Working memory problems

[smalltownpsych]

Just tested a first grade kid with a clinically significant discrepancy between VCI in the High Average range VSI and FRI in the Average range, and WMI in the Extremely Low Range and PSI in the Low Average Range. Doesn't really appear to meet any of the criteria for ADHD but clearly struggles with holding information in his head and it is affecting academics. Also, reading and spelling are in the 9th %ile.

Intact family, no real psychosocial factors, father by his own report struggled academically, but couldn't give me much more than that. Most significant medical issue was osteomyelitis that was treated with IV antibiotics when pt. was almost 3 years of age.

Any thoughts or ideas about what is going on and some strategies to improve this or compensate or mitigate the effects of this discrepancy would be welcome.

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[WisNeuro]

Any other WM/Attention tests given outside of the WISC?

 

[smalltownpsych]

Any other WM/Attention tests given outside of the WISC?

No.

 

[psych844]

no real psychosocial factors

Not a professional opinion but...I had tons of issues at home but nobody really knew and I would never actually tell Physicians..ended up doing all kinds of heart tests/lung tests..which prob didn't need to be done if I was just honest. Everyone thought we were the most nicest/kindest/normal family. I think particular cultures are especially prone to hiding that stuff. (ie bring shame to family). Not sure how that would play into issues with working me..if at all..but ya.

 

[WisNeuro]

No.

What was the RDS?

 

[smalltownpsych]

Not a professional opinion but...I had tons of issues at home but nobody really knew and I would never actually tell Physicians..ended up doing all kinds of heart tests/lung tests..which prob didn't need to be done if I was just honest. Everyone thought we were the most nicest/kindest/normal family. I think particular cultures are especially prone to hiding that stuff. (ie bring shame to family). Not sure how that would play into issues with working me..if at all..but ya.

Absolutely correct, I guess I should have clarified with no known or obvious psychosocial factors.

What was the RDS?

RDS?

 

[erg923]

Absolutely correct, I guess I should have clarified with no known or obvious psychosocial factors.

RDS?

reliable digit span

 

[WisNeuro]

Reliable Digit Span.

 

[LETSGONYR]

What was the RDS?

Not the most reliable indicator of performance validity in a first grader, unfortunately.

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[WisNeuro]

Not the most reliable indicator of performance validity in a first grader, unfortunately.

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Definitely not. Not the most reliable indicator in many populations, but I'm assuming that this particular assessment doesn't have much to choose from in this area.

 

[DrMikeP]

Any anxiety issues? I'm assuming hearing and vision tested ok???

Some people just have poor WM. It can be improved through various memory games like matching and such. Compensation by learning to take notes or create cues can help.

 

[WisNeuro]

WMI in the Extremely Low range puts the kid in the <2.2%ile assuming he's using standard Wechlser terms. So, we're looking at an already low base rate in a neurologically healthy population. Pair that with discrepancies against primary indices in the high average and average ranges, and the base rate is that much smaller. Validity concerns are on my list. After that, there's always the zebras. Also, remember that neuropsych testing does not predict or characterize ADHD. At all.

 

[smalltownpsych]

The working memory was probably not as poor as the score would indicate. Pt. clearly had some difficulty with understanding digits backward and putting digits in order that depressed the result, but kid also struggled with visual span even though that one was well understood and engaging. So much variability in kids at the low end of the standardization sample, it makes it difficult to interpret. Nevertheless, this is a kid that has a unique profile and am trying to find some direction to help before starting next grade. Has been having increased anxiety around school performance issues and has already internalized that they are stupid. Don't think anxiety affected performance on measures except for the WMI much as rapport was solid and kid enjoyed most stuff. Was painful observing him try to sound out words. Would love to refer to neuropsych, but that is four hours away and not sure of financial or insurance situation. What was striking was hearing the kid define more difficult words clearly and articulately when cat and run were the extent of his reading ability.

 

[IT514]

Been a while since my peds neuro days, but that profile seems fairly c/w what you could see in a reading disorder. In regard to base rates here, in a kiddo, I wouldn't be thinking in terms of "neurologically healthy," vs not but would be thinking about whether the kid is in the "typically achieving" group. Based on the above reading and spelling scores, he might not be typically achieving in that area. Working memory problems can be observed in that group, though the question is always whether working memory problems are independent of phonological processing (though I have no idea how to separate them in this age group). So, I would explore that a bit more, might lead you down the road to a Wilson reading or Orton-Gillingham type of intervention. And PLEASE don't use RDS as a validity indicator in a first grader.

