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tially explained by the inclusion of the new Matrix Reasoning subtest; in post hoc analyses, Martin et al. (2000) determined that this subtest, in fact, was not affected by increased injury severity. Thus, the overall impact of the inclusion of Matrix Reasoning in the 5-subtest P-IQ, and, especially, in the 3-subtest POI, may be a lessening of sensitivity to diffuse brain injury. Future neuropsychological research is vital, especially for samples with injuries other than TBI, and with injuries lateralized to one hemisphere. The prospect of the index profile rendering the WAIS-III V P IQ profile obsolete for the clinical analysis and research investigation of brain damage is both exciting and provocative. We urge researchers to report both IQs and factor indexes, however, to permit comparisons between the two approaches, as was done by both The Psychological Corporation (1997) and Fisher, Ledbetter, Cohen, Marmor, & Tulsky (2000), but not Martin et al. (2000). Overview of Results The V > P pattern on the WAIS, WAIS-R, and WAIS-III for patients with bilateral damage or diffuse brain injury conforms to Wechsler s (1958) original clinical observation that patients with organic brain disease usually display depressed Performance IQs. However, the WAIS-III Processing Speed Index may be even more sensitive than the global measures of V-IQ and P-IQ on the WAIS-III or on any of its predecessors. That possibility is partially due to the addition of Matrix Reasoning to the WAIS-III Performance Scale, and, perhaps equally, to the elimination of the highly-speeded Object Assembly subtest from all global measures of nonverbal ability on the WAIS-III.

where a is a positive constant, or equivalently, uki(t - 1)]

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patients having left-, right-, and bilateral hemisphere disease, and the small number of WAIS-III studies on bilateral/diffuse brain damage: 1. Patients with damage to the right hemisphere, whether the damage is unilateral or accompanied by damage to the left hemisphere as well, are very likely to manifest a substantial V > P profile. 2. Patients with unilateral damage to the left hemisphere may show a slight P > V profile, but not of a magnitude that is large enough or displayed consistently enough to be of much diagnostic benefit; indeed, they are almost as likely to show V > P or no V P discrepancy. 3. Patients with bilateral or diffuse brain injury may show a V > P profile on the W-B, WAIS, and WAIS-R. However, on the WAIS-III such a pattern will likely not be as pronounced, and, instead, the most evident pattern will be in the factor indexes with the Processing Speed index being the most depressed, especially in comparison to the Perceptual Organization index. For the present, concerning lateralized brain damage, let s ignore the subtleties of the study-tostudy differences in the brain-damaged samples, or in the neuropsychological procedure employed, and combine data from all relevant investigations. In the absence of ideal, well-controlled studies using large numbers of patients with unilateral brain damage, a compilation of data from the existing literature with the Wechsler-Bellevue, WAIS, and WAIS-R provides the best guess at the relationship between V P IQ difference and lateralized brain lesions. This overview of 2,695 adult patients (combining data from Tables 8.1, 8.2, and 8.3) is as follows: Left Lesion (N = 1,336) P > V = 3.6 Right Lesion (N = 1,359) V > P = 8.9

and location of a brain lesion, for example, of acuteness versus chronicity of lesion, age of onset, gender, race, and the role played by each separate subtest, are discussed later in this chapter.

When Smith (1966a, 1966b) reported the first major negative findings regarding left- versus right-brain damage and direction of V P IQ discrepancy, he also speculated on the intervening variables that may have led to the contradictory findings. He pointed to methodological problems in most studies, including his own, stressing that lumping together younger and older patients with different types of lesions in various parts of the two hemispheres obscures possible significant differences in effects as a function of the nature, age, extent, dynamics, and specific locus of the lesion within arbitrarily defined cortical and subcortical gross structures (Smith, 1966a, p. 121). Bornstein and Matarazzo (1984) also tried to reconcile McGlone s (1977, 1978) negative findings for females with the bulk of positive findings for other patient samples by focusing on the nature of the brain damage in her samples. They note: [R]eview by us of McGlone s actual data in her published studies reveals that right lesion females did demonstrate the expected pattern of VIQ greater than PIQ; and that, among the left lesion women, patients ...vascular symptoms did demonstrate the expected pattern of VIQ less than PIQ, but women patients with tumor did not (p. 707). Bornstein and Matarazzo (1984) went one step further in this sub-analysis to emphasize that [a]mong the left tumor females..., more than 50 per cent had meningiomas...which tend to be slowly progressive [and] may allow the brain to compensate (pp. 707 708). Herring and Reitan (1986) further noted that the males in

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