Diversity, culture, and ethics talking with patients about IQ results

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borne_before

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Okay, so I've been on a bit of a cultural competency kick lately. Now I want to tackle or have a discussion about one of the most contentious issues in modern psychological debate: dealing with racial/ethnic/cultural differences on IQ tests. Specifically, I want to focus on if we should be having these discussions when going over results with culturally diverse patients.

As we know, IQ tests do not purely measure how smart someone is. Rather, things like impulsivity, knowledge, cultural background, anxiety, etc., can affect how a person scores on an IQ test.

I wonder if there is utility in providing education about testing bias - that when someone’s culture does not necessarily fall in the dominant group in a normed test, IQ tests must be interpreted cautiously - especially as results can underestimate certain skills, as can a myriad of things. Sometimes when working with a hyper or anxious kid, I will communicate something along the lines of "this estimate is likely an underestimate of their true reasoning skills because of the behaviors observed above." Has anyone ever communicated this with diverse patients?

APA recently issued an apology for the role measuring intelligence has historically played in eugenics. And people use IQ assessment to create a hierarchy, and I want to get in front of that. I think they lay public puts too much of an emphasis on IQ, failing to understand that other things affect that score. The family is one google away from finding some horrendous stuff about race and IQ under the guise of science (some twitter accounts seem to be very popular). I want to get in front of that a little. People take fake IQ tests online and boast about their results. IQ is ubiquitious as E-MC^2. I want to just make it clear that a lot of stuff can, like attention, impulsivity, culture, background, language issues can affect an IQ score and the point is to help the family know that it’s not a simple summative number - that there is more to it than intelligence.

There is some debate about IQ and bias. But this is my best understanding: "Intelligence tests contain cultural bias — they contain a bias that is in favor White, middle class groups; for example: (a) the tests measure knowledge and content that are more familiar to White, middle class students than to diverse students; (b) the language on these tests is more familiar to White, middle class students; and (c) the examples used in questions are more familiar to White, middle class students. In this case, it is argued that such tests are measuring what diverse groups have not been exposed to and their differential experiences rather than their intelligence — the construct being assessed."

As a result of these issues regarding intelligence tests, those who believe tests contain cultural bias argue that diverse groups are denied access to high quality, challenging educational opportunities, such as gifted education programs, and they are often misplaced in special education programs and low ability groups.

And we know that expectations matter. From Rosenthal and Jacobsen's groundbreaking work with Pygmalion in the Classroom to Good's work on expectation effects that established that some teachers do form and communicate differential expectations to their students and that some students internalise these expectations in ways that manifest in their actual performance (e.g., they get asked different types of questions, or get grouped differently).

Would it be wrong, if a kid was in a limited education setting (e.g., a behavioral classroom), to say "oh so and so IQ's is Average, and in fact, their reasoning skills are above that, because we know things like attention, cultural background and test bias, can serve to artificially deflate a score. To further highlight their strengths.

It kills me how many culturally Black/AA, Native American, etc., have missed out on gifted ed for missing a cutoff.

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Would it be wrong, if a kid was in a limited education setting (e.g., a behavioral classroom), to say "oh so and so IQ's is Average, and in fact, their reasoning skills are above that, because we know things like attention, cultural background and test bias, can serve to artificially deflate a score. To further highlight their strengths.
Certainly not! In fact, I'd argue that youd be wrong not to do so (and for any clie t, regardless of stated or perceived cultural identity. I'm frequently giving context to low cognitive scores, mainly due to language issues. For example, on the Bayley-4, a toddler with limited language skills is going to max out with a SS of about 75. I tell the parent that though the score is low, I'm not concerned with the child's problem solving skills- if they can see what they're supposed to do, they can do it. When their language gets better, I'd expect that score to go up.

If you're encountering this issue a lot due to cultural differences, you should come up with a good feedback script to acknowledge this issue in your reports and discussions. I work primarily with bilingual families where Spanish is the primary language of at least one member of the household. My reports will often contain some acknowledgement that of the fact that, though the child speaks and understands English and testing was done in English, Spanish is is spoken in the home and thus scores should be interpreted with an appropriate degree of caution.

If this issue is coming up a lot for you, you probably should find a different instrument. If others are using a score from any single test that you do for placement purposes, they are misusing your services and need to be set straight.
 
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I take into account all the factors that could impact the results and very much address those issues directly. I am reluctant to even give an IQ number when there are reasons that it would have less meaning. Testing is tough because people misunderstand it no matter how good the feedback is and I have spent many hours of therapy challenging some of what the patients “hear” that was probably not close to what was said. Sometimes I think I would rather have a patient hear that the results of the test are a bunch of crap when looking at someone like me and that I can pretty much accomplish any task I want to so long as I use effective strategies.
 
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Certainly not! In fact, I'd argue that youd be wrong not to do so (and for any clie t, regardless of stated or perceived cultural identity. I'm frequently giving context to low cognitive scores, mainly due to language issues. For example, on the Bayley-4, a toddler with limited language skills is going to max out with a SS of about 75. I tell the parent that though the score is low, I'm not concerned with the child's problem solving skills- if they can see what they're supposed to do, they can do it. When their language gets better, I'd expect that score to go up.

If you're encountering this issue a lot due to cultural differences, you should come up with a good feedback script to acknowledge this issue in your reports and discussions. I work primarily with bilingual families where Spanish is the primary language of at least one member of the household. My reports will often contain some acknowledgement that of the fact that, though the child speaks and understands English and testing was done in English, Spanish is is spoken in the home and thus scores should be interpreted with an appropriate degree of caution.

If this issue is coming up a lot for you, you probably should find a different instrument. If others are using a score from any single test that you do for placement purposes, they are misusing your services and need to be set straight.
Could you help me develop a script? I know that's a big question to ask, but I'd love to see your main bullet points.
 
I take into account all the factors that could impact the results and very much address those issues directly. I am reluctant to even give an IQ number when there are reasons that it would have less meaning. Testing is tough because people misunderstand it no matter how good the feedback is and I have spent many hours of therapy challenging some of what the patients “hear” that was probably not close to what was said. Sometimes I think I would rather have a patient hear that the results of the test are a bunch of crap when looking at someone like me and that I can pretty much accomplish any task I want to so long as I use effective strategies.
Exactly. As a somewhat related aside- I remember reviewing some IQ test result with a parent of a child whose ABA services I was supervising. FSIQ solidly in the average range (~95), as were all subscales except one- maybe VCI- that was an 85. She could not get past the whole "low-average" designation and the relative difference, demanding that something needed to be directly addressed or taught her son to "get that score up." Ultimately I just had to "Sorry, it really doesn't work that way and I'm not going to do anything related to that."
 
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"I am so honored to be able to work with your family and one of the things, as part of my training that I know, is that when we cultural differences between us, that it makes me not have as much awareness of some of the issues that you may experience differently than me. And so I have some questions that I wanna ask, so that I make sure that I tap into some of those things and so that I hope you'll answer as openly as you feel comfortable. I feel like it's really important that I get at some of those things to make sure that include all of you and your child in this process."
 
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So, funny and somewhat tangenital personal story about this--I have a congenital disability that affects, among other things, fine motor skills. I had an IEP since kindergarten and was mainstreamed the entire time. When I moved to new state at 12, the school district insisted that I have an IQ test, even though there were zero concerns about my academic/cognitive performance. The result was that my subtest scores were very, very lopsided--I scored very highly on subtests not involving fine motor skills (~130s-140s, IIRC) and very low on subtests involving timed fine motor skills (~40-50s, IIRC), with an end result of a FSIQ of around 85-90. My mom, who has zero training or background in anything related to psychology, psychometrics, etc., was like "a) why are you giving someone with known fine motor disability tests that involve fine motor skills? and b) you clearly can't average very different scores together and say the averages mean anything." The psychometrist kept arguing that yes you could and that the same subtests needed to given to and interpreted for everyone, even if they had a clearly mitigating disability. My mom finally asked what they would do about someone with essentially no fine motor function, like Steven Hawking. The psychometrist thought that he was another student and not, you know, a world renowned astrophysicist.
 
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So, funny and somewhat tangenital personal story about this--I have a congenital disability that affects, among other things, fine motor skills. I had an IEP since kindergarten and was mainstreamed the entire time. When I moved to new state at 12, the school district insisted that I have an IQ test, even though there were zero concerns about my academic/cognitive performance. The result was that my subtest scores were very, very lopsided--I scored very highly on subtests not involving fine motor skills (~130s-140s, IIRC) and very low on subtests involving timed fine motor skills (~40-50s, IIRC), with an end result of a FSIQ of around 85-90. My mom, who has zero training or background in anything related to psychology, psychometrics, etc., was like "a) why are you giving someone with known fine motor disability tests that involve fine motor skills? and b) you clearly can't average very different scores together and say the averages mean anything." The psychometrist kept arguing that yes you could and that the same subtests needed to given to and interpreted for everyone, even if they had a clearly mitigating disability. My mom finally asked what they would do about someone with essentially no fine motor function, like Steven Hawking. The psychometrist thought that was another student.
That's...unfortunate. And shows just how much harm, "you don't know what you don't know" can do.

To be fair (and hopefully not to get too personal, future), I don't think testing fine motor skills would be altogether inappropriate, if for example the idea is to quantify functioning in that area. But yeah, I'm pretty sure even without advanced psychometric training, just the manual says a thing or two about averaging domain scores that are discrepant by 6+ SDs.
 
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That's...unfortunate. And shows just how much harm, "you don't know what you don't know" can do.

To be fair (and hopefully not to get too personal, future), I don't think testing fine motor skills would be altogether inappropriate, if for example the idea is to quantify functioning in that area. But yeah, I'm pretty sure even without advanced psychometric training, just the manual says a thing or two about averaging domain scores that are discrepant by 6+ SDs.
Yeah, but the point wasn’t to test fine motor skills but to assess the domains of IQ represented by that subtest. The fact that I have fine motor deficits due to an orthopedic problem had been well-established for 10+ years by that point.
 
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Yeah, but the point wasn’t to test fine motor skills but to assess the domains of IQ represented by that subtest. The fact that I have fine motor deficits due to an orthopedic problem had been well-established for 10+ years by that point.
Yeah, exactly. At that point, like you've said, the subtest is no longer measuring what it was intended to measure in the way it was intended to measure it.
 
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So, funny and somewhat tangenital personal story about this--I have a congenital disability that affects, among other things, fine motor skills. I had an IEP since kindergarten and was mainstreamed the entire time. When I moved to new state at 12, the school district insisted that I have an IQ test, even though there were zero concerns about my academic/cognitive performance. The result was that my subtest scores were very, very lopsided--I scored very highly on subtests not involving fine motor skills (~130s-140s, IIRC) and very low on subtests involving timed fine motor skills (~40-50s, IIRC), with an end result of a FSIQ of around 85-90. My mom, who has zero training or background in anything related to psychology, psychometrics, etc., was like "a) why are you giving someone with known fine motor disability tests that involve fine motor skills? and b) you clearly can't average very different scores together and say the averages mean anything." The psychometrist kept arguing that yes you could and that the same subtests needed to given to and interpreted for everyone, even if they had a clearly mitigating disability. My mom finally asked what they would do about someone with essentially no fine motor function, like Steven Hawking. The psychometrist thought that he was another student and not, you know, a world renowned astrophysicist.
Regardless of other areas of your mom’s cognitive abilities she clearly gets cognitive testing better than any of the therapists I have worked with the last ten years or so. Always refreshing to talk with someone who can grasp these concepts or even more impressive, like your mom, connect the dots independently. My mom was a journalist by trade so…. 🤷‍♂️ 😉
 
Yeah, but the point wasn’t to test fine motor skills but to assess the domains of IQ represented by that subtest. The fact that I have fine motor deficits due to an orthopedic problem had been well-established for 10+ years by that point.

I'm sorry that happened to you.
That was clearly a poorly trained person. Even the Wechsler tests now have in the manuals accommodations or highlight when adaptations are needed specifically for persons that cannot perform the physical parts at a similar level to how it was standardized.

On the main topic: I don't know how training is now in the US, but a decade or so ago, the training I received basically made almost no mention to cultural considerations. I mean yes, they said that someone from a different background may be at a disadvantage, but the reports were basically kept the same and interpreted the same. It was infuriating.

The very recent training I have received in Canada is a totally different story. A lot of time is spent discussing cultural considerations and impact during training, and reports and feedback take this into consideration. Most of the time, FSIQ is not even given if it's believed to be impacted in this way, and only main indexes are interpreted, adding in some of the caveats mentioned by previous posters.
Hopefully in the US things are on a similar track. To be honest, I was relieved that they have this approach and I didn't have to "debate" again how certain differences can impact someone's score.

We also recently did a pretty big search trying to find some more "culturally sensitive" tests for our purposes. I am sad to say that we didn't find any that would fit most cases. There are a few that have more non-verbal components, but those also have their flaws. If someone has any recommendations, I would be grateful!
 
The very recent training I have received in Canada is a totally different story. A lot of time is spent discussing cultural considerations and impact during training, and reports and feedback take this into consideration. Most of the time, FSIQ is not even given if it's believed to be impacted in this way, and only main indexes are interpreted, adding in some of the caveats mentioned by previous posters.
Hopefully in the US things are on a similar track. To be honest, I was relieved that they have this approach and I didn't have to "debate" again how certain differences can impact someone's score.

We also recently did a pretty big search trying to find some more "culturally sensitive" tests for our purposes. I am sad to say that we didn't find any that would fit most cases. There are a few that have more non-verbal components, but those also have their flaws. If someone has any recommendations, I would be grateful!
The flip side of this can be seen in California, where school psychologists (and possibly clinical psychologists as well, but I'm not 100% on that) are banned from giving IQ assesments to Black minors, and so psychoeducational assessments are often lacking in potentially important and useful information. I understand what the California courts were aiming for there, but it has had some negative effects as well.
 
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I'm sorry that happened to you.
That was clearly a poorly trained person. Even the Wechsler tests now have in the manuals accommodations or highlight when adaptations are needed specifically for persons that cannot perform the physical parts at a similar level to how it was standardized.

On the main topic: I don't know how training is now in the US, but a decade or so ago, the training I received basically made almost no mention to cultural considerations. I mean yes, they said that someone from a different background may be at a disadvantage, but the reports were basically kept the same and interpreted the same. It was infuriating.

The very recent training I have received in Canada is a totally different story. A lot of time is spent discussing cultural considerations and impact during training, and reports and feedback take this into consideration. Most of the time, FSIQ is not even given if it's believed to be impacted in this way, and only main indexes are interpreted, adding in some of the caveats mentioned by previous posters.
Hopefully in the US things are on a similar track. To be honest, I was relieved that they have this approach and I didn't have to "debate" again how certain differences can impact someone's score.

We also recently did a pretty big search trying to find some more "culturally sensitive" tests for our purposes. I am sad to say that we didn't find any that would fit most cases. There are a few that have more non-verbal components, but those also have their flaws. If someone has any recommendations, I would be grateful!
Compounding this issue is when a state or agency requires an IQ test for eligibility for services.
 
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The flip side of this can be seen in California, where school psychologists (and possibly clinical psychologists as well, but I'm not 100% on that) are banned from giving IQ assesments to Black minors, and so psychoeducational assessments are often lacking in potentially important and useful information. I understand what the California courts were aiming for there, but it has had some negative effects as well.
Just like how physicians were prevented from adjusting GFR for African Americans.

Oh wait, they didn't cede their authority to use whatever tests they deemed necessary.
 
There is some debate about IQ and bias. But this is my best understanding: "Intelligence tests contain cultural bias — they contain a bias that is in favor White, middle class groups; for example: (a) the tests measure knowledge and content that are more familiar to White, middle class students than to diverse students; (b) the language on these tests is more familiar to White, middle class students; and (c) the examples used in questions are more familiar to White, middle class students. In this case, it is argued that such tests are measuring what diverse groups have not been exposed to and their differential experiences rather than their intelligence — the construct being assessed."
Where this is quote from?

I keep looking for evidence of cultural biases from IQ tests but seem to not be able to find research that shows clear evidence of cultural bias that is not refuted by follow up studies (this is not my area of expertise but I would love some resources if anyone has them to share). Stereotype threat, for example, was long considered a bias of testing until new research indicates its lack of real-world effect. While individual item analysis may indicate bias that does not indicate that the entire assessment is biased.

To be clear, the IQ tests is the oldest and most studied assessment in psychology. Based on the copious amount of validity research, a range of different IQ tests for different populations, and consistent updating, the IQ test (as a category) is likely the least biased and most valid assessment in psychology.

I understand that IQ tests are a loaded topic and feedback about testing must done carefully (more what this thread is about). I was taught, despite the lay public's belief, that the FSIQ is the least important part of the feedback. But we must be careful, especially on a forum like this (as opposed to Reddit or Facebook), to try to provide the most updated information about sensitive topics.

with that in mind...
we know things like attention, cultural background and test bias, can serve to artificially deflate a score
do we know this? Putting aside attention (and anxiety), which should be monitored by the test administrator and taken into consideration when interpreting results (which the lay public does not understand is crucial for validity), do we know that cultural background and test bias significantly deflate scores? Or is this a myth that keeps getting passed on generation to generation? I truly am asking for clarification, when I look for information on this I find the opposite. Here are some citations that may be of interest:


 
Where this is quote from?

I keep looking for evidence of cultural biases from IQ tests but seem to not be able to find research that shows clear evidence of cultural bias that is not refuted by follow up studies (this is not my area of expertise but I would love some resources if anyone has them to share). Stereotype threat, for example, was long considered a bias of testing until new research indicates its lack of real-world effect. While individual item analysis may indicate bias that does not indicate that the entire assessment is biased.

