Running Head: NEPSY-II

NEPSY-II Test Review Angela Chiasson University of Calgary, AB APSY 657 April 14, 2011

NEPSY-II

INTRODUCTION The NEPSY-II is a comprehensive, co-normed, and multidomain neuropsychological battery designed for assessing neurocognitive abilities in preschoolers, children and adolescents (ages 3 through 16.11) (Brooks et al., 2009). There are two forms of the NEPSY-II which include Form A (ages 3-4) and Form B (ages 516). The purpose of the NEPSY-II is to provide detail and extended information of an individuals neuropsychological functioning, beyond that which academic and cognitive assessments can provide. Information obtained through the NEPSY-II can be used for diagnoses, planning intervention for childhood disorders and recommendations for those who work closely with the child. Information gathered from the NEPSY-II can provide the clinician with insight into a childs academic, social and behavioural difficulties. STRUCTURE The NEPSY-II battery contains 32 subtests, which are divided into six theoretically derived domains of cognitive functioning: Attention and Executive Functioning; Language; Memory and Learning; Sensorimotor; Social Perception; and Visuospatial Processing (see APPENDIX A for a description of each subtest within the mentioned domains). The Attention and Executive Functioning Domain consists of six subtests including: Animal Sorting; Auditory Attention and Response Set; Clocks; Design Fluency; Inhibition; Statue. This domain measures the inhibition of prepotent responses; monitoring and self-regulation; vigilance; selective and sustained attention processes; the capacity to create, preserve, and adapt a response set; nonverbal problem solving;

NEPSY-II preparing and managing a multifaceted response; and figural fluency (Davis and Mathews, 2010). The Language domain consists of seven subtests including: Body Part Naming and Identification; Comprehension of Instructions; Oromotor Sequences; Phonological Processing; Repetition of Nonsense Words; Speeded Naming; and Word Generation. The subcomponents measured within this domain include phonological processing, phonological decoding, expressive and/or receptive labeling of common objects, semantic fluency, rhyming, and comprehension of oral instructions (Davis & Mathews, 2010). The Memory and Learning domain includes seven subtests: List Learning (delayed); Memory for Designs (delayed); Memory for Faces (delayed); Memory for Names (delayed); Narrative Memory; sentence Repetition; and Word List Interference. This domain assesses the areas of working memory and immediate and delayed recall of simple stimuli, unprompted descriptive memory, cued recall, and recognition, repetition, and recall amid interference (Davis & Mathews, 2010). Next, the Sensorimotor Functioning domain is comprised of four subtests including Fingertip Tapping; Imitating Hand Positions; Manual Motor Series; and

Visuomotor Precision. The subcomponents assessed within this domain include hand and finger dexterity, complex motor sequencing, and fine motor speed and precision (Davis & Mathews, 2010). The Social Perception domain has Affect Recognition and Theory of Mind making up its two subtests. The subcomponents assessed include recognition of facial expression and perspective taking (Davis & Mathews, 2010).

NEPSY-II Finally, the Visuospacial Processing domain consists of six subtests which include: Arrows; Block Construction; Design Copying; Geometric Puzzles; Picture

Puzzles; and Route Finding. The subcomponents assessed include the visual orientation, design copy, inductive visual reproduction, visualization or rotation, deductive visual process, recognition of part-while relationships, and schematic map reading (Davis & Mathews, 2010). NEPSY TO NEPSY-II The original NEPSY, published in 1998, has had many revisions based on many factors including: research in neuropsychology; child development and child psychology; feedback from experts and customers; experience of the authors; and early pilot studies of revisions and newly developed subtests (as cited in Brooks et al., 2010). The authors, Marit Korkman, Ursula Kirk and Sally Kemp, had four primary goals for revising the NEPSY into the NEPSY-II, which was published in 2007 by Harcourt Assessment Incorporated: 1) Improvement and expansion of cognitive domains covered across the age span which was achieved by adding new subtests to existing domains (Affect Recognition and Theory of Mind) and removing other subtests due to low clinical sensitivity (Knock and Tap, Tower, Visual Attention and Finger Discrimination); 2) Enhancing clinical and diagnostic utility by removing five domain scores; 3) Improvement of psychometric properties of the NEPSY-II by expanding concurrent validity studies with various measures; and 4) Enhancing usability and ease of administration. On the NEPSY-II the clinician reviews the performance of the child at the abilities level rather than at the global domain level. THEORETICAL & HISTORICAL FOUNDATIONS

