WRAML2

Wide Range Assessment of Memory and Learning

Second Edition

MEMORY AND ITS MEASUREMENT

Without memory, life as we know it will be impossible.

Memory is a central feature of human intelligence and is represented in nearly all day to day functions, including intellectual, academic, social, vocation, or recreational.

IN DEFINITION Memory is the ability to recall an event,

an object, or a behavior-to remember something.

I forgot to feed the dog

•Memory is also a Central Cognitive Process

SO WHAT’S OUT THERE TO MEASURE MEMORY??? The Wide Range Assessment of Memory

and Learning-Second Edition (WRAML2). It is a major comprehensive memory

battery currently available for assessment of memory function in children and adults.

This battery is intended to reliably sample a variety of memory functions that are of clinical and theoretical interest for children, adolescents, and adults.

Some people considered the definition of learning

as also defining memory, due to the thought that anything recalled must have been learned.

The WRAML2 distinguish memory and learning by providing subtest that assess both immediate memory as well as new learning over multiple trails, and subsequent recall of new acquired information.

HISTORICAL FOUNDATIONS Hans Ebbinghaus is generally

recognized as among the first to study memory. He studied memory using digit span task and nonsense syllables.

He showed that the amount to be remembered affects performance and having a way to chunk information increased performance.

MANY OTHER CONTRIBUTORS Alfred Binet- Very interested in memory and

20% of his first intelligence test consisted of questions directly assessing immediate verbal and visual memory abilities.

Karl Lashly- 1950 studied long term memory Alexander Luria -1956 unlimited long term

memory George Miller- 1956 7(+) or (-)2 rule. And many others contributed an enormous

amount of research that help us better understand memory.

HISTORICAL FOUNDATION Despite over a century of research on

the topic of memory, the clinical assessment of normal and disordered memory has been loaded with problems, many of which stem from difficulties separating attention and memory as well as immediate memory from short-term and long-term memory.

HISTORICAL FOUNDATIONS

What’s today's date?, What are some current new items? Repeat after me…

Standard neurological exams dating back to the beginning of the last century, neurologist have always asked the patient questions concerning “today’s date,” current new items, and some recitation of letters, words, or sentences as a basic attempt to establish whether memory was normal.

Neurological disorders impact memory with such variability that more elaborate assessment methods were necessary. Impaired or not impaired was the only diagnostic assumption.

HISTORICAL FOUNDATIONS

Qualitative methods did not provide an awareness of milder deficit or identification of areas of memory strength.

Your memory is impaired!

HISTORICAL FOUNDATION

The need for some type of standardization or battery of test that that could assess memory became obvious during the era of World War II. For the first time in history, many soldiers survived brain injuries and many of these victims had accompanying deficits in memory function.

Such a battery will depend on quantification.

MEMORY TEST BEFORE THE WRAML2

Wechsler Memory Scale (WMS)- developed in 1945. Was good, but was primarily an adult measure.

Rey Auditory Verbal Learning Test-1946, it examined forgetting which is a factor that is important in certain neurological disorders. Never fully standardized or normed.

Benton Visual Retention test-(1974), assessed visual memory. This test was not standardized for lower age ranges.

Most memory test were designed to test memory for adults

SHORT CHRONLOGY OF

MEMORY TEST1941. Rey-OSTERRIETH Complex Figure Task

1945. Wechsler Memory Scale (1987, Second Edition, 1997, Third Edition, 2009, Fourth Edition)

1946. Benton Visual Retention Test

1958. Rey Verbal Learning Test

1974. Selective Reminding Task

1987 California Verbal Learning Test

1990. Wide Range Assessment of Memory and Learning

1994. Test of Memory and Learning Test

1997. Children’s Memory Scale

2003. Wide Range Assessment of Memory and Learning Second Edition.

2007. Test of Memory and Learning-Second edition

ORIGINAL VERSION OF THE WRAML

It was not until the 1990’s that the first comprehensive, pediatrically focused memory measure appeared, The original version of the WRAML.

When interpreting the WRAML, knowledge of the neurobiological aspects of memory and it’s pathology are important in guiding understanding of clinical observations and test findings.

Ex: Damage to the hippocampl region can result in a persons being able to recall immediately a brief stimulus such as a picture or short sentence, but seconds later that information is no longer available to the person because the damaged region cannot help in storing new information. Patient HM

OVERVIEW OF THE WRAML An individually administered test battery

designed to assess memory ability in children and adults

The battery is for clinical assessment of immediate and delayed recall of verbal and visual memory, and provides a global memory performance estimate.

