What Does Your IQ Score Actually Tell You? | WAIS-5 Explained

Dr Marianne Trent (: 00:00:00

What does an IQ score actually tell you about a person and why is the answer much more complicated than just one number? For more than 70 years, the WAIS has been part of the way psychologists have tried to answer that question. But across those seven decades, both the test itself and the way we understand intelligence have changed enormously. Today, we're tracing how one of psychology's most famous assessments evolved, but also what those scores can mean for a real person's life. I'm joined by Dr. Keith Jenkins, consultant neuropsychologist, who has worked with different versions of the WAICE across his career and has also been part of my professional journey too. Hi, welcome along to Psychology Actually. I'm Dr. Marianne Trent, a qualified clinical psychologist, and I'm joined here today by Dr. Keith Jenkins, a lead consultant neuropsychologist. We are discussing all things cognitive assessment, and we are very proud to be in partnership today, sponsored by Pearson, because we are talking about the history of the WAIS-V, which stands for the Wechsler Adult Intelligence Scale Version five.

(: 00:01:18

Keith and I are really excited to get started and to kind of guide you through this 70 plus years history. Welcome along, Keith. Lovely to have you here.

Dr Keith Jenkins (: 00:01:28

Hi, Marion. Thank you. It's great to be here and yeah, a fascinating topic.

Dr Marianne Trent (: 00:01:32

Yeah, absolutely. I totally agree. It's going to be a really interesting episode. Now, of course, because of the nature of podcast episodes, people might be accessing this for a variety of reasons. Perhaps they haven't picked up a WAIS, haven't done any adult assessment in a while. Perhaps the first time ever, they're looking to prepare and gather some insight, or maybe someone is undergoing cognitive assessment themselves or knowing or supporting someone who is, and they're just looking for a little bit of an idea about what it's all about really. So we're hoping that this is going to be a multi-use episode and that people will find it really interesting. But before we get into the history of it and what it is, let's cover a quick fire question round.

Dr Keith Jenkins (: 00:02:16

Okay, I'm ready.

Dr Marianne Trent (: 00:02:18

Okay. So what is a WAIS?

Dr Keith Jenkins (: 00:02:22

Well, a WAIS Marion is the Wechsler Adult Intelligence Scale. It's a measure of cognition that's thinking and reasoning that can be administered by psychologists or suitably qualified professionals. And it comprises a whole range of different tasks, a bit like problem solving, puzzling, but very much standardised and designed to access underlying abilities.

Dr Marianne Trent (: 00:02:49

Amazing. Really interesting. It's bringing back lots of lovely memories. Okay, onto our next question. What kind of clients might we actually consider for a WAIS assessment?

Dr Keith Jenkins (: 00:03:02

Well, the history of using assessments like the WACE is quite wide ranging. So it has been used historically to vet people for military positions or by large companies to see if they were recruiting the most bright and able potential staff. But from a psychologist's point of view, we're likely to be calling upon the WAICE if we referred somebody where there are concerns about their cognition or reasoning abilities.

Dr Marianne Trent (: 00:03:32

Absolutely. Could not agree more. Thank you. Next question. What are some of the main reasons a psychologist or clinician might use a WAICE?

Dr Keith Jenkins (: 00:03:42

Well, probably in clinical practise, it's going to be if maybe a family member, the individual themselves, or potentially other health colleagues have raised a concern about someone's cognitive ability, some concern about some aspect of their reasoning or functioning, which suggests perhaps a change from what people have experienced from them in the past. So the idea would be then to administer a WACE, which is a standardised measure of abilities, and then to compare the current score with what might be reasonably expected for that person, all other things being equal. And there are a range of things that a psychologist can use to predict and come up with an expectation as to what someone's scores ought to be. So it does enable us to see if things are changing.

Dr Marianne Trent (: 00:04:37

Yeah, it really does. And it's bringing back memories for me that actually when families or kind of friend groups have spent more time together with people than they might usually spend for longer periods of time, such as over Christmas or celebrations, you might start to notice those changes in someone. So I seem to remember that you might suddenly get an influx of referrals for cognitive assessments or cognitive changes at that time. Let's have a look at our next quick fire question. So is a WAICE just an IQ test, Keith?

Dr Keith Jenkins (: 00:05:08

It's not just an IQ test. So it can do much more than come up with a single figure, which is properly known as someone's intelligence quotient or IQ. The WAIS is based upon a theory and understanding of intelligence that sees it comprised of different components, if you like, different processing modules within our brains. And so the WAIS accesses those different modules by having different tasks. So as well as giving us an IQ figure, it breaks down someone's functioning into those different modules and different patterns of strength and relative weakness.

Dr Marianne Trent (: 00:05:48

Thank you so much. That was put really, really well. Can the results genuinely inform someone's care or treatment plan?

Dr Keith Jenkins (: 00:05:58

Absolutely. I mean, the results allow you to look at someone's performance on a standardised measure and then try and link that potentially to some historical information. Maybe they've had an accident and have suffered a brain injury. You may even have scanning evidence. So you can have a reasonable expectation as to what processing modules in that person's brain may be compromised. And then the results on the WAIS will tell you whether that actually is the case, that maybe someone, for example, has a reduced ability to manipulate numbers, a reduced ability to pay attention and hold information in a temporary store whilst they think about it. A whole range of different cognitive tasks that we all very much take for granted that may change following an accident or injury or can change due to illness. And the biggest illness that can cause change that psychologists may use a WAIS for will be something like a dementia.

Dr Marianne Trent (: 00:06:59

Yeah. And I know when I've worked with someone with traumatic brain injuries or organic change such as dementia, actually being able to see that someone still has the relative strengths can be really validating and really, really important for someone's self-esteem and self-worth, but also for how their family can then help them to thrive more optimally.

Dr Keith Jenkins (: 00:07:20

And that's really true. I can think of people where I've done assessments with them, maybe a range of measures and it might show that someone's memory is really very, very poor, maybe because of accident or because of dementia. But then you can often contrast that with some really strong performances on the WAIS that show that their preserved knowledge or information or preserved ability to address certain problems is still where it should be expected to be. And it can help somebody then be able to cope with the loss of memory ability. And you can use the fact that there is some retained intelligence ability and say, look, you've got the ability here to compensate for these memory problems. You're clearly still very bright and able. Let's work on some compensatory strategies or learn to use some new aids or devices.

Dr Marianne Trent (: 00:08:12

Oh, that's wonderful, Keith. And it's really poignant, that really connected with me because these are real people and real people's lives and this really does matter. And so getting this right and helping people understand themselves, but also understanding their loved ones better, it really does matter.

Dr Keith Jenkins (: 00:08:30

No, it's absolutely true. And of course the other thing that isn't unusual is that people, for example, have had a bit of a challenging time at school and never really liked school. I often find that to be presented with an IQ test or any psychology test can be quite disconcerting. So there is a need often to kind of settle people into the room, into the assessment setting before presenting them with something which may generate lots of very bad associations with this is a bit like being at school and I really struggled at school. So that's another thing to be aware of about the individual that's before you.

Dr Marianne Trent (: 00:09:09

Absolutely. Really important. Okay. Our next question. How long would you say, and it might be how long is a piece of string, but how long would you say it takes to be kind of competent and skilled at administering a WAICE? And are there any minimal kind of qualifications that you're aware of?

Dr Keith Jenkins (: 00:09:29

I suppose to answer the first part of that, I guess my temptation is to say that you're always learning to do the WAIS well because each person that comes before you where you're going to administer a WACE is an individual. So there'll always be some subtle variation in how the person is, and then you as the clinician are trying to get them to approach the WAIC and you're trying to present it to them in a very consistent standardised way in order to make sure that their performance and the scores that you get and interpret are reliable and are valid. In terms of how long it takes just to be more than basically competent, it probably takes well over a year, I would say, just thinking of my own experience, because you need to administer quite a few WACEs. You need to become a bit more comfortable with the practicalities of administering it so you can then turn on more of your psychologist brain just to look at how the person before you seems to be.

(: 00:10:37

How comfortable do they seem to be? Are they anxious? Are they being distracted? Because you really do need to pick up on those things as part of your later interpretation of their performance.

Dr Marianne Trent (: 00:10:49

That's such a good point. It needs to become part of your kind of arsenal of skills really that you're not having to consciously think too much about so that you're more freed up to be present with the person and do your delivery, do your assessment, but not having to be thinking, what comes next? How do I do this? How do I hold this? How do I do this? It really is important to make sure that the person feels like you know what you're doing so that you can hold that session comfortably and help that person to relax.

Dr Keith Jenkins (: 00:11:25

That's absolutely true. I mean, fortunately it's rare, but there have been occasions when maybe I've stumbled over a particular subtest and like you say, your immediate concern is they're going to think I don't know what I'm doing because you may have been distracted or preoccupied by something else that's coming to your mind. So it is a discipline to be really focused in the moment on what you're administering.

Dr Marianne Trent (: 00:11:48

Yeah. And thinking about career stage then, so it's not uncommon for assistant psychologists to have experience of conducting WAIC assessments or at least being kind of present when they're done or maybe doing sub-tests here and there to practise on to kind of hone their skills. And certainly when I was a trainee, I was delivering whole WAIS assessments. Do you think it's important that someone that's qualified has got clinical oversight for the scoring and the interpretation and for signing off on the report, Keith?

Dr Keith Jenkins (: 00:12:20

I really do think that's crucially important. And I know in my own practise, I've maybe not always done that as well as I would recommend. I think if we're asking an assistant psychologist or a trainee clinical psychologist to do a WAIS, we maybe do need to ask them to record it or we do need to be present just to get a sense of how they are presenting it. Because typically supervisors will just say to somebody, read the manual, maybe practise it with someone, but they won't be present. They won't see what's going on. So I think there is a professional responsibility to make sure that if we aren't administering all of the WAIS assessments ourselves, if we're giving them to assistant psychologists, that we've ensured that they do give it in an appropriate way. Because otherwise, if we don't, we may receive the form appropriately filled in with the relevant numbers and start calculating and interpreting, but actually that raw data may not be reliable if they've not given that assessment in the way that is required.

Dr Marianne Trent (: 00:13:28

Such an important point and it's about acting with integrity. And I know sometimes there can be a pressure to do things when you feel like maybe they are slightly above your level of competence, but it really does matter, especially speaking as a psychologist, if we're asking junior members of staff to stay within their competence and ask for help and hopefully that support is available to them. Okay. Onto our next question, Keith. All right. So when it comes to looking at strengths and weaknesses, I know I'm putting you on the spot here, but can you give me a little bit of an example of how the strengths and weaknesses profile might give an indication about what might be going on clinically for someone that might help answer some questions for them?

Dr Keith Jenkins (: 00:14:10

Yeah. I mean, it's one of the things that the WAIS can be useful for, and in standardising it, there often are examples given of different types of problem and what you might expect to see in terms of the strengths and relative weaknesses across the component subtests. So quite a good example, because it's a fairly common neurodevelopmental difficulty, is dyslexia. So in giving the WAIS to somebody with dyslexia, you may, at a very basic level, see quite a discrepancy between how they do on the verbally based subtests and how they do on the subtests that are more about manipulating visual material and information. And you might also find that even on the verbal subtests, some aspects of their dyslexia come across in terms of their ability to hold and repeat back digits in the digit span tasks, or even in the basics of their vocabulary and their knowledge as shown on the information subject.

