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Verbal Performance IQ Discrepancies: A Neuropsychological Approach
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Wechsler (1939) published the first edition of the Wechsler-Bellevue about a half century ago, and clinical interest in Verbal Performance IQ (V P) discrepancies probably surfaced a few minutes after publication. Just as Wechsler researchers enjoy nothing more than factor-analyzing or abbreviating a battery, Wechsler clinicians have a difficult time satisfying their craving for interpreting V P IQ discrepancies and relating such differences to neurological impairment, psychopathology, and diverse variables encompassing nearly every aspect of human behavior. Because of the extensive literature on group differences in verbal and nonverbal functioning and the clinical value of Wechsler s dichotomy for any particular individual, this book treats the topic of V P IQ differences in two chapters. 8 deals with five major areas, all pertaining to a neuropsychological understanding of V P IQ discrepancies: (1) an overview of V P studies of neurological patients having damage confined to the left or right hemisphere; (2) the 244
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nature of brain damage; (3) subtest patterns for left- and right-lesions patients; (4) the interaction of gender and race with V P discrepancies in brain damage; and (5) the interaction of age and education with V P discrepancies in brain damage. 9 focuses on a more clinical understanding of V P IQ differences. Although the WAIS-III offers an additional way to examine verbal nonverbal differences, namely the discrepancy between the Verbal Comprehension and Perceptual Organization indexes, s 8 and 9 focus primarily on V-IQ and P-IQ because WAIS-III literature on discrepancies is sparse.
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V P DISCREPANCIES AND BRAIN DAMAGE
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Research in neuropsychology has consistently supported the notion that lesions in the left cere-
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V P IQ DISCREPANCIES: A NEUROPSYCHOLOGICAL APPROACH
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bral hemisphere are associated with diminished verbal and language abilities, whereas lesions in the right cerebral hemisphere are accompanied by visual spatial deficits (Reitan, 1955c). Consequently, a logical hypothesis is that people with left-brain lesions will demonstrate P > V profiles, and those with documented right-brain lesions will show V > P discrepancies. This hypothesis has been tested in dozens of research investigations with the Wechsler-Bellevue, WAIS, and WAIS-R, and the results of these many studies are summarized and integrated in this section. The one WAIS-III study was reported in the WAIS-III technical manual (Psychological Corporation, 1997), but only a partial seven-subtest battery was administered to small samples of adults with temporal lobe epilepsy; these data are integrated with the large body of data on previous Wechsler adult scales. The latter half of this chapter treats numerous issues regarding the literature on brain damage, such as the controversial topic of gender differences in the relationship between localization of lesion and V P differences.
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Right- versus Left-Brain Lesions
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The predicted interaction between the nature of a brain-damaged patient s V P IQ discrepancy and the location of his or her lesion has been investigated with a diversity of samples, for example, those with head injuries (Mattis, Hannay, Plenger, & Pollock, 1994; Uzzell, Zimmerman, Dolinskas, & Obrist, 1979), those wounded by a missile (Black, 1973, 1976), patients with epilepsy undergoing temporal lobectomies (Chelune, Naugle, Luders, Sedlak, & Awad, 1993; Ivnik, Sharbrough, & Laws, 1987; Meier & French, 1966), and patients with strokes or tumors (Haaland & Delaney, 1981; Mattis, Hannay, & Meyers, 1992). Most samples, however, are heterogeneous regarding the cause of the brain damage and are best labeled mixed (Matarazzo & Herman, 1985). Table 8.1 summarizes pertinent studies with the Wechsler-Bellevue, Table 8.2 summarizes the numerous WAIS studies, and Table 8.3 summa-
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rizes the WAIS-R studies. Many of the WechslerBellevue and WAIS references were compiled by Matarazzo and Herman (1985, pp. 902 905) and Inglis and Lawson (1982), although we tracked down the original source for every study in both tables. The few studies available on brain injury employing the WAIS-III used subjects with diffuse brain injury (or the authors did not specify the brain region that was affected); thus, we were not able to include data from the WAIS-III on right- and left-hemisphere lesions. Tables 8.1 and 8.2 also include studies that have previously been excluded from past summaries because the investigators failed to provide Verbal and Performance IQs for the brain-damaged samples. These include studies that provided just the V P IQ discrepancy, but not the actual V- and PIQs (Goldstein & Shelly, 1973; Lansdell, 1968; Reitan & Fitzhugh, 1971), as well as investigations that provided just the subtest scaled scores (Reitan, 1955c) or weighted sums of scaled scores (Smith, 1966b, 1966c) for the brain-damaged patients. Because several of these studies have been widely cited in the literature (especially Reitan, 1955c and Smith, 1966b) it seemed important to include their data in the computations to determine the relationship between V P discrepancies and location of brain lesion. For Reitan s (1955c) and Smith s (1966b, 1966c) studies, it was necessary to determine the best estimate of the Wechsler-Bellevue IQs for the brain-damaged samples. For his samples, Smith (1966b, 1966c) provided the weighted sums of Verbal scores (excluding Vocabulary) and Performance scores. We entered these sums into the Wechsler-Bellevue IQ conversion table using the mean age of each sample to determine the appropriate column to enter (i.e., the column for ages 45 49 for 46- and 47-year-olds; the midpoint of the columns for ages 40 44 and 45 49 for his 45-year-olds). Reitan (1955c) provided a graph of scaled scores on the separate subtests. To estimate V- and P-IQs, we determined the scaled score on each subtest (excluding Vocabulary) from his graph, computed the weighted Verbal and Performance sums, and entered these
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