Only consider a person’s obtained IQ scores for 12.05B.1 and 112.05B.1. Do not raise or lower an IQ score or consider IQ scores that are slightly above or below the criteria in 12.05B.1.a, 12.05B.1.b, 112.05B.1.a, or 112.05B.1.b to find medical equivalence. The 12.05B.1.b and 112.05B1.b criteria for significantly subaverage general intellectual functioning already account for the scenario involving an obtained full scale IQ score that is slightly above 70. If the record contains obtained IQ scores that do not satisfy the IQ score criteria in 12.05B.1 or 112.05B.1 but the criteria in 12.05B.2 or 112.05B.2 are satisfied, consider whether the impairment meets or medically equals listing 12.11 or 112.11 for neurodevelopmental disorders or 12.02 or 112.02 for neurocognitive disorders.

NOTE: For more information about determining medical equivalence for intellectual disorder under listing 12.05 and 112.05, see DI 24583.010B.

A full scale (or comparable) IQ score is “accompanied by” a verbal or performance part IQ score when the IQ scores were obtained on the same administration of the same intelligence test on the same day. Do not combine obtained IQ scores from different intelligence tests to meet or medically equal the requirements of 12.05B.1.b or 112.05B.1.b.

EXAMPLE: An adult person obtained a full scale IQ score of 72 on the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV), administered in 2018. On a previous administration of the WAIS-IV in 2013, the person obtained a verbal comprehension index score of 68. Do not combine these scores to find the requirements of 12.05B.1.b are satisfied.

NOTE: Do not purchase an additional intelligence test simply to obtain verbal or performance part scores. Additional testing may create an inconsistency that must be resolved or yield scores affected by the practice effect, see DI 24583.055F.2. If the evidence of record contains multiple intelligence tests with scores that vary by more than a few points, see DI 24583.055I.8.

A comparable score is an IQ score that reflects the same type and scope of a person’s intelligence, even though a different name for the score may be used.

IQ scores are at the margin when they are within a few points on either side of the scores specified in the listings. Only consider the obtained IQ scores included in the report to determine whether the score meets or medically equals the requirements of listings 12.05 and 112.05. The obtained full scale IQ score and relevant part scores, where applicable, must be at or below the value specified in the listing. Do not consider other factors when determining whether the reported IQ score satisfies the requirements of 12.05B.1 or 112.05B.1. Do not raise or lower an IQ score by assuming it was within the standard error of measurement.

The narrative report is particularly important when IQ scores are at the margin. While only qualified specialists may determine an obtained IQ score is not an accurate reflection of the person's typical intellectual functioning, adjudicators must consider intelligence test results in the context of the entire medical record.

The standard error of measurement is a statistical confidence interval within which the person’s true IQ score falls. The standard error of measurement estimates the significance of an IQ score that improves on retesting with the same instrument. It is a standard deviation unit defining the degree of chance error for any particular score and varies by intelligence test. Generally, we expect a person's true score to fall within approximately 3 to 5 points both above and below the reported score.

Only consider obtained IQ scores. Do not raise or lower an IQ score or consider IQ scores that are slightly above or below the criteria in 12.05B.1.a, 12.05B.1.b, 112.05B.1.a, or 112.05B.1.b by assuming they are within the standard error of measurement.

The practice effect refers to gains in IQ scores on tests of intelligence that result from a person being retested on the same instrument. The size of the practice effect decreases as the time between test administrations lengthens. Use best efforts to obtain a copy of the test report for previously administered intelligence tests to determine the test version and date of the previous administration. When purchasing intelligence tests, avoid purchasing the same intelligence test within 12 months from the first administration. When multiple administrations of the same intelligence test are present in the record and show an improvement in IQ scores over time, consider the time between test administrations. If intelligence testing is administered as part of a consultative examination (CE) and the person is retested on an instrument they previously completed, make the CE provider aware of the previous testing and ask them to consider its effect. Only qualified specialists, medical and psychological consultants (MC or PC), and other contracted medical and psychological experts may conclude the obtained IQ scores are not an accurate reflection of the person's general intellectual functioning.

Do not use an interpreter for standardized intelligence testing. The tests are intended to be administered with a standard protocol, which often includes specific wording used for presenting test instructions and test items. Any deviation from the standard protocol can impact performance, scoring of the test, and interpretation of results. For example, test items presented in a different language may not be equivalent to how the item is presented in English. For more information on intelligence testing options that do not rely on fluency in a particular language, see DI 24583.055I.3.

There are Spanish language versions of some intelligence tests. Most of these tests do not meet programmatic requirements due to the lack of normative data based on Spanish-speaking individuals who reside in the United States. Additionally, many of the Spanish-language versions of intelligence tests are based on an edition of the English-language test other than the current publication. A limited number of Spanish language intelligence tests may be acceptable under very specific circumstances. Do not purchase Spanish language intelligence tests that do not meet programmatic requirements. If an intelligence test is needed, instead purchase a nonverbal intelligence test.

Many nonverbal intelligence tests will not satisfy the requirements for standardized tests of general intelligence found in section 12.00H of the mental disorders listings. Although many nonverbal tests measure multiple areas of intelligence, they do not include language and thus are not comprehensive tests of general intelligence.

Nonverbal intelligence tests are sometimes the only way to assess a person’s intellectual functioning. In particular, nonverbal intelligence tests are used when the person is unable to undergo standard administration of traditional intelligence tests that include both verbal and performance components. Common situations where nonverbal intelligence tests are acceptable include testing of people who do not speak English as their first language or who have significant language impairments. In cases where a nonverbal intelligence test is the only way to accurately measure a person’s intellectual functioning, medical equivalence may be appropriate.

Purchase a nonverbal intelligence test when the person is unable to undergo standard administration of a traditional intelligence test. The results of nonverbal intelligence tests used in the clinical setting to diagnose intellectual disorder may be used to medically equal the IQ requirements of listing 12.05 or 112.05. Examples of nonverbal intelligence tests used in the clinical setting include, but are not limited to, the Comprehensive Test of Nonverbal Intelligence, Second Edition (CTONI-2), Leiter International Performance Scale, Third Edition (Leiter-3), and Wechsler Nonverbal Scale of Ability (WNV). Do not use the results of a nonverbal intelligence test to meet the IQ requirements of listing 12.05 or 112.05.

For more information about medical equivalence, see DI 24508.010 and DI 24583.010.

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 intelligence tests.

Abbreviated IQ tests are quick measures of intelligence used in a variety of situations when a comprehensive assessment is not required. Most abbreviated IQ tests are essentially screening tests. For example, the Wechsler Abbreviated Scale of Intelligence (WASI) is an abbreviated test used to estimate IQ based on some, but not all, of the subtests contained in the Wechsler series of intelligence tests.

Do not use the results of abbreviated tests to determine whether the person has a mental impairment that meets or medically equals the requirements of listings 12.05 or 112.05. 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 abbreviated tests or screening tests only in rare circumstances. If the record only contains results of an abbreviated test and those results suggest the person may have a cognitive impairment, then consider purchasing a programmatically acceptable intelligence test.

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.

School records, including transcripts and individualized education programs (IEP), sometimes include the results of intelligence tests. Do not use the results of intelligence tests reported in school records if only the score is documented. Only use IQ scores reported in school records when the documentation includes the required test administration information and narrative report, see DI 24583.055D.

NOTE: Intelligence test results contained in school records may not be current. For example, school transcripts from elementary school that contain otherwise acceptable intelligence test results cannot be used to meet or medically equal the IQ requirements for an adult person. For more information, see DI 24583.055I.7.

IQ scores must be current to be used to meet or medically equal the IQ requirements of listings 12.05 and 112.05. IQ scores stabilize after age 16 and are generally considered current after that time. For younger children, consider the child's age at the time of testing and the test results themselves when determining whether IQ test results obtained before age 16 are sufficiently current for adjudication. The general guidelines are:

Intelligence test results obtained at age 16 or older may be considered current indefinitely, provided they are not inconsistent with the person’s current functioning.

For additional guidelines regarding current IQ scores in children, see DI 24583.060.

NOTE: IQ scores that are not current may still provide useful information about whether a person’s intellectual disorder began during the developmental period. For example, a full scale IQ of 88 obtained when the person was age 15 may provide evidence the intellectual disorder did not begin during the developmental period

The record may contain multiple intelligence tests administered to the same person. Generally, use the results from the most recently administered intelligence test if that test was programmatically acceptable. While only qualified specialists may determine an obtained IQ score is not an accurate reflection of the person's typical intellectual functioning, adjudicators must consider the extent to which intelligence test results support their determination whether a mental impairment meets or medically equals a listing in the context of the entire medical record. Important considerations include, but are not limited to, the following:

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  Was there a statement regarding validity included in the narrative report?

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  Was there an intervening event, such as a head injury, that might account for a significant decrease in obtained IQ scores?

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  Was the same version of the same intelligence test administered in close succession so that the practice effect might be a factor?

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  How old was the person at each intelligence test administration?

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  Are the most recent intelligence test results and the person's customary behavior and daily activities consistent with one another?

For information about considering and resolving inconsistencies, see DI 24501.016.

NOTE: When purchasing an additional intelligence test, provide a copy of the previous intelligence test results and report to the qualified specialist administering the new test.