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The identification of insufficient effort is critical to neuropsychological evaluation, and several existing instruments assess effort on neuropsychological tasks. Yet instruments designed to detect insufficient effort are underutilized in standard neuropsychological assessments, perhaps in part because they typically require significant administration time and are, therefore, not ideally suited to screening contexts. The Test of Memory Malingering (TOMM) is a commonly administered, well-validated symptom validity test. This study evaluates the utility of TOMM Trial 1 as a relatively brief screening measure of insufficient effort. Results suggest that TOMM Trial 1 demonstrates high diagnostic accuracy and is a viable option for screening insufficient effort. Diagnostic accuracy estimates are presented for a range of base rates. The need for more comprehensive SVT assessment in most clinical and forensic situation is discussed.

Objective Directly estimate the prevalence of cognitive malingering in persons claiming exposure to occupational and environmental substances. Methods Retrospective review of 128 neuropsychological cases with financial incentive. Estimates were based on two methods: (1) clinical identification using the Slick, Sherman and Iverson criteria for malingered neurocognitive dysfunction (MND), and (2) statistical modeling based on patient performance on several individual psychometric indicators of malingering. Results The prevalence based on the clinical method was 40%. The statistically based estimates ranged from 30% to more than 45% depending on model parameters. Different incentive parameters may influence prevalence. Conclusions Cognitive malingering in toxic exposure is common and must be adequately addressed in the clinical neuropsychological assessment of toxic exposure and in research on its neurocognitive effects or findings will likely over-estimate the degree of cognitive impairment and related disability.

This study used a known-groups design to examine the classification accuracy of the Test of Memory Malingering in detecting cognitive malingering in patients claiming cognitive deficits due to exposure to environmental and industrial toxins. Thirty-three patients who met Slick et al. criteria for Malingered Neurocognitive Dysfunction were compared to 17 toxic exposure patients negative for evidence of malingering, 14 TBI patients and 22 memory disorder patients, both groups without incentive. The original cutoffs (45) for Trial 2 and Retention demonstrated perfect specificity (0% false positive error rate) and impressive sensitivity (50%). These findings indicate the TOMM can be used with confidence as an indicator of negative response bias in cases of cognitive deficits attributed to exposure to alleged neurotoxic substances.

Toxic torts are increasing across the country and often the results of the neuropsychological evaluation are crucial for defining damages. Therefore, the accurate differentiation of those damaged by toxic exposure from those exaggerating or fabricating deficits is important. However, there is little research on malingering in this context. Presented are four patients claiming cognitive deficits after apparent occupational neurotoxic exposure who were diagnosed as malingering using the Slick, Sherman, and Iverson criteria. The goals of this article were to (1) illustrate the application of the Slick Criteria; (2) discuss current knowledge about the neurological and neurocognitive effects of toxic substances and its impact on clinical decision-making; (3) discuss the application of the Slick Criteria, specifically, and malingering research, generally, to toxic exposure cases; and (4) propose a paradigm in which medical, toxicological and neuropsychology professionals coordinately evaluate cases of alleged neurotoxic chemical exposure.

This study examined the sensitivity and false-positive error rate of reliable digit span (RDS) and the WAIS-III Digit Span (DS) scaled score in persons alleging toxic exposure and determined whether error rates differed from published rates in traumatic brain injury (TBI) and chronic pain (CP). Data were obtained from the files of 123 persons referred for neuropsychological evaluation related to alleged exposure to environmental and industrial substances. Malingering status was determined using the criteria of Slick, Sherman, and Iverson (1999). The sensitivity and specificity of RDS and DS in toxic exposure are consistent with those observed in TBI and CP. These findings support the use of these malingering indicators in cases of alleged toxic exposure and suggest that the classification accuracy data of indicators derived from studies of TBI patients may also be validly applied to cases of alleged toxic exposure.

Background.Laparoscopic simulator training translates into improved operative performance. Proficiency-based curricula maximize efficiency by tailoring training to meet the needs of each individual; however, because rates of skill acquisition vary widely, such curricula may be difficult to implement. We hypothesized that psychomotor testing would predict baseline performance and training duration in a proficiency-based laparoscopic simulator curriculum. Methods.Residents (R1, n!20) were enrolled in an IRB-approved prospective study at the beginning of the academic year. All completed the following: a background information survey, a battery of 12 innate ability measures (5 motor, and 7 visual-spatial), and baseline testing on 3 validated simulators (5 videotrainer [VT] tasks, 12 virtual reality [minimally invasive surgical trainer‐ virtual reality, MIST-VR] tasks, and 2 laparoscopic camera navigation [LCN] tasks). Participants trained to proficiency, and training duration and number of repetitions were recorded. Baseline test scores were correlated to skill acquisition rate. Cutoff scores for each predictive test were calculated based on a receiver operator curve, and their sensitivity and specificity were determined in identifying slow learners. Results:Only the Cards Rotation test correlated with baseline simulator ability on VT and LCN. Curriculum implementation required 347 man-hours (6-person team) and $795,000 of capital equipment. With an attendance rate of 75%, 19 of 20 residents (95%) completed the curriculum by the end of the academic year. To complete training, a median of 12 hours (range, 5.5-21), and 325 repetitions (range, 171-782) were required. Simulator score improvement was 50%. Training duration and repetitions correlated with prior video game and billiard exposure, grooved pegboard, finger tap, map planning, Rey Figure Immediate Recall score, and baseline performance on VT and LCN. The map planning cutoff score proved most specific in identifying slow learners. Conclusions:Proficiency-based laparoscopic simulator training provides improvement in performance and can be effectively implemented as a routine part of resident education, but may require significant resources. Although psychomotor testing may be of limited value in the prediction of baseline laparoscopic performance, its importance may lie in the prediction of the rapidity of skill acquisition. These tests may be useful in optimizing curricular design by allowing the tailoring of training to individual needs. (Surgery 2006;140:252-62.)

This study was designed to identify the types of neuropsychological deficits that are unique to familial and nonfamilial forms of schizophrenia. Seventy-two patients who met Research Diagnostic Criteria for schizophrenia or schizoaffective disorder, mainly schizophrenic, were divided into two groups on the basis of the presence or absence of a family history of psychosis. The two groups were then compared for differences on six neuropsychological parameters as well as for differences in psychotic symptoms. Multivariate analyses indicated that schizophrenic patients with a family history of psychosis showed significantly higher levels of overall neuropsychological deficit and significantly greater deficits on tests of motor-control and abstraction and problem-solving. Factor analyses indicate that schizophrenic patients with a family history of psychosis show a pattern of specific neuropsychological deficits, while schizophrenic patients without a family history show a pattern of more consistent cognitive deficits. The results of this study indicate that recent-onset schizophrenic patients with and without a family history of psychosis show distinctly different patterns of neuropsychological dysfunction. These data suggest that abnormalities in the dorsolateral prefrontal cortex and nonprimary motor areas may be associated with an increased familial risk for psychotic disorder.

The stated intent of this rather hefty book is to “provide a readily available handbook for neuropsychology interns, fellows, and practicing clinicians,” with a focus on the “major differential diagnoses that neuropsychologists are routinely asked to make,” particularly in a hospital-based neuropsychological practice. These are optimistic goals that are frequently, although not always, fulfilled. The editors are to be commended for their success in organizing a knowledgeable and erudite group of contributors, who generally have conformed to the recommended stylistic and content guidelines. However, as is typical of most edited works, the stated intent(s) of the book are rather unevenly addressed in both the scope of the included topics and by the various authors. The book includes 30 chapters divided into five sections: General Issues (101 pp.), Pediatric Psychology (64 pp.), Geriatric Psychology (66 pp.), Neurological Disorders (159 pp.), and Neuropsychological Syndromes (225 pp.), and an appendix of medical abbreviations. The result is a not-so-brief handbook that is useful as a desk reference guide for students, interns, fellows, and nonneuropsychological clinicians working with neurological patients. For experienced neuropsychologists, the book is likely to be of less value due to its intentionally brief reviews of most topics.

