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Measuring Working Memory With Digit Span and the Letter-Number

Sequencing Subtests From the WAIS-IV: Too Low Manipulation Load and Risk
for Underestimating Modality Effects

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Measuring Working Memory With Digit Span and
the Letter-Number Sequencing Subtests From the
WAIS-IV: Too Low Manipulation Load and Risk for
Underestimating Modality Effects
ab
Jens Egeland
a
Division of Mental Health & Addiction, Vestfold Hospital Trust, Tønsberg
b
Institute of Psychology, University of Oslo, Oslo, Norway
Published online: 24 Apr 2015.

To cite this article: Jens Egeland (2015): Measuring Working Memory With Digit Span and the Letter-Number Sequencing
Subtests From the WAIS-IV: Too Low Manipulation Load and Risk for Underestimating Modality Effects, Applied
Neuropsychology: Adult, DOI: 10.1080/23279095.2014.992069

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 APPLIED NEUROPSYCHOLOGY: ADULT, 0: 1–7, 2015
Copyright # Taylor & Francis Group, LLC
ISSN: 2327-9095 print/2327-9109 online
DOI: 10.1080/23279095.2014.992069

Measuring Working Memory With Digit Span and the

Letter-Number Sequencing Subtests From the WAIS-IV:
Too Low Manipulation Load and Risk for Underestimating
Modality Effects
Jens Egeland
Division of Mental Health & Addiction, Vestfold Hospital Trust, Tønsberg, and
Institute of Psychology, University of Oslo, Oslo, Norway
Downloaded by [University of Oslo] at 00:44 27 April 2015

The Wechsler Adult Intelligence Scale (WAIS) is one of the most frequently used tests
among psychologists. In the fourth edition of the test (WAIS-IV), the subtests Digit Span
and Letter-Number Sequencing are expanded for better measurement of working memory
(WM). However, it is not clear whether the new extended tasks contribute sufficient
complexity to be sensitive measures of manipulation WM, nor do we know to what
degree WM capacity differs between the visual and the auditory modality because the
WAIS-IV only tests the auditory modality. Performance by a mixed sample of 226
patients referred for neuropsychological examination on the Digit Span and Letter-Number
Sequencing subtests from the WAIS-IV and on Spatial Span from the Wechsler Memory
Scale-Third Edition was analyzed in two confirmatory factor analyses to investigate
whether a unitary WM model or divisions based on modality or level/complexity best fit
the data. The modality model showed the best fit when analyzing summed scores for each
task as well as scores for the longest span. The clinician is advised to apply tests with
higher manipulation load and to consider testing visual span as well before drawing
conclusions about impaired WM from the WAIS-IV.

Key words: attention/perception, cognitive/learning, Digit Span, Letter-Number Sequencing, tests,

