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NEUROPSYCHOLOGICAL ASSESSMENT ON THE INTERNET/WWW: THE NEXT STEP

Paul Jones, Ed.D.
Neuropsychological Assessment Lab
Department of Educational Psychology
University of Nevada, Las Vegas
Las Vegas, NV 89154-3003
Phone: (702) 895-3937
FAX: (702) 895-1658
Email: jones@nevada.edu

There are two primary objectives for this paper and presentation. The first is to report results of a pilot test conducted in the Spring of 1999 as the initial stage in development of a new scale appropriate for use with persons with visual disability. The second objective is to seek assistance about the appropriate next step from those who attend the presentation and/or read this paper.

The 1999 International Conference on Technology and Persons with Disabilities included presentation (Jones & Riceberg, 1999) of a series of three test instruments designed for equitable use by persons with and without visual disability and available for administration and interpretation via the Internet/WWW. Two of the tests, CogAttention and CogMemory, were designed to directly address basic cognitive functions as identified in the contemporary PASS theory (Naglieri & Das, 1990) built on Luria's model of neuropsychological functions. In essence this model identifies four functions: (P)lanning, (A)ttention, (S)equential processing, and (S)imultaneous processing. CogAttention and CogMemory appear consistent with the functions of attention and sequential processing, respectively.

Adaptation of available tests of the planning (problem solving) function for appropriate use by persons with visual disability is problematic. Essentially all of the available tests of this function rely heavily on visual stimuli, and most depend on precise timing in test administration. The former is a typical problem when adapting tests for use by persons with visual disability, and the latter is particularly troublesome when the objective is for the test to be administered via the Internet/WWW.


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An Hypothesis:

Even a brief perusal of recent literature clearly indicates that Naglieri and Das’s (1997) Cognitive Assessment System (CAS) has emerged as one of the primary tools for neuropsychological assessment of sighted persons. It affords the user a comprehensive and theory-consistent approach to cognitive measurement. It is flexible, relatively easy to administer and score, and is keyed to linking intervention strategies with test results.

Inspection of the CAS scales used for assessment of the planning function suggests that the key element is in how quickly the individual "catches on", recognizes a pattern in the task. Differentiation is based on speed of response; essentially 100% accuracy would be expected on the tasks if there was no time limit.

While the CAS scale dependence on visual stimuli and precise timing precluded its adaptation for use in the desired context, a potential alternative appeared to be available in a "grammar" test, one of the computer-based instruments from the Automated Neuropsychological Assessment Metrics battery (ANAM/TWB). These scales were developed by the Office of Military Performance Assessment Technology and are organized as a Tester’s Workbench.

In the grammar scale, the user is first given two symbols separated by a relationship identifier (e.g. * AFTER #). This is then followed by another statement (e.g. & AFTER *), and then by the test stimulus (e.g. # * &). In standard application, the user responds with "match" if both of the statements are true or if both of the statements are false and responds "non-match" if only one of the statements is true.

The hypothesis which emerged involved first making a change in the structure of the grammar test so that one of the statements would always be true. The user would then be asked to respond by indicating whether both statements are true (e.g. the test stimulus is correctly described by both statements) or whether one of the statements is false. With this modification, the user who "catches on" to the pattern would recognize that if the first statement is false, it is not necessary to attend to the second statement. With a balanced number of instances in which it was and was not necessary to attend to both statements, the score on the test would be based on the difference in response time between instances in which it was necessary to listen to both statements and instances in which it was not.


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The Pilot Test:

The format of the revised grammar test suggested that it would be amenable to either an auditory presentation or a visual presentation, and a score based on contrast between time of response to different stimuli opened the possibility of administration via the Internet/WWW. Before proceeding, however, it was necessary to determine if in fact this adaptation would result in comparable outcome to that obtained with a standard test of the planning function.

The opportunity for a pilot test of this hypothesis was provided in a study of computer-based assessment being conducted in the UNLV Neuropsychological Assessment Lab. In the Spring of 1999, subjects in this lab were administered a clinical subset of computer-based instruments from the ANAM/TWB battery. For this pilot study, these subjects also were administered the CAS basic battery planning subtests (matching numbers and planned codes) and the adapted grammar test.

Participation in this study was solicited from students enrolled in each of two sections of an upper division educational psychology course in the spring 1999 semester. The course is required in the teacher licensure program, and the syllabus for each of these two sections included a course requirement for participation in a research activity. Serving as a subject in studies in the Neuropsychological Assessment Lab was one of the alternatives offered to meet the research requirement. A total of 54 students provided data for the initial analysis. The majority were female (75%), between the age of 18 and 25 (56%), with cumulative grade point average between 3.0 and 4.0 (55%) All were sighted.

Although norms for the CAS are available only through age 17, perusal of the CAS norms tables suggested that performance on the planning scale appeared to be stabilizing near the upper age range. It thus appeared reasonable to assume that the stabilization could be to an extent to provide sufficient discrimination at age levels beyond the norms, and the data obtained from this sample supported this assumption. In the Basic CAS battery, the two subtests used in this pilot study are combined to form a Planning score with mean = 100 and s.d. = 15. Using the highest available age norms (17-8 to 17-11), the upper division students in this study obtained a mean of 108.6 with a standard deviation of 15.39. This outcome is consistent with expectations for the ability level of the sample, and the results were consistent between the two subtests.

With the above data supporting use of the CAS Planning scale as a base, the critical question then was in whether the data appeared to warrant use of the adapted grammar scale as an alternative. Correlations and exploratory factor analysis with these data provided such support. The adapted grammar scale appears to be tapping the same cognitive function being measured by the CAS scale.


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The Next Step:

The results of this preliminary study suggest that a computer-based test using stimuli amenable to aural presentation may be a viable alternative for assessment of the neuropsychological "planning" function. However, much research is needed before it would be prudent to make the instrument available for actual application.

Use of sighted objects for the first study provided some criterion validity data for the adapted instrument, but a number of questions remain to be answered. One of the questions which can be addressed in the lab is the impact of auditory vs. visual presentation with sighted subjects. Other questions, however, will require assistance from persons with visual disability.

Among the questions of particular concern to this researcher are whether the short-term memory demands of an aural presentation are reasonable for such assessment and whether sufficient precision of timing will be available in a web-based administration to provide the score contrast. Answers to these and other questions will require assistance from the broad community of persons with visual disability and the professionals with and without visual disability who serve them.

This need for assistance is the second of the two objectives noted at the beginning of this paper. Having such a scale available for use with persons with visual disability is an important need, and suggestions/comments for guidance about the next step will be welcomed. The scale adapted for this study is in the public domain, and this researcher would be happy to make the adaptation available for other independent or collaborative studies.


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References:

Jones, W. P., & Riceberg, J. (1999). Neuropsychological assessment on the internet/WWW: Adaptation for persons with visual disability. [On-line] Available World Wide Web: http://www.dinf.org/csun_99/session0093.html


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