338
344
354
364
.. 367
336
A. J. AYRES
a similar analysis of data acquired from a comparable group chosen without reference to perceptual skill.
337
A. J. AYRES
METHOD
A battery of perceptual-motor tests was given individually to each member
of two separate groups of children, one group selected on the basis of suspected
perceptual deficits, especially as reflected in learning problems, and the other
group chosen to represent the "normal" or average school population, without reference to behavior or academic performance. T h e scores of each group were intercorrelated and then subjected to R-technique analysis. Correlations between
scores for the group with suspected dysfunction were subjected to Q-technique
factor analysis. T h e data were gathered between August, 1962, and July, 1963.
Subjects
T h e 100 children who conlprised the group with suspected dysfunction were
selected from regular public schools-which comprised about 50% of the group
-and from special schools and medical centers. T h e major criteria for selection
were ( a ) teachers' reports of difficulty in learning, especially comparatively
3 39
greater difficulty wich reading, writing, or arithmetic than with oral language or
social studies, ( b ) additional observations by teachers of clu~nsiness,hyperactiviry
and distractabilicy, and ( c ) lower scores on performance or perceptual than on
verbal subtests of intelligence tests. Psychological tests and/or reports were
available for assessing possible perceptual deficits in approximately 70 of the
children with si~specteddysfunction. Another requirement for the group was a
verbal intelligence qootient above 70. In 6 8 Ss intelligence quotients, based on
various types of tests, were available and used to determine the adequacy of verbal
intelligence as well as to estimate the mean intelligence of the dysfunction group.
Ss on whom quotients were not available (mainly the younger children) were
judged either by a psychologist or teacher or by the academic grades to have intelligence quotients within the normal range. Many of the children were preliterate.
T h e use of a single screening device was avoided for fear of biasing the selection
of Ss through preconceived ideas of perceptual dysfunction. Effort was extended
to include every possible type of perceptual-motor dysfunction which might exist
in children of 6 or 7 yr. of age outside the cerebral palsied or mentally retarded
populations. N o child carried a medical diagnosis of cerebral palsy.
T h e mean IQ of the dysfunction Ss, based on 6 8 cases and on verbal scores
only when possible, was 96.97, wich a. standard deviation of 14.05 and a range
from 71 to 139. The mean chronological age was 84.1 mo., wich a standard deviation of 7.3 and a range from 70 to 96 mo., a coverage of 2 6 mo. There were 69
males and 3 1 females in the dysfunction group. Tile control group of 50 children
was chosen to match the dysfunction group on mean, variance, and range of
mental age and on sex. T h e estimated mean mental age of the dysfunction group
was 81.48 mo.; the mean chronological age of the control Ss was 81.50 mo. T h e
standard deviation of age of the control Ss was 7.5 and the range was 68 to 95
d males and 15 females, chosen
mo., a coverage of 27 mo. The g r o ~ ~i npc l ~ ~ d e35
from public and private schools and child care centers on the basis of parental
occupation so as to represent proportionately the working population of the
United States and thus, presumably, representing also the normal range of intelligence. On completion of the study, comparison of the mean scores of the control
group with the normative data of the two standardized tests used suggested a few
months immaturity of visual perception in the control Ss. All 150 Ss lived within
the metropolitan Los Angeles area.
T h e Test Battery
T h e tests which were adrniniscered to Ss are described below, numbered to
facilitate reference to them in the tables. All estimates of reliability reported are
based on scores of the dysfunction group only, unless otherwise indicated. W h e r e
tests were split in half for use of either the K~~der-Richardson
or Rulon formula,
the division was made in such a manner as to avoid comparing performance of
one side of the body with the other side.
340
A. J. AYRES
39.
T e s t protocols and items, described in detail in Document No. 8179, may be obtained by
remitting $2.50 for photocopies or $1.75 for 35-mm. microfilm from the AD1 Auxiliary
Publications Project, Photoduplication Service, Library of Congress, Washington 25, D. C .
34 1
342
A. J. AYRES
was determined by frequency with which one hand was used for common tasks.
extent
( 2 2 ) Degree of agreement between eye and hand domina?zce."The
to w h ~ c hhomologous eye and hand preference were demonscrated was the basis
for this test. A limitation in the nanire of scoring the test lay in the fact that S
who was strongly right-handed and left-eyed, or the opposite, received a much
poorer score than the one who had established neither eye nor hand dominance.
For this reason and others, following the factor analyses results were rescored for
analysis with nonparametric statistics.
( 2 3 ) Body v i s a a l i z a t i o n . ~ Swas required to respond to verbal questions
regarding the spatial relations of the body. T h e Rulon estimate of reliability of
.64 reflects low internal consistency of the test.
( 2 4 ) Crossing the mid-line of the body."-The
test attempted to evaluate
the tendency to avoid crossing the mid-line of the body with the hands.
( 2 5 ) Perception of joint nzovement.-With
S's arm resting on a kinesthesiometer and vision occluded, the child was asked to indicate when his arm was
moved by the examiner. T h e score was determined by the number of degrees of
excursion before motion was perceived. Many of the children with suspected dysfunction had much difficulty in grasping the concept involved in the test, quite
possibly because they had very poor perception of joinc motion. In these cases,
objectivity in scoring was severely diminished and prevented the collection of precise data necessary for estimating reliability.
( 2 6 ) Fine motor planning: wire-grommet device.:'-The
instrument involved consisted of a twisted wire held in both hands by handles a t each end. By
continuously changing the spatial orientation, a rubber grommet was manipulated
from one handle to the other. Three devices, of graded complexity, were used, the
score resulting from the time taken by S to maneuver the grommet from one end
to the other.
