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Neuropsychological Assessment in the School
Setting
Stephen R. Hooper, Ph.D.Carolina Institute for Developmental DisabilitiesUniversity of North Carolina School of Medicine
Chapel Hill, NC.
North Carolina School Psychology Association Fall Conference, October 3, 2011
Objectives To increase participants’ understanding of
neuropsychological assessment versus other types of assessment.
To increase participants’ understanding of various approaches to neuropsychological assessment with children, with a specific focus on the flexible battery approach.
To examine various applications of neuropsychological assessment in the school setting, with a specific focus on writing problems in early elementary school children.
Assessment: A Definition
Assessment is a goal directed problem solving process that uses various measures within a theoretical framework. It is a variable process that depends on the questions asked, the type of student, and a myriad of social, developmental, and contextual factors. It cannot be reduced to a finite set of steps or rules.
Neuropsychology: A Definition
Clinical Neuropsychology is an applied science concerned with the behavioral expression of brain function/dysfunction. It is the study of the relationship between brain function and subsequent behavior.
Goals of Neuropsychological Assessment
Determine spared versus impaired abilities.
Understanding impact of injury and/or a neurodevelopmental problem (e.g., LD).
Assist in localization of function and dysfunction.
Goals of Neuropsychological Assessment
Assist in determining whether to remediate or to compensate.
Generate suggestions for remediation and compensation.• Growing base of evidence-based
interventions.
Suggestions for monitoring and tracking of progress in school setting.
When to Consider a Referral
Documented brain injury/insult Suspected brain injury or insult Neurodevelopmental disorder Unusual psychological profile Positive neurological findings Severe behavior problems Treatment needs
The Development of Neuropsychological Assessment
Development of the Field
Referred children appear more complex. Improvements in medical science have
decreased mortality, but increased morbidity. Contributions by child development. New measurement techniques. Specific training guidelines for the field. Steady evolution over past 60-70 years.
Stage I: Single Test Approach(mid-1940s to mid-1960s)
Goal:• Global differentiation of children with brain
damage from normals.
Features:• Use of general, all-purpose measures of
“organicity.”
• Brain damage as a unitary construct.
• Strictly empirical and atheoretical.
Stage II: Test Battery/Lesion Specification (early 1960s to mid-1970s)
Goal:• Detection and differentiation of brain lesions.
Features:• Use of varied battery of tests (e.g., Halstead-Reitan
Battery)
• Greater appreciation for the variability of brain damage
• Continued emphasis on maximizing hit- rates in categorical diagnosis
Stage III: Functional Analysis(1970s to 1980s)
Goals:• Specifying the behavioral effects of cerebral lesions
• Identifying the underlying components of impaired performance
Features:• De-emphasis on the use of neuropsychological tests
to make inferences regarding brain lesions
• “Re-Psychologizing” of neuropsychology
• Emphasis on neuropsychological description
Stage IV: Ecological Analysis(early 1980s to present)
Goals:• Relating assessment results to the child’s everyday
life and future potential
• Specifying conditions for maximizing adaptive functioning
Features:• Emphasis on neuropsychological prescription and,
most recently, evidence-based practice
• Evaluation of deficits relative to developmental and environmental demands
• Biopsychosocial framework
Stage V: Integrative Approach(mid-1990s to present)
Goal:• A more precise integration of brain structures with
corresponding brain function Features:
• Use of more sophisticated neuroradiologic assessment procedures (fMRI, MRS)
• Requires concomitant measurement of neurobehavioral functioning
• A 21st century merger of neurology and psychology
Neurological versus Psychological Assessments
Neurological Examination Components
Station and gait Motor tone and strength Cranial nerve functions Sensory-perceptual functions Mental status Neurostructural/neurophysiological
measures (not routine)
Major Features
Time efficient Largely assesses lower, and some
higher, cerebral functions Typically not standardized or normed Typically viewed as a screening
procedure
Psychological Examination Components
Intellectual Selected aspects of cognitive functioning
(e.g., visual-perceptual) Achievement Personality/Social-Behavioral
Major Features
Largely assesses higher cognitive functions
Rarely includes measures of lower cerebral measures
Usually adequately normed and standardized
Requires extended time
Neuropsychological Assessment
Neuropsychological assessment represents a combination of the neurological and psychological assessment strategies.
