[W2] - CH7 Flashcards
School Neuropsychological Test Batteries for Children
What were the primary neuropsychological assessments for paediatric populations before the 1990s?
The Halstead-Reitan or the Luria-Nebraska Batteries
What are some of the distinctions between the NEPSY (1997) and the NEPSY-II: A Developmental Neuropsychological Assessment (Korkman, Kirk, & Kemp, 2007)?
The NEPSY was the first neuropsychological test battery specifically designed for children ages 3–12.
Some of the major differences between the second edition and the original include its extension up for children from 3 to just Under 17 Years of Age (16 years 11 months), new subtests, and the removal of domain scores.
{note: not all of the NEPSY-II tests are suitable for use with all ages in the 3 to 16 range}
What theory is the NEPSY-II grounded in, and what sort of approach does it take?
NEPSY-II is grounded in Lurian theory and has a strong process-oriented approach.
The data obtained from it are interpreted in both a quantitative and qualitative manner.
Name 4 purposes of the NEPSY-II Tests
[Effects of brain damage; brain damage follow-ups; identifying patterns of deficiencies and connecting those to neurodevelopmental disorders; identifying strengths and weaknesses to guide interventions]
- Assessing the effects of damage to the brain
- Facilitating long-term follow-up of children with acquired or congenital brain damage/dysfunction.
- Identifying patterns of deficiencies in children; and connecting those patterns to research on neurodevelopmental disorders.
- Identifying strengths and weaknesses that can be directly linked to prescriptive interventions.
Name the 6 functional domains assessed by the NEPSY-II
(ML / AEF / L / S / V / SP)
My Little Alligator Eats Fairly Lazy Swimmers Very Slowly, Prudence
- Attention/Executive Functions
- Language
- Sensorimotor
- Visuospatial
- Memory and Learning
Social Perception
Name the four batteries that an examiner can utilise within NEPSY-II; depending on the situation.
Full Assessment, General Referral Battery, Diagnostic Referral Batteries, Selective Assessment Batteries
When/How is the Full Assessment Battery from the NEPSY-II used?
All of the age-appropriate subtests across all six domains are performed.
This approach is utilised when time permits, and a thorough neuropsychological assessment is required. This would apply if a student had severe brain damage, exposure to notable neurodevelopmental risk factors (i.e., prenatal maternal drug use), a long-term monitored severe learning/behavioural problem, or is undergoing a medical treatment that can affect the central nervous system (i.e., radiation treatment for cancer).
The purpose of a full assessment is to establish a comprehensive profile of the student’s neurocognitive strengths and weaknesses and to use that information to tailor evidence-based interventions.
When/How is the General Referral Battery from the NEPSY-II used?
This is a subset of all of the NEPSY-II tests that taps into five of the core domains: excluding Social Perception (which is typically utilised only when the student is suspected of having autism).
It’s the standard starting point for school-based referrals, especially when multiple problems are cited or the reason for referral is somewhat unclear.
When/How are the Diagnostic Referral Batteries from the NEPSY-II used?
There are eight diagnostic referral batteries designed to address problems that present in a specific way. The subtests chosen for each battery reflect which neurocognitive processes are predictive of the relevant type of clinical syndromes (based on matched comparisons/research).
It is worth noting that children commonly have multiple learning problems that cut across these diagnostic categories; which is why it is preferrable to start with the general referral battery!
The eight diagnostic referral batteries are:
o Learning Differences—Reading
o Learning Differences—Math
o Attention/Concentration
o Behaviour Management
o Language Delays/Disorders
o Perceptual-Motor Delays/Disorders
o Social Perception
o School Readiness
When/How are the Selective Assessment Batteries from the NEPSY-II used?
Selected subtests from the NEPSY-II can also be used as part of a cross-battery assessment, since the NEPSY-II’s subtests are not subject to order effects (can be used in any order).
