ADHD: Accept, Understanding and WISC-IV

My child’s WISC IV report has lots of other scores besides an IQ. What do they mean? It is a well-established good practice to perform a WISC-IV test on children suspected of having been born with ADHD. But what does the test actual say, and what does that mean for my child? In this article I explain how you interpret and understand the WISC-IV test scores, as well as how that relate to everyday functioning of your child.

Let us not ask what our children can do for us, but what we can do for our children …

Peter ‘ADDspeaker’ Vang
Is your child a purple flower in a field filled with white and yellow ones? Don’t despair!

Introduction

Unfortunately it is a normal reaction when parents get a child with a disability to try to ‘normalize’ the child out of love and the need to protect their most precious belonging. But as many parents of children with ADHD can attest, it becomes an almost impossible, stressful and ultimately a silly thing to try to achieve.

Some 10 years ago now, I worked as a Business Consultant and my speciality was helping people and companies to better implement their visions, by reinterpreting how they understand and used their corporate (or personal values), in unison and with a common understanding of what those values meant, what behavior (verbal and non-verbal) was needed and what they meant for the person, the team, the department, and hopefully in time – the entire cooperation.

During my work, I realized that no matter what I tried to get people to change, I would not move them along an inch … in the beginning … until I realized something very profound – people are born with something called ‘free will’. This may not come as a big surprise to most of you, but since I am a person who have both ADHD and Atypical Autism, I’d never really comtemplated the idea of ‘other people having their own inner world’.

But once I realized this, I could create a wonderful hands-on and easy model for ‘Anchoring your changed behavior, values and skills into a new and improved version of yourself – your new identity’. The trick for making this work, with almost all people, in all positions, of all ages … ACCEPTANCE

Once we as humans are able to accept that something has (or soon will) change, and accept that this is now fact, no longer is up for discussion no matter how much you believe, feel or want it to be different, we are set free.

When I was diagnosed with ADHD and Atypical Autism at age 40 in 2012, I was a lucky son of a gun, since I knew that the sooner I accepted these facts, the sooner I could get to work on re-inventing myself and building a new identity that better suited the demands of my future life.

I talk to and have talked to numerous parents of children with ADHD and Autism in our Facebook Groups and Support Forums, and they mostly have a grief response, once their child is diagnosed with ADHD and/or Autism.

This grief response is comparable to the grief response we experience when we loose someone dear to us. In this case, it is a metaphore for the lost dream of being the perfect parent to the perfect child (or something less ambitious but still important), so when I coach parents, I always ask them to forgive themselves for feeling negative feelings about the situation that they have been put in by Nature.

Because once they have accepted, grieved and come out alive on the other side, then it is time for me to help them realize how much we know about how to create the good life for people like myself and help us live a positive, productive and happy life – with ADHD.

So it’s OK to cry, curse and agonise for a while – but then you have to be the adult here and take up your responsibility and help your child become all that they wish to become!

Don’t misunderstand, there is NO benefits of having a chronic, life-long and severly impairing mental disorder like ADHD, but it is not a life sentence to a life in unavoidable misery and it does not have to end up in disarray and bad statistics … if you help your child for their sake, disregarding all the bullshit that Scientology and others try to fill you head with, you can succeed in helping them amount to their full potential.

Being born with ADHD does not mean that you are unable to learn new stuff, what it does mean, however, is that since your inhibitory control is delayed by 30% in it’s maturation, compared to neuro-typical children (normal), causing your 10 year old child with ADHD to have the ability to control, regulate and manage emotions, needs and behavior which is what we would expect of a 7 year old child, without ADHD.

The reason why we do not ‘learn from our mistakes’ is not due to lack of willpower, lack of intelligence or lack of trying for that matter … It is because our mental disorder causes an impairment in the Performance (doing) aspect of our behavior, whereas the Knowledge (knowing) aspect is not impaired, but are not even close to becoming useful, since our impulsivity due to lack of inhibitory control and our inability to postpone innediate needs gratification.

Get some insight into how Attention acutally works in humans

People with ADHD are not more or less clever or stupid than the general public, but we are often perceived to be just that, since we repeat the same unwanted behavior over and over again, which, rightfully, annoy the hell out of people in our lives.

One thing that you must understand (and accept) is that ADHD is a neurobiological, chronic and life-long, neurodevelopmental disorder which, untreated, will cause your child to have an Estimated Life Expectancy which is 12.7 year reduced, compared to people not having been born with ADHD.

Another thing that you must accept, is that the risk of your child developing so-called Comorbidity (additional illnesses and disorders besides ADHD) is very common, 80% have ADHD + 1 comorbid disorder, 55% have ADHD + 2 comorbid disorders, and almost half have ADHD + 3 comorbid disorders.

So the ‘norm’ is that you will not only have to manage the ADHD, but like-wise ensure that your child have been given the optimal opportunities to reduce the relative risk of developing comorbidity, later in life.

Scientific consensus today, in regards to optimal treatment of ADHD in all ages, is to medicate with ADHD medication and simultaneously create a ‘scaffolding’ for them to help them lessen their handicap in their meeting with societal demands and expectations and at the point of performance, not in a classroom or at some therapy session!

Today, 55 years into the use of ADHD medications, we are pretty certain that it do not cause any serious side effects and that the non-serious side effects are mild and manageable. I will not go into any discussion about this topic in this article, I’ve spent countless hours on explaining why this is, so please read my arguments in my other articles, for now let us just trust me, OK?

In november 2018 I had the pleasure of meeting my long-time (unofficial) mentor, Dr. Russell A. Barkley, Ph.D., who was visiting Denmark and during that meeting, he explained how the latest scientific evidence points to an amazing finding, namely that children who have been treated with ADHD medication from age 4 and up continously, actually have rewired their brain’s circuitry and thereby have ‘error corrected’ the symptoms that this neurodevelopmental disorder comes with, and that they in adulthood now is completely treated for their ADHD, leaving them without any impairment and scoring like neuro-typicals would! This is the case in around 15% of the children which he has follow in his longitudinal study going over 27 years, where he has followed a large group of children with ADHD-C and a control group, all under rigourously scientific standards.

If you do not know who Dr. Barkley is, then let me briefly tell you the short version. Dr. Barkley is widely recognised as the father of modern understanding of ADHD, which is based on his pivotal work published in the book “ADHD and the Nature of Self-control” (1997). Dr. Barkley has been awarded a Diplomate (board certification) in three specialties, these being Clinical Psychology (ABPP), Clinical Child and Adolescent Psychology, and Clinical Neuropsychology (ABCN, ABPP). He is a clinical scientist, educator, and practitioner who has authored, co-authored, or co-edited 20 books and clinical manuals. He has published more than 200 scientific articles and book chapters related to the nature, assessment, and treatment of ADHD and related disorders.

So when I say that ADHD medication + psychosocial support is what is the only scientifically verfied recommendation for treating ADHD, please know that this comes from my research into ADHD for the past 7 years, not from my agendas for anything else, nor promoting any political, religious or financial interests of my own!

OK, let’s get back on track, shall we?

Remembering that a handicap is not the cause of the impairment (e.g. being blind, being deaf or having ADHD), it is the perception of the person’s ability to feel accepted by society, as well as the limitations they meet, when trying to participate in societal life.

I have a statement I use to remember its definition, and it goes like this;


“You cannot BE disabled, you can only HAVE a disability, and that only when you experience you fail to meet societal demands and expectations!

Peter ‘ADDspeaker’ Vang

OK, that said, lets move on and see if we can figure out how we best service our children, based on the knowledge we can gain from tests like The Wechsler Intelligence Scale for Children-IV (WISC-IV).

Overview of WISC-IV

The Wechsler intelligence scales were developed by Dr. David Wechsler, a clinical psychologist with Bellevue Hospital. His initial test, the Wechsler-Bellevue Intelligence Scale, was published in 1939 and was designed to measure intellectual performance by adults.

Wechsler constructed the WBIS based on his observation that, at the time, existing intelligence tests for adults were merely adaptations of tests for children and had little face validity for older age groups.

Since 1939, three scales have been developed and subsequently revised, to measure intellectual functioning of children and adults. The Wechsler Adult Intelligence Scale-III (WAIS-III) is intended for use with adults. The Wechsler Intelligence Scale for Children-IV (WISC-IV) is designed for children ages 6 – 16, while the Wechsler Preschool and Primary Scale of Intelligence-III (WPPSI-III) is designed for children age 4 – 6 1/2 years.

Definition of Intelligence

Wechsler defined intelligence as an individual’s ability to adapt and constructively solve problems in the environment.

It is significant that Wechsler viewed intelligence not in terms of capacity, but rather, in terms of performance.