Patients with penetrating missile wounds confined to one of the four brain quadrants were evaluated to determine the incidence and severity of constructional apraxia. The visual constructive tasks used were the WAIS Block Designs subtest and the Bender Gestalt (reproduction) Test. Estimates of lesion size were used to investigate the effect of this factor on constructional ability. Patients with right posterior lesion tended to perform least adequately in general, although significant differences were obtained only for the Bender Gestalt Test. The effect for lesion laterality was greater than that for caudality , although neither analysis reached statistical significance. Lesion size made a relatively minor contribution to the visual constructional deficits in this sample. Only in the left posterior sample did lesion size correlate significantly with measures of constructional impairment. The lack of consistent findings may have been due to the restricted lesion size in these patients and to the absence of significant cognitive deficits in most subjects. The results support either a regional interpretation of the mass action theory or the possible role of deficient verbal mediation in the constructional performance of patients with left hemisphere lesions. This study emphasizes the importance in neurobehavioral research of controlling potentially confounding variables (e.g., lesion size and type of associated cognitive deficits) when studying any specific aspect of neuropsychological functioning.

The primary purpose of this study was to gather concurrent validity data on the age norms provided in the 1980 Dunst manual for use with the Uzgiris and Hunt Infant Psychological Development Scale. The sample included 39 infants and toddlers who had heterogeneous handicapping conditions which brought about their enrollment in infant intervention programs. Test scores on a traditional measure, the Mental Scale of the Bayley Scales of Infant Development, were compared with scores on the Infant Psychological Development Scale. Evidence supporting the validity of the age norms was obtained. The correlation between the mental age estimates from the two infant scales was highly significant (r = .92, p < .01). A discussion of the Infant Psychological Development Scale including the patterns of inter-correlation, the multiple purposes to which it may be applied, and cautions and limitations of the use of this ordinal scale of infant assessment, conclude this report.

The achievement test performance of low and high perceiving learning disabled children was compared, and the relationship of visual-perceptual and achievement variables in a sample of learning disabled children was investigated. With the effects of intelligence controlled, the reading test performance of the low perceivers was significantly higher than that of the high perceivers. No significant differences existed between the two samples in spelling or arithmetic. Only two of a possible 18 correlations between perceptual and achievement variables were found to be significant. The implications of the use of perceptual tests in the evaluation and remediation of a learning disability are discussed.

This study compares psychological test performance of 24 dyslexic boys and 24 normal readers using four age levels (7, 9, 11, and 13 years). Screening of all boys and matching techniques were used to eliminate the possibility that reading differences were due to social or educational deprivation, gross sensory-motor handicaps, specific neurologic deficiencies, intellectual impairment, or primary emotional disorders. All children were administered a psychological battery composed of measures of perceptual and perceptual-motor abilities (WISC Performance IQ, Bender-Gestalt, and an auditory-visual integration test) and of verbal-cognitive skills (WISC Verbal IQ, two dichotic listening tasks, and a test of word fluency). Significant developmental differences between dyslexics and controls were found only for the overall measure of perceptual-motor and verbal-cognitive ability. The results of this study do not support a hypothesis of a single etiology, either deficit or developmental delay, for dyslexia. In a final section, the educational implications of this study are discussed with particular consideration of programs for reading remediation.

A systematic mental status exam often can differentiate accurately patients with organic brain disease from normal persons and those with functional disorders. The present study attempts to validate the memory portion of the Strub-Black Mental Status Exam by comparing it to the Wechsler Memory Scale. Twenty-five brain-damaged and 25 routine medical patients were given Form I of the Wechsler Memory Scale and the memory portion of the Strub-Black Mental Status Exam at their hospital bedside. Results indicate significant differences in almost all scores between the brain-damaged and normal groups on both the Wechsler Memory Scale and Mental Status exam; the Mental Status Exam differentiated between groups at a higher level of significance of ANOVA and ANCOVA comparisons of total memory scores, as well as several subtests. In these samples, age, more than education, was an important factor that affected memory test performance. The Mental Status Examination appears valid for the differentiation of clinical samples and for the documentation of specific aspects of memory dysfunction in individual brain-damaged patients. This study represents a beginning step in providing normative data on components of the Strub-Black mental status examination.