It uses assessment methods that tap both higher and lower cerebral functions in an effort to provide a comprehensive view of brain function.
Structure-Function Continuum
Neurostructural Measures
Neurobehavioral Measures
Neurophysiological Measures
MRICT
PETEEGERP
RCBF
PSYCHNEURO
NEUROPSYCH
fMRI
Neuropsychological Assessment: Approaches and Models
Approaches to Assessment
Fixed Battery Approach Eclectic/Flexible Battery Approach Boston Process Approach Qualitative Approach
Fixed Battery Approach:Characteristics
Aims to provide a comprehensive assessment of brain function using an invariant set of validated test procedures.
Major emphases placed on standardization and quantification.
Fixed Battery Approach:Advantages
Serves to assure a consistently broad-based assessment.
Replicability. Provides a standard data base for
comparative studies (clinical and scientific).
Fixed Battery Approach:Disadvantages
Generally does not provide an in-depth analysis of selected aspects of function.
Inflexibility. Assumes a relatively high degree of
patient compliance and no handicapping conditions that might interfere with task administration.
Flexible Battery Approach:Characteristics
Generally there is at least an implicit outline of the relevant neuropsychological constructs that should be assessed.
Any of a variety of validated tests may be selected to assess each functional area.
Psychometric properties and complementarity are usually key selection features.
Flexible Battery Approach:Advantages
Preserves the quantitative aspects of neuropsychological assessment.
Potential for a balanced and broad-based assessment if tests are selected according to key constructs.
Flexibility with respect to adapting it to different applications.
Flexibility with respect to upgrading.
Flexible Battery Approach:Disadvantages
Possible constraints on replicability and comparability.
Problems in making comparisons among measures that may differ in terms of norms, test construction, etc.
Variable composition may preclude validation studies on the battery as a whole.
A Construct-Driven Approach to Neuropsychological Assessment
Neuropsychological Constructs:Reitan/Rourke
Tactile perception Visual perception Auditory perception/language-related Problem solving, concept formation,
reasoning Motor and psychomotor Other (e.g., attention)
Neuropsychological Constructs:Fletcher
Language Visual-spatial and constructional Somatosensory Motor-sequential Memory and learning Attention[Fletcher suggests designing the battery around
the characteristics of the disorder]
Neuropsychological Constructs:Luria Clinical Model
Motor Sensory Attention Visual Language Memory Intellectual
Neuropsychological Constructs:Wilson Clinical Model
Language
• Auditory integration
• Auditory cognition
• Auditory short-term memory Visual
• Visual-spatial
• Visual cognition
• Visual short-term memory Motor
• Fine-motor
• Graphomotor
Neuropsychological Constructs
Motor Sensory perceptual Attention Language Visual processing Memory and
Learning Executive Functions
Related Domains• Intellectual
• Achievement
• Adaptive behaviors
• Social-emotional
• Family
• School environment
Motor Components
Gross motor strength Basic fine-motor speed Complex fine-motor speed Motor coordination and planning Spatial-based movement Oral-motor Balance
Sensory-Perceptual Abilities
Most evaluations typically assess the tactile, visual, and auditory modalities.
The modalities of olfaction and taste are tapped less routinely, although olfaction can be disrupted in many traumatic brain injuries or neurological processes affecting the prefrontal cortex.
Attention Abilities
Selective Attention (Focus/Execute)• Modality specific
• Alertness and Disinhibition Sustained Attention (Vigilance, Span) Encoding Attentional Set Shifting Divided Attention Stabilize/ReadinessNeed to distinguish between attention as a process
versus attention as a disorder.
