Cognitive slippage is considered a milder and sub-clinical presentation of formal thought disorder observed via unusual use of language.Meehl, P. E. (1962). Schizotaxia, schizotypy, schizophrenia. American Psychologist,17(12), 827-838. doi:10.1037/h0041029 It is often identified when a person attempts to make tangential connections between concepts that are not immediately understandable to listeners.Loas, G., Dimassi, H., Monestes, J. L., & Yon, V. (2013). Criterion Validity Of The Cognitive Slippage And Schizotypal Ambivalence Scales1. Psychological Reports,113(3), 930-934. doi:10.2466/02.19.pr0.113x27z5 When observed repeatedly, this is taken as evidence for unusual, maladaptive or illogical thinking patterns.
Cognitive slippage is typically assessed in the context of mental health evaluations, but there is ongoing debate about how to best quantify this type of unusual language usage in research settings.Kagan, D. L., & Oltmanns, T. F. (1981). Matched tasks for measuring single-word, referent communication: The performance of patients with schizophrenic and affective disorders. Journal of Abnormal Psychology,90(3), 204-212. doi:10.1037/0021-843x.90.3.204 Cognitive slippage is supposed to exist on a continuum which can be observed in its most extreme forms among some individuals with schizophrenia (e.g., word salad).O'Connor, Kieron (March 2009). "Cognitive and Meta-cognitive Dimensions of Psychoses". Canadian Journal of Psychiatry. 54: 152. Several mental disorders are known to co-occur with cognitive slippage. Although cognitive slippage is associated with difficulties in communication, it is not necessarily indicative of lower intelligence.
Examples An example of cognitive slippage:
"List some types of cars." "Let's see, there's Ford, Chevrolet, Toyota, Japan, Rising Sun, Hiroshima, Atomic Bomb, Enola Gay, oh and Miata."
The inclusion of extraneous items in the list is evidence of cognitive slippage. Although the concepts such as Toyota, Japan, Rising Sun, etc. are all related, the relation does not fall under the category of the initial prompt: types of cars.
Another example: "What animals did you see at the zoo today?" "We saw tigers, bears, Dolphins, the Baltimore Ravens, the Packers, Carolina Panthers, jaguars, lions, and otters."
Here we see the slip occur between animal names and football teams with animals as their mascot. As the person lists animals they saw at the zoo, they mention "bears" and "dolphins" which double as the names of NFL teams. This results in a "slip" to a tangentially related list of football teams then back again to animals after the mention of the Carolina Panthers relates to the other big cats they saw - jaguars and lions. The cognitive slippage is associated with an inability to identify and disregard these extraneous connections. It results in patterns of speech and associations similar to those seen here.
Theory
In 1962, Paul E. Meehl emphasized that thought disorder was a critical component of schizophrenia diagnosis. He coined the term "cognitive slippage" to describe a more mild form of thought disorder that he believed was still relevant. He recognized that even in the absence of more severe forms of thought disorder, individuals with schizophrenia exhibited more cognitive slippage than non-schizophrenic individuals. As a result, Meehl deemed thought disorder a necessary component of the disorder for diagnoses, regardless of severity. He declared that any characterization of either schizophrenia or schizotypy that lacked cognitive slippage as a component was unacceptable and he insisted that cognitive slippage, interpersonal aversiveness, anhedonia, and ambivalence were the universal "core behavior traits" of all schizotypic individuals.Kendler, K. S. (1985). Diagnostic Approaches to Schizotypal Personality Disorder: A Historical Perspective. Schizophrenia Bulletin,11(4), 538-553. doi:10.1093/schbul/11.4.538 He also noted that the amount of slippage can vary from case to case, with some highly anxious individuals exhibiting less slippage than some minimally anxious individuals. This suggests that cognitive slippage may be affected by altering the effect of the individual, but Meehl mentions that this feature is not groundbreaking or unique to cognitive slippage.
Meehl (1962) also noted that cognitive slippage occurred in some typically developed relatives of individuals with schizophrenia. Though the findings were preliminary, he noted that among a group of ten individuals with schizophrenia, they were able to detect mild thought disorder in at least one parent of each individual. He thus suggested that future research into this discovery should be a priority of schizophrenia researchers. Meehl also sought to understand where the cognitive dysfunctions associated with schizophrenia stemmed from, yet he found cognitive slippage a difficult symptom to parse out. He considered that, on some level, "everybody has to learn how to think straight," and supposed there could be a social learning component to the development of organized, rational thought and speech.
Meehl noticed that slippage occurred even when an individual was trying fervently to communicate clearly. He considered a neurological explanation that suggested cognitive slippage was tied to "synaptic slippage," or an error in the electrical transmission of messages from neuron to neuron in the brain. He suggested this issue was caused by an error in cell selectivity, meaning the wrong neuron received the message. According to this theory, "primary cognitive slippage" refers to the slippage at the central nervous system synapse as a result of an error in neural transmission. The observable behavior of disorganized speech, as a result of the transmission error, would be classified as "secondary cognitive slippage".Lenzenweger, M. F. (2006). Schizotaxia, Schizotypy, and Schizophrenia: Paul E. Meehl's Blueprint for the Experimental Psychopathology and Genetics of Schizophrenia. Journal of Abnormal Psychology,115(2), 195-200. doi:10.1037/0021-843x.115.2.195 He also contemplated the possibility that cognitive slippage could stem from different underlying causes based on the disorder it was a part of.
