alternate forms of the auditory-verbal learning test: issues of test comparability, longitudinal...

Pergamon Archives of Clinical Neuropsychology, Vol. IO, No. 2, pp. 133-145, 1995

Copyright Q 1995 National Academy of Neuropsychology

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Alternate Forms of the Auditory-Verbal

Learning Test: Issues of Test

Comparability, Longitudinal Reliability,

and Moderating Demographic Variables

Craig Lyons Uchiyama, Louis F. D’Elia, Ann M. Dellinger,

James T. Becker, Ola A. Selnes, Jerry E. Wesch, Bai Bai Chen, Paul Satz, Wilfred van Gorp, and Eric N. Miller

Multicenter AIDS Cohort Study

The present investigation examines the alternate-form and longitudinal reliability of two versions of the Auditory-Verbal Learning Test (AVLT) on a large, multire- gional, healthy male sample. Subjects included 2,059 bisexual and homosexual HIV-seronegative males recruited from the Multicenter AIDS Cohort Study from centers in Baltimore, Chicago, Los Angeles, and Pittsburgh. The findings revealed no significant differences between forms upon initial or l-year longitudinal admin- istration, supporting the equivalence of the two versions. However; significant practice effects were noted longitudinally, arguing for the need of appropriate retest normative data. Furthermore, as age, ethnic&y, and education were found to significantly affect test performance, it is recommended that normative data be interpreted according to these variables. In addition to providing normative and

This study was supported by National Institutes of Health contracts NO1 AI 7263 1, AI 72634, AI 32535, AI 72676, and AI 72632.

Address all correspondence to: Craig Lyons Uchiyama, PhD, UCSF Langley Porter Psychiatric Institute, 401 Pamassus, Box CPT, San Francisco, CA 94143-0984.

Craig Lyons Uchiyama is affiliated with the UCSF Langley Porter Psychiatric Institute. Louis F. D’Elia, Paul Satz, Wilfred van Gorp, and Eric N. Miller are affiliated with the UCLA School of Medicine. Ann M. Dellinger is affiliated with the UCLA School of Public Health. James T. Becker is affiliated with the University of Pittsburgh Graduate School of Public Health and School of Medicine. Ola A. Selnes and Bai Bai Chen are affiliated with the Johns Hopkins University School of Hygiene and Public Health. Jerry E. Wesch is affiliated with the Howard Brown Memorial Clinic - Northwestern University Medical School.

133

I34 C. L. Uchiyama et al.

longitudinal data, this investigafion presents information concerning the use and

limitations of the alternate forms of the AVLT.

The Auditory-Verbal Learning Test (AVLT), initially developed by Rey (1964) and later revised for English usage (Lezak, 1983; Taylor, 1959), is a measure of rote verbal memory that assesses multiple memory domains, including immedi- ate memory span, new learning, retroactive and proactive interference, and recognition (Lezak, 1983; Spreen & Strauss, 1991). Impaired performance on this test has been associated with such conditions as left temporal lobe dysfunc- tion (Malec, Ivnik, & Hinkeldey, 1991), depression (Query & Megran, 1984), psychosis (Rosenberg, Ryan, & Prifitera, 1984) mild head injury (Lcininger, Gramling, Farrell, Kreutzer, & Peck, 1990), entrenched Alzheimer’s (Haddad & Nussbaum, 1989), and alcoholism (Query & Megran, 1984).

Several alternate forms of the test have been developed for repeated adminis- tration (Crawford, Stewart, & Moore, 1989; Lezak, 1983; Shapiro & Harrison, 1990), as retest assessments often are clinically necessary to monitor the course of degenerative conditions or the recovery from cerebral trauma. Probably the most well known of these forms was developed by Taylor (1959). Although there has been limited support for the immediate-retest reliability of this version in male inpatients (Ryan & Geisser, 1986; Ryan, Geisser, Randall, & Georgemiller, 1986), the application of such findings to nonpatient populations has been questioned, given the very depressed scores of this sample’s subjects.

