Assessment of Cognitively Impaired Individuals

[MrDave100]

What are some good IQ assessments for individuals with IQs below 55-60?

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[Fan_of_Meehl]

What are some good IQ assessments for individuals with IQs below 55-60?

VA job application.

 

[PhDToBe]

I think the Stanford Binet has a floor of 40.

 

[WisNeuro]

VA job application.

HR?

 

[WisNeuro]

The confidence intervals get somewhat low down there. At that point it's probably more useful to measure adaptive functioning than get a real accurate estimate of IQ below a certain point.

 

[singasongofjoy]

The SB has extended norms in addition to the standard ones, and these go below 40. However, the confidence intervals are wider and I also agree that it's more useful to get good measures of adaptive functioning. (of course, some systems require you to admin an IQ test to qualify for services etc but it's not the most useful info at that point when looking at treatment planning). I like to also get a measure of receptive and expressive language and in some cases I'll try a nonverbal test, especially in some of my more impaired folks with autism. The Leiter is a pain to administer though. If you're looking for change over time, I know of one developmental center that uses developmental measures (e.g., Mullen) every few years and uses the age equivalencies across different domains to assess for changes over time which is useful as many of the residents are getting up into their AARP years. Obviously that's not going to give you an IQ but might be useful if you're putting together evals for the required reassessment every so often.

 

[AcronymAllergy]

SB is the one I saw used most commonly in my developmental center days. WAIS in the case of mild ID.

 

[WisNeuro]

I don't deal with this much at all, but for those that do, is there any real benefit for discriminating <60 IQ scores? Like, are there different benefit levels based on the severity of ID? I'd still think that a finer grained understanding of their adaptive functioning is what will drive more of the recommendations for care and assistance.

 

[AcronymAllergy]

I don't deal with this much at all, but for those that do, is there any real benefit for discriminating <60 IQ scores? Like, are there different benefit levels based on the severity of ID? I'd still think that a finer grained understanding of their adaptive functioning is what will drive more of the recommendations for care and assistance.

It's been a good while since I've worked in severe/profound ID. There can be (or at least were) differing levels of available support, depending on the state, although I don't remember the demarcation points (might've been severe/profound vs. mod vs. mild).

Once we got into the severe/profound range, though, IQ became much less meaningful in a clinical sense, other than to let you know that, on average, the profound folks would likely have more "other stuff" going on than the severe folks. Like you said, it was then primarily about assessing and monitoring adaptive and psychological functioning. Usually via lots of observation and self-report. Cognitive assessments were also useful, but weren't related to measuring IQ.

 

[psych.meout]

I don't deal with this much at all, but for those that do, is there any real benefit for discriminating <60 IQ scores? Like, are there different benefit levels based on the severity of ID? I'd still think that a finer grained understanding of their adaptive functioning is what will drive more of the recommendations for care and assistance.

That's what I was thinking. What is the incremental validity of adding a measure to get beyond the floor affects of another measure? For research purposes, there would likely be some value, but in terms of clinical validity and utility, wouldn't it be better to spend time getting at their functioning in various spheres/roles? If someone can't hold down a job or function independently and require various kind of support and disability services/payments, does it really matter if their FSIQ is 45 vs. 55?

 

[WisNeuro]

Yeah, only reason I could see is as AA hinted at, some agency needs an arbitrary number to check off a box because the people usually making healthcare types of decisions at a high level usually have no experience in healthcare and just like nice looking spreadsheets.

 

[psych.meout]

Yeah, only reason I could see is as AA hinted at, some agency needs an arbitrary number to check off a box because the people usually making healthcare types of decisions at a high level usually have no experience in healthcare and just like nice looking spreadsheets.

Which reminds me of the second post in this thread. I would not be surprised if those spreadsheet checkboxes exist, because of previous abuse of disability system, like in the VA. E.g. What kind of assessment go into the VA's program of paying for family member to stay at home and be caregivers for veterans with various forms of psychopathology or CI and how are they assessing disability and functioning, if at all. Are these based on clinical science research and practice or just bias in the opposite extreme of the spectrum from getting too far into the weeds of the minutia of IQ scores in ID populations?

 

[Justanothergrad]

The norm groups for the WAIS are terrible for lower range measurement of ID in my opinion. I did a paper looking at the factor structure and had to combine the moderate/severe groups because there was not a sufficient number in each to compare on their own. IIRC, there were only about 70 after being combined. This is frequently the problem of measuring beyond a 2nd SD. FWIW, it looked like the factor structure generally held between the mild and moderate/severe groups- if construct validity is the type of validity evidence you find most appropriate.

