Online cognitive assessment in the era of COVID-19: Examining the validity of the MEZURE.

Developed more than 2 decades ago, the MEZURE (Assessment Technologies, 1995-2020; https://www.mezure.com/) has received increased attention as a result of the COVID-19 pandemic. It is the first individualized test of cognitive ability created to use an online (local or remote) assessment modality. The MEZURE claims to be aligned both with the extended Gf-Gc theory and the Cattell-Horn-Carroll model of abilities. Whereas the test publisher claims it used exploratory factor analysis to investigate the instrument's factor structure, only the subtest factor loadings on the Gf-Gc factors were furnished. No other structural validity information was provided, suggesting that users of the instrument should interpret the scores produced by the MEZURE with caution. Accordingly, the present study used exploratory and confirmatory factor analysis to more fully investigate the structural validity of the MEZURE. The results revealed that the MEZURE contains a combined perceptual reasoning (i.e., [Gf/Gv]/working memory [Gwm]) group factor, a verbal ability group factor, and a relatively weak general factor that is dominated by perceptual reasoning. The finding of a paltry general factor that is weakly loaded by verbal subtests is inconsistent with the broader research on traditional cognitive ability assessment and could be related to the online administration format of the test. Future research is required to better understand this finding. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Bootstrap Exploratory Graph Analysis of the WISC-V with a Clinical Sample.

One important aspect of construct validity is structural validity. Structural validity refers to the degree to which scores of a psychological test are a reflection of the dimensionality of the construct being measured. A factor analysis, which assumes that unobserved latent variables are responsible for the covariation among observed test scores, has traditionally been employed to provide structural validity evidence. Factor analytic studies have variously suggested either four or five dimensions for the WISC-V and it is unlikely that any new factor analytic study will resolve this dimensional dilemma. Unlike a factor analysis, an exploratory graph analysis (EGA) does not assume a common latent cause of covariances between test scores. Rather, an EGA identifies dimensions by locating strongly connected sets of scores that form coherent sub-networks within the overall network. Accordingly, the present study employed a bootstrap EGA technique to investigate the structure of the 10 WISC-V primary subtests using a large clinical sample (N = 7149) with a mean age of 10.7 years and a standard deviation of 2.8 years. The resulting structure was composed of four sub-networks that paralleled the first-order factor structure reported in many studies where the fluid reasoning and visual-spatial dimensions merged into a single dimension. These results suggest that discrepant construct and scoring structures exist for the WISC-V that potentially raise serious concerns about the test interpretations of psychologists who employ the test structure preferred by the publisher.

Long-term stability of Wechsler Intelligence Scale for Children-fifth edition scores in a clinical sample.

This study investigated the stability of Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) scores for 225 children and adolescents from an outpatient neuropsychological clinic across, on average, a 2.6 year test-retest interval. WISC-V mean scores were relatively constant but subtest stability score coefficients were all below 0.80 (M = 0.66) and only the Verbal Comprehension Index (VCI), Visual Spatial Index (VSI), and omnibus Full Scale IQ (FSIQ) stability coefficients exceeded 0.80. Neither intraindividual subtest difference scores nor intraindividual composite difference scores were stable across time (M = 0.26 and 0.36, respectively). Rare and unusual subtest and composite score differences as well as subtest and index scatter at initial testing were unlikely to be repeated at retest (kappa = 0.03 to 0.49). It was concluded that VCI, VSI, and FSIQ scores might be sufficiently stable to support normative comparisons but that none of the intraindividual (i.e. idiographic, ipsative, or person-relative) measures were stable enough for confident clinical decision making.

Conducting Psychoeducational Assessments During the COVID-19 Crisis: the Danger of Good Intentions.

Decision-makers in school psychology are presently engaged in the process of determining how to, if possible, move forward with conducting mandated psychoeducational evaluations of students in schools during the pandemic. Whereas prominent organizations within the profession (e.g., American Psychological Association, National Association of School Psychologists) have issued guidance and encouraged practitioners to delay testing, it is not clear whether that is a viable option in every jurisdiction. Accordingly, professionals are now considering the potential use of telehealth platforms to conduct assessments, in some form, as we move forward and deal with this crisis. The goal of this brief commentary is to raise some provisional limitations associated with the use of telehealth to conduct psychological assessments that we believe will have to be considered as use of these platforms is debated. Recommendations for professional practice are also provided.

