A Comparison of WAIS‐R and WAIS‐III in the Lower IQ Range: Implications for Learning Disability Diagnosis

Background Whether the Flynn effect (the increase in the populations’ IQ over time) affects the IQ scores of people with learning disability or borderline learning disability remains unclear. The issue is important as the Flynn effect should alter the number of people eligible for health service resources. A comparison of the Wechsler Adult Intelligence Scale‐Revised (WAIS‐R) with the Wechsler Adult Intelligence Scale‐Third Edition (WAIS‐III) in individuals with learning disability or borderline learning disability was conducted. Method All participants completed the WAIS‐R and the WAIS‐III. Discrepancy scores were calculated for the Full Scale IQ score and the Verbal and Performance subscale scores. Results WAIS‐III Full Scale scores were significantly lower by over 4 IQ points. Verbal and Performance Scale IQ scores were also significantly lower than the corresponding WAIS‐R scores. Conclusion The shift from WAIS‐R to WAIS‐III means that 66% more people meet criterion A for the diagnosis of learning disability and hence this has major resource implications for health service providers.     

The Distribution of Scaled Scores and Possible Floor Effects on the WISC‐III and WAIS‐III

Objective It has been suggested that, as the Wechsler Adult Intelligence Scale‐Third Edition (WAIS‐III) and the Wechsler Intelligence Scale for Children‐Third Edition (WISC‐III) give a scaled score of one even if a client scores a raw score of zero, these assessments may have a hidden floor effect at low IQ levels. The study looked for indications of this in a sample of assessments that had been given for clinical and diagnostic reasons. Design The degree to which a hidden floor effect could be present was assessed by looking at the proportion of scaled scores of one in IQ bands: 50–59, 60–69 and 70 plus and by plotting the distribution of scaled scores in these bands for both the WISC‐III and WAIS‐III. Method Fifty WISC‐III and 49 WAIS‐III assessments were obtained from records and analysed. Results The distribution of scaled scores in the WAIS‐III was approximately normal with very few scale scores of one, suggesting that a hidden floor effect would only be a potential problem for IQs in the 40s and 50s. The WISC‐III had a skewed distribution of scaled scores with more scaled scores of one than any other scaled score. Scaled scores of one were shown in all IQ levels up to 70 plus. Conclusions There is potentially a significant floor effect on the WAIS‐III at IQs in the 40s and 50s and on the WISC‐III up to IQs in the 70s. There are also indications that the WISC‐III has a much harder criterion for gaining a scaled score of two than the WAIS‐III, resulting in it producing lower IQs.     

Coins and Costs: A Simple and Rapid Assessment of Basic Financial Knowledge

Introduction We describe a simple and rapid screening test for basic financial knowledge that is suitable for administration to people with mild intellectual disabilities. Method The Coins and Costs test asks respondents to name coins, and to estimate prices of objects ranging between £1 (an ice cream) and £100K (a small house). The test was administered, alongside a battery of neuropsychological tests, to 40 people attending day services (mean Full‐Scale IQ = 59.1). Results Total scores were normally distributed, and correlated significantly with receptive language ability and performance on memory tests, but not with IQ or executive functioning. Conclusion The test provides a rapid (<5 min) screening test that has good psychometric properties and appears very suitable for assessing basic financial knowledge of people with mild intellectual disabilities.     

Talking About Real‐life Events: An Investigation Into the Ability of People with Intellectual Disabilities to Make Links Between Their Beliefs and Emotions Within Dialogue

