- Email: [email protected]
Intelligence and school phobia
Journal of School Psychology Volume 11, No. 1, 1973
INTELLIGENCE AND SCHOOL PHOBIA EDWARD HAMPE, LOVICK MILLER, CURTIS BARRETT, and HELEN NOBLE Child Psychiatry Research Center University of Louisville School of Medicine Summary: Although the notion is widespread that school phobics are generally brighter than average, data to support this notion have never been collected systematically. Evidence from this study suggests that if the sample size is large and if economic barriers to treatment are not present, one finds that intelligence is distributed among school phobics as it is distributed in the general population. Implications for practice and research are discussed. One of the most consistent themes permeating the school phobia literature concerns the prevalence of above average intelligence and achievement among school phobic children. Eisenberg (1958), for example, has found that "most commonly he (the school phobic) is of average or better intellectual endowment and has done well academically prior to the onset of his neurotic symptoms." The frequent occurrence of high intelligence among children with school phobia has also been reported by Talbot (1957); A. Rodrigues, M. Rodriguez, & Eisenberg (1959); Leton (1962); Jarvis (1964); Coolidge, Brodie, & Feeney (1964); Warnecke (1964); Adams, McDonald, & Huey (1966); and Radin (1967). The above studies have not been concerned primarily with determining the relationship between cognitive skills and school phobia, with the perceived occurrence of above average intellectual ability being reported only incidentally. In these studies, the sample size was relatively small, and the samples consisted of accumulations of clinical cases. Moreover, no attempt was made to ensure that the samples of school phobic children which came to the attention of the investigators were representative of the population of school phobic children. Hence, it is possible that the perceived correlation between school phobia and high intelligence may be faultY and a result of uneven sampling of the school phobic population. Hersov (1960a, 1960b), in the only reported study found by the authors that contained a large number of subjects (N=50), found the mean IQ of school phobic children to be only slightly above average (X= 106.4, S.D. = 13.7, range =75-150). The slight elevation in average intelligence was probably due to the absence from the potential referral pool of children with IQs below 75, rather than to the alleged intellectual superiority of school phobic children. The present study was designed to determine systematically the relationship between cognitive abilities and school phobia. 66
Intelligence and School Phobia
67
METHOD Subjects. The subjects for this study were 57 school phobic children aged 6-15, a group which constituted all but four of the school phobic children seen at the Child Psychiatry Research Center between the inception of the phobia project in September, 1967, and its termination in June, 1970. This project has been reported in detail elsewhere (Miller, Barrett, Hampe, & Noble, 1972). Of the four cases for which no psychometric data were available, two broke off their relationship with the Center before they were to be tested. The other two remained in treatment, but refused to have a psychological evaluation. All four of these children were judged clinically to be of average intelligence. Referrals of children with clinical level phobias were sought as follows: In September of 1967, 1968, and 1969, letters were sent to all of the school principals, pediatricians, general practitioners, psychiatrists, and social agencies within the geographical area served by the University of Louisville Medical Center. The letter described the Child Psychiatry Research Center (a new facility in September, 1967) and its mission and described the characteristics of phobic children that would be either visible to, or reported by, parents to a potential referral source. Thus, cases were solicited from the entire socioeconomic range, from all of the schools in each of the local school systems (public, private, and parochial), and from all of the medical, psychological, and social work professionals in the community whose practice brought them into contact with children. Families were not charged for services, and transportation funds were available for indigent families. Procedure. Following an intake interview with the parents and a diagnostic interview in which the child was interviewed first with his parents present and then alone, each child was given a psychological evaluation. The child was tested by one of ten volunteers trained in the administration and scoring of the Wechsler Intelligence Test for Children and the Wide Range Achievement Test. All of the volunteers were women, all of them were parents, most of them were college graduates, and all of them had some college experience. Their training and supervision was at least as thorough as that which graduate psychology students receive in test administration and scoring. All ten became very capable psychometricians. Every testing session was followed by a supervisory session with a doctoral-level clinical psychologist. Scoring was checked during these sessions, and special problems related to test data gathering were discussed. No protocols had to be discarded.
RESULTS Despite attempts to recruit a representative sample of the general population, the sample differed from the general population in several ways. It contained fewer blacks and Catholics and fewer lower and middle socioeconomic status children. Precise demographic characteristics of the sample have been published elsewhere (Miller, et al., 1972). The major point to be made here is that while the sample is not representative of the general population,
Journal of School Psychology
68
we believe it represents the population of school phobic children whose parents are willing to seek help. The results of the current study support those of Hersov in that we found that intelligence is distributed among the school phobics in the sample virtually as it is distributed in the general population. This occurred despite the demographic inadequacies of the sample, inadequacies which skewed the sample in favor of the upper middle-class family. Table 1 presents the means, standard deviations, and ranges for each of the WISC subtests, the Verbal, Performance, and Full Scale IQs, and the Wide Range Achievement Test for the males, females, and total sample of school phobics. The WlSC data are virtually identical to the WISC standardization data (Wechsler, 1949). The mean IQs for the boys in the sample are slightly depressed because of the presence of four moderately defective boys. There were no moderately defective girls in the sample. Level of academic achievement is also distributed among the school phobic sample as it is distributed in the local general population. The achievement levels are quite comparable to those of the school populations from which they were drawn (Miller, 1972). While there are no differences between the sexes on intelligence, the girls' achievement level in reading and spelling is significantly higher than that of the boys'. These differences also reflect a general population difference. Among the children in the local school systems, underachievement is more prevalent among males than among females (Miller, 1972), Table 1 Intelligence and Achievement Tests: Means, Standard Deviations, and Ranges Tests
Males (N=34)
Females (N=23)
Total
M 9.0 9.7 8.9 10.1 8.7
SD 3.4 3.2 3.1 4.4 2.8
R
M
Inf. Comp. Arith. Sire. Voc.
2-16 5-17 3-17 0-20 4-15
9.3 9.6 9.5 11.3 9.3
SD 3.5 2.8 2.8 3.6 3.4
R 5-19 5-14 4-15 6-19 5-17
M 9.1 9.7 9.1 10.6 9.0
SD 3.4 3.1 3.0 4.1 3.0
R 2-19 5-17 3-17 0-20 4-17
PC PA BD OA Cod
9.7 9.6 9.8 10.2 10.3
3.2 3.2 3.7 4.0 4.2
2-17 2-17 0-20 3-18 1-18
11.1 9.7 10.0 11.0 11.8
3.2 2.8 2.8 2.6 4.0
7-19 6-16 4-14 7-16 7-20
10.3 9.7 9.9 10.5 10.9
3.2 3.0 3.4 3.6 4.1
2-19 2-17 0-20 3-18 1-20
VIQ PIQ FSIQ
95.5 99.4 97.0
16.8 18.8 18.5
55-128 51-135 48-135
98.7 105.14 101.86
17.6 15.4 16.4
72-134 78-135 76-135
96.7 101.6 98.9
17.1 17.7 17.7
55-134 51-135 48-135
Read.
85.2* 84.8 84.7
16.8 16.2 14.8"
39-118 104.59" 26-122 99.18" 26-106 89.91
20.6 12.0 9.7
63-152 66-121 69-104
92.7 90.4 86.7
20.5 16.2 13.2
29-152 26-122 26-106
Spell. Arith.
