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The Use of Serial Testing to Identify Young Children in Need of Comprehensive Neuropsychological Evaluation
Abstract
This study was designed to use a short, two-phase testing procedure to predict the outcome of a comprehensive neuropsychological examination among young children (aged 5-8 years). Phase 1, requiring less than 10 minutes to administer, predicted Phase 2 results and results of comprehensive testing with acceptable accuracy. Phase 2 testing evaluated both lower-level (sensory-motor) and higher-level functions, required about 45 minutes to administer, and also closely predicted the outcome of comprehensive testing. Cutoff scores for individual tests, areas of function, and the total score for preliminary testing were determined, and accuracy rates were identified. The results suggest that preliminary testing, as described in this article, may serve to identify young children who need a comprehensive neuropsychological examination.
The aim was to verify the applicability of Reitan and Wolfson's proposed neuropsychological screening battery for adults (2006,
2008) in the Czech population. The sample consisted of 70 participants aged 19–65 years, all of whom were examined using a
screening method as well as the full Halstead–Reitan neuropsychological battery (HRNB). The correlation, logistic regression,
ROC curve analysis, sensitivity and specificity, and positive and negative predictive values were all calculated. The Pearson
correlation between the screening scale of neuropsychological deficit and the General Neuropsychological Deficit Scale (GNDS)
from HRNB was 0.78 (p < .001). When optimal cut-off scores of 8 were utilized (in accordance with Horwitz, Lynch, McCaffrey, & Fisher in Screening
for neuropsychological impairment using Reitan and Wolfsońs preliminary neuropsychological test battery. Archives of Clinical Neuropsychology, 23, 393–398, 2008, but different from Reitan, & Wolfson in The use of serial testing in evaluating the need for comprehensive
neuropsychological testing of adults. Applied Neuropsychology, 15, 21–32, 2008), 78.6% of individuals were correctly classified having neuropsychological impairment or no impairment according
to the GNDS. Our results confirm that this neuropsychological screening battery has good psychometric properties in the Czech
population.
Adequate reliability and valid factor structure are prerequisites for appropriate use of a measure in a population. Although the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) has been used to examine cognition in Parkinson's disease (PD), its reliability and factor structure have not been examined in this population. This study examined the reliability and factor structure of the RBANS in participants with de novo PD recruited for two NIH Exploratory Trials in Parkinson's Disease (NET-PD), using Cronbach's alpha and factor analysis. Confirmatory factor analysis (CFA) was implemented on the factor structure proposed in the RBANS manual, and exploratory factor analysis (EFA) was conducted to identify a valid factor structure given the proposed one was not supported. The RBANS exhibited poor reliability in participants with NET-PD. Cronbach's alpha ranged from 0.03 to 0.74 for the five domains and the full scale. CFA results indicated that the proposed factor structure in the RBANS manual was not supported in this sample. EFA identified a two-factor structure for six of the 12 RBANS items. Six items were eliminated due to low correlation with other items or severe ceiling effects. This new factor structure was validated by another CFA. The two domains have fair reliability. Cronbach's alpha ranged from 0.65 to 0.74 for the two factors in the two datasets. These results suggest that the current RBANS domain and total scores may not provide valid measurement of the neuropsychological status for patients with early PD.
The aim of this study was to develop a short screening battery that would predict whether older children would show significant impairment on comprehensive neuropsychological testing. The screening battery was subdivided into two phases. Phase 1 was intended as a broad catchment effort; Phase 2 was designed to be a more detailed and selective procedure. Administration of the full set of screening tests requires about 45 minutes. Their predictive validity was assessed using the Neuropsychological Deficit Scale (NDS), which summarizes results in the entire Halstead-Reitan Neuropsychological Test Battery for Older Children. Cutoff scores and guidelines for interpretation of the screening tests were developed, and the results were substantially correct in identifying children who performed normally versus children who were impaired on the testing and therefore required comprehensive testing to evaluate their neuropsychological status and deficits.
Reports on studies emphasizing a neuropsychological approach to the investigation of learning disabilities in children. Areas reviewed include the level of performance approach, attentional deficits, EEG abnormalities, comparisons of performance on the 2 sides of the body, differential score approaches, and the investigation of particular learning disabilities. These studies indicate that cerebral impairment is at least one crucial factor limiting the satisfactory adaptation of children with learning disabilities. (37 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents results of a comparative psychological examination of 29 cerebrally damaged and 29 normal 5-8 yr old children. Distinctly different types of impairment were evident in the cerebrally damaged Ss when compared with normals, and psychological deficits were more marked than in adults and of a different type, although there was some indication that certain types of deficits were correctable when they developed at an early age. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The performance of 75 brain-damaged, learning-disabled, and normal children aged 9 to 14 years was compared on 13 neuropsychological test measures. Analysis of variance, supplemented by t-tests, indicated a significant difference beyond the .01 level on 11 measures and beyond the .05 level on one measure. A discriminant analysis based on weightings of the 13 measures yielded 80 per cent correct classification of subjects, a finding in agreement with the outcome of the multivariate analysis of variance. The results indicated that these psychological measures were individually sensitive to differences among the three categories of subjects and, as a group, were capable of classifying children at a level far exceeding chance. It would appear that neuropsychological variables (brain-sensitive tests) may account for much of the uniqueness in many children with learning disabilities.
Sensory-perceptual and motor functions are closely dependent on the integrity of the brain and nervous system. Standardized tests have been developed to assess these functions, but such tests are not routinely used to evaluate children who are suspected of having a neuropsychological basis for their difficulties. Higher-level functions (such as verbal and academic abilities, executive functioning, etc.) are obviously important in producing successful performances, but the brain and nervous system correlates of these abilities are less well defined than the correlates for sensory-motor abilities. Our contention is that tests from these two general areas (higher-level and lower-level aspects of brain functioning) can be used effectively in a complementary manner to evaluate individual children. The first step in this process is to evaluate formal sensory-motor tests and to assess their validity as a brief preliminary examination used to differentiate between brain-damaged and control children. The results of this study demonstrated striking differences between the groups and indicated that sensory-motor testing might serve very effectively, when used in conjunction with higher-level tests, to identify those children whose higher-level impairment is due to brain impairment rather than a lack of environmental opportunities or advantages.
This study explores the use of the Progressive Figures Test as an instrument for broad initial screening of children in the 6- through 8-year age range with respect to the possible need for more definitive neuropsychological evaluation. Considering earlier results obtained in comparison of brain-damaged and control children [Clinical Neuropsychology: Current Applications, Hemisphere Publishing Corp., Washington, DC, 1974, p. 53; Proceedings of the Conference on Minimal Brain Dysfunction, New York Academy of Sciences, New York, 1973, p. 65], the Progressive Figures Test seemed potentially useful as a first step in determining whether a comprehensive neuropsychological evaluation is indicated. In this investigation, three groups were studied: (1) children with definitive evidence of brain damage or disease who, when compared with normal controls, help to establish the limits of neuropsychological functioning, (2) a group of children who had normal neurological examinations but also had academic problems of significant concern to both parents and teachers, and (3) a normal control group. Statistically significant differences were present in comparing each pair of groups, with the brain-damaged children performing most poorly and the controls performing best. Score distributions for the three groups make it possible to identify a score-range that represented a borderline or "gray" area and to suggest a cutting score that identified children whose academic problems might have a neurological basis and for whom additional neuropsychological evaluation appeared to be indicated.
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