Certain subtests may be selected for use due to their relevance to the referral question(s), and subsequently integrated into a broader comprehensive assessment battery. However, a few selected subtests being added to a routine test of cognitive abilities, should NOT be classified as a neuropsychological assessment.
How is an order of administration chosen for the NEPSY-II?
Factors like the ability of the child to sustain interest in the tasks and the time lapse between the immediate and delayed memory tasks play a role.
Furthermore, you would rarely start with a subtest you would expect would be difficult for the child (in light of the referral questions).
Do not take a long break, and do not intersperse other memory tests in the immediate/delayed recall intervals; in order to minimize interference effects.
Note that the subtests are generally not subject to order effects.
Scores Generated by the NEPSY-II
Scaled Scores: Normalized scores; corrected by age group. Mean of 10, standard deviation of 3.
Percentile Rank Ranges: Normalized, corrected by age, but expressed as a percentile score. The percentile ranks are grouped into ranges with the following classifications: ≤2—well below expected level; 3–10–below expected; 11–25—slightly below expected; 26–75—at expected level; >75—above expected level.
Cumulative Percentages (Base Rates): The cumulative percentages of the standardization sample, or one of the clinical validation groups used to construct the diagnostic referral batteries. Descriptive base rates - not actual percentile ranks (i.e., a base of 26 = “26% of the same-aged children obtained the same score or lower.”)
Combined Scores: Two standardized scores integrated into one from the same subtest (i.e., completion time score and accuracy score on the same task combined). Should really only be used when there is no significant difference between the two scores used to form the combined score; otherwise, the individual scores must be interpreted independently.
Contrast Scores: Takes the difference between two scores and creates a norm-based value to determine the statistical (and clinical) significance of the difference in performance on those two measures.
Process Scores: Used to evaluate subtle aspects of a student’s performance on a given task (i.e., examining the number of novel sort and repeated sort errors made on the Animal Sorting test)
Qualitative Behavioural Observations: Number of occurrences, or the absence, of certain qualitative behaviours (i.e., asking for repetitions on verbal tasks). Base rates can be determined with comparisons made to the same age group within the standardization sample.
Reporting the NEPSY-II
The sheer number of scores generated by the NEPSY-II can be at first overwhelming. Its organization does make it easier to report the results based on the six functional domains. However, many of the NEPSY-II tests have sub-scores and process scores that may involve neurocognitive processes other than the principle processing domain in which the test is categorized. Hence, later chapters will re-classify the NEPSY-II scores according to the broad classification, second-order classifications, and third-order classifications of the Integrated SNP/CHC Model.
NEPSY-II is a valuable assessment tool, but it does require practice to administer and score; as well as careful consideration towards how to interpret the wide variety of the scores it generates.
For whom/when is the WISC-V Integrated; Wechsler Intelligence Scale for Children, Fifth Edition Integrated (Wechsler & Kaplan, 2015) appropriate?
Suitable for children between the ages of 6.0 and 16.11 years.
It is an extension of the WISC-V and is not designed to be a stand-alone battery. When an examinee has a WISC-V subtest score that is below average (greater than 1.0 or more standard deviations) compared with other WISC-V subtest scores (and a related WISC-V Integrated subtest is available), it should be administered.
The WISC-V Integrated affords school neuropsychologists the opportunity to systematically test the limits for low performing WISC-V scores ( and provides more clinically relevant qualitative information about the examinee’s performance).
WISC-V Integrated has 14 subtests; 8 of which are adaptations of WISC-V subtests. These contain the same items found on the WISC-V, but the presentation/response modes/administration of the items is modified.
The 5 Domains of the WISC-V Integrated - (Rainford, 2017)
[Plus Very Weird Funky Visions]
- Verbal Comprehension
- Visual-Spatial
- Fluid Reasoning
- Working Memory
- Processing Speed
The Verbal Comprehension Subtest Distinctions in the WISC-V Integrated
[Changed from free-recall in WISC-V to recognition – decreases verbal expression and memory retrieval demands]
These subtests use the same content as the WISC-V version, except the response format is changed from free recall to recognition. Hence, the demands for verbal expression and memory retrieval are decreased (e.g., instead of asking “what is a banana?”; the question would be: “Is a banana a: (a) vegetable, (b) mineral, (c) fruit, (d) meat.”)
{This domain includes: Similarities Multiple Choice, Vocabulary Multiple Choice, Picture Vocabulary Multiple Choice, Comprehension Multiple Choice, and Information Multiple Choice.}
The Visual-Spatial Subtest Distinctions in the WISC-V Integrated
[Removes the motor planning and execution demands from WISC-V]
Block Design Multiple Choice is the relevant subtest from this domain, which is designed to measure visual-perceptual and perceptual-organizational skills. Instead of showing a child a 2D picture of a block design and asking them to reconstruct it in 3D; the child is asked to choose the 3D reconstruction from four response options within a time limit. This requires mental imaging.
The subtest can be administered in timed and untimed conditions to test for the negative influences of processing speed, motor skills, and so on.
The Fluid Reasoning Subtest Distinctions in the WISC-V Integrated
[Decreased emphasis on completion time or processing speed demands] - The Figure Weights Process Approach.
[Decreased attentional and working memory demands] - Arithmetic Process Approach (non-verbal math problems)
[Decreased attentional and language processing demands] - Written Arithmetic Subtest (not story format)
The Working Memory Subtest Distinctions in the WISC-V Integrated
[From verbal to nonverbal] - The Spatial Span subtest (tapping raised blocks - measures visual-spatial short-term/working memory)
[From visual to verbal working memory] - WISC-V Integrated Sentence Recall subtest (yes or no)
The Processing Speed Subtest Distinctions in the WISC-V Integrated
[Removes paired associative element and solely evaluates graphomotor speed/accuracy] - Coding Copy subtest (+Coding Recall)
[Reduced semantic loading] - WISC-V Integrated Cancellation Abstract (assesses visual processing speed)
For whom/when is the D-KEFS; Delis-Kaplan Executive Function System (Delis, Kaplan, & Kramer, 2001) appropriate?
Suitable for use between the ages of 8 to 89 (except for the Proverbs Test:16–89).
It is a comprehensive battery of tests that measure skills associated with executive functioning.
Its subtests have evolved from some previous tests (i.e., the Stoop Colour-Word test), however, its advantages over the previous versions are (a) the updated normative sample, and (b) the integration of a process assessment approach (i.e., “testing the limits” to create a hypothesis for poor performance - isolating process contributions)
The D-KEFS still requires a greater body of research on its clinical efficacy; particularly to confirm its sensitivity and specificity. It produces a large amount of quantitative data. Furthermore, its tests are stand-alone measures of different aspects of executive functions and are not interchangeable. They also measure other interdependent neurocognitive processes such as: processing speed and cognitive efficiency, memory and learning, visual-spatial processing, sensory-motor functions, and language functions.
The subtests of D-KEFS
[9]
- Trail Making Test
- Verbal Fluency
- Design Fluency
- Colour-Word Interference Test
- Card Sorting Test
- Word Context Test
- Twenty Questions
- Tower Test
- Proverbs Test
For whom/when is the RBANS Update; Repeatable Battery for the Assessment of Neuropsychological Status Update (Randolph, 2012) appropriate?
Suitable for 12.0 to 89.11 years.
It is a brief individually administered battery designed to measure cognitive decline - (with adolescents, its purpose is to screen for neurocognitive status)
It consists of 12 subtests which can be administered in 20–30 minutes by a trained examiner. The test has alternative forms (to enable repeated testing), is available in multiple languages and on the iPad Q-interactive platform from Pearson Assessments.
The Domains of the RBANS Update
- Immediate Memory Domain
- Delayed Memory
- Visuospatial/Constructional domain
- Language
- Attention
- Indices
