Comparing Neuropsychological Profiles Between Girls With Asperger’s Disorder and Girls With Learning Disabilities

Abstract

Research examining neuropsychological profiles of girls with Asperger’s disorder (AD) is sparse. In this study, we sought to characterize neurocognitive profiles of girls with AD compared to girls with learning disabilities (LD). Two groups of school-age girls referred for neuropsychological assessment participated in the study. A total of 23 girls with AD were compared to 50 girls with LD using intellectual, academic, neuropsychological, and behavioral assessments. Standard two-tailed t-tests revealed statistically significant discrepancies in a number of areas, and results were interpreted to conclude that the participants with AD had a more severe cognitive and behavioral presentation than same-age girls with LD. The severity of these discrepancies indicates the need for routine neuropsychological and behavioral screening to promote early diagnosis and intervention. Based on this study, we challenge the idea that girls present with a more benign expression of AD than boys.

Keywords

Asperger’s disorder autism spectrum disorders neuropsychological profile cortical underconnectivity learning disabilities

Asperger’s disorder (AD) is an autism spectrum disorder (ASD) characterized by predictable deficits in social reciprocity, communication, and repetitive ritualized or restrictive interests and behaviors. On a functional level, youth with AD often evidence awkwardness or oddities in communication despite age-appropriate language acquisition. Such youth have difficulty reading the behaviors of others, may have a preference for predictability, and also may have a tendency toward specific and intense interests (Bolick, 2004). Bolick’s (2004) description also indicates inefficient organization and productivity despite reasonably strong intelligence, difficulty integrating sensory information, and predictable problems regulating mood and anxiety. There has been a dramatic increase in the number of youth diagnosed with ASD throughout the past decade (Wilkinson, 2008), that has consistently reflected a gender gap with boys identified at rates substantially higher than those of girls (Wilkinson, 2008).

There is little empirical research characterizing the neuropsychological, academic, and behavioral profiles of girls with AD. Some authors have suggested that girls evidence a milder presentation or form of the disorder (Mattila et al., 2007). Other researchers have suggested that girls experience a delay in diagnosis and may be at risk for underidentification. For example, Wilkinson (2008) found that boys are referred 10 times as much as girls with regard to a possible AD diagnosis. The gender gap in diagnosis, suspected underidentification, and late diagnosis in girls with AD necessitate a greater understanding of the impact of this neurodevelopmental disorder in girls and merits descriptive and prospective research.

The exact cause and mechanism of AD are unknown; however, the prevailing theory that has become a primary focus of autism researchers in recent years is cortical underconnectivity (Just, Cherkassky, Keller, Kana, & Minshew, 2006). The fundamental basis of this theory is a concept of developmental disconnection, suggesting that higher order processing areas of the brain, typically mediated by frontal structures, fail to develop a level of integration necessary to support typical neurodevelopment. The resulting impairment of ability to integrate information can be characterized by behaviors associated with autism as well as cognitive deficits (Cherkassky, Kana, Keller, & Just, 2006).

Similarly, theories underlying the causality of learning disabilities (LD), particularly dyslexia, focus on convergent research indicating hypoactivation and diminished connectivity in regions specific to language processing, sound symbol association, and rapid word form recognition (Gabrieli, 2009). Although both disorders manifest quite differently in children, mechanisms of cortical underconnectivity and diminished activation, with greater regional specificity in LD, may be evident.

Our aim was to depict and describe the intellectual, academic, neuropsychological, and behavioral profiles specific to girls with AD. Despite the presumption of a milder presentation of the disorder for girls than for boys, we hypothesized that girls with AD would demonstrate more significant neurodevelopmental and behavioral discrepancies when compared with same-age girls identified with LD. Documentation of the clinical presentation of AD in girls is imperative to more accurately recognize, diagnose, and treat them.

Method

Participants

Case reports of 23 school-age girls consecutively referred for neuropsychological assessment and subsequently diagnosed solely with AD, based on test scores and direct examination with a pediatric neuropsychologist, were reviewed. The girls ranged in age from 7 years to 21 years, with a mean age of 12 years 5 months.

The comparison group consisted of 50 school-age girls consecutively referred for neuropsychological assessment and subsequently diagnosed with LD, based on test scores and direct examination by a pediatric neuropsychologist. Girls with LD ranged in age from 5 years to 23 years, with a mean age of 12 years 4 months.