The rationale for conceptualizing intelligence as a performance variable is that it does not really matter how much intelligence one has, in order to adapt to the environment. What matters is how well one uses his/her intelligence.

Also, since intellectual capacity cannot be seen nor its existence concretely verified, it cannot be reliably measured. Performance can be measured and, thus, should be the focus of the test.

Although Wechsler has written much to support this position, other intelligence developers have taken essentially the same position regarding the nature of intelligence.

Most major intelligence tests, such as the Stanford-Binet, the Peabody Picture Vocabulary Test, and the Guilford Intelligence Scales, are grounded in the view of intelligence tests as performance measures.

The Wechsler scales, like the Binet and other tests, measure intellectual performance as a multidimensional construct.

This means that, rather than conceptualizing intelligence as a single characteristic, the tests contain numerous scales assessing qualitatively different types of intellectual functioning.

The notion of multidimensional intelligence is certainly not new in cognitive psychology; in the 1920s, Thurstone and Spearman viewed intelligence as consisting of several components.

Credibility of WISC-IV Results

How do we know the WISC-IV is a reliable measure of intelligence? Standardized intelligence tests are constructed according to strict guidelines to ensure reliability and validity.

Reliability refers to the consistency of a measure over time and across the content (i.e., the item responses) of the test. A test is considered reliable if we are able to get the same/similar result repeatedly. For example, if a test is designed to measure intelligence, two of the same form of test (say, Part A and Part B) should bear very close results when administered to a subject.

A test is considered valid if the scores accurately and consistently describe a child’s intellectual performance and adaptation in day to day life. Among other reasons, testing is done when one has some concerns about a child’s learning needs and wants to determine the child’s learning potential and placement in certain programs (usually gifted programs).

Apart from providing IQ scores, the WISC-IV also provides essential information and critical clinical insights into a child’s cognitive functioning. It also integrates current conceptualizations and recent research to provide the most essential information about a child’s strengths and weaknesses. There is a lot of input from practitioners and experts in the field.

Over time and several reviews, the WISC-IV (which is an update of the WISC-III) is concluded to represent significant advances in the understanding of cognitive abilities. Administered in a time period between 65 and 80 minutes, the WISC-IV contains 10 core subtests and 5 additional subtests.

These are summed to four indexes (the Verbal Comprehension Index, the Perceptual Reasoning Index, the Working Memory Index and the Processing Speed Index) and one Full Scale IQ (FSIQ) which ranges from lowest 40 to highest 160 points. Subtests are given for additional examination of processing abilities.

The age range for this test is between 6 years and 16 years 11 months. In terms of difference in scores, an individual who has taken the WISC-III, then retested with the WISC-IV may show a 5 point drop in FSIQ. This is due to new aspects of the test, and the novelty of some of the new items and subtests.

The following are the four main indexes of the WISC-IV and what they measure:

Verbal Comprehension Index (VCI)

Measure: Verbal concept formation. Tests include Similarities, Vocabulary, and Comprehension. Optional tests are Information and Word Reasoning.

Assesses children’s ability to listen to a question, draw upon learned information from both formal and informal education, reason through an answer, and express their thoughts aloud. It can tap preferences for verbal information, a difficulty with novel and unexpected situations, or a desire for more time to process information rather than decide “on the spot.”

Perceptual Reasoning Index (PRI)

Measure: Non-verbal and fluid reasoning. Tests include Block Design, Picture Concepts, and Matrix Reasoning. Optional test is Picture Completion.

It assesses children’s ability to examine a problem, draw upon visual-motor and visual-spatial skills, organize their thoughts, create solutions, and then test them. It can also tap preferences for visual information, comfort with novel and unexpected situations, or a preference to learn by doing.

Working Memory Index (WMI)

Measure: Working memory. Tests include Digit Span and Letter-Number Sequencing. Optional test is Arithmetic.

It assesses children’s ability to memorize new information, hold it in short-term memory, concentrate, and manipulate that information to produce some result or reasoning processes. It is important in higher-order thinking, learning, and achievement. It can tap concentration, planning ability, cognitive flexibility, and sequencing skill, but is sensitive to anxiety too. It is an important component of learning and achievement, and ability to work effectively with ideas as they are presented in classroom situations.

Processing Speed Index (PSI)

Measure: Speed of Information Processing. Tests include Coding and Symbol Search. Optional test is Cancellation.