 

[smalltownpsych]

Been a while since my peds neuro days, but that profile seems fairly c/w what you could see in a reading disorder. In regard to base rates here, in a kiddo, I wouldn't be thinking in terms of "neurologically healthy," vs not but would be thinking about whether the kid is in the "typically achieving" group. Based on the above reading and spelling scores, he might not be typically achieving in that area. Working memory problems can be observed in that group, though the question is always whether working memory problems are independent of phonological processing (though I have no idea how to separate them in this age group). So, I would explore that a bit more, might lead you down the road to a Wilson reading or Orton-Gillingham type of intervention. And PLEASE don't use RDS as a validity indicator in a first grader.

Thanks so much for this info. This is right along the lines of what I was thinking about this morning. This case is unusual for me in the fact that the parents are seeking intervention at such an early stage of development. I usually don't see these kids till much later down the road when the problems have magnified so am feeling extra motivated to try to prevent some of that. I am thinking that focusing on extra help and strategies for reading is the key. Heck, I wanted to start teaching the kid myself while he was trying so hard to decode the words. I am also thinking that the working memory is implicated because when faced with an unfamiliar word he would make the correct sounds, but then couldn't decode the word because he would lose track of the first sound. Meanwhile, with more familiar words, no errors at all. Regardless, learning to read is key and this kid has the vocabulary and just needs to be able to match the verbal to the written with a minimum of internalized self-defeating messages.

 

[WisNeuro]

And PLEASE don't use RDS as a validity indicator in a first grader.

As above, it's not a great indicator in isolation for any age group. But, if it's 6, I'm suspicious. If it's under 5, I have serious reservations about the data. Ideally, you have a few PVT's spread out through the test, and more psychometrically sound. But, you have to use what you got in circumstances where adequate testing is not done. There is data on this, and other PVT's in such a young population. While the adult cutoffs are definitley no bueno, there is still utility in the figure at certain levels.

 

[smalltownpsych]

As above, it's not a great indicator in isolation for any age group. But, if it's 6, I'm suspicious. If it's under 5, I have serious reservations about the data. Ideally, you have a few PVT's spread out through the test, and more psychometrically sound. But, you have to use what you got in circumstances where adequate testing is not done. There is data on this, and other PVT's in such a young population. While the adult cutoffs are definitley no bueno, there is still utility in the figure at certain levels.

I would like to know more about the importance or benefit to adding PVTs to a battery. During my training, including some with board certified neuropsychologists, this was not really discussed other than in the context of ruling out malingering. In my last job, I reviewed testing conducted on hundreds of kids and none that I can recall had specific PVT measures. Of course, most of my own training was about 10 years ago now so I might be lagging a bit especially when practicing in a more remote location without constant influx of new info such as you would find in larger training facilities.

 

[IT514]

If wildly low, then sure, some reservation about the data is fine. But we're talking about a measure that taps a common problem in reading disorder folks. In a kid this young with this rule-out, I would stay as far away as possible from thinking of RDS as a PVT even if its all I had. Need to know base rates of low scores at various levels in this particular group with all of the subtests that are used particularly if there is imbedded PVT, and also performance levels of specific subgroups on the PVT. When it comes to PVT use in particular I don't subscribe to the idea of using what you got, if it could be inappropriate given the context of the eval. Yes, I use PVTs in every eval but context comes first. Way too many neuropsychs out there jumping to validity conclusions because of inappropriate PVT use, IMO. The opposite is also true (absence of considering validity or assuming all performance as valid) and has been so for many years leading to all sorts of iatrogenic cognitive "disorders," among other problems. But lets be cautious here. I'm part of the slow money and slow food movements, so sign me up also for the slow PVT movement.

 

[smalltownpsych]

What was the RDS?

5
That was from digits forward only as they got zero digits correct on backward and sequencing.

 

[WisNeuro]

ALWAYS include PVT's. Low effort/engagement does not mean malingering. It is not a categorical thing. If you look at the literature, a not insignificant number of child studies will show low effort in evals. And children even admitting that they were not really putting forth good effort when asked. All of the neuropsych associations have consensus position statements regarding the use of PVT's. If you're not using any validity checks, you are doing a disservice to your patients and your practice.

