Neurocognitive Profiles Associated With Limited English Proficiency in Cognitively Intact Adults

OBJECTIVE

The objective of the present study was to examine the neurocognitive profiles associated with limited English proficiency (LEP).

METHOD

A brief neuropsychological battery including measures with high (HVM) and low verbal mediation (LVM) was administered to 80 university students: 40 native speakers of English (NSEs) and 40 with LEP.

RESULTS

Consistent with previous research, individuals with LEP performed more poorly on HVM measures and equivalent to NSEs on LVM measures-with some notable exceptions.

CONCLUSIONS

Low scores on HVM tests should not be interpreted as evidence of acquired cognitive impairment in individuals with LEP, because these measures may systematically underestimate cognitive ability in this population. These findings have important clinical and educational implications.

Hierarchical Structure of the Wechsler Adult Intelligence Scale–Fourth Edition with an Egyptian Sample

The Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV) is one of the most well-known tests in the field of adult intelligence assessment. This study explores the validity of the Egyptian adaptation for the subscales of the WAIS-IV. Confirmatory factor analysis (CFA) indicated that the first-order, second-order, and bifactor models of both the five-factor Cattel–Horn–Carroll (CHC) and the four-factor structures fitted with the WAIS-IV. When the Arithmetic subscale was pathed to Perceptual Reasoning and Working Memory, the modified four first-order factor showed a better fit than any other model. Estimates of internal consistency revealed that Cronbach’s alpha was very high (.91) for the WAIS-IV scale and for four-factor structures (ranging from .81 to .95), while [Formula: see text] was low (0.61) for the WAIS-IV scale and for four-factor structures, ranging from 0.20 to 0.68. Overall, these findings provided adding evidence about the dimensionality of WAIS-IV with a new sample.

Impaired or Not Impaired, That Is the Question: Navigating the Challenges Associated with Using Canadian Normative Data in a Comprehensive Test Battery That Contains American Tests

It has been well documented that IQ scores calculated using Canadian norms are generally 2-5 points lower than those calculated using American norms on the Wechsler IQ scales. However, recent findings have demonstrated that the difference may be significantly larger for individuals with certain demographic characteristics, and this has prompted discussion about the appropriateness of using the Canadian normative system with a clinical population in Canada. This study compared the interpretive effects of applying the American and Canadian normative systems in a clinical sample. We used a multivariate analysis of variance (ANOVA) to calculate differences between IQ and Index scores in a clinical sample, and mixed model ANOVAs to assess the pattern of differences across age and ability level. As expected, Full Scale IQ scores calculated using Canadian norms were systematically lower than those calculated using American norms, but differences were significantly larger for individuals classified as having extremely low or borderline intellectual functioning when compared with those who scored in the average range. Implications of clinically different conclusions for up to 52.8% of patients based on these discrepancies highlight a unique dilemma facing Canadian clinicians, and underscore the need for caution when choosing a normative system with which to interpret WAIS-IV results in the context of a neuropsychological test battery in Canada. Based on these findings, we offer guidelines for best practice for Canadian clinicians when interpreting data from neuropsychological test batteries that include different normative systems, and suggestions to assist with future test development.

Getting Back to the Main Point

Miller et al. have challenged the findings of our two previous studies, based largely on the assumption that our findings are biased due to the clinical sample used. However, they fail to address the primary tenet of our studies, namely, that clinicians will obtain different scores on the Wechsler Adult Intelligence Scale-IV (WAIS-IV) depending on whether Canadian or American norms are used. This reply seeks to provide empirical evidence supporting the existence of such score differences even when nonclinical samples are used, and identifies some of the clinical decisions that are potentially affected by choice of normative data.

Intelligent Use of Intelligence Tests

It is well established that Canadians produce higher raw scores than their U.S. counterparts on intellectual assessments. As a result of these differences in ability along with smaller variability in the population’s intellectual performance, Canadian normative data will yield lower standard scores for most raw score points compared to U.S. norms. Two recent studies have questioned the utility of the WAIS–IV Canadian norms based on the performance of a mixed clinical sample of post-secondary students. These studies suggest that a greater proportion of cases from their mixed clinical samples fall below a full-scale IQ of 85 using the WAIS–IV Canadian norms than should be “expected.” The purpose of the current study is threefold: First, to summarize the consistent finding of Canada–U.S. differences on measures of ability and present new empirical analyses to demonstrate these results are not due to a smaller sample size for Canadian norms. Second, and most importantly, matched sample comparisons demonstrate that the proportion of low scoring individuals (FSIQ < 85) in mixed clinical samples is consistent with the rates published by recent studies, and not greater than expected. Third, we offer evidence-based advice to clinicians practicing in Canada on the appropriate use of Canadian norms for Canadian clients during an individual assessment of intellectual functioning.