1. IQ testing: time to move on?
Jenny Webb
Consultant Clinical Psychologist

2. An early question ...
“IQ as a score is inherently meaningless and not infrequently misleading as well. ‘IQ’ has outlived whatever usefulness it may once have had and should be discarded ... Combined scores such as the ‘Index Scores’ in Wechsler batteries may also obscure important information
obtainable only by examining
discrete scores”
(Lezak et al, 2004:22)

3. Mapping the territory History Reliability Validity IQ testing
Alternatives
Purpose
Context

4. The First World War 1916 Terman devised IQ score, based
Wechsler was an army test administrator
Used Alpha, Beta & Army Performance
tests in selection of recruits
1.7 M men tested
1916 Terman devised IQ score, based
on ratio of mental to chronological age
In the First World War, psychologists made themselves useful to the army by devising intelligence tests for recruits. Work by Binet in French schools was drawn upon to devise a verbal assessment known as the Alpha Tests. However, these were inaccessible to illiterate recruits, so some of the Ellis Island tests to devise non-verbal tests. These were known as the Beta tests.
In 1916 Terman published the Stanford-Binet intelligence test. It included the innovative Intelligence Quotient, which involved dividing the subject’s mental age by his chronological age and dividing the resulting figure by 100
Yerkes thought that introducing intelligence testing into the army could provide his entree into the Army Medical Corps. He other psychologists (including Wechsler) tested 1.7 M men. Yerkes did enter the army – the Sanitary Corps.

5. And after the war ...
Post-war use of tests in schools and acceptance of idea of fixed, inherited intelligence, in both US and Britain
Wechsler repackaged army tests for
psychiatric patients in asylums, with
new method of computing IQ scores
The birth of the IQ test as
we now know it in 1939 with
publication of the Wechsler-Bellevue
After the war the psychologists were no longer needed in the army and they took their battery of tests into schools and psychiatric hospitals.
Intelligence tests came to be widely used in American schools to identify feeble-minded students. And in England, in 1924 the Board of Education reported on the use of ‘psychological tests of educational capacity’ as a way of discriminating between normal and defective children (Digby, 1996). The idea of a fixed, inherited intelligence had taken root: “Thousands of people became fascinated by the (Binet-Simon) test, but most employed it while ignoring Binet’s insistence on the pliancy of intelligence” (Trent, 1994, p. 158).
After the war Wechsler, whilst working in an asylum, started to administer the Alpha and Beta tests to psychiatric patients. Eventually he hit on the idea of combining them into a single test, with Verbal and Performance scales. This was published in 1939 as the Wechsler-Bellevue Intelligence test.
He also devised a new method of computing IQ scores. This involved basing IQ score on comparison of subject’s score with those achieved by others in same age group

6. But what was being measured?
“to demand ... that one who would measure intelligence should first present a complete definition of it, is quite unreasonable ... Electrical currents were measured long before their nature was well understood” (Terman, 1916)
“Intelligence is what the
intelligence tests test”
(Boring, 1929)
“Statistical norms and values become incorporated within the very texture of conceptions of what is today’s psychological reality.” (Rose, 1991)
Testing has driven theoretical developments:
“The technical and instrumental forms that psychology has adopted for the demonstration and justification of theoretical propositions have come to delimit and shape the space of psychological thought itself ... Statistical norms and values become incorporated within the very texture of conceptions of what is today’s psychological reality.” (Rose, 1991)

7. Wechsler’s concept of intelligence
1944: The “capacity of the individual to act purposefully, to think rationally, and to deal effectively with his environment”
1981: “an overall competency or global capacity”
“Multi-faceted and multi-determined”
“A function of the personality as a whole – responsive to factors other than cognitive abilities” (‘conative’ variables)
(what IQ tests measure) “is not something which can be expressed by one single factor alone, say ‘g’” (Wechsler, quoted in Tulsky et al, 2003)