 

[LETSGONYR]

I would like to know more about the importance or benefit to adding PVTs to a battery. During my training, including some with board certified neuropsychologists, this was not really discussed other than in the context of ruling out malingering. In my last job, I reviewed testing conducted on hundreds of kids and none that I can recall had specific PVT measures. Of course, most of my own training was about 10 years ago now so I might be lagging a bit especially when practicing in a more remote location without constant influx of new info such as you would find in larger training facilities.

I recommend Mike Kirkwood's recent book: Validity Testing in Child and Adolescent Assessment: Evaluating Exaggeration, Feigning, and Noncredible Effort (Evidence-Based Practice in Neuropsychology).

Amazon product

 

[WisNeuro]

5
That was from digits forward only as they got zero digits correct on backward and sequencing.

Any testing of limits? Bc that is abysmal, and I usually only see that in adults when someone is well along in the dementia process, or engaged in C&P.

 

[smalltownpsych]

Any testing of limits? Bc that is abysmal, and I usually only see that in adults when someone is well along in the dementia process, or engaged in C&P.

Yes. I made a few extra stabs at trying to help the kid do the task, and they were able to hold the digits in their head, but kept doing the backward and order thing incorrectly. I usually see better performance in dementia patients, but they understand the task, they just can't do it very well.

 

[IT514]

Any testing of limits? Bc that is abysmal, and I usually only see that in adults when someone is well along in the dementia process, or engaged in C&P.

Ever evaluate kids with reading disorders? The WM problems can be quite striking, and this is well documented in the literature. I'm not saying this performance is valid, I'm just saying again that we need to be cautious about raising validity concerns that cloud the overall picture based on one measure that may not be appropriate. This isn't an adult, the kid is in first grade. The data seem to converge to a RD rule out for me.

 

[WisNeuro]

Ever evaluate kids with reading disorders? The WM problems can be quite striking, and this is well documented in the literature. I'm not saying this performance is valid, I'm just saying again that we need to be cautious about raising validity concerns that cloud the overall picture based on one measure that may not be appropriate. This isn't an adult, the kid is in first grade. The data seem to converge to a RD rule out for me.

Back in the day I did quite a few, and I agree, LD is on my differential for sure. At this point, it's just a R/O though without a comprehensive eval. That's the problem with neuropsych lite, it can maybe identify some potential problems, it just can't adequately characterize or differentiate them from other possible explanations.

 

[Par4thecourse]

Any anxiety issues? I'm assuming hearing and vision tested ok???

Some people just have poor WM. It can be improved through various memory games like matching and such. Compensation by learning to take notes or create cues can help.

Would you share the names/publishers's information regarding memory games that establish a proven benefit for working memory, please? Was unaware of any that yielded long term gain. Thanks

 

[DrMikeP]

Would you share the names/publishers's information regarding memory games that establish a proven benefit for working memory, please? Was unaware of any that yielded long term gain. Thanks

Don't have the research or my psychology. books handy these days. There was a study with children that found wm to benefit from matching type and other. games with cards that comes to mind. Don't remember the details, but if I remember correctly it associated improvements in wm as part of the improvement with the practice effect. There was an article in one of the APA journals that reviewed the lit on wm, but don't remember which. I know that some of the new online brain training memory stuff has been discredited, but haven't kept up with the latest.

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[WisNeuro]

Memory games and the like of Lumosity, do not work. They only improve very narrow, task specific performance. As far as all of the research I am familiar with, it does not generalize to real world, functional settings at all. One of the big reasons Lumosity just lost a multi-million dollar lawsuit for deceptive advertising.

 

[Par4thecourse]

Don't have the research or my psychology. books handy these days. There was a study with children that found wm to benefit from matching type and other. games with cards that comes to mind. Don't remember the details, but if I remember correctly it associated improvements in wm as part of the improvement with the practice effect. There was an article in one of the APA journals that reviewed the lit on wm, but don't remember which. I know that some of the new online brain training memory stuff has been discredited, but haven't kept up with the latest.

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Thanks. I haven't found anything that seems to work long haul.

 

[Par4thecourse]

Memory games and the like of Lumosity, do not work. They only improve very narrow, task specific performance. As far as all of the research I am familiar with, it does not generalize to real world, functional settings at all. One of the big reasons Lumosity just lost a multi-million dollar lawsuit for deceptive advertising.

That's what I thought. If a product did come along that showed real promise in this area, I'd do nothing else in life but use it. My wm is rather lazy, worn out or never was. I couldn't win at Concentration for all the hot dogs in Canada

 

[WisNeuro]

That's what I thought. If a product did come along that showed real promise in this area, I'd do nothing else in life but use it. My wm is rather lazy, worn out or never was. I couldn't win at Concentration for all the hot dogs in Canada

It's Canada man, why go hotdogs? Give me some of that sweet, gravy-laden poutine.

 

[AcronymAllergy]

One of my former supervisors mentioned that he'd read a then-recent article by one of the bigger neurorehab names (Cicerone maybe?) that suggested the author was very, very tentatively and possibly coming around a bit on long-term effects from "brain training" type programs. Although I don't remember which article it was, nor what the specifics of the training program and outcomes entailed.

That being said, my take on the reading of the majority of the literature up to this point is consistent with WisNeuro's summary.

 

[Par4thecourse]

Stimulants/other drugs for ADHD that help an individual to focus may not improve wm directly, but the enhanced ability to attend to information improves our overall cognitive functioning. Every little bit helps. And who knows, perhaps someday new treatments will be discovered so that each brain part/system will be targeted and will work better? Perhaps in 25 years they will look back and be amazed how we managed to get by with the little we knew at this point.

 

[Par4thecourse]

And appreciate stuff like this:

1. "The effect of stimulant medication on recognition memory was examined in 18 children with attention-deficit/hyperactivity disorder (ADHD). Recognition memory was assessed using a delayed matching-to-sample task at 6 delays ranging from 1 to 32 s. Each child was tested on 2 separate occasions, once 60 to 90 min after taking stimulant medication and the other at least 18 hr after taking medication. Children performed significantly better on medication than off. Stimulant administration significantly increased accuracy and the number of nickel reinforcers earned. Decreases in observing response latency and correct choice response latency occurred after taking stimulant medication. The results indicate that stimulant medication improved recognition memory for children with ADHD." (PsycINFO Database Record (c) 2012 APA, all rights reserved)

 

[DrMikeP]

Thanks. I haven't found anything that seems to work long haul.

Here's an article I had bookmarked on my computer. It's a bit older and not the one I was thinking of, but the one mentioned in it may be: Journal of the American Academy of Child & Adolescent Psychiatry (Vol. 44, No. 2, pages 177-186.) I don't have journal access at this point to see.

I do agree that Luminosity and other such online scams are of limited value in WM, but people do enjoy them.

http://www.apa.org/monitor/sep05/workout.aspx

 

[Par4thecourse]

It's Canada man, why go hotdogs? Give me some of that sweet, gravy-laden poutine.

Doesn't matter to me as long as there are vast quantities of whatever it is.

 

[psych844]

It's Canada man, why go hotdogs? Give me some of that sweet, gravy-laden poutine.

Have you had good poutine?

I live just 5 minutes from a really good poutine place!

 

[WisNeuro]

Have you had good poutine?

I live just 5 minutes from a really good poutine place!

I grew up on the Canadian border. Also, there are some pretty good poutine places in Montreal that I've been to several times.

 

[psych844]

I grew up on the Canadian border. Also, there are some pretty good poutine places in Montreal that I've been to several times.

Good stuff. Montreal is a fantastic town!

 

[OneNeuroDoctor]

From my experience with the WISC V, when the WMI or the PSI or both are significantly lower than the FSIQ it is recommended to use the GAI rather than the FSIQ. I have administered the WISC V on some six-years-old children recently and I had some similar results. WMI and PSI typically have been lower than the other scales. In these cases I use the GAI rather than the FSIQ. Seems that the younger children have problems understanding symbol search so I substitute it with cancellations. I believe the WISC V more heavily emphasizes visual working memory rather than auditory working memory. WMI and PSI are less sound measures than the other scales, especially at the younger age ranges. For this age range which is usually seven or below it seems that the WPPSI IV picture memory and zoo locations are much easier tasks as numbers and letters are not involved. I would give the CVLT-C and CMS to rule out memory deficits rather than relying on the WMI of the WISC V. These are on QInteractive and relatively easy to administer test that only takes an additional 25-30 minutes.

Are you using QInteractive or the paper version of the WISC V? Seems that the younger children are having some difficulty with the digital version of coding and symbol search so I am still using the paper version for these subtest. Just my two cents, given that VCI, VSI, and FSI are all average or above for a first grader it does not overly concern me that WMI and PSI are significantly lower. I would be more concerned if they were a nine or ten-year-old. Reading and spelling at the 9th %ile for a first grader seems to be very low considering their IQ scores and could have been due to other factors such as fatigue or lack of effort. It seems that at this age-level from my experience it is common for a first grader to either rush through these tasks or they are tired and fatigued and don't really try. You did not mention concerns with math, so I gather they did okay in this area. From my experience, math is more commonly an area of concern for a first grader.

