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TABLE 8.4
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V P IQ discrepancies for adult patients with bilateral or diffuse brain damage Year Test N 33 62 49 32 11.4 13.0 13.0 11.5 28 33 37 52 29 0 83 22 23 905 45 950 .0 64 52 44 33 27 36 11.9 11.9 12.1 12.6 13.0 58 13.3 12.9 10.5 79 73 73 70 72 100 90 100 70 9 29 15 260 25 77 20 28 138 152 61 12.2 WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-R WAIS-III WAIS-III (1988) (1992) (1994) (1994) (1995) (1996) (1996) (1996) (1996) (1997) (1997) (1998) (1998) (1997) (2000) % Males Mean Age Mean Education 86 95 87 90 94 95 84 87 87 91 87 85 90 90 96 V-IQ
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P-IQ 78 90 79 88 98 96 79 82 81 89 87 78 83 85 100
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Mean V P Discrepancy +8.5 +4.4 +8.3 +1.6 4.4 1.3 +4.6 +5.1 +6.2 +2.7 +0.5 +7.0 +6.6 +5.1 3.7 +1.5 +0.6 +1.4
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Weighted Mean of WAIS-R Studies
Weighted Mean of WAIS-III Studies
Weighted Mean of WAIS-R and WAIS-III Studies
TABLE 8.5
Mean WAIS-III factor indexes for samples with traumatic brain injury Background Information N 22 64 52 36 34 52 29 31 105 23 27 13.3 12.9 12.9 99.5 92.7 94.6 % Males Mean Age Mean Education
Mean Factor Index Verbal Comprehension 89.6 95.8 Perceptual Organization 92.1 104.6 100.3 98.0 98.8 Working Memory 89.8 96.1 100.3 95.4 95.7 Processing Speed 73.4 95.3 100.9 88.1 90.1
Study/Severity of Injury
The Psychological Corporation (1997) Mild
Fisher et al. (2000) Mild
Martin et al. (2000)
Mild
Moderate to Severe
Weighted Mean
V P IQ DISCREPANCIES: A NEUROPSYCHOLOGICAL APPROACH
IQ. Instead, their marked deficiency was specifically in their ability to process information quickly. Three of the four samples summarized in Table 8.5 earned their highest standard score on Perceptual Organization and their lowest on Processing Speed. The fourth sample, the group with mild TBI studied by Martin et al. (2000) displayed a totally flat profile, standard scores of 100 101. Because of the small sample sizes in each study, the most meaningful set of mean indexes is the one provided for the total of 105 patients with TBI: POI (99), WMI/VCI (95-96), and PSI (90). This overall index profile suggests intact Perceptual Organization and weak Processing Speed. Indeed, for three of the four samples, the discrepancy between these indexes was at least 9 points. Hawkins (1998) examined the clinical samples tested during the WAIS-III standardization to determine if there were any indicators of brain dysfunction that could be derived from study of the WAIS-III IQs and indexes; his results also support the sensitivity of the PSI. The clinical groups included: Alzheimer s disease (N = 35), Huntington s disease (N = 15), Parkinson s disease (N = 10), traumatic brain injury (TBI; N = 22), chronic alcohol abuse (N = 28), Korsakoff s syndrome (N = 10), and schizophrenia (N = 42), in addition to 25 patients with Multiple Sclerosis. For all seven clinical populations, the PSI was the low point in the WAIS-III profile (on average, nearly one standard deviation below the high point on each profile). Despite the clinical lore regarding the sensitivity to general brain dysfunction of fluid reasoning and visuo-constructional abilities, the POI did not tend to be depressed for this diversity of clinical samples. Hawkins s (1998) data suggest that Verbal Comprehension Processing Speed comparisons will better facilitate screening of brain injuries than Verbal Performance IQ comparisons. The relatively unaffected performance by the subjects with diffuse TBI on the Perceptual Organization index (as well as some of the other clinical samples studied by Hawkins) may be par-
tially explained by the inclusion of the new Matrix Reasoning subtest; in post hoc analyses, Martin et al. (2000) determined that this subtest, in fact, was not affected by increased injury severity. Thus, the overall impact of the inclusion of Matrix Reasoning in the 5-subtest P-IQ, and, especially, in the 3-subtest POI, may be a lessening of sensitivity to diffuse brain injury. Future neuropsychological research is vital, especially for samples with injuries other than TBI, and with injuries lateralized to one hemisphere. The prospect of the index profile rendering the WAIS-III V P IQ profile obsolete for the clinical analysis and research investigation of brain damage is both exciting and provocative. We urge researchers to report both IQs and factor indexes, however, to permit comparisons between the two approaches, as was done by both The Psychological Corporation (1997) and Fisher, Ledbetter, Cohen, Marmor, & Tulsky (2000), but not Martin et al. (2000). Overview of Results The V > P pattern on the WAIS, WAIS-R, and WAIS-III for patients with bilateral damage or diffuse brain injury conforms to Wechsler s (1958) original clinical observation that patients with organic brain disease usually display depressed Performance IQs. However, the WAIS-III Processing Speed Index may be even more sensitive than the global measures of V-IQ and P-IQ on the WAIS-III or on any of its predecessors. That possibility is partially due to the addition of Matrix Reasoning to the WAIS-III Performance Scale, and, perhaps equally, to the elimination of the highly-speeded Object Assembly subtest from all global measures of nonverbal ability on the WAIS-III.