( 2 7 ) Fine motor planning: string ,winding.-The task involved winding a
heavy string, making a figure eight, around two bolts set 3 in. apart in a piece of
plywood. T h e score was based on the number of figure eights completed within
a given period of time on two separate attempts. Since estimate of reliability
would have had to be based on an infeasible test-retest procedure, reliability was
nor computed for either fine motor planning test.
(28) Two-point tactile discrimination."-The
standard test of two-point
discrimination was administered using the two points on a sewing gauge. Rulon
reliability was estimated at .99, which is spurious, due to the nature of scoring
procedures.
a protocol based on that of
( 2 9 ) Two simultaneoz~stactile stimuli."Using
Swanson (1957) and apparently developed originally by Bender and associates
( 1954; Fink, 1 9 5 3 ) , the degree to which S could simultaneously perceive two tactile stimuli applied to hand and/or cheek was ascertained. T h e Rulon reliability
was estimated at 36.
343
344
A. J. AYRES
MEANSA N D STANDARD
DEVIATIONS
OF TEST SCORESOF DYSFUNCTION
AND
CONTROLGROUPS,WITH SIGNIFICANCE
OF DIFFERENCE
BETWEENMEANS
Tesr
1
-7
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
+A critical ratio
Dysfunction Group
M
SD
431.6
5.6
34.2
372.0
6.4
17.0
10.6
66.9
13.7
37.5
10.3
4.7
5.2
4.8
3.7
26.2
10.9
11.7
9.0
22.4
5.5
10.5
15.7
9.1
113.7
56.0
8.3
32.5
26.7
13.0
12.0
14.8
66.1
3.3
2.6
84.1
55.4
1.6
10.8
47.1
2.5
6.0
2.9
66.0
14.6
10.8
4.0
2.4
4.5
1.5
2.2
7.7
4.9
3.6
4.8
5.7
2.1
5.1
4.3
2.7
55.7
18.5
5.8
10.9
5.9
4.1
4.3
4.2
14.7
1.0
0.8
7.3
Control Group
M
463.3
6.2
38.9
394.1
8.7
20.3
11.7
119.0
21.1
37.8
13.3
6.5
7.6
5.7
5.5
35.7
15.0
15.6
11.7
29.8
6.1
11.2
20.6
10.0
149.7
68.7
11.7
38.0
30.0
15.7
15.2
17.2
81.5
3.9
2.9
81.5
of 1.96 is required at P.46 and 2.58 at P.au.
CR*
SD
15.6
.9
9.3
36.7
1.6
2.5
1.6
69.4
15.8
7.0
3.2
2.2
4.3
1.3
1.4
8.0
4.4
1.9
4.9
5.2
1.7
5.3
3.7
2.1
30.8
5.4
4.6
4.1
2.3
2.2
2.9
1.6
11.6
0.4
0.4
7.6
5.29
2.63
2.77
3.13
7.03
4.72
3.17
4.37
2.73
.19
4.85
4.00
3.17
3.87
5.99
6.32
5.18
8.39
3.18
7.91
1.94
.72
7.18
2.28
5.04
6.31
3.82
4.40
4.91
5.17
5.39
5.04
6.92
5.45
3.56
2.00
345
ratios) between means in Table 1. Those tests showing poor discriminative properties were perception of verticality (Var. 1 0 ) and degree of agreement between
eye and hand dominance (Var. 22 ) . The test of unilateral hand dominance (Var.
21) approached but did not reach the statistical differentiation between means of
scores.
<
= .01.
W i t h 48
346
A. J. AYRES
pretable as hypothesized behavioral correlates of patterns of neurological dysfunction. Unrotated factors are shown in Table 4 o n pp. 350 and 351.
A comparable analysis of the intercorrelations among scores of the control
group yielded 27 factors, the first 26 of which are shown on the right in Table 3.
T h e algebraic signs of the loadings were reversed on Factors A, C, F, G, H, K, M,
N, 0 , R, S, T, U, and W. The eigenvalues for the factors were 8.26, 2.51, 2.07,
1.77, 1.58, 1.45, 1.38, 1.27, 1.15, 1.00, .89, 35, .76, 67, 62, .51, .50, .41, .39, .33,
29, 26, .19, .IS, .09, .07. Unrotated factors are in Table 5 ( p p . 352-353). Factors
o n the whole, were not comparable to the major factors emerging from the dysfunction group. One exception to the dissimilarity was the appearance of Factors
I and K which seem related to Factor L, figure-ground discrimination, of the dysfunction group. T h e second exception was the presence of Factor E in the control
group with similar high loading of body balance as in Factor H in the dysfunction
group. I n addition, some of the singlets were repeated. Factor A, accounting for
most of the variance in the control group, appeared to be one of general perceptual-motor and cognitive ability, with the highest loadings on Variables 15 (Frostig Space Relations), 18 (gross motor planning), 33 (number concepts), and
12 (Frostig Figure-Ground). Inspection of the remaining factors in the matrix
did not lead to meaningful
interpretations.
A third R-technique factor analysis of the intercorrelations of scores of the
combined dysfunction and control groups yielded, essentially but less clearly, the
same major factors as did the dysfunction group alone. One exception was the
emergence of a factor appearing to reflect somatic perception and the motor skills
directly associated with them. Standing balance did not load on this factor.
Descriptive titles proposed for the five major factors emerging from the dysfunction group were expressed as the following syndromes: ( a ) Factor A =
apraxia, ( b ) Factor C = perceptilal dysfunction: form and position in twodimensional space, ( c ) Factor E = tactile defensiveness, ( d ) Factor K = deficit
of integration of function of the two sides of the body, and ( e ) Factor L = perceptual dysfunction: visual figure-ground discrimination.
