The Washington Group Questions And The Disability Continuum

Data based on the Washington Group (WG) questions can be used in different ways to get at the diversity among persons who report a range of difficulties in functioning. The difficulties can be conceptualized and measured on a continuum or spectrum of severity from ‘no difficulty’ to ‘unable to do’. In my work, it became apparent that it was important to explore and use this continuum.

The WG questions collect data on severity with a four point answer scale for each of the six domains: ‘1-no difficulty’; ‘2-some difficulty’; ‘3-a lot of difficulty’; and ‘4-unable to do’. To identify persons with disabilities, a threshold needs to bet set, which represents a social judgment to differentiate persons with and without disabilities. The WG recommendation for international reporting is to use “a lot of difficulty” as a threshold: persons who report “a lot of difficulty” or “unable to do” for at least one domain are considered to have a disability. Others are considered as not having a disability.  Other cut points can be used for other purposes and, as will be shown, it is possible and useful to take fuller advantage of the information collected by the four-point answer scale.

In a recent study I initially planned to use exclusively the dichotomy disability vs no disability as per the WG recommendations. Because a pattern emerged that persons experiencing ‘some difficulty’ were worse off than persons with ‘no difficulty’ for several wellbeing dimensions, I ended up using two thresholds and an index based on the Washington Group questions to try to capture the continuum of difficulties and assess if it is correlated with deprivations.

First, using two thresholds, individuals were grouped into three mutually exclusive categories of difficulties:

• no difficulty in the six domains;
• ‘some difficulty’ in one domain (or more) and no difficulty in other domains;
• ‘a lot of difficulty’ or ‘unable to do’ in one domain (or more).

(2) and (3) were labeled as having moderate and severe difficulties respectively.

Second, the study also relied on a score, which is the normalized Sum of answers (each ranging from 1 to 4) to the six questions with a minimum of six (MinScore) and a maximum of 24 (MaxScore) as follows: