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NEPSY-II

Overview
BY
BROOKE SCHAUDER, PHD

What this introduction will cover:


Development of the NEPSY-II
Domains of Focus
When to use NEPSY-II
Specific Subtests
Case Presentations

Ongoing

Practice Administration
Conduct subtests with patients
Review scores and interpretation

Background
Original NEPSY developed in 1998 (Finnish version in 1988)
NEPSY-II increases content and psychometric properties
Strong basis for development was Lurias approach to assessment of

adults with brain damage

Luria Nebraska 11 clinical scales:

reading
writing
arithmetic
visual
memory
expressive language
receptive language
motor function
rhythm
tactile
intellectual

Developmental & Neuropsychological Theory


Subtests to assess BASIC components of cognition

(i.e., fingertip tapping)


Subtests to assess complex cognition, requiring skills
from basic components (i.e., auditory attention)

Thus, scores can help inform how performance in one domain


can affect performance in other, more complex mental
processes.
Performance on BASIC tests would ceiling at early age, while
COMPLEX improves over childhood

Standardization
1,200 cases
3-16 years
Proportions of races (within each age group) based

on 2003 census
Division of geographic quadrants (Northeast,
Midwest, South, West) according to census bureau
data
Stratified Sample according to parent education
Each age group had 50 males and 50 females

Reliability & Validity


MOST have adequate to

high internal consistency or


stability

Lower Reliability

Highest relaibility subtests:

Comprehension of
Instructions
Design Copying
Fingertip Tapping
Imitating Hand Positions
List Memory
Memory for Names
Phonological Processing
Picture Puzzles
Sentence Repetition

Response Set Total


Correct (.55 for 11 & 12
year olds)
Inhibition Total Errors
(.35 for 10 year olds)
Memory for Designs
Spatial and Total Scores
Memory for Designs
Delayed Total Score (.44
for 10 year olds)

Test & Retest Stability


Range

from .44-89 (most in in 70-80 range)

INTERSCORER

AGREEMENT

93-99%

VALIDITY

moderate - high correlations with WISC-IV


and DAS-II

Administration
Ages: 3-16 years
General Assessment:
Preschool-ages - 45 minutes
School ages - 1 hour
Full Assessment:
Preschool-ages - 90 minutes
School ages - 2 to 3 hours

Attention and Executive Functioning


(self-regulatory skills)
Strategic planning
Regulation based on

environmental feedback

SUBCOMPONENTS
Initiation
Inhibition
Selective Attention
Flexibility
Sustained Attention
Fluency
Working Memory

Language
Expressive

Oromotor Control and


Articulation
Naming
Repetition
Word Generation

Receptive

Phonological Processing
Repetition

Memory and Learning


Immediate and Delayed

Memory
Encoding
Retrieval
Working Memory
Memory Span
Repetition
Rote Memory

Supraspan Learning:

memorization of material
exceeding max. capacity
for immediate memory
(through repetition)

Motor Skills
Sensorimotor Functioning and Motor

Coordination
Visuomotor Functions
Imitation of Motor Positions and Sequences

Social Perception
Memory for Faces
Facial Affect Recognition
Theory of Mind

Visual and Visuoperceptual Processing


Visual Perception
Spatial Processing
Visuoconstructional Skills
Local and Global Processing

Referral Questions
Learning Disorder

Language
Learning Disorder
Mathematics
ADHD
Behavioral Problems
Language Delays

Perceptual/Motor Delays
School Readiness
Social/Interpersonal

Differences
General

Attention/Concentration
Animal Sorting (7-16): formulation of basic concepts,

categories, shifting from on concept to another


Auditory Attention (5-16): selective auditory
attention, vigilance

Auditory Response set (7-16): shift and maintain attention,


inhibition of previously learned information, responding to
matching or contrasting stimuli

Attention and Concentration (continued)


Clocks (7-16): planning, organization,

visuoperceptual and visuospatial skills


Design Fluency (5-12): behavioral productivity in
generation of designs
Inhibition (5-16): inhibition of automatic
responses, switching between response type
Statue (3-6): motor persistence and inhibition
Speeded Naming (3-16): Rapid semantic access
Word Generation (3-16): Verbal productivity and
generation