Medical, behavioral, and family histories were collected at the time of the evaluation for both groups of girls. Excluded from the study were girls who had a known history of premature birth, neurologic insult, intellectual disability, and/or comorbid diagnoses of attention-deficit/hyperactivity disorder (ADHD) or anxiety disorder.

To assess intellectual, academic, neuropsychological, and behavioral functioning, the second author, a pediatric neuropsychologist, and staff in his office, administered the following evaluative measures:

Wechsler Intelligence Scale for Children (WISC-IV, Wechsler, 2003),

Woodcock–Johnson Tests of Achievement–III (WJ III; Woodcock, McGrew, & Mather, 2001),

Grooved Pegboard Test (GPB; Kløve, 1963),

Developmental Test of Visual-Motor Integration (VMI; Beery & Butenica, 1997),

Rey–Osterrieth Complex Figure Test (RCF; Osterrieth, 1944),

Wide Range Assessment of Memory and Learning–Second Edition (WRAML-2; Sheslow & Adams, 2003),

Controlled Oral Word Association Test (COWA; Benton & Hamsher, 1989),

Category Fluency Test (CFT; Benton & Hamsher, 1989), and

Child Behavior Checklist–Parent Form (CBCL; Achenbach & Rescorla, 2001).

Data Analysis

Scores on measures of intellectual, academic, neuropsychological, and behavioral functioning were compared between the two groups of girls. A standard two-tailed t-test was used to assess the significance, if any, of discrepancies between psychometric data for the group of girls with AD when compared with the group of girls with LD.

Results

Intellectual Functioning

Intelligence was assessed via the WISC-III or WISC-IV. Scores tabulated by diagnosis included Verbal IQ, Performance IQ, and Full Scale IQ (FSIQ) composite scores and the Verbal Comprehension, Perceptual Organization, Freedom From Distractibility, Word Memory, and Processing Speed indices (Wechsler, 2003). The Global Assessment of Functioning (GAF) from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) formulation also was included. Mean scores for the groups were compared and significant discrepancies were noted, as shown in Table 1.

Table 1.

Intellectual Ability by Diagnosis

	Girls with SLD			Girls with AD
Measure	Score	SD	Count	Score	SD	Count	Difference	Difference ratio	T-score	P
WISC composite scores
Verbal IQ	101.0	14.1	30	110.0	8.4	11	9.2	1.1	2.0	.049*
Performance IQ	98.9	14.4	29	107.0	12.0	10	7.7	1.1	1.5	.014
FSIQ	106.0	11.4	48	106.0	13.0	22	−0.2	1.0	0.1	.921
WISC indexes
Verbal Comprehension	104.0	13.7	40	112.0	16.0	23	8.6	1.1	2.3	.025*
Perceptional Organizational	106.0	10.8	48	107.0	11.0	23	0.6	1.0	0.2	.842
Freedom From Distractibility	95.5	16.9	13	105.0	8.1	3	9.1	1.1	0.9	.383
Word Memory	100.0	11.6	38	99.9	14.0	20	−0.4	1.0	0.1	.921
Processing Speed	99.5	15.0	48	92.3	13.0	23	−7.2	0.9	2.0	.049*
GAF	65.1	3.95	47	56.3	5.0	23	−8.8	0.9	7.9	.000***

Note: SLD = specific learning disability; AD = Asperger’s disorder; WISC = Wechsler Intelligence Scale for Children; FSIQ = Full Scale IQ; GAF = Global Assessment of Functioning. Study used the third edition and the fourth edition (WISC-IV; Wechsler, 2003). The GAF is based on the diagnostic formulation from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000).

p < .05. **p < .01. ***p < .001.

The two-tailed t-test revealed statistically significant discrepancies between the scores of the AD group and the LD group, with the AD group exhibiting significantly higher scores in the areas of Verbal IQ and Verbal Comprehension Index (VCI), but lower in GAF and Processing Speed.

Academic Functioning

Academic functioning was assessed by comparing the WJ III scores for the Broad and Cluster Reading, Math, and Written Language subtests. Mean Broad scores for both groups are found in Table 2. Two-tailed t-test results yielded no statistically significant differences in academic skills, comparing Broad Reading, Math, and Written Language scores. There was an expected trend for stronger reading skills in the girls with AD.

Table 2.

