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Wechsler subscale IQ and subtest profile in early treated phenylketonuria


AIM Mildly depressed IQ is common in treated phenylketonuria. This study explored whether a particular intellectual ability profile typifies early and continuously treated phenylketonuria and whether component skills comprising the IQ relate to socioeconomic and treatment factors.

METHODS IQ scores were collected retrospectively from variants of the “Wechsler intelligence scale for children” performed at age 8 on 57 children with early treated, classic phenylketonuria. The mental ability pattern underlying IQ was investigated by analysing subscale and subtest scores and dietary factors, such as historical phenylalanine blood concentrations.

RESULTS The children's mean full scale IQ of 91.11 was significantly below the healthy population norm. There was a significant discrepancy between their mean verbal IQ (94.65) and mean performance IQ (89.42), suggestive of a spatial deficit, but the data did not support a biochemical or sociological explanation. Individual Wechsler subtests had no distinctive pattern. Phenylalanine control at age 2 was predictive of overall IQ. At this age, children with annual median phenylalanine < 360 μmol/litre (recommended UK upper limit) had a mean IQ 10 points higher than those above.

CONCLUSIONS Early and continuous treatment of phenylketonuria does not necessarily lead to normalisation of overall IQ. Verbal intelligence in the primary school years appears to normalise if blood phenylalanine is maintained below 360 μmol/litre in infancy, but spatial intelligence may remain poor. However, the discrepancy in skill development is not the result of social status or treatment variables. Perhaps weak spatial intelligence is an ancillary effect of a protective rearing style occasioned by the dietary treatment regimen.

  • The lower than average IQ often found in treated phenylketonuria might be caused in part by specific weakness in spatial ability

  • Conformity to current UK recommendations for phenylalanine concentrations at least in infancy is associated with normal verbal IQ in later childhood

  • Better verbal than spatial intelligence in treated phenylketonuria might not be a function of dietary treatment factors or social status

  • phenylketonuria
  • intelligence quotient
  • dietary treatment
  • policy
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