Identification Number:
DI 24583 TN BASIC
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Evaluation of Specific Issues - Mental Disorders
Type:POMS Transmittals
Program:Disability
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 245 – Medical Evaluation
Subchapter 83 – Evaluation of Specific Issues - Mental Disorders
Transmittal No. BASIC, 07/19/2019

Audience

PSC: DE, DEC;
ODD-DDS: ADJ, DHU;
OCO-OEIO: CR, ERE, FCR, FDE, RECONE;
OCO-ODO: DE, DEC, DPS, DS, RECONE;

Originating Component

ODP

Effective Date

Upon Receipt

Background

This is a new subchapter with new Program Operations Manual System (POMS) sections, which consolidate information about evaluating mental disorders into a single subchapter. The sections revise, reorganize, and expand the policy guidance currently contained in DI 24505.025, DI 24515.055, and DI 24515.056, moving that content into the new sections. We plan to archive DI 24505.025, DI 24515.055, and DI 24515.056 when we publish the new sections. Additionally, the sections incorporate information from the revised listings for evaluating mental disorders that we published in the Federal Register on September 26, 2016, and became effective on January 17, 2017 (81 FR 66137). We also include policy guidance in response to questions from our adjudicators and PolicyNet feedback submissions.

 

Summary of Changes

DI 24583.005 Evaluating Mental Impairments Using the Psychiatric Review Technique (PRT)

This is a new section. We revised the policy guidance formerly in DI 24505.025. This section provides guidance on how to apply the regulatory requirements for the PRT. It focuses on the steps required to evaluate mental impairments using the PRT and describes the documentation requirements for each level of adjudication.

 

DI 24583.010 Determining Medical Equivalence for Mental Impairments

This is a new section. We revised the policy guidance formerly in DI 24515.056. This section provides guidance on how to determine medical equivalence for mental disorders. It provides examples of different situations encountered when determining medical equivalence for mental disorders, gives additional guidance on listings 12.05 and 112.05 for intellectual disorder, and provides information about documenting medical equivalence determinations.

 

DI 24583.050 Using Psychological Tests to Evaluate Mental Disorders

This is a new section. We revised the policy guidance formerly in DI 24515.055 and split it into three new sections. This section provides guidance about program requirements for psychological tests, different types of psychological tests, and how to consider psychological tests.

 

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

This is a new section. We revised the policy guidance formerly in DI 24515.055 and split it into three new sections. This section provides guidance about program requirements for intelligence tests, how to consider intelligence quotient (IQ) scores, and other considerations for intelligence tests such as using interpreters, nonverbal intelligence tests, and test information contained in school records.

 

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

This is a new section. We revised the policy guidance formerly in DI 24515.055 and split it into three new sections. This section provides guidance on additional considerations for psychological tests in children. It includes guidance on current IQ scores, IQ scores that are slightly out of date, overlap in age range for intelligence tests, using age- and grade-equivalent scores, and evaluating developmental milestone criteria.

Conversion Table
Old POMS ReferenceNew POMS Reference
DI 24505.025DI 24583.005
DI 24515.005DI 24583.050
DI 24515.005DI 24583.055
DI 24515.005DI 24583.060
DI 24515.056DI 24583.010

DI 24583.005 Evaluating Mental Impairments Using the Psychiatric Review Technique (PRT)

A. How do we evaluate medically determinable mental impairments at steps 2 and 3 of the sequential evaluation process?

We use a special technique called the PRT when evaluating mental impairments in adults under Part A of the Listing of Impairments. Using the PRT helps us:

  • Identify the need for additional evidence to determine impairment severity;

  • Consider and evaluate functional limitations of the mental disorder(s) relevant to the ability to work; and

  • Organize and present findings in a clear, concise, and consistent manner.

We use the PRT at steps 2 and 3 of the sequential evaluation process to determine whether a medically determinable mental impairment(s) is severe and, if so, whether the mental impairment(s) meets or medically equals a listed impairment. The PRT is used at all levels of the administrative review process.

NOTE: Do not use the PRT to evaluate mental disorders in children under Part B of the Listing of Impairments. The PRT is used to evaluate mental disorders for persons under age 18 when using Part A of the Listing of Impairments.

B. How do we use the PRT?

We use the PRT by following these steps:

  • First, determine whether the person has a medically determinable mental impairment(s) (see DI 24583.005C);

  • Second, rate the degree of functional limitation resulting from the mental impairment(s) (see DI 24583.005D);

  • Third, determine the severity of the mental impairment(s) (see DI 24583.005E);

  • Fourth, determine whether the mental impairment(s) meet or medically equals a listed impairment (see DI 24583.005F); and

  • Fifth, document the application of the PRT (see DI 24583.005G).

