Published on

  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide


  1. 1. Wide Range Assessment of Memory and Learning Second Edition
  2. 2.  Without memory, life as we know it will be impossible.  Memory is a central feature of human intelligence and is represented in nearly all day to day functions, including intellectual, academic, social, vocation, or recreational.
  3. 3.  Memory is the ability to recall an event, an object, or a behavior-to remember something. I forgot to feed the dog •Memory is also a Central Cognitive Process
  4. 4.  The Wide Range Assessment of Memory and Learning-Second Edition (WRAML2).  It is a major comprehensive memory battery currently available for assessment of memory function in children and adults.
  5. 5.  This battery is intended to reliably sample a variety of memory functions that are of clinical and theoretical interest for children, adolescents, and adults.  Some people considered the definition of learning as also defining memory, due to the thought that anything recalled must have been learned.  The WRAML2 distinguish memory and learning by providing subtest that assess both immediate memory as well as new learning over multiple trails, and subsequent recall of new acquired information.
  6. 6.  Hans Ebbinghaus is generally recognized as among the first to study memory. He studied memory using digit span task and nonsense syllables.  He showed that the amount to be remembered affects performance and having a way to chunk information increased performance.
  7. 7.  Alfred Binet- Very interested in memory and 20% of his first intelligence test consisted of questions directly assessing immediate verbal and visual memory abilities.  Karl Lashly- 1950 studied long term memory  Alexander Luria -1956 unlimited long term memory  George Miller- 1956 7(+) or (-)2 rule.  And many others contributed an enormous amount of research that help us better understand memory.
  8. 8.  Despite over a century of research on the topic of memory, the clinical assessment of normal and disordered memory has been loaded with problems, many of which stem from difficulties separating attention and memory as well as immediate memory from short-term and long-term memory.
  9. 9. What’s today's date?, What are some current new items? Repeat after me… Standard neurological exams dating back to the beginning of the last century, neurologist have always asked the patient questions concerning “today’s date,” current new items, and some recitation of letters, words, or sentences as a basic attempt to establish whether memory was normal. Neurological disorders impact memory with such variability that more elaborate assessment methods were necessary. Impaired or not impaired was the only diagnostic assumption.
  10. 10.  Qualitative methods did not provide an awareness of milder deficit or identification of areas of memory strength. Your memory is impaired!
  11. 11.  The need for some type of standardization or battery of test that that could assess memory became obvious during the era of World War II. For the first time in history, many soldiers survived brain injuries and many of these victims had accompanying deficits in memory function.  Such a battery will depend on quantification.
  12. 12.  Wechsler Memory Scale (WMS)- developed in 1945. Was good, but was primarily an adult measure.  Rey Auditory Verbal Learning Test-1946, it examined forgetting which is a factor that is important in certain neurological disorders. Never fully standardized or normed.  Benton Visual Retention test-(1974), assessed visual memory. This test was not standardized for lower age ranges.  Most memory test were designed to test memory for adults
  13. 13. 1941. Rey-OSTERRIETH Complex Figure Task 1945. Wechsler Memory Scale (1987, Second Edition, 1997, Third Edition, 2009, Fourth Edition) 1946. Benton Visual Retention Test 1958. Rey Verbal Learning Test 1974. Selective Reminding Task 1987 California Verbal Learning Test 1990. Wide Range Assessment of Memory and Learning 1994. Test of Memory and Learning Test 1997. Children’s Memory Scale 2003. Wide Range Assessment of Memory and Learning Second Edition. 2007. Test of Memory and Learning-Second edition
  14. 14.  It was not until the 1990’s that the first comprehensive, pediatrically focused memory measure appeared, The original version of the WRAML.  When interpreting the WRAML, knowledge of the neurobiological aspects of memory and it’s pathology are important in guiding understanding of clinical observations and test findings.  Ex: Damage to the hippocampl region can result in a persons being able to recall immediately a brief stimulus such as a picture or short sentence, but seconds later that information is no longer available to the person because the damaged region cannot help in storing new information. Patient HM
  15. 15.  An individually administered test battery designed to assess memory ability in children and adults  The battery is for clinical assessment of immediate and delayed recall of verbal and visual memory, and provides a global memory performance estimate.  WRAML was released in 1990 and was the first well-normed and standardized test battery that could be used to assess memory abilities in children.
  16. 16.  However, a number of revisions were introduced with the WRAML  One of the major test changes is the expansion of the age range so that the battery can now be used with adults as well as children and teens.
  17. 17. WRAML Modifications WRAML2 5-17 years Age range 5-85+ years 9 Number of core subtests 6 4 Number of delay memory tasks 7 0 Number of working memory subtests 2 1 Number of recognition memory subtests 4 0 Qualitative analyses data >25 data sets 3 factors: moderate support Factor Structure 3 factors: strong support
  18. 18.  The inclusion of more than two dozen supplemental data sets allow interested clinicians to ask more questions of the subtest.  This will allow clinicians to piece together what may be contributing to the deficits being detected.
  19. 19.  Comprised of six subtests that yield three indexes:  Verbal Memory Index  Visual Memory Index  Attention/Concentration Index  Combine these three core indexes form the General Memory Index  The WRAML2 especially focuses on visual and auditory memory
  20. 20.  There are no time constraints on clients response time.  A typical administration of the six core subtests by an experienced examiner takes less than 40 minutes  Tables for all indexes include standard scores (M=100, SD=15) and confidence intervals.  Intrabattery subtest and index discrepancy tables are provided for determine differences that constitute statistical significances as well as prevalence data for those differences.
  21. 21. General Memory Index Verbal Memory Index Visual Memory Index Attention/ Concentration Index Story Memory Subtest Verbal Learning Subtest Design Memory Subtest Picture Memory Subtest Finger Windows Subtest Number/ Letter Subtest
  22. 22.  Domain assessed: This subtest evaluates auditory memory of extended meaningful verbal material such as is associated with listening to a conversation or a lecture, as well as reading text in a news paper
  23. 23.  Subtest Procedure- Two short stories are read to the participant who, following each is asked to orally recall as many parts of the story as they can be remembered. 3 stories are included in the subtest, but only two are given to the client. The clients are to determine which pair to utilize. Some information within each story must be remembered exactly (verbatim) to receive credit, and other information need only to be paraphrased.
  24. 24.  Domain Assessed- this subtest evaluates auditory memory of meaningful verbal information that is without context (or language structure). Evaluates a clients ability to actively learn new, relatively unrelated verbal information. Since four learning episodes or trails are administered, a learning acquisition curve is obtained.
  25. 25.  Subtest procedure- The verbal learning subtest is a list of learning task. The evaluator reads the participant a list of common single syllable words followed by an immediate free-recall trail. Three identical word-list presentation and immediate recall trails follow. For participants 8 years and younger, 13 words are used. For participants 9 years and older, 16 words make up this list learning task. The total number of words accurately reported over the four learning trails make up the subtest raw score.
  26. 26.  Domain assessed: This subtest evaluates short term visual retention of quasi- meaningful visual information by using a brief exposure to simple geometric shapes and then having the client redraw them in their proper locations. The task evaluates a clients ability to remember new relatively unrelated visual information.
  27. 27.  Subtest procedure: One at a time, five 4x6 inch cards with multiple, simple geometric forms are each presented for a 5 second exposure. Following each card’s exposure and then a 10 second delay. The participant is asked to draw what he/she remembers of the card’s content.
  28. 28.  This subtest evaluates visual memory using skills to detect changes in specific features or details within meaning visual arrays- specifically, four different “familiar” scene’s. The task evaluates a clients ability to remember new, context related visual information.  Ex: Remembering visual content from a billboard just passed or in a room just visited.
  29. 29.  Subtest Procedure: The participant is briefly shown a colorful, everyday scene that he/she is asked to scan for 10 seconds, before it is removed. Then a similar, alternate scene is immediately presented and the participant is asked to identify those pictured elements that have been moved, changed or added. The participant makes the remembered changes right on the altered scene. The total number of currently identified changes across all four cards constitutes the clients total raw score.
