Junior and Senior High School Music Students ...

Disability Factor Scale Attitudes 1

Junior and Senior High School Music Students' Attitudes Toward Individuals with a Disability Alice-Ann Darrow Christopher M. Johnson The University of Kansas


Running Head: DISABILITY FACTOR SCALE ATTITUDES Abstract The purpose of the present study was to: 1) assess junior and senior high school music students' attitudes toward disabled persons, and 2) to expand upon the existing literature by differentiating between disability groups and by extending the age range of subjects. A questionnaire, the Disability Factor Scale (DFS) (Siller, Ferguson, Vann, and Holland, 1967), was administered during three summer music camps located on a large midwestern university campus. Seven hundred fifty-two questionnaires were administered of which six hundred ninety-nine (N=699) surveys were completed correctly and used for subsequent analyses. These surveys represented 424 junior high school students and 275 senior high school students from 19 states. Results indicated that the junior high school students expressed a lower level of sensitivity toward people with disabilities than did the senior high school students with regard to all disabilities but one. Further results showed that females demonstrated a more accepting attitude toward people with a disability than males in every disability subscale. While junior high and senior high campers and males and females differed in the degree to which they were accepting of people with disabilities, a rank ordering of disabilities from the most to the least acceptable revealed that the three most accepted disabilities for both gender groups and age groups were: (1) visible scars, (2) heart condition, and (3) deafness. There was also overwhelming agreement regarding the three least acceptable conditions, which were: (8) paralysis, (9) AIDS, and (10) blindness. Implications for music therapists and music educators are cited.


Junior and Senior High School Music Students' Attitudes Toward Individuals with a Disability Attitudes are enduring, general evaluations of people, objects, or issues (Baron & Byrne, 1987). Though they are not directly observable or measurable, attitudes can be inferred from verbal and social behaviors. Attitudes are generally learned from others during the course of socialization or are formed based upon personal experiences. An attitude has three components: affect, behavior, and cognition. These components refer to our feelings, actions, and thoughts regarding the attitudinal target. Attitudes carry the connotation of a "pro" or "con" disposition toward a person(s) or object; and consequently, greatly affect our behavior. Stereotypic attitudes are the result of a biased or generalized image of an ethnic or social group. Disabled persons are particularly susceptible to stereotypic attitudes due to their minority status and limited integration into the mainstream of society. Relatively few people can count among their close friends, neighbors, or coworkers, a person with a severe disability. Stereotyped interpretations of behavior frequently reflect underlying devaluating attitudes. For example, a person with a disability is often considered to be "compensating" when, in fact, his or her behavior merely reflects interest. Attitudes, both general and stereotypic, toward disabled persons are complex and multidimensional (Antonak & Livneh, 1988). These attitudes, though subtle, are for the most part negative (Roessler & Bolton, 1978; Wright, 1983). Research has shown that nondisabled people in face-to-face interactions with disabled individuals: maintain more physical distance, terminate their conversations more quickly, engage in less eye contact, smile less, and show more signs of restlessness or discomfort (Wright, 1983). The result of negative or stereotypic attitudes is the tendency to create or maintain inadequate expectations of disabled persons which ultimately impacts upon their successful integration into society and their development of personal


independence. Until these subtle barriers to full acceptance are recognized and eliminated, persons with disabilities will be denied many of the benefits afforded their nondisabled peers such as employment and accessibility. The obstacle that a disability poses may be as much social attitudes as the physical disability itself. With some disabilities, such as facial disfigurement, the handicapping factors reside almost entirely in negative social implications (Wright, 1983). In such cases, measuring social attitudes can predict behaviors and thus, prepare professionals to intercede. Many attitudes are conveyed in the use of certain terminology, such as using the expression, "confined to a wheelchair." Most wheelchair users view their source of mobility as a lifeline rather than something to which they are "confined." Other social attitudes are more subtle, such as accolades which devalue: "You'd never know he was blind," "She dances well for person with an artificial leg," or "He is so brave and courageous." Attitudes are often revealed simply by the need to comment upon one's disability. Itzhak Perlman, world famous concert violinist (and post-polio paraplegic), once stated on the television news show, "60 Minutes" that it would be nice to read a review that did not mention his disability, especially since it was totally irrelevant to his performance. Altman (1981) stated that attitudes toward disabled persons may be conceived as operating in three distinct, yet interacting social circles or levels. Disabled persons' relatives, friends, and peers comprise the innermost circle. The attitudes of these influential groups affect not only the development of the disabled individual's self-concept, but also the socialization of the individual into typical community activities. The two outter circles, rehabilitation professionals and the general public, are not as critical to disabled persons' sense of self-worth and social acceptance as are family, friends, and peers. Though music educators and music therapists generally have little influence over a disabled persons' family, they are often in a position to create


