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A comparison of Wechsler Adult Intelligence Scale-Revised profiles was made with samples of 35 individuals with high-functioning autism and 102 individuals with adult learning disability. Results are discussed in terms of the substantial differences in cognitive structure between these 2 neurodevelopmental disorders.
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A Comparison of WAIS–R Profiles in Adults With High-Functioning Autism or Differing Subtypes
A comparison of Wechsler Adult Intelligence Scale-Revised profiles was made with samples of 35 individuals with high-functioning autism and 102 individuals with adult learning disability. Results are discussed in terms of the substantial differences in cognitive structure between these 2 neurodevelopmental disorders.
A comparison of Wechsler Adult Intelligence Scale-Revised profiles was made with samples of 35 individuals with high-functioning autism and 102 individuals with adult learning disability. Results are discussed in terms of the substantial differences in cognitive structure between these 2 neurodevelopmental disorders.
A Comparison of WAISR Profiles in Adults With High-Functioning
Autism or Differing Subtypes of Learning Disability GOLDSTEIN ET AL. A COMPARISON OF WAISR PROFILES Gerald Goldstein VA Pittsburgh Healthcare System and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Sue R. Beers, Don J. Siegel, and Nancy J. Minshew School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA To examine cognitive differences among adults with differing developmental disorders, a com- parison of Wechsler Adult Intelligence ScaleRevised profiles was made with samples of 35 in- dividuals with high-functioning autism (HFA) and 102 individuals with adult learning disability (LD). All participants had Verbal and Performance IQscores of 70 or higher. The LD group was divided into 3 subtypes based on relative achievement levels in mechanical reading and arithmetic. The group with HFA had a profile characterized by a high score on Block De- sign with a lowComprehension score. The HFAgroup most resembled the LDsubtype that had superior achievement in reading relative to arithmetic, with the exception of their poor perfor- mance on measures of social perception and judgment. Results are discussed in terms of the substantial differences in cognitive structure between these 2 neurodevelopmental disorders and are considered in the context of the learning deficits reported for Aspergers Disorder and nonverbal learning disability. Key words: autism, learning disability subtypes, WAISR Clinical and neuropsychological prototypes in the form of Wechsler Adult Intelligence Scale (WAIS) profile configurations of the scaled scores (Wechsler, 1944, 1955, 1981, 1998) have been described from the time of Rapaport, Gill, and Schafer (1945) to more recent times (Reitan & Wolfson, 1993). Numerous group comparisons have been reported, demonstrating often substantially different intellectual profiles in nu- merous developmental and psychiatric disorders. Ad- ministration of an intelligence test is often advised or required for diagnosis and description of the client be- ing assessed, not only to rule out mental retardation but also to provide information about the profile of cognitive abilities that may contribute to the academic deficit or to provide data about potentially compensa- tory abilities (Francis, Espy, Rourke, & Fletcher, 1991). Although the intelligence test may be supple- mented with additional psychoeducational and neuropsychological tests, it provides unique informa- tion about complex abilities in a number of areas, such as working memory or complex spatial prob- lem-solving skills. In this research, we provide a comparison between high-functioning autism (HFA) and adult learning dis- ability (LD). Such a comparison is of interest because both are neurodevelopmental disorders that emerge early in life but persist into adulthood (McCue & Goldstein, 1991). Shea and Mesibov (1985) believed that there may be an unclear boundary between HFA and severe LD and remarked on the resemblance be- tween the core deficits of autism and those of the social and nonverbal developmental disorders. An uneven profile of skills involving aspects of language, cogni- tion, and social adjustment is common to each disorder. HFA and LD are distinguished from each other, how- ever, by differences in the nature of deficient language and communication and academic and social skills. Applied Neuropsychology Copyright 2001 by 2001, Vol. 8, No. 3, 148154 Lawrence Erlbaum Associates, Inc. This research was supported by National Institute of Neurologi- cal Disorders Grant NS33355 and the Medical Research Service, Department of Veterans Affairs. Requests for reprints should be sent to Gerald Goldstein, VA Pittsburgh Healthcare System, 7180 Highland Drive (151R), Pitts- burgh, PA 15206, USA. E-mail: ggold@nb.net Extensive neuropsychological research