advanced cross-battery assessment using chc theory and neuropsychological measures

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


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

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




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





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

advanced cross-battery assessment using chc theory and neuropsychological measures

Documents