NEUROPSYCHOLOGICAL NEUROPSYCHOLOGICAL ASSESSMENTASSESSMENT

Antonio E. Puente, Ph.D.Antonio E. Puente, Ph.D.Department of PsychologyDepartment of Psychology

University of North Carolina at WilmingtonUniversity of North Carolina at WilmingtonWilmington, NC 28403-3297Wilmington, NC 28403-3297

Phone: (910) 962-3812 Fax: (910) 962-7010Phone: (910) 962-3812 Fax: (910) 962-7010E-mail: puente@uncwil.eduE-mail: puente@uncwil.edu

International Symposium on Biological International Symposium on Biological Aspects and Drug Therapies of Mental Aspects and Drug Therapies of Mental

DisordersDisorders

Habana, CubaHabana, Cuba

June, 2000June, 2000

Outline of the PresentationOutline of the Presentation

IntroductionIntroduction Current trends:Current trends:

– Review of LiteratureReview of Literature– Division 40 DiagnosticsDivision 40 Diagnostics

Available TestsAvailable Tests Specific Issues in AssessmentSpecific Issues in Assessment SummarySummary

INTRODUCTION:INTRODUCTION:AssumptionsAssumptions

Antonio E. PuenteAntonio E. Puente North American BiasNorth American Bias Traditional Variables of InterestTraditional Variables of Interest

TranslatorsTranslators AvailabilityAvailability

BiasBias

Literal TranslationLiteral Translation

NormsNorms

Limited AvailabilityLimited Availability

Exchangeability of NormsExchangeability of Norms

Sampling TechniquesSampling Techniques

ConfoundsConfounds

Cultural AdaptationCultural Adaptation

Educational AttainmentEducational Attainment

Non-Verbal TestsNon-Verbal Tests

Ecological ValidityEcological Validity

Example: LuriaExample: Luria

RussiaRussia

DenmarkDenmark

United StatesUnited States

SpainSpain

CURRENT TRENDS:CURRENT TRENDS:Review of the LiteratureReview of the Literature

Psych Lit Rankings: 1974-1990Psych Lit Rankings: 1974-1990 ProfessionalProfessional DiagnosticDiagnostic TestingTesting RehabilitationRehabilitation ForensicForensic

Review of the Literature Review of the Literature (Cont.)(Cont.)

Psych Lit Rankings: 1990- Psych Lit Rankings: 1990- PresentPresent

ProfessionalProfessional DiagnosticDiagnostic ForensicForensic TestingTesting RehabilitationRehabilitation

Topic Ranking for Topic Ranking for Neuropsychology ReviewNeuropsychology Review

DiagnosticDiagnostic TestingTesting ProfessionalProfessional RehabilitationRehabilitation ForensicForensic

Topic Ranking for Topic Ranking for Journal Journal of the International of the International Neuropsychological Neuropsychological

SocietySociety

DiagnosticsDiagnostics TestingTesting RehabilitationRehabilitation

Topic Rankings for Topic Rankings for Archives of Clinical Archives of Clinical

Neuropsychology Neuropsychology 1995- 1995- PresentPresent

DiagnosticDiagnostic TestingTesting ProfessionalProfessional RehabilitationRehabilitation ForensicsForensics

Topic Ranking of APA Topic Ranking of APA Division of Division of

Neuropsychology Neuropsychology Conferences 1984- Conferences 1984-

presentpresent

Syndromes (e.g., head injury, AIDS)Syndromes (e.g., head injury, AIDS) AssessmentAssessment DevelopmentalDevelopmental AnatomyAnatomy Treatment/RecoveryTreatment/Recovery

Current Trends: Current Trends: DiagnosticsDiagnostics

SyndromesSyndromes– Head InjuryHead Injury– DementiaDementia

DevelopmentalDevelopmental– PediatricPediatric– AgingAging

PsychopathologyPsychopathology– SchizophreniaSchizophrenia– DepressionDepression

AVAILABLE TESTSAVAILABLE TESTSSelected Psychological Selected Psychological

Tests - SpainTests - Spain

PERSONALITYPERSONALITY

AFFECTIVEAFFECTIVE

DEVELOPMENTALDEVELOPMENTAL

1. Personality1. Personality MMPIMMPI CAQ, Cuestinario de Analisis ClinicoCAQ, Cuestinario de Analisis Clinico Cuestinario de PersonalidadCuestinario de Personalidad

– PinillasPinillas– EysenkEysenk– CattellCattell

Cuestinario Psicologica de CaliforniaCuestinario Psicologica de California KuderKuder 16 PF16 PF Myers-BriggsMyers-Briggs