Like WisNeuro said, it makes more sense to me for incorporating functional measures if you are looking to accurately describe clinical capacity. If you need a rubber stamp check box, any stamp will do.

 

[WisNeuro]

Which reminds me of the second post in this thread. I would not be surprised if those spreadsheet checkboxes exist, because of previous abuse of disability system, like in the VA. E.g. What kind of assessment go into the VA's program of paying for family member to stay at home and be caregivers for veterans with various forms of psychopathology or CI and how are they assessing disability and functioning, if at all. Are these based on clinical science research and practice or just bias in the opposite extreme of the spectrum from getting too far into the weeds of the minutia of IQ scores in ID populations?

If you're talking about the caregiver support program in the VA, there really were no evals initially to get into this program. In many areas, it was just a rubber stamp assembly line. At my former VA placement, they finally started reviewing CS cases and sent us quite a few for neuro evals to determine if they actually met some kind of meaningful criteria. My validity failure rate for these cases? 100% That is not an exaggeration for effect.

 

[psych.meout]

If you're talking about the caregiver support program in the VA, there really were no evals initially to get into this program. In many areas, it was just a rubber stamp assembly line. At my former VA placement, they finally started reviewing CS cases and sent us quite a few for neuro evals to determine if they actually met some kind of meaningful criteria. My validity failure rate for these cases? 100% That is not an exaggeration for effect.

Yeah, this is what I was talking about, both in terms of the program and how it is a scientifically and clinically invalid program that abuses the disability system.

 

[Fan_of_Meehl]

I don't deal with this much at all, but for those that do, is there any real benefit for discriminating <60 IQ scores? Like, are there different benefit levels based on the severity of ID? I'd still think that a finer grained understanding of their adaptive functioning is what will drive more of the recommendations for care and assistance.

Yeah...last time I was in the developmental disability part of the field, I think they were trying to move away from an emphasis on intellectual functioning bands altogether and replace it with a level of adaptive functioning scheme. Once you get down to the lower strata of IQ, the construct of intelligence, I would argue, merges almost completely with adaptive functioning and/or basic skills.

 

[Fan_of_Meehl]

Which reminds me of the second post in this thread. I would not be surprised if those spreadsheet checkboxes exist, because of previous abuse of disability system, like in the VA. E.g. What kind of assessment go into the VA's program of paying for family member to stay at home and be caregivers for veterans with various forms of psychopathology or CI and how are they assessing disability and functioning, if at all. Are these based on clinical science research and practice or just bias in the opposite extreme of the spectrum from getting too far into the weeds of the minutia of IQ scores in ID populations?

It's a horrible and indefensible idea (from a 'clinical science' or, hell, even a common sense perspective). I've seen plenty of guidelines/publications for how to treat run-of-the-mill mental disorders commonly presenting in the veteran population (PTSD, depression, SUDS, (generally undiagnosed) personality disorders) and I am not aware of a single half-way reputable source (or any disreputable source, for that matter) in the literature that recommends paying someone's spouse money so that they can stay home and be a full-time 'caregiver' as a component of treatment for any of these conditions. Anyone with any clinical training or experience would tell you that it would probably be expected, if anything, to lead to deterioration in their condition over time and would be contraindicated.

Either (a) the VA gods/administrators did not even bother to check with decent psychologists on staff in central office before instantiating the program; (b) they checked with them, were told it was contraindicated, but decided to do it anyway (because the VA is actually a PR organization, not a healthcare organization), or (c) the psychologists they consulted yielded to the temptation to kiss the asses of the bosses and tell them what they wanted to hear (which is generally how anyone moves 'up' (I would call it 'down') in the VA organizational hierarchy).

 

[temppsych123]

I've used the Vineland as a measure of adaptive functioning, involves a parent/caregiver interview (can also do a client interview if they're able to do it, teacher interview if relevant), and it's normed from birth to age 90, so captures a lot of variability in functioning regardless of cognitive ability. Just my 2c.

 

[LETSGONYR]

Depending on the patient's age, I like the DAS-II. Less language-heavy than the SB, goes down to age two so it's good for low functioning individuals. Though, as others have said, there's only so much testing you can do at the extreme low end of the spectrum.

 

[helga]

Depends on the pattern of strengths/weaknesses, age of the individual and reason for evaluation (dx/progress monitoring/describing characteristics of a research sample...)

If use of/understanding of language is below 2.5yr level, I'd go to a nonverbal (Leiter); if language is more developed DAS/SB. All of these measures should be used with a caregiver-rated adaptive behavior measure (e.g. Vineland/ABAS).