C. How do we determine whether the person has a medically determinable mental impairment?

We evaluate the pertinent symptoms, signs, and laboratory findings to determine whether the person has a medically determinable mental impairment. We must specify the symptoms, signs, and laboratory findings that substantiate the presence of the impairment(s) on a standard document. For more information about the standard document, see DI 24583.005G. For more information about establishing medically determinable impairments generally, see DI 24501.020.

D. How do we rate the degree of functional limitation resulting from the mental impairment(s)?

Assessment of functional limitations is a complex and highly individualized process that requires consideration of multiple issues and all relevant evidence to obtain a longitudinal picture of the person's overall degree of functional limitation. We consider all relevant and available clinical signs and laboratory findings, the effects of symptoms, and how functioning may be affected by factors including, but not limited to, chronic mental disorders, structured settings, medication, and other treatment.

We rate the degree of functional limitation based on the extent to which the impairment(s) interferes with the person's ability to function independently, appropriately, effectively, and on a sustained basis in a work setting. We consider such factors as the quality and level of overall functional performance, any episodic limitations, the amount of supervision or assistance required, and the settings in which the person is able to function. For more information about the evidence and factors to consider when rating the degree of functional limitation, see DI 34001.032 (12.00C through F of the adult mental disorders listings).

We rate the degree of functional limitation in four broad areas of mental functioning:

  • Understand, remember, or apply information;

  • Interact with others;

  • Concentrate, persist, or maintain pace; and

  • Adapt or manage oneself.

These four areas of mental functioning are commonly referred to as the “paragraph B criteria.” For a description of the paragraph B criteria, see DI 34001.032 (12.00E of the adult mental disorders listings).

We rate the degree of limitation in the paragraph B criteria using the following five-point scale: none, mild, moderate, marked, and extreme. The rating of extreme on the scale represents a degree of limitation that is incompatible with the ability to do any gainful activity. For more information about how to use the paragraph B criteria to evaluate mental disorders, see DI 34001.032 (12.00F of the adult mental disorders listings).

E. How do we determine the severity of the mental impairment(s)?

After rating the degree of functional limitation resulting from the impairment(s), we determine the severity of the mental impairment(s). If the degree of limitation in the areas of mental functioning are “none” or “mild,” we generally conclude that the impairment(s) is not severe, unless the evidence otherwise indicates that there is more than a minimal limitation in the ability to do basic work activities. For example, in some cases with multiple “mild” ratings, we may still find there is a severe impairment. For more information about the rating scale, see DI 34001.032 (12.00F of the adult mental disorders listings).

F. How do we determine whether the mental impairment(s) meets or medically equals a listed impairment?

If the mental impairment(s) is severe, we next determine whether it meets or medically equals a listed mental disorder. We compare the medical evidence of record about the mental impairment(s) and the rating of the degree of functional limitation with the criteria of the appropriate listed mental disorder. For the adult mental disorders listings, see DI 34001.032. For more information on determining medical equivalence for mental impairments, see DI 24583.010.

If we find that the mental impairment(s) neither meets nor medically equals a listed impairment, we then assess the person’s mental residual functional capacity (MRFC) and proceed to steps 4 and 5 of the sequential evaluation process. For more information about the MRFC, see DI 24510.060.

G. How do we document the application of the PRT?

We document the application of the PRT by recording the presence or absence of the listing criteria and the rating of the degree of functional limitation on a standard document. A PRT rationale should provide a description of the symptoms, signs, and laboratory findings substantiating the mental impairment, including, but not limited to, mental status examination findings, a summary of the longitudinal history of the disorder, and an assessment of the consistency of the evidence of record.

NOTE: When determining medical equivalence, the rationale may require additional information. For more information about medical equivalence, see DI 24508.010 and DI 24583.010.

1. Initial and reconsideration levels

At the initial and reconsideration levels of the administrative review process, the standard document is the Psychiatric Review Technique Form (PRTF) or an approved electronic equivalent such as the Disability Case Processing System (DCPS) or the Electronic Claims Analysis Tool (eCAT).

The medical or psychological consultant (MC or PC) has overall responsibility for assessing medical severity. The disability examiner may assist in preparing the PRTF. However, the MC or PC must review and sign the document to attest that it is complete and that he or she is responsible for its content, including the findings of fact and any discussion of supporting evidence.

For determinations that are less than fully favorable, the Disability Determination Services (DDS) must make every reasonable effort to have the medical portion of the case review conducted by a psychological consultant (a psychiatrist or psychologist). If the signed PRTF reflects that the MC or PC’s findings complete the medical portion of the determination, the MC or PC is not required to sign the SSA-831 (Disability Determination and Transmittal).