It assesses children’s abilities to focus attention and quickly scan, discriminate between, and sequentially order visual information. It requires persistence and planning ability, but is sensitive to motivation, difficulty working under a time pressure, and motor coordination too. Cultural factors seem to have little impact on it. It is related to reading performance and development too. It requires persistence and planning ability, but is sensitive to motivation, difficulty working under a time pressure, and motor coordination too. It is related to Working Memory in that increased processing speed can decrease the amount of information a child must “hold” in working memory. On the other hand, lower processing speed can impair the effectiveness of working memory by requiring the child to “hold” in working memory more information than the child can effectively process at a given time.

Understanding what the test scores actually means …

In addition to a Full Scale IQ (FSIQ), the WISC IV also yields four “Composite” standard scores in the areas of verbal reasoning, perceptual reasoning, working memory, and processing speed.

The Verbal Comprehension Index (VCI) assesses the child’s use and understanding of language using subtests that assess abstract reasoning, vocabulary development, and common sense reasoning. A child with an average score in Verbal Comprehension Index can participate in conversation, understand directions, follow classroom discussion, and explain his ideas as well as other students his age.

The Perceptual Reasoning Index (PRI) assesses nonverbal reasoning and problem solving. It is composed of subtests that measure nonverbal abstract reasoning skills, perceptual reasoning, and perceptual organization. Ability to maintain consistent focus and attention impact these subtests. Students with average scores should be able to follow a sequence in solving problems, interpret visual or three-dimensional representations of concepts (illustrations or models), and show average artistic ability.

The Working Memory Index (WMI) reflects a child’s ability to recall, manipulate, and sequence auditory information. This test measures rote verbal leaning, working memory, and the ability to sequence auditory information. The student’s score can be affected by the use of strategies and her ability to concentrate on the task. A student with average Working Memory Index should be able, for example, to memorize math facts with some practice.

Processing Speed Index (PSI) is the fourth Composite score on the WISC. This composite measures the speed and accuracy of visual motor integration. The subtests use a paper and pencil format and have time limits. The student’s score is affected by perceptual discrimination, persistence, concentration, and fine motor dexterity. A student with an average Processing Speed Index should finish written class work at a pace similar to his peers.

Examples of WISC-IV Test Scores

The table below have been made, so that I could better inform you on how to interpret diverging test scores and to give you a ‘cheat sheet’ to understand your own child’s scores.

This table contains data from 3 different sources, which has been correlated to give you an example of how you can interpret the 5 scores which you will receive, when your child (6 – 16 years) have been tested using the WISC-IV tests.

Data source 1 (Subject) is data from a ‘real’ test of an anonymous girl between 6 -16 years.

Data source 2 (Girls, Boys, NT, ADHD) is from a study on how girls and boys, with or without ADHD, typically score, on the WISC-IV test. What is special about this study, is that it showed a marked difference between how girls with ADHD differs from boys with ADHD, in their factual test scores, which is brand new from the science in 2017.

Data Source 3 (True or Pseudo) is taking from a study that examined the test scores of children with ADHD, compared to children without ADHD, but with ADHD-like behavioral traits, but where the causes was due to other mental disorders (such as anxiety, depression, conduct disorder, intellectual disability etc).

How to read the ‘ADDspeaker WISC-IV Cheat Sheet’

At the top part of the table, you will find the definitions of the classifications, as they are set by both traditional IQ and ability testing, as well as the WISC-IV classifications.

The next part of the table, named “WISCV-IV Scores” contains data from all 3 sources, matched by corresponding test scores.

The next part of the table “Percentage Point Differences (Subject vs.)” contains the difference between the reference score (Subject) and the scores for the same measurement from the other sources. The formula used is: =SUM(Subject-Other)=Difference.

The next part of the table named “Relative Ratio (Subject vs.)” contains a relational index number, which tells you how the Subject performed compared to each of the other measurements. The formula used is =SUM(Subject/Other)=Relative Ratio Index.

Note: I am an European (Denmark) and here we use the comma (,) as the diveder between whole numbers and decimals (In the US they use punctaion (.) instead. So when you read a score which is above 1,000 (1) means that Subject performs better than the compared score from the other sources, a score below 1,000 (1) means that the Subject performed worse than the compared score from the other sources.)

Legends: NT = Neuro-typical (has normal or control), ADHD = clinically diagnosed, True = formerly diagnosed with ADHD vs. Pseudo = Not clinically diagnosed and Not have ADHD, but exhibit ADHD-like symptoms due to other mental disorder(s).

