DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY ORIGINAL ARTICLE

Stability of cognitive performance in children with mild

intellectual disability
OSKAR G JENNI 1,2 | SYLVIA FINTELMANN 1 | JON CAFLISCH 1 | BEATRICE LATAL 1,2 | VALENTIN ROUSSON 3 |
AZIZ CHAOUCH 3

1 Child Development Center, University Children’s Hospital Z€urich, Z€urich; 2 Children’s Research Center, University Children’s Hospital Z€urich, Z€urich; 3 Centre
Hospitalier Universitaire Vaudois and University of Lausanne, Statistical Unit, Institute of Social and Preventive Medicine, Lausanne, Switzerland.
Correspondence to Oskar G Jenni at Department of Pediatrics, Child Development Center, University Children’s Hospital, Steinwiesstrasse 75, CH-8032 Z€urich, Switzerland.
E-mail: oskar.jenni@kispi.uzh.ch

PUBLICATION DATA AIM Longitudinal studies that have examined cognitive performance in children with
Accepted for publication 19th September intellectual disability more than twice over the course of their development are scarce. We
2014. assessed population and individual stability of cognitive performance in a clinical sample of
Published online 2nd November 2014. children with borderline to mild non-syndromic intellectual disability.
METHOD Thirty-six children (28 males, eight females; age range 3–19y) with borderline to
ABBREVIATIONS mild intellectual disability (Full-scale IQ [FSIQ] 50–85) of unknown origin were examined in a
FSIQ Full-scale IQ retrospective clinical case series using linear mixed models including at least three
SES Socio-economic status assessments with standardized intelligence tests.
RESULTS Average cognitive performance remained remarkably stable over time (high
population stability, drop of only 0.38 IQ points per year, standard error=0.39, p=0.325)
whereas individual stability was at best moderate (intraclass correlation of 0.58), indicating
that about 60% of the residual variation in FSIQ scores can be attributed to between-child
variability. Neither sex nor socio-economic status had a statistically significant impact on
FSIQ.
INTERPRETATION Although intellectual disability during childhood is a relatively stable
phenomenon, individual stability of IQ is only moderate, likely to be caused by test-to-test
reliability (e.g. level of child’s cooperation, motivation, and attention). Therefore, clinical
decisions and predictions should not rely on single IQ assessments, but should also consider
adaptive functioning and previous developmental history.

Cognitive performance tests are widely used in the clini-
cal evaluation of children with intellectual disabilities.
Medical diagnostic and therapeutic procedures as well as
the need for special educational services are often decided
on the magnitude of intellectual impairment of these indi-
viduals. For example, special needs services are offered
depending on individual IQ test scores (e.g. children with
an IQ<70 or 75 will receive support, while others will
not). Moreover, physicians may initiate further diagnostic
procedures (such as genetic testing, magnetic resonance
imaging, and so on) if an IQ is below a certain cut-off
value or if cognitive decline is occurring. In this context,
a critical question is whether cognitive functions remain
stable over time and, thus, are valid measures of the true
abilities of the individual and therefore support further
clinical decisions. One approach to address this question
is to study children with intellectual disability several
times during their development.
While there is an abundance of earlier studies about the
stability of IQ test scores in children with typical develop-
ment (for an older, but comprehensive review and
references see Conley1 and a recent twin study considering
genetic and environmental contributions2) and in children
with genetic syndromes such as Fragile X, Down syn-
drome, or Williams syndrome,3–7 only few studies exist
that include children with mild intellectual disability of
unknown origin (i.e. non-syndromic or unspecific intellec-
tual disability). For instance, Naglieri and Pfeiffer8 studied
54 children with a mean Full-scale IQ (FSIQ) of 75 at age
9 years, re-tested them 3 years later using the Wechsler
Intelligence Scale for Children (WISC-R) and found a cor-
relation coefficient of 0.56. Similarly, Friedman et al.9
assessed 44 individuals with intellectual disability with a
mean FSIQ of 80 at age 9 years, examined them 1.5 years
later and found a correlation coefficient of 0.68 on the
WISC FSIQ. In 2008, Whitaker10 summarized all available
studies in a meta-analysis on the stability of IQ in patients
with mild intellectual disability of unknown origin. Includ-
ing 17 studies in his analysis, he found a weighted mean
correlation coefficient of 0.82 for FSIQ over a mean test–
retest interval of 2.8 years. He concluded that IQ remains
relatively stable over time in children and adolescents with