In reconsideration determinations, a different MC or PC (other than the MC or PC who signed the PRTF for the initial determination) may adopt the initial level PRTF without completing a new PRTF if the evidence does not warrant change in the initial determination in any way. Enter the following statement in Section IV (Consultant’s Notes) of the initial level PRTF: “I have reviewed all the evidence in file, and the PRTF of [date] is adopted as written.” This statement must be signed, dated, and annotated with the specialty code by the MC or PC.

2. Hearing and Appeals Council (AC) levels

At the hearing level and the AC level where the AC issues a decision, we document application of the PRT in the written decision. The written decision must:

  • Incorporate the pertinent findings and conclusions based on the PRT;

  • Show the significant history, including examination and laboratory findings, and the functional limitations that were considered in reaching a conclusion about the severity of the mental impairment(s); and

  • Include a specific finding as to the degree of limitation in each of the areas of mental functioning.

3. Continuing disability reviews (CDR)

The PRT is used when a disability hearing officer makes a reconsideration determination during the CDR evaluation process to assess the severity of mental impairments and, where applicable, to determine whether the mental impairment meets or medically equals one of the adult mental disorders listings. For more information about the use of the PRT in CDRs, see DI 28010.140. For more information about the Medical Improvement Review Standard (MIRS) and mental impairments, see DI 28010.135. For more information about advisory PRTs, see DI 29025.001.

When a disability hearing officer makes a reconsideration determination, the determination must document the application of the PRT, incorporating the disability hearing officer’s pertinent findings and conclusions based on the PRT. For more information about disability hearing officer decisions, see DI 33015.020.

H. References

  • DI 24501.020 Establishing a Medically Determinable Impairment (MDI)

  • DI 24508.010 Impairment or Combination of Impairments Equals a Listing – Medical Equivalence

  • DI 24510.060 Mental Residual Functional Assessment

  • DI 24583.010 Determining Medical Equivalence for Mental Impairments

  • DI 28010.135 Medical Improvement Review Standard (MIRS) Issues in Adult and Child Cases Involving Mental Impairments

  • DI 28010.140 Psychiatric Review Technique Form (PRTF) (SSA-2506-BK) in Continuing Disability Reviews (CDRs) for Adult Mental Disorders Listings

  • DI 29025.001 Disability Determination Services (DDS) Action When Fully Favorable Reconsideration Determination Is Not Issued

  • DI 33015.020 Writing the Disability Hearing Officer’s (DHO’s) Decision

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

DI 24583.010 Determining Medical Equivalence for Mental Impairments

A. How do we determine medical equivalence for mental impairment(s)?

An impairment(s) is medically equivalent to a listed impairment in the Listing of Impairments (listings) if it is at least equal in severity and duration to the criteria of any listed impairment. We evaluate medically determinable mental impairment(s) using the mental disorders listings. For the general rules for finding medical equivalence, see DI 24508.010. For rules on finding medical equivalence in children, see DI 25220.010. For the adult mental disorders listings, see DI 34001.032. For the childhood mental disorders listings, see DI 34005.112.

The mental impairment identified by the paragraph A criteria of the mental disorders listings must cause the functional limitations assessed by the paragraph B or paragraph C criteria of the mental disorders listings. Many people have multiple co-occurring mental impairments. Sometimes it is not possible to determine whether the mental impairment identified by the paragraph A criteria is the cause of the functional limitations due to multiple co-occurring mental impairments. In those cases, consider whether the combination of mental impairments medically equals a mental disorders listing. For more information, see DI 24583.010A.3.

There are three ways to find medical equivalence. We consider whether the person has:

  • A listed mental impairment (that is, a mental impairment in a listed mental disorders category);

  • An unlisted mental impairment (that is, a mental impairment that is not part of a listed mental disorders category); or

  • A combination of mental impairments.

1. Listed mental impairments

If a person has a mental impairment that is evaluated under one of the mental disorders listings, but the findings related to the impairment do not satisfy the paragraph A criteria (for every listing except listing 12.05), determine whether the clinical findings are at least of equal medical significance to the listed paragraph A criteria. The mental impairment must also impose limitations as described in paragraph B (of every listing except 12.05) or paragraph C (for listings 12.02, 12.03, 12.04, 12.06, and 12.15), as appropriate. There are not findings that can be substituted for the paragraph B or paragraph C criteria. When the paragraph B or paragraph C criteria are not satisfied, the person does not have a mental impairment that meets or medically equals a listed mental impairment.

NOTE: For special instructions regarding listing 12.05, see DI 24583.010B.

