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Information to Users INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand corner and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6" x 9" black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. UMI University Microfilms International A Bell & Howell Information Company 300 Nortfi Zeeb Road. Ann Arbor. Ml 48106-1346 USA 313/761-4700 800.521-0600 Order Number 9120711 The validity of the Luria Nebraska Neuropsychological Battery-Children’s Revision for children with mild mental retardation Patterson, Carolyn McCreary, Ph.D. The Ohio State University, 1991 UMI 300 N. Zeeb Rd. Ann Arbor, MI 48106 THE VALIDITY OF THE LURIA NEBRASKA NEUROPSYCHOLOGICAL BATTERY-CHILOREN'S REVISION FOR CHILDREN WITH MILD MENTAL RETARDATION DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Carolyn McCreary Patterson, B.S., M.S. The Ohio State University 1991 Dissertation Committee: Approved by 0. Hammer, Ph.D. G . G. Berntson, Ph.D. H. L e l a n ^ Ph.D., Adviser Department of Psychology Regina Gunsett, Ph.D. VITA July 20, 194:2 ........... Born - Painesville, Kentucky 1966 ...................... B.9., Ohio Btate University 1964 ...................... M .9., Ohio Btate University 1966-1967 .................. Occupational Therapist Orient State Institution for the Mentally Retarded Orient, Ohio 1967-1969 .................. Occupational Therapist Children’s Hospital Columbus, Ohio 1969-1981 ........... Occupational Therapy Consultant Skilled Nursing Facilities Columbus, Ohio 1372-1976 ................. Occupational Therapist ECCQ Family Health Center Columbus, Ohio 1978-1981 ................. Occupational Therapist Springfield City Schools Springfield, Ohio 1982-1984 ................. Occupational Therapy Instructor Columbus Public Schools Columbus, Ohio 1981-1988 ............... Occupational Therapist Nisonger Center for the Mentally Retarded Ohio State University Columbus, Ohio 1987-1990 ................. Occupational Therapy Instructor School of Allied Medical Prof. Ohio State University Columbus, Ohio ii 1990-present ............... Postdoctoral Fellow, Pediatric Neuropsychology Children's Hospital Columbus, Ohio FIELD OF STUDY Major Field: Psychology 111 TABLE OF CONTENTS VITA ......................................................... ii LIST OF TABLES .............................. v LIST OF FIGURES ................................ vi CHAPTER PAGE I. INTRODUCTION ..................... 1 The Research Question ................... 6 II. LITERATURE REVIEW ................. 9 Luria’s Theory of the Functional Organization of the B r a i n .............................. 9 Developmental Neuropsychology ............. 14 Brain Dysfunction in Persons with Mental Retardation ................................. 22 Brain Dysfunction and Spina Bifida .... 23 The Luria Nebraska Neuropsychological Battery-Children’s Revision................ 26 The Wisconsin Card Sorting T e s t ........... 31 Trail Making T e s t .......................... 35 AAMD Adaptive Behavior Scale - School E d i t i o n ..................................... 36 III. METHODOLOGY . 40 P u r p o s e ..................................... 40 S u b j e c t s ................................... 40 Procedure ................................ 41 IV. RESULTS AND CONCLUSIONS ................. 43 O v e r v i e w ................................... 43 Nature of Neuropsychological Function . 45 Clinical and Statistical Agreement .... 58 Myelomeningocele Statistical and Clinical M e m b e r s h i p ................................. 65 Adaptive Behavior .......................... 65 S u m m a r y ..................................... 75 V. DISCUSSION ........................ 78 LIST OF REFERENCES .............................. 94 APPENDIX A ....................................... 101 iv LIST OF TABLES TABLE PAGE 1. Cluster means, standard deviations, and ranges for Cl through S 3 .................... 47 S. Clusters defined by LNNB-C scale means, plus and minus one standard deviation . 51 3. LNNB-C scales contributing to significant differences between cluster pairs ......... 52 4. Cluster frequencies for TUT part A ......... 57 5. Cluster frequencies for TUT part B ......... 57 G . Clinical category frequency ................ 61 7. Typical clinical protocol, B41 ............. 62 8. Typical clinical protocol, N B l ............. 64 3. Mean ABS-SE factor scale scores for clusters ................. 67 10. Cluster frequency of ABS-SE factor scale scores in the deficient r a n g e ............. 69 11. Mean ABS-SE factor scores for clinical c a t e g o r i e s ................................... 71 12. Frequency of ABS-SE factor scale scores in the deficient range for clinical c a t e g o r y ..................................... 72 13. Mean ABS-SE factor scale scores for diagnostic category ........................ 73 14. Frequency of ABS-SE factor scale scores in the deficient range for diagnostic c a t e g o r y ..................................... 74 LIST OF FIGURES FIGURES PAGE 1. Cluster profiles, based on average LNNB-C I score distance from critical l e v e l .......................................... IB VI CHAPTER I INTRODUCTION The use of neuropsychological assessment with a devel­ opmental ly disabled school age population, including persons with mild mental retardation, is growing in importance. This development is based predominantly on a basic theoreti­ cal rationale, with little direct evidence available regard­ ing practical application or the validity of specific neuro­ psychological assessments with these populations (Fischer, 1988; Skoff, 1988). Utilization of neuropsychological assessment with persons with mental retardation or with developmental delay can contribute on two levels: 1) knowl­ edge related to the nature of the processes and the possible amelioration of specific patterns of deficit in intellectual functioning, and 2) knowledge regarding the ontogenetic development of neuropsychological functions (Fischer, 1988; Skoff, 1988; Fletcher & Taylor, 1984). Knowledge related to the nature and possible ameliora­ tion of deficits in intellectual functioning can contribute to the development of optimal programming. School age chil­ dren with mild mental retardation are not a homogeneous group and optimal educational strategies will vary among 2 individuals. Neuropsychological assessment can assist in identifying relative neuropsychological strengths and weak­ nesses which can serve as a basis For determining optimal instructional/habilitâtion strategies. A developmental neuropsychological approach to assess­ ment within these populations has additional importance. Knowledge regarding the ontogenetic development of neuropsy­ chological functions can contribute to basic information re­ garding normal child neuropsychological development, provide a basis for prediction of "risk" for disability and a basis for long term program planning. Developmental neuropsy­ chology places an emphasis on change as a unit of analysis. Assuming this emphasis, neuropsychology can focus on how developmental disabilities disrupt processes of systematic change CFletcher & Taylor, 19B4; Fletcher, Miner, & Ewing- Cobbs, 1987). Fletcher and Taylor C1984) propose a "func­ tional organization approach" to developmental neuropsychol­ ogy . Their approach takes into consideration the manifest form of a disability and correlated abilities/disabilities, which covary with a set of moderator variables including environmental characteristics and social influences. Al­ though Fletcher cites Biegel, Bisanz, and Bisanz C19B3) and Werner and Kaplan C1956) as examples of theories which view development as a process of increased differentiation and hierarchical organization, and thus focus on change, the earlier theories of Pavlov and Vygotsky provide a stronger 3 basis for current developmental neuropsychology. Vygotsky (19G2), building on Pavlov’s concept of functional organiza­ tion, CPavlov, 13573 proposed criteria for an approach to the study of neurological function as it relates to behav­ ior. He believed that the approach should be developmental, should address the relationship between higher mental func­ tions and lower, elementary psychological functions, and should take into consideration socially meaningful activity as an explanatory principle (Kozulin, 19BBD. Luria,
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