NEPSY-II A major source of inspiration for the creation of the NEPSY was A.R. Lurias approach to assessing cognitive functions in adult with brain damage. Lurias approach to assessment clearly articulated that multiple brain systems contribute to and mediate complex cognitive functions (Davis & Mathews, 2010). The Lurian tradition reflects the view that complex cognitive functions can be impaired in ways that are comparable to what occurs when a complicated system is not working. It is thought that if one subcomponent of a function is deficient, then the complex cognitive functions that it contributes may also be deficient. The basic diagnostic principle that underlies the Lurian approach is to identify the primary deficits underlying impaired performance in one functional domain that affect performance in other functional domains. Both assessment of performance and qualitative behavioral observations are necessary to detect and distinguish between primary and secondary deficits. Principles similar to Luria's are evident in recent approaches to neuropsychological assessment of adults and children. These approaches emphasize the need to look beyond global performance scores, as they often fail to capture the

underlying mechanisms contributing to the poorer performance. The approach utilized in the NEPSY-II follows these approaches and provides information on both basic, fundamental skills required to complete more complex tasks and on higher-level cognitive abilities. The scores provided in the NEPSY-II, combined with behavioral observations, error analysis, and task analysis, provide a basis for estimating the degree to which a deficit in a basic subcomponent in one functional domain contributes to poor performance both within that domain and across functional domains.

NEPSY-II Neuropsychological assessment of children came out of knowledge and experience that was derived from the assessment of adults with brain damage. Initially, as a result of this, tests were used that were originally designed to assess the loss of acquired skills in adults with brain damage that were normed on small samples of

children. The development of the NEPSY represented a shift away from this practice by developing tests that were specifically designed for use with children. In creating the NEPS, over 30 years ago, subtests were designed for 5-6 year olds in five functional domains: attention/executive function, language, sensory-motor functions, visuospatial processing, and memory and learning. An extended version was then designed for 3-9 year old children. A psychometric approach was integrated with the qualitative Lurian approach so that the childrens performance on the subtests could be presented in a performance profile. Shortly after this, a Swedish version for 4-7 year old children was published. Revisions were then made and it was expanded upon to a broader age range which was standardized in Finland and the United States. The North American version was then revised, built upon, and expanded into the NEPSY-II. PURPOSE What does the test measure? The NEPSY-II is designed to assess cognitive functions not typically covered by general ability or achievement batteries in children ages 3-16. This battery is designed to provide an assessment centered on specific diagnostic or referral questions and to allow for extended testing to provide more detail or comprehensive information regarding the childs neuropsychological functioning. Results obtained from a NEPSY-II assessment inform diagnoses and aid in intervention planning for a variety of childhood disorders

NEPSY-II (ADHD, Pervasive Developmental Disorders, Language Disorders, Reading Disorders

and Math Disorders, etc.). In particular, the NEPSY-II provides the clinician with insight regarding academic, social, and behavioral difficulties while allowing for extended testing to provide comprehensive information regarding neuropsychological functioning. Who can use the NEPSY-II? Because of the complexities of test administration, interpretation, and diagnosis, examiners who use the NEPSY-II should have graduate-level training and experience in the administration and interpretation of standardized clinical instruments. Although a trained technician or a research assistant can administer the subtests and score them under supervision, the test results should be interpreted only by those who have appropriate graduate or professional training in conducting assessments. When the NEPSY-II is to be used for a neuropsychological assessment, the examiner should have appropriate training in neuropsychology and neuropsychological assessment. When would you use the NEPSY-II? A clinician would use the NEPSY-II when conducting a neuropsychological assessment with a client to receive more information about the childs cognitive and executive functioning abilities. The NEPSY-II will aid in; 1) suggesting possible remedial aids (e.g. learning or teaching strategies, therapies); 2) providing conceptualizations of the childs behavior problems and propose alternative means for dealing with disruptive behavior; 3) uncovering specific areas of learning problems to help the teacher, parent, and child, understand the nature of the childs learning difference and provide appropriate recommendations for improving academic functioning; 4) making recommendations about the suitability of educational or behavioral interventions

NEPSY-II based on the childs cognitive strengths and weaknesses and lastly; and 5) improving classification decisions. ADMINISTRATION The first step to good administration is establishing good rapport with the client before the administration process. The NEPSY-II is a standardized test, therefore instructions must be read verbatim. Prior to administration one must determine which subtests will be administered and ensure that there is an appropriate time delay between

immediate and delayed memory tasks. It is important to note that immediate and delayed tasks of a subtest must be given in the same session. The clinician needs to be aware of the thirty-two subtests different start and stop points, reverse and discontinue rules, and time limits before administering the test (see APPENDIX B). SCORING AND INTERPRETATION Many of the NEPSY-II subtests yield multiple score options, reflecting assorted information including a childs general performance, rate of errors, or a measurement of subcomponent skills necessary for task completion (Davis and Mathews, 2010). Multiple scores are beneficial in that they provide the clinician with a more in depth understanding of the fundamental cognitive process that may influence a childs performance on a task. Scores within the NEPSY-II can be expressed as scaled scores, percentile ranks, cumulative percentages, or a normative sample percentage as determined by the needs of the examiner and or the subtests structure (Davis and Mathews, 2010). There are four different types of scores provided in the NEPSY-II, including primary, process, and contrast scores, and behavioral observations. Primary scores represent the overall ability measured by each subtest and are presented as age-adjusted scaled scores (mean = 10,

NEPSY-II standard deviation = 3) (Brooks et al., 2010). Included within primary scores are combined scores. Combined scores are created by combining two measures within a subtest (Brooks et al., 2010) and describe performance across two variables (NEPSY-II Manual). The intention of process scores is to measure specific skills, abilities, or error rates, and enhance the specificity of the component skills influencing the examinees

cognitive processes (Davis and Mathews, 2010). Contrast scores are scaled scores which allow for the comparison within or between subtests, affording the examiner information on higher level skills or controlling deficits. Behavioral observations provide the clinician with a quantitative account of the frequency of commonly observed behaviours, and are often indicative of underlying weaknesses (Davis and Mathews). ASSESSMENT The testing materials contained within the NEPSY-II kit are relatively straightforward in administration and scoring (Davis and Mathews, 2010). The NEPSYII manual provides complete information for administration of the instrument and preliminary technical data to support its use and there is a introductory CD included which addresses many administrative issues which may be useful to novice users (Davis and Mathews, 2010). There are four common types of assessment for the NEPSY-II: General assessment; Diagnostic assessment; Selective assessment; and Full assessment. A general assessment provides an overview of a childs neuropsychological status across 5 functional domains. This type of assessment is administered when there is no specific referral battery that addresses a referral question. When there is a presence of a specific problem, a diagnostic assessment is recommended in order to investigate the problem in

NEPSY-II greater depth. A selective assessment involves the examiner choosing subtests for a particular evaluation. For example, graphomotor production required for handwriting

