INCLUSION TEST


The Test:

The Inclusion test was developed by Seymour Epstein and
was adapted to the computer by Marvin Miller, M.D. and Morgan
Tharp.
The Inclusion Test is a 50 item test: Each item
consists of a key word and 5 associated words; the task is
to decide whether or not each associated word is
absolutely necessary to make the key word complete. Words
that are not necessary but are chosen as necessary are
counted as overinclusions; words that are necessary but
are not chosen are counted as overexclusions.
The administration of the test consists of the
computer screen displaying the key word in capital
letters, followed by the 5 associated words. Each word
blinks in turn, and a prompt appears on the screen asking
the patient to choose "Y" if the word is absolutely
necessary, and "N" if it is not. After all 5 words have
been considered, the next key word and its associated
words appear. Total testing time in most patients is less
than 45 minutes. Following the test, a printout is
generated which gives the net scores, lists the
overincluded and overexcluded words, and gives some
comments pertaining to interpretation of the results.


Purpose:
The test was originally designed to be used as a
tool in analyzing schizophrenic patients. Dr. Epstein
found that 63% of schizophrenics overincluded 18 or more
words, while 22% of controls were beyond this cutoff.
However, other researchers have shown a wide variance in
their means, ranging from 17.8 to 73.1 for schizophrenic
patients and 10.9 to greater than 18 for controls. All
have been consistent in showing a large standard deviation
for schizophrenic patients, and Epstein noted that
certainly not all schizophrenics overinclude. Thus, the
test is not necessarily to be used freely in a
differential diagnosis, but can be useful in following a
patient's progress.
Some researchers have also noted that depressed
patients overinclude significantly (Payne & Hirst), that
obsessive personality disorders overexclude (Reed), and
that "passive" personalities overinclude more than do
"active" personalities (Foster).


Interpreting the Results:
As mentioned above, a wide variance of means of
overinclusion has been found for schizophrenics. Epstein
found that, on the average, schizophrenics overinclude 2
times the mean of controls. No differences in
overexclusion have been noted. While abstract thinking
ability is not correlated with overinclusion, intellectual
impairment/ability and vocabulary level have been shown to
be correlated with overinclusion. Because controls can
overinclude and many schizophrenics do not, the test is not
ideal for differential diagnosis, but rather is good for
following a patient's progress and perhaps for adding
information in evaluating the patient's progress. Epstein
further noted that overinclusion increases with increasing
personality disorganization. Dudek further concluded that
the test is not good for evaluating early schizophrenia.
Perhaps of the greatest interest in evaluating the
patient are the neologistic words. There are 5
neologistic key words, which are handled significantly
differently by schizophrenics than by controls: controls
usually make 0 or 1 choice following a neologistic word,
while schizophrenics often make 2. There are also several
neologistic associated words throughout the test.
According to Epstein, the 15 items containing neologistic
words, as key or associated words, gives more
discriminating scores between schizophrenics and neurotics
(Dudek). Related to this, schizophrenics also often
respond to words that they don't know the meaning of.
These patients also tend to select specific examples of a
category as necessary, e.g. a lion is required to have an
animal.

A copy of the test words and an example printout follow
the references.


References:

Al-Issa, Ihsan. "Stimulus generalization and overinclusion
in normal and schizophrenic subjects." Journal of
Consulting & Clinical Psychology, 1972, vol 39, No. 2,
182-186.
Desai. "Intelligence and verbal knowledge in relation to
Epstein's overinclusion test." Journal of Clinical
Psychology, 1960, vol 16, 417-419.
Dudek, S. Z. "Intelligence, psychopathology, and primary
thinking disorder in early schizophrenia." The Journal of
Nervous and Mental Disease, 1969, vol 148, No. 5,
515-.
Epstein, Seymour. "Overinclusive thinking in a
schizophrenic and a control group." Journal of Consulting
Psychology, 1953, vol 17, No.5, 384-388.
Foster, Leila M. "Personality differences in inclusive
behavior." Psychological Reports, 1977, vol 40, 227-230.
Gathercole, C. E. "A note on some tests of 'overinclusive
thinking.' " British Journal of Medical Psychology, 1965,
vol 38, 55-.
Gerner, David. "Linguistic rules and the perception and
recall of speech by schizophrenic patients." British
Journal of Social and Clinical Psychology, 1967, vol 6,
204-.
Payne & Hirst. " " Journal of
Consulting Psychology, 1957, vol 21, 18 6-188.
Reed, G. F. " 'Under-inclusion'--A characteristic of
obsessional personality disorders I." British Journal of
Medical Psychology, 1969, vol 115, 781-.
Schwartz, S. "Diagnosis, level of social adjustment, and
cognitive deficits." Journal of Abnormal Social
Psychology, 1967, vol 72, 446-.
Watson, Charles G. "Relationships between certain
personality variables and overinclusion." Journal of
Clinical Psychology, 1967, vol 23, 327-.