2. Affective2. Affective

Inventario de Situaciones y Inventario de Situaciones y Respuetas de AniedasRespuetas de Aniedas

Inventario de Actividad de JenkinsInventario de Actividad de Jenkins Cuetinario de Ansiedad Cuetinario de Ansiedad

Estado/Rasgo (adutos/ninos)Estado/Rasgo (adutos/ninos)

3. Developmental3. Developmental

FrostigFrostig

Test Illinois de Aptitudes Test Illinois de Aptitudes

PsicolinguisticosPsicolinguisticos

Selected Selected Neuropsychological Tests - Neuropsychological Tests -

SpainSpain

COMMUNICATIONCOMMUNICATION MEMORYMEMORY SPATIAL & PRAXICSPATIAL & PRAXIC COGNITIONCOGNITION INTELLECTUALINTELLECTUAL BATTERYBATTERY

1. Communication1. Communication

Test de Vocabularo de BostonTest de Vocabularo de Boston

2. Memory2. Memory BentonBenton RivermeadRivermead

3. Spatial & Praxic3. Spatial & Praxic

ReyRey Harris Test de la Dominancia Harris Test de la Dominancia

LateralLateral

4. Cognition4. Cognition StroopStroop

5. Intellectual5. Intellectual WAISWAIS WISCWISC WPPSIWPPSI BayleyBayley OtisOtis Factor “g”Factor “g”

6. Battery6. Battery Test de BarcelonaTest de Barcelona LuriaLuria

Selected Psychological Selected Psychological Tests - United StatesTests - United States

PERSONALITYPERSONALITY– MMPIMMPI– 16 PF16 PF

AFFECTIVEAFFECTIVE– SpeilbergerSpeilberger– Beck-IIBeck-II

DEVELOPMENTALDEVELOPMENTAL

Selected Selected Neuropsychological Tests - Neuropsychological Tests -

United StatesUnited States

ORIENTATION & ATTENTIONORIENTATION & ATTENTION COMMUNICATIONCOMMUNICATION MEMORYMEMORY SPATIAL & PRAXIC ABILITIESSPATIAL & PRAXIC ABILITIES COGNITION/INTELLECTUALCOGNITION/INTELLECTUAL BATTERYBATTERY

1. Orientation & Attention1. Orientation & Attention

Mini-mental stateMini-mental state

Digit SymbolsDigit Symbols

““A” Cancellation TestA” Cancellation Test

2. Communication2. Communication

Spanish Naming TestSpanish Naming Test Boston Diagnostic AphasiaBoston Diagnostic Aphasia Spanish Repetition TestSpanish Repetition Test Reading & Writing Abilities TestReading & Writing Abilities Test Spanish Phonemic Discrimination TestSpanish Phonemic Discrimination Test Spanish Grammar TestSpanish Grammar Test Verbal FluencyVerbal Fluency

3. Memory3. Memory

Verbal Serial Learning CurveVerbal Serial Learning Curve

Digit SpanDigit Span

Facial Memory TestFacial Memory Test

4. Spatial & Praxic Abilities4. Spatial & Praxic Abilities

Draw a CubeDraw a Cube

Finger TappingFinger Tapping

5. Cognition/Intellectual5. Cognition/Intellectual

EIWAEIWA Beta IIIBeta III PeabodyPeabody Woodcock-MunozWoodcock-Munoz

6. Battery6. Battery LuriaLuria

SPECIAL ISSUES IN SPECIAL ISSUES IN ASSESSMENT:ASSESSMENT:Study SampleStudy Sample

Sample DescriptionsSample Descriptions 2700 = Total members of NAN in 19942700 = Total members of NAN in 1994 1200 = Total # sampled1200 = Total # sampled 324 = Initial response (27%)324 = Initial response (27%) 242 = Second response (20 %)242 = Second response (20 %) 566 = Total responses (47 %)566 = Total responses (47 %) 119 = Reported < 5hrs/week of 119 = Reported < 5hrs/week of

evaluationsevaluations 447 = Total used from original sample447 = Total used from original sample

ResultsResults

Hours Spent TestingHours Spent Testing Percentage of BatteriesPercentage of Batteries Minutes to AdministerMinutes to Administer Percentage of Testing with Percentage of Testing with

ComputersComputers TestsTests

Results I: Time Spent Results I: Time Spent TestingTesting

HoursHours NN %% 0-40-4 116116 2121 5-95-9 6262 1111 10-1410-14 9292 1616 15-2015-20 105105 1919 > 20> 20 188188 3333 No responseNo response 44 11

