An Algorithm of Neuropsychological Assessment:
Effects on Student Training and Perceived Self-Efficacy
Luton, Lindsay M., & Burns, Thomas G.
As the field of Neuropsychology continues to develop, training in neuropsychological assessment will Procedure. Self-perceptions of assessment abilities were obtained via completion of identical
necessitate an understanding of increasingly complex decision-making processes. One factor that questionnaires prior to algorithm training and again after using the pathways for three weeks. Due to
may complicate training is the steady growth in the number of neuropsychological tests. Implicit in the paucity of training-based questionnaires, we developed a 19-question survey that allowed for
adequate training is an understanding of test-specific administrative and developmental restrictions; responding on a 7-point Likert scale questions (e.g., “I feel confident in my ability to determine which
thus, an increase in test availability requires the acquisition of additional, test-specific knowledge. measures of executive functioning are most appropriate when evaluating patients of different ages”).
Further, departmental inconsistency in test selection may deter effective student training.
Statistical Analysis: Using the SPSS version 12.0 statistics package, a series of paired samples t-
To address these issues and enhance the training of doctoral-level practicum students, an educational tests was conducted to compare pre- and post-intervention responses so as to determine if utilization
initiative in neuropsychological assessment was piloted in the Neuropsychology Department of a of a neuropsychological algorithm enhanced students’ perceptions of assessment abilities.
large, Southeastern children’s hospital. Specifically, clinical pathways were developed to facilitate
students’ diagnostic decision-making skills. Through the implementation of these pathways, we hoped RESULTS & DISCUSSION
to provide students with a step-by-step approach to neuropsychological test selection. Further, we Results from paired sample t-test were demonstrative of significantly enhanced perceptions of
anticipated that exposure to these algorithms would promote the acquisition of test-based knowledge diagnostic, decision-making abilities in 18 of the 19 areas assessed. For example, after using the
(e.g., developmental restrictions). As such, we hypothesized that the introduction of clinical pathways algorithm, students reported feeling more confident in their ability to develop a case-specific,
would enhance student perceptions of related to one’s assessment-based, decision-making abilities. comprehensive test battery, t(9)=5.471, p =.001, α=.01. They also endorsed feeling more efficacious
when identifying age-appropriate measures for evaluating different neurocognitive domains, such as
METHODS visual-spatial skills (p=.001), receptive (p=.001) and expressive language (p=.001), attention
Development of the algorithm. Twelve department-sanctioned, domain-specific clinical pathways (p=.003), and executive functioning (p=.003).
were developed and integrated into a single, comprehensive algorithm of neuropsychological
assessment (See below). Tests were selected for inclusion in the algorithm through the collaborative These findings are consistent with our hypothesis, as the use of an assessment-based algorithm
efforts of six licensed neuropsychologists. appears to augment the perceived self-efficacy of diagnostic trainees. Although there are clearly
limitations to the current study (e.g., small sample size, potential response bias), results lend support
Participants. Ten doctoral-level, diagnostic practicum students (n=10) were trained to use clinical to the utility of clinical pathways in facilitating the acquisition of neuropsychological test knowledge.
pathways as a means of facilitating neuropsychological test selection. Students were educated on the Future studies should include objective measures as a means of evaluating training effectiveness.
conceptual bases for the algorithms, exposed to examiner modeling of algorithm use, and provided Additionally, including larger sample sizes and multiple training institutions may help to clarify the
with in vivo, supervised practice using case examples. usefulness of this program. Finally, longitudinal studies examining residual effects are also warranted.
PATIENT PRESENTS FOR A
OWLS Written Expression
Is the patient Is reading
Can the No Yes No or
Is the patient Is the patient kindergarten ability of No
No Yes patient No Yes WJ-III ACH
between the between the age or concern? Are there Woodcock Johnson-III ACH
communicate Letter-Word Id.
ages of 4-5 ages of 0-3 younger? GO TO THE concerns Yes Math Fluency
verbally? Woodcock Johnson-III ACH Passage Comp
years? years? NEXT DOMAIN
Letter-Word Identification related to math Applied Problems
Word Attack GO TO THE NEXT abilities? Key Math (select subtests)
Spelling DOMAIN Is the child 9
WJ-III ACH years or Yes
Bayley-3 World Attack older?