WAIS, working memory

The concept of working memory (WM) has attained
widespread significance among psychologists working in
different fields. WM is related to fluid intelligence (Shelton,
Elliot, Matthews, Hill, & Gouvier, 2010) and might mediate
state-dependent decrements in learning (Egeland et al.,
2003) and attention (Andersen, Hovik, Skogli, Egeland, &
Øie, 2013). It is also closely linked to executive function
and memory (Unsworth & Spillers, 2010). Deficits in
WM are associated with most clinical states. Reflecting this
close relationship, the concept has been more closely inte-
grated into the Wechsler intelligence scales with successive
Address correspondence to Jens Egeland, Ph.D., Division of Mental
Health & Addiction, Vestfold Hospital Trust, P. O. Box 2267, Tønsberg,
3103 Norway. E-mail: jens.egeland@siv.no
revisions of the tests. In Norway, the Wechsler Adult
Intelligence Scale (WAIS) is the only test used by a
majority of practicing psychologists (Vaskinn & Egeland,
2012), and it is also rated as the most frequently used test
among European psychologists (Evers et al., 2012). It thus
seems reasonable to assume that this test is also the most
widespread measure of WM. Historically, the Wechsler
tests were divided into two factors, performance and verbal
IQ. A third factor called “freedom from distractibility” had
already been identified in the Wechsler-Bellevue Scale in
1952 (Cohen, 1952), although it did not become clinically
relevant until the publication of Kaufman’s (1979) book,
Intelligent Testing With the WISC-R. The third factor was
later further developed and divided into separate measures
 2 EGELAND
of Processing Speed and Working Memory. In the fourth
revision of the WAIS (Wechsler, 2008), both the Digit Span
test and the Letter-Number Sequencing subtest were further
developed to provide a better assessment of the manipu-
lation element in WM. WM is still only tested in the
auditory modality. The question asked here is whether the
changes made are sufficient for considering the Wechsler
Adult Intelligence Scale-Fourth Edition (WAIS-IV) a
relevant tool for measuring WM.
In the Letter-Number Sequencing subtest in the WAIS-
IV, participants now receive 3 training tasks and the number
of tasks are extended from 21 to 30 by introducing 6 tasks
involving only one letter and number and by extending the
number of three-letter tasks to 9 instead of 3. Sequential
Span was introduced as a new subtask in the WAIS-IV Digit
Span, adding to Digit Forward and Backward to increase
manipulation WM load. The base-rate figures are offered
based on the maximal span for each of the tasks as are base
Downloaded by [University of Oslo] at 00:44 27 April 2015
rates for difference scores between the different conditions.
Originally, the concept of WM was introduced by
Baddeley and Hitch (1974) and was referred to as the multi-
modal model of WM. Two modality-specific slave systems
were posited: the phonological loop and the visual-spatial
scratchpad. The slave systems were equivalent to attention
span or short term-memory capacity and were involved in
simple storage of information for a short period of time.
Whenever the information had to be manipulated in some
way, a more complex overarching non-modality-specific
system called the central executive had to be activated.
The unique contribution of the model was the postulation
of the central executive because short-term memory was
already an established concept (Miller, 1956). When
referring to WM today, it is unclear whether one refers to
the central executive element solely or whether the slave
systems are considered as well. Engle (2010) argue that it
is the complex span tests that are important for variability
in WM. Individual differences appear mainly when there
is demand for some distracting activity or retrieval from
secondary memory (Unsworth & Engle, 2007). According
to this view, only the complex tests have external validity
in the sense of being able to account for differences in
learning ability specifically (Unsworth & Engle, 2007) or
other cognitive and adaptive functions more broadly (Engle,
2010). This is in line with Miake’s (2001) view, calling for
the use of WM span tasks that are different from simple
short-term memory tasks such as digit span by imposing
dual-task demand on the participant (i.e., some sort of
simultaneous mental manipulation while processing infor-
mation). In the Engle (2010) view of WM, the phonological
loop and visual-spatial scratchpad posited by Baddeley and
Hitch (1974) become less central, as they are considered
merely two of what could be a dozen modality- or
material-specific stores.
The distinction between simple storage and complex
manipulation tasks seems now to be well established and
is often used in clinical research. One example is the
finding of Martinussen, Hayden, Hogg-Johnson, and
Tannock (2005) that participants with attention-deficit
hyperactivity disorder (ADHD) are more impaired in
manipulation compared with simple storage.
On the other hand, possible domain-specific impair-
ments have continued to be of interest within research in
dyslexia, specific language impairment, and nonverbal
learning disorders. Shah and Miyake (1996) demonstrated
that reading span correlated well with reading comprehen-
sion measures but not with spatial ability measures,
whereas the spatial span showed the opposite pattern.
However, Miake (2001) emphasized that the correlations
between reading comprehension and WM are higher for
complex reading span than for digit span, although these
measures also correlate. Reduced phonological awareness,
which is highly associated with reduced digit span perfor-
mance, is characteristic of dyslexia. In a meta-analysis of
53 studies, Melby-Lervåg, Lyster, and Hulme (2012) found
that participants with dyslexia performed 0.71 standard
deviations below healthy controls on auditory short-term
memory measures, including Digit Span Forward. Of
studies comparing impairment within both the auditory
and visual domains, Gooch, Snowling, and Hulme (2011)
found that digit recall was impaired in dyslexia but not in
ADHD, while visual span was impaired only in ADHD.
Witruk, Ho, and Schuster (2002) found no support for
a general, modality-independent deficit in children with
dyslexia, as found in those with ADHD. The previously
cited study by Martinussen et al. (2005) also revealed
a modality effect in ADHD, with larger effect sizes in both
visuospatial storage and manipulation tasks compared with
the corresponding auditory WM tasks. Preßler, Krajewski,
and Hasselhorn (2013) identified groups of children charac-
terized by either visual or phonological WM deficits and
found that good phonological WM was favorable for the
later acquisition of reading, writing, and mathematics,
whereas good visual WM was a prerequisite for arithmetic
skills. These studies indicate that modality differences in
WM capacity may be important when considering reading
and writing impairments. Aboitiz, Aboitiz, and Garcia
(2010) claimed that the phonological loop is vital both for
the phylogenetic and ontogenetic development of language.
In their meta-analysis of brain mechanisms underlying
WM, Nee et al. (2013) found that a content division (i.e.,
modality) was more prominent than functional divisions
(i.e., storage and manipulation).
Summing up, it seems to be a convergence among
researchers that complex span tasks are best for detecting
test variability and to account for daily life variability
in performance. The first question posed here, however,
is whether the changes made in both the Digit Span
and Letter-Number Sequencing subtests in the WAIS-IV
are sufficient for differentiating them from the simple
forward condition measuring short-term memory capacity.
 WAIS WORKING MEMORY 3

