NEUROPSYCHOLOGICAL ASSESSMENT LABPAUL JONES, ED.D.
UNIVERSITY OF NEVADA, LAS VEGAS
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TEST INSTRUMENTS:
Series Three
The ANAM/TWB (ANAM) battery described in prior studies continues as the primary source of cognitive scales in the series three studies. ANAM is a clinical subset of instruments developed by the Office of Military Performance Assessment Technology and organized as a Tester's Workbench (TWB). The structure of the ANAM/TWB allows the user to construct batteries tailored for specific needs and anticipated levels of cognitive function. Common in the ANAM scales is highly-structured, repetitive information processing tasks with well-defined stimuli and simple response modes. Scores are available for each cognitive scale including task accuracy, mean response time for accurate responses (ms), and an efficiency score defined as the number of correct responses per minute.
Participants in the series three studies completed two standard ANAM/TWB tests: Simple 2-Choice Reaction Time and Procedural Reaction Time. Two scales adapted from ANAM/TWB instruments were also used: an adaptation of the Mood Scale 2 and an adaptation of the Grammatical Reasoning scale.
Also included in the series three studies were two subtests from the Cognitive Assessment System (CAS). The two CAS subtests completed by the participants were: Matching Numbers and Planned Codes.
Detailed descriptions of the scales are provided below. All testing was completed in a single half hour session. CAS subtests were administered by the research assistant in standard paper-pencil format before the computer-based tests were administered. For the standard and adapted ANAM/TWB cognitive scales, the actual test trial was preceded by a practice trial with comparable, but fewer, stimuli. The practice session was intended to familiarize the subject with the task. Feedback (correct or incorrect) was provided in the practice trial. For each of the standard ANAM/TWB scales, the number of items, stimulus duration, and time allowed for response were chosen to facilitate comparison of the participant's scores to results in published studies. Orientation trials with a comparable but simpler task were provided for the adapted Grammatical Reasoning scale to familiarize the subjects with the general format prior to the practice trial and the actual test.
Administration of an ANAM/TWB scale provides a number of summary scores for each scale as well as individual item accuracy and response times. The primary summary scores used with the ANAM/TWB scales are: 1) percentage of correct responses, and 2) efficiency (defined as number of correct responses per minute). Percentage correct is limited by ceiling effects, and accuracy at the 90+ percent level is common. The efficiency score, however, may (Levinson & Reeves, 1997) be limited only by an individual's level of CNS function.
Schlegel, Gilliland, and Crabtree (1992) conducted a series of test-retest reliability studies with ANAM/TWB cognitive scales with intervals of 30 minutes, 24 hours, one week, and three weeks. They found that the low ceiling on the percent correct scores seriously compromised the obtained accuracy coefficients; overall scores were so high that little variability was retained in the measurement. Test-retest reliabilities based on response time, however, were typically at acceptable levels (e.g. .80 to .90).
This classic two-choice reaction time task was used in the series three studies to provide a fundamental measure of reactivity with minimal cognitive loading. In this task, the symbol "*" or "o" is presented on the computer screen. The subject responds simply by clicking the left mouse button or right mouse button to identify which symbol is on the screen. Stimuli (6 in the practice trial, 30 in the test) are presented on the screen for up to 8000 ms with a maximum of 9000 ms allowed for response.
In the standard version, the numerals 2,3,4, and 5 are presented on the computer screen, one at a time. The subject is requested to respond by clicking the left mouse button if the stimulus is a 2 or 3, and the right mouse button if the stimulus is a 4 or 5. Stimuli (6 in the practice trial, 37 in the test) are presented on the screen for up to 8000 ms with a maximum of 9000 ms allowed for response.
There are a number of versions of this scale. In some applications there is a mixture of alphabetic characters and numbers. It is also possible to have an unpredictable time interval between stimuli. The total length of the test can be a few minutes or an extended time period. The common feature in all of the variations is a purpose to test a subject's ability to continue making decisions and rapid responses to visual symbols for nonstop periods.
For the series three studies, there were five trials with the Procedural Reaction Time scale. The first trial used the standard format with predictable time interval between stimuli. This format was also used in trials three and five. For trials two and four, the task demand was identical, but the interval between presentation of the stimuli was unpredictable.