PERCEPTUAL-hlOTOR DYSFUNCTION IN
TABLE 2
INTERCORRELATIONS OF
R2
1
87
2
78
80
3
4
76
81
5
68
6
7
85
84
8
85
9
65
10
11
84
12
87
80
13
14
83
88
15
87
16
75
17
82
18
72
19
20
91
65
21
22
69
81
23
24
79
67
25
80
26
77
27
68
28
89
29
81
30
80
31
77
32
87
33
78
34
77
35
76
36
Note .-Decimals
78
73
55
74
56
52
58
57
36
51
65
53
47
51
41
24
01
27
02
21
03
39
21
19
-03
05
29
19
44
26
37
28
32
20
09
20
13 -12
13
39
57
39
37
52
51
19
18
15
26
30
34
37
38
35
30
40
12
-04
04 -01
38
27
33
-22
07
03
14
15 -02
02 -01 -15
17
16
04
14
29
34
28
40
26
01 -15
11
-01
31
17
46
25
08
10 -04
08
18
29
23
17 -05
06
10
06
28
07
18
23
50
28
36
39
14
17
15
39
13
30
28
35
have been omitted.
26
-02
27
19
-10
09
13
09
-12
05
10
31
12
19
14
31
-10
12
30
02
-02
08
26
-12
25
-07
13
-15
19
02
-09
03
-13
37
35
15
-03
26
14
27
21
27
31
04
25
02
12
-02
14
10
30
-10
17
34
-01
22
13
37
-06
35
40
05
41
10
11
TESTS:DYSFUNCTION
GROUP( U P P E R RIGHT) AND C
12
13
14
IS
16
17
CHILI
18
19
20
24
NTROL
22
GROUP(LOWER LEFT)
23
24
25
26
27
28
29
30
31
32
wmwr.m
N N N N N
349
areas. Nevertheless, using the patterns of ipsative standard scores, Ss showing the
clearest cases of the major syndromes were selected to test additional hypotheses.
A. J. AYRES
y)
- u m + b ~ m m ~ ~ ~ m m w O r - m - W
p:
0 ~ 0 0 0 0 0 0 0 0 0 0 0 - 0 0 0 0
I I
I
I I I I I
m w ~ w m m m w o m w - m r n o w a a
0 0 0 0 0 0 0 0 0 - 0 0 0 0 - 0 0 0
,
0
Sb
e
2 -
w N
n
..
Ul-
2 g gI sI gI 2 g 3 2I" o g
I " o S I 2 Iz g
I
m w w o - m m m - r - + m ~ m - ~ m -
144"
0 0 0 0 0 ~ 0 0 0 0 - ' N + 0 0
I I
I I
I
b m n w m m o m m w w - m - o m - I I
I
I I I I I
I
I . w r - h C \ v m O O O m - - n N ~ - w
0 ~ 0 0 0 0 0 ~ ~ ~ 0 - 0 0 0 - 0
I
I I I I I I
I I
I
m r n w ~ w + o d o m - ~ m m w w m m
O O O ~ O - - O O O - O - - O - O O
I
I
I I
I I I I I
I
o m w - . w o m o w m ~ w m n m r - . d w
+ 0 0 0 ~ 0 0 - 0 0 0 0 - + 0 0 - 0
I
I
I I
I l l
m r - o w m w r - m w + - r n - ~ w - ~
~ + + O O m O ~ O O - O ~ O O O O O
I
I I
I I I I
I
I G ,
N m b m w m o o m r - m w - r n w m w d ~
~ O N O ~ O + I~ 0 ~ -I O + 0 O O I l l 1
I
Y
~
~
w
~
w
m
~
~
u
~
~ xw
w
0 0I 0l ~l 0 0I m 0
I 0
l 0
l 1
- 0 - m a - 0 - IUc
0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 - - -
~
O
w m ~ ~ r - o m n m + ~ m w m r - o m ~ ~
o
o
~
o
~
0
o
~
m
~
+
o
0
0
0
~
I l l
I I I I
I
I
C
u
L
3,
W
V,
4
L
g1
r1
I~ I &
I
~ I I
R I2
~I
I8
1~8
&
<
~
S
~
'
" u -I &
" " I~ IgI " g & I~ " 8 uI gI ~ g w
I
+ m v m m m w o w v - - v - w m r - o
( U O O N O O ~ O O O O O - - N O - m
I
I
I
I I I I I
m w w m w ~ m ~ r - m ~ m ~ ~
01 01 - 1- N1 O
1 -1 O1 O1 N1 - 1N 1O 1O O O N O
I
n m m m + m r n m ~ w ~ o r - r - m m w m
O
I
O
N I O
I
N
O
~I
~
~
N
O I~
V
m v w ~ ~
~
0
I
~ n ~ +
w ~ r . w
h i - m ~ m m v r - w m w m o m
~
0
0
+
m
m
~
+
~
0
~
I
I l l
I
m m v m ~ n w ~ b o r n w m m
w m w w ~ W w r - w m r - ~ v r -
- m m v m w r - w m o - m m m m w r - m
, - , - - r t + - C I - -
TABLE 4 (Cont'd)
m
W
FACTORS(UNROTATED): DYSFUNCTIONGROUP
Tests
Note.-Decimals
19
36 0 6 -11 34
20
68 32 -12 21
21
17 29 -08 -13
22
-10-01-04-07
23
38 02 09 49
24
56 02 -12 36
25
50 15 -18 -02
26
70 11 -03 -08
27
76 -03 -02 00
28
74 32 04 04
29
71 3 2 - 1 5 11
30
76 -24 -08 00
31
61 -36 -07 -07
32
71 -03 -22 27
33
69 -36 21 25
34
71 28 -20 04
35
52 35 -26 -12
36
13 -62 -15 -02
have been omitted.
Factors
J
K
5?