* p < .05
Intelligence and School Phobia
69
DISCUSSION The fact that school phobics as a group appear to be neither more nor less intelligent than are children from the general population carries with it several implications for mental health workers, school personnel, and researchers. First, a school mental health worker's index of suspicion for school phobia should not vary as a function of the intelligence of the child. We have observed clinically a tendency on the part of school personnel, and on our part as well, to think of refusal to go to school on the part of children with less than average intelligence as due to factors other than school phobia. If the child has good intelligence and performs well, an assessment of the child is likely to result in the diagnosis phobic. However, if a child is less intelligent, one is prone to interpret the child's behavior in other terms. With such a child, one is likely to be more sensitive to, and assign greater etiological importance to, signs of such things as delinquency, poor impulse control, and learning disorders. Not infrequently the child's presenting symptoms encourage such a misdiagnosis. It has been our experience that children do not always conceptualize their reluctance to go to school in terms of being afraid, and it may be that many children of low intelligence come from families that have never permitted the child to express fear as fear. Thus, the child has learned to alert society to the fact that he is afraid by being aggressive or by a paralysis of his ability to learn. In any event, the school mental health worker needs to be alert to the possibility of an intellectually limited child's reticence to attend school as being a phobic r e a c t i o n - t o realize that school phobia occurs just as often among children with below average intelligence as it does among children with above average intelligence. The second major implication of our findings concerns research strategy in the mental health field. One of the major data sources in mental health research is the clinic's or practitioner's flies. Case reports are an excellent source of hypothesis generation, but a test of a hypothesis requires careful sampling of the population. People who are patients at a psychiatric clinic rarely constitute a representative sample of the population from which they come. Thus, in order to derive accurate values for the epidemiological parameters of a particular disorder, one must either directly sample the population of persons with the disorder, or he must do all in his power to maximize the likelihood that the population of patients arriving at a clinic is indeed representative of the population of persons with the disorder. The second strategy is one which is especially adaptable to a community-oriented mental health center. Its use would not only produce more accurate information about the demography of disorders, but it would also simultaneously provide the mental health center with more accurate data with which to plan for the development and allocation of resources.
REFERENCES Adams, P., McDonald, N., & Huey, W. School phobia and bisexual conflict: A report of 21 cases.Psychiatry, 1966, 123, 541-547. Coolidge., J, Brodie, R., & Feeney, B. A ten-year follow-up study of sixty-six schoolphobic children. American Journal of Orthopsychiatry, 1964, 34, 675-784.
70
J o u r n a l of S c h o o l P s y c h o l o g y
Eisenberg, L. School phobia: A study in the communication of anxiety. American Journal of Psychiatry, 1958, 114, 712-718. Hersov, L. Persistent non-attendance at school. Journal of ChiM Psychology and Psychiatry, 1960, 1, 130-136. (a) Hersov, L. Refusal to go to school. Journal o f Child Psychology and Psychiatry, 1960, 1, 137-145. Co) Jarvis, V. Countertransference in the management of school phobia. Psychoanalytic Quarterly, 1964, 33, 411-419. Leton, D. Assessment of school phobia. Mental Hygiene, 1962, 46, 256-264. Miller, L. The school behavior check list: An inventory of deviant behavior for elementary school children. Journal o f Consulting and Clinical Psychology, 1972, 38, 134-144. Miller, L., Barrett, C., Hampe, E., and Noble, H. Comparison of reciprocal inhibition, psychotherapy, and waiting list control for phobic children. Journal of Abnormal Psychology, 1972, 79, 269-279. Radin, S. Psychodynamic aspects of school phobia. Comprehensive Psychiatry, 1967, 8, 119-128. Rodriguez, A., Rodriguez, M., & Eisenberg, L. The outcome of school phobia: A follow-up study based on 41 cases. American Journal of Psychiatry, 1959, 116, 540-544. Talbot, M. Panic in school phobia. American Journal of Orthopsychiatry, 1957, 27, 286-295. Warnecke, R. School phobia and its treatment. British Journal of Medical Psychology, 1964, 3L 71-79. Weehsler, D. WISCManual. New York: The Psychological Corporation, 1949. Edward Hampe Assistant Professor of Clinical Psychology University of Louisville School of Medicine 608 South Jackson Street Louisville, Kentucky, 40202 Lovick Miller Professor of Clinical Psychology Child Psychiatry Research Center University of Louisville School of Medicine 608 South Jackson Street Louisville, Kentucky 40202 Curtis Barrett Assistant Professor of Clinical Psychology Child Psychiatry Research Center University of Louisville School of Medicine 608 South Jackson Street Louisville, Kentucky 40202 Helen Noble Research Social Worker Child Psychiatry Research Center University of Louisville School of Medicine Louisville, Kentucky 40202 Received: August 14, 1972 Revision Received: September 28, 1972
INTELLIGENCE AND SCHOOL PHOBIA EDWARD HAMPE, LOVICK MILLER, CURTIS BARRETT, and HELEN NOBLE Child Psychiatry Research Center University of Louisville School of Medicine Summary: Although the notion is widespread that school phobics are generally brighter than average, data to support this notion have never been collected systematically. Evidence from this study suggests that if the sample size is large and if economic barriers to treatment are not present, one finds that intelligence is distributed among school phobics as it is distributed in the general population. Implications for practice and research are discussed. One of the most consistent themes permeating the school phobia literature concerns the prevalence of above average intelligence and achievement among school phobic children. Eisenberg (1958), for example, has found that "most commonly he (the school phobic) is of average or better intellectual endowment and has done well academically prior to the onset of his neurotic symptoms." The frequent occurrence of high intelligence among children with school phobia has also been reported by Talbot (1957); A. Rodrigues, M. Rodriguez, & Eisenberg (1959); Leton (1962); Jarvis (1964); Coolidge, Brodie, & Feeney (1964); Warnecke (1964); Adams, McDonald, & Huey (1966); and Radin (1967). The above studies have not been concerned primarily with determining the relationship between cognitive skills and school phobia, with the perceived occurrence of above average intellectual ability being reported only incidentally. In these studies, the sample size was relatively small, and the samples consisted of accumulations of clinical cases. Moreover, no attempt was made to ensure that the samples of school phobic children which came to the attention of the investigators were representative of the population of school phobic children. Hence, it is possible that the perceived correlation between school phobia and high intelligence may be faultY and a result of uneven sampling of the school phobic population. Hersov (1960a, 1960b), in the only reported study found by the authors that contained a large number of subjects (N=50), found the mean IQ of school phobic children to be only slightly above average (X= 106.4, S.D. = 13.7, range =75-150). The slight elevation in average intelligence was probably due to the absence from the potential referral pool of children with IQs below 75, rather than to the alleged intellectual superiority of school phobic children. The present study was designed to determine systematically the relationship between cognitive abilities and school phobia. 66
Intelligence and School Phobia
67
METHOD Subjects. The subjects for this study were 57 school phobic children aged 6-15, a group which constituted all but four of the school phobic children seen at the Child Psychiatry Research Center between the inception of the phobia project in September, 1967, and its termination in June, 1970. This project has been reported in detail elsewhere (Miller, Barrett, Hampe, & Noble, 1972). Of the four cases for which no psychometric data were available, two broke off their relationship with the Center before they were to be tested. The other two remained in treatment, but refused to have a psychological evaluation. All four of these children were judged clinically to be of average intelligence. Referrals of children with clinical level phobias were sought as follows: In September of 1967, 1968, and 1969, letters were sent to all of the school principals, pediatricians, general practitioners, psychiatrists, and social agencies within the geographical area served by the University of Louisville Medical Center. The letter described the Child Psychiatry Research Center (a new facility in September, 1967) and its mission and described the characteristics of phobic children that would be either visible to, or reported by, parents to a potential referral source. Thus, cases were solicited from the entire socioeconomic range, from all of the schools in each of the local school systems (public, private, and parochial), and from all of the medical, psychological, and social work professionals in the community whose practice brought them into contact with children. Families were not charged for services, and transportation funds were available for indigent families. Procedure. Following an intake interview with the parents and a diagnostic interview in which the child was interviewed first with his parents present and then alone, each child was given a psychological evaluation. The child was tested by one of ten volunteers trained in the administration and scoring of the Wechsler Intelligence Test for Children and the Wide Range Achievement Test. All of the volunteers were women, all of them were parents, most of them were college graduates, and all of them had some college experience. Their training and supervision was at least as thorough as that which graduate psychology students receive in test administration and scoring. All ten became very capable psychometricians. Every testing session was followed by a supervisory session with a doctoral-level clinical psychologist. Scoring was checked during these sessions, and special problems related to test data gathering were discussed. No protocols had to be discarded.
RESULTS Despite attempts to recruit a representative sample of the general population, the sample differed from the general population in several ways. It contained fewer blacks and Catholics and fewer lower and middle socioeconomic status children. Precise demographic characteristics of the sample have been published elsewhere (Miller, et al., 1972). The major point to be made here is that while the sample is not representative of the general population,
Journal of School Psychology
68
we believe it represents the population of school phobic children whose parents are willing to seek help. The results of the current study support those of Hersov in that we found that intelligence is distributed among the school phobics in the sample virtually as it is distributed in the general population. This occurred despite the demographic inadequacies of the sample, inadequacies which skewed the sample in favor of the upper middle-class family. Table 1 presents the means, standard deviations, and ranges for each of the WISC subtests, the Verbal, Performance, and Full Scale IQs, and the Wide Range Achievement Test for the males, females, and total sample of school phobics. The WlSC data are virtually identical to the WISC standardization data (Wechsler, 1949). The mean IQs for the boys in the sample are slightly depressed because of the presence of four moderately defective boys. There were no moderately defective girls in the sample. Level of academic achievement is also distributed among the school phobic sample as it is distributed in the local general population. The achievement levels are quite comparable to those of the school populations from which they were drawn (Miller, 1972). While there are no differences between the sexes on intelligence, the girls' achievement level in reading and spelling is significantly higher than that of the boys'. These differences also reflect a general population difference. Among the children in the local school systems, underachievement is more prevalent among males than among females (Miller, 1972), Table 1 Intelligence and Achievement Tests: Means, Standard Deviations, and Ranges Tests
Males (N=34)
Females (N=23)
Total
M 9.0 9.7 8.9 10.1 8.7
SD 3.4 3.2 3.1 4.4 2.8
R
M
Inf. Comp. Arith. Sire. Voc.
2-16 5-17 3-17 0-20 4-15
9.3 9.6 9.5 11.3 9.3
SD 3.5 2.8 2.8 3.6 3.4
R 5-19 5-14 4-15 6-19 5-17
M 9.1 9.7 9.1 10.6 9.0
SD 3.4 3.1 3.0 4.1 3.0
R 2-19 5-17 3-17 0-20 4-17
PC PA BD OA Cod
9.7 9.6 9.8 10.2 10.3
3.2 3.2 3.7 4.0 4.2
2-17 2-17 0-20 3-18 1-18
11.1 9.7 10.0 11.0 11.8
3.2 2.8 2.8 2.6 4.0
7-19 6-16 4-14 7-16 7-20
10.3 9.7 9.9 10.5 10.9
3.2 3.0 3.4 3.6 4.1
2-19 2-17 0-20 3-18 1-20
VIQ PIQ FSIQ
95.5 99.4 97.0
16.8 18.8 18.5
55-128 51-135 48-135
98.7 105.14 101.86
17.6 15.4 16.4
72-134 78-135 76-135
96.7 101.6 98.9
17.1 17.7 17.7
55-134 51-135 48-135
Read.
85.2* 84.8 84.7
16.8 16.2 14.8"
39-118 104.59" 26-122 99.18" 26-106 89.91
20.6 12.0 9.7
63-152 66-121 69-104
92.7 90.4 86.7
20.5 16.2 13.2
29-152 26-122 26-106
Spell. Arith.
* p < .05
Intelligence and School Phobia
69
DISCUSSION The fact that school phobics as a group appear to be neither more nor less intelligent than are children from the general population carries with it several implications for mental health workers, school personnel, and researchers. First, a school mental health worker's index of suspicion for school phobia should not vary as a function of the intelligence of the child. We have observed clinically a tendency on the part of school personnel, and on our part as well, to think of refusal to go to school on the part of children with less than average intelligence as due to factors other than school phobia. If the child has good intelligence and performs well, an assessment of the child is likely to result in the diagnosis phobic. However, if a child is less intelligent, one is prone to interpret the child's behavior in other terms. With such a child, one is likely to be more sensitive to, and assign greater etiological importance to, signs of such things as delinquency, poor impulse control, and learning disorders. Not infrequently the child's presenting symptoms encourage such a misdiagnosis. It has been our experience that children do not always conceptualize their reluctance to go to school in terms of being afraid, and it may be that many children of low intelligence come from families that have never permitted the child to express fear as fear. Thus, the child has learned to alert society to the fact that he is afraid by being aggressive or by a paralysis of his ability to learn. In any event, the school mental health worker needs to be alert to the possibility of an intellectually limited child's reticence to attend school as being a phobic r e a c t i o n - t o realize that school phobia occurs just as often among children with below average intelligence as it does among children with above average intelligence. The second major implication of our findings concerns research strategy in the mental health field. One of the major data sources in mental health research is the clinic's or practitioner's flies. Case reports are an excellent source of hypothesis generation, but a test of a hypothesis requires careful sampling of the population. People who are patients at a psychiatric clinic rarely constitute a representative sample of the population from which they come. Thus, in order to derive accurate values for the epidemiological parameters of a particular disorder, one must either directly sample the population of persons with the disorder, or he must do all in his power to maximize the likelihood that the population of patients arriving at a clinic is indeed representative of the population of persons with the disorder. The second strategy is one which is especially adaptable to a community-oriented mental health center. Its use would not only produce more accurate information about the demography of disorders, but it would also simultaneously provide the mental health center with more accurate data with which to plan for the development and allocation of resources.
REFERENCES Adams, P., McDonald, N., & Huey, W. School phobia and bisexual conflict: A report of 21 cases.Psychiatry, 1966, 123, 541-547. Coolidge., J, Brodie, R., & Feeney, B. A ten-year follow-up study of sixty-six schoolphobic children. American Journal of Orthopsychiatry, 1964, 34, 675-784.
70
J o u r n a l of S c h o o l P s y c h o l o g y
Eisenberg, L. School phobia: A study in the communication of anxiety. American Journal of Psychiatry, 1958, 114, 712-718. Hersov, L. Persistent non-attendance at school. Journal of ChiM Psychology and Psychiatry, 1960, 1, 130-136. (a) Hersov, L. Refusal to go to school. Journal o f Child Psychology and Psychiatry, 1960, 1, 137-145. Co) Jarvis, V. Countertransference in the management of school phobia. Psychoanalytic Quarterly, 1964, 33, 411-419. Leton, D. Assessment of school phobia. Mental Hygiene, 1962, 46, 256-264. Miller, L. The school behavior check list: An inventory of deviant behavior for elementary school children. Journal o f Consulting and Clinical Psychology, 1972, 38, 134-144. Miller, L., Barrett, C., Hampe, E., and Noble, H. Comparison of reciprocal inhibition, psychotherapy, and waiting list control for phobic children. Journal of Abnormal Psychology, 1972, 79, 269-279. Radin, S. Psychodynamic aspects of school phobia. Comprehensive Psychiatry, 1967, 8, 119-128. Rodriguez, A., Rodriguez, M., & Eisenberg, L. The outcome of school phobia: A follow-up study based on 41 cases. American Journal of Psychiatry, 1959, 116, 540-544. Talbot, M. Panic in school phobia. American Journal of Orthopsychiatry, 1957, 27, 286-295. Warnecke, R. School phobia and its treatment. British Journal of Medical Psychology, 1964, 3L 71-79. Weehsler, D. WISCManual. New York: The Psychological Corporation, 1949. Edward Hampe Assistant Professor of Clinical Psychology University of Louisville School of Medicine 608 South Jackson Street Louisville, Kentucky, 40202 Lovick Miller Professor of Clinical Psychology Child Psychiatry Research Center University of Louisville School of Medicine 608 South Jackson Street Louisville, Kentucky 40202 Curtis Barrett Assistant Professor of Clinical Psychology Child Psychiatry Research Center University of Louisville School of Medicine 608 South Jackson Street Louisville, Kentucky 40202 Helen Noble Research Social Worker Child Psychiatry Research Center University of Louisville School of Medicine Louisville, Kentucky 40202 Received: August 14, 1972 Revision Received: September 28, 1972