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Autism Research - 2020 - Audras Torrent - WISC V Profiles and Their Correlates in Children With Autism Spectrum Disorder
Autism Research - 2020 - Audras Torrent - WISC V Profiles and Their Correlates in Children With Autism Spectrum Disorder
The intellectual functioning of people with autism spectrum disorder (ASD) without intellectual developmental disorder
(IDD) has not been widely studied. However, marked heterogeneity in assessment measures, samples, and results has
been an obstacle for the generalization of findings. We aimed to (a) describe WISC-V intellectual functioning in a sample
of children with autism spectrum disorder without intellectual developmental disorder, (b) identify WISC-V profiles, and
(c) explore whether WISC-V intellectual functioning is related to ASD symptom severity and adaptive skills. Our sample
consisted of 121 children from 6 to 16 years of age with ascertained ASD without an intellectual developmental disorder
(IDD). The intellectual functioning of the participants was within the average range. Intra-individual analysis showed
that children with ASD performed better on visual than auditory working-memory tasks. Moreover, the intellectual func-
tioning of the participants correlated negatively with ASD symptom severity but positively with adaptive communication
skills. Overall, we identified six intellectual profiles according to verbal and reasoning skills. These findings highlight the
relevance of WISC-V assessment for children with ASD without an IDD to individualize intervention, especially remedia-
tion. Autism Res 2021, 14: 997–1006. © 2020 International Society for Autism Research, Wiley Periodicals, LLC
Lay Summary: This study examined WISC-V intellectual functioning in 121 children with autism spectrum disorder
(ASD) without an intellectual developmental disorder (IDD). We found their intellectual functioning to be within the
average, as was that of their peers with typical development (TD), and their verbal and reasoning skills were the most dis-
criminant. In addition, the better their intellectual functioning was, the better their adaptive communication skills and
the less severe their ASD symptoms. These findings highlight the relevance of WISC-V assessment in ASD to individualize
early psychological remediation.
Keywords: autism spectrum disorder; children; intellectual functioning; WISC-V; profiles; adaptive functioning
Introduction and decision making [Dai & Sternberg, 2004]. It has been
widely studied in ASD, but many studies have excluded
Autism spectrum disorder (ASD) is a neurodevelopmental participants with IDD from their sample to reduce clini-
disorder characterized by social communication impair- cal heterogeneity [Black, Wallace, Sokoloff, &
ment, associated with stereotyped and repetitive patterns Kenworthy, 2009; Lai et al., 2017; Mayes &
in behavior, interests, or activities [American Psychiatric Calhoun, 2008; Oliveras-Rentas, Kenworthy, Roberson
Association, 2013]. Intellectual developmental disorders 3rd, Martin, & Wallace, 2012]. Overall, available studies
(IDDs) are frequently associated with ASD, its estimated often report strengths and weaknesses in intellectual
prevalence in ASD being 50% in France [Mottron, 2010]. functioning of children with ASD. Indeed, they found
It is well known that IDDs have a negative impact on that individuals with ASD commonly have higher perfor-
overall functioning in ASD [American Psychiatric mance reasoning (i.e., nonverbal performances) than ver-
Association, 2013; Matson & Shoemaker, 2009]. bal scores [Girardot et al., 2012; Hedvall et al., 2013;
Intellectual functioning refers to complex, higher-order Oliveras-Rentas et al., 2012]. In addition, studies using
forms of cognition, such as reasoning, problem solving, various Wechsler Intelligence Scales (WIS; WPPSI-III,
From the Centre de Ressource Autisme Languedoc-Roussillon, Centre d’Excellence sur l’Autisme et les Troubles Neurodéveloppementaux (CeAND),
Montpellier, France (L.A.-T., E.M., F.C., F.D., M.B., C.M., A.B.); Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France (M.-C.P.,
A.B.); Department of Medical Information, University Hospital, Montpellier, France (M.-C.P.); Faculté de Médecine, Université de Montpellier, Montpel-
lier, France (A.B.)
Received July 15, 2020; accepted for publication November 9, 2020
Address for correspondence and reprints: Amaria Baghdadli, Centre de Ressource Autisme Languedoc-Roussillon, Centre d’excellence sur l’autisme et
les troubles neurodéveloppementaux, 191 Avenue du Doyen Gaston Giraud, Montpellier 34000, France. E-mail: rech-clinique-autisme@chu-
montpellier.fr
Published online 27 November 2020 in Wiley Online Library (wileyonlinelibrary.com)
DOI: 10.1002/aur.2444
© 2020 International Society for Autism Research, Wiley Periodicals, LLC
Data Analysis The 121 participants were aged from 6 years to 16 years
and 11 months (mean age 10.7 ± 2.7 years). Their clinical
Descriptive statistics were generated for all measures to characteristics and psychiatric comorbidities are pres-
provide an overview of the children’s characteristics in ented in Table 2. The parent occupation of mothers cov-
the entire sample. For the first aim, we performed intra- ered the following categories: employee (46.4%), worker
individual analysis between the 10 WISC-V subtests using (43. 6%), manager (21.4%), intermediate occupation
the Wilcoxon signed rank test, for which we calculated (12.5%), craftsman (8.9%), and without professional
Sex
Male 102 84.3
Female 19 15.7
Age
6–11.11 years 40 33.1
12–16.11 years 81 66.9
Psychiatric comorbidities 24 19.8
ADHD (F90) 13 10.7
DCD (F82)
Measures n Mean SD
ADOS-2 Severity score 115 7.5 2.0
ADHD (F90), % (n) 21.4 (3) 20 (4) 15 (3) 13.0 (3) 21.1 (7) 36.4 (4) ns
DCD (F82), % (n) 7.1 (1) 10 (2) 15 (3) 8.7 (2) 6.1 (2) 27.3 (3) ns
AS: average scores; ASHR: high average reasoning; ASHV: average scores with high verbal; ASHVR: average scores with high reasoning; LSAR: low scores
with average reasoning; LSAV: low scores with average verbal; ns: non significant.