2. Unlisted mental impairments

There are not mental disorders listings for all mental impairments. If a person’s mental impairment is not part of a listed mental disorders category, compare the clinical findings of the unlisted mental impairment to the paragraph A criteria in a closely analogous mental disorders listing (for every listing except 12.05) and determine whether the clinical findings are at least of equal medical significance to the analogous listing. The mental impairment must also impose limitations as described in paragraph B (of every listing except 12.05) or paragraph C (for listings 12.02, 12.03, 12.04, 12.06, and 12.15), as appropriate.

EXAMPLE: Dissociative identity disorder is an unlisted mental impairment that may sometimes reach listing level severity under one or more listings. Dissociative identity disorder could be evaluated under listing 12.04, Depressive, bipolar, and related disorders based on the similarities in diagnostic features. However, based on the individual presentation of signs and symptoms in a given person, evaluation under a different listing may also be appropriate.

NOTE: For special instructions regarding listing 12.05, see DI 24583.010B.

3. Combination of impairments

If a person has a combination of mental impairments, his or her condition may medically equal a mental disorders listing in three ways, as described below. The combination of mental impairments must also impose restrictions as described in paragraph B (of every listing except 12.05) or paragraph C (for listings 12.02, 12.03, 12.04, 12.06, and 12.15), as appropriate.

NOTE: For special instructions regarding listing 12.05, see DI 24583.010B.

NOTE: It is generally not appropriate to medically equal a mental disorders listing using a combination of physical and mental impairments. However, in cases where the mental effects of multiple physical and mental disorders cannot be separated, it may be appropriate to consider medical equivalence using a combination of physical and mental impairments. For example, consider a case with a claimant with a neurological disorder causing physical and mental limitations that do not meet the criteria of any neurological disorders listing, along with a coexisting mental impairment, the effects of which cannot be separated from those of the neurological disorder. In such a situation, it may be appropriate to medically equal a mental disorders listing.

a. Medical equivalence to the paragraph A criteria through a combination of mental impairments

Medical equivalence may be appropriate when the paragraph A criteria of a mental disorders listing (for every listing except 12.05) are satisfied through a combination of mental impairments. These cases will always involve limitations resulting from a combination of mental impairments to satisfy the paragraph B criteria or paragraph C criteria. There are not findings that can be substituted for the paragraph B or paragraph C criteria. When the paragraph B or paragraph C criteria are not satisfied, the person does not have a mental impairment that meets or medically equals a listed mental impairment.

EXAMPLE: The person has generalized anxiety disorder and posttraumatic stress disorder that do not individually satisfy the paragraph A criteria of either listing 12.06 or 12.15. If the combination of generalized anxiety disorder and posttraumatic stress disorder result in clinical findings that are at least of equal medical significance to the listed paragraph A criteria, then a finding of medical equivalence may be appropriate.

b. Medical equivalence to the paragraph B criteria through a combination of mental impairments

In many cases involving multiple mental impairments, it is not possible to identify which mental impairment causes the functional limitations that satisfy the paragraph B criteria. In these cases, medical equivalence may be appropriate because the combination of mental impairments results in extreme limitation of one, or marked limitation of two, of the four areas of mental functioning in the paragraph B criteria (for every listing except 12.05, see DI 24583.010B.3).

EXAMPLE: The person has generalized anxiety disorder and posttraumatic stress disorder that individually satisfy the paragraph A criteria of listings 12.06 and 12.15, respectively. The person also has marked limitations in the paragraph B criteria for interact with others and concentrate, persist, or maintain pace. However, it is not clear from the medical evidence whether the functional limitations result from the generalized anxiety disorder, the posttraumatic stress disorder, or the combination of the two mental impairments. A finding of medical equivalence would be appropriate.

c. Medical equivalence to the paragraph C criteria through a combination of mental impairments

A finding of medical equivalence for the paragraph C criteria is appropriate only in cases that involve a combination of mental impairments that are all evaluated under listings that contain paragraph C criteria. Do not find medical equivalence when one of the mental impairments is evaluated under a listing that does not contain paragraph C criteria.

EXAMPLE: The person has schizoaffective disorder and depressive disorder that individually satisfy the paragraph A criteria of listings 12.03 and 12.04, respectively. The person has only mild or moderate limitations in each of the paragraph B criteria. If the person’s combination of depressive disorder and schizoaffective disorder satisfy the requirements of the paragraph C criteria, a finding of medical equivalence may be appropriate because both listings 12.03 and 12.04 contain paragraph C criteria.

EXAMPLE: The person has bipolar disorder and borderline personality disorder that individually satisfy the paragraph A criteria of listings 12.04 and 12.08. The person has only mild or moderate limitations in each of the paragraph B criteria. Even if the person’s combination of mental impairments satisfy the requirements of the paragraph C criteria of listing 12.04, do not find medical equivalence because listing 12.08 does not contain paragraph C criteria.

B. How do we determine medical equivalence for intellectual disorder under listing 12.05?

Listing 12.05 is used to evaluate intellectual disorder and has two paragraphs, A and B. Each paragraph contains the three elements of the medical definition of intellectual disability – significant deficits in general intellectual functioning, significant deficits in adaptive functioning, and evidence that the disorder began during the developmental period. A person’s impairment meets the listing when all of the criteria of either paragraph are satisfied. Generally, it is not possible to find that an intellectual disorder medically equals listing 12.05 except in certain limited circumstances described in DI 24583.010B.2.b and DI 24583.010B.3.

1. Medical equivalence for 12.05A

Do not find that an impairment medically equals 12.05A. There are no clinical findings at least of equal medical significance to an inability to participate in standardized tests of intellectual functioning, dependence upon others for personal needs, or onset during the developmental period.

2. Medical equivalence for assessing significantly subaverage general intellectual functioning under 12.05B

a. Intelligence quotient (IQ) scores

Do not find that other clinical findings are at least of equal medical significance to the IQ scores specified under 12.05B.1. Only consider a person’s obtained IQ scores for 12.05B.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 or 12.05B.1.b to find medical equivalence. The 12.05B.1.b criterion for significantly subaverage general intellectual functioning already accounts for the scenario involving a person with intellectual disorder whose obtained full scale IQ score is slightly above 70. If the record contains obtained IQ scores that do not satisfy the IQ score criteria for 12.05B.1 but the criteria in 12.05B.2 are satisfied, consider whether the impairment meets or medically equals listing 12.11 for neurodevelopmental disorders or 12.02 for neurocognitive disorders.

b. Nonverbal intelligence tests

Many nonverbal intelligence tests will not meet our requirements for standardized tests of general intelligence found in section 12.00H of the mental disorders listings. In cases where a nonverbal intelligence test is the only way to accurately measure a person’s intellectual functioning, medical equivalence may be appropriate. For more information about using nonverbal intelligence tests, see DI 24583.055I.3.

3. Medical equivalence for assessing significant deficits in adaptive functioning under listing 12.05B

In most cases involving intellectual disorder in combination with other impairments, it is not possible to medically equal the criteria in 12.05B.2 because the functional limitations must result from intellectual disorder. The criteria in 12.05B.2, which are the paragraph B criteria in the other mental disorders listings, are used to assess the intellectual disorder requirement for significant deficits in adaptive functioning. These deficits must be present before age 22. When a case involves intellectual disorder in combination with another impairment that arose after age 22 and you cannot differentiate which impairment affects the rating of the paragraph B criteria, you cannot establish that deficits in adaptive functioning were present before age 22.

Instead, consider whether the impairment meets or medically equals 12.11 for neurodevelopmental disorders or 12.02 for neurocognitive disorders, rather than whether the impairment medically equals listing 12.05. In limited circumstances, medical equivalence may be appropriate for cases involving a combination of intellectual disorder and another mental disorder that began prior to attainment of age 22, such as autism spectrum disorder.

4. Medical equivalence for assessing whether the intellectual disorder began during the developmental period

Do not make a finding of medical equivalence when considering the requirement that the intellectual disorder began prior to the attainment of age 22. If the person’s cognitive impairment satisfies the requirements in 12.05B.1 and 12.05B.2 but there is no evidence supporting the conclusion the disorder began prior to the attainment of age 22, consider whether the impairment meets or medically equals 12.11 for neurodevelopmental disorders or 12.02 for neurocognitive disorders, rather than whether the impairment medically equals listing 12.05.

NOTE: We do not require evidence that existed or was recorded prior to when the person attained age 22. We only need evidence that is consistent with the conclusion the disorder began prior to age 22. For more information about this criterion, see DI 34001.032 (12.00H.4 of the adult mental disorders listings).

C. How do we document medical equivalence determinations?

We evaluate mental impairments using the Psychiatric Review Technique (PRT). We document the application of the PRT on a standard document. For more information about the PRT and the standard document, see DI 24583.005.

On the standard document, describe the pertinent symptoms, signs, and laboratory findings that substantiate the presence of the impairment. Document the rationale for the finding of medical equivalence, including which clinical findings are at least of equal medical significance to the listed requirements. Include the following types of information, as appropriate:

  • Which finding was not exhibited or was not as severe as specified in the listing?

  • What other findings were at least of equal medical significance?

  • Which mental impairment is an unlisted impairment, and which listing is the analogous listing?

