WISC-V Assessment and Interpretation: Scientist-Practitioner Perspectives

2014.

Preface

Lawrence G. Weiss, Donald H. Saklofske, James A. Holdnack and Aurelio Prifitera

Beginning with the third revision of the Wechsler Intelligence Scale for Children in 1990, we have developed an accompanying book with chapters on important clinical and research topics cast within the scientist-practitioner framework. While the evidence for the psychometric integrity and clinical efficacy of the Wechsler intelligence scales is vast, given the number of published articles that have included the scales, bringing the information together in such a way to address some of the key clinical and practice issues has always been the main driver of this Academic Press series on the Wechsler intelligence tests.

We have attempted always to give a balance between the empirical basis established during the extensive standardization studies and subsequent published research studies with clinical practice and utility. The editors of the series, some of whom worked directly on the revisions to the WISC-V and earlier versions, have also included editors and chapter authors who were not part of the extensive test development process. We believe this balance of in-depth information of the process of test development as well as the perspective of those from clinical, professional training and research settings has resulted in a unique perspective and insights into the testing and assessment process using the Wechsler scales. We have been pleased with the positive response we have received to all of the volumes in this series and thank our readers for their support. We are also most grateful to the numerous authors who have contributed to the chapters over the years, and this book in particular.

Most importantly, we owe so much to David Wechsler for his genius and dedication to the psychological assessment of children, youth, and adults. His original conceptualization of the Wechsler tests was visionary and has allowed the scales to continue to evolve as valuable, leading assessment tools in the field of psychology since the original Wechsler-Bellevue published in 1939. There are only a handful of instruments in the field of psychological and psychoeducational assessment that have lasted that long and we, the editors of this series, are proud to be able to have participated to a small degree in that long legacy of excellence in cognitive assessment.

One reason the Wechsler tests have endured is because of the openness to change from revision to revision and the significant resources and investment that have gone into those revisions. The amount of investment into the Wechsler scales has been second to none in the testing field. The scales have also benefited from the wisdom of David Wechsler himself through the first revisions, to his family’s support on the later revisions after his death in 1981. In addition, others who have worked on various aspects of the tests over the years such as Joseph Matarazzo and Alan Kaufman have paved the road for these later test revisions. The tradition has continued and those of us who have also worked inside the organizations responsible for the revisions have been fortunate to have the unwavering support and freedom to do what we thought was best for the assessment of intelligence and cognitive abilities.

The iconic Wechsler scales, even with all their success and changes, are not immune to a multitude of factors that have shaped and will continue to impact both psychological tests and the assessment of intelligence and cognitive processes. We see already on the horizon a significant shift in the future direction of the scales, how they will be used, and the changes that will be different in the next generation of assessments. One of the main drivers of the change is the move from paper towards digital assessment. Although the WISC-V is available in both paper and digital modes, it is fairly clear that the usage patterns are changing rapidly and clinicians are adopting the digital administration. We are just now seeing some of the benefits of a digital modality through the Q-interactive application and we know there are more advantages that will emerge that are not apparent today. In addition to the clear advantages such as portability, ease of use, lower entry costs for tests, faster administration and scoring and ease of accessibility of tests, a digital format will allow for many more benefits in the near future. One of the main benefits is the flexibility that will let the psychologist choose to give a subset of the tests most relevant to addressing the key clinical questions. It is also very easy to give a set of subtests from across various tests on the Q-interactive system that are custom selected for the assessment needs of particular children. This allows for greater personalization of the test battery and for much more flexibility in the approach to assessment. A digital format will also allow the measurement of variables that could not be measured in a paper and pencil format.

Introducing a digital format brings new challenges and measurement issues into the test development process such as validating task equivalence with paper versions but also the need for understanding and incorporation of design and usability into the development so that the testing experience is valid and optimized. Additions and new information on interpretation, meaning of score patterns, norms and new tests can be easily added and accessed through a digital format. This, we believe, will give the clinician and researcher unprecedented access to tools, data, and analysis. This overall more flexible approach concept (now enabled with technology) was originally proposed by Edith Kaplan and advocated through her many students including Dean Delis who is carrying that model forward. With access to these data, the empirical basis of score patterns and levels will be more readily available and reach users of the test more quickly.

Another major change over the years has been the growth of international editions of the WISC. One of the most powerful aspects to the Wechsler model of intelligence is that it is fairly robust, consistent, and congruent in terms of the constructs measured and factor structures replicated across different cultures. The WISC-IV is now available with country norms in at least a dozen countries, and WISC-V standardization data are being collected in six countries as we write. As the world shrinks due to technology and mass communication, the ability to use these tests consistently and compare results across various cultures brings a new dimension in the understanding of intelligence and various clinical conditions. The usage of the Wechsler scales has grown significantly outside the US over the past 25 year to the point where usage now is higher outside than inside the US.

