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How to help a child to achieve his best
July, 1968 T h e J o u r n a l o[ P E D I A T R I C S
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How to help a chiM to achieve his best "What one knows must constantly be relearned" --U N K N O WN
What is contained herein will not be new to most pediatricians. At a time, however, when the basic concepts of our social structure are being tested as never be[ore, the guidelines enumerated by Dr. Illingworth may not only help the child's physician to be more effective in the guidance o[ his patients and their parents, but will rein[orce his confidence in his role as a stabilizing [actor within his community. EDITOR
R. S. Illingworth, M.D., F.R.C.P., D.P.H., D . C . H . S I~IEFFIELD~ ENGLAND
MosT PARENTS w a n t to do their best for their child, but w h a t t h e y d o n ' t know is how to do it. If t h e y seek advice, the opinions expressed are a p t to be conflicting, because, in fact, no one really knows the answer. W e know a g r e a t deal about a child's n u t r i t i o n a l needs a n d about the p r e v e n t i o n of disease, t h o u g h we a r e n o t so good at translating w h a t we k n o w i n t o practice. W e know m u c h less a b o u t a child's intellectual needs a n d a b o u t the means of p r o m o t i n g his o p t i m u m intellectual development. I t ls n o w b e c o m i n g increasingly recognized t h a t a large n u m b e r of children do not achieve their m a x i m u m intellectual potential. U n d e r a c h i e v e m e n t at school is thought to be common. W i m b e r g e r ~ considered t h a t between 30 a n d 50 p e r cent of school child r e n were p e r f o r m i n g at a level f a r below t h a t which should correspond to their intelIectuaI ability, as j u d g e d b y psychological testing, a n d so are underachievers. Address: Department o] Child Health, University o[ Shel~eld Children's Hospital, Western Bank, She~eld 10, England.
H a v i g h u r s t ~a wrote in the U n i t e d States It seems probable that our society actually discovers and develops no more than perhaps half its potential intellectual talent. Some evidence for this statement lies in the fact that former immigrant groups, which one time did the heavy labor of America, at first produced very few mentally superior children; but after a sojourn in this country of 2 or 3 generations, they have produced large numbers of mentally superior people. They did this through bettering the environment in which they reared their children. 13 Bartlett ~ studied 715 children in the second y e a r at a g r a m m a r school or technical school who were doing so b a d l y t h a t a transfer to a less exacting t y p e of e d u c a t i o n was planned. H e found that 70 h a d an I.Q. score of 120 to 135, 65 h a d an I.Q. of 135 to 140, a n d 73 h a d an I.Q. of over 140. R a d i n a n d M a s l i n g 22 described a 10-year-old boy referred to t h e m for school failure, a p a t h y , disinterestedness in work, and difficulty w i t h arithmetic, whose I.Q. score on the Binet Scale was 196. T h e r e are m a n y reports about such u n d e r a c h i e v e m e n t . Vol. 73, No. 1, pp. 61-68
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The causes of underachievement are numerous. They include problems in the school, in the child, and in the home. Factors in the school include poor teaching, lack of motivation, conflict between child and teacher, and wrong choice of subject. Factors in the child include visual and auditory defects, specific learning disorders or other handicaps, poor concentration, laziness, overactivity, daydreaming, slow thought, inability to express ideas, excessive devotion to sport, and miscellaneous behavior problems. Havighurst la summarized the features of underachieving children as follows: they feel inadequate; they have lower aspirations than achievers; they do not like school or enjoy learning as much; they are less popular with their schoolfellows; they tend to come from broken or emotionally inadequate homes, and homes of low social class; they have less ambition and work less hard; and they are less well adjusted than achievers. There have been several valuable papers and books on underachievement; they inelude those of the following: Burt, 4 Floud, Halsey, and Martin, a~ Wall, Schonell, and Olson, 24 Radin and Masling, 22 Deisher, Cressey, and Tjossem, s Bloom, 2 Douglas, 9 Jackson and Marsden, is Glaser and Clemens, 11 Dale and Griffith7 Kornrich, a9 Bartlett, 1 and Brodie and Winterbottom? Underachievement, by definition, is not due to lack of talent; it is due to a wide variety of factors which result in the child not using his talent. In this paper I am concerned with the avoidance of underachievement, with particular regard to factors in the child's management at home which may help him to achieve his maximum potential and to use to the full the talents which he possesses. DESIRABLE INFLUENCES IN THE HOME
In our book Lessons from Childhood, ~ in which we described the childhood of 450 famous men and women of history, we attempted to summarize in the concluding chapter the factors which seemed to have been at least partly responsible for the eminence which these children achieved. The
The Journal o[ Pediatrics July 1968
factors which we named were a reasonably good I.Q. level, persistence, willingness to work hard, personality, ambition, ability to profit from mistakes, an inquiring mind, creativity, opportunity, a good home, and good education. By no means all those who achieved fame experienced all these favorable factors; but they serve as a guide for the section to follow. Emotional, physical, and intellectual development are interrelated. Many are prevented from achieving their best intellectually because of emotional factors, personality problems, and their attitude and behavior to others. Promotion eludes them because they are unpopular and "cannot get on with people." Personality is partly inherited but largely engendered by environment. It is essential, therefore, to consider those factors which affect a child's emotional development and which may lead to the development of desirable personality characteristics. One aim of all good parents is to make the childhood a happy one. A happy Childhood is at least one major factor in the development of desirable character traits in the adult. I suggest that the following are the most important factors for a child's emotional and intellectual development. Satisfaction of basic emotional needs. These include love and security; firm, loving discipline; acceptance at all times, however much he misbehaves or fails to come up to his parents' scholastic expectations, or whatever personality traits he exhibits; the gradual acquisition of independence; the instillation of good moral values and a sensible attitude to sex; and encouragement rather than discouragement, with praise for his achievements, however meager they are. It means the avoidance of constant nagging and reprimands, excessive strictness or lack of discipline, and use of sarcasm, scorn, ridicule, and derogation. Favoritism, prolonged separation of the child from the parents, a frigid rejecting attitude, friction between child and parent, and friction be= tween the parents should not occur. Parents should avoid setting too high a standard for a child and should refrain from efforts, in.