Background This study compares how people with and without intellectual disabilities talk about events, beliefs and emotions in dialogues about real‐life, emotive events and in a structured task assessing understanding of cognitive mediation. Materials and Methods A cognitive‐emotive interview was used to assist 19 adults with intellectual disabilities and 19 adults without disabilities in generating an account of an emotive, interpersonal event. Participants also completed a cognitive mediation task and an assessment of intellectual and verbal ability. Results Between‐group analyses indicated that participants with intellectual disabilities scored significantly lower than those without disabilities on the cognitive‐emotive interview and the cognitive mediation task. Participants with intellectual disabilities generated fewer beliefs within their dialogues and were less likely to provide alternative perspectives on events. Within‐group comparisons showed no significant association between the ability to talk about events, beliefs and emotions within a dialogue and performance on a cognitive mediation task, or with Full Scale or Verbal IQ scores. Conclusions Participants with intellectual disabilities had more difficulties than those without disabilities in talking about events, beliefs and emotions. Within a therapeutic context, they are likely to require assistance to reflect on events and consider alternative interpretations, which take into account individual and environmental factors. Future therapeutic developments may benefit from placing greater emphasis on emotional understanding and the intuitive links that people make between events and emotions.     

A SURVEY OF INTELLECTUAL DISABILITIES AMONGST MEN ON REMAND IN PRISON

Men detained in a South London prison on remand were screened for intellectual disabilities (mental handicap) over a three-month period. Of 157 men screened, 33 reported having intellectual disabilities. Twenty-one of these completed the General Health Questionnaire (GHQ) and were tested for IQ (on the WAIS-R), for reading and numeracy (on the British Ability Scales). An equal number of men were selected for the control group, on a ‘next man in’ basis, and they were assessed in an identical way. None of the index men had an IQ in the intellectual disabilities (mental handicap) range but the mean Verbal IQ, mean Full Scale IQ, mean reading age and mean numeracy age were all significantly lower in the index group than in the control group. Moreover, the index group had significantly higher scores on the GHQ and often had a recent history of mental illness or psychiatric hospital admission. It is concluded that men with intellectual disabilities were not over-represented in prison but that there were a number of men close to the disability range who were psychologically very vulnerable.     

Cognitive Therapy Abilities in People with Learning Disabilities

Background There is a need to develop and adapt therapies for use with people with learning disabilities who have mental health problems. Aims To examine the performance of people with learning disabilities on two cognitive therapy tasks (emotion recognition and discrimination among thoughts, feelings and behaviours). We hypothesized that cognitive therapy task performance would be significantly correlated with IQ and receptive vocabulary, and that providing a visual cue would improve performance. Method Fifty‐nine people with learning disabilities were assessed on the Wechsler Abbreviated Scale of Intelligence (WASI), the British Picture Vocabulary Scale‐II (BPVS‐II), a test of emotion recognition and a task requiring participants to discriminate among thoughts, feelings and behaviours. In the discrimination task, participants were randomly assigned to a visual cue condition or a no‐cue condition. Results There was considerable variability in performance. Emotion recognition was significantly associated with receptive vocabulary, and discriminating among thoughts, feelings and behaviours was significantly associated with vocabulary and IQ. There was no effect of the cue on the discrimination task. Conclusion People with learning disabilities with higher IQs and good receptive vocabulary were more likely to be able to identify different emotions and to discriminate among thoughts, feelings and behaviours. This implies that they may more easily understand the cognitive model. Structured ways of simplifying the concepts used in cognitive therapy and methods of socialization and education in the cognitive model are required to aid participation of people with learning disabilities.     

Association between employment status and quality of life for individuals with intellectual or developmental disability

The current study examined how employment conditions (competitive employment, work center employment, unemployment) are associated with the quality of life (QoL) for individuals with intellectual or developmental disabilities. Using the Comprehensive Quality of Life Scale – Intellectual/Cognitive Disability (5th Edition; ComQoL-I5; Cummins, 1997a) to measure objective QoL factors, and the PWI-ID (Personal Wellbeing Index – Intellectual Disability, 3rd Edition; Cummins & Lau, 2005b) to measure subjective well-being, participants answered self-reporting questions regarding the seven QoL domains. Kruskal–Wallis H for Oneway Analysis of Variance was used to determine statistical significance between comparison work conditions. Results indicate significant findings in the objective QoL domains of Material Well-Being, Productivity, and Safety between the work conditions for individuals with intellectual and developmental disabilities, with participants in the competitive-employment group reporting the highest QoL objective scores in these areas. Implications of these findings for practice and research are discussed.     

