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Advanced Cross-Battery Assessment Using CHC Theory and Neuropsychological Measures. Catherine A. Fiorello, Ph.D., ABPP Temple University September 30, 2011. Workshop Objectives. Participants will be able to: U se XBA to detect processing deficits in identifying students with LD and ADHD - PowerPoint PPT Presentation
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Advanced Cross-Battery Assessment
Using CHC Theory and Neuropsychological Measures
Catherine A. Fiorello, Ph.D., ABPPTemple University
September 30, 2011
Workshop Objectives
Participants will be able to:• Use XBA to detect processing deficits
in identifying students with LD and ADHD
• Describe how processing assessment can be integrated within an RtI model
• Understand how CHC Theory and neuropsychological assessment work together
Cognitive Product or Process:Synthesizing Paradigms
• Compares individual to norm
• Focuses on score: Assessment Product
• Interpret levels of performance
• Compares individual to self
• Focuses on performance: Assessment Process
• Interpret patterns of performance
Nomothetic Assessment
Idiographic Assessment
BOTH essential for effective assessment and intervention
IDEA 2004: The Impetus for Developing Better Assessmentand Intervention Strategies
Identifying Children with Learning Disabilities:
IDEA Definitions and Practices
• Learning Disabilities is a disorder of one or more of the basic psychological processes that adversely affects educational achievement in one or more academic domains
Defining Learning Disabilities
• Discrepancy between “ability” and “achievement” (typically using cut-off points and global IQ)
• Failure to respond to scientific research-based intervention
• May permit the use of other alternative research-based procedures for determining whether a child has a specific learning disability, as defined in §300.8(c)(10) (OSERS Final Regulations-8/06)
Determining Learning Disabilities
RtI as Prereferral Process
• Prereferral interventions, with good progress monitoring, are essential to serving children.
• Interventions may help a large number of children (e.g., Torgeson, early reading, 94-96%).
• Tracking response to intervention provides good information about what works and what doesn't.
• Avoids “waiting to fail.”
Problems with RtI• Established interventions for many
referral problems do not exist.• Agreement on goal setting (what is
failure to respond?) can be problematic.
• Many children are referred for multiple areas of difficulty.
• Failure to respond may be due to many reasons other than disability.
RtI and LD
• RtI provides valuable information as part of an evaluation for learning disabilities
• A failure to respond to interventions is not, by itself, diagnostic of a learning disability.
• Cognitive and neuropsychological processing is critical to identifying LD.
• School psychologists can and should evaluate processing.
~85%
~10%
~3%
~2%
Protocol-based interventions
Personalized interventions
IEP
Universal screening
Individual screening
Comprehensive assessment:
cog/neuro/ach ecobehavioral personality etc.
High quality research-based teaching
Fiorello Comprehensive RTI Model
Cognitive Hypothesis Testing Model
Source: Hale, J. B., & Fiorello, C. A. (2004). School Neuropsychology: A Practitioner’s Handbook. New York, NY: Guilford Press.
Theory
Hypothesis
Data Collection
Interpretation
1. Presenting Problem
2.Intellectual/Cognitive Problem
3. Administer/Score Intelligence Test
4. Interpret IQ or Demands Analysis
5. Cognitive Strengths/Weaknesses
6. Choose Related Construct Test
7. Administer/Score Related Construct Test
8. Interpret Constructs/Compare
9. Intervention Consultation
10. Choose Plausible Intervention
11. Collect Objective Intervention Data
12. Determine Intervention Efficacy
13. Continue/Terminate/Modify
Implications for Assessment and Intervention
Processing and LD
• Literature in cognition, cognitive assessment, neuropsychology, and learning disabilities links cognitive processing with achievement and LD.
• Regular education curricula tend to focus on a few areas of processing (e.g., phonemic awareness) to the exclusion of many others.
• Once there has been failure to respond, process assessment can be used to develop interventions.
School Neuropsychology: The Key to Reconceptualizng Cognitive Processes
for Assessment and Intervention
The Two Axes Interpretation
Posterior-Sensory Input-Comprehension
Anterior-Executive Functions-Motor Output
Structural Hemispheric Differences
MoreGreyMatter
MoreWhiteMatter
MorePrimaryCortex
MoreAssociation Cortex
Left Hemisphere
Right Hemisphere
MoreIntramodalConnections
MoreIntermodalConnections
Source: Goldberg, E., & Costa, L. D. (1981). Hemispheric differences in the acquisition and use of descriptive systems. Brain and Language, 14, 144-173.
The Two Axes Interpretation
Posterior-Sensory Input-Comprehension
Anterior-Executive Functions-Motor Output
Left Hemisphere-Routinized/Detailed/Local-Convergent/Concordant-Crystallized Abilities
Right Hemisphere-Novel/Global/Coarse-Divergent/Discordant-Fluid Abilities
Is There Evidence?
• Newborn language processing• Musician processing of symphonies• American Sign Language in the deaf• Brain activation in novice-new learning vs.
expert-learned• Bilateral fMRI activation: Left and right for
Verbal; Right and left for nonverbal processing
Source: Hale, J. B., & Fiorello, C. A. (2004). School Neuropsychology: A Practitioner’s
Handbook. New York, NY: Guilford.
Psychological processes matter more thanstimulus input or response output!
Hemispheric Functions andLanguage
Left HemisphereRight Hemisphere
Low Demand High Demand
Source
Belger & Banich, 1998
Local/Detailed Global/Holistic Delis et al., 1986
Microstructural Macrostructural Glosser, 1993
Fine Processes Coarse ProcessesBeeman/Chiarello, 1998
Close Semantic Distant Semantic Chiarello, 1998
Concordant/Convergent
Discordant/Divergent
Bryan & Hale, 2001
Simple Syntax Complex Syntax Cooke et al., 2001
Routinized/AutomaticNovel/New LearningGoldberg/Costa, 1981
Comprehensive Assessment Model
STUDENT
HOME SCHOOL
COMMUNITY
PEERS
Instruction
Interventions
Structure
Supports
Services
Family Constellation
Siblings
Attachment
Parental Mental Health
Parental Educational Background
Resources
Economic Resources
Social Resources
Role Models
Violence
Friendship
Role Models
Bullying
Social SkillsVocational
Interests
Academic
Skills
Study SkillsAdaptive
Behavior
Developmental Status
Physical Health
Cognitive Abilities
Emotion Regulation
Psychopathology
Language History
Language Development
Background Knowledge
Motivation
The Cattell-Horn-Carroll (CHC) ModelAchievement Basic Reading Reading
ComprehensionWritten Expression
CHC Factors Ga-PC Phonetic Coding (Phonemic Awareness)
Ga Auditory Processing-Phonetic Coding
Ga-PC Phonetic Coding
Gsm Short-Term Memory-Memory Span-Working Memory
Gsm Short-Term Memory-Memory Span-Working Memory
Glr Long-Term Storage and Retrieval
Glr Long-Term Storage and Retrieval-Naming Facility (RAN)-Meaningful Memory
Gs Processing Speed-Perceptual Speed
Gs Processing Speed-Perceptual Speed
Gs Processing Speed
Gc Crystallized Ability-Vocabulary-Listening Skills-Language Development-General Knowledge
Gc Crystallized Ability-General Knowledge-Listening Skills
Gc Crystallized Ability-Vocabulary-Language Development-General Knowledge
Gf Fluid Reasoning
CHC Model, cont.
Achievement Basic Math Math Reasoning Oral Language/Listening Comprehension
CHC Factors Ga-PC Phonetic Coding
Ga-PC Phonetic Coding
Gsm-MW Working Memory
Gsm Short-Term Memory-Memory Span-Working Memory
Gs Processing Speed-Perceptual Speed
Gs Processing Speed-Perceptual Speed
Gc Crystallized Ability
Gc Crystallized Ability
Gc Crystallized Ability
Gf Fluid Reasoning Gf Fluid Reasoning
Gq Math Knowledge
Gq Math Reasoning
Gv Visual Processing?(Higher Math?)
The Neuropsychology ofReading Disorders
• Phonological Awareness
• Symbolic Representation
• Phoneme-Grapheme Correspondence
• Timing/Automaticity
• Word Attack vs. Sight Word Strategies
• Semantics• Syntax• Pragmatics• Timing/
Automaticity-Fluency
• Explicit-Factual vs. Implicit-Inferential Comprehension
Word Recognition Reading Comprehension
Double-Deficit or multiple subtypes?Source: Hale, J. B., & Fiorello, C. A. (2004). School Neuropsychology: A Practitioner’s Handbook. New York, NY: Guilford.
The Neuropsychology ofMath Disorders
• Quantitative Knowledge
• Value-Grapheme Correspondence
• Sequential/Working Memory
• Visual-Perceptual-Spatial (higher only)
• Graphomotor
• Auditory Processing
• Verbal Comprehension
• Quantitative Knowledge
• Word/Symbolic Representation
• Sequential/Working Memory
• Fluid/Quantitative Reasoning
Computation Word Problems
Source: Hale, J. B., & Fiorello, C. A. (2004). School Neuropsychology: A Practitioner’s Handbook. New York, NY: Guilford.