Attention and Concentration


(continued)

Sentence Repetition (3-6): Sentence repetition of

increasing complexity
Word List Interference (7-16): Verbal working
memory, repetition, word recall following
interference
Imitating Hand Positions (3-12)
Manual Motor Sequences (3-12): Imitation of
rhythmic movement sequences
Affect Recognition (3-16): Recognition of affect

Attention and Concentration


(continued)

Theory of Mind (3-16): Understanding belief,

intention, deception, emotion, imagination, and


pretending, perspective taking
Arrows (5-16): Line oriention
Design Copying (3-16): Visuospatial and visuomotor
ability
Geometric Puzzles (3-16): Mental rotation,
visuospatial analysis, attention to detail

Behavioral Problems
Animal Sorting
Auditory Attention and Response Set
Clocks
Design Fluency
Inhibition
Statue
Comprehension of Instructions (3-16): Ability to

receive, process, and execute oral instructions

Behavioral Problems
(continued)

Speeded Naming
Word Generation
Memory for Faces Immediate and Delayed (5-16):

Encoding of facial features, discrimination,


recognition
Sentence Repetition
Fingertip Tapping (5-16): Finger dexterity, motor
speed, rapid motor programming.
Visuomotor Precision (3-12): Graphomotor speed
and accuracy

Behavioral Problems
(continued)

Affect Recognition
Theory of Mind
Arrows
Design Copying

Language Delays/Disorders
Animal Sorting
Auditory Attention and Response Set
Clocks
Inhibition
Statue
Comprehension of Instructions
Body Part Naming and Identification (3-4):

Confrontation naming and name recognition,


expressive and receptive language

Language (continued)
Comprehension of Instructions
Oromotor Sequences (3-12): Oromotor

Coordination
Repetition of Nonsense Words (5-12):
Phonological encoding and decoding
Speeded Naming
Memory for Names (5-16): Encoding, immediate,
and delayed memory of visual and verbal
information
Narrative Memory (3-16): Memory for organized
verbal material, retrieval of memory

Language (continued)
Sentence Repetition
Word List Interference
Imitating Hand Positions
Visuomotor Precision
Affect Recognition
Design Copying

Social/Interpersonal
Animal Sorting
Auditory Attention and Response Set
Design Fluency
Inhibition
Statue
Comprehension of Instructions
Phonological Processing
Speeded Naming
Word Generation

Social/Interpersonal (continued)
Memory for Faces
Memory for Designs (3-16): Spatial Memory for

novel visual material


Narrative Memory
Word List Interference
Fingertip Tapping
Imitating Hand Positions
Manual Motor Seequences
Visuomotor Precision

Social/Interpersonal (continued)
Affect Recognition
Theory of Mind
Arrows
Block Construction (3-16): Motor and visual-

perception
Design Copying
Geometric Puzzles
Picture Puzzles (7-16): Visual Discrimination,
spatial localization, visual scanning, whole-part
relationships

Learning Differences - Reading


Primary Domains Tested: Attention and Executive

Functioning & Language

Learning Differences Math


Primary Domains: Attention and Executive

Functioning, Memory and Learning, Visuospatial


Processing

School Readiness
Major Domain Assessed: Language

Perceptual/Motor Delays/Disorders
Attention and Executive, Sensorimotor, Visuospatial

Processing

Interpretation
Attention and Exec. Fxn Subtests:
Animal

Sorting Low Score:


poor initiation, poor self-monitoring, poor
conceptual reasoning, low semantic knowledge
Low Auditory Attention Score:
Poor selective attention, poor sustained
attention, slow responding, poor inhibition

Interpretation
Attention and Exec. Fxn Subtests (Cont)
Low

Response Set Score:


same as Auditory + possible poor working
memory
Low Clocks Score:
poor planning and organization, poor drawing
ability, poor reading ability
Design Fluency Low:
Problems with initiation, poor cognitive
flexibility

Interpretation
Inhibition Low Score:

Poor inhibition

Inhibition-Switching Low Score:

Poor inhibition, poor cognitive flexibility

Statue Low Score

Poor overall inhibition

LANGUAGE DOMAIN
Body Part Naming low score:

Poor word finding

Body Part Identification low score:


Underdeveloped semantic knowledge

Interpretation
Comprehension of Instructions low score:

Linguistic or syntactic deficit, poor ability to follow multistep


commands

Oromotor Sequences low score:

Deficits in motor programming for speech production

Phonological Processing low score:

Poor phonological awareness and processing

Interpretation
Repetition of Nonsense Words low score:

Poor articulation, poor language analysis

Speeded Naming low score:

Reduced automatic lexical access; slow processing speed, poor


naming ability

Word Generation low scores:

poor executive control, poor initiation

Interpretation
MEMORY
Low List Memory (Immediate and Delayed)

Poor remote memory or supraspan (verbal) skills

Low Memory for Designs:


Poor visuospatial memory
Low Memory for Faces:
Poor visual discriminatin and recognition
Low Memory for Names:
Poor learning (encoding) or retrieval
Low Narrative Memory:
Poor expression or comprehension; poor verbal encoding

Interpretation
Low Sentence Repetition:

Poor Verbal (short-term) memory

Low Word-List Interference


Poor Verbal Working memory

SENSORIMOTOR
Low Fingertip Tapping:

Poor fine-motor control

Low Imitating Hand Positions:


Poor fine-motor programming and differentiation, low
visuospatial abilities

Interpretation
Low Manual Motor Sequences:

Poor manual motor programming

Low Visuomotor Precision:

Poor fine-motor coordination, low speed

SOCIAL PERCEPTUAL
Low Affect Recognition:

Poor facial affect recognition

Low Theory of Mind:

Problems with perspective taking

Interpretation
VISUOSPOATIAL
Low Arrows:

Poor visuospatial skills

Low Block Construction:

Poor visuoconstructional skills, poor planning, deficits in


perceiving gestalt (3-D)

Low Design Copying:

Poor visuoconstructional skills (2-D)

Low Geometric Puzzles:

Poor perception, poor mental rotation

Interpretation
Low Picture Puzzles:

Poor visual perception, poor scanning

Low Route Finding

Poor visual-spatial relations, poor orientation

Scoring
Three types of scores
Primary Scores: Global aspects or key clinical
variables

Examples: AR total, AW total

Usually expressed as SCALED SCORE, but can be as PERCENTILE


RANK

Combined Score (a type of Primary Score): total scores made


by combining 2 measures within the subtest

Example: Animal Sorting total errors combined with total correct

Scoring
Primary Scores (cont)
Cumulative

Percentage: % of children at a specific


age that exhibit the behavior
Base rate of 10% means that 10% of children had
an equal or lower score
Base rate: concept is on rareness of the finding
rather than how well child performed relative to
normal distribution

Scoring
Primary Scores (cont)
Combined

scores:
One score is weighted more heavily toward the
construct being measured; for example with
errors vs. speed in inhibition tasks, errors are
weighted more heavily than speed because
errors are related to executive functions more
so than speed of processing.
Always presented as Scaled Scores

Scoring
Process Scores: more specific than Primary Scores.

May not be relevant for all children- depends on referral


question.

For example, on Affect Recognition, there is a process score for


emotion error type may only be relevant to certain
assessment questions (i.e. an individual being tested for ASD)

Can be expressed as percentile rank, scaled score, or


cumulative percentage

Scoring
Contrast Scores: To compare higher level (more

complex) to lower level (more basic) functions to


help ascertain where the problem lies by providing
data on one variable while controlling the other

Compares how child did compared to norm who had same


score on the variable being controlled

Example: AA combined = 10 and RS combined = 4, Contrast score


= 4; means that child did well below expected level on RS
considering his score on AA combined; conversely, if AA=4 and
RS=10, Contrast may = 14, meaning that child didmuch better
than expected on RS considering his score on AA

Contrast scores are always Scaled Scores

Scoring
Behavioral Observations, such as distracted, off-task

behaviors, physical movement receive cumulative


percentages or percents.

THE END

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