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CONFIRMATORY FACTOR ANALYSIS OF THE NEPSY: A DEVELOPMENTAL NEUROPSYCHOLOGICAL ASSESSMENT, SECOND EDITION IN A MIXED CLINICAL SAMPLE OF CHILDREN A DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY IN THE GRADUATE SCHOOL OF THE TEXAS WOMAN’S UNIVERSITY COLLEGE OF ARTS AND SCIENCES TEXAS WOMAN’S UNIVERSITY BY CRISTINA SEVADJIAN, B.A., M.A. DENTON, TEXAS AUGUST 2014 i Copyright © Cristina Sevadjian, 2014 rights reserved. iii DEDICATION This dissertation is dedicated to my father, Dale Petrini, whose steadfast love, support, guidance, and encouragement has profoundly impacted the woman I have become. Thank you for reminding me that I could do anything I set my mind to. iv ACKNOWLEDGEMENTS This dissertation is the culmination of years of support, encouragement, and guidance from many individuals; therefore, I would like to take this opportunity to express my utmost gratitude. I would like to first and foremost thank Him who makes all things possible and blessed me in a multitude of ways. Greg, you have provided amazing stability, sacrifice, and support which has allowed my dreams and aspirations to become our reality. I would like to thank my grandparents for valuing and providing opportunities for higher education. To my family (Beth, Bruce, Grandma Mary Louise, Dale, Rita, Michael, Kristen, Thomas, Christopher, Allison, Jonathan, Karis, Jan, Aimee, Clint, Maddie, Lily Claire, Sutton, Emile, Becky, Bryant, Bradley, and Blake) I cannot express how much your love has meant to me throughout this process. My best friends (Leslie, Carin, Jenny, Emily, Lindsay, Mckenzie, Shellie, Alicia, Rebecca, Jennifer, Chris, and Angie) thank you for years of support, patience, and interest in all my endeavors. Angela, words cannot express what your friendship has meant to me over the past five years. I am also extremely grateful for the assistance provided by my dissertation committee members. Dr. Maricle, I am thankful for your guidance, teaching, and support. Thank you also to Drs. Daniel Miller, Wendi Johnson, and Steve Lytle for providing advice and encouragement. v ABSTRACT CRISTINA SEVADJIAN CONFIRMATORY FACTOR ANALYSIS OF THE NEPSY: A DEVELOPMENTAL NEUROPSYCHOLOGICAL ASSESSMENT, SECOND EDITION IN A MIXED CLINICAL SAMPLE OF CHILDREN AUGUST 2014 The NEPSY: A Developmental Neuropsychological Assessment, Second Edition (NEPSY-II) is a comprehensive battery of neuropsychological measures purported to assess the neurocognitive functioning in children between the ages of 3 to 16 (Korkman, Kirk, & Kemp, 2007a). Specifically, the measure is intended to identify problems that underlie poor academic performance and disinhibited behaviors. The NEPSY-II and its predecessors were developed out of a growing need for systematic, comprehensive, and normative assessment tools to assess neurocognitive deficits in children. While this measure is commonly used among pediatric neuropsychologists to assess neurocognitive functioning, specific research on this measure is limited. In fact, fewer than five studies have been conducted examining the psychometric properties of the NEPSY-II and there have been no studies confirming the Korkman, Kirk, and Kemp, (2007b) theoretical model of neurocognitive functioning in children. A Confirmatory Factor Analysis (CFA) is a critical step in providing empirical support for the Korkman et al. (2007b) theoretical position. vi The purpose of this study was to examine the underlying factor structure of the NEPSY-II in a mixed clinical sample of children. A CFA was used to determine if a modified-five factor theoretical model proposed by Korkman et al. (2007b) provides the best fit for the observed data. The data utilized in this study are archival and were collected from case studies submitted to fulfill requirements for the KIDS, Inc. School Neuropsychology Post-Graduate Certification Program. The results indicated that a modified-five factor theoretical model was an inadequate fit; a further modified-five factor model demonstrated a slightly more adequate fit. Interpretations of the finding were discussed with an emphasis on the complexity of neurocognitive constructs and the importance of using the NEPSY-II along with other clinical data to develop a diagnostic impression of a child. Future research on the NEPSY-II should include a replication of this study along with examining the author-proposed model in comparison with other neurocognitive models to determine which model fits best with the data. vii TABLE OF CONTENTS Page COPYRIGHT .............................................................................................................. iii DEDICATION ............................................................................................................ iv ACKNOWLEDGEMENTS ......................................................................................... v ABSTRACT ................................................................................................................ vi LIST OF TABLES ....................................................................................................... x LIST OF FIGURES .................................................................................................. xiii Chapter I. INTRODUCTION ................................................................................................. 1 Purpose, Rationale, and Significance of the Study .......................................... 8 II. REVIEW OF THE LITERATURE ..................................................................... 10 Theoretical Underpinnings and Development of the NEPSY ....................... 10 Luria’s Theory ............................................................................................... 10 NEPS Development ....................................................................................... 12 NEPSY Development .................................................................................... 13 Attention and Executive Functioning Domain .............................................. 14 Language Domain .......................................................................................... 16 Sensorimotor Functions Domain ................................................................... 17 Visual-Spatial Functions Domain .................................................................. 18 Learning and Memory Domain ...................................................................... 19 Psychometric Properties of the NEPSY: Standardization, Reliability, and Validity ........................................................................... 21 Factor Structure of the NEPSY ...................................................................... 23 Development of the NEPSY-II ...................................................................... 25 Revision of the NEPSY ................................................................................. 25 NEPSY-II Development Phases .................................................................... 28 Review of the NEPSY-II ............................................................................... 32 viii NEPSY-II Domain Descriptions .................................................................... 32 NEPSY-II Scoring and Classification of Performance .................................. 34 Psychometric Properties of the NEPSY-II ..................................................... 37 Normative Sample ......................................................................................... 37 Reliability of the NEPSY-II ........................................................................... 39 Validity of the NEPSY-II............................................................................... 40 Strengths of the NEPSY-II............................................................................. 42 Limitations of the NEPSY-II ......................................................................... 44 Rationale and Purpose of the Current Study .................................................. 46 Summary ........................................................................................................ 48 III. METHODS .......................................................................................................... 49 Participants ..................................................................................................... 49 Procedures ...................................................................................................... 50 Measure .......................................................................................................... 51 Attention and Executive Functioning ............................................................ 51 Language ........................................................................................................ 55 Memory and Learning.................................................................................... 58 Sensorimotor .................................................................................................. 62 Social Perception ........................................................................................... 64 Visuospatial Processing ................................................................................. 66 Subtest Utilized in the Analysis ..................................................................... 68 Reliability and Validity of the NEPSY-II Subtests........................................ 68 Research Rationale, Significance,
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