© 2014 Mac Keith Press DOI: 10.1111/dmcn.12620 463

intellectual disability, although IQ assessments in these
children should be taken with care because some individu-
als may change in their cognitive abilities more than others
(i.e. show an increase or decrease of IQ>10 points). Whi-
taker stated, however, that only few studies are available
for individuals with three or more tests and an initial age
of <10 years (see also Table I in Whitaker10). In fact, lon-
gitudinal studies that have assessed children with intellec-
tual disability several times (i.e. more than three times) in
the course of their development are practically non-existent
(but see as an exception Clare et al.11).
The stability of longitudinal profiles of children with
mild intellectual disability can be described with two dif-
ferent concepts. First, one may examine how the popula-
tion globally evolves over time. In this context, the
population mean is of particular interest. Thus, a constant
mean would refer to a stable situation (i.e. ‘population sta-
bility’), whereas a positive or negative trend in the mean
over time would be synonymous with changing conditions
(or ‘population instability’). Second, it might be of interest
to quantify how individuals track their own centile, that is,
whether their longitudinal profile follows the same pattern
as that of the population mean (‘individual stability’ or
reproducibility of the measurement) or whether future IQ
measurements of a child are largely unpredictable given
the past values (‘individual instability’).
In this study we assessed population and individual sta-
bility by using FSIQ in a group of children with borderline
to mild non-syndromic intellectual disability referred to
our clinical center.
METHOD
Measures
Children were included in the analysis when valid FSIQ
test scores of the following standardized instruments were
obtained: the Snijders-Oomen Nonverbal Intelligence tests
(3–7y, SON-Y12 or SON-R13), the German version of the
Wechsler Preschool and Primary Scale of Intelligence
WPPSI (4y 5mo–7y, HAWIVA14), the German version of
the Wechsler Intelligence Test for Children WISC (6–18y,
Table I: Time interval between two successive assessments for each IQ
test
Time between successive assessments
Test Minimum (y:mo) Maximum (y:mo)
HAWIK-III 0:9 4:9
HAWIVA 0:9 5:0
HAWIK-R 0:8 6:2
K-ABC 0:10 3:11
SON-R 1:2 1:11
SON-Y 0:6 2:0
K-ABC, German version of the Kaufman-Assessment Battery for
Children; HAWIK-R or HAWIK-III, German version of the Wechsler
Intelligence Test for Children WISC; HAWIVA, German version of
the Wechsler Preschool and Primary Scale of Intelligence; SON-R
or SON-Y, Snijders-Oomen Nonverbal Intelligence test.
464 Developmental Medicine & Child Neurology 2015, 57: 463–469
What this paper adds
• Knowledge about stability of cognitive performance in children with intellec-
tual disability.
• Better clinical understanding of cognitive improvements or declines in intel-
lectual disability.
• Intellectual disability is a relatively stable phenomenon, but with moderate
test-to-test IQ stability.
• Sixty per cent of the intellectual disability variation is explained by
between-child variability.
• Interpretation of cognitive profiles must not only include IQ, but also judg-
ment of adaptive functioning and previous developmental history.
HAWIK-R15 or HAWIK-III16), and the German version
of the Kaufman-Assessment Battery for Children (3–12.5y,
K-ABC17). Only FSIQ was considered, because indices and
subtest scores are known to be less reliable than FSIQ (see
Whitaker10). All testers were certified fellows or consul-
tants in developmental pediatrics with experience in the
psychological testing of children with developmental disor-
ders. Individual testers did not examine children and ado-
lescents more than once.
Participants
Using a retrospective case series methodology we analyzed
the database of our outpatient clinic which included
13 569 patients younger than 20 years evaluated between
1990 and 2006 for developmental disorders (global devel-
