The Journal of General Psychology

ISSN: 0022-1309 (Print) 1940-0888 (Online) Journal homepage: https://www.tandfonline.com/loi/vgen20

WISC-III Cognitive Profiles in Children with ADHD:

Specific Cognitive Impairments and Diagnostic
Utility

Octávio Moura, Paulo Costa & Mário R. Simões

To cite this article: Octávio Moura, Paulo Costa & Mário R. Simões (2019): WISC-III Cognitive
Profiles in Children with ADHD: Specific Cognitive Impairments and Diagnostic Utility, The Journal
of General Psychology, DOI: 10.1080/00221309.2018.1561410

To link to this article: https://doi.org/10.1080/00221309.2018.1561410

Published online: 07 Feb 2019.

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THE JOURNAL OF GENERAL PSYCHOLOGY
https://doi.org/10.1080/00221309.2018.1561410

WISC-III Cognitive Profiles in Children with ADHD:

Specific Cognitive Impairments and Diagnostic Utility
Oct
avio Mouraa, Paulo Costab, and M
ario R. Simo
~esa
a
University of Coimbra; bLeiria Hospital Center

ABSTRACT ARTICLE HISTORY

This study aimed to investigate the presence of specific cogni- Received 11 August 2018
tive impairments and the diagnostic utility of the WISC-III in Accepted 12 December 2018
children with ADHD. Ninety-eight children with ADHD and 81
KEYWORDS
children without ADHD matched by age and gender (control
Attention-Deficit/
group), between the ages of 6 and 12 years, participated in Hyperactivity Disorder
the study. Children with ADHD revealed the most pronounced (ADHD); cognitive profiles;
deficits in the subtests tapping working memory and process- processing speed; WISC;
ing speed. Freedom from Distractibility was the cognitive pro- working memory
file most impaired and that showed the highest diagnostic
accuracy to discriminate children with ADHD. The optimal cut-
off scores of the most common WISC-III cognitive profiles
revealed greater diagnostic accuracy than the traditional
approach of full or partial profiles. Taken together, these
results suggested that in the context of a comprehensive psy-
chological assessment, the WISC may provide knowledge
about the specific cognitive strengths and weaknesses that
characterize this disorder and may be useful in the decision-
making process relative to ADHD diagnosis.

Introduction
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most com-
mon neurodevelopmental disorders, affecting approximately 5% of children.
It is characterized by a persistent pattern of inattention and/or hyperactivity-
impulsivity that interferes significantly with the individual’s functioning or
development. The number and combination of these symptoms can give rise
to three types of presentation: predominantly inattentive (ADHD-I), pre-
dominantly hyperactive-impulsive (ADHD-HI) and combined (ADHD-C)
(American Psychiatric Association, 2013). It has been hypothesized that
ADHD results from a dysfunction in the prefrontal-striatal circuitry that
underpins deficits in executive functions (Castellanos & Proal, 2012).
Numerous studies demonstrate that children with ADHD performed poorly

CONTACT Oct
avio Moura octaviomoura@gmail.com Psychological Assessment and Psychometrics

Laboratory, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Col
egio Novo, 3000-
115, Coimbra, Portugal.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/vgen.
ß 2019 Taylor & Francis Group, LLC
2 O. MOURA ET AL.

on measures of working memory (Alloway & Cockcroft, 2014), processing

speed (Shanahan et al., 2006; Willcutt, Pennington, Olson, Chhabildas, &
Hulslander, 2005), inhibition, and shifting (Moura et al., 2017; Roberts,
Martel, & Nigg, 2017), among others.
As a result of the cognitive deficits observed in individuals with
ADHD, many studies have tried to identify specific Wechsler Intelligence
Scale for Children (WISC) profiles (e.g., Filippatou & Livaniou, 2005;
Mayes & Calhoun, 2006; Prifitera & Dersh, 1993). Thus, the present study
aimed to analyze the cognitive profiles and the diagnostic utility of WISC-
III (Wechsler, 1991, 2003) in children with ADHD using the traditional
approach (i.e., group differences, percentages of discrepancies among index
scores, and the presence of a pattern of low scores on the subtests included
in the most common WISC cognitive profiles) and applying a different
approach based on other statistical methods [i.e., receiver operating charac-
teristics (ROC) curve analysis and optimal cutoff scores].
The first attempt to identify specific WISC’s cognitive profiles is thought
to have been proposed by Bannatyne (1968, 1971). He suggested that
WISC subtest scores could be re-categorized into four composite scores
(spatial abilities: Block Design, Object Assembly and Picture Completion;
conceptual abilities: Vocabulary, Similarities and Comprehension; sequential
abilities: Digit Span, Coding and Arithmetic; and acquired knowledge:
Information, Arithmetic and Vocabulary) and that children with learning
disabilities exhibited a specific pattern: spatial abilities > conceptual abili-
ties > sequential abilities. Although the Bannatyne pattern has been investi-
gated mostly in children with reading difficulties yielding mixed results
(Moura, Sim~ oes, & Pereira, 2014; Smith & Watkins, 2004), some research-
ers also analyzed its diagnostic utility in children with ADHD. For
example, Prifitera and Dersh (1993) found a base rate of 47% in children
with ADHD (vs. 13.6% in the WISC-III normative sample) and suggested
that the Bannatyne WISC-III pattern is useful for diagnostic purposes.
€
More recently, Hesapçioglu, Çelik, Ozmen, and Yigit (2016) found signifi-
cant differences in the spatial abilities and sequential abilities composite
scores among children with ADHD and typically developing children, with
an odds ratio of 0.761 for the spatial abilities.
Anastopoulos, Spisto, and Maher (1994) were one of the first to
analyze the diagnostic utility of the WISC-III Freedom from Distractibility
Index1 (Arithmetic and Digit Span subtests) in identifying children with
ADHD. They found that children with ADHD scored significantly lower
in the Freedom from Distractibility Index than in either the Verbal
Comprehension Index or the Perceptual Organization Index. At an individ-
ual level, they observed that 25% of the children with ADHD displayed
significant Verbal Comprehension Index–Freedom from Distractibility
 THE JOURNAL OF GENERAL PSYCHOLOGY 3

Index differences according to the WISC-III manual, and 52% displayed

significant Verbal Comprehension Index or Perceptual Organization
Index–Freedom from Distractibility Index differences. Mayes and Calhoun
(2002, 2004) found that Freedom from Distractibility Index was the lowest
index score in 57% of the children with ADHD, the low Freedom from
Distractibility Index profile was two times more common in ADHD
than in children with any other clinical diagnosis (e.g., autism, learning dis-
abilities, brain injury), and that 78.8% of the children with ADHD exhib-
ited a Freedom from Distractibility Index lower than the WISC-III
Full Scale IQ. Hesapçioglu et al. (2016), using a logistic regression
analysis, found an odds ratio of 0.722 suggesting that for a one-unit
increase in the score of Freedom from Distractibility the risk of ADHD fell
by 27.8%.
Two other WISC cognitive profiles have been extensively investigated in
children with ADHD: the ACID (Arithmetic, Coding, Information, and
Digit Span subtests) and the SCAD (Symbol Search, Coding, Arithmetic,
and Digit Span subtests). Prifitera and Dersh (1993) found that the full
ACID pattern (i.e., the four ACID subtests were less than or equal to the
scores on the remaining subtests) was more common in the ADHD sample
(12.3%) than in the WISC-III standardization sample (1.1%). Filippatou
and Livaniou (2005) observed that children with ADHD scored signifi-
cantly lower on the mean score of ACID than the mean score of the
remaining WISC-III subtests, but when a stepwise discriminant function
analysis was applied, the ACID profile did not efficiently separate children
with ADHD from those without ADHD.
In relation to the SCAD profile, Mayes, Calhoun, and Crowell (1998)
identified that for 87.4% (study 1) and 76.9% (study 2) of children with
ADHD, the sum of the SCAD subtests was less than the sum of Verbal
Comprehension Index and Perceptual Organization Index subtests, with a
positive predictive power of 76.5% (study 1) and 81.6% (study 2). In
another study, Mayes and Calhoun (2006) also found that children with
ADHD performed significantly higher in the Verbal Comprehension Index
and Perceptual Organization Index (or Perceptual Reasoning Index in
WISC-IV) than Processing Speed Index and Freedom from Distractibility
Index (or Working Memory Index in WISC-IV) in WISC-III (medium to
large effect sizes; d ¼ 0.5 to 1.0) and in WISC-IV (very large effect sizes;
d ¼ 1.6 to 1.9). In WISC-III, 88% of children with ADHD scored lowest on
Freedom from Distractibility Index or Processing Speed Index.
Interestingly, Snow and Sapp (2000) observed that a difference of  17
points between Perceptual Organization Index and SCAD was observed in
25.7% of children with ADHD, which contrasts with the low percentage
observed in the WISC-III standardization sample (2.6%). Kaufman (1994)
4 O. MOURA ET AL.