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and drawing might be further evaluated with subtests that assess fine motor coordination, the production of rhythmic motor sequences, visuomotor integration, and spatial perception. Full assessments consist of administration of every subtest appropriate for the childs age. It is especially useful when a child is referred for a thorough neurodevelopmental evaluation due to brain damage or dysfunction, neurodevelopmental risk factors, central nervous system infections, or medical treatments that affect the CNS. Full assessments are also recommended for children who have been followed over time for severe learning or developmental disorders (Davis and Mathews, 2010). STANDARDIZATION The NEPSY-II normative data were derived from a normative sample of 1200 (100 children in each of the 12 age groups) individuals that were closely representative of the US population of children between the ages of 3 and 16. The normative sample was stratified on key demographic variables including, age, sex, race/ethnicity, parent education level, and geographic region, according to the Oct. 2003 US census data (Brooks et al., 2010). Sex of the sample was not stratified according to the census; instead it was split 50% male and 50% female. For each age group in the normative sample, examinees were further separated by the race/ethnicity category. Each child in the normative sample was categorized as belonging to one of the following groups: White, African American, Hispanic, or Other. (Davis and Mathews, 2010). Children were also stratified by geographic region. The United States was divided into four major regions: Northeast, Midwest, South, and West.

NEPSY-II Children were selected for the normative group in accordance with the proportions of children living in each region (Davis and Mathews, 2010). The sample was further

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stratified by parent education level. For children in two-parent homes, the average of the parents educational level was used. The groups were also stratified by gender to include 50% males and 50% females (Davis and Mathews, 2010). The lack of data on urban/rural residences is a concern. The sample was quite representative in terms of parent education level, however a few discrepancies are apparent. In the Other ethnic category, there was no representation for persons with < 11 years of education for ages 3,4,5,13 to 14, and 15 to 16 (Davis and Mathews, 2010). The authors made an effort to include participants with a variety of special education disability classifications or diagnoses in the standardization sample. According to the manual, children with the following diagnoses were included: Attention Deficit/Hyperactive Disorder (ADHD), Reading Disorder, Language Disorder, Mathematics Disorder, Intellectual Disorder (i.e. Mental Retardation). Autistic Disorder, Aspergers Disorder, Traumatic Brain Injury, Deaf and Hard of Hearing, and Emotionally Disturbed (Davis and Mathews, 2010). PSYCHOMETRIC PROPERTIES Reliability Internal reliability, or the measure of the consistency to which a measurement provides a given score, for the NEPSY-II was impressive. Overall, NEPSY-II internal reliability coefficients were adequate to very high across the age groups. The highest internal consistency scores were found on comprehension of instructions, design copying,

NEPSY-II

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and finger tapping. The lowest internal consistency scores were found on the inhibition and memory for design subtests. Test-retest reliability, or the constancy of test performance over time, for many of the NEPSY-II subtests were found to be generally adequate to high. Pearson product moment coefficients (r) .21 to .91. The lowest Person Coefficient (r) was found in imitating hand positions and the highest r-value was found in picture puzzles. Largest practice effects are found in the memory and learning domain and on the inhibition switching combined scale in the attention and executive domain. Other domains such as language, sensorimotor, social perception, and visuospatial processing have only small to negligible practice effects. Interrater reliability was calculated as the percentage of agreement between trained scorers in evaluating the NEPSY-II protocol. Agreement rates ranged from the lowest level at 93% for word generation to the highest level at 99% for memory for names. Validity The majority of subtests included in the NEPSY-II have strong theoretical and experimental evidence of validity based on response processes. Extensive literature reviews, expert consultations, and empirical evaluations were conducted to provide additional evidence of validity. Evidence of validity is provided by a series of correlational studies with a variety of instruments designed to measure cognitive ability, academic achievement, neuropsychological functioning and behavior (see APPENDIX C for a scaled score description of the NEPSY-II compared to Weschler classifications). Because of the wide array of skills assessed on the NEPSY-II, the authors selected to

