Assessing Intellectual Disability in Culturally and Linguistically Diverse Adults: A United Kingdom Delphi Study.
Eimear McCabe, Freddie O'Donald, Doug McConachie and 1 others
Twenty UK psychologists agreed that current cognitive and adaptive behaviour tests are culturally limited, that existing guidance is too vague for consistent practice, and that assessments need more time, interpreter continuity, and specific training.
In practice, fewer than half used any alternative to the WAIS-IV.
Key findings
1Sixteen of the 32 statements reached expert consensus, with 100% agreement on developing cognitive assessments not requiring culture-specific norms, researching trauma's impact on cognition, researching cultural differences in social skills, and allocating additional clinical time for these assessments.
2Fewer than half of the 20 experts (9) reported using alternative or culturally adapted assessment measures instead of the WAIS-IV, while 11 reported no access to or not using such measures.
3Statements about using cognitive assessments in non-standardised ways, giving provisional diagnoses, and making diagnoses without a definitive IQ score were reported as areas of divergence, reflecting ongoing uncertainty in clinical practice.
Still to come
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The panel of 20 was professionally homogeneous (19 clinical psychologists, 1 Clinical Associate) and geographically concentrated (14 of 20 in NHS Scotland), so the consensus reflects a narrow slice of UK ID services and may not represent areas with higher linguistic diversity. No service user or family perspectives were captured; the findings are entirely clinician-driven and say nothing about how the assessment process is experienced by the people being assessed. Practice data were self-reported, which may be influenced by recall bias or social desirability. Only the 7 non-consensus items from Round 2 were re-rated in Round 3, so response stability across all items could not be examined. Both positively and negatively worded items were used, which can introduce method effects; consensus rates for negatively phrased items should be interpreted cautiously. The 85% consensus threshold was chosen a priori for a small panel; different cut-offs would have produced different patterns of agreement, so non-consensus items reflect genuine uncertainty rather than unimportance.
Declared interests
The authors declare no conflicts of interest and report no funding.
The easy way to misread this
Do not read the consensus on the need for 'culture-free' tools as evidence that current diagnoses are wrong or that the WAIS-IV is invalid. This is a panel of 20 UK psychologists (14 from NHS Scotland) stating what they wish existed; it is not a demonstration that any specific diagnosis was misapplied, and the panel's views are shaped by their shared professional training and service context.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →