Learning prolonged

Banarasi ABSTRACT
learning and

disabilities and poor iodine deficiency13

Tiwari, The Madan effect
was

motivation
Chattopadhyay, Anita
on children-

to achieve
Mandal, and the tests which recently (4). iodine areas new deficiency Given worldwide, that to been Ambrish basic measure information recommended on the neural

due to
Mithal apparatus ability be for potential of children is surprisingly prolonged (although absorbed assessment of children at little lowering within risk inforcan learning numbers there are and necessary. the and of effiprothe in of

M of

Godbole,
iodine hundred

Naibedya
deficiency male

prolonged
One

gence More ciency

representing dynamic by have of

motivation

studied.

learning

matched were was

serum

for selected

age, from

socioeconomic both (MID) lower severely villages. in the SID

was

status, Mean than

significantly nmol/L, 32.31

and urinary in the

nmol/L,

formal (SID) iodine MID P P

<

educationand

iodine-deficient

mildly cessed

iodine-deficient significantly compared

thyroxine

excretion effect group (219.84 endemic The

(90.36

57.52 6.46 serum higher compared administered motivation. compared over though was MID The lowered proved prevent their able KEY achievement better

with 449.14
concentration

0.001). 0.001) (6.23

iodine mation It is circulating 0.34 normal bral

deficiency

lower
<

compared in the with

with SID 4.85

123.70 group
0.28

15.42

and were

on this important now accepted concentrations the

aspect (5). slight but of thyroxine

Downloaded from www.ajcn.org by guest on August 19, 2011

of the in whole

thyroid-stimulating

hormone than
mUlL,

(TSH) in P
<

was group The

significantly children tasks and are slow

the

MID

0.01).

range for hypothyroidism

population) may in the clinically

produce state a of cereeuthyroid populations of the on socioneighbors, to quantitate requirement

maze, verbal, and The results showed with MID children. in performance
).

pictorial learning that SID children In both younger of older scored neural
resulting

groups (aged (aged

the 9-12

rate y)

trials the (P children results

was initial
<

superior 0.01 on SID

a test of SID areas, which may lead to slow mentation learners society (6). Assessing the effect of iodine deficiency of learning cultural stimuli provided by siblings, peers, parents, children aland the community as a whole is important y) children variables than as for poor ing
and be

12-15 scale (P as
<

like

motivation to test variables and through (4).

to

achieve. that capacities exposure motivation

As reflect

such, the

the

children achievement of

significantly impairment
in learning

lower 0.01). well

methods and

intelligence

contribution through also achieve learncannot and

of

the suggestive

motivation

sociocultural overlooked

acquired to education to of on

are

particularly

sociopsychologic

stimulation,

disability

Because two of

the

achievement motivation. Unless in the community as whole, a these millions of children from the SID

iodine nutrition abnormalities areas from are

is imability to learn (7) are may investigated the effect achieving availSUBJECTS
AND

important aspects iodine deficiency

intelligence, we these variables.

full potential even if learning opportunities to them. Am J Clin Nutr l996;63:782-6. WORDS Iodine motivation deficiency, learning

made

METHODS

disability,

Subjects The domized for age, selected present group study design was in carried which status, the and villages The was goiter chosen out two formal from 3.4%, by using simple a groups were education the Padruana of indicating rates < as the ranmatched (8). We region goiter SID. 10% and controls. was Four withHow-

INTRODUCTION Certain bal and

abstractions,

socioeconomic 10 iodine-deficient Pradesh, cretinism same region of cretinism

specific

cognitive

and

intellectual

functions,

eg,

perceptual performance, memory, and mathematical are particularly vulnerable to iodine deficiency by
Available

in eastern Uttar ver> 60% and the as villages out any of the cases

India. rate with were

prevalence

suggested (1

serious at

impairment
does

of or

these
not

capacities
indicate any

in cretins
gross speI

2).

information

cific
it is

defects generally from nervous more used the effects subtle

physiologic (SID) populations that

functional other than spectrum to frank of difficult Thus,

utero

levels cretins; of iodine and to alternate on

Am

in

severely however, features the

iodine-deficient extend populations. central are monly test 782 mild The

From the Department of Psychology, Department of Medical Endocrinology,

of Medical Medical Sciences, Lucknow, Delhi.

Kashi Vidyapeeth, Sanjay Gandhi

India.