Expressive Language
Communicative intent Oral-motor fluency Naming Word and phrase repetition Organization of output Vocal tone and prosody Pragmatics
Receptive Language
Phonemes Word and phrase comprehension Conflictual and comparative statements Vocal tone and prosody Speed of processing Pragmatics
Visual Processing
Visual recognition (faces, colors, objects) Visual discrimination Visual closure Visual-spatial (2-dimensional) Visual-spatial (3-dimensional) Visual organization and planning Visual problem solving and efficiency
Memory and Learning
Modality Time Retrieval
• Strategies for retrieval
Memory Components - Modality
Visual Verbal
• Language
• Non-verbal auditory Somatosensory/Tactile Taste Smell Multisensory
Memory Components - Time
Immediate/Short-Term – Information that you need once or for a few seconds.
Long-Term – Information that you need to retrieve at a later time.• Remote Recall – A special condition of long-
term recall
Memory Components - Retrieval Recognition Automatic Episodic vs. Nonepisodic Memory
• Contextualized recall Declarative vs. Procedural Memory
• Facts vs. procedures Strategies for retrieval
• Multiple repetitions
• Semantic cues
• Phonemic cues
• Associative learning
• Recognition
Executive Functions (Luria, 1966)
Executive function is defined as the ability to maintain an appropriate problem-solving set for attainment of a future goal. This set can involve (a) an intention to inhibit a response or to defer it to a later, more appropriate time; (b) a strategic plan of action sequences and/or; (c) a mental representation of the task, including the relevant stimulus information encoded in memory and the desired future goal-state.
Executive Functions (Welsh & Pennington, 1988)
Executive function is primarily the set maintenance required to achieve a future goal. This set would include the requisite skills of planning, organization, inhibition of maladaptive responses, self-monitoring, and flexibility of strategies contingent on feedback.
Goldman-Rakic (1990) would add to this definition the concept of working memory.
A Conceptual Model of Executive Functioning (Denckla, 1993)
Delay between stimulus and response Internal representation of schema Internal representation of action plan Response inhibition Efficiency and consistency of response Active strategies and deployment Flexible strategies and deployment
An Empirical Model of Executive Functioning (Welsh et al., 1991)
Speeded responding
• Visual search - achieved at age 6
• Verbal fluency - > age 12
• Motor sequencing - > age 12 Set maintenance
• Wisconsin Card Sort - achieved at age 10
• MFFT - achieved at age 10 Planning
• Tower of Hanoi (3 disk) - achieved at age 6
• Tower of Hanoi (4 disk) - > age 12
Executive Functions
Dorsolateral Prefrontal Cortex (DlPFC)
Regions within DlPFC appear to influence:• The selection of behaviors
• Recognition of context-dependent changes between stimuli and behavior
• Potentiation of sets of stimulus-response contingencies related to behaviors in context
• Flexible, goal-driven control of behavior
Executive Functions
Varying levels of damage to the DlPFC are associated with:• Lack of motivation, creativity, or goal-following• Difficulty in initiating or flexibly modifying actions,
resulting in stereotyped responses• Inability to assess others’ mental states – Theory of
Mind• Perseveration and more random-choice errors than
age-matched controls• Increased distractibility and problems with sustained
attention• Impaired working memory• Understanding of complex task rules
Executive Functions
Ventromedial Prefrontal Cortex (VmPFC) The VmPFC is critical for elucidating the
relation between stimuli and reinforcers and for explaining the inability of individuals with vmPFC damage to learn reward contingencies.
Executive Functions Damage to the orbitofrontal cortex, consisting
of both ventral and medial regions, leads to:• Impulsivity• Sensitivity to immediate rewards• Lack of self-control• Disruption of both affective and nonaffective stimuli
Individuals with VmPFC damage tend to select behaviors with the highest perceived reward, not the highest perceived utility.
Dorsolateral Prefrontal Cortex
Ventromedial Prefrontal Cortex
Frontal Pole
Eclectic Battery Framework
Key Constructs______________________________________________C1 C2 Language C4 C5 Cx______________________________________________
SC1 SC2 Speech perception SC4 SC5 SCxPhonology
SemanticsMorphologyLexicon
______________________________________________
Related Domains
Intellectual Achievement - critical to placement
• Reading, Writing, Arithmetic, etc.
