The Role of WISC-V/WAIS-IV in the Assessment of Children with
ADHD
Courtney Thompson
Illinois School of Professional Psychology
Introduction
Attention-deficit/hyperactivity
disorder (ADHD) is a neurodevelopmental disorder that is prevalent in both
children and adults. Current diagnostic criteria describe the disorder as a “persistent
pattern of inattention and/or hyperactivity-impulsivity” that impedes daily
functioning and may interfere with normal development (American Psychiatric Association, 2013,
p. 59).
The
WISC-V and WAIS-IV have been shown to be important parts of identifying the strengths and
weaknesses of children, adolescents, and adults with ADHD.
ADHD
According
to the Centers for Disease Control and Prevention between 2013-2015 at least
10.4% of population of children were being diagnosed with ADHD. Many
people believe that ADHD is mostly a male problem. Boys are twice as likely as
girls to be diagnosed, but the numbers may begin to shift as there have been
more studies on how ADHD shows up in females (Brody, 2015).
A
child can be diagnosed with one of these three subtypes of ADHD:(1) ADHD Predominantly Inattentive presentation (ADHD-I), (2)
ADHD Predominantly Hyperactive-Impulsive presentation (ADHD-H), and (3)
ADHD Combined presentation (ADHD-C). The different subtypes of ADHD are
characterized by inattentive symptoms, hyperactive/impulsive symptoms or a
combination of both. For a child to qualify for a diagnosis of ADHD
they must exhibit six or more symptoms. The inattentive symptoms that
a child would display to receive the diagnosis would be: an inability to
pay attention to details; a tendency to make careless errors in school work
or other activities; difficulty with sustained attention in tasks;
apparent listening problems; difficulty following instructions; and
problems with organization (American
Psychiatric Association & American Psychiatric Association, 2013).Hyperactive/impulsive
symptoms include: fidgeting or squirming; difficulty remaining seated;
excessive running or climbing; difficulty playing quietly; always seeming to
be “on the go”; excessive talking; blurting out answers before hearing the
full question; difficulty waiting for a turn or inline; and problems with
interrupting or intruding (American
Psychiatric Association et al., 2013). Finally, the Combined type is characterized
by a combination of the other two types. The combined type is the most
commonly diagnosed type of ADHD and, overall, this type is characterized
predominantly by a difficulty controlling one’s behavior (American Psychiatric Association et al.,
2013).
The
onset of behaviors typically begins in preschool and the initial behavior to
manifest is hyperactivity, with the inattention emerging in elementary
school (American Psychiatric
Association et al., 2013). According to the DSM-5, a child must
display these symptoms before the age of 7, and the symptoms must be more
severe than other children their age. The child must display the behaviors for
at least 6 months, and they must occur in and negatively affect at least
two areas of a child’s life (i.e., home and
school). Lastly, these behaviors must not be linked to trauma
or stress at home or in school (American Psychiatric Association, 2013).
Executive functioning
allows a child to organize and order behavior (Nugent, 2013). According to Berkley,
ADHD includes deficits in behavioral inhibitions. There are
4 neuropsychological functions that appear to depend on it for their
effective execution, working memory, self-regulation of
affect-motivation-arousal, internalization of speech, and reconstitution
(behavioral analysis and synthesis) (Barkley, 1997, p. 65). Berkley’s
model focuses on the importance the child’s ability to self-regulate their
behavior which is tied to the difficulties the child may experience with
executive functioning. Although children with ADHD possibly struggle with self-regulating
their behavior, persistence with modeling and teaching self-regulating
behaviors will allow the child to achieve their full potential.
Berkley’s
model suggests that children with ADHD struggle with working memory, retention
and oral repetition of digit spans (especially in reverse order); mental
arithmetic, such as serial addition; locating stimuli within spatial arrays of
information that must be held in memory; and holding sequences of information
in memory to properly execute a task.(Barkley,
1997). Children with ADHD tend to perform poorly on the tasks digit span,
athematic and coding. There is a concern the children that are performing
poorly on working memory tasks may have deficient athematic knowledge or
slow motor speed but the research concludes that it’s from the
deficiency in working memory for children with ADHD.
WISC-V/WAIS-IV
Intelligence tests
are an important diagnostic tool for ADHD for both children and
adults. In 2014, the most recent edition of Wechsler’s intelligence
scales was introduced, the WISC-V (Wechsler,
2014a). The Wechsler’s scales continue to be updated based on emerging
research. The Wechsler scale continues to maintain itself as a culturally
valid measure through ongoing research. The Wechsler scale has
always included some measure of fluid reasoning, working memory, and processing
speed. The WISC-V was structured in a way to ensure the measures are more
significant.
The
WISC-V is comprised of a five-factor structure assessing verbal
comprehension (VCI), visual-spatial (VSI), fluid reasoning (FRI), working
memory (WMI), and processing speed (PSI) (Wechsler, 2014a). The PRI from
WISC-IV was split with Block Design (BD) becoming part of the VSI on the WISC-V.
Visual Puzzles (VP), which was previously seen in the Wechsler Adult
Intelligence Scale, Fourth Edition (WAIS-IV), was also included on the
VSI. Matrix Reasoning (MR) became part of the FRI, along with Figure
Weights (FW) from the WAIS-IV. Supplemental measures for the FRI include
Picture Completion (PC) and Arithmetic (AR). The VCI is comprised of
Vocabulary (VC) and Similarities (SI), with Information (IN) and
Comprehension (CO) included as supplemental measures. The WMI kept Digit Span
(DS) and added a new visual working memory task called Picture Span (PS).
Letter-Number Sequencing (LN) became a supplementary subtest. The PSI
remains the same (Wechsler, 2014a).
WISC-V/WAIS-IV and ADHD
As a
group, children with ADHD tend to have a slightly lower IQ than comparison
groups of children (Nigg, 2009).
Children with ADHD sometimes underachieve academically as a result of of
their poor attention and inability to focus on a task. Children with
inattention and hyperactive traits of ADHD consistently perform poorly on
measures of attention, executive function, and processing speed (Clark, Prior, & Kinsella, 2000)
Having
children suspected of ADHD complete cognitive measures is important, and
one role of the WISC-V in the assessment process of ADHD lies in its
ability to aid in ruling out other comorbid conditions such as learning
disabilities, reading disorder, and dyslexia. In severely affected children,
marked problems with auditory memory accompany the learning
disability (Nigg, 2009, p. 2). Children
with a weakness in verbal processing may benefit from other interventions such
as pictures, diagrams, lists, maps.
For children
who are diagnosed with ADHD from a young age, addressing the challenges
the child will experience has the potential to give the child the greatest
chance of success. The diagnosis has the potential to impact many aspects
of their lives both academically and socially. Throughout a child’s educational
career if they remain undiagnosed this will have adverse effects on their
academic, social, and developmental needs. If a child is correctly diagnosed
early in life this will give them the greatest opportunity for successfully navigating academic, social, emotional, and behavioral needs.
Conclusion
The
WISC-V and WAIS-IV are integral parts of identifying the strengths and
weaknesses of children, adolescents, and adults with ADHD. Having an
understanding of a client’s cognitive strengths and weaknesses can inform what
their treatment process will be. This will provide them with the greatest
success academically, socially, emotionally and, developmentally. The WISC -V
can provide tailor made recommendations for the teachers and parents for the
management of a child’s ADHD. If the right interventions are set into motion
early the child will have a greater chance at success. Many
children with ADHD struggle with executive function and their struggle to focus
so as psychologists it’s about giving the parents, teachers and, children the
tools for success.
References