‘Diagnostic Overshadowing’ Amongst Clinicians Working with People with Intellectual Disabilities in the UK

Background Mental health problems are known to be hard to recognize in people with intellectual disabilities. One factor that may contribute to this is the diagnostic overshadowing bias, which describes the tendency of the clinicians to overlook symptoms of mental health problems in this client group and attribute them to being part of ‘having an intellectual disability’. Although a small amount of research has investigated this in the USA, very little has taken place in the UK. Materials and methods Two clinical vignettes were produced. Both described identical clinical problems, except that one vignette described a man with an IQ of 58 and impaired social functioning (i.e. an intellectual disability) and one a man with an IQ of 108 and normal social functioning (i.e. non‐intellectually impaired). Psychiatrists (n = 274) and clinical psychologists (n = 412) throughout UK were randomly assigned to either the low IQ or normal IQ condition, and sent a corresponding clinical vignette. Results One hundred and thirty‐three psychologists and 90 psychiatrists responded. Diagnostic overshadowing did appear to be present. Clinicians were more likely to recognize a range of symptoms in those with IQs in the normal range than those with intellectual disabilities. Furthermore, psychiatrists appeared more likely to make this error under some circumstances than clinical psychologists. Conclusions Diagnostic overshadowing may contribute to the difficulties that mental health professionals commonly experience in identifying mental health problems in people with intellectual disabilities. However, the methodology commonly used in this type of research has a number of weaknesses, and would benefit from an alternative approach.     

Relationship of Cognitive Functioning and Aggressive Behavior with Emotionally Disabled and Specific Learning Disabled Students

This study investigated the relationship between cognitive functioning and Emotionally Disabled (ED) and Specific Learning Disabled (SLD) students' aggressive behavior. Secondarily, it was of interest to examine the two groups' academic functioning and social factors related to aggressive behavior. Data were analyzed using initial and most recent Wechsler Intelligence Scale for Children, Third Edition (WISC-III) scores and Woodcock—Johnson—Revised (WJ-R) scores obtained from students' special education folders. District discipline records and local juvenile court records were searched for documentation of participants' aggressive conduct disorder (CD) behavior. The sample consisted of 322 special education students from an urban school district in the American Southwest. Of this sample, 168 students had been previously identified as ED and 154 as SLD. Seventy percent were males and 30% were females, which approximated the gender distribution of the district's special education population. The ethnic distribution of the sample included White (67%), Hispanic (24%), Black (7%), and other (2%), which was representative of both the district and its special education population. Results indicated that ED and SLD students identified as aggressive demonstrated significantly lower initial WISC-III Verbal IQ scores in comparison to their initial Performance IQ scores. However, this relationship was not observed in subsequent testing. ED students demonstrated a significant decrease in WISC-III Full Scale IQ scores when initial and most recent scores were compared. In addition, aggressive ED students demonstrated a significant decrease in WISC-III Verbal IQ scores. Also, both aggressive ED and aggressive SLD students demonstrated a significant decrease in WJ-R Broad Math scores whereas nonaggressive students' scores showed no significant change. Furthermore, aggressive behavior was negatively related to families' social status; students from single-parent households had a significantly higher incidence of reported aggressive behaviors. No relationship between aggressive behavior and either ethnicity or gender was found.     

颞叶癫痫患者的认知功能与MRI和DTI的关系研究

目的:研究颞叶癫痫患者认知功能及其与核磁共振(MRI)和弥散张量成像(DTI)的关系。方法:选取我院36例颞叶癫痫患者为癫痫组,36例同期体检健康者为对照组,分别采用简易精神状态量表(MMSE)、韦氏成人智力量表(WAIS)进行认知功能评估及MRI、DTI检查,对比2组大脑感兴趣区的平均扩散率与部分各向异性值,分析其认知功能与影像学表现的关系。结果:癫痫组的MMSE、WAIS评分均较对照组低(P均0.05);癫痫组的左右丘脑与左右内囊后肢部分各向异性值均低于对照组(P均0.05);左内囊后肢、左内囊膝部及左丘脑平均扩散率与WAIS评分呈负相关(P均0.05),左内囊前肢、左枕叶部分各向异性与MMSE评分呈正相关(P均0.05),左枕叶部分各向异性与操作智商呈正相关(P0.05),右枕叶部分各向异性与全量表智商、语言智商及操作智商呈正相关(P均0.05)。结论:颞叶癫痫患者存在一定程度的认知功能障碍,MRI和DTI可有效检出患者脑组织受损处与评估受损程度。     

Assessing Components of Empathy in Sex‐ Offenders with Intellectual Disabilities

Background Because of a lack of research investigating empathy in sex offenders with intellectual disabilities, this study explored empathy in sex offenders and non‐offenders with intellectual disabilities. Specific aims were to explore differences between these groups on measures of the components of empathy. Methods The scores of 21 sex‐offenders and 21 non‐offenders with intellectual disabilities, matched by age, gender and IQ, were compared on the Test of Emotional Perception. Results No differences were found between the two groups across the components of empathy. However, sex offenders who had received treatment performed better on tasks of emotion recognition, emotion replication and response decision than the non‐offenders. Conclusions Further research is needed to understand empathy in sex offenders with intellectual disabilities before any recommendations can be made regarding treatment programmes.     

Supported Employment for People with Intellectual Disability: The Effects of Job Breakdown on Psychological Well‐Being

Background This paper focuses on the transition to supported employment for people with intellectual disabilities paying particular attention to the impact of job breakdown on psychological well‐being; an issue often omitted from studies. Materials and Methods Forty‐nine people with intellectual disabilities were interviewed within 3 months of entering supported employment and 9–12 months later. Data collection involved in‐depth interviews with people with intellectual disabilities, their carers and employers and completion of a self‐report measure of depression and anxiety (an adapted form of the Hospital Anxiety and Depression Scale), and a self‐report measure of quality of life (the ComQol). Results By time of the follow‐up interviews, 13 of the 49 jobs had broken down. Analysis of scores measuring quality of life, anxiety and depression showed no effect for loss of employment. However, interviews with participants indicated that job loss had a considerable impact on those affected. Conclusions There were a wide range of reasons for job breakdown, many of which were particular to the circumstances of people with intellectual disabilities. Although job breakdown does not have an impact of anxiety or depression many participants found job loss traumatic.     

The Prevalence,Incidence, and Factors Predictive of Mental Ill‐Health in Adults with Profound Intellectual Disabilities

Background There are no previous studies of the prevalence and incidence of mental ill‐health in adults with profound intellectual disabilities. Method In this population‐based prospective cohort study, adults with profound intellectual disabilities underwent psychiatric assessment (n = 184), with further assessment after 2 years (n = 131). Results Point prevalence of mental ill‐health was 52.2% by clinical, 45.1% by Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities (DC‐LD), 10.9% by the ICD‐10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research (1993) (DCR‐ICD‐10) and 11.4% by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (2004) (DSM‐IV‐TR) criteria. The highest 2‐year incidence rates were for affective disorders (6.1%) and problem behaviours (6.1%). Type of accommodation/support, and the number of preceding life events were predictive of incidents of mental ill‐health, but age, gender, living in areas of greatest deprivation, and having special communication needs were not. Conclusions Mental ill‐health is more commonly experienced by adults with profound intellectual disabilities than the general population, or other adults with intellectual disabilities, warranting proactive supports/interventions. Predictive factors differ, compared with the general population.     

