Download - Nepsy ii
BYBROOKE SCHAUDER, PHD
NEPSY-IIOverview
What this introduction will cover:
Development of the NEPSY-IIDomains of FocusWhen to use NEPSY-IISpecific SubtestsCase Presentations
Ongoing Practice Administration Conduct subtests with patients Review scores and interpretation
Background
Original NEPSY developed in 1998 (Finnish version in 1988)NEPSY-II increases content and psychometric propertiesStrong basis for development was Luria’s approach to
assessment of adults with brain damage Luria –Nebraska 11 clinical scales:
reading writing arithmetic visual memory expressive language receptive language motor function rhythm tactile intellectual
Developmental & Neuropsychological Theory
Subtests to assess BASIC components of cognition (i.e., fingertip tapping)
Subtests to assess complex cognition, requiring skills from basic components (i.e., auditory attention) Thus, scores can help inform how performance in one
domain can affect performance in other, more complex mental processes.
Performance on BASIC tests would ceiling at early age, while COMPLEX improves over childhood
Standardization
1,200 cases 3-16 yearsProportions of races (within each age group)
based on 2003 censusDivision of geographic quadrants (Northeast,
Midwest, South, West) according to census bureau data
Stratified Sample according to parent education
Each age group had 50 males and 50 females
Reliability & Validity
MOST have adequate to high internal consistency or stability Highest relaibility
subtests: Comprehension of
Instructions Design Copying Fingertip Tapping Imitating Hand Positions List Memory Memory for Names Phonological Processing Picture Puzzles Sentence Repetition
Lower Reliability Response Set Total
Correct (.55 for 11 & 12 year olds)
Inhibition Total Errors (.35 for 10 year olds)
Memory for Designs Spatial and Total Scores
Memory for Designs Delayed Total Score (.44 for 10 year olds)
Range from .44-89 (most in in 70-80 range)
INTERSCORER AGREEMENT 93-99%
VALIDITY moderate - high correlations with
WISC-IV and DAS-II
Test & Retest Stability
Ages: 3-16 years
General Assessment: Preschool-ages - 45 minutes School ages - 1 hour Full Assessment: Preschool-ages - 90 minutes School ages - 2 to 3 hours
Administration
Attention and Executive Functioning(self-regulatory skills)
Strategic planningRegulation based on
environmental feedback
SUBCOMPONENTSInitiationInhibitionSelective AttentionFlexibilitySustained AttentionFluencyWorking Memory
Language
Expressive Oromotor Control and
Articulation Naming Repetition Word Generation
Receptive Phonological
Processing Repetition
Memory and Learning
Immediate and Delayed Memory
EncodingRetrievalWorking MemoryMemory SpanRepetitionRote Memory
Supraspan Learning: memorization of material exceeding max. capacity for immediate memory (through repetition)
Motor Skills
Sensorimotor Functioning and Motor Coordination
Visuomotor FunctionsImitation of Motor Positions and Sequences
Social PerceptionMemory for FacesFacial Affect RecognitionTheory of Mind
Visual and Visuoperceptual Processing
Visual PerceptionSpatial ProcessingVisuoconstructional SkillsLocal and Global Processing
Referral Questions
Learning Disorder – Language
Learning Disorder – Mathematics
ADHDBehavioral ProblemsLanguage Delays
Perceptual/Motor Delays
School ReadinessSocial/Interpersonal
DifferencesGeneral
Attention/Concentration
Animal Sorting (7-16): formulation of basic concepts, categories, shifting from on concept to another
Auditory Attention (5-16): selective auditory attention, vigilance Auditory Response set (7-16): shift and maintain
attention, inhibition of previously learned information, responding to matching or contrasting stimuli
Attention and Concentration (continued)
Clocks (7-16): planning, organization, visuoperceptual and visuospatial skills
Design Fluency (5-12): behavioral productivity in generation of designs
Inhibition (5-16): inhibition of automatic responses, switching between response type
Statue (3-6): motor persistence and inhibition
Speeded Naming (3-16): Rapid semantic access