L
8
?=
E
3
U
<
V)
c"
2
Z
2
n
i
Z
A. J. AYRES
n w o m m o m m ~ ~ m a ~ ~
3 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0
I
I 1
4 m n m m + - v b m m m w m m m m m
3 0 0 0 4 4 4 0 0 c 0 0 0 0 0 0 0 0
I
3 m w m o w + + m m m w ~ r n o w - ~
3 0 0 0 0
I
y y - 0 0 0I 0 0I 0 +I - 0 0
~ - m r n O O - N ~ N W O u N O O ~ +
3 d 0 0 0 N N 0 0 0 0 d 0 0 0 + 0 0
I
n m N N w m w + m m m o w - m - N m
3 0 N 0 0 0 0 0 0 0 0 0 0 0 ~ - 0 0
I
bwmmrnmr-OW-Wmmr-Wr-Qm
> 0 0 + 0 + 0 d 0 0 0 0 0 0 0 d 0 0
I
3 r n - m - m w m - w o ~ + m + ~ ~ m
~ ~ - O N ~ O O O O N - O - - O O O
I
-0-OVmOl.Wr-mW+VmNWW
~ + - N + - O m o
0 0 0 N 0 0 0
I
* m u + - m N w w N m m m m O N m O
- - 0 0 - 0 0 0 - 0 0 - ~ 0 ~ 0 N O
I
n W O ~ w m w ~ w w m m w O m m W 0
- ~ - + 0 0 0 0 0 0 + 0 0 - 0 0 - +
n m - v w m w w w - m o o m u r - m w
3 - 0 0 0 0 0 0 - m - 0 N 0 - 0 0 I
~ w - O w m + r . J w P - b w w m - O 3 + 0 + - 0 + + O N O
~ m b m u o w w m - ~ - r n m c o - w +
3 0 0 0 N 0 + 0 0 N O - - O O N O N ~
I
m m w r - ~ + m m v m m m m o o r n m m ~
+ ~ - ~ o o O - N - m N O N - - + N X
I
'
e w m w ~ m w m ~ m ~ b o m w w - N
~
=0
m m m - e o r - m - m r - m v + ~ c o ~ m w . S
- 0 - 0 - N - 0 0 0 0 - ~ N - N O O ~
I
d ~ N ~ 0 0 e d + N 0 - + 0 - 0 0 -
m U m m m - + m m W w w W m m m ~ m
N
y-yyo4yTNy?
m m m m a w w m o + w m m 0 - + ~ +
o m - r n w - m o o - - O N - 0 - - I
~ ~ f i m ~ W C O N W P V Q V P W C 3 O O
0 0 0 + 0 0
447"47474"Y0
V w W b b m W m d O m V d b m + m d
m + o w m - ~ o + - o - ~ O I
19-7
O - N O N N O V ~ ~ + - - - 0 0 - +
~ m m m - m m w m o r - m m v r - - m W
m O N + v N 0 0 m + 0 0 + - 0 0 0 0
I
o m - e r - m m - ~ - o r - m m o m ~ ~ - N ~ ~ o o o N ~ ~ ~ ~ ~
I
+ d m + m ~ m m w ~ b w m u w + W W
o + ~ m O m m C d ~ O - O
I
I
I I
4 O T T 4
w ~ m m m w r - o r - ~ m u r - m m f i ~ m
73CYT73YTyY'TCY'TYTY
+ ~ m ~ m w b m m O - ~ m - T m Q r - C O
3
TABLE 5 (Cont'd)
FACTORS(UNROTATED)
: CONTROLGROUP
Tests
19
-06 -15 32 -10 -01 46
20
- 4 7 -52 34 04 -04 -11
21
17 30 02 21 -14 13
-28 23 09 40 -19 13
22
23
-58 -19 11 -33 -16 17
24
- 4 9 35 -28 04 -30 16
25
-03 -35 19 -13 -05 -38
26
- 4 3 01 -14 -25 42 -04
27
- 4 9 -23 13 46 10 -07
28
-14 -13 17 -21 -06 - 0 9
29
- 4 7 -50 -33 -08 -23 19
30
-25 42 48 23 24 -27
31
-34 26 34 15 30 24
32
-23 64 13 -17 -19 05
33
-76 -07 26 12 -08 01
34
- 4 8 03 -12 -06 -09 21
35
-12 -20 - 4 8 37 -30 -30
36
-58 22 -12 07 31 -03
No~e.-Decimals have been omitted.
G
01
-05
03
-25
23
11
33
24
15
-59
08
15
-14
09
04
23
-08
-02
-17 -30
14 15
10-35
15 11
-06 -02
-05 07
-09 10
30 -13
12 -11
-04 02
06 04
15 07
-19 31
11 -24
-20 -19
-53 -04
-07 19
-24 05
29
27
47
23
-12
-13
19
23
08
-04
03
00
-02
13
-10
-02
20
19
-18
-01
-15
21
-03
-34
-26
00
-11
-25
-26
-18
-14
16
16
07
-02
07
-02
-13
-03
-24
13
-19
09
06
02
26
-30
00
18
-05
-08
-05
-03
06
Factors
M N
01
04
12
-03
18
-09
-04
-17
02
09
08
-12
-10
05
09
-01
-18
-06
20
-16
-17
20
06
06
-06
02
09
-17
02
20
20
-13
-09
13
14
-24
-15
07
-06
05
-20
11
-09
25
-02
-03
06
03
-09
-10
-13
04
-20
-22
-16
07
10
02
-05
-05
-17
08
-05
16
08
03
-07
01
-01
29
02
19
eel
m
R
05 14 -01
-29 04 10
04 09 10
-05 -02 -13
-15 -06 10
-08 -02 -01
14 -15 -03
-05 -04 14
32 -09 -10
07 03 05
07 04 06
-01 03 03
-16 03 17
-08 -28 00
-12 -05 -04
07 -11 00
-09 07 06
06 11 -05
-13 -08
07 14
-09 07
04 -07
08 -12
11 -02
03 08
06 -08
18 00
- 0 5 -14
02 -12
-05 -10
13 05
01 -02
05 -13
03 14
-09 01
06 07
05 01
-08 02
-05 -04
11 05
20 0 0
08 -01
-02 17
06 -01
02 -02
08 05
-17 -03
02 -01
-13 -04
-06 07
-15 -06
05 07
07 03
10 -03
05
06
00
-09
-09
03
-02
-16
-04
-01
-04
08
00
09
-07
08
00
-13
02
-04
00
-07
-09
13
06
05
-08
-01
-01
00
01
00
09
-02
03
06
-03
-04
04
06
-01
-01
06
02
-07
03
-03
05
-04
-07
11
02
-01
-07
z
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i
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5
5
2
n
A. J. AYRES
TABLE 6
HANDEDNESS
AND AGREEMENT
OF EYE-HAND
DOMINANCE
AMONGSS
BY VARIOUS CATEGORIES
Category
A Eye-hand Dominance
Strong
Strong
Mixed
Homol.
