1. The Clinical Utility of the LANSE- A and LANSE-C Jennifer L. Harrison, M.A., Megan Pollock, M.A., Amy Mouanoutoua, M.A. Ashley Brimager, M.A., & Paul C. Lebby, Ph.D., California School of Professional Psychology at Alliant International University Introduction The Lebby-Asbell Neurocognitive Screening Examination for Children (LANSE-C) and Lebby- Asbell Neurocognitive Screening Examination for Adolescents (LANSE-A) were developed as tools to help clinicians identify areas of relative weakness involving cognitive functioning in children 6-years to 11-years, 11-months (LANSE-C) and adolescents 12-years to 17-years, 11-months (LANSE-A). The test is comprised of 14 components that measure a variety of cognitive abilities. These abilities include Level of Consciousness, Orientation, Verbal Memory, Visual Memory, Passive and Sustained Attention, Active Attention, Receptive and Expressive Language, Verbal Reasoning, Visual/Spatial Reasoning, Judgment, Visual/Motor Integration and Visual Neglect. The tests were designed to be completed in approximately 20 to 30-minutes, a period of time that fits with most therapy regimens in acute care facilities. This time-frame allows for assessment of many patients with compromised attentional and arousal tolerance. The purpose of this study was to assess the clinical utility of the Lebby Asbell Neurocognitive Screening Evaluation for Adolescents and Children (LANSE-A and C). It was predicted the LANSEs would accurately discriminate brain injured from non-brain injured subjects. Further statistical analysis evaluated three cutoff values with respect to sensitivity, specificity and positive predictive value. Methods This study compared performance on the 14 subtests of the LANSE-C and LANSE-A for brain-injured patients and non-injured participants. Data were analyzed using a one-way between-groups multivariate analysis of variance (MANOVA). Nonparametric data analysis was used to measure sensitivity, specificity and positive predictive value. Participants N = 249 Two Groups: The non-injured control group (NC) N = 190 individuals The traumatic brain injured group (TBI) N = 59 individuals Procedures The non-injured control data were collected from a community population in Central California. The data for the brain-injured population was collected at Children’s Hospital Central California, Department of Neuropsychology and Medical Rehabilitation. Measures The Lebby-Asbell Neurocognitive Screening Examination for Children/Adolescents (LANSE- C/A). Provided with the book: The Source for Traumatic Brain Injury (TBI)/Lebby and Asbell 2007, LinguiSystems, Inc. Publishers (Linguisystems.com) Discussion As the LANSE-A and LANSE-C are screening measures, using two or more missed subtests in order to provide the best sensitivity is the most appropriate classification technique. These data suggest that using the number of subtests failed by a subject is useful way to assess functioning, and that a child or adolescent being tested that fails two or more subtests (scores fall below the cutoff) should be considered at risk of cognitive compromise and referred for more comprehensive assessment. Moreover, the LANSE-A and LANSE-C efficiently categorized brain-injured persons from non-brain-injured on all 14 dependent variables. The statistical analysis performed in this study suggest the LANSE-A and LANSE-C demonstrate good clinical utility in differentiating brain injury. The LANSE-A and LANSE-C are published and packaged with: The Source For TBI – Children and Adolescents, Lebby and Asbell (2007), Linguisystems, Inc. Example pages from the LANSE-A and LANSE-C Results MANOVA A one-way between-groups multivariate analysis of variance was performed to investigate LANSE-A and LANSE-C scores among brain-injured and non- brain-injured children and adolescents. There were 14 dependent variables, which are the subtests in the LANSE-A and LANSE-C. The dependent variables include: Level of Consciousness, Orientation, Verbal Memory, Visual Memory, Passive and Sustained Attention, Active Attention, Receptive and Expressive Language, Verbal Reasoning, Visual- Spatial Reasoning, Judgment, Visual-Motor Integration, and Visual Neglect (see Figure 1). Preliminary assumption testing was conducted to check for normality, linearity, univariate and multivariate outliers, homogeneity of covariance matrices, and multicollinearity. The assumptions of homogeneity of covariance matrices was violated using Box’s M (p>.001). Data transformation was not appropriate for this analysis. Homogeneity of variance was attained in three subtests: Number- Sequencing Forward, Number-Sequencing Backward, and Number-Letter-Sequencing using Levene’s test of equality of error variances. The violation of homogeneity of covariance matrices can be explained by the nature of the data as this analysis compares brain-injured versus controls; these two populations are inherently going to differ in cognitive functioning. Therefore, the researchers continued with the use of the multivariate analysis of variance. There was a statistically significant difference between brain-injured and non-brain- injured on the combined dependent variables, F (14, 234) = 46.530, p<.001; Wilk’s Lambda =.264; partial eta 2 =.763. When the dependent variables were considered separately, 13 of the 14 subtests reached statistical analysis at the p<.001. One of the subtests (ObjUse) reached statistical significance at the p<.01 level. A Bonferroni correction was utilized in calculating main effects. Results indicate that brain-injured scored significantly lower on the LANSE-A and LANSE-C compared to the non- brain-injured controls (see Table 1). This suggests greater cognitive impairment in the brain-injured group. Measures of Tests Nonparametric data analysis was used to measure sensitivity, specificity, positive predictive value, and negative predictive value. There was a 97.69% positive predictive value using a cut-off of one failed subtest; a sensitivity of 94.62% using a cut-off of two failed subtests; and a specificity of 98.73% using three failed subtests as a cut-off (see Table 2). As the LANSE-A and LANSE-C are screening measures, using two or more missed subtests in order to provide the best sensitivity is the most appropriate classification technique. Results suggest that using the number of subtests failed by a subject is useful way to assess functioning, and that a child or adolescent being tested that fails two subtests (scores fall below the cutoff) should be considered at risk of cognitive compromise and referred for more comprehensive assessment.