The ADDspeaker WISC-IV Cheet Sheet

So what does that all mean, in real life?

Intelligence is not the same as being smart or clever. Intelligence is the ability to adapt to new challenges in the environment and develop new skills and ability to cope with them.

A classic example is from the evolutionary biology literature, which explains that we did not leave the threes willingly, we were actually forced out of the trees by competitors, like the chimpanzees, and since we now had to adapt to a whole different environment, our brain had to change (physically) to facilitate new skills, like better ability to have foresight, communicate using language and inhibitory control to postpone immediate gratification of needs to have a better return later on than we could receive in the here and now.

Since the brain has a somewhat fixed outer limit for it volume, evolution decided to ‘rewire’ our neuronal networks so that we could better survive in this new environment. But due to the volume restrictions, we also had to shed some of our old abilities and if we compare ourselves to the chimpanzees today, they are way superior to humans , when it comes to visually spot a large number of information (e.g. how many enemies are there is the opposing group) in milliseconds, whereas we humans have given up on this and today can manage between 7 +/- 2 objects in our memory.

Therefore our ability to store vast amounts of information (memory), communicate using language (speaking, reading and writing), share knowledge across generations (hindsight), as well as have the ability to imagine future possible outcomes of current actions (foresight) are today the main skills we use for survival.

Intelligence is today important, maybe more than ever, since our increased social groups have become vast and global, whereas we on the Savanna would have had to keep track of up to 200 individuals in our peer group, whereas we today maybe have thousands of ‘Facebook friends’ and constantly is being bombarded with information from every angle.

Furthermore our workforce have gone from having to depend on our physical abilities and skills, to today where our mental abilities and skills are what is being requested by employers. This puts a strain on how people with intellectual or neurodevelopmental disorders fair in everyday life.

As Temple Grandin, who is a magnificent women with Autism, have stated on a TED talk I saw, that we need to understand that just because your social skills are impaired, it doesn’t mean that you are unable to participate in society and be a productive member as well.

Her argument is (somewhat) supported by historical fact, since Newton (who lectured even though no students were present in the auditorium), Einstein (who could emerge himself into an inner world of visual traveling on a light beam) or Edison (who was so rigid and tenacious, that he tried to make a lightbulb and failed more than 10,000 times, before getting it right, and actually electrocuted an elephant in public, just to prove how dangerous Tesla’s technology was) and the list goes on and on and on just think about Elon Musk, Bill Gates, and Richard Branson …

So my point is that, no matter what your child’s score might be, please do not take that as anything else than a guide to which areas his or her strengths and weaknesses are, compared to a so-called Neuro-typical score (normal), and try to re-use their special interests in ways that support their overall development of general skills needed to participate in society.

As I myself have stated over and over again:

“My ADHD is not an excuse for my behavior, but it is a damn good explanation for it …”

I’ve lived a successful life for 40 years, without much formal education or parental guidance growing up, and if it hadn’t been for the inevitable burnout leading to a 2-year battle with depression and anxiety as a result of having lived for 40 years without anyone noticing my ‘oddities’ to be actually diagnosable as ADHD and Atypical Autism and now had to pay the price, big time, as my body and mind had come to the edge of its ability to keep masking all my symptoms and perform in (work)life at the same time, I would probably still be a millionaire and still be living in Bel Air, like I did back in 2012.

Today I am 47, diagnosed and well medicated, and I’ve never felt better, since now I am aware of my limitations and aware of when I need to slow down and take a break. My intelligence is somewhat above average, but I have massive impairment on certain skills, such as not being able to have an inner dialog (talking to myself with my Inner Voice), nor able to ‘visualize’ images in my Mind’s Eye, which are both skills, that is absolutely essential for being able to have ‘hindsight’ and ‘foresight’ which is crucial for being able to ‘learn from previous experiences’ as well as ‘predict possible future outcomes” also called understanding consequences.

My life can be summed up to: “I’m driving along a road where everything is always new and where I have no clue what’s coming at me, and where all I see in the rearview-mirror, are the ‘bodies’ of the people I’ve run over on my way forward in life. I can never learn to avoid hitting people beforehand, but I can learn how to apoligize to them afterwards, instead”.

I hope that you have felt that this article have helped your understanding of both how the WISC-IV actually looks like and understood how it works, and finally that the scores are not the important information gained here, what is important is how you help your child use what they’ve been giving, to make their life as good as it gets – for them …

/Peter ‘ADDspeaker’ Vang

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