WASI-II Record Form

"""°" "
"o
WECHSlbR ABBREVIATED SCALE ÌCSE
eNTELUGENCE SECOND EDITlON
atC
-
Examinee N

Sex: F M Handedness: R L Test Age

Address/School/Testing Site:

Highest Education/Grade:

Examiner Name:

Total Raw Score to TScore Conversion ExamineeVisual/HearingAids During Testing

S Meek Check tyeseof aid examinee needed:

Design

Vocabulary Prescription Lenses

Matrix Reasoning
Otsssted Listening Device
Similarities

Sum of TScores
Verbal Perc. Full Full
Comp. Rsng. Scale--4 Scale-2

Sum of TScores to Com.osite ScoreConversion Subtest TScore Profile Com osite ScoreProfile

- -
Confidence Verbal Perceptual
interval Comirehension Reasoning
CoSmposeite
VC Si BD MR
160-
Verbal Comp. VCI
80- 160-
Pere. Rsng. PRI
75-
FSl0-4 I 140
Full Scale-4
70-
Full Scale-2 FSIG-2 130
65- 125

120-

50- 100

45-

-
90
40-
80
35- -
70
30- 6S

25- 60
55 -
20- ¯ - 50

40-

PEA RSO N Copyright © 2011 NCS Pearson, Inc, All rights reserved PSychCorp
3 4 5 6 7 8 9 10 11 12 A BCDE 282563-1 a Product Number 0158981596
1. Block Design sa tt
Start Record & Score
O Ages 6-8:
Item i
Reverse
Ages 9-90: Does not obtain a perfect score on either
\tem 3 or item 4, administer the preceding items in
Discontinue
After 2 consecutive
scores of 0-
Stop
Ages OS:
After item 1L
Items14:
Score 0, 1, or 2 points.
Ages 9-90: reverse order untiltwo consecutive perfect scores Items 13:
are obtamed.
Item 3 Score 0, 4, 5, 6, or 7 points

- ' '
.
]
Design
Examinee
Presentation
Method
Completion

Trial 1
Time
Trial 2
Constructed

Trial 1
Design
Trial 2
Score

Model and

Examiner 0 1 2

Trial l Trial 2 Trial l Trial 2

Modd and

0 1 2
·
i 3. Trial i Trial 2 T T
Modd and
45"
0 1 2

4. Triall Trial2 T T
Modd and
45
0 1 2

21-60 16-20 11-15 1-10

Picture 60"
0 4 5 6 7

21-60 16-20 11-15 1-10

Picture 60"
0 4 5 6 7
7.
21-60 16-20 11-15 1-10
Picture 60"
0 4 5 6 7

21-60 16-20 11-15 1-10

Picture 60"
0 4 5 6 7

71-120 46-70 31-45 1-30

Picture 120"

0 4 5 6 7

10.
61-120 46-60 36-45 1-35
Picture 120"

Picture 61 120 4 60 36-45 1-35

120

Picture 120 61 120 46 60 36 45 1 35

101 120 81 100 56 80 1-55

Picture 120

Maximum Raw Score Block Design

Ages 6-8: 57 Total Raw Score
Ages 9-90: 71
2. Vocabulary
Start Reverse Discontinue Stop Record & Score
O Ages 6-90:
Item4
Ages 6-90: Does not obtain a perfect score
on either item 4 or item 5, administer the
After 3
consecutive
Age 6:
After item 22-
,

4' Items1-3: Score 0 or 1 point.

Items 4-5: Score o or 2 points,
preceding items in reverse order untiltwo scores of 0- Ages 7-11: items 6-31: Score 0, 1, or 2 points.
consecutive perfect scores are obtained. After item 25 See the Manual for sample responses
Ages 12-14:
After item 28.
Item Response Score
1. Fish
0 1

2. Shovel
0 1

3. Shell
0 1

†4. Shirt
0 2

5. Car
0 2

6. Lamp
0 1 2

7. Bird
0 1 2

8. Tongue
0 1 2

9. Per
0 1 2

10. Lunch
0 1 2

11. Bell
0 1 2

12. Calendar
0 1 2

13. Alligator
0 1 2

14. Dance
0 1 2

†lf the examinee provides a 2-point response that requires feedback or gives an incorrect (0 point) response, provide corrective feed baci< as
insitucted in the MamiaL

WASI-Il Record Form 3

2. Vocabulary (continued) Discontinue after 3 consecutive scores of 0.
Item Response Score
15. Summer

0 1 2

16. Reveal

0 1 2

17. Decade

0 1 2

18. Entertain

0 I 2

19. Tradition

0 l 2

20. Enthusiastic

0 1 2

21. Improvise

0 1 2

22. Haste
0 1 2

23. Trend
0 1 2

24. Impulse
0 1 2

25. Ruminate
0 1 2

i·
7 11
26. Mollify
0 1 2

27. Extirpate
0 1 2

28. Panacea
0 1 2

4 WASI-II Record Form

2. Vocabulary(continued) Discontinue after 3 consecutive scores of 0.
Item Response Score
29. Perfunctory
0 1 2

30. Insipid
0 1 2

31. Pavid
0 1 2

Maximum Raw Score Vocabulary

Age 6: 41 Total Haw Score
Ages 7-11: 47
Ages 12-14: 53
Ages 15-90: 59

3. Matrix Reasoning
Start
O Ages 8:
Sample Items A & 8,
Reverse
Ages9-90: Does not obtain a perfect score
on either Item 4 or ltem 5, administer the
Discontinue
After 3 consecutive
scores of 0
Stop
Ages &-8:
After (tem 24.
/
,
Record & Score
Score 0 or 1 point.
Correct responses are in color.
then item 1 preceding items in reverse order until two
Ages 9-90: consecutive perfect scores are obtained.
Sample items A & B,
then item 4
Response Response

2345 15.1234501

sil 2345 16.1234501

1.1234501 17.1234501

2. 1 2 3 4 5 0 1 18. I 2 3 4 5 0 1

3. 1 2 3 4 5 0 1 19. 1 2 3 4 5 0 1

4.1234501 20.1234501

5.1234501 21.1234501

6. 1 2 3 4 5 0 1 22. 1 2 3 4 5 0 1

7. I 2 3 4 5 0 1 23. 1 2 3 4 5 0 1

8. 1 2 3 4 5 0 1 24. 1 2 3 4 5 0 1
6-0
9.1234501 25.1234501

10. I 2 3 4 5 0 1 26. 1 2 3 4 5 0 1

11. 1 2 3 4 5 0 1 27. 1 2 3 4 5 0 1

12.1234501 28.1234501

13.1234501 29.1234501

14. 1 2 3 4 5 0 1 30. 1 2 3 4 5 0 1

Maximum Raw Score Matrix Reasoning

Ages 6-8: 24 Total Raw Score
Ages 9-90: 30

WASI-Il Record Form 5

4. Similarities
Start Reverse Discontinue Stop Record & Score
Ages 6-8: Ages9-90: Does not obtaina After 3 consecutive Ages 6-8: Items 1-3: Score 0 or 1 point.
Item 1 perfect score on either item 4 or scores of 0
Ages 9-90: Ltemm a mn er erp ec ng
After Item 22. Correct responses are in color.
Items 4-5: Score 0 or 2 points,
item 4 consecutive perfect scores are Items &-24: Score 0, 1, or 2 points.
obtained See Manual for sample responses.

Response Response Response

†1.1234501 2. 1234501 3. 1234501

VerbalItems Response Score

§† 4. Green-Blue

0 2

§† 5. Square-Triangle

0 2

6. Cow-Bear

0 1 2

7. Shirt-Jacket
0 1 2

8. Pen-Crayon

0 1 2

9. Hat-Umbrella

0 1 2

10. Airplane-Bus

0 1 2

11. Door-Window

0 1 2

12. Child-Adult

0 1 2

§If the examinee provides a response that suggests he or she does not understand the task, provide the specified prompt in the ManuaL
lErhe examince provides a 2-point response that requires feedback or provides an incorrect (0 point) response, provide corrective Feedbackas
instructed in the ManuaL

6 WASI-II Record Form

 IllÎlâl°itieS
. (continued) Discontinue after 3 consecutive scores of 0.

Verbal Items Response Score

13. Shoulder-Ankle

0 1 2

14. Love-Hate

0 1 2

15. Smooth-Rough

0 1 2

16. Hand-Flag

0 1 2

17. Wall-Line

0 1 2

18. Heat-Wind

0 1 2

19. More-Less

0 1 2

20. Shadow-Echo

0 1 2

21. Tradition-Habit

0 1 2

22. Peace-War

0 1 2

23. Time-Progress

0 1 2

24. Memory-Practice

0 1 2

Maximum Raw Score Similarities

Ages 6-8: 41 Total Raw Score
Ages 9-90: 45
WAS1-Il Record Form 7
 Examinee Name: Age:

Parent/Guardian Name:
WECHSLER ABBREVIATEDSCALE
OF INTELLIGENCE"- SECOND EDlTION
Examiner Name:

Record Form
BehavioralObservations
Referral source/Reason Ÿorreferral/Presenting complaint(s)

Physical appearance

Language (e.g., first/native language, other language, English fluency, expressive and receptive language ability, articulation)

Attention and concentration

Artitude toward testing (e.g., rapport, eager to speak, working habits, interest, motivation, reaction to success/failure)

Affect/Mood

Unusual behaviors/Verbalizations (e.g., perseverations, stereotypic movements, bizarre and atypical verbalizations)

Other notes

Normal Curve

Percent of Cases 50% 2.2%

Qualitative Descriptions Average

SupÛor
Composite Scores 70 80 85 90 100 110 115 120 130

Pearson Executive Office 5601 Green Valley Drive Bloomington, MN 55437

PEA RSO N 800.627.72½ www.PsychCorp.com
Copyright © 2011 NCS Pearson, Inc. All rights reserved.

Warning: No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopy, recording, or any information storage and retrieval system, without permission in writing from the
copyright owner.
Pearson, the PSI logo, PsychCorp, WASI, Wechster, and Wechsler Abbreviated Scale of Intelligence are trademarks,
in the U.S. and/or other countries, of Pearson Education, Inc., or its affiliate(s).
Portions of this work were previously published.
Printed in the United States of America.