The importance of modality differences for variability in
WM is less clear. Modality-specific impairments may play
a role in dyslexia, particularly when measured with simple
span tasks, but they may perhaps account for less variability
in more complex manipulation tasks. The next research
question is therefore related to the amount of modality-spe-
cific variability in the span tests in the WAIS-IV. In the
clinic, we were interested in whether it is sufficient to test
WM only in the auditory modality as is done in the
WAIS-IV.
In the technical and interpretative manual of the WAIS-
IV (Wechsler, 2008, p. 15), Digit Span Forward is described
as a test involving “attention, encoding and auditory
processing,” while the term WM is reserved for the Back-
ward and Sequencing tasks as well as the Letter-Number
Sequencing subtest. There is no reference to modality
specificity in describing these tasks. The question for the
clinician is whether (a) to limit interpretations of impaired
Downloaded by [University of Oslo] at 00:44 27 April 2015
relevant only in special cases but not necessarily in standard
assessments because it does not posit a fundamental threat
to generalizing the auditory tests to WM in general. A best
fit for the unitary model would be taken as an indication
that the Backward, Sequencing, or Letter-Number Sequen-
cing tasks are not sufficiently complex to be differentiated
from the simple Forward task. If a level model gives best
fit to the data, the WAIS has accomplished what was
intended with the revision of the WM tasks from the third
to the fourth revision. If the modality model gives the best
fit, one must be careful in inferring both a general WM defi-
cit and an impairment in the executive element as well. The
WAIS-IV offers both measures of length of best span or
total score earned for each condition. It is an empirical
question as to which set of measures best reflects the under-
lying structure of WM or whether they show the same struc-
ture. In the CFA presented here, the three hypothesized
models are tested both with the total points for each subtask

