Basic Learning Functions among Young Adults Suffering from Schizophrenia

Research Article

J Schizophr Res. 2016; 3(1): 1020.

Basic Learning Functions among Young Adults Suffering from Schizophrenia

Ben Gal A1*, Shani M2, Apter A3 and Koren D2

¹Department of Education, Tel-Hai College, Upper Galilee 12210, Israel

²Department of Learning Disabilities, Haifa University, Mount Carmel, Haifa 31905, Israel

³Schneider Medical Center, 14 Kaplan St., Petach Tikvah 49202, Israel

4Department of Psychology, Haifa University, Mount Carmel, Haifa 31905, Israel

*Corresponding author: Ben Gal A, Department of Education, Tel-Hai College, Upper Galilee 12210, Israel

Received: July 27, 2015; Accepted: February 05, 2016; Published: February 08, 2016


Background: The purpose of the research was to examine specific learning functions among people suffering schizophrenia and the relationship between the different aspects of intellectual disability and the severity of the mental illness. We hypothesized that (a) a lower level of basic learning functions among people with schizophrenia compared with the general population; (b) wide variance in the degree of damage to the respective functions; and (c) a correlation between the severity of the illness and the degree of intra-individual variance in learning functions.

Methods: The sample consisted of 38 people (35 men and 3 women) suffering schizophrenia, ages 20 to 37 (average 28.6 years), hospitalized in two psychiatric hospitals. The attending physicians in different hospital departments made the formal diagnoses of schizophrenia. The learning functions were examined using MATAL, a computerized set of standardized tests and questionnaires developed for the diagnosis higher education applicants and students who request accommodations on exams and assistance with studies due to learning disabilities.

Results: The learning functions of the participants were lower than the norm of the general population, most significantly in tasks of rapid naming objects, writing efficiency, automatic arithmetic actions (criteria of accuracy and time), delayed recall (recognition), and parallel visual perception. However, no correlation was found between these functions and the severity of the illness.

Conclusion: The precise and correct treatment of learning disabilities might indirectly improve the quality of life of those suffering from schizophrenia.

Keywords: Schizophrenia; Learning functions; Neuropsychological functioning; Positive symptoms; Negative symptoms; Intellectual disability


Schizophrenia is one of the most serious mental illnesses. Characterized by disability in the cognitive, perceptual, and emotional realms, it is a chronic syndrome that impairs development and functioning. Research in the field has consistently indicated a general intellectual impairment among people with schizophrenia although most of the research has dealt with general cognitive deficiency in schizophrenia; some have discussed specific cognitive disorders. Research comparing the neurocognitive functions among adolescents with schizophrenia with those of their peers has indicated a significant difference between the groups, in favor of the healthy participants, in those functions related to working memory, concentration, and administrative functions [1]. As early as 1911, Bleuler [2] reported attention disorder among people with schizophrenia; however, despite the numerous reports on this subject, there is a wide disparity between the theory and the empirical findings, perhaps because of the many factors involved [3]. General cognitive disability and functional impairment are commonly found among people with schizophrenia. However, there is little published research on the learning functions of schizophrenia patients. “Learning functions” refers to basic learning abilities, which project on general academic functioning, including reading, writing, arithmetic, verbal memory and visual perception. Knowledge about learning functions among schizophrenia patients, as well as the relationship between these functions and cognitive disabilities is important, because it may enable the mapping of the academic competence of patients and the planning of appropriate intervention. It has been shown that the treatment of cognitive abilities can potentially change the functional ability of patients [4]. In addition, research on this subject might be able to draw upon information available in the education system to investigate the development of cognitive deficits during the period prior to a first episode of schizophrenia. Recently, researchers used such information to examine differences in former school grades and teacher ranking of students at age 13-14 among people hospitalized as adults for schizophrenia or affective disorders. Comparison of the eighth-grade report cards of the patients with those of their classmates indicated that students who were later hospitalized had significantly poorer nonacademic (behavioral) performance relative to their classmates. The results indicated that performance in nonacademic realms and lower behavior scores by teachers correlated significantly with an early age at the first episode of schizophrenia [5]. Although this study demonstrated the potential of using data from the education system to better understand the development of cognitive deficits in schizophrenia, there is almost no information to date on the character and level of impairment in learning functions among people with schizophrenia. The purpose of the present research was to help fill this lacuna in the literature. Based on the theoretical considerations and preliminary findings reviewed earlier, we hypothesized: (1) the basic learning function scores of schizophrenia patients after the first episode of the disease would be lower than the norms in the general population; (2) the degree of disability in the different functions would vary; in other words, for a single individual, some function scores would be lower than others; (3) the severity of the disease would be related to the degree of scattering, or variance, among the different learning functions. This hypothesis was based on research that found a significant correlation between high variance in intellectual functioning and the risk of suffering schizophrenia [6].


Research participants

The study sample was comprised of 38 patients with schizophrenia who were hospitalized in two psychiatric hospitals in northern Israel. The criteria for inclusion in the research were (a) a diagnosis of schizophrenia according to DSM IV [7]; and (b) absence of mental retardation (IQ > 70) or a history of sensory (visual or hearing) impairment or any other chronic medical disability that may have an effect on cognitive functioning. As part of their regular work, the attending physicians in the different departments of the hospital conducted formal diagnoses of schizophrenia with the research participants, based on all the medical information available to them. All the participants signed an informed consent form that was approved by the Helsinki Committee.

The final sample included 35 men and 3 women, with a mean age of 28.6 years. Thirty-five of the participants were born in Israel and 3 were born in other countries (Ethiopia, Russia, and the United States). They all spoke Hebrew as their mother tongue. The mean age of first stay in a psychiatric hospital was 24.4 years (minimum 17; maximum 31). The mean number of times hospitalized was 7.2 times (minimum once; maximum 17 times). The mean total duration of hospitalization was 407.4 days (minimum 17; maximum 1416).

Procedure and measures

The attending physicians in the hospitals evaluated the presence and severity of positive and negative symptoms using the Positive and Negative Syndrome of Schizophrenia Scale (PANSS). This research instrument includes 30 items, grouped into three scales: positive symptoms, negative symptoms, and general symptoms. Every item examines the presence of a symptom and is scored on a seven-point scale (from 1 to 7). The developers of the instrument reported internal consistency of α = .73 for the positive scale, α = .83 for the negative scale, and α = .79 for the general scale (p < .001). The information on drug treatment (type and dosage) was collected from the medical files of the participants.

Current cognitive functioning was examined by means of MATAL, a system for diagnosing learning disabilities in adults. MATAL is a computerized system of standardized tests and questionnaires developed in Israel for diagnosis of prospective and current students of higher education who request special conditions on exams and help with studies due to learning disabilities. Israel’s National Institute for Testing and Evaluation developed MATAL with the assistance of experts in learning disabilities [8]. The system was designed to diagnosis common learning disabilities: dyslexia, dyscalculia, and dysgraphia, as well as attention disorder. The original diagnostic system consists of two questionnaires and 20 computerized exams that test cognitive functions in different areas: language (reading and writing), quantitative functions, attention, memory, visual perception, and general speed of processing. The effectiveness of the instruments for the purpose of diagnosing learning disabilities was examined in comprehensive validation research conducted at ten institutions of higher education and encompassing about 200 participants. The research tested the quality of the examinations, the process of administering them, and validation of the different performance measures of the tests with clinical populations. Later, national norms of performance were calculated for each diagnostic instrument with a representative sample of the population of candidates and students in institutions of higher education. The sample for the norms was comprised of 508 native Hebrew speakers without learning disabilities, enrolled in bachelor’s degree studies at universities and colleges. In other words, there are Israeli norms for each of the tasks examined, which can be compared with the functioning of any individual tested with the system.

In the present research, we selected eight of the tasks from the entire system in order to represent the different areas of the MATAL system, and to examine the primary basic functions in the areas of language, arithmetic, memory, and perception. The tasks included: decoding text, dictation, rapid naming, verbal fluency, automation of arithmetic, immediate recall, delayed recall, and parallel visual perception.

The tasks selected from the MATAL system for use in this research are presented in Table 1.