Alan S. Kaufman, Nadeen L. Kaufman) Specific Learning

Specific learning disabilities and difficulties in children and adolescents
Psychological assessment and evaluation

Theassessment of speciclearningdisabilitiesanddisorders(SLD) haslongbeencontroversial.
Denitions, diagnosis, andtreatmentshavebeenvigorouslydebatedfor decades, withtheuseof
IQtestsattractingparticular controversy. However, inrecent timestherehavebeenmanyother
newassessment tools devisedfor measuringintelligenceand neuropsychological functioning,
extendingwell beyondthescopeof Wechslersscales. In thiscutting-edgesurvey, aninterna-
tional teamof leadersintheeldexaminestheavailablemethods. Manyof thecontributorsare
themselvesthedevelopersof themost recent assessment tests.
The authors of each chapter evaluate the diversity of clinical applications of these new
instrumentsinSLD, andtheir importantimplicationsforeducational intervention. Thehistorical
contextandtheunderlyingneuropsychological andcognitivetheoryarealsoexpertlyexamined.
Thisbookwill beessential readingfor anypractitioner or traineedealingwithspeciclearning
issuesinyoungpeople.
AlanandNadeenKaufmanarebasedat theYaleUniversity School of Medicineandtogether
havedevelopedandpublishedeight testsof intelligence, achievement, andneuropsychological
functioning, including the Kaufman Brief Intelligence Test (K-BIT), the Kaufman Test of
Educational Achievement (K-TEA), and theKaufman Adolescent and Adult IntelligenceTest
(KAIT). Theyareworld-renownedauthoritiesintheareaof neuropsychological andcognitive
assessment for speciclearningdisabilitiesanddisorders.
Cambridge Child and Adolescent Psychiatry
Childandadolescent psychiatryisanimportantandgrowingareaof clinical psychiatry. Thelastdecade
hasseenarapidexpansionof scienticknowledgeinthiseldandhasprovidedanewunderstandingof
theunderlyingpathologyof mental disordersintheseagegroups. Thisseriesisaimedat practitioners
and researchers both in child and adolescent mental health services and developmental and clinical
neuroscience. Focusingonpsychopathology, it highlightsthosetopicswherethegrowthof knowledge
has had thegreatest impact on clinical practiceand on thetreatment and understandingof mental
illness. Individual volumes benet both fromtheinternational expertiseof their contributors and a
coherencegeneratedthroughauniformstyleandstructurefor theseries. Eachvolumeprovidesrstly
anhistorical overviewandaclear descriptiveaccount of thepsychopathologyof aspecicdisorder or
group of related disorders. Thesefeaturesthen formthebasis for athorough critical review of the
etiology, natural history, management, preventionandimpact onlater adult adjustment. Whilst each
volumeisthereforecompleteinitsownright, volumesalsorelatetoeachother tocreateaexibleand
collectableseriesthat shouldappeal tostudentsaswell asexperiencedscientistsandpractitioners.
Editorial board
Serieseditor Professor IanM. Goodyer Universityof Cambridge
Associateeditors
Professor Donald J. Cohen Dr Robert N. Goodman
YaleChildStudyCenter Instituteof Psychiatry, London
Professor BarryNurcombe Professor Dr Helmut Remschmidt
TheUniversityof Queensland Klinikumder Philipps-Universitat, Germany
Professor Dr HermanvanEngeland Dr FredR. Volkmar
AcademischZiekenhuisUtrecht YaleChildStudyCenter
Already published in this series:
PsychotherapywithChildrenandAdolescentseditedbyHelmut Remschmidt 0521775582pb
TheDepressedChildandAdolescent second edition editedbyIanM. Goodyer 0521794269pb
SchizophreniainChildrenandAdolescentseditedbyHelmut Remschmidt 0521794285pb
AnxietyDisordersinChildrenandAdolescents:Research, AssessmentandInterventioneditedbyWendy
SilvermanandPhilipTreffers0521789664pb
Conduct DisordersinChildhoodandAdolescenceedited by Jonathan Hill and BarbaraMaughan
0521786398pb
AutismandPervasiveDevelopmental DisorderseditedbyFredR. Volkmar 0521553865hb
CognitiveBehaviour Therapyfor ChildrenandFamilieseditedbyPhilipGraham0521572525hb
0521576261pb
HyperactivityDisordersof ChildhoodeditedbySeijaSandberg0521432502hb
Specific learning
disabilities and
difficulties in children
and adolescents
Psychological assessment and evaluation
Edited by
AlanS. Kaufman
and
NadeenL. Kaufman
publi s hed by the pres s s yndi cate of the uni versi ty of cambri dge
ThePitt Building, TrumpingtonStreet, Cambridge, UnitedKingdom
cambri dge uni vers i ty pres s
TheEdinburghBuilding, CambridgeCB22RU, UK
40West 20thStreet, NewYork, NY 10011-4211, USA
10StamfordRoad, Oakleigh, vi c 3166, Australia
RuizdoAlarcon13, 28014Madrid, Spain
DockHouse, TheWaterfront, CapeTown8001, SouthAfrica
http:/ / www.cambridge.org
CambridgeUniversityPress2001
Thisbookisincopyright. Subject tostatutoryexception
andtotheprovisionsof relevant collectivelicensingagreements,
noreproductionof anypart maytakeplacewithout
thewrittenpermissionof CambridgeUniversityPress.
First published2001
PrintedintheUnitedKingdomat theUniversityPress, Cambridge
TypefaceDanteMT 11/ 14pt SystemPoltype
[vn]
Acataloguerecordfor thisbookisavailablefromtheBritishLibrary
Libraryof CongressCataloginginPublicationdata
Speciclearningdisabilitiesanddifcultiesinchildrenandadolescents/ editedbyAlanS. Kaufman
andNadeenL. Kaufman.
p. cm. (Cambridgechildandadolescent psychiatry)
Includesindex.
ISBN0521658403(pb)
1. Learningdisabilities Treatment. 2. Learningdisabledchildren. I. Kaufman, AlanS., 1944
II. Kaufman, NadeenL. III. Cambridgechildandadolescent psychiatryseries
RJ506.L4S6442001
618.92'85889dc21 00-064187
ISBN0521658403paperback
Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateandup-to-dateinformationwhichisin
accordwithacceptedstandardsandpracticeatthetimeof publication. Nevertheless, theauthors, editorsand
publisher canmakenowarrantiesthat theinformationcontainedhereinistotallyfreefromerror, not least
becauseclinical standardsareconstantlychangingthroughresearchandregulation. Theauthors, editorsand
publisherthereforedisclaimall liabilityfordirectorconsequential damagesresultingfromtheuseof material
containedinthisbook. Readersarestronglyadvisedtopaycareful attentiontoinformationprovidedbythe
manufacturer of anydrugsor equipment that theyplantouse.
To Blanche Kaufman,
OUR MOTHER
She loved us, and she listened.
Hear our love and gratitude,
For we are lonely without you.
MMMM
Contents
List of contributors ix
Preface xiii
Part I History and Tradition 1
1 Historylessons 3
Margaret Jo Shepherd
2 TheWechsler intelligencescales 29
Gary Groth-Marnat
Part II Alternative Cognitive Approaches to Learning Disabilities
Assessment and Remediation 53
3 Applicationof theWoodcockJohnsonTestsof Cognitive
AbilityRevisedtothediagnosisof learningdisabilities 55
Nancy Mather and Richard W. Woodcock
4 TheKaufmantests K-ABCandKAIT 97
Elizabeth O. Lichtenberger
5 UsingtheCognitiveAssessment System(CAS) withlearning-disabled
children 141
Jack A. Naglieri
6 Applicationof theDifferential AbilityScales(DAS) andBritishAbility
Scales, SecondEdition(BASII), for theassessment of learningdisabilities 178
Colin D. Elliott
7 Isdynamicassessment compatiblewiththepsychometricmodel? 218
Reuven Feuerstein and Raphael S. Feuerstein
8 Multi-perspective, clinicaleducational assessmentsof language
disorders 247
Elisabeth H. Wiig
vii
Part III Neuropsychological Approaches to Learning Disabilities
Assessment and Remediation 281
9 Learningdisabilitiesandtheir neurological foundations, theories,
andsubtypes 283
Otfried Spreen
10 TheHalsteadReitanNeuropsychological Test Battery: research
ndingsandclinical application 309
Ralph M. Reitan and Deborah Wolfson
11 Developmental assessment of neuropsychological functionwiththe
aidof theNEPSY 347
Marit Korkman, Sarah L. Kemp, and Ursula Kirk
12 Clinical neuropsychological assessment of childandadolescent
memorywiththeWRAML, TOMAL, andCVLTC 387
Erin D. Bigler and Wayne V. Adams
Part IV Integration and Summation 431
13 Assessment of speciclearningdisabilitiesinthenewmillennium:
issues, conicts, andcontroversies 433
Alan S. Kaufman and Nadeen L. Kaufman
Index 463
viii Contents
Contributors
WayneV. Adams
Professor of Psychology
GraduateSchool of Clinical Psychology
GeorgeFoxUniversity
414NorthMeridianStreet
Newberg
Oregon97132
USA
E-mail: wadams@georgefox.edu
ErinD. Bigler
Professor andChair
Department of Psychology
BrighamYoungUniversity
1082Kimball Tower
Provo
Utah84602
USA
E-mail: erin
bigler@byu.edu
ColinD. Elliott
860Fowler Avenue
NewburyPark
California91320
USA
E-mail: Basdasman@aol.com
Raphael S. Feuerstein
International Centerfor theEnhancementof
LearningPotential
POBox7755
47NarkisStreet
Jerusalem91077
Israel
E-mail: reuvenf@actcom.co.il
ReuvenFeuerstein
International Centerfor theEnhancementof
LearningPotential
POBox7755
47NarkisStreet
Jerusalem91077
Israel
E-mail: reuvenf@actcom.co.il
GaryGroth-Marnat
Senior Lecturer inClinical Health
Psychology
School of Psychology
CurtinUniversity
GPOBoxU1987
Perth
WesternAustralia6001
Australia
E-mail:
G.Groth-Marnat@psychology.curtin.edu.au
AlanS. Kaufman
Clinical Professor of Psychology
YaleChildStudyCenter
YaleUniversitySchool of Medicine
POBox207900
230SouthFrontageRoad
NewHaven
Connecticut 06520-7900
USA
E-mail: NadeenKaufman@msn.com
ix
NadeenL. Kaufman
Lecturer, Clinical Faculty
YaleChildStudyCenter
YaleUniversitySchool of Medicine
POBox207900
230SouthFrontageRoad
NewHaven
Connecticut 06520-7900
USA
E-mail: NadeenKaufman@msn.com
SarahL. Kemp
1802S. CheyenneDrive
Tulsa
Oklahoma74119
USA
E-mail: Doctorsally@comnpuserve.com
UrsulaKirk
Apt. 27B, 222E. 93rdStreet
NewYork
NewYork10128-3759
USA
E-mail: uk12@columbia.edu
MaritKorkman
Professor of ChildNeuropsychology
TheHospital for ChildrenandAdolescents
Helsinki andUusimaaHospital District
Helsinki
Finland
E-mail: marit.korkman@skynet.be
ElizabethO. Lichtenberger
SalkInstituteof Biological Studies
6740TeaTreeStreet
Carlsbad
California92009
USA
E-mail: drlizmike@aol.com
NancyMather
AssociateProfessor
Collegeof Education 409
Department of Special Educationand
Rehabilitation
Universityof Arizona
Tucson
Arizona85721
USA
E-mail: nmather@U.Arizona.EDU
JackA. Naglieri
Director
Center for CognitiveDevelopment
GeorgeMasonUniversity
4400UniversityDrive
Fairfax
Virginia22030
USA
E-mail: naglieri.1@osu.edu
RalphM. Reitan
ReitanNeuropsychologyLaboratory
2920S. 4thAvenue
SouthTucson
Arizona85713-4819
USA
E-mail: Reitanlab@aol.com
MargaretJoShepherd
454W. 46thStreet
Apt. 4C-S
NewYork
NewYork10036
USA
E-mail: mjs96@columbia.edu
x List of contributors
OtfriedSpreen
Professor Emeritus
Department of Psychology
Universityof Victoria
POBox3050
Victoria
BritishColumbiaV8W3P5
Canada
E-mail: spreen@UVic.CA
ElisabethH. Wiig
7101LakePowell Drive
Arlington
Texas76017-3517
USA
E-mail: ehwiig@krii.com
DeborahWolfson
ReitanNeuropsychologyLaboratory
2920S. 4thAvenue
SouthTucson
Arizona85713-4819
USA
E-mail: Reitanlab@aol.com
RichardW. Woodcock
532CreelmanLane
Ramona
California92065
USA
E-mail: rww4m.ramona@worldnet.att.net
xi List of contributors
MMMM
Preface
Thisbook, Speciclearningdisabilitiesanddifcultiesinchildrenandadolescents:
Psychological assessmentandevaluation, isdevotedtothetopicof speciclearning
disabilities, withafocuson their assessment. Thetermslearningdisabilities
(LD)andspeciclearningdisabilities(SLD)areusedinterchangeablythrough-
out the book. When a chapter author uses the termlearning disabilities, it
shouldalwaysbeinterpretedasspeciclearningdisabilities.
Theeldof learningdisabilitiesassessment haslongbeencontroversial, and
remainsso asthetwenty-rst centurybegins. Controversieshaveragedover
denitions, interventions, and instruments. Recent articles in the Journal of
Learning Disabilities (by leaders in the eld such as Linda Siegel, Keith
Stanovich, and Frank Vellutino) have called for the elimination of the IQ
achievement discrepancy fromthe denition of specic learning disabilities,
and some leaders are demanding the elimination of IQ tests from the
psychoeducational assessment process. To someextent, theseargumentsare
basedon thecontinueduseof Wechslersscalesfor thediagnosisof specic
learningdisabilities. Wedeal withthesecontroversiesintheconcludingchap-
terofthisbook. However, oneof thereasonsthatwewantedtowritethisbook
intherst placewasbecauseof themanyalternativesto theWechsler scales
thatbecameavailableduringthelasttwodecadesof thepreviousmillennium.
Thereisnowmuch moreto intellectual assessment thanWechsler scales.
Thisfact isprobablyobviousintheUK, wheretheBritishAbilityScales(BAS)
andnowitsrevision, theBASII, havebeencommonlyused(ashaveWechsler
scales) for evaluations of specic learning disabilities. The fact may be less
obvious in the USA, where Wechsler scales (then the WISC and WAIS)
surpassedtheStanfordBinet (thenFormL-M) andestablishedtheir supreme
reign during the 1960s. The ascendance of the Wechsler scales at the time
coincided, but not by coincidence, with the burgeoning eld of learning
disabilities, whoseleadersdemandedmulti-scoreprolesinsteadof global IQs.
ThereigncontinuedthroughtheR tests(WISCRandWAISR)inthe1970s
xiii
and1980sandisstill goingstrongwiththethirdgenerationof tests(WISCIII
and WAISIII). However, it may betimefor clinicians to re-evaluateor, at
least, explorethediversityof optionsthatarenowavailablefor speciclearning
disabilities evaluations. Many of these tests are theory based, with Lurias
neuropsychological theoryandHornsuidcrystallizedtheoryof intelligence
eachformingthefoundationof several newtests. Incontrast, Wechsler scales,
liketheBinet beforethem, weredevelopedfrompragmatic, decidedly non-
theoretical, frameworks.
Inconceivingthisbook, wewantedtoputondisplaythemanynewmethods
developedfor theneuropsychological, intellectual, andlanguageassessment of
children, adolescents, and adults, with the chapter authors endeavoring to
relate the tests to the diagnosis and treatment of individuals with specic
learningdisabilities. A number of chaptersarewrittenbyauthorswho know
thespecicinstrumentsintimately, namelytheauthorsof theteststhemselves.
Amongthenewbreedof tests, thisdual roleof test/ chapterauthorwastruefor
theWoodcockJohnsonTestsof CognitiveAbilityRevised(WJR) andWJ III
(Nancy Mather and Richard Woodcock, Chapter 3), the Cognitive Ability
Scales(CAS)(JackNaglieri, Chapter 5), theBritishAbilityScalesII (BASII)and
Differential AbilityScales(DAS) (ColinElliott, Chapter 6), theNEPSY (Marit
Korkman, Sally Kemp, and Ursula Kirk, Chapter 11), and comprehensive
measuresof memory and learning(WRAML and TOMAL) (Erin Bigler and
WayneAdams, Chapter 12). Wedidnot goright tothehorsesmouthfor the
Kaufmantests, becauseweknewthat thehorseswouldhavetheir sayinthe
nal, integrativechapter(Chapter13), butthepsychologistweselectedtowrite
Chapter 4on the K-ABC and KAIT, Elizabeth Lichtenberger, was clinically
supervisedandtrainedby NadeenandhascollaboratedwithAlanonseveral
texts.
Inadditionto thechaptersonnewmeasures, therearethreechaptersthat
featuremoreestablishedinstruments, but that focusjust asmuchonaspecic
styleof assessment asontheteststhemselves. Thesechapters, too, arewritten
directlybytheprofessionalswhodevelopedthefeaturedtestsand, evenmore
importantly, innovatedaparticular styleof assessment dynamicassessment
(Reuven Feuerstein and Raphael Feuerstein, Chapter 7), clinicaleducational
language assessment (Elisabeth Wiig, Chapter 8), and neuropsychological
assessment (RalphReitanandDeborahWolfson, Chapter 10).
Thebest waytounderstandwhereaeldisheadedinthefutureistohavea
solidgroundingonwhereit hasbeen. Theeldof speciclearningdisabilities
has had a colorful history and can trace its roots to both neurology and
education. Webelievedthat it wasimportant tooffer bothof thesehistorical
xiv Preface
perspectives,andenlistedexpertswhohavewitnessedthegrowthof theeldof
specic learning disabilities from its inception and have been dynamically
involvedwiththedirectionsspeciclearningdisabilitiesandtheir assessment
havetakenduringtheir evolution. Representingtheeducational viewpoint is
Margaret JoShepherd(Chapter 1), withOtfriedSpreen(Chapter 9) supplying
theneurological perspective.
This book might have been organized in a number of ways, particularly
because of the complexity of both of the elds we have merged, specic
learning disabilities and assessment. Whereas education and neurology can
appear worlds apart, they are intertwined for specic learning disabilities
assessment, anditisdifculttoseparatethem; indeed, itisnotpossibletowrite
about theapplicationof aninstrument for speciclearningdisabilitiesassess-
ment without blendingbiological basesandpresumedbraindysfunctionwith
academic decitsandeducational intervention. Wehavechosento organize
thebookinfour parts. Therst andlast partsarerelativelyshort, themiddle
two parts more extensive. We begin with history and tradition in Part I,
encompassing Shepherds education-oriented and practical-focused History
lessons (Chapter 1) and Gary Groth-Marnats treatment of Wechsler scales
(Chapter 2). PartII presentsalternativecognitiveapproachestospeciclearning
disabilities assessment and remediation, meaning alternatives to Wechsler
scales, andincludesavarietyof newinstrumentsinChapters3to6, aswell as
theFeuersteins dynamicassessment approachinChapter 7, andWiigsclini-
caleducational approachtolanguageassessmentinChapter 8. PartIII features
neuropsychological approaches to specic learning disabilities assessment and
remediation, encompassingthehistorical foundationsin Chapters9, theold,
establishedHalsteadReitaninChapter 10, thenewNEPSYinChapter 11, and
tests specically geared to memory and learning in Chapter 12. Part IV,
composedsolelyof our concludingchapter, integratesthetopicscoveredinthe
book, addressingcontemporary controversiesandillustratinghowthescales
and subtests discussed throughout the book can be hand-picked and reor-
ganizedto measureadiversityof keyareasthat areroutinelyassessedduring
speciclearningdisabilitiesevaluations, for exampleattention, reasoning, and
motor coordination.
Becausethisbook waseditedby Americanauthors, publishedby aBritish
company, andtargetedfor aworld-wideaudience, wewantedto achievean
international avor. Towardthat endwehaveassembledaninternational cast
that includesanumber of Americanchapter authorsaswell asauthorsfrom
Great Britain(ColinElliott, currentlylivingintheUSA), Finland(Marit Kork-
man), Israel (Reuven and Raphael Feuerstein), Germany (Otfried Spreen,
xv Preface
currentlylivinginCanada), andAustralia(American-bornGaryGroth-Marnat).
Webelievethat this book will beof extremevalue to anyone interested
in learning disabilities or assessment. It is intended for graduate students
and upper-level undergraduatestudents in education, special education, and
psychology (e.g., school, clinical, educational, and counseling psychology;
neuropsychology; psychometrics), and for practicing, academic, and
research-oriented professionals in each of these disciplines. Neurologists,
medical students, andotherswith amedical orientation shouldalso nd the
topicsinformativeandvaluable.
Acknowledgments
Weareextremelygrateful to anumber of peoplefor their direct or indirect
contributionsto thisbook: to Dr JamesC. Kaufman, for hisgenerous, swift,
invaluableresearchandeditorial assistance not just withthisbook, but with
all of our research, test development, and writing projects and for his
unagging love, support, and friendship; to Dr Margaret Jo Shepherd, for
servingas our mentor for morethan aquarter of acentury in theelds of
learning disabilities and clinical inference, and for a close friendship that
developedwhilecollaboratingonthisbook; toDr Peter Melchers, of Cologne,
Germany,andtoJanandRuyaAlm, of Uppsala, Sweden, whohaveenrichedus
withtheir knowledgeof theinternational scopeof dyslexiaandclinical assess-
ment, andwhohavedemonstratedthat deepfriendshipscaneasilytranscend
oceans and cultures; and to Kathy Howell and Shauna Cooper, who gave
generously of their time and effort to facilitate the nal preparation of this
manuscript.
xvi Preface
Part I
History and Tradition
MMMM
1
History lessons
Margaret Jo Shepherd
Introduction
InApril 1963, Samuel Kirk, aprominent psychologist/ special educator, stood
beforeagroupcomposedof peoplewhosechildrenwereintroubleinschool
andother people, insmaller numbers, who hadaprofessional interest inthe
children, andsaid:
I know that one of your problems at this meeting is to nd a term that applies to every child. Last
night, a friend of mine accosted me with the statement, Were going to ask you to give us a term
(Kirk, 1963, p. 1).
A few sentences later, Dr Kirk referred to children with developmental
decits of one kind or another and then, after pointing out problems with
technical and complex labels and arguing for behavioral descriptions of
childrensproblemsrather thanetiological statements, said:
Recently, I have used the term learning disabilities to describe a group of children who have
disorders in development in language, speech, reading and associated communication skills
needed for social interaction. In this group I do not include children who have sensory handicaps
such as blindness or deafness, because we have methods of managing and training the deaf and
the blind. I also exclude from this group children who have generalized mental retardation. This
approach has led me and my colleagues to develop methods of assessing children, or describing
their communication skills in objective terms (Kirk, 1963, pp. 23).
Dr Kirk concludedthespeechwith adetaileddescriptionof atest hewas
creating, theIllinoisTest of Psycholinguistic Abilities, emphasizingthetests
capacitytospecifydecitsandstrengthsinthepsychological processesunderly-
ingspokenand, byimplication, writtenlanguage.
Subsequently, speciclearningdisability wasacknowledgedinfederal laws
as a disability that entitled every individual so described to publicly funded
special educationandrelatedspecial servicesandtoprotectionfromdiscrimina-
tionineducationandemployment. Simultaneously, professionalsstruggledto
3
turntheideabehindthenameDr Kirksuggestedintocriteriafor identifyingthe
children. Thatstrugglecontinues, andpeoplewhochoosetoreadthisbookare
at theheart of it.
Althoughthenamelearningdisabilities hasarelatively short history, the
ideas behind the name are older. I was asked to place these ideas and the
identicationpracticestheyengender inhistorical perspective. At rst, mytask
seemed easy, because the history is written (see Wiederholt, 1974; Kessler,
1980; Doris, 1986, 1993; Farnham-Diggory, 1992; Kavale& Forness, 1995; and
Torgesen, 1998; among others). Using these texts, I planned to construct
another historydifferingfromthoseinprint intheemphasisI wouldplaceon
identication(moreaccuratelynamedassessment) practices.
FollowingLeeWiederholtslead(1974), most historiesare, understandably,
chronological. These histories link work on acquired spoken and written
languagedisorderswith work on developmental written languagedisorders,
andlinkwork onacquireddisordersof perception, attention, andmoodwith
similardevelopmental disorders. Althoughtherearevariationsinsequence, the
peoplewhoseideasrelatetolanguagedisordersareusuallyconsideredrst and
thosewhoseideasareassociatedwithdisordersof perception, attention, and
moodareconsideredsecond. Whatever thesequence, theimplicationisthat
ideasabout developmental languagedisordersandideasabout perceptual and
mood disorders and the clinical and research traditions each set of ideas
spawned are part of a single history linked to the contemporary concept
learningdisabilities.
I believethehistorical storyshouldbetoldinadifferent way. Inagreement
withothers(Hallahan& Cruickshank, 1973; Kessler, 1980; Kavale& Forness,
1995; Torgesen, 1998), I believethat ideasabout developmental disordersof
perception are the inuential ideas in the terms learning disabilities and
specic learningdisability. Weshouldcarry thisanalysisfurther, however.
1
Ideasabout developmental writtenlanguagedisorders, originatinginthework
of JamesHinshelwoodandSamuel Orton, arenot compatiblewiththeideas
about developmental disorders of perception that originated in thework of
HeinzWernerandAlfredStrauss. Developmental dyslexiaandspeciclearning
disabilityaredifferent conceptsandcannot becombined.
Anillustrationofthispointshouldhelp. BecauseI thinkitisaclear statement
about speciclearningproblems, I wantedtobeginthischapter asfollows:
Some children enter school without giving advance notice of trouble ahead and proceed to
experience severe and persistent difculty learning to read, spell, write or calculate. The struggle
with learning that we see is restricted, initially at least, to this list of tasks and to specic tasks
4 Margaret Jo Shepherd
within the list. Some children have difculty learning to read (reading, here, is dened as
transcribing printed words back to speech) and spell; others have difculty learning to write
(writing, here, is dened as composing text) and spell. Still others have difculty learning to use
numbers and write (writing, here, is dened as forming letters, numbers, and words). The
childrens learning problems must exist, in some form, before they enter school, but we do not see
themuntil the children confront reading, writing, or arithmetic. With help, correction and compen-
sation occur, but the children carry the learning problems into their adult lives. These children and
the adults they become are the topic of this book.
Hinshelwood and Orton are talking in this paragraph and Strauss and
Wernersvoicesaresilent. Consequently, I couldnot beginthischapter with
thisparagraph. I couldnot combinethesetwoclinical andresearchconditions
andtell anaccuratestory. HinshelwoodandOrtonbelievedthat braindamage
or dysfunction could disrupt learning specic to reading and writing. They
describedchildren and adolescents who wereconsidered intelligent by their
teachers except in relation to reading and writing. In contrast, Werner and
Strauss believed that brain damage could affect a specic mental activity,
perception, andconsequently disrupt learningon any task that requiredthat
mental activity. StraussandWernerstudiedadolescentswhowereknowntobe
mentallyretardedand, presumably, struggledto read, spell, write, andcalcu-
late.StraussandWernerandHinshelwoodandOrtoncannotspeakinthesame
paragraph. Their viewsabout speciclearningdisabilitiesweredifferent inthe
ways described above. And their views about remedial or special education
weredifferent, too.
Bothviewsarepresentedin thischapter. I begin with theWerner/Strauss
viewbecause, asindicatedearlier, several peoplewhohavestudiedthishistory
believethat their viewinuencedthedenitionof speciclearningdisability
in federal laws and also inuencedUSpublic school practices. TheStrauss/
Wernerviewisintroducedwithastorytoldbyaschool psychologistwho, with
theothermembersofhisassessmentteam, istryingtousethefederal denition
andcriteriatoidentifystudentswithlearningdisabilities. TheHinshelwood/
Ortonviewisintroducedwithastoryabout anadolescent whohasaspecic
arithmetic and writing (penmanship) disability. I have a preference for the
HinshelwoodandOrtonview, andthat preferenceiscertainlyreectedinthe
way I wrotethischapter. I do not believethat I haveprivilegedknowledge,
however, sointheendI leavedecisionandchoiceinyour hands.
Thoughit will berepetitivetosomeof you, I will prefacethepsychologists
story with information about assessment guidelines in the federal special
educationlaw.
2
Remember, eachstateeducationagencydevelopsregulations
for thestatethat must conformwith, but canexceed, thefederal regulations.
5 History lessons
Furthermore, most statesgivesomelatitudeto local school districts. Conse-
quently, thereisnot onewayacrossall statesandall school districtswithina
statetodeterminethat achildhasalearningdisability.
Specific learning disability according to Federal Special Education Law
A denitionof speciclearningdisability wasrst incorporatedinto federal
law when Congress amended Title V of the Elementary and Secondary
EducationAct toincludeTheChildrenwithSpecicLearningDisabilitiesAct
of 1969(PL 91-230). Thisact authorizedfederal fundsto support theprofes-
sional preparation of educators, programs of research, and the creation of
model educationprogramsfor childrenwithspeciclearningdisabilities. The
samedenitionwasincorporatedintotheRighttoEducationfor All Handicap-
pedChildrensAct of 1975(PL 94-142). Unliketheearlier legislation, however,
PL 94-142 not only contained a denition, but also criteria for identifying
learning-disabledstudents. Thedenitionandidenticationcriteriahavebeen
maintained, without change, through thevariousamendmentsto PL 94-142
andarecurrentlyinplaceintheIndividualswithDisabilitiesEducationAct of
1997(PL 105-17). Thedenitionreads:
Specic learning disability means a disorder in one or more of the basic psychological processes
involved in understanding or in using language, spoken or written, that may manifest itself in an
imperfect ability to listen, speak, read, write, spell, or do mathematical calculations. The term
includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dys-
lexia, and developmental aphasia. The term does not apply to children who have learning
problems that are primarily the result of visual, hearing, or motor disabilities, of mental retarda-
tion, of emotional disturbance, or of environmental, cultural, or economic disadvantage (Federal
Register 42 [1977] p. 60582).
Regulationsthenspecifythat amultidisciplinaryassessment teamcannda
speciclearningdisability if:
(1) The child does not achieve commensurate with his or her age and ability when provided with
appropriate educational experiences, and (2) the child has a severe discrepancy between achieve-
ment and intellectual ability in one or more of seven areas related to communication skills and
mathematics abilities (Federal Register 42 [1977] p. 65083).
Theseverediscrepancyspeciedintheregulationsmaybefoundinoneor
moreof thesedomains:oral expression;listeningcomprehension;basicreading
skill; reading comprehension; mathematical calculation; and mathematical
reasoning. Aspart of theassessment, onemember of theteammust observe
the child in the classroom. A child may not be called learning disabled,
regardlessof discrepancy(ies), unlesstheteamcanexcludeother disabilitiesand
adverseenvironmental factors(seelistindenition)ascausesfor thediscrepan-
cies. Membersof theassessment teammust alsodocument aneedfor special
education.
Federal law, then, speciesthreeidenticationcriteria:discrepancybetween
ameasureof aptitudeandmeasureof achievement; exclusionof certaincauses
for the discrepancy(ies) between aptitude and achievement; and need for
special education. Most stateeducationagenciesusethefederal denitionand
eligibilitycriteriawithonlyminor variations(Frankenberger &Harper, 1987).
It mayinterest youtolearn, if youdonot alreadyknow, that speciclearning
disability is the only disability for which federal law species identication
criteria.
Nowthat weknowthepsychologiststask, wecanhear hisstory.
One psychologists story
NewYorkStateisbeautiful inthefall. Andyoudont havetotravel far from
NewYorkCitytoenjoythebeauty. Oneparticularlyprettyautumnday, notso
verylongago, afriendcalledtoaskif I wouldliketojoinhimon, inhiswords, a
fall foliagewalk. Aswewalked, ourconversationturnedtoretirementandmy
friendaskedwhenI plannedtoleavethefacultyat Teachers College. I replied
to hisquestion by sayingthat I enjoyedteachingandwantedto continueas
longas I hadreason to believethat my lectureswerecurrent andcoherent.
Hearingmyreply, hestoppedwalking, turnedtofacemeand, withalookon
his facethat would be difcult to describe, exclaimed, Jo, you teach about
learningdisabilities. Howwill anyoneknowif your lecturesarecoherent!. He
wasteasing, of course, andhewasnt teasing, too.
He has reason to care. He leads a school-based assessment teamwhose
membersareresponsiblefor assigningstudentstospecial education. Inanyone
school year, theyplacemorestudentsinthecategoryspeciclearningdisabil-
ity than in all the remaining disability categories that entitle students to
publiclynancedspecial educationcombined. Theydothis, hesays, despitethe
fact that theyaredissatisedwiththewaytheymakethedecision. Subsequent
toour fall foliagewalk, wetalkedabouthisteamsconcernsaboutassessment
for learningdisabilities. I reportsummariesof theseconversationsasthoughhe
isspeakingdirectlytoyou.
He begins, A child is referred to us for assessment because of persistent
learningand, frequently, behaviorproblemsintheclassroom.Wearesupposed
to decide how to explain these problems and to determineif the child will
7 History lessons
benet fromspecial education. Speciclearningdisabilityisanexplanationfor
learningproblemsthat wecan useto recommendspecial education. Federal
special education law and state education codes give us a denition and
identicationcriteriatoguideor assessments.
Drawingabreath, hecontinues, Hereisour problem. Wedont knowhow
todene, letalonetestfor, thepsychological processdisorder(s)speciedinthe
denition. Wedont know if wearesupposedto look for adisorder that is
commontoall of thesymptomslistedinthedenitionor if weshouldlookfor
aprocessdisorder specictoeachsymptom: imperfect abilitytolisten, speak,
read, etc. Wethought wehadthisproblemsolvedfor readingdisabilitywith
theevidencethat aphonological processingdisorder causes specic reading
disability. We ordered new tests and began testing phonological processing
skillsto differentiatestudentswithspecicreadingdisabilityfromother poor
readers. Thenwelearnedthat phonological processingdisordersarecommon
to all children who havedifculty decodingprint back to speech, including
childrenwhoarementallyretarded.
Hepausesfor amoment andcontinues, Sincewedont knowhowto use
thefederal denitiontoguideour assessments, weareleftwithcriteriathattell
ustondadiscrepancybetweenanIQscoreandachievement test scores. We
can select appropriateintelligenceand achievement tests. Though weknow
that underachievement isaproblematicconcept, wehaveacceptablemethods
for determiningexpectedachievement basedonIQandfor determiningif the
distancebetweenexpectedandactual achievement issignicant. Whenwedo
this carefully, though, what do we have when we are nished?We have a
symptom, only a symptom. After we exclude other explanations for the
discrepancy, weareleftwithanunexplainedsymptom. Presumably, thereason
for thediscrepancy isthelearningdisability that wecouldnt ndintherst
place. Soweendwherewebegan.
Speaking a little faster, he says, I want to be sure you understand our
concernshere. Thiswouldmakemoresenseto usif wecouldndboth the
process disorder (i.e., the learning disability) and a signicant discrepancy
betweenIQ andachievement, but without theprocessdisorder, thediscrep-
ancydoesnot makesenseasadiagnosis. Wearewillingtousethediscrepancy
andexclusioncriteriato justifytheneedfor special education. But wedonot
like to label those students learning disabled without better evidence for a
disability.
Thispauseislonger than therst. Finally, hesays, Thereismoreto this
story. Becausewedont knowhowto treat thisconstruct asadiagnosis, we
often give tests and then put our data aside and place the student in the
learning-disabilitycategoryfor reasonsunrelatedtoour data. For example, we
respondto teacherswho needrelief in their classroomsand to parentswho
either want their child in special education or want to protect achild from
special education. Our decisionsarealwaysinuencedbytheresourcesfor help
that areavailablein our school. If astudent needshelpand ateacher needs
relief andspecial educationisall wehave, weuseitregardlessof themessagein
theassessmentdata. I dontunderstandwhatI amabout tosaybutI canfeel it.
Theambiguous denition and identication criteriathat do not explain the
problemparalyzeus. Wearereluctant, or, perhaps, afraid, touseprofessional
or clinical judgment toguideour decisions. Wearenot happywithour rolein
thisprocess. Wefeel trappedbetweenthecommonlyheldbelief that specic
learningdisability isanexplanationfor learningproblemsinschool andthe
fact that, asweuseit, thenameisnothingmoreor lessthananunrestricted
ticket tospecial education.
Wait, hesays, after thinkingfor amoment, I amnot nished. I haveone
morethingto say. Theidenticationcriteriaweareusingtell usthat wecan
ndaspeciclearningdisabilityif thestudent presentsaseverediscrepancyin
oneor moreof two languageandveacademicdomainsWhat isso specic
about a learning disability that technically can occur across all of these do-
mains?
Beyond one psychologists story
Myfriendtellsusthat, for hisassessment team, at least, thefederal denition
andidenticationcriteriadonot work. Hesaysthat themembersof histeam
arenot willingto createtheir owninterpretationsof apsychological process
disorder andthat, thoughtheycanminimizethetechnical problemsindeter-
miningadiscrepancybetweenIQandachievementtestscoresand, thus, create
aconsistentcriterionfor special educationplacement, theyareunwillingtocall
childrendisabled onthebasisof oneunexplainedsymptom. Headmitsthat
theyusuallymakedecisionsbasedonadults needsandavailableresources.
Thisisonepersonsstory. It isanimportant story, whichcertainlywarrants
our attention, if it isacommonstory. Althoughwehaveto drawinferences
aboutpracticefromthedata, wedohavestudies, conductedover several years
andindifferent places, that describethecharacteristicsof studentsidentiedas
learning disabled by the assessment teams in their schools. These studies
indicatethat other teamsalsohavedifcultyusingthedenitionandidentica-
tioncriteriainfederal lawandstateeducationcodes.
Therst studies (Kirk & Elkins, 1975; Norman & Zigmond, 1980; Mann
9 History lessons
et al., 1983) wereconducted with students enrolled in themodel education
programs, called Child Service Demonstration Centers, funded under PL
91-230 (1969). As indicated earlier, these centers were created before the
discrepancyandexclusioncriteriawereaddedtofederal law. Thus, thedeni-
tion of specic learning disability, alone, provided theguidelines for ident-
ifyingstudentsto beservedas learningdisabled. Datafor thestudieswere
obtainedeither throughquestionnairesor by visitingthesitesandreviewing
students records. Summarizingresultsfromall threestudies, Zigmond(1993)
concludedthat, givenasignicant number of IQscoresbelow85concomitant
with low-achievement test scores across academic domains, many of the
studentsidentiedaslearningdisabledinthesecenter programscouldalsobe
identiedasmentallyretardedor asslowlearners. Shereportedthat investiga-
tors for each study could not nd evidence that the denition in the law
authorizingthecenterswasusedtoselectstudents. Noticethattherstof these
studieswas publishedin 1975, revealingthat thedenition was problematic
fromthestart.
MacMillan and Speece (1999) reviewed three studies (Shepard, Smith, &
Vojir, 1983; Shaywitz et al., 1990; MacMillan, Gresham, & Bocian, 1998)
conducted after PL 94-142 was implemented. Assessment teams identifying
students whosecaserecords provided thedatafor thesestudies wereusing
regulations that included the denition and the discrepancy and exclusion
criteria. Inthesestudies, theinvestigatorscreatedidenticationcriteriaderived
fromstateeducationcodesand, usingrecords review, soughttodeterminethe
percentage of students identied by their school teams who also met the
investigators criteriaas learningdisabled. Across thethreestudies, between
52%and 70%of the students identied as learningdisabled by their school
teams did not meet the investigators criteria (MacMillan & Speece, 1999).
Shepardet al. (1983), for example, foundrecordsof studentsfor whomEnglish
wasasecondlanguage, recordsdocumentingemotional problems, andrecords
indicatingIQscoreslowenoughtomeet criteriafor mental retardationamong
therecordsof studentsidentiedaslearningdisabled. Conclusionsreachedby
MacMillanandSpeececonrmour psychologistsstory:
Several observations about howthe schools sort students with severe and persistent achievement
problems into the LD category seem in order. First, LD in the schools is a nonspecic category of
children with absolute lowachievement relative to school peers (italics added). At present, school
practices do not appear to consider aptitude and achievement simultaneously as the denitions
and education codes suggest they should. Cases where the low achievement is consistent and
inconsistent with expected levels of achievement are not differentiated . . . Second, the classi-
cation of mental retardation apparently is viewed as pessimistic in its prognosis, and LD appears
to be a more acceptable diagnosis. As a consequence, the schools have evolved a practice of
certifying most students with absolute low achievement as LD, regardless of whether the IQ is
below the cutoff for mental retardation or whether the achievement qualies as discrepant from
expected level . . . Finally, the schools do adhere to the requirement of administering instruments
and scales required for certication of children as eligible under the various state-sanctioned
disability categories. Hence, individual intelligence tests, achievement tests, adaptive behavior
scales, and processing tests are administered; however, this is done more to conform to require-
ments than to secure data on which a differential diagnosis is to be made (1999, p. 11718).
Remember, theseconclusionsarenotbasedondirect observationsof assess-
ment teamsat work, but ontherecordsthat their workproduces.
Our psychologistsstoryandconclusionsfromthestudiescitedherehelpus
to understanddatareleasedby theUSOfceof Education in 1996. Between
1977 and 1995, the percentage of students identied as learning disabled
increased from1.8%to 5.8%of the total public school enrollment (grades
kindergarten through 12). This represents an increase close to 200%in the
numberof studentsidentiedaslearningdisabledinlessthan20years. By1995,
studentsidentiedaslearningdisabledaccountedfor slightlymorethan50%of
all students enrolled in special education. Consistent with MacMillan and
Speecesconclusions, duringtheperiodcharacterizedbyadramaticincreasein
thenumbersof studentsidentiedaslearningdisabled, thenumber of students
identiedasmentallyretardeddecreasedby41%andthenumber of students
identied as speech and languageimpaired decreased by 15%(USOfce of
Education, 1994).
By now you should be prepared to understand the following quotation,
taken from the rst chapter of a book emanating from a symposium on
learningdisabilitiesconvenedunder theauspicesof theNational Institutefor
ChildHealthandHumanDevelopment:
The eld of learning disabilities has grown since learning disabilities were rst recognized as a
federally designated disabling condition in 1968 to represent almost half of all students receiving
special education nationally. At the same time, learning disabilities remain one of the least
understood yet most debated disabling conditions that affect children in the United States (Lyon &
Moats, 1993, p. 1).
Similar statements, decryingthefact that psychologistsand educators are
placing students, in ever-increasing numbers, in a disability category that
cannot bedened and that no oneunderstands, appear continuously in the
literatureabout learningdisabilities. (Toreadparticularlypassionatecriticisms
of thispracticeandtoseethat thepracticehasbeencriticizedfor alongtime,
readFreeman, 1976, andStanovich, 1999.)
11 History lessons
Howdidthishappen?LookingbackfromSamuel Kirksspeech, delivered, as
youwill remember, in1963, helpsanswerthisquestion. WelookbacktoAlfred
Strauss, Heinz Werner, and a colleague, Newell Kephart. We also look to
WilliamCruickshank and, again, to Samuel Kirk. Pleaseunderstand, though,
looking back to the work of these people and to special education and its
advocatesdoesnot provideacompleteanswer toour question
3
Frombrain injury to specific learning disability
I maketwohistorical pointsinthischapter. Therst isthat astudyof history
revealstwoperspectivesonspeciclearningproblems: aperspectiverepresen-
ted in the work of James Hinshelwood and Samuel Orton (who were not
collaborators), andaperspectiverepresentedintheworkof AlfredStraussand
HeinzWerner (whowerecollaborators). I claim, alongwithJosephTorgesen
(1998), that these perspectives, though they share some assumptions, are
signicantlydifferent. Thesecondhistorylesson isthattheStraussperspective
shapedthedenitionanddiagnosticcriteriafor speciclearningdisability in
the federal laws. Others have made the same historical point: Kavale and
Forness (1995) in particular. My purpose here is to develop this second
historical point withtheassistanceof KennethKavaleandStevenForness.
As weconsider Strauss and Werners work, it is helpful to usethename
speciclearningdisability andrefrainfromusingthenamespeciclearning
disabilities. Historical accounts of specic learning disability usually begin
with Kurt Goldstein, a German neurologist, because he was a teacher and
mentor for Alfred Strauss. Goldstein studied the behavior of soldiers who
recovered from head injuries sustained in combat. Based on the soldiers
performanceonseveral experimental tasks, Goldsteindescribedthemasprone
toperceptual confusion, distractible, disinhibited, perseverative, disinclinedto
abstract thinking, and given to extreme emotional responses that shifted
quickly (Goldstein, 1942). Strauss was apparently interested in rening the
diagnosisof mental retardation andfelt that Goldsteinsndings with brain-
injuredadultscouldbehelpful.
Using Goldsteins experimental tasks and a group of mentally retarded
adolescents(who, incidentally, werealsoadjudicateddelinquents), Straussand
Werner claimedabehavioral distinctionbetweenmental retardationof famil-
ial, presumably genetic, origin and mental retardation caused by external
insultstothebrainsubsequenttoconception. AccordingtoStraussandWerner
(1943), mentally retarded youngsters without a familial history of mental
retardation and with birth and medical histories suggestive of brain injury
behaved with the experimental tasks like Goldsteins soldiers. Similar task
performancewas not noted among the youngsters with afamily history of
mental retardation. Werner and Strauss drew these conclusions fromtheir
studies: mental retardationcausedby brain injury wasdifferent frommental
retardation that wasinherited; brain injury producedspecic perceptual and
behavioral consequences; brain injury could be diagnosed on the basis of
(inferredfrom) thosebehavioral andperceptual consequences; andyoungsters
whose mental retardation was caused by brain injury might benet froma
special education different fromthespecial education providedfor mentally
retardedyoungsterswhoinheritedmental retardationfromtheir parents.
Working with Laura Lehtinen, an educator, Strauss designed a learning
environment for brain-injured childrenthat eliminated, or at least controlled,
opportunitiesfor distractionandinattentionandemphasizedperceptual train-
ing. In Strauss and Lehtinens words, the erratic behavior of brain-injured
childreninperceptual tasksmight beexplainedbyagure-grounddeciency,
and an approach to remedy such deciency should be directed toward
strengtheningthegure-groundperception (1947, p. 50). Thespecial learning
environment wasdesignedtoberemedial, that is, tocorrect or amelioratethe
problemswithperceptionandattentionand, insodoing, removeobstaclesto
learningtoread, write, andcalculate. Theimplicationwasthat, witheffective
remedial instruction, thechildren might leavetheir mentally retarded status
behindthem.
It was not long before investigations similar to those conducted with
mentallyretardedadolescentswereundertakenwithchildrenof normal intelli-
gence. WilliamCruickshank(Cruickshank, Bice, &Wallen, 1957)strengthened
theclaimthat thedisordersof perception, attention, andemotionStraussand
Werner linkedtobraindamagewere, infact, linkedtobraindamagebynding
themin the performance of cerebral-palsied children with normal or near-
normal IQscores. Straussandanothercolleague, Newell Kephart, extendedthe
research to children whose performance on intelligence tests placed them
abovestandardcut-off points for mental retardation, but who didnot show
clinical signs of brain injury (Strauss & Kephart, 1955). These men, Kurt
Goldstein, Alfred Strauss, Heinz Werner, WilliamCruickshank, and Newell
Kephart, establishedtheconcept of alearningandbehavior disability, caused
by minimal (i.e., not necessarily observable through standard clinical signs)
braininjurythat couldbedisassociatedfrommental retardation. Further, they
hadideasabout special education, remedial special education, that is.
Their message was important and appealing. Some difcult children are
actuallybraininjuredandtheir difcult behaviorsstemfromthebraininjury.
13 History lessons
Thedifcultbehaviorsareneither willful nor their parents fault. Moreimport-
ant, thebrain injury causes specic decits in perception and attention that
impair learning on tasks that depend on perception and attention. These
learning and behavior problems can be corrected, or at least controlled,
through special education. Private schools were created to educate these
brain-injured children. Theseschoolsservedasmodelsfor special education
that emphasized training attention, perception, and perceptualmotor pro-
cesses. By themid-1950s, afewpublicschool districtswereprovidingspecial
education classes modelled on the private school programs. In somestates,
children placed in theseclasseswerecalledbrain injured or neurologically
impaired. Inother states, thechildrenplacedinthesenewspecial education
classeswerecalledperceptuallyimpaired. Torepeat, thecurriculuminthese
classes, regardlessof thenamegiven to thechildren, emphasizedperceptual
andperceptualmotor educationpreparatoryfor academiceducation.
The emergence of local and state organizations, composed primarily of
parents advocating publicly funded education, paralleled the emergence of
publiclyfundedspecial educationclasses. Aswastruefor thechildrenenrolled
inthespecial classes, advocacyorganizationschosefromoneof several possible
names. AdvocateslivinginNewYorkStatenamedthemselvesTheNewYork
Associationfor Brain-InjuredChildren, whereasadvocateslivinginCalifornia
becametheCaliforniaAssociationfor NeurologicallyImpairedChildren. One
stateorganization, perhapstheoldest, TheFundfor thePerceptuallyImpaired,
establishedin Evanston, Illinois, in 1957, choseto host aconferencefor the
purposeof forminganational organizationandselectingonenameacceptable
todelegatesfromeachof thestateorganizations. Asindicatedat thebeginning
of thischapter, thenamespeciclearningdisability becamepublicpropertyat
that conference. ActingonSamuel Kirkssuggestion, membersof thevarious
stateorganizationsvotedto formanational organization namedtheAssoci-
ationfor ChildrenwithLearningDisabilities.
In this move, a concept acquired a new name, but the concept did not
change. Remember theconcept, becauseit underpinsthedenitioninsubse-
quent federal laws: minimal brain damage, insufcient to produce classical
clinical signs, candisrupt aspecicpsychological processtypicallydenedasa
perception, creatingobstaclestolearningacrossmanytasks, mostprominently
speaking, listening, reading, writing, and arithmetic. Because the learning
disabilityisspecicandcanbeisolated, it can, perhaps, alsobecorrectedor, at
least, the impact can be ameliorated. Assessment designed to identify the
psychological processingdisorder shouldleadto special educationbasedona
curriculumdesigned to correct the psychological process (read perceptual)
deciencies. Learning disability, a behavioral name, replaced brain injury, a
medical name for the concept and the related assessment and instructional
practices.
4
Between1963andtheenactment of thefederal special educationlegislation
in 1975, studieswereconductedthat challengedthisconcept and theassess-
ment andeducational practicesthat emanatedfromit. (For acomprehensive
review of these studies, see Kavale & Forness, 1995). Some of the studies
challenged the technical properties of the tests that were used to assess
psychological processes. Others produced evidence that special education
programs designed to remediate decient psychological processes were not
having the intended effects. (Later, Kavale and Forness would re-analyze
Strauss and Werners data and conclude that they had not, in fact, proved
perceptual and behavioral differences between the two groups of mentally
retardedadolescents: reportedinKavale&Forness, 1985).
Itwasevidentthattheconceptspeciclearningdisability, intheformithad
taken, couldnot bevalidatedjust as thenameand denition wereabout to
becomelaw. An alternativeto specic learningdisability, denedonly as a
psychological processingdisorder, wasneededandtheaptitude/ achievement
discrepancycriterionwasthealternative. BarbaraBatemanmayhaveprovided
thejusticationfor theaptitude/ achievement discrepancy criterion with the
followingdenition:
Children who have learning disorders are those who manifest an educationally signicant discrep-
ancy between their estimated intellectual potential and actual level of performance related to
basic disorders in the learning process, which may or may not be accompanied by demonstrable
central nervous system dysfunction and which are not secondary to generalized mental retarda-
tion, educational or cultural deprivation, severe emotional disturbance, or sensory loss (Bateman,
1965, p. 220).
Specific learning disability or specific learning disabilities
TheStraussconcept wasbasedonaparticular classof psychological theories,
prominent in theearly decades of thetwentieth century, that assumed that
intellectual performancewasacompositeof manyspecicmental abilitiesor
faculties. Betweenthesefacultiesof mindandwithinanyof them, onemight
expect to nd strengths and weaknesses. Assumingaweak faculty could be
isolated, it might bestrengthenedwith exercise, to thebenet of thewhole
mental system, inthesamewaythatexercisestrengthensmusclestothebenet
of thebody. Ann Brown andJoseph Campioneprovideadescription of this
theoryinaction:
15 History lessons
A child is brought to a practitioners attention because she is experiencing difculty in reading.
After she is subjected to a battery of diagnostic tests it is determined that she has particular
problems with auditory memory and that this decit is stable and reliable across situations and
over time. Traditionally, the most likely prescription for remediation would be practice on tasks of
auditory short-term memory presented out of the context of any academic task of which auditory
short-term memory could be assumed to be a component (1986, p. 1060).
Assuming that auditory short-term memory could be strengthened, im-
provement in readingshouldfollow. Giventhetheory, wemight expect our
youngstudent tohavedifcultywithother tasksrequiringauditoryshort-term
memory. Thespeciclearningdisability, weak short-termauditorymemory,
might alsocreatedifcultylearningarithmetic.
HinshelwoodandOrtondidnot relyontheseassumptionsabout learning.
Theyobservedchildrensfailuretolearnspecicskillsandreasonedfromthose
observationsdirectlytobraindamageor dysfunction. Achildsdisabilitywasa
readingdisability, awritingdisability, or, by logical extension, an arithmetic
disability, not a visual perception disability or an auditory disability. As we
consider HinshelwoodandOrtonswork, it ishelpful tousethenamespecic
learningdisabilities andrefrainfromusingthenamespeciclearningdisabil-
ity.
TheOrton/ Hinshelwoodperspectiveis reected in theway learningdis-
orders are presented in Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV; American Psychiatric Association, 1994). DSM-IV presents four
learningdisorders: readingdisorder; mathematicsdisorder; disorder of written
expression;andlearningdisordernototherwisespecied. Eachispresentedasa
distinct disorder, identiableasadiscrepancybetweenthechildsachievement
andchronological ageandmeasuredintelligence.
Lisa, an adolescent with alearningdisability in arithmetic, introducesthe
HinshelwoodandOrtonperspective.
Lisas story
Although children with learning problems specic to reading, writing, or
arithmetichavebeenidentied, described, andstudiedformorethanacentury,
it hasproven surprisinglydifcult to construct reliablegeneralizationsabout
them. For that reason, werely on descriptionsof individualsto conrmthe
existenceof learningproblemsspecic to thesescholastictasks. Lisaandher
Englishteacher will helpusthistime.
Lisalooksawayfromthecomputer screenfor amoment tothinkabout the
text sheiscreating. Voicingher thoughts, shesays, MrsAbbott toldustouse
wordstomakepicturesinour readers minds. CanI seemycharacterswhenI
readwhat I havewritten? Returningtothescreen, shere-readsher text with
that questioninmind.
5
I imagine myself sitting in a rocking chair, my husbands arm around my blue-clad shoulders: his
other hand stroking my rough, bony old limbs. My snow white hair, the curls straightened by age,
iesinto my sunburned wrinkled face. I amdreaming of the days when I was young but my mind is
old and worn and it is hard. The sound of my husbands heavy breathing brings me back to the
present moment. Are you alright? I ask in a raspy voice, no longer clear and beautiful.
He takes my hand in his. My hands, the only still young aspect of me, are petite, soft and smooth.
I turn my head to the side to gaze at himand the expression of his love for me gleams through his
eyes. There is no pain in my neck and I amrelieved. Slowly I slip, once again, into a daytime reverie
but this time I do not dream of the younger days I have left behind. Instead I dreamof all the days
ahead that my beloved husband and I will share together.
Satisedthat sheisrespondingto theintent of her teachersassignment, Lisa
continuestoworkwithher text.
Tomorrow, or thedayafter, MrsAbbott, theeighthgradeEnglishteacher,
will readLisastext. Wecanpredict that at somepoint asshereads, shewill
lookawayfromLisastextasLisalookedawayfromthecomputer. Voicingher
thoughts, Mrs Abbott will say somethingto this effect: This youngwoman
cannot learntoreadtimefromanordinaryclock. I havetosuspendall of my
beliefsabout learningandintelligencetoaccept thistext ashers. Shestruggles
sowithnumbers, howcanshewritelikethis?
Lisasteacher isnot theonly person stunnedby thecontrast betweenher
competencewhenreading, spelling, andwriting(usingacomputer), andthe
absenceof competencewhensheisperformingarithmeticcalculations, writing
with a pen or pencil, and drawing. Members of the assessment teamwho
worked with Lisa, though more knowledgeableabout striking disparities in
academiccompetencethanLisasteachers, werealsostunnedbythecontrasts.
You probably will besurprised, too. Consider, for example, thecontrasts in
scoressheobtainedonstandardizedreading, spelling, andmathematicstests.
Her readingscores(GatesMacGinitie, FormL) wereat or slightlyabovethe
50thpercentilefor her age; her spellingscores(Test of WrittenSpelling 2)
wereat the70thpercentilefor her age; but her mathematicsscores(Sequential
Assessment of MathematicsInventory) werebelowthe10thpercentilefor her
age. Similar contrastswereapparent inthestandardscoresobtainedfromthe
Wechsler IntelligenceScalefor ChildrenRevised. Onthistest, Lisaobtained
IQsof 102(Verbal) and64(Performance), producingaFull ScaleIQof 81.
Membersof theteamresponsiblefor theassessment remarkedthat it was
17 History lessons
painful towatchLisaworkwithsomeof theassessmenttasks, particularlytasks
fromthePerformanceScaleof theWechsler. Abrief report of scoresobtained
with theWechsler isinstructive. Lisadidnot ndmissingdetailsin pictures
easily (Picture Completion 3). Among other problems, she did not have a
systematicstrategyfor scanningthepictures. Shehadgreat difcultywiththe
simplest puzzles (Object Assembly 2). Sheusually did not realize when she
misplacedapuzzlepiece. Oneof themorestrikingexamplesoccurredwhen
sheplacedthehorseshoof under histail. Whenaskedif shewassatisedwith
theconstruction, shereplied, Thehorselooksjust netome. Attemptingthe
blockdesigns, sheplacedtheblocksinarowrather thantryingtoconstructthe
picturedpattern(BlockDesign4).
Think back to Lisas text. She constructed a vivid picture of two elderly
peopleusingtheir feelingsfor eachother toeasethepainof beingold. But she
seemedunableto construct mental images to guidetheconstruction of the
puzzlesandblockdesigns. Her teacher toldusthatshecouldnot tell timefrom
an ordinary clock, but shewroteastory about time. Her competencewith
language, asrevealedinher text, isconrmedbyscoresontheVerbal subtests
of theWechsler (Similarities13; Vocabulary11; andComprehension13).
6
Lisas medical history is suggestive of neurological impairment. She was
bornwithacongenital heartdefect, hadtoberesuscitatedafewdaysafter birth
whenher heart stoppedbeating, andhadcorrectiveheart surgery when she
was three. Her motor development, prior to entering school, was delayed.
However, resultsfromstandardneurological examinationsareunremarkable.
Neurologicimpairment remainsaninference.
If weonlyknewLisasageandher mathematicsandWechsler Performance
test scores, wewouldprobablyassumethat sheismentallyretarded. Onthe
otherhand, if, knowingherage, wewereonlygivenherstory, andtheReading,
Spelling and Verbal IQ test scores, we would not assume that learning is
difcult for her.
I will refer to the critical features in Lisas story as compass points,
acknowledgingthat, whereaswecanset thecompass, wecannot construct an
exact mapof her learningproblems. Asnotedearlier, themost strikingfeature
of Lisas academic and cognitive development is the fact that she acquires
verbal knowledgeeasilyandstrugglestoacquirespatial knowledge. Todiffer-
entiate Lisas learning disability from a learning disability that involves all
knowledgedomains, wedescribeitasspecic. Weassumeaspeciccognitive
decitthat impairslearningtocalculateandformletters, but spareslearningto
readandspell. Weassumethat thecognitiveandacademicdecitsarecaused
byneurologicdysfunction. Moreexactly, weassumethat neurological impair-
ment istheprimarycauseof Lisaslearningdisability. Assuminganeurologic
causedoesnot, however, blindusto thefact that thesymptomsof learning
disabilitytakeforminacomplexinteractionbetweenbiologyandexperience.
Lisaslearningdisabilityisoneof threespeciclearningdisabilities. Interest
intheselearningdisabilities, conceptualizedasdifcultyacquiringtheknowl-
edgeessential toreading, writing, or arithmetic, predatesStraussandWerner.
Asweshall see, therehasbeenmoreinterest, historically, inreadingdisability
and spelling disability (dyslexia) than in writing and spelling disability (dys-
graphia) andarithmeticdisability(dyscalculia).
Dyslexia, dysgraphia, and dyscalculia
Bytheendof thenineteenthcentury, physiciansinGreat Britain, France, and
Germany publisheddescriptionsof adultswho lost theability to readsubse-
quent totraumaincertainregionsof thebrain. Surprisingly, thelosswasoften
specic. Anindividual might, for example, losetheabilitytoreadbutretainthe
ability to write and spell. Reecting the specic nature of adults loss of a
learnedskill after braintrauma, Dejerine(1892) describedaman, Monsieur C.,
wholosttheabilitytoreadsubsequenttoastroke. AccordingtoDejerine(cited
in Kessler, 1980, p. 23), the man was still able to express himself uently,
understandeverythingsaidto him, remember minutedetailsfromconversa-
tions, andwritewithout difculty. Hewas, however, unabletonamelettersor
evenreadwhat hehadwritten.
A morerecent example(Warrington, 1982) illustrates the loss of learned
skills in mathematics subsequent to brain trauma. Warrington described an
adult who, withintwoweeksafter sufferingastroke, demonstratedareturnto
normal intellectual functioning, languagecomprehension, reading, andverbal
memory. Hecouldnot, however, retrievebasicnumber facts. Hecouldwrite
numbersandspecifytheprocessneededtoperformaparticularcalculation,but
couldnot performthecalculationwithout countingand, evenwiththeaidof
counting, madefrequent calculationerrors.
Theearlier observationsabout adultsandreadingsoonbecameinferences
about children. Therst publisheddescriptionof suchachild(Morgan, 1896)
capturestheessenceof thelearningproblem. PercyF., aged14, wasreferredto
PringleMorgan, aphysician, bytheheadmaster of hisschool becausehecould
not learn to read, despitelaborious and persistent training. Suggestingthat
Percys problemwas specic to reading, his headmaster is quoted as saying
that, hewouldbethesmartest ladin school if theinstructionwereentirely
oral (p. 1378). Morgansaidabout Percy, referringtohisinabilitytoread, This
19 History lessons
inabilityissoremarkableandsopronouncedthat I havenodoubt it isdueto
somecongenital defect (p. 1378). Subsequent to PringleMorgans report, a
clinical literatureevolveddescribingchildrenwithspecicreadingandwriting
disabilities (Kerr, 1897; Morgan, 1914; Hinshelwood, 1917; Monroe, 1932;
Orton, 1937). Earlyreportsof learningdisabilitiesinarithmetic(Schmitt, 1921;
Guttman, 1937) appearedtowardtheendof theearly history of readingand
writing disabilities. All of these clinicians and researchers, except Marian
Monroe, assumedabiological causefor thelearningdisabilitiestheydescribed.
Monroeacknowledgedbiologyasonecauseof readingdisability, but consider-
edother causesaswell.
When you stop to think about it, the logical distancefrombrain-injured
adultsto, mostlynormal, childrenislarge. Obviously, proceduresfor studying
brainfunctionhaveevolvedsinceMorganandothersstartedusonthispath.
Westill donot haveunequivocal direct evidenceof abiological causefor the
learning disabilities that we describe as specic, however.
7
We do have
evidenceof geneticcausationfor someportionof all individualswithspecic
readingdisability.
8
Wealsohaveindirect evidenceof theinuenceof biology
on these learning disabilities in the fact that some children show signs of a
developmental languagedelayprior todevelopingareadingdisabilityinschool
(Scarborough, 1990), andinthefact that readingandwritingdisabilitiespersist
intoadulthooddespiteremedial instruction(Snowling& Hulme, 1989; Olson
et al., 1997; Bruck, 1998; Felton, 1998). However, wehavenot yet proventhe
historical claimthat symptomsobservedinadultsknownto bebraininjured
aretheonlyevidenceweneedtoassert braindysfunctioninchildren.
Aswastruefor StraussandWerner, physiciansandpsychologistsinterested
inthestudyandtreatment of reading, writing, or arithmeticdisabilitiesrecom-
mendededucational treatments. HinshelwoodandOrtonillustratethepoint.
In 1917, James Hinshelwood, a Scottish ophthalmologist with a bent for
neurology, published a monograph, Congenital Word Blindness, describing
children who appearedintelligent but struggled with reading. Hinshelwood,
reasoningfrombrain-injuredadults, attributedtheseproblemstoacongenital
lesion in theleft angular gyrus, which, hehypothesized, madeit difcult to
store and retain visual memories for letters and words. He noted that the
disorder occurredmorefrequentlyamongmalesthanfemalesandalso noted
its familial tendency. Partsof acasereport fromthat monograph areworth
quoting, becauseof insight wegainabout Hinshelwoodsapproachto assess-
ment:
A boy, 12 years of age, was brought in March 1902 to the Glasgow Eye inrmaryby his mother, to
see if there was anything wrong with his eyesight. The boy had been seven years at school, and
there had been from the outset the greatest difculty in teaching him to read . . . On examining
him, I found that his reading was very defective for a boy who had been seven years in school. He
could rarely read by sight more than two or three words, but came to a standstill every second or
third word . . . The words he stuck at were chiey polysyllables, but this was not always the case,
as he often failed to recognize by sight even simple monosyllabic words . . . He read all combina-
tions of gures with the greatest uency up to millions. I made him do several sums up to
compound addition. All of these he did smartly and correctly (pp. 4951).
The next good clinical description of reading disorders was provided by
Samuel Orton (1937). Ortoncalledthedisorder strephosymbolia(twistedsym-
bols),highlightingreadingerrorsthathebelievedwereaconstantfeatureof the
disorder: difcultyreadingandwritingreversibleletters(bandd, pandq); a
tendencytoconfusereversedwords(wasandsaw; onandno); andatendency
to reverse paired letters, whole syllables, and words. These transpositions
occurredintermittently, givingtheimpressionthat thechildrenreadfromleft
toright sometimesand, at other times, fromright toleft.
Ortonsassessmentsconsistedofdetailedfamilyandschool histories, andthe
administrationof anintelligencetestandtestsof reading, spelling, andarithme-
tic. Healso askedhisyoungpatientsto writefor him. Hewasinterestedin
contrasts between scores on the achievement tests, assuming that students
with areadingdisability would havelower readingand spellingscores than
arithmeticscoresandthat studentswithawritingdisabilitywouldearnlower
spellingscoresthanreadingandarithmeticscores. All of Ortonspatientshad
difculty at school over the years and decades that he followed their lives.
Many had speech disorders(speech delay or stuttering) andmotor disorders
(abnormal clumsiness) in addition to readingdisorders. Males outnumbered
females among his patients. He frequently treated several members of one
family. Unlike Hinshelwood, who postulated brain damage as the cause of
specicreadingdisability, Ortonpostulatedafunctional braindisorder, failure
of onehemispheretobecomedominant inthecontrol of language.
Although HinshelwoodandOrton haddifferent viewsabout thecauseof
thisdisorder, they sharedacommon viewabout assessment and treatment.
Theyassessedreading, spelling, andarithmeticskills. Accordingtobothphys-
icians, the treatment of choice was intensive individual reading instruction
teaching sound to letter correspondences (Hinshelwood) or letter to sound
correspondences(Orton). Eachphysicianurgedhispatients teacherstorefrain
fromusingmethodsof readinginstructionwherewordsarelearnedwithout
usingsound/ letter or letter/ soundcorrespondences.
By the1930s, neurologistsweredocumentingtheexistencein children of
arithmetic disorders associated with brain damage (see Cohn, 1961, 1971;
21 History lessons
Badian, 1983; Rourke, 1989; for reviews). Dyscalculicchildrenwereshownto
manifest the same range of symptoms as brain-injured adults who lost the
ability to calculate. The children were shown to have difculty learning
numberwordsandfacts, formingnumerals,aligningnumeralsincorrectarrays
for computation, andapplyingcomputational skill toproblemsolving. Aswith
readingandwritingdisabilities, though, thecausewaspresumedtobebiologi-
cal andrecommendedtreatmentswereeducational.
Conclusion
If number of citationsisanindicationof inuence, LeeWiederholtshistoryof
thepeopleandideasbehindthetermlearningdisability, publishedin1974, is
the most inuential history in print. Wiederholt divides the clinical and
researchtraditionsbehindthetermintothreecategories: disordersof spoken
language, beginningwith Gallsrst publicationin1802; disordersof written
language, beginningwithHinshelwoodspublicationin1917; anddisordersof
perceptual andmotor processing, beginningwithGoldsteinsrst publication
in1927. To summarizethishistory, hepresentsadiagram(p. 105) indicating
that eachof theselinesof work convergedinthetermlearningdisability in
1963. I havearguedfor adifferent interpretationof thishistory. I will summar-
izethat argument here.
First, I believethat theworkonlanguagedisorders, spokenandwritten, and
theworkondisordersof perceptionandperceptualmotor processesdoesnot
rest comfortablyinthesameconcept. Thoughpeopleinterestedinbothtypes
of disorders believed in a biological cause and believed that developmental
versionsof thesedisorderscouldbediagnosedonthebasisof behavioral signs
only, similarities between these classes of disorders end there. Perceptual
theoristswereinterestedinmental traits, or faculties, that theybelievedcould
be isolated from each other and from the cognitive system as a whole.
Consequently, they believed that the learning disability (defective faculty)
could co-occur with below-average, averageand above-averageintelligence.
Theyalsobelievedthat thelearningdisabilitywouldbegeneral initseffect. If
thedefectivefacultywasvisual perception, anytaskrequiringvisual perception
wouldbedifculttolearn. Assessment,for thesetheorists, requiredasearchfor
the defective faculty, and treatment was remedial training of the defective
faculty. Clinicians and researchers interested in language disorders believed
thatbraindamageor dysfunctioncouldinterferewiththeacquisitionof specic
languageskillsandleavetheabilitytoacquireother skillsunimpaired. Assess-
ment, for thesetheorists, requireddescriptionof theimpairedskillsandthose
that hadbeenspared; andtreatment wasdirect languageinstruction. Differen-
cesbetweenthesetwoclinical andresearchtraditionsaresubstantial.
Mysecondpoint echoesothers(particularlyHallahan&Cruickshank, 1973;
Kavale& Forness, 1995). If I wereto construct adiagramsimilar to Weider-
holts, I wouldmakelearningdisability adirect descendant of theperceptual
theorists, only. LetusreturntoSamuel KirkinChicagoin1963. Remember, he
said:
Recently, I have used the term learning disabilities to describe a group of children who have
disorders in development in language, speech, reading and associated communication skills
needed for social interaction (p. 2).
Asindicatedat thebeginningof thischapter, Dr Kirkwasworkingonatest to
assesspsycholinguisticfunctionsinyoungchildrenat thetime. Healsohad, at
earlier timesinhiscareer (1936, 1940), publishedinuential booksonreading
andreadinginstruction. Surelyhemust havebeenthinkingabout aphasiaand
dyslexiawhenhespoke. Now, let uslookat therst linesof thedenitionthat
guidespracticeonceagain.
Specic learning disability means a disorder in one or more of the basic psychological processes
involved in understanding or in using language, spoken or written, that may manifest itself in an
imperfect ability to listen, speak, read, write, spell or do mathematical calculations.
Thedisability in this denition is in apsychological process, and that is the
Straussorientation. IfOrtonwerepresentinthisdenition, thedisabilitywould
be the reading disorder. We would have seven distinct disabilities in the
denition. That is not theway thedenition or theregulations arewritten.
Remember, theregulationsallowdiscrepanciesinseveral domainsconcurrent-
lytobediagnosticof speciclearningdisability.
If weareseriousabout theconcept of speciclearningdisabilities, I believe
theHinshelwood/ Ortonperspectiveistheappropriateancestor for contem-
poraryclinical practiceandresearch. Toswitchfromthedenitionandguide-
linesinfederal lawtoataxonomysimilar to theDSM-IV taxonomycreatesa
dilemmafor practice, however. A perspectiveon specic learningdisabilities
that restrictsthediagnosisto youngsterslikeLisawill includefewer children.
Theguidelinesfor diagnosisinfederal lawsare, bydesign, I think, muchmore
inclusive. Totheextent that thediagnosislearningdisability turnsfailureinto
hopeandgainsaccesstoentitlementsthatarehelpful, whowouldbesocallous
astotryto takeit awayfromanychild. Dowewant lessinclusivediagnostic
criteria?
Thinkabout thechildrenwhoarereceivingspecial educationbecausethey
23 History lessons
are learning disabled, though. Some of themare undeniably mentally re-
tarded; othershavebehavior problemstooserioustoallowthemtoworkina
classroom; othersdonot speakEnglish; andothershaveverypoor attendance
at school. Afewof them, perhapsone-third, resembletheStrauss/Werner and
Cruickshank/ Kephart idea of learning disability, and still fewer of themre-
sembleLisa. Itishardtoimagineateacher workingeffectivelywith15students
who present so many different problems. Perhaps it is time to clarify the
concept, evenif it meansmakingit moreexclusive. Otherswhohavewritten
histories about learningdisability, John Doris, SylviaFarnham-Diggory, and
JaneKessler, havebeensayingthat for sometime.
ENDNOTES
1 JoeTorgesen(1998)doesthis. HeclaimsnotonlythatSamuel Ortonsworkhasaweaklinkto
special educationfor studentswith learningdisabilities, but also that perceptual theoriesof
learningdisabilityandlanguagetheoriesaredifferent.
2 Thecurrent iterationof thelawistheIndividualswithDisabilitiesEducationAct of 1997(PL
106-17).
3 In thehistory that follows, I do not includetwo important facts documented by Lazerson
(1983) and Tropea (1987), among others. Special classes for children with learning and
behavior problems were created contiguous with the enactment of compulsory school
attendancelaws. Furthermore, administratorsinurbanschoolscreatedtherstclasses. People
whowritehistoriesof special educationthat includeall thesefactsusuallyembedtheminthe
claimthat publiceducationfor all childrencouldnot exist intheformit doesinthiscountry
without anopen, that is, subjectivelydened, special educationcategory into whichschool
psychologistscaneasilyplacestudentswhoseratesof learningand/ or behavior interferewith
classroomwork. For aparticularly interestingversion of this claim, seeRichardson (1999).
Richardson observes that school administrators named the open category rst, calling it
backward children. When the responsibility for naming this category was transferred to
psychologists, therst namewasmental retardation andthenlearningdisability. Fromthis
perspective, school psychologists, andother membersof school-basedassessment teams, are
beholden rst to the structure of the institution in which they work and second to the
characteristicsof thestudentsreferredtothemfor assessment.
I placethisnoteinthistext becausemyfriendsstoryandthestudiesthat conrmhisstory
showthat learningdisability asusedinschoolshasabroader meaningthandisability. I place
it asanote, however, becauseI donot want thisclaimtooverpower theideaof biologically
inuencedspeciclearningdisabilities anideathat needstobepreservedandprotected. You
shouldknow, however, that others(seeChristensen, 1999, for example)wouldmakeRichard-
sonsclaimthemaintext inanhistorical account of learningdisabilities.
4 Samuel Kirk was particularly wary of medical explanations and names for educational
problems(seeKirk&Becker, 1963).
5 Lisascredibilityasastudent withaspecial learningdisabilityrestsinlargemeasurewiththe
authenticityof her text. TheseparagraphsaretakenfromalongercompositionwritteninMay
1991. Lisas English teacher sent the text to the Child Study Center (now the Center for
Educational andPsychological Services) at Teachers College, ColumbiaUniversity. Lisahad
beenreferredtotheChildStudyCenterfor alearningdisabilitiesassessment. Shewas14when
shewrotethecomposition, andwaspreparingtograduatefromtheeighthgradeat aprivate
school inNewYorkCity. AccordingtoLisasteacher, theseparagraphsrepresentarstdraftof
her text andhavenot beeneditedfor grammar, spelling, or punctuation.
6 Thesescoreswereobtainedfromthepsychoeducational assessment conductedinJune1991.
Though late in the school year, Lisas parents brought her to the Child Study Center at
TeachersCollegefor adviceabout anewschool placement for ninthgrade. Bythetimeshe
tookthesetests, Lisahadworkedwithaspecial educationteacher andoccupational therapist
for seven years. Lisas education had taken place in private school. Her parents paid for
occupational therapyandspecial education.
7 Thisisalargeliterature. Arecent book(Duane, 1999) providesaccesstothelarger literature.
SeealsoBigler, Lajiness-ONeill, &Howes(1998); Sternberg&Grigorenko(1999).
8 Thisisalargeliteraturetoo. Duane(1999) andSternberg& Grigorenko(1999) arerelevant
here, too. SeealsoPennington(1994).
REFERENCES
AmericanPsychiatricAssociation(1994). DiagnosticandStatistical Manual of Mental Disorders, 4th
edn. Washington, DC: AmericanPsychiatricAssociation.
Badian, N.A. (1983). DyscalculiaandNonverbal DisordersofLearning, Vol. 5, pp. 23564. NewYork:
Grune&Stratton.
Bateman, B.D. (1965). An educators view of a diagnostic approach to learning disorders. In
LearningDisorders, Vol. 1, ed. J. Hellmuth, pp. 21939. Seattle, WA: Special ChildPublications.
Bigler, E.D., Lajiness-ONeill, R., &Howes, N. (1998). Technologyintheassessmentof learning
disability. Journal of LearningDisabilities, 31, 6782.
Brown, A. & Campione, J. (1966). Psychological theory andthestudy of learningdisabilities.
AmericanPsychologist, 41, 105968.
Bruck,M. (1998). Outcomesof adultswithchildhoodhistoriesof dyslexia.InReadingandSpelling:
DevelopmentandDisorders, ed. C. Hulme&R.M. Joshi, pp. 179200. Mahwah, NJ: Erlbaum.
ChristensenC.A. (1999). Learningdisability: issuesof representation, power, andthemedicaliz-
ationof school failure. InPerspectivesonLearningDisabilities:Biological, Cognitive, Contextual, ed.
R.J. Sternberg&L. Spear-Swerling, pp. 22749. Boulder, CO: WestviewPress.
Cohn, R. (1961). Dyscalculia. Archivesof Neurology, 4, 3017.
Cohn, R. (1971). Arithmeticandlearningdisabilities. InProgressinLearningDisabilities, Vol. 2, ed.
H.R. Myklebust, pp. 32289. NewYork: Grune&Stratton.
25 History lessons
Cruickshank, W.M., Bice, H.V., & Wallen, N.E. (1957). PerceptionandCerebral Palsy. Syracuse,
NY: SyracuseUniversityPress.
Doris, J. (1986). Learningdisabilities. InHandbookofCognitiveSocial andNeuropsychological Aspects
of LearningDisabilities, Vol. 1, ed. S.J. Ceci, pp. 353. Hillsdale, NJ: Erlbaum.
DorisJ.L. (1993). Deninglearningdisabilities: ahistory of thesearch for consensus. In Better
UnderstandingLearningDisabilities: NewViewsfromResearchandtheir Implicationsfor Education
andPublicPolicies, ed. G.R. Lyon, D.B. Gray, J.F. Kavanagh, & N.A. Krasnegor, pp. 97115.
Baltimore, MD: Paul H. Brookes.
DuaneD.D. (ed.) (1999). ReadingandAttentionDisorders: Neurobiological Correlates. Baltimore,
MD: YorkPress.
Farnham-Diggory, S. (1992). TheLearning-disabledChild. Cambridge MA: Harvard University
Press.
Felton, R. (1998). Thedevelopmentof readingskillsinpoor readers: educational implications. In
Readingand Spelling: Development and Disorders, ed. C. Hulme & R.M. Joshi, pp. 21933.
Mahwah, NJ: Erlbaum.
Frankenberger, W. & Harper, J. (1987). States criteriaandproceduresfor identifyinglearning
disabled children: a comparison of 1981/ 82 and 1985/ 86 guidelines. Journal of Learning
Disabilities, 20, 11821.
Freeman, R.D. (1976). Minimal brain dysfunction, hyperactivity, and learning disorders: epi-
demicor episode?School Review, 85, 530.
Goldstein, K. (1942). After-effectsof BrainInjuriesinWar. NewYork: Grune&Stratton.
Guttman, F. (1937). Congenital arithmeticdisabilityandacalculia(Henschen). BritishJournal of
Medical Psychology, 16, 1635.
Hallahan,D.P. &Cruickshank, W.M. (1973).Psychoeducational FoundationsofLearningDisabilities.
EnglewoodCliffs, NJ: Prentice-Hall.
Hegge, T.G., Kirk, S.A., & Kirk, W.D. (1936). Remedial ReadingDrills. AnnArbor, MI: George
Wahr.
Hinshelwood, J. (1917). Congenital WordBlindness. London: H.K. Lewis.
Kavale, K.A. & Forness, S.R. (1985). TheScienceof LearningDisabilities. SanDiego, CA: College
Hill Press.
Kavale,K.A. &Forness, S.R. (1995). TheNatureofLearningDisabilities:Critical ElementsofDiagnosis
andClassication. Mahwah, NJ: Erlbaum.
Kerr, J. (1897). School hygienein its mental, moral and physical aspects. Journal of theRoyal
Statistical Society, 60, 61380.
Kessler, J.W. (1980). History of minimal brain dysfunctions. In Handbook of Minimal Brain
Dysfunctions: aCritical View, ed. H.E. Rie&E.D. Rie, pp. 1851. NewYork: Wiley.
Kirk, S.A. (1940). TeachingReadingtoSlowLearningChildren. Boston: HoughtonMifin.
Kirk,S.A. (1963). Behavioral diagnosisandremediationof learningdisabilities.InProceedingsofthe
Annual Meetingof theConferenceonExplorationintotheProblemsof thePerceptuallyHandicapped
Child, Vol. 1, pp. 37. Chicago, IL.
Kirk, S.A. & Becker, W.C. (eds.) (1963). ConferenceonChildrenwithMinimal BrainImpairment.
Chicago, IL: National Societyfor CrippledChildrenandAdults.
Kirk, S.A. &Elkins, J. (1975). Characteristicsof childrenenrolledintheChildServiceDemonstra-
tionCenters. Journal of LearningDisabilities, 4, 621.
Lazerson, M. (1983). Theoriginsof special education. InSpecial EducationPolicies: Their History,
Implementation, andFinance, ed. J.G. Chambers&W.T. Hartman, pp. 1547. Philadelphia, PA:
TempleUniversityPress.
Lyon, G.R. & Moats, L.C. (1993). An examination of research in learning disabilities: past
practices and futuredirections. In Better UnderstandingLearningDisabilities: NewViews from
Researchandtheir Implicationsfor EducationandPublicPolicies, ed. G.R. Lyon, D.B. Gray, J.F.
Kavanagh, &N.A. Krasnegor, pp. 113. Baltimore, MD: Paul H. Brookes.
MacMillan D.L., Gresham, F.M., & Bocian, K.M. (1998). Discrepancy between denitions of
learning disabilities and what schools use: an empirical investigation. Journal of Learning
MacMillan, D.L. & SpeeceD.L. (1999). Utilityof current diagnosticcategoriesfor researchand
practice. In Developmental PerspectivesonChildrenwithHigh-incidenceDisabilities, ed. R. Galli-
more, L.P. Bernheimer, D.L. MacMillan, D.L. Speece, &S. Vaughn, pp. 11133. Mahwah, NJ:
Erlbaum.
Mann, L., Davis, C.H., Boyer, C.W., Metz, C.M., & Wolford, B. (1983). LD or not LD that
wasthequestion: aretrospectiveanalysisof ChildServiceDemonstrationCenters compli-
ance with the federal denition of learning disabilities. Journal of LearningDisabilities, 16,
1417.
Monroe, M. (1932). ChildrenwhoCannot Read. Chicago, IL: Universityof ChicagoPress.
Morgan, B.S. (1914). TheBackwardChild. NewYork: Putnam.
Morgan, W.P. (1896). Acaseof congenital wordblindness. BritishMedical Journal, 2, 1378.
Norman, C.A. Jr &Zigmond, N. (1980). Characteristicsof studentslabelledandservedinschool
systemsafliatedwithChildServiceDemonstrationCenters. Journal ofLearningDisabilities, 13,
5467.
Olson, R.K., Wise, B., Ring, J., &Johnson, M. (1997). Computer-basedremedial readingtraining
inphonemeawarenessandphonological decoding: effectsonthepost-trainingdevelopment
of wordrecognition. ScienticStudiesof Reading, 1, 23553.
Orton, S.T. (1937). Reading, WritingandSpeechProblemsinChildren. NewYork: Norton.
Pennington, B.F. (1994). Geneticsof learningdisabilities. Journal of ChildNeurology, 19(Suppl.),
S69S76.
PublicLaw94142, Educationfor All HandicappedChildrenAct of 1975(23August 1977). 10
U.S.C. 1401et seq. Federal Register, 42(163), 42474518.
Richardson, J.G. (1999). Common, Delinquent, andSpecial: theInstitutional Shapeof Special Educa-
tion. NewYork: Faimer.
Rourke, B.P. (1989). Nonverbal LearningDisabilities: TheSyndromeand theModel. New York:
Guilford.
Scarborough, H.S. (1990). Veryearlylanguagedecitsindyslexicchildren. ChildDevelopment, 61,
172843.
Schmitt, C. (1921). Extremeretardationinarithmetic. ElementarySchool Journal, 21, 52947.
Shaywitz, S.E., Shaywitz, B., Fletcher, J.M., & Escobar, M.D. (1990). Prevalence of reading
27 History lessons
disability in boys and girls: results fromtheConnecticut Longitudinal Study. Journal of the
AmericanMedical Association, 264, 9981002.
ShepardL.A., Smith, M.L., & Vojir, C.P. (1983). Characteristicsof pupilsidentiedaslearning
disabled. AmericanEducational ResearchJournal, 20, 30931.
Snowling, M. & Hulme, C. (1989). A longitudinal casestudy of developmental phonological
dyslexia. CognitiveNeuropsychology, 6, 379401.
Stanovich, K.E. (1999). The sociopsychometrics of learning disabilities. Journal of Learning
Sternberg, R.J. & Grigorenko, E.L. (1999). Our LabeledChildren: What everyParent andTeacher
needstoknowabout LearningDisabilities. Reading, MA: PerseusBooks.
Strauss, A.A. &Kephart, N.C. (1955). PsychopathologyandEducationof theBrain-injuredChild: Vol.
II ProgressinTheoryandClinic. NewYork: Grune&Stratton.
Strauss,A.A. &Lehtinen,L.E. (1947). PsychopathologyandEducationoftheBrain-injuredChild. New
York: Grune&Stratton.
Strauss, A.A. &Werner, H. (1943). Comparativepsychopathologyof thebrain-injuredchildand
thetraumaticbrain-injuredadult. AmericanJournal of Psychiatry, 99, 8358.
Torgesen, J.K. (1998). Learningdisabilities: an historical andconceptual overview. In Learning
about LearningDisabilities, 2ndedn, ed. B. Wong, pp. 334. SanDiego, CA: AcademicPress.
Tropea, J.L. (1987). Bureaucraticorder andspecial children:urbanschools, 1890s1940s. History
of EducationQuarterly, 27, 2953.
USOfceof Education (1994). SixteenthAnnual Report toCongresson theImplementationof the
IndividualswithDisabilitiesEducationAct. Washington, DC: Author.
USOfceof Education(1996). EighteenthAnnual Report toCongressontheImplementationof the
IndividualswithDisabilitiesEducationAct. Washington, DC: Author.
Warrington, E.K. (1982). Thefractionationof arithmetical skills: asinglecasestudy. Quarterly
Journal of Experimental Psychology, 34A, 3151.
Wiederholt, J.L. (1974). Historical perspectivesontheeducationof thelearningdisabled. InThe
SecondReviewofSpecial Education,ed. L. Mann&D. Sabatino,pp.10352. Philadelphia,PA:JSE
Press.
Zigmond,N. (1993). Learningdisabilitiesfromaneducational perspective. InBetterUnderstanding
LearningDisabilities: NewViews fromResearch and their Implications for Education and Public
Policies, ed. G.R. Lyon, D.B. Gray, J.F. Kavanagh, & N.A. Krasnegor, pp. 25172. Baltimore,
MD: Paul H. Brookes.
2
The Wechsler intelligence scales
Gary Groth-Marnat
The Wechsler intelligence scales are individually administered, composite
batteries which measure a wide range of intellectual abilities. Given the
diversityof abilitiesmeasured, theyareoftenperceivedasbeingwell suitedfor
theassessment of learningdisabilities. Accordingly, theyhavebecomesomeof
the most extensively used and time-honored tools in learning disabilities
assessment. Inorder toevaluatetheir relevancefor thistask, it isessential both
toprovideacompletedescriptionof theinstrumentsand, moreimportantly, to
outlineclearlyWechsler scalestrategiesfor learningdisabilitiesassessment.
History, development, and goals
Duringthe1930s, DavidWechsler wantedtodeviseabroad-bandintelligence
testfor adults. Hewasinpart guidedbyhisconceptionthat intelligenceisboth
global innatureandalso guidedby awidenumber of aspectsof personality.
Specically, heconsideredthat intelligenceinvolvedapersonsability to act
purposively, thinkrationally, anddeal effectivelywithhisor her environment.
Wechsler also stressed that intellectual assessment must be considered in
relationtothepersonasawhole. Thismight includenonintellectual aspectsof
apersonsfunctioning, suchasinterests, persistence, drive, or needfor achieve-
ment. Despitethisearlyemphasisonageneral or unitaryaspectof intelligence,
therehasbeenconsiderableinterest andcontroversyconcerningtheextent to
which the Wechsler scales can measure more specic aspects of a persons
functioning(Lezak, 1988; McDermott, Fantuzzo, & Glutting, 1990; Kaufman,
1994; Gluttinget al., 1997). Strategieshavebeendesignedtoorganizevarious
Wechsler scores around such areas as distractibility, uid versus crystallized
intelligence, and simultaneous as opposed to sequential styles of processing
information (seeKaufman, 1990; Groth-Marnat, 1999). Becauselearningdis-
abilityassessment isoftenconcernedwithunderstandingspecicdifcultiesin
informationprocessing, theextent to whichtheWechsler scalescanactually
measurethesespecicabilitiesiscrucial for full evaluation.
29
Even though Wechsler was guided by his unitary conceptualization of
intelligence, hebeganto designhisscaleby searchingfor specicsubtests. A
number of these were derived from portions of the 1937 Stanford Binet
(Comprehension, Arithmetic, Digit Span, Similarities, Vocabulary). Others
camefromadiversityof previouslydevelopedscales, includingtheArmyAlpha
(Information, Comprehension), Army Beta (Digit Symbol, Coding), Kohs
BlockDesign(BlockDesign), PintnerPattersonTest(ObjectAssembly), Healy
PictureCompletion(PictureCompletion), andtheArmyGroupExaminations
(PictureArrangement). In1939thesescaleswerecombinedandpublishedas
the WechslerBellevue Intelligence Scale. Due to technical difculties, the
WechslerBellevuewas revised in 1955to formthe Wechsler Adult Intelli-
genceScale(WAIS). TheWAIShasbeenrevisedandupdated, oncein1981(the
Wechsler Adult IntelligenceScaleRevised; WAISR) and, most recently, in
1997astheWechsler Adult IntelligenceScaleThirdEdition(WAISIII). The
purposeof theserevisionswasto insurethat thestandardizationsamplewas
representativeof current demographicsandperformance, to updatethesub-
tests, incorporatenewsubtests, andrenetheinstructionsandtest materials
(Psychological Corporation,1997;Sattler&Ryan, 1998). TheWAISIII hasalso
been normed and integrated with the Wechsler Memory ScalesIII and the
Wechsler Individual Achievement Test (Psychological Corporation, 1997).
TheWAISandeachof itsrevisionshaveallowedexaminersto calculatea
Full ScaleIQ aswell asVerbal andPerformanceIQs. Thesesubdivisionsinto
verbal and nonverbal (performance) aspectsof intelligencearesupportedby
boththeoretical formulationsandempirical research. Factoranalyticstudieson
theWAISandWAISR havetypically foundaslightly different clusteringof
subteststoformVerbal ComprehensionandPerceptual Organizational factors,
aswell asathirdfactor whichhasbeenreferredtoasFreedomFromDistracti-
bility (Kaufman, 1990, 1994; Allen & Thorndike, 1995). When theWAISIII
wasdeveloped,threenewsubtestswereadded(Symbol Search, MatrixReason-
ing, LetterNumber Sequencing; see Table 2.1). Thesehave resulted in the
emergenceof thefollowingfour-factor or index scores: Verbal Conceptualiz-
ation, Perceptual Organization, WorkingMemory (previously referredto as
FreedomfromDistractibility), andProcessingSpeed. Theadvantageof these
indexscoresisthat theyallowtest interpreterstoevaluateaclientsstrengths
andweaknessesbynotingwhether or not theseindexesareclearlyhigher or
lower relativetooneanother. Thisispotentiallyrelevantfor assessinglearning
disabilitiesinthatithasoftenbeensuggestedthatsuchpopulationsarelikelyto
belowest inFreedomfromDistractibilityandProcessingSpeed.
In order to extend the range of the WAIS, Wechsler also developed the
30 Gary Groth-Marnat
Table 2.1. Descriptions of WAISIII and WISCIII subtests
Subtest Description
Verbal subtests
Vocabulary* List of orallyandvisuallyprintedwords; theexamineeis
requestedtoprovideoral denitions
Similarities Orallypresentedpairsof words; examineeexplainsthe
similaritybetweenthetwowordsor concepts
Information Orallypresentedquestionsrelatedtocommonevents,
objects, places, andpeople
Comprehension Seriesof orallypresentedquestionsrelatedtosocial rulesand
conceptsor solutionstoeverydayproblems
Arithmetic Seriesof orallypresentedarithmeticproblems; examinee
must solvethemmentallyandexpressthemorally
Digit Span Seriesof orallypresentednumbers; examineeisrequestedto
repeat themverbatimfor DigitsForwardsandinreversefor
DigitsBackwards
LetterNumber Sequencing
(WAISIII only)
Seriesof orallypresentedlettersandnumbers; examinee
mentallytrackstheseandorallypresentsthemwiththe
numbersinascendingorder andthelettersinalphabetical
order
Performancesubtests
PictureArrangement Cartoon-typepicturespresentedinamixed-uporder;
examineemust rearrangethemtomakealogical story
sequence
PictureCompletion Set of color picturesor commonobjectsandsettings, each
pictureismissinganimportant part; theexamineeis
requestedtoidentifythemost important part that ismissing
BlockDesign Set of blocks; examineemust arrangetheblockstoreplicate
variouspatterns
MatrixReasoning(WAISIII
only)
Seriesof incompletegriddedpatterns; examineeanswersby
indicatingwhichof apossiblevepatternsiscorrect
Coding(WISCIII) or
DigitSymbolCoding
(WAISIII)
Seriesof numberswhicharepairedwiththeir ownsymbol;
examineemust matchandwritedownthesymbol which
correspondswiththenumber
Symbol Search Seriesof pairedgroupsof symbolswitheachpair
representingatarget groupandasearchgroup; examinee
markstheappropriateboxtoindicatewhether thetarget
groupsymbol appearsinthesearchgroup
Object Assembly Set of puzzlesof commonobjects; examineeassemblesthe
piecestoreplicatetheobjects
AdaptedfromWechsler (1997a).
*All subtestsareonboththeWAISIII andWISCIII unlessotherwiseindicated.
31 The Wechsler intelligence scales
Wechsler Intelligence Scales for Children (WISC) in 1949. This primarily
representedadownwardextensionof theWAISsubtestsin that easier items
wereincluded. Normsweredevelopedfromchildren between theagesof 5
years0monthsand15years11months. However, theseearlynormsincluded
exclusively European Americanchildren andover-representedchildren from
middleandupper socioeconomicbackgrounds. In1974, theWISCwasrestan-
dardizedonamorerepresentativesampletoformtheWISCR. Theagerange
wasalsoextendedupto16years11months. Themost recent (1991) revision
(WISCIII)wasnot onlybasedonacurrentrepresentativestandardization, but
alsoincorporatedthenewSymbol Searchsubtest. IQscorescanbecalculated
for Full Scale, Verbal, andPerformanceabilities. Similar to theWAISIII, the
following four index scores can also be calculated: Verbal Comprehension,
Perceptual Organization, FreedomfromDistractibility, andProcessingSpeed.
In1967, adownwardextensionof theWISC wasdevelopedintheformof
the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). This
enabledpractitionerstoassesschildrenbetweentheagesof 4yearsand6years
6months. TheWPPSI includedsimpler itemsthantheWISC, aswell ascertain
types of items unique to the WPPSI itself. The WPPSI was most recently
revisedin1989(WPPSIR). Thesubtestsbetweenthe1967and1989versions
haveremainedessentiallythesame, except that theWPPSIRhasemphasized
speedof performancemorethantheWPPSI did.
Thepsychometricpropertiesof theWechsler intelligencescaleshavegen-
erally been excellent. They areoften usedasmodelsfor other psychological
tests. The following descriptions focus on the most recent versions of the
Wechsler intelligencescales(WAISIII andWISCIII). It shouldalsobenoted
that the psychometric data reported below are abbreviated. More detailed
descriptionscan befound in themanuals (Wechsler, 1991, 1997a, 1997b) or
varioustexts(Kaufman, 1990, 1994;Sattler, 2001;Groth-Marnat,1999;Sattler&
Ryan, 1998; Kaufman&Lichtenberger, 1999).
TherecentWAISIII manual (Wechsler, 1997)hasreportedsplithalf reliabil-
ities for the Full Scale, Verbal, and Performance IQs as .98, .97, and .94
respectively. Testretest reliabilities over a six-week retesting interval have
been slightly lower but still comparable. Split half reliabilities for the index
scoreshavebeensimilarlyhigh(Verbal Comprehension=.96, Perceptual Or-
ganization=.93, Working Memory=.88, Processing Speed=.88). For the
mostpart, reliabilitiesfor thesubtestshavebeenintheeightiestolownineties.
Thehighest reliabilitieshavebeenreportedfor Vocabulary(split half r=.93)
andInformation(split half r=.91). Incontrast, relativelylowreliabilitieshave
been foundfor Object Assembly (split half r=.70) andPictureArrangement
(split half r=.74).
Validityof theWAISIII will vary, of course, dependingon thecriteriaor
strategyusedtoestablishitsvalidityandthepurposefor whichthetest isbeing
used. Typical WAISIII validation strategies include correlations with the
earlier (andwell-validated) WAISR, correlationswithother abilitymeasures,
factor analysis, andability to predict theperformanceof clientswith known
cognitive decits (i.e., Alzheimers disease). Overall, research ndings have
beenquitesupportive. Forexample,correlationswiththeearlierWAISRwere
quitehigh(Full ScaleIQ=.93, Verbal IQ=.94, Performance=.86). Thissug-
geststhat muchof thevalidityestablishedfor theWAISRisalsotransferable
to the WAISIII. Thus, it would be expected that the WAISIII would be
equally as good at predictingacademic and occupational performanceas its
predecessors(seeHunter, 1986; Schmidt, Ones, &Hunter, 1992; Neisser et al.,
1996). Correlations with other ability measures have also been quite high.
These include the Stanford BinetIV (0.88), Standard Progressive Matrices
(withthePerformanceIQ r=.79), andtheWechsler Individual Achievement
Test(r=highsixtiestohighseventies). Factor analysessupport thepresenceof
ageneral intelligencefactor (g), as well as thedivision into both verbal and
performanceabilities, andthepresenceof thefour indexes(Wechsler, 1997b).
Finally, theWAISIII hasbeenfoundtobesensitivetocognitiveimpairments
present in various clinical groups. For example, Alzheimersdiseasepatients
werefoundoverall toscorelower thancontrolsandto scoreparticularlylow
onProcessingSpeedcomparedtotheir Verbal Conceptual abilities.
Similar totheWAISIII, theWISCIII reportsexcellent psychometricprop-
erties. Split half reliabilityacrossthe11different agegroupsfor theFull Scale,
Verbal,andPerformanceIQsare.96, .95, and.91respectively(Wechsler, 1991).
Aswouldbeexpected, reliabilitiesfor thespecicsubtestsarelower but still
generallyintheeighties. Thehighest split half reliabilitywasfor Vocabulary
(.87), withthelowest for Object Assembly(.69). Ingeneral, lower reliabilities
werefoundamongtheyounger agegroups. Testretest reliabilitiesfor theIQs
andsubtestsover a23-dayinterval wereroughlycomparableto thesplit half
reliabilities. For example, testretest reliabilitiesfor theFull Scale, Verbal, and
PerformanceIQswere.94, .94, and.87. Theabovedataindicatethat theWISC
isbothstableover timeandinternallyconsistent.
Strategiesto validatetheWISCIII includeestablishingitscorrelationwith
theWISCR, correlatingit withexternal abilitymeasures, factor analysis, and
assessingits ability to predict relevant performance. TheWISCIII has been
foundtocorrelatehighlywiththeearlier WISCR(Full Scaler=.89, Verbal IQ
r=.90, Performance IQ r=.81). This suggests that much of the validity
establishedfor theWISCRcanalsobegeneralizedtotheWISCIII (Dixon&
Anderson, 1995). Selected correlations between the WISCIII and external
ability measures include the StanfordBinetIV (median r=.78), Kaufman
Assessment Battery for Children (K-ABC; median r=.70), Wide Range
Achievement Test (r range=.52.59), and the Peabody Individual Achieve-
ment Test (medianr=.71; seeSattler, 1992). Factor analysessupport boththe
presence of generalized intelligence (g) as well as Wechslers division into
verbal and performanceabilities. Factors have also emerged supporting the
presence and use of the four indexes (Verbal Comprehension, Perceptual
Organization, Freedom from Distractibility, and Processing Speed). The
WISCIII hasalsobeenfoundtopredict relevant performance, suchasthe.47
correlationwithschool grades(Wechsler, 1991).
Description of the instruments
TheWechsler intelligencescalesarecomprisedof anadministrationmanual,
stimulus materials, and scoring sheets (Fig. 2.1). The WAISIII also has a
technical manual. Theadministrationmanualsareclearlylaidout andeasyto
read. They beginwith informationon howthetestsweredevelopedandon
standardization, reliability, andvalidity. Theythenincludeclear descriptionsof
eachof thedifferent subtests, followedbydetailedadministrationandscoring
instructions.Theappendixesincludefurtherclaricationonadministrationand
scoring, aswell astablesthat canbeusedtoconvert rawscorestothedifferent
IQs, indexes, and subtest scaled scores. The manuals have generally been
praised as providing sufcient guidelines to work appropriately with and
administer the stimulus materials. In somecases, however, decidingon the
most appropriatescorecanbesomewhat difcult. Inaddition, thenumber of
administrationandscoringerrorsmadebypractitionersishigher thanitshould
be(Slate& Hunnicutt, 1988; Slate, Jones, & Murray, 1991). Thisunderscores
the need to follow optimal training guidelines (see Fantuzzo, Blakey, &
Gorsuch, 1989; Slate et al., 1991) with well supervised repeated practice
administrations.
Thestimulus materials for the Verbal subtests (seeTable 2.1) are simply
wordsor sentenceswhicharereadtotheexaminee. For example, Information
items involve clients answering questions related to their general fund of
knowledge, andVocabularyrequirestheexaminer toreadaseriesof progress-
ivelymoredifcultwordswhichtheexamineemustdene. Theadministration
Fig. 2.1. Wechsler IntelligenceScalefor ChildrenIII.
manual clarieswhen(or whether) theexaminer shouldrepeat thequestions
orprobeforfurtherexplanation. Mostof theitemsonthePerformancesubtests
use physical materials that the examinee must somehow manipulate. For
example, theBlockDesignsubtest requiresexamineestoarrangedesignsusing
a series of blocks so that they match pictures of designs. Similarly, Picture
Arrangement requiresexamineestorearrangeacartoon-typeseriesof pictures
intoanewordersothattheymakeoptimal sequential sense. AswiththeVerbal
subtest instructions, themanual providesdetailedinformationonsuchthings
aswhattosaytotheexamineeandhowtoarrangethestimulusmaterialsprior
totheexamineeworkingonthem.
Thescoringsheetsincludespacetorecordtheexamineesresponses, graphs
toallowaproleof thedifferent scores, andtables/ gurestoassist incalculat-
ingIQ, index,andsubscalescores. TheWAISIII alsoincludestablesthatcanbe
usedtocalculatetheextent towhichtheindexscoresvaryfromoneanother.
Boththemorerecent WISCIII andWAISIII scoringsheetsallowfor more
calculationsandtablesthan their previousversions. This is potentially quite
useful, becauseit allows practitioners to have access to a larger amount of
potentially useful data. For example, neither the WISCR nor the WAISR
allowed for the calculation of index (factor) scores. In contrast, these are
standardfeatureson theWISCIII andWAISIII. Thismight beparticularly
useful for assessingclientssuspectedof havinglearningdisabilitiesinthat wide
variationsincognitiveabilitieswouldbeexpectedtounderlietheir difculties
andthereforepossiblybereectedontheindexscores. However, thegreater
number of calculationswould also beexpectedto increasethelikelihoodof
clerical errors. Thisisconsistent withthendingthat, evenwiththesimpler
earlyWechslerintelligencescales, thenumberof clerical errorswasworryingly
high(Slate&Hunnicutt, 1988; Slateet al., 1991).
Normative and developmental issues
Each of the versions of the Wechsler intelligence scale variations has been
standardizedongroupsthat aregenerallyrepresentativeof peoplefromdiffer-
ent age, ethnic, educational, and geographic groups within the USA. The
representativenesshasbeenaparticularlyprominentfeatureofthemorerecent
versions. Incontrast, theWAISandWISCsomewhat over-representedpeople
frommorehighlyeducatedpopulationsanddidnothaveasufcientnumberof
people from ethnic minorities. The various age groups are used to make
comparisonsof peoplewithincertainagegroupstodevelopIQsbasedonthe
performanceof peoplewithintheseages. Thescaleshavealsobeenstandard-
izedonvariousinternational groupssothatthetestscoreswill moreaccurately
reect patternswithinthevariouscountries.
TheWAISIII wasstandardizedon2450adultsbetweentheagesof 16and
89. The group represented European Americans, African Americans, and
Hispanics accordingto the1995UScensus. Therewere morefemales than
malesin thehigher agebrackets, but this is consistent with censusdata. All
geographic regions in theUSA wererepresented, andstratiedaccordingto
different educational levels. Therewere200peoplewithineachof the13age
groups, withtheexceptionof the8084and8589agegroups, whichhad100
and150peoplerespectively.
Thestandardizationsamplefor theWISCIII wasalsoexcellentinthatithad
asufcient number of peopleandwasalsorepresentativeof UScensusdata. A
total of 2200childrenwereincludedbetween theagesof 6and16andwere
dividedinto 11agegroups. Each grouphad100malesand100females. The
sample was stratied based on age, race/ ethnicity, geographic region, and
parent education(usedto reect socioeconomicstatus). Therelativepropor-
tions closely reected 1988 US census data. Subjects were also selected to
represent different geographical regionswithintheUSA.
Application to diagnosis and treatment of learning disabilities
Theassessment of learningdisabilitiesusingtheWechsler intelligencescalesis
intrinsicallylinkedtothestrategyof interpretingthescalesthemselves. Thus,
an initial familiarity with Wechsler interpretivestrategies is outlined below.
Suchaninterpretationissuccessiveandbeginswiththemoregeneral features
of the scales (Full Scale IQ) and gradually proceeds to morespecic details
(qualitativeanalysisof unusual responses). It shouldbestressedthat thereis
more support for interpreting the more global aspects and relatively less
support for themorespecicdetails. Thus, afairlyhighreliancecanbeplaced
oninterpretationsof IQandindexscores. Incontrast, interpretationsbasedon
ananalysisof varioushighandlowsubtestsshouldbeconsideredashypotheses
inneedof further conrmation. Someauthorsevenrecommendnot interpret-
ingindividual subtestsat all, becausethesubtestshaveinsufcient reliability,
specicity, and validity (McDermott et al., 1990; Glutting et al., 1997). In
contrast, others believe that prole analysis not only can but should be
performed, inthat itallowstheclearestrepresentationof apersonsintellectual
strengths and weaknesses (Lezak, 1988, 1995; Kaufman, 1990, 1994; Groth-
Marnat et al., 2000). Thisisaparticularly crucial issuefor theassessment of
learningdisabilities, which typically entails understandingapersons specic
strengthsandweaknessesastheyrelatetohisor her disability. However, even
thosewho advocateproleanalysis emphasizethe importanceof obtaining
additional support, making careful observations of the client, and paying
attention to issues of ecological validity (Kaufman, 1994; Sbordone& Long,
1996; Groth-Marnat &Teal, 2000; Kaufman&Lichtenberger, 1999).
Wechsler interpretation typically proceeds along the following ve-step
process(Table2.2).
Level I: Full Scale IQ
TheFull ScaleIQcanbeconsideredthemost reliableandvalidestimateof a
clients overall ability. Extensive research supports the ability of the IQ in
predictingacademicandoccupational performance.TheFull ScaleIQcanoften
be more clearly represented as a percentile rank or IQ classication (Very
Superior, Superior, High Average, Average, Low Average, Borderline, Ex-
tremelyLowRange).Itisalsosometimesuseful toincludethestandarderrorof
measureof anIQ scoreso that readersof areport areawarethat thereisan
Table 2.2. Outline of successive, ve-level WAISIII/WISCIII interpretive procedures
Level I. Interpret Full ScaleIQ
Level II. Interpret VerbalPerformance, IndexScores, andAdditional Groupings
a. VerbalPerformanceIQs
b. IndexScores: Verbal Comprehension, Perceptual Organization, Working
Memory/ FreedomfromDistractibility, ProcessingSpeed
c. Additional Groupings: Bannatynescategories, ACID/ SCADproles, Horngroupings
Level III. Interpret Subtest Variability(ProleAnalysis)
Level IV: AnalyzeIntrasubtest Variability
Level V. Conduct aQualitativeAnalysis
AdaptedfromGroth-Marnat (1997).
expectedrangeof error aroundthescore, butcanalsobeassuredthattherange
of error still clusters fairly closely around theIQ itself. If thereis very little
variation among VerbalPerformanceIQs, indexes, or subtests, then a high
degreeof reliancecanbeplacedintheFull ScaleIQ. However, whenvariations
inthesescoresdooccur, thenit meansthat theFull ScaleIQislikelytobeless
unitary. It thenbecomesimportant to understandtheimportanceandmean-
ingsbehindthesevariations.
Level II: VerbalPerformance IQs, Index scores, and additional groupings
Level II interpretation focuses on subdividing different abilities based on
variousclustersof subtests. Themost time-honoredcluster isrepresentedby
Wechslersgroupingsintoeither Verbal or Performancesubtests. Anine-point
VerbalPerformancedifferenceontheWAISIII anda12-point differenceon
theWISCIII aregenerallyconsideredsignicantat the0.05level. If theVerbal
IQ is signicantly higher than thePerformanceIQ, it suggests anumber of
possibilities, includingmorehighlydevelopedverbal comprehensionabilities,
higher educational level, tendencytowardoverachieving, difcultywithpracti-
cal tasks, decits with performance tasks, the presence of right hemisphere
lesions, or either aslow, deliberateworkstyle(resultingingreater penaltieson
thetimedperformancesubtests) or animpulsiveworkstyle(resultinginmore
errorson theperformancesubtests). In contrast, aPerformanceIQ which is
signicantlyhigher thanVerbal IQsuggestssuperior perceptual organizational
abilities, tendency toward low academic achievement, ability to work well
undertimepressure, apersonfromalowsocioeconomicbackground,presence
of alanguagedecit, or left hemispherelesions.
It shouldbenotedthat statisticallysignicant VerbalPerformancedifferen-
cesarenot particularly unusual. A full 18%of theWAISIII and24%of the
WISCIII standardizationsampleshadVerbalPerformancedifferencesof 15or
morepoints. Thismeansthat interpretationsshouldbetreatedcautiouslyand
alwayssupportedbyadditional sourcesof information.
A ner distinctioninabilitiescanbefoundbynotingwhether or not there
are signicant differences between index (factor) scores. The WAISIII and
WISCIII prolesheetsprovidegraphsfor plottingtheindexscores, andthe
signicanceof thedifferencescanbenotedintheadministrationandscoring
manuals. Strengthsor weaknessescan behypothesizedby notingsignicant
elevations/ loweringsonthefollowingindexes(factors):
Verbal Comprehension: ability to work with abstract symbols, degree of
benet fromeducation, verbal uency, verbal memory.
Perceptual Organization: ability to integrateperceptual stimuli with relevant
motor responses, work in concretesituations, work quickly, assess visuo-
spatial information.
WorkingMemory(WAISIII)/ FreedomfromDistractibility(WISCIII): short-
termmemory, concentration, attention, abilitytomakeappropriatemental
shifts, sequencing, abilitytoattendtostimuli.
Processing Speed: mental and motor speed in solving nonverbal problems;
ability to plan, organize, and develop relevant strategies; scores can be
loweredduetoaslowreectiveproblem-solvingstyleor poor motivation.
Aswithdifferencesfor VerbalPerformanceIQs, interpretationsshouldbe
madewithappropriatecaution(includinghypothesistesting) andalsowithan
awarenessthat moderatedifferencesareafairlyfrequent occurrence. It should
also benotedthat theabilitiesmeasuredby boththeVerbal Comprehension
andPerceptual Organizationindexesareessentiallythesameasfor theVerbal
andPerformanceIQs.
Many of the additional Wechsler intelligence scale groupings have been
developedinattemptsto assesslearningdisabilitiesmorefully. Thesegroup-
ingsareobjectivelydescribedbelow, but their effectivenessinassessinglearn-
ingdisabilitiesareevaluatedinalater subsection.
Oneof theearliest attemptsat aspecic learningdisability proleis Ban-
natynescategories(Bannatyne, 1974). The theory underlyingBannatynes re-
categorizationisthat peoplewithlearningdisabilitieswouldbeexpectedtodo
best on spatial, holistic taskswhich requiresimultaneousprocessing. In con-
trast, theywouldbeexpectedtodoquitepoorlyontasksrequiringsequencing,
andthiswouldresultinpoor academicperformance, whichwouldbereected
in a low level of acquired knowledge. This led to the following subtest
groupingsandexpectedrelativemagnitudes:
Table 2.3. Summary of Teds WISCIII results
IQscores
Verbal IQ 81
PerformanceIQ 89
Full ScaleIQ 83
Indexscores
Verbal Comprehension 84
Perceptual Organization 120
FreedomfromDistractibility 72
ProcessingSpeed 75
Subtest scores
Information 6 PictureCompletion 9
Similarities 7 Coding 4
Arithmetic 5 PictureArrangement 10
Vocabulary 7 BlockDesign 18
Comprehension 8 Object Assembly 16
Digit Span 5 Symbol Search 6
Bannatynescategories(meanof subtestsineachcategory)
Spatial (14.3)9Verbal Conceptualization(7.3)9AcquiredKnowledge(6)9Sequential (4.7)
SCADprole(convertedtoIQequivalent): 66
Spatial (PictureCompletion+BlockDesign+Object Assembly+?Matrix
Reasoning)9
Verbal Conceptualization(Vocabulary+Comprehension+Similarities)9
Sequential (Digit Span+Arithmetic+Coding+?LetterNumber
Sequencing)9
AcquiredKnowledge(Information+Vocabulary+Arithmetic).
Thiscanbemoresimplysummarizedasfollows:Spatial 9Verbal Conceptual-
ization9Sequential 9AcquiredKnowledge(seeexampleinTable2.3). Ques-
tion marks appear beforeMatrix Reasoningand LetterNumber Sequencing
becausethesearenew WAISIII subtests and their appropriatenessfor Ban-
natynescategorieshasnot yet beenevaluated. Theoretically, however, they
wouldbeexpectedtobeincludedintheindicatedgroupings. It shouldalsobe
notedthatsometimesAcquiredKnowledgehasnotbeenincludedasoneof the
categories.
TheACID, ACIDS, andSCADprolesaresimilar recategorizations. Theyare
basedonthetheoryandobservationthat learning-disabledpeopletendto do
particularly poorly on some subtests as opposed to others (Kaufman, 1990,
1994; Pritera& Dersh, 1993; Mayes, Calhoun, & Crowell, 1998). TheACID
prolewasoriginallydevelopedfor theWISCR(andWAISR) andissimply
thescoresonArithmetic, Coding, Information, andDigit Span. TheWISCIII
hasincludedaSymbol Searchsubtest such that aWISCIII variationon the
ACID prole is simply to add Symbol Search to create an ACIDS prole.
Kaufman(1994) hasrecommendedasomewhat similar WISCIII SCAD pro-
le, whichisalso comprisedof thenewer Symbol Searchsubtest, alongwith
Coding, Arithmetic, andDigit Span. It shouldbenotedthat theACID/ SCAD
prolesaresomewhat similar toBannatynesrecategorizationinthat threeof
the ACID/ SCAD subtests are included in Bannatynes Sequential category
(Arithmetic, Coding, andDigitSpan). ThesubscalescoresontheACID/ SCAD
prolescaneither becombinedtoformanoverall subscalemean, or aformula
canbeusedtocalculateanequivalentACID/ SCADproleIQ (seeexamplein
Table2.3; Kaufman, 1990, 1994; Groth-Marnat, 1999). BecausetheWAISIII
includesanupwardextensionof theWISCIII Symbol Searchsubtest, it would
bereasonableto assumethat aSCAD prolemight also berelevant for the
WAISIII. It might also bespeculatedthat learning-disabledpeoplewoulddo
relativelypoorlyonLetterNumber Sequencing, becausethissubtest requires
sequencingandattentional abilities. However, no researchiscurrently avail-
able investigating the relation between learning disabilities and either the
WAISIII Symbol Searchor LetterNumber Sequencingsubtest.
A nal recategorizationhasbeenorganizedaroundHornsuidintelligence
versus crystallized intelligence(Horn & Cattell, 1966), as well as additional
categoriesfor retention(ontheWAISR)andachievement(for theWISCIII).
Asnoresearchhasbeenconductedonthesecategoriesandlearningdisabilities,
thespecicsubtestsusedtocalculatethesecategorieswill not beincluded, but
areavailableinGroth-Marnat (1999) andKaufman(1990, 1994).
Level III: interpreting subtest variability
A further strategy isto determinethemeaningof outstandingly lowor high
subtest scores. Thisprocessneedstobeundertakenwithcaution, becausethe
individual subtestsmaynot havesufcient specicityor reliability, andahigh
degreeof subtest scatter isafairlycommonoccurrence. It islikelythat many
clinicianshaveregularlyoverinterpretedthemeaningsof highor lowsubtests.
In order to guard against such overinterpretation, careful interpretive steps
needto betaken(seeKaufman, 1990, 1994; Groth-Marnat, 1999; Kaufman&
Lichtenberger, 1999; Groth-Marnat et al., 2000). First, practitioners should
determine whether subtest uctuations are statistically signicant. Next,
hypothesesshouldbecheckedagainst themeaningsof other patternsof high
andlowsubtests. For example, ahighBlockDesignsubtest might betheresult
of good visual abstract reasoning, speed of information processing, or a
combinationof both. If another subtest that primarilymeasuresvisual abstract
reasoning (i.e., Matrix Reasoning) was also high, this further supports the
importanceof visual abstract reasoning. Incontrast, if subteststhat primarily
involvedspeededperformancewerelow(i.e., Symbol Search), thenit reduces
thelikelihoodthat speedwasacrucial factor involvedinthehighBlockDesign
score(andfurther supportstherelativeimportanceof visual abstract reason-
ing). Thenal stepistointegratesubtest hypotheseswithadditional informa-
tion. Thisstepisextremelyimportant andinvolvesconsideringsuchfactorsas
theclientslevel of motivation, school records, reportsfromteachers,other test
results, medical records, or relevant history.
Level IV: intrasubtest variability
The Wechsler subtest items are organized such that there is an even pro-
gression from less difcult items to more difcult ones. This means that
subjectsarelikely to missprogressivelymoreitemsat afairly even rate. If a
client missesearlyeasier itemsbut passeslater moredifcult ones, thisshould
beinvestigatedfurther. Possibleexplanationsmight includepoor attentional
abilities, poor motivation, or even motivationto do poorly, which might be
consistent withmalingering.
Level V: qualitative analysis
Often, clientswill makeuniqueresponsesto theWechsler itemsthat helpto
further understand their thought processes and personalities. For example,
responsesmight represent concretethinking, unusual associations, impulsive-
ness, or aggressivetendencies. It shouldbestressed, however, that thislevel of
interpretation is more speculative than the others, relies more on clinical
judgment (seeGarb, 1998), andshouldbetreatedwithappropriatecaution.
Theabovereview of Wechsler intelligencescaleinterpretation provides the
necessarybackgroundandstructurefor morefullyunderstandingthevarious
strategiesusedtoassesslearningdisabilities. Therst threeof theselevelshave
beenfairlythoroughlyutilizedandresearched. Theresultsof thestrategiesand
relativesupport for themcanenablepractitionerstoevaluatetheappropriate-
nessof usingtheWechsler scalesfor individual cases.
The Full Scale IQ
TheFull ScaleIQisthebest overall indicator of apersonsability. Assuch, it
canbeusedasoneof avarietyof variablestodeterminewhether someoneis
achievingat hisor her expectedlevel. For example, further investigationneeds
tobemadeif achildisperformingpoorlyinschool buthasaFull ScaleIQinthe
Superior range. A diagnosis of learning disabilities is one possibility. Other
possibilitiesmight includeemotional disturbance, littlesupport fromhisor her
familyenvironment, or poor studentteacher relationships. Incontrast, achild
whoisperformingpoorlybuthasaFull ScaleIQintheBorderlineorExtremely
Low Rangeis morelikely to begiven aquitedifferent diagnosis(and treat-
ment). Inthiscase, theFull ScaleIQcanbeusedtoexcludelearningdisabilities
and, along with relevant measures of adaptive functioning, can be used to
diagnoseintellectual disabilities(mental retardation).
Usually, thesearchfor learningdisabilitiesproceedsbeyondtheFull ScaleIQ
into an understandingof relativecognitivestrengthsand weaknesses. These
discrepanciesmight theoretically bereectedin variationsamongthechilds
subtest scores.
VerbalPerformance discrepancies
Because learning-disabled people typically do relatively poorly in academic
areas, it might beexpectedthat their verbal subtests(andVerbal IQ) wouldbe
lowerrelativetotheirperformanceabilities. Several studieswiththeWISCand
WISCRhaveprovidedsomesupportfor thishypothesis(Anderson, Kaufman,
& Kaufman, 1976; Smithet al., 1977). Inaddition, moderatesupport hasbeen
foundfor Verbal beinglower thanPerformanceIQsfor theWISCIII (Daley&
Nagle, 1996), inthat27%of asampleof learning-disabledpeoplehaddiscrepan-
ciesof 16pointsor higher. Incontrast, theWISCIII manual reporteddiscrep-
anciesof 16or morepointsinonly21.6%of thestandardizationsample.
The above data suggest that, while there is some support for Perform-
ance9Verbal discrepanciesamonglearning-disabledpeople, thisoccurrence
isnot muchhigher thanamongthenormal population. Althoughthismaynot
providemuch of an argument for thedistinctivenessof greater performance
abilitiesamonglearning-disabledpeople, thepatternof abilitiesstill mayhave
interpretivesignicancefor anindividual casein thesameway that it would
haveinterpretivesignicancefor nonlearning-disabledpeople. Thus, it might
helptounderstandindividual casesinmoredepth. Afurther point isthat while
Performance9Verbal may be present for approximately 27%of learning-
disabledpeople, thisstill meansthat thispatterndidnotoccur intheremaining
73%. Again, even though Performance9Verbal discrepanciesoccurredin a
fairlylargeproportionof learning-disabledpeople, theabsenceof thispattern
doesnot excludeadiagnosisof learningdisabilities.
Index (factor) scores
EarlyresearchontheWISC/ WISCRindicatedthat learning-disabledpopula-
tions typically showed a distinctive prole in which Perceptual Organiz-
ation9Verbal Comprehension9FreedomfromDistractibility(Galvin, 1981;
Stanton&Reynolds, 1998). Ashasbeennoted, theWISCIII hasbeenfoundto
havethethreefactorsoriginally foundwith theWISC/ WISCR aswell asa
fourth(ProcessingSpeed) factor, whichwasformedfromcombiningCoding
with Symbol Search. Findings with the WISCIII index scores and learning
disabilitieshavebeen generally supportiveof theabovepattern. Specically,
someresearchershavefoundthat both ProcessingSpeedandFreedomfrom
Distractibilityweredepressedwhen comparedwith Perceptual Organization
andVerbal Comprehension(Wechsler, 1991; Pritera& Dersch, 1993; Mayes
et al., 1998). Incontrast, DaleyandNagle(1996) foundmixedsupport inthat
FreedomfromDistractibilitywaslower thaneither ProcessingSpeedor Per-
ceptual Organization. However, theyfoundnodifferencesbetweenFreedom
fromDistractibilityandVerbal Comprehension.Therewerealsonodifferences
between Verbal Comprehension, ProcessingSpeed, and Perceptual Organiz-
ation.
Research with the WAISIII is limited because it has only been recently
published. The WAISIII/ WMSIII Technical Manual has reported a pro-
nouncedpattern for peoplediagnosedwith learningdisabilities. Theclearest
ndingwasthat Verbal Comprehensionwassignicantlyhigher thanWorking
Memory (7 and 13 points for reading-disabled and math-disabled groups,
respectively). A full 41.7%of thelearning-disabledgrouphaddiscrepanciesin
which Verbal Comprehension was 15points or more higher than Working
Memory(versusonly13%of theWAISIII standardizationsample). Similarly,
Perceptual Organization was an average of 7points higher than Processing
Speed. A 15-point or morediscrepancy was found in 30.4%of thelearning-
disabled group (compared with 14%of the standardization sample). At the
presenttime, then, therearedatatosupportthehypothesisthat, atleastfor the
WAISIII, WorkingMemoryandProcessingSpeedarerelativelylower among
peoplediagnosedwithlearningdisabilities. Incontrast, researchontheWISC
III ismoreequivocal.
Additional groupings: Bannatynes categories and ACID/ACIDS/SCAD proles
Most of the research with the Wechsler scales and learning disabilities has
focused on trying to nd a distinctive grouping of subtests that would be
specic to learningdisabilities. Bannatynes recategorization was one of the
earliest formulations, but researchwithit hasreceivedmixedresults. Insome
studies, learning-disabledstudentshaveexhibitedtheexpectedSpatial 9Con-
ceptual 9Sequencing9Acquired Knowledge pattern (Kavale & Forness,
1984; Ackerman, McGrew, &Dykman, 1987; Kaufman, 1990, 1994; Katzet al.,
1993; Daley & Nagle, 1996). When working with Bannatynes categories,
caution is needed in that even studies with positivendings report that the
Bannatyneproleonlyoccurredslightlymorefrequentlyamongthelearning-
disabledgroupthanamongthenormal population. Inaddition, themajorityof
learning-disabledpeopledidnothavetheprole. TheclassicBannatynepattern
has also frequently been found amongother groups, such as juveniledelin-
quents(Groff&Hubble, 1981;Culbertson, Feral, &Gabby, 1989)andemotion-
ally handicapped children (Thompson, 1981). The above means that the
Bannatyneproleisneither specictolearningdisabilities, nor doesitsabsence
excludeadiagnosisof learningdisabilities. However, it isfar fromuseless, in
that if theproledoesoccur inindividual cases, it canbeusedto understand
morefullytheclientsvariousstrengthsandweaknesses(seeillustrativecase).
Onecaution is that sometimes quitebright, highly motivated peoplecan
compensatefor their learningdisabilitybydevelopingahighlevel of acquired
knowledge. Theresult wouldbethat theAcquiredKnowledgecategorymight
be outstandingly high even though the person might struggle with poor
sequencing abilities (low Sequencing; Ackerman et al., 1987). In contrast,
many, if not most, learning-disabledpeoplewouldndacademiclearningboth
frustrating and unrewarding. Therefore, they would benet less than other
people, withtheresult that theywouldacquirelittleknowledge(lowAcquired
Knowledge).
TheACIDproleiscomprisedof thosesubtestsonwhichlearning-disabled
people do particularly poorly (Arithmetic, Coding, Information, and Digit
Span).Thishasbecomeanimportantmarkerforlearningdisabilities,whichhas
been supported by numerous studies. Most of these studies indicate that
approximately20%of learning-disabledpeopleexhibit either apartial (threeof
thefour subtestsarelowest) or full (all four of thesubtestsarelowered) ACID
prole (Cordoni et al., 1981; Ackerman et al., 1987; Kaufman, 1990, 1994;
Wechsler, 1991; Pritera & Dersh, 1993; Mayes et al., 1998; Stanton &
Reynolds, 1998). For example, datapresentedintheWISCIII manual indicate
that 20.2%of learning-disabledpeoplepresentedwithapartial ACID prole,
comparedto 5.6%of thestandardizationsample. Similarly, 24%of learning-
disabled people on the WAISIII exhibited a partial ACID prole and 6.5%
exhibitedafull ACIDprole(Wechsler, 1997a). Incontrast, theACIDSprole
(which includes the new Symbol Search subtest) has received less support.
Wardet al. (1995), for example, actuallyfoundthat Symbol Searchwasoneof
thehighest scoringsubtestsamongtheir sampleof learning-disabledchildren.
Similar to theACID subtests, theSCAD groupingiscomprisedof subtests
whichemphasizespeedof informationprocessing, visual short-termmemory,
visualmotor coordination(Symbol Search andCoding), alongwith number
abilityandsequencing(ArithmeticandDigit Span). A number of studieshave
foundthatchildrenwithlearningdisabilities(andalsoattentiondecitdisorder)
scoreparticularlylowontheSCADsubtests(Pritera&Dersh, 1993;Kaufman,
1994; Mayeset al., 1998). Incontrast, Wardet al. (1995) foundthat theSCAD
proledidnot occur signicantlymoreinalearning-disabledpopulationthan
intheWISCIII standardizationgroup(19.6%versus16.0%, respectively).
Researchoneachof theaboveproles(Bannatyne, ACID, SCADS)seemsto
come to the same general conclusions. These proles do seem to occur
somewhat more frequently among learning-disabled populations. However,
there are other groups that also have these proles, the frequency of the
proles is not that much higher than in the normal population, and the
majorityof peoplediagnosedwithlearningdisabilitiesstill donot exhibitthem.
Afurther cautionisthat learning-disabledsixandsevenyear oldsdidnot have
theseprolesanymorefrequentlythannormal comparisonchildren(Mayeset
al., 1998). Thisisprobablyduetodifcultyinmakinganaccuratediagnosisfor
children this young, such that probably a large proportion of the learning-
disabled groupwasnot actuallylearningdisabled(seeChapter 1for diagnostic
issues).
Subtest variability
Themajor featuresof subtestvariabilityhavebeenincorporatedintotheabove
sectionsonpatternsofvarioussubtests. However,onehypothesisthathasbeen
put forward is that therewould begreater overall subtest variability (range
betweenhighest andlowest subtests) amongpeoplewithlearningdisabilities.
Thisseemsplausible, inthat learningdisabilitiesmight beconsideredtobethe
result of ahighdegreeof disparitiesinabilities. Ingeneral, thishypothesishas
not beensupportedbyresearch(Bolenet al., 1995; Bolen, 1998; Mayeset al.,
1998).
Intrasubtest variability
Littleresearch has been doneinvestigatingthemeaningof high intrasubtest
scatter. However, Dumont andWillis(1995) didndthat therewassomewhat
morescatter on the WISCIII subtests of Vocabulary, Comprehension, and
BlockDesignamongasampleof learning-disabledpeople. Themeaningof this
scatter was unclear. Investigation of intrasubtest variation on the WISCIII
Codingsubtest didnot reveal any differencesbetween learning-disabledand
othergroups(Dumontetal., 1998). Amongadultpopulations, greaterintrasub-
test scatter hasbeenfoundamongthosewith cognitivedysfunction(Mitten-
berg, Hammeke,&Rao, 1989;Kaplanetal., 1991), butthishasnotbeenstudied
in relation to adults with learning disabilities. Dumont and Willis (1995)
concludetheir study by emphasizingthat intrasubtest scatter should not be
usedto makediagnosticinferences, eventhoughtheremaybesomevaluein
usingscatter todescribeindividual cases. Thus, intrasubtest scatter shouldnot
beusedto diagnoselearningdisabilities(or anyother condition) but, whenit
does occur, should be used as a marker which can potentially be used to
understandtheperson.
Summary and conclusions
Giventheabovereview, thefollowingsummarypointsseemwarranted.
The Full Scale IQ can be most appropriately used to estimate the persons
overall potential andassistinexcludingpossibleexplanationsfor pooracademic
performanceother thanlearningdisabilities(i.e., intellectual disabilities/ men-
tal retardation).
There is moderate to equivocal evidence that some proles (relatively low
ProcessingSpeed and Working Memory/ FreedomfromDistractibility, Spa-
tial 9Conceptual 9Sequential,ACID, SCAD)occurmorefrequentlyinlearn-
ing-disabledpopulationscomparedtothegeneral population.
Theaboveprolesarenot uniqueto learningdisabilities, but often occur in
other groups as well (juvenile delinquents, attention decit hyperactivity
disorder, emotionallyhandicapped).
If apersondoeshavealearning-disabled Wechsler prole(ACID, etc.) it is
consistent withalthoughnot necessarilydiagnosticof learningdisabilities.
The majority of learning-disabled people do not have Wechsler learning-
disabled proles. Thus, theabsenceof oneof theproles doesnot excludea
diagnosisof learningdisabilities.
Thevarious patterns of Wechsler subtests can, at times, beused to further
understandindividual casesof peopleexperiencinglearningdifculties(seecase
illustration).
Illustrative case study
Tedisa16-year-old, white, right-handedmaleinhistenthyear of highschool
who wasreferredby hisfamily practicephysician to determinewhy hewas
performingpoorlyinschool. Hisparentsreportedthat four yearsprior tothe
current evaluation he had been labeled mentally retarded. They could not
recall if anyformal testinghadbeendone, andhispast recordswereunavail-
able. Duetohisearlier diagnosis, hehadbeenplacedinprogramswithother
intellectuallydisabled(mentallyretarded) people. Hisparentsweresomewhat
confusedthat hedidpoorlyinschool yet seemedextremelygoodat practical
tasks, suchasquicklyandefcientlydisassemblingandreassemblingbicycles.
He appeared for his assessment casually dressed and seemed motivated to
performwell onthetaskspresentedtohim. However, hiseyecontactwaspoor
andhisspeechwassometimeshalting. Hefrequentlystoppedinthemiddleof
hissentences, sayingum. . . ah, andthenwouldcontinuewithwhat hewas
saying.
Aspart of hisassessment, hewasadministeredafull WISCIII battery(see
Table2.3). HisFull ScaleIQof 83placedhimintheLowAveragerangeor 13th
percentile when compared with his age-related peers. Thus, his previous
diagnosisof mentallyretardedwasbothinappropriateandresultedindecisions
whichwerelikely to havebeen detrimental to hiseducational development.
DifferencesbetweenhisVerbal andPerformanceIQswerenot signicant and
werethereforenot interpreted.
The striking differences in his index and subtest scores enable a more
detailed understanding of Teds learning difculties. Formal calculations in-
volving his index scores revealed a signicant lowering in Freedom from
Distractibility(72) andProcessingSpeed(75) whencomparedwithPerceptual
Organization(120) andVerbal Comprehension(84). Thissuggeststhat hewas
experiencingdifculties with short-termmemory, sequencing, poor number
facility, andspeedof processingsequential information. It shouldbenotedthat
hehadextremelyhighscoresonBlockDesign(18) andObject Assembly(16),
both of which aretimedtests. Thissuggeststhat whenworkingon material
involvingprocessingsimultaneous, nonverbal information, hecanworkquite
quickly, efciently, and accurately. In contrast, when processing sequential
information he would be likely to perform poorly. This interpretation is
consistent withhisacademichistory aswell asreportsby hisparentsthat he
appeared quite adept at xing everyday objects (repairing bicycles). Poor
sequencingwasalso supportedby theobservationof reversalsinhiswriting
(writingwas insteadof saw).
A partial Bannatyne prole was found in that his Spatial (mean of sub-
tests=14.3) and Verbal Conceptualization (7.3) were clearly superior to his
Sequential (4.7) andAcquiredKnowledge(6) subtests. What wasparticularly
strikingwasthediscrepancybetweenhisSpatial andSequential subtests. This
stronglysuggeststhat hisabilitytoprocessinformationinanefcient, simulta-
neousmanner isanoutstandingstrength, particularlywhencomparedwithhis
markedweaknessinsequencing. HisSCADprole(IQequivalent=66), which
is primarily composed of sequencingtests, also supports this interpretation.
Thus, informationderivedfromtheindexes, additional groupings, aswell as
other sources of information all help to support theaboveinterpretation of
Tedsrelativestrengthsandweaknesses.
Theaboveinformationwasusedto conrmalearning-disabilitydiagnosis.
Hewasplacedinspecial educationclasses, whichin part focusedon helping
himtocompensatefor hislowsequencingabilities. Hisoutstandingabilitiesin
simultaneously processingand problemsolvingnonverbal information were
alsousedtobuildhisself-esteembyallowinghimtodevelopanddemonstrate
thesestrengths. Career counselingsimilarlyfocusedonhisobtainingtraining
and later employment in occupations which emphasized his strengths (i.e.,
mechanic, bicyclerepairs).
REFERENCES
Ackerman, P.T., McGrew, M.J., &Dykman, R.A. (1987). Aproleof maleandfemaleapplicants
for aspecial collegeprogramfor learningdisabled students. Journal of ChildPsychology, 43,
6778.
Allen, S.R. &Thorndike, R.M. (1995). Stabilityof theWAIS-RandtheWISC-III factor structure
usingcross-validationof co-variancestructures. Journal of Clinical Psychology, 51, 64557.
Anderson, M., Kaufman, A.S., & Kaufman, N.L. (1976). Use of the WISC-R with a learning
disabledpopulation: somediagnosticimplications. PsychologyintheSchools, 13, 3817.
Bannatyne, A. (1974). Diagnosisanoteonrecategorizationof theWISCscaledscores. Journal of
LearningDisabilities, 7, 2723.
Bolen, L.M. (1998). WISC-III scorechanges for EMH students. PsychologyandtheSchools, 35,
32732.
Bolen, L.M., Aichinger, K.S., Hall, C.W., &Webster, R.E. (1995). Acomparisonof theperform-
anceof cognitivelydisabledchildrenontheWISC-RandWISC-III. Journal of Clinical Psychol-
ogy, 51, 8994.
Cordoni, B.K., ODonnell, J.P., Ramaniah, N.V., Kurtz, J., & Rosenshein, K. (1981). Wechsler
Adult Intelligence Scale patterns for learning disabled young adults. Journal of Learning
Culbertson, F.M., Feral, C.H., &Gabby, S. (1989). Patternanalysisof Wechsler IntelligenceScale
for ChildrenRevisedprolesfor delinquent boys. Journal of Clinical Psychology, 45, 65160.
Daley, C.E. & Nagle, R.J. (1996). Relevanceof WISC-III indicatorsfor assessment of learning
disabilities. Journal of Psychoeducational Research, 14, 32033.
Dixon,W.E. &Anderson,T. (1995). EstablishingcovariancecontinuitybetweentheWISC-Rand
theWISC-III. Psychological Assessment, 7, 11517.
Dumont, R., Farr, L.P., Willis, J.O., &Whelley, P. (1998). 30-secondinterval performanceonthe
codingsubtestof theWISC-III:furtherevidenceof WISCfolklore?PsychologyintheSchools, 35,
11117.
Dumont,R. &Willis, J.O. (1995). Intrasubtestscatter ontheWISC-III for variousclinical samples
vs. thestandardizationsample: anexaminationof WISCfolklore. Journal of Psychoeducational
Assessment, 13, 27185.
Fantuzzo, J.W., Blakey, W.A., & Gorsuch, R.L. (1989). WAIS-R: Administration and Scoring
TrainingManual. SanAntonio, TX: ThePsychological Corporation.
Galvin, G.A. (1981). Usesandabusesof theWISC-Rwiththelearningdisabled. Journal ofLearning
Garb, H.N. (1998). StudyingtheClinician:JudgmentResearchandPsychological Assessment. Washing-
ton, DC: AmericanPsychological Association.
Glutting, J.J., McDermott, P.A., Watkins, M.M., Kush, J.C., &Konold, T.R. (1997). Thebaserate
problemand its consequences for interpreting childrens ability proles. School Psychology
Quarterly, 26, 17688.
Groff, M. &Hubble, L. (1981). RecategorizedWISC-Rscoresof juveniledelinquents. Journal of
Groth-Marnat, G. (1999). Handbookof Psychological Assessment, 3rdedition(revised). NewYork:
Wiley.
Groth-Marnat, A., Gallagher, R.E., Hale, J.B., & Kaplan, E. (2000). TheWechsler Intelligence
scales. In Neuropsychological Assessment in Clinical Practice: a GuidetoTest Interpretation and
Integration, ed. G. Groth-Marnat, pp. 12994. NewYork: Wiley.
Groth-Marnat, G. & Teal, M. (2000). Block Designasameasureof everyday spatial ability: a
studyof ecological validity. Perceptual andMotor Skills, 90, 5226.
Horn, J.L. & Cattell, R.B. (1966). Renement and test of the theory of uid and crystallized
intelligence. Journal of Educational Psychology, 57, 25370.
Hunter, J.E. (1986). Cognitiveability, cognitiveaptitudes, jobknowledge, andjobperformance.
Journal of Vocational Behavior, 29, 34062.
Kaplan, E., Fein, D., Morris, R., &Delis, D. (1991). Manual for theWAIS-RasaNeuropsychological
Instrument. SanAntonio, TX: ThePsychological Corporation.
Katz, L., Goldstein, G., Rudisin, S., & Bailey, D. (1993). A neuropsychological approachto the
Bannatynerecategorizationof theWechsler intelligencescalesinadultswithlearningdisabili-
ties. Journal of LearningDisabilities, 26, 6572.
Kaufman, A.S. (1990). AssessingAdolescent andAdult Intelligence. Boston: Allyn&Bacon.
Kaufman, A.S. (1994). Intelligent TestingwiththeWISC-III. NewYork: Wiley.
Kaufman, A.S. &Lichtenberger, E.O. (1999). Essentialsof WAIS-III Assessment. NewYork: Wiley.
Kavale, K.A. &Forness, S.R. (1984). Ameta-analysisof thevalidityof Wechsler scaleprolesand
recategorizations: patternsor parodies. LearningDisabilityQuarterly, 7, 13656.
Lezak, M.D. (1988). IQ: R.I.P. Journal of Clinical andExperimental Neuropsychology, 10, 35161.
Lezak, M.D. (1995). Neuropsychological Assessment, 3rd edition. New York: Oxford University
Press.
McDermott, P.A., Fantuzzo, J.W., & Glutting, J.L. (1990). Just say no to subtest analysis: a
critiqueonWechsler theoryandpractice. Journal of Psychoeducational Assessment, 8, 290302.
Mayes, S.D., Calhoun, S.L., & Crowell, E.W. (1998). WISC-III proles for children with and
without learningdisabilities. PsychologyintheSchools, 35, 30916.
Mittenberg, W., Hammeke, T.A., & Rao, S.M. (1989). Intrasubtest scatter ontheWAIS-Rasa
pathognomonicsignof braininjury. Psychological Assessment, 1, 2736.
Neisser, U., Boodoo, G., Bouchard, T.J. et al. (1996). Intelligence: knowns and unknowns.
AmericanPsychologist, 51, 77101.
Pritera, A. &Dersh, J. (1993). Baseratesof WISC-III diagnosticsubtest patternsamongnormal,
learningdisabled, andADHD samples. In AdvancesinPsychoeducational Assessment: Wechsler
IntelligenceScaleforChildren,3rdedition, ed. B.A. Bracken&R.S. McCallum, pp. 4355. Journal
of Psychoeducational Assessment monograph series. Germantown, TN: Psychoeducational
Corporation.
Sattler, J.M. (2001). Assessmentof Children, 4thedition. SanDiego: JeromeSattler Publisher.
Sattler, J.M. &Ryan, J.J. (1998). Assessmentof Children, 3rdedition, revisedandupdatedWAIS-III
supplement. SanDiego: JeromeSattler Publisher.
Sbordone, R.J. &Long, C.J. (eds.) (1996). Ecological Validityof Neuropsychological Testing. Odessa,
FL: Psychological Assessment Resources.
Schmidt, F.L., Ones, D.S., &Hunter, D.E. (1992). Personnel selection. Annual Reviewof Psychol-
ogy, 43, 62770.
Slate, J.R. & Hunnicutt, L.C. (1988). Examiner errors on the Wechsler scales. Journal of
Psychoeducational Assessment, 6, 2808.
Slate, J.R., Jones, C.H., & Murray, R.A. (1991). Teaching administration and scoring of the
Wechsler Adult IntelligenceScaleRevised: an empirical evaluation of practice administra-
tions. Professional Psychology, 22, 3759.
Smith, M.D., Coleman, J.M., Dokecki, P., &Davis, E.E. (1977). RecategorizedWISC-Rscoresof
learningdisabledchildren. Journal of LearningDisabilities, 10, 4854.
Stanton, H.C. &Reynolds, C.R. (1998). Congural frequencyanalysisasamethodof determin-
ingWechslerproletypes. Paperpresentedattheannual meetingoftheAmericanPsychologi-
cal Association, SanFrancisco, CA.
Thompson, R.J. (1981). Thediagnosticutilityof BannatynesrecategorizedWISC-Rscoreswith
childrenreferredtoadevelopmental evaluationcenter. PsychologyintheSchools, 18, 437.
Ward, S.B., Ward, T.J., Hatt, C.V., Young, D.L., & Mollner, N.R. (1995). Theincidenceand
utility of the ACID, ACIDS, and SCAD proles in a referred population. Psychology in the
Schools, 32, 26776.
Wechsler, D. (1991). Manual for theWechsler IntelligenceScalefor ChildrenRevised. SanAntonio,
TX: ThePsychological Corporation.
Wechsler, D. (1997a). WAIS-III Administration and Scoring Manual. San Antonio, TX: The
Psychological Corporation.
Wechsler, D. (1997b). WAIS-III/ WMS-III Technical Manual. SanAntonio, TX: ThePsychological
Corporation.
Part II
Alternative Cognitive Approaches to
Learning Disabilities Assessment
and Remediation
MMMM
3
Application of the WoodcockJohnson
Tests of Cognitive AbilityRevised to the
diagnosis of learning disabilities
Nancy Mather and Richard W. Woodcock
TheWJRisbasedonaphilosophythat theprimarypurposeof testingshouldbetondout
moreabout theproblem, not todetermineanIQ (Woodcock, 1997a).
Theprimaryobjectiveunderlyingthedevelopmentof thetestsdescribedinthis
chapter was to provideclinicians with better and morecomprehensivepro-
ceduresfor investigatingproblemsof cognitionandlearning. TheWoodcock
JohnsonTestsof CognitiveAbilityRevised(WJRCOG) (Woodcock&John-
son, 1989) approachesthisgoal intwoways. First, theWJRCOGprovidesa
broader array of information about factors that may be related to learning
problems than is available through the use of any other single instrument.
Second, certaininterpretiveproceduresareespeciallyuseful for evaluatingthe
signicanceandimplicationsof obtainedinformation. Becauseof theseunique
features, boththe1977(Woodcock&Johnson, 1977) andthe1989WJRhave
beenwidelyusedinschool andclinical settingsfor thediagnosisof learningand
readingdisabilities(Ostertag&Baker, 1984; Dalke, 1988; Cuenin, 1990; Lewis,
1990).
The WJR COG is a wide-age-range, comprehensive set of individually
administeredtests for measuringcognitiveabilities, scholastic aptitudes, and
oral language that is complemented by the fully co-normed Woodcock
JohnsonTestsof AchievementRevised(WJRACH) (Woodcock& Johnson,
1989). TheWJR ACH measuresimportant aspectsof reading, mathematics,
written language, and three areas of academic knowledge (science, social
studies, andhumanities). TheWJRACH hastwoformsthat arematchedin
content:FormAandFormB. BoththeWJRCOGandWJRACHhavedirect
Spanish languagecounterparts, theBater aR COG and theBater aR ACH
(Woodcock& Munoz-Sandoval, 1996a, 1996b), whichcontainall of thesame
55
tests and interpretivefeatures. A somewhat more compact version of these
batteries is the Woodcock Diagnostic Reading Battery (Woodcock, 1997b),
which contains the ten most useful WJR tests for the diagnosis of reading
disorders. The WDRB draws the four reading achievement tests from the
WJRACH andsixtestsfromtheWJRCOG. Amongthecognitivetestsare
twomeasuresof phonemicawareness, twomeasuresof oral comprehension, a
test of short-termmemory, andatest of cognitiveprocessingspeed.
Another importantfeatureof thesebatteriesisthattheymeasureintellectual
abilityandachievement fromage24monthsto over 90years. Special norms
are provided for the college/ university population. In addition, a computer
programdesignedtoassist withwritinginterpretivereports, WoodcockScor-
ing&InterpretiveProgram(Schrank&Woodcock, 1997), includesautomated
scoringprocedures, aswell asproducingareport basedoninformationfrom
anycombinationof factors, clusters, or tests. Thereport maybeeditedbythe
examiner inanywaydesiredusingawordprocessingprogram. Althoughthe
greatest advantage derives fromusing the WJR COG and WJR ACH to-
getherinanevaluation, thefocusofthischapterisontheuseof theWJRCOG
andthecounterpart Bater aRCOG.
Thischapter beginswithareviewof thetheoretical andclinical foundations
of the WJR, including an overview of the CattellHornCarroll theory of
cognitiveabilities(CHCtheory) andtheCognitivePerformanceModel. Then
brief descriptions of the WJR COG and Bater aR tests and clusters are
provided, aswell asinformationabout thetechnical featuresof theseinstru-
ments. Next, theapplicationof theseinstrumentsfor thediagnosisof learning
disabilitiesisdiscussedandtwo illustrativecasestudiesarepresented. In the
nal section, abrief overviewof thenewWJ III COGisprovided(Woodcock,
McGrew, &Mather, 2001).
Theoretical and clinical foundations
Theoriginal WoodcockJohnsonTestsof CognitiveAbility(WJ COG)(Wood-
cock&Johnson, 1977)presentedamulti-factor approachtotest interpretation.
At thetimeof the1977publication, theinterpretationof theWechslerswas
based on a Verbal/ PerformanceIQ dichotomy and the StanfordBinet pro-
vided a single IQ score. The 1977 WJ moved beyond these unitary and
dichotomizedviewsof intelligencebypresentingafour-factor(Gc, Gf, Gsm, and
Gs)interpretivemodel. For the1989WJRCOG, interpretationisenhancedby
themeasurement of sevenfactorsthat represent major componentsof human
56 Nancy Mather and Richard W. Woodcock
intellectual ability(Reschly, 1990; Ysseldyke, 1990; McGrew, 1994). Twoaddi-
tional factors (Grw, a reading/ writing factor, and Gq, a quantitative ability
factor) aremeasuredbytheWJRACH. Thus, nineGfGcabilitiesaremeas-
uredacrosstheWJRCOGandWJRACH. Table3.1liststheseninefactors,
providesabrief denitionforeachbroadability,andincludesastatementof the
possibleimplicationsof adecit. Theimplicationsfor academicperformance
arederivedfromstudiesthat examinedtherelationshipsamongGfGcabilities
andachievementacrossthelifespan(McGrew, 1993, 1994; McGrew&Hessler,
1995; McGrew&Flanagan, 1998).
Theoretical model
Thetheoretical basisfor theWJRCOGisfoundedintheCHCtheory(Carroll
&Horn, personal communication, July1999). Theworkof Cattell andHornis
oftenreferredtoasGfGctheory(Cattell, 1941;Horn, 1965, 1991; Horn&Noll,
1997). At an American Psychological Association conferencein 1941, Cattell
proposedthathumanabilitiesconsistedof twotypes: uidintelligence(Gf)and
crystallizedintelligence(Gc). Basedontheresearchconductedinthelast 30or
40 years, this conceptualization has been expanded into a nine-factor or
ten-factor abilitystructure.
Thisfactor structurehasbeenconsistently replicatedthroughthework of
Horn, Carroll, andmany others. Carrollswork isoften referredto asthree-
stratumtheory (Carroll, 1993, 1998), with StratumIII representingageneral
factor (g); StratumII thebroadabilitieslistedinTable3.2(seepp. 623); and
StratumI themanynarrowabilities. Thistheoryisviewedasdynamic, rather
than static, and in the future will be subject to change, probably by the
denitionandinclusionof morefactors(Woodcock, 1990).
Oneimportant featureof thistheoryisthedistinctionbetweenbroadand
narrowabilities(i.e., StratumII andStratumI inCarrollswriting). Eachof the
broadabilitiesismeasuredbyvariedtasks, involvingseveral narrower aspects
of theability. Thesenarrowabilitiesrepresent ner differentiationsof ability
(Carroll, 1993). To measure verbal comprehensionknowledge (Gc), for
example, onecouldincludetestsof vocabulary, knowledgeof geology, general
information, or evenstreet-wiseness. Withinindividuals, thepatternof scores
withinthesamebroadabilitymayshowpatternsof strengthsandweaknesses.
For example, a person could be knowledgeable about geology, but not as
knowledgeableabout art.
57 The WoodcockJohnson Tests of Cognitive AbilityRevised
Table 3.1. Description of nine GfGc broad abilities
GfGcability Description Sampleimplicationsof decits
Short-termMemory(Gsm)
Memoriaacortoplazo
Theabilitytohold
informationinimmediate
awarenessandthenuseit
withinafewseconds, also
relatedtoworkingmemory
Difcultyinremembering
just-impartedinstructionsor
information; easily
overwhelmedbycomplexor
multistepverbal directions
ProcessingSpeed(Gs)
Rapidezenel
procesamiento
Speedandefciencyin
performingautomaticor very
simplecognitivetasks
Slowinexecutionof easy
cognitivetasks; slow
acquisitionof newmaterial;
tendencytobecome
overwhelmedbycomplex
events; needfor extratimein
respondingtoeven
well-practicedtasks
Comprehension
Knowledge(Gc)
Comprension
Conocimiento
Thebreadthanddepthof
knowledgeincludingverbal
communication, information,
andreasoningwhenusing
previouslylearnedprocedures
Lackof information, language
skills, andknowledgeof
procedures
QuantitativeAbility(Gq)
Habilidadcuantitativa
Theabilitytocomprehend
quantitativeconceptsand
relationships; thefacilityto
manipulatenumerical
symbols
Difcultywitharithmeticand
other numerical tasks; poor at
handlingmoneyand
calculatingchange
Reading/ Writing(Grw)
Lectura/ Escritura
Anabilityinareascommonto
bothreadingandwriting;
probablyincludesbasic
readingandwritingskills, and
theskillsrequiredfor
comprehensionand
expression(not yet well
denedintheliterature)
Difcultywithwordattack,
readingcomprehension, or
other basicreadingskills;
writingisinconsistent and
characterizedbyerrorsof
spellingandusageandof poor
expression
Visual Processing(Gv)
Procesamientovisual
Spatial orientation, theability
toanalyzeandsynthesize
visual stimuli, andtheability
toholdandmanipulate
mental images
Poor spatial orientation;
misperceptionof objectspace
relationships; difcultywith
art andwithusingmaps;
tendencytomisssubtlesocial
andinterpersonal cues
Table 3.1. (cont.)
GfGcability Description Sampleimplicationsof decits
AuditoryProcessing(Ga)
Procesamientoauditivo
Theabilitytodiscriminate,
analyze, andsynthesize
auditorystimuli; alsorelated
tophonological awareness
Speechdiscrimination
problems; poor phonological
knowledge; failureto
recognizesounds; increased
likelihoodof
misunderstandingcomplex
verbal instructions
Long-TermRetrieval (Glr)
Recuperacionalargoplazo
Theabilitytoefcientlystore
informationandretrieveit
later
Difcultyinrecallingrelevant
informationandinlearning
andretrievingnames; needs
morepracticeandrepetition
tolearnthanpeers;
inconsistent inremembering
previouslylearnedmaterial
FluidReasoning(Gf)
Razonamientouido
Theabilitytoreasonand
solveproblemsthat often
involveunfamiliar
informationor procedures;
manifestedinthe
reorganization,
transformation, and
extrapolationof information
Difcultyingraspingabstract
concepts, generalizingrules,
andseeingimplications; has
difcultychangingstrategiesif
rst approachdoesnot work
Empirical support
Acentral featureof CHCtheoryisthatitisnotbasedonanyparticulartest, but
ratherisderivedfromthestatistical andlogical analysesof hundredsofdatasets
frompublishedandunpublishedtests. Eight to ten broadabilitieshavebeen
identiedconsistentlythroughfactor analyses. For example, Woodcock(1990)
presentedresultsfrom15setsof exploratoryandconrmatoryfactor analyses
that includedatotal of 68variables. All analyseswiththesevariablessupported
aneight-factor model of CHC theory. Furthermore, thefactor structurethat
hasbeenobservedinclinical dataalsoapproximatesthestructurepredictedby
CHC theory (Woodcock, 1998a; Dean& Woodcock, 1999). TheGfGctaxo-
nomy appears to be the most comprehensive and empirically supported
psychometricframework availablefor understandingthestructureof human
cognitiveabilities(McGrew&Flanagan, 1998).
TheCognitivePerformanceModel
Theapplicationof CHC theory, asthebasisfor interpretingthemeaningand
implicationsof test scores, canbeenhancedbyasimpledynamicmodel called
theCognitivePerformanceModel (CPM) (Woodcock, 1993, 1998b). TheCPM
(showninFig. 3.1)impliesthat thevariousGfGcabilitiesarenotautonomous,
but fall intoseveral functional categories. Thelevel andqualityof anindivid-
uals cognitive performance result fromthe interaction among these three
types of cognitive factors: (a) stores of acquired knowledge, (b) thinking
abilities, and(c) cognitiveefciency, plusvariousnoncognitivefactorsknown
asfacilitator-inhibitors.
Thestoresof acquiredknowledgeincludebothprocedural anddeclarative
knowledge. Thinking abilities are drawn upon when information cannot be
processed automatically and must be processed with some level of intent.
Cognitiveefciencyfactorsincludespeedof processingandshort-termmem-
ory, whichareimportant prerequisitesfor smooth, automatic, cognitivepro-
cessing. Facilitator-inhibitorsrepresent noncognitivefactorsthat impact cogni-
tive performance for better or for worse, often overriding or mediating
strengths and weaknesses among cognitive abilities. Facilitator-inhibitors
include internal factors (e.g., health, emotional status, or persistence) and
external factors(e.g., distractionsin theenvironment or typeof instruction).
Experiencedcliniciansknowthat scoresobtainedfromcognitivetestsmust be
interpretedwithcaution, becausetheobservedperformancemaybedistorted
by environmental and test situation variables. The CPM emphasizes the
concept that both cognitive and noncognitive abilities interact to produce
performance. Inother words, goodor poor cognitiveperformanceisrarelythe
result of asingleinuence.
TheCPM also providesasimplebut useful descriptionof certainrelation-
shipsamongthecognitiveandachievement measuresof theWJRCOGand
WJRACH andisthemodel followedbythenarrativereport producedbythe
Woodcock Scoring & Interpretive Program(Schrank & Woodcock, 1997).
Conrmatory factor analysis studies by Keith (1997) and Woodcock (1998b)
providesomesupport for theorganizationof GfGcabilitiesintotheCPM.
Description and features of the WJR COG and Bater aR
The WJR COG and Bater aR measure the following seven intellectual
abilities: Long-term Retrieval (Glr), Short-term Memory (Gsm), Processing
Speed(Gs), AuditoryProcessing(Ga), Visual Processing(Gv), Comprehension
Knowledge (Gc), and Fluid Reasoning (Gf). Although somewhat different
namesmaybeusedfromonewriter toanother, thesymbolsor abbreviations
followingthenameof eachbroadabilityaresimilar tothenotationsfoundin
theliterature.
Tests
TheWJRCOGandthecounterpart Bater aRCOGarecomposedof 21tests.
TheStandardBatteryconsistsof seventests, eachmeasuringadifferent GfGc
intellectual ability. TheSupplemental Battery consistsof 14tests. Tests814
provideanother measureof eachof thesevenintellectual abilities. Tests1521
provideadditional diagnosticmeasures. Thesemeasuresmaybeusedfor more
in-depth assessments or selectively when further evaluation of a particular
factor of cognitiveability isdesired. Table3.2presentsabrief description of
thesetests.
Clusters
Clustersaretheprimaryinterpretiveunit intheWJR. For thecluster scores,
resultsfromtwoor moretestsarecombinedtoprovideameasureof abroad
ability. Theprincipleof cluster interpretationisthat it minimizesthedanger
of generalizingfromasinglenarrowaspect of behavior, such asoral expres-
sive vocabulary, to a broader multifaceted ability, such as oral language.
Clusters are more valid for prediction than individual tests, because they
contain two or more qualitatively different indicators of the respective
broader ability. This structure parallels the principle that clinical decisions
shouldnot bebasedonasingletest measuringanimportant ability. All cluster
scorereliabilitiesareat .90or higher. Table3.3presentsabrief descriptionof
eachWJRCOGcluster.
Technical characteristics
In-depthinformation about thetechnical featuresof theWJR COG ispres-
entedintheWJRTechnical Manual (McGrew, Werder, &Woodcock, 1989).
For thepurposesof thischapter, abrief discussionof thecharacteristicsof the
standardizationsample, andareviewof thedevelopmental changesincogni-
tiveabilitiesobservedacrossthelife-spanareprovided.
Standardization
Normativedataarebasedonasinglesampleadministeredbothcognitiveand
achievement tests. Over 100geographicallydiversecommunitieswererepre-
sented. These tests were nationally standardized on 6359 subjects, aged 24
monthsto 90+years of age, and includeasampleof collegeand university
Table 3.2. Description of the WJR COG tests
Test name Abilitymeasured
StandardBattery
1. Memoryfor Names(Glr) Abilitytolearnassociationsbetweenunfamiliar auditory
andvisual stimuli (auditoryvisual association)
2. Memoryfor Sentences(Gsm) Abilityimmediatelytorecall meaningful phrasesand
sentences
3. Visual Matching(Gs) Abilitytolocateandcirclequicklytwoidentical numbers
inaseries
4. IncompleteWords(Ga) Abilitytoidentifywordswithmissingphonemes
(auditoryclosure)
5. Visual Closure(Gv) Abilitytoidentifypicturedobjectsthat havemissing
parts, arealteredbydistortion, or havesuperimposed
patterns
6. PictureVocabulary(Gc) Abilitytonamepicturedobjects
7. AnalysisSynthesis(Gf) Abilitytoanalyzeanincompletelogicpuzzleand
determinethemissingcomponents
8. VisualAuditoryLearning
(Glr)
Abilitytopair novel visual symbols(rebuses) with
familiar wordsandthentranslatethesymbolsintoverbal
phrasesandsentences(visualauditoryassociation)
9. Memoryfor Words(Gsm) Abilitytorepeat listsof unrelatedwordsincorrect
sequence
10. CrossOut (Gs) Abilitytoscanandcomparegeometricpatternsquickly
11. SoundBlending(Ga) Abilitytosynthesizeorallypresentedsyllablesand/ or
phonemesintowholewords
12. PictureRecognition(Gv) Abilitytorecognizeasubset of previouslypresented
pictureswithinaeldof distractingpictures
13. Oral Vocabulary(Gc) Abilitytostateantonymsor synonymsfor givenwords
14. Concept Formation(Gf) Abilitytoexamineaset of geometricguresandidentify
theruleswhenshowninstancesandnon-instancesof the
concept
15. DelayedRecallMemoryfor
Names(Glr)
Abilitytorecall previouslylearnedauditoryvisual
associationsafter 18days
16. Delayed
RecallVisualAuditory
Learning(Glr)
Abilitytorecall namesfor previouslylearned
visualauditoryassociationsafter 18days
17. NumbersReversed(Gsm) Abilitytorepeat aseriesof digitsinreverseorder
18. SoundPatterns(Ga) Abilitytodeterminewhether or not complexsound
patternsdiffer inpitch, rhythm, or soundcontent
Fig. 3.1. GfGcCognitivePerformanceModel.
Table 3.2. (cont.)
Test name Abilitymeasured
19. Spatial Relations(Gv) Abilitytoselect thecomponent partsfromaseriesof
visual shapesthat areneededtoformawholeshape
20. ListeningComprehension
(Gc)
Abilitytolistentoashort passageandsupplyamissing
nal word
21. Verbal Analogies(Gf/ Gc) Abilitytocompleteanalogieswithwordsthat indicate
comprehensionof therelationships
Table 3.3. Description of the WJR COG clusters
Cluster Description
BroadCognitiveAbility(BCA)
BCAEarlyDevelopment Abroad-basedmeasureof intellectual abilityappropriatefor
preschool childrenor individualswhoarelowfunctioning
(Tests1, 2, 4, 5, 6)
BCAStandardScale Abroad-basedmeasureof intellectual abilityappropriatefor
subjectsat kindergartenlevel or above
(Tests17)
BCAExtendedScale Abroad-basedmeasureof intellectual abilityappropriatefor
subjectsat kindergartenlevel or above
(Tests114)
Cognitivefactor clusters
Long-TermRetrieval (Glr) Effectivenessinstoringandretrievinginformationby
associationover extendedtimeperiods
(Tests1, 8)
Short-TermMemory(Gsm) Apprehensionanduseof informationwithinashort period
of time
(Tests2, 9)
ProcessingSpeed(Gs) Abilityonclerical speed-typetasks, particularlyunder
pressuretomaintainfocusedattention
(Tests3, 10)
AuditoryProcessing(Ga) Analysisandsynthesisof auditorypatternsandsounds
(Tests4, 11)
Visual Processing(Gv) Perceivingnon-linguisticvisual patterns, spatial
congurations, andvisual details
(Tests5, 12)
ComprehensionKnowledge
(Gc)
Breadthanddepthof knowledgeanditseffectiveapplication,
includinglanguagecomprehension
(Tests6, 13)
FluidReasoning(Gf) Capabilityfor abstract reasoninginnovel situations
(Tests7, 14)
QuantitativeAbility(Gq) Abilitytocomprehendquantitativeconceptsand
relationships, skill inmentallymanipulatingnumerical
symbols
(Tests24, 25)
Oral language
Oral Language Broad-basedreceptiveandexpressiveverbal ability
(Tests2, 6, 13, 20, 21)
Table 3.3. (cont.)
Cluster Description
Aptitudeclusters
ReadingAptitude Predictedreadingperformancebasedonthemost relevant
set of cognitiveskills
(Tests2, 3, 11, 13)
MathematicsAptitude Predictedmathematicsperformancebasedonthemost
relevant set of cognitiveskills
(Tests3, 7, 13, 14)
WrittenLanguageAptitude Predictedwrittenlanguageperformancebasedonthemost
relevant set of cognitiveskills
(Tests3, 8, 11, 13)
KnowledgeAptitude Predictedacquiredknowledgeperformancebasedonthe
most relevant set of cognitiveskills
(Tests2, 5, 11, 14)
Oral LanguageAptitude Predictedoral languageperformancebasedonthenonverbal
abilitiesmost relatedtooral languageprociency
(Tests12, 14, 17, 18)
students. Bothgradeandagenormsareavailable. Oneadvantageousfeatureof
the WJR is the use of continuous-year norms for school-age subjects, and
year-by-year norms for adult subjects (ages 1990+). Thus, scores can be
comparedto thoseof peopleof thesameageor gradelevel, rather than to
individualsgroupedintobroadtimeperiods, suchastwiceduringtheyear(e.g.,
SpringandFall norms).
AlthoughCHC theoryisusedthroughout thischapter, analternatewayof
classifyingthesetestscanhelpacliniciandeterminewhichset of testsit maybe
most useful toadminister basedonthereferral question. Four useful categori-
zationsof teststhat cut acrossGfGcfactorsincludetestsof: (a) attention, (b)
memory and learning, (c) language, and (d) reasoningand problem-solving.
These categories have particular relevance to the assessment of learning
disabilitiesasthesedisordersinvolvemanydifferent perceptual andcognitive
linguisticprocesses.
Tests of attention
Inthepast several decades, attentionhasevolvedfromitsconceptualizationas
aunitaryconstruct toacomplexandmultidimensional construct. Asnotedby
Barkley(1994, p. 69):
Attention plays a critical role in the neuropsychological assessment of children with developmen-
tal, learning, or other neuropsychological problems because it underlies the very capacity of
children to undergo any formof psychological testing. Without adequate attention by a child to the
tests or tasks given by the examiner, the test results are open to considerable question as to their
representativeness of that childs neuropsychological integrity.
Becausesomanychildrenwithlearningdisabilitiesalsohaveattentiondecit
hyperactivitydisorder (ADHD), andbothof thesedisordersinuencecognitive
performance, theissueof comorbiditymust beaddressed(Fletcher, Shaywitz,
&Shaywitz, 1994).
Although the WJR COG does not measureall important aspects of this
construct, three aspects (selective attention, sustained attention, and atten-
tional capacity) aremeasuredby sixWJR testsandlistedin Table3.4. Two
tests, Visual Matching(Gs) andCrossOut (Gs), eachwithathree-minutetime
limit, require both selective and sustained attention. A third test, Writing
Fluency, in theWJR ACH, probablyrequiressustainedattentiononly. This
test hasaseven-minutetimelimit andisafactoriallymixedmeasureof Gsand
Grw. ThreeotherWJRtestsaremeasuresofattentional capacityorthespanof
auditoryshort-termmemory: Memoryfor Words(Gsm), Memoryfor Senten-
ces(Gsm, Gc), andNumbersReversed(Gsm).
Studentswithlearningdisabilitiesfrequentlydisplayweaknessesinmemory
and speed of processing basic symbolic information (Meltzer, 1994). These
decits then interferewith academic performance. The skilled clinician will
havetodetermineif weaknessesontheseWJRCOGtestsaremoreindicative
of ADHD, learningdisabilities, or both.
Tests of memory and learning
Memory and learning tests constitute a rather broad category of tests in a
traditional neuropsychological classication. At least threefactorially distinct
GfGcabilities(Gsm, Glr, Gc)fall withinthiscategory. Theclinical assessmentof
memorydecitstypicallyinvolvesevaluatingtheabilitytolearnandremember
newmaterial presentedinbothauditoryandvisual modalities. Theadequacy
of bothshort-termmemory(or immediaterecall) andlong-termretention(or
delayed recall) is typically assessed. Indices of remotememory may also be
helpful withpeopleof advancedageandother clinical populations. For individ-
ualswith learningdisabilities, theinteractionsamongvariousabilities(auto-
maticity, cognitiveexibility, andworkingmemory)arepowerful predictorsof
Table 3.4. WJR/BATR tests of attention
Test Gf/ Gc Description
factor
SustainedandSelectiveAttention
3 Visual Matching
Pareovisual
Gs Measurestheabilitytoquicklylocate
andcirclethetwoidentical numbersin
arowof sixnumbers: taskproceedsin
difcultyfromsingle-digit numbersto
triple-digit numbersandhasa
3-minutetimelimit
10 CrossOut
Tachar
Gs Measurestheabilitytoquicklyscan
andcomparevisual information:
subject must markthevedrawingsin
arowof 20drawingsthat areidentical
totherst drawingintherow;
examineeisgivena3-minutetime
limit tocompleteasmanyrowsof
itemsaspossible
SustainedAttention
35 WritingFluency
Fluidezenlaredaccion
Gs, Grw Measurestheexamineesskill in
formulatingandwritingsimple
sentencesquickly; thissubtest hasa
7-minutetimelimit
Attentional Capacity
9 Memoryfor Words
Memoriaparapalabras
Gsm Measurestheabilitytorepeat listsof
unrelatedwordsinthecorrect
sequence; wordsarepresentedby
audiotape
2 Memoryfor Sentences
Memoriaparafrases
Gsm, Gc Measurestheabilitytoremember and
repeat simplewords, phrases, and
sentencespresentedauditorilybya
tapeplayer
17 NumbersReversed
Inversiondenumeros
Gsm, Gf Measurestheabilitytorepeat aseries
of randomnumbersbackward;
number sequencesarepresentedby
audiotape; ameasureof working
memory
Table 3.5. WJR/BATR tests of memory and learning
factor
Short-TermMemory
9 Memoryfor Words
Memoriaparapalabras
Gsm Measurestheabilitytorepeat listsof
unrelatedwordsinthecorrect
sequence; wordsarepresentedby
audiotape
Memoriaparafrases
Gsm, Gc Measurestheabilitytoremember and
tapeplayer
17 NumbersReversed
Inversiondenumeros
Gsm, Gf Measurestheabilitytorepeat aseries
audiotape; ameasureof working
memory
12 PictureRecognition
Reconocimentodedibujos
Gv, Glr Measurestheabilitytorecognizea
subset of previouslypresentedpictures
withinalarger set of pictures
Long-TermRetrieval
1 Memoryfor Names
Memoriaparanombres
Glr Measurestheabilitytolearn
associationsbetweenunfamiliar
auditoryandvisual stimuli (an
auditoryvisual associationtask): task
requireslearningthenamesof aseries
of spacecreatures
8 VisualAuditoryLearning
Aprendizajevisualauditivo
Glr Measurestheabilitytoassociatenew
visual symbols(rebuses) withfamiliar
wordsinoral languageandtotranslate
aseriesof symbolspresentedasa
readingpassage(avisualauditory
associationtask)
15 DelayedRecallMemory
for Names
MemoriadiferidaMemoria
paranombres
Glr Measurestheabilitytorecall (after 18
days) thespacecreaturespresentedin
Memoryfor Names
Table 3.5. (cont.)
factor
Delayed
RecallVisualAuditory
Learning
Memoria
diferidaAprendizage
visualauditivo
Glr Measurestheabilitytorecall (after 18
days) thesymbols(rebuses) presented
inVisualAuditoryLearning
RemoteMemory
28 Science
Ciencia
Gc Measuresthesubjectsknowledgein
variousareasof thebiological and
physical sciences
29 Social Studies
Estudiossociales
Gc Measuresthesubjectsknowledgeof
history, geography, government,
economics, andother aspectsof social
studies
30 Humanities
Humanidades
Gc Measuresthesubjectsknowledgein
variousareasof art, music, and
literature
academic performance (Meltzer, 1994). Eleven WJR tests are identied in
Table3.5asgoodmeasuresof someaspect of memoryor learning.
Tests of auditory short-termmemory include Memory for Words (Gsm),
Memory for Sentences (a mixed measure of Gsmand Gc), and Numbers
Reversed(Gsm). NumbersReversedmay also beinterpretedasameasureof
workingmemory. PictureRecognition(Gv) isincludedinTable3.6asit isan
indicator of immediate visual recall. The next four tests in Table 3.6 are
measuresof newlearning, long-termretrieval, or associational memory. Mem-
oryfor Names(Glr)isanauditoryvisual associationlearningtask, andthenext
test, VisualAuditoryLearning(Glr), isavisualauditoryassociationlearning
task. Both tests require learning new associations, with corrective feedback
provided whenever the examinee makes an error. A delayed recall version
existsfor eachof thesetwotestsbasedupontheabilitytorecall, fromoneto
eight dayslater, thenewly learnedassociations: DelayedRecallMemory for
Names (Glr) and DelayedRecallVisualAuditory Learning(Glr). TheWJR
Table 3.6. WJR/BATR tests of oral language
factor
6 PictureVocabulary
Vocabulariosobredibujos
Gc Measurestheabilitytonamefamiliar
andunfamiliar picturedobjects
13 Oral Vocabulary
Vocabulariooral
Gc Measuresknowledgeof word
meanings: inPart A: Synonyms, the
examineemust sayawordsimilar in
meaningtothewordpresented; in
Part B: Antonyms, theexamineemust
sayawordthat isoppositeinmeaning
tothewordpresented
Memorial parafrases
Gc, Gsm Measurestheabilitytoremember and
tapeplayer
20 ListeningComprehension
Comprensiondeoraciones
Gc Measurestheabilitytolistentoashort
tape-recordedpassageandtoverbally
supplythesinglewordmissingat the
endof thepassage
21 Verbal Analogies
Analog asverbales
Gc, Gf Measurestheabilitytocomplete
phraseswithwordsthat indicate
appropriateanalogies; althoughthe
vocabularyremainsrelativelysimple,
therelationshipsamongthewords
becomeincreasinglycomplex
delayed recall tests are among the few clinical memory tests that include
standardizedandnormeddelayproceduresextendingmorethan24hoursafter
initial administration.
Tests of language
Theabilitytocommunicatethroughlanguageistypicallyassessedbyexamin-
ingbothreceptiveandexpressiveabilities. Asnoted, theWJRandBater aR
haveparallel testsinEnglishandSpanish. Thisfeatureallowstheclinicianto
exploreissuesinregardtolanguagedevelopmentinbothlanguages, whichcan
help clarify whether or not learningdifculties may beattributedto second
languageacquisition, asopposedtointrinsiclearningproblems.
One important aspect of a learning disability evaluation is to distinguish
between children whose problems are specic to one or more cognitive
domainsandthosewhoseproblemsresult fromamorepervasiveimpairment
in language skills (which may be more appropriately classied as an oral
languagedisorder: Fletcher et al., 1998). Thethreebroaddivisionsof language
are oral language, reading, and writing. A commonly proposed discrepancy
model is a comparison of oral language abilities with reading or writing
achievement (Stanovich, 1991a, 1991b). Althoughtherearelimitationsto this
typeof procedureaswell, manyindividualswithspecicreadingandwriting
impairmentshaveadiscrepancybetweenoral andwrittenlanguagecompeten-
cies.
Theoral languagetests are in the WJR COG, whereas the reading and
writing tests are in the WJR ACH. The spectrumof oral language tasks
includedintheWJRrangesfromthenamingof picturestoverbal reasoning.
Theveoral languagetestslistedinTable3.6include:PictureVocabulary(Gc),
Oral Vocabulary(Gc), Memoryfor Sentences(Gsm/ Gc), ListeningComprehen-
sion(Gc), andVerbal Analogies(Gc/ Gf).
Thefour readingtestsmeasureaspectrumof readingabilitiesfromident-
ifyinglettersandwordsinisolationtocomprehensionof writtentext. Thetests
are LetterWord Identication (Grw), Word Attack (Grw/ Ga), Reading Vo-
cabulary (Grw/ Gc), and Passage Comprehension (Grw). The four tests of
writingabilityincludeDictation(Grw), Proong(Grw), WritingFluency(Grw/
Gs), andWritingSamples(Grw).
Tests of reasoning and problem-solving
Problem-solving, or theabilitytoarriveat solutionsinnovel andunpracticed
situations, involvesacomplexset of cognitiveprocesses. Somestudentswith
learningdisabilitieshavebeenobservedtobeinexibleandinefcient intheir
applicationof problem-solvingstrategies(Meltzer, 1991). Abstractthinkingand
adequate concept formation are required to formulate exible ideas and
strategiesandtoapplythemacrossavarietyof situations. Thesetypesof tasks
arelikelytobemorerelatedtoacademictasksrequiringproblem-solving(e.g.,
readingcomprehension) than to those requiringautomaticity and efciency
(e.g., basic reading skills). Meltzer (1994) summarized several studies that
comparedstudentswithlearningdisabilitiestostudentswithout suchdifcul-
ties. For the students with learning disabilities, problem-solving tasks that
assessedpatternanalysiswerethesecondmost important variablefor predic-
ting reading comprehension (automatic memory for sight vocabulary was
rst), aswell asmathperformance(rapidandautomaticcomputationwasrst).
Table3.7lists thetests in theWJR COG and WJR ACH that measure
aspectsof reasoningand problem-solving. Two testsarestrongmeasuresof
abstractreasoning:Analysis-Synthesis(Gf)andConceptFormation(Gf). Three
other testsalsomeasurereasoning, thoughfactoriallymixedwithother cogni-
tiveabilities: Verbal Analogies(Gc/ Gf), Spatial Relations(Gv), andNumbers
Reversed (Gsm). Carroll (1993) species quantitative reasoning as another
aspect of reasoning. The only WJR ACH test that may be considered a
measureof quantitativereasoningisAppliedProblems(Gq).
Application of the WJR and BateraR to the diagnosis and treatment of
learning disabilities
Past research in the eld of learning disabilities has often focused upon
neuropsychological andinformation-processingmodels(Torgesen, 1986). The
purpose is to attempt to understand the specic factors that are affecting
scholastic or vocational performance, andthen to developappropriateinter-
ventions. When viewed fromthe perspectiveof aneuropsychological para-
digm, thegoalsof alearningdisabilityandaneuropsychological assessmentare
similar: todocument anindividualsintact or preservedfunctions, aswell asto
identify theimpaired functions or theunderlyingspecicity of thedisorder.
Both types of assessments are designed to explore cognitivelinguistic pro-
cesses. Thepurposeisto uncover thecentral processingabilitiesanddecits
that predisposeanindividual todifferent patternsof social aswell asacademic
learningdifculties(Rourke, 1994).
Touncover specicdecits, theclinicianshouldinvestigateperformanceon
awidearrayof tasks. Rourkenotesthat acomprehensiveneuropsychological
assessment should sample tasks involving sensory, perceptual, attentional,
linguistic, andproblem-solvingabilities. Inaddition, thesetestsshould: (a)vary
alongacontinuumofdifculty, rangingfromquitesimpletoquitecomplex, (b)
varyalongdimensionsof roteandnovel requirements, and(c) varyfromtasks
thatinvolveprocessingwithinonemodalitytothosethatinvolvethecoordina-
tion of response requirements within several modalities. The WJR COG
providesacollectionof teststhat addressesthesethreedimensions.
Analysisof WJRCOGresultscanhelppractitionerstoconsidertherelation-
shipsamongabilities, explorehowtheseabilitiesmayaffectscholasticperform-
ance, and develop a more comprehensive understanding of an individuals
needs. AsScarborough(1991, pp. 389) soaptlyexplained:
Table 3.7. WJR/BATR tests of reasoning and problem-solving
factor
7 AnalysisSynthesis
AnalisisS ntesis
Gf Measurestheabilitytoanalyzethe
componentsof anincompletelogic
puzzleandtodetermineandnamethe
missingcomponents
14 Concept Formation
Formaciondeconceptos
Gf Measurestheabilitytoidentifyand
statetherulefor aconcept about aset
of coloredgeometricgureswhen
showninstancesandnoninstancesof
theconcept
21 Verbal Analogies
Analog asverbales
Gf, Gc Measurestheabilitytocomplete
phraseswithwordsthat indicate
appropriateanalogies; althoughthe
vocabularyremainsrelativelysimple,
therelationshipsamongthewords
becomeincreasinglycomplex
19 Spatial Relations
Relacionesespaciales
Gf, Gv Measurestheabilitytovisuallymatch
andcombineshapes; subject must
select, fromaseriesof shapes, the
component partscomposingagiven
wholeshape
17 NumbersReversed
Inversiondenumeros
Gf, Gsm Measurestheabilitytorepeat aseries
audiotape
25 AppliedProblems
Problemasaplicados
Gq Measuresthesubjectsskill in
analyzingandsolvingpractical
problemsinmathematics; subject
must decidenot onlytheappropriate
mathematical operationstousebut
alsowhichof thedatatoincludeinthe
calculation
. . . instead of casting the preschool characteristics of dyslexic children as precursors and the
reading problems of these children as outcomes, it might be more helpful to view both as
successive, observable symptoms of the same condition . . . Therefore, while the education goal
may be to explain reading disability for its own sake, the neuropsychological goal is to dene the
nature of the fundamental difculty that manifests itself most evidently, but not solely, as
underachievement in reading.
Table3.8illustratestherelativecontributionsof different cognitiveabilities
for predictingachievementinasimulatedreferral samplefor Grades1to12. All
individuals from the normative sample with achievement standard scores
below90wereselectedfor thisanalysis. Differentpatternsof cognitiveabilities
areassociatedwith poor performancein different areasof achievement. For
example, Gaabilitiesshowastrongrelationshipwithbasicreadingbutnotwith
readingcomprehension, whichishighlyrelatedtoGc. Processingspeed(Gs) is
highlyrelatedtomathskillsbut nottomathapplications, whichismorehighly
relatedtoGsm, andGf. Glr andGsarehighlyrelatedtowrittenlanguageskills.
Gc, which is ameasureof verbal ability, is highly related to performancein
science, social studies, andhumanities.
TheonlyabilitythatdoesnotshowupinTable3.8asanimportantpredictor
of achievement decitsisGv, visualspatial thinking. Thissuggeststhat if the
purposeof assessment istoinvestigatedifcultiesinschool performance, these
abilitiesgenerallywill notberelevant. Thetabledemonstratesagainthecritical
importance of using a comprehensive battery when attempting to describe
learningabilitiesanddisabilities.
Neurological basis of learning disabilities
Although many children struggle to learn because of extrinsic factors (e.g.,
environmental), learningdisabilitiesarebelievedtobeanintrinsicdisorder or
specic neurological difference that inhibits various facets of performance.
Throughoutthecentury, learningdisabilitieshavebeenassociatedwithcentral
nervoussystemdysfunctionsanddescribedasneurologicallybasedphenomena
that result indifferencesinperceptual, linguistic, and/ or cognitiveprocessing.
In the1980s, attemptsweremadeto discredit theneurological roots of this
disability,butnewinsightsfromcognitiveresearchandadvancesinneuroimag-
inghaverevivedtheinterest inandstudyof neuropsychological andinforma-
tionprocessing. Forexample, ODonnell (1991)foundthat42%of youngadults
with learningdisabilitiesshowedindicationsof mild cerebral dysfunction on
neuropsychological test scores. (SeeReitanandWolfsonsthoroughdiscussion
of ODonnellsstudyinChapter 10.)
Acommonpremiseof manydenitionsisthat anindividual withalearning
Table 3.8. Relative contributions of GfGc abilities to predicting achievement in a simulated grade 1 to 12 referral sample
Standardizedcoefcients
Broad
Total Reading:90 Total Math:90 Total WrittenLanguage:90 Knowledge
:90
(n=436) (n=460) (n=474) (n=488)
GfGcability Reading Reading Math Math Written Written
skills comprehension skills applications language language
skills expression
AcquiredKnowledge
Verbal Ability Gc .38** .09 .14* .15** .49**
ThinkingAbilities
VisualSpatial Thinking Gv .09*
AuditoryProcessing Ga .28** .08 .14** .12** .12**
Long-TermRetrieval Glr .11* .09 .20* .14**
FluidReasoning Gf .11** .09 .15**
CognitiveEfciency
Short-TermMemory Gsm .08 .13* .08* .20** .09 .16**
ProcessingSpeed Gs .15** .14** .21** .11 .18** .14** .09*
*p:0.05.
**p:0.01.
disabilityhasgreater difculty acquiring, applying, andretaininginformation
thanwouldbepredictedfromother informationabout theperson(Bateman,
1992). Kirk(1978) stated: I liketodenealearningdisabilityasapsychological
or neurological impediment to the development of adequate perceptual or
communication behavior (p. 617). In other words, children with learning
difcultieshavesignicant discrepanciesinthedevelopment of their psycho-
logical processes(e.g., perception, attention, memory). For example, anindi-
vidual withperceptuallybasedlearningdisabilitiesmaybesuccessful ontasks
that involvehigher-order cognitiveprocesses, suchaslanguageandreasoning,
but have difculty with tasks that involve lower-order processing, such as
processingspeedor short-termmemory. Thesedevelopmental disordersthen
contribute to domain-specic academic deciencies. Thus, the person de-
scribedabovemayhaveadequatecomprehensionof text, but acompromised
readingrate. In addition, performanceislikely to improvewhen listeningto
text, rather thanreading.
Consult Shepherd(Chapter 1) for ahistorical analysisof Kirksdenitionof
specic learningdisability in thecontext of alternatedenitions. Also, for an
extended discussion of the neurological bases of learning disabilities froma
historical andresearchperspective, seeSpreen(Chapter 9), andconsult Reitan
andWolfson(Chapter 10) for asummaryof neuropsychological researchwith
individualswithspeciclearningdisabilities.
Learning disabilities viewed as a disorder in basic cognitive processes
To diagnose learning disabilities accurately, it is important to differentiate
betweenunderachievementcausedbyneurological differencesandthat caused
byother factors(Adelman, 1992). Althoughadiscrepancybetweenabilityand
achievement may be present in an individual with a learning disability, it
represents only one manifestation of the disability (i.e., underachievement)
(Lewis, 1990), andshould, therefore, not beusedasthesole, or anecessary,
diagnosticcriterion(Fletcher et al., 1998; Mather &Healey, 1990). Althougha
signicant cognitivedecit cancontributetothedevelopment of anaptitude
achievementdiscrepancy, alearningor readingdisabilityshouldnot bedened
asadiscrepancybetweenaptitudeandachievement. Todiagnoselearningand
reading disabilities accurately, the core concept of decits in cognitive pro-
cesses needs to be maintained (Torgesen, 1979). As Torgesen (1979, 1986)
suggested, thelearningdisabilitieseldsproblemwithpsychological processes
arosebecausetheideawasaheadof itstime.
Although current legal requirementsoften control theassessment process
withinpublicschoolsintheUSA, lessrestrictivedenitionsof learningdisabili-
tiesincludethreepremises: (a) learningdisabilitiesarecausedbydisordersin
processinginformation; (b) theseprocessingdecitsareareectionof neuro-
logical, constitutional, and biological factors; and (c) the decit depresses
specicareasof cognitiveandacademicfunctioning(Swanson, 1991). Similarly,
theassumptionthat underliestheconcept of dyslexiaisthat acognitivedecit
exists that is reasonably specic to thereadingtask (Stanovich, 1991b). The
garden-variety poor reader (Gough&Tunmer, 1986) hasageneral cognitive
delay or developmental lag, whereasareader with adisability has aspecic
cognitivedecit that contributestothereadingproblembut doesnot extend
into all cognitive domains (Stanovich, 1988, 1991a, 1991b). This theme of
specicityhaspermeatedthehistoryof theeld. Indescribingwordblindness
in children, Orton (1925) noted that difculty memorizing symbols is an
isolateddisability, not theresult of ageneral mental defect.
Thecommon themeisthat learningdisabilitiesarisefromadeciency in
basiccognitiveprocesses, whichinturncontributeto academicfailure(Senf,
1978). Thesesymbol-processingdecitsarenot maturational lagsasthey are
also present in adults with low reading and spelling skills (Fraunheim &
Heckerl, 1983; Read& Ruyter, 1985). Intestingthebasic literacy of 50men,
ReadandRuyter observedthat disabilitiesresultedfromdecitsinperception,
short-termmemory, or analysis of speech. Learning disabilities result from
intra-individual differences in patterns of cognition. A pattern of islands of
excellence withinasea of disabilitiescanoftenhavevery important neuro-
psychological signicance(Rourkeet al., 1983).
Although thediagnosis is not as simpleas lookingat subtest scatter on a
proletodocumentstrengthsandweaknesses, thetenetof aspecicdeciency
inbasiccognitiveprocessesisafundamental concept of learningdisabilities. In
mostinstances, itisnottheactual testscoresthatallowclinicianstounderstand
thebehaviors, but rather the information that is obtained froman in-depth
analysisof thetypesof errorsmadebytheindividual (Morris, 1993).
In other words, theemphasis of aneuropsychological assessment is on a
detailedevaluationof theability structureof thechild(Fletcher et al., 1995).
Similarly, thegoal of alearningdisabilityassessment istouncover theunique
abilitiesanddisabilitiesof anindividual. TheWJRCOGprovidesinformation
to helpthepractitioner understandelementsof apersonsperceptual, cogni-
tive, andlinguisticfunctioning. AsnotedbyRourke(1994), acomprehensive
neuropsychological or learningdisabilityassessment alsoincludesinformation
onwhatapersoncando, aswell aswhatheor shecannotdo. Inother words, a
major goal of theassessment isto identifytheareasinwhichtheindividuals
abilities are intact. This information is critical for designing an appropriate
treatment/ interventionplan. TheWJRdiscrepancyproceduresaredesigned
toreveal theseintra-abilitystrengthsandweaknesses.
Discrepancy Analysis
TheWJR provides information on three types of discrepancy (Woodcock,
1984). Type1, an aptitudeachievement discrepancy, reects theamount of
disparitybetweencertainintellectual capabilitiesandactual academicperform-
ance. It isaunidirectional comparison, with cognitiveabilitiesbeingusedto
predictachievement.OntheWJRCOG, theaptitudeclustersarecomposedof
thespecicabilitiesthat comprisethebest predictor of performance. Type2,
anintracognitivediscrepancy, ispresent withinindividualswho havespecic
cognitivestrengthsor weaknesses. For thisprocedure, anindividualsperform-
anceononecognitivefactor iscomparedtohisor her averageperformanceon
the other six cognitive factors. Analysis of intra-cognitive discrepancies can
contributetoanappreciationof thetypesof tasksthat will beeasyor difcult
for an individual (Woodcock & Mather, 1989). For example, a person with
limitedcomprehensionof oral languagemaystrugglewithtasksthat involve
reading comprehension and written expression, but be successful on tasks
involving mathematical calculations. Type 3, an intra-achievement discrep-
ancy, ispresent withinindividualswho havespecic academicstrengthsand
weaknesses. Both intracognitive and intra-achievement discrepancies are bi-
directional; equal interest existsin theindividual who hasastrengthin uid
reasoningbutaweaknessinshort-termmemory, andintheindividual whohas
astrengthinshort-termmemory, but aweaknessinuidreasoning.
Although each of thesediscrepanciesisuseful aspart of acomprehensive
learningdisabilitiesassessment, an intracognitivediscrepancy constitutesthe
primary disability, whereas the other two types of discrepancies, aptitude
achievementandintra-achievement, areconsideredtobesecondarydiscrepan-
ciesthat arisefromthedeciencieswithincognitiveprocesses(Mather, 1993).
Figure3.2, adapted fromWoodcock (1984), depicts therelationshipsamong
thesethreediscrepancies.
Consider thefollowingexample, which illustrates theinteractiverelation-
shipsamongthethreetypesof discrepancies. Ann, athird-gradestudent, hada
signicant intracognitiveweaknessinauditoryprocessing. Performanceonall
other cognitive factors was within the average range. Ann did not have a
signicant aptitudeachievement discrepancy in reading, given her cognitive
abilities (including the weakness in auditory processing). Ann also had a
signicant intra-achievement discrepancy. Reading and writing performance
werelower thanperformanceinmathematicsandacquiredknowledge. This
Primary
Discrepancy
COGNITIVE
SKILLS
TYPE 2:
Intracognitive
Discrepancies
Secondary
Discrepancy
ACHIEVEMENT
SKILLS
TYPE 1:
Aptitude-
Achievement
Discrepancies
ACHIEVEMENT
SKILLS
TYPE 3:
Intra-achievement
Discrepancies
Fig. 3.2. Amodel of psychoeducational discrepancies.
wouldbeexpectedbecauseproblemsin phonological processingwill havea
greater impact on thedevelopment of literacy, rather than numeracy, skills.
EventhoughAnnsreadingabilitywaswithinthepredictedrangefor others
with similar cognitiveabilities, thediagnostic question then becomesoneof
identifyingthefactorsthat havecontributedtoher poor readingperformance
byexaminingthecognitiveabilitiesthat underlieor support successful reading
(e.g., phonological processing). In other words, the focus has shifted from
readingabilityper setoidenticationof thespeciccognitiveabilitiesthat have
interferedwiththeacquisitionof readingskills. WJRCOGresultscanhelpthe
clinicianunderstandthefactorsaffectingreadingperformance.
Part of theconfusionhasstemmedfromtheeldslackof clarityregarding
useof thetermscategoryanddiagnosis(Mather &Healey, 1990). Intheeldof
learningdisabilities, thetermlearningdisability is often usedincorrectly to
subsume both the category of disability, as well as the presumed causative
factor or the diagnosis. The categorical termis learning disability, but the
diagnosisneedstobeadescriptionof aspecicsubtypeor specicsymptoms,
suchaspoor short-termmemory or phonological awareness. For thecaseof
Dan, presented later in the chapter, one would say that he has a learning
disability(thecategory)andthat thesubtypeof learningdisabilityperformance
ispoor phonological awareness(thediagnosis). Whenthediagnosisisnot as
apparent, onewoulddescribethespeciccharacteristicsobserved.
Cognitive patterns by types of sample
TheWJRCOGmayalsobeuseful for differentiatingamongvariousclinical
disorders. A pool of clinical data has been assembled for the purpose of
documenting and validating neuropsychological applications. The subjects
range in age from6 to 81 years and have a variety of neuropsychological
diagnoses, includinglearningdisabilities, ADHD, languagedisorders, andcen-
tral auditory processingdisorders. Table3.9presentstheresultsobtainedon
theclusterslistedbystandardscoreorder for selectedclinical groups.
Although differences in performance exist, an interesting and consistent
patternof lowGsandhighGvscoresexistsacrossall clinical subgroups. The
results suggest that Gs scores may be particularly associated with learning
disabilitiesandADHD, whereasGvabilitiesappear tobegenerallyunaffected
bytheseconditions(Woodcock, 1998a; Dean&Woodcock, 1999). Fletcher et
al. (1995)foundsimilar resultswhenexaminingtheproleperformanceinnine
cognitive domains by three groups of children with reading disabilities. All
threegroupshadparticular difcultyonaphonemedeletiontask, andmoder-
atedifcultiesontasksinvolvingverbal memory, vocabulary, andrapidnam-
ing, but performedmuchbetter ontasksinvolvingvisualspatial skills.
Inaddition, specicclinical groupsarelikelyto exhibit different proleson
theWJRACH. Asarecent example, Marshall et al. (1999) foundthat students
withADHDscoredlower ontheCalculationtest thantheydidontheApplied
Problemstest, regardlessof subtype. WhenWJRACHresultsareanalyzedfor
selectedclinical groups, different patternsof performanceoccur. For example,
Dictation and Word Attack are two of the highest achievement scores in
individuals with mild mental retardation, whereas they are the two lowest
achievement scores for students with reading disabilities. Dalke (1988) also
found that these two tests were thelowest when examiningthe proles of
collegestudentswithlearningdisabilities.
This type of information again documents the need to use a cognitive
batterythat measuresthespectrumof abilitiesthat mayimpact learning. If this
spectrum of measurement is not available with a given battery, then an
evaluator should supplement the instrument by selecting tests fromother
sources. This principle is known as cross-battery assessment and is most fully
developed in the Intelligence Test Desk Reference (McGrew & Flanagan,
1998). Table 3.10 illustrates the breadth of measurement of GfGc abilities
providedbyseveral commonlyusedcognitivebatteries.
Illustrative case studies
Whencombinedwithassessment of academicperformance, classroomobser-
vations, work samples, and other pertinent information, WJR COG results
canhelptheevaluatordeterminethetypeandseverityof learningdisabilityand
theindividualspresentcognitivestatus.Inotherwords, WJRCOGresultscan
help an evaluator understand the manifestations and symptomatology of
speciclearningdisabilities. Observeddifferencesincognitiveprocessingmay
be most useful for characterizing different subtypes of learning disabilities
(Fletcher et al., 1993).
Althoughsomewhat atypical intheseverityof theproblem, aswell asthe
circumspectnatureof thedisability, twoillustrativecaseswithresultsfromthe
intracognitivediscrepancyprocedureareprovided(Mather, 1993).
Jon
Jonwasenrolledinaprivateschool forchildrenwithlearningdisabilities. Table
3.11presentsintracognitivediscrepancy datafor Jon as afth-gradestudent.
WhenJonslowperformanceontheLong-TermRetrieval factor iscompared
tohisaverageperformanceontheothersixcognitivefactors, only1outof 1000
(DiscrepancyPercentileRank: 0.1)individualswouldhaveaGlrscoreaslowor
lower. Conversely, whenhishighperformanceontheFluidReasoningfactoris
compared to the average of his other abilities, only 3 out of 1000 subjects
(DiscrepancyPercentileRank: 99.7) wouldobtainascoreashighor higher. In
regardtoacademicperformance, Jonwasstrugglingwithreadingandwriting
tasks, but hadhighaverageperformanceinmathematics, aslongasthetasks
werenot timed.
Erroranalysisprovidesadditional supportfor theconclusionof goodreason-
ingand languagecomprehension, but difculty in performinglearningtasks
requiringassociativememory, aGlr function. For example, Fig. 3.3illustrates
Jonsattempt tosolvethefollowingitemontheWJRACHAppliedProblems
test: Mr. Robertslivesinalargecity. Hisjobisinasuburbthirty-sevenmiles
fromhishome. Howmanymilesdoeshetravel duringave-dayworkweek
drivingonlytoandfromhisjob?
Jon began by setting up a problem of adding together ve 37s. He
Table 3.9. GfGc cluster score pattern by type of sample (age=581 years)
GfGccluster bystandardscoreorder
Sample n BCA 1 2 3 4 5 6 7
Referencesamples
WJRnorming 5470 Cluster: BCA Gv Gc Gf Ga Gs Glr Gsm
sample Mdn: 100 100 100 100 100 100 100 100
Total clinical SD: 16 16 16 15 15 16 16 16
sample 1315 Cluster: BCA Gs Glr Gc Ga Gf Gsm Gv
Mdn: 90 87 91 92 93 93 94 98
Gifted SD: 18 18 15 18 15 17 18 17
84 Cluster: BCA Gv Gsm Ga Glr Gf Gs Gc
Mdn: 120 105 110 111 112 116 118 120
SD: 11 13 15 13 16 11 14 13
Clinical samples
DecitsinAcquired
Knowledge
Knowledge :70 56 Cluster: BCA Gc Gf Gs Gsm Glr Ga Gv
Mdn: 56 58 65 68 70 72 73 76
SD: 11 10 12 15 12 16 11 16
Math:70 122 Cluster: BCA Gs Gc Gf Gsm Glr Ga Gv
Mdn: 64 68 68 72 77 78 80 82
SD: 14 15 16 12 14 15 13 16
Oral Language:70 63 Cluster: BCA Gc Gsm Gf Gs Glr Ga Gv
Mdn: 59 60 70 70 71 73 74 77
SD: 10 10 11 11 12 12 11 15
Reading:70 133 Cluster: BCA Gc Gs Gsm Gf Glr Ga Gv
Mdn: 66 69 72 75 76 77 82 89
SD: 15 16 13 15 14 13 13 16
Written
Language:70 164 Cluster: BCA Gs Gc Glr Gsm Gf Ga Gv
Mdn: 70 75 76 78 78 80 83 89
SD: 15 14 16 12 15 14 13 16
AnxietySpectrum 100 Cluster: BCA Gs Glr Ga Gc Gf Gsm Gv
Disorders Mdn: 95 91 94 94 96 97 97 100
SD: 16 17 15 15 17 16 16 15
Table 3.9. (cont.)
GfGccluster bystandardscoreorder
Sample n BCA 1 2 3 4 5 6 7
AttentionDecit/ 494 Cluster: BCA Gs Glr Ga Gc Gf Gsm Gv
Hyperactivity
Disorders, Mdn: 95 90 93 94 96 96 97 100
Mixed SD: 16 17 14 14 16 15 17 15
BrainTumors, 32 Cluster: BCA Gs Gc Glr Gsm Ga Gf Gv
Mixed Mdn: 90 90 92 93 94 94 96 97
SD: 15 20 17 12 14 11 14 16
DepressiveSpectrum 150 Cluster: BCA Gs Gc Gf Gsm Glr Gc Gv
Disorder Mdn: 95 92 94 96 96 97 98 100
SD: 16 18 13 14 17 14 17 15
Impulsive/ Disruptive 73 Cluster: BCA Gs Gc Gf Ga Gsm Glr Gv
SpectrumDisorders Mdn: 87 86 87 91 90 92 94 98
SD: 16 19 14 16 14 17 14 17
LanguageDisorders 48 Cluster: BCA Gsm Gc Ga Gs Gf Glr Gv
Mdn: 78 81 82 82 84 86 88 100
SD: 15 14 16 11 15 17 15 14
LearningDisorders, 484 Cluster: BCA Gs Glr Gc Ga Gf Gsm Gv
Mixed Mdn: 88 86 89 91 92 93 93 98
SD: 15 17 14 16 14 15 17 16
Mental Retardation, 81 Cluster: BCA Gc Gf Gs Gsm Ga Glr Gv
MildtoProfound Mdn: 56 62 66 68 71 74 75 80
SD: 13 12 13 16 13 13 15 17
Motor Impairment 52 Cluster: BCA Gs Glr Ga Gf Gv Gsm Gc
Mdn: 93 90 90 95 96 96 101 102
SD: 17 16 18 13 16 18 20 18
Key to cluster abbreviations: BCA=Broad Cognitive Ability; Gsm=Short-Term Memory;
Gs=Processing Speed; Glr=Long-TermRetrieval; Gv=Visual Processing; Gc=Comprehen-
sionKnowledge; Ga=Auditory Processing; Gf=Fluid Reasoning; Mdn=median; SD=stan-
darddeviation.
Table 3.10. GfGc composites available in eight cognitive batteries
1
Cognitivebattery
GfGc WJR CAS DAS K-ABC KAIT SBIV WAISIII WISCIII
ability (1989) (1997) (1990) (1983) (1993) (1986) (1997) (1991)
Gsm Short-Term
Memory
Successive Sequential
Processing
Short-Term
Memory
(primarily
Gsm, someGv)
Working
Memory
(primarilyGsm,
someGq)
Gs Processing
Speed
Planning
Attention
Processing
Speed
Processing
Speed
Gc Comprehen-
sion
Knowledge
Verbal Ability Crystallized
Scale
(primarilyGc,
someGrw)
Verbal
Reasoning
Verbal
Comprehen-
sion
Verbal
Comprehen-
sion
Gv Visual
Processing
Spatial Ability Simultaneous
Processing
(primarilyGv,
someGf)
Abstract/
Visual
Reasoning
(primarilyGv,
someGf)
Perceptual
Organization
(primarilyGv,
someGf)
Perceptual
Organization
(primarilyGv,
someGc)
Ga Auditory
Processing

Glr Long-Term
Retrieval

Gf Fluid
Reasoning
Nonverbal
Reasoning
Ability
Quantitative
Reasoning
(primarilyGf,
someGq)

Compositesnot includedaboveduetomixtureof GfGcabilitiesthat impact diagnosticutility
Simultaneous
(mixedGvand
Gf)
FluidScale
(mixedGv,
Glr, andGf)
Freedomfrom
Distractibility
(mixedGqand
Gsm)
1
Basedinpart oninformationfromKeith(1997); McGrew&Flanagan(1998); andWoodcock(1990).
WJR, WoodcockJohnsonTestsof CognitiveAbilityRevised; CAS, DasNaglieri CognitiveAssessment System; DAS, Differential AbilityScales; K-ABC,
Kaufman Assessment Battery for Children; KAIT, Kaufman Adult IntelligenceTest; SBIV, StanfordBinet, Fourth Edition; WAISIII, Wechsler Adult
IntelligenceScale, ThirdEdition; WISC-III, Wechsler IntelligenceScalefor Children, ThirdEdition.
Table 3.11. Discrepancy data for Jon
Intracognitivediscrepancies Actual Predicted PR
1
SD
2
SS SS diff
Long-TermRetrieval (Glr) 59 100 0.1 3.33
Short-TermMemory(Gsm) 104 92 82 0.92
ProcessingSpeed(Gs) 81 97 12 1.18
AuditoryProcessing(Ga) 99 93 69 0.49
Visual Processing(Gv) 100 95 64 0.37
ComprehensionKnowledge(Gc) 99 91 76 0.71
FluidReasoning(Gf) 120 87 99.7 2.80
1
DiscrepancyPercentileRank(PR): thisscorerepresentsthepercentageof thepopulationthat
hasactual factor abilitythesameor lower, giventhepredictedfactor ability.
2
Diff: thedifferencebetweenthesubjectsactual andpredictedstandardscoresinunitsof the
standarderror of estimate, theappropriatestandarddeviationstatisticfor thisapplication.
SS, standardscore.
commented that after he added the ve numbers, he would double the
resultingsum. Jonrstattemptedtosequencecountbysevens. After becoming
confusedtwice, hecrossedout thesenumbersandattemptedanewstrategy.
Analysisof hissolutionto thisproblemillustratessystematicapplicationof a
strategybut poor retrieval of number facts.
Figure3.4illustratesseveral of JonsresponsesfromtheWJRACHWriting
Samplestests. Bothspellingandvisualmotor difcultiesmaybeobserved. Jon
commentedthatsometimeswhenheiswriting,heforgetswhetherornothehas
already startedaword. Fromtheassessment results, aswell as theinformal
observations,Jonappearstobeastudentwithaveragetoabove-averagelanguage
comprehension(Oral Languagestandardscore=115),above-averagereasoning
abilities, but difcultywithtasksinvolvingrotelearning, suchasmultiplication
factsandspelling.Hisdifcultywithschool tasksrequiringrotelearningappears
toberelatedtohispoor performanceonassociational learningtests.
Dan
Table 3.12 presents intracognitive discrepancy data for Dan, a beginning
ninth-grade student. Dan had received learning disability services in a self-
contained classroomsince second grade. Upon transferring to a new high
school, Dan was re-evaluated and determined to be ineligible for learning
disabilityservicesbecausehenolonger showedasignicant aptitudeachieve-
Fig. 3.3. JonsresponsetoAppliedProblems, FormA, Item41.
ment discrepancy between his Full Scale WISCIII score and his WJR
Achievement cluster scores.
Thenatureandseverityof Dansproblemwithtasksinvolvingphonological
processingbecomeapparent whenanalyzingWJRintracognitivediscrepancy
data. WhentheAuditoryProcessingfactor (IncompleteWords, SoundBlend-
ing)iscomparedtohisaverageperformanceontheother sixfactors, only1out
of 1000 students would obtain a score as low or lower. Dans decit in
phonological processing has interfered with his development and progress
in both word pronunciation and spelling. Not surprisingly, Dan has failed
Fig. 3.4. JonsresponsesontheWritingSampleTest, FormA.
IntroductorySpanishtwice. WiseandOlson(1991) provideathoroughreview
of research that suggests that phonological coding skills are the strongest
predictorandcorrelateof readingdisabilities, thattheyareuniquelydecientin
most readerswithdisabilities, andthat thedecit ishighlyheritable.
Although the cases of Jon and Dan are unusual in the severity of the
impairment, analysis of their patterns of scores on the WJR COG yields
informationfor bothdiagnosticandinstructional purposes. Aswiththeinter-
pretation of any intra-individual differences, a practitioner would want to
corroborate these ndings with other data sources (McGrew & Flanagan,
1998).
Table 3.12. Discrepancy data for Dan
Intracognitivediscrepancies Actual Predicted PR
1
SD
2
SS SS diff
Long-TermRetrieval (Glr) 98 91 72 0.59
Short-TermMemory(Gsm) 91 93 44 0.16
ProcessingSpeed(Gs) 109 91 92 1.38
AuditoryProcessing(Ga) 54 100 0.1 3.54
Visual Processing(Gv) 109 91 92 1.38
ComprehensionKnowledge(Gc) 101 90 85 1.03
FluidReasoning(Gf) 95 92 60 0.24
For explanationsof abbreviations, seeTable3.11.
Brief description of the new WJ III COG
The WJ III COG (Woodcock, McGrew, & Mather, 2001) will be a revised
versionof theWJRTestsof CognitiveAbilities(Woodcock&Johnson, 1989).
Althoughmanyof thebasicfeatureshavebeenretained, theextensiverenorm-
ing, aswell asseveral newtests, clusters, andinterpretiveprocedures, improve
andincreaseitsdiagnosticpowerasatool for assessinglearningdisabilities.The
WJ III COGorganizational format andinterpretiveplanhavebeenmodiedto
increaseboththebreadthanddepthof coverage.
AlthoughtheWJ III issimilarinmanyrespects, thecognitivefactorstructure
hasimprovedconstruct validity, withseveral newteststoensurethat eachtest
in a cluster measures a qualitatively different narrow aspect of the broader
ability. Other newtestsweredesignedto better measureimportant informa-
tion-processingabilities, suchasworkingmemory, planning, cognitiveuency,
andattention,all ofwhicharerelevanttotheassessmentoflearningdisabilities.
Table3.13depictsthetests includedin theWJ III COG, as well as thenew
organizational format. Table3.14providesabrief descriptionof thenewtests.
Theproceduresfor evaluatingaptitude/ achievement aswell asintra-ability
discrepancieshavebeenexpanded. Inadditiontotheformer intracognitiveand
intra-achievement procedures, a new intra-individual discrepancy procedure
will have particular relevance to the assessment and diagnosis of learning
disabilities. Thisprocedurewill allowtheevaluator toexaminesimultaneously
anindividualsstrengthsandweaknessesacross30clusters, bothcognitiveand
academic. Onenewability/ achievement discrepancyprocedurewill beavail-
ablein which Oral Languagemay beusedas themeasureof aptitude. This
Table 3.13. WJ III COG organization
Test Standardbattery Extendedbattery
Verbal ability
Verbal
ComprehensionKnowledge
(Gc) 1. Verbal Comprehension 11. General Information
Thinkingabilities
Long-TermRetrieval (Glr) 2. VisualAuditoryLearning 12. Retrieval Fluency
Visual Processing(Gv) 3. Spatial Relations 13. PictureRecognition
AuditoryProcessing(Ga) 4. SoundBlending 14. AuditoryAttention
FluidReasoning(Gf) 5. Concept Formation 15. AnalysisSynthesis
Cognitiveefciency
ProcessingSpeed(Gs) 6. Visual Matching 16. DecisionSpeed
Short-TermMemory(Gsm) 7. NumbersReversed 17. Memoryfor Words
Supplemental (Ga, Gs, Gsm, Gf,
Glr)
8. IncompleteWords 18. RapidPictureNaming
9. AuditoryWorking
Memory
19. Planning
10. VisualAuditory
LearningDelayed
20. Pair Cancellation
ability/ achievement procedure may have particular relevance for helping
clinicians to distinguish between individuals with adequate oral language
capabilities, but poor readingandwritingabilities(i.e., specicreadingdisabili-
ties), versusindividualswhoseoral languageabilitiesarecommensuratewith
readingandwritingperformance. Intherst case, interventionwouldfocuson
readingandwritingdevelopment; in thesecondcase, interventionwouldbe
directedtoall aspectsof language.
Conclusion
In most instances, a child is referred for a learning disability or a neuro-
psychological assessment becauseinsufcient informationisknownabout that
childinorder todevelopatreatment plan(Rourkeet al., 1983). Whenusedin
conjunctionwith other assessments, interviews, andobservations, theWJR
andtheBater aRareuseful toolsfor helpingpractitionersdeterminethetype
andseverityof alearningdisability.
Table 3.14. Description of the new tests in the WJ III COG
Test Description
Test 1: Verbal
Comprehension(Gc)
Measuresverbal abilitythroughfour tasks: therst requires
namingpicturedobjects, thesecondrequiresproviding
synonyms, thethirdrequiresprovidingantonyms, andthe
fourthrequiresprovidinganalogies
Test 8: AuditoryWorking
Memory(Gsm)
Measuresaspectsof short-termauditorymemoryspanand
workingmemory: thetaskinvolvesretainingtwotypesof
information(wordsandnumbers) that arepresentedorally
inaspeciedrandomorder andthenreorderingthat
informationsequentially
Test 12: Retrieval Fluency
(Glr)
Measuresanaspect of ideational uency: thetaskmeasures
theabilitytolist orallyasmanyitemsaspossibleineachof
threecategories(thingstoeat or drink, rst namesof people,
andanimals) in1minute
Test 14: AuditoryAttention
(Ga)
Measuresanaspect of auditorydiscrimination: thetask
measurestheabilitytodifferentiateamongsimilar-sounding
wordswithincreasinglevelsof backgroundnoise(recorded)
Test 16: DecisionSpeed
(Gs)
Measuresanaspect of conceptual reasoningspeed: thetask
measurestheabilitytoscanarowof picturesandthencircle
thetwodrawingsthat aremost related
Test 18: RapidPicture
Naming(Gs)
Measuresaspectsof lexical retrieval anduency: thetask
requiresthesubject tonamecommonobjectsrapidly
Test 19: Planning(Gv, Gf) Measuresanaspect of spatial scanningandplanning: thetask
requiresthesubject touseforwardthinkingbyplanninga
tracingroutethat coversasmanysegmentsof avisual
patternaspossiblewithout retracingor liftingthepencil
Test 20: Pair Cancellation
(Gs)
Measuresanaspect of sustainedattention: thetaskmeasures
theabilitytoscanandcirclearepeatedpatterninseveral
rowsof pictures
When conductingan assessment of learningdisabilities, it isimportant to
keep several factors in mind. The focus of the evaluation should be on
determininghow, or if, speciccognitiveimpairmentsareaffectingschool or
vocational performance. Individualswithlearningdisabilitiesdonot displaya
single, unitarypatternof neuropsychological assetsanddecits(Rourke, 1994).
Inaddition, whenconsideringacomprehensiveassessment of learningdisabili-
ties, it isimportant tointegrateaperspectiveof learningdisabilitiesasdiscrete
processing decits into broader paradigms that recognize that learning
disabilitiesareheterogeneous, developmental, andcompriseamultiplicityof
interacting characteristics (Meltzer, 1994).When evaluated with diagnostic
informationfromother sources, informationfrompsychological assessments
can contribute to an understanding of etiology, as well as to the design of
effectiveinstructional programs.
Individualswithlearningdisabilitiesvarysignicantlyinregardtolinguistic
andcognitivecharacteristics. Teststhat provideonlyafewbroad-basedscores
ignore the signicant research advances made over the last decade (Share,
McGee, & Silva, 1991). Current notions of intelligence focus on multiple
abilitieswhereeachtypeof intelligencerepresentsspecicabilitiesor process-
ingcapacitiesthatarerelatedtosolvingdifferenttypesof problems(Fletcher et
al., 1998). In order to assessthesespecicabilitiesor processingcapacities, a
clinicianshoulduseabatterythat addressesthesefactorsor movetothemore
complexalternativeof cross-batteryassessment.
REFERENCES
Adelman, H.S. (1992). LD: thenext 25years. Journal of LearningDisabilities, 25, 1722.
Barkley, R.A. (1994). The assessment of attention in children. In Frames of Referencefor the
Assessmentof LearningDisabilities: NewViewsonMeasurementIssues, ed. G.R. Lyon, pp. 69102.
Bateman, B. (1992). Learningdisabilities: thechanginglandscape. Journal of LearningDisabilities,
25, 2936.
Carroll, J.B. (1993). Human CognitiveAbilities: A Survey of Factor-Analytic Studies. Cambridge:
CambridgeUniversityPress.
Carroll, J.B. (1998). Humancognitiveabilities: acritique. InHumanCognitiveAbilitiesinTheory
andPractice, ed. J.J. McArdle&R.W. Woodcock, pp. 523. Mahwah, NJ: Erlbaum.
Cattell, R.B. (1941). Sometheoretical issuesinadult intelligencetesting. Psychological Bulletin, 38,
592.
Cuenin, L.H. (1990). Useof theWoodcockJohnsonPsycho-Educational Batterywithlearning
disabledadults. LearningDisabilitiesFocus, 5, 11923.
Dalke, C. (1988). WoodcockJohnsonPsycho-Educational test battery proles: acomparative
studyof collegefreshmenwithandwithoutlearningdisabilities. Journal ofLearningDisabilities,
21, 56770.
Dean,R.S. &Woodcock,R.W. (1999). TheWJ-RandtheBater a-RinNeuropsychological Assessment,
ResearchReport Number 3. Itasca, IL: Riverside.
Fletcher, J.M., Francis, D.J., Rourke, B.P., Shaywitz, S.E., &Shaywitz, B.E. (1993). Classication
of learningdisabilities: relationshipswith other childhooddisorders. In Better Understanding
LearningDisabilities: NewViews fromResearch and their Implications for Education and Public
Policies, ed. G.R. Lyon, D.B. Gray, J.F. Kavanagh, & N.A. Krasnegor, pp. 2755. Baltimore,
Fletcher, J.M., Francis, D.J., Shaywitz, S.E. et al. (1998). Intelligent testingandthediscrepancy
model for children with learning disabilities. LearningDisabilities Research and Practice, 13,
186203.
Fletcher, J.M., Shaywitz, B.A., &Shaywitz, S.E. (1994). Attentionasaprocessandasadisorder.
InFramesofReferencefortheAssessmentof LearningDisabilities: NewViewsonMeasurementIssues,
ed. G.R. Lyon, pp. 10316. Baltimore, MD: Paul H. Brookes.
Fletcher, J.M., Taylor, H.G., Levin, H.S., &Satz, P. (1995). Neuropsychological andintellectual
assessment of children. In ComprehensiveTextbook of Psychiatry, ed. H. Kaplan & B. Sadock,
pp. 581601. Baltimore, MD: BasicBooks, Williams&Wilkins.
Fraunheim, J.G. & Heckerl, J.B. (1983). A longitudinal studyof psychological andachievement
test performanceinseveredyslexicadults. Journal of LearningDisabilities, 16, 33946.
Gough, P. &Tunmer, W. (1986). Decoding, reading, andreadingdisability. Remedial andSpecial
Education, 7, 610.
Horn, J.L. (1965). Fluidandcrystallizedintelligence. Unpublisheddoctoral dissertation, Univer-
sityof Illinois, Urbana-Champaign.
Horn, J.L. (1991). Measurement of intellectual capabilities: a review of theory. In WJR
Technical Manual, ed. K.S. McGrew, J.K. Werder, &R.W. Woodcock, pp. 267300. Itasca, IL:
Riverside.
Horn, J.L. & Noll, J. (1997). Human cognitive capabilities: GfGc theory. In Contemporary
Intellectual Assessment: Theories, Tests, and Issues, ed. D.P. Flanagan, J.L. Genshaft, & P.L.
Harrison, pp. 5391. NewYork: Guilford.
Keith, T.Z. (1997). Using conrmatory factor analysis to aid in understanding theconstructs
measuredbyintelligencetests. InContemporaryIntellectual Assessment:Theories, Tests, andIssues,
ed. D.P. Flanagan, J.L. Genshaft, &P.L. Harrison, pp. 373402. NewYork: Guilford.
Kirk, S.A. (1978). AninterviewwithSamuel Kirk. AcademicTherapy, 13, 61720.
Lewis, R. (1990). Educational assessment of learningdisabilities: anewgenerationof achieve-
ment measures. LearningDisabilities: AMultidisciplinaryJournal, 1(2), 4955.
Marshall, R.M., Schafer, V.A., ODonnell, L., Elliott, J., & Handwerk, M.L. (1999). Arithmetic
disabilitiesandADDsubtypes: implicationsfor theDSM-IV. Journal of LearningDisabilities, 32,
23947.
Mather, N. (1993). Critical issues in the assessment of learning disabilities addressed by the
WoodcockJohnsonPsycho-Educational BatteryRevised. Journal of Psychoeducational Assess-
ment. Monograph Series: Advances in psychoeducational assessment: WoodcockJohnson
Psycho-Educational BatteryRevised, pp. 10322.
Mather, N. &Healey, W.C. (1990). Deposingaptitudeachievement discrepancyastheimperial
criterionfor learningdisabilities. LearningDisabilities: AMultidisciplinaryJournal, 1, 408.
McGrew, K.S. (1993). TherelationshipbetweentheWJRGfGccognitiveclustersandreading
achievement across the lifespan. Journal of Psychoeducational Assessment. Monograph Series:
Advancesinpsychoeducational assessment:WoodcockJohnsonPsycho-Educational Battery
Revised, pp. 3953.
McGrew, K.S. (1994). Clinical Interpretation of theWoodcockJohnson Tests of CognitiveAbility
Revised. Boston: AllynandBacon.
McGrew, K.S. & Flanagan, D.P. (1998). The Intelligence Test Desk Reference (ITDR): GfGc
Cross-BatteryAssessment. Boston: AllynandBacon.
McGrew, K.S. & Hessler, G.L. (1995). The relationship between the WJR GfGc cognitive
clustersandmathematicsachievement acrossthelife-span. Journal of Psychoeducational Assess-
ment, 13, 2138.
McGrew, K.S., Werder, J.K., & Woodcock, R.W. (1989). WJR Technical Manual. Itasca, IL:
Riverside.
Meltzer, L.J. (1991). Problem-solvingstrategiesandacademicperformanceinlearningdisabled
students: dosubtypesexist?InSubtypesof LearningDisabilities, ed. L.V. Feagans, F.J. Short, &
L.J. Meltzer, pp. 16388. Hillsdale, NJ: LawrenceErlbaumAssociates.
Meltzer, L.J. (1994). Assessment of learningdisabilities: the challenge of evaluating cognitive
strategiesandprocessesunderlyinglearning. InFramesofReferencefortheAssessmentofLearning
Disabilities: NewViewsonMeasurement Issues, ed. G.R. Lyon, pp. 571606. Baltimore: Paul H.
Brookes.
Morris, R. (1993). Issuesinempirical versusclinical identicationof learningdisabilities. InBetter
UnderstandingLearningDisabilities: NewViewsfromResearchandtheir Implicationsfor Education
andPublicPolicies, ed. G.R. Lyon, D.B. Gray, J.F. Kavanagh, & N.A. Krasnegor, pp. 7393.
ODonnell, J.P. (1991). Neuropsychological assessment of learning-disabled adolescents and
young adults. In Neuropsychological Foundations of Learning Disabilities: A Handbook of
Issues, Methods, andPractice, ed. J.E. Obrzut &G.W. Hynd, pp. 33153. SanDiego: Academic
Press.
Orton, S.T. (1925). Word-blindnessin school children. Archivesof NeurologyandPsychiatry, 14,
581615.
Ostertag, B.A. & Baker, R.E. (1984). A Follow-up of Learning Disabled Programs in California
CommunityColleges. Sacramento, CA: CommunityCollegeChancellorsOfce.
Read, C. & Ruyter, L. (1985). Readingandspellingskillsinadultsof lowliteracy. Remedial and
Special Education, 6(6), 4352.
Reschly, D.J. (1990). Found: our intelligences: what do theymean?Journal of Psychoeducational
Assessment, 8, 25967.
Rourke, B.P. (1994). Neuropsychological assessment of children with learning disabilities. In
FramesofReferencefortheAssessmentofLearningDisabilities:NewViewsonMeasurementIssues, ed.
G.R. Lyon, pp. 475514. Baltimore, MD: Paul H. Brookes.
Rourke, B.P., Bakker, D.J., Fisk, J.L., &Strang, J.D. (1983). ChildNeuropsychology: AnIntroduction
toTheory, Research, andClinical Practice. NewYork: Guilford.
Scarborough, H.S. (1991). Antecedentsto readingdisability: preschool languagedevelopment
andliteracyexperiencesof childrenfromdyslexicfamilies. InReadingDisabilities: Geneticand
Neurological Inuences, ed. B.F. Pennington, pp. 3145. Dordrecht: Kluwer.
Schrank, F.A. & Woodcock, R.W. (1997). Woodcock Scoring& InterpretiveProgram. Itasca, IL:
Riverside.
Senf, G.M. (1978). Implicationsof thenal proceduresfor evaluatingspeciclearningdisabilities.
Journal of LearningDisabilities, 11, 1113.
Share, D.L., McGee, R., &Silva, P.A. (1991). Theauthorsreply. Journal oftheAmericanAcademyof
ChildandAdolescent Psychiatry, 30, 697.
Stanovich, K.E. (1988). Explainingthedifferencesbetweenthedyslexicandthegarden-variety
poor reader: thephonological-core-variable-differencemodel. Journal of LearningDisabilities,
21, 590604, 612.
Stanovich, K.E. (1991a). Conceptual and empirical problems with discrepancy denitions of
readingdisability. LearningDisabilityQuarterly, 14, 26980.
Stanovich, K. (1991b). Discrepancydenitionsof readingdisability: hasintelligenceledusastray?
ReadingResearchQuarterly, 26, 729.
Swanson, H.L. (1991). Operational denitions and learningdisabilities: an overview. Learning
DisabilityQuarterly, 14, 24254.
Torgesen, J.K. (1979). What shall we do with psychological processes? Journal of Learning
Torgesen,J.K. (1986). Learningdisabilitiestheory:itscurrentstateandfutureprospects. Journal of
Wise, B.W. &Olson, R.K. (1991). Remediatingreadingdisabilities. InNeuropsychological Founda-
tionsof LearningDisabilities: AHandbookof Issues, Methods, andPractice, ed. J.E. Obrzut &G.W.
Hynd, pp. 63158. SanDiego, CA: AcademicPress.
Woodcock, R.W. (1984). A responseto somequestionsraisedabout theWoodcockJohnson.
School PsychologyReview, 13, 35562.
Woodcock, R.W. (1990). Theoretical foundations of the WJ-R measures of cognitiveability.
Journal of Psychoeducational Assessment, 8, 23158.
Woodcock, R.W. (1993). Aninformationprocessingviewof GfGctheory. Journal ofPsychoeduca-
tional Assessment. MonographSeries: Advancesinpsychoeducational assessment: Woodcock
JohnsonPsycho-Educational BatteryRevised, pp. 80102.
Woodcock, R.W. (1997a). The WoodcockJohnson Tests of Cognitive AbilityRevised. In
ContemporaryIntellectual Assessment: Theories, Tests, andIssues, ed. D.P. Flanagan, J.L. Genshaft,
&P.L. Harrison, pp. 23046. NewYork: GuilfordPress.
Woodcock, R.W. (1997b). WoodcockDiagnosticReadingBattery. Itasca, IL: Riverside.
Woodcock, R.W. (1998a). TheWJ-R and Bater a-R in Neuropsychological Assessment, Research
Report 1. Itasca, IL: Riverside.
Woodcock, R.W. (1998b). ExtendingGfGctheoryintopractice. InHumanCognitiveAbilitiesin
TheoryandPractice, ed. J.J. McArdle&R.W. Woodcock, pp. 13756. Mahwah, NJ: Erlbaum.
Woodcock, R.W. & Johnson, M.B. (1977). WoodcockJohnsonPsycho-Educational Battery. Allen,
TX: DLM.
Woodcock, R.W. & Johnson, M.B. (1989). WoodcockJohnsonPsycho-Educational BatteryRevised.
Itasca, IL: Riverside.
Woodcock, R.W. & Mather, N. (1989). WJ-R Tests of Achievement: examiners manual. In
WoodcockJohnsonPsycho-Educational BatteryRevised, ed. R.W. Woodcock & M.B. Johnson.
Itasca, IL: Riverside.
Woodcock, R.W., McGrew, K.S., & Mather, N. (2001). WoodcockJohnson Tests of Cognitive
Abilities, III. Itasca, IL: Riverside.
Woodcock, R.W. & Munoz-Sandoval, A.F. (1996a). Bater a WoodcockMunoz: Pruebas deap-
rovechamientoRevisada. Itasca, IL: Riverside.
Woodcock, R.W. &Munoz-Sandoval, A.F. (1996b). Bater aWoodcockMunoz: Pruebasdehabilidad
cognitivaRevisada. Itasca, IL: Riverside.
Ysseldyke, J.E. (1990).Goodnessof t of theWoodcockJohnson Psycho-Educational Battery
RevisedtotheHornCattell GfGctheory. Journal of Psychoeducational Assessment, 8, 26875.
4
The Kaufman tests K-ABC and KAIT
Elizabeth O. Lichtenberger
Thischapter providesacontext inwhichtounderstandhowtwoinstruments
developedbyAlanandNadeenKaufmanmaybeutilizedinthediagnosisand
treatment of learningdisabilities. Thetheoretical underpinningsof bothof the
measures are described, as well as the process of their development and
standardization. To clarify how these instruments may be applied to the
diagnosisandtreatment of learningdisabilities, casestudiesarepresented. The
Kaufman Assessment Battery for Children (K-ABC, Kaufman & Kaufman,
1983) andtheKaufmanAdolescent andAdult IntelligenceTest (KAIT; Kauf-
man&Kaufman, 1993) arethetwofeaturedintelligencetests.
History, development, and goals of the K-ABC and KAIT
Indevelopmentof their twotestsof intelligence, theK-ABCandtheKAIT, the
Kaufmans steppedaway fromthecommon conception of intelligenceas an
overall global entity(knownasg). Bothof thebatteriesweredevelopedwith
the intention of improving upon existing individually administered tests of
intelligence. UnliketheWechsler tests, both theK-ABC and theKAIT were
developedonthebasisof neuropsychological theoriesandtheoriesof cognitive
psychology, aswell asonthebasisof availableresearch.
K-ABC theory and development
TheK-ABC isbasedon atheory of sequential andsimultaneousinformation
processing.Thistheoretical perspectivefocusesonhowchildrensolveproblems
rather thanwhat typeof problemstheymust solve(e.g., verbal or nonverbal).
An updated version of avariety of theories provides theframework for the
sequential andsimultaneousprocessingmodel that underliestheK-ABC(Kam-
phauset al., 1995). Boththeinformation-processingapproachof Luria(1966)
and the cerebral specialization theory of Sperry (1968, 1974), Bogen (1975),
Kinsbourne(1978), andWada, Clarke, andHamm(1975) providethetheoreti-
cal andexperimental foundation for thesequential and simultaneousframe-
work.
Theobservationsof thosesuchasAlexander Luria(1966, 1973) andRoger
97
Sperry(1968), coupledwiththepsychoeducational researchof J.P. Das(1973;
Das, Kirby, &Jarman, 1975, 1979; Naglieri &Das, 1988, 1990) andNadeenand
AlanKaufmanspsychometricresearch(1983) supplytheoriginsof theneuro-
psychological processingmodel. Thestrengthsof theneuropsychological pro-
cessingmodel includethefollowing: (1) it providesauniedframework for
interpretinga wide rangeof important individual difference variables; (2) it
rests on a well-researched theoretical base in clinical neuropsychology and
psychobiology; (3) it presents a processing, rather than a product-oriented,
explanation for behavior; and(4) it lends itself readily to remedial strategies
basedon relatively uncomplicatedassessment procedures(Kaufman& Kauf-
man, 1983; McCallum&Merritt, 1983; Perlman, 1986).
Individualsutilizetwo distinct typesof processes to organizeand process
information, accordingto theneuropsychological processingmodel. One of
thesetypesof processesissuccessiveor sequential andtheother typeisholistic
or simultaneousprocessing(Levy&Trevarthen, 1976; Luria, 1966). Thesetwo
processesaresimilar totheproblem-solvingstrategiesof theright hemisphere
of the brain (gestaltholistic) and the left hemisphere (analyticsequential)
(Sperry, 1968). TheseprocessesarealsorepresentedinLurias(1966) theoryas
coding processes part of theBlock2 functions.
Withall of thesetheoretical modelstakentogether, whenindividualspro-
cessinformationusingasequential or serial order, they areusingsuccessive
processing. Inprocessinginformationinthismanner, thetotal system, or the
big picture, is not available at any one point in time. In contrast, when
individualsprocessinformationbysynthesizingseparateelementsintogroups,
theyareusingsimultaneousprocessing. Usingasimultaneousmodetoprocess
information, any part of the result may be looked at individually without
dependenceonitspositioninthewhole. Anassumptionof thesetwotypesof
processingisthattheyarebothavailabletoanindividual;theyarenotmutually
exclusive. At any giventime, individualsmay usesuccessiveor simultaneous
processingdependingonthedemandsof thetaskandwhattheirhabitual mode
of processingis (Das et al., 1979). It is thought that an individuals habitual
modeof processingisdeterminedbysociocultural andgeneticfactors(Daset
al., 1979).
Inapplyingthesequential andsimultaneousprocessingmodel tothescales
of theK-ABC, simultaneousprocessingrefersto theability to mentally inte-
grateinformationall at oncetosolveaproblem. Spatial, analogic, or organiza-
tional abilities are commonly used in simultaneous processing (Kaufman &
Kaufman, 1983;Kamphaus&Reynolds, 1987). Ontasksrequiringsimultaneous
processing, there is often a visual aspect to the problem, requiring visual
98 Elizabeth O. Lichtenberger
imagerytosolveit. AK-ABCsubtestthatexempliesthesimultaneousprocess-
ingmodeis Triangles. LiketheBlock Design subtest of Wechslers tests, in
Trianglesachildmustseetheentiredesigninhisor her mindandintegratethe
individual piecestoformthewhole.
Theother mental processingscalesontheK-ABCaretheSequential Process-
ingscales. Thesescalesemphasizetheabilitytoarrangestimuli insequential or
serial order. There is alinear or temporal relationship between each of the
stimuli, which creates a formof serial interdependencewithin the stimulus
(Kaufman & Kaufman, 1983). The subtests of the K-ABC assess sequential
abilitiesviamanymodalities. For example, somesubtestsrequirevisual input
andamotor response(HandMovements), othersinvolveauditoryinput anda
vocal response (Number Recall), while others involve auditory input and a
simplemotor response(WordOrder). Becausedifferent modesof input and
output are utilized in the Sequential Processing subtests of the K-ABC, the
examiner canassesssequential abilitiesinmanydifferent ways.
Oneof thewaysinwhichtheK-ABCisdramaticallydifferent fromexisting
testsof intelligence, suchastheWechsler scales, isthat itsmental processing
subtests do not includesubtests found on theVerbal Scaleof theWISCIII
(Wechsler, 1991) or on similar testsof intelligence. Instead, an Achievement
scale of the K-ABC was developed by Kaufman and Kaufman (1983) that
includes subtests that require children to assimilate information fromtheir
cultural andschool environment. TheK-ABC therebydistinguishesproblem-
solvingtasksfromthosethat requireknowledgeandfacts. Onmanyother IQ
tests, anindividualsacquiredfactual knowledgeandappliedskillsgreatlyaffect
theobtainedIQ; however, inthedevelopment of theK-ABC, theseskillswere
kept separatefromtasksthat measureIQ(Kaufman&Kaufman, 1983).
KAIT theory and development
TheKAIT isbasedonthetheoryof HornandCattell (1966), but other theories
alsoguidedthedevelopment of theKAIT. Piagetstheoryof formal operations
(Inhelder & Piaget, 1958; Piaget, 1972) andLuriasmodel of planningability
(Luria, 1973, 1980) helpedin thedevelopment of high-level, decision-making
tasksfor adultson theKAIT. Thenotionof planningability, asdescribedby
Luria(1980), involvesdecisionmaking, evaluationof hypotheses, andexibil-
ity. Planningabilityisassociatedwiththetertiaryareasof theprefrontal region
of thebrain and represents thehighest levels of development of themam-
malianbrain (Golden, 1981, p. 285).
Theformal operationsconcept describedbyPiaget alsodepictsahypotheti-
caldeductiveabstract-reasoningsystem. Thissystemiscapableof generating
99 The Kaufman tests K-ABC and KAIT
andevaluatinghypothesesthroughthetestingof propositions. Formal oper-
ational thoughtisbelievedtoemergearoundages11to12(Piaget,1972), which
isapproximatelythesametimethattheprefrontal areasof thebrain(associated
withplanningability) mature(Golden, 1981). Thetheoriesof LuriaandPiaget
seem to converge with respect to the ability of individuals to deal with
abstraction. Thisconvergenceprovidedtherationalefor theKAITslower age
boundarybeingset at age11andfor attemptingto measuredecisionmaking
andabstract thinkingwithvirtually everytask onthetest (Kaufman& Kauf-
man, 1993).
Althoughthetheoriesof LuriaandPiaget wereinstrumental inthedevelop-
ment of manyof theKAITstasks, KaufmanandKaufman(1993) reliedonthe
HornCattell theory for organizing and interpreting their test. The Horn
Cattell model distinguishes uid fromcrystallized intelligence. Fluid intelli-
gence (Gf) refers to novel tasks that tap problem-solving and the ability to
learn. Crystallized intelligence(Gc) involves acquired skills, knowledge, and
judgmentsthat havebeensystematicallytaught or learnedthroughaccultura-
tion. Gcoftenreectscultural assimilationandisinuencedbyformal educa-
tion. Althoughtherearepurer versionsof Gf andGcinHornsexpandedand
renedversionof theHornCattell uidcrystallizedtheory(Horn, 1989;Horn
& Hofer, 1992), the KAIT does not utilize these pure abilities that are
measuredbytheexpandedandrenedHorntheory. Rather, theKAIT subtests
attempt to measure the complex nature of adult intelligence, which the
Kaufmansbelievecallsfor asmall number of clinicallyuseful scalesrather than
manyspecicscales(Kaufman&Kaufman, 1997a). Thus, intheKAIT, someof
the Crystallized subtests also have a Gf component, and some of the Fluid
subtestsalsorequirememoryprocesses(e.g., Hornsshort-termapprehension
andretrieval; SAR). Combiningsomeof theseprocessesallowsthesubteststo
measurecomplexcognitiveprocesses, rather thansimpleones.
It isimportant to notethat thecrystallizeduidconstruct split is not the
same as the verbalnonverbal split on Wechslers (1974, 1981, 1991) scales.
Although the Crystallized subtests of the KAIT seemto measure the same
ability as theWechsler Verbal IQ, theKAITsFluidIQ doesnot correspond
well to the Wechsler Performance IQ. The evidence for the dissociation
betweenscalescomesfromafactor analyticstudyusingtheWISCR, WAISR
and KAIT subtests (Kaufman & Kaufman, 1993). In asample of 118people
administeredtheKAIT andWISCR and338peopleadministeredtheKAIT
andWAISR, theexploratoryandconrmatoryfactoranalyseswereexamined.
KaufmanandKaufman(1993) reportedthat theKAIT CrystallizedandWech-
sler Verbal subtestsloadedonthesamefactor, but theKAIT Fluidsubtestsand
the Wechsler Performance subtests for the most part loaded on separate
factors. TheKAIT Memoryfor BlockDesignssubtestloadedonthePerceptual
Organizationfactor aswell astheFluidfactor, whichisunderstandablegiven
the visualspatial coordination needed for this Fluid subtest. The Wechsler
Arithmeticsubtest alsoloadedmeaningfullyontheFluidfactor, which, too, is
understandableasit emphasizesreasoning(acomponent of Gf). Thedissocia-
tionbetweentheKAIT FluidsubtestsandtheWechslerPerformancesubtestsis
not surprising given that the KAIT subtests minimize the role played by
visualspatial abilityandvisualmotor speedfor correct responding, but they
stressreasoningandverbal comprehension.
Description of the K-ABC and KAIT
Structure of the K-ABC
TheK-ABCisabatteryof testsdesignedtomeasuretheintelligenceof children
aged2
1
2
to 12
1
2
. It yieldsscoresonfour scales: Sequential Processing, Simulta-
neousProcessing, Mental ProcessingComposite(Sequential andSimultaneous
together), andAchievement. Anadditional Nonverbal Scalescorecomprisedof
portions of the Sequential and Simultaneous Processing scales may also be
obtained. Eachof thescalesyieldsastandardscorewithameanof 100anda
standard deviation of 15. The individual K-ABC subtests yield scaled scores
withameanof 10andastandarddeviationof 3. A descriptionof thesubtests
(Kaufman&Kaufman, 1983) isprovidedinTable4.1.
K-ABC psychometric properties
TheK-ABC has strongpsychometric properties(Lichtenberger, Kaufman, &
Kaufman, 1998). Split-half reliability coefcients for theK-ABC global scales
rangefrom.86to .93(mean=.90) for preschool children, andfrom.89to .97
(mean=.93)for childrenaged5to12
1
2
years(Kamphausetal., 1995). Therange
of split-half reliability coefcients for individual mental processing subtests
administeredto preschoolerswas .72to .78(mean=.80), andfor school-age
children the coefcients ranged from .71 to .85 (mean=.80). Testretest
reliability data were provided from a study of 246 children tested after a
twofour-week interval. Theresearch revealed adevelopmental trend, with
thestabilityof thetest beingstronger asthechildrengot older. Thestability
coefcientsfor theMental ProcessingCompositewere.83for childrenaged2
years6monthsto4years11months; .88for ages5yearsthrough8years; and
.93for ages9yearsthrough12years5months. OntheAchievement scale, the
Table 4.1. Description of K-ABC subtests
Mental ProcessingScale
Sequential ProcessingScale SimultaneousProcessingScale
Subtest Subtest
(Age (Age
administered) Description administered) Description
Hand
Movements
(Ages2
1
2
to12
1
2
)
Childimitatesaseriesof
handmovementsinthe
samesequencethat the
examiner performed
them
MagicWindow
(Ages2
1
2
to4)
Childidentiesapicture
that theexaminer has
exposedbypassingit
throughanarrowslit,
makingthepictureonly
partiallyvisibleat any
onetime
Number Recall
(Ages2
1
2
to12
1
2
)
Childrepeatsaseriesof
digitsinthesameorder
astheyweresaidbythe
examiner
Face
Recognition
(Ages2
1
2
to4)
Childselects, froma
groupphotograph, the
oneor twofacesthat
wereshownbrieyina
precedingphotograph
WordOrder
(Ages2
1
2
to12
1
2
)
Childtouchesaseriesof
picturesinthesame
sequenceastheywere
namedbytheexaminer,
withmoredifcult items
involvingacolor
interferencetask
Gestalt Closure
(Ages2
1
2
to12
1
2
)
Childnamesanobject or
scenepicturedina
partiallycompleted
drawing
Triangles
(Ages4to12
1
2
)
Childassemblesseveral
identical blueandyellow
trianglestomatcha
model
MatrixAnalogies
(Ages5to12
1
2
)
Childselectsthe
meaningful pictureor
abstract designwhich
best completesavisual
analogy
Spatial Memory
(Ages5to12
1
2
)
Childisrequiredtorecall
thelocationof the
placement of pictureson
apageexposedbriey
PhotoSeries
(Ages6to12
1
2
)
Childplacesphotographs
of anevent in
chronological order
Table 4.1. (cont.)
Achievement Scale
Subtest Subtest
(Age (Age
administered) Description administered) Description
Expressive
Vocabulary
(Ages2
1
2
to4)
Childnamesanobject
picturedinaphotograph
Riddles
(Ages3to12
1
2
)
Childnamesanobject or
concept describedbya
list of three
characteristics
Faces&Places
(Ages2
1
2
to12
1
2
)
Childnamesa
well-knownperson,
ctional character, or
placepicturedina
photographor drawing
Reading
Decoding
(Ages5to12
1
2
)
Childhastonameletters
andreadwords
Arithmetic
(Ages3to12
1
2
)
Childdemonstrates
knowledgeof numbers
andmathematical
conceptsthroughaseries
of questions
Reading
Understanding
(Ages7to12
1
2
)
Childisrequiredtoact
out commandsgivenina
writtensentence
testretest coefcientsfor thesameagegroupswere.95, .95, and.97, respect-
ively(Kamphauset al., 1995).
ValiditydatawereobtainedthroughmanystudiesontheK-ABC(Kaufman
&Kaufman, 1983; Kamphaus& Reynolds, 1987). TheK-ABCMental Process-
ingCompositeandtheWISCRFull ScaleIQ(Wechsler, 1974) werefoundto
correlate.70in asampleof 182normally developingchildren. In samplesof
exceptional children, theK-ABC andWISCR overall IQsarefoundto have
correlationsrangingfrom.57to.74. Withthesizable, yet not perfect, correla-
tions, theK-ABCandWISCRseemtooverlapagooddeal, butyetshowsome
independence(Kamphauset al., 1995).
Structure of the KAIT
TheKAIT isanindividuallyadministeredintelligencetest for individualsaged
11through85andolder. It providesthreeglobal IQscores: Fluid, Crystallized,
and Composite, each a standard score with a mean of 100 and a standard
deviationof 15. TheKAIT structureincludesaCoreBattery(threeCrystallized
andthreeFluidsubtests) andanExpandedBattery(includingtheCoreBattery
Table 4.2. Description of KAIT subtests
CoreBattery
Crystallizedsubtests Fluidsubtests
Denitions. Examineesworkout awordby
studyingthewordshownwithsomeof its
lettersmissingandhearingor readingaclue
about itsmeaning
RebusLearning. Examineeslearnthewordor
concept associatedwithaparticular rebus
(drawing) andthenread phrasesand
sentencescomposedof theserebuses
AuditoryComprehension. Examineeslistentoa
recordingof anewsstoryandthenanswer
literal andinferential questionsabout the
story
Logical Steps. Examineesattendtological
premisespresentedbothvisuallyandaurally,
andthenrespondtoaquestionbymaking
useof thelogical premises
DoubleMeanings. Examineesstudytwosetsof
wordcluesandthenthinkof awordwith
twomeaningsthat relatescloselytobothsets
of clues
MysteryCodes. Examineesstudythe
identifyingcluesassociatedwithaset of
pictorial stimuli andthengureout thecode
for anovel pictorial stimulus
ExpandedBattery
AuditoryDelayedRecall. Examineesanswer lit-
eral and inferential questions about news
stories that they heard approximately 25mi-
nutesearlier duringAuditoryComprehension
RebusDelayedRecall. Examineesread phrases
and sentences composed of rebuses they
learnedabout 45minutesearlier duringRebus
Learning
FamousFaces. Examineesnamepeopleof cur-
rent or historical fame, basedontheir photo-
graphsandaverbal clueaboutthem(alternate
Crystallizedsubtest)
Memory for Block Designs. Examinees study a
printedabstract designthat isexposedbriey,
andthencopythedesignfrommemoryusing
sixyellowandblackwoodenblocksandatray
Supplemental subtest
Mental Status. Examineesanswer simplequestionsthat assessattentionandorientation to the
world
plus two supplementary subtests, and two measures of delayed recall). An
eleventh subtest, Mental Status, may also be administered, but it does not
contributeto thecalculation of theIQ. Each of thesubtests, except Mental
Status, yieldsanage-scaledscorewithameanof 10andastandarddeviationof
3. Table4.2providesadescriptionof eachof theKAIT subtests.
KAIT psychometric properties
Like the K-ABC, the KAIT has strong psychometric properties. The mean
split-half reliabilitycoefcientsfor theCrystallized, Fluid, andCompositeIQs
were.95, .95, and.97, respectively(Kaufman& Kaufman, 1993). For theten
Table 4.3. Oblimin factor loadings of KAIT subtests on Crystallized and Fluid factors for
the total standardization sample
KAIT subtest Crystallized Fluid
CrystallizedScale
Denitions .80 .07
AuditoryComprehension .69 .15
DoubleMeanings .69 .15
FamousFaces .84 .11
FluidScale
RebusLearning .23 .55
Logical Steps .13 .66
MysteryCodes .05 .71
Memoryfor BlockDesigns .09 .76
Source: Kaufman&Kaufman(1993, Table8.8).
Note. Loadingsof .50or greater areshowninbold.
individual subtests, themeansplit-half reliabilitycoefcientsrangedfrom.71
on Auditory DelayedRecall to .93on RebusLearning(median=.90). Mean
testretest reliabilitycoefcients, basedon153identiednormal individualsin
threeagegroups(1119, 2054, and5585+years), retestedafter aone-month
interval, were.94for CrystallizedIQ, .87for FluidIQ, and.94for Composite
IQ. Mean testretest reliability valuesfor each of theten individual subtests
ranged from .63 on Auditory Delayed Recall to .95 on Denitions (me-
dian=.78).
Theconstruct validityof theCrystallizedandFluidscaleswassupportedby
exploratoryandconrmatoryfactor analysis. Two-factorsolutionswereidenti-
edforthetotal standardizationsampleaswell asfor separategroupsofwhites,
AfricanAmericans,andHispanics,andmalesandfemales(Gonzalesetal., 1995;
Kaufman, McLean, & Kaufman, 1995). Table 4.3 shows the oblique factor
solutionfor thetotal standardizationsample(n=2000).
Theconstruct validity of theKAIT was further demonstratedthrough its
correlationswithothermeasuresof adolescentandadultintelligence(Kaufman
&Kaufman, 1993). Infour samplesbetweentheagesof 16and19, 20and34, 35
and49, and50and83, theCompositeIQof theKAIT correlatedfrom.83to.88
with the Full Scale IQ of the Wechsler Adult Intelligence ScaleRevised
(WAISR; Wechsler, 1981). Inasampleof 79adolescentsandadults, theKAIT
Composite IQ was found to correlate .87 with the Stanford BinetFourth
Edition(SBIV; Thorndike, Hagen, &Sattler, 1986). Inasampleof 124normal
1112 year olds, the KAIT composite was found to correlate .66 with the
K-ABC Mental Processing Composite, but showed a stronger correlation
(r=.82) withtheK-ABCAchievement Scale(Kaufman&Kaufman, 1993).
K-ABC standardization
TheK-ABCwasstandardizedonasampleof 2000children, stratiedtomatch
the1980UScensusdataaccordingtogender, age, geographicregion, commu-
nitysize, socioeconomicstatus, raceor ethnicgroup, parental occupationand
education, and educational placement of the child. The sample included a
number of children(proportionatewiththenumber inthegeneral population)
with speech impairment, learning disabilities, mental retardation, emotional
disturbance, and gifted and talented capabilities. Each six-month age group
betweentheagesof 2
1
2
and12
1
2
inthestandardizationsamplewascomprisedof
100children(50femaleand50male). Inadditionto thesechildren, 496black
children and 119 white children were tested for the sociocultural norming
programthat was usedto developsociocultural normsby raceandparental
educational level.
Developmental trends on the K-ABC
Somedevelopmental trendswerenotedintheK-ABCstandardizationdata. As
mentioned above in the Normative and Developmental Issues section, the
preschool children tended to haveless stablescores on theK-ABC than the
school-agechildren. However, thistrendisconsistentwiththeknownvariabil-
ity over timethat characterizespreschool childrensstandardizationtest per-
formanceingeneral (Kamphaus& Reynolds, 1987). Another differenceinthe
scales as development progresses has to do with the factor structure. In
evaluatingthefactor structureof theK-ABC, KaufmanandKamphaus(1984)
concludedthat theK-ABC producesonlytwo meaningful factorsat agestwo
andthree, withthethird(achievement)factor beginningtoemergeat agefour.
Itappearsthattheachievementfactor becomesevenmoredistinctshortlyafter
theonset of formal schooling.
AnalysesoftheK-ABCdatafrompreschool childrenbetweentheagesof two
andahalf andveyearsshowsequential andsimultaneousfactorswhen all
mental processingandachievement subtestsarefactor analyzed. TheSequen-
tial andSimultaneousProcessingsubtestsshowthehighest loadingsonthese
factors, andeven when athirdfactor isextractedfor agesfour andve, the
sequential and simultaneous dimensions remain robust (Kaufman & Kam-
phaus, 1984). At agesfour andve, theK-ABC Achievement subtestshavean
average loading above 0.50 on the achievement factor, and in school-age
children the achievement factor is even more robust. Thus, the three-scale
structureof theK-ABCiswell supportedfor childrenwhohavereachedtheir
fourthbirthday(Lichtenberger & Kaufman, 2000). For childrenyounger than
agefour, thefollowingachievement subtestsarebest interpretedasmeasures
of simultaneous processing: Expressive Vocabulary, Faces and Places, and
Riddles. However, theArithmetic subtest may beinterpreted primarily as a
sequential subtest.
SpecicK-ABC subtestswerealsonotedtobeapparentlymeasuringdiffer-
ent modesof processingat different developmental stages. For example, for
childrenagedfour andyounger, theHandMovementssubtest wasapotent
measureof Sequential Processing, but for children aged veandabove, this
subtest also had adecidedSimultaneous component (Kaufman & Kaufman,
1983). It washypothesizedthat theprocessingdemandsrequiredfor thelonger
seriesof handmovementsweredifferent fromthoserequiredfor theshorter
series.
KAIT standardization
TheKAIT normativesamplewas comprised of 2000adolescents and adults
betweentheagesof 11and94years. Thesamplewasstratiedtomatch1988
UScensusdataonthevariablesof gender, geographicregion, socioeconomic
status, and race or ethnic group. For the socioeconomic variable, parental
educationwasusedfor subjectsaged11to24andself-educationwasusedfor
thoseaged24to94. Between100and250subjectsweretestedat eachagelevel
of thesample. ThesamplematchedUScensusdatawell on thevariablesof
race, gender, andeducational attainment. Thematchesfor geographicregion
were close for the North Central and South regions, but the sample was
underrepresentedintheNortheast andoverrepresentedintheWest (Kaufman
&Kaufman, 1993).
Developmental trends on the KAIT
Crystallizedabilitieshavebeennotedtobefairlywell maintainedthroughout
thelifespan, but uidabilitiesarenot asstable, peakinginadolescenceor early
adulthoodbeforedroppingsteadilythroughthelifespan(Horn, 1989;Kaufman,
1990; Kaufman & Lichtenberger, 1999). To analyze age trends in the KAIT
standardization data, a separate set of all-adult norms was developed to
providethemeansbywhichtocompareperformanceontheKAIT subtestsand
Fig. 4.1. CrystallizedandFluidIQacrosstheagespanontheKAIT (Kaufman&Kaufman, 1993,
Fig. 8.3).
IQscales(Kaufman&Kaufman, 1993). Datafrom1500individualsbetweenthe
agesof 17and85+weremergedto createtheall-adult norms. TheIQsfrom
thisnewall-adultnormativegroupwerealsoadjustedfor yearsof education, so
that thiswouldnot beaconfoundingvariableinanalyses.
Analysesof theCrystallizedandFluidscalesacrossages17to85+produced
resultsthat generallyconformedto thosereportedinpreviousinvestigations.
AsshowninFig. 4.1, thecrystallizedabilitiesgenerallyincreasethroughage50,
but do not dropnoticeably until age75andolder. Theuidabilities, on the
other hand, doappear topeakintheearly20s, thenplateaufromthemid-20s
throughthemid-50s, andnallybegintodropsteadilyafterage55(seeFig. 4.1).
Thesendingswereconsistentformalesandfemales(Kaufman&Horn, 1996).
KaufmanandKaufman(1997a)hypothesizethattheuidaspectsofsomeof the
KAIT Crystallizedsubtestsmayhavecontributedtotheacceleratedage-related
declineinscoresonthesesubtests.
Thediagnosisof alearningdisabilityrequiresassessment of bothintellectual
ability and achievement. Thus, acomprehensivebattery of tests is typically
requiredto assessadequatelyfor alearningdisability. TheK-ABC providesa
measureof both of these parts of a learning disabilities assessment battery,
whichisbenecial intheprocessof diagnosis. However, all areasof achieve-
ment ability are not tapped by the K-ABC Achievement Scale. The KAIT
providesmeasuresof cognitiveaptitude, andbeginstogiveasenseof howwell
developed an individuals base of school-learned knowledgeis (through the
Crystallized Scale), but a formal measure of achievement is not part of the
KAIT battery.
Inlight of thefact that theK-ABC lackstestsof certainachievement skills,
examiners may nd that they need to supplement the K-ABC with other
instruments that tap verbal expression and additional areas of achievement
aptitude. For example, thesubtestsof theWISCIII (Wechsler, 1991) Verbal
Scalerequiremuchmoreverbal expressionthantheK-ABC, andcanbeusedto
obtaindataabout achildsabilitiesinthisarea. Infact, theamount of verbal
expression required on the K-ABC was purposefully minimized during the
development of the instrument in order to lessen the role of language in
assessment of IQandtoprovidesimpleobjectivescoringsystems(Kaufman&
Kaufman, 1983). TheK-ABCAchievementScalealsodoesnot providesubtests
that assessareassuchaswrittenexpression, spelling, andwrittenmathematical
computation. Thus, other testsof achievement suchasthePeabodyIndividual
Achievement TestRevised (PIATR; Markwardt, 1989, 1997), the Kaufman
Test of Educational Achievement (Kaufman& Kaufman, 1985, 1997b), or the
WoodcockJohnson Tests of AchievementRevised (Woodcock & Johnson,
1989) maybeuseful supplementsto theK-ABC battery. Standardizedtestsof
achievement for adultsarenot asplentiful asthosefor children. Thus, when
assessingfor learningdisabilitiesinadults, obtainingameasureof achievement
abilities can be a bit more challenging. The WoodcockJohnson Tests of
AchievementRevised (Woodcock & Johnson, 1989) are normed through
adulthood, andtheKaufmanFunctional AcademicSkillsTest (K-FAST; Kauf-
man&Kaufman, 1994)maybeusedtomeasurethereadingandmathematical
skillsof adolescentsandadults.
Anotherareathatisnotwell coveredintheK-ABCortheKAIT thattypically
needstobemeasuredaspartof alearningdisabilityassessmentisvisualmotor
reproduction. TestssuchastheDevelopmental Test of Visual Motor Integra-
tion(VMI; Beery, 1997), theCodingsubtest of theWISCIII or WAISIII, or
informal drawingssuchasDraw-a-Persontestsmaybeusedtoobtaininforma-
tion of visualmotor skill. Additional factors that should be ruled out in
diagnosingproblemsrelatedto learningincludememory andattention. The
ChildrensMemoryScale(CMS; Cohen, 1997), theWechsler MemoryScale
Third Edition (Wechsler, 1997b), Wide Range Assessment of Memory and
Learning (WRAML; Sheslow, & Adams, 1990), the Test of Memory and
Learning(TOMAL, Reynolds& Bigler, 1994), or theWorkingMemoryIndex
of theWAISIII (Wechsler, 1997a) canbeuseful toolsin examiningmemory
andattention.
Intheprocessof diagnosis, informationmust beobtainedfrommultipletest
scoresonthevarioustestsadministered, inadditionto informationfromthe
clientsdevelopmental, medical, educational, andpsychological history. Before
interpretingthescores, examinersmust evaluateobservationsthat havebeen
madeof theclientsbehavior duringtestingandinother settings. It isonlyin
thecontext of thesebehaviorsandobtainedhistorythat thetest scorescanbe
appropriatelyinterpreted. Keepinginmindthephilosophythat multiplebitsof
datamust beusedtosupport ahypothesisisimportant. Thisphilosophyisone
that is strongly advocated by Kaufman and others (e.g., Kaufman, 1994;
Kaufman&Lichtenberger, 1999).
Althougheach childor adult with learningdisabilitieswill showaunique
patternof scoresinhisor her K-ABC or KAIT prole, therearesomegeneral
patternsthat haveappearedin theliterature. On theK-ABC, therehasbeen
mixed evidencesupportingasignicant discrepancy between theSequential
and Simultaneous Processing scales in favor of the Simultaneous Scale for
childrenwhohavebeendiagnosedwithreadingor learningdisabilities. Some
of thestudieswhichreportgroupdiscrepanciesfavoringSimultaneousProcess-
ingfor studentswith learningdisabilities includeObrzut, Obrzut, and Shaw
(1984), Kempa, Humphries, andKershner (1988), Rethazi andWilson(1988),
Smithet al. (1988), andKaufmanandKaufman(1983). However, thereisalsoa
bodyof evidencewhichhasfoundapatternof either equivalent Simultaneous
andSequential Processingor differencesinfavor of Sequential Processingfor
children with learning disabilities (Naglieri & Haddad, 1984; Klanderman,
Perney, &Kroeschell, 1985;Bain, 1993). Thereasonfor theinconsistencyinthe
literatureisnot clear. It maybedueinpart tothedifferentselectioncriteriafor
learningdisabilitiesusedinthevariousstudies. Table4.4providesasummary
of someof theresearchon children with learningdisabilitieson theK-ABC.
When interpreting the K-ABC prole of a child with a potential learning
disabilityit isimportant tokeepinmindthat theliteraturehasnot denitively
shownacertainpatternof processingtobepresent amongst all childrenwith
learningdisabilities.
OntheKAIT, prolesof individualswithlearningdisabilitieshavenot been
asheavilyresearchedor asclear cut asontheK-ABC. KaufmanandKaufman
(1993)reportedinasmall sampleof 14adolescentswithreadingdisabilitiesthat
therewereno differencesbetween this sampleand matchedcontrols. How-
ever, they did report that a trend was evident, with the Fluid Scale being
signicantlyhigher thantheCrystallizedScale.
Inastudycomparingtheperformanceof 30collegestudentswithlearning
disabilitieswith that of 30studentswithout learningdisabilitieson theKAIT
andWAISR, interestingnonsignicant differenceswerefound(Morganet al.,
1997). Theparticipantswithlearningdisabilitieshadbeenpreviouslydiagnosed
with alearning disability. Morgan and colleagues found that therewere no
differencesbetweenthelearning-disabledgroupandthegroupwithout learn-
ing disabilities on the following: WAISR Full Scale IQ, Verbal IQ, and
PerformanceIQ, andKAIT Composite,Crystallized,andFluidScale. However,
when comparing the scales of the KAIT to the scales of the WAISR, one
signicant difference was found. In both the groups (those with and those
without learningdisabilities), theWAISR PerformanceIQ was signicantly
higher than the KAIT Fluid IQ. Possible explanations for the differences
betweenthesetwoscalesinclude: (1) theKAIT hasnewer norms, and(2) the
Fluidsubtestsaremorenovel than thePerformancesubtests(Morganet al.,
1997). Because these results demonstrate that the KAIT offers comparable
resultstothoseobtainedwiththeWAISR, thenewformatof theKAIT, which
haslessemphasisonexpressivelanguage, appearstobeavaluableadditiontoa
learningdisabilitiesassessment battery.
Differential diagnosis
In making a differential diagnosis between learning disabilities and other
disorderssuch aspsychiatricdisorders, it isimportant to examinenot only a
persons scores but also clinical symptoms. In children, for example, the
behavioral manifestationof alearningdisabilitymaybeconfusedwithopposi-
tional deant disorder, conduct disorder, attention-decit hyperactivity dis-
order, or beinglazy(Culbertson&Edmonds, 1996). Becauseof thestrugglesin
school that children with learning disabilities have, it is not surprising that
secondary emotional difculties and adjustment problems often develop.
When symptoms of a behavioral or emotional disorder are present, it is
important to determinewhether thesymptomsareprimary or secondary to
the learning disability. Silver (1993) discusses in detail some responses that
children with learning disabilities exhibit, such as withdrawal, regression,
somaticcomplaints, paranoia, depression, clowning, or impulsiveness.
Learningdisabilitiescanbemoresubtleinadultsthaninchildren, because,
after yearsof strugglingwiththedisability, individualsoftendevelopcompen-
satorystrategies. For example, anadultwithalearningdisabilitymaybeaware
Table 4.4. Summary of research on K-ABC with students with learning disabilities
K-ABCmeanscores Other IQmeasure Achievement measure
Other V-IQor P-IQ FS-IQ
instruments Verbal Abstract or
utilized Sample n MPC Seq. Sim. Ach. Reasoning Reasoning Composite Math Reading Reference
WISCR MR 33 78 78 82 70 71 84 75 Naglieri (1985)
LD 34 96 92 100 86 93 103 97
Normal 34 109 109 107 104 106 110 108
WISCR LD
PIAT Referrals
86 96 95 97 87 94 97 95 93 91 Clarizio&Bennett
(1987)
WISCR LD
Normal
43 95 91 99 88 96 103 99
27 104 101 109 108
Rethazi &Wilson
(1988)
LD 94 81 89 79 Bain(1993)
SBIV LD 30 86 89 89 77 81 93 84 Knight, Baker, &
Minder (1990)
WISCR LD 32 80 78 85 72 77 86 80 Obrzut, Obrzut, &
Shaw(1984)
PPVT LD
Referrals
47 87 88 89 84 90
a
DMato, Gray, &
Dean(1987)
WISCR LD 198 92 91 93 87 93 96 94 Kaufman&McLean
(1986)
WISCR LD 32 94 90 98 90 94 101 97 Smithet al. (1988)
LD 35 98 96 100 94 102 99 101
Referrals
WISCR LD 44 93 92 88 92 97 94 Klanderman,
Perney, &
Kroeschell (1985)
Note. All values have been rounded to the nearest whole number. MPC=Mental Processing Composite; Seq.=Sequential Processing Scale;
Sim.=SimultaneousProcessingScale; Ach.=Achievement Scale; MR=mentallyretarded; LD=learningdisabled; WISCR=Wechsler IntelligenceScale
for ChildrenRevised; PIAT =PeabodyIndividual Achievement Test; SBIV=StanfordBinetFourthEdition; PPVT =PeabodyPictureVocabularyTest;
V-IQ=Verbal IQ; P-IQ=PerformanceIQ; FS-IQ=Full ScaleIQ.
a
ThePPVT isameasureof receptivevocabulary.
that heor sheispronetomakingnumerousspellingerrorsor confusingletters
suchasbandd, but yet whenhomeworkishandedinto acollegeprofessor,
thereareveryfewerrors. Clinically, what needstobenotedisthat theperson
has spent an inordinateamount of time with a dictionary or computerized
spell-check. The process by which he or she arrived at a nearly awlessly
spelledpaper waslaboriousandexhausting. That samepersonmaybehesitant
or dysuentinreadingor maytakeextratimebeforebeingabletorespondtoa
test item(Culbertson& Edmonds, 1996). Not onlymaytheadultsacademic
history reect poor performancein academic areas affected by the learning
disability, but testsof intellectual abilitymayalsoreect thelearningdisability.
OntestsliketheWechsler scales, theVerbal IQswouldbeexpectedtobelow;
on theK-ABC, theAchievement Scalewouldbelow; and on theKAIT, the
CrystallizedScalemaybelow. Manytestsof cognitiveabilityareconfounded
with school-learnedknowledgeto someextent, asmentionedearlier. Adults
with learning disabilities often show a history of underachievement that is
reectedintheir cognitivetest scores.
KAIT illustrative case study
Wechsler Adult Intelligence ScaleRevised (WAISR)
90%condence
Scale IQ interval Percentilerank
Verbal Scale 82 5 12
PerformanceScale 71 9 3
Full Scale 76 5 5
Age-scaledscore
Subtest Scaledscore Age-scaledscore percentilerank
Information 3 (5) 5
Digit Span 10 (11) 63
Vocabulary 5 (7) 16
Arithmetic 7 (8) 25
Comprehension 4 (5) 5
Similarities 7 (9) 37
PictureCompletion 3 (4) 2
PictureArrangement 6 (5) 5
BlockDesign 6 (6) 9
Object Assembly 3 (3) 1
Digit Symbol 9 (9) 37
Kaufman Adolescent and Adult Intelligence Test (KAIT)
Standardscore90%
Composites condenceinterval Percentilerank
FluidScale 875 20
CrystallizedScale 845 15
Total CompositeScale 854 15
Subtests Scaledscores Percentilerank
FluidScale
RebusLearning 5 5
Logical Steps 9 37
MysteryCodes 9 37
Memoryfor Block 4 2
Designs
CrystallizedScale
Denitions 7 16
Auditory 9 37
Comprehension
DoubleMeanings 5 5
FamousFaces 9 37
DelayedRecall
RebusDelayedRecall 5 5
Kaufman Functional Academic Skills Test (K-FAST)
90%condence
Subtest Standardscore interval Percentilerank
Arithmetic 81 7490 10
Reading 80 7290 9
Composite 80 7587 9
Kaufman Test of Educational Achievement (K-TEA): Comprehensive Form
Standardscore90%
condenceinterval Percentilerank
Composite
ReadingComposite 936 32
MathematicsComposite 826 12
BatteryComposite 914 27
Subtest
MathematicsApplications 758 5
ReadingDecoding 1037 58
Spelling 1108 75
ReadingComprehension 858 16
MathematicsComputation 918 27
Peabody Picture Vocabulary TestRevised (PPVTR)
Standardscore Percentilerank
PPVTR 74 4
Wechsler Individual Achievement Test (WIAT)
Subtest Standardscore Percentilerank
WrittenExpression 80 9
Developmental Test of VisualMotor Integration (VMI)
VMI 86 18
WoodcockJohnsonRevised Tests of Cognitive Ability (WJR) prole
Subtest Standardscore Percentilerank
Visual Closure 93 32
Memoryfor Names 107 68
AnalysisSynthesis 73 3
WoodcockJohnson Revised: Tests of Achievement (WJR) prole
BroadKnowledge 66 1
Science 77 6
Social Studies 75 5
Humanities 61 0.5
Reasonforreferral
LeoM. wasreferredfor assessment of learningdisabilityat theageof 17years.
Hewasreferredfor an evaluationbecauseof hisparents concern about the
presenceof apossiblelearningdisability. Hisparentsalsowantedinformation
todetermineif therewasanywaytohelpLeoget intocollege, andtosucceed
onceheentered college. Mr and Mrs M. stated that Leo has difculty with
comprehensionof written passages, processinginformationandcomingout
withanappropriateresponse, vocabulary, andself motivation. Leosparents
developedquestionsabouthisabilityandapotential learningdisabilityafter he
receivedlowscoresontheSAT examhehadrecentlytaken(Verbal 260, Math
260). Leo stated that he can remember vocabulary for a test, but cannot
remember it later. Healso statedconcern over thefact that it issometimes
difcult for himto concentratewell enough to comprehendfully what heis
reading.
Backgroundinformation
Leoistheyoungestof threechildreninhisfamily.Hecurrentlylivesalonewith
hisparents, ashistwosistersareattendingcollegeout-of-state. Mr andMrsM.
bothworkinthecomputer industry.
MrsM. reportedthat Leosprenatal andbirthhistorieswereunremarkable.
Shehadanormal, full-termpregnancy, andgavebirthtoLeothroughanormal
delivery. Leo weighed7pounds3ouncesat birthandwas19.75incheslong.
Accordingtohismother, Leosmedical historyincludeshavingtubesplacedin
hisearsat theageof 33months, dueto repeatedear infections. Healso had
chickenpoxat theageof ve, andiscurrentlyaffectedmildlybyhayfever. No
other major illnessesor injurieswerereported. Hisparentsindicatedthat he
hasaphysical examinationannuallyfor hisparticipationinschool athletics.
Withtheexceptionof hisspeechdevelopment, Mr andMrsM. reportedthat
all of Leos developmental milestones were reached within the normally
expectedtimeframe.Hesatupatage3.5months,walkedat13months,andwas
completely toilet trainedby aroundtheageof three. Leosparentsreported
that, in his early language development, his language was very indistinct.
Thus, hereceivedlanguagetherapyfromtheageof threetove. Hisparents
statedthat thelanguagedifcultywasremediatedthroughthistreatment.
Leoseducational historybeganwhenheenteredpreschool attheageof two
andahalf. Heattendedpreschool until hewasveyearsold, andhisparents
reportedthat heenjoyedit. Inrst gradeLeoparticipatedinaspecial language
programtohelphimwithvocabularyandcomprehension. Hisparentsstated
that theythought thisprogramhelpedhimbecausehetestedtoo highat the
endof theyear onatest toqualifytocontinueintheprogram.
Leo has attended his high school since ninth grade. He is currently on
summer vacation and will be beginning the twelfth grade in less than one
month. Accordingto his report card, his overall grade point averageis just
under aB, at2.79. Leoreportedthathedoesnotlikemathandscience, buthe
doeslikehistory. Thelowestgradeshehasobtainedinhighschool havebeenin
Spanish, English, Biology, andChemistry.
He is an active participant in extracurricular sports such as soccer and
basketball. Leo andhisparentsbothreport that theyhopehemaybeableto
receiveanathleticscholarshipfor college. MrandMrsM. statedthatsportstake
up much of Leos time after school. To completeall of his homework, his
parentsindicatedthat theymust helpmotivatehimor pushhimtodoit. They
statedthat heseemstodobetter whenhehasanexampleinfront of himfrom
whichtowork.
Appearanceandbehavioral characteristics
Leoisanathletic-looking17year old, of huskystature. Heisatall youngman,
withshort blondehair. Hedressedcomfortablyandappropriatelyfor eachof
theevaluation sessions, wearingshorts, aT-shirt, andtennisshoes. Leo was
responsiblefor makingappointmentsandgettinghimself toeachof hisevalu-
ationsessions. Hedemonstratedhisresponsibilitybyhisprompt arrival at the
clinicafter drivinghimself toeachof hisappointments.
Uponinitiallymeetingtheexaminer, Leodidnot seemnervousor anxious,
butwassomewhatapprehensiveaboutthetestingprocess. Hewasabitquietat
rst, but always responded to questions asked by the examiner. As rapport
developedthrough initial conversation with theexaminer, hebegan to elicit
conversation morespontaneously, and even sharedwith theexaminer what
someof hisconcernswereabout hisability. Duringthetestingitself, hewas
veryfocusedonthetaskat handandseldominitiateddialogue, unlessaskeda
questionbytheexaminer.
Leosfaceandbody wererather expressionlessduringtheevaluation. He
rarelysmiled,frowned,grinned, orgrimaced,andhesatstill inhischairwithno
excessbodymovement. Occasionally, whenhewaspresentedwithaproblem
that hethought lookeddifcult, hisinitial responsebeforeattemptingtosolve
itwas, whew or wow. Henever tookbreaksofferedtohimbytheexaminer;
hejust wantedto keep goingthrough each part of theevaluation. Leo was
sociallyappropriate, pleasantlyfriendly, andcooperative.
Leoshowedastrongabilitytoconcentrateandfocusoneachtaskpresented
tohim. Hisattentionnever drifted, evenontasksthat weresomewhat boring
for himtodo. Healsodemonstratedstaminaandpersistenceworkingontasks
that werequitechallengingfor him. For example, onataskthat requiredhim
to recreatean exampleof ageometric design with colored blocks, Leo had
difculty making the correct design, but kept on trying and attempted to
complete the design. On other tasks, if he did not know the answer to a
problemhesaid, I dont know, but wouldnot let hisinabilitytoanswer one
questioninterferewithhisattemptingthenext question.
While attempting more school-related tasks, Leo stated occasionally, I
knowthat answer, I learnedit inschool . . . I cant remember. Heappeared
momentarilyfrustrated, butthenjustcontinuedonwiththenextproblem. Leo
appearedtotryhishardestoneachitem. Whenaskedbytheexaminer whether
hisperformancewasanaccurateassessment of hisabilities, heagreedthat it
was. Becauseof hislevel of motivationtodohisbest, andhisaforementioned
behaviorsandgoodconcentration, theresultsof thisevaluationareconsidered
avalidestimateof hiscurrent cognitiveandacademicabilities.
Testsadministered
Developmental Test of VisualMotor Integration(VMI).
KaufmanAdolescent andAdult IntelligenceTest (KAIT).
KaufmanFunctional AcademicSkillsTest (KFAST).
KaufmanTest of Educational Achievement (K-TEA) ComprehensiveForm.
KineticFamilyDrawing.
PeabodyPictureVocabularyTestRevised(PPVTR).
Wechsler Adult IntelligenceScaleRevised(WAISR).
Wechsler Individual Achievement Test (WIAT): SelectedSubtest.
WoodcockJohnsonRevised (WJR): Tests of Achievement: Selected Sub-
tests.
WoodcockJohnsonRevised(WJR): Testsof CognitiveAbility: SelectedSub-
test.
Testresultsandinterpretation
Cognitiveabilities
Leo was administered both the Wechsler Adult Intelligence ScaleRevised
(WAISR) and theKaufman Adolescent and Adult IntelligenceTest (KAIT),
whichareindividuallyadministeredtestsof apersonsintellectual abilityand
cognitivestrengthsandweaknesses. TheWAISRgroupsanindividualsabil-
itiesintotwoglobal areas: Verbal IQandPerformanceIQ. LeosVerbal IQof
825(12thpercentile; LowAverageRange) wassignicantlyhigher thanhis
PerformanceIQof 719(3rdpercentile; BorderlineRange), indicatingthat he
is able to solve problems better when they are presented auditorially and
requireaverbal response, such as answeringaquestion or deningaword,
thanwhenproblemsarepresentedvisuallyandrequireanonverbal or motor
response, suchasmanipulatingobjects. However, it isimportant tonotethat
thereisasignicant amount of variabilityinbothLeosverbal andnonverbal
abilities. For example, on the Verbal Scale, his scores showed discrepant
abilities, with subtest scores ranging from the 5th percentile to the 63rd
percentile,andonthePerformanceScale, hissubtestscoresrangedfromthe1st
percentile to the 37th percentile. Leos Full Scale IQ of 765 is rendered
meaninglessbecauseit only representsthenumerical averageof thesemany
verydiscrepantabilities. Becauseof thesignicantamount of variabilitywithin
his scores, it is more meaningful to look at his individual strengths and
weaknessestogainabetter understandingof hiscognitiveabilities. Hiscogni-
tivestrengthsandweaknesseswill bediscussedindetail later inthereport.
Another measure of Leos cognitive abilities was obtained through the
KAIT.TheKAIT groupsanindividualscognitiveabilitiesintotwoglobal areas:
FluidandCrystallized.Leoobtainedascaledscoreof 875(20thpercentile)on
theFluidScale, whichmeasuresonesabilitytosolvenovel problems, andhe
earnedascaledscoreof 845(15thpercentile)ontheCrystallizedScale, which
measuresonesabilitytosolveproblemsthat aredependent onschoolingand
acculturationforsuccess. Hisindividual subtestscoresoneachof thetwoscales
werenot unusuallyvariable, andthetwo global scaleswerenot signicantly
different fromoneanother. Thus, his ability to solvenew problemsand his
ability to solve problems using school-learned knowledge are equally well
developed. Hisoverall KAIT Compositestandardscoreof 855(15thpercen-
tile; BelowAverage) representstheaverageof all hisabilities.
Oneof Leosrelativecognitivestrengthsisintheareaof rotememoryand
recall. Heperformedwell onaWAISRtaskthat requiredhimtoconcentrate,
remember, and repeat sequences of numbers that were presented to him
auditorially(63rdpercentile). Healsoperformedwell onanother WAISRtask
whichrequiredhimto copy acodeof symbols(37thpercentile). Onboth of
thesetasks, Leo usedhisstrongattentionandincorporatedhisrotememory
and sequencing abilities to succeed. Similarly, his good short-termmemory
abilities were evident in a WoodcockJohnsonRevised Test of Cognitive
Ability (WJR) task that required himto learn and remember the unusual
namesof numerousvisuallypresentedcartoonspacecreatures, suchasPlik
andDelton. Leo performedat the63rdpercentileon thistask by usinghis
memoryandroterecall abilities.
Another relativecognitivestrengthof Leoswashisabilityto useplanning
andreasoning. Suchreasoningisusedwhendifferent premisesarepresented
andalogical conclusionisfoundfromthem. Thisstrengthwasevident ontwo
KAIT tasks, onewhichrequiredLeotorespondtoaquestionbymakinguseof
logical premises(37th percentile), and another which requiredhimto gure
out thecodeof anovel pictorial stimulus(37thpercentile). Inaseparate, but
related, logictaskontheWJR, Leodidnot performaswell. Onthistask, in
whichLeohadtocompletealogicpuzzle, hescoredat onlythe3rdpercentile.
Hislower performanceonthistaskincomparisontothetwoKAIT reasoning
tasksseemedtobeduetothefact that hehaddifcultywhenthetaskquickly
becamemoreandmorecomplex. Leocouldreason-outtheone-stepproblems,
buthadmuchmoredifcultywhenhehadtointegratemorestepstosolvethe
problems.
Leo demonstratedsomerelativecognitiveweaknessesintheverbal realm.
Hisbasicfundof general information, includingknowledgeobtainedthrough
formal schoolingandknowledgeobtainedthroughacculturationandgeneral
awareness of ones environment, is low compared to his other abilities and
othershisage(5thpercentile). Thisweaknesswasfurther supportedbythree
Achievement subtestsof theWoodcockJohnsonRevised(WJR ACH). On
subtestsmeasuringhisknowledgein theareasof science, social studies, and
humanities, Leoobtainedscoresinthe6th, 5th, and0.5thpercentiles, respect-
ively. In contrast to this, on a KAIT task measuring knowledge of general
factual informationfromhistory, literature, sports, entertainment, science, and
art, which oneacquiresthrough television, magazines, andnewspapers, Leo
scoredhigher (37th percentile). Thedifferenceappearsto bein theway the
information was presented to Leo. He performed better on the task that
presentedaverbal cueabout afamousfaceshown, whichhehadto identify,
thanontaskswhichsimplyrequiredhimtoanswer questionsabout facts. The
useof verbal andpictorial cluesencouragesintegrationof factsandconcepts,
and makes the task more of a problem-solving exercise than just purely a
long-termmemorytask. Thus, it appearsthat Leoisnot adequatelyabletouse
purelyhislong-termmemorytoretrievethebroadbaseof general information
that ispresentedtohiminandout of academicsettings.
Leo also demonstrated arelativeweakness in verbal comprehension. For
example, onaWAISRtaskthat requiredhimtolistentoaverballypresented
questioninvolvingcommonsenseandjudgment, andrespondverbally, hehad
difculty(5thpercentile). Thisdifcultywasparalleledbyhisperformanceon
the Reading Comprehension subtest of the Kaufman Test of Educational
Achievement (K-TEA). Thissubtest requiredhimto readshort passagesand
answer brief questionsabout what hehadread. Heperformedat theBelow
Average Level (16th percentile) on this task. Similarly, on a task fromthe
Kaufman Functional Academic Skills Test (K-FAST) that required Leo to
understandwrittenmaterial usedineverydaysituations, suchassigns, labels,
recipes, andabbreviations, hisdifcultywasapparent asheearnedascoreat
the9thpercentile. However, incontrast to thesedifculties, heperformedat
theAverageLevel (37thpercentile)onarelatedKAIT taskthat requiredhimto
listen to a mock radio news broadcast, and answer questions about it. The
differencesinhisperformanceonthesedifferent verbal comprehensiontasks
maybetwo-fold. First, ontasksthataremoreschool-like,requiringreadingand
answeringquestions, rather than listeningto news on theradio, hehas less
condence and weaker ability. Second, on tasks that require himto make
inferencesor usemorethanjust basicroterecall about what hehasheardor
read, hehasmoredifculty.
Related to his difculties in verbal comprehension, Leo demonstrated a
weaknessinwordstorageandretrieval throughpairedassociatelearning. Ona
KAIT task that simulates reading and is like learning a new language, Leo
scoredat the5thpercentile. Thisissimilar to hisperformanceonaWAISR
vocabularytaskandKAIT taskof wordknowledgeandconcept formation, in
which he earned scores at the 16th percentile. In addition, Leo earned a
standard score of 74 (4th percentile) on the Peabody Picture Vocabulary
TestRevised(PPVTR), whichisatest of receptivevocabulary.
Visualmotor abilities
Overall, Leosabilitiesto perceiveandvisually organizematerial areweaker
than his global verbal abilities. This was evident on most of the WAISR
Performance Scale subtests, including those requiring him to identify the
missingpart of apicture, arrangepicturecardsinthecorrect sequential order,
copyageometricdesignwithblocks, andsolveapuzzle. Hisscoresonthese
tasks ranged from the 1st to 9th percentiles. Supportive evidence for his
perceptual organization and visual organization difculties was present in a
similar KAIT taskof replicatingadesignwithblocks, frommemory(heearned
ascore at the 2nd percentile). Likewise, on a task of visualmotor skill, he
performedat abelowaveragelevel (VMI standardscoreof 86; 18thpercentile).
Toruleout apotential decit insimultaneousprocessing, or holisticprocess-
ing, aWJRsubtest wasadministered. Thissubtest requiredLeotoidentifya
drawingor picturethat isdistorted, hasmissinglines, or hasasuperimposed
pattern. His performancewas higher (32nd percentile) on this task than on
perceptual organizational taskspreviouslymentioned, indicatingthat hisdif-
cultiesarenot likelytobeduetoaweaknessinholisticprocessing.
Achievementabilities
Leos achievement abilities were thoroughly evaluated, in addition to his
cognitiveabilities. Someof hisachievement scoreshavebeendiscussedprevi-
ouslyinconjunctionwithhiscognitiveabilities, butall achievementscoreswill
be discussed in detail in the following paragraphs. Leo was administered
multiple separate tests of achievement, to assess his reading ability, both
comprehensionanddecoding, hismathematicscomputationandappliedabil-
ities, hiswrittenexpressionability, hisreceptivevocabulary, hisspellingability,
andhisbasicknowledgeskills. Ingeneral, hisachievement abilitieswereat a
level commensurate with his cognitive abilities, with the exception of his
spellingand reading decoding, which were higher than would be predicted
fromhis cognitive scores. This indicates that Leo does not have a learning
disabilityand, infact, it isclear that heworksveryhardtoachieveat thelevel
hedoes, academically, asevidencedbyhiscurrent gradepoint average(GPA)
of 2.79.
OntheKaufmanTest of Educational Achievement Comprehensiveform
(K-TEA), Leo earned Spellingand ReadingDecodingscores at the75th and
58th percentiles, respectively. Given his overall performanceon the tests of
cognitiveability andintelligence(KAIT and WAISR), rangingfromthe3rd
percentileonWAISR PerformanceIQ to the20thpercentileon KAIT Fluid
IQ, heappearstobeoverachievingintheseparticular areas. Oncloser inspec-
tion, it seems that Leo is usinghis strongrotememory abilitiesto perform
stronglyonspellingwordsandonwordpronunciation. Heappearsto havea
goodunderstandingandmemory of thephonicsinvolvedin wordpronunci-
ation, which enables himto sound-out words with which he may not be
familiar.
LeoslowscoreontheSAT Verbal exam(260), reportedbyhisparents, was
paralleledbyhisK-TEAReadingComprehensionscoreat the16thpercentile,
his KFAST Reading score at the 9th percentile, and his PPVTR receptive
vocabularyscoreat the4thpercentile. Commensuratewiththeseverbal scores
is his written expression ability (Wechsler Individual Achievement Test
(WIAT), 9th percentile). On this task of written expression, points may be
earnedintheareasof vocabulary, organization, ideasanddevelopment, sen-
tence structure, grammar, and capitalization and punctuation. His achieve-
ment abilitieson thistestingalso appear to bein linewith hislower grades
obtainedat school inEnglishandSpanish.
Like his SAT Math score (260), in the area of mathematics, Leo earned
signicantly lower scores on tasks that were applied and required problem-
solvingineverydaysituations, thaninthecomputationof writtenmathematics
problems. OntheK-TEAMathematicsApplicationsandKFAST Arithmetic, he
earnedscoresat the5th and10th percentiles, respectively. However, on the
K-TEA Mathematics Computation he earned a higher score, at the 27th
percentile. Thisdiscrepancyisanalogoustohisperformanceontheaforemen-
tionedreasoningtasks, onwhichhewasableto solvesimple, one-stepprob-
lems, buthadmuchmoredifcultywithincreasinglycomplexproblems, asare
theappliedmathproblems.
Summaryanddiagnosticimpressions
LeoM. isa17-year-oldstudent, who isabout to enter hissenior year inhigh
school. Hewasreferredfor anevaluationbecauseof hisparents concernabout
his academic abilities and apossiblelearning disability. This evaluation was
performedto answer Mr andMrsM.squestionsabout whether thereisany
waytohelpLeowiththeacademicdifcultieshehas, whichmayaidhimonce
heenterscollege. Cognitive, achievement, andsupplemental testswereadmin-
isteredover thecourseof four sessions. Leodemonstratedgoodconcentration
andattentionduringtheentireevaluation. Hewaspersistent andmotivatedto
tryhisbest, evenonverychallengingtasks. Detailedbehavioral observationsof
thetesting, aswell asinformationprovidedbyaclinical interviewwithLeoand
hisparents, andacademicrecordsgavefurther insight intoLeosstrengthsand
weaknesses.
Leoscognitiveabilitieswereassessedbytwoinstruments, theWAISRand
theKAIT. OntheWAISR, Leoperformedsignicantlybetter ontasksrequir-
ingansweringquestionsverballythanonsolvingproblemsthat arepresented
visuallyandrequireanonverbal, or motor response. HeearnedaVerbal IQof
825 (Low Average Range) and a Performance IQ of 719 (Borderline
Range). Becauseof thesignicantvariabilitywithinthesedifferentscales, Leos
cognitive abilities are most meaningfully represented by his individual
strengthsandweaknessontheWAISR. OntheKAIT, Leosperformancedid
not show a signicant amount of variability, indicating that his measured
abilitieswereevenlydeveloped. HeearnedaFluidIQof 875(BelowAverage
Range) andaCrystallizedIQof 845(BelowAverageRange), indicatingthat
hesolvesproblemsequallywell whether theyarenovel problemsor whether
theyareproblemsdependent onschoolingandacculturationfor success.
Leosrelativecognitivestrengthswereevident intwoareas: hisrotemem-
ory and recall abilities, and his ability to use planning and reasoning in
problem-solvingof uncomplicated, one-stepproblems. However, whenmore
complex reasoning is involved in problems requiring the integration of
multiplesteps, Leohasmuchmoredifculty. Overall, Leogenerallyhadmore
difcultyontasksthatrequiredvisual organizationandperceptual organization
than on thosethat required only verbal abilities. Specic areas of weakness
werefoundinLeosgeneral fundof knowledge. It appearsthat Leosabilityto
learn, store, and retrieveinformation fromhis long-termmemory is below
average. Leo has less difculty when he can use pictorial or visual cues in
addition to verbal cues, but has much moretroublewhen heis requiredto
answer questionsabout facts that arepresentedin awritten or oral format,
suchasismost commonlydoneinanacademicsetting. Leoalsodemonstrated
a weakness in verbal comprehension of both academic-type material and
writtenmaterial usedineverydaysituations. Incomprehension, Leoagainwas
foundtoperformmuchbetterwhenhewasabletousebasicrotememory, but
isquitechallengedwhenrequiredto utilizemorecomplexprocesses, suchas
makinganinferencefromwhat hehearsor reads.
Therewereno signicant discrepancies between Leos cognitiveabilities,
indicated by his IQ scores, and his Achievement abilities, indicated by his
achievement standard scores, which demonstrates that he does not have a
learningdisability. LeosscoresontheindividuallyadministeredAchievement
testswerecommensuratewithhisscoresontheSAT exam. Intwoareas, word
pronunciationandspellingwords, Leo achievedscoresthat werebetter than
wouldhavebeenpredictedbyhisglobal IQ. It seemsthat inthesetwoareas,
Leo is ableto usehis strongrotememory to succeed. Similar to what was
found in the cognitive testing, Leo performed signicantly better on math
problemsthat involvedonly calculationof writtenproblemsthanonapplied
problems which were more complex and involved multiple steps. Leos
achievement in theverbal arearanged fromthe4th percentilein Receptive
Vocabulary, tothe9thpercentileinWrittenExpression, tothe16thpercentile
inReadingComprehension.
Leoshigh-school gradepoint averageof just under aB-average, seemsto
bequiterepresentativeof thediligence, effort, andpersistencethat heshowsin
hisacademicwork. It islikelythat academicworkismoredifcultfor Leothan
for other studentsof hisage. Throughhisperformanceat school, asevidenced
byhisgradesandcommentsbyhisteachers, suchasconscientiousworker and
excellent attitude, it appears that Leo is able to compensate well for his
weaknesses.
Recommendations
Thefollowingrecommendationshavebeenmadetoassist Leoandhisparents
tobest utilizehisstrengthsinareasthat aremorechallengingfor him, bothin
andout of academicsettings.
1. AsLeowasfoundnottohavealearningdisability,hewill notqualifyfor special
academicprogramsat acollegeor universityto helpwithlearningproblems.
However, Leo may still ndthat hewill havedifculty with collegecourses
that aremorecomplexandchallengingthanhighschool work. Becausesuch
advancedcoursesmaybeharder for himthanfor other students, it isrecom-
mended that he and/ or his parents look into academic programs that offer
tutoring support. This may include peer tutoring or teaching by advanced
students. Informationmay beobtainedby telephoningor writingto student
affairsor student servicesdepartmentsof variousuniversitiesor community
colleges.
2. Inchoosingacollegeor university, Leoandhisparentsmaywant toconsider
thesizeof classes. In makingthetransition to higher education, sometimes
studentswhostruggleacademicallygetlostinbiglecturecoursesthatareoften
foundat largeuniversities. Leowill probablybenet fromasmaller classsize
whereone-on-oneinteractionwiththeprofessor/ teacher ispossible. Thiswill
allowhimeasier accessto someonewhowill answer hisquestions, andplace
himat lower riskfor just beinglost inthecrowdof students.
3. If Leo decides to enter a school for pursuing his athletic interests, such as
football, hewill want toconsider howrigoroustheathleticschedulewill be. In
college, he will have to set his own study schedule, and the time taken by
athletic practice and games should be factored in as a potential conict.
Choosing a programthat allows enough time for studying and tutoring, if
necessary, will becritical toLeosacademicsuccessbeyondhighschool.
4. AsLeo demonstrateddifculty in tasksthat rely on general knowledge, it is
recommendedthathegainsmoreenrichmentfromhisenvironment. Thismay
includeactivitiessuch as watchingdocumentary movies, goingto museums
andconcerts, tryingnewthingssuchasfollowingarecipeto cookameal, or
other suchactivities.
5. Leohasdifcultyretrievinginformationthat isstoredlongterm. Tohelphim
better remember suchinformation, several thingsarerecommended. Leomay
benetfromtapinglecturesandlisteningtothemmorethanonce. Hewill also
benetfromhavingnewinformationpresentedinsuchawaythat hecanboth
hearandseewhatheisexpectedtolearn. Thismaybemadepossiblebytalking
tohisprofessorsandaskingif theycanuseoverheadsor videosinadditionto
lecture. Hewill alsobenet fromgaininginformationthroughother channels
suchastouchandmovement. Usingactual objectstoillustrateconceptswill be
benecial. Thus, when available, Leo will benet fromlaboratory classes, or
classesthat providehands-onwork.
6. Learningnewinformationiseasierif itisclearlyassociatedwithsomethingyou
alreadyknow. Therefore, Leowill benet fromformingrelationships, organiz-
ing information, and integrating information with prior knowledge. For
example, whenreadinganewtext onascienticconcept suchasgravity, Leo
will benet formvisualizingafamiliar object, likeabaseball beingpitched, to
problemsolvehowthenewconcept isapplied. Thus, usingvariousstrategies,
suchasvisualization, canhelpincreaseretentionof information.
7. Leoreportedthat hehasdifcultystayingfocusedonreadingfor anextended
periodof timeandrememberingandcomprehendingwhathehasalreadyread.
Hemaybenet fromreadingapassagebybreakingit downintosmaller parts,
makingsurethat heunderstandseachsmall part ashegoesalong. Heshould
periodicallystopandaskhimself questionsabout what hehasread. Highlight-
ingimportant text andtakingnotesinthemarginarealso effectivestrategies
for enhancing comprehension. He should allow himself extra time while
readingsohemaytakebreakstoavoidfatigueandboredom.
LizLichtenberger, PhD
CarrenStika, PhD
K-ABC illustrative case study
Kaufman Assessment Battery for Children (K-ABC)
Subtest/ scale Standardscore Percentilerank
Sequential Processing 898 23
SimultaneousProcessing 1218 92
Mental ProcessingComposite 1-77 68
Achievement 1056 63
Sequential Processing Scaledscore Percentilerank
HandMovements 8 25
Number Recall 10 50
WordOrder 7 16
SimultaneousProcessing Scaledscore Percentilerank
Gestalt Closure 15 95
Triangles 12 75
MatrixAnalogies 12 75
Spatial Memory 13 84
Achievement Subtest Standardscore Percentilerank
Faces&Places 11113 77
Arithmetic 10410 61
Riddles 10911 73
ReadingDecoding 967 39
WoodcockJohnsonRevised Tests of Cognitive Ability (WJR): Early Development Scale
Subtest Scaledscore Percentilerank Gradeequivalent
Memoryfor Names 825 12 K.0[12]
Memoryfor Sentences 875 19 K.0[24]
IncompleteWords 1105 75 K.5
Visual Closure 1016 54 K.2
PictureVocabulary 1017 53 K.2
BroadCognitiveAbility
Global Score 954 38 K.0[43]
Developmental Test of VisualMotor Integration (VMI)
Subtest Standardscore Percentilerank Ageequivalent
VMI 116 86 6.0
Wechsler Preschool and Primary Scale of Intelligence (WPPSI)
Subtest Scaledscore Percentilerank
Comprehension 11 63
Reasonforreferral
AbbyR. isa5yearoldattendingalocal preschool. Shewasreferredtotheclinic
by her teacher for assessment of her readinessto begin kindergarten and to
determinewhether she may be showing early signs of a learningdisability.
Abbysteacher administeredEarlyScreeningProles(ESP) toher prior tothis
evaluation. FromtheresultsobtainedontheESP, questionswereraisedabout
Abbysvisual processingabilityandher overall level of maturity. Theresultsof
thisevaluationwill beusedtodetermineif thereareanydifcultiesthatmaybe
problematicfor Abbywhenshebeginskindergartennext autumn.
Backgroundinformation
Abby lives at home with her parents, Mr and Mrs R., and her 8-year-old
brother, Jake. Mr R. isself-employedandMrsR. isafull-timehomemaker. Mr
R. statedthat Abbysbrother currentlyreceivesalowdoseof Ritalinbecause
he is mildly ADD. In Abbys prenatal history, Mrs R. reported that she
experienced premature dilation at 36 weeks, which required her to be on
medication. Sheindicatedthat therewereno other difcultieswithher preg-
nancy and Abby was born at 38weeks after 12 hours of labor, weighing 7
poundsand1ounce. Accordingtoher parents, Abbyhashadnomajor illnesses
or hospitalizations. About one year ago, Abby was evaluated by a pediatric
ophthalmologist. Mr R. indicated that Abby was prescribed eyeglasses for
visionproblems anddifcultywithastrayeye. Abbywearsher glassesdaily.
Accordingtoher parents, Abbyreachedall of her developmental milestones
withinthenormallyexpectedtimelimits. Shesatupatsixmonths, saidher rst
wordsatninemonths, walkedat14months, andcompletedtoilettrainingat30
months. Her parentsnotedthat, becauseof nodulesonher vocal cords, she
haddifcultywithher speechandtheythereforetookher toaspeechtherapist.
Abbywasinspeechtherapyfor approximatelyoneyear. Thespeechtherapist
stated that, through various exercises practiced at home and during speech
therapy, thenodulesonAbbysvocal cordswereeliminated. Accordingtothe
therapist, Abbyhaddifcultypronouncingseveral soundssuchas, L, R, Sh,
Ch, and J. After approximately four months of speech therapy, Abbys
difcultypronouncingL wasclearedup. Thespeechtherapist reportedthat
Abbystill hasdifcultypronouncingR, Sh, Ch, andJ sounds, whichshe
felt may lead to problems and frustration for Abby in learning phonics in
school.
Abbyhasattendedpreschool sinceshewas18monthsof age. Her mother
reportedthat, duringtherst year of preschool, Abbyattendedjust onedaya
week, andsincetheageof twoandahalf, shehasattendedthreedaysaweek.
Abbyscurrent school includesapproximately30preschoolers, withclassroom
sizevaryingdependingonthechildrensactivity. Abbywasobservedduringa
typical day at preschool, with activities including music, story reading, art
activities,freetime, andshow-and-tell.Abbywasobservedtointeractwell with
her peers. Sheshowedtheability to shareandcooperate. Sheallowedother
children to helpher completeapuzzleshewasworkingon, andat another
point allowedastudent toplaywithblocksthat shewasalreadyplayingwith.
At times Abby demonstrated spurts of excessive energy. For example, she
twirled around for a couple of minutes at one time and inappropriately
scatteredpuzzlepiecesatanotherpoint. However, shewasabletoquietherself
downquicklyandbehavedoverall veryappropriately. Abbydemonstratedthe
abilitytoworkindependentlyonapuzzlefor areasonableamountof time. She
wasquitepersistent andpatient in her work on solvingthepuzzle. Shewas
quiet and attentive when her teacher read a story, and was comfortable
participatingverbally when askedquestions. Abby appearedself-condent as
shepresentedfour toysshehadbrought for show-and-tell.
Accordingto her parents, Abby andher brother get alongwell, they play
togetheralot, andarenicetoeachother. Abbysinterestsincludeplayingwith
stuffedanimals, PollyPocketandher newpuppy. Her parentsdescribeAbbyas
feminine, petite, andalittleimmature. Abbyreportedlyfollowsher parents
directionsat least 50%of thetime, but theyindicatethat shecanbestubborn
withcertainissues. Overall,MrandMrsR.characterizeAbbyasaneasychild.
Appearanceandbehavioral characteristics
Abbyisaverypetite5-year-oldgirl, whowearssmall, pinkeyeglassesandsmall
earrings. She speaks with slight speech articulation immaturities (difculty,
especially, articulatingR andTh), whichmakesher soundslightlyyounger
thansheis. For example, shepronouncedworldaswald andthreeasfree. Her
speech, along with her diminutive size, give the impression that Abby is
younger than her chronological age. Shewas tested on threeseparateocca-
sions. Initially, shewasquiteshyandrequestedthat her mother joinher inthe
testingroom. Duringeachof thesessionshermother escortedher totheroom.
Abbyappearedmoreat easeonceshewasoccupiedbydrawingwithmarkers.
Sheslowlywarmeduptotheexaminer, rst answeringquestionswithnonver-
bal nods while still drawing and then progressing to short, quick, verbal
responses. Abby appears to bemorecomfortableexpressingherself through
nonverbal rather than verbal communication. After ashort period with her
mother present intheroom, Abbyagreedthat shewascomfortablebeingleft
aloneandseemedindifferent when mother didleavetheroom. Shedemon-
stratedagoodabilityto usefantasyplaywhileinteractingwiththeexaminer
andalsoappearedtohaveagoodsenseof humor.
Abby tended to haveashort attention span duringmany of thesubtests.
Testswhich providedvisual stimulation or manipulationof objectsheldher
attention much morethan tests which werepurely auditory in nature. Her
inattention was accompanied by much dgeting, resistance, and difculty
following directions. Her dgeting was evident when she kicked the table,
playedwithpagesof theeasel, andpickedher nose. Abbywasresistant when
shewastiredof atask. Thiswasexhibitedinher attemptstoclosethepagesof
theexaminerseasel, when shesank down in her chair until shewasunder-
neaththetable, whenshepulledher dressover her face, andwhenshemade
statementssuchasThisistheend andI wannabedone. Followingdirections
wasproblematicfor Abbyduringatask whichrequiredher to copy adesign
withtriangular-shapedblocks. Shewantedto reconstruct thedesignher way,
whichwasstandingthetrianglesupontheir side, insteadof at onthetableas
theexaminer hadinstructed. After multipleredirection, Abbywasstill ableto
followdirectionsonlyabout 50%of thetime.
Abbyappearsto enjoy tactile, visual, andkinestheticstimuli, but seemsto
nd auditory stimulation less exciting. Sherepeatedly attempted to provide
additional self-soothingstimulationfor herself bysuckingher thumb, putting
theexaminerseasel inher mouth, or byfeelingtheweight of theeasel onher
head. She enjoyed manipulating small rubber triangles with her hands and
repeatedlyaskedtoplaywiththeseitemsduringother subtests. Abbywasable
toattendtoauditorytasksbetter whenshecouldoccupyherself withphysical
objects. For example, shewasdgetingandhavingdifcultyattendingtoatask
requiringher to listento anincompletewordandthenidentifythecomplete
word. However, when she was allowed to hold onto and manipulate a
stopwatchduringtheauditorytask, shewasabletocalmdownandfocusher
attentionbetter. Similarly, shewasallowedtoplaywithsmall rubber triangles
duringanauditoriallypresentedsocial comprehensiontask, andthisseemedto
allow her to redirect her attention so she was free to listen and respond
appropriately.
AlthoughAbbypreferredvisual stimuli, at timesshebecameoverwhelmed
whenthestimuluseldwastoocrowded. Thishappenedduringtwoseparate
subtests. Ononeauditoryvisual associationtask, shewasshownapictureof a
spacecreatureandtoldthespacecreaturesname. Thenshewasrequiredto
point out the space creature froma group of others. When the number of
creaturesbecametoo great for Abby, shecouldnot remember any and just
pointedtothemall. Shehadsimilardifcultyonadifferenttaskrequiringherto
lookatapagewithtwotovepicturesonit, andthenpointonablankpageto
wherethosepictureshadbeenlocated. Whenthepagewascrowdedwithtoo
many items for Abby (four to ve), she was unable to respond and just
randomlypointedtomultiplespotsonthepage.
When faced with too much challenge, Abby responded with adecreased
interest andeffort andoftenrespondedinasillymanner. Duringataskwhich
requiredher torepeat aseriesof handgesturesdemonstratedbytheexaminer,
she began to make up her own creative gestures when the items became
difcult. Similarly, duringmorechallengingitemsonanumber recall task, she
begantosayanyrandomnumberthatcametoher mind. Whenencouragedby
theexaminer onother taskstotryalittleharder togiveareal insteadof silly
answer, sheoften cameup with thecorrect answer. For example, on atask
requiring Abby to identify a distorted picture, she identied one itemas a
bloodhead, but after encouragement fromtheexaminer, respondedwiththe
correct answer, train. OnchallengingitemsAbbytendstogiveupeasily. She
respondedtosomeitemsbysayingtheyweretoohard beforeevenattempt-
ing to answer. She did not appear overly concerned or anxious about her
performanceanddemonstratedlowfrustrationtolerance. Her randomor silly
responseswerecompensationsthat helpedher deal withthisfrustration.
Abbytendedtobequicktorespondwhenshedenitelyknewtheanswer to
aproblem, but was ableto slow herself down to think about moredifcult
problems. Duringadesigncopyingtask, sheinitiallyrespondedvery rapidly,
but asthedesignsbecamemoredifcult, shesloweddownandtook timeto
studythedesignsmorecarefullybeforecopyingthem. Sheappearedtoenjoy
tasks that were administered quickly, and responded to the problems in a
similarlyquickmanner. Abbyhaddifcultywithitemsthat requiredasequen-
tial problem-solving style. She had difculty remembering a sequence of
verballypresentednumbersandasequenceof visuallypresentedhandmove-
ments. Onceeachof thesequencesgot toolong, shelost all of theinformation
presentedtoher. Ononeauditoryvisual sequencingtask, shewasrequiredto
listen to a verbally presented list of objects and then point to the correct
sequenceof picturesonapage. Abbyat timesverbalizedthecorrect order of
itemsinthesequence, but thenwouldnot beabletopoint themout correctly.
Testsadministered
KaufmanAssessment BatteryFor Children(K-ABC).
Developmental Test of VisualMotor Integration(VMI).
WoodcockJohnsonRevised(WJR): Testsof CognitiveAbility(EarlyDevel-
opment Scale).
Wechsler Preschool and Primary Scale of IntelligenceRevised (WPPSIR):
selectedsubtest.
OntheK-ABC, AbbyearnedaSequential Processingstandardscoreof 898, a
SimultaneousProcessingstandardscoreof 1218, aMental ProcessingCom-
positestandardscoreof 1077(68thpercentile), andanAchievementstandard
scoreof 1056 (63rd percentile). These global scores classify her cognitive
abilities within awiderangefromtheLow Averagelevel of functioningto
Superior. The 32-point difference between her Sequential Processing (23rd
percentile) andher SimultaneousProcessing(92ndpercentile) standardscores
is statistically signicant and unusual and suggests that she performs better
whensolvingproblemsbyintegratingmanystimuli at oncethanwhensolving
problemsinalinear, step-by-stepfashion. However, thesubstantial difference
betweenher twoprocessingstyleswaslargelyaffectedbyAbbyshighlevel of
distractibility during the testing. Thus, the discrepancy in favor of Simulta-
neousProcessingmaybeanoverestimateof theprocessingdifferencebecause
theSequential Processingscalesubtestsarequitesusceptibleto theeffectsof
distractibility. Becauseof thelargediscrepancyandthenegativeeffect of her
distractibility, theCompositescoreshouldnot beusedasanindicationof her
overall ability. Rather, her scoreontheSimultaneousProcessingscaleshould
beconsideredthebest estimateof her intellectual potential.
On the three subtests comprising the Sequential Processing scale, Abby
scoredat the16th, 25th, and 50th percentiles. Abbysdifculty attending, as
noted in the behavioral observations, signicantly affected these subtests.
During a test requiring her to repeat with her hands a sequence of hand
gestures, shehad difculty rememberingasequenceof morethan two ges-
tures. On a test that requires recalling a sequence of verbally presented
numbers, Abby had difculty remembering a sequence of more than three
numbers. Onataskcallingfor integrationof averballypresentedsequenceof
wordsandaresponseof pointingtothepicturesof theseobjects, shecouldnot
remember asequenceof morethantwoitems. Eachof thesesubtestsrequired
ashort periodof sustainedattentionandtheability to recall theinformation
presented. It appearsthat themost critical factor affectingher relativelylower
scoreswasher inabilitytoremember dueto her highdistractibilitywhenthe
stimuli were presented. Two subtests on the WJR Cognitive Battery also
conrmed that her difculty remembering may have been affected by her
problemsustaining attention for an entire test. On a WJR auditoryvisual
associationtaskmeasuringlong-termretrieval, Abbyscoredatthe12thpercen-
tile. OnaWJRtaskrequiringshort-termretrieval, shehaddifcultyremem-
beringandrepeatingsinglewordsandphrases, scoringat the19thpercentile.
On tasks that are more resistant to the effects of distractibility, Abby
performedmuchbetter. Most of thesetasksrequiredholisticprocessingrather
thansequential processing. For example, oneof Abbysstrengthswasshown
on a K-ABC subtest requiring her to look at a partially completed inkblot
drawingandnameor describethat drawing. Shescoredat the95thpercentile
on this test of perceptual closure and inference. On asimilar WJR subtest
requiringAbbyto identifyapicturewhichisdistorted, hasmissinglines, or a
superimposedpattern, shescoredintheAveragerange(54thpercentile). Other
well-developedareasfor Abbyincludeher visual organization, her alertnessto
her environment andvisual detail. Her visualmotor skillswerealsoshownto
be well developed on the Developmental Test of VisualMotor Integration
(VMI). On this design copying task, Abby scored at the 86th percentile,
equivalent toachildafull year older thanher ownchronological age.
Abby also showed a well-developed ability to determine the relationship
betweenawholeanditsparts. Whenpresentedwithawordwithoneor more
phonemesmissing, shewasquickly ableto identify thecompleteword. She
scoredat the75thpercentileonthisWJRauditoryclosuretask. OnaK-ABC
task that required Abby to infer the name of a concrete or abstract verbal
concept when given several of its characteristics, she demonstrated similar
ability to determine the partwhole relationship, as she scored at the 73rd
percentile. Abby demonstrated the ability to infer partwhole relationships
withvisual stimuli duringaK-ABCtaskof assemblingseveral rubber triangles
tomatchapictureofanabstractdesign(75thpercentile).TheK-ABCandWJR
visual closuretasksmentionedabovealsoprovideconrmingevidenceof this
well-developedsynthesizingability (shereceivedscoresat the95th and54th
percentiles).
Abbys academic achievement, as measured by the K-ABC Achievement
subtests, wasintheAveragerange. Shescoredat the77thpercentileonatest
measuringher fundof general informationbyaskingher tonamepicturesof
ctional characters, famouspeople, or well-knownplaces. OntheArithmetic
subtest, whichmeasuredAbbysabilityto identifynumbers, count, compute,
anddemonstrateunderstandingof mathematical concepts, shescoredat the
61st percentile. Abbys reasoning, verbal comprehension, and fund of word
knowledgeweremeasuredinataskrequiringher tosolveverballypresented
riddles (73rd percentile). On a WJR test of receptive vocabulary, she also
scoredintheAveragerange(53rdpercentile). Anadditional subtest measuring
her verbal comprehension, as well as common sense, social judgment, and
social maturity, againshowedher abilitytoachieveintheAveragerange(63rd
percentile). The only area of weakness for Abby within the Achievement
subtestswasher abilitytoidentifylettersandreadandpronouncewords(39th
percentile). AbbycouldonlyrecognizeanA andaY, but didknowthat they
werelettersinher name.
Summaryanddiagnosticimpressions
Abby R. isa5-year-oldgirl who wasreferredfor anevaluationto determine
whether she may be exhibiting early signs of a learning disability and to
determineher level of readinessfor kindergarten. After beinggivenaprelimi-
nary screening test by her teacher, questions were raised about her visual
processing ability and level of maturity. During the evaluation, Abby was
highlydistractible, demonstratedlowfrustrationtolerance, andhaddifculty
followingdirections.Shewasabletofocusbetteronauditorytasksif shehadan
object tomanipulate, whichallowedher toredirect her attention.
TheassessmentshowsAbbysabilitiestoencompassawiderangeof intellec-
tual functioning (Low Average to Superior). Her Simultaneous Processing
ability signicantly outweighed her Sequential Processing ability, but this
differenceisprobablyexaggeratedbecauseher inattentionnegativelyimpacted
many of the Sequential subtests. She had weaknesses in remembering se-
quencesof visual andauditorystimuli. Correspondingly, sheperformedbelow
averageonatestof long-termretrieval of auditoryvisual informationandona
testof short-termretrieval of wordsandphrases. Abbyhadstrengthsinholistic
processing, visual organization, attentiontovisual detail, andalertnesstoher
environment. Her performanceonAchievement subtestsshowedher tohave
average acquisition of learned material in all areas, with the exception of
low-averageabilitytoidentifylettersandpronouncewords.
Overall, Abbyisaself-condent, strong-willedyounggirl, wholacksstrong
concentration skills and motivation to keep on trying when a situation
becomeschallengingtoher. Shelikestotakecontrol of situationsandcantake
several minutestoredirect if her behavior isproblematic. Althoughshecanbe
highly inattentive, she can become more focused if she is occupied with a
physical object whileattemptingamoreabstract auditoryor visual task. From
these test results, it does not appear that Abby has any visual processing
difculties, as earlier hypothesized froman initial screening. However, her
ability to decode written material is signicantly lower than would be ex-
pected given her cognitivepotential. The 25-point discrepancy between her
ReadingDecodingandSimultaneousProcessingstandardscoresindicatesthat
this area should be closely monitored for the potential development of a
learningdisability as sheenters school. As shehas not yet entered aformal
academicsetting, diagnosisof alearningdisabilitywouldbeprematureat this
time. Sheisalsosomewhat immaturefor her age, whichisaccentuatedbyher
attentional problems, but doesnot possessany severecognitiveor academic
decitswhich wouldcausedifculty for her in akindergartensetting. There
isapossibilitythat Abbyisdemonstratingsignsof amildattentiondecit, or
she may merely be a bit younger developmentally in her self and impulse
control.
Recommendations
1. GivenAbbysattentional problemsandlevel of maturity, itwill beimportantto
ndanexperiencedkindergartenteacher for her, whoiswillingtomakesome
accommodations for her in the classroom. For example, when the class is
expectedtolistenquietlytotheteacher reading, Abbymayneedalsotohave
her handsoccupiedwithasmall object, or mayneedtodoodlewhilelistening.
2. Abbywill benet frombeinginstructedthroughtheuseof hands-onactivities.
She enjoys feeling and manipulating objects and will probably stay focused
longer withataskthat allowsher todoso.
3. Because of Abbys short attention span, lessons should be kept as brief as
possible. Plannedinterruptionswhen longer lessonsaregivenwill beuseful.
Forexample, Abbymayneedtogetupandgetsomemoresuppliesafterpartof
alessoniscomplete. Incorporationof quiet activitiesandactiveoneswithina
lessonwill alsohelptokeepher attention.
4. Abbysstronger simultaneousprocessingstylethansequential processingstyle
shouldberecognizedinteachingher. Knowledgeof her goodvisual organiz-
ationandattentiontovisual detail mayalsobeuseful ininstructingher.
5. Abby will benet frompracticing letters and numbers at home as much as
possible. Such practice can be quite enjoyable, through the use of various
gamesor enjoyablecomputer programs.
6. GivenAbbyslowtolerancefor frustrationanddesiretodothingsher way, it
will beuseful for herteacher andher parentstosetrealisticbehavioral goalsfor
her, andfollowthroughwithreinforcement whenshedoeswhat isexpected
andwith consequenceswhen shedoes not follow thesebehavioral expecta-
tions. Reinforcementmaybeintheformof tangibleor intangiblerewards. For
example, when appropriate behavior is demonstrated, classroomprivileges,
freetime, andhelpingtheteacher may begivenastangiblerewards. Smiles,
patsontheback, andpraisemaybegivenasintangiblerewards.
7. It is recommended that if Abbys distractibility and attentional difculties
become unmanageable in the classroom, a referral be made to a medical
specialistforanevaluationtodetermineif shewouldbenetfromatrial doseof
Ritalin.
LizLichtenberger, PhD
NadeenL. Kaufman, EdD
REFERENCES
Bain,S.K. (1993). Sequential andsimultaneousprocessinginchildrenwithlearningdisabilities:an
attemptedreplication. TheJournal of Special Education, 27, 23546.
Beery, K.E. (1997). TheBeeryBuktenicaDevelopmental Test of VisualMotor IntegrationAdministra-
tionScoringandTeachingManual. Parsippany, NJ: ModernCurriculumPress.
Bogen, J.E. (1975). Someeducational aspectsof hemisphericspecialization. UCLAEducator, 17,
2432.
Clarizio, H.F. & Bennett, D.E. (1987). Diagnostic utility of theK-ABC and WISCR/ PIAT in
determiningseverediscrepancy. PsychologyintheSchools, 25, 30914.
Cohen, M. (1997). ChildrensMemoryScale. SanAntonio, TX: ThePsychological Corporation.
Culbertson, J.L. & Edmonds, J.E. (1996). Learning disabilities. In Neuropsychology for Clinical
Practice: Etiology, Assessment, andTreatment of CommonNeurological Disorders, ed. R.L. Adams,
O.A. Parsons, J.L. Culbertson, & S.J. Nixon, pp. 331408. Washington, DC: American
Psychological Association.
DMato, R.C., Gray, J.W., & Dean, R.S. (1987). Concurrent validity of thePPVTR with the
K-ABCfor learningproblemchildren. PsychologyintheSchools, 24, 359.
Das, J.P. (1973). Structure of cognitive abilities: evidence for simultaneous and successive
processing. Journal of Educational Psychology, 65, 1038.
Das, J.P., Kirby, J.R., & Jarman, R.F. (1975). Simultaneousandsuccessivesyntheses: analterna-
tivemodel for cognitiveabilities. Psychological Bulletin, 82, 87103.
Das, J.P., Kirby, J.R., & Jarman, R.F. (1979). SimultaneousandSuccessiveCognitiveProcesses. New
York: AcademicPress.
Golden, C.J. (1981). The LuriaNebraska Childrens Battery: theory and formulation. In
Neuropsychological Assessment of the School-age Child, ed. G.W. Hund and J.E. Obrzut,
pp. 277302. NewYork: GruneandStratton.
Gonzales, J., Adir, Y., Kaufman, A.S., & McLean, J.E. (1995). Raceand gender differences in
cognitivefactors: aneuropsychological interpretation. Paper presentedat themeetingof the
international Neuropsychological Society, Seattle.
Horn, J.L. (1989). Cognitive diversity: a framework of learning. In Learning and Individual
Differences, ed. P.L. Ackerman, R.J. Sternberg, &R. Glaser, pp. 61116. NewYork: Freeman.
Horn, J.L. & Cattell, R.B. (1966). Renement and test of the theory of uid and crystallized
intelligence. Journal of Educational Psychology, 57, 25370.
Horn, J.L. & Hofer, S.M. (1992). Major abilities and development in the adult period. In
Intellectual Development, ed. R.J. Sternberg & C.A. Berg, pp. 4499. New York: Cambridge
UniversityPress.
Inhelder, B. &Piaget, J. (1958). TheGrowthof Logical ThinkingfromChildhoodtoAdolescence. New
York: BasicBooks.
Kamphaus. R.W., Beres, K.A., Kaufman, A.S., & Kaufman, N.L. (1995). TheKaufman Assess-
ment Batteryfor Children(K-ABC). InMajor Psychological Assessment Instruments, 2ndedition,
ed. C.S. Newmark, pp. 38499. Boston: Allyn&Bacon.
Kamphaus, R.W. &Reynolds, C.R. (1987). Clinical andResearchApplicationsof theK-ABC. Circle
Pines, MN: AmericanGuidanceService.
Kaufman, A.S. (1990). AssessingAdolescent andAdult Intelligence. Boston, MA: Allyn&Bacon.
Kaufman, A.S. (1994). Intelligent TestingwiththeWISCIII. NewYork: Wiley.
Kaufman,A.S. &Horn, J.L. (1996). Agechangesontestof uidandcrystallizedabilityfor females
andmaleson theKaufman Adolescent andAdult IntelligenceTest (KAIT) at ages17to 94
years. Archivesof Clinical Neuropsychology, 11, 97121.
Kaufman,A.S. &Kamphaus, R.W. (1984). Factor analysisof theKaufmanAssessmentBatteryfor
Children(K-ABC) for ages2
1
2
through12
1
2
years. Journal of Educational Psychology, 76, 62337.
Kaufman, A.S. &Kaufman, N.L. (1983). InterpretiveManual for theKaufmanAssessment Batteryfor
Children. CirclePines, MN: AmericanGuidanceService.
Kaufman, A.S. & Kaufman, N.L. (1985). KaufmanTest of Educational Achievement. CirclePines,
MN: AmericanGuidanceService.
Kaufman, A S. & Kaufman, N.L. (1993). Manual for KaufmanAdolescent & Adult IntelligenceTest
(KAIT). CirclePines, MN: AmericanGuidanceService.
Kaufman, A.S. & Kaufman, N.L. (1994). Manual for Kaufman Functional Academic Skill Test
(K-FAST). CirclePines, MN: AmericanGuidanceService.
Kaufman, A. S. & Kaufman, N.L. (1997a). TheKaufmanAdolescent andAdult IntelligenceTest
(KAIT). InContemporaryIntellectual Assessment:Theories, Tests, andIssues, ed.D.P. Flanagan,J.L.
Genschaft, &P.L. Harrison, pp. 20929. NewYork: Guilford.
Kaufman, A.S. & Kaufman, N.L. (1997b). KaufmanTest of Educational Achievement/ NU. Circle
Kaufman, A.S. &Lichtenberger, E.O. (1999). Essentialsof WAIS-III Assessment. NewYork: Wiley.
Kaufman, A.S. & McLean, J.E. (1986). K-ABC/ WISCR factor analysis for alearningdisabled
population. Journal of LearningDisabilities, 19, 14553.
Kaufman, A.S., McClean, J.E., & Kaufman, J.C. (1995). The uid and crystallized abilities of
white, black, and Hispanic adolescents and adults, both with and without an education
covariate. Journal of Clinical Psychology, 51, 63747.
Kempa, L., Humphries, T., &Kershner, J. (1988). Processingstylesof learningdisabledchildren
ontheKaufmanAssessment Batteryfor Children(K-ABC) andtheir relationshipto reading
andspellingperformance. Journal of Psychoeducational Assessment, 6, 24252.
Kinsbourne, M. (Ed.)(1978). Asymmetrical FunctionoftheBrain. NewYork:CambridgeUniversity
Press.
Klanderman,J.W., Perney, J., &Kroeschell, Z.B. (1985). Comparisonsof theK-ABCandWISC-R
for LDchildren. Journal of LearningDisabilities, 18, 5247.
Knight, B.C., Baker, E.H., & Minder, C.C. (1990). Concurrent validity of theStanfordBinet,
Fourth Edition, and Kaufman Assessment Battery for Children with learning-disabled stu-
dents. PsychologyintheSchools, 27, 11625.
Levy, J. & Trevarthen, C. (1976). Metacontrol of hemispheric function in human split-brain
patients. Journal of Experimental Psychology: HumanPerceptionandPerformance, 2, 299312.
Lichtenberger, E.O. & Kaufman, A.S. (2000). Theassessment of preschool children with the
Kaufman Assessment Battery for Children. In ThePsychoeducational Assessment of Preschool
Children, 3rdedition, ed. B.A. Bracken, pp. 10323. Boston: Allyn&Bacon.
Lichtenberger, E.O., Kaufman, A.S., & Kaufman, N.L. (1998). TheK-ABC: theoryandapplica-
tion. InAdvancesinCross-cultural Assessment, ed. R.J. Samuda, pp. 2055. ThousandOaks, CA:
SagePublications.
Luria, A.R. (1966). Higher Cortical FunctionsinMan. NewYork: BasicBooks.
Luria, A.R. (1973). TheWorkingBrain: An Introduction to Neuro-psychology. London: Penguin
Books.
Luria, A.R. (1980). Higher Cortical FunctionsinMan, secondedition. NewYork: BasicBooks.
Markwardt, F.C. (1989). PeabodyIndividual AchievementTestRevised. CirclePines, MN: American
GuidanceService.
Markwardt, F.C. (1997). Peabody Individual Achievement TestRevised/ NormativeUpdate. Circle
McCallum, R.S. & Merritt, F.M. (1983). Simultaneoussuccessive processing among college
students. Journal of Psychoeducational Assessment, 1, 8593.
Morgan, A.W., Sullivan, S.A., Darden, C., & Gregg, N. (1997). Measuringtheintelligenceof
collegestudentswithlearningdisabilities: acomparisonof resultsobtainedontheWAISR
andtheKAIT. Journal of LearningDisabilities, 30, 5605.
Naglieri, J.A. (1985). Useof theWISCRandK-ABCwithlearningdisabled, borderlinementally
retardedandnormal children. PsychologyintheSchools, 22, 13341.
Naglieri, J.A. &Das, J.P. (1988). PlanningArousalSimultaneousSuccessive(PASS):amodel for
assessment. Journal of School Psychology, 26, 3548.
Naglieri, J.A. & Das, J.P. (1990). Planning, Attention, Simultaneous, and Successive (PASS)
cognitiveprocessesasamodel forintelligence.Journal ofPsychoeducational Assessment,8,30337.
Naglieri, J.A. & Haddad, F.A. (1984). LearningdisabledchildrensperformanceontheK-ABC.
Obrzut, A., Obrzut, J.E., & Shaw, D. (1984). Construct validity of the Kaufman Assessment
Batteryfor Childrenforchildrenwithlearningdisabledandmentallyretarded.Psychologyinthe
Schools, 21, 41724.
Perlman, M.D. (1986). Towardanintegrationof acognitivedynamicviewof personality: the
relationship between defense mechanisms, cognitive style, attentional focus, and neuro-
psychological processing. Unpublisheddoctoral dissertation, CaliforniaSchool of Professional
Psychology, SanDiego.
Piaget, J. (1972). Intellectual evolutionfromadolescencetoadulthood. HumanDevelopment, 15,
112.
Rethazi, M. & Wilson, A.K. (1988). TheKaufmanAssessment Batteryfor Children(K-ABC) in
theassessment of learningdisabledchildren. PsychologyintheSchools, 25, 38391.
Reynolds, C.R. &Bigler, E.D. (1994). Test of MemoryandLearning. Austin, TX: Pro-Ed.
Sheslow, D. &Adams, W. (1990). WideRangeAssessment of MemoryandLearning: Administration
Manual. Wilmington, DE: JastakAssessment Systems.
Silver, L.B. (1993). Thesecondaryemotional, social, andfamily problemsfoundwithchildren
and adolescents with learning disabilities. Child and Adolescent Psychiatric Clinics of North
America, 2, 295308.
Smith, D.K., Lyon, M.A., Hunter, E., & Boyd, R. (1988). RelationshipbetweentheK-AC and
WISCRfor studentsreferredfor severelearningdisabilities. Journal ofLearningDisabilities, 21,
50913.
Sperry, R.W. (1968). Hemisphere deconnection and unity in conscious awareness. American
Psychologist, 23, 72333.
Sperry, R.W. (1974). Lateral specialization in the surgically separated hemispheres. In The
Neurosciences: ThirdStudyProgram, ed. F.O. Schmitt &F.G. Worden, pp. 72333. Cambridge,
MA: MIT Press.
Thorndike, R.L., Hagen, E.P., & Sattler, J.M. (1986). StanfordBinet IntelligenceScaleFourth
Edition. Chicago, IL: Riverside.
Wada, J., Clarke, R., &Hamm, A. (1975). Cerebral hemisphereasymmetryinhumans. Archivesof
Neurology, 37, 23446.
Wechsler, D. (1974). Manual for theWechsler IntelligenceScalefor ChildrenRevised(WISCR). San
Antonio, TX: Psychological Corporation.
Wechsler, D. (1981). Manual for the Wechsler Adult Intelligence ScaleRevised (WAISR). San
Wechsler, D. (1991). Manual fortheWechslerIntelligenceScaleforChildrenThirdEdition(WISCIII).
SanAntonio, TX: Psychological Corporation.
Wechsler, D. (1997a). Manual fortheWechslerAdultIntelligenceScaleThirdEdition(WAISIII). San
Wechsler, D. (1997b). Manual for the Wechsler Memory ScaleThird Edition (WMSIII). San
Woodcock, R.W. & Johnson, M.B. (1989). TheWoodcockJohnsonTestsof AchievementRevised.
Chicago, IL: Riverside.
5
Using the Cognitive Assessment System
(CAS) with learning-disabled children
Jack A. Naglieri
Introduction
TheWechsler scaleshavedominatedtheeldof intelligencetestingfor some
timeand thetest continuesto bethemost widely usedmeasure(Wilson &
Reschly, 1996). It is important to consider, however, that the Wechsler ap-
proachtomeasuringintelligencerepresentsatraditioninpsychological assess-
ment that beganwiththepublicationof theWechslerBellevueScalesin1939.
Wechsler developedtheWechslerBellevueScaleslargelyonthebasisof the
methodsdescribedinthebookArmyMental Testing(Yoakum&Yerkes, 1920),
whichwereusedbytheUSmilitaryintheearlypart of thetwentiethcentury.
Wechslerborrowedmanyofthetestsandconvertedthemfromgroupadminis-
trationtotheindividuallyadministeredformatusedtoday. Thetechnologyhas
withstoodthetest of time, but recent researchhassuggestedthat thisgeneral
intelligenceapproach has considerablelimitationswhen exceptional children
areevaluated, especially thosewith learningdisabilities(Naglieri, 2000). The
utility of theWechsler scales for theevaluation of thosespecic intellectual
problemsassociatedwithlearning-disabledchildrensacademicfailurehasled
someto consider alternativeperspectives(Kaufman& Kaufman, 1983; Stern-
berg, 1988; Das, Naglieri, & Kirby, 1994). There have been advances in
psychology(especiallycognitiveandneuropsychology), whichoccurredafter
thedevelopment of theWechsler scales, that haverelevancetotheevaluation
of childrenwithlearningproblems.
Oneof themost important developmentsintheeldof psychologythat has
considerablerelevancetotheevaluationof childrenwithlearningdisabilitiesis
thecognitiverevolution. Thisrevolutioninthinkingwasinitiatedbycognitive
psychologists who studied cognition, neuropsychology, neuroscience, and
higher mental processes. Therevolution described, for examplein thebook
PlansandtheStructureofBehavior byMiller, Galanter, andPribram(1960), hada
141
substantial inuenceonbothappliedandtheoretical psychologistsandeduca-
tors. These and other researchers encouraged a move fromthe behavioral
approach, whichfocusedpsychologyonobservableevents, toawillingnessto
makeinferencesabout behaviorsassociatedwithinternal cognitiveprocesses.
Amongthecognitiveandneuropsychological researcherswho helpedstimu-
latethisrevolutionwasA.R. Luria, themost frequentlycitedSoviet scholar in
American, British, and Canadian psychology periodicals (Solso & Hoffman,
1991, p. 251). Luriasworks includedHumanBrainandPsychological Processes
(1966), Higher Cortical FunctionsinMan(1980), TheWorkingBrain(1973), and
LanguageandCognition(1982), whichweresomeof hismost signicant works
that helpedstimulatethecognitiverevolution. Thecognitiverevolutionalso
inuencedhowintelligencewasconceptualizedandmeasured.
The impact of the cognitive revolution on the assessment practices of
psychologistswasapparent with thepublicationof theKaufman Assessment
Batteryfor Children(K-ABC; Kaufman& Kaufman, 1983). Thistest reected
theauthors conceptualizationof intelligenceaccordingtocognitiveandneuro-
psychological perspectivesrather than thegeneral intelligenceapproach that
dominatedtheeldsincetheearly part of thetwentieth century. TheKauf-
mans reliance on the works of neuropsychologists such as Luria (1966),
Gazzaniga(1975), andKinsborne(1978), andof cognitivepsychologistssuchas
Neisser (1967) andDas, Kirby, andJarman(1975, 1979), placedthat test within
thecognitiverevolutionaryperspectiveandmarkedasignicant point in the
evolutionof intelligencetests. TheK-ABC model of SequentialSimultaneous
processesdifferedsubstantiallyfromthegeneral intelligenceandfactor analytic
approachtotheoryandtest building. Importantly, thistest wastherst of its
kindto redeneintelligenceascognitiveprocessesandthereby question the
makeup of traditional IQ tests. The idea that IQ tests could be improved
throughmodicationandredenitionbasedoncognitiveprocesseswithelim-
ination of achievement fromthemeasureof ability was, andstill is, arevol-
utionaryconcept.
Many scientic advancesarerootedin thework of thosethat havecome
before. TheK-ABCprovidedacognitiveframewithinwhichthenext alterna-
tiveto psychometricapproaches(e.g., Wechsler, StanfordBinet, Woodcock
Johnson, and Differential Ability Scales) would be placed. That test is the
CognitiveAssessment System(CAS), whichI publishedwithmycolleagueJ.P.
Das(Naglieri & Das, 1997a). Thistest wasdevelopedaccordingto aspecic
theoryof abilityredenedasPlanning, Attention, Simultaneous, andSuccess-
ive(PASS) cognitiveprocesses(Naglieri & Das, 1997a), based largely on the
neuropsychological workof A.R. Luria(1966, 1973, 1980, 1982). Inadditionto
142 Jack A. Naglieri
being grounded on a specic theory of cognitive processes the CAS was
designedtomeasuremorecomponentsthanhadever beenincludedinatestof
ability. DasandI usedthePASStheory with its rootsin thesamecognitive
revolutionarythinkingthat ledtotheK-ABC, but wefocusedmoredirectlyon
theneuropsychological workof A.R. Luria.
TheCAS, liketheK-ABC, takesacognitiveprocessingapproachto theory
building rather than a factor analytic one, and puts more emphasis on the
speciccomponentsof intelligence, rather thanonIQscores. Infact, thefour
PASSscalesrepresent thebasic psychological processes, describedin Individ-
ualswithDisabilitiesEducationAct(IDEA1997; seeNaglieri &Sullivan, 1998),
whichareused, for example, inthedenitionof aspeciclearningdisability.
Thesebasic psychological processescanbeusedto gainanunderstandingof
howwell thechildthinksandtodiscoverstrengthsandneedsof childrenwhich
can then be used for effective differential diagnosis, to make appropriate
instructional decisions, andto select or designappropriateinterventions. The
CAScanachievethesegoalsbecauseof theimportantrolePASSprocesseshave
inacademicperformance.
Description of the PASS theory and CAS
PASS theory
Naglieri (1999) statesthat Planning, Attention, Simultaneous, andSuccessive
cognitiveprocessesarethebasicbuildingblocksofhumanintellectual function-
ing. Thesefour processesformaninterrelatedsystemof functionsthat interact
with an individuals base of knowledgeand skills. Accordingto this theory,
humanabilityincludesfour components:
Planningisamental activitythat providescognitivecontrol, useof processes,
knowledgeandskills, intentionality, andself-regulation.
Attentionisamental activitythat providesfocused, selectivecognitiveactivity
over timeandresistancetodistraction.
Simultaneous is amental activity by which the child integrates stimuli into
groups.
Successive is a mental activity by which the person integrates stimuli in a
specicserial order toformachain-likeprogression.
Planning
This process provides the means to solve problems of varying complexity
and may involve attention, simultaneous, and successive processes as well
as knowledge and skills. Planning is central to all activities for which the
143 Using the Cognitive Assessment System (CAS) with learning-disabled children
individual hastodeterminehowtosolveaproblem, includingself-monitoring
andimpulsecontrol aswell asplangeneration. SuccessonCASPlanningtests
requiresthechildtodevelopaplanof action, evaluatethevalueof themethod,
monitor itseffectiveness, reviseor reject aplan to meet thedemandsof the
task, andcontrol theimpulseto act without careful consideration. All of the
CASPlanningsubtestsrequiretheuseof strategiesfor efcient performance
and the application of these strategies to novel tasks of relatively reduced
complexity. Theinvolvementof strategiestosolveCASPlanningtestsisamply
documentedbyNaglieri andDas(1997b).
Attention
Attention is amental processby which theindividual selectively focuses on
particular stimuli while inhibitingresponses to competingstimuli presented
over time. All CAS tests included on the Attention scale demand focused,
selective, sustained, andeffortful activity. Focusedattentioninvolvesdirected
concentrationtowardaparticular activity, andselectiveattentionisimportant
for theinhibitionof responsestodistractingstimuli. Sustainedattentionrefers
to the variation of performanceover time, which can be inuenced by the
differentamount of effortrequiredtosolvethetest. All CASAttentionsubtests
present children with competing demands on their attention and require
sustainedfocus.
Simultaneousprocessing
Simultaneousprocessinggivestheindividual themeansto integrateseparate
stimuli into a single whole or group. An essential aspect of simultaneous
processingistheneedtoseehowall of theseparateelementsareinterrelated
intoawhole. For thisreason, SimultaneousProcessingtestshavestrongspatial
and logical aspects. The spatial aspect of simultaneous processing includes
perception of stimuli as a whole. For example, simultaneous processing is
involvedingrammatical statementsthat demandtheintegrationof wordsinto
awholeidea. Thisintegrationinvolvescomprehensionof wordrelationships,
prepositions, andinectionsso theperson can obtain meaningbasedon the
wholeidea. SimultaneousProcessingtests in theCASrequireintegration of
partsintoasinglewholeandunderstandingoflogical andgrammatical relation-
ships. These processes are used in tests that involve nonverbal and verbal
content, andrecall of thestimuli, but theessential ingredient issimultaneous
processing.
Successiveprocessing
The essence of successive processing is the organization of stimuli into a
specicserial order thatformsachain-likeprogression. Successiveprocessingis
requiredwhenapersonmust arrangethingsinastrictlydenedorder, where
eachelement isonlyrelatedtothosethat precedeit andthesestimuli arenot
interrelated. Successiveprocessinginvolvesboth theperception of stimuli in
sequence and the formation of sounds and movements in order. For this
reason,successiveprocessinghasstrongsequential componentsandisinvolved
withthesyntaxof language, for example. All CASSuccessivetestsdemanduse,
repetition, or comprehensionbasedonorder.
PASS processes
ThefourPASSprocessesarenotunrelatedconstructsthatfunctioninisolation,
but, instead, theoppositeisassumed. Luria(1973) statedthiswhenhewrote,
each formof conscious activity is always a complex functional systemand
takes place through the combined working of all three brain units, each of
which makes its own contribution. The well established facts of modern
psychologyprovideasolidbasisfor thisview (p. 99). Thisconceptionmeans
that thefour PASSprocessescan bethought of as afunctional system, or a
workingconstellation(Luria, 1966, p. 70)of cognitiveactivity, thuspermitting
individualstoperformthesametaskwiththecontributionof variousprocesses
andtheparticipationof theknowledgeandskills. Althougheffectivefunction-
ingisaccomplishedthroughtheintegrationof all PASSprocessesasdemanded
bytheparticular task, not everyprocessisequallyinvolvedineverytask. For
example,testslikethoseincludedintheCASsubtestsmaybeheavilyweighted,
orinuenced,byasinglePASSprocess. Infact, oneof thegoalsindevelopment
of theCASwastoefcientlymeasureeachof thefour processes.
Description of the CAS
The development of the CAS was based on a systematic effort to develop
efcient measuresof theprocessesincludedinthePASStheoryandtoprovide
anindividuallyadministeredinstrumentforassessingtheseimportantcognitive
functioning. ThePASStheorywasusedtoguidetheconstructionof theCAS
and the content of the test was not constrained by previous approaches to
intelligence. CAS reects the merging of high psychometric qualities and a
specic theory of cognitive processing within the context of providing a
user-friendly, practical test. Thus, CASwasdevelopedtointegrateboththeor-
etical andappliedknowledgeinpsychology.
There were several assumptions and goals that were used during the
development of theCAS, whichareasshownbelow.
1. Atest of intelligenceshouldbebasedonasoundtheory.
2. A theory of intelligence should be based on modern cognitive and neuro-
psychological constructs.
3. A theory of ability should be based on the view that intelligence is best
describedascognitiveprocessesrather thantheconcept of general ability.
4. Atheoryof cognitivefunctioningshouldhaveasizeableresearchbaseandhave
beenproposed, tested, modied, andshowntohaveseveral typesof validity.
5. Thetermcognitiveprocesses shouldreplacethetermintelligence.
6. A theory of cognitiveprocesses should informtheuser about thosespecic
abilitiesthat arerelatedtoacademicsuccessesandfailures.
7. Atheoryof cognitiveprocessesshouldhaverelevancetodifferential diagnosis.
8. A theory of cognitive processes should provide guidance to the selection
and/ or development of effectiveprogrammingfor intervention.
9. A test of cognitiveprocessingshouldfollowcloselyfromthetheoryof cogni-
tiononwhichit isbased.
10. Atestof cognitiveprocessingshouldevaluateanindividual usingitemsthatare
asfreefromacquiredknowledgeaspossible.
Development of CAS subtests
CASsubtestsweredevelopedspecicallytooperationalizethePASStheoryof
cognitive processing over a period of about 25 years (summarized in three
sources:Dasetal., 1979, 1994;Naglieri &Das, 1997b). Selectionoftestswasnot
dictated or constrained by psychometric theories of human abilities (e.g.,
Carroll, 1993) or by thecontent of traditional tests of intelligence. Thesole
criterion for inclusion was each subtests correspondence to the theoretical
frameworkof thePASStheory. Development of theCASsubtestswasaccom-
plished followingan experimental sequenceinvolvingitemgeneration, data
analysis, test revision, and re-examination until the instructions, items, and
other dimensionswererenedthroughaseriesof pilot tests, researchstudies,
national tryouts, and national standardization. This process allowed for the
identicationof subteststhat provideanefcient wayto measureeachof the
processes(Daset al., 1994; Naglieri &Das, 1997b).
TheCASisorganizedaccordingtothePASStheoryand, for that reason, is
comprisedof four scales. ThePlanning, Attention, Simultaneous, andSuccess-
ivescalesarederivedfromthesumofsubtestsincludedineachrespectivescale.
LiketheFull Scalescore(derivedfromthesumof all subtests), eachPASSscale
hasanormativemeanof 100andastandarddeviationof 15. ThePASSscales
Table 5.1. Structure of the CAS scales and subtests
Full Scale Scales Subtests
Planning
* MatchingNumbers
* PlannedCodes
PlannedConnections
Simultaneous
* Nonverbal Matrices
* VerbalSpatial Relations
FigureMemory
Attention
* ExpressiveAttention
* Number Detection
ReceptiveAttention
Successive
* WordSeries
* SentenceRepetition
SpeechRate(ages57years) or SentenceQuestions
(ages817years)
*SubtestsincludedintheBasicBattery.
represent achildscognitivefunctioningandareusedin theidenticationof
specic strengths and weaknesses in cognitive processing. There are two
combinationsofsubtestsusedtoobtainPASSScaleandFull Scalescores. Oneis
calledtheBasicBatteryandtheother theStandardBattery. TheBasicBattery
includeseight subtests(twoper PASSscale), theStandardBatteryincludesall
12subtests.
TheCASsubtestsandscalestowhichtheyareassignedareshowninTable
5.1.Eachsubtestscaledscoreissetatameanof10andastandarddeviationof3.
TheCASsubtests areintended to be measures of thespecic PASSprocess
correspondingtothescaleonwhichtheyarefoundratherthanspecicabilities.
They do, however, havevaryingcontent (someareverbal, somenot; some
involvememory, othersnot, etc.), but themost important point isthat eachis
aneffectivemeasureofaspecicPASSprocess.Eachsubtestisdescribedbelow.
Planning Scale
MatchingNumbersconsistsof four pages, eachwitheightrowsof numbers, six
numbers per row. Children areinstructed to underlinethetwo numbers in
eachrowthat arethesame. Numbersincreaseinlengthacrossthefour pages
fromonedigit tosevendigits, withfour rowsfor eachdigit length. Eachitem
hasatimelimit. Thesubtest scoreisbasedon thecombination of timeand
number correct for eachpage.
Planned Codes contains two pages, each with adistinct set of codes and
arrangementof rowsandcolumns. Alegendatthetopof eachpageshowshow
letterscorrespondtosimplecodes(e.g., A, B, C, DcorrespondtoOX, XX, OO,
XO, respectively). Eachpagecontainssevenrowsandeight columnsof letters
without codes. Childrenll intheappropriatecodesinemptyboxesbeneath
eachletter. Ontherst page, all theAsappear intherst column, all theBsin
thesecondcolumn, all theCsinthethirdcolumn, andso on. Onthesecond
page, lettersarecongured in adiagonal pattern. Children arepermittedto
completeeachpageinwhatever fashiontheydesire. Thesubtestscoreisbased
onthecombinationof timeandnumber correct for eachpage.
Planned Connections contains eight items. The rst six items require
childrento connect numbersappearinginaquasi-randomorder onapagein
sequential order. Thelast twoitemsrequirechildrentoconnect bothnumbers
andlettersin sequential order, alternatingbetween numbersandletters (for
example, 1-A-2-B-3-C). Theitemsareconstructedsothat childrennever com-
pleteasequencebycrossingonelineover theother. Thescoreisbasedonthe
total amount of timeinsecondsusedtocompletetheitems.
Attention Scale
ExpressiveAttentionusestwodifferent setsof items, dependingontheageof
thechild. Childrenagedeight yearsandolder arepresentedwiththreepages.
Ontherst page, childrenreadcolor words(i.e., BLUE, YELLOW, GREEN,
andRED), presentedinquasi-randomorder. Next, theynamethecolorsof a
seriesof rectangles(printedinblue, yellow, green, andred). Finally, thewords,
BLUE, YELLOW, GREEN, andRED, areprintedin inksof adifferent color
fromthecolorsthewordsname. Thechildisinstructedtonamethecolor of
inkthewordisprintedin, ratherthantoreadtheword. Performanceonthelast
pageis used as themeasureof attention. Thesubtest scoreis based on the
combinationof timeandnumber correct.
Number Detectionconsistsof pagesof numbersthat areprintedindifferent
formats. Oneachpage, childrenarerequiredtondaparticular stimulus(e.g.,
thenumber 1, 2, and3printedin an open font) on apagecontainingmany
distractors(e.g., thesamenumbersprintedinadifferent font). Thereare180
stimuli with45targets(25%targets)onthepages. Thescorereectstheratioof
accuracy(total number correct minusthenumber of falsedetections) tototal
timefor eachitemsummedacrosstheitems.
Receptive Attention is a two-page paper-and-pencil subtest. On the rst
page, lettersthat arephysicallythesame(e.g., TT but not Tt) aretargets, but
onthesecond, lettersthat havethesamename(e.g., Aanot Ba) aretargets.
Eachpagecontains200pairsof letterswith 50targets(25%targets) andthe
sameset of distractors. Thescorereectstheratioof accuracy(total number
correct minus the number of false detections) to total time for each page,
summedacrosspages.
Simultaneous Scale
Nonverbal Matrices is a 33-itemsubtest that utilizes shapes and geometric
designsthat areinterrelatedthroughspatial or logical organization. Children
are required to decode the relationships among the parts of the item and
choosethebestof sixoptionstooccupyamissingspaceinthegrid. Eachmatrix
itemisscoredascorrect or incorrect. Thesubtest scoreisbasedon thetotal
number of itemscorrectlyanswered.
VerbalSpatial Relationsiscomposedof 27itemsthat requirethecompre-
hension of logical and grammatical descriptions of spatial relationships.
Childrenareshownitemscontainingsixdrawingsandaprintedquestionatthe
bottomof each page. The items involve both objects and shapes that are
arrangedinaspecic spatial manner. For example, theitem, Which picture
showsacircletotheleftof acrossunder atriangleaboveasquare? includessix
drawingswithvariousarrangementsof geometricgures, onlyoneof which
matchesthedescription.Theexaminerreadsthequestionaloudandthechildis
requiredtoselecttheoptionthatmatchestheverbal description.Childrenmust
indicatetheir answerswithina30-secondtimelimit. Thesubtest scorereects
thetotal number of itemscorrectlyanswered.
FigureMemoryisa27-itemsubtest. Thechildisshownatwo-dimensional
or three-dimensional geometric gure for ve seconds. The gure is then
removed, and the child is presented with aresponsepage that contains the
original design embeddedin alarger, morecomplexgeometricpattern. The
child is asked to identify the original design embedded within the more
complexgure. Tobescoredcorrect, all linesof thedesignhavetobeindicated
without any additions or omissions. The score reects the total number of
correct items.
Successive Scale
Word Series requires the child to repeat words in the sameorder as stated
by the examiner. The test consists of the following nine single-syllable,
high-frequency words: Book, Car, Cow, Dog, Girl, Key, Man, Shoe, Wall.
Thereare27itemsthat theexaminer readstothechild. Eachseriesrangesin
lengthfromtwotoninewords, presentedat therateof onewordper second.
Itemsarescoredascorrect if thechildreproducestheentirewordseries. The
scoreisbasedonthetotal number of itemscorrectlyrepeated.
SentenceRepetitionrequiresthechildto repeat 20sentencesthat areread
aloud. Eachsentenceiscomposedof color words(e.g., Theblueisyellowing).
Thechildisrequiredtorepeat eachsentenceexactlyasit waspresented. Color
wordsareutilizedsothatthesentencescontainlittlesemanticmeaning, tohelp
reducetheinuenceof SimultaneousProcessingandaccentthedemandsof the
syntaxof thesentence. Eachitemisscoredcorrect if thesentenceisrepeated
exactlyaspresented. Thesubtest scorereectsthetotal number of sentences
correctlyrepeated.
SentenceQuestionsisa21-itemsubtest that usesthesametypeof sentences
asthoseinSentenceRepetition. Childrenfromages8to17arereadasentence
andthenaskedaquestionabout thesentence. For example, theexaminer says,
Theblueisyellowing, andasksthefollowingquestion: Who isyellowing?
The correct answer is The blue. Responses are scored correct if the child
successfully answers thequestion regarding thesentence. The subtest score
reectsthetotal number of questionsansweredcorrectly.
CAS scale reliabilities
TheCASsubtestsandscaleshavehighreliabilityandmeetor exceedminimum
valuessuggestedbyBracken(1987). TheFull Scalereliabilitycoefcientsfor the
Standard Battery range froma low of .95 to a high of .97 and the average
reliabilitiesfortheStandardBatteryPASSscalesare.88(PlanningandAttention
scales)and.93(SimultaneousandSuccessivescales). TheBasicBatteryreliabili-
tiesareasfollows: Full Scale=.87, Planning=.85, Simultaneous=.90, Atten-
tion=.84, andSuccessive=.90.
Normative and validity studies of CAS
CAS standardization
TheCASwasstandardizedon alargerepresentativegroup of children aged
517yearsusingastratiedrandomsamplingplanwhichresultedinasample
that closelymatchestheUSpopulation. Childrenfrombothregular education
andspecial educationsettingswereincludedintheir appropriateproportions.
Duringthestandardizationandvaliditystudydatacollectionprogram, atotal
of 3072children wereadministered theCAS. Of that sample, 2200children
madeupthenormativesampleandanadditional 872childrenparticipatedin
reliabilityandvalidity. Asubsampleof 1600of theentirestandardizationgroup
wasalsoadministeredagroupof achievement tests. TheCASstandardization
samplewasstratiedonthebasisof: age(5years0monthsthrough17years11
months); gender (female, male); race(black, white, Asian, NativeAmerican,
other);Hispanicorigin(Hispanic, Non-Hispanic); Region(Midwest, Northeast,
South, West); community setting (urban/ suburban, rural); classroomplace-
ment (full-timeregular classroom, part-timespecial education resource, full-
timeself-containedspecial education); educational classication(learningdis-
ability, speech/ languageimpairment, socialemotional disability, mental retar-
dation, giftedness, andnon-special education); andparental educational attain-
ment level (lessthanhighschool degree, highschool graduateor equivalent,
somecollegeor technical school, four or moreyearsof college) Themethods
usedto collect thedataweredesignedto yieldhigh-qualitydataonasample
that closelyrepresentstheUSpopulation(Naglieri & Das, 1997b). For details
on therepresentativenessof thesample, seetheCASinterpretivehandbook
(Naglieri &Das, 1997b).
Validity
Naglieri andDas(1997b) andNaglieri (1999) provideconsiderableinformation
about thevalidityof theCAS. Naglieri (1999) showsthat theCASoffersmany
advantages, but there are three important dimensions of validity that are
particularly relevant to the discussion of the use of this test with learning-
disabled children. The rst point involves different PASS proles found for
childrenwithreadingdisabilitiesandattentiondecit hyperactivitydisorders.
Second, theCASis morestrongly relatedto achievement than similar tests.
Finally, theCAShasbeenshowntohavedirect linkstointervention. Eachof
thesethreepointswill bemorefullydiscussedbelow.
PASSproles
Naglieri (1999) provides a discussion of cognitive proles for children with
attentiondecit andlearningdisabilitiesfor theWechsler IntelligenceScalefor
Children, Third Edition (WISCIII), WoodcockJohnson Tests of Cognitive
AbilityRevised(WJR)Cognitive, andCAStakenfromthetest manualsanda
recent publication by Woodcock (1998). In theWISCIII manual, Wechsler
(1991) provides three studies involving children with learning disabilities
(n=65) and attention decit hyperactivity disorder (n=68). The resulting
prolesof WISCIII Indexscoresfor thetwogroupsof childrenwereessential-
lythesame. Similarly, Woodcock(1998) reportedprolesfor thesevenGfGc
Fig. 5.1. Prolesof AbilityscoresontheCAS, WISCIII, andWJRCognitiveTestbatteries. (LD,
learningdisabled; ADHD, attentiondecit hyperactivitydisorder; Plan, Planning; Sim, Simulta-
neous; Att, Attention; Succ, Successive; VC, Verbal Comprehension; PO, Perceptual Organiz-
ation; FFD, FreedomfromDistractibility; PS, ProcessingSpeed.)
clusters for children with learning disabilities (n=62) and attention decit
disorders (n=67). His results also showed similar proles for the groups.
Therefore, theseven-factor GfGc, liketheWISCIII four Indexlevel scores,
does not yield distinctive proles of scores for the learning disabilities and
attentiondecit hyperactivitydisorder samplesused. Incontrast aretheresults
for theCAS. InthestudiesreportedbyNaglieri andDas(1997b), childrenwith
readingdisorders(n=24)andattentiondecit(n=66)earnedPASSscoresthat
showadifferent pattern. Theattentiondecit hyperactivitydisorder children
werepoor inPlanningandsomewhat lower inAttention, whereasthereading
disorderssamplewaspoor inSuccessiveProcessing. Thus, theprolesfor the
various tests (shown in Fig. 5.1) were different fromthoseobtained for the
Wechsler andWoodcock.
Thecomparativeresults for theWISCIII, WJR, and CASillustratehow
different theeffectivenessof theseinstrumentsarein sensitivity to theprob-
lems children with learning disabilities have. The failure of the Wechsler
accurately to identify learning-disabledchildren is well documented, despite
the widespread use of scale and subtest interpretive methods (Kavale &
Forness, 1984; McDermott, Fantuzzo, & Glutting, 1990). Naglieri (2000) has
proposedthat subtest analysisisproblematicbecausetheWechsler scalesdo
not measureabilitybroadlyenough, nor doesthat test differentiateabilityinto
important parts. This is why repeated attempts to validateWechsler prole
analysishavemetwithfailure.Moreover, thereisnoevidencethatreanalysisof
theWechsler subtests, for exampleusingthecrossbatteryapproachadvocated
byMcGrewandFlanagan(1998), offersanadvantage. Infact, thedatainFig.
5.1showthattheGfGcapproachutilizedbyWoodcockwasalsodiagnostically
ineffective. Thisisconsistentwithdiscussionsof thevalidityevidenceonGfGc
providedbyMcGrewet al. (1997) andHornandNoll (1997), whichprovideno
evidenceof differential prolesfor exceptional children.
Relationshipstoachievement
BecausetheCASwasconstructedusinganalternativemethodtotheWechsler
scales, one important test of the theorys utility is to examine how well it
correlateswithachievement. Naglieri (1999) conductedastudyof therelation-
ships between several tests of ability and achievement and found that the
correlationbetween theFull Scaleof theCASandachievement washighest
amongthemajor intelligencetests. Thisndingisespeciallyimportant for two
reasons. First, oneof themost important dimensionsof validity for atest of
cognitive ability is the relationship to achievement (Brody, 1992; Cohen,
Swerdlik, &Phillips, 1992). Second, theCAS, unliketheWechsler scales, does
not include subtests that are highly reliant on acquired knowledge (e.g.,
Arithmetic, Information, Vocabulary).
Naglieri (1999) summarized several studies involving large numbers of
children and several important tests. It was found that median correlation
betweentheWISCIII (Wechsler, 1991)Full ScaleIntelligenceQuotient(FSIQ)
and all Wechsler Individual Achievement Test (WIAT) achievement scores
(Wechsler, 1992) is.59for asampleof 1284childrenaged519yearsfromall
regionsof thecountry, different racial and ethnic groups, and each parental
educational level. Asimilar correlationof .60wasfoundbetweentheDifferen-
tial AbilityScales(Elliott, 1990), General Conceptual Ability, andAchievement
in Basic Number Skills, Spelling, and Word Readingis for asampleof 2400
childrenincludedinthestandardizationsample. UsingtheWoodcockJohnson
RevisedBroadCognitiveAbilityExtendedBatteryScore(whichiscomprisedof
sevenGfGcfactors) andWoodcockJohnsonRevisedAchievement Test Bat-
teries(reportedbyMcGrew, Werder, &Woodcock, 1991), themedianwas.63
(n=888childrenaged6, 9, and13years). Thisvalueisvirtuallythesameasthe
mediancorrelationbetweentheK-ABC Mental Processingcomposite(MPC)
andtheK-ABCAchievement, WoodcockReadingMasteryTest, andKeyMath
DiagnosticMathTest reportedbyKaufmanandKaufman(1985), whichis.63
for 2636for childrenaged2
1
2
through12
1
2
years. Importantly, theK-ABC only
hastwoscales, andcontent that doesnot includeverbal/ achievement content
likethat foundintherst threetests. Finally, themediancorrelationbetween
the CAS Full Scale and the WJR Test of Achievement (Naglieri and Das,
1997b) was.70(for arepresentativesampleof 1600childrenaged517years
Table 5.2. Relationships between achievement and ability as measured by several
intelligence tests
Abilitytest n Correlation Percentage
variance
WISCIII 1284 .59 35
Differential AbilityScale 2400 .60 36
WoodcockJohnsonCognitive 888 .63 40
K-ABC 2636 .63 40
CAS 1600 .70 49
whocloselymatchtheUSpopulation).TheseresultsarepresentedinTable5.2.
The correlations between the various ability tests and achievement sum-
marizedby Naglieri (1999) illustrated that theCASFull Scalescorewas the
most powerful predictor of achievement, accounting for considerably more
varianceinachievement thananyof themeasuresincluded. Thesendings, in
conjunctionwith separateprolesfor hyperactivity disorder attention decit
andreading-disabledchildren andtheintervention implicationsof PASSper-
formance (discussed later in this chapter), provide strong support for the
validityof theCAS. Additionally, theycast doubt onstatementsbyMcGrewet
al. (1997) that theGfGctheoryisthemost useful frameworkfor understand-
ingcognitivefunctioning (p. 194). Instead, thesedatabegthequestion: why
would seven GfGc scales be needed if two on the K-ABC (Sequential and
Simultaneous) arejust as effectivefor prediction of achievement and if four
fromCAS (PASS) predict even higher?Moreover, given the differences be-
tweenlearning-disabledandattentiondecithyperactivitydisorder childrenon
PASS, thisscaleappearstobewell suitedfor analysisof thecognitiveproblems
childrenwithlearningdisabilitiesmayhave.
Intervention
Twoapproachestothetranslationof CASresultsintointerventionfor children
with learning problems are discussed in this chapter. The rst is the PASS
Remedial Program(PREP by J.P. Das, 1999), andthesecondisthePlanning
FacilitationMethoddescribedbyNaglieri (1999). Bothof theseapproachesare
basedonPASSanduseinformationfromthetheoryto buildanintervention
method. Inaddition, bothhavebeenshowntobeeffective: PREP for reading
decoding, andPlanningFacilitationfor mathcalculation.
Fig. 5.2. Illustrationof PREP Global andBridgingtasks.
PREPRemedial Program
ThePREP programhasitsrootsintheearlyresearchof Brailsford, Snart, and
Das (1984), Kaufman and Kaufman (1979), and Krywaniuk and Das (1976).
These researchers showed that students trained to use simultaneous and
successive processes more efciently, improved their performance on that
processandsometransfer to specicreadingtasksalsooccurred (Ashman&
Conway, 1997, p. 169). Thecurrent versionof PREP (Das, 1999) makesmore
explicit the connection between successive and simultaneous cognitivepro-
cessesand reading. Thetrainingprogramincludes moretasks that focus on
successiveprocessingthansimultaneousprocessing. Eachtaskhastwoforms,
calledglobal andbridging.
ThePREPglobal tasksarenonacademicincontent andspecicallydesigned
toillustratetheconcept. Thebridgingtasksaresimilar toreading, but repeat
thesame conceptual point. For example, Fig. 5.2shows an illustration of a
successiveglobal andbridgingtaskinPREP. Inthisexample, thechildisbeing
taught about atwo-stepsequenceusingthebeginningsandendingsof pictures
of animals. Toextendthistothebeginningsandendingsof words, thesecond
bridgingtaskisprovided. Similar tasksareusedtoteachthechildrentowork
effectivelywithlonger sequences.
ThePREPprogramhasbeenexaminedinrecentresearchstudies, withgood
results. Carlson andDas(1997) andDas, Mishra, and Pool (1995) conducted
studiesof theeffectivenessof PREP for childrenwithreadingdecodingprob-
lemsintheUSA. TheCarlsonandDas(1997)studyinvolvedChapter1children
who receivedPREP (n=22) or regular readingprogram(control n=15) and
weretestedbeforeandafter interventionusingthemeasuresof WordAttack
andWord Identication. Theintervention was conductedin two 50-minute
10
15
20
25
30
WA-
PREP
WA-C WI-
PREP
WI-C
Pre
Post
Das, Misha,& Pool (1995)
10
15
20
25
30
WA-
PREP
WA-C WID-
PREP
WID-C
Pre
Post
Carlson & Das (1997)
Fig. 5.3. Researchreport of two experimentsontheeffectivenessof PREP. (WA-PREP, Word
AttackPREP group; WAC, WordAttackcontrol group; WI-PREP, WordIdenticationPREP
group; WI-C, WordIdenticationcontrol group.)
sessionseachweekfor 12weeks. Similarly, theDaset al. (1995) studyinvolved
51reading-disabledchildrenwhoweredividedintoaPREP(n=31)andcontrol
(n=20) group. There were15PREP sessions given to small groups of four
children. WordAttack andWord Identication testswereadministeredpre-
treatmentandpost-treatment. Inbothstudies, PREPgroupsoutperformedthe
control groups. Thesendings(summarizedinFig. 5.3) suggest that process
trainingcanassistinspecicaspectsof beginningreading (Ashman&Conway,
1997, p. 171).
PlanningFacilitation
ThewayinwhichtheCASscoresonPASScanbeappliedtointerventionsfor
childrenwithlearningdisabilitieswasclosely examinedin aseriesof papers.
These intervention studies focused on planning and math based on similar
research by Cormier, Carlson, and Das (1990) and Kar et al. (1992). These
researchers developed a method that stimulated childrens use of planning,
which had positive effects on performance. The method was based on the
assumption that planningprocessesshouldbefacilitatedrather than directly
instructed, so that children discover thevalueof strategy usewithout being
specicallytoldto do so. BoththeCormier et al. (1990) andKar et al. (1992)
investigations demonstrated that students differentially beneted from a
verbalization technique intended to facilitate planning. They found that
participantswho initially performed poorly on measures of planningearned
signicantly higher scores than those with good scores in planning. The
verbalizationmethodencouragedawell-plannedandorganizedexaminationof
thedemandsof thetaskandthishelpedthosechildrenwhoneededtodothis
themost (thosewith low planningscores). Thesestudieswerethebasis for
three experiments by Naglieri and Gottling (1995, 1997) and Naglieri and
Johnson (2000), which focusedon improvingmath calculation performance.
Therst two researchstudiesbyNaglieri andGottlingdemonstratedthat an
interventionthatfacilitatedplanningledtoimprovedperformanceonmultipli-
cationproblemsfor thosewithlowscoresinplanning, but minimal improve-
ment wasfoundfor thosewithhighplanningscores. Thus, learning-disabled
studentsbeneteddifferentiallyfromtheinstructionbasedontheir cognitive
processingscores; matchingtheinstruction to thecognitiveweaknessof the
childwasshowntobeimportant.
AdescriptionofthePlanningFacilitationintervention
ThePlanningFacilitation method used in these studies has been applied to
individual or groupsof children. Inthemost recent studies, teachersprovided
instructionto thestudentsabout two to threetimesper week andconsulted
withtheschool psychologistsonaweeklybasisto assist intheapplicationof
theintervention, monitor theprogressof thestudents, andconsider waysof
facilitating classroom discussions. Students completed mathematics work
sheetsinasequenceof about sevenbaselineand21interventionsessionsover
aboutatwo-monthperiod. Intheinterventionphase, thestudentsweregivena
ten-minuteperiodforcompletingamathematicspage, aten-minuteperiodwas
usedfor facilitatingplanning, andasecondten-minuteperiodfor mathematics.
All studentswereexposedtotheinterventionsessionsthat involvedthethree
ten-minute segments of mathematics/ discussion/ mathematics in 20-minute
instructional periods. During the group discussion, self-reection and dis-
cussionwerefacilitatedsothat thechildrenwouldunderstandtheneedtoplan
anduseanefcient strategywhencompletingthemathematicsproblems. The
teachersprovidedprobes which facilitated discussion designedto encourage
thechildrento consider variouswaysto bemoresuccessful. Whenastudent
providedaresponse, thisoftenbecamethebeginningpoint for discussionand
further development of theidea.
Teacher probesincludedstatementslikeHowdidyoudothemath?, What
could you do to get more correct? or What will you do next time? The
teachersmadenodirectstatementslike, That iscorrect, or Remember touse
that samestrategy, nor didtheyprovidefeedbackontheaccuracyonprevious
pages, andtheydidnot givemathematicsinstruction. Theroleof theteacher
Table 5.3. Summary of research investigations of the percentage of change from
baseline to intervention for children with good or poor Planning scores
Study HighPlanning LowPlanning Difference
(%) (%) (%)
Cormier, Carlson, &Das(1990) 5 29 24
Kar et al. (1992) 15 84 69
Naglieri &Gottling(1995) 26 178 152
Naglieri &Gottling(1997) 42 80 38
Naglieri &Johnson(2000) 11 143 132
Medianvaluesacrossall studies 15 84 69
wastofacilitateself-reectionand, therefore, encouragethestudentstoplanso
that they could complete the work sheets. In response to teacher probes,
studentsmadestatementssuchas, I havetoremember toborrow, I haveto
keepthecolumnsstraight or I get thewronganswer, andBesuretoget them
rightnotjustgetitdone.InterestedreadersshouldseeNaglieri (1999)for more
detailsonthePlanningFacilitationinterventionmethodandresultsfromthese
studies.
Theuseof thePlanningFacilitationmethodisperhapsbest illustratedinan
investigationby Naglieri andJohnson(2000) followingproceduressimilar to
thoseusedbyNaglieri andGottling(1995, 1997), but withalarger sampleand
withchildrenwithlearningproblems. Becausethepurposeof their studywas
todetermineif childrenwithspecicPASSproleswouldshowdifferent rates
of improvement, children wereselectedto formgroupsbased on their CAS
scores. Childrenwithacognitiveweakness(an individual PASSscoresigni-
cantly lower than the childs mean and below 85) in Planning, Attention,
Simultaneous, and Successive scales were selected to formcontrast groups.
Thecontrastinggroupsof childrenrespondedverydifferentlytotheinterven-
tion. Childrenwith acognitiveweaknessinPlanningimprovedconsiderably
over baselinerates, whereasthosewithnocognitiveweaknessimprovedonly
marginally. Similarly, children with cognitive weaknesses in Simultaneous,
Successive, and Attention also showed substantially lower rates of improve-
ment. Thus, these studies (summarized in Table 5.3) illustrate that PASS
processesarerelevant tointerventionfor childrenwithlearningdisabilities.
In summary, theresultsof thestudieson PREP and PlanningFacilitation
illustratehowCAScanbeusedtohelpdetermineif childrenevidenceaPASS
cognitiveprocessingweaknessthat hasrelevanceto interventionselectionor
design. Determinationof achildsPASSproleisalsouseful for diagnosticand
eligibilitydecisions. Thelatter isdiscussedinthenext section.
How CAS can be used for learning disabilities diagnosis
Thereauthorizationof theIndividualswithDisabilitiesEducationAct Amend-
mentsof 1997(IDEA1997) requiresthat achildsuspectedof havingaspecic
learningdisability(SLD) must beassessedinall areasrelatedtothesuspected
disability, including intelligence and academic performance. An evaluation
mustincludetechnicallysoundinstrumentsthatmeettheprescribedstandards,
includingprotectionsagainst racial, ethnic, language, or other bias. IDEA1997
includesthedenitionof childrenwithSLDthat follows(p. 46):
A disorder in one or more of the basic psychological processes involved in understanding or in
using language, spoken or written, which may manifest itself in an imperfect ability to listen,
speak, read, write, spell, or do mathematical calculations. Such term includes such conditions as
perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental
aphasia. Such term does not include a learning problem that is primarily the result of visual,
hearing, or motor disabilities, or mental retardation, of emotional disturbance, or of environment-
al, cultural, or economic disadvantage.
This denition of SLD has been operationalized in different ways (see
Shepherds thorough historical discussion of the issue of SLD denition in
Chapter 1). Professionalshavetraditionallydeterminedeligibilityonthebasis
of anabilityachievement discrepancyor identicationof acognitiveprocess-
ingdecit. Theseconceptscanbeintegratedintoamorecompleteapproachto
theidenticationofchildrenwithSLDsbasedonpsychological processing(e.g.,
PASS)cognitiveproblems. PASSprocessescanbeusedasameanstodenethe
basic psychological processes described in IDEA 1997(Naglieri, 1999), and
practitionersandresearcherscanusetheCASto obtainscoresthat represent
thesebasic psychological processes. TheCASscorescanbeappliedto detect
disordersinoneor moreof thebasic psychological processesandwithinthe
widelyuseddiscrepancymodel.
The discrepancy approach to the identication of SLD children became
popular, inpart, becausethemost widelyusedIQtests(Wechsler scales) were
not developed to measure basic psychological processes, but rather were
designedaccordingtotheconcept of general intelligence. Thus, theWechsler
providedaconvenient wayto assessdiscrepancies. Inorder to assessSLD on
thebasisof aprocessingdisorder, somethingother thanatraditional general
intelligenceIQ test is required. Fortunately, in recent years such tests have
becomeavailable. TheK-ABC isoneexamplethat providesatest tomeasure
Sequential andSimultaneousprocesseswhichcanbeusedwithintheguidelines
set forthintheIDEA1997. Another test, for exampletheWoodcockJohnson
Tests of Cognitive Ability (Woodcock & Johnson, 1989b), has a few scales
describedasmeasuresof processing(Visual ProcessingandAuditoryProcess-
ing) which could offer another option. However, thetest is largely built on
factor analysisrather than on acomprehensivetheory of basic psychological
processes, andto dateno empirical evidencesubstantiatestheuseof specic
GfGcabilityscoresinmakingdiagnostic(or treatment) recommendations(see
McGrewet al., 1997, for adiscussionof thesepoints). Thus, it appearsthat the
K-ABCandCASarethebest optionsfor theassessment of basicpsychological
processes within the guidelines provided in IDEA 1997. In the following
section, theproceduresfor theidenticationof weaknessesinbasicpsychologi-
cal processesarediscussed, alongwithmethodstorelatetheseweaknessesto
academicfailure.
Identicationofabasicpsychological processingdisorder
Naglieri andSullivan(1998)provideguidelinesfor howtheCAScanbeusedto
identify SLD children with a disorder in basic psychological processes as
denedin IDEA 1997. Analysis beginswith an examination of an individual
childsPASSproletodetermineif thereexistsarelativeorcognitiveweakness.
A relativeweaknessisfoundwhen at least onePASSScalestandardscoreis
signicantlylower thanthechildsmeanPASSscore. BecausethePASSscores
arecomparedtotheindividual childsaverage(andnot thenormativemeanof
100), this tells us about relative strengthsor weaknesses. For example, if a
childhasscoresof 114(Planning), 116(Simultaneous), 94(Successive), and109
(Attention), theSuccessivescore, whichis14.25pointsbelowthechildsmean
of 108.25, isarelativeweakness. Thisapproachhasbeenusedinintelligence
testing (see Sattler, 1988; Naglieri, 1993; Kaufman, 1994) for some time. In
contrast, adual criterion is used to determinewhether thereis acognitive
weakness. This includesarelativeweaknessandthelowest scorehas to be
belowaverage.
Naglieri (1999) suggeststhat achildwho hasadisorder inoneof thefour
PASSbasicpsychological processesshouldhaveevidenceof acognitiveweak-
ness becauseonlyinthiscaseisthechildsweaknessbelownormal expecta-
tions. That is, aPASSrelativeweaknesscouldstill bewithintheaveragerange,
but acognitiveweakness demands poor performancerelativeto age-mates.
The child with a cognitive weakness is likely to have signicantly lower
achievement scores and more likely to have been identied as exceptional
(Naglieri, 2000).
Relatingbasicpsychological processingweaknesstoacademics
Theviewthat alearning-disabledchildhasadisorder inabasicpsychological
processandasimilarlylowacademicscoreisanintegral partof thedenitionof
SLDinIDEA1997. Onewaytoevaluateif achildsscoresareconsistent with
this denition is to use the approach described by Naglieri (1999), which is
summarizedhere. Whenachildhasacognitiveweakness, it will beimportant
to determine the differences between the separate PASS Scale scores and
achievement.Todoso, compareall of thePASSscorestotheacademicscore. If
thehighPASSscoresaresignicantlydifferentfromachievement,butthePASS
cognitiveweaknessisnotsignicantlydifferentfromanacademicarea, thenan
important ndingisuncovered. That is, thereisacognitiveweaknessinPASS,
andtheweakPASSscoreisconsistent withthepoor academicscore(s). Thisis
calledaDiscrepancy/ ConsistencyApproachbyNaglieri (1999).
To apply the discrepancy/ consistency method, rst compare each of the
PASSandFull Scalescoresto achievement. Naglieri (1999) providestablesof
thesizeof thedifferencesneededfor signicancewhencomparingCAStoall
achievementscores. For example, if achildhasscorespresentedinFig. 5.4, it is
foundthattheSuccessivescoreof 71issignicantlylowerthanthechildsPASS
meanof 91.8. Similarly, thechildhasalowachievement test scoreinLetter
WordIdentication(84) andWordAttack (82). Thesescoresaresignicantly
lower than thePlanning, Simultaneous, andAttentionscoresbut not signi-
cantlylower thantheSuccessivescore. Inthiscasethereisbothadiscrepancy
between Planning, Attention, and Simultaneous scales with Successive, and
betweenPlanning, Attention, andSimultaneousscaleswithachievement. The
lack of asignicant differencebetween SuccessiveandReadingDecoding(a
relationshipanticipatedfrompreviousresearchsummarizedinDaset al., 1994)
providesan explanationfor theacademicproblem. That is, becauseastrong
relationshipbetweenworddecodingandsuccessiveprocessingisreportedin
the literature (Kirby & Williams, 1991; Das et al., 1994), this connection is
warranted.
ThedatainFig. 5.4aregraphicallyorganizedintogroupsinFig. 5.5. Figure
5.5showstherelationshipamongthecognitiveandacademicmeasures. At the
baseofthetrianglearetheweaknesses,thoseinachievement(WordAttackand
LetterWordIdentication) and onein cognitiveprocessing(Successive). At
thetopof thetrianglearethechildshighscores. TheseincludethePlanning,
Simultaneous, and Attention scales as well as areas of achievement that are
relativelygoodfor thechild. Whenthisrelationshipisfound, thepractitioner
hasanimportant perspectiveonthechild. Thischildhasacognitiveweakness
andassociatedacademicweaknessthat warrant intervention.
Fig. 5.4. CASresults.
Fig. 5.5. CASAchievementtestdiscrepancyandconsistencyresultsfor anillustrativecasestudy.
Themostimportantadvantageof usingacognitiveprocessingperspectiveto
uncover adisorder inbasic psychological processingwith academic failureis
theexplanatorypowertheviewgives. Inthecurrentillustration,thechildslow
scorein SuccessiveProcessingandreadingfailuregivean explanation about
why thechild has had such difculty. In thiscase, thechildsdifculty with
successiveprocessing(dealingwiththingsinspecicorder) isrelatedtosimilar
demands of reading. In particular, successive processing is important in as-
semblingthesoundsinthecorrect order tomakewords, orderinglettersand
groupsof lettersto spell, soundsblending, etc. Thisexamplealso illustratesa
caseinwhichthePREP interventionwouldbeappropriate, becauseit teaches
childrentofocusonthesoundsof eventsinorderandhelpsthemtoapplythese
processestoreading. Thestepsneededtointerpretthiscaseareprovidedinthe
next section.
Case examples of interpretation of PASS theory and CAS
Case illustration 1
ThedataprovidedinFig. 5.4arefor agirl aged7years6monthsincludedinthe
CASstandardizationsample. ThecaseisshowntoillustratehowtheCAScan
beusedto uncover PASScognitiveweaknessandhow theweaknesscan be
relatedtoacademicperformance.Thisillustrationisnotintendedtoshowafull
evaluation of a child, but rather, the use of CAS. The steps required for
interpretationandtheimplicationsof theseresultsareasfollows:
1. ThePASSandFull Scalestandardscoresareobtainedandexamined. Itisfound
that thechild has threeout of thefour PASSscales that fall in theAverage
Range but the Successive Scale standard score is very low (in the Below
AverageclassicationfromNaglieri &Das, 1997b, p. 193).
2. Thefour PASSscoresarecomparedusingtheipsativemethodandit isfound
that theSuccessiveScalestandardscoreis20.8pointslower than thechilds
meanof 91.8. Thisdifferenceissignicantandunusual, onlyoccurringinabout
3%ofchildreninregulareducational settings. TheSimultaneousScalestandard
scoreis arelativestrength, but thedifferenceof 10.3points is not unusual,
occurringinabout 27%of childreninregular educational settings.
3. Examinationof theAchievement Test resultsindicatesthat thechildearned
averageor higher scoresintheWJRAchievement subtestsPassageCompre-
hension(94), Calculation(103), AppliedProblems(103), Dictation(104), Read-
ingVocabulary(96), QuantitativeConcepts(112), andProong(100), but her
WordAttackandLetterWordIdenticationstandardscoreswere82and84,
respectively. For achildat thisage, thelowSuccessiveProcessingscoreand
lowReadingscoresreecttheconnectionbetweenbasicpsychological process-
inganduseof soundsinorder. Giventheageof thechildandtheextent of the
SuccessiveProcessingdecit, thechilddoeshaveadisorder inoneof thebasic
psychological processes involved in understanding or in using written lan-
guage, asdemonstratedbyher lowreadingtest scores. Thisprovidessupport-
iveevidencethat thechildmaymeet regulationsfor identicationasSpecic
LearningDisabledunder IDEA1997.
Case illustration 2
Sam, agedeight yearsandthreemonths, isinsecondgradeat BaileyElemen-
tarySchool inColumbus, Ohio. Accordingtohisteacher, MrsCorso, Samhas
had difculty with reading since his kindergarten year, when he began the
ReadingRecoveryprogram. SamhascontinuedinReadingRecoverythrough
thecurrentyear. InadditiontotheReadingRecoveryprogramatschool, Sams
parentsprovideinstructioninreadingandspellingeachnight. Unfortunately,
despitetheeffortsathomeandatschool, Samcontinuestohaveproblemswith
readingandspelling(Table5.4).
Samsmother, MrsD., reportedthathewasdiagnosedwithArnoldChiari 1
malformation, which is a rare neurological disorder in the brainstem. This
malformation can lead to spinal cord uid ow difculties, which result in
Table 5.4. Case illustration: Sam, aged 8 years 3 months
Scale Standard 95%condence Percentile Differencefrom
score interval rank childsmean
CAS
Planning 96 88105 39 2.0
Simultaneous 114 105121 82 16.0*
Attention 84 7795 14 14.0*
Successive 98 90106 45 0.0
Full Scale 97 91103 42 NA
DSMDscales
Conduct 54 5057 69 4.3
Attention 63 5468 91 13.3
Anxiety 43 3752 31 6.7
Depression 43 3851 35 6.7
Autism 44 3951 39 5.7
AcuteProblems 51 4358 81 1.3
DSMDcomposites
Externalizing 59 5562 83 9.3
Internalizing 43 3948 30 6.7
Critical Pathology 47 4253 55 2.7
PIATR
General Information 118 112125 88 NA
ReadingRecognition 83 8087 13 NA
Reading
Comprehension 78 7186 7 NA
Total Reading 80 7683 9 NA
Mathematics 95 85106 37 NA
Spelling 82 7689 12 NA
Total test 88 8491 21 NA
Note: ChildsmeanPASSscorewas98.0. Differencesthat aresignicant fromthechildsmean
(p=0.05) arenotedwithanasterisk. DSMDistheDevereuxScalesof Mental Disorders.
ChildsmeanDSMDScaleT-scoreis51.3andthemeancompositeT-scoreis49.7.
headaches.Arecentsurgical procedurewasperformedtoremoveagrowthand
this operation seems to have alleviated the effects of the problem. Sam
continuestohaveacademicproblems, however.
Samstatedthat hehaslotsof problemswithreadingandspelling, but loves
mathandscienceandisverygoodat themboth. For example, Samreported
that herecentlymisspelledthewordgrapeonhisspellingtest becauseheleft
offthee. Whenaskedwhy, hestatedthathedidnotwriteitbecausehedidnt
remember seeing it before. Thus, it appears that he has not focused his
attentionon thedetailsof words. DespiteSamsstateddesireto do better in
readingandspelling, hendsthesesubjectsverydifcult andreportedthat he
hastroubleconcentratingwhenstudying.
Clinical observations
Samwascooperativeandfriendlythroughoutthetestingsession, andengaged
in appropriate social interactions with the examiner. Although he typically
responded well to thequestions, Samappeared anxious when hecould not
easilyanswersomeof them. Atthosetimesitwasclear thathelostfocusonthe
taskandavoidedinteractingwiththeexaminer. Healsostatedthathebeginsto
sweat if thequestionisreallyhard andinthesesituationsit getshardfor me
toconcentrate. Difcultywithfocusof attentionwasalsoapparent onseveral
occasions when he was provided with a multiple-choice test. For example,
duringamathtest Samrespondedverballywiththecorrect choice(e.g., 12.1),
but choseanincorrect option, inthisexample121. Additionally, onother tests
with multipleoptions that weresimilar, heoften chosean answer that was
closetothecorrect option, but not completelycorrect. Heapparentlydidnot
noticethesimilarityof theoptions.
Selectedtests
CognitiveAssessment System(CAS).
DevereuxScalesof Mental Disorders(DSMD).
PeabodyIndividual Achievement TestRevised(PIATR).
Samsperformanceonvariousmeasuresof ability, achievement, andbehavior
variedconsiderably andprovidedimportant insight into hiscurrent levelsof
functioning. HeearnedaCASFull Scalescoreof 97, whichfallsintheAverage
range and ranks himat the 42nd percentile rank when compared to other
childrenofhisage. Thereisa95%probabilitythathistrueFull Scalefallswithin
therangeof 91103. However, becausetherewassignicant variationamong
thefour scalesthat comprisetheCASFull Scale, thescoreof 97shouldnot be
consideredagoodoverall descriptionof hisperformance. Infact, hisscoreson
theseparatePASSscalesof theCASvariedconsiderably, from84(Attention
Scale) to114(SimultaneousScale). SamsAttentionscoreisacognitiveweak-
nessandhisSimultaneousscoreisarelativestrength. LikethePASSscales, his
Achievementtest resultsonthePIATRalsoshowedvariability, withscoresin
Fig. 5.6. Caseillustration2: graphicrepresentationof Samstest results.
thelow80sinReadingandSpellingbut AverageandAboveAveragescoresin
MathandGeneral Information, respectively. Similarly, SamsDevereuxScales
of Mental Disorders(DSMD) Total ScaleT-scorewasAverage(T-scoreof 49,
58thpercentile),butincludedscoresthatrangedfromtheAverageclassication
(Anxiety, Depression, Autism, andAcuteProblems) totheElevatedclassica-
tion(63inAttention). Thesescoresindicatethat thebehaviorsratedbySams
father suggest signicant problems with attention. The scores on tests of
ability, behavior, and achievement all reect the difculty Sam has with
attention(Fig. 5.6).
Samsattentionwasformallyassessedintwoways, usingtheCASAttention
Scaleandabehavior ratingscale(DSMD)completedbyhisfather. Samearned
ascorethat fallsintheLowAveragerangeandisrankedat the14thpercentile
onacognitivemeasureof attention. ThismeansthatSamdidonlyaswell asor
better than14%of childrenof hisageonthesubteststhat makeuptheCAS
AttentionScale. Hisattentional processingwasmeasuredbytestsontheCAS
that requiredhimtorespondonlyto particular stimuli andnot torespondto
distracting stimuli. He had problems both nding the correct targets and
avoiding responding to the stimuli that were designed to be distracting.
Although hetriedhisbest duringthesetasks, hewasanxiousandfrustrated
withhisinabilityto respondandoftensaid, I just cant concentrateonthis!.
Thus, it appearedthat hispoor performancewasacombinationof difculty
nding targets and resisting distractions. These ndings are consistent with
poor scoresontheDSMDitemsdealingwithdistractibility, payingattention,
andconcentration. Thus, Samearnedverypoor scores(intheElevatedrange,
T-scoreof 63andpercentileof 91)ontheDSMDsAttentionScaleandtheCAS
(behavioral andcognitivemeasures, respectively).
Attentionprocessingproblemscaninuenceacademicachievementinmany
ways. For Sam, choosing the incorrect answer instead of the option that is
almost correct but not completelycorrect (adistractor option) wasanindica-
tionof hisdifcultywithattention, asdemonstratedbypoor scoresontheCAS
AttentionandDSMD Attentionscales. Samsscoreson testsof achievement
dealingwiththedecodingof wordsweresignicantlylower thanhisperform-
anceonall of theother academictests. HeearnedaPIATRSpellingstandard
scoreof 82(12percentile, 95%condencerangeof 7689), aReadingRecogni-
tionscoreof 83(13thpercentile, 95%rangeof 8087), andReadingCompre-
hensionscoreof 78(7th percentile, rangeof 7186). Throughout thesetests,
Samoveremphasizedphoneticrulesandoftenchoseoptionsthatwerecloseto,
butnotexactly, thecorrectanswers. Healsomademanycomprehensionerrors
becausehemisreadthestatements. For example, onequestionrequiredhimto
understandthestatement, Themonkey isholdingarocket with it tail, and
Samchoseananswer that showedamonkeyholdingarock withitstail. His
failuretoattendtothedetail of thesentence(rocketnot rock)andhisfailureto
notethesimilarityof thetwooptionsledtopoorperformanceonthisacademic
taskandothers. Similarly, Samlost pointsonthePIATRMathematicssubtest
becausehechoseoptionsthat wereclosebut not correct. Thesendingsare
consistent with his poor scores on the CAS Attention Scale and problems
reportedontheDevereuxAttentionScale.
In contrast to Sams poor performanceon cognitive, behavioral, and aca-
demic tasks that involved attention, he performed very well on tests that
demanded simultaneous processing. The tests that measure simultaneous
processingrequiredSamtointegrateseveral piecesof informationintoawhole
or group. His scoreof 114on theCASSimultaneousScalefallsin theHigh
Averagerangeandisrankedat the82ndpercentile(range=105121). Notonly
isthisahigh scorerelativeto hisage-mates, but it ishigher than hisoverall
PASSscore. Theseresultssuggest that Samcanperformwell whenheisasked
toseerelationshipsor patternsamongthingsandtoseehowpartst withina
larger whole.
SamearnedAveragescoresonsuccessiveprocessingtests. Heearnedascore
of 98(45thpercentile, 95%range=90106)ontheSuccessiveScaleof theCAS.
Successiveprocessingwasmeasuredby teststhat requiredinformationto be
arrangedinaspeciclinear order inwhicheachstepwasrelatedonlyto the
previousone. For example, Successivetestsrequiretheretentionof theorder
of words spoken by the examiner and comprehension of the syntax of oral
statements.Samsuccessfullyremembereduptofourunrelatedwordsatatime.
Samperformed within theAveragerangeon tests that demand planning
processing. Heearneda96onthePlanningScaleof theCAS, whichfallsat the
39thpercentile(rangeof 88105). SamsscoreonthePlanningScalereectshis
ability to generateand useefcient andeffectivestrategiesfor solvingprob-
lems, self-monitoring, andself-regulation. For example, onatest that required
himtoconnect numbersandlettersseriallyonapage, Samutilizedacombina-
tion of efcient strategies by repeating the alphabet and number series to
himself, scanningthepagefor thenextnumber or letter, andliftinghishandoff
thepageinorder toseebetter.
Summary
Samearned scores on measures of cognitiveprocessing, behavior, and aca-
demic achievement that varied considerably. His scores fall in the Below
Average(CASAttentionScale, DevereuxAttentionScale, PIATRReadingand
Spelling), Average(CASPlanningandSuccessivescales, Devereuxscales), and
Superior (CASSimultaneous Scale, PIATR Math and General Information)
classications. Sams cognitive weakness on the CAS Attention Scale (84
standardscore) andpoor scoreontheAttentionScaleof theDSMD indicate
considerabledifcultywhenhewasaskedtoidentifycorrect targets(focushis
attention) and avoid responding to the stimuli that are distracting (resist
distraction). Thus, these two different approaches to measuring attention
suggest that Samhasconsiderabledifcultywithconcentration, payingatten-
tion, anddealingwithdistractions. Samsscoresinattentionarecommensurate
withhisscoresin reading(PIATR ReadingComprehensionscoreof 78and
ReadingRecognitionscoreof 83) andspelling(PIATR Spellingscoreof 82).
Thesescoresindicatethat Samsdifcultywithattentionisadisorder inoneof
thebasicpsychological processesinvolvedinunderstandingandusingwritten
language which manifested itself as signicant problems with reading and
spelling.
SamexhibitedastrengthontheSimultaneousProcessingScaleof theCAS
(scoreof 114, which falls within theHigh Averageclassication). This high
scoreindicates that hecan performwell when asked to seerelationshipsor
patternsamongthingsanddeterminehowpartst withinalarger whole. Sam
also earned average scores on the CAS Planning Scale (score of 96), which
indicatesthat hedevelopedand used efcient solutions to problems hewas
presented with. Similarly, he earned an Average score on the Successive
ProcessingScaleof theCAS(scoreof 98), indicatingthat heeffectively dealt
with information that was presented or arranged in specic linear order. In
summary, Sam was found to have a strength; average performance; and
cognitive, behavioral, andacademicweaknessrelatedtoattention.
Recommendations
1. Sams difculty with the CAS Attention Scale and DSMD Attention rating,
along with his poor academic performance, indicatethat his problems with
attention arerelatedto thespecic areasof academic difculty. Oneway to
help him improve his attention is to utilize a cognitive training program
designed to help children better understand their attention difculty and
overcomeit throughavarietyof compensatoryskills. TheDouglasCognitive
Control Programshould be implemented to help teach Samstrategies for
paying attention to his work through providing successful experiences and
teachinghimgeneral rulesonhowtoapproachtasks. Theprogramisdescribed
in the book LearningProblems: A CognitiveApproach by Kirby and Williams
(1991) onpages1526andinthehandout at theendof thisreport.
2. Samsstrengthinsimultaneousprocessingshouldbeutilizedto teachhimto
recognizeandspell wordsbetter. For example, atechniquecalledWordSorts
shouldbeattemptedto helpSamlearnto spell. Thistechniquedrawsonthe
similaritiesamongwordspellingsandencourageschildrentoseethepatterns
of spelling and sound/ symbol association needed for reading decoding. Be-
causeSamissogoodat SimultaneousProcessing, it will beeasyfor himtosee
theseinterrelationshipsandworkwithwordsinthismanner. For example, the
teachermaygivealistof wordssuchasgrape, he, tree, knee, save, andtubeand
request that Samsort themaccordingto how theeat theend of theword
sounds(e.g., grape, save, andtubeall havesilente, whereashe, be, andkneeall
endinlongesound). Thisapproachisappropriatefor Sambecauseit hasan
emphasison Simultaneous Processing, which is his strength. A summary of
howWordSortsworksisprovidedintheinterventionbelow.
PamGutter
JackA. Naglieri
INATTENTI ON HANDOUT
From: J.R. Kirby & N.H. Williams (1991). LearningProblems: A CognitiveAp-
proach.
Thishandout outlinesmethodsto increasechildrensability to attendand
resist distraction. Thepresent summaryisbasedonthediscussionKirby and
Williams(1991) provideinChapter 11about howto improveattention. The
goal of theinterventionistohelpchildrenlearntoimprovecognitivecontrol of
attentionandresist distraction.
Overviewof theDouglassCognitiveControl Program(citation: Douglas,
V.I. (1980). Treatment andtrainingapproachesto hyperactivity: establishing
internal or external control. InHyperactiveChildren: TheSocial EcologyofIdenti-
cationandTreatment, C.K. Whalen&B. Hencker, NewYork: AcademicPress.)
Level I: Helpchildrenunderstandthenatureof their decitsincluding:
1. Attention, resistancetodistraction, andcontrol of attention
2. Recognitionof howthesedecitsaffect dailyfunctioning
3. That thedecit canbeovercome
4. Basicelementsof thecontrol program.
Level II: Improvemotivationandpersistence
1. Promotesuccessviasmall steps
2. Ensuresuccessat school andat home
Allowfor oral responsestotests
Circumvent readingwhenever possible.
3. Teachrulesfor approachingtasks
Denetasksaccurately
Assesschildsknowledgeof problems
Consider all possiblesolutions
Evaluatevalueof all possiblesolutions
Checkingworkcarefullyisrequired
Correct your owntest strategy(seePressley&Woloshyn, 1995, p. 140).
4. Discouragepassivityandencourageindependence
Teacher shouldonlyprovideasmuchassistanceasisneeded
Discourageexclusiveuseof teacherssolutions
Childneedsto
takeresponsibilityfor correctingownwork
seethedifferencebetweencarelesserrorsandthosethat reect prob-
lemswithknowledge
beself-reliant (Scheid, 1993).
5. Helpchildrenavoid
Excessivetalking
Workingfast withlittleaccuracy
Givinguptooeasily
Sloppy, disorganizedpapers.
Level III: Teachingspecicproblem-solvingstrategies
1. Model andteachstrategiesthat improveattentionandconcentration
Childmust recognizeif heisunder or over attentive
Teachtheuseof verbal self-commands(e.g., OK, calmdownandthink
about what thequestionis.)
Teachtheuseof organizedandexhaustivescanningtechniques
Teachfocusingstrategiessuchascheckingfor critical features
Careful listeningfor basicinformation
Teachafewstrategiesbut teachthemwell (Pressley&Woloshyn, 1995).
2. Teachstrategiesthat increaseinhibitionandorganization
Encouragetheuseof datebooks
Encouragetheuseof special notebooksfor keepingpapersorganized
Teachthechildtostopandthinkbeforeresponding
Teachthechildtocount to10beforeanswering.
3. Teachstrategiestoincreasealertness
Teachthechildtobeawareof levelsof alertness
Teachthechildtousecalmingself statements
Encourageplannedbreaks.
4. Teachother relevant strategies
Teachrehearsal andmnemonicdevices(Mastropieri &Scruggs, 1991)
Teachreadingor mathstrategies(Pressley&Woloshyn, 1995).
I NTERVENTI ON HANDOUT
Word Sorts Intervention for Spelling and Reading Decoding
Thishandout outlinesamethodcalledWordSorts, whichisdesignedtohelp
children learn spelling and sound/ symbol associations needed for reading
decodingthat has an emphasison simultaneousprocessing. Thegoal of the
interventionistohelpchildrenseetheinterrelationshipsamongspellingrules
andletter patternsthat areassociatedwithdifferent sounds. Thesummaryis
basedonthepaper: Zutell, J. (1998). Wordsorting: adevelopmental spelling
approach to word study for delayed readers. Reading& WritingQuarterly:
OvercomingLearningDifculties, 14, 21938.
Overview
Wordsortingisaninterventioninwhichstudentsorganizewordsprintedon
cardsintocolumnsonthebasisof particular sharedconceptual, phonological,
orthographic, andmeaning-relatedfeatures (Zutell, 1998, p. 226). Thisteaches
studentsto generateconceptsandgeneralizationsabout thefeaturesof how
wordsarespelled, andit helpsthemconnect newwordstoonestheyalready
know(Pinnell &Fountas, 1998). Thetechniqueinvolvescareful analysisof the
students current methodsfor spelling(Barnes, 1989) andinvolvesaseriesof
activities conducted for about 10 minutes each day. The basic systemand
different waysof sortingwordsareexplainedbelow.
1. Teachchildrenabout WordSorts
Therearemanywaysthatwordscanbesortedaccordingtotheirspelling.
Thisincludessortsbysound(longe)orsilentletters(winthewordwrist).
Exampleof awordsort activity:
Give children the following words: wrap, white, wren, what, wrist,
write, would, when, whistle, wrong.
Twooptions:
Closedsortstheteacher choosesthecategoryof silentversusnonsilent
W inthewords. Childrenarethentaught to sort thewordsinthe
two groups accordingto therule. Closedsorts arehelpful in that
they can beusedto focus thechilds attention on aspecic word
characteristicthat mayhelpwithwordrecognitionandproduction
(Zutell, 1998).
Opensorts theteacher instructsthechildrento categorizethewords
based on shared features that the students discover (Pinnell &
Fountas, 1998). Thistypeof sort maybeuseful becauseit allowsthe
students to display how they think about words (Zutell, 1998).
Regardlessof thestudents level, it isimportantthat theydiscussthe
wordswhiletheyaresortingthembecausethediscussionwill help
with the internalization of the principles and it promotes under-
standing(Pinnell &Fountas, 1998).
Therearemany different categories of words, sounds, patterns, etc.
that canbeusedinword-sortingactivities. Thesecategoriescanhelp
students sound and letter patterns and get past regular, easy letter
sound correspondence, allowing for students to learn how to nd
complexpatterns(Pinnell &Fountas, 1998).
2. Howtoapplythetechnique
TheWordSortsinstructionshouldbeadailyactivitythat lastsabout 10
minutesandcan bedonein groups, pairs, or individually. Becausethe
Englishlanguagehasmanydimensions, anunlimitednumberof sortscan
beusedanddiscovered.
Conclusions
This chapter began with the assumption that intelligence tests have not
changed appreciably since the beginning of the twentieth century and that
advances in cognitive psychology and neuropsychology have provided the
opportunity for change in this eld. Tests like the K-ABC and CAS offer
cognitiveprocessingalternativesto thegeneral intelligencemodel. TheCAS
anditsbase, thePASStheory, offer astrongalternativeto traditional tests, as
evidenced by three important ndings. First, childrens PASS proles are
relevant todifferential diagnosisandespeciallyhelpful for thosewithlearning
disabilitiesandattentiondecits. Second, theCASisanexcellent predictor of
achievement, despitethefact that it doesnot containverbal andachievement-
based tests like those found in traditional measures of IQ. Third, the CAS
provides information that is relevant to intervention and instructional plan-
ning.
REFERENCES
Ashman, A.F. & Conway, R.N.F. (1997). An Introduction to Cognitive Education: Theory and
Applications. London: Routledge.
Barnes, W. (1989). Word Sorting: the cultivation of rules for spelling in English. Reading
Psychology: AnInternational Quarterly, 10, 293307.
Bracken, B.A. (1987). Limitationsof preschool instrumentsandstandardsfor minimal levelsof
technical adequacy. Journal of Psychoeducational Assessment, 5, 31326.
Brailsford, A., Snart, F., &Das, J.P. (1984). Strategytrainingandreadingcomprehension. Journal
of LearningDisabilities, 17, 28790.
Brody, N. (1992). Intelligence. SanDiego: AcademicPress.
Carlson, J. &Das, J.P. (1997). Aprocessapproachtoremediatingworddecodingdecienciesin
Chapter 1children. LearningDisabilitiesQuarterly, 20, 93102.
Carroll, J.B. (1993). Human CognitiveAbilities: A Survey of Factor-analytic Studies. New York:
Cohen, R.J., Swerdlik, M.E., & Phillips, S.M. (1992). Psychological TestingandAssessment. Moun-
tainView, CA: Mayeld.
Cormier, P., Carlson, J.S., & Das, J.P. (1990). Planningability andcognitiveperformance: the
compensatoryeffectsof adynamicassessment approach. LearningandIndividual Differences, 2,
43749.
Das, J.P. (1999). PASSReadingEnhancement Program. Deal, NJ: SarkaEducational Resources.
Das, J.P., Kirby, J.R., & Jarman, R.F. (1975). Simultaneousandsuccessivesyntheses: analterna-
tivemodel for cognitiveabilities. Psychological Bulletin, 82, 87103.
Das, J.P., Kirby, J.R., & Jarman, R.F. (1979). SimultaneousandSuccessiveCognitiveProcesses. New
York: AcademicPress.
Das, J.P., Mishra, R.K., & Pool, J.E. (1995). An experiment on cognitive remediation or
word-readingdifculty. Journal of LearningDisabilities, 28, 6679.
Das, J.P., Naglieri, J.A., & Kirby, J.R. (1994). Assessment of CognitiveProcesses. NeedhamHeights,
MA: Allyn&Bacon.
Elliott, C.D. (1990). Differential AbilityScales: IntroductoryandTechnical Handbook. SanAntonio,
Gazzaniga, M.S. (1975). Recent research on hemispheric lateralization of the human brain:
reviewof thesplit-brain. UCLAEducator, 17, 912.
Horn, J.L. & Noll, J. (1997). Human cognitive capabilities: GfGc theory. In Contemporary
Intellectual Assessment: Theories, Tests and Issues, ed. D.P. Flanagan, J.L. Genshaft, & P.L.
Harrison, pp. 5391. NewYork: Guilford.
Kar, B.C., Dash, U.N., Das, J.P., & Carlson, J.S. (1992). Two experiments on the dynamic
assessment of planning. LearningandIndividual Differences, 5, 1329.
Kaufman, A.S. (1994). Intelligent TestingwiththeWISCIII. NewYork: Wiley.
Kaufman, D. &Kaufman, P. (1979). Strategytrainingandremedial techniques.Journal ofLearning
Kaufman,A.S.&Kaufman,N.L. (1983). KaufmanAssessmentBatteryforChildren.CirclePines, MN:
AmericanGuidanceService.
Kaufman,A.S.&Kaufman,N.L. (1985). KaufmanAssessmentBatteryforChildren.CirclePines, MN:
Kavale, K.A. &Forness, S.R. (1984). Ameta-analysisof thevalidityof theWechsler Scaleproles
andrecategorizations: patternsor parodies?LearningDisabilityQuarterly, 7, 13651.
Kinsborne, M. (1978). Asymmetrical Functionof theBrain. Cambridge, UK: CambridgeUniversity
Press.
Kirby, J.R. &Williams, N.H. (1991). LearningProblems: ACognitiveApproach. Toronto: Kaganand
Woo.
Krywaniuk, L.W. & Das, J.P. (1976). Cognitive strategies in native children: analysis and
intervention. AlbertaJournal of Educational Research, 22, 27180.
Luria, A.R. (1966). HumanBrainandPsychological Processes. NewYork: Harper &Row.
Luria, A.R. (1973). TheWorking Brain: An Introduction to Neuropsychology. New York: Basic
Books.
Luria, A.R. (1980). Higher Cortical FunctionsinMan, 2ndedition. NewYork: BasicBooks.
Luria, A.R. (1982). LanguageandCognition. NewYork: Wiley.
Mastropieri, M.A. &Scruggs, T.E. (1991). TeachingStudentsWaystoRemember. Cambridge, MA:
BrooklineBooks.
McDermott,P.A.,Fantuzzo, J.W., &Glutting, J.J. (1990). Justsaynotosubtestanalysis:acritique
onWechsler theoryandpractice. Journal of Psychoeducational Assessment, 8, 290302.
McGrew, K.S. & Flanagan, D.P. (1998). TheIntelligenceTest DeskReference: GfGcCrooss-battery
Assessment. Boston, MA: Allyn&Bacon.
McGrew, K.S., Keith, T.Z., Flanagan, D.P., &Vanderwood, M. (1997). Beyondg: theimpact of
GfGcspeciccognitiveabilitiesresearchonthefutureuseandinterpretationof intelligence
testsintheschools. School PsychologyReview, 26, 189210.
McGrew, K.S., Werder, J.K., & Woodcock, R.W. (1991). WJRTechnical Manual. Chicago, IL:
Riverside.
Miller,G., Galanter, E., &Pribram,K. (1960). PlansandtheStructureofBehavior. NewYork:Henry
Holt andCompany.
Naglieri, J.A. (1993). PairwiseandIpsativeWISCIII IQandIndexScorecomparisons. Psychologi-
cal Assessment: AJournal of ConsultingandClinical Psychology, 5, 11316.
Naglieri, J.A. (1999). Essentialsof CASAssessment. NewYork: Wiley.
Naglieri, J.A. (2000). Can proleanalysisof ability test scoreswork?An illustration usingthe
PASStheoryandCASwithanunselectedcohort. School PsychologyQuarterly, 15, 41933.
Naglieri, J.A. & Das, J.P. (1997a). CognitiveAssessment System. Chicago, IL: RiversidePublishing
Company.
Naglieri, J.A. & Das, J.P. (1997b). CognitiveAssessment SystemInterpretiveHandbook. Chicago, IL:
RiversidePublishingCompany.
Naglieri, J.A. &Gottling, S.H. (1995). Acognitiveeducationapproachtomathinstructionfor the
learningdisabled: anindividual study. Psychological Reports, 76, 134354.
Naglieri, J.A. &Gottling, S.H. (1997). MathematicsinstructionandPASScognitiveprocesses: an
interventionstudy. Journal of LearningDisabilities, 30, 51320.
Naglieri, J.A. &Johnson, D. (2000). Effectivenessof acognitivestrategyinterventiontoimprove
mathcalculationbasedonthePASStheory. Journal of LearningDisabilities, 33, 5917.
Naglieri, J.A. & Sullivan, L. (1998). IDEA and identication of children with specic learning
disabilities. Communique, 27, 201.
Neisser, U. (1967). CognitivePsychology. NewYork: Appleton-Century-Crofts.
Pinnell, G. &Fountas,I. (1998). WordMatters: TeachingPhonicsandSpellingintheReading/ Writing
Classroom. Portsmouth, NH: Heinemann.
Pressley, M.P. &Woloshyn, V. (1995). CognitiveStrategyInstructionthat reallyImprovesChildrens
AcademicPerformance, 2ndedition. Cambridge, MA: BrooklineBooks.
Sattler, J.M. (1988). Assessmentof Children, 3rdedition. SanDiego, CA: JeromeM. Sattler.
Scheid, K. (1993). HelpingStudentsBecomeStrategicLearners. Cambridge, MA: BrooklineBooks.
Solso, R.L. &Hoffman,C.A. (1991). Inuenceof Sovietscholars. AmericanPsychologist, 46, 2513.
Sternberg, R.J. (1988). TheTriarchicMind: ANewTheoryof HumanIntelligence. NewYork: Viking.
Wechsler, D. (1991). Wechsler IntelligenceScalefor Children, ThirdEdition. SanAntonio, TX: The
Wechsler, D. (1992). Wechsler Individual Achievement Test. SanAntonio, TX: ThePsychological
Corporation.
Wilson, M.S. & Reschly, D.J. (1996). Assessment in school psychology training and practice.
Woodcock, R.W. (1998). TheWJRandBateriaRinNeuropsychological Assessment:ResearchReport
Number 1. Itasca, IL: RiversidePublishingCompany.
Woodcock, R.W. & Johnson, M.B. (1989a). WoodcockJohnson Revised Tests of Achievement:
StandardandSupplemental Batteries. Itasca, IL: RiversidePublishing.
Woodcock, R.W. & Johnson, M.B. (1989b). WoodcockJohnsonRevisedTestsof CognitiveAbility:
StandardandSupplemental Batteries. Itasca, IL: RiversidePublishing.
Yoakum, C.S. &Yerkes, R.M. (1920). ArmyMental Tests. NewYork: HenryHolt andCompany.
Ysseldyke, J., Dawson, P., Lehr, C., Reschly, D., Reynolds, M., & Telzrow, C. (1997). School
Psychology: ABlueprintfor TrainingandPracticeII. Bethesda, MD: NASP.
Zutell, J. (1998). Wordsorting: adevelopmental spellingapproachto wordstudy for delayed
readers. Reading& WritingQuarterly: OvercomingLearningDifculties, 14, 21938.
6
Application of the Differential Ability
Scales (DAS) and British Ability Scales,
Second Edition (BAS II), for the
assessment of learning disabilities
Colin D. Elliott
Introduction and overview
Twodecadeshavepassedsincewhat wasthenanewtest battery theBritish
AbilityScales(BAS; Elliott, Murray, &Pearson, 1979) wasintroducedtothe
stableof testsfor assessingcognitiveabilitiesinchildren. Thebatteryhassince
beenfurther developed, resultinginthepublicationof theDifferential Ability
Scales(DAS; Elliott, 1990a) andtheBritishAbilityScales, SecondEdition(BAS
II; Elliott, 1997a), whichhaveachievedwidespreadacceptanceandpopularity
intheUSAandUK, respectively.
The BAS II and DAS represent an advance in cognitive assessment. In a
reviewof theoriginal BAS, Embretson(1985) stated: TheBASisanindividual
intelligencetest with greater scopeandpsychometricsophisticationthan the
major Americanindividual tests. Thetest development proceduresandnorms
arelaudatory (p. 232). Inanother review, Wright andStone(1985) statedthat
the BAS is a signicant advance in mental measurement . . . Its formand
functionareamodel for contemporarytestbuildersandapreviewof thefuture
of test construction (p. 232). Kamphaus(1993), inreviewingtheDAS, wrote:
Thereiseveryindicationthat thedevelopersof theDASerredinthedirection
of quality at every turn. The manual is extraordinarily thorough, the
psychometricpropertiesarestrong, andthetest materialsareof highquality
(pp. 3201). Similarly, Anastasi andUrbina(1997), inareviewof theDASinthe
seventheditionofPsychological Testing,writethattheDASisastateoftheart
instrument of itstype, asyet unsurpassedinthepossibilitiesandadvantagesit
affords to users (p. 232). Sound theory, technical sophistication, and high-
quality norms all characterize the BAS II and the DAS, and are essential
qualities in a good cognitive assessment instrument. Perhaps even more
importantly, theinstrumentsarealso engagingfor children, time-efcient for
178
the examiner, and yield a range of subtest and composite scores that are
reliable, interpretable, relevant to childrens learning and development, and
havemuchtooffer theclinicianintranslatingassessment resultsintopractical
recommendations.
History, development, and goals
History
Theinitial stagesof thedevelopmentof theBASweresetagainstabackground
of increasingprovisionfor childrenwithspecial needsandanexpansionof the
roleof educational psychologists.Until the1960s, psychologistsinGreatBritain
had used adaptations of scales published in the USA, such as the various
WechslerscalesoreditionsoftheStanfordBinet.Theseinstrumentsmetmany
of theneedsof Britishusers, yieldingcredibleestimatesof general abilityand
useful predictionsof school achievement. At thesametime, however, these
scaleswerecriticizedalongseveral lines. Forexample,sometestquestionswith
specically American content were considered unsuitable for use in Great
Britain. Thelack of British normswasalso an important issue, although the
results of a Scottish standardization of the Wechsler Intelligence Scale for
Children(WISC; Wechsler, 1949)inthemid-1960swereextremelyclosetothe
USnorms(ScottishCouncil for ResearchinEducation, 1967).
Psychologistsalsocriticizedtheavailableintelligencescalesinmoregeneral
terms. Concernsover ethnicandsocial-classbiasintest scoresfuelledresearch
andprovokedcontroversy. Sometest usersweredissatisedwithscaleswhose
purposeswereprimarilytoproduceasummaryscore(IQ)andonlysecondarily
toyieldmultiplesubscoreswithknowndiagnosticimplications. Furthermore,
inthe1960s, researchersinspiredby Piagetiantheory wereexploringseveral
dimensionsof earlycognitivedevelopmentthatwerenotmeasuredbyexisting
ability-test batteries.
All of these concerns amplied the need for a new intelligence battery
constructed and standardized in Great Britain. In the late 1950s, the British
Psychological Societyconvenedacommitteeof specialiststoproduceaplanfor
such a battery. The British Governments Department of Education and
Science provided a substantial grant to the British Psychological Society to
support thedevelopment of thenewscale, tobecalledtheBritishIntelligence
Scale. Inturn, thisgrant madepossibletheestablishment of aresearchunit at
theUniversityof Manchester, whichbeganitsworkin1965under thedirection
of Professor F.W. Warburton.
Initial item development and trialling went ahead until 1969, with the
179 The Differential Ability Scales (DAS) and British Ability Scales, Second Edition (BAS II)
untimelydeathof FrankWarburtoncoincidingwiththecessationof theinitial
funding. The project restarted in 1973, with additional funding, under the
direction of the present author. The purpose of the battery was reconcep-
tualized, primarilyemphasizingitsdevelopment asan instrument measuring
ability proles rather than having its primary emphasis as a measure of
intelligence. Thisreconceptualizationresultedinthechangeof nameto the
BritishAbilityScales. Theperiod1973to1978wasspent inrestructuringthe
battery, writingmanynewitemsanddevelopingnewsubtests, carryingout a
national standardization, andpreparingthebatteryfor publication.
Following initial publication, analytic work continued, together with the
further development of somescalestorectifyanumber of weaknesses, includ-
inglackofsufcientitemsatparticularagelevelsandprocedural problemswith
thescoring. Thus, after completionof thisworkin1982, arevisededitionwas
published in 1983. Also in 1983, ThePsychological Corporation in theUSA
startedaproject to developaversionof theBAStailoredfor NorthAmerica,
which becamethe DAS, published in 1990. This version dropped six of the
original BASscales, anddevelopedfour additional scales(or subtests).
1
Other
major revisionsweremadethat aredescribedbyElliott (1990c).
Finally, the changes made to the DAS were incorporated in the BAS II,
publishedin1997. Inaddition, theBASII includedonesubtest not intheDAS,
aswell asanumber of revisionstoother subtests.
Development and goals
Twoprinciples self-evidenttruthstomanypractitioners drovethedevelop-
mentoftheDASandtheBASII. Therstisthatprofessionalsassessingchildren
withlearninganddevelopmental disabilitiesneedinformationatanerlevel of
detail thananIQscore. IQtestsinthepast havehadaprimary, disproportion-
atefocusonglobal compositescores. Thesecondprincipleisthatpsychometric
assessment hasmuchtooffer thepractitioner: psychometrictestsof cognitive
abilities not only have well-established qualities of reliability, validity, time
efciency, objectivity, andlackof bias, but oftengiveusinformationcritical to
our understandingof achildslearningstylesandcharacteristics.
Therst principleledtothemajor priorityinthedevelopment of theDAS
andBASII: toproduceabatteryinwhichsubtestswouldbesufcientlyreliable
andmeasuresufcientlydistinctcognitivefunctionstomakethemindividually
interpretable. While it was expected that meaningful composites would be
derivedfromthesubtests, theprimary focusin test development wasat the
subtest level. ThisemphasisdistinguishestheDASandBASII frommost other
batteries. Althoughsome(usuallythecriticsof thewholepsychometricenter-
180 Colin D. Elliott
prise) maymisleadinglycharacterizetheDASandBASII asIQtests, intruth
theyarenot. Theydownplaytheimportanceof thegeneral composite, anddo
not evencall that compositeIQ. Indeed, thetermsintelligence andIQ are
rejected: theyhavebeensovaguelyandvariouslydenedasto havebecome
scientically meaningless. Back in 1927, Spearman also expressed the same
viewwhenhedescribedintelligenceasawordwithso manymeaningsthat
nallyithasnone (p. 14). Thus, thegoal for theDASandBASII istomeasurea
rangeof cognitiveabilities. Thetermcognitiveability referstoamorespecic
andnarrower domainof humancognitionthanthetermintelligence.
Spearmansghasnot beenlost, however. For all agelevelsfrom3years6
monthsupwards, sixsubtests, measuringanumber of cognitiveabilities, form
an overall compositescorereectingthegeneral factor g. Psychometric gis
dened as the general ability of an individual to performcomplex mental
processingthat involvesconceptualizationandthetransformationof informa-
tion (Elliott, 1990c, p. 20). Fromthisdenitioncomesthetermusedtodescribe
themost general DASandBASII compositescore: General Conceptual Ability
(GCA).
If one is to produce a test battery that measures proles of childrens
strengths and weaknesses across a range of distinct cognitive abilities, it is
necessaryto havelower-order compositesandsubtestswithsufcientlyhigh
specicityandreliabilityastoallowthecliniciantointerpreteachasmeasuring
somethinguniqueanddistinct fromtheothers. Thepurposeof thisenterprise
is that the creation of a reliable prole of a childs cognitive strengths and
weaknesseswill leadtoabetter understandingof hisor her learningdifculties
and ultimately to practical recommendations to classroom teachers about
remediation(Elliott, 1990c).
TheDASandBASII werenot developedsolelytoreect asinglemodel of
cognitive abilities, but may be interpreted from a number of theoretical
perspectives. Their content isdesignedtoaddressprocessesthat oftenunderlie
childrensdifcultiesinlearning, andwhat weknowof neurological structures
underlyingtheseabilities. AsCarroll (1993) hasshown, thereareconsiderable
similaritiesinthefactor structuresof cognitivebatteries. Ageneral factor (g) is
aninescapablereality. It pervadesall measuresof ability andall relationships
betweencognitiveabilitiesof anykind. It must thereforeberepresentedinany
test battery structure and in its theoretical model. In reviewing the many
theoriesof thestructureof abilities, it was apparent that no singletheory is
entirely persuasive and certainly no single theory has universal acceptance
amongtheoreticiansor practitioners. Even theproponentsof what has now
becomeknownastheCattellHornCarroll (CHC) theory, currentlythemost
popular factor theory of the structureof abilities, are not all agreed on the
number of factorsinthemodel or theprecisenatureof eachfactor (McGrew,
1997).
Despitethefact that no singletheory or model has universal acceptance,
thereisacommoncoreof theoryandresearchthatissupportiveof anumberof
propositionsonwhichthedevelopment of theDASandBASII wasbased:
Humanabilitiesarenot explainablesolelyintermsof asinglecognitivefactor
(g) or evenintermsof twoor threelower-order factors.
Humanabilitiesformmultipledimensionsonwhichindividualsshowreliably
observable differences (Carroll, 1993), and which are related in complex
wayswithhowchildrenlearn, achieve, andsolveproblems.
Humanabilitiesareinterrelatedbut not completelyoverlapping, thusmaking
manyof themdistinct (Carroll, 1993).
Thewiderangeof humanabilitiesrepresentsanumber of interlinkedsubsys-
temsof informationprocessing.
Subsystemsof informationprocessinghavestructural correlatesinthecentral
nervous system, in which some functions are localized and others are
integrated.
Thelast twoof thesepointswill beelaboratedlater inthischapter.
Description of the BAS II and DAS
TheBASII andtheDASareindividuallyadministeredcognitivetest batteries,
standardizedfor childrenbetweentheagesof 2years6monthsand17years11
months.
Structure of the batteries
Thestructureof theBASII andDASassumesahierarchical organization of
cognitive ability (Elliott, 1990b). Subtests, or specic measures of distinct
abilities, make up the base of this structure. However, because all ability
measures are intercorrelated, these subtests will tend to group together in
clusters at a second higher level. These clusters, in turn, are interrelated,
thereby yieldingan estimate of psychometric gwhich is at the apex of this
hierarchical structure. It seemspossible, fromtheanalysesof standardization
data, that thishierarchybecomesmoredifferentiatedasachilddevelops.
Thepreschool andschool-agebatteriesaresimilar instructure. Subtestsin
the two instruments are designated as either core or diagnostic. Core
subtestsarethosethat arethemost highly gloaded, andthusmeasuremore
complex mental processing. They are used in the estimation of the Cluster
Table 6.1. Number of BAS II and DAS subtests and composites at each age level
Agelevel Number of General Cluster
subtests composites scores
Lower preschool level
Age2:63:5
(Extendedage
2:64:11)
4core
2diagnostic
1. GCA
2. Special
Nonverbal
Upper Preschool level
Age3:65:11
(Extendedage
3:66:11)
6core
BASII: 6diagnostic
DAS: 5diagnostic
1. GCA
2. Special
Nonverbal
BASII:
1. Verbal Ability
2. Pictorial
Reasoning
Ability
3. Spatial Ability
DAS:
1. Verbal Ability
2. Nonverbal
Ability
School-Agelevel
Age6:017:11
(Extendedage
5:017:11)
6core
BASII: 5diagnostic
DAS: 4diagnostic
Bothinstruments:
3achievement
1. GCA
2. Special
Nonverbal
1. Verbal Ability
2. Nonverbal
Reasoning
Ability
3. Spatial Ability
scores, theGCA score, andtheSpecial Nonverbal Composite(SNC). Onthe
other hand, diagnostic subtests are intended to measure more specic or
distinct skills, suchasaspectsof short-termmemory or speedof information
processing. They havealower correlation with gandmeasureless complex
mental processing. Theoverall structureissummarizedinTable6.1.
The BAS II and the DAS each comprise essentially two cognitive test
batteries. Therst isgearedto preschool andearly school-agechildrenfrom
age2years 6months through 5years 11months. This preschool battery is
further subdividedintoanupper andlower preschool level. Thelower level is
specicallydesignedfor childrenfrom2years6monthsto 3years5months.
Theupper preschool level isusedfor assessingchildrenfrom3years6months
to7years11months. Thesecondcognitivebatteryisdesignedfor school-age
children fromage 5 years 0 months to 17 years 11 months. Although the
nominal agerangesof thetwobatterieshaveadividingpoint at 6years, they
werecompletelyco-normedacrosstheagerange5years0monthsthrough7
Table 6.2. Subtests of the BAS II and DAS Preschool Cognitive Batteries, showing
abilities measured (and relation of measures to CattellHorn factors) and their
contribution to composites
Subtest Abilitiesmeasured Contributiontocomposite
Coresubtests
BlockBuilding
1
Visualperceptual matching,
especiallyof spatial orientation, in
copyingblockpatterns(Gv)
GCA
Verbal Comprehension Receptivelanguage:
understandingoral instructions
usingbasiclanguageconcepts
(Gc)
GCA
Verbal
NamingVocabulary Expressivelanguage: knowledge
of names(Gc)
GCA
Verbal
PictureSimilarities Nonverbal Reasoning: matching
picturesthat haveacommon
element or concept (Gf)
GCA
Special Nonverbal
BASII: Pictorial Reasoning
DAS: Nonverbal
PatternConstruction Nonverbal, spatial visualizationin
reproducingdesignswithcolored
blocksandat squares(Gv)
GCA
Special Nonverbal
BASII: Spatial
DAS: Nonverbal
Copying Visualspatial matchingand
ne-motor coordinationin
copyinglinedrawings(Gv)
GCA
Special Nonverbal
BASII: Spatial
DAS: Nonverbal
EarlyNumber Concepts
2
Knowledgeof pre-numerical and
numerical quantitativeconcepts
(Gq)
GCA
BASII: Pictorial Reasoning
Diagnosticsubtests
MatchingLetter-Like
Forms
Visual discriminationof spatial
relationshipsamongsimilar
shapes(Gv)
Recall of DigitsForward
(DAS: Recall of Digits)
Short-termauditorysequential
memoryfor sequencesof
numbers(Gsma)
Recall of Objects Short-termandintermediate-term
learningandverbal recall of a
displayof pictures(Glr)
(BASII alsohasspatial recall)
Table 6.2. (cont.)
Recognitionof Pictures Short-term, nonverbal visual
memorymeasuredthrough
recognitionof familiar objects
(Gsmv, Gv)
Recall of DigitsBackward
(onlyinBASII)
workingmemoryfor sequences
of numbersrecalledinreversed
order (Gsma)
1
Usedonlyfor theGCAcompositeat theLower Preschool level. Usedasadiagnosticsubtest at
theupper Preschool level.
2
Not usedfor either cluster score, becauseit hassimilar factor loadingsonboththeVerbal and
Nonverbal factors.
years11months, andmay beusedequivalentlyin that agerange. Thus, the
school-agebattery may be used appropriately to assess relatively gifted ve
year olds. Mostimportantlyfor themajorityof clinicians, thepreschool battery
may be used to assess six and seven year olds, for whom the school-age
materialsaredevelopmentallylessappropriate.Thereisalsoabrief achivement
test batteryfor school-agechildrenineachinstrument.
Subtest composition
Thecomponent subtestsfor thePreschool Cognitive, School-AgeCognitive,
andAchievementbatteriesarelistedanddescribedinTables6.2, 6.3, and6.4. In
each cognitivebattery table, thesubtestsaregrouped accordingto whether
theyaredesignatedcore subtestsor diagnostic subtests. Eachsubtest hasa
brief descriptionof theabilitiesit measures, includingitsrelationtotheCHC
factors. Subtests have normative scores in a T-score metric (mean=50;
SD=10).
Tables6.2and6.3also showthecompositesthat canbederivedfromthe
coresubtests, andthesubteststhat contributetothosecomposites. Twotypes
ofcompositeareprovided, all inastandardscoremetric(mean=100;SD=15).
First are lower-order cluster scores. There are three of these at the Upper
Preschool level for the BAS II: Verbal, Pictorial Reasoning, and Spatial, for
childrenaged3years6monthsto 5years11months. At thesameagelevel
there are two cluster scores for the DAS: Verbal and Nonverbal. For both
instruments, there are three cluster scores at the School-Age level (Verbal,
Table 6.3. Subtests of the BAS II and DAS School-Age cognitive batteries, showing
abilities measured (and relation of measures to CHC factors) and their contribution to
composites
Coresubtests
WordDenitions Expressivelanguage: knowledge
of wordmeanings(Gc)
GCA
Verbal
Verbal Similarities
(DAS: Similarities)
Verbal, inductivereasoningand
verbal knowledge(Gc)
GCA
Verbal
Matrices Nonverbal, logical reasoning:
perceptionandapplicationof
relationshipsamongabstract
gures(Gf)
GCA
Special Nonverbal
Nonverbal Reasoning
QuantitativeReasoning
(DAS: Sequential and
QuantitativeReasoning)
Detectionof sequential patterns
or relationshipsinguresor
numbers(Gf)
GCA
Special Nonverbal
Nonverbal Reasoning
Recall of Designs Short-termrecall of visualspatial
relationshipsthroughdrawing
abstract gures(Gv, Gsmv)
GCA
Special Nonverbal
Spatial
PatternConstruction Nonverbal, spatial visualizationin
reproducingdesignswithcolored
blocksandat squares(Gv)
GCA
Special Nonverbal
Spatial
Diagnosticsubtests
Recall of DigitsForward
(DAS: Recall of Digits)
memoryfor sequencesof
numbers(Gsma)
Recall of Objects Short-termandintermediate-term
learningandverbal recall of a
displayof pictures(Glr)
(BASII alsohasSpatial recall)
Speedof Information
Processing
Speedinperformingsimple
mental operations(Gs)
Recall of DigitsBackward
(onlyinBASII)
workingmemoryfor sequences
of numbersrecalledinreversed
order (Gsma)
Table 6.4. BAS II and DAS Achievement tests
Achievement test Skillsmeasured
BasicNumber Skills Knowledgeandwrittenrecall of spellings; includesdiagnostic
performanceanalysisonitems
Spelling Recognitionof printednumbersandperformanceof arithmetic
operations; includesdiagnosticperformanceanalysisof errors
WordReading Recognitionanddecodingof printedwords
Nonverbal Reasoning, and Spatial). Note that at the Lower Preschool level
(ages2years6monthsto3years5months) therearenocluster scores.
Secondarethehigher-ordercomposites.Formostchildren, themostgeneral
compositewill betheGCAscore. For childrenfor whomit isjudgedthat the
verbal component of that scoreisinappropriate, aSNC isprovided. For both
instruments at the Upper Preschool age level, this is formed from three
subtests. Also for both instruments, the SNC for the School-Age battery is
formedfromthefour subtestsintheNonverbal ReasoningandSpatial clusters.
Table6.4liststhethreeachievement tests. Thenormativescoresonthese
testsareinastandardscoremetric(mean=100;SD=15), tofacilitatecompari-
sonwith compositescoresfromthecognitivebattery. Theachievement and
cognitive batteries were fully co-normed. Discrepancies between ability (as
measured by GCA or SNC) may be evaluated taking either (a) the simple
differencebetweentheachievementscoreandthecomposite,or(b)thedifference
betweenpredictedandobservedachievement, with predicted achievement being
based on the GCA or SNC score. TheBAS II and DAS handbooks provide
informationonboththestatistical signicance(or reliability) of discrepancies,
and their frequency of occurrence (or unusualness) in the standardization
sample.
Inconsideringthecompositionof thesubtestsof theBASII andtheDAS,
one of their greatest advantages is their high appeal for all children, and
particularlypreschoolers. For atest toprovideareliableandvalidassessment
when used with young children, it must not only have good psychometric
characteristics,butalsolookinterestingenoughsothattheywanttoparticipate
intheassessmentandkeepgoingwhentheworkstartsbecomingdifcult. The
instrumentsincludemanyactivitiesatall agelevelsforchildrentodowiththeir
hands.Manypsychologistswhoworkwithpreschoolershavelamentedtheloss
frommany newer instrumentsof thelittletoysandactivitiesfromtheStan-
fordBinet L-M(Terman&Merrill, 1960), whichhavegenerallybeenreplaced
by amuchgreater requirement for thechildto focuson lookingat pictures.
TheDASrestorestheStanfordBinetL-Mapproachtoworkingwithpreschool
children.
Another importantfeatureof theinstrumentsisthat administrationtimefor
thecoresubtestsissignicantlyshorter thanthat typicallyneededfor competi-
torsliketheStanfordBinet or theWechsler scales. Anexperiencedexaminer
can complete the core subtests of the DAS and obtain a reliable and valid
estimateof clusters andGCA in about 30to 40minutes. Most professionals
report that theStanfordBinet, FourthEdition, theWechsler IntelligenceScale
for Children, ThirdEdition (WISCIII) andtheWechsler Preschool and Pri-
mary Scaleof IntelligenceRevised(WPPSIR) takeabout 15to 30minutes
longer thantheDAStoobtainasimilar estimate. Thisisacritical advantagein
workingwithpopulationsnot distinguishedfor their lengthyattentionspans.
Psychometric properties
Thepsychometricpropertiesof theBASII andtheDASaregivenindetail in
their respectivetechnical handbooks(Elliott, 1990c, 1997a). A brief reviewof
themajor featuresisthereforegivenbelow, and, unlessotherwisestated, all
dataarequotedfromtherespectivetechnical handbooks.
Tailoredassessments
Theuseofitemresponsetheoryinthedevelopmentofthesubtestshasresulted
inwhat iscalledan itemset approachto assessment. For most children on
mostsubtests, it isunnecessarytostart eachsubtestat therst andeasiest item
andthenprogressto atraditional ceilinglevel say, veconsecutivefailures
beforediscontinuing. IntheBASII andtheDAS, smallersetsofitemsfromeach
subtestaregiven.Formostsubtests, ifthechildhasthreepassesandthreefailed
items, that itemset givesareliableestimateof thechildsability.
Thegreat advantagesof thisapproacharereducedtimespent intestingfor
boththechildandtheexaminer, andareducedexposuretofailureonitemsfor
thechild. Indeed, inthePatternConstructionsubtest, it ispossiblefor avalid
estimateof ability to beobtained fromeight or ten items which may all be
passed by the child. In the Standard method of administration, items carry
several pointseach, dependingonthetimetakentomakethepatterncorrectly.
Theexaminermaystoptestingatagivendecisionpointif thechildhasfailedto
get a maximum score on any three items in the set. The advantages are
obvious: thesubtest is often completedin less than veminutes, and many
childrenhavenoexperienceof failurewhatsoever. Thetechnical basisfor this
newapproachtosubtestadministrationisexplainedinthetechnical handbooks
for theinstruments(Elliott, 1990c, 1997a).
Reliability
Unsurprisingly, theBASII andtheDAShavesimilar psychometriccharacteris-
tics. Internal reliabilityishighat thelevel of theGCA andcluster scores. The
meanGCAreliabilitiesfor theBASII andDAS, respectively, are.89and.90at
theLowerPreschool level, .93and.94attheUpper Preschool level, and.96and
.95for theSchool-Agebatteries. Themeanreliabilityof theSNCisapoint or
two lower. BothinstrumentsshowSNC mean reliability at .89at theUpper
Preschool and.94at theSchool-Agelevel. Meancluster scorereliabilityranges
from.85 to .93 for the BAS II and from .88 to .92 for the DAS. Internal
consistencyat thesubtest level isalsorelativelystrong, withsomeexceptions,
withmeanreliabilitycoefcientsrangingfrom.70to.92. For theBASII, of the
27possiblemeaninternal reliabilitycoefcientsfor subtests, 19are.8or greater
and, of these, sevenare.90or greater. Similarly, for theDAS, of the26possible
mean internal reliability coefcientsfor subtests, 17are.8or greater, andof
these, four aregreater than.9.
Theassessment of testretest reliability wasaccomplishedusingthreeage
groupsfor theBASII andfour agegroupsfor theDAS. Resultsshowedthat
GCAandcluster scoresareverystable. For theBASII, GCAtestretest scores
correlatedbetween.90and.95, witharangeof .74to.96for cluster scores. For
theDAS, therangewas.89to.94for theGCA and.79to.90for theclusters.
Four DASsubtests, whichrequireasignicantamountof clinicianjudgmentto
score, wereexaminedfor interrater reliability. Coefcientswerefoundtobe.9
or above.
Specicity
BASII andDASscoreswerealsoevaluatedintermsof specicityor howmuch
of thescorevarianceisreliableanduniqueto that measure. Thehigher the
specicityof ameasure,themorecondentthecliniciancanbeaboutinterpret-
ing the score as measuring something unique from the other tests in the
battery. McGrew and Murphy (1995) argue that specicity is high when it
accountsfor 25%or moreof theteststotal varianceandwhenitisgreaterthan
theerror variance. Everycluster scoreinbothinstruments, everysubtestinthe
DAS, and every subtest but one
2
in theBASII, meets this criterion of high
specicity.
For theBASII at thePreschool level, specicitiesfor subtestsrangefrom.38
to .57, with cluster specicitiesof .34to .55. At theSchool-Agelevel, BASII
subtest specicitiesrangefrom.24to.82, withcluster specicitiesof .45to.57.
For theDAS, subtest specicitiesat thePreschool level rangefrom.31to.65,
withcluster specicitiesof .35and.45. At theSchool-Agelevel, DASsubtest
specicities range from.30 to .82, with cluster specicities from.39 to .49.
Elliott (1997b) presentsthesedatainmoredetail, together withdatashowing
that theDAShasapproximatelyone-thirdmorereliablespecicitythanother
widelyusedcognitivebatteries, includingtheWechsler scales. Thedataonthe
specicityof theBASII, publishedsubsequent tothepreparationof theElliott
(1997b)article, showthattheconclusionabouttheheightenedspecicityof the
DASalsoappliestotheBASII.
Validity
Construct validityfor boththeBASII andtheDASissupportedbyconrma-
tory and exploratory factor analyses (Elliott, 1990c, 1997a). For both instru-
ments, resultssupport aone-factor model at theLower Preschool level. At the
Upper Preschool level, theBASII resultssupport athree-factor model. Inthe
Britishstandardizationdata, EarlyNumber Conceptswasslightlymorehighly
correlatedwithPictureSimilaritiesthanintheUSdataontheDAS. Thus, these
two subtests formed aseparatecluster named Pictorial Reasoning. This left
Copying and Pattern Construction to form an easily interpretable Spatial
cluster. By way of contrast, theDASresultssupportedatwo-factor (Verbal/
Nonverbal)model attheUpper Preschool level. Inthissolution, EarlyNumber
Conceptsloadedequallyonbothfactors, sothissubtest isnot usedintheDAS
asacomponentofanyclusterscore, although(becauseithasahighgloading)it
isusedinthecalculationof theGCAscore. Bothinstrumentshaddataclearly
supporting a three-factor (Verbal/ Nonverbal/ Spatial) model for school-age
children(Elliott, 1990c, 1997a). Keiths(1990) independent hierarchical conr-
matory factor analyses of DAS data reported consistent results that Elliott
(1997b) foundwereessentiallyinagreement withtheDASdataanalysesgiven
in the test handbook (Elliott, 1990c). Importantly, Keiths (1990) analyses
demonstratedthat thegfactor, asmeasuredbytheGCA, isindistinguishablein
thePreschool andSchool-Agebatteriesof theDAS. Inasimilar study, Elliott
(1997a) reported acorrelation of approximately 1.0between theunderlying
general factorsderivedfromthePreschool andSchool-Agebatteriesof theBAS
II.
Elliott (1997b) alsoreportsajoint factor analysisof theDASandWechsler
Intelligence Scale for ChildrenRevised (WISCR; Wechsler, 1974), which
supportsaVerbal/ Nonverbal Reasoning/ Spatial factor model for school-age
children. Interestingly, theresultsof thisstudyshowthattheDASMatricesand
Sequential andQuantitativeReasoningsubtestsdonot relatestronglytoanyof
theWechsler subtests. TheWechsler Performancesubtestsappear tomeasure
Spatial Ability(or GvintheCHCmodels), theVerbal subtestsmeasureVerbal
Ability(or Gc), andnoWechsler subtestsappear tobestrongmeasuresof Fluid
Reasoning(Gf). Astudyon38childrenwhohadbeenassessedusingtheBASII
andtheWISCIII, reportedby Elliott (1997a), showed very similar ndings,
althoughthesamplesizeprecludedanyfactor analyses.
Evidencefor theconcurrent validityof theBASII andDASisprovidedby
studies(Elliott, 1990c, 1997a; Wechsler, 1991) showingconsistentlyhighcorre-
lationsbetweentheGCAandthecompositescoresof other cognitivebatteries,
such as theWISCIII (Wechsler, 1991), WPPSIR (Wechsler, 1989), andthe
StanfordBinet IntelligenceScale, Fourth Edition (Thorndike, Hagen, & Sat-
tler, 1986). HighcorrelationswerealsofoundbetweentheDASachievement
tests and other group or individual achievement tests as well as with actual
student grades(Elliott, 1990c, 1997a).
Bias
Extensiveeffortwasputintoensuringthefairnessof theBASII andDASacross
culture. For bothinstruments, test itemswererst reviewedfor possiblebias
byapanel representingwomenandseveral ethnicminoritygroupsand, based
ontheir recommendations, anumber of itemswerechangedor droppedfrom
thetest. Toaidstatistical analysesof biasintheDAS, anadditional 600Hispanic
and African American children were tested along with the standardization
sample in order that each test itemcould be analyzed for differential item
difculty acrossculture. Thechildren inthisbiasoversamplealso assistedin
ensuring that test scoring rules reected possible culture-specic responses
fromminoritychildren.
Itembias analyses were conducted on the standardization data for both
instruments. A small number of items that proved to be biased despite the
earlier expert reviews were deleted fromthenal published versions of the
testsat thisstage. Studiesof predictionbiaswerealsoreported. Inthecaseof
the BAS II, three samples of 39 White, 27 Black, and 54 Pakistani/
Bangladeshi childreninYear 3at school weregiventheBASII andtheSuffolk
ReadingScale(Hagley, 1987). Resultsshowedthat theGCA scorepredicted
SuffolkReadingscoresinthesamewayfor different ethnicgroups, indicating
nopredictionbias. Thisresult issupportedbyamuchlarger studyconducted
usingtheDAS. Thisstudyemployedsamplesof 125Black, 133Hispanic, and
467White childrenwhohadtakentheDAS, group-administeredachievement
tests, andtheBasicAchievement SkillsIndividual Screener (BASIS; Psychologi-
cal Corporation, 1983). Onceagain, resultsshowedthat therewasno unfair
biasagainst minoritychildrenintheabilityof theDASGCA scoreto predict
school achievement (Elliott, 1990c).
Further analyses of these data have examined construct bias in the DAS
(Keithet al., 1999). Thisstudy wasaccomplishedby conductinghierarchical,
multi-sample conrmatory factor analysis of the DAS standardization data,
including data from the bias oversample. Results showed that the DAS
measures the same constructs for all three ethnic groups (Black, White,
Hispanic) acrosstheentireagerangeof the2through17years. Thus, it was
concludedthat theDASshowsnoconstruct biasacrossgroups.
Proleanalysis
Aparticularlystrongfeatureof theBASII andtheDASisthesupport provided
totheclinicianintheprocessof interpretingtest results(Elliott, 1990c, 1997a).
Theclinicianisguidedthroughasystematicplanof attackfor interpretingDAS
test scoresaswell asaclear rationalefor thisapproach. Toenablesignicantly
highandlowscorestobeidentied, thetest RecordFormsindicatedifferences
betweenscoresthatarestatisticallysignicantatthe0.05level. Suchdifferences
are adjusted to take into account the fact that the psychologist is making
multiplecomparisons. Differencesthat aredetectedat thislevel of signicance
are by denition reliable; that is, they are unlikely to have arisen due to
measurement error.
Encouragement isgiventocheckingrst for signicant differencesbetween
theclusterscoresthemselvesandthenbetweentheclusterscoresandtheGCA.
Themethod also evaluates whether coresubtestswithin clusters aresigni-
cantlydifferent, andwhether anysubtest issignicantlyhigher or lower than
the childs own mean of the core subtests. With the availability of scoring
software for both instruments (Elliott et al., 1998), this detailed analysis,
includingananalysisof cognitiveprocessesunderlyingsubtest scores, ismade
easy.
Detailed analyses of subtest relative strengths and weaknesses are not
encouraged unless asignicant differenceis found between scores. This ap-
proach should signicantly reduce the risk of Type I error during subtest
analyses. Thetechnical handbooksfor thetwo instrumentsprovideguidance
ontheclinical interpretationof cluster andsubtest proles, includingtablesof
thefrequency, or unusualness, of scoredifferencesaswell asof their statistical
signicance.
Standardizations
Thestandardizationsamplesfor bothinstrumentswereintendedto berepre-
sentativeof thenormal rangeof childrenandstudentswithinthepopulation.
They drew children frompublicly funded school and fromprivate schools,
withoutrespecttospecial educationstatus. Thesamplesonlyexcludedchildren
inspecial schools(averysmall percentageof thechildpopulationinboththe
USAandGreat Britain), whichinpracticemeant that onlychildrenwithsevere
intellectual decitsorwithsevereemotional problemswereexcluded.Children
receivingspecial educational provisioninordinaryschoolswereeligibletobe
drawnfor thesample.
The DAS was standardized between 1987and 1989on a sample of 3475
childrenselectedtomatchthe1988UScensusonthestraticationvariablesof
age, gender, ethnicity, geographic location, and parent education level. The
preschool samplewasfurther stratiedtomatchthecensusdataaccordingto
theproportionof childrenwhohadattendedapreschool educational program.
Detailedcensusrecordswereusedinorder that at eachage-level of thetest the
standardizationsamplematchedthepopulationat that particular age-level in
terms of the joint distributions of ethnicity, geographic location, and parent
educationlevel.
Thisisanunusuallystringentconstraintinsampling,andfarmoredifcultto
achievethanrepresentativedistributionson eachstraticationvariabletaken
singly. This, and other procedural renements in sampling, made the DAS
uniqueinitssamplingaccuracy(Elliott, 1997b). A sampleof 175childrenwas
utilizedfor eachsix-monthageinterval at thepreschool range, andasampleof
200 children was utilized at each age-level of the school-age range (Elliott,
1990c).
TheBASII wasstandardizedin 1995on asampleof 1689children. Apart
froma shortfall of cases at the upper and lower extreme age groups, the
number of children at each year level was generally in excess of 100. For
preschool children, appropriatequotasof children wereobtainedwho spent
their daytime hours in certain environments such as nursery classes, play-
groups, with childminders, or full-time at home. For school-age children,
informationwasgatheredontheirschoolstheirtype, size, region, andrelative
number of childrenreceivingfreeschool meals. Informationonindividualsin
thesamplewasalsogatheredonethnicity, parent educationlevel, familytype
andsize, andchildsbirthorder inthefamily. Onthesevariables, thestandard-
izationsamplesprovidedagoodmatchto1994populationdistributions.
Child development considerations
Theworkof manycliniciansisconcernedwithchildrenwithlearningdifcul-
tiesor thosewhosedevelopmentisdelayedinoneormorecognitiveareas. The
DAS offers great exibility in choosing an individually tailored assessment
batteryfor childrenwithdevelopmental disabilities. Also, itoffersmuchgreater
sensitivitythanmanycognitivebatteriestothedifferential diagnosisof severe
andprofoundmental retardation. Sometimes, too, psychologistsneedtoassess
giftedchildren, whosedevelopmentisadvancedcomparedtoaveragechildren
of their age. For suchchildren, four major featuresof thedesignof theBASII
andtheDASareaimedat providingclinicianswithresourcestobeabletotest
childrenwithappropriatetaskswhatever their developmental level.
SeparateandoverlappingPreschool andSchool-Agebatteries
As describedearlier, thecognitivebatteries of thetwo instrumentsareeach
dividedintotwolevels, for preschool andschool-agechildren. Thetwolevels
of the cognitive batteries were deliberately designed to be developmentally
appropriateandengagingfor preschool andschool-agedchildren, respectively.
Bycontrast, thepracticeof other test developers(for exampleintheWechsler
andWoodcockJohnsonscales) topushtasksoriginallydesignedfor adultsor
older children into thepreschool domain was considered to beundesirable.
Such a practice leads to tasks that are less intrinsically interesting for pre-
schoolers,resultinginpoorermotivationandgreaterdifcultyfor theexaminer
inmaintainingrapport.
ThePreschool and School-Agelevels of thecognitivebatterieswerefully
co-normed for children in the agerange of 5 years 0months to 7years 11
months. Thisprovidesamajor advantagefor theprofessional examiner, who
hastheoptionof choosingwhichbatteryismost developmentallyappropriate
for agivenchildinthisagerange.
Out-of-level testing
The design of the BAS II and the DAS, by incorporating the concept of
out-of-level testing, makes tests normally used within a given age range
availablefor assessingexceptional childrenwhoareoftenolder, andsometimes
younger, thantheusual agerange. Tomakethispossible, anumber of subtests
were standardized across a wider age range than the usual one for certain
subtests. For example, Block Building is focused mainly on the Lower Pre-
school children, beingacoresubtest at thislevel. However, it isstandardized
throughage5years11monthsintheBASII and4years11monthsintheDAS,
enabling it to be used as a supplementary diagnostic subtest for older pre-
schoolers. Similarly, NamingVocabulary is aPreschool level subtest, but is
standardizedthrough7years11monthsintheBASII and8years11monthsin
theDAS, enablingit tobeusedasanalternatesubtest toWordDenitionsif a
youngschool-agedchildisunableor unwillingto respondappropriately. The
most broadly standardized subtest that is used out-of-level for school-aged
childrenisRecognitionof Pictures, standardizedinbothinstrumentsthrough
theentireagerangeto17years11months. Thisisanexcellent supplementary
diagnostic test of visual short-termrecognition memory for children whose
abilitiesinthat domainareaveragetobelow-average.
Special Nonverbal Composite
If aclinicianjudges, either prior toor duringtesting, that it will not befair to
includeverbal tasksas componentsof theGCA, theSNC can beusedasan
alternativeassessment of thegeneral factor g. For older preschool children, the
Special Nonverbal scaleconsistsof threesubtests(PictureSimilarities, Pattern
Construction, andCopying). At theschool-agelevel, thefour subtestsin the
Nonverbal ReasoningandSpatial clustersareusedtoformtheSpecial Nonver-
bal scale. Thedirectionsfor all thesubtestsincludedinthiscompositecan, if
necessary, beconveyedthroughgestures. It isexpectedthat thecompositewill
beused by clinicians assessingarangeof children such as shy preschoolers,
elective mutes, children suspected of hearing loss, and those from home
environmentslackinginverbal stimulationor wheretheprimarylanguageis
not English. However, it shouldbenotedthat if theSNCisused, thisdoesnot
meanthat theverbal subtestswill not beadministered. They will often give
valuableinformationabout thechildscurrent level of verbal skills.
DownwardextensionofGCAscores
Bothof theinstrumentsallowfor theestimationof extendedGCA scoresfor
children with moderate to severe levels of mental retardation. The normal
rangeof GCAscoresrunsfrom50to150. However, situationssometimesarise
inwhichachildverylowinabilityearnsT-scoresof 20onseveral of thecore
subtests;orwhenaretardedindividual needstobegiventhePreschool subtests
even though he or she may be12or 13years old and the subtests are not
normed to that age level. For such individuals, extended GCA norms are
provided, basedonanequatingof thescalesacrossages. Thesenormsenable
usersto assesschildrenwith moderateto severedevelopmental delaysusing
developmentallyappropriatetasks, yieldingGCAscoresaslowasabout 25.
The relationship between cognitive abilities and neurological structure
Therelationshipbetweencognitiveabilitiesandneurological structurehasfor
long exercised the discipline of psychology, because although it has been
knownformanyyearsthattherearecause-and-effectrelationships, theirnature
hasnot beenclear. Thefollowingsectionof thischapter brieyoutlinessome
links between the factor structure of abilities and the neuropsychological
evidence concerning the nature of structures underlying verbal and spatial
abilities, uidor general intelligence, andsomeaspectsof memory. BASII and
DAS measures (both subtests and composites) will be mapped onto this
structure.
Broadverbal andvisualspatial abilities
Two of the major ability clusters in the BAS II, DAS, and other cognitive
batteries, reect two major systems through which we receive, perceive,
remember, andprocessinformation. Thesesystemsarelinkedtotheauditory
andvisual modalities. Factorially, thesystemsarerepresentedby verbal and
visualization/ spatial factors GcandGvintheCHCtheory. Neuropsychologi-
cally, thereisstrongevidencefor theexistenceof thesesystems. Theytendto
belocalizedintheleft andright cerebral hemispheres, respectively, although
thereareindividual differencesinareasof localizationof function. Moreover,
the systems are doubly dissociated that is, they represent two distinct,
independent systems of information processing (Springer & Deutsch, 1989;
McCarthy & Warrington, 1990). In theBASII and DAS, theverbal factor is
measuredbytheVerbal cluster inboththePreschool andSchool-Agecognitive
batteries. At thePreschool level, theVerbal cluster isformedbytheNaming
VocabularyandVerbal Comprehensionsubtests, andat theSchool-Agelevel it
isformedbyVerbal Similarities(intheDAS, Similarities) andWordDeni-
tions. Thevisualizationor spatial factor ismeasuredbytheSpatial cluster at the
School-Agelevel (consistingof thePatternConstructionandRecall of Designs
subtests), andby thePatternConstruction, Block BuildingandCopyingsub-
testsat thePreschool agelevel.
Integrationofcomplexinformationprocessing
For normal cognitivefunctioning, theauditoryverbal andvisualspatial sys-
temsoperatein an integratedfashion. Integration of thevisual andauditory
informationprocessingsystems(andinformationfromall subsystems) isprob-
ably a necessary underpinningfor complex mental activity. Factorially, this
integrativesystemisrepresentedbytheFluidReasoning(Gf)factorintheCHC
theory. Measuresof Gf typicallyrequireintegratedanalysisof bothverbal and
visual information. Neuropsychologically, it seems that theintegrativefunc-
tion of frontal lobesystemsiscentral to complexmental functioning(Luria,
1973, discussed by McCarthy and Warrington, 1990, pp. 34364), and it is
thereforereasonableto hypothesizethat it providesastructural correlatefor
Gf. IntheBASII andDAS, theGf factor ismeasuredintheSchool-Agebattery
bytheNonverbal Reasoningcluster. Bothsubtestsrequireintegratedanalysis
andtransformationof bothvisual andverbal information. For example, inthe
Matricessubtest, verbal mediationiscritical for thesolutionof visually pres-
entedproblemsfor most individuals. At thePreschool agelevel, thePicture
Similaritiessubtest providesameasureof uidreasoning.
Thereisconsiderableevidencethat Gf formsthebasisof thehigher-order
general factor (g). Although there are many factors at a lower order of
generalitythat arerelatedtog, thethreethat havethegreatest contributionto
deninggaretheGf, Gv, andGcfactors, discussedabove. Carroll (1993) putsit
thisway: Thereisabundant evidencefor afactor of general intelligence. . .
that dominatesfactorsor variablesthat canbemasteredinperforminginduc-
tion, reasoning, visualization, andlanguagecomprehensiontasks (p. 624). The
central importanceof Gf is also emphasized by Gustafsson (1988, 1989) and
Harnqvist et al. (1994), whoseresearchindicatesthat theloadingof Gf onghas
beenfoundconsistentlytobeunity, whichimpliesthat gisequivalent touid
intelligence. Thehierarchical factor analysesof theDASstandardizationdata
byKeith(1990), referredtoearlier inthischapter, providefurther support for
thisposition. IntheBASII andtheDAS, gismeasuredbytheGCAcomposite.
Becauseitisestimatedfromonlythosesubteststhatarethebestestimatorsof g
(that is, thosethat measureGf, Gc, andGv), theGCA isapurer measureof g
thanthecompositesof mostotherbatteriesthatincludeall cognitivesubtestsin
thecomposite, irrespectiveof their gloading.
Verbal andvisual short-termmemorysystems
Some cognitive tests, such as the StanfordBinet Intelligence Scale, Fourth
Edition (SB-IV; Thorndike et al., 1986), and the WoodcockJohnson
Psychoeducational BatteryRevised (WJR; Woodcock and Johnson, 1989),
represent memory by a single factor. The CHC theory of the structure of
mental abilities also does not distinguish between separate, modality-related
memorysystems.However, thereismuchevidencefromcognitivepsychology
andfromneuropsychologythat verbal andvisual short-termmemorysystems
aredistinctandaredoublydissociated(Hitchetal., 1988;McCarthy&Warring-
ton, 1990, pp. 27595). The BAS II and the DAS keep visual and auditory
short-termmemory tasks as distinct measures, and do not treat short-term
memoryasunitary. Visual short-termmemoryisrepresentedat thePreschool
level by Recognition of Pictures and at the School-Age level by Recall of
DesignsandRecognitionof Pictures(thisbeingout-of-level for ageseight and
over: It is a reliable and valid measure for older children of average to
below-averageability). Auditoryshort-termmemoryisrepresentedacrossthe
entireagerangebyRecall of Digits, asubtestdesignedtobeapurer measureof
thisfunctionthantheDigitSpansubtestof anumberof other batteries. Also, in
theBASII at theSchool-Agelevel (agesixyearsandupwards), Recall of Digits
Backwardsprovidesanadditional verbal short-termmemorytask.
Theintermediate-termmemoryfactor (Glr intheCHC model) istypically
measuredbyteststhat havebothvisual andverbal components. IntheBASII
andDASRecall of Objectssubtest,for example,picturesarepresented,butthey
havetoberecalledverbally. McCarthyandWarrington(1990, p. 283) call this
visualverbal short-termmemory, and conclude that it is underpinned by
another distinct information processingsystem. In theBASII and DAS, the
Recall ofObjectssubtest, whichprovidesameasureof thisfactor, isfor children
of four yearsandolder.
Aspreviouslydiscussed, theBASII andDASwerecreatedwiththeintentionof
providingaproleof achilds cognitivestrengthsand weaknesses, with the
hopethat thisprolewouldleadtoabetter understandingandmoreeffective
remediation of possiblelearningdifculties. Major texts on assessment with
childrenemphasizetheimportanceof acareful examinationof thepatternsof
performance on the various subtests of an instrument (Sattler, 1992; Kam-
phaus, 1993; Kaufman, 1994). Kaufman(1994) statesthat thecompositescores
tell usabout thewhat of achildsabilities, whereasthesubtestsbringtolight
the how. However, it will be argued that the instruments lower-order
composites (Verbal, Nonverbal Reasoning, and Spatial) are also particularly
important inilluminatingthehow.
Controversy surrounding the analysis of cognitive test proles
Inrecent years, theanalysisof subtest prolepatternsto giveabetter under-
standingof achildslearningstrengthsandweaknesseshasbeencontroversial,
and McDermott, Glutting, and colleagues (e.g., McDermott, Fantuzzo, &
Glutting, 1990;McDermottet al., 1992; McDermott&Glutting, 1997; Glutting
et al., 1997, 1998; Youngstrom, Kogos, &Glutting, 1999)havebeenveryactive
inquestioningsuchprocedures. At thebeginningof thelast decade, McDer-
mottet al. (1990)madeageneral statementadvisingthatpsychologistsjust say
notosubtestanalysis.Thiswasonthebasisofacritiqueofpracticeusingthe
Wechsler, but therecommendationcametobeperceivedasgeneralizedtoall
cognitivetests. Oneof their concernscentersontherelativelylower reliability
andstabilityof subtestscoresincomparisonwithcomposites. Theyarguethat,
becausesubteststypicallyhavelowerreliabilityandstabilitythancomposites,it
is likely that the pattern of strengths and weaknesses among subtests that
appear onedaymight not betherethenext. Another concernrelatestotheuse
of ipsative scores in prole interpretation. Ipsative scores are produced by
subtractingthechilds averagenormativescoreacross varioussubtests from
eachindividual subtest score, therebyremovingthemeanelevationof scores
(i.e., variance associated with g). We emphasize that, although they have
appliedthesecritiquestotheDAS, theydonotconstituteamajorthreattoBAS
II or DASproleinterpretationsfor thefollowingreasons.
Interpretationof highandlowsubtestandcompositescoresisonlyrecommen-
ded when differences between scores are statistically signicant. This takes
account of thereliability of themeasures beingcompared. Relatively lower
reliabilityresultsinlargerdifferencesbeingrequiredfor signicance.Moreover,
theBASII andDASmethodadjustssignicantdifferencesfor multiplecompari-
sons: because several comparisons are being made, differences required for
signicance are greater than for a simple comparison of two scores. This
conservativeapproachisdesignedtoensurethat onlyreliabledifferences, not
attributabletomeasurement error, arereported.
McDermott and Gluttings negative conclusions about the value of prole
analysisusingipsativescoresdo not applyto theBASII andDAS, whichuse
direct comparisonsof normativesubtest andcompositescores. Theonlytime
scores are ipsatized is when the mean standardized T-score for the core
subtestsissubtractedfromindividual subtest scoresfor thepurposeof evaluat-
ing whether that subtest score is, overall, signicantly high or low. The
ipsatizedscore(orthedifferencescore, toputitanotherway)isneverreported:
onceasubtest scoreisidentiedassignicantly high or low, theunadjusted
T-score itself is reported. Also, note that the composite scores are never
ipsatizedintheBASII andDASprocedure.
Gluttinget al. (1997) havealso madethepoint that theinterpretationof a
proleshouldbedonewithreferencetobaserateinformation. Baseratesrefer
to thefrequency with which aparticular proleis found in thepopulation.
Glutting et al. (1997) correctly assert that statistically signicant differences
(thosethat arereliable, unlikelytohavearisenbecauseof measurement error)
canbequitecommonandordinary, eventhoughverysignicant. Toaddress
this problem, Holland and McDermott (1996), using hierarchical multistage
cluster analyses of the DAS standardization sample, identied seven core
proletypesinthissample, whichwasrepresentativeof thechildpopulation.
Fiveof theseproles, shownbyatotal of 71%of thesample, wereat interms
of their scoreson theDAScoresubtests(althoughtherewassomevariation
among the diagnostic subtests). The differences between the groups were
dened mainly by variation in general ability. In other words, the proles
variedinthealtituderather thaninthepatternof their scores. Theremaining
twocoreproletypesweredenedby(a) 16%of studentswhohadrelatively
highVerbal versuslowSpatial subtest scores, and(b) 13%of studentswhohad
relativelyhighSpatial versuslowVerbal subtest scores. TheVerbal andSpatial
cluster scoresweretenpointsdifferent inbothcases. Thesetwoproletypes
arediscussedmorefullyinthenext sectionof thischapter.
Attemptsto show theutility of proleanalyseswith theBASII and DAS
havepreviouslyconcentratedmostlyonchildrenwithlearningdisabilitiesand
inparticular onchildrenwithreadingdisabilities. Readersmayrefer tostudies
byElliott (1990c, 1997a), Kercher andSandoval (1991), Shapiro, Buckhalt, and
Herod (1995), McIntosh and Gridley (1993), and McIntosh (1999). In these
studies,avarietyofclusterandsubtestproleswasreported.Itseemscommon,
bothinstudiesof anormal populationandinstudiesof childrenwithdisabili-
ties, tondsomegroupswithat cluster and/ or subtest proles. Lookingonly
at cluster scores, somestudieshavefoundgroupswithrelativelyhighVerbal
versusSpatial scores, relativelyhighSpatial versusVerbal scores, andrelatively
low Nonverbal Reasoningversus Verbal and Spatial scores. In most studies,
therewasconsiderablevariabilityamongthediagnosticsubtests.
Thestudydescribedbelowattemptstoaddressmost of theissuesraisedby
criticsof proleinterpretation, andalso aimsto identifyanumber of distinct
proles of BAS II and DAS cluster scores among groups of normal and
exceptional children.
Proles of samples of dyslexic and learning-disabled children
Thisstudyisprincipallybasedonanexaminationof patternsof cluster scores,
measuring Verbal, Nonverbal Reasoning, and Spatial abilities. Four major
sourcesof dataareused, asfollows.
1. DAS standardization sample. This consists of 2400 children aged 6 years 0
monthsthrough17years11months. Atotal of 353poorreaderswereidentied
inthistotal sample. Poor readersaredenedasthosewithDASWordReading
standardscoresbelow85. Thesepoor readerswerefurthersubdividedintotwo
subsamples:
Poor Readers with No Signicant Discrepancy: 86 poor readers whose ob-
servedWordReadingscorewasnot signicantlylower thanthat predicted
fromtheir GCA.
Poor ReaderswithSignicant Discrepancy: 267poor readerswhoseobserved
WordReadingscorewassignicantlylower thanthat predictedfromtheir
GCA.
Thissampleprovidesdataconstitutingabaselineagainstwhichresultsfromthe
other twosamplesmaybeevaluated.
2. DASdyslexicsample.
3
Thissamplecomprises160childrenidentiedasdyslexic
bypsychologistsoftheDyslexiaInstituteinEngland. Thissamplehasthemajor
advantagefromaresearchperspectivethat theDAShadnot beenusedinthe
original diagnosticprocesstoidentifytheseindividualsasdyslexic. Noinforma-
tionisavailableastohowmuchtimeelapsedbetweentheirinitial identication
and thesubsequent DASassessment. It seems likely that many would have
received a considerable period of intervention for their reading difculties
beforetheir DASassessment. Thesamplewasdividedintotwosubsamples, as
follows:
DyslexicswithDASWordReadingstandardscoresbelow85.
DyslexicswithDASWordReadingscoresbetween85and100.
3. Learningdisabilitiessample.
4
Thissamplecomprises53childrenidentiedas
learning disabled, with the WISCIII used as the initial assessment battery.
Onceagain, thissamplehasthemajor advantagethat theDAShadnot been
usedintheoriginal diagnosticprocesstoidentifytheseindividualsaslearning
disabled. The sample was re-evaluated on the DAS three years after initial
assessment. Full detailsof thesample, theprocedure, andinitial ndingsare
reportedbyDumont et al. (1996).
4. BASII dyslexic sample.
3
This samplecomprises 287children referred to the
Head of Psychology at the Dyslexia Institute in England for assessment as
possiblydyslexic. All childrenwereasssessedbythesamepsychologist. Asin
the case of the DAS dyslexic sample, this sample was divided into two
subsamples, asfollows:
DyslexicswithBASII WordReadingstandardscoresbelow85.
DyslexicswithBASII WordReadingscoresbetween85and100.
Denitionofsubgroups
Children in all three samples were placed into subgroups based upon the
presence or absence of signicant discrepancies between scores that were
signicant at the5%condencelevel, adjustedfor multiplecomparisons. The
differenceswereobtained fromTables B.4. and B.5. in theBASII and DAS
handbooks(Elliott,1990c, 1997a), andaresimilartothedifferencesindicatedon
therespectiveRecordForms.
Thesubgroupsweredenedaccordingtothepossiblecombinationsof high
andlowscoresthatmaybefoundamongthethreeschool-ageclusters, andalso
includingsubgroupswithat cluster proles. Evenamongpoor readerswitha
signicant discrepancybetweenGCA andWordReading(or, moreproperly,
betweenobservedWordReadingandWordReadingpredictedfromtheGCA),
it wouldbeexpectedthat therewouldbeaproportion of children with at
cognitivetest proles. Poor readinghasmanycauses, andthereisnoreasonto
believethat children who havefailedto readbecauseof lack of exposureto
teaching through absences from school, or because of poor teaching, or
becauseof poor motivation, shouldhaveanythingother thannormal (i.e., at)
cognitiveproles. Other poor readersmay haveverbal or spatial disabilities,
both of which areamply reportedin theliterature(e.g., Rourkeet al., 1990;
Snow, Burns, & Grifn, 1998). Finally, wemay ndsomewhoseNonverbal
Reasoningability islower than both their verbal andspatial abilities. Such a
grouphadbeenidentiedbyMcIntoshandGridley(1993). Thepresent author
hasalsoreceivedmanyquestionsandcommentsduringthepast several years
frompsychologistswhohadobservedLDchildrenshowingthisprolepattern.
Finally, theremay besomeindividualswho show thereversepattern, with
Nonverbal Reasoningabilityhigher thanbothverbal andspatial, althoughno
researchstudieshaveidentiedsuchasubgroup. Thesubgroupsaretherefore
asfollows.
Flat cluster prole: No signicant differences among the three DAS cluster
scores.
LowSpatial, HighVerbal: Verbal cluster signicantlyhigher thanSpatial cluster.
Possiblynonverbal learningdisability.
LowVerbal, HighSpatial: Verbal cluster signicantlylower thanSpatial cluster.
Typicallyreportedpatternfor poor readers(e.g., Snowet al., 1998; British
Psychological Society, 1999).
HighNonverbal Reasoning: Nonverbal Reasoningcluster higher than both the
Verbal andSpatial scores, andsignicantlyhigher thanat least oneof them.
Interpreted as signifying good ability to process complex auditoryvisual
information.
LowNVR: Nonverbal Reasoningcluster lower thanboththeVerbal andSpatial
scores, and signicantly lower than at least one of them. Interpreted as
havingdifcultyinprocessingcomplexauditoryvisual information.
Results
Tables6.5and6.6showthefrequencyandpercentagesof childrenwitheach
prole in the standardization sample and in the dyslexic/ LD samples. Chi-
squaretestsshowedthat:
thereisnosignicant differencebetweenthetwoDASdyslexicgroups(Word
Readingbelow85andWordReading85100;
2
=5.13; df=4; N.S.);
thereisnosignicantdifferencebetweenthetwoBASII dyslexicgroups(Word
Table 6.5. Number of students drawn from DAS standardization sample with various
proles: normative baseline data
Typeof prole Poor Poor Total DAS
Readers Readers standardization
withno with sample
discrepancy discrepancy
Flat cluster prole 57 121 1203
66.3 45.3 50.1
LowSpatial, HighVerbal 6 16 257
7.0 6.0 10.7
LowVerbal, HighSpatial 8 63 239
9.3 23.6 10.0
HighNonverbal Reasoning 8 28 355
9.3 10.5 14.8
LowNonverbal Reasoning 7 39 346
8.1 14.6 14.4
Columntotals 86 267 2400
Column percentagesareshown in bold type. Thesubsamples in therst two columns form
14.7%of thetotal standardizationsample.
Readingbelow85andWordReading85100;
2
=5.49; df=4; N.S.);
thereisno signicant differencebetweenthecombinedDASdyslexicgroups
andDumontsLDsample(
2
=1.337; df=4; N.S.);
thereisasignicantdifferencebetweenthecombinedDASdyslexicgroupsand
the combined BAS II dyslexic groups (
2
=17.92; df=4; p:0.01). This
differenceislargelyattributableto differencesbetweenthetwo samplesin
theproportionof childrenwithaLowNonverbal Reasoningprole.
Asmight beexpectedfrominspectionof Tables6.5and6.6, thereisahighly
signicant differencebetweenthefrequenciesfor eachprolefor thedyslexic
and LD samples, on the one hand, and the standardization sample, on the
other. Comparison of thefrequenciesfor each prolefor thecombineddys-
lexic/ LD sample and the Poor Readers with Discrepancy, taken from the
standardizationsample, yieldsachi-squareof 28.09(df=4; p:0.001). Similar-
ly, comparisonof thecombineddyslexic/ LDsampleandTotal standardization
sampleyields achi-squareof 102.76(df=4; p:0.001). Thedifferencesthat
account for the highest chi-square values are for children with the Low
Nonverbal Reasoningprole.
Table 6.6 shows estimated base rates of each prole in the school-age
Table 6.6. Number of dyslexic and LD students with various proles
Typeof prole DAS: DAS: Dumont BASII: BASII:
dyslexic dyslexic et al. dyslexic dyslexic
with with LD with with
Word Word sample Word Word
Reading Reading Reading Reading
below85 85100 below85 85100
Flat cluster prole 28 28 20 48 78
Lowspatial, 4 12 5 7 10
HighVerbal 4.9 15.2 9.4 6.0 5.8
LowVerbal, 10 7 6 26 28
HighSpatial 12.3 8.9 11.3 22.4 16.4
HighNonverbal 5 4 1 5 18
Reasoning 6.2 5.1 1.9 4.3 10.5
LowNonverbal 34 28 21 30 37
Reasoning 42.0 35.4 39.6 25.9 21.6
Columntotals 81 79 53 116 171
Columnpercentagesareshowninboldtype.
population. Fiftypercent of thetotal standardizationsamplehadaat cluster
prole. However, 66.3%of thepoor readerswhohadnodiscrepancybetween
observedandpredictedreadinghadaat cluster prole. Therangeof GCA
scoresin this particular group is quiterestricted, rangingfrom54to 84, the
groupthereforeincludingchildrenwhomaybemildlytomoderatelymentally
retarded. The larger group of poor readers with a signicant discrepancy
between observed andpredictedreadinghave, as wouldbeexpected, larger
variance in GCA scores, ranging from46 to 118. Compared with the total
standardization sample, a slightly smaller percentage (45.3%) of these poor
readerswith adiscrepancyshowedat proles. Also, about aquarter of this
subgroup(23.6%), asmight beexpected, hadsignicantly lower Verbal than
Spatial ability. Other percentageswereunremarkable: inthetotal standardiz-
ation sample, 10%of children hadLow Spatial and High Spatial scores, and
1415%showedLowandHighNonverbal Reasoningproles.
Table 6.6 shows the results for the dyslexic and LD samples. They are
remarkably similar for thethreesamples, despitethedatabeinggatheredin
different countriesandindifferent settings. About one-thirdtonearlyone-half
ofthesesampleshadatclusterproles, fewerthaninthestandardizationsample
but still asubstantial proportion. Both the DAS dyslexic samplewith Word
Readingbelow 85and theDumont samplehad 1112%in theLow Verbal,
HighSpatial subgroup. Thisisabouthalf thefrequencyof LowVerbal children
inthecomparablesubgroupfromthestandardizationsamplewhowerepoor
readers with abilityachievement discrepancies. One wonders whether Low
Verbal childrentendnot to beidentiedasdyslexicor LD. It seemspossible
that manysuchchildrenmaybefoundininner-cityandpoor socioeconomic
environments. They may therebyget special educational servicesfromother
sources(for exampleTitle1fundingintheUSA). Suchchildrenmayoftenbe
consideredtobegarden-variety poor readers, touseStanovichs(1988) term,
rather thandyslexicor LD. However, theBASII sampleof childrenreferredas
possiblydyslexic, andwho hadWordReadingscoresof 85andbelow, hada
verysimilar proportionof LowVerbal childrentothebase-rategroupfromthe
standardizationsampleof Poor ReaderswithDiscrepancy. Further researchis
neededtoclarifytheseissuesconcerningtheproportionof LowVerbal children
referredandlateridentiedasdyslexicor LD. TurningtotheLowSpatial, High
Verbal subgroup, thedyslexic andLD samplesshowedasimilar proportion,
comparedto thebaserate, of students with thisprole. It is possiblethat a
number of children with this prole have a Nonverbal Learning Disability
(Rourkeet al., 1990).
Apart fromtheBASII-tested dyslexics with Word Readingscores greater
than85, fewdyslexicor LDchildrenhadaHighNonverbal Reasoningprole
considerably fewer than theproportion in thetotal DASsample. However,
morethanone-thirdof theDAS-testeddyslexicandLD samplesandabout a
quarter of the BASII-tested sample fell into the Low Nonverbal Reasoning
subgroup. Althoughthenumber of BASII-testedchildrenwiththisproleis
signicantly lower than for the other dyslexic and LD groups, it is still
substantially greater than thebaserate. Consideringthedifferent times and
settings when these datawere gathered, the results are remarkably similar,
providingmutual cross-validationof thesendings. Themeanprolefor the
combineddyslexicandLDchildrenwhoareinthissubgroup(n=83) isshown
inFig. 6.1. Thedifferencesbetweenthemeanscoresaredramatic: Nonverbal
Reasoning is lower than both Verbal and Spatial means by more than one
standarddeviation.
WhyshouldchildrenwithreadingdisabilitiesscorepoorlyonthetwoDAS
subtestsmeasuringNonverbal Reasoning?Theanswer seemsmostplausiblyto
liein thenatureof thetasks of readingand nonverbal reasoning. Reading
requires a high level of visual/ verbal integration in order to convert visual
printedcodesintosoundsandwords. For uent reading, andfor recognitionof
common words or letter strings, an individual needs information in the
Fig. 6.1. Mean scores on BASII and DAS clusters for dyslexic and LD children in the Low
Nonverbal Reasoning(NVR) subgroup.
auditory/ verbal and visual processing systems to be effectively integrated.
Similarly, toperformwell ontheDASNonverbal Reasoningtasks(or, indeed,
anygoodmeasuresof uidreasoning), oneneedsgoodintegrationof thevisual
andverbal processingsystems. Thesetasksarepresentedvisually hencethe
termnonverbal that describesthem but to solvetheproblemseffectively,
the use of internal language to label and to mediate the solution of the
problemsisgenerallyessential. Evenif anindividual hasexcellent verbal and
spatial abilities,if thetwobrainprocessingsystemsspecializedfor thoseabilities
do not talk to each other effectively, this may have an adverse effect on
performance, bothinreasoningandinreadingacquisition.
Readers may wonder why these striking ndings, on two independent
samples, havenot beenreportedpreviouslyfor other test batteries. Thesimple
andshortanswer(asthereisinsufcientspacetoelaborateonit)isthatall other
psychometric batteries used with children, with oneexception, do not have
threeseparatemeasuresof Verbal ability(Gc), Spatial ability(Gv), andNonver-
bal Reasoningability(Gf).
5
A brief account of thecaseof Mike(age7years11months) may serveto
illustrateatypical dyslexicor reading-disabledstudent withaLowNonverbal
Reasoning prole. Mike was referred for assessment because, despite being
self-evidently bright verbally andvery capablein visualmotor tasks, hehad
hadpersistent problemssincestartingschool inlearningtoreaduentlyandto
spell accurately. HisscoresontheDASareshowninTable6.7.
There are no signicant differences between Mikes scores on the two
Table 6.7. DAS subtest, cluster, and achievement scores for Mike
DASsubtest or cluster Score
Coresubtests (T-score)
WordDenitions 53
Similarities 49
Matrices 40
Sequential andQuantitativeReasoning 47
Recall of Designs 59
PatternConstruction 61
Diagnosticsubtests
Recall of Digits 40(L)
Recall of Objects(Immediate) 50
Speedof InformationProcessing 61(H)
Clusters (Standardscore)
Verbal 101
Nonverbal Reasoning 88(L)
Spatial 116(H)
GCA 102
Achievementtests (Standardscore)
WordReading 79(L)
Spelling 87(L)
BasicNumber Skills 91(L)
Inthescorecolumn, (L) denotesastatisticallysignicant lowscore, and(H) astatistically
signicant highscore. Theseareexplainedmorefullyinthetext.
Verbal, thetwo Nonverbal Reasoning, or thetwo Spatial subtests. However,
his Nonverbal Reasoningcluster scoreis signicantly lower than his Spatial
clusterscore, andislower thanhisVerbal score(thisdifferencefallingjustshort
of statistical signicance). Nevertheless, hisNonverbal Reasoningscoreiswell
below both the Verbal and Spatial scores, making his prole t the Low
Nonverbal Reasoningsubgroup. HisNonverbal ReasoningandSpatial scores
arealsosignicantlylowerandhigher thanhisGCAscore, respectively,andare
consequentlymarkedL andH. Asdiscussedearlier, it seemsprobablethat
whereasMikeisuent verbally, andhasgoodspatial skills, hehasproblemsin
auditoryvisual integration that arguably have inuenced his acquisition of
readingskills.
Turning to the diagnostic subtests, Mikes score on Recall of Digits is
signicantly low, in comparison with hismean T-scorederivedfromthesix
core subtests. His score on Speed of Information Processing is signicantly
high. Hethereforeappearsto haveasignicant weaknessin auditory short-
termmemory, inadditionto hisrelativeweaknessinauditoryvisual integra-
tion. Hisparentsandteacher alsocommentedthat Mikeoftenquicklyforgets
verballygiveninstructions. Theyput thisdowntoinattention, but analterna-
tivehypothesisisarelativeweaknessinshort-termverbal processing. Onthe
other hand, his speed of visual information processing is relatively high,
supportinghisgoodspatial ability.
On the three DAS achievement tests, Mikes obtained scores on Word
Reading, Spelling, andBasicNumber Skillsareall signicantlylower thanthe
scorespredictedfromhis GCA score(WordReadingand Spellinghavepre-
dictedscores of 101; Basic Number Skills has apredictedscoreof 102). The
differenceof 22pointsbetweenMikesobservedandpredictedscoresonWord
Readingisfoundinfewer than5%of children.
So, whatwouldappropriateinterventionrecommendationsbefor aboylike
Mike?For many years, teachersof dyslexic children haveactively advocated
multi-sensory teaching methods, despiteresearch evidence that appeared to
discreditauditoryvisual integrationasacauseof poorreadingacquisition(e.g.,
Bryant, 1968). Teachers appear to have long held to the view that dyslexic
childrenhavedifcultyintegratingvisual andverbal information. Thereader
will recall thatitishypothesizedthatarelativeweaknessinthisabilityunderlies
theLowNonverbal Reasoningprolefoundinthesamplesof dyslexicandLD
children, reported earlier. Thus, it was recommended that a multi-sensory
teaching method should be used with Mike. His poor auditory short-term
memoryshouldalsobetakenaccount of through(a) minimizingthelengthof
verbal instructions; (b) using repetition where necessary; and (c) using his
above-averagevisual short-termmemorytocompensatefor hisrelativelypoor
auditory short-termmemory, perhaps by keeping a notebook of things to
remember. Useful referencesto multi-sensoryteachingapproachesaregiven
by Thomson andWatkins (1998), Augur and Briggs(1992), and Walker and
Brooks(1993). The40%of dyslexicandLDchildrenfoundinthisstudywitha
LowNonverbal Reasoningprolemaywell benet fromsuchanapproach.
Illustrative case study: Benjamin W.
Thecasepresentedhereillustratestheuseof theBASII in investigatingthe
abilitiesof achild referredbecauseof concern about hisbasic school attain-
ments. BenwasassessedontheBASII attheageof 8years1month. Hedidnot
showadramaticallyspikycognitiveproleontheBASII. Thecasestudyshows
how various hypotheses may be tested and evaluated in conjunction with
careful observationandinformationfromhomeandschool, andillustrateshow
the conclusions drawn are then used to develop recommendations about
appropriateinterventions.
Introduction
Bensparentshadapproachedhisteacher andheadteacher at school, asthey
weresomewhat concernedabout hisprogressat school inbasicskills. Hewas
showinglittleinterest inreadingfor pleasure, andwasresistant todoingsmall
homeworktasksinspelling, reading, writing, or maths. Theteacher hadalso
noticed that Ben would do the bareminimumthat she set himto do, and
wouldoften beinattentivein class. Theschool then referredhimfor assess-
ment. Thepsychologist focusedontheareaof basicskills, andconrmedthe
teacherscommentsafter observinghiminclass. Hewasnot stronglyengaged
inclassroomtasksthat focusedonbasicskills, but wasclearlyauent thinker
andspeaker inconversation. Hewasenthusiasticabout physical activitiesand
creativetasksinart. Socially, hemixedwell withotherchildrenandwithadults.
The BASII was used to assess Bens cognitive abilities. All tests were
completedinasinglesession. Bencooperatedwell, maintainingattentionand
interest until near theendof thesession.
Summaryoftestresults
Benstest resultsontheBASII aresummarizedinTable6.8. Thetablestarts
with the core scales, from which the composite scores are derived, then
presentsthediagnostic scales, measuringaspectsof short-termmemory and
speedof informationprocessing, andconcludeswiththeschool achievement
tests.
Discussionandinterpretation
Cognitiveabilities
Benscognitiveabilitiesarealmost uniformlyaboveaverage: heiswithinthe
top15%of childrenof hisage. Hisscoresonthecorescalesof theBASII are
very similar indeed, with no signicant scatter. Thus, hisVerbal, Nonverbal
Reasoning, andSpatial abilitiesare113, 112, and115respectively. Hehasaat
proleonthecoresubtestsandcluster scores.
On the diagnostic scales, he again performed at a similar level to his
performance on the core scales. He scored exceptionally well on Speed of
Information Processing, within the upper 1% of children of his age. His
short-termmemoryabilitiesalsoappear tobeaboveaverage.
The single exception to his succession of above-average scores was his
signicantlylowscore(whencomparedtohisownscoresonother scales) on
Table 6.8. Bens scores on the BAS II
Score Percentile Descriptivecategory
CoreScalescores
a
(Mean=50, SD=10)
WordDenitions 61 86
Verbal Similarities 55 69
Matrices 62 88
QuantitativeReasoning 53 62
Recall of Designs 59 82
PatternConstruction 59 82
DiagnosticScalescores
(Mean=50, SD=10)
Recall of Objects(Verbal Recall of
Pictures)
61 86
Speedof InformationProcessing 74 99 Signicantlyhigh
Recall of DigitsForward(Auditory
Memory)
61 86
Recall of DigitsBackward(Auditory
Memory)
49 46 Signicantlylow
Recognitionof Pictures(Visual
Memory)
59 82
Compositescores
(Mean=100, SD=15)
Verbal Ability 113 81 AboveAverage
Nonverbal ReasoningAbility 112 79 AboveAverage
Spatial Ability 115 84 AboveAverage
General Conceptual Ability(GCA) 116 86 AboveAverage
Achievement scalescores
(Mean=100, SD=15)
WordReading 100 50 Signicantlylow
b
Spelling 98 45 Signicantlylow
b
Number Skills 109 73
a
Therearenosignicant differencesamongthecorescalescores.
b
Thesescoresaresignicantlylower thanthescoresthat arepredictedby hisGCA score. For
childrensuchasBen, withaGCAscoreof 116, scoresontheWordReadingandSpellingtestsare
bothpredictedtobe109.
Recall of DigitsBackward. Thistestrequiresachildtorepeat, inreverseorder, a
stringof single-digit numberspresentedverballyat therateof two digitsper
second(for example3, 9, 7, 8, 2). Thetest is consideredto beameasureof
verbal working memory, requiring the child to hold and manipulate the
numbersbeforeproducingaresponse.ThiswasthelasttestgiventoBenaftera
long session, and his relatively low score may simply be attributable to
tiredness, particularlybecausehewasableto do theRecall of DigitsForward
task at an above-average level (repeating digit strings in the same order as
presented). Bens score on Recall of Digits Backward was relatively low in
comparisonwithhisownscoresonother scales. However, incomparisonwith
other children of his age, his score was average. On balance, therefore, the
psychologist didnot consider thisscoreto beimportant intheoverall assess-
ment of Bensabilities, and concludedthat, with aat proleacross awide
rangeof cognitiveabilities, Benshowednoevidencethat cognitiveprocessing
difcultiesaccounted for his relatively poor attainments. In other words, he
doesnot haveaspeciclearningdisability.
Basicschool achievement
Onall threetests, Bensscoresfell intotheaveragerangefor hisage. Although
Bensscoreswerewithin theaveragerangeon Word Readingand Spelling,
bothof thesescoresweresignicantlylower thantheachievement scoresthat
wouldbeexpectedfromhiscognitiveabilities, andspecicallyfromhisGCA
score. Basedonthat score, WordReadingandSpellingscoresof 109wouldbe
expected. Hisactual scoresonWordReadingandSpellingareveryconsistent.
Hisactual scoreof 100onWordReadingplaceshimat the50thpercentile, and
his score of 98on Spelling places himat the 45th percentile. However, his
expectedpositionisaroundthe73rdpercentile. Suchdiscrepanciesarefoundin
about 2025%of children with GCA scores of 116. However, although not
unusual, the results do support the concerns expressed by his parents and
teacher.
Anobservationof bothhisreadingandspellingstrategiessuggeststhat Ben
readsandspellsfamiliar wordsquicklywhenheknowsthem. Whenfacedwith
anunfamiliar word, however, hehasfewsystematicstrategiestodecodethem
(if reading)or encodethem(if spelling). Thus, hiserrorsinreadingshowsignsof
unduedependenceonstrategiesof visual recognitionandanonuseof system-
aticphoneticstrategiesto solveunfamiliar words. Unknownwordstherefore
tendtobeguessedquicklyrather thanbeingslowlyandsystematicallybroken
down.
Inspelling, heclearlyhasavocabularyof (for him) irregular words, suchas
come andeight. For wordshedoesnot know, hiserrorsinspellingtendtobe
of asimplephonetictype. Hehasnot yet developedorthographicstrategiesfor
longer words(strategiesthat show heis developinghypothesesthat aword
might belongtoafamily of letter combinations). Hisvisual strategiesarenot
efcient enough to allowhimto recognizeillegal letter combinations. Some
examplesfromtheSpellingtest areasfollows:
Cueword Bensspelling Comment
work werk Simplephonetic
walk work Simplephonetic didnt recognize
that thissaidwork!
soil soal Illegal combination(oa never spells
thesoundoi)
friend frend Simplephonetic
know no Simplephonetic hasnt learnt this
homonym
catch cach Simplephoneticwithanillegal ending
worse wers Asabove
circle calcale Nosystematicphoneticmappingof
sounds. Somevisual resemblance
Such spelling errors are, of course, very common in young children. Al-
thoughhisabsolutelevelsof readingandspellingarejust averagefor hisage,
this assessment indicates that his literacy skills need improvement, and are
belowexpectation, baseduponhiscognitivedevelopment acrossverbal, spa-
tial, anduidreasoningareas.
Interventionsuggestions
Whilst Bensreadingandspellingperformanceisaroundaveragefor hisage,
anddoesnotrequirespecialistremedial resourcesatthistime, theresultsof this
assessment indicatethat Bendoeshavethecognitiveabilitytodosignicantly
better. At theageof eight years, heshouldbedevelopingsystematicphonetic
andorthographicstrategiesfor readingandspelling.
InobservingBensreading, bothinthisassessment sessionandingeneral at
school andat home, it appearsthat therearetwomajor issues. Therst isthat
heneedstolearnalarger rangeof systematicdecodingandencodingskillsthat
areessential foundationsof literacy. Thesecondkeyissueismotivation:hewill
needalot of encouragement.
At school, thefollowingstepsarerecommended.
1. Hear Benreaddaily.
2. Systematicallyteacharangeof phoneticandorthographicstrategies.
3. Notehiscommonerrorsandusetheseasafocusfor teachingdecodingand
encodingskills.
4. Readingandwritingtasks, whether intheformof aphonicsprogrammeor in
theformof booksto reador writtenexpressionof ideas, shouldhaveahigh
interest level for himwherever possible.
5. Try to developreadingspeedprovidedhisreadingisaccurate(i.e., uency).
Perhapshavealonger passageanddivideit upintochunksof, say, velines,
with Ben readingapieceeach day under timed conditions and chartinghis
progress(number of wordsreadin, say, 60seconds, or timetakentoread, say,
velines). Benenjoysthechallengeof doingthingsquickly, andtryingtobeat
hisprevioustime!
At home, thefollowingstepsarerecommended.
1. Mumor Dadshouldhear Benreadfor tenminuteseachday. Booksshouldbe
selected for pleasure or interest. If possible, choose books that he can read
reasonablyuently, sothat heexperiencessuccess. If hesticksonaword, help
himbreak it down, if it is reasonably regular. If it isnt anything he could
reasonablydecodeat thisstage, saytheword, andget himtorepeat it. At the
endof thesession, gobacktotwoorthreewords(maximum)thathegotwrong
(but youthinkheshouldknowthem), andget himtoreadthemagain.
2. GiveBen aquiet time of maybe30or 45minuteseach day. Givehimthe
choiceof doingreadingor writing, aswell asthechoiceof what hereads(keep
drawingpicturestoaminimum itsaneasydiversion!). Havesomeonecheck
periodicallytomakesurehesnot just daydreaming.
3. RationthetimehespendswatchingTV or doingcomputer andvideogames!
Maybegivetimeonthemasarewardfor constructivereadingor writing.
4. Haveastar chart systemfor recordinggoodwork each day, with associated
rewards(couldbeextraTV time, pocket money, etc.).
Follow-up
Bensbasicskillsachievementswerefollowedupsixmonthsafter thisassess-
ment.Histeacherandparentsreportedthattheyhadputtherecommendations
into practice systematically. Ben had made excellent progress in reading,
spelling, andwrittenexpression. Hewasenjoyingtheseactivities, andhistest
scores had increased as follows: Word Reading 115, Spelling 110. Now the
concernof histeacher andhisparentsishisnumber skills!
ENDNOTES
1 Individual subtestsinthetwoinstrumentsarecalledsubtests intheDASandscales inthe
BASII. For thesakeof clarity, theyarereferredtoassubtests inthischapter.
2 TheexceptionistheWordDenitionssubtest, whichhasaspecicityof .24, therebynarrowly
failingthe.25criterion.
3 The data for this sample have been very kindly provided by Martin Turner, Head of
Psychology, DyslexiaInstitute, Staines, England.
4 Thedatafor thissampleareusedbykindpermissionof Dr RonDumont, Director, MA and
PsyD ProgramsinSchool Psychology, FarleighDickinsonUniversity, Teaneck, NewJersey,
USA.
5 The one exception is the WoodcockJohnson Tests of Cognitive AbilityRevised (WJR;
Woodcock & Johnson, 1989). A lack of research evidence on such difculties with uid
reasoningtasksfor dyslexicandlearning-disabledchildrenmaybeduetooneof twopossible
reasons: (a) alackof researchwithsubstantial samples; or (b) aproblemwiththesubteststhat
purport tomeasureGvandGf. For example, thecorrelationbetweenthetwoWJRsubtests
measuringGv(Visual ClosureandPictureRecognition) isverylow: .22at agesixyears, .30at
agenineyears, and.29at age13years. Suchlowcorrelationsbegthequestionof whether the
compositeformedfromsuchaweak pairingmeasuresanythingmeaningful. Incomparison,
the correlations between the two DAS measures of Gv (Recall of Designs and Pattern
Construction) are.56, .54, and.61for thesameagegroups.
REFERENCES
Anastasi, A. & Urbina, S. (1997). Psychological Testing, SeventhEdition. Upper SaddleRiver, NJ:
PrenticeHall.
Augur, J. &Briggs, S. (eds.)(1992). TheHickeyMultisensoryLanguageCourse, 2ndedition. London:
Whurr.
BritishPsychological Society(1999). Dyslexia, LiteracyandPsychological Assessment. Report by a
workingpartyof theDivisionof Educational andChildPsychology.Leicester, England:British
Psychological Society.
Bryant, P.E. (1968). Commentsonthedesignof developmental studiesof cross-modal matching
andcross-modal transfer. Cortex, 4, 12737.
Carroll, J.B. (1993). Human CognitiveAbilities: A Survey of Factor Analytic Studies. New York:
Dumont, R., Cruse, C.L., Price, L., & Whelley, P. (1996). The relationship between the
Differential Ability Scales (DAS) and the Wechsler Intelligence Scale for ChildrenThird
Edition(WISCIII) for studentswithlearningdisabilities. PsychologyintheSchools, 33, 2039.
Elliott, C.D. (1990a). Differential AbilityScales. SanAntonio, TX: ThePsychological Corporation.
Elliott, C.D. (1990b). Thenatureandstructureof childrensabilities: evidencefromtheDifferen-
tial AbilityScales. Journal of Psychoeducational Assessment, 8, 37690.
Elliott, C.D. (1990c). Differential AbilityScales: IntroductoryandTechnical Handbook. SanAntonio,
Elliott, C.D. (1997a). BritishAbilityScales, 2ndedition. Windsor, England: NFER-Nelson.
Elliott, C.D. (1997b). The Differential Ability Scales. In Contemporary Intellectual Assessment:
Theories, Tests, andIssues, ed. D.P. Flanagan, J.L. Genshaft, &P.L. Harrison, pp. 183208. New
York: GuilfordPress.
Elliott, C.D., Dumont, R., Whelley, P., & Bradley, J. (1998). ScoringAssistant for theDifferential
AbilityScales. SanAntonio, TX: ThePsychological Corporation.
Elliott, C.D., Murray, D.J., & Pearson, L.S. (1979). British Ability Scales. Windsor, England:
National Foundationfor Educational Research.
Embretson, S. (1985). Reviewof theBritishAbilityScales. InNinthMental MeasurementsYearbook,
ed. J.V. Mitchell, pp. 2312. Lincoln, NE: Universityof NebraskaPress.
Glutting, J.J., McDermott, P.A., Konold, T.R., Snelbaker, A.J., & Watkins, M.W. (1998). More
upsanddownsof subtest analysis: criterionvalidity of theDASwith anunselectedcohort.
Glutting, J.J., McDermott, P.A., Watkins, M.W., Kush, J.C., &Konold, T.R. (1997). Thebaserate
problemand its consequences for interpreting childrens ability proles. School Psychology
Review, 26, 17688.
Gustafsson, J.-E. (1988). Hierarchical models of individual differences in cognitiveabilities. In
AdvancesinthePsychologyof HumanIntelligence, Vol. 4, ed. R.J. Sternberg, pp. 3571. Hillsdale,
NJ: Erlbaum.
Gustafsson, J.-E. (1989). Broadandnarrowabilitiesin researchon learningandinstruction. In
Abilities, Motivation, and Methodology: TheMinnesota Symposiumon Learning and Individual
Differences, ed. R. Kanfer, P.L. Ackerman, &R. Cudeck, pp. 20337. Hillsdale, NJ: Erlbaum.
Hagley, F. (1987). TheSuffolkReadingScale. Windsor, England: NFER-Nelson.
Harnqvist, K., Gustafsson, J.-E., Muthen, B.O., & Nelson, G. (1994). Hierarchical models of
abilityat individual andclasslevels. Intelligence, 18, 16587.
Hitch, G.J., Halliday, S., Schaafstal, A.M., &Schraagen, J.M.C. (1988). Visual workingmemoryin
youngchildren. MemoryandCognition, 16, 12032.
Holland, A.M. & McDermott, P.A. (1996). Discovering core prole types in the school-age
standardizationsampleof theDifferential AbilityScales. Journal ofPsychoeducational Assessment,
14, 13146.
Kamphaus, R.W. (1993). Clinical Assessmentof ChildrensIntelligence. Boston: Allyn&Bacon.
Kaufman, A.S. (1994). Intelligent TestingwiththeWISCIII. NewYork: Wiley&Sons.
Keith,T.Z. (1990).Conrmatoryandhierarchical conrmatoryanalysisof theDifferential Ability
Scales. Journal of Psychoeducational Assessment, 8, 391405.
Keith, T.Z., Quirk, K.I., Schartzer, C., & Elliott, C.D. (1999). Construct biasintheDifferential
Ability Scales? Conrmatory and hierarchical factor structure across three ethnic groups.
Kercher, A.C. &Sandoval, J. (1991). ReadingdisabilityandtheDifferential AbilityScales. Journal
of School Psychology, 29, 293307.
McCarthy, R.A. &Warrington, E.K. (1990).CognitiveNeuropsychology:AnIntroduction. SanDiego,
CA: AcademicPress.
McDermott,P.A.,Fantuzzo, J.W., &Glutting, J.J. (1990). Justsaynotosubtestanalysis:acritique
of Wechsler theoryandpractice. Journal of Psychoeducational Assessment, 8, 290302.
McDermott, P.A., Fantuzzo, J.W., Glutting, J.J., Watkins, M.W., & Baggaley, A.R. (1992).
Illusionsof meaningintheipsativeassessmentof childrensability. Journal of Special Education,
25, 50426.
McDermott, P.A. & Glutting, J.J. (1997). Informingstylisticlearningbehavior, disposition, and
achievementthroughabilitysubtestsor, moreillusionsof meaning?School PsychologyReview,
26, 16375.
McGrew, K.S. (1997). Analysis of the major intelligence batteries according to a proposed
comprehensiveGfGcframework. InContemporaryIntellectual Assessment: Theories, Tests, and
Issues, ed. D.P. Flanagan, J.L. Genshaft, & P.L. Harrison, pp. 15179. New York: Guilford
Press.
McGrew, K.S. & Murphy, S. (1995). Uniqueness and general factor characteristics of the
WoodcockJohnson Tests of Cognitive AbilityRevised. Journal of School Psychology, 33,
23545.
McIntosh, D.E. (1999). Identifyingat-riskpreschoolers: thediscriminant validityof theDifferen-
tial AbilityScales. PsychologyintheSchools, 36, 110.
McIntosh, D.E. & Gridley, B.E. (1993). Differential Ability Scales: prolesof learning-disabled
subtypes. PsychologyintheSchools, 30, 1124.
Psychological Corporation(1983). BasicAchievementSkillsIndividual Screener. NewYork: Psycho-
logical Corporation.
Rourke, B.P., Del Dotto, J.E., Rourke, S.B., &Casey, J.E. (1990). Nonverbal learningdisabilities:
thesyndromeandacasestudy. Journal of School Psychology, 28, 36185.
Sattler, J.M. (1992). Assessmentof Children, 3rdEditionRevised. SanDiego, CA: Sattler.
Scottish Council for Research in Education (1967). TheScottishStandardisationof theWechsler
IntelligenceScalefor Children. London: Universityof LondonPress.
Shapiro, S.K, Buckhalt, J.A., &Herod, L.A. (1995). Evaluationof learningdisabledstudentswith
theDifferential AbilityScales(DAS). Journal of School Psychology, 33, 24763.
Snow, C.E., Burns, M.S., & Grifn, P. (eds.) (1998). Preventing Reading Difculties in Young
Children. Washington, DC: National AcademyPress.
Spearman, C. (1927). TheAbilitiesof Man. London: Macmillan.
Springer, S.P. &Deutsch, G. (1989). Left Brain, Right Brain, 3rdedition. NewYork: Freeman.
Terman, L.M. & Merrill, M.A. (1960). StanfordBinet IntelligenceScale: Manual for theThird
Revision, FormL-M. Boston, MA: Houghton-Mifin.
Thomson, M.E. & Watkins, E.J. (1998) Dyslexia: A TeachingHandbook, 2nd edition. London:
Whurr.
Thorndike, R.L., Hagen, E.P., & Sattler, J.M. (1986). Technical Manual for theStanfordBinet
IntelligenceScale: FourthEdition. Chicago, IL: Riverside.
Walker, J. &Brooks, L. (1993) DyslexiaInstituteLiteracyProgramme. London: JamesandJames.
Wechsler, D. (1949). Wechsler Intelligence Scale for Children. New York: The Psychological
Corporation.
Wechsler, D. (1974). Wechsler Intelligence Scale for ChildrenRevised. San Antonio, TX: The
Wechsler, D. (1989). Wechsler Preschool andPrimaryScaleof IntelligenceRevised. SanAntonio, TX:
ThePsychological Corporation.
Wechsler, D. (1991). Wechsler IntelligenceScalefor ChildrenThirdEdition. SanAntonio, TX: The
Woodcock, R.W. & Johnson, M.B. (1989). WoodcockJohnsonPsycho-Educational BatteryRevised.
Wright, B.D. & Stone, M.H. (1985). Review of the British Ability Scales. In Ninth Mental
MeasurementsYearbook, ed. J.V. Mitchell, pp. 2325. Lincoln, NE: Universityof NebraskaPress.
Youngstrom, E.A., Kogos, J.L., &Glutting, J.J. (1999). Incremental efcacyof Differential Ability
Scalesfactor scoresinpredictingindividual achievement criteria. School PsychologyQuarterly,
14, 2639.
7
Is dynamic assessment compatible with
the psychometric model?
Reuven Feuerstein and Raphael S. Feuerstein
Avtalyonsaid: Scholars, becareful withyour words!Youmayincur thepenaltyof exileandbe
banishedtoaplaceof evil watersandthediscipleswhofollowyouintoexilearelikelytodrink
of themanddie. . . (Ethicsof theFathers, I, 11).
Thispaper, presentingour stancetowardsdynamicassessment, isdedicatedto
two of our most devotedcolleaguesandsupporters: Dr DavidKrassilovsky,
MD, zal, renownedpsychiatrist, former headof TalbiehHospital, afounding
member andlong-timeAssociateDirector of theInternational Center for the
Enhancement of LearningPotential, and Mr Shimon Tuchman, zal, former
Deputy Director General of Youth Aliyah who was deeply involved in the
development of thecenter. Theybothcontributedtomakingour experimen-
tal, clinical, andempirical work possible. May thispaper keeptheir memory
aliveandbeablessingtothecontinuationof our work.
Summary
The purpose of this chapter is to examine the risks involved in using the
psychometricmodel inshapingthedynamicassessment of cognitivedevelop-
ment. It isshown that thepsychometric denition of intelligenceasastable
traitclassiesindividualsasafunctionof their manifestlevel of functioning. By
contrast, thedenition of intelligenceas acluster of states that governs the
LearningPropensityAssessmentDeviceandthetheoryof Structural Cognitive
Modiability which underlies it evaluates an individuals propensity for
modiability. Conventional psychometric conceptions and tools constitutea
barrier to the evaluation of the modiability of the individuals states, and
hinder our ability to assess andultimately raisethelevel of low functioning
individuals, so that they canbenet fromeducationtowardshigher levelsof
adaptabilityandmoreefcient levelsof functioning.
218
IQ revisited
How can individual differences in the results be accounted for? There is no satisfactory answer but
it may be assumed in all likelihood that different mental processes are tapped by the different
tasks and that these processes are not identical across all children.
Who is the author of this very modern statement on the interpretation of
intelligencetests?Strangelyenough, it istheinventor of theprocedurehimself,
Alfred Binet, writing in Les Idees Modernes sur les Enfants [Modern Ideas on
Children, 1909], twoyearsbeforehisdeathin1911. Nearlyacenturyago, when
Binet was studyingin Paris, psychology as aeldwas heavily inuencedby
Darwinism.Binet, likehismentorBroca, studiedcraniometry(measurementof
theskull), whichwasdesignedtorankracesaccordingtotheirintelligence(e.g.,
skull size) andhencecreateacriterionfor thesuperiorityof somesegmentsof
humanityoverothers. Inoneexperiment,Binetmeasuredtheskullsof students
denedbytheir teachersaseither themostor theleast capable. Fortunatelyfor
the history of psychology, Binet only found small differences in skull size
(1mm), andsomeweakstudentsevenhadlarger skulls. TheconclusionBinet
drewfromthefailureof theseexperimentswasthat theparadigmitself was
wrong: rather than searchingfor aglobal denition of intelligence, psychol-
ogists should not exclude the individual differences they obtain through
measurement, but rather focusonthese. Theway, accordingtoBinet, would
be to discard the psychophysical description of simple processes (and the
psychophysical crutch of aphysical measurefor each mental state) andbase
psychologyonthestudyof higherprocesses. Toachievethisgoal, Binethimself
was assisted by two factors. The rst was his longitudinal study of the
developmentof histwodaughters, begunin1890, ahighlydifferential account
of their cognitive development which curiously pregures Piagets precise
analysis of cognitive behavior.
1
The second was the commission fromthe
French Ministry of Public Education in 1904to develop amethodto screen
abnormal fromnormal childreninpublicschools.
AlfredBinetsmajor theoretical breakthroughwastheideato associatethe
metric of development age to thescoresobtainedon histestsof mental
ability. By associatingameasurablequantity (age) with another measurable
quantity(score), heprovidedasolutionto theproblemBrocaandothershad
triedtosolvebyusinganexternal criterionsuchasskull sizeasadimensionof
intelligence. AsZazzo pointsout, thefailuresof hispredecessorsarosefrom
their inabilityto trulydisengagethemselvesfromlaboratoryinstrumentsand
thephilosophyimplicit totheseinstruments but alsotheir inabilitytonda
measurecommontothediversityof mental phenomena. (1962, p. 13).
219 Is dynamic assessment compatible with the psychometric model?
Nevertheless, Binetstrueparadigm-breakinginsightseither went unnoticed
or weredeliberately disregarded by those who were too eager to bend the
notionof mental agetotheir ownpurposes. What didBinet himself intendhis
test tomeasure?
Our goal, when we have a child in front of us, is to measure his intellectual capacities in order to
determine whether he is normal or retarded. For this purpose we should study his current state and
this state only. Neither his past nor his future should concern us; hence we ignore his etiology and
in particular we make no distinction between acquired retardation and congenital retardation; and
above all we will avoid all considerations as to anatomical pathology which could account for his
intellectual decit. As regards the future, the same abstention holds: we are neither attempting to
establish nor prepare a prognosis and we leave unanswered the question of whether his retarda-
tion is curable or not, subject to improvement or not. We restrict ourselves to gathering the truth on
his current state.
2
Further, Binet warnedthat intelligencewasacompositenotionandcouldnot
bereducedtoalinear measure:
This scale serves, not strictly speaking as a measure of intelligence, since intellectual qualities
cannot be measured like lengths, they are not superposable but rather as a classication, a
hierarchy between diverse intelligences.
Binet warnedthat theuseof anagescaleitself callsfor special interpretation
becauseadifferenceinageisrelativetototal age. Agivendevelopmental delay,
sayatwo-year delay, doesnot meanthesamethingat age15asit doesat age
ve. Finally, Binet foresawthesocial misuseof hisscalesandclearlyattempted
toshowthat hisscalecouldbeinuencedbysocial factors:
Take children of the rich, it is absolutely certain that they will answer better on the average and
will be a year, two years ahead, of our little primary schools students. Take children from the
countryside, maybe they will answer less well? Take children from Belgium in areas where they
speak both French and Walloon, the lower class children will answer even less well in particular on
the language tasks. Our colleague Rouma, professor at the Charleroi Teachers College drew our
attention to these astounding inequalities in intelligence which he observed using our tests, and
which are dependent on background (Binet, 1909, p. 138).
Perhaps because Binets untimely death prevented him from expanding
upon his theories, his efforts at developing a measure of current state of
performanceandhiscareinrestrictinghisinterpretationof hisndingswere
shuntedaside. Hisreal intentionsweremisinterpretedandthenotionof mental
agebecameareiedIQ measurebasedon arank order, leadingpsychomet-
riciansto aclassicationandcategorizationresultingin thepredictionof the
futureof humanbeingsaccordingtotheircurrentmanifestlevel offunctioning.
220 Reuven Feuerstein and Raphael S. Feuerstein
However, asearlyas1934, Professor AndreRey
3
decriedtheillsof categor-
ization and labeling of manifest levels of functioning as measured by
psychometrictests. Asheoncepointedout, if wewereaskedto comparethe
behavior of two dogs, one of which had received training to produce a
conditionedreexandtheother hadnot, wewouldviewtherequestasabsurd,
because we do not compare animals that are different on the basis of an
acquired characteristic. The right question would have been whether the
seconddogafter trainingcouldalsodisplaytheconditionedreex. Yet conven-
tional psychometric approaches, Rey argued, regardintelligenceasxedand
immutableandhaveatendencytoincludeenvironmental factorsasthemselves
reectingcertainendogenousparameters. (Rey, 1934, citedinFeuersteinet al.,
1979, p. 28.)
Impact of the psychometric model on the concept of intelligence
For many years now, this narrow misinterpretation of mental agehas been
recognizedasasourceof injusticetoindividuals, groups, andtothepsychology
of intelligence itself. Clearly, there are great dangers associated with this
misinterpretation, themajor onebeingthebelief that inheritedIQ servesto
distinguishpeopleandgroupsanddestinesthesepeoplefor agivenstationin
life,i.e., thatthedifferencesacrossgroupsaretheoutcomeof heredityandthat
differencesinqualityof lifehavelittleor noimpactonIQ. I will notaddressthe
fallacies of the genetic analysis of IQ scores because it has been dealt with
comprehensivelyelsewhere(see, for instance, Gould, 1996).
Thereisagreater consensustodaythat alowscoreonanygivenIQsubtest
canbeattributedtoavarietyof socioeconomicaswell asgeneticfactors. The
issueasregardsintelligencescoresishenceoneof interpretationof theseresults
andtheusemadeof thisinterpretation. Therst of theseissuesistheroleof
isolatedperformanceonthetestitself. It hasbeenarguedthatproblemsolving
strategiesdiffer not onlybecausevariousindividualspossessvariousabilities
but also becauseindividuals strategiesaredifferent under variousconditions
andbecauselevel of performanceinanydecisionmakingtaskmaydependon
different processes (Gitmez, 1971). Thus, beyond spurious genetic claims,
socioeconomic handicap such as a lack of exposure to a certain type of
educational conditionsand/ or skillsrequiredfor adaptationnegatively affect
performanceonanIQ(or anyother) test.
Thisisoneof thereasonswhysomebehavioral scientists, primarilyinthe
19501960s, sought tocorrect theverbal natureof theIQteststomakeit more
culturefree, primarilybyusingpictorial or visual devices. Culturefair tests,
such as the DavisEells Games (1953), which integrated games non-main-
streamchildrenwerefamiliar with, weredevelopedinanattempt at positive
discrimination. Anastasi (1961, p. 268) commented, nevertheless, that lower
classchildrenperformaspoorlyonthesetestsastheydoonother intelligence
tests. The poor outcomes of these culture-free and culture fair tests led
researchersto concludethat renderingaseptican intelligencetest wouldnot
solvetheproblemof differencesinperformance, or thereadinessto respond
appropriatelytoatest situationitself.
Similarly, researchers rejected the predictive value of clean tests: What
couldit predict?Coveringupdifferencesinthiswaydoesnot erasetest bias.
Rather it delimits drastically thekinds of information onecan gather about
problemsolvingstrengthsandweaknessesassociatedwith groupsas well as
individuals. (Masland, Saranson, & Gladwin, 1958, p. 723). In the 1960s,
Wesman rejected thegold mine approach to intelligencetesting, in which
intelligenceis areied substancethat must berooted out fromunderneath
layersof classiableperformance(speed, length, weight, etc.): Because[these
objects]canbemeasureddoesnot meanthattheyaresubstances. Weneednot
accept theconversenotionthat if somethingismeasurableit isnecessarilya
substance ( 1968, p. 267).
Later attemptsat correctingfor differencesinbackgroundwithintheframe-
workof psychometricswerealsounsuccessful. Onesuchattemptwasmadeby
Mercer (1979), whodevelopedtheSOMPA(Systemof Multicultural Pluralistic
Assessment). TheSOMPA suggestedcompensatingfor relativesociocultural
andeducational level byapointsystem. Althoughtheintentwaspraiseworthy,
thescorescorrectedby theindividualslevel of socioeconomic disadvantage
wereof littlevalueto educators becausethey providedno indications as to
what remediational intervention was possibleand what path to follow. The
incorporationof thispoint systemwithintheWechsler batteryservedmerely
toreturnthesystemtoitsinherent psychometricrootsandweaknesses.
Theawarenessthat psychometricassessmentdoesnot respondsatisfactorily
tothefactthatcertainsocioeconomicgroupsareoverrepresentedinspecialized
schoolshaspromptedasearchfor other assessment instruments, bothwithin
the psychometric tradition and in reaction to it, in the form of dynamic
assessment (for anoverview, seeNeisser et al., 1996). Over thelast 40years,
interest indynamicassessment hasdevelopedasaresponsetotheinabilityof
staticpsychometricteststocharacterizenon-mainstream, culturallydifferent,
socioculturally disadvantaged, deprived, and geneticchromosomal-impaired
children.
In the early 1960s, the rst author introduced the principles behind the
Learning Propensity Assessment Device (LPAD) in relation to work with
culturallydifferent children. Dynamic assessment, whoseprinciplesbegan to
evolveintheearly1950s, arosefromtheneedtoassessculturallydifferent and
deprivedchildrenwhoselevel of functioningwassuchthat theywereclassied
asmentally retardedat varyingdegreesof severity. Dynamic assessment has
spread, andisnowusedbyresearcherswhohavebeeninspiredbytheoriginal
LPAD notions or havedevelopedmodelsof their own.
4
Thetestteachtest
model hasservedmany of thosewho wereinspiredby Vygotsky (1962) and
Feuersteinetal. (1979, 1980, 1987, 1988, 1997). Thegeneral principleguidingall
dynamic approaches to assessment is the introduction of a learning phase
withintheassessmentprocedureitself.
5
Thisfeaturehasmajor implicationsfor
thecontent of learning, theroleof theexaminer, theinterpretationof change
scores, and, obviously, for thetheoryof learningbehindtheprocedure. Some
forms of dynamic testing maintain psychometric properties for purposes of
preservingthestatistical powerrequiredfor normingthesetests. Manymiscon-
ceptionsarisefromattemptstoforcedynamicassessment intoapsychometric
mold when the theory of modiability of the learner is at odds with these
concepts. In particular, the LPAD and the theory of StructuralCognitive
Modiabilityhaveoftenbeenviewedthroughapsychometricprismandhave
hencebeendilutedof muchof their explanatoryimpact andintent. Thenext
sectionreviewsthedevelopment of theLPAD in an attempt to clarify these
issues.
Children of the Ashes
Intheearly1950s, Israel wasfacedwiththeenormoustaskof theimmigration
andabsorptionof childvictimsof theHolocaust andadolescentsfromvastly
different ethno-cultural, economic, and social backgrounds (Yemen, Cochin,
NorthAfrica, Europe, etc.). Inadditiontothehardshipsof displacement, these
childrenandadolescentsoftencamefrombrokenandpoverty-strickenfamilies.
Standardpsychometric tests classiedsomeof themas below normal. How
could these individuals be integrated into technological Israeli society?The
moral issuesunderlyingthenecessityof aidtotheseadolescentswerecoupled
withthetheoretical problemoftheassessmentoftheirreal abilitiessoastodo
justicetotheir needsfor schoolingandcognitiveandeducational growth.
The LPAD was the dynamic assessment tool that emerged from these
experiences. Over thelast 50years, theLPADhasbeenexpandedupontodeal
withchildrenandadultswithavarietyof etiologiesof learningdisorders. The
LPAD(1979) andthetheoryof StructuralCognitiveModiabilitywhichisat
its coremakeit clear that anumber of conceptslinkedto thepsychometric
model havebecometotallyoutdatedandirrelevant to thedynamicmodel. If
humanbeingshaveaprimeoptionof becomingmodiedandthismodiability
isnot merelyachangeinthequantityof knowledgeor skillsbut representsa
real changeinthemental structureof theorganism,thefollowingconceptswill
needtoberecast.
1. The shift from the concept of trait as representative of the stable and
immutablecharacteristicsof theindividual to theconcept of state reecting
themodiabilityof thehumancondition. Thetrait concept shouldbereplaced
bytheconcept of states. Intelligenceisastateinwhichtheindividual behaves
in a given way for a more or less extensive period of time in a seemingly
permanentwaydependingonwhathasproducedthisstate. Astateisdenedas
the product of a constellation of conditions in which bio-neurological and
sociocultural, experiential factors play a combined role. Further, state is a
concept that describesamodal typeof receptivity of theorganism. It canbe
extendedtoawiderangeof modalitiesof humanfunctioning, includingsome
pathological manifestations. For instance, schizophreniamust not beseenasa
trait that will persist forever. It is a statethat may appear or disappear.
Dyslexia, to useanother example, isviewedby someasastateexistingeven
after itsmanifestationshavelongsincevanished for instancetheprofessor
who considershimself to bedyslexicafter havingwritten 40booksandread
manyhundredsmore.
2. Theconcept of measurement should bereplaced by the terms assessment/
evaluation. Measurement asaconcept hasbeenusedlegitimatelywhenrefer-
ringtoatrait asastableentity, similar tothestabilityweattributetoanobject,
becausethereicationof humancharacteristicslegitimatestheconcept of IQ
measurementif IQitselfisseenasareiedentity. However,measurementisno
longer relevant to the concept of state because a state is highly volatile,
dynamic,andnotamenabletomeasurement,unlikeatrait. Measurementmust
bereplacedbyother conceptssuchasassessment or evaluation; theseinturn
must betheproduct of methodologiesdifferent fromthoseusedfor measure-
ment. This implies looking for something other than hard-wired reiterative
dimensions, whichareusuallythegoal of measurement.
3. Theissueof predictability.If theessenceof humanexistenceisformedbystates
rather thantraits, andasaconsequencestatesareperceivedasmodiable, then
predictabilitymaynolonger beanoption. Canwepredict thedevelopment of
certainstatesonthebasisof their manifestationsat agivenpoint intimeinthe
individual, giventhat statesaredeterminedbylife, andindividualsareexposed
tomeaningful changeintheseconditions?
Predictability can only be dened as a condition of generalization of the
measures, functions, and stability of traits over time, and variations of the
functions to which measures are applied. Predictability is impossible if
theassessedstate ishighly unstableandmodiable. However, certainstates
maybecomemorepermanentthroughtheeffectsof long-termpresenceinthe
lifeof theindividual, thesocioeconomicconditionsof anindividualsstate, or
bythecreationof aninternal self-imagethat will consolidatecertainmodesof
behavior. Thefact that someindividualscanescapethesestates suggeststhat
certaintypesof interventionor evenchangesinconditionsof lifeareeffective,
andcanthusovercomeconditionsof resistanceto change. Theseindividuals
will requiremoremassivetypesof interventiontorestorethelevel of exibility
andplasticitynecessarytobecomemodied.
4. Validity and reliability of measurement must be reconsidered. Reliability of
measurement ensuresthat what ismeasuredindeedreectsastablereiterable
condition, whichisobservableunder manychangedcircumstancesandcondi-
tions. Yet, doestheIQof athree-year-oldgirl staythesamewithage, despite
the enormous increase in speech and skills and modality of function? The
stabilityof theIQisduetothereliabilityof themeasurement, which, despite
thechanges in content and substanceof themeasured function, will never-
theless not budge. Anyone familiar with test construction knows how to
achievethistypeof reliability. Namely, thereisdeliberateeliminationfromthe
measurementscaleof all of theitemsthat exhibit acertaindegreeof sensitivity
tothechangedconditionsof theindividual, suchasmood, level of functioning,
skills, attitude, etc. Sensitiveitems areeliminatedin order to gain as high a
reliabilitycoefcient aspossible. Theleft-overs thestronghabits affect it,
andreliability, infact, measuresthemost hard-wiredtraitsor characteristicsof
theindividual.
Thecaseof Alexisrelevant to thispoint. Alexisan18-year-oldadolescent
sufferingfromSturgeWebersyndrome. Hewastotallynonverbal until theage
of nine. His rst wordsappearedonly after heunderwent left hemispherec-
tomy. Hisinitial IQof 35went uptoapproximately52after surgeryandonset
of speech. His greatest progress started after he was referred to us by his
motherattheageof15, aboutsixyearsaftersurgery.WeassessedAlexwiththe
LPADinorder toevaluatehismodiability. Thetreatmentstaff inLondonwas
very skeptical about the possibility of modifyinghis level of functioning, in
particular as regards reading, writing, and higher-order thinking, which he
could not master, despite attempts made by teachers and specialists. The
process observed during the LPAD showed a high level of exibility and
learningpropensity. Alexmasteredandappliedalargenumber of operations
and strategies for learning. Yet repeated measures on conventional IQ tests
weretotallyinsensitivetotheconsiderablechangesinhislevel of functioning,
achievedover aperiod of threeyears of MediatedLearningExperienceand
Instrumental Enrichment, andremainedstableandxedonthelevel of 50to
52. Alex learned to read and write in a highly functional way. He became
procient insolvinganalogiesinverbal, gural, andnumerical modalities. He
becameawell-motivatedlearner andshowedreadinesstocontinuehisstudies
beyondthelevel hehadreached.
Paradoxically, the application of the Wechsler Adult Intelligence Scale
(WAIS) at theageof 18showedaconsiderableincreaseinIQ, from50onthe
Wechsler Intelligence Scale for Children (WISC) administered at the same
time, to80ontheWAIS. Afunctional analysisof hisproblem-solvingbehavior
indicated that even the IQ of 80 did not reect the level of operational
functioningAlexexhibitedinhiscognitivebehavior. TheWISCaswell asthe
WAISaretestswithahighlevel of reliability. Theyareconstructedandapplied
insuchawayastostayinsensitivetothechangesthat occur intheindividual
followingdiverseformsof activity, experiences, andinterventions. Wewill not
enter intothelengthydiscussionastothedeterminantsof theinsensitivityof
psychometrically constructedinstruments and test situations. However, it is
our rmcontentionthattheuseof instrumentswithhighordersof reliabilityis
radically opposed to the very concept of assessment of modiability. Tests
which are constructed to show reliability and construct validity cannot be
sensitive to the dynamics of development and the change inherent to this
processandthereforeareinadequatetoassessmodiability.
The theory of StructuralCognitive Modifiability
Thetheoryof StructuralCognitiveModiabilitypostulatesthat modiability
isanoptionavailabletoall humanbeings, irrespectiveof theetiology, theage
at whichtheoptionbecomesempoweredthroughintervention, or severityof
condition. Theemphasisonthecognitiveelement isbasedonthebelief that it
plays a crucial role in the plasticity and exibility of the human mental
structure. Thispostulaterepresentssomewhat of ade-emphasisof theroleof
emotional factors, whichareviewed(asPiaget did)astheenergeticrather than
thestructural dimensionof humanbehavior.
Theontogenyof humandevelopmentisconsideredtobedual (assuggested
byRomHarre(1989), asanextensionof Vygotsky), andismadeupof:
Biological ontogeny, whichisdenedasacommunityof cellsinteractingamong
themselvesandtheoutsideworld, and
Sociocultural ontogeny, which denestheindividual astheproduct of cultural
transmissionactingonhisor her life.
Theimpactof biological andsociocultural ontogenyoneachother mayvary
greatly at different ages, states, and under different conditions. Thus, the
biological andthesocial remaininapermanent stateof dynamictensionand
disequilibrium.
Thebasictenetof thetheoryof StructuralCognitiveModiabilityisthatthe
human being is in a constant state of evolvement toward new states and
structures, which develop as a result of processes and confrontation with
activities requiring new structures and the adjustment of old ones. This is
consonant with Piagets three-pronged denition of structure. Briey, the
partwhole relationship in the structure of modiability means that the
changesinonepart will result inachangeinthewholetowhichthechanged
part belongs. Structural change produces transformations that are sustained
beyondtheconstancy of aprocess. Finally, structural changeismarkedby a
conditionof self-perpetuationandcontinuityof theprocessof changeinitiated
byanexternal action. Thiscontinuityandself-perpetuationisinresponsetothe
qualityof thetotal eld, i.e., theparticular needsystemaffectedbythechange.
Modiability is an option for all individuals, irrespective of the variables
actingasobstructiveagents. Thetheoryof StructuralCognitiveModiability
views modiability as an option even when theetiology is related to endo-
genous inherited or chromosomal organic deciencies which are normally
viewedaspartof thexedandimmutablenatureof theorganism. Thebarriers
producedbyetiologycanbeovercomeunder specicconditionsof interven-
tion providedto theindividual. Modiability isalso consideredas an option
irrespective of the age at which intervention takes place or at which the
conditionsfor changearecreated. Theconditionsfor changeexist at anytime
in ones life. The severity of the condition as a barrier to change is also
consideredlikelytochangeprovidedcertaincharacteristicsof theintervention
respondtoresistanceproducedintheorganismover time.
Themajor aimof assessment isnot tomeasureor detect aparticular trait or
characteristic. Rather, thequestioniswhether astate, condition, or structure
can bebrought into existence. Thefocus is thus on themodiability of the
condition, rather than the existence and scope of the condition. In other
words, doesthepropensity for modiability (andchange) exist andcan it be
brought to existenceandincreased?Howresistant isthestateto attemptsto
producechanges?Whatisthebestwaytoproducechanges?Whatisthequality
ofchangeinstatewehopetoachieve?Howpermanentandgeneralizableisthis
change?Howtransferableisittoother situations?Whatwill betheeffectof the
changesso producedonother statesthat will emergeintherepertoireof the
individual?
Basedonthetheoryof StructuralCognitiveModiability, theLPADassess-
ment procedure examines the process of change as it becomes manifest
through observation of the examinees adaptability to increasingly and pro-
gressively new situations, as comparedto situations in which heor she has
learned via mediation to adapt himor herself. These changes are achieved
throughtheLPADbyusingthetestmediateretest model, althoughthetest
phasesarenot necessarilysharplydelineatedfromthemediationandpost-test
phases.Theexibilityof theMediatedLearningExperienceisdesignedtoadapt
itself to theindividualscondition. Themeansusedto overcomethebarriers
andresistanceprecludeanyrigorousstandardizedapplicationof theinterven-
tionsuchasthosenecessaryfor normativecomparablepsychometricmodels.
Principles of the LPAD
There are four meaningful shifts required to turn regular conventional
psychometricmeasures, or certainadaptationsof theLPADsuggestedbyother
authors, intothedynamicLPADassessment. Thesechangesrepresentacrucial
departurefromthemeasurement approach. Wherever thesechangesarenot
included, onemayhavedoubtsastothedynamicnatureof theassessment.
1. Changesinthenature, structure, andcontent of theinstrumentsusedfor the
dynamicassessment andevaluation.
2. Changes in the test situation by restructuring the interaction between the
examiner andexaminee.
3. Theshift fromproduct toprocess.
4. Changesintheinterpretationof theresults.
Changes in the instrument
To produce reiterative comparable measurement, the measurement tool in
conventional psychometricassessment must demonstrateanacceptedlevel of
reliability, i.e., it must guaranteethat theresultsobtainedat agivenpoint in
timeonagivenindividual or situationwill repeat themselvesat thenext point
of measurement. One of the greatest successes of psychometrics was to
producehighinstrumentreliability. However, wheretheydidnot succeedisin
renderingtheobject of their measurement sufcientlyreliable. Conventional
tests are constructed to measure reiterable, structural consistency, which is
unalterable. Nevertheless, agreatdeal of reliabilityandvalidityaretheproduct
of measurement itself, becausethetreatment andintervention generatedby
measurement determine to a large extent the often-observed self-fullling
prophesy.
Bycontrast, theLPADdynamicbatteryof testsisdesignedtocreatesamples
of change, andevaluatesthesechangesasindicativeof themodiabilityof the
individual. The battery addresses itself primarily to uid intelligence rather
thantocrystallizedintelligence, whichrequiresextensiveinvestmentintimein
order to be modied. Further, crystallized intelligence is less amenable to
transferandgeneralizationbecauseitisbasedonhabitformationinarestricted
areaof activity. Manypsychometrictestsbasetheir dataoncrystallizedfunc-
tioningrather thanon uidintelligence(Rey, 1934) becausethey attempt to
evaluateintelligenceonthebasisof what hasbeenlearned, rather thanwhat
canbelearned, usingarepertoirewhichtheyequatewithintelligence, i.e., the
personscapacitytolearnasmanifestedbywhat heor sheknows.
TheLPADassessesuidintelligencebecauseanassessment of modiability
mustbebasedontasksinwhichgeneralizationandtransfer will beeasedbythe
small distances the individual must go to apply the newly acquired rules,
cognitivestructures, andneedsfor elaboration. Thisiswhywehavedeveloped
anumberof tasksthatincludevariationsof theproblemsthattheexamineehas
tosolve. Welookfor thewayinwhichthepreviousexposuretoaprocess the
learningof previoustasks affectstheindividualsreadiness, andpropensity
(not capacity) tosolvetheproblemat hand.
Themediational processisformulatedinsuchawayastoincludetranscen-
dence. Webuild theorientation toward transfer and generalization into the
mediational interaction. Theevaluator alsotakesintoaccount (doesnot count,
doesnotmeasure)theamountof mediationnecessaryuntil anadequateresponse
isproduced. Thisisacrucial component intheevaluationof theamount and
natureof intervention needed to achieveahigher level of functioning. The
assessmentasawholeisorientedtowardevaluationof theeffectsof producing
asampleof themental, cognitive, andperformancebehavior on taskswhich
will becomeprogressivelymoredistant andmorecomplexfromthetasksused
for training. ThisisillustratedschematicallybytheCylinder Model inFig. 7.1.
Changes in the test situation
Thesecond changeis theshift fromastatic measurement model of human
intelligencetoadynamicone, andisachievedbyacompletechangeinthetest
situation. Briey, thenomotheticnatureof statictestsrequireshighlystandar-
dizedformsof presentationwhich areonly feasibleif thetest conditionsare
rigorouslystandardizedtoguaranteethecomparabilityof theresultsobtained
ononeindividual tohisor her normativegroup. Thisstandardizationexcludes
Fig. 7.1. TheLPADcognitivemap.
any attempt on the part of the psychologist or examiner to provide the
examineewiththeamount andnatureof theinstructionsneededto perform
thetask. It forbidsanyfeedbacktotheexamineeastothenatureof hisor her
answers, for fear that theresponseswhich will followwill not beviewedas
spontaneous and representing the present level of functioning. It requires a
neutral attitudefromtheexaminer and, inmanycases, ademeanor that canbe
misleading to the examinees, making them believe that their answer was
appropriate. Thus, inmanycases, theexamineeswill not learnfromthetask
about thenatureof their responses. Theoppositeistrueof thetest situationin
dynamicassessment whosepivotal principleistheMediatedLearningExperi-
ence. TheMediatedLearningExperienceisnot only usedto generatein the
individual thedataneededto solvetheproblemin theappropriateway, but
alsoincludestranscendingelementsthat will enabletheindividual toapplythe
newlyacquiredmodesof functioningandtransfer themtonewtasks.
Thetest situationincorporatescarefullyplannedstepsof mediation, which
varywiththeparticular needsof theindividual. Theseneedsbecomeobserv-
abletotheexaminer over thecourseof interactionwiththeexamineeand/ or
becomeavailablefrominformationthat heor shehasgatheredontheexam-
ineeslevel of functioning, or problemsexperiencedbytheexamineeinother
areasof activity.
Oneof themost important goalsisto correct thedecient functionsthat
havebeenfoundby theexaminer to impair thefunctioningof theexaminee
(Table7.1).
Theexaminer keepsinmindaseriesof decient cognitivefunctionsonthe
level of Input, ElaborationandOutput. Sheor hewill intervenetocorrect the
decienciesandobservetheeffectsof interventiononfuturefunctioningof the
individual on the parts of thetest wherethe samedeciencies arelikely to
reappear. Attemptswill bemadetoseewhether thesedeciencieshavebeen
correctedtothepointthattheyareabsentfromtherepertoireof theexaminee,
and the way the correction of thespecic deciency affects theindividuals
efciencyof functioning. OntheInput level, blurredperceptionoftenhampers
the childs activities. Similarly, the unsystematic search for data makes the
individual neglect certainelementsneededtosolvetheproblemat hand, asdo
the lack of use of additional sources of information, and the lack of use of
temporal andspatial dimensionstodenetheobservedobjectsor stimuli. On
the elaborational level, decient functions are characterized by a lack of
readiness to dene the problemand egocentric and inadequate, imprecise,
impulsiveformsof behavior, lackof comparativebehavior, lackof theneedfor
logical evidence, etc. All thesewill becomethefocus of intervention by the
examiner duringthetest situation.
ThroughtheMediatedLearningExperience, theexaminer will endowthe
student with the verbal, conceptual, operational tools needed to solve the
problemsathand. Theprimegoal istoenrichandorienttheexamineetowards
insightful activitysothat theprocessof changecanbecomethemajor locusof
contemplation, namely:
HowdidI change?
WhydidI dobetter?
WhydidI fail?
All thesewill betheproducts of amediational interaction whosegoal is to
maketheindividual awareof theongoingprocessesaschangesareoccurring.
Table 7.1. List of decient functions
Decient functionsat theInput Phase
1. Blurredandsweepingperception.
2. Unplanned, impulsive, andunsystematicexploratorybehavior.
3. Lackof, or impaired, receptiveverbal toolsthat affect discrimination(e.g., objects, events,
andrelationshipsarenot appropriatelylabeled).
4. Lackof, or impaired, spatial orientationandlackof stablesystemsof referencebywhich
toestablishorganizationof space.
5. Lackof, or impaired, temporal concepts.
6. Lackof, or impaired, conservationof constancies(e.g., size, shape, quantity, color,
orientation) acrossvariationsinoneor moredimensions.
7. Lackof, or decient, needfor precisionandaccuracyindatagathering.
8. Lackof capacityfor consideringtwoor moresourcesof informationat once. Thisis
reectedindealingwithdatainapiecemeal fashionrather thanasaunit of factsthat are
organized.
Decient cognitivefunctionsat theElaborationPhase
1. Inadequacyintheperceptionof theexistenceof aproblemanditsdenition.
2. Inabilitytoselect relevant asopposedtoirrelevant cuesindeningaproblem.
3. Lackof spontaneouscomparativebehavior or thelimitationof itsapplicationbya
restrictedneedsystem.
4. Narrownessof themental eld.
5. Episodicgraspof reality.
6. Lackof needfor theeducationor establishment of relationships.
7. Lackof needfor and/ or exerciseof summativebehavior.
8. Lackof, or impaired, needfor pursuinglogical evidence.
9. Lackof, or impaired, inferential hypothetical (iffy) thinking.
10. Lackof, or impaired, strategiesfor hypothesistesting.
11. Lackof, or impaired, planningbehavior.
12. Lackof, or impaired, interiorization.
13. Nonelaborationof certaincognitivecategoriesbecausetheverbal conceptsarenot apart
of theindividualsverbal inventoryat areceptivelevel, or becausetheyarenot mobilized
at theexpressivelevel.
Decient cognitivefunctionsat theOutput Phase
1. Egocentriccommunicationmodalities.
2. Difcultyinprojectingvirtual relationships.
3. Blocking.
4. Trial anderror responses.
5. Lackof, or impaired, verbal or other toolsfor communicatingadequatelyelaborated
responses.
6. Lackof, or impaired, needfor precisionandaccuracyinthecommunicationof ones
responses.
7. Deciencyinvisual transport.
8. Impulsive, random, unplannedbehavior.
Equallycrucial, mediationcreatesaneedfor intrinsicmotivation, byproviding
theindividual with an awarenessof themeaningof hisor her activity anda
meaning of the change produced. Finally, a crucial subgoal in mediational
interactionistorender theindividual awareof hisor her roleasagenerator of
newinformation, rather thanthemererecipient or reproducer of information
providedreadymadebyothers.
Themediational processadherestotheparametersof theMediatedLearning
Experienceinanactiveandinteractiveway, permittingtheexaminer toseethe
typesof changesinvitro alongwiththecooperativereportingof theexaminee
about thechangeswhich haveoccurredinthestructureof hisor her modal
behavior. Thereadinessto createan interactivemodeof assessment, during
whichfeedbackandinsightful activitiestakeplace, endowstheindividual with
thenecessarytoolsfor adequatefunctioning. Thisenablesindividualstorepeat
thesuccessfullymasteredtaskstoachieveacertaindegreeof solidicationand
crystallization of their recently acquired behavior. All these processes are
meant to produce samples of change in the examinee, which will then be
interpretedasindicatorsof modiability.
Thelevel of permanencyof thesechangesmaynot behigh, but issufcient
to serveas an indicator of the amount, nature, extension, and, to acertain
degree, thedurabilityof changeproduced. Thedifferential levelsof changein
areasof perceptual, logical, andverbal functioningetc., will also point to the
areasof greater or lesser resistanceto change. By thesametoken, they also
provideinformationontheamountandnatureof intervention(mediational or
otherwise) neededtoproduceagivenresult, thusfulllingakeyrequirement
of theLPAD namely, to createastronglink between theassessment and
planningof theinterventionneededto producechange. Thetest situationis
clearlythepivotal aspect of theLPAD. It isobviousthat applyingthetest this
waywill disqualifyit for conventional reliabilitymeasures. Further validityis
notbasedonascore(aproduct), but rather ontheprocesswhichhasmadethe
observedresultspossible.
The shift from product to process
Themajor focus is on theprocess of assessment. Limited interest, if any, is
devotedtotheproduct.Inotherwords,atestresultwhichindicatesahighlevel
of functioningwill beof verylittlevalueinattemptingtoexplainthedifculties
the examinee has encountered in academic functioning. The test product,
which may be the outcome of certain capacities, may totally conceal these
difculties, whichwill cometo theforeoncetheindividual iscalleduponto
applythesefunctionsinaparticular learningor functioningsituation. Thisis
thecasefor thegifted underachiever, who, indeed, may show giftedness in
certain types of tasks but fails to recognize the deciencies or processes
underlyinghisorherresults. Aproduct-basedtesthasverylittlesignicanceif it
cannot shedlight onthediscrepanciesbetweengoodtest resultsandfailurein
areasof academicor other typesof achievement. Thevalueof theLPADliesin
the identication of the process underlying an individuals functioning or
dysfunctioning. Evenwhenanindividual hasprovenabletorespondadequate-
ly on some particular task, it may have been solved by compensating for
difcultiesby usingcertainhypertrophiedfunctionsthat cover upthosede-
ciencieswhichsuppresshisor her functionsastheycometotheforeinother
situations.
Theanalysisof thecognitivebehavior of theindividual onagiventaskmay
enableustoanswer suchquestionsastowhat extent successor failureof this
individual is due to content specic to this task. Is this content familiar or
unfamiliar to the individual, enabling problem solution without requiring
investment or activelytestingadaptationtothetask?Or towhat extent isthe
languageof the task responsible for the failure of the individual to interact
successfullywiththetask?Languageisknowntoactasasourceof disadvantage
for certainminoritypopulations, but alsofor certainindividualswhomayhave
different languagebackgroundsor prioritiesastothelanguagethroughwhich
theyinteract best. Thesameistruefor thelevel of abstraction, thelevel of task
complexity, andthelevel of elaborationrequiredononeof thethreephasesof
the mental act (Input, Elaboration, and Output). The Cognitive Map may
answer suchquestionsaswhat level of efciencyisrequiredfor thistasktobe
successfullyperformed. Wedeneefciencyastherapidityprecisioncomplex,
to whichweaddanimponderabledimension namely, thelevel of mobiliz-
ationandenergeticinvestmentneededtosolveagiventask. Efciency, or lack
of efciency, which may betotally extraneousto thetruepropensity of the
individual tolearn, maybeamajor sourceof failurefor aparticular individual
whenthereisinabilitytorespondtothelevel of efciencyrequiredbyaspecic
task. For instance, imagineyou needto dial atelephonenumber with 5060
digitswithinacertainlapseof timeinorder toconnect. Inefciency, alackof
rapidity, etc. maycausetheindividual to fail, andrepeatedfailurescanmake
the individual reluctant to become involved in such activities except when
absolutelyessential (thesameistruefor reading). Efciencyistoolowandthe
failureto connect will not berelevant to thecognitivelevel of theindividual
but rather totherapidityof processing. Hence, thoroughunderstandingof the
two conceptual tools (Decient Functions and the Cognitive Map) helps
characterizeboth theprocess of functioningand thetypes of changes being
producedintheindividual asheor shebecomesinvolvedintheproductionof
samples of change. This is associated with the fourth change in perspective
fromconventional testing.
A change in the interpretation of the results
Theshift toadynamicmodalityof interpretationof theresultsobtainedinthe
LPAD isbest illustratedby our attempt to produceaproleof modiability
whichisbasedontheobservedprocessofchange. Theproleusesthedatathat
weregatheredduringtheassessment of thethreedimensionswhicharedealt
withduringthemediational intervention.
I. Thedimensionof content: what arethecontentsthat haverequiredcorrection
andneededtobecomemodiedinorder toincreasetheoperations, functions,
andefciencyof theindividual?Thisdimensionisassessedinfour major areas.
(a) Decient functions: towhat extent havetheybeencorrectedandwhere?
(b) The acquisition of higher-order operations, relations (verbal, visualmotor,
other modes of operation) needed for the intervention to be acquired and
appliedonthetasks.
(c) Changes in the emotional, attitudinal, and affective responsiveness of the
examinee.
(d) Level of efciencyacquiredduringthemediational andexperiential exposure
totheintervention.
II. The dimensions of the prole deal with the denition of the nature of the
observedchanges.
(a) Thepermanenceof theobservedchange, thedegreeof resistanceto thetask
(novelty, complexity, lackof meaning).
(b) Lackof motivation.
(c) Generalizationandtransfer of newlyacquiredfunctions.
III. Thethirddimensionistheevaluationof thechangeintheamount andnatureof
mediational experienceneededtoproduceaparticularchangeintheperformance
level of theindividual. Thisdegreeof reductioninneedfor mediationreects
thelevel of independencetheindividual hasacquiredin dealingwith certain
taskscomparedtothedegreeof dependencemanifestedinhisor her function-
ingintheinitial stagesof assessment. Thisdimensionisextremelyclosetothe
VygotskyandLuriaformulationof theassessmentof effectsof supportgivento
theexamineefor independent functioning.
Thus, insteadof anindex, or acoefcient basedonthenumber of success-
fullymasteredtasks, theresultsshouldexpressthedynamicsof aprocesswhich
canbeobservedasit changesacrosstime, acrosstasks, acrossdifferent modali-
tiesof interaction, acrossdifferent tasksandcontents. Theinterpretationtakes
into account the preferential mode of functioning initially observed in the
individual, which can exhibit meaningful changes. Dimensionssuch asthose
suggestedbyA. andN. KaufmansuchastheKaufmanAdolescent andAdult
IntelligenceTest (KAIT) certainly tap very important and interesting styles,
experiences,andtypesof activitiesintermsof theirpresenceintherepertoireof
theindividual, theaccessheor shehasto them, andhisor her efciency in
usingthem. However, thefocusof theLPAD isontheextent to whichsuch
preferential functionsareamenabletochangeif andwhennecessary. Thereal
issue is the interpretation of mediational interaction and observations of
processesduringwhichsuchchangescanbeproduced. Thesameholdstruefor
avarietyof other attemptsto seeindividualsfromthepoint of viewof their
most preferredareasof functioning, asfoundin Gardnersseven dimensions
andSternbergsTriarchicIntelligence. Wedo not denythat suchpreferential
formsof functiondo, indeed, exist. Our questionconcernstheadaptabilityof
theindividual tosituationsrequiringchangesinstyleandpreferencesinorder
to succeedandsurvive, byadaptingto changesheor sheisconfrontedwith.
Theinterpretationof theresultsintheLPADtakesintoaccount thenatureof
resistance encountered by the individual during involvement in an active
mediational process, andtheamount of mediationneededtoaffect himor her
differentiallyinoneof theseareastocreateaproleof change. Thisenablesthe
LPAD examiner to dene the nature, features, and magnitude of change
produced in the examinee and to evaluate themin terms of the nature of
interventionnecessaryinorder toproduceaparticular level of modiabilityin
thevariousareasof functioning.
Thisisacomplexprocedure. Thislevel of complexitymaylenditself poorly
toastatistical elaborationor toanattempt tocreatethenecessaryprocessesof
reliability. Yet thevalidity may well besubstantiatedby avariety of criteria
whenever processesof changeareavailabletoassessment andthemeaningof
changeissubstantiatedinareasof theindividualsadaptation. Thesefeatures
areexaminedinthenext section.
Principles of construction of the LPAD test battery
The battery of tests which was chosen for structuring the LPAD has its
rationaleinthefollowingdimensions.
1. Theinstrumentswhich evaluateuid thinkingmay provideinsight into the
processes leading to the evolvement of samples of change. The LPAD test
batteryisdrawnfromspeciallystructuredmaterial or fromother testsonthe
basis of thefunctions which they requirefromtheexaminee. Thetasks are
aimedat uidtypesof cognitivefunctionsandoperationsrather thancrystal-
lized functions, because the latter require automatization based on solidi-
cationthroughrepetitionandexposuretothetask. Fluidthinkingispreferred,
becauseit lendsitself better totheprocessof generalizationandtransfer ona
varietyof other typesof taskswhichserveasindicatorsof modicationinthe
individual.
There is little interest within the framework of the LPAD in producing
samples of crystallized functions because of the time limits, which do not
permittheamountof interventionnecessarytoproduceautomatizedmodesof
functioning.Ifcrystallizedfunctionsemergedespitethebrevityof intervention,
theycanbeinterpretedasapositivelearningqualityof theindividual.
2. All thefunctionslend themselvesto mediatedintervention. Thesecond cri-
terionfor thechoiceof thetest instrument isaccessibilitytomediationandthe
meaningful increaseinthefunctioningof theindividual followingtheMediated
LearningExperience. Not all tasks required fromthe individual can benet
frommediation in the sense of intentionality, transcendence, and meaning.
Some tasks are simply informative by nature and call for the retrieval and
enrichmentof theinformational repertoireof theindividual, wherethelearner
at best actsastherecipient of informationcommunicatedtohimor her bythe
mediator. Thetypesof teachingwhichmayaffecttheindividualsrepertoireof
functioningmayberestrictedtothefocusof theparticular content. For these
reasons, thechoiceof LPADtasksarethosewhichlendthemselvestoasmany
parametersof mediationaspossible; inother words, thosetasksthat will affect
thecognitive, emotional, andbehavioral aspectsof thecognitivestructureof
theexaminee.Theresultsofthesetaskswill thenbeusedtodrawupaproleof
modiabilitybasedontheproducedsamplesof change. Thetaskscall onthe
examineetocontributeinaverydirect andactivewaytotheorganizationand
fulllment of thetask. Here, mediational interaction, even though variedto
correspondtothediversityof populationsit will addressitself to, will allowus
to view the samples of change that are directly linked to the nature of
mediation. For instance, Ravens B812 task, which even high-functioning
individualsnd difcult to solve,
6
may bemediatedto very low-functioning
children with no familiarity with summativemathematical behavior or pro-
ceduresto discover conceptual forms of negativeand positivenumbers and
evenlessexperienceoperatingwiththemvolitionallyandconsciously. Never-
theless, because of the nature of the task and because we can induce an
orientationin thechildto look for transformationsoccurringon each of the
threelines, wecanmakethechilddiscovertherule, whichbecomesobviousby
followingthetransformationthatwaspresentintherstline,conrmedbythe
Fig. 7.2. RavensB-8andsixLPADvariations.
second line, and then reapplied to the third line. Once the rule discovery
procedurehas been established, many low-functioningchildren succeed and
provetheir propensity by applying theruleto variations requiringits redis-
coveryacrosschangesinthenatureandtheformof thetask(Fig7.2).
By choosingsimilar high-level cognitivefunctions, wecreateasampleof
modiabilityinareasnot consideredaccessibletolow-functioningindividuals.
It also provides us with arare opportunity to observelearningstyle, dene
decient functions displayedin action, determinetheamount and natureof
intervention necessary for functioning and giving meaning to changes pro-
ducedbytheinterventioninorder tomaketheindividual modiable.
3. Thetest instruments arestructuredin such away as to study theeffects of
mediation even when they emerge in a very minimal way. The LPAD has
developedtaskswhichact asatightlyknit net throughwhicheventhemost
minimal changesinthestructureof focusing, learning, thinking, andcompre-
hension in the examinee can be observed in vitro and are accessible to
interpretationasreectingpropensityfor change. TheCylinder Model serves
as abasis for constructingthetest material for theLPAD becauseit is ne
tunedtodetect anychangeproducedbyinterventionandinteractionwiththe
task, andtheeffectsof thesechangesontheindividualsfunctioninginother
situations.Thismakesitpossibletoassignapproximateattributestothediverse
determinantssuchastaskmanagement,mediation, repetition,andpriorexperi-
ence. The most minimally detected change is seen as representative of a
universeof possiblechangeswhichcanbeproducedinasimilar constellation.
The key target of observation is change in the level of modiability of the
examinee.
4. The test instruments can be used to interpret functions implemented and
assessedinother studies. Thecriteriafor taskselectionareboththeoretical and
practical. Thechoiceof testspreviouslyusedfor staticmeasurementwasmade
bothto benet frompreviousstudies, andto challengetheir resultsbyintro-
ducing mediational interaction. Because the LPAD is based on theory and
practice to a large extent at variance with other theoretical and practical
methodologies, wechoosesomeof thetasksfromtheexistent repertoireof
tests that have been found satisfactory to the psychometrician from the
standpoint of reliabilityandvalidation. Thereby, weareableto relyonthese
designed materials and interpret our results with the help of attributes of
meaning, signicance, functions, etc. Ravens analysis of the B812 task, as
quotedabove, is basedon alargeset of data. Wechosehis conclusion that
low-functioningindividualsareunabletosolvetheanalogiesasatargetfor our
intervention to challenge his claim. We designed a special interventional,
mediational format for thestructuringof thought processesinchildrenclassi-
edasverylowfunctioning, trainablementallyretarded(IQ3550). Oneof the
great andgratifyingsurpriseswasthat thechildrenwerenot onlyabletograsp
theanalogy but also could generalizeit through thenecessary mediation to
solvevariationsontheanalogywithgreat success.
5. Theresultscanbecomparedto thebodyof existingdata. Ininterpretingthe
results, comparisonwithdataproducedbyother researchershelpsattributea
general value to the ndings (in particular, theprocesses underlyingthem).
Furthermore, theresultsareanalyzedonthesevendimensionsof theCogni-
tiveMap, whichevaluatesthetask asto thelevel of abstraction, complexity,
and efciency required from the individual to reach out to the particular
functionsrequiredbythetask.
Finally, many of the tasks chosen fromexistent data have been adapted
dynamically. Changes weremadein thetask itself, by producingvariations,
and/ or by changingthemodality of presentation, application, or interpreta-
tion. The box below presents the tests as they cluster around particular
functions, althoughthetaskscanbeelaboratedinavarietyof ways.
LPADinstrumentclusters
PerceptualMotor FunctionsorganizedbyCognitiveComponents
Organizationof DotsComplexFigureDrawingTestDiffuseAttention
Test (Lahi) Reversal Test
MemorywithaLearningComponent
Positional LearningTest PlateauxTest Functional AssociativeRecall
(functional reductionandpartwhole) WordMemory
Higher-Order CognitiveProcessesandMental Operations
Ravens Colored Progressive Matrices, Ravens Standard Progressive
Matrices, Set Variations I, II Representational Stencil Design Test
Numerical ProgressionsOrganizer
Themosaic natureof thesetests enables us to respond to highly diverse
populationswhoareinneedof dynamicassessmentanddisplaydeciencieson
awidespectrumof levels. Two recent developmentsin thetest instrument
nowbroadenthereachof theLPAD. Therst isadownwardextensionof the
LPADusingthree-dimensional materialsintheformof puzzlesfor nonverbal
childrenandsomeadults. Thedownwardassessment material isdesignedfor
children with acquired or developmental deciencies which preclude them
fromrespondingtoverbal or operational typesof thinkingor havedeteriorated
through certain pathological adverse conditions. The mosaic nature of the
downwardextensionispreservedbyintroducinglearningtasksinavarietyof
dimensions(spatial, temporal, numerical, logicalverbal, anddialogic).
Theseconddevelopment isanupwardextensionto high-functioningindi-
viduals who need to be assessed for their propensity to be involved in the
processesof changeinareaswheretheyareexperiencingdifcultydespitetheir
highlevel of functioning. Inparticular, wehavedesignedadynamicassessment
batterymeasuringreadinesstolearnfor peoplewhoneedto changejobsand
learnanewtechnology.
Conclusion
TheLPADthusdescribedhasbeenappliedsincethemid-1950sandhasproven
tobeuseful for avarietyof populationswhoselevel of academic, occupational,
and personal functioning required an evaluation of the modiability of the
individual for purposes other than classication, categorization, or labeling.
Over thelast vedecades, theLPADhasprovenitself to bethecrucial, vital,
anddecisivemethodologytoassessthemodiabilityof theculturallydifferent
and societally disadvantaged, and to convince, parents, teachers, and the
children themselves of the legitimacy of the ght to education within a
mainstreamenvironment. Such placement entails thedenition of goals for
theseindividualsandtheuseof appropriatemeanstoreachthem.
The application of the LPAD has proven itself highly useful to tens of
thousands of youngsters in their struggle to becomeintegrated into society
throughadequateeducation. Childrenwhowereclassiedasonlyaccessibleto
menial tasksintermsof their manifest level of functioningasmeasuredbyIQ
testsdemonstratedprocessesof changefollowingdynamicassessment. Many
of thesechildren received mainstreamplacement. For theseyoungsters, dy-
namicassessmentresultedinadramaticchangeinthecourseof their lives. Our
greatestsuccesshasbeenwithDownssyndromechildren, whohavebeenable
tochangeradicallythestereotypedviewthat thechildwithDownssyndrome
couldnot havean IQ over 70. Here, our dynamic assessment ndings have
beenabletoshowthattheDownssyndromechildiseligibleforfull integration
into high school, sometimes can nish high school, and exhibits the higher
mental functionsrequiredfor further studies.
The most striking recent application of the LPAD is to Ethiopian child
immigrants to Israel. These children were dened as the most extremely
culturallydifferent groupto beabsorbedbyaWesternculture, becausetheir
integrationrequiredefcient literacy, andtheywerechildrenwhosetradition
of pre-literacygoesback over tensof generations. Inparticular, their integra-
tion called for atransition to alanguagebased on conceptual superordinate
concepts. Many other assessmentsusingconventional tests(culturefair, cul-
turefree, developmental tests, operational tests) indicatedthat thesechildren
could only be placed in special education classes. Some 5000 children and
youngsterswereadministeredagroupLPAD battery, andabout 1000whose
level of functioningonthegrouptest wasnot satisfactoryhadto beassessed
individually. Theresultsliterallysavedthemfromplacement inspecial educa-
tionandthetypical watered-downprogramofferedtochildrenwhosemanifest
level of functioningsuggeststheycannot beplacedinmainstreameducation.
Onlysome1520%hadto beplacedinaspecial preparatoryprogram, where
theyweregivenmediatedinterventionfor 15hoursaweek, includingreading,
math, andInstrumental Enrichment, whileintegratedintoclasseswithnormal
childrenfor therest of theschool day. Thisresultedinthepossibilityof fully
integratingthegreat majorityof thechildrenafter theyhadacquiredthebasic
school andthinkingskillsinaregular classthreetoninemonthslater.
The shift froma static, conventional, psychometric model to a dynamic
approachtotheassessmentof cognitivemodiabilityis, todaymorethanever,
apervasiveneed. Our dynamicapproach, seekingthosestatesintheindividual
that aremodiable, isbasedon threemajor assumptions, which havefound
increasingconrmationinresearchandpractice.
1. Thedenition of modal behaviorsof thehuman beingas states, rather than
beingdenedascharacteristics, traits, or other formsof hard-wiredconditions
of theperson. Astateis, bydenition, modiable, whereasatrait representsa
stableandimmutableconditionof theindividual.
2. The understanding that the human organism is the product of a double
ontogeny biological and sociocultural. The relationship between the two
sources of development is a constant process of equilibration, with the
sociocultural factor beinginmanyinstancesdominant andproducingchanges
intheindividual whichenabletheorganismtobypassbiologicallydetermined
limits. If we consider the condition of the child with Downs syndrome as
determinedtoaverylargeextent bychromosomal conditions, asociocultural
interferencewith thebiological condition clearly accountsfor theenormous
changes now evident in level of functioning, which were not considered
accessibletothesechildrenbecauseof theirbiological condition. Thestatement
oftenexpressedin relationshipto our work, that chromosomesdo not have
thelast word, illustratesthiscritical relationshipbetweenthebiological and
sociocultural factorsasan option for thedevelopment of all individualsirre-
spectiveof their biological conditions.
3. Theplasticityof thebrainanditsresponsivenessto certaintypesof activities
imposeduponit that mayaffect thebrainsstructureinaverymeaningful way
andnot onlyaswaspreviouslybelieved thestructureof behavior.
Asthesethreesourcesof evidencefor human modiability arebecoming
accepted, theLPADshouldbecomethemajor tool for evaluatingmodiability,
itscondition, extent, meaning, level of permanence, degreeof generalizability,
and transfer, and the modalities by which such modiability can best be
achieved. It is obviousthat dynamic assessment requiresacertain degreeof
liberation from the psychometric mode of thinking, which adheres to the
measurementof certaintraitsastheyarereiedbytheprocessof measurement
itself. Dynamic assessment calls for freedomof theevaluation process from
thosedimensionsshapedbythepsychometricmodel inorder torespondtothe
concept of intelligenceasan object, andpromoteseducabilityasacondition
that isimmutableandessentiallyunchangeableintheindividual. Thisrefersto
theconceptsof reliabilityofthetestinstruments,thefactthatthevalidityof test
resultsistightlyrelatedtothetypeof intervention, andrecommendationsthat
arisefromtheresultsofthepsychometricallyorientedprocess. Thetendencyof
someresearcherswhohavecriticizedtheconceptof IQ, thegfactor, andother
static concepts of intelligence, but have attempted to introduceadynamic
teaching factor to comply with their need to preserve the rigor of the
psychometric approach, are actually eliminating the major benets of the
dynamicassessment processasembodiedintheLPAD.
Howdynamic can an assessment beif it must bedonewith reliabletests,
wherereliabilitymeansthat theindividual must staythesameinorder tokeep
theprocessreliable?Whatkindof dynamicscanoneattributetoatestsituation
wheretherelationshipbetweenthetask andtheindividual iskept sterileand
everythingis done to insurethat no changeoccurs except theone that the
assessor hasrigorouslyattemptedtoproduce?
Theattempt tocreateadynamicassessmentwhichwill maintainarigorous,
limited, or predeterminedformof measurement(for instancehowmanytimes
theexamineewascued, what kindsof scriptedpromptswereused, what levels
of failurewereexperienced, etc.) isacontradictioninterms. TheLPADis, of
necessity,basedontheuseofMediatedLearningExperience,whichmustadapt
totheneedsof theindividual inorder toproducemaximal samplesof change
whichtheindividual canproduceat agivenpoint inhisor her interaction.
Thischapter hasattemptedto respondto someof thequestionsthat have
beenraisedbycolleagues, manyof whomhavebecomeconvincedof theneed
for Mediated Learning Experience, but who feel it necessary to constrict
themselves by adheringto someof the rules of the game required by the
scientic (psychometric) measurement approach. Theposition taken hereis
that thereisaneedtofreeourselvesof thisapproachandproduceaproleof
changewiththemeansthat areat thedisposal of theexaminer asamediator.
Thisistheessenceof theLPADasadynamicassessment process. Indeed, this
wayhasbeenstronglyadvocatedbysomeof thosewhohaveadheredtoand
accepted our interpretation of dynamic assessment. The rst author of this
chapter admitsto havebeenhimself searchingfor modalitiesto bridgestatic
and dynamic assessment by looking for psychometric tools which could be
compatiblewiththeLPAD. DuringtheauthorsmanydiscussionswithProfes-
sor L. J. Cronbach, he requested help from this eminent statistician and
methodologist inshapingtheinstrumentsof themediational processandthe
interpretationof theresults in such away asto makeit consonant with the
psychometricmodel andyet not offensivetothedynamicnatureof theLPAD.
Cronbacharguedagainstthis, statingthattheuseof apsychometrictool would
neutralize and eventually dilute the true meaning of the LPAD and thus
prevent it from attaining its goals. During this dialogue, the author again
expressedhisdesiretoestablishsomekindof convergencewithpsychometrics
fromwhich theuseof samplesof behavior representingalarger universeof
functionscouldhavebeenpreserved. Yet again, nowaywasfoundtoestablish
a language which would be common to the psychometric model in the
appropriatemodesfor shapingtest instrumentsandinformation. Thisrequest
was made to Cronbach because of his development of the AptitudeTreat-
mentInteraction (ATI), which seemed to provide a potential structure to
bridgebetweenthetwomodes. After listeningtotheargumentsandrequest,
Professor Cronbachroseupfromhischair, threwhishandsinto theair, and
exclaimed: I cannot advise you to use it . . . I am more Feuerstein than
Feuerstein!
ENDNOTES
1 Inoneexperiment, Binet usedtokensof different sizesandaskedhisdaughter (agedfour) to
comparegroupsnumerically. Binet showedthat thechildusedthesizeof thetokens(amount
of space the larger tokens took up) rather than numeration to determine which group of
tokenswasmathematicallylarger. (SeeZazzo, 1962, for adescription.)
2 Binet, Alfred, AnneePsychologique, VolumeXI, 1905, p. 191, quotedinZazzo, 1962, p. 47. Note
theusemadebyBinet of theconcept of state, whichweconsider astheonlywaytodene
manyof theconditionsof thehumanbeing. Asshownlater, theconcept of stateiscontrasted
bytheauthorswiththeconceptof traitor characteristic.Binetsconceptof etat maynothave
beencoupledontheother polewiththeconcept of trait, but hisuseof thetermcomesvery
closetotheoppositionusedherebetweenstateasmodiable, andtrait asastablecharacteris-
tic.
3 Reys belief in educabilite and his view that classication was of limited value because
intelligencearisesfromvaryingeducational andenvironmental interactionshadaprofound
impactonthedevelopmentof theLearningPotential AssessmentDevice(Feuerstein, Rand, &
Hoffman, 1979). Thefact that Reys1934paper onthissubject onlycametotheattentionof
the rst author and many other students after Reys death highlights the pressure on
behavioral scientiststo conformto thedominant genetichereditybelief systemconcerning
theoriginsof intelligence boththenandnow, becauseReyspublicpositionwaspsychomet-
ric.
4 AlecturebyReuvenFeuersteinattheNewYorkMedical Collegein1963cametotheattention
of MiltonBudoff, whothenadapteddynamicprinciplestohisownresearch.
5 For a critical presentation of current models of dynamic assessment, see, in particular,
GrigorenkoandSternberg, 1998.
6 A high-grade intellectually defective person remains throughout life characteristically in-
capableof solvingthemoredifcult problemsof Set B. . . (Raven, 1965, p. 25).
REFERENCES
Anastasi, A. (1961). Psychological Testing. NewYork: Macmillan.
Binet, A. (1909). Lesideesmodernessur lesenfants, Flammarion, Paris, quoted in Zazzo, Rene,
Conduiteset Conscience, p. 139.
Eells, K., Davis, A., Havighurst, R.J., Herrick, V.E., &Tyler, R.M. (1951). IntelligenceandCultural
Differences. Chicago, IL: Universityof ChicagoPress.
Feuerstein, R., FeuersteinS., & Schur Y. (1997). Processascontent inregular educationandin
particular in education of thelowfunctioningretardedperformer. In EnvisioningProcessas
Content; TowardsaRenaissanceCurriculum, ed. A.L. Costa&R.M. Leibmann. ThousandOaks,
CA: CorwinPress.
Feuerstein, R., Rand, Y., & Hoffman, M. (1979). TheDynamicTestingof RetardedPerformers: The
LearningPotential AssessmentDevice: Theory, InstrumentsandTechniques. Baltimore, MD:Univer-
sityParkPress.
Feuerstein, R., Rand, Y., & Hoffman, M. (1980). Instrumental Enrichment. Baltimore, MD:
UniversityParkPress.
Feuerstein, R., Rand, Y., Jensen, M.R., Kaniel, S., &Tzuriel, D. (1987). Prerequisitesfor testingof
learningpotential: theLPADModel. InDynamicTesting, ed. C.S. Lidz, pp. 3551. NewYork:
GuilfordPress.
Feuerstein, R., Rand, Y., &Rynders, J.E. (1988). Dont AcceptMeasI am: HelpingRetarded People
toExcel. NewYork: PlenumPress.
Gitmez,A.S. (1971). Instructionsasdeterminantsof performance:theeffectof informationabout
thetaskonproblemsolvingefciency. NATOConferenceonCultural FactorsinMental Test
Development, Turkey.
Gould, S.J. (1996). TheMismeasureof Man. NewYork: W.W. Norton.
Grigorenko, E.L. &Sternberg, R.J. (1998). Dynamictesting. Psychological Bulletin, 124(1), 75111.
Harre, R. (1989). Metaphysics and methodology: some prescriptions for social psychological
research. EuropeanJournal of Social Psychology, 19, 43953.
Masland, R.L., Saranson, S.B., & Gladwin, T. (1958). Mental Subnormality. New York: Basic
Books.
Mercer, J.R. (1979). Technical Manual, SOMPA. NewYork: Psychological Corporation.
Neisser,U., Boodoo, G., Bouchard,T. etal. (1996). Intelligence, knownsandunknowns. American
Psychologist, 51(2), 77101.
Raven, J.C. (1965). GuidetoUsingtheColoredProgressiveMatrices, SetsA, Ab, andB. London: H.K.
Lewis.
Rey, A. (1934). Dun procede pour evaluer leducabilite, quelques applications en psycho-
pathologie. ArchivesdePsychologie, XXIV, 96, 32637.
Vygotsky, L.S. (1962). Thought andLanguage. Cambridge, MA: MIT Press.
Wesman, A.G. (1968). Intelligencetesting. AmericanPsychologist, 23(4), 26774.
Zazzo, R. (1962). Conduiteset Conscience, PsychologiedelEnfant et MethodeGenetique. Neuchatel,
Switzerland: Delachauxet Niestle.
8
Multi-perspective, clinicaleducational
assessments of language disorders
Elisabeth H. Wiig
History, development, and assessment objectives
Assessment and intervention paradigms
Theintentionof thischapter isto present selectedissuesassociatedwith the
assessmentof primarylanguagedisordersandlanguage-basedlearningdisabili-
ties, and to discuss amulti-perspectiveassessment processfor obtainingand
interpretinglanguagetest results. Inthesediscussions, thereareassumptions
and premises. The rst is that to implement equitable assessments of lan-
guageandcommunicationintodaysglobal society, multi-cultural andmulti-
linguistic factors must be considered. Secondly, the process must embrace
multi-dimensional and multi-perspectiveapproaches. Theuseof norm-refer-
enced and standardized tests is considered to be an integral component of
multi-perspectiveassessment. The instruments should be complemented by
naturalistic andauthentic procedures. Theobjectivesof amulti-dimensional
andmulti-perspectiveassessment processaremany. Oneobjective, however,
standsout. Itistoarriveatinterpretationsanddecisionsthatreecteducational
andsocial, aswell asclinical perspectives.
IntheUSA, theinclusionmovement (Will, 1986; Biklen, 1992) provideda
forceful impetusfor collaborationamongregularandspecial educators, suchas
speechlanguagepathologists. Public Law 94-142 started this movement by
mandating that special education services should be provided in the least
restrictive environment. As a result, students with language disorders have
beenintegratedinregular educationclassroomswithadequateandappropriate
support fromteachers, specialists, and related services. Traditional pull-out
therapyprogramsinspeechlanguagepathologyweremodiedinmanydiffer-
ent ways, amongothersbymovinglanguageinterventionfromclosets tothe
classrooms.
Amongtangibleoutcomesarethatmodelshavebeenpresentedfor develop-
ingteam-basedassessment andinterventionfor inclusion. TheOhioHandbook
247
for theIdentication, Evaluation, andPlacementof ChildrenwithLanguageProblems
(OhioDepartment of Education, 1991) isoneexample. At thesametime, the
objectives, content, strategies, and formats for language intervention have
changed. The intervention objectives for students with language disorders
weretraditionallydecitdrivenandreactive.Incontrast, theyarenowstrength
driven, curriculumbased, andproactiveinnature.
In the past, the emphasis in languageassessment was on clinically based
testingtoestablishadiagnosisanddetermineeligibilityfor speechandlanguage
services. Several norm-referencedlanguagetestsrespondtothisemphasis(e.g.,
Wiig, Secord, & Semel, 1992b; Semel, Wiig, & Secord, 1995, 1998). The1997
Individuals with Disabilities Education Act (IDEA) (Public Law 105-17) has
initiated signicant changes in language assessment and intervention in the
USA, theextentof whichisnot yetclear. AmongstatedIDEAmandatesareto:
(a) usetheprimarylanguageof thechild not necessarilythat of theparents;
(b) providealternativeassessmentsfor childrenwhocannot participateinstateor
district-wideassessments;
(c) giveachildaccesstoassistivetechnologyasneeded;
(d) evaluateachildsstrengthsandcommunicationneeds, parental concerns, and
needforassistivetechnologytodevelopanIndividualizedEducationPlan(IEP)
that isfollowedbyperiodicreviewandrevision;
(e) describehowachildslanguagedisorder affectseducational performance;
(f) linkinterventionobjectivesandannual goalstothecurriculum.
Speechlanguagepathologistsnow developprolesof languageandcom-
municationstrengthsandweaknessesbasedondatafromavarietyof sources,
and they use a variety of approaches to assessment. This has led to the
development of, for example, criterion-referenced tests and observational
scalesforlanguageandlearningdisabilities(Wiig, 1990;Semel, Wiig, &Secord,
1996; Hammill & Bryant, 1998). Thescopeof assessment hasbroadened, and
theprocessisdesignedtoprovideopportunitiestoobtainauthenticindicators
of performancesinthereal-worldsettingsof classrooms, family, communities,
andwork. Therecommendedapproachestolanguageassessment arecontex-
tual, interactive, andperformanceandreal-worldoriented. Norm-referenced
tests for assessing languageare often discredited or considered irrelevant, a
point of viewthat isnot takenhere.
The model for a multi-perspective language assessment process in this
chapter advocatestheinclusionof norm-referencedlanguagetestsandstandar-
dizedmeasures. Other methods, suchascriterion-referencedinstrumentsand
behavioral ratingsof languageandcommunicationbehaviorsin natural con-
texts, are also discussed. Thepremisefor all discussions is that thechild or
248 Elisabeth H. Wiig
student isamulti-facetedentitywithlanguageandcommunicationbehaviors
that change and impact other performances differently with age, cognitive
development, andexternal demands.
Language-assessment objectives
The objectives for language assessment should combine clinical as well as
educational perspectives. Fromaclinical perspective, theprimarypurposesare
toestablishevidenceof aprimarylanguagedisorder, determinecausal factors,
andestablishthedegreeandgeneral natureof thedisorder. Fromaneducation-
al perspective, the objectives are to (a) develop proles of language and
communication strengths and weaknesses, (b) identify language-learning
needs, (c) establishinterfacesbetweendecit areasandacademicperformance,
(d) determine eligibility for special services, and (e) develop a curriculum-
relatedintervention plan for implementation in theleast restrictiveenviron-
ment. Inamulti-perspective, collaborativelanguageassessment process, there
should be no conict in meeting both clinical and educational objectives.
Moreover, there should be no conict in developing the most appropriate
interventionplanandsequenceof implementation,if thereisanunderstanding
that somesyndromesor symptomsarebest managedwithmedical interven-
tion, whereasothersarebestmanagedwitheducational intervention, or witha
combinationof these. Constraintsinnancial or humanresourcesfor medical
and/ or educational interventionsmaycausethesystemtofail infullymeeting
agivenchildsor studentsneeds.
Causal factors
Advances in probing neurological functions, systems, and interactions have
revolutionizedour understandingof brainbehavior relationships(ReidLyon
& Rumsey, 1996; Chin & Marx, 1997). It is accepted that workingmemory
capacity contributesto languagecomprehension and acquisition, verbal and
nonverbal reasoning, and intelligence(Wickelgren, 1997). It is also accepted
that auditoryprocessingdecits, attentiondecit disorders, anddysnomiaare
neurobehavioral disorders(Tallal, 1983; Rourke, 1989; Korhonen, 1991, 1995;
Goodglass&Wingeld, 1997; Wolf, Bowers, &Biddle, 2000).
Decitsin auditory andphonological processing, speedof processing, and
short-termverbal memory areconsideredto becentral to primary language
disorders(Tallal etal., 1996). Thisissupportedbyevidencefrombrainimaging,
indicating that anatomical asymmetry of the auditory cortex, observed as
primarily H-planar asymmetry, contributes to the prediction of decits in
phonological awareness(Leonardet al., 1996). Investigationsof studentswith
249 Multi-perspective, clinicaleducational assessments of language disorders
dyslexia identify auditory processing and speed of naming decits as two
distinct, contributingfactors(Ackerman, Dykman, &Gardner, 1990; Torgesen
et al., 1990; Shankweiler et al., 1995).
Post-hocanalysesof datafromresearchwithstudentswithdyslexiapoint to
thealternativethat an underlying, precisetimingmechanism, sharedby lan-
guageandmotor functions, maybedecient, resultinginreducedcontinuous-
namingspeed(Wolf et al., 2000). Thereisevidencefor theexistenceof three
clinical subgroupsamongdyslexicreaders. Thelargest, single-decit, subgroup
containschildrenwithmodestreadingimpairmentsandprimarilyphonological
decits. Asecondsingle-decit subgroupcontainschildrenwithprimarynam-
ing-speed decits. A smaller, double-decit, subgroup contains children in
whomnaming-speed and phonological-processingmeasures are signicantly
loweredandreadingismost impaired. Thisindicatesthat decitsin naming
speedandphonological processescanoccur concomitantlyor independently.
Inarelatedstudy, Wiig, Zureich, andChan(2000) report that, inagroupof
morethan 300children with primary languagedisorders, about 50%exhibit
signicant reductionsin continuous namingspeed for colorshapecombina-
tions. Nearlyall (97%) inthenaming-decit groupexhibitedseverereceptive
expressivelanguagedisorders. Naming-speeddecits, either independentlyor
incombinationwith phonological-processingdecits, arehypothesizedto be
contributingfactorsinprimarylanguagedisorders, aswell.
Damagetotheprefrontal areasisdetrimental toplanningandgoal-directed
behavior (Krasnegor, ReidLyon, &Goldman-Rakic, 1997, pp. 211378). These
areas play a central role in regulating cognitive and emotional behaviors,
executivefunctions, workingmemory, andaspectsof languagedecodingand
encoding. Electrical stimulation of the left anterior frontal lobe results in
disruption of naming, reading, and sequencing orofacial movements
(Ojemann, 1983; Stuss& Benson, 1984). Retrieval frommemoryseemsto be
disrupted, especiallywhentheinferior andorbital sectionsareinvolved. Ina
similar vein, Warkentin et al. (1991) measured regional blood ow during
associativenamingwithamodiedversionof theWordFluencyTest (Benton
& Hamsher, 1977). Blood-ow values were signicantly higher in the left
anterior andinferior frontal areas, and lower in theleft central and anterior
parietal areas during the test condition than during resting. The ndings
support theideathat thedisruptionsresult fromblockageof aprecisetiming
mechanisminvolvedincontrollinglanguagedecodingandencoding.
Developmental patterns
Oneobjectivefor languageassessment isto identifypatternsof strengthand
weakness. Examinersarelookingfor evidenceof languageandcommunication
behaviorsthat arecommondecitsinchildrenwithlanguagedisorders. This
sectiongivesashort reviewof researchndingsthat indicatewhattheexpecta-
tionsmight be.
Languageandcommunicationdisorderscauseprimaryaswell assecondary
adaptiveproblems for students during childhood and adolescence, and may
persist in adulthood(Bashir, Wiig, & Abrams, 1987; Gerber, 1993; Ratner &
Harris, 1994; Owens, 1995). Duringthepreschool andearlyschool years, the
childslanguageimpairmentsresult inproblemsin acquiringandusingbasic
languageskillsfor social interaction, academiclearning, andperformance. In
themiddleandupper school years, theadaptiveproblemsareoftenreectedin
inadequaciesinusinglanguagefor reasoning, problemsolving, andcommuni-
cationinacademic, vocational, andsocial contexts. Theimpact of alanguage
disorder canbefar reachingandmay interferewithcommonsense, life-long
learning, andsocial adjustment inadolescenceandadulthood.
Wordandconcept knowledgeareexcellent measuresof cognitivelinguistic
growth,learningpotential,andacademicperformance(Gardner,1991). Among
studentswith languagedisorders, early spontaneousconcepts, such asbusor
angry, maybeadequatelydeveloped, whereasabstract andscienticconcepts,
such as liquid or idealism, may not. Students with limited, fragmented, or
episodicwordandconceptknowledgeremainconcreteinthinkinganddonot
tendtothinkinlogical, sequential termsor tousecauseeffectreasoning. They
may, therefore, not makethetransitionfromconcretetoabstract thinkingand
conceptualization spontaneously (Piaget & Inhelder, 1969; Feuerstein et al.,
1980). Theyarelikelytoplateauinwordandconcept knowledgeat fthgrade
level, limitingtheability to accessthelanguageof classroominstructionand
learningmaterials(Wiig& Secord, 1992; Wiig, Freedman, & Secord, 1992a;
Nippold, 1993). Thesedecitscommonlyco-occur withdifcultiesininterpret-
ingandusingverbal analogiesandgurativelanguage, resultinginconcrete,
literal communications.
Linguisticrulesfor formingwordsandsentencesgivestructureandpredicta-
bilitytolanguage. Intheearlyschool years, studentswithlanguagedisorders
mayattractattentionduetowordformationproblems(e.g., sayingwrited for
wrote). In the later school years, problems in forming complex sentences
with,for example,subordinatedandrelativeclausesandachievinggrammatical
and logical consistency (e.g., using appropriate conjunctions and transition
words) aremorelikelytoattract attention(Wiig& Secord, 1992; Semel et al.,
1995). Limitations in linguistic-rule acquisition are often reected in break-
downsandinefcienciesincommunicatingknowledgeandintents, exchanging
anddiscussinginformation, participatinginconversation, andproducingwrit-
tenlanguage.
Theacquisitionof pragmaticrulesandsocial conventionsfor communica-
tion in context is usually decient among students with languagedisorders.
Classroomlistening, speaking, reading, and writing are often compromised
(Kamhi & Catts, 1988; Gerber, 1993; Owens, 1995). Decitsinusinglanguage
for communication in context may reect, among other things, inadequate
linguistic-ruleacquisition, lack of cognitiveand linguistic exibility, or prob-
lemsinperspectivetaking.
Languageprovidesasequential codefor internalizingscripts, creatinghigh-
er-order abstractions(schemata), andorganizingcommunication. It isavalu-
ablecodefor guidingcategorization, aproductiveapproach to organization,
task management, anddevelopingmental models(Lakoff, 1987). Duringthe
school years, difcultiesinacquiringmetalinguisticabilitiesseemtocontribute
to theacademic andadaptiveproblemsof studentswith languagedisorders.
Theymaynot beabletoanalyzeandtalkabout language, or uselanguageasa
tool, or interpret jokes, sarcasm, or metaphors. Inadequaciesintheacquisition
of metacognitive abilities and problem-solving processes are also evident
amongthesestudents(Stone& Forman, 1988; Wansart, 1990; EllisWeismer,
1992; Meltzer, 1993). Theresultingdifcultiesmay bereectedin problems
with, for example: (a) planningandorganizinglanguagefor extendedspeaking
and writing; (b) making inferences and forming hypotheses from text; (c)
developingandselectingamongcommunicationoptionsfor speakingor writ-
ing; and(d) monitoring, correcting, or editinglanguageinuse. Studentswith
language disorders must often depend on auditory and working memory
functionsthat maybeinadequatefor thetask demands. Decitsinaspectsof
languageandcommunication, inner language, andverbal mediation, unfortu-
nately, alsomakeeffectivecompensationdifcult.
Primarylanguagedisordersamongchildrenandadolescentsareheterogen-
eousinnature. Thisdictatesthat languageassessment must bebroadinscope
andcontent, probemultipledimensionsof languageuse, andreect multiple
perspectives to catch individual symptoms, syndromes, and behavioral vari-
ations. Theassessment processmust incorporateadiversity of methodsand
measures (e.g., norm-referenced, standardized, informal, authentic, and de-
scriptive) andshouldincludeself-assessment (Reif, 1990; Roffman, Herzog, &
Wershba-Gershon, 1994). Tomeet educational objectivesfor languageassess-
ment, thediagnosticianmust consider theconstraintsanddemandsplacedon
languageand communication by different academic subjects and settings in
which a student is required to function. Interactions among a students in-
herent strengthsandweaknessesandexternal constraintsanddemandsmust
alsobeconsidered.
Assessment perspectives and methods
Studentclinician perspectives
Older studentswith languagedisordersbringupcommonthemes. They feel
theyhavelittleor no control of their livesandoftendonot understandwhat
went wrong. Many emphasizethat they performedwell in thelower grades
andstill do well insubjectssuchasmathandsciences. Theyoftenhavelittle
awarenessof howalanguagedisorder impactslearningandsocialization. They
maynot understandhowadisorder affectsacademicperformanceinreading,
writing, andother language-basedsubjects. Theyfeel that othersplaceunreas-
onabledemandsonthemandtheyshowevidenceof lowself-esteem.
Studentswithlanguagedisordersoftensaythat their primaryconcernisto
nd out what hampers academic performance. Many students are direct in
commentingontheroletheyseefor themselvesintheevaluationandinterven-
tion process. Older studentsfeel they must participatein assessinglanguage,
planning intervention, and evaluating outcomes. They also comment that
cliniciansshouldnot deneacomplexlanguagedecitinsimplisticterms, such
as saying that dysnomia means that words are trapped inside. They want
insight intolanguagestrengthsandweaknessestoempower theminhandling
problemsover thelongterm. Theywant concreteexamplesof difcultiesthat
maybecausedbyaprimarylanguagedisorders.
Theprofessional perspectiveof studentswithlanguagedisordersisincreas-
inglyholistic(Vygotsky, 1962) andit isappliedtoassessment andintervention
(Gerber, 1993; Shames, Wiig, &Secord, 1998). Cliniciansaccept that language
disordersmaypersist intoadolescenceandevenadulthood(Bashir et al., 1987;
Lapadat, 1991; Bashir &Scavuzzo, 1992; Gerber, 1993; Nippold, 1993; Capute,
Accardo, & Shapiro, 1994). They recognizethat languagedisordersco-occur
with other decits such as attention decit disorders, dyslexia, or nonverbal
learningdisabilities, andthat thesymptomstakenewformswith changesin
academic, vocational, andsocial demands.
Despite broadened understanding, a given language evaluation may not
meet astudentsmost urgent needs. Thismayreect therealitiesof aclinicor
school system, wheretime, nancial, andstaff resourcesfor testingareoften
limited. Clinicians must, therefore, select assessment instruments and ap-
proachescarefullytoobtainreliableandvaliddatafor astudent.
Multi-perspective and collaborative assessments
Theevolutionof languageassessment hasturnedattentionto thesettingsin
which a student is taught and learns (Wiig, Secord, & Hutchinson, 1997).
Teachers, parents, andstudentshavebecomelegitimateobserversandratersof
language, communication, and other prerequisite behaviors for successful
learning. Norm-referencedtestingiscomplementedbyauthentic, descriptive,
and other qualitativeassessments, such as checklists, behavioral ratings, and
self-evaluations to assess achilds potential for learningin the regular class-
room.
Theabilitytolearnandperforminschool maybecompromisedbyfactors
other than achilds inherent languagedisorder. Theremay beamismatch
betweentheinstructional language, classroom, andcurriculumdemands, and
thestudentsabilitytorespondtothese. Competenciesrequiredfor reasoning
andthinking, emotional control, andself-control, andinteractingsociallywith
others may be compromised and must be evaluated. A multi-perspective
approachto assessment canhelpput together thepuzzleof agivenstudents
languagestrengthsor weaknesses. It cansuggest howthedemandsof different
settings or tasks impinge on the student to cause either success or failure.
Students with language disorders form a heterogeneous group, and every
approachtoassessment hasassetsandlimitationsinthefaceof thisheterogen-
eity. Furthermore, communication contexts, demands, and personal percep-
tionsof adequacyvaryamongindividualsandwithinindividualsover time.
In amulti-perspectiveassessment process, cliniciansevaluatetheinherent
abilitiesandbehaviorsthechildbringstotheprocessof learningandalsohow
sheor heinteractswitheducational andsocial demands. Amongvariablesto
explore are abilities required for listening, speaking, reading, and writing,
interpersonal interactionandsocialization, andpersonal awarenessandman-
agement.Aspectsof thechildsculture,language, andfamilybackgroundsmust
alsobetakenintoaccount. Figure8.1showsaconceptualizationof what needs
to beassessed in astudent-centeredevaluation to probeinherent as well as
external dimensionsandfactors.
Multi-perspectiveassessment probesachildslanguageandcommunication
fromseveral pointsof view, asshowninFig. 8.2. It usesquantitativeaswell as
qualitativeassessment tools. It engagesclinicians, teachers, parents, students,
andothersintheprocess(Semel etal., 1996;Wiigetal., 1997). Thisimpliesthat
theassessmentisacollaborativeprocessof detectionandfactndingabout the
child.
Thestudentslanguageandcommunicationstrengthsandweaknessespro-
vide the inputs to the process. The clinician explores the target situation
through multi-dimensional, multi-perspectivedatacollection by usingnorm-
referencedor standardizedtests, observations, interviews, recordsof previous
evaluations, and other appropriate means. The clinician and others then
Oral Language
Listening
Speaking
Expressing Ideas
Other
Personal Awareness
Emotional & Social
Self-Awareness
Motivation
Compensation
Family and Culture
Family Dynamics
Language/Dialect
Social & Religious
Support Systems
Classroom
Expectations
Behaviors
Instruction
Management
Other Practices
Literacy
Reading
Writing
Other
Personal Management
Task Time
Reasoning
Study Skills
Interpersonal
Verbal & Nonverbal
Communication
Social Interaction
Other
Executive Functions
Attention
Monitoring
Self-Evaluation
Revision/Repair
School Supports
Classroom & Teacher
Learning Center
Administration
Peers & Others
Curriculum Demands
Content
Expectations
Objectives
Testing & Grading
Student Characteristics
Interactive Effects
Context Characteristics
Fig. 8.1. Overviewof dimensionsof student-centered,multiperspectiveassessment.(Reproduced
withpermissionfromWiiget al., 1997.)
addresscritical issuesor questions. Thedataaresubjectedto analysis, evalu-
ation, andsynthesistoarriveataholisticviewof thechildscurrentstatus. This
usuallyleadstoaprocessof reframingthechildssituation, inwhichissuessuch
asprioritiesandoptionsfor interventionareaddressed. Attheconceptual level,
data and interpretations are integrated to evaluate the childs potential for
regular-classroominclusionandtodevelopalong-termclinical or educational
interventionplan. Thenal stepin theprocessisto addressissuesrelatedto
evaluatingthestudentsprogressandtheefcacyof interventionover time. To
Uncontrollable
Controllable
Modifiable
Manageable by
inclusion
Teachers
Student
Parents
Others
Inclusion
Resource room
Team-based
Other
Academic
Social
Vocational
Other
Analysis Synthesis Evaluation Application
What is the
problem?
What are the
causal factors?
What are the
dynamics?
What is most
important?
What are the
driving forces?
What are the
priorities?
What are the
instructional
options?
How will
interventions
help the student?
What worked? What did not work?
Variables Stakeholders Possible options Expected outcomes
Standardized
Assessments
Checklists and
Behavioral Ratings
Interviews Self-Assessments
Language and Communication Strengths and Weaknesses
Method
Issues
Issues
Issues
Data
Input
Assessment of Clinical and Educational Outcomes
Revision of Intervention Plans
Fig. 8.2. A model for multidimensional, multiperspectivelanguageassessment. (Adaptedfrom
Wiig, 1994.)
bridgethetransitionfromassessmenttointervention, staff andother resources
areidentied, andthefunctions, roles, andresponsibilitiesof eachparticipantin
the intervention plan are delineated. As in all collaborative ventures, all
participantsshareavailableresources, responsibilities, risks, andrewards.
Norm-referenced language assessments
Theuseof norm-referencedteststo obtainquantitativemeasuresof achilds
language and communication has been questioned, and not without cause
(Damico, 1993). However, therearemanyjustiablereasonsfor usingnorm-
referencedtestsforevaluatingthelanguageof studentsinschools(Hutchinson,
1996; Sabers, 1996). Oneasset of anorm-referencedtest isthetimeandcare
investedinthedevelopment. A secondisthat thestatistical characteristicsof
the instrument (e.g., internal consistency, testretest reliability, concurrent
validity, standard error of measurement) are controlled and available for
evaluation.
Norm-referencedlanguagetestsmaybefocusedor broadinscope. Testsof
vocabulary and auditory comprehension of language(Dunn & Dunn, 1997;
Carrow-Woolfolk, 1999) are among examples of focused, norm-referenced
instruments. Theadministrationof alanguagetest withaspecicfocusdoes
not provide the measures necessary for diagnosing a primary language dis-
order, even though test scores may correlatesignicantly with scores from
broader-based language tests. Language tests with a narrow scope cannot
identify or predict decits in language abilities beyond the scope of their
content, andarebest usedto exploreaspecicproblemsuch asarticulation,
vocabularydevelopment, or wordnding.
Norm-referencedlanguagetests, whicharebroadinscopeandcontent, are
designedwiththeobjectiveof identifyinganddiagnosingalanguagedisorderin
a statistical comparison with performances by the students age-level peers.
ThisincludestestssuchastheClinical Evaluationof LanguageFundamentals
Preschool (CELFP) (ages37), Clinical Evaluation of LanguageFundamen-
tals3(CELF3) and CELF3Spanish Edition (ages 621) (Wiig, Secord, &
Semel, 1992b; Semel, Wiig, & Secord, 1995, 1997), the Test of Language
DevelopmentPrimary(TOLDP:3)(ages310)andIntermediate(TOLDI:3)
(ages714), andtheTest of Adolescent Language(TOAL3) (Hammill et al.,
1994; Hammill &Newcomer, 1997; Newcomer &Hammill, 1997). Thesetests
can determine the degree, extent, and nature of a language disorder. The
compositestandardscorescanidentifywhetheralanguagedisorderisprimarily
receptive, primarilyexpressive, or mixedinnature. Theycanalsoidentifyareas
or modalitiesof relativestrengthor weaknessin theinterpretationor useof
languagecontentor structurebycomparingscores. Norm-referencedlanguage
testsareacomponent of theevaluationprocesstoestablishachildseligibility
for (a) language intervention, either through individualized therapy or lan-
guage adaptations and interventions in the classroom; (b) using alternative
technologiesfor completingclassroomwork;or (c) takingclassroomandother
testswithout timelimits(Wiig&Secord, 1991).
Design features and interpretation
Mostbroadlybasedlanguagetestsfollowastandarddesign. Thisisthecasefor
theCELF(CELFP, CELF3, andCELF-Spanish), TOLD(TOLDP:3, TOLD
I:3), andTOAL3tests. Anumberof content-relatedtestitems, usuallyfrom20
to 30or more, aregroupedinto themajor subtests, usuallyfromfour to six.
Eachsubtest representsadimensionof theabilitytested. Subtestsareclustered
into composites that measure a specic theoretical construct, for example
primarilyreceptiveversusprimarilyexpressivelanguageabilities. TheCELF3
featuressupplementarysubteststhat focusonassociativenaming, rapidnam-
ing, and understanding spoken paragraphs. Scores fromthe supplementary
subtestsarenotincludedinformingthetotal, receptive, or expressivelanguage
scoresthat areusedfor diagnosticdecisionmaking.
Two languagetestsfor infantsandpreschool children, thePreschool Lan-
guageScale(ages36) (Zimmerman, Steiner, & Pond, 1992) andtheTest of
EarlyLanguageDevelopment3(ages37) (Hresko, Reid, & Hammill, 1999),
differ in design. The latter contains subtests, whereas the former does not.
Despitethisdifference, theybothallowfor thecalculationof total, receptive,
andexpressivelanguagescores.
Innorm-referencedlanguagetests, thetotal languagescorereectsageneral
performanceconstruct. It is usually the most reliablesingle measureof the
collectiveset of tasksandconstructs. Thereceptiveandexpressivelanguage
compositesreectmodalitydifferencesinthetasksandconstructs.Fordiagnos-
ticpurposes, thetotal, receptive, and/ or expressivelanguagescoresshouldbe
used for diagnosing the degree and general nature of a language disorder.
Rather than basing the diagnosis on the actual standard score earned, the
condenceinterval for the90%level of condenceshouldbeused. Thisisthe
interval withinwhichthetrue scorecanbeexpectedtofall if thechildistested
repeatedlywiththesametest. Diagnosticcategorizationanddecisionsrelating
toeligibilityfor servicesshouldgenerallybebasedonthetotal languagescore.
Anexceptionoccurswhenthereceptiveandexpressivelanguagescoresdiffer
signicantlyor the90%condenceintervalsfor thetwoscoresdonot overlap.
Subtest or linguistic content-based standard scores should not be used to
determineadiagnosis. Thesescorescanpointtorelativestrengthsor weakness
in languagecontent or structure. They can also suggest areas for follow-up
evaluation with criterion-referenced tests, observational rating scales, and
other descriptiveor performance-basedmeasures.
Scope, content, and development
Norm-referencedlanguagetestsvaryinthescopeof content andtaskformats
andintheunderlyingmodelsfor subtestsandtheoretical constructs. TheCELF
testscontainsubteststhat addresslinguisticskillsandtheinteractionsbetween
linguisticskillsandauditorymemory, retrieval, andrecall (Wiiget al., 1992b;
Semel et al., 1995). Other broad-based, norm-referencedtestsreect anunder-
lying model which is primarily linguistic in nature and evaluates primarily
linguisticskillsin theareasof semanticsandsyntax(Hammill & Newcomer,
1997; Newcomer & Hammill, 1997) or using these for listening, speaking,
reading, or writing(Hammill et al., 1994). Thewidely usednorm-referenced
languagetestsemploy essentiallysimilar proceduresfor normativesampling,
standardization,establishingvalidity,reliability, anderrorofmeasurement,and
analyzingfor itembias.
Relativelyfewnorm-referencedlanguagetestsevaluatethetransitionsfrom
linguistic-skill tometalinguistic-abilityacquisitionandcommunicationstrategy
use. TheTest of LanguageCompetence Expanded(TLCE) (Wiig&Secord,
1989) isanexampleof alanguagetest designedtoexplorethedevelopment of
metalinguisticabilities. It includesasupplementarysubtest for assessingwork-
ingmemory that probestherecall of wordpairsin two sequential presenta-
tions. TLCE canbehelpful inacomparisonto evaluatewhether alanguage
decit encompasses linguistic skills, metalinguistic abilities, and communica-
tionstrategies. Norm-referencedlanguageteststhat probemetalinguisticand
strategic aspectsof languageuseareappropriatefor rst-timeevaluationsof
adolescentsorfor establishingoutcomesafterlanguageinterventioninelemen-
taryandsecondaryschool students.
Norm-referencedlanguagetestscancombineaspecicfocuswithabroad
content. TheTest of WordKnowledge(TOWK) (Wiig& Secord, 1992) isan
example of a focused yet broadly based test of semantics. It evaluates the
acquisitionof referential (e.g., receptiveandexpressivevocabulary), relational
(e.g.,worddenitions,synonyms, andantonyms), andmetalinguisticaspectsof
wordknowledge(e.g., multiplecontexts, gurativeusage, conjunctions, and
transitionwords). Inaheterogeneoussampleof studentswithlearningdisabili-
ties, decits in word and concept knowledgewere found in 6075%of the
subjects(Wiig, Jones, &Wiig, 1996). Fortunately, interventiontoexpandword
knowledgeandfoster concept formationisreadilyinstitutedinclassroomsand
appearseffectiveinimprovingastudentsacademicachievement (Wiiget al.,
1992a).
Commonly used norm-referenced language tests have gone through an
extensive developmental process, which may be described in the technical
manual (Wiiget al., 1992b; Secordet al., 1995), startingwith astatement of
objectivesandconceptualizationfor thedesignof subtestsanditems. Thepilot
versionissubmittedtoseveral studies, followedbyextensivestatistical analyses
andrevisions. Theprocessendswith large-scalenormativetesting, statistical
analyses, standardization, and publication. Thestatistical characteristics of a
test can support or causeus to question theuseof agiven norm-referenced
languagetest. Amongcharacteristicsto evaluatein any norm-referencedtest
arewhether or not (a) thelanguagecontent, dimensionsevaluated, designof
tasks,andage-normsareappropriate;(b)thetestiswell standardized,valid, and
reliable, witharelativelysmall StandardError of Measurement (SEM); and(c)
theresultscanreveal performancepatternsor syndromesorleadtohypotheses
or conclusionsthat arenot easilyarrivedat throughinformal testing(Hutchin-
son, 1996).
Relationships to IQ
Thereareseveral indicationsof therelationshipsclinicianscanexpect between
broadly based, norm-referenced measures of language(standard scores) and
intelligence(IQ) (Table8.1). Duringstandardizationof CELFPreschool (Wiig
et al., 1992b), twotestsof intelligence Wechsler Preschool andPrimaryScale
of IntelligenceRevised (WPPSIR) (Wechsler, 1989b) and the Differential
AbilityScales(DAS)(Elliot, 1990) wereco-administeredtoagroupof over 50
children. ThecorrelationbetweentheCELFPreschool Total LanguageScore
andVerbal IQisclearlystronger thanthat for PerformanceIQ. Thepatternof
correlationsbetweentheCELFPreschool andDASscoreswassimilar.
Inthestandardizationof CELF3(Semel et al., 1995), thethirdeditionof the
Wechsler Intelligence Scale for Children (WISC3) (Wechsler, 1989a) was
co-administered to a sample of 203 students. The pattern of correlations
support theCELF3asameasureof general verbal ability.
TheWechsler IntelligenceScalefor ChildrenRevised(WISCR)(Wechsler,
1974) was co-administered with the TLCE (Wiig & Secord, 1989). The
correlationbetweentheTLCETotal LanguageScoreandWISCRVerbal IQ
wassignicantlystronger thanthat withPerformanceIQfor bothlevelsof the
test.
Across CELFPreschool, CELF3, and TLCE, apattern emerges for the
relationshipbetweenthestandardscoresfor total languageabilityandintelli-
gence. ThecorrelationsbetweentheTotal LanguageScoresandFull ScaleIQ
aresignicant,butmoderate(.71to.75). ThecorrelationswithVerbal IQorthe
DAS Verbal Cluster are consistently higher (.70 to .78) than those with
PerformanceIQor theDASNonverbal Cluster (.12to.60).
Table 8.1. Correlations for standard scores on language and intelligence tests
Language Mean(SD) Intelligence Mean(SD) Correlation
CELFP WPPSIR
Total Language 101.5(14.0) Full Scale 101.7(14.0) r=.71
Verbal 101.0(12.6) r=.72
Performance 102.1(14.9) r=.58
DAS
General 102.7(13.6) r=.68
Conceptual
Verbal 102.6(13.4) r=.70
Nonverbal 101.7(14.7) r=.58
CELF3 WISCIII
Total Language 102.0(15.8) Full Scale 103.7(15.2) r=.75
Verbal 102.4(15.3) r=.75
TLCELevel 1 WISCR
Composite 77.7(12.2) Full Scale 93.4(13.8) r=.46
Verbal 88.7(13.1) r=.70
TLCELevel 2 WISCR
Composite 73.1(9.9) Full Scale 95.3(12.5) r=.75
Verbal 89.3(12.7) r=.78
Limitations
Anoften-citedlimitationof languagenorm-referencedtestsisthat theyare, by
their nature, biasedagainst someindividualsandminorities. Thisbiascanbe
minimized during development by obtaining expert bias reviews and using
statistical procedurestoidentifyitemswithsignicantbiasandeliminatethem.
It canalso beminimizedby givingseparatenormsfor selectedminoritiesor
directives for interpretation within a multi-lingual, multi-dialectic, or multi-
cultural framework. As examples, the family of CELF tests (CELFP and
CELF3) (Wiiget al., 1992b; Semel et al., 1995) underwent extensivereviews
andstatistical analyseswith different proceduresfor bias. Itemsthat showed
gender or minoritybiasweredeletedor redesigned. TheCELF testsalsogive
examiners extensive guidelines for scoring and interpreting the effects of
linguistic or dialectic variations. Recently, the incorporation of item-bias
analyses has becomemorecommon. Clinicians who feel that anorm-refer-
encedtest istoo easy or too difcult for their populationcan createlocal or
special population norms by following guidelines (Bryant, 1992) or using
softwareprograms(Pinsach, 1992; Sabers, Hutchinson, &Mobley, 1992).
Misuses
Norm-referencedlanguagetestscanbemisusedor abused. Thesetransgress-
ionsmayreect: (a)inappropriateuseof testnorms; (b)usingsinglesubteststo
develop a diagnosis, (c) using subtest results for developing skill-based IEP
objectives, and(d)implementinginterventionsthatrespondonlytothespecic
test content or tasks. Cliniciansmaymaketheerroneousassumptionthat by
providinginterventionthatfocusesonthechildslanguageandcommunication
decits, the inherent difculties can be reduced or eliminated. Teaching to
itemsinatestdevelopssplinterskillsandinvalidatesfurtheruseof thesametest
toevaluateprogress. It must beavoided.
Another sourceexists when aclinician interpretsan exact languagescore
rather than the expected range of scores to establish a diagnosis. Norm-
referencedtestsusuallyprovideanindex, theSEM, of thesizeof measurement
errortobeexpected. Statistically, agivenchildstruescore shouldfall withina
range that is determined by the size of the SEM. All important decisions
diagnosis, nature, degree, andeligibilityfor services shouldbemadebasedon
interpretingcondenceintervalsat 90%for thetotal, receptive, andexpressive
languagescores. Subtest scorescan only suggest areasof strengthsor weak-
nesses. Major clinical or educational decisionsabout achildshouldbebasedon
interpretingcondenceintervalsfor thetotal languagescoreor thereceptiveor
expressivecompositescores, if thereisasignicantdiscrepancybetweenthese.
Cross-cultural and linguistic issues
Languageisaninherentlybiasedtool for exchanginginformationandinterac-
tingsociallyinwhichthevocabulary(semantics)andrulesfor usinglanguagein
context (pragmatics) aremodiedinanevolvingprocess. Therulesfor what,
how, andwhentocommunicateindifferent contextsvaryandreect, among
other things, authority, religion, andsocial statuswithinacultureor language
community. Cultural andlinguisticdiversitiesplayout inlanguage, communi-
cation, andsocial interactionat manylevels.
Someof theseissuesemergedinthestandardizationof theClinical Evalu-
ationof LanguageFundamentals Spanish, developedtorespondtotheneeds
of alargeHispanicpopulationintheUSA(Semel, Wiig, &Secord, 1997). Inthe
development, the visual stimuli were modied to reect the norms of a
Hispaniccommunity. Subtestsanditemswerechangedor modied, starting
withtheidenticationof Spanishlanguagecharacteristicsthat couldbesensi-
tiveinidentifyinglanguageimpairments. Oneof theCELF3Englishsubtests,
SentenceAssembly, requiresthestudent tomaketwosentenceswithdifferent
meaningsor intents(e.g., statement versusaquestion) with thesamegiven
words. This format proved of limited diagnostic value due to the many
combinatorial choicesinSpanishandwasleft out.
Languagecliniciansinmetropolitansettingsservechildrenfromavarietyof
cultural and linguistic backgrounds. There may be no norm-referenced or
criterion-referencedtestsfor agivenchildsprimarylanguage. Whenthisisthe
case, it isimportant to determinepossiblepointsof conict betweenachilds
primary language and English. A comparison of the cultural and linguistic
features of the primary and the instructional language (English) can assist
clinicians in predicting problem areas. Parents or other competent adult
speakersfromthechildsprimarylanguagecommunitycanprovidetheinfor-
mationfor acomparisonof thevocabulary, morphology, andsyntax.
Criterion-referenced assessments
Criterion-referenced assessments are standard in format and administration
andgenerally usetasksor test probeswith narrowly focusedcontent. These
assessmentsmayresult inrawscoresthat canbecomparedtoage-level criteria
for performance, as is thecasefor tests of articulation (Goldman & Fristoe,
1986; Hodson, 1986) andrapidautomaticnaming(Wolf, 1986; Semel, Wiig, &
Secord, 1995). Theymayalsoresult inpercentagescoresthat canbecompared
toperformancelevelsbasedonage, grade, rateof growth, or other criteriafor
languageacquisition (Wiig, 1990; Sanclementeet al., 1998; Wiig& Wilson,
1999).
Several criterion-referencedtests evaluatefunctions associated with rapid,
automatic naming decits. The Stroop ColorWord Test is the classical
example (Stroop, 1935). There are a number of more recent continuous
rapid-namingtasksthat arecriterion-referencedandpredict dyslexiaandinter-
ferencewith uency in languageproduction (Denckla& Rudel, 1976; Wolf,
1986, 1991; Semel et al., 1995).
Rapidautomatic naming(RAN) tasksareusedfor diagnostic purposesby,
among others, aphasiologists, neuropsychologists, speechlanguage patholo-
gists, and psychoeducational specialists. RAN tests that are diagnostically
sensitiveto namingdecitsappear to requirerapidperceptual or conceptual
shiftsfromonedimensionor semanticeldtoanother (Wiiget al., 2000; Wolf
et al., 2000).
From a clinical perspective, the rationale for administering continuous
rapid-namingtasksistoidentifywhether anamingdecitmightbeacontribut-
ingfactor inaprimarylanguagedisorder or dyslexia. TheCELF3RAN tasks
(Semel et al., 1995)andtheRapidAlternatingStimuli (RAS)namingtest (Wolf,
1986)arewell suitedfor co-administrationfor clinical andeducational diagnos-
ticpurposes. Theclinicianmaywanttoanalyzeaspontaneouslanguagesample
for additional evidenceof dysnomia(German, 1991) if arapid-namingdecit is
established.
Criterion-referenced language inventories
Speechlanguage pathologists are getting reacquainted with criterion-refer-
enced measures for evaluating language (McCauley, 1996). Criterion-refer-
encedmeasurescanprobe, amongotherthings, linguisticcontent,skill andrule
acquisition, anduseof languageinsocial contextsor for meetingcurriculum
objectives(Starlin& Starlin, 1973; Wilson, 1980; Wiig, 1990; Wiig& Wilson,
1999). Criterion-referencedlanguageinventoriescanbeusedtovalidatenorm-
referencedtestresults, behavioral ratings, andobservationsof errorpatterns, to
determinebaselinesandtargetsfor intervention, andto evaluategrowthand
educational outcomes.
Criterion-referencedlanguageinventoriesusuallycontainaseriesof probes,
eachwithtenrelateditems, toevaluatespeciclanguageandcommunication
skills, rules, or objectives. Itemswithinagivenlanguageprobetest thesame
abilityat different levelsof difcultyor complexity, or indifferent contexts.
Theuseof ten itemsin alanguageprobeallowsfor easy conversion to a
percentage-correct level for theperformance. Thispercentagecanestablisha
studentslevel of successor failurecomparedto somestandardof judgment.
Seventypercent accuracyisoftenacceptedtoindicateadequateacquisitionof
thecontent or skill tested(Wilson, 1980). Thisoverlooksthefact that language
acquisition progressesat aslowed-down rateamongstudents with language
disorders and that over-learningis benecial for thesestudents (Wiig, 1990;
Sanclemente et al., 1998; Wiig & Wilson, 1999). Examiners are therefore
advisedto usevariablecriteriafor determiningastudentsperformancelevel
andinterventionneeds. Anexampleof avariablecriteriaperformancescalefor
languageassessment issummarizedinTable8.2.
TheWiigCriterion-ReferencedInventoryofLanguage(CRIL)probeslanguage
content (semantics), form(morphology and syntax), and use(pragmatics) in
threeseparatemodules(Wiig, 1990). In themorphologyandsyntaxmodule,
Table 8.2. Variable performance criteria for criterion-referenced language assessment
Mastery
(80%or abovecorrect)
ReectsMasteryandabilitytoperformindependentlyin
most contexts
Transition
(6079%correct)
Reectsatransitiontoindependent performance(Mastery)
Opportunitiesfor practice, modeling, coaching, andother
support issometimesneeded
Emergence
(4059%correct)
Reectsaneedfor instructionwithscaffolding, guided
questioning, andother facilitators(Emergence)
RandomPerformance
(below39%correct)
Reectstrial-error responding(RandomPerformance) anda
critical needfor direct interventiontoestablishbasic
concepts, skills, rules, or strategies
Source: adaptedfromWiig&Wilson(1998).
for example, aprobefor Englishmorphologyfocusesexclusivelyonforming
noun plurals; another focuses on forming past tense of regular verbs. An
examiner canselect probesfromthelanguageinventoryaccordingto criteria
for linguisticcontent or ruleacquisition, ageanddevelopment, or grade-level
curriculumobjectives. Theinventory can serveas a long-termresource for
selectingage-level or grade-level probes. Specicprobescanbereadministered
totrackachildsprogressinaspecicareaof usinglinguisticcontent, rules, or
conventionsfor oral communication. Inthebroader context of literacy, CRIL
canevaluatetheadequacyof oral-languageprerequisitesfor languagecontent,
rule, andusesystems.
Theefcacy of interpretingtheresults of criterion-referencedassessments
dependsonselectingtheappropriateprobecontent for educational objectives
andevaluatingresponsesagainst thechildsprimary culturallinguistic back-
ground. ASpanish-languageinventory(Sanclementeet al., 1998) broadensthe
application of criterion-referenced assessment to bilingual, SpanishEnglish,
students.TheSpanish-languageinventoryreportsgrowthcurvesforchildrenin
Spain. Parallel probesintheEnglishandSpanishlanguageinventoriescanbe
usedasaresourcefor educatorswhowant tocompareperformancelevelsfor
SpanishEnglishbilingual students. Table8.3showsan exampleof aparallel
languageprobe.
WiigandWilson(1994, 1999) usecriterion-referencedmeasurestoevaluate
textcomprehensionintheclassroom. Theassessmentcomponentfeaturestwo
grade-level appropriate passages for each of Grades 2 to 7. Each passage
featurestentest questions, designedaccordingto BloomsTaxonomyof Educa-
tional Objectives(Kratwohl, Bloom, &Masai, 1964). Thequestionsaregrouped
Table 8.3. Comparison of a bilingual, English/Spanish language probe
English Spanish
Spatial prepositions Locativo
WhereisMisty(acat) sleeping?(in) DondeduermeMoni?
WhereisMistysitting?(on) DondeestasentadoMino?
WhereisMistyhiding?(under) DondeestaescondidoMino?
WhereisMistyhidingnow?(behind) DondeestaahoraMino?
WhereisMistysitting?(infront of) DondeestaescondidoahoraMino?
WhereisMistysitting?(between) PerodondesehacolocadoMino?
WhereisMistystanding?(by) Dondeestaparado?
WhereisMistysleeping?(outside) DondeestadurmiendoMino?
WhereisMistygoing?(inside) HaciadondevaMino?
WhereisMistyplaying?(inthemiddle) DondejuegaMino?
Source: adaptedfromWiig(1990), andSanclementeet al. (1998).
toprobetwobroadlevelsof comprehensionandfacilitatescoringandinterpre-
tation. Five questions measure recalling and using given information (i.e.,
knowledge, analysis). Fiveother questionsprobetheabilitytogo beyondthe
giveninformation(i.e., comprehension, application, synthesis). Theresulting
measuresdifferentiatestudents with languagedisordersfromtheir normally
developingage-level andgrade-level peers(Wiig&Wilson, 1994).
Descriptive assessments
Checklists and behavioral ratings
Observational checklistsandinterviewsarerichsourcesof informationthatcan
validate language, communication, and literacy difculties (Wiig & Secord,
1991; Damico, 1992; Westby & Erickson, 1992). There are many checklists
availablefor evaluatinglanguageandcommunicationbehaviors(Nelson, 1992,
1993; Secord, Wiig, & Damico, 1994a; Secordet al., 1994b). However, onlya
fewobservational ratingscalesof languageabilitiesarestandardizedandtested
for diagnosticvalidity(Semel et al., 1996).
The descriptive procedures and ratings in checklists are not necessarily
designedtodifferentiatestudentsbydiagnosticcategories. Theitemcontent of
languagechecklistscanberelativelynarrowor encompassingincontent and
scope(Semel et al., 1996; Wiiget al., 1997). Checklistscan exploredifferent
dimensionsof language(e.g., content, form, andstructure)andlanguage-based
performance (e.g., listening, speaking, reading, and writing) from different
perspectives (e.g., teacher, parent, and student). The data provide valuable
informationfor identifyinglanguagestrengthsandweaknesses, learningneeds,
andplanninginterventions.
Behavioral checklists can be administered in self-administered or other-
administeredformats, interviews, or computer-administeredprocedures. This
addsexibilityfor theuser andtheopportunityfor dynamicinteraction. The
behavioral ratings can be completed by teachers, parents, or educational
specialists. Older students can complete a checklist in a self-evaluation pro-
cedure.
Checklists with observational ratings can be valid sources for identifying
languagedisorders. Thishasbeensupportedinastandardizationandvalidation
study of theCELF3Observational RatingScales(ORS) (Semel et al., 1996).
The research edition probed and rated 42 listening, speaking, reading, and
writingbehaviors. Thechecklist questionswerestatedinthenegativetoelicit
decitratings. Thefrequencyof occurrencewasratedonafour-pointscaleand
assignedascoreinwhichNever wasassigned1point, Sometimes2, Often3, and
Always4points. Thenal versionof CELF3ORScontains40itemsdistributed
in four categories: Listening, Speaking, Reading, and Writing. TheLearning
DisabilitiesDiagnosticInventory(Hammill &Bryant, 1998)providessimilar as
well as complementary measures. It targets characteristics commonly asso-
ciatedwithdyslexiaandlearningdisabilities.
Standardization of ORS indicated that the sumof the frequency ratings
Often (3points) andAlways (4points) differentiatedstudentswithprimary
languagedisorderswithahighdegreeof accuracy(90%). Correlationsbetween
thebehavioral ratingscoresbyteachersandCELF3diagnosticlanguagetest
scoreswerenegativeandinthelowrange(0.35to0.43). Thesecorrelations
leadto two conclusions. First, abehavioral ratingscaledoesnot providethe
samediagnostic dataas abroadly based diagnostic languagetest. Second, a
clinician can obtain a greater diversity of data for determiningintervention
objectivesbythecombinedadministrationof anorm-referencedlanguagetest
(e.g., CELF3) andabehavioral ratingscale(e.g., CELF3ORS).
Asingle, student-centeredperspectivefor behavioral observationandrating
overlooksthefact that childrenaresubjectedto varyingacademicandsocial
demandsfor languageandcommunication. Teachers, curriculumobjectives,
subject areas, andsocial situationsimposedifferent constraintsanddemands
that must bemet for effectivecommunication. For thesereasons, Wiiget al.
(1997) recentlydevelopedalarge-scaledatabaseof categorizedchecklist items
for observing, questioning, andratingspeech, language, communication, and
language-basedaspectsof literacyindifferentacademicandsocial contextsand
indyadicinteraction.
TheDiagnosticSpeechandLanguageProle(DSLP) (Wiiget al., 1997) isa
performance-basedsystemfor monitoringlanguageandcommunicationfrom
theinitial identication through management and long-termprogressevalu-
ation. DSLPcontainsmorethan1000categorizeditemsthat, together withthe
softwaresystemwhichoperationalizesthedatabase, givetheuser exibilityin
selecting, adapting, andadministeringchecklist probes. It isacomprehensive,
naturalistictool for ratingobservationsof languagebehaviorsin action. The
behavioral ratingscan comefromavariety of observers, includingteachers,
parents, and students. DSLP can also identify points of agreement and/ or
conict between thestudents inherent languageabilities and teacher, class-
room, or curriculumdemands. Onesectionof probesfocusesonthestudent
andtheinherent languageabilitiessheor hebringstotheclassroom. Asecond
focusesondyadicinteractionsbetweenthestudent andtheteacher, classroom
context, instructional language, and curriculumdemands. An example of a
dyadiclanguageprobeispresentedinTable8.4.
The DSLP items are written in apositivevoice to focus on strengths. A
ratingscalewith four labelsisusedto developqualitativeratingsandassign
point scoresfor quantitativeanalyses. Thequantitativeratingscanbeusedto
developlocal or regional statistical informationornormsforexpectedperform-
ancesat different ageor gradelevels. TheDSLP databaseandsoftwaresystem
canassist indevelopingandmanagingappropriate, individualizedintervention
objectivesbasedonnaturalisticmeasures. It canalsoassist schoolsindevelop-
inginterfaceswithcurriculumobjectives, andtrackingeducational outcomes
toconformtonewFederal RegulationsintheUSA(IDEAAmendmentstoPublic
Law105-17, 1997).
Interviews
Interviewingtheteacher, parents, or student isatime-testedoptionfor obtain-
inginformation about achildor for administeringchecklist itemsor probes.
Theinterviewcanbeindividualizedandmodiedbasedonanswersandother
feedback (e.g., nonverbal communication cues). The procedure has many
assets, amongthemthattheinterviewercanbuildstrongworkingrelationships
withparentsandstudents. Interviewingcanalsostrengthencollaborationand
consultationwithprofessionalsandconsumers. Ethnographicinterviewstypi-
callytakemoretimethanusingchecklistswithbehavioral ratings. However,
theaddedtimecanyieldunexpectedinformation.
Onepurposeof aninterviewmaybetocompleteachecklist toexplorethe
Table 8.4. Illustrative checklist probe for classroom demands and expectations for
questioning and answering questions. Probe 3. Teacher questions and student
responses
Theteacher Thestudent
Asksquestionsfor content (i.e., factual or
quiz-like)
Respondswell toquestionsfor content
Asksopen-ended, WH-questions Respondswell toWH-questions
Asksquestionsfor feelingsor reactions Respondswell toquestionsfor feelingsor
reactions
Asksquestionsfor prior experienceand
knowledge
Respondswell toquestionsfor past
experienceandknowledge
Asksquestionsfor evaluation/ opinion
(e.g., right, wrong, neutral)
Respondswell toquestionsfor evaluation
or opinion
Asksimplicationsor inferencequestions
(i.e., causeseffects)
Respondswell toquestionsfor implications
or inference
Asksexplorationor probingquestions Respondswell toquestionsthat exploreor
probefor information
Repeatsstudentsanswerstoverify(e.g.,
Yousaid. . .)
Acceptsor correctsteachersrepetitionof
answers
Encouragesquestionsfor clarication Asksquestionsfor claricationasneeded
Elaboratesoncomments, opinions, or
views
Learnsfromteacherselaborationsof
students commentsor opinions
Source: Wiig&Secord(1999), reprintedwithpermission.
WH-questions: Who?What?Where?When?Why?How?
frequency of occurrenceof behavioral strengths and weaknesses. Thereare
other purposes for interviewing, among themto gain understandingof the
childscultural andlinguisticbackground, family constellationanddynamics,
and available support systems. When an exploratory interview has been
completed, an evaluation teamshouldreviewtheresponses, summarizethe
ndingsintermsof languageandcommunicationstrengthsandweaknesses,
clarifyanyquestionsor concerns, andintegrateall ndings.
Self-assessments
Many educational specialists use self-assessments with late elementary and
secondary-level students, collegestudents, andadults(Gerber et al., 1990; Reif,
1990; Roffmanet al., 1994). Theimportanceof allowingan older child(ages
eight and up) to assess himor herself as part of an evaluation cannot be
minimized. The student feels empowered, assumes ownership, and takes
charge of language and learning difculties, and becomes his or her own
advocate. Self-assessmentallowsstudentstodescribeacademic, emotional, and
social strengthsand weaknesses. It may probeastudents perception of lan-
guage, academic, andsocial performances, emotional impacts, useof coping
andcompensationstrategies, motivation, andfuturegoals.
Self-assessmentscanuse, amongother things, interviewprocedures, check-
lists, anecdotal accounts, or exchangesof lettersor notes. Eachprocedurehas
assets, demands, and limitations that must be discussed before a specic
approachischosencollaboratively. Self-assessmentscanassist inanalyzingand
evaluatingnorm-referencedandethnographicdata, perceptionsandreactions
byself andothers, andidentifyinginstructional difcultiesandneeds. Theycan
helpprofessionals, parents, andstudentsinreframingall input fromtestingto
arriveat anoverall strategyfor educational management intheleast restrictive
environment.
Computer-based assessments and analyses
Advancesinmicrocomputer technologyhavehadadrastic, if localized, inu-
enceoneducational practicesandprograms(Thomas, Sechrest, &Estes, 1994).
Inspeechlanguagepathology, thesetechnologiesareused, for example, for:
(a) client management; (b) spontaneouslanguage-sampleanalysis; (c) scoring
andinterpretingnorm-referencedtest results; (d) assessingaspectsof language;
and (e) providingdirect, interactivelanguageintervention (Long, 1991; Fer-
guson, 1993; Fitch, 1993; Long&Masterson, 1993; Wiig&Wiig, 1993;Tallal et
al., 1996; Semel, Wiig, &Secord, 1998). Therearestill areaswheremicrocom-
puter technologies have not yet been exploited, such as for broad-based,
interactive, or self-administeredlanguageassessments.
Spontaneouslanguagesampleanalysisisacommonlyusedtool for evaluat-
ing early expressivelanguage and story-telling abilities (Miller & Chapman,
1991; Hedberg& Westby, 1993). Recent proceduresanalyzeandratesponta-
neous language samples beyond the early developmental stages (Miller &
Chapman, 1991;Dollaghan, 1992). Therearenowproceduresfor, amongother
things, computerizedanalysisof structural featuresandof frequencyandtypes
of disruptions(e.g., mazes, repetitions) (Dollaghan& Campbell, 1992; Miller
et al., 1992).
Todays microcomputer technologies can provide multi-media presenta-
tions, text-to-speechandspeech-to-text transformations, andinteractivecom-
munication. Students can select a keyboard, mouse, or touch screen for
responding. Wiig, Jones, and Wiig (1996) used some of these features in
computer-based, self-administeredadaptationof theTest of WordKnowledge
(TOWK) (Wiig& Secord, 1992). Correlations between theresults fromthe
computer-administeredversionandastandardoral administrationof TOWK
weremoderatelyhigh. Thissuggestedthat aspectsof languageassessment can
beconductedinsupervisedinteractionbetweenstudentsandmicrocomputers
linkedto amainframe. It cangivestudentsandteachersfreedomto schedule
testingat aconvenient timeandplace, if therequiredtechnologiesareavail-
able. Observational checklistsandcriterion-referencedlanguageprobescanbe
stored in a database within an interactive software system. This can allow
teachers to customizeprobes and teachers and students to enter behavioral
ratings directly. Automatic scoring routines could be developed, and the
learningdifcultiesandneedsof astudent couldbeidentiedbycomputerized
proling. Computer-basedlanguageevaluationswithappropriateadaptations
mayalsoensureequityof accesstoassessment for studentswithhandicapping
conditionsor whorelyoncomputersfor communication.
Illustrative case history
Introduction
Thiscasestudyfocusesonachildwithlanguageandcommunicationdisorders
who received individual language intervention, enhanced by an approach
called conceptual mapping (Wiig & Wilson, 1998, 2000; Wiig & Kusuma-
Powell, 1999). In conceptual mapping, visual diagrams are combined with
cognitivemediationtodevelopcritical thinkingskillsandbuildmental models
for languageandcommunication. Thechild, Jane, wasevaluatedbeforeand
after oneyear of therapy(Wilson& Wiig, 1998). ShewasbornintheUSA as
thesecondchildof ahighlyeducated, bilingual family. EnglishisJanesprimary
language, andshespeaksonlyabasicformof her parents nativelanguage.
Jane was referred for language assessment by a teacher in grade 4. The
teacherreportedthatJanesclassroombehaviorschangeddrasticallyduringthe
academicyear. Shebecamediscouraged, depressed, andseriouslooking, and
hardly looked up fromher materials during instruction. Her behavior was
tenacious, with ahigh degreeof motivation and an overwhelmingdesireto
achieve and please her parents. When asked to do a task, Jane was hyper-
focusedandkept sayingI want to dowell. I havetostayat myschool. The
referral mentionedclassroomdifcultiesinlistening, payingattention, follow-
ing directions, reading comprehension, and staying on task. Her parents
indicatedthat Janecriedeasily, when frustratedor discouraged, anddidnot
expressher feelingsverbally.
Table 8.5. CELF3 and TOWKLevel 2 standard scores and 90% condence intervals (in
parentheses) before and after language intervention
Pre-intervention Post-intervention
CELF3
Total 78(7284) 102*(96108)
Receptive 69(6177) 102*(94110)
Expressive 90(8397) 102(95109)
TOWKLevel 2
Total Score 89(8296) 97(90104)
Receptive 86(7993) 100*(93107)
Expressive 93(86100) 93(8799)
*Indicatesasignicant differenceat the0.05level.
Source: Wilson&Wiig(1998), reprintedwithpermission.
Pre-intervention and post-intervention assessments
Onintake, Jane(aged10years1month) wasevaluatedtodetermine:
Readingachievement (WoodcockJohnson Psycho-Educational Battery: Part
2: Testsof Achievement);
Intellectual ability (Wechsler Intelligence Scale for ChildrenIII and Matrix
AnalogiesTestExpandedForm, MATEF);
Languageand communication (Clinical Evaluation of LanguageFundamen-
tals3, CELF3Observational Rating Scale, and Test of Word Knowledge
Level 2).
Janeobtained aWoodcockJohnson Reading-Cluster Age-Level scoreof 495, a
LetterWordIdenticationscoreof 171, aWordAttackscoreof 163, andaPassage
Comprehension score of 161. The results indicated that Jane read words and
nonsensesyllables and comprehendedparagraphs at levels below averagefor her
age. JanesWISCIII Full ScaleIQ was99, Verbal IQ 110, andPerformanceIQ 87.
Thedifferenceof 23points between Verbal and PerformanceIQ was signicant.
Janestotal MATEF scorewas89.
TheCELF3andTOWKLevel 2compositelanguagescoresareshowninTable
8.5. The CELF3 Receptive Language score falls within the moderate to severe
decit rangebeforeintervention, whiletheExpressiveLanguagescorefallswithin
the average-normal range. The TOWK Total, Receptive and Expressive scores
indicateperformanceswithintheaverage-normal range. Thedifferencebetweenthe
Expressive (10) and Receptive Vocabulary (3) standard score was signicant. A
standard score of 3 on the supplementary subtest, Conjunctions and Transition
Words, indicatedseveredifcultiesinintegratingsemanticsandsyntax. TheCELF3
ORSidentiedconsistent difcultiesintheareasof Listening, Reading, andWriting,
andselecteddifcultiesinSpeaking. Theobservational ratingssupportedtheareasof
difcultyidentiedbynorm-referencedtestsof languageandreading.
After oneyear of intervention, theCELF3, CELF3ORS, andTOWKLevel 2
werereadministered. Thepre-interventionandpost-interventiontestresultsindicate
signicant progressinall areasof language(Table8.5).
Conclusion
Inconclusion, theassessment of languagedisordersinchildrenof school ageis
acomplextask. Itrequiresacliniciantoevaluatewhatthestudentbringstothe
learning context in terms of linguistic and metalinguistic repertories and
strategies. It also requiresassessment of theadequacy of neuropsychological
and neurolinguistic functions that support speed and accuracy of auditory
processing, andlanguagecomprehensionandproductionto differentiatelan-
guage delays and differences from specic language disorders. The clinical
assessmentsmust becomplementedbycontextual, performance-basedevalu-
ations to determine how the characteristics of a specic language disorder
manifest themselvesunder academicandsocial constraintsanddemands. This
chapter discusses formats, assets and limitations of, among others, norm-
referenced and criterion-referenced tests, behaviour ratings of language in
action, and developing structured, multidimensional assessment proles (S-
MAP) of portfoliosamples. Thecasehistorywasintroducedto illustratethat
focused language intervention can result in observable and educationally
signicantchangesinastudentslanguageandcommunication.Thedesignand
implementationof appropriateinterventionsare, after all, theend-goalsfor all
languageassessments.
REFERENCES
Ackerman, P.T., Dykman, R.A., &Gardner, M.Y. (1990). Countingrate, namingrate, phonologi-
cal sensitivity, andmemoryspan: major factorsindyslexia. Journal of LearningDisabilities, 23,
3257.
Bashir, A.S. & Scavuzzo, A. (1992). Children with learning disabilities: natural history and
academicsuccess. Journal of LearningDisabilities, 25, 5365.
Bashir, A.S., Wiig, E.H., & Abrams, J.C. (1987). Languagedisordersin childhoodand adoles-
cence: implicationsfor learningandsocialization. PediatricAnnals, 16, 14558.
Benes, F. (1997). Corticolimbic circuitry and the development of psychopathology during
childhoodandadolescence. InDevelopment of thePrefrontal Cortex: Evolution, Neurobiology, and
Behavior, ed. N.A. Krasnegor, G. ReidLyon, & P.S. Goldman-Rakic, pp. 21139. Baltimore,
Benton, A.L. & Hamsher, K. (1977). Multilingual AphasiaExamination. IowaCity: Universityof
Iowa.
Biklen, D. (1992). SchoolingWithout Labels: Parents, Educators, andInclusiveEducation. Philadel-
phia, PA: TempleUniversityPress.
Bryant,B.R.(1992).Creatinglocal orspecial normsfornorm-referencedtests.LDForum,17,224.
Capute, A.J., Accardo, P.J., & Shapiro, B.K. (eds.) (1994). LearningDisabilitiesSpectrum: ADD,
ADHD, & LD. Timonium, MD: YorkPress.
Carrow-Woolfolk,E. (1999). TestofAuditoryComprehensionofLanguage, ThirdEdition. Austin, TX:
Pro-Ed.
Chin, G.J. &Marx, J. (eds.) (1997). Cognitiveneuroscience. Science, 275, 1579610.
Damico, J.S. (1992). Descriptive/ nonstandardized assessment in the schools. Best Practices in
School SpeechLanguagePathology, Vol. 2. SanAntonio, TX: ThePsychological Corporation.
Damico, J.S. (1993). Languageassessment in adolescents: addressingcritical issues. Language,
Speech, andHearingServicesinSchools, 24, 2935.
Denckla, M.B. & Rudel, R.G. (1976). Rapidautomatized naming(R.A.N.): dyslexiadifferenti-
atedfromother learningdisabilities. Neuropsychologia, 14, 471.
Dollaghan, C.A. (ed.) (1992). Analyzingspontaneous language: new methods, measures, and
meanings. TopicsinLanguageDisorders, 12(2).
Dollaghan, C.A. &Campbell, T.F. (1992). Aprocedurefor classifyingdisruptionsinspontaneous
languagesamples. InAnalyzingspontaneouslanguage: newmethods, measures, andmean-
ings, ed. C.A. Dollaghan. TopicsinLanguageDisorders, 12(2), 5668.
Dunn, L.M. &Dunn, L. (1997). PeabodyPictureVocabularyTest, ThirdEdition. CirclePines, MN:
AmericanGuidanceServices.
Elliot, C.D. (1990). Differential AbilityScales. SanAntonio, TX: ThePsychological Corporation.
Ellis Weismer, S. (1992). Hypothesis-testingabilitiesof languageimpairedchildren. Journal of
SpeechandHearingResearch, 34, 132938.
Ferguson, M.L. (1993). Computer technology: useinpublicschools. AmericanSpeechLanguage
HearingAssociation, 35(9), 467.
Feuerstein, R., Rand, V., Hoffman, M., & Miller, R. (1980). Instrumental Enrichment: AnInterven-
tionProgramfor CognitiveModiability. Baltimore, MD: UniversityParkPress.
Fitch, J.L. (ed.) (1993). Computer technology. American SpeechLanguageHearingAssociation,
35(9), 3551.
Gardner, H. (1991). TheUnschooledMind: HowChildrenThinkandHowSchoolsShouldTeach. New
York: BasicBooks.
Gerber, A. (1993). Language-relatedLearningDisabilities: Their NatureandTreatment. Baltimore,
MD: Paul H. Brooks.
Gerber, P.J., Schneiders, C.A., Paradise, L.V., Reiff, H.B., Ginsberg, R.J., & Popp, P.A. (1990).
Persistingproblemsof adultswithlearningdisabilities: self-reportedcomparisonsfromtheir
school-ageandadult years. Journal of LearningDisabilities, 23, 5703.
German, D.J. (1991). Test of WordFindinginDiscourse. Austin, TX: Pro-Ed.
Goldman, R. & Fristoe, M. (1986). GoldmanFristoe Test of Articulation. Circle Pines, MN:
Goodglass, H. & Wingeld, A. (1997). Anomia: Neuroanatomical and CognitiveCorrelates. San
Diego, CA: AcademicPress.
Hammill, D.D., Brown, V.L., Larsen, S.C., &Wiederholt, J.L. (1994). Test of AdolescentandAdult
Language, 3rdedition. Austin, TX: Pro-Ed.
Hammill, D.D., & Bryant, B.R. (1998). LearningDisabilities Diagnostic Inventory. Austin, TX:
Pro-Ed.
Hammill,D.D. &Newcomer, P.L. (1997). TestofLanguageDevelopmentIntermediate, 3rdedition.
Austin, TX: Pro-Ed.
Hedberg, N.L. &Westby, C.E. (1993). AnalyzingStorytellingSkills. SanAntonio, TX: Communi-
cationSkillsBuilders.
Hodson, B.W. (1986). The Assessment of Phonological Processes, revised edition. Danville, IL:
InterstatePrintersandPublishers.
Hresko,W.P.,Reid, K., &Hammill,D.D. (1999). TestofEarlyLanguageDevelopment, ThirdEdition.
Austin, TX: Pro-Ed.
Hutchinson, T.A. (1996). What tolookfor inthetechnical manual: twentyquestionsfor users.
Language, Speech, andHearingServicesinSchools, 27, 10921.
IDEAAmendmentstoPublicLaw105-17. (1997). Washington, DC: USCongress.
Kamhi, A. & Catts, H. (1988). ReadingDisabilities: ADevelopmental LanguagePerspective. Austin,
TX: Pro-Ed.
Korhonen,T.T. (1991). Neuropsychological stabilityandprognosisof subgroupsof childrenwith
learningdisabilities. Journal of LearningDisabilities, 24, 4857.
Korhonen, T.T. (1995). The persistence of rapid naming problems in children with reading
disabilities: anine-year follow-up. Journal of LearningDisabilities, 28(4), 2329.
Krasnegor, N.A., ReidLyon, G., &Goldman-Rakic, P.S. (eds.)(1997). DevelopmentofthePrefrontal
Cortex: Evolution, Neurobiology, andBehavior. Baltimore, MD: Paul H. Brookes.
Kratwohl, D.R., Bloom, B.S., & Masai, B.B. (1964). Taxonomy of Educational Objectives: The
Classicationof Educational Goals. HandbookII: AffectiveDomain. NewYork: DavidMcKay.
Lakoff, G. (1987). Women, Fire, andDangerousThings. Chicago, IL: Universityof ChicagoPress.
Lapadat, J. (1991). Pragmaticlanguageskillsof studentswithlanguageand/ or learningdisabili-
ties: aquantitativesynthesis. Journal of LearningDisabilities, 24, 14758.
Leonard, C.M., Lombardino, L.J., Mercado, L.R., Browd, S.R., Breier, J.I., &Agee, O.F. (1996).
Cerebral asymmetryandcognitivedevelopment inchildren: amagneticresonanceimaging
study. Psychological Science, 7, 8994.
Leonard, P. (1997). Languageandtheprefrontal cortex. In Development of thePrefrontal Cortex:
Evolution, Neurobiology, andBehavior, ed. N.A. Krasnegor, G. Reid Lyon, & P.S. Goldman-
Rakic, pp. 14166. Baltimore, MD: Paul H. Brookes.
Long, S. (1991). Integratingcomputer applicationsintospeechandlanguageassessments. Topics
inLanguageDisorders, 11, 117.
Long, S. & Masterson, J.J. (1993). Computer technology: use in language analysis. American
SpeechLanguageHearingAssociation, 35(9), 407.
McCauley, R.J. (1996). Familiar strangers: criterion-referenced measures in communication
disorders. Language, Speech, andHearingServicesinSchools, 27, 12231.
Meltzer, L.J. (ed.)(1993). StrategyAssessmentandInterventionforStudentswithLearningDisabilities.
Austin, TX: Pro-Ed.
Miller, J. &Chapman, R. (1991). SALT: SystematicAnalysisof LanguageTranscripts. Madison, WI:
Universityof WisconsinPress.
Miller, J.F., Freiberg, C., Rolland, M., & Reeves, M.A. (1992). Implementing computerized
languagesampleanalysisinthepublicschool. TopicsinLanguageDisorders, 12(2), 6982.
Nelson, N.W. (1992). Targetsof curriculum-basedlanguageassessment. Best PracticesinSchool
SpeechLanguagePathology, 2, 7386.
Nelson, N.W. (1993). ChildhoodLanguageDisordersinContext: InfancythroughAdolescence. Boston,
MA: Allyn&Bacon.
Newcomer, P.L. & Hammill, D.D. (1997). Test of LanguageDevelopment Primary, 3rdedition.
Austin, TX: Pro-Ed.
Nippold, M. (1993). Developmental markers in adolescent language: syntax, semantics, and
pragmatics. Language, Speech, andHearingServicesinSchools, 24, 218.
Ohio Department of Education (1991). Ohio Handbook for the Identication, Evaluation,
and Placement of Children with Language Problems. Columbus, OH: Ohio Department of
Education.
Ojemann, G.A. (1983). The intrahemispheric organization of human language derived from
electrical stimulationtechniques. TINS, 1849.
Owens, R. (1995). LanguageDisorders: A Functional ApproachtoAssessment andIntervention, 2nd
edition. Boston, MA: Allyn&Bacon.
Piaget, J. &Inhelder, B. (1969). ThePsychologyof theChild. NewYork: BasicBooks.
Pinsach, J.R. (1992). DisenodeTests. Barcelona, Spain: IdeaInvestigacionyDesarrollo, S.A.
Ratner, V. & Harris, L. (1994). UnderstandingLanguageDisorders: TheImpact on Learning. Eau
Claire, WI: ThinkingPublications.
ReidLyon, G. &Rumsey, J.M. (eds.) (1996). Neuroimaging. Baltimore, MD: Paul H. Brookes.
Reif, L. (1990). Findingthevaluein evaluation: self assessment in amiddleschool classroom.
Educational Leadership, 47, 2.
Roffman, A.J., Herzog, J.E., &Wershba-Gershon, P.M. (1994). Helpingyoungadultsunderstand
their learningdisabilities. Journal of LearningDisabilities, 27, 41319.
Rourke, B.P. (1989). Nonverbal LearningDisabilities: TheSyndromeand theModels. New York:
GuilfordPress.
Sabers, D.L. (1996). Bytheir testswewill knowthem. Language, Speech, andHearingServicesin
Schools, 27, 1028.
Sabers, D., Hutchinson, T., & Mobley, M. (1992). User Norms Software. Chicago, IL: Applied
Symbolix.
Sanclemente, M.P., Wiig, E.H., Pinsach, J.R., &Perez, A.S. (1998). BateriadeLenguajeObjectivay
Criterial. Barcelona, Spain: Masson.
Secord,W.A., Wiig, E.H., &Damico,J.S. (1994a). ClassroomCommunicationAssessment:Evaluating
PerformanceinContext. Chicago, IL: AppliedSymbolix.
Secord, W.A., Wiig, E.H., Damico, J.S., & Goodin, G.L. (1994b). ClassroomCommunicationand
LanguageAssessment. Chicago, IL: AppliedSymbolix.
Semel, E.M., Wiig, E.H., &Secord, W.A. (1995). Clinical Evaluationof LanguageFundamentals3.
SanAntonio, TX: ThePsychological Corporation.
Semel, E.M., Wiig, E.H., & Secord, W.A. (1996). CELF3: Observational Rating Scales. San
Antonio, TX: ThePsychological Corporation.
Semel, E., Wiig, E.H., & Secord, W.A. (1997). Clinical Evaluation of LanguageFundamentals
Spanish. SanAntonio, TX: ThePsychological Corporation.
Semel, E.M., Wiig, E.H., &Secord, W.A. (1998). Clinical Evaluationof LanguageFundamentals 3.
ScoringAssistant. SanAntonio, TX: ThePsychological Corporation.
Shames, G.H., Wiig, E.H., & Secord, W.A. (1998). HumanCommunicationDisorders, 5thedition.
Boston, MA: Allyn&Bacon.
Shankweiler, D., Crain, S., Katz, L. et al. (1995). Cognitiveprolesof reading-disabledchildren:
comparisonof languageskillsinphonology, morphology, andsyntax. Psychological Science, 6,
14956.
Starlin, C. & Starlin, A. (1973). Guides for Continuous Decision Making. Bemidgi, MN: Unique
CurriculumUnlimited.
Stone, C.A. & Forman, E.A. (1988). Differential patterns of approach to a complex problem
solvingtaskamonglearningdisabledstudents. Journal of Special Education, 22, 16785.
Stroop, J.R. (1935). Studiesof interferenceinserial verbal reactions. Psychological Monographs, 50,
3848.
Stuss, D.T. &Benson, D.F. (1984). Neuropsychological studiesof thefrontal lobes. Psychological
Bulletin, 95, 328.
Tallal, P. (1983). A precisetimingmechanismmay underlieacommonspeechperceptionand
production areain theperi-Sylvian cortexof thedominant hemisphere. TheBehavioral and
BrainSciences, 6, 21920.
Tallal, P., Miller, S.L., Bedi, G. et al. (1996). Language comprehension in language-learning
impairedchildrenimprovedwithacousticallymodiedspeech. Science, 271, 814.
Thomas, M., Sechrest, T., &Estes, N. (eds.) (1994). Decidingour Future: technological impera-
tivesfor education,Vol. 2. Proceedingsof the11thInternational ConferenceonTechnologyin
Education, London.
Torgesen, J.K., Wagner, R.K., Simmons, K., & Laughon, P. (1990). Identifying phonological
codingproblemsindisabledreaders: naming, counting, or spanmeasures?LearningDisability
Quarterly, 13, 23643.
Vygotsky, L.S. (1962). Thought andLanguage. Cambridge, MA: MIT Press.
Wansart, W.L. (1990). Learningtosolveaproblem: amicroanalysisof thesolutionstrategiesof
childrenwithlearningdisabilities. Journal of LearningDisabilities, 23, 16470.
Warkentin, S., Risberg, J., Nilsson, A., Karlson, S., & Graae, E. (1991). Cortical activityduring
speechproduction: astudyof regional cerebral bloodowin normal subjectsperforminga
word uency task. In Brain Dysfunction in Psychosis, ed. S. Warkentin, pp. 1139. Lund,
Sweden: Departments of Psychiatry and Psychogeriatrics, University Hospital and Depart-
ment of Psychology, Universityof Lund.
Wechsler, D. (1974). Wechsler Intelligence Scale for ChildrenRevised. San Antonio, TX: The
Wechsler, D. (1989a). Wechsler IntelligenceScalefor ChildrenThirdEdition. SanAntonio, TX: The
Wechsler,D. (1989b). WechslerPreschool andPrimaryScaleofIntelligenceRevised. SanAntonio, TX:
Westby, C. &Erickson, J. (eds.) (1992). Changingparadigmsinlanguage-learningdisabilities:the
roleof ethnography. TopicsinLanguageDisorders, 12(3), 187.
Wickelgren, I. (1997). Gettingagrasponworkingmemory. Science, 275, 155802.
Wiig, E.H. (1990). WiigCriterionReferencedInventoryof Language. SanAntonio, TX: ThePsycho-
logical Corporation.
Wiig, E.H. (1994). AMulti-dimensional Assessment Model. WorkingPaper. Arlington, TX: Know-
ledgeResearchInstitute.
Wiig, E.H., Freedman, E., & Secord, W.A. (1992a). Developing words and concepts in the
classroom: aholisticthematicapproach. InterventioninSchool andClinic, 27, 27885.
Wiig, E.H., Jones, S.S., &Wiig, E.D. (1996). Computer-basedassessment of wordknowledgein
teenswithLD. Language, SpeechandHearingServicesinSchools, 27, 217.
Wiig, E.H. &Kusuma-Powell,O. (1999). Visual ToolsforCritical ThinkinginClassrooms. (Prepubli-
cationversion.) Arlington, TX: SchemaPress.
Wiig, E.H. &Secord, W.A. (1989). Test of LanguageCompetenceExpanded. SanAntonio, TX: The
Wiig, E.H. & Secord, W.A. (1991). Measurement and Assessment: A Marriage Worth Saving.
Wiig, E.H. &Secord, W.A. (1992). Test of WordKnowledge. SanAntonio, TX: ThePsychological
Corporation.
Wiig, E.H. & Secord, W.A. (1999). DiagnosticSpeechandLanguageProler. Experimental Edition.
Arlington, TX: SchemaPress.
Wiig, E.H., Secord, W.A., & Hutchinson, T. (1997). Diagnostic Speech and LanguageProler,
Experimental Edition. Chicago, IL: AppliedSymbolix.
Wiig, E.H., Secord, W.A., & Semel, E. (1992b). Clinical Evaluation of LanguageFundamentals
Preschool. SanAntonio, TX: ThePsychological Corporation.
Wiig, E.H. &Wiig, E.D. (1993). Test of WordKnowledgeComputer-based: Experimental. Arlington,
TX: SchemaPress.
Wiig, E.H. & Wilson, C.C. (1994). Is aquestion aquestion?Differential patternsin question
answering by students with LLD. Language, Speech, and Hearing Services in Schools, 25,
2509.
Wiig, E.H. & Wilson, C.C. (1998). Visual Toolsfor LanguageandCommunication. Chicago, IL:
AppliedSymbolix.
Wiig, E.H. &Wilson, C.C. (1999). LadderstoInterpretation: AssessingandDevelopingText Compre-
hension. Arlington, TX: SchemaPress.
Wiig, E.H. & Wilson, C.C. (2000). Map it Out! Visual Tools for Thinking, Organizing and
Communicating. EauClaire, WI: ThinkingPublications.
Wiig, E.H., Zureich, P., & Chan, H-N.H. (2000). A clinical rationale for assessing rapid,
automaticnamingin childrenwith languagedisorders. Journal of LearningDisabilities, 33(4),
35974.
Will, M. (1986). Educatingstudentswithlearningdisabilities: asharedresponsibility. Exceptional
Children, 52, 41115.
Wilson, C.C. &Wiig, E.H. (1998). LanguageInterventionwithConceptual Mapping: AOne-yearCase
Study. WorkingPaper. Arlington, TX: KnowledgeResearchInstitute.
Wilson, R. (1980). Test ServiceNotebook 37: Criterion-referencedTesting. San Antonio, TX: The
Wolf, M. (1986). Rapidalternatingstimulusnamingin thedevelopmental dyslexias. Brainand
Language, 27, 36079.
Wolf, M. (1991). Namingspeedandreading: thecontribution of thecognitiveneurosciences.
ReadingResearchQuarterly, 26, 12341.
Wolf, M., Bowers, P.G., & Biddle, K. (2000). Naming-speedprocesses, timing, andreading: a
conceptual review. Journal of LearningDisabilities, 33(4), 387407.
Zimmerman, I.L., Steiner, V.G., &Pond, R.E. (1992). Preschool LanguageScale. SanAntonio, TX:
MMMM
Part III
Neuropsychological Approaches to
Learning Disabilities Assessment
and Remediation
MMMM
9
Learning disabilities and their
neurological foundations, theories, and
subtypes
Otfried Spreen
Thischapter dealswithtwoseparate, but linked, linesof research. First, isthe
historicrelationshipbetweenneuropsychologyandlearningdisability(LD):the
accumulating evidence of neurological impairment is reviewed, as well as
theoriesabouttheroleof neurological decit. Second, thequestionof subtypes
of LD is discussed. Surprisingly, subtype research has, for the most part,
proceededinisolationfromthesearchfor aneurological substrateof LD. An
attemptismadetoshowthataconvergenceof thesetwotypesof researchmay
contributegreatlytoour knowledgeof theeld.
TherelationshipbetweenneuropsychologyandLDisbuilt intomost deni-
tions. For example, the National Joint Committee on Learning Disabilities
(1998) describes LD as a heterogeneous group of disorders manifested by
signicant difcultiesintheacquisitionanduseof listening, speaking, reading,
writing, reasoning, or mathematical skills. . . Thesedisordersareintrinsicto
theindividual, presumedtobeduetocentral nervoussystemdysfunction.
Thestressisonpresumed. Incontrast, detaileddescriptions, assessments,
andoftenalso treatment protocolshavebeendevelopedfor manychildhood
disordersof neurological origin, butLDarestill basedonapresumedneurologi-
cal origin the same is true for pervasive developmental disorders and
attentiondecit hyperactivitydisorder (ADHD).
AsBenton(1982) wroteinareviewof childneuropsychology18yearsago:
Muchof theresearchandclinical andeducational servicethatwecategorizeas
neuropsychological is, in fact, purely behavioural in nature . . . It is neuro-
psychological onlybecauseof myassumption, whichisderivedfromobserva-
tionsof adult patientswithdemonstrablebraindisease. Oscar Parsons(1977)
put it evenstronger, bycallingthesearchfor braincorrelatesof psychological
impairment without independent physiological or anatomical conrmation
thenewphrenology. Thequestionremains: havewelearnedmoreabout this
relationshipor doesitstill remainanassumption?Also, whatcontributiondoes
283
concept
center
acoustic nerve motor centers for
speaking and writing
opqpr = optic-motoric pathways for written language
qpr = pathways for writing down thoughts
optic nerve
sensory center for
melodic attributes
sensory center for
visual word images
sensory center for
word (acoustic) images
B b
a
C d
C' r
o
p B'
u
B'
c
x
q
z
J
x'
Fig. 9.1. Kussmaulsmodel of SpokenandWrittenLanguage(1877).
theknowledgeof aneurological connection maketo thetreatment of the
individual dyslexic?
History
Even before the description of the rst cases of acquired dyslexia, Adolf
Kussmaul in Heidelberg (1877) provided an outline of the brain processes
involved in reading (Fig. 9.1). In the tradition of the diagram makers, he
describedtheconnectionbetweentheopticnerveandthesensorycenter for
visual word images connectingto asensory center for melodic attributes,
leadingto thecrucial concept center, perhaps not too different fromWer-
nickesarea. Heproposedfurther connectionsto theopticmotoricpathway
for writtenlanguage andapathwayfor writingdownthoughts. Theconcept
center wasalso connectedto thesensorycenter for word(acoustic) images,
andtotheacousticnerve.
In1892, Dejerine, usingtheclassical connectionistmodel, conrmedthatthe
lesionforacquiredword-blindnesswasprobablylocatedintheleftangulargyrus
areaandextendedtotheoccipital hornof thelateral ventricle.
Thehistoryof therelationshipbetweenneuropsychologyanddevelopmental
dyslexiastartsin1896, whenPringleMorgan, ageneral practitioner inSeaford,
England, presented a rst case of congenital word-blindness in the British
284 Otfried Spreen
Medical Journal. Theyearbefore, JamesHinshelwoodinScotlandhadpublished
acaseof acquiredword-blindness after injurytotheangular gyrus.
Hinshelwood, an ophthalmological surgeon in Glasgow, respondedin the
samejournal and accepted Morganssuggestion of acongenital formof the
disorder. He and other physicians in Europe and North America followed
quicklywithreportsof 14casesof their own, sothat Hinshelwood, inhis1917
monographentitledCongenital WordBlindness, wasabletopresenttheaccumu-
latedevidenceof awell-establisheddisorder. ButHinshelwoodwarnedthatthe
termshouldbereservedfor casesthat weremarkedby(a) thegravityof the
defect, and (b) thepurity of symptoms, that is, that they should resemble
closelythecasesof acquiredword-blindnesswithlesionsintheangular gyrus
area. Cases where children simply lag somewhat behind their fellows in
acquiringthevisual memoriesof lettersor words shouldnot bedescribedby
thisterm.
Thediscoveryof dyslexiaasaspecial conditionwithneurological causesset
thedirectionfor most subsequent research. Inthe1930s, Samuel Orton(1928,
1937), aneurologist, usedthetermstrephosymbolia aswell asdevelopmental
alexia, andaddedanother signicant dimension, namelylateralization, tothe
presumed substrate: his language areas involved in reading are not too
different from those hypothesized by Kussmaul. His diagram includes the
angular gyrus, WernickesandBrocasarea, andpartsof themotor strip(Fig.
9.2). But Orton also didaway with Hinshelwoodsstringent denition: Our
experienceinstudyingandretrainingseveral hundredsuchcaseshasconvinced
usthat theyformagradedseriesincludingall degreesof severityof thehandicap.
Ortonacceptedthenotionof theoriginof dyslexiaintheangular gyrusregion,
but stressedthat it maynot originatefromaspecicallydeviant development
of that region, but fromadeviation in theprocess of establishingunilateral
brainsuperiorityinindividual areaswhiletakingintoaccount hereditaryfacts.
Hefurther wrotethat suchdisordersshouldrespondtospecictrainingif we
becomesufciently keen in our diagnosis, and if weproveourselves clever
enoughtodeviseproper trainingmethodstomeet theneedfor eachparticular
case.
Thisisasurprisinglymodernstatement, inviewof thecurrent researchon
subtypesandtrainingmethods. Ortonalsosuggestedwhat couldbecalledthe
rstattempt atsubtypingLD: hedescribeddevelopmental alexia, developmen-
tal agraphia, developmental word-deafness, developmental apraxia(abnormal
clumsiness), andcombinedmixedsyndromes.
Incidentally, dyscalculia, the other major formof LD, has a similar early
history, but wasnot describedinfurther detail until muchlater.
285 Learning disabilities: neurological foundations, theories, and subtypes
Left
Hemisphere
Right
Hemisphere
1
2
3
4
Fig. 9.2. Amapof theouter surfacesof theleft andright hemispheresof ahumanbrain, showing
thecritical languageareas. Thisdiagramshowstheconditionsastheyexist inaright-handed
individual, withthecritical areasfor languageintheleft hemisphereonly.
Ortonstheoryremainedatheoryuntil, in1947, StraussandLehtinencalled
attentiontothefrequent appearanceof neurological signsinlearning-disabled
children. Much hasbeen written about thepresenceof neurological signsin
learning-disabledpopulations, particularlyabout theso-calledsoft, pastel, or
non-focal signs, i. e., signswith dubiousor nonfocal signicance. Studiesof
suchsignshavebeenavailablesincethe1950s. Anincreasedincidenceof soft
neurological signsinlearning-disabledchildrenwasreportedbyHertzig(1983)
andinsixother studiesinthe1970sand1980s. Onecriticismisthat thesesigns
are developmental, and therefore disappear with time. The Victoria study
with 203 learning-disabled children (Spreen, 1988), however, compared the
occurrenceof eachsignat ages8to12yearsandinafollow-upat age25: they
didnot disappear withtime, but tendedtopersist or evenincreaseinnumber.
Theother problemwithsuchsignsisthat theyrarelypointtospeciclocations
inthecortex. For thisreason, theyhavelimiteduseinpursuingtherelationship
between LD and neurological abnormalities. In an attempt to relatespecic
signstotheoutcomeof LDinyoungadulthood, onlyageneral factor of motor
integrity wasfound, which hadadirect bearingon outcome(Spreen, 1989a,
1989b). After acritical evaluation of themany contradictory ndings in the
literature, Rie (1987) concluded that the child who fails in school, who is
otherwisepsychologicallyhealthy, andwhomanifestsoneormoreof themore
complexsoftsignsishighlylikelytosufferfromalearningdisability. However,
soft neurological signs have also been found in children with hyperactivity,
autism, affectivedisorders, andschizophrenia. It issuggestedthat thesesigns
may be explored as expressions of central nervous systemabnormality, of
subtlemalfunction, maldevelopment, or malformation, whichmayor maynot
contributetoLD.
Aninterestingparallel to Hertzigsndingsistheobservationby Waldrop
286 Otfried Spreen
andcollaboratorsabout minor physical anomalies(Waldrop, Pedersen, &Bell,
1968; Waldrop, Bell, & Goering, 1976) in LD. Single anomalies without
physical or cosmeticsignicance, likeattachedear lobes, singlepalmar crease,
andfurrowedtongue, arenot uncommoninachildpopulation, but Waldrop
found that multiplephysical anomalies are more common in children with
psychiatric or academic difculties, and arecent study reported ahigh inci-
denceinautism. Infact, twostudies(Willems,Noel, &Evrard, 1972;Paulson&
ODonnell, 1980)reportedanincreasednumberof minor physical anomaliesin
childrenwithsoft neurological signs, andonestudyrelatedtheseanomaliesto
atypical cerebral lateralization(Yeoet al., 1997). Again, theseabnormalitiesare
nonfocal; they are also not specic to dyslexia they have been found in
schizophrenics, but not in their siblingsor in bipolar disorders(Green et al.,
1994a; Green, Satz, &Christenson, 1994b).
Sincethelate1960s, new and morespecic evidencefor therelationship
betweendyslexiaandneurological impairment hasbeenpresentedinmacro-
scopic studies. Therst evidencecamefromtheautopsy study of adyslexic
child by Drake in 1968, and later fromve further autopsies published by
Galaburdaand Kemper (1978), and Humphreys, Kaufmann, and Galaburda
(1990). Theautopsy studies showed microdysgenesis with ectopias and dys-
plasias bilaterally along the Sylvian ssure frontally and along the planum
temporale, in the left more than in the right hemisphere. Whereas normal
brains show only one or two ectopias, the dyslexics brains had 30 to 100
ectopias(nestsof neuronsinlayer 1). Theoccurrenceof ectopiasisassumedto
beduetoincreasedsurvival of neuronsduringcorticogenesisat mid-gestation.
Thesestudiesaddarst pieceof real evidenceof neurological abnormalities.
Sincethelate1970s, furtherevidenceof anumberof structural abnormalities
fromcomputerizedtomography(CT) andmagneticresonanceimaging(MRI)
hasbecomeavailable.
Asymmetry of lobes and ventricles
TherstCT studybyHier andcollaboratorsin1978showedabnormal reversal
of thetypical normal posterior leftwardasymmetry(Fig. 9.3), althoughalater
CT studybyDenckla, LeMay, andChapman(1985)foundsuchasymmetriesin
onlyasmall number of dyslexics. Alater studybyLarsenet al. (1990) founda
higher proportion of symmetrical plana. Theresults of ten other studiesare
contradictory in part. Adjustmentsfor ageand gender arenecessary in such
studies. Schultz and collaborators (1994) found no difference between 17
dyslexicsand14nonimpairedchildreninavarietyof areas, especiallyinsurface
areasandintheplanumtemporale, andreportedthat apparent differencesin
Fig. 9.3. Normal asymmetry of the human brain. Note the increased size of the planum
temporaleandof Heschlsgyrusontheleft, andof thefrontal areaontheright side.
thesizeof theleft hemispherestructuresandsymmetry of theplanumtem-
poralebetweendyslexicsandcontrolswerenotreliableaftercontrollingfor age
andoverall brainsize. Both Beaton(1997) andMorganandHynd(1998; see
alsoClintonet al., 1998), inrecent reviews, notethat symmetryor abnormal
asymmetryof theplanahasnot beenconsistentlyfoundindyslexics, that they
arenot sufcient to producedyslexia, and that such ndingshavealso been
reportedinchildrenwithspeciclanguageimpairment, not just dyslexia.
Corpus callosum
Rumseyandcollaborators(1996) andDuaraet al. (1991) foundenlargement of
theareaof theisthmusandthespleniumof thecorpuscallosumin 21adult
dyslexics. They suggested that this could beinterpreted as asign of greater
numberof crossingbers, thickerbers, densermyelination,or greaterpacking
density. This, inturn, couldleadto increasedcommunicationbetweenhemi-
spheres, resultingindecreasedlateralizationof languageorincreasedinhibition
of onehemispherebytheother. Temple, Reeves, andVillaroya(1990) related
dysgenesisof thecorpuscallosumtothephonological aspectsof dyslexia. Ina
Dutch study, Njiokiktjien (1993; Njiokiktjien & deSonneville, 1994) focused
onlyononetypeof dyslexia, thedysphasicdyslexicsyndrome. Theylooked
at themid-callosal size in 110children, and found the size to benormal in
dyslexic/ dysphasic children without a family history of such disorders, but
thicker inchildrenwithfamilial dysphasia/ dyslexia. Other ndingshavebeen
contradictory, whichmaybeexplainedbytheconfoundingfactor of age: the
corpuscallosumhasbeenshownto showlinear androbust growthbetween
theagesof 4and18in 114normal subjects, specically in theposterior and
mid-regions(Gieddet al., 1996). Inarecent review, Beaton(1997) concluded
thatit isclearlytooearlytodrawrmconclusionsregardingcallosal morphol-
ogyindyslexia (p. 304).
288 Otfried Spreen
Reviewing the evidence from all CT studies, Rumsey (1996) concluded
cautiouslythat thestudiesso far showthat subtledevelopmental anomalies
mayconstitutethesubstrateof dyslexia, butthattheyarenotstrictlylocalized
toanysmall portionof thecortex. Rather, cortical anomaliesmaybevariably
distributed, and additional subcortical structures (e.g., thalamus) may be af-
fected (p. 73).
Functional abnormalities
Most recently, studies have looked at the functional rather than structural
abnormalities in children with learningdisabilities. Positron emission tomo-
graphy (PET), single-photon emission tomography (SPECT), and functional
MRI (fMRI) measurelocal changesinhemodynamicresponsesthat arecorre-
latedwithchangesinneuronal activity. fMRI hasbeenmostpromisingbecause
it is noninvasive and can therefore be used in larger numbers of subjects.
Investigatorsgenerallymeasurechangesinbloodowandbloodoxygenation
inoneexperimental conditionrelativetoanothercondition. Unfortunately, the
ndingsarenot asclear asonewouldhope, becausemost studiesuseveryfew
subjects,andthesesubjectsshowalotofbehavioral heterogeneity,andbecause
comorbidity, especiallywithgeneral LDandlowIQ, andwithADHD, ishigh.
Asmight beexpected, thetypeof taskselectedasareadingtest alsoplaysan
importantrole, e.g., whether thechildor adultreadsaloudor silently, readsfor
meaning, for phonology, or for orthography, whether accuracy or rate of
readingisstressed: theactivatedregions, therefore, areparticipatingbut not
necessarilycritical for reading.
Asanexample, Fig. 9.4(Rumsey, 1996) showsresultsduringrhymedetec-
tionfor wordsandfor atonal memorytaskinthelower panels. It alsoshows
that rhymedetectionregistersmainlyintheleft hemisphere, andtonal mem-
oryintheright. Indyslexics, ontheright panels, bothtasksshowunderactiva-
tionof several areas.
With the advent of these techniques in the 1990s, a host of new studies
concentratedonthequestionof what areasareinvolvedinreadingandwhat
areasareimpairedindyslexia.Rumsey(1996)reviewed13anatomical andeight
functional neuroimagingstudiesondevelopmental dyslexia. Twelveadditional
studieshaveappearedsince.
Notsurprisingly,aconsiderablenumberofareasofthebrainshowactivation
duringnormal reading: theleft temporo-parietal regionisprimarilyinvolvedin
phonological processing(Table9.1). Phonological processingwasalsorelated
toleftinferior frontal andtemporal sites. Lexicalsemanticprocessingactivated
middleandsuperiortemporal areas, whereasorthographicprocessingactivated
A
B
C
D
E
A
B
C
D
E
Posterior
Frontal
Anterior
Frontal
Middle
Temporal
A
B
C
D
E
A
B
C
D
E
Posterior
Frontal
Anterior
Frontal
Middle
Temporal
Anterior
Temporal Temporal
Posterior
Temporal
Right
Tonal
Memory
A
B
C
D
E
A
Plane
Level
B
C
D
E
Posterior
Frontal
Parietal
Middle
Temporal
Rolandic
A
B
C
D
E
A
Plane
Level
B
C
D
E
Posterior
Frontal
Parietal
Middle
Temporal
Rolandic
Left and Medial
Auditory Rhyme
Detection
Control Task Rest
Differences Between
Dyslexics and Controls
Fig. 9.4. Activationpatternsanddifferencesbetweendyslexicmenandcontrol associatedwith
auditory rhyme detection and tonal memory tasks. Black and grey areas indicate activation;
stippledareasindicateunderactivation. Dyslexicmenfailedtoactivatetheleft temporoparietal
cortex during rhyme detection and activated fewer right frontotemporal areas during tonal
memorytasks. (ReproducedwithpermissionfromRumsey, 1996.)
theleft extrastriateareaandtheperi-insular cortexbilaterally. Inaddition, the
occipital extrastriatecortexwasfoundtobeinvolvedintheprocessingof visual
word forms. However, conclusions and results fromthese studies differ to
someextent. Although Shaywitz andtheHaskinsgroupconrmedtheloca-
tionsfor phonologic andorthographic processing, they found confusingevi-
dence for semantic processing locations, whereas the National Institute of
Health (NIH) group conrmed thetemporal location. Whereas theHaskins
groupstressedphonological andsimultaneousprocessingasthecorecompo-
nentof reading, theNIHgroup(Rumseyetal., 1997a, 1997b)offersamultifocal
serial processingmodel andascribesthesometimesconictingresults to the
heterogeneity in the neuropsychological decits associated with dyslexia.
Activation is primarily on the left side in men, but bilateral in women.
Bookheimer andLapretto(1996) point out that theparticipationof thefrontal
areas is primarily dependent on task demands, i.e., oral word generation
290 Otfried Spreen
Table 9.1. Component processes of reading and corresponding brain areas
Typeof processing Brainareasinvolved
Phonological processing
Non-wordrhymejudgment
Inferiorfrontal (Brodman44/ 45, Shaywitz,
Pugh, Liberman); left inmen, bilateral in
women
Pseudowordpronunciation
Sensitivitytostimulus-lengtheffects
Picturenaming, especiallywithpolysyllabic
or low-frequencywords
Superior temporalparietal (Petersen,
Borkheimer), angularsupramarginal, planum
temporale(Rumsey)
Lexicalsemanticprocessing(meaning) Middle/ superior temporal (ShaywitzPugh)
Semanticcategoryjudgment (Wernicke) Frontal
Orthographicvisual processing
Letter-caserecognition
Occipitalstriateextrastriate(Galaburda,
ShaywitzPugh, Rumsey, Petersen, Eden)
Visual wordformrecognition
Visual motion
Visual, oculomotor system(Raghavar)
Auditoryprocessing
Speechsounddiscrimination
Medial geniculatenuclei, Heschlsgyrus
(Galaburda)
produces strongincreases in several frontal loberegions . . . in theprimary
motor cortex(moutharea), whereassilent readingdoesnot.
Another sourceof informationabout thebrainareasinvolvedinreadingis
the studies by Ojemann (1989) using electrical stimulation of the exposed
surfaceof thebrainduringepilepsysurgery. AsFig. 9.5shows, stimulationof a
largenumber of frontal, temporal, andparietal areasresultedindisruptionof
readingand/ ornaminginatotal of 55patients. Theparticipationof otherareas
is probably limited by therestricted operatingeld duringepilepsy surgery.
Ojemann stressed in his interpretation that there was a large amount of
individual variability, i.e., that the areas disrupted in one patient were not
necessarilythesameasinanother.
In dyslexics, Rumsey and collaborators (1994) tested 17adult men and 14
controls, and found altered patterns of activation in the mid to posterior
temporal cortexbilaterallyandintheleft inferior parietal cortex, but normal
activationof theleft inferior frontal areas, suggestingbilateral involvement of
theposteriortemporal andparietal cortexindyslexia. Theyinterpretedthisasa
failuretoactivatetheleft temporo-parietal cortexduringphonological process-
ing, asignof dysfunctionof thecortical languageareainseveredyslexia, and
report that dyslexics differed primarily in magnitude rather than location.
Similar ndingswerereportedbyGross-Glennet al. (1990) andbyKanekoand
collaborators(1998) for familial dyslexics. Decreasedactivitywasalsofoundin
M S
N
B
25
21
30
R
TOTAL PATIENTS:55
13
19
21
18
24 18
17
25
21
19
30
23
31
27
24
25
32
22
9
6
11
Fig. 9.5. Individual variabilityinareasof electrical stimulationevokingchangesinNaming(N),
SentenceReading(R) or both(B). Ineachzonethenumber of patientswithoneor moresites
creating errors in that zone is indicated by a bar graph. (Reproduced with permission from
Ojemann, 1989.)
theextrastriateand theperi-insular cortex. Not included in Table9.2is the
cerebellar area, proposed by Nicolson and Fawcett (1999) of the Shefeld
group, becauseitspresenceremainstheoretical at thistime.
Inaddition, anumber of studiesof evokedpotentialshaveinvestigatedthe
differencebetweendyslexicandnormal readers. Remschmidt, Schulte-Korne,
and Henninghausen (1998; Henninghausen, Remschmidt, & Warnke, 1994)
foundsomeconsensusthat, foratleastasubgroupofmoreseveredyslexics, the
N1component waslacking, suggestingadelayedpatternof visual information
processing. Of course, evoked potentials, electrical stimulation andfMRI do
not point to actual defects of the brain itself, only to abnormal or absent
processingincertainareasof thebrain, whichmaybeduetothelackof practice
inreading.
Unfortunately,inall studies, thedescriptionof thedyslexicpopulationunder
study often leaves much to be desired and includes wide ranges of age, of
ability, and of areas of learning. As Hynd and Semrud-Clikeman(1989) also
noted, reportsof possiblecomorbidityandof academicperformancemeasures
other thanthetaskusedduringfunctional measurementsareentirelymissing.
Theories
Therst autopsy ndingson dyslexicsledNorman Geschwindto developa
major explanatorytheoryabouttheoriginof therelationshipbetweenlearning
disabilitiesandneurological abnormalitiesinthe1970s. Geschwind(1984) and
292 Otfried Spreen
Table 9.2. MRI, CT and fMRI study results in dyslexics
Frontal Normal frontal asymmetry(larger onright)
Smaller andsymmetrical frontal areas(Hynd)
Shorter insulae
fMRI: left inferior frontal activationnormal (Rumsey)
left inferior frontal overactivated(Shaywitz)
Temporal Reversal of left-dominant ventricular asymmetry
Reversal of asymmetryor symmetryof planumtemporale
(increaseof areaonright side, Rumsey; Morgan; Hynd;
Semrud-Clikeman; Larsen)
Extent of asymmetryrelatedtoseverityof dyslexia(Duara)
Left asymmetryof temporal bank(Leonard)
fMRI: left mid-posterior temporal activationreduced(Rumsey)
Parietal Right asymmetryof parietal bank
fMRI: left mid-parietal andinferior parietal activation
(Wernicke, angular gyrus, striatum) reduced(Shaywitz)
Nodifferenceafter adjustment of datafor ageandsex
Occipital fMRI: poor activationof cortical visual system(magnocellular
subsystem)
Corpuscallosum Spleniumandisthmusenlarged(Duara, Rumsey)
Spleniumandisthmusreduced(Semrud-Clikeman, Temple)
Mid-callosumthicker infamilial dyslexicsonly(Njiokiktjen)
Mid-callosumreducedinADHD(confoundingfactor, Beaton)
Medial geniculatenuclei Smaller onleft side(Galaburda)
GeschwindandGalaburda(1993) reviewedtheevidenceandconcludedthat
thecommondenominator inthesecaseswasanomalouscerebral dominance
due to defective neuronal migration and assembly, especially in the left
cortex, leading to dysplasias, ectopias, and arteriovenous malformations or
lateralizeddevelopmental arrest. They wrotethat it isprecisely this typeof
minor developmental pathology that is responsible for many of the
learningdisabilitiesandrelateddisordersandpsychiatricconditions (p. 445).
In a much-cited theoretical design, the authors interpreted the concept
of anomalous dominance, originally rst raised by Orton, in terms of its
relevancenot only for LD, but also for handedness, special giftedness, emo-
tional disorders, immune deciencies, other disorders, and even hair color.
Without goinginto detailshere, themalefetus, inparticular, developsin an
estrogen-saturatedenvironment andproducesthegeneticallydeterminedan-
drogenichormonetestosteroneandrelatedhormonesnotonlytodevelopinto
amale, but alsotoalter theformationof brainstructures, specicallytoslow
down left hemisphere development or, according to a later reappraisal, to
promotethegrowthof theright (Galaburdaet al., 1985; Galaburda, 1993); and
altering brain functioning. Cerebral dominance, according to this theory, is
inverselyrelatedtothesizeanddensityof thecorpuscallosum. Faultycompo-
sitionof thehormonal environment, aswell asavarietyof teratogenicfactors,
contributetothesedisordersof cell migrationandaretheultimatecauseof a
varietyof disorders.
Geschwindand Galaburdahaveprovidedonepossibleframework for the
predispositionto LD aswell asto emotional disorders. They proposeaclear
relationshipbetweenanumber of symptomsandacause. Infact, Geschwind
considered the disturbance of the birth process to be a consequence of
the hormonal atmosphere of pregnancy (1984, p.681). Geschwind and
Galaburdasworkwasamilestoneintakingusfromspeculationtotheactual
mechanismsof predisposition,whichmayultimatelyhaveitsorigininenviron-
mental aswell asgeneticcauses.
Unfortunately, their theoretical framework provides only for one general
mechanismanddoesnotallowfortheoccurrenceof specictypesofemotional
disorder or specic types of LD. Congenital brain dysfunction of the type
proposed by Geschwind and Galaburdadoes not allow the description of a
clear-cut relationshipbetweenfocusof lesionandformof psychopathology; in
fact, onemaygosofar astosaythat, basedonthismodel, aclear relationship
between form of damage and form of disorder cannot even be expected,
particularlyif oneconsidersthenumerousandcomplexcompensationmech-
anisms of the embryonic and infant brain (Prechtl, 1978; Spreen, Risser, &
Edgell, 1995).
During the last 20 years, several critical appraisals of the Geschwind
Galaburdaconceptandstudiestoconrmthetheoryhavebeenpublished(Van
Strien, Bouma, &Bakker, 1987; Satz, Soper, &Orsini, 1988; Soper et al., 1988;
Bryden, McManus, & Bulman-Fleming, 1994; St. Marseille & Braun, 1994;
Biedermanetal., 1995;Flannery&Liederman, 1995; Bulman-Fleming, Bryden,
&Wise, 1996). Onerecentregistry-basedeldstudyof2202LDadultsbySmith
et al. (1996) foundnosupport for Geschwindslateralizationtheory; thisstudy
and others (Hugdahl, Synnevagt, & Satz, 1990; Hugdahl, 1993; Jariabkova,
Hugdahl, & Glos, 1995) also foundonly marginal association betweensome
immunedisordersandleft-handednessindyslexicsandnegativeassociationsin
others. Inaddition, atotal of 12different studiesfailedto conrmtheassoci-
ationsproposedinthemodel, or foundonlylimitedsupportfor oneassociation
but not for others.
Most of the studies reviewed so far and the Geschwind theory do not
attempt to split the LD into subgroups, let alone split the dyslexics into
subtypes. AsRourke(1990) argued, lumping LDchildrenintoasinglegroup
294 Otfried Spreen
maybecounterproductiveinthatitobscuresthehypothetical relationshipwith
neurological evidence. Sincethelate1960s, ishasbeensuspectedthatLDisnot
ahomogeneousclassication, andseveral uniqueformsof dyslexiaaswell as
degrees of severity may exist (Hynd, Hooper, & Takahashi, 1992). If this is
correct, thenthetheoretical frameworkfor theneurological basisof LDmust
be expanded. There are three theories that suggest a strong relationship
betweensubtypesandspecicneurological abnormalities.
1. The rst subtype theory relating to a neurological basis was developed by
Bakker(1979). Histheoryproposedtwotypesof dyslexia:theslowbutaccurate
reader (whichhecalledtheP type) whousesaright hemispherestrategy, and
the fast and sloppy reader (which he called the L type) who uses a left
hemispherestrategy. ThePtypereliesheavilyontheearlymethodsof dealing
withscript, i.e., spatialtemporal exploration; theL typereliesprematurelyon
linguisticskills, bypassingtheearlyexploratorystage. Bakker suggestedthat a
hemisphericimbalancecouldbedemonstratedbydichoticlisteningandevoked
potential techniques, and developed a hemisphere-specic training method
(Bakker, Licht, &Kappers, 1995)tocorrecttheimbalancebyexposinglettersto
theright or left visual andtactileelds. Bakker didnot specify what specic
areasof thebrainareimpaired, merelythat thereisahemisphericimbalance.
However, it wastherst theorytoproposespecicsubstratesfor twodifferent
formsof LDandarst formulafor type-specictreatment.
A critical appraisal of Bakkers model (Hynd et al., 1992) points out that
subtypesevolveover time, andthat subtypesaremorecomplexthanindicated
by themodel. Fewindependent investigatorshavereplicatedBakkerswork.
Graceand Spreen (1994) tried to replicateit, but found that the distinction
betweenL andP typeisverydifcult to make, becauseinmost poor readers
thereisacontinuumof bothcharacteristicsproposedbyBakker. IntheVictoria
study,theattempttoselectstudentswhobestttedBakkersmodel andtotrain
them in the suggested fashion also showed little success. When placebo
trainingwasused, all studentsimprovedmoderately, regardlessof typology.
Similar resultswerefoundinarecent Britishstudyandinconsistent resultsin
another (VandenHonert, 1977). Other studieslackeduntreatedcontrols. Van
der Vlugt(1998)suggestedthatthePandL typescorrespondroughlytotwoof
vesubtypesisolatedintwostudies.VanderLeij, vanDaal, andVieijras(1998)
critical appraisal nds little support for Bakkers theory other than that it
stimulatedthedevelopment of anewformof treatment research.
2. Satz (1990, 1991) proposedasomewhat similar theory, involvingboth hemi-
spheres. Reviewing the remarkable recovery fromaphasiadue to a shift in
languagedominanceinearlychildhood, hearguedthat similar compensation
mechanisms should be available for lesions causing dyslexia. Therefore, we
need to think of the neurological substrate of dyslexia in terms of bilateral
damage. Subtypes similar to Bakkers may exist, dependingon which hemi-
spheresustainedthemoreseveredamage. Satzproposedthat
. . . in cases of predominant left-hemisphere anomaly one might expect to nd the characteristic
language-disorder subtype . . . This is also compatible with Bakkers P-type which is characterized
by over-reliance on perceptual strategies because of the delay or impairment in linguistic process-
ing. In cases of predominant right-hemisphere anomaly, one might expect to ndthe visuo-spatial
subtype . . . This subtype is also compatible with Bakkers L-type, which is characterized by
over-reliance on left-hemisphere strategies because of the delay or impairment in abstracting
perceptual features fromscript. In cases of predominant bifrontal lobe anomaly, one might expect
to ndsome of the attentional and disinhibition difcultiesobserved in some dyslexic children with
attention-decit disorders (Satz, 1991, p. 108).
Incidentally,thistypologyisverysimilartothetypesproposedbyLovett(1984)
therate-disabledand theaccuracy-disabledreader and to Boders (1973)
dysphoneticanddyseideticdyslexics. Unfortunately, therehasbeennofollow-
uponSatzsheuristicformulation.
3. Whereas Bakkers theory focused mainly on dyslexia, a third theory, by
Rourke, focusedmainlyononeform, thenonverbal learningdisability. In1985,
Rourke described an unusual complex of cognitive and emotional decits
whichresemblesapatternrst mentionedbyMyklebust in1975. Accordingto
Rourkes(1995) theory, right-hemispherebraindysfunction(primarilyfrontal)
isetiologically relatedto nonverbal learningdisorder, e.g., clumsiness, poor
spatial thinking, difcultiesintheorganizationof mathematical problemsand
knowledgeof timeof day, poor handwriting, estimationof size, distance, and
weight, losingtheplaceonthepagewhilereading. Basedontheir experience
with29suchcases, HernadekandRourke(1994) describedthissubtypeof LD
as non-verbal perceptualorganizationaloutput disability (NPOOD). They
foundthat psychopathologywasfrequent inthesechildren, characterizedby
psychotictrends, depression, withdrawal, anxiety, andpoor socializingability,
summarized as personality deviance and internalized psychopathology.
Rourke explained this specic disability as poor performance on measures
ordinarilythought to besubservedprimarilyby theright hemisphere (1985,
p. 173), althoughdamagetoeither hemispherewill disruptarithmeticlearning
in the child. In a further extension and revision of this hypothesis, Rourke
(1987, p. 215) proposedthat dysfunctionof whitematter necessaryfor inter-
modal integration is the main basis of this syndrome, whereas right-hemi-
spherelesionsmay constituteasufcient, but not necessary condition. The
specicationof theinvolvementof whitematter isbasedonthenotionthatthe
296 Otfried Spreen
right hemispherehasmorelongmyelinatedber connectionsthantheleft and
thereforeismoreinvolvedinintegrativeprocessing.
However, replicationor conrmationof theproposedwhitematter abnor-
malitieshasshownmixedresults. Atotal of 14papersfailedtondevidencefor
theproposedright-hemisphereor whitematter damageinnonverbal LDand
relateddisorders. Inarecent paper, RourkeandConway(1997) statedthat no
entirelysatisfactorystatementof therelationshipbetweenarithmeticandbrain
functionhasyet emerged.
Clearly, Rourkehascalledattentiontoanimportant, thoughrare, subtypeof
LD. He is also one of the few authors who addressed the complex area of
developmental dyscalculia. (See the related discussion of Rourkes work in
Chapter 10, where Reitan and Wolfson focus primarily on Rourkes neuro-
psychological researchinvestigationsandtheir implications.)
Subtypes
To study whether subtypes are related to neurological ndings, a subtype
analysiswasattemptedof thelearning-disabledchildreninour study, basedon
test variablesat thetimeof referral (Spreen & Haaf, 1986). Weusedcluster
analysis, and replicatedveclustersfrequently reported in theliterature: (1)
minimally impaired, (2) primarily arithmetic disabled, (3) specic reading
disabled, (4) visuo-perceptuallyimpaired, and(5) linguisticallyimpaired(Table
9.3). Inaddition, wefoundgroupsof normal learnersandchildrenwhowere
impairedinall areas. However, noneof thesesubtypeswasrelatedtospecic
soft or hardneurological signs.
This list of subtypes is not presented here as a denite solution to the
subtypingproblem, but toillustratethat someconsensusappearstobeemerg-
ing from older and more recent subtyping studies. A similar, though not
identical, solutionhasbeenproposedinarecent studybyvander Vlugt (1998)
andinaverycomprehensiveanalysisbyFletcher et al. (1997) andMorriset al.
(1998), which reported a nine-cluster solution with two near-normal, two
severelyandgenerallyimpairedgroups atypical ndingincluster analysis. In
addition, theyfoundvespecicsubtypes, whichtheylabelledaccordingtothe
decitsfound in phonological, lexical, rate, and memory aspects of reading.
Thereisstrongsimilarity, also, withsubtypesproposedinearlier studies. The
differencesaremost likelytobeduetodifferencesintest selection.
Thereis no shortageof subtypes suggested by various authors, based on
clinical experience and/ or on empirical or statistical analyses, but without
referencetoaspecicneurological basis. Boder (1973)suggestedadysphonetic,
Table 9.3. Changes in subtypes of learning disability over a 15-year period
Percentageof subjectsinstudy
Aged812years Aged25years
1. Nearlynormal inall areasor minimally
impaired
7 8
2. Arithmeticdisabled 7 20
3. Auditorylinguisticdysphonetic,
phonologic
12 13
4. Visuoperceptualspatialdyseidetic 17 14
5. Linguisticsemantic(similarities,
vocabulary)
9
6. Graphomotorvisuomotor (coding) 17 4
7. Graphomotorsequencing(blockdesign,
coding, rightleft orientation, sequencing
12 14
8. Globallyimpairedinall areas 18 27
FromSpreen&Haaf (1986).
dyseidetic,andmixedtype, atypologythatisstill themostfrequentlyused, and
issomewhatsimilar toLyons(NewbyandLyon, 1991)typology. Marshall and
Newcomb(1973) suggestedavisual (word-form), surface, anddeepdyslexia,
based mainly on studies of acquired alexia, later replicated in dyslexics by
Castles and Coltheart (1993) and by Stanovich et al. (1997) as surface and
phonological subtypes. Mattis, French, & Rapin(1975) suggestedalinguistic,
articulo-graphomotor, and visuo-perceptual type (based on post-hoc data
analysis, butconrmedbyothers). Denckla(1977)proposedsimilartypesplusa
dysphonemic sequencing disorder. Decker and DeFries (1981) suggested a
typology based on factor scores, including impairment of spatial reasoning,
codingspeed, andreadingimpairmentonly. DoehringandHoshko(1977)used
Q-typefactoranalysistodevelopthreetypesof dyslexia:associative, sequential,
and oral. But, despitethemany different and confusingterms and disagree-
mentsbetween thesetheoretical andempirical typologies, andat therisk of
oversimplication, acertainconsensusappearstobeemerging, asindicatedin
Table9.4. A similar consensuswasalsonotedinreviewsbyNewbyandLyon
(1991), Hynd et al. (1992), and Cohen, Campbell, & Yaghmai (1989). For
example:
1. Satz, Boder, Lyon, Bakker, Lovett, Rourke, andMorrisall describewhat could
becalledanauditorylinguisticsubtype, alsodescribedasaphonologicalform
of dyslexia.
298 Otfried Spreen
Table 9.4. Subtypes of learning disabilities based on cluster analysis (Spreen & Haaf, 1986) and similar subtypes proposed by other
authors
Morris v.dVlugt Satz Rourke Bakker Doehring Denckla Mattis Marshall Lovett Boder Lyon
1. Near normal inall areasor
minimallyimpaired
X X X X
2. Arithmeticdisabled X X X X
3. Auditorylinguisticdysphonetic,
phonologic
X X X X X X X X X X X
4. Visuoperceptualspatialdyseidetic X X X X X X X X X X X X
5. Linguisticsemantic(similarities,
vocabulary)
X X X X X X
6. Graphomotorvisuomotor (coding) X X X X X X X X
7. Graphomotorsequencing(block
design, coding, RL orientation)
X X X
8. Globallyimpairedinall areas X X X X X
2. Lyon, Tallal, Boder, Bakker, andSatzdescribeavisualperceptual type.
3. Satz, Lyon, Morris, andmostotherauthorsdescribealanguage-decitsubtype.
4. All authorsdescribeoneor moreglobal or mixedimpairment typesaswell as
oneor moreminimallyimpairedsubtypesappearingintheir analysis.
Thereisnoagreementastowhetherthesearediscretesubtypes, orwhether,
asLyonsuggested, thesesubtypeslieon continuousdimensionsof verbal or
visual impairment.
Stability and outcome of subtypes
Another persistingproblemisthelack of stability of subtypes. That dyslexia
persistsintoadulthoodisnowgenerallyacceptedandhasalsobeenshownby
thendingof structural andfunctional changesinadult dyslexics. But, asJan
Rispens(1998) inarecent Dutchbookpointsout, thepredictionof dyslexiaof
anykindfromkindergartenor grade1to grade6hasbeennotoriouslypoor.
For example, the Connecticut study found that only 28% of 414 children
classiedaslearningdisabledingrade1receivedthesameclassicationingrade
3(Shaywitzetal., 1992, 1998), andJormetal. (1986)foundonly6of 25children
classied as LD with the same classication in grade 2. Furthermore, the
questionof changesof subtypesover longer periodsandof adult outcomehas
notbeenaddressedinmoststudies. Perhapsoneshouldexpectthemostserious
or bilateral anomaliesinthosesubtypesthat havethepoorest outcome. There
arefour studiesthat describethefateof subtypesasthechildgrowsolder. In
theVictoriaStudy(Spreen&Haaf, 1986)andinotherstudies, asubgroupof LD
characterizedaslanguageimpairedat thetimeof referral at ageten, showed
thepoorest outcomeat adult age: nearlyall changedfromgroup5togroup8,
the globally impaired type. This is consistent with ndings in several other
studies that children with early language impairment frequently show LD
persistinginto adulthood. Denckla(1993) referredto asimilar groupof adult
LDsubjects, suggestingthat thecoreof their disabilitymayhaveshiftedtoan
executivedysfunction, andthat thefocusonacademicdisabilitiesat thisage
masksamoregeneral dishevelmentinthepatientslife. Membershipinother
subtypes in our study remained constant for 36%, but changed for a large
number of subjectsfromage10toage25.
Conclusions
Although theneurological explanation has been widely accepted(Gaddes &
Edgell, 1993), thenaggingfeelingthat weareneurologizing inanimportant
eldof educationremains, especiallyamongspecial educators, who, perhaps
300 Otfried Spreen
rightly, suggest that aneurological explanationleadstoeducational pessimism.
Colleaguesin behavioral psychology often suggest that causes do not really
matter, andonlydelayandhinder remedial efforts(Reschly&Gresham, 1989).
Thischapter hastriedto reviewtheevidencefor therelationshipbetween
LD and neuropsychology. Theneurological connection was rst based on
casesanalogoustobrain-damagedadultswithacquiredalexia. Thisparallel has
launched and propelled research in the eld for the past 100 years. Yet it
remainedan analogyuntil recently. Theneurological basisisno longer pre-
sumed, althoughit isnot alwaysconrmed, andlessspecicthanwewould
likeit tobe.
Therearethreeconclusionstobedrawnfromthematerial presented.
1. Wenowknowalot moreabout thecomponent processesof readingand, to
someextent, of arithmetic. It isclear fromthat evidencethat aconsensusis
emergingabout theareasof thebrainthat areinvolvedinreading. Wecannot
expect a single location, such as the angular gyrus, to be the only critical
component of dyslexia. Which of these areas is of critical importance or
whether thereareseveral areasremainsto bedetermined. Instead, wemust
focusonthesubtypeapproach, withdifferentformsof LDandseveral different
locations.
2. Several theoriesabout theneurological substrateof LDhavebeenpresented.
Noneof themhasfoundunanimoussupportinsubsequentstudies. Onereason
for thisisthat thecurrentlyofferedtheoriesdonot takeintoaccount thelarge
individual variabilityfoundinneuroanatomical, neurophysiological, andfunc-
tional studiesof normal andabnormal readers.
3. Themajorityof studiessuggest that LDispersistent over theschool yearsand
into adulthood. However, the Victoria study suggests that the outcome of
specicsubtypesmaydiffer asthechildrengrowintoadulthood. Howspecic
subtypesfareover thecourseof development of thechild, isanother eldof
studies, with important consequences for remediation that need to be ad-
dressedin futureresearch. For example, Joschko and Rourke(1985) implied
that theadult formof theACID(ArithmeticCodingInformationDigit Span
decit ontheWechsler IntelligenceTest) subtypeshowspoor prognosisinall
areas, andour andother studiesshowpoor outcomefor thelanguage-impaired
subtype.
4. Thesearchfor subtypesof LDhasbeencontinuingsincethe1960sinapparent
isolation fromstudies of the neurological substrate of LD. A fair degree of
consensusbetweendifferent subtypesystemsisnoted, anddifferencesappear
tobemostlyrelatedtotheuseof different areasof assessment. Inaddition, the
subtypeclassicationappearstobesubject toage-relatedchanges. It isargued
that careful selectionof subjectsfor functional andneuroanatomical research
alongthelinesof subtypes, ontheonehand, andsubtyperesearchusingthe
availableliteratureontheneuroanatomical substrateof LD, ontheother, may
beof mutual benet andresult inaclearer pictureof LDwhichwill eventually
aidthetrainingandtreatment of childrenwithLD.
The situation in the neighboring elds of autismand ADHD is not very
different fromthat inLD. Thesearchfor anunderlyingneurological substrate
hasproducedmanystudies, butwithcontradictoryorspuriousresults(Pivenet
al., 1990; Ozonoff &Miller, 1996; Baron-Cohenet al., 1999). fMRI studieseven
suggest that areassimilar tothoseimplicatedinLDareinvolved, e.g., superior
temporal gyrus and prefrontal areas in social intelligence. Here, again, the
suggestion of subtype analysis has been proposed, and may lead to more
convincingevidence. If wemoveintosophisticatedanalysesof variousneuro-
logical or neuroradiological techniques, thepsychologist selectingthesubjects
shouldbeequallysophisticated:weshouldbesurethat our groupof subjectsis
well dened, intermsofage, of severity,andof subtype.Thiswouldseemtobe
themost important programfor thefuture.
REFERENCES
Bakker, D.J. (1979). Hemisphericspecializationandstagesinthelearningtoreadprocess. Bulletin
of theOrtonSociety, 23, 84100.
Bakker, D.J., Licht, R., & Kappers, E.J. (1995). Hemispherestimulationtechniquesin children
with dyslexia. In Advances in Child Neuropsychology, Vol. 3, ed. M.G. Tramontana & S.R.
Hooper, pp. 14477. NewYork: Springer.
Baron-Cohen, S., Ring, H.A., Wheelwright, S. et al. (1999). Social intelligenceinthenormal and
autisticbrain: anfMRI study. EuropeanJournal of Neuroscience, 11, 18918.
Beaton, A.A. (1997). Therelationof theplanumtemporaleasymmetryandmorphologyof the
corpus callosumto handedness, gender, and dyslexia: a review of the evidence. Brain and
Language, 60, 255322.
Benton, A.L. (1982). Child neuropsychology: retrospect and prospect. In Perspectiveson Child
Study, ed. J. deWit &A.L. Benton, pp. 416. Lisse, Netherlands: Swets&Zeitlinger.
Biederman, J., Milberger, S., Faraone, S.V., Lapey, K.A., Reed, E.D., &Seidman, L.J. (1995). No
conrmationof Geschwindshypothesisof associationsbetweenreadingdisability, immune
disorders, andmotor preferenceinADHD. Journal of Abnormal ChildPsychology, 23, 54552.
Boder, E. (1973). Developmental dyslexia:adiagnosticapproachbasedonthreeatypical reading
spellingpatterns. Developmental MedicineandChildNeurology, 15, 66387.
Bookheimer, S.Y. & Lapretto, M. (1996). Functional neuroimagingof languagein children. In
302 Otfried Spreen
Developmental Neuroimaging: MappingtheDevelopmentof BrainandBehavior, ed. R.W. Thatcher,
G.R. Lyon, J. Rumsey, &N. Krasnegor, pp. 6577. SanDiego, CA: AcademicPress.
Bryden, M.P., McManus, I.C., &Bulman-Fleming, M.B. (1994). Evaluatingtheempirical support
for theGeschwindBehanGalaburdamodel of cerebral lateralization. BrainandCognition, 26,
165.
Bulman-Fleming, M.B., Bryden, M.P., & Wise, D.M. (1996). Associations among familiar
sinistrality, allergies, anddevelopmental languagedisorders. International Journal of Neurosci-
ence, 87, 25765.
Castles, A. &Coltheart, M. (1993). Varietiesof developmental dyslexia. Cognition, 47, 14980.
Clinton, A.B., Kroese, J.M., Morgan, A.E., & Hynd, G.W. (1998). Reversedplanumtemporale
asymmetryassociatedwithlanguageimpairment?Journal of theInternational Neuropsychological
Society, 4, 5960(Abstract).
Cohen, M., Campbell, R., & Yaghmai, E. (1989). Neuropathological abnormalitiesin develop-
mental dysphasia. Annalsof Neurology, 25, 56770.
Decker, S.N. & DeFries, J.C. (1981). Cognitive ability proles in families of reading-disabled
children. Developmental MedicineandChildNeurology, 23, 21727.
Dejerine, J. (1892). Contribution a letude anatomicpathologique et clinique des differentes
varietesdececiteverbale. ComptesRendusdesSeancesetMemoiresdelaSocietedeBiologieetdeSes
Filiales, 44, 61.
Denckla, M.B. (1977). Minimal braindysfunctionanddyslexia: beyonddiagnosisbyexclusion. In
TopicsinChildNeurology, ed. M.E. Blaw, I. Rapin, & M. Kinsbourne, pp. 24362. NewYork:
Spectrum.
Denckla, M.B. (1993). The child with developmental disabilities grows up: adult residuals of
childhooddisorders. NeurologicClinics, 11, 10525.
Denckla, M.B., LeMay, M., &Chapman, C.A. (1985). FewCT scanabnormalitiesfoundevenin
neurologicallyimpairedlearningdisabledchildren. Journal of LearningDisabilities, 18, 1326.
Doehring, D.G. &Hoshko, I.M. (1977) Classicationof readingproblemsbytheQ-techniqueof
factor analysis. Cortex, 13, 28194.
Drake, W.E. (1968). Clinical andpathological ndings in achildwith developmental learning
disability. Journal of LearningDisabilities, 1, 925.
Duara,B.,Kushch,A.,Gross-Glenn,K.etal.(1991).Neuroanatomicaldifferencesbetweendyslexic
andnormal readersonmagneticresonanceimagingscans. Archivesof Neurology, 48, 41016.
Flannery, K.A. &Liederman, J. (1995). Istherereallyasyndromeinvolvingtheco-occurrenceof
neurodevelopmental disorder, talent, non-right handedness, and immune disorder among
children?Cortex, 31, 50315.
Fletcher, J.M., Morris, R., Lyon, G. etal. (1997). Subtypesof dyslexia:anoldproblemrevisited. In
Foundations of ReadingAcquisition and Dyslexia. Implications for Early Intervention, ed. B.A.
Blachman, pp. 95114. Mahwah, NJ: LawrenceErlbaum.
Gaddes, W.H. & Edgell, D. (1993). LearningDisabilitiesandBrainFunction: aNeuropsychological
Approach, thirdedition. NewYork: Springer.
Galaburda, A.M. (ed.) (1993). DyslexiaandDevelopment: Neurobiological Aspectsof Extra-ordinary
Brains. Cambridge, MA: HarvardUniversityPress.
Galaburda, A.M. & Kemper, T.L. (1978). Cytoarchitectonic abnormalities in developmental
dyslexia: acasestudy. Annalsof Neurology, 6, 94100.
Galaburda, A.M., Sherman, G.F., Rosen, G.D., Aboitiz, F., & Geschwind, N. (1985). Develop-
mental dyslexia: four consecutivepatientswithcortical abnormalities. Annalsof Neurology, 18,
22233.
Geschwind, N. (1984). Cerebral dominance in biological perspective. Neuropsychologia, 22,
67583.
Giedd, J.N., Rumsey, J.M., Castellanos, F.X. et al. (1996). AquantitativeMRI studyof thecorpus
callosumin children and adolescents. Brain Research and Developmental Brain Research, 91,
27480.
Grace, G.M. &Spreen, O. (1994). Hemisphere-specicstimulationof L-andP-types:areplication
studyandacritical appraisal. InTheBalanceModel of Dyslexia. Theoretical andClinical Progress,
ed. R. Licht &G. Spyer, pp. 13381. Assen, Netherlands: VanGorcum.
Green, M.F., Bracha, H.S., Satz, P., & Christenson, C.D. (1994a). Preliminaryevidencefor an
association between minor physical anomalies and second trimester neurodevelopment in
schizophrenia. PsychiatryResearch, 53, 11927.
Green, M.F., Satz, P., & Christenson, C. (1994b). Minor physical anomalies in schizophrenia
patients, andtheir siblings. SchizophreniaBulletin, 20, 43340.
Gross-Glenn, K., Duara, R., Yoshii, F. et al. (1990). PET scan studies: familial dyslexics. In
PerspectivesonDyslexia, Vol. 1, ed. G.Th. Pavlidis, pp. 10918. NewYork: Wiley.
Henninghausen, K., Remschmidt, H., & Warnke, A. (1994). Visual evokedpotentialsin boys
withdevelopmental dyslexia. EuropeanChildandAdolescent Psychiatry, 3, 7281.
Hernadek, M.C.S. & Rourke, B.P. (1994). Principal identifying features of the syndrome of
nonverbal learningdisabilitiesinchildren. Journal of LearningDisabilities, 27, 14454.
Hertzig,M.E. (1983). Temperamentandneurological status. InDevelopmental Neuropsychiatry, ed.
M. Rutter, pp. 16480. NewYork: GuilfordPress.
Hier, D.B., LeMay, M., Rosenberger, P.B., & Perlo, V.B. (1978). Developmental dyslexia:
evidenceof asubgroupwithreversal of cerebral asymmetry. Archivesof Neurology, 35, 902.
Hinshelwood, J. (1895). Word-blindnessandvisual memory. Lancet, 2, 156470.
Hinshelwood, J. (1917). Congenital WordBlindness. London: H.K. Lewis.
Hugdahl,K. (1993). Functional brainasymmetry, dyslexia,andimmunedisorders. InDyslexiaand
Development: Neurobiological Aspectsof Extra-OrdinaryBrains, ed. A.M. Galaburda, pp. 13354.
Cambridge, MA: HarvardUniversityPress.
Hugdahl, K., Synnevagt, B., & Satz, P. (1990). Immuneand autoimmune diseasein dyslexic
children. Neuropsychologia, 28, 6739.
Humphreys,P., Kaufmann,W.E., &Galaburda, A.M. (1990). Developmental dyslexiainwomen:
neuropathological ndingsinthreecases. Annalsof Neurology, 28, 76474.
Hynd, G.W. (1992). Neurological aspectsof dyslexia: comment onthebalancemodel. Journal of
Hynd, G.W., Hooper, S.R., & Takahashi, T. (1992). Dyslexia and language-based learning
disabilities. In Textbook of PediatricNeuropsychiatry, ed. C.E. Coffey & R.A. Brumback, pp.
186205. Washington, DC: AmericanPsychiatricPress.
304 Otfried Spreen
Hynd, G.W. & Semrud-Clikeman, M. (1989). Dyslexia and brain morphology. Psychological
Bulletin, 106, 44782.
Jariabkova,K., Hugdahl, K., &Glos, J. (1995). Immunedisordersandhandednessindyslexicboys
andtheir relatives. ScandinavianJournal of Psychology, 36, 35562.
Jorm, A.F., Share, D.L., Maclean, R., & Matthews, R. (1986). Cognitivefactorsat school entry
predictiveof specicreadingretardationandgeneral readingbackwardness: aresearchnote.
Journal of ChildPsychologyandPsychiatry, 27, 4554.
Joschko, M. & Rourke, B.P. (1985). Neuropsychological subtypesof learning-disabledchildren
who exhibit the ACID pattern on the WISC. In Neuropsychology of Learning Disabilities.
Essentialsof SubtypeAnalysis, ed. B.P. Rourke, pp. 6588. NewYork: GuilfordPress.
Kaneko, M., Uno, A., Kaga, M., Matsuda, H. et al. (1998). Cognitiveneuropsychological and
regional cerebral bloodowof adevelopmentallydyslexicchild. Journal ofChildNeurology, 13,
45761.
Kussmaul, A. (1877). DieStorungen der Sprache. Versuch einer Pathologieder Sprache. Leipzig:
Vogel.
Larsen, J.P., Hien, T., Lundberg, I., & Odegaard, H. (1990). MRI evaluation of the size and
symmetry of theplanumtemporalein adolescents with developmental dyslexia. Brainand
Language, 39, 289301.
Lovett, M.W. (1984). A developmental perspectiveon readingdysfunction: accuracy andrate
criteriainthesubtypingof dyslexicchildren. BrainandLanguage, 22, 6791.
Marshall, J.C. & Newcomb, F. (1973). Patterns of paralexia: a psycholinguistic approach.
Developmental MedicineandChildNeurology, 2, 17599.
Mattis, S., French, J.H., & Rapin, J. (1975). Dyslexia in children and young adults: three
independent neuropsychological syndromes. Developmental MedicineandChildNeurology, 17,
15063.
Morgan, A.E. &Hynd, G.W. (1998). Dyslexia, neurolinguisticability, andanatomical variations
ontheplanumtemporale. NeuropsychologyReview, 8, 7993.
Morgan, P. (1896). Acaseof congenital word-blindness. BritishMedical Journal, 2, 1378.
Morris, R.D., Stuebing, K.K., Fletcher, J.M. etal. (1998). Subtypesof readingdisability: variability
aroundaphonological core. Journal of Educational Psychology, 90, 34773.
Myklebust, H.R. (1975). Nonverbal learningdisabilities: assessment andintervention. InProgress
inLearningDisabilities, Vol. 3, ed. H.R. Myklebust, pp. 85121. NewYork: Grune&Stratton.
National Joint CommitteeonLearningDisabilities(1998). OperationalizingtheNJCLD deni-
tionof learningdisabilitiesfor ongoingassessment inschools. LearningDisabilitiesQuarterly,
21, 18693.
Newby, R.F. & Lyon, G.R. (1991). Neuropsychological subtypes of learning disabilities. In
Neuropsychological Foundationsof LearningDisabilities, ed. J.E. Obrzut &G.W. Hynd, pp. 355
86. SanDiego, CA: AcademicPress.
Nicolson, R.J. & Fawcett, A.J. (1999). Developmental dyslexia: theroleof thecerebellum. In
Dyslexia: Advances in Theory and Practice, ed. I. Lundberg, F.E. Tonnessen, & I. Austad,
pp. 5468. Dordrecht, Netherlands: Kluwer.
Njiokiktjien, C. (1993). Neurological arguments for ajoint developmental dysphasiadyslexia
syndrome.InDyslexiaandDevelopment:Neurobiological AspectsofExtra-OrdinaryBrains, ed. A.M.
Galaburda, pp. 20536. Cambridge, MA: HarvardUniversityPress.
Njiokiktjien, C. & deSonneville, L. (1994). Callosal sizein children with learningdisabilities.
Behavioral andBrainResearch, 64, 21318.
Ojemann,G.A. (1989). Somebrainmechanismsinreading. InBrainandReading,ed. C. vanEuler,
I. Lundberg, &G. Lennarstrand, pp. 4759. NewYork: StocktonPress.
Orton, S.T. (1928). Specicreadingdisability strephosymbolia. Journal of theAmericanMedical
Association, 90, 10959.
Orton, S.T. (1937). Reading, Writing, andSpeechProblemsinChildren. NewYork: Norton.
Ozonoff, S. & Miller, J.N. (1996). An exploration of right-hemisphere contributions to the
pragmaticimpairmentsof autism. BrainandLanguage, 52, 41134.
Parsons, O. (1977). Humanneuropsychology:thenewphrenology. Journal ofOperational Psychia-
try, 8, 4756.
Paulson, K. & ODonnell, J.P. (1980). Therelationshipbetweenminor physical anomaliesand
soft signs of braindamage. Perceptual andMotor Skills, 51, 40210.
Piven, J., Berthier, M.L., Starkstein, S.E., Nehme, E. et al. (1990). Magneticresonanceimaging
evidencefor adefect of cerebral cortical developmentinautism. AmericanJournal of Psychiatry,
147, 7349.
Prechtl, H.F.R. (1978). Minimal brain dysfunctionsyndromeandtheplasticity of thenervous
system. AdvancesinBiological Psychiatry, 1, 96115.
Remschmidt, H., Schulte-Korne, G., &Henninghausen, K. (1998). What isspecicabout specic
readingdisorder. In Perspectiveson theClassicationof SpecicDevelopmental Disorders, ed. J.
Rispens, T.A. vanIperen, &W. Yule, pp. 12632. Dordrecht, Netherlands: Kluwer.
Reschly, D.J. & Gresham, F.M. (1989). Current neuropsychological diagnosisof learningprob-
lems: aleap of faith. In Handbook of Clinical ChildNeuropsychology, ed. C.R. Reynolds & E.
Fletcher-Jantzen, pp. 50320. NewYork: PlenumPress.
Rie, E.D. (1987). Soft signsin learningdisabilities. In Soft Neurological Signs, ed. D.E. Tupper,
pp. 20124. Orlando, FL: Grune&Stratton.
Rispens, J. (1998). Thevalidity of thecategory of specic developmental readingdisorder. In
Perspectives on theClassication of Specic Developmental Disorders, ed. J. Rispens, T.A. Van
Yperen, &W. Yule, pp. 1220. Dordrecht, Netherlands: Kluwer.
Rourke, B.P. (1985). Neuropsychologyof LearningDisabilities. Essentialsof SubtypeAnalysis. New
Rourke, B.P. (1987). Syndromeof nonverbal learningdisabilities: thenal commonpathwayof
white-matter disease/ dysfunction?Clinical Neuropsychologist, 1, 20934.
Rourke, B.P. (1990). Learningdisabilitysubtypes: aneuropsychological perspective. In Perspec-
tivesonDyslexia, Vol. 1, Neurology, Neuropsychology, andGenetics, ed. G.T. Pavlidis, pp. 2746.
NewYork: Wiley.
Rourke,B.P. (ed.)(1995). SyndromeofNonverbal LearningDisabilities. Neurodevelopmental Manifesta-
tions. NewYork: GuilfordPress.
Rourke, B.P. &Conway, J.A. (1997). Disabilitiesof arithmeticandarithmeticreasoning: perspec-
tivesfromneurologyandneuropsychology. Journal of LearningDisabilities, 30, 3446.
306 Otfried Spreen
Rumsey, J.M. (1996). Neuroimagingindevelopmental dyslexia: areviewandconceptualization.
InNeuroimaging: aWindowtotheNeurological Foundationsof LearningandBehavior inChildren,
ed. G.R. Lyon&J.M. Rumsey, pp. 5777. Baltimore: Brookes.
Rumsey, J.M., Casanova, M., Mannheim, G.B. et al. (1996). Corpuscallosummorphology, as
measuredwithMRI, indyslexicmen. Biological Psychiatry, 39, 76975.
Rumsey, J.M., Horwitz, B., Donahue, B.C., Nace, K., Maisog, J.M., & Andreason, P. (1997a).
Phonological andorthographiccomponentsof wordrecognition: aPETrCBF study. Brain,
120, 73959.
Rumsey, J.M., Nace, K, Donahue, B., Wise, D., Maisog, J.M., & Andreason, P. (1997b). A
positronemissiontomographystudyof impairedwordrecognitionandphonological process-
ingindyslexicmen. Archivesof Neurology, 54, 56273.
Rumsey, J.M., Zametkin, A.J., Andreason, P. et al. (1994). Normal activationof frontotemporal
language cortex in dyslexia, as measured with oxygen 15 positron emission tomography.
Archivesof Neurology, 51, 2738.
Satz, P. (1990). Developmental dyslexia: anetiological reformulation. InPerspectivesonDyslexia,
Vol. 1, Neurology, Neuropsychology, andGenetics, ed. G.T. Pavlidis, pp. 326. NewYork: Wiley.
Satz, P. (1991). The Dejerine hypothesis: implications for the etiological reformulation of
developmental dyslexia. In Neuropsychological Foundations of Learning Disabilities, ed. J.E.
Obrzut &G.W. Hynd, pp. 99112. SanDiego, CA: AcademicPress.
Satz, P., Soper, H.V., &Orsini,D.L. (1988). Humanhandpreference. Threenondextral subtypes.
In Brain Lateralization in Children: Developmental Implications, ed. D.L. Molfese & J.S.
Segalowitz, pp. 2817. NewYork: GuilfordPress.
Schultz, R.T., Cho, N.K., Staib, L.H. et al. (1994). Brain morphology in normal and dyslexic
children: theinuenceof sexandage. Annalsof Neurology, 35, 73242.
Shaywitz,S.E., Escobar,M.D., Shaywitz, B.A., Fletcher,J.M., &Makuch, R. (1992). Evidencethat
dyslexiamayrepresent thelower tail of anormal distributionof readingability. NewEngland
Journal of Medicine, 326, 14550.
Shaywitz, S.E., Shaywitz, B.A., Pugh, K.R. etal. (1998). Functional disruptionintheorganization
of thebrainfor readingindyslexia. Proceedingsof theNational Academyof Science, Neurobiology,
95, 263641.
Smith, S., Branford, D., Collacott, R.A., Cooper, S.A., & McGrother, C. (1996). Prevalenceand
cluster typology of maladaptivebehaviors in ageographically dened population of adults
withlearningdisabilities. BritishJournal of Psychiatry, 169, 21927.
Soper, H.V., Cicchetti, D.V., Satz, P., Light, R., &Orsini, D.L. (1988). Null hypothesisdisrespect
in neuropsychology: dangers of alpha and beta errors. Journal of Clinical and Experimental
Neuropsychology, 10, 25570.
Spreen, O. (1988). LearningDisabledChildrenGrowingUp. NewYork: OxfordUniversityPress.
Spreen, O. (1989a). The relationship between learning disability, emotional disorders, and
neuropsychology: someresults and observations. Journal of Clinical andExperimental Neuro-
psychology, 11, 11740.
Spreen,O.(1989b).Learningdisability,neurology,andlong-termoutcome:someimplicationsfor
theindividual andfor society. Journal of Clinical andExperimental Neuropsychology, 11, 389408.
Spreen, O. & Haaf, R.G. (1986). Empirically derivedlearningdisability subtypes: areplication
attempt andlongitudinal patternsover 15years. Journal of LearningDisabilities, 19, 17080.
Spreen, O., Risser, A.H., & Edgell, D. (1995). Developmental Neuropsychology, 2ndedition. New
York: OxfordUniversityPress.
St. Marseille, A. & Braun, C.M. (1994). Commentsontheimmuneaspectsof theGeschwind
BehanGalaburdamodel andof thearticleof Bryden, McManus, andBulman-Fleming. Brain
andCognition, 26, 28190.
Stanovich, K.E., Siegel, L.S., Gottardo, A. et al. (1997). Subtypes of developmental dyslexia:
differencesinphonological andorthographiccoding. InFoundationsof ReadingAcquisitionand
Dyslexia. Implications for Early Intervention, ed. B.A. Blachman, pp. 11542. Mahwah, NJ:
LawrenceErlbaum.
Strauss, A. & Lehtinen, L. (1947). PsychopathologyandEducationof theBrain-injuredChild. New
York: Grune&Stratton.
Temple, C.M., Reeves, M.A., & Villaroya, O.O. (1990). Readingincallosal agenesis. Brainand
Language, 39, 23553.
Van den Honert, D. (1977). A neuropsychological techniquefor training dyslexics. Journal of
Van der Leij, A., van Daal, V.H.P., & Vieijra, J.P.M. (1998). Neuropsychological treatment of
dyslexia: acritical appraisal. InChildNeuropsychology, ReadingDisabilityandMore. ATributeto
Dirk J. Bakker, ed. R. Licht, A. Bouma, W. & W. Koops, pp. 14560. Delft, Netherlands:
Eburon.
Vander Vlugt, H. (1998). Balancingthescaleof thebalance. In ChildNeuropsychology: Reading
Disability andMore, ed. R. Licht, A. Bouma, & W. Koops, pp. 12744. Delft, Netherlands:
Eburon.
Van Strien, J.W., Bouma, A., & Bakker, D.J. (1987). Birth stress, autoimmune disease, and
handedness. Journal of Clinical andExperimental Neuropsychology, 9, 77580.
Waldrop, M.F., Bell, R.Q., & Goering, J.D. (1976). Minor physical anomalies and inhibited
behavior inelementaryschool girls. Journal of ChildPsychologyandPsychiatry, 17, 113.
Waldrop, M.F., Pedersen, F.A., & Bell, R.C. (1968). Minor physical anomaliesandbehavior in
school children. ChildDevelopment, 39, 3919.
Willems,G., Noel, A., &Evrard, P. (1972). Lexamenneuropediatriquedesfonctionsdapprentic-
age chez lenfant en age prescolaire. Revue Francaise dHygiene et de Medicine Scolaire et
Universitaire, 32, 318.
Yeo, R.A., Gangestad, S.W., Thoma, R., Shaw, P., &Repa, K. (1997). Developmental instability
andcerebral lateralization. Neuropsychology, 11, 55261.
308 Otfried Spreen
10
The HalsteadReitan Neuropsychological
Test Battery: research findings and
clinical application
Ralph M. Reitan and Deborah Wolfson
Thetermlearningdisabilities, asacategorical entity, isattributedtoSamuel Kirk
(Kirk & Bateman, 1962), although there had been many earlier studies of
academicunderachievers. Thehistoryof neuropsychology, withitsemphasis
on brain damageor impairment as a basis for limitinghigher-level abilities,
madeit reasonableto postulateabiological basis for learningdisabilities. It
must be recognized, however, that a host of factors (including genetic and
maturational variables,auditoryand/ orvisual impairments,differencesinrates
of development, conictsinhandednessandfootedness, variationsincognitive
style, deviant patternsof cerebral dominance, emotional andpsychiatricprob-
lems, and, perhaps the most common cause, poor teaching) have been im-
plicated. Awareof thesemany possibleetiological inuences, Spreen (1976)
favored a multiple cause multiple outcome interaction model. Learning
disabilitiesobviouslyrepresent acomplexcondition, andmanyfactorscanbe
contributory.
Rourkes research program
The rst systematic program of investigation based on a modern neuro-
psychological approachwasinstitutedbyRourke(1975). (SeeSpreensrelated
discussion of Rourkes work in Chapter 9, where the focus is on Rourkes
theoryrather thanonhisresearchmethodology.)Fromthebeginning, Rourke
includedsubjectswhowereperformingverypoorlyinoneor moreacademic
subjects, but excludedchildrenwithmental retardation, emotional disturban-
ces, cultural deprivation, and defective hearing or vision as primary factors,
despitepoor academicprogress. McCarthyandMcCarthy(1969), followingthe
predispositiontopresumecerebral dysfunctionasacritical factor inproducing
learning disabilities, had recommended the use of exclusionary procedures.
They believed that cerebral dysfunction was implicated if other possible
309
etiological factors could be eliminated. Rourke, however, felt that scientic
standards required positive criteria to identify the behavioral or neuro-
psychological characteristicsof childrenwithlearningdisabilities. Inhisstudies,
heusedsubjectswithdenitiveevidenceof cerebral diseaseor damage, even
though they might beacademically impaired, for comparison with learning-
disabledchildrenwhodidnot haveevidenceof braindamage. Thus, Rourkes
aimwasto produceresearchresultsthat characterizedchildrenwithlearning
disabilitiesasarelatively uniquecategory, distinct fromother etiologiesthat
might affect achildsacademiccapability.
Inorder to placethisresearchinaneuropsychological frameof reference,
Rourkeutilizedinvestigativetestsandmeasuresthathadestablishedsensitivity
tocerebral damageor dysfunctionandmetmethodological criteriafor demon-
stratingbrain-related(neuropsychological)decits. Herecognizedtheneedfor
comprehensiveneuropsychological testinginordertoassesstheentirerangeof
functionstocharacterizeacategory(learningdisability) that wasundoubtedly
complexand variablefromonesubject to another. Thetest battery Rourke
routinely used included apertinent version of Wechslers scales to evaluate
general intelligence, theHalsteadReitanNeuropsychological Test Batteryfor
Older Children (HRNTBOC), the ReitanIndiana Neuropsychological Test
Battery for Young Children, the KlveMatthews Motor Steadiness Battery,
andmeasuresof academicachievement.
Rourkewasalsoconcernedthat theresearchbatteryheusedbesusceptible
toanalysisusingvariousmethodsof inferencetoidentifybraindamage. Reitan
(1966), indescribinghisresearchprograminvestigatingtheneuropsychological
effectsof brainlesionsinhumanbeings, describedfour methodsof inference
(or techniquesfor deducingbraindamage)whichhefelt it wasnecessarytouse
inacomplementarymannertodrawvalidinferencesaboutindividuals. Rourke
wasalsoconcernedthat theresearchbatteryheusedwouldproduceresearch
datathat relatedexplicitlyto individual children(ascontrastedwith research
ndingsthat stoodaloneasseparatepointsof information). AsReitan(1967)
had noted earlier, Rourke made it quite clear that an individuals level of
performanceonanytest neededtobesupplementedbyadditional approaches.
One of these approaches, or methods of inference, utilized tests that could
producepathognomonicsigns(indicationsof impairedperformance) that oc-
curredessentiallyonlyamongpeoplewithcerebral damage. Rourkerealized
that eventhoughthesesignsdidnot occur amongnormal subjects, theymight
alsofail tooccuramonganumberof childrenwithbraindamage. However,if a
childdiddemonstrateapathognomonicsign, it wouldbeareliableindication
of brainimpairment. Inthetest batteriesthat hedevelopedfor botholder and
310 Ralph M. Reitan and Deborah Wolfson
younger children, Reitanhadexplicitlyincludedanumber of teststhat areable
toelicit pathognomonicsigns.
Reitan, recognizingthat brain-damagedchildrenmight besignicantlyim-
pairedinoneareaof functionascomparedwithother areas, includedanother
methodof inferencethatassessesintra-individual deviationsamongtestresults.
Thismethod, sometimesreferredto asthedifferential scoreapproach, hasa
long history in the evaluation of the effects of brain damage among adults
(Babcock, 1930; Hunt, 1943). A nal method of clinical neuropsychological
inference that Rourke wished to investigate also concerned intra-individual
differences. Thisapproachusedsensoryperceptual andmotor tasksto evalu-
ate comparative performances on the two sides of the body. The brain is
wired in such amanner that onesideof thebrainprincipally controlsboth
input(sensoryfunction)andoutput(motor function)of theoppositesideof the
body. Manypeoplewhosustainbrainimpairment haveadifferential degreeof
damageononesideof thebrainor theother and, correspondingly, agreater
degreeof impairmentononesideof thebodythantheother. Astrikingdegree
of intra-individual disparityinsensoryperceptual andmotor functionsserves
almost asapathognomonicsignof braindamageinbothadultsandchildren
(Reitan & Wolfson, 1992, 1993). Rourke and his colleagues (1973b) studied
childrenwithlearningdisabilitieswhowereselectedbecauseof poor perform-
ances on one side of the body or the other, and Rourke (1975) drew the
followingconclusionfromthesestudies:
The results of these studies indicate that when children with learning disabilities are separated
into groups solely on the basis of patterns of lateralized decits on a complex psychomotor task,
their performances are, in many respects, similar to those exhibited by adult subjects with
well-documented cerebral lesions.
Rourke and his colleagues also performed a series of studies using the
differential scoreapproachtoidentifypatternsthat characterizechildrenwith
learningdisabilities. Inoneseriesof studies(Rourke&Telegdy, 1971; Rourke,
Young, & Flewelling, 1971; Rourke, Dietrich, & Young, 1973a), childrenwith
learning disabilities were divided into groups according to their patterns of
performanceon theWechsler IntelligenceScalefor Children (WISC). These
investigators found that older children (in the 914-year age range) with
learning disabilities demonstrated Verbal IQ/ Performance IQ discrepancies
that werequitesimilar tothat whichwouldbeexpected(onthebasisof adult
data) if they were experiencing the effects of cerebral dysfunction (p. 916).
Younger children, however, did not show these same clear-cut patterns of
abilitydecits.
311 The HalsteadReitan Neuropsychological Test Battery
RourkeandFinlayson(1975) investigateddifferential levelsof performance
on Parts A and B of the Trail Making Test, having noted that Reitan and
Tarshes(1959) hadpublishedndingsindicatingthat adultswithleft cerebral
lesionsperformedquitepoorlyonPart Bascomparedwiththeir ownperform-
ancesonPart A, whereasthereverserelationshipoccurredwithright cerebral
lesions.
TheapproachusedbyRourkeandFinlaysonwastoestablishthreegroupsof
learning-disabledchildren in accordancewith their differential performances
on the two parts of the Trail Making Test. Thus, there was one group of
childrenwho performednormallyonbothPartsA andB, asecondgroupof
childrenwho performednormallyonPart A but didpoorlyonPart B, anda
thirdgroupof childrenwhoperformedpoorlyonbothPartsAandB. Rourke
and Finlayson compared these three groups and reported that the children
demonstratedrather clearlythat specicpatternsof performanceontheTrail
Making Test were related to consistent differences on a number of verbal,
auditoryperceptual, visualspatial, and psychomotor abilities (p. 916). In
addition, childrenwho performedpoorlyonPart Bof theTrail MakingTest
demonstrateddeciencies on other measures that would imply left cerebral
dysfunction, whereas children who performed poorly on Part A showed, in
general, apatternof relativelydecient right cerebral functions.
Rourke and his colleagues carried these research efforts much further,
alwaysbeingcareful toinvestigatetheapplicabilityof researchndingstothe
interpretation of results for individual children. These research results, and
their applicationinindividual cases, havebeenextensivelyreported(Rourkeet
al., 1983; Rourke, 1985, 1989, 1991; Rourke, Fisk, & Strang, 1986; Rourke&
Fuerst, 1991). Thesearticlesreport ontheidenticationof subtypesof children
withlearningdisabilitiesandexploredifferential adaptational capabilitiesand
problemsinpsychosocial functioningof childrenwithlearningdisabilities.
In one of these reports, Rourke (1989) describes in detail a category of
childrenwithnonverbal learningdisabilities. Becauseour orientationtolearn-
ingissoheavilyweightedtowardacademicdecienciesandverbal limitations,
thismaywell seemto beaverysurprisingcategory. However, childrenwho
have principally nonverbal decits that limit their academic development
constituteavery important category, anddemonstrate: (1) thebroadbaseof
dysfunction (in contrast to a delimited area of decit corresponding with
involvement of the language area of the cerebral cortex) that would be
expected to occur when adverse circumstances cause brain impairment or
damage; and(2) theintegrativenatureof abilitiesdependent uponthebiologi-
cal conditionof thebrain, eventotheextent that basicimpairment of nonver-
bal abilitiesmayhaveageneralizingeffect andinuencemanyother aspectsof
adaptiveskills, includingacademicprogress.
Deans research program
Deanandhiscolleagues(Batchelor &Dean, 1991) alsodevelopedandpursued
a research program aimed toward gaining an improved understanding of
learningdisabilities. They pointedout that theNational Joint Committeefor
Learning Disabilities noted that the learning disorders are intrinsic to the
individual andpresumedto bedueto acentral nervoussystemdysfunction
(Hamill et al., 1981). Deanandhiscolleaguesfelt that development of knowl-
edge that would be sufcient to diagnose learning disorders would require
identication of brain-related neuropsychological functions. Their research
programwasconceptualizedandimplementedonthisbasis.
Deanandhisassociatesfeltthatitwasnecessarytoadministerastandardized
batteryof teststo all childrenintheir studiesinorder to developareplicable
researchprogram. They selectedtheHRNTBOC, theWechsler Intelligence
Scale for ChildrenRevised (WISCR), the Wide Range Achievement Test
(WRAT), andReitansLateral DominanceExamination. All of their subjects
had evidence of learning disabilities, but no subject was included who had
diagnosed neurologic or psychiatric disorders. Learningdisability was estab-
lished in accordance with criteria stated in Public Law 94-142, based on
decisionsmadebyamultidisciplinaryteamof educational specialists.
Theprincipal areasof investigationintheresearchprogramconductedby
Dean and his associates included the nature of the relationship between
severity of academic achievement decits and neuropsychological dysfunc-
tions, theinuenceof intelligenceandageon neuropsychological measures,
and the neuropsychological correlates of functional capabilities in reading,
spelling, andarithmetic. Theseresearchersalso investigatedthepossibilityof
establishingsubgroupsof children with learningdecits. They usedtwo ap-
proaches: (1) to establish subtypes on the basis of clinical observations and
patterns of relationships among test scores, and (2) to subject a range of
neuropsychological measurements to various statistical techniques such as
Q-factor analysisandcluster analysis.
Using the rst approach, Batchelor, Dean, and Williams (1989) formed
groupsof learning-disabledchildreninaccordancewithdiscrepanciesbetween
expected grade-equivalent performances and actual grade-equivalent scores
earnedoneachof thethreeWRAT subtests. Childrenweregroupedaccording
to three levels: current grade level or higher, grade level one year below
expectedgrade-equivalent performance, andgradelevel morethan oneyear
belowexpectedgrade-equivalent performance. Arangeof neuropsychological
variableswasthenusedinadiscriminantanalysistopredictgroupmembership
for eachindividual. Thisprocedurewassuccessful inpredictingonly32%of the
cases, with false-positives and false-negatives occurring in each of the three
groups(whichwerecomposedaccordingtodifferencesbetweenWRAT scores
andgradelevel). Theresultsappearedtobeof littleclinical useincharacteriz-
ingsubgroupsof childrenwithlearningproblems.
As a second step in this study, the investigators reorganized the subjects
according to the severity of their decits (marginal to mild, moderate, and
severe) in reading, spelling, and arithmetic. A discriminant function analysis
accuratelyclassied64%of thechildrenwithseveredecienciesand63%of the
childrenwithmoderatedeciencies; however, only25%of themarginallyto
mildlydecient subjectswereidentiedcorrectly. Theseresultssuggestedthat
when severity of decitswas considered(as contrastedwith typeof decit),
neuropsychological dysfunctioncorrelatedmorecloselywithacademicdecits
(Davis, Dean, &Krug, 1989).
A host of studies have used statistical methods to group either tests or
subjects according to neuropsychological ndings, but the results of these
investigationshavebeencharacterizedbyaconsiderabledegreeof variability.
Reasons for variability are not unexpected, considering differences in the
groupsof children evaluated, variationsin tests, anddifferencesin statistical
procedures. Inaddition, however, thereisasignicantquestionconcerningthe
degree to which any resulting subgroups of learning-disabled children who
havebeenidentiedusingthesestatistical procedureswouldactuallyt clini-
callymeaningful categories.
Batchelor, Kixmiller, andDean(1990) usedamultiregressionprocedureto
analyzedatafromtheHRNTBOC, theWISCR, andtheWRAT. Acanonical
analysisof thedatafromthesametestswasperformedbyBatchelor andDean
(1989). Thesestudiesshowedasimilarityamongteststhat predictedreading
andspellingperformance. Theteststhat demonstratedasignicant predictive
valuefor both Readingand SpellingAchievement scores fell in theareas of
verbal attention and short-termmemory, remote verbal memory, symbolic
languageintegration, nonverbal concept formation, andmotor skillsinvolving
strengthof thedominant upper extremityandne-motor speedanddexterity
of thenondominant upper extremity. Additional analyses, however, suggested
that when reading and spelling performances were combined into a single
score, the neuropsychological relationships with performances in these aca-
demicareaswerediminished(Batchelor et al., 1990). Theauthorsconcluded
that readingandspelling, fromaneuropsychological point of view, shouldbe
viewedasseparatefunctionswhichsharesomecommonelements.
Theseinvestigatorsalsostudiedtheneuropsychological aspectsof arithmetic
decits, concentrating not only on adequacy of performance, but also on
differences and similarities in results when data were based upon verbal
arithmetic performance (WISCR performances) and written arithmetic
(WRAT performances). A number of neuropsychological abilitieswassigni-
cantlylinkedwithbothoral andwrittenarithmeticperformance, but written
arithmetic performance was most closely related to measures of nonverbal
attention and immediatespatial memory. Verbal arithmetic tasks, however,
appearedtodependmoreheavilyuponverbal facility, abstract verbal reason-
ing, nonverbal short-termmemory, andnonverbal concept formation. These
investigatorsconcludedthat bothverbal andnonverbal functionsarerequired
to solve arithmetic problems, and that both verbal and written arithmetic
performancesappear toinvolvethefunctionsof boththeright andleft cerebral
hemispheres.
Itisinterestingtoconsider theseresultswithrelationtondingsreportedon
adult subjectswho hadtheadvantageof normal development throughchild-
hoodand then sustainedalateralizedcerebral lesion in adulthood. Children
withlearningdisabilitiesdevelopacademicabilitiesusingbrainfunctionsthat
maybedeviant incertainrespects, eventhoughthereisnofrankevidenceof
neurological diseaseor damage. In astudy of adult subjectswith lateralized
cerebral lesions, Wheeler andReitan(1962)foundthatabout75%of thosewho
demonstrateddyscalculiahadleft hemispherelesionsand25%hadright hemi-
spherelesions.
Thesendingswouldstill suggestthat bothhemispheresmaybeinvolvedin
arithmetical processes, but whenonehemisphereisdamaged, thegreat pre-
ponderanceof patientswithdyscalculiaarethosewithlefthemispheredamage.
It is entirely possible that the organization of behavioral capabilities in the
brainsof learning-disabledchildrenisdifferent, at least toanextent, fromthat
in thebrains of peoplewho havehad anormal brain in thedevelopmental
years. Thisseemsclearly to bethecaseamongchildrenwho havesustained
lateralizedlesionsearlyinlife(seeReitan&Wolfson, 1992).
ODonnells research program
ODonnell (1991) and his colleagues instituted a programoriented toward
producingboth researchandclinical ndingsin theinvestigationof learning
disabilities in adolescents and young adults. ODonnell noted that early
postulates, basedonstudiesof patientswithacquiredaphasia, suggestedthat
focal left cerebral lesionsmight beresponsiblefor thedifcultyencounteredby
children in acquiring reading, spelling, and computational skills. However,
most children with learning disabilities did not demonstrate any positive
ndings on the physical neurological examination or show any evidence of
major focal lesionsof thebrainon imagingprocedures. A secondhypothesis
relatedto developmental lag, which suggestedthat children with academic
problems were only a little delayed in the development of their abilities to
master academicsubject matter, andthat they could, intime, outgrowtheir
academicdifculties.
ODonnell pointed out that many studies, based upon longitudinal evalu-
ations as well as other procedures, have indicated quite clearly that many
childrenwithlearningdisabilitieshavedifcultiesthatpersistintoadulthood.In
their study of individuals who had learning disabilities in young adulthood,
ODonnell, Kurtz, andRamanaiah(1983) interpretedtheir resultsasreecting
thesamekindof psychological decitsnotedbySelzandReitan(1979a)among
childrenwithlearningdisabilities. For thesereasons, ODonnell andhisassoci-
atesfelt that comprehensiveresearchandevaluationof adolescentsandyoung
adultswithlearningdisabilitieswererequired.
ODonnell electedtoadopttheHRNTBfor Adultsashisbasicprocedurefor
collecting neuropsychological test data, essentially for the same reasons as
thosecitedbyRourkeandDean. Ascontrastedwiththeuseof anindividual
test, orevenaseriesofindividual tests,thereisagreatadvantageinunderstand-
ing a persons comparative abilities on a series of tests to determine that
personscomparativestrengthsandweaknesses, andtousethisinformationto
develop a remediation program that is appropriate for the individual.
ODonnell indicatedthat therewerefour purposesthat wereof signicancefor
hisresearchprogram:
1. To determine whether the HRNTB, together with some additional tests,
would provide evidence of neuropsychological functions that might be rel-
evant totheacademicandlearningdecienciesof youngadults.
2. Todeterminewhether theseneuropsychological measurescoulddifferentiate
among(a) normal youngadults, (b) youngadultswhohadbeendiagnosedas
havinglearningdisabilities, and(c) youngadultswhohadsustainedsignicant
head injuries, in order to establish the validity of inferences about neuro-
psychological impairment inyoungadultswithlearningdisabilities.
3. To determine whether the test results provided a basis for differentially
identifyingsubgroupsof learning-disabledyoungadultsthat might beof value
inplanningindividuallyappropriateinterventions.
4. To determinewhether socioemotional factors aresignicant in determining
theadjustmental statusof youngadultswithlearningdisabilities.
ODonnell andhiscolleaguesstudiedagroupof 233applicantstoacollege
support programfor studentswith learningdisabilities. Theseapplicantshad
been independently diagnosed in primary or secondary grades as having
learningdisabilities, andthesediagnosesappearedto havebeencontinuingly
relevant throughhighschool. Althougheachsubject met federal government
criteria for the diagnosis of learning disabilities, the subjects were not all
consistently impaired on objective measures of academic achievement. Full
ScaleIQ had been used as astandard with respect to scores earned on the
WRAT, and79%of thesesubjectshadat least onescore(Reading, Spelling, or
Arithmetic) that was15or morestandard-scorepointsbelowhisor her own
Full ScaleIQ. Inthisgroup, 83%hadat least oneWRAT scorethat wasbelow
the20thpercentile.
ODonnell pointed out that this group might not be typical generally of
young adults who have learning disabilities. Only 35%of the group had a
WRAT Readingsubtest scorethat waslessthanthe20thpercentile, whereas
83%had decient Spellingscores, and 72%had decient Arithmetic scores.
Noneof thesubjectshadahistory of brain injury, seizures, sensory decits,
drugabuse, or severeemotional problems. Thesubjectshadameanageof 18.6
yearsandameanWechsler Adult IntelligenceScale(WAIS) Full ScaleIQ of
103.4(SD9.6).
ODonnell conductedafactor analysisof theteststhat wereadministered
(essentially theHRNTB for Adults plus afew additional tests) to determine
whether theemergingfactorshadanysignicantrelevancetolearningdisabili-
ties. Sixfactorsaccountedfor 92.3%of thetotal variance, althoughthelast two
factors were not sufciently supported to be subject to interpretation.
ODonnell interpretedtherst factor aspossiblycharacterizedby nonverbal
reasoning. Thesecondfactor seemedtoreect decitsinauditoryprocessing
abilities. The third factor, based principally on tests that reected motor
functions, was clearly a motor-abilities factor. The fourth factor received
signicant loadingsfrommeasuresof sensoryperceptual skillsplusameasure
of visualmotor abilitiesandwasinterpretedasrepresentingasensorymotor
factor. ODonnell interpreted these results as suggesting that the measure-
ments in the neuropsychological test battery were relevant to deciencies
demonstratedbypeoplewithlearningdisabilities.
Thenextstepintheanalysisof theresearchdataconcernedintercorrelations
of measures fromthe neuropsychological test battery and scores fromthe
WAISandtheWRAT. Scoreswerecorrelatedfor eachof thesixfactors, scores
fromtheVerbal andPerformancesubtestsof theWAIS, andstandardscores
fromtheWRAT. Thesecorrelationswereminimal, suggestingthat theWAIS
andWRAT measureswererelatively independent of theneuropsychological
test scores. However, correlationof acombinedscorefor thesixfactorswitha
combinedscorefor PictureCompletion, PictureArrangement, Block Design,
andObject AssemblysubtestsfromtheWAISyieldedacorrelationof .60.
CorrelationsbetweenWRAT scoresandscoresfor factorsonethroughsix
weregenerallyminimal, except for acorrelationof .46betweenReadingand
thefactor representingNonverbal Reasoning, andacorrelationof .40between
Spellingand thesamefactor of Nonverbal Reasoning. Correlationsbetween
theWRAT Arithmeticscoreandfactorsonethroughsixwereminimal.
Themajor ndingsof interest inODonnellsreport concernedthesensitiv-
ityof theneuropsychological testsindifferentiatingbetweengroupsof normal,
learning-disabled, andhead-injuredyoungadults. ODonnell hadnotedthat in
previousstudiesbothlearning-disabledandbrain-damagedchildrenhadlower
IQsthannormal children, andfelt that it wouldbeadvantageoustoequateIQ
values in the groups that he studied. It should be noted, however, that
WechslerIQvalueshaverepeatedlybeenfoundtobedependentvariableswith
relationtobraindamageand, inall probability, represent part of thepictureof
neuropsychological impairment. Thus, elevating IQ values for learning-dis-
abledpeopleandbrain-damagedpeoplewould, to theextent that thesevari-
ableswerecorrelatedwithneuropsychological measures, diminishthedifferen-
cesbetweenthegroupsin termsof neuropsychological test ndingsaswell.
Nevertheless, even though ODonnellsnormal, learning-disabled, and head-
injuredgroupswerematchedfor Full ScaleIQ, hefoundverystrikingdifferen-
ces between the groups on neuropsychological measures. ODonnell per-
formedalinear discriminant functionanalysisinevaluationof thetest scores
for subjectsrepresentingthesethreegroups, andfoundthat 92%of all subjects
werecorrectlyclassied. A breakdownamongthethreegroupsindicatedthat
correct classication occurred in 100%of the normal subjects, 93%of the
learning-disabledsubjects, and80%of thehead-injuredsubjects. Sevenpercent
of the learning-disabled subjects and 7%of the head-injured subjects were
misclassiedasnormal, whereas13%of thehead-injuredsubjectswereclassi-
ed as learning disabled. The Halstead Impairment Index was particularly
effectiveindifferentiatingsubjectsamongthethreegroups. UsinganImpair-
ment Indexof 0.4asacut-off point, 97%of normal subjectswerebelowthis
point and 97%of the head-injured subjects were above it. Using this same
cut-off point, 42% of the learning-disabled subjects scored in the impaired
range. Thelearning-disabledsubjectsthereforeoccupiedanintermediateposi-
tionbetweenthenormal subjectsandthesubjectswith signicant traumatic
brain injuries, with asubstantial proportion of thelearning-disabledsubjects
experiencingadegreeof neuropsychological impairment.
ODonnell summarizedtheresultsof Phillips (1986) doctoral dissertationin
whichshecluster-analyzedthetest protocolsof 163subjects(143menand20
women) who were applicants for the Learning Disability College Support
Program. This analysis was based principally upon tests included in the
HRNTB, with the addition of a few other tests. Her analysis yielded ve
clusters: (1) normal test scores, (2) auditory processing decits, but normal
results on visualspatial measures, (3) spatial processingdecits, but normal
resultsonauditoryandlanguagemeasures, (4)global decits, and(5)language-
processingdecits.
These results suggest that adults with learning disabilities demonstrate a
variety of neuropsychological patterns, emphasizingthediversiednatureof
this condition as it is reected in neuropsychological functions. Although a
number of categoriesmaybeidentiedthroughtheuseof statistical analytical
processes, our contentionisthat everyindividual withlearningdisabilities, if
examinedover asufcientrangeof functions, will showauniqueconguration
of test scoresthat must berespected. Statistical methodsof categorizationmay
haveinvestigational or heuristic value, but wemust never forget that every
human being is an individual, and the full range of individuality should be
recognizedindealingclinicallyandtherapeuticallywitheachperson.
ODonnell also summarized the ndings of Leicht (1987), who used
LanyonsPersonalityScreeningInventory(PSI) (Lanyon, 1978) toevaluatethe
personality and social functioningof normal youngadults andyoungadults
withlearningdisabilities.
Comparisons of the normal and learning-disabled subjects, using linear
discriminant functionanalysesof thePSI data, showedthat theprolesfor the
two groups were signicantly different (p:0.001). The learning-disabled
groupconsistentlyhadhigher scoresonthePSI scales, but theaccuracywith
whichthetest scoresallocatedsubjectsto their appropriategroupswasonly
moderatelysatisfactory,withacorrectclassicationof 72.7%of thenormal and
67.1%of thelearning-disabledsubjects. ThePSI severityindexcorrectlyclassi-
ed74.4%of thenormal, but only52%of thelearning-disabledsubjects.
Leicht also performedacluster analysisof thePSI scoresfor thelearning-
disabledsubjects, whichyieldedsixclusters. Thesendingsthereforesuggested
that learning-disabledyoungadultsfall intoarangeof categorieswithrespect
to personality/ social problems. The rst cluster suggested the presence of
impulsive, sociallydominant behavior withadisregardfor social conventions
(extroverted, social nonconformists). Thesecondcluster includedpeoplewho
tendedtodenynegativefeelingsandviewthemselvesaswell-adjusted(defens-
ivelyadjusted). Thethirdcategoryincludedpeoplewhosetest resultssuggest-
ed that they were overly sensitive, had poor interpersonal skills, and were
anxious and dissatised with theworld (alienated, anxious nonconformists).
Thefourthcluster wascomposedof peoplewithnoclinicallysignicant scores
(normal subjects). The fth and sixth clusters were determined by a single
high-scaledscore, withthefthcluster suggestingadegreeof social isolation
and the sixth cluster being similar to the rst cluster, with proles that
suggestedextroverted, anxiousnonconformists. As might beexpected, these
resultsindicatedthat youngadultswithlearningdisabilitiestendedto showa
degreeof personalityandsocial problems, but problemsof thistypeappear to
berather diversied.
Individualswhofell intothesevariousclusterswerealsostudiedinrelation
to evidenceof academicskill decits, andno meaningful differencesbetween
thegroupswerefound. Theneuropsychological subtypespreviouslyfoundby
Phillips(1986)werealsocomparedtothePSI severityindex, andanalysisof the
data yielded no differences in neuropsychological subtests with respect to
personalityandsocial problems.
Withregardto hisndingsinstudyingyoungadultswithlearningdisabili-
ties, principallyusingtheHRNTB, ODonnell said:
The present results showed that the neuropsychological test battery denes academically relevant
constructs, it accurately discriminates LD from normal young adults, it shows that a proportion
(perhaps as many as 40%) of LD young adults exhibit mild neuropsychological dysfunction, and it
shows that the dysfunctional LD fall into dened subgroups (Phillips Subtypes III and IV) with
predictable educational decits. Although some LD were maladjusted (Leichts Subtypes III and V),
these maladjustments were unrelated to academic skills or to neuropsychological status. In other
words, the present research seems to support the continued viability of the neurological hypo-
thesis.
ODonnell went ontosaythat thepresent ndingsconrmthevalidityof
the HalsteadReitan Neuropsychological Test Battery in the assessment of
youngadultswithlearningdisabilities.
Reitan and Wolfsons research program
Researchandclinical workontheneuropsychologyof childrenwithlearning
and academic problems was begun by Reitan shortly after theHRNTBOC
was completed in 1955(Reitan, 1974). TheHRNTB was initially developed
accordingtothemodel later enunciatedbyReitanandWolfson(anddescribed
below), being driven by the decits actually shown by children with brain
diseaseor damage. Thus, inaveryreal sense, themodel of neuropsychological
functionsproposedbyReitanandWolfsonrepresentsaconceptual framework
that was not merely derived theoretically, but instead was determined by
empirical observation, testing, andclinical workwithbrain-damagedchildren.
Infact, eachchildenrolledineveryresearchstudywasalsotreatedasaclinical
casein order to promotetheprospect of transferring research ndings into
clinicallymeaningful andapplicableinformation.
BecausetheReitanWolfsonmodel wasalso theframework withinwhich
our studiesof academicandlearningdecitswereperformed, it isnecessaryto
providethereader withadescriptionof themodel (whichappliestoadultsas
well as children) before proceeding with discussion of research and clinical
ndingsintheareaof learningdisabilities.
TheReitanWolfson model of neuropsychological functioningprovides a
conceptual frameworkthat isimplementedusingtheHalsteadReitanBattery
for individual assessment complemented by REHABIT, an extensive set of
cognitive rehabilitation materials for remediation of the neuropsychological
decits. As descriptions and integration of the ReitanWolfson model with
assessment proceduresusingtheHalsteadReitanBatteryandbrain-retraining
procedures have been discussed in detail in other publications (Reitan &
Wolfson, 1988a, 1988c, 1992), thismodel will bedescribedonlybrieyat this
point.
AsnotedinFig. 10.1, theinitial aspect of thismodel isconcernedwithinput
of sensory information to thebrain. Theneuropsychological responsecycle
rst requiresinput tothebrainfromtheexternal environmentviaoneor more
of the sensory avenues. Primary sensory areas are located in each cerebral
hemisphere, indicatingthat thislevel of central processingiswidelyrepresen-
ted in thecerebral cortex, and involves thetemporal, parietal, and occipital
areasparticularly.
Onceinformationreachesthebrain, therst stepincentral processingisthe
registrationphase, andrepresentsalertness, attention, continuedconcentra-
tion, and the ability to screen incoming information with relation to prior
experiences (immediate, intermediate, and remote memory). Alertness and
concentrationarenecessaryfor all typesof problem-solving, andappear tobe
generallydistributedthroughout thebrain.
After initial registrationof incomingmaterial, thebrainproceedstoprocess
verbal informationintheleft cerebral hemisphereandvisualspatial informa-
tionin theright cerebral hemisphere. At thispoint, thespecializedfunctions
Fig. 10.1. Asimpliedgraphicrepresentationof theReitanWolfsonmodel of neuropsychologi-
cal functioning.
(left-brain/ right-brain) of thetwo cerebral hemispheresbecomeoperational.
Theleft cerebral hemisphere, asit developsneuropsychological capabilities,
isparticularlyinvolvedinspeechandlanguagefunctions,or theuseof language
symbolsfor communicationpurposes. Itisimportanttorememberthatdecits
may involvequitesimplekindsof speech andlanguageskillsor, conversely,
mayinvolvethesophisticatedhigher-level aspectsof verbal communication. It
must alsoberecognizedthat languagefunctionsmaybeimpairedintermsof
expressivecapabilities, receptivefunctions, or both.
Right cerebral functions particularly center on spatial abilities (mediated
principallybyvision, but also bytouchandauditoryfunction) andmanipula-
toryskills. Again, it mustbekeptinmindthatanindividual maybeimpairedin
the expressive aspects or receptive aspects of visualspatial functioning, or
both. It must alsoberememberedthat weliveinaworldof timeandspaceas
well as in a world of verbal communication. People with impairment of
visualspatial abilitiesareoftenseverelyhandicappedintermsof efciencyof
functioningin apractical, everyday sense, and this typeof impairment may
havegeneral effectswhichimpingeonlearninganddevelopment of academic
skills.
In the ReitanWolfson model, the highest level of central processing is
representedbyabstraction, reasoning, concept formation, andlogical analysis
skills. Researchevidenceindicatesthat thesefunctionsaregenerallyrepresent-
edthroughout thecerebral cortex(Doehring& Reitan, 1962). Thegenerality
andimportanceof abstractionandreasoningskillsmaybesuggestedbiologi-
callybythefact that theseskillsaredistributedthroughout thecerebral cortex
rather thanbeinglimitedasaspecializedfunctionof onecerebral hemisphere
or aparticular areawithinacerebral hemisphere. Generalizeddistributionof
abstractionabilitiesthroughout thecerebral cortexmayalso besignicant in
theinteractionof abstractionwithmorespecicabilities(suchaslanguage)that
arerepresentedmorefocally.
Impairment at thehighest level of central processinghasprofoundimplica-
tions for theadequacy of neuropsychological functioning. Peoplewith such
decits have lost a great deal of the ability to prot fromexperience in a
meaningful, logical, and organized manner. In casual or supercial contact,
however, suchpeoplemayappear toberelativelyintact, becausethenatureof
their decitsisgeneral rather than specic. Becauseof thecloserelationship
betweenorganizedbehavior andmemory, theseindividualsoftencomplainof
memoryproblemsandaregrosslyinefcient inpractical, everydaytasks. They
arenot ableto organizetheir activities properly, and frequently direct their
energytoelementsof asituationthat arenot appropriatetothenatureof the
problem. Ineverydaybehavior, decitsof thiskindaugment anyweaknesses
that thechildmayhaveinareasof attentionandfocusedconcentration.
This nonappropriate activity, often followed by an eventual withdrawal
fromattempting to deal with problemsituations, also constitutes a major
componentof whatisfrequently(andimprecisely)referredtoasapersonality
change. Uponclinical inquiry, suchchangesareoftenfoundtoconsistof erratic
and poorly planned behavior, deterioration of personal hygiene, a lack of
concernandunderstandingfor others, etc. Whenexaminedneuropsychologi-
cally, it is often discovered that these behaviors are largely represented by
cognitivechangesatthehighestlevel of central processingandaremisclassied
asprimaryemotional problems.
Finally, insolvingindividual problemsor expressingintelligentbehavior, itis
important to recognize that the sequential element from input to output
frequentlyinvolvesaninteractionof thevariousaspectsof central processing.
Visualspatial skills, for example, arecloselydependent uponregistrationand
continuedattentiontoincomingmaterial of avisualspatial nature,butanalysis
andunderstandingof theproblemalsoinvolvethehighest element of central
processing, representedbyconcept formation, reasoning, andlogical analysis.
Exactly the same kind of relationship between areas of functioning in the
ReitanWolfson model determines ones effectiveness in using verbal and
languageskills. Infact, thespeedandfacilitywithwhichanindividual carries
out such interactions within the content categories of central processing
probably in themselves represent a signicant aspect of efciency in brain
functioning.
The nal aspect of the model is represented by output, or the motor
responsethat isrequiredtoimplement theinput (observationof theproblem)
andcentral processing(analysisof theproblem). It must berememberedthat
the motor response, in and of itself, is not usually the critical element of
neuropsychological efciency or adaptability. The central processes, which
guidetheresponse, usuallyrepresent thecritical competencies. Thus, thechild
with learning disabilities may haveadequatesensory function and adequate
muscular functiontoperform, but thelimitingcompetencieslieinthelinkage
betweenthesetwoareas, namelycentral processingcapabilities. TheHRNTB
wasdevisedtoprovideanunderstandingof theseimmenselycomplexlinkages
astheyexist for theindividual child.
Some basic principles of neuropsychology
If impairment of brain functions, even though subtleand perhaps relatively
mildinmostcasesoflearningdisability,isafactorinproducinglimitedaptitude
for academicachievement, itisimportanttoreviewcertainbasicprinciplesthat
havebeenlearnedthroughthestudy of childrenwith knowndamageof the
brain.
Principle 1
Theeldof childneuropsychologyhasbeenplaguedfor manyyearsbywhatis
referredto astheKennardprinciple. Thisprinciplestatesthat, becauseof the
plasticity of the immature brain, and the great potential for recovery of
functions, theeffectsof cerebral damageininfancyor earlychildhoodarefar
lessimpairingthantheeffectsof braindamagesustainedinadulthood(follow-
ingmaturationof brainbehavior relationships).
TheKennardprinciplewasbasedonthework of Margaret Kennardinthe
late1930sandearly1940s(Kennard, 1936, 1938, 1942). Kennardimposedbrain
lesionsininfantileandadult monkeysandfound, ingeneral, that therewasa
lesser degreeof decit andgreater recoveryof motor functionsintheinfantile
monkeys. AlthoughKennardherself didnot generalizethisndingto human
beings, and even recognized that the ndings did not apply perfectly in
differentiatinginfantileandadultmonkeys, therewasastrongtendencyamong
psychologists and neuroscientists to generalize the principle. In fact, Rudel
(1978) citedthewell-knownneuropsychologist Hans-LukasTeuber ashaving
commentedduringamajor conferenceon theeffectsof headtraumain the
1960sthat if onewereto sustainabraininjury, it wouldbewiseto havethe
headinjuryinchildhoodratherthaninadulthoodinordertoescapedeleterious
andimpairingeffects.
Reitan and Wolfson (1992) reviewed, in considerabledetail, theliterature
concerningtheeffectsof infantileversusadult braindamage, andfoundthat
althoughanumber of neuroscientistshadbeguntoquestionitsapplicabilityto
humans, arather pervasivebelief intheKennardprinciplecontinuedtoexist in
the1980s. ReitanandWolfsonconcludedthattheKennardprinciple, insteadof
beingaruletofollow, isinmost casesquitemisleadingwithrespect tohuman
beings. Evaluations of children who had sustained infantile brain damage
provideevidenceof quitesignicant and serious neuropsychological impair-
ment, apparently resultingfromthefact that thechilds impairedbrain pro-
vided an equally impaired potential for developing normal intellectual and
cognitiveabilities. Inorder toevaluatethegenerallyimpairingeffectsof early
cerebral damage, Reitan and Wolfson (1992) performed a very simple test.
Theyidentiedtherst tenchildrenintheir leswhohadabraininjurythat
datedbacktothetimeof thechildsbirth. TheirIQvalues, whentestedasolder
children, wereasfollows: 34(estimated), thenext childwastoo impairedto
test, 91, 46, 82, 46, 52, 73, 57, and50. Omittingthechildwhowassoimpaired
thatitwasnotpossibletotesthim, thesevaluesyieldameanFull ScaleIQof 59
(meanVerbal IQ, 63.56; meanPerformanceIQ, 60.44).
Althoughmanyneuroscientistshaveemphasizedtheplasticityof theimma-
turebrainandthepotential for recovery(baseduponneurophysiological and
neurochemical studiesat thecellular level aswell asinvestigationsusinglower
animals), it wouldappear to bemorepertinent to direct thequestion to the
actual developmentof humanbeings. Theresultsof suchinquiriesindicatethat
development of higher-level intellectual and cognitivefunctions is generally
difculttoachievefor childrenwithdamagedbrains, particularlyif thedamage
issubstantial.
Principle 2
Onefactor that issignicant indeterminingneuropsychological test resultsfor
individual childrenrelatestotheageatwhichbraindamagewassustained(and
thereciprocal factor, thedurationof cerebral damage).
Fig. 10.2. Schematic illustration of a theoretical postulate regarding the effect on neuro-
psychological development of cerebral damagesustainedat different ages.
Theearlier braindamagehasbeensustained(other factorsbeingequal), the
moreseveretheneuropsychological impairment (seeReitan&Wolfson, 1992,
for amorecompletediscussion). If neuropsychological development isessen-
tially complete before brain damage is sustained, the limitation of future
development of neuropsychological function is less signicant. However, in
this latter casethechild comes closer to thetypical situation of adults who
sustaincerebral damageheor shesuffersimpairmentof previouslydeveloped
abilities.
Figure10.2providesanillustrationof thegeneral effectsof cerebral damage
and the developmental consequences with relation to the ageat which the
damagewas sustained. This graph obviously represents asimplication and
generalizationof theserelationships. For example, neuropsychological devel-
opment undoubtedly is not a single or unitary factor. Some research has
indicatedthat verbal abilitiesandskillsmatureconsiderablymoreslowlythan
abilitiesrelated to abstraction and logical reasoning. Nevertheless, if abrain
lesionof fairlysignicant proportionsissustainedat theageof twoyears, the
consequences appear to be relatively severe, because the child is put on a
generallydifferent courseof development ascomparedwiththenormal child.
If damage is sustained at the age of four years, a greater degreeof normal
development has preceded the occurrence of cerebral damage and, even
though the child is put on a reduced general course of neuropsychological
development, hisor her eventual level of abilitiesissomewhat higher. It must
berememberedthat afairlysubstantial brainlesionisnecessarytoproducethe
typeof effectsnotedinFig. 10.2, that other factorsarealso of inuence, and
that individual variationistobeexpected.
Figure10.2hasverypractical signicancefor thosepsychologistsinvolvedin
the longitudinal assessment of individual children. For example, it is not
uncommonfor achildwithcerebral damagetoshowprogressivelylower IQs
asheorshegrowsolder. Insomeinstances, thisapparentdeclineinintelligence
hascausedconcernabout thepossibilityof sometypeof progressivedeteriora-
tionof brainfunctions. Itmustberemembered,however, thatabrain-damaged
child does not usually have the basic brain functions to develop neuro-
psychological abilitiesat thesamerateas anormal child, even though their
chronological agesprogressat exactlythesamerate. Thus, theratiobetween
mental ageandchronological agefailstofollowthenormal progressionandthe
fractiondecreases, resultinginalower IQ.
Principle 3
The age at which brain damage is sustained has a signicant inuence on
neuropsychological development, andthisinuenceinteractswithimpairment
of abilitiesthat havealreadybeenacquired.
Ingeneral, theyounger thechildat thetimebraindamageissustained, the
greater the inuence of age at the time of brain damage in limiting future
development, andthelesser theinuenceof lossor impairment of pre-existing
abilities(seeReitan& Wolfson, 1992, for amorecompletediscussion). With
older children, however, specic and selectiveimpairment of previously ac-
quiredabilitiesisafactor of increasedsignicance, andthebrainspotential to
acquireadditional neuropsychological abilitiesassumesalesser role.
It isimportant torecognizethat theinteractionof thesevariablesinuences
thepatternof neuropsychological decit for theindividual child. Braindamage
earlyinlife, whichlimitspotential for development, hasageneralizedeffecton
neuropsychological abilities, and tends to produce a picture of generalized
impairment regardlessof thelateralizationor locationof thelesion. However,
inolder childrenwhohavealreadyacquiredbrain-relatedabilities, alateralized
lesionmayproducemorespecicdecits(for example, inanolder child, aloss
of Performanceintelligencemay result fromright cerebral damage). Astime
progressesfollowingthebrainlesion, evenwitholder childrenandadults, the
acute effects (selective impairment) of focal or lateralized lesions tend to
diminish, yieldingtoapictureof moregeneralizedhigher-level decits.
Theinferential approachconcernedwithcomparisonsof identical perform-
anceson thetwo sidesof thebody (such asnger tappingandtactilenger
localization) tendsnot tobeinuencedbydevelopmental factorstotheextent
andinthesamemannerashigher-level neuropsychological functions. Sensory
perceptual and motor functions areheavily dependent upon theanatomical
pathways by which they are mediated. For example, a lesion of the right
cerebral hemisphere occurring early in life is likely to produce sensory
perceptual andmotordecitsonthecontralateral sideof thebodyregardlessof
thechildsage, eventhoughhigher-level abilities(suchasVerbal andPerform-
anceintelligence) arebothimpairedandmaynot showanysubstantial differ-
ence.
Theabovethreeprinciplescannot beexpectedtoapplyperfectlytochildren
with learning disabilities, inasmuch as these children generally show little
evidence of structural damage of the brain tissue. Thus, they would, in all
probability, differ in a number of neuropsychological aspects fromchildren
withknownbraindamage. However, if biological impairment of brainfunc-
tionsisarelevant factor inproducinglearningdisabilities, thesechildrenmay
also be similar in a number of neuropsychological aspects to children with
known brain damage, and particularly to those children who sustain brain
damageearlyinlife.
Research finding comparing normal, learning-disabled, and
brain-damaged children
TherehavebeenextensivestudiesvalidatingtheHRNTBOCasabatterythat
signicantlydifferentiatesbetweenbrain-damagedandnormal children(Reed,
Reitan, & Klve, 1965; Boll, 1974). Additional investigationsincludedchildren
with academic deciencies and learningdisabilities for comparison with the
abovetwogroups.
Selz andReitan (1979a) conducted adetailedstudy that comparedneuro-
psychological test results of three groups: 25 control children, 25 learning-
disabledchildren, and25brain-damagedchildren. Thepurposeof this study
wastoidentifytheuniqueneuropsychological featuresof childrenwithlearn-
ingdisabilitiescomparedwithcontrol andbrain-damagedchildren. However,
theseinvestigationsalso demonstratedthestrikingandconsistent differences
between control children and brain-damagedchildren, and identied certain
consistentcharacteristicsthatwererelativelyuniquetothegroupwithlearning
disabilities.
The25control subjectsintheSelzandReitanstudieswerevolunteersfrom
twoschool systems; 15childrencamefromasmall-townschool andtenwere
fromasuburbanschool. Noneof thesechildrenhadevidenceof braindysfunc-
tion, and all were functioning normally without any academic problems or
complaints. Obviously, this does not mean that every child was performing
ideally,butnoneof thechildrenhadevidenceof pastorpresentcerebral disease
or damage and all were progressing adequately within their normal class
placements. Themeanageof thisgroupwas128.16months(SD13.08).
Nine of the children with learning disabilities attended city schools, four
attendedsuburbanschools, and12wereenrolledinschoolsinsmall towns.The
subjectsfor thisgroupwerereferredfor neuropsychological testingprimarily
onthebasisof school-relateddecient performance. All of thesechildrenhad
signicant academicdecits; disciplineor moregeneral school problemswere
alsonotedintherecordsof vesubjects. Four childrenhadbeenheldbackone
year inschool, onechildwasheldbacktwoyears, andonechildhadrepeated
threegrades. Inaddition, scoresontheWRAT indicatedthat 22of thechildren
showed a year or more retardation in reading and/ or spelling. The three
childrenwho didnot showdecient WRAT performanceswerefromprofes-
sional families, and had well-documented evidence of signicant learning
problems. Noneof thesubjectswith learningdisabilitieshadaFull ScaleIQ
below 80. All of the children were given a complete physical neurological
examination, and any child who had positive past or present evidence of
clinicallysignicant cerebral diseaseor damagewasexcludedfromthegroup.
Therewere 19 boys and six girls in this group, with a mean age of 134.88
months(SD14.79).
Amongthebrain-damaged children, nine attended city schools, seven at-
tendedsuburban schools, andninewereenrolledin schoolsin small towns.
Thesubjectswereselectedonthebasisof compellingevidencederivedfrom
their neurological examination (includingspecialized neurological diagnostic
procedures), and each child had independent and documented evidence of
structural brain damageor aclinically signicant brain disorder. Selectionof
thesechildrenwasentirelyindependentof psychological testperformances. No
attemptwasmadetoselectbrain-damagedchildrenaccordingtolocation, type,
or severity of cerebral damage, and the total group therefore represented
heterogeneousbraininvolvement. Thediagnosesof thisgroupincludedintra-
cranial tumor, both open and closedhead injuries, arteriovenousmalforma-
tion, encephalitis, cerebral abscess, idiopathic epilepsy, and birth injury. The
meanageof thebrain-damagedgroupwas133.80months(SD17.31).
Inthisstudy, thedependent variablesincludedVerbal IQ, PerformanceIQ,
Full Scale IQ, and the results of ten tests included in the HRNTBOC.
Multivariateanalysisof varianceindicatedthat themeanvalueswerenot the
samefor all threegroups, yielding ahighly signicant difference. Using the
three diagnostic categories, a discriminant analysis based on 13 measures
correctly classied23of the25controls, 19of the25children with learning
disabilities, and18of the25childrenwithbraindamage.
Fourof thechildrenwithbraindamagewereverymildlyimpairedand, from
the statistical analysis, appeared to be control subjects. A certain degree of
overlapof thiskindistobeexpected, buttheresultsindicatedquiteclearlythat
the test results, generally considered for the children in the three groups,
permitteddifferential classicationintotheir appropriatecategories. Thisstudy
demonstrated that children with learning disabilities tended to have neuro-
psychological test scoresthat wereintermediatetotheother twogroups.
Theoutstandingndingof thisinvestigation, however, wasthatthechildren
withcerebral damageperformedmuchmorepoorlythanthecontrol subjects.
Infact, amongthethreegroups, discriminantanalysisyieldedanoverall correct
classication of 80%. When thegroup with learningdisabilitieswas deleted
fromconsideration, differentiationbetweenthecontrol andthebrain-damaged
subjectswasachievedwithahit-rateof about 87%correct classications.
Thisstudyprovidedanunequivocal answertotherstquestionthatmustbe
asked: does the HRNTBOC provide a valid and sensitive procedure for
differentiating between children with normal brains and children with
damagedbrains?Thisisaquestionthat iscritical totheutilizationof thetest
battery, andtheanswer, clearly, waspositive. Secondly, thestatistical analyses
alsoseparatedthelearning-disabledchildrenfromboththenormal controlsand
thebrain-damagedchildren. EvenwithFull ScaleIQstatisticallycontrolled, the
neuropsychological measuresdifferentiatedthethreegroupsat ahighlevel of
statistical signicance.
The signicance of this study lies in the fact that an approach oriented
toward adequacy of brainbehavior relationships was relevant not only in
differential classicationof thegroupwith denitebraindamage, but also of
subjects with learning disabilities. The results give strong support to the
postulatethat neuropsychological disabilitiesunderliemanyinstancesof acad-
emicfailure. Thisndingisespecially interestingin considerationof thefact
that the learning disabilities group was carefully screened on the basis of
neurological (medical) ndings, andthelearning-disabledchildrenwereindis-
tinguishable fromthe control subjects in this respect. Thus, it would seem
possible to conclude that neuropsychological decits or deviations, in the
absenceof medical neurological abnormalities, mayberelevantinasubstantial
proportionof childrenwithlearningdisabilities.
The next question concerned the prospect of developing a method for
classifying individual children correctly into their appropriate groups. The
same three groups (normal controls, children with learning disabilities, and
childrenwithbraindamage) wereusedfor thispurpose.
First, entirelyseparategroupsof 19childrenwerecomposedineachof the
threecategories. Usingresultsof theHRNTBOCalone, wedeveloped37rules
for generatingascorefor any childwho hadbeengiventhebattery of tests.
Rawscoreswereconvertedtoscaledscores, withascoreof zerorepresentinga
performanceinthenormal tosuperior range. Ascoreof 1indicatedaperform-
ancethat wasstill inthenormal range, but not quiteasgoodasmayhavebeen
expected. A scoreof 2wassomewhat belownormal limits, andascoreof 3
correspondedwithdeniteimpairment. Whereasthescoresfor thepilotgroup
wereused as thebasisfor determiningthesescore-ranges, theactual cut-off
points were based on our extensive clinical experience rather than upon
arbitrary statistical procedures. The systemof rules was not only based on
level of performance, but alsoincludeddifferencesinscoresfor thetwosides
of thebody, patternsof scores, andpathognomonicdecitsoncertainsimple
tests.
Theruleswerethen tested (Selz & Reitan, 1979b) with thethreegroups,
eachof whichincluded25subjects. A total scorecouldbeobtainedfor each
subject, andthemeansfor thethreegroupswerestrikinglydifferent (10.60for
thecontrols; 24.44for thegroupwith learningdisabilities; and 40.60for the
brain-damagedchildren), with probability levels far exceeding0.001in com-
parisonof anypair of groups.
In total, the rules systemcorrectly classied 73.3%of the75children: 24
(96%)of thecontrols, 14(56%) of thechildrenwithlearningdisabilities, and17
(68%) of thebrain-damagedchildren. Obviously, therulessystemwasconser-
vativein identifyingchildrenasnon-normal, although it must also berecog-
nizedthat somelearning-disabledchildren, andevensomechildrenwithmild
initial braindamagewhohavelargelyrecovered, might beexpectedto fall in
thenormal rangeof neuropsychological functions.
Theseresultsindicatethat, ingeneral, entirelyobjectivedatarepresentedby
neuropsychological test scorescandifferentiatenormal, learning-disabled, and
brain-damagedgroupsof children, withthelearning-disabledgroupsoccupying
anintermediatepositionwithrespect tothedegreeof impairment. Detailsfor
scoringthe37rules areprovidedin theoriginal publication (Selz & Reitan,
1979b), but consideringtheerror-ratenoted above, werecommendthat the
scoresbeusedonlyasaguidelinefor further evaluation.
Becausethelearning-disabledgroupconsistedof childrenwho hadnormal
results on the physical neurological examination, it is apparent that many
childrenwhohavealearningdisabilityappear normal onroutineneurological
evaluationbut demonstratesomewhat deviant brainfunctionsonthebasisof
neuropsychological evaluation.
Becauseneuropsychological testingappearsto bemoresensitiveto subtle,
higher-level cognitive dysfunction than does the neurological exam(Klve,
1974), it isimpliedthat learningdisabilityrepresentsfairlynormal lower-level
functions(asrepresentedin theneurological examination), with impairment
primarily evident in thehigher-level cognitiveprocesses (as indicated in the
neuropsychological examination). Furthermore, because all of the learning-
disabledsubjectswereinthenormal rangeaccordingtothephysical neurologi-
cal exam, it follows that neuropsychological screeningfor learningdisability
may be far more effective than neurological screening. The rules system
provides a convenient method for interpreting test results, and should be
helpful intheclinical evaluationof childrenwithlearningdisabilities.
Developmental dysphasia and its relationship to learning disabilities
Aconditioninchildrenreferredtoasdevelopmental dysphasiaappearstobevery
similar tolearningdisabilities, but theliteraturepertainingtotheseconditions
tendstooverlaprelativelylittle. Zangwill (1978) referredtooneof theearliest
casesof developmental dysphasiatobereportedat somelength, andthiswas
byHead(1926) inhiswidelyrecognizedbookAphasiaandKindredDisordersof
Speech. Thus, developmental dysphasia, asacategorical disorder, far precedes
learningdisabilitiesintime.
Wyke(1978)describeddevelopmental dysphasiaasthedecitintheacquisi-
tion of normal language functions in children of normal or above normal
intelligence and with adequate hearing ability to permit the perception of
verbal sounds. Zangwill (1978) statedthat developmental dysphasiadenotes
slow, limitedor otherwisefaultydevelopmentof languageinchildren whodo
not haveevidenceof grossneurological or psychiatricdisability, mental retar-
dation, autism, or deafness. Hewentontosaythattheoutstandinghandicapof
such children is social and educational rather than physical, and sensory or
motor decitsarerarelyevident.
Therehas been agooddeal of debateabout whether developmental dys-
phasiaimplicatesbrain impairment biologically or whether it may bedueto
other factors(Wyke, 1978). Gaddes(1980)espousedapositioninwhichhewas
unequivocal inrelatingbrainfunctionto thedevelopment of languageskills.
His review of the evidence led himto conclude that the brain is not only
generallyinvolvedindevelopmental dysphasia, but isinvolvedspecicallyin
termsof thelocationandseverityof damageinthebraincentersnecessaryfor
language. Hefelt that milddysfunction in thelanguagecenterswill causea
child to have a specic learning disability, whereas more severe damage in
thesecenterswill merit adiagnosisof dysphasia. Hestatedexplicitlythat it is
important to remember that while the child with specic developmental
dyslexiaisfreefromgrossneurological damageasshownontheneurological
examination, this, of course, doesnot excludethepossibilityof veryminimal
neurological braindysfunctions. Aswell, theremaybeafurther possibilityof a
geneticdecit that somewhat interfereswithnormal reading (p. 252). Gaddes
andEdgell (1994) alsoreviewedindetail theneurobiological basesfor reading
decits.
Itisapparentthatthedenitionof developmental dysphasia, aswell asmany
of the issues surrounding it, is very similar to the denitions of learning
disabilities. Consideringour interest inbothdevelopmental dysphasia(Reitan,
1964, 1985;Reitan&Klve, 1968)andlearningdisabilitiesandthemethodsthat
wedevelopedtoevaluatedysphasicmanifestations(Reitan, 1960, 1984, 1985),
wewereeager toexaminelearning-disabledchildrenusingtheReitanIndiana
AphasiaScreeningTest (Reitan, 1985). Thistest consistsof itemsthat require
namingof objects, identicationof numbersandletters, simplereading, simple
writing, spelling, arithmetic in the form of subtraction and multiplication,
repetition of words and sentences, explanation of the meaning of a simple
sentence, demonstrationof theuseof objects, identicationof right andleft
together withidenticationof body parts, andcopyingspatial congurations
such as a square, cross, and triangle. Failures on items of the test can be
translatedintodysphasicandrelatedsymptomssuchasbodydysgnosia, visual
number and/ or letter dysgnosia, auditory verbal dysgnosia, dysnomia, dys-
graphia, dyslexia, dyscalculia, spellingdyspraxia, central dysarthria, rightleft
confusion, andconstructional dyspraxia(seeReitan&Wolfson, 1992, 1993, for
amore completedescription of the AphasiaScreeningTest, procedures for
administrationand scoring, areviewof research reports, and illustrationsof
clinical interpretation). The test usually requires less than 30 minutes for
administration.
ReitanandWolfson(1985) analyzedresultsontheReitanIndianaAphasia
ScreeningTest for thethreegroupsof children(normal, learning-disabled, and
brain-damaged) used by Selz and Reitan (1979b). Results wereevaluated by
assigningscaledscorestoeachdecitthatwasfound. Ascoreof 0wasgivenfor
performancesthatfell withinthenormal range. Ifaparticulardecitwasfound,
it was assignedascoreof 1, 2, or 3, dependingupon thesignicanceof the
decit for cerebral damage. For example, spellingdyspraxiareceivedascaled
scoreof 1, whereasdysnomia, whichisamoredeniteandsignicantindicator
of cerebral impairment, receivedascoreof 3.
Thisparticularstudyincludedanapproachtowardvalidationof thedatathat
israrely used: weelectedto predict theresultsthat wouldbefoundin each
group and to compare the predicted result with the actual outcome. This
procedurewaspossiblebecausethescoringprocedurewasbasedonthe4-point
scaledescribedabove.
Havinghadconsiderableexperiencewithchildrenineachof thegroups, we
feltthat it mightbepossibletopredict thepercentageof childrenineachgroup
whowouldshoweachtypeof decit. For example, if weexpectednoneof the
subjectstodemonstratebodydysgnosia, thepredictionwouldbethat all 25of
thesesubjectswouldhaveascoreof 0for that variable. If wefelt that noneof
thecontrolswouldshowevidenceof dysnomia, all 25childrenwouldbeplaced
in the normal category. Dysnomia occurs occasionally in brain-damaged
children, andwepredictedthatfourof these25children(16%)wouldshowthis
particular decit. In thismanner, predictionsweremadefor each variablein
eachgroupwithout knowledgeof theactual results.
It isobviousthat any attempt to makepredictionsof thiskindnecessarily
depends upon havingaconsiderableamount of clinical experiencewith the
broadrangeof childrenwhofall ineachof thethreegroupsbeingstudied, as
well asagooddeal of knowledgeof thetypesof resultsthat werereectedby
thedependent variables. It wasthereforepossiblethat suchpredictionswould
endupbeingstrikinglydeviant fromtheactual outcome. Ontheother hand, if
thepredictionsagreedrelativelycloselywiththeactual outcome, therewould
beaverypowerful validationof theexperimental ndings.
As shown in Table 10.1, we predicted that none of the control children
woulddemonstratethedecitsnoted, andtheactual outcomedataindicated
that thispredictionwascorrect. Wealsopredictedthat noneof thesedecits
wouldoccur amongthe25childrenwithlearningdisabilities, andthispredic-
tionagainwasconrmed. However, wefelt that it waslikelythat onechildin
thegroup of 25brain-damagedchildren (4%) would show thesedecits. As
indicatedin Table10.1, body dysgnosiaand auditory verbal dysgnosiawere
eachdemonstratedbyonechild(4%), whereastwochildrenwithbraindamage
(8%) showedevidenceof visual number dysgnosia.
Considering the rare occurrence of these particular decits, one could
question why tests for themwere even included in the examination. It is
important to recognizethat, when theseparticular decits arepresent, they
haveserious implicationsfor impairment of brain functions. Fromaclinical
point of view, it isimportant todiscerndecitsof thiskind, eventhoughthey
occur rarely.
Thenext groupingof decits fromtheAphasiaScreeningTest was com-
posedof thetypeof disordersfrequentlymanifestedbychildrenwithlearning
Table 10.1. Predicted and actual incidence of infrequent aphasic symptoms in control
children, learning-disabled (LD) children, and brain-damaged (BD) children
Decit Control (%) LD(%) BD(%)
Predicted Actual Predicted Actual Predicted Actual
Bodydysgnosia 0 0 0 0 4 4
Auditoryverbal 0 0 0 0 4 4
dysgnosia
Visual number 0 0 0 0 4 8
dysgnosia
Table 10.2. Predicted and actual incidence of aphasic symptoms seen frequently in
children with learning disabilities (LD) and children with brain damage (BD)
Visual letter 0 0 16 12 16 12
dysgnosia
Dysnomia 0 0 16 12 16 12
Dysgraphia 4 0 24 24 24 36
Dyscalculia 4 0 40 40 40 36
Central dysarthria4 4 40 40 40 40
disabilities. AsseeninTable10.2, thesedecitsincludedvisual letter dysgnosia,
dysnomia, dysgraphia, dyscalculia, and central dysarthria. Table 10.2 also
shows that weexpected noneof thecontrol children to demonstratevisual
letter dysgnosiaor dysnomia, but weestimatedthat onechildinthecontrol
group(4%) would showdysgraphia, dyscalculia, and central dysarthria. The
outcomeresultsfor thecontrol childrenwerejust alittlebetter thanwehad
predicted. Onechildshowedevidenceof central dysarthria, but noneof the
control childrenmanifestedanyof theother difculties.
Amongthechildrenwithlearningdisabilitiesandbraindamage, wefelt that
thesedisorderswouldbemorecommonandcomparableinthetwogroups. As
seen in Table10.2, wepredictedan incidencerangingfrom16%to 40%for
thesevariables. Theactual outcomewasverycloseto thepredictedfrequen-
cies, conrmingour estimatesof themorecommonmanifestationsof dyscal-
culiaandcentral dysarthriathanof theother decits.
Weelectedtotreat dyslexiaasaseparatevariablebecauseof itscentral role
Table 10.3. Predicted and actual incidence of dyslexia
Dyslexia 4 4 56 52 44 40
LD, learning-disabledchildren; BD, brain-damagedchildren.
Table 10.4. Predicted and actual incidence of common symptoms
Rightleft 24 36 48 48 48 28
confusion
Spelling 24 12 76 76 68 68
dyspraxia
amonglearning-disabledchildren, and thepredicted and actual incidenceof
dyslexiaisshowninTable10.3. Wefeltthatoneof the25control children(4%)
wouldshowevidenceof readingimpairment on theAphasiaScreeningTest,
andthispredictionwasconrmed. Wepredictedthat readingdifcultywould
actuallybemorecommonamongthechildrenwithlearning-disabilitiesthan
amongthebrain-damagedchildren, respectingthefact that each childin the
learning-disabilitygrouphadbeenidentiedbytheclassroomteacherashaving
specicacademicdecitswhichneededevaluationandremediation. Thus, we
predicted that 56% of the children in this group would manifest positive
ndings on the Aphasia Screening Test, and the actual outcome was 52%.
Readingdifcultiesarenot uncommonamongchildrenwithcerebral lesions,
andwepredictedthat 44%of thesechildrenwouldhavesuchevidence. The
actual outcomewas40%. Again, thecorrespondencebetween predictedand
actual valueswasextremelyclose.
Table10.4presentsthepredictedandactual resultsfor rightleft confusion
and spelling dyspraxia, two types of decits that are fairly common, even
amongcontrol subjects, inthe9-year through14-year agerange. Wepredicted
that 24% of the control children would manifest rightleft confusion and
spellingdyspraxia. Our predictionsfor thesevariableswererather deviantfrom
theoutcome: morechildrenthanexpectedactuallydemonstratedevidenceof
Table 10.5. Predicted and actual incidence of constructional dyspraxia
Constructional 4 8 32 32 48 52
dyspraxia
rightleft confusion, andfewer childrenthanexpecteddemonstratedspelling
dyspraxia.
Our predictionsof thefrequencyof thesedecitsamongthechildrenwith
learning disabilities turned out to be exactly in accordance with the actual
outcome. As we had predicted, children with brain damage also frequently
manifest evidence of spelling dyspraxia. However, in this brain-damaged
sample, the incidence of rightleft confusion was strikingly low, not only
deviating fromour predicted frequency, but actually being lower than the
frequencyfor thecontrol sampleinthisstudy.
Thenal variableweevaluatedwasconstructional dyspraxia. Weexpected
thisdecit to bemorecommonamongbrain-damagedchildrenthanamong
thesubjectswithlearningdisability, andtooccur rarelywithcontrol children.
As shown by the values in Table 10.5, these predictions were essentially
conrmed.
After we made predictions about the frequency of each decit for each
group, wewereabletocomputemeanscoresfor thepredictionsaswell asfor
theactual outcomeresults. AsseeninTable10.6, thecontrolshadapredicted
mean of 0.64 and an actual outcome of 0.80. This means that the average
performanceof thecontrol childrenwasnearlyperfect ontheAphasiaScreen-
ingTest, becauseanytypeof decit wouldhavecontributedaminimumscore
of 1. Predictionsfor thelearning-disabledgroupyieldedameanof 5.88points;
theactual outcomewas5.72points. Thebrain-damagedgroupperformedjusta
little worse than the children with learning disabilities, earning a predicted
meanof 6.24points(whichagreedexactlywiththeactual outcome).
It isapparent fromthesesummarizedndingsthat basicandsimpleaspects
oflanguageabilitiesaresubstantiallyimpairedingroupswithlearningdisability
or brain damage, but that performances are essentially normal for control
children. This observation led us to tally thenumber of children in each of
several categories to determinedifferences in thedistributions for thethree
groups. TheseresultsareshowninTable10.7.
Table 10.6. Predicted and actual mean scores (based upon ratings from 0 to 3 for
each variable) for control children (LD), learning-disabled children, and
brain-damaged children (BD)
Control LD BD
Predictedoutcome .64 5.88 6.24
Actual outcome .80 5.72 6.24
Table 10.7. Performance of groups on the Aphasia Screening Test and classicationof
subjects based on aphasic decits
Groups Total Decit Score Correct
classication(%)
0 1 2or more
Control 12 11 2 92
Learning-disabled 2 4 19 76
Brain-damaged 2 2 21 84
Intotal, 23of the25control children(92%) hadtotal scoresof 0or 1. More
specically, 12 of the control children made no errors at all on the entire
AphasiaScreeningTest. Elevenchildrendemonstratedeitherspellingdyspraxia
or rightleft confusion, and two of the 25 children had difculties which
extendedbeyondthislevel.
Childrenwithlearningdisabilityor braindamagewererarelyperfectintheir
performances, andusuallyaccumulatedasubstantial number of points, reect-
ingtheir decits. Infact, 19(75%)of thechildrenwithlearningdisabilityand21
(84%) of thebrain-damagedchildren had scores of 2or morepoints. These
resultssuggestthattheAphasiaScreeningTestcanbeaveryvaluablescreening
procedurefor identifyingchildrenwithlearningdisabilitiesor braindamage. In
addition, theresultsdemonstratethat theAphasiaScreeningTest isuseful in
identifyingimpairment in theability to uselanguageandverbal symbolsfor
communicationpurposes.
Concerningthevaryingpositionsreviewedat thebeginningof thissection
aboutthenatureof developmental dysphasiaanditsrelationshiptothebiologi-
cal conditionof thebrain, our resultsstronglyconrmthepositionof Gaddes
(1980), whofeltthatbrain-damagedsubjectswouldperformsignicantlyworse
thancontrols, andthatlearningdisability, atleastinmostcases, resultedfroma
more subtle type of cerebral impairment. In turn, these empirical ndings
arguestrongly that (1) acondition such as developmental dysphasiaand/ or
learningdisabilities can beidentied using even simpletechniques and pro-
ceduresof examination; (2) thedecitsmanifestedby childrenwithdevelop-
mental and/ or learning disabilities are related to cerebral damage; and (3)
clinical evaluation usingtheAphasiaScreeningTest can providevery useful
information, not onlyfor childrenwithdenitecerebral damage, but also for
childrenwithlearningdisabilities.
Research comparisons of brain-damaged, learning-disabled, and control
groups using the NDS
ReitanandWolfson(1992, 1993) developedNeuropsychological Decit Scales
(NDS)for bothadultsandchildren. Thescalesarereportedanddescribedfully
in bookson theHRNTBfor adultsandchildren. NDSscores, basedon raw
scores, canbedeterminedfor eachvariableinthebattery(45variablesfor older
children; 42variables for adults). Theadvantageof NDSscores is that they
representfour classicationsandrelatetotheclinical signicanceof rawscores.
AnNDSscoreof 0representsanexcellentperformance;ascoreof 1isanormal
score, but not quiteas good as it might be. A distinct dividingpoint occurs
betweenNDSscoresof 1and2, becausescoresof 2fall inthebrain-damaged
range. NDSscoresof 2correspondwith mildto moderatedecits, andNDS
scoresof 3represent severedecits.
ReitanandWolfson(1988b) usedNDSscorestocharacterizeandcompare
normal, learning-disabled, and brain-damaged children. In this study, 35
childrenwithbraindamage, 35childrenwithnormal brainfunctions, and23
childrenwithlearningdisabilitieswereevaluated. Agedifferencesbetweenthe
groupsdidnot approachstatistical signicance.
Although none of the children with learning disabilities showed any evi-
denceof abnormalities on thephysical neurological examination, each child
demonstratedsignicant problemsinschool. Ineverycasetheseproblemshad
beenformallynotedintheclassroom, andthechildwasreferredfor evaluation
becauseof learningdecits. Thesechildrenalso demonstratedretardation of
one year or more in Reading and/ or Spelling on the WRAT. None of the
learning-disabledchildrenhadaWISCRFull ScaleIQbelow80.
Rawscoreswereconvertedto NDSscoresandmeanswerecomputedfor
eachof thethreegroupsinthefollowingsubcategories: (1) Motor Functions,
(2) SensoryPerceptual Functions, (3) VisualSpatial Skills, (4) Attention and
Concentration, (5) ImmediateMemory, and (6) Abstraction, Reasoning, and
Logical Analysis. A Total Level of Performancescorewas also obtained by
addingthesubtotalsof thesesixsubcategories. Theresultsfor thethreegroups
aredepictedinFigure10.3.
Multivariate analysis of variance yielded highly signicant differences be-
tweenthethreegroups, withthecontrol childrenhavingthebest meanscores
in every subcategory aswell as thebest total NDSscore. Thechildren with
learningdisabilitieshadintermediatescoresineveryareaexcept Attentionand
Concentration. Onthissection, their scoreswereworsethaneventhebrain-
damagedgroup.
In each of the other subcategories, the brain-damaged group performed
mostpoorly. Comparisonsofpairedgroupsfor thetotal NDSscorewerehighly
signicant ineachinstance, clearlyindicatingthat whentheneuropsychologi-
cal variableswereconsideredintotal, thecontrolsperformedbest, thegroup
with learning disabilities was intermediate, and the brain-damaged group
performedmost poorly.
Theresultsof thisstudydemonstratedthatdifferential levelsof performance
characterizedtheneuropsychological functionsof control children, learning-
disabledchildren, andbrain-damagedchildren. Thisndingwasnot particular-
ly surprising, although thequantitativeresultshelpto provideguidelinesfor
theclinical interpretationof theprotocolsof individual subjects.
Thestrikingndinginthisstudywastheseveredegreeof decit shownby
childrenwithlearningdisabilitiesintheareaof AttentionandConcentration.
Thisresultwouldappear tohavedeniteimplicationsfor remedial approaches.
Prior research has indicated that impairment in abstraction, reasoning, and
logical analysishasconstitutedasignicant problemfor childrenwithlearning
disabilities (Reitan, 1985; Selz & Reitan, 1979a), but thegreat difculty that
thesechildrenhaveinrelationtootherareasof neuropsychological functioning
is in the area of Attention and Concentration, indicating that they need
structuredhelp, focusedondevelopingprimaryattentional capabilities.
Itappearsthatinadditiontoabstractionandreasoningdecits, childrenwith
learningdisabilityhavegreat difculty at therst level of central processing,
whichisconcernedwiththeregistrationof incomingmaterial tothebrainand
maintenanceof continuedattentionor concentration. If achildislimitedinthe
ability to register information per unit of time, it is obvious that additional
aspectsof central processingwill suffer. Inturn, impairment inbasicaspectsof
Abstraction, Reasoning, andLogical Analysis(thesecondlowest areafor the
learning-disabledgroup) wouldtendtoexacerbateattentional decits, asmen-
tionedabove.
Thecomparativeperformancesof thethreegroupsof childrenusedinthis
study and the strikingly deviant pattern of the learning-disabled group
Fig. 10.3. Comparativeperformancein various neuropsychological areas of normal children,
childrenwithlearningdisabilities, andbrain-damagedchildreninthe9-year through14-year age
range.
wouldhavebeenmuchmoredifcult to discernwithout thetypeof scoring
providedby theNDSfor Older Children. It wouldthereforeappear that the
NDSmay beparticularly advantageousasabasisfor groupingtest resultsin
researchanalysesaswell asintheclinical interpretationof resultsfor individual
children. Inclinical evaluationandinplanningaprogramof remediation, it is
imperative that both the strengths and weaknesses of the child be fully
recognized. Disparitiesamongvariousaspectsof abilitystructure, ascontrasted
with overall level of performance, may well be the critical factor in the
neuropsychological basesof learningdisabilities.
Spacelimitationsdo not permit discussionandillustrationof thecritically
signicantremainingapplicationsof theHRNTBOC: (1)clinical evaluationof
theindividual subject andthevalueof theinformationprovidedbyacompre-
hensiveneuropsychological examination, and(2) theintegrationof acompre-
hensiveexamination with thedevelopment of apersonally appropriateplan
for remediation. Inorder toprovideremediationthat ismaximallyeffective, it
isobviously necessaryto identifythedecitsthat represent stumblingblocks
for the individual person. For example, as shown in Fig. 10.3, the major
stumblingblocksfor most learning-disabledpeoplefall in theareasof atten-
tion/ concentration and reasoning/ abstraction/ logical analysis. In individual
cases, when these areas of deciency are remediated, academic progress is
achievedwithmuchlesseffort, andbehavioral problemsareoftenresolved. It
isnecessary, of course, that theremediation(cognitiveretraining) programbe
designed to dovetail with the assessment procedures (in this case, the
HRNTBOCandREHABIT ReitanEvaluationof HemisphericAbilitiesand
BrainIntensiveTraining). Theinterestedreader maygainadditional informa-
tionabout theintegrationof thesemethodsof neuropsychological assessment
andcognitiveretrainingfromseveral sources(Reitan& Wolfson, 1992, 1993,
inpress).
Finally, weshouldmentiontheimportant matter of theearlyidentication
of neuropsychologically based learning deciencies which, in turn, permits
earlyremediationefforts. Our studiesof childrenagedsixthrougheight years,
using the ReitanIndiana Neuropsychological Test Battery, demonstrated a
clear differentiationof groupsof control, learning-disabled, andbrain-damaged
children, with scarcely any overlap of mean scores amongthethreegroups
across thefull rangeof tests includingtheWechsler IntelligenceScalefor
Children(WISC; Reitan& Boll, 1973). Blind clinical evaluationof individual
test protocolsacrossthethreegroupsconrmedthesignicanceof thestatisti-
cal data, with96%of thebrain-damagedchildrenand80%of thechildrenwith
learningdisabilitiesshowingdeniteneuropsychological impairment. Incon-
trast, 64%of thecontrolswerejudgedtobenormal neuropsychologically,with
36%showingevidenceof mildimpairment whichappearedto bein genuine
needof remediation.
Theseresults suggest that acomprehensivebattery of neuropsychological
tests, validated individually and as a battery for their sensitivity to cerebral
impairment, mayservetoidentifychildrenwhohavebrain-basedproblemsof
learningdisabilitiesthat theyareunlikelytooutgrowthroughnormal matura-
tion, andwho thereforearein needof individual remediation andcognitive
retraining. Wehavehadexcellent resultswithindividual childreninwhomthe
decitshavebeen selectiveandrather delimited(aweak link inthechain of
integrated abilities), whereas our success has been less encouraging with
childrenin whomneuropsychological decitshavebeengeneralizedandthe
entireplatformof abilitiesneededtoberaised(Reitan&Boll, 1973).
Our experience with a broad range of individual children has led to an
appreciationof theuniquenessof eachchild, asdemonstratedbyfullycompre-
hensiveneuropsychological testing; thesignicanceof recognizingtheindivid-
uality of theneuropsychological ability structureof each child; thecomplex
interactionof seeminglyunrelateddecitsinproducinglearningdisabilitiesin
theindividual instance;andtheoversimplication, fromaclinical andremedia-
tional viewpoint, of theoutcomeof studiesaimedtowardidentifyingdifferen-
tial categoriesor subtypesof learningdisabilities.
REFERENCES
Babcock, H. (1930). An experiment in the measurement of mental deterioration. Archives of
Psychology, 18, 5105.
Batchelor, E.S. & Dean, R.S. (1989). Empirical derivation and classication of subgroups of
childrenwithlearningdecitsat separateagelevels. Unpublishedmanuscript.
Batchelor, E.S. Jr &Dean, R.S. (1991). Neuropsychological assessment of learningdisabilitiesin
children. In Neuropsychological Foundations of LearningDisabilities, ed. J.B. Obrzut & G.W.
Hynd, pp. 30929. NewYork: AcademicPress.
Batchelor, E.S., Dean, R.S., &Williams, R. (1989). Severityof neuropsychological functioningin
clinicallyderivedgroupsof learning-disabledchildren. Paper presentedat theannual conven-
tionof theNational Academyof Neuropsychology, Washington, DC.
Batchelor, E.S., Kixmiller, J., & Dean, R.S. (1990). Neuropsychological aspectsof readingand
spellingperformanceinchildrenwithlearningdisorders. Unpublishedmanuscript.
Boll, T.J. (1974). Behavioral correlates of cerebral damage in children age 914. In Clinical
Neuropsychology: Current StatusandApplication, ed. R.M. Reitan& L.A. Davison. Washington,
DC: HemispherePress.
Davis, B., Dean, R., &Krug, D. (1989). Subtestsof theWechsler IntelligenceScalefor Children
Revisedaspredictorsof neuropsychological impairment. Unpublishedmanuscript.
Doehring, D.G. & Reitan, R.M. (1962). Concept attainment of human adults with lateralized
cerebral lesions. Perceptual andMotor Skills, 14, 2733.
Gaddes, W.H. (1980). LearningDisabilitiesandBrainFunction. NewYork: Springer-Verlag.
Gaddes, W.H. & Edgell, D. (1994). LearningDisabilitiesandBrainFunction: ANeuropsychological
Approach, 3rdedition. NewYork: Springer-Verlag.
Hamill, D.D., Leigh, J., McNutt, G., & Larson, S.C. (1981). A new denition of learning
disabilities. LearningDisabilitiesQuarterly, 4, 33642.
Head, H. (1926). AphasiaandKindredDisordersof Speech, Vol. 1. Cambridge: CambridgeUniver-
sityPress.
Hunt, H.F. (1943). Apractical clinical test for organicbraindamage. Journal of AppliedPsychology,
27, 37586.
Kennard, M.A. (1936). Age and other factors in motor recovery from precentral lesions in
monkeys. AmericanJournal of Physiology, 115, 13846.
Kennard, M.A. (1938). Reorganization of motor function in the cerebral cortex of monkeys
deprivedof motor andpremotor areasininfancy. Journal of Neurophysiology, 1, 47797.
Kennard, M.A. (1942). Cortical reorganization of motor function. Archives of Neurology and
Psychiatry, 48, 22740.
Kirk, S. A. & Bateman, B. (1962). Diagnosis and remediation of learning disabilities. The
Exceptional Child, 29, 738.
Klve, H. (1974). Validationstudiesinadultclinical neuropsychology. InClinical Neuropsychology:
CurrentStatusandApplications,ed. R.M. Reitan&L.A. Davison. Washington, DC:Hemisphere
Press.
Lanyon, R.T. (1978). Psychological ScreeningInventory:Manual, 2ndedition. Goshen, NY: Research
PsychologistsPress.
Leicht, D.J. (1987). Personality/ social/ behavior subtypes of learning-disabled young adults.
Unpublisheddoctoral dissertation, SouthernIllinoisUniversityCarbondale.
McCarthy, J.J. &McCarthy, J.F. (1969). LearningDisabilities. Boston, MD: Allyn&Bacon.
ODonnell, J.P. (1991). Neuropsychological assessment of learning-disabled adolescents and
youngadults. InNeuropsychological Foundationsof LearningDisabilities, ed. J.B. Obrzut &G.W.
Hynd, pp. 33153. NewYork: AcademicPress.
ODonnell, J.P., Kurtz, J., & Ramanaiah, N.V. (1983). Neuropsychological test ndings for
normal, learning-disabled, andbrain-damagedyoungadults. Journal of ConsultingandClinical
Phillips, F.L. (1986). Subtypesamonglearning-disabledcollegestudents: aneuropsychological
multivariate approach. Unpublished doctoral dissertation, Southern Illinois University
Carbondale.
Reed, H.B.C., Reitan, R.M., &Klve, H. (1965). Theinuenceof cerebral lesionsonpsychologi-
cal test performancesof older children. Journal of ConsultingPsychology, 29, 24751.
Reitan, R.M. (1960). Thesignicanceof dysphasiafor intelligenceandadaptiveabilities. Journal of
Reitan, R.M. (1964). Relationshipsbetweenneurological andpsychological variablesandtheir
implications for reading instruction. In MeetingIndividual Differences in Reading, ed. H.A.
Robinson, pp. 10010. Chicago, IL: Universityof ChicagoPress.
Reitan, R.M. (1966). A researchprogramonthepsychological effectsof brainlesionsinhuman
beings.InInternational ReviewofResearchinMental Retardation, Vol. I, ed. N.R. Ellis. NewYork:
AcademicPress.
Reitan, R.M. (1967). Psychological assessmentof decitsassociatedwithbrainlesionsinsubjects
withnormal andsubnormal intelligence. InBrainDamageandMental Retardation: APsychologi-
cal Evaluation, ed. J.L. Khanna, pp. 13759. Springeld, IL: CharlesCThomas.
Reitan, R.M. (1974). Psychological effectsof cerebral lesionsinchildrenof earlyschool age. In
Clinical Neuropsychology: Current Applications, ed. R.M. Reitan & L.A. Davison, pp. 5390.
Washington, DC: HemispherePress.
Reitan, R.M. (1984). AphasiaandSensoryPerceptual DecitsinAdults. Tucson, AZ: Neuropsychol-
ogyPress.
Reitan, R.M. (1985). Aphasia and SensoryPerceptual Decits in Children. Tucson, AZ: Neuro-
psychologyPress.
Reitan, R.M. & Boll, T.J. (1973). Neuropsychological correlatesof minimal braindysfunction.
Annalsof theNewYorkAcademyof Sciences, 205, 6588.
Reitan, R.M. &Klve, H. (1968). Identifyingthebrain-injuredchild. InClinical StudiesinReading
III, ed. H.M. Robinson&H.K. Smith. Chicago, IL: Universityof ChicagoPress.
Reitan, R.M. & Tarshes, E.L. (1959). Differential effectsof lateralizedbrainlesionsontheTrail
MakingTest. Journal of NervousandMental Disease, 129, 25762.
Reitan,R.M. &Wolfson, D. (1985). TheHalsteadReitanNeuropsychological TestBattery: Theoryand
Clinical Interpretation. Tucson, AZ: NeuropsychologyPress.
Reitan, R.M. &Wolfson, D. (1988a). TheHalsteadReitanNeuropsychological Test Batteryand
REHABIT: a model for integrating evaluation and remediation of cognitive impairment.
CognitiveRehabilitation, 6, 1017.
Reitan, R.M. & Wolfson, D. (1988b). Neuropsychological functionsof learning-disabled, brain-
damaged, andnormal children. TheClinical Neuropsychologist, 2, 278.
Reitan, R.M. & Wolfson, D. (1988c). TraumaticBrainInjury, Vol. II, RecoveryandRehabilitation.
Tucson, AZ: NeuropsychologyPress.
Reitan, R.M. & Wolfson, D. (1992). Neuropsychological Evaluationof Older Children. Tucson, AZ:
NeuropsychologyPress.
Reitan,R.M. &Wolfson, D. (1993).TheHalsteadReitanNeuropsychological TestBattery: Theoryand
Clinical Interpretation, secondedition. Tucson, AZ: NeuropsychologyPress.
Reitan, R.M. & Wolfson, D. (inpress). Neuropsychological Evaluationof YoungChildren. Tucson,
AZ: NeuropsychologyPress.
Rourke, B.P. (1975). Brainbehaviorrelationshipsinchildrenwithlearningdisabilities:aresearch
program. AmericanPsychologist, 30, 91120.
Rourke, B.P. (ed.). (1985). Neuropsychologyof LearningDisabilities: Essentialsof SubtypeAnalysis.
NewYork: GuilfordPress.
Rourke, B.P. (1989). Nonverbal LearningDisabilities: TheSyndromeand theModel. New York:
GuilfordPress.
Rourke, B.P. (ed.). (1991). Neuropsychological Validationof LearningDisabilitySubtypes. NewYork:
GuilfordPress.
Rourke, B.P., Bakker, D.J., Fisk, J.L., &Strang, J.D. (1983). ChildNeuropsychology: AnIntroduction
toTheory, Research, andClinical Practice. NewYork: GuilfordPress.
Rourke, B.P., Dietrich, D.M., &Young, G.C. (1973a). Signicanceof WISCverbalperformance
discrepanciesfor younger children with learningdisabilities. Perceptual andMotor Skills, 36,
27582.
Rourke, B.P. & Finlayson, M.A.J. (1975). Neuropsychological signicance of variations in
patternsof performanceontheTrail MakingTest for older childrenwithlearningdisabilities.
Journal of Abnormal Psychology, 84, 41221.
Rourke, B.P., Fisk, J.L., & Strang, J.D. (1986). Neuropsychological Assessment of Children: A
Treatment-orientedApproach. NewYork: GuilfordPress.
Rourke, B.P. & Fuerst, D.R. (1991). LearningDisabilitiesandPsychosocial Functioning: A Neuro-
psychological Perspective. NewYork: GuilfordPress.
Rourke, B.P. & Telegdy, G.A. (1971). Lateralizing signicance of WISC verbalperformance
discrepancies for older children with learning disabilities. Perceptual and Motor Skills, 33,
87583.
Rourke, B.P., Yanni, D.W., MacDonald, G.W., & Young, G.C. (1973b). Neuropsychological
signicance of lateralized decits on the Grooved Pegboard Test for older children with
learningdisabilities. Journal of ConsultingandClinical Psychology, 41, 12834.
Rourke, B.P., Young, G.C., & Flewelling, R.W. (1971). The relationships between WISC
verbalperformance discrepancies and selected verbal, auditoryperceptual, visual
perceptual, and problem-solving abilities in children with learning disabilities. Journal of
Clinical Psychology, 27, 4759.
Rudel, R.G. (1978). Neural plasticity: implicationsfor development andeducation. InEducation
andtheBrain, Part 2, ed. J.S. Chall &A.R. Mirsky. Chicago, IL: Universityof ChicagoPress.
Selz, M. &Reitan, R.M. (1979a). Comparativetestperformanceof normal, learning-disabledand
brain-damagedolder children. Journal of NervousandMental Disease, 167, 298302.
Selz, M. & Reitan, R.M. (1979b). Rulesfor neuropsychological diagnosis: classicationof brain
functioninolder children. Journal of Clinical andConsultingPsychology, 47, 25864.
Spreen, O. (1976). Neuropsychology of learning disorders: post-conference review. In The
Neuropsychologyof LearningDisorders: Theoretical Approaches, ed. R.M. Knights& D.J. Bakker,
pp. 44567. Baltimore, MD: UniversityParkPress.
Wheeler, L. &Reitan, R.M. (1962). Thepresenceandlateralityof braindamagepredictedfrom
responsestoashort AphasiaScreeningTest. Perceptual andMotor Skills, 15, 78399.
Wyke, M.A. (ed.). (1978). Developmental Dysphasia. NewYork: AcademicPress.
Zangwill, O.L. (1978). Theconcept of developmental dysphasia. InDevelopmental Dysphasia, ed.
M.A. Wyke. NewYork: AcademicPress.
11
Developmental assessment of
neuropsychological function with the aid
of the NEPSY
Marit Korkman, Sarah L. Kemp, and Ursula Kirk
Goals, history, and development of the NEPSY
Children with developmental disorders or learning disabilities often exhibit
multiple, overlappingcognitiveor visuomotor disorders. For example, verbal
learning disorders tend to co-occur with attention disorders (Dykman &
Ackerman, 1991; Gilger, Pennington, &DeFries, 1992; Stanford&Hynd, 1994)
and with motor coordination and visuomotor problems (Denckla& Rudel,
1978; Denckla, 1985; Korkman & Pesonen, 1994). Even in children with
averagecognitivecapacity, asmeasuredbypsychometrictestsof intelligence,
multipleimpairmentsmaybeseen. Similarly, multipleor diffuseimpairmentis
also characteristic of children with amedical history associated with neuro-
developmental risks, suchasfetal alcohol exposure(Conry, 1990; Carmichael
Olsonet al., 1992; Don&Rourke, 1995) or verylowbirthweight (Herrgardet
al., 1993; Robertson&Finer, 1993).
One important aimof a neuropsychological assessment is to identify all
impairmentsof thechild, aswell asareasof relativestrength. Acomprehensive
assessment is necessary to identify impairments and to capture the childs
patternof strengthsandweaknesses.
Comprehensivesetsof psychometricallydevelopedtestscanbeachievedby
usingtestsfromvarioussources. However, atest prolebasedonseparately
standardizedtestsmayreect differencesintest norms, rather thananindivid-
ualsstrengthsand weaknesses(Russell, 1986; Wilson, 1992). Theideal is to
create and simultaneously standardize a comprehensive set of neuro-
psychological testsfor children.
An equally important aimof theneuropsychological assessment is that it
should lead to an understandingof thenatureof theproblems of thechild.
347
Insight into the mechanisms of a cognitive disorder makes it possible to
developrealisticexpectationsconcerningthechildsachievement,andprovides
abasisfor theplanningof interventionandremedial teaching. Theinsight can
beobtainedthroughaneuropsychological analysisof theimpairedfunction, by
evaluatingthesubprocesses that contributeto thefunction in question. For
example, inaneuropsychological assessmentof poor graphomotorproduction,
different typesof motor andvisuoperceptual functionsneedtobeassessedto
determinetheunderlyingdecit.
Goals
TheNEPSY wasdesignedfor thefollowingdiagnosticaims: (1) to performa
comprehensive scanning and evaluation of neuropsychological functions in
children; and(2) toanalyze, indepth, disordersof complexfunctions. Inorder
to achieve a sufcient comprehensiveness, 27 subtests were included. The
subtests were selected so as to correspond to important subprocesses or
componentsof complexfunctions. Intheassessment, thecomponentsof the
impairedfunction may beassessed oneby oneand thedecient link in the
chainof subprocessesmaybedetermined.
Rationale
The theoretical underpinnings of the NEPSY were derived fromtwo main
traditions: (1) Luriastheoretical andclinical frameof reference, and(2) more
contemporary traditions of neuropsychological assessment of children with
learningdisordersor neurological risksor conditions. Anoverviewof thebasic
conceptsof Luriastraditionispresentedrst, followedbyadescriptionof how
theseconceptswereintegratedwithrecentchildneuropsychological traditions.
Luriastradition
Oneof theadvantagesof Luriasframeof referenceisthat it integratestheory
with clinical practice. The clinical assessment is guided by the clinicians
knowledge of brainbehavior relationships and of neurocognitive disorders.
This knowledge incorporates four interconnected levels: the structure of
neurocognitivefunctions, thefunctional organizationof thebrain, syndromes
andimpairmentsarisinginbraindisorders, andclinical methodsof assessment.
On thefunctional level, Luriadescribescognitiveand motor processes as
dynamicsystems, characterizedbyaspecicaimbut carriedout, inadynamic
and variablefashion, by many interconnected subprocesses, or components
(Luria, 1973, pp. 2630). Thedynamic aspect of functional systems may be
illustrated by developmental changes that may be seen in the function of
348 Marit Korkman, Sarah L. Kemp, and Ursula Kirk
copyingatext. A youngchildneedsactivelytosearch, perceive, andproduce
the graphic characteristics of each letter, whereas an adult automatically
verbally codes the written text and transforms it into overlearned motor
schemes(Luria, 1973, p. 32). Thestructureof language, memory, attention,
motor performance, andthinkinginadultsisdescribedindetail byLuria(1973,
1980; seealsoKorkman, 1999).
Onthebrainlevel, Luriaspeciestheprocessesof different regionsin the
brain and relates them to the functional components, in accordance with
prevailingtraditionsinadult neuropsychology. For example, inadults, motor
programmingof speechisdependent on left precentral andpremotor neural
systems(Brocasarea), whereasdecodingspeechisdependent onleft posterior
temporal regions (Wernickes area). The brain is viewed as a functional
mosaic, thedifferent partsof whicharebrainprocesses. Thesebrainprocesses
are combined in a exible and adaptive manner to form various types of
cognitiveandpractical activity(Luria, 1963, 1973).
On thelevel of symptomsanddisorders, Luriadescribesconsequencesof
impairments of functional components following focal brain damage. For
example, asevereimpairment of verbal memory span impairs theability to
comprehendverbal passagesinspeechreceptionandreading, andmaydisrupt
cognitive processes in general. Luria describes different types of aphasic,
amnestic, agnostic, andapraxicdisordersinadults, arisingasaresult of damage
tovariouslocations. Thedescriptionsof syndromesincludeclinical characteris-
tics, primary and secondary decits, and probable localization of damage.
Together, thesesyndromedescriptionsformacomprehensivetaxonomythat
mayguidethediagnosticassessment of adult patients.
Ontheassessmentlevel (Christensen, 1975), therationaleofLuriasmethods
istoanalyzedisordersof complexfunctionsthroughasystematicassessmentof
their components, withtheaidof focusedtasksandobservations. Thisanalysis
aimsat specifyingtheprimary decitsunderlyinganeurocognitivedisorder.
For example, when analyzingan aphasicdisorder, testsof motor production
and articulation of speech, dynamic verbal uency and ideation, auditory
phonological analysis, comprehension of syntactic structuresand conceptual
relations, word-ndingabilities, and verbal short-termmemory areadminis-
tered. Clinical observationsmayalsogiveimportant cluesasto thenatureof
thedecit. For example,differenttypesof speechdistortionandmisarticulation
arecharacteristicof different typesof aphasia(Luria, 1973).
349 NEPSY a Developmental Neuropsychological Assessment
IntegratingLuriasapproachwithcontemporarychildneuropsychology
Many aspects of Lurias frame of reference are shared by most neuro-
psychological views. LikeLuriastheory, contemporarychildneuropsychology
views cognitive functions as complex processes consisting of several sub-
processes. For example, attention has been viewed as incorporating many
different aspects: selective attention, sustained attention, attention span or
divided attention, and inhibition and control of behavior (Douglas, 1984;
Barkley,1988;Mirsky, 1989;Cooley&Morris, 1990). Anotherexpressionof this
viewistheattempt tospecifysubtypesof disorders, suchaslanguagedisorders
(e.g., Bishop&Rosenbloom, 1987; Rapin&Allen, 1988). Thus, theconcept of
cognitivefunctionsascomplexfunctional systemsisprobablyvalidalsoinchild
neuropsychology.
However, theexact componentsthat areseenascontributingto cognitive
functions in children do not necessarily correspond to those of Lurias syn-
dromedescriptions. In addition, different authorspresent different views a
consensus does not yet exist concerning the structure and components of
neurocognitive functions in children. It seems evident, therefore, that all
aspectsof Luriastheorycannot bedirectlyappliedtochildren, althoughmany
parallelsmaybefound. Table11.1summarizessomeof theviewsconcerning
components of neurocognitive functions in children (for a more extensive
review, seeKorkman, 1999). Evaluatingthesecomponentsisconsideredim-
portant in aneuropsychological assessment of children. Most of thecompo-
nentsareoperationalizedintheNEPSY, intheformof subtests.
History
TheNEPSY istheresult of alongdevelopment that startedwithattemptsto
applyLuriasmethodsdirectlytochildren, andevolvedintoaninstrumentthat
integrates important aspects of Lurias approach with contemporary ap-
proaches to the neuropsychological assessment of children. In the 1970s,
clinical neuropsychology started to gain recognition as a branch of applied
science. Neuropsychological assessmentsbecamepart of thecareof neurologi-
cal patients. InFinland, neuropsychological methodsdevelopedintheUSAand
Europewereusedtogether withLuriasmethodsfromtheSovietUnion. For a
longtime, this practiceremainedrestrictedto adult patients. Corresponding
neuropsychological knowledgeandclinical instrumentshadnot beendevelop-
edfor childrenwithbraindamageor learningdisorders. Theneedfor adequate
neuropsychological instrumentsfor childreneventuallyledtotheconstruction
of aFinnishmethodof assessment. Thisrst versionof theNEPSY wascalled
NEPS(aNeuropsychological Assessment of Children; Korkman, 1980).
Table 11.1. Components of cognitive processes in children
Attention Sensorimotor functions
Selectiveattention Sensorimotor differentiation
Attentionspan Productionof motor series
Activity/ hyperactivity Tactileperception
Sustainedattention Psychomotor speed
Executivefunctions Visuospatial functions
Planning, strategies Visual perception
Fluency Visuospatial judgment
Shift of set Visuoconstructiveperformance
Inhibition Graphomotor production
Search
Language Memoryandlearning
Motor production Visual short-termmemory
Verbal expression Verbal short-termmemory
Phonological decoding Supraspanlearning
Verbal comprehension Namelearning
Naming Long-termmemory
ReprintedwithpermissionfromKorkman(1999). ApplyingLuriasdiagnosticprinciplesinthe
neuropsychological assessment of children. NeuropsychologyReview, 9, 89105. Copyright 1999
byKluwer Academic/ PlenumPublishers, NewYork.
TheNEPSwasacloseadaptationofLuriasassessmentfor usewithchildren.
It includedacomprehensiveseriesof brief tests, similar incontent andformat
to those of Lurias assessment (Maruszewski, 1971; Christensen, 1975). The
itemswereof apassfail type, yieldingscoresof 0, 1, or 2. Nosumscoreswere
calculated. Normswerebasedonbaserates(percentagepassingeachitem) for
5-year-old and 6-year-old children. The level of difculty of the items was
adjustedso that most childrenpassedthemin aprescribedmanner. A failed
itemwas considered asign of impairment in thesameway as ndings in a
medical examination.
TheNEPSevidentlylledavoid, andaneedtoexpandthemethodinterms
of agebecameevident. Arevisedinstrument calledNEPS-UinFinnish(NEPS-
Uudistettu, i.e., NEPSRevised) and NEPSY in publications in English was
developedandpublishedin Finlandfor children aged3years6monthsto 9
years6months(Korkman, 1988a, 1988b, 1995). TheNEPSYwasalsopublished
in Sweden (Korkman, 1990) andDenmark (Korkman, 1993) for asomewhat
morerestrictedagerange(seeTable11.2). Inthese19881993NEPSYversions,
the subtests were modied and psychometrically developed into homo-
geneous, reliablescales with graduateddifculty. Theresultsof thesubtests
wereexpressedasz-scores(3to+1), basedonagenorms.
Therevisionalsoprovidedanopportunityfor revisionsof thecontent. New
subtestswereadded, basedontest ideasderivedfromemergingtraditionsin
child neuropsychology (e.g., Boehm, 1969; Venger & Holmomskaya, 1978;
Reitan, 1979; Benton et al., 1983). Two tests, the shortened version of the
Token Test (DeRenzi & Faglioni, 1978) and the Developmental Test of
VisuoMotor Integration(VMI; Beery, 1983), wereusedintheir original form,
andstandardizedalongwiththeNEPSY subtests.
TheNEPSY attractedinterest internationally, andplansfor aninternational
versiontook form. Further revisionswereundertakenfor theneweditionin
FinlandandintheUSA. Theoriginal subtestswereexpandedtoaccommodate
abroader agerange, from3to 12years, byaddingitemsfor younger andfor
older children. Somesubtestsweredroppedor combined, and new subtests
wereaddedor changed(seeKorkman, 1999). Most subtestsremainedbasically
thesameintheir content, but wererenamed. TherevisedNEPSY appearedin
Finlandin1997(Korkmanet al., 1997) andintheUSAin1998(Korkmanet al.,
1998). The 1997 Finnish and 1998 US NEPSY versions correspond closely,
except for threesubtestswhichwereincludedintheFinnishNEPSYbut not in
theAmerican NEPSY. They differ somewhat fromthe1988Finnish NEPSY,
especiallywithrespecttoagerange(seeKorkmanet al., 1998; Korkman, 1999).
ArevisedSwedishNEPSY, equivalent tothe19978NEPSY, will bepublished
in2000. Anoverviewof thesuccessiveNEPSY versionsispresentedinTable
11.2.
Description of the NEPSY
Domains and subtests
TheNEPSY contains 27subtests in all. Thesubtestsareorganizedinto ve
domains: Attention/ ExecutiveFunctions, Language, Sensorimotor Functions,
Visuospatial Functions, and Learningand Memory. This subdivision groups
thesubtests, accordingtotheir content, intocategoriesappliedinchildneuro-
psychology(e.g., Mattis, 1992), andalsocomparabletothoseinLuriasassess-
ment (Christensen, 1975). Thedomainsshould not beseen as denitefunc-
tional compartments; neither aretheycomparabletothefactorsderivedfrom
factor analysis. Sometasksarecomplexandcouldactually belongto two or
eventhreedomains. For example, learningalist of wordsover manytrialstaps
languagefunctions, memory, andattentionandexecutivefunctions.
Table 11.2. Published versions of the NEPSY
Year Agerange Country Authors Teamresponsiblefor
(years) national edition
1980 5:0to6:11 Finland Korkman Korkman
1988b 3:6to9:5 Finland Korkman Hakkinen, Leppala, Levanen,
Peltomaa, Rissanen,
&Vakkuri
1990 4:0to7:11 Sweden Korkman Amberla, Andersson,
Johansson, Kihlgren,
Kvarnevik, &Lindberg
1993 4:0to7:11 Denmark Korkman Holm, Frandsen, Jordal, &
Trillingsgaard
1997 3:0to12:11 Finland Korkman, Kirk,
&Kemp
Korkman, Klenberg,
Barron-Linnankoski,
Ginstrom, Kesti,
Lahti-Nuuttila, &
Lindblom-Ikonen
1998 3:0to12:11 USA Korkman, Kirk, Publisher
&Kemp
1999 3:0to12:11 Sweden Korkman, Kirk, Kihlgrenet al.
&Kemp
Attention/ ExecutiveFunctions
Tower
Thissubtest is basedon aclassic test idea(Shallice, 1982), thought to assess
planningandmonitoringrule-based, problem-solvingperformance. Thechild
has to placethreeballs on pegs to formspecic patternsshown in pictures.
Onlyaprescribednumber of movesisallowedineachtask, sothechildhasto
planthesequenceof movesbeforeperformingthetask.
AuditoryAttentionandResponseSet
Thissubtest isdesignedasacontinuousperformance-typetest of attentionand
mental control. The child listens to a long array of words, presented on
audiotape. OntheAuditoryAttentiontask, thechildtakesaredtokenfroma
pileof tokensof variouscolorswhenever thewordred issaid, anddropsit
intoabox. OntheResponseSettask, thechilddropsayellowtokeninthebox
wheneverthewordred issaid, aredtokenwheneverthewordyellow issaid,
andabluetokenwhenever thewordblue issaid(seeFig. 11.1A).
(A)
(B)
(C)
Fig. 11.1. Examplesof NEPSY tasks: (A) TheAuditoryAttentionandResponseSet subtest: the
childpicksuparedsquarewhenshehearsthewordyellow anddropsit inthebox. (B) The
ImitatingHandPositionssubtest: thechildimitatespositionsof theexaminershands. (C) The
BlockConstructionsubtest: thechildbuildsblockconstructionsfrommodels.
Visual attention
Thissubtest isavisual cancellationtask. Thechildmarksall of theguresthat
areidentical totarget gurespresentedat thetopof thesheet. Threetasksare
presented. Intherst task(Bunnies; 34year olds), theguresareplacedina
linear array. In the second task (Cats; all ages), the gures are placed in a
randomarray, whichcallsfor visual searchinadditiontoattention. Inthethird
task (Faces; 512year olds), thetarget gures arecomplex linedrawings of
faces, andtheguresareplacedinalinear array.
Statue
This subtest is a motor inhibition task. The child has to stand still for 75
seconds, eyesclosed, andinhibitimpulsestoopenthem, tomakevocalizations,
or tomove, despitenoisedistractorssuchaswhentheexaminer knocksonthe
table.
DesignFluency(basedonRegard, Strauss, & Knapp, 1982)
This subtest is a gural uency task. The child has to draw designs by
connectingdotscontainedinsmall squaresonasheet. Thechildisinstructedto
generateasmanyuniquedesignsaspossibleinoneminute.
KnockandTap
Thissubtest isamental control andverbal regulationtask. Thechildinhibits
theimpulsetodothesamethingastheexaminer andresponds, instead, with
another action. For example, thechildknocksonthetablewhentheexaminer
tapsandtapswhentheexaminer knocks.
Language
BodyPart Naming
Thissubtest isanamingtask for youngchildren (34year olds). Ninebody
partsarepointedout inpicturesandthechildisaskedtonamethem.
Phonological Processing
Thissubtest isaphonological awarenesstask, consistingof two parts. In the
easier tasks, the examiner says a word segment and the child points to the
appropriatepicturefromthreealternatives. For example, theexaminer says:
Here, youseeacastle, apostcard, andcandy. Inwhichwordisthereapart
such as-ost? Moredemandingtasksconsist of stimuluswordsthat areonly
orallypresented. Thechildisaskedtodeleteonesegmentor aphonemefroma
word, or exchangeit for another, for example: Saychanging. Sayit again,
but change-ange to-omp.
SpeededNaming
Thissubtest isarapidalternatingnamingtask. Thechildnames, asquicklyas
possible, thesize, color, andshapeof 20guresonasheet. For example, the
childsays: Littleredcircle, bigbluesquare, etc.
Comprehensionof Instructions
This subtest is a verbal comprehension task. The child responds to verbal
directions, for example: Showmethegurethat isaboveonecrossandbeside
another cross.
Repetitionof NonsenseWords
The subtest is a complex task that puts demands on auditoryphonemic
decoding, articulation, andshort-termmemory. Thechildrepeatsphonologi-
callycomplexnonsensewords, suchasIncusement or Pledgyfriskree, pres-
entedonaudiotape.
Verbal Fluency
Thissubtest isaworduencytask. Thechildnamesasmanyanimalsandas
manythingstoeat or drink(semanticuency)asheor shecangenerateinone
minute. Inasecondtask, thechildnamesasmanywordsbeginningwithSand
F(phonemicuency) asheor shecangenerateinoneminute.
Oromotor Sequences
Thissubtest isan oromotor production task. Thechildrepeatsphonological
sequences or tongue twisters, for example Scoobelly doobelly/ scoobelly
doobelly, four times.
Sensorimotorfunctions
FingertipTapping(basedonDenckla, 1973)
Thissubtest assessesthetappingspeedof eachhand. Thechildtapsthetipsof
the index nger and the thumb together as quickly as possible 32times. A
secondtaskconsistsofrapidlytappingthetipsofthengerssequentiallyagainst
thetipof thethumbeight times, asquicklyaspossible. Thescoreconsistsof
performancetime.
ImitatingHandPositions
Thissubtest assessestheability to imitatehandpositions. Thechildimitates
positionsof thehand, suchaspointingoutwardwiththethumbandthelittle
nger whilekeepingtheother ngersinast (seeFig. 11.1B).
Visuomotor Precision
This subtest assesses visuomotor speed and precision on a paper-and-pencil
task. Thechilddrawscontinuouslinesalongcurvilinear tracks. Crossingthe
edgeof thetrackisanerror.
Manual Motor Sequences
This subtest represents manual motor learning. The child is taught manual
motor sequencesand repeatsthemvetimes. Oneexampleisto knock the
knucklesof theright handonthetable, thentheleft-handknuckles, thentap
right palm, thentapleft palm.
Finger Discrimination
Thesetwosubtestsassessnger discriminationbasedontouchfor bothhands
separately. Thechildshandishiddenfromhisor her viewby ashield. The
examiner touchesoneor twongersat atime. Thechildpointstothenger
that wastouched.
Visuospatial functions
DesignCopying
Thissubtest isatwo-dimensional visuomotor constructiontypeof task. The
childcopiesgeometricdesignsof increasingcomplexity.
Arrows
Thissubtest assessestheabilitytoevaluatethespatial orientationof lines. The
stimuli consist of pictures with eight arrows pointingto atarget. Thechild
indicatesthetwoarrowsineachpicturethat point tothecenter of thetarget.
BlockConstruction
Thissubtest is athree-dimensional construction task. Thechildbuildsblock
constructionsfrommodels(seeFig. 11.1C).
RouteFinding(basedonVenger & Holmomskaya, 1978)
This subtest requires visuospatial analysis of directionality as well as visual
search. Thechildlocateshousesonschematicmapsaccordingtoaminiature
drawingof theroutetothehouse.
MemoryandLearning
Memoryfor Faces
Thissubtest putsdemandsonvisual memoryfor faces. Thechildisshown16
black-and-whitephotographsof children. Then 16pages arepresented, each
showingoneof thepreviousphotographsandtwodistractors. Thechildpoints
to thephotographspreviously seen. Half an hour later, thechildisaskedto
point to thetarget photographsagain amongnewdistractors(delayedrecall
condition).
Memoryfor Names
Thissubtest isaname-learningtask. Six(for 5year olds) or eight (for 612year
olds) linedrawingsof childrensfacesarepresented. Each drawingisnamed
andthechildrepeatsthename. Afterthatthechildisshownthedrawingsandis
askedtorecall thenames. Correctresponsesareprovidedwhennecessary.This
procedureisrepeatedtwice. Half anhour after theimmediaterecognitiontask,
thedrawingsareshown again andthechildisaskedto namethem(delayed
recognition).
NarrativeMemory
Thissubtest assessestheimmediatereproductionandrecall of anarrative. A
storyistoldtothechild. Inafreerecall condition, thechildisaskedtotell the
storyagain. Inacuedrecall condition, questionsareaskedconcerningall details
thechildomittedinthefreerecall.
SentenceRepetition
This subtest is a short-termverbal memory task. The child has to repeat,
verbatim, progressively longer sentences, startingfromtwo-wordsentences,
thelongest sentenceconsistingof 19words.
List Learning
Thissubtest isaverbal learningtask. Thechildisreadalist of 15unconnected
wordsandrepeatsasmanyheor sheremembers. Theprocedureisrepeated
four more times, after which a new (interference) list is taught once and
recalled. Thechildis, thereafter, askedto recall therst list oncemore, and
againhalf anhour later.
Core Domain score:
Language Core
Domain score
Subtest score:
(other subtest)
(other subtest)
Speeded
Naming
Supplemental
scores:
Time
Accuracy
Qualitative
Observations:
Body Movements
Increasing Voice Volume
Reversed Sequences
Fig.11.2. Exampleof scoresderivedfromonesubtest.ThemainresultfromtheSpeededNaming
subtestistheSubtestscore. ThisscoremayalsobeincludedintheLanguageCoreDomainscore.
Inaddition, twoSupplemental scores, andthreeQualitativeObservationsmaybederived.
Psychometric data
Typesofscores
For avery comprehensiveassessment, thefull NEPSY may beadministered.
However, inclinical practice, timerestraintsoftenforceexaminerstofocuson
somecentral problemsof thechild, and/ ortoperformabriefer scanningacross
all domains. TheNEPSY providesapool fromwhichtestsmaybeselectedfor
such purposes. To aid examinersto select subtests, different typesof assess-
mentsareproposedinthemanual (seebelow). Oneof theseistheorienting, or
Core Assessment. Thirteen subtests, two or three from each domain, are
administered to providesamples of performanceacross domains. Expanded
Assessments may then be performed by using the other subtests fromthe
domain. Coreand Expanded subtests yield subtest scores. In addition, Core
DomainscoresmaybecalculatedfromtheCoresubtestsof eachdomain.
In addition to the subtest scores, a number of Supplemental scores and
QualitativeObservations may bederived. TheSupplemental scores aresub-
scores of the subtests, related to different aspects (e.g., performance time,
number of correct responses, anderrorsof different types) or different partsof
thesubtest. Theyprovideawaytoseparateparticular aspectsof performance,
in order to provide more specic diagnostic information. The Qualitative
Observations represent behaviors or signs, such as tremor, misarticulations,
mirror movements, off-taskbehaviorsetc., whichmaybenotedandrecorded
asthechildperformsthetasks. Normsareavailablealsofor theSupplemental
scores and the Qualitative Observations. Examples of the different types of
scoresaregiveninFig. 11.2.
TheCoreDomainscoresareexpressedinstandardscoreswithameanof100
andastandarddeviationof 15, asintheintelligencequotientsof theWechsler
intelligencescales(Wechsler, 1989, 1991). Theresultsof theCoreSubtestsand
mostof theExpandedSubtestsareexpressedinstandardscoreswithameanof
10andastandarddeviationof 3, asinthesubtestsof theWechsler tests. Some
of theExpandedsubtestswerenot normallydistributedinthenormsample,
andwere, therefore, expressedas percentileranks. TheSupplemental scores
and Qualitative Observations are expressed in standard scores (mean=10,
SD=3), percentagesof thestandardizationsampledisplayingthebehaviors, or
meansandstandarddeviationsat thedifferent agelevels, asappropriate.
Standardizationandreliability
TheAmericanstandardizationwasperformedonageographically, ethnically,
andsociallyrepresentativesampleof children(n=1000), 100childrenper age
level. Eachagegroupincludedanequal number of boysandgirls. Thelarge
normsamplefully reectstheethnic andsocial variationof theUSA, which
renders the normal variation relatively broad. Finnish and Swedish norm
groupsinclude40and50childrenper agelevel, respectively.
For theAmericanNEPSY(Korkmanet al., 1998) reliabilitycoefcientswere
calculated for each age level separately. Average(across agelevels) internal
consistency(split-half) reliabilitiesarebetween.70and.91, withoneexception
(Design Fluency=.59). The average (across age levels) stability (testretest)
coefcient varies from.52(Arrows) to .81(Visual Attention). Theinterrater
agreement for qualitative observations varies fromkappacoefcients of .42
(=fair agreement;Misarticulations)to1.00(=perfectagreement;Visual Guid-
ance, Incorrect Position, Body Movement). In all, reliability measures were
acceptable, adequate, or good.
Developmental issues
Developmental changes in subtest scores
Thetest normsof theFinnishNEPSY areexpressedintablesand, unlikethe
1998USversion, alsographically. Thenormgraphsprovideanopportunityto
study the developmental curves of the NEPSY subtest scores. It may be
assumedthat thesendingsarecomparabletodatathat maybederivedfrom
other countriesaswell. Ingeneral, thenormgraphssuggest that development
israpidfromagethreeuntil ageeight andnine, but lesssignicant after that.
Figure 11.3 presents examples of the results across age levels of six subtest
scores. It maybeseenthat thescores, exceptone, increasesteeplyuntil around
ageeight, andlesssteeplyafter that. Thestandarddeviationstendtodecrease
Fig. 11.3. Examplesof age-relatedchangesinsubtestsscoresof sixNEPSY subtests. Thedatais
derivedfromtheFinnishnormsample(n=400). Theboldlinerepresentsthemeansof theage
groups (n:40), and the lines below and above are drawn at one, two, and three standard
deviationsbelowandabovethemean. (FromNEPSY. Lastenneuropsykologinentutkimus, by M.
Korkman, U. Kirk, & S.L. Kemp (1997). Helsinki, Finland: Psykologien kustannus. Copyright
1997. Adaptedwithpermission.)
across age levels, except for the same subtest. This exception is the Verbal
Fluencysubtest, inwhichthenumber of wordsthechildcanproduceinone
minuteincreasesmoreinthehigher agerangethaninthelower.
TheAttention/ ExecutiveFunctionssubtestdataof theFinnishnormsample
(n=400) was studied in greater detail by Klenberg, Korkman, and Lahti-
Nuuttila(in press). Thisanalysisindicatedthat thesubtestsof Attentionand
ExecutiveFunctionshadsomewhat different developmental timetables. The
Attentionsubtests(AuditoryAttentionandResponseSet, Visual Attention) as
well asthesubtestspurportedto measureinhibition(Statue, KnockandTap)
developedrapidly in younger agegroupsandleveledoff at agessixto eight
years. IntheTower subtest, ataskthoughttoinvolveplanningandmonitoring
of responses, signicant increaseintest scorescontinuedsomewhat longer. By
contrast, the scores on the Design Fluency subtest and the Verbal Fluency
subtest continuedto showstrongdevelopmental trendsacrossthewholeage
range. Earlier studies(Regardet al., 1982; Vik&Ruff, 1988)haveindicatedthat
gural uency increases throughout adolescence. Thedifferencein develop-
mental trajectoriesisprobably relatedto thenatureof theuency tasks: the
number of words anduniquedesignsthat may beproduced is, in principle,
limited only by performance time. The childs increasing vocabulary and
graphomotor skills, andimprovingstrategiesfor controlledsearchmayinter-
act, producing an exponential (upturned curve, see Fig. 11.3), rather than
linear, increaseinproduction.
Figure11.3alsodemonstratesanother interestingdevelopmental trajectory
intheFinnishdata:thatof thePhonological Processingsubtestscore. Thescore
for thissubtest inFig. 11.3representsthecapacityfor phonemedeletionand
exchangingphonemesof words. Theperformanceof childrenbelowtheageof
veisnot shownbecausethesechildrendonot takethemoredemandingpart
of thesubtest. Fromagesixtoageeight years, thedevelopmental curveshows
asteepincreasein groupmeans. Finnish children go to school at theageof
seven, andthesharpincreaseinthiscapacityisrelatedtothestart of schooling.
Theacquisitionof readingandspellingmayenhancetheir capacitytoanalyze
thesoundcompositionof wordsandtomanipulatethesoundsmentally. One
aspectofthisfacilitationmaybethatthelettersandlettercombinationsprovide
concrete symbols of the sounds and make it easier to conceptualize and
perceivethem. Theseresults(Korkman, Barron-Linnankoski,&Lahti-Nuuttila,
1999)conformtothoseobtainedbyother authorsaswell (Bentin, Hammer, &
Cahan, 1991; Wimmer et al., 1991; Morrison, Smith, & Dow-Ehrensberger,
1995).
Developmental data fromthe large US standardization sample are being
analyzedatpresent. Accumulatingnormativedatafromdifferentcountrieswill
alsoprovidepossibilitiesfor cross-cultural studies.
Relationship of cognitive level to test performance
Neuropsychological measures arealmost always administeredtogether with
measuresof general cognitiveability, usually theWechsler scales(Wechsler,
1989, 1991). Thegeneral cognitivecapacity isimportant per se, but can also
provideapoint of referencefor theinterpretationof achildsneuropsychologi-
cal test results. A retardedchildcannot beexpectedtoachieveaverageresults
ontestsof language,motor, visuospatial, andother tasks. Incontrast, particular
areas of impairment in a child with normal psychometric intelligence are
usually seen as indicating specic learning or developmental disorders. For
such clinical interpretationsit is, however, important to knowtheextent to
whichneuropsychological performanceisrelatedtopsychometricintelligence.
Table11.3presentsthecorrelationsP.30of theNEPSY subtestswithsubtests
of the Wechsler Intelligence Scale for ChildrenThird Edition (WISCIII;
Wechsler,1991). SubjectswerechildrenfromtheUSNEPSYnormsamplewho
alsoperformedtheWISCIII (n=127). Themeanagefor thisgroupwas9.87
years(SD=1.95), meanVerbal IQwas104.4(SD=14.72), andmeanPerform-
anceIQ103.4(SD=13.74) (Korkmanet al., 1998).
The correlations between the Wechsler Preschool and Primary Scale of
IntelligenceRevised (WPPSIR; Wechsler, 1989) IQ values and the NEPSY
CoreDomainscoresinnormal 36year olds(n=45), alsodrawnfromtheUS
NEPSY standardization sample, varied between .24and.60(Korkman et al.,
1998). Preliminary datafromastudy on 4-year-old children exposedto lead
demonstrated even higher correlations between WPPSIR and the NEPSY
CoreDomainscores(Chandlee, Tuesday-Heatheld, &Radcliffe, 1999).
Relationship of neurological development to test performance
Neurological riskfactorsandconditionsmayaffect thechildsneurocognitive
development, andarefrequent indicationsfor referralsfor neuropsychological
assessments. Ingeneral, theneuropsychological sequelaeseemto varylessin
accordancewiththelocalizationor lateralizationof abraininsult thanwiththe
typeofriskfactororinsult. Theabsenceof localizationandlateralizationeffects
onneuropsychological test performanceisparticularlyconspicuousinchildren
withcongenital or earlydamagetothebrain(seebelow).
Onereason for this is that early brain insults or abnormalitiestend to be
diffuseor multifocal. Thisis thecase, for example, in postasphyxial damage
Table 11.3. Correlations P0.30 of the NEPSY subtests with the WISCIII subtests
I S A V C DS PC Cd PA BD OA SS Mz
Attention/ ExecutiveFunctions
Tower 0.30 0.31 0.31
AuditoryAttention
andResponseSet
Visual Attention
DesignFluency 0.34
Statue
KnockandTap
Language
Phonological Processing 0.43 0.40 0.39 0.41 0.30 0.52
SpeededNaming 0.32 0.31 0.34 0.39
Comprehensionof 0.44 0.47 0.42 0.45 0.41 0.41
Instructions
Repetitionof Nonsense 0.38 0.40. 38. 50
Words
Verbal Fluency 0.38 0.36 0.33 0.35 0.31 0.33
Oromotor Sequences 0.41 0.57 0.30 0.47 0.31 0.32 0.34
Sensorimotor
FingertipTapping
ImitatingHand
Positions
Visuomotor Precision
Manual Motor Sequences 0.39 0.34
Finger Discrimination
Visuospatial
DesignCopying 0.32 0.38 0.35
Arrows 0.35 0.34 0.31 0.33 0.36 0.38
BlockConstruction 0.30 0.33 0.35 0.42 0.40
RouteFinding
MemoryandLearning
Memoryfor Faces
Memoryfor Names 0.44 0.34 0.30 0.33
NarrativeMemory 0.36 0.34 0.39 0.40
SentenceRepetition 0.52 0.50 0.50 0.53 0.43 0.55 0.45
List Learning 0.32
AdaptedwithpermissionfromNEPSY. ADevelopmental Neuropsychological Assessment, byM.
Korkman, U. Kirk, &S.L. Kemp(1998). SanAntonio, TX: ThePsychological Corporation.
Copyright 1988byThePsychological Corporation.
I =Information; S=Similarities; A=Arithmetic; V=Vocabulary; C=Comprehension;
DS=Digit Span; PC=PictureCompletion; Cd=Coding; PA=PictureArrangement;
BD=BlockDesign; OA=Object Assembly; SS=Symbol Search; Mz=Mazes.
(Truwit et al., 1992; Volpe, 1992; Williamset al., 1993), or alcohol exposure
(Miller, 1986; West & Pierce, 1986). However, childrenwithmorefocal brain
damagealso fail to demonstratedisorderssuch as aphasiaor neglect, which
wouldbetypical of damagetothesamebrainregionsinadults. For example,
childrenwithearlyleft-sideddamagedonot exhibit asignicant verbal disad-
vantage as compared to nonverbal performance (Aram & Ekelman, 1988;
Vargha-Khadem& Polkey, 1992; Korkman & von Wendt, 1995). Even in
children with acquired damage in childhood, aphasic signs tend to subside
rapidly (Hecaen, 1983). Evidently, brain development may adapt to a focal
damage.
Thefunctional compensationisprobablyrelatedtoahighdegreeof neural
redundancy in childhood; that is, an early surplus of neurons and synapses,
whicharegraduallyreducedtoadult levels(Cowan, 1979; Huttenlocher et al.,
1982). Neuronsandsynapsesthat arenot yet functionallycommittedmaybe
recruited to compensate for lost or undeveloped groups of neurons. One
extremeexampleof plasticityisthat of transfer, whenlanguagedevelopsinthe
theright hemispherein left-sideddamage(see, for example, Strauss, Satz, &
Wada, 1990). This mechanismhas been one explanation of the absence of
aphasia in left-sided damage in children. However, other, intrahemispheric
forms of neural adaptation probably also operate (Korkman & von Wendt,
1995).
Incontrast to thesenonspecicndingsinchildren, theliteraturecontains
manyexamplesof neuropsychological ndingsthatarecharacteristicof specic
neurological etiologies. Inthiscontext, someof thendingsobtainedwiththe
1988FinnishNEPSY arereported.
Theabsenceof lateralization-speciceffectswasdemonstratedinastudyby
Korkmanandvon Wendt (1995) comparingchildren, agedveto nine, with
hemiplegiaandcongenital left-sidedbraindamage(n=17) or right-sidedbrain
damage(n=16). Only children with normal intelligencewereincluded. The
NEPSY subtestswerecollapsed to four summary scales, representingverbal
comprehension, oromotor production, naming, and avisuoconstructiveper-
formance. Theresultswerewithintheaveragerangeonall scales. Bothgroups
weremost impairedontheVisuoconstructiveScale, but thediscrepancywas
larger in the children with right-sided damage. However, group differences
werenot signicant. Thus, inchildrenwithcongenital, unilateral braindam-
age, nosignicantimpairmentwasseen. Arelativevisuoconstructiveweakness
was, however, evident, especiallyinchildrenwithright-hemispheredamage.
A secondstudyexaminedthetest prolesof Finnishchildren, agedveto
nineyears, exposed to alcohol in utero for varying durations. The children
weresubdividedaccordingto durationof maternal alcohol abuse, asfollows:
duringtrimester I (n=16), duringtrimestersI andII (n=16), andthroughout
pregnancy(n=14). A control group(n=26) consistedof unexposedchildren.
Thegroupexposedthroughout pregnancywassignicantlyimpairedoncom-
positeNEPSY scoresof Naming, ReceptiveLanguage, andAttention, andtoa
lesser degreeonManual Motor andVisualMotor Performance. Thesubtests
of Verbal andVisual MemoryandManual Motor Precisiondidnotsignicantly
differentiatethegroups. Thegroupexposedduringtrimester II hadprecisely
thesamepatternof ndings; however, onlytheNamingscoredifferedsigni-
cantlyfromthat of thecontrol group(Korkmanet al., 1998).
In contrast to the studies above, a third study on the consequences of
perinatal hypoxiadidnot ndany characteristicstrengthsandweaknessesin
thechildrensneuropsychological test prole. Different kindsof perinatal risks
were studied, as follows: (1) children born with very low birth weight
(:1500g) who were small for gestational age (VLBWSGA) (n=34); (2)
childrenbornwithverylowbirthweight whowereappropriatefor gestational
age(VLBWAGA)(n=43); (3) childrenbornat termwithacutebirthasphyxia
(n=36); and (4) control children (n=45). Moderately and severely disabled
children wereexcluded. Thegroups differed with respect to degreebut not
type of impairment. The VLBWSGA group had the poorest results. The
VLBWAGA groupwassomewhat lessimpaired, whereasthebirthasphyxia
groupperformedat acontrol group level. Group differenceswereseen in a
diffusepatternonsubtestsof different types(e.g., VMI, oneattentionsubtest,
the 1988 Phonological Processing subtest, Body Part Naming, and Finger
Discrimination), with no childdemonstratingspecic learningor attentional
disorder (Korkman, Liikanen, &Fellman, 1996).
Thesestudiesindicatedthat different typesof neurological impairment may
beassociatedwithcharacteristicneuropsychological effects: childrenexposed
to alcohol had particularly pronounced verbal and attentional problems;
childrenwithhemiplegiatendedtohavemorevisuoconstructivethanverbal
impairment, irrespectiveof sideof lesion, andVLBWchildrentendedtohave
diffuseimpairment.
Applications
Test selection and structure of assessment
The NEPSY is intended for all types of neuropsychological assessments of
children aged three to 12 years. The most prevalent referral questions are
probably related to learning disorders or attention problems in school-age
children, generalized or specic developmental delays, including attention
problemsand hyperactivity (ADHD), anddelayed languageor sensorimotor
development inyoungchildren, anddifferent typesof neurological or neuro-
psychiatricconditionsor risksthat may haveimplicationsfor neurocognitive
functionsinchildrenof all ages. Theseconditionsmayincludebraintrauma,
chromosomeabnormalities, epilepsy, fetal alcohol exposure, Aspergers syn-
dromeandautistic spectrumdisorders, andTourettessyndrome, to namea
few.
Obviously, theneedsof thesechildrendiffer. Insomechildren, for example
young children with signs of developmental delay, the task is to evaluate
neurocognitivedevelopment broadly anddeterminetypesanddegreeof im-
pairments.Inothercases, aparticularproblemsuchasdevelopmental language
disorder or dyslexiamayrequireathoroughanalysisof thedisorder, asabasis
for intervention. Inadditiontothedifferencesinreferral questions, examiners
differ with respect to their backgroundand orientation. Also, settingsdiffer,
some offering more time and possibilities for in-depth assessments, others
demandingassessment of manychildreninlesstime.
Aswasstatedpreviously, theNEPSY wasdesignedto provideapool from
which tests may be selected for various purposes. There are no strict rules
concerninghowto select theNEPSY subtests. A successful administrationof
theNEPSYisdependentontheexaminersqualicationsrather thanonthetest
itself. However, different typesof assessments, performedby usingdifferent
selectionsof subtests, wererecommendedinthemanual.
TheFull Assessment, usingall NEPSY subtests, providesathorough, com-
prehensiveassessmentacrossall domainsof neurocognitivedevelopment. The
Full Assessmentisparticularlyuseful toevaluatethedevelopmentof theyoung
childwithmultiplesignsof developmental delays. Thesechildrenoftenneed
early intervention, and the neuropsychological survey of assets and impair-
mentsisuseful asabasisfor planningintervention. School-agechildrenwho
havecomplexlearningdisordersalso benet fromathorough assessment at
least oncein their school career. Other cases in which aFull Assessment is
recommendedarechildren with ahistory of brain insult or signicant risks,
suchasencephalitis, trauma, epilepsy, etc., whoneedacomprehensiveevalu-
ationof brainfunctionsbytheneuropediatricteam. Further, theFull NEPSYis
alsooftenadministeredasfollow-upassessmentsof treatmenteffectswhenthe
childrenarereceivingcertaintreatments, suchasneuropsychological interven-
tion.
The Core Assessment involves a briefer scanning across domains. The
purposeis to performan overviewof all domains, and to evaluatewhether
therearesignsof impairmentthatwill necessitateamorethoroughevaluation.
TheCoresubtestsof theNEPSY areproposedfor thispurpose. Thechoiceof
Core subtests was based on the psychometric properties of the subtests (a
normal distribution was required), as well as on clinical considerations, and
previousresearchndings.
The results of the Core Assessment may be expressed as Core Domain
scores. However, preliminary datashow that particular Core subtest scaled
scoresandeventheSupplemental scoresof theCoresubtestsmaybeequally
useful as screeners. In a study on 41 children diagnosed with ADHD, the
Response Set score fromthe Auditory Attention and Response Set subtest
differentiatedtheADHDchildrenfrommatchedcontrol childrenmoresigni-
cantly(p=0.001) thandidtheDomainscore(p=0.002). Further, Qualitative
Observationsalso discriminatedtheADHD childrensensitively(Commission
ErrorsontheResponseSet part of theAuditory AttentionandResponseSet
subtest: p=0.001; OmissionErrors: p=0.001; Number of RuleViolationson
theTower subtest: p=0.001; Huckebaet al., 1998). Thus, thesubtest scores,
theSupplemental scores, andtheQualitativeObservations, obtainedfromthe
CoreAssessments, shouldall beconsideredwhen decidingabout aneedfor
morethoroughassessments.
TheCoreAssessment isfollowedbyExpandedAssessmentsinareaswhere
signsof impairment havebeenfound, or inaccordancewithcomplaintsfrom
daily life or reported in the childs history. Children who have attention
problemsmaybegivenall subtestsfromtheAttentionandExecutiveFunctions
domainaswell asfromtheMemoryandLearningdomain. For childrenwith
developmental languagedisorder or reading disorder, as well as those with
other typesof verbal learningproblems, thesubtestsfromtheLanguageand
the Memory and Learning domains may be administered. Children with
visuomotor problems, intheformof poor drawing, shouldbeadministeredall
subtestsfromtheSensorimotorandtheVisuospatial domains. Inother typesof
disorders, test selection may be guided by characteristics of the particular
condition, asreportedintheliterature, andbywhat processesmaylogicallybe
thought tobeimplicatedinanimpairedfunction. For example, inarithmetical
operations, executivefunctions, andworkingmemoryareprobablyinvolved,
in addition to attention, languageand visuospatial abilities. To evaluatethis
complexfunctionindepth, aFull Assessment isadvisable(seealsotheNEPSY
manual,p. 49, for analternativeselection). TheCoreandExpandedsubtestsfor
512year oldsarepresentedinTable11.4. Threeandfour year oldsperforma
slightlydifferent selectionof subtests.
A special problemisrelatedto theassessment of attention. Attentiontests
Table 11.4. Core and Expanded subtests for 512-year-old children
Domain Subtest Typeof score
Attention/ ExecutiveFunctions Tower Core
AuditoryAttentionandResponseSet Core
Visual Attention Core
DesignFluency Expanded
Statue Expanded
KnockandTap Expanded
Language Phonological Processing Core
SpeededNaming Core
Comprehensionof Instructions Core
Repetitionof NonsenseWords Expanded
Verbal Fluency Expanded
Oromotor Sequences Expanded
Sensorimotor FingertipTapping Core
ImitatingHandPositions Core
Visuomotor Precision Core
Manual Motor Sequences Expanded
Finger Discrimination Expanded
Visuospatial DesignCopying Core
Arrows Core
BlockConstruction Expanded
RouteFinding Expanded
MemoryandLearning Memoryfor Faces Core
Memoryfor Names Core
NarrativeMemory Core
SentenceRepetition Expanded
List Learning
1
Expanded
1
For ages712only.
tendtoyieldrelativelyinconsistent resultsandtohavelowhit rates(Halperin
et al., 1990; Barkley, 1991; Matier-Sharmaet al., 1995). Onereasonmaybethat
attentioninchildrenwithADHDtendstouctuatefromsituationtosituation,
and that it is highly motivation dependent. Children may nd the testing
situation motivating, and their attention problems may not always become
evident onatest level. It isthereforeimportant to beawarethat normal test
resultsontheattentionsubtestsdonot excludethepossibilityof anattention
disorder. Despitethesensitivityof theAttention/ ExecutiveFunctionssubtests
to ADHD, reported in the study by Huckeba et al. (1998), other types of
information, especiallyratingscalesandinterviewswithparentsandteachers,
arealso essential. In all cases in which attention problemsaresuspected, an
Expanded Assessment of Attention is indicated, irrespectiveof whether the
Attention/ ExecutiveFunctionsCoreDomainscoreispoor or not. A compre-
hensiveassessmentofattentionismorelikelytodetectattentionproblemsthan
onlytwoattentiontests. Similarly, whenthereisreasontosuspect other types
of impairment motor, language, perceptual, etc. ExpandedAssessmentsare
also required when theCoreDomain scoredoes not giveclear evidenceof
impairment.
Administering a Core Assessment followed by Expanded Assessments is
actually an example of a process-oriented approach in Lurias tradition
(Christensen, 1984; Kaplan, 1988), andabranchingapproach asproposedby
Cantwell andBaker (1987). Common to theseapproachesis that theassess-
ment isguidedbysuccessivequestionsandhypotheses. Questionsandhypo-
theses may also arise in the process of interpretation. The examiner may
sometimesneedto go back andadminister additional teststo test thehypo-
thesis. Becausetheremay bearisk that administeringadditional tests isnot
possible after the initial assessment, it is always safer to administer the full
NEPSY whenever possible.
For acompleteneuropsychological assessment, theNEPSY isnot sufcient.
Other instrumentsanddatamaybeneededaswell. Therst questioninthe
evaluationoftenconcernswhether thechildscognitivecapacityisnormal or
not, soatest of cognitivecapacityneedstobeadministered. Thenext question
maybewhether or not thechildhassignsof impairment inanydomain. For
suchadecision, obtainingathoroughhistoryandcollectingdatafromparents,
school, andother examinationsareessential, inadditiontoaCoreAssessment
(see history in the NEPSY manual, Appendix H). A further question may
concernthenatureof thechildsneurocognitiveimpairments. Toanswer this
question, all subtests fromthe impaired domain or related to the impaired
functionneedtobeadministered. Inaddition, qualitativeobservationsanddata
concerninghowtheproblemsarepresent inpracticearehelpful.
Insomeinstances, timerestraints, limitedcooperationof thechild, or other
factors may call for a more restricted assessment. The examiner may then
chooseto analyzethe most disturbingproblemof the child, ignoringother
possiblequestionsfor thetimebeing. A needfor suchSelectiveAssessments
mayarise, for example, inchildrenwho needinterventionfor developmental
languagedisorder or dyslexia.
Principles of interpretation
As expressed above, the aims of a NEPSY assessment are: (1) to performa
comprehensivescanningandevaluationof neurocognitivefunctions;and(2)to
analyze, in depth, disorders of complex functions. Theinterpretation of the
results is in accordance with these aims. In contrast, the NEPSY was not
primarily constructed to yield diagnostic labels, such as Learning Disorder,
Communication Disorder, or Attention-Decit/ Hyperactivity Disorder.
Nevertheless, theassessmentmayaidinassigningsuchlabels, aswhenthedata
meet thecriteriaof theDiagnosticandStatistical Manual of Mental Disorders,
fourth edition (DSM IV: American Psychiatric Association, 1994). NEPSY
resultscanalso providesupport for adiagnosisof variouslearningdisabilities
whenunderlyingprocessesareimpaired(e.g., poor phonological processingin
readingdisorder).
The results according to the rst aimof the assessment to performa
comprehensiveevaluation of thechilds neurocognitivestrengthsand weak-
nesses canmost of thetimebeexpressedinarelativelystraightforwardand
descriptivefashion. Sometimes, however, determiningwhether weaknessesor
impairments arepresent is not entirely unproblematic. TheNEPSY manual
providestablesfor signicancesof discrepanciesbetween subtest scores, and
betweentheCoreDomainscoreandspecicsubtest scores. Moreimportant,
however, isthepatternof results. Inparticular, theexaminer shouldlookfor
consistent evidenceof animpairment. Asaruleof thumb, animpairment may
be indicated when two or more subtest scores, Supplemental scores, or
QualitativeObservationspoint inthesamedirection. For example, atleasttwo
Language/ Verbal Memory scores signicantly below the subtest mean for
normal children(:7), or resultssignicantlybelowthechildsgeneral level of
performance, wouldindicatealanguageimpairment. ExpandedNEPSYassess-
mentsaswell asaconsiderationof QualitativeObservations(e.g., misarticula-
tions) are often required to obtain sufcient evidence of an impairment.
External data, suchasdatafromhistory, school, or home, or assessment with
other instruments, mayalsosupport aNEPSY nding.
Thesecond purposeof theassessment is to analyzeastated impairment.
This typeof analysis is pertinent in disorders of complex functions, such as
languagedisorders, dyslexia, arithmeticdisorders, andgraphomotor problems.
Thendingsareinterpretedbyspecifyingtheprimarydecit(s)of adisorder, as
well as itseffects on other complexfunctionsor subcomponents(secondary
decits). Theliteratureonsubtypesof disordersor specicdecitsunderlying
disorders is an important source in the forming and testing of hypotheses.
This type of interpretation demands some special knowledge in child
neuropsychology. Examinerswith littleexperiencein childneuropsychology
maychoosetoprovideonlydescriptiveinterpretations, asdescribedabove.
Findingsarenot alwayscausallyrelatedbut may, instead, represent comor-
bid, separate disorders. An example of primary, secondary, and comorbid
disordersmaybeachildwithdyslexiawhosetest prolesuggestsadecit of
phonological analysisanddecoding, asevidencedby impairedresultson the
Phonological Processingsubtest andtheRepetitionNonsenseWordssubtest.
These results seem logically consistent with a dyslexia. Secondary decits
foundonreceptivelanguagetasksandverbal memoryandlearningtaskswould
conrmthe hypothesis of a primary phonologicalreceptivedecit. In mild
cases, such secondary effectsmay not occur. If thesamechildalso haspoor
manual sensorimotor differentiation, as evident on theImitatingHand Posi-
tions and Tactile Finger Discrimination subtest, this problemwould be an
unrelated, comorbidproblem.
It should be pointed out that several different underlying decits may
contributetoadisturbanceof thesamecomplexfunction. Suchisthecase, for
example,whenbothvisuospatial andsensorimotorproblemsunderlieimpaired
graphomotor production. A special complication is provided by the high
prevalenceof comorbiddisordersinchildren(seeabove). If achildhasthreeor
moretypesof impairments, or agenerallypoor performancelevel, specifying
primaryandsecondarydecitsmaynot bemeaningful.
Thenal stepistoverifytheinterpretation. Themost important waytodo
thisisto check theinterpretationfor ecological validity. Statedimpairments
needtocorrespondtodatafromhistory, home, andschool. If theassessment
pointstoimpairmentsthathavenotbeensuspectedbefore, theexaminerneeds
todouble-checkthat thediagnosticconclusionisbasedonrmevidenceinthe
NEPSY ndings. In verifying the interpretation of primary and secondary
decits, oneimportant sourceof vericationistheliterature. If disordershave
beendescribedinasimilar fashionintheliterature, theexaminer knowsthat
theinterpretationisat least plausible.
Contradictoryandunrelatedndingsarenot uncommoninchildren. Fur-
ther assessments may sometimes be indicated to yield sufcient data for
conclusions. Inother casesit may bepossibleonlyto suggest potential prob-
lemsor possiblemechanismsof disorder.
Theresults of theassessment may also beconsideredwith respect to the
degreeto which they shedlight on theparticular problemsandassetsof the
child. Thevalueof theassessment dependsonthedegreetowhichit provides
useful informationfor child, parents, andschool, andservesasaguidefor the
planningandfollow-upof intervention.
NEPSY studies on learning disorders
Dyslexia
Childneuropsychologyisrelativelyyoungasanappliedscience, andstill lacksa
generallyacceptedtaxonomy classicationsanddescriptionsof subtypes of
disorders. Interpretationsof ndingsmay thusvary accordingto theorienta-
tionof theclinicians. Oneexampleisthetheoriesconcerningdyslexia.
Most authorsrecognizetheimportanceof phonological analysisandaware-
ness, i.e., awarenessof thesoundstructureinspeech, asamainprerequisitefor
the normal acquisition of reading and writing (e.g., Liberman et al., 1974;
Bradley & Bryant, 1985; Stanovich & Siegel, 1994; Torgesen, Wagner, &
Rashotte, 1994; Shaywitz, 1998). However, alternative or additional factors
have also been emphasized. Some authors emphasize the role of semantic
retrieval (naming) (Korhonen, 1991; Wolf & Obregon, 1992), others that of
verbal memory processes (Siegel & Ryan, 1989; Douglas & Benezra, 1990;
Gathercole&Baddeley, 1990). AccordingtoTallal etal. (Tallal, Miller, &Fitch,
1993; Tallal et al., 1996), slowedauditory processingistheprimary decit in
impairedlanguagelearning, andmayalsoaffect readingacquisition. Galaburda
and Livingstone(1993), Lovegrove(1994), and Stein (1994) proposespecic
types of visual processing problems to be implicated in reading disorders.
Decitscontributingtoreadingdisordersmayincludeall of theabove.
Thevalidationstudyof childrenwithreadingdisorder intheNEPSYmanual
indicatedthatthesechildren(n=36)wereparticularlyimpairedonthesubtests
Phonological Processing, SpeededNaming, Oromotor Sequences, Memoryfor
Names, NarrativeMemory, andSentenceRepetition. Theseresultspoint toan
underlyinglanguageproblem. Two of these ndings (Speeded Naming and
NameLearning) point toproblemsof semanticretrieval, that is, todysnomia.
The poor score on Phonological Processing may be related to that on the
SentenceRepetition. Bothmayindicateanimpairment intheperceptionand
processingof phonological sequences. Thepoor NarrativeMemoryscoremay
berelatedtothepoor Oromotor Sequencesscore, becausebotharethoughtto
besensitiveto impairmentsinexpressivespeech: phonological programming
andarticulationandproductionof anarration. Thus, inthisreadingdisorder
sample, manychildrenmayhaveimpairment inphonological analysis, seman-
ticretrieval, andsubtle, maybecompensated, expressivelanguageandspeech
problems(Korkmanet al., 1998).
Somemilder but still signicant impairmentsindicatedapresenceof comor-
bidproblemsinthesampleof readingdisorder children. Visuospatial problems
were indicated by poor scores on the Design Copying and Route Finding
subtests. Whether or not thisimpairmentmayhavecontributedtothereading
problems cannot be concluded. Logically, reversals may be related to poor
perceptionof directionality, but thereislittleresearchevidencetoverifysucha
hypothesis. Poor performanceontheManual Motor Sequencessubtest corre-
spondstothat ontheOromotor Sequences. Bothndingsindicateimpairment
inmotor programming. Thisdecit mayalsocontributetothepoor result in
DesignCopying.
Developmental language disorder
Languageinvolvesmanyseparatesubprocessesorcomponents.Notsurprising-
ly, many primary decits have been proposed as underlying and explaining
languagedisorders. Theseincludeadecitinprocessingrapidlychanginginput
(Tallal et al., 1996), impaired phonological analysis (Rapin & Allen, 1988;
Scarborough, 1990), problemswithsyntaxandmorphology(Gopnik&Crago,
1991), impairedverbal short-termor phonological workingmemory(Gather-
cole& Baddeley, 1990), amotor programmingdecit (seeBishop, 1992), and
dysnomicproblems(Korkman&Hakkinen-Rihu, 1994). Someauthorsempha-
sizeonesingleresponsiblemechanism, whereasothersrecognizethepossibil-
ity of subtypes with different primary decits. For athorough treatment of
languageassessment andthesubprocessesof language, seeWiig(Chapter 8).
ThestudybyKorkmanandHakkinen-Rihu(1994) wasperformedtodelin-
eatesubtypesof developmental languagedisorder, andusedtheFinnish1988
NEPSY. In80childrenwithdevelopmental languagedisorder, four subgroups
werefoundandvalidated. Therst subgroupwasaglobal subgroup. Children
in this category werecharacterizedby global andseverelanguagedisorders,
evident asimpairment onall subtestsof language. Thesecondsubgroupwasa
specicverbal dyspraxiasubgroup. Childreninthissubgroupwerecharacter-
izedby impairedscoreson theRepetition of NonsenseWordsandtheOro-
motor Sequencessubtests. Thethirdsubgroupwasaspeciccomprehension
subgroup. Common characteristicswereproblemsin tasksdemandingcom-
prehension of instructions and concepts, with or without difculties on the
Phonological Processingsubtest (onlytheeasier part wasadministered). The
fourth subgroup was a small, specic dysnomia subgroup. This group was
characterized by dysnomic problems, including poor performance on the
Speeded Naming and Name Learning subtests. At follow-up of part of the
sample, threeyearslater, thechildrenfromgroupsoneandthreewerefoundto
bedyslexic. Follow-up data were not obtained for the small dysnomiasub-
group, but previous studies (e.g., Korhonen, 1991; Wolf & Obregon, 1992)
wouldpredict that thissubgroupwouldalsoendupbeingdyslexic.
Thendingthat phonological processinganddysnomic problemsmay be
separate problems may be relevant also for dyslexia. It may indicate that
dyslexia, too, mayincludesubtypescharacterizedby phonological awareness
problemsanddysnomicproblems, respectively. For amoredetaileddiscussion
of subtypes, seeSpreen(Chapter 9) andReitanandWolfson(Chapter 10).
Thestudy also shows that dyslexiamay be predicted on the basis of the
NEPSYsubtestscores. Thisndingmayhavepractical implications. Treatment
of dyslexiamaystart preventivelybeforethestart of formal readingeducation.
Suchpreventivetreatment wasactuallyprovidedto agroupof childrenwith
developmental languagedisorder, diagnosedwiththeNEPSY. Preschool train-
ingof phonological awareness and preliminary phonemegraphemeconver-
sions, providedtoagroupof childrenwithdevelopmental languagedisorder,
resultedinsignicantlybetter resultsonreadingandspellingtestsat follow-up
than thoseobtained by acontrol group receivingmoretraditional forms of
treatment (Korkman&Peltomaa, 1993).
Attention disorders
As already mentioned, attention has been viewed as incorporating many
different aspects: selective attention, sustained attention, attention span or
divided attention, and inhibition and control of behavior (Douglas, 1984;
Barkley, 1988; Mirsky, 1989; Cooley&Morris, 1990). Attentiondisordershave
been mainly subdivided into apredominantly hyperactiveimpulsivetype, a
predominantly inattentivetype, and acombined type(American Psychiatric
Association, 1994).
An attempt to delineate subtypes of and predict attention disorders was
madeusingtheFinnish1988NEPSY (Korkman& Peltomaa, 1991). A hetero-
geneous group consisting of 46 kindergarten students at risk for attention
problemswasadministeredtheNEPSY Attention subtestsandtheMatching
Familiar Figurestest (MFFT; Kagan, 1966). Thetest prolesweregroupedinto
subgroupswith theaidof aQ-typefactor analysis. Two subgroupshad test
ndingsthat seemedto predict attentionproblemsat school: poor resultson
the Attention subtests, including the Inhibition and Control subtest (which
includedthe1988versionof theStatueandtheKnockandTapsubtests), ona
subtest calledSustainedConcentration(ameasureof howlongthechildwas
ableto go on workingon thetestingsession), and on theMFFT. Subgroup
membership predicted attention problems at school with fair accuracy (Co-
henskappa=.41). However, theNEPSYtest prolesusedinthisstudydidnot
discriminatebetweenimpulsiveandinattentivechildren.
Closely related to attention are executivefunctions, that is, planningand
Table 11.5. Summary of types of disorders observed with NEPSY
Dyslexia
Phonological analysisdecit
Dysnomic(semanticretrieval) problems
Languagedisorder (compensatedor evident)
Developmental languagedisorders
Oromotor dyspraxia
Receptivedisorder: phonological decodingdecits
verbal processingandcomprehensiondecit
Dysnomia
Global
Attentionandexecutivefunctionsdisorders
Decitsof control andinhibition, inattention(ADHD)
Executivefunctionsproblems
strategyemployment, abilityto maintainandshift set, organizedsearch, and
impulse control (Welsh, Pennington, & Groisser, 1991; Levin et al., 1991).
Pennington, Groisser, andWelch(1993) foundADHDchildrentoperformless
well thanlearning-disabledchildrenontasksof executivefunctions: theWis-
consinCardSortingtest(seePenningtonetal., 1993)andtheTower of London
test (Shallice, 1982).
It isnotcertain, however, thatattentionandexecutivefunctionsareinsepar-
able. ThestudybyKlenberget al. (inpress)showednotonlythattheAttention
andtheExecutiveFunctionssubtest scoreshaddifferent developmental time
tables(seeabove), but thesubtestsalso loadedon different factors, with the
attentionandcontrol andinhibitionsubtestsloadingononefactor, theuency
subtests (Design Fluency and Verbal Fluency) on a second, and the Tower
subtest onathird. It istobehopedthat researchwill disentangletherelation-
shipof thesefunctions.
Asummaryof distinctionsof typesof disorderssofar madewiththeNEPSY
ispresentedinTable11.5. Theoverviewistoberegardedaspreliminaryandis
notcross-validated. Further distinctionsmayalsobeproposedinthefuture, for
exampleof typesof attention disorders. Theoverview representsan ideaof
howwemayattempttoconstructataxonomyofsubtypesof disorderswiththe
NEPSY.
Comorbidity
In accordancewith previousstudies(e.g., Denckla, 1985; Dykman & Acker-
man, 1991; Gilger et al., 1992; Stanford& Hynd, 1994), Korkmanet al. (1998)
reportedahighprevalenceof overlappingandcomorbiddisordersinchildren
with ADHD, readingdisorder, anddevelopmental languagedisorder, asevi-
dent on the NEPSY subtests. In addition to their impaired scores on the
Attention/ ExecutiveFunctions Domain score, children with ADHD (n=51)
weresignicantlyimpairedalsoontheLanguage, Sensorimotor, Visuospatial,
andMemoryandLearningCoreDomainscores. Themost severeimpairment
wasnotedonthelanguagesubtests, for whichresultsinall subtestsexcept one
weresignicantly poorer than in agroup of matched control children. The
manual motor andsensorysubtestsalsoshowedwidespreadimpairmentinthe
ADHD children. Lessimpairment wasseen on theVisuospatial subtests, for
whichnoneof thesubtestsdifferedbetweenthegroups, despitethesignicant
differenceontheCoreDomainscore. Of theMemoryandLearningsubtests
the SentenceRepetition and the List Learning subtests differed signicantly
betweenthegroups. Similarly, Huckebaet al. (1998) foundsignicant differen-
cesonmanySupplemental scoresandQualitativeObservationsacrossdomains
inthesamegroupsof children.
Incontrast, childrenwithreadingimpairment (n=36) wereimpairedonly
ontheLanguageandtheMemoryandLearningDomainscoresof theNEPSY,
whencomparedto matchedcontrol children. Theydid, however, differ with
respect totheStatue, theManual Motor Sequences, theDesignCopying, and
theRouteFindingsubtests. Childrenwithlanguagedisorders(n=19) differed
signicantlyfrommatchedcontrol childrenonall CoreDomainscoresexcept
theVisuospatial CoreDomainscore. Theattentionsubtestsweremorewidely
affectedthanthesensorimotor subtests.
In thestudiesabove, thechildren hadbeenassignedto thegroupson the
basisof adiagnosis, andthepossibilityof comorbiddisorderswasnot explicitly
excludedby external measures, such as tests of academic achievement. In a
previousstudy, usingthe1988FinnishNEPSY, KorkmanandPesonen(1994)
found children with specic ADHD and no reading disorders to have a
relativelygoodoverall performancelevel, but theyperformedsignicantlyless
well ontheInhibitionandControl subtest (seeabove). Childrenwithreading
disorderbutnoattentiondisorderperformedsignicantlylesswell thanADHD
childrenonthe1988phonological processing-typesubtest, adigitspantest, and
the 1988 memory for narration-type subtest. Children with attention and
readingdisorder had thesamedecits as both theADHD and thelearning-
disabledgroups. Inaddition, thisgroupperformedpoorlyontheVisuomotor
Precisiontest andtheVMI aswell, whichmayindicatecomorbidgraphomotor
problems. In addition to the differences between groups, the Memory for
Names and the Speeded Naming subtests were poor in both groups. This
ndingindicatedthat theattention-impairedchildren might also haveaten-
dencyfor language-level problemsof nameretrieval.
Thendings demonstrated thestrongtendency for overlappingattention
andverbal learningdisorders, aswell asatendencyfor comorbidproblemsthat
wereparticularlypronouncedinchildrendiagnosedasattentiondisordered.
Case study: executive functions and attention disorder
Thecasethatillustratestheapplicationof theNEPSYisthatof agirl, Sally, aged
9 years 11 months. This case was chosen because it illustrates the clinical
reasoninginvolvedintheapplicationof theNEPSY. Typical of thisreasoningis
aninvestigative, process-orientedapproachinaLuriansense. Sallyscasealso
illustratestheprinciplethat NEPSY assessment aimsat enhancingour under-
standingof learningdisordersandproblems, ratherthanatattachingdiagnostic
labels.
Sallywasnot atypical learning-disabledchildanddidnot haveadiagnosisof
learningdisability. Shecameto achildrensclinicfor assessment becauseher
achievement wasunexpectedlypoor at school. Earlier, shehadsufferedfrom
epileptic seizures, which were controlled by medication at the time of the
assessment. Her cooperationontheassessment wasvariable, but for themost
part good. Her psychometric intelligence was found to be normal (Verbal
IQ=101; PerformanceIQ=111). Sallywaswell dressedandgavetheimpres-
sionof beingcondent, bright, talkative, andlively. Accordingtoschool grades
and achievement tests, she was not clearly dyslexic, but she did relatively
poorlyinreadingandspelling. Inclassshedidnotattendwell andhadbehavior
problemsandpoor peer relations.
Figure11.4presentsthefull NEPSY proleof Sally. Asmaybeseen, most
test resultswereaverage. OntheAttention/ ExecutiveFunctionsassessment,
theTower subtest wasdiscontinuedbecauseSallyrefusedafter failingseveral
tasks. Thefailureswererelatedtoimpulsiveperformanceshedidnottakeher
time to plan the sequences of moves. Based on her performance before
discontinuation, it wasevident that thissubtest waspoorlyachieved, but exact
resultswerenot obtained. TheresultsontheAuditoryAttentionandResponse
Set andtheVisual Attention subtestswerewithin normal limits, but supple-
mental analyses revealed that fast responses compensated for a larger than
Fig11.4. NEPSY test proleof Sally, aged 9years11months, with poor school achievement
despiteaveragecognitivecapacity. Notebelow-expectedscoresonStatueandList Learning, and
apoor result inrelationtoaverageabilityonMemoryfor Names. OntheTower subtestsSally
refusedto continueafter several failures. Supplemental scoreson theAuditory Attentionand
ResponseSet subtest revealedmoreerrorsthan expected. Resultssuggest executivefunctions
problemsandattentionproblemswithhyperactivityandimpulsivity. (FromNEPSY. ADevelop-
mental Neuropsychological Assessment, byM. Korkman, U. Kirk, &S.L. Kemp(1998). SanAntonio,
TX:ThePsychological Corporation.Copyright1988byThePsychological Corporation.Adapted
withpermission.)
averagenumber of errors. OntheResponseSet subtest part, Sallymadethree
commissionerrors, whichcorrespondedtoalevel belowtheexpected, accord-
ingtotheFinnishnorms. Poor impulsecontrol andhyperactivityloweredthe
scoretowell belownormal ontheStatuesubtest.Thus, attentionproblemsofa
hyperactiveandimpulsivetypewereevident.
Decitstypical of dyslexiawerenot clearlyevident, but arelativeweakness
inphonological processingcorrespondedto arelativelypoor achievement in
readingandspellinginschool, andmayhavecontributedto thepoor overall
school performanceandmotivation. FingertipTappingcouldnot bescoredas
Sallydidnot followinstructionsproperly. Poor resultswereachievedalso on
theVisuomotor Precisionsubtest. However, thisndingwasnot conrmedby
any other nding, and was contradicted by good results on the Copying
Designs subtest as well as by good handwriting, so it was not considered
signicant. Thefailureon this subtest was probably caused by too fast and
impulsiveaperformance.
IntheMemoryandLearningDomain, goodresultsontheSentenceRepeti-
tionsubtest correspondedto agoodperformanceonRepetitionof Nonsense
Wordssubtest, butcontrastedwithpoorer thanaveragescoresontheMemory
for NamesandListLearning. Thesefailuresindicatedproblemswithcontrolled
andactivememorizingbut not with mechanical short-termmemory per se.
This result, in combination with the problems on the Tower subtest, gave
reasontosuspectdifcultieswithorganizingandmonitoringperformance, that
is, executivefunctionsproblems. In addition, subtleproblemsin particularly
complextasksof languagelearning, relatedto thepoor phonological percep-
tion, also seemedpossible, andmayhavecontributedto theproblemsinthe
learningsubtestsandinschool.
Inconclusion, Sallyseemedtohaveproblemsrelatedtoexecutivefunctions,
especiallyincomplextasksdemandingorganizedactivityandeffort, andwith
attention, control, andinhibition. Subtleproblemsinphonological processing
andlanguagelearningmayhavecontributedtothedifcultiesencounteredin
school. Astructuringof thedailyroutinesof schoolworkaswell asstructuring,
supervision, andmotivatingaids(atimer, keepingrecords, rewards)tosupport
homeworkwererecommended. Inaddition, tutoringinreadingdecodingand
spellingwasthoughttohelptoimproveperformanceandmotivationinschool.
Assetsweregoodverbal comprehensionandrotelearning, fast andaccurate
motor performance, andgoodvisuospatial andvisualconstructional abilities.
Conclusion
ThebasicLurianframeof referenceof theNEPSY iscomprised, inanutshell,
as follows: cognitive functions, such as speech, reading, graphomotor
performance, learning, paying attention, etc., are all complex systems that
incorporatemanycomponents. Inorder toanalyzeadisorderedfunction, the
componentsneedto beassessedoneby one. Thesecomponentsareactually
brainprocesses, andthereforeacomprehensiveneuropsychological assessment
isalsoascanningof brainfunctions. TheNEPSY subtestsaimat assessingthe
components/ brainfunctionscontributingto cognitiveandvisuomotor func-
tioning.
It was stated previously that a successful assessment using the NEPSY
dependsmoreontheexaminersqualicationsthanonthetestitself. However,
acomprehensiveneuropsychological viewwasincorporatedinto theNEPSY
andprovidesahelpful structureto theassessment. AdministeringtheNEPSY
mayprovetobeaneducativeprocess. Suchanexperiencewasexpressedbya
youngcolleague, anoviceinneuropsychology, who, after performingher rst
fewassessmentsusingtheNEPSY, exclaimedthat theNEPSY hastaught her a
neuropsychological wayof thinking.
REFERENCES
American Psychiatric Association (1994). Diagnostic andStatistical Manual of Mental Disorders,
FourthEdition(DSMIV). WashingtonDC: AmericanPsychiatricAssociation.
Aram, D.M. &Ekelman, B.L. (1988). Scholasticaptitudeandachievement amongchildrenwith
unilateral brainlesions. Neuropsychologia, 26, 90316.
Barkley, R.A. (1988). Attention. InAssessment IssuesinChildNeuropsychology, ed. M.G. Tramon-
tana&S.R. Hooper, pp. 14576. NewYork: PlenumPress.
Barkley, R.A. (1991). Theecological validityof laboratoryandanalogueassessment methodsof
ADHDsymptoms. Journal of Abnormal ChildPsychology, 19, 14978.
Beery, K.E. (1983). Developmental Test of VisualMotor Integration. Cleveland, OH: Modern
CurriculumPress.
Bentin, S., Hammer, R., &Cahan, S. (1991). Theeffectsof agingandrst gradeschoolingonthe
development of phonological awareness. Psychological Science, 2, 2714.
Benton, A.L., Hamsher, K. de S., Varney, N.R., & Spreen, O. (1983). Contributions toNeuro-
psychological Assessment. NewYork: OxfordUniversityPress.
Bishop, D.V.M. (1992). Theunderlyingnatureof speciclanguageimpairment. Journal of Child
PsychologyandPsychiatry, 33, 366.
Bishop, D.V.M. &Rosenbloom, L. (1987). Classicationof childhoodlanguagedisorders. Clinics
inDevelopmental Medicine, 1012, 1641.
Boehm, A.E. (1969). BoehmTest of BasicConcepts. NewYork: ThePsychological Corporation.
Bradley, L. & Bryant, P.E. (1985). RhymeandReason in ReadingandSpelling. Ann Arbor, MI:
Universityof MichiganPress.
Cantwell, D.P. & Baker, L. (1987). Developmental Speech and LanguageDisorders. New York:
GuilfordPress.
Carmichael Olson, H., Sampson, P.D., Barr, H., Streissguth, A.P., & Bookstein, F.L. (1992).
Prenatal exposuretoalcohol andschool problemsinlatechildhood:alongitudinal prospective
study. DevelopmentandPsychopathology, 4, 34159.
Chandlee, L., Tuesday-Heatheld, L., & Radcliffe, J. (1999). NEPSY ndingsamong4-year-old
children with low to moderate lead toxicity. Journal of theInternational Neuropsychological
Society, 5, 147.
Christensen, A.-L. (1975). LuriasNeuropsychological Investigation. Copenhagen: Munksgaard.
Christensen, A.-L. (1984). TheLuriamethodof examination of thebrain-impairedpatient. In
Clinical Neuropsychology aMultidisciplinaryApproach, ed. P.E. Logue&J.M. Schear, pp. 528.
Springeld, IL: CharlesC. Thomas.
Conry, J. (1990). Neuropsychological decitsinfetal alcohol syndromeandfetal alcohol effects.
Alcoholism: Clinical andExperimental Research, 14, 6505.
Cooley, E.L. & Morris, R.D. (1990). Attentioninchildren: aneuropsychologicallybasedmodel
for assessment. Developmental Neuropsychology, 6, 23974.
Cowan, W.W. (1979). Thedevelopment of thebrain. ScienticAmerican, Sept.-79, 10717.
Denckla, M. (1973). Development of speed in repetitiveand successivenger-movements in
normal children. Developmental MedicineandChildNeurology, 15, 63545.
Denckla, M.B. (1985). Development of motor coordinationin dyslexicchildren. In Dyslexia: a
NeuroscienticApproachtoClinical Evaluation, ed. F.H. Duffy & N. Geschwind, pp. 18795.
Boston, MA: Little, Brown.
Denckla, M.B. & Rudel, R.G. (1978). Anomalies of motor development in hyperactiveboys.
Annalsof Neurology, 3, 2318.
DeRenzi,E. &Faglioni, P. (1978). Normativedataandscreeningpower of ashortenedversionof
theTokenTest. Cortex, 14, 419.
Don, A. & Rourke, B.P. (1995). Fetal alcohol syndrome. In Syndromeof Nonverbal Learning
Disabilities. Neurodevelopmental Manifestations, ed. B.P. Rourke, pp. 372406. New York:
GuilfordPress.
Douglas,V.I. (1984). Attentional andcognitiveproblems. InDevelopmental Neuropsychiatry,ed. M.
Rutter, pp. 280329. Edinburgh, UK: Churchill Livingstone.
Douglas, V.I. & Benezra, E. (1990). Supraspanverbal memoryinattentiondecit disorder with
hyperactivity, normal, and reading-disabled boys. Journal of Abnormal Child Psychology, 18,
61738.
Dykman, R.A. &Ackerman, P.T. (1991). Attentiondecitdisorder andspecicreadingdisability:
separatebut oftenoverlappingdisorders. Journal of LearningDisabilities, 24, 96103.
Galaburda, A. & Livingstone, M. (1993). Evidencefor amagnocellular defect indevelopmental
dyslexia. In Temporal processingin thenervous system, ed. P. Tallal, A.M. Galaburda, R.
Liinas, &K. vonEuler. Annalsof theNewYorkAcademyof Sciences, 682, 7182.
Gathercole, S.E. &Baddeley, A.D. (1990). Phonological memorydecitsinlanguagedisordered
children: isthereacausal connection?Journal of MemoryandLanguage, 29, 33660.
Gilger, J.W., Pennington, B.F., & De Fries, J.C. (1992). A twin study of the etiology of
comorbidity: attention-decit hyperactivity disorder and dyslexia. Journal of the American
Academyof ChildandAdolescent Psychiatry, 31, 3438.
Gopnik, M. & Crago, M.B. (1991). Familial aggregationof adevelopmental languagedisorder.
Cognition, 39, 150.
Halperin, J..M., Newcorn, J.H., Sharma, V., & Healy, J. (1990). Inattentiveandnon-inattentive
ADHDchildren: dotheyconstituteaunitarygroup?Journal of Abnormal ChildPsychology, 18,
43749.
Hecaen, H. (1983). Acquiredaphasiainchildren: revisited. Neuropsychologia, 21, 5817.
Herrgard, E., Luoma, L., Tuppurainen, K., Karjalainen, S., & Martikainen, A. (1993). Neuro-
developmental proleatveyearsof childrenbornat=/ :32weeksgestation. Developmental
MedicineandChildNeurology, 35, 108396.
Huckeba,W.M., Kreiman, C.L.,Korkman, M., Kirk, U., &Kemp,S.L. (1998). Qualitativeanalysis
of NEPSYperformanceinchildrenwithADHD. Paper presentedatthe106thAnnual Meeting
of APA, SanFrancisco, CA, August 1998.
Huttenlocher, P.R., deCourten, C., Garey, L.J., & VanDer Loos, H. (1982). Synaptogenesisin
humanvisual cortexevidenceforsynapseeliminationduringnormal development.Neurosci-
enceLetters, 33, 24752.
Kagan, J. (1966). Reection impulsivity: thegenerality and dynamics of conceptual tempo.
Journal of Abnormal Psychology, 71, 1724.
Kaplan, E. (1988). Aprocessapproachtoneuropsychological assessment. InClinical Neuropsychol-
ogy and Brain Function: Research, Measurement, and Practice, ed. T. Boll & B.K. Bryant, pp.
129167. WashingtonDC: AmericanPsychological Association.
Klenberg, L., Korkman, M., & Lahti-Nuuttila, P. (in press). Development of attention and
executivefunctions: separatedevelopmental trends?Developmental Neuropsychology.
Korhonen,T.T. (1991). Neuropsychological stabilityandprognosisof subgroupsof childrenwith
learningdisabilities. Journal of LearningDisabilities, 24, 4857.
Korkman,M. (1980). NEPS. LastenNeuropsykologinenTutkimus. Kasikirja[NEPS. Neuropsychological
Assessmentof Children. Manual]. Helsinki, Finland: PsykologienKustannus.
Korkman, M. (1988a). NEPSY anadaptationof Luriasinvestigationfor youngchildren. The
Clinical Neuropsychologist, 2, 3759.
Korkman, M. (1988b). NEPS-U. Lasten neuropsykologinen tutkimus. Uudistettu laitos [NEPSY.
Neuropsychological Assessment of Children. Revised Edition]. Helsinki, Finland: Psykologien
Kustannus.
Korkman, M. (1990). NEPSY. Neuropsykologiskundersokning: 47ar. Svenskversion[NEPSY. Neuro-
psychological Assessment: 47years. SwedishVersion]. Stockholm, Sweden: Psykologiforlaget.
Korkman, M. (1993). NEPSY. Neuropsykologisk undersgelse 47 ar. Dansk vejledning [NEPSY.
Neuropsychological Assessment: 47 years. Danish Manual]. (Translated from Swedish by K.
Holm, K. Frandsen, J. Jordal, &A. Trillingsgaard. Denmark: DanskPsykologiskForlag.
Korkman, M. (1995). A test proleapproachintheanalysisof cognitivedisordersinchildren
experiencesof theNEPSY. InAdvancesinChildNeuropsychology, Vol. 3, ed. M.G. Tramontana
&S.R. Hooper, pp. 84116. NewYork: Springer-Verlag.
Korkman, M. (1999). ApplyingLuriasdiagnosticprinciplesintheneuropsychological assessment
of children. NeuropsychologyReview, 9, 89105.
Korkman, M., Autti-Ramo, I., Koivulehto, H., & Granstrom, M.-L. (1998). Neuropsychological
effectsat earlyschool ageof fetal alcohol exposureof varyingduration. ChildNeuropsychology,
3, 199212.
Korkman, M., Barron-Linnankoski, S., & Lahti-Nuuttila, P. (1999). Effectsof ageand reading
instruction on the development of phonological awareness, speeded naming, and verbal
memory. Developmental Neuropsychology, 16, 41531.
Korkman, M. & Hakkinen-Rihu, P. (1994). A new classication of developmental language
disorders(DLD). BrainandLanguage, 47, 96116.
Korkman, M., Kirk, U., &Kemp, S.L. (1997). NEPSY. Lastenneuropsykologinentutkimus[NEPSY. A
Developmental Neuropsychological Assessment]. Helsinki, Finland: PsykologienKustannus.
Korkman, M., Kirk, U., & Kemp, S.L. (1998). NEPSY. ADevelopmental Neuropsychological Assess-
ment. SanAntonio, TX: ThePsychological Corporation.
Korkman, M., Kirk, U., &Kemp, S.L. (inpress). NEPSY. Neuropsykologiskbedomning3:012:11ar.
[NEPSY. ADevelopmental Neuropsychological Assessment.] Stockholm: Psykologiforlaget.
Korkman, M., Liikanen, A., &Fellman, V. (1996). Neuropsychological consequencesof verylow
birthweightandasphyxiaatterm: follow-upuntil school-age. Journal ofClinical andExperimen-
tal Neuropsychology, 18, 22033.
Korkman, M. &Peltomaa, K. (1991). Apatternof test ndingspredictingattentionproblemsat
school. Journal of Abnormal ChildPsychology, 19, 45167.
Korkman, M. & Peltomaa, K. (1993). Preventivetreatment of dyslexiaby apreschool training
programforchildrenwithlanguageimpairments.Journal ofClinical ChildPsychology,22,27787.
Korkman, M. & Pesonen, A.-E. (1994). A comparison of neuropsychological test proles of
children with attention decit-hyperactivity disorder and/ or learning disorder. Journal of
Korkman, M. & von Wendt, L. (1995). Evidence of altered dominance in children with
congenital spastichemiplegia. Journal of theInternational Neuropsychological Society, 1, 25170.
Levin,H.S., Culhane,K.A., Hartmann, J. etal. (1991). Developmental changesinperformanceon
testsof purportedfrontal lobefunctioning. Developmental Neuropsychology, 7, 37795.
Liberman, I.Y., Shankweiler, D., Fisher, F.W., &Carter, B. (1974). Readingandtheawarenessof
linguisticsegments. Journal of Experimental ChildPsychology, 18, 20112.
Lovegrove, W. (1994). Visual decits in dyslexia: evidence and implications. In Dyslexia in
Children. MultidisciplinaryPerspectives, ed. A. Fawcett & R. Nicolson, pp. 11335. NewYork:
Harvester Wheatsheaf.
Luria, A.R. (1963). Restoration of Function after Brain Injury (translated by B. Haigh). Oxford:
PergamonPress.
Luria, A.R. (1973). TheWorkingBrain(translatedbyB. Haigh). London: PenguinPress.
Luria, A.R. (1980). Higher Cortical FunctionsinMan, secondedition(translatedbyB. Haigh). New
York: BasicBooks.
Maruszewski, M. (1971). Unpublishedtest material. Personal communication.
Matier-Sharma,K., Perachio, N., Newcorn,J.H., Sharma,V., &Halperin, J.M. (1995). Differential
diagnosis of ADHD: are objective measures of attention, impulsivity, and activity level
helpful?ChildNeuropsychology, 1, 11827.
Mattis, S. (1992). Neuropsychological assessment of school-agedchildren. InHandbookof Neuro-
psychology, Vol. 6: Child Neuropsychology, ed. I. Rapin & S.J. Segalowitz, pp. 395415.
Amsterdam: Elsevier.
Miller, M.W. (1986). Effects of alcohol on the generation and migration of cerebral cortical
neurons. Science, 233, 130811.
Mirsky, A.F. (1989). The neuropsychology of attention: elements of a complex behavior. In
IntegratingTheoryandPracticeinClinical Neuropsychology,ed. E. Perecman, pp. 7591. Hillsdale,
NJ: LawrenceErlbaumAssociates.
Morrison. F.J., Smith, L., & Dow-Ehrensberger, M. (1995). Education and cognitivedevelop-
ment: anatural experiment. Developmental Psychology, 31, 78999.
Pennington, B.F., Groisser, D.M., & Welsh, M.C. (1993). Contrasting cognitive decits in
attentiondecit hyperactivitydisorder versusreadingdisability. Developmental Psychology, 29,
51123.
Rapin, I. & Allen, D.A. (1988). Syndromes in developmental dysphasiaand adult aphasia. In
Language, CommunicationandtheBrain, ed. F. Plum, pp. 5774. NewYork: RavenPress.
Regard, M., Strauss, E., & Knapp, P. (1982). Childrens production on verbal and non-verbal
uencytasks. Perceptual andMotor Skills, 55, 83944.
Reitan, R.M. (1979). Manual for Administrationof Neuropsychological Test Batteriesfor Adultsand
Children. Tucson, AZ: ReitanNeuropsychological Laboratory.
Robertson, C.M.T. & Finer, N.N. (1993). Long-termfollow-upof termneonateswithperinatal
asphyxia. ClinicsinPerinatology, 20, 48397.
Russell, E.W. (1986). Thepsychometricfoundationof clinical neuropsychology. InHandbookof
Clinical Neuropsychology, Vol. II, ed. S. Filskov & T.J. Boll, pp. 4580. New York: Wiley &
Sons.
Scarborough, H.S. (1990). Veryearlylanguagedecitsindyslexicchildren. ChildDevelopment, 61,
172841.
Shallice, T. (1982). Specicimpairmentsof planning. Philosophical Transactions. TheRoyal Society
of LondonB, 298, 199209.
Shaywitz, S.E. (1998). Dyslexia. NewEnglandJournal of Medicine, 338, 30712.
Siegel, L.S. & Ryan, E.B. (1989). Thedevelopment of workingmemoryinnormallyachieving
andsubtypesof learningdisabledchildren. ChildDevelopment, 60, 97380.
Stanford, L.D. & Hynd, G.W. (1994). Congruenceof behavioral symptomatology in children
withADD/ H, ADD/ WO, andlearningdisabilities. Journal of LearningDisabilities, 27, 24354.
Stanovich, K.E. & Siegel, L.S. (1994). Phenotypicperformanceproleof childrenwithreading
disabilities: aregression-basedtest of thephonological-corevariable-differencemodel. Journal
of Educational Psychology, 86, 2453.
Stein, J. (1994). A visual defect indyslexics. InDyslexiainChildren. MultidisciplinaryPerspectives,
ed. A. Fawcett &R. Nicolson, pp. 13756. NewYork: Harvester Wheatsheaf.
Strauss, E., Satz, P., & Wada, J. (1990). Note. An examination of thecrowdinghypothesisin
epilepticpatientswhohaveundergonethecarotidamytal test. Neuropsychologia, 28, 12217.
Tallal, P., Miller, S.L., Bedi, G. et al. (1996). Language comprehension in language-learning
impairedchildrenimprovedwithacousticallymodiedspeech. Science, 271, 814.
Tallal, P., Miller, S., & Fitch, R.H. (1993). Neurobiological basis of speech: a case for the
preeminencefor temporal processing. InTemporal processinginthenervoussystem, ed. P.
Tallal, A.M. Galaburda, R. Liinas, &K. vonEuler. Annalsof theNewYorkAcademyof Sciences,
682, 2747.
Torgesen, J.K., Wagner, R.K., & Rashotte, C.A. (1994). Longitudinal studies of phonological
processingandreading. Journal of LearningDisabilities, 27, 27686.
Truwit,C.L., Barkovich,A.J., Koch, T.K., &Ferriero, D.M. (1992). Cerebral palsy:MRndingsin
40patients. AmericanJournal of Neuroradiology, 13, 6778.
Vargha-Khadem, F. &Polkey, C.E. (1992). Areviewof cognitiveoutcomeafter hemidecortica-
tioninhumans. AdvancesinExperimental Biological Medicine, 325, 13751.
Venger, L.A. & Holmomskaya, V.V. (1978). Diagnostikaumst vennogorazvitjadoskolnekov[Diag-
nosingtheCognitiveDevelopment of Preschool Children]. Moscow: Pedagogika.
Vik, P. &Ruff, R.R. (1988). Childrensgural uencyperformance:developmentof strategyuse.
Developmental Neuropsychology, 4, 6374.
Volpe, J.J. (1992). Braininjuryin theprematureinfant current conceptsof pathogenesisand
prevention. Biologyof theNeonate, 62, 23142.
Wechsler, D. (1989). Wechsler Preschool andPrimaryScaleof IntelligenceRevised. SanAntonio, TX:
Wechsler, D. (1991). TheWechsler IntelligenceScalefor ChildrenThirdEdition. SanAntonio, TX:
Welsh, M.C., Pennington, B.F., & Groisser, D.B. (1991). A normativedevelopmental studyof
executivefunction: awindowonprefrontal functioninchildren. Developmental Neuropsychol-
ogy, 7, 13149.
West, J.R. &Pierce, D.R. (1986). Perinatal alcohol exposureandneuronal damage. InAlcohol and
BrainDevelopment, ed. J.R. West, pp. 12057. NewYork: OxfordUniversityPress.
Williams, C.E., Mallard, C., Tan, W., & Gluckman, P.D. (1993). Pathophysiologyof perinatal
asphyxia. ClinicsinPerinatology, 2, 30525.
Wilson, B.C. (1992). The neuropsychological assessment of the preschool child: a branching
model. In Handbook of Neuropsychology, Vol. 6: Child Neuropsychology, ed. I. Rapin & S.J.
Segalowitz, pp. 37794. Amsterdam: Elsevier.
Wimmer, H., Landerl, K., Linortner, R., & Hummer, P. (1991). Therelationshipof phonemic
awareness to reading aquisition: more consequencethan precondition but still important.
Cognition, 40, 21949.
Wolf, M. & Obregon, M. (1992). Earlynamingdecits, developmental dyslexiasandaspecic
decit hypothesis. BrainandLanguage, 42, 21947.
12
Clinical neuropsychological assessment of
child and adolescent memory with the
WRAML, TOMAL, and CVLTC
Erin D. Bigler and Wayne V. Adams
Introduction
Central to all aspects of cognition is some facet of memory. Consequently,
most neurological and neuropsychiatric disorders disrupt various aspects of
normal memory function(seereviewsof memory disordersandtheir assess-
ment inCullum, Kuck, & Ruff, 1990; Knight, 1992; Reeves& Wedding, 1994;
Baron, Fennell, &Voeller, 1995;Gillberg, 1995;Lezak, 1995;Mapou&Spector,
1995; Cytowic, 1996). For example, in cases of traumatic brain injury (TBI),
memorydisturbancesarethemost commonof all patient complaints(Cron-
wall, Wrightson, &Waddell, 1990; Golden, Zillmer, &Spiers, 1992; Reeves&
Wedding, 1994). BecauseTBI representsoneof themost commonsourcesof
childhoodinjury(Goldstein&Levin, 1990), assessment of memorydisorder in
children who have sustained a TBI is one of the most frequently explored
domainsby pediatric neuropsychologists. Similarly, abnormal memory func-
tiontypicallyaccompaniesmost learningdisorders, themost commonreferral
concernsresultinginpsychological assessment of children(Lorsbach, Wilson,
&Reimer, 1996; Swanson, Ashbacker, & Lee, 1996; Bull &Johnston, 1997; de
Jong, 1998; Nation et al., 1999). Table12.1liststhemost frequent childhood
disorders in which memory and learningare likely to becompromised and
shouldbeassessed. Closelyalliedwithassessment istreatment for disordered
memory, theprimarytherapeuticfocusincognitiverehabilitation(Prigatano,
1990), which again underscorestheimportanceof goodassessment toolsfor
theevaluationof memory.
Given the ubiquitous nature of memory in everyday life (e.g., academic
performanceduringtheschool-ageyears), andtheimportanceof memoryin
evaluatingthefunctional andthephysiological integrityof thebrain(Parkin,
1993; Cowan, 1997), it is surprising that the availability of comprehensive
memoryassessment measuresfor childrenandadolescentsisarecent pheno-
menon. Thisseemsparticularlyoddgiventheplethoraof suchtasksavailable
for adultssincethe1930s.
387
Table 12.1. Most frequent childhood disorders in which memory and learning are
likely to be compromised
Attentiondecit hyperactivity
disorder
Inuterotoxicexposure(e.g.,
cocainebabies, fetal
alcohol syndrome)
Neurobromatosis
Autismandother
developmental disorders
JuvenileHuntingtonsdisease PraderWilli syndrome
Cancer (especiallybrain
tumors, lungcancer,
parathyroidtumors,
leukemia, andlymphoma)
Juvenileparkinsonism Rettssyndrome
Cerebral palsy Kidneydisease/ transplant Schizophrenia
Downsyndrome Learningdisability Seizuredisorders
Endocrinedisorders LeschNyhandisease Tourettessyndrome
Extremelylowbirthweight Major depressivedisorder Toxicexposure(e.g., lead,
mercury, carbon
monoxide)
FragileX Meningitis Traumaticbraininjury
Hydrocephalus Mental retardation Turnerssyndrome
Hypoxicischemicinjury Myotonicdystrophy XXY syndrome
Inbornerrorsof metabolism
(e.g., phenylketonuria,
galactosemia)
Neurodevelopmental
abnormalitiesaffecting
braindevelopment (e.g.,
anencephaly, microcephaly,
callosal dysgenesis)
XYY syndrome
To someextent, memory assessment with children and adolescentsmust
havebeen viewed as important, becausetheearliest of modern intelligence
tests(the1905Binet) andeventhevenerableWechsler scales, intheir various
childrens versions, all included one or two brief assessments of immediate
recall. DorotheaMcCarthy, thenotedpsycholinguist, wasawareof theimport-
anceof memory and included amemory index on the then-innovativeMc-
CarthyScalesof ChildrensAbilities(McCarthy, 1972). Koppitz(1977), another
pioneer in the assessment of children, noted the need for a more detailed
evaluationof childrensmemoryfunctionsanddevisedthefour-subtestVisual
Aural Digit SpanTest (VADS).
Nonetheless, themajor childneuropsychologytextsof the1970sand1980s
(e.g., Hynd&Obrzut, 1981; Bakker, Fisk, &Strang, 1985)makelittlereference
tomemoryassessment. Inretrospect, thislackinthedevelopment of compre-
hensivemeasuresof memoryfunctioninchildrenuntil recentlyisparticularly
388 Erin D. Bigler and Wayne V. Adams
puzzling, because, even by 1987, 80%of a sample of clinicians involved in
assessmentnotedmemoryasakeyaspectof cognitiveassessment (Snyderman
&Rothman, 1987). Incontrast, assessmentof memoryfunctioninchildrenhas
nowbecomeacentral focusindiscussionof variouschildhoodmedical (e.g.,
Baronet al., 1995) andneuropsychiatricdisorders(e.g., Gillberg, 1995) andisa
routinetopicincludedinmajor worksonchildneuropsychology(Tramontana
&Hooper, 1988; Pennington, 1991; Rourke, 1991).
No real attempt at developing a comprehensive assessment of childrens
memory appears until the introduction of the Wide Range Assessment of
Memory and Learning(WRAML) (Sheslow& Adams, 1990). TheWRAML,
designedfor children aged 5to 17years, was born fromthefrustration and
dissatisfactionof itsauthorsinnot havingasound, comprehensivemeasureof
memoryfunctioninginchildren(Sheslow& Adams, 1990). Another compre-
hensiveassessmentbatterydesignedtoevaluatememoryfunctioninchildrenis
theTest of MemoryandLearning(TOMAL) byReynoldsandBigler (1994b).
Althoughthesetwo comprehensiveassessment batteriesarethefocusof this
chapter, a brief review of the basic neurobiology of memory is presented
initiallytoprovideaconceptual contextinwhichtoviewthesecomprehensive
measures. Thechapterconcludeswithabrief overviewof theCaliforniaVerbal
LearningTest ChildrensVersion(CVLTC) (Deliset al., 1994).
Basic neurobiology of memory
Memoryhasbeenthetopicof interest withinexperimental psychologysince
thebeginningsof thediscipline(Baddeley, 1990). Acomprehensivetreatiseon
theneurobiology of memory is beyond this chapter, particularly in light of
excellent reviewsonthistopicelsewhere(seeDiamond, 1990; Scheibel, 1990;
Bauer, Tobias, & Valenstein, 1993; Cohen, 1993). Nonetheless, some brief
discussion of the apparent memory systems and their associated anatomic
structuresisimportant. Obviously, for newlearning, somefeatureof sensation,
either singularlyor acombinationof thesenses, isrequiredfor initial process-
ing. Thewayinwhichinitial sensoryprocessingoccursmaylaythefoundation
for thetypeandmodalityof memoryfunction. For example, if weinvitethe
reader tothinkof thespaceshipChallenger, andthedisastrouslaunchof 1984,
what isrecalled?Theexplodingspacecraft, thethreeplumesof white, bilious
smoke, the stunned look on the faces of the spectators, President Reagan
addressingtheshockedworld, or somethingelse?For many, therecollectionof
thishistorical eventisprimarilymediatedthroughavisual memory becauseit
wasinitially processedusingthevisual sense. Weall witnessedthedramatic
389 The assessment of memory with the WRAML, TOMAL, and CVLTC
Fig. 12.1. Diagramof thebrain highlightingthelimbicsystem, in particular thehippocampus.
The hippocampus is located in the temporal lobe and is critical in the process of memory
function. (Reproduced with permission fromM.T. Banich (1997). Neuropsychology: theNeural
Basesof Mental Function. Boston: Houghton-MifinCo.)
event onthetelevision, or sawthepicturesinnewsprint. Regardlessof howan
event is processed visual, tactile, auditory, gustatory (think of a favorite
childhood candy), or olfactory (think of the smell of grandmas house or a
favoritefood) memoriesareestablished. Althoughmemoriesareformedand
retrievedwithinany of thesemodalities, most peopleprocesspredominantly
viathevisual, verbal,andauditorysenses.Thus,muchofwhatisassessedinthe
testing of memory focuses upon these three modalities, with a particular
emphasisonverbal processing. Asdiscussedbelow, generallytheverbalvisual
distinction also alignswith hemispheric specialization: theleft hemisphereis
moreorientedtowardverbal andtheright towardvisual memory (Bigler &
Clement, 1997).
Regardlessof thetypeof memory, several critical brain structurespartici-
pate, in particular the hippocampus, amygdala, fornix, mammillary bodies,
variousthalamicnuclei, anddisseminatedregionsof thecerebral cortex(Fig.
12.1). Thesensoryinformationfromanymodality, or combinationof modali-
ties, inputstothehippocampus, viapathwaysthat coursethroughthemedial
inferioraspectofthetemporal lobeontheirwaytothehippocampus.Although
avast oversimplication, informationthat haslittlesaliencyremainsat some
momentarysensoryregister andisnever includedinthefull processof storage
andretrieval. Suchmomentaryprocessingdoesnot accessall of theseneural
structures. Informationthathassomerelevanceor saliencymaytapall of these
structuresinthenormal processof memoryacquisition, storage, andretrieval.
It isonthislast andmoreinclusive, aspect of memorythat clinical assessment
typicallyconcentrates.
Again, anoversimplication, but thehippocampusanditsassociatedstruc-
turesarecritical to theshort-termstorageof memory that is destinedto be
availablefor long-termstorage, which, inturn, isdependent onmoredistrib-
utedcerebral cortical functioning. Thus, if thehippocampusisdamaged(or its
output fornix, mammillary body, anterior thalamus), then the ability for
immediaterecall isdisrupted,andinseverecasesdestroyed. Despitehippocam-
pal damage, sensory registration of the information may proceed normally.
Thus, if theinformationtoberecalledisabrief stimulus, suchasalistof twoor
threewords or numbers, it may be immediately recalled without difculty.
However, for retentionof informationbeyondimmediateor short-termmemory
span,
1
that is, morethan several seconds, additional structures arerequired.
Thus, anydelayedrecall of informationbecomesproblematicwhenthehippo-
campus is damaged, because more complicated information exceeds simple
sensory inputprocessingregistrationandrecitation. Accordingly, thehippo-
campus and attendant limbic structures are essential for many aspects of
memorythat havebeentraditionallyreferredtoaslong-termmemory.
1
Given normal brain functioning, information to be retained progresses
throughalong-termstorageprocessthat appearsto relyonmoredistributed
functionsof thecerebral cortex. Thus, thebasic neural systemsfor memory
involveaninitial sensoryprocessing(i.e., specicneural pathwaysthat process
the sensory information and direct that information to appropriate cortical
areas). Next involvedisasteptodeterminethesaliencyof theinformationto
berecalled. Salientinformationseemstorequireprocessingatthehippocampal
level for short-termretention and then within the cerebral cortex for more
long-termstorage, retention, andretrieval.
Another featureof theneurobiologyof memorydealswithlateralizationof
brain function (Stark & McGregor, 1997). Typically, the left hemisphere is
morelateralizedfor language-basedfunctions, whereastheright hemisphere
involvesmorevisual andspatial processes. Thislateralizationsetsthestagefor
assessingdifferencesinmemoryprocesses,basedonwhethertheinformationis
processedasalanguage-basedversusspatial-basedfunction. Thus, damageto
theleft hemisphere, particularlytheleft temporal lobe, mayleavetheindivid-
ual with verbal memory decits and spared visualspatial function. Just the
oppositemayoccurwithdamagetotherighthemisphere, particularlytheright
temporal lobe. Regardlessof lateralization, therecall ofwell-establishedmemo-
riestendstobeoneof themost robust of neural functions, whereassustained
attention, concentration, andtheformationof newmemoriestendto bethe
most fragile. This is why memory decits are so common in neurological
disorders.
Finally, no discussionof theneurobiologyof memory wouldbecomplete
without mention of attention. Memory andattention areintegral aspects of
cognition, anddifcult to teaseapart withinanassessment framework. From
theneuroanatomical perspective, thereisnospecicregionthatistheexclusive
provinceof attention. Of course, thereisthelong-knownreticular activating
and diffuse thalamic projecting systems essential to arousal, but damage to
thesecorestructuresof thebrain typically resultsin unmistakabledecitsin
primaryarousal (i.e., coma). Fromtheneuropsychological perspective, atten-
tion isprobablyanonlocalizedneural processwithmajor contributionsfrom
frontal andtemporal loberegions. However, it isalsowell knownthat damage
just about anywhereinthecerebral cortexhasthecapacitytoaffect attention.
Thus, attentionmayalsobeconsideredawhole-brainintegratedsystemand,
thereby, attention can be disrupted in a variety of ways when the brain is
damaged or made dysfunctional. Disrupted attention may be difcult to
distinguishfromcertainaspectsof impairedmemory. For example, if sufcient
attention is not directed to the stimulus being processed, it will not be
processedproperlyandthereforepoorlyretained. However, thisdifcultywith
performanceismoreadecit inattentionthaninstorageor retrieval.
Currently, assessment of memoryhassomeoperationallydenedtasksthat
assess attention. However, as might be expected, attention is rather an
ethereal cognitive function that remains problematic whether establishing
diagnosticcriteria(e.g., DSM-IV)or attemptingtooperationalizetasksfor tests
of memory. Essentially, all measures of memory require attention; care,
therefore, isalwaysrequiredontheexaminerspart toinsurethat thesubjectis
properlyattendingtothememorytaskor stimulus.
Wide Range Assessment of Memory and Learning
Structure
TheWRAML (Sheslow&Adams, 1990) wastherst comprehensivememory
measurefor childrenandadolescents. Until theWRAML waspublished, most
General
Memory
Index
Visual
Memory
Index subtests
Verbal
Memory
Index subtests
Number
Letter
Sentence
Memory
Story
Memory
Finger
Windows
Design
Memory
Picture
Memory
Verbal
Learning
Visual
Learning
Sound
Symbol
Delayed
Recall
(optional)
Recognition
(optional)
Delayed
Recall
(optional)
Delayed
Recall
(optional)
Delayed
Recall
(optional)
Learning
Index subtests
Fig. 12.2. Schematicof theIndexandsubtest structureof theWRAML.
clinicianswantingto assessmemoryfunctionsinchildrenhadto usevarious
tasks fromvarious sources. Thenorms associated with thesememory tasks
werevariableinquality, andhadbeencollectedondifferentgroupsof children.
With the publication of the WRAML, clinicians and researchers had a
psychometricallysoundtool whichutilizedabroadvarietyof memorytasks,
eachof whichhadacommonnorm-base, thusallowingmeaningful intertask
comparisonsfor therst time.
The WRAML is normed for children aged 5 through 17 years. While
administrationtimedependsupontheageandpaceof thechildaswell ason
theexperienceoftheexaminer, generally,theentireWRAML takesbetween45
and60minutesto administer. An Examiner RecordFormand an Examinee
ResponseFormareutilizedinthestandardadministration.
Thestructureandhierarchical organizationof theinstrument areillustrated
inFig. 12.2. ThecompositeGeneral MemoryIndexisderivedfromperform-
ancein threedomains: Verbal Memory, Visual Memory, andLearning. The
rst two domains, verbal and visual, assess the two dominant information-
processingmodesof memoryfor childrenandadolescents. ThethirdWRAML
domainhighlightsmemory withinthecontext of acquiringinformationover
consecutivelearningepisodes. Suchacquisitionopportunities areprovidedfor
visual, verbal, anddual (visual withverbal) modalities.
Theconceptual rationaleissimilar for theorganization of theVerbal and
Visual domains. Subtests of each domain provide a gradually increasing
amountof informationtobeimmediatelyrecalled. SubtestswithinbothVerbal
andVisual domainsrangefromrotememorytasksusingminimallymeaningful
Table 12.2. Description of each WRAML subtest associated with each WRAML domain
Domain Subtest name Subtest description
Verbal Memory Number/ Letter Thechildisaskedtorepeat aseriesof
bothnumbersandlettersverbally
presentedat arateof oneper second.
Thesubtest beginswithanitemtwo
unitsinlength(e.g., 1-A) andproceeds
until thediscontinueruleissatised
SentenceMemory Thechildisaskedtorepeat meaningful
sentences. Startingwithathree-word
sentence, thechildattemptstorepeat
progressivelylonger sentences, until the
discontinueruleissatised
StoryMemory Thechildisreadandthenaskedtoretell
aonetwo-paragraphstory. Asecond
storyisthenreadandagainthechildis
askedtoretell thestory. Scoringboth
exact andgist recalledinformationis
recorded
Visual Memory Finger Windows Thechildindicateshis/ her memoryof a
rotevisual patternbysequentially
placinganger intowindows, or holes,
inaplasticcard, attemptingto
reproduceasequencedemonstratedby
theexaminer. Startingwithasequence
of twoholes, thechildcontinuesuntil
thediscontinueruleissatised
DesignMemory Acardwithgeometricshapesisshown
tothechildfor veseconds. Followinga
ten-seconddelay, thechildisaskedto
drawwhat wasseen. Ablankcardwith
spatial demarcationsisprovidedfor the
childsdrawing. Four different cardsare
presentedinthisfashion
PictureMemory Thechildisshownameaningful scene
withpeopleandobjectsfor tenseconds.
Thechildisthenaskedtolookat a
second, similar scene. Memoryof the
original pictureisindicatedbythe
childsmarkingelementswhichhave
beenalteredor addedinthesecond
picture. Thisprocedureisrepeatedwith
threeadditional scenes
Table 12.2. (cont.)
Domain Subtest name Subtest description
Learning Verbal Learning Thechildisreadalist of common,
single-syllablewordsandisprovideda
freerecall opportunity. Threeadditional
learningtrialsareadministeredinsimilar
fashion. Adelayedrecall trial isavailable
followinganinterferencetask
Visual Learning After initiallyseeingall locations, the
childisaskedtoindicatethespecic
locationof 12or 14(dependingonage)
visual stimuli nestedwithina4;4
array. Correctionof errorsoccurs. Three
additional learningtrialsfollow. A
delayedrecall trial isalsoavailable
SoundSymbol Thechildispresentedapaired-associate
taskrequiringhim/ her torecall which
soundisassociatedwithwhichabstract
andunfamiliar symbol shape. Four
separatelearningtrialsareadministered
andadelayedrecall trial isalsoavailable
content, totasksmakingmemorydemandsusingquitemeaningful content. In
thismanner, theexaminer hastheopportunitytoobserveachildsimmediate
memoryabilityontaskswhicharemodalityspecic(i.e., verbal or visual) and
whichvaryinmeaningfulness.
Threesubtests contribute to each of the WRAMLs three domains. Each
subtest yields a scaled score (mean=10, SD=3), and each domain yields a
standardscore(mean=100, SD=15). Thescaledscoresof all ninesubtestsare
pooledto yieldaGeneral MemoryIndex(mean=100, SD=15). Thefamiliar
metrics make for easy examiner understanding, and allow easy comparison
withother cognitivemeasuressuchasintelligenceandachievement tests.
In addition to the nine core subtests dening the three major domains,
thereareoptional Delayed Recall components associated with each of the
learning-over-trialssubtests. Oneof theVerbal Memorysubtests(StoryMem-
ory) alsoprovidesaDelayedRecall aswell asaRecognitionMemoryoption.
Subtest description, rationale, and clinical utility
Table 12.2 provides a description of the subtests within each domain. The
narrativethat follows provides a rationalefor the subtest and some clinical
applicationsthatmightbederivedfromagivensubtestorsubtestcombination.
Verbal Memory Scale
Thesubteststhat comprisetheVerbal Memory Scaleallow theexaminer to
assessthechildscapabilitiesonarote, auditorymemorytaskandtocompare
thatperformancetothatof taskswithmorelanguagedemands. Thisallowsthe
examiner toformhypothesesabout thechildsabilitytoutilizelanguageasan
aide or detractor in remembering. The three subtests can be viewed as
demandingincreasingamountsof languageprocessing, sothatthecliniciancan
alsobesensitivetolanguagedecits, whichmayconfoundmemoryassessment
withinthisdomain. ThethreesubtestscomprisingtheVerbal MemoryScale
areasfollows.
Number/ Letter
Theformat of thissubtestisfamiliar tomost clinicians. Unlikesomesuchtests,
however, onlyaforwards directionof recall isrequiredintheNumber/ Letter
subtest. Becauseabackwardsrecall seemstorequireadifferent cognitiveskill
fromforwardsrecall (Lezak, 1995), theNumber/ Lettertaskdoesnotconfound
thesetwooperations.
SentenceMemory
Thebits of informationthatcanberememberedchangeinthistaskcompared
to that in theNumber/ Letter subtest becauseof themental glue language
affords. Clinically, becausethis task requirestheability to remember oneor
twosentences, it isthought tobegintotapthekindof memoryskillsrequired
tofolloworal directionsbeinggiventoachildat homeor at school.
StoryMemory
Twostoriesarereadtothechild. Thestoriesdiffer indevelopmental level of
interest andlinguistic complexity. Usingtwo storiespermitsbetter sampling
thanusingasinglestory. It is, then, reasonableto assumethat agreater than
chancedifferencebetween therst andsecondstoriessuggestslower verbal
intellectual ability, alanguagedisorder, or aninefcient or inconsistent ability
toattendtooral information.
Likewise, a child who retells the story in an erratic sequence may have
sequencingor organizational problems. BycomparingsequencinginNumber/
Letter andSentenceMemorywiththat of StoryMemory, oneshouldbeginto
differentiate between sequencing, organizational, and language decits. Be-
causeof theimportanceof rememberingsemanticallyrelatedinformationto
classroomandsocial functioning, theclinicianmaywishtoexplorewhetherthe
child doing poorly on Story Memory remembers the material but cannot
reproduceit inafreerecall format. Therefore, aStoryRecognitionsubtest is
alsoprovidedbypresenting15questionsrelatedtotheharderstory, andusinga
multiple-choice format to help determine a retention (or storage) versus a
retrieval (or expressivelanguage) decit.
Comparing performance on the Sentence Memory and Story Memory
subtestscanalso beuseful. If performanceon SentenceMemory isrelatively
poor, onemight conjecturethat therotecomponentsof directionswouldbe
missed(such as thepagenumber of theassignment). Proportionately better
performanceonStoryMemorywouldsupport thenotionthat thegist of the
orallydelivereddirections(or lecture)wouldnonethelessbepreserved, despite
decitsretainingrotedetails.
Visual Memory Scale
In a manner similar to the Verbal Memory subtests, the Visual Memory
subtestsvaryaccordingto rotememorydemands. ThethreeVisual Memory
subtestsareasfollows.
FingerWindows
The Finger Windows subtest is analogous to the Number/ Letter subtest
withintheVerbal Domain, inthatdiscreteandrelativelynonmeaningful bitsof
informationarepresented, oneper second, andimmediaterecall isrequired.
Retainingavisual traceof asequenceisrequired.
DesignMemory
Thissubtest introducesagreater degreeof meaningfulnessthanFinger Win-
dows. Thechildisaskedtodrawthedisplayof commonshapessuchascircles,
dots, straight lines, rectangles, andtriangles. Thereisave-secondexposure,
followed by aten-second delay before drawingbegins. For youngsters who
maystruggleto reproducesuch shapesbecauseof perceptualmotor difcul-
ties, anoptional copytaskisrst administeredsothat thechildsreproduction
of eachshapebecomesthecriterionfor scoringthat shapeintherecall phase.
Designplacementaswell asinclusionarescored. Confusionsinplacementmay
indicate poor spatial memory, whereas shape omission may indicate poor
memory for visual detail. The relatively brief ve-second exposure time
allowed for each stimulus card is intended to minimize the use of verbal
mediationtocompletethetask. Theecological validityof thistaskwasderived
fromeveryday demands such as copying froma classroomchalkboard, or
rememberingvisual detailsof aroomafter leavingit.
PictureMemory
Thecontent of this subtest is quitemeaningful in that each of four pictures
depictsascenemost childrenwill ndfamiliar. Childrenwithso-calledphoto-
graphicmemory will doespeciallywell onthissubtest, becausetaskexpecta-
tionsrequirestorageof ascenesothat it canbecomparedfrommemorytoa
similar sceneinwhich2040%of thevisual detailshavebeenalteredinsome
way.
Interestingly, it has been discovered that children with attention decit
hyperactivity disorder (ADHD) scoreaswell asor better than anonreferred
sampleonthePictureMemorysubtest becauseof aconfoundcreatedbythe
scoringprocedure(Adams, Hyde, &deLancey, 1995). Thesubtestsdirections
indicatethat thechildistoidentifyperceivedchangesineachscenebyusinga
felt-tippedmarker,markingthethingsyouaresureof.Theexaminerisdirected
toverballydiscourageguessing, but not topenalizeguessing, insteadincluding
only correct responses in the scoring. In their impulsiveness, children with
ADHDprobablymarksomecorrect detailsbychance, resultinginaspuriously
higherscore.WhatwehavefoundisthatchildrenwithADHDbetweenveand
eightyearsof ageusuallymakethreeincorrectselectionsperpicture, compared
tooneincorrectselectionper picturemadebychildreninthisagerangewithin
thestandardizationsample.Whiletheerrors-per-pictureratiodropsfrom3:1to
2:1fortheolderchildrenwithADHD,theeffectremainsstatisticallysignicant.
Learning Scale
Verbal Learning
TheVerbal Learningsubtest wasadaptedfromRey(1958). Thechildisreada
list of 13or 16(dependingon thechilds age) common words, immediately
after which the child is asked to recall as many words as possible. This
procedureisrepeatedthreemoretimes. UnlikeReys(1958) procedure, four,
rather than ve, learning trials are administered on the WRAML, because
pre-standardizationdatademonstrated(similar toReys(1958) ndings), that a
fth trial contributes little additional information. Also different from Rey
(1958), a second list is not used for an interference task following the nal
list-recall trial, becausemost childrenandexaminersdonot welcomeanother
such a task and, ecologically, most real-life learning is not followed by an
almost identical activity serving as interference. Therefore, for economy of
administration andto eliminatemountingfrustration for somechildren, the
Story Memory subtest follows the Verbal Learning subtest, and serves as
theinterferencetask. FollowingtheStoryMemorysubtest, adelaytrial of the
Verbal Learningtaskisadministered.
Duringlist-recall opportunities, childrenwill occasionallyreport wordsnot
onthelist. Theseerrors, calledintrusionerrors, occur onceor twiceover the
four trials amongst the standardization sample, especially with younger
children. Children with ADHD will, however, averagefour to veintrusion
errors(Adamset al., submitted). Thereissomefeelingthat thenatureof the
intrusion error is relevant, with semantic errors (saying eyerather than ear)
moresuggestiveof expressivelanguagedifculties, andphoneticerrors(saying
bakerather thanlake) moresuggestiveof phonological or auditoryprocessing
difculties.
Visual Learning
Similar toitsverbal counterpart, theVisual Learningtaskrequeststhechildto
learnaxednumber of stimuli presentedover four trials. Toaccomplishthis,
visual designsarepresentedinaparticular locationonagame board, andthe
child is asked to remember thespatial location associated with each design.
Immediate feedback for itemcorrectness is provided to promote learning.
SimilartotheVerbal Learningsubtest, adelayedrecall trial canbeadministered
followinganinterveninginterference task.
SoundSymbol
This cross-modal learning task resembles demands made in early reading
mastery, withbothphonological andvisual symbolicstimuli utilized. Thechild
isaskedtoremember asoundthat goeswithaprintednonsense symbol. Ina
paired-associatedfashion, shapesarepresentedandthechildisaskedtosaythe
correspondingnonsense sound; four learningtrialsof thesound/ shapepairs
arepresented. Adelayedrecall trial isalsoavailable.
While not yet empirically demonstrated, there is considerable anecdotal
evidencesuggestingthat children whosepoor performanceon thethirdand
fourthtrialsof thissubtest ischaracterizedbyresponsesresemblingfewof the
soundsassociatedwithin thesubtest, arethosechildrenwho will experience
considerabledifcultylearningphonicsintheir earlyelementaryschool grades.
If empiricallysubstantiatedbyastudycurrentlyunderway, atleast oneformof
areadingdisorder mightbethoughtof asaselectivememorydisorderaffecting
those subprocesses involved in remembering sound units associated with
symbol markingsfoundonapage(seealsoSwanson, 1987).
Short Form
Administrationof theentireWRAML batterymayrequiremoretimethanan
examiner hasavailable, andsoashort form versionwasdevelopedtoscreen
memory functions quickly, and thereby help the examiner decide if more
in-depthassessmentisindicated. Preliminaryresearchyieldedfoursubteststhat
werevariedincontent yet highlycorrelatedwiththeGeneral MemoryCom-
posite (r=.84). Accordingly, these four subtests were placed rst in the
WRAMLandcomprisetheScreeningForm:PictureMemory, DesignMemory,
Verbal Learning, and Story Memory. The Short Form, therefore, samples
aspectsof visual andverbal memory, andverbal learning. TheScreeningForm
requiresapproximately1015minutestoadminister. Thepsychometricinteg-
rity of the norms associated with the Screening Formmatches that of the
completeWRAML, becausetheentirestandardizationsamplewasutilizedto
derivethenorms, astherst four subtestsof theabbreviatedscalearetherst
four subtests of the entire battery. The General Memory Index estimate
generatedfromtheShort Formversiontendsto beabout four pointshigher
thantheGeneral MemoryIndexgeneratedfromtheentirebattery(Kennedy&
Guilmette, 1997).
Technical informa tion
Standardization
TheWRAML was standardized on apopulation-proportionatesamplestrat-
iedby age, gender, ethnicity, socioeconomicstatus, geographic region, and
communitysize. Thesampleconsistedof 2363children, ranginginagefrom5
to17years. Detailsof thestandardizationprocedureandstraticationdataare
providedinthetest manual (Sheslow&Adams, 1990).
Reliability
TheWRAML subtestsandcompositeindexesshowhighinternal consistency
reliability. Itemseparationstatisticsrangedfrom.99to 1.0. Personseparation
statisticsrangedfrom.70to.94. Coefcient alphasrangedfrom.78to .90for
thenineindividual subtests. For theVerbal MemoryIndex, theVisual Memory
Index, and theLearningIndex, themedian coefcientsare.93, .90, and .91,
respectively. TheGeneral Memory Index coefcient alphais .96. Therefore,
verygoodinternal consistencyisdemonstratedbytheWRAML.
Usingasubgroupof thestandardizationsample(n=153), atestretest study
wascompleted. Thenatureof memoryandlearningtasksmakesthemproneto
practiceeffects, soknowingtheincremental effectoccurringwithreadministra-
Table 12.3. Correlations of WRAML Index scores and WRATR subtests, ages 6 years 0
months8 years 11 months
Verbal Memory Visual Memory Learning General Memory
Index Index Index Index
Reading .18 .26* .40* .35*
Spelling .22 .32* .42* .39*
Arithmetic .24 .46* .40* .46*
*p:0.05.
tionwouldbeuseful information. Generally, aone-point scaledscoreincrease
inmemorysubtestsandatwo-point increaseinlearningsubtestswerefound.
Over athree-monthto six-monthinterval, therewasno correlationbetween
thenumber of dayselapsedandtheincremental increaseinscore. That is, the
slight incremental increase in WRAML subtest performance seems to be
uniformly obtained throughout a three-months to six-months post-testing
interval. Stabilitycoefcientsfor Indexscoresrangedfrom.61to.84.
Validity
TheWRAML manual (Sheslow&Adams, 1990)reportsseveral studiesprovid-
ingevidencethat theWRAML isavalidmeasureof memoryfunctioning. The
correlationsbetweenthethreeWRAML indexesandtheWISCRVerbal and
PerformanceIQsrangedfrom.22to.51. Aspredicted, memory, asmeasured
by the WRAML, is related to but not the same as intelligence (most well-
constructedintelligencetestsyieldcorrelationswitheachother rangingfrom
.75to.85). TheWRAML General MemoryIndexcorrelationwiththememory
sectionsof theStanfordBinetFourthEditionandMcCarthyscaleswas.80and
.72, respectively.
Memorywouldbeexpectedtobeaconstructrelatedtoschool achievement.
Further, onemight reasonthat, aschildrenproceedinschool, verbal memory
wouldbecomemorepredictiveof performancethan visual memory. Tables
12.3and12.4showthisto bethecasewhenWRAML indexesarecorrelated
withmeasuresof reading, spelling, andarithmetic. Interestingly, withchildren
inearlyelementaryschool, verbal memoryseemstoplaylittlerole, but visual
memory and, especially, learning over trials play a more dominant role.
However, by high school, thereverseseemsto betrue. Thinkingabout the
content demandsmadebytypical school curriculafoundat theseextremesof
the formal school experience, these ndings make intuitive sense. That is,
Table 12.4. Correlations of WRAML Index scores and WRATR subtests, ages 16 years 0
months17 years 11 months
Verbal Memory Visual Memory Learning General
Index Index Index Index
Reading .41* .14 .05 .23
Spelling .40* .09 .24 .30
Arithmetic .34* .26 .34* .38*
*p:0.05.
learningtoidentifyletters, numbers, newwords, andhowtowriteproperlyon
apageareamajor focusof rst andsecondgrades. However, history, science,
literature, andmathclasseswouldmakegreater verbal memorydemands, and
proportionatelyfewer visual memoryandrotelearning(over trials) demands.
Factor structure
Three-factor Principal Components analyses were performed on the nine
WRAML subtests using the full standardization sample of 2363 children.
Factorswereextractedfor two agegroupingsof children, determinedby the
tests age division at which slightly different administration procedures and
itemsapply. TheresultsarefoundinTables12.5and12.6.
Ascanbeobserved, for theyounger children, theVisual factor ismadeupof
PictureMemory, Design Memory, andFinger Windows, as expected. How-
ever, Visual Learningalsoloadedwiththissamefactor. Moretroublesomewas
theclusteringof SentenceMemoryandNumber/ LetterwiththeVerbal factor,
but not Story Memory. This inconsistency continued, with Verbal Learning
andSoundSymbol appropriatelyloadingontheso-calledLearningfactor, but,
asnoted, Visual Learningnot loadingonthispredictedfactor.
Asimilar patternof inconsistencyoccurredwiththeolder sample(seeTable
12.3), again calling into question whether a Learning Index score can be
justied.Several investigatorshavereportedsimilarfactoranalyticresultsusing
nonreferredandclinical samples(Aylwardet al., 1995; Phelps, 1995; Burton,
Donders, &Mittenberg, 1996; Dewey, Kaplan, &Crawford, 1997; Gioia, 1998;
Burton et al., 1999). Gioia(1998) has suggested that, based upon the factor
analyticresults, theWRAML Indexscoresshouldnot beutilized, but, instead,
thesubtest scores should beused as theappropriatelevel of analysis. Some
havethought thissuggestionabit extreme, becauseonlytwoof ninesubtests
(Story Memory and Visual Learning) loaded inconsistently, not surprising
Table 12.5. Results of Principal Components Analysis with Varimax Rotation of
WRAML subtests (completed on children 5 years 0 months through 8 years 11 months
of age)
Factor
Visual Verbal Learning
PictureMemory .569 .148 .320
DesignMemory .669 .078 .259
Finger Windows .655 .382 .160
StoryMemory .285 .222 .585
SentenceMemory .159 .800 .320
Number/ Letter .082 .859 .113
Verbal Learning .311 .111 .615
Visual Learning .605 .158 .157
SoundSymbol .004 .125 .749
Shadingconnotesthesubtest loadedonthepredictedfactor.
Table 12.6. Results of Principal Components Analysis with Varimax Rotation of
WRAML subtests (completed on children 9 years 0 months through 17 years, 11
months of age)
Factor
Shadingconnotesthesubtest loadingonthepredictedfactor.
Table 12.7. Alternative interpretation of the Principal Components Analysis of WRAML
subtests (completed on children 5 years 0 months through 8 years 11 months of age)
Factor
Shadingconnotesthesubtest loadedonthepredictedfactor.
given that the Learningfactor clearly consists of visual and verbal memory
components, contributingnonorthogonalitytotheanalyses.
Another waytointerpret thendingsinlight of researchthat followedthe
publicationof theWRAML istoretaintheVisual factor, renametheLearning
factor as Verbal, and substitute Attention for the original Verbal factor
designation. Theresultof thisrelativelyminor alterationisillustratedinTables
12.7 and 12.8. This conceptual arrangement continues to group the highly
intercorrelatedsubtestsof SentenceMemoryandNumber/ Lettertogether,but
asmeasuresof attention/ concentrationandnot of verbal memory. Inresearch
reportedbelow, welearnthatchildrenwithattentionproblemsconsistentlydo
poorlyonthesetwosubtestsaswell asonFinger Windows. Interestingly, for
theolderchildren, Finger WindowsloadsonourrelabeledAttentionfactorand
the Visual factor almost equally, suggesting both visual memory skills and
attention are involved in succeeding on this task. That would, then, leave
Verbal andVisual factorsbut addafactor of Attention/ Concentration. Sucha
reconceptualization avoids the apparent nonorthogonality of the Learning
subtests, andmakesfor aconceptual t for all WRAML subtestswithinthe
newlyconguredfactors.
Table 12.8. Alternative interpretation of the Principal Components Analysis of WRAML
subtests (completed on children 9 years 0 months through 17 years 11 months of age)
Factor
Shadingconnotesthesubtest loadingonthepredictedfactor.
WRAML performance with children with reading disability and attention decit
hyperactivity disorder
Adams et al. (submitted) administered the WRAML to children with high-
frequencyreferral diagnoses: readingdisability (RD) andADHD combined
type. Four groups were utilized: an RD group, an ADHD group, an RD/
ADHD group, and a nonclinical comparison group. Children in the clinical
groups were selected using traditionally accepted denitions. Therefore,
childrenwithRD werethosewhoseWechsler IntelligenceScalefor Children
(WISC)Full ScaleIQswere85or higher, but whohadaReadingAchievement
scoreat least 15pointsbelowtheir Verbal IQ, andwhoselevel of arithmetic
achievement wascommensuratewiththeir Full ScaleIQ. Theydidnot meet
criteriafor ADHD. Thesecondgroupwascomposedof childrendiagnosedas
having ADHD. Each child was diagnosed through a hospital-based ADHD
clinic and most scored at least two standard deviations aboveaverage on a
standard attention rating scaleboth at homeand at school. Children in the
ADHD group also had Full Scale IQs985and reading, spelling, and math
achievement commensuratewith their Full ScaleIQs. Thethird group met
criteriafor bothclinical conditions. Childrenineachgroupaveragedabout ten
years of age and none had a history of hard neurological disorder (e.g.,
seizures, head injury, etc.) or of signicant psychological difculties such as
anxietyor depression. Thefourthgroup, anonclinical comparisongroup, was
Table 12.9. Canonical Discriminant Functions using WRAML subtest performance
Canonical Loadings
FunctionI FunctionII
Number/ Letter .75 .08
SoundSymbol Learning .60 .31
SentenceMemory .51 .33
Finger Windows .50 .09
Verbal Learning .22 .64
Canonical DiscriminantFunctions(groupcentroids)
ADHD .5935 .3655
RD .6407 .4762
Nonreferred .6785 .0087
RD/ ADHD .8462 .4191
ADHD, attentiondecit hyperactivitydisorder; RD, readingdisabled.
createdfromthestandardizationsample, witheachchildfromaclinical group
being matched on age, gender, geographic region, urban/ rural, and
socioeconomicclass.
EachchildwasadministeredtheWRAML. A discriminatefunctionanalysis
was completed on the WRAMLs nine subtest scores. It was found that
WRAML scores were able to distinguish between groups (Wilks
lambda=0.560,
2
=115.2, df=27), p:0.001). Thetwosignicant functions,
insuccession, accountedfor 73.5%and26.5%of thebetween-groupvariability.
Groupcentroidsintheupper part of Table12.9reveal that therst function
maximallyseparatestheclinical groups(i.e., theADHD, RD, andRD/ ADHD
groups) fromthenonreferredcohort. Thesecondfunctionbest differentiates
childrenwith RD fromthosewith ADHD andthosewho werenonreferred.
The pattern of correlations indicates that the rst function is dened by
appreciablecontributionsfromthesubtests Number/ Letter, Sound Symbol,
Sentence Memory, and Finger Windows. Combining information fromthe
group-centroidcomparisons, as well as fromthediscriminantfunctionvari-
able correlations, one would infer that the construct of rote, short-term
memory best separates children with ADHD and RD from those without
documented symptomatology. Recently, Howes et al. (1999) also demon-
stratedthat readersstruggledmost with theTOMAL subtestsrequiringrote
oral recall (recitingdigitsor lettersforwards, aswell asbackwards).
Thesecondfunctionismadeupof contributionsfromtheVerbal Learning
subtest, whichdistinguishestheRDfromtheother threegroups. Aunivariate
analysisof theVerbal Learningsubtest didshowtheRD scaledscoregroup
mean to be statistically lower than the other groups (mean=8.8), with the
RD/ ADHDgroupmeanalsolower (9.3), but onlytendingtowardsignicance
(p:0.10), compared to the ADHD (mean=10.5) and nonreferred
(mean=10.4) groupmeans.
Therefore, childrenof averageIQwhoperformpoorlyonNumber/ Letter,
Sound Symbol Learning, Sentence Memory, and Finger Windows (but do
reasonablywell ontheremainder of theWRAML subtests) arelikelytohave
somekindof psychopathology. However, if thesechildrenalsohavelowVerbal
Learning scores, there is an increased likelihood that the diagnosis is RD.
Interestingly, thosechildrenwhohaddual diagnosescouldnot bewell distin-
guishedfromsingle-diagnosischildren, whichmaysuggest that thereisnot an
additivenegativeeffectonmemoryimpairmentifonehasbothADHDandRD.
Itisfortunatethatdifferentclinical groupswereutilizedinthisinvestigation.
If onlychildrenwithADHD(or onlychildrenwithRD) hadbeencomparedto
the nonreferred sample, one might have erroneously concluded that lower
scores on Number/ Letter, Sound Symbol, Sentence Memory, and Finger
Windows forma diagnostic cluster helpful in diagnosing ADHD (or RD).
Interestingly, preliminary results from an investigation of children being
treatedfor depressionarealsodemonstratinglower scoresonthepathology
cluster madeupof thesesamefour WRAML subtests(Whitney, 1996). Includ-
ing multiple diagnostic groups in cognitive investigations seems critical in
preventingerroneousconclusionsthat ndingsareuniqueto agivenclinical
population.
WRAML performance and brain injury and other CNS insults
Duis(1998) areconcludinganinvestigationdemonstratingthat childrenwho
havesustainedmoderateor severeTBI exhibit asignicant decrement in all
WRAML subtests following a period of rehabilitation and recovery. Table
12.10listsWRAML subtest meansandstandarddeviationsof theADHD, RD,
and TBI groups. TheWRAML subtest scores of children with head injuries
weregenerallyonestandarddeviationbelowaverage, andthoseof thechildren
with RD and ADHD were about 0.5 standard deviations below average.
Farmeretal. (1999)reportasimilar degreeof decrementfor childrenwhohave
sustained severe TBI. For a sample of children who sustained a mild to
moderateinjury, poorer performancewasnotedononlytwosubtests, Sound
Symbol and Design Memory. The WRAML Screening Formhas been used
Table 12.10. WRAML subtest means and standard deviations (in parentheses) for
children with attention decit hyperactivity disorder (ADHD), reading disability (RD),
and traumatic brain injury (TBI)
Subtests Groups
ADHD RD TBI Nonreferred
Number/ Letter 7.3(2.5) 7.8(2.5) 7.1(2.8) 10.1(2.4)
SoundSymbol 8.5(3.1) 7.6(2.1) 7.6(3.0) 10.3(2.9)
SentenceMemory 9.1(2.8) 8.1(2.9) 7.1(3.4) 10.6(3.2)
Finger Windows 8.3(2.5) 8.7(3.0) 7.5(3.2) 10.1(2.6)
Verbal Learning 10.5(2.9) 8.8(2.9) 8.2(3.1) 10.5(2.9)
StoryMemory 10.1(2.7) 9.7(2.8) 7.2(3.7) 10.1(2.6)
DesignMemory 7.9(3.1) 9.5(2.8) 7.2(3.5) 9.8(2.9)
PictureMemory 10.1(2.6) 9.8(2.3) 8.7(3.4) 10.1(3.0)
Visual Learning 9.4(3.1) 9.7(3.0) 8.5(3.1) 10.1(3.2)
AdaptedfromDuis(1998).
withTBI patientsaswell, withtheMemoryScreeningIndex(generatedbythe
four screeningsubtests) correlatingsignicantly withlength of coma, andas
stronglyastheWISCPerformanceIQ(Woodward&Donders, 1998). Further,
thosechildrenwithsevereTBI hadsignicantlylower ScreeningIndexesthan
didchildrenwithmildor moderateinjuries.
Children with seizuredisorders seemto show aWRAML subtest pattern
differentfromthosewithADHD, RD, or TBI. Whileperformingasagroupata
level slightlyhigher thanchildrenwithTBI, therewasgreater subtest variabil-
ity for the epilepsy sample (Williams & Haut, 1995). Children who had
survived childhood lymphoblastic leukemia, havingbeen treated with intra-
thecal chemotherapy, showed mild but consistent residual decits on most
WRAML Visual andVerbal Memorysubtests, aswell asontheVisual Learn-
ing. Thisndingcorrespondedtolower IQresultsfoundinthesamesample,
comparedtohealthy, matchedcontrols(Hill et al., 1997).
Case study: Brett
BrettcametoaLearningDisordersClinic, attheageof 7years7months, at the
request of bothhisparentsandteachers. Hehadexperiencedpersistent acad-
emic struggles associated with reading and spelling, and behavior problems
werestartingtoemergeduringhomeworktimes.
Brettwasadoptedattwomonthsof age. Theadoptiveparentshadbeentold
by the agency assistingwith the adoption that Bretts parents were both in
collegeand no signicant medical history wasassociatedwith either family.
Good prenatal care was provided and a recent medical examination was
normal.
Duringinfancy, Brett wascolickyanddidnot transitionintoroutineseasily.
Asatoddler, heseemedabit overactivecomparedtoage-mates. Nonetheless,
hehadasuccessful preschool andnurseryschool experience. However, inrst
gradehebegantoexperiencedifcultybymid-year, but, withextrahelp being
providedat homeandschool thefollowingspring, Brettsteacher felt that he
wouldbeready to go on to second grade. However, by theend of therst
markingperiodof thenewschool year, itwasevidentthat Brettwasstruggling
withbothreadingandspellingassignments. Eveninghomeworksessionswere
extendingbeyondtwohours, andwerebecomingincreasinglycharacterizedby
anger outburstsanddeance. Acomprehensivepsychoeducational assessment
providedtheresultsshowninTable12.11.
Interpretation
Takentogether, theabovendingssuggest that Brettsacademicstrugglesare
not dueto ADHD, expressiveor receptivelanguagedifculties, visualspatial
weakness, or lowintellectual ability. Thedatadosuggest, however, that heis
experiencing considerable difculty remembering sound and symbol associ-
ations, ataskessential tomasteringthephonicsskillsrequisitetouentreading
or spellingabilities. Thelower WISC Informationscoreisattributableto the
difculty Brett experienced with temporal concepts (e.g., days of the week,
monthsof theyear, etc.), whicharegivenmuchweight bythissubtest at this
age. Temporal conceptsarefoundto bedifcult for manydyslexic children
havingtroublewithvarioussymbol systems. Roteshort-termverbal memory,
whilearelative weakness, is adequate for classroomsurvival (as per Digit
Span, Number/ Letter, andSentenceMemorysubtests).
Inaddition, Brett isexperiencingsomefairlysignicant visualmotor prob-
lemswhichseemtoberelatedtobothane-motor awkwardness(WideRange
Assessment of Visual Motor Abilities, WRAVMA, nemotor score; Adams&
Sheslow, 1995) andhisability to remember andgraphically reproducevisual
gestalts (WRAML Design Memory, WISC Coding, and WRAVMA Visual
Motor Integration scores). Therefore, handwriting is difcult for Brett and
some of his spelling errors are due to written letter reversals (e.g., b/ d) in
additiontohisstruggletoremember soundsymbol combinations.
Table 12.11. WRAML table case study
Wechsler IntelligenceScalefor ChildrenIII
VIQ=123
PIQ=112
Information 8
Similarities 14
Arithmetic 13
Vocabulary 12
Comprehension 13
Digit Span 9
PictureCompletion 11
Coding 8
PictureArrangement 12
BlockDesign 15
Object Assembly 13
WideRangeAchievement Test
Reading 92
Spelling 84
Arithmetic 111
WideRangeAssessment of VisualMotor Integration
Fine-Motor Skills 72
VisualSpatial Skills 109
VisualMotor Integration 88
WideRangeAssessment of MemoryandLearning
Verbal Memory
Number/ Letter 10
SentenceMemory 11
StoryMemory 16
Visual Memory
Finger Windows 12
DesignMemory 8
PictureMemory 12
Learning
Verbal Learning 12
Visual Learning 14
SoundSymbol Learning 6
DelayTask
StoryMemory 14
VIQ=Verbal IQ; PIQ=PerformanceIQ.
FormidablestrengthsinreasoningareascanbecapitalizeduponasBrett is
referred to a reading specialist to receive remedial help. At the same time,
classroomaccommodationsmustbemadesothatBrettcanremaininvolvedin
thecontent of hisclassroomscience, social studies, andmathcurricula. Once
his decoding skills are improved, reading comprehension should progress
(supported by Bretts strong Story Memory results). However, until then,
Brettsparentsandteachersneedtoworkhardtokeephismasteryof content
area progressing despite his difculty in reading. Providing taped textbook
chapters and library books (Story Memory results suggest he will have no
difculty with listening comprehension), and allowing taped homework re-
sponseswill beessential. Avoidanceof in-classreadingshouldalsobeobserved
inorder toreduceBrettslevel of frustration.
Comment
ThiscasestudyillustrateshowtheWRAML cancontributetoapsychoeduca-
tional work-up. In this case, results provided the examiner with data to
concludethat Brettsstrugglehas, at least in part, an information-processing
basis. TheWRAML resultswouldsupport thenotionthat thereislittleor no
decit in the areas of receptive language, short-termvisual or verbal rote
memory, verbal forgettingrate, or visual sequencingskills. However, percep-
tual motor inefcienciesandanabilityto makesound-to-symbol associations
areeachareasdeservingmoreinvestigation. Withrespecttothelatter, anerror
analysisof theSoundSymbol subtest might suggest whether lookingat audi-
torydiscrimination, soundsegmentation, or soundsequencingwouldnext be
indicateddiagnostically.
Test of Memory and Learning
TheTOMAL isacomprehensivebatteryof 14memoryandlearningtasks(ten
coresubtestsandfour supplementary subtests), normedfor usefromages5
years0monthsthrough19years11months(Table12.12). Thetencoresubtests
are divided into the content domains of Verbal Memory and Nonverbal
Memory, which can becombined to deriveaCompositeMemory Index. A
DelayedRecall Indexisalso availablethat requiresarepeat recall of therst
four subtests stimuli 30minutesafter their rst administration.
As notedabove, memory performancein any subject may beuniqueand
variableandtraditional content approachestomemorymaynot bethemost
useful. TheTOMAL thusprovidesalternativegroupingsof thesubtestsinto
Table 12.12. Core and Supplementary subtests and indexes available for the TOMAL
M SD
Coresubtests
Verbal
Memoryfor Stories 10 3
WordSelectiveReminding 10 3
Object Recall 10 3
DigitsForward 10 3
PairedRecall 10 3
Nonverbal
Facial Memory 10 3
Visual SelectiveReminding 10 3
Abstract Visual Memory 10 3
Visual Sequential Memory 10 3
Memoryfor Location 10 3
Supplementarysubtests
Verbal
LettersForward 10 3
DigitsBackward 10 3
LettersBackward 10 3
Nonverbal
Manual imitation 10 3
Summaryscores
Coreindexes
Verbal MemoryIndex(VMI) 100 15
Nonverbal MemoryIndex(NMI) 100 15
CompositeMemoryIndex(CMI) 100 15
DelayedRecall Index(DRI) 100 15
Supplementaryindexes(expert derived)
Sequential Recall Index(SRI) 100 15
FreeRecall Index(FRI) 100 15
AssociativeRecall Index(ARI) 100 15
LearningIndex(AI) 100 15
AttentionConcentrationIndex(ACI) 100 15
Factor scores(empiricallyderived)
ComplexMemoryIndex(CMFI) 100 15
Sequential Recall Index(SRFI) 100 15
BackwardsRecall Index(BRFI) 100 15
Spatial MemoryIndex(SMFI) 100 15
M=mean; SD=standarddeviation.
the Supplementary Indexes of Sequential Recall, Free Recall, Associative
Recall, Learning, andAttentionandConcentration. ToestablishtheseSupple-
mentaryindexes, agroupof expert neuropsychologistssortedthe14TOMAL
subtestsintological categories. Toprovidegreater exibilitytotheclinician, a
set of four purely empirically derived factor indexes representing Complex
Memory, Sequential Recall, Backward Recall, and Spatial Memory has also
beenmadeavailable(Reynolds&Bigler, 1996).
Table 12.12 summarizes the names of the subtests and summary scores,
alongwiththeir metric. TheTOMAL subtestsarescaledtothefamiliar metric
withameanof tenandastandarddeviationof three(range1to20). Composite
or summaryscoresarescaledtoameanof 100andstandarddeviationof 15. All
scaling was done using the method of rolling weighted averages and is de-
scribedindetail inReynoldsandBigler (1994a).
TOMAL subtests
The ten core and four supplementary TOMAL subtests require about 60
minutesfor askilledexaminer if theDelayedRecall subtestsarealsoadminis-
tered. Thesubtestswerechosentoprovideacomprehensiveviewof memory
functions (Ferris & Kamphaus, 1995). The subtests are named and briey
describedinTable12.13.
The TOMAL subtests systematically vary the mode of presentation and
responsesoastosampleverbal, visual, motoric(nonverbal), andcombinations
of thesemodalitiesinpresentationandinresponseformats. Multipletrialstoa
criterionareprovidedon several subtests, includingSelectiveReminding, so
that learningor acquisitioncurvesmaybederived. Multipletrials(at least ve
arenecessaryaccordingtoKaplan, 1996, andtheTOMAL providesuptoeight)
areprovidedon theSelectiveRemindingsubteststo allowan analysisof the
depthof processing. IntheSelectiveRemindingformat(whereinexamineesare
remindedonlyof stimuli forgotten or unrecalled), whenitemsoncerecalled
areunrecalled by theexamineeon later trials, problems arerevealed in the
informationtransfer fromimmediateandworkingmemorytomorelong-term
storage. Cueingis also providedat theend of certain subteststo addto the
examinersabilitytoprobedepthof processing, becausethedifferencebetween
cuedrecall andfreerecall maybeof diagnosticimportancefor certainneuro-
logical disorders.
Well-establishedmemorytasks(e.g.,recallingstories)thatalsocorrelatewell
withacademiclearningareincluded. Inaddition, memorytasksmorecommon
toexperimental neuropsychologythathavehigh(e.g., Facial Memory)andlow
(e.g., Visual Selective Reminding) ecological salience are included in the
Table 12.13. Description of TOMAL subtests
Core
Memoryfor Stories Averbal subtest requiringrecall of ashort storyreadtothe
examinee; providesameasureof meaningful andsemanticrecall
andisalsorelatedtosequential recall insomeinstances
Facial Memory Anonverbal subtest requiringrecognitionandidentication
fromaset of distractors: black-and-whitephotosof variousages,
malesandfemales, andvariousethnicbackgrounds; assesses
nonverbal, meaningful memoryinapractical fashionandhas
beenextensivelyresearched; sequencingof responsesis
unimportant
WordSelective
Reminding
Averbal free-recall taskinwhichtheexamineelearnsawordlist
andrepeatsit, onlytoberemindedof wordsleft out ineach
case: testslearningandimmediaterecall functionsinverbal
memory; trialscontinueuntil masteryisachievedor until eight
trialshavebeenattempted: sequenceof recall unimportant
Visual Selective
Reminding
Anonverbal analoguetoWordSelectiveRemindinginwhich
examineespoint tospecieddotsonacard, followinga
demonstrationof theexaminer, andareremindedonlyof items
recalledincorrectly; aswithWordSelectiveReminding, trials
continueuntil masteryisachievedor until eight trialshavebeen
attempted
Object Recall Theexaminer presentsaseriesof pictures, namesthem, asksthe
examineetorecall them, andrepeatsthisprocessacrossfour
trials; verbal andnonverbal stimuli arethuspairedandrecall is
entirelyverbal, creatingasituationfoundtointerferewithrecall
for manychildrenwithlearningdisabilitiesbut tobeneutral or
facilitativefor childrenwithout disabilities
Abstract Visual Memory Anonverbal task, whichassessesimmediaterecall for
meaninglessgureswhenorder isunimportant; theexamineeis
presentedwithastandardstimulusandrequiredtorecognize
thestandardfromanyof sixdistractors
DigitsForward Astandardverbal number recall task; it measureslow-level rote
recall of asequenceof numbers
Visual Sequential
Memory
Anonverbal taskrequiringrecall of thesequenceof aseriesof
meaninglessgeometricdesigns; theordereddesignsareshown,
followedbyapresentationof astandardorder of thestimuli,
andtheexamineeindicatestheorder inwhichtheyoriginally
appeared
PairedRecall Averbal paired-associativelearningtaskisprovidedbythe
examiner; easyandhardpairsandmeasuresof immediate
associativerecall andlearningareprovided
Table 12.13. (cont.)
Memoryfor Location Anonverbal taskthat assessesspatial memory; theexamineeis
presentedwithaset of largedotsdistributedonapageand
askedtorecall thelocationsof thedotsinorder
Supplementary
Manual Imitation Apsychomotor, visuallybasedassessment of sequential
memoryinwhichtheexamineeisrequiredtoreproduceaset of
orderedhandmovementsinthesamesequenceaspresentedby
theexaminer
LettersForward Alanguage-relatedanaloguetocommondigit spantasksusing
lettersasthestimuli inplaceof numbers
DigitsBackward ThisisthesamebasictaskasDigitsForward, except the
examineerecallsthenumbersinreverseorder
LettersBackward Alanguage-relatedanaloguetotheDigitsBackwardtaskusing
lettersasthestimuli insteadof numbers
TOMAL. Subtestsalsodiffer intermsof whether theinformationtoberecalled
isbasedonhighlymeaningful material (e.g., Memoryfor Stories) versusmore
abstract information processing (e.g., Abstract Visual Memory, which uses
abstrusecomplexgeometricforms).
Apart from allowing a comprehensive review of memory function, the
purposefor includingsuchafactorial arrayof tasksacrossmultipledimensions
istoallowathorough, detailedanalysisof memoryfunctionandthesourceof
anymemorydecitsthatmaybediscovered. Thetaskof theneuropsychologist
demands subtests with great specicity and variability of presentation and
response, and that sample all relevant brain functions in order to solve the
complexpuzzleof dysfunctional brainbehavior relationships. Kaufman(1979)
rst presented a detailed model for analyzing test data in a comprehensive
format (later elaborated: Kaufman, 1994) that likensthetaskof theclinicianto
that of adetective. Thethoroughness, breadth, andvariabilityof theTOMAL
subtestsallowstheapplicationof thisintelligent testing model intheanalysis
of brainbehavior relationshipsassociatedwithmemoryfunction.
Standardization
The TOMAL was standardized on a population-proportionate stratied
(by age, gender, ethnicity, socioeconomic status, region of residence, and
community size) randomsampleof children throughout theUSA. Standard-
izationandnormingwereconductedfor ages5upto 20years. Detailsof the
standardizationandspecicstatisticsonthesampleareprovidedinReynolds
andBigler (1994a).
Reliability
The TOMAL subtests and composite indexes show excellent evidence of
internal consistencyreliability. ReynoldsandBigler (1994a) report coefcient
alphareliabilityestimatesthat routinelyexceed.90for individual subtestsand
.95for compositescores. Stabilitycoefcientsaretypicallyinthe.80s.
Validity
TheTOMAL scores correlatearound .50with measures of intelligenceand
achievement, indicatingtheTOMAL isrelatedto, but not thesameas, these
measures(Reynolds&Bigler, 1994a), becausemeasuresofintelligencetypically
correlatewithoneanotheraround.75to.85andwithmeasuresof achievement
around.55to .65. Similarly, select subtests(i.e., Word SelectiveReminding)
correlatepositivelywiththepreviouslyacceptedstandardtest of verbal (word)
memory, theReyAuditoryVerbal Learningtest. Likewise, for older children
(1620 years), the Memory for Stories subtest correlates highly with the
venerableadult test, the Wechsler Memory ScaleRevised (see Reynolds &
Bigler, 1997).
Incontrast totheverbal subtests, thenonverbal sectionsof theTOMAL are
relativelyindependent of traditional nonverbal memorytests(seeReynolds&
Bigler, 1997). The TOMAL nonverbal subtests, unlike a number of other
purportedly visual and nonverbal memory tests, aredifcult to encodever-
bally, making themmore specic and less contaminated by examinees at-
temptsat verbal mediation. On thenonverbal or visual memory portionsof
existingmemory batteries, examinersshouldexpect larger differencesacross
teststhanonverbal memorymeasures.
Factor structure of the TOMAL
Basedon1342children, detailsof thefactor structure, analyses, andindicesof
theTOMAL havebeen extensively reviewed by Reynolds and Bigler (1996,
1997) andarebeyondbut brief mentionhere. Usingthemethodof principal
factorswith VarimaxandPromaxrotations, thecorrelationmatrixfor all 14
TOMAL subtestswasexamined. Factorswereextractedfor threeagegroup-
ings(58, 912, and1318) andwerefoundto beconsistent acrossagelevels.
Theanalysesreviewedbelowarebasedonthefull sampleof 1342children. Itis
worthyof notethat thoseanalysesarebasedonnormal, nonreferredchildren
and the factor analyses do not always demonstrate the same results with
exceptional samples, especiallysampleswithcentral nervoussystemdysfunc-
tion(e.g., seereviewmaterial byKamphaus&Reynolds, 1987).
Thetwo-factor solutionsof theTOMAL didnot support thedivisionof the
subtests into a verbal and a nonverbal scale. Clearly, the structure of the
TOMAL is more complex than is represented by these two simple,
dichotomous groupings. Nevertheless, Reynolds and Bigler (1994b) retained
theverbal/ nonverbal distinctionbecauseofitsclinical utility. Thereisageneral
factor present, much as with the intellectual factor (g), but weaker, that
nevertheless supports the use of a composite score such as the Composite
Memory Index (CMI) with normal populations. Unconstrained, exploratory
factor analyseshavealso been performed, wherein afour-factor solution (as
presented below) appeared best to capture the clinical composition of the
TOMAL (Reynolds&Bigler, 1997).
ComplexMemoryFactor Score(CMF)=Memoryfor Stories+WordSelective
Reminding+Object Recall +Paired Recall +Visual Selective Reminding+
Facial Memory.
Sequential Recall Factor Score (SRF)=Digits Forward+Letters Forward+
Visual Sequential Memory+Manual Imitation.
BackwardsRecall Factor Score(BRF)=DigitsBackward+LettersBackward.
Spatial MemoryFactor Score(SMF)=Abstract Visual Memory+Memoryfor
Location.
TherstandstrongestfactorappearinginthePromaxsolutionappearstobe
areection of overall memory skills that perhaps represents morecomplex
memory tasks and cuts across all modalities and memory processes. The
second factor emphasizes sequential recall and attention. The third factor
consistsof DigitsBackwardandLettersBackward, pointingclearlytotheneed
for separatescalingof backwardandforwardmemory span tasks. Backward
digit recall isknowntobeamorehighlyg-loadedtaskthanforwarddigit recall
and is likely to be more demanding mentally (e.g., see Jensen & Figueroa,
1975). Thefourthfactorappearstobeanonverbal factor, composedof Abstract
Visual Memory and Memory for Location. This factor seems to tap spatial
memory more strongly than other tasks. The four-factor Varimax solution
resultedinsimilar ndings.
Internal consistency reliability datafor thefour TOMAL factor indexesat
one-year ageintervals fall above0.90, except for thespatial Memory Factor
Indexat theyoungest age(veyears) whenit hasareliabilitycoefcient of .85.
Nearlyall of thevaluesarebetween.94and.99, withmedianvaluesof .95for
the Complex Memory Factor Index and .94 for the spatial Memory Factor
Index. Thus, these reliability coefcients of the empirically derived factor
indexesarequitecomparabletotheTOMAL CoreIndexesandSupplementary
IndexesdescribedintheTOMAL manual (Reynolds&Bigler, 1994a).
The presence of high reliability of these factor indexes is thus highly
consistent andaddsto thearmamentariumof theclinicianseekingto under-
standindividual cases. Also, theseTOMAL factor structurestudiessuggestthat
memoryasevaluatedbythisinstrument ismoreprocessthancontent driven.
Although the verbalnonverbal memory distinction is clinically useful, es-
peciallyfor thosewithTBI or withlocalizedlesions, whenmemoryfunctionis
examinedinnormal individuals, processappearstobemoresalient thanitem
content or modalityof presentation.
Subtest specicities
Subtest-specic variance can be derived from factor analysis as well, and
representstheproportionof varianceof asubtest that isspecictothesubtest
(not sharedwithother variables) andthat isalsoreliable. Aspecicityvalueof
0.25hasbeenconsideredappropriatetosupport interpretationof anindividual
subtest score(e.g., seeKaufman, 1979). ThevaluesreportedbyReynoldsand
Bigler(1994a, 1994b, 1996)reectquitehighspecicitiesrelativetomeasuresof
intelligenceandachievement, whichtendtobemorehighlyinterrelated. Inall
cases, theTOMAL subtestsshowspecicityof 0.40or higher andeachspecic-
ityvalueexceedstheerror varianceof thesubtest. TheTOMAL subteststhus
demonstratemorethanadequatespecicityto support their individual inter-
pretation. Thus, whenexceptional performance(either highor low) occurson
asubtest (or compositescore), that exceptional performancecanbetrustedas
an indication of particular strength or weaknessof memory performancein
thatdomain. Proceduresfor makingclinical inferencesaboutsuchobservations
arepresentedintheTOMAL manual (Reynolds& Bigler, 1994a) andarealso
available through automated interpretation (Stanton, Reynolds, & Bigler,
1995).
Cross-ethnic stability of factor indexes
TheTOMAL wasstandardizedandnormedwithanethnicallydiversepopula-
tion. Verylittleresearchhasbeendonewithneuropsychological measuresand
the cultural test bias hypothesis particularly relative to the plethora of bias
researchonintelligencetests(e.g., seeReynolds, 1995). Several analyseshave
beenperformedonthestandardizationsamplewithregardtoethnicbias(see
Reynolds& Bigler, 1994a, 1996; Mayeld& Reynolds, 1996). Theseanalyses,
which should be considered only preliminary, suggested consistency of the
factor structures of the TOMAL across race for African-Americans and for
Caucasians. This would indicate that the test materials are perceived and
reactedtoinahighlysimilar manner for thesetwogroups. Consistentinterpre-
tation of performance across race on the TOMAL is thus supported, and
changesininterpretationasafunctionof racedonot appear tobeappropriate
basedoncurrent results.
Forward versus backward recall
Asalludedto in theintroduction, recall of digitsin theforwardand reverse
directionhasbeenacommonpracticeinstandardizedcognitivetesting. How-
ever, the number of digits recalled in the forward direction was typically
combinedwith thenumber recalled in thereversedirection to formatotal
scoreof digit span. Onefeatureof theTOMAL wastheindividual normingof
digits and letters recalled in theforward and reversedirection. Ramsay and
Reynolds (1995) and Reynolds (1996) have demonstrated that forward and
backwardmemoryspantasksshouldbetreatedseparately. Whereasforward
memoryspanhasstrongattentional andsequential demands, backwardmem-
oryspanappearsto havespatial and/ or integrativeelementsnot apparent in
forwardmemoryspan. Current evidenceseemstosupport forwardspantasks
as being more simple, perhaps verbally oriented, and strongly sequential,
whereasbackwardmemoryspaninvokesmorecomplexprocessesthat require
transformations not necessary with forward memory span. Backward recall
mayalsoinvoke, for manyindividuals, visuospatial imagingprocesses, evenfor
ostensiblyverbal material suchasletters. It isclear that forwardandbackward
memory recall tasks are sufciently different to be assessed separately for
clinical purposes, andaresopresentedontheTOMAL.
Delayed recall
Delayedrecall hasalwaysbeenacomponentof memorytesting. Delayedrecall
on the TOMAL requires the examinees to recall stimuli fromthe rst four
subtestsadministered(twoverbal, twononverbal), 30minutesafter testinghas
beeninitiated. TheDelayedRecall Index(DRI) actsasameasureof forgetting.
Most examinees will score within about ten points of their CMI on the
TOMAL. TheTOMAL manual also containsvaluesfor assessingthesigni-
canceof thedifferencebetweenDRI andCMI, andthisischeckedautomati-
callybytheTOMAL computer scoringprogram.
DRI scores signicantly below the CMI are often an indication of an
organicallybaseddisturbanceof memory, althoughavarietyof neuropsychiat-
ricdisordersalsodisrupt memory(e.g., Grossmanet al., 1994). DRI allowsthe
cliniciantoexploreavarietyof hypothesesabout depthof processing(especial-
lyinconjunctionwithselectivereminding, whichmayshowmoreintermedi-
ateforgetting), forgetting, andmotivation.
Table 12.14. Means and standard deviations by group for TOMAL indices, WRAT-3 and
PPVT scaled scores, and FSIQ score
Group
Control Mild Moderate Severe
TOMAL
VMI 102(8)* 95(12)* 96(12)* 86(16)*
a,b,c,
NMI 104(11)* 97(11) 92(19)*
a
89(14)*
a
CMI 103(8)* 96(10)* 94(15)*
a
87(14)*
a,b
DRI 104(7)* 99(7)* 96(9)*
a
92(13)*
a,b
PPVTR 106(12)* 99(14) 98(21) 94(18)*
a
FSIQ 105(12)* 99(13) 95(15) 94(18)*
a
*p:0.05, asexaminedbypost hocTukeysHSDprocedure.
a
Reliablydifferent fromcontrol group.
b
Reliablydifferent frommildbraininjurygroup.
c
Reliablydifferent frommoderatebraininjurygroup.
TOMAL=Test of MemoryandLearning; VMI =Verbal MemoryIndex; NMI =Nonverbal
MemoryIndex; CMI =CompositeMemoryIndex; DRI =DelayedRecall Index;
PPVTR=PeabodyPictureVocabularyTestRevised; FSIQ=Wechsler Full ScaleIQ.
Interpretive strategies
The TOMAL manual reviews a basic top-down interpretive strategy that
mimicsKaufmans(1979, 1994) basicphilosophyof intelligent testingandthat
requiresintegrationof historyandother test data. Theadditional information
presentedhereandinother paperscitedthroughout thischapter supplements
thestrategiesgivenbyReynoldsandBigler (1994a), whoalsoprovidedataon
within-testscatter andtherelationshipof theTOMAL tothemajor intelligence
scales and to achievement tests as well. Lajiness-ONeill (1996) examined
TOMAL performance in children with traumatic brain injury. Mean index
scoresfromthisstudyarepresentedinTable12.14. Thesechildrenwithmore
severebrain injury had greater memory decit as assessed by the TOMAL.
Howes et al. (1999) examined TOMAL performance in reading-disabled
children. Children with reading disorders had signicantly lower CMI than
matchedcontrols. Thesestudiesdemonstratetheclinical utilityof theTOMAL,
asdoesthefollowingcasestudy.
Fig. 12.3. MagneticresonancescanfromDoug. Thedarkareasrepresent theventricular system
(internal uid-lledcavityof thebrain), whichhassignicantlyenlargedontheright secondary
todamagefromanintrauterinestroke. Theright hemisphereissignicantlydamagedandthere
isgeneralizedatrophyof thehemisphere. Thishasproducedprominent left-sidemotor decits
andimpairednon-verbal abilitiesandvisual memory.
Case study: Doug (seeFig. 12.3)
Doug suffered a probable intrauterine right middle cerebral artery stroke,
which resultedin signicant damageto theright hemisphere(seeFig. 12.1).
Thelesionwasdetectedat birthwhenacomputerizedtomographyscanwas
obtainedafter it wasclinicallynotedthat hehadlimitedspontaneousleft-side
movement alongwithabnormal reexes. Hewasgivenextensivephysical and
occupational therapy as an infant and, by early childhood, could ambulate
independently, although general motor skills remained delayed. In contrast,
verbal abilitiesdevelopednormally. Despitenormal verbal abilities, hewas
pronouncedtohavelearningproblems intheclassroom.
When evaluated at the age of 11 years 8 months, Doug obtained the
followingscores on theWechsler IntelligenceScalefor ChildrenIII: Verbal
IQ=108, Performance IQ=57, and Full Scale IQ=81. His standard score
performanceon thePeabody PictureVocabulary Test performancewas108
(70%). Standardized academic testing with the Wide Range Achievement
TestRevisedindicatedstandardscoresof 98(45%) inbothreadingandspell-
ing, withthemathscoreat 84(14%). Visuomotor abilityontheBeeryVisual
Motor Integration Test found this child to becapableof performingwith a
standard score of 70 (2%), indicating signicant limitations in visuomotor
ability. Theneuropsychological interpretation of thesendings is consistent
withclassicright hemisphereinvolvement disruptingnonverbal, visuospatial,
Table 12.15. TOMAL case study
Wechsler IntelligenceScalefor ChildrenIII
VIQ=108
PIQ=57
Information 14
Similarities 12
Arithmetic 6
Vocabulary 11
Comprehension 14
Digit Span 8
PictureCompletion 2
Coding 4
PictureArrangement 2
BlockDesign 3
Object Assembly 3
WideRangeAchievement Test
Reading 93
Spelling 98
Arithmetic 84
BeeryTest of Visual Motor Integration
StandardScore 70
Test of MemoryandLearning
Indexscores Data
Standardscore %
Verbal Memory 101 53
Nonverbal Memory 79 8
CompositeMemory 90 25
DelayedRecall 98 45
Attention/ Concentration 85 16
VIQ=Verbal IQ; PIQ=PerformanceIQ.
andmotor functions. However, despitetheintactnessof verbal abilities, Doug
wasstrugglinginschool, characterizedbyinconsistentclassroomperformance.
TOMAL testingdemonstratedintact verbal memorybut impairednonverbal
memory (Table 12.15). Also, the Attention/ Concentration Index was low
(16%), particularlyincontrast toverbal intellectual abilities(70%). Theclinical
interpretation of these TOMAL ndings indicates decits in the nonverbal,
visualspatial memory and problematic attention. Teachers were overinter-
pretingthischildscognitiveabilitybecausehecouldperformsowell onverbal
tasks. ShowingtheteacherstheseTOMAL scores, alongwiththeothernonver-
bal, visualspatial decits, helped in devising an educational plan in which
additional timeandrepetitionweregivenfor nonverbal memory. Theprob-
lemswithattentionwerefoundtobedominatedbyDougbecomingdistracted
by not being able to visually and spatially process information, particularly
information presented on the chalkboard or by visual display. Thus, when
informationwasorallypresented, hecouldperformintheaverageto above-
averagerange. Conversely, if theteacher switchedback-and-forthbetweenoral
presentation and the chalkboard (or any other visual display format), Doug
couldnot tracktheinformationbecauseof thedecitsinnonverbal memory.
Improvedgradeperformancewasachievedwhenthesechangesweremadein
theclassroom.
California Verbal Learning TestChildrens Version
TheCVLTC(Deliset al., 1994)isarelativelybrief memorytaskthat provides
theclinicianwithameansof evaluatingvariousprocessesof verbalauditory
learningand recall. Its structureis similar to theCaliforniaVerbal Learning
Test (CVLT) (Deliset al., 1987), theReyAuditoryVerbal LearningTest (Rey,
1958), and theVerbal Learningsubtest of theWRAML (Sheslow & Adams,
1990). TheCVLTC isappropriatefor childrenaged5to16years(theCVLT
beginsat age17). Thetaskrequestschildrento learntwolistsof familiar and
categorizedwords presentedas shoppinglists. Theauthors suggest that this
task is relevant to children and may simulate how they might approach a
real-worldmemorysituation.
InadministeringtheCVLTC, thechildinitiallyhearsandisaskedtorepeat,
infreerecall format, alist of 15words. Thechildsresponsesarerecordedand
therecitationrecall procedureisrepeatedfour additional times. Althoughnot
mentionedtothechild, thewordscanbesortedintothreecategories clothes,
fruits,andtoyswithanequal numberofwordsassociatedwitheachcategory.
Followingadministrationof therst list of words, asecondshoppinglist is
then presented. Thesecondlist consistsof 15different words, which can be
sortedinto thecategoriesof furniture, fruits, anddesserts. Followingasingle
learning/ recall trial usingthesecondlist, thechildisagainaskedtorepeat the
rst shoppinglist. Next, thechildistoldthethreecategoriesinto which the
wordsof therst list couldbegrouped. Withthiscueavailable, recall for each
categoryiselicited.
A20-minutedelayinterval isthenintroduced, duringwhichother nonverbal
testingmaybecompleted. At theendof thisinterval, thechildisagaingivena
free-recall trial of therstlist, followedbyacuedrecall trial. Finally, thechildis
askedtolistento alist of wordsthat includeitemsfrombothlearninglistsas
well asdistracterwords. Thechildisaskedtoidentifythosewordsfromtherst
shopping list. The entire procedure requires approximately 30 minutes to
complete, not includingthe20-minutedelay.
Carewasexercisedindeterminingiteminclusion. Thewordschosenfor the
shopping lists were selected based on their frequency of occurrence in the
Englishlanguageaswell asonhowoftentheywerereportedbychildren. To
avoidthepossibilitythat childrenwouldonlyreport themost commonwords
inacategoryrather thanthoselearnedfromthelist, thethreemost commonly
usedwordsfor eachcategorywerenot included. Thewordsusedfor eachlist
weredesignedtobecomparable.
Standardization
The CVLTC standardization used the 1988 US census to guide subject
inclusion. The sample was stratied by age, gender, ethnicity, geographic
region, andparent education. Detailsof thestandardization, includingsamp-
lingstatistics, arefoundinthemanual (Deliset al., 1994).
Reliability
Reliability calculationsfor theCVLTC arereportedasmeasuresof internal
consistency, aswell astestretest reliability. Acrossthevetrialsfor therst
shoppinglist, theaverageinternal consistencycorrelationis.88, witharange
from.84to.91. Reliabilityacrosscategoriesyieldsanaverageinternal consist-
encycoefcient of .72for all agegroups.
Testretest measures were obtained. The interval between test periods
averaged28days. Recall performanceonthesecondCVLTC administration
increased by ve, six, and nine words for the 8-year-old, 12-year-old, and
16-year-oldage-groups, respectively. Reliability coefcientsderivedfromthe
rstandsecondadministrationscoresrangedfrom.31to.90, whichtheauthors
consideredacceptablefor thenatureof this auditoryverbal memory assess-
ment tool.
Clinical utility of the CVLT
TheCVLTC isarelatively short andeasy test to administer. Responsesare
recordedbytheexaminer andcategorizedastotheir semanticrelationshipto
theoriginal words. In addition, occurrencesof perseverationsand intrusions
arerecorded. Variousprocess-orientedscorescanbecalculatedandempirical
groundingfor qualitativeanalysesof memoryfunction. Theseprocessscores
answer questionssuchas: doesthechildtendto learnthingsincategoriesor
randomly?Doesthechildbenet fromalonger delaybetweennewinforma-
tion?Shouldsimilar subject areas beseparatedthroughout theday to avoid
interferencefrompreviouslylearnedtasks?Asoftwareprogramfor theCVLT
C isavailable. It providescomputationandmultilevel interpretiveanalysesof
thevariouswaysthetest resultscanbeconsidered.
ENDNOTES
1 This chapter does not deal with theongoingscientic debateover memory nomenclature
(Fuster, 1995). Thereare, infact, differencesbetweenimmediateandshort-termmemory. Asa
simplication, wehaveheldontoolder taxonomyrather thanthemorerecent declarative(or
explicit), nondeclarative(or implicit or procedural) and thetermworkingmemory. Other
memoryterms, suchasepisodicandsemanticmemory, arenotdiscussed. Theolder classica-
tionof memorytswithhowthegeneral cliniciandealswiththepractical conceptualization
andimplicationsinmemoryassessment. For example, inafeedbackconferencewithaparent,
teacher and counselor, the use of terms other than immediate, short termand long term
becomesconfusing.
REFERENCES
Adams, W.V., Hyde, C.L., & deLancey, E.R. (1995). Use of the Wide Range Assessment of
MemoryandLearninginDiagnosingADHDinChildren. Paper presentedat theChildHealth
PsychologyConference, Gainesville, FL.
Adams, W.V., Robins, P.R., Sheslow, D.V., &Hyde, C.L. (Submitted). Performanceof children
with ADHD and/ or reading disabilities on the Wide Range Assessment of Memory and
Learning.
Adams, W. & Sheslow, D. (1995). WideRangeAssessment of Visual Motor Abilities. Washington,
DC: WideRange, Inc.
Aylward, G.P., Gioia, G., Verhulst, S.J., & Bell, S. (1995). Factor structureof theWideRange
Assessment of MemoryandLearninginaclinical population. Assessment, 13, 13242.
Baddeley, A.D. (1990). HumanMemory: TheoryandPractice. Hove, UK: LawrenceErlbaum.
Bakker, D.J., Fisk, J.L., &Strang, J.D. (1985). ChildNeuropsychology. NewYork: GuilfordPress.
Baron, I.S., Fennell, E.B., &Voeller, K.K.S. (1995). PediatricNeuropsychologyintheMedical Setting.
London: UniversityPress.
Bauer, R.M., Tobias, B.A., & Valenstein, E. (1993). Amnesticdisorders. InClinical Neuropsychol-
ogy, ed. K.M. Heilman&E. Valenstein, pp. 523602. NewYork: OxfordUniversityPress.
Bigler, E.D. & Clement, P. (1997). DiagnosticClinical Neuropsychology, 3rdedition. Austin, TX:
Universityof TexasPress.
Bull, R. &Johnston, R.S. (1997). Childrensarithmetical difculties: contributionsfromprocess-
ingspeed, itemidentication, andshort-termmemory. Journal ofExperimental ChildPsychology,
65, 124.
Burton, D.B., Donders, J., & Mittenberg, W. (1996). A structural equationanalysisof thewide
rangeassessment of memoryandlearninginthestandardizationsample. ChildNeuropsychol-
ogy, 2, 3947.
Burton, D.B., Mittenberg, W., Gold, S., &Drabman, R. (1999). Astructural equationanalysisof
theWideRangeAssessment of MemoryandLearninginaclinical sample. ChildNeuropsychol-
ogy, 5, 3440.
Cohen, R.A. (1993). TheNeuropsychologyof Attention. NewYork: PlenumPress.
Cowan, N. (1997). TheDevelopmentof MemoryinChildhood. Hove, UK: PsychologyPress.
Cronwall, D., Wrightson, P., & Waddell, P. (1990). Head Injury: theFacts. Oxford: Oxford
UniversityPress.
Cullum, M., Kuck, J., & Ruff, R.M. (1990). Neuropsychological assessment of traumatic
brain injury in adults. In TraumaticBrain Injury, ed. E.D. Bigler, pp. 129163. Austin, TX:
Pro-Ed.
Cytowic, R.E. (1996). TheNeurological Sideof Neuropsychology. Cambridge, MA: MIT Press.
deJong, P.F. (1998). Workingmemorydecitsof readingdisabledchildren. Journal of Experimen-
tal ChildPsychology, 70, 7596.
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (1994). California Verbal LearningTest
ChildrensVersion. SanAntonio, TX: ThePsychological Corporation.
Delis, D.C., Kramer, J.H., Kaplan, J.H., & Kaplan, E. (1987). CaliforniaVerbal LearningTest. San
Dewey, D., Kaplan, B.J., & Crawford, S.G. (1997). Factor structureof theWRAML inchildren
with ADHD or reading disabilities: further evidence of an attention/ concentration factor.
Developmental Neuropsychology, 13, 5016.
Diamond, M.C. (1990). Morphological cortical changes as a consequence of learning and
experience. InNeurobiologyof Higher CognitiveFunction, ed. A. Schiebel & A. Wechsler. New
Duis, S.S. (1998). Differential performances on the Wide Range Assessment of Memory and
Learningof childrendiagnosedwithreadingdisorder, attention-decit/ hyperactivitydisorder,
andtraumatic braininjury. [DissertationAbstract] DissertationAbstractsInternational: Sec-
tionB. TheSciencesandEngineering, 58(7B), 3919.
Farmer, J.E., Haut, J.S., Williams, J., Kapila, C., Johnstone, B., &Kirk, K.S. (1999). Comprehen-
siveassessment of memoryfunctioningfollowingtraumaticbraininjuryinchildren. Develop-
mental Neuropsychology, 15, 26989.
Ferris, L.M. &Kamphaus, R.W. (1995). Reviewof theTest of MemoryandLearning. Archivesof
Clinical Neuropsychology, 10.
Fuster, J.M. (1995). MemoryintheCerebral Cortex. Cambridge, MA: MIT Press.
Gillberg, C. (1995). Clinical ChildNeuropsychiatry. Cambridge: CambridgeUniversityPress.
Gioia, G.A. (1998). Re-examiningthefactor structureof theWideRangeAssessmentof Memory
andLearning: implicationsfor clinical interpretation. Assessment, 5, 12739.
Golden, C.J., Zillmer, E., & Spiers, M. (1992). Neuropsychological Assessment and Intervention.
Springeld, IL: CharlesCThomas.
Goldstein, F.C. &Levin, H.S. (1990). Epidemiologyof traumaticbraininjury: incidence, clinical
characteristics, andrisk factors. In TraumaticBrainInjury, ed. E.D. Bigler, pp. 5167. Austin,
TX: Pro-ed.
Grossman, I., Kaufman, A.S., Mednitsky, S., Scharff, L., & Dennis, B. (1994). Neurocognitive
abilitiesfor aclinicallydepressedsampleversusamatchedcontrol groupof normal individ-
uals. PsychiatryResearch, 51, 23144.
Hill, D.E., Ciesielski, K.T., Sethre-Hofstad, L., Duncan, M.H., &Lorenzi, M. (1997). Visual and
verbal short-termmemorydecitsinchildhoodleukemiasurvivorsafter intrathecal chemo-
therapy. Journal of PediatricPsychology, 22, 86170.
Howes, N.L., Bigler, E.D., Lawson, J.S., &Burlingame, G.M. (1999). Readingdisabilitysubtypes
andthetest of memoryandlearning. Archivesof Clinical Neuropsychology, 14(3), 31739.
Hynd, G. & Obrzut, J. (1981). Neuropsychological Assessment of theSchool-agedChild: Issuesand
Procedures. NewYork: Grune&Stratton.
Jensen, A.R. & Figueroa, R. (1975). Forwardandbackwarddigit spaninteractionwithraceand
IQ: predictionsfromJensenstheory. Journal of Educational Psychology, 67, 88293.
Kamphaus, R.W. & Reynolds, C.R. (1987). Clinical andResearchApplicationof theK-ABC. Circle
Kaplan, E. (1996). Discussant. Paper presentedat thesymposiumat theannual meetingof the
National Associationof School Psychologists, Atlanta, GA.
Kaufman, A.S. (1979). Intelligent TestingwiththeWISCR. NewYork: WileyInterscience.
Kaufman, A.S. (1994). Intelligent TestingwiththeWISCIII. NewYork: WileyInterscience.
Kennedy, M.L. & Guilmette, T.J. (1997). The relationship between the WRAML memory
screeningandgeneral memoryindicesinaclinical population. Assessment, 4, 6972.
Knight, R.G. (1992). TheNeuropsychologyof DegenerativeBrainDiseases. Hillsdale, NJ: Lawrence
Erlbaum.
Koppitz, E.M. (1977). TheVisual Aural Digit SpanTest. NewYork: Grune&Stratton.
Lajiness-ONeill, R. (1996). Ageat injuryasapredictor of memoryperformanceinchildrenwith
traumatic brain injury. Unpublished Doctoral Dissertation, Department of Psychology,
BrighamYoungUniversity, Provo.
Lezak, M.D. (1995). Neuropsychological Assessment, thirdedition. NewYork: OxfordUniversity
Press.
Lorsbach, T.C., Wilson, S., & Reimer, J.F. (1996). Memoryfor relevant andirrelevant informa-
tion: evidence for decient inhibitory processes in language/ learning disabled children.
ContemporaryEducational Psychology, 21, 44766.
Mapou, R.L. &Spector, J. (eds.)(1995). Clinical Neuropsychological Assessment. NewYork: Plenum
Press.
Mayeld, J.W. & Reynolds, C.R. (1996). Blackwhitedifferencesin memory test performance
amongchildrenandadolescents. Archivesof Clinical Neuropsychology, 11(5), 4223.
McCarthy, D. (1972). McCarthyScalesof ChildrensAbilities. SanAntonio, TX: ThePsychological
Corporation.
Nation, K., Adams, J.W., Bowyer-Crain, A., & Snowling, M.J. (1999). Workingmemorydecits
inpoor comprehendersreect underlyinglanguageimpairments. Journal of Experimental Child
Parkin, A.J. (1993). Memory: Phenomena, ExperimentandTheory. Oxford: Blackwell.
Pennington, B.F. (1991). DiagnosingLearningDisorders: A Neuropsychological Framework. New
Phelps, L. (1995). Exploratoryfactor analysisof theWRAML withacademicallyat-riskstudents.
Prigatano, G.P. (1990). Recovery and cognitive retraining after cognitive brain injury. In
TraumaticBrainInjury, ed. E.D. Bigler, pp. 27395. Austin, TX: Pro-Ed.
Ramsey, M.C. & Reynolds, C.R. (1995). Separatedigit tests: abrief history, aliteraturereview,
andareexaminationof thefactor structureof theTest of MemoryandLearning(TOMAL).
NeuropsychologyReview, 5, 15171.
Reeves, D. &Wedding, D. (1994). TheClinical Assessment of Memory. Berlin: Springer-Verlag.
Rey, A. (1958). LExamenCliniqueenPsychologie. (Englishtranslation1964). Paris: PressesUniver-
sitairesdeFrance.
Reynolds, C.R. (1995). Test biasandtheassessment of intelligenceandpersonality. InInterna-
tional Handbookof PersonalityandIntelligence, ed. D. Saklofske&M. Zeidner, pp. 54573. New
York: PlenumPress.
Reynolds, C.R. (1996). Forwardandbackwardmemoryspanshouldnot becombinedfor clinical
analysis. Archivesof Clinical Neuropsychology, 11(5), 440.
Reynolds, C.R. & Bigler, E.D. (1994a). Manual for theTest of MemoryandLearning. Austin, TX:
Pro-Ed.
Reynolds, C.R. &Bigler, E.D. (1994b). Testof MemoryandLearning. Austin, TX: Pro-Ed.
Reynolds, C.R. &Bigler, E.D. (1996). Factor structure, factor indexes, andother useful statistics
for interpretationof theTest of MemoryandLearning(TOMAL). Archivesof Clinical Neuro-
psychology, 11(1), 2943.
Reynolds, C.R. & Bigler, E.D. (1997). Clinical neuropsychological assessment of child and
adolescent memory with the test of memory and learning. In Handbook of Clinical Child
Neuropsychology, secondedition, ed. C.R. Reynolds& E. Fletcher-Janzen, pp. 296319. New
York: PlenumPress.
Rourke, B.P. (1991). Neuropsychological Validation of Learning Disability Subtypes. New York:
GuilfordPress.
Scheibel, A.B. (1990). Dendriticcorrelatesof higher cognitivefunction. InNeurobiologyof Higher
CognitiveFunction, ed. A. Scheiberl &A. Wechsler. NewYork: GuilfordPress.
Sheslow, D. & Adams, W. (1990). WideRangeAssessment of MemoryandLearning. Wilmington,
DE: JastakAssociates.
Snyderman, M. & Rothman, S. (1987). Survey of expert opinion on intelligenceand aptitude
testing. AmericanPsychologist, 42, 13744.
Stanton, H.C., Reynolds, C.R., &Bigler, E.D. (1995). PRO-SCORE: ComputerScoringSystemfor the
Test of MemoryandLearning. Austin, TX: Pro-Ed.
Stark, R.E. & McGregor, K.K. (1997). Follow-upstudyof aright- andleft-hemispherectomized
child:implicationsfor localizationandimpairmentof languageinchildren.BrainandLanguage,
60, 22242.
Swanson, H.L. (ed.) (1987). MemoryandLearningDisabilities. London: JAI Press, Inc.
Swanson, H.L., Ashbacker, M.H., &Lee, C. (1996). Learning-disabledreaders workingmemory
asafunctionof processingdemands. Journal of Experimental ChildPsychology, 61, 24275.
Tramontana, M.G. &Hooper, S.R. (1988). AssessmentIssuesinChildNeuropsychology. NewYork:
PlenumPress.
Whitney, S.J. (1996). ThePerformanceof ChildrenwhoareDepressedontheWideRangeAssessmentof
MemoryandLearning. NewBrunswick, NJ: RutgersUniversity.
Williams, J. & Haut, J.S. (1995). Differential performances on the WRAML in children and
adolescentsdiagnosedwithepilepsy, headinjury, andsubstanceabuse. Developmental Neuro-
psychology, 11(2), 20113.
Woodward,H. &Donders, J. (1998). Theperformanceof childrenwithtraumaticheadinjuryon
theWideRangeAssessment of MemoryandLearning Screening. AppliedNeuropsychology, 5,
11319.
MMMM
Part IV
Integration and Summation
MMMM
13
Assessment of specific learning
disabilities in the new millennium:
issues, conflicts, and controversies
Two elds that have embraced controversy fromtheir inception areintelli-
gencetestingandspeciclearningdisabilities. Thisbook, withitsfocusonthe
assessment of speciclearningdisabilities(SLDs), unitesthetwo, providinga
doubledose of controversy. Indeed, one does not need to look very far to
understand that professionals differ dramatically in their perceptions about
SLDs causes, denitions, diagnosis, treatment and about the role that
shouldbeplayedbyIQ testsandother standardizedneuropsychological tests
duringthediagnosticprocess.
Shepherdsinsightful history lessoninChapter 1, rootedin neurology and
special educationandalwaysorientedtowardapragmatic, educational perspec-
tive, delineatesthedifferent roadsthat havebeentraveledbythepioneersin
theeld, andenlightensusastowherethesepathshaveledinthepresent. Yet
otherhistoriesof learningdisabilitiesalsoaboundinthisbook, notablySpreens
neurological history (Chapter 9) that emphasizes theory and research, and
stressesSLD subtypes; Reitan and Wolfsonshistory of SLDs fromaneuro-
psychological researchperspective(Chapter 10), in whichtheemphasisison
discriminatingSLDindividualsfromnormal andbrain-injuredindividuals, and
on understandingeach SLD personsuniqueneuropsychological prole; and
Mather andWoodcocksapproach(Chapter 3) that citesthehistorical preced-
entsfor interpretingSLDsintermsof thecommontheme. . . that learning
disabilitiesarisefromadeciency inbasiccognitiveprocesses, whichin turn
contributetoacademicfailure (seep. 77).
The histories include many of the same names such as Hinshelwood,
Strauss, Orton, Kirk, andRourke but theyareeachdistinct intheir emphases
andinterpretationsof just what SLDsare, howtodiagnosethem, andhowto
treatthem. FromShepherds(Chapter1)vividpictureof thedifferentpathways
that weretraveledon theroadto contemporary denitionsof SLD, andthe
confusionsand contradictionsthat were(andare) inherent in theseperspec-
tives, it isapparent that consensusabout SLD cannot easilybeachieved, that
433
lackof agreementhasconsistentlyledtocontroversy, andthat suchcontrover-
siesareasalivetodayastheywere30or 40yearsago.
Contemporary critiques of intelligence tests for SLD assessment
Onenoteworthycontroversyconcernstheassessment of SLD. It iscurrently
appearinginthepagesof Journal of LearningDisabilities, andisdemandingthe
elimination of IQ tests fromthe SLD assessment process. Stanovich (1999)
stated, LD advocacy will alwaysbeopen to chargesof queuejumping as
long as the eld refuses to rid itself of its IQ fetishism, refuses to jettison
aptitudeachievement discrepancy, andfails to freeclinical practicefromthe
pseudoscienticneurologythat plaguedtheeldinthe1970s (p. 359). Not to
beoutdone, Siegel (1999), respondingtoissuesof SLDdenitionanddiagnosis
raisedbyalawsuit (Guckenberger v. BostonUniversity), said, ScoresonIQtests
areirrelevant and not useful and may even bediscriminatory (p. 304). Vel-
lutino, Scanlon, andLyon(2000), thoughgenerallyskeptical aboutthevalueof
IQ testsfor SLD diagnosis, takealessextremeposition. They interpret data
fromtheirempirical studiesof readingasarguingstronglyagainsttheuseof the
IQachievement discrepancy as part of the functional denition of reading
disability, but donot proposetodismissIQtestsaltogether. UnlikeStanovich
(1999) and Siegel (1999), Vellutino et al. (2000, p. 236) give a lukewarm
endorsement to IQtests, concedingthat, theremaybesomethingimportant
aboutachildsIQ, particularlywithrespect tohowit interactswiththat childs
emotional andbehavioral responsetofailure.
Thecriticismsof IQtestsput forthbySiegel (1999) andStanovich(1999) are
notnew. Siegel pointsout, for example, that somesubtestsassignbonuspoints
for speed, suchthat, Apersonwithaslow, deliberatestylewouldnot achieve
as high ascoreas an individual who respondedmore quickly (p. 311). She
statesfurther that theSLDinreadingislikelytoimpair performanceonanIQ
test, especiallyontestsof vocabularyandsimilar verbal tasks, andcitesother
limitations of IQ tests that would preclude the use of an IQachievement
discrepancyfor thediagnosisof SLD. StanovichechoesSiegelspoints, especial-
lytheonesthat impugntheuseof anabilityachievementdiscrepancyfor SLD
diagnosis, andalsoemphasizesthefactthatIQtestsdonot adequatelymeasure
onespotential.
Thereareafewdifferent (but related) issueshereworthyof discussion.
1. Siegel (1999) andStanovich(1999) linkthefallaciesinherent intheIQachieve-
ment discrepancy with the elimination of IQ tests for SLD assessment.
Stanovich,inparticular, criticizesthosewhobelievethatlowintelligencecauses
434 Alan S. Kaufman and Nadeen L. Kaufman
readingdifculty(Toassumesowouldmakethefundamental reasoningerror
of inferringcausefrom. . . correlation, p. 352). Yet, bothprofessionalsmake
theimplicit causeeffect assumptionthat if thediscrepancycriterioniselimin-
atedfromthedenitionof SLDdiagnosis(aferventwishof both), thenIQtests,
with all their imperfections, should be trashed, and deleted fromthe SLD
assessmentprocess. Webelievethattheseissuesareseparateandthatknee-jerk
dismissal of IQtestsisnot apertinent responsetoremoval of thediscrepancy
concept fromtheSLDdenition. ThoughVellutinoet al. (2000) donot make
this samecausal inference, they clearly perceivethevalue of IQ tests to be
marginal, more clinical than psychometric (perhaps offering insight into
childrensresponsetofailure), andmorerelatedtopeoplesmisperceptionsof
the value of IQ tests than to any real value. Regarding the latter point,
Vellutino et al. (2000, p. 236) arguethat IQ isunrelatedto readingability or
remedial progress(argumentsembracedaswell bySiegel andStanovich), but
concedethat, becauseof thewidespreadbelief that IQandreadingabilityare
related, itmightwell bethecasethatmoreresourceswouldbebroughttobear
tosupport thereadingdevelopment of achildwho scoredhighonanintelli-
gencetest ascomparedwithachildwhoscoredintheaverageor low-average
rangeonthetest.
2. All of theseauthorsseemtoequateIQtest withWechsler test. Accordingto
Siegel (1999): IQtestsconsist of measuresof factual knowledge, denitionsof
words, memory, nemotor coordination, anduencyof expressivelanguage;
they do not measurereasoningor problem-solvingskills (p. 311). Stanovich
(1999) discusses(with apparent disdain) howprofessionalshavearguedover
whether verbal or nonverbal measures provide the best IQ criterion for
evaluating the intelligence of a child with SLD as if the verbal-nonverbal
distinctionthat characterizesthenontheoretical Wechsler testsistheonlyone
of interest toconsider, therebyignoringtheprevalenceof non-Wechsler tests
that now abound, most of which are derived fromtheory. Yes, Wechslers
scalesarestill, byfar, themost frequentlyusedIQtestsfor SLDdiagnosis. But
that does not excuse authors for failing to consider the use of alternative
measuresof intelligence, especiallyinarticlesthat arepassionatelycallingfor
theeliminationof IQtests.
3. All of theseauthorsrefer toIQasif it istheunidimensional g factor positedby
Spearman(1904) acenturyagoandsupportedbyJensen(1998) inthepresent.
They demonstrateno awarenessthat theg construct isantithetical to most
moderntheoriesof intelligence, includingHorns(1989) expansionandelabor-
ationof theHornCattell GfGctheory, thetheorythat hasprovedto bethe
most inuential model for thedevelopment of new and revisedintelligence
435 Assessment of specific learning disabilities in the new millennium
tests (Woodcock & Mather, 1989; Kaufman, 2000; Woodcock, McGrew, &
Mather, 2001)andhasgreatlyinuencedtheinterpretationof Wechslersscales
(Kaufman, 1994; Kaufman & Lichtenberger, 1999, 2000). Furthermore, the
authors display some misconceptions about the assumptions that underlie
intelligence tests and the IQ construct. One of these misconceptions was
mentioned in point 1 regarding Stanovichs (1999) claimthat low IQ is at-
tributedto beacauseof readingdisabilities. Also, what IQ test developer or
psychologist awareof theliteratureon individual differencesandtest scatter
wouldagreewithSiegel (1999)that, Oneassumptionbehindtheuseof IQtests
isthatthescorespredictandsetlimitsonacademicperformance, sothatif aperson
hasalowIQscore, weshouldnot expect muchfromhimor her inthewayof
academicskills (p. 311, our italics).
4. Thediverseauthorsseemtobeabandoningtheconcept of SLDaltogether, in
favor of an approach that lumps all low-achieving students into a single
package, without regard to thepresenceof neuropsychological intactness in
unaffected domains. This implicit notion of discrepancy (i.e., that the low
achievement in aspecic academicareasuchasreadingdecoding whichis
linkedtoacognitivedecit, suchasinphonological processing isinconsistent
with measured integrities in other cognitiveprocesses) is absent fromthese
authorsapproaches.Forexample, Siegel (1999)discussesidenticationof SLDs
intermsof what cut-off touseonachievement tests, withnoconsiderationof
intra-individual differencesin cognitiveprocessesor academic skills. Shedis-
cussesthemeritsof identifyingasSLDall studentswhoscorebelowthe25th
percentile, but notesthat the20thor 15thpercentilesmight alsobeacceptable
cut-off criteria. She acknowledges that there are some exclusionary criteria,
namely, rulingout inadequateeducation, sensorydecits, seriousneurologi-
cal disorders, and social/ emotional difculties as causes of low academic
achievement. Yet, thoughsheperceivestheseexclusionarycriteriaasreason-
able (p. 311), she is not convinced that they are necessary. She endorses a
decit model that has no room for systematic evaluation of exclusionary
criteria or for the need to demonstrate the students neuropsychological,
cognitive, or academicintactness.
Wecanagreewiththesuggestiontoabandonthepsychometric, formulaic
IQachievement discrepancy, but not with theeliminationof theconceptual
notion of a discrepancy as one of the hallmarks of any denition of SLD.
Certainly, theneedfor anotablediscrepancybetweenabilityandachievement
isspelledoutclearlyintheIndividual withDisabilitiesEducationAct(IDEA)of
1997(PL 105-17) guidelinesandinDSM-IV(AmericanPsychiatricAssociation,
1994) criteriafor ReadingDisorder (no. 315.00) andother SLDs. Eliminating
theuseof arigidformulaisdefensible; eliminatingthediscrepancyconcept is
not.
The IQachievement discrepancy
DoweneedtohavetheIQachievement discrepancyasanaspect of theSLD
denition?FromShepherdsperspective(Chapter 1), thediscrepancyistangen-
tial, perhapsirrelevant, to thepractical task of placingchildrenin thespecial
educationcategorynamedspeciclearningdisability. Fromher ownclinical
experiences and the experiences of others, data are often put aside when
diagnosticdecisionsaremade, supplantedbypractical factorssuchasavailable
resourcesandtheneedsof adults(usuallyparentsandteachers). Fromrecent
researchthatShepherdcites(MacMillan&Speece, 1999), heranecdotal impres-
sionsof thewaydecisionsaremadeconformtotheresultsof empirical studyof
thedilemma. MacMillanandSpeece(1999) reviewedthreestudiesconducted
after PL 94-142 was enacted and reported that more than half of the SLD
students in each study did not meet relevant diagnostic criteria; these re-
searchersconcludedthattheappropriatetestsweregivenprimarilytoconform
to legal requirements, but that the data were not systematically used for
differential diagnosis. Indeed, lowachievementwasgenerallythehallmarkof a
diagnosisof SLD, apart fromthesizeof thediscrepancyor theindividualsIQ
level (verylowIQswereoftenacceptablefor anSLDdiagnosisbecausesucha
diagnosisisdeemedtobemoreoptimisticthanadiagnosisof mental retarda-
tion).
What a waste! Why bother having trained psychologists to administer
90-minuteIQ tests and haveother professionals administer time-consuming
achievement, adaptivebehavior, or processingtests, if thesemeasuresarejust
givenso theprofessionalscan cover their own backs?Onedoesnot needto
weighthecarefullyreasoned(thoughoccasionallyawed) argumentsof Siegel
(1999), Stanovich (1999), or Vellutino et al. (2000) against the use of the
IQachievement discrepancy for SLD diagnosis. Their attacks on IQ tests,
however motivated, arefar lessimpressiveevidencefor abandoningtheIQ
achievementdiscrepancythanaretheapparenteverydayrealitiesof differential
diagnosis. The discrepancy is often not used when diagnosing SLD, even
though thepertinent test dataareinvariably obtained. Given therealitiesof
clinical practice, at least in schools, why not delete the IQachievement
discrepancyfromthedenitionof SLD?
As test authors ourselves, that intuitive decision makes sense. Indeed,
one of the reasons that we separated intelligence fromachievement when
we constructed the Kaufman Assessment Battery for Children (K-ABC;
Kaufman&Kaufman, 1983) wasbecauseof our deep-seatedbelief that Wech-
slersVerbal IQwastoosimilar conceptuallytoconventional testsof achieve-
menttopermitmeaningful discrepanciestobeobtainedfor SLDdiagnosis. We
havenoproblemgoingonestepfurther andsupportingtheeliminationof the
IQachievement discrepancy fromfederal andstateguidelinesfor SLD diag-
nosis; andwearenot theonlytestauthorstoendorsethisnotion. InChapter3,
Mather andWoodcock, authorsof theWoodcockJohnsonTestsof Cognitive
AbilityRevised (WJR) and WoodcockJohnson Tests of Cognitive Ability,
Third Edition (WJ III), state, Although a signicant cognitive decit can
contribute to the development of an aptitudeachievement discrepancy, a
learningor readingdisabilityshouldnot bedenedasadiscrepancybetween
aptitude and achievement (p. 76). Naglieri (Chapter 5), co-author of the
Cognitive Assessment System(CAS), minimizes the importance of the IQ
achievement discrepancy, tracingits emergenceto thefact that thepopular
Wechsler scalesweredesignedaccordingtotheg concept, not fromanytype
of processing model, providing an easy and convenient way to measure
discrepancies.
But the ease of computing discrepancies is deceiving. Intelligence tests,
includingWechslers, werenot built tobeusedinmathematical formulasor in
conjunctionwithrigidcut-off pointsto determineeligibilityfor SLD, mental
retardation, or gifted placements. Francis Galton (1869, 1883), half-cousin of
CharlesDarwin, wasstrictly ascientist, andattemptedto developan intelli-
gencetest that wasaccuratetothenearest tenthof apoint. Thoughhisreliable
measureswereinuential inshapingtheworld-wideassessmentof intelligence
at theturn of thetwentiethcentury, later studiesof hissensory, motor, and
reaction-timetasks challenged their validity as measures of the elusivecon-
struct(Kaufman, 2000). Enter AlfredBinet(1903), whoinsistedthatanythingas
complexashumanintelligencedemandedcomplextasksfor itsmeasurement.
AsFeuersteinandFeuerstein(Chapter 7) explainintheir fascinatinghistorical
account of thepsychometric measurement of intelligence, Binet wasindeed
inuencedbyBroca, andstudiedskull measurementsandbelievedthat neither
etiologynor futurepredictionswerepertinentwhenassessingmental abilityin
thepresent, andthattestperformancecouldnotbereducedtoalinearmeasure
likelength. Also, as theFeuersteinsalso point out, Binetsmajor theoretical
breakthroughwasinhisinsight that chronological ageissystematicallyrelated
to performanceonmental tasks. However, attentionalso needstobepaidto
another of Binetsmentors: theEnglishphilosopher JohnStuart Mill. ToBinet
(1903), Mill washisonly teacher of psychology (p. 68). Mill (1875) claimed,
Thescienceof humannature. . . fallsfar short of thestandardof exactness
nowrealizedinAstronomy (p. 432), andthatbecameBinetsguidingprinciple.
Byusingcomplextaskstomeasureintelligence, Binet andSimongaveusthe
rst modern intelligencetest in 1905. Yet, to us, Binetsbiggest contribution
was his Mill-inspired insistencethat onemust bewillingto accept acertain
degreeof measurement error inorder toevaluatehumanintelligence.
The acceptance of error as a necessary prerequisite for measuring IQ,
embracedbyDavidWechsler, oneof therst psychologiststo administer the
1916StanfordBinet inhisroleasarmypsychologist duringWorldWar I, has
persistedfromonecenturytothenextandcontinuesintothenewmillennium.
Error isafact of assessmentlife, afundamental tenet of apsychologistsclinical
training, and antagonistic to the use of any discrepancy formulas or cut-off
points. Factor intheerrorsof measurement intheachievement test, andone
must contend with two sets of errors instead of onewhen interpretingIQ
achievement discrepancies, forcingthemeasurement errorstomultiply.
Onedoesnot havetobeaspecial educator or learningdisabilitiesspecialist
tocriticizethepsychologiststools. Wehavehistorical reasonstoacknowledge
evenembrace their limitations. OnedoesnotneedtoreadSiegels(1999)or
Stanovichs(1999) criticisms of IQ tests to discover that thesemeasures are
imperfect. Thesetestsdohaveerror; differentdiagnosticresultsarelikelytobe
obtainedif differentinstrumentsareusedor if differentIQs(WechslersVerbal,
Performance, or Full ScaleIQ) areappliedinthediscrepancyformula; Verbal
tasksoverlapwiththecontent of achievement tests; processdecitsarejust as
likelytoimpair performanceonIQtestsasontestsof academicskills; neither
verbal nor nonverbal measuresof IQ arenecessarilybetter or morevalid(or
validatall)indicatorsof theintelligenceof anindividual withSLD; IQdoesnot
effectivelyprovideameasureof apersonspotential; andsoforth.
Thesearecriticismsof IQtests, yes, buttheyarecriticismsthatarebuiltinto
themeasurement of IQbyvirtueof Binetssensibleadoptionof Millsphilos-
ophy. Theyaregivens. TheyemergeasoffensiveproblemsprimarilywhenIQ
testsareusedinthewrongway, suchaswhentheyarepluggedintoformulas
thatarethenusedtomakeimportantlifedecisionsfor childrenandadults. The
real problemresidesinthefederal andstateguidelinesthat mandatetheuseof
theseformulas(evenif their useisillusoryinmanyreal-lifesituations). Astest
authors, wehaveattempted to provideinstrumentssuch as theK-ABC (see
LichtenbergersChapter 4) inaneffort tomakethecomparisonsof abilityand
achievement fairer for studentssuspectedof SLD. Other test authors, suchas
Mather and Woodcock (Chapter 3), have provided clever, innovative ap-
proaches to computing abilityachievement discrepancies, making use of
multipleregressionmethodologyto offer speciccomparisons(e.g., expected
achievement inwritingversuspredictedwritingachievement) insteadof com-
parisonsinvolvingglobal measuresof IQ. Inthat sense, wehavebought into
the notion of the IQachievement discrepancy. But that purchase is really
nothingmorethananacceptanceof thereal-worldfactsof liferegardingthe
practical applicationof federal andstatediagnosticguidelines.
Can we discard the notion of computing formula-based IQachievement
discrepancies when assessing children, adolescents, or adults for SLD? In a
heartbeat. Doesthediscrepancyhavetobeincludedaspart of thedenitionof
SLD?Absolutelynot. Doweendorsetheremoval of theIQtest fromtheSLD
assessment process?Not so fast. That iswherewedivergedramaticallyfrom
Siegel, Stanovich, andothers, whowouldclickonbackspace todeleteIQtests
fromSLDassessment.
These tests have multiple applications for SLD evaluations, even if the
anti-IQ rebels succeed in removingthemandatory IQachievement discrep-
ancyfromSLDguidelinesspeciedbytheIndividualswithDisabilitiesEduca-
tion Act (IDEA) of 1997 (PL 105-17) and DSM-IV (American Psychiatric
Association, 1994) criteria. IQ and related tests have key applications in the
diagnostic process, as part of the search for the persons spared neuro-
psychological assets (in thefaceof specic academic decits), as part of the
understandingof eachreferredindividualsuniqueproleof strongandweak
cognitive abilities, as part of the quest for process decits that can lead to
academicproblems, andaspart of thecrucial jobof remediation. Indeed, the
authorsof thechaptersin therst threepartsof thisbook havemadethese
points abundantly clear concerning the intelligent use of Wechslers scales
(Chapter 2), comprehensive cognitive (usually theory-based) alternatives to
Wechslersscales(Chapters3, 4, 5, and6), theevaluationof learningpropensity
and learningability (Chapters 7and 12), thethorough measurement of lan-
guageabilities(Chapter 8), andin-depthneuropsychological assessment(Chap-
ters9, 10, and11).
IQ test "Wechsler test
Despite their continued, widespread popularity for the psychoeducational
assessmentof SLD, theWechsler IntelligenceScalefor ChildrenThirdEdition
(WISCIII; Wechsler, 1991) andWechsler Adult IntelligenceScaleThirdEdi-
tion(WAISIII; Wechsler, 1997) arenot theonlyintelligencetestsavailableto
professionals. Thesetests havean impressivetradition and research history,
with an abundance of published empirical research conducted with SLD
populations(seeGroth-Marnat, Chapter 2). Wechsler didnot, however, devel-
op his scales fromany theoretical base, relying instead on the selection of
intellectual tasks that were already developed to meet practical needs. His
Verbal tasks had their roots in the Army Alpha Test, essentially a group-
administeredBinet Scaleconstructedtotest recruitsandofcersduringWorld
War I. His Performancesubtests also had their roots in World War I, with
Wechslerselectingsubtestsfromthenonverbal group-administeredArmyBeta
andfromtheindividuallyadministeredArmyPerformanceScaleExamination.
Thelatter test wasdeveloped, To proveconclusivelythat amanwasweak-
mindedandnot merelyindifferent or malingering (Yoakum& Yerkes, 1920,
p. 10).
TheArmyPerformanceScaleExaminationbearsastrikingresemblanceto
present-day Wechsler Performancescales. Because the borrowed nonverbal
subtestsweredevelopedfor thelowendof theIQspectrum, ratherthanfor use
intheselectionof ofcers, therewasno emphasisonconstructinghigh-level
thinkingtasksthattappedintoPiagetsformal operational thought. Thislackof
top on the Performance subtests was easily solved psychometrically by
Wechsler: all he had to do to maintain the reliability of the subtests for
adolescents and adults was to add several bonus points for quick perfect
performanceonnumerousnonverbal items. Theadditionof bonuspointsfor
speedalsoenabledmeantest scorestoincreasefromchildhoodtoadolescence
andyoungadulthood; otherwise, meanrawscorestendedtoplateauat about
theageof11or12years.Thoseagescorrespondtotheonsetof Piagetsstageof
formal operations (Inhelder & Piaget, 1958; Piaget, 1972), and also to the
developmentof theprefrontal cortexof thefrontal lobe(Golden, 1981), which
islargelyresponsiblefor theplanningfunctionsthat characterizeLurias(1973,
1980) Block 3(seeNaglierisdiscussioninChapter 5). Therefore, becausethe
precursor of Wechslers Performance Scale was developed froma practical
rather thanfromatheoretical foundationandfor thelower endof theability
spectrum, theabstract formal operational skillsfromPiagetscognitivedevel-
opmental framework and the highly similar planning abilities fromLurias
neuropsychological perspectivewereunintentionallyslighted. Yet, Luriasno-
tionof planningability, involvingdecision-making, evaluationof hypotheses,
andexibility, representsthehighest levelsof developmentof themammalian
brain (Golden, 1981, p. 285).
Furthermore, thearrayof PerformancesubtestsselectedbyWechsler for his
original WechslerBellevue(Wechsler, 1939) andcontinuedinhispresent-day
test batterieshaveadecidedemphasison visualspatial abilities, givinglittle
weighttothekindsof reasoningandproblem-solvingabilitiesthat characterize
Horns(1989) denitionof uidintelligenceinhisexpansionandrenementof
the HornCattell GfGc theory (Horn & Hofer, 1992; Horn & Noll, 1997).
Whether thePerformanceScalemeasuresuidintelligencetoacertainextent
(Horn&Hofer, 1992; Kaufman, 1994)or not at all (Woodcock, 1990; Flanagan
& McGrew, 1997) is open to debate, but it is quiteevident that Wechslers
scalesemphasizevisualspatial skills, visualmotor coordination, andvisual
motor speedtoafar greater extent thantheystressgeneral reasoning, andfall
short of assessingtheabstract abilitiesthat aresoimportant tothetheoriesof
Piaget andLuria. Theadditionof MatrixReasoningto theWAISIII wasan
attempttoremedythesituation thistaskmeasuresthetypeof uidreasoning
that Horn considers a prototype of uid intelligence, does not depend on
coordination, anditsitemsareuntimed but that onetask doesnot alter the
overall picturesubstantially.
Consider Siegels(1999) criticismthat IQtestsfail to measurereasoningor
problem-solvingskills. If onedepartsfromtheWechsler systemandexamines
theavailablewell-constructed, well-designed, theory-driventest batteries(both
cognitiveandneuropsychological),onendsanabundanceof scalesor subtests
that measure the kinds of abilities that Horn would classify as uid and
Piagetians would consider dependent on formal operational thought. The
WoodcockJohnsonTestsof CognitiveAbility-Revised(WJR) andWJ III (see
Mather & Woodcock, Chapter 3), developed fromHorns expanded theory
(nowreferredtobythetestauthorsastheCattellHornCarroll (CHC)theory
of cognitiveabilities), includeaFluidReasoningcluster, featuringthesubtests
AnalysisSynthesis and Concept Formation. The Kaufman Adolescent and
Adult IntelligenceTest (KAIT), whosetheoretical rootsencompassthemodels
of Luria, Piaget, andHornCattell (seeLichtenberger, Chapter 4), containsa
FluidScale; theMysteryCodesandLogical Stepssubtestsareespeciallygood
measures of uid/ planning ability. Similarly, the two-subtest British Ability
Scales(BAS) II Nonverbal ReasoningAbility First-Order Composite(andthe
highly similar Differential Ability Scales (DAS) Nonverbal ReasoningAbility
Scale) is an excellent measure of Horns uid reasoning ability. Naglieris
(Chapter5)Luria-basedCASincludesaPlanningScaleintendedtomeasurethe
skills associated with Block 3, and the Developmental Neuropsychological
Assessment (NEPSY), also built fromaLuriaframework, includeswithinthe
domain of Attention/ ExecutiveFunctions the Tower subtest, a measure of
planningability and rule-based problem-solvingperformance(seeKorkman,
Kemp, & Kirk, Chapter 11). The Category Test, fromthe HalsteadReitan
Neuropsychological TestBattery(seeReitan&Wolfson, Chapter10), isalsoan
excellent measureof uidor planningability.
InadditiontotheWechsler tests shortageof high-level reasoningtasks, the
channels of communication measured by the various Wechsler subtests fall
into oneof only two categories: auditoryvocal (Verbal subtests) andvisual
motor (Performance subtests). These are important channels, but clinicians
whoevaluateindividualssuspectedof SLDwill oftenbenetbyassessingother
channels of communication. For example, the K-ABC includes subtests for
school-agechildrenwithintheauditorymotor channel (WordOrder) andthe
visualvocal channel (Gestalt Closure, Faces & Places) as well as the two
channelsmeasuredbyWechslersscales(seeLichtenberger, Chapter 4). Simi-
larly, the WJR (see Mather & Woodcock, Chapter 3) includes two visual
vocal subtests (Picture Vocabulary, Visual Closure) and the CAS (Naglieri,
Chapter 5) includesanauditorymotor subtest, VerbalSpatial Relations. The
NEPSY (Korkmanet al., Chapter 11) containstheauditorymotor subtestsof
AuditoryAttentionandResponseSet andComprehensionof Instructions, as
well asthevisualvocal subtest of SpeededNaming.
These comments about selected advantages of theory-based tests over
Wechslersscalesareillustrative, not exhaustive, andareintendedto empha-
sizethenotionthatthenewbreedof testsdevelopedinthe1980sand1990sare
notclonesof theWechslerscales, butoffer avarietyof advantagestoclinicians,
includingthosewhoevaluateindividualswithsuspectedor knownSLD. There
isnointentiontodemeantheWISCIII andWAISIII or tominimizethevalue
of therich empirical and clinical histories that haveaccompanied thewide-
spreaduseof Wechslerstest batteriesfor morethan60years. But thetimehas
comefor professionalsto becomeuent with thenewwaveof instruments,
such that psychologists weigh alternativeoptions carefully before automati-
callychoosingaWechsler scalefor inclusionintheir assessment battery and
special educators, likewise, consider diversealternativesbeforeuncompromis-
ingly recommendingthedeletion of IQ tests frompsychoeducational evalu-
ations.
WhereasWechslerstestsreignsupremeintheUSA, that circumstancedoes
not necessarily characterizetherest of theworld. In Germany andGerman-
speaking countries, for example, the German KABC is the number one
childrenstest for psychoeducational, clinical, andneuropsychological assess-
ment, relegatingtheGerman WISCR to therunner-up position (Melchers,
1999). IntheUK, accordingto BASII andDASauthor C.D. Elliott (personal
communication, December 10, 1999), theWISCIII andBASII areprobably
runningeachotherclose. MyfeelingisthatBASandBASII havebeenpreferred
for most large-scaleresearchstudiesintheUK.
Misconceptions about the IQ construct
Siegels(1999)claimthatIQisbelievedtosetlimitsonacademicachievementis
notvalid. IQisknowntobeagoodpredictorof academicachievement, butitis
not agreat predictor. Coefcientsof correlationinthe.50sand.60saremost
commonfor global measuresof intelligence, withvaluespeakingat about .70
(seeNaglierisdiscussionof pertinent researchinChapter 5, pp. 1534). These
are good relationships, strong enough to support the predictive validity of
diverseintelligencetests. But themagnitudeof thesewell-knownrelationships
meansthat onlyabout25%to50%of achievementtest scorevarianceoverlaps
withIQvariance. If IQcanbesaidtoaccountfor aboutone-quarter toone-half
of thevarianceinachievementtest scores, thatmeansthat uptothree-quarters
of thevarianceinachievement scoresisdueto factorsother thanIQ, suchas
motivation, qualityof teaching, parental involvement, perseverance, andplain
old error. But we are talking about the IQs ability to predict scores on
standardizedtestsof achievement not exactly thesamethingaspredicting
school grades. CorrelationsbetweenIQandachievement testsaresometimes
spuriouslyhighbecauseof overlapincontent(e.g., WechslersInformationand
Arithmetic subtests) and because of test-taking ability. Coefcients with
teachers grades are usually notably lower, sometimes in the .20s or .30s.
Althoughthelatter ndingmight relatetotheunreliabilityandsubjectivityof
thecriterion (i.e., teachers evaluationsof students work), therelevant con-
clusion fromtherich body of empirical research relatingglobal and specic
scores on IQ tests to achievement is that most of thevariability in academic
achievement isduetofactorsother thanIQ. That soberingresearch-basednding
makes it ridiculous to claimthat IQ is believed to limit students academic
achievement. Furthermore, thevast bodyof researchontest scatter thatbegan
to accumulate in the mid-1970s (Kaufman, 1979, 1994) indicates that it is
common, for normal aswell asfor SLDandother exceptional individuals, to
differ widelyintheir test scoresondifferent cognitivetasks. Largedifferences
amongcognitiveandacademicskill areasarethenorm, not theexception. It is
unreasonabletoexpect that IQs, inwhatever rangeof ability, wouldset limits
onacademicachievement. Abilitiesandacademicskillswill differ, witheither
one higher than the other, simply because scatter is a built-in aspect of
cognition and because IQ (as well as subscores on IQ tests) accounts for a
minorityof thevarianceindeterminingonesacademicachievement.
Stanovich (1999) states that, Intelligence has played a major role in the
conceptual muddlesurroundingthenotionof readingfailure. Theconfusion
arisesbecauseit makesnosensetosaythat lowintelligence. . . causesreading
difculties, givenwhat iscurrentlyknownabout readingdisabilities (p. 352).
Why implicateintelligencefor this misconception?Thewholenotion of IQ
causingreadingdifcultiescertainly doesnot comefromthosewho develop
intelligencetests or frompsychologists who research these tests. The same
argumentsappliedpreviouslytotherelationshipbetweenIQandachievement
applyhereaswell. Obviously, if IQaccountsfor half or lessof thevariancein
academicachievement, thenother variablesareevenmoreimportant, collec-
tively, inpredictingeither readingsuccessor readingfailure. Wheredo these
causation accusations come from? They do not even make sense from a
traditional readingdisabilitydenition. Thewholenotionof usingIQachieve-
ment discrepanciesfor identifyingindividualswithreadingdisabilities, aprac-
ticethatStanovichdecries, ispredicated(rightlyor wrongly)onthenotionthat
IQdoesnot predictreadingability. That istosay, whenlookingfor adiscrepancy
asameansof identifyingreading-disabledchildren, oneisseekingto identify
those individuals whose reading difculties are specically not predicted by
their IQs otherwisetherewouldbenodiscrepancy. Attheveryleast, it seems
thatitisthereasoningof thosewhoadvocatethenotionthatIQcausesreading
difculties that is creating the conceptual muddle referred to by Stanovich.
Blaming the concept of intelligence directly, and IQ tests indirectly, is not
sensible.
Siegel (1999), Stanovich(1999), andVellutinoet al. (2000) all citeaplethora
of research that relatesIQ to variousreading-relatedtasks, readingdecoding
(and occasionally comprehension) tasks, processing mechanisms accounting
for word recognition problems, ability to benet fromremediation, and the
like. Invariably, theresultsof thesestudiesshowthat IQdoesnot distinguish
betweengroupsthat it issupposedto discriminate. However, eachof these
studiesreportedbytheresearchersdealswithIQasif theconstruct isnothing
morethang or general intelligence. It istruethat Wechsler, himself, wasag
theorist, even though he provided three IQs and a multi-subtest prole of
scaledscores. But hisscaleshavebeen interpretedfromavariety of theories
(see Groth-Marnat, Chapter 2; Kaufman, 1994; Kaufman & Lichtenberger,
1999, 2000) that extendhisscoresandsubscoreswell beyondgeneral ability.
Once again, Wechslers scales do not dene IQ measurement. Would the
varioussubgroupsstudiedbyVellutinoet al. (2000), for example, havediffered
onother IQ-relatedconstructs, evenif theydidnot differ onglobal IQ(or on
Verbal IQor onPerformanceIQ)?MighttheyhavedifferedontheAttentionor
PlanningScalesontheCAS(Naglieri, Chapter 5)?OntheAttention/ Executive
Functionscluster ontheNEPSY (Korkmanet al., Chapter 11)?Intheir cogni-
tivemodiability(Feuerstein&Feuerstein, Chapter7)?IntheirK-ABCSequen-
tialSimultaneousdiscrepancy or KAIT FluidCrystallizeddiscrepancy (Lich-
tenberger, Chapter 4)?In their BASII or DASNonverbal ReasoningAbility
Verbal Abilitydifference(Elliott, Chapter 7)?Onanyof thesevenHorn-based
clustersthatcomprisetheWJRor WJ III Testsof CognitiveAbility(Mather &
Woodcock, Chapter 3)?Onnewandforthcomingneuropsychologicallybased
instrumentsthat aredesignedtogobeyondconventional prolesof scoreson
IQtests, suchastheWISCIII asaProcessInstrument (WISCIII PI) or the
DelisKaplanTest of ExecutiveFunctions?
Furthermore, the empirical research that relates IQ to various reading-
relatedtasksandtoremedial progressoftentreatsreadingdisabilityasif it, too,
isaglobal construct. Yet, theneuropsychological researchondifferent reading
subtypes, asdiscussedandinsightfullyinterpretedby Spreen(Chapter 9) and
ReitanandWolfson(Chapter 10), cannot simplybeignoredor brushedaside.
Different resultsmight havebeenobtainedintheSiegelStanovichVellutino
researchstudieshaddatabeenanalyzedfor homogeneoussubtypesof reading-
disabledchildreninsteadof for heterogeneoussamples.
SummarilydismissingIQ testsfromtheSLD psychoeducational diagnostic
and assessment process becauseglobal IQ, Wechslersor otherwise, did not
effectively discriminate on reading tasks or ability to be remediated is not
reasonable. Testsbuilt upontheoriessuchasHornsor Lurias that placeno
stockatall intheg conceptprovidefertilegroundfor newempirical research
with SLD children (such as the exciting intervention research discussed by
Naglieri, Chapter 5, with the CAS). These new tests should not merely be
includedaspart of themassburial infertilegroundthat isadvocatedbythose
who areprimarily interestedin eliminatingtheIQachievement discrepancy
fromtheSLDdenition.
Discrepancy versus decit models
The decit models for identifying individuals with SLD, proposed either
explicitlyor implicitly by Siegel (1999), Stanovich(1999), andVellutino et al.
(2000), deviatefromacceptedguidelinesfor SLD, specicallytheonesspecied
bytheIndividualswithDisabilitiesEducationAct (IDEA) of 1997(PL 105-17)
andDSM-IV(AmericanPsychiatricAssociation,1994). AsShepherd(Chapter1)
indicates, theseguidelinesgivelatitudeto stateeducation agenciesandlocal
school districts, but that latitudeisnot sogreat that onecansummarilydismiss
thenotionof adiscrepancyfromthedenitionof SLD. Of course, theauthors
who are arguing for a decit model that neatly eliminates IQ and other
cognitivetestsfromtheequationareall leadersintheSLD eldandarewell
aware of the guidelines. Their hope, apparently, is to change conventional
thinkingaboutSLDandconvertthedenitionfromfocusingondiscrepancyto
dealingsolelywithspecicachievement decits.
Oneof their major argumentsfor emphasizingdecitsinsteadof discrepan-
ciesisthesameastheir mainjusticationfor trashingIQtests, namely, their
documentation of an accumulation of research on children with reading
disordersthat hasdemonstratednodifferencesinthesestudents performance
onreading-relatedtasks(suchasphonological processing), regardlessof their
IQs. StudentswithreadingproblemswhoseIQsaresubstantiallyhigher than
their reading scores perform no differently on tests such as phonological
processing than do reading-disordered students whose IQs are similar in
magnitudeto their readingscores. Thefailureof IQ level to differentiatethe
performanceof reading-disorderedsampleson cognitiveprocessingtests, on
other psychometric measures, on remedial gains, and so forth, may have
reasonable explanations, as already mentioned. There is more to IQ than
Wechslersnotion of IQ andthereismoreto intelligencethan global intelli-
gence.
Butsupposeweignorethefactorsthatpotentiallycontaminatetheresultsof
many of the readingstudies the authors cite and, instead, accept their con-
clusions about reading disability as valid: all poor readers have the same
cognitivedecit, regardlessof their IQlevel andindependentof thesizeof their
IQachievement discrepancy. That nding, more than any other, seems to
haveimpelledSiegel (1999) andStanovich(1999) to react so negativelyto IQ
testsandtothenecessityof anIQachievementdiscrepancyfor SLDdiagnosis.
Yet, that ndingisneither astoundingnor acompellingreasonto abandona
discrepancymodel of SLDinfavor of adecit model. Wequotesomesalient
pointsfromaletter wereceivedfromM.J. Shepherd
1
(personal communica-
tion, October 14, 1999):
Siegel and Stanovichs claimthat phonological reading disability occurs at all IQlevels is de ja` vu all
over again Cruikshank, Kephart et al. claimed that specic learning disability (meaning visual
perceptual decit) occurred at all IQ levels . . . If we accept the hypothesis that mental activity is
specic(unique) to the task being performed it makes sense that all children having difcultywith
a particular task (word recognition and spelling) will have similar cognitive decits. This means (to
me) that we will not achieve a full understanding of specic learning disabilities by looking at
decits alone. In neuropsychological terms we have to document the cognitive traits that have
been spared. This is the point that Stanovich and Siegel arent making because (a) they insist on
working with a limited conception of reading (word recognition) and/or (b) they have a political
agenda protect the poor against the rich.
Thecuriousequatingof readingability to readingdecodingby Siegel and
Stanovich, with only lip service paid to reading comprehension, may have
inuencedtheoutcomeof many of thestudiescited. Comprehension, much
more so than decoding, requires the reasoning and complex thinking skills
associated with higher levels of intelligence. Furthermore, Spreens review
(Chapter 9) of the fascinating neurological literatureon the use of positron
emissiontomography(PET), singlephotonemissioncomputerizedtomogra-
phy (SPECT), functional magnetic resonanceimaging(fMRI), evokedpoten-
tial, and other techniques demonstratesthat neurological functioningdiffers
substantiallywiththetypeof readingtask, forexamplephonological processing
versus lexicalsemantic processing (see Spreens History section, especially
thesubsectionentitledFunctional abnormalities, plushisTables9.1and9.2
andFigures9.4and9.5).
However, evenif theresultsof thevariousresearchstudiescitedbySiegel
(1999) and Stanovich (1999), or conducted by Vellutino et al. (2000), are
replicatedwithmeasuresof readingcomprehension(or mathcomputation, or
mathapplications), suchndingswouldnot eliminatetheneedtoidentifythe
individualsneuropsychological integritiesinthefaceof thespecicacademic
decit. If everyonewithagivenSLDdisplaysthesamecognitivedecit, thenit
becomes even more important to identify each persons specic cognitive
strengthsto facilitateabetter understandingof thedisabilityandof themost
appropriatewaystodevelopinterventionplans.
Comprehensivecognitiveandacademicassessment, inaddition, allowsthe
examiner to understand the individuals array of strengths and weaknesses,
aidingintheessential taskof identifyingthespeciccognitivedecitsthat are
causally linked to specic academic decits. The identication of cognitive
competenciesalso permitsthedeterminationof whether theindividual hasa
meaningful discrepancy between ability and achievement (based on profes-
sional judgment in interpretingtheproleof cognitiveandacademic scores,
not onformulas) toestablishthepresenceof aSLD. Regardlessof theaccumu-
latedresearchonreadingdecodingandthepossibleirrelevanceof global IQfor
distinguishing among groups of poor readers, the concept of one or more
academic decits in the face of cognitive integrities i.e., the notion of a
discrepancy remainsthecornerstoneof theIDEAandDSM-IVdenitionsof
SLDandislogicallynecessaryfor SLDtoretainaviablecategorization.
The neurological, neuropsychological, neurophysiological, and neuro-
anatomical variables that distinguish SLD individuals fromcontrol samples
havebeenamplydocumentedbytheresearchstudiescitedbySpreen(Chapter
9), Reitan and Wolfson (Chapter 10), and other chapter authors. As Spreen
aptlystates, Theneurological basisisnolonger presumed, althoughit isnot
alwaysconrmed, andlessspecicthanwewouldlikeit tobe (p. 301). Reitan
and Wolfsons reports of research on their HalsteadReitan and related
measures, suggest that acomprehensivebatteryof neuropsychological tests,
validatedindividuallyandasabatteryfor their sensitivity to cerebral impair-
ment, may serve to identify children who have brain-based problems of
learningdisabilitiesthat theyareunlikelytooutgrowthroughnormal matura-
tion, andwho thereforearein needof individual remediation andcognitive
retraining (p. 343). Researchsupportsabiological basisforSLD, adisorderthat
involves cognitiveintegrities as well as deciencies, one that should not be
confused(or lumpedtogether)withsimplereadingor mathdecits. However,
onedoesnot needtheextensiveresearchdocumentationthat dominatesthe
literature and is summarized in this book to conclude that SLD is a real
category. OnecansimplyreadHinshelwoodsoriginal documentationof word
blindnessin 1917or theevenearlier observationsof PringleMorganin1896
(both discussed in some depth by Shepherd in Chapter 1and by Spreen in
Chapter 9) to realizethat SLDsareadiscretedisorder. FromMorgansearly
paper, theheadmastersstatement about Percy, the14year oldunabletoread,
would apply to any number of children throughout history with SLDs: he
would be the smartest lad in school if the instruction were entirely oral
(Shepherd, Chapter 1, p. 19).
Fromahumanisticstandpoint, onecannotarguewithSiegels(1999)dissatis-
factionwithguidelinesthat denyvariouslow-achievingstudentstheaccom-
modationsthat areavailabletostudentswithalearningdisability (p. 311). Her
concern is shared by any layperson or professional who realizes theblatant
unfairness of alegal systemthat requires categorization and labelingbefore
funds are available to provide help that is obviously needed. But those are
differentissues. Theydonot speaktotheresearch-supportedandhistory-based
facts that SLD is a meaningful category, one that is different frommerely
havingdecitsthat areamenableto remediation, andthat themost effective
interventionfor individualswithSLDwill result fromakeenunderstandingof
thebiological basesof SLD, ingeneral, andfromknowledgeof eachindivid-
ualsspecicneuropsychological or psychological prole.
Applications of contemporary instruments for SLD assessment
The previous 12 chapters of this book are concerned, either explicitly or
implicitly(asintheFeuersteins discussionof cognitivemodiability), withthe
useof specictestsor assessment proceduresfor theevaluationof individuals
known or suspected to have SLD. These tests and procedures are typically
intended to accomplish the following goals: to identify the persons intra-
individual proleof assetsanddecits, tofacilitateabetterunderstandingof the
personscognitive/ neuropsychological functioningversusacademicfunction-
ing, toidentifythelinksbetweentheformer andthelatter typesof functioning,
andtotranslatetest prolestoeducational intervention.
If standardizedtestsaregivenduringSLD evaluationsprimarilyto comply
with federally or state-mandated rules, but thedataareswept into acorner
while decisions are made on other bases, as indicated by MacMillan and
Speeces(1999) researchresultsandanecdotal sources(Shepherd, Chapter 1),
thenmuchtimeandenergyhavebeenwasted. Thetimehascometo release
professionalsfromtheburdenof usingpsychometricinstrumentsfor purposes
thatthetestauthorsnever intended,andinways(e.g., pluggingobtainedscores
into uncompromisingformulas) that defy acommon-senseunderstandingof
psychometrics. Forget theuseof an IQachievement discrepancy of agiven
magnitude (you are categorized as SLD in Illinois and Texas, but not in
MontanaandNewJersey),butdonotthrowawaytheconceptof adiscrepancy,
whichremainsacrucial ingredient tounderstandingSLDs.
If theneed for an IQachievement discrepancy of aspecic magnitudeis
eliminatedfromtheSLDdenition(but not theneedtoidentifytheneurologi-
cal or cognitiveintegritiesthathavebeenspared, despitethespecicacademic
decit or decits), that will freeexaminersto usetestsintelligently. Therst
positiveconsequencewill befor theexaminer tohavethefreedomtochoosea
test regardlessof what it iscalledor whether it isonsomeacceptable list of
intelligencetests. Thesecondwill befor professionalstobeabletoadminister
theabilitytestsbasedontrainingandexperiencerather thanontheir specic
label aspsychologist, learningdisabilitiesspecialist, andso forth, concerning
precisely who is qualied to givespecic IQ tests. Thethird positiveconse-
quence will be to allow approaches that are not mainstream and do not
necessarily meet specic psychometric guidelines to beused for SLD evalu-
ations; agoodexampleistheunstandardizedtestteachtest LearningPropen-
sityAssessment Device(LPAD) describedbyFeuersteinandFeuerstein(Chap-
ter 7), whichcanprovidevaluableinformationabout apersonspropensityfor
learningandresponsivenesstofeedback, if usedbyexaminerswithappropriate
training. Interestingly, theFeuersteinsdonot distinguishSLDfromother types
of disorders, but emphasize the same philosophy for virtually all cognitive
assessments:Thefocusis. . . onthemodiabilityof thecondition, rather than
theexistenceandscopeof thecondition. Inother words, doesthepropensity
for modiability (and change) exist and can it be brought to existence and
increased? (p. 227).
Theabilitytousetestsfor SLDevaluationsregardlessof theirtype becomes
ahugeadvantageto examinerswho otherwisemight routinely administer a
Wechsler scale. Certainly, Wechslersscalesprovideawealthof informationif
theyareinterpretedintelligentlyandnot just usedtoproduceIQs(seeGroth-
Marnat, Chapter 2; Kaufman, 1990, 1994; Kaufman & Lichtenberger, 2000).
However, examinersshouldhavethechoicetoadminister neuropsychological
tests instead, if that is their preference, such as the NEPSY (Chapter 11);
HalsteadReitan(Chapter 10); or atest of memoryandlearningability, suchas
the Test of Memory and Learning (TOMAL), Wide Range Assessment of
Memory and Learning (WRAML), or California Verbal Learning Test
Childrens Version (CVLT-C) (Chapter 12). Similarly, process-oriented tests
liketheK-ABC(Chapter 4)andCAS(Chapter 5) andability-orientedtestslike
theWJR/ WJ III TestsofCognitiveAbility(Chapter3), KAIT (Chapter4), DAS
(Chapter6), andBASII (Chapter6)canoffermuchinsightintoanindividuals
intellectual assetsanddecits, even if most of thesetestsavoidthetermIQ.
Additionally, if examinersarenot requiredblindly to administer aWechsler
scale, they will havethetimeto obtain afar morethorough evaluationof a
persons language abilities than is afforded by Wechslers Verbal Scale, by
administering one or more of the norm-referenced or criterion-referenced
languagetestsdevelopedand/ or describedbyWiig(Chapter 8).
Indeed, eventhelabel givento atest issometimesambiguousor, at least,
arguable. SamKirksIllinoisTest of PsycholinguisticAbilities(ITPA)cameout
in 1968, and, as Shepherd (Chapter 1) explained, he had this new type of
language test very much in mind when he was coming up with the label
learning disabilities at his now-famous 1963 talk. The test was new in its
theoretical model (Osgoodstheoryof communication), itschoiceof subtests,
itsnamesfor subtests, anditsmetrics(mean=36, SD=6!). But howdifferent
was his subtest Auditory Reception (Do carpenters kneel? Do barometers
congratulate?) from Wechslers Information or Vocabulary subtests? How
differentwashismeasureof Visual Association(pictureanalogies)fromWech-
slersPerceptual Organizationsubtests?Andhowdifferent, conceptually, was
his auditoryvocal versus visualmotor distinction fromWechslers Verbal
Performancediscrepancy?Onemight just aswell havecalledtheITPA anIQ
test or theWISC apsycholinguistic test. (For an interpretation of WISCIII
subtestsfromtheITPAmodel, seeKaufman, 1994, pp. 1568.) Boundariesare
similarlyfuzzywhenthinkingof theNEPSY asaneuropsychological test, but
theWJR/ WJ III Testsof CognitiveAbilityasameasureof cognitiveability. If
theIQachievement discrepancyisever eliminatedfromtheSLDdenition, a
goodnext stepwouldbetoeliminatearticial distinctionsbetweenthenames
of different typesof comprehensivetest batteriesthat all haveessentiallythe
samegoalsof providingaproleof apersonsstrengthsandweaknesses a
prolethat, it isto behoped, will facilitateunderstandingtherelationshipof
specicprocessdecitstospecicacademicdecits(i.e., identifyingthelearn-
ingdisability), andwill translatetorecommendationsfor educational interven-
tion.
Wedonot wishtorepeat informationpresentedineachof thecomponent
chaptersof thisbook, buturgereaderstointernalizeeachof theinstrumentsor
proceduresdescribedinthepreviousthreesections. Eachhasitsownunique-
ness, growingbodyof research, clinical value, andrelationshiptoSLDassess-
ment. ThechaptersontheWJR/ WJ III (Mather &Woodcock, Chapter 3)and
theCAS(Naglieri, Chapter 5), inparticular, deal extensivelywiththethorny
issue of IQachievement discrepancies as well as with the need to assess
cognitive process decits and link these weaknesses to specic academic
decits; bothof thesetopicsformanintegral part of thedenitionof SLD in
IDEA 1997. Most of thechapters on specic tests includeoneor morecase
studies to demonstrate the specic application of the test batteries to SLD
assessment, especially the translation of test scores to remedial suggestions.
Thecasestudiesof Leo(KAIT) andAbby(K-ABC) byLichtenberger (Chapter
4) serveasgoodillustrationsof theintelligent useof cognitivetests(including
the integration of data from numerous instruments, several of which are
discussedinthisbook) andtheimportanceof integratingdatafromcognitive
testswithstandardizedachievement testsfor SLDdiagnosis.
Even though most chapters discuss one or morespecic tests, examiners
shouldnot feel compelledtoadminister anentirecomprehensivetest battery.
Thatpracticeisnefor devoteesof aparticular testor approach, butitmaynot
suit examinerswhoareorientedtowardtheassessment of specicdomainsof
functioning, usingavarietyof carefullychosentestsor subteststhat together
constituteahand-pickedcomprehensivebattery. Thelatter kindof examiner
will ndadiversityof scalesandtaskstochoosefromintheprecedingpagesof
thisbook. InChapter 3, Mather andWoodcockreorganizedtheWJR/ WJ III
subtests(cognitiveandachievement)bydomainssuchasAttention, Language,
and Reasoning and Problem Solving. Similarly, we present Table 13.1
(pp. 4459), organized by thekinds of domains that arecommonly assessed
whenconduct-ingSLDevaluations, insteadof bytest battery. WhereasMather
andWoodcockspertinent domaintables are, naturally, limitedtoWJR/ WJ
III tasks, Table 13.1 includes subtests, scales, and complete tests that are
discussedinthechaptersinPartsI, II, andIII of thisbook.
Thedomainswechoseandthetestsineachcategoryreect our opinions,
andarelikely to differ to someextent fromtheopinionsof others; in some
cases, we differ fromMather and Woodcock in the categorization of their
subtests. That isneandnormal, becauseconsensusisrareinassessment. The
tableshouldbeconsideredasfoodfor thought andillustrativeof thekindsof
waysthat tasksfromdifferent batteries might beuniedinto new batteries,
uniqueto each examiner andperhapsuniquefor each individual testedby a
givenexaminer. Wehaveavoidedsomecategories(eventhoughtheyarehot
topics), such as working memory and executive functioning. The NEPSY
(Korkman et al., Chapter 11) includes an Attention/ Executive Functioning
domain, and theCAS(Naglieri, Chapter 5) includes Attention and Planning
scales all of whicharecloselyassociatedwithcurrent conceptionsof execu-
tive functioning. However, because many other subtests and scales from
diversetestsalsorequirekeyaspectsof executivefunctioning, wepreferredto
avoidclassifyingtestsintothiscomplexcategory. Thesamereasoningapplies
toworkingmemory: wepreferredtosticktoshort-termandlong-termmem-
ory. Yet, even here, therearedifferencesin how to interpret thesekinds of
memory. Fromsomeperspectives, anytypeof memorytask that takesmore
than15or 30secondsislong-termrather thanshort-termmemory. Mather and
Woodcock(Chapter 3) includetheir subtestsMemoryfor NamesandVisual
Auditory Memory, both paired-associatelearningtasks, on theWJR/ WJ III
Long-termMemorycluster. However, weprefer Horns(1989; Horn&Hofer,
1992)stipulationthatatleastsometimepreferablyhoursordayselapsefor a
taskto betrulyameasureof long-termmemory. Therefore, themeasuresof
long-termmemory that welist in Table13.1areall delayedrecall teststhat
incorporate some type of interference (administration of different tasks) in
betweenstimulusandresponse. (For acomprehensivediscussionof theneuro-
biologyof memoryanditsassessment, seeBigler andAdams, Chapter 12.)
Summary and conclusions
Theeldsof SLDassessment andIQtestingarebothcontroversial. Thesetwo
eldsintersectinthisbookaswell asinrecentarticlesappearingintheJournal of
LearningDisabilities(Siegel, 1999; Stanovich, 1999; Vellutinoet al., 2000). The
authorsof theserecent articlesareall critical of theuseof IQ tests, with all
proposingtheeliminationof theIQachievement discrepancyfromthedeni-
tionof SLD, andtwo(Siegel andStanovich)proposingthat IQtestsshouldnot
beusedfor SLD assessment at all. Wendawsinsomeof thereasoningof
these critics of IQ tests, most notably: (a) eliminating the IQachievement
discrepancydoesnot necessarilymeanthat it iswisetoeliminateIQtestsfrom
theSLDassessmentprocessaltogether;(b)theWechsler scalesarenottheonly
high-qualityIQ testsavailable; (c) theg approachto IQ that they indirectly
espousedoes not reect theapproach inherent in most modern theories of
intelligencesuchasHorns; and(d) theytendtofavor anachievement decit
model of SLDinsteadof amodel thatincorporatesthenecessityof demonstrat-
ingspared neuropsychological integritiesdespitespecicacademicfailure.
We have addressed these four reasoning aws in some depth from a
perspectivethat embracesboththeeducational andtheneurological histories
of SLD andthat emphasizesthemany assessment alternativesto Wechslers
scalesthat haverecently becomeavailableasweenter thenewmillennium.
We believe that it is feasible to eliminate the strict, formulaic use of an
IQachievement discrepancy for the determination of SLD, but that it is
essential toretainadenitionof SLDthat includesthenotionof discrepancy.
That istosay, thereisalonghistorical precedent, alongwithanabundanceof
neurological andneuropsychological research, tosupport theconceptual de-
nitionof SLDasanacademicdecit (presumablylinkedtoaspeciccognitive
process or neuropsychological decit) that occurs despite the simultaneous
presence of spared neurological and cognitive skills. The IQachievement
discrepancy isexpendable, especially in viewof empirical andanecdotal evi-
dencethat strongly suggestsablatant disregardfor such discrepancieswhen
practitionersmaketheir diagnosesof SLD state-mandatedandfederal guide-
linesnotwithstanding. But theuseof intelligence, neuropsychological process-
ing, learningpropensity, andother instrumentsintheSLDassessment process
isnot expendable. Indeed, thechaptersin thisbook present astate-of-the-art
tableauof thenewwaveof theory-basedandclinicallyderivedinstrumentsthat
showexceptional promisefor thediagnosisandremediationof SLD. Someof
theseinstruments (e.g., WJR/ WJ III, K-ABC, CAS, BASII, NEPSY) can be
used as comprehensive test batteries to serve as alternatives to Wechslers
scales, whereas others (such as tests of language, memory, learning, and
learningpropensity) canll vital adjunct rolesalongsidecomprehensivetests.
Another optionistoselect subtestsor scalesfromseveral differentinstruments
describedinthisbookto tailor-makecomprehensivebatteriesfor SLD assess-
ment, therebyensuringthat most keyareasof cognitiveandneuropsychologi-
cal functioningarethoroughlyassessed. Table13.1isprovidedtofacilitatethis
multi-batteryapproach.
AlthoughWechslersscalesstill havemuchtooffer for SLDassessment, as
long as the proles are interpreted intelligently, the new set of alternative
instrumentsincludesavarietyof subteststhat measureessential skillsthat are
coveredweaklyornotatall bytheWISCIII andWAISIII. Theseskillsinclude
uidreasoning, learningability, planningability, attention, andthemeasure-
ment of intelligenceinchannelsother thanauditoryvocal andvisualmotor.
Basedontheresearchpresentedthroughout thisbook, whether specictothe
underlyingbiological mechanismsof SLDor totheinterpretationandclinical/
educational applicationsof thetestsfeaturedinvariouschapters, thefutureof
SLDassessment inthisnewmillenniumseemsquitebright.
ENDNOTE
1 Dr Margaret Jo Shepherd, author of Chapter 1 of this book, played a unique role in our
professional development. ShewasNadeensmentor, chairingher doctoral dissertationinthe
Learning Disabilities program at Teachers College, Columbia University; and her intra-
individual approachto test interpretationformedthefoundationof theclinical approachto
Wechsler interpretation that Alan developed and implemented in his books that promote
intelligent testing (e.g., Kaufman, 1979, 1990, 1994).
Table 13.1. Organization of tests, scales, and subtests discussed in this book by
domains that might be assessed in SLD evaluations
Global intelligence
WISCIII/ WAISIII Full Scale(Chapter 2)
WJR/ WJIII BroadCognitiveAbility(Chapter 3)
K-ABCMental ProcessingComposite(Chapter 4)
KAIT Composite(Chapter 4)
CASFull Scale(Chapter 5)
BASII General Conceptual AbilityScale(Chapter 6)
DASGeneral Conceptual AbilityScale(Chapter 6)
Problem-solvingability/ reasoning/ planning
WJR/ WJIII FluidReasoningCluster (especiallyAnalysisSynthesis, Concept Formation
subtests) (Chapter 3)
KAIT FluidScale(especiallyLogical Steps, MysteryCodessubtests) (Chapter 4)
CASPlanningScale(Chapter 5)
BASII Nonverbal ReasoningAbilityFirst-Order Composite(Chapter 6)
DASNonverbal ReasoningAbilityScale(Chapter 6)
LPADRavensMatricessubtest, Representational Stencil DesignTest, Numerical Progressions
Organizer subtest (Chapter 7)
HalsteadReitanCategoryTest (Chapter 10)
NEPSYTower subtest (Chapter 11)
Languageskills
WISCIII/ WAISIII Verbal Scale(Chapter 2)
WJR/ WJIII Comprehension-KnowledgeCluster (Chapter 3)
K-ABCAchievement Scale(Chapter 4)
KAIT CrystallizedScale(Chapter 4)
BASII Verbal AbilityFirst-Order Composite(Chapter 6)
DASVerbal AbilityScale(Chapter 6)
Clinical Evaluationof LanguageFundamentals(CELF3) (Chapter 8)
Test of WordKnowledge(TOWK) (Chapter 8)
Languageskills(cont.)
Test of LanguageCompetence Expanded(TLC-E) (Chapter 8)
WiigCriterion-ReferencedInventoryof Language(CRIL) (Chapter 8)
Test of Adolescent andAdult Language(TOAL) (Chapter 8)
Test of LanguageDevelopment (TOLD) (Chapter 8)
NEPSY LanguageDomain(Chapter 11)
NEPSY List Learningsubtest (Chapter 11)
WRAML Verbal MemoryScale(Chapter 12)
TOMAL Memoryfor Stories, WordSelectiveReminding, PairedRecall subtests(Chapter 12)
CVLTC(Chapter 12)
Nonverbal skills
WISCIII/ WAISIII PerformanceScale(Chapter 2)
WJR/ WJIII Spatial Relationssubtest (Chapter 3)
K-ABCNonverbal Scale(Chapter 4)
CASNonverbal Matrices, FigureMemorysubtests(Chapter 5)
BASII Nonverbal ReasoningFirst-Order Composite(Chapter 6)
DASNonverbal ReasoningAbilityScale(Chapter 6)
BASII Spatial AbilityFirst-Order Composite(Chapter 6)
DASSpatial AbilityScale(Chapter 6)
BASII Recognitionof PicturesDiagnosticScale(Chapter 6)
DASRecognitionof PicturesDiagnosticsubtest (Chapter 6)
LPADRavensMatricessubtest, Representational Stencil DesignTest (Chapter 7)
NEPSY DesignFluency, Manual Motor Sequencessubtests(Chapter 11)
NEPSY Visuospatial FunctionsDomain(Chapter 11)
WRAML Visual MemoryScale(Chapter 12)
TOMAL Visual SelectiveReminding, Visual Sequential Memory, Manual Imitation, Abstract
Visual Memory, Facial Memory, Memoryfor Locationsubtests(Chapter 12)
Processing auditory
WJR/ WJIII AuditoryProcessingCluster (Chapter 3)
HalsteadReitanSpeechSoundsPerceptionTest (Chapter 10)
HalsteadReitanRhythmTest (Chapter 10)
NEPSY LanguageDomain(especiallyPhonological Processing, Oromotor Sequences,
Comprehensionof Instructions, Repetitionof NonsenseWordssubtests) (Chapter 11)
Processing visual
WISCIII/ WAISIII PictureCompletionsubtest (Chapter 2)
WJR/ WJIII Visual ProcessingCluster (Chapter 3)
K-ABCGestalt Closure, Spatial Memory, HandMovementssubtests(Chapter 4)
CASNumber Detection, ReceptiveAttentionsubtests(Chapter 5)
BASII Recognitionof PicturesDiagnosticScale(Chapter 6)
DASRecognitionof PicturesDiagnosticsubtest (Chapter 6)
NEPSY DesignFluency, Arrowssubtests(Chapter 11)
Processing kinesthetic/ tactile
HalsteadReitanTactual PerformanceTest, TactileFinger RecognitionTest, TactileForm
RecognitionTest, FingertipNumber WritingPerceptionTest, SensoryImperceptionTest
(Chapter 10)
NEPSYFinger Discrimination, ImitatingHandPositionssubtests(Chapter 11)
Processing cognitivestyle
K-ABCSequential ProcessingScale(Chapter 4)
K-ABCSimultaneousProcessingScale(Chapter 4)
CASSuccessiveScale(Chapter 5)
CASSimultaneousScale(Chapter 5)
Visualmotorcoordination/ visualspatial
WISCIII/ WAISIII PerformanceScale(Chapter 2)
WISCIII/ WAISIII Perceptual OrganizationIndex(Chapter 2)
WJR/ WJIII Spatial Relationssubtest (Chapter 3)
K-ABCSimultaneousProcessingScale(Chapter 4)
BASII Spatial AbilityFirst-Order Composite(Chapter 6)
DASSpatial AbilityScale(Chapter 6)
LPADOrganizationof DotsTest, ComplexFigureDrawingTest, Reversal Test (Chapter 7)
HalsteadReitanTrail MakingTest (Chapter 10)
NEPSYDesignFluencysubtest (Chapter 11)
NEPSYVisuospatial FunctionsDomain(Chapter 11)
Motorcoordination/ functioning(noncognitive)
HalsteadReitanTactileFinger RecognitionTest, TactileFormRecognitionTest, Fingertip
Number WritingPerceptionTest, SensoryImperceptionTest, GripStrengthsubtest
(Chapter 10)
NEPSYStatuesubtest (Chapter 11)
NEPSYSensorimotor FunctionsDomain(except Manual Motor Sequencessubtest) (Chapter
11)
Attention
WISCIII FreedomfromDistractibilityIndex(Chapter 2)
WAISIII WorkingMemoryIndex(Chapter 2)
WISCIII/ WAISIII ProcessingSpeedIndex(Chapter 2)
WJR/ WJIII ProcessingSpeedCluster (Chapter 3)
CASAttentionScale(Chapter 5)
LPADDiffuseAttentionTest (Chapter 7)
HalsteadReitanRhythmTest (Chapter 10)
NEPSYAttention/ ExecutiveFunctionsDomain(especiallyAuditoryAttentionandResponse
Set, Visual Attentionsubtests) (Chapter 11)
Memory short-term
WISCIII FreedomfromDistractibilityIndex(Chapter 2)
WAISIII WorkingMemoryIndex(Chapter 2)
WJR/ WJIII Short-termMemoryCluster (Chapter 3)
WJR/ WJIII PictureRecognitionsubtest (Chapter 3)
K-ABCSequential ProcessingScale(Chapter 4)
CASSuccessiveScale(Chapter 5)
BASII Recall of DigitsForward, Recall of DigitsBackward, Recognitionof Pictures, Recall of
Objects(Immediate) Diagnosticscales(Chapter 6)
DASRecall of Digits, Recognitionof Pictures, Recall of Objects(Immediate) Diagnostic
subtests(Chapter 6)
NEPSY Memoryfor Faces, NarrativeMemory, SentencesRepetitionsubtests(Chapter 11)
WRAML Verbal MemoryScale(Chapter 12)
WRAML Visual MemoryScale(Chapter 12)
TOMAL Sequential Recall Index(Chapter 12)
TOMAL BackwardRecall Index(Chapter 12)
TOMAL Spatial MemoryIndex(Chapter 12)
TOMAL Memoryfor Stories, Facial Memorysubtests(Chapter 12)
Memory long-term
WJR/ WJIII DelayedMemoryfor Names, DelayedVisualAuditoryLearningsubtests
(Chapter 3)
KAIT DelayedRecall subtests(Chapter 4)
BASII Recall of Objects(Delayed) DiagnosticScale(Chapter 6)
DASRecall of Objects(Delayed) Diagnosticsubtest (Chapter 6)
NEPSY DelayedMemoryfor Faces, Memoryfor Namessubtests(Chapter 11)
TOMAL DelayedRecall Index(Chapter 12)
CVLTC(Chapter 12)
Speed
WISCIII/ WAISIII ProcessingSpeedIndex(Chapter 2)
WJR/ WJIII SpeedCluster (Chapter 3)
CASPlanningScale(Chapter 5)
BASII Speedof InformationProcessingDiagnosticScale(Chapter 6)
DASSpeedof InformationProcessingDiagnosticsubtest (Chapter 6)
HalsteadReitanTrail MakingTest, Finger OscillationTest (Chapter 10)
NEPSY SpeededNaming, FingertipTappingsubtests(Chapter 11)
Learningability
WJR/ WJIII AnalysisSynthesis, Concept Formationsubtests(Chapter 3)
WJR/ WJIII Memoryfor Names, VisualAuditoryLearningsubtests(Chapter 3)
KAIT RebusLearning, MysteryCodessubtests(Chapter 4)
LPADPositional LearningTest, PlateauxTest, AssociativeRecall, WordMemorysubtest
(Chapter 7)
Learningability(cont.)
LPAD(EntireTest) (Chapter 7)
HalsteadReitanCategoryTest (Chapter 10)
NEPSYManual Motor Sequencessubtest, Memoryfor Names, List Learningsubtests(Chapter
11)
WRAML LearningScale(Chapter 12)
TOMAL WordSelectiveReminding, Visual SelectiveReminding, Object Recall, PairedRecall
subtests(Chapter 12)
CVLTC(Chapter 12)
REFERENCES
American Psychiatric Association (1994). Diagnostic andStatistical Manual of Mental Disorders,
FourthEdition. Washington, DC: AmericanPsychiatricAssociation.
Binet, A. (1903). LetudeExperimentaledelIntelligence(Theexperimental study of intelligence).
Paris: Schleicher.
Flanagan, D.P. & McGrew, K.S. (1997). A cross-batteryapproachto assessingandinterpreting
cognitive abilities: narrowing the gap between practice and cognitive science. In Beyond
Traditional Intellectual Assessment: ContemporaryandEmergingTheories, Tests, andIssues, ed. D.P.
Flanagan, J.L. Genshaft, &P.L. Harrison, pp. 31425. NewYork: GuilfordPress.
Galton,F. (1869). HereditaryGenius:AnInquiryintoitsLawsandConsequences.London:Macmillan.
Galton, F. (1883). InquiriesintoHumanFacultyanditsDevelopment. London: Macmillan.
Golden, C.J. (1981). TheLuriaNebraskaChildrensBattery: theoryandformulation. InNeuro-
psychological AssessmentoftheSchool-ageChild, ed. G.W. Hynd&J.E. Obrzut, pp. 277302. New
York: GruneandStratton.
Hinshelwood, J. (1917). Congenital Word-blindness. London: H.K. Lewis.
Horn, J.L. (1989). Cognitive diversity: a framework of learning. In Learning and Individual
Differences, ed. P.L. Ackerman, R.J. Sternberg, &R. Glaser, pp. 61116. NewYork: Freeman.
Horn, J.L., & Hofer, S.M. (1992). Major abilities and development in the adult period. In
Intellectual Development, ed. R.J. Sternberg & C.A. Berg, pp. 4499. New York: Cambridge
UniversityPress.
Horn, J.L. & Noll, J.G. (1997). Human cognitive capabilities: GfGc theory. In Contemporary
Intellectual Assessment: Theories, Tests and Issues, ed. D.P. Flanagan, J.L. Genshaft, & P.A.
Harrison, pp. 5391. NewYork: GuilfordPress.
Inhelder, B. &Piaget, J. (1958). TheGrowthof Logical ThinkingfromChildhoodtoAdolescence. New
York: BasicBooks.
Jensen, A.R. (1998). ThegFactor: TheScienceof Mental Ability. Westport, CT: Praeger.
Kaufman, A.S. (1979). Intelligent TestingwiththeWISCR. NewYork: JohnWiley.
Kaufman, A.S. (1990). AssessingAdolescent andAdult Intelligence. Boston, MA: Allyn&Bacon.
Kaufman, A.S. (1994). Intelligent TestingwiththeWISCIII. NewYork: JohnWiley.
Kaufman, A.S. (2000). Tests of intelligence. In Handbook of Intelligence, ed. R.J. Sternberg, pp.
44576. NewYork: CambridgeUniversityPress.
Kaufman, A.S. &Kaufman, N.L. (1983). K-ABCInterpretiveManual. CirclePines, MN: American
GuidanceService.
Kaufman, A.S. & Lichtenberger, E.O. (1999). Essentialsof WAISIII Assessment. NewYork: John
Wiley.
Kaufman,A.S. &Lichtenberger, E.O. (2000).EssentialsofWISCIII andWPPSIRAssessment. New
York: JohnWiley.
Luria, A.R. (1973). TheWorkingBrain: An Introduction to Neuro-psychology. London: Penguin
Books.
Luria, A.R. (1980). Higher Cortical FunctionsinMan, secondedition. NewYork: BasicBooks.
MacMillan, D.L. &Speece, D.L. (1999). Utilityof current diagnosticcategoriesfor researchand
practice. In Developmental PerspectivesonChildrenwithHigh-incidenceDisabilities, ed. R. Galli-
more, L.P. Bernheimer, D.L. MacMillan, D.L. Speece, &S. Vaughn, pp. 11113. Mahweh, NJ:
LawrenceErlbaum.
Melchers, P. (1999). TheGermanK-ABCResearchandclinical interpretation. InA.S. Kaufman,
P. Melchers, & N.L. Kaufman (presenters), The K-ABC and other means of intellectual
assessment. APALevel III Workshopandsupervisionfor experiencedclinicians. Presentedat
the German/ Dutch Neuropsychological Society: Neuropsychology on the Brink of the
Millennium, Cologne, Germany.
Mill, J.S. (1875). A Systemof Logic, Ratiocinative, and Inductive, beinga Connected Viewof the
Principles of EvidenceandtheMethods of ScienticInvestigation, ninth edition, Vols. 1 and 2.
London: Longmans, Green, Reader andDyer.
Morgan, P. (1896) Acaseof congenital word-blindness. BritishMedical Journal, 2, 1378.
Piaget, J. (1972). Intellectual evolutionfromadolescencetoadulthood. HumanDevelopment, 15,
112.
Siegel, L.S. (1999). Issuesinthedenitionanddiagnosisof learningdisabilities: aperspectiveon
Guckenberger v. BostonUniversity. Journal of LearningDisabilities, 32, 30419.
Spearman, C.E. (1904). General intelligence, objectively determinedandmeasured. American
Journal of Psychology, 15, 20193.
Stanovich, K.E. (1999). The sociopsychometrics of learning disabilities. Journal of Learning
Vellutino, F.R., Scanlon, D.M., &Lyon, G.R. (2000). Differentiatingbetweendifcult-to-remedi-
ateandreadilyremediatedpoor readers: moreevidenceagainst theIQachievement discrep-
ancydenitionof readingdisability. Journal of LearningDisabilities, 33, 22338.
Wechsler, D. (1939). Measurementof Adult Intelligence. Baltimore, MD: Williams&Wilkins.
Wechsler, D. (1991). Manual fortheWechslerIntelligenceScaleforChildren, ThirdEdition(WISCIII).
SanAntonio, TX: ThePsychological Corporation.
Wechsler, D. (1997). Manual for theWechsler Adult IntelligenceScaleThirdEdition(WAISIII). San
Woodcock, R.W. (1990). Theoretical foundations of the WJR measures of cognitiveability.
Woodcock, R.W. & Mather, N. (1989). WJR Tests of Cognitive Ability Standard and
Supplemental batteries: examinersManual. In WoodcockJohnsonPsycho-Educational Battery
Revised, ed. R.W. Woodcock&M.B. Johnson. Chicago, IL: Riverside.
Woodcock, R.W., McGrew, K.S., & Mather, N. (2001). WoodcockJohnson Psycho-Educational
Battery, ThirdEdition(WJ3). Chicago, IL: Riverside.
Yoakum, C.S. &Yerkes, R.M. (1920). ArmyMental Tests. NewYork: HenryHolt.
MMMM
Index
Note: guresandtablesareindicatedbyboldpagenumbers.
abstract thinking, seeKaufmantests, KAIT
academicachievement, andintelligencetesting
4434
achievement tests 109
BASII 187
CASAchievement test discrepancy 163
correlationwithCAS 1534
discrepancyanalysis, SLDs(WJRCOG) 7880
discrepancyapproach 15960
discrepancyvsdecit models 4469
IQachievement discrepancy 43440
age, andintelligence 219
ageat braindamage, principlesof
neuropsychology 3248
alcohol, FASsubjects, NEPSY 3656
aphasia, developmental dysphasia 3329
AphasiaScreeningTest 333, 337, 338
assessment 43355
aims 2278
applicationsof contemporaryinstruments
44953
clinical neuropsychological assessment 387425
CognitiveAssessment System(CAS) 14177
dynamicassessment, psychometricmodel
21846
eliminationof IQtests? 4347
languagedisorders 25371
LearningPropensityAssessment Device
(LPAD) 22836
Neuropsychological Assessment (NEPSY)
34786
SOMPA 222
attention, inattentionhandout 1712
attentiondisorders
ADHDandNEPSY 369
NEPSY 3756
tests 457
AttentionScale(PASS) 148
auditorymemory, short term, deciency 16
auditoryprocessing(Ga) 59, 74, 75
Bakker, theoriesof dyslexia 295
Binet
onJSMill 4389
metricof development 21920
birthasphyxia, NEPSY 366
brainactivity
central processing, highest levels 323
critical languageareas 286, 291, 349
dyslexiavscontrols 290
Kennardprinciple 3245
left/ right cerebral functioning 3213, 3912
phonology 28990, 291
brainfunctioning, short-/ long-termmemory
3912
brainimaging
asymmetryof lobesandventricles 2879
normal asymmetry 288
PET andSPECT, functional abnormalities
28992, 448
brain-injuredsubjects 1215
age, principlesof neuropsychology 3248
comparedwithSLDandnormal 32832
comparedwithSLDandnormal (NDS) 33943
differential scoreapproach 311
Luriasframeof reference 34850
specicskill loss 1922
brainmorphology
limbicsystemandhippocampus 390
pre-frontal areas, functions 250, 349
BritishAbilityScales(BASII) 177217
batteries 1825
achievement tests 187
separateandoverlapping 194
subtests 183, 1845, 186
casestudy 20813
diagnosisandtreatment of SLDs 198208
uidreasoning 442
history, development, andgoals 17982
psychometricproperties 18892
proleanalysis 192
reliability, specicity, validity, bias 18992
tailoring 188
Brocasarea 349
CaliforniaVerbal LearningTestChildrensVersion
(CVLTC) 4235
CattellHornCarroll theoryof cognitiveabilities
(CHCtheory) 56, 57, 182, 442
cognitiveperformancemodel (CPM) 589, 60
empirical support 59
ninebroadabilities 589
seealsoWoodcockJohnsontests(WJRCOG)
463
checklists, languagedisorders 2669
ChildServiceDemonstrationCenters 10
ChildrenwithSpecicLearningDisabilitiesAct (1969)
6
Clinical Evaluationof LanguageFundamentals
(CELF) 25763
cognitiveabilities
componentsof processing 351
andneurological structure 1958
complexinformationprocessing 1967
verbal andvisual short-termmemory 1978
verbal andvisuospatial ability 196
CognitiveAssessment System(CAS) 14177
achievement correlation 1534
aptitudeachievementdiscrepancy 438
casestudies 16370
identicationof basicpsychological processing
disorder 160
inattentionhandout 1712
interventionhandout 1724
normativeandvaliditystudies 15063
PASSdescription 14550
scalesandsubtests 147
PASSproles 1513
PASStheoryandprocesses 1435
relatingbasicpsychological processingdisorder
toacademics 1613
useinSLDdiagnosis 15960
worksheet 162
cognitivedevelopment, psychometricmodel,
compatibilitywithdynamicassessment
21846
cognitiverevolution 1412
comprehensiveknowledgetesting 58
corpuscallosum, morphology 2889
craniometry, andintelligence 219
crystallizedintelligence, seeGfGc(CHCtheory)
cultural/ socioeconomicclass, culture-fair tests
2203
Dean, researchondyslexia 31315
decisionmaking, seeKaufmantests, KAIT
Differential AbilityScales(DAS) 177217
casestudy 2068
history, development andgoals 17982
standardization 1924
andWPSSI-R 260
seealsoBritishAbilityScales(BASII), batteries
andpsychometricproperties
DisabilitiesEducationAct, seeIndividualswith
DisabilitiesEducationAct, (1997)
DSM-IV, learningdisorders 16
dyscalculia 1922, 285
dysgraphia 1922
dyslexia 2006, 204
clinical subtypes 250, 285, 297300
vscontrols, brainactivity 290, 2917
CT, MRI andfMRI studies 293, 448
developmental, andneuropsychology 2845
historical aspects 1922, 2847
incidence, predictedandactual, SLDvsbrain
damaged 336
andintelligencetesting 434, 4447
NEPSY 3734, 376
asstate 224
theories 2927
Bakker 295
GeschwindGalaburda 2925
Rourke 296
Satz 2956
dysphasia, developmental 3329
dyspraxia, incidence, predictedandactual, SLDvs
braindamaged 336, 337, 338
environmental factors 1214, 221
epilepsysurgery, readingandbrainactivity 2912
federal Special Educationlaw, identicationof
speciclearningdisability, criteria 7
uidintelligence, seeGfGc(CHCtheory)
uidreasoning(Gf) 59, 73, 75
gfactor/ construct 4356
General Conceptual Ability(GCA) 181
downwardextensionof scores 195
Germany, IQtests 443
GeschwindGalaburda, theoriesof dyslexia 2925
GeschwindGalaburdatheory, predispositionto
SLD 2925
GfGc(CHCtheory) 100, 435
seealsoWoodcockJohnsontests(WJRCOG)
HalsteadImpairment Index 318
HalsteadReitanNeuropsychological Test Battery
(HRNTB) 30946
brain-injuredsubjects
vsSLDandnormal 32832
vsSLDandnormal (NDS) 33943
development 3204
ReitanWolfsonmodel 321, 322
hippocampus, morphology 390
historical aspects 328
Holocaust, childsurvivors, assessment 223
HornCattell GfGctheory 4356, 441
crystallizedintelligence 100
hyperactivity, inattentionhandout 1712
IndividualswithDisabilitiesEducationAct (1997) 6,
159, 248, 436
intelligence
andage 219
concept, impact of psychometricmodel 2213
andcraniometry 219
uidandcrystallized(GfGc), seeGfGc(CHC
theory)
intelligencetesting
andacademicachievement 4434
464 Index
discrepancyanalysis, SLDs(WJRCOG)
7880
elimination 450
misconceptions 4436
problem-solvingvslearnedskills 99
andreadingability 434, 4447
tests 455
seealsoassessment
intervention, at school andat home 21213
interventionhandout, spelling/ reading 1724
Kaufmantests 97143
casestudies 11737
differential diagnosis 11114
history, development andgoals 97101
K-ABC
illustrativecasestudy 12837
normativeanddevelopmental issues 1067
separationof intelligencefromachievement
4378
structure 101
subtests 1023
summaryof researchonSLDstudents
11213
theoryanddevelopment 979
KAIT
illustrativecasestudy 11727
structure 103
subtests 104, 105
theoretical roots 442
theoryanddevelopment 99101
Kennardprinciple, brainlesions 3245
Kussmaul, model of spokenandwrittenlanguage
284
languageability
critical areas 286, 291, 349
tests 4556
languagedisorders 24782
assessment objectives 249
assessment perspectivesandmethods 25371
computer-basedassessments 2701
criterion-referencedassessments 2636
descriptiveassessments 26670
misuse 262
multi-perspectiveandcollaborative 2536
norm-referencedassessments 25763
relationshipstoIQ 260
studentclinicianperspectives 253
casestudy 2713
causal factors 24950
checklists 2669
cross-cultural andlinguisticissues 262
developmental patterns 2502
NEPSY 3745, 376
self-assessments 26970
tests 4556
languagemodel, Kussmaul 284
lateralizeddecits
children, psychomotor functioning 311
andTrail MakingTest 312
learningability, tests 4589
learningdisability, seespeciclearningdisability
(SLD)
LearningPropensityAssessment Device(LPAD)
2414, 450
cognitivemap 230
constructionof test battery 23641
decient cognitivefunctions 232
development 2236
instrument clusters 240
mediatedlearningexperience 2303
principles 223, 22837
changesininstrument 2289
changesintest situation 22934
interpretationof results 2356
shift fromproduct toprocess 2335
sixvariations 233
structuralcognitivemodiabilitytheory 223,
2268
legislation
ChildrenwithSpecicLearningDisabilitiesAct
(1969) 6
federal Special Educationlaw 6
IndividualswithDisabilitiesEducationAct (1997)
6, 159, 248
Right toEducationfor All HandicappedChildrenAct
(1975) 6
limbicsystem, andhippocampus, morphology 390
lists, tests, scalesandsubtests 4559
long-termretrieval (Glr) 59, 73, 75
Luria, andNeuropsychological Assessment
(NEPSY) 34786
measurement
vsassessment/ valuation 224
JSMill on 4389
validityandreliability 225
measurement error 439
memory
andattention 392
compromisingdisorders 388
long-termmemory 3912, 453
tests 458
neurobiology 38992
short-termmemory 3912, 453
(Gsm) 58, 73, 75
tests 458
verbal andvisual short-term, neurological
structureandcognitiveabilities 1978
seealsoTest of MemoryandLearning(TOML);
WideRangeAssessment of Memoryand
Learning(WRAML)
465 Index
Mill, JS, onmeasurement 4389
motor coordination/ functioning(noncognitive),
tests 457
neurological foundationsof learningdisabilities
746, 283308
developmental dysphasia 3329
principlesof neuropsychology 3248
researchndings
brain-damaged, SLDandnormal 32832
NDS 33943
researchprograms
Dean 31315
ODonnell 31520
ReitanandWolfson 3204
Rourke 296, 30913
seealsobrain; dyslexia
neuropsychological assessment, clinical 387425
Neuropsychological Assessment (NEPSY) 34786
applications 36672
coreandfull assessment 3678, 369
casestudy 37880
comorbidity 3778
description 35260
domainsandsubtests 352
publishedversions 353
standardizationandreliability 360
developmental issues 3606
goalsandrationale 348
history 3502
learningdisorders, studies 3738
psychometricdata 359
Tower subtest 442
andWISCIII 364
Neuropsychological Decit Scales(NDS) 33943
neuropsychology, principles 3248
nonverbal skills, tests 456
ODonnell, researchprogram 31520
ontogenyof humandevelopment 2268
PersonalityScreeningInventory 31920
phonology, brainactivity 28990, 291
physical anomalies, andSLD 287
PlanningFacilitationinterventionmethod 1579
PlanningScale(PASS) 1478
remedial program(PREP) 154
theoryandprocesses 1435
positivediscrimination 222
pre-frontal areas, functions 250, 349
predictability 2245
PREP, seePlanningScale(PASS)
problem-solvingability
vslearnedskillsinIQtesting 99, 2213
tests 455
processing
auditory, tests 456
cognitivestyle, tests 457
kinesthetic/ tactile, tests 457
visual, tests 456
visual (Gv) 58, 73, 75
processingspeed
(Gs) 58, 73, 75
tests 458
psychometricmodel
compatibilitywithdynamicassessment
21846
impact onconcept of intelligence 2213
quantitativeability(Gq) 58, 73, 75
rapidalternatingstimuli (RAS) test 264
rapidautomaticnaming(RAN) tasks 2634
reading, brainareaactivity 291
readingdisorders
historical aspects 202
andintelligencetesting 434, 4447
seealsodyslexia
reading/ writing(Grw) 58, 73, 75
ReitanIndianaNeuropsychological Test Battery
342
ReitanWolfsonmodel
neuropsychological functioning 321, 322
andresearchprogram 3204
RighttoEducationfor All HandicappedChildrenAct
(1975) 6
rightleft confusion, incidence, predictedand
actual, SLDvsbraindamaged 336
Rourke
dyslexiatheory 296
researchprogram 30913
Satz, theoriesof dyslexia 2956
scales, testsandsubtests 4559
schizophrenia, asstate 224
short-termmemory(Gsm) 58, 73, 75
SimultaneousScale(PASS) 149
small-for-gestational age, NEPSY 366
socioeconomicclass 2203
SOMPA(systemof multicultural pluralistic
assessment) 222
Special Nonverbal Composite(SNC) scale 195
speciclearningdisability(SLD)
applicationsof contemporaryinstruments
44953
assessment, seeassessment
brain-damaged, SLDandnormal adults/ children
compared 32832, 33943
clinical subtypes 250, 285, 297300
changesover 15years 298
cluster analysis 299
stabilityandoutcome 300
compromisingdisorders 388
dened 34, 159
DisabilitiesEducationAct (1997) 6, 159, 248, 436
disabilityvsdisabilities 1516
discrepancyapproach 15960, 4347
discrepancyvsdecit models 4469
asdisorder inbasiccognitiveprocess 768
federal Special Educationlaw 6
466 Index
geneticvsenvironmental 1214
historical aspects 1215, 2847
identicationcriteria 712
neurological basis 746, 283308
numbers(19771995) 11
SLDcategoryinschools 1011
tests 4589
state, vstrait 224
strephosymbolia(Orton) 21
StroopColorWordtest 263
structuralcognitivemodiabilitytheory 223,
2268
SturgeWeber syndrome 225
SuccessiveScale(PASS) 14950
Test of Adolescent Language(TOAL) 257
Test of LanguageCompetence(TLC) 259, 261
Test of MemoryandLearning(TOML) 389,
41123
casestudy 4213
delayedrecall 41920
forwardvsbackwardrecall 419
standardization 41516
structure412
subtests 41315
Test of WorldKnowledge(TOWK) 259, 271
tests, scalesandsubtests 4559
three-stratumtheory 57
Trail MakingTest, andlateralizeddecits 312
trait, vsstate 224
UK, IQtests 443
visual processing(Gv) 58, 73, 75
visualmotor coordination, tests 457
Wechsler intelligencescales
acidcodinginformationdigitspan(ACID)
301
application 226
ArmyPerformanceScaleExamination 441
Bannatynescategoriesand
ACID/ ACIDS/ SCADproles 445
casestudy 489
anddenitionsof IQtests 435
index(factor) scores 44
VerbalPerformancediscrepancies 434
history, development andgoals 2934, 141
level I: full scaleIQ 378, 43
level II: VerbalPerformanceIQs 3841
level III: interpretingsubtest variability 412
level IV: intrasubtest variability 42
level V: qualitativeanalysis 42
Preschool andPrimary(WPPSI) 32, 260, 363
subtest variability 467
WAIS-III andWISC-III 31, 326
andNEPSY 364
procedures 38
andTLC 260
WAIS-R 30, 32
Wernickesarea 349
WideRangeAssessment of MemoryandLearning
(WRAML) 389, 392411
casestudy 40811
performance
andADHD 4057
andbraininjury 4078
principal componentsanalysis, varimaxrotation
403
structure 392400
technical information 4007
andWRATR 402
WoodcockJohnsontests(WJRCOG) 5595
batteries 556, 6072
clusters 645
standardization 615
testsof attention 656, 67
testsof language 70, 701
testsof memoryaandlearning 6670, 68
testsof reasoning 712, 73
casestudies 819
clinical foundations 567
aptitudeachievement discrepancy 438
cognitivepatterns 801
discrepancyanalysis 7880
neuropathology/ neuropsychology 745
processdisorder 768
GfGcabilities 589, 623, 75
model 579
WJIII COG, forthcoming 8991
wordsorting, spelling/ readingdecoding,
interventionhandout 1724
467 Index

Alan S. Kaufman, Nadeen L. Kaufman) Specific Learning

Transféré par

Informations du document

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Alan S. Kaufman, Nadeen L. Kaufman) Specific Learning

Transféré par

Droits d'auteur :

Formats disponibles

Specific learning disabilities and difficulties in children and adolescents

Psychological assessment and evaluation

Vous aimerez peut-être aussi