  • What combination of mental impairments does the person have, and how is that combination of at least equal medical significance?

NOTE: These are only examples of information that might be included in an acceptable medical equivalence rationale. The actual rationale used to document the finding of medical equivalence must reflect the specific circumstances of the case.

D. References

  • DI 24508.010 Impairment or Combination of Impairments Equaling a Listing – Medical Equivalence

  • DI 24583.005 Evaluating Mental Impairments Using the Psychiatric Review Technique (PRT)

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

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

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 intelligence 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))

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

A. What are 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.

B. How do we use intelligence tests?

We use the results of intelligence tests to assess a person’s general intellectual functioning. Intelligence tests are most commonly used to evaluate cases involving intellectual disorder, specifically to determine whether the person has significantly subaverage general intellectual functioning as required by listings 12.05 and 112.05. However, intelligence tests may also be used when evaluating other cognitive disorders, such as neurocognitive disorder or borderline intellectual functioning, under listings 12.02, 12.11, 112.02, and 112.11. For the mental disorders listings, see DI 34001.032 and DI 34005.112.

NOTE: We do not endorse, prefer, or require any specific intelligence test. Tests are programmatically acceptable when they satisfy the requirements in DI 24583.050B, DI 24583.050C, DI 24583.055C, and DI 24583.055D.

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

C. What are our program requirements for intelligence tests?

If the obtained IQ scores will be used to meet or medically equal the IQ requirements of listing 12.05 or 112.05, the intelligence test must meet the program requirements for psychological tests described in DI 24583.050B . That is, the 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.

In addition to the program requirements for psychological tests, intelligence tests must have a mean of 100 and a standard deviation of 15 if the obtained scores will be used to meet or medically equal the requirements of listing 12.05 or 112.05. All intelligence tests published since 2003 (and most tests published prior to that time) satisfy this requirement. In the rare case you encounter an older intelligence test that used a different mean or standard deviation, contact your Regional Office for additional guidance.

Do not purchase intelligence tests that do not meet these programmatic requirements except for nonverbal intelligence tests under limited circumstances. For more information about nonverbal intelligence tests, see DI 24583.055I.3.

NOTE: These requirements apply to intelligence tests used to meet or medically equal the IQ criteria of listing 12.05 or 112.05. For information about how to consider tests that do not meet these requirements, see DI 24583.055H.

D. What information do we need about the intelligence test?

Just as with psychological tests, we require a test report containing information about the particular test administration and a narrative report. Do not find a person has an intellectual disorder that meets or medically equals the IQ requirements of listing 12.05 or 112.05 unless the record contains the test report with the required information and a narrative report. For more information, see DI 24583.050C.

E. How do we consider IQ scores obtained on intelligence tests?

IQ scores are used to satisfy the criteria in listing 12.05B.1 or 112.05B.1. The criteria are satisfied either when the person has a full scale IQ score of 70 or below or when the person has a full scale IQ score of 71 to 75 accompanied by a verbal or performance (or comparable) IQ score of 70 or below.

NOTE: IQ scores only satisfy one part of the criteria needed to find a person has intellectual disorder that meets or medically equals listing 12.05 or 112.05. For the other criteria, see the mental disorders listings in DI 34001.032 and DI 34005.112.

1. Obtained IQ scores

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.

2. Full scale IQ "accompanied by" verbal or performance IQ scores

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.

3. "Comparable" scores

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.

a. Full scale IQ scores

A full scale IQ score reflects a wide range of cognitive abilities, such as verbal comprehension, perceptual reasoning, memory, and processing speed. A score that is comparable to a full scale IQ score will also represent a person’s general intelligence. Some IQ tests refer to these scores as “total,” “overall,” or “general intellectual ability” scores, which are comparable to a full scale IQ score.

b. Verbal IQ scores

A verbal IQ score represents a person’s verbal intelligence, which measures verbal ability, comprehension, and knowledge and the ability to think abstractly. A score that is comparable to a verbal IQ score will also represent a person’s verbal abilities. Some IQ tests refer to these scores as a “verbal comprehension index,” which is comparable to a verbal IQ score.

c. Performance IQ scores

A performance IQ score represents a person’s nonverbal intelligence, which is the ability to analyze information and solve problems using visual and spatial reasoning, sometimes requiring good eye-hand coordination and speed. A score that is comparable to a performance IQ score will also represent a person’s nonverbal intelligence. Some IQ tests refer to these scores as a “perceptual reasoning index,” which is comparable to a performance IQ score.

d. Other part scores

Not all IQ tests produce part scores that are comparable to verbal and performance IQ scores. Some IQ tests produce part scores that are not comparable to full scale, verbal, or performance IQ scores. Do not consider part scores that are not comparable to full scale, verbal, or performance IQ scores. For example, “working memory” and “processing speed” indices are part scores that are not comparable to full scale, verbal, or performance IQ scores.

