Nepsy ii


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  • 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
  • Nepsy ii

    2. 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. 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. 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. 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. 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. 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. 8. AdministrationAges: 3-16 yearsGeneral Assessment: Preschool-ages - 45 minutes School ages - 1 hour Full Assessment: Preschool-ages - 90 minutes School ages - 2 to 3 hours
    9. 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. 10. Language Expressive  Receptive  Oromotor Control and  Phonological Processing Articulation  Repetition  Naming  Repetition  Word Generation
    11. 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. 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. 13. Visual and Visuoperceptual Processing Visual Perception Spatial Processing Visuoconstructional Skills Local and Global Processing
    14. 14. Referral Questions Learning Disorder –  Perceptual/Motor Delays Language  School Readiness Learning Disorder –  Social/Interpersonal Mathematics Differences ADHD  General Behavioral Problems Language Delays
    15. 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. 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. 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. 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. 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. 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. 21. Behavioral Problems (continued) Affect Recognition Theory of Mind Arrows Design Copying
    22. 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. 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. 24. Language (continued) Sentence Repetition Word List Interference Imitating Hand Positions Visuomotor Precision Affect Recognition Design Copying
    25. 25. Social/Interpersonal Animal Sorting Auditory Attention and Response Set Design Fluency Inhibition Statue Comprehension of Instructions Phonological Processing Speeded Naming Word Generation
    26. 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. 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. 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. 29. School Readiness Major Domain Assessed: LanguagePerceptual/Motor Delays/Disorders Attention and Executive, Sensorimotor, Visuospatial Processing
    30. 30. Interpretation Attention and Exec. Fxn Subtests:  Animal Sorting Low Score: poor initiation, poor self-monitoring, poor conceptual reasoning, low semantic knowledge  Low Auditory Attention Score: Poor selective attention, poor sustained attention, slow responding, poor inhibition
    31. 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. 32. Interpretation Inhibition Low Score:  Poor inhibition Inhibition-Switching Low Score:  Poor inhibition, poor cognitive flexibility Statue Low Score  Poor overall inhibitionLANGUAGE DOMAIN• Body Part Naming low score: • Poor word finding• Body Part Identification low score: • Underdeveloped semantic knowledge
    33. 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
    34. 34. Interpretation Repetition of Nonsense Words low score:  Poor articulation, poor language analysis Speeded Naming low score:  Reduced automatic lexical access; slow processing speed, poor naming ability Word Generation low scores:  poor executive control, poor initiation
    35. 35. Interpretation MEMORY Low List Memory (Immediate and Delayed)  Poor remote memory or supraspan (verbal) skills Low Memory for Designs:  Poor visuospatial memory Low Memory for Faces:  Poor visual discriminatin and recognition Low Memory for Names:  Poor learning (encoding) or retrieval Low Narrative Memory:  Poor expression or comprehension; poor verbal encoding
    36. 36. Interpretation Low Sentence Repetition:  Poor Verbal (short-term) memory• Low Word-List Interference • Poor Verbal Working memory SENSORIMOTOR• Low Fingertip Tapping: • Poor fine-motor control• Low Imitating Hand Positions: • Poor fine-motor programming and differentiation, low visuospatial abilities
    37. 37. Interpretation Low Manual Motor Sequences:  Poor manual motor programming Low Visuomotor Precision:  Poor fine-motor coordination, low speed SOCIAL PERCEPTUAL Low Affect Recognition:  Poor facial affect recognition Low Theory of Mind:  Problems with perspective taking
    38. 38. Interpretation VISUOSPOATIAL Low Arrows:  Poor visuospatial skills Low Block Construction:  Poor visuoconstructional skills, poor planning, deficits in perceiving gestalt (3-D) Low Design Copying:  Poor visuoconstructional skills (2-D) Low Geometric Puzzles:  Poor perception, poor mental rotation
    39. 39. Interpretation Low Picture Puzzles:  Poor visual perception, poor scanning Low Route Finding  Poor visual-spatial relations, poor orientation
    40. 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. 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. 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. 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. 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. 45. Scoring Behavioral Observations, such as “distracted, off-task behaviors, physical movement” receive cumulative percentages or percents.
    46. 46. THE END