Testing for Intellectual Disability�Prong-1

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Antonio E. Puente, PhD

University of North Carolina Wilmington

�(with assistance Juan A. Serrano, PsyD)

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MCLAP Meeting

San Antonio, TX

May 16, 2024

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Disclaimer

The information contained in this presentation does not reflect the policy of APA, any division of APA, APA Psychological Services, NAN, or any state psychological or specialty association. Further, this information is intended to be informative. It does not supersede APA or state provincial licensing boards, ethical guidelines, and/or local, state, provincial, or national regulations and/or laws. This is a living document that can and will be revised as additional information becomes available. The ultimate responsibility for the validity, utility, and application of the information contained herein lies with the individual and/or institution using this information and not with any supporting organization and/or the author of this presentation. Suggestions or changes should be addressed directly addressed to the author. Note that whenever possible, references are provided. The information provided serves as a source of education to the readers of the materials contained or attendees at this presentation and is not intended for public distribution. Thank you

�OUTLINE

1. BACKGROUND
2. HISTORY OF INTELLECTUAL DISABILITY (ID)
3. DEFINITION OF ID
4. ASSESSING INTELLECTUAL FUNCTIONING – PRONG 1
5. BEST PRACTICES
6. CHALLENGES
7. FUTURE DIRECTIONS

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�OUTLINE

1. BACKGROUND
2. HISTORY OF INTELLECTUAL DISABILITY (ID)
3. DEFINITION OF ID
4. ASSESSING INTELLECTUAL FUNCTIONING – PRONG 1
5. BEST PRACTICES
6. CHALLENGES
7. FUTURE DIRECTIONS

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ROGER W SPERRY�NEUROPSYCHOLOGY LABORATORY���

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Roger W. Sperry�(rogersperry.org)

Alexander Luria

�OUTLINE

1. BACKGROUND
2. HISTORY OF INTELLECTUAL DISABILITY (ID)
3. DEFINITION OF ID
4. ASSESSING INTELLECTUAL FUNCTIONING – PRONG 1
5. BEST PRACTICES
6. CHALLENGES
7. FUTURE DIRECTIONS

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History of Intellectual Disability #1

• 18th-19th centuries: institutionalization and “idiot”

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• Early 20th century: “feeblemindedness,” “idiocy,” “imbecility,” and “moronity”

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• 1950s-1970s: ICD 9 “mental retardation”

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• 1994: DSM-IV “mental retardation”�
• 2007: AAIDD “intellectual disability”

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• 2010s: ICD 10 still referred to as "mental retardation.”

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• 2013: DSM-5 shifted to “intellectual disability (intellectual developmental disorder).” �
• 2022: The DSM-5-TR uses “intellectual developmental disorder (intellectual disability)” to align with the new ICD-11 classification system.

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History of Intellectual Disability #2

• Evolving definitions focused on intelligence then adding

adaptive behavior.

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• Evolving definition solely relying on IQ to a more comprehensive assessment approach.

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• Reduction of stigma and improved understanding.

History of Intellectual Disability #3

• Penry v. Lynaugh (1989): SCOTUS- ID and death penalty.

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• Atkins v. Virginia (2002): SCOTUS- violation of the Eighth Amendment's on “cruel and unusual punishment.”
• “evolving standards of decency” and national consensus.
• States to define ID and establish procedures

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• Hall v. Florida (2014): SCOTUS- rejection of Florida’s strict IQ cutoff of 70
• Standard error of measurement.

�OUTLINE

1. BACKGROUND
2. HISTORY OF INTELLECTUAL DISABILITY (ID)
3. DEFINITION OF ID
4. ASSESSING INTELLECTUAL FUNCTIONING – PRONG 1
5. BEST PRACTICES
6. CHALLENGES
7. FUTURE DIRECTIONS

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Defining Intelligence

• Intelligence as “the aggregate or global capacity of the individual to act purposefully, to think rationally and to deal effectively with his environment”

(Wechsler, 1944)

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Definition of ID

Standard of ID diagnosis: �

• American Association for Intellectual and Developmental Disability (AAIDD, 11^th and 12^th Editions)

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• Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association (DSM, 5^th edition and 5-TR Editions)

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• International Classification of Diseases by the World Health Organization (ICD, 10^th and 11^th Editions)

Definition of ID

Three criteria or prongs: �

Prong 1- An intellectual ability that is two standard deviations or more below the population (70).