Digit repetition was investigated in samples of unilaterally (N = 87) and bilaterally (N = 75) brain-damaged adults. The study was designed to investigate the hemispheric and neuropsychological factors that underlie performance on these two dissimilar tasks. Digit repetition was disproportionately depressed in such patients, especially those with left hemisphere lesions. The incidence of individually impaired digit repetition performance, especially of digits backward, was significantly higher than in normals, again particularly within the left hemisphere sample. However, impaired digit repetition was not invariably associated with brain dysfunction. The data suggest, but do not confirm, a differential function hypothesis, as well as a unilateral hemispheric hypothesis that underlies the ability to repeat forward and backward digits; this finding is consistent with some previous literature. Group performance showed considerable overlap, which limited the possibility of demonstrating a double dissociation between digits forward and verbal measures, and digits backward and nonverbal factors. Digit repetition in brain-damaged patients appears to have some theoretical value, but limited clinical utility.

Explored the relationship between attribution of control and the fear of death in a medical student population. Ss were 50 first-year students at the LSU School of Medicine at New Orleans, with a mean age of 24.7 years. Instruments included the Rotter Internal-External Locus of Control Scale and the Templer Death Anxiety Scale. Ss were divided into two groups (internal or external) based upon scores on the Locus of Control Scale, and a one-way analysis of variance was computed between the groups. The dependent variable was level of death anxiety. The results revealed that the internally oriented group obtained a significantly lower mean score on the Death Anxiety Scale when compared to the externally oriented group (F = 2.28, p less than .02). Two additional ANOVAs that used sex and age as the independent variables revealed no significant differences on the death anxiety measure, thus strengthening the apparent relationship between locus of control and fear of death.

Investigated the effects of discrete brain lesions on MMPI performance in well-matched samples of patients with anterior and posterior injuries. Because of the nature of the samples and careful matching for potentially confounding variables, particular emphasis could be given to the study of brain-behavior relationships. Patients with posterior lesions produced a significantly more abnormal composite MMPI profile, had a consistent tendency to produce elevated (70+) individual MMPI scales, and had individual profiles that were universally rated as abnormal using standard criteria. The differential MMPI patterns exhibited by these two samples were compatible with traditionally held clinical hypothesis with regard to distinct personality differences secondary to focal lesions in the caudal plane. It is our conclusion that lesion caudality does have a differential effect upon MMPI performance when factors such as cognitive, motor, and sensory defects are controlled adequately. The implications are that this effect is locus specific and is not necessarily related to the degree of other neurobehavioral impairment, as has been hypothesized previously.

A study was conducted to test the utility of Rotter's social learning theory in predicting the type of delinquent behavior, sexual or non-sexual, in which adolescent girls would engage. It was hypothesized that (1) sexually delinquent girls would place high reward value for love and affection and have low expectancy for attaining it, (2) non-sexually delinquent girls would place high reward value for recognition and status and have low expectancy for attaining it, and (3) that normals would not be significantly low on reward value or expectancy for either love and affection or recognition status. Hypotheses 1 and 3 were supported, while the variable of recognition status appeared to have little relevance for Ss' behavior.

Investigated digit repetition performance in learning-disabled children in an effort to assess its clinical and theoretical significance. Clinically, learning-disabled children were found to demonstrate a higher than expected incidence of large verbal-performance discrepancies, although mean overall digit repetition performance did not differ appreciably from that expected on the basis of intelligence (N = 100). Children with large discrepancies did not differ from those with no such discrepancies when compared on a variety of psychometric and neurobehavioral factors. Theoretically, a hemispheric specialization model and a neuropsychological function model have been proposed to underlie performance on the two somewhat different digit repetition tasks (forward and backward repetition). Some support was found for the neuropsychological function model, with significant correlations obtained between digits forward and a measure of language function and between digits backward and a test of visual constructional ability. Stronger evidence that could have been provided by a double dissociation of correlational findings was limited by a smaller, but significant, correlation between digits forward and Bender Gestalt errors. However, the results are consistent with previous research in suggesting that digit repetition can be an avenue to the study of brain-behavior relationships.