Clinical Syndrome
Apraxia
Perceptual Dysfunction: Form and Space
Deficit of Functional Integration
of Sides of Body
Perceptual Dysfunction: Figure-ground
Degree of Dysfunction
Highest Standard Scores
Lowest Standard Scores
Dysfunction vs Control Group
Dysfunction Group
Controls
Note.--R = Right-handed (Scores of +4 to +8), L = Left-handed (Scores of -4 to -8),
A = Adominant (Scores of -3 to + 3 ) . Strong eye-hand dominance determined by rest
scores of - t 5 or greater on both eye and hand dominance tests, agreement of algebraic signs
indicating homologous dominance and disagreement indicating mixed dominance. Ss with
weak eye o r hand dominance excluded from two right-hand columns.
D ~ s c u s s r oAND
~ CONCLUSIONS
Because knowledge of perceptual-motor disability is in its early, descriptive
le
has been the source of difficulties in building
stages and because its s ~ ~ b cnature
theories of perceptual-motor development, considerable structure has been imposed on the findings. Attention is called to the fact that this strucnlre is considered provisional and will need to be modified as additional scientific data become available.
The factor analytic structure leads to postulating the existence of five major
patterns of perceptual dysfunction. Future investigations may well reveal a larger
number. The fact that four of the five identifiable major factors emerging from
analysis of the scores of the dysfunction group did not appear in the factor matrix
of the control group leads to the hypothesis that those factors were not due to
normal developmental processes but to underlying deficits in specific mechanisms
of integration, resulting in symptom complexes. The fifth factor, which appeared on both matrices, was identifiable as figure-ground perception, a behavioral parameter long considered vulnerable to central nervous system dysfunction.
These two facts served as a basis for simplifying reference to the patterns of dysfunction as clinical syndromes. Attention is called to the fact that the syndromes
do not reflect inherent categorizations based on individual sensory modalities but
seem, to some degree, to be expressive of rather specific mechanisms by which
355
intersensory and (sometimes) motor information is coordinated to enable development of perceptual-motor functions.
Developmental Apravia
The fact that Factor A tended to load the greatest constellation of variables
suggests that a large number of tests of this disorder were included in the test battery, thus yielding the clearest definition of the factor. T h e descriptive title was
chosen o n the basis of high loading of Variable 1 (eye-hand accuracy), 2 6 (motor
planning using the grommet-wire device), and 18 (gross motor planning). Since
all Ss in the dysfunction group were young children and presumably had had perceptual-motor difficulty from an early age, "developmental apraxia" might be a
more accurate term. Finger identification (Var. 2 0 ) is a definite part of the
syndrome.
Of particular interest are the significant loadings of every test of tactile perception (Vars. 4, G, 7, 28, and 2 9 ) , suggesting that praxis is strongly dependent
upon perception of tactile stimuli. T h e substantial relationship between finger
identification and tactile perception tests seems to indicate that finger gnosis is
partly a matter of identifying location of tactile stimulus. T h e mutual appearance
of finger agnosia and deficit in motor planning on the same factor is in accord
with the theorem, arising from several sources, that finger dyspraxia is associated
with finger agnosia. Benton (1959a), for example, found a significant correlation in a group of normal children between finger localization and motor tasks involving movement of individual fingers in reference to each other. Both finger
agnosia and apraxia may stem, partially, from a common etiological factor-a disordered tactile system.
Rather unexpectedly, kinesthesia carried a much lower loading on the factor,
with kinesthetic memory (Var. 3 ) being .30 and perception of joint movement
(Var. 2 5 ) showing no significant saturation. T h e diffici~ltiesencountered in
evaluating perception of joint movement may have influenced this variable's appearance as a singlet in the analysis. Attention also is drawn to the fact that
graphic skills (Var. 2 ) loaded on the apraxia factor to a barely significant degree.
T h e common practice of including drawing of geometric forms in the training o f
children with percepnial deficits may have reduced the validity of this test item as
an indicator of percepmal-motor dysfunction.
T h e slight loading of the eye-pursuit test on the factor favors the conjecnlre
that the poor control over voluntary oailar movement as assessed in the snidy is
related to apraxia.
Benton (1951) found the concept of the body scheme "vague and ill-defined." These research data d o not add appreciable clarification, but it seems that
one aspect of body-scheme is the neurological substrate of which praxis is the behavioral or motor manifestation. If this is the case, then tactile impulses form
the major sensory source for the development of the body scheme. Another
356
A. J. AYRES
aspect of body scheme may be found i n the integration of function of the two
sides of the body, which is discussed below. The development of the body scheme
is considered to be dependent upon organization of past experience rather than
upon concomitant sensory information. T h e present findings show comparability
with the concept, for the test which best represented apraxia (fine mocor planning: wire) provided little tactile stimulation relevant to what was primarily a
visual-motor planning cask. T h e constellation of the syndrome militates against
the specificity of the finger scheme as separate from the body scheme in these
children.