Results II: Number & % of Results II: Number & % of BatteriesBatteries

Practice AreasPractice Areas NN %% AdaptiveAdaptive 194194 4343 AphasiaAphasia 205205 4646 Behavioral MedBehavioral Med 127127 2828 DevelopmentalDevelopmental 115115 2727 IntellectualIntellectual 354354 7979 NeurobehavioralNeurobehavioral 228228 5151 NeuropsychologicalNeuropsychological 427427 9595 PersonalityPersonality 353353 7979

Results III: Minutes to Results III: Minutes to Administer TestAdminister Test

Practice AreasPractice Areas Admin.Admin. ScoreScore IntInt.. AdaptiveAdaptive 74 74 3232 4848 AphasiaAphasia 61 61 2424 3939 Behavioral MedBehavioral Med 110110 3535 5858 DevelopmentalDevelopmental 113113 3636 5959 IntellectualIntellectual 122122 3434 6161 NeurobehavioralNeurobehavioral 80 80 2626 4747 Neuropsych.Neuropsych. 304304 7979 135135 PersonalityPersonality 103103 4646 7575

Results IV:Results IV:Testing With ComputersTesting With Computers

ActivityActivity %% AdministrationAdministration 2 2 ScoringScoring 1010 InterpretationInterpretation 3 3

Results V: Test FrequencyResults V: Test Frequency

Total # of Tests = 102Total # of Tests = 102

Tests used exclusively by Tests used exclusively by

neuropsychologists = 8neuropsychologists = 8

Longest tests used =Longest tests used =– HRNB (400 min.)HRNB (400 min.)

– Wechsler Scales (130 min.)Wechsler Scales (130 min.)

Results V: Top 26 TestsResults V: Top 26 Tests MMPIMMPI WAISWAIS WMSWMS Trial MakingTrial Making FAS Word FluencyFAS Word Fluency Finger TappingFinger Tapping HRNBHRNB Boston Naming TestBoston Naming Test Category testCategory test WRAT -R/IIIWRAT -R/III Beck DepressionBeck Depression

Results V: Top 26 Tests Results V: Top 26 Tests (Cont.)(Cont.)

Rey Complex Figure TestRey Complex Figure Test Wisconsin Card SortingWisconsin Card Sorting California Verbal LearningCalifornia Verbal Learning Grooved PegboardGrooved Pegboard WISC-R/IIIWISC-R/III Aphasia Screening TestAphasia Screening Test Rorschach InkblotRorschach Inkblot Hooper Visual OrganizationHooper Visual Organization

Results V: Top 26 Tests Results V: Top 26 Tests (Cont.)(Cont.)

Hand DynamometerHand Dynamometer Dementia Rating ScaleDementia Rating Scale StroopStroop PASATPASAT MillonMillon Bender GestaltBender Gestalt Thematic Apperception TestThematic Apperception Test

SUMMARY:SUMMARY:Predicted Trends for the Predicted Trends for the

New MillenniaNew Millennia

Ecological Validity/ Value-AddedEcological Validity/ Value-Added Continuum of CareContinuum of Care GlobalizationGlobalization Increase in ForensicsIncrease in Forensics Call for ResearchCall for Research Neuropsychological “g”Neuropsychological “g”

SUMMARY: SUMMARY: Theoretical ProspectsTheoretical Prospects

Neuropsychology as a Hybrid DisciplineNeuropsychology as a Hybrid Discipline To Expand, Neuropsychology Must To Expand, Neuropsychology Must

Appreciate Ignored DisciplinesAppreciate Ignored Disciplines Historical and Philosophical Historical and Philosophical

Underpinnings Must be Better Underpinnings Must be Better UnderstoodUnderstood

Neuropsychology Must make Further In-Neuropsychology Must make Further In-Roads with Science, Medicine, & SocietyRoads with Science, Medicine, & Society

SUMMARY:SUMMARY: Theoretical Prospects Theoretical Prospects

(Cont..)(Cont..)

The Cognitive and Subjective Must The Cognitive and Subjective Must

Play an Important RolePlay an Important Role

Neuropsychology will Become Neuropsychology will Become

UniversalUniversal

Is Psychology Nothing More than Is Psychology Nothing More than

Neuropsychology Re-Defined by a Neuropsychology Re-Defined by a

Century of Misguided Behaviorism?Century of Misguided Behaviorism?