and subtests. Intra-individual analyzes showed the VCI, In our findings, child’s FSIQ was associated to mother
FRI, and VSI to be significantly higher than the WMI, PSI, occupation. Indeed, children whose mothers were
and FSIQ (except VCI, which was quasi equal). Previous employees had a lower FSIQ than children whose
studies have also reported that children with ASD have mothers were managers. This result is concordant with
strengths in performance reasoning skills [Girardot past literature [Delobel-Ayoub et al., 2015; Piccolo,
et al., 2012; Mayes & Calhoun, 2008; Scheuffgen Arteche, Fonseca, Grassi-Oliveira, & Salles, 2016], which
et al., 2000], perhaps enhanced by the motor-free design highlight the need to focus attention more on family
of the intellectual tasks that were used [Oliveras-Rentas contextual factors in adapting the child intervention and
et al., 2012]. Charman et al. [2011] and Nader family support plan.
et al. [2016] showed that people with ASD have higher Our study also highlighted the presence of links
visual–spatial and abstract reasoning abilities, which may between WISC-V intellectual functioning and several
be specific markers of their intellectual functioning. In clinical dimensions of ASD. We observed a negative cor-
our sample, as well as in previous studies, the mean relation between intellectual functioning, particularly
VABS-II Communication, Socialization, and Daily Living verbal and visual–spatial skills, and the ASD symptom-
Skills scores were lower than the mean FSIQ scores severity score. These findings replicate those of previous
[Charman et al., 2011; Flanagan et al., 2015; Matthews studies [Black et al., 2009; Oliveras-Rentas et al., 2012]
et al., 2015; Yang, Paynter, & Gilmore, 2016]. This result that showed lower intellectual verbal skills to be related
suggests that many individuals with ASD have problems to greater impairment of communication and socializa-
in converting their intellectual skills into efficient adap- tion, measured by the ADOS [Joseph et al., 2005; Klin
tive skills [Charman et al., 2011; Tillmann et al., 2019]. It et al., 2007]. The finding of weak associations between
is well recognized that people with ASD and average ADOS-2 and WISC-V scores requires further studies on
intellectual functioning are not spared from adaptive dif- larger samples. Furthermore, our results show that overall
ficulties [Charman et al., 2011; Kraper, Kenworthy, Popal, intellectual functioning is strongly related to adaptive
Martin, & Wallace, 2017]. Consequently, the term “high- functioning, especially to VABS-II communication skills,
functioning” should be used with caution for the popula- as previously reported in the literature [Oliveras-Rentas
tion of individuals with ASD without IDD [Alvares et al., 2012]. The observation that visual–spatial and fluid
et al., 2020]. reasoning in children with ASD is related to daily living
Furthermore, the Working Memory (WMI) of the chil- skills reinforces the evidence that intellectual functioning
dren in our sample was poorer than their Verbal (VCI), influences daily life functioning [Black et al., 2009].
Fluid Reasoning (FRI), Visuo-Spatial (VSI), and Global We then performed a cluster analysis on our sample
Intellectual Skills (FSIQ), in accordance with the results of and identified six WISC-V profiles, the cluster-based dif-
previous studies [Mayes & Calhoun, 2008; Wang ferences mainly covering verbal and reasoning skills, pre-
et al., 2017]. A low WMI could be attributed to the atten- viously reported to be discriminant in ASD [Black
tion and language comprehension problems commonly et al., 2009; Girardot et al., 2012; Mayes &
found in ASD [Hedvall et al., 2013; Mayes & Calhoun, 2008; Mottron, 2004; Oliveras-Rentas
Calhoun, 2008; Oliveras-Rentas et al., 2012]. The results et al., 2012; Silleresi et al., 2020]. The subgroup with the
in the literature concerning WM have been contradic- highest intellectual scores in all domains and strengths in
tory, with some studies finding no differences between both verbal and reasoning skills (ASHVR) was that with
spatial and verbal WM in ASD [Joseph et al., 2005], the fewest children with associated psychiatric conditions
whereas others found that spatial WM was more highly (28.6%). At the opposite extreme, the subgroup with the
impaired in this population [Lai et al., 2017; Wang lowest scores in all domains, except verbal (LSAV), was
et al., 2017]. We found better visual than auditory WM that with the most children with associated conditions
among our participants. This could be due to the visual (63.6%). The VABS-II scores did not differ between the
component of the Picture Span subtest, which may have groups, except in the domain of communication, for
helped the participants to maintain their attention which the LSAR group had lower scores than the others,
[Girardot et al., 2012]. possibly related to lower verbal skills.