WAIS-III and WAIS-IV ethics and critical thinking

[Sanman]

Suppose, you've been following a patient for a few years. They came in with memory complaints. You assessed them with a full current battery at that point. You see that the scores are a little low in a nomethetic comparison, but still within reasonable expectation. No functional decline is reported. They come in again, scores are a little worse in some areas a little better in others, still no functional decline. You've compared them against themselves. New tests come out. Your patient comes back. Do you switch to new assessment tools in which case all you have is nomothetic assessment, or do you stick with the older tools? I think, depending on the patient, I stick with the older tools (taking into account new data on practice effects as a diagnostic tool, etc. . .).

Based on my training, I think it would depend on whether there was a significant functional decline reported since the previous assessment and the domains of function that the pt has historically struggled with and how well they could be assessed using other instruments in the battery as you will need to eventually complete a re-assessment with the new tool. Will new subtests provide a better assessment in areas of conern? I would also want to be consistent with versions of other Wechsler assessment tools used (WAIS-III with WMS-III vs WAIS-IV and WMS-IV). Finally, given that the WAIS-IV does have a reduced administration time (does it really?, I only gave a few WAIS-IV batteries before shifting over to more therapy and briefer assessments), what role might cognitive fatigue of a longer assessment play in deciding the battery. Anyway, I can see a case for the WAIS-III for reassessment, limits testing, etc.

At this point though, it seems as if it would be iffy for forensic evaluations given that the WAIS-IV is hitting the four year mark.

EDIT: D'oh, just realized that was an old comment.

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[paramour]

I sort of expected that to be the case after my research earlier today. Now to convince my new site that they *need* to order the WAIS-IV. 😳 On one hand, I was told to let them know if there are any materials I need requisitioned. On the other hand, yikes, I don't want to be the one responsible for ordering a costly kit!

 

[paramour]

Based on my training, I think it would depend on whether there was a significant functional decline reported since the previous assessment and the domains of function that the pt has historically struggled with and how well they could be assessed using other instruments in the battery as you will need to eventually complete a re-assessment with the new tool. Will new subtests provide a better assessment in areas of conern? I would also want to be consistent with versions of other Wechsler assessment tools used (WAIS-III with WMS-III vs WAIS-IV and WMS-IV). Finally, given that the WAIS-IV does have a reduced administration time (does it really?, I only gave a few WAIS-IV batteries before shifting over to more therapy and briefer assessments), what role might cognitive fatigue of a longer assessment play in deciding the battery. Anyway, I can see a case for the WAIS-III for reassessment, limits testing, etc.

At this point though, it seems as if it would be iffy for forensic evaluations given that the WAIS-IV is hitting the four year mark.

EDIT: D'oh, just realized that was an old comment.

They're going to love me ordering all this crap.

I actually wanted to ask about the admin time for the WAIS-IV. I kept reading that it does have a reduced time in comparison to the WAIS-III (up to 15% reduction in time based on the literature I read), yet the average times I've seen *seem* to be comparable with what I'm used to for the WAIS-III. I think reduced admin time would be a selling point for the WAIS-IV at this particular setting, but not certain whether the admin time is actually significantly less in practice?

 

[AcronymAllergy]

I read about the reduced admin time as well, although I don't know that I've given enough to be able to notice (~2-3 complete administrations; we typically stick with either the WASI or a significantly abbreviated/prorated battery at the rotations I've worked in this year).

 

[Pragma]

I read about the reduced admin time as well, although I don't know that I've given enough to be able to notice (~2-3 complete administrations; we typically stick with either the WASI or a significantly abbreviated/prorated battery at the rotations I've worked in this year).

I give it a lot and I can say that it is qualitatively much shorter. The d/c rules help a lot. But, depends on the patient, and it still takes a bit to get 4 factors.

 

[AcronymAllergy]

Yeah, I have noticed the reduced d/c rules, which I would imagine helps quite a bit. And the reduced length of some of the instructions, which probably also adds up. Good to know it does at least actually feel shorter.

 

[Pragma]

Yes it flows better and is more comfortable as a tester. I would guess that the 10 base subtests take an hour, give or take.

 

[AcronymAllergy]

In my small handful of run-throughs, I did prefer the overall flow of the subtests in the IV to the III (once I'd gotten used to it), yep. Now I at least won't be quite so potentially unenthused about switching over for postdoc; thanks, Pragma.

 

[cara susanna]

The WAIS-IV tends to be much shorter than the WISC-IV for me because of the discontinuation criteria being less. I didn't learn the WAIS-III so I can't really compare with that, unfortunately.

