Archives of Clinical Neuropsychology 22 (2007) 917924

Rapidly-administered short forms of the Wechsler Adult Intelligence Scale3rd edition

Alison J. Donnell a , Neil Pliskin a , James Holdnack b , Bradley Axelrod c , Christopher Randolph d,
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States b Harcourt Assessment, Inc., San Antonio, TX, United States c Psychology Section, Detroit Veterans Administration Medical Center, Detroit, MI, United States d Department of Neurology, Loyola University Medical Center, Maywood, Illinois, United States Accepted 20 June 2007
a

Abstract Although the Wechsler Full Scale IQ (FSIQ) is a common component of most neuropsychological evaluations, there are many clinical situations where the complete administration of this battery is precluded by various constraints, including limitations of time and patient compliance. These constraints are particularly true for dementia evaluations involving elderly patients. The present study reports data on two short forms particularly suited to dementia evaluations, each requiring less than 20 min of administration time. One of the short forms was previously validated in dementia for the WAIS-R [Randolph, C., Mohr, E., & Chase, T. N. (1993). Assessment of intellectual function in dementing disorders: Validity of WAIS-R short forms for patients with Alzheimers, Huntingtons, and Parkinsons disease. Journal of Clinical and Experimental Neuropsychology, 15, 743753]; the second was developed specically for patients with motor disabilities. These short forms were validated using the WAIS-III normative standardization sample (N = 2450), neurologic sample (N = 63), and matched controls (N = 49), and a separate mixed clinical sample (N = 70). The results suggest that each short form provides an accurate and reliable estimate of WAIS-III FSIQ, validating their use in appropriate clinical contexts. The present data support the use of these short forms for dementia evaluations, and suggests that they may be applicable for the evaluation of other neurological and neuropsychiatric disorders that involve acquired neurocognitive impairment. 2007 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved.
Keywords: Wechsler Adult Intelligence Scale; Dementia; Short form

1. Introduction Measurement of general intellectual ability, although essentially a composite score reecting ability across multiple neurocognitive domains, remains a core component of psychological and neuropsychological evaluations. The Wechsler Adult Intelligence Scale (WAIS), in its various editions, has been the most popular measure for assessing intelligence in the United States (Harrison, Kaufman, Hickman, & Kaufman, 1988; Matarazzo & Herman, 1984; Rabin, Barr, & Burton, 2005). The most recent revision, Wechsler Adult Intelligence ScaleThird Edition (WAISIII), extends the upper age normative data assessing the intellectual abilities of adults ages 16 through 89 (Wechsler,

Corresponding author. ABPP-CN, 1 East Erie, Suite 355, Chicago, IL 60611, United States. Tel.: +1 708 216 3539; fax: +1 708 216 4629. E-mail address: crandol@lumc.edu (C. Randolph).

0887-6177/$ see front matter 2007 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.acn.2007.06.007

