Neuropsychological Assessment

Fernandez, Lao & Valdez

neuropsychological assessment
- is a process by which a persons cognitive, psychological/emotional and behavioural functioning is comprehensively assessed. This is accomplished via a detailed interview and standardised testing of areas relevant to the presenting problem. - typically evaluates multiple areas of functioning. It is not restricted to measures of intelligence (e.g., IQ) and achievement but examines other areas of functioning that also have an impact on performance in the classroom, with peers, at home, or on the job.

Procedure
1. 2. 3. 4. 5. History Taking Interviewing Test-taking Intelligence Tests Other Tests

cognitive functions
Sensory perceptual and motor functions Attention Memory Auditory and visual processing Language Concept formation and problem solving Planning and organization Speed of Processing Intelligence Academic skills Behavior, emotions, and personality

Test Selection
the referral questions age of the child clinicians preference soundness of the measures issues pertinent to a particular child childs developmental history the clinical interview observations of test behavior (e.g., during more or less structured situations) naturalistic observations(e.g., adjustment in the classroom) behavioral and emotional presentation interviews with selected individuals in the childs everyday environment (e.g., teachers, therapists) Exploring why the child is encountering difficulties involves examining converging lines of evidence from different tests, parent and teacher report, observations of behavior, and clinical judgment.

Battery of tests
o Intelligence Tests (eg. Wechsler Scales, Stanford-Binet Intelligence Scale-IV) o Personality Tests (eg. MMPI, Rorschach Test) o Perceptual-Motor / Memory Tests (eg. Wechsler Memory Scale-Revised)

Assessment sections
Reasons for referral Background information (history and current concerns) Tests administered Behavioral observations Test results and interpretation Summary of impressions Recommendations and need for referrals to other specialists

Who will benefit?

is especially valuable for pervasive developmental disorders (e.g., autism, Asperger syndrome) where there is usually considerable scatter in the childs profile. Learning disabilities Attention deficit disorders Neuropsychiatric disorders (e.g., pervasive development disorders, Tourette syndrome, anxiety and depression) Closed head injury Seizure disorders Brain tumors Strokes Effects of toxic substances (e.g., lead poisoning) Genetic disorders (e.g., Turner syndrome, Williams syndrome)

In this regard, knowing more about the childs strengths and weaknesses can assist in interpreting their behaviors and guiding program/treatment planning. Examples: The child who has a deficit in planning and organization may also have difficulty completing assignments, expressing their ideas orally or in writing, adapting to novel circumstances, and/or coming up with alternate responses for a specific problem or situation. If the child has strong visual perceptual skills, visual cues such as graphic organizers
Common to many types of neurological impairment disorder of orientation is a lack of awareness of one's relationship to one's surroundings (anosagnosia)

Neuropsychological evaluation (NPE)

is a testing method through which a neuropsychologist can acquire data about a subjects cognitive, motor, behavioral, linguistic, and executive functioning. these data can provide information leading to the diagnosis of a cognitive deficit or to the confirmation of a diagnosis, as well as to the localization of organic abnormalities in the central nervous system (CNS) these tests are often coupled with information from clinical reports, physical examination, and increasingly, premorbid and postmorbid self and relative reports.

Neuropsychological Tests
a brief summary

Memory Tests
Wechler Memory Scale-Revised -the task is to recall stories and other verbal stimuli. -the test is appropriate for people within the ages of 16-74.

Nonverbal memory
Benton Test of Visual Retention-Revised, Memory for Designs Test, Rey-O Complex Figure

-these tests provide a measure of the test takers

ability to perceive and retain images of visually presented geometric figures.

Nonverbal tests of abstraction

Wisconsin Card Sorting Test -test of problem solving and ability to develop and test hypotheses Stroop Test -test of cognitive flexibility

Verbal functioning
Controlled Word Association Test -the examiner says a letter of the alphabet and the subjects task is to think of as many words as possible beginning with that letter. Reitan-Indiana Aphasia Screening Test -contains a variety of items using language, including naming common objects, following verbal, and writing familiar words.

Perceptual and Motor Tests

Auditory Discrimination Test -the task is to discriminate between short words such as muss and much. Purdue Pegboard Test -a measure of manual dexterity where the object is to insert pegs into holes using one hand, then the other hand, and then both hands. Bender Visual-Motor Gestalt Test -the test consists of nine cards, on each of which is printed one design believed to assess perceptual maturation and neurological impairment. -the test taker is shown each of the cards in turn and instructed to, "Copy it as best you can. -after all nine designs have been copied, the test taker is given a fresh sheet of paper with the instructions, " Now please draw all of the designs you can remember. -evidence in support of the use of the Bender-Gestalt to assess personality is tenuous: Early reviews on the validity were favorable, but they were found to include inappropriate subject selection procedures. -a high false negative rate was associated with it. -also, this was associated with a high rate of false positives.

Neuropsychological Test Batteries

The Flexible Battery -specific tests chosen for some purpose relevant to the unique aspects of the patient and the presenting problem. -the clinician hand-picks the test to be included in the battery as opposed to a prepackaged group of test. The Prepackaged Battery -designed to comprehensively sample the patient's neuropsychological functioning. -especially appealing to clinicians new to neuropsychological assessment, because it tends to be less demanding in many ways. Luria-Nebraska Neuropsychological Battery -has 11 scales on Form 1, and 12 scales on Form 2. -the scales assess cognitive processes and functions. -is appealing because it takes about 1/3 the time of the Halstead-Reitan and can be administered at bedside. -the psychometric soundness has been challenged; it is presumed to be overly dependent on language and to yield a high rate of false negative findings.

Neuropsychological Test Batteries

Halstead-Reitan Neuropsychological Battery -the battery consists of 7 subtests: 1. Category-Measure of abstracting ability. 2. Tactual Performance-Measures memory and localization. 3. Rhythm-Task is to discriminate between like and unlike pairs of musical beats. 4. Speech Sounds Perception-Task is to discriminate spoken syllables. 5. Finger Tapping-Measure of manual dexterity. 6. Time Sense-Task of reproducing movement from sight as well as ability to estimate time span. 7. Trails A & B-Measures Psycho-Motor speed and flexibility. -administration requires a highly trained examiner. -the battery requires a full day to complete. -interpretation requires a trained neuropsychologist. -high degree of clinical and psychometric reliability for most of the tests in the battery.

References
http://www.aspennj.org/pdf/information/articles /unraveling-the-neuropsychologicalassessment.pdf http://neurotreatment.com.au/neuropsychologic al-assessment.aspx http://schatz.sju.edu/neuro/npsych/npsych.html