• Skill deficits versus performance deficits Adaptive behavior Social-emotional Psychosocial environment (school,
family, social)
Developmental Shifts
Rate of information Volume of information Intensity (complexity) of information While important for all children, knowledge of
when these shifts may occur become critical for children with special needs because of the mismatch between the curriculum and their respective needs.
School Applications
School Applications Neurodevelopmental Disorders
• Learning Disabilities• High Functioning Autism
Genetic Disorders• Fragile X Syndrome• Turner Syndrome• Prader Willi Syndrome
Psychiatric Disorders• Early Onset Schizophrenia• Bipolar Affective Disorder• Neglect and Maltreatment• Post Traumatic Stress Disorder
Pediatric Disorders• Chronic Kidney Disease• Pediatric Hypertension• Traumatic Brain Injury
Other Conditions and Disorders
School ApplicationsWritten Language
Written Language The study of written language as a cognitive process
has slowly expanded over the past 30 years. High stakes testing and heightened accountability in
writing present new challenges. Research efforts fall well behind reading and math. National Center for Learning Disabilities report, “The
State of Learning Disabilities 2009,” doesn’t even mention writing disorders.
New guidelines for the DSM-V propose to eliminate Writing Disorder as a diagnostic entity.
Written Language
The cognitive origins of written language view it as a problem-solving process whereby authors attempt to produce their declarative knowledge.
This is more challenging for preschoolers and early elementary school children as they are just beginning to learn to write.• Most prevalent communication disability, with recent
estimates being at approximately 15% (Katusic et al., 2009).
• Writing problems increase with advancing age (e.g., 25% of students are proficient on the NAEP Writing Test) (National Center for Educational Statistics, 2005).
Written Language
Key theoretical models provide guidance.• Hayes and Flower (1980) – Classic recursive model
• Hayes (1996) – Revised recursive model
• Kellogg (1996) – Working memory model
• Berninger & Winn (2006) – Not-So-Simple View of Writing• Developmental unfolding of functions to facilitate writing
Hayes (1996) Recursive Model
Kellogg’s (1996) Working Memory Model
The Not-So Simple View of Writing Model(Berninger & Winn, 1996)
Written Language
From a neuropsychological perspective, these models suggest the involvement of several key functions:• Fine-Motor
• Language
• Memory
• Executive Functions and other regulatory mechanisms
-1.2
-1
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-0.6
-0.4
-0.2
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0.4
0.6
0.8
Good WritersPoor Writers
Executive Functions in Good versus Poor Writers
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Hooper et al.. (2002), Journal of Learning Disabilities
56789
10111213
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Good WritersPoor Writers
Scale
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Test of Memory and Learning Subtests
Memory Functions in Good versus Poor Writers
Verbal Nonverbal
Hooper et al.. (2011), In Submission
480
485
490
495
500
505
510
9.5 10.5 11.5
Age
WJ-
R B
road
Wri
tin
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kill
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Average Attention
Low Attention
Kindergarten Teacher Attention Ratings and Written Language Trajectories
Hooper et al. (2010), School Psychology Quarterly
480
485
490
495
500
505
510
9.5 10.5 11.5
Age
WJ
Bro
ad R
ead
ing
Low K Total Language
High K Total Language
Kindergarten Language Abilities and Written Language Trajectories
Hooper et al. (2010), School Psychology Quarterly
Classification Variables
readingspellingsemanticsgrammarunderstandability
Sta
nd
ard
ize
d M
ea
n
2
1
0
-1
-2
-3
-4
C 1
C 2
C 3
C 4
C 5
C 6
Written Language Subtypes (n = 257)
Wakely, Hooper, et al. (2006), Developmental Neuropsychology.
