The Value of the Wechsler Intelligence Scale for Children-Fourth Edition Digit Span as an Embedded Measure of Effort: An Investigation into Children with Dual Diagnoses

Abstract

The Test of Memory Malingering (TOMM) is a measure of test-taking effort which has traditionally been utilized with adults, but which more recently has demonstrated utility with children. The purpose of this study was to investigate whether the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Digit Span, commonly used in neuropsychological evaluations, can also be functional as an embedded measure by detecting effort in children with dual diagnoses; a population yet to be investigated. Participants (n = 51) who completed neuropsychological evaluations including the TOMM, WISC-IV, Wisconsin Card Sorting Test, Children's Memory Scale, and Delis-Kaplan Executive Function System were divided into two groups: Optimal Effort and Suboptimal Effort, based on their TOMM Trial 2 scores. Digit Span findings suggest a useful scaled score of ≤4 resulted in optimal cutoff scores, yielding specificity of 91% and sensitivity of 43%. This study supports previous research that the WISC-IV Digit Span has good utility in determining optimal effort, even in children with dual diagnosis or comorbidities.