Measure of cognitive slippage
The Cognitive Slippage Scale (CSS) was introduced in 1985 by Miers and Raulin. The CSS is composed of 35 self-reported true or false questions intended to identify speech deficits and disorganized, confused thinking.Osman, A. (1992). Reliability And Validity Of The Cognitive Slippage Scale In Two Populations. Psychological Reports,70(1), 131. doi:10.2466/pr0.70.1.131-136 Higher scores on this test indicate a higher level of cognitive slippage. The test has been shown to be applicable and accurate to both clinical and non-clinical populations. Examples of questions included on the test are, "Often when I am talking I feel that I am not making sense," and "Sometimes my thoughts just disappear.".
With a few exceptions, this scale has seldom been evaluated for its reliability and validity. The validity of the CSS was assessed in 1992 by comparing clinical and non-clinical, undergraduate samples. The reliability of the CSS was assessed using Cronbach's alpha, a coefficient between 0 and 1 that indicates that the items on a scale have greater covariance as it approaches 1. They found that the CSS had a coefficient of 0.89 for the clinical participants with schizophrenia, and 0.86 for the non-clinical, undergraduate participants. They also suggested the CSS has adequate test-retest reliability by re-administering the CSS after a 4-week period.
In 2013, a study conducted by Loas, Dimassi, Monetes, and Yon proposed that validity could also be assessed by comparing the CSS results of healthy first-degree relatives of individuals with schizophrenia to those without it. They recruited 27 first-degree relatives of individuals with schizophrenia and thirty first-degree relatives of individuals without schizophrenia. All participants were administered the French version of the CSS. The results indicate that the first-degree relatives of individuals with schizophrenia scored significantly higher on the CSS than did the first-degree relatives of typically developed individuals.
Research on specific disorders
As a symptom of schizophrenia
Cognitive slippage is characterized as a mild symptom of schizophrenia.Cognitive Slippage, Journal of Nervous and Mental Disease. Retrieved 20 March 2014 Schizophrenia is a psychiatric illness defined by both abnormal behaviors and cognitive dysfunctions. Formal thought disorder (FTD) is characterized by problems with thought, language, and communication and is considered to be the key feature of the cognitive dysfunction component of schizophrenia.Radanovic, M., Sousa, R. T., Valiengo, L., Gattaz, W. F., & Forlenza, O. V. (2013). Formal Thought Disorder and language impairment in schizophrenia. Arquivos de Neuro-Psiquiatria,71(1), 55-60. doi:10.1590/s0004-282x2012005000015 As Meehl suggested, cognitive slippage is a milder form of FTD, making it also a key component of schizophrenia.
In considering the genetic element of schizophrenia, researchers have examined the presence of symptoms, such as cognitive slippage, in first degree relatives. For example, Oltmanns (1978) looked at the prevalence of cognitive slippage in the children of individuals with schizophrenia. For their purposes, they defined "cognitive slippage" to include associative disturbances, difficulties in thinking, and errors in reasoning. The researchers administered an object sorting task to 156 children of schizophrenic individuals, 102 children of depressed individuals, and 139 children of healthy parents. The task required participants to either sort objects or explain the reasoning behind a sorted group of objects. The task was designed to target responses that would differ noticeably between individuals with schizophrenia and without schizophrenia. All the participants were children between the ages of 6 and 15. Their responses were then sorted as either superordinate, complex, vague, or thematic. The children of parents with schizophrenia made fewer superordinate responses and more complex responses than the control children. Though small, the findings were reliable, and suggest that the children of individuals with schizophrenia are more prone to the cognitive dysfunctions associated with cognitive slippage.Oltmanns, T. F., Weintraub, S., Stone, A. A., & Neale, J. M. (1978). Cognitive Slippage in Children Vulnerable to Schizophrenia. Journal of Abnormal Child Psychology,6(2), 237-245. doi:10.1007/bf00919128
The loose definition of cognitive slippage can make the symptom difficult to identify, so Braatz (1970) designed a study to determine if preference intransitivity could be used as an indicator of cognitive slippage. He proposed that from a logical standpoint, intransitivities in preference would result from cognitive slippage. Preference intransitivity occurs when one's preferences and values lead to potentially unresolvable conflicts. He administered a scale of 120 items meant to judge preferences of both schizophrenia patients and healthy controls and found that individuals with schizophrenia endorse more intransitive judgments than healthy individuals. Though he acknowledges that the scale in its current form is underdeveloped, his findings suggest that further research into the connection between preference intransitivity and cognitive slippage could result in a scale powerful enough to aid schizophrenia diagnosis. He also suggests future research could expand the scale to apply in cases other than clinical schizophrenia.Braatz, G. A. (1970). Preference intransitivity as an indicator of cognitive slippage in schizophrenia. Journal of Abnormal Psychology, 75(1), 1-6. doi:10.1037/h0028808