Intellectual, perceptual, academic, and behavioral comparisons were made for matched samples of elementary school children with suspected and documented neurological dysfunction. Significant differences were obtained between samples on most intellectual (WISC) variables, with all comparisons favoring the suspected neurological dysfunction sample. The samples did not differ appreciably on perceptual, academic, and two of three behavioral variables, suggesting that the pattern of performance for the two samples in areas highly relevant for education wus similar. WISC Verbal-Performance discrepancies exceeding 15 points were relatively good predictors of documented neurological dysfunction.

The findings of this study may be summarized as follows: (1) No significant general cognitive impairment occurred in S samples with unilateral frontal lobe lesions; (2) Impairment of cognitive performance was greater in Ss with lesions posterior to the Fissure of Rolondo than in well-matched Ss with frontal lobe lesions; (3) Specific cognitive deficits are infrequent in Ss with frontal lobe lesions; (4) No significant differential impairment of cognitive performance was associated with hemispheric lateralization of frontal lesions; and (5) No significant differential impairment of verbal and nonverbal performance was associated with hemispheric lateralization of frontal lesions. Language: en

Two left-handed siblings with developmental stuttering are comprehensively described. The methods of study included speech and language evaluation, neurological and neuropsychological examinations, dichotic listening, auditory evoked responses, electroencephalogram, and CT scan asymmetry measurements. The data from each sibling showed evidence of anomalous cerebral dominance on many of the variables investigated. The CT scan measurements showed atypical asymmetries, especially in the occipital regions. These findings support the theory that stuttering may be related to anomalous cerebral dominance, both on functional as well as structural bases. Implications of anomalous dominance and the resultant effect of hemispheric rivalry on speech fluency are discussed.

Summary Digit span forward and backward was investigated in well-matched samples of patients with discrete quadrant brain lesions. The incidence of significantly unpaired digit repetition performance and the incidence of large forward and backward digit span discrepancies were also studied. Correlational data of digit span performance and various intellectual, memory, and constructional measures was examined. Approximately 60% of all brain-damaged patients showed an impairment of digit span forward, while only 5% showed a similar impairment on the digit span backward task. These data indicate that digit span forward is a more sensitive measure of brain dysfunction from focal brain lesions. No difference was found in the performance of patients with right or left hemisphere lesions; however, the low incidence of aphasia (8%) in this sample may account in part for the relatively adequate performance by the left hemisphere patients. Although the current data regarding visual constructive deficits and impaired ability to repeat digits backward is inconclusive, there did not appear to be a strong relatianship between these two functions for these patients. Digit repetition performance does appear to be related to both general intellectual ability and to performance on the Wechsler Memory Scale.

Wechsler Memory Scale scores and paired-associate learning performance were compared in matched samples of Ss with right- and left-hemisphere brain lesions secondary to penetrating missile wounds and normal controls. Wechsler Memory Quotient, easy paired-associate learning scores, and difficult paired-associate learning scores for left-hemisphere Ss were significantly lower than those for normal controls; while the mean scores for right-hemisphere and normal control Ss did not differ significantly. For the latter Ss the Wechsler Memory Quotient and the difficult paired-associate learning task differed significantly with lower mean scores for left-hemisphere Ss. Significant relationships were obtained between Wechsler Memory Quotient and all paired-associate learning scores and between WAIS IQ and Wechsler Memory Quotient, total and easy paired-associate learning scores.

To investigate the effect of intelligence on the level of reading achievement of elementary school children with significant reading problems, 100 consecutive referrals to the psychology department of the Kennedy Memorial Hospital were evaluated psychometrically. The statistical procedures used indicated a lack of significant effect of intelligence on level of reading retardation within this sample of children. The study suggests that factors other than WISC Full Scale intelligence must play a significant role in reading problems.

The incidence of and relationships among word and letter reversals in writing and Bender-Gestalt rotation errors were investigated in matched samples of 100 normal and 100 retarded readers. No significant differences in the incidence of reversal and rotation errors were found in the two groups. Word reversal was an isolated finding with low frequency, while letter reversal and Bender rotation were less isolated and more frequent. The significance of examining for such errors by elementary school children to predict reading retardation is discussed in the light of the research findings.