Continuous performance tasks such as this have been shown to be effective in detecting brain damage with the impairment likely to be revealed in the form of attentional lapses rather than as a steady decline of detection efficiency (Rosvald, et al., 1956). Sykes, Douglas, and Morgenstern (1973) reported that hyperactive children detect fewer signals and make more overall incorrect responses than their normal counterparts, with particular evidence of decreasing level of performance over extended time periods. Levinson and Reeves (1997) found differences in the predicted direction among patients classified as marginal-mild impairment, mild-moderate impairment, and moderate impairment. All of these individuals had suffered traumatic brain injuries, most from automobile accidents.
In summary, Procedural Reaction Time is a cognitive vigilance task. It is a short scale requiring sustained attention performance and would be susceptible to any number of conditions known to effect attention processes (e.g. brain damage, sleep loss and drugs). It would appear to tap the "attention" function in the contemporary PASS theory (Naglieri & Das, 1997) built on Luria's model of neuropsychological functions.
The Mood Scale 2 is a measure of personality state included with the ANAM/TWB battery. Subjects are instructed to indicate how well an adjective (e.g. miserable, uneasy, energetic) displayed on the screen describes their present feeling. Response alternatives are: 1) not at all; 2) somewhat or slightly; 3) mostly or generally. In the standard form, there are 36 adjectives with responses summarized into one of six scales: activity, happiness, depression, anger, fatigue, and fear. The adaptation for the series three studies used 24 adjectives, organized as follows:
ACTIVITYenergetic restless easily excited impulsive loud curiousATTENTION- (reverse scored)disorganized absentminded distractible impatient easily bored inattentiveANXIETYnervous tense upset insecure scared afraidDEPRESSIONsad depressed tired cheerful (reverse scored) happy (reverse scored) satisfied (reverse scored)
Grammatical Reasoning Adaptation
The purpose of the standard ANAM/TWB Grammatical Reasoning (Logical Reasoning) scale is to measure the subject's general reasoning ability. With forms for various levels of complexity, the subject is presented with a series of letters or symbols and one or more statements about their sequential arrangement. The subject's task is to determine whether the series matches the statement. For example, in simplest form, the subject would be presented the statement "A is followed by B" and the series BA. The correct answer would be "false".
The more demanding task provides the subject with two statements and a series of symbols. If both statements are true or if both statements are false, the correct answer is "match", otherwise the correct answer is "nonmatch".
The objective in this adaptation was to create a task which could be interpreted in a manner comparable to that provided by the Cognitive Assessment System Planning tests. To accomplish the objective, stimuli were modified such that one of the two statements would always be correct. The subject's task was to identify whether both statements matched the test stimulus (match) or just one of the two statements matched the test stimulus (nonmatch). Ten items were constructed (Condition A) in which the first statement did not match the test stimulus, so the correct answer was evident before reading the second statement. In another 10 items (Condition B) the first statement was correct, and the second was incorrect. For the remaining 10 items, both statements were correct. The intent then was to contrast the subject's performance on those items (Condition A) in which an efficient problem-solving strategy could reduce the time required for response with the subject's performance when both statements had to be read in order to correctly respond.
The test trial for this task was preceded by a practice session with five items including each of the three conditions. The practice session was preceded in this case by an "orientation to the task". In the orientation trial the subjects completed five sample and ten trial items in which there was only one statement and the task was to identify whether the test stimulus was consistent with the statement.
Actual test stimuli for the 30-item adapted test are provided in the table below.