Monte Carlo Modeling of Contemporary Intelligence Test (IQ) Factor Structure: Implications for IQ Assessment, Interpretation, and Theory.

Researchers continue to debate the constructs measured by commercial ability tests. Factor analytic investigations of these measures have been used to develop and refine widely adopted psychometric theories of intelligence particularly the Cattell-Horn-Carroll (CHC) model. Even so, this linkage may be problematic as many of these investigations examine a particular instrument in isolation and CHC model specification across tests and research teams has not been consistent. To address these concerns, the present study used Monte Carlo resampling to investigate the latent structure of four of the most widely used intelligence tests for children and adolescents. The results located the approximate existence of the publisher posited CHC theoretical group factors in the Differential Abilities Scales-Second edition and the Kaufman Assessment Battery for Children-Second edition but not in the Wechsler Intelligence Scale for Children-Fifth edition or the Woodcock-Johnson IV Tests of Cognitive Abilities. Instead, the results supported alternative conceptualizations from independent factor analytic research. Additionally, whereas a bifactor model produced superior fit indices in two instruments (Wechsler Intelligence Scale for Children-Fifth edition and Woodcock-Johnson IV Tests of Cognitive Abilities), a higher order structure was found to be superior in the Kaufman Assessment Battery for Children-Second edition and the Differential Abilities Scales-Second edition. Regardless of the model employed, the general factor captured a significant portion of each instrument's variance. Implications for IQ test assessment, interpretation, and theory are discussed.

Construct Validity of the WISC-V in Clinical Cases: Exploratory and Confirmatory Factor Analyses of the 10 Primary Subtests.

Independent exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) research with the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) standardization sample has failed to provide support for the five group factors proposed by the publisher, but there have been no independent examinations of the WISC-V structure among clinical samples. The present study examined the latent structure of the 10 WISC-V primary subtests with a large (N = 2,512), bifurcated clinical sample (EFA, n = 1,256; CFA, n = 1,256). EFA did not support five factors as there were no salient subtest factor pattern coefficients on the fifth extracted factor. EFA indicated a four-factor model resembling the WISC-IV with a dominant general factor. A bifactor model with four group factors was supported by CFA as suggested by EFA. Variance estimates from both EFA and CFA found that the general intelligence factor dominated subtest variance and omega-hierarchical coefficients supported interpretation of the general intelligence factor. In both EFA and CFA, group factors explained small portions of common variance and produced low omega-hierarchical subscale coefficients, indicating that the group factors were of poor interpretive value.

Cognitive profile analysis in school psychology: History, issues, and continued concerns.

Intelligence testing remains a fixture in school psychology training and practice. Despite their popularity, the use of IQ tests is not without controversy and researchers have long debated how these measures should be interpreted with children and adolescents. A controversial aspect of this debate relates to the utility of cognitive profile analysis, a class of interpretive methods that encourage practitioners to make diagnostic decisions and/or treatment recommendations based on the strengths and weaknesses observed in ability score profiles. Whereas numerous empirical studies and reviews have challenged long-standing assumptions about the utility of these methods, much of this literature is nearly two decades old and new profile analysis methods (e.g., XBA, PSW) have been proffered. To help update the field's understanding of these issues, the present review traces the historical development of cognitive profile analysis and (re)introduces readers to a body of research evidence suggesting new and continued concerns with the use of these methods in school psychology practice. It is believed that this review will serve as a useful resource to practitioners and trainers for understanding and promoting a countering view on these matters.

Revisiting Carroll's survey of factor-analytic studies: Implications for the clinical assessment of intelligence.