The WPPSI IV is coming out on QInteractive in late May early June. It goes up to age 7 or 7.7 from my recollection, so I plan on using it in the future for these six or seven-year-old children as it seems that this age range has some difficulty with understanding some of the subtest on the WISC V.

 

[smalltownpsych]

From my experience with the WISC V, when the WMI or the PSI or both are significantly lower than the FSIQ it is recommended to use the GAI rather than the FSIQ. I have administered the WISC V on some six-years-old children recently and I had some similar results. WMI and PSI typically have been lower than the other scales. In these cases I use the GAI rather than the FSIQ. Seems that the younger children have problems understanding symbol search so I substitute it with cancellations. I believe the WISC V more heavily emphasizes visual working memory rather than auditory working memory. WMI and PSI are less sound measures than the other scales, especially at the younger age ranges. For this age range which is usually seven or below it seems that the WPPSI IV picture memory and zoo locations are much easier tasks as numbers and letters are not involved. I would give the CVLT-C and CMS to rule out memory deficits rather than relying on the WMI of the WISC V. These are on QInteractive and relatively easy to administer test that only takes an additional 25-30 minutes.

Are you using QInteractive or the paper version of the WISC V? Seems that the younger children are having some difficulty with the digital version of coding and symbol search so I am still using the paper version for these subtest. Just my two cents, given that VCI, VSI, and FSI are all average or above for a first grader it does not overly concern me that WMI and PSI are significantly lower. I would be more concerned if they were a nine or ten-year-old. Reading and spelling at the 9th %ile for a first grader seems to be very low considering their IQ scores and could have been due to other factors such as fatigue or lack of effort. It seems that at this age-level from my experience it is common for a first grader to either rush through these tasks or they are tired and fatigued and don't really try. You did not mention concerns with math, so I gather they did okay in this area. From my experience, math is more commonly an area of concern for a first grader.

The WPPSI IV is coming out on QInteractive in late May early June. It goes up to age 7 or 7.7 from my recollection, so I plan on using it in the future for these six or seven-year-old children as it seems that this age range has some difficulty with understanding some of the subtest on the WISC V.

Good info. I'll probably use the GAI as I agree that will likely provide a better representation of functioning. I am using paper to administer. I'm old fashioned that way and also I like to be able to observe some of the graphomotor stuff too. The reading and spelling results were consistent with academic performance and was the reason for referral so am not surprised at that result. All in all, it's safe to say that the kid is behind in some of these skills and my recommendations will likely include additional structured support and interventions for the potential reading disability.

 

[AcronymAllergy]

From my experience with the WISC V, when the WMI or the PSI or both are significantly lower than the FSIQ it is recommended to use the GAI rather than the FSIQ. I have administered the WISC V on some six-years-old children recently and I had some similar results. WMI and PSI typically have been lower than the other scales. In these cases I use the GAI rather than the FSIQ. Seems that the younger children have problems understanding symbol search so I substitute it with cancellations. I believe the WISC V more heavily emphasizes visual working memory rather than auditory working memory. WMI and PSI are less sound measures than the other scales, especially at the younger age ranges. For this age range which is usually seven or below it seems that the WPPSI IV picture memory and zoo locations are much easier tasks as numbers and letters are not involved. I would give the CVLT-C and CMS to rule out memory deficits rather than relying on the WMI of the WISC V. These are on QInteractive and relatively easy to administer test that only takes an additional 25-30 minutes.

Are you using QInteractive or the paper version of the WISC V? Seems that the younger children are having some difficulty with the digital version of coding and symbol search so I am still using the paper version for these subtest. Just my two cents, given that VCI, VSI, and FSI are all average or above for a first grader it does not overly concern me that WMI and PSI are significantly lower. I would be more concerned if they were a nine or ten-year-old. Reading and spelling at the 9th %ile for a first grader seems to be very low considering their IQ scores and could have been due to other factors such as fatigue or lack of effort. It seems that at this age-level from my experience it is common for a first grader to either rush through these tasks or they are tired and fatigued and don't really try. You did not mention concerns with math, so I gather they did okay in this area. From my experience, math is more commonly an area of concern for a first grader.

