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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.

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Presentation on theme: "Advanced Cross-Battery Assessment Using CHC Theory and Neuropsychological Measures Catherine A. Fiorello, Ph.D., ABPP Temple University September 30, 2011."— Presentation transcript:

1 Advanced Cross-Battery Assessment Using CHC Theory and Neuropsychological Measures Catherine A. Fiorello, Ph.D., ABPP Temple University September 30, 2011

2 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

3 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

4 IDEA 2004: The Impetus for Developing Better Assessment and Intervention Strategies

5 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

6 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.”

7 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.

8 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.

9 ~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

10 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

11 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.

12 School Neuropsychology: The Key to Reconceptualizng Cognitive Processes for Assessment and Intervention

13 The Two Axes Interpretation Posterior -Sensory Input -Comprehension Anterior -Executive Functions -Motor Output

14 Structural Hemispheric Differences More Grey Matter More White Matter More Primary Cortex More Association Cortex Left Hemisphere Right Hemisphere More Intramodal Connections More Intermodal Connections Source: Goldberg, E., & Costa, L. D. (1981). Hemispheric differences in the acquisition and use of descriptive systems. Brain and Language, 14, 144-173.

15 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

16 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 than stimulus input or response output!

17 Hemispheric Functions and Language Left Hemisphere Right Hemisphere Low DemandHigh Demand Source Belger & Banich, 1998 Local/DetailedGlobal/HolisticDelis et al., 1986 MicrostructuralMacrostructuralGlosser, 1993 Fine ProcessesCoarse ProcessesBeeman/Chiarello, 1998 Close Semantic Distant SemanticChiarello, 1998 Concordant/ Convergent Discordant/ Divergent Bryan & Hale, 2001 Simple Syntax Complex SyntaxCooke et al., 2001 Routinized/AutomaticNovel/New LearningGoldberg/Costa, 1981

18 Comprehensive Assessment Model STUDENT HOMESCHOOL COMMUNITYPEERS 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 Skills Vocational Interests Academic Skills Study Skills Adaptive Behavior Developmental Status Physical Health Cognitive Abilities Emotion Regulation Psychopathology Language History Language Development Background Knowledge Motivation

19 The Cattell-Horn-Carroll (CHC) Model AchievementBasic ReadingReading Comprehension Written Expression CHC FactorsGa-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 -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

20 CHC Model, cont. AchievementBasic MathMath ReasoningOral Language/Listening Comprehension CHC FactorsGa-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 Gf Fluid Reasoning Gq Math KnowledgeGq Math Reasoning Gv Visual Processing? (Higher Math?)

21 The Neuropsychology of Reading 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.

22 The Neuropsychology of Math 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.

23 Developing and Testing Hypotheses About 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

24 Demands Analysis: Block Design Determining Input  Processing  Output Demands

25 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 Input  Processing  Output Demands

26 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 Input  Processing  Output Demands

27 Output Demands: Fine motor response, arrange manipulatives Bimanual sensory (visual-somatosensory) – motor coordination Processing speed

28 Processing Assessment Using Specific Tests

29 DAS-II CopyingGv:VzVisual-motor integration, graphomotor skills Early Number Concepts Gq:A3, KMReceptive language, spatial and numerical concepts Matching Letter-Like Forms Gv:VzVisual perception, orientation, attention to details MatricesGf:IInductive reasoning, multiple choice Naming VocabularyGc:VL, LDExpressive naming Pattern ConstructionGv:SRVisual-spatial processing, constructional praxis, planning, bimanual coordination Phonological Processing Ga:PCPhonological awareness, segmentation, assembly Picture SimilaritiesGf:IFluid reasoning, visual perception Rapid NamingGlr:NA Gs:Pc Fluent retrieval from LTM; automaticity of visual-auditory associations Recall of DesignsGv:MVVisual and spatial memory Recall Digits-ForwardGsm:MSRote auditory memory, sequencing

