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Lightning Review of Neuropsychological Assessments Lightning Review of Neuropsychological Assessments Lightning Review of Neuropsychological Assessments Geared To Psychiatry Board Exam Preparation By Jack Krasuski, MD 877-225-8384 1 of 23 www.masterpsych.com Lightning Review of Neuropsychological Assessments Table of Contents Psychological Testing Overview Wechsler Adult Intelligence Scale Wechsler Intelligence Scale for Children Wechsler Preschool & Performance Scale of Intelligence Leiter International Performance Scale Bayley Scales of Infant and Toddler Development Wechsler Memory Scale Auditory Verbal Learning Test California Verbal Learning Test Hopkins Verbal Learning Test Peabody Picture Vocabulary Test Boston Diagnostic Aphasia Examination Western Aphasia Battery Stroop Color & Word Test Wisconsin Card Sorting Test Connors Continuous Performance Test Test of Variables of Attention Wechsler Individual Achievement Test Peabody Individual Achievement Test Halstead Reitan Neuropsychological Battery Luria Nebraska Neuropsychological Battery Minnesota Multiphasic Personality Inventory Thematic Apperception Test (TAT) 877-225-8384 2 of 23 www.masterpsych.com Lightning Review of Neuropsychological Assessments Notices Copyright Notice Copyright © 2009-2018 American Physician Institute for Advanced Professional Studies, LLC. All rights reserved. This manuscript may not be transmitted, copied, reprinted, in whole or in part, without the express written permission of the copyright holder. Requests for permission or further information should be addressed to Jack Krasuski at: [email protected] or American Physician Institute for Advanced Professional Studies LLC, 900 Oakmont Ln., Suite 450, Westmont, IL 60559 Disclaimer Notice This publication is designed to provide general educational advice. It is provided to the reader with the understanding that Jack Krasuski and American Physician Institute for Advanced Professional Studies LLC are not rendering medical services and are not affiliated with the American Board of Psychiatry and Neurology. If medical or other expert assistance is required, the services of a medical or other consultant should be obtained. The author and publisher disclaim any liability arising directly or indirectly from the use of this book. 877-225-8384 3 of 23 www.masterpsych.com Lightning Review of Neuropsychological Assessments Psychological Testing Overview Before reviewing the individual assessment instruments, I begin with an overview of the categories in which neuropsychological and psychological assessments fall. Once you understand the big picture, you will better understand the role of each individual assessment instrument. Main Categories of Assessment Instruments • IQ tests • Achievement tests • Tests of adaptive function • Tests of cognitive functions o Tests of individual cognitive function o Batteries: comprehensive series of tests • Personality tests IQ Tests • Background: David Wechsler, the neuropsychologist who developed several IQ tests described intelligence as "the global capacity of a person to act purposefully, to think rationally, and to deal effectively with his/her environment." Note the word 'global.' Thus, intelligence is hypothesized to be a measure of general mental ability. • When: order IQ tests in children, adolescents, and adults when a diminished intellectual capacity is suspected or school performance is poor. • Examples of available IQ tests o Wechsler Adult Intelligence Scale o Stanford-Binet Intelligence Scale o Wechsler Intelligence Scale for Children o Wechsler Preschool & Performance Scale of Intelligence o Bayley Scale for Infant & Toddler Development o Leiter International Performance Scale (a specialized non-verbal test) • Always ensure the child or adolescent with poor school performance or disruptive behavior is tested for hearing and vision since sensory impairments can present similarly. Achievement Tests • Background: Achievement tests measure a student's acquired knowledge and skills in the major educational areas. The key word here is 'acquired,' which refers to measuring what the student actually has learned in school. The types of achievement measured are: reading, mathematics, and language skills. • When: order achievement tests when a student shows poor school performance. Order both an IQ test and an achievement test and look for a discrepancy between the IQ test and achievement test results. A discrepancy between normal or higher IQ scores and poor school performance suggests a problem other than limited intellectual capacity as an explanation for the poor school performance. Such a discrepancy should trigger a careful exploration for presence of 1) psychopathology such as, for example, depression, anxiety, trauma, ADHD, and substance use, and 2) psychosocial stressors such as, for example, abuse, neglect, and domestic violence. 877-225-8384 4 of 23 www.masterpsych.com Lightning Review of Neuropsychological Assessments • Examples of commonly available achievement tests o Wechsler Individual Achievement Test o Peabody Individual Achievement Test o Woodcock Johnson III Test of Achievement o Wide-range Achievement Test Tests of Adaptive Function • Background: When diagnosing intellectual disability or dementia/neurocognitive disorder (NCD), the diagnosis requires more than an assessment of intellectual or cognitive function. Diagnosis also requires an assessment of adaptive function. Note that irrespective of IQ score, if a patient meets the standards for adaptive ability for their age and cultural group, then they do NOT have intellectual disability. • When: conduct an assessment of adaptive function in patients with suspected intellectual disability, cognitive impairment, autism spectrum disorders, and poor school performance or behavioral problems. • Example of test of adaptive function o Vineland Adaptive Function Scale Tests of Cognitive Functions • Background: the main divisions of cognitive function are as follows: o Attention o Language: receptive, expressive, word finding o Memory: verbal, visual o Motor: gross, fine, procedural memory (praxis) o Construction o Perception (agnosia) o Executive function • A large number of cognitive assessments exist for assessing each cognitive domain. You usually will be able to recognize them by their titles, which often make clear what they assess. For example, the Peabody Picture Vocabulary Test assesses vocabulary, a language function, by showing the subject a card of four pictures and requesting that the subject point to the picture showing an object related to the word spoken by the examiner. • In addition, there exist neuropsychological batteries, which are bundled series of cognitive tests that assess a broad range of cognitive domains. • Examples of neuropsychological batteries o Halstead-Reitan o Luria-Nebraska Personality or Psychological Tests • Background: this category of tests shed light on a patient's personality and emotional function and, also, can help identify some forms of psychopathology more clearly than can be identified through clinical interviewing. For instance, the Minnesota Multiphasic Personality Inventory (MMPI), Thematic Apperception Test (TAT), and Rorschach Test can identify psychotic beliefs that the patient may be too guarded to share during a diagnostic interview. 877-225-8384 5 of 23 www.masterpsych.com Lightning Review of Neuropsychological Assessments • When: when personality and emotional function needs further assessment, or when psychosis is suspected but cannot be delineated through interview. Additionally, the MMPI is used to help identify malingering or factitious disorders. • Examples o Thematic Apperception Test (TAT) o Minnesota Multiphasic Personality Inventory (MMPI) o Rorschach Test Intelligence Tests Concepts Relevant to IQ Tests Before I begin presenting the various IQ testing options, I present a few concepts relevant to our understanding. • Intelligence Quotient (IQ) Test Definition o An intelligence test is a standardized test that measures potential ability or learning capacity. This is in contradistinction to an achievement test, which measures acquired learning, in a specific subject area such as reading or arithmetic. • Flynn Effect o The rise of IQ scores over the generations, that is, IQ scores have been rising over the period in which they’ve been given. The score increases have averaged about 3 IQ points per decade. Now, in several countries starting in the mid 1990’s the Flynn effect has stopped or reversed, and IQ scores have been falling at rates similar to their previous increases. o The reason for the Flynn Effect is unclear. It may be due to rising intelligence levels but it may not. The tests that are most related to exposure to improved education are in fact the tests that have NOT seen the largest score increases. Rather the largest score increases are on tests, such as Raven Progressive Matrices that are loaded for general intelligence factors o The Flynn Effect is one reason that IQ tests need to be renormed, which means recalibrating scores over time to maintain a mean score of 100 points. • Nonverbal Intelligence Tests o Under normal circumstances, verbal responses are assumed to provide an indication of a person’s intelligence. However, in some individuals the verbal response is not an appropriate measure of their intelligence and other assessment approaches must be used. For example, some individuals have features that interfere with their ability to provide a verbal response and, thus, the verbal response is not a true measure of their intelligence. The features that
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