opmental delays, learning disorders, intellectual disabilities,
neurodevelopmental impairments, genetic syndromes,
inborn errors of metabolism, and endocrine diseases) as
well as children with behavioral disorders (e.g. sleep prob-
lems, attention-deficit–hyperactivity disorder, etc.). The
clinical database was screened for individuals with border-
line to mild intellectual disability at the first visit (as
defined by a FSIQ score below 85 [1SD below the mean]
and above 50) and having at least three cognitive assess-
ments. Although the children were selected based on their
IQ, they were all suffering from a number of functional
deficits (in language, memory, school and social abilities,
self-management, etc.), which was the reason for referral
to our center for further evaluation and therapeutic man-
agement. Children with genetic syndromes, abnormal pre-
natal/perinatal history, identifiable neurological disorders,
autism, psychosocial deprivation, drug exposure and any
other known aetiology for the disability were excluded
from the analysis. The final sample consisted of 36 individ-
uals (28 males and eight females; age range 3–19y) with
isolated non-syndromic (non-specific) mild intellectual dis-
ability or borderline intelligence of unknown origin (i.e. no
confirmed aetiology of the disability). These children were
all born between 1984 and 1997 (median year of birth:
1989). Nineteen children had three to four IQ measure-
ments, 13 had five to six data points, and four children had
seven to nine tests (164 FSIQ assessments with irregularly
spaced observations). The FSIQ at first evaluation was
measured between 51 and 83 scores with a median of 73
scores. The age at the first evaluation ranged from 3 to 8
years 2 months, while the time between two successive
assessments performed on the same child ranged from
1 month up to 8 years and 4 months. When considering
assessments performed using the same test, this time was
quite variable (see Table I), but no shorter than 6 months
(SON-Y). The time between the first and the last assess-
ment on the same child (duration of follow-up) ranged
from 2 years and 2 months up to 14 years and 2 months
with a median of 8 years. To accommodate these varying
lengths of follow-up and the developmental age of the
child, individuals were tested using different tests over
time. Most of the children (70%) had two or three differ-
ent tests during their follow-up. A single child was assessed
three times using the same test (K-ABC). On the other
hand, two children with a long follow-up time (>7y) were
tested with five different tests.
Information about parental occupation was gathered at
study entry and converted into the International Socio-
Economic Index.18 The higher International Socio-Eco-
nomic Index score of the father or mother was used as the
socio-economic status (SES) of the child. The SES ranged
from 21 to 88 with a median of 40 points on the Interna-
tional Socio-Economic Index scale. We note that the
International Socio-Economic Index score in our study
sample was lower than in the representative Swiss PISA
study (n=1190, mean 52.9 [SD 16.4], unpublished data
from Urs Moser, PhD, 2012).
The institutional review board confirmed that the study
was performed according to the Declaration of Helsinki,
and conformed to legal and ethical norms.
Statistical analysis
Our modeling approach addressed both definitions of sta-
bility, namely the evolution of the population mean over
time in a group of children with mild intellectual disability
(population stability) and how these individuals track their
own centile given that average evolution in the population
(individual stability). Stability of longitudinal profiles of
FSIQ among children with mild intellectual disability was
analyzed using a linear mixed model (see Appendix S1, sup-
porting information published online for more details of
the statistical analysis). In this model the FSIQ of an indi-
vidual is adjusted for the test, sex, and SES at study entry.
Cohort and practice effects have also been included in the
