Intellectual Profile of Sexually Abused Children in Japan: An analysis of WISC-III Subtests compared with Physically Abused, Neglected, and Non-Maltreated Children

doi:10.4236/psych.2011.23027

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Psychology

2011. Vol.2, No.3, 169-172

Intellectual Profile of Sexually Abused Children in Japan: An

Analysis of WISC-III Subtests Compared with Physically Abused,

Neglected, and Non-Maltreated Children

Kohske Ogata

Osaka Prefectural Government Tondabayashi Child-Family Center, Tondabayashi, Japan.

Email: [email protected]

Received January 25th, 2011; revised March 7th, 2011; accepted April 11th, 2011.

In previous studies, a subtest profile of the Wechsler series test was used to characterize maltreated children.

Specifically, a higher score on the Picture Completion suggested hypervigilance symptoms related to

post-traumatic stress disorder (Frankel et al., 2000). The aim of this study was to replicate the previous study

using Japanese children and to extend the findings by examining the types of maltreatment, especially focusing

on child sexual abuse. Participants were selected retrospectively from records at a Child Guidance Center, where

maltreated children were protected, assessed, and treated in Japan. Data of 12 sexually abused children, 12

physically abused, 12 neglected, and 12 non-maltreated, matched for sex and age, were collected. All children

had completed the Wechsler Intelligence Scale for Children third edition Japanese version; 10 core subtests were

used as dependent variables and Full Scale IQ was used as a covariate. Analysis of covariance showed signifi-

cant differences on both the Picture Completion and Vocabulary subtests among groups. Post-hoc tests indicated

that sexually abused children scored higher than non-maltreated comparisons on the Picture Completion test, but

there were no significant differences on the Vocabulary test between sexual abuse and other groups. These find-

ings replicate and extend the results reported in previous studies. The clinical implication of this study within the

Japanese cultural context suggests that sexually abused children with higher scores on the Picture Completion

test should be referred to a child psychiatrist to screen for post-traumatic symptoms.

Keywords: WISC-III, Child Sexual Abuse, Subtest Profile, Intelligence

Introduction

Frankel, Boetsch, and Harmon (2000) studied the elevated

Picture Completion score of maltreated children. The research-

ers demonstrated that maltreated preschoolers scored signifi-

cantly higher on the Picture Completion subtest of the Wechsler

Preschool and Primary Scale of Intelligence Revised (WPPSI-R)

compared with the children’s mean scores of performance sub-

tests and all subtests. Frankel et al. (2000) concluded from the

results that a higher score on the Picture Completion test related

to a hypervigilance symptom of post-traumatic stress disorder

(PTSD) in maltreated children.

In Turkish literatures, Bulut and colleagues studied the PTSD

in children who have experienced the natural disasters (Bulut,

2004, 2006, 2010; Bulut, Bulut, & Tayli, 2005). For example,

Bulut (2010) reported from longitudinal investigations that

overall PTSD rates of children gradually decreased. The re-

search revealed the gender differences that were detected on

intrusion and avoidance symptoms. Factor analyses on the

sub-symptoms showed that avoidance loaded across factors,

and the avoiding place behavior was associated with vigilance

symptom (Bulut, 2004).

To the best of the author’s knowledge, no research in Japan

has yet been carried out to examine developmental effects by

the form of child maltreatment; with respect to PTSD, child

sexual abuse (CSA) is likely to be a more serious traumatic

event (Rowan & Foy, 1993) and have tremendously detrimental

effects on child development than physically abused or ne-

glected children (Schaaf & McCanne, 1998; Sullivan, Fehon,

Andres-Hyman, L i p s c hitz, & Grilo, 2006; Widom, 1999).

The aim of the current study is twofold: to replicate the find-

ings of Frankel et al. (2000) using Japanese samples, hypothe-

sizing that the Picture Completion test of Japanese maltreated

groups gives scores higher than the non-maltreated group; to

extend the findings by examining the differential effects of

maltreatment types, particularly predicting that the score of

sexually abused children, the primary focus of this study, will

be highest in the present groups.