Finally, the ways of interpreting the WISC will see continuing evolution. Much of it due to the impact of digital capabilities mentioned above and the ability to quickly access data from a variety of sources globally. This big data capability will have enormous impact and benefit to the research base and clinical understanding and interpretation of these tests. Also, with each revision there has been a steady movement away from simple reliance on summary IQ scores (i.e., Verbal IQ, Performance IQ, and Full Scale IQ) to more sophisticated and nuanced views of the five major domains of cognitive ability now built into WISC-V (i.e., verbal comprehension, visual spatial, fluid reasoning, working memory, and processing speed) and their combination. The neuropsychologist and author Muriel Lezak was a major force advocating this approach in her writings. These newer approaches to interpretation have been greatly influenced by approaches such as the process approach advocated by Edith Kaplan, Dean Delis and others and the Processing Strengths and Weakness approach advocated by, among others, Hale and Fiorello. Finally longitudinal research by Sally Shaywitz documenting dyslexia as an unexpected difficulty in reading relative to intelligence, as well as research similar to the work done by Virginia Berninger linking patterns of performance to brain imaging and interventions for specific disorders is changing how tests are used and interpreted. These new approaches share a focus of looking at all tests within the context of other tests and not just those in a particular test battery, are driven by hypothesis testing and discover, and are based on solid understanding of the cognitive processes and clinical conditions. We expect this next edition of this book series to follow this dynamic change in interpretative process and benefit from the digital transformation in testing that is just beginning.

We end here by thanking our contributing authors who added a depth of knowledge that has made those chapters much richer in both empirical and practice information. As always, we thank Nikki Levy and Barbara Makinster who have so professionally guided all of our Wechsler books to publication. We also appreciate the professional editing work of Melissa Read seen throughout this book. Finally, our hope is that you, the readers of this book, will find it an important and useful resource both in your use of the WISC-V and the assessment of children’s intelligence.

Part I

Applied Considerations

Outline

Chapter 1 WISC-V: Advances in the Assessment of Intelligence

Chapter 2 Practical Issues in WISC-V Administration and Scoring

Chapter 3 Practical Considerations in WISC-V Interpretation and Intervention

Chapter 1

WISC-V

Advances in the Assessment of Intelligence

Lawrence G. Weiss¹, Donald H. Saklofske², James A. Holdnack³ and Aurelio Prifitera⁴,    ¹Pearson Clinical Assessment, San Antonio, TX, USA,    ²Department of Psychology, University of Western Ontario, London, Ontario, Canada,    ³Pearson Clinical Assessment, Bear, DE, USA,    ⁴Pearson Clinical Assessment, Upper Saddle River, NJ, USA

This chapter show how the contemporary Wechsler model has evolved and expanded from two to five factors based on a careful research program spanning decades and multiple editions of the various Wechsler tests (WPPSI, WISC, and WAIS). We describe the WISC-V subtests related to each of the five primary and five ancillary cognitive indexes, as well as the three complementary indexes designed to assist psychologists with psychoeducational evaluations of specific learning disabilities.

Keywords

Verbal IQ (VIQ); Performance IQ (PIQ); Full Scale IQ (FSIQ); Wechsler tests; subtests; Verbal Comprehension Index (VCI); Visual–Spatial Index (VSI); Fluid Reasoning Index (FRI); Working Memory Index (WMI); Processing Speed Index (PSI)

Introduction

The Wechsler scales are the most widely used measures of intelligence, and have been translated, adapted, and standardized in dozens of countries around the world. Since first introduced in the Wechlser–Bellevue Intelligence Scale (WBIS), the Wechsler model has evolved substantially, but remains grounded in Dr. Wechsler’s foundational definition of intelligence:

…the aggregate or global capacity of the individual to act purposefully, to think rationally, and to deal effectively with his (or her) environment.

(Wechsler, 1939, p. 3)

A Brief Historical Recap

The Wechsler series of tests consists of the WISC for school-aged children, the WPPSI for preschool children, and the WAIS for adults. Each of these tests has undergone multiple revisions over several decades. This book is about the fifth edition of the WISC. As we discuss the evolution of the WISC-V, we must necessarily refer to various editions of the WPPSI and WAIS as the evolution of these assessment tools are interrelated theoretically and conceptually as part of the contemporary Wechsler model of intelligence.

