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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). Thus, the find-
ings reported here are likely to be applicable to the
WAISIII. Clearly, however, further research in this
area should use this newly developed, state-of-the-art
instrument. Limitations of this study are insufficient
sample size to perform factor analyses and more ad-
vanced analyses of profile similarities and differences
as well as use of the WAISR rather than the
WAISIII, necessitated by the low prevalence of HFA.
As larger samples of individuals with HFA become
available, further exploratory as well as confirmatory
factor analytic studies might yield valuable new infor-
mation regarding ability structures in these different
developmental disorders.
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Original submission March 31, 2000
Accepted February 8, 2001
GOLDSTEIN ET AL.