Confirmatory factor analysis was used to determine the factor structure of the Wechsler Intelligence Scale for Children–Fourth Edition (WISC-IV) scores of 297 children referred to a children’s hospital in the Southwestern United States. Results support previous findings that indicate the WISC-IV is best represented by a direct hierarchical (bifactor) model including four first-order factors and one general intelligence factor. In this sample, the general intelligence factor accounted for 50% of the total variance and 76% of the common variance. Of the first-order factors, the Verbal Comprehension factor accounted for the most total (5.6%) and common (8.4%) variance. Furthermore, the general intelligence factor accounted for more variance in each subtest than did its respective first-order factor and it was the only factor that exhibited adequate measurement precision (_h = .87). These findings support previous recommendations that WISC-IV interpretations should focus on the general intelligence factor over first-order factors.