4. IQ scores at the margin

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.

F. What other considerations may affect obtained IQ scores?

1. Standard error of measurement

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.

2. Practice effect

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.

G. Who is responsible for conclusions based on testing?

Presume the obtained IQ scores are an accurate reflection of the person’s current general intellectual functioning at the time the test was administered, unless evidence in the record suggests otherwise. Only qualified specialists, MCs or PCs, 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. Administrative law judges and other lay adjudicators are not qualified specialists and cannot make this determination. For more information about conclusions based on testing, see the mental disorders listings in DI 34001.032 and DI 34005.112.

H. How do we consider intelligence tests that do not satisfy program requirements?

The record may contain results of intelligence tests that do not satisfy program requirements. Do not use those results to meet or medically equal the requirements of listings 12.05 and 112.05 except when using nonverbal intelligence tests. For more information about nonverbal intelligence tests, see DI 24583.055I.3.

Consider intelligence tests that do not satisfy program requirements for the information they provide. For example, if an intelligence test was not administered by a qualified specialist and the results indicate potentially listing-level IQ scores, then purchase a programmatically acceptable test.

I. Additional considerations

1. Use of interpreters

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.

2. Spanish language intelligence tests

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.

a. Spanish language tests that may be programmatically acceptable

  • Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V) Spanish: This test may be used for Spanish-speaking children who have not completed more than 5 consecutive years in the United States school system. It is not programmatically acceptable for children with more than 5 years of schooling in the United States.

b. Spanish language tests that are not programmatically acceptable

  • Bateria III Woodcock-Muñoz: This test is not programmatically acceptable. It uses norms substantially based on populations outside of the United States (for example, Central America, South America, Spain, Puerto Rico).

  • Escala de Inteligencia de Wechsler para Adultos-Tercera Edicion (EIWA-III): This test is not programmatically acceptable. It uses norms based on the Puerto Rican census.

  • Escala de Inteligencia Wechsler Para Niños-Revisada de Puerto Rico (EIWN-R PR): This test is not programmatically acceptable. It uses norms based on the Puerto Rican census and is anchored to an outdated edition of the WISC.

NOTE: Older versions of these tests also are not programmatically acceptable, as are Spanish-language versions of the WISC other than the Spanish versions of the WISC-IV and WISC-V.

For more information on considering intelligence tests that do not meet programmatic requirements, including Spanish-language intelligence tests, see DI 24583.055H.

3. Nonverbal intelligence tests

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.

4. Screening and other abbreviated IQ 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 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.

5. Updated editions of intelligence 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.

6. School records

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.

7. Current IQ scores

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:

Age at time of testing

IQ less than 40

IQ 40 or greater

Before attainment of age 7

Current for 2 years

Current for 1 year

From age 7 to attainment of age 16

Current for 4 years

Current for 2 years

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

8. Multiple or serial intelligence tests

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:

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

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

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

  • How old was the person at each intelligence test administration?

  • 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.

J. References

  • DI 24501.016 Evidence Evaluation

  • DI 24508.010 Impairment or Combination of Impairments Equals a Listing – Medical Equivalence

  • DI 24583.010 Determining Medical Equivalence for Mental Impairments

  • DI 24583.050 Using Psychological Tests to Evaluate Mental Disorders

  • 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))

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

A. How are psychological tests used to evaluate childhood disability claims?

Psychological tests for children must satisfy the same requirements as psychological tests for adults. However, there are additional guidelines that are specific to psychological tests for children. For more information about psychological tests, see DI 24583.050. For more information about intelligence tests, see DI 24583.055.

B. When do these additional guidelines for children apply?

Follow these additional guidelines for children when evaluating standardized tests for a child who has not attained age 18. Use the person’s chronological age when determining whether these guidelines apply.

C. What are the specific guidelines for intelligence tests for children?

1. Current IQ scores

IQ scores must be current to be used to meet or medically equal the requirements of listing 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 test administration and the test results themselves when determining whether IQ test results obtained before age 16 are sufficiently current for adjudication. The general guidelines are:

Age at time of test administration

IQ less than 40

IQ 40 or greater

Before attainment of age 7

Current for 2 years

Current for 1 year

From age 7 to attainment of age 16

Current for 4 years

Current for 2 years

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.

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 score of 88 obtained when the person was age 15 may provide evidence the intellectual disorder did not begin during the developmental period.

