remained with the project for a two-year period. Activities at the center include recreation and athletics; art, sewing, and other informal classes; and social situations.
The dimensions included on the observational schedule were "total number of interactions", "number involving the leader only", "orientation of act" (toward group goals, nonpurposive, etc.), "expressions of self-esteem", "reactions to frustration", "nature of emotion expressed in interaction", "terminator of interaction", "goal attainment".
It was hypothesized that as regards intrapsychic feeling and interpersonal relations :
Both the handicapped and the normal children would improve from the first to the second year.
The handicapped children would perform more poorly during the first year than would the normal children.
The performance of the handicapped group would equal the performance of the normal group during the second year-except in "self-esteem", where handicapped children were not expected to reach the levels of the normal children.
The predictions relating to the "total number of interactions" were for the most part not realized: there was no difference between the handicapped and the normal children in number of interactions during Time I (the beginning of the program); while at the end of Time II (the end of the program), the number of interactions for the normals had increased and the number for the handicapped remained the same. Regarding the number of interactions involving the leader, no changes were demonstrated over time, the handicapped children interacting with the leader more often than the normals in both Times I and II.
While the outcomes in these dimensions did not support the predictions, other predictions were partially confirmed. In comparison with their respective initial levels of performance, both groups improved significantly in "orientation toward group goals", "realistic expressions of self-esteem", and "goal attainment"; although the handicapped children did not attain the final level reached by the normal group on the first two dimensions. Only the handicapped group improved significantly on the dimensions of "eliminating expressions of poor self-esteem", "tolerating the frustration of failure in goal attainment", and "taking the initiative in terminating interactions appropriately".
The assumption that performance in both groups would be equal at the end of the project was confirmed in some dimensions: "negative expressions of self-esteem", "degree of withdrawal in the face of frustration", "expression of emotion", "appropriate termination of interaction", and "goal attainment or goal failure". The normal children, however, were significantly superior to the handicapped in "total number of interactions", in "displaying less dependence upon the leader", in "orientation toward group goals", and in "realistic expressions of self-esteem". In no instance did the handicapped group exceed the normal.
Thus it is apparent that while only some of the predictions were realized, the accruing benefits justified both the use of the observational schedule and the endeavor to integrate handicapped with normal children. Perhaps it was too much to expect that group interaction alone would erase all the difference traceable to a hampering physical disability. The substantial benefits accruing to the handicapped children are emphasized by the finding that they improved in seven of the ten dimensions, while the normal children (initially higher on five of the ten) improved in only four.
A Comparison Between the Attitudes Toward Child Rearing Among Mothers of Orthopedically Handicapped and Non-Handicapped, Preadolescent Children
Written in collaboration with Patricia Smolka.
The research reported in this paper deals with the attitudes toward child rearing of the mothers of the 17 handicapped children who regularly participated in the integrated community center program, together with those of randomly selected mothers of normal children of the same ages who attended the center. Inasmuch as one focus of the program was the parents' involvement in the integrating process, it was particularly important to measure their salient attitudes as well as any changes that might occur. It was hypothesized that:
Differences in attitudes toward child rearing would exist between parents of handicapped and parents of nonhandicapped children.
Changes in attitude toward child rearing would occur among parents of handicapped children as their children participated in an integrated social experience and as they engaged in consultation with the staff.
The attitudes towards child rearing held by parents of handicapped children would approximate more closely those held by parents of nonhandicapped children after the integrated social experience.
Both groups of mothers completed a questionnaire as part of the annual fall registration procedure at the Community Center in 1964. The questionnaire dealt with the following variables: fostering dependency, martyrdom, fear of harming the baby, exclusion of outside influences, deification, approval of activity, suppression of sex, ascendancy of mother, in-trusiveness, acceleration of development. In 1965 the same 17 mothers of handicapped children again completed the questionnaire. Among the mothers of nonhandicapped children, no attempt was made to locate the respondents of the previous year. Instead, 17 questionnaires were selected at random from approximately 90 completed by mothers whose children had been in the program the preceeding year.
No significant differences were found, among any of the subscales, between either of the subject populations or the two times of presentation --i.e., between Time I and Time II. Thus the results did not support any of the hypotheses on which the study was based. However, the differences between the scores of the parents of the handicapped and the normal children were greater in Time II than in Time I. That is, at Time II the parents of the handicapped children showed greater disagreement with, or scored lower than, the parents of the normal children than was the case at Time I.
The lack of demonstrable difference between the attitudes of the two populations initially could be attributed, in part, to the fact that most of the handicapped children had non-handicapped siblings and that therefore their parents might be expected to have attitudes toward child rearing closely approximating those of parents of nonhandicapped children simply because they were also parents of nonhandicapped children.
As a result of the study, the authors believe that some of our assumptions about the need for changing the attitudes of parents of handicapped children may be completely unfounded. Whereas it had been expected that such mothers would in time respond like mothers of normal children, it appears that it may be of greater benefit to the handicapped child if his parents scored lower in some items--accepting the fact that their child is different from other children and thus lowering their demands upon him.
From the three papers reviewed, the following conclusions are drawn:
The observational schedule is a productive technique in the objective assessment of the interactions among children, which can be supplemented by narrative reports.
The gains made by the handicapped children when they were integrated with the nonhandicapped children were sufficiently substantial to justify such a program. Further gains might be achieved if group therapy sessions were instituted, both to solidify the improved self-image of the handicapped children and to modify normal children's attitudes toward disability.
In a group comprised solely of handicapped children, it is of course possible that similar gains from Time I to Time II might have ensued. This hypothesis is indeed worthy of experimental tests. Nevertheless, the fact that handicapped children could demonstrate improvement in seven of the ten dimensions in comparison with only four of ten in the normal group suggests that integration of these groups was productive for both and, especially, for the handicapped children who were not completely intimidated by the presence of the normal children.
In view of the fact that the statements on the Parental Attitudes Questionnaire betray overprotective, authoritarian and "child-pushing" attitudes, it is of greater benefit to both the handicapped and normal children if their parents endorse fewer such statements .
Samuel A. Weiss, Ph.D. is the Associate Project Coordinator at New York University Prosthetic and Orthotic Studies