To be clear, the IQ tests is the oldest and most studied assessment in psychology. Based on the copious amount of validity research, a range of different IQ tests for different populations, and consistent updating, the IQ test (as a category) is likely the least biased and most valid assessment in psychology.

I understand that IQ tests are a loaded topic and feedback about testing must done carefully (more what this thread is about). I was taught, despite the lay public's belief, that the FSIQ is the least important part of the feedback. But we must be careful, especially on a forum like this (as opposed to Reddit or Facebook), to try to provide the most updated information about sensitive topics.

with that in mind...

do we know this? Putting aside attention (and anxiety), which should be monitored by the test administrator and taken into consideration when interpreting results (which the lay public does not understand is crucial for validity), do we know that cultural background and test bias significantly deflate scores? Or is this a myth that keeps getting passed on generation to generation? I truly am asking for clarification, when I look for information on this I find the opposite. Here are some citations that may be of interest:


If you really want to delve into this stuff check out the twitter sphere around the bell curve and there being large differences between race on iq measures with black/aa scoring about a standard deviation below the mean, Hispanic/Latino about half a standard dev below, Europeans bang on average, and Asians about two thirds of standard dev above the mean.

I highly doubt that racial differences actually exist. That’s what I’m talking about. The gaps are closing through time tho and are most prominent on verbally loaded items. But there’s tons of modern scientific racism around this stuff.

Btw - I view IQ as being a better measure of un intelligence than intelligence. That is to say that an iq is test is better at predicting outcomes with low iq than that reversed.
 
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If you really want to delve into this stuff check out the twitter sphere around the bell curve and there being large differences between race on iq measures with black/aa scoring about a standard deviation below the mean, Hispanic/Latino about half a standard dev below, Europeans bang on average, and Asians about two thirds of standard dev above the mean.
I am very familiar about the group differences on IQ measures but that does not indicate a bias in the test.

I highly doubt that racial differences actually exist. That’s what I’m talking about. The gaps are closing through time tho and are most prominent on verbally loaded items. But there’s tons of modern scientific racism around this stuff.
Why are you so sure that group differences (not just race) don't exist? I can't imagine it is empirical evidence. Theoretical reasons? Gut feeling?

Also, as mentioned in my previous post, while individual item analysis may indicate bias that does not indicate that the entire assessment is biased.

Btw - I view IQ as being a better measure of un intelligence than intelligence. That is to say that an iq is test is better at predicting outcomes with low iq than that reversed.
I have similar views. I have always wondered about the predictive power of IQ tests for scores of 85 and above. IQ is a modest predictor of some outcomes but I wonder how much of that is influenced by the lower end of the curve. Would love data on this and am just curious.

I am not meaning to pile on you specifically, but this is the second time recently that a post on this forum states something about psychology but when I ask for references or more resources none are provided. Twitter is not the first place I go to for empirical findings, especially on a topic that has been this extensively researched and debated.

To be clear, I am not an intelligence researcher and I do not care much about the group differences in IQ. I care about myths and fallacies about psychology that continue to live on despite being fairly well debunked.
 
The flip side of this can be seen in California, where school psychologists (and possibly clinical psychologists as well, but I'm not 100% on that) are banned from giving IQ assesments to Black minors, and so psychoeducational assessments are often lacking in potentially important and useful information. I understand what the California courts were aiming for there, but it has had some negative effects as well.

Wait, really? I had no idea about this.
But what do you do when you need to assess the cognitive abilities of a child, and they happen to be a Black minor? I mean this extends from accommodations for LDs to gifted programs, and everything in between. Does this also extend to other non-white non-English speaking (as a first language) minors?
 
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Wait, really? I had no idea about this.
But what do you do when you need to assess the cognitive abilities of a child, and they happen to be a Black minor? I mean this extends from accommodations for LDs to gifted programs, and everything in between. Does this also extend to other non-white non-English speaking (as a first language) minors?
There’s been other (national, iirc) Court cases on assessing bilingual/multilingual children in their dominant language, but Larry P. (The Black/African-American IQ ban case) is specific to California. Basically you can’t give cognitive assessments to a Black child if that assessment could potentially lead to an ID classification. Here’s a good explainer: Science, Politics, and Best Practice: 35 Years After Larry P. - Contemporary School Psychology

Testing guidance:

More testing guidance:

 
Thank you, that is helpful.
My US training was in a east coast state, but one would figure instructors would share something about this...

In any case, I am partial to my current Canadian training. It fits better since Canada has been aiming to bring in 500k new people each year and many of them are minors. When you have to assess kids that grew up all over the world, in various cultures, you really have to take the cultural aspects (and differences) into consideration.
 
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