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An Algorithm of Neuropsychological Assessment

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					                                                                                                                                                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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            WRAT-4 Reading
                                                                                                                                                                                                                                                                                                                                                                                                                                                       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
                                                                                                                                                                                                Yes                                                                                                                 Calculation
                                                                                                                                                                                                                                                                       Bayley-3                                                                                                                                         World Attack                                                                                                                                                 older?
                                                                                                                                                                                                                                                                                                                    Passage Comprehension                                                                                                                                                                                        Are results
                                                                                                                                                                                                                                  No                                      or                                                                                                                                            Letter-Word Id.                    Yes
                                                                                                                                                                                                                                                                                                                                                                                                                        Passage Comp.                                                                  Yes                      suggestive of
                                                                                                                                                                                                                                                                       Mullen (back up)                                                                                                                                                                                                                                            reading
                                                                                                                                                                                             WPPSI-III                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       No
                                                                                                                                                                                                                                                                                                                                No                                                                                                                                                                                               difficulties?

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Is the
                                                                                                                                                   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
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         Rec. Lang.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                           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
                                                                                                                                                                                                                                                                                                                                                                                                                         Sentence Sequencing
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   CELF-4 Following Directions
                                                                                                                                                                                                                                                                                                                                                                                                                         Reading the Directions of the Classroom
                                                                                                                                                                                                                                                                                                                          Yes                                                                                                                                                                                                                                                                                                                                                                                                                             or
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             Yes                                                                                                                                                                                                                                                   OWLS Listening
                                                                                                                                             GO TO THE                                                                 No
                                                                                                                                                                                 CVLT-II                                                                                                                                                                                                                                                                                                                                                  WJ-III ACH Reading Fluency
                                                                                                                                            NEXT DOMAIN
                                                                                                                                                                                                                                                                                                                   BRIEF-Parent                                                                          No                                                                                                                               TOWRE:
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Sight Word Efficiency
                                                                                                                                                                                   Yes                                                                                                                                                                                                                                                                                            Grey Oral Reading Test-4
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 GO TO THE
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                NEXT DOMAIN
                                                                                                                                                                                                                                                                                                                                                                                                       Are there
                                                       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
                                                                                                                                       Immediate                                                                                                          No
                                                                                                                                       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
                                 patient                                                                                               Immediate
                    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
                                                                                                     older?                                                                                                                                                                                                                                                                                                                                                     developmental
                                                                                                                                                                                                           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
                                                                                                                                                                                                                                                                                                                                                                           CDI                                                                                                                                                                                                                                      No
                           Exp. Lang. Composite                                                       No                                                                                                                                                                                                                                                                                              ABAS-2
                                                                                                                                                                                                                                                                                                                                                                           RCMAS                                                                                                                                                                                     WISC-IV Digit Span
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     CPT-2                                                                                                             Yes                                               Sensorimotor:
                                                                                                                  CELF-4                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 VMI
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
                                                                                                                                                                                                                                                                                                                                                                             older?                                                                                                                                                                   No
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 between 4
                                    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?
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                concerns?                                                                                            Visual
       years or                difficulties in
        older?                 pragmatics?                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Spatial                              No

         Yes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Sensory:
                                    Yes                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Dean-Woodcock
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Rey-O Complex Figure Test
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             (selected subtests)
                                                                    CASL Pragmatic Judgment
 DKEFS Verbal Fluency
                                                                    OWLS Listening

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