The WPPSI IV is coming out on QInteractive in late May early June. It goes up to age 7 or 7.7 from my recollection, so I plan on using it in the future for these six or seven-year-old children as it seems that this age range has some difficulty with understanding some of the subtest on the WISC V.

RE: the above bolded point, I'm still not sold that the electronic version is fully equivalent with the paper version, both in younger children (apparently) and older adults. I know that point has been raised on neuropsych listserves in the past as well. I think there's a lot to be gained from developing electronic versions of many of our tests (e.g., different ways of assessing and parsing reaction time/response latency characteristics, more accurate timing of measures, etc.), but it's of course faulty to assume that just because the subtest has the same rules and items, it's equivalent across administration mediums.

Also, PSI (and, to a lesser extent, WMI) does tend to "regress to the mean" a slight bit more than VCI/PRI, so that folks who are high average in the latter may often be closer to "only" average in the former without that actually reflecting a deficit per se. And I don't know if I'd say WMI/PSI are less sound than VCI/PRI, but they do have higher SEE. But I'm not as familiar with the kiddo versions and can see how they might be more problematic.

 

[OneNeuroDoctor]

I am using the digital version for all of the Wechsler Scales and my impression is that the administration and scoring process is much easier. I know there seems to be reluctance to use the digital version by other psychologist because of the expense. I typically do 20 or more intellectual assessments per month. I have not heard any information related to decreased reliability and validity of using the digital version. Seems that some psychologist have indicated HIPPA reasons for not using digital versions, but Pearson contends privacy and confidentiality of digital version meets HIPPA rules.

 

[LETSGONYR]

From my experience with the WISC V, when the WMI or the PSI or both are significantly lower than the FSIQ it is recommended to use the GAI rather than the FSIQ. I have administered the WISC V on some six-years-old children recently and I had some similar results. WMI and PSI typically have been lower than the other scales. In these cases I use the GAI rather than the FSIQ. Seems that the younger children have problems understanding symbol search so I substitute it with cancellations. I believe the WISC V more heavily emphasizes visual working memory rather than auditory working memory. WMI and PSI are less sound measures than the other scales, especially at the younger age ranges. For this age range which is usually seven or below it seems that the WPPSI IV picture memory and zoo locations are much easier tasks as numbers and letters are not involved. I would give the CVLT-C and CMS to rule out memory deficits rather than relying on the WMI of the WISC V. These are on QInteractive and relatively easy to administer test that only takes an additional 25-30 minutes.

Are you using QInteractive or the paper version of the WISC V? Seems that the younger children are having some difficulty with the digital version of coding and symbol search so I am still using the paper version for these subtest. Just my two cents, given that VCI, VSI, and FSI are all average or above for a first grader it does not overly concern me that WMI and PSI are significantly lower. I would be more concerned if they were a nine or ten-year-old. Reading and spelling at the 9th %ile for a first grader seems to be very low considering their IQ scores and could have been due to other factors such as fatigue or lack of effort. It seems that at this age-level from my experience it is common for a first grader to either rush through these tasks or they are tired and fatigued and don't really try. You did not mention concerns with math, so I gather they did okay in this area. From my experience, math is more commonly an area of concern for a first grader.

The WPPSI IV is coming out on QInteractive in late May early June. It goes up to age 7 or 7.7 from my recollection, so I plan on using it in the future for these six or seven-year-old children as it seems that this age range has some difficulty with understanding some of the subtest on the WISC V.

I think whenever we are interpreting test results, we have to use our clinical training... that includes things like knowing about when we should use the GAI vs. FSIQ, and is not limited to the WISC-V.

Some of your other comments don't really make sense to me. "WMI and PSI have fewer auditory measures than the previous version of the test, especially at the young ages." (paraphrased). Well, yes, since the WISC-V uses Digit Span and Picture Memory to calculate the WMI, rather than Digit Span/LNS. But Digit Span is expanded (now involves sequencing too, like the WAIS), and LNS was always so difficult for so many kids to understand. Plus then you say that you prefer the WPPSI... while some of their tasks are much more kid-friendly (I do like Bug Search), they are entirely visual, so if anything, it exacerbates the problem you were just complaining about. Also... Picture Memory and Symbol Search aren't included in the calculation of the FSIQ, so even if a kid didn't understand those and totally bombed them, it wouldn't affect their FSIQ.

