1. WAIS DIFFERENTIAL ABILITIES AND GENERALIZED ANXIETY DISORDER
Raymond C. Hawkins, II Christopher Harte, Martita Lopez
Fielding Graduate University University of Texas at Austin
Also, change the "Hawkins et al." citation in the Discussion section to "Hawkins & Lopez." X-Sieve: CMU Sieve 2.2 X-Sender: Date: Thu, 3 Nov :55: To: Ray Hawkins From: Martita Lopez Subject: Poster 1.  Unnecessary word "in" in Abstract, sixth line from bottom. 2.  Under the lit review I doubt that the word "collinearity has two Ls. 3.  Under Discussion on line 5 from the top the sentence reads like a word is missing ("only about 25% that accounted for...") 4.  Under References, the Michael et al. one is missing a word in the title (after "significant") Other than these very minor typos it looks great!  Many thanks for doing this, Ray- Martita --
Abstract
Table 2:
Discussion
Table 1:
Figure 1:
Mean MMPI-2 clinical scale T scores for the NVLD group by GAD status
Demographics of the participant sample
Training clinic young adult clients with a SCID-I GAD diagnosis and/or an elevated PSWQ showed WAIS differential verbal abilities (e.g., VIQ > PIQ; VOC, SIM, or INF higher; BD, OA, CODING, or AR lower).
We found indications that Rourke’s (1989, 2008) WAIS NVLD criteria considerably overlap DSM-IV SCID criteria for GAD, and possibly for other Axis I disorders (e.g., OCD, major depression, and  substance use disorders).
One hypothesis may be Borkovec’s (1990, 2004) GAD theory that posits an overuse of verbal linguistic avoidance strategies (safety maneuvers) and underuse of perceptual organizational problem solving strategies. A related construct, obsessive rumination, may underlie the comorbidities with OCD, major depression, and substance use disorders. Behavioral exposure techniques, as well as mindfulness and cognitive defusion interventions (Hayes’ ACT) may enhance attentional focus on direct action, problem solving, and flexible experiencing rather than anxious rumination.
There are several imitations of this study including the fact that none of the clients had a diagnosed learning disability, as well as the fact that the overall n was small.
The reliability and internal validity of Rourke’s NVLD criteria need to be verified. Rourke’s theory posits NVLD as a stable neuropsychological trait dimension, but alternative causal explanations need to be ruled out (e.g., an anxiety state differentially influencing certain WAIS indices). On the other hand we contend that there are multiple paths to mental disorders involving anxiety and depression.
We attempted to validate the GAD – NVLD relationship. MMPI-2 clinical scales and content / supplementary scales for anxiety were not found to be significantly higher, although scale 9 (Mania) and Obsessiveness were significantly higher in the GAD subgroup. BAI and BDI scores did not differ between the GAD and non-GAD subgroups.
Combining neuropsychological tests with robust measures of personality dimensions (e.g., the FFM) may have potential for increasing the unification and coherence of theoretical mechanisms for the development, maintenance, and treatment of emotional disorders.
Introduction
Borkovec and colleagues (1990, 2004) proposed that a verbal-linguistic processing style preference (i.e., for "worry thoughts") maintains the avoidance of threatening images and decreases autonomic arousal.
Based on this model we hypothesized that the diagnosis of GAD would be associated with differential abilities on the WAIS (e.g., higher verbal IQ than performance IQ).
Rourke and his colleagues (1989, 2008) have described neuropsychological individual differences that may link nonverbal learning disabilities (NVLD) with subsequent vulnerability to anxiety and depression.
NVLD individuals display a preference for using verbal rules and therefore would be disadvantaged in novel situations where perceptual reasoning (including socio-emotional reasoning) would be needed, leading to internalized symptoms of psychopathology (anxiety), social difficulties, and parental over-protectiveness.
This description resembles Borkovec's GAD theory. Links between models of neuropsychology and psychopathology have been given insufficient attention. Heller and colleagues (1997), however, have shown that hemispheric lateralization is associated with emotional disorders.
Mean MMPI-2 clinical scale T scores for the overall training clinic sample (N = 490)
Figure 2:
DSM-IV axis I comorbidities for the NVLD group (strictly defined)
Versus the comparison group
Table 2:
Note: One client in the comparison group met lenient criteria for NVLD
Method
References
In our training clinic archival database (N=490) there were 156 cases where the WAIS-R or WAIS-III had been administered.
WAIS profiles were independently scored according to Rourke’s NVLD criteria (e.g., VIQ > PIQ by 10 points; VOC, SIM, or INF higher; BD, OA, CODING, or AR lower), yielding 32 strictly defined NVLD cases.
For comparison purposes we selected a group defined solely by a 10 point PIQ > VIQ difference (n=21) (See Table 1).
All clients sought treatment at our clinic primarily for anxiety problems or depression, not for learning disabilities.
We also identified 42 clients with a SCID-I GAD diagnosis and/or a Penn State Worry Questionnaire (PSWQ) score exceeding 62, the threshold for probable GAD (Behar, Alcaine, Zuellig, & Borkovec, 2003), who had also been administered the WAIS.
Behar, E., Alcaine, O.M., Zuellig, A. R., & Borkovec, T. D. (2003). Screening for generalized anxiety disorder using the Penn State Worry Questionnaire: A receiver operating characteristic analysis. Journal of Behavior Therapy and Experimental Psychiatry, 34,
Borkovec, T.D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R.G. Heimberg, C.L. Turk, & D.S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice. New York: Guilford Press.
Borkovec, T.D. & Hu, S. (1990). The effect of worry on cardiovascular response to phobic imagery. Behaviour Research and Therapy, 28,
Heller, W., Nitschke, J., Etienne, M., & Miller, G. (1997). Patterns of regional brain activity differentiate types of anxiety. Journal of Abnormal Psychology, 106,
Rourke, B. (1989). Nonverbal learning disabilities: The syndrome and the model. New York, NY US: Guilford Press.
Rourke, B. (2008). Neuropsychology as a (psycho) social science: Implications for research and clinical practice. Canadian Psychology, 49 (1),
Results
13 of the 32 strictly defined NVLD clients were either diagnosed with GAD or had PSWQ scores above 62, versus only 5 in the comparison group defined by PI – VIQ > 10.
Inspection of the anomalous cases of GAD / PSWQ elevations in the comparison group revealed that 1 of the 5 cases exhibited all of Rourke's NVLD criteria except that the VIQ - PIQ difference was reversed.
The groups did not differ significantly in gender or other socio-demographic characteristics.
The strictly defined NVLD group tended to have more SCID-I diagnoses of OCD, substance use disorders, and depression.
We also examined the 24 remaining cases with GAD and/or PSWQ >62, for whom the VIQ > PIQ difference was < 10, but where at least 2 of the other NVLD criteria were met defined as the lenient NVLD group), we found an additional 10 cases.
Out of the 42 cases a GAD diagnosis and/or PSWQ score >62, 13 cases met the strict NVLD criteria and 10 cases met the more lenient criteria.
We examined the MMPI-2 clinical scales, MMPI-2 content/supplementary scales for anxiety, depression, and obsessiveness, and the Beck Scales. Inspection of Fig 1 shows that the GAD subgroup had higher mean T scores on clinical scales characteristic of anxiety problems (7, 2) than the non-GAD subgroup, but these particular scales did not differ significantly.
However, scale 9 (Mania) was sig higher for the GAD subgroup. Fig 2 indicates that MMPI-2 clinical scales for our overall training clinic sample (n = 490) also showed elevated mean T scores for scales 2 and 7. The GAD subgroup showed a trend to score significantly higher on the obsessiveness scale (p = .06), but there were no significant differences on the BAI or the BDI.
Acknowledgments
ABBREVIATIONS: AR: Arithmetic; BD: Block Design; D: Depression; GAD: Generalized Anxiety Disorder; Hs: Hypochondriasis; Hy: Hysteria; INF: Information; Ma: Mania; M/F: Masculine/Feminine; MMPI: Minnesota Multiphasic Personality Inventory- II; NVLD- Non-Verbal Learning Disability; OA: Object Assembly; OCD: Obsessive Compulsive Disorder; Pa: Paranoia; Pd: Psychopathic Deviate; PIQ: Performance IQ; PSWQ: Penn State Worry Questionnaire; Pt: Psychasthenia; PTSD: Posttraumatic Stress Disorder; Sc: Schizophrenia; SCID: Structured Clinical Interview for DSM Disorders; Si: Social Introversion; SIM: Similarities; VIQ: Verbal IQ; VOC: Vocabulary; WAIS: Weschler Adult Intelligence Scale
We thank Michael Telch, Ph.D., David Collins, Ph.D., and all graduate student clinicians who supervised, screened, assessed, and treated these patients. We also thank all patients who took part in this study.