Basic (07-19)

DI 24583.050 Using Psychological Tests to Evaluate Mental Disorders

A. How do we use psychological tests to evaluate mental disorders?

Different psychological tests are used for specific purposes in clinical settings. We do not require the results of psychological tests in disability determinations or decisions except for intelligence tests used to determine whether the person has a cognitive mental impairment that meets or medically equals listing 12.05 or 112.05.

Psychological tests, on their own, generally do not establish the existence of mental disorder. When included in the case record, consider the results of psychological tests along with all other relevant evidence. The persuasiveness of particular test results may be affected by the information about the test contained in the record, including the type of test administered, the presence of a narrative report, the results of the test, and the recency of the test administration. Explain any inconsistency between the test results, clinical history, and other evidence of record such as reports of third parties.

Do not rely on test results alone when evaluating the severity of a medically determinable mental impairment, rating the four areas of mental functioning, or assessing the mental residual functional capacity.

NOTE: We do not endorse, prefer, or require any specific intelligence test, publisher, or instrument. Tests are programmatically acceptable when they satisfy the requirements in DI 24583.050B.

NOTE: The information provided in this section applies generally to psychological tests for both adults and children. There are additional guidelines specific to intelligence tests and psychological tests for children. For more information, see DI 24583.055 and DI 24583.060.

B. What are our program requirements for psychological tests?

The psychological test must be individually administered, administered by a qualified specialist, and standardized, and must meet contemporary psychometric standards for validity, reliability, normative data, and scope of measurement. Do not purchase psychological tests that do not meet these program requirements except for nonverbal intelligence tests under limited circumstances. For more information about nonverbal intelligence tests, see DI 24583.055I.3.

NOTE: For information about how to consider tests that do not meet these requirements, see DI 24583.050E.

1. Individually administered

A psychological test must be individually administered. Tests that are designed for administration in group settings are not programmatically acceptable, even if they are administered individually in a specific situation.

2. Administered by a qualified specialist

A psychological test must be administered by a qualified specialist according to all prerequisite testing conditions. A qualified specialist is a person who is currently licensed or certified at the independent level of practice in the State where the test was performed, and has the training and experience to administer, score, and interpret psychological tests. Tests administered in a classroom by a teacher are not programmatically acceptable.

NOTE: If a psychological assistant or paraprofessional (e.g., a psychometrist) administered the test, then a supervisory qualified specialist must interpret the test findings and co-sign the examination report.

3. Standardization

Psychological tests must be administered and scored in a predetermined, standard manner with consistent questions, conditions for administering, scoring procedures, and interpretations.

4. Contemporary psychometric standards

Psychological tests must meet contemporary psychometric standards for validity, reliability, appropriate normative data, and wide scope of measurement. Even when a psychological test meets these contemporary psychometric standards, consider and resolve any discrepancies between the formal test results and the person’s customary behavior and daily activities.

a. Validity

The test measures what it is supposed to measure and demonstrates both construct and criterion validity for the demographic and diagnostic groups for which it is used.

b. Reliability

The obtained test results are consistent when the person takes the same test over time, or when multiple qualified specialists administer it.

c. Normative data

The test allows comparison of a person’s performance to that of his or her peers through data relating to a recent and appropriate cross-section of the population.

d. Scope of measurement

The test should measure a broad range of elements associated with the domain being assessed.

C. What information do we need about the psychological test administration?

1. Test administration information

The test report must contain the name of the test administered and any subtests, the date of administration, the person administering the test (to determine whether the person is a qualified specialist), composite and individual subtest scores obtained during the test administration, and a narrative report.

2. Narrative reports

Test results must be accompanied by a narrative report. While the format and content of the narrative report are up to the individual test administrator, the key elements of the report are statements about the validity of the test results and whether those results are an accurate reflection of the person’s mental functioning. Generally, narrative reports will also include information about whether the testing results are consistent with the person’s developmental history, the degree of functional limitation, and other useful information. For example, the report may include the specialist’s observations regarding the person’s abilities to sustain attention and concentration, to relate appropriately to the specialist, and to perform tasks independently without prompts or reminders.

NOTE: The "validity" of a test result refers to the psychometric standard described in 24583.050B.4.a above. However, you may also see the term "valid" used in evidence to describe whether test results are an accurate reflection of a person's functioning.

D. What are the different types of psychological tests?

There are a variety of different types of psychological tests. This section describes different types of commonly seen psychological tests. It is not an all-inclusive list.

1. Intelligence tests

Intelligence tests are standardized tests that measure a person’s intellectual performance in multiple aspects of cognitive functioning. They may also be referred to as intelligence quotient or IQ tests. For more information about intelligence tests, see DI 24583.055.

2. Standardized tests of adaptive functioning

Standardized tests of adaptive functioning are designed to measure how well a person uses conceptual, social, and practical skills to function in his or her daily life. Standardized tests of adaptive functioning may be used in clinical practice. These tests often rely on a third party, such as a parent or teacher, to rate a person's adaptive functioning. We do not require the results of an individually administered standardized test of adaptive functioning. Standardized tests of adaptive functioning may be purchased when appropriate. When contained in the case record, consider these test results along with all other relevant evidence when determining whether the person has significant deficits in adaptive functioning.

3. Academic achievement tests

Academic achievement tests are used to measure how well the person has mastered basic academic skills such as reading, writing, and arithmetic. Some tests measure knowledge in specific content areas such as history or science. Academic achievement tests may be purchased when appropriate. When included in the record, consider academic achievement tests for the information they provide. Do not substitute academic achievement scores for IQ scores to determine whether the person’s mental impairments meets or medically equals listing 12.05 or 112.05.

When considering the criteria of listing 12.05 or 112.05, ensure the test being considered is an intelligence test and not an academic achievement test. For example, the Woodcock-Johnson Tests of Cognitive Abilities is an intelligence test but the Woodcock-Johnson Tests of Achievement is an academic achievement test. Only results from the Woodcock-Johnson Tests of Cognitive Abilities may be used to determine whether the mental impairment meets or medically equals the requirements of listing 12.05 or 112.05

4. Neuropsychological batteries

Neuropsychological batteries are designed to establish the existence and extent of brain dysfunction that causes psychological symptoms. We do not require neuropsychological batteries to evaluate mental impairments, including those impairments considered under 12.02, neurocognitive disorders. Do not purchase neuropsychological batteries. However, consider the results of neuropsychological batteries when they are part of the medical evidence of record. If we need to purchase testing to fully evaluate a specific neuropsychological impairment, consider the precise elements we need addressed and purchase the specific tests that address those elements alone.

5. Memory tests

Memory tests are used to measure different memory functions in a person. Clarify any allegations of “memory problems” or “forgetfulness” with the person. Memory tests do not establish the existence of a memory disorder, such as an amnestic state or dementia. Additionally, memory problems are not diagnostic when they are symptomatic of another mental disorder, such as depression, are related to medication side effects, or cannot be distinguished from the person's typical or previous mental functioning.

Generally, memory tests are not necessary because memory can be adequately assessed in less formal ways, such as through a mental status examination. We neither require nor prohibit the purchase of memory tests. Decide whether a specific test of memory is necessary given the particular facts of a case.

6. Personality measures

Personality measures provide information about personality traits. The two most common types are self-reported inventories, where the person being tested rates how well a question or statement applies to them, and projective techniques, where the person is presented with a vague scene, object, or scenario and then asked to give their interpretation of the test item. Do not purchase personality measures. However, consider the results of personality measures when they are part of the medical evidence of record.

7. Screening tests

Screening tests are used to provide only gross determinations of levels of functioning. They are frequently used to determine whether a person needs more comprehensive evaluation and do not replace more comprehensive versions of psychological tests. Although the results of a screening test may suggest the presence of a mental impairment, additional evidence is required to establish the presence of a medically determinable mental impairment and any resulting functional limitations. Abbreviated or screening tests may be used to rule out a medically determinable impairment but cannot be used to establish a medically determinable impairment. Purchase screening tests only in rare circumstances. When screening tests are part of the record, consider whether the results indicate a need for further development or the need to purchase a consultative examination (CE).

8. Performance validity tests

Performance validity tests provide information about a person’s effort on tests of maximal performance, such as cognitive tests. Many psychological tests include embedded validity measures. Do not purchase specific performance validity tests. Consider embedded validity measures that are part of other psychological tests. Additionally, consider the results of performance validity tests when they are part of the medical evidence of record.

9. Symptom validity tests

Symptom validity tests provide information about the consistency and accuracy of a person’s self-report of symptoms he or she is experiencing. We do not require symptom validity tests to evaluate mental impairments. Do not purchase symptom validity tests because they have limited usefulness in our program. However, consider the results of symptom validity tests when they are part of the medical evidence of record.

E. How do we consider psychological tests that do not satisfy program requirements?

The record may contain reports of psychological tests that do not satisfy program requirements. Consider psychological tests that do not satisfy program requirements for the information they provide. For example, if the record contains the results of the California Achievement Test, which is administered in a group setting typically by a teacher, consider those results to determine if additional development such as identification of treatment records, a CE, or an intelligence test is necessary.

F. Additional considerations

1. School records

School records, including transcripts and individualized education programs (IEP), sometimes include the results of psychological tests such as academic achievement tests, standardized tests of adaptive functioning, or impairment-specific tests such as autism scales. Do not use the results of psychological tests reported in school records if only the score is documented. Only use the results of psychological tests reported in school records when the documentation includes the required test administration information and narrative report. For additional information about intelligence test results contained in school records, see DI 24583.050C.

2. Updated editions of psychological tests

Most providers will transition to updated editions within a reasonable period of time following the release of the updated edition due to State and national ethical codes and a need to keep current with advances in psychological testing. The provider is allowed to exercise professional judgment in selecting the most appropriate test instrument for a particular person. We expect this will usually be the most recently normed edition of the test. When considering tests for purchase as part of a CE, do not purchase tests more than two years after the publication of the new editions.

G. References

  • DI 24583.055 Using Intelligence Tests to Evaluate Cognitive Disorders, Including Intellectual Disorder

  • DI 24583.060 Additional Guidelines for Using Psychological Tests to Evaluate Mental Disorders in Children

  • DI 34001.032 Mental Disorders (Listing of Impairments – Adult Listings (Part A))

  • DI 34005.112 Mental Disorders (Listing of Impairments – Child Listings (Part B))


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DI 24583.050 - Using Psychological Tests to Evaluate Mental Disorders - 07/19/2019
Batch run: 12/11/2019
Rev:07/19/2019