Applied Neuropsychology

2003, Vol. 10, No. 3, 182190

Copyright 2003 by
Lawrence Erlbaum Associates, Inc.

BOOK AND TEST REVIEWS

ment between the different estimates for a given case is

usually lacking. For the demographic based estimates,
occupational classification is not always straightforward (depending as it does on self-report) and surprisingly large differences in IQ estimate result when an
occupational classification value is changed by one
point. The Wechsler Test of Adult Reading (WTAR) is
intended to be a solution to these barriers to reliability,
with quick and simple administration to boot. The test
is based on the same approach as other adult reading
tests (but not the reading achievement test), and consists of counting the number of correctly pronounced
words from a list of items that have irregular spelling
(e.g., gnat and aisle).
Who is to be credited with authorship of the WTAR
is not clearly identified; rather, the project appears to
be the result of a committee of well-respected neuropsychologists. The statistical estimates of IQ and its
indexes (Full Scale, Verbal, Performance, Verbal
Comprehension, Perceptual Organization, Working
Memory, and Processing Speed) and of memory indexes (Immediate, General, and Working) were derived
from the same standardization sample used in the
development of the WAIS-III and the WMS-III.
Conorming with the WAIS-III and WMS-III is a
good idea because they are the most up to date instruments for measuring IQ and memory. The previously
existing estimators were developed using scores from
the older WAIS-R as the outcome measure, and few
have estimates of memory at all. Furthermore, by using
data from the same sample as the validation sample,
the standard errors are all comparable. The WTAR
manual presents data on its validation in several
clinical groups of interest to neuropsychologists
[Alzheimers, Traumatic Brain Injury (TBI), neuropsychiatric, and developmental], as well.
The manual consists of 90 pages of descriptions
and 187 pages of appendixed look-up tables. From this
ratio one can infer that the WTAR provides a lot of
predictive data from one single observation. To see
how well the WTAR works, lets use these hypothetical
demographics: A 50-year-old Caucasian male with

Wechsler Test of Adult Reading, The Psychological Corporation, Harcourt Assessment Company, San Antonio, TX, 2001
A method for estimating a persons level of intellectual function before cerebral trauma or insult, or developmental decline (e.g., dementia, schizophrenia), is of
great importance in the practice of clinical neuropsychology. Existing methods of estimating pre-morbid
IQ include: the Barona demographic formula (Barona,
Reynolds, & Chastain, 1984); the Crawford demographic formula (Crawford & Allen, 1997); the North
American Adult Reading Test (NAART or NART-R),
(Blair & Spreen, 1989; Wiens, Bryan & Crossen,
1993); the American Nelson Adult Reading Test
(AMNART), (Grober & Sliwinski, 1991); Oklahoma
Premorbid Intelligence Estimate (OPIE), (Krull, Scott,
& Sherer, 1995); Wide Range of Achievement TestRevised (WRAT-R), (Karaken & Gur, 1995); and Wide
Range of Achievement Test-3 (WRAT-3), (Griffin,
Mindt, Rankin, Ritchie, & Scott, 2002). A tip:
Efficiently arranged worksheets for several of these
methods of estimation have been formulated (Spreen &
Strauss, 1998), and a nifty equation developed by J. R.
Crawford that computes the statistical significance of
the difference between measured IQ and IQ estimated
with his formula (plus other equations applicable to
neuropsychological test scores) can be found on the
web at http://www.psyc.abdn.ac.uk/homedir/jcrawford/
psychom.htm or through the links section of Neuropsychology Central.
Numerous research efforts have indicated that the
reliability of each of the various aforementioned methods is problematic under certain conditions (e.g., type
of population or level of IQ estimated). A second major
drawback may also be added, which is that none of the
research, even the most current, utilizes updated versions of estimators (e.g., WRAT-3) and outcomes
[Wechsler Adult Intelligence Scale (3rd ed.; WAIS-III)
and Wechsler Memory Scale (3rd ed.; WMS-III)]. To
compound the problem, practitioners find that agree-