Methods

Participants. The participants were selected from case file

records at a child guidance center (CGC) in Osaka Prefecture,

Japan. The total number of candidates was 705 maltreated cases:

349 child physical abuse (CPA), 29 CSA, and 327 child neglect

(CN). Sample selection was conducted as follows. First, chil-

dren with both a history of CSA and whose psychometric intel-

ligence had been tested using the Wechsler Intelligence Scale

for Children third edition (WISC-III) were elicited from the

case files. Informed consent had been obtained from their par-

ents or caregivers at the outset of administration of the test.

Thus, 12 records of CSA cases were obtained, and they all were

girls. CSA was defined in this study as attempted or actual

sexual contact or interaction of any form between the partici-

pant and a caregiver or other responsible adult for purposes of

the adult’s sexual gratification. Sexual contact experiences

K. OGATA

170

ranged from fondling, genital touching, and masturbation of or

by another person to attempted or completed vaginal inter-

course. Secondly, 12 CPA cases, who had been tested using the

WISC-III and had no experience of other forms of maltreatment

from their records, were matched for sex and age in months,

which was limited to the range from one year or older to one

year or younger than that of the CSA counterpart. Physical

abuse consisted of bruises, burns, cuts, scratches, or bone frac-

tures. Thirdly, 12 CN girls were selected using the same criteria

as the CPA group. Neglect was composed of two subtypes: the

first subtype, failure to provide, involves the failure of the care-

giver or responsible adult to meet the minimum physical needs

of the child; the second subtype, lack of supervision, occurs

when the caregiver or responsible adult does not take sufficient,

developmentally appropriate action to ensure the child’s safety

inside and outside the home setting. Finally, 12 girls who had

neither been abused nor neglected from their records and had

been tested using the WISC-III was matched for comparison

(Non-Maltreated: NM group). The NM group on CGC had such

alleged problems as 4 juvenile delinquency, 2 truancy, 2 low

school achievement, 3 school refusal, and 1 intellectual disabil-

ity. The child who was alleged by her parents to have intellec-

tual disability was tested and the results disproved this assertion.

The NM group did not experience any maltreatment, according

to information in the records obtained from their parents. All

CGC reports, whether substantiated or not, were considered

reliable indicators of maltreatment in Japan. The sample selec-

tion in this study included only the above criteria and other

clinical data were not involved. All 48 participants were girls

and their mean ages ranged from 7 to 16 years, as shown in

Table 1.

Procedures. A child’s cognitive development was measured

by the WISC-III Japanese version; the author confirmed from

the case file s that a trained chil d psychologist had administered

the WISC-III to the child in a CGC. The WISC-III Japanese

version has been standardized using a national sample of 1,125

children ranging in age from 5 through 16 years and 11 months.

In Japan, the WISC-III was revised from the WISC-R in 1998.

Psychometric traits of the WISC-III Japanese version were

adequate for reliability and validity (Wechsler, 1991/1998).

Reliability coefficients, based on split-half correlations, range

from .64 to .85 for the 10 core subtests, and .95 for the FIQ;

reliability coefficients, based on test-retest correlations, range

from .54 to .89 for the 10 core subtests, and .93 for the FIQ

(Wechsler, 1991/1998). Construct validity was also confirmed

using factor analysis; the four factor model was adopted, which

is the same as the original Wechsler model. The test comprises

10 core and 3 supplemental subtests. This study analyzed only

the 10 core subtests because a large number of values were

missing on the supplemental subtest scores.

Results

Mean and standard deviation of subtest scores are shown in

Table 1. Results showed no differences in age (F[3, 44] = .009,

p = .999) but a significant difference of the FIQ between groups;

the IQ range of the NM group was 82 to 107, including no

children with intellectual disabilities.

ANCOVA was performed on 10 subtests among groups. In

the analyses, FIQ was related to the differences in subtest

scores and therefore used as a covariate; age did not reach sig-

nificance and therefore was not used as a covariate. The inde-

pendent variable was group status (CSA, CPA, CN, NM) and

the dependent variables were the 10 subtest scores. Due to the

number of comparisons, the Bonferroni correction was em-

ployed, and alpha was set at .005 for each F test. Before the F

tests of the main outcomes, three pretests were conducted to

confirm the validity of applying ANCOVA to the data in this

study (Table 2). Firstly, equivalent slopes of regressions, which

reflected the relationship between the FIQ and each subtest

score across groups, were confirmed. On all subtests, the dif-

ferences of the slopes did not reach significance and therefore

all regressions seemed to be parallel across groups. Secondly, it

was underpinned that the regression coefficients from the FIQ

to each subtest score were significant. Thirdly, the Levene tests

verified the equality of variance in the groups. Finally, F tests

were conducted on the basis of the results in the three pretests.

In ANCOVA, significant differences were detected on the Pic-

ture Completion and the Vocabulary subtests (Table 2).

Table 1.

WISC-III subtest scores, F IQ , and age among groups.

CSA CPA CN NM ANOVA

Subtests M SD M SD M SD M SD F(3, 44)p

Picture Completion 8 3 7 2 6 3 7 2 0.910 .444

Information 5 2 7 3 4 2 8 2 5.900 .002

Coding 7 4 9 4 8 3 10 2 1.733 .174

Similarity 6 3 7 3 6 3 10 2 7.615 .000

Picture Arrangement 6 3 6 2 7 2 9 3 4.228 .010

Arithmetic 5 3 8 3 4 3 9 1 7.259 .000

Block Design 8 4 7 4 7 3 10 3 1.427 .248

Vocabulary 6 2 8 2 5 2 10 3 10.627 .000

Object Assembly 8 3 6 3 7 4 8 3 0.805 .498

Comprehension 8 3 8 2 7 3 10 2 4.495 .008

FIQ 76 17 79 14 76 13 93 8 4.352 .009

K. OGATA 171

Table 2.

Results of ANCOVAs on subtest scores usin g FIQ as a covariate.

Equivalent slope across the groupsRegression significance Levene test F test

Subtests F(3, 40) p F(1, 43) p F(3, 43)p F(3, 43) p







Picture Completion 0.052 .984 44.651 .000 0.869 .465 5.159 .004 .265

Information 2.113 .114 29.083 .000 0.676 .571 3.079 .037 .177

Coding 1.024 .392 25.860 .000 0.483 .696 1.019 .394 .066

Similarity 0.387 .763 27.237 .000 1.751 .170 2.671 .059 .157

Picture Arra ngement 1.370 .266 40.770 .000 1.466 .237 1.660 .190 .104

Arithmetic 2.183 .105 21.997 .000 0.808 .496 4.585 .007 .242

Block Design 1.357 .270 44.754 .000 0.554 .648 0.550 .651 .037

Vocabulary 1.023 .392 12.235 .001 2.360 .084 5.808 .002 .288

Object Assembly 1.177 .331 44.118 .000 0.507 .679 3.782 .017 .209

Comprehension 0.729 .541 11.183 .002 0.668 .576 1.531 .220 .097

Significant effects detected in ANCOVA were assessed us-

ing post-hoc procedures corrected by the Bonferroni method

(Figure 1). Post-hoc analyses indicated that only the pair be-

tween the CSA and NM on the Picture Completion test reached

significance, set at 0.00833; the CSA group had a higher score

than the NM group on the Picture Completion subtest. No other

comparisons were significant.

Discussion

These results are similar to Frankel and colleagues’ (2000)

findings in that only the Picture Completion subtest score was

higher in the CSA than the NM group; however, in this study

there were no difference between the other maltreated groups

and the comparison group. These findings render this study a

partial replication of their study with a Japanese sample. Most

previous studies have used Western populations and therefore

most of those findings cannot be generalized to Japanese sub-

jects. This research has some advantages in extending the find-

ings of Frankel et al. (2000), indicating that although limited to

the CSA, generalization of the findings would be partially valid.

The present findings need to be validated from cross-cultural

perspectives. Japanese culture has collectivistic characters in

nature, and Turkish culture also has similar ones. Bulut et al.

(2005) investigated the Turkish children who experienced the

earthquake in 1999 and compared the high-impact with low-

impact trauma groups on PTSD diagnosis. Results showed that

there was no significant difference between high and low im-

pact groups, suggesting that on the number of children who met

the PTSD requirement was almost the same in both groups in

number and severity. However, the results of another research,

comparing the exposed with non-exposed group, indicated that

the estimated prevalence rates of PTSD reached on a very high

proportion of 73% in the earthquake exposed group whereas

9% in the non-exposed-control group (Bulut, 2006). Thus,

findings obtained by Bulut and colleagues suggests that expo-

sure to the traumatic event may suffer from PTSD in Turkish

culture similar to Japanese one. The CSA as well as the natural

disasters appeared to have traumatic impact on the PTSD in

victim children. The current findings might have some cross-

cultural validity in particular compared with Turkish literatures.

In addition to the generalization, the extension of the previ-

ous study was confirmed. Frankel et al. (2000) used various

samples compounded from all types of maltreatment, and

therefore no analysis was performed on the factor of maltreat-

ment forms. The results of the present study demonstrated that

only the CSA group was higher than the NM group on the Pic-

ture Completion test. These findings suggested that the type of

maltreatment has diverse effects on child cognitive develop-

ment, and the CSA might be different from both the CPA and

CN. Given that the Picture Completion test represents a marker

of the hyper-arousal symptom of PTSD, these findings showed

that the CSA may influence their vigilance ability.

These findings suggest a clinical implication in the Japanese

cultural context. A sexually abused child who scores higher on

the Picture Completion test should be referred to a child psy-

chiatrist for screening for traumatic symptoms for the CSA. In

Japan, maltreated children are not necessarily referred for med-

ical evaluation of their traumatic symptoms. In practice, in the

CGC, a child psychologist routinely evaluates the intellectual

and emotional status of children, but is not trained to conduct

diagnostic evaluations. In the CGC, both a social worker and a

child psychologist usually work together for maltreated chil-

dren but a child psychiatrist is rarely involved; however, the

CSA might be a more traumatic event and probably has exac-

erbating effects on a child. These findings can be used as a cue

for staff at the CGC to support their decision making and to

determine if more extensive medical support is needed for the

child.

An alternative interpretation of the elevated Picture Comple-

tion score may involve the level of motivation for completing

the intelligence test. The Picture Completion test is the first

subtest in the WISC-III sequence, and might score relatively

higher among all subtests if sexually abused children have a

difficulty with attention–retention (Bremner, Narayan, Staib,

Southwick, McGlashan, & Charney, 1999); however, difficul-

ties with concentration were not measured in this study, and

further studies are needed to clarify the association between

CSA and attention–retention problems.

K. OGATA

172

Picture CompletionVocabulary

Subtests significant by ANCOVA

Adjusted Mean Score

CSA

CPA

p < .0083

p < 0.0083

Picture CompletionVocabulary

Subtests signific ant b y ANCOVA

Figure 1.

Post-hoc tests on the two subtests for which ANCOVA detected significant differences. Comparisons were examined between the sexual group and the

other three groups. Due to comparing 6 pairs, Bonferroni corrected alpha was set at 0.0083. Mean scores were adjusted by the FIQ as a covariate;

error bars indicate 95% confidence interval.

There was a limitation of this study. Socioeconomic status

(SES) was not measured because the FIQ was controlled di-

rectly as a covariate. Most previous research has measured the

SES to reduce the environmental effect on the difference in IQ

between the maltreated group and the comparison group (e.g.,

Perez & Widom, 1994). Nevertheless, the SES was found not to

be a determinant factor in the intellectual functioning of mal-

treated children. Perez & Widom (1994) showed that mal-

treated children had a lower IQ than non-maltreated children

after controlling for the SES using multivariate analysis. Thus,

adjusting the FIQ by ANCOVA would increase the internal

validation of the current examination to compare the subtest

profile between groups; however, it is unclear whether the SES

has different effects on each subtest score, and the current find-

ings should therefore be interpreted carefully.

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