NEPSY-II

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validate this measure using a variety of instruments, including for cognitive the Wechsler Intelligence Scale for children fourth edition, Differential abilities scales second edition, and the Wechsler nonverbal scale of ability, for academic the Wechsler individual achievement test second edition was used, and the Children's memory scale was used for the memory and learning domain. After reviewing the standardization and validation data, the final selection of subtests for each of the six functional domains was made. Subtests were selected for each of the diagnostic batteries and scores were derived. Three standardization subtests, A Not B, Recognition of reversals, and visual attention, were dropped due to difficulty with administration or low clinical sensitivity. Several subtests were not re-normed in the NEPSY-II and the norms collected for the 1998 NEPSY are reprinted. Design fluency, imitating hand positions, list memory, manual motor sequences, oromotor sequences, repetition of nonsense words, and route finding were not re-normed. Due to the length of the standardization battery, subtests that were not modified from the 1998 NEPSY were reviewed closely for psychometric and theoretical issues. For those subtests in which normative changes were not expected based on the Flynn effect or changes in the population, the decision was made not to renorm. The normative data for these subtests is based on the 1998 NEPSY sample and is reported with the data collected during the standardization of the NEPSY-II. EVALUATION Strengths The NEPSY-II has many strengths, including the fact that it remains one of a very small number of tests developed specifically and primarily as a neuropsychological

NEPSY-II battery for children (Brooks et al., 2010). This test is one of the only pediatric

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neuropsychological tools available for comparing performance across subtests using conormed data (Brooks et al, 2010). The NEPSY-II is easy to administer which makes it appealing to administrators. Another strength is that it is possible to choose sections of the test to administer, depending on what kind of assessment you are looking to administer: general, diagnostic, selective, or full assessment. The NEPSY-II assists with differential diagnosis of disorders such as: ADHD, Pervasive Developmental Disorders, Language, Reading and Math disorders. The NEPSY-II is designed to assist examiners in identifying neurological strengths and weaknesses typical in a number of conditions diagnosed in childhood and adolescence. This battery has excellent coverage of the main cognitive domains that most users need clinically, including inclusion of the new domain of social perception, which many would find particularly appealing for use in assessing children with this type of difficulty (e.g. autism spectrum disorder) (Brooks et al., 2010). Limitations The NEPSY-II, like all neuropsychological tests, has limitations that clinicians should be aware of. First and foremost, the NEPSY-II is not Canadian normed. Also, this battery is limited to testing between the ages of 3 and 16; which means that if the individual was before the age of 3 or after the age of 16, he/she would not be able to take this test. Some aspects of the NEPSY-II are complex and require time to master. It is also difficult to determine the psychometric strengths and weaknesses of individual subtests (Brooks et al., 2010).

NEPSY-II Although administration can be easy, scoring of the NEPSY-II can be complex for some subtests, with numerous primary, process, and contrast scores, as well as behavioral observations. Using the computerized scoring software reduces the

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complexity of some aspects of scoring. However, the computer-scored print out provides a large number of scores, which can make it challenging to read and select which scores to interpret. Several subtests from the NEPSY-II have not been re-normed, these include: Design Fluency, Imitating Hand Positions, List Memory, Manual Motor Sequences, Oromotor Sequences, Repetition of Nonsense Words, and Route Finding subtests. The normative data for these subtests were collected approximately ten years earlier than the norms on the other NEPSY-II subtests; are based on the performance of different children than the current standardization; are stratified according to a previous U.S. census; and are not co-normed with the other NEPSY-II tests. These discontinuous norms may complicate subtest interpretation in retest situations of individual children being tracked over time. The NEPSY-II has much strength, despite its limitations, that contribute to its use for many clinicians in the field of psychology. Its relatively easy administration, good validity, and good reliability has helped clinicians in making the decision to choose the NEPSY-II as a measurement tool for assessing neurocognitive abilities in children between the ages of 3 and 16.

NEPSY-II REFERENCES Brooks, B.L., Sherman, E. and Strauss, E. (2010). NEPSY-II: A developmental neuropsychological assessment, second edition. Child Neuropsychology: A

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journal on Normal and Abnormal Development in Childhood and Adolescence. 16: 1, 80-101 Davis, J. L. & Matthews, R. N. (2010). NEPSY-II Review. Journal of Psychoeducational Assessment, 28(2), 175-182. Doi: 10.1177/0734282909346716 Kemp, S. L. & Korkman, M. (2010). Essentials of NEPSY-II Assessment. Hoboken, NJ: John Wiley & Sons, Inc. Korkman, M., Kirk, U., & Kemp, S. (2007). NEPSY Second Edition (NEPSY-II). San Antonio, TX: Harcourt Assessment. Smith, D. R. Introducing NEPSY-II. Pearson Assessment/Psychcorp. Retrieved from http://www.region10.org/specialeducation/documents/IntrotoNEPSYIIfinalhandout.pdf NEPSY Second Edition (NEPSY-II). (n.d.). Retrieved from http://www.pearsonassessments.com /HAIWEB/Cultures/enus/Productdetail.htm?Pid=NEPSY-II&Mode=summary