The clinical utility of the Arthur Adaptation of the Leiter International Performance Scale (LIPS) was investigated in a sample of 100 children with either developmental or acquired aphasia. Test-retest reliability data and concurrent validity data with the Peabody Picture Vocabulary Test (PPVT) were obtained. Group and individual performance on the LIPS over a period of six months was highly consistent. The reliability coefficient was 0.916, which compares favorably with the reported reliability of most commonly used intelligence tests. Although a moderately significant correlation was obtained between PPVT and LIPS IQs, group performance on the PPVT was substantially lower than that on the LIPS. The LIPS provided higher IQs in 75 of the 100 subjects, suggesting that the LIPS is a more adequate measure of intellectual potential and the PPVT performance reflects the extent of the language disability. The LIPS appears adequately reliable for use with aphasic children. The utility of concurrent use of the LIPS and PPVT is discussed.

Presents a table that provides a simplified procedure for obtaining WISC-R factor scores expressed as IQ equivalents. Three factors, based on Kaufman's recent analysis of the 1974 Revised WISC, were included: (1) Verbal Comprehension (Information, Similarities, Vocabulary, and Comprehension); (2) Perceptual Analytic (Picture Completion, Picture Arrangement, Block Design, Object Assembly, and the optional subtest, Mazes); and (3) Attention Concentration (Arithmetic, Digit Span, and Coding). The techniques for deriving the factor score equivalents and the use of the table, both procedurally and clinically, are discussed.

References from a random selection of learning disability citations in Psychological Abstracts from 1970 to 1972 were examined to determine the nature and recency of the source. The references examined appeared in a wide variety of educational, psychological, and medical sources; with a high incidence of recent journal sources. A listing of the 20 most frequently cited journals is provided.

Samples of 15 Ss with right- and 20 Ss with left-hemisphere brain lesions secondary to war-related penetrating missile wounds were matched for age, education, and recency of injury and evaluated with the MMPI. Right-hemisphere lesioned Ss produced a composite profile with all scales within normal limits. In contrast, the composite profile of left-hemisphere lesioned Ss showed significant elevations on the Sc, D, and Hs clinical scales, suggesting increased psychopathological responses in such Ss. Although the general configurations of the composite MMPI profiles in the two samples were similar, significant differences in the elevation of both validity and clinical scales were obtained. The results tend to support previous findings of a depressive-catastrophic reaction in patients with lesions in the dominant hemisphere, while not supporting the euphoric-indifference response in nondominant-hemisphere lesioned Ss.

The WAIS verbal and nonverbal subtest performance of Ss with unilateral brain lesions secondary to penetrating missile wounds was examined and compared with that of normal controls. The performance of matched right- and left-hemisphere lesion Ss differed significantly on only two verbal and one nonverbal measures, however, all performance differences were in the direction hypothesized. The performance of right-hemisphere lesioned and control Ss differed significantly on all measures, with consistently lower scores by brain-injured Ss, while the performance of left-hemisphere and control Ss differed significantly on the three verbal measures and WAIS Full Scale IQ. These results are in general agreement with previous reports using a similar research design and tend to support the hypothesis of differential impairment of verbal and nonverbal test performance in Ss with unilateral brain lesions.

Summary Sixty patients with missile wounds confined to one of the four quadrants of the brain were investigated. All patients had neurosurgical verification of the limits of their lesions. The incidence and severity of constructional apraxia was studied using the WAIS Block Designs and Object Assembly subtests, and the Bender Gestalt Test. A uniformly significant caudality effect was obtained, with more posteriorly localized lesions resulting in more severe constructional apraxia. A significant laterality effect was obtained on two of three criterion measures with uniformly inferior performance by patients with right hemisphere lesions. The magnitude of the laterality effect, however, was less than that of the caudality effect for all criterion variables. The degree of severity of constructional apraxia in patients with right posterior lesions was uniformly greater than that of patients with other quadrant loci. The incidence of constructional apraxia in the four quadrants varied as expected with the left anterior lesion sample showing very little evidence of constructional apraxia, while the right posterior sample showed a high incidence of such deficits. The absolute incidence of significant constructional apraxia in all samples was surprisingly low. This finding might be partially accounted for by the age and general good health of the subjects studied, the relative absence of general cognitive impairment in the majority of subjects, and the discrete nature of the lesions.