(: 00:15:12

So things that reflect maybe some of that educational disadvantage somebody may have had with undiagnosed at the time dyslexia. So certainly it's something I find with adults of a certain age upwards where dyslexia was far less on the radar in the school setting and somebody may have lived with dyslexia for the rest of their working life, but never perhaps been aware that that's what they have. And something like the WAIS can help you think, "Oh, hold on a second. Has anybody ever spoken to you about dyslexia?" And you take that forward with that particular client.

Dr Marianne Trent (: 00:15:49

Oh, it can be life changing, can't it? And enlightening and helps people see their own life in a whole different way.

Dr Keith Jenkins (: 00:15:57

Yes, definitely. It can be, I should say, enlightening and also validating and suddenly allow someone to rethink some difficulties or experiences they've had and to understand them in a different way.

Dr Marianne Trent (: 00:16:11

Yeah. And if we are doing this maybe in an older adult service or you're working in an older adult placement, if you're a trainee, what a privilege to get to do that with someone in the latter stages of their life to help them make sense of themselves really.

Dr Keith Jenkins (: 00:16:27

Yes. As you say, it can be a privilege. It can answer questions for people. And importantly, because the WAIC is multi-component in its approach, there's hopefully always going to be something that the person is good at and that you can try and link maybe then to something in their ordinary life that they're good at and show how the test has highlighted this particular ability or skill, which is maybe why they're very good at something they're doing in their day-to-day life.

Dr Marianne Trent (: 00:16:57

Absolutely. So is it possible for two people to have, for example, the same full scale IQ score and yet have a very different strengths and weaknesses profile?

Dr Keith Jenkins (: 00:17:08

So absolutely, it's the case that somebody on the WAIS can get an IQ figure and somebody else gets the same IQ figure, but the WAIS description, when you look at the components, will be very different. So somebody that's very verbally able and skilled may get some high scores on the verbally loaded items, but relatively lower scores on the items that are more about visualisation and holding information in short-term memory. And they may have the same IQ as the other person that's got some pretty poor scores on the verbal items because they've never been very verbally able, or they may have the dyslexia we spoke about earlier, and they may show a much higher performance on the non-verbal abilities and be tremendous at holding information in short-term stories, particularly when it's visual. Yet the IQ figure's the same. If you wanted to use that to differentiate between people, you couldn't differentiate between these two people.

(: 00:18:08

You need to then dig down into what are the components saying about their relative strengths and weaknesses.

Dr Marianne Trent (: 00:18:14

Thanks so much. It really is fascinating stuff. Okay, let's look at our next question. So obviously we are all individual. We're all different. How much can something like anxiety, fatigue, poor sleep, being hangry, being thirsty, how much can all of those kind of impact on someone's performance in something like a WAIS assessment?

Dr Keith Jenkins (: 00:18:39

They can all have a tremendously significant impact, and I think that's where experience in administering the WAIS comes in because a clinician who's done WAICE administrations over time will have experienced someone that maybe is suffering from fatigue as the assessment goes on because they have a brain injury or some other neurological condition that gives them fatigue as a side effect. Or you may have someone that comes to the assessment and they're not very happy to be there. They maybe are involved in a litigation and they've been told they have to go for this assessment. So immediately they may not be very keen to cooperate or to make much effort because they just want to get out of your office as quickly as possible. Any individual factor can be playing a role in how someone does the WAIS. And so the interpretation of their scores needs to somehow take that into consideration.

(: 00:19:37

And probably most likely it'll be about just how certain you are in giving your opinion about their ability. That certainty will vary on a scale depending upon how many and how strong those other factors are.

Dr Marianne Trent (: 00:19:53

Yeah, absolutely. I'm guessing if someone turns up and you suspect that they've been drinking alcohol or taking substances that are not prescribed or not as they're intended to be prescribed, that obviously is a very big issue and I'm guessing we wouldn't do the WAIS at all, Keith.

Dr Keith Jenkins (: 00:20:10

No, it certainly would be a very good kind of grounds on which to avoid having a one-to-one interaction around something that could be quite so triggering as doing a WICE. If it triggers frustration or triggers bad memories, if someone's under the influence of a substance, that's not a great situation to be in or for them to be in.

Dr Marianne Trent (: 00:20:32

Yeah, absolutely. Okay. Final question about not particularly very quick fire round, but I found it all so fascinating. Personal preference time. Do you prefer a paper kit or are you getting a bit more high tech? What's your preference, Keith?

Dr Keith Jenkins (: 00:20:48

I think my preference still is for the paper kit, and that's probably something to do with experience in using paper-based assessments. With a paper-based assessment, you can give more of your attention to watching how the person's performing that assessment. You're not needing to pay attention to your tablet computer and get ready for queuing up the next part of the assessment or wondering how to use the particular software that you may be interacting with.

Dr Marianne Trent (: 00:21:18

Yeah. And I have got a waste here. It is not a small piece of kit. It's on wheels now, which I love. When I was a more junior psychologist, I felt so cool carrying briefcases. I won't lie, but now it's a wheelie bag. But just before we kind of get into the main content of our episode then, if people are like, "Oh, it's been a minute, it's been a while," what are the other options if we're not wheeling around a suitcase? How else can a waste exist these days?

Dr Keith Jenkins (: 00:21:52

Well, fortunately there are some more cutting edge options that reflect our attraction to smart devices. So Pearson do have their queue interactive system, which means that administration of the waste can be done using a tablet computer, but you need two of them. So two iPads, one which you give to the person you're examining and one that you have as examiner. And the beauty of using that system is that some of the timings of items are taken care of for you and the scoring is taken care of for you. So it really does give you a much more current way of administering. And I suspect over the coming years that many people that we're seeing will be so familiar with using smart devices that they maybe would struggle with the paper-based presentation. It just won't be what they're used to.

Dr Marianne Trent (: 00:22:42

Really important. So now we're going from the anxiety of have I got enough waste sheets? Have I got enough blank ones? Have I sharpened my pencils to have I charged my devices? That's our modern well done anxiety about assessments.

Dr Keith Jenkins (: 00:22:55

No, that's very true. There's always some anxiety.