Consecutive Evaluations and Subscale Scores From the WJ III

	Girls with SLD			Girls with AD
WJ III scores	Average	SD	No. of data	Average	SD	No. of data	Difference	T-score	p value
Broad Reading	98.4	14.7	39	104.0	13	23	−5.8	1.6	.115
Broad Math	102.0	14.5	50	98.1	16	23	3.4	0.9	.371
Broad Written Language	104.0	14.6	40	102.0	15	14	2.5	0.6	.585

Note: WJ III = Woodcock–Johnson Tests of Achievement–III (Woodcock, McGrew, & Mather, 2001); SLD = specific learning disability; AD = Asperger’s Disorder.

Neuropsychological Functioning

Neuropsychological functioning was assessed using scores from the GPB (dominant and nondominant hand), VMI, RCF (Copy and Delayed), COWA, CFT, and WRAML-2 (Verbal, Story, and Sentence). Girls with AD had significantly higher scores on the WRAML-2 Sentence subtest, but significantly lower scores on the GPB test for the dominant and nondominant hands, and on the VMI.

Behavioral Functioning

The presence and severity of behavioral issues were assessed using the parent version of the CBCL, and the pediatric neuropsychologist’s use of the GAF from the DSM-IV-TR diagnostic formulation. The two-tailed t-test revealed multiple statistically significant differences between the mean scores for the two groups of girls. The AD group had significantly higher scores on seven of the eight syndrome scales and five of the six DSM-oriented scales. The scale exhibiting the greatest discrepancy was Social Problems. The scale exhibiting the least discrepancy was Delinquent Behavior, for which there were no significant differences between the two groups.

Discussion

Our aim in this study was to describe neuropsychological profiles of school-age girls diagnosed with AD and to compare these profiles with those of same-age girls diagnosed with LD. We hypothesized that there would be significant discrepancies among intellectual, academic, neuropsychological, and behavioral measures. We also hypothesized the girls with AD would evidence more significant deficits across these measures given the diffuse nature of their neurodevelopmental disorder. This hypothesis was based on literature in the field indicating the pervasiveness of the effects of ASD on multiple domains of function. We also believed that girls with AD could be differentiated along various developmental domains compared with normative test values reflecting typically developing girls.

We interpreted the results of the study to support our hypothesis regarding the neuropsychological profiles of girls with AD as compared with girls with LD. Girls with AD exhibited significantly more behavioral problems (see Table 3), which may indicate a deficit in executive functioning. Girls with AD also exhibited significantly lower VCI and verbal intelligence scores (see Tables 1 and 4), which may indicate deficits in verbal memory and verbal fluency. In addition, girls with AD exhibited a significantly lower VMI score (see Table 4), which may indicate deficits in visual construction. Finally, girls with AD exhibited significantly lower scores on the GPB tasks (see Table 4), which may indicate deficits in manual dexterity. They also were more likely to exhibit greater deficits in processing speed, efficiency, and overall behavioral regulation than the girls with LD.

Table 3.

CBCL and GAF Categories by Diagnosis

Scale	Girls with SLD			Girls with AD
	Average	SD	No. of data	Average	SD	No. of data	Difference	T-score	Significant (p < .05)
CBCL syndrome
Anxiety/Depressed	122	14.5	16	108	14.0	44	14.0	3.5	.001***
Withdrawn	126	16.1	16	105	12.0	44	20.0	5.1	.000***
Somatic Complaints	120	15.8	16	108	13.0	44	12.0	3.1	.003**
Social Problems	128	12.8	16	107	8.7	40	21.0	7.0	.000***
Thought Problems	123	13.2	16	107	8.6	40	16.0	5.3	.000***
Attention Problems	130	14.5	16	108	14.0	44	22.0	5.4	.000***
Rule-Breaking Behavior	111	12.2	16	106	9.1	40	4.8	1.6	.115
Aggressive Behavior	117	12.4	16	104	13.0	44	13.0	3.6	.001***
GAF
Affective Problems	123	14.7	15	108	13.0	43	15.0	3.9	.000***
Anxiety Problems	121	13.7	15	108	13.0	43	14.0	3.6	.001***
Somatic Problems	117	14.8	15	108	13.0	43	9.0	2.2	.032*
ADHD Problems	123	10.7	15	106	14.0	43	16.0	4.1	.000***
Oppositional/Defiant Problems	120	13.2	15	104	12.0	43	16.0	4.3	.000***
Conduct Problems	113	13.1	15	107	11.0	40	6.8	1.9	.062

Note: CBCL = Child Behavior Checklist–Parent Form (Achenbach & Rescorla, 2001); GAF = Global Assessment of Functioning (American Psychiatric Association, 2000); SLD = specific learning disability; AD = Asperger’s disorder; ADHD = attention-deficit/hyperactivity disorder.

p < .05. **p < .01. ***p < .001.

Table 4.

Neuropsychological Evaluations by Diagnosis

	Girls with SLD			Girls with AD
Evaluation	Average	SD	No. of data	Average	SD	No. of data	Difference	T-score	Significant (p < .05)
GPB
Dominant hand	85.8	22.6	19	104.7	13.0	41	18.9	4.1	.000***
Nondominant hand	88.8	19.6	19	101.8	15.8	41	13.0	2.7	.009**
VMI	82.2	13.0	15	97.7	12.4	22	15.5	3.7	.001***
RCF
Copy	73.1	20.4	17	83.3	22.9	37	10.2	1.6	.112
Delayed	77.6	20.5	17	83.7	18.5	36	6.1	1.1	.276
CFT	94.9	11.8	19	100.4	11.9	49	5.4	1.7	.094
COWA letters	92.9	22.5	19	92.7	20.2	44	−0.2	0.0	1.000
WRAML-2
Verbal learning	95.0	12.5	8	101.6	16.9	19	6.6	1.0	.327
Story memory	104.3	18.6	7	96.7	21.7	16	−7.6	0.8	.433
Sentence recall	116.3	12.5	4	97.3	9.8	11	−19.0	3.1	.008**

Note: SLD = specific learning disability; AD = Asperger’s disorder; GPB = Grooved Pegboard Test (Kløve, 1963); VMI = Developmental Test of Visual-Motor Integration (Beery & Butenica, 1997); RCF = Rey–Osterrieth Complex Figure Test (Osterrieth, 1944); CFT = Category Fluency Test (Benton & Hamsher, 1989); COWA = Controlled Oral Word Association Test (Benton & Hamsher, 1989); WRAML-2 = Wide Range Assessment of Memory and Learning–Second Edition (Sheslow & Adams, 2003).

p < .05. **p < .01. ***p < .001.

Girls with AD were not significantly different from girls with LD with regard to overall intelligence, academic skills, and select aspects of neuropsychological functioning such as visual memory and perceptual organization skills. Although there were no significant discrepancies between the FSIQs of the AD group and the LD group, girls with AD exhibited higher Verbal IQ and VCI score as measured by the WISC-IV. This group also demonstrated a higher score on the Sentence subtest of the WRAML-2, a measure requiring immediate verbal memory, than girls with LD.

Behaviorally, girls with AD were significantly discrepant from girls with LD on all but one CBCL syndrome scale. Significant discrepancies were evident on scores for Anxiety/Depressed, Withdrawn, Somatic Complaints, Social Problems, and Attention Problems. There also was a significant discrepancy for Aggressive Behavior, with girls with AD having higher scores. The only scale that did not demonstrate a discrepancy was Delinquent Behavior.

The most compelling finding of this study is the significant discrepancy observed in the behavioral profile of girls with AD versus girls with LD. This profile suggests that girls with AD have difficulties with internalizing and externalizing behaviors, as well as predictable difficulties with social skills. From a cognitive standpoint, girls with AD demonstrated higher mean Verbal IQ scores compared with those of girls with LD. Academically, the girls with AD were indistinguishable from the girls with LD. This finding is particularly interesting in that one might expect lower scores for girls with LD. The absence of a significant academic discrepancy may suggest that girls with AD generally demonstrate lower levels of academic skill consistent with the profile of girls with LD. From a neurocognitive standpoint, slower fine-motor speed, weaker visual-construction skills, and weaker verbal fluency scores were evident. Weakness in verbal fluency may be particularly important as this skill has a more direct impact on conversational give and take and, ultimately, social skills.

With regard to emerging theories of causality related to AD and autism, the diffuse nature of deficits spanning cognitive, neuropsychological, and behavioral domains may reflect diminished neural integration as posited by theorists proposing cortical underconnectivity (Cherkassky et al., 2006). In contrast, researchers examining the neurological underpinnings of LD, particularly dyslexia, suggest a more regionally specific pattern of underactivation and functional disconnections in those tracts relevant to language processing (Gabrieli, 2009). Future research is necessary to link cognitive and behavioral profiles with neuroimaging and genetic studies. Future research also is indicated to understand biological factors governing gender-based differences in AD (Baron-Cohen, 2009).