In addition, the need to examine alternate forms longitudinally has been sup ported previously (Lezak, 1983) as significant practice effects have been noted for the original version over periods ranging from 6 months to 1 year on a small sample (n = 23) of young males. In another study, Lezak (1979) also reported that the percentage of 24 male head-trauma patients functioning within normal limits increased over a 3-year period. However, the findings of the latter study are difficult to interpret, as such elevations may reflect either recovery from the traumatic event or practice effects from repeated exposure (Franzen, 1989).

The purpose of the present investigation is to examine longitudinally the alter- nate forms of the Rey Auditory-Verbal Learning Test on a large, healthy, multire- gional male sample; assess the psychometric equivalence of the two forms across time; determine the effects of repeated administrations on AVLT test scores; and investigate the moderating effects of demographic variables on test performance.

Subjects

METHOD

Subjects were participants of the Multicenter AIDS Cohort Study (MACS), and included 2,059 homosexual and bisexual HIV-seronegative males from

Alternate Forms of the Auditory-Verbal Learning Test 135

sites in Baltimore, Chicago, Los Angeles, and Pittsburgh. The purpose of the MACS is to research longitudinally the neurological and neuropsychological functioning of HIV-l seropositive and seronegative persons. Subjects were excluded from the investigation if they demonstrated a history of learning dis- ability, a prior loss of consciousness, or a primary language other than English. Sample demographics are presented in Table 1. For further informa-

tion on subject recruitment procedures, the reader may refer to the previously published works by Miller et al. (1990) and Kaslow et al. (1987).

Because the current sample was composed of seronegative, healthy gay and bisexual men, the possibility was raised that the validity and normative results of this investigation would not be reflective of the general male population. Therefore, the scores from Trial 5 of the present study were compared to those of previously reported normative studies of men. Normative studies were excluded from comparison that were not stratified by gender, by age, or that were based on patient populations. Of the two studies found to meet this crite- ria, the stratified age groups that overlapped with the present study were selected for comparison.

The mean score from Trial 5 of the present study was found to be almost identical (differing by only .31 points) to that of Bleeker, Bolla-Wilson, Agnew, and Meyers (1988). Although slightly better performance (1.58 points) was noted in the present sample over another sample (Geffen, Moar, O’Hanlan, Clark, & Geffen, 1990), this difference was likely related to the very small sample size of the latter study (mean = 10.4 persons per cell), as well as the fact that the males in the Geffen et al. sample had less than a high school education (mean years of education = 11.34) compared to the Bleeker et al. sample (mean years of education = 13.52) and the present sample. These findings demonstrate the similarity of the present study with previously

TABLE 1 Demographic Means and Standard Deviations for Alternate Versions of the AVLT

Total Sample

Form 1 Normative

Sample

Form 2 Form 1 Form 2 Normative Longitudinal Longitudinal

Sample Sample Sample

N 2,059 1,818 Age 36.55 (7.19) 36.54 (7.20) Education 15.94 (2.39) 15.95 (2.40) Ethnicity

Caucasian American 88% 89% Hispanic American 5% 5% African American 5% 5% Hispanic/African

American < 1% < 1% Native American < 1% < 1% Asian American < 1% < 1% Other < 1% < 1%

241 37.63 (7.16) ::.69 (6.01) ::.46 (6.95) 15.80 (2.31) 16.47 (2.04) 16.03 (2.21)

82% 94% 84% 8% 6% 3% 8% 11%

< 1% 3% < 1%

1% < 1%

136 C. L. Uchiyam et al.

published works, and would indicate no reason that the current findings can- not be generalized to heterosexual males.

It was found that 1,818 individuals received Form 1 on their first adminis-

tration, and 241 subjects received Form 2. Demographic information for these samples are presented in Table 1. General linear model one-way analyses found no significant between-group differences for age (F = .03; p > .05) and level of education (F = .88; p > .05). However, significant Pearson chi-squares were found in ethnicity (p < .05) when this variable was dichotomized (Caucasian, non-Caucasian) for reasons of small cell size. How this variable was controlled in the analyses is described in the Results section.

In the l-year longitudinal analyses, 47 persons were initially administered Form 1 in Wave 3, and participated in Waves 5,7, and 9 (each of which was 1 year apart). Thirty-seven persons were initially administered Form 2 and par- ticipated in Wave 4, which was 1 year after the initial administration. Demographic information for the longitudinal samples is presented in Table 1. Some of the subjects included in the longitudinal analyses received exposure to the alternate form midway between their exposure to the original form. However, as analyses revealed that these subjects demonstrated no significant differences in scores from persons not receiving such exposure, they were retained in the longitudinal analyses.

The longitudinal groups showed no significant demographic differences in terms of age (F = .03; p > .05), education (F = .90; p > .05), or ethnicity (Pearson chi-square = 2.09; p > .05). Because more subjects were inducted into the study after Wave 3 from Pittsburgh and Los Angeles, the results from the l-year longitudinal analyses may be less generalizable in terms of geo- graphic representation.

Data from Waves 1 and 2 could not be used in the l-year longitudinal anal- yses, as Form 1 was administered in both these waves (which were 6 months apart). To include them in the analyses would introduce confounding factors of unequal time periods and differential test exposure. However, these waves were included in the 6-month retest reliability analyses.

Procedure

Subjects were tested over 12 data collection periods, or waves, that were each 6 months in length. Two forms of the Auditory-Verbal Learning Test (Rey, 1964; Taylor, 1959) were administered (actual items in lists are present- ed in Lezak, 1983). The first, which will subsequently be referred to as Form 1, consisted of a 15-item word list (List A) presented 5 times (Trials 1 to 5). In these trials, the subjects were instructed to recall as many words as they could in any order. Immediately after the fifth presentation, a 15item distractor list (List B) was presented (Trial 6) with a similar test of recall. Following the dis- tractor task, the subjects were immediately asked to recall List A without the benefit of another presentation (Trial 7). After a 30-minute delay, the subjects

Alternate Forms of the Auditory- Verbal Learning Test 137

were presented both with a free recall (Trial 8) and a forced-choice recogni- tion task (Trial 9) of List A.

The second version, which will be referred to as Form 2, was identical to Form 1 with the exception that the words in List A (presented 5 times) were substituted with words from List C. The interference trial (List B) of Form 2 was identical to that of Form 1.

RESULTS

Normative Analyses

The means and standard deviations from the normative analyses, which were stratified according to age and education, are presented for Forms 1 and 2 in Tables 2 and 3, respectively. The comparability of the two forms was analyzed using a four-way general linear model due to discrepant cell sizes which made such statistics as classical MANOVA's inappropriate. In this analysis, the independent variables included test form, age, education, and ethnicity; and the dependent variables included the scores from Trials 1 to 9 and the total number of Intrusions from Trials 1 to 5. Because the two groups differed in terms of ethnicity, this variable was dichotomized (Caucasian, non-Caucasian) in the manner of an indicator variable, and entered into the analysis as an inde- pendent variable. This way, should significant main effects be found, an exam- ination of the appropriate partial sums of squares would indicate the effects of test form without the influencing effects of ethnicity.

The results of the normative analyses revealed no significant main effect for test form (F = .82; df = 13; p > .05), supporting the comparability of the two versions upon initial administration. In examining the learning curves for Trials 1 to 5, a repeated-measure, general linear model was again used for the previously cited rationale. In this model, test form and ethnicity were the inde- pendent variables; trial was the repeated measure independent variable; and scores from Trials 1 to 5 were the dependent variables. The results of these analyses indicated a significant trial by form interaction (F = 2.67; df = 4; p < .05), suggesting that the learning curve for the two forms was significantly different upon initial administration. As there was no trial by ethnicity interac- tion (F = .24; df = 1; p > .05), there is no reason to believe that ethnicity, the only demographic variable that was significantly different for the two groups, was differentially influencing the learning curves of the two forms.

The effects that the demographic variables had on Trial 5 test scores were examined by a general linear multiple regression, with ethnicity again being entered as an indicator variable. The partial F ' s were significant for age (F = 51.90; df= 1; p < .05), ethnicity (F = 21.52; df= 1; p < .05), and educa- tion (F = 71.94; df= 1;p < .05), demonstrating the strong relationship of these variables with test scores, as well as the need for interpreting normative data

TA

BL

E 2

N

orm

ativ

e M

eans

and

Sta

ndar

d D

evia

tion

s for

the

AY

LT

: For

m 1

~.

-

..___

- _.

_..

-___

_1__

___~

.-_

.- __

___.

A

@

Edu

cati

on

- --

____

- __

I~~

Tot

al S

ampl

e 20

-29

30-3

9 40

-49

5Oan

dabo

ve

c 16

Yea

rs

16 Y

ears

T

rial

>

16

Yea

rs

(n =

181

8)

(n =

333

) (n

= 9

68)

(n =

437

) (n

= 8

0)

(n =

662

) (n

= 4

95)

(n =

653

) . ..

~ ~.

--

_ __

T

rial

1

6.66

(1.

81)

6.86

(1.

86)

6.74

(1.

83)

6.46

( 1

.68)

5.

80 (1

.73)

6.

31 (

1.83

) 6.

84 (

1.73

) z

6.86

(1.

81)

0 T

rial

2 9.

59 (

2.15

) 9.

82 (2

.28)

9.

72 (2

.21)

9.

26 (1

.88)

8.

88 (1

.97)

9.

14 (2

.10)

9.

77 (2

.02)

9.

91 (

2.23

) T

rial

3

11.1

7 (2

.19)

11

.32

(2.2

0)

11.3

6 (2

.21)

10

.82

(2.0

8)

10.1

5 (1

.96)

10

.67

(2.1

8)

11.4

4 (2

.09)

11

.48

(2.1

9)

Tri

al 4

12

.06

(2.0

0)

12.3

8 (1

.90)

12

.15

(1.9

7)

1 I.7

6 (2

.09)

11

.34

(1.9

1)

11.6

6 (2

.05)

12

.26

(1.9

4)

12.3

3 (1

.94)

T

rial

5

12.6

3 (1

.89)

12

.84

(1.7

9)

12.7

6 (1

.91)

12

.45

(1.8

4)

12.0

3 (2

.02)

12

.34

(1.9

9)

12.8

1 (1

.83)

12

.91

(1.7

8)

Intr

. Tri

al

6.50

(2.

07)

6.85

(2.

08)

6.58

(2.

05)

6.15

(2.

04)

6.16

(2.

28)

6.13

(2.

01)

6.54

(2.

07)

6.84

(2.

07)

Imm

. Rec

all

1 I .0

5 (2

.68)

11

.39

(2.4

0)

11.2

4 (2

.73)

10

.50

(2.6

0)

10.2

0 (3

.03)

10

.78

(2.7

0)

11.1

9 (2

.58)

11

.21

(2.7

0)

Del

. Rec

all

10.8

7 (2

.82)

11

.27

(2.5

4)

11.0

8 (2

.82)

10

.25

(2.8

4)

9.87

(3.

3 f)

10

.53

(2.9

0)

t 1.0

4 (2

.76)

11

.07

(2.7

8)

Del

. R

ecog

. 14

.19

(1.2

8)

14.3

6 (1

.13)

14

.23

(1.2

3)

14.0

1 (1

.42)

13

.89

(1.5

7)

14.1

1 (1

.37)

14

.27

(l-2

3)

14.2

1 (1

.22)

In

k E

rror

s (T

rial

s l-

5)

3.04

(2.

93)

3.05

(2.

89)

3.09

(3.

00)

2.91

(2.

88)

2.91

(2.

67)

3.14

(2.

99)

2.95

(2.

82)

2.97

(2.

96)

Tri

al

Tri

al 2

1

Tri

al

3 T

rial

4

Tri

al 5

In

k T

rial

Im

m.

Rec

all

Del

. R

ecal

l D

el.

Rec

og.

Intr

. E

rror

s (T

rial

s l-

5)

Tot

al

Sam

ple

(n =

241

)

6.41

(1

.73)

8.

94

(2.2

1)

10.7

0 (2

.12)

11

.61

(2.0

6)

12.2

0 (1

.83)

6.

29

(2.1

2)

10.1

1 (2

.68)

9.

75

(2.9

8)

13.3

4 (1

.98)

4.

42

(3.8

1)

TA

BL

E

3 N

orm

ativ

e M

eans

an

d St

anda

rd

Dev

iati

ons

for

the

AV

LT

: F

OR

M

2

Age

E

duca

tion

20-2

9 (n

= 4

6)

30-3

9 (n

= 1

18)

40-4

9 (n

= 6

6)

50 a

nd a

bove

<

16 Y

ears

16

Yea

rs

> 16

Yea

rs

(n=

11

) (n

=91)

(n

=81)

(n

= 6

8)

6.78

(1

.80)

6.