[Correction Notice: An Erratum for this article was reported in Vol 30(8) of Psychological Assessment (see record 2018-37729-003). In the article "Revisiting Carroll's Survey of Factor-Analytic Studies: Implications for the Clinical Assessment of Intelligence," by Nicholas F. Benson, A. Alexander Beaujean, Ryan J. McGill, and Stefan C. Dombrowski (Psychological Assessment, Advance online publication, May 24, 2018, http://dx.doi.org/10.1037/pas0000556), the majority of values in the ωH and ωHS columns of Table 4 were incorrect and have been amended. These revisions required text in the fourth paragraph of the Results section to be changed from "Moreover, the ωHS value for Gs is relatively high and very close to the and ωH values for g" to "Moreover, the ωHS values for Gs and Gv are relatively high, exceeding the ω and ωH values for g." All versions of this article have been corrected.] John Carroll's three-stratum theory (and the decades of research behind its development) is foundational to the contemporary practice of intellectual assessment. The present study addresses some limitations of Carroll's work: specification, reproducibility with more modern methods, and interpretive relevance. We reanalyzed select data sets from Carroll's survey of factor analytic studies using confirmatory factor analysis as well as modern indices of interpretive relevance. For the majority of data sets, we found that Carroll likely extracted too many factors representing Stratum II abilities. Moreover, almost all factors representing Stratum II abilities had little-to-no interpretive relevance above and beyond that of general intelligence. We conclude by discussing the implications of this research with respect to the interpretive relevance and clinical utility of scores reflecting cognitive abilities at all strata of the three-stratum theory and offer some directions for future research. (PsycINFO Database Record

What Does the WRAML2 Core Battery Measure? Utilizing Exploratory and Confirmatory Techniques to Disclose Higher Order Structure.

The present study examined the factor structure of the Wide Range Assessment of Memory and Learning-Second Edition (WRAML2) core battery with participants from the normative sample aged 9 to 90 years ( n = 880) using higher order exploratory and confirmatory factor analytic techniques that were not reported in the in the WRAML2 Administration and Technical Manual. Exploratory factor analysis results suggested only one factor, whereas confirmatory factor analysis results favored the three factors posited by the test authors. Although model fit statistics were equivalent for the oblique, indirect hierarchical, and direct hierarchical measurement models, it was determined that the bifactor model best disclosed the influence of latent dimensions on WRAML2 manifest variables. In the three-factor bifactor model, the general factor accounted for 31% of the total variance and 69% of the common variance, whereas the three first-order factors combined accounted for 41% of the total variance and 31% of the common variance. Latent factor reliability coefficients (as estimated by ωh) indicated that only the general factor was measured with enough precision to warrant confident clinical interpretation. Implications for clinical interpretation of WRAML2 scores and the procedures utilized in the development of related measures are discussed.

A Misuse of IQ Scores: Using the Dual Discrepancy/Consistency Model for Identifying Specific Learning Disabilities.

The purpose of this article is to describe the origins of patterns of strengths and weaknesses (PSW) methods for identifying specific learning disabilities (SLD) and to provide a comprehensive review of the assumptions and evidence supporting the most commonly-used PSW method in the United States: Dual Discrepancy/Consistency (DD/C). Given their use in determining whether students have access to special education and related services, it is important that any method used to identify SLD have supporting evidence. A review of the DD/C evidence indicates it cannot currently be classified as an evidence-based method for identifying individuals with a SLD. We show that the DD/C method is unsound for three major reasons: (a) it requires test scores have properties that they fundamentally lack, (b) lack of experimental utility evidence supporting its use, and (c) evidence supporting the inability of the method to identify SLD accurately.

Hierarchical exploratory factor analyses of the Woodcock-Johnson IV Full Test Battery: Implications for CHC application in school psychology.

The Woodcock-Johnson (fourth edition; WJ IV; Schrank, McGrew, & Mather, 2014a) was recently redeveloped and retains its linkage to Cattell-Horn-Carroll theory (CHC). Independent reviews (e.g., Canivez, 2017) and investigations (Dombrowski, McGill, & Canivez, 2017) of the structure of the WJ IV full test battery and WJ IV Cognitive have suggested the need for additional factor analytic exploration. Accordingly, the present study used principal axis factoring (PAF) followed by the Schmid and Leiman (SL; Schmid & Leiman, 1957) procedure with the 2 school-aged correlation matrices from the normative sample to determine the degree to which the WJ IV total battery structure could be replicated. Although 7 factors emerged across the 9 to 19 age range, the pattern of subtests loadings did not fully cohere with the structure presented in the Technical Manual, most notably for the academic fluency subtests. Also, the Fluid Reasoning (Gf) and Quantitative Reasoning (Gq) subtests coalesced to form a combined factor rather than 2 separate factors and the Long Term Retrieval (Gltr) subtests aligned with a variety of different factors. The results of this study indicated that the general intelligence factor variance far exceeded the variance attributed to the lower-order CHC factors. The combination of subtest migration and nominal total/common variance of the CHC lower-order factors suggests caution when interpreting the myriad CHC-related indices when making high stakes decisions. Implications for clinical practice are discussed. (PsycINFO Database Record

Survival analysis of hypotensive cats admitted to an intensive care unit with or without hyperlactatemia: 39 cases (2005-2011).