8. And in the WAIS-IV ... What it does ...
Validity established by extent to which results correlate with those of earlier intelligence tests, and correlations between result on subtests which comprise the four indexes
What it says ...
Validity refers to the degree to which evidence supports the interpretation of test scores for the intended purpose ... As a result, examination of a test’s validity requires an evaluative judgement by the tester
Evolving conceptualizations of validity no longer speak of different types of validity but speak instead of different types of validity evidence, all in service of providing information relevant to specific intended interpretation of test score.
(American Educational Research Association, in WAIS-IV Manual, 2008)
Manual states there is evidence for:
:a general factor of intelligence g
Hierarchical structure
8-10 broad cognitive domains that are ‘interrelated functionally and neurologically’
It claims ecological validity but no evidence is given for this

9. What does DSM-V say? The definition of LD is largely unchanged
But a proposal has been made to locate it within a group of conditions labelled ‘Neurodevelopmental Disorders’. ‘Mild mental retardation’ is to be placed at one end of a single spectrum that includes people with autistic spectrum disorders (Andrews et al, 2009).
Very few references taken from the LD literature

10. What does the BPS say?
In its response, the BPS recognised that the diagnostic systems for mental illness “fall short of the criteria for legitimate medical diagnoses”.
But as far as LD is concerned, the BPS said that:“the use of diagnostic labels has greater validity, both on theoretical and empirical grounds” (BPS, 2011).
No changes were suggested

11. What does it mean to ask about construct validity?
Based on the assumptions that:
the construct ‘really’ exists
it forms part of a theoretical network of propositions which yield falsifiable predictions (Boyle, 2001; Popper, 1963)
These assumptions are problematic, in the case of both intelligence, and hence with learning disability, which piggy-backs on the construct of intelligence

12. Theories of intelligence and LD
The definition of intelligence is still disputed.
Psychiatric diagnoses in general do not meet the criteria of construct validity given above
The definition of LD includes reference to adaptive function, which is one of the behaviours that the intelligence test seeks to predict
Poor reliability implies absence of validity

13. Reliability
Poor reliability applies not just to cut-off point but to standardisation in general including:
Method of recruitment of standardisation sample
Exclusion criteria
Very low numbers of people with LD in each age group
Assumption of normal curve, which probably does not apply in the low IQ range
Irregulaties in test administration by clinicians
Arbitrary changes in test content
Test items not standardised on PWLD

14. Ecological validity
Intelligence as measure by IQ correlates with academic performance, occupational achievement (Sternberg et al, 2001; Dickerson Mayes et al, 2009), and survival into old age (Deary et al, 2008)
But relationship to measures of adaptive behaviour only moderate (Whitaker, 2003)
IQ in PWLD a less significant contributor to self-determination than opportunity to make choices (Wehmeyer & Garner, 2003)

15. Historical relativity
We cannot assume that ‘learning disability’ equates with earlier labels for people seen as having cognitive impairments (Goodey, 2011). Abilities needed to function in different eras vary
The medicalisation of LD only occurred in the 19th Century with the institutional ascendance of the medical profession
There has also always been a political agenda, beginning with concern about property rights in Middle Ages
From the definition of LD given by the AAMR specified an IQ of one SD below the mean (ie IQ 85). In 1973 this was revised to raise the cut-off point to two SDs below the mean (ie IQ 70)

16. Cultural relativity ICD10 Diagnostic Criteria for Research
Detailed diagnostic criteria cannot be specified for mental retardation, since ‘low cognitive ability and diminished social competence, are profoundly affected by social and cultural influences’ (WHO, 1993: F70-7). Eg
Kenya: intelligence defined as “the ability to do without being told what needed to be done around the homestead”
Brazilian street children: may fail maths at school, but run successful street businesses
(Sternberg, 2001 on ‘Practical Intelligence’)
Taiwan: no precise translation of word intelligence, and related words include reference to qualities such as intellectual self-effacement
Practical intelligence (Sternberg, 2001)
“the ability to adapt to, shape and select real-world environments”
“there is a conflict between the kinds of intellige1nce valued by schooling and the kinds of intelligence valued by local communities”
How can we incorporate this into our assessments?
We lack an accepted definition of intelligence and therefore lack an adequate theoretical context for the definition of LD.
Since both intelligence and LD are social constructions, to seek a ‘true’ definition of LD is a fruitless endeavour.
LD can only be defined in relation to a particular social context; it is about relationships as well as individual cognitive function
We need to consider the definition of LD in relation to the purpose for which it is intended.

17. How is the WAIS used?
As a way of locating the person in relation to the hypothesised normal distribution of intelligence. They may then be labelled as ‘having’ or ‘not having’ a LD and services may be allocated on this basis.
As a test of discrete cognitive functions eg verbal expression, visuo-spatial ability, though most of the tests involve multiple cognitive functions.

18. Alternative models of cognitive assessment
Neuropsychological (localisation/functional interconnections) (Lezak et al, 2004; Luria, 1970)
Developmental (Hogg & Sebba, 1986)
Developmental cognitive neuropsychology (Karmiloff-Smith, 1995)
Capacity to learn (Feuerstein R & Rand Y, 1998)
Environmental demands/supports (AAMR, 1992)
Central role of non-cognitive variables (Raven & Raven, 2008)

19. Social implications
Intelligence testing has always served a social function, at its worst associated with labelling, stigma, discrimination, eugenic solutions, racism, imprisonment and control of reproduction eg: “intelligence tests ...will ultimately result in curtailing the reproduction of feeblemindedness and the elimination of an enormous amount of crime, pauperism, and industrial inefficiency” (Terman, quoted in Minton, 1988).
In my experience IQ score is currently used as way of rationing services. ‘Mild’ LD is equated with low risk or mild problem. This is regardless of the actual level of risk the person faces.
A moral dimension attaches to this discrimination, so that certain people are seen as not only ineligible but undeserving of services. This is reminiscent of Victorian distinction between the deserving and undeserving poor.
An alternative story could be told about the eugenic philosophy which drove intelligence testing, and to which many, if not most, of the early psychologists subscribed
Eg results of army recruits on the Alpha and Beta tests were used as evidence of the racial inferiority of Negros.
In the Uk eugenics was linked to Victorian ideas of the deserving and undeserving poor – an idea which is barely disguised in the rationale which is sometimes given for cuts to services.
(1913 Mental Deficiency Act

20. Stephen, aged 25 Prospective father
Born with cerebral palsy, and has hearing impairment
Has a troubled history
Is very chatty and appears capable
Refused service from both LD SS and Locality SS team
ABAS results:
General Adaptive Composite (per. rank 3)

21. Stephen’s WAIS results
Scaled Score
Similarities 4
Digit Span 6
Vocabulary 4
Arithmetic 3
Information 8
Composite Percentile Score Rank
Verbal Comprehension Index
Perceptual Reasoning
Working Memory
Processing Speed
Full Scale IQ
Scaled Score Block Design 6 Matrix Reasoning 6 Symbol Search 9 Coding 4

22. Stephen’s OT AMPS Assessment (Assessment of Motor & Process Skills)
Standard score Percentile rank
*ADL Motor < 1.0
^ADL Process <45 < 1.0
*Observable, goal-directed actions enabling a person to move themselves or task objects
^Observable, goal-directed actions that are used to logically organise & adapt behaviour in order to complete a task

23. Stephen’s OT Report Difficulties in eg:
Positioning body, reaching for objects, manipulating & carrying objects, coordination, walking
Distraction, carelessness, organisation, anticipating change & responding to problems, learning from experience
Conclusions: safety issues; limited potential to learn new skills; need for compensatory strategies

24. Stephen’s SALT Report, after initial visit
Tangential conversation
Reluctant to say he does not understand
Literal interpretation
Difficulty in understanding negatives, prepositions, reversible sentences, comparatives, plurals, complex sentences
Unable to tell the time
Acquiescent, leading to frustration & anger

25. How should we report on Stephen’s LD assessment?
Say he has not ‘got’ a learning disability?
Produce a long and
nuanced report?
Fiddle the results?
McKenzie K, Murray G C &Wright J (2004) Adaptations and accommodations: the use of the WAISIII with PWLD Clinical Psychology 43, 23-6

26. A different direction? Leave definition of ID to the
psychiatrists and redefine LD
in a clinically meaningful way
There are several suggestions which we can draw on. These mostly include the concepts of:
age of onset
cognitive function
adaptive function
risk
vulnerability

27. Alternative definitions of LD
Flynn (2000) suggests the use of direct tests of impaired adaptive behaviour to assess intellectual disability.
Greenspan & Switzky (2006) suggest defining ID in terms of deficits of conceptual, practical and social intelligence that result in a need for supports in order to succeed in culturally relevant roles
Greenspan et al (2011) suggest that impairments are demonstrated by the person’s history of academic, practical and social risk
Whitaker’s (2008) definition links competence, environmental demands, intellect, risk and distress.
Raven & Raven (2008) suggest finding out what interests the person, and then how good they are at the cognitive functions needed for this task. 

28. Another suggestion ...
“The learning disabled are those people who, due to cognitive deficits beginning at birth or during childhood, are unable to fulfil social roles in a way that is expected in a particular society at a particular time, and hence are considered to be at risk, practically, physically, socially or emotionally.” (Webb, 2014)

29. Link between LD definition, formulation and intervention
BPS Good Practice Guidelines on Formulation: recent moves within Clinical Psychology to begin to "develop coherent, credible alternative forms of categorisation which are based on psychological theory and which have direct implications for both aetiology and intervention" (BPS, 2011)

30. Whatever we decide ...
I hope we will not collude in withholding of services to very vulnerable people by continuing to use a definition of learning disability which is theoretically & methodologically unsound. I hope that today we can begin to seek a definition which is both meaningful and helpful to our very vulnerable clients

31. Selected references re definition
BPS (June 2011) Response to American Psychiatric Association: DSM-V Development Flynn J R (2000) The hidden history of IQ and special education Psychology, Public Policy and Law, 6, 1, Greenspan S & Switzky N (2006) What is Mental Retardation? Ideas for an evolving disability in the 21st Century Washington DC: AAMR Greenspan et al (2011) Intelligence involves risk-awareness and intellectual disability involves risk-unawareness: implications of a theory of common sense Journal of Intellectual and Developmental Disability 36, Raven J & Raven J eds (2008) The Uses & Abuses of Intelligence NY: Royal Fireworks Press Webb J (2014) A guide to psychological understanding of people with learning disabilities: eight domains and three stories London: Routledge Whitaker S (2008) Intellectual disability: a concept in need of revision? British Journal of Developmental Disabilities 54(1) 3-9

32. Other references
Andrews G et al (2009) Exploring the feasibility of a meta-structure for DSMV and 1CD11: could it improve utility and validity? Psychological Medicine 39,
Boyle M (2000) Schizophrenia: a Scientific Delusion?
BPS (2011) Good Practice Guidelines on the Use of Psychological Formulation Leicester: BPS
Feuerstein R & Rand Y (1998) Don’t Accept Me As I Am Arlington Heights: Skylight
Flynn J R (2000) The hidden history of IQ and special education Psychology, Public Policy and Law, 6, 1, 191-8
Goodey CF (2011) A History of Intelligence and Intellectual Disability: the shaping of Psychology in early modern Europe Farnham: Ashgate
Luria A R (1970) The functional organisation of the brain Scientific American 222 (3)

33. Other references cont’d
McKenzie K, Murray G C &Wright J (2004) Adaptations and accommodations: the use of the WAISIII with PWLD Clinical Psychology 43, 23-6
Murdoch S (2007) IQ testing: the brilliant idea that failed London: Duckworth Overlook
Popper K (1963) Conjectures and refutations London: Routledge
Russell E W (2010) The ‘obsolescence’ of assessment procedures Applied Neuropsychology 17, 60-67
Sternberg R J et al (2001) The predictive value of IQ Merrill-Palmer Quarterly 457(1), 1-41
Wehmeyer M L & Garner N W (2003) The impact of personal characteristics of people with intellectual and developmental disability on self-determination and autonomous functioning Journal of Applied Research in Intellectual Disabilities 16,