 

[Therapist4Chnge]

Yes it flows better and is more comfortable as a tester. I would guess that the 10 base subtests take an hour, give or take.

That seems really short, particularly for things like Vocab, Matrix Reasoning, etc. Of course...it is *still* shorter than giving a WMS...which feels like death by many papercuts. Thank G-d for psychometricians!

 

[IT514]

The WAIS-IV tends to be much shorter than the WISC-IV for me because of the discontinuation criteria being less. I didn't learn the WAIS-III so I can't really compare with that, unfortunately.

The time difference is also due to the comprehension subtest in the WISC-IV, which isnt part of the standard battery in the WAIS-IV. Howebver, in many/most cases I would love to swap out information for comprehension on the WAIS b/c it gives more info if you want more than just a VCI.

Time-wise, I average around 45 minutes, with brighter folks taking around an hour, which is an improvement over the III.

Theres a lot more lit now than a year ago on WAIS-IV in terms of clinical utility...but by the time we have a useful knowledge base, the frakin WAIS-V will come out.

 

[AcronymAllergy]

I honestly don't remember my WAIS-III sessions taking longer than maybe 75 minutes (with the occasional 90-minute session once every few months), although that might've just been perceptual distortion based on how blazingly quick it is compared to the WJ-III (oh, the horror). And I do recall my WMS-III's actually almost universally being shorter than my WAIS administrations, although we stuck to only the required subtests. Then again, I never timed the administrations, so maybe it just felt shorter.

One thing is certain: I'm so very glad picture arrangement is no longer required and object assembly was dumped entirely.

 

[paramour]

I read about the reduced admin time as well, although I don't know that I've given enough to be able to notice (~2-3 complete administrations; we typically stick with either the WASI or a significantly abbreviated/prorated battery at the rotations I've worked in this year).

Doubt I'm going to be that lucky. 😀

I give it a lot and I can say that it is qualitatively much shorter. The d/c rules help a lot. But, depends on the patient, and it still takes a bit to get 4 factors.

Yeah, I have noticed the reduced d/c rules, which I would imagine helps quite a bit. And the reduced length of some of the instructions, which probably also adds up. Good to know it does at least actually feel shorter.

The WAIS-IV tends to be much shorter than the WISC-IV for me because of the discontinuation criteria being less. I didn't learn the WAIS-III so I can't really compare with that, unfortunately.

I noticed the d/c rules had changes across most (if not all) subtests, so presumed this is what accounted for the admin differences. But then wasn't sure if there were other changes that simply hiked the time back up.

Thanks, ladies & gents! My program was not in WAIS-IV mode quite yet (I believe they adopted it right after I left the clinic--and I stuck around for extra time 🙄), so this gives me something to go by in addition to the other info I've pulled already.

 

[AcronymAllergy]

No worries, paramour, same thing happened to me--our university clinic, which had the WAIS-IV for a good 6-10 months, didn't start using it until about a month after I left. Luckily, I was at least exposed to portions of it and, to a much greater degree, the WMS-IV here on internship. Oh, how I truly appreciate the improved visual reproduction scoring criteria.

 

[cara susanna]

The time difference is also due to the comprehension subtest in the WISC-IV, which isnt part of the standard battery in the WAIS-IV. Howebver, in many/most cases I would love to swap out information for comprehension on the WAIS b/c it gives more info if you want more than just a VCI.

Time-wise, I average around 45 minutes, with brighter folks taking around an hour, which is an improvement over the III.

Theres a lot more lit now than a year ago on WAIS-IV in terms of clinical utility...but by the time we have a useful knowledge base, the frakin WAIS-V will come out.

That's funny because I HATE the comprehension subtest. The fact that I don't have to give it is probably why I like administering the WAIS better than the WISC. 😉

 

[IT514]

That's funny because I HATE the comprehension subtest. The fact that I don't have to give it is probably why I like administering the WAIS better than the WISC. 😉

I'm with you there. The scoring criteria on the WAIS-IV is a beast. It took me a while to become fluid with it.

 

[paramour]

No worries, paramour, same thing happened to me--our university clinic, which had the WAIS-IV for a good 6-10 months, didn't start using it until about a month after I left. Luckily, I was at least exposed to portions of it and, to a much greater degree, the WMS-IV here on internship. Oh, how I truly appreciate the improved visual reproduction scoring criteria.

Sounds similar to what happened here. They had the WAIS-IV but only made it available for training classes first. Theeen, they finally brought it out for the clinicians to use.

That's funny because I HATE the comprehension subtest. The fact that I don't have to give it is probably why I like administering the WAIS better than the WISC. 😉

I didn't "hate" comprehension, but it was certainly one of my least favorites... primarily due to the time issue (with me scratching my head while scoring a few times).