Varanasi, and Post Graduate CounDepart-

recognized subclinical system in of nature iodine intelligence

the effects

clinical deficiency function detect

Institute
2

hypothyroidism (CNS) may tests

cretinism

in affected

Supported
of Address

by grant
Research, reprint

5/4-4/18(M)
New to MM 226014,

NCD-I(8706390)
Godbole, Associate

of the Indian
Professor,

cil

on by

requests

development be (3).

that ment of Medical cornMedical Sciences, to Received Accepted

April

Endocrinology,
Lucknow 27, 1995.

Sanjay

Gandhi
India.

Post

Graduate

Institute

of

methods intelli-

deficiency in

fluid
J C/in

for publication
Printed in USA.

January
1996

19, 1996.
American Society for Clinical Nutrition

Nutr 1996;63:782-6.

MOTIVATION ever, mild were biochemical iodine situated deficiency at an Cultural such and 340 in both SD average indexes as weekly SID and male Cretins evaluation (MID). distance such markets MID children as of the Both

AND control SID of 6 km dialects, and rural festivals aged 8-18

LEARNING group and from MID the suggested

IN
starting

IODINE-DEFICIENT
point

CHILDREN with a metal and over been stylus time Learning trials. used through taken was 10 reflected

783 learning to reach by modified im-

to

goal

The number of errors villages trials. point were recorded. town the goal of provement to culdrama version to Verbal The of in the performance test that has

in seconds

Padrauna. tural events programs, be from similar Initially, the

exposure dance and were y were from

We used the extensively (1 1, 12).

participation goitrous

in religious villages.

found selected

learning verbal

learning test was a modified version of one used study.earlier (1 1). Two separate lists of vernacular (Hindi) words, Initial selection was based on socioeconomic status (SES) rating each containing 15 items (words), three from each of the five scores (which measured nine components of deprivation: housing conceptual categories (animal, fruit, vegetable, cereals, and conditions, home environment, economic sufficiency, nutrition, utensils) were prepared. The selection of these words was clothing, formal educational experiences, parental characteristics, based on familiarity calibration of a large number of words. travel and recreation, and miscellaneous components) within the Words of a moderate degree of familiarity were used in the range of 80-1 10 (9). Of these, 160 were selected thisfor study present study. The items were printed on 3- by 5-inch (8- by villages. were excluded the because
prerequisite

of

their

formal included 100 children as the 5ff) because

educational of motivation the ability

experience, to achieve. to read,

which Formal write, and

was

for assessment

ucation, prehend.
y) were

as defined, Finally,
selected

a 13-cm) ed- no two com- sequences

cards. words were

The of method

cards the arranged and method

were same in B of at

given category two for learning,

a fixed appeared lists: A learning

sequence adjacently. for by were item was correct

such learning serial-recall

that The by

(50 aged 9-12 y and group. The remaining did from and 0.05,
NS]

were hundred the SES

group

excluded control
[t

they children The P

>

not MID

know groups and

their

50 aged 12-15 free-recall 60 children method. exact age. One In the were selected matched as orally for When to were goiter trials recall one the

Downloaded from www.ajcn.org by guest on August 19, 2011

free-recall by whole the items one list

items of liked. of one The the subject

presented per s. 2 instructed recalls Ten such of learning, sequence in

age-matched subjects.
=

MID

villages formal In

to subject a was in any

a speed he

SW)

were

presented, order

(198) from Ia,

1.33,
=

educational

experience grade old grade identity protocol Council from the

[t (198)

1.90,

the whereas

endemic 40 (80%)

P > 0.05, NS]. villages, 10 (20%) had and goiter 4 (8%) grade

the 9-l2-y-old subjects had lb. In12-15-ythe had goiters

recorded. This constituted were given in all. In the

one trial serial-recall the

learning. method in the

group,

15 (30%),

3 1 (62%),

subjects

Ia, Ib, and II, respectively. of the group to which was of approved Medical parents by Research. before the

Investigators the subjects Ethical Informed

were blinded belonged. The of was study. the consent

the subject was required of which they were presented. to the studyPictorial learning Indian Twenty black-and-white the were the

to recall

items

Committee

obtained

photographs same with randomly group,

(55

mm

45

mm)

of and were groups: 10 photo-

childrens analysis of

start of the the

boys all approximately neutral facial expressions prepared. the old The group stimuli and

age with moderate divided each

uniform dress identifiability into two containing

Biochemical The magnitude

new

graphs. Five learning trials were given to each subject. In each of subjects was ascertained by biochemical analysis of urinetrial, a subject was shown the old group of 10 photographs one and blood samples collected from one-third of the total subafter the other, each for a duration of 3 s. Then these photojects, who were randomly selected. The urinary excretion of graphs were mixed and shuffled with the 10 photographs of the iodine was determined by the method of dry ashing (10) and new group and the subject was asked to identify those photoserum thyroxine (normal range in our laboratory: 70-170 graphs that were shown to him previously. Five such learning nmol/L) and thyroid-stimulating hormone (TSH) (normal trials were run. The number of correct recognitions in each trial range: 0.30-5.0 mUlL) by radioimmunoassay using a kit from was recorded. Pictorial learning was reflected in the increasing BARC, Bombay. The urinary excretion of iodine (219.84 number of correct recognitions over trials. 57.52 and 449.14 32.31 nmollL for SID and MID groups, respectively, P < 0.001) and serum thyroxine (90.36 6.46 Achievement motivation scale and 123.70 significantly 0.001) was This scale purports to measure the feeling of competence and the MID group. worth, tendency to achieve success, and sense of striving for Serum TSH was significantly higher in the SID group than in superior performance in school and other phases of life. It also the MID group (6.23 0.34 and 4.85 0.28 mUlL, respecmeasures perseverance, risk-taking ability, task-orienting aptively, P < 0.01). Urinary iodine excretion and TSH suggested proach, and belief in hard work. This scale (11, 14) consists of that by international standards our MID subjects were mildly 16 yes-or-no items with a high degree of test-retest reliability iodine-deficient and may also have had subclinical hypothy(0.79) and internal consistency (0.81). It is suitable for assessroidism. ing motivation to achieve only for those children who are going
<

iodine

deficiency

in SID

and

MID

groups

15.42 less in

nmollL, the SID

respectively, P group than

in

Learning Human

materials stylus maze subjects having required were tested one through-path to learn the by using a and some human blind

to

school

and

can

read

and

understand

the

items.

Statistics stylus The effects alleys. their interaction from(age)

X

Blindfolded maze pattern Subjects were

of (trials)

iodine were trend

deficiency, ascertained analysis by

age, of

and variance

practice with

trials repeated

and

2 (iodine

deficiency) X 2

correct

through-path

10

784 measures. larly analysis with of motivation The five were variance. data levels for of pictorial trial by variable. 2 (iodine learning The were data deficiency)

TIWARI analyzed for achievement X

ET simi2 (age)

AL
300

250 200 z 150 100

analyzed

RESULTS
50

Maze SID learning < 0.01). than but the

learning children than The of rate committed did their MID initial performance the of younger reduction significantly more
-

errors

in

maze

5 TRIALS

10

that the

170.36, P FIGURE 2. Mean time taken in 10 trials of maze learning by severely group was better iodine-deficient (SID) and mildly iodine-deficient (MID) subjects averaged group(F11,1961 = 200.15, P < 0.01), over age and in different age groups. The pooled SEM lies between 5.5% in errors was significantly greater in and 6.7%. SID (-), MID (- -), younger group (A), older group (x). 88.81,
=

counterparts (F111961 of the older

younger children (F19171 = SID children took significantly did older 0.01), greater 2). learning effect of method task, iodine was did not deficiency not the but in MID children the rate younger children (F131961 took less

P more
64.61,

<

0.01) (Figure time to learn

P<

1). the Here

maze
=

than also, P
<

0.01).
=

9.76,
27.64,

<

0.01)
<

on

motivation effect Results were children test scores was indicate

to also

achieve. that MID more

The

iodine children,

time

to

learn (F111961 in the

= 65.45,

310.83, of
P<

deficiency learning
=

x
P than

age older were

interaction 0.01). ones, SD

significant (F111961 motivated to

of improvement children (FI917MI

speed

was

0.01)

particularly achieve Correlations

significantly (Figure5). and

(Figure Verbal The free-recall demanding children that SID 0.01).

32.32,

Downloaded from www.ajcn.org by guest on August 19, 2011

between

severity

of

iodine

on

verbal Free between

learning recall, SD being and

<
=

by

deficiency the learning, in were

TSH a decline

significant. discriminate

a less In maze MID progress iodine -0.40) negative over -0.32). errors of (r
=

in error errors(r Thyroxine errors (r

a significant
= = =

and negative -0.58) also -0.53)

time

scores correlations and

indicates of
=

learning. excretion observed.