Developing and Testing HypothesesAbout Cognitive Processes and
Achievement• Examine profile for significant subtest or factor
scatter • If global scores are invalid, interpret subtest
performance within and between subtests• Use Demands Analysis to examine Input,
Processing, and Output Demands (Caution: Processing Demands More
Relevant)• Demands Analysis is prone to error, must
validate with additional measures (Caution: Avoid Cookbook Interpretation)• Data must show convergent, divergent, AND
ecological validity
Demands Analysis: Block DesignDetermining InputProcessingOutput
Demands
Input Demands:• Models and abstract visual pictures• Lengthy oral directions-receptive
language• Demonstration and modeling• Perception of timed task• Low cultural knowledge and emotional
content
Demands Analysis: WISC-IV Block Design
Determining InputProcessingOutput Demands
Processing Demands:• Novel task for most children (note
beginning vs. later task performance-also when lines removed)
• Visual processing: Spatial-global• Visual processing: Directional
orientation-local• Perceptual analysis (divergent thought)
and synthesis (convergent thought)• Planning, strategizing, and monitoring
performance: Match to sample• Sustain attention, inhibit
impulsive/error responding
Demands Analysis: WISC-IV Block Design
Determining InputProcessingOutput Demands
Demands Analysis: WISC-IV Block Design
Determining InputProcessingOutput Demands
Output Demands:• Fine motor response, arrange
manipulatives• Bimanual sensory (visual-
somatosensory) – motor coordination• Processing speed
Processing AssessmentUsing Specific Tests
DAS-IICopying Gv:Vz Visual-motor integration,
graphomotor skills
Early Number Concepts
Gq:A3, KM
Receptive language, spatial and numerical concepts
Matching Letter-Like Forms
Gv:Vz Visual perception, orientation, attention to details
Matrices Gf:I Inductive reasoning, multiple choice
Naming Vocabulary
Gc:VL, LD
Expressive naming
Pattern Construction
Gv:SR Visual-spatial processing, constructional praxis, planning, bimanual coordination
Phonological Processing
Ga:PC Phonological awareness, segmentation, assembly
Picture Similarities
Gf:I Fluid reasoning, visual perception
Rapid Naming Glr:NAGs:Pc
Fluent retrieval from LTM; automaticity of visual-auditory associations
Recall of Designs
Gv:MV Visual and spatial memory
Recall Digits-Forward
Gsm:MS Rote auditory memory, sequencing
DAS-II, cont.Recall Digits—Backward
Gsm:WM Working memory for auditory material
Recall Objects—Immediate
Glr:M6 Memory for verbal and pictorial stimuli
Recall Objects—Delayed
Glr:M6 Longer-term memory, verbal and pictures
Recall Sequential Order
Gsm:WM Short-term memory for verbal and pictorial stimuli, sequencing
Recog. of Pictures
Gv:MV Nonverbal visual memory, recognition
Seq. & Quant. Reasoning
Gf:I, RQ Fluid reasoning, sequential reasoning, figural and numeric
Verbal Similarities
Gc:LD Verbal knowledge, verbal reasoning
Speed of Info Processing
Gs:N, R9 Processing speed, graphomotor
Verbal Comp. Gc:LD, LS
Receptive language, basic language concepts
Word Definitions
Gc:VL, LD
Verbal knowledge, oral expression
KABC-IISimultaneous/Gv
Triangles Visual-spatial processing, constructional praxis, planning, bimanual coordination
Face Recognition Visual facial memory (ventral stream)
Pattern Reasoning (5-6)
Inductive reasoning, visual processing, figural
Block Counting Visual-spatial processing, quantitative knowledge
Story Completion (5-6)
Reasoning, sequencing, attention to visual details
Conceptual Thinking
Inductive reasoning, visual processing, pictorial
Rover Planning, inhibition, spatial processing
Gestalt Closure Visual processing, holistic perception
Sequential/Gsm
Word Order Short-term auditory memory for unrelated words, nonverbal response, later items interference task
Number Recall Short-term auditory memory
Hand Movements Short-term visual memory, sequencing, praxis
KABC-II, cont.Planning/Gf
Pattern Reasoning (7-18)
Inductive reasoning, visual processing, figural
Story Completion (7-18)
Reasoning, sequencing, attention to visual details
Learning/Glr