 

[cara susanna]

My issue is mainly how the questions seem completely inaccessible to modern children and teenagers. I'd give examples but, you know, testing security and whatnot. 😉

 

[paramour]

My issue is mainly how the questions seem completely inaccessible to modern children and teenagers. I'd give examples but, you know, testing security and whatnot. 😉

It's been quite a while since I've given the WISC (and only a handful at that), but I believe I remember what you're talking about. And, yes, I seem to recall folks having difficulty with these. Throw in some cultural barriers (1st generation) with the folks I administered and oh, my, oh, what fun!

 

[cara susanna]

Haha, glad I'm not alone! They're so bad, it's like they tried to make them as irrelevant to today's generation as possible. 😉 Which would be understandable if it were an older test, but they JUST updated it.

 

[Pragma]

That seems really short, particularly for things like Vocab, Matrix Reasoning, etc. Of course...it is *still* shorter than giving a WMS...which feels like death by many papercuts. Thank G-d for psychometricians!

It isn't really short. Sometimes it takes longer, generally if they are a) high functioning and not d/cing or b) have slowed processing and take maximum amounts of time on things like block design or untimed tests.

Now keep in mind, not all of us have the luxury of techs!

 

[Pragma]

I'm with you there. The scoring criteria on the WAIS-IV is a beast. It took me a while to become fluid with it.

Yeah I didn't make the transfer until internship. Really the main sticking point is familiarity. I was scared to transfer because I was so efficient with the WAIS-II, but after the learning curve, it is a MUCH MUCH better test (and you become just as familiar). Now when I have to give the WAIS-III for some reason I grumble.

 

[Therapist4Chnge]

It isn't really short. Sometimes it takes longer, generally if they are a) high functioning and not d/cing or b) have slowed processing and take maximum amounts of time on things like block design or untimed tests.

Now keep in mind, not all of us have the luxury of techs!

I actually handle most of my own assessment, as I'm primarily in-patient and our techs work primarily out-pt. I don't mind though, as I like to test limits and swap out measures on the fly. Time is tight on the in-pt side, so test-selection and being flexible are both required to the Nth degree. We have some great techs, so when I need to get a patient seen on the in-pt side, they jump in and do a great job. I also was lucky on internship to also work with a tech who could step in and help, so I'm spoiled in that regard.

I work with specific populations that tend to take longer because of processing speed, attentional issues, etc (e.g. TBI, ADHD, etc), so it can be a bit of a marathon if I need to get a lot of stuff done. Most of our assessments are done on an out-pt. basis, so more time is available if needed, it just means I have to stay a lot later. 👎

 

[Pragma]

I actually handle most of my own assessment, as I'm primarily in-patient and our techs work primarily out-pt. I don't mind though, as I like to test limits and swap out measures on the fly. Time is tight on the in-pt side, so test-selection and being flexible are both required to the Nth degree. We have some great techs, so when I need to get a patient seen on the in-pt side, they jump in and do a great job. I also was lucky on internship to also work with a tech who could step in and help, so I'm spoiled in that regard.

I work with specific populations that tend to take longer because of processing speed, attentional issues, etc (e.g. TBI, ADHD, etc), so it can be a bit of a marathon if I need to get a lot of stuff done. Most of our assessments are done on an out-pt. basis, so more time is available if needed, it just means I have to stay a lot later. 👎

Yeah I much prefer inpatients to outpatients. Outpatients take forever and where I am at are a little more scripted than inpatients are.

The WAIS-IV is the least of my concerns for taking up too much assessment time, in part because the subtests all give me information I value. It's those pesky achievement measures that drive me crazy!

 

[Therapist4Chnge]

I have a particular interest in executive dysfunction in post-injury populations, so a lot of my other measures take longer than any of the WAIS subtests. The WCST (128 not 64) is one that should only take 10-15min, often takes much longer.

I don't give much in the way of the WJ or similar, though I think I did enough administrations of that to last a career (one of my first research groups used parts of it and I was a lowly psychtech). We still had the TAPES too. Talk about archaeic....

 

[FadedC]

I've noticed that I don't see much talk about the WJ on these forums. At my school they are big advocates of CHC theory, so they put some extra emphais on the WJ-3. That's true to a lesser extent of field assessment placement as well. But I'm not sure how common that is.

I don't give much in the way of the WJ or similar, though I think I did enough administrations of that to last a career (one of my first research groups used parts of it and I was a lowly psychtech). We still had the TAPES too. Talk about archaeic....