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