Dr Marianne Trent (: 00:22:58

All right. Lovely. Thank you so much for taking part in our not particularly quick fire round, but really, really important stuff that's come as a result of that. So as we are here today to celebrate the publication of the WAIS-V by Pearson, I thought it might be really interesting to look at the history of intelligence testing, the history of the WAIS itself, where it's all come from. How have we been conceptualising intelligence before the WAIS-5, for example, when it all started?

Dr Keith Jenkins (: 00:23:26

Okay. Wow. There's quite some history to theories of intelligence and understanding it. Of course, throughout millennia, people have had opinions about other people's ability to put it in the most basic form. And then that over time became known as IQ, some way of capturing what is this general ability in order to make it measurable in some way. So it was in the late 1800s that Francis Gaulton, a British statistician, came up with the idea, the concept of intelligence as something that could be measured and assessed. And in his thinking, intelligence was something that would be related to head size and related to reaction time. So again, some very early ideas about intelligence as a faculty and what it might be related to, as we know, not at all related to head size. So that way of thinking about intelligence did need to evolve and grow.

(: 00:24:27

And it was a French psychologist, Bine, who working with a colleague called Simon, came up with the Bine Simon test, and that was in France. And the idea of that was to have some verbal reasoning tasks in order to identify what at the time was called mental retardation. But actually the reason for identifying that was in order to then provide special education, special support for people that were having a lower intelligence than might be expected. And the way of judging that was also to look at something called mental age. So basically if a task that an average six-year-old could pass was the only task you could pass as someone aged 14, then you were said to have a mental age of six, which would identify you as somebody needing some additional support or help. So mental age, IQ were a little bit interchangeable for a while, but then improvements came along with working the states.

(: 00:25:34

So Henry Goddard working on the Stanford Binet, so Stanford University, the Stanford Bine Assessment of Intelligence. Again, still largely verbally based, but something that was used to help in World War I with identifying the abilities of different recruits into the army to make decisions about what area of work might be best for soldier recruits and who might be more marked as someone as good officer material. Again, a bit of an assumption that you have to be the brighter group of people will make the best offices. I'm not sure that's necessarily the case on all occasions. But all of this was very much thinking about intelligence as a kind of a one faculty, an overall global faculty. And it was the work of David Wechsler and colleagues that came to the thinking that, hold on a second, intelligence is about more than one overall faculty. So the so-called psychometric approach to intelligence started to break it down into components, started to introduce nonverbal tasks into the measurement of intelligence and its assessment.

(: 00:26:44

So the Wechsler Bellevue assessment was the earliest assessment task from David Wechsler, and this was a more balanced assessment task. And then this went on to become the WAIS. And through several iterations, we get to the WAIS five that is what brings us together today. So thinking of intelligence in different ways meant you had to think about different assessments and those different assessments have come to fruition in the WAIS five.

Dr Marianne Trent (: 00:27:15

Amazing. What a wonderful kind of illustration over time you've given us. They did really well with that, Keith. Thank you. Yeah. And thinking about those kind of different iterations, it might be a really nice chance to talk about our first experience of WAIS. And actually, Keith, I don't know if you know, but mine really involves you. So you and I already knew of each other, didn't know each other hugely well before I approached you to reach out for this episode, because we were working at the same private healthcare facility, private hospital at the time. I was working as an assistant psychologist in older adult services, and you were working in a unit for people with acquired brain injuries. And as part of some of the research you were doing, because you've always been a very research-based clinician, which has been great, you were asking for people to come along and take part in some of your research.

(: 00:28:11

And I was one of your little control guinea pigs, actually. So mine was the WAIS three. So you administered that to me. And it's interesting when we were talking earlier about some of the factors that can get involved in our performance and helping us thrive. I was so worried, Keith, because we were in your office. I would've been 27, 28 at the time, maybe 26, something like that. And yeah, I was coming towards what I thought was probably almost getting to be time to move on from the role I was in. And I would've quite liked to work in your department. And so I was thinking you must do well or he's going to think you're stupid. He's never going to give you a job. So yeah, when I was with you, it's a WAIS three, but because I started my training in 2008, it would have been the WAIS four during my training.

(: 00:29:02

Keith, can you tell us a little bit about your first experience or memories of the WAIS?

Dr Keith Jenkins (: 00:29:08

Gosh, going back a little bit. My first WAIS experience was as a trainee clinical psychologist, my very first clinical placement and had asked to do a WAIS with one of our outpatient clients. So it was actually the WAIS-R, so that the Wechsler Adult Intelligence Scale revised, so the second version of the WAIS. And obviously we're talking about the fifth version today. So I used the second version. And my approach was one, lots of reading of the manual, lots of practising with pretend patients doing the presenting of materials. But yeah, I mean, really not too sure, not too certain in administering. I hadn't had the advantage of Being an assistant psychologist and actually having more exposure to doing that assessment. So basically it was what was presented to me during my clinical training and then my supervisor on placement supporting me with administering the waste R to a client.

Dr Marianne Trent (: 00:30:17

How wonderful to have you here with us and to have all of that knowledge of all these iterations and all the patients that you've seen and you've done this with and all of the clinicians that you supervised as well and to have you bring that knowledge to us today. So thank you again for being here. We're not finishing. I know that sounds like a wrap up. We're not. It's just, I see real clinical skill and a flare for this in you, Keith. And just want to thank you again for being here.

Dr Keith Jenkins (: 00:30:50

No, it's a great opportunity for me. I love nothing more than sharing things that I've learned, things that I've seen with new people coming into the profession and equally continuing to learn from them as they look at things that I might have noticed or I might be doing and say, why are you doing that? Or bring along something they've learned that I've not actually read or seen. So it's always an interaction between experience and new learning.