recommended the use of the SCAD instead of the ACID because it is less
vulnerable to contamination from school learning (i.e., Information subtest)
and that the differences between clinical groups (e.g., ADHD and learning
disabilities) and typically developing children are largely attributable to the
subtests comprising the Freedom from Distractibility Index and Processing
Speed Index. We did not find studies that explored optimal cutoff scores
for the Freedom from Distractibility, ACID, and SCAD composite scores in
children with ADHD.
Surprisingly, although the General Ability Index (a composite score that
includes Verbal Comprehension Index and Perceptual Organization Index
subtests) was first developed for use with the WISC-III (Prifitera, Weiss, &
Saklofske, 1998), only with the publication of the WISC-IV some studies
have explored its diagnostic accuracy to correctly identify children with
ADHD. The General Ability Index is a useful composite score to estimate
overall intellectual ability because it is sensitive to cases in which working
memory performance is significantly discrepant from verbal comprehension
performance and/or processing speed performance is significantly discrep-
ant from perceptual reasoning performance (Prifitera et al., 1998; Raiford,
Weiss, Rolfhus, & Coalson, 2008). Indeed, for some children with ADHD,
learning disabilities or other neurodevelopmental disorders, concomitant
working memory and processing speed deficits lower the Full Scale IQ
(Montes, Allen, Puente, & Neblina, 2010; Poletti, 2016). Thus, the Full
Scale IQ–General Ability Index discrepancy and the General Ability
Index–Cognitive Proficiency Index discrepancy may provide valuable
information in a number of neuropsychological and psychoeducational
evaluations. In a technical report on the clinical utility of WISC-IV General
Ability Index, it was reported that 65.9% of the children with ADHD dis-
played a Full Scale IQ < General Ability Index, for 35.4% the discrepancy
was 5 points or greater, and for 6.1% the discrepancy was 10 points or
greater. Percentages were higher in children with a comorbid diagnosis of
ADHD and learning disorder: 73.2%, 43.9%, and 24.4%, respectively
(Raiford et al., 2008). Similar findings were also reported for adults with
ADHD, with 57.8% showing a WAIS-IV Full Scale IQ < General Ability
Index, and for 43.1% a significant discrepancy was observed (Theiling &
Petermann, 2016). Based on these findings, it is relevant to analyze the
diagnostic utility of the General Ability Index, in WISC-III, to verify
whether it replicates the results obtained from WISC-IV or shows a differ-
ent pattern of results. Inversely, Devena and Watkins (2012), through a
ROC curve analysis, found area under the curve (AUC) values ranging
between .46 and .64, which suggest a low diagnostic accuracy of the WISC-
IV General Ability Index–Cognitive Proficiency Index discrepancy in iden-
tifying children with ADHD.
 THE JOURNAL OF GENERAL PSYCHOLOGY 5

In another line of investigation, confirmatory factor analytic studies have

found different factor solutions for WISC-IV in samples of children with
ADHD. While some studies have reported that the WISC-IV four-factor
model fitted well for children with ADHD (Yang et al., 2013), other studies
only found evidences for the use of the Full Scale IQ scores (Gomez,
Vance, & Watson, 2016; Styck & Watkins, 2017), and others showed that it
is highly unlikely that WISC-IV index score profiles can validly contribute
to ADHD assessments (Fenollar-Cort
es, L
opez-Pinar, & Watkins, 2018).

The present study

Taken together, these findings lend some support for the diagnostic utility
of WISC in ADHD. Indeed, investigating performance in WISC subtests
and profile analysis are useful because they may provide knowledge about
the specific cognitive strengths and weaknesses that characterize certain dis-
orders, and they may alert psychologists to certain diagnostic possibilities,
to the eligibility for the special education system and to the intervention
planning (Donders, 1996; Mayes & Calhoun, 2004; Prifitera et al., 1998).
Although new editions of the WISC (-IV and -V) have since been pub-
lished, the WISC-III continues to be the most recent edition available in
many countries (e.g., Greece, Netherlands, Portugal). On the other hand,
the large body of research about WISC cognitive profiles have been con-
ducted on English-speaking samples, but it is also particularly important to
analyze the presence of such profiles in samples of children whose native
language is not English in order to understand which ADHD cognitive def-
icits may be universal and which are culturally specific. Thus, the present
study aimed to investigate the presence of specific cognitive impairments
and the diagnostic utility of the WISC-III in children with ADHD. This
study extended previous research by: (1) examining the diagnostic utility of
WISC-III in Portuguese children with ADHD (no similar studies with
the Portuguese version of WISC-III were found); (2) performing ROC
curve analysis for the index scores discrepancies and the composite scores
of the most common WISC-III cognitive profiles (few studies computed
this type of statistical analysis); and (3) identifying optimal cutoff scores
with the associated sensitivity and specificity values (to the best of our
knowledge, the present study is the first to explore optimal cutoff scores of
WISC-III in children with ADHD).
Based on the existing literature, we hypothesized that: (1) children with
ADHD would reveal more significant weaknesses in subtests tapping work-
ing memory and processing speed (Parke, Thaler, Etcoff, & Allen, 2015;
Schwean & Saklofske, 2005; Thaler, Bello, & Etcoff, 2013); (2) discrepancies
among index scores and the presence of a pattern of low scores on the
6 O. MOURA ET AL.

subtests included in the Bannatyne, Freedom from Distractibility Index,

ACID, and SCAD profiles would demonstrate moderate accuracy to
discriminate children with ADHD (Hesapçioglu et al., 2016; Mayes &
Calhoun, 2006); and (3) optimal cutoff scores for the index scores discrep-
ancies and for the composite scores of the most common WISC-III cogni-
tive profiles would reveal more adequate sensitivity and specificity values
than the traditional approach (Moura et al., 2014).