1
2
3
4
5
6
Pre-Test Post-Test
Ave
rage
Hol
isti
c S
core
s
S1 (n = 4)
S2 (n = 8)
S3 (n = 13)
S4 (n = 14)
S5 (n = 10)
S6 (n = 6)
S7 (n = 13)
Response to Problem Solving Intervention
Hooper et al. (2006), Developmental Neuropsychology
Writing Skills Development Project
Funded by: Institute for Educational Science; PI - Hooper
Specific Objectives
Examine the cognitive underpinnings for the development of written expression.
Examine the co-morbidity that is present in children at-risk for writing problems.
Examine the response to evidence-based intervention for children at-risk for writing problems.
Research Questions
Can we create a measurement model that is relatively stable across early elementary school grades?
Do the components of this model relate to written language in early elementary grades?• According to the Not-So-Simple View of Writing, we
would expect the fine-motor and language functions to correlate the strongest with written language in first and second grades.
Participants
N = 205 students ascertained from a single school district in NC. (stratified across 7 elementary schools and associated classrooms).
Inclusion/Exclusion criteria:• English-speaking
• Participation in kindergarten
• Bulk of education in the regular curriculum
Participants
Chronological Age• First Grade = 6.54 years
• Second Grade = 7.54 years
Race: 75.1% Caucasian Gender: 57.1% Male Maternal Education: HS+ = 75% IQ = 96.78 (13.09)
Measures
Tasks were extracted from the various developmental models of writing and included measures of:• Fine-motor
• Language
• Attention/Executive Functions
Tasks were normatively based, age-appropriate, and readily available to the typical clinician.
Measures Motor
• PAL Finger Sense Succession-Dominant Hand• PAL Finger Sense Succession-Nondominant Hand
Language• PAL Elision• PAL Letters• PAL Word Choice
Attention/Executive Functions • Verbal working memory• Visual working memory• WJ-III Planning• WJ-III Verbal Retrieval• Vigil Errors of Omission• Vigil Errors of Commission
Neurocognitive Components Model
Fine Motor
Attention/
Executive
Function
Language
WIAT IIWritten
Expressionand Spelling
PAL Finger
Succession
Dominant
PAL Finger Succession
Non-Dominant
Verbal Working Memory
WJ-III Retrieval Fluency
WJ-III Planning
VIGIL Omission
s
VIGILCommissions
PAL Letters
PAL Word
Choice
Elision/PAL
Phonemes
Visual Working Memory
Hooper et al. (2011), Reading and Writing.
Measures The WIAT-II Written Expression Subtest served as
the primary outcome measure.• At grades 1 and 2, the Written Expression subtest consists of
three tasks: timed alphabet writing, written word fluency, and sentence combining.
• At grade 3, the student is asked to write a paragraph in accordance with a specific writing prompt.
The WIAT-II Spelling Subtest includes items to demonstrate knowledge of written letters, letter groups, and words.
The WIAT-II Written Expression Subtest was administered to the entire sample each fall, and at the beginning and ending of the treatment trial to the designated At-Risk students.
Results
Time Χ2 GFI RMSEA SRMR
Grade 1 43.23 .99 .02 .04
Grade 2 54.71 .96 .05 .04
Criteria: Goodness of Fit Index > .95, Root-Mean Squared Error of Approximation < .06,and Standardized Root-Mean Squared Residual < .08
Predictive Relationships
Predictive Models
Written Expression R2
Spelling R2
1st Grade-1st Grade
.48 .74
2nd Grade-2nd Grade
.57 .82
1st Grade-2nd Grade
.58 .76
Predictive Relationships
Predictive Models Written Expression
Spelling
1st Grade-1st Grade EF + Gender (male)
EF
2nd Grade-2nd Grade
EF + Language
Reading
1st Grade-2nd Grade
EF +Gender (male)
EF + Reading
Summary The neurocognitive model works well at each time
point and over time. There is strong relationship of the neurocognitive
model with written expression (48%-58% of the variance) and spelling (74%-82% of the variance) at each time point.• Executive functions and language abilities appear to
contribute the most to these relationships. Suggests the foundation for an empirically-based
neurocognitive assessment for writing in young children, but reinforces the need to include specific measures.
Summary These relationships provide support for the
neurocognitive components espoused by several different theoretical models of writing in young elementary school children.