| Statement 1 | Statement 2 | Test Stimulus | Condition | ||
|---|---|---|---|---|---|
| * AFTER # | & AFTER * | # * & | C | ||
| & BEFORE * | & AFTER # | # & * | C | ||
| # BEFORE * | & AFTER * | & # * | B | ||
| # AFTER * | & BEFORE # | * # & | B | ||
| * AFTER & | & BEFORE # | * & # | A | ||
| # AFTER * | * AFTER & | & * # | C | ||
| # BEFORE & | # BEFORE * | & # * | A | ||
| # BEFORE * | * AFTER & | & # * | C | ||
| # BEFORE * | & BEFORE # | # & * | B | ||
| & AFTER * | * BEFORE # | * & # | C | ||
| # AFTER & | * AFTER # | & # * | C | ||
| # BEFORE & | # AFTER * | * # & | C | ||
| # BEFORE * | * AFTER & | & * # | A | ||
| # BEFORE * | * AFTER & | & * # | A | ||
| * BEFORE # | & BEFORE # | * # & | B | ||
| # BEFORE * | * BEFORE & | * & # | A | ||
| * AFTER & | # AFTER * | & * # | C | ||
| * AFTER & | # BEFORE & | & * # | B | ||
| * AFTER & | # BEFORE * | # * & | A | ||
| & AFTER # | & AFTER * | # & * | B | ||
| & AFTER * | # BEFORE * | * & # | B | ||
| * BEFORE & | # BEFORE & | # & * | A | ||
| & AFTER * | & AFTER # | * & # | B | ||
| # AFTER * | & AFTER # | # * & | A | ||
| & AFTER # | & AFTER * | # & * | B | ||
| * AFTER # | # BEFORE & | # * & | C | ||
| # AFTER & | & BEFORE * | # & * | A | ||
| & AFTER * | & AFTER # | # & * | A | ||
| # BEFORE * | * BEFORE # | & # * | B | ||
| # AFTER * | # BEFORE & | * # & | C |
The Cognitive Assessment System (Naglieri & Das, 1997) is a battery of tests measuring planning, attention, simultaneous, and successive processing functions. It is organized as two forms, a basic battery with two subtests for each function, and a standard battery with three subtests for each function. The common feature in the CAS Planning scales is the use of strategies for efficient performance and application of the strategies to tasks with limited complexity.For this study, each participant completed the two standard paper and pencil basic battery tests for the planning function, matching numbers and planned codes.
Norms for the CAS extend only through age seventeen. However, inspection of the norms tables suggested that the norms could be extended upward for the matching numbers and planned codes scales. For example, on the matching numbers test, a scaled score of 10 (mean) was assigned to raw scores of 16 and 17 for the age range of 15-0 to 16-11 and to raw scores of 17 and 18 for the age range 17-0 to 17-11. A scale score of 13 (one s.d. above mean) was assigned to a raw score of 20 for the age range 15-0 to 15-11, to a raw score of 21 for the age range 16-0 to 16-11, and to raw scores of 22-23 for the age range 17-0 to 17-11. A scale score of 7 (one s.d. below mean) was assigned to a raw score of 13 for age range 15-0 to 17-11. While not as pronounced, a comparable flattening of performance growth with age was also evident in norms for the planned codes test. For example, a raw score of 104 on planned codes was assigned a scale score of 10 on the age range from 15-0 to 17-11.
The task on this scale involves finding and underlining the two numbers that are the same in each row. Each of three items (presented on separate pages) has eight rows of numbers, and each row contains six numbers. Each item is separately timed. The obtained score is a ratio of accuracy and speed of response.
The task on this scale is to translate letters into specific codes. Each of two pages has one item consisting of boxes marked with the letters A,B,C, and D. The coding system of Xs and Os, for example A=OX and B=XX, is at the top of each page. For each item the code is different, and there is a different arrangement of response locations. Each item is separately timed. Both items are administered at all age levels, but the time limit is longer for young children. The obtained score is a ratio of accuracy and speed of response.
References
Levinson, D.M., & Reeves, D.L. (1997). Monitoring recovery from traumatic brain injury using Automated Neuropsychological Assessment Metrics. Archives of Clinical Neuropsychology, 12, 155-166.
Naglieri, J.A., &; Das, J.P. (1997). Cognitive Assessment System. Itasca, IL: Riverside Publishing.
Rosvald, H. E., Mirsky, A.F., Sarason, I., Bransome, E.D., & Beck, L.M. (1956). A continuous performance test of brain damage. Journal of Consulting Psychology, 90, 343-350.
Schlegel, R.E., Gilliland, K., & Crabtree, M.S. (1992). Development of the UTC-PAB Normative Database: Technical Report. Springfield, VA: National Technical Information Service.
Sykes, D. H., Douglas, V.I., & Morgenstern, G. (1973). Sustained attention in hyperactive children. Journal of Child Psychology and Child Psychiatry, 14, 213-221.
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