DISCUSSION
This infant is the youngest patient reported
with massive condyloma acuminata, and is the
only such patient in whom there is a docu-mented record of condyloma acuminata being present in the mother during the pregnancy.’
The relatively rapid growth and fungating
appearance of these lesions may suggest a
ma-lignant potential to the unwary examiner.
Fur-thermore the entity which has been called
“giant condylomata acuminata ( Buschke-Loew-enstein tumor) has often been confused with
simple condylomata acuminata.2 The
Buschke-Loewenstein giant condylomata acuminata
usually occur in males and have a definite ma-lignant potential which is easily discernible on
histological examination. The simple
condylo-mata acuminata, as in this case, remain
super-ficial and, although looking malignant, have no
malignant potential whatsoever.
Although these massive condylomata
acumi-nata have no malignant potential, their
treat-ment may be difficult due to the tendency for
recurrence of this undoubtedly virally induced
growth. The large lesions are not amenable to the application of podophyllin resins because of their size. Therefore, surgical excision for both diagnostic biopsy and therapy is the treatment
of choice. Since the warty growths occur for the
most part on the ends of very small stalks of skin,
these stalks lend themselves to ligation
followed by excision rather than excision and
extensive electrocautery of the bleeders which results in subsequent skin necrosis and delayed secondary healing with scarring. Following
re-moval of the larger growths, the smaller lesions can be treated with podophyllin or local
appli-cation of 5% ammoniated mercury ointment.4
SUMMARY
A case of massive condylomata acuminata in
an 18-month old, the youngest patient
diag-nosed with this lesion, is presented. This is the
only case reported in an infant whose mother
was known to have condyloma acuminata
dur-ing pregnancy and delivery. The surgical and
medical aspects of the management are
dis-cussed and the benign nature of this lesion is emphasized.
RA5HMI PATEL, M.D.
DILLER B. GROFF, M.D.
Department of Surgery
The New Jersey Medical College
65 Bergen Street
Newark, New Jersey 07107
REFERENCES
1. Grace, D. A., and McLain, C. R. : Vulvar condy-lomata acuminate in prepubertal females.
J.A.M.A., 201:151, 1967.
2. Gilbert, C. : Case reports giant condylomata
acuminata (Buschke-Loewenstein tumor). Arch. Derm., 93:715, 1966.
3. John R. J.: Giant condylomata acuminate in-volving vulva and rectum. Arch. Path., 88:46, 1969.
4. Huffman, J. W. : Disorders of external genitalia.
Pediat. Clin. N. Amer., Feb:35, 1958.
An
Investigation
of the Efficacy
of the
Frostig Program for the Development
of Visual
Perception
In recent years there has been increased
con-cern with those children of normal intelligence without apparent emotional disturbance or sen-sory impairment who manifest severe learning disabilities. Clinical examination of these chil-dren often indicates a number of significant problems including hyperactivity and marked perceptual difficulties. Of special interest to ed-ucators has been the alleged interference of the
above-noted deficits with the acquisition of
ba-sic educational skills. There is some evidence
to suggest that the perceptually disabled child is inferior in a number of school subjects such as reading and arithmetic with a cumulating deficit as he passes from one grade to another.
The purpose of the investigation was to es-tablish a means of identifying and treating the perceptually handicapped child within the reg-ular school framework. The study was seen as having three major emphases. First, in view of
the cumulating deficit noted above, an attempt
was made to identify and treat the perceptu-ally handicapped child as early as possible in the educational process. Secondly, an attempt was made to determine the feasibility of con-ducting the identification and treatment proce-dures within the regular school framework. Thirdly, an attempt was made to investigate the efficacy of one program designed for the remediation of perceptual-motor deficit. This was done to determine whether such remedial programs are feasible without the use of special educational facilities. The implication of such a finding would be of major importance to those
school systems which lack the resources to
im-plement such separate facilities.
Pro-TABLE I
EXPERIMENTAL GROUP MEAN SCORES FOR PRE- AND
POST-TESTING ON THE FIVE FROSTIG SUBTESTS AND PERCEPTUAL QUOTIENT
I Ii III IV V PQ
Pre 79.50 78.80 71.70 79.80 80.55 86.45
Post 11.05 96.00 106.80 91.95 94.35 109.75
EXPERIENCE AND REASON-BRIEFLY RECORDED 155
* Significant at or beyond .05 level. gram for the Development of Visual
Percep-tiofl.1 This program was selected because it has demonstrated positive training effects with mentally retarded2 and neurologically impaired children.3 It also appears to be one of the
bet-ter standardized programs available with
norms extending down to the younger age
group.
METHOD
Phase I of this investigation was a training
institute in which the teachers of each of the 22 classes to be utilized in the study were trained
in the use of the Frostig Developmental Test of
Visual Perception.4 This institute was
pre-sented in four sessions of 4 hours each and was
conducted by one of the investigators. The first
session was a presentation and a discussion of the major concepts relating to perceptual-motor functioning and learning disabilities in general.
It served to introduce the Frostig Test to the
teachers involved and to present the theory and
rationale behind the development of the test.
During this session the aims and objectives of
the study were examined and related to the
material to be used. The second session
con-sisted of the administration of the Frostig Test
to the teachers themselves on a group basis.
The purpose of this administration was to
fa-miliarize the teachers with the demands of the
test from the student’s viewpoint. This enabled
them to understand the need to adhere to
stan-dard procedures of administration and to
antic-ipate those areas of test performance which
were most likely to present difficulties to the
students. The administration of the test was
followed by a demonstration of the scoring
techniques in which each teacher was shown
the proper methods for scoring the completed
record. The third session was devoted to
prac-tice periods in which the teachers alternated in
administering the test to small groups of other
teachers. This provided additional test
proto-cols for further practice in scoring. The fourth
session included continuation of practice
ses-sions as needed, as well as an overview of the
procedures already presented with an emphasis
upon establishing standard and consistent methods of administration and scoring among the teachers.
Phase II involved the administration of the
Frostig Test by the recently trained teachers to
all of the first grade students (N = 578) in the
South Portland School System. Each teacher
administered the test on a group basis to
stu-Cor’rrRoL GROUP MEAN SCORES FOR PRE- AND PosT-TESTING ON THE FIVE FROSTIG SUBTESTS
AND PERcEPTUAL QUOTIENT
I II III IV V PQ
Pre 77.49 70.13 64.50 75.46 79.13 88.88
Post 90.50 85.07 76.46 80.50 88.11 91.18
dents in his/her own class. Each teacher then scored the test results for his/her own students. One of the investigators was available to assist with any specific scoring problems encountered by the teachers. In a check on the validity and the consistency of the teachers’ scoring, two
test protocols were randomly selected from
each teacher and the scoring was reviewed.
The test results of each student were expressed as age-equivalent scale scores for each of the five subtests and then were combined to obtain the total perceptual quotient for each child.
Phase III involved analyzing the total
per-ceptual quotients so that the mean score and standard deviation for the group could be
ob-tamed. The mean perceptual quotient was
TABLE II
PRE- AND POST-TEST DIFFERENCE SCORES ON THE
FROSTIO DEVELOPMENTAL TEST OF VISUAL
PEScsa’rIoN WITH ASSOCIATED t VALUES
Subte4
Group
I
Experimeno1 Conftot
I 8.50 13.01 4*
II 11.94
III 85.10 11.96 5.41*
IV 1.15 5.04 #{149}93*
V 13.80 8.98
156
106.55 with a standard deviation of 12.97. All students whose total perceptual quotient fell
more than one standard deviation below the
obtained mean were selected as demonstrating
significant perceptual deficits. Based on an
mi-tial group of 578 students, this procedure
re-suited in the selection of 97 students. This
number was subsequently reduced to 92 when
the families of five children moved from the
area. The next step in this phase was the ad-ministration of the California Short Form Test
of Mental Maturity5 to the selected students.
The resultant mean IQ was 91.27 with a
stan-dard deviation of 14.5. All students whose IQ
score fell more than one standard deviation
be-low the obtained mean were excluded from the
project. This resulted in the exclusion of 13
children, leaving a group of 79 from which the
experimental and control groups were derived.
This resulted in a group of children who
dem-onstrated normal intelligence with marked per-ceptual deficits. A group of 20 children was randomly selected to serve as the experimental
group while the remaining 59 served as con-trols. A statistical comparison indicated no sig-nificant differences between the experimental and control groups on any of the five subtests, total perceptual quotient, or IQ.
Phase IV was concerned with attempts to
improve the perceptual functioning of those 20
children included in the experimental group. This was implemented through the use of The Frostig Program for the Development of Visual Perception.’ This program is oriented toward
developing and expanding the
visual-percep-tual skills of children between the ages of 3%
and 7%. Included in this program are tasks
which further the development of muscular
coordination, teach the child body concepts,
and introduce and reinforce perceptual
dis-criminations. One of the investigators spent
two half-hour sessions per week with each child
of the experimental group during regular school
hours. This program lasted for a period of 7 months.
Phase V of the program was implemented at
the end of the school year and involved the
re-administration of the Frostig Test to all of the students in both the experimental and control groups. Administration and scoring was
con-ducted as outlined in Phase II. The results
were separately tabulated for the experimental and control groups, and a statistical comparison
of the results was completed to determine
if the two groups had differed significantly.
RESULTS
The results were examined by comparing the
amount of change each group underwent from
pre-test to post-test. Table I contains the mean scores for both the experimental and control
groups on both pre- and post-testing for each
of the five Frostig subtests as well as for the perceptual quotient. The amount of change was determined by subtracting the mean pre-test score from the mean post-test score for each group and expressing the result as a mean difference score for each of the five subtests and the perceptual quotient. These mean
dif-ference scores are contained in Table II along
with the associated t values for each group. As can be seen in this Table, the experimental group showed significanfly more improvement
from pre-test to post-test on all measures. In
terms of total perceptual quotient they showed
three times as much improvement as the
con-trol group. Another important finding was that
none of the children in the experimental group
showed a decline in performance from pre-test
to post-test, while 25.4% (N = 15) of the
con-trol group manifested such a decline.
DISCUSSION
The results suggest that it is possible to iden-tify and treat the perceptually handicapped child early in his educational career. The
desir-ability of early identification and treatment is
enhanced by the findings that 25% of the
con-trol group actually declined in performance
over the 6-month treatment period. The results
of this study also suggest that it is quite feasi-ble to conduct the identification and treatment procedures within the regular school
frame-work. Feedback, obtained from school
person-nel after this study was completed, indicated
that they did not perceive it as disruptive of
regular school routine and saw no reason why it could not become a regular part of school
procedure. These results also suggest that the
Frostig Program for the Development of Visual Perception1 is an effective program in raising the visual-perceptual abilities of children
iden-tified as perceptually handicapped.
Further-more, these results suggest that the
remedi-ation program is effective in a very general
sense in that all subtests as well as the total
perceptual quotient showed the hypothesized
pro-EXPERIENCE AND REASON-BRIEFLY RECORDED 157
gram manifested its efficacy without the use of
elaborate educational facilities and it would
appear that this particular type of remediation program would be highly beneficial for those
school systems which lack the necessary
re-sources to implement separate facilities. It should be noted, however, that further research will be needed before definitive statements can
be made regarding the validity of the Frostig
Program. One question which could be raised
concerning this study is to what extent the
im-provement shown on the Frostig Test of
Devel-opmental Perception is a result of practice on
test-like items contained in the Frostig Pro-gram for the Development of Visual
Percep-lion. Future studies should include other
re-lated instruments to see if the effects can be
generalized to other related areas of function-ing. It would also be interesting to determine if such programs result in improved academic
performance and achievement as well as the
demonstrated improvement in perceptual abil-ities.
J
OHN S. BisHop, Pn.D.University of Maine at Portland-Gorham
Portland, Maine 04103
WILLIAM F. GAYrON, PH.D.
University of Rochester Medical Center
Rochester, New York 14620
JOHN E. BASSETT
Memphis State University
Memphis, Tennessee 38152
ADDRESS FOR REPRINTS: (W.F.G. ) Strong
Memorial Hospital, 280 Crittenden Boulevard, Rochester, New York 14620.
REFERENCES
1. Frostig, M., and Home, I. : The Frostig Program for the Development of Visual Perception. Chicago: Follett, 1964.
2. Allen, B., Dickman, I., and Haupt, T. : Clearing house: A pilot study of the immediate effec-tiveness of the Frostig-House training pro-gram with educable retardates. Exceptional Child., 33:41, 1966.
3. Tyson, M. : Pilot Study of Remedial Visuo-Mo-tor Training. Special Education, 52:22, 1963. 4. Maslow, P., Frostig, M., Lefever, I., and
Whitt-lesey, J.: The Mariane Frostig developmental
test of visual percention, 1963
standardiza-lion. Percept. Motor Skills, 19:463, 1964. 5. Sullivan, E. T., Clark, W., and Tiegs, E. W.:
