Computerized adaptive test strategies for the matrix reasoning subtest of the Wechsler Adult Intelligence Scale, 4th Edition (WAIS-IV).

OBJECTIVE: Most neuropsychological tests were developed without the benefit of modern psychometric theory. We used item response theory (IRT) methods to determine whether a widely used test - the 26-item Matrix Reasoning subtest of the WAIS-IV - might be used more efficiently if it were administered using computerized adaptive testing (CAT). METHOD: Data on the Matrix Reasoning subtest from 2197 participants enrolled in the National Neuropsychology Network (NNN) were analyzed using a two-parameter logistic (2PL) IRT model. Simulated CAT results were generated to examine optimal short forms using fixed-length CATs of 3, 6, and 12 items and scores were compared to the original full subtest score. CAT models further explored how many items were needed to achieve a selected precision of measurement (standard error ≤ .40). RESULTS: The fixed-length CATs of 3, 6, and 12 items correlated well with full-length test results (with r = .90, .97 and .99, respectively). To achieve a standard error of .40 (approximate reliability = .84) only 3-7 items had to be administered for a large percentage of individuals. CONCLUSIONS: This proof-of-concept investigation suggests that the widely used Matrix Reasoning subtest of the WAIS-IV might be shortened by more than 70% in most examinees while maintaining acceptable measurement precision. If similar savings could be realized in other tests, the accessibility of neuropsychological assessment might be markedly enhanced, and more efficient time use could lead to broader subdomain assessment.

Design of a multi-institutional neurocognitive discovery study in adult congenital heart disease (MINDS-ACHD).

BACKGROUND: Neurocognitive dysfunction (NCD) is a common comorbidity among children with congenital heart disease (CHD). However, it is unclear how underlying CHD and its sequelae combine with genetics and acquired cardiovascular and neurological disease to impact NCD and outcomes across the lifespan in adults with CHD. METHODS: The Multi-Institutional Neurocognitive Discovery Study in Adults with Congenital Heart Disease (MINDS-ACHD) is a partnership between the Pediatric Heart Network (PHN) and the Adult Alliance for Research in Congenital Cardiology (AARCC) that examines objective and subjective neurocognitive function and genetics in young ACHD. This multicenter cross-sectional pilot study is enrolling 500 young adults between 18 and 30 years with moderate or severe complexity CHD at 14 centers in North America. Enrollment includes 4 groups (125 participants each): (1) d-looped Transposition of the Great Arteries (d-TGA); (2) Tetralogy of Fallot (TOF); (3) single ventricle (SV) physiology; and (4) "other moderately or severely complex CHD." Participants complete the standardized tests from the NIH Toolbox Cognitive Battery, the NeuroQoL, the Hospital Anxiety and Depression Scale, and the PROMIS Global QoL measure. Clinical and demographic variables are collected by interview and medical record review, and an optional biospecimen is collected for genetic analysis. Due to the COVID-19 pandemic, participation may be done remotely. Tests are reviewed by a Neurocognitive Core Laboratory. CONCLUSIONS: MINDS-ACHD is the largest study to date characterizing NCD in young adults with moderate or severely complex CHD in North America. Its results will provide valuable data to inform screening and management strategies for NCD in ACHD and improve lifelong care.

Rationale and Design of the National Neuropsychology Network.

OBJECTIVE: The National Neuropsychology Network (NNN) is a multicenter clinical research initiative funded by the National Institute of Mental Health (NIMH; R01 MH118514) to facilitate neuropsychology's transition to contemporary psychometric assessment methods with resultant improvement in test validation and assessment efficiency. METHOD: The NNN includes four clinical research sites (Emory University; Medical College of Wisconsin; University of California, Los Angeles (UCLA); University of Florida) and Pearson Clinical Assessment. Pearson Q-interactive (Q-i) is used for data capture for Pearson published tests; web-based data capture tools programmed by UCLA, which serves as the Coordinating Center, are employed for remaining measures. RESULTS: NNN is acquiring item-level data from 500-10,000 patients across 47 widely used Neuropsychology (NP) tests and sharing these data via the NIMH Data Archive. Modern psychometric methods (e.g., item response theory) will specify the constructs measured by different tests and determine their positive/negative predictive power regarding diagnostic outcomes and relationships to other clinical, historical, and demographic factors. The Structured History Protocol for NP (SHiP-NP) helps standardize acquisition of relevant history and self-report data. CONCLUSIONS: NNN is a proof-of-principle collaboration: by addressing logistical challenges, NNN aims to engage other clinics to create a national and ultimately an international network. The mature NNN will provide mechanisms for data aggregation enabling shared analysis and collaborative research. NNN promises ultimately to enable robust diagnostic inferences about neuropsychological test patterns and to promote the validation of novel adaptive assessment strategies that will be more efficient, more precise, and more sensitive to clinical contexts and individual/cultural differences.

Hippocampal Volumes in Amnestic and Non-Amnestic Mild Cognitive Impairment Types Using Two Common Methods of MCI Classification.

OBJECTIVES: Mild cognitive impairment (MCI) types may have distinct neuropathological substrates with hippocampal atrophy particularly common in amnestic MCI (aMCI). However, depending on the MCI classification criteria applied to the sample (e.g., number of abnormal test scores considered or thresholds for impairment), volumetric findings between MCI types may change. Additionally, despite increased clinical use, no prior research has examined volumetric differences in MCI types using the automated volumetric software, Neuroreader™. METHODS: The present study separately applied the Petersen/Winblad and Jak/Bondi MCI criteria to a clinical sample of older adults (N = 82) who underwent neuropsychological testing and brain MRI. Volumetric data were analyzed using Neuroreader™ and hippocampal volumes were compared between aMCI and non-amnestic MCI (naMCI). RESULTS: T-tests revealed that regardless of MCI classification criteria, hippocampal volume z-scores were significantly lower in aMCI compared to naMCI (p's < .05), and hippocampal volume z-scores significantly differed from 0 (Neuroreader™ normative mean) in the aMCI group only (p's < .05). Additionally, significant, positive correlations were found between measures of delayed recall and hippocampal z-scores in aMCI using either MCI classification criteria (p's < .05). CONCLUSIONS: We provide evidence of correlated neuroanatomical changes associated with memory performance for two commonly used neuropsychological MCI classification criteria. Future research should investigate the clinical utility of hippocampal volumes analyzed via Neuroreader™ in MCI.

Memory Performance and Quantitative Neuroimaging Software in Mild Cognitive Impairment: A Concurrent Validity Study.

OBJECTIVE: This study examined the relationship between patient performance on multiple memory measures and regional brain volumes using an FDA-cleared quantitative volumetric analysis program - Neuroreader™. METHOD: Ninety-two patients diagnosed with mild cognitive impairment (MCI) by a clinical neuropsychologist completed cognitive evaluations and underwent MR Neuroreader™ within 1 year of testing. Select brain regions were correlated with three widely used memory tests. Regression analyses were conducted to determine if using more than one memory measures would better predict hippocampal z-scores and to explore the added value of recognition memory to prediction models. RESULTS: Memory performances were most strongly correlated with hippocampal volumes than other brain regions. After controlling for encoding/Immediate Recall standard scores, statistically significant correlations emerged between Delayed Recall and hippocampal volumes (rs ranging from .348 to .490). Regression analysis revealed that evaluating memory performance across multiple memory measures is a better predictor of hippocampal volume than individual memory performances. Recognition memory did not add further predictive utility to regression analyses. CONCLUSIONS: This study provides support for use of MR Neuroreader™ hippocampal volumes as a clinically informative biomarker associated with memory performance, which is a critical diagnostic feature of MCI phenotype.

Neuropsychological differences between men and women with Alzheimer's disease.

BACKGROUND: It has been suggested that men and women with Alzheimer's disease (AD) at comparable levels of global cognitive impairment perform differently on neuropsychological measures. Such differences may have practical implications for designing cognitive interventions that address symptoms of dementia. METHODS: We compared men (n = 86) and women (n = 96) with AD on tests of immediate and delayed prose memory, verbal fluency, semantic fluency, semantic memory and confrontation naming. Mean years for age, education and duration of illness were 70.81 (SD = 7.55), 13.37 (SD = 3.38) and 2.17 (SD = 1.72) for men and 73.11(SD = 8.53), 12.27 (SD = 2.86) and 2.42 (SD = 1.92) for women. The groups were comparable in global cognitive functioning as indicated by Dementia Rating Scale total scores for men of 89.27 (SD = 29.80) and women of 90.86 (SD = 30.20). RESULTS: Men earned significantly better scores in immediate prose memory, semantic verbal fluency, semantic memory and response naming. Men and women performed similarly on the remaining tests. When the variables of age, education and duration of disease were controlled, the significant effect of gender was maintained only on tests of semantic fluency, semantic memory and confrontation naming. CONCLUSIONS: The hypothesis of the study was partially confirmed in that women with AD evidenced greater impairment than men with AD on three of six neuropsychological measures even after potentially confounding variables were controlled.

Prorating WAIS - IV summary scores for patients with relapsing-remitting multiple sclerosis.

We evaluated the utility of prorating appropriate combinations of two, six and eight Wechsler Adult Intelligence Scale - Fourth Edition (WAIS - IV) subtests for estimating the Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Full Scale IQ (FSIQ) and General Ability Index (GAI) in a sample of individuals diagnosed with multiple sclerosis (MS). Forty-eight outpatients completed the WAIS - IV and Wechsler Memory Scale - Fourth Edition (WMS - IV) as part of a comprehensive neuropsychological battery. Means for age, education and duration of diagnosis were 42.35, 14.21 and 8.30 years, respectively. Paired t-tests showed no significant differences between prorated and standard means for VCI (93.46 vs. 93.73), PRI (90.19 vs. 89.44), FSIQ (88.53 vs. 88.47) or GAI (90.56 vs. 90.65). Correlations between prorated and standard composites were ≥0.89 in every instance. Correlations between the standard and prorated composites and education, disability status and WMS - IV indexes did not reveal a single contrast, where the correlations were significantly different. The present findings support the use of the two-subtest VCI and PRI composites and the eight-subtest FSIQ and four-subtest GAI in the assessment of patients with MS.

Decreased Cerebrovascular Reactivity in Mild Cognitive Impairment Phenotypes.

BACKGROUND: Cerebrovascular health plays an important role in cognitive health in older adults. Cerebrovascular reactivity (CVR), a measure of cerebrovascular health, changes in both normal and pathological aging, and is increasingly being conceptualized as contributory to cognitive decline. Interrogation of this process will yield new insights into cerebrovascular correlates of cognition and neurodegeneration. OBJECTIVE: The current study examines CVR using advanced MRI in prodromal dementia states (amnestic and non-amnestic mild cognitive impairment phenotypes; aMCI and naMCI, respectively) and older adult controls. METHODS: CVR was assessed in 41 subjects (20 controls, 11 aMCI, 10 naMCI) using multiband multi-echo breath-holding task functional magnetic resonance imaging. Imaging data were preprocessed and analyzed using AFNI. All participants also completed a battery of neuropsychological tests. T-tests and ANOVA/ANCOVA analyses were conducted to compare controls to MCI groups on CVR and cognitive metrics. Partial correlation analyses between CVR derived from regions-of-interest (ROIs) and different cognitive functions were conducted. RESULTS: CVR was found to be significantly lower in aMCI and naMCI patients compared to controls. naMCI showed intermediate patterns between aMCI and controls (though aMCI and naMCI groups did not significantly differ). CVR of ROIs were positively correlated with neuropsychological measures of processing speed, executive functioning, and memory. CONCLUSION: The findings highlight regional CVR differences in MCI phenotypes compared to controls, where aMCI may have lower CVR than naMCI. Our results suggest possible cerebrovascular abnormalities associated with MCI phenotypes.

The Future of Cognitive Screening in Neurodegenerative Diseases.

Cognitive screening instruments (CSI) have variable sensitivity and specificity to the cognitive changes associated with dementia syndromes, and the most recent systematic review found insufficient evidence to support the benefit of cognitive screening tools in older adults residing within the community. Consequently, there is a critical need to improve CSI methods, which have not yet incorporated advances in psychometrics, neuroscience, and technology. The primary goal of this article is to provide a framework for transitioning from legacy CSIs to advanced dementia screening measurement. In line with ongoing efforts in neuropsychology and the call for next-generation digital assessment for early detection of AD, we propose a psychometrically advanced (including application of item response theory methods), automated selective assessment model that provides a framework to help propel an assessment revolution. Further, we present a three-phase model for modernizing CSIs and discuss critical diversity and inclusion issues, current challenges in differentiating normal from pathological aging, and ethical considerations.

Construct identification in the neuropsychological battery: What are we measuring?

OBJECTIVE: Major obstacles to data harmonization in neuropsychology include lack of consensus about what constructs and tests are most important and invariant across healthy and clinical populations. This study addressed these challenges using data from the National Neuropsychology Network (NNN). METHOD: Data were obtained from 5,000 NNN participants and Pearson standardization samples. Analyses included variables from four instruments: Wechsler Adult Intelligence Scale, 4th Edition (WAIS-IV); Wechsler Memory Scale, 4th Edition (WMS-IV); California Verbal Learning Test, 3rd Edition (CVLT3); and Delis-Kaplan Executive Function System (D-KEFS). We used confirmatory factor analysis to evaluate models suggested by prior work and examined fit statistics and measurement invariance across samples. We examined relations of factor scores to demographic and clinical characteristics. RESULTS: For each instrument, we identified four first-order and one second-order factor. Optimal models in patients generally paralleled the best-fitting models in the standardization samples, including task-specific factors. Analysis of the NNN data prompted specification of a Recognition-Familiarity factor on the WMS-IV and an Inhibition-Switching factor on the D-KEFS. Analyses showed strong to strict factorial invariance across samples with expected differences in factor means and variances. The Recognition-Familiarity factor correlated with age more strongly in NNN than in the standardization sample. CONCLUSIONS: Factor models derived from healthy groups generally fit well in patients. NNN data helped identify novel Recognition-Familiarity and Inhibition-Switching factors that were also invariant across samples and may be clinically useful. The findings support efforts to identify evidence-based and optimally efficient measurements of neuropsychological constructs that are valid across groups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Design and Harmonization Approach for the Multi-Institutional Neurocognitive Discovery Study (MINDS) of Adult Congenital Heart Disease (ACHD) Neuroimaging Ancillary Study: A Technical Note.

Dramatic advances in the management of congenital heart disease (CHD) have improved survival to adulthood from less than 10% in the 1960s to over 90% in the current era, such that adult CHD (ACHD) patients now outnumber their pediatric counterparts. ACHD patients demonstrate domain-specific neurocognitive deficits associated with reduced quality of life that include deficits in educational attainment and social interaction. Our hypothesis is that ACHD patients exhibit vascular brain injury and structural/physiological brain alterations that are predictive of specific neurocognitive deficits modified by behavioral and environmental enrichment proxies of cognitive reserve (e.g., level of education and lifestyle/social habits). This technical note describes an ancillary study to the National Heart, Lung, and Blood Institute (NHLBI)-funded Pediatric Heart Network (PHN) "Multi-Institutional Neurocognitive Discovery Study (MINDS) in Adult Congenital Heart Disease (ACHD)". Leveraging clinical, neuropsychological, and biospecimen data from the parent study, our study will provide structural-physiological correlates of neurocognitive outcomes, representing the first multi-center neuroimaging initiative to be performed in ACHD patients. Limitations of the study include recruitment challenges inherent to an ancillary study, implantable cardiac devices, and harmonization of neuroimaging biomarkers. Results from this research will help shape the care of ACHD patients and further our understanding of the interplay between brain injury and cognitive reserve.

Estimating WAIS-IV indexes: proration versus linear scaling in a clinical sample.

OBJECTIVES: We compared the accuracy of proration and linear scaling for estimating Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), Verbal Comprehension Index (VCI), and Perceptual Reasoning Index (PRI) composites from all possible two subtest combinations. The purpose was to provide practice relevant psychometric results in a clinical sample. DESIGN: The present investigation was an archival study that used mostly within-group comparisons. We analyzed WAIS-IV data of a clinical sample comprising 104 patients with brain damage and 37 with no known neurological impairment. RESULTS: In both clinical samples, actual VCI and PRI scores were highly correlated with estimated index scores based on proration and linear scaling (all rs ≥.95). In the brain-impaired sample, significant mean score differences between the actual and estimated composites were found in two comparisons, but these differences were less than three points; no other significant differences emerged. CONCLUSIONS: Overall, findings demonstrate that proration and linear scaling methods are feasible procedures when estimating actual Indexes. There was no advantage of one computational method over the other.

Changes in Cerebral Volume and White Matter Integrity in Adults on Hemodialysis and Relationship to Cognitive Function.

INTRODUCTION: Patients on hemodialysis (HD) have a significant burden of cognitive impairment. Characterizing the cerebral structural changes in HD patients compared to healthy controls and evaluating the relationship of cerebral structural integrity with cognitive performance in HD patients can help clarify the pathophysiology of the cognitive impairment in HD patients. METHODS: In this cross-sectional study, in-center HD patients ≥50 years of age underwent brain structural and diffusion MRIs and cognitive assessment using the NIH Toolbox cognition battery. The cerebral imaging measures of the HD participants were compared to imaging from age-matched controls. Gray matter volume, white matter volume, and white matter integrity determined by diffusion tensor imaging parameters (including fractional anisotropy [FA]) were measured in both cohorts to determine differences in the cerebral structure between HD participants and healthy controls. The association between cognitive performance on the NIH Toolbox cognition battery and cerebral structural integrity was evaluated using multiple linear regression models. RESULTS: We compared imaging measures form 23 HD participants and 15 age-matched controls. The HD participants had decreased gray matter volumes (526.8 vs. 589.5 cm3, p < 0.01) and worsened white matter integrity overall (FA values of 0.2864 vs. 0.3441, p < 0.01) within major white matter tracts compared to healthy controls. Decreases in white matter integrity in the left superior longitudinal fasciculus was associated with lower executive function scores (r2 = 0.24, p = 0.02) and inferior longitudinal fasciculus with lower memory scores (r = 0.25 and p = 0.03 for left and r2 = 0.21 and p = 0.03 for right). CONCLUSIONS: HD patients have a pattern of decreased white matter integrity and gray matter atrophy compared to controls. Decreases in white matter integrity were associated with decreased cognitive performance in the HD population.

Use of the 21-Item Test with children and adolescents 5 to 16 years of age.

The goals of the present study were to: (a) collect preliminary normative data on the 21-Item Test in children and adolescents and to determine if cutoffs for biased responding in adults can be generalized to a younger population; (b) determine if Caucasian and Hispanic children perform differently on the test; and (c) ascertain the relationships of age and verbal intelligence with effort test performance. The 21-Item Test was administered to 153 children attending either a public (n = 96) or private (n = 57) school. The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was also administered to the private school sample. The results indicated that the 21-Item Test has potential as a tool for identifying children who do not put forth maximal effort during formal assessment and that the adult cutoffs appear applicable to children 8 years and older. Caucasian and Hispanic participants performed similarly on the test. Forced-choice scores ≤12 were associated with age and lower levels of performance on the Verbal Comprehension Index of the WISC-IV.

WAIS-IV GAI and CPI discrepancies in multiple sclerosis and traumatic brain injury.

We examined relationships between the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) General Ability Index (GAI) and Cognitive Proficiency Index (CPI) in two clinical samples. The mean pattern produced by 42 individuals with multiple sclerosis (MS) and 47 with traumatic brain injury (TBI) was the same, GAI > CPI. This pattern occurred in 61.9% and 78.7% of the protocols of patients with MS or TBI, respectively. The MS sample earned a significantly larger CPI mean than did patients with TBI. The group means did not differ on the GAI. Patients with TBI had significantly larger GAI-CPI discrepancy score means than those with MS. Receiver operating characteristics (ROC) analysis assessed the ability of GAI-CPI discrepancies to differentiate the samples. The area under curve (AUC) was 0.67, 95% [0.55, 0.78], which indicated low accuracy in terms of group classification.

Identifying self-reported neurocognitive deficits in the adult with congenital heart disease using a simple screening tool.

OBJECTIVE: Children with congenital heart disease (CHD) and adults with acquired heart disease are at an increased risk of neurocognitive impairment. The objective of this study was to determine the prevalence of self-reported neurocognitive impairment and its risk factors in the adult congenital heart disease (ACHD) population. DESIGN: The Wisconsin Adult Congenital Heart Disease Program recently began screening ACHD patients to identify those with significant self-perceived neurocognitive impairments. Screening consists of using a validated neuro-oncology screening instrument that has been modified for the ACHD population. Patients who answer this survey in a predetermined fashion consistent with significant self-perceived neurocognitive deficits are referred for a formal neurocognitive evaluation. Demographic and clinical information are obtained by chart review. RESULTS: Three hundred ten patients (49% males) completed the screening process. The average age was 30 years (range: 17-69 years). For the cohort, 57 (18%) patients had no prior cardiac surgeries, 85 (28%) one surgery, 77 (25%) two, and 91 (29%) at least three surgeries. Of those screened, 106 (34%) met criteria for a formal neurocognitive evaluation. Patients who were referred had undergone a greater number of prior cardiac surgeries (2.2 vs 1.7, P = .008) and were more likely to have severe complexity CHD (P = .006). Of those patients who were referred, the worst perceived functioning was in math and attention. CONCLUSION: There is a high prevalence of ACHD patients with significant self-perceived neurocognitive deficits. Simple screening questionnaires may help identify those patients at high risk and allow for timely and appropriate referral for formal neurocognitive evaluation, diagnosis, and therapy.

Classification Accuracy of Sequentially Administered WAIS-IV Short Forms.

A Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) short form (SF) may be effective for ruling out subnormal intelligence. To create a useful SF, subtest administration should follow the order prescribed in the manual and, depending upon individual performance, be terminated after completion of 2, 3, 4, or 5 subtests. One hundred and twenty-two patients completed the WAIS-IV. In two analyses, Full-Scale IQs (FSIQs) ≤69 and ≤79 were classified as impairment. Classification accuracy statistics indicated that all SFs using both cutoff scores exceeded the base rate (i.e., 14% and 34%) of subnormal intelligence, with hit rates ranging from 84% to 95%. The FSIQ cutoff of ≤69 had poor sensitivity for detecting impaired intellectual functioning with the 2-, 3-, 4-, and 5-subtest SFs; specificity, positive predictive value (PPV), and negative predictive value (NPV) were excellent for each SF. With the FSIQ cutoff of ≤79, sensitivity was strong to excellent for the 3-, 4-, and 5-subtest SFs as were specificity, PPV, and NPV.

Sensitivity and specificity of memory and naming tests for identifying left temporal-lobe epilepsy.

The sensitivity and specificity of the Selective Reminding Test (SRT) Delayed Recall, Wechsler Memory Scale (WMS) Logical Memory, the Boston Naming Test (BNT), and two nonverbal memory measures for detecting lateralized dysfunction in association with side of seizure focus was examined in a sample of 143 patients with left or right temporal-lobe epilepsy (TLE). Scores on the SRT and BNT were statistically significantly lower in the left TLE group compared with the right TLE group, whereas no group differences emerged on the Logical Memory subtest. No significant group differences were found with nonverbal memory measures. When the SRT and BNT were both entered as predictors in a logistic regression, the BNT, although significant, added minimal value to the model beyond the variance accounted for by the SRT Delayed Recall. Both variables emerged as significant predictors of side of seizure focus when entered into separate regressions. Sensitivity and specificity of the SRT and BNT ranged from 56% to 65%. The WMS Logical Memory and nonverbal memory measures were not significant predictors of the side of seizure focus.

Development of alternate paragraphs for the Logical Memory subtest of the Wechsler Memory Scale-IV.

The purpose of the two studies included in this article was to validate an alternate form, the Morris Revision-Fourth Edition (MR-IV), to the Logical Memory paragraphs of the Wechsler Memory Scale-Fourth Edition (LM-IV) for use when retesting of individuals is desired. Study I demonstrated high correlation with the LM-IV paragraphs. Study II was a replication that again demonstrated high correlation between the original LM-IV and the new MR-IV paragraphs. High interrater reliability also was demonstrated. Consequently, the MR-IV paragraphs can be considered an alternate form to the LM-IV paragraphs. Although other attempts have been made to develop alternate stories, these new paragraphs are the only ones that are equivalent in structure, affective tone, and number of scorable units. They have considerable clinical utility and research potential.

Stability of WISC-IV process scores.

Forty-three students were administered on two occasions approximately 11 months apart the complete Wechsler Intelligence Scale for Children-Fourth Edition, including the seven process components of Block Design No Time Bonus, Digit Span Forward (DSF), Digit Span Backward (DSB), Cancellation Random (CAR), Cancellation Structured (CAS), Longest Digit Span Forward (LDSF), and Longest Digit Span Backward (LDSB). Mean ages at first and second testing were 7.77 years (SD = 1.91) and 8.74 years (SD = 1.93), respectively. Mean Full-Scale IQ at initial testing was 111.63 (SD = 10.71). Process score stability coefficients ranged from .75 on DSF to .32 on CAS. Discrepancy score stabilities ranged from .45 on DSF minus DSB to .05 on CAS minus CAR. Approximately 21% of participants increased their LDSF on retest, and 16.3% showed a gain on LDSB. Caution must be exercised when interpreting process scores, and interpretation of discrepancy scores should probably be avoided.