50

(1.7

8)

6.11

(1.

53)

5.64

(1

.57)

6.

36

(1.8

3)

6.32

(1

.58)

6.

57

(1.7

6)

9.52

(2

.61)

9.

03

(2.0

9)

8.48

(2

.10)

8.

18 (

1.72

) 8.

84

(2.1

1)

9.04

(2

.23)

8.

90

(2.2

9)

11.1

3 (2

.24)

10

.81

(1.9

5)

10.2

9 (2

.36)

10

.09

(1.6

4)

10.3

8 (2

.01)

10

.95

(2.0

4)

10.7

9 (2

.35)

12

.09

(1.9

3)

11.6

0(1.

95)

11.4

2 (2

.26)

10

.91

(2.3

0)

11.3

5 (1

.92)

11

.80

(2.1

6)

11.7

1 (2

.10)

12

.30

(2.0

0)

12.3

8 (1

.56)

11

.94

(2.1

3)

11.4

5 (1

.81)

12

.03

(1.6

2)

12.3

1 (2

.00)

12

.31

(1.9

2)

7.02

(2

.39)

6.

15

(2.0

6)

6.23

(2

.03)

5.

27

(1.4

9)

6.24

(2

.21)

5.

96

(2.0

1)

6.80

(2

.09)

10

.91

(2.6

6)

10.0

9 (2

.48)

9.

82

(2.8

7)

8.82

(3

.16)

9.

78

(2.4

5)

10.4

1 (2

.80)

10

.15

(2.8

4)

10.4

8 (3

.16)

9.

71

(2.7

1)

9.48

(3

.18)

8.

73

(3.5

2)

9.52

(2

.58)

9.

98

(3.1

2)

9.75

(3

.32)

13

.83

(1.6

9)

13.4

7 (1

.96)

12

.82

(2.1

5)

13.1

8 (1

.78)

13

.24

(2.0

3)

13.5

9 (1

.80)

13

.16

(2.1

1)

3.87

(4

.61)

4.

77

(3.7

5)

4.23

(3

.31)

4.

09

(3.6

2)

4.53

(4

.20)

4.

22

(3.8

4)

4.47

(3

.23)

140 C. L. Uchiyama et al.

in accordance with such variables. It was found that higher scores were associ- ated with younger age and higher education.

Longitudinal Analyses

Normative information on the longitudinal samples may be found in Table 4. The longitudinal data were subjected to two sets of repeated measure MANOVA’s. As no statistical differences were found between the groups in terms of age, education, or ethnicity, these variables were not statistically con- trolled. The first MANOVA used test form, time, and trial as independent vari- ables; and scores from Trials 1 to 9 and total Intrusions across the first two time periods were used as dependent variables. The variables of time and trial were treated as within-subject repeated measure variables. The results indicated no significant longitudinal effect for test form (F = .78; df= 1; p > .OS).

In examining the practice effects across repeated exposure, the results were significant (F = 322.12; df= 1; p < .05), demonstrating that scores significant- ly increased at l-year repeated administration. As there was no significant interaction between test form and time (F = SO; df = 1; p > .05), these practice effects appear to be similar for the two forms.

The second MANOVA examined the learning curves for Trials 1 to 5 between the two forms across time, and incorporated test form as the between- subject independent variable, time and trial number as the within-subject inde- pendent variables, and scores from Trials 1 to 5 for both initial and l-year retest as the dependent variables. The results of this MANOVA revealed no signifi- cant interaction for test form by trial (F = .91; df = 4; p > .05), suggesting that longitudinally, the two forms evidence similar learning curves for Trials 1 to 5.

Equivalent-Form Reliability

The equivalent-form, long-term retest reliabilities comparing the retest

periods for the two forms with the initial testing are presented in Table 5. The long-term reliabilities for the scores were all significant, except for the Form 1 Intrusion scores which were notably lower than the Intrusion scores of Form 2. In addition to the previously mentioned exception, the l-year reliability of the two forms appeared to be generally comparable, although Trial 1 and Delayed Recall scores for Form 1 were slightly less reliable than those of Form 2. The coefficients were lowest for both forms for Trial 1, and highest for Delayed Recall.