Uses of Rasch scaling in the measurement of cognitive development and growth

This report describes two types of findings: (a) the consistency between two major cognitive tests in terms of their developmental scales based on item-response theory, and (b) the initial development of ideas and methods for the revival of the classic concept of ratio IQ. The ratio IQ (e.g., Stanford-Binet, 1937) was formed by the division of mental age (derived from test performance) by chronological age multiplied by 100. Following a multitude of criticisms about the scaling qualities of the ratio IQ, it was mostly abandoned by the major intelligence batteries, beginning with the Wechsler scales in the 1940's, in favor of standard scores. This study presents a new approach to age equivalence scores as a basis for mental age, and the calculation of ratio IQ, based on Rasch-model item response theory. The new ratio IQ was compared statistically with standard-score IQ (mean 100, SD 15) from the Leiter International Performance Scale--Revised (Leiter-R) and from the Woodcock-Johnson Psychoeducational Battery--Revised (WJ-R). The essential element of the new ratio IQ is the W-scale, a Rasch-based score employed in the WJ-R and in the Leiter-R. Mental age was estimated from the W-scale estimate of ability and chronological age from a W-scale age equivalence for each month of age. Statistical results showed a highly similar growth curve for the W-scale scores on the Leiter-R and the WJ-R, even though the two scales have different content and standardization samples. Also, high correlations were found between the new ratio IQ and standard-score IQ (e.g., correlations ranging from .87 to .95 depending on age range). Criterion-related evidence of validity was found in the correlation of .82 between the new ratio IQ and the Wechsler Intelligence Scale for Children--Third Edition (WISC-III) standard-score IQ and in correlations with achievement-test scores. Finally, the ratio IQ showed predictable mean differences between groups of children with typical cognitive ability, cognitive delay levels of performance and giftedness. The standard deviation of the new ratio IQ was somewhat variable across age groups, however, so new interpretive guidelines would be needed if the new index is to employed in published tests. Implications of the scaling methods are discussed.     

Exploring How Knowledge Translation Can Improve Sustainability of Community‐based Health Initiatives for People with Intellectual/Developmental Disabilities

Community‐based health initiatives (CBHI) play an important role in maintaining the health, function and participation of people with intellectual/developmental disabilities (I/DD) living in the community. However, implementation and long‐term sustainability of CBHI is challenging. The Promoting Action on Research Implementation in Health Services ( PARiHS) is a knowledge translation (KT) framework that is particularly relevant to intellectual/developmental disabilities research as it identifies the barriers and facilitators of implementation and action plans. This framework provides a foundation for understanding how KT can be used to aid the implementation and sustainability of CBHI for people with intellectual/developmental disabilities. The following study explores how KT – specifically the PARiHS framework – can be used to help sustain CBHI for people with intellectual/developmental disabilities.     

50例学习困难儿童智力水平分析及相应指导

对５０例学习困难儿童的智力水平进行评定,采用韦氏儿童智力量表中国修订本（ＷＩＳＣ－ＣＲ）,对每个儿童进行测试,计算出各分测验量表分和总智 商,结果显示：多种原因导致了儿童学习困难;各类学习困难儿童测验结果不同;男孩子多于女孩,对智力特点不同的学习困难儿童进行ＷＩＳＣ－ＣＲ分析,为医护人员进行早期干预,治疗矫正提供了有力依据。     

