Application of Clinical Psychology
- Provide a brief overview of your selected case
250 – 275 words
Format your analysis consistent with APA guidelines,
This is the case study the group agreed on
Case Study: Paul—WAIS-IV (Intellectual Assessment)
(Case provided by clinical psychologist John Brentar, PhD)
Age: 20 years
Education: College Junior
Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) The Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV) is a standardized measure of intelligence designed to assess verbal comprehension, perceptual organization, working memory, and processing speed. Scaled scores between 8 and 12 and standard scores between 90 and 109 (25th to 75th percentiles) reflect age-appropriate functioning.
|Verbal Comprehension||Scaled Score||Perceptual Reasoning||Scaled Score|
|Working Memory||Scaled Score||Processing Speed||Scaled Score|
|Index Scores||Standard Score||Percentile|
|* Perceptual Organization||109 (121)||73 (92)|
|* FULL SCALE IQ||98||45|
*Scores in parentheses indicated performance when time limits tested.
Paul’s overall score on the WAIS-IV indicated that his cognitive skills are in the mid-average range of functioning. However, there were significant discrepancies among domain scores, as well as between his performance under standard timed conditions and when given credit for correct responses after the time limits. Specifically, Paul displayed verbal and nonverbal reasoning abilities in the high end of the average range under standardized conditions compared to significant weaknesses in his auditory working memory and speed of processing skills, both below average. However, his overall performance on tests of nonverbal reasoning improved from the average to superior range when time limits were tested due to his exceptional performance on the Visual Puzzles subtest without time constraints.
Within the Verbal Comprehension domain, Paul displayed average verbal reasoning and knowledge. Specifically, his performance indicated age-appropriate word knowledge (Vocabulary = 75th percentile) and abstract reasoning (Similarities = 63rd percentile). His fund of knowledge (Information) was also average, at the 63rd percentile. Of note, Paul required time to consider the questions and often struggled to formulate his responses, causing him visible frustration.
Paul’s overall performance on tests of his nonverbal reasoning skills was impacted by his deliberate pace when faced with complex problems, and he displayed average skills when standard, timed conditions were used. However, when limits were tested and he was given credit for correct responses after the time limit, his overall performance improved to the superior range. This was due to the significant impact of time on his performance on the Visual Puzzles subtest, which measured his ability to analyze and synthesize abstract visual stimuli. Indeed, his performance under timed conditions was at the 84th percentile and improved to the 99.9th percentile when given credit for the items he answered correctly after the 30-second time limit. In fact, Paul answered all of the problems correctly, 6 after the time limit, and spent as much as 2 minutes on some problems. The impact of time was not as apparent during the Block Design subtest, which measured visual-motor and spatial organization, although Paul did not receive some of the bonus points for working quickly despite answering all items correctly. During this subtest, he talked his way through the problems and exhibited a systematic approach to constructing the designs. Paul had the most difficulty on the Matrix Reasoning subtest, which measured his reasoning skills for abstract visual information, at the 37th percentile. He appeared flustered during this subtest, commenting “Why am I not putting this together?” and also seemed to rush to provide answers. His anxiety appeared to worsen as the test progressed, which likely impacted his overall performance.
Paul’s auditory working memory, or his ability to hold information in memory in order to complete a task, was in the low average range of functioning, at the 13th percentile, indicating a significant weakness.
During the Digit Span subtest, he appeared confused about the task requirements, and especially struggled when asked to recall digits backward. Additionally, Paul’s performance on the Arithmetic subtest was impacted by his need for more time, and he answered 5 questions correctly after the time limit. He used helpful strategies during this subtest, including “writing” on the desk when solving the problems, and requested that the examiner repeat many of the problems. This approach improved his accuracy but slowed his performance. Overall, Paul appeared to benefit from the context provided by the items of the Arithmetic subtest compared to the less meaningful number lists, but he required time to fully consider the more complex problems.
Paul’s overall performance on tests of processing speed indicated a significant weakness, at the 14th percentile. Specifically, he demonstrated weak performance when completing the Coding subtest, which assesses speeded graphomotor coordination, at the 16th percentile. Similarly, his visual scanning skills as assessed by the Symbol Search subtest were below average, also at the 16th percentile.