2011. Vol.2, No.3, 169-172
Copyright © 2011 SciRes. DOI:10.4236/psych.2011.23027
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.
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
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.
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
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.
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.
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.
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
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.
Picture CompletionVocabulary
Subtests significant by ANCOVA
Adjusted Mean Score
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.
Bremner, J. D., Narayan, M., Staib, L. H., Southwick, S. M., McGla-
shan, T., & Charney, D. S. (1999). Neural correlates of memories of
childhood sexual abuse in women with and without posttraumatic
stress disorder. American Journal of Psychiatry , 156, 1787-1795.
Bulut, S. (2004). Factor structure of posttraumatic stress disorder in
children experienced natural disaster. Psychologia: An International
Journal of Psychology i n t he O r i e n t , 47, 158-168.
Bulut, S. (2006). Comparing the earthquake exposed and non-exposed
Turkish children’s Post Traumatic Stress Reactions. Anales De Psi-
cología, 22, 29-36.
Bulut, S. (2010). Children’s posttraumatic stress reactions and
sub-symptoms: Three years of a longitudinal investigation study after
a direct exposure to the earthquake and school’s collapse. Turk Psi-
koloji Dergisi, 25, 87-98. (Abstract in English)
Bulut, S., Bulut, S., & Tayli, A. (2005). The dose of exposure and pre-
valence rates of post traumatic stress disorder in a sample of Turkish
children eleven months after the 1999 Marmara earthquakes. School
Psychology International, 26, 55-70.
Frankel, K. A., Boetsch, E. A., & Harmon, R. J. (2000). Elevated pic-
ture completion scores: A possible indicator of hypervigilance in
maltreated preschoolers. Child Abuse & Neglect, 24, 63-70.
Perez, C. M., & Widom, C. S. (1994). Childhood victimization and
long-term intellectual and academic outcomes. Child Abuse & Ne-
glect, 18, 617-633. doi:10.1016/0145-2134(94)90012-4
Rowan, A. B., & Foy, D. W. (1993). Post-traumatic stress disorder in
child sexual abuse survivors: A literature review. Journal of Trau-
matic Stress, 6, 3-20. doi:10.1002/jts.2490060103
Schaaf, K. K., & McCanne, T. R. (1998). Relationship of childhood
sexual, physical, and combined sexual and physical abuse to adult
victimization and posttraumatic stress disorder. Child Abuse & Ne-
glect, 22, 1119-1133. doi:10.1016/S0145-2134(98)00090-8
Sullivan, T. P., Fehon, D. C., Andres-Hyman, R. C., Lipschitz, D. S., &
Grilo, C. M. (2006). Differential relationships of childhood abuse
and neglect subtypes to PTSD symptom clusters among adolescent
inpatients. Journal of Traumatic Stress, 19, 229-239.
Wechsler, D. (1998). Manual for the wechsler intelligence scale for
children (3rd ed.). Translated by Publication Committee on WISC-III
Japanese version. New York: The Psychological Corporation.
Widom, C. S. (1999). Posttraumatic stress disorder in abused and ne-
glected children grown up. American Journal of Psychiatry, 156,