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evitably futile, to make him perfect. The parents should not disapprove and reject the child when he fails to live up to their expectations. This is very important because insecurity is a potent cause of underachievement. Satisfying emotional needs asks a great deal of parents, since none are perfect and all will at times fail in these respects. Occasional failure will do no h a r m ; a child brought u p without any stress is likely to find it difficult to face stress when he inevitably does face it in later years. I t does no h a r m for the parents to have an occasional break from the small child, for a weekend or a little longer, provided that he is left in the care of someone he loves. It helps t h e parents, who are refreshed by a break and as a result are more tolerant of the child, and it helps the child to become used to separation from the parents. All children need firm, loving discipline. All children must be allowed to grow u p and to take steps toward the eventual acquisition of independence and responsibility. All children need encouragement and praise, especially when they have really tried, even though in fact they have achieved little. Wherever possible failure should be avoided, for success breeds success, and failure m a y result in further failure because the child m a y be discouraged. I t is unwise to cause a child to try to learn (e.g., to swim) before he is ready for it. Early learning. Parents wrongly think that it is soon enough for a child to learn when he starts school. I n fact children find great pleasure in learning and practicing their new skills, and from early infancy they should be given the necessary play material. T h e child will then learn to use his hands, to coordinate his hands with his eyes, to investigate, to explore, and to use his imagination. Within 6 or 8 weeks of birth, the baby m a y w a n t to be propped up so that he can see what is going on. T h e baby who is left flat on his back all day in the garden, with nothing but a brick wall to see, has no stimulus to learn. H e cannot be expected to
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progress as m u c h as the b a b y who is picked up, loved, and played with. As he grows older, suitable play material should be supplied. This should allow him to use his imagination, to create, and to construct. I n the first place he is given bricks of suitable sizes and shapes, bobbins (wooden spools), and other safe objects. He graduates to p y r a m i d rings, to interlocking bricks, to bead threading, to designs, and later to Bildit, Leggo, M e c c a n o (Tinker Toys, Erector sets), and other construction toys. I have discussed the type of toy suitable for different ages elsewhere. 17 Most mechanical toys are of limited value. T h e y do not allow the child to use his imagination, to design, and to construct. An intelligent boy is more likely to want to construct different layouts for an electric railway than to play with a preconstructed railway whose design cannot be altered. If he shows interest in sketching or painting, the necessary materials should be supplied. It is not intended to suggest that the child should be subjected to quite such intensive early training as that meted out to John Stuart Mill, L o r d Kelvin, and Carl Witte, as described in our book Lessons [rom Childhood. 15 It is intended to suggest that children find great pleasure in learning things which interest them and that suitable play material should therefore be given. There is m u c h to be said for Bloom's observation 2 that the pattern of learning is established long before the child starts school, and it is up to the parents to set a good pattern in the child's first 5 years. Pringle, 21 in an address to the Royal Society of Medicine, said Learning to learn does not mean beginning to learn arithmetic or reading at the earliest possible time. It is far more basic and subtle, and includes motivating the child to find pleasure in learning to develop his ability to pay attention to others, to engage in purposeful activity, to delay gratification of his wishes, and to work for more distant rather than immediate rewards and goals. It also includes developing the child's view of adults as sources of information and ideas, as well as of approval and rewards. Through such learning the child develops his self-image, the standards he sets for himself for achievement,
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and his attitudes toward others, be they his contemporaries or adults. Evidence is accumulating to show that early failure to stimulate a child's desire to learn may result in a permanent impairment of learning ability or intelligence. The child should "learn to learn" and decide whether learning is a pleasurable challenge or a disagreeable effort to be resisted as far as possible. The child must find very early that learning is pleasure. His parents play with him, show him how things work, show him how to do things, and read to him. Many parents do not think of reading to their young child. A 12-month-old baby of average intelligence begins to appreciate the rhythm of nursery rhymes, and soon learns to understand what is being read to him. He is shown pictures and soon is given pictures to match. Before long he enjoys the picture dominoes, the posting box, into which blocks of different shapes are posted, the simple formboard, and increasingly difficult jigsaws, beginning with the 6 or 8 piece ones. All these are vital steps to reading which will introduce him to new pleasures. I do not wish to imply that all children have the same interests; all children are different and have their own interests and aptitudes. There is mounting evidence that the socalled sensitive or critical period, so well documented in animals, is of great importance in the human chiid. 1~ For instance, normal babies usually learn to chew at 6 or 7 months. We showed that if babies are not given solids to chew within a few weeks of learning to chew, but are only given solids later (e.g., at a year of age), they wiI1 refuse them or vomit them. It is well known that if the congenital cataract is not removed early enough, the child will remain blind, and that if the squint is not corrected early enough, the child will be blind in the squinting eye. If deafness is not treated early, it becomes increasingly difficult to teach the child to speak. If the cleft palate is not corrected early enough, normal speech may never Le attained. Whereas most children learn a foreign language with ease and acquire a good accent, highly intelligent adults commonly find it difficult or impossible ever to
The Journal o[ Pedfatrfcs July 1968
acquire a good accent. The predominant theme of Madame Montessori's teaching system was the use of the sensitive period; she insisted that children should be taught various subjects as soon as they were ready to learn--not before and not later. Her ideas were years ahead of her time. Unfortunately some parents are afraid of overstraining the child. This will not occur, provided that learning is a pleasant process, devoid of coercion. If the 3 or 4 year old shows himself ready to learn to read, it would be wrong to hold him back. As soon as he is able to read, he is provided with books. He is taken on visits to factories, museums, and workshops so that he can begin to learn how things work. He is introduced to outdoor interests--to games, to the names of flowers and birds, and later, to swimming. Care must be taken that the older child does not concentrate so exclusively on sport that his work suffers, but normal sports activities are altogether desirable. When he becomes interested in the more hazardous sports, calculated risks will be taken. Interest in the child's education. Some parents equate education with authority and oppose it11; some not only show no interest in the child's homework and school progress, but positively discourage it. Some parents don't provide a warm, comfortable room for the child to do his homework in, away from the television set and other members of the family and their friends. Some, even though there is no real financial need, expect their children to earn money, as in newspaper rounds, instead of doing their homework. They provide no books or other learning materials and fail to give the child any means of learning outside the home and school. Lack of interest in the child's education is reflected in their lack of contact with the school and the teachers. It is also reflected in premature removal from school. The Crowther report Gin Britain showed that 48 per cent of children with an I.Q. score of over 120 left school by the age of 16 and as a result did not go to the University. The great majority of these were from the lowest social class. Vance Packard 2~ showed that
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half of those in a New York high school with an I.Q. score of 135 or more did not go to college. Clegg 5 showed that children of white collar workers in England were 16 times more likely to secure university places than children of manual w o r k e r s - - t h o u g h university education is free of cost to all but the most wealthy (and all students receive at least a small grant). This is largely because the latter are taken away from school too soon. This in no way suggests that the universities favor the former; there is no class distinction in this matter, the universities accepting the best of those offered to them. But it does mean that there is a great deal of underachievement in the lower classes. T h e right parental attitude to education is of the greatest importance. T h e child is guided into the right pattern of work and play by their attitude to his homework. If, as soon as he has homework, he is led to realize that it is automatic that he should complete it before going out to play, watching the television, or indulging in his hobby, there will never be need for unpleasantness about it. H e must be given a suitable room in which to work. M a n y public libraries in England provide rooms for school children to do their homework if home conditions are unsatisfactory. These facilities are widely used. T h e ready availability of books for reference is a great help for such children. Parents who really have their children's welfare at heart are likely to have much more contact with the school and the teacher than other parents. T h e y discuss the child's difficulties and successes together and seek advice on the best way to help the child. This is of particular importance if a child's work is deteriorating. T h e cause of deterioration may be a simple one, such as preoccupation with sport, or a complex one, depending on something at home or school which is rendering him insecure. It m a y then be necessary that the family doctor or pediatrician should be called in to help. Parents should have confidence in the school, but not unquestioning implicit confidence. Some schools are better than others. Teachers are h u m a n and have their failings.