Atlantis +Delayed Associative memory, meaningless symbols and names, syllable length cues
Rebus +Delayed Associative memory, rebus clues to meaningful sentences
Knowledge/Gc
Riddles Receptive language, reasoning, long-term memory retrieval
Expressive Vocabulary
Word knowledge, oral expression
Verbal Knowledge General knowledge, multiple choice, pictorial representations
CASPlanning
Planned Codes
Gs:R9 Sustained attention, psychomotor speed, strategy use
Matching Numbers
Gs:P Sustained attention, visual scanning, psychomotor speed, strategy use
Planned Connections
Gs:P Sustained attention, visual scanning, psychomotor speed, strategy use
Simultaneous
NV Matrices Gf:I Inductive reasoning, multiple choice
Verbal/Spatial Relations
Gv:SRGc:LS
Receptive language, working memory, grammatical relationships, visual scanning/discrimination
Figural Memory
Gv:MV, CF
Visual perception, spatial relationships, visual memory, graphomotor reproduction, constructional skills, figure-ground relationships
CAS, cont.Attention
Expressive Attention
Glr:NA Inhibition of automatic response; similar to Stroop
Number Detection
Gs:P Cancellation task, sustained attention, visual scanning, visual discrimination, inhibition, psychomotor speed
Receptive Attention
Gs:P Sustained attention, visual scanning, attend to perceptual, then shift set to meaning
Successive
Word Series Gsm:MS Word span, rote auditory memory
Sentence Repetition
Gsm:MSGc:MY
Rote recall of meaningless sentences, grammatical structure important
Sentence Questions
Gsm:WMGc:LD
Language comprehension based on grammatical structure with meaningless content
Speech Rate Gps:PT Oral praxis
WISC-IV IntegratedVerbal Comprehension
Verbal Subtests Multiple Choice
Long-term memory retrieval; compares free-recall and recognition memory
Working Memory
Visual Digit Span (Forward)
Compare visual to auditory memory span
Spatial Span (Forward and Backward)
Compare visual to auditory working memory
Letter Span (Forward) Compare numbers to letters (familiarity)
L-N Seq Process Approach
Arithmetic Process Approach
Compare working memory effects
Written Arithmetic Compare arithmetic knowledge
WISC-IV Integrated, cont.Perceptual Reasoning
Block Design Multiple Choice
Visual discrimination and spatial perception; removes v-m integration and speed demands
Block Design Process Approach
Comparison of orientation (LH) versus configuration (RH) errors
Elithorn Mazes Executive funtions—planning, organization, monitoring, inhibition; graphomotor skills
Processing Speed
Coding Copy Visual-motor integration, graphomotor skills, processing speed
Coding Recall Paired-associate symbol and digit recall, free recall
CMSAuditory/Verbal
Stories Glr:MM Auditory attention, semantic long-term memory encoding and retrieval, sequencing/grammar, verbal comprehension, expressive language
Word Pairs Glr:MA Paired-associate task; auditory attention, learning novel word pairs
Word Lists Glr:M6 Selective reminding task; long-term memory encoding, storage and retrieval of unrelated words
Visual/Nonverbal
Dot Locations
Gv:MV Visual-spatial memory encoding and retrieval (dorsal stream); susceptibility to interference
Faces Gv:MV Facial memory encoding and retrieval (ventral stream)
Attention/Concentration
Sequences Gsm:WM
Rote recall followed by mental manipulation--executive function (working memory)
NEPSY-II
Executive Functions/Attention
Animal Sorting
Gf:I Problem-solving, verbal and spatial concept formation, categorical thinking, flexibility of thinking
Auditory Atten & Response Set
Gs Sustained auditory atten., vigilance, inhibition, set maintenance, flexibility
Clocks Gv:VzGc:K0
Telling time, reading analogue clocks, visual-spatial processing, graphomotor
Design Fluency
Glr:FF Visual-motor fluency, flexibility, divergent thinking, graphomotor
Inhibition Glr:NA Naming fluency, inhibition, shifting set
Knock and Tap
Gsm:WM
Self-regulation, inhibition, maintaining set
Statue Resistance to distraction, inhibition, motor persistance
NEPSY-II, cont.Language
Body Part Naming
Gc:K0 Knowledge of body parts, receptive and expressive
Comprehension of Instructions
Gc:LS Receptive language, sequencing, grammar
