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and use of leisure time; weaknesses seemed present in some aspects of communication, domestic, and community skills. Personality assessment indicated feelings of sadness, lack of energy, preoccupation with death and loss in general, and insubstantial social relationships. Diagnostic Impression DSM-IV Classification Axis I. 300.40 Dysthymic Disorder
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Axis II. 317.00 Mild Mental Retardation Axis III. History of seizurelike behavior, chronic gastrointestinal disorder (by medical report) Axis IV. Psychosocial stressors: brother s heart attack
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Axis V. Highest level of adaptive functioning in past year: 45 Recommendations Robert should continue therapy at the mental health clinic to deal with his emotional problems and build social skills. The therapist should be in touch with staff at the workshop to devise a program aimed at increasing his productivity. It is recommended that Robert take courses in functional academic skills (e.g., reading, writing, arithmetic) at one of the area community colleges. Improved skills in these areas should increase his chances of obtaining competitive employment. Examiner: Maria Nucci Supervisor: Judith Ivins, Psychologist III
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The following variables are often believed to be associated with characteristically high P-IQs: learning disabilities or illiteracy, delinquency or psychopathic behavior, mental retardation, bilingualism, and autism. Adolescents and adults diagnosed as learningdisabled, illiterate, or dyslexic often display a characteristic P > V profile of about 5 to 15 points. However, college students with learning disabilities are an exception; they usually evidence the opposite profile or have no V P difference at all. Various profiles in the Wechsler subtests have been suggested for learning-disabled samples. We reviewed the ACID profile, the Bannatyne profile, and SCALD profile, and suggested that
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Bannatyne s categories or the SCALD profile might be the most useful in assessing (although not necessarily diagnosing) learning disabilities. Better still will be application of the factor index profile, pending the outcome of future research. The P > V sign for delinquents and psychopaths was advocated by Wechsler over a half century ago. Whereas groups of delinquents and psychopaths sometimes average about 6 points higher on P-IQ than V-IQ, supporting Wechsler s generalization, many samples of adolescents and adults do not manifest this anticipated profile. Also, Wechsler s claim that the sign is useful for individual diagnosis has not been supported. Further, among delinquents and psychopaths, the P > V discrepancy tends to be larger for younger adolescents than for older adolescents and adults; larger on the WISC/WISC-R than
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on the WAIS/WAIS-R; sometimes larger for Caucasians than African Americans; and sometimes explainable by intervening variables like reading disabilities or number of criminal offenses. Mental retardation has sometimes been associated with P > V profiles; most studies with adolescents and adults, however, suggest only a slight profile (2 3 points), with the possibility that individuals with very low IQs may even display a high Verbal low Performance profile. Numerous investigations have shown that bilingual Hispanic and American Indian children earn substantially higher Performance than Verbal IQs. This finding has been validated for American Indian adults, but not for Hispanic adults. Indeed, WAIS-III data reveal only a slight P > V profile for Hispanic adults, and a trivial POI > VCI discrepancy. Research on individuals with Autistic Disorder is complicated by the presence of mental retardation in many of the subjects. Evidence from some studies of individuals with autism indicates a pattern of high Performance low Verbal on Wechsler s scales and related tasks, but it may lack sensitivity as it has not been found consistently across all studies. In addition, when samples of relatively high-functioning individuals with Autistic Disorder are tested on a Wechsler scale, the opposite pattern of V > P sometimes emerges. Overall, the variables believed to be associated with P > V profiles (including left-hemisphere brain damage, discussed in 8) have not been associated with that pattern either consistently or of a magnitude that is large enough to be practically or clinically meaningful. The following variables are believed to be associated with V > P profiles: high educational attainment, psychiatric disorders, motor coordination problems, Alzheimer s-type dementia, and high IQs. Individuals with at least one year of graduate school earn higher V-IQs, but that generalization does not necessarily apply to those who have attended college. Psychiatric patients, in general, display V > P profiles; this finding has been observed for patients with schizophrenia (although some have argued for low V-IQ in schizophre-
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nia), depression, and bipolar disorder. The consistent finding has been explained by impaired concentration, psychomotor retardation, anxiety, or low motivation. Performance subtests range from the ones requiring little or no motor coordination (Picture Completion and Matrix Reasoning) to a test of psychomotor speed (Digit Symbol-Coding), with most of Wechsler s nonverbal tasks requiring good coordination for success. Groups with known motor problems (patients with multiple sclerosis, Huntington s disease, or Parkinson s disease) earn substantially higher V- than P-IQs. Among multiple sclerosis patients, discrepancies were larger for chronic than relapsing remitting patients (12 vs. 5 points), with the chronic patients performing worst on the tasks most dependent on motor coordination. Analogous results were obtained when patients with advanced Huntington s disease were compared to those with a recent onset. Individuals who have abused alcohol show a higher Vthan P-IQ, as do patients with Alzheimer s disease. The Fuld profile has been called a marker for Alzheimer s disease by many, but we are recommending that the Fuld formula be abandoned in favor of an emphasis on the WAIS-III profile of four factor indexes. In general, much research needs to be done with the index profile to help understand the cognitive assets and deficits of a variety of clinical samples. Data provided by the publisher of the WAIS-III in the technical manual for small samples of clinical patients suggest strongly that the index profile for different groups will provide information of much clinical value. For example, patients with Huntington s disease scored almost 2 standard deviations higher on their mean VCI than their mean PSI. Gifted individuals often also show V > P discrepancies. When assessing individuals in the gifted or superior range of intelligence there is often not a consistent profile, but rather much scatter. It is important to incorporate multiple data sources in the evaluation of these individuals. Overall, the variables believed to be associated with V > P profiles were upheld in most studies, including patients with right-hemisphere brain
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