Quality of Life for the Camberwell Cohort

Background Despite the acknowledged difficulties of measuring satisfaction for people with intellectual disabilities, the current study examined the quality of life (QoL) of the Camberwell Cohort, a total population sample of people with severe intellectual disability and/or autism [ Wing & Gould, Epidemiology and Classification, 9 , 1979, 11 ]. Methods The Lifestyle Satisfaction Scale (LSS) [ Harner & Heal, Research in Developmental Disabilities, 14 , 1993a, 221 ] was combined with selected questions from the Quality of Life Questionnaire Schalock & Keith 1993 , Quality of Life Questionnaire, IDS Publishing Corporation, Worthington and conducted with 12 people with intellectual disabilities and 72 proxy respondents. Results Inter‐rater reliability on overall score was available for 10 participants and was acceptable with a Spearman’s Rank order correlation co‐efficient over 0.8. There were no significant differences between the scores of proxies and service users on the domains of the LSS. The sample of service users who completed the interviews was too small to allow further detailed analysis of their responses. However, responses from the proxy interviews indicated that there were no differences in life satisfaction between those socially impaired and socially able. However those with autism were reported to be less satisfied on Community Satisfaction while those with challenging behaviour had lower scores overall and specifically on Community Satisfaction. Those with an IQ below 50 had lower scores overall, than those with an IQ above 50 and specifically on Recreation Satisfaction. Linear regression analysis on total QoL score indicated that only three variables seemed to be important in predicting proxy QoL scores: challenging behaviour at Time 3, IQ at Time 3 and independent living skills at Time 1. Conclusions Despite the difficulties encountered, this study provided some support for the widely help belief that QoL is lower for those with intellectual disability and for those with challenging behaviour.     

The Intellectually Disabled Offender: Methodological Problems in Identification

Background Reliable evidence concerning the prevalence of intellectually disabled offenders that would inform the clinician's approach to the assessment and management of risk is in short supply. This paper aims to assist the clinician in interpreting the available evidence. Methods A literature search was conducted for all years up to January 2003. Each study was first examined for the methods employed to define and measure intellectual disability. Then, the effect of this on prevalence estimates was considered. Results A wide range of methods has been used to ascertain the presence of intellectual disability – administrative definitions, psychiatric diagnosis, educational background, self‐report and direct measurement of IQ and adaptive behaviour. Conclusions Most studies reviewed used less than adequate ascertainment methods. Reliable answers to two key questions – which offenders have intellectual disabilities and which people with intellectual disabilities offend – therefore remain elusive.     

The Development of a Health Status Measure for Self‐report by People with Intellectual Disabilities

Background Health status is an important domain of quality of life of people with intellectual disabilities. This paper describes the development of a self‐report health status measure for use with people with intellectual disabilities living in staffed community‐based accommodation, and reports preliminary reliability data for the schedule. Method Question and response items were adapted from a well‐established measure (SF‐36) used in the general population incorporating subscales such as General Health, Physical Functioning, Bodily Pain, Vitality, Mental Health, and Sensory Functioning. A variety of closed and open response formats were used based on the growing literature examining methods for interviewing people with intellectual disabilities. Results Internal reliability and response consistency were investigated. Reliability for Physical Functioning, General Health and Bodily Pain was reasonable, but was unsatisfactory for Sensory Functioning, and Mental Health. Conclusions The findings are discussed in light of the challenge of eliciting reliable responses from people with intellectual disabilities. Question methodologies can be built upon in further research.     

奥氮平对首发精神分裂症患者疗效及认知功能的影响

目的探讨奥氮平对首发精神分裂症患者的疗效及认知功能的影响。方法对31例首发精神分裂症患者给予口服奥氮平治疗,观察12w。于治疗前后采用阳性症状量表、阴性症状量表、简明精神病量表评定临床疗效,采用韦氏成人智力量表、韦氏记忆量表、韦斯康星卡片分类测验评定患者的认知功能。结果奥氮平治疗12w末,入组患者阴性症状和阳性症状均有明显改善,不良反应轻微;阳性症状量表、阴性症状量表、简明精神病量表评分均较治疗前显著下降（P〈0．01）;韦斯康星卡片分类测验中的错误应答数较治疗前显著下降（P〈0．01）,非持续性错误也有显著下降（P〈0．05）;韦氏记忆量表中的再生、理解、记忆商因子分均显著高于治疗前（P〈0．05）。结论奥氮平治疗精神分裂症疗效显著、安全性高、依从性好,同时又能显著提高患者的部分认知功能。