Method
Participants
Participants included 179 Portuguese children (73.7% male) between the
ages of 6 and 12 years (M ¼ 8.73 and SD ¼ 1.86) who were in first to sev-
enth grade in school.
In the ADHD group (n ¼ 98), 76.5% were male, with a mean age of 8.55
(SD ¼ 1.92) of which 36 (36.7%) were diagnosed with ADHD-I, 36 (36.7%)
with ADHD-HI, and 26 (26.5%) with ADHD-C, according to the diagnos-
tic criteria of the Diagnostic and Statistical Manual of Mental Disorders –
5th edition (DSM-5; American Psychiatric Association, 2013).
In the control group (n ¼ 81), 70.4% were male, with a mean age of 8.94
(SD ¼ 1.78). This group was recruited through contact with schools, teachers,
parents, and other participants using a snowball sampling strategy. Children
with special educational needs were excluded. The groups were matched by
gender v2(1) = 0.869, p = .351 and by age v2(6) = 9.623, p = .141.
For both groups, only children who met the following criteria were
included in the study: (1) WISC-III Full Scale IQ  80; (2) native speakers
of European Portuguese; (3) absence of any visual, hearing, or motor handi-
cap; (4) never having been diagnosed with a language impairment, emotional
disturbance, specific learning disorder, oppositional defiant disorder, conduct
disorder, neurological impairment, or other psychiatric disorder. All partici-
pants attended regular classes in public and private schools.

ADHD – Criteria for inclusion

Children with ADHD were recruited from the Department of Pediatrics of
the [withheld for blind review] Hospital Center in Portugal. Diagnosis of
ADHD was confirmed by a comprehensive clinical diagnostic assessment
made by qualified pediatricians and a psychologist. The diagnostic evalu-
ation included: (1) semistructured interview with parents using the DSM-5
criteria (American Psychiatric Association, 2013); (2) both parent and
teacher ratings of at least 1.5 SD (T-score  65) above the mean on the
ADHD Index of the Conners Rating Scale–Revised (Conners, 1997);
 THE JOURNAL OF GENERAL PSYCHOLOGY 7

(3) neuropsychological tests of attention and executive functions (e.g.,

Conners’ Continuous Performance Test – 2nd edition, Stroop Color and
Word Test, and Tower of London); and (4) other complementary assess-
ments (e.g., Child Behavior Checklist and Teacher’s Report Form).
To ensure that WISC-III performance was uninfluenced by psychostimu-
lants (Jepsen, Fagerlund, & Mortensen, 2009), children with ADHD who
were prescribed psychostimulants (i.e., methylphenidate) did not receive
medication during the week in which the evaluation was performed. This
longer period is more stringent than the criterion used by other studies, in
which medication was ceased only 24 hours prior to evaluation (Alloway &
Cockcroft, 2014; Moura et al., 2017).

Measure and procedures

The WISC-III (Wechsler, 1991) is an individually administered intelligence
test for children between the ages of 6 to 16 that includes three composite
IQ scores (Full Scale IQ, Verbal IQ, and Performance IQ with a M ¼ 100
and SD ¼ 15), four index scores (Verbal Comprehension Index, Perceptual
Organization Index, Processing Speed Index, and Freedom from
Distractibility Index with a M ¼ 100 and SD ¼ 15) and 13 subtests
(Information, Similarities, Arithmetic, Vocabulary, Comprehension, Digit
Span, Picture Completion, Coding, Picture Arrangement, Block Design,
Object Assembly, Symbol Search, and Mazes with a M ¼ 10 and SD ¼ 3).
The factor structure of the Portuguese version of WISC-III (Wechsler,
2003), analyzed through exploratory and confirmatory factor analyses, sug-
gested a two-factor (Verbal IQ and Performance IQ) and a three-factor
model (Verbal Comprehension Index, Perceptual Organization Index, and
Processing Speed Index). As in other countries (e.g., Netherlands and
Greece), the Portuguese version of WISC-III does not include the Freedom
from Distractibility Index; however, it has been shown that this index score
can be relevant in a context of a psychological evaluation of some neurode-
velopmental disorders (Moura et al., 2017; Thaler et al., 2013). In order to
include this index score in the present study, the Freedom from
Distractibility Index was estimated by applying a linear equating method
proposed by Tellegen and Briggs (1967) based on data provided in the
Portuguese version of the WISC-III Manual. This method is based on a lin-
ear scaling of composite subtests scaled scores to obtain deviation quotients
that maintain the index score distribution (M ¼ 100 and SD ¼ 15). This
method has been commonly used in studies that analyzed WISC index
scores and short forms due to their accurate estimation of composite scores
(e.g., Girard, Axelrod, Patel, & Crawford, 2015; van Ool et al., 2018). In the
present study, the Mazes subtest was not administered to all participants.
8 O. MOURA ET AL.

As highlighted earlier, in some neurodevelopmental disorders and special

education cases, the General Ability Index may be a slightly higher estimate
of overall intellectual ability than the Full Scale IQ because it excludes
subtests that are related to processing speed and working memory. Due to
its relevance in neuropsychological and psychoeducational evaluations,
Prifitera et al. (1998) provided a WISC-III norms table for the General
Ability Index, which we used in the present study.
The children were tested in three sessions of approximately 45 minutes,
held in a clinic setting scheduled on a regular day. All of the measures
were individually administered in a fixed order. The study was approved by
the Ethics Committee of the [withheld for blind review] Hospital Center
and the Scientific Committee of the Faculty of Psychology and Educational
Sciences – University of [withheld for blind review]. Voluntary participa-
tion was requested of all participants and the objectives of the study were
fully explained. Informed parental consent and child assent were obtained
for each evaluation.

Statistical analyses
Statistical analyses were performed using IBM SPSS Statistics 23 and
MedCalc 12.7. Independent-samples t-tests and univariate analysis of vari-
ance (ANOVA) were calculated to investigate the significance of differences
in WISC-III scores comparing children with and without ADHD. If the ini-
tial ANOVA revealed a significant main effect, planned post hoc compari-
sons were conducted among the groups with a Bonferroni adjustment for
multiple comparisons. Cohen’s d or partial eta-squared (g2p) were also cal-
culated to determine the effect size of the differences between groups.
Previous to any of these analyses, each dependent variable was assessed
for outliers, normal distribution and homogeneity of variances. No outliers
were found in the data. All dependent variables revealed skewness and kur-
tosis values lower than 1, suggesting normal distribution of the data. The
Levene’s test of homogeneity of variances was not significant (p > .05) in
all independent-samples t-tests and ANOVAs.
A ROC curve analysis was performed to examine the accuracy with
which WISC-III index scores discrepancies and cognitive profiles were
able to discriminate between the ADHD group and the control group.
The ROC curve analysis is produced by showing the false-positive rate
(1-specificity) on the x axis and the true-positive rate (sensitivity) on the
y axis for each possible cutoff score and calculates the AUC. That is, sensi-
tivity and specificity are determined for each cutoff point (Fawcett, 2006).
The AUC is the average of the true positive rate, taken uniformly over
all possible false positive rates, which ranges between .5 and 1.0
 THE JOURNAL OF GENERAL PSYCHOLOGY 9

(Krzanowski & Hand, 2009). An AUC value of 1.0 is perfectly accurate

because the sensitivity is 1.0 when the false positive rate is .0 whereas an
AUC value of .5 reflects a completely random classifier. An AUC of .5 to
.7 indicates a poor discrimination, .7 to .8 an acceptable discrimination, .8
to .9 an excellent discrimination, and .9 to 1.0 an outstanding discrimin-
ation (Hosmer, Lemeshow, & Sturdivant, 2013).

Results
IQs, Index scores and subtests: Group differences
Statistically significant differences were found between control group and
children with ADHD for all IQs and index scores, with the control group
outperforming children with ADHD (see Table 1). The largest group differ-
ence was observed for Freedom from Distractibility Index with a Cohen’s d
of 1.10 (i.e., the mean score of the control group is z ¼ 1.10 above the mean
score of the ADHD group), with 83.7% of children with ADHD having a
Freedom from Distractibility Index score below the mean of the control
group. At the subscale level, children with ADHD scored significantly lower
than control group in eight of the 12 WISC-III subtests, with Digit Span
(d ¼ 0.95) and Arithmetic (d ¼ 0.75) showing the largest group differences.
We also performed a series of ANOVAs contrasting control group and
ADHD subtypes (control group vs. ADHD-I vs. ADHD-HI vs. ADHD-C).
Significant main effects were found for all IQs and index scores as well for
six of the 12 WISC-III subtests. Planned post hoc tests revealed significant
differences between control group and some ADHD subtypes, but non-sig-
nificant differences were found among children with ADHD, the exception
was the Performance IQ (ADHD-HI > ADHD-C) (see Appendix).

Index scores discrepancies and cognitive profiles: Group differences

As shown in Table 1, significant index scores discrepancies between control
group and children with ADHD were found for Full Scale IQ–General
Ability Index, Verbal Comprehension Index–Freedom from Distractibility
Index, Perceptual Organization Index–Freedom from Distractibility Index,
and Processing Speed Index–Freedom from Distractibility Index.
Interestingly, children with ADHD scored 3 points lower in the Full Scale
IQ than the General Ability Index; 8 points lower in the Freedom from
Distractibility Index than the Verbal Comprehension Index, and 4 points
lower in the Freedom from Distractibility Index than the Perceptual
Organization Index and Processing Speed Index.
Significant group differences were also found for all composite scores of
cognitive profiles (control group > children with ADHD), with large effect
10 O. MOURA ET AL.

Table 1. WISC-III mean scores for control group and ADHD group.
Control group (n ¼ 81) ADHD group (n ¼ 98) t(177) d
IQs
Full Scale IQ 103.69 ± 10.05 96.04 ± 10.77 4.873 0.73
Verbal IQ 105.77 ± 10.24 99.90 ± 10.91 3.681 0.55
Performance IQ 101.52 ± 10.24 94.65 ± 12.15 4.033 0.61
Index Scores
General Ability Index 103.89 ± 8.50 98.89 ± 9.19 3.747 0.56
Verbal Comprehension Index 105.20 ± 10.46 100.67 ± 11.07 2.789

0.42
Perceptual Organization Index 100.90 ± 10.01 96.64 ± 12.16 2.522 0.38
Processing Speed Index 104.01 ± 13.76 96.58 ± 13.69 3.605 0.54
Freedom from Distractibility Index 105.15 ± 9.93 92.99 ± 12.07 7.257 1.10
Subtests 
Information 10.38 ± 2.07 9.59 ± 2.53 2.253 0.34
Similarities 11.25 ± 2.44 10.96 ± 2.62 0.753 0.11
Arithmetic 11.01 ± 2.33 9.27 ± 2.28 5.043 0.75
Vocabulary 10.78 ± 2.72 9.51 ± 2.67 3.133 0.47
Comprehension 11.05 ± 2.45 10.67 ± 2.76 0.951 0.14
Digit Span 10.70 ± 2.29 8.40 ± 2.53 6.309 0.95
Picture Completion 10.60 ± 2.34 10.09 ± 2.79 1.314 0.19
Coding 10.37 ± 2.66 8.85 ± 2.95 3.587

0.54
Picture Arrangement 10.51 ± 2.70 9.61 ± 2.54 2.272 0.34
Block Design 9.95 ± 2.12 9.51 ± 2.46 1.267 0.19
Object Assembly 10.22 ± 2.42 9.02 ± 2.85 3.000

0.45
Symbol Search 11.01 ± 2.96 9.92 ± 2.92 2.476 0.37
Discrepancies
FSIQ – GAI 0.20 ± 4.18 2.85 ± 5.79 3.439 0.52
VIQ – PIQ 4.25 ± 10.78 5.24 ± 14.22 0.520 0.07
VCI – POI 4.30 ± 11.01 4.03 ± 14.30 0.137 0.02
VCI – PSI 1.19 ± 15.60 4.09 ± 15.41 1.249 0.18
VCI – FDI 0.05 ± 11.75 7.68 ± 13.69 3.954 0.60
POI – PSI 3.11 ± 15.47 0.06 ± 15.40 1.368 0.20
POI – FDI 4.25 ± 11.32 3.65 ± 14.97 3.912 0.59
PSI – FDI 1.14 ± 15.33 3.59 ± 14.90 2.085 0.31
Cognitive Profiles (composite scores)
Freedom from Distractibility 21.72 ± 3.31 17.66 ± 4.02 7.257 1.10
ACID 42.47 ± 5.48 36.10 ± 6.99 6.670 1.01
SCAD 43.10 ± 6.35 36.43 ± 7.21 4.492

0.98
Spatial Abilities 30.78 ± 4.68 28.62 ± 6.26 2.562 0.39
Conceptual Abilities 33.07 ± 5.51 31.14 ± 5.74 2.280 0.34
Sequential Abilities 32.09 ± 4.43 26.51 ± 5.52 7.336 1.11
Note. p < .05; p < .01; p < .001. IQ and Index Scores are composite IQs scores (M ¼ 100 and SD ¼ 15)
and Subtests scores are age-adjusted-scaled scores (M ¼ 10 and SD ¼ 3). FSIQ ¼ Full Scale IQ. VIQ ¼ Verbal IQ.
PIQ ¼ Performance IQ. GAI ¼ General Ability Index. VCI ¼ Verbal Comprehension Index. POI ¼ Perceptual
Organization Index. PSI ¼ Processing Speed Index. FDI ¼ Freedom from Distractibility Index. FD ¼ Freedom
from Distractibility (the sum of the age-adjusted-scaled scores of Arithmetic and Digit Span subtests).
ADHD ¼ Attention-Deficit/Hyperactivity Disorder.

sizes in the Bannatyne sequential abilities (d ¼ 1.11), Freedom from

Distractibility (d ¼ 1.10), ACID (d ¼ 1.01), and SCAD (d ¼ 0.98) compos-
ite scores.
ANOVAs contrasting control group and ADHD subtypes revealed sig-
nificant main effects for several index scores discrepancies and composite
scores of cognitive profiles (control group > ADHD subtypes). Once again,
non-significant differences were found among children with ADHD
(ADHD-I ¼ ADHD-HI ¼ ADHD-C) (see Appendix). These findings may
suggest that WISC-III did not adequately differentiate the three ADHD
 THE JOURNAL OF GENERAL PSYCHOLOGY 11

subtypes. Thus, in the following analyses, we will only compare children

from the control group to children with ADHD (subtypes will no longer
be considered).