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BOOK AND TEST REVIEWS

postgraduate education. The prediction intervals (PI)

presented later are all at the 95% level. (By the way,
there are parallel tables for a sample from the United
Kingdom, which will not be considered here.) For this
hypothesis, we will assume an achieved score of 46/50
correct pronunciations.
First, the achieved score would be converted to a
WTAR standard score. This actual WTAR standard
score can then be compared to (a) a demographics-predicted WTAR standard score, (b) test-retest obtained
scores, and (c) predicted WAIS-III and WMS-III scores;
the respective difference scores naturally are then tested
for statistical significance. Our hypothetical performance of 46/50 yields a WTAR standard score of 119.
The demographics estimate of WTAR is based on
race, education, and age. For the hypothetical case,
WTAR estimated is 116, +/ 24. This 95% PI for estimated performance seems quite large (minimum of 92
and maximum of 140, range 48), and there would be
proportionally greater effect on estimates based on
lower educational demographics, as these predict lower
WTAR performance. With an actual WTAR of 119 and
a demographics-predicted WTAR of 116, the difference score is +3 (predicted is subtracted from the actual). A quick glance at the appropriate look-up table
shows that, as expected, this difference falls into the
cumulative percentage range of 5074% of the standard sample.
The manual warns that if the actual WTAR score is
more than 20 points lower than predicted, the WTAR
should not be used for predicting IQ memory scores;
when actual is 1520 points lower than predicted, then
interpretive emphasis should be loss of function rather
than on accuracy of predicted premorbid scores. Furthermore, the manual states that the WTAR should not
be used at all for predicting premorbid intellectual functioning for people with a history of reading disability.
All reading-based estimators of premorbid cognition
have in common the fact that they are not appropriate in
cases where a history of reading disorder is present. The
WTARs use of a demographically predicted performance score adds a useful method of screening for acquired dyslexia, which protects against underestimation
of premorbid intellectual level and its associated high
likelihood of false negative clinical decision making.
WAIS-III IQ scores are predicted in several ways,
first from four demographics (mentioned earlier, plus
Gender); for the hypothesis, full score intelligence
quotient (FSIQ) is estimated to be 118 +/ 23. This
Appendix would seemingly be more usefully included
with the WAIS-III, however, and the reason for its inclusion with WTAR is not made explicit in the manual.

FSIQ is also predicted from an achieved WTAR

standard score, taken by itself. Using our hypothesis
(actual WTAR of 119), FSIQ is estimated to be 114 +/
21. Tables predicting FSIQ from WTAR plus demographics are also provided. With demographics, the hypothetical FSIQ is predicted to be 121 +/ 18. This estimate is evidently better than the estimate using
WTAR score alone because of the smaller PI, and it
certainly may be reasonably expected that the necessary demographic data could be collected along with
the obtained score. So, tables predicting IQ scores from
either demographic variables alone or from WTAR
scores alone do not appear to be better than the score
predicted from WTAR plus demographics.
The estimate of a Wechsler memory score for our
hypothesis follows, using as an example Working
Memory from the WMS-III (note: Working Memory
from WMS-III is estimated separately from, and has
slightly different values than, estimates of Working
Memory Index from the WAIS-III). Estimated premorbid Working Memory is 110 +/ 26 (WTAR score
alone) and 111 +/ 25 (WTAR-demographics). It must
be noted here that the PIs for memory are even greater
than they are for FSIQ.
To give it a more thorough walk through, a second
hypothetical case with the same demographics for age
and education was assumed, but African American instead of Caucasian racial classification was used. In
this case, the actual WTAR for 46/50 remains 119 because demographics do not enter into the table. However, the WTAR from demographics was 98 +/ 26 versus an estimated WTAR of 116 (+/ 24) for a
comparable Caucasian. The estimated FSIQ from a
WTAR standard score of 119 for an African American
is 105 +/ 18 versus 121, +/ 18 for a Caucasian. For
WMS-III Working Memory, the estimate for an
African American is 106 +/ 25 versus 111 +/ 25 for
a Caucasian. This highlights the large impact that race
plays in the estimates of Wechsler scores.
The results of this hypothetical application of the
WTAR suggests a caveat: Use of the WTAR for the
determination of premorbid intellectual and memory
level of function is most useful for highly educated
Whites, and begins to raise questions when applied to
African Americans with low educational attainment
because of its bias towards lower estimates for
African Americans, which brings with it a large proportionality of confidence interval for these lower estimates. This bias reflects racial differences in
achieved scores on the Wechsler products rather than
true differences in intellectual level. Consider, for example, the case of an African American with average
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BOOK AND TEST REVIEWS