and monitor social situations which facilitate positive interactions between disabled students/clients and their peers. By exploring the nature of the interaction between these two groups, we can better understand the components of negative attitudes (avoidance, rejection) as well as positive attitudes (interaction, acceptance) toward persons with a disability (Yuker, 1965). Examining the dimensions of negative and positive attitudes can also provide the background necessary for initiating change procedures and assessing the effect of intervention (Siller, 1984). Investigations of attitudes toward people with disabilities began over a half century ago with the work of Strong (1931) and Barker (1948). Subtle attitudes are identifiable even in these investigations themselves. The title of Mussen and Barker's 1943 study was "Attitudes toward Cripples" published in the Journal of Abnormal and Social Psychology. In their study, attitudes toward disabled persons were derived from computing the difference between the ratings of the "ideal" person and of the disabled individual. Many of these early attitudinal studies were concerned with the sensory impairment of blindness (Rusalem, 1950; Steingisser, 1954). By the early 1960s, studies concerned with attitudes toward other disability groups were initiated (Efron & Efron, 1967; Horowitz, Rees, & Horowitz, 1965). Due to the passage of the PL 94:142, The Education for All Handicapped Children Act, researchers in the 1970s focused on attitudes toward the mainstreaming of students with disabilities. During the 1980s, two of the most widely used attitude measures were developed, the Attitude Toward Disabled Persons Scale (ATDP) (Antonak, 1980c; Livneh, 1982a) and the Scale of Attitudes Toward Disabled Persons (SADP) (Antonak, 1981a, 1982). The attitudes of peers and music educators toward disabled students has been given attention, though somewhat limited, since the passage of PL 94:142 in 1974. In an early study, Stuart and Gilbert (1977) designed a videotape scale to measure attitudes toward atypical students and their musical behavior. Jellison (1985) developed an Acceptance Within Music Scales


(AMS), a questionnaire designed to measure children's attitudes toward disabled peers specific to music activities and to parallel existing items on a general Acceptance Scale (AS) with demonstrated validity for the measurement of children's attitudes toward disabled peers. In a later study, Jellison, Brooks and Huck (1984) examined the effect of three teaching conditions (large groups, small cooperative groups, and small cooperative groups with a music contingency for cooperation) on the frequency of positive social interactions between disabled and nondisabled peers in grades 3-6. Results indicated that the percentages of positive interactions were the highest for all grades under the small-group music contingency condition and the lowest under the largegroup condition. These data provide support for the feasibility of increasing positive interactions between disabled students and their nondisabled peers in a music setting. In more recent studies concerned with disabled students in the music classroom, Jellison and Flowers (1991) were interested in the music preferences, experiences, and skills of both disabled students and their nondisabled peers. Results indicated similar responses from these two groups of students. The purpose of a study by Cassidy and Sims' (1991) was to examine the effects of the presence or absence of disability labels on children's and music educators' evaluations of a musical performance by students with disabilities. Results indicated that the two groups of subjects seem to have used the information related to disability differently. Peers rated the musical performance by students with disabilities higher when given the disability label. Music educators rated the music performance higher when given no label. Elliot and Sins (1981/1982) were concerned with the attitudes of music students toward their disabled peers. Middle school students were surveyed regarding their opinions and attitudes toward the presence of disabled peers in the music classroom. The questionnaire was administered to 27 music classes in four southern and midwestern states. Students' attitudes were viewed as an indication of their acceptance of mainstreamed students. No differentiation was


made among handicapping conditions. Results indicated that little over half of the students responded positively concerning their own attitudes toward the integration of disabled students, females tended to be more positive regarding their own attitudes and when projecting the opinions of their classmates, and students in segregated classes were more positive than those in integrated classes, indicating that hypothetical situations with disabled classmates were viewed more positively than real experiences with disabled peers. Older students tended to be more positive than younger students. The purpose of the present study was to: 1) assess junior and senior high school music students' attitudes toward disabled persons, and 2) expand upon the existing literature by differentiating between disability groups, by extending the age range of subjects, and by examining several additional dimensions of attitude. Examining the current status of student attitudes can provide music therapists and music educators the opportunity to reinforce appropriate attitudes, modify inappropriate attitudes, predict behaviors, as well as program for interventions which facilitate positive interactions. The interactions and attitudes of teachers, and peers in particular, can have an important impact upon the development of the disabled student's self concept. Method