Oromotor Sequences
Gps:PT Oral praxis, sequencing, memory span
Phonological Processing
Ga:PC Auditory attention, phonological awareness, segmentation, assembly
Recognition of Reversals
Gv:MVGc
Visual perception of orientation, orthographic knowledge
Repetition of Nonsense Words
Ga:UMGsm:MS
Phonemic awareness, auditory memory span, sequencing
Speeded Naming
Glr:NA Naming automaticity, processing speed
Word Generation
Glr:FW Verbal fluency, integrated RH/LH functioning, compare category with letter responses
NEPSY-II, cont.Sensorimotor Functioning
Fingertip Tapping
Gps:MT
Simple motor speed, perseverance
Imitating Hand Positions
Gp:P2 Visual perception, praxis, kinesthesis
Manual Motor Series
Gp Imitate a series of rhythmic movements
Visuomotor Precision
Gp Visual-motor integration, graphomotor w/o construction
Social Perception
Affect Recognition
Gkn:BC
Facial processing (ventral stream), matching emotions
Theory of Mind Gkn:BC
Perspective taking for knowledge and emotions
NEPSY-II, cont.Visuospatial Processing
Arrows Gv:SR
Spatial processing, visualization, line orientation, inhibition, no motor
Block Construction
Gv:Vz
Visual-spatial processing, constructional praxis, planning, bimanual coordination
Design Copying
Gv:Vz
Visual-motor integration, graphomotor skills, local and global processing
Geometric Puzzles
Gv:Vz
Visual-spatial processing; figural, mental rotation, no motor demands
Picture Puzzles
Gv:CFGc:K0
Visual-spatial processing, pictorial, visual discrimination, local detail processing, figure-ground
Route Finding
Gv:SS
Visual-spatial processing, orientation
NEPSY-II, cont.Memory and Learning
List Learning (Delay)
Glr:M6 Verbal memory
Memory for Designs (Delay)
Gv:MV Visual memory, spatial recall and visual details
Memory for Faces (Delay)
Glr:MA Facial memory (ventral stream)
Memory for Names (Delay)
Glr:MA Associative memory, names and faces
Narrative Memory
Glr:MM
Meaningful memory
Sentence Repetition
Gsm:MSGc:LD
Auditory short-term memory, content and grammatical structure important
Word List Interference
Gsm:WM
Auditory memory, short term and working memory (with interference)
D-KEFSSorting Problem-solving, verbal and spatial concept
formation, categorical thinking, flexibility of thinking
Trail Making
Mental flexibility, sequential processing on visual-motor task, set shifting
Verbal Fluency
Verbal fluency
Design Fluency
Visual fluency
Color-Word Interference
Attention and response inhibition
Tower Planning, flexibility, organization, spatial reasoning, inhibition
20 Questions
Hypothesis testing, verbal and spatial abstract thinking, inhibition
Word Context
Deductive reasoning, verbal abstract thinking
Proverb Metaphorical thinking, generating versus comprehending abstract thoughts
CTOPPPhonological Awareness
Elision Ga:PC Phonological perception, segmentation
Blending Words
Ga:PC Phonological assembly
Sound Matching
Ga:PC Phonological perception, segmentation
Phoneme Reversal
Ga:PCGsm:WM
Phonological perception, segmentation, working memory
Blending Nonwords
Ga:PC Phonological assembly
Segmenting Nonwords
Ga:PC Phonological perception, segmentation
Phonological Memory
Memory for Digits
Gsm:MS
Short-term memory, sequencing
Nonword Repetition
Ga:UMGsm:MS
Phonemic analysis, assembly, working memory
CTOPP, cont.
Rapid Naming
Rapid Digit Naming
Glr: NA
Number automaticity, processing speed, verbal fluency
Rapid Letter Naming
Glr: NA
Letter automaticity, processing speed, verbal fluency
Rapid Color Naming
Glr: NA
Color name knowledge, naming automaticity, processing speed, verbal fluency
Rapid Object Naming
Glr: NA
Object recognition, naming automaticity, processing speed, verbal fluency
Tests Discussed
• CMS Children’s Memory Scale PsychCorp/Pearson
• CAS Cognitive Assessment System Riverside• CTOPP Comprehensive Test of Phonological
Processing Pro-Ed• DAS-II Differential Abilities Scales Second
Edition PsychCorp/Pearson• D-KEFS Delis-Kaplan Executive Function
System PsychCorp/Pearson• KABC-II Kaufman Assessment Battery for
Children Second Edition Pearson Assessments • NEPSY-II PsychCorp/Pearson• WISC-IV Integrated PsychCorp/Pearson