true IQ but hardly any educational achievement who

has a moderate degree of acquired cerebral dysfunction. The predicted WTAR, IQ, and memory scores
will all be underestimates with proportionally very
large PIs. This circumstance appears to be a recipe for
a false negative result because true loss of cognitive
capacity due to acquired cerebral dysfunction would
not be distinguished from underestimates of IQ and
memory.
To be fair, we should compare the prediction intervals of the WTAR with the comparable figure for each
of the previously existing methods. To do that, the standard error of estimates (SEE) for the bunch are needed.
Using FSIQ as a predicted outcome, the SEE of the
WTAR on WAIS-III FSIQ is easily derived by using
data from the manual, and is found to be 10.3. The following SEE data for the other methods all predict the
older WAIS-R FSIQ and are taken from the literature:
OPIE6.4, NAART7.6, AMNART7.8, Crawford
9.1, WRAT-R (with parental education)10.2, WRAT311.6, and Barona11.9. Thus, it may be seen that
the WTAR does not obviously represent an improvement in predictive accuracy.
Does the WTAR system add incremental information to what could be gleaned from using a WRAT
reading achievement score? The earlier work (Kraken
& Gur, 1995) built a regression equation using WRATR reading standard score and parental educational level
to predict WAIS-R IQ in normals; it is not known how
well this equation would work with clinical groups, but
there is a suspicion that the greater the acquired cerebral dysfunction and the greater the parental education,
the less reliable the estimate would be, bearing in mind
that deterioration in reading performance is known to
occur in cases of moderate to severe levels of dementia
with linguistic deficits (Patterson, Graham, & Hodges,
1994). Recent research (Griffin et al., 2002) compared
the WRAT-3 reading standard score directly as an IQ
proxy with the NAART, Barona, and OPIE estimates of
IQ in a sample of pain patients. Results showed that
WRAT-3 more accurately classified individuals with
below average WAIS-R IQ, while the OPIE more accurately classified those with above average IQ. These
three methods provided relatively equivalent classifications in the average IQ range, but Barona systematically under- and overestimated FSIQ across the intelligence continuum. Unfortunately, a head-to-head
comparison of WRAT-3 with the WTAR using the most
current Wechsler intelligence and memory measures is

184

not available, but this appears to be a fertile research

ground.
Neuropsychologists in need of valid estimates of
premorbid cognitionboth intellectual and memory
now have several options to consider; each case must
be carefully considered when selecting the most appropriate method to use, and caution must be taken in
clinical decision making based on the results.
J. P. Ginsberg, Neuropsychology Services, 6 Viking
Court, Columbia, SC 29229, USA

References
Barona, A., Reynolds, C. R., & Chastain, R. (1984). A demographically based index of premorbid intelligence for the WAIS-R.
Journal of Consulting and Clinical Psychology, 52, 885887.
Blair, J. R., & Spreen, O. (1989). Predicting premorbid IQ: A revision
of the National Adult Reading Test. The Clinical Neuropsychologist, 3, 129136.
Blyler, C. R., Gold, J. M., Iannone, V. N., & Buchanan, R. W.
(2000). Short form of the WAIS-III for use with patients with
schizophrenia. Schizophrenia Research, 46(15), 209215.
Crawford, J. R., & Allen, K. M. (1997). Estimating premorbid
WAIS-R IQ with demographic variables: Regression equation
derived from a U.K. sample. The Clinical Neuropsychologist,
11, 192197.
Griffin, S. L., Rivera, Mindt, M., Rankin, E., Ritchie, A. J., & Scott,
J.G. (2002). Estimating premorbid intelligence: Comparison
of traditional and contemporary methods across the intelligence continuum. Archives of Clinical Neuropsychology,
17(5), 497507.
Grober, E., & Sliwinski, M. (1991). Development and validation of
a model for estimating premorbid verbal intelligence in the
elderly. Journal of Clinical and Experimental Neuropsychology, 13(6), 933949.
Kraken, D. A., & Gur, R. C. (1995). Reading on the Wide Range
Achievement Test-Revised and parental education as predictors of IQ: Comparison with the Barona formula. Archives of
Clinical Neuropsychology, 10(2), 147157.
Krull, K., Scott, J., & Sherer, M. (1995). Estimation of premorbid
intelligence from combined performance and demographic
variables. The Clinical Neuropsychologist, 9, 8388.
Patterson, K., Graham, N., & Hodges, J. R. (1994). Reading in
dementia of the Alzheimer type: A preserved ability? Neuropsychology, 8(3), 395407.
Spreen, O., & Strauss, E. (1998). A Compendium of neuropsychological tests: Administration, norms, and commentary (2nd
ed.). New York: Oxford University Press.
Wiens, A. N., Bryan, J. E., & Crossen, J. R. (1993). Estimating
WAIS-R FSIQ from the National Adult Reading Test-Revised
in normal subjects. The Clinical Neuropsychologist, 7(1),
7084.