WRAML was released in 1990 and was the first well-normed and standardized test battery that could be used to assess memory abilities in children.

OVERVIEW OF THE WRAML However, a number of revisions were

introduced with the WRAML One of the major test changes is the

expansion of the age range so that the battery can now be used with adults as well as children and teens.

MAJOR MODIFICATIONS MADE IN THE REVISION OF WRAML

WRAML Modifications WRAML2

5-17 years Age range 5-85+ years

9 Number of core subtests

6

4 Number of delay memory tasks

7

0 Number of working memory subtests

2

1 Number of recognition memory subtests

4

0 Qualitative analyses data

>25 data sets

3 factors: moderate support

Factor Structure 3 factors: strong support

REVISION OF THE WRAML The inclusion of more than two dozen

supplemental data sets allow interested clinicians to ask more questions of the subtest.

This will allow clinicians to piece together what may be contributing to the deficits being detected.

STRUCTURE OF THE WRAML2 Comprised of six subtests that yield

three indexes:Verbal Memory IndexVisual Memory IndexAttention/Concentration Index

Combine these three core indexes form the General Memory Index

The WRAML2 especially focuses on visual and auditory memory

STRUCTURE OF THE WRAML2

There are no time constraints on clients response time.

A typical administration of the six core subtests by an experienced examiner takes less than 40 minutes

Tables for all indexes include standard scores (M=100, SD=15) and confidence intervals.

Intrabattery subtest and index discrepancy tables are provided for determine differences that constitute statistical significances as well as prevalence data for those differences.

WRAML2 CORE SUBTEST INDEXES

General Memory Index

Verbal Memory Index

Visual Memory IndexAttention/

Concentration Index

Story Memory Subtest

VerbalLearningSubtest

DesignMemorySubtest

PictureMemory Subtest

FingerWindowsSubtest

Number/Letter

Subtest

VERBAL MEMORY INDEX Domain assessed: This subtest

evaluates auditory memory of extended meaningful verbal material such as is associated with listening to a conversation or a lecture, as well as reading text in a news paper

VERBAL MEMORY INDEXSTORY MEMORY SUBTEST Subtest Procedure- Two short stories are

read to the participant who, following each is asked to orally recall as many parts of the story as they can be remembered. 3 stories are included in the subtest, but only two are given to the client. The clients are to determine which pair to utilize. Some information within each story must be remembered exactly (verbatim) to receive credit, and other information need only to be paraphrased.

VERBAL MEMORY INDEXVERBAL LEARNING SUBTEST Domain Assessed- this subtest

evaluates auditory memory of meaningful verbal information that is without context (or language structure). Evaluates a clients ability to actively learn new, relatively unrelated verbal information. Since four learning episodes or trails are administered, a learning acquisition curve is obtained.

VERBAL LEARNING SUBTEST Subtest procedure- The verbal learning

subtest is a list of learning task. The evaluator reads the participant a list of common single syllable words followed by an immediate free-recall trail. Three identical word-list presentation and immediate recall trails follow. For participants 8 years and younger, 13 words are used. For participants 9 years and older, 16 words make up this list learning task. The total number of words accurately reported over the four learning trails make up the subtest raw score.

VISUAL MEMORY INDEXDESIGN MEMORY SUBTEST Domain assessed: This subtest

evaluates short term visual retention of quasi-meaningful visual information by using a brief exposure to simple geometric shapes and then having the client redraw them in their proper locations. The task evaluates a clients ability to remember new relatively unrelated visual information.

VISUAL MEMORY INDEXDESIGN MEMORY SUBTEST Subtest procedure: One at a time,

five 4x6 inch cards with multiple, simple geometric forms are each presented for a 5 second exposure. Following each card’s exposure and then a 10 second delay. The participant is asked to draw what he/she remembers of the card’s content.

VISUAL MEMORY INDEXPICTURE MEMORY SUBTEST This subtest evaluates visual memory

using skills to detect changes in specific features or details within meaning visual arrays- specifically, four different “familiar” scene’s. The task evaluates a clients ability to remember new, context related visual information.

Ex: Remembering visual content from a billboard just passed or in a room just visited.