model as potential confounders (Appendix S1). The mean
evolution (population stability) is summarized by the coeffi-
cient b5 whereas the intraclass correlation defined on the
interval [0,1] quantifies how children globally track their
own centile (individual stability or reproducibility), with
low values (close to 0) referring to poor tracking or low sta-
bility and large values (close to 1) indicating a strong track-
ing or high stability. Confidence intervals (CIs) for model
parameters were calculated using 2000 bootstrap-t samples
(see Davison and Hinkley19 [p. 194] and Appendix S1).
RESULTS
Figure 1 illustrates individual longitudinal profiles of all 36
individuals included in the study. Substantial changes in
individual FSIQ scores occurred between tests, although
most individuals remained in the low IQ range (50–85).
Table II presents estimates and 95% CIs for model
parameters. We note that the test means at study entry
(a values) vary. However, these coefficients should be inter-
preted with caution as they may encompass a possible con-
founded effect of age at entry. The cohort effect was not
significant (p=0.721) which is not surprising since all chil-
dren were born within a period of only 13 years. On the
other hand, for children tested with the same assessment
test within 1 year, a practice effect (i.e. IQ gain caused by
taking the same test at two consecutive assessments) was
observed, with children scoring on average 5.26 points
higher (p=0.001) at the second occasion. Neither sex nor
SES had a statistically significant impact on FSIQ,
although the eight females in our sample had a slightly
lower average FSIQ compared to the 28 males (b1=
2.31).
The evolution of FSIQ in the population was found to be
barely negative with an estimated drop of 0.38 points of
IQ per year (standard error=0.39), but this result was again
not statistically significant in our limited sample (p=0.325).
The intraclass correlation was estimated at 0.58 (95% CI
0.46–0.74) indicating that about 60% of the residual varia-
tion in FSIQ scores of the participants can be attributed to
between-child variability (individual stability).
DISCUSSION
Clinicians are frequently asked by parents and other pro-
fessionals to make predictions for the developmental course
of children with intellectual disability. While a prediction
can be made or is more robust in children with moderate
to severe intellectual disability that is often associated with
a genetic syndrome, the prediction for children with bor-
derline to mild intellectual disability is far more difficult.
Our knowledge about the longitudinal course of these chil-
dren is based on studies which have included only two data
points. Although the exisiting literature proposes a ‘high’
correlation between initial and subsequent IQ testing in
children with non-syndromic intellectual disability,10 we
are relatively often faced with the clinical situation where
children have made improvements or have declined
between assessments. Thus, more data on the longitudinal
course of these children are needed.
In this study including a true clinical sample, we have
used a linear mixed model to study the stability of individ-
ual profiles of FSIQ among a group of children with bor-
derline to mild non-syndromic intellectual disability. We
used the time since the first evaluation as the metric for
recording time while adjusting for the IQ test for two rea-
sons. First, in IQ testing current age and tests are partly
collinear because tests change with increasing age. Second,
children referred to our center for suspected intellectual
disability and with a number of impairments in adaptive
functioning had to score between 50 and 85 at their first
FSIQ assessment to enter the study. Thus, it was not
appropriate to use age for recording time because new par-
ticipants entering the study would have constantly pulled
Cognition in Children with Intellectual Disability Oskar G Jenni et al. 465
 IQ Test
HAWIK-III K-ABC
HAWIVA SON-R
HAWIK-R SON-Y