BOOK AND TEST REVIEWS

Andreasen, N. C., Brave New Brain: Conquering

Mental Illness in the Era of the Genome, Oxford
University Press, New York, 2001
This is Andreasens post-Decade-of-the-Brain
sequel to The Broken Brain, her 1980s-era book written
for a general audience. Her perspective here is the story
of psychiatry coming of age in the eras of neuroscience
and genome mapping, rather than the broader story of
a contemporary clinical neuroscience that includes
psychiatry. Andreasen frames her story as a synthesis
of available information, rather than its analysis, to
avoid the traps of what she considers to be some of the
more limiting and divisive dichotomies in mental
health (e.g., drugs vs. psychotherapy). The title of the
book, though, alludes to a dichotomy that Andreasen
does believe is important to the face of psychiatry that
will emerge in our new century: the contrast between
the wonderment and wisdom of goodly folk in the
Shakespearean brave new world of The Tempest and
the hollow ranks of the darkly artificial and decanted
ones in Huxleys fictional world.
The book comprises four sections. The initial section provides a case presentation of an individual with
depression, from which the author unfolds an introduction to contemporary psychiatry. The second section
offers three overview chapters about the brain, genetics, and neuroimaging, respectively. Her outline of
neurotransmitter systems is a strongpoint of the brain
chapter and is accompanied by useful figures. Her
presentation of genetic advances via a five-step pathway for organizing genetic knowledge is a useful device for both general and professional readers.
Four disorders are represented in the books third
section: affective disorders, the dementias, schizophrenia, and anxiety disorders. This section begins with a
practical chapter about defining mental illnesses. Case
presentations make concrete some of the manifestations of each disorder. In addition to outlining diagnostic and treatment issues, she offers a report card of
progress in representative disorders as of 2001. The final section offers the authors musings about where
psychiatry has come from, where it is now, and where
it can go in the future, returning to the central dichotomy of the book concerning which brave new
world of the brain will take hold in our new century.
The writing style throughout is an accessible one for
a nonprofessional audience. She makes the effort to
deal with technical terminology in an admirably patient
way. Brave New Brain seems to be especially well
suited to undergraduate students who will often wish to

get a broader feel for these topics than is available in

their textbooks. In general, the books audience is a
public interested in learning more about the brain at a
time when media commonly highlight both the advances in medicine and the problems of access to insurance coverage and to service providers.
For the professional, it offers a readable overview
about her centers research activities at The University
of Iowa. In particular, Chapter 6 on neuroimaging offers an interesting description of the authors functional
imaging work that began in the 1980s. As a member of
the DSM team, her account of that experience offers an
interesting vignette.
A synthesis such as this runs the risk of being limited to broad strokes to keep the story readable for the
intended audience. Andreasen avoids this and admirably manages to mix in some depth and detail to the
story. Apart from her campus contemporary at the University of Iowa, Antonio Damasio, of the Universitys
neurology department, these are two authors who are
accumulating an interesting shelf of books about neuroscience issues for the general public. Add Oliver
Sacks and a handful of others to the mix and we have a
niche genre of writings for the general public: readable
accounts which make sure that our professional knowledge base can be accompanied by a human face and
can possess enough drama to reflect real-life issues of
patients as people and of the individuals whom they interact with in their daily lives.
Anthony H. Risser, Department of Psychology,
University of Houston, Houston, TX 77204, USA

Semrud-Clikeman, Margaret, Traumatic Brain

Injury in Children and Adolescents: Assessment
and Intervention, Guilford Press, New York,
2001
This book addresses important neuropsychological
issues associated with pediatric traumatic brain injury
(TBI). It is intended to serve as an introductory and applied resource for school psychologists, clinical child
psychologists, and educators. The stated goal is to provide information school practitioners can use in their
work with these children. There is very little emphasis
upon technical aspects of TBI such as neuropathology
or functional neuroanatomy. The primary emphasis, and
the strength of this book, is a focus upon practical
knowledge. Whereas it will prove to be a readable, informative, and clinically relevant presentation for the
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BOOK AND TEST REVIEWS