  30. 30.  Domain assessed: This subtest evaluates short-term memory of rote, visual sequential pattern. The task evaluates a clients ability to actively remember rote and sequential visual information.  Ex: trying to remember a route found on a map.
  31. 31.  Subtest procedure: The participant shows memory of a demonstrated visual pattern using a 8x11 inch plastic template containing nine asymmetrically located holes, or windows. The examiner, sitting behind the template that is held horizontally perpendicular to the work surface, models a given sequence of windows and ask the participant to imitate the sequence by placing her/his finger through the same windows in the correct order. The total number of correct sequences achieved determines the level of performance.
  32. 32.  Domain assessed: This subtest evaluates a clients ability to remember sequential, rote auditory information using the familiar digit- span format, although this task uses letters as well as digits.  Ex: When someone provides a new phone number and you try to remember it until it gets written down.
  33. 33.  Subtest procedure- The number letter subtest requires the participant to repeat a sequence of single digits and letters orally presented by the examiner. Items range from one symbolic element to ten.
  34. 34.  There are several optional subtests provided and co-normed with the core tests, allowing for a more comprehensive assessment of memory function. Provides examiners with scaled scores. Used if the examiner wants a qualitative analysis of the individual.  Qualitative analyses is used in the WRAML2 manual to the clinician that standardization data are available for testing diagnostic impressions
  35. 35. Working Memory Index Verbal Working Memory Visual working memory
  36. 36. Recognition Index Story Memory Recognition Design Memory Recognition Verbal Learning Recognition Picture Memory Recognition
  37. 37. Sound Symbol Sentence Memory Delay Recall Subtest Story memory delay recall Verbal Learning Recall Verbal Learning Delay Recall *Not going to go into detail…….sorry
  38. 38. • Room well lit. • Furniture comfortable and size appropriate. • Room relatively free from distractions. • Participant seated and positioned appropriately at table. • Examiner sits across table from participant. • Attempts to establish and maintain rapport evident. • Participant told breaks are okay. • Avoids use of words "test" and "pass/fail." • All test forms available but not observable by client. • Test materials available (e.g., pencils, timer). • Preliminary questions asked by participant answered. • Sequence of subtests followed accurately. • Examiner speaks loudly and clearly.
  39. 39. • Responses recorded immediately and accurately. • Efforts to maintain motivation evident and appropriate. Only three subtests have timing requirements: Design Memory, Picture Memory, and Sound Symbol. There is no need to time responses for the other subtests. The Manual allows examiners to tape-record examinee's responses for later scoring, particularly for the Story Memory section. The examiner needs to be careful when testing a nervous or paranoid examinee, however.
  40. 40. • Story Memory o Examinee's response is recorded on the Examiner Form. o The response is scored based on keywords used.  The form provides a loose guideline; it is recommended that the examiner refer to the Manual for scoring.  The order in which the keywords are presented do not matter in scoring, though they may be of clinical significance. o Scores can be manipulated to create other measures.  Story Memory Retention  Individual Story Comparison  Verbatim Measure  Gist Measure In the interest of time, only the core subtests will be covered.
  41. 41. • Design Memory o If there is a question about the accuracy of the examinee's drawing, score it in favor of the examinee. o The key things to look for are memory for the design and its placement. o Direction or rotation errors are not considered in the scoring (i.e., not marked incorrect). o There are general scoring guidelines for each of the shapes in the Manual.  For younger examinees or examinees with fine motor challenges, they are asked to draw these shapes separately prior to the subtest.  When scoring, these sample figures take precedence over the guidelines in the manual.
  42. 42. • Design Memory o The Manual provides scoring guidelines for specific items in the subtest as well.
  43. 43. • Verbal Learning o One point is awarded for each correctly recalled word. o Points are summed within and across trials. o Errors of commission where words not on the list are recalled are noted on the Examiner Form. o An additional trial -- the Verbal Learning Delay Recall -- can be given for additional analysis. o Scores can be manipulated to create other measures.  Verbal Learning Retention  Verbal Learning Slope  Verbal Learning Intrusion Errors
  44. 44. • Picture Memory o Points are given for each correctly identified item in each picture. o These points are summed. o Incorrectly identifying an item (error of commission) does not affect the subtest score, but it may be of clinical interest. These are recorded as a separate score.
  45. 45. • Finger Windows o If a child eight years or younger responds incorrectly on any of the first three items (A, B, or C), the examiner should give assistance until the child can respond correctly. These items are then marked incorrect. o If a child nine years or older responds incorrectly on the first item (#4), the examiner should start the subtest with item A. Item #4 is not readministered. o One point is given for each correct sequence.  Like the WISC-IV, examinees are given perfect scores on items they skipped based on age if they correctly respond to their first item.
  46. 46. • Number Letter o Like the WISC-IV Digit Span subtests, each correct response is scored one point. o These points are summed.
  47. 47. • There are three levels of analysis. o Combined  General Memory Index (GMI) o Index  Visual  Verbal  Attention/Concentration  [Working Memory]  [Recognition Memory] o Individual Any of these can be combined in any order for an individualized analysis.
  48. 48. • The General Memory Index is the preferred method. o Of the three methods previously described, the General Memory Index has lower and less variable standard error than the other methods across all age groups. o With the GMI, you get a more holistic picture of the examinee's ability. • In some cases, using the GMI is less desirable. o If there are any significant discrepancies among the index scores, then the GMI is likely not representative of the examinee's ability.  These can be found in the manual. o In this case, the examiner should look at the core indices for analysis.
  49. 49. • In the same vein, if there are significant discrepancies between subtests in a core index score, then the core index score should not be used in interpretation. o Discrepancy analysis results for many subtests are not listed in the Manual. o However, standard errors of measurement are provided, and using these, one can infer which discrepancies are significant.
  50. 50. • Compared to the GMI and core indices, individual subtest scores have lower reliability. • Interpreting from subtests should be taken as a last resort or at least in conjunction with other supporting evidence, such as history or other test results.
  51. 51. • Story Memory o Poor performance may be indicative of:  Poor verbal memory  Expressive Language Disorder  Expressive/Receptive Language Disorder  Low verbal intelligence  Low overall intelligence  Hearing impairment  Anxiety o It may be a good idea to talk with the examinee prior to administering the test to get an idea of the examinee's listening and articulation skills. In the interest of time, only the core subtests will be covered.
  52. 52. • Design Memory o Poor performance may be indicative of:  Poor visual memory  Spatial skills deficit  Visual field cut or neglect  Impairment in visual acuity
  53. 53. • Verbal Learning o Poor performance may be indicative of:  Poor short-term verbal memory  Poor long-term verbal memory storage  Communication disorder  Hearing impairment  Anxiety  Poor executive functioning
  54. 54. • Picture Memory o Poor performance may be indicative of:  Poor visual memory  Spatial skills deficits  Visual field cut or neglect  Impairment in visual acuity  Impulsiveness
  55. 55. • Finger Windows o Poor performance may be indicative of:  Poor visual, rote immediate recall  Deficits in sequential processing  Spatial skills deficits  Visual field cut or neglect  Impairment in visual acuity  Fine motor impairment
  56. 56. • Number Letter o Poor performance may be indicative of:  Poor auditory or verbal, rote immediate recall  Poor auditory sequential recall  Impaired hearing
  57. 57. • The WRAML2 can be administered to individuals between 5 and 85 years of age; however, there may be floor and ceiling issues that need to be taken into consideration. o Examine the norms tables for each subtest. o Floor: In general, the ability of 5-year olds who do poorly may be overestimated. This is not an issue with 6-year olds. o Ceiling: There are no ceiling issues of which we know. The WRAML2 can be used to determine the degree to which an examinee is gifted with memory.
  58. 58.  There are no evidence for item bias between genders as well as across principal ethnic groups.  Motivation plays a significant role in test performance, so estimating motivation is an important part of this evaluation.  Assesses memory of all ages  Can be used to supplement evaluations of ADHD, and problems in children as well as a number of other disorders across the age span.