The invariant weighting of the specific constructs in the model at grades 1 and 2 does not support the sequential unfolding of the core neurocognitive functions.• The developmental unfolding may occur at a different time
point (e.g., does fine-motor happen earlier?).• The relative strength of executive functions to written
expression was surprising at this age, but highlighted the importance of assessing these functions early in written language development and interventions.
Summary Reflection of the measures used? What will
happen when other variables are added to the model (e.g., affect, motivation)?
Will model work differently with younger or older children? Children with WD? Heterogeneity of WD? Response to intervention?
Need more research to examine evidence-based diagnostic and treatment practices.
What about linkages to neuroscience?
The Importance of Cognitive Functions in a Response-to-Treatment Paradigm
for Writing
Research Questions
Can we show improvement in the writing of at-risk writers using an evidence-based approach to writing?
Do specific cognitive variables have any influence on response to treatment?
Do selected cognitive subgroups perform differently in their response to treatment?
Participants Second grade participants were screened with respect
to their writing skills with the WIAT-II Written Expression scale.
This resulted in 138 students deemed at-risk for a written language disorder (i.e., < 25th percentile), and 67 students not at-risk for writing problems.
• The not at-risk students were selected randomly at the school and classroom levels.
Students deemed at-risk were randomly assigned into treatment (n = 68) versus no-treatment (n = 70) conditions.
Measures Employed the same measurement model. The WIAT-II Written Expression Subtest served as the
primary outcome measure.• At grades 1 and 2, the Written Expression subtest consists of three
tasks: timed alphabet writing, written word fluency, and sentence combining.
• At grade 3, the student is asked to write a paragraph in accordance with a specific writing prompt.
The WIAT-II Spelling Subtest includes items to demonstrate knowledge of written letters, letter groups, and words.
The WIAT-II Written Expression Subtest was administered to the entire sample each fall, and at the beginning and ending of the treatment trial to the designated At-Risk students.
Procedures Comprehensive assessments were conducted in the fall
of first, second, and third grade. Interventions were conducted via small groups (i.e., 3 to
6 students) between January and May of the second grade.
Interventions comprised use of the PAL Lesson Plans #4 and #7 (Abbott & Berninger, 2003).• Focused on development of alphabetic principle at the subword
and word levels, and aspects of text generation.• Manualized treatment protocol that is commercially available.
Conducted twice a week for 12 weeks at 25 minutes per session.• 94% fidelity rate for the second grade intervention.• 85% attended at least 75% of the sessions.
Procedures
Students assigned to the no treatment at-risk group and the typical group received written language instruction via the regular classroom setting in a Business-As-Usual model.• For these students, written language instruction
followed a state-wide standard course of study. Writing skills were immersed in daily classroom
activities, with little in the way of direct instruction for written expression.
Question 1: Findings All three of the groups demonstrated growth in their writing
skills over time. When the contrasts between the three groups are examined,
the treatment effect was significant only on the quadratic component of the slope (B Estimate = 1.18, p < .006).• The quadratic component represents an acceleration parameter,
indicating that the treatment induced acceleration in the rate of writing skill acquisition for treated participants.
The growth rate for the treated group begins to accelerate such that by the start of third grade the growth rate for the treated group has significantly exceeded the rate for the untreated at-risk group (B Estimate = 2.79, p < .003).
Effect sizes were small.
Hooper et al. (2011), Annals of Dyslexia.
Question 1: Findings
Using curriculum-based measures for the Treatment Group, we also found evidence for significant progress in:• Writing Organization as determined by
sentence structure and the total number of words correctly sequenced.
• The number of varied vocabulary words used.
• The number of words spelled correctly.
• The total number of words written.
• Overall holistic score
Question 2: Findings When the interactions between the treatment group
were examined, both the attention/executive function and language moderators approached significance.• There was no interaction between treatment group and
fine-motor speed. For language, this was seen in both the linear (B = -
1.42, p < .10) and quadratic (B = -1.95, p < .06) growth curves.