2. Scores that are slightly past being current

When a child has not attained age 16, the IQ scores may sometimes be only slightly past the requirements for being current. Consider how much time has passed since the test in the claim file was administered and whether the same test would be given currently. Do not use IQ scores that are more than 6 months beyond what is considered current to determine whether the child has an intellectual disorder that meets or medically equals listing 112.05.

EXAMPLE: An 8 year old child was administered the Stanford-Binet Intelligence Scales: Fifth Edition (SB-5) and received a full scale IQ score of 65 on June 22, 2014. The scores are considered current for program purposes until June 21, 2016. The claim is being adjudicated on August 15, 2016. Because the score is less than 6 months beyond what is considered current and the SB-5 would still be the appropriate test, updated testing would generally not be required to make a determination about whether the child has an intellectual disorder that meets or medically equals listing 112.05.

EXAMPLE: A 15 year old child was administered the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) and received a full scale IQ of 65 on June 22, 2014. The scores are considered current for program purposes until June 21, 2016. The claim is being adjudicated on August 15, 2016. Although the score is less than 6 months beyond what is considered current, the WISC-IV is no longer the same test that would be given because the child is now 17 years old and the WISC-IV is only appropriate for children through age 16 years and 11 months. Updated intelligence testing is required to make a determination about whether the child has an intellectual disorder that meets or medically equals listing 112.05.

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

3. Overlap in test age ranges

The Wechsler series of intelligence tests have overlap in the age range for each test. For example:

Test name

Lower end

Upper end

Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV)

2 years and 6 months

7 years and 7 months

Wechsler Intelligence Scale for Children-Fifth Edition (WISC-V)

6 years and 0 months

16 years and 11 months

Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV)

16 years and 0 months

90 years and 11 months

When deciding which test to purchase for children in the overlap age ranges, test developers recommend choosing the test with the lower minimum age if the child is suspected of being of below average cognitive ability.

EXAMPLE: A child is 6 years and 9 months old and has suspected low cognitive ability. Purchase the WPPSI-IV and not the WISC-V for this child because the WPPSI-IV is the test with the lower end of the age range.

NOTE: We do not endorse, prefer, or require any specific intelligence test. While the Wechsler series of intelligence tests are frequently seen in our program, there are other intelligence tests that satisfy our program requirements for acceptable intelligence tests and may also be purchased when appropriate.

D. How do we use age- and grade-equivalent scores when evaluating children?

Some test reports, particular reports from achievement tests, contain information about age and grade equivalence.

1. Definitions

a. Raw score

A raw score is the unconverted score on a standardized test.

b. Age-equivalent score

An age-equivalent score is the average age of children who received the same raw score on a standardized test.

c. Grade-equivalent score

A grade-equivalent score is the grade and month of the school year that is the average grade placement for students who received the same raw score on a standardized test.

2. Use of age- and grade-equivalent scores

Age- and grade-equivalent scores represent average scores and are not standard scores that can be converted to standard deviations. Because we compare the child to other children his or her age, an age- or grade-equivalent score by itself has limited usefulness since it does not indicate how well the child did in comparison to other children his or her age who do not have impairments. Do not rely on any test score alone. Consider the information from the test along with all the other evidence. These scores, along with other information, may give a picture of the child's overall progress in development or learning.

E. How do we evaluate developmental milestone criteria?

Developmental milestones refer to the attainment of particular mental or motor skills at an age-appropriate level. Developmental milestone criteria are used for determining disability when a child’s young age or condition precludes formal standardized testing.

Only consider developmental milestone criteria for children who have not attained age 3. Consider developmental milestone criteria for these children in combination with professional observations of a child’s performance, behavior, and activities. Consider whether findings about developmental milestones are consistent with the child’s daily activities and with professional observations of the child’s performance and behavior. Do not substitute statements by relatives or other parties regarding the child’s behavior or capabilities for professional observations.

F. How do we consider psychological tests that are specific to a particular disorder?

Psychological tests are sometimes used in the clinical setting as part of the diagnostic process. These diagnostic tests are often specific to particular disorders, such as autism spectrum disorder. Generally, diagnostic testing is not necessary to evaluate mental disorders in children because the disorders can be adequately assessed using other findings available in the medical evidence. We do not require the results of diagnostic tests to make a determination about whether a medically determinable impairment (MDI) exists, the severity of that MDI, or whether the MDI meets or medically equals a listing. We neither require nor prohibit the purchase of diagnostic tests. Decide whether a specific standardized test typically used in the diagnostic process is necessary given the particular facts of a case.

G. References

  • DI 24583.050 Using Psychological Tests to Evaluate Mental Disorders

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

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


DI 24583 TN BASIC - Evaluation of Specific Issues - Mental Disorders - 7/19/2019