APPENDIX A

NEPSY-II Description of NEPSY-II Subtests Attention and Executive Functioning Domain Animal Sorting Description of Subtests

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Auditory Attention & Response Set Clocks

Design Fluency

Inhibition

Statue Language Domain Body Part Naming and Identification Comprehension of Instructions Oromotor Sequences Phonological Processing

Assesses the ability to formulate basic concepts, to transfer those concepts into action (sort into categories), and to shift set from one concept to another. The child sorts cards into two groups of four cards, each using various self-initiated sorting criteria. Auditory attention is designed to assess selective auditory attention and the ability to sustain it. Response Set is designed to assess the ability to shift and maintain a new and complex set involving both inhibition of previously learned responses and correctly responding to matching or contrasting stimuli. The child listens to a series of words and touches the appropriate circle when he or she hears a target word. Assesses planning and organization, visuoperceptual and visuospatial skills, and the concept of time in relation to analog clocks. For each drawing item, the child draws the image of a clock and places the hands where the examiner indicates. For visual items, the child reads the time on clocks that either have or do not have numbers. Assesses the behavioral productivity in the childs ability to generate unique designs by connecting up to five dots, presented in two arrays: structured and random. The child draws as many designs as he or she can on each array within a specified time limit. Assesses the ability to inhibit automatic responses in favor of novel responses and the ability to switch between response types. The child looks at a series of black and white shapes or arrows and names either the shape or direction or an alternate response, depending on the color of the shape or arrow. Assesses motor persistence and inhibition. The child is asked to maintain a body position with eyes closed during a 75-second period and to inhibit the impulse to respond to sound distracters.

Description of Subtests
Assesses confrontation naming and name recognition, basic components of expressive and receptive language. For Naming items, the child names the parts of the body on a figure of a child or on his or her own body. For identification items, the child points to corresponding parts of the body on a figure as the examiner names them aloud. Assesses the ability to receive, process, and execute oral instructions of increasing syntactic complexity. For each item, the child points to appropriate stimuli in response to oral instructions. Assesses oromotor coordination. The child repeats articulatory sequences until the required number of repetitions is reached. Composed of two phonological processing tasks designed to assess phonemic awareness. Word Segment Recognition requires identification of words from word segments. It is designed to assess phonological processing at the level of word segments (syllables) and of letter sounds (phonemes). The child is asked to repeat a word and then to create a new word by omitting a syllable or a phoneme, or by substituting one phoneme in a word for another. Assesses phonological encoding and decoding. The child repeats nonsense words presented aloud.

Repetition of Nonsense

NEPSY-II Words Speeded Naming Word Generation Memory and Learning Domain List Learning

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Assesses rapid semantic access to and production of names of colors, shapes, sizes, letters, or numbers. The child is shown an array of colors and shapes; colors, shapes, and sizes; or letters and numbers. He or she names them in order as quickly as possible. Assess verbal productivity through the ability to generate words within specific semantic and initial letter categories. The child is given a semantic or initial letter category and asked to produce as many words as possible in 60 seconds.

Description of Subtests
Assesses verbal learning and memory, rate of learning, and the role of interference in recall for verbal material. The child is read a list of words several times, recalling them after each presentation. A delayed task assesses long-term memory for words. Assess spatial memory for novel visual material. The child is shown a grid with four to ten designs on a page, which is then removed from view. The child selects the designs from a set of cards and places the cards on a grid in the same location as previously shown. A delayed task assesses long-term visuospatial memory. Assesses encoding of facial features, as well as face discrimination and recognition. The child looks at a series of faces and then is shown three photographs at a time from which he or she selects a face previously seen. A delayed task assesses long-term memory for faces. Assesses the ability to learn the names of children over three trials. The child is shown six or eight cards with drawings of children on them while being read the childs name. The cards are then shown again and the child is asked to recall the name of the child on the card. A delayed task assesses long-term memory for names. Assesses memory for organized verbal material under free recall, cued recall, and recognition conditions. The child listens to a story and is then asked to repeat the story. The child is then asked questions to elicit missing details from his or her recall of the story. Assesses the ability to repeat sentences of increasing complexity and length. The child is read a series of sentences and asked to recall each sentence immediately after it is presented.

Memory for Designs

Memory for Faces Memory for Names

Narrative Memory Sentence Repetition Sensorimotor Functioning domain Finger Tapping Imitating and Positions Manual Motor Series Visuomotor Social Perception

Description of Subtests
The first part is designed to assess the childs finger dexterity and motor speed. The second part is used to assess rapid motor programming. The child copies a series of finger motions demonstrated by the examiner as quickly as possible. Assesses the ability to imitate a series of rhythmic movement sequences using one or both hands. The child repeats a series of hand movements demonstrated by the examiner until the required number of movements is completed. Assesses the ability to imitate a series of rhythmic movement sequences using one or both hands. The child repeats a series of hand movements demonstrated by the examiner until the required number of movements is completed. Assesses graphomotor speed and accuracy. The child uses his or her preferred hand to draw lines inside of tracks as quickly as possible.

Description of Subtests

NEPSY-II domain Affect Recognition

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Theory of Mind

Assesses the ability to recognize affect (happy, sad, anger, fear, disgust, and neutral) from photographs of childrens faces in four different tasks. In one task, the child simply states whether or not two photographs depict faces with the same affect. In a second task, he or she selects two photographs of faces with the same affect from 34 photographs. In a third task, the child selects one of the four faces that depict the same affect as a face at the top of the page. Finally, the child is briefly shown a face and, from memory, selects two photographs that depict the same affect as the face previously shown Assesses the ability to understand mental functions such as belief, intention, deception, emotion, imagination, and pretending, as well as the ability to understand that others have their own thoughts, ideas, and feelings that may be different from ones own and the ability to understand how emotion relates to social context and to recognize the appropriate affect given various social contexts. In the Verbal task, the child is read various scenarios or shown pictures and is then asked questions that require knowledge of another individuals point of view to answer correctly. In the Contextual task, the child is shown a picture depicting a social context and asked to select a photograph from four options that depicts the appropriate affect of one of the people in the picture.

Visuospacial Processing domain Design Copying Geometric Puzzles Picture Puzzles

Description of Subtests
Assesses motor and visual-perceptual skills associated with the ability to copy two-dimensional geometric figures. The child copies figures displayed in the Response Booklet. Assesses mental rotation, visuospatial analysis, and attention to detail. The child is presented with a picture of a large grid containing several shapes. For each item, the child matches two shapes outside of the grid to two shapes within the grid. Assesses visual discrimination, spatial localization, and visual scanning, as well as the ability to deconstruct a picture into its constituent parts and recognize part-whole relationships. The child is presented a large picture divided by a grid and four smaller pictures taken from sections of the larger picture. The child identifies the location on the grid of the larger picture from which each of the smaller pictures was taken. Assesses knowledge of visual spatial relations and directionality, as well as the ability to use this knowledge to transfer a route from a simple schematic map to a more complex one. The child is shown a schematic map with a target house and asked to find that house in a larger map with other houses and streets.

Route Finding

Note. The information provided in the table is a brief summary of each subtest from the NEPSY-II, for more information one must review the NEPSY-II test battery.