WORDS ON TEST

MAN arms shoes hat toes head
AUTOMOBILE wheels driver radio head-light bumper
SEX male sin love marriage female
ESKIMO ice blubber human sled igloo
LOCK key key-hole door locker safe
CANDLE fire wax wicked kandle light
IMPRISONMENT bars restriction police criminal loneliness
BOX wood shape nails width corners
SPARROW feathers feet William Bill teeth
PAINT painter brush liquid terpenzine red
FISHERMAN worm trout pole fins heart
PHOTOGRAPHY art camera topography filmature snap-pin
CHAIR table cushion wood paint seat
ROYBLE stately harsh cheese noble fable
HOLE weight whole space air doughnut
TOOL carpenter hammer handle work-nack tool
MANICRON science time insect gyroscope metal
BLOOD death celloplasm horror liquid bandage
ANIMAL lion fur tail creature zoo
SOUNTONIFIC loud soft sound secret music
AFTER late before time after after
SHOE laces socks buckles leather sole
YES no maybe yes no yes
RELIGION heaven faith heel soul belief
UNHAPPINESS myself everyone sinners sadness tears
TOPITCH insect disease royble scratch topic
LOCOMOTIVE steam motor electricity engine engineer
TREE oak wood roots growl bark
LOVE hate feeling kisses marriage sex
HORSE hoofs saddle horse-shoe reins farm
PARTY enjoyment birthday celebration people festival
BOAT oars motor ship sail water
SPEECH sound audience words writing language
CIGARETTE tobacco smoke fire paper Camels
HEART blood valentine hearth love flesh
CLIMATE rain weather barometer moon wind
APPLE seed fruit tree orchard peel
RUSSIAN communist green red person villain
SERLEDICT creed derelict edict savage Tibetan
WORD meaning sentence eipword symbol sound
EAR head hearing lobe sound hole
FARM cows vegetables horses land plow
WAGON wood horse wheels wood driver
WHISTLING tune air sound music whistle
NEWS paper event radio commentator views
BIRD canary song feathers flight cage
BALL bat roundness base object football
DIAMOND ring rock stone engagement money
BLOTTER sponge bladder ink paper absorption
ALPHABET numbers postcards stamps letters grammar
SAMPLE PRINTOUT

INCLUSION TEST


Patient: Joe Smith Date: 08-11-1987
Patient #: 12345

Net Scores: OVERINCLUSIONS OVEREXCLUSIONS
16 8

Words incorrectly included (overinclusions) were:
------------------------------------------------

Key Word Associated Word(s)

AUTOMOBILE driver, radio
ESKIMO ice, blubber
ESKIMO sled, igloo
CANDLE fire, wicked
CANDLE kandle, light
BOX wood, nails
BOX corners
PAINT painter, brush
PAINT liquid


Words excluded by the patient (overexclusions) were:
---------------------------------------------------

Key Word Associated Word(s)

MAN arms, toes
MAN head
SEX male, female
IMPRISONMENT restriction
SPARROW feathers, feet



NOTE: Due to the manner in which this test is scored, it is possible that
the number of over-inclusions actually chosen is greater than the
test's net score of over-inclusions.












Interpreting the Results:

Schizophrenics AS A GROUP overinclude, with the mean for overinclusion being
2 times that of controls. However, overinclusion is not characteristic of
EVERY schizophrenic.
If the distinguishing point of 18 overinclusions is used, 63% of schizo-
phrenics and 22% of controls fall beyond this point. Therefore, 37% of
schizophrenics do not overinclude more than controls.
Controls have equal overinclusions to overexclusions, whereas schizo-
phrenics average 2 overinclusions to 1 overexclusions.
All 5 neologistic key words are handled significantly differently by schizo-
phrenics than controls. Controls make no or 1 choice following the key
word, while schizophrenics often make 2.
The neologistic key words are ROYBLE, MANICRON, SOUNTONIFIC, TOPITCH,
and SERLEDICT.
While abstract thinking ability is NOT correlated with overinclusion,
intellectual impairment is. Further, overinclusion tends to increase with
increasing personality disorganization.
Schizophrenics also tend to select specific examples of a category as
necessary, e.g. a lion as being required to make an animal.