The results of this study have important implications for identification, diagnosis, and intervention regarding girls with AD. Educators and clinicians should be aware of the more pervasive and diffuse behavioral concerns identified in such girls. Results of our study can be interpreted to indicate the importance of a comprehensive assessment to identify anticipated cognitive weaknesses that may affect academic productivity and exacerbate social functioning. These findings may contribute to an increased recognition of the complexity of issues facing young girls with AD and provide a means to discriminate such girls from girls with LD.

Accommodations, Modifications, and Strategies

In light of these findings and recognizing the impact that cognitive and behavioral regulation and difficulties have on girls with AD in school environments, the following accommodations, modifications, and strategies are suggested. We have grouped these suggestions into accommodations/modifications that the teacher may offer the student (Teacher–Student), modifications that should travel with the student from class to class (Academic), and strategies that may be implemented either schoolwide or directly with the girls with AD to promote successful behavioral regulation and overall academic and social functioning.

Teacher–student interventions

Avoid implicit directions or task constructions.

Avoid abstract language, inferences, and idiomatic language.

Do not rely on nonverbal cues to communicate a message or direction.

Use visual supports, repetition, and checks for comprehension, given weaknesses in verbal memory.

Cue the student prior to calling on her to allow extra processing time and the ability to formulate an oral response.

Recognize students’ areas of interest and allow opportunities to showcase their knowledge.

Girls may require observation or facilitation of social interactions during less structured times of day, such as lunch or before/after school.

Encourage girls with AD to participate in clubs or organizations that offer a high degree of acceptance and support, and a nonjudgmental atmosphere (drama, peer mediation, and service groups may be a great place to start).

Consider peer mentoring, although this must be done in a thoughtful and well-planned manner.

Identify a point person or mentor on staff who may be available for periodic check-ins and problem solving for difficult social or academic situations.

Offer faculty training in social thinking strategies (e.g., Winner, 2005).

Academic interventions

Provide extended time on testing to accommodate for diminished processing speed. This may be particularly important in establishing a basis for extended time on high-stakes testing such as the SAT or ACT.

Offer prereading and prewriting rubrics to support organization and executive function.

Break down longer assignments into smaller segments with more frequent feedback to accommodate weaknesses in executive functioning.

Check to ensure that the girl with AD comprehends task instructions.

Recognize that the curriculum contains increasing amounts of inferential, conceptual, and abstract information as students progress through middle school. This may require greater scaffolding to support comprehension of more abstract concepts.

Allow girls with AD to leave the room if anxiety necessitates a break from class.

Consider preferential seating near those students who may be appropriate language, gender, or social models.

Social interventions and cognitive behavioral strategies

The significant elevations in aspects of behavioral regulation may reflect the difficulty girls with AD experience in navigating the academic and social demands of a school setting. Many girls with AD do not feel part of the school’s social fabric and may experience persistent symptoms of anxiety that further aggravate cognitive and social weaknesses. Strategies to promote behavioral regulation may include the following:

Create an environment that appreciates the strengths and weaknesses of girls with AD. This may include staff training by local professionals, involvement of the school psychologist, or the efforts of a local advocacy group.

Girls with AD may benefit from evidence-based cognitive behavioral strategies in the management of anxiety. These strategies may include thought stopping, self-verbalization, self-calming, and relaxation.

Some schools have implemented Mindfulness programs based on the work of Kabat-Zinn (2005) to promote self-calming and meditation.

Because bullying is a problem often encountered by girls with AD in middle or early high school settings, bully-proof training for faculty is recommended. It is also important to recognize that (a) girls with AD may be reluctant to identify themselves as victims of bullying, and (b) bullying may be much more subtle in girls than is evident in boys.

If the student has an individual education plan (IEP) or a 504 plan, there should be provisions to recognize triggers to anxiety or loss of behavioral control. Some girls with AD may require a Functional Behavioral Assessment and Behavioral Intervention Plan, which are more formal means for addressing behaviors that may interfere with academic or social functioning.

Medication may be an appropriate tool for some girls with AD. Medication may be used to reduce anxiety, reduce impulsivity, or strengthen aspects of executive functioning such as attention and working memory. The school nurse and appropriate faculty should be made aware of any medication issues.

It may be helpful to identify a physical space where the girl with AD can go if she is feeling overwhelmed or anxious. This space should allow some privacy—with monitoring—in which a student can employ stress-reducing strategies such as drawing, meditating, listening to music, reading, and so forth.

Friendship groups, lunch bunches, and other adult-facilitated opportunities for socialization may be helpful. Such groups should be monitored for their efficacy.

Provide opportunities for girls with AD to explore and develop their specific interests. This may be accomplished through classroom-based projects, extra-credit opportunities, or greater autonomy in choosing topics for papers and projects.

Accommodations and interventions may be provided through the context of an IEP, a 504 plan, or some form of a student action plan. In any event, it is important that there be a written plan to facilitate students’ academic and social progress and avoid the difficulties identified in this study.

Strengths and Limitations

Strengths of this study include an empirical assessment of girls with AD, given the paucity of such research. Additional strengths include the sample size given the low prevalence of girls diagnosed with AD. The LD control group also was of considerable size and strength.

The broad strength of this study is that it contributes to a very small body of research concerning the clinical presentation of girls with AD. The results are interpreted to demonstrate that these girls present in a similar way as girls with LD, and may be useful in making more accurate diagnoses.

Weaknesses of this study include its retrospective design, absence of greater sociodemographic features associated with the sample size, and participant selection from a group of youth specifically referred for assessment.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

References

Achenbach

T. M.

Rescorla

L. A.

(2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont, Research Center for Children, Youth, and Families.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Baron-Cohen

(2009). Autism: The empathizing-systemizing (E-S) theory. Annals of the New York Academy of Sciences, 1156, 68–80.

Beery

K. E.

Butenica

N. A.

(1997). Developmental Test of Visual Motor Integration. Odessa, FL: Psychological Assessment.

Benton

A. L.

Hamsher

K. D.

(1989). Multilingual aphasia examination. Iowa City, IA: AJA Associates.

Bolick

(2004). Asperger syndrome and adolescence: Helping preteens and teens get ready for the real world. Gloucester, MA: Fair Winds.

Cherkassky

Kana

Keller

Just

M. A.

(2006). Functional connectivity in a baseline resting-state network in autism. Neuroreport, 17, 1687–1690.

Gabrieli

(2009). Dyslexia: A new synergy between education and cognitive neuroscience. Science, 325, 280–283.

Just

Cherkassky

Keller

Kana

Minshew

(2006). Functional and anatomical cortical underconnectivity in autism: Evidence from an FMRI study of an executive function task and corpus callosum morphometry. Cerebral Cortex, 174, 951–961.

10.

Kabat-Zinn

(2005). Wherever you go, there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.

11.

Kløve

(1963). Clinical neuropsychology. In Forster

F. M.

(Ed.), The medical clinics of North America (pp. 1647–1658). New York, NY: Saunders.

12.

Mattila

M. L.

Kielinen

Jussila

Linna

Bloigu

Ebeling

Moilanen

(2007). An epidemiological and diagnostic study of Asperger syndrome according to four sets of diagnostic criteria. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 636–646.

13.

Osterrieth

P. A.

(1944). Filetest de copie d’une figure complex: Contribution a l’etude de la perception et de la memoire [The test of copying a complex figure: A contribution to the study of perception and memory]. Archives de Psychologie, 30, 286–356.

14.

Sheslow

Adams

(2003). Wide Range Assessment of Memory and Learning–Second Edition: Administration and technical manual. Lutz, FL: Psychological Assessment.

15.

Wechsler

(2003). Wechsler Intelligence Scale for Children–Fourth Edition (WISC-IV). San Antonio, TX: Psychological Corporation.

16.

Wilkinson

(2008). The gender gap in Asperger syndrome: Where are the girls? Teaching Exceptional Children Plus, 4, 1–10.

17.

Winner

M. G.

(2005). Think Social! A social thinking curriculum for school-age students for teaching social thinking and related social skills to students with high functioning autism, Asperger syndrome, PDD-NOS, ADHD, nonverbal learning disability and for all others in the murky gray area of social thinking. San Jose, CA: Think Social.

18.

Woodcock

R. W.

McGrew

K. W.

Mather

(2001). Woodcock-Johnson III. Itasca, IL: Riverside.