One thing I wanted to mention is that the WISC-V has different (and too strict, IMO) rules about how many subtests can be substituted into the calculation of the index scores. Double check the manual, but from the top of my head, I believe you are only allowed to substitute one subtest into the FSIQ and none into any of the other index scores.

I agree that the CVLT-C would help rule out memory problems. I also use the WRAML in kids that young.... I don't like it, although I dislike it less than the CMS. I haven't used the ChAMP yet but I've heard good things.

 

[AcronymAllergy]

I am using the digital version for all of the Wechsler Scales and my impression is that the administration and scoring process is much easier. I know there seems to be reluctance to use the digital version by other psychologist because of the expense. I typically do 20 or more intellectual assessments per month. I have not heard any information related to decreased reliability and validity of using the digital version. Seems that some psychologist have indicated HIPPA reasons for not using digital versions, but Pearson contends privacy and confidentiality of digital version meets HIPPA rules.

I'm still not comfortable having to send patient data to "the cloud" in order to have it scored.

 

[Par4thecourse]

From my experience with the WISC V, when the WMI or the PSI or both are significantly lower than the FSIQ it is recommended to use the GAI rather than the FSIQ. I have administered the WISC V on some six-years-old children recently and I had some similar results. WMI and PSI typically have been lower than the other scales. In these cases I use the GAI rather than the FSIQ. Seems that the younger children have problems understanding symbol search so I substitute it with cancellations. I believe the WISC V more heavily emphasizes visual working memory rather than auditory working memory. WMI and PSI are less sound measures than the other scales, especially at the younger age ranges. For this age range which is usually seven or below it seems that the WPPSI IV picture memory and zoo locations are much easier tasks as numbers and letters are not involved. I would give the CVLT-C and CMS to rule out memory deficits rather than relying on the WMI of the WISC V. These are on QInteractive and relatively easy to administer test that only takes an additional 25-30 minutes.

Are you using QInteractive or the paper version of the WISC V? Seems that the younger children are having some difficulty with the digital version of coding and symbol search so I am still using the paper version for these subtest. Just my two cents, given that VCI, VSI, and FSI are all average or above for a first grader it does not overly concern me that WMI and PSI are significantly lower. I would be more concerned if they were a nine or ten-year-old. Reading and spelling at the 9th %ile for a first grader seems to be very low considering their IQ scores and could have been due to other factors such as fatigue or lack of effort. It seems that at this age-level from my experience it is common for a first grader to either rush through these tasks or they are tired and fatigued and don't really try. You did not mention concerns with math, so I gather they did okay in this area. From my experience, math is more commonly an area of concern for a first grader.

The WPPSI IV is coming out on QInteractive in late May early June. It goes up to age 7 or 7.7 from my recollection, so I plan on using it in the future for these six or seven-year-old children as it seems that this age range has some difficulty with understanding some of the subtest on the WISC V.

Wow. Sprechen Sie Deutsch? Could you try English for a moment, please? Just kidding.

I followed the general idea here, but not the specifics. BTW, are you familiar with the Woodcock-Johnson Tests of Cognitive Abilities? I wonder if some of these testing batteries are so complex that even the administrators get stymied sometimes?

 

[Par4thecourse]

Previous research that has investigated examiner errors on the various Wechsler Scales indicates that regardless of the examiners’ level of training (professional or graduate student), a significant number of errors have been found across test records (Alfonso et al., 1998; Loe, Kadlubek, &Marks, 2007; Sherrets, Gard, & Langner, 1979; Slate & Chick, 1989; Slate, Jones, Coulter, &Covert, 1992). The most frequent types of errors revealed in studies on the Wechsler Scales include failure to record responses, reporting incorrect FSIQ, adding subtest scores incorrectly, incorrect point assignment, use of incorrect basal and ceilings, incorrect calculation of age, and a number of other less frequent errors (Alfonso et al., 1998; Alfonso & Pratt, 1997; Loe et al., 2007; Slate &Jones, 1990). Table 1 provides a summary of several studies that have assessed examiner errors on the various Wechsler Scales. The results of these studies demonstrate that regardless of the examiners’levels of experience (i.e., graduate students in training or practicing professionals), a high number of examiner errors occur during the administration and scoring of these cognitive tests,which often lead to the miscalculation of FSIQ scores.

Graduate student administration and scoring errors on the Woodcock-Johnson III Tests of Cognitive Abilities (PDF Download Available).