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Prong 2- Significant impairments in adaptive functioning.

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Prong 3- Both of these must be presented prior to the age of 22.

(AAIDD, 2021)

Normal Distribution Bell Curve�

�OUTLINE

1. BACKGROUND
2. HISTORY OF INTELLECTUAL DISABILITY (ID)
3. DEFINITION OF ID
4. ASSESSING INTELLECTUAL FUNCTIONING – PRONG 1
5. BEST PRACTICES
6. CHALLENGES
7. FUTURE DIRECTIONS

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Intellectual and Neuropsychological Evaluation Procedure

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Fairness in Testing

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“Accessible testing situations are those that enable all test takers in the intended population, to the extent feasible, to show their status on the target construct(s) without being unduly advantaged or disadvantaged by individual characteristics (e.g., characteristics related to age, disability, race/ethnicity, gender, or language) that are irrelevant to the construct(s) the test is intended to measure.” (AERA, et al., 2014, p.52).

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Assessment of Intellectual Functioning

• “Select specific standardized test(s) that are culturally and linguistically appropriate for the individual, as well as for their communication, sensory, and motor limitations.” (AAIDD, 12^th Edition, p. 43)

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• “Intellectual functioning is typically measured with individually administered and psychometrically valid, comprehensive, culturally appropriate, psychometrically sound tests of intelligence.” (DSM-5 TR, p.38).

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• “Instruments must be normed for the individual’s sociocultural background and native language.” (DSM-5 TR, p.38).

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Example of the Complexity of Spanish

“Validity and reliability/precision considerations are paramount, but the demographic characteristics of the group(s) for which the test originally was constructed and for which initial and subsequent normative data are available also are important.” (AERA et al., 2014, p. 152)

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Standard 10.5:

• Tests selected for use in psychological testing should be suitable for the test taker's characteristics and background (AERA et al., 2014, p. 165).

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Test Selection

Native vs Dominant vs Preferred Language

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• Native Language: Mother tongue, first language, and acquires from birth.

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• Dominant Language: Greatest proficiency, used more frequently and most comfortable using.

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• Preferred Language: Chosen for communication.

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Note: Native, dominant, and preferred language may or may not be the same.

Clinical Interview for Assessing Language Proficiency

• Questions:
• language spoken?
• language did you learn first as a child?
• language(s) spoken at home?
• contextual/situations (e.g. at home, at work, with friends, etc.)?
• In what language do you feel most comfortable expressing yourself?

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• Years of education (US vs other)

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Examples of Tests Used to Evaluate �Spanish/English Language

Spanish:

• Bateria IV: Prueba de Aprovechamiento (Test of Achievement)

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English:

• Woodcock-Johnson IV (WJ IV): Test of Achievement
• Wide Range Achievement Test, 5^th Edition (WRAT-5)

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English/Spanish:

• Woodcock-Muñoz Language Survey III (WMLS III)

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Assessment of Intellectual Functioning #3

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There are circumstances in which it may be appropriate to select alternative instruments rather than rely on the more traditional intelligence tests. “This may be because the individual being assessed ... is influenced by a variety of cultural, social, ethnic, and language - based factors... For example, it may be appropriate to use a test such as the C-TONI..” (AAIDD, 11^th Edition)

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Comprehensive Test of Nonverbal Intelligence, 2^nd Edition �

• Abbreviation: CTONI-2
• Publication date: 2009
• Age range: 6:0 to 89:11

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• The CTONI-2 is a norm-referenced test that uses nonverbal formats to estimate the general intelligence of children and adults whose performance on traditional intelligence tests might be adversely affected by subtle or overt impairments involving language or motor abilities.

