Cognitive Factors in Childhood Psychoses
I. KOLVIN, M. HUMPHREY and A. MCNAY
BJP 1971, 118:415-419.
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Brit. 3. Psychiai. (zg@i), ii8, 415—19
VI. CognitiVe Factors in Childhood
By I. KOLVIN,
M. HUMPHREY
This is the sixth and final paper of a series
studying
various
symptomatic,
physical
and
Psychoses
and A. MCNAY
scored within the normal range. But the intellec
tual status of these children
was markedly
superior to that of the I.P. group, I.Q.s of 70
and over being recorded
four times as often
social aspects of a sample of 47 cases of infantile
psychosis (I.P.) and 33 cases of late onset
(x2 284,p < .ooi)
psychosis (L.O.P.).
They were seen at the Park
Hospital for Children, Oxford, and the Newcastle
The
functional
level
of the
I.P.
group
was
Child Psychiatry Unit.
poor even in relation to other published
series.
The results of routine psychological testing
Only 2 I per cent exceeded the upper limit of
are shown in Table I. In older, more accessible,
educational
subnormality
(I.Q.
70), whereas
and brighter
childrentheWechslerIntelligencefigures of 29 per cent have been quoted by
Scale for Children or the 1960 revision of the Rutter (I 966a) and 39 per cent by Gittelman
and Birch (I 967). Many of these children were
TABLE I
indeed totally unresponsive to verbal testing,
Distribution of I.Q. in two psychotic groups
so reliance had
Global I.Q.L.O.P. no.ofcasesno. ofcases
47BothN%N%N%Under30I.P.
of learning
assessed
Untestable
4
8
13
26
13
over iioi
43
4
Stanford-Binet
51
27
7
3
15
6
L-M)
17
22
15
20
was used
and
impression
achieved
30
of
There
the
an I.Q.
group
these
children
of at least
gave
is clear evidence
a
mean
would
70. The
I.Q.
of
in
of a downward
amounting
to almost one
even in the L.O.P. group,
something
in certain
on
the
respects
Vineland
when
Social
is lost
by
pooling
heterogeneous
cases of childhood psychosis and that the dis
tinction we have introduced has implications
for prognosis, at least in the cognitive sphere.
From the clinical findings we have estimated
the long-term
educability
and employability
of both groups.
Without
a follow-up
study
we have no means of testing our predictions,
have
other
85
capacity
indirectly
If we were to ignore age of onset the overall
distribution of our own series would approxi
mate quite closely to theirs. This suggests that
the other cases the Merrill-Palmer.
Although
figures obtained from these different instruments
are not strictly comparable,
it was thought
legitimate to combine them within the twenty
point bands employed here. No mean I.Q. has
been calculated for the I.P. group, since a high
percentage of these children were untestable.
Only 3 of the L.O.P. group were not available
for testing but both on educational history and
clinical
the Merrill
the failure
of these authors
to distinguish
between early and late onset of the psychosis.
i6 2!
433 5
—¿25
1324
(Form
13
on
Maturity Scale.
A possible factor in the more favourable I.Q.
distribution of Gittelman and Birch's series is
50/
50—69
70—89
90—110
to be placed
Palmer battery with its high performance
loading and allowance for refusal of items.
Some of the untestable children gave evidence
@9.
but we believe that the L.O.P.
child is more
likely to be educable
than employable
after
leaving
school.
Indeed,
subject
to various
qualifications
all but one of these children had
already proved responsive to schooling. With
appropriate
treatment or educational help 12
were maintained at ordinary schools, another 8
shift
standard
deviation
only half of whom
415
416
COGNITIVE
at schools for the maladjusted
lent;
5 at schools
normal;
for the
FACTORS
IN CHILDHOOD
or their equiva
educationally
sub
6 had received special schooling in the
course of longish periods in institutions;
and
another
child,
after assessment
in hospital,
@
PSYCHOSES
I.Q. and Complications
The I.P.and L.O.P. group are considered
separately in Tables II and III. The L.O.P.
cases have been divided into three classes.
Taking
I.Q.
go as the lower
limit of normality,
there is a relationship between low I.Q. and
delayed milestones (p almost .05). However,
though the figures are small, perinatal complica
tions seem quite unrelated to later intellectual
level, with only one patient faffing below
I.Q. 90. Cumulative
evidence of cerebral
likely to prove
capable
eventually
of even
dysfunction proved more likely to be associated
unskilled work.
with poor intellectual level, but again not to
a statistically significant extent.
The I.P. group presented a more complex
picture. With these children the initial assess
Milestone delays in the I.P. group were so
ment would often lead to recommendations common that no useful patterns
emerged.
which couldnot be implemented.The number The lower I.Q.s were more frequently associ
ofrecommendationsthusexceededthenumber ated with perinatal complications, but this fell
of cases, and they do not extend beyond the
short of statistical
significance.
Yet when
nursery and infant school periods. Of the ‘¿4 cumulative
evidence of cerebral dysfunction
children recommended
for nursery school i i
(see Paper V) is considered a clearer association
were placed; of the 4 children recommended
appears. If the I.Q.s are divided into those
for an ordinary infant class, 3 survived there;
above and those below 50 a suggestively higher
proportion of the below-5o group have evidence
of the i6 recommended
for special schooling
(principally of the Rudolf Steiner type) most
of earlier
cerebral
dysfunction.
This
is in
ended in special units in subnormality hospitals
accord with the findings of Gittelman
and
or in E.S.N. schools; of the 5 recommended
Birch that perinatal
complications
were partic
ularly characteristic of ‘¿schizophrenic' children
for E.S.N. schools 4 were placed there. Places
were found for all 13 of the children who were
with lower intelligence and clinical evidence
of neurological dysfunction.
recommended for either a subnormality hospital
A number of follow-up studies have demon
or a training centre in default of any better
strated that infantile psychotics are often later
solution. In 4 cases no decision had been reached
reclassified as cases of primary mental deficiency
when the child was seen last. Finally, even
(Lourie et a!., 1943; Eisenberg,
1957; Gittelman
when the recommendations
were acted upon
and Birch, 1967). Some authors have explained
the child was sometimes unable to remain where
this in terms of deterioration or developmental
he had been placed. (Not surprisingly only
failure due to the psychotic process (Lourie
6 children in this group (13 per cent) were
regarded
as having reasonable
prospects of eta!.),while othershave argued thatthe mental
subnormality
was there from the beginning
employment.)
had returnedhome where therecommendation
unfortunately could not be implemented. Thus
at one time or another 32 out of 33 children in
the L.O.P. group had attended
either an
ordinary or an E.S.N. school. In contrast only
i8
per cent) impressed the clinician as
TABLE II
I.Q. and complicationsin L.O.P. Group
evidence
of cerebral
dysfunctionUnder7o
I.Q.TotalMilestone
70—89
Over9O5
8
175
delayPerinatal
5
6—
complicationsAccumulative
I
3
43
4
BY I. KOLVIN,
TABLE
M. HUMPHREY
III
ANTHONY,
=
= perinatal
totalB complications
C = accumulative
evidence of
cerebral dysfunction
I.Q.A
N%Under
—¿
13
5
Over7o23
1013
3
40SignificanceN.S.p
38
3016
5
(1962).
that if such a child reaches
0.
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upon
Tyne, and Statistician,
Xewcastle Regional Hospital Board