30 DAS-II, cont. Recall Digits— Backward Gsm:WMWorking memory for auditory material Recall Objects— Immediate Glr:M6Memory for verbal and pictorial stimuli Recall Objects— Delayed Glr:M6Longer-term memory, verbal and pictures Recall Sequential Order Gsm:WMShort-term memory for verbal and pictorial stimuli, sequencing Recog. of PicturesGv:MVNonverbal visual memory, recognition Seq. & Quant. Reasoning Gf:I, RQFluid reasoning, sequential reasoning, figural and numeric Verbal SimilaritiesGc:LDVerbal knowledge, verbal reasoning Speed of Info Processing Gs:N, R9Processing speed, graphomotor Verbal Comp.Gc:LD, LSReceptive language, basic language concepts Word DefinitionsGc:VL, LDVerbal knowledge, oral expression

31 KABC-II Simultaneous/Gv TrianglesVisual-spatial processing, constructional praxis, planning, bimanual coordination Face RecognitionVisual facial memory (ventral stream) Pattern Reasoning (5-6)Inductive reasoning, visual processing, figural Block CountingVisual-spatial processing, quantitative knowledge Story Completion (5-6)Reasoning, sequencing, attention to visual details Conceptual ThinkingInductive reasoning, visual processing, pictorial RoverPlanning, inhibition, spatial processing Gestalt ClosureVisual processing, holistic perception Sequential/Gsm Word OrderShort-term auditory memory for unrelated words, nonverbal response, later items interference task Number RecallShort-term auditory memory Hand MovementsShort-term visual memory, sequencing, praxis

32 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 +DelayedAssociative memory, meaningless symbols and names, syllable length cues Rebus +DelayedAssociative memory, rebus clues to meaningful sentences Knowledge/Gc RiddlesReceptive language, reasoning, long-term memory retrieval Expressive VocabularyWord knowledge, oral expression Verbal KnowledgeGeneral knowledge, multiple choice, pictorial representations

33 CAS Planning Planned CodesGs:R9Sustained attention, psychomotor speed, strategy use Matching Numbers Gs:PSustained attention, visual scanning, psychomotor speed, strategy use Planned Connections Gs:PSustained attention, visual scanning, psychomotor speed, strategy use Simultaneous NV MatricesGf:IInductive reasoning, multiple choice Verbal/Spatial Relations Gv:SR Gc:LS Receptive language, working memory, grammatical relationships, visual scanning/discrimination Figural MemoryGv:MV, CF Visual perception, spatial relationships, visual memory, graphomotor reproduction, constructional skills, figure-ground relationships

34 CAS, cont. Attention Expressive Attention Glr:NAInhibition of automatic response; similar to Stroop Number Detection Gs:PCancellation task, sustained attention, visual scanning, visual discrimination, inhibition, psychomotor speed Receptive Attention Gs:PSustained attention, visual scanning, attend to perceptual, then shift set to meaning Successive Word SeriesGsm:MSWord span, rote auditory memory Sentence Repetition Gsm:MS Gc:MY Rote recall of meaningless sentences, grammatical structure important Sentence Questions Gsm:WM Gc:LD Language comprehension based on grammatical structure with meaningless content Speech RateGps:PTOral praxis

35 WISC-IV Integrated Verbal Comprehension Verbal Subtests Multiple ChoiceLong-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 ApproachCompare working memory effects Written ArithmeticCompare arithmetic knowledge

36 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 MazesExecutive funtions—planning, organization, monitoring, inhibition; graphomotor skills Processing Speed Coding CopyVisual-motor integration, graphomotor skills, processing speed Coding RecallPaired-associate symbol and digit recall, free recall

37 CMS Auditory/Verbal StoriesGlr:MMAuditory attention, semantic long-term memory encoding and retrieval, sequencing/grammar, verbal comprehension, expressive language Word PairsGlr:MAPaired-associate task; auditory attention, learning novel word pairs Word ListsGlr:M6Selective reminding task; long-term memory encoding, storage and retrieval of unrelated words Visual/Nonverbal Dot LocationsGv:MVVisual-spatial memory encoding and retrieval (dorsal stream); susceptibility to interference FacesGv:MVFacial memory encoding and retrieval (ventral stream) Attention/Concentration SequencesGsm:WMRote recall followed by mental manipulation-- executive function (working memory)

38 NEPSY-II Executive Functions/Attention Animal SortingGf:IProblem-solving, verbal and spatial concept formation, categorical thinking, flexibility of thinking Auditory Atten & Response Set GsSustained auditory atten., vigilance, inhibition, set maintenance, flexibility ClocksGv:Vz Gc:K0 Telling time, reading analogue clocks, visual-spatial processing, graphomotor Design FluencyGlr:FFVisual-motor fluency, flexibility, divergent thinking, graphomotor InhibitionGlr:NANaming fluency, inhibition, shifting set Knock and TapGsm:WMSelf-regulation, inhibition, maintaining set StatueResistance to distraction, inhibition, motor persistance

39 NEPSY-II, cont. Language Body Part NamingGc:K0Knowledge of body parts, receptive and expressive Comprehension of Instructions Gc:LSReceptive language, sequencing, grammar Oromotor Sequences Gps:PTOral praxis, sequencing, memory span Phonological Processing Ga:PCAuditory attention, phonological awareness, segmentation, assembly Recognition of Reversals Gv:MV Gc Visual perception of orientation, orthographic knowledge Repetition of Nonsense Words Ga:UM Gsm:MS Phonemic awareness, auditory memory span, sequencing Speeded NamingGlr:NANaming automaticity, processing speed Word GenerationGlr:FWVerbal fluency, integrated RH/LH functioning, compare category with letter responses

40 NEPSY-II, cont. Sensorimotor Functioning Fingertip TappingGps:MTSimple motor speed, perseverance Imitating Hand Positions Gp:P2Visual perception, praxis, kinesthesis Manual Motor SeriesGpImitate a series of rhythmic movements Visuomotor Precision GpVisual-motor integration, graphomotor w/o construction Social Perception Affect RecognitionGkn:BCFacial processing (ventral stream), matching emotions Theory of MindGkn:BCPerspective taking for knowledge and emotions

41 NEPSY-II, cont. Visuospatial Processing ArrowsGv:SRSpatial processing, visualization, line orientation, inhibition, no motor Block Construction Gv:VzVisual-spatial processing, constructional praxis, planning, bimanual coordination Design Copying Gv:VzVisual-motor integration, graphomotor skills, local and global processing Geometric Puzzles Gv:VzVisual-spatial processing; figural, mental rotation, no motor demands Picture Puzzles Gv:CF Gc:K0 Visual-spatial processing, pictorial, visual discrimination, local detail processing, figure-ground Route FindingGv:SSVisual-spatial processing, orientation

42 NEPSY-II, cont. Memory and Learning List Learning (Delay)Glr:M6Verbal memory Memory for Designs (Delay) Gv:MVVisual memory, spatial recall and visual details Memory for Faces (Delay) Glr:MAFacial memory (ventral stream) Memory for Names (Delay) Glr:MAAssociative memory, names and faces Narrative MemoryGlr:MMMeaningful memory Sentence RepetitionGsm:MS Gc:LD Auditory short-term memory, content and grammatical structure important Word List Interference Gsm:WMAuditory memory, short term and working memory (with interference)

43 D-KEFS SortingProblem-solving, verbal and spatial concept formation, categorical thinking, flexibility of thinking Trail MakingMental flexibility, sequential processing on visual-motor task, set shifting Verbal FluencyVerbal fluency Design FluencyVisual fluency Color-Word Interference Attention and response inhibition TowerPlanning, flexibility, organization, spatial reasoning, inhibition 20 QuestionsHypothesis testing, verbal and spatial abstract thinking, inhibition Word ContextDeductive reasoning, verbal abstract thinking ProverbMetaphorical thinking, generating versus comprehending abstract thoughts

44 CTOPP Phonological Awareness ElisionGa:PCPhonological perception, segmentation Blending WordsGa:PCPhonological assembly Sound MatchingGa:PCPhonological perception, segmentation Phoneme ReversalGa:PC Gsm:WM Phonological perception, segmentation, working memory Blending NonwordsGa:PCPhonological assembly Segmenting Nonwords Ga:PCPhonological perception, segmentation Phonological Memory Memory for DigitsGsm:MSShort-term memory, sequencing Nonword Repetition Ga:UM Gsm:MS Phonemic analysis, assembly, working memory

45 CTOPP, cont. Rapid Naming Rapid Digit Naming Glr: NANumber automaticity, processing speed, verbal fluency Rapid Letter Naming Glr: NALetter automaticity, processing speed, verbal fluency Rapid Color Naming Glr: NAColor name knowledge, naming automaticity, processing speed, verbal fluency Rapid Object Naming Glr: NAObject recognition, naming automaticity, processing speed, verbal fluency

46 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

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