nonspecialist, many neuropsychologists, especially

those with a pediatric focus, will likely find this book
useful as a summary of important issues supported by
recent and relevant citations, rather than as an in depth
or technical resource. However, the later chapters related to practical issues and interventions are superior to
the earlier chapters related to theory, research, neuropathology and assessment, and will prove useful to
both novice and specialist grappling with practical issues of optimizing academic performance of children
with TBI.
The first chapter begins with a primer of important
terms and concepts related to TBI followed by a review
of relevant literature of critical issues related to pediatric head injury, including age at time of injury, severity of injury, and prognostic factors. The terms, concepts, and issues discussed provide a broad and useful
overview of pediatric TBI. A short section provides a
concise description of typical neurodiagnostic methods
and their relative strengths and weaknesses. However,
there were a number of inaccuracies, inconsistencies,
and stylistic problems that diminished the authors authority for the neuropsychologist. For example, the internal capsule was defined as a tract running from the
anterior to posterior region of the brain and ischemia
simply defined as death of neurons. Inconsistencies reflect faulty editing of the text. The Glasgow Coma
Scale is confused with the Glasgow Outcome Scale.
Donders (1992) is cited as demonstrating both similar
(p. 6) and more problematic (p. 11) premorbid adjustment compared to the norm. Shaffer (1995) is cited as
demonstrating psychiatric disorder following head injury as related to no neurologic abnormality or intellectual impairment and significantly related to damage
to the central nervous system (p. 10). At times, findings from adult literature are cited within the discussion of pediatric populations, without distinction. The
Kolb and Wishaw (1990) model of critical ages of brain
injury related to prognosis is discussed as it applies to
a child with TBI. (p. 12). In reality, the Kolb and
Wishaw model was derived from research on children
with focal lateralized lesions, not TBI, and would
predict findings in TBI contrary to some cited by the
author in the same chapter. Fortunately, these disconcerting problems were not particularly obvious in the
remainder of the book.
Chapter 2 provides an overview of neuroanatomy,
detailing the structure and major functions of the central nervous system, primarily the brain. The author
then emphasizes the developmental approach and outlines the developmental sequencing of brain regions
and associated functions. This is followed by an
186

overview of the Lurian functional systems model associated with the progressive hierarchical integration and
regulation of lower brain center by higher regions. This
is the weakest chapter of the book. It appears as if it
was included only to familiarize the nonneuropsychologist with neuroanatomy and terminology. However,
there is simply too much information packed into very
few pages, and the presentation is far more rote than
conceptual. There is little effort to focus upon or highlight the functional neuroanatomy related to TBI. Although the section on brain development and acquisition of neuropsychological skills is relevant and
necessary, there is no indication how this relates to the
neuropsychological sequelae of traumatic injury occurring at different ages and stages of brain development.
Unfortunately, expectations that this information related to functional neuroanatomy and developmental
sequencing would be integrated and applied in subsequent sections of the book were not satisfied.
Chapter 3 is organized by areas of functional impairments observed after TBI in pediatric populations:
intellectual, academic, attention and executive, memory, perceptual/visual-motor, and psychosocial and behavioral functioning. This chapter is really an extension of Chapter 1 and should logically follow it in
sequence, without the intrusion of the neuroanatomy
chapter. The primary value of this chapter resides
within each section wherein a number of relevant and
interesting studies are discussed. The author does a
good job in integrating the data to reveal a number of
core deficits responsible for the panoply of findings
across studies (in contrast to many reviews that essentially provide a laundry list of impairments). The research strongly supports factors of age of injury, severity of injury, premorbid adjustment, and environmental
support discussed in Chapter 1 as being highly related
to the impairment and prognosis across all realms of
functioning. The last section on psychosocial and behavioral functioning covers a variety of topics and
serves as a platform to introduce the authors working
model of viewing the outcome of pediatric TBI as an
interaction among premorbid functioning, severity of
injury and the reactions of the child and the family to
the injury.
Chapter 4 is a brief but rich synopsis of the impact
of pediatric TBI upon the family and the influence the
family environment has upon the ultimate adjustment
of the injured child. Effective intervention and treatment requires an appreciation of these issues, any of
which would warrant lengthier discussion in a book
primarily focused upon recovery and intervention.
Family stages associated with the childs acute and

BOOK AND TEST REVIEWS

chronic symptoms are discussed. Factors relating to the

resilience of the family in adjusting to the childs
changes are referenced as including financial concerns, family cohesiveness and communication patterns, and the availability of social support. Stresses
upon family members are noted to include risk of marital problems with the parents, sibling conflict and resentment toward the injured sibling, and emotional and
behavioral problems in siblings. Risk factors discussed
include parental psychological problems, single parent
home, and poorer family functioning prior to the injury. It was noted greater adjustment challenges to the
family are posed when a child has a TBI compared to
an orthopedic injury. Consistently, severe TBI was
most highly related to indexes of family stress compared to moderate TBI or orthopedic injuries. The subsequent section provides thoughtful considerations
when communicating with the family and ways in
which to help them optimize their childs functioning.
Making the parents an equal partner in the treatment
and rehabilitation of their child is advocated with a
four stage empowerment model offered as an illustration of how this partnership can be realized.
Chapter 5 provides fundamental information about the
application of neuropsychological assessment within the
academic setting. An educational definition is provided
to distinguish TBI from other disabilities qualified for
special education. The author points out the special needs
of TBI students indicate that they are often underserved
because of lack of training or understanding by teachers
and special educators, who may be more familiar with
specific learning disorders and disabilities other than
TBI. Comments and case examples clearly illustrate
some of the particular issues and concerns, serving as a
useful and practical primer for those with little experience when working with this population. A cursory
overview of major neuropsychological and other tests
serves the purpose of introducing a wide variety of instruments beyond those typically used in school settings.
Although the sections providing description and review
of the instruments are superficial and not particularly
balanced, they serve well their purpose of introducing the
methodology and interpretive process that commends the
neuropsychological approach over the static score-based
approach in common practice. Embedding test performance within a broader context of history and qualitative
behavioral observations is emphasized. A critique of intelligence testing, the cornerstone of most academic evaluations, in a TBI population is particularly appreciated.
Chapter 6 presents the history, behavioral observations, and test data for 2 children who suffered from
TBI. These cases provide concrete examples of the

assessment approach and a number of test instruments

referenced in the preceding chapter. However, the information is often descriptive rather than focusing
upon the process, the what rather than the how,
contrary to the authors emphasis in the prior chapter.
Chapter 7 considers the critical issues pertinent to optimizing the transition of the TBI child or adolescent back
into the school environment. This chapter should be required reading for anyone who works with TBI within the
school setting. A virtual checklist of considerations are
cogently discussed, including criteria for school readiness, ways to integrate medical, community, family and
school resources, common obstacles and challenges
faced within the school environment, and qualities of the
learning environment. Suggestions for dealing with expected problems in a proactive manner are presented. A
much neglected topic of transitioning the adolescent to
college or the work environment is also addressed. The
chapter concludes with an illustrative case workup in
which the data are cogently integrated into a series of useful recommendations to optimize academic functioning.
The utility of a comprehensive neuropsychological evaluation in similar cases is clearly evident.
Chapter 8 begins by a discussion of the issues related
to classroom intervention of impaired skills and behaviors. General considerations such as distinguishing between impairment of content versus process and need to
focus upon transfer and generalization of skills beyond
the immediate learning context are presented. A task
analysis is emphasized as the cornerstone to ensure appropriate direction of intervention strategies. In this
model, impairments are viewed as resulting from the
breakdown of specific component skills within a functional system. The author expands upon the functional
systems approach when next turning her attention to a
variety of strategies, approaches and techniques for specific disorders of attention, memory, executive functions, academic skills, and social and behavior difficulties. She cautions that there is little evidence for the
applicability of the various interventions to children
with TBI (but) they have been found to be quite successful with children with other types of disabilities. At the
least, this section provides a useful compendium of techniques and a good primer of important components
comprising relevant neuropsychological skills. The last
section of the chapter provides a brief overview regarding the utility of medications for attention, aggressive
and disruptive behaviors, and mood disorders, serving
mostly to familiarize the reader with the major medications and some of the pros and cons related to their use.
Chapter 9 presents a case illustration of a neuropsychological evaluation of a 10 year 6 month old boy
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who had suffered a severe head injury at the age of 3.

His academic functioning was limited, resulting in a
request for the neuropsychological evaluation. A brief
background and history are followed by a discussion
of the test results, presented in the format of a neuropsychological assessment report. The Impressions
and Recommendations section of the report does a
good job of summarizing the main points. Most importantly, this section provides a tangible illustration
of how the information obtained can be used: (a) to
identify underlying neuropsychological weaknesses to
be the targets or intervention and (b) which interventions might be appropriate, drawing upon the compendium presented in the earlier chapter. This child
was re-evaluated at age 12. The comparison of the
results from the two assessments demonstrates assessment as a dynamic process, as advocated by the
author, highlighting the implications of changes in
functioning in this child over time.
Chapter 10 is the concluding chapter and is entitled
Final Thoughts. The author offers recommendations in
response to pertinent issues presented within the earlier
chapters. She advocates the need for more empirical research to examine the efficacy of intervention strategies
in children with TBI. She cautions Before anyone can
begin to prescribe treatment, educational or medical, it is
generally helpful to carefully determine and understand
the parameters of a disorder and the impact it may have
on everyday life. She particularly emphasizes the need
to evaluate the childs premorbid functioning as a contributor to post head injury problems, and urges a thorough interview to gain better perspective on the historical
and current contextual factors that need to be considered
in diagnosis, treatment planning, and prognosis. She discusses the need to consider conditions and problems often appearing comorbid to TBI, such as delinquency, substance abuse, family discord, and a variety of other
cognitive and behavioral difficulties. The diagnosis and
treatment of the child needs to consider whether such
problems are primary to TBI. The author contemplates
the need to assess the strengths and weaknesses of the
family system itself, optimizing the familys critical role
in an integrated treatment and intervention strategy. She
cautions against overzealous, but well intended, treatment which overtaxes the child and leaves little time and
energy to live life. Finally, she encourages additional
training and coursework in neuropsychology for school
psychologists and child clinical psychologists.
Arnold D. Purisch, Independent Practice, 24422
Avenida de la Carlota, Suite 270, Laguna Hills,
California 92653, USA
188

Wechsler, D., WPPSI-III: Wechsler Preschool

and Primary Scale of Intelligence (3rd Ed.), The
Psychological Corporation, San Antonio, TX,
2002
Commenting on the state of cognitive assessment
over 20 years ago, Carroll stated, The present scene in
intelligence testing is essentially one of stagnation, with
much talk but little progress (1978, p. 93). The condition and breadth of intelligence testing has surely
changed since those words were penned. Most certainly,
the recent release of the Wechsler Preschool and Primary Scale of Intelligence (3rd ed.), (WPPSI-III;
Wechsler, 2002) is not another stagnant offering, but
is a much-needed improvement to an established psychometric measure of childrens cognitive functioning.
At a time when test revisions seem prolific and the
accompanying consumer reaction can border on cynicism, the revision of the Wechsler Preschool and
Primary Scale of Intelligence-Revised (WPPSI-R;
Wechsler, 1989) is indeed justifiable and a vast improvement over its predecessor. It would appear that a concerted effort was put forth on the part of David Wechsler
and company to improve the WPPSI product in multiple
areas. As identified in the WPPSI-III manual, the five
primary revision goals were to: (a) update theoretical
foundations, (b) increase developmental appropriateness, (c) enhance clinical utility, (d) improve psychometric properties, and (e) increase user-friendliness. By and
large, the revision appears to have met these goals.
Remarks by Sattler (1991, 1992) regarding the elaborateness of the older WPPSI-R and its more extensive
age range are ironically true of the newer WPPSI-III.
The new age range has been lowered by 6 months
(2 years and 6 months to 7 years and 3 months), which
benefits earlier intervention evaluations. Additionally,
the overall age range has been divided into two age
bands, each with separate consumables and differing
core subtests. The battery for children ages 2:63:11
includes four core subtests, while the battery for children ages 4:07:3 involves seven core subtests. The age
split was motivated by developmental sensitivities.
Core subtests for the younger cohort were designed to
measure reasoning ability with less reliance on verbal
comprehension. Additionally, the older cohort battery
includes subtests that establish a Processing Speed
quotient, which is a considerable improvement over the
WPPSI-III predecessor.
Several WPPSI-R subtests remain in the updated
version; however, five subtests were removed, including animal pegs, arithmetic, geometric design, mazes,

BOOK AND TEST REVIEWS

and sentences. There are seven new subtests, many of

which will be already familiar to Wechsler scale users.
Two of the new subtests (receptive vocabulary, picture
naming) were designed particularly to address the
younger cohorts expressive and receptive language
abilities. These language subtests will be welcomed additions for neuropsychological evaluations, if not for
offering alternate forms for testing receptive and expressive language. All subtests now offer teaching and
practice items, which more fully ensures that the client
follows the gist of each subtest. Additionally, the new
editions improved item formulation offers enhanced
sensitivities for the practitioner to effectively plumb
the clients floor and ceiling abilities, which was most
certainly a major drawback of the WPPSI-R. The
WPPSI-III now offers a more valid instrument for testing both the intellectually gifted and the mentally deficient populations.
In efforts to improve the administration time, the
number of core WPPSI-III subtests has been reduced,
with a concurrent increase in the number of optional
supplemental subtests. This allows the practitioner to
administer core subtests, while still tailoring the complete cognitive battery to address specific concerns.
Time conscious practitioners will be impressed with
the overall administration time for core WPPSI-III subtests, which has been comparatively reduced. The manual states that 90 percent of the standardization sample
completed the core subtests within practical time limits
(45 min for younger cohort, 61 min for older cohort).
The administration time appears reasonable, granted it
favors clients similar to the norming population. An example of time efficiency is exhibited in the WPPSI-IIIs
revision of the Object Assembly subtest. Specifically,
the object assembly subtest offers the benefit of a new
discontinue rule of three consecutive errors. Although
its potential length may initially appear daunting
(14 items for the younger cohort), the combination of
the new discontinue rule, a shorter time limit of 90 sec,
and the simplicity of the floor items should ensure a
quickened testing pace. In contrast, the newly added
word reasoning subtest may prove to be lengthy to administer. Word Reasoning has a five-failure cutoff, no
time limit, and a number of items with three accompanying cues. Yet, to the developers favor, the WPPSI-III
appears to be time sensitive.
Besides theoretical changes (i.e., more emphasis on
fluid reasoning) and the welcome inclusion of bidirectional base rate tables, the improved age appropriateness of the WPPSI-III is particularly admirable. The
presentation of test materials is much more child
friendly, with all stimulus booklet art having being

