2. What this introduction will cover:
Development of the NEPSY-II
Domains of Focus
When to use NEPSY-II
Specific Subtests
Case Presentations
Ongoing
Practice Administration
Conduct subtests with patients
Review scores and interpretation
3. Background
Original NEPSY developed in 1998 (Finnish version in 1988)
NEPSY-II increases content and psychometric properties
Strong basis for development was Luria’s approach to
assessment of adults with brain damage
Luria –Nebraska 11 clinical scales:
reading
writing
arithmetic
visual
memory
expressive language
receptive language
motor function
rhythm
tactile
intellectual
4. Developmental & Neuropsychological Theory
Subtests to assess BASIC components of cognition
(i.e., fingertip tapping)
Subtests to assess complex cognition, requiring skills
from basic components (i.e., auditory attention)
Thus, scores can help inform how performance in one domain
can affect performance in other, more complex mental
processes.
Performance on BASIC tests would ceiling at early age, while
COMPLEX improves over childhood
5. Standardization
1,200 cases
3-16 years
Proportions of races (within each age group) based
on 2003 census
Division of geographic quadrants
(Northeast, Midwest, South, West) according to
census bureau data
Stratified Sample according to parent education
Each age group had 50 males and 50 females
6. Reliability & Validity
MOST have adequate to
high internal consistency Lower Reliability
or stability Response Set Total Correct
(.55 for 11 & 12 year olds)
Highest relaibility subtests:
Inhibition Total Errors (.35
Comprehension of
Instructions for 10 year olds)
Design Copying Memory for Designs Spatial
and Total Scores
Fingertip Tapping
Memory for Designs Delayed
Imitating Hand Positions
Total Score (.44 for 10 year
List Memory
olds)
Memory for Names
Phonological Processing
Picture Puzzles
Sentence Repetition
7. Test & Retest Stability
Range from .44-89 (most in in 70-80 range)
INTERSCORER AGREEMENT
93-99%
VALIDITY
moderate - high correlations with WISC-IV
and DAS-II
8. Administration
Ages: 3-16 years
General Assessment:
Preschool-ages - 45 minutes
School ages - 1 hour
Full Assessment:
Preschool-ages - 90 minutes
School ages - 2 to 3 hours
9. Attention and Executive Functioning
(self-regulatory skills)
Strategic planning SUBCOMPONENTS
Regulation based on Initiation
environmental feedback Inhibition
Selective Attention
Flexibility
Sustained Attention
Fluency
Working Memory
10. Language
Expressive Receptive
Oromotor Control and Phonological Processing
Articulation Repetition
Naming
Repetition
Word Generation
11. Memory and Learning
Immediate and Delayed Supraspan Learning:
Memory memorization of material
Encoding exceeding max. capacity
Retrieval for immediate memory
(through repetition)
Working Memory
Memory Span
Repetition
Rote Memory
12. Motor Skills
Sensorimotor Functioning and Motor Coordination
Visuomotor Functions
Imitation of Motor Positions and Sequences
Social Perception
Memory for Faces
Facial Affect Recognition
Theory of Mind
13. Visual and Visuoperceptual Processing
Visual Perception
Spatial Processing
Visuoconstructional Skills
Local and Global Processing
14. Referral Questions
Learning Disorder – Perceptual/Motor Delays
Language School Readiness
Learning Disorder – Social/Interpersonal
Mathematics Differences
ADHD General
Behavioral Problems
Language Delays
15. Attention/Concentration
Animal Sorting (7-16): formulation of basic concepts,
categories, shifting from on concept to another
Auditory Attention (5-16): selective auditory
attention, vigilance
Auditory Response set (7-16): shift and maintain attention,
inhibition of previously learned information, responding to
matching or contrasting stimuli
16. Attention and Concentration (continued)
Clocks (7-16): planning, organization,
visuoperceptual and visuospatial skills
Design Fluency (5-12): behavioral productivity in
generation of designs
Inhibition (5-16): inhibition of automatic
responses, switching between response type
Statue (3-6): motor persistence and inhibition
Speeded Naming (3-16): Rapid semantic access
Word Generation (3-16): Verbal productivity and
generation
17. Attention and Concentration
(continued)
Sentence Repetition (3-6): Sentence repetition of
increasing complexity
Word List Interference (7-16): Verbal working
memory, repetition, word recall following
interference
Imitating Hand Positions (3-12)
Manual Motor Sequences (3-12): Imitation of
rhythmic movement sequences
Affect Recognition (3-16): Recognition of affect
18. Attention and Concentration
(continued)
Theory of Mind (3-16): Understanding belief,
intention, deception, emotion, imagination, and
pretending, perspective taking
Arrows (5-16): Line oriention
Design Copying (3-16): Visuospatial and visuomotor
ability
Geometric Puzzles (3-16): Mental rotation,
visuospatial analysis, attention to detail
19. Behavioral Problems
Animal Sorting
Auditory Attention and Response Set
Clocks
Design Fluency
Inhibition
Statue
Comprehension of Instructions (3-16): Ability to
receive, process, and execute oral instructions
20. Behavioral Problems
(continued)
Speeded Naming
Word Generation
Memory for Faces Immediate and Delayed (5-16):
Encoding of facial
features, discrimination, recognition
Sentence Repetition
Fingertip Tapping (5-16): Finger dexterity, motor
speed, rapid motor programming.