357
Tactile Defensivenes~
Factor E, most clearly delineated by hyperactive-distractible behavior, has
been interpreted as a previously unrecognized syndrome characterized by deficit
in tactile percepcion, a defensive response to certain types of tactile stimulation
(Var. 34) and hyperactive behavior (Var. 3 5 ) . Attention is directed to the fact
that hyperactive-distractible behavior, a rather frequent concomitant of perceptual-motor dysfunction, appeared with significant loading on Factor E only, suggesting that, in this group, disinhibited behavior could be linked especially with
one particular pattern of neurological dysfunction. A theoretical rationale for the
existence of the syndrome of tactile defensiveness has been developed and presented elsewhere (Ayres, 1964b).
D e f i c i ~of Integrution of Function of the T w o Sides of the Body
The emergence of Factor K, along with the findings of other investigators,
may evenrually contribute to a theoretical system of considerable heuristic value.
Although the number of variables which loaded on the factor is limited, their configuration plus inspection of the correlation matrix provides some insight into
possible inherent linkage between isolated symptoms observed over the past century. Of the dimensions of behavior tested, the ability of the child to discriminate
between the right and left sides of the body (Var. 1 9 ) most clearly evaluates the
status of the symptom complex. T h e tendency of a child to cross or avoid crossing
the mid-line of the body wich his hand (Var. 24) was the next best indicator.
The appearance of the test of time and rhythm (Var. 3 2 ) wich a low loading o n
the factor adds clarification to the nanlre of the syndrome. Two-thirds of the
358
A. J. AYRES
items of the time and rhythm test required accurate and carefully timed reciprocal
interaction of the two upper extremities. Interitem correlations of scores of the
dysfunction group suggest natural relationships between right-left discrimination
and tactile and motor functions. However, in the control group, the only correlations approaching significance were with strength of hand dominance and body
visualization. Rather surprisingly, visual tests of a type of right-left discrimination, as in the items of the Frostig test of position in space or the Ayres Space
Test seem unrelated to perception of the right and left sides of the body.
These findings are not inconsistent with Benton's ( 1959b) conclusion that
the right-left gradient of the body scheme, on its most elementary level, is a function of somasthesia and motor integration. Benton suggested a probably decisive
role of proprioceptive innervation in the development of right-left discrimination.
Contrary to his premise, the tests designed to evaluate kinesthesis failed to load on
the same factor as right-left discrimination. T h e correlations between right-left
discrimination and each of the two kinesthetic variables also lacked statistical significance. I n the dysfunction group, the relationship of kinesthesis with crossing
the mid-line was low but significant. W h e n considered along with the substantial correlation between body balance and crossing the mid-line, there seems to be
some basis for proprioceptive linkage with the syndrome. T h e data point toward
a closer relationship of right-left discrimination with tactile and possibly vestibular than with kinesthetic perception. In view of the limitations inherent in
evaluating kinescher~c functions, these findings sho~ild not be considered irreversible.
N o evidence was found in the research data to support the supposition that
the degree of right-left discrimination was significantly related to symbolic language function in children, which Benton feels is necessary for discrimination beyond an elementary level. T h e data, however, did not provide an adequate test of
such an hypothesis. T h e sample population may have been at what Benton would
consider an elementary level. T h e age and degree of neurological integration of
any group probably are important factors in investigating right-left orientation.
Considering the small sample of behavior tapped by the test of crossing the
mid-line, the test scores yielded an unexpected amount of information. That some
brain-injured individuals have a tendency to avoid crossing the mid-line in activity
has long been reported in the literature. Its relationship to sensorimotor function
is expressed in the significant correlations with tactile perception and body balance in the dysfunction group and with tactile perception in the control group.
Inspection of the operations forming the basis for quantification of behavior
for analysis may shed possible insight into the nature of the syndrome. Some of
the items of che finger identification test, which was substantially related to crossing the mid-line, required that the child identify a finger on the opposite hand or
o n the analogous hand of the examiner, which would be o n the opposite side of
the child's indicated hand. Introduction of a task involving the relationship of
359
the two sides of the body may have introduced an element common to the test for
crossing the mid-line. O n the other hand, both parameters may be linked with
tactile functions or a complex neurological mechanism not yet understood.
Similarly, the greatest degree of association of the scores on crossing the midline with any of the tests of visual perception was with Frostig's test of space relations, in which the child was required to look o n one side of the page and reproduce a line on the other side. W h e n the page was centered in front of the child,
the left side of the body space was interacting visually with the right side. Visual
impulses from the left part of the field of vision course to the right hemisphere
while the left hemisphere primarily directs the copying by the right hand. Warnings, however, are directed against acceptance of a mere heuristic explanation,
however attractive. Froscig's space relations test was particularly sensitive to what
might be a common element in most perceptual-motor dysfunction. T h e common
element may account for the correlation.
Occasional reference is found in the literature to difficulty in ocular movement across the mid-line. W h i l e the degree of association between tests of crossing the mid-line and eye pursuits was low but significant in both the dysfunction
and control groups, the association of right-left discrimination with eye pursuits
in the dysfunction group was greater. I t is not unreasonable to conjecture that
some aspects of ocular movement are partially dependent upon the same neurophysiological mechanism as the other dimensions of behavior reflected in this
syndrome.
T h e above observations have led to concepnializing this pattern of deficits as
encompassing more than difficulty in crossing the mid-line or in identifying right
and left sides of the body. There seems to be a basic defect suggestive of lack of
interhemispheral integration. The cencrencephalic system of Penfield ( Penfield
& Roberts, 1959) may be pertinent to the syndrome. T h e system, located in the
brain stem, was hypothesized as a "coordinating mechanism that makes possible
appropriate employment of various parcs of the brain." Penfield reasons that
there must be a place in which activity of both hemispheres is summarized and
fused, making conscious planning possible.
Inspection of the pattern of ipsative standard scores used with the Q-technique factor analysis suggests that a considerable number of children whose main
difficulty appeared to lie in the syndrome of lack of integration of function of the
sides of the body also scored low on tests loading on the facror of perception of
form and space, an association not necessarily reflected in the correlation matrix.
There may be an inherent relationship between the two types of disorder, although
the only direct statistical support comes from the loading of number concepts on
both of the factors.
Although reading was not a behavioral element under study in this research,
a few comments about possible relationships may s u B e s t new directions for seeking understanding of reading disorders. An invariable right-left disorientation in
360
A. J. AYRES
children with dyslexia has been reported by Gooddy and Reinhold (1961) who
found it reflected in telling time, mirror reversal of letters, and the right-left orientation of doors. Frequently attendant to the symptom array were trouble wich
ll~athematicalsymbols, mixed dominance, and lack of establishment of handedness. T h e authors suggest, as a causal factor, failure to establish asymlnetry of
function, of which handedness, writing, and reading are the outcome.
Assuming that crawling and creeping enhance integration of the two sides
of the body through sensorimotor activity, the use of the basic quadrupedal ambulation patterns to enhance perceptual-motor integration may have its basis in the
mechanism of integration reflected in this syndrome. Further, assuming that
some reading disorders result from perceptual dysfunction, the use of creeping as
an aid to learning to read, as reported by Delacato (1963), may have a neurological basis related to the mechanism underlying these research observations.
Caution must be used, however, in accepting a convenient heuristic explanation
of what is undoubtedly a very complicated process.
Factor L, identified by its two best representatives, superimposed figures and
Gestalt completion (Vats. 30 and 31), is identified as ability to discriminate foreground from background. Operationally, the Gestalt completion test seems to involve organizing visual stimuli into a whole, pulling them into a foreground.
T h e superimposed figures cest required separating a part our from a whole, or
forcing a figure and ground relationship onto competing visual stimuli. Coefficients of the scores on the two tests with the other perceptual-motor tests suggest
that figure-ground perception is linked almost as closely to somesthecic and motor
processes as visual functions. The substantial relationship with tactile perception
is noteworthy. T h e high multiple correlation ( R = 9 2 ) between scores on the
test of superimposed figures and all other test scores leads to reasoning that the
test is particularly sensitive to neurophysiological dysfunction basic to much of the
percepmal-motor domain.
I t is noteworthy that visual figure-ground perception emerged as an independent factor as well as appearing linked wich apraxia. There may be a neurophysiological mechanism specifically responsible for figure-ground perception.
This mechanism may be v~llnerableto dysfunction in a manner similar to that
which underlies apmxia.
T h e emergence of the figure-ground factor in the control group factor analysis may bear some significance, perhaps to the effect that the ability may be expressive of a discrete area of normal development. T h e higher loading of the
age-related Gestalt function on the factor in the control group matrix attests to
this interpretation. The greater discriminative value (as judged by the critical
ratio) of the Gestalt cest was likely a function of its greater difficulty and not a
matter of sensitivity to neuropathology. T h e superimposed figures test did not
discriminate well among the better Ss in the dysfunction group. Identifying
361
362
A. J. AYRES
Laterality Functions
The failure of the variable "degree of agreement between eye and hand
dominance" to manifest strong associative bonds with any of the other variables
suggests that it is not related to perceprual-motor dysfunction as measured in this
study. These results, of course, do not preclude the possibility of the establishment of relationships between this variable and other dimensions of behavior,
such as language functions, or in different populations, or under different operational procedures for dominance.
The findings in relation to right- or left-hand preference also fail to supply
363
any support to theorems regarding the relationship of the variable to the percepmal-motor functions under investigation.
Of the laterality functions studied, strength of unilateral hand preference, regardless of whether right or left, appeared to be most closely linked to perceptualmotor functions. T h e degree to which strength of hand dominance correlated
with the other variables suggests that the behavioral parameter is related to functions of the eye and to manual dexterity; however, these data certainly d o not provide cogent evidence to that effect.
T h e one finding which lends support to Benton's (1959b) hypothesis thac
right-left discrimination is associated with strength of hand dominance was found
in the appearance of the two variables on the same factor in the analysis of all 150
Ss as one group.
I n addition to ascertaining the strength of hand dominance, the test battery
originally included a measurement of the strength of body-laterality, determined
by the sum of strength of unilateral hand, eye, and foot preference. Since the
measurement was not experimentally independent of the test of strength of unilateral hand preference or degree of agreement between eye and hand dominance,
it was excluded from the factor analysis. T h e correlations between strength of
unilateral body dominance and all other variables gave some information of value,
however. While strength of unilateral hand dominance demonstrated something
in common with the other variables, strength of lateralization of the body showed
n o significant relationship whatever. If strength of lateralization is linked with
perceptual-motor function, i t is likely limited to that of hand dominance.
Number Concepts
T h e results of this study are not inharmonious with the frequent attempts as
reported in the literanire to relate mathematical skill to perceptual-motor functions. T h e strong and comprehensive relationship of that type among Ss with
suspected dysfunction was particularly noteworthy, leading to the thesis that this
cognitive function is especially jeopardized by perceptual deficits. T h e data augur
for both a pervasive handicap as well as some specific connections. The most
obvious association is that with visual form perception. Distinguishing between
a "2" and a "3" is analogous to distinguishing between a rectangle and a square.
T h e spatial element of performance on number concepts may lie in the dependence upon spatial sequences and arrangements of objects used by the child and
instructor in forming the elementary concepts central to understanding number
relationships.
Danger lies in seeking only direct, external association between perception
and numerical learning as just illustrated. There is no self-evident explanation
for the appearance of number concepts as part of the symptom array reflecting integration of interhemispheral function. I t may be thac the presence of this symptom complex provides particular interference in the development of cognitive
processes.
364
A. J. AYRES
The classical question of relationship between finger agnosia and arithmetical ability, then, seems to be a part of the premise chat perceptual-motor development in general undergirds this academic skill. Finger identification is one of
the becter indicacors of level of perceptual-motor funccions. It is quite conceivable, though, that in children wich or without niinor perceptual deficits, other
factors i~nderlyingcognitive functions may be stronger determinants of academic
attainment.
OVERVIEW
T h e study was designed to discover and demonstrate relationships among the
different kinds of sensory perception, motor activity, laterality, and selected areas
of cognitive funccion. The sensory modalities under study were vision, tooch, and
proprioception. Langoage processes were excluded. I t was hypothesized ( a )
that factors of percepmal-motor function would emerge from R- and Q-technique
factor analyses of data obtained from sample populations of children with and
without suspected perceptual dysfunction, and ( b ) that factors derived from data
gathered from a sample population with suspected perceptual deficits would differ from those appearing from analysis of data from a matched group chosen
without reference to perceptual skill. T h e illtimate objective of the search for a
taxonomical categorization was to provide empirical data for the building of a
theoretical structure to explain the nature of perceptual-motor dysfunction,
thereby providing a basis for treatment procedures.
Method
A battery of 35 perceptual-motor tests was given individually to each member of two separate groups of children, one group selected on the basis of suspected or known percepnial deficits, especially as reflected in learning difficulty,
and the ocher group chosen from the "regular" public and private schools without
reference to behavior or academic performance. T h e tests evaluated the following areas of function: eye-hand coordination, graphic skills, visual perception,
kinesthetic perception, tactile functions, ocular control, finger identification, onelegged standing balance, gross and fine motor planning, right-left discrimination,
strength of unilateral hand dominance, degree of agreement between eye and hand
dominance, crossing the mid-line of the body, time and rhythm, number concepts,
tactile defensive behavior, and hyperactive distractible behavior.
The 69 males and 31 females who comprised the group wich suspected perceptual dysfunction were selected from regular and special schools and medical
centers. A requisite for inclusion in the group was a verbal intelligence quotient
above 70. T h e estimated mean IQ of the dysfunction group was 96.97; the mean
age was 84.1 mo. with a standard deviation of 7.3 mo. T h e control group of 50
children was chosen to approximate the dysfunction group on mean, variance, and
range of mental age, on sex, and o n the basis of parental occupation to proportionately represent the working population of the United States.
365
Using the IBM 7090 computer, intercorrelations between the 35 test scores
plus age were subjected to an R-technique orthogonal rotation factor analysis.
Analyses were made of the data from the dysfunction group alone, from the control g r o ~ alone,
~ p and from the total group of 150. T h e data from the dysfunction
group were also subjected to Q-technique analysis. T h e frequency distribution of
handedness and strong mixed or hornologoi~seye-hand dominance was determined
for the control and dysfunction Ss as well as for those Ss who showed natural
clusters best representing the major syndromes, as determined by the data from
the Q-technique analysis. T h e significance of differences of frequencies was determined with application of the ~"esc.
Resz~ltsand Discz~ssion
For the dysfunction group, 23 factors emerged from the R-technique analysis. Six factors accounted for most of the variance; five of the six were interpretable as hypothesized behavioral correlates of patterns of neurological dysfunction. T h e factor matrix derived from scores of the control group did not, for the
most part, yield faccors comparable to the major ones emerging From the dysfunction group, and those thac did emerge appeared to have little theoretical importance, suggesting that the factors derived from the dysfunction group reflected
symptom complexes or clinical syndromes. From the factor matrix based on all
150 Ss emerged factors similar to those derived from the dysfunction group, but
the factors were less clearly defined. I t is hypothesized for heuristic purposes that
the patterns appearing as factors in the dysfunction group were not due to normal
developmental processes, bot to underlying deficits in specific mechanisms of integra tion.
Major clinical syndromes.-The five interpretable patterns of percepmalmotor dysfunction (based on dysfunction group data only), their descriptions, and
their proposed means of identification follow.
Developmental apmxia: T h e first factor to emerge tended to load quite a
consrellation of variables, especially those designed co evaluate motor planning
and eye-hand accuracy. Also appearing on the factor were finger identification
and all tests of tactile perception, suggesting a strong relation berween praxis and
tactile functions. Kinesthetic perception demonstrated a much lower saturation
with the factor than did tests of tactile functions. The loading of eye pursuit on
the factor favors the conjecture thac poor control over voluntary ocular movement
is related to apraxia.
Perceplaal dysfz~nciion,form and position in two-dimen~ionalspace: This
factor, which also loaded a considerable number of variables, was best represented
by visual tests of form constancy and space relations. The appearance of tests of
manual perception of form and kinesthetic perception on the factor leads to interpretation of the factor as including tactile, kinesthetic, and visual perception of
form and position in space.
366
A. J. AYRES
367
eye-hand dominance bear little connection to perceptual-motor functions as evaluated. The laterality dimension showing the strongest affiliation with perception
was strength of hand dominance, but there was little statistical evidence to support
any theoretical formulations.
Number concepts.-This
cognitive function demonstrated close association
with perceptual-motor functions, especially within the dysfunction group. T h e
factor analyses showed the test to be most heavily saturated with the factors defined as form and space perception and ns integration of the two sides of the body.
Percepn~aldeficits in children show affinities resulting in symptom arrays or
syndromes which are not found in children from a random population. T h e syndromes do not reflect inherent categorization based on individual sensory modalities but seem, ro some degree, to be expressive of rather specific mechanisms by
which incersensory and (sometimes) motor information is coordinated to permit
development and manifestation of perceptual-motor ability. These mechanisms
appear to be differentially vulnerable.
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