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BACKGROUND

The WISC is the most widely used test of cognitive abilities in children. Many interpretive models suggest that subtests can be used to help diagnose mood or attention problems (Sattler, 2001; Kaufman, 1994). There has been relatively little research investigating this use of the WISC or other similar tests of cognitive ability for discriminating ADHD (cf. Prifitera & Dersh, 1993; Assesmany et al., 2000, and Filippatou & Livaniou, 2005 for exceptions), and no published research pertaining to discrimination of pediatric bipolar disorder despite recent interest in neuropsychological functioning in bipolar (e.g., Dickstein et al., 2005). Given the popularity of the WISC and the growing interest in diagnosing both ADHD and pediatric bipolar disorder, it would be highly valuable to understand whether subtests are indeed useful in predicting these diagnoses. If ADHD or bipolar disorder showed distinctive patterns of performance on subtests of the WISC, this also could help define an “endophenotype” that would aid research into the underlying mechanisms of illness and treatment.

Does the WISC Help Discriminate Bipolar Disorder or ADHD in Youths Referred for Clinical Services?

METHOD

Data were collected over a period of five years at an inpatient psychiatric facility in New York State (1988-1993). See Carlson & Kelly (1998) for a detailed description of inclusion criteria and measures administered in this sample. We examined a subset of 227 individuals for whom both KSADS diagnoses and WISC data (WISC-R) were available. Diagnoses were based on the KSADS semistructured interview of both parent and child and observations by trained staff over the first 2 weeks of hospitalization (Carlson & Youngstrom, 2003).

Contact eric.youngstrom@unc.edu for more information

Megan F. Joseph^a, BA, Eric Youngstrom^a, PhD, & Gabrielle Carlson^b, MD�^aUniversity of North Carolina – Chapel Hill, ^bSUNY Stony Brook

RESULTS

Receiver Operating Characteristic (ROC) analyses investigated the ability of the WISC Full Scale, Verbal IQ, Performance IQ, and subtests to discriminate three different clinical groups: (a) any ADHD versus all other diagnoses, (b) corroborated mania versus all others, and (c) parent report or corroborated mania versus all others. None of the WISC scores (full scale, VIQ, PIQ, or subtest scores), nor VIQ-PIQ discrepancies or the ACID subtest profile distinguished any of the clinical groups from the rest of the sample to a meaningful degree. Only 3 of 51 comparisons achieved p < .05, and the largest Area Under the Curve was .58 (p = .050) for VIQ minus PIQ detecting ADHD. Stepwise entry logistic regression analyses tested whether combinations of scales produced better classification. None of the WISC scales entered into the model for two of the criteria, and the Similarities subtest was the only predictor (p < .05) to enter the other model, but without improvement in observed classification accuracy.

DISCUSSION

Results indicated that WISC subtest profiles do not have diagnostic utility in predicting bipolar disorder or ADHD. Even very liberal procedures (e.g., stepwise regression) failed to find predictors that discriminated groups. The sample size was more than adequate for power to detect medium effects, let alone effect sizes that would aid in clinical decision-making. Tools other than cognitive ability testing that are more appropriate for diagnostic purposes should be used when attempting to identify children with bipolar disorder and ADHD.

REFERENCES

Assesmany, A., McIntosh, D. E., & Phelps, L. (2001). Discriminant validity of the WISC-III with children classified as ADHD. Journal

of Psychoeducational Assessment, 19(2), 137-147.

Carlson, G.A. & Kelly, K.L. (1998). Manic symptoms in psychiatrically hospitalized children--what do they mean? Journal of Affective

Disorders, 51(2), 123-135.

Carlson, G.A. & Youngstrom, E.A. (2003). Clinical implications of pervasive manic symptoms in children. Biological Psychiatry,

53(11), 1050-1058.

Dickstein, D.P., Treland, J.E., Snow, J., McClure, E.B., Mehta, M.S., Towbin, K.E., Pine, D.S., & Leibenluft, E. (2004).

Neuropsychological performance in pediatric bipolar disorder. Biological Psychiatry, 55(1), 32-39.

Filippatou, D.N. & Livaniou, E.A. (2005). Comorbidity and WISC-III profiles of Greek children with attention deficit hyperactivity

disorder, learning disabilities, and language disorders. Psychological Reports, 97(2), 485-504.

Kaufman, A.S. (1994). Intelligent testing with the WISC-III. Oxford, England: John Wiley & Sons.

Prifitera, A. & Dersh, J. (1993). Base rates of WISC-III diagnostic subtest patterns among normal, learning-disabled, and ADHD

samples. In Bracken, B.A. & McCallum, R.S., Wechsler Intelligence Scale for Children: Third edition. Brandon, VT: Clinical

Psychology Publishing Co, 43-55.

Sattler, J.M. (2001). Assessment of children: Cognitive applications (4th ed.). La Mesa, CA: Jerome M Sattler Publisher.

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SAMPLE CHARACTERISTICS