OBJECTIVE To examine the association between blood lactate concentration and survival to hospital discharge in critically ill hypotensive cats. DESIGN Retrospective case series. ANIMALS 39 cats admitted to an intensive care unit of a university veterinary hospital between January 2005 and December 2011 for which blood lactate concentration was recorded ≤ 1 hour before or after a Doppler-derived arterial blood pressure measurement ≤ 90 mm Hg (ie, hypotension) was obtained. PROCEDURES Medical records of each cat were reviewed to assess survival to hospital discharge, illness severity, duration of hospitalization, age, body weight, and PCV. Results were compared between hypotensive cats with and without hyperlactatemia (blood lactate concentration ≥ 2.5 mmol/L). RESULTS 6 of 39 (15%) hypotensive cats survived to hospital discharge. Twelve (31%) cats were normolactatemic (blood lactate concentration < 2.5 mmol/L), and 27 (69%) were hyperlactatemic. Hypotensive cats with normolactatemia had a higher blood pressure and higher survival rate than hypotensive cats with hyperlactatemia. Five-day Kaplan-Meier survival rates were 57% for normolactatemic cats and 17% for hyperlactatemic cats. Age, body weight, duration of hospitalization, PCV, and illness severity did not differ significantly between hypotensive cats with and without hyperlactatemia. CONCLUSIONS AND CLINICAL RELEVANCE Hypotensive, normolactatemic cats in an intensive care unit had a significantly greater chance of survival to hospital discharge than their hyperlactatemic counterparts. Blood lactate concentration may be a useful prognostic indicator for this patient population when used in conjunction with other clinical and laboratory findings.

Exploratory and hierarchical factor analysis of the WJ-IV Cognitive at school age.

Exploratory and confirmatory factor analytic studies were not reported in the Technical Manual for the Woodcock-Johnson, 4th ed. Cognitive (WJ IV Cognitive; Schrank, McGrew, & Mather, 2014b) Instead, the internal structure of the WJ IV Cognitive was extrapolated from analyses based on the full WJ IV test battery (Schrank, McGrew, & Mather, 2014b). Even if the veracity of extrapolating from the WJ IV full battery were accepted, there were shortcomings in the choices of analyses used and only limited information regarding those analyses was presented in the WJ IV Technical Manual (McGrew, Laforte, & Shrank, 2014). The present study examined the structure of the WJ IV Cognitive using exploratory factor analysis procedures (principal axis factoring with oblique [promax] rotation followed by application of the Schmid-Leiman, 1957, procedure) applied to standardization sample correlation matrices for 2 school age groups (ages 9-13; 14-19). Four factors emerged for both the 9-13 and 14-19 age groups in contrast to the publisher's proposed 7 factors. Results of these analyses indicated a robust manifestation of general intelligence (g) that exceeded the variance attributed to the lower-order factors. Model-based reliability estimates supported interpretation of the higher-order factor (i.e., g). Additional analyses were conducted by forcing extraction of the 7 theoretically posited factors; however, the resulting solution was only partially aligned (i.e., Gs, Gwm) with the theoretical structure promoted in the Technical Manual and suggested the preeminence of the higher-order factor. Results challenge the hypothesized structure of the WJ IV Cognitive and raise concerns about its alignment with Cattell-Horn-Carroll theory. (PsycINFO Database Record

Structural validity of the Wechsler Intelligence Scale for Children-Fifth Edition: Confirmatory factor analyses with the 16 primary and secondary subtests.

The factor structure of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V; Wechsler, 2014a) standardization sample (N = 2,200) was examined using confirmatory factor analyses (CFA) with maximum likelihood estimation for all reported models from the WISC-V Technical and Interpretation Manual (Wechsler, 2014b). Additionally, alternative bifactor models were examined and variance estimates and model-based reliability estimates (ω coefficients) were provided. Results from analyses of the 16 primary and secondary WISC-V subtests found that all higher-order CFA models with 5 group factors (VC, VS, FR, WM, and PS) produced model specification errors where the Fluid Reasoning factor produced negative variance and were thus judged inadequate. Of the 16 models tested, the bifactor model containing 4 group factors (VC, PR, WM, and PS) produced the best fit. Results from analyses of the 10 primary WISC-V subtests also found the bifactor model with 4 group factors (VC, PR, WM, and PS) produced the best fit. Variance estimates from both 16 and 10 subtest based bifactor models found dominance of general intelligence (g) in accounting for subtest variance (except for PS subtests) and large ω-hierarchical coefficients supporting general intelligence interpretation. The small portions of variance uniquely captured by the 4 group factors and low ω-hierarchical subscale coefficients likely render the group factors of questionable interpretive value independent of g (except perhaps for PS). Present CFA results confirm the EFA results reported by Canivez, Watkins, and Dombrowski (2015); Dombrowski, Canivez, Watkins, and Beaujean (2015); and Canivez, Dombrowski, and Watkins (2015). (PsycINFO Database Record

Factor structure of the Wechsler Intelligence Scale for Children-Fifth Edition: Exploratory factor analyses with the 16 primary and secondary subtests.

The factor structure of the 16 Primary and Secondary subtests of the Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V; Wechsler, 2014a) standardization sample was examined with exploratory factor analytic methods (EFA) not included in the WISC-V Technical and Interpretive Manual (Wechsler, 2014b). Factor extraction criteria suggested 1 to 4 factors and results favored 4 first-order factors. When this structure was transformed with the Schmid and Leiman (1957) orthogonalization procedure, the hierarchical g-factor accounted for large portions of total and common variance while the 4 first-order factors accounted for small portions of total and common variance; rendering interpretation at the factor index level less appropriate. Although the publisher favored a 5-factor model where the Perceptual Reasoning factor was split into separate Visual Spatial and Fluid Reasoning dimensions, no evidence for 5 factors was found. It was concluded that the WISC-V provides strong measurement of general intelligence and clinical interpretation should be primarily, if not exclusively, at that level. (PsycINFO Database Record

Survival analysis of critically ill dogs with hypotension with or without hyperlactatemia: 67 cases (2006-2011).

OBJECTIVE: To determine whether critically ill hypotensive dogs without hyperlactatemia have the same prognosis as critically ill hypotensive dogs with hyperlactatemia. DESIGN: Retrospective case series. ANIMALS: 67 critically ill dogs with hypotension. PROCEDURES: Medical records were searched from January 2006 through December 2011 for dogs that were hospitalized in the intensive care unit and that had hypotension and measurement of blood lactate concentration. Blood lactate concentration, systolic blood pressure, and survival rate were compared between hypotensive dogs with and without hyperlactatemia. RESULTS: 19 of 67 (28%) dogs survived and were discharged from the hospital. Hypotensive dogs without hyperlactatemia had a significantly higher systolic blood pressure and were 3.23 (95% confidence interval, 1.04 to 9.43) times as likely to survive, compared with hypotensive dogs with hyperlactatemia. Age, weight, severity of clinical illness, and duration of hospitalization did not differ significantly between hypotensive dogs with and without hyperlactatemia. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that hypotensive dogs without hyperlactatemia had a better prognosis and chance of surviving to hospital discharge than did hypotensive dogs with hyperlactatemia. Because blood lactate concentration was negatively associated with systolic blood pressure and survival probability, it may be a useful metric for determining the prognosis of hypotensive dogs.

Investigating the structure of the WJ-III Cognitive at school age.

During its development, the Woodcock-Johnson, Third Edition Cognitive (WJ-III Cognitive; McGrew & Woodcock, 2001) was never subjected to structural analysis using exploratory and higher order factor analyses. Instead, confirmatory factor analyses were conducted on separate sets of WJ-III correlation matrices, yielding a seven-factor model across all age ranges. To see whether the structure holds for the WJ-III Cognitive, currently recognized best practice exploratory factor analysis (EFA) procedures were applied to two school-aged correlation matrices (ages 9-13; 14-19) from the normative sample. Using EFA and higher order factor analysis, four factors emerged at age 9 to 13 and three factors emerged at age 14 to 19. The results of this analysis indicated a robust manifestation of general intelligence (g) that exceeded the variance attributed to the lower order factors. An additional analysis was conducted that disregarded factor extraction rules and forced the seven-factor fit. The resulting solution was only partially aligned (i.e., Gc, Ga, and Gsm) with the theoretical structure posited in the WJ-III Technical Manual. Surprisingly, this study represents the first time to my knowledge that the WJ-III Cognitive has been subjected to EFA analyses given the instrument's significant use by practitioners and that it has served as the initial evidentiary base for Cattell-Horn-Carroll theory.

Exploratory and higher order factor analysis of the WJ-III full test battery: a school-aged analysis.

Development of the Woodcock-Johnson (3rd ed.; WJ-III; Woodcock, McGrew & Mather, 2001a) was guided in part by Carroll's (1993) 3-stratum theory of cognitive abilities and based on confirmatory factor analysis (CFA), even though Carroll used exploratory factor analysis (EFA) to derive his theory. Using CFA, McGrew and Woodcock (2001) found a 9-factor model across all age ranges. To determine if the 9-factor structure holds for the full WJ-III battery, we applied currently recognized best practices in EFA to 2 school-aged 42-subtest correlation matrices (ages 9­13 and 14­19 years). Six factors emerged at the 9­13 age range, while 5 factors were indicated at the 14­19 age range. The resulting 1st-order factors displayed patterns of both convergence with and divergence from the WJ-III results presented in the Technical Manual. These results also revealed a robust manifestation of general intelligence (g) that dwarfed the variance attributed to the lower order factors. It is surprising that this study represents the first time the WJ-III full battery was subjected to EFA analyses given the instrument's significant use by practitioners and that it served as the initial evidentiary basis for Cattell-Horn-Carroll (CHC) theory. The lack of confirmation of CFA results with EFA methods in the current study permits questioning of the structure of the WJ-III and its relationship with CHC theory. Additional independent, structural analyses are clearly indicated for the WJ-III full test battery before we can be confident in its structure.

Assessing Children's Homework Performance: Development of Multi-Dimensional, Multi-Informant Rating Scales.

Efforts to develop interventions to improve homework performance have been impeded by limitations in the measurement of homework performance. This study was conducted to develop rating scales for assessing homework performance among students in elementary and middle school. Items on the scales were intended to assess student strengths as well as deficits in homework performance. The sample included 163 students attending two school districts in the Northeast. Parents completed the 36-item Homework Performance Questionnaire - Parent Scale (HPQ-PS). Teachers completed the 22-item teacher scale (HPQ-TS) for each student for whom the HPQ-PS had been completed. A common factor analysis with principal axis extraction and promax rotation was used to analyze the findings. The results of the factor analysis of the HPQ-PS revealed three salient and meaningful factors: student task orientation/efficiency, student competence, and teacher support. The factor analysis of the HPQ-TS uncovered two salient and substantive factors: student responsibility and student competence. The findings of this study suggest that the HPQ is a promising set of measures for assessing student homework functioning and contextual factors that may influence performance. Directions for future research are presented.

Smoking during pregnancy: association with childhood temperament, behavior, and academic performance.

OBJECTIVE: This study investigated the association between maternal smoking during pregnancy and ratings of offspring's temperament, behavior, and academic performance at various developmental periods in childhood. METHODS: Multivariate analyses of a birth cohort examined the outcomes for children on measures of temperament, behavior, and academic performance in infancy (6 months), at age 5, and at age 12. RESULTS: When controlling for maternal psychiatric hospitalization, psychological distress during pregnancy, hospitalization for accidents, socioeconomic status, age, and symptoms of upper respiratory infection and nausea, a range of associations between maternal smoking and child outcomes were observed at different ages studied. CONCLUSION: Despite widespread warning regarding smoking cessation during pregnancy, the literature base on the longer-term effects beyond the neonatal and infant period is less available. This is one of the first studies to investigate the association between maternal smoking during pregnancy and child outcomes at several stages of development. The results provide evidence for the lasting effects of smoking during pregnancy on the development of the child.