performance to a possible modality-specific impairment, and with the maximal length of each task. For the Spatial
or (b) to interpret impairment in the latter three WM tests Span in the WMS-III, no such division between span length
as a level effect in manipulation specifically or (c) as and total scores is offered.
a general effect. This could be crucial when examining
participants for either reading or language deficits or a more
general deficit expected, for example, in ADHD or schizo- METHODS
phrenia. How often this leads to problems of interpretation
of the test findings when test participants exhibit a range Participants
of different cognitive problems is not clear. This could
be rephrased as a question of what is the most potent Two hundred and twenty-six sequentially collected test
dimension of WM when using the span tests offered in the protocols were taken from the author’s part-time private
Wechsler tests and whether it could be tested in practice. Permission was granted by the Norwegian Data
a confirmatory factor analysis (CFA). Inspectorate. The participants had been referred for specia-
The last two revisions of the WAIS have been standar- lized neurocognitive assessment. Table 1 shows the compo-
dized together with new versions of the Wechsler Memory sition of the sample divided according to diagnosis or cause
Scale (WMS). This scale offers a visual analogue to the of referral/tentative diagnosis before assessment to give the
Digit Span subtest in the WAIS, the Spatial Span subtest, reader a picture of the heterogeneity of the cognitive and
which is equivalent to the Corsi Block Test. A CFA of psychological conditions involved. The age of the parti-
the WMS-Third Edition (WMS-III) showed a separate cipants ranged from 16 to 82 years old (Mage ¼ 38.1 years,
WM factor composed of Spatial Span and Letter-Number
Sequencing (Millis, Malina, Bowers, & Ricker, 1999). A TABLE 1
joint WMS-III and WAIS-Third Edition (WAIS-III) CFA Cause of Referral/Tentative Diagnosis
also showed a WM factor composed of Spatial Span N %
together with the three WAIS-III tests comprising the
WM index in that test. A CFA of the WAIS-IV and the Attention-deficit hyperactivity disorder 55 24.3
Learning disorders 45 20.0
WMS-Fourth Edition (Holdnack, Zhou, Larrabee, Millis,
Mild cognitive impairment 12 5.3
& Salthouse, 2011) showed two models that fit the data Cerebrovascular accidents 12 5.3
equally well: a seven-factor model with separate auditory Traumatic brain injury 12 5.3
and visual WM factors and a five-factor solution with a Acquired cognitive dysfunction of unclear origin 33 14.6
unitary WM factor. Addiction 14 6.2
Affective disorders 11 4.9
In the current study, we analyzed the raw scores of the
Toxic solvent exposure 6 2.7
WMS-III Spatial Span Forward and Backward tasks Anxiety disorders/posttraumatic stress disorder 6 2.6
together with the WAIS-IV Digit Span and Letter-Number Fatigue 10 4.4
Sequencing raw scores to determine whether a unitary WM Schizophrenia 5 2.2
factor, level, or modality factors provide the best fit to the Mental retardation 1 0.4
Other 4 1.8
data. If a unitary factor or a level model offers the best
Total 226 100.0
fit, one could claim that the testing of visual WM may be
 4 EGELAND
SD ¼ 14.3). Fifty-three percent of participants were men
and 47% were women. The mean General Ability Index
was 92 (SD ¼ 15) and ranged from 57 to 141.
Measures
From the WAIS-IV Digit Span subtest, the following mea-
sures were collected: Digit Span Forward, Backward, and
Sequencing total scores, as well as longest span for each
task. Total score and longest score were also collected from
the Letter-Number Sequencing subtest. To give background
information as to the overall intellectual functioning of
the participants, the General Ability Index was computed
based on the three subtests comprising the Verbal Compre-
hension Index (Similarities, Vocabulary, and Information)
and the three subtests comprising the Perceptual Reasoning
Index (Block Design, Matrix Reasoning, and Visual
Puzzles).
Downloaded by [University of Oslo] at 00:44 27 April 2015
From the WMS-III, the total scores on the subtest Spatial
Span Forward and Backward were analyzed.
Data Analyses
The goodness-of-fit for five different factor models was
tested in two separate sets of analyses, where total scores
were entered in the first set. In the second set, the relevant
span length was entered for the WAIS-IV data, because the
WAIS provides an assessment of these measures as well.
For Spatial Span, total scores for the forward and backward
conditions were entered in both sets of analyses. The
models read as follows:
1. One general WM factor underlying all six measures.
2. a, 2b, and 2c. Level of processing distinguishing
between a simple storage factor and a manipulation
factor. To be comprehensive, we tested three variants
of the division in levels: In 2a, Digit Span Forward
and Spatial Span Forward were considered simple
storage tasks, while Digit Span Backward, Sequential
Span, and Spatial Span Backward and the Letter-
Number Sequencing subtest were considered manipu-
lation tasks tapping the central executive. Model 2b
tests the hypothesis that the two backward conditions
are not complex enough to sufficiently tax executive
functions and will therefore group together with the
forward conditions of the same task. The Sequential
task and the Letter-Number Sequencing Span will
then comprise the more complex manipulation factor.
Model 2c is based on the findings by Wilde, Strauss,
and Tulsky (2004) and Kessels, van den Berg, Ruis,
and Brands (2008) that Spatial Span Backward differs
from Digit Span Backward by not being more
demanding than the forward condition. Replicating
this finding in healthy controls, Bacon, Parmentier,
and Barr (2013) nevertheless found that in dyslexia,
Spatial Span Backward is differentially impaired.
Thus, in this model, Digit Span Forward and both
Spatial Span conditions are considered to measure
simple storage, while Digit Span Backward, the
Sequential task, and the Letter-Number Sequencing
Span measure manipulation.
3. The modality model. In this model all auditory tests
are grouped together (all three subtasks of Digit
Span þLetter-Number Sequencing) in one factor
hypothesized to differ from a visual factor composed
of Spatial Span Forward and Backward.
CFA was conducted on raw scores for each of the four
models, applying the LISREL 8.3 program (Jöreskog &
Sörbom, 1993). The goodness-of-fit measures should be
interpreted as follows (Keith, 2005).
Chi-square (v2). When applying chi-square in
comparing the hypothesized and observed models, a low
value means a good fit.
v2/df. If the chi-squares for two models are the same,
the more constrained or more parsimonious model is pre-
ferred. Parsimony is reflected in CFA models by df. Thus,
the smallest v2 in comparison to df represents the best fit
of the data and should be no more than 2 for a good model
fit (Jöreskog & Sörbom, 1993).
Goodness-of-fit index and adjusted goodness-of-fit
index. These measures show how much better the model
fits as compared with no model at all. The adjusted
goodness-of-fit index is adjusted for degrees of freedom.
Values can vary from 0 to 1. Values greater .90 indicate a
good model fit.
Comparative fit index. Values of .95 or greater sug-
gest a good fit of the model to the data, and values greater
than .90 suggest an adequate fit.
Root mean square error of approximation. The
root mean square error of approximation (RMSEA) is a mea-
sure of approximate fit. Smaller values suggest a better fit,
with values of .06 or less suggesting a good fit and those
of approximately .08 suggesting an adequate fit.
RESULTS
Table 2 shows the results of the CFA based on total scores
from each of the WM subtests. Only the modality factor
model depicted in Figure 1 shows adequate or good fit
between the model and the observed results for all fit
indexes. The high v2/df and RMSEA values clearly show
that the other factor models are not valid. Table 3 shows
the equivalent fit statistics based on the best or longest span.
 WAIS WORKING MEMORY 5