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Some schools have rigid methods, failing, for instance, to allow a child to work at his own pace in an appropriate group, or failing to encourage him in a particular interest of his because it does not h a p p e n to fit easily into the curriculum. It is the responsibility of the parent to keep a "friendly" eye on the child's education and to take the necessary steps if they are u n h a p p y about any aspect of it. The choice of subject at school must depend partly on the advice of teachers, partly on the advice of the parents, but finally on the desires of the child. It should not just be left to chance, as it often is. As far as possible the child should concentrate on those subjects in which he is most interested. If he expresses great interest in a particular subject, there should be powerful reasons for not making it possible for him to study it. As for choice of career, the child should be given the opportunity of seeing what fields are open to him, and their scope, so that he can make his own decision when the time comes. I t is nearly always wrong to try to persuade a child to take up a particular career, for the choice must be his. For instance, if a child shows a particular bent in the engineering field, it should be possible to arrange for him to see different branches of engineering in a technical school, university, or industry. It is tragic that so m a n y children are removed prematurely from school when they are so well equipped to proceed to advanced education. T h e avoidance of unnecessary absence from school. Parents allow their children to be absent from school for m a n y trivial complaints and for reasons unconnected with illness. Asthmatic children are kept out of school for the slightest wheeze. After a trivial infection, such as a cold or cough, or one of the c o m m o n infectious diseases, the child is kept out of school longer than necessary. This is not, by any means, due always to lack of appreciation of the value of education. It 9m a y be due to overprotection. It is obvious that unnecessary absence from school should be avoided. T h e wise choice of school. Some parents are guided in the choice of school by snobbery rather than by quality. Some parents,
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by choosing a third rate expensive boarding school instead of a state school, greatly lower their child's chance of gaining admittance to a university. They m a y choose a school because of its so-called "modern methods of education," by which it is meant that he can work as little or as much as he wants. There is something to be said for this, provided only that it does not prevent the child from competing with others for the right to advanced education in due course, or otherwise achieving his best. T h e avoidance of overambition. It is hard to strike the balance between underambition and overambition. Either is likely to be harmful to the child's career. If too little is expected of him, he is apt to respond by underachievement. If too much is expected of him, he responds by insecurity, anxiety, and again by underachievement. Parents are apt to expect the child to achieve more than his intellectual endowment will permit and express disapproval if he fails to satisfy their ambition. They blame him for not trying and blame the teachers and the school for his poor performance. This in turn has a bad effect on the child, for it leads to strained teacher-child relationships. Prior to an examination, they say so much to him about the importance of success that they create anxiety to such an extent that his performance suffers. Some are foolish enough to offer a reward, such as a new bicycle, if he reaches a certain level in his examination. They are so demanding of success that the child is worried and afraid of their reactions when they see his school report; he fears blame, disapproval, and loss of affection if his report is unsatisfactory. The setting of a good example. One factor which helps a child to achieve his best is good relationships with others. For this reason the parents should go out of their way to set good examples of kindness, love, unselfishness, honesty, and of respect for the feelings of ethers. It is a good thing to avoid criticism of others and to make a practice of finding excuses for their shortcomings, of looking for the good in people rather than for the bad and encouraging the child to do likewise. I t is essential that the parents should
The Journal o[ Pedzatrzc's July 1968
apologize to the child for loss of temper, for they cannot otherwise expect him to apologize when he fails in the same way. It is most desirable that the child as he grows up should learn that no one is perfect, that all have their faults, but all have their good points; the good points should be looked for and emphasized. The parents should set a good example in other ways, in the nature of their reading, their choice of magazines, newspapers, television programs, and phonograph records, and in the nature of their conversation, including care with their language. Some other success factors. Persistence, accuracy, and thoroughness are traits which may in part be inherited characteristics, but are almost certainly largely implanted by environment. The child should be encouraged to try, try, and try a g a i n - - b u t where possible, eventual failure should be avoided by the parent giving judicious help. He should be encouraged and shown how to do things well and properly, so that a slipshod attitude is avoided. Curiosity, originality, and creativity should be greatly encouraged. Their importance is discussed in detail in the excellent book Contrary imaginations, by Hudson, 14 of Cambridge University. He concluded that curiosity, originality, and creativity were largely the product of environment, but he noted how often they cause conflict between child and teacher. The child should certainly not be discouraged by reprimands for some untoward consequences of his curiosity, some result of his quest for knowledge which he had not foreseen. The child should be helped to find out how things work and encouraged to try to discover it himself. H e should be encouraged to design and create, to use his imagination, to improve on things. He should constantly be stimulated to find out the reason why. He must, therefore, be given the means for making his discoveries, i.e., the suitable play materials, and later, suitable reading materials. H e will be introduced to the junior library, and soon he will be shown how to use the ordinary library and the reference library, how to seek help from the library staff, and how to find out for himself.
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I suggest that a conscious effort should be made to teach these traits and that their development should not be left to chance. The ability to think around a subject is an important success factor. He should be encouraged to think of the other possible explanation of what he sees and hears, to think of implications, and to seek proof. The parents should themselves set the example in their conversation. As he grows older the child will begin to query statements which he hears on the radio and sees in the press and demand evidence of what he hears. He will question his parents about the accuracy of what they say and this should constantly be encouraged. Unfortunately, many parents discourage argument by forbidding it, because they do not like to have their authority questioned. Initiative and leadership are other desirable traits. The child should be encouraged to take the lead, to take action when he sees that something should be done, instead of taking the easier course and doing nothing. He should also be helped and encouraged to make decisions for himself, for it is easy to make the mistake of making all decisions for a child. Pride in achievement, self-confidence because of his achievements and the encouragement which he receives for them, an interest in learning, and ambition to achieve more are all necessary steps to success and all have their beginnings in early childhood. T h e child is helped to find learning pleasant and to fin t that learning brings its rewards. His intel'ectual endowment may be meager, but wh ~tever its level it can be helped forward by encouragement and stimulation on the lines suggested. All possible steps should be taken to prevent him from concluding that learning is unpleasant and to prevent him from feeling that he cannot live up to his parents' expectations. H e must be helped to achieve his best, whatever that is. H e must never be allowed to acquire a sense of failure, a feeling that his parents are disappointed in him. If the child is afraid of what his parents will think of his school reports or of his examination results, there is something wrong in the parent-child relationship.