Some readers may recall that the original Wechsler model was based on a two part structure comprised of the Verbal Intelligence Quotient (VIQ) and Performance Intelligence Quotient (PIQ), which combined to form the Full Scale Intelligence Quotient (FSIQ). In a series of major theoretical shifts from the original Wechsler model described in 1939, the Wechsler tests have evolved with each version. The WISC-V is based on a five part structure, and the resulting five, factor-based index scores have become the primary level of clinical interpretation. The contemporary Wechsler theoretical model measures the following five domains of cognitive ability: verbal conceptualization, visual–spatial organization, fluid reasoning, working memory, and processing speed.

The modern expansion of the Wechsler model began in 1991 when the WISC-III became the first of the Wechsler scales to offer four factor-based index scores as an optional alternative to the traditional VIQ/PIQ structure: verbal comprehension, perceptual organization, freedom from distractibility, and processing speed. The WAIS-III followed suit in 1997 with the same dual model in which those four index scores were offered but considered supplemental to main VIQ, PIQ, and FSIQ scores. At that time, working memory was referred to as freedom from distractibility—an older term that reflected the incomplete understanding of the construct at that time.

Following from advances in cognitive psychology, neuropsychology, and clinical psychology, in 2003 the scientific caretakers of the Wechsler Scales at PsychCorp/Pearson broke the proverbial apron strings tying the Wechsler tests to the VIQ and PIQ model proposed by David Wechsler in the original WBIS. The VIQ and PIQ were eliminated completely from the WISC-IV, along with changing the name of the freedom from distractibility index to the working memory index to reflect the improved understanding of that construct, and changing the name of the perceptual organization index to the perceptual reasoning index to reflect the increased focus on fluid reasoning among the newly created perceptual subtests. The WISC-IV elevated the four index scores to the primary level of clinical interpretation. The WAIS-IV followed this model in 2008. In 2012, the WPPSI-IV (Wechsler, 2012) introduced the first five factor Wechsler model for children ages 4 to 7 years. To accomplish this, new subtests were created and combined with selected perceptual reasoning and working memory subtests to create a fluid reasoning factor.

From the Past to the Present

The 75-year (1939–2014) history of the Wechsler tests has seen major changes from a focus on general mental ability complemented by verbal and performance IQ scores to either a four (WISC-IV, WAIS-IV) or a five (WPPSI-IV) factor structure. The debate over both the empirical foundations and clinical utility of a four versus five factor structure was the focus of an influential set of papers published in a special issue of the Journal of Psychoeducational Assessment (JPA) (Tobin, 2013). This five factor model was shown to fit the data slightly better than the four factor model for both WISC-IV and WAIS-IV (Weiss, Keith, Zhu, & Chen, 2013a, 2013b). The fifth factor, of course, was fluid reasoning (FR), which was formed by some subtests previously assigned to the perceptual reasoning and working memory factors.

Another key finding from these papers was that the five factor solution fit the data well in large samples of mixed clinical subjects for both WISC-IV and WAIS-IV, thus supporting the clinical application of the model. As the two target papers in the special issue of JPA, these papers were subject to invited critiques by eight prominent researchers, and generally positively reviewed (see Kaufman, 2013 for a summary and discussion of the reviews, and see Weiss, Keith, Zhu, & Chen, 2013c for a rejoinder). Thus, these papers served as the catalyst for a five factor model of WISC-V.

The Wechsler five factor model overlaps substantially with the Cattell–Horn–Carroll (CHC) theory of intelligence that predates it (Carroll, 1993). As a result, recent literature concerning a fifth Wechsler factor has sometimes been cast as a contest between the Wechsler and CHC models of intelligence (Benson, Hulac, & Kranzler, 2010; Ward, Bergman, & Herbert, 2011). However, adding working memory and processing speed factors to the original two factor Wechsler model has been a systematic research goal for the Wechsler test development team, which began in 1990 with the third editions and was fully implemented in the fourth editions (Weiss, Saklofske, Coalson, & Raiford, 2010; Weiss, Saklofske, Prifitera, & Holdnack, 2006). Similarly, adding a fluid reasoning factor to the Wechsler model has also been a systematic research goal since 1997, leading to the development and validation of three fluid reasoning subtests introduced successively in various subsequent editions: Matrix Reasoning, Picture Concepts, and Figure Weights.

While the psychometric fit of the third and fourth editions of the Wechsler series to a four factor model has been well established for decades, the continuous evolution of the contemporary Wechsler scales to a five factor theoretical model has been guided less by CHC-related factor analytic findings and more by ongoing clinical research in neuropsychology and cognitive information processing, as described in Chapter 5. The good news for our science is that independent research labs have derived surprisingly similar models of intelligence based on different lines of research, and this is ultimately confirming the progress the field is making in better understanding the nature of intellectual functioning.