Word Generation (3-16): Verbal productivity and generation
Attention and Concentration (continued)
Sentence Repetition (3-6): Sentence repetition of increasing complexity
Word List Interference (7-16): Verbal working memory, repetition, word recall following interference
Imitating Hand Positions (3-12)Manual Motor Sequences (3-12): Imitation of
rhythmic movement sequencesAffect Recognition (3-16): Recognition of
affect
Attention and Concentration (continued)
Theory of Mind (3-16): Understanding belief, intention, deception, emotion, imagination, and pretending, perspective taking
Arrows (5-16): Line orientionDesign Copying (3-16): Visuospatial and
visuomotor abilityGeometric Puzzles (3-16): Mental rotation,
visuospatial analysis, attention to detail
Behavioral Problems
Animal SortingAuditory Attention and Response SetClocksDesign FluencyInhibitionStatueComprehension of Instructions (3-16): Ability
to receive, process, and execute oral instructions
Behavioral Problems(continued)
Speeded NamingWord GenerationMemory for Faces Immediate and Delayed
(5-16): Encoding of facial features, discrimination, recognition
Sentence RepetitionFingertip Tapping (5-16): Finger dexterity,
motor speed, rapid motor programming.Visuomotor Precision (3-12): Graphomotor
speed and accuracy
Behavioral Problems(continued)
Affect RecognitionTheory of MindArrowsDesign Copying
Language Delays/Disorders
Animal SortingAuditory Attention and Response SetClocksInhibitionStatueComprehension of InstructionsBody Part Naming and Identification (3-4):
Confrontation naming and name recognition, expressive and receptive language
Language (continued)
Comprehension of InstructionsOromotor Sequences (3-12): Oromotor
CoordinationRepetition of Nonsense Words (5-12):
Phonological encoding and decodingSpeeded NamingMemory for Names (5-16): Encoding,
immediate, and delayed memory of visual and verbal information
Narrative Memory (3-16): Memory for organized verbal material, retrieval of memory
Language (continued)
Sentence Repetition Word List InterferenceImitating Hand PositionsVisuomotor PrecisionAffect RecognitionDesign Copying
Social/Interpersonal
Animal SortingAuditory Attention and Response SetDesign FluencyInhibitionStatueComprehension of InstructionsPhonological ProcessingSpeeded NamingWord Generation
Social/Interpersonal (continued)
Memory for FacesMemory for Designs (3-16): Spatial Memory
for novel visual materialNarrative MemoryWord List InterferenceFingertip TappingImitating Hand PositionsManual Motor SeequencesVisuomotor Precision
Social/Interpersonal (continued)
Affect RecognitionTheory of MindArrowsBlock Construction (3-16): Motor and
visual-perceptionDesign CopyingGeometric PuzzlesPicture Puzzles (7-16): Visual
Discrimination, spatial localization, visual scanning, whole-part relationships
Learning Differences - Reading
Primary Domains Tested: Attention and Executive Functioning & Language
Learning Differences – MathPrimary Domains: Attention and Executive
Functioning, Memory and Learning, Visuospatial Processing
School Readiness
Major Domain Assessed: Language
Perceptual/Motor Delays/Disorders
Attention and Executive, Sensorimotor, Visuospatial Processing
Interpretation
Attention and Exec. Fxn Subtests: Animal Sorting Low Score:
poor initiation, poor self-monitoring, poor conceptual reasoning, low semantic knowledge
Low Auditory Attention Score: Poor selective attention, poor sustained
attention, slow responding, poor inhibition
Interpretation
Attention and Exec. Fxn Subtests (Cont) Low Response Set Score:
same as Auditory + possible poor working memory
Low Clocks Score: poor planning and organization, poor
drawing ability, poor reading ability Design Fluency Low:
Problems with initiation, poor cognitive flexibility
Interpretation
Inhibition Low Score: Poor inhibition
Inhibition-Switching Low Score: Poor inhibition, poor cognitive flexibility
Statue Low Score Poor overall inhibition
LANGUAGE DOMAIN• Body Part Naming low score:• Poor word finding
• Body Part Identification low score:• Underdeveloped semantic knowledge