A questionnaire, the Disability Factor Scale (DFS) (Siller, Ferguson, Vann, and Holland, 1967), was administered during three summer music camps located on a large midwestern university campus. Students were categorized by: junior or senior high, year in school, gender, major ensemble participation (band, chorus, orchestra, piano), and by classification of major instrument family (woodwind, brass, percussion, string, voice, piano). Seven hundred fifty-two surveys were completed, of which six hundred ninety-nine (N=699) were


completed correctly and used for analysis. These surveys represented 424 junior high school students and 275 senior high school students from 19 states. The DFS questionnaire consists of sixty-nine self-report summated rating scales designed to measure attitudes toward specific disabilities and across disabilities. The disabilities selected, which sample different degrees of both functionality and visibility of impairment, include: amputation, blindness, cosmetic conditions, deafness, paralysis, epilepsy, and health related disabilities such as cancer. The DFS is composed of statements depicting a variety of reactions, assumed attributes, and advocated policies toward several types of physical disabilities. In expressing their level of agreement or disagreement with statements regarding each disability, respondents select one of six possible choices, ranging from 1 "strongly agree" to 6 "strongly disagree." After data collection was completed all answers were coded such that a 6 represented the most positive attitude toward a certain disability group; conversely, a 1 represented the most negative attitude. Information related to the reliability and validity of the DFS reports adequate reliability and validity (Antonak & Livneh, 1988). It should be noted that six AIDS questions were added to the survey from its original format increasing the total number of items on the survery to 75. All of the AIDS questions were adapted directly from the questions asked about other health related disabilities and were placed in the survey in random order. These items were added due to the predominance of AIDS in society today. Considering the health related illnesses included in this survey, it is likely that AIDS would have also been included in the instrument had it been the public issue when the survey was developed that it is today. The researchers involved in this study believe that AIDS is a disease with considerable social implications and hence, wanted to investigate students' attitudes toward persons with this disease. Results


Surveys including 75 statements concerning people with disabling conditions were completely correctly by 699 students at three summer music camps. Each of the statements concerned some aspect of an attitude such as imputed functional limitations, rejection of intimacy, interaction strain and generalized rejection. Individual items were directed toward a single disability. Data involved circling a number from 1 to 6 indicating whether each subject agreed or disagreed with the given statement. All answers were coded such that a 6 represented the most positive attitude toward a certain disability group and a 1 the most negative.

Overall mean and standard deviation scores for each disability are illustrated in Table 1. The three disabilities receiving the most positive scores were clearly viewed in a more positive light than the other seven. Conversely, the three disabilities at the bottom of the list received notably lower scores than the top seven. The four disabilities in the middle were rated similarly.

Insert Table 1 about here

When survey data were analyzed with regard to ensemble type, instrumental identification, and age, no significant differences were found. However, the demographic divisions according to educational level and gender showed several interesting contrasts. When student responses were considered with regard to whether they attended the junior high or senior high camp, several differences in attitudes were prominent. Data were processed using t-Test procedures and in five of the ten subscales the senior high school students demonstrated a significantly more positive attitude toward persons with a particular disability than did the junior high school music campers (see Table 2). The five disabilities that were significantly different were: amputation (t = 3.27, df = 697, p = .001), blindness (t = 1.98, df =


697, p = .048), deafness (t = 4.10, df = 697, p < .001), epilepsy (t = 6.61, df = 697, p < .001), and heart condition (t = 2.70, df = 697, p = .007). Although not significantly different, the senior high campers registered a higher degree of acceptance for four of the remaining five disability variables: cancer, physical deformity, paralysis, and visible scars, though not AIDS.


The data also revealed several interesting differences when examining responses in regard to subjects' gender (see Table 3). Of the ten subscales, only two were not significantly different: cancer and epilepsy. The subscales which did show significant differences were: AIDS (t = 3.37, df = 697, p = .001), amputation (t = 3.37, df = 697, p = .001), blindness (t = 4.64, df = 697, p < .001), deafness (t = 3.64, df = 697, p < .001), heart condition (t = 3.81, df = 697, p < .001), paralysis (t = 4.50, df = 697, p < .001), physical deformity (t = 5.53, df = 697, p < .001), and visible scars (t = 4.34, df = 697, p < .001). In every subscale females demonstrated a more accepting attitude toward people with a disability.


While junior high and senior high campers and males and females differed in the degree to which they were accepting of people with disabilities, a rank ordering from the most to the least acceptable revealed concurrence between age and gender groups that is uncommonly uniform (see Table 4). Without exception, the three most accepted disabilities were: (1) visible scars, (2) heart condition, and (3) deafness. Agreement was also found for the three least acceptable conditions: (8) paralysis, (9) AIDS, and (10) blindness. When these rank order data were subjected to a


Friedman Two-Way Analysis of Variance on Rank Orders the Kendall Coefficient of Concordance was .004 (X2 = .16, df = 4, p = .997).


Discussion Inclusive practices (the full-time integration of students with disabilities into the regular classes) are becoming increasingly common; and hence, require heightened sensitivity to related issues. The purpose of the present study was to: 1) assess junior and senior high school music students' attitudes toward disabled persons, and 2) expand upon the existing literature by differentiating between disability groups, by extending the age range of subjects, and by examining several additional dimensions of attitude. Junior high school students in the present study expressed a lower level of sensitivity toward people with disabilities than did the senior high school students. These data corroborate the findings of Elliot and Sins (1981/82). These data also seem to support the common assumption that junior high school aged students are less accepting of people who are "different." The fact that senior high school students demonstrated a more accepting attitude in every measure but one indicates that acceptance can be learned and that the liklihood of acceptance increases with time and exposure. This would indicate that the inclusion of students with disabilities in the music classroom should occur as early as possible in order to maximize the benefits of socialization. The results of this study might also indicate that student maturation has an effect on acceptance. Students in senior high were more accepting of people with disabilities for every disability, but AIDS. Why this was the case could be any number of reasons. AIDS was the only


condition on this survey that is transmittable, and hence, the only category on this list in which the person with the condition very often has some control over its acquisition, although a moderate case could be made for the possibility of avoiding heart conditions. AIDS is also the one condition on the survey that, at least to date, is truly terminal. It might also be the case that many high school students still harbor some misconceptions about AIDS. High school students' increasing sexuality may also make the threat of AIDS more real than for junior high school students. Previous literature (Eichinger, 1992) suggests that females show a more positive attitude toward people with disabilities than males. This was the case with every disability examined in this study. This result presents an important question. If one believes that sensitivity is not innate but a learned attribute, why is it not taught as effectively to male students? As teachers and therapists, perhaps there is cause to examine our own gender attitudes with regard to our students and clients. Possibly the most interesting result of this study is the order that occurs when disabilities are ranked according to acceptance by demographic subgroups. Although the junior high school students are less accepting than the senior high school students and although the male students are less accepting than the female students, all students appear to accept some disabling conditions more readily than others (see Table 4). Visible scars (mostly characterized as facial scars), heart trouble, and deafness were the three most accepted disabilities of the survey. Perhaps the acceptance of deafness and heart trouble is understandable since they are relatively "invisible" disabilities. Given this premise, it would seem odd that facial scars also was considered to be one of the more acceptable disabilities. It is possible, however, that subjects' frame of reference was the type scars with which they are probably the most familiar -- scars which are the result of childhood accidents, not the disfiguring nature of scars caused by serious injury such as burns.


The high profile of deaf actors today, such as Marlee Matlin, movies such as "Children of a Lesser God" and the increased exposure of sign language in society may also account for the acceptance of deafness as a disability.