The present study provided normative data applicable to a corticallyimpaired adult population on the Spreen-Benton Sentence Repetition Test. Data were presented for decade groups ranging from 20 to 70 years. The current research indicated that intelligence may play a relatively strong role in performance on this test; also, that memory may be involved, but to a lesser degree. It was recommended that patients' intellectual levels be considered when interpreting the results of the Sentence Repetition Test.

WISC Verbal-Performance discrepancy, Vocabulary-Block Design discrepancy, and Similarities-Object Assembly discrepancy were investigated in matched samples of 25 normal, suspected neurological dysfunction, and documented neurological dysfunction children. The results suggest a continuum of deficit in these samples ranging from normal performance by normal controls to moderate impairment in Ss with documented neurological dysfunction. The suspected neurological dysfunction sample occupied a median position in the continuum as predicted. An analysis of WISC IQ and subtest scores in the three samples also supported the predicted continuum of deficit. Specific WISC subtest comparisons may be of some research and clinical utility in the prediction of neurological dysfunction in pediatric patients.

With increased sophistication of noninvasive neurodiagnostic techniques, localization of lesions is no longer a major function of the clinical neuropsychologist. However, it remains an area of considerable theoretical interest in the study of brain-behavior relationships. Since the introduction of the Wechsler-Bellevue, there has been continuing investigation regarding the effects of lateralized cerebral lesions on the verbal and nonverbal components of the Wechsler series of tests. It was originally hypothesized that lesions of the left hemisphere would exert their greatest effect upon the verbal scale of the Wechsler, while corresponding right hemispheric lesions would result in an impairment primarily of nonverbal or performance tasks. Although this basic hypothesis has been supported by some reports, it has been seriously challenged by more recent rigorous studies. See Matarazzo (2) for a review of these conflicting data. Variables which significantly confound the easy study of discrete brain-behavior relationships have been well enumerated by Smith (3) among others, and include acute vs chronic lesions, intrinsic vs extrinsic lesions, etiology, locus of the lesion within the hemisphere, momentum of lesion and effects of pressure, attempts at treatment, the presence of neurobehavioral and motor deficits, and the age and general health of the patients. Necessary reliance upon "patients of opportunity" produces serious problems in matching samples. The present study provides data on the effect of lateralized lesions on WAIS performance in patients having few associated deficits. The subjects were 34 right- and 34 left-hemisphere-lesioned, righthanded patients, suffering discrete brain lesions secondary to war-related shrapnel wounds. Samples were matched for locus of lesion within the hemisphere, size of lesion after neurosurgical debridement, WAIS Full Scale IQ, recency of injury, general medical health, age, and education. All subjects were well prior to injury with no history of psychiatric, neurologic or known drug-abuse problems; there were no clinically significant complications of the initial brain wound nor wounding to other body areas. The total sample means were 20.8 yr. (SD = 1.2) for age, 11.9 yr. (SD = 1.6) for educational level, 2.9 mo. (SD = .7) for recency of injury, and 97.7 (SD = 15.1) for WAIS Full Scale IQ. Full Scale IQ did not differ appreciably between the right- (M = 100.0, SD = 13.7) and the lefthemisphere- (M = 95.4, SD = 16.4) lesioned samples (t = 1.3 1). The mean Verbal-Performance discrepancy for the total sample was 11.4 (SD = 8.0); the discrepancy in the right hemisphere (M = 12.8, SD = 8.8) and the left hemisphere (M = 9.9, SD = 7.6) did not differ significantly (t = 1.01). As expected, the incidence of high Verbal Scale IQs predominated in the right hemisphere sample (22 of 34), while the incidence was approximately equal in the left hemisphere sample (15 of 34); however, the distribution did not differ significantly from chance (X3 =