Interpretation
Comprehension of Instructions low score: Linguistic or syntactic deficit, poor ability to follow
multistep commandsOromotor Sequences low score:
Deficits in motor programming for speech productionPhonological Processing low score:
Poor phonological awareness and processing
Interpretation
Repetition of Nonsense Words low score: Poor articulation, poor language analysis
Speeded Naming low score: Reduced automatic lexical access; slow processing
speed, poor naming abilityWord Generation low scores:
poor executive control, poor initiation
Interpretation
MEMORYLow List Memory (Immediate and Delayed)
Poor remote memory or supraspan (verbal) skillsLow Memory for Designs:
Poor visuospatial memoryLow Memory for Faces:
Poor visual discriminatin and recognitionLow Memory for Names:
Poor learning (encoding) or retrievalLow Narrative Memory:
Poor expression or comprehension; poor verbal encoding
Interpretation
Low Sentence Repetition: Poor Verbal (short-term) memory
• Low Word-List Interference• Poor Verbal Working memory
SENSORIMOTOR• Low Fingertip Tapping:
• Poor fine-motor control• Low Imitating Hand Positions:
• Poor fine-motor programming and differentiation, low visuospatial abilities
Interpretation
Low Manual Motor Sequences: Poor manual motor programming
Low Visuomotor Precision: Poor fine-motor coordination, low speed
SOCIAL PERCEPTUALLow Affect Recognition:
Poor facial affect recognitionLow Theory of Mind:
Problems with perspective taking
Interpretation
VISUOSPOATIALLow Arrows:
Poor visuospatial skills Low Block Construction:
Poor visuoconstructional skills, poor planning, deficits in perceiving gestalt (3-D)
Low Design Copying: Poor visuoconstructional skills (2-D)
Low Geometric Puzzles: Poor perception, poor mental rotation
Interpretation
Low Picture Puzzles: Poor visual perception, poor scanning
Low Route Finding Poor visual-spatial relations, poor orientation
Scoring
Three types of scoresPrimary Scores: Global aspects or key clinical
variables Examples: AR total, AW total
Usually expressed as SCALED SCORE, but can be as PERCENTILE RANK
Combined Score (a type of Primary Score): total scores made by combining 2 measures within the subtest Example: Animal Sorting total errors combined with total
correct
Scoring
Primary Scores (cont) Cumulative Percentage: % of children at a
specific age that exhibit the behavior Base rate of 10% means that 10% of
children had an equal or lower score Base rate: concept is on rareness of the
finding rather than how well child performed relative to normal distribution
Scoring
Primary Scores (cont) Combined scores:
One score is weighted more heavily toward the construct being measured; for example with errors vs. speed in inhibition tasks, errors are weighted more heavily than speed because errors are related to executive functions more so than speed of processing.
Always presented as Scaled Scores
Scoring
Process Scores: more specific than Primary Scores. May not be relevant for all children- depends on
referral question.
For example, on Affect Recognition, there is a process score for emotion error type – may only be relevant to certain assessment questions (i.e. an individual being tested for ASD)
Can be expressed as percentile rank, scaled score, or cumulative percentage
Scoring
Contrast Scores: To compare higher level (more complex) to lower level (more basic) functions to help ascertain where the problem lies by providing data on one variable while controlling the other Compares how child did compared to norm who had
same score on the variable being controlled Example: AA combined = 10 and RS combined = 4,
Contrast score = 4; means that child did well below expected level on RS considering his score on AA combined; conversely, if AA=4 and RS=10, Contrast may = 14, meaning that child didmuch better than expected on RS considering his score on AA
Contrast scores are always Scaled Scores
Scoring
Behavioral Observations, such as “distracted, off-task behaviors, physical movement” receive cumulative percentages or percents.
THE END