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Efficacy of the WISC-III short form for children diagnosed with conduct and oppositional defiant disorders
6
Abstracts from the 18th Annual Meeting
tion, short term memory, verbal memory and learning, comprehension, and nonverbal problem-solving (Fornazzari et al., 1983; Homes et al., 1986). The present case study involves a 17-year-old right-handed male with a neuropsychologic history of A D H D and polysubstance abuse involving daily marijuana use for about 3 years, weekend alcohol binges, occasional abuse of prescription drugs (including Percocet, Lortab, and Valium), and a circumscribed 3- to 4-week period of daily inhalation of a variety of glues. The patient reported significant concern over the inhalant abuse since he specifically noticed impaired memory subsequent to that period of use, in contrast to no subjective awareness that cognition was compromised subsequent to other drug or alcohol use. In fact, he was reluctant to undergo a neuropsychological evaluation for fear that it would confirm his suspicions. There was no history of neurological exam, including brain imaging or E E G . The neuropsychological battery was administered 3 months after cessation of all alcohol and other substance use and consisted of the WAIS-R, WMS-R, WCST, Trail Making Tests A and B, WRAT-R, Rey-Osterrieth Complex Figure Test, Finger Tapping Test, Visual Search and Attention Test, Connors Rating Scale, and a cerebellar and sensory-perceptual exam. Intellectual ability was assessed in the average range (VIQ = 100, PIQ = 94, and FSIQ = 97) which was consistent with an estimated premorbid functioning level. Assessment of language (with the exception of a pre-existing developmental disorder of written expression), attention/concentration, perception, construction, executive functions, fine motor dexterity, did not reveal sufficient evidence of lateralized or focal deficits. His performance on the WMS-R was remarkable, however, as evidenced by the following obtained Index Scores: Verbal Memory = 87, Visual Memory = 80, General Memory = 83, Attention/Concentration = 102, and Delayed Recall = 59. His Delayed Recall Index score is greater than two standard deviations below the mean (<1 percentile), and less than 5% of the standardization sample had a General MemoryDelayed Recall discrepancy greater than 22 points. His performance on delayed memory tasks was consistent with his subjective report of memory problems. The temporal onset of his memory problems was subsequent to the abuse of inhalants that most likely included toluene and/or acetone, although it is important to note that the patient was not able to reliably report the types of glues used and therefore the precise neurotoxin(s) are not known. Of particular importance is that the period of abuse was of brief duration, and subjective awareness of memory deficits became evident only after the period of glue inhalation. Further research is needed to make conclusive judgements about the link between delayed memory deficits and abuse of toluene and acetone. Limitations of the case study will be discussed.
Furgueson, C., Greenstein, D., McGuffin, P., & Soffer, S. Efficacy of the WISC-III Short Form for Children Diagnosed with Conduct and Oppositional Defiant Disorders. Over the past five decades, numerous abbreviated versions of the Wechsler Intelligence Scales have been developed to find brief batteries which provide data on an individual's functioning consistent with the data the full Wechsler provides. In addition to the importance of developing short forms of the Wechsler scales that are brief, they must also be clinically useful. For children, a commonly used short form consists of the Information, Vocabulary, Picture Completion, Block Design, and Coding subtests of the WISC-III. Few studies, however, have addressed the utility of the WISC-III short form in evaluating children from clinical populations. An earlier study by these authors documented the efficacy of a short form measure for use with children carrying a clinical diagnosis of A D H D . This study evaluated the use of the same short form of the WISC-III for use with those children carrying clinical diagnoses of Conduct Disorder or Oppositional De-
Abstracts from the 18th Annual Meeting
7
fiant Disorder. Of an initial sample of 234 psychiatrically hospitalized children, 76 (n = 76) children diagnosed with Conduct Disorder or Oppositional Defiant Disorder were evaluated. Following full administration of the WlSC-III, a Short Form I.Q. score was calculated and correlated with full WlSC-III administration scores. The correlation coefficient was 0.94 (p < .001), indicating that the short form adequately reflected these children's cognitive abilities. Results suggested that, as a brief screening measure or for research purposes with the behavioral disorder populations, this abbreviated version of the WISC-III is a reasonable alternative.
Gangarosa-Emerson, M. E., Jansiewicz, E. M., Emerson, R. L., Groover, W. D., & Grant, M. L. Cognitive Differences in Children with Type IIA and Classical PKU. Studies investigating neurocognitive functions of children with phenylketonuria (PKU), a genetic disease with inborn error of metabolism, have shown deficits in executive functioning, attention, reaction time, visual-spatial-motor skills, conceptual skills, problemsolving, and reading and math skills (Brunner, Berch, & Berry, 1987; Faust, Libon, & Pueschel, 1986; Waisenbran, Brown, Sonneville, & Levi, 1994; Welsh, Pennington, Ozonoff, Rouse, & McCabe, 1990). In addition, recent MRI studies have provided evidence of white matter disease associated with PKU even in individuals with adequate dietary control (Cleary, Walter, Wraith, Jenkins, Alani, Tyler, & Whittle, 1994). However, previous studies have focused primarily on children with classical PKU. Few studies have investigated the outcome of children with Type IIA PKU who are born with moderate levels of plasma phenylalanine. This study attempted to investigate potential cognitive differences in children diagnosed with Type IIA, classical PKU, and benign hyperphenylalanine (Type IIB). The latter group was included to serve as a clinical control group. Sixty-two children who were administered the WISC-III in conjunction with a state mandated study of children followed for PKU were initially included in the study. Those children identified as having inadequate dietary compliance (average lifetime blood phe levels >15 over 40% of the time; Netley, Hanley, & Rudner, 1984) were excluded from the study (N = 11). Fifty-one subjects were included in the analysis: Type IIA PKU (Group 1; N = 9; mean age 11.1); classical PKU (Group 2, N = 28, mean age 10.6); and Type lIB PKU (Group 3, N = 16, mean age 10.6). Phe levels, as measured by the Guthrie test, were averaged yearly and across life span. ANOVA's revealed no significant group differences for mother's education or test age. Life span phe levels for clinical groups 1 (mean = 8.2) and 2 (mean = 8.1) did not differ from each other but were significantly higher than Group 3 levels (mean = 5.3). A p value of less than .10 was considered significant for the current exploratory analyses. Analysis of variance (ANOVA) revealed a significant difference between groups for Verbal IQ (p = .06). T-tests revealed that Group 1 had significantly lower scores than Groups 2 or 3. Group 2 scores were also significantly lower than Group 3. The Freedom from Distractibility Index also differed significantly across groups (ANOVA, p = .07), with Groups 1 and 2 obtaining scores that were significantly lower than Group 3. Performance IQ and the Processing Speed Index scores did not differ significantly across groups. The current data suggest that children with Type IIA PKU, despite a life-time of good dietary control, demonstrate mild cognitive difficulties and appear to display a neurocognitive profile which differs from children with classical PKU.
Gold, S. G., Mittenberg, W., Aguila-Puentes, G., Burns, W. J., & Thomas, E. M. Acute Effects of Pediatric Traumatic Brain Injury on Memory Functioning. Although past research has suggested that deficits in the memory functioning of children occur with brain injury, studies have generally employed psychometric instruments
Abstracts from the 18th Annual Meeting
tion, short term memory, verbal memory and learning, comprehension, and nonverbal problem-solving (Fornazzari et al., 1983; Homes et al., 1986). The present case study involves a 17-year-old right-handed male with a neuropsychologic history of A D H D and polysubstance abuse involving daily marijuana use for about 3 years, weekend alcohol binges, occasional abuse of prescription drugs (including Percocet, Lortab, and Valium), and a circumscribed 3- to 4-week period of daily inhalation of a variety of glues. The patient reported significant concern over the inhalant abuse since he specifically noticed impaired memory subsequent to that period of use, in contrast to no subjective awareness that cognition was compromised subsequent to other drug or alcohol use. In fact, he was reluctant to undergo a neuropsychological evaluation for fear that it would confirm his suspicions. There was no history of neurological exam, including brain imaging or E E G . The neuropsychological battery was administered 3 months after cessation of all alcohol and other substance use and consisted of the WAIS-R, WMS-R, WCST, Trail Making Tests A and B, WRAT-R, Rey-Osterrieth Complex Figure Test, Finger Tapping Test, Visual Search and Attention Test, Connors Rating Scale, and a cerebellar and sensory-perceptual exam. Intellectual ability was assessed in the average range (VIQ = 100, PIQ = 94, and FSIQ = 97) which was consistent with an estimated premorbid functioning level. Assessment of language (with the exception of a pre-existing developmental disorder of written expression), attention/concentration, perception, construction, executive functions, fine motor dexterity, did not reveal sufficient evidence of lateralized or focal deficits. His performance on the WMS-R was remarkable, however, as evidenced by the following obtained Index Scores: Verbal Memory = 87, Visual Memory = 80, General Memory = 83, Attention/Concentration = 102, and Delayed Recall = 59. His Delayed Recall Index score is greater than two standard deviations below the mean (<1 percentile), and less than 5% of the standardization sample had a General MemoryDelayed Recall discrepancy greater than 22 points. His performance on delayed memory tasks was consistent with his subjective report of memory problems. The temporal onset of his memory problems was subsequent to the abuse of inhalants that most likely included toluene and/or acetone, although it is important to note that the patient was not able to reliably report the types of glues used and therefore the precise neurotoxin(s) are not known. Of particular importance is that the period of abuse was of brief duration, and subjective awareness of memory deficits became evident only after the period of glue inhalation. Further research is needed to make conclusive judgements about the link between delayed memory deficits and abuse of toluene and acetone. Limitations of the case study will be discussed.
Furgueson, C., Greenstein, D., McGuffin, P., & Soffer, S. Efficacy of the WISC-III Short Form for Children Diagnosed with Conduct and Oppositional Defiant Disorders. Over the past five decades, numerous abbreviated versions of the Wechsler Intelligence Scales have been developed to find brief batteries which provide data on an individual's functioning consistent with the data the full Wechsler provides. In addition to the importance of developing short forms of the Wechsler scales that are brief, they must also be clinically useful. For children, a commonly used short form consists of the Information, Vocabulary, Picture Completion, Block Design, and Coding subtests of the WISC-III. Few studies, however, have addressed the utility of the WISC-III short form in evaluating children from clinical populations. An earlier study by these authors documented the efficacy of a short form measure for use with children carrying a clinical diagnosis of A D H D . This study evaluated the use of the same short form of the WISC-III for use with those children carrying clinical diagnoses of Conduct Disorder or Oppositional De-
Abstracts from the 18th Annual Meeting
7
fiant Disorder. Of an initial sample of 234 psychiatrically hospitalized children, 76 (n = 76) children diagnosed with Conduct Disorder or Oppositional Defiant Disorder were evaluated. Following full administration of the WlSC-III, a Short Form I.Q. score was calculated and correlated with full WlSC-III administration scores. The correlation coefficient was 0.94 (p < .001), indicating that the short form adequately reflected these children's cognitive abilities. Results suggested that, as a brief screening measure or for research purposes with the behavioral disorder populations, this abbreviated version of the WISC-III is a reasonable alternative.
Gangarosa-Emerson, M. E., Jansiewicz, E. M., Emerson, R. L., Groover, W. D., & Grant, M. L. Cognitive Differences in Children with Type IIA and Classical PKU. Studies investigating neurocognitive functions of children with phenylketonuria (PKU), a genetic disease with inborn error of metabolism, have shown deficits in executive functioning, attention, reaction time, visual-spatial-motor skills, conceptual skills, problemsolving, and reading and math skills (Brunner, Berch, & Berry, 1987; Faust, Libon, & Pueschel, 1986; Waisenbran, Brown, Sonneville, & Levi, 1994; Welsh, Pennington, Ozonoff, Rouse, & McCabe, 1990). In addition, recent MRI studies have provided evidence of white matter disease associated with PKU even in individuals with adequate dietary control (Cleary, Walter, Wraith, Jenkins, Alani, Tyler, & Whittle, 1994). However, previous studies have focused primarily on children with classical PKU. Few studies have investigated the outcome of children with Type IIA PKU who are born with moderate levels of plasma phenylalanine. This study attempted to investigate potential cognitive differences in children diagnosed with Type IIA, classical PKU, and benign hyperphenylalanine (Type IIB). The latter group was included to serve as a clinical control group. Sixty-two children who were administered the WISC-III in conjunction with a state mandated study of children followed for PKU were initially included in the study. Those children identified as having inadequate dietary compliance (average lifetime blood phe levels >15 over 40% of the time; Netley, Hanley, & Rudner, 1984) were excluded from the study (N = 11). Fifty-one subjects were included in the analysis: Type IIA PKU (Group 1; N = 9; mean age 11.1); classical PKU (Group 2, N = 28, mean age 10.6); and Type lIB PKU (Group 3, N = 16, mean age 10.6). Phe levels, as measured by the Guthrie test, were averaged yearly and across life span. ANOVA's revealed no significant group differences for mother's education or test age. Life span phe levels for clinical groups 1 (mean = 8.2) and 2 (mean = 8.1) did not differ from each other but were significantly higher than Group 3 levels (mean = 5.3). A p value of less than .10 was considered significant for the current exploratory analyses. Analysis of variance (ANOVA) revealed a significant difference between groups for Verbal IQ (p = .06). T-tests revealed that Group 1 had significantly lower scores than Groups 2 or 3. Group 2 scores were also significantly lower than Group 3. The Freedom from Distractibility Index also differed significantly across groups (ANOVA, p = .07), with Groups 1 and 2 obtaining scores that were significantly lower than Group 3. Performance IQ and the Processing Speed Index scores did not differ significantly across groups. The current data suggest that children with Type IIA PKU, despite a life-time of good dietary control, demonstrate mild cognitive difficulties and appear to display a neurocognitive profile which differs from children with classical PKU.
Gold, S. G., Mittenberg, W., Aguila-Puentes, G., Burns, W. J., & Thomas, E. M. Acute Effects of Pediatric Traumatic Brain Injury on Memory Functioning. Although past research has suggested that deficits in the memory functioning of children occur with brain injury, studies have generally employed psychometric instruments