Alternate-Form Reliability

The alternate-form, 6-month reliability coefficients for the two forms were found to be moderate to moderately high, with the exception of Intrusions

TA

BL

E

4 L

ongi

tudi

nal

Mea

ns

and

Stan

dard

D

evia

tions

fo

r th

e A

VL

T:

Form

1

and

Form

2

Tri

al

5 T

rial

1

Tri

al

2 T

rial

3

Tri

al 4

T

rial

5

Ink

Tri

al

Imm

. R

ecal

l D

el.

Rec

all

Del

. R

ecog

In

tr.

Err

ors

(Tri

als

1-5)

Form

1

Form

2

Tim

e 1

0 Y

ears

(n

= 4

7)

Tim

e 2

1 Y

ear

(n =

47)

6.89

(2

.11)

9.

98

(2.4

4)

11.3

2 (2

.46)

12

.15

(2.2

9)

12.6

4 (1

.91)

6.

74

(2.1

8)

11.2

6 (2

.82)

10

.98

(3.1

0)

13.6

4 (1

.54)

2.

40

(1.7

3)

7.79

(2

.26)

10

.26

(2.4

3)

11.8

9 (2

.26)

12

.64

(2.1

7)

12.8

9 (2

.00)

6.

55

(2.1

7)

11.7

2 (2

.58)

11

.49 (2

.79)

13

:87

(1.6

2)

3.32

(3

.14)

Tim

e 3

2 Y

ears

(I

I = 4

7)

7.57

(2

.54)

10

.70

(2.6

1)

12.2

6 (2

.08)

13

.15

(1.6

7)

13.6

4 (1

.48)

6.

57

(2.0

7)

12.3

6 (2

.57)

11

.98

(2.7

1)

14.0

0 (1

.35)

4.

45

(4.7

3)

Tim

e 4

3 Y

ears

(n

= 4

7)

Tim

e 1

0 Y

ears

(n

= 3

7)

Tim

e 2

1 Y

ear

(n =

37)

7.79

(2

.42)

10

.83

(2.2

7)

12.5

1 (2

.28)

13

.32

(1.6

8)

13.8

9 (1

.39)

6.

81

(2.3

7)

12.4

9 (2

.44)

12

.47

(2.3

9)

14.0

6 (1

.34)

4.

83

(4.8

9)

6.78

(1

.65)

9.

22

(1.9

3)

10.8

4 (1

.83)

11

.65

(1.6

2)

12.0

5 (1

.96)

6.

60

(1.6

9)

10.3

2 (2

.59)

10

.24

(2.3

3)

13.9

5 (1

.73)

4.

51

(3.0

8)

7.19

(1

.79)

10

.19

(2.0

5)

11.8

4 (1

.94)

12

.35

(2.2

1)

12.4

6 (1

.84)

6.

60

(1.7

7)

10.8

9 (2

.84)

10

.60

(3.2

4)

13.9

7 (1

.30)

3.

60

(4.1

9)

142 C. L. Uchiyam et al.

TABLE 5 Equivalent-Form Retest Reliability Coeffkients of the AVLT

Trial 6-Month (n = 322)

Form 1

I-Year 2-Year (n = 47) (n = 47)

3-Year (n = 47)

Form 2

l-Year (n = 37)

Trial 1 .344** .297* .537** .394** .521** Trial 5 .481** .600** sOQ** .531** .596** Imm. Recall .603** ..571** .641** .662** Del. Recall .655** .572** .783** .808** Del. Recog. .280** .364* .644** .480** .394* Ink Errors (Trials 1-5) .414 .176 ,041 .114 .562** -

*p < .05 2-tailed significance; **p < .Ol 2-tailed significance.

scores. All coefficients were significant at the p < .05 (Ztailed) level. The 6- month alternate-form reliabilities were .363 for Trial 1 (n = 890) .488 for Trial 5 (n = 890), 574 for Trial 7 (n = 659), .604 for Trial 8 (n = 662) .345 for Trial 9 (n = 888), and .285 for Intrusions (n = 890).

DISCUSSION

The results of this investigation provide normative and longitudinal data for two forms of the Auditory-Verbal Learning Test on a large, multiregional, healthy male sample. The overall sample was relatively young and well-edu- cated; however, normative scores were stratified by age and education so that the data may be interpreted across a range of demographic values. Although the current sample was composed of gay and bisexual men, there is no a priori reason to believe that these normative data would not be applicable to the gen- eral male population. This position was supported by the similarity of the cur- rent normative data and previously published studies.

In the normative analyses, there were no differences between the two AVLT test forms, supporting their psychometric equivalence upon initial

administration. The learning curves for Trials 1 to 5, however, were found to be significantly different between forms, a difference that did not appear to be affected by the slightly different racial makeup of the groups. Because of this reason, diagnoses and interpretations that are based on rates learning should be made on test-specific normative data, such as those reported herein.

An examination of the association of age and test scores revealed signifi- cant regression coefficients, with higher scores being associated with younger age. These findings are generally consistent with the reported literature (Bishop, Knights, & Stoddart, 1990; Geffen et al., 1990; Mitrushina, Satz, Chervinsky, & D’Elia, 1991; Petersen, Smith, Kokmen, Ivnik, & Tangalos, 1992; Query & Berger, 1980) although such an association has not been uni-

Alternate Forms of the Auditory-Verbal Learning Test 143

versally replicated (Bolla-Wilson & Bleecker, 1986). As the effect of age appears to be influenced by other moderating variables, such as diagnostic sta-

tus (Query & Berger, 1980) and intelligence (Query & Megran, 1983), caution should be exercised when interpreting the effects of this variable.

The significant effects of education demonstrated in this investigation are consistent with those of Query and Megran (1983), where education was

found to be related to AVLT scores in male inpatients. Although these findings were not replicated in a developmental study of children (Forrester & Geffen, 1991), the discrepancy between these studies may be related to the pediatric nature of the latter sample.

Despite the fact that a significant predictive relationship was noted for ethnicity and test score, this finding should be viewed with caution, given the small non-Caucasian sample size and the increased possibility of selec- tion bias. It was for this reason that these data could not be presented norma- tively. However, it is recommended that this variable be investigated more closely in future research in conjunction with such variables as social eco- nomic status and cultural factors that could significantly moderate or explain the present findings.

Whether the normative data provided herein can be used with women remains to be demonstrated. Although gender effects have not been found in children (Forrester & Geffen, 1991), adult females have been noted to score higher than males on the AVLT (Bolla-Wilson & Bleecker, 1986; Geffen et al., 1990). Therefore, as the present sample consisted of healthy males, it is rec- ommended that the normative data provided not be used with females until further examination of this question can be undertaken.

The longitudinal analyses did not demonstrate significant differences between forms at l-year retesting which, taken in conjunction with the norma- tive analyses, support the long-term psychometric equivalence of the two ver- sions. However, significant practice effects were found for the forms at l-year retesting, and these practice effects appeared to be similar for the two forms. These findings demonstrate the need for the use of appropriate longitudinal normative data in interpreting retest results.

The scores of the two forms showed similar equivalent-form retest reliabili- ties, with the exception of Intrusion scores for Form 1, which were nonsignifi- cant and notably smaller than that of Form 2. The fact that Form 1 Intrusion scores are poor predictors of future Intrusions limits their clinical utility when

assessing errors in situations requiring multiple assessments, and should be interpreted discerningly given their longitudinal unreliability. The reason that Intrusion errors for Form 1 should evidence less covariance than those of Form 2 is unclear, and may be related to such factors as the mental salience of the words included in the lists or their associative links to other nonlist words. However, this finding is worthy of continued research.

The results of this investigation support the comparability of the two AVLT versions both upon initial and long-term retest administration. Because the

144 C. L. Uchiyama et al.

present analyses were based on a nonpatient sample, it is recommended that future research also focus on similar psychometric issues with clinical sam-

ples. In addition, the present research examined demographic characteristics that could potentially affect test scores, with significantly poorer performance associated with increasing age and lower education. Lastly, the study provides

researchers and clinicians with information concerning the learning curves, longitudinal practice effects, and psychometric properties of the alternate ver- sions of the AVLT, issues that have great potential impact on the understand- ing of this test of verbal learning.

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