Nepsy ii

1. By Brooke schauder , PhD NEPSY-II Overview

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 or stability Highest relaibility subtests: Comprehension of Instructions Design Copying Fingertip Tapping Imitating Hand Positions List Memory Memory for Names Phonological Processing Picture Puzzles Sentence Repetition Lower Reliability Response Set Total Correct (.55 for 11 & 12 year olds) Inhibition Total Errors (.35 for 10 year olds) Memory for Designs Spatial and Total Scores Memory for Designs Delayed Total Score (.44 for 10 year olds)

7. Range from .44-89 (most in in 70-80 range) INTERSCORER AGREEMENT 93-99% VALIDITY moderate - high correlations with WISC-IV and DAS-II Test & Retest Stability

8. 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 Administration

9. Attention and Executive Functioning (self-regulatory skills) Strategic planning Regulation based on environmental feedback SUBCOMPONENTS Initiation Inhibition Selective Attention Flexibility Sustained Attention Fluency Working Memory

10. Language Expressive Oromotor Control and Articulation Naming Repetition Word Generation Receptive Phonological Processing Repetition

11. Memory and Learning Immediate and Delayed Memory Encoding Retrieval Working Memory Memory Span Repetition Rote Memory Supraspan Learning: memorization of material exceeding max. capacity for immediate memory (through repetition)

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 – Language Learning Disorder – Mathematics ADHD Behavioral Problems Language Delays Perceptual/Motor Delays School Readiness Social/Interpersonal Differences General

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

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. 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

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. 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. 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. 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. 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. Interpretation Low Picture Puzzles: Poor visual perception, poor scanning Low Route Finding Poor visual-spatial relations, poor orientation

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.

46. THE END