Index scores discrepancies and cognitive profiles: Diagnostic accuracy

Although the results from the previous inferential analyses indicated signifi-
cant group differences (control group > ADHD) with moderate to large
effect sizes, it does not imply that index scores discrepancies and cognitive
profiles can correctly discriminate the children with and without ADHD.
Therefore, four levels of analyses were carried out to determine the diag-
nostic accuracy of these measures: (1) percentages of discrepancies among
IQs and index scores in control group and children with ADHD; (2) sensi-
tivity and specificity values for a pattern of low scores on the subtests
included in Freedom from Distractibility, ACID, SCAD and Bannatyne
profiles (i.e., full or partial profiles); (4) a ROC curve analysis for the index
scores discrepancies and the composite scores of cognitive profiles; and (4)
optimal cutoff scores with the associated sensitivity and specificity values.
As reported in Table 2, the Full Scale IQ < General Ability Index were
obtained by more than 77% of children with ADHD, and for 39.8% of
them the discrepancy was equal to or higher than 5 points (vs. 8.6% of
control group). The Verbal Comprehension Index > Freedom from
Distractibility Index was observed in 73.5% of children with ADHD; 66.3%
of them performed 5 or more points in Verbal Comprehension Index than
Freedom from Distractibility Index, and for 46.9% this discrepancy was 10
points or greater (vs. 16% for control group). The Perceptual Organization
Index > Freedom from Distractibility Index was observed in more than
60% of children with ADHD; 44.9% performed 5 or more points in
Perceptual Organization Index than Freedom from Distractibility Index,
and for 32.7% the discrepancy was 10 points or greater (vs. 11.1% for con-
trol group). The Freedom from Distractibility Index was the lowest index
score for 42.9% of children with ADHD (vs. 11.1% for control group), and
64.3% of them scored lowest on Freedom from Distractibility Index or
Processing Speed Index.
Following the traditional approach suggested by Prifitera and Dersh
(1993), children were considered to be positive for the full profile when
their scores on the four ACID (excluding Symbol Search and Mazes) and
SCAD subtests or on the two Freedom from Distractibility subtests were
less than or equal to the scores on the remaining subtests. Partial profiles
were obtained when the scores on any three of the four ACID and SCAD
subtests had to be less than or equal to the scores on the remaining subt-
ests. We also investigated other partial profiles, namely the presence of
12 O. MOURA ET AL.

Table 2. Percentages of the discrepancies among IQs and Index Scores in control group and
ADHD group.
 10  5  1 1 5  10
FSIQ – GAI
Control group 0 8.6 46.9 38.3 9.9 2.5
ADHD 7.1 39.8 77.6 15.3 3.1 1.0
VIQ – PIQ
Control group 8.6 19.8 35.8 60.5 46.9 30.9
ADHD 18.4 23.5 33.7 64.3 56.1 43.9
VCI – POI
Control group 11.1 22.2 30.9 64.2 46.9 35.8
ADHD 21.4 27.6 33.7 64.3 53.1 36.7
VCI – PSI
Control group 24.7 35.8 46.9 51.9 37.0 29.6
ADHD 17.3 26.5 38.8 57.1 45.9 35.7
VCI – FDI
Control group 16.0 32.1 48.1 50.6 32.1 16.0
ADHD 11.2 16.3 24.5 73.5 66.3 46.9
POI – PSI
Control group 27.2 45.7 56.8 37.0 33.3 19.8
ADHD 27.6 38.8 49.0 49.0 38.8 27.6
POI – FDI
Control group 27.2 55.6 64.2 33.3 21.0 11.1
ADHD 17.3 26.5 36.7 60.2 44.9 32.7
PSI – FDI
Control group 27.2 43.2 49.4 37.0 27.2 23.5
ADHD 16.3 28.2 34.7 60.2 46.9 31.6
Note. FSIQ ¼ Full Scale IQ. VIQ ¼ Verbal IQ. PIQ ¼ Performance IQ. GAI ¼ General Ability Index. VCI ¼ Verbal
Comprehension Index. POI ¼ Perceptual Organization Index. PSI ¼ Processing Speed Index. FDI ¼ Freedom from
Distractibility Index. ADHD ¼ Attention-Deficit/Hyperactivity Disorder.

Freedom from Distractibility in the three and four lowest-scoring subtests,

and the ACID and SCAD in the five and six lowest-scoring subtests. The
Bannatyne pattern was established when children exhibit a specific pattern
on Bannatyne’s composite measures: spatial abilities > conceptual abili-
ties > sequential abilities.
As shown in Table 3, the full Freedom from Distractibility, ACID, and
SCAD profiles misclassified the children with ADHD, only 2% to 5.1% of
whom were properly diagnosed (true positive). The Freedom from
Distractibility in the four lowest-scoring subtests was the cognitive profile
that showed the highest diagnostic accuracy, with a sensitivity of 27.6%, a
specificity of 95.1%, a positive predictive power of 87.1% (i.e., 87.1% of
children classified as positive are children with ADHD), and a negative pre-
dictive power of 52% (i.e., 52% of children classified as negative are chil-
dren from the control group). In general, these results suggested that the
presence of the pattern of low scores on the subtests included in Freedom
from Distractibility, ACID, SCAD, and Bannatyne profiles did not effi-
ciently distinguish between children with and without ADHD (low sensitiv-
ity values).
Additionally, a ROC curve analysis was performed to determine the diag-
nostic accuracy of the index scores discrepancies and the composite scores
 THE JOURNAL OF GENERAL PSYCHOLOGY 13

Table 3. Diagnostic accuracy (in percentages) of full and partial cognitive profiles in children
with ADHD.
Positive Negative
True-Positive True-Negative False- False- predictive predictive
(Sensitivity) (Specificity) Positive Negative power power
Freedom from
Distractibility
full profile 5.1 98.8 1.2 94.9 83.3 46.2
in 3 lowest subtests 16.3 95.1 4.9 83.7 80.0 48.4
in 4 lowest subtests 27.6 95.1 4.9 72.4 87.1 52.0
ACID
full profile 2.0 100 0 98.0 100 45.8
partial profile 16.3 95.1 4.9 83.7 80.0 48.4
in 5 lowest subtests 7.1 98.8 1.2 92.9 87.5 46.8
in 6 lowest subtests 17.3 93.8 6.2 82.7 77.3 48.4
SCAD
full profile 4.1 100 0 95.9 100 46.3
partial profile 9.2 93.8 6.2 90.8 64.3 46.1
in 5 lowest subtests 10.2 100 0 89.8 100 47.9
in 6 lowest subtests 16.3 97.5 2.5 83.7 88.9 49.1
Bannatyne pattern 22.4 93.8 6.2 77.6 81.5 50.0

of cognitive profiles (the Bannatyne pattern was not included because it is

a dichotomous variable: presence vs. absence). The more accurately a test is
able to discriminate between groups (higher AUC values), the more its
ROC curve will deviate toward the upper left corner of the graph. Table 4
shows the AUC values, and Figure 1 illustrates the ROC curve for the three
composite scores that revealed the highest AUC values. The AUC value for
Freedom from Distractibility was .781 (i.e., a randomly selected child with
ADHD will have a lower Freedom from Distractibility score than a ran-
domly selected child without ADHD approximately 78.1% of the time), for
sequential abilities it was .770, and for ACID it was .752. These three com-
posite scores yielded .70  AUC values < .80, which is classified as
“acceptable discrimination” (Hosmer et al., 2013, p. 177).
The results of the ROC curve analyses were also used to determine opti-
mal cutoff scores. The optimal cutoff score is where the overall number of
errors (i.e., false positives and false negatives) is minimized (Bewick, Cheek,
& Ball, 2004). To select optimal cutoff scores, the Youden index (Youden,
1950) was calculated (J = sensitivity þ specificity – 1) and the cutoff score
associated with the highest J value is considered to indicate the optimal
cutoff score. Graphically, J is the maximum vertical distance between the
ROC curve and the diagonal line. The optimal cutoff score of the Freedom
from Distractibility ( 17) revealed the highest Youden index (J = .404),
which yielded a sensitivity of 49% and a specificity of 91.4%. Sequential
abilities, ACID, SCAD, and the discrepancy Full Scale IQ – General Ability
Index also produce optimal cutoff scores with interesting sensitivity (
39.8%) and specificity ( 82.7%) values. Table 4 shows the optimal cutoff
score for the index scores discrepancies and composite score of cognitive
14 O. MOURA ET AL.