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Beta- 4

• Abbreviation: None
• Publication date: 2016
• Age range: 16 to 99+ years

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• The Beta-4 is an instrument that can be administered to groups or individuals in English or Spanish to provide a quick and reliable measure of nonverbal intellectual ability for examinees ages 16 to 99+ years.

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• This revision of the Beta III provides test scaled scores and a composite score (i.e., the Beta IQ).

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Raven’s Progressive Matrices, 2^nd Edition

• Abbreviation: Raven’s 2
• Publication date: 2019
• Age range: 4-69 years

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• The Raven's Progressive Matrices 2, Clinical Edition (Raven's 2) is a nonverbal assessment of general cognitive ability.�
• Specifically, Raven defines the trait that the progressive matrices measures as eductive ability, which is one of the key components of general intelligence or g, identified by Spearman. �
• Eductive ability involves the ability to think clearly and solve complex problems.

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Bateria IV

• Batería IV Woodcock-Muñoz: Tests of Cognitive Abilities
• Abbreviation: Batería IV COG
• Publication date: 2018
• Age range: 2:00-90+

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• Is an adaptation and translation of the Woodcock-Johnson IV Tests of Cognitive Abilities (WJ IV COG) into Spanish.
• Provides a General Intellectual Ability score.
• Norms based on the Woodcock-Johnson IV (WJ IV).
• A separate calibration study was conducted with 601 native Spanish speakers to equate the Spanish test items to the scales underlying the English WJ IV tests.

Intelligence Tests in Spanish Providing an Intelligence Quotient (IQ)

• Wechsler Adult Intelligence Scale, 4th Edition (Mexican)
• Abbreviation: WAIS-IV
• Publication date: 2014
• Age range: 16:0-90:11

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• Is a revision of the Wechsler Adult Intelligence Scale-III (WAIS-III).
• Provides a Full-Scale IQ score.
• Norms are representative of the Mexican population according to the 2010 Mexican census.

WAIS-III (Mexican)

Numerous challenges present with the Mexican version of the WAIS-III (Suen & Greenspan, 2009):

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• Extremely poor reliability,
• Lack of a meaningful reference population,
• Lack of score normalization,
• Exclusion of certain groups from the standardization sample,
• Use of incorrect statistics and calculations, and
• Incorrect application of the true score confidence interval method.

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Risk Factors for Developing ID

• The American Psychiatric Association and American Association for Intellectual and Developmental Disability identified several risk factors for Intellectual Disabilities (ID) and divided them into prenatal, perinatal, and postnatal periods and categories and into the following four categories:

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• Biomedical
• Social
• Behavioral
• Educational

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�OUTLINE

1. BACKGROUND
2. HISTORY OF INTELLECTUAL DISABILITY (ID)
3. DEFINITION OF ID
4. ASSESSING INTELLECTUAL FUNCTIONING – PRONG 1
5. BEST PRACTICES
6. CHALLENGES
7. FUTURE DIRECTIONS

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Research Foundations

• Standard error of measurement (SEM) and report scores as a range (ApA, 2013; Schalock et al., 2010).

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• Flynn effect and norm obsolescence.

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• Context of the person's cultural and linguistic background (Tassé, 2009;

see research by Ardila as well as Puente).

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• Integrate findings from multiple sources, not just test scores.
• You may be able to fake a low IQ score, but not a life of ID.

Standard Error of Measurement (SEM)

• SEM = an estimate of error or imprecision in IQ score.

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• Range IQ score using a 95% confidence interval.

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• Typical SEM is around 3-5 points.

Flynn Effect

• Documented rise in IQ scores over time, around 3 points per decade.

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• IQ tests are periodically re-normed to keep the mean score at 100.

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• Older versions may inflate scores due to outdated norms.

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• Raises serious ethical and legal concerns (Blume et al., 2009; Reynolds et al., 2010).

Puente Practices

• Bicultural and Bilingual Research and Clinical Teams and Programs
• Testing Approaches
• Multiple Tests and Approaches
• Multiple Norms and Approaches
• Multiple Scoring and Checking; Heavy Scientific/Technical Focus
• Presentation of Data Using Narrative and Numbers
• Interfacing Test Scores with History, Records, and Prior Testing
• Estimating Potential Origins for ID
• Review of Second Opinions and Testimony for Improving Practices
• Involvement in Teaching, Profession, & Specialty Activities & Policy Development

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�OUTLINE

1. BACKGROUND
2. HISTORY OF INTELLECTUAL DISABILITY (ID)
3. DEFINITION OF ID
4. ASSESSING INTELLECTUAL FUNCTIONING – PRONG 1
5. BEST PRACTICES
6. CHALLENGES
7. FUTURE DIRECTIONS

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Using a Translator

• Decrease errors by matching the examinee with evaluator's native language.�
• Sources of error: rapport, validity of test results, adaptation, distractibility, norm interpretation, and construct equivalence.

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• Translators can affect rapport, communication, and validity. (Tassé, 2009)

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• Inconsistent with testing environment being free from distractions (NAN, 2000)

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• 3^rd party introduces an unknown variable and prevents valid comparisons (NAN, 2000).

Using Spanish Translations vs. Adaptations

• Avoid translations (especially customized); use adapatation
• Spanish tests (Puente, et al, 2015)
• 500 Tests,
• 50 regularly used;
• 5 likely appropriate
• Focus on adaptations of constructs (Judd, et al, 2009)
• Close to meeting recognized scientific standards of validation.
• Representative of the population with whom they are being used.
• Follow standards of translation and adaptation.

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Racial Justice Act (RJA)

• RJA was enacted in North Carolina in 2009 to allow death row inmates to challenge their sentences on the grounds of racial bias.

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• Defendants can present evidence of racial bias at any stage of the criminal proceedings, including during charging, conviction, or sentencing.

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Prosecutorial Challenges

• Prong 1 vs. Prong 2
• Tests
• WAIS
• Non-Full Scale tests
• Psychometrics
• Norms
• US
• Non-US
• Standard Error of Measurement
• Flynn effect

�OUTLINE

1. BACKGROUND
2. HISTORY OF INTELLECTUAL DISABILITY (ID)
3. DEFINITION OF ID
4. ASSESSING INTELLECTUAL FUNCTIONING – PRONG 1
5. BEST PRACTICES
6. CHALLENGES
7. FUTURE DIRECTIONS

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An Alternative Paradigm

Division 52, International Psychology,

American Psychological Association

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Seeks to develop a science that is contextually informed, cultural

inclusive, serves the public interest, and promotes global perspectives

(within and outside of APA).

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Antonio E. Puente

President, 2022-2023

Minnesota Neuropsychology Conference: Diversity, Equity, & Inclusion Aspirations

• Demonstrate cultural humility and respect; understand culture’s impact on all professional activities; be aware of intersectional identities and associated inequities; be aware of historical and institutional inequities; and advocate for marginalized and/or minoritized individuals, populations, and perspectives, traditionally defined by differing ability levels, ethnicity, gender, sexual orientation, and other social and economic constructs.

Minnesota Assessment Definition

• Conduct culturally-informed neuropsychological evaluations. Use tests and procedures, including measures developed with innovative methods and technologies, that are evidence-based, reliable, valid, and culturally and normatively appropriate. Develop diagnostic case conceptualizations and interpretations that consider ethnicity, language, education level and quality, literacy, gender, sexual orientation, disability status, and other identities and their intersectionality. Utilize tests and procedures, including measures developed with innovative methods and technologies, that are evidence-based, reliable, valid, and culturally and normatively appropriate...

Neuro/Psychological Methodology

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• Sperry
• Upward/Downward Causation
• Quantitative
• Luria & Vygotsky
• Socio-historical-cultural context
• Qualitative
• Hybrid
• From bottom to top/From right to left
• Scientific & Socio-historical-cultural integration
• “Romantically scientific”

Information

• Vita/ Academic: antonioepuente.com
• Clinical: clinicalneuropsychology.us

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antonioenriquepuente@gmail.com

clinicalneuropsychology@gmail.com

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Recursos

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• American Psychological Association
• Ethical Standards for Psychologists
• Standards for Educational and Psychological Tests & Assessments
• Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists
• National Academy of Neuropsychology
• Hispanic Neuropsychological Society
• Available book chapters & articles
• www.antonioepuente.com
• www.alfredoardila.wordpress.com

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References

• American Educational Research Association, American Psychological Association, & National Council on Measurement in Education (Eds.). (2014). Standards for educational and psychological testing. American Educational Research Association.�
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596�
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787�
• Axelrod, B., Barth, J., Faust, D., Fisher, J., Heilbronner, R., Larrabee, G., Pliskin, N., Silver, C., & Policy and Planning Committee, National Academy of Neuropsychology (2000). Presence of third party observers during neuropsychological testing: official statement of the National Academy of Neuropsychology.  Archives of Clinical Neuropsychology, 15(5), 379-380.

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• Blume, J. H., Johnson, S. L., & Seeds, C. (2009). Of Atkins and men: Deviations from clinical definitions of mental retardation in death penalty cases. Cornell Journal of Law and Public Policy, 18(3), 689-733. �
• Ellis, J. W., Everington, C. & Delpha, A. M. (2018) Evaluating Intellectual Disability: Clinical Assessments in Atkins Cases. Hofstra Law Review, 46 (4), 1305-1419.

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• Judd, T., Capetillo, D., Carrión-Baralt, J., Mármol, L. M., Miguel-Montes, L. S., Navarrete, M. G., Puente, A. E., Romero, H. R., Valdés, J., & NAN Policy and Planning Committee (2009). Professional considerations for improving the neuropsychological evaluation of Hispanics: a National Academy of Neuropsychology education paper.,Archives of clinical neuropsychology. 24(2), 127–135.

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• Reynolds, C. R., Niland, J., Wright, J. E., & Rosenn, M. (2010). Failure to apply the Flynn correction in death penalty litigation: Standard practice of today maybe, but certainly malpractice of tomorrow. Journal of Psychoeducational Assessment, 28(5), 477–481. https://doi.org/10.1177/0734282910373348

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References (continued)

• Schalock, R. L., Borthwick-Duffy, S. A., Bradley, V. J., Buntinx, W. H. E., Coulter, D. L., Craig, E. M., Gomez, S. C., Lachapelle, Y., Luckasson, R., Reeve, A., Shogren, K. A., Snell, M. E., Spreat. S., Tassé, M. J., Thompson, J. R., Verdugo-Alonso, M., Wehmeyer, M. L., & Yaeger, M. H. (2010). Intellectual Disability: Definition, classification, and systems of supports (11th ed.). American Association on Intellectual and Developmental Disabilities.

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• Schalock, R. L., Luckasson, R., & Tassé, M. J. (2021). Intellectual disability: Definition, diagnosis, classification, and systems of supports (12th ed.).American Association on Intellectual and Developmental Disabilities.

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• Suen, H. K., & Greenspan, S. (2009). Serious problems with the Mexican norms for the WAIS-III when assessing mental retardation in capital cases. Applied neuropsychology, 16(3), 214–222. https://doi.org/10.1080/09084280903098786  

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• Tassé M. J. (2009). Adaptive behavior assessment and the diagnosis of mental retardation in capital cases. Applied neuropsychology, 16(2), 114–123. https://doi.org/10.1080/09084280902864451

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• Wechsler, D. (1944). The measurement of adult intelligence (3rd ed.). Baltimore: Williams & Wilkins.

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• World Health Organization. (2016). International statistical classification of diseases and related health problems (10th ed.). https://icd.who.int/browse10/2016/en

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• World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/

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