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Nothing but harm arises from pushing the child beyond the limit of his capabilities, but there is much to be said for encouraging him to work at a level suitable for his capability, instead of a long way behind it. Attention to certain physical factors. These include adequate nutrition in the early months, attention to visual and hearing defects, attention to speech defects, to orthodontic requirements, to the prevention of obesity, and to the maintenance of physical fitness. There is evidence that malnutrition in the early months leads to a lowering of intelligence. 23 As for defects of vision and hearing, the child will not complain of these. Adults have to make the diagnosis. Any child with delayed speech, or speech indistinct for his age, should have the hearing checked by an expert. I t is wrong to leave speech defects untreated so that he starts school with them. Obesity should never be allowed to develop. It causes a great deal of unhappiness and may well interfere with school work as a result. Only rarely is it possible to prevent it. Physical fitness, with outdoor sports and pursuits, must at all times be maintained and encouraged. Physical factors become closely intermingled with a child's emotional and intellectual development. Their importance is readily forgotten. The attitude to illness is important. A healthy attitude with no excess of fuss and anxiety about symptoms is essential to a child's emotional development. Symptoms are readily magnified by giving medicines for any complaint of discomfort, or by putting him to bed, keeping him out of school, and expressing undue concern. This is particularly important for children with chronic ailments, like asthma. Every effort should be made to avoid showing anxiety about the attacks or about the child's health between the attacks. T h e child should be led to minimize rather than exaggerate his disability. CONCLUSION Much of what has been said may suggest that the aim of every parent should be to make his child a genius. This is not intended at all. I t is well recognized, however, that
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the h o m e e n v i r o n m e n t can raise or lower a child's I . Q . score by at least 30 or 4:0 points. T h e suggestions m a d e refer n o t so m u c h to the d e v e l o p m e n t of talents, b u t rather to the use of the talents which he has, not so m u c h to raising his I.Q., b u t to using it to the fullest. This applies not just to the child with an inherited high I.Q. but to the child with a merely average intellectual endowment. I t is well recognized t h a t the child with an average I . Q . m a y achieve a great deal m o r e in life t h a n a child of superior I.Q. w h o lacks certain other attributes, some of which I h a v e tried to outline. O n e m i g h t a d d that a child with an I.Q. below the average can be enormously helped by p r o p e r m a n a g e m e n t , so that he can achieve far m o r e t h a n a more clever child who has a less stimulating environment. N o parents are perfect. This p a p e r is int e n d e d to suggest a goal to be a i m e d at but n o t one which is likely to be reached. All children a n d adults w h o succeed in one field, fail in another. Every child has his own limitations. T h e really essential thing is this: t h a t h a v i n g given the child all the help one can, he is accepted for w h a t he is, with his limitations and assets; that he should be helped to the extent of his ability to face his limitations a n d develop his assets to the fullest; a n d t h a t at all times he should feel loved and w a n t e d . O n e m u s t at all times r e m e m b e r that the clever child m a y ultimately achieve far less t h a n the m u c h less clever child, who has a m o r e pleasant personality (largely as a result of his h o m e e n v i r o n m e n t ) , or has m o r e persistence, creativity, ambition, a n d powers of leadership. REFERENCES
I. Bartlett, E. M.: In Howels, J. G , editor: Modern perspectives in child psychiatry, London, 1965, Oliver & Boyd, Ltd. 2. Bloom, B. J.: Stability and change in human characteristics, New York, 1964, John Wiley & Sons, Inc. 3. Brodie, R. D., and Winterbottom, M. R.: Failure in elementary school boys as a func-
The Journal o[ Pediatrics July 1968
4. 5. 6. 7. 8. 9. t0. 11. 12. 13.
14. 15. 16.
17. 18. 19. 20. 21. 22. 23.
24. 25.
tion of trauma, secrecy and derogation, child Develop. 38: 701, 1967. Burt, C.: The causes and treatment of backwardness, London, 1953, University of London Press. Ctegg, A. B.: Dangers ahead, Education, Feb. 5, 1965. Crowther Report: Report of the Central Advisory Council for Education, London, 1959, Her Majesty's Stationery Office. Dale, R. R., and Griffith, S.: Downstream, London, 1965, Routledge and Kegan Paul. Deisher, R. W., Cressey, C. O., and Tjossem, T. D.: Adolescent school failure, GP: 89, Feb. 27, 1963. Douglas, J. W. B.: The home and the school, London, 1964, MacGibbon and Kee. FIoud, J. E., Halsey, A. H., and Martin, F. M.: SociaI class and educational opportunity, London, 1956, Heinemann. Glaser, K., and Clemens, R. L.: School failure, Pediatrics 35: 128, 1965. Hammar, S. L.: School underachievement in the adolescent, Pediatrics 40: 373, 1967. ttavighurst, R. J.: Conditions productive of superior children, in Grinder, R. E., editor: Studies in adolescence, New York, 1963, The MacMillan Company. Hudson, L.: Contrary imaginations. A psychological study of the English schoolboy, London, 1967, Penguin, Illingworth, R. S., and Illingworth, C. M.: Lessons from childhood, Edinburgh, 1966, E. & S. Livingstone, Ltd. Illingworth, R. S., and Lister, J.: The critical or sensitive period, with special reference to certain feeding patterns in infants and children, J. PEmAT. 65: 839, 1964. Iltingworth, R. S.: The normaI child, ed. 4, London, 1968, J. & A. Churchill, Ltd. Jackson, B., and Marsden, D.: Education and the working class, London, 1965, Routledge and Kegan Paul. Kornrich, M.: Underachievement, Springfield, Ill., 1965, Charles C Thomas, Publisher. Packard, V.: The status seekers, London, 1959, Penguin Series. Pringle, M. L. K.: Speech, learning and child health, Proc. Roy. Sac. Med. 60: 885, 1967. Radin, S. S., and Masling, J.: Tom, a gifted underachieving child, J. Child Psychol. Psychiat. 4: 183, 1963. Stoch, M. B., and Smythe, P. M.: Does undernutrition during infancy inhibit brain growth and subsequent intellectual development? Arch. Dis. Childhood 38: 546, 1963. Wall, W. D., Schonell, F. J., and Olson, W. C.: Failure in school, Hamburg, I962, UNESCO Institute for Education. Wimberger, H. C,: Conceptual system for classification of psychogenic school underachievement, J. P~D~AT. 69: 1092, 1966.
