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Measurement of Intelligence in Children and Adolescents with Autism Spectrum Disorder: Factors Affecting Performance

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Measurement of Intelligence in Children and Adolescents with Autism Spectrum Disorder: Factors Affecting Performance Measurement of Intelligence in Children and Adolescents with Autism Spectrum Disorder: Factors Affecting Performance A doctoral dissertation submitted to the Graduate School of the University of Cincinnati in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Psychology of the College of Arts and Sciences by Katherine T. Baum, M.A. September 1, 2011 Committee: Paula Shear, Ph.D. (Chair) Somer Bishop, Ph.D. Steven Howe, Ph.D. Sarah Whitton, Ph.D. Abstract The assessment of children with autism spectrum disorders (ASD) requires the measurement of intelligence, because the diagnostic criteria include a judgment about whether social and communication deficits are greater than would be expected given the general developmental level of the child. In addition, results of cognitive testing, including IQ scores and the potential discrepancy between verbal and nonverbal intellectual abilities, impact educational placement, treatment strategies, research design, and theories of neurodevelopment and cognition in ASD. Despite its widespread importance, there are fundamental methodological aspects of intellectual assessment in ASD, such as the intelligence measure selected, that may affect testing results. The Wechsler Intelligence Scale for Children (WISC) and the Stanford-Binet (SB) are two of the most commonly used measures to evaluate intelligence in ASD. Full-scale and composite scores on the WISC and SB have been shown to be highly correlated with each other in several pediatric populations, including children with mild intellectual disability (ID) or attention-deficit hyperactivity disorder (ADHD), as well as in typically-developing children. Despite these high correlations, significant discrepancies between the scores, as many as 20 IQ points, have been reported for an individual. Comparisons between scores on the WISC and SB have not been made in children with ASD. The present study focused on how the WISC and SB compare on IQ scores, as well as characterization of intelligence and verbal-nonverbal discrepancy. The study also addressed the question of whether diagnostic symptoms, adaptive functioning, or neuropsychological deficits associated with the clinical presentation of ASD, differentially affect performance on the WISC and the SB. Forty children with ASD between the ages of 10 and 16, who were recruited through an autism clinic, completed a test battery (WISC-IV, SB-5, Beery VMI, CELF-Screener, and NEPSY – vii Theory of Mind) and parents completed several measures assessing behavior, ASD symptomatology and adaptive functioning. Full-scale (FSIQ), verbal, nonverbal and working memory scores were highly correlated between the two tests. FSIQ and verbal IQ scores differed significantly between the two tests, although on average, less than 4 IQ points. The majority (72%) obtained higher FSIQ scores on the SB-5, with 14% obtaining scores on the two tests that were greater than one standard deviation from one another. Verbal and nonverbal differences between scores were similar with 16% and 18%, respectively, scoring more than one standard deviation. Classification of verbal-nonverbal discrepancies was consistent for 62-67% of the sample, depending on criteria used. The expectation that domains of cognitive functioning that are disproportionately affected in this population (e.g., language abilities, visual-motor skills, and theory of mind) would be related to performance on intelligence measures, was not supported. However, age was associated with FSIQ and nonverbal IQ difference scores on the two tests with older participants scoring higher on the SB-5. All IQ scores from both the WISC-IV and SB-5 were moderately correlated with adaptive functioning, with the exception of the WISC’s nonverbal score (WISC-PRI). Overall, the convergent validity of the WISC-IV and SB-5 is good in children and adolescents with ASD. Although the average difference between tests on FSIQ and verbal scores was relatively small, approximately 15% of individuals obtained significantly different scores and classifications on the two tests. Older children and those with greater theory of mind skills tended to score higher on SB-5 full-scale and nonverbal indices relative to the WISC-IV. Further, verbal- nonverbal discrepancy classifications were only moderately consistent. Replication of these findings and comparisons to other diagnostic groups will provide further support for the convergent validity of the two measures and a more comprehensive assessment of neuropsychological functioning may determine whether these factors differentially impact performance on these two IQ tests. viii ix ACKNOWLEDGEMENTS I would first like to acknowledge my dissertation committee members, Drs. Paula Shear, Steven Howe, Somer Bishop, and Sarah Whitton, whose feedback was instrumental in the preparation of this document. My chair and mentor, Dr. Paula Shear, deserves special acknowledgement for her guidance on this document and throughout my training. Her encouragement and support instigated the beginning and completion of this ambitious project. This research would not have been possible without the incredible knowledge and direction of Dr. Somer Bishop who revealed the need for this type of research. Somer, your passion for the world of autism is infectious and I am grateful to have been under your mentorship. A special thanks to Dr. Steve Howe for his time and expertise on this project, as well as throughout my graduate training. Oh how I will miss your honest and witty critiques. Additionally, thank you to the ‘Bishop Lab’ of Cincinnati Children’s Hospital for their support, especially Dr. Amie Duncan and Ms. Leslie Markowitz who spent hours collecting parent data. Thanks to Suzan Sucro for her assistance. This work was supported by Dr. Catherine Lord (NICHD#: RC1MH089721), Dr. Mike Richardson of the University of Cincinnati’s Department of Psychology, and the Department of Psychology’s Seeman- Frakes funds. I am particularly grateful to all the families who shared their time, energy, and lives with me through participation in this study. Parents, you are not alone in seeing the beautiful light that your children bring to this world through their strength, minds, and unique characters. The completion of this dissertation project marks the culmination of many years of work toward by doctorate in psychology at UC. Thank you to those who made my life outside of UC worthwhile: to my grad school friends for walking side-by-side with me through these last few years, to my family, especially my parents, whose love and pride have proven to be an inspiration, and most importantly, to my husband and best friend. Nick, your unyielding encouragement, support, and understanding has kept me sane and made this all possible. You are my rock. x TABLE OF CONTENTS Page ABSTRACT………………………………...…………………………………...…………….. vii ACKNOWLEDGMENTS……………………..…………………………………………….. x TABLE OF CONTENTS……………………………..………………….………………….. xi LIST OF TABLES………………………………………………...……………………...…... xiii LIST OF FIGURES …………………………..……………...………………………..……... xiv CHAPTER I. INTRODUCTION 1 Diagnostic Assessment…………………………………………………………...………… 1 Theory of Intelligence in ASD……………………………………..…………..……………. 4 IQ and Other Domains …………………………………………………………………….. 5 Service Eligibility and Planning………………………………....………………………..….. 8 Clinical use of IQ Scores in ASD……………………………...…………………………..… 9 Use of IQ in ASD Research…………………………………..…………………………….. 10 Adaptive Functioning in ASD………………………………………………………………. 12 Selection of Instruments to Estimate Intelligence in ASD……………………...…………… 13 II. METHOD 21 Participants……….………………………………………………………………........……. 21 Procedures………………………………………………...………………………...………. 23 Measures……………………………………..………………………………..……………. 25 Statistical Analyses……………………………………………...………………..………….. 34 xi III. RESULTS 36 Convergent Validity Between WISC-IV and SB-5………………………...…...…………….. 36 Full Scale IQ………………….…………………………………...............…………………. 39 Verbal Intelligence Scores………………………………………………………..…………. 41 Nonverbal Intelligence Scores……....…………………………...…………………...……… 43 Working Memory Scores…………………………………………..…………………..……. 44 Classification of Intellectual Functioning Based on Index Scores Across Measures………..... 45 Verbal–Nonverbal IQ Discrepancy Scores on the WISC-IV and SB-5…………..………….. 49 Variables Associated With Score Differences Between WISC-IV and SB-5………..………... 52 Test Order Effects on Group Differences………………………………………………… 58 IQ and Adaptive Functioning…………………………...…………..……………………… 62 IV. DISCUSSION 66 Classification of Intelligence………………………...………..……………………………... 70 Factors Accounting For IQ Score Differences……………………………...………………. 72 Verbal-Nonverbal Discrepancies……………….…………………………………….…… 75 Test Order Effects………………………………….……………………….……………… 76 IQ Scores and Adaptive Functioning……………………………………….……………… 78 Sample Characteristics…………………………….…………………….…………………... 79 Limitations and Future Studies……………………………………………..……………….. 80 REFERENCES……………………………………………………………………………… 82 xii LIST OF TABLES TABLES Page 1. DSM-IV-TR Criteria for Autistic Disorder (AD), Asperger’s Disorder (AspD), and PDD-NOS ...……………………………………….……………………. 3 2. Child Demographic and Diagnostic Data (n = 40) ………………...………… 24 3. Index Scores by IQ Measure………………………………………..………… 27 4. Multi-trait, Multi-method Evaluation of the Wechsler Intelligence Scale for Children 4TH Edition (WISC-IV) and Stanford Binet, 5th Edition (SB-5) …...… 38 5. Child IQ Data……………………...…………………………………………. 39 6. Classification of Cognitive Ability by FSIQ Scores on
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