Visuomotor Precision (3-12): Graphomotor speed
and accuracy
21. Behavioral Problems
(continued)
Affect Recognition
Theory of Mind
Arrows
Design Copying
22. Language Delays/Disorders
Animal Sorting
Auditory Attention and Response Set
Clocks
Inhibition
Statue
Comprehension of Instructions
Body Part Naming and Identification (3-4):
Confrontation naming and name recognition,
expressive and receptive language
23. Language (continued)
Comprehension of Instructions
Oromotor Sequences (3-12): Oromotor
Coordination
Repetition of Nonsense Words (5-12): Phonological
encoding and decoding
Speeded Naming
Memory for Names (5-16): Encoding, immediate,
and delayed memory of visual and verbal
information
Narrative Memory (3-16): Memory for organized
verbal material, retrieval of memory
24. Language (continued)
Sentence Repetition
Word List Interference
Imitating Hand Positions
Visuomotor Precision
Affect Recognition
Design Copying
25. Social/Interpersonal
Animal Sorting
Auditory Attention and Response Set
Design Fluency
Inhibition
Statue
Comprehension of Instructions
Phonological Processing
Speeded Naming
Word Generation
26. Social/Interpersonal (continued)
Memory for Faces
Memory for Designs (3-16): Spatial Memory for
novel visual material
Narrative Memory
Word List Interference
Fingertip Tapping
Imitating Hand Positions
Manual Motor Seequences
Visuomotor Precision
27. Social/Interpersonal (continued)
Affect Recognition
Theory of Mind
Arrows
Block Construction (3-16): Motor and visual-
perception
Design Copying
Geometric Puzzles
Picture Puzzles (7-16): Visual
Discrimination, spatial localization, visual
scanning, whole-part relationships
28. Learning Differences - Reading
Primary Domains Tested: Attention and Executive
Functioning & Language
Learning Differences – Math
Primary Domains: Attention and Executive
Functioning, Memory and Learning, Visuospatial
Processing
29. School Readiness
Major Domain Assessed: Language
Perceptual/Motor Delays/Disorders
Attention and Executive, Sensorimotor, Visuospatial
Processing
31. Interpretation
Attention and Exec. Fxn Subtests (Cont)
Low Response Set Score:
same as Auditory + possible poor working
memory
Low Clocks Score:
poor planning and organization, poor drawing
ability, poor reading ability
Design Fluency Low:
Problems with initiation, poor cognitive
flexibility
32. Interpretation
Inhibition Low Score:
Poor inhibition
Inhibition-Switching Low Score:
Poor inhibition, poor cognitive flexibility
Statue Low Score
Poor overall inhibition
LANGUAGE DOMAIN
• Body Part Naming low score:
• Poor word finding
• Body Part Identification low score:
• Underdeveloped semantic knowledge
33. Interpretation
Comprehension of Instructions low score:
Linguistic or syntactic deficit, poor ability to follow multistep
commands
Oromotor Sequences low score:
Deficits in motor programming for speech production
Phonological Processing low score:
Poor phonological awareness and processing
40. Scoring
Three types of scores
Primary Scores: Global aspects or key clinical
variables
Examples: AR total, AW total
Usually expressed as SCALED SCORE, but can be as PERCENTILE
RANK
Combined Score (a type of Primary Score): total scores made
by combining 2 measures within the subtest
Example: Animal Sorting total errors combined with total correct
41. Scoring
Primary Scores (cont)
Cumulative Percentage: % of children at a
specific age that exhibit the behavior
Base rate of 10% means that 10% of children had
an equal or lower score
Base rate: concept is on rareness of the finding
rather than how well child performed relative to
normal distribution
42. Scoring
Primary Scores (cont)
Combined scores:
One score is weighted more heavily toward the
construct being measured; for example with
errors vs. speed in inhibition tasks, errors are
weighted more heavily than speed because
errors are related to executive functions more
so than speed of processing.
Always presented as Scaled Scores
43. Scoring
Process Scores: more specific than Primary Scores.
May not be relevant for all children- depends on referral
question.
For example, on Affect Recognition, there is a process score for
emotion error type – may only be relevant to certain
assessment questions (i.e. an individual being tested for ASD)
Can be expressed as percentile rank, scaled score, or
cumulative percentage
44. Scoring
Contrast Scores: To compare higher level (more
complex) to lower level (more basic) functions to
help ascertain where the problem lies by providing
data on one variable while controlling the other
Compares how child did compared to norm who had same
score on the variable being controlled
Example: AA combined = 10 and RS combined = 4, Contrast score
= 4; means that child did well below expected level on RS
considering his score on AA combined; conversely, if AA=4 and
RS=10, Contrast may = 14, meaning that child didmuch better
than expected on RS considering his score on AA
Contrast scores are always Scaled Scores
45. Scoring
Behavioral Observations, such as “distracted, off-task
behaviors, physical movement” receive cumulative
percentages or percents.
How many have conducted a NEPSY-II?Purpose of this intro is not to make you competent, but to introduce the NEPSY-II. Over course of the year hopefully we’ll have some cases where you can conduct portions with supervision and develop competency. This will be broken into portions.
Think back to neuropsych and the Luria model. Luria- Nebraska purpose is mainly to identify focal damage
Why the NEPSY-II is such a different test is that it is based on a combination of developmental AS WELL AS Neuropsychological Theory SLIDEIf time/budget allowed, excellent for ALL kids with learning disorders and special needs who have certain functions intact and others impaired – most daily tasks are extremely complex, not fingertip tapping. Examining specific functions extremely closely can provide much clearer picture and inform more effective intervention
SLIDEAs with most neuropsych instruments, verbal subtests have higher reliability
Overall, considered a stable and valid measure – can find all info on various measures of validity and reliability in manual
Overall, considered a stable and valid measure – can find all info on various measures of validity and reliability in manual
The major domains tested
How might each of these manifest in child psych or in ASD?General: Most sensitive of subtests from each domainPASS OUT SUBTEST RECS FOR REFERRAL BATTERIES