redrawn, enlarged, and colorized. The WPPSI-III has

an engaging appearance, which cannot be emphasized
enough when assessing this particular target audience.
An equally wise move was to replace the cumbersome
WPPSI-R flat blocks (Block Design) with the more
age-appropriate (and graspable) cube blocks. The significantly improved presentation of the puzzle pieces
will be a welcome inclusion to most batteries. Owing
to the central contribution that motivation makes when
testing young clients, the qualitative improvements of
the WPPSI-III are not idle matters. There is little doubt
that such enhancements will allow this measure to
more easily maintain the childs interest.
The WPPSI-III has robust psychometric qualities
with noticeable improvements. Norming data was gathered from a stratified representative sample of 1,700
children, with additional data obtained from various
special group studies, including mental retardation,
developmental delay, attention deficit/hyperactivity disorder, and autism, among others. The WPPSI-III was
subject to adequate investigation for convergent and
discriminant validity. Additionally, in comparison to its
predecessor, the WPPSI-III evidences substantial psychometric improvements regarding reliability. The average reliability coefficients for the four IQ scales are excellent, ranging from .89 to .96, although the average
processing speed quotient of .89 is below the .90 benchmark. Similarly, the reliability for the Performance
Scale IQ is below .90 for ages 2:62:11 and 3:03:5.
Subtest reliability has been vastly improved ranging
from .83 to .95. Particular improvements are noted in
the coefficients for Object Assembly, which improved
from .86 to .95, and for Similarities, which improved
from .86 to .95.
The manual attests that all test items were reviewed
for ethnic, gender, regional, and socioeconomic bias.
One test item that appears to have slipped under the
bias radar is the inclusion of a dated electric can
opener in the Picture Concepts subtest. Idiosyncratic as
it may seem, few children may correctly identify this
item. More importantly, the addition of the Processing
Speed quotient for the older cohort rides solely on the
performance of two motor dependent pencil and paper
subtests: coding and symbol search. This does not bode
well for children from ethnic groups who do not
emphasize speed.
The clientele for whom the administration of the
WPPSI-III may offer the biggest challenges could be
with the younger members of the older cohort, particularly with 4-year-old children. The somewhat abstract
instructions for Matrix Reasoning and Picture
Concepts may be particularly problematic for mildly
189

BOOK AND TEST REVIEWS

delayed 4- and 5- year-olds. Perhaps it would have been

advisable to include more teaching items and directional prompts for children struggling with sample
items from these two subtests. A less consuming criticism concerns the stimulus booklets. The WPPSI-III
stimulus booklets have a format that many new tests
are unfortunately turning to: coiled flipcharts lacking
appropriate cover and binding support. Although this is
a likely cost saver for the publisher, the covers for the
two stimulus books become easily bent without the
benefit of more sturdy support. More appropriate binding would have added to the longevity and appearance
of the measure.
Nonetheless, the WPPSI-III has relatively few shortcomings. The enhancement and advances of the
WPPSI-III over the WPPSI-R are considerable. Its overall improved appearance, utility, statistical power, and
theoretical basis mirror the sound judgment and planning that undergird the latest edition of this intelligence
testing staple. Despite the few aforementioned drawbacks, it is a welcome improvement on a measure
steeped in solid tradition. In comparison to the DAS and
the Stanford-Binet intelligence measures for this age
group, the WPPSI-III may well provide practitioners

190

with a superior intellectual functioning measure. The

previous WPPSI-R drawback of inadequate attention to
floor and ceiling consideration can no longer be
claimed. As with any new measure, time and future
research will assist in verifying the WPPSI-IIIs utility.
William Hamilton, Ph.D., and Thomas G. Burns,
Psy.D., Childrens Healthcare of Atlanta, Atlanta,
GA, USA

References
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York: Guilford Press.
Sattler, J. M. (1991). Normative changes on the Wechsler Preschool
and Primary Scale of Intelligence-Revised Animal Pegs
subtest. Psychological Assessment, 3, 691692.
Sattler, J. M. (1992). Assessment of children. San Diego: Author.
Wechsler, D. (1989). Wechsler preschool and Primary Scale of
Intelligence-Revised. San Antonio, TX: Psychological
Corporation.
Wechsler, D. (2002). Wechsler Preschool and Primary Scale of
Intelligence-III. San Antonio, TX: Psychological Corporation.