Dr Marianne Trent (: 00:31:18

Absolutely. I remember when I was on a training placement, one of my supervisors said, I love having trainees and assistants because I learn so much. They're so curious and they bring with them learning from other services. And this is how we all get better at what we do. So it really does matter that two way learning process. And that we of course learn from our clients as well, don't we? They'll give us feedback about what they like, what they didn't like, what they found challenging. And we will then, it's like a really respectful kind of learning and amelioration experience that we then become better clinicians because of the work we've done with them.

Dr Keith Jenkins (: 00:32:02

No, I absolutely agree. I mean, I think maybe some professions in healthcare have a different view of themselves, but my view of myself and psychologists in general maybe is that we're nothing special. We've learned some special things. We try to do some special things, but we are ordinary people and the people we see, our clients and our colleagues are on the level with us and we need to learn from them and absolutely show tremendous respect for their experience and what they think and feel as we try and do our work with them.

Dr Marianne Trent (: 00:32:39

Absolutely. So important. Okay. So when we're looking at the WAIS-5 then, I'm guessing this looks really very different even in terms of the way we're interpreting it and scoring it than your earlier experience with the iterations done. What's standing out for you most about some of these brand new changes, Keith?

Dr Keith Jenkins (: 00:32:59

Yeah. I mean, certainly thinking over time, what the WAIS has done is to become much better at picking up components of reasoning or intelligence, so-called indexes. So I mean that WAIS R I did back in the day, you've got a full scale IQ and then a verbal and performance IQ. So broadly your verbal abilities and your nonverbal abilities, that was it. Then as the WAIS has evolved through WAIS three, four, and up to five, the number of components or index scores has increased to reflect a deeper understanding of how intelligence isn't just one factor or three, it's actually five in the new model within the WAIS five. So we're looking at that verbal ability, but we're also looking at visual spatial ability, fluid reasoning and working memory and processing speed. So all of these are components that sum together to give us our overall general intelligence score or the full scale IQ.

(: 00:34:09

And within each of those components, there are the sub tests or tasks that the person completes in order to generate that index score. So much improved, much more trying to fractionate what's going on underneath somebody's intellectual performance.

Dr Marianne Trent (: 00:34:28

Great. Thank you so much. Okay. So we're very much getting this idea of how clinically useful this can be for the person administering the test, but also of course the person who is undertaking the assessment. But we wouldn't want someone to think that this is really reductionist and that this is them in a nutshell. Are there any other kind of theories or things that can help support our understanding of the person and their abilities, Keith?

Dr Keith Jenkins (: 00:34:56

Yeah. So that's a really good point, Marianne, that we don't want it all to be about the IQ score and even the component index scores that we can get from the WAIS if we want to understand the person as a whole person. The theory of intelligence that I've always liked and encountered it many years ago is the triarchic theory of Robert Sternberg. And actually it was first put forward in 1985. So it's a very long lasting theory and obviously it's gone through its own evolutions and becoming better described. But basically what we're measuring on the WAIS is what Sternberg would call an element of componential intelligence. So it's one of the components of our ability to reason and function is the score on something like the WAIS and the IQ that we might get. But actually that's just one of three different intelligences that Sternberg puts forward.

(: 00:35:56

The other two, experiential intelligence is really our ability to cope with novel situations in the real world and also to be able to learn how to do certain things more or less automatically without thinking. So we all have an experiential intelligence ability. And then the final bit is number three, contextual intelligence, which is the one that I kind of love the most because contextual intelligence is our ability to adapt to the environment in which we are. Sometimes nowadays it's referred to as being street smart, but rather than thinking of being street smart, I like to kind of give the example of if you took somebody from the UK that got an incredibly great score on the WAIS-5 and popped them into the Kalahari desert, isolated all by themselves, what's likely to happen to them? I think we know, don't we sadly, they're not going to be walking out of that desert.

(: 00:36:56

Whereas if you take a Kalahari bushman or bush person, give them the Wechsler intelligence assessment, they may get an appalling score. They may do. But actually in the Kalahari desert, they're going to survive. They're absolutely street smart for living in the Kalahari desert. So who's the most intelligent person in that situation? So I love that theory of looking at intelligence in different contexts and different components. And I think it's worth having in mind and maybe even sharing for someone that perhaps really struggles with the WAIS, but maybe in real life, they're living a good life and are well respected by friends and family because they are street smart. They are adapted to getting by in this modern world.

Dr Marianne Trent (: 00:37:46

Yeah, really important. And again, I just love how much you still love this and how much it still clearly energises you and it's part of your why and your purpose. And it's really just lovely to see someone that still is really enjoying that at this stage of their career. And I don't want that to make it sound like you're really old and you're really ancient, but how wonderful to still be a clinical psychologist after all this time and still love it, Keith.

Dr Keith Jenkins (: 00:38:15

We're in a privileged position and I always feel that the chosen area of work for me for people with acquired brain injury is a very privileged position because my work, my opportunities actually built upon other people's awful misfortune. And that's something that I always try not to forget.

Dr Marianne Trent (: 00:38:33

Yeah, absolutely. This might be a really nice chance to then think about how sometimes when someone's got a real relative strength, and I see this in mental health stuff as well. If someone is really, really highly functional, it can mask areas of real clinical need or real areas that aren't going well for them. Can that happen in our waste assessments as well?

Dr Keith Jenkins (: 00:39:01

I think the waste assessment can sometimes give us a bit of a window into that situation where somebody maybe day to day is masking some background difficulties. The most straightforward way in which that sometimes happens is some people can be very, very verbally able in terms of they talk a lot, they're great in conversation. And often we can make this false correlation that because someone's quite good at talking about things, that means they're very bright in a general sense. And it certainly isn't always the case. And the Wechsler test can show us that in that somebody may do quite well on those verbal items, but show us in some other aspects of reasoning or in terms of their attention and working memory ability that actually they've got some issues going on and that maybe they talk a lot day to day because they're trying not to find themselves challenged by needing to remember what somebody else is saying to them.

