Neuropsychological Assessment

1) Mental Activity-Attention and speed of information processing Filtering, focusing, shifting tracking Filtering, focusing, shifting tracking Filter and attend to relevant info/stimulus, while ignoring the irrelevant Filter and attend to relevant info/stimulus, while ignoring the irrelevant Ability to shift attention and Focus Ability to shift attention and Focus Either being overly focused or too ready to shift will cause difficulty (perseverations vs. distractibility) Either being overly focused or too ready to shift will cause difficulty (perseverations vs. distractibility) Attention can be measured by reaction time Attention can be measured by reaction time Trails A & B and Digit Span

2) Visuoconstructive Abilities Accurate construction of objects; Perceptual, Spatial, Motor Accurate construction of objects; Perceptual, Spatial, Motor Tests for VC: Bender Gestalt, Block Design, Object Assembly, HTP, Free Drawing Tests for VC: Bender Gestalt, Block Design, Object Assembly, HTP, Free Drawing

Bender Gestalt Bender Gestalt Test (pg 540 for scoring sheet) Nine designs to be drawn by client. Test is brief, economical, flexible, nonverbal, and researched Bender Gestalt Test (pg 540 for scoring sheet) Nine designs to be drawn by client. Test is brief, economical, flexible, nonverbal, and researched Right hemisphere lesions- fragmented and lose overall design Right hemisphere lesions- fragmented and lose overall design Left hemisphere- duplicate design, but leave out details Left hemisphere- duplicate design, but leave out details This test is to “screen” for severe types of brain damage DOES NOT DIAGNOS This test is to “screen” for severe types of brain damage DOES NOT DIAGNOS

How Children may compensate can be seen on the Bender Gestalt Reproductions maybe accurate but observe Reproductions maybe accurate but observe Length of time (excessive) Length of time (excessive) “anchoring” items with a finger “anchoring” items with a finger Reproducing by memory Reproducing by memory Checking and rechecking dots, but being unsure of number Checking and rechecking dots, but being unsure of number Rotating their paper of the card itself Rotating their paper of the card itself Drawing impulsively/quickly and then correcting with extreme difficulty Drawing impulsively/quickly and then correcting with extreme difficulty Expressed dissatisfaction with poor designs after repeated attempts to correct them Expressed dissatisfaction with poor designs after repeated attempts to correct them

Children and inadequate reception vs expression Reception- difficulty in visual perception Reception- difficulty in visual perception Child report poor designs as accurate Child report poor designs as accurate Expression- difficulty in reproducing what is accurately seen Expression- difficulty in reproducing what is accurately seen Recognition that design has been poorly reproduced Recognition that design has been poorly reproduced

Block Design and Object Assembly Block Design- is more abstract so may show clients with a more concrete form of problem solving Block Design- is more abstract so may show clients with a more concrete form of problem solving Object Assembly-is more concrete, thus the same person may do well on it Object Assembly-is more concrete, thus the same person may do well on it

3)Memory and Learning Sensory, short-term, long term, rehearsal, consolidation, recall, recognition and forgetting Sensory, short-term, long term, rehearsal, consolidation, recall, recognition and forgetting Declarative Memory- learning about information, objects, and events Declarative Memory- learning about information, objects, and events Procedural or implicit memory- automatic, habitual responses Procedural or implicit memory- automatic, habitual responses

Overview of general intactness of memory Extent to which cl can acquire and retain material Extent to which cl can acquire and retain material How quickly material is forgotten How quickly material is forgotten Extent to which competing information interferes with learning Extent to which competing information interferes with learning Degree of specificity or generality of deficit Degree of specificity or generality of deficit Stability or fluctuation of deficit over time Stability or fluctuation of deficit over time Distinguish between memory and attention Distinguish between memory and attention

Tests of Memory Start in the interview Start in the interview Weschler Memory Scale Weschler Memory Scale WAIS-III or WISC-III WAIS-III or WISC-III Digit symbol coding, information, (digit span, letter-number sequencing-measure attention too) Digit symbol coding, information, (digit span, letter-number sequencing-measure attention too) Rey Auditory Verbal Learning Test- Cl repeats back a list of 15 unrelated words Rey Auditory Verbal Learning Test- Cl repeats back a list of 15 unrelated words

4) Verbal Functions and Academic Skills Aphasias- impaired speech, writing or understanding spoken or written language Aphasias- impaired speech, writing or understanding spoken or written language Problems with speech production Problems with speech production Resulting in poor articulation, loss of verbal fluency, word-finding problems, poor repetition of words/sentences, poor auditory comprehension, reading difficulties and impaired writting Resulting in poor articulation, loss of verbal fluency, word-finding problems, poor repetition of words/sentences, poor auditory comprehension, reading difficulties and impaired writting

Tests for Verbal Functions Information, Comprehension, Similarities, Vocabulary, and Arithmetic Information, Comprehension, Similarities, Vocabulary, and Arithmetic Clinical Interview noting for difficulties Clinical Interview noting for difficulties Controlled Oral Word Association- Cl says as many words as possible beginning with a certain letter in a fixed amount of time Controlled Oral Word Association- Cl says as many words as possible beginning with a certain letter in a fixed amount of time

5) Executive Functions Ability to regulate and direct self behavior Ability to regulate and direct self behavior Initiate, Plan, Act purposefully, and Effective performance Initiate, Plan, Act purposefully, and Effective performance Frontal lobe damage is most typically the difficulty and can be impaired while other cognitive functioning remains intact Frontal lobe damage is most typically the difficulty and can be impaired while other cognitive functioning remains intact Interview, behavioral observations, look for detail in description of activities, family members ( due to lack of awareness) Interview, behavioral observations, look for detail in description of activities, family members ( due to lack of awareness)

What to look for in assessing executive functions Does patient initiate activity? Does patient initiate activity? Are there unusual social behaviors? Are there unusual social behaviors? Are these behaviors pre or post morbid if there is an injury? Are these behaviors pre or post morbid if there is an injury? Look at planning abilities when cl organize Bender Gestalt, Bock Design, Stories on TAT. Look at planning abilities when cl organize Bender Gestalt, Bock Design, Stories on TAT. Do they have difficulty attending to stimuli while simultaneously performing another task (freedom from distractibility on WISC/WAIS) Do they have difficulty attending to stimuli while simultaneously performing another task (freedom from distractibility on WISC/WAIS)

6) Motor Performance Expected difference between the dominant hand and the nondominant hand should be 10%. Differences of 20% or more infer lesions contralateral to the side of weakness or slowing. (Use with Caution) Expected difference between the dominant hand and the nondominant hand should be 10%. Differences of 20% or more infer lesions contralateral to the side of weakness or slowing. (Use with Caution) Finger Tapping Test Finger Tapping Test

7) Emotional Status Are Cognitive difficulties the cause or result of emotional problems? Are Cognitive difficulties the cause or result of emotional problems? Concentration (Anxiety, Depression) Concentration (Anxiety, Depression) Impulsivity (Anxiety, ADHD) Impulsivity (Anxiety, ADHD) Processing speed- (depression) Processing speed- (depression) Retention and Retreval (Anxiety) Retention and Retreval (Anxiety) Paranoia, aggressiveness, and irritability can effect test results Paranoia, aggressiveness, and irritability can effect test results Limited self-awareness, impulsivity, concreteness, and poor social awareness could be due to frontal lobe damage Limited self-awareness, impulsivity, concreteness, and poor social awareness could be due to frontal lobe damage LD can lead to depression and anxiety LD can lead to depression and anxiety

Assessing LD and ADHD See Worksheet