The three conditions least accepted were paralysis, AIDS, and blindness. Though paralysis and AIDS might well be perceived as two of the more disabling conditions, people who are blind have functioned well in the mainstream of society for many years. Possible explanations are that AIDS results in death and both blindness and paralysis have serious implications for personal mobility which is highly valued, particularly by young people. The other four disabilities received acceptability ratings which were very close to each other and consequently have a less distinct ordering pattern across the subgroups. The survey instrument used in this study did not attempt to probe why a subject found a person with a particular disability more or less acceptable, it merely attempted to establish an acceptability level. Furthermore, there are several disabilities that are not included in this survey, i.e. persons with serious speech impairments which previous research (Anderson & Antonak, 1992) has found to be more unacceptable than many physical disabilities. Knowledge of current student attitudes can provide music therapists and music educators the opportunity to reinforce appropriate attitudes, modify inappropriate attitudes, as well as plan for interventions which will most likely facilitate positive interactions. It seems axiomatic that reinforcement or modification of these attitudes is not possible until they are first identified. Because of the Americans with Disabilities Act (1990) and educational reforms such as mainstreaming and inclusion, persons with disabilities are more actively


participating in life's full range of activities. As persons with disabilities are increasingly accepted into the mainstream of society, we would hope that attitudes toward them will be modified accordingly. This study identifies two main concerns which are deserving of further attention: 1) the need to nurture and encourage acceptance of persons with disabilities by males as well as females, and 2) to identify "handicapism" as it might apply to all disabilities, regardless of the visibility and severity of the disability. Further investigation into why some disabilities seem to be more acceptable than others would also enlightening. It would also be very interesting to observe the subjects and compare their overt behaviors in the presence of people with disabilities to their ideational answers on an anonymous survey. One would only hope they were as understanding in practice as they appear to be philosophically. Experimental research should address strategies which help to overcome prejudice and modify negative attitudes as well as facilitate and foster positive attitudes toward persons with a disability. While the proximity of students with disabilities to their nondisabled peers appears to be helpful in fostering acceptance, the modeling of accepting behaviors by teachers and therapists as well as effective intervention procedures may further promote the development of positive attitudes.


References Altman, B. M. (1981). Studies of attitudes toward the handicapped: The need for a new direction. Social Problems, 28, 321-337. Anderson, R., & Antonak, R. F. (1992). The influence of attitudes and contact on reactions to persons with physical and speech disabilities. Rehabilitation Counseling Bulletin, 35, 240247. Antonak, R. F. (1980c). Psychometric analysis of the Attitude Toward Disabled Persons Scale, Form-O. Rehabilitation Counseling Bulletin, 23, 169-176. Antonak, R. F. (1981a). Development and psychometric analysis of the Scale of Attitudes Toward Disabled Persons (Technical Report No. 1). Durham, NH: University of New Hampshire, Education Department. Antonak, R. F. (1982). Development and psychometric analysis of the Scale of Attitudes Toward Disabled Persons. The Journal of Applied Rehabilitation Counseling, 13(2), 22-29.

Antonak, R. F., & Livneh, H. (1988). The measurement of attitudes toward people with disabilities: Methods, psychometrics and scales. Springfield, IL: Charles C Thomas. Barker, R. G. (1948). The social psychology of physical disability. Journal of Social Issues, 4(4), 28-38. Baron R., & Byrne, D. (1987). Social psychology: Understanding human interaction. Boston, MA: Allyn and Bacon, Inc. Cassidy, J. W. & Sims, W. (1991). Effects of special education labels on peers' and adults' evaluations of a handicapped youth choir. Journal of Research in Music Education, 39, 23-34. Efron, R. E., & Efron, H. Y. (1967). Measurement of attitudes toward the retarded and an application with educators. American journal of Mental Deficiency, 72, 100-106.


Eichinger, J. (1992). Attitudes related to attitudes toward people with disabilities. Journal of Rehabilitation Research, 15, 53-56. Elliott, C. & Sins, N. (1981/82). Attitudes and opinions of middle school music students toward the presence of handicapped peers in music classes. Contributions to Music Education, 9, 4859.