Significant with with

uri-

of any age. The results children are slower older 0.01)

<

of serial learning again learners (F111961 = 64.45, P better improvement younger initially (F[1196] in learning
17j

showed nary

time (r a
correlation

showed and negative

significant
=

The P was
54.3

children but the (Figure

performed rate better 3). of in the

correlation
showed

time (r correlation and

<

positive

with

trials
=

significantly 0.01)

children (F19

,1 P

0.18) indexes

and with

time (r

0.38). iodine

The

these

urinary

excretion

thyroxine

and their positive correlation with TSH indicate a significantly Pictorial learning poorer rate of learning in the SID group. The results showed that the MID group performed better at A significant positive correlation for urinary iodine excretion pictorial learning than the SID children (F111961 = 173.04, P < was observed with pictorial learning (r = 0.25) and achieve0. 01). Although the older children performed better on the firstment motivation (r = 0.39). Correlation of urinary iodine trial of learning (F11,1961 = 54.73, P < 0.01), the rate of excretion and verbal learning was not significant. A significant improvement in correct recognition of pictures was better in positive correlation was observed between thyroxine and moyounger children (F147841 = 1 1.29, P < 0.01) (Figure 4). tivation to achieve (r = 0.39). Correlation of thyroxine concentration Achievement The iodine analysis deficiency motivation of variance (F111961
=

with with with

verbal Although verbal pictorial

and

pictorial TSH showed

=

learning a -0.17)

was significant it did not

not

found negative show a

to

be revealed
12.56,

significant.

significant P
<

main and

effects

0.01)

age (F111961

correlation of correlation

learning (r learning.

12 10
(I)

0 a:
LJJ z
5

8 6
4
-.

LU4

__J

crW
U

LU

--.-

z
__--.o._
g_ _

2
0 1 2 3

w w
-.*_

(f)

5
TRIALS

6 7 in
age

10

4 5 TRIALS

10

FIGURE
severely averaged between group (x).

1. Mean
iodine-deficient over 4.3% age and

number
(SID) and 10.0%. in

of errors
and different SID (-), mildly

10 trials of
groups.

maze The group

learning (MID) pooled (A),

iodine-deficient

FIGURE by subjects iodine-deficient

SEM older trials lies averaged

3. Mean
(SID) over

correct
and age and

serial
mildly

recall
age

in verbal
groups.

learning
(MID) The group pooled (A),

by severely
subjects SEM older in 10 lies

iodine-deficient

in different

MID (- -), younger

between
group

3.9%
(x).

and

8.3%.

SID

(-),

MID -), younger (-

MOTIVATION

AND

LEARNING

IN fetal

IODINE-DEFICIENT stage, in stimulation surrounding iodine the development.

CHILDREN deficiency psychologic In these is further also stimulation iodine-deficient weakened children are by gives rise essential villages, the dull, fact apathetic, children that to a

785
significant for psychothe and do not one so on social unnormal

If)

LU

a:
0(I)

scarcity cognitive
LU

ULI)
0< ZLz Z

logic groups

a:<
LUD I

motivated.

As a consequence,

iodine-deficient

find
new
2
TRIALS

a congenial
skills of and learning

sociopsychologic
various facilitates cognitive another

environment
abilities type of (14). learning,

for
Note

learning
that and

z4

LU

type

FIGURE (SID) and

over and age 7.3%.

4. Mean pictorial learning scores of severely iodine-deficient of mildly iodine-deficient (MID) subjects in five trials averaged
and in different age groups. The group pooled (A), SEM older lies group between (x). SID (-),

sequentially. factors retards

a child, the

When the combination cognitive development

basic potential in later

of the above-mentioned in the initial stages of life

stages may not improve

MID

(- -), younger

even if opportunities 4.7% achieve is an acquired

the the context performance (15). All are of standards stand psychologic learned to achieve

for learning motivation

of well (16). is an on motives,

are that

available. involves
and including is

Motivation performance
a desire such motivation to against

to in
have stanto as

excellence evaluation

DISCUSSION Our results indicate that SID children are slower

dards

than MID children. This was true for all learning istered except verbal learning by free recall.
which tests, finding practice We also deficiency is cognitively to that less demanding than the proved was was be a poor discriminator. the rate of improvement greater age-dependent ability. in MID than

tasks This
other

adminthat method,
learning

achieve, learners motivation

Psychogenic acquired of anxiety.