TABLE 2
CFA of Unitary, Level, and Modality Models of WM-Span Subtest Scores From WAIS-IV and WMS-III (N ¼ 226)

Model χ2 (df) χ2/df GFI AGFI CFI RMSEA

1. Unitary WM 32.43 (9) 3.60 .95 .90 .94 .109

2a. Level model: DF þ SF vs. DB, DS, SB, LN 27.13 (8) 3.39 .96 .90 .94 .104
2b. Alternative level model: DF, DB, SF, SB vs. DS, LN 30.83 (8) 3.85 .96 .88 .94 .114
2c. Alternative level model: DF, SF, SB vs. DB, DS, LN 32.52 (8) 4.06 .95 .88 .93 .118
3. Modality model 6.55 (8) 0.82 .99 .97 1.0 .0

Note. Numbers in bold satisfy criteria for adequate fit between model and data. CFA ¼ confirmatory factor analysis; WM ¼ working memory; WAIS-IV ¼
Wechsler Adult Intelligence Scale-Fourth Edition; WMS-III ¼ Wechsler Memory Scale-Third Edition; GFI ¼ Goodness-of-Fit Index; AGFI ¼ Adjusted
Goodness-of-Fit Index; CFI ¼ Comparative Fit Index; RMSEA ¼ root mean square error of approximation; DF ¼ Digit Span Forward; DB ¼ Digit Span
Backward; DS ¼ Digit Span Sequence; LN ¼ Letter-Number Span; SF ¼ Spatial Span Forward; SB ¼ Spatial Span Backward.