APPENDIX B

NEPSY-II Start, Stop, Reverse, Discontinue and Time Limit Rules for the NEPSY-II Subtest
Animal Sorting Auditory Attention & Response Set Clocks Design Fluency Inhibition

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Start
Teaching Example Teaching Example Item 1 Teaching Example Teaching Example (1: Naming) Intro to statue Item 1 5: item 1 6-12:1433 13-16: 17 5-7: teach ex. then 1 8-12: teach ex. then 4 5-6: item 9 7-8: 15 9-12: ex.1&2, then 31 13-16: ex.3&4 then 31 Item 1 5-6: Item 3 7-8: Item 4 916:Item5 Item 1 Trial 1 5-6: teach. ex., Trial 2 716:teach.

Stop
None After auditory attention None None After inhibition test None None None

Reverse Rule
None None None None None

Discontinue Time Rule Limit

360 sec. or when finished DND DND DND DND 360 seconds None None 60 sec/array Naming:180s Inhibition &Switching:240s 75 seconds None None

Statue Body Part Naming & Identification Comprehension of Instructions Oromotor Sequencing

None None 6-12: item1 13-16: rev. until 2 scores of 1 8-12: go to item 1

DND Naming: 4 0s Identification: DND 7 consecutive scores of 0 4 consecutive scores of 0

None

1-8: 1/sec. 9-14:1/2 secs.

Phonological Processing

None

5-6: Item 1 7-16: reverse until 2 cons. scores of 1

6 consecutive Scores of 0

None

Repetition of Nonsense Words Speeded Naming Word Generation List Learning (*delayed) Memory for Designs (*delayed)

None 5-6: after item 4 5-6: after item 2 None 5-6: after Trial 5 *None

None None

After 4 consecutive scores of 0 DND

None 300 seconds

None None None

DND DND DND

60 seconds 1 word/second *None 10 seconds *None

NEPSY-II
Ex., Trial 3 Learning items, then *Item 1 Learning Trial, trial 1 5-10: story 2 11-16: story 3 Item 1 Teach ex., item 1 Teach ex, 1 Dom: 3 Nondom:15 5-7: item 1 8-12: item 3 Car 5-6: Item 9 7-16: 17 5-6: Item 1 7-8: Item4 9-16: 6 5-8: Ex.1, item 1 9-16: ex.2, item 5 5-6: Item1 7-16: Item8 Item 1 Item 1 Item 1 Item 1

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Memory for Faces (*delayed) Memory for Names (*delayed) Narrative Memory Sentence Repetition Word List Interference Finger Tapping Imitating Hand Positions Manual Motor Series Visuomotor Perception Affect Recognition Theory of Mind Arrows

None

None

DND

5 seconds *None 10 seconds * none None

5-6: after trial 5 * None 5-10: 2 & recog. 16 11-12: 3 & recall 17 None None None None None None 5-6: after item 25 None None

None None

DND DND

None None None Dom:item1 Non-dom: item 13 8-12: item 1 None Until 2 consecutive scores of 1 7-16: until 2 consecutive scores of 1 9-16: 2 consecutive scores of 1 2 consec. scores of 1 None None None None

4 consecutive scores of 0 3 consecutive scores of 0 Do not disc. Both hands: 3 consecutive scores of 0 4 consecutive scores of 0 Do not discontinue 5 consecutive scores of 0 Verbal: 4 scores of 0 Contextual:N0 After 5 consecutive scores of 0 After 4 consecutive 0s DND DND DND DND

None None 1-2: 60s 3-4: 90s 20 seconds Faster than one movement/ second 180 seconds/ item 26-35: 5 s/ stimulus None None

Block Construction Design Copying Geometric Puzzles Picture Puzzles Route Finding

None

None None None None

1-7: 30s 8-19: 60s time bonus on 11-19 None None None None

Note. The NEPSY-II subtests have been colour coordinated to match the following domains: Attention and Executive Functioning subtests, Language subtests, Memory and Learning subtests Sensorimotor Functioning subtests, Social Perception subtests, Visuospatial subtests. Abbreviations: DND: do not discontinue, s or sec: seconds, consec: consecutive, APPENDIX C

NEPSY-II
Classification Descriptors for Scaled Score Performance on the NEPSY-II Compared to Weschler Classifications

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