Dr Marianne Trent (: 00:40:01

Yeah, absolutely. And I always try and make things as clear as I can for our audience. And I think that one of the really good ways of doing that, that really brings theory to life is when we've got a bit of a case study. So shall we have a little look at a bit of a case study that might help people to understand some of this stuff?

Dr Keith Jenkins (: 00:40:23

That makes perfect sense to try and kind of root it in this as an example and work through the example.

Dr Marianne Trent (: 00:40:30

Okay. So let's imagine we've got a 40-year-old male who's called Jazz. He's very sadly experienced a traumatic brain injury. Physically, let's say he's reasonably well recovered and maybe those who don't know him super well might think that he's kind of doing all right, seems to be kind of back to how Jazz used to be, but he's really struggling to get back to work. Maybe he's feeling irritable, he's feeling like his concentration is kind of not what it used to be. He's really struggling maybe with even planning and predicting what he's going to do next at work. How could a WAIS five help Jazz to understand himself? How could it help the clinical team around him? How could it help his friends and family?

Dr Keith Jenkins (: 00:41:22

I think the WAIS-5 would be actually quite a key part of an assessment with Jazz to try and help him understand his areas of strength and newly acquired difficulty. And probably following a traumatic brain injury where the WAIS-5 would pick up on some of those changes with Jazz would be around aspects of conceptual reasoning, maybe linking into so-called executive dysfunction, and also things around speed of information processing and working memory. So those areas that maybe are all coalescing to make it difficult for Jazz to cope with work, with planning, with organising, with attending. Whereas it could also pick up on the fact that maybe verbally, Jazz is still quite able and skilled, which is why his friends and family are thinking, "Oh, he seems like he's okay. Why is he having such problems at work?"

Dr Marianne Trent (: 00:42:19

Yeah. And I think when something like a traumatic brain injury or a cognitive change happens, it really does bring to our attention just how complex we are as humans and the number of different tasks that we'll kind of juggle, the things we'll hold in mind. And when certain elements of that don't work as well, it really can become apparent quite quickly, can't it?

Dr Keith Jenkins (: 00:42:51

I think certainly in kind of a workplace or social setting, just things around just controlling impulses, which again can be evident on formal testing on occasion, people rushing their responses, people not really processing the instructions. But in a real life setting, that poor impulse control can lead to real relationship strain, real difficulty in maintaining your employment if you can't hold back from saying something to your boss that really shouldn't be said.

Dr Marianne Trent (: 00:43:24

Absolutely. And this matters, doesn't it? Because we want people to be able to live a good quality of life. And of course, having somewhere to live and being able to pay your bills, especially if sometimes with traumatic brain injuries, there is litigation that happens, but sometimes there isn't. And so families are then having to struggle with very limited resources to try and live a good life with somebody who doesn't quite seem like they did beforehand. So better understanding them, I think can be so powerfully important because it can really deshame, can't it? It can add compassion and understanding and let everybody just take a little bit of a pause and to think about how we can, I guess, help everybody in this situation to perform and cope optimally with this new version of jazz.

Dr Keith Jenkins (: 00:44:15

No, I agree. Understanding is the key to approaching many difficulties in life and many of those that come within the area of psychology. But yes, for brain injury, understanding what's happened and how it's affected you is really important. But of course it comes at an emotional cost as well because people don't want to be changed, don't want to feel permanently damaged by an accident or an injury. But sadly, that is very often the case that there is a permanent change and it's supporting them psychologically to cope with that and to find ways where they can around the particular obstacles in cognition that may have been generated.

Dr Marianne Trent (: 00:44:58

Yeah. Thank you so much. It's really important. All right. So if we stay with Jazz then, if we maybe make Jazz same age, but born and raised in India and then moved to the UK, for example, he might have had very different educational experiences and kind of cultural experiences of course, than Jace might have had or Jazz might have had if he'd been born and raised in the UK. So I know that the WAIS has always kind of had the norms, but can you tell us about why they matter so much and what might be different about the WAIS - five norms?

Dr Keith Jenkins (: 00:45:42

Yeah. I mean, norms are important because we need to compare somebody with their cultural setting, their society. So the first version of the WAS five was standardised in the USA, so testing of lots of American citizens in order to come up with what would be the expected scores across a range of ages and a range of backgrounds. Now, of course, the UK isn't the USA, so a different makeup in our society. So the WAIS-5 UK is based upon data using the WAIS-V with UK citizens, and again, across a demographic range. So that means that when we give the WAIS-V, we've got our own norms to look at. Now, the problem is with somebody like Jazz who may be representative of a quite small part of the UK population, it's how far his performance on the WAIS-V can be straightforwardly compared to those UK norms. And particularly if we find that Jazz spends a lot of his time maybe conversing with family and friends, let's say in Urdu or a similar language, it may be that some of his verbally based functioning as assessed by the WAIS-V won't necessarily show us his real ability.

(: 00:47:07

Now, some of the non-verbal assessments may still have a slightly greater reliability and comparison with the norms. So it's that psychological complexity. We always have to bear in mind where is somebody coming from? And if there are any obstacles around language or education having been in a different country, we have to somehow factor that into our interpretation. We can't factor it into our scoring. The scoring is standardised. That's a given. But when we look at what those scores mean in comparing it to the normative data, what the index scores are, what the IQ is, we may want to give some well thought through caveats to our interpretation that link to someone's own unique history and background.

Dr Marianne Trent (: 00:47:55

Yeah. And speaking of language then, so if we are finding ourselves in a position where we as a clinician are administering this, but the person doesn't speak maybe any English, is it still robust and valid to have an interpreter with us interpreting what we say? I know it will add quite a lot of time to the assessment, but is that still all right, Keith?