Table 4. ROC curve analysis and optimal cutoff scores for discrepancies and for the composite
scores of cognitive profiles.
Optimal Cut-
AUC (95% CI) off Score Youden Index (J) Sensitivity (%) Specificity (%)
Discrepancies
FSIQ – GAI .705 (.632–.770)  5 .311 39.8 91.4
VIQ – PIQ .541 (.465–.616) 9 .156 49.0 66.7
VCI – POI .508 (.433–.584)  11 .115 78.6 9.9
VCI – PSI .556 (.480–.631)  3 .107 66.3 44.4
VCI – FDI .684 (.611–.751) 5 .342 66.3 67.9
POI – PSI .555 (.480–.630) 2 .131 49.0 64.2
POI – FDI .671 (.597–.740)  5 .291 73.5 55.6
PSI – FDI .607 (.531–.679) 1 .231 60.2 63.0
Cognitive Profiles
(composite
scores)
FD .781 (.713–.839)  17 .404 49.0 91.4
ACID .752 (.682–.814)  36 .387 51.0 87.7
SCAD .747 (.677–.809)  37 .317 49.0 82.7
Spatial Abilities .613 (.538–.685)  26 .204 37.8 82.7
Conceptual .593 (.517–.665)  29 .173 40.8 76.5
Abilities
Sequential .770 (.701–.829)  27 .379 49.0 88.9
Abilities
Note. p < .05; p < .01; p < .001. AUC ¼ area under the curve. FSIQ ¼ Full Scale IQ. GAI ¼ General Ability
Index. VCI ¼ Verbal Comprehension Index. POI ¼ Perceptual Organization Index. PSI ¼ Processing Speed Index.
FDI ¼ Freedom from Distractibility Index. FD ¼ Freedom from Distractibility.

profiles. These results showed greater diagnostic utility of the composite

scores than the presence of full or partial profiles.

Discussion
The Wechsler intelligence scales are considered to be the gold standard
measures of intellectual functioning. While the Wechsler intelligence scales
do not diagnose ADHD (nor were they ever were intended to do so), sev-
eral studies have analyzed their utility in the psychological assessment of
individuals with ADHD. It has been extensively reported in the literature
that in addition to inattention and hyperactivity-impulsivity symptoms,
children with ADHD revealed specific cognitive impairments (Moura et al.,
2017; Roberts et al., 2017; Willcutt et al., 2005). Thus, because the WISC-
III may be useful to analyze the cognitive strengths and weaknesses in chil-
dren with ADHD, the present study investigated their diagnostic accuracy
to correctly discriminate children with and without ADHD.
In a meta-analytic study, Frazier, Demaree, and Youngstrom (2004)
reported that overall intellectual ability of individuals with ADHD is sig-
nificantly lower than healthy participants, with a weighted mean effect size
of d ¼ 0.61 for Full Scale IQ, d ¼ 0.67 for Verbal IQ, and d ¼ 0.58 for
 THE JOURNAL OF GENERAL PSYCHOLOGY 15

Figure 1. ROC curve analysis comparing true- and false-positive rates between children with
and without ADHD in the Freedom from Distractibility (FD), Sequential Abilities and ACID com-
posite scores. Dashed lines represent 95% confidence interval lines.

Performance IQ. It means that the ADHD groups performed at approxi-

mately 9 Full Scale IQ points lower than the control groups if a theoretical
SD of 15 is assumed. Interestingly, they observed that the magnitude of the
effect sizes for several neurocognitive measures of attention, working mem-
ory, and behavioral inhibition was equivalent or smaller than that obtained
for Full Scale IQ. In our study, we also found that WISC-III Full Scale IQ
was significantly lower in children with ADHD than in control group (D =
7.65 points, d ¼ 0.73), as well the Verbal IQ (D = 5.87 points, d ¼ 0.55) and
Performance IQ (D = 6.87 points, d ¼ 0.61). This finding is relevant given
the fact that some confirmatory factor analytic studies with children with
ADHD recommended that interpretation of the WISC (particularly for
WISC-IV) should remain at the Full-Scale IQ score level (Devena, Gay, &
Watkins, 2013; Fenollar-Cort
es et al., 2018; Gomez et al., 2016; Styck &
Watkins, 2017). It is well-known that performance on the WISC is particu-
larly influenced by executive functions because they include some subtests
16 O. MOURA ET AL.

that assess working memory and processing speed abilities. Executive func-
tions may also influence the performance on the WISC subtests through
alterations in response style and problems with the inhibitory control, cog-
nitive flexibility, planning, and self-regulation, among others (Kaufman &
Lichtenberger, 2000). In addition, inattention problems may also explain
the lower IQ scores observed in children with ADHD. Jepsen et al. (2009)
estimated that the inattention-related mean influence on Full Scale IQ may
be in the 2- to 5-point range. Deficits on academic achievement, language,
verbal and visuospatial memory are commonly encountered in individuals
with ADHD (Alloway & Cockcroft, 2014; Kasper, Alderson, & Hudec,
2012; Moura et al., 2017), which may also reduce the IQs and index scores.
Interestingly, the performance on the WISC-III (IQs, index scores, subt-
ests, and cognitive profiles) were not significantly different in the three
ADHD subtypes. This finding suggests that in our sample, WISC-III did
not find independent subgroups of children with ADHD. In their meta-
analytic study, Frazier et al. (2004) also found that ADHD subtypes did not
significantly differ on Full Scale IQ. Mayes, Calhoun, Chase, Mink, and
Stagg (2009) identified similar performance between children with ADHD-
C and ADHD-I in the Freedom from Distractibility Index (95 and 93,
respectively), Processing Speed Index (99 and 97, respectively), and in the
discrepancy Full Scale IQ – Freedom from Distractibility Index (12 and 14,
respectively). Several other studies have investigated the performance on a
variety of cognitive measures between ADHD subtypes, and the results
have shown that the ADHD-I, ADHD-HI, and ADHD-C exhibit more sim-
ilarities than differences (Bernfeld, 2012; Fenollar-Cort
es, Navarro-Soria,
Gonz
alez-G
omez, & Garc
ıa-Sevilla, 2014; Koziol & Budding, 2012; Riccio,
Homack, Jarratt, & Wolfe, 2006; Solanto et al., 2007). For example,
Chhabildas, Pennington, and Willcutt (2001) observed that children with
ADHD-I and ADHD-C had similar deficits in tasks that require assessing
inhibition, processing speed, and vigilance, whereas children with ADHD-
HI were not significantly impaired from carrying out any of these tasks
once subclinical symptoms of inattention were controlled. The ADHD-I
did not differ from ADHD-C in the WISC-R Full Scale IQ, Verbal IQ and
Performance IQ scores. In a meta-analytic study, Willcutt et al. (2012) did
not find evidences for the validity of ADHD-H after first grade and for the
presence of distinct academic and cognitive functioning between ADHD-I
and ADHD-C. Moreover, they did not identify ADHD subgroups with suf-
ficient long-term stability to justify the classification of distinct forms/sub-
types of this neurodevelopmental disorder. Obviously, the diagnosis of
ADHD subtypes is particularly influenced by clinicians’ decisions regarding
informants, instruments, and the method for aggregating information
across informants and instruments (Valo & Tannock, 2010), but is also
 THE JOURNAL OF GENERAL PSYCHOLOGY 17