5 10 15 20 5 10 15 20 5 10 15 20

100

85

70

55

40
100

85

70

55

40
100

85
Full-scale IQ

70

55

40
100

85

70

55

40
100

85

70

55

40
100

85

70

55

40

5 10 15 20 5 10 15 20 5 10 15 20
Age (years)

Figure 1: Illustration of the individual longitudinal profiles of all 36 individuals. K-ABC, German version of the Kaufman-Assessment Battery for Children;
HAWIK-R or HAWIK-III, German version of the Wechsler Intelligence Test for Children; HAWIVA, German version of the Wechsler Preschool and Pri-
mary Scale of Intelligence; SON-R or SON-Y, Snijders-Oomen Nonverbal Intelligence test.

466 Developmental Medicine & Child Neurology 2015, 57: 463–469

Table II: Parameter estimates with 95% confidence intervals

Coefficient Description Estimate Standard error p 95% Bootstrap CI

a1 SON-Y test mean 73.77 2.58 – 69.88; 77.91

a2 SON-R test mean 69.48 3.37 – 62.22; 75.84
a3 HAWIVA test mean 67.48 2.53 – 62.34; 70.54
a4 K-ABC test mean 67.81 2.93 – 62.03; 73.08
a5 HAWIK-R test mean 63.35 3.47 – 57.38; 69.45
a6 HAWIK-III test mean 72.73 3.94 – 66.09; 78.94
b1 Cohort effect 0.19 0.52 0.721
0.85; 1.21
b2 Practice effect (IQ gain if two consecutive assessments 5.26 1.61 0.001 2.80; 7.66
separated by 1y use the same test)
b3 FSIQ difference for females (compared to males)
2.31 4.11 0.577
11.95; 9.43
b4 FSIQ change associated with an increase of 1 pt SES 0.07 0.09 0.445
0.16; 0.29
b5 FSIQ difference per year of follow-up
0.38 0.39 0.325
1.18; 0.40
q Intraclass correlation 0.58 – – 0.46; 0.74

Bootstrap-t using 2000 replicates (resampling of individuals) were used to construct 95% CI. A variance stabilizing transformation was used
to compute the CI of the intraclass correlation. Note that a 95% CI that does not include zero indicates a statistically significant result
(p<0.050). FSIQ, Full-scale IQ; K-ABC, German version of the Kaufman-Assessment Battery for Children; HAWIK-R or HAWIK-III, German
version of the Wechsler Intelligence Test for Children WISC; HAWIVA, German version of the Wechsler Preschool and Primary Scale of
Intelligence; SON-R or SON-Y, Snijders-Oomen Nonverbal Intelligence test.

down the average FSIQ score at a given age thus generat-
ing biased estimates. We note that neither year of birth,
sex nor SES at study entry were found to have a statisti-
cally significant impact on FSIQ scores, which is in line
with earlier studies (e.g. SES was not associated with any
IQ stability measures in children with mild intellectual dis-
ability20). On the other hand, the data did support the exis-
tence of a practice effect.
In terms of population stability, we observed that after
adjusting for tests, practice and cohort effects, SES at study
entry, and sex, the FSIQ of the children tended to decrease
over time, although this result was not statistically signifi-
cant (
0.38 points of IQ per year, p=0.325). In contrast, if
one would select a subset of healthy children scoring below
85 at their first visit, one would expect their average FSIQ
to improve over the next few visits. Some children with
average or above-average individual performances may
score below 85 at some point only because of random
measurement errors. At the next visits these children would
likely score higher thus inducing a general improvement in
population IQ performances (regression to the mean). The
magnitude of that regression to the mean depends on the
proportion of variance related to measurement errors; a
larger measurement error variance would induce a larger
potential improvement in the population mean. Although
the confidence interval for b5 (Table II) cannot rule out a
positive trend in the evolution of population IQ score over
time, the fact that the regression to the mean was not
observed on our sample suggests that, on average, cogni-
tive performance of clinically referred children with bor-
derline to mild intellectual disability should not be
expected to improve over time, but rather remain relatively
stable. This high population stability in non-syndromic
intellectual disability stands in contrast to the cognitive
decline of children with specific syndromes such as Fragile
X, Down syndrome, or Williams syndrome3–7 where a pro-
gressive IQ decline has been consistently reported. The IQ
drop in these clinical populations across age may be
explained by the increasing weaknesses in abstract reason-
ing and higher symbolic language skills, which are part of
the cognitive testing procedures of these individuals.4
Regarding individual stability, the estimated intraclass
correlation coefficient indicates that the average correlation
between two FSIQ measurements made on the same indi-
vidual is 0.58 (CI 0.46–0.74). Thus, the correlations from
test to test are rather moderate. In fact, the figure illustrates
individual profiles, which reflect ‘bouncing and rebouncing
trends’ rather than steady patterns of improvement or
decline (as expressed by Moffitt et al.21). We have recently
investigated the intraindividual stability of neuromotor and
IQ scores in a sample of 256 healthy children of the Zurich
Longitudinal Studies and reported a correlation between
two FSIQ measurements in these healthy individuals of
0.72 (CI 0.68–0.77) for measurements taken 4 years apart.22
This finding may suggest that long-term individual stability
of FSIQ in children with borderline to mild intellectual dis-
ability is lower than that of children with typical develop-
ment. In fact, cooperation, motivation, fatigue, and
attention may play a more important role in the clinical
population of children with intellectual disability during the
test situation than in typically developing participants. Of
note, our estimated intraclass correlation is lower than the
average correlation of 0.82 found in the meta-analysis
reported by Whitaker.10 This may be because the follow-
up was longer in our study with more changes of tests along
the years. However, recall that even a correlation of 0.8 as
found by Whitaker10 cannot be considered as high when
the focus lies in predicting future IQ levels of a child. In
fact, with such a correlation a 95% CI for the difference
between two IQ measurements performed on the same
pffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffiffi
child would lie within 1:96  2  ð1
qÞ ¼ 1:24 standard
deviations. This means that despite such a ‘high’ correlation
one may still observe a difference of up to 1.24915=18.6
IQ points between two repeated measurements (Whitaker
actually found that 14% of children had scores that chan-
ged by more than 10 points10).

Cognition in Children with Intellectual Disability Oskar G Jenni et al. 467

 Several limitations must be kept in mind when interpret-
ing the results of this study. While it might appear desir-
able to adjust the FSIQ of a child for his/her age at entry,
an inherent difficulty pertaining to the study of longitudinal
IQ measurements is that IQ tests change with age. In fact,
in clinical practice different test instruments are often used
during different times and by different examiners which
reflects the true clinical situation. Thus, systematic differ-
ences between score means of specific tests may be attrib-
uted to test effects. Furthermore, the FSIQ scores of the
children in our study may be influenced both by the test
used during the assessment and the age at which the test
was performed. These partial effects, however, are difficult
to disentangle because of changes in the testing procedures.
In other words, the effects of age and tests remain con-
founded. Therefore, one should not over interpret the coef-
ficients a1–a6 presented in Table II. Individual stability is
also affected by changing tests and although this cannot be
avoided in the context of IQ measurements, changing tests
generate some instability in the score, which in turns lowers
the estimated intraclass correlation. We note that the intra-
class correlation is a measure of average individual stability
over the period for which measurements are available. The
correlation between any two IQ measurements of an indi-
vidual is fixed in our model and does not depend on age or
on the time lag separating these two measurements (no
serial correlation). These simplifications resulted from the
limited sample size and the fact that only few individuals
had more than four or five data points in their individual
profiles, preventing the fit of more complex models.
Several conclusions may be drawn from this study based
on a clinical sample of children with mild to borderline
intellectual disability of unknown origin. The FSIQ of chil-
dren with borderline to mild non-syndromic intellectual
disability remains remarkably stable over time (high popu-
lation stability) suggesting that intellectual disability is not
a transitory phenomenon and catch up of the cognitive
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ACKNOWLEDGEMENTS
This study was supported by the Swiss National Science
Foundation, grant no 3200B0-112324 and the Anna Muller
Grocholski Foundation.
DISCLOSURE
The authors have stated that they had no interests that
might be perceived as posing a conflict of interest.
SUPPORTING INFORMATION
The following additional material may be found online:
Appendix S1: Supporting statistical information.
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The burden of central nervous system (CNS) infections
in children – and particularly in children in resource poor
settings – is staggeringly high. Doctors caring directly for
acutely ill children, and neurologists from whom special-
ized opinions are sought, need a practical resource to
keep abreast of developments in this fast-moving field.
This was attested to in a poll of members of the Interna-
tional Child Neurology Association that identified the
topic of children’s CNS infections as high on their wish
list for an up-to-date textbook. In Central Nervous System
Infections in Childhood, the team of Singhi, Griffin, and
Newton have, in my opinion, produced a valuable,
scholarly resource for paediatricians and paediatric neurol-
ogists. All three editors are eminent in the field compris-
ing that small zone of trisection in the Venn diagram
that represents the bodies of knowledge making up paedi-
atrics, infectious diseases, and neurology. As well as
bringing a wealth of practical clinical experience and
complementary research to their project, they have
recruited an ‘A list’ of international contributors, each
with personal experience and expertise in the areas of
their contributions, to produce a remarkably well-bal-
anced multi-author textbook.
Scene-setting chapters provide a background in epidemi-
ology, bacterial and viral pathogenesis, general principles of
the management of CNS infections and their acute compli-
cations, and neuroimaging, with a further useful contribu-
tion by Neville on the important topic of febrile seizures.
Khandelwal and Rumboldt’s chapter on neuroimaging, with
its emphasis on magnetic resonance imaging (MRI), is per-
haps inevitably presented in highly technical language. It
reminds the reader of the rapid, transformative impact on
neurology of computed tomography and MRI, and fore-
shadows exciting technological developments to be antici-
pated with, for example, diagnostic magnetic resonance
spectroscopy. The chapter represents a valuable primer text
to assist discussion with neuroradiologist colleagues.
20. Bernheimer LP, Keogh BK, Guthrie D. Young children 22. Jenni OG, Chaouch A, Locatelli I, et al. Intra-individual
with developmental delays as young adults: predicting stability of neuromotor tasks from 6 to 18 years: a longi-
developmental and personal-social outcomes. Am J Ment tudinal study. Hum Mov Sci 2011; 30: 1272–82.
Retard 2006; 111: 263–72. 23. American Psychiatric Association. Diagnostic and Statis-
21. Moffitt TE, Caspi A, Harkness AR, Silva PA. The natu- tical Manual of Mental Disorders (DSM-5). Arlington,
ral history of change in intellectual performance: who VA: American Psychiatric Association, 2013.
changes? How much? Is it meaningful? J Child Psychol
Psychiatry 1993; 34: 455–506.
Seventeen disease-/syndrome-specific chapters by a range
of experts form the bulk of the work, each providing a con-
cise, up-to-date summary of one or more important CNS
infections, with in each case appropriate attention paid to
practical matters of diagnosis and specific management.
Notable among many excellent, well-referenced contribu-
tions are Whitley’s presentation of a lifetime of experience
in his chapter on herpes simplex CNS infection; Kumar and
Singh’s, and Kanta’s chapters on Japanese B encephalitis and
rabies; the Singhis’ expositions of their wealth of experience
of the management of bacterial and fungal brain infections,
neurocysticercosis and the life-threatening bacterial exo-
toxin-mediated syndromes; Schoeman and van Toorn’s
authoritative summary of CNS pathology caused by tuber-
culosis, with their starkly juxtaposed reminders that while
early diagnosis and treatment is usually completely curative,
in most settings (resource poor and rich alike) diagnosis is
long delayed and disability or death are common outcomes;
and Sladky and Willison’s comprehensive discussion of
acute disseminated encephalomyelitis, Guillain-Barre syn-
drome, and other post-infectious neurological disorders.
The editors’ intention is that an electronic version of the
book, available online, will be periodically updated, when
no doubt – for example – the dramatic impact of Meningo-
coccal A conjugate vaccine (MenAfriVac), developed for
use in sub-Saharan Africa’s meningitis belt, can be pre-
sented in some detail. In this way too perhaps one unac-
countable omission can soon be addressed: perhaps
representing the triumph of hope for the eradication of
measles by vaccination over the general experience of fal-
tering progress, there is at present no chapter on this terri-
bly important viral infection of the brain in this otherwise
comprehensive book.
At close to half the length of Bell and McCormick’s
Neurologic Infections in Children (2nd edition, 1981; digi-
tized, 2008), Central Nervous Systems Infections in Childhood
nevertheless provides a valuable, well-referenced textbook
for paediatricians and neurologists everywhere, and, with
regular updates, has every chance of becoming an endur-
ing, standard text.
J Simon Kroll
Department of Medicine, Imperial College London, London, UK.
doi: 10.1111/dmcn.12586
Cognition in Children with Intellectual Disability Oskar G Jenni et al. 469