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How to help a chiM to achieve his best "What one knows must constantly be relearned" --U N K N O WN
What is contained herein will not be new to most pediatricians. At a time, however, when the basic concepts of our social structure are being tested as never be[ore, the guidelines enumerated by Dr. Illingworth may not only help the child's physician to be more effective in the guidance o[ his patients and their parents, but will rein[orce his confidence in his role as a stabilizing [actor within his community. EDITOR
R. S. Illingworth, M.D., F.R.C.P., D.P.H., D . C . H . S I~IEFFIELD~ ENGLAND
MosT PARENTS w a n t to do their best for their child, but w h a t t h e y d o n ' t know is how to do it. If t h e y seek advice, the opinions expressed are a p t to be conflicting, because, in fact, no one really knows the answer. W e know a g r e a t deal about a child's n u t r i t i o n a l needs a n d about the p r e v e n t i o n of disease, t h o u g h we a r e n o t so good at translating w h a t we k n o w i n t o practice. W e know m u c h less a b o u t a child's intellectual needs a n d a b o u t the means of p r o m o t i n g his o p t i m u m intellectual development. I t ls n o w b e c o m i n g increasingly recognized t h a t a large n u m b e r of children do not achieve their m a x i m u m intellectual potential. U n d e r a c h i e v e m e n t at school is thought to be common. W i m b e r g e r ~ considered t h a t between 30 a n d 50 p e r cent of school child r e n were p e r f o r m i n g at a level f a r below t h a t which should correspond to their intelIectuaI ability, as j u d g e d b y psychological testing, a n d so are underachievers. Address: Department o] Child Health, University o[ Shel~eld Children's Hospital, Western Bank, She~eld 10, England.
H a v i g h u r s t ~a wrote in the U n i t e d States It seems probable that our society actually discovers and develops no more than perhaps half its potential intellectual talent. Some evidence for this statement lies in the fact that former immigrant groups, which one time did the heavy labor of America, at first produced very few mentally superior children; but after a sojourn in this country of 2 or 3 generations, they have produced large numbers of mentally superior people. They did this through bettering the environment in which they reared their children. 13 Bartlett ~ studied 715 children in the second y e a r at a g r a m m a r school or technical school who were doing so b a d l y t h a t a transfer to a less exacting t y p e of e d u c a t i o n was planned. H e found that 70 h a d an I.Q. score of 120 to 135, 65 h a d an I.Q. of 135 to 140, a n d 73 h a d an I.Q. of over 140. R a d i n a n d M a s l i n g 22 described a 10-year-old boy referred to t h e m for school failure, a p a t h y , disinterestedness in work, and difficulty w i t h arithmetic, whose I.Q. score on the Binet Scale was 196. T h e r e are m a n y reports about such u n d e r a c h i e v e m e n t . Vol. 73, No. 1, pp. 61-68
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The causes of underachievement are numerous. They include problems in the school, in the child, and in the home. Factors in the school include poor teaching, lack of motivation, conflict between child and teacher, and wrong choice of subject. Factors in the child include visual and auditory defects, specific learning disorders or other handicaps, poor concentration, laziness, overactivity, daydreaming, slow thought, inability to express ideas, excessive devotion to sport, and miscellaneous behavior problems. Havighurst la summarized the features of underachieving children as follows: they feel inadequate; they have lower aspirations than achievers; they do not like school or enjoy learning as much; they are less popular with their schoolfellows; they tend to come from broken or emotionally inadequate homes, and homes of low social class; they have less ambition and work less hard; and they are less well adjusted than achievers. There have been several valuable papers and books on underachievement; they inelude those of the following: Burt, 4 Floud, Halsey, and Martin, a~ Wall, Schonell, and Olson, 24 Radin and Masling, 22 Deisher, Cressey, and Tjossem, s Bloom, 2 Douglas, 9 Jackson and Marsden, is Glaser and Clemens, 11 Dale and Griffith7 Kornrich, a9 Bartlett, 1 and Brodie and Winterbottom? Underachievement, by definition, is not due to lack of talent; it is due to a wide variety of factors which result in the child not using his talent. In this paper I am concerned with the avoidance of underachievement, with particular regard to factors in the child's management at home which may help him to achieve his maximum potential and to use to the full the talents which he possesses. DESIRABLE INFLUENCES IN THE HOME
In our book Lessons from Childhood, ~ in which we described the childhood of 450 famous men and women of history, we attempted to summarize in the concluding chapter the factors which seemed to have been at least partly responsible for the eminence which these children achieved. The
The Journal o[ Pediatrics July 1968
factors which we named were a reasonably good I.Q. level, persistence, willingness to work hard, personality, ambition, ability to profit from mistakes, an inquiring mind, creativity, opportunity, a good home, and good education. By no means all those who achieved fame experienced all these favorable factors; but they serve as a guide for the section to follow. Emotional, physical, and intellectual development are interrelated. Many are prevented from achieving their best intellectually because of emotional factors, personality problems, and their attitude and behavior to others. Promotion eludes them because they are unpopular and "cannot get on with people." Personality is partly inherited but largely engendered by environment. It is essential, therefore, to consider those factors which affect a child's emotional development and which may lead to the development of desirable personality characteristics. One aim of all good parents is to make the childhood a happy one. A happy Childhood is at least one major factor in the development of desirable character traits in the adult. I suggest that the following are the most important factors for a child's emotional and intellectual development. Satisfaction of basic emotional needs. These include love and security; firm, loving discipline; acceptance at all times, however much he misbehaves or fails to come up to his parents' scholastic expectations, or whatever personality traits he exhibits; the gradual acquisition of independence; the instillation of good moral values and a sensible attitude to sex; and encouragement rather than discouragement, with praise for his achievements, however meager they are. It means the avoidance of constant nagging and reprimands, excessive strictness or lack of discipline, and use of sarcasm, scorn, ridicule, and derogation. Favoritism, prolonged separation of the child from the parents, a frigid rejecting attitude, friction between child and parent, and friction be= tween the parents should not occur. Parents should avoid setting too high a standard for a child and should refrain from efforts, in.
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evitably futile, to make him perfect. The parents should not disapprove and reject the child when he fails to live up to their expectations. This is very important because insecurity is a potent cause of underachievement. Satisfying emotional needs asks a great deal of parents, since none are perfect and all will at times fail in these respects. Occasional failure will do no h a r m ; a child brought u p without any stress is likely to find it difficult to face stress when he inevitably does face it in later years. I t does no h a r m for the parents to have an occasional break from the small child, for a weekend or a little longer, provided that he is left in the care of someone he loves. It helps t h e parents, who are refreshed by a break and as a result are more tolerant of the child, and it helps the child to become used to separation from the parents. All children need firm, loving discipline. All children must be allowed to grow u p and to take steps toward the eventual acquisition of independence and responsibility. All children need encouragement and praise, especially when they have really tried, even though in fact they have achieved little. Wherever possible failure should be avoided, for success breeds success, and failure m a y result in further failure because the child m a y be discouraged. I t is unwise to cause a child to try to learn (e.g., to swim) before he is ready for it. Early learning. Parents wrongly think that it is soon enough for a child to learn when he starts school. I n fact children find great pleasure in learning and practicing their new skills, and from early infancy they should be given the necessary play material. T h e child will then learn to use his hands, to coordinate his hands with his eyes, to investigate, to explore, and to use his imagination. Within 6 or 8 weeks of birth, the baby m a y w a n t to be propped up so that he can see what is going on. T h e baby who is left flat on his back all day in the garden, with nothing but a brick wall to see, has no stimulus to learn. H e cannot be expected to
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progress as m u c h as the b a b y who is picked up, loved, and played with. As he grows older, suitable play material should be supplied. This should allow him to use his imagination, to create, and to construct. I n the first place he is given bricks of suitable sizes and shapes, bobbins (wooden spools), and other safe objects. He graduates to p y r a m i d rings, to interlocking bricks, to bead threading, to designs, and later to Bildit, Leggo, M e c c a n o (Tinker Toys, Erector sets), and other construction toys. I have discussed the type of toy suitable for different ages elsewhere. 17 Most mechanical toys are of limited value. T h e y do not allow the child to use his imagination, to design, and to construct. An intelligent boy is more likely to want to construct different layouts for an electric railway than to play with a preconstructed railway whose design cannot be altered. If he shows interest in sketching or painting, the necessary materials should be supplied. It is not intended to suggest that the child should be subjected to quite such intensive early training as that meted out to John Stuart Mill, L o r d Kelvin, and Carl Witte, as described in our book Lessons [rom Childhood. 15 It is intended to suggest that children find great pleasure in learning things which interest them and that suitable play material should therefore be given. There is m u c h to be said for Bloom's observation 2 that the pattern of learning is established long before the child starts school, and it is up to the parents to set a good pattern in the child's first 5 years. Pringle, 21 in an address to the Royal Society of Medicine, said Learning to learn does not mean beginning to learn arithmetic or reading at the earliest possible time. It is far more basic and subtle, and includes motivating the child to find pleasure in learning to develop his ability to pay attention to others, to engage in purposeful activity, to delay gratification of his wishes, and to work for more distant rather than immediate rewards and goals. It also includes developing the child's view of adults as sources of information and ideas, as well as of approval and rewards. Through such learning the child develops his self-image, the standards he sets for himself for achievement,
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and his attitudes toward others, be they his contemporaries or adults. Evidence is accumulating to show that early failure to stimulate a child's desire to learn may result in a permanent impairment of learning ability or intelligence. The child should "learn to learn" and decide whether learning is a pleasurable challenge or a disagreeable effort to be resisted as far as possible. The child must find very early that learning is pleasure. His parents play with him, show him how things work, show him how to do things, and read to him. Many parents do not think of reading to their young child. A 12-month-old baby of average intelligence begins to appreciate the rhythm of nursery rhymes, and soon learns to understand what is being read to him. He is shown pictures and soon is given pictures to match. Before long he enjoys the picture dominoes, the posting box, into which blocks of different shapes are posted, the simple formboard, and increasingly difficult jigsaws, beginning with the 6 or 8 piece ones. All these are vital steps to reading which will introduce him to new pleasures. I do not wish to imply that all children have the same interests; all children are different and have their own interests and aptitudes. There is mounting evidence that the socalled sensitive or critical period, so well documented in animals, is of great importance in the human chiid. 1~ For instance, normal babies usually learn to chew at 6 or 7 months. We showed that if babies are not given solids to chew within a few weeks of learning to chew, but are only given solids later (e.g., at a year of age), they wiI1 refuse them or vomit them. It is well known that if the congenital cataract is not removed early enough, the child will remain blind, and that if the squint is not corrected early enough, the child will be blind in the squinting eye. If deafness is not treated early, it becomes increasingly difficult to teach the child to speak. If the cleft palate is not corrected early enough, normal speech may never Le attained. Whereas most children learn a foreign language with ease and acquire a good accent, highly intelligent adults commonly find it difficult or impossible ever to
The Journal o[ Pedfatrfcs July 1968
acquire a good accent. The predominant theme of Madame Montessori's teaching system was the use of the sensitive period; she insisted that children should be taught various subjects as soon as they were ready to learn--not before and not later. Her ideas were years ahead of her time. Unfortunately some parents are afraid of overstraining the child. This will not occur, provided that learning is a pleasant process, devoid of coercion. If the 3 or 4 year old shows himself ready to learn to read, it would be wrong to hold him back. As soon as he is able to read, he is provided with books. He is taken on visits to factories, museums, and workshops so that he can begin to learn how things work. He is introduced to outdoor interests--to games, to the names of flowers and birds, and later, to swimming. Care must be taken that the older child does not concentrate so exclusively on sport that his work suffers, but normal sports activities are altogether desirable. When he becomes interested in the more hazardous sports, calculated risks will be taken. Interest in the child's education. Some parents equate education with authority and oppose it11; some not only show no interest in the child's homework and school progress, but positively discourage it. Some parents don't provide a warm, comfortable room for the child to do his homework in, away from the television set and other members of the family and their friends. Some, even though there is no real financial need, expect their children to earn money, as in newspaper rounds, instead of doing their homework. They provide no books or other learning materials and fail to give the child any means of learning outside the home and school. Lack of interest in the child's education is reflected in their lack of contact with the school and the teachers. It is also reflected in premature removal from school. The Crowther report Gin Britain showed that 48 per cent of children with an I.Q. score of over 120 left school by the age of 16 and as a result did not go to the University. The great majority of these were from the lowest social class. Vance Packard 2~ showed that
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half of those in a New York high school with an I.Q. score of 135 or more did not go to college. Clegg 5 showed that children of white collar workers in England were 16 times more likely to secure university places than children of manual w o r k e r s - - t h o u g h university education is free of cost to all but the most wealthy (and all students receive at least a small grant). This is largely because the latter are taken away from school too soon. This in no way suggests that the universities favor the former; there is no class distinction in this matter, the universities accepting the best of those offered to them. But it does mean that there is a great deal of underachievement in the lower classes. T h e right parental attitude to education is of the greatest importance. T h e child is guided into the right pattern of work and play by their attitude to his homework. If, as soon as he has homework, he is led to realize that it is automatic that he should complete it before going out to play, watching the television, or indulging in his hobby, there will never be need for unpleasantness about it. H e must be given a suitable room in which to work. M a n y public libraries in England provide rooms for school children to do their homework if home conditions are unsatisfactory. These facilities are widely used. T h e ready availability of books for reference is a great help for such children. Parents who really have their children's welfare at heart are likely to have much more contact with the school and the teacher than other parents. T h e y discuss the child's difficulties and successes together and seek advice on the best way to help the child. This is of particular importance if a child's work is deteriorating. T h e cause of deterioration may be a simple one, such as preoccupation with sport, or a complex one, depending on something at home or school which is rendering him insecure. It m a y then be necessary that the family doctor or pediatrician should be called in to help. Parents should have confidence in the school, but not unquestioning implicit confidence. Some schools are better than others. Teachers are h u m a n and have their failings.