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1997) and is considered more useful for an elderly population than past editions (Wymer, Rayls, & Wagner, 2003). However, several practical issues commonly interfere with administering the WAIS-III to an older population. First, patient endurance often dictates shorter exams, especially in a cognitively compromised elderly population where patients can become fatigued, frustrated, and agitated. The WAIS-III manual reports that the average administration time for the 11 WAIS-III subtests that yield the three IQ scores requires approximately 75 min (Wechsler, 1997), although administration time of the WAIS-III in clinical populations may be as long as 90 min (Ryan, Lopez, & Werth, 1998). Second, neuropsychologists are under increasing pressure to be time- and cost-efcient and with time constraints dictated by third party reimbursement for assessments, the full WAIS-III often becomes impractical to administer. Consequently, an abbreviated version of the WAIS-III that reduces the evaluation time without signicantly impacting the reliability or validity of the Full Scale IQ (FSIQ) score for a compromised elderly population would be valuable. Shortened versions of intellectual tests in a dementia evaluation are useful for obtaining a quick measurement of FSIQ to compare to estimates of premorbid function for the purpose of gauging intellectual decline. In a situation where assessment is time limited, a briefer evaluation of intelligence in older adults would also allow more time for the assessment of other neuropsychological functions to take place. The use of shortened versions of Wechsler scales has been ongoing since 1956 (Doppelt, 1956). Although a number of short forms exist for the WAIS and several have been validated specically for the WAIS-III, few have been objectively evaluated with an older cognitively compromised sample. One criterion for an acceptable abbreviated version is that the total testing time should be reduced by at least 50% (Levy, 1968). Resnick and Entin (1971) also proposed that an intelligence quotient (IQ) obtained from an abbreviated version should signicantly correlate with the Full Scale IQ, and according to Nunnally (1978), have reliabilities equal to or higher than 0.90. The four-subtest short form proposed by Kaufman (1990) for the WAIS-revised (WAIS-R) has one of the shortest administration times (less than 20 min) and correlated 0.96 with the FSIQ in the standardization sample of the WAIS-R. This short-form tetrad of subtests is composed of Arithmetic, Similarities, Picture Completion, and Digit Symbol-Coding. Because of its high reliability, short administration time, and practical utility in terms of the information obtained for a dementia evaluation (i.e., arithmetic computation, abstraction, attention, and processing speed), Randolph, Mohr, and Chase (1993) examined the psychometric properties of the Kaufman tetrad in a dementia sample and found that it actually underestimated the FSIQ in their sample. As such, Randolph et al. revised Kaufmans scaling table in order to correct for this underestimation. Results indicated that the revised scaling table produced a high correlation with the WAIS-R FSIQ (r = 0.96) and corrected for the underestimation. In fact, 72% of the entire sample was within ve points of their actual IQ whereas only 52% were within this range using the original Kaufman scaling. The present study was undertaken in order to validate this revised version of the Kaufman short-form for the WAIS-III. Therefore, the goal of the present study was to examine the revised scaling of the short form Kaufman tetrad (SF1) for the WAIS-III in healthy and compromised older adult samples. Additionally, a second short form was validated that substituted Letter-Number Sequencing and Symbol Search for Arithmetic and Digit Symbol-Coding. The second short form (SF2) was developed to aid the clinician working with patients having signicant motor problems or when working with subjects that have low educational attainment and subsequently may have poorly developed arithmetic skills. Additionally, this study examined SF1 estimated FSIQs as compared to the Wechsler Test of Adult Reading (WTAR: The Psychological Corporation, 2001) premorbid predicted FSIQ to examine the anticipated change in FSIQ with cognitively compromised samples. We chose to use the full WAIS-III normative sample to validate these short forms for normals across the full age range (1689), as these short forms may also prove useful in neuropsychological evaluations of younger patients under certain circumstances. We hypothesized that the Randolph et al. revised scaling of SF1 would prove valid for the WAIS-III, and that SF2 would prove to be a reliable alternative. 2. Method 2.1. Participants Participants were members of the WAIS-III/WMS-III standardization sample (Wechsler, 1997), which contains both healthy controls (N = 2450) and specic clinical samples. A group of older healthy adults (N = 49) were extracted

A.J. Donnell et al. / Archives of Clinical Neuropsychology 22 (2007) 917924 Table 1 Demographic information for the matched control and clinical samples Matched controls (n = 49) Age Gender Female Male Race/ethnicity Caucasian African American Hispanic Other Education 8 years 911 years 12 years 1315 years 16 years 63.0 (S.D. = 15.5) 57.1 42.9 89.8 8.2 0.0 2.0 6.1 4.1 28.6 24.5 36.7 Neurologic sample (n = 63) 64.1 (S.D. = 14.5) 54.0 46.0 90.5 6.3 1.6 1.6 6.3 4.8 28.6 20.6 39.7

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Mixed VA sample (n = 70) 53.7 (S.D. = 15.0)

100.0 60.0 40.0

7.1 27.1 28.6 24.3 12.9

from the standardization sample and were matched on age, education, gender, and ethnicity to the clinical groups identied from the standardization sample as the groups of interest. The clinical groups included those diagnosed with degenerative neurological disorders of Alzheimers disease, Huntingtons disease, and Parkinsons disease (neurologic sample). There were no signicant differences between the neurologic sample and the matched control group on any demographic variables. A second sample of clinical cases from a veterans medical center (mixed VA sample) was also included and comprised of heterogeneous neurological and psychiatric disorders, such as Alzheimers, seizure, stroke, vascular dementia, Huntingtons, depressive disorder, schizophrenia, alcohol abuse, bipolar, and personality disorders (N = 70). All participants in the WAIS-III/WMS-III standardization project underwent informed consent procedures. The mixed VA sample data were obtained during clinical evaluations predating HIPAA legislation; these WAIS-III data have been previously reported and were re-analysed for the present study. Table 1 provides the demographic data for matched control and clinical samples. 2.2. Procedure The WAIS-III and WTAR were administered according to the standardized procedures outlined in their respective manuals (Wechsler, 1997b, c; The Psychological Corporation, 2001). All of the subtests were administered in order. Therefore, all subjects completed the full version of the WAIS-III and not just the proposed short forms. All WTAR predictions of premorbid FSIQ used the WTAR + demographics tables in the WTAR manual. Pearson correlation coefcients were used to compare short form and full WAIS-III FSIQ scores. 3. Results 3.1. Healthy standardization sampleSF1 Results indicated that in the normal standardization sample the SF1 estimated FSIQ correlated highly (r = 0.93) with the actual FSIQ. The SF1 estimated FSIQ and the actual FSIQ means for the standardization sample were both 100.3, resulting in no difference. Seventy-two percent of the standardization samples SF1 estimated FSIQ was within 5 points of their actual FSIQ and 94% was within 10 points. It is important to note that for the healthy samples, it was necessary to adjust the sum of scaled scores by subtracting 2 points from the total of Similarities, Picture Completion, Arithmetic and Digit Symbol to estimate the SF1 FSIQ. The Appendix provides the table to convert the sum of scaled scores to the estimated SF1 FSIQ.

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Table 2 Means and standard deviations of SF1, Actual FSIQ, and WTAR Difference Standardization sample* Matched controls* Neurologic sample Mixed VA sample SF1 FSIQ mean (S.D.) 100.3 (14.5) 108.0 (16.3) 0.5 86.1 (13.0) 83.0 (10.3) Actual FSIQ mean (S.D.) 100.3 (14.5) 108.4 (17.8) 86.2 (11.5) 83.3 (11.1) Difference mean (S.D.) 0.0 (5.3) 0.4 (5.8) 0.1 (4.3) 0.3 (4.5) WTAR-P mean (S.D.) 107.5 (12.3) 104.2 (10.5) SF1-WTAR-P

18.1

Note: SF1: Short-Form 1; FSIQ: Full Scale IQ; WTAR-P: Wechsler Test of Adult Reading predicted premorbid FSIQ. * In the standardization and matched control samples, it is necessary to adjust the sum of scaled scores by subtracting 2 points to the total of Similarities, Picture Completion, Arithmetic and Digit Symbol before looking up the FSIQ equivalent. Wechsler Adult Intelligence Scale-3rd edition Copyright 1997 by The Psychological Corporation. Reproduced by Permission. All Rights Reserved.

3.2. Clinical samplesSF1 Results indicated that the SF1 estimated FSIQ correlated highly (r = 0.95) with the actual FSIQ for the neurologic sample. The SF1 estimated FSIQ average for the neurologic sample was 86.1 and the actual FSIQ average was 86.2, resulting in a negligible mean difference of 0.1. Eighty-three percent of the neurologic sample estimated IQ was within 5 points of their actual IQ and 97% was within 10 points of their actual IQ. The mean WTAR-predicted premorbid FSIQ for the neurologic sample was 104.2, resulting in a mean difference from their SF1 estimated IQ of 18.1 and reected the expected drop from their premorbid IQ. The actual mean WAIS-III FSIQ for the subset of healthy normals matched to the neurologic sample on demographic variables was 108.4, and the SF1 estimated FSIQ for this group was 108.0. The WRAT predicted FSIQ for this healthy subgroup was 107.5. Therefore, the SF1 estimated FSIQ for the neurologic sample was a reliable estimate of actual current FSIQ, and both measures reected a drop from premorbid FSIQ of approximately 18 points based upon WTAR prediction, and of approximately 22 points based upon comparison to demographically-matched controls. For the mixed VA sample, results indicated that the SF1 estimated FSIQ also correlated highly (r = 0.91) with the actual FSIQ. The SF1 estimated FSIQ average for the mixed VA sample was 83.3 and the actual FSIQ average was 83.0, resulting in a mean difference of only 0.3. Eighty percent of the mixed VA sample estimated IQ was within 5 points of their actual IQ and 97% was within 10 points. Tables 2 and 3 provide means, standard deviations, reliability, and percentages for SF1. 3.3. Healthy samplesShort Form 2 Results indicated that in the standardization sample the SF2 estimated FSIQ correlated highly (r = 0.89) with the actual FSIQ. The SF2 estimated FSIQ average was 100.5 and actual FSIQ was 100.3, resulting in a mean difference of 0.2. Fifty-nine percent of the standardization samples SF2 estimated FSIQ was within 5 points of their actual FSIQ and 87% was within 10 points. For the healthy samples, it was necessary to adjust the sum of scaled scores by subtracting 3 points from the total of Similarities, Picture Completion, Letter-Number Sequencing, and Symbol Search to estimate the SF2 estimated FSIQ. Appendix A provides the table to convert the sum of scaled scores to the estimated SF2 FSIQ.
Table 3 SF1 compared to Actual FSIQ Correlation SF1 and FSIQ Standardization sample Matched controls Neurologic sample Mixed VA sample 0.93 0.94 0.95 0.91 % within 5 pts or less 71.5 65.4 83.3 80.0 % within 10 pts or less 94.0 85.8 96.7 96.6 % within 15 pts or less 99.4 100.0 100.0 100.0

Note: SF1: Short-Form 1; FSIQ: Full Scale IQ.

A.J. Donnell et al. / Archives of Clinical Neuropsychology 22 (2007) 917924 Table 4 Means and Standard Deviations of SF2, Actual FSIQ, and WTAR SF2 FSIQ difference mean (S.D.) Standardization sample* Matched controls* Neurologic sample Mixed VA sample 100.5 (14.6) 106.3 (15.9) 86.0 (13.3) 86.7 (10.5) Actual FSIQ mean (S.D.) 100.3 (14.5) 108.4 (17.8) 86.2 (11.5) 83.3 (11.1) Difference mean (S.D.) 0.2 (7.1) 2.1 (7.5) 0.2 (5.8) 3.4 (4.3) WTAR-P mean (S.D.) 107.5 (12.3) 104.2 (10.5)

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SF2-WTAR-P

1.2 18.2

Note: SF2: Short-Form 2; FSIQ: Full Scale IQ; WTAR-P: Wechsler Test of Adult Reading predicted premorbid FSIQ. * In the standardization and matched control samples, it is necessary to adjust the sum of scaled scores by subtracting 3 points to the total of Similarities, Picture Completion, Letter-Number Sequencing and Symbol Search before looking up the FSIQ equivalent. Wechsler Adult Intelligence Scale-3rd edition Copyright 1997 by The Psychological Corporation. Reproduced by Permission. All Rights Reserved. Table 5 SF2 compared to actual FSIQ Correlation SF2 and FSIQ Standardization sample Matched controls Neurologic sample Mixed VA sample 0.89 0.90 0.90 0.92 % within 5 pts or less 59.4 57.5 70.0 66.7 % within 10 pts or less 87.0 79.6 96.7 97.1 % within 15 pts or less 96.0 98.0 98.3 100.0

Note: SF2: Short-Form 2; FSIQ: Full Scale IQ.

3.4. Clinical samplesShort Form 2 Results indicated that for the SF2 estimated FSIQ correlated highly (r = 0.90) with the actual FSIQ for the neurologic sample. The SF2 estimated FSIQ average for the neurologic sample was 86.0, resulting in a mean difference of 0.2 from their actual FSIQ of 86.2. Seventy percent of the neurologic sample estimated IQ was within 5 points of their actual IQ and 97% was within 10 points of their actual IQ. As stated previously, the mean WTAR- predicted premorbid FSIQ for the neurologic sample was 104.2, resulting in a mean difference from their SF2 estimated IQ of 18.2 and again reected the expected drop from their premorbid IQ. The SF2 estimated FSIQ for the subset of healthy normals matched to the neurologic sample on demographic variables was 106.3, resulting in a mean difference of 2.1. For the mixed VA sample, results indicated that for the SF2 estimated FSIQ also correlated highly (r = 0.92) with the actual FSIQ. The SF2 estimated FSIQ average for the mixed VA sample was 86.7, resulting in a mean difference of 3.4 from their actual mean of 83.3. Sixty-seven percent of the mixed VA sample estimated IQ was within 5 points of their actual IQ, and 97% was within 10 points. Tables 4 and 5 provide means, standard deviations, reliability, and percentages for SF2. 4. Discussion Neuropsychological assessments of older adults with suspected dementia or neurological compromise typically evaluate multiple cognitive domains. The evaluation of current intelligence is often important in that it can provide information about the extent of cognitive decline when compared to predicted premorbid performance. The WAIS-III FSIQ is a well-understood composite measure of general cognitive functioning and a common component of most neuropsychological and psychological evaluations. There are, however, many clinical situations where the complete administration of this battery is precluded by various constraints, including limitations of time and patient compliance. Therefore, the use of a valid, reliable, and quick evaluation of intelligence is benecial in these circumstances. The short forms used in this study meet the acceptable criteria for abbreviated versions of measuring intelligence. Both short forms can be rapidly administered, in less than 20 min, which reduces the total testing time of intelligence by more than 75%. Additionally, both short forms are signicantly correlated with the Full Scale IQ and have reliabilities generally above 0.90. The SF1 appears to provide a slightly more accurate estimate of FSIQ and assesses clinical domains of interest (i.e., arithmetic computation, abstraction, attention, and processing speed), for a dementia evaluation. Therefore, the

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use of SF2 is recommended only for those people with substantial motoric compromise while SF1 is recommended for most other clinical populations. It should be noted that the Symbol Search task included in SF2 also has a motoric component, although the motor demands of this task are quite minimal and unlikely to impact signicantly upon test performance. The WTAR + demographics prediction of premorbid FSIQ in our neurological sample studied resulted in a slight underprediction, in comparison to the observed FSIQ of the matched control group. This underprediction was small, however (approximately 3 points), and consistent with the frequently reported observation that reading pronounciation performance does tend to decline somewhat with advancing dementia. The use of the WTAR is obviously the best methodology for predicted premorbid WAIS-III FSIQ, as these measures were co-normed, and clinicians can be reasonably assured that use of this methodology will result in a conservative estimate of intellectual decline in dementia evaluations employing the WTAR and these short forms (or full WAIS-III testing). That is, estimates of premorbid FSIQ using the WTAR in a clinical sample will be most accurate in cases of minimal acquired impairment, and will tend to slightly underestimate premorbid FSIQ with advancing dementia. Estimates of the magnitude of decline will be affected accordingly, with a tendency to slightly underestimate the magnitude of decline in cases of more advanced dementia. This is, if anything, preferable to error in the opposite direction (overestimating decline, and perhaps committing a type I error in making a diagnosis of dementia in the absence of acquired cognitive decline). In sum, the use of these short forms will be helpful in minimizing frustration and fatigue on the part of the patient, providing a reliable estimate of current intellectual status (and decline from predicted premorbid level using the WTAR). This will result in greater efciency in neuropsychological assessment of elderly or more impaired patients, also allowing the inclusion of other neuropsychological tests critical to the evaluation of dementia within a single focused test session. Appendix A Scaling tables for Short Form 1 and Short Form 2
Short Form 1 Sum SS 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 IQ 55 55 55 55 55 57 59 61 62 63 64 66 66 67 68 69 71 74 75 76 78 79 80 82 84 85 87 90% CI 5262 5262 5262 5262 5262 5464 5666 5868 5969 6070 6171 6273 6273 6374 6475 6576 6778 7081 7181 7282 7484 7585 7686 7888 8090 8191 8293 95% CI 5163 5163 5163 5163 5163 5365 5567 5769 5870 5971 6072 6174 6174 6275 6376 6477 6679 6982 7082 7183 7385 7486 7587 7789 7991 8092 8194 Percentile 0.1 0.1 0.1 0.1 0.1 0.2 0.3 0.5 1 1 1 1 1 1 2 2 3 4 5 5 7 8 9 12 14 16 19 Short Form 2 Sum SS 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 IQ 58 59 59 60 60 61 62 64 65 66 67 68 69 71 73 74 75 77 78 79 80 81 82 84 85 87 88 90% CI 5566 5667 5667 5768 5768 5869 5970 6072 6173 6274 6375 6476 6577 6778 6980 7081 7182 7384 7485 7586 7687 7688 7789 7991 8092 8293 8394 95% CI 5467 5568 5568 5669 5669 5770 5871 5973 6074 6175 6276 6377 6478 6680 6881 6982 7083 7285 7386 7387 7488 7589 7690 7892 7993 8195 8295 Percentile 0.3 0.3 0.3 0.4 0.4 0.5 1 1 1 1 1 2 2 3 4 4 5 6 7 8 9 10 12 14 16 19 21

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Appendix A (Continued )
Short Form 1 Sum SS 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 IQ 88 89 91 93 94 96 97 98 100 102 104 106 108 110 111 112 115 117 119 120 121 123 125 128 130 132 133 134 135 142 153 155 155 155 155 155 155 155 155 155 155 155 155 155 155 155 90% CI 8394 8495 8697 8899 89100 91101 92102 93103 95105 97107 99109 100111 102113 104115 105116 106117 109119 111121 113123 114124 115125 117127 119129 121132 123134 125136 126137 127138 128138 135145 145156 147157 147157 147157 147157 147157 147157 147157 147157 147157 147157 147157 147157 147157 147157 147157 95% CI 8295 8396 8598 87100 88101 90102 91103 92104 94106 96108 98110 99112 101114 103116 104117 105118 108120 110122 112124 113125 114126 116128 118130 120133 122135 124137 125138 126139 127139 134146 144157 146158 146158 146158 146158 146158 146158 146158 146158 146158 146158 146158 146158 146158 146158 146158 Percentile 21 23 27 32 34 39 42 45 50 55 61 66 70 75 77 79 84 87 90 91 92 94 95 97 98 98 99 99 99 99.7 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 Short Form 2 Sum SS 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 IQ 89 90 93 94 96 97 98 100 102 104 106 108 110 111 112 114 116 118 120 121 123 125 128 129 130 132 134 135 139 142 143 153 155 155 155 155 155 155 155 155 155 155 155 155 155 155 90% CI 8495 8596 8899 89100 91102 91103 92104 94106 96108 98109 100111 102113 104115 105116 106117 107119 109121 111123 113124 114125 116127 118129 121132 122133 123134 124136 126138 127139 131142 134145 135146 144156 146157 146157 146157 146157 146157 146157 146157 146157 146157 146157 146157 146157 146157 146157 95% CI 8396 8497 87100 88101 89103 90104 91105 93107 95109 97111 99112 101114 103116 104117 105118 106120 108122 110124 112126 113127 115128 117130 120133 120134 121135 123137 125139 126140 130143 133146 134147 143157 145158 145158 145158 145158 145158 145158 145158 145158 145158 145158 145158 145158 145158 145158 Percentile 23 25 32 34 39 42 45 50 55 61 66 70 75 77 79 82 86 88 91 92 94 95 97 97 98 98 99 99 99.5 99.7 99.8 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9 >99.9

Wechsler Adult Intelligence Scale3rd edition Copyright 1997 by The Psychological Corporation. Reproduced by Permission. All Rights Reserved.

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