unstable over time (Lahey, Pelham, Loney, Lee, & Willcutt, 2005), which
may explain the mixed findings reported in literature with regard to the
endophenotype of ADHD subtypes.
Although inferential analysis showed significant group differences for
almost all WISC-III scores, children with ADHD revealed most pro-
nounced weaknesses in subtests tapping working memory and processing
speed. The Freedom from Distractibility Index was the index score most
impaired in children with ADHD (d ¼ 1.10); the three subtests with the
highest effect sizes were Digit Span, Arithmetic, and Coding; the Freedom
from Distractibility, ACID, SCAD and Sequential Abilities cognitive profiles
are significantly reduced in children with ADHD; and approximately two-
thirds of children with ADHD scored lowest on Freedom from
Distractibility Index or Processing Speed Index. These findings are consist-
ent with the first hypothesis and have been extensively reported in litera-
ture (Hesapçioglu et al., 2016; Mayes & Calhoun, 2006; Parke et al., 2015;
Schwean & Saklofske, 2005; Snow & Sapp, 2000; Thaler et al., 2013).
Although children with ADHD performed significantly lower than con-
trol group for almost all WISC-III scores, the presence of a significant dif-
ference alone does not imply that a subtest or an index/composite score
can discriminate among subjects with sufficient accuracy. Thus, additional
analyses were performed in order to investigate the accuracy of the WISC-
III in the diagnosis of children with ADHD. We hypothesized that the dis-
crepancies among index scores would demonstrate moderate accuracy to
discriminate children with ADHD, which was partially confirmed. Indeed,
for a large number of children with ADHD, concomitant working memory
and processing speed deficits lower the Full Scale IQ. More than 77% of
children with ADHD showed a Full Scale IQ lower than the General
Ability Index. The AUC value of .705 indicates acceptable discrimination
accuracy in terms of group classification (Hosmer et al., 2013), and a dis-
crepancy of 5 points or greater was identified as the optimal cutoff score
with a sensitivity of 39.8% and a specificity of 91.4%. Similar results were
reported by Raiford et al. (2008) based on the WISC-IV Technical and
Interpretive Manual: 65.9% of the children with ADHD displayed a Full
Scale IQ < General Ability Index, and for 35.4% the discrepancy was 5
points or greater. Following the original proposal of Prifitera et al. (1998),
we found that the General Ability Index was a slightly higher estimate of
intellectual ability than the Full Scale IQ (approximately 3 points higher
than Full Scale IQ) and probably a more adequate measure to identify
intellectual functioning in children with ADHD. Similar evidence was also
found for children with specific learning disorder (Giofre, Toffalini, Altoe,
& Cornoldi, 2017; Moura et al., 2014; Poletti, 2016). For example, Giofre
et al. (2017) found that the Full Scale IQ–General Ability Index discrepancy
18 O. MOURA ET AL.

represents an effective criterion for differentiating between children with

and without specific learning disorder (AUC value of .762).
The examination of the most common WISC cognitive profiles linked to
ADHD provided additional diagnostic information beyond the index
scores- and subtest-level analyses. Some studies have found that the pattern
of low scores on the subtests included in Freedom from Distractibility,
ACID, SCAD, and the Bannatyne profiles is useful for diagnostic purposes
(Hesapçioglu et al., 2016; Mayes & Calhoun, 2004; Prifitera & Dersh, 1993;
Snow & Sapp, 2000), but our results did not fully support their conclusion.
Although the presence of the Bannatyne pattern and full or partial
Freedom from Distractibility, ACID and SCAD profiles was more prevalent
among children with ADHD, the sensitivity and specificity values revealed
a low diagnostic accuracy. The most accurate cognitive profiles were the
presence of the Freedom from Distractibility in the four lowest-scoring
subtests and the Bannatyne pattern that were present in 27.6% and 22.4%
of children with ADHD, respectively. Likewise, Filippatou and Livaniou
(2005) through a stepwise discriminant function analysis found that the
ACID profile did not efficiently identify children with ADHD from those
without ADHD.
Based on these findings, we explored other approaches to (re)interpret
the data from the most common WISC cognitive profiles. Through a ROC
curve analysis and by applying the Youden index, we identified the optimal
cutoff scores associated with the Freedom from Distractibility, ACID, and
SCAD composite scores. To the best of our knowledge, the present study is
the first to explore optimal cutoff scores of WISC-III in children with
ADHD. The results obtained with this approach revealed greater diagnostic
accuracy than the traditional full or partial profiles, which support our
third hypothesis. For example, the Freedom from Distractibility showed the
highest AUC value (= .781), and a score less than or equal to 17 correctly
identified 49% of children with ADHD with a Full Scale IQ  80 (only
8.6% of false-positives). The Sequential Abilities revealed the second highest
AUC value (= .770) and the sum of the age-adjusted-scaled scores of Digit
Span, Coding, and Arithmetic subtests less than or equal to 27 correctly
identified 49% of children with ADHD (11.1% of false-positives). The opti-
mal cutoff scores for ACID and SCAD also showed adequate diagnos-
tic accuracy.
Thus, optimal cutoff scores for WISC cognitive profiles may be another
indicator to identify specific cognitive deficits and may be useful in the
decision-making process relative to ADHD diagnosis. Obviously, WISC’s
cognitive profiles alone cannot be considered a diagnostic marker of
ADHD (or of any other neurodevelopmental disorder) but may provide
knowledge about the cognitive strengths and weaknesses that characterize
 THE JOURNAL OF GENERAL PSYCHOLOGY 19

this disorder. It would be of interest if future research could replicate

these findings with larger samples of children with ADHD and analyze the
diagnostic accuracy of optimal cutoff scores with the WISC-IV and -V.
Notwithstanding the relevance of the present study, there are some limi-
tations that should be considered when interpreting the results. First, the
Freedom from Distractibility Index was estimated by applying a linear
equating method that was developed by Tellegen and Briggs (1967), which
allowed the Freedom from Distractibility Index to be calculated based on
the correlation between the Arithmetic and Digit Span subtests. In com-
parison to the Freedom from Distractibility Index scores based on the
standardization sample (not available in the Portuguese version of WISC-
III), this statistical technique underestimates scores in the upper portion of
the distribution and overestimates scores in the lower portion of the distri-
bution (the difference is approximately 2–3 points) (Raiford et al., 2008).
Although the Tellegen and Briggs method is appropriate for use if the
standardization data are not available (Flanagan & Kaufman, 2004; Raiford
et al., 2008), the interpretation of this index score should be made with
some caution. Second, the General Ability Index scores used in this study
were obtained from the Prifitera et al. (1998) norms table because the
Portuguese version of the WISC-III did not provide this index score. Thus,
the interpretation of General Ability Index scores should also be made with
some caution. Third, the ADHD group only included 98 children, which
limits the generalizability of the findings. Fourth, although the children
with ADHD did not receive psychostimulants during the week in which
the evaluation was performed, it would be a better baseline comparison if
all children with ADHD were medication naïve.
To conclude, children with ADHD revealed most pronounced deficits in
the WISC-III subtests tapping working memory and processing speed,
which consequently lower the Full Scale IQ. The General Ability Index may
be a more adequate measure to identify intellectual functioning in children
with ADHD. The Freedom from Distractibility was the index score/cogni-
tive profile most impaired and that showed the highest diagnostic accuracy
to discriminate children with and without ADHD. The optimal cutoff
scores of the most common WISC cognitive profiles revealed greater diag-
nostic accuracy than the traditional approach of full or partial profiles.
Although the information obtained from the WISC are of significant
importance in the ADHD evaluation and decision-making process (Mayes
& Calhoun, 2004; Prifitera et al., 1998; Schwean & Saklofske, 2005), it
needs to be viewed in the context of a more comprehensive psychological
assessment that includes a clinical interview, rating scales, observation of
the child behavior, and cognitive measures (e.g., executive functions, atten-
tion, and working memory), among others.
20 O. MOURA ET AL.

