USE OF TEE DESPERT FABLES WITH DISTURBED CHILDREN 179

ment with that of Despert(') and Fine@); this may be because of the limited com- parisons made in their studies.

REFERENCES 1. DESPERT, J. L. Psychosomatic Study of Fifty Stuttering Children. Am@. J. Orthopsychiat.,

2. FINE, Reuben. Use of the Despert Fables (Revised Form) in Diagnostic Work with Children.

3. PEIXOTTO, H. E. Reliabihty of the Despert Fables, A story Completion Projective Test for

4. PEIXOTTO, H. E. Popular Responses for the Deapert Fables. J . elin. PsychoZ., 1957,ld, 73-79.

1946, 16, 100-73.

J . Proj. Tech., 1948,ld, 106-18,

Children. J. clin. Psychol., 1956, I d , 75-78.

THE INTELLECTUAL FUNCTIONING OF POSTPOLIOMYELITIC PATIENTS

LEON.4RD V. WENDLAND, ALBERT H. URMER AND H. WILLIAM SAFFORD

Respiratory and Rehabilitation Center for Poliomyelitis Rancho Los Amigos Hospztal, Downey, Caltfornia

INTRODUCTION A traumatic incident such as contracting poliomyelitis has been shown to have

sufficient effect upon the personality as to throw some doubt on the interpretation of the results in commonly utilized tests. In conjunction with this finding, interest was manifested in the intellectual function of the postpoliomyelitic patient. If the post- poliomyelitic patient functions below his preonset level on a particular instrument, then care must be taken in utilizing this instrument for prediction, since the pre- dictive accuracy of the instrument may be greatly reduced. This investigation had a dual purpose, (a) to evaluate the level of intelligence of a sample of the hospital respiratory-poliomyelitic population on the basis of their intellectual function, and (b) to determine if their function has changed from that of prepoliomyelitis onset.

PROCEDURE The verbal portion of the Wechsler Adult Intelligence Scale (WAIS) was ad-

ministered to 93 patients of whom 77 were inpatients a t the time of the testing. The initial purpose of the research was to study the relation between intelligence test scores and the following variables: (a) sex, (b) age at onset, and (c) length of time between onset and testing. In conjunction w t h the above, it was necessary to trace back into the patient history to get test results which might give us indices of pre- onset intellectual function. Since patients varied in age from below 20 years to ap- proximately 50 years, this tracing process proved rather difficult. A total of 20 patients were found on whom preonset intelligence testing was available, including 12 patients on whom Otis scores (various forms) were obtained and 8 patients on whom California Test of Mental Maturity scores were available. Both tests have been adequately validated which made their use feasible. The only caution necessary is the comparison of these group tests to an individual test (WAIS).

To analyze the intellectual level of our sample with the three variables men- tioned above, the analysis of variance technique was utilized. To investigate pre- and postonset intellectual function, it was necessary to convert the actual test scores on the various measures into a common ordinal scale in order to utilize some statistical method of comparison. The method utilized was to consider the mean score as given by the test as equivalent to a score of 50 and essentially convert all

180 LEONARD v. WENDLAND, ALBERT H. URMER AND H. WILLIAM SAFFORD

our scores to T scores. Therefore, a standard deviation of one on any of the measures would be equivalent to 10 score points in our new scale. This method was considered valid as no assumptions were made about the distribution of the test, rather the assumption was about the population. Presumably a person being tested on a series of tests, yet still remaining in the same population will fall within the same relative area in the normal distribution curve. Therefore, the type of test has no bearing on our new scale score as the person will still have the Bame relative ranking to the population as a whole. By converting to T scores these data were normalized, making the assumptions more valid.

RESULTS Table 1 indicates the I& means on the WAIS for the population. The analysis

of variance indicated that there was a significant difference between age groups as shown by an F of 4.45 which exceeded the .01 level of conildence. There was no

TABLB 1. WAIS SCORBS

Mean IQ N

Patients 109 93 Sex

Male Female

113 46 106 47

Length of time, onset to teatiig 0 - 6montha 104 22 7 - 12 months 107 20

13 - 24 month 111 19 2 - 5years 113 18 6 y e m and over 112 14

Age at onset 20 years and under 21 - 25 26 - 30 31 - 35 36 years and over

103 19 104 22 110 20 115 23 118 9

significant difference between the time interval of onset of poliomyelitis and the ad- ministration of the test. There was a significant difference in the test scores between males and females as indicated by an F of 10.15, again exceeding the .01 level of confidence. To investigate the difference between the means where the over-all age differences were significant, Sheffe’s method for getting the standard error of the difference of the means was used. The result was the 20 year and younger age groups and the 21-25 year age group differed significantly from the 31 and older age groups.

It is noteworthy that the mean I& on this test tends to increase with increased age groups (Table 1). The questions to be answered are (a) is this strictly a function of the test? (which we seriously doubt because the WAIS does compensate for in- creases in ages), (b) is this a selective factor of our poliomyelitic population?, and (c) is this a true difference which would tend to indicate that the older age groups tend to function more efficiently, intellectually? Our results are inconclusive ag to these factors and further investigations need to be undertaken to answer these questions.

The second part of this investigation dealt with a comparison of the preonset to postonset intellectual functions of the patients on whom preonset intelligence test data were available. Wilcoxon’s Matched Paired Sign Ranks Test was used for three reasons: (1) The group distributions were not normal. (2) The data were derived from matched samples. (3) A non-parametric technique was desired which does evaluate and weigh the actual numerical difference between two scores rather than just ranking them as other nonparametric techniques.

THE INTELLECTUAL FUNCTIONING O F POSTPOLIOMYELITIC PATIENTS 181

The results indicated that there was a significant decrease in intellectual func- tion, postonset (Table 2), as indicated by a T (Wilcoxon) of 48 which with an N of

T a m 2. COMPARISON OF PRE- AND POSTONSET TEST SCORES (2' SCORES)

Patient

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 19 20

Preonset Test Score

Otis Otis CTMM Otis Otis CTMM CTMM CTMM Otis CTMM Otis Otis Otis

57.2 78.4 55.5 59.6 46.4 54.7 42.9 45.5 59.0 46.1 57.2 58.4 71.4

Otis 68.5 CTMM CTMM

39.4 61.9

OtiS 44.0 Otis 57.6 Otis 54.1 CTMM 47.1

Postonset Score (WAIS)

46.1 54.6 55.9 61.8 44.1 44.1 46.7 38.8 51.3 51.3 55.9 51.3 42.1 54.6 46.1 58.6 44.1 49.4 52.6 55.3

20 is significant beyond .05 level of confidence. It is also noteworthy that out of the 20 patients, seven increased scores from pre- to postonset while 13 decreased their scores. However, the mean increase was only a total of 3.7 scale points while the mean decrease was 9.7 scale points. While the increase was roughly the same, which is mostly a chance factor, the decrease was highly significant being almost one standard deviation.

SUMMARY AND CONCLUSIONS The level of intellectual function of 93 post bulbospinal poliomyelitic patients

was investigated to determine if any systematic changes had occurred. The results indicate that (a) intellectual scores increase monotonically with increasing age, (b) male scores were significantly higher than female scores, and (c) a significant re- duction in intellectual function from preillness function is found.

While this investigation utilized only postpoliomyelitic patients, it is probable that similar results would be obtained using other disease groups requiring long-term hospitalization. It is, therefore, necessary to emphasize that the above reduction in test scores is not necessarily due to polio, but maybe a depression effect due to hospitalization per se. In evaluating the test results of postpoliomyelitic patients it is therefore important that these results be considered since a negative bias may result in predicting a patient's future potential.