Passage Comprehension Are results
No or Letter-Word Id. Yes
Passage Comp. Yes suggestive of
Mullen (back up) reading
Yes TOWL-3 GO TO THE
Does the TONI-3 Bracken Basic Concept Scale-3 NEXT DOMAIN
patient need a Is the or School Readiness Composite No
No Screener: No
comprehensive patient 4 UNIT
evaluation of years old? or
intelligence? LITER Is the patient
Yes Bracken Basic Concept Scale-3 Do results
between 0-5 Is written
(School Readiness Composite) warrant No GO TO THE No
years? expression of
further NEXT DOMAIN
Yes Yes testing?
UNIT Phoneme Reversal
Yes Rapid Naming
Is the patient
between 6 No WAIS-III or
and 16 years TOWRE Are there
old? Phonemic Efficiency Is the patient concerns
No Yes No patient less Yes
Is phonemic between 3 related to
Nelson Denny Reading Test than 3 years
processing Yes No and 5 years? receptive
Reading Rate old?
of concern? language?
Reading Vocabulary CELF-4 No
Standard Achievement Test for Rec. Lang. Composite
GO TO THE Adults
WISC-IV No Are there
NEXT DOMAIN questions about Yes
Yes receiving college
Is silent for Reading LD or Is the patient
Yes No Yes No
reading of Dyslexia? CELF-P-2 between 3
concern? Rec. Lang. Composite and 5 years?
Is the CELF-P-2 Concepts
Is the patient Choose one of the following:
Yes GO TO THE No patient GO TO THE Grey Silent Reading Test-3 and either
TVPS (qualitative review) developmentally BRIEF-Preschool Is reading
NEXT DOMAIN 5 years or NEXT DOMAIN Test of Silent Contextual Reading Fluency Is oral CELF-P-2 Following Directions
delayed? No fluency or site Yes
older? TORC-3 reading of or
reading of OWLS Listening CELF-4 Concepts
Paragraph Reading concern?
concern? and either
CELF-4 Following Directions
Reading the Directions of the Classroom
Yes OWLS Listening
GO TO THE No
CVLT-II WJ-III ACH Reading Fluency
BRIEF-Parent No TOWRE:
Sight Word Efficiency
Yes Grey Oral Reading Test-4
GO TO THE
Are there Is the
Is the patient concerns related
expressive No patient 5 Yes No Is the patient No Yes
Boston Naming Test between the BASC-2 Parent Report to social/
language years or older than 16
ages of 5 and
Is the emotional
delays? older? years? No patient
16 years? functioning?
7 years or
Visual Memory Screener ABAS-2
Yes No WRAML-2 Design Memory
Recognition Yes Wisconsin Card Sorting Test Yes
Is the Children’s Category Test Yes
Is the WRAML-2 Picture Memory No Is the patient 8
No No patient Yes Bayley-III years or older? Does the
between 3 Yes Recognition Is the
less than 3 Exp. Lang. Is the patient patient
and 6 DKEFS No patient 5 No GO TO THE
years? 6 years or evidence DKEFS Trails, Trial 1
years? Auditory Memory Screener Is additional Yes Trails years or NEXT DOMAIN
CVLT-C testing Verbal Fluency younger?
delay? No Is the patient No Yes
WRAML-2 Stories Is the patient Motor:
Yes needed? Rey-O Complex Figure between 4
Immediate Yes older than 5 Grooved Pegboard
Drexel Tower of London and 5 years
CELF-P-2 Recognition Yes
Exp. Lang. Composite No ABAS-2
RCMAS WISC-IV Digit Span
CPT-2 Yes Sensorimotor:
CELF-4 Formulating Sentences CPT: Kiddie version BASC-2
Exp. Lang. Composite Parent Report Scale Motor:
Teacher Report Scale Optional:
Boston Naming Test Bayley-3 Motor:
Yes WRAVMA Matching
Is the Gross Motor Purdue Pegboard TVPS
patient 5 No TESTING IS Is the patient Yes Fine Motor
WISC-IV Picture Completion
years or COMPLETE 8 years or
older? No Is the patient older?
12 years or Is the patient
Yes and 5 years? Sensorimotor:
Boston Naming Test No
Yes Optional: Did the patient
NEPSY Yes perform at least 1
BASC-2 Self-Report Arrows standard deviation
Visuomotor Precision below the norm on
Design Copying the VMI?
BASC-2 the referral
No Is the patient Yes GO TO THE
Parent Report Scale question involve Sensorimotor:
Is the Does the 6 years or NEXT DOMAIN
Teacher Report Scale attentional VMI
patient 8 No patient have No older?
years or difficulties in
older? pragmatics? Spatial No
Rey-O Complex Figure Test
CASL Pragmatic Judgment
DKEFS Verbal Fluency