Notes
1. Throughout the article the term “Freedom from Distractibility” will be used to refer
to the composite measure of the sum of the age-adjusted-scaled scores of Arithmetic
and Digit Span subtests (ranging from 2 to 38 points). In the case of the full and
partial cognitive profile analysis, the “Freedom from Distractibility” will be also used
to refer to a specific pattern of low age-adjusted-scaled scores on the Arithmetic and
Digit Span subtests that were less than or equal to the scores on the remaining
WISC-III subtests. The term “Freedom from Distractibility Index” will be used to
refer to the WISC-III index score (M ¼ 100 and SD ¼ 15).

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Appendix

WISC-III mean scores for control group and ADHD subtypes.

ADHD subtypes Control group vs. ADHD subtypes
Control
group ADHD-I ADHD-HI ADHD-C post hoc
(n ¼ 81) (n ¼ 36) (n ¼ 36) (n ¼ 26) F(3, 175) g2p (Bonferroni)
IQs
FSIQ 103.69 96.58 98.53 91.85 10.273 .150 CG > ADHD-I,
(10.05) (11.18) (11.99) (6.79) ADHD-C
VIQ 105.77 100.14 101.64 97.15 5.447 .085 GC > ADHD-C
(10.24) (11.58) (11.22) (9.23)
PIQ 101.52 95.17 97.58 89.88 8.016 .121 GC > ADHD-I,
(10.24) (10.79) (13.79) (10.37) ADHD-C;
ADHD-
HI > ADHD-C
Index Scores
GAI 103.89 98.39 101.28 96.27 6.447 .100 GC > ADHD-I,
(8.50) (8.50) (10.84) (6.00) 
ADHD-C
VCI 105.20 100.86 102.53 97.85 3.561 .058 GC > ADHD-C
(10.46) (11.26) (11.78) (9.52) 
POI 100.90 97.00 98.86 93.08 3.514 .057 GC > ADHD-C
(10.01) (10.65) (14.24) (10.49)
PSI 104.01 98.75 98.25 91.27 6.226 .096 GC > ADHD-C
(13.76) (14.65) (11.67) (14.01)
FDI 105.15 92.00 95.00 91.58 18.162 .237 GC > ADHD-I,
(9.93) (12.14) (12.00) (12.17) ADHD-HI,
ADHD-C
Subtests 
Information 10.38 9.25 10.17 9.27 2.864 .047
(2.07) (2.62) (2.79) (1.90)
Similarities 11.25 10.94 11.44 10.31 1.200 .020
(2.44) (2.69) (2.95) (1.91)
Arithmetic 11.01 9.22 9.69 8.73 5.303 .139 GC > ADHD-I,
(2.33) (2.33) (1.96) (2.58) ADHD-HI,

ADHD-C
Vocabulary 10.78 9.69 9.22 9.65 3.464 .056 GC > ADHD-HI
(2.72) (2.92) (2.53) (2.56)
Comprehension 11.05 11.17 10.92 9.65 2.167 .036
(2.45) (2.90) (2.70) (2.48)
Digit Span 10.70 8.11 8.64 8.46 13.472 .188 GC > ADHD-I,
(2.29) (2.53) (3.02) (1.72) ADHD-HI,
ADHD-C
Picture 10.60 9.92 10.42 9.88 0.866 .015
Completion (2.34) (2.72) (3.28) (2.12)
Coding 10.37 9.22 9.39 7.58 6.894 .106 GC > ADHD-C
(2.66) (3.09) (2.53) (3.03)
Picture 10.51 9.86 9.56 9.35 1.908 .032
Arrangement (2.70) (2.28) (2.86) (2.49)
Block Design 9.95 9.25 10.14 9.00 2.021 .033
(2.12) (2.11) (2.69) (2.48)
Object 10.22 9.17 9.58 8.04 4.833 .077 GC > ADHD-C
Assembly (2.42) (2.65) (2.87) (2.93)
Symbol Search 11.01 10.31 9.94 9.35 2.574 .042
(2.96) (2.93) (3.07) (2.72)
Discrepancies
FSIQ – GAI 0.20 1.81 2.75 4.42 5.320 .084 GC > ADHD-C
(4.18) (8.45) (2.76) (3.92)
VIQ – PIQ 4.25 4.97 4.06 7.27 0.414 .007
(10.78) (13.08) (14.14) (16.09)
VCI – POI 4.30 3.86 3.67 4.77 0.046 .001
(continued)
 THE JOURNAL OF GENERAL PSYCHOLOGY 25

Continued.
ADHD subtypes Control group vs. ADHD subtypes
Control
group ADHD-I ADHD-HI ADHD-C post hoc
(n ¼ 81) (n ¼ 36) (n ¼ 36) (n ¼ 26) F(3, 175) g2p (Bonferroni)
(11.01) (14.05) (14.03) (15.51)
VCI – PSI 1.19 2.11 4.28 6.58 0.937 .016
(15.60) (14.09) (12.58) (20.23)
VCI – FDI 0.05 8.86 7.53 6.27 5.377 .084 GC > ADHD-I,
(11.75) (14.16) (11.56) (15.99) ADHD-HI
POI – PSI 3.11 1.75 0.61 1.81 0.910 .015
(15.47) (14.63) (15.09) (17.14)
POI – FDI 4.25 5.00 3.86 1.50 5.416 .085 GC > ADHD-I,
(11.32) (13.37) (16.70) (14.87) ADHD-HI
PSI – FDI 1.14 6.75 3.25 0.31 2.578 .042
(15.33) (13.68) (14.75) (16.26)
Cognitive Profiles
(composite
scores)
FD 21.72 17.33 18.33 17.19 18.162 .237 GC > ADHD-I,
(3.31) (4.05) (4.00) (4.06) ADHD-HI,
ADHD-C
ACID 42.47 35.81 37.89 34.04 17.073 .226 GC > ADHD-I,
(5.48) (7.57) (6.86) (5.85) ADHD-HI,
ADHD-C
SCAD 43.10 36.86 37.67 34.12 15.688 .212 GC > ADHD-I,
(6.35) (7.97) (6.33) (6.99) ADHD-HI,
ADHD-C
Spatial Abilities 30.78 28.33 30.14 26.92 3.968 .064 GC > ADHD-C
(4.68) (5.50) (7.19) (5.54)
Conceptual 33.07 31.81 31.58 29.62 2.616 .043
Abilities (5.51) (5.98) (5.90) (5.08)
Sequential 32.09 26.56 27.72 24.77 20.014 .255 GC > ADHD-I,
Abilities (4.43) (5.84) (5.02) (5.47) ADHD-HI,
ADHD-C
Note. p < .05. p < .01. p < .001. IQ and Index Scores are composite IQs scores (M ¼ 100 and SD ¼ 15)
and Subtests scores are age-adjusted-scaled scores (M ¼ 10 and SD ¼ 3). FSIQ ¼ Full Scale IQ. VIQ ¼ Verbal IQ.
PIQ ¼ Performance IQ. GAI ¼ General Ability Index. VCI ¼ Verbal Comprehension Index. POI ¼ Perceptual
Organization Index. PSI ¼ Processing Speed Index. FDI ¼ Freedom from Distractibility Index. FD ¼ Freedom
from Distractibility (the sum of the age-adjusted-scaled scores of Arithmetic and Digit Span subtests).
CG ¼ Control group. ADHD ¼ Attention-Deficit/Hyperactivity Disorder. ADHD-I ¼ Attention-Deficit/Hyperactivity
Disorder predominantly inattentive. ADHD-HI ¼ Attention-Deficit/Hyperactivity Disorder predominantly hyper-
active/impulsive. ADHD-C ¼ Attention-Deficit/Hyperactivity Disorder combined. Standard deviations in
parentheses.