Dr Keith Jenkins (: 00:48:23

I think sometimes we don't have any choice that we've been asked maybe in the context of a medicolegal claim or maybe in the context of very difficult differential diagnosis within the NHS. We've been asked to do the assessment, but we're presented with a person that doesn't speak English. So we have to then use an interpreter and that will have some impact upon how the assessment flows. And in fact, with the WAIS-V, some of the tasks that we need to administer need to be done verbally in quite a particular way. So we will introduce a large degree of variance in interpreting that person's performance. So it really comes back to experience and also knowledge about those other factors that influence someone's performance and score. But I think some of the new WAIS-5 subtests, particularly the running digits, which is about a very fast administration of numbers, may be affected by a different language needing to be used.

(: 00:49:30

And I'm not sure how far we can teach an interpreter to give the WAIS five, which is really in an ideal world what you'd need. So it's always really challenging when English isn't the first language, but if someone doesn't speak English at all when we're using the interpreter, we really need to be very cautious and think very carefully about maybe what components of the WAIS-5 are likely to be the most reliable and link it to other information about the person if we're wanting to give a formulation as to their cognitive abilities.

Dr Marianne Trent (: 00:50:04

Yeah, really important. And when I've been working with interpreters, sometimes if the budget allows and the service allows, it can be helpful to meet with the interpreter beforehand to kind of take them through and obviously reinforce that we can't be supporting or helping the person with their answers. I've definitely done some assessments in the past where perhaps some of the staff members in the room at the time were trying to help the person to do better and I was having to go, "No, no, no, no." But yeah, if we're able to spend some time just explaining what that's like, not in front of the client, not in front of the patient, that can be really important. And if you're doing tests or appointments over a series of days, if it's possible, sometimes it can be helpful to have the same interpreter so that you've got those consistencies and that you're not having to then re-explain all of those things, but we're having to do the best we can for the client with the resources we've got.

Dr Keith Jenkins (: 00:51:04

Yes, absolutely. I mean, it could be an area that's well worth further exploration and whether colleagues at Pearson can offer some support or information about those occasions, which aren't incredibly rare in a really diverse society as we have in the UK, where language is a bit of an issue with people we're asked to assess.

Dr Marianne Trent (: 00:51:27

Absolutely. All right. So thinking about WAIS-V again then, are there any kind of big changes? Are there any things that are different that people might want to look out for if they're familiar with older versions?

Dr Keith Jenkins (: 00:51:40

So yeah, the WAIS-5 has really shown an evolution from previous versions. And actually the five is quite an interesting number because there are five new subtests, but I'm not going to give you the same detail as you would get in the manual about those five sub-tests because what we don't want is for people to be so prepared in advanced that they can practise at similar looking tasks, and therefore the performance they give when we administer the WAST-5 isn't as reliable as we'd like it to be. So I'll just give you a little heads up about the five new sub-tests. There's one called running digits, which is an auditory verbal working memory task. There's one called set relations, which is a task where people have a visual choice of responses. There's a spatial addition task where people, again, are using visual stimuli. There's the symbol span task, which some people might be familiar with from the WIMS.

(: 00:52:45

And there's the naming speed quantity, which is around how quickly people can visually see a quantity and report it back verbally. I think I've not given away too much detail, but also I've given you a sense that there's some new things to get your head around as someone administering the WAIS-V, and a little bit of practise may be required.

Dr Marianne Trent (: 00:53:09

Absolutely. So if you're familiar with WAIS-IV and your new WAIST-5 has arrived, or maybe as a result of this video, you're going to treat yourself to a WAIS-V for your clinic, you're going to need to put some hours in to practise to make sure that you are familiar with that. Now, obviously, like I said at the beginning, people might be watching this for a variety of reasons, and one of those reasons might be that someone is going to be undergoing a WAIS-V themselves. They might be a bit disappointed by that answer that we've just given, because they might be like, "But I wanted to do really well." Or why is that a problem then that we're not giving away all these secrets? Why can't we help these people to do as well as they can?

Dr Keith Jenkins (: 00:53:51

There's a really interesting psychological phenomenon known as a practise effect. So the more we practise something, the better our score will be, but that is just from practise rather than necessarily reflecting our underlying ability. So an interesting real life example is often families have youngsters who are doing an 11 plus test to see whether they can get into the local grammar school. And if you get your youngster to practise the 11-plus tests, you will actually give them an advantage in that they will score better than if they hadn't practised. And that may be the difference between them getting in or not getting in to their local grammar school.

Dr Marianne Trent (: 00:54:37

But of course, if they then are offered that place, when it comes down to actually doing the work that is being required, sometimes that can feel like a very steep learning curve and people can feel like they are outside their comfortable levels of ability. And I guess that's why this matters, because we want to get a genuine snapshot, a genuine overview of this person's presentation and of their strengths and limitations. And if you are feeling really anxious about going to the test, please just tell your clinician and they can help you work through that without you needing to practise, practise, practise, and to make sure that nothing's going to catch you off guard. Because actually, whilst it might sound a little bit unsettling, partly what we want to do is to have these novel tests, not to catch you out, but to help us understand you better.

Dr Keith Jenkins (: 00:55:33

Yeah. I think sometimes it's worth saying to someone that there is no good or bad result from this assessment. It just offers a quantification of ability across different areas, which is helpful in understanding your strengths, your relative weaknesses, or understanding what's happened to your thinking ability due to an accident or injury. But there's no good or bad result. And again, going back to our thinking about intelligence and intelligence series, the value of a person is not in their IQ or intelligence. That was the mistake made in the 1930s with the eugenics movement and using IQ as a reason for seeing some people as good and some people as bad. We've grown beyond that, thank heavens, and there is no good or bad result from a WAIS-5.

Dr Marianne Trent (: 00:56:32

Yeah, really, really important. Thank you, Keith. Okay, let's have another look at a quick fire round, Keith. What's the biggest misconception that people have about IQ scores?

Dr Keith Jenkins (: 00:56:44

Probably that the higher your IQ, the more successful and rich and famous you're going to be, because ability in real life is about a bit more than your IQ score, and it's about a bit more than maybe how you might perform on a standardised measure like the WAIS-5. And the best example is we think about Albert Einstein, probably most people would agree, wow, he's a genius and came up with some fantastic ideas, but actually Albert Einstein also had dyslexia. We spoke earlier about dyslexia being shown by performance on some of the WAIS-V subtests won't necessarily be that great. So Albert Einstein may not have got a great overall score on an intelligence test or even on the WAIS-5. Yet we'd all agree he was a genius. And then the earlier example, somebody that can survive in the Kalahari desert, well, I think he's pretty smart, but actually on the WAIS-5 or any similar tests may get really bad scores.

(: 00:57:47

So there, that's the misconception. High IQ doesn't necessarily mean high success or high survivability.

Dr Marianne Trent (: 00:57:55

Absolutely. So important. So does a high IQ mean someone is going to thrive?

Dr Keith Jenkins (: 00:58:02

It doesn't necessarily because there are so many other factors within our society that determine whether somebody thrives or not. You may be from a marginalised minority group, you may have a fantastic IQ, but because of the group that you're from, you may suffer a range of adversities in ordinary life. You may even be an incredibly intelligent woman, but choose to go into a career where there is prejudiced or a lack of culture that embraces incredibly bright women. So no, sadly, we know that thriving in our society is about far more than just your IQ.

Dr Marianne Trent (: 00:58:42

Yeah. And often if we're working with someone from a complex trauma background, someone might be incredibly bright and able, but just kind of socially, demographically and all of the kind of... Sometimes it takes money to do really well as well. And if you've got less of that, sometimes it's just less opportunities to do what society would think of as thriving.

Dr Keith Jenkins (: 00:59:04

Yeah, and that's a really good point. And I suppose kind of cycles back to this idea around selection or measurement in education. If we had a culture fair or free way of identifying really bright young people, regardless of their background, so that they could actually receive the educational support that could allow them to really achieve, that would make a wonderful contribution to our society. But it's finding those ways that are as culture fair and culture free as possible.

Dr Marianne Trent (: 00:59:38

Yeah, absolutely. You've kind of led us really nicely into then thinking about the future. What do you think the future of adult intelligence testing looks like?

Dr Keith Jenkins (: 00:59:53

Gosh, that's a massive question, isn't it? It's kind of almost into science fiction territory, aren't we, in terms of thinking about what What might be coming along that will be much brighter and smarter than us psychologists and even our really cutting edge tests like the WAIS five we have at the moment. Maybe AI will bring the ability to have a tool that can look at so many more aspects of the individual that we're assessing simultaneously in order to say something more valuable about their ability to cope in day-to-day life or say something more valuable about the difficulties they've acquired due to an injury and ways in which they may be better compensated for by using the abilities that are still retained.

Dr Marianne Trent (: 01:00:46

Yeah. Okay. And obviously I'm aware that many of us are weaving AI into our own lives. How do you think that is impacting on our capability, on our abilities, on our IQ?

Dr Keith Jenkins (: 01:01:06

Well, scarily, it may be making our IQs a little bit worse. So if we think about something that's been known about by psychologists for several decades, the so-called Flynn effect based upon the researcher that first identified it. So for quite a long time, IQ was rising. So year-on-year measurement of average IQ showed that it was actually rising over time. But since the mid 1990s, overall IQ appears to be falling by maybe two or three IQ points each year. And this is based upon the fact probably that we aren't exercising our brains and those components of intelligence quite as much as we used to because we are relying upon AI and other systems to do things for us. So there's an interesting balance to be found and to be still achieved between using technology to support us in tasks and actually continuing to use our mental faculty to do tasks because reliance upon external devices and aids may mean that when one day they break down, we then struggle to be able to, for example, take a pencil and paper and do some calculations.

(: 01:02:33

So yeah, really interesting times and interesting questions for us to ask ourselves and to ask our society about how much we do use the wonders of AI and making life easy for ourselves, what the cost is in doing that and the dependence that develops upon those devices and aids.

Dr Marianne Trent (: 01:02:55

Oh, absolutely. Wow. That really is something to consider, isn't it? So before we finish, let's just have a little look at how the WAIS-V is kind of clinically useful and helpful as a tool for clinicians. What would you say, Keith?

Dr Keith Jenkins (: 01:03:15

I think I'd say that the WAIS-5 is another step change in the Wechsler history of tests. I mean, it really is learning from experience and learning from increasing depth of knowledge about components of intellectual function. So it brings in new sub-tests to enable us to look better at someone's abilities. It also brings in for people where we think or where it's clear that they do have a degree of intellectual ability or giftedness, it introduces new ways of starting the sub-tests that take account of the fact that someone can maybe start further on in that particular sub-test, therefore making the assessment faster for people that do come along with clearly some gifts or ability. So I think it's learning from experience in how to make administration faster where that's possible and how to make assessment deeper in terms of those components of intellectual function. So I think the WAIS-5 takes us on another journey of yes, as clinicians, we've got to learn how to do some new things, but as clinicians, if we learn that, we'll actually be having an assessment that gives us a much richer picture that we can use in understanding the person before us.

Dr Marianne Trent (: 01:04:43

Absolutely. And I guess with that in mind, if people do want to get hold of a WAIS-5, so the Wechsler Adult Intelligence Scale version five, the details are in the description and in the show notes. Thank you to Pearson for working with both myself and Keith to produce this really helpful episode. I've really, really enjoyed. I've really enjoyed working with you again, Keith, as well. So thank you for your time. If you're watching or listening, please do let us know in the comments either on YouTube or Spotify how this episode has helped illuminate your understanding of adult intelligence testing. Keith, thank you again for your time.

Dr Keith Jenkins (: 01:05:27

Thank you, Barry. It's been a pleasure. Thank you.

Dr Marianne Trent (: 01:05:29

It really has. Thank you, Keith.