VISUAL MEMORY INDEXPICTURE MEMORY SUBTEST Subtest Procedure: The participant is

briefly shown a colorful, everyday scene that he/she is asked to scan for 10 seconds, before it is removed. Then a similar, alternate scene is immediately presented and the participant is asked to identify those pictured elements that have been moved, changed or added. The participant makes the remembered changes right on the altered scene. The total number of currently identified changes across all four cards constitutes the clients total raw score.

ATTENTION/CONCENTRATION INDEX FINGER WINDOWS SUBTEST Domain assessed: This subtest

evaluates short-term memory of rote, visual sequential pattern. The task evaluates a clients ability to actively remember rote and sequential visual information.

Ex: trying to remember a route found on a map.

ATTENTION/CONCENTRATION INDEX FINGER WINDOWS SUBTEST Subtest procedure: The participant shows

memory of a demonstrated visual pattern using a 8x11 inch plastic template containing nine asymmetrically located holes, or windows. The examiner, sitting behind the template that is held horizontally perpendicular to the work surface, models a given sequence of windows and ask the participant to imitate the sequence by placing her/his finger through the same windows in the correct order. The total number of correct sequences achieved determines the level of performance.

ATTENTION/CONCENTRATION INDEXNUMBER LETTER SUBTEST

Domain assessed: This subtest evaluates a clients ability to remember sequential, rote auditory information using the familiar digit-span format, although this task uses letters as well as digits.

Ex: When someone provides a new phone number and you try to remember it until it gets written down.

ATTENTION/CONCENTRATION INDEXNUMBER LETTER SUBTEST

Subtest procedure- The number letter subtest requires the participant to repeat a sequence of single digits and letters orally presented by the examiner. Items range from one symbolic element to ten.

OPTIONAL SUBTEST There are several optional subtests

provided and co-normed with the core tests, allowing for a more comprehensive assessment of memory function. Provides examiners with scaled scores. Used if the examiner wants a qualitative analysis of the individual.

Qualitative analyses is used in the WRAML2 manual to the clinician that standardization data are available for testing diagnostic impressions

OPTIONAL WRAML

Working Memory Index

Verbal Working Memory

Visual working memory

OPTIONAL WRAML

Recognition Index

Story Memory Recognition

Design Memory Recognition

Verbal Learning Recognition

Picture Memory Recognition

OPTIONAL WRAML

Sound Symbol Sentence Memory

Delay Recall Subtest

Story memory

delay recall

Verbal Learning

Recall

Verbal Learning

Delay Recall

*Not going to go into detail…….sorry

ADMINISTRATION

• Room well lit.• Furniture comfortable and

size appropriate.• Room relatively free from

distractions.• Participant seated and

positioned appropriately at table.

• Examiner sits across table from participant.

• Attempts to establish and maintain rapport evident.

• Participant told breaks are okay.

• Avoids use of words "test" and "pass/fail."

• All test forms available but not observable by client.

• Test materials available (e.g., pencils, timer).

• Preliminary questions asked by participant answered.

• Sequence of subtests followed accurately.

• Examiner speaks loudly and clearly.

ADMINISTRATION

• Responses recorded immediately and accurately.• Efforts to maintain motivation evident and appropriate.

Only three subtests have timing requirements: Design Memory, Picture Memory, and Sound Symbol. There is no need to time responses for the other subtests.

The Manual allows examiners to tape-record examinee's responses for later scoring, particularly for the Story Memory section. The examiner needs to be careful when testing a nervous or paranoid examinee, however.

SCORING

• Story Memoryo Examinee's response is recorded on the Examiner Form.o The response is scored based on keywords used.

The form provides a loose guideline; it is recommended that the examiner refer to the Manual for scoring.

The order in which the keywords are presented do not matter in scoring, though they may be of clinical significance.

o  Scores can be manipulated to create other measures. Story Memory Retention Individual Story Comparison Verbatim Measure Gist Measure

In the interest of time, only the core subtests will be covered.

SCORING

• Design Memoryo If there is a question about the accuracy of the examinee's

drawing, score it in favor of the examinee.o The key things to look for are memory for the design and

its placement.o Direction or rotation errors are not considered in the

scoring (i.e., not marked incorrect).o There are general scoring guidelines for each of the

shapes in the Manual. For younger examinees or examinees with fine motor

challenges, they are asked to draw these shapes separately prior to the subtest.

When scoring, these sample figures take precedence over the guidelines in the manual.

SCORING

• Design Memoryo The Manual provides scoring guidelines for specific items

in the subtest as well.

SCORING

• Verbal Learningo One point is awarded for each correctly recalled word.o Points are summed within and across trials.o Errors of commission where words not on the list are

recalled are noted on the Examiner Form.o An additional trial -- the Verbal Learning Delay Recall --

can be given for additional analysis.o Scores can be manipulated to create other measures.

Verbal Learning Retention Verbal Learning Slope Verbal Learning Intrusion Errors

SCORING

• Picture Memoryo Points are given for each correctly identified item in each

picture.o These points are summed.o Incorrectly identifying an item (error of commission) does

not affect the subtest score, but it may be of clinical interest. These are recorded as a separate score.

SCORING

• Finger Windowso If a child eight years or younger responds incorrectly on

any of the first three items (A, B, or C), the examiner should give assistance until the child can respond correctly. These items are then marked incorrect.

o If a child nine years or older responds incorrectly on the first item (#4), the examiner should start the subtest with item A. Item #4 is not readministered.

o One point is given for each correct sequence. Like the WISC-IV, examinees are given perfect scores

on items they skipped based on age if they correctly respond to their first item.

SCORING

• Number Lettero Like the WISC-IV Digit Span subtests, each correct

response is scored one point.o These points are summed.

INTERPRETATION

• There are three levels of analysis.o Combined

General Memory Index (GMI)o Index

Visual Verbal Attention/Concentration [Working Memory] [Recognition Memory]

o Individual

Any of these can be combined in any order for an individualized analysis.

INTERPRETATION

• The General Memory Index is the preferred method.o Of the three methods previously described, the General

Memory Index has lower and less variable standard error than the other methods across all age groups.

o With the GMI, you get a more holistic picture of the examinee's ability.

• In some cases, using the GMI is less desirable.o If there are any significant discrepancies among the index

scores, then the GMI is likely not representative of the examinee's ability. These can be found in the manual.

o In this case, the examiner should look at the core indices for analysis.

INTERPRETATION

• In the same vein, if there are significant discrepancies between subtests in a core index score, then the core index score should not be used in interpretation.o Discrepancy analysis results for many subtests are not

listed in the Manual.o However, standard errors of measurement are provided,

and using these, one can infer which discrepancies are significant.

INTERPRETATION

• Compared to the GMI and core indices, individual subtest scores have lower reliability.

• Interpreting from subtests should be taken as a last resort or at least in conjunction with other supporting evidence, such as history or other test results.

INTERPRETATION

• Story Memoryo Poor performance may be indicative of:

Poor verbal memory Expressive Language Disorder Expressive/Receptive Language Disorder Low verbal intelligence Low overall intelligence Hearing impairment Anxiety

o It may be a good idea to talk with the examinee prior to administering the test to get an idea of the examinee's listening and articulation skills.

In the interest of time, only the core subtests will be covered.

INTERPRETATION

• Design Memoryo Poor performance may be indicative of:

Poor visual memory Spatial skills deficit Visual field cut or neglect Impairment in visual acuity

INTERPRETATION

• Verbal Learningo Poor performance may be indicative of:

Poor short-term verbal memory Poor long-term verbal memory storage Communication disorder Hearing impairment Anxiety Poor executive functioning

INTERPRETATION

• Picture Memoryo Poor performance may be indicative of:

Poor visual memory Spatial skills deficits Visual field cut or neglect Impairment in visual acuity Impulsiveness

INTERPRETATION

• Finger Windowso Poor performance may be indicative of:

Poor visual, rote immediate recall Deficits in sequential processing Spatial skills deficits Visual field cut or neglect Impairment in visual acuity Fine motor impairment

INTERPRETATION

• Number Lettero Poor performance may be indicative of:

Poor auditory or verbal, rote immediate recall Poor auditory sequential recall Impaired hearing

INTERPRETATION

• The WRAML2 can be administered to individuals between 5 and 85 years of age; however, there may be floor and ceiling issues that need to be taken into consideration.o Examine the norms tables for each subtest.o Floor: In general, the ability of 5-year olds who do poorly

may be overestimated. This is not an issue with 6-year olds.

o Ceiling: There are no ceiling issues of which we know. The WRAML2 can be used to determine the degree to which an examinee is gifted with memory.

STRENGTHS AND WEAKNESS There are no evidence for item bias

between genders as well as across principal ethnic groups.

Motivation plays a significant role in test performance, so estimating motivation is an important part of this evaluation.

Assesses memory of all ages Can be used to supplement evaluations

of ADHD, and problems in children as well as a number of other disorders across the age span.