has demon- strated substantial differences in the cognitive func- tioning of children and adults with HFA and individuals with LD. Individuals with autismhave been characterized alternatively as having executive dys- function (Griffith, Pennington, Wehner, & Rogers, 1999; Ozonoff, 1995) or impaired complex information processing (Minshew, Goldstein, & Siegel, 1997) as the core dysfunction. Their weakness lies in conceptu- alizing and organizing information. However, they typ- ically have intact mastery of the mechanical aspects of language, including phonetics, spelling, and simple cal- culation, and often remarkably good spatial skills (Minshew, Goldstein, Muenz, & Payton, 1992). Indi- viduals with LDmay have fully adequate nonverbal ab- stract reasoning abilities and spatial skills but are typically significantly impaired in phonetics and re- lated mechanical aspects of language (Ozols &Rourke, 1991). Individuals with autism typically have substan- tial difficulties with the pragmatic and metaphoric as- pects of language (Brook & Bowler, 1992) and may often showa pattern marked by fully intact oral reading but poor reading comprehension (Frith & Snowling, 1983; Minshew, Goldstein, Taylor, & Siegel, 1994; Whitehouse & Harris, 1984). In a direct demonstration of such differences in the adult population, Rumsey and Hamburger (1990) found no differences between groups of average-IQ adults with either autism or dys- lexia on measures of perceptual organization, word flu- ency, tactile perception, and motor speed and coordination. The performance of these groups on mea- sures of simple language and visualspatial skills was similar. The group with autism performed more poorly on tests of verbal and nonverbal reasoning, comprehen- sion, and recall of complex verbal and visual material, but they outperformed the dyslexia sample with respect to auditory recall of simple information and on tests of basic academic skills. Thus, the literature suggests the presence of important cognitive differences between individuals with HFA and with LD. Studies using Wechsler Adult Intelligence ScaleRevised (WAISR; Wechsler, 1981) subtest profiles also suggest the presence of such a difference. A study and literature review of WAISR performance in adults with autismnoted the high prevalence of a pat- tern of relatively elevated scores on Block Design, with diminished performance on Comprehension (Siegel, Minshew, & Goldstein, 1996). In the case of a hetero- geneous sample of adults with LD, McCue and Goldstein (1991) described a WAISR profile charac- terized by relatively lowscores on Information, Vocab- ulary, and Arithmetic, with Performance IQ subtests, except for Digit Symbol, approaching the average range. However, the use of a heterogeneous LD sample may have obscured the possible existence of differing profiles among LD subtypes. A comparison between HFA and LD in general may be misleading because although HFA is a reasonably well-defined condition, LD is not a unitary disorder. Various subtyping systems have been developed based on characteristic behavioral and psychometric patterns (Fletcher & Satz, 1985; Rourke, 1985, 1991). Rourke (1982) developed an empirically based systemthat clas- sifiesindividualswithLDonthebasisof performanceon reading and arithmetic tests. Utilizing the Wide Range Achievement TestRevised (WRATR; Jastak & Wilkinson, 1984), it encompasses individuals uniformly deficient on the Reading and Arithmetic subtests (Global group), individuals who are poor in Reading but better in Arithmetic (A> Rgroup), and individuals who are at least average inReading, but poor inArithmetic (R > A group). The Global group is characterized by defi- cient reading and mathematical achievement relative to general intellectual level. TheA>Rgrouptypicallydoes not exceedaverage-level arithmetic ability, but arithme- tic performance is substantially better than reading. Thus, individuals in this group are often severely dys- lexic. The R>Agroup is characterized by average-level reading skill but is deficient in arithmetic. Rourkes (1985) research showed that these subtypes are associ- ated with differing neuropsychological characteristics. Summarizing this work briefly, the R> Agroup is char- acterized by relatively good verbal abilities and rela- tively poor spatial, fine rapid psychomotor, and higher conceptual skills. The A > R group has the reverse pat- tern. Good spatial and relatively poor linguistic abilities also characterized the group that was disabled in both reading and arithmetic. This investigation compared WAISR performance of adults with HFAand those with the three Rourke LD subtypes to investigate differences in the WAISR subtest profile of each group. A major concern was that the consideration of LD subtypes may substantially re- duce the confounding that may result from a compari- son with a heterogeneous LDsample. We hypothesized that adults with HFA and LD would have distinct WAISR profiles. In regard to subtest