motivation such behavioral manifestation

satisfies

ones
and

need
reduction

for excellence, drives, important although innate of the

social
These

power,
motives

feeling
are

of
not

competence,

Downloaded from www.ajcn.org by guest on August 19, 2011

Another in performance in SID effect group,

innate like important contribution

children. of by behavior

physiologic of some
cannot be

the possibility determinants study subjects

of the of such required

significantly

ruled

out.

found an on learning

retarding Within the SID only children associations

children learned the tasks that involved tions faster, despite the fact that older tage in the initial stage. associations. Learning These and and the stimulus-response

iodine formal educational experience, including the ability to read and younger write, the study was biased toward higher-functioning children. cognitive funcThis bias in fact tends to work against the likelihood of finding had an advanof (engrams) new iodine

Note

that

because

the

choice

involves

formation

learning
supports

disabilities
the

and

further
to

strengthens

the

argument

that

deficiency thesis

leads that

general

learning of iodine

disability deficiency

and are

are generally formed in the CNS cortex. Whatever the location tional) task due of engrams, It seems of the the depends to practice on

specifically in the nature (structural in formation performance and

cerebral not all or none or funcof

consequences

improvement

consolidation to significant of these not be

in character. Iodine deficiency seems a range of deficits and developmental disadvantages any communities residing in iodine-deficient endemic
possible to reverse this process with proper iodine

to lead to of whole areas. It is

supplemen-

of engrams. retardation

that iodine deficiency leads formation and consolidation of SID subjects also in endemic development been found backward may be

grams.
The entirely the is paucity necessary inferior of performance impairment; stimulation psychologic of stimuli has of socioeconomically normal psychologic for deprivation to achieve to neurologic it may

tation enmance

and thus improve the psychomotor of the whole population (17).

and

cognitive
areas are the

perforpoorly serious spe-

The fact that children in iodine-deficient due motivated to achieve, a hitherto unknown an outcome of consequences of the iodine-deficiency disorders, areas, which (13, to affect commu14). grams the chemical

aspect of deserves correlation

cial

attention
for

and

adds

a further

sense

of urgency
such as

to the
of urinary

probioiodine

Prolonged motivation

their measures

eradication. of iodine and

The

significant nutrition

nities time
appears

(9, 12). The results that SID children

that besides

excretion of this study have shown for the first various are poorly motivated to achieve. It
neurologic development in

and
indexes

thyroxine
of learning

concentrations,
motivation results processes in and

with
increased responses.

test

scores
suggest proneness For learning

for
to

to achieve,

retarding

that poor the errors, and

iodine slow

nutrition mental

10
LI)

tasks, a decline in the task indicates progress errors and time taken
excretion relation in the and thyroxine with TSH SID group.

error rate in learning. in maze

and time taken The negative learning with

and their

to perform the correlations of urinary iodine

positive rate corof learning one and

concentrations,

LU

cc 9
0
U

indicate a significantly poor This effect seems to a be selective

(I)

4
LU

V.

the test
day-to-day

functions
life,

that
such

the child
as verbal

performs
learning,

more
are

frequently
not affected

in his
by

iodine
deficiency
9-12y 12-15y

nutritional
alone whether or in adult still utero or and

status.
the stages evaluation effect or remains

Whether
is due

this
to

effect
thyroid To

is due
hypothyroiddeficiency answer

to

iodine
during some of more

to iodine

deficiency-induced is a residual unanswered. of cognitive

ism
scores between of (MID, 3.7% severely -) and iodinesubjects 8.4%.

FIGURE
deficient different age

5. Mean (SID, -) groups.

achievement and The mildly pooled

motivation iodine-deficient SEM lies

juvenile state of these

effect a hypothyroid of functions with

questions,

786 sensitive mentation We Tiwari neuropsychologic of thank SR and Ram iodine-deficient instruments children after iodine

TIWARI suppleU

ET
7.

AL
Freeman FS. Theory and practice of psychological testing. New York:

is required.
assistance by

Holt,
8. Edwards

Rinehart
AL.

and

Winston,

Inc,
design

1962:149-82.
in psychological in research. relation New to

Experimental

Naik for critical review. Technical Bhoosan Mishra is acknowledged.

Umesh

York: Holt, Rinehart 9. Tiwari AN, Misra prolonged deprivation.

SB, Humphrey 10. Barker

and Winston, Inc. 1968. GA. Studyof achievement motive Psychologia

MJ, Soley

1977;20:172-89.
MH. The clinical determination of

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