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Estimation of Premorbid Intelligence in Traumatic Brain Injury Estimation of Premorbid Intelligence in Traumatic Brain Injury: NART and AUSNART Performance in an Australian Sample. Tracey A. Dean BA (Hons) Submitted in fulfillment of the requirements for the Degree of Doctor of Psychology School of Psychology University of Tasmania October 2009 This thesis contains no material, which has been accepted for a degree or diploma by the University or any other institution. To the best of my knowledge and belief this thesis contains no material previously published or written by another person except where due acknowledgement is made in the text of the thesis, nor does the thesis contain any material that infringes copyright. Date: a0 • \\ • 2 009 Tracey Dean This thesis may be made available for loan and limited copying in accordance with the Copyright Act 1968. Date: "70 • i -a007 Tracey Dean Acknowledgements I would like to express my sincere thanks to so many people, without whom this research would not have been possible. First my supervisor, Clive Skilbeck, who has been an incredible source of knowledge and wisdom; who always remained positive, supportive and patient and was always available for my incessant queries. I would like to thank all staff at the Neurotrauma Register Research (NTR), particularly Avril and Sama who's never failing support, encouragement and friendship has been a motivating force. To the patients who gave up their time for research, often in difficult circumstances, I would like to say thank you as without you this research would not be possible. I would also like to thank staff and colleagues at the University of Tasmania, particularly Jan Martin and Matt Thomas who have always provided support and encouragement and made the journey an enjoyable one. Finally I would like to sincerely thank my wonderful family and friends for their consistent unfailing words of encouragement and support for many years, particularly my parents, my sister and my daughters, Elle and Laura who have been beside me for this long journey. To my husband, David, I sincerely thank you for the endless love, support and encouragement and to Chris, Alex and Grace thank you also for your patience and kind words of encouragement. Table of Contents Abstract 1 Chapter 1 Overview of the Thesis 3 Chapter 2 Introduction to Traumatic Brain Injury 8 2.1 Epidemiology 8 2.2 Traumatic brain injury defined 9 2.3 Types of brain trauma 10 2.4 Measuring severity of injury 12 2.5 Outcome following brain injury 15 2.6 Summary 18 Chapter 3 Estimation of Premorbid Ability 20 3.1 Demographic-predicted intelligence estimate 21 3.2 'Hold'/'don't hold' methods 23 3.3 Best performance method 24 3.4 Combined demographic-current measures 26 3.5 Reading ability 29 3.5.1 Schonell Graded Word Reading Test 31 3.5.2 Wide Range Achievement Test 32 3.5.3 Cambridge Contextual Word Reading Test 34 3.5.4 Wechsler Test of Adult Reading 35 3.6 Lexical decision making task 38 3.7 Summary 39 Chapter 4 Development of the National Adult Reading Test 41 4.1 Reliability 46 4.2 Validity 48 4.3 NART & WAIS-R validation 52 4.4 NART & WAIS-III validation 55 4.5 Validation of NART with clinical groups 55 4.6 Validity of the short-NART 59 iv 4.7 Combined NART-demographic regression equations 63 4.8 NART adaptations 67 4.9 The Australian National Adult Reading Test (AUSNART) 67 4.10 NART limitations 70 4.11 Summary 71 Chapter 5 Can NART performance be Impaired? 73 5.1 Summary 79 Chapter 6 NART Performance in Traumatic Brain Injury 81 6.1 Summary 89 Chapter 7 Study 1: Examining NART Sensitivity to TBI 92 7.1 Aims and hypotheses 92 7.2 Method 94 7.2.1 Participants 94 7.2.2 Materials 96 7.2.3 Procedure 96 7.2.4 Design and analyses 97 7.3 Results 98 7.3.1 Descriptive statistics 98 7.3.2 Severity & age analyses 101 7.3.3 Severity & education analyses 104 7.3.4 Severity & socio-economic status (SES) analyses 111 7.3.5 Severity & gender analyses 114 7.4 Discussion 115 7.4.1 Limitations 122 Chapter 8 Study 2: Examining the Australian NART (AUSNART) in a TBI 126 Population: Effects of Demographic Variables and Comparison with NART 8.1 Aims and hypotheses 129 8.2 Method 130 8.2.1 Participants 130 8.2.2 Materials 131 8.2.3 Procedure 131 8.2.4 Design and analyses 132 8.3 Results 133 8.3.1 Descriptive statistics 133 8.3.2 Severity & age analyses 136 8.3.3 Severity & education analyses 137 8.3.4 Severity & gender analyses 141 8.3.5 Comparison of NART & AUSNART performance 142 8.4 Discussion 144 8.4.1 Limitations 148 Chapter 9 Study 3: Predicting NART Performance in Traumatic Brain Injury 150 9.1 Aims and hypotheses 153 9.2 Method 153 9.2.1 Participants 153 9.2.2 Materials 154 9.2.3 Procedure 154 9.2.4 Design and analyses 154 9.3 Results 155 9.3.1 Descriptive statistics 155 9.3.2 Correlations 155 9.3.3 Multiple Regression 156 9.3.4 Accuracy rates 160 9.3.5 Mean Change prediction method 162 9.3.6 Accuracy rate for the mean change prediction method 164 9.4 Discussion 166 9.4.1 Limitations 172 Chapter 10 General Discussion 174 10.1 Overview of the findings 177 10.2 Clinical implications 187 10.3 Future research 188 vi References 190 Appendix A 204 Al NART Word List 205 A2 NART errors and estimated WAIS-III FSIQ scores 206 A3 AUSNART Word List 207 A4 AUSNART errors and estimated FSIQ scores 208 A5 Conversion of obtained NART error score to predicted 210 NART error score Appendix B Studyl CD B1 Raw Data B2 Frequencies B3 Severity & age SPSS print out B4 Severity & education SPSS print out B5 Severity & SES SPSS print out B6 Severity & gender SPSS print out Appendix C Study 2 CD Cla Raw data for AUSNART analyses Clb Raw data for AUSNART & NART analyses C2 AUSNART frequencies C3 Severity & age SPSS print out C4 Severity & education SPSS print out C5 Severity & gender SPSS print out C6 AUSNART & NART correlations C7 AUSNART & NART frequencies C8 AUSNART & NART repeated measures & t-tests Appendix D Study 3 CD D1 Raw Data for Study 3 D2 Correlations D3 Multiple Regression D4 Multiple Regression Education Level 1 vii D5 Multiple Regression Education Level 2 D6 Prediction equation accuracy rates D7 Accuracy rates for FSIQ groups D8 Mean Change Score Method analyses viii List of Tables Chapter 7— Study 1 Table 7.1 Descriptive statistics for the total sample (7■1 = 194). Table 7.2 Frequencies and percentages of cause of injury. Table 7.3 Number of participants in each age group for each severity group. Table 7.4a Means (standard deviations) of NART error scores according to age for all three assessments. Table 7.4b The t-values and significance levels of age group comparisons of NART errors for all three assessments. Table 7.5 Number of participants in each education group for each severity group. Table 7.6a Means (standard deviations) of NART errors according to years of education and severity for all three assessments. Table 7.6b The t values and significance levels for differences in NART errors between education groups for each severity group for all three assessments. Table 7.7a The t values and significance levels for comparisons of NART errors according to severity for participants with < 1 years education (n = 87) for all three assessments. ix Table 7.7b The t values and significance levels for comparisons of NART errors according to severity for participants with >11 years education (n = 107) for all three assessments. Table 7.8 Number of participants in each SES group for each severity group for three assessments. Table 7.9 The t - values and significance levels for SES group comparisons for all three assessments. Chapter 8— Study 2 Table 8.1 Descriptive statistic for the total AUSNART sample (N = 92). Table 8.2 Frequencies and percentages of cause of injury for the total AUSNART sample (N = 92). Table 8.3 Frequencies and percentages of demographic/clinical variables for the sample who completed both NART and AUSNART at each assessment (N = 88). Table 8.4 Number of participants in each age group for each severity group. Table 8.5 Number of participants in each education group for each severity group. Table 8.6 The t-values and significance levels comparisons of AUSNART errors for each age group for all three assessments. x Table 8.7 Means, standard deviations and correlations (Pearson 's) for NART and AUSNART estimated FSIQ. Table 8.8 Mean (standard deviation) and t-values for comparisons of NART and AUSNART estimated FSIQ for each assessment. Chapter 9— Study 3 Table 9.1 Correlations between NART score and estimated FSIQ with education and age for the total sample (N = 194). Table 9.2 Multiple Regression for predicting NART initial errors from demographic variables. Table 9.3 Multiple Regression for predicting 12 month NART errors from demographic variables. Table 9.4 Multiple Regression for predicting 12 month NART errors from the initial NART error scores and demographic variables. Table 9.5 Percentages and frequencies (n) of predicted — obtained difference scores Table 9.6 Percentages and frequencies (n) of predicted - obtained difference scores according to FSIQ for the NART initial error prediction equation. Table 9.7 Means (standard error) for the initial impaired NART, 12 month recovered NART and mean NART improvement over 12 months for each education level and each age group.
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