patterns, an ele- vated Block Design and Digit Span with depressed Comprehension was anticipated in the autism group. Many studies have demonstrated that individuals with HFA have intact mechanical reading abilities (Minshew et al., 1994). The WRATR Reading subtest involves only mechanical reading and not comprehen- sion, particularly in adults (Coneley & Kramer, 1989). A COMPARISON OF WAISR PROFILES 149 150 We therefore predicted that the HFA profile would most greatly resemble the R > A LD subtype profile, not because remarkably poor Arithmetic scores are an- ticipated but because of the excellent mechanical oral reading abilities often shown by individuals with HFA. Indeed, children with autism have been characterized as having hyperlexia, or advanced ability to read and pronounce written words (Frith & Snowling, 1983). Method Participants To meet accepted diagnostic criteria for HFA, and to exclude individuals with mental retardation in both groups, all participants had Verbal, Performance, and Full Scale WAISR IQ scores of 70 or above. The group with HFA consisted of 35 participants (12% women). The diagnosis of autism was established through expert clinical evaluation in accordance with accepted clinical descriptions of HFA(Minshew, 1996; Minshew & Payton, 1988; Rapin, 1991; Rutter & Schopler, 1987) and two structured diagnostic instru- ments, the Autism Diagnostic Interview (ADI; LeCouteur et al., 1989; Lord, Rutter, & LeCouteur, 1994) and the Autism Diagnostic Observation Sched- ules (ADOS; Lord et al., 1989). Areviewand rescoring of the videotaped ADI and ADOS for all participants with autism by a developer of these instruments docu- mented diagnostic accuracy. Eligibility for inclusion was dependent on consistency of diagnosis across all assessments, with cases of disagreement excluded. In- dividuals with impairments in social interaction and re- stricted patterns of behavior, but with no clinically significant delay in language, cognition, and adaptive behavior, were considered to have Aspergers Disorder and were also excluded, as were cases of autism with a known etiology, such as Fragile-X syndrome. These participants constituted essentially the same sample as was used in the Siegel et al. (1996) study. The LD group consisted of 102 participants (34% women). All were referrals to a neuropsychological clinic from the Office of Vocational Rehabilitation or other community agency. The sample included only in- dividuals meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSMIIIR]; Ameri- can Psychiatric Association, 1987) criteria for specific developmental disorder. These criteria require marked impairment of academic skills not explained on the ba- sis of mental retardation, inadequate education, or sen- sory defects. Appropriate clinical and psychometric assessment documenting a history of academic diffi- culties and significantly impaired performance on psychoeducational tests established the presence of these criteria. Individuals with acquired academic defi- cits (e.g., acquired alexia) were excluded. This sample was utilized in several other studies (Goldstein, Katz, Slomka, & Kelly, 1993; Katz, Goldstein, Rudisin, & Bailey, 1993) where more detail concerning the estab- lishment of the diagnoses is provided. To summarize, all participants met both DSMIIIR and State of Penn- sylvania Office of Vocational Rehabilitation require- ments for an LDdiagnosis. Demographic and academic data for the autism group and the three LD subtypes are presented in Table 1. Procedure To classify participants in the group with an LD di- agnosis into the Rourke subtypes, we used standard scores from the Reading and Arithmetic subtests of the WRATR. A presence or absence of a 15-point dis- GOLDSTEIN ET AL. Table 1. Demographic and Psychometric Data for the High-Functioning Autism and Learning Disability Groups Autism A > R R > A Global Variable M SD M SD M SD M SD F Age 26.62 9.23 32.17 10.99 19.13 2.66 23.75 8.16 7.80** Years of Education 12.06 2.65 10.67 3.18 12.13 1.26 11.31 2.09 1.93 WAISR Verbal IQ 94.91 19.57 82.94 9.17 96.94 13.45 86.69 10.31 5.86** WAISR Performance IQ 89.44 11.92 88.89 13.63 95.50 16.87 88.19 14.86 1.14 WAISR Full Scale IQ 91.88 16.05 84.83 10.62 96.13 15.01 86.28 10.31 3.98* Reading Achievement 88.97 17.85 62.17 14.55 100.19 16.49 77.69 14.09 21.20** Arithmetic Achievement 82.88 22.92 84.50 12.09 77.81 11.03 78.93 11.50 1.10 Note: WAISR = Wechsler Adult Intelligence ScaleRevised. * p < .01. **p < .001. crepancy between Reading and Arithmetic determined subtype membership. WAISR profiles were com- pared with multivariate analysis of variance (MANOVA) followed by individual comparisons. Scheffes test (p < .05) was used for making multiple comparisons. Because autism is a rare disorder, it took some time to obtain a sufficient sample, and data collection began before the recently published Wechsler Adult Intelli- gence ScaleThird Edition (WAISIII; Wechsler, 1998) appeared. However, because of the stability of structure and subtest composition of the different edi- tions of the Wechsler scales, and because the study in- volved an evaluation of cognitive profile rather than assessment of individuals relative to the most contem- porary norms, it was felt that WAISRdata remain per- tinent. The user of the WAISIII, which has an extended set of subtests, would, of course, have to use the WAISR subtest set to make comparisons with this study. WRATR data were not available for the HFA par- ticipants. Because we wished to provide information concerning their level and pattern of academic achieve- ment, we reported data fromthe Reading Decoding and Mathematics Computation subtests of the Kaufman Test of Educational Achievement (Kaufman & Kaufman, 1985). We provided descriptive data using those tests for the HFA sample only for reference pur- poses with regard to academic status, without any im- plication concerning the presence or absence of LD in any individual case. The academic performance of the HFA group was found to be commensurate with gen- eral intellectual level and not suggestive of substantial difficulties in mechanical reading or calculation. Results Demographic and academic data are presented in Table 1. There was not a statistically significant differ- ence among groups in education, but there was in age. The A > R group was significantly older than the R > A and Global groups but was not older than the autism group. The autism group was significantly older than the R > A group. Correlations between age and the WAISR scales were significant (p < .05) for the Infor- mation, Vocabulary, Picture Arrangement, and Digit Symbol subtests. However, analyses of covariance us- ing age as the covariate did not substantially alter the findings for these four subtests with regard to statistical significance. A MANOVA of the 11 WAISR subtests providing comparisons among the HFA and the three subtypes of the LDsample resulted in a statistically sig- nificant main effect, F(33, 363) = 3.68, p < .001. The subtest profiles for the four groups are presented graph- ically in Figure 1. Univariate F tests indicated signifi- cant differences for all subtests except Similarities, Block Design, Object Assembly, and Digit Symbol. Further analyses were accomplished by multiple com- parisons utilizing Scheffes test (p < .05). In the cases of Information, Digit Span, and Arithmetic, the HFA group performed significantly better than the A> Rand the Global group, but not the R> Agroup. For Compre- hension, Picture Completion, and Picture Arrange- ment, the R > A group performed significantly better than the HFA group. Although an overall significant difference was found for Vocabulary, there were no significant between-group differences. These data are reported in Table 2. Discussion This study compared WAISR subtest mean pro- files between groups of adults with HFA and individu- als with three different academic profiles in an effort to determine cognitive profile characteristics that discrim- inated among these groups. The adults with LD were divided into subtypes based on performance levels in mechanical reading and arithmetical computation. In general, the HFA group performed better than the LD subtypes on the WAISR subtests. Examination of the profiles suggests that the HFA group was most like the R > A LD subtype with regard to both verbal and per- formance abilities. The HFA group, however, did more A COMPARISON OF WAISR PROFILES 151 Figure 1. WAISR subtest profiles for the autism and learn- ing disability group 152 poorly than the R> Asubtype on subtests involving so- cial judgment, including Comprehension, Picture Completion, and Picture Arrangement. Otherwise, there were no significant differences, or the HFAgroup outperformed the A> Rgroup and the Global group but not the R > A group. The results of this study suggest that individuals with HFA have a very different cognitive profile from LD subtypes. Individuals with HFA have relatively strong points in the areas of semantic memory, atten- tion, and spatialconstructional abilities. They are rela- tively weak with regard to tasks requiring social judgment and perception. The strengths of the LD par- ticipants depend to some extent on the subtype. The R> A subtype had relatively good social judgment, verbal reasoning, and spatialconstructional abilities. The A> R subtype had generally low subtest scores but rela- tively good spatialconstructional abilities. Rourke (1989) described this subtype as being low functioning in the sense that although arithmetic may be better than reading, it is typically at a below-average level. The Global subtype has almost precisely the same WAISR subtest profile as does the A > R subtype, but it is slightly elevated. These results indicate that the cognitive profile of in- dividuals with HFAis most like what is seen in individ- uals with LD who are not significantly impaired in reading but who have academic difficulties in other ar- eas. Examination of the R > A WAISR profile indi- cates that this group did most poorly on those subtests that involve numbers, with other test scores ranging around the average level. They may be best character- ized as having the DSMIIIR diagnosis of Develop- mental Arithmetic Disorder. That is, the members of this group typically did not have dyslexia and appeared to have relatively good social cognition, but they had a rather specific difficulty with working with numbers. Klin, Volkmar, Sparrow, Cicchetti, and Rourke (1995) reported that the cognitive profile in Aspergers Disorder, but not HFA, is similar to non- verbal LD (Rourke, 1989). Findings from this study would therefore parallel their conclusions in that al- though we did not study individuals with Aspergers Disorder, the profile of the HFA participants con- tained many differences from what is observed in nonverbal LD. Particularly notable in the HFA profile was the absence of deficits in arithmetic and in spa- tialconstructional abilities. Perhaps the profile for the HFA group can be best characterized as being similar to the R > A group with the exception of tasks requir- ing social judgment, on which the HFA group demon- strated relatively impaired performance both in verbal and performance modalities. Thus, the difference is better conceptualized in terms of social versus nonsocial task requirements, rather than verbal versus performance abilities. Although this study was conducted with an adult sample, there are implications for children in a number of respects. With regard to autism, the course of this disorder is lifelong and there is no indication of a remis- sion during adolescence or adulthood. However, there is a developmental pattern characterized by differing courses for different cognitive abilities. The situation appears to be that individuals with autismdo not deteri- orate but, rather, do not keep up with their normal age peers for certain abilities. For basic language skills such GOLDSTEIN ET AL. Table 2. WAIS-R Subtest Scores for the High-Functioning Autism and Learning Disability Groups Autism A > R R > A Global Subtest M SD M SD M SD M SD F Scheffe a Information 9.03 4.26 6.28 1.74 7.38 2.39 6.68 2.28 5.97*** 1 > 2, 4 Comprehension 7.35 3.70 8.28 3.18 10.44 3.29 8.57 2.84 3.51* 3 > 1, 2, 4 Arithmetic 8.68 3.96 6.39 1.91 6.88 1.50 6.56 1.97 5.77* 1 > 2, 4 Similarities 8.53 3.52 7.72 3.01 10.38 2.87 8.72 2.98 2.16 Digit Span 9.00 3.58 5.94 1.95 8.06 1.91 6.76 1.75 9.38*** 1 > 2, 4 Vocabulary 8.41 3.60 6.39 2.30 8.56 2.56 6.97 2.17 4.11** Digit Symbol 6.85 2.65 6.89 2.63 7.31 2.06 7.25 2.35 0.29 Picture Completion 7.41 2.08 8.06 3.35 9.94 2.69 8.43 2.58 3.56* 3 > 1 Block Design 9.21 3.21 8.11 2.45 9.00 2.53 8.26 2.60 1.19 Picture Arrangement 8.24 2.55 7.39 2.52 10.63 2.75 8.38 2.56 4.91** 3 > 1, 2, 4 Object Assembly 8.74 3.45 8.72 2.63 8.56 3.46 8.29 2.77 0.21 a 1 = Autism; 2 = A > R; 3 = R > A; 4 = Global. *p < .05. **p < .01. *** p < .001. as phonetics, they start out at normal levels and retain normal function into adulthood. However, for compre- hension skills, they start out at a level comparable to age peers but lose ground as they growolder. Still other abilities, particularly those involving conceptual rea- soning, start out abnormally and remain that way. This material is described in detail in a cross-sectional age-difference study by Goldstein, Minshew, and Siegel (1994). In the case of LD, it is now no longer be- lieved that it is typically outgrown, and remarkable similarities have been found in academic profile and academic performance in children and adults (McCue & Goldstein, 1991). Lincoln, Courchesne, Kilman, Elmasian, and Allen (1988) performed a factor analysis of the Wechsler scales basedona sample of individuals withautism. The first factor received high loadings fromall of the Verbal Scale subtests, the second from Block Design, Object Assembly, andDigit Symbol/Coding, andthe thirdfrom Picture Completion and Picture Arrangement. Thus, it was quitediscrepant fromtheconventional Verbal Com- prehension, Perceptual Organization, and Freedom from Distractibility factors (Cohen, 1957). The factor structure obtained by Lincoln et al. (1988) would there- fore be consistent withour findingof a large discrepancy in the HFA group between Block Design and both Pic- ture Arrangement and Picture Completion, suggesting that the structure of intellectual function in HFAis quite different fromwhat is the case for the general population and for LD. For users of the WAISIII, it has been reported that the factor structure of the WAISIII is quite similar to that of the WAISR, containing Verbal Comprehen- sion, Perceptual Organization, and Freedom from Distractibility (now called Working Memory) factors, with a Processing Speed factor added. Furthermore, the correlations between the two editions are .94, .86, and .93 for Verbal, Performance, and Full Scale IQ, respec- tively (Tulsky, Zhu, & Prifitera, 2000). 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