DISCUSSION

The study is based on clinical data. The research literature

convincingly shows that WM can be subdivided according
to both modality and level of processing (Martinussen et al.,
Downloaded by [University of Oslo] at 00:44 27 April 2015

2005) and that complex WM tasks better detect ecologically

FIGURE 1 Two-factor modality-based model for Digit Span, Spatial
Span, and Letter-Number Sequencing. DF ¼ Digit Span Forward; DB ¼
Digit Span Backward; DS ¼ Digit Span Sequence; LN ¼ Letter-Number
Span; SF ¼ Spatial Span Forward; SB ¼ Spatial Span Backward.
The fit measures were best for the modality model as well,
although the v2/df was not less than 2, as is considered the
cutoff for a good model fit. Thus, the modality model based
on total scores was superior to all other models.
valid variability. The first issue addressed here is whether
the difference in complexity or manipulation load between
the simple storage test (i.e., the forward span condition on
the one side) and the manipulation tasks (i.e., the backward,
sequencing conditions, and the Letter-Number Sequencing
subtest) are large enough to stand out as separate factors
in a CFA. The second issue addressed is whether modality
differences can confound interpretations of WM impair-
ment when only the auditory modality is assessed as is
the case in the WAIS-IV. Both issues are highly relevant
for clinical practice because the WAIS-IV is so frequently
in use in the clinic. The results show that the differences
in level of processing were not large enough to separate
a manipulation or complex WM element from the simple
storage element. However, the CFA showed that a unitary
WM model did not provide a good fit for the data either.
The modality model was the only model that had satis-
factory fit to the data when analyzing total scores, and
it was superior to the other models when analyzing span
length as well.
The findings are consistent with the findings of Kessels
et al. (2008) of a verbal and spatial factor in a principal

TABLE 3
CFA of Unitary, Level, and Modality Models of WM-Span Best Performance Scores From the WAIS-IV and WMS-III (N ¼ 226)

Model χ2 (df) χ2/df GFI AGFI CFI RMSEA

1. Unitary WM 54.48 (9) 6.05 .92 .82 .88 .152

2a. Level model: DF þ SF vs. DB, DS, SB, LN 52.07 (8) 6.51 .93 .81 .88 .158
2b. Alternative level model: DF, DB, SF, SB vs. DS, LN 41.38 (8) 5.17 .94 .85 .91 .138
2c. Alternative level model: DF, SF, SB vs. DB, DS, LN 55.20 (8) 6.90 .92 .80 .87 .164
3. Modality model 18.09 (8) 2.26 .97 .93 .97 .076

Note. Numbers in bold satisfy criteria for adequate fit between model and data. CFA ¼ confirmatory factor analysis; WM ¼ working memory; WAIS-
IV ¼ Wechsler Adult Intelligence Scale-Fourth Edition; WMS-III ¼ Wechsler Memory Scale-Third Edition; GFI ¼ Goodness-of-Fit Index; AGFI ¼ Adjusted
Goodness-of-Fit Index; CFI ¼ Comparative Fit Index; RMSEA ¼ root mean square error of approximation; DF ¼ Digit Span Forward; DB ¼ Digit Span
Backward; DS ¼ Digit Span Sequence; LN ¼ Letter-Number Span; SF ¼ Spatial Span Forward; SB ¼ Spatial Span Backward.
 6 EGELAND
component analysis of Digit Span and Corsi Block Span in
elderly individuals. Bowden, Petrauskas, Bardenhagen,
Meade, and Simpson (2013) performed a CFA on all single
Digit Span Forward and Backward items and found no fit
for the forward/backward dichotomy. They concluded that
forward and backward span reflect the same cognitive
ability. Neither Perry et al. (2001) nor Twamley, Palmer,
Jeste, Taylor, and Heaton (2006) found differences between
forward and backward span in patients with schizophrenia,
otherwise expected to have a specific deficit in the manipu-
lation element of WM. This was taken to mean that the
backward span was not sensitive enough to capture differ-
ential impairments. Instead one has to use more complex
tests, as suggested by Engle (2010) and Miyake (2001).
The fact that the differences in manipulation load were
lower than the size of the modality effect even when includ-
ing the Sequence task and the extended Letter-Number
Sequencing subtest indicates that the addition and extension
Downloaded by [University of Oslo] at 00:44 27 April 2015
of the presumptive WM tasks in the WAIS-IV are not suf-
ficient to test complex WM considered to be most clinically
relevant.
The fit between the modality model and the observed
scores was not only better than the different complexity
models, but it represented a good fit. The supremacy of
the modality model was therefore not due to the lack of sen-
sitivity to complexity differences. There could be several
reasons for this. One is related to the sample: Could it be
an overrepresentation of participants with specific learning
deficits either related to language or visuospatial proces-
sing? Twenty percent were referred with a suspected
learning deficit. Thirteen of these participants (5% of the
sample) were suspected to have a language-related learning
disorder, and five (2% of sample) were suspected to have
a possible nonverbal learning deficit, which is as expected
in a mixed clinical sample. Another explanation seems
more plausible: As claimed by Engle (2010), simple tasks
are more automatic and do not capture deficits in controlled
attention, shifting, or inhibition that constitute the varia-
bility seen in more complex tests. The closer one gets to
testing sensory capacity with little demand for executive
monitoring, the more dominant the interindividual differ-
ences in preferred or dominant processing mode will be.
If we then consider the span tests of the WAIS as more
simple storage capacity tests and not tests of complex WM,
it is important not to conclude that participants have a nor-
mal WM based on such tests alone. Conversely, impaired
span test performance could not safely be interpreted as
anything more than a deficit in auditory processing capacity
unless it is supplemented by a corresponding test of
visuospatial span, such as the one applied here from the
WMS. Detecting a modality supremacy or deficit in
individual cases, however, may be important both for the
diagnosis of learning deficits and reading disorders and
for guidance as to how patients will learn most effectively.
The latter is particularly important if the modality
difference in simple span is also corroborated in memory
tests or by a difference between the Perceptual Reasoning
and Verbal Comprehension Indexes in the WAIS-IV.
Lasonen, Leppämäki, and Hokkanen (2009) found that
only participants with dyslexia and not those with ADHD
performed poorer than controls on the Digit Span subtest
of the WAIS-III. Goldstein, Beers, Siegel, and Minshew
(2001) found that only those with a reading disorder or glo-
bal deficits were impaired in the Digit Span in a comparison
of children with deficits in arithmetic and reading, global
learning disorders, and autism. These results are to be
expected given the present findings, but to the author’s
knowledge, they have not been replicated with the WAIS-
IV extended span testing.
The Digit Span and Letter-Number Sequencing of the
WAIS are only two of the three tests comprising the
WAIS-IV WM Index score. However, the problem of gen-
eralizing an auditory test result to WM in general might be
accentuated when including the third subtest, Arithmetic.
For the third version of the WAIS, the Arithmetic subtest
was found to measure verbal learning more than WM
(Gregoire, 2004), and it fit better into a verbal comprehen-
sion factor than a WM factor (Egeland, Bosnes, &
Johansen, 2008). The CFA based on the normative sample
of the WAIS-IV showed the best fit between model and
observed scores when the Arithmetic subtest was allowed
to load on both Verbal Comprehension and Working
Memory (Wechsler, 2008). This finding had nevertheless
no consequences for the computation of index scores in
the WAIS-IV.
There are some limitations to the study. The sample is
not very well described in terms of diagnoses, only by
initial cause of referral, which in some cases included
a good diagnostic process. The purpose of the neuro-
psychological testing involving the WAIS-IV was to give
a functional description, rather than a diagnosis. In the cases
where a definite diagnosis was set, the test results were part
of the diagnostic decision, thus confounding independent
and dependent variables. Nevertheless, the list of causes
of referral shows that a wide array of clinical problems
was examined and contributed to variance in the examined
measures. If only participants with specific learning deficits
were examined, the modality effects would probably be
even more prominent. The study is based on clinical file
data. If the study had been designed as a WM study from
the start, we would have included WM tests that involved
a higher cognitive load, and thus, we would have expected
that complexity level would emerge as a factor. However,
the purpose of the study was not to test the dimensions of
WM as such, but to check the validity of the presumed
WM tests in the WAIS-IV. The finding of the prominence
of modality advises the clinician on the one hand to also
apply tests of complex span and to include a spatial or
visual measure before drawing firm conclusions about
a WM deficit.

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