Horowitz, L. S., Rees, N. S., and Horowitz, M. W. (1962). Attitudes toward deafness. A paper presented at the Convention of the American Speech and Hearing Association, New York. Jellison, J. A. (1985). An investigation of the factor structure of a scale for the measurement of children's attitudes toward handicapped peers within regular music environments. Journal of Research in Music Education, 33, 167-177. Jellison, J., Brooks, B. & Huck, A. M. (1984). Structuring small groups and music reinforcement to facilitate positive interactions and acceptance of severely handicapped students in the regular music classroom. Journal of Research in Music Education, 32, 243-264. Jellison, J., & Flowers, P. (1991). Talking about music: Interviews with disabled and nondisabled children. Journal of Research in Music Education, 39, 322-333. Livneh, H. (1982a). Factor analysis of the Attitudes Toward Disabled Persons Scale-form A. Rehabilitation Psychology, 27, 235-243. Mussen, P. H., & Barker, R. G. (1943). Attitudes toward cripples. Journal of Abnormal and Social Psychology, 39, 351-355. Roessler, R., & Bolton, B. (1978). Psychosocial adjustment to disability. Baltimore, MD: University Park Press. Rusalem, H. (1950). The environmental supports of public attitudes toward the blind. New Outlook for the Blind, 44, 277-288.


Siller, J. (1984). Attitudes toward the physically disabled, In R. L. Jones (Ed.), Attitudes and attitude change in special education: Theory and practice (pp. 184-205). Reston, VA: Council for Exceptional Children. Siller, J., Ferguson, L. T., Vann, D. H., & Holland, B. (1967). Structure of attitudes toward the physically disabled: The Disability Factor Scales -- Amputation, Blindness, Cosmetic Conditions. Studies in reactions to disability: XII. New York University School of Education, New York. Steingisser, E. R. (1954). The influence of set upon attitudes toward the blind as related to selfconcept. Unpublished Master's thesis, University of new Hampshire, Durham. Strong, E. K. (1931). Changes of interest with age. Palo Alto, CA: Stanford University Press. Stuart, M. & Gilbert, J. (1977). Mainstreaming: Needs assessment through a videotape visual scale. Journal of Research in Music Education, 2, 3-6. Wright, B. A. (1983). Physical disability -- A psychosocial approach (2nd ed.). New York: Harper and Row. Yuker, H. E. (1965). Attitudes as determinants of behavior. Journal of Rehabilitation, 31, 15-16.


Table 1 Means and Standard Deviations for all disabilities in descending order

Disability

Mean

Standard Deviation

Visible scars

4.66

.83

Heart Condition

4.47

.67

Deafness

4.37

.66

Amputation

4.25

.66

Physical deformity

4.23

.88

Cancer

4.21

.75

Epilepsy

4.13

.66

Paralysis

4.07

.62

AIDS

3.92

.76

Blindness

3.88

.60


Table 2 Means and Standard Deviations for all disabilities for Junior and Senior High School Aged Subjects

Disability

Junior High

Senior High

Significance

Mean

S. D.

Mean

S. D.

AIDS

3.94

.74

3.89

.78

.349

Amputation

4.19

.66

4.35

.66

.001

Blindness

3.85

.58

3.94

.61

.048

Cancer

4.17

.75

4.27

.76

.073

Deafness

4.28

.65

4.49

.66

.000

Epilepsy

4.00

.66

4.33

.63

.000

Heart Condition

4.42

.67

4.56

.66

.007

Paralysis

4.05

.59

4.10

.67

.256

Physical deformity 4.19

.89

4.28

.86

.180

Visible scars

.83

4.67

.84

.761

4.65

p


Table 3 Means and Standard Deviations for all disabilities for Male and Female Subjects

Disability

Males

Females

Significance

Mean

S. D.

Mean

S. D.

AIDS

3.80

.76

4.00

.75

.001

Amputation

4.14

.70

4.32

.63

.001

Blindness

3.75

.60

3.96

.58

.000

Cancer

4.19

.75

4.22

.75

.652

Deafness

4.25

.75

4.43

.59

.000

Epilepsy

4.08

.71

4.16

.64

.149

Heart Condition

4.35

.76

4.55

.60

.000

Paralysis

3.93

.63

4.15

.61

.000

Physical deformity 3.99

.91

4.36

.82

.000

Visible scars

.93

4.76

.75

.000

4.48

p


Table 4 Rank Order of Acceptability of Disabilities taken from Mean Attitude Scores

Disability

Overall

Males

Females

Junior High

Senior High

AIDS

9

9

9

9

10

Amputation

4

5

5

4

4

10

10

10

10

9

Cancer

6

4

6

6

7

Deafness

3

3

3

3

3

Epilepsy

7

6

7

8

5

Heart Condition

2

2

2

2

2

Paralysis

8

8

8

7

8

Physical deformity 5

7

4

5

6

Visible scars

1

1

1

1

Blindness

1