For attention/executive functions it was seen for the linear growth function (B = 1.20, p < .08).
These findings suggest that moderating effects of different cognitive functions cannot be ruled-out as contributors to the response-to-intervention effects.
60
70
80
90
100
T1 T2 T3 T4 T5
Low EF
Intact EF
Assessment Time Points
WIA
T-I
I W
ritte
n E
xpre
ssio
nS
tand
ard
Sco
res
Moderating Effects of EFs on Treatment
p < .08
Question 3: Findings To construct the latent class groupings, we
employed the three latent variables from our measurement model (Fine-Motor, Attention/Executive Functions, Language) for the available 138 students.
Findings revealed two empirically-based classes.• Specific Deficit Group (n = 90), with average probability
of class membership of .93.
• Low g Group (n = 58), with average probability of class membership of .93.
Question 3: Findings Based on latent class analysis, there were 5 groups:
• Typically Developing (TD)• Specific-Deficit Untreated• Specific-Deficit Treated• Low-g Untreated• Low-g Treated
Findings indicated that there was significant change over time on the WIAT-II Written Expression for all 5 groups.
When we focused on the treatment effects within the two latent classes, significant treatment effects were observed within both the Specific-Deficit and Low-g classes.
Question 3: Findings For the Specific-Deficit Class, the treatment
significantly affects only the quadratic component of the trajectory (B = 1.28, p < .02), although the linear component of the growth trajectory approached significance in the expected direction (B = 0.73, p < .10).• In each instance, the students in the treatment groups show a
steeper slope than the untreated students following the intervention.
In the Low-g Class, the treatment positively and significantly affects both the linear component (B = 1.54, p < .01) and the quadratic component (B = 2.08, p < .002).• The Low-g treated group showed a faster rate of gain on the
WIAT-II Written Expression score following the intervention.
Hooper et al. (2011), Annals of Dyslexia.
Summary
This study provides modest support for the PAL Lesson Plans in the treatment of young elementary school children at-risk for problems in written expression.• This change follows only 10 hours of intervention.
• The rate of growth for the treatment group was superior to the other two groups following intervention.
This study also examined moderator effects on intervention for students at-risk for writing disorders.• Both language and attention/executive functions approached
significance such that lower scores influenced overall performance.
Summary
In addition to specific cognitive moderators, when latent class groupings of students were derived, a differential rate of change was noted.
These differences were seen in:• Students with skill deficits in writing, but with
relative strengths in their executive functions.
• Students with overall lower functioning.
Summary
An RTI model and associated curriculum based measures may not be enough for many children to succeed with treatment.
Perhaps other variables, such as executive functions, need to be considered and factored into the intervention paradigm.
These findings suggest the need for more detailed assessments of many children prior to beginning an RtI paradigm so as to facilitate the effectiveness of instruction.
Conclusions
Conclusions
There is a long standing history of the involvement of neuropsychology with educational settings and learning.• School Neuropsychology
Knowing the differences in how you approach an assessment as an examiner as well as from a consumer perspective is important.
Conclusions From an empirical perspective, under no
circumstance is the wholesale use of IQ testing for identification of LD justified, and the same could be said for neuropsychological assessments.
Evidence-based hypotheses should guide the assessment process (e.g., spatial abilities in math, phonological awareness in reading, executive functions in writing), and the use of neurocognitive constructs should facilitate this effort.• Remember, it is a problem solving process!
Conclusions A comprehensive neuropsychological evaluation probably
should be employed for the most severely involved LDs (e.g., the Tier 2-3 cases) and medically involved cases.• Subtype X Treatment models remain to be verified, although the findings
are mixed at present.• Utilization of neurocognitive data in the RtI model has not been fully
tested. A comprehensive neuropsychological evaluation also may
be useful in younger learners or children with medical difficulties where neurocognitive abilities may be predictive of later learning.
Given the high rate of co-morbid conditions in the school setting, these conditions also should be considered in the assessment process.• The underlying neurobiological mechanisms may be inter-related (e.g.,
ADHD and RD).
Questions?Contact Information: