The standardization of a test is an important part of its development, used to align scores (along the often assumed normal distribution of cognitive abilities in the population of interest, the Gaussian curve) and to establish the standard deviation and standard errors of the test.
Hold tests are neuropsychological tests which tap abilities which are thought to be largely resistant to cognitive declines following neurological damage. As a result, these tests are widely used for estimating premorbid intelligence in conditions such as dementia, traumatic brain injury, and stroke.
![Test Of Premorbid Functioning Norms Test Of Premorbid Functioning Norms](/uploads/1/2/4/8/124851151/521584013.jpg)
Usage[edit]
In neuropsychological assessment it is important to be able to accurately estimate premorbid intelligence. Accurate estimation allows the quantification of the impacts of neurological damage or decline, when compared to tests of current intelligence. The magnitude of decline is important for prognosis, rehabilitation planning and financial compensation.[1]
Hold tests used[edit]
Hold tests typically measure crystallised intelligence, that is stored knowledge and skills, such as vocabulary and pronunciation.[2]Of course, hold tests of abilities directly affected by neurological damage are likely to underestimate intelligence. For example, using reading tests in patients with aphasia. Examples of hold tests used:
- National Adult Reading Test (NART)[1]
- North American Adult Reading Test (NAART)[1]
- Picture Completion subtest of Wechsler Adult Intelligence Scale[3]
- Similarities subtest of Wechsler Adult Intelligence Scale[3]
- Wechsler Test of Adult Reading (WTAR)[1]
- Wide Range Achievement Test (WRAT)[4]
Alternate methods[edit]
The use of hold tests is only one of a few possible methods of quantification of premorbid function. In practice a neuropsychologist may use a combination of methods to yield the most accurate estimate of premorbid intelligence.[2] Some of the other methods used are:
- Previous testing: While this method can be highly accurate and useful, it is rare that such information is available and even rarer still that any information beyond basic IQ testing was obtained. In the majority of cases this information is not available and other methods of estimation are required.[5]
- Historical method: This involves a clinical interview and review of records to make a subjective estimation of premorbid Intelligence.[1] An advantage of this method is that a clinical interview and review of records are an essential part of assessment and thus can be assessed from information that is obtained in the normal course of assessment.
- Statistical estimation: Involves the incorporation of demographic information, such as age, race education and occupational attainment into a regression equation that yields a probable intelligence complete with standard error of the estimate. One advantage of this method is the avoidance of the use current performance levels.[5]
- Best estimate: This method determined from test scores, other observations and historical data what is the best performance of an individual. Once the highest level of functioning has been identified this is the standard against which all other performance is measured. In general a single high score should not be relied upon, unless supported from other observations. In most cases the best performance estimate will be based on a cluster of highest scores and a single. For example, a doctor who performs in tests at an average level but who has displayed superior function in prior education and occupational performance is obviously underperforming upon potential in test and past education and occupation would represent the best estimate. The advantage of the best estimate method is that a broad range of abilities are taken into account and neuropsychologists are not bound to any single battery of tests.[2]
A review examined whether hold tests, best estimate or regression equation methods were most accurate in predicting overall IQ (full scale IQ) as determined by Wechsler Adult Intelligence Scale (WAIS-R) in a non-neurologically impaired population. It was found that different methods were more accurate depending on the IQ level of participants e.g. WRAT-3 (hold test) was most accurate for those of below average intelligence, NAART (hold test) was most accurate for those of average intelligence and the best estimate method was most accurate for above average intelligence. This provides support for the idea that no single method is superior in all cases and a combination of approaches is most appropriate in clinical practice.[5]
References[edit]
- ^ abcdeGreen, R., Melo, B., Chtistensen, B., Ngo, L., Monette, G. & Bradbury, C. (2008). 'Measuring premorbid IQ in traumatic brain injury: An examination of the validity of the Wechsler Test of Adult Reading (WTAR)'. Journal of Clinical and Experimental Neuropsychology. 30 (2): 163–172. doi:10.1080/13803390701300524. PMID18213530.CS1 maint: Multiple names: authors list (link)
- ^ abcLezak, M. D., Howieson, D. B., Loring, D. W., Hannay, H. J. & Fischer, J. S. (2004). Neuropsychological Assessment (4th ed.). Oxford: Oxford University Press. p. 1016. ISBN0-19-511121-4.CS1 maint: Multiple names: authors list (link)
- ^ abJohnsen, G. E., Kanagaratnam, P. & Asbjornsen, A. E. (2008). 'Memory impairments in posttraumatic stress disorder are related to depression'. Journal of Anxiety Disorders. 22 (3): 464–474. doi:10.1016/j.janxdis.2007.04.007. PMID17532601.CS1 maint: Multiple names: authors list (link)
- ^Orme, D. R., Johnstone, B., Hanks, R., & Novack, T. (2004). 'The WRAT-3 reading subtest as a measure of premorbid intelligence among persons with brain injury'. Rehabilitation Psychology. 49 (3): 250–253. doi:10.1037/0090-5550.49.3.250.CS1 maint: Multiple names: authors list (link)
- ^ abcGriffin, S. L., Mindt, M. R., Rankin, E. J., Ritchie, A. J. & Scott, J. G. (2002). 'Estimating premorbid intelligence: Comparison of traditional and contemporary methods across the intelligence continuum'. Archives of Clinical Neuropsychology. 17 (5): 497–507. doi:10.1016/S0887-6177(01)00136-6. PMID14592003.CS1 maint: Multiple names: authors list (link)
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The Wechsler Test of Adult Reading (WTAR) is a neuropsychological assessment tool used to provide a measure of premorbidintelligence, the degree of Intellectual function prior to the onset of illness or disease.[1]
Test Design[edit]
Developed for use with English-speaking patients aged 16 to 89 years,[1] WTAR is a “hold” test, a type of neuropsychological test that relies on abilities thought to be unaffected by cognitive decline associated with neurological damage. In the design of WTAR, the demographic prediction tables were co-normed with the widely used Wechsler Adult Intelligence Scale (WAIS) and Wechsler Memory Scale (WMS). This gives it an advantage for comparative analyses on predicted and actual general intellectual and memory function over similar reading tests such as the National Adult Reading Test (NART), which do not share normative data sets with the other widely used Wechsler assessments.[2] Using vocabulary level as a correlate to IQ, the test relies on reading recognition’s resistance to the cognitive impacts of brain damage to estimate premorbid function.[2] The patient is presented with irregularly spelled words and prompted to pronounce each; the irregular grapheme-to-phoneme translations (such as the “gh” in the word tough) in the prompts make it difficult pronounce without having previously learned the word. Since the patient cannot apply standard pronunciation rules to complete the task, the examiner can assess their vocabulary by their ability to pronounce the irregularly spelled words, and by extension, estimate their premorbid IQ.[2] WTAR was published in 2001 by Pearson.[1]
Instructions for administration and scoring[edit]
The WTAR is composed of 50 irregularly spelled words and takes approximately 10 minutes to complete. The examiner begins by presenting the first word card and prompting the patient for a single pronunciation of the word. This procedure continues through all 50 word cards and is discontinued if the patient provides 12 consecutive incorrect pronunciations. Lists of acceptable pronunciations and tape recordings are provided by the publisher to account for words with multiple pronunciation variants. Each correct pronunciation is given a score of 1, with 50 as the maximum raw score. The raw score is then standardized by age and compared to the scores predicted for the patient’s demographic classification.[2]
Validity[edit]
In standardized samples, WTAR scores were shown to correlate highly with measures of verbal IQ (r = .75), verbal comprehension (r = .74), and full scale IQ (r = .73).[2] Patients recovering from traumatic brain injury (on average measuring in severely impaired ranged on the Glasgow Coma Scale) showed high stability in WTAR scores during their recovery period while performing highly similar to demographic estimates, suggesting the test is a reliable estimate of premorbid intelligence in individuals with TBI.[3] Presented in an inpatient neuropsychologic battery for TBI, WTAR scores have been shown to be significant predictors of 1-year outcome, suggesting score stability over time and predictive validity.[4] WTAR performance also appears to remain stable in patients exerting suboptimal effort.[5] Evaluation of WTAR scores across the degree of sustained TBI (mild, moderate, severe) suggests that the assessment may underestimate premorbid IQ in patients with more severe damage.[6] In patients with Alzheimer's disease, WTAR scores declined as the degree of cognitive impairment increased in more affected individuals.[2][7] Individuals with preexistinglearning disorders were found to perform poorly relative to those without learning disorders. Reading-disabled individuals scored lower on WTAR than on WAIS test measures; WTAR is not recommended for use with such individuals.[2]
References[edit]
- ^ abcHoldnack, H.A. (2001). Wechsler Test of Adult Reading: WTAR. San Antonio. The Psychological Corporation
- ^ abcdefgSpreen, O., & Strauss, E. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary. Oxford University Press, USA.
- ^Green, R. E., Melo, B., Christensen, B., Ngo, L. A., Monette, G., & Bradbury, C. (2008). Measuring premorbid IQ in traumatic brain injury: An examination of the validity of the Wechsler Test of Adult Reading (WTAR). Journal of Clinical and Experimental Neuropsychology, 30(2), 163-172.
- ^Hanks, R.A., Millis, S.R., Ricker, J.H., Giacino, J.T., Nakese-Richardson, R., Frol, A.B., Novack, T.A., Kalmar, K., Sherer, M., Gordon, W. (2008). The predictive validity of a brief inpatient neuropsychologic battery for person with traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89, 950-957.
- ^Whitney, K. A., Shepart, P.H., Mariner, J., Mossbarger, B., Herman, S. (2010). Validity of the Wechsler Test of Adult Reading (WTAR): Effort Considered in a Clinical Sample of U.S. Military Veterans. Applied Neuropsychology: Adult, 17(3), 196-204.
- ^Mathias, J.L., Bowden, S.C., Bigler, E.D., Rosenfeld, J.V. (2007). Is performance on the Wechsler test of adult reading affected by traumatic brain injury? British Journal of Clinical Psychology, 46(4), 457-466.
- ^McFarlane, J, Welch, J, Rodgers, J. (2006). Severity of Alzheimer's disease and effect on premorbid measures of intelligence. British Journal of Clinical Psychology, 45(4) 453-63.
Further reading[edit]
- Goldstein, Gerald; Beers, Susan, eds. (2004). Comprehensive Handbook of Psychological Assessment: Volume I: Intellectual and Neurological Assessment. Hoboken (NJ): John Wiley & Sons. ISBN978-0-471-41611-1. Lay summary (23 November 2010). This practitioner's handbook includes chapters by J.P. Das, Michael C. Ramsay, Cecil R. Reynolds, Jianjun Zhu, Lawrence G. Weiss, Aurelio Prifitera, Diane Coalson, R.W. Kamphaus, Anna P. Kroncke, Glen P. Aylward, Gerald Goldstein, Sue R. Beers, Ralph M. Reitan, Deborah Wolfson, Charles J. Golden, Robert A. Leark, Marit Korkman, Guila Glosser, Patricia M. Fitzpatrick, Elizabeth Kelley, Garland Jones, Deborah Fein, John DeLuca, Nancy D. Chiaravalloti, Michael J. Miller, Jo Ann Petrie, Erin D. Bigler, Wayne V. Adams, Connie C. Duncan, Allan F. Mirsky, Allan F. Mirsky, Connie C. Duncan, Richard D. Sanders, Antonio E. Puente, Anna V. Agranovich, Victor Nell, Jim Hom, and Janice Nici.
- Strauss, Esther; Sherman, Elizabeth M.; Spreen, Otfried (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford: Oxford University Press. ISBN978-0-19-515957-8. Retrieved 14 July 2013.
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