To be fair to Dr. Wechsler’s legacy, his model has always included subtests that researchers now understand as measures of working memory, processing speed, and fluid reasoning. These were buried inside the VIQ and PIQ depending on whether the stimuli and response processes were verbal or visual–perceptual, respectively. Still, Dr. Wechsler knew that mental manipulation of numbers was importantly related to intelligence and that is why he included the Arithmetic and Digit Span subtests in the VIQ. Similarly, he knew that quick visual scanning played an important role in cognition and so he included the Coding subtests as part of the PIQ. As we have also seen, with the addition of newer subtests to reflect contemporary models of and research on intelligence, subtests such as Arithmetic have emerged from being initially included in the VIQ to being a key subtest tapping working memory and now finding a place as an optional subtest on the Fluid Reasoning domain.

Present-day researchers have developed well-articulated theories about the underlying neurocognitive processes tapped by these tasks and how they are related to intelligence. Much like the well-known aspirin that continues to be found relevant in the treatment of many more health issues than initially considered, Digit Span is now understood as tapping working memory, especially when digits are recalled in reverse or rearranged in an ordered sequence. Coding is now understood as a measure of cognitive processing speed rather than just simple copying or hand-eye coordination. As more has been learned about these areas, the Wechsler tests have changed over time such that these constructs have been disentangled from VIQ and PIQ, and stand alone. Furthermore, new tasks such as Letter-Number Sequencing and Cancellation were added to elaborate the assessment of working memory and processing speed, respectively. Also, Digit Span was significantly revised in the WAIS-IV and now WISC-V by adding the digit sequencing items to make it a better measure of working memory based on our current understanding of that construct.

Similarly, although the term fluid reasoning was not used in Dr. Wechsler’s time, some of the original Wechsler subtests were believed to be related to the ability to solve novel problems (i.e., Similarities, Block Design). It was very much the seminal contributions of Horn and Cattell (1966) that led to describing and distinguishing between fluid (Gf) and crystallized (Gc) intelligence somewhat in comparison to Wechsler’s VIQ and PIQ. Although most intelligence tests going back to the early Binet measures seem to have amply covered the more crystallized side, further research on fluid reasoning led to the development of four new Wechsler subtests that measure this construct more directly. Specifically, Matrix Reasoning (which first appeared in WISC-III and was then added to WAIS-III and WISC-IV, and retained in WAIS-IV and WISC-V), Picture Concepts (which first appeared in WISC-IV and was then added to WPPSI-III), and Figure Weights (which appeared for the first time in WAIS-IV, and has now been added to WISC-V).

The key point of this brief 75-year historical backdrop is that the Wechsler scales have changed substantially over the decades, keeping pace with rapid advances in the understanding of intelligence. Yet, without Dr. Wechsler’s far-reaching clinical insights, the field of intellectual assessment would not be where it is today. The WISC-V is a very different test than the one that Dr. Wechsler gave us—one that builds upon multiple modern theories of cognitive neuroscience informed by ongoing clinical and neuropsychological research.

Structure and Content of the WISC-V

Psychologists have come to recognize that while general mental ability measured by the FSIQ is a powerful metric for more global descriptions of a person’s cognitive abilities, the greatest clinical usefulness comes from an analysis of the index scores; those primary mental abilities that more specifically describe the key or most important components of intellectual and cognitive functioning. As we often state at workshops, 100 children all with FSIQs of 100 can show many different patterns of strengths and weaknesses among the primary cognitive abilities, leading to considerable variability in school achievement and many other facets of behavior in which intelligence plays a major role.

The WISC-V consists of five primary index scores: Verbal Comprehension Index (VCI), Visual–Spatial Index (VSI), Fluid Reasoning Index (FRI), Working Memory Index (WMI), and Processing Speed Index (PSI). Each of these five index scores is defined and measured by two primary subtests. Most of these five domains include secondary subtests, which are optional and when administered may provide additional information regarding performance in the respective domain. In later chapters we will more fully describe the index scores and their relevance in diagnostic assessment and program-intervention planning. The focus here is to provide an overview of the parts or subtests that comprise the whole as reflected in both the index scores and the FSIQ. As those familiar with the Wechsler tests will note, many of the subtests included in the WISC-V are psychometrically and clinically improved versions from earlier editions of the WISC and WAIS tests, whereas others were specifically developed to enhance the five factor model that now defines the newest addition to the Wechsler family. Figure 1.1 shows the structure of the WISC-V as defined by basic composition of the FSIQ, the five primary index scores, the five ancillary index scores, and the three complementary index scores.

Figure 1.1 Structure of the WISC-V as defined by basic composition of the FSIQ, the five primary index scores, the five ancillary index scores, and the three complementary index scores. Subtest descriptions are reused with permission from the WISC-V Manual (Wechsler,