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Some schools have rigid methods, failing, for instance, to allow a child to work at his own pace in an appropriate group, or failing to encourage him in a particular interest of his because it does not h a p p e n to fit easily into the curriculum. It is the responsibility of the parent to keep a "friendly" eye on the child's education and to take the necessary steps if they are u n h a p p y about any aspect of it. The choice of subject at school must depend partly on the advice of teachers, partly on the advice of the parents, but finally on the desires of the child. It should not just be left to chance, as it often is. As far as possible the child should concentrate on those subjects in which he is most interested. If he expresses great interest in a particular subject, there should be powerful reasons for not making it possible for him to study it. As for choice of career, the child should be given the opportunity of seeing what fields are open to him, and their scope, so that he can make his own decision when the time comes. I t is nearly always wrong to try to persuade a child to take up a particular career, for the choice must be his. For instance, if a child shows a particular bent in the engineering field, it should be possible to arrange for him to see different branches of engineering in a technical school, university, or industry. It is tragic that so m a n y children are removed prematurely from school when they are so well equipped to proceed to advanced education. T h e avoidance of unnecessary absence from school. Parents allow their children to be absent from school for m a n y trivial complaints and for reasons unconnected with illness. Asthmatic children are kept out of school for the slightest wheeze. After a trivial infection, such as a cold or cough, or one of the c o m m o n infectious diseases, the child is kept out of school longer than necessary. This is not, by any means, due always to lack of appreciation of the value of education. It 9m a y be due to overprotection. It is obvious that unnecessary absence from school should be avoided. T h e wise choice of school. Some parents are guided in the choice of school by snobbery rather than by quality. Some parents,
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by choosing a third rate expensive boarding school instead of a state school, greatly lower their child's chance of gaining admittance to a university. They m a y choose a school because of its so-called "modern methods of education," by which it is meant that he can work as little or as much as he wants. There is something to be said for this, provided only that it does not prevent the child from competing with others for the right to advanced education in due course, or otherwise achieving his best. T h e avoidance of overambition. It is hard to strike the balance between underambition and overambition. Either is likely to be harmful to the child's career. If too little is expected of him, he is apt to respond by underachievement. If too much is expected of him, he responds by insecurity, anxiety, and again by underachievement. Parents are apt to expect the child to achieve more than his intellectual endowment will permit and express disapproval if he fails to satisfy their ambition. They blame him for not trying and blame the teachers and the school for his poor performance. This in turn has a bad effect on the child, for it leads to strained teacher-child relationships. Prior to an examination, they say so much to him about the importance of success that they create anxiety to such an extent that his performance suffers. Some are foolish enough to offer a reward, such as a new bicycle, if he reaches a certain level in his examination. They are so demanding of success that the child is worried and afraid of their reactions when they see his school report; he fears blame, disapproval, and loss of affection if his report is unsatisfactory. The setting of a good example. One factor which helps a child to achieve his best is good relationships with others. For this reason the parents should go out of their way to set good examples of kindness, love, unselfishness, honesty, and of respect for the feelings of ethers. It is a good thing to avoid criticism of others and to make a practice of finding excuses for their shortcomings, of looking for the good in people rather than for the bad and encouraging the child to do likewise. I t is essential that the parents should
The Journal o[ Pedzatrzc's July 1968
apologize to the child for loss of temper, for they cannot otherwise expect him to apologize when he fails in the same way. It is most desirable that the child as he grows up should learn that no one is perfect, that all have their faults, but all have their good points; the good points should be looked for and emphasized. The parents should set a good example in other ways, in the nature of their reading, their choice of magazines, newspapers, television programs, and phonograph records, and in the nature of their conversation, including care with their language. Some other success factors. Persistence, accuracy, and thoroughness are traits which may in part be inherited characteristics, but are almost certainly largely implanted by environment. The child should be encouraged to try, try, and try a g a i n - - b u t where possible, eventual failure should be avoided by the parent giving judicious help. He should be encouraged and shown how to do things well and properly, so that a slipshod attitude is avoided. Curiosity, originality, and creativity should be greatly encouraged. Their importance is discussed in detail in the excellent book Contrary imaginations, by Hudson, 14 of Cambridge University. He concluded that curiosity, originality, and creativity were largely the product of environment, but he noted how often they cause conflict between child and teacher. The child should certainly not be discouraged by reprimands for some untoward consequences of his curiosity, some result of his quest for knowledge which he had not foreseen. The child should be helped to find out how things work and encouraged to try to discover it himself. H e should be encouraged to design and create, to use his imagination, to improve on things. He should constantly be stimulated to find out the reason why. He must, therefore, be given the means for making his discoveries, i.e., the suitable play materials, and later, suitable reading materials. H e will be introduced to the junior library, and soon he will be shown how to use the ordinary library and the reference library, how to seek help from the library staff, and how to find out for himself.
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I suggest that a conscious effort should be made to teach these traits and that their development should not be left to chance. The ability to think around a subject is an important success factor. He should be encouraged to think of the other possible explanation of what he sees and hears, to think of implications, and to seek proof. The parents should themselves set the example in their conversation. As he grows older the child will begin to query statements which he hears on the radio and sees in the press and demand evidence of what he hears. He will question his parents about the accuracy of what they say and this should constantly be encouraged. Unfortunately, many parents discourage argument by forbidding it, because they do not like to have their authority questioned. Initiative and leadership are other desirable traits. The child should be encouraged to take the lead, to take action when he sees that something should be done, instead of taking the easier course and doing nothing. He should also be helped and encouraged to make decisions for himself, for it is easy to make the mistake of making all decisions for a child. Pride in achievement, self-confidence because of his achievements and the encouragement which he receives for them, an interest in learning, and ambition to achieve more are all necessary steps to success and all have their beginnings in early childhood. T h e child is helped to find learning pleasant and to fin t that learning brings its rewards. His intel'ectual endowment may be meager, but wh ~tever its level it can be helped forward by encouragement and stimulation on the lines suggested. All possible steps should be taken to prevent him from concluding that learning is unpleasant and to prevent him from feeling that he cannot live up to his parents' expectations. H e must be helped to achieve his best, whatever that is. H e must never be allowed to acquire a sense of failure, a feeling that his parents are disappointed in him. If the child is afraid of what his parents will think of his school reports or of his examination results, there is something wrong in the parent-child relationship.
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Nothing but harm arises from pushing the child beyond the limit of his capabilities, but there is much to be said for encouraging him to work at a level suitable for his capability, instead of a long way behind it. Attention to certain physical factors. These include adequate nutrition in the early months, attention to visual and hearing defects, attention to speech defects, to orthodontic requirements, to the prevention of obesity, and to the maintenance of physical fitness. There is evidence that malnutrition in the early months leads to a lowering of intelligence. 23 As for defects of vision and hearing, the child will not complain of these. Adults have to make the diagnosis. Any child with delayed speech, or speech indistinct for his age, should have the hearing checked by an expert. I t is wrong to leave speech defects untreated so that he starts school with them. Obesity should never be allowed to develop. It causes a great deal of unhappiness and may well interfere with school work as a result. Only rarely is it possible to prevent it. Physical fitness, with outdoor sports and pursuits, must at all times be maintained and encouraged. Physical factors become closely intermingled with a child's emotional and intellectual development. Their importance is readily forgotten. The attitude to illness is important. A healthy attitude with no excess of fuss and anxiety about symptoms is essential to a child's emotional development. Symptoms are readily magnified by giving medicines for any complaint of discomfort, or by putting him to bed, keeping him out of school, and expressing undue concern. This is particularly important for children with chronic ailments, like asthma. Every effort should be made to avoid showing anxiety about the attacks or about the child's health between the attacks. T h e child should be led to minimize rather than exaggerate his disability. CONCLUSION Much of what has been said may suggest that the aim of every parent should be to make his child a genius. This is not intended at all. I t is well recognized, however, that
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the h o m e e n v i r o n m e n t can raise or lower a child's I . Q . score by at least 30 or 4:0 points. T h e suggestions m a d e refer n o t so m u c h to the d e v e l o p m e n t of talents, b u t rather to the use of the talents which he has, not so m u c h to raising his I.Q., b u t to using it to the fullest. This applies not just to the child with an inherited high I.Q. but to the child with a merely average intellectual endowment. I t is well recognized t h a t the child with an average I . Q . m a y achieve a great deal m o r e in life t h a n a child of superior I.Q. w h o lacks certain other attributes, some of which I h a v e tried to outline. O n e m i g h t a d d that a child with an I.Q. below the average can be enormously helped by p r o p e r m a n a g e m e n t , so that he can achieve far m o r e t h a n a more clever child who has a less stimulating environment. N o parents are perfect. This p a p e r is int e n d e d to suggest a goal to be a i m e d at but n o t one which is likely to be reached. All children a n d adults w h o succeed in one field, fail in another. Every child has his own limitations. T h e really essential thing is this: t h a t h a v i n g given the child all the help one can, he is accepted for w h a t he is, with his limitations and assets; that he should be helped to the extent of his ability to face his limitations a n d develop his assets to the fullest; a n d t h a t at all times he should feel loved and w a n t e d . O n e m u s t at all times r e m e m b e r that the clever child m a y ultimately achieve far less t h a n the m u c h less clever child, who has a m o r e pleasant personality (largely as a result of his h o m e e n v i r o n m e n t ) , or has m o r e persistence, creativity, ambition, a n d powers of leadership. REFERENCES
I. Bartlett, E. M.: In Howels, J. G , editor: Modern perspectives in child psychiatry, London, 1965, Oliver & Boyd, Ltd. 2. Bloom, B. J.: Stability and change in human characteristics, New York, 1964, John Wiley & Sons, Inc. 3. Brodie, R. D., and Winterbottom, M. R.: Failure in elementary school boys as a func-
The Journal o[ Pediatrics July 1968
4. 5. 6. 7. 8. 9. t0. 11. 12. 13.
14. 15. 16.
17. 18. 19. 20. 21. 22. 23.
24. 25.
tion of trauma, secrecy and derogation, child Develop. 38: 701, 1967. Burt, C.: The causes and treatment of backwardness, London, 1953, University of London Press. Ctegg, A. B.: Dangers ahead, Education, Feb. 5, 1965. Crowther Report: Report of the Central Advisory Council for Education, London, 1959, Her Majesty's Stationery Office. Dale, R. R., and Griffith, S.: Downstream, London, 1965, Routledge and Kegan Paul. Deisher, R. W., Cressey, C. O., and Tjossem, T. D.: Adolescent school failure, GP: 89, Feb. 27, 1963. Douglas, J. W. B.: The home and the school, London, 1964, MacGibbon and Kee. FIoud, J. E., Halsey, A. H., and Martin, F. M.: SociaI class and educational opportunity, London, 1956, Heinemann. Glaser, K., and Clemens, R. L.: School failure, Pediatrics 35: 128, 1965. Hammar, S. L.: School underachievement in the adolescent, Pediatrics 40: 373, 1967. ttavighurst, R. J.: Conditions productive of superior children, in Grinder, R. E., editor: Studies in adolescence, New York, 1963, The MacMillan Company. Hudson, L.: Contrary imaginations. A psychological study of the English schoolboy, London, 1967, Penguin, Illingworth, R. S., and Illingworth, C. M.: Lessons from childhood, Edinburgh, 1966, E. & S. Livingstone, Ltd. Illingworth, R. S., and Lister, J.: The critical or sensitive period, with special reference to certain feeding patterns in infants and children, J. PEmAT. 65: 839, 1964. Iltingworth, R. S.: The normaI child, ed. 4, London, 1968, J. & A. Churchill, Ltd. Jackson, B., and Marsden, D.: Education and the working class, London, 1965, Routledge and Kegan Paul. Kornrich, M.: Underachievement, Springfield, Ill., 1965, Charles C Thomas, Publisher. Packard, V.: The status seekers, London, 1959, Penguin Series. Pringle, M. L. K.: Speech, learning and child health, Proc. Roy. Sac. Med. 60: 885, 1967. Radin, S. S., and Masling, J.: Tom, a gifted underachieving child, J. Child Psychol. Psychiat. 4: 183, 1963. Stoch, M. B., and Smythe, P. M.: Does undernutrition during infancy inhibit brain growth and subsequent intellectual development? Arch. Dis. Childhood 38: 546, 1963. Wall, W. D., Schonell, F. J., and Olson, W. C.: Failure in school, Hamburg, I962, UNESCO Institute